by Sean Martin
We could almost view the diseases brought about by the Neolithic revolution – the development of agriculture, towns and, in the course of time, cities – as being humanity’s own rite of passage, from the ‘childhood’ of the nomadic hunter-gatherers to the ‘adulthood’ of settled, ‘civilised’ life. And we’ve gained most of our diseases in the process, leaving Dilmun and Yima’s garden far behind.36
2
Antiquity
The Bible is seething with plagues. In the book of Exodus (Chapters 8 to 12), the Old Testament’s infamously wrathful God inflicts ten plagues on Egypt, as a punishment for keeping the Israelites captive. Acting with divine sanction, Moses and Aaron use their staffs, raise their hands and scoop out soot from furnaces to call down afflictions on the land (and, in doing so, become archetypal wizards to rival Pharaoh’s own, ancestors to Gandalf and Merlin). The waters in the rivers are turned to blood, killing all the fish; the Nile then teemed with frogs. Lice and flies followed, harming livestock. The Egyptians’ animals further suffered in an epidemic, and then – along with their human keepers – developed boils. A storm of hail and fire swept the land, followed by locusts and darkness. Finally, with land and livestock decimated, the firstborn children died.
Such widescreen, epic disasters have turned ‘Old Testament’ from a noun into an adjective (in the sense of ‘Old Testament wrath’, and the like). But how many of the ten plagues of Egypt were actual diseases? And could they have actually happened? Was it the hand of the Almighty, or could they have been natural phenomena such as drought. Or a metaphor for a bad harvest, shorthand for hardship? New research suggests that the plagues could have actually happened, but were a series of natural disasters inaugurated by climate change, centred on the ancient city of Pi-Ramesses in the Nile Delta.37 The reign of pharaoh Ramses II (1279–1213 BC) coincided with a warm, wet period, after which temperatures dropped. This, so the theory goes, caused the Nile to dry up, but not before the warmer temperatures had led the normally fast-flowing Nile to become a semi-stagnant artery of mud. These charming conditions would have been perfect for the formation of a form of freshwater algae known as Burgundy Blood algae (Oscillatoria rubescens), which is known to have existed 3,000 years ago and is still with us today. As the algae dies, it stains the water red, hence the water of the Nile becomes ‘changed into blood’. (An alternative theory suggests the red colouring could have been caused by chromatiaceae bacteria, brought on by a drought.38)
The algae would also have started a domino effect that produced the second, third and fourth plagues – frogs, lice and flies. The algae would have accelerated the life cycle of frogs, and caused them to leave the river in search of a new habitat. Without frogs, mosquitoes and lice would have flourished in the absence of their main predator, causing insect-borne diseases to flourish; in Old Testament parlance, these were the fifth and sixth plagues – diseased livestock and boils. A volcanic eruption as far away as Crete could have caused a second domino effect, leading to the seventh, eighth and ninth plagues that brought hail, locusts and darkness to Egypt. Volcanic ash could have mingled with thunderstorms to produce hail; it could also have led to higher humidity, leading to a surge in the locust population; and it could also have caused darkness, the clouds of ash creating an eclipselike gloom.
All of which brings us to the final plague, the deaths of the firstborn. One theory suggests that this could have been caused by grain supplies becoming infected by a fungus. Emerging from a period of darkness and disaster, infants would have been the first to be fed, and therefore the first to die.
While this explanation of the ten plagues remains conjecture – indeed, the whole field of Bible-as-history is controversial – such chain reactions are not unknown and, as we will see in Chapter 5, were to cause catastrophe in nineteenth century East Africa.
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The ten plagues of Egypt are not the only afflictions in the Old Testament: there are over a hundred mentions of disease. The books of Numbers (21:6,8) and Deuteronomy (8:15) both mention a ‘fiery serpent’, which, it has been suggested,39 could be a reference to the guinea worm, which causes dracunculiasis, a parasitic infection caused by drinking infected water. Mummies from this period (c. 1450–1500 BC) also show evidence of worm infestation. Worms are also mentioned in the Rig Veda, which was probably composed around the same time, offering magical remedies against infestation in both children and cattle.40
Elsewhere in Numbers (11:32–35), a plague broke out among the Israelites. Wearying of manna from heaven, they began desiring the varieties of meat they had eaten while enslaved in Egypt. They ate migrating quail, which had been forced to make an emergency landing due to a storm. The Israelites suffer from a ‘very great plague’ as a result of eating the bird meat. Although Numbers doesn’t provide any more information – other than to inform us that the Almighty was not very pleased with the gluttonous Israelites, who suffered many casualties as a result of their impromptu feasting – we could hazard a guess that, if there is any historical basis to the story at all, the Israelites could have contracted avian influenza from the birds. The word ‘plague’ in the Bible therefore doesn’t usually mean plague in the medical sense of bubonic plague. It is a somewhat nebulous term, usually signifying an epidemic, not infrequently mildly catastrophic.
The Bible’s relationship to historical fact is equally vague. It is more helpful for our purposes to think of it as containing some truth where diseases and epidemics are concerned, in that the descriptions given by the Biblical writers sometimes – as in the cases discussed – allow us to conjecture what diseases may have been active in that era. The writers themselves certainly saw disease as a divine punishment for the wrongdoings of humanity. This was the mindset of the culture that produced the Bible – and, indeed, of most societies up until the nineteenth and twentieth centuries, when the scientific causes of disease came to be understood. In seeing disease as punishment from the Almighty, the Judeo-Christian tradition is not unique: almost all mythic and religious texts see disease as an affliction sent down from on high for moral transgressions and all manner of wickedness.
However, some religious strictures (such as those from the Book of Leviticus) may have had a more practical origin. As the historian of disease William McNeill noted, the Jewish and Muslim prohibition of pork:
appears inexplicable until one realizes that hogs were scavengers in Near Eastern villages, quite capable of eating human faeces and other ‘unclean’ material. If eaten without the most thorough cooking, their flesh was easily capable of transferring a number of parasites to human beings… the ancient prohibition of pork presumably rested rather on an intuitive horror of the hogs’ behaviour.41
However, in the main, disease was punishment. In Genesis, Eve eats of the fruit of the Tree of Knowledge of Good and Evil: the consequences of this action include pain in childbirth; a multiplication of sorrows; enmity between men and women, between parents and children; patriarchy; and toiling all the days of one’s life until humans return to the dust from which they were made (Genesis 3: 15–19). Life spans also shortened, from the ‘old as Methuselah’ variety – Methuselah himself is said to have lived to the age of 969, Adam to 930 (Genesis 5:27, 5:5) – down to the less mythic ‘threescore and ten’ (Psalm 90:10).
Expulsion from the Garden saw human beings forced to live short lives of toil and tumult. God tells Adam that a life of toil will bring few rewards:
…cursed is the ground for thy sake; in sorrow shalt thou eat of it all the days of thy life; Thorns also and thistles shall it bring forth to thee; and thou shalt eat the herb of the field (Genesis 3: 17–18).
God seems to be compelling man to a life of farming, and the Neolithic agricultural revolution, as we’ve seen, brought forth one of the biggest multiplications of sorrows in human history: the shift to a settled agrarian existence formed another major shift in the human disease burden.
The familial enmity suggested by Genesis took immediate shape in the story of Cain and Abel.
The two brothers could be seen as representing the clash between the hunter-gatherer and the settled farmer. After an unspecified argument – possibly over a woman – or because of jealousy when God accepted Abel’s offering, but rejected Cain’s, Cain kills Abel.42 God then cursed Cain (Genesis 4:11), afflicting him with the mysterious ‘mark of Cain’ (Genesis 4:15) and made his farmland barren (Genesis 4:12). Cain became a wanderer, like his murdered brother.
This could explain why Cain then goes on to found the first city, named after his son, Enoch (Genesis 4:17). Cities represent another major change in the human disease burden (as mentioned in Chapter 1). Like farms before them, cities proved to be fertile breeding grounds for disease. Lurking in contaminated drinking water, thriving due to bad or non-existent hygiene, exacerbated by overcrowding, carried from person to person and neighbourhood to neighbourhood by dogs, livestock and insects, diseases flourished in cities. Given the link between the development of urban living and disease, it might be appropriate to suggest that the mark of Cain could be nothing other than disease.
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Greek myth accounts for the appearance of disease among people with the story of Pandora’s Jar which, since a textual corruption in the sixteenth century, has been known as Pandora’s Box. Hesiod recounts the story in Works and Days. Charged by Zeus with the task of creating humanity, the Titan Prometheus became moved by the lot of (a presumably all-male) humanity, and did all he could to help them. He tricked the gods out of food, donating the fare from a sacrificial feast to humans. Then he really got Zeus’s back up: he stole fire. Angered by Prometheus’s audacious theft, Zeus ordered the blacksmith Hephaestus to create the first human woman as a means of punishing humanity. Hephaestus set to work, sculpting a figure out of water and earth. Pandora – her name means all-giving, in that all the gods on Olympus gave her a gift – was the result. She was endowed with various divine attributes: Aphrodite gave her beauty, Hermes speech and cunning; Athena clothed her, while the Horae decked her hair with spring flowers. Pandora came to earth as a bride for Epimetheus, Prometheus’s brother, and brought with her a wedding present from Zeus: a jar. But upon arriving in Epimetheus’s house, Pandora’s curiosity got the better of her, and she decided to open the jar, releasing a cloud of spirits that ‘scattered pains and evils among men’. As with Eve eating the fruit, this was the moment when humanity became plagued with every known affliction: ‘thousands of troubles wander[ed] the earth./The earth was full of evils, and the sea./Diseases c[a]me to visit men by day and, uninvited, c[a]me again at night.’43 The golden age was over.
From Myth to Medicine:
Disease in the Ancient Near East
The Bible is not particularly old: most of the Old Testament was written down between the sixth to first centuries BC; more recent than Hesiod, who wrote in the eighth century BC. The oldest records concerning disease are therefore not Biblical or Classical at all, but are to be found among Egyptian stele and tomb paintings and papyri; Akkadian tablets; and Chinese and Indian medical tracts. According to the historian Manetho of Sebennytos (fl. third century BC), Egypt suffered the earliest recorded epidemic, which was said to have occurred in 3180 BC. Writing in his Aigyptiaka (A History of Egypt), Manetho notes that the reign of the pharaoh Mempses in the First Dynasty was blighted by a terrible epidemic. Unfortunately, he declines to elaborate on what precisely it was, merely recording that ‘In his reign many portents and a great pestilence occurred.’
As in the Bible, ancient Greece and the story of Dilmun, other early cultures such as those of the Babylonians, Hittites and Egyptians, were not without their stories of disease as divine displeasure, or at the very least the work of demons. A gloss in the ancient Egyptian text known as the Edwin Smith Papyrus attributes disease to ‘something entering from outside’ which is ‘the breath of an outside god or death’.44 Another demon was said to enter the body through the eye, while the Ebers Papyrus refers to the stomach being susceptible to attacks from the nesiet demon; elsewhere, deafness is ascribed to inhaling air from the ‘beheading demon’.45 Despite this, it is with writings from ancient Egypt and Mesopotamia that we move from the realms of myth into history for the first time.
An Akkadian tablet from 1770 BC shows that King Zimri-Lim ordered a secretary to write a note for his queen, Shiptu, warning her about a servant woman named Nanna, who was suffering from lesions. The King instructed Shiptu to avoid drinking from shared cups, and not to use a bed or a chair if poor old Nanna had been using it before her. Zimri’s note to his queen is possibly the earliest surviving precaution for avoiding contagious disease.
The Babylonians give us the first description of what is probably rabies, as recorded in the Eshnunna Code, a legal document written around 2300 BC. The text describes how the bite of a dog could be fatal, and recommends a fine for the animal’s owner.46
If a dog is mad and the authorities have brought the fact to the knowledge of its owner; if he does not keep it in, it bites a man and causes his death, then the owner shall pay two-thirds of a mina (40 shekels) of silver. If it bites a slave and causes his death he shall pay 15 shekels of silver.47
However, being of a legal nature, the Eshnunna tablets don’t go into detail about precisely how a dog bite can be fatal, so we must be cautious with saying that this is definitely rabies. The name of the disease is not mentioned, being of a later coining – rather aptly coming from the Latin, ‘to rave’, while the name of the virus (‘lyssavirus’) comes from the Greek lyssa, meaning ‘to do violence’. As with the Biblical plagues, the Eshnunna Code is another example of how imprecise ancient texts can be when it comes to identifying disease. If a text was to describe some of the symptoms of rabies without mentioning the bite of a dog, then we would be on less certain ground; the disease could be epilepsy or tetanus, for example, which produce similar symptoms. But the presence of a dog (sometimes a bat, fox or jackal), and a bite, followed by madness and death, are strongly suggestive of rabies. (Rabies, or something very much like it, was also known in China, where it is mentioned in a text from the sixth century BC, and it is also described in a first century Indian source.)
Possibly the earliest known mention of epilepsy comes from an Akkadian tablet from c. 2000 BC. This text described the symptoms, in which the condition of antasubbû as ‘a person whose neck turns left, whose hands and feet are tense, and eyes wide open, froth flowing from the mouth and consciousness being lost’.48 There was a widespread fear that epilepsy might be caused by the ‘Star of Marduk’ (Jupiter) or demonic possession. Indeed, the name antasubbû means ‘touched by the hand of a god’.
Disease in Ancient Egypt
The role of demons as disease-causing agencies is attested to by some of the very earliest medical texts that have come down to us – the Egyptian medical papyri. Unlike the Eshnunna Code, Egyptian papyri such as the Ebers Papyrus are actual medical texts, devoting much space to disease, medicine and remedies. Although demonology was present in the Egyptians’ medical thinking, it by no means dominates. The papyri are ‘by far the most important sources of our knowledge’49 when it comes to trying to establish what diseases the ancient Egyptians suffered from.
One of the most important papyri – and the longest – was bought by a somewhat shady character called Edwin Smith, an American adventurer and antiquities dealer. On Smith, as the scholar of ancient Egypt John F Nunn comments, ‘there are rather diverse views’. He was reputed to ‘advise on, and even practise, the forgery of antiquities’.50 Smith acquired the papyrus at Luxor in 1862, and it has since become known as the Ebers Papyrus, named after the man to whom Smith later sold it. Nothing is known for certain of its provenance, other than that Smith didn’t forge it. The papyrus was said to have been found between the legs of a mummy in the Assassif area of the Theban necropolis, but when its importance was realised, the finders were dead – foul play does not seem to have been involved – and the actual location of the tomb was never established. One passage implies that the papyrus dates from around 300
0 BC, stating that it was presented to the King of the First Dynasty, the pharaoh Den (whose reign began c. 2970 BC). However, such an early dating needs to be taken with a pinch of salt. Assigning a much earlier date to a papyrus – thereby hoping to invest it with the supposed authority that age brings – was common practice. In fact, a passage on the verso dates the papyrus to 1534 BC (in the ninth year of the reign of Amenhotep I).
The Ebers Papyrus is laid out in a somewhat haphazard fashion. Some parts of Ebers seem to assume that ‘the diagnosis has already been made and simply lists the recommended treatments.’51 Other parts are possibly in the wrong order or seem muddled. It starts with three spells designed to be used prior to, or in conjunction with, taking a remedy that the doctor has prescribed.52 Following this is a section which concentrates mainly on diseases of the belly, worms in particular. From the belly, the papyrus moves down to diseases of the anus. There are various prescriptions ‘to relieve a pathological condition of the body’, although what this is is impossible to say. Several other diseases are also difficult to identify. Specific terms such as ‘wekhedu of aaa’ remain obscure.