Table Of ContentCostas Tsiamis
Plague in Byzantine Times
Medicine in the
Medieval Mediterranean
Edited by
Alain Touwaide
Scientific Committee:
Vivian Nutton, Marie Hélène Congourdeau,
Dimitri Gutas and Filippo Ronconi
Volume 9
Costas Tsiamis
Plague in
Byzantine Times
A Medico-historical Study
ISBN 978-3-11-061119-9
e-ISBN (PDF) 978-3-11-061363-6
e-ISBN (EPUB) 978-3-11-061125-0
ISSN 2569-314X
Library of Congress Control Number: 2022945601
Bibliographic information published by the Deutsche Nationalbibliothek
The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie;
detailed bibliographic data are available on the Internet at http://dnb.dnb.de.
© 2023 Walter de Gruyter GmbH, Berlin/Boston
Cover illustration: Redrawings of two enamels on the Holy Crown of Ungary, Byzantium, ca. 1070 A.D.
Printing and binding: CPI books GmbH, Leck
www.degruyter.com
To Chryssa
Τhereisnothingmoredeceptive
thananobviousfact…
SirArthurConanDoyle
Foreword
Ancient Epidemics
The Necessity of a Multidisciplinary Approach
Inthiswell-researched, insightfulmonographPlagueinByzantineTimes:AMedico-
historical Study,Costas Tsiamis accepts the challenge of a topic that has long right-
fully been considered a vexata quaestio in the historyof both medical practice and
pathology: ancient epidemics. To this date it has proved particularly complicated
for scholars to determine the exact aetiologyof infectious diseases that caused epi-
demico-pandemic manifestations, as well as their epidemiology, clinical presenta-
tions, and disappearance. A classic example of this, also aptly discussed in this
study,isthePlagueofAthensthatdevastatedtheancientAtticpolisinthe5thcentury
B.C. In combination with the Peloponnesian War, plague provoked the decline of
Athens and represented its farewell to its long-held imperial ambitions.
Despiteundeniableadvancesintheresearchmethodologiesandthebiomedical
techniquesthathaveopenedaneweraformedico-historicaldiscoveries,ancientepi-
demics and pandemics are still more of a conundrum than a terra cognita to be
crossedatease.Questions and doubts aremore numerousthan answers.This ises-
peciallytrueifoneconsidersnotonlytheantiquityofdiseases,butalsotheirevolu-
tionaryhistory.Onemaybetoohastilytemptedtobelievethattheclinicalpresenta-
tionofdiseaseshasindeedalwaysbeenthesamethroughoutthecenturies,whereas
it cannot be excluded that their semiology may have changed owing to pathomor-
phosis,whichcouldreflectgeneticmutationsinthepathogensandtheirinteraction
withtheirhosts.Thisissomethingthatoughtnottobeneglectedandshouldbecon-
sidered when examining ancient literary accounts of epidemics.
Moreover,asitemergesfromTsiamis’pages,theancientliterarysourcesshould
beapproachedwithextremecautionastheymayusealanguageandknowledgethat
predate, sometimes by many a century, the discoveries of contemporary medicine.
Theverytermsusedtodescribetheclinicalmanifestationsofnosologicalconditions
shouldbecarefullyanalyzedbeforeanyconclusions,eitheraimingtobedefinitiveor
being preliminary, can be drawn and put forward, and multiple sources should be
scrutinizedinthesearchforevidence.Suchevidencecouldbemadeofdataextract-
ednotonlyfromliteraryaccounts,butalsofromarchaeologicalexcavations,numis-
matics, and ancient human remains, amongothers.
Inaddition,possibleinterpretativeconfusionsandtheinherentlimitationsofthe
matter subjected to the study of scholars devoting their academic activity to these
topics, are not only an issue for the assessment of the past of infectious diseases,
but also for the present, as the COVID-19 pandemic has recently demonstrated.
This is particularly true when one reflects on the general despair encountered in
both world leadership and populations facing a new, so-called “invisible enemy”,
which may appear a novel phenomenon at first glance, whereas, at closer look
https://doi.org/10.1515/9783110613636-001
VIII Foreword
and availing oneself of the tools of historico-medical research, it can be shown to
have alwaysexistedand have characterised humankind’sresponse tosuch epochal
manifestations of unexplained forces, alternatively interpreted as the results of di-
vinewrathorsomeconspiracyascribedtocertainethnicorreligiousminoritiesplot-
tingagainstconstitutedauthority.Furthermore,ingeneral,itcanbestatedthatepi-
demics mark epoch transitions or even end up accelerating them, something that
makes their studyof peculiar transdisciplinary interest.
ExaminingJustinian’sinteractionwiththepoliticalandreligiousinstitutionsina
time of epidemics in the Byzantine Empire is relevant to the understanding of the
complex socio-cultural dynamics taking place in the current pandemic times. Let
us consider, for instance,the law Justinian issued on March 23,543 A. D.decreeing
that God’s teaching (i.e., the punishment of Humankind through the plague) was
over.Thatdecisionhadsocialandeconomicreasons,inspiteofthefactthatthepla-
gue would still continue to exist in the Empire and would continue to kill a high
number of its subjects:this can be catalogued as a form of an ante litteram manip-
ulationoftheepidemiologicalreality,somethingthatmanyagovernmentworldwide
attempted to implement in recent times when protests against restrictions of social
interactions or economic hardships emerged in the COVID-19 pandemic.
Distancinghimselffromthoseapproachesthatvalueonemethodovertheother,
Costas Tsiamis rightly chooses to look at the complex matter lying before his eyes,
adopting a multidisciplinary methodology that combines historical, archaeological,
anthropological, and palaeopathological approaches in avery appropriate blend.
While much is still to be written about the nature and presentations of ancient
epidemics, including those fromthe Byzantine Empire that Costas Tsiamis dwells a
greatdealupon in hisresearch,Plague inByzantine Times shows how thepastofa
disease can be fully understood only if methods are combined and knowledge is
shared between scholars from various fields of research, never forgetting that Sci-
ence is one,while its interpreters and disciples may be multiple.
Francesco M.Galassi
Flinders University
June 2022
Contents
Acknowledgments XI
Introduction 1
Chapter 1: What is Plague? 9
The Discovery of Yersinia pestis 9
Classification of Yersinia pestis 10
Geographical Distribution of Plague 12
Morphology of Yersinia pestis 13
Growth Conditions, Survival and Resistance 14
Infectious Agents of Yersinia pestis 16
Epidemiological Cycle of Yersinia pestis 17
Differential Diagnosis, Clinical Picture and Therapy 20
Dying from Yersinia pestis 23
Chapter 2: Inside the Molecular World of Yersinia pestis 25
Principles of Molecular Biology 25
Genetic Variation and Mutations 27
From “Innocent Pathogen” to “Natural-Born Killer”: Evolution of Yersinia
pestis 31
The Use of Polymerase Chain Reaction (PCR) in Molecular Studies 38
Chapter 3: Aggravating Factors of Plague 41
Epidemiological Aspects of Plague 41
The Byzantines as Hosts: Geography and Demography 44
The Byzantine City as a Risk Factor 47
Immunological Aspects of Plague 53
Climate asa Trigger Factor 63
Chapter 4: Plague-resembling Epidemics from Antiquity to Byzantium 71
The Plague of the Achaeans (12 c. B.C.) 72
The Plague of the Philistines (11 c. B.C.) 72
The Plague of Athens (430 B.C.) 73
The Antonine Plague (165/166–180 A.D. and 189 A.D.) 76
The Plague of Cyprian (250–266 A.D.) 79
Epidemics on the Borderline of the Ancient and Medieval Worlds 80
Chapter 5: First Plague Pandemic 85
Chronicle of the Plague of Justinian 85
X Contents
Bubonic Plague in the Old Territories of the Byzantine Empire 94
The Plague of Justinian in the Kingdoms of Western Europe 99
Chapter 6: The Second Plague Pandemic 105
Europe Taken by Surprise 105
The Byzantine Empire in the Midst of the Two Pandemics 108
The Black Death in the Byzantine Empire (1347–1400) 112
The Black Death in the Byzantine World of the 15 Century 116
Chapter 7: Analysis of the First Pandemic 123
Aggregations of Epidemics during the First Pandemic in Byzantium 123
The Port of Clysma asa Possible Gateway of the Disease 141
The Molecular View of the First Pandemic 148
Chapter 8: Analysis of the Second Pandemic 153
Kaffa-Trebizond-Constantinople: Re-Evaluation of de’ Mussi’s
Narrative 153
Pax Tatarica and the Origins of the Black Death 158
The Nature of the Second Pandemic: Bubonic or Pneumonic
Plague? 165
Aggregations of Epidemics during the Black Death in the Byzantine
Space 168
The Molecular View of the Second Pandemic 181
Chapter 9: Theories on the Disappearance of Plague (751–1346) 185
Epilogue 191
Lists of Tables, Figures and Maps 201
Tables 201
Figures 201
Maps 201
Bibliography 203
Sources 203
Secondary literature 207
Glossary 235
Index of Names and Places 239
Subject Index 246
