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Bulletin of the History of Medicine 78.2 (2004) 466-468



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Sylvie Bazin-Tacchella, Danielle Quéruel, and Évelyne Samama, eds. Air, miasmes et contagion: Les épidémies dans l'Antiquité et au Moyen Âge. Hommes et Textes en Champagne. Langres, France: Dominique Guéniot, 2001. 199 pp. €22.90 (paperbound, 2-87825-208-X).

The spread of disease has frightened and puzzled mankind through the ages. The eight papers in this volume, while focused on antiquity and the Middle Ages, broadly illuminate the range of responses and explanations. The collection opens with a lucid account of the original meaning of "miasma" by Jacques Jouanna. Originating outside medical thought, denoting a "stain" or "taint" in Greek (approximated in Latin by infectio), and implying contagious "pollution," the term was associated with pestilence in popular and religious lore—as may be seen in Oedipus Rex. In the rational medicine of the Hippocratic corpus, miasmata (plural) changed from a moral to a physical cause, spreading disease by exhalation rather than contact and calling for correction of the air rather than ritual purification.

Miasma virtually disappeared from postclassical Greek medicine, even as the [End Page 466] emphasis on air and the disregard of touch persisted. When Galen explicated Hippocratic teaching on the transmission of plague, he endeavored to "think the invisible" (p. 50) by the stringent application of reason to experience, as Véronique Boudon demonstrates. Mere analogy yielded his tantalizing phrase "germs (spermata) of pestilence" (pp. 52-53); logic led him to include exhalations from swamps and corpses among the causes: the root cause was "putrefaction (sepsis)" (p. 52), which emanated from the breakdown or "corruption" of living matter. This explanation had a long life and far-reaching consequences. Béatrice Caseau traces the conceptual linkage between decomposition, dangerous fetor, and the role of perfumes in religious ritual and a "form of aromatherapy" (p. 81). The protective power of perfumed smoke induced early Christianity, after initial resistance, to adopt incense. In medieval plague treatises, surveyed by Joëlle Ducos, corrupted air was not only cause but also effect, subject to meteorological conditions and planetary conjunctions. The authors evinced an "extreme ambiguity" (p. 92) by agreeing on the crucial role of air while diverging widely in their interpretations. Theories about airborne transmission had no counterpart in speculations about waterborne diseases, although the importance of drinking water was recognized. Franck Collard observes that, while plague readily raised suspicions of poisoning, dysentery rarely triggered similar allegations, "no doubt because people were accustomed to this evil" (p. 193).

In contrast with this volume's tightly thematic discussions, the comparative examinations of selected texts seem less conclusive. Évelyne Samama compares the plague reports by Thucydides and Procopius, who witnessed dissimilar epidemics and were separated by almost one thousand years: it is difficult to gauge the significance of their differences; their chief similarity, namely a military perspective, reveals more about the writing of history than about the understanding of epidemics. Sylvie Bazin-Tacchella collates Latin and French versions of the report issued by the Paris medical faculty after the plague of 1348, and of a chapter in Guy de Chauliac's 1363 manual on surgery: this textual collation, while made more valuable by appended transcripts (pp. 132-56), pertains more to the Black Death than to the subject of this collection.

Contagiousness has most persistently been associated with leprosy—notwithstanding scientific findings to the contrary. In a complementary stereotype, the contagious leper has come to personify the frightful Middle Ages. Demolishing this "caricature" (p. 160), François-Olivier Touati argues that "contagion" was a fluid notion, and that it was not the principal concern in the proliferation of leprosaria, which peaked in the twelfth century. Around 1220-30 there came a "change in perspective" (p. 175), when an influx of new translations from Arabic stimulated questions about the exact nature of infection. Then, over the course of several decades and in an increasingly structured society, physicians presented leprosy, successively, as communicable by proximity, as spreading...

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