Tuesday, January 17, 2012

Retro-Diagnosis Run Amok—Sophocles’ Plague of Thebes

Posted by Darin Hayton on 01/17 at 03:47 PM

It has been a great year for scientists’ efforts to retro-diagnose epidemics. Early last fall scientists proved once again that the great medieval plague was bubonic plague, yersinia pestis. Then, this winter, scientists confirmed that Christopher Columbus brought syphilis back from the New World like some twisted souvenir. Typically, evidence comes from mass graves and careful analysis of skeletal remains.

While I remain deeply skeptical about the benefits that might result from studying historical epidemics, I cannot see any payoff in studying fictional epidemics. Nonetheless, that’s precisely what a group of physicians from Athens have done. In an article just published in Emerging Infectious Diseases the authors analyzed the literary descriptions of the epidemic in Sophocles’ Oedipus Rex in order to unravel its clinical features, determine its cause, and discuss some possible therapeutic options.1

Sophocles may have existed, but did his plague? (Source: Image from Wikipedia page on Sophocles)

  • Clinical features: From Sophocles’ description, which includes “A blight upon the grazing flocks and herds,” “a blight is on our harvest in the ear,” and “a blight on wives in travail,” reveals to them that “the disease [was] a cattle zoonosis of high mortality,” that “the fruits or ears may participate in transmission,” and that “the causative pathogen leads to miscarriages or stillbirths.”
  • Causes: “The most probable cause of the plague in Thebes is B. abortus.” But then the symptoms — extremely rare human-to-human transmission and the low mortality rates — seem to argue against B. abortus. So they conclude that the plague of Thebes had two or more causative agents.
  • Therapeutic options: The authors don’t actually get to the therapeutic options.

The authors seem to vacillate between analyzing Sophocles’ plague as a real, historical epidemic and trying to correlate the plague in Sophocles’ play to the Athenian plague described by Thucydides. If they were trying to argue that Sophocles was inspired by Thucydides to include a plague, that would be fine. But they insist on positing a real, causal agent for Sophocles’ plague. Further, they suggest that Sophocles’ plague might guide archeological research in the way Heinrich Schlieman used Homer to guide his excavations of Troy.

I find the entire retro-diagnosis project flawed on a number of levels, not the least of which is the problem of mapping modern symptoms onto medieval or earlier reports. Even when a physician was recording symptoms and treatments, those symptoms and treatments made sense in his world of humoral medicine, not our germ-theory world. What counted as a symptom and a meaningful account of that symptom has changed. Moreover, historical symptoms lack a quantitative specificity that we depend on today. These difficulties might be surmountable.

But on another level I find the retro-diagnosis project pointless. I simply do not understand what is gained by ascertaining the “actual” cause of some historical disease. What is the value of showing the New World origins of syphilis? How are we better off today for knowing that the medieval epidemic was bubonic plague? Do we adjust our therapies in light of this new knowledge? Our prophylactic measures? Our diagnosis or prescriptions? Are our living conditions comparable to 5th-century Athens?

Maybe the retro-diagnosis project is just fun. Maybe it’s the academic version of climbing a mountain just because it’s there. If so, great. If there is a greater payoff, somebody needs to argue persuasively for that payoff.

1A.A. Kousoulis et al., “The Plague of Thebes, A Historical Epidemic in Sophocles’ Oedipus Rex,” Emerging Infectious Diseases 18(January 2012): 153–57 along with a technical appendix.

Tags: ancient plagues, oedipus rex, plague of thebes, retrodiagnosis, sophocles