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OPEN ACCESS J PREV MED HYG 2024; 65: E456-E463
https://doi.org/10.15167/2421-4248/jpmh2024.65.3.3383
E456
E456
The present article reviews the major historical plague epidem‑
ics that characterised human history by combining data derived
from historical sources and biomedical evidence emerged in
recent years thanks to advancements of palaeogenetics and pal‑
aeopathology.
Notes are offered on the Plague of Athens, the Antonine Plague,
the Plague of Cyprian, the Justinian Plague, the Black Death
down to more recent centuries and presenting key aspects that
continued to be preserved over time and would also partly char‑
acterise the recent COVID‑19 pandemic.
History of medicine and etHics
A historico-medical perspective on ancient epidemics
and their impact on past human societies
FRANCESCO M. GALASSI1, ELENA VAROTTO2, ELENA PERCIVALDI3, VALENTINA VITTORI4, LUIGI INGALISO5,
MAUROVACCAREZZA6,7, MARIANO MARTINI8, DOMENICO RIBATTI9
1 Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland;
2 Archaeology, College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, SA, Australia;
3 Centro Studi Storico Archeologici del Gargano, Foggia, Italy;
4 FAPAB Research Center, Sicily, Italy; 5 Department of Humanities (DISUM), University of Catania, Catania, Italy;
6 Curtin Medical School & Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth, Australia;
7 Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy;
8 Department of Health Sciences, University of Genoa, Genoa, Italy;
9 Department of Translational Biomedicine and Neuroscience, University of Bari Medical School, Bari, Italy
Keywords
COVID-19 • Epidemics • History of medicine • Immunology • Plague • Prevention • Infectious diseases
Summary
Introduction
The severe impact of the COVID-19 pandemic,
amounting to more than 704,753, 890 cases worldwide
and 7,010,681 deaths as of April 13, 2024[1], on the
world’s population has led the international scientific
community to reflect deeply on the history of epidemic-
pandemic phenomena and the anthropic response, at
medical as well as social and political levels. Indeed,
those events have powerfully shaped the economic,
political, and social aspects of human civilization[2-4].
Epidemic outbreaks have defined some of the basic tenets
of modern medicine, pushing the scientific community
to develop principles of epidemiology, prevention,
immunization, and antimicrobial treatments[2-4].
The aim of this contribution is to retrace the main
pestilential events that have disrupted human societies,
starting from the mythical Achaean plague narrated
in the Iliad to the plague of the 14th century AD,
thus emphasising the interaction between scientific-
epidemiological and socio-cultural components.
History of plague
Plague is an infectious disease of bacterial origin
caused by the bacillus Yersinia pestis, a Gram-negative
bacterium belonging to the enterobacteria family[5]. The
disease is primarily a murine zoonosis, and its reservoir
is made up of various species of rodents including the
common rat (Rattus rattus). Many types of animals,
such as rock squirrels, wood rats, ground squirrels,
prairie dogs, chipmunks, mice, voles, and rabbits can be
affected by plague. Wild carnivores can become infected
by eating other infected animals. The vector is the rat flea
(Xenopsylla cheopis): when the latter bites an infected
rat to feed on its blood, it receives the bacterium in the
esophagus, where it multiplies [6]. The decimation of
infected rat colonies forces fleas to seek alternative hosts,
such as humans. In this case too, contagion occurs through
the bite of the flea, which regurgitates the bacterium and
carries it into the human blood. Added to these modes
of transmission is, in the case of the pulmonary form,
contagion from person to person through droplets, the
respiratory droplets spread by coughing, and it can also
be transmitted by animal scratches or by the inhalation
of infected particles from animals having a respiratory
infection; furthermore infection through the handling
of infected animals is also documented or during the
autopsy of infected animals[7-9].
Plague has occurred in people of all ages, though 50%
of cases occur in people ages 12-45. It occurs in both
men and women, though historically is slightly more
common among men, probably because of increased
outdoor activities that put them at higher risk. Modern
antibiotics are effective in treating plague. Without
prompt treatment, the disease can cause serious illness
or death. Human plague infections continue to occur in
HISTORICAL EVOLUTION OF PLAGUE EPIDEMICS
E457
rural areas in the western United States, but significantly
more cases occur in parts of Africa and Asia[10].
However, if the exact aetiology of the plague has only
been clarified relatively recently, the disease has been
well known since ancient times and has given rise
to various pandemics throughout history, which is
confirmed both in archaeological finds and in written
sources. Regarding the latter, however, it should
immediately be clarified that what the ancients would
call plague did not necessarily refer specifically to
infection by Y. pestis. The Latin word pestis, for example
(as well as the corresponding terms that derive from it
in many European languages) is in fact very often used
to generally designate a misfortune, a calamity, a ruin,
or a generic epidemic. Similarly, plaga (like the Greek
πληγή), which gave rise to the corresponding Italian
word piaga and the English plague, designates a serious
damage, a scourge or a calamity; in the case of diseases, it
does not specifically indicate what type of calamity[10].
Less vague, in the sense that it indicated a contagious
infectious disease, is the term pestilentia, introduced in
the late Roman Republican age and used for example
by Julius Caesar (100-44 BC) to define the epidemic
that broke out in Marseille, which forced the inhabitants
to surrender. The use of pestilentia in these contexts
is influenced by the miasmatic theory and is therefore
frequently connected to the climatic and orographic
conditions that accompany epidemics and endemics and
is a sign of the progressive affirmation of the rationalistic
interpretation of epidemics to the detriment of the long-
standing tendency prevalent, to consider them – not
knowing the pathogens – as catastrophic events to be
attributed to supernatural intervention[11].
A striking example is given by the ‘plague’ (νοῦσος)
narrated at the opening of the Iliad (I.10), caused by
Apollo to punish the Achaeans and their supreme leader
Agamemnon. The latter had refused to return the young
Chryseis, his war prey, to her father Chryses, priest of
the god, chasing him away in a bad way. Chryses, having
set out towards the sea, then stopped to pray to Apollo,
reminding him of the many opulent sacrifices made to
him and imploring her revenge:
the old man prayed to the lord Apollo, whom fair‑
haired Leto bore: “Hear me, god of the silver bow,
who stand over Chryse and holy Cilla, and rule
mightily over Tenedos, Sminthian god, if ever I
roofed over a temple to your pleasing, or if ever I
burned to you fat thigh‑pieces of bulls and goats,
fulfill this prayer for me: let the Danaans pay for my
tears by your arrows” So he spoke in prayer, and
Phoebus Apollo heard him. Down from the peaks
of Olympus he strode, angered at heart, bearing
on his shoulders his bow and covered quiver. The
arrows rattled on the shoulders of the angry god
as he moved, and his coming was like the night.
Then he sat down apart from the ships and let fly
an arrow: terrible was the twang of the silver bow.
The mules he assailed first and the swift dogs, but
then on the men themselves he let fly his stinging
shafts.[Iliad I. 35-52][12]
The plague that appears in the Greek camp therefore
serves to punish the arrogance (ὕβρις) of Agamemnon,
who had dared to challenge the gods by rejecting the
request of one of their priests. The same equation plague
= divine punishment is present other times in Greek
literature, for example in Sophocles’ Oedipus Rex[vv.
25-30, 168-187] (around 430-420 BC). In the prologue
it is narrated how the Thebans, devastated by the plague,
beg the wise king Oedipus to intervene to stop the spread
of the disease. In both the Iliad and Oedipus Rex, no
description is made of the disease. What matters is
only to underline how it is caused by the supernatural
intervention of the gods, in the first case by Apollo,
triggered by the wicked action of man. The symptoms
of νοῦσος as well as its course are also ignored, making it
impossible to exactly identify the type. The only useful
detail provided by the poetic account of the Iliad, namely
that it affects mules first, then dogs and finally men,
corresponds to the ‘classic’ scheme of zoonoses, favored
by promiscuity. No mention is made even of prophylaxis:
the only precaution to contain the contagion seems to be
the elimination of the corpses through cremation, while
for the rest the Achaean camp remains totally exposed as
well as its occupants, defenseless and submissive to the
unraveling of the events.
Just like the cause, the remedy is also, in both cases,
linked solely to the supernatural sphere. In the Iliad, the
soothsayer Calchas reveals what caused the plague, who
will say that it broke out because of Apollo’s anger at
the mistreatment of his priest; in Sophocles’ tragedy,
however, the cause revealed by the oracle of Delphi
is the killing, which went unpunished, of the previous
sovereign Laius. Both human attitudes have caused the
balance to be broken, and to remedy it will be necessary
to restore it by returning, respectively, Chryseis to her
father and identifying and punishing Laius’ murderer.
The ‘didactic’ message conveyed by both episodes is
therefore very clear: only respect for the will of the gods
guarantees order and the status quo; on the contrary, the
lack of respect towards the deities and the infringement
of the rules triggers chaos and the epidemic, which is a
symbolic manifestation of it.
Among the plagues mentioned in ancient sources,
only very few can be attributed with certainty to Y.
pestis. Biblical descriptions, for example, are very
vague to allow for certain identification. The Book of
Samuel[1 Sam 5] narrates the plague of the Philistines
(ca. 11th century BC), sent by God as punishment for
having stolen the ark of the covenant from the defeated
Israelites. The disease manifests itself through ‘buboes’,
and the people’ groans, ‘rose to heaven’.
Another alleged plague account relates to the siege
of Jerusalem by Sennacherib’s Assyrian army (701
BC). The biblical source [2 Kings 19:3] limits itself
to asserting that one morning the besieged awoke to
discover that during the night an angel of the Lord had
killed all their enemies; however Herodotus, who also
cites the episode, adds that ‘when they arrived, the
enemies suffered an invasion of field mice at night that
gnawed at their quivers and bows and shield straps, so
F.M. GALASSI ET AL
E458
that the next day, left defenseless, they fled and fell in
great numbers’[Herodotus II, 2.141] The only clue to
a possible plague epidemic is the presence of rodents in
large numbers, but the hint is too vague to be conclusive.
As for the famous plague of Athens (430 BC), it
was narrated in detail by Thucydides [History of the
Peloponnesian War II.2, 47-54]. [13] Ever since the
beginning of written evidence, it had always been
supposed that a person who had recovered from a certain
disease became immune to contracting it again. Indeed,
some 2,500 years ago, Thucydides (460 BC-404 or 399
BC; Fig. 1), in his description of an epidemic that hit
Athens, observed that “No one has ever been affected a
second time, or at least fatally”[14, 15].
The plague arrived in Athens through the port at
Piraeus shortly after the beginning of the Second
Peloponnesian War (431-404 BC) fought between
Athens and Sparta. The symptoms described have, over
time, suggested its identification as typhus, Ebola or
haemorrhagic fever; more likely, however, it was typhoid
fever, given that its pathogen, Salmonella enterica
serovar Typhi, was found in DNA extracted from the
dental pulp of three teeth recovered from the Athenian
cemetery of Kerameikos [16]. Thucydides reports the
following symptoms of the disease: headache, red eyes,
red throat, bad breath, sneezing, hoarseness, coughing,
vomiting, convulsions, body blisters, fever, thirst,
restlessness, sleeplessness, bowel ulcers, diarrhea,
gangrene, memory loss.
Other plagues reported by sources also do not appear to
be caused by Y. pestis but by other pathogens. Moreover,
it was not easy for the ancients to distinguish diseases
only based on symptoms, so pathologies such as measles,
chickenpox and smallpox were often confused with each
other and with ‘plague’ itself[17].
This is the case, for example, of the Antonine Plague
(165–180 AD) during the reign of Marcus Aurelius also
known as the Plague of Galen (after Galen, the Greek
physician who described it) (Figure 2).
Galen knew the plague and had direct experience because
he was in Rome when the plague reached the city in AD
166 and also during an outbreak among troops stationed
at Aquileia during the winter of AD 168-169.
His suggestions, notes and remarks to the plague are
scattered and often brief but they are interesting and enough
to identify and recognize the plague as smallpox [18].
His description of the exanthema is fairly typical of the
smallpox rash; the symptoms described by Galen in the
Methodus medendi while observing the troops stationed
in Aquileia – fever, diarrhea, inflammation of the pharynx
and eruptions on the skin, both dry or purulent, which
manifested themselves around the ninth day of illness -
rather indicate a smallpox pandemic with devastating
consequences[17] (Fig. 3).
The Antonine Plague was a terrible, long, and destructive
epidemic that had a terrible impact on the entire Roman
Empire; it felled ten thousand people in first-century
Rome; it began in Mesopotamia in late AD 165 or early
AD 166 during Verus’ Parthian campaign, and quickly
spread to Rome. It was possibly contracted and spread
by soldiers who were returning from the exhausting and
challenging campaigns of war in the Near East.
It lasted at least until the death of Marcus Aurelius in
AD 180. This pandemic then spread across the Empire
to North Africa, Western Asia and other parts of Europe;
it is believed to have caused five million deaths.
In the same way, the Plague of Cyprian (around 250-
266 AD) (Fig. 4), which arrived in Rome after having
devastated Africa and reached Britain, touching the Vallum
Hadriani, favored by rapid emptying of cities. The disease
Fig. 1. Tucidide (Θουκυδίδης) (Athens, 460 BC - Athens, after 404 or
399 BC) (Adapted by the authors) (Wikipedia Commons - public
domain).
Fig. 2. The angel of death striking a door during the plague of
Rome: an engraving by Levasseur after Jules-Elie Delaunay (1894)
(Wikipedia Commons -public domain).
HISTORICAL EVOLUTION OF PLAGUE EPIDEMICS
E459
takes its name from Archbishop Cyprian of Carthage, who
described it in De mortalitate[Chapter 14]:
Now the fact that the belly, gripped by cramps,
disperses the body’s strength in an uncontrolled
dysentery, that deep within the bones the infection
flares up causing sores in the throat and to expand by
boiling, that the intestines are shaken by continuous
vomiting, that the eyes burn with bloodshot, that the
feet or other limbs have to be amputated due to the
contagion of the unhealthy gangrene, which due
to this loss or damage to parts of the body, while
weakness creeps in everywhere, the step becomes
uncertain, the hearing fades, the sight becomes
dark, all this is useful to show our true faith.
As we can see, however, these symptoms, recently
rediscussed by Harper, would seem to point in the
direction of a hemorrhagic fever like Ebola rather than
the plague[19].
No doubt however for the well-known epidemic
that raged in the Byzantine Empire, especially in
Constantinople, between 541 and 542 during the reign of
Justinian I (527-565) and which we know well from the
detailed account given by Procopius of Caesarea (490-
565)[Bellum Persicum 2.22] and other authors such as
Gregory of Tours and Paul the Deacon[20].
Considered the first plague pandemic in history [21],
the Plague of Justinian caused a very high number of
victims – almost 100 million according to Procopius
– contributing to the decline of what remained of
Roman Empire and the definitive transition between
the Classical world and the Middle Ages. The Y. pestis
bacillus responsible for the disease was found in some
skeletons buried in Sens (France) and Aschheim, Bavaria
(6th century); the analyzes conducted in 2014 by a team
of scholars on the DNA extracted from the teeth of two
individuals (A120 and A76) buried in the latter burial
ground also demonstrated that the genomes belonged to
a pathogen form a now extinct strain[22].
From the 6th century until around the year 1000, no
major plagues or plagues occurred in Europe except
for leprosy or scrofula[23]. However, around the turn
of the millennium a milder climate (especially in the
continental West), together with the recovery of trade
Fig. 3. Galen (Κλαύδιος Γαληνός). An 18th-century engraving by
Georg P. Busch (Wikipedia Commons -public domain).
Fig. 4. 16th-century painting of Saint Cyprian, who documented
the plague in his writings (Wikipedia commons - public domain).
F.M. GALASSI ET AL
E460
and the introduction of various technological innovations
improved the quantity and quality of crops. The richer
diet and the growth in individual living standards,
combined with the sense of greater security conferred by
the progressive stabilization of political structures, led to
a progressive increase in the population which, however,
in the long run led to the growth of urban development,
with consequent overcrowding of the cities and
deterioration of general hygienic conditions. Climatic
conditions worsened again in the 14th century, when
temperatures increased rains and the drop in temperature
corresponded to a contraction in agricultural production
which gave rise to various episodes of famine, leaving
the population exhausted. The conditions were ideal for
the outbreak of the second plague pandemic caused,
once again by Y. pestis, the infamous Black Death which
reached its peak in Europe from 1347 to 1351 causing
about 15 to 25 million deaths.
The Black Death or bubonic plague
The bacillus appeared around the 1320s in Asia and
reached the Crimea through the Russian steppes. Here
the Tatar khan Ganī Bek occupied in the siege of Caffa
(today’s Fedosia, Crimea) ordered the corpses of the
infected dead to be thrown inside the city walls as an
ante‑litteram ‘bacteriological weapon’. From Caffa,
a Genoese colony at the time, the plague was brought
to Constantinople by Ligurian ships, finally landing in
Europe from the ports of Genoa, Messina and Marseille
to spread throughout the continent until reaching,
in the space of three years, the extreme north and the
Scandinavian peninsula.
Accounts of the time show that, as in ancient times,
the disease was considered a divine punishment which
desperately attempted to be remedied through prayers,
penances, processions and pilgrimages. The medicine of
the time ignored the aetiology of the disease and proved
completely powerless in containing the pandemic. A
report compiled at the University of Paris, for example,
attributed the blame for the plague to some unknown and
inscrutable celestial event:
An astral conjunction, together with other
conjunctions and eclipses, is the real cause of the
gravely deadly corruption of the air around us,
source of mortality and famine [...]. We believe
that the present epidemic or plague comes directly
from the air corrupted in its substance, and not
only from the alteration of its qualities. This fact
must be understood in this way: since the air is, in
fact, by its nature pure and clear, it does not putrefy
and does not become corrupt unless evil vapors are
mixed with it, following any cause.
Many corrupt vapors, at the time of the said
conjunctions and by their own virtue, rose from
the land and the sea and spread into the air itself;
many of those vapors, under the influence of the
frequent blowing of hot and humid and violent
southerly winds, owing to the damp and strange
vapors which those winds carried with them,
have corrupted the air in its very substance.
Consequently, this air, thus corrupted, necessarily
penetrating the lungs, attracted by breathing,
corrupts the gaseous substance that is found in it
and, due to the humidity, causes everything that is
close to it to putrefy. This is where the fevers arise
from nature, which corrupt the principle of life[...].
We cannot hide the fact that, when the epidemic
proceeds from divine will, we have no other
advice to give than to humbly entrust ourselves
to this will, without abandoning the doctor’s
prescriptions’ – (translation of the quoted passage
by the Authors)[24].
In the impossibility of identifying a certain cause,
scapegoats were sought for, identified, as often happens
in similar cases, in the ‘weakest’ and most marginal
categories of society, especially women and Jews.
As for prophylaxis, it was almost non-existent: doctors
examined patients wearing a sort of beak-shaped mask -
the use of which was perfected in the seventeenth century,
an experienced French physician named Charles de
Lorme (1584–1678), (who practiced in various regions
of Europe during the 17th century) and was court doctor
of Louis XIII (1601-1643)[25].
In 1619, the bubonic plague erupted in Paris, and Delorme
created the “plague preventive costume” (Fig. 5), which
consisted of a long overclothing garment which went
from the neck all the way down to the ankle; the gist was
that the air could not penetrate. The outfit also contained
gloves, boots, and a hat; the hat was made of waxed
leather. The hat was not really part of the costume; it was
more of a symbol of the physician’s position as a medical
practitioner. There was also a mask which had a nose
half a foot long, shaped like a beak, filled with perfume
with only two holes, one on each side near the nostrils;
it could suffice to breathe and to carry along with the air
one breathes the impression of the drugs enclosed further
along in the beak. The mask is filled with aromatic herbs
to help the wearer bear unpleasant smell. The eyes were
also covered and protected with specs.
The doctor also has a stick to examine patients without
touching them. With this complete set of equipment,
Delorme and other physicians could assist patients who
required their help[26].
During the 1619 French plague, Delorme was seen as
a star, assisting numerous people struck by the plague.
His clothing received many grants, and he was much
appreciated; his name was associated with the term ‘the
beak doctor’.
Alternatively, those who could (like the Pope in Avignon)
practiced fumigation with herbs and aromatic substances
to purify the air[27].
The Black Death took around four years to make its
way along the Silk Road from the Steppes of Central
Asia, via Crimea, to the Western most parts of Europe,
the Middle East and North Africa. The Black Death
had epochal consequences on late medieval European
society, triggering an economic recession that caused
revolts by peasants in various parts of Europe, such as
HISTORICAL EVOLUTION OF PLAGUE EPIDEMICS
E461
the jacquerie in France and England, and in Florence
the riot of the Ciompi (wool workers), as well as the
strengthening of the feudal system in Eastern Europe.
In the long run, however, the demographic collapse
imposed a redistribution of assets and incomes, creating
new, better-paid jobs, while the shortage of labor led to
the cultivation of only the most profitable and fertile land
and stimulated new technological inventions. Those who
survived therefore experienced a well-being that they
had never achieved before. Even from a cultural point of
view, the epochal tragedy represented a break with respect
to values that had remained unchanged for centuries.
Having called into question religious certainties, the
man who escaped the scourge had to find a new role for
himself within a universe in which everything was more
precarious and he himself now appeared to be the direct
architect of his own destiny. Despite its tremendous
burden of mourning, the Black Death projected Europe
into Humanism, closing the Middle Ages and starting a
new era. A rough estimate is that 25 million people in
Europe died from plague during the Black Death. By
the end of the 1800s, developments in bacteriology and
infection control meant that medical researchers were
able to observe and investigate the disease in detail for
the first time. Three types of vaccines[28, 29] namely
killed whole-cell (KWC) vaccines, live attenuated
vaccines (EV76), and recombinant subunit vaccines,
have been developed against plague.
Although KWC and EV76 vaccines provide protection
against plague in animal models, both have side effects
and need repeated immunizations for developing
immunity in humans. Analysis of centuries-old DNA
from both victims and survivors of the Black Death has
identified key genetic differences that helped people
survive the plague. Evidence has been put forward that
agenevariantthat helped people survive the Black Death
also significantly lessens the impact of COVID-19[30].
The recent COVID-19 (2020) pandemic has brought the
global population back to confront a world unprepared to
deal with a health emergency of such magnitude, despite
the fact that over time the cinema and media have helped
shape the collective perception of pandemics, playing an
educational role but also fueling myths and beliefs[31].
The contribution of health professionals, particularly
WHO physicians[32], has been crucial, especially with
the experience gained during the 2003 SARS outbreak
that cost Dr. Carlo Urbani his life[33]. Early recognition
of the disease and its systemic implications [34], in
fact, coupled with the implementation of preventive
measures, proved essential to improve treatments and
limit damage. Historical containment measures such as
quarantine and curfews have proven their relevance[35]
in stemming the spread of infection as much as possible,
while highlighting the need to prioritize preventive
medicine during health crises rather than allowing it to
be influenced by political considerations[36].
Pandemics are not only health emergencies, but also
events with profound social, political, and systemic
implications. Historical experience and preventive
medicine remain central to managing and preventing
future health crises, while international collaboration
and science must guide global responses.
Concluding remarks
Our essential review of the major epidemics of the ancient
world and the Middle Ages allows us to draw the following
general conclusions: 1. Psychological mechanisms shared
by world populations and ancestral nature have always
characterized the way in which the human species has
tried to ‘rationalize’ sudden epidemic phenomena and has
tried to counter them. 2. The application of a historical-
medical, archaeological and paleopathological approach
to these problems not only allows scholars to reconstruct
the origin and evolutionary path of infectious diseases, but
also complements historical research in the strict sense,
determining the global changes level of communities
and societies shocked by the infectious phenomenon. 3.
Epidemics have always represented a powerful catalyst in
history. 4. A multidisciplinary approach to past epidemics
can provide an interesting and useful key to understanding
the pandemic events that characterize contemporary times.
The next pandemic could be imminent, driven by factors
such as urbanisation, climate change, global travel and
zoonotic diseases; notwithstanding the enlightening
insights gained from the recent outbreak, the medical
community and the global population at large continue
to exhibit deficiencies in their preparedness for future
virus-based crises [37]. A review of the historical
records of plague [38] and SARS [39] reveals that
pandemics have a significant impact not only on public
health but also on social and political dynamics[40]. It
Fig. 5. Copper engraving of a plague doctor of 17th-century
Rome. (Wikipedia commons - public domain).
F.M. GALASSI ET AL
E462
is evident that innovation in health responses and global
collaboration are vital to prevent and contain future
epidemic threats[41]. The eradication of a pandemic is
a complex process that necessitates a multidisciplinary
approach, encompassing the eradication of infectious
diseases and the utilisation of novel technologies[42,
43]. The effective management of infectious diseases
requires a multidimensional approach that integrates
innovation, global collaboration, and historical
analysis[44-46].
Note
A preliminary version of this research was presented
at the congress Schemata, la città oltre la forma.
Università degli studi di Catania & Università degli
studi della Campania “Luigi Vanvitelli”, Siracusa
(Italy), 26-28 February, 2020. Moreover, apart from
reference[8], for which a direct quotation was inserted,
all other citations of classical sources were limited to
reporting the relevant passage without giving a full
bibliographic reference.
Acknowledgements
This research received no external funding.
Informed consent statement
Not applicable.
Data availability statement
Not applicable.
Conflict of interest statement
The authors declare that the research was conducted in
the absence of any commercial or financial relationships
that could be construed as a potential conflict of interest.
Authors’ contributions
FMG, EV, EP, LI, DR: designed the study; FMG, EV,
EP, LI, DR: conceived the manuscript; FMG, EV, EP,
LI, DR: drafted the manuscript; VV, LI, MV, MM,
DR: revised the manuscript; LI, MM, MV, DR, EV:
performed a search of the literature; DR, MV, EV,VV:
critically revised the manuscript; FMG, EV, EP, LI,
DR: conceptualization, and methodology; FMG, EV,
EP, LI, DR, MM, MV: investigation and data curation;
FMG, EV, EP: original draft preparation; MV, MM, VV:
editing. All authors have read and approved the latest
version of the paper for publication.
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Received on September 3, 2024. Accepted on September 25, 2024.
Correspondence: Elena Varotto, Archaeology, College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, SA, Aus-
tralia. E-mail: elena.varotto@flinders.edu.au
How to cite this article: Galassi FM, Varotto E, Percivaldi E, Vittori V, Ingaliso L, Vaccarezza M, Martini M, Ribatti D. A historico-
medical perspective on ancient epidemics and their impact on past human societies. J Prev Med Hyg 2024;65:E456-E463. https://doi.
org/10.15167/2421-4248/jpmh2024.65.3.3345
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