The Plague of Caere (C. 535 Bce): Airborne Botulism?

Medical Research Archives 2015 Issue 3

THE PLAGUE OF CAERE (C. 535 BCE): AIRBORNE BOTULISM?

1Jean MacIntosh Turfa, Ph.D. 2Adrian Harrison, D.Phil.(cantab.)

1Mediterranean Section, The University of Pennsylvania Museum, 3260 South Street, Philadelphia, PA 19104-6324, (215) 573-6497, [email protected]

2IKVH, The Faculty of Health and Medical Sciences, Copenhagen University, Grønnegaardsvej 7, 1870 Frederiksberg C, Denmark, [email protected]

ABSTRACT

An unusual “plague” that occurred in late 6th-century BCE Italy, at Caere – modern day Cerveteri, located approximately 50-60 kilometres north-northwest of Rome, may have been a rare instance of airborne botulism following an atrocity on the Etruscan seashore, to judge from highly specific details furnished in the surviving account by the historian Herodotus. We have revisited the information available and compared the documented symptoms with likely causes. The hypothetical diagnosis we suggest is that of airborne botulism. In conclusion, an examination of the symptoms and possible modes of transmission in this unique event merits further consideration in the light of modern discoveries of terrorist activities and possible consequences of large-scale human disasters.

Keywords: Botulism; Airborne infection; Etruscan; Plague

1. PRISONERS AND PLAGUES: Kadmeian victory for them, for they lost HISTORICAL ACCOUNT OF A forty of their ships, and the twenty that SUDDEN EPIDEMIC remained were unusable, as their rams had been twisted askew. Sailing back to Alalia, War was known in the ancient they picked up their children and wives world as a chief cause of sickness as well and as many belongings as they could fit as traumatic death, and modern examples into the ships and leaving Corsica sailed to still abound. A single event that occurred Rhegion [on the Straits of Messina]. during the 6th century BCE on the “The Carthaginians and Etruscans Tyrrhenian coast of Italy seems to have cast lots for the men [taken prisoner] from provoked a sudden and severe affliction the destroyed ships, for they were more among the population of the affluent numerous than those who escaped. Of the Etruscan city of Caere (modern Cerveteri, Etruscans, it was the Caeretans [called north of Rome). The only disease that fits Agyllaians after the Greek name for their the description recorded by the great city, Agylla] who brought them ashore, historian Herodotus is botulin intoxication and stoned them to death. Afterward, all – it appears that an atrocity committed by those approaching the area in which the the civilian citizens of Caere inadvertently dead Phokaians lay suffered a stroke or accomplished what modern terrorists have became twisted and paralyzed, sheep and attempted and failed to produce (for the draft animals just as much as men. The literary sources, some tangential, see Agus Caeretans sent a delegation to Delphi to 2000; Gras 2000). learn how to expiate the offense. And so In short, the so-called plague the Pythia [oracular priestess of Apollo] occurred after the Etruscans and their allies told them to do what the Agyllaians still do the Carthaginians had won (or survived) a today: they make a great sacrifice and hold huge naval battle with interlopers in the contests, both gymnastic and equestrian.” Sardinian Sea, a group of colonists from (Herodotus 1.166-167.2, translation JMT). East Greece (Phokaia in coastal Asia While the exact site of the battle in Minor) who had settled at Alalia (modern the Sardinian Sea cannot be precisely Aleria) in Corsica after escaping the known, the site of the atrocity and Persian conquest of their land. The epidemic is clearly the seashore and port Phokaian settlers, short of agricultural region serving the city of Caere (3-4 miles land, had turned to piracy, and probably inland). In the aftermath, the Greek had raided shipping and the coastal towns colonization movement was curtailed, as of Etruria and Punic Sardinia. In the words Alalia’s settlers removed themselves to of Herodotus of Halikarnassos (1.165- other Greek cities such as Marseille and 167.2) Elea/Velia. There is an extensive literature “...the Tyrrhenians [Etruscans] and on the battle and its ramifications, see: Carthaginians made a joint agreement Bernardini 2001; Colonna 1989 and 2000; against them, and sailed to attack them Gras 1997; Jehasse 1962 and Jehasse and with sixty ships each. The Phokaians also Jehasse 1973, 2001 and 2004. The move to manned their ships, sixty in number, and Rhegion (Reggio Calabria) implies their met the enemy in what is called the intent to continue in piracy, preying upon Sardinian Sea. They joined battle and the the traffic passing through the Straits of Phokaians won, but it was a sort of Messina. The effect on the Etruscan

Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 2 Medical Research Archives 2015 Issue 3 captors of the Greek prisoners of war was closely enough to be stricken. to be even more profound. It is generally Herodotus says the captives were assumed that citizens walked out from the more numerous than the oarsmen who city of Caere to witness or participate in escaped with their mangled ships: since 40 the massacre. Greek ships were lost, if they were all The site of the stoning must have pentekonters (see Figure 1) – open long- been in the vicinity of the great sanctuaries ships carrying 50 oarsmen -- then as many of the port of Pyrgi, dedicated to Uni-Juno- as 2000 men could have been captured – Astarte and Śuri-Apollo. The area where although in battle undoubtedly scores or the bodies were left must have been close hundreds died, and the crews of naval enough to the main road and the port- vessels may not have been complete to towns, Pyrgi and Alsium, that people and begin with. But it would seem that flocks/herds could not simply avoid it in hundreds could have been taken prisoner their seasonal or daily activities – only to be stoned by as many Caeretans. otherwise no one would have approached

Figure 1. An artist's version of an war ships. Pentekonters were very versatile early pentekonter. a fore-runner of the and had a long-range, so they could be bireme and trireme. Pentekonters emerged used for sea trade, piracy and warfare. at a time when there was no clear They had sails, but as their name suggests, distinction between merchant vessels and (Pentekonter - trans. fifty oared) these

Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 3 Medical Research Archives 2015 Issue 3 vessels were rowed by fifty oarsmen, neurological symptoms in which victims arranged in two rows of twenty-five on “would suffer strokes and become twisted each side of the ship. You can clearly see and crippled” (Purvis 2009, 92). What sort the ram that was used to engage other of pathogens could have infected a vessels at the prow of the drawings (Upper passerby and fairly soon thereafter have (A): re-drawn (AH) after a depicted ship caused paralysis? A number of other on an 8th-century BCE bowl from Thebes serious diseases, like poliomyelitis, were shown in McGrail (2002) pg. 128; Lower present in the ancient environment and (B): re-drawn (AH) after a depicted ship on could have produced some of the an 8th-century BCE krater found at the symptoms (Aufderheide and Rodríguez- ancient cemetery of Dipylon, near the Martín 1998, 212), but the Herodotean set Dipylon Gate at Kerameikos (northwest of of symptoms, coupled with the apparently the Acropolis) in Athens, and acquired by airborne mode of delivery, precludes most the Louvre in 1884 - FR 513.2010). candidates (cf. Dembek et al. 2007, 126). Various poisons have severe effects but are 1. IDENTIFICATION OF THE DISEASE not aerosols (see, recently, Mayor 2010). Botulism and tetanus (which are not The account describes the local zoonotic) will cause paralysis or similar people and their livestock as stricken by a neurological problems, and tetanus toxin, very unusual infection or intoxication that also present in soil, is similar to botulism affected multiple species, “equally sheep, toxin, but its most striking symptom is draft animals and men” – which constitutes muscle spasm such as lockjaw: the internal evidence, if we believe Herodotus proprioception signals (feedback) from at all, that this is not a case of hysterical muscles to the central nervous system paralysis among guilt-stricken men, since become lost, and the motor cortex over- sheep and oxen would not have been compensates by contracting the muscles susceptible to suggestion. for prolonged periods of time. Further, the Ancient Italy was prone to a effects of tetanus toxin could only be number of zoonoses, such as cutaneous observed 7 to 21 days after infection with (rather than lethal) anthrax, and Brucellosis C. tetani, so in the minds of observers, any (as experienced by Napoleon and others connection with exposure to the corpses who drank unpasteurized goats-milk - See would be more tenuous (Reddy and Bleck Turfa 2012, 190, 193). The discovery of a 2009; Rossetto et al. 2011). Bronze Age Pompeii, in the site of Nola- Some diseases cause some subset, Croce del Papa, where, ca. 1800 BCE, but not all, of the symptoms recounted by Vesuvius covered a village, has revealed Herodotus. Only one fits the complete humans living in close proximity to their profile. One disease that fits some of the farm animals, and in conditions that were symptoms mentioned by Herodotus is GBS highly unsanitary according to modern - Guillain-Barré syndrome. This is a standards (see Turfa 2012, 156-158 with disease with many subtypes, one of which references. Prehistoric Nola-Croce del presents with acute motor axonal Papa: Mastrolorenzo et al. 2006; Albore neuropathy (Rajabally et al. 2014). Livadie and Vecchio 2005; Albore Livadie Typically, subjects show signs of 2002). The problem with equating the symmetrical weakness that usually affects “Caeretan plague” with any of the the lower limbs first, and rapidly significant zoonoses lies in the progresses in an ascending fashion Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 4 Medical Research Archives 2015 Issue 3 (Yadegari et al. 2014). As the weakness possibilities of its airborne use in progresses upward, usually over a period bioterrorism (see Dembek et al. 2007; of hours to days, the arms and facial Greenfield et al. 2002. Smith and muscles also become affected and subjects Sugiyama 1988, 3-4). However, note that often experience respiratory difficulties as there are sparse data on the disease for the paralysis worsens. This disease antiquity, one of the few proposed matches the paralysis aspect that instances being 2 Chronicles 32:21, in Herodotus describes, and an outbreak in which soldiers and officers of the army of northern China, which was thought to Sennacherib besieging Jerusalem in 701 follow Campylobacter jejuni infection, BCE were annihilated, causing the proved to be seasonally (summer) related campaign to be curtailed, but botulism here (Blaser et al. 1991). However, GBS would seems unlikely. Some Byzantine not be expected to induce twisting – quite regulations on foodstuffs could reflect an the reverse in fact, nor to the best of these attempt to deal with almost any sort of authors knowledge would it be transmitted food poisoning. to, or affect animals as Herodotus states. The affliction has been detected in The symptoms of botulism are the many animal species as well as humans. It only set that accord with the ancient does not occur directly through infection description of this shocking event. There by the anaerobic bacteria, Clostridium are seven distinct forms of botulinum botulinum, but rather through intoxication, toxin, types A–G and four of these (types exposure to the strong neurotoxins it A, B, E and rarely F) cause human produces. Three main routes are well botulism (Hambleton, 1992). Types C, D known: ingestion of toxic foodstuffs and E cause illness in other mammals, (poorly preserved produce, meat or dairy birds and fish. Botulism toxin E is products that allow growth of the bacteria), therefore most likely to have been infection of wounds, or, in infants, responsible for the plague at Caere, as this colonization of the digestive tract. Today, is the only one to affect both humans and iatrogenic cases can occur with the animals alike (Hambleton, 1992). improper commercial use or handling of Botulinum toxins are ingested through the toxin, Botox, for cosmetic purposes improperly processed food in which the (for basic information on Botulism, bacteria or the spores survive and symptoms, etc. see Yu et al. 2009; Penn subsequently produce toxins. Though 2010; Dembek et al. 2007; Poulin et al. mainly a food derived form of intoxication, 2006; Sobel 2005; Greenfield et al. 2002; botulism can also be caused by intestinal Maselli 1998; Aufderheide and Rodríguez- infection in infants, wound infections, and Martín 1998, 184; Smith and Sugiyama by inhalation (Hambleton, 1992; Wang et 1988; Barker 1993). al. 2014; Sugiyama et al. 1986). The airborne version seems rare in today’s world: the only well documented 3. SYMPTOMS AND TRANSMISSION case involved laboratory workers handling OF BOTULISM the bodies of experimental victims, rabbits and guinea pigs, that had been injected The literary evidence seems to with toxins (Holzer 1962); one attempted closely fit a description of botulism, today aerosol spraying of botulin toxin by a commonly viewed as a form of food terrorist group failed (Greenfield et al. poisoning, but currently under study for the 2002; Park and Simpson 2003). The Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 5 Medical Research Archives 2015 Issue 3 disease must have occurred in past eras, period of recuperation, but supportive but it was only officially described in the therapy would not have been possible in late 18th century, when an outbreak was antiquity, and a significant number of traced to poorly preserved sausage (Latin sufferers would have died. Animals such as botulus): anaerobic conditions, and drying, sheep, cattle or horses would be lost to pickling or canning with too little salt or breathing problems that today are dealt heat, are conducive to survival of the with by slings and special bedding (see bacteria, which grow best around 40 Wilkins 2007). degrees C. They cannot survive in an acid The bacteria are ubiquitous, environment (pH <4.6), and must be occurring in soil as spores, which are often heated above boiling temperature to be found in hay that is eaten by animals, or in killed, so modern processing and hygiene a decomposing animal body, which also have greatly changed the picture (Yu et al. often goes unnoticed in stored fodder or 2009). may be consumed by sheep or other The various species of Clostridium animals. Indeed, modern fur farms are botulinum produce at least 7 strains of responsible for some botulism outbreaks as toxin, considered the most lethal and they feed raw fish or meat to mink, foxes dangerous naturally occurring poisons in or ferrets. A sheep, cow or horse ingests the world. They affect vertebrates, some spores and/or toxin while grazing; spores species more than others, and especially can germinate in the intestinal tract or in birds and mammals, but also turtles and anaerobic conditions in wounds, at some fish (Poulain et al. 2006; Barker temperatures between 15 and 45 degrees C 1993; Smith and Sugiyama 1988, 135-164; (59-113 F). It is suggested that other cases Maselli 1998, 122-123). The Clostridia in animals originate from spores or toxin toxins, of whatever source, seem to carried by birds from places where produce the same panel of symptoms, carcasses of large animals such as horses attacking the nervous system, targeting have been buried or dumped (Wilkins neurons and acting on the release of 2007, 372 with references). neurotransmitters (see Poulain et al. 2006, 352-376). The toxin prevents transmission 4. EXPOSURE OF THE CAERETANS of signals in the nerves. Symptoms of the intoxication could The documented ubiquity of spores be mistaken for stroke: they begin at the today contrasts with a relatively low rate of cranial nerves, with slackening of facial infection/intoxication – except for man- muscles, drooling, slurred speech, made cases like contaminated food, drooping eyelids, etc., and extend to the victims seem to be infants or trauma cases, limbs; muscle weakness spreads to not just everyday passers-by. So it has shoulders, then arms, then legs, and ends been speculated that some factors of the with paralysis. In some cases, the paralysis potential human hosts make intoxication causes breathing to stop and death is less likely for some (Yu et al. 2009, 167). inevitable. Modern treatment includes Likewise, botulism seems to be more administering antitoxin, and sustaining prevalent in certain regions or certain breathing with a ventilator; with care for flocks/herds than elsewhere, for instance, complications such as dehydration and sheep/cattle in Australia or South Africa constipation, a high proportion of those (see Wilkins 2007, 372; Maselli 1998, 124; afflicted can survive, albeit with a long Barker 1993, 624). It has been suggested Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 6 Medical Research Archives 2015 Issue 3 that mineral deficiencies in soils in certain weaker immune systems, than more regions stimulate the condition of pica, affluent, urban citizens. Modern studies of causing animals to turn to eating carcasses horses and other animals, and clinical or bones (cf. Riet-Correa et al. 2012; Smith observations of humans, found that and Sugiyama 1988, 135-144). Such symptoms could begin within 6 hours to behaviors, in the warm summertime several days (up to 10 days) of exposure; climate on the Tyrrhenian coast, might the period for wound botulism is usually have begun the infection, and then the from 4 to 14 days (Yu et al. 2009, 167; winds and the sheer numbers of exposed Smith and Sugiyama 1988, 121). The only human corpses producing large amounts of data on inhalation botulism note that bacteria and toxins might account for their classic symptoms, including paralysis, spread, over short distances, by sea become evident on the third day (Holzer breezes. C. botulinum bacteria have been 1962; Park and Simpson 2003). With identified in coastal marine sediments and modern medical care (in cases of sandy soils in many parts of the world, and contaminated food), mortality rates are have been associated with fish, so the relatively low, but various authors seaside location of the stoned and speculate that without use of antitoxin, abandoned bodies could have been a mechanical means of ventilation, and continuing source of contamination (Smith intensive care for additional problems like and Sugiyama 1988, 14-15 and passim 11- dehydration, 50-60% of victims would 21). surely have died (cf. Sobel 2005, 1171). Symptoms seem to develop in Even the modern recovery period lasts proportion to the amounts of toxin or weeks to months. bacteria taken in: the incubation period appears to be shorter and the symptoms 4. SOURCES OF CLOSTRIDIA SPORES more severe when toxin levels are higher (Yu et al. 2009, 167). The climate of the It would seem possible – although a central Mediterranean in the 6th century very unusual occurrence – that ubiquitous BCE was similar to today’s, and could Clostridia spores or toxins were present in easily have supported the sprouting of the wounded bodies of some of the spores; anaerobic conditions in the prisoners who were stoned to death and left abandoned corpses could have supported to decompose on the shore, and that in the growth and production of toxin. The level weather of summer (the chosen time for of infection and severity of symptoms wars, battles and seafaring in the ancient would be proportional to how closely Mediterranean) spores could easily grow victims approached the site, how long they and more toxin be produced. remained there, and the status of their Herodotus mentions that the individual immune systems. Grazing flocks Phokaians sailed to Corsica as colonists or herds would have ingested appreciable with their wives and children (and fled amounts of bacteria or toxin. Shepherds, with their families after the battle), which say, pasturing several dozen sheep, might raises the question as to whether they have remained at a site all day, seated on brought the disease with them? It is quite the ground or within range of a sea breeze; possible that the Phokaians travelled with those Etruscans found regularly at the botulinum spores in their boats and only shore, such as seamen or peasants, might infected themselves once wounded. Wound have had poorer nutrition, thus potentially related botulism is rare and only occurs Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 7 Medical Research Archives 2015 Issue 3 when botulinum spores gain access to the bottom-feeding fish, caught as they lay off body through an open wound (Hambleton, shore prior to the sea battle with the 1992), subsequently reproducing in an Etruscans. anaerobic environment – typically a deep wound or cut. The symptoms are similar to 6. AIRBORNE TRANSMISSION OF those of food-derived botulism. TOXINS If we follow the line of thought that the Phokaians might have brought the The one confusing issue is the botulinum spores with them, then a likely means of delivery: airborne transmission is source, bearing in mind the fact that they possible, although not at all common. were travelling with their wives and Recent literature attests to governmental children, could be infant botulism. concerns over use of the toxins as Although there are several possible sources bioterrorist weapons, but to date no of infection for infant botulism, spore- instances have been documented (a contaminated honey has been associated Japanese group claimed to be attempting with a number of cases (Arnon et al. 1979). aerosol delivery of botulism, but failed, Parents are therefore warned not to feed and no botulin toxins could be identified in honey to infants before the age of one year. their equipment) (Yu et al. 2009, 172; Greek culture, from the Late Dembek et al. 2007, 123; Greenfield et al. Bronze Age through the Hippokratic 2002). Perhaps the combination of some corpus and Roman-era medical authors like source of bacteria (a wounded captive or a Soranus, associated honey with birth and dead, beached sea-creature?), augmented babies and recommended feeding it to with large numbers of bodies heaped newborns (sources in Giuman 2008: 73- together, the summer weather and sea 78). Assuming therefore that they travelled breezes, and the observation of the with C. botulinum spore infected honey, infection or intoxication of a group noticed and that this was fed to infants which in the vicinity, could have concatenated subsequently infected the boat through into the “plague” that terrified the guilty their fecal matter (Midura & Arnon, 1976), Caeretans. Its sudden onset and the the Phokaians could then have easily shocking severity of its lethal symptoms infected themselves during the battle and would have seemed like a blow from the the spores could have reproduced gods. anaerobically in any deep wounds or cuts. Since it is known that airborne An alternative source of transmission of botulism is possible, albeit Clostridium botulinum type E, which still not at all common, the warning given by poses a real threat even today, is through the World Health Organization (WHO) the consumption of infected fish and concerning inhalation of botulinum toxin fishery products (Hyytiä et al. 1998). Huss should be seen as a very sensible and Pedersen (1979) reported a precaution. The WHO advises that “..in considerably higher prevalence of type E order to minimize the risk of inhalation of in bottom-feeding fish species as compared botulinum toxin, which is a protein, to plankton-feeders, and concluded that the individuals should remove any exposed sea bed was the primary source of items of clothing worn by aerosol infected contamination. Thus the sea-faring individuals prior to washing them with Phokaians could have become infected soap and water..” (WHO, 2013). Such through the consumption of infected recommendations with regard to airborne Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 8 Medical Research Archives 2015 Issue 3 spores of the toxin make one wonder if the observers. The idea of rituals for the spread of this disease in Caere was perhaps benefit of the dead (in this case, perhaps via the fur of infected animals if the family members lost in the sea battle or Etruscans were sharing the same air space prior raids by the Phokaians) might help to with their livestock at night? Indeed, one explain the unusual aerosol transmission of study has proven that Clostridium botulism the toxins. Perhaps those who stoned the is capable of infecting individuals by prisoners were perceived as offering them means of airborne transmission (Sugiyama to the spirits of the Etruscan dead, with et al. 1986). Furthermore, these authors exposure to their blood a part of the ritual. cite the work of Long and colleagues Wounds from battle or from the laming (1985), who report that C. botulinum is air- and stoning of the prisoners would have disseminated from its soil /faecal habitats, enabled botulism spores to grow, as in the and that the spores of this toxin can be one proven incident of airborne brought into a home carried on clothes. intoxication (Holzer 1962), where Whilst botulism toxin inhalation technicians were apparently careless in presents with a very similar clinical handling fluids and body parts. footprint to that of food derived botulism The Etruscans were famed for their (WHO, 2013), the average lethal dose for ability to perform a ritual for the creation humans has been estimated at two or support of human dead as the dii nanograms of botulinum toxin per animales, the ”spirits made into gods,” but kilogram bodyweight, which is a level few details are preserved beyond the approximately three times greater than that account of the late 3rd-century Christian known to cause food derived cases. Thus apologist Arnobius (Adversus nationes for an average size human weighing 70 kg, 2.62) that it required the killing of an some 140 ng of botulinum toxin would animal victim, and the use of living blood. need to be inhaled. Following toxin (On blood-shedding ritual, see also inhalation, symptoms become visible Swaddling and Woodford 2014, 23 with within 1–3 days, although a longer onset note 6.) This probably involved the time is found with lower levels of handling of small animals, to judge from a intoxication. Symptoms proceed in a few finds of fragmentary bone from young similar manner to those found with mammals (perhaps piglet, puppy or lamb) ingestion of botulinum toxin, and cremated with a human corpse and then culminate in muscular paralysis and partially gathered and buried in the urn (for respiratory failure (WHO, 2013). instance, two examples from 7th-century BCE Narce, and two from 6th- century 7. ETRUSCAN FUNERARY RITUALS Chiusi are preserved in the University of AND THE LIKELIHOOD OF Pennsylvania Museum) (Becker et al. TRANSMISSION OF TOXINS OR 2009, 104-108 - for “normal” animal SPORES sacrifice, see Donati and Rafanelli 2004). Portions of sheep/goat, pig, cattle, dogs, Larissa Bonfante (2012) has horse and tortoise sacrificed in the early suggested that some incidents of human 7th-century BCE were displayed at the Via sacrifice or ritual killing probably reflected San Jacopo tumulus in the necropolis of native Etruscan rituals for appeasing or the city of Pisa; these also attest prolonged assisting the deceased, in a belief system ritual handling and exposure to (animal) that was misunderstood by Greek sacrificial victims (Sorrentino 2004). Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 9 Medical Research Archives 2015 Issue 3 Imagery of animals preying on humans and mules and swift dogs, and then strikes the related themes of bloodshed appear in warriors. Such plagues end only when Etruscan art from the Archaic period atonement is accepted by the gods. In fact, onward (see Warden 2009). Sporadic when the Caeretans obeyed the Delphic circumstantial evidence suggests some oracle and buried the bodies, the “plague” familiarity with earlier traditions of human ended. Certainly the burial of the mangled sacrifice in Iron Age Italy: a wounded corpses would have done much to remove sword-fighter apparently dispatched later, the danger, even if burial workers suffered in ritual fashion, at mid-8th-century BCE exposure to contamination. The Tarquinia (and other possible killings there Montetosto site seems to have been used – Bonghi Jovino, Malegni and Usai 1997) for producing the annual athletic and and painted tombs with scenes of equestrian games of expiation, but no mass bloodletting such as the Tomb of the grave has been identified, and it may never Augurs at Tarquinia (Steingräber 1986, pl. be possible to prove a diagnosis of airborne 20), painted around the same time as the botulism, this seems the only complete Caere massacre and plague. If Bernardini explanation of this startling phenomenon. (1999) is correct in suggesting as the site of the stoning and abandonment of the 8. CONCLUSIONS bodies, Montetosto, where a large building was erected about this time (Bernardini If the plague of Caere is an 1999), perhaps for staging the historical example of airborne transmission of funerary games, it would mean that botulism toxins, then the conditions noted prisoners were marched a mile or two from in the ancient historical account, warm the shore into the Caeretan necropolis, and weather, seashore conditions, wounded thus imply a deliberate funerary ritual. humans and exposed, decomposing bodies The application of such rituals to in proximity to grazing livestock, bear human victims under special conditions, further scrutiny, in the interests of such as the extermination of pirates, or the preparedness for future problems whether aftermath of a major battle with foreign iatrogenic or related to cosmetic practices, enemies, might not be such a great leap, or as the result of terrorism. given the legendary images used in later tombs such as the François Tomb of Vulci 9. ACKNOWLEDGEMENTS (c. 350 BCE) for instance, where murals depict Achilles’ throat-cutting sacrifice of We are grateful to several Trojan captives after they have been colleagues and friends for ideas and deliberately weakened by bleeding leg discussion of this topic, including Larissa wounds (Steingräber 1986, pl. 183; see Bonfante, Ross Cowan and Marshall Bonfante 2012 for full treatment). Becker, and especially to Dr. Julia Lane Humans have long associated war (Steinbach Veterinary Hospital) and Judith with the spread of disease, as seen in Near Swaddling. Eastern divination texts and in the Etruscan Brontoscopic Calendar (Turfa 2012, 191- 203). The Trojan War legends included plagues sent by the Olympian gods, as at Iliad 1.8-26, 1.33-108, when Apollo sends a “bad disease” which fells the Greeks’ Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 10 Medical Research Archives 2015 Issue 3

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