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The Question of Plagues in Ancient Rome and the Cholera
Epidemics in Ibadan1
Abstract
Classical authors such as Livy, Marcus Aurelius, Dio Cassius have all, in their
treatises on the ancient Roman society mentioned occurrences of plagues and their
devastating effects on both humans and animals. In analyzing the plagues, some Modern
commentaries on the Greaco-Roman world have postulated different theories and have drawn
conclusions as to what these plagues actually were for ancient authors merely mentioned the
diseases as plagues or epidemics. Modern authors on Ibadan have also mentioned the regular
occurrences of the cholera epidemics in the city. The aim of this paper is to examine the
plagues or epidemics that occurred in the Greaco-Roman world and the cholera epidemics in
Ibadan. It attempts to examine factors responsible for the plagues and epidemics in both
societies and the methods adopted in combating the epidemics. This paper concludes with the
thrust that because the ancients were not fully conversant with these plagues, high mortality
was recorded. For modern Ibadan, lack of safe water, proper sanitation and food safety
among others caused the preponderance and repeated occurrences of the cholera epidemics
and its effects in Ibadan. Further studies can interrogate alternative medicine towards health
care in the events of plagues and epidemics in both ancient Rome and modern Ibadan.
Keywords: plagues, epidemics, cholera, child, ancient Rome, Ibadan
Introduction
It has been noted and documented that the occurrences of plagues and epidemics in
antiquity decimated the population at the time of incidences. These happenings were not
annual events and the time they transpired, a lasting cure was not found, however, it is highly
probable that people observed good health therefore, plagues and epidemics materialized,
more often than not, in warring periods and other periods of insecurity in the city, when there
was overcrowding in the city.
Classical authors such as Livy (59BC), Thucydides (c 460-c400), Marcus Aurelius
Antoninus ((AD 180), Lucian of Samosata (c A.D 125 –c A.D. 182), Saint Cyprian and
1 An aspect of my PhD thesis, for which the financial support from the Council for the Development of Social
Science Research in Africa (CODESRIA) and the MacArthur Foundation Grant, University of Ibadan are highly
appreciated.
2
Pontus of Carthage (A.D. 259) documented the occurrences of plagues in the Graeco-Roman
world. Some of these authors gave graphic descriptions of the effects of these plagues, while
others merely mentioned one or two of the plagues or epidemics in passing. The plagues in
antiquity were not annual occurrences. They occurred years and centuries apart. The cholera
epidemic in Ibadan which has been acknowledged by the media; - print, radio and television -
has become a regular occurrence, especially after flooding, since its first incidence in 1970.2
However, the spread gets contained to the extent that very many people who live in the vast
city of Ibadan do not get infected. This study closely examines the occurrences of the
plagues in antiquity and Ibadan with a view to understanding the factors that generated the re-
occurrences of the plagues in antiquity and the cholera epidemics in Ibadan and their effects.
Plague is synonymous to disease or pestilence. It is any infectious disease that kills
numerous people. Plague is also an epidemic3. An epidemic is a large number of cases of a
particular disease happening at the same time in a particular community.4 The word plague
may have been an old-fashioned word for epidemic as it is often evidenced in the works of
classical authors who documented the occurrences of the plagues in antiquity. However, Livy
(59BC) used the words plague and epidemic interchangeably. Therefore, a plague is also an
epidemic. For the purpose of this paper, the word plague shall be used interchangeably with
epidemic. Plagues or epidemics have the propensity of spreading from city to city and from
continent to continent. If any of these situations occurred, then the plague is regarded as
pandemic. Even though the plagues in antiquity became pandemic, Classical authors stuck to
the word plague or with Livy, serious epidemics.5 In Ibadan, the word epidemic is used to
describe the situation where many suffer from the disease at the same time and several deaths
occurring from the effect of the cholera disease. This has motivated prompt response from
health workers and the government such that a sensitive disease surveillance system is
obtained for the early detection and reporting of cases, including analysis of the surveillance
data for appropriate decision-making to guide targeted public health intervention.6
Methodology
2 Lawoyin TO, Ogunbodede NA, Olumide EA, Onadeko MO., Outbreak of Cholera in Ibadan,
http://www.ncbi.nlm.nih.gov/pubmed/10414378
3 Oxford Advanced learners’ Dictionary of Current English, pg 1106,7th edition, ed Wehmeir S., Mclntosh C.,
Turnbull J., Ashby M., Oxford University Press, 1997.
4 Oxford Advanced learners’ Dictionary of Current English, pg 491,7th edition, ed Wehmeir S., Mclntosh C.,
Turnbull J., Ashby M., Oxford University Press, 1997.
5 Livy, The Early History of Rome, Books 3, 3.6 pg 294, translated by Audrey De Selicourt, 1973, Penguin
Books, England
6 World Health Organization, 2010, Cholera Annual Report 2009, Weekly Epidemiologica Record. Vol
85(31):293-308.
3
The study employed historical and comparative methodologies to highlight the
occurrences and effects of the plagues and epidemic in both antiquity and modern Ibadan.
Sources utilised on Ancient Rome were classical and modern authors. For Ibadan,
information was gathered from medical literature and newspaper reports. The data were
subjected to content analysis.
Plagues in Ancient Rome
Quintus Livius Titus popularly known as Livy in his Early History of Rome
documented plagues that occurred at two different periods in ancient Rome. The first of this
plague occurred in ancient Rome from 463 to 462 B.C. It began in the year when Lucius
Aebutius and Publius Servilius were elected consuls. There was a great deal of sickness and
it was aggravated by overcrowding as farmers and their animals were accommodated into
inadequate quarters in the town and country for fear of raids from the enemies of Rome. The
people suffered from heat and lack of sleep while attendance upon the sick or mere contact of
any kind continually spread the infection. Livy reports that the plague is so devastating that
majority of the soldiers who are affected could not take up arms to defend the city against the
invading enemy. The plague sends the consul Aebutius to his untimely grave and also leaves
his colleague Servilius, in a “lingering state.”7 Livy writes, “. . . her strength gone and with
no one to lead her, Rome lay helpless. Only her tutelary gods could save her – and her own
abiding Fortune.”8 Livy does not provide further description of the disease or infection. A
pertinent factor here is that it exterminated a large number of people, including children as
well as animals at the same time and in the same place. The plague certainly occurred as a
result of overcrowding which was motivated by fear of the invading enemy. Because it was a
state of emergency or because those in authority may have lacked an understanding of the
fact that overcrowding would occur following the migrations into the city; or the leaders
could not have fathomed that overcrowding could lead to devastating impairment to health,
they were unable to avert the inevitable occurrence of the plague. An understanding of the
effects of plagues may have aided in dealing with the disease, save majority of lives and
prevent another occurrence. Furthermore, this may have been far from occurring if the
leaders of Rome at this period had not been too preoccupied with the consolidation of the
Roman State.
7 Livy, The Early History of Rome, Books 3, 3.6 pg 190, translated by Audrey De Selicourt, 1973, Penguin
Books, England.
8 Livy, The Early History of Rome, Books 3, 3.6 pg 190, translated by Audrey De Selicourt, 1973, Penguin
Books, England.
4
The plague recorded by Thucydides (c 460-c400), an Athenian General, a historian
and a political critic, who himself was a victim of this deadly plague, occurred between 430
and 426 B.C. in Athens and probably spread to Rome. It is called the Athenian plague and it
claimed the life of Pericles the leader of Athens and the lives of many people especially
children’s. This plague occurred three decades away from the first plague recorded by Livy
in ancient Rome. It should have been imperative for the Greeks to have studied the cause of
the plague in Rome during the period it occurred and should have attempted to discover
methods in curtailing an occurrence of such in their territory. The Greeks had political, social
and trade relations with the Romans especially during the Republic.
The second plague which Livy describes as “serious epidemics” occurred in 435 and
lasted through 432 B.C. It seems probable that what Livy describes as “serious epidemics” is
the Athenian plague which may have spread to Rome. These serious epidemics claimed the
lives of so many soldiers as well as civilians. Livy writes that this second plague occurs
when Gaius Julius and Lucius Verginius are consuls. This plague destroyed any desire for
aspirations in the empire. Raids and any thought of aggressive operations are not considered
because of its effect. People of any class or kin were affected. It also encouraged raids from
the invading enemy from Fidenae and it took the generalissimo and military strategy of Aulus
Servilius Dictator to beat and completely defeat the enemy even after they took refuge in a
fortified city. This plague lasted for about four years and many lives went with it. During
these years, according to Livy, people were incapacitated by this plague. The government at
this time was probably at its wits end and did not seem to know what to do. The doctors tried
their best. Nature of course played its part and some people survived the effects of the
plague. It was not until 432 B.C that something was done by the leaders. Livy records that in
432, the epidemics grows worse such that men are distracted from political agitations.
Therefore on behalf of the public health a temple was vowed to Apollo in order to placate the
wrath of the gods who they believed would avert the epidemics and heal the populace. The
people indeed may have believed that the plague was caused by supernatural beings.
However, people continued to expire. “. . . but in spite of all both men and cattle died and
there were terrible losses in town and country. The farmers, too, were falling sick, and in fear
of famine delegations were sent to buy grain in Etruria and the Pomptine, and finally as far as
Sicily.”9
It is pertinent to note here that while Livy discusses the effect of both plagues he does
not mention the effect on children. The reason is obvious. Livy is writing about politics, war
9 Ibid, Book 4: 4.25 pg 296.
5
and consolidation of the ancient empire of Rome. However it is easy, from this history, to
understand that while this plague claimed the lives of consuls, soldiers, men, cattle and even
farmers, the lives of children could not have been invincible to this plague. Livy clearly
mentions indirectly, this plague as a cause of child mortality in ancient Rome. If the two
plagues recorded by Livy could exterminate and weaken soldiers in the city then it had the
capacity to send children to their untimely graves.
Other plagues are the Antonine, the Cyprian and the Justinian plagues. The Antonine
plague occurred between 165 and 180 A.D when Marcus Aurelius was Emperor.
The Antonine plague claimed the lives of two Emperors, Lucius Verus (AD 130-169)
and his co-Regent Marcus Aurelius Antoninus (AD 165-180). In his Meditations Marcus
Aurelius writes that the plague was less deadly than a corruption of the intellectual aspect of
the existence of man. He seems to be suggesting that if the intellectual aspect of man is
corrupt, depravity would set in and the harm that would emanate from it may have
devastating effects than what the plague could ever muster. He was not in actual fact treating
the plague and its intricacies; rather he was analytical of the falsehood and wickedness of
men which he believed were far worse than the plague that was affecting the populace during
this period. “It were the more desirable lot, to depart from among men, unacquainted with
falsehood, hypocrisy, luxury, or vanity. The next choice were, to expire, when cloy’d with
these vices, rather than continue among them: and does not even experience, yet, persuade
you to fly from amidst the plague? For a corruption of the intellectual part is far more a
plague than any pestilential distemper and change of this surrounding fluid which we breathe.
The one is only a pestilence to animals, as they are animals; but the other to men, as they are
men.”10
From the above, it seems probable that children were not exempted from the scourge
of a disease that he regards as a pestilence to man. Marcus Aurelius probably had access to
the best of doctors, yet he could not survive the attack of this plague. Children of the poor,
who may not have had access to good and effective medical attention, may have had little
chance of surviving especially considering their fragile body system.
Dio Cassius11 the Roman Historian writes that the disease broke out again nine years
later and claimed the lives of about two thousand people. So the most important issue to be
considered here is that in spite of the wreck and havoc the plague was wreaking on the
10 Marcus Aurelius, 1991,“Meditations” - IX.2.
11 Cassius Dio, Roman History, Book 71:2.4, Translation by Earnest Cary. Loeb Classical Library, Harvard
University Press, 1914 through 1927.
6
populace, no effective medications was invented to deal with a recurrence of any kind of
plague, whether in Greece or Rome.
Lucian of Samosata (c A.D 125 –c A.D. 182) was an Assyrian,12 a rhetorician and a
satirist. He is noted for his witty and scoffing nature. While describing the character of
Alexander of Abonoteichus (born in c 105 A.D), as that of a false and fraudulent prophet, he
mentions the Antonine plague which killed people. He states that people especially
commoners believe in Alexander’s magic which is nonetheless ineffective against the plague
while also pinpointing peoples’ carelessness in dealing with the plague because of their belief
in Alexander and his antics. His mentioning of desolate houses suggests that the occupants
which naturally, include adults and children were wiped out by the plague irrespective of the
so called magic chant supplied by the false prophet and which was hung in front of such
houses.
His finger once in the Italian pie, Alexander devoted himself to
getting further. Sacred envoys were sent all over the Roman Empire,
warning the various cities to be on their guard against pestilence and
conflagrations, with the prophet's offers of security against them. One
oracle in particular, an autophone again, he distributed broadcast at a
time of pestilence. It was a single line:
Phoebus long-tressed the plague-cloud shall dispel.
This was everywhere to be seen written up on doors as a prophylactic.
Its effect was generally disappointing; for it somehow happened that
the protected houses were just the ones to be desolated. Not that I
would suggest for a moment that the line was their destruction; but,
accidentally no doubt, it did so fall out. Possibly common people put
too much confidence in the verse, and lived carelessly without
troubling to help the oracle against its foe; were there not the words
fighting their battle, and long-tressed Phoebus discharging his arrows
at the pestilence?13
It is a well known fact that one who is mentally and physically lazy seeks short-cuts in
attempting to deal with issues that affect one’s life and destiny. This set of people hardly asks
questions but resort to anything that they assume has the capacity to deal with their fears. The
case is not far-fetched with regard to the magic-chant of Alexander. Therefore, people
especially children became victims on the altar of apathy and indolence.
12 Parpola Simo, Helsinki, 2003 Assyrian Identity in Ancient Times and Today, Journal of Assyrian Academic
Studies. p. 17. http://www.aina.org/articles/assyrianidentity.pdf.
13 The Works of Lucian of Samosata, Volume II, Alexander – The Oracle Monger, 36, pg 228. Translations
by H. W. Fowler and F. G. Fowler, 1905, Oxford: The Clarendon Press.
7
The Cyprian Plague occurred in about 259 A.D. and it was documented by Saint
Cyprian, the Assyrian. He was a Bishop and a Christian writer. This plague of Cyprian, a
pandemic, probably of smallpox, broke out in A.D. 251 in ancient Rome and even had
devastating effects on the people in Roman Carthage. The plague is named after Saint
Cyprian. He not only witnessed it but vividly documented it as well. It is believed that about
5,000 people died everyday at Rome from the pandemic.14 Below St Cyprian describes the
plague and its devastating effects. This is a plague that definitely decimated the population at
Rome during this period. In later verses of this volume, he affirms that the plague affects
everyone, pagan, Christian or Epicurean; boys, girls and adults. The description below
proves that it had a painful effect and its victims were a gory sight to behold. “ This trial, that
now the bowels, relaxed into a constant flux, discharge the bodily strength; that a fire
originated in the marrow ferments into wounds of the fauces; that the intestines are shaken
with a continual vomiting; that the eyes are on fire with the injected blood; that in some
cases the feet or some parts of the limbs are taken off by the contagion of diseased
putrefaction; that from the weakness arising by the maiming and loss of the body, either the
gait is enfeebled, or the hearing is obstructed, or the sight darkened;--is profitable as a proof
of faith. What a grandeur of spirit it is to struggle with all the powers of an unshaken mind
against so many onsets of devastation and death! what sublimity, to stand erect amid the
desolation of the human race, and not to lie prostrate with those who have no hope in God;
but rather to rejoice, and to embrace the benefit of the occasion; that in thus bravely showing
forth our faith, and by suffering endured, going forward to Christ by the narrow way that
Christ trod, we may receive the reward of His life and faith according to His own
judgment!.15
Pontius of Carthage, also a Christian writer, wrote the biography of Saint Cyprian
shortly after Cyprian’s death in about A.D. 259. He gives a vivid account of the effect of the
plague on its victims in Carthage. Pontius’ description is much more vivid than that of
Cyprian. It brings to the fore how lethally this disease is. From the description below it is
not out of place to assume that majority of the populace who succumbed to this plague were
children less than five, boys and girls. If this occurred in Carthage, then it must have also
occurred in ancient Rome during this period. Works of other classical authors corroborate
this fact. It is quite clear that Cyprian and Pontius did not set out to write about causes of
14 Plague of Cyprian, sourced in June 2009, from http://en.wikipedia.org/wiki/Plague_of_Cyprian
15 Cyprian of Carthage, On the Mortality (or Plague), 14:1-7. Translated by the Rev. Ernest Wallis, Ph.D.,
http://www.ewtn.com/library/PATRISTC/ANF5-15.TXT.
8
child mortality, but these excerpts clearly show the plagues as a factor responsible for child
death in ancient Rome between the 2nd and 3rd centuries A.D.
Afterwards there broke out a dreadful plague, and excessive
destruction of a hateful disease invaded every house in succession of
the trembling populace, carrying off day by day with abrupt attack
numberless people, every one from his own house. All were
shuddering, fleeing, shunning the contagion, impiously exposing their
own friends, as if with the exclusion of the person who was sure to
die of the plague, one could exclude death itself also. There lay about
the meanwhile, over the whole city, no longer bodies, but the carcases
of many, and, by the contemplation of a lot which in their turn would
be theirs, demanded the pity of the passers-by for themselves. No one
regarded anything besides his cruel gains. No one trembled at the
remembrance of a similar event. No one did to another what he
himself wished to experience.16
The Justinian plague on the other hand happened between 500 and 650 A.D when
Justinian was the emperor of the Byzantine Empire. This plague affected Asia Minor, Africa
and Europe.
Otto Seeck17 argues that more than half of the population of the ancient empire
perished. Littman and Littman (1973), having studied information about the Antonine plague
maintain that the plague was an outbreak of hemorrhagic small pox.18 McNeill also assumes
the plague as an outbreak of small pox19. Other modern authors suggest that it was either an
outbreak of small pox or of measles which caused severe devastation on the population.
Smith (1996) writes that the Antonine plague was introduced into the Italian Peninsula
by soldiers, who were returning from the Far East or from Seleucia. He claims that this
plague wiped out a whole town. In other words, every inhabitant of this town, male and
female, boy and girl, infants inclusive did not outlive the disease. There is no gainsaying the
fact that a disease that could exterminate energetic, strong, viable adults could and quite
easily kill children because their immune system and other body system had not developed
fully. Smith concludes that the plague destroyed about one third of the Roman population.20
16 Pontius of Carthage, Life of Cyprian, sourced in June 2009 from
http://en.wikipedia.org/wiki/Plague_of_Cyprian
17 Otto Seeck, 1910, Geschichte des Untergangs der antiken Welt
18 Littman, R.J. and Littman M.L., 1973, Galen and the Antonine Plague, American Journal of Philology 94 :
254-55.
19 McNeill, William H. 1976, Plagues and Peoples. Bantam Doubleday Dell Publishing Group, Inc., New York,
NY
20 Smith, Christine A., 2006 Plague in the Ancient World: A Study from Thucydides to Justinian.
http://www.loyno.edu/~history/journal/1996-7/Smith.html Retrieved 6th October, 2007
9
Hass claims that from the description of the diseases with regard to the Antonine plague, it
was an outbreak of small pox.21 He writes that the plague killed innumerable number of
people. Gillian22 agrees that this plague is a significant factor in the decline of the population
of ancient Rome, but suggests that as a factor in the decline of the population other authors
have greatly exaggerated. However, he suggests a plausible estimate of about two percent or
one million deaths.
The Athenian, Antonine, Cyprian and Justinian plagues played their roles as killers of
people, adults and children alike as well as sackers of cities.
Cholera Epidemic in Ibadan
Ibadan is the capital of Oyo State in Nigeria; the largest city in West Africa and the
second largest geographical area in Africa after Cairo. Since its establishment in 1829, the
city continues to witness an increase in population. It is estimated that Ibadan has a
population of about 4.1 million people.23 The city also witnesses series of developmental
activities as well as environmental risks arising from sources such as poorly managed
urbanization, air pollution, water contamination and many more which directly cause
devastating effect on human health.24 People obtain their drinking water from various sources
to meet their drinking needs. These sources include; sachet water, boiled water, water from
boreholes, water from deep wells, streams, rain water and distilled water (water from air
conditioners). However, water from some of these sources are contaminated with water-borne
diseases such as typhoid, cholera, polio, diarrhea etc, therefore, health problems affecting
people are witnessed and children who are the most vulnerable are affected and avoidable
deaths resulting from diarrhoeal diseases are witnessed. According to the World Health
Organzation, these diarrhoeal diseases account for “an estimated 4.1% of the total daily
global burden and is responsible for the deaths of 1.8 million people every year. It was
estimated that 88% of that burden is attributable to unsafe water supply, sanitation and
hygiene.”25
In many contemporary developing countries, outbreaks of cholera had hitherto
become a recurring event, and in cities where there are inadequate medical interventions, a
21 Hass Charles, The Antonine Plague, http://lib.bioinfo.pl/pmid:17195627
22 Gilliam, J. F., 1961, The Plague under Marcus Aurelius, American Journal of Philology 82, 228-29
23 Federal Office Statistics (FOS), “Population of Ibadan,” 2009. http://www.wideopenaccess.net//WACREN
24 Tomori M. A., Ibadan Metropolitan Area and the Challenges to Sustainable Development, retrieved from
http://macosconsultancy.com/Ibadan%20metropolitan.html
25 World Health Organization, 2005, “Guidelines for Drinking Water,” WHO, Geneva
10
high fatality rate is recorded26 and children are the worst hit. After the worldwide cholera
endemic in 1970, cholera became epidemic in Nigeria.27 Unsafe water supply and excreta
disposal habits instigate cholera contamination.28 One can argue that with urbanization came
rapid population growth, therefore inadequate water supply, poor sewage disposal, frequent
power failures, dependence on well water from poorly constructed wells without casings and
lack of effective drainage systems to combat flooding during rainy seasons cause the cholera
epidemic in Ibadan. Contamination easily occurs in situations where both a well and a pit
latrine exist. It also easily occurs during flooding with the flushing of open excreta dumps in
wells and surface water.29 Ali et al.30 state that due to its rapid spread, cholera was one of
three diseases that needed notification to the WHO in the 1969 International Health
Regulations (IHR), and today, after the 2005 revision of the International Health Regulations,
cholera outbreaks still require notification.
According to the WHO, cholera is an acute diarrhoeal infection caused by ingestion of
food or water contaminated with the bacterium Vibrio cholera. Cholera can kill within hours
if left untreated. The short incubation period of two hours to five days, enhances the
potentially explosive pattern of outbreaks.31 Cholera is characterized by a severe watery
diarrhea caused by the aforementioned toxigenic Vibrio cholerae, which colonizes the small
intestine and produces an enterotoxin, cholera toxin (CT),32 it leads to rapid dehydration, and
death occurs in 50 to 70% of untreated patients. Cholera is endemic in southern Asia and
parts of Africa and Latin America, where seasonal outbreaks occur widely and are
particularly associated with poverty and poor sanitation.33
Codeco (2001)34 states that due to problems cholera epidemics have created
worldwide, attention to cholera epidemiology have increased for over two decades.
26 Feikin RD, Tabu WC, Gichuki J., 2010, Does Water Hyacinth on East African Lakes Promote Cholera
Outbreaks? The American Journal Of Tropical Medicine And Hygiene, vol. 83(2):370-373.
27 Wilson AM., 1970-71, The Spread of Cholera to and Within Nigeria, Journal of Clinical Pathology, Vol.
4(8):768.
28 Umoh JU, Adesiyun AA, Adekeye JO, Nadarajah M., 1983, Epidemiological Features of an Outbreak of
Gastroenteritis/Cholera in Katsina, Northern Nigeria, Journal of Hygiene (Lond). Vol. 91(1):101-111.
29 Fatiregun,A.A., Olowookere, S.A., Isere, E.E., Ayede. A.I., 2012, Epidemiology of an Outbreak of Cholera in
a South-West State of Nigeria. South African Journal of Epidemiological Infections. Vol. 27(4):201-204
30 Ali M., Lopez A.L., You Y.A., Kim Y.E., Sah B., Maskery B., & Clemens J.,, 2012, The Global Burden of
Cholera, Bulletin of the World Health Organization 2012;90:209-218A.
31 Cholera, retrieved on 25th May, 2014 from http://www.who.int/mediacentre/factsheets/fs107/en/
32 WHO Scientific Working Group, 1980, Cholera and other Vibrio-associated diarrhoeas. Bull. W. H. O.
58:353–374. Medline
33 Shah M. Faruque, M. John Albert, John J. Mekalanos, 1998, Epidemiology, Genetics, and Ecology of
ToxigenicVibrio cholerae, Microbiology and Molecular Biology Reviews, vol. 62 no. 4 1301-1314
34 Codeço, Cláudia T., 2001, Endemic and Epidemic Dynamics of Cholera: the Role of the Aquatic Reservoir,
BMC Infectious Diseases, http://www.biomedcentral.com/1471-2334/1/1
11
According to Codeco, detailed investigations of the cholera disease have shown that cholera
dynamics is much more complex than it was previously thought. It has been discovered that
cholera toxin is codified by a lisogenic phage that can be transferred horizontally between
bacteria.35 Codeco affirms that, V.cholerae can survive in water for a long period of time,
assuming a non-culturable form and living in association with aquatic organisms. These
findings increase the complexity of the cholera system, that passes from a two-factor system
(human – pathogen) to a three or four factor system (virus-bacteria-aquatic organisms-
humans). Therefore, in order to effectively exterminate the pathogen a proper understanding
of the epidemiology of cholera is needful.
Oluwafemi and Oluwole (2012)36 state that water-borne diseases such as polio,
hepatitis, cholera, typhoid, diarrhea, stomach cramps, etc., are caused by pathogenic micro-
organisms, transmitted when contaminated water is consumed. The cholera epidemics in
Ibadan have been linked to floods that occurred after heavy rainfall. The epidemics in Ibadan
began in 197037. It occurred again in 1996 and became a public health challenge. During this
period, 1384 people excluding children under one year were diagnosed and treated for the
disease. The age adjusted case fatality rate was 5.3%. Symptoms of the disease present in
about 97.3% of the patients were a combination of both diarrhoea and vomiting, and 84.3%
of the patients presented symptoms of diarrhoea, vomiting and dehydration. The median
number of days spent on admission was only 2 days.38
The study of Falade and Lawoyin (1999) 39 on the 1996 cholera epidemic in Ibadan
showed that of the cases of cholera seen, 95 percent of people affected were children of
people who lived in the unplanned, densely populated areas of Ibadan. They believe that the
provision of clean and potable water to the residents of these areas should help in no small
way to arrest the spread of cholera. Studies have also shown that child mortality rates are less
in privileged areas.40
35 Levin BR, Tauxe R:, 1996, 1996,Cholera: Nice Bacteria and Bad Viruses, Current Biology,1389-1391,
PubMed.. Taylor, R.K., 1999, Virus On Virus Infects Bacterium, Nature, 399:312-313. PubMed.
36 Oluwafemi F., and Oluwole, M.E., 2012, Microbiological Examination of Sachet Water Due to a Cholera
Outbreak in Ibadan, Nigeria, Open Journal of Medical Microbiology, 2, 115-120
37 Lawoyin, T.O, Ogunbodede., N.A., Onadeko. M.O., Outbreak of Cholera in Ibadan, Nigeria, 1999, European
Journal of Epidemiology. Vol. 15(4):367-70.
38 Ibid
39 Falade G., Lawoyin T., 1999, Features of the 1996 cholera epidemic among Nigerian children in Ibadan,
Nigeria, Journal of Tropical Pediatrics, 45 (1): 59-62.
40 Timaeus, Ian M. & Louisiana Lush, 1995, Intra-urban Differentials in Child Health. Health Transition Review
5. No.2:163-190. Stephens, Carolyn, 1996, Healthy Cities or Unhealthy Islands? The Health and Social
Implications of Urban Inequality, Environment and Urbanization 8. No.(2):9-30. Harpham Trudy, Tim Lusty,
and Patrick Vaughan. 1988. In the Shadow of the City: Community Health and the Urban Poor, Oxford
University Press.
12
After the flood of August 2011 and one of its immediate consequences such as the
cholera epidemic which claimed 18 lives in Ibadan, Olufemi and Oluwole41 undertook a study
on the microbiological examination of sachet water for microorganisms related to water-
borne diseases. This study showed among others that some sachet water is not pure but poor
due to reasons ranging from manufacturing to consumer handling.42 The study also showed
that some people who suffered from the cholera infections may have been infected through
their consumption of sachet water. Olufemi and Oluwole sampled sachet water picked
randomly from street vendors within five local government areas of Ibadan; Ibadan South
West, Ibadan South East, Ibadan North West, Ibadan North East and Oluyole Local
Government areas. The water factories producing this sachet water were visited and it was
noted that each factory sunk a borehole within the vicinity. The objectives of their study
were; to isolate microorganisms and enumerate microorganisms present in sachet water; to
characterize isolates obtained using biochemical parameters; and to determine some
physicochemical properties of sachet water. Their findings were interesting. They discovered
that, “the pH of the sachet water ranged from 6.3 - 8.7. Twenty eight percent of the water
samples had pH values above the WHO approved range of 6.4 - 7.6. No residual chlorine was
detected. Iron levels were minimal in all water samples. Thirty percent of water samples had
faecal coliforms above the recommended WHO standard of zero coli-forms per 100 mL.
Sugar fermentation results revealed Escherichia coli had the highest incidence of 17%. Other
probable isolates were Staphylococcus aureus, Bacillus sp., Enterobacter aerogenes,
Flavobacterium sp., Proteus sp., Klebsiella sp., Streptococcus faecalis, Acine- tobacter sp.
Only one sample of sachet water had Gram negative cocoid bacilli that were curved,
indicating Vi- brio sp. Vibrio cholerae was confirmed using sugar fermentation tests.” In
other words, the cholera pathogen was discovered in the sachet water sampled.
In Ibadan and some parts of the world, Cholera epidemic usually struck after the
events of flooding, earthquakes or hurricanes. In August 2010, Pakistan experienced cholera
epidemic43 after the monsoon rainfall and the simultaneous glacier melt which affected an
area of 61.776 square miles displacing more than 20 million people.44 In 2010, Haiti was hit
41 Oluwafemi F., & Oluwole, M.E., 2012, Microbiological Examination of Sachet Water Due to a Cholera
Outbreak in Ibadan, Nigeria, Open Journal of Medical Microbiology, 2, 115-120
42 Cabral D., & Fernández, P., 2002, Fungal Spoilage of Bottled Mineral Water, International Journal of Food
Microbi-ology, Vol. 72, No. 1-2, pp. 73-76.
43 Muhammad Ali Shah1, Ankur Mutreja1, Nicholas Thomson1, Stephen Baker, Julian Parkhill, Gordon Dougan,
Habib Bokhari, and Brendan W. Wren, 2014, Genomic Epidemiology of Vibrio cholerae O1 Associated with
Floods, Pakistan, 2010, Emerging Infectious Disease Journal, Vol. 20, 1.
44 Singapore Red Cross. Pakistan floods: the deluge of disaster. Facts & figures as of 15 September 2010 [cited
2010 Oct 18]. http://reliefweb.int/report/pakistan/pakistan-floodsthe-deluge-disaster-facts-figures-15-september-
2010
13
by cholera ten months after the 2010 earthquake that occurred on the 12th of January 2010,
killing 467245 people by March 2011 and hospitalizing more. Again in 2012 after Hurricane
Sandy struck the Island cholera killed many in Haiti.46 In 2012, cholera hit Dakar in Senegal
killing and leaving many sick. It also hit Freetown and Conakry as well as Guinea after a
heavy rainy season leading to the deaths of about 250 to 300 people with many hospitalized.47
The cholera epidemic which hit Ibadan in 2011 was exacerbated by heavy rainfall
resulting in flooding and the areas worst hit were communities in the Ibadan North West such
as Ayeye, Idikan, Alawo, Abebi, and Ekotedo as well as the Ido local government areas. Yemi
Bamidele48 reported that four people were confirmed dead with sixteen others hospitalized in
Ibadan North West Local Government area. In the Omi-Adio community of the Ido local
government area, cholera claimed the lives of 18 people and the disease spread to other
communities in the local government area, hundreds of other victims were treated in various
hospitals including the University College Hospital. Cholera was said to have claimed the
lives of victims within 24 hours of stooling and vomiting due to lack of proper and effective
interventions.49 It was reported that at this period the UCH recorded an average of three cases
per day with eleven cases confirmed dead and 30 hospitalized. It was also noted that 947
suspected cases of cholera were recorded across the state between June and September,
2011.50
Causes of the Plagues in Antiquity and the Cholera Epidemics in Ibadan
As has earlier been noted, the plagues in antiquity were caused by overcrowding
motivated by insecurity in the city. In modern Ibadan, various authors have documented
factors responsible for cholera as lack of hygienic conditions and environments, pollution of
drinking water, lack of toilets and waste bins. Flooding further aggravate the problems
mentioned above.
45 PAHO's Interactive Report of Cholera Outbreak
46 2010-2013 Cholera Outbreak, retrieved on 26th May, 2014 from
http://en.wikipedia.org/wiki/Haiti_cholera_outbreak
47 Adam Nossitter, August 2012, Cholera Epidemic Envelops Coastal Slums in West Africa retrieved on the 26th
of May 2013 from http://www.nytimes.com/2012/08/23/world/africa/cholera-epidemic-envelops-coastal-slums-
in-west-africa.html?_r=0
48 Yemi Bamidele, August 23, 2011, Cholera outbreak claims four lives in Ibadan, Nigerian Health Journal
retrieved from http://nigerianhealthjournal.com/?p=1293
49 Nigeria: Curbing cholera epidemics, September 21, 2011, retrieved from
http://crofsblogs.typepad.com/h5n1/2011/09/nigeria-curbing-cholera-epidemics.html
50 Grappling with cholera epidemic, Sunday, September 25, 2011, retrieved from
http://odili.net/news/source/2011/sep/25/858.html
14
Combating the Cholera Epidemic in Ibadan
It is pertinent to note that occurrences of the cholera epidemics in Ibadan have caused
panic and disrupted the social and economic structure of the communities. It is also
important to note that cholera infections can be prevented through increasing hygiene
standards even if proper sewage treatments and other more permanent improvements were
impossible. Simple actions such as washing of hands before eating could help stay the
infections.51 During the epidemic in 2011, the Disease Surveillance Officers in all the 33
local governments in Oyo State did a rapid diagnostic test which was conducted on stool
samples to ascertain the cause of the infection and curtail the spread. The group also
distributed intravenous fluids and supplied medical equipment to hospitals and clinics in the
affected local governments. It also mobilized private health facilities in the areas, in order to
assist patients with the disease. Other measures such as case management, health education,
fumigation of different parts of the State and community mobilization were done by the
Disease Surveillance Officers. The Ministry of Health educated the masses through the
media; radio jingles were used to educate people on causes and symptoms of cholera and first
aid treatment on patients with diarrheal cases.52
Many scholars have noted that cholera infections can be prevented if proper measures
are taken by the government and the people. Government should provide portable water and
effective sewage connection. People should observe basic hygiene such as boiling water
before consuming and maintaining a non-expensive, but hygienic lifestyle. It is pertinent
that, campaigns for improved personal hygiene be intensified and that the citizenry be
adequately enlightened with regard to the importance of fluid replacement through the Oral
Rehydration Therapy as it can prevent death that can occur within 24 hours of this kind of
infection.
Conclusion
The ancients did not name the plagues and epidemic as attacks of cholera. However
descriptions of the effects of the Athenian plague suggest that the people may have suffered
from cholera epidemic. The Antonine and Justinian plagues may have been attacks of small
pox. The point to note here is that these plagues as documented by Classical authors occurred
51 Codeço C.T., Coelho F.C., (2006) Trends in Cholera Epidemiology. PLoS Med 3(1): e42.
doi:10.1371/journal.pmed.0030042
52 Oyo Government Tackles Cholera Outbreak in Ibadan, retrieved from
http://www.thenigerianvoice.com/news/58904/1/oyo-govt-tackles-cholera-outbreak-in-ibadan.html on the 16th
May, 2014.
15
years and some centuries apart, although they may have endured for two to three years or
more. The doctors offered what they could, for ancient medicine was a combination of
physical techniques using various tools, and holistic medicine using rituals and religious
belief systems. They believed diseases were brought upon by the gods and since many
diseases later went away, they believed they had managed to appease the gods through sacred
rites. Religious cures were rare but magical treatments were commonly applied.
It is interesting to note that the plagues in antiquity that occurred years apart is not
unconnected to the fact that the doctors and the people understood how to prevent the
occurrences of the various illnesses that plagued the people. For example, Marcus Terentius
Varro (116 B.C. – 27 B.C.), the Roman scholar whom Julius Caesar named director of the
imperial library, attributed some diseases to the swamps, which one may assume to be
malaria infections or possibly the Vibrio cholerae which, according to modern studies, has the
capacity to survive in water with other aquatic organisms. Varro writes that these diseases are
caused by “animaculae which cannot be seen with the eyes,”53 Varro makes clear that it is
better to abandon places that attract such infections or one should build his house in a manner
that suggests that the builder must understand the nature or direction of winds. Other medical
doctors, in order to curtail the spread of a disease, placed accommodations away from insect
infested swamps, installed drains and effective sewage connection, and built separate rooms
to quarantine people with infectious diseases. Little wonder reoccurrences of the plagues
were witnessed centuries apart.
In modern Ibadan the cholera epidemics have claimed many lives. The doctors
offered what they could and some survived the disease. As a matter of fact, the government
of the day, even in the 1970s put various measures to prevent the occurrence of the epidemic.
For instance, health officers nicknamed “wole wole,” inspected streets as well as peoples’
houses to ascertain that they observed necessary sanitation. Today, health officers still
observe their rounds. There are also the weekly Thursday, and the monthly last Saturday of
the month sanitation exercises instituted by the State and Federal governments. These are
duly observed by the people. Yet the cholera epidemic still occurs. In some parts of Oyo
State, drainage systems have been constructed and some are under construction, yet the
cholera epidemic still occurs. Then what exactly is the problem? It simply means we are not
doing what is necessary or not doing it properly and effectively. The last cholera epidemic in
the east end of London occurred in 1866, a hundred and forty-eight years ago.54 The last time
53 Marcus Terentius Varro, De Re Rustica, Book I.12:2-3, 1934, translated by W.D. Hooper and H.B. Ash, 1934,
Loeb Classical Library.
54 Cholera in London, retrieved from http://www.choleraandthethames.co.uk/ on the 6th of June 2014.
16
it hit the United States and occurred in New York city, it was between 1910 and 1911 over a
hundred years ago.55
Some other countries have not experienced the cholera plagues for well over 50 years
or more. Many factors account for this. One can argue that advancement in medical
technology may have caused this. But there are also many others; factors such as patriotism,
civic responsibility, lack of deep seethed nepotism and corruption and the list runs on.
In antiquity, classical authors mentioned that the plagues decimated the population,
one can understand that especially because medical technology had not advanced compared
to what obtains today. However, Ibadan is in a modern setting, therefore the cholera plague
should not even rear up its head. This is not the case. Rather repeated occurrences of the
cholera epidemic fill the air waves. One can argue that if Ibadan had existed during the
Greaco-Roman era, cholera would have so decimated the population such that what remains
of the population would have been taken away by a more formidable people through war.
It is high time the cholera epidemic be brought to a total and complete end in Ibadan,
since there is access to information, medical technology and others. Further studies may
interrogate methods that can be adopted to ensure that cholera infection in Ibadan is brought
to a hasty end.
55 http://www.nydailynews.com/news/national/cholera-hits-united-states-florida-woman-visited-haiti-develops-
potentially-deadly-disease-article-1.456737
17
REFERENCES
2010-2013 Cholera Outbreak, retrieved on 26th May, 2014 from
http://en.wikipedia.org/wiki/Haiti_cholera_outbreak
Adam Nossitter, August 2012, Cholera Epidemic Envelops Coastal Slums in West Africa
retrieved on the 26th of May 2013 from
http://www.nytimes.com/2012/08/23/world/africa/cholera-epidemic-envelops-coastal-slums-
in west-africa.html?_r=0
Ali M., Lopez A.L., You Y.A., Kim Y.E., Sah B., Maskery B., & Clemens J.,, 2012, The
Global Burden of Cholera, Bulletin of the World Health Organization 2012;90:209-218A.
Cabral D., & Fernández, P., 2002, Fungal Spoilage of Bottled Mineral Water, International
Journal of Food Microbiology, Vol. 72, No. 1-2, pp. 73-76.
Cassius Dio, Roman History, Book 71:2.4, Translation by Earnest Cary. Loeb Classical
Library, Harvard University Press, 1914 through 1927.
Cholera, retrieved on 25th May, 2014 from
http://www.who.int/mediacentre/factsheets/fs107/en/
Codeço C.T., Coelho F.C., (2006) Trends in Cholera Epidemiology. PLoS Med 3(1): e42.
doi:10.1371/journal.pmed.0030042
Codeço, Cláudia T., 2001, Endemic and Epidemic Dynamics of Cholera: the Role of the
Aquatic Reservoir, BMC Infectious Diseases, http://www.biomedcentral.com/1471-2334/1/1
Cyprian of Carthage, On the Mortality (or Plague), 14:1-7. Translated by the Rev. Ernest
Wallis, Ph.D., http://www.ewtn.com/library/PATRISTC/ANF5-15.TXT.
Falade G., Lawoyin T., 1999, Features of the 1996 cholera epidemic among Nigerian children
in Ibadan, Nigeria, Journal of Tropical Pediatrics, 45 (1): 59-62.
Fatiregun,A.A., Olowookere, S.A., Isere, E.E., Ayede. A.I., 2012, Epidemiology of an
Outbreak of Cholera in a South-West State of Nigeria. South African Journal of
Epidemiological Infections. Vol. 27(4):201-204
Federal Office Statistics (FOS), “Population of Ibadan,” 2009.
http://www.wideopenaccess.net//WACREN
Feikin RD, Tabu WC, Gichuki J., 2010, Does Water Hyacinth on East African Lakes Promote
Cholera Outbreaks? The American Journal Of Tropical Medicine And Hygiene, vol.
83(2):370-373.
Gilliam, J. F., 1961, The Plague under Marcus Aurelius, American Journal of Philology 82,
228-29
Grappling with cholera epidemic, Sunday, September 25, 2011, retrieved from
http://odili.net/news/source/2011/sep/25/858.html
18
Harpham Trudy, Tim Lusty, and Patrick Vaughan. 1988. In the Shadow of the City:
Community Health and the Urban Poor, Oxford University Press.
Hass Charles, The Antonine Plague, http://lib.bioinfo.pl/pmid:17195627
Lawoyin, T.O, Ogunbodede., N.A., Onadeko. M.O., Outbreak of Cholera in Ibadan, Nigeria,
1999, European Journal of Epidemiology. Vol. 15(4):367-70.
Levin BR, Tauxe R:, 1996, 1996,Cholera: Nice Bacteria and Bad Viruses, Current
Biology,1389-1391, PubMed..
Littman, R.J. and Littman M.L., 1973, Galen and the Antonine Plague, American Journal of
Philology 94 : 254 55.
Livy, The Early History of Rome, Books 3, 3.6 pg 190, translated by Audrey De Selicourt,
1973, Penguin Books, England.
Marcus Aurelius, 1991,“Meditations” - IX.2.
McNeill, William H. 1976, Plagues and Peoples. Bantam Doubleday Dell Publishing Group,
Inc., New York, NY
Muhammad Ali Shah, Ankur Mutreja, Nicholas Thomson, Stephen Baker, Julian Parkhill,
Gordon Dougan, Habib Bokhari, and Brendan W. Wren, 2014, Genomic Epidemiology of
Vibrio cholerae O1 Associated with Floods, Pakistan, 2010, Emerging Infectious Disease
Journal, Vol. 20, 1.
Nigeria: Curbing cholera epidemics, September 21, 2011, retrieved from
http://crofsblogs.typepad.com/h5n1/2011/09/nigeria-curbing-cholera-epidemics.html
Oluwafemi F., & Oluwole, M.E., 2012, Microbiological Examination of Sachet Water Due to
a Cholera Outbreak in Ibadan, Nigeria, Open Journal of Medical Microbiology, 2, 115-120
Otto Seeck, 1910, Geschichte des Untergangs der antiken Welt
Oxford Advanced learners’ Dictionary of Current English, 7th edition, ed Wehmeir S.,
Mclntosh C., Turnbull J., Ashby M., Oxford University Press, 1997.
Oyo Government Tackles Cholera Outbreak in Ibadan, retrieved from
http://www.thenigerianvoice.com/news/58904/1/oyo-govt-tackles-cholera-outbreak-in-
ibadan.html on the 16th May, 2014.
PAHO's Interactive Report of Cholera Outbreak
Parpola Simo, Helsinki, 2003 Assyrian Identity in Ancient Times and Today, Journal of
Assyrian Academic Studies. p. 17. http://www.aina.org/articles/assyrianidentity.pdf.
Plague of Cyprian, sourced in June 2009, from
http://en.wikipedia.org/wiki/Plague_of_Cyprian
19
Pontius of Carthage, Life of Cyprian, sourced in June 2009 from
http://en.wikipedia.org/wiki/Plague_of_Cyprian
Shah M. Faruque, M. John Albert, John J. Mekalanos, 1998, Epidemiology, Genetics, and
Ecology of ToxigenicVibrio cholerae, Microbiology and Molecular Biology Reviews, vol. 62
no. 4 1301-1314
Singapore Red Cross. Pakistan floods: the deluge of disaster. Facts & figures as of 15
September 2010 [cited 2010 Oct 18]. http://reliefweb.int/report/pakistan/pakistan-floodsthe-
deluge-disaster-facts-figures-15-september-2010
Smith, Christine A., 2006 Plague in the Ancient World: A Study from Thucydides to
Justinian. http://www.loyno.edu/~history/journal/1996-7/Smith.html Retrieved 6th October,
2007
Stephens, Carolyn, 1996, Healthy Cities or Unhealthy Islands? The Health and Social
Implications of Urban Inequality, Environment and Urbanization 8. No.(2):9-30.
Taylor, R.K., 1999, Virus On Virus Infects Bacterium, Nature, 399:312-313. PubMed.
The Works of Lucian of Samosata, Volume II, Alexander – The Oracle Monger, 36, pg 228.
Translations by H. W. Fowler and F. G. Fowler, 1905, Oxford: The Clarendon Press.
Timaeus, Ian M. & Louisiana Lush, 1995, Intra-urban Differentials in Child Health. Health
Transition Review 5. No.2:163-190.
Tomori M. A., Ibadan Metropolitan Area and the Challenges to Sustainable Development,
retrieved from http://macosconsultancy.com/Ibadan%20metropolitan.html
Umoh JU, Adesiyun AA, Adekeye JO, Nadarajah M., 1983, Epidemiological Features of an
Outbreak of Gastroenteritis/Cholera in Katsina, Northern Nigeria, Journal of Hygiene (Lond).
Vol. 91(1):101-111.
WHO Scientific Working Group, 1980, Cholera and other Vibrio-associated diarrhoeas.
Bull. W. H. O. 58:353–374. Medline
Wilson AM., 1970-71, The Spread of Cholera to and Within Nigeria, Journal of Clinical
Pathology, Vol. 4(8):768.
World Health Organization, 2005, “Guidelines for Drinking Water,” WHO, Geneva
World Health Organization, 2010, Cholera Annual Report 2009, Weekly Epidemiologica
Record. Vol 85(31):293-308.
Yemi Bamidele, August 23, 2011, Cholera outbreak claims four lives in Ibadan, Nigerian
Health Journal retrieved from http://nigerianhealthjournal.com/?p=1293
20
