CHILD MORTALITY IN ANCIENT ROME AND MODERN IBADAN BY Y MONICA OMOYE ANENI R B.A., M.A. HONS (Ibadan) A BR LI N A thesis in the Department oDf CLASSICS, A Submitted to the Faculty of Arts in pa rtIiaBl fulfillment of the requirements for the awardF of the degree of YDO C OTOR OF PHILOSOPHY T SI Of the R UNIVERSITY OF IBADAN IV E UDN epartment of Classics University of Ibadan Ibadan May, 2013. CERTIFICATION I certify that this work was done by ANENI, MONICA OMOYE of the Department of Classical Studies, University of Ibadan, Nigeria, under my supervision. RY A R IB L ------------------------------------ N---------------------------- (Supervisor) A Date Professor James A. Ilevbare Department of Classical Studies D University of Ibadan, Ibadan, A Nigeria. B F I O SI TY ER IV UN i i DEDICATION I dedicate this thesis to God Almighty who sent His son Jesus Christ to die for mankind thereby, reconciling man to God. AR Y BR N LI A BA D F I O SI TY ER NI V U ii i ACKNOWLEDGEMENTS I want to first all acknowledge God the Father, Jesus Christ the Son and the Holy Spirit, whose help, guide and direction aided in the completion of this thesis. I wish to appreciate my supervisor, Professor J. A. Ilebvare for his patience and understanding, thorough supervision, his painstaking corrections and all the efforts he put into the work. RY I also appreciate the Postgraduate School under the indefatigable DeaAnship of Professor Olayinka Idowu for the scholarship awarded me for theR position of Teaching and Research Assistant at the Department of ClasIsiBcs, through the University of Ibadan Postgraduate School Teaching and R eLsearch Assistantship Scheme for the 2003/2004 Session. I also must not fail toN thank the Council for the Development of Social Science Research in Africa (CAODESRIA) for the award of the Small Grants Programme for Thesis WritiAng iDn October 2007. The financial as well material aids have greatly facilitated Bthe work. Worthy of mention also is the John D and Catherine T MacArthur Fo uIndation Grant of the University of Ibadan which I received in 2009 towards thFe completion of the PhD programme. I also do appreciate the International OAssociation of Greek and Latin Epigraphy for the th bursary award towards attYend ing the 13 Congress of Greek and Latin Epigraphy at Oxford in SeptemIbeTr 2007. I am eternally grateful to these award- granting bodies for the assSistance rendered me towards the production and completion of this thesis. VE R The Iincumbent Head of Department Dr. Olakunbi Olasope has been very suNpportive and truly encouraging, I hereby show my appreciation. I thank my Uother colleagues Professor Folake Onayemi, Mr N. Henry, Dr. Doyin Odebowale, Dr. Tosin Adekannbi, Dr. Funsho Taiwo, Dr. Goke Akinboye and Mr Idowu Alade for their support and encouragement. Other members of non-academic staff; Mrs. Stella Iroegbuchu and Mr. Egbakumen Yakubu are also appreciated. Members of my family are highly appreciated for their unflinching and unflagging support and encouragement. Members of the Iyere clan of Emado in Ugboha; my mother, grandma Asaba, Mrs. Felicia Iyere, my siblings Matthew Iyere, Theodore iv Iyere, Pastor Joseph Iyere, Lucky Iyere and Mrs Blessing Obehi Onwusah. Members of the Aneni clan of Unuwazi in Uromi, my second parents, grandma and grandpa Kunle Abass Bodija, Mr. and Mrs. A.A. Aneni, Dr. Ose Aneni, Mr Abu Aneni, Dr. Ehimen Aneni, Mr Daniel Ogbole and Mr Anthony Ogbole. I do appreciate my husband and friend Mr. Sele Aneni for his unfaltering and unwavering support as well as his prayers. The support and prayers of my children, especially the ―...mummy, God bless you!‖ will continue to reverberate in my eaYrs and be always true in my life. God bless you too Ojie, Ivie and Eki in Jesus‘ nRame. Amen. RA I will not fail to mention some of my other colleagues and friends Bwho have shown concern towards me in respect of my work. Mrs. Deola O mLoloIlu, thank you for the times you spent babysitting for me while I worked. MNy former office mate Dr. Oye Paul Taiwo, neighbour Dr. Mrs K. Labeodan; Aother colleagues and friends, Professor A.I. Sanni, Dr. O.S.A Oluwole, DDr. C.B.N Ogbogbo, Dr Akin Ademuyiwa, Dr. Angela Chukwu and Dr. OA. Muojama; thank you all for your support. I also thank Mr. Charles NwaogIuBgu for his encouragement and prayers. I also appreciate my house cell pastFor Mrs Bunmi Akintoba. Mrs Felicia Omowa (grandma Rofel), Mr. Essien AOntigha, Mrs Tayo Adesuyi, Dr Fehintola Asa, Mrs Temitope Arogunmati andY M rs Wunmi Chukwurah are all appreciated for their encouragement, suppIoTrt and prayers. I must not fail to mention Alhaji Bola Salawu my amiaSble landlord and my neighbours Dr. Femi Popoola and Dr. Eselobo for thReir consistent support and encouragement. IVLet E me conclude by saying that since humans are not known to be perfect, I acNcept responsibility for all the errors in this work. U v TABLE OF CONTENTS Title Page ii Certification iii Dedication iv Acknowledgement v RY Table of Contents Avii R Abbreviations IB xi Abstract L 2 N CHAPTER ONE 4 DA Introduction A 4 1.0 Statement of the Problem IB 4 1.1 Expected Outcome F 7 1.2 Methodology O 7 1.3 A Brief History of YAnc ient Rome and Ibadan Land 8 CHAPTER TWO I T 13 Literature ReviewS 13 2.0. IntrEoduRction 13 2.1. The CIL 13 2.2. IVClassical Authors 13 U2.N3. Modern Commentaries on Ancient Rome 17 2.4. Sources on Ibadan 21 2.5. Conclusion 23 CHAPTER THREE 24 Causes of Child Mortality 24 3.0 Ancient Rome 24 3.1 Malaria 26 v i 3.2 Consumption 38 3.3 Paralysis 38 3.4 Diseases Common to the Weather 39 3.5 Infanticide 41 3.6 Lead Poisoning 51 3.7 Plagues 60 3.8 Superstitious/Religious Beliefs 66 3.9 Social Deprivation 67 Y 3.10 Deprivation by Parents 69 R 3.11 Conclusion RA73 B CHAPTER FOUR LI 74 Child Mortality in Modern Ibadan Land AN 74 4.0. Introduction 74 4.1. Lack of Access to Portable Water and AEffDective Sewerage System 74 4.2. Environment B 77 4.3. Cholera I 79 4.4. Measles F 80 4.5. Malnutrition O 80 4.6 Apathetic Attitude Yof Health Workers 81 4.7. Lack of GenuiInTe Concern 82 4.8. Out of RHosSpital Births 82 4.9. Table 1 83 4.10. VMaElaria 84 4.11. I Poverty 84 U4.N12. Other Causes of Childhood Deaths 86 4.13. Table 3: Principal Causes of 12,522 Childhood Deaths in Ibadan from 1996-2000 86 4.14. Vitamin A Deficiency (VAD) 88 4.15. HIV/AIDS 92 4.16. Maternal Illiteracy 93 4.17. Socio-Cultural Beliefs 94 vi i a. Unhealthy Delivery Practises 94 b. Figure of Authority 94 c. The Ogbanje or Abiku Phenomenon 94 4.18. Taboos and Myths 96 4.19. Conclusion 97 CHAPTER FIVE 99 Child Funerary Inscriptions 99 Y 5.0. Introduction 99 R 5.1. Importance of Latin Inscriptions A99 5.2. Understanding Child Funerary Inscriptions R 100 5.3. The Name of the Child Commemorated IB 101 5.4. The Period of Time the Deceased Lived L 101 5.5. Abbreviations N 102 5.6. Name and Identity of the Dedicator A 102 5.7. Emotions of the Commemorator AD 103 5.8. The Symbol of the Cross B 105 5.9. The Status of Parents I 105 5.10. Table 1: The number of maleF and female children below age 6 commemorated O 106 5.11. Inscriptions TY 106 5.12. ConclusionS I 112 CHAPTER SIX 114 SummaryE andR Conclusion 114 APPENDIX I 119 IV ANPPENDIX II 129 U BIBLIOGRAPHY 132 vi ii LIST OF ABBREVIATIONS USED IN THIS WORK Afr J Med Med Sci African Journal Of Medicine And Medical Sciences AHR American Historical Review AIDS Acquired Immune Deficiency Syndrome AJP American Journal of Philology RY AUM Acute Uncomplicated Malaria RA CIL Corpus Inscriptionum Latinarum IB CQ Classical Quarterly L DNA Deoxyribonucleic Acid AN EPA Environmental Protection ADgency A FESTAC Festival of Arts a nIdB Culture GNP Gross NationFal Product HIV HumYan Im Omuno Virus HTR IHTealth Transition Review S IITA R International Institute for Tropical Agriculture IQ IV E Intelligence Quotient JHNM Journal of the History of Medicine U JPR Journal of Population Research JRS Journal of Roman Studies JTMH Journal of Tropical Medicine and Hygiene JTP Journal of Tropical Pediatrics ix MDGs Millennium Development Goals NI New Internationalist PEM Protein Energy Malnutrition PHCN Power Holding Company of Nigeria PS Population Studies Y SM Severe Malaria AR TF Tertian Fever BR UN United Nations LI USAID United States Agency InternatiAonaNl Development VAD Vitamin A Deficiency AD West Afr J Med West African Jou rInBal of Medicine WHF World HealthF Forum WHO WorYld H e Oalth Organization T SI R EIV UN x ABSTRACT High records of occurrences of child mortality were documented in ancient Rome and in modern Ibadan. Available studies on ancient Rome focused on the effect of female infanticide on the population, and those on modern Ibadan, concentrated on the effects of cerebral malaria on children below the age of 5. However, these studies ignored the comparative possibility of health situations in both societies despite their related experiences. This study, therefore, compared the causes of child mortality (ages 0-5) in both societies. RY The study employed historical and comparative methodologies to Ahighlight the factors that caused child mortality in both societies. Sources utiliseRd on ancient Rome were volume X of the Corpus Inscriptionum Latinarum, fIroBm which gender distribution of mortality and chronological age of childre n Lwere gleaned. Data were also extracted from classical and contemporary auNthors. For modern Ibadan, information was gathered from medical literature andA newspaper reports. The data were subjected to content analysis. D The factors which brought about cBhildA death in ancient Rome and modern Ibadan were similar, but they occu rIred in varying degrees of magnitude. Respiratory tract infections such Fas pneumonia, acute bronchitis, asthma, and tonsillitis caused child morta lOity in both societies. Air-borne and water-borne diseases such as tubercuYlosis, cholera, typhoid, measles and diarrhea killed children below age 6.I TThese diseases were often aggravated by malaria. Dysentery and inflammatoryS bowel diseases such as entiritis also accounted for children‘s death. Other Rdiseases that included jaundice, malaria, convulsions, neo-natal tetanusV, mEeningitis, severe malnutrition, severe birth syphxia, ulcers and gangrene also Icaused child mortality in both societies. Maternal illiteracy, superstitious beNliefs, social deprivation, and poverty were the social and economic factors which Upermitted child mortality in the two civilisations. In both societies, children less than 3 were worst affected by these diseases due to their vulnerability. In ancient Rome, neo-natal death resulting from venereal diseases such as gonorrhea and syphilis were transferred from mother to child at birth, but this death was rare in modern Ibadan since people were informed of the disease in modern Ibadan than in antiquity. Lead poisoning, superstitious beliefs and social deprivation caused death in both societies. In ancient Rome, social deprivation ranked highest, x i followed by superstitious beliefs and lead poisoning because of government‘s enthusiasm about the empire‘s consolidation. In modern Ibadan, superstitious beliefs caused more death than lead poisoning and social deprivation due to the people‘s belief system. While malaria and tuberculosis killed thousands of children than other diseases in ancient Rome, neonatal tetanus, prematurity and low birth weight, neonatal septicaemia and severe birth sphyxia ranked highest in modern Ibadan. They ranked highest in antiquity and Ibadan respectively due to weather conditions and people‘s ignorance of the diseases. Y Child mortality in ancient Rome and modern Ibadan was caused byA troRpical diseases, sexually transmitted infections and respiratory tract infecRtions. Thus, child mortality was a social challenge in both societies. FurthBer studies could examine the divergence and convergence in the medical apLprIoaches applied to infant diseases in ancient Rome and modern Ibadan. N A Key words: Child mortality, Epitaphium, ADncient Rome, Modern Ibadan, Diseases. A Word Count: 493 IB OF ITY ER S IV UN xi i CHAPTER ONE INTRODUCTION 1.0. Statement of the Problem References to child mortality in the works of Classical authors are accidental. These works do not examine closely the factors responsible for child death. Modern authors on ancient Rome also view the various causes of chilYd death in passing. Not one of these authors set out to document diseases and Rother factors responsible for child mortality in antiquity. The aim of thiRs stuAdy is to examine causes of child mortality in ancient Rome and supplemenBt ancient sources with Latin child funerary inscriptions. LI In ancient Rome, because of the extent of the powe r (patriae potestas) of the male head of the household (paterfamilias), chAildreNn had few, if any, rights throughout the Roman Empire, and little attentDion has been paid to children in contemporary scholarship. Most research focAus on the family (which include not only the natal family, but also the conju gIaBl, extended, and foster family and slaves) and genealogies and relationshipsF within the family. It becomes necessary therefore to supplement epigrapOhic evidence with ancient literary sources on child mortality in antiquity. Latin child funerary inscriptions utilized in this work are th sourced from the 10I TvolYume of the Corpus Inscriptionum Latinarum. The first part of this volumSe contains inscriptions found in Roman Campagna and Latium Adiectum, while the second part includes inscriptions discovered on the islands of Sardinia, CEorsRica and Sicily. In antiquity, records of events were kept as required by theI Vadministration of the state, but records of birth and death of children in the emNpire were not documented in official records. As a result, there are no records Ukept for the purpose of further studies. Therefore these Latin inscriptions prove very useful in the elucidation of child mortality in ancient Rome. Erecting epitaphs for the departed was an aspect of the culture of ancient Romans. Burial was an important facet in the lives of these people, even from the prehistoric peoples of Italy. Historians, Epigraphists as well as Archaeologists have been able to explain the cultures of the Pallafitte, the Terremare, the Villanova, the Etruscans and other peoples who populated Italy prior to the incursion of the Romans through 1 1 evidence found at burial sites. The importance of these epitaphs cannot be overemphasized. Although some scholars have argued that epitaphs or inscriptions 2 do not give proper statistics of mortality in antiquity, they are unambiguous facts that can and indeed aid in the elucidation of child death in the Greaco-Roman 3 world. For ancient Rome this work will cover generally, the period between the th th 5 century B.C. and the 7 century A.D. It will concentrate more on the period nd nd between the 2 century B.C. and the 2 century A.D. The reason is that there is more evidence from both epigraphic and literary sources. The literary workYs include those of Thucydides, Tacitus, Celsus, Galen, Soranus, Pliny the ERlder, Columella, Vitruvius, Varro, Tertullian, Philo Judaeus and Marcus AuRreliuAs. In modern Ibadan, the State‘s Ministry of Health does notB possess data or records of death of children of ages 1-5 from 1980 to 2005. B uLt thIere are records of birth and death of neonates from all the ten local governments of Ibadan. The Ministry of Health sends out field workers to accumAulaNte data of birth and deaths 4 of new born babies. Hospitals also send their datDa to the secretariat. These pieces of information throw some light on the birth aAnd death rate of neonates. Research which has been carried out by medic alI pBractitioners, authors and columnists on causes of child mortality in modern FIbadan is scanty. However, not one of Othese authors, researchers and columnists has documented altogether diseas es and other reasons responsible for child death in Ibadan. This work wIiTll eYxamine diseases and other factors responsible for child death in modern ISbadan in the periods between 1980 and 2005. Of all the extant works on chiRld mortality, no author has documented side by side the factors responsibleE for child death in both ancient Rome and modern Ibadan. This study aims ItoV do that. In so doing it will examine ancient Roman authors and Latin epNitaphs documenting deaths of children between ages 0 and 5. It will determine U 1 Boak, A. E.R., 1935, A History of Rome to 565 A.D. pg 8-44, London, Routledge Publishers explains that from burial sites the culture, and even food consumed by the people could be deciphered. Sometimes the skeletons discovered also revealed the physique of these inhabitants. 2 Engels, D., 1980, The Problem of Female Infanticide, Classical Philology 75: 112-120. Harvard University Press. 3 See King Margaret, Commemorating Infants on Roman Funerary Inscriptions, The Epigraphy of Death pg118 , Studies in the History and Society of Greece and Rome, ed by G.J., Oliver, Liverpool University Press and Ikurite‘s, 1973, Notes on Mortality in Roman Africa pg 59, Museum Africum. West African Classical Association in conjunction with the Department of Classics, University of Ibadan. 4 The Records officer at the Ministry of Health, Oyo State Secretariat, Ibadan, attests to this. 2 diseases and other factors responsible for child death in ancient Rome and modern Ibadan. And it will compare the causes of child death in both ancient Rome and modern Ibadan. This study makes a significant contribution to scholarship in examining and documenting diseases and other factors responsible for child mortality in antiquity and modern Ibadan. It will be an addendum to knowledge on family values in antiquity and in modern Ibadan. It will also motivate further research in the area of identifying, in modern names, ancient diseases and correlating both the ancienRt anYd modern. Ancient Roman Empire had her share of everything and anRythinAg that a society endures. Some of the issues experienced in antiquity arBe evident in the everyday activities and lifestyle of the people in modern Ibad aLn. I Though two thousand years distant in timAe, NAncient Rome is still relevant to our debates anDd assumptions today because . . . Rome was the startiAng point for some of the standard historical narrativeIsB about the evolution of the 1 family and State that infForm our modern assumptions. O Ibadan metropolis likYe a ncient Rome has experienced and tackled various political, economic, sIoTcial, religious and health issues. It is a place where rival classes struggled for power; a place in which the major changes, structural, institutional anRd idSeological, in the larger society produced fundamental reactions 2affecting thEe structure of social and political behavior. IbIaVdan (Yoruba: Ìbàdàn or fully l b - d n, the city at the junction of the saNvannah and the forest) is the capital of Oyo State. It is located in southwestern UNigeria, in the southeastern part of Oyo State. With a population of 2,338,659, and 2 a total area of 1,190 sq mi (3,080 km ), Ibadan is the largest metropolitan 1 rd Saller Richard, 2004, Family Values in Ancient Rome pg 1-2, sourced on 23 Feb., 2007 from http://fathom.lib.uchicago.edu/1/777777121908/ 2 Labinjoh J., 1991, Modernity and Tradition in the Politics of Ibadan: 1900-1975,p 2, Ibadan, Nigeria. 3 geographical area in Nigeria. It is also the third largest city in Africa after Cairo 1 and Johannesburg . There are eleven Local Governments in Ibadan Metropolitan area which consists of five urban in the city and six semi-urban local governments in the less 2 city . The five urban local governments are; Ibadan North, Ibadan North East, Ibadan North West, Ibadan South East and Ibadan South West. The six semi urban 3 are; Akinyele, Egbeda, Ido, Lagelu, Ona Ara and Oluyole local governments. Since inception in 1829, Ibadan has witnessed population growth anYd modernization. Ibadan became a major trading centre after it became Aa BRritish protectorate in 1893. R B 1.1. Expected Outcome LI It is expected that at the end of this research, seveNral f actors that led to child mortality in ancient Rome and modern Ibadan will bAe identified. Latin epigraphy should have a much more solid database at the DDepartment of Classics, University of Ibadan. It is an area that is little looked inAto for now. At the end of this work more materials on Latin and Greek IepBigraphy should be available to other researchers who may develop intereFst in this area. O 1.2. Method ology This work adIopTts Ya methodology that combines historical evidence and comparative perspSective. Ancient Rome was the seat of power in antiquity. It was the city par eRxcellence. People moved to Rome because it was a city where opportunitEies abounded for anyone who desired success and eventual steps up the socialI Vladder. She had a long history attached to many aspects of her society; isNsues relating to politics, economics, religion, cultural practices, health and social Umobility. The population of ancient Roman Empire is pegged between 4 and 5 4 million people. Modern Ibadan with a population of 2,338,659 and eleven local governments is a metropolitan city and has always drawn attention. It was the capital of southern and Western Nigeria and her history presents an appealing tale 1 th Ibadan, http://en.wikipedia.org/wiki/Ibadan, retrieved on 6 May, 2013. 2 Tomori M. A. ―Ibadan Metropolitan Area and the Challenges to Sustainable Development‖ th retrieved from http://macosconsultancy.com/Ibadan%20metropolitan.html on 6 May, 2013 3 Ibid 4 http://makinapacalatxilbalba.blogspot.com/2009/01/population-of-ancient-rome-in-popular.html 4 of commercial rise from the period of colonization even to date. Ancient Rome and Ibadan share social cultural principles, political ideologies and permitted the organizations of different religious sects. Therefore, it becomes necessary to adopt a methodology that is both historical and comparative. Sources utilized include literary and epigraphic documentation and in the 1 case of Ibadan, interactive interviews. Latin epitaphs commemorating children less than 6, classical and contemporary literatures on ancient Rome, as well as documentation treating child mortality in modern Ibadan are consulted. ThYis historical approach may also facilitate further studies that aim at adapting anRcient solutions of child mortality to modern times. Latin epitaphs are transRlatedA into the English language and analyzed. Works of Classical and moIdBern authors on ailments that have led to death are examined. Works of reLsearchers concerning child mortality in modern Ibadan from 1980 to 2005 are also analyzed. The first chapter presents the introductionA of Nthis study. It gives an overview of the entire thesis. It states the proDblem to be solved, the expected outcome and the methodology employed in thAe study. The second chapter reviews the various literatures utilized in the couIrBse of this study. The third chapter treats the probable causes of child morFtali ty in ancient Rome. The fourth chapter examines some Latin funerary iOnscriptions commemorating children between ages 0 and 5 in ancient Rome.Y T he fifth chapter elucidates causes of child death in modern Ibadan fromI tThe period 1980 to 2005, and the sixth chapter compares ancient Rome andS modern Ibadan and concludes the thesis. ER1.3. A Brief History of Ancient Rome and Ibadan Land IVAncient Rome N Ancient Rome was a civilization that thrived and endured for about 1200 Uyears. According to legends ancient Rome was founded by Romulus and Remus descendants of the Trojan prince Aeneas. They were sons of the Vestal virgin, Rhea Silvia the daughter of Numitor, therefore, grandsons of this Latin King of Alba Longa. The king forced Rhea Silvia to become a Vestal Virgin for the Vestal Virgin were meant to be chaste until death The main reason was that she would not be given in marriage to a man and she would not procreate. The king felt she 1 Oral interviews make up a minute percentage of data compiled for this study. 5 might give birth to sons who might grow up to become his rivals. Contrary to his plan, Rhea Silvia was raped and impregnated by the god Mars and gave birth to twins who were considered demy gods. The king then hatched a plan to annihilate the children and so asked someone, perhaps Faustulus, a swineherd, to expose the boys. Faustulus left the twins on the river bank where a she-wolf nursed them, and a woodpecker fed and guarded them until Faustulus took them into his care again. The two boys were well educated by Faustulus and his wife, Acca Larentia. They grew up to be strong and attractive. Y "They say that his name was Faustulus; and that they were carried bRy him to his homestead and given to his wife Larentia to be brought up. SomRe aAre of the opinion that Larentia was called Lupa among the shepherds frBom her being a 1 common prostitute, and hence an opening was afforded for thLe mIarvelous story." The boys needed their own kingdom and settled in the arNea in which they had been raised, but the two young men couldn't decide on the Aexact site and started building separate sets of walls around different hills: RomDulus, around the Palatine; Remus, around the Aventine. There they took augurieAs to see which area the gods favored. On the basis of conflicting omens, eac hI tBwin claimed his was the site of city. An angry Remus jumped over RomuluFs' wall and Romulus killed him. Rome was therefore named after RomuluOs. "A more common account is that Remus, in derision of his brother, leape d over the newly-erected walls, and was thereupon slain by Romulus in aT fiYt of passion, who, mocking him, added words to this effect:" So perish evIery one hereafter, who shall leap over my walls." Thus Romulus obtaRinedS possession of supreme power for himself alone. The city, when 2built, was cEalled after the name of its founder." IVRome eventually became a haven for indigent, exiled and unwanted people. RNome had many of such men but lacked women. Therefore, in order to secure Uwives for her men folk, Romulus travelled far and wide in order to obtain marriage alliances with other peoples. He did not succeed. Therefore, the Latins invited the Sabines to a festival and stole their maidens. This is known as the rape of the Sabines. As a result, the Latins and the Sabines became amalgamated. 1 Livy, The Rise of Rome, Books 1–5, 1998, translated from by T.J. Luce, 1998. Oxford University Press. 2 Livy, The Rise of Rome, Books 1–5, 1998, translated from by T.J. Luce, 1998. Oxford University Press. 6 1 Vergil‘s version tells us that Aeneas was destined by the gods to found a new Troy and after many adventures, Aeneas and his son arrived at Laurentum on the West Coast of Italy. Aeneas married Lavinia, the daughter of Latinus the king. In honour of his wife, Aeneas founded the town of Lavinium. Ascanius, the son of Aeneas built a city which he named Alba Longa. Alba Longa was the hometown of Romulus and Remus, who were separated from Aeneas by about a dozen generations. These myths surrounding the founding of Rome are discussed extensively by other Classical and modern authors. Y th Historically, at about the 8 century B.C., located by the MediterrRanean Sea, she began her growth on the Italian Peninsula. This city expandedR andA became 2 one of the largest empires in the ancient world. The Roman cBivilization came under several political dispensations. It began as a monarchy.L AnId when the kings were expelled from Rome, it became a Republic in 509 B.C. and then an autocratic empire in the first century B.C. It had control overA SouNthern, Northern, Western and parts of Eastern Europe, Asia Minor and NoDrth Africa through conquests and her policy of assimilation. A This society influenced the WIBestern world, to a large extent, in government, law, politics, engineeFrin g, art, literature, architecture, technology, warfare, religion and languagOe. The res publica is an inspiration for modern 3 republics. Under the YRep ublic Rome‘s conquests stretched beyond the Mediterranean. It extIeTnded from the Atlantic to Judea and from the mouth of the 4Rhine to North Africa. As a result of the campaigns of Julius Caesar‘s Rome claimed France, thSe Netherlands and Belgium. Portugal, Spain, Greece and Egypt also cameE unRder Rome through the efforts of Julius Caesar. The Parthians in PontuIsV and Zela in the Middle East were conquered by Rome. Syria. Israel, WNestern Turkey and Northern Lybia were added to Rome through the efforts of UJulius Caesar. Due to several civil wars during the era of the Republic, the Empire 5 began to experience decline. The hundred years of strife which ended with the battle of Actium left the Roman Republic, exhausted and helpless, in the hands of 1 Vergil, The Aenid, translated by John Dryden. Retrieved from http://classics.mit.edu/Virgil/aeneid.7.vii.html 2 Chris Scarre, 1995, The Penguin Historical Atlas of Ancient Rome, London. 3 Mortimer N. S. Sellers, 1994, American republicanism: Roman ideology in the United States Constitution, Pg. 90. New York. 4 http://en.wikipedia.org/wiki/Ancient_Rome 5 Hadfield Andrew , 2005, Shakespeare and republicanism, p.68, Cambridge University Press. 7 one wise enough and strong enough to remold its crumbling fragments in such a manner that the state, which seemed ready to fall to pieces, was prolonged for another five hundred years. This wise and strong man was Octavius or Augustus Caesar. He established the political structure that was to be the basis of the Roman 1 imperial government for the next four or five centuries . Many other Emperors ruled the Roman Empire after Augustus. The Roman Empire constantly came under attack from without and suffered incessant internal instability. Consequently, the Western part of the Empire became divided into independenYt th kingdoms in the 5 century A.D. The Eastern part which was much more sRtable than the Western part endured for another millennium until it RwaAs finally conquered by the Turkish Ottoman Empire. This period, that Bis the medieval period of the Empire is known by historians as the Byzantine ELmIpire. Ibadan Land AN Ibadan was, according to legend establishDed by Lagelu the commander-in- chief of the army of Ile-Ife. He first settled Awith his people at Awotan in Apete. When certain people mocked the egungIuBn masquerade at Eba-Odan by disrobing it, Sango, the Alaafin of Oyo ordeFred that Eba-Odan be destroyed. Lagelu and those who survived the attack Otook refuge on a hill and lived on oro fruits. They later migrated to another sYettlement, Ibadan. Ibadan was established in 1829. After the fall of Oyo betwIeTen 1826 and 1827, many people took refuge in this city, Ibadan, and by 185S0 the population had increased to about 250,000. Ibadan political system was different from many others. There was no office of thEe ORba, rather four high offices were created. They were Iba or Baal’le; he waIsV the civil head of town. Then the Balogun later Basorun, he was the head of thNe military. Next was the Seriki second in command to the Balogun, it was also a Umilitary office. The last office was that of the Iyalode, a very powerful office of women leader. Under the leadership of Oluyole, Ibadan played an important role in Yoruba land. Oluyole fought and won several wars. These wars include; Ibadan versus Ijebu, Ibadan versus Owu, Ibadan versus Ife and Ibadan versus Egba. After the war with the Egbas, Ibadan controlled many Egba towns. As a result, Oluyole 1 Mary Beard, BBC History, BBC, March 29, 2011 8 became the Areago of Ibadan and later was titled the osi-ona-kankan-fo of Yoruba land. Because Ibadan was able to drive the rampaging Fulanis away from Igbomina, Oshogbo, and protect Ekiti and Akoko from threats from the Fulanis, Ibadan became the leader over the Yoruba. For by 1840, Ibadan soldiers, having defeated the Fulanis, pushed them back to Ilorin. After the Ijaye war of 1860-61, Ibadan established her military supremacy th over Yoruba land. Prominent Ibadan rulers of the 19 century include; Basorun Oluyole, Basorun Ibikunle, Basorun Ogunmola, Basorun Latosisa and IyalodYe Efunsetan Aniwura. Ibadan continued to wage war with other Yoruba peopRle. In 1877, Ibadan warred with Egba/Ijebu because they attacked IbRadanA traders returning from Port Novo. In 1878, the Ijesa/Ekiti attacked Bdespotic Ibadan indigenes in their territories. This called for war which la stLed Ifor sixteen years. These and many wars raged on. The Yoruba fought one another frequently and 1 ferociously to such an extent that British colonialisAts wNere confounded. These wars raged on until 1886, when peace began tDo return to Ibadan. It happened through the efforts of the Church, spearheadeAd by Samuel Johnson, Charles Phillip and Maloney, Lagos State governor. IB By 1900, the history of FYo ruba land changed. Ibadan retained her dominance over Yoruba land aOnd became the political and administrative head of 2 Yoruba land. ITY RS IV E UN 1 Ayandele., E.A., 1979, The Yoruba Civil Wars and The Dahomian Confrontation, in Ayandele E.A, Nigerian Historical Studies p 52-64, London. 2 Apart from authors cited with regard to Ibadan, information was retrieved from http://yorupedia.com/subjects/yoruba-from-19th-to-date/after-the-fall/ 9 CHAPTER TWO LITERATURE REVIEW 2.0. Introduction In the course of this study various sources are used. They include the Corpus Inscriptionum Latinarum (CIL), ancient authorities such as ThucydideYs, Cato, Varro, Vitruvius, Livy, and Horace. Celsus, Seneca, Pliny the Elder, PeRrsius, Josephus the Jewish Historian, Juvenal, Tacitus, and Aulus Gellius pRroveAd useful. Others are Galen, Tertullian, Columella, Marcus Aurelius AntonBinus, Augustine, Lactantius, and Paul of Aegina. Commentaries and articles oLn Iancient Rome and contemporary Ibadan by modern scholars are also consulted. AN 2.1. The CIL D The first volume of the Corpus InscAriptionum Latinarum (CIL) was first published in 1853 under the leadership IoBf Theodor Mommsen. Several volumes followed. The CIL is being updatFed by the Berlin-Brandenburgische Akademie der Wissenschaften. Presently,O there are altogether seventeen (17) volumes of the CIL in about seventy parts recording about one hundred and eighty thousand 1 (180,000) inscriptionsI TcolYlected from various parts of ancient Roman Empire. The CIL iSs a very useful source for aspects of the history, social and economic life of the people. These inscriptions include those commemorating children inE the Roman Empire. However these epitaphs put up for children, do not indicaIteV the causes of child mortality. UN 2.2. Classical Authors 2 3 4 The works of classical authors such as Thucydides, Cato, Varro, 1 2 3 4 5 6 7 Vitruvius, Livy, Horace, Celsus, Seneca, Pliny the Elder, Persius, Josephus 1 Corpus Inscriptionum Latinarum 2. Durchgesehene und alktualisierte Auflage Deutsch – English, 2007, The Corpus Today: A Review, pg 25, Berlin-Brandenburgische Akademie Der Wissenschaften. 2 c 460-c 400B.C 3 234 BC – 149 BC 4 116 B.C. – 27 B.C. 1 0 8 9 10 11 the Jewish Historian, Juvenal, Tacitus, and Aulus Gellius are of varying value. 12 13 14 15 Others include Galen, Tertullian, Columella, Marcus Aurelius Antoninus, 16 17 18 Tertullian, Augustine, Lactantius, and Paul of Aegina a Byzantine physician th in the 7 Century A.D. They demonstrate various aspects of the society that relate to child mortality in ancient Rome. 19 The Twelve Tables of the Law (449 B.C.) were written so that plebeians could easily memorize them. However, they are not a comprehensive statement of all law; they are various forms of definitions of various private rights anYd procedures. The original text has been lost. They were destroyed when RomRe was 20 burnt down by the Gauls under Brennus in 390 B.C. Only excerpts sRurvAive today and it is very useful in providing links to causes of child mortaBlity in antiquity. Later authors such as Cicero quoted from the Twelve TablLes Iof the Law while substantiating infanticide which was a cause of child death in ancient Rome. 21 This study relies heavily on the Hippocratic WAritiNngs (430B.C.-330 B.C.). The Hippocratic Writings explains the roles plaDyed by the elements, superstition th th and religion with regard to child death in thAe 5 and 4 century B.C. in ancient Rome. Consequently, it is an author itIatBive source for causes of child death in antiquity. F 1 ca 70 – ca 50 B.C 2 59 B.C O3 55 B.C. 4 25 B.C. Y 5 ca4 B.C.-A.D. 66 T 6 A.D 23–A.D. 79 I 7 A.D. 34 8 S A.D. 37 – A.D. R100. The Works of Flavius Josephus, Against Apion. Cambridge: Harvard University Press. 9 A.D. 55 10 E 124 A.D. 11 AulusV Gellius was born between A.D. 125 and 128 12 NHe wIas born in about A.D. 129 and died in about A.D. 216. He probably documented his literary Uworks between 168 and 169 A.D. 13 160 A.D. 14 st 1 century A.D 15 Marcus Aurelius was a co-Emperor of Rome and also a writer. He lived and reigned as emperor in about 161 - 180 A.D. 16 Tertullian lived in the ancient city of Carthage in about 200 A.D 17 354-430 A.D. 18 rd th 3 to 4 century A.D. 19 Duodecim Tabularum Leges, in Fontes iuris Romani antiqui I, ed. Georg Bruns et Otto Gradenwitz Tübingen, 1909. Sourced Dec. 2008, from http://www.hs- augsburg.de/~harsch/Chronologia/Lsante05/LegesXII/leg_ta00.html 20 http://en.wikipedia.org/wiki/Twelve_Tables sourced 20th March, 2009. 21 The Hippocratic Writings, translated by Chadwick J. And Mann W.N., ed with introduction by Lloyd G.E.R., 1978, Penguin Books, London. 1 1 1 Marcus Porcus Cato (234 BC – 149 BC) known as Cato the Elder presents in his work a miscellaneous collection of rules of husbandry and management as well as sidelights of country life. He advises that leaded cauldrons are better preferred to earthen cauldrons while preparing mustum. His advice was heeded, lead poisoning became gradually effective and child death was not far to seek. Vitruvius also discusses the importance of consuming potable water conveyed through earthen pipes rather than leaded pipes. These authors provide hints with regard to lead poisoning as a factor responsible for child mortality in antiquity. Y 2 The Roman Poet Quintus Horatius Flaccus otherwise known as HRorace (December 8, 65 BC - November 27, 8 BC), gives very insufficient inRformAation on child death in antiquity. His Epodes which belong to the iambic Bgenre of ‗blame poetry‘, was written to shame fellow citizens and goad themL intIo a sense of their social obligations. He satirizes corruption, societal ills, bad governance and ignorance of people in the society. Horace mentionsA an Nattack of the quartan fever on a child whose mother is ignorant of its effectD. From his writings, malaria as a cause of child death can be deduced. A 3 Livy writes the history of RomeI iBn the first four books from its foundation to the Gallic invasion in 390. PortiFons of his work with regard to the plague that depopulated the city allude toO a cause of child death. The works of Marcus Vitruvius Pollio (ca 70 – ca 50 B.C) a Roman writer, an architect and an engineer 4 is used in this study. TAltYhough his work is on architecture, causes of child death can be gathered from Iit. 5 The worksS of the medical practitioner Celsus, is a primary source on diet, pharmacy,E surRgery, causes of child death and related fields and it is one of the best 6 7 sourcIesV concerning medical knowledge in the Roman world. Galen and Soranus U N 1 Marcus Porcius Cato: On Agriculture and Marcus Terentius Varro: On Agriculture, 1935, translated by William Davis Hooper, revised by Harrison Boyd Ash. Oxford. 2 Horace: Satires and Epistles, Perseus: Satires, Horace, Book II, Satire. 3, 281-295, 1973, a verse translation and notes by Niall Rudd, Penguin Books, London. 3 Livy, The Early History of Rome, Books I-V, translated by Audrey De Selicourt, 1973, Penguin Books, England. 4 MarcusVitruvius Pollio De Architectura (VIII.6.10-11) sourced in December 2007 from http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Vituvius/9‘.html A. Cornelius Celsus, De Medicina, Book III.3:3-6, translated by Spencer W.G., Loeb Classical Library. 6 Galen, The Therapeutic Method: Books 1 & 2 (De methodo medendi), 1991, edited and translated by R.J. Hankinson. Clarendon Press, Oxford. 7 Soranus, Gynaecology, 2:18-20, translated by Temkin O.G., 1948, Oxford. 1 2 are sources for documenting causes of child mortality in antiquity which are not found in the CIL. They mention various diseases and social conditions such as malaria, tuberculosis and wet nursing that led to child death in antiquity. They provide insights into causes of child mortality during the periods 25 B.C. to 161 A.D. 1 Aspects of the work of Philo Judaeus (20 A.D.) a Jewish writer treats 2 infanticide and its ills. Marcus Terentius Varro mentions the effects of mosquitoes and how to deal with them in order to be malaria free even in antiquitYy. This aspect of his work throw light on malaria, even as a cause of child dReath. 3 Gaius Plinius Secundus popularly known as Pliny the Elder (A.D 23R- AAugust 25, AD 79), provide useful information on causes of child mortalityB. He mentions a cure for the deadly quartan fever that affects old and young, mLaleI and female. The 4 5 Satires of Aules Persius Flaccus (Persius) and D. IuniNus J uvenalis also provide inadequate information. However, they can be reliAed upon as they demonstrate cultural practice of the people with regard to carDe and love shown towards a child fit to live. A Tacitus‘ Histories, a portion of tIheB De Ira written by Seneca, the moralist, and a portion of the Apology by TeFrtullian a Christian writer (c A.D 160) mention infanticide, a cultural practice Oof abandoning unwanted babies which of course, caused the death of such children. Aspects of the Meditations of the Roman Emperor, Marcus AuIreTliuYs Antoninus (161 - 180 A.D), who himself died in the Antonine plague isS another important source, though fragmentary. 6 stLuciusR Junius Moderatus Columella, of the 1 century A.D., does not specificallyE write on child death, but like Pliny the Elder, Columella provides hints that doV not go further than Pliny. However, Josephus the Jewish Historian also a wNriterI in the first century A.D, document causes of child death in antiquity. U 1 Philo. The Special Laws. 1968. Translated by F. H. Colson. London: William Heinemann Ltd. 2 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. 3 Retrieved in Jan 2008 from http://en.wikipedia.org/wiki/Pliny_the_Elder 4 Horace: Satires and Epistles, Perseus: Satires, Satire. 2: 31-38, pg 214, 1973, a verse translation and notes by Niall Rudd, Penguin Books, London. 5 Juvenal, the Sixteen Satires, VI: 602-604, pg 52, 1998, Translation with an Introduction and Notes Notes by Peter Green. Penguin Classics, England. 6 Columella: On Agriculture XII.19.1, 19.6, 20.1, 21.1, 1954, translated by E. S. Forster and Edward H. Heffner, Loeb Classical Library. 1 3 The above classical authors provide evidence and hints on child mortality in ancient Rome. In these works causes of child mortality, more often than not, are mentioned in passing. From others, factors responsible for child death can be inferred. However writers in the early Christian era speak and write about some cultural practices of the people which do not portray Christian values. Their literary works in the forms of letters and epistles are of immense value as they provide facts about these cultural practices and superstitions that caused child death in the first and second centuries A.D. Classical authors not mentioneYd supplement the works above and they are acknowledged below in footnotes asR well as the bibliography. None of them set out to write specifically about cRhildA death in ancient Rome. B LI 2.3. Modern Commentaries on Ancient Rome 1 2 3 4 Otto Seeck (1910), Gillian (1961), Littman aAnd NLittman (1973), McNeill 5 6 (1976), Smith, C.A. (1996), and Hass CharleDs, while depending on ancient sources, especially, The Meditations of MaArcus Aurelius, treat the plagues that exterminated people; old and young in IanBtiquity even during the reign of Marcus Aurelius as Emperor of Rome. 7 F 8 9 10 Macdonnel (1913), WiOlliamson (1978), Boswell (1984), Harris (1994), 11 12 13 Milner (1998), CadwellY (2 004), Dianne R. Moran, argue and propose views T 1 Otto Seeck, 1910, GSeschIichte des Untergangs der antiken Welt, 3rd ed., I: 398-405. Stuttgart. 2 J. F. Gilliam, 19R61, The Plague under Marcus Aurelius, American Journal of Philology 82, 228-29 3 Littman, R.J. and Littman M.L., 1973, Galen and the Antonine Plague, The American Journal of Philology, VoEl. 94, No. 3, pp. 243-255, The Johns Hopkins University Press. 4 McNeiVll, William H. 1976, Plagues and Peoples, Bantam Doubleday Dell Publishing Group, Inc., New York. 5 Smith, Christine A., 2006, Plague in the Ancient World: A Study from Thucydides to Justinian. htNtp://wIww.loyno.edu/~history/journal/1996-7/Smith.html Retrieved 6th October, 2007 6U Hass Charles, The Antonine Plague, http://lib.bioinfo.pl/pmid:17195627 7 Macdonell W.R, 1913, On the Expectation of Life in Ancient Rome, and in the provinces of Hispania and Lusitania and Africa, Biometrika, Vol. 9, No. ¾, pp 366-380, Boimetrika Trust. 8 Williamson, Laila, 1978, Infanticide: An Anthropological Analysis. Infanticide and the Value of Life, pg 61-75, ed., Marvin Kohl. Prometheus Books, New York. 9 Boswell John Eastburn, 1984, Expositio and Oblatio: The Abandonment of Children and the Ancient and Medieval Family, American Historical Review 89, 12 10 Harris, W.V, 1994, Child-Exposure in the Roman Empire, The Journal of Roman Studies, Cambridge University Press. 11 Milner, Larry S. 1998, Hardness of Heart Hardness of Life: The Stain of Human Infanticide, Kearney, NE: Morris Publishing. 12 Cadwell, John C, 2004, Fertility Control in the Classical world: Was there an Ancient Fertility transition? Journal of Population Research. 13 Dianne R, Moran, Infanticide, http://www.deathreference.com/Ho-Ka/Infanticide.html 1 4 on deliberate population reduction, longevity and cultural practices. Their views and assumptions on infanticide in the Graeco-Roman world provide useful links that aid in establishing causes of child mortality in ancient Rome. 1 2 3 4 Montgomery (1971), Nriagu (1983), Eisinger Josef (1982), Jack Lewis 5 (1985), and Eisinger Josef et al (1987), discussing the preponderance and usefulness of lead, as vessels (especially among aristocrats) assume that may have contributed to the death of children under 5 years of age. These authors believe that lead so poisoned the aristocrats themselves that they became incapable oYf discharging their duties. Therefore, the fall of the ancient empire of RomeR was 6 inevitable. Scarborough (1984) is one contemporary author who RcorAroborates Litman and Litman, but disagrees with them that lead led to thBe fall of ancient Rome. These sources are useful; they supplement classical LautIhors‘ information on the hints they provide as to reasons for child death in anci ent Rome. 7 8 9 The Wikipedia, Vazifdar (2007), HealthScAoutN and others are internet sources that provide information on lead and leDad poisoning. They establish the importance of the metal and its devastatingA effects. They also ascertained the source of lead and means of contamina tiIoBn. Although some of these sources have little or nothing to do with child dFeath in antiquity, they nonetheless supplement classical and contemporary au thOors‘ works in understanding, to a great extent, the impact that lead may have Yhad on citizens, especially children under 6 years of age, in ancient Rome. 1T0 Donald EnSgelsI (1980) mentions that female infanticide could hardly have been practiceRd in antiquity and provides calculations to support his theory. V E 1 MontIgomery Dan, 1997, Lead, Floride, the Roman Empire and the Decline of Academic Achievement in the United States. Sourced from http//sonic.net/kryptox/environ/lead/romans.htm 2 NNriagu Jerome O., 1983, Saturnine Gout Among Roman Aristocrats: Did Lead Poisoning UContribute to the Fall of the Empire? New England Journal of Medicine, 308, 660-663. 3 Eisinger Josef, 1982, Lead and Wine: Eberhard Gockel and the Colica Pictonum, Medical History, 26, 279-302. 4 Lewis Jack, 1985, Lead Poisoning: A Historical Perspective (EPA Journal), Ohio, USA. 5 Eisinger J., Patterson C.C., Shirahata H., Ericson J.E., 1987, Lead in Ancient Human Bones and Its Relevance to Historical Developments of Social Problems with Lead. 6 Scarborough John, 1984, The Myth of Lead Poisoning Among the Romans: An Essay Review. Journal of the History of Medicine, 39, 469-475. 7 Lead Poisoning, sourced in June 2006 from http://en.wikipedia.org/wiki/Lead_poisoning 8 Vazifdar Lena, 2007, Retrieved 28th April, 2008 from http://www.divinecaroline.com/article/22182/26720-toxic-truth-lead-poisoning/2 9 http://www.healthscout.com/ency/407/287/main.html, retrieved April 2008 10 Engels Donald, 1980, The Problem of Female Infanticide in the Greaco-Roman World, Classical Philology 75: 112-120. Cambridge University Press. 1 5 1 2 However, to disagree were Golden (1981) and Harris William (1982), as they theoretically and historically explain that female infanticide was practiced. The aforementioned works prove quite useful for this study. These authors, no doubt, establish another cause of infant mortality in ancient Rome. With them, French 3 Valerie suggests that in the event of poor midwifery the chances of survival of both mother and child are very slim. French suggests that child mortality rate is higher among the poor than among the rich. 4 Concerning Latin Inscriptions, Lawrence Keppie‘s (1991) maYin contribution is in understanding Latin inscriptions and being able to decipher Rsigns and symbols that are common to inscriptions. The theme of his boRok Ais not on child death, rather he treats abbreviations, praenomen among oBthers, which are common place in inscriptions and which help in breaking dLowIn and explaining inscriptions commemorating children and adults in ancient R ome. 5 Rogan John (2006) makes Reading Roman AInscNriptions not only easy but interesting as well. He explains Latin epigraDphy and makes clearer Roman inscriptions by categorizing them. And so insAcriptions recognized include Imperial inscriptions, inscriptions denoting senaItoBrial and equestrian ranks, inscriptions found on tombstones dedicated toF on e deity or the other and inscriptions that inform about the army, loca l Ogovernment, commerce and trade and provincial administration. The cenYtral theme is learning to understand these various inscriptions especially Twhere the names have been abbreviated and where signs and symbols are notedI. And so from Reading Roman Inscriptions, one can learn to decipher inscrRiptioSns commemorating children as a means to an end in the question of child deEath in antiquity. Also, Brain K Harvey‘s Roman Lives: Ancient Roman Lives IaVs Illustrated by Latin Inscriptions, explicates the importance of Latin 6inNscriptions in understanding social and economic situations of the populace. King U(2000) does not make references to causes of child death in antiquity. However, 1 Golden, Mark, 1981, Demography and the Exposure of Girls at Athens, Phoenix 35: pp 316-331. 2 Harris V. William 1982, The Theoretical Possibility of Extensive Infanticide in the Greaco- Roman World, The Classical Quarterly 32. No. 1. 114-116. Cambridge University Press. 3 French Valerie, 1986, Midwives and Maternity Care in the Roman World, Rescuing Creusa: New Methodological Approaches to Women in Antiquity, Helios, New Series, 13(2), pp. 69-84). 4 Keppie Lawrence, 1991, Understanding Roman Inscriptions, The John Hopkins University Press, Baltimore. 5 Rogan John, 2006, Reading Roman Inscriptions, Tempus Publishing Limited, Great Britain. 6 Margaret King, 2000, Commemorating Infants on Roman Funerary Inscriptions, The Epigraphy of Death, ed., G.J. Oliver, Liverpool University Press. 1 6 she considers the use of epitaphs as evidence for Roman reactions to the death of an infant child. 1 Lefkowitz (1992) generally informs about different aspects of the family especially those relating to women. In this book the original sources are assembled. Quotations from the original sources include topics relating to male child preference, wet-nursing and its intricacies, and childbirth among others. Sources quoted include the Oxyrhrnchus papyrus, Soranus, Galen, Celsus, and Seneca. This book is useful as a source on classical authors who documenYt, however fragmentary, causes of child death in antiquity. R 2 Taking a closer look at the demography of Ancient RoRme,A Parkin (assuming that life expectancy was between 20 and 30 years) reliesB on comparative evidence in order to choose an illustrative model for Roman LmoIrtality. An aspect 3 of his work alludes to child mortality. Scheidel‘s (199N6) demonstrates the most methodologically sophisticated analyses of ancient pAopulation. In the last chapter he uses early Christian epitaphs to establish seasoDnal mortality in different parts of 4 the empire such as Rome, Egypt and CarthAage. King (2000) and Christopher 5 Price (2004) rely on the CIL and clasIsiBcal authors such as Tacitus, the Twelve Tables of the Law, Cicero and SeneFca, to substantiate their arguments on reactions to infant death, infanticide an dO its ills. They both provide information on child mortality in ancient Rome. 6 Gigante LindaI TassYumes that, between 100 and 200 A.D., about 95% of the people with their Schildren lived in poverty. Describing the economic and social conditions of Rthese citizens she mentions some social factors as causes of child death. IV E U N 1 ndLefkowitz Mary R., 1992, Women’s Life in Greece and Rome, A source book in translation, 2 Edition, The John Hopkins University Press, Baltimore. 2 Parkin Tim G., 1992, Demography and Roman Society. Baltimore and London: The Johns Hopkins University Press. 3 Scheidel Walter, 1996, Measuring Sex, Age and Death in the Roman Empire: Explorations in Ancient Demography. Journal of Roman Archaeology, Supplementary Series 21. Ann Arbor. Pp. 184 4 Margaret King, 2000, Commemorating Infants on Roman Funerary Inscriptions, The Epigraphy of Death, ed., G.J. Oliver, Liverpool University Press. 5 Christopher Price, 2004, http://www.christiancadre.org/member_contrib/cp_infanticide.html 6 Gigante Linda, Diseases and Death in ancient Rome, sourced in Jan. 2006 from http://www.innominatesociety.com/Articles/Death%20and%20Disease%20in%20Ancient%20Rom e.htm 1 7 2.4. Sources on Ibadan 1 2 3 Schultz (1980), Feachem (1981), Puffer, R.R. and C.V. Serrano (1973), 4 5 World Health Organization (1978) and Shi Anqing (1999) are useful for evaluating and documenting causes of child mortality in modern Ibadan. These sources, with the exception of Shi, do not mention causes of infant mortality in Ibadan, but their opinions and findings are similar to situations that lead to child death in Ibadan. 6 Adamson (1986), a Newspaper Columnist, substantiates his essay witYh 7 Caldwell (1979). They both note that education plays an important role tAowaRrds a decline in infant mortality in Ibadan. 8 R 9 The works of Harpham et al (1988), Timaeus, Ian M. and BLouisiana Lush 10 (1995) and Stephens, Carolyn (1996), mention briefly similaLr rIeasons such as the role the community; urban and rural need to play witNh re gard to the health of people; importance of social amenities in commuAnities and how these, if not persistently sought after and installed, cause childD mortality in Ibadan 11 12 1 Falade and Lawoyin (1999), AyooAla et al (2001), Lagunjun, et al 2 3 (2006), Oyedeji G.A. (2006), and Osin uIsiB, K. (2007), variously focused on one or F 1 Schultz, 1980, Interpretation of Re laOtions among Mortality, Economics of the Household, and the Health Environment. Proceedings of the Meeting on Socioeconomic Determinants and Consequences of Mortality, Mexico City, June, 19-25, 1979, Geneva: World Health Organization. 2 Feachem, 1981, The WatTer aYnd Sanitation Decade, Journal of Tropical Medicine and Hygiene. Vol 84 (2). 3 Puffer, R.R. and C.VS. SeIrrano. 1973. Patterns of Morality in Childhood. Pan American Health Organization, Washington, D.C. 4 World Health ORrganization, 1978, Main Findings of the Comparative Study of Social and Biological EEffects on Perinatal Mortality, World Health Statistics 31(3). 5 Shi, AVnqing, 2000, How Access to Urban Portable Water and Sewerage Connections Affects Child MIortality, World Bank Policy Research Working Paper No. 2274. (This research by Shi was carried out on 237 cities in 100 countries, Ibadan and Onitsha are included in the 237 cities.) 6 ANdamson Peter, 1986, Why Reading Keeps Children Alive, New Internationalist, issue 164, UOctober 1986. Retrieved in September 2008 from http://www.newint.org/issue164/reading.htm 7 Caldwell J.C., 1979, Education as a Factor in Mortality Decline An Examination of Nigerian Data, Population Studies, Vol. 33, No. 3, pp. 395-413, Population Investigation Committee. 8 , Harpham, Trudy, Tim Lusty, and Patrick Vaughan 1988, In the Shadow of the City: Community Health and the Urban Poor. Oxford University Press. 9 Timaeus, Ian M. and Louisiana Lush. 1995, Intra-urban Differentials in Child Health. Health Transition Review 5. No.2:163-190. 10 Stephens, Carolyn, 1996. Healthy Cities or Unhealthy Islands? The Health and Social Implications of Urban Inequality. Journal of Environment and Urbanization 8. No.(2):9-30. 11 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. 12 Ayoola O.O., Orimadegun E.A, Akinsola A K, Osinusi K, 2001, A five-year review of childhood mortality at the University College Hospital, Ibadan. West African Journal of Medicine; 24 (2):175-179. 1 8 two factors such as cholera epidemic and measles as causes of under five mortality 4 5 in Ibadan Also, Rossington C.E., Bamgboye, E.A., and Familusi, J.A., (1990), 6 7 8 Akinyole et al (2004), Akinyele (2005), Orimadegun et al (2006) and 9 Orimadegun, et al (2008),, are dependable sources. They all carried out intensive research in documenting that the environment, measles and malnutrition are some of the factors responsible for infant mortality in Ibadan in different periods. 10 11 McLaren D.S. et al (2001), Maziya-Dixon B. et al (2004) and Ogunyemi 12 Dele of the Daily Champion (2008) focus on Vitamin A Deficiency and proteYin energy malnutrition as factors that hamper the health and well being of underR fives 13 and lead to their death, in Ibadan. In the same vein, Sommer etR al A (1986), 14 15 16 1 WHO (1992), WHO (2001), Ajaiyeoba (2001) and AkinIyiBnka O.O, et al L 1 Lagunju I.A,, Orimadegun A E, Oyedemi D G, 2006, Measles in Ibadan: a continuous scourge. Afr J Med Sci., 34 (4):383-7. N 2 st Oyedeji G.A, 2006, Easing The Burden Of Diseases, Theme: Medical Training In The 21 Century And Its Relevance To Developing Countries, Faculty OAf Clinical Sciences Week Lecture University of Ibadan. 3 D Osinusi Kikelomo, 2007, Environment and Child Health, Archives of Ibadan Medicine Vol 8, 2 4 Rossington Christine E., Environmental aspectsI oBf chi Ald growth and nutrition: A case study from Ibadan, Nigeria, http://www.springerlink.com/content/j411340633671u40/ 5 Bamgboye EA, Familusi J.B, 1990, Mortality pattern at a children's emergency ward, University College Hospital, Ibadan, Nigeria. AfricanF Jou rnal Of Medicine And Medical Sciences, 19(2):127-32. 6 Akinyole, I.O., Amire, F.T. Ajayi, OO.A., Sanusi, R.A., 2004, Profiles: A nutritional advocacy tool for Nigeria. Technical Committee of ANG Working Group IITA/USAID. 7 Akinyele, O., 2005. Poverty, Malnutrition and the Public Health Dilemma of Disease. University of Ibadan Postgraduate SchTool YInterdisciplinary Research Discourse. Ibadan. 8 Orimadegun A.E, 2006, Increasing Burden of Childhood Severe Malaria in a Nigerian Tertiary Hospital: ImplicationS for IControl, African Journal of Medicine and Medical Sciences. 35(2) 132-145. 9 Orimadegun A.RE, Akinbami, F.O; Tongo, O.O;.Okereke, J. O, 2008, Comparison of Neonates Born OutsideE and Inside Hospitals in a Children Emergency Unit, South West of Nigeria, Pediatric EmergenVcy Care. 24(6):354-358.June 2008. 10 McLIaren DS, Frigg M., 2001, Sights and life Manual on Vitamin A Disorders (VADD), 2nd edition, Task Force Sight and Life, Basel, Switzerland. 11N Maziya-Dixon B, Akinyele IO, Sanusi RA, Oguntana EB, Harris E., 2004, Vitamin A Status of UChildren under 5 in Nigeria: Results of the Nigeria Food Consumption and Nutrition Survey. Presented at the XXII International Vitamin A Consultative Group (IVACG) Meeting, Vitamin A and the Common Agenda for Micronutrients,15–17 November 2004, Lima, Peru. 12 Ogunyemi Dele, Daily Champion, August 2008, Nigeria: Malnutrition, Major Cause of Child Mortality, retrieved in Sept 2008 from http://allafrica.com/stories/200808260290.html 13 Sommer A, Tarwotio I, Djunaedi E, 1986, Impact of Vitamin A Supplementation on Childhood Mortality- A Randomized Controlled Community Trial. The Lancet Vol 1:1169-1173. 14 Food Agriculture Organization. World Health Organization. 1992, World declaration and plan of action for nutrition. International Conference on Nutrition. Rome, Italy, Food Agriculture Organization 15 World Health Organization, 2000, Nutrition for Health and Development: a Global Agenda for Combating Malnutrition, Geneva, Switzerland, WHO. 16 Ajaiyeoba A.I., 2001, Vitamin A Deficiency in Nigerian Children, African Journal of Biomedical Research, Vol 4, N0 3, 107 -110, Ibadan Biomedical Communication Group. 1 9 (2001) in corroborating the afore-mentioned authors discuss the risk factors in lack of vitamin A in children under five. They are important literary works on the health and wellbeing of children under six years of age. Child health in the Tropics, edited by D.B. Jelliffe makes interesting 2 reading on child death in Ibadan. Erinosho O.A tackles the sociological and psychological aspects of health, theories of diseases and research methods in the field of health. Y 2.5. Conclusion R Many of the authors that have been mentioned in this stuRdy Aexplicate various issues and causes of infant mortality and child health generBally, but none of them addresses the question of child mortality in ancient RomLe aInd modern Ibadan in its totality, but their various views, their painstaking research on different aspects of health in both antiquity and Ibadan all coAntriNbute in varying degrees to an attempt to present a consistent picture and Dshed light on child mortality in th th ancient Rome (4 century B.C. – 6 centuryA A.D/) and modern Ibadan (1980 – 2005). F I B O SI TY ER NI V U 1 Akinyinka O.O, Usen S.O, Akanni A., Falade A.G., Osinusi K., Ajaiyeoba I.A., Akang E.E., 2001,Vitamin A Status of Pre-School Children in Ibadan (South West, Nigeria), Risk Factors and Comparison of Methods of Diagnosis, West African Journal of Medicine, Jul – Sep; 20 (3): 243-8 2 Olayiwola. A. Erinosho, 1998, Health Sociology, Sam Bookman Educational and Communication Services, Ijebu-Ode, Nigeria. 2 0 CHAPTER THREE CAUSES OF CHILD MORTALITY 3.0 Ancient Rome Introduction Y Causes of child death in ancient Rome range from diseases to superstRitious and religious beliefs, chemical poisons, infanticide and social deprivatiAon. The 1 diseases include; malaria fever, ophthalmia, plague, dysentery, BasthRma, wasting diseases, racking pains, feebleness of the limbs, privation oLf bIodily senses and vexing assaults of unclean spirits. Others include; jaundic e, bladder complaints, 2 piles, ulcer, leprosy, dropsy, paralysis, epilepsy and sAcurvNy. 3 Classical authors mention different kindsD of diseases. Apuleius refers to 4 cataracts; Tertullian refers to utter blindnAess and other diseases of the eye. 5 Augustine also refers to eye diseases. IB Apart from the fact that a gFood number of ailments resulted in death as a result of lack of medical facilitiOes, there was a widespread belief among the people that demons brought diseaYses upon humans. As a result, patients were not given 6scientific cure and so Ia Tlarge number of deaths could not be prevented. 1 This embraces aRll diSseases suffered by a large number of persons. However, Livy (The Early History of Rome, 1960, translated by Aubrey De Selincourt, Penguin Books), Marcus Aurelius, 1991,(“MediEtations” IX.2. Translated by George Long, http://claVssics.mit.edu//Antoninus/meditations.mb.txt), Lucian Samosata, (Volume II, Alexander – The OrIacle Monger, 36, pg 228. Translations by H. W. Fowler and F. G. Fowler, 1905, Oxford: The Clarendon Press.), Cyprian of Carthage, (On the Mortality (or Plague), 14:1-7. Translated by thNe Rev. Ernest Wallis. http://www.ewtn.com/library/PATRISTC/ANF5-15.TXT). and Dio Cassius, U(Cassius Dio, Roman History, Book 71:2.4, 1914 through 1927, translation by Earnest Cary. Loeb Classical Library, Harvard University Press), while discussing the effect of this disease simply mention it as plague. From the description of the effect of the disease, especially in Livy, it is possible that the people were affected by small pox. 2 These diseases are indicated in the works of various classical authors, particularly the Hippocratic Writings. 3 Apuleius, Florida 17, 2001, Translated by Harrison S.J., Hilton J.L., Vincent Hunink, Oxford University Press. 4 Tertullian, Res., Mort.. 4. Sourced from http://www.tertullian.org/latin/latin.htm on 28th April 2008. 5 St. Augustine of Hippo, Civ Dei, xxii, 8, Contra Iulianum 3, 162,translated by Portalié, Eugène, 1907, The Catholic Encyclopedia. Vol. 2. New York: Robert Appleton Company. 6 The sacred disease indicated in the Hippocratic Writings, is believed by the people to have been brought upon them by supernatural beings. 2 1 In spite of all these, there were cases of cure for some of these diseases. In 1 the 5th century B.C, Herodotus tells of some North African tribes whose medication of goat‘s urine sprinkled on their children resulted in cure for epilepsy. Similar medication is known in Nigeria. Among the Yorubas, it is cow urine. Among the Awka Ibo and the Idoma, goat urine mixed with palm oil is taken 2 orally. In Pliny the Elder, a mixture of honeysuckle (lonicera) and wine alleviates 3 the tertian or quartan fever. Oric Bates mentions malaria fevers. The itinerant Arabs in Roman AfricYa who could be under the attack of this killer disease, found a preventive meaRsure; which was to suspend their nomadic life-style until the seasons wheRn thAe disease was less prevalent. B LI . . .owing to the prevalence of malaria fe vers at certain times of the year, many of theA noNmad Arabs will not enter Siwah in autumnD for fear of that 4 sickness. A 5 IB 6 Oric Bates also observed thFat o pthalmia and syphilis which were common were diseases that were widespOread. He also noted that plague and cholera almost depopulated towns, but thYeir mode of life which was nomadic, saved them from plague and cholera epidemics. S7 T Hope (2007) Iasserts that poor sanitation, disease, famine, malnutrition and warfare are soRme factors that caused death in ancient Rome. ThiEs chapter will examine malaria, consumption, paralysis, diseases commIoVn to the weather, infanticide, lead poisoning, plague, superstitious/religious beNliefs and social deprivation as causes of child mortality in ancient Rome. U 1 Herodotus iv. 187, 1975, The Histories, translated by Aubrey De Selincourt, Penguin Books. 2 Ojoade, J.O., 1973, Health in Roman Africa pg 69, Museum Africum, West African Classical Association in conjunction with the Department of Classics, University of Ibadan. 3 Elder Pliny, Natural History, xxii 49, 1945, translated by H. Rackham Loeb Classical Library. 4 Bates Oric, 1970, The Eastern Libyans pg25, Frank Cass and Company Limited, London. 5 Bates Oric, 1970, The Eastern Libyans pg25, Frank Cass and Company Limited, London. 6 Homosexuality was practised in ancient Roman Empire; sexual affairs with young boys, especially by men of repute, was common. Although the ages of these young boys range from 8 to 16, it is highly probable that this activity was done on children about five years of age. Therefore, there is the possibility that children who were victims of such practise may have contacted syphilis a sexually transmitted disease and this disease may have caused their death. 7 Hope Valerie, 2007, Death in Ancient Rome pg 3, The Open University, UK. 2 2 3.1 Malaria Plasmodium falciparum, the most virulent of the four species of human malaria is the disease that the Romans suffered from the most due to the presence of extensive marshy areas in the valleys of the River Tiber and along the coast. These marshy areas in the river valleys resulted from the jamming of streams by soil that were washed down from the hills and thus became a breeding ground foYr 1mosquitoes. Of the diverse and copious diseases that plagued ancient RomansA, mRalaria was the most dangerous. It exterminated both old and young incluRding fetuses. Malaria (which was loosely termed fever(s) at that time also) hadB appeared in the writings of Hippocrates, who is also known as "The FatheLr oIf Medicine" and probably the first malariologist by 400BC. These fevers which are the tertian, quartan, quotidian, nocturnal and irregular fevers aAre mNentioned and they point 2 unmistakably to malaria. The Hippocratic WritinDgs distinguishes the intermittent malaria fever from the continuous fever of othAer infectious diseases, and also notes the daily, every-other-day, and every-tIhiBrd-day (quotidian, tertian and quartan) rise in temperature. The HippocraFtic Writings mentions the splenic change in malaria. Hippocrates also relateOs the fever to a particular time of the year, to the 3 weather and to the locatioYn o f patients. There was also causus (ardent fever). They are all malaria IiTn nature and are caused by plasmodium falciparum. The Dictionary of CelSl and Molecular Biology – Online affirms that ―P. vivax causes the tertian typRe, P. malariae the quartan type and P. falciparum the quotidian or 4irregular tyEpe of disease, the names referring to the frequency of fevers.‖ IVIrrespective of the type of plasmodium that caused fevers, none of the feNvers were less harmful than others. In their intense form they all led to death. In Uthe words of the doctor of the Hippocratic Writings, ―All the diseases described caused death . . .‖ (Epidemics I. 10) 1 Boak, A.E.R., 1921, History of Rome to 565 A.D pg 5, London, Routledge Publishers 2 The Hippocratic Writings, Epidemics 1:6, translated by Chadwick J. And Mann W.N., ed with introduction by Lloyd G.E.R., 1978, Penguin Books, London., 3 In various parts of the entire Book I and Book III of Epidemics as well as The Aphorism, the fevers were related to the time of the year, the location of patients and especially to the weather. 4 th The Dictionary of Cell and Molecular Biology – Online! sourced on 25 February 2008 from www.mblab.gla.ac.uk/~julian/dict2.cgi?3849 2 3 Below is one of the medical cases that were documented by the doctor. Included in this case-note are some of the descriptions of the effects of various fevers described in The Hippocratic Writings. However it is highly probable that the cases mentioned in The Hippocratic Writings represent a minute fraction of the cases that occurred in antiquity. In Epidemics I, fourteen cases are described while in Epidemics III twenty-seven cases are noted making a total of forty-one cases illustrated. These seem infinitesimal compared to the vast population of ancient Romans. Y R During the autumn and on into the winter there were caseRs A of continued fever, in a few cases causus, diurnaIlB and nocturnal fevers, roughly tertian and exact tertiaLn fevers, quartans and fevers of no regular form. There w ere many cases of each of the fevers . . . AN D Causus was the least frequent oAf these fevers and those affected by it suffered the le aIsBt. . . F The tertian fevers Owere more common than causus and more troublesome. . . TY The qSuartIan fevers showed, in many cases, their quartan naRture from the start. In not a few cases, however, they Eemerged as quartans only on the departure of other fevers IV and ailments. . . N U There were many cases of quotidian, nocturnal and irregular fever; they lasted a long time whether the patients were confined to bed or not. . . Often the disease was accompanied by convulsions, especially in the case of children. . . The worst most protracted and most painful of all the diseases then occurring were the continued fevers. These 2 4 showed no real intermissions although they show paroxysms, in the fashion of tertian fevers, one day remitting slightly and becoming worse the next. They began mildly, but continually increased, each paroxysms carrying the disease a stage further. A slight remission would be followed by a worse paroxysms and the malady generally became worse on the critical days. Although all patients suffering from these various fevers showed Y shivering fits at irregular times, such fits were least R frequent and most regular in patients with these continueRd A fevers. Again, the fevers generally were attended Bwith many fits of sweating but in cases of continued feLverIs they were infrequent and brought harm rather than relief. In continued fevers too the extremities wereA chiNlled and could only be warmed with difficulty, and inDsomnia was followed by coma. In the fevers generallyA, digestion was disturbed and difficult but this was mIoBst marked in these cases of continued fever. In themF too, the urine was either (a) Thin, raw and colourless ,O becoming slightly more concocted at a crisis, (b) thickY, but cloudy rather than forming sediment or (c) of smIaTll quantity, bad and forming a raw sediment. Urine Sof this last variety was the most serious. Cough accRompanied the fever . . . (Epidemics I. 6-11). VE I All the diseases described caused death, but the greater N number was among those suffering from these continued U fever and especially children, including infants, older children (eight and ten year olds) and those approaching puberty. (Epidemics I. 10) Citing this long passage from The Hippocratic Writings is deliberate. This is because it is necessary to demonstrate how deleterious malaria was to people in 2 5 the ancient Empire of Rome especially children less than six. Malaria was so harmful that it had side effects such as insomnia, indigestion, convulsion and cough. All these brought general discomfort to the body system. Although some survived, the majority of the people who were infected with these various forms of malaria infections died. There is also the need to demonstrate one case of the forty-seven cases recorded in The Hippocratic Writings in order to reveal the doctor‘s perception of the process of malaria fever and its effect. Patients‘ names and ages are usualYly noted. However the age of the patient mentioned in the case below is not shRown. The patient may have been a child less than six. He had convulsionsR. ThAe doctor in the Hippocratic Writings confirms that more often than not, chBildren who were infected with malaria fever usually had convulsions. LI Erasinus lived near the gully of Bootes. A HeN was taken ill after dinner and passed a disturbed niDght. The first day was restful; was distressed during the nAight. Second day: all symptoms ImBore pronounced, delirium at night. F Third day: painful, mOore delirium. Fourth day: worst of all so far, did not sleep at all at night. Visual haIllTucinYations, delirium. These were followed by even mSore marked disturbances, feelings of fear and his illnRess was very severe. EFifth day: in the early morning he became lucid and quite IV regained consciousness of his wits. But some time before N noon, he became mad and could not be restrained; U extremities cold and somewhat livid. Suppression of urine, He died about sunset. He had fever throughout the illness accompanied by sweating. The hypochondrium was distended and contracted only with pain. The urine was dark containing suspended globular particles which did not form sediment on standing. His bowels remained open and he passed solid stools. Thirst throughout was not 2 6 excessive. He had many convulsions accompanied by 1 sweating at the time of death. The above case represents so many other cases of this nature in the ancient empire. It also suggests that the patient was infected with the quotidian fever, which is synonymous to malaria. Also malaria affected his upper abdomen causing it to swell and possibly his kidney, making him to pass urine that contained particles. The ailment not only destabilized the patient but at a point in timYe rendered him mental. The whole body system of the patient was in disarrayR; and he could neither help himself nor be helped. RA Marcus Terentius Varro (116 B.C. – 27 B.C.), the RomaBn scholar whom Julius Caesar named director of the imperial library, attributedL soIme diseases to the swamps, which one may assume to be malaria infections. It seems probable that these diseases were caused by mosquitoes, which, as AVarNro writes, are ―animaculae 2 which cannot be seen with the eyes,‖ suggesting Damong others, malaria. Perhaps, there may be certain creatureAs other than mosquitoes that breed in swamps which cannot be seen by the eyIeBs. These may be sand flies whose bites are painful and very itchy, but saFnd flies are not known to be carriers of the plasmodium falciparum virus tOhat causes malaria. However it seems certain that Varro is referring to mosqYuito es which breed in swampy areas and which are so tiny that they are not IeTasily seen with the eyes. Varro makes clear that it is better to abandon placesS that attract such infections or find a way to work around them. It seems probRable that this advice was adhered to by some people if one is to consider thEat in ancient Rome inheriting a farm was not an everyday event and not everyIonVe was lucky enough to inherit one. Therefore if someone did inherit one, raNther than abandon it for problems such as mosquitoes and the malaria they bring, UVarro advises that one should build in a manner that suggests that the builder must understand the nature or direction of winds. A point to consider here is that many people in ancient Rome may not have been educated enough to understand the nature or direction of winds. Therefore, they would rather build as much as they knew or obtain rented accommodation wherever they found one. 1 Epidemics Book I. VIII 2 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. 2 7 Agrius‘ advise to either sell or abandon the farm, and another advice by Scrofa that Fundamnius should rather build on a well ventilated place, especially that from Scrofa, are not different from what we know today from medical practitioners, with regard to the control of malaria in our environment. The problems that mosquitoes cause are enormous and ultimately deadly. The satires of the Roman poet, Quintus Horatius Flaccus (December 8, 65 BC - November 27, 8 BC) portray the culture of the people in ancient Rome. In the third satire of Book II Horace pinpoints the quartan fever while satirizing thYe superstition of an ignorant mother. However, the theme of Horace‘s satire Ris not child death in ancient Rome, but this aspect of his satires below provRidesA clues to child mortality in the ancient empire. B LI ―O Lord who givest and takest away our heaviest sorrows,‖ (a mother is praying for her son, who hasA beeNn five months in bed) D ―If my boy succeeds in shaking Aoff the quartan fever he will stand naked in the TibIerB on the morning of the day which thou dost appointF for fasting.‖ If thanks to luck or Othe doctor the patient is saved from his critical conditiYon, the crazy mother will hold him in the freezing wIaTter and kill him by bringing back his fever. And wShat destroyed her reason? Superstition, pure and 1simRple. IV E By about 30 A.D., Celsus refers to and describes two types of tertian fevers asN well as other types of fever which are malaria fever. He refers to the tertian, Uquartan and the quotidian fevers. These fevers are malaria in nature. The De Medicina gives exclusively a pragmatic view of these fevers, the clinical picture, and the practical remedy of these fevers. 1 Quintus Horatius Flaccus, Book II, Sat. 3, 281-295. A verse translation and notes by Niall Rudd, 1973, Penguin Books, London. 2 8 Ex his una cotidiana, altera tertiana, altera quartana est. Interdum etiam longiore circuitu quaedam redeunt, sed id raro fit. Et quartanae quidem simpliciores sunt. Incipiunt febres ab horrore, deinde calor erumpit, finitaque febre biduum integrum est: ita quarto die revertitur. Tertianarum vero duo genera sunt. Alterum eodem modo, quo quartana, et incipiens et desinens, illo tantum Y interposito discrimine, quod unum diem praestat integrum, R tertio redit. Alterum longe perniciosius, quod tertio quidemR A die revertitur, ex quadraginta autem et octo horis Bfere triginta et sex per accessionem occupat (interdum LetiaIm vel minus vel plus), neque ex toto in remissione d esistit, sed tantum levius est. Id genus plerique mAediNci ἡμιτριταῖον appellant. D Cottidianae vero variae sunt et Amultiplices. Aliae enim protinus a calore incipiunt, aIliBae a frigore, aliae ab horrore. Frigus vero, ubi extremFae partes membrorum inalgescunt, horrorem, ubi co rpOus totum intremit. Rursus aliae sic desinunt, ut Yex toto sequitur integritas; aliae sic, ut aliquantumIT quidem minuatur ex febre, nihilo minus tamen quaedaSm reliquiae remaneant, donec altera accessio accRedat; ac saepe aliae . . . vix quicquam aut nihil remittant Esed continuent. V NI Of fevers, one is quotidian, another tertian, a third quartan. U At times certain fevers recur in even longer cycles, but that is seldom. Now quartan fevers have the simpler characteristics. Nearly always they begin with shivering, then heat breaks out, and the fever having ended, there are two days free; then on the fourth day it recurs. 2 9 But of tertian fevers there are two classes. The one, beginning and desisting in the same way as a quartan, has merely this distinction, that it affords one day free, and recurs on the third day. The other is far more pernicious; and it does indeed recur on the third day, yet out of forty- eight hours, about thirty-six, sometimes less, sometimes more, are in fact occupied by the paroxysm, nor does the fever entirely cease in the remission, but it only becomes Y less violent. This class most practitioners term hemitritaion. R Quotidian fevers, however, vary and have many forms. FoRr A some begin straightaway with a feeling of heat, otheBrs of chill, others with shivering. I call it a chill wLheIn the extremities become cold, shivering when the w hole body shakes. Again, some desist so that cAomNplete freedom follows, others so that there is somDe diminution of the fever, yet none the less some rAemnants persist until the onset of the next paroxysm;I aBnd others often run together so that there is little orF no remission, but the attacks are 1 continuous. O The above shoIwTs, tYhat Celsus must have spent a great deal of time studying these fevers and became well informed about them. These fevers caused by plasmodium fRalcipSarum killed people especially children. Although Celsus did proffer treaEtment for these fevers it is highly probable that it was not that effective. IVPliny (XXII 49) mentions the use of a toad to treat the tertian or quartan feNvers. Pliny also writes that the item, Honeysuckle (lonicera caprifolia) dissolved Uin white wine and taken for thirty days also cured the tertian and quartan fevers. (NH XXX. 42). It is estimated that twenty-five percent of children in ancient Rome died before their first birthday for several reasons but children between ages 0 and 10 1 A. Cornelius Celsus, De Medicina, Book III.3:3-6, translated by Spencer W.G., Loeb Classical Library. 3 0 1 died from malaria infections. Lanciani (1888) suggests that malaria may have become prevalent in antiquity, especially at the period when volcanic activities ceased. In the words of Luciani, ―there can no longer be any doubt that malaria 2 invaded the volcanic regions the very minute they ceased to be volcanic.‖ In ancient Rome there were altars dedicated to various deities. Among these altars is one dedicated to the goddess of fever. Near the modern railway station I have found, myself, an Y altar dedicated to Verninus, the god of microbes: and . . . in R the very centre of the Roman forum, there was an altaRr A3 sacred to Cloacina, a goddess of typhoid, I suppose. I L B From the above one may conclude that typhoid fev er which goes side by side with malaria fever, was prevalent in the ancienAt ENmpire, and so altars were erected to the god of microbes and the goddessD of typhoid, believing that these deities would cure the fevers. A point to nAote here is that malaria had been in existence before the volcanic activity in qIuBestion. In his studies of inscriptionsF fro m CIL VI and CIL VIII, Macdonell (1913), presents broad conclusions onO life expectation in antiquity: life expectation in Africa was higher than iYn R ome. Evidence from inscriptions ―brings out very clearly the extreme unhTealthiness of ancient Rome, and on this point it agrees with the literary evidence.I‖ And as for Roman Africa he concludes that ―conditions 4 were much mRore Sfavourable to longevity than in Rome and Hispania.‖ For in Rome, liviEng conditions for the poor majority was very low. The people especially childrIeVn suffered from contagious diseases as well as fevers. N Russel J.C. (1985) attributes the Antonine plague of the second century UA.D to plasmodium falciparum and suggests that extremely high adult mortality in 1 Eve D‘Ambra (2007), Roman Women, Cambridge Introduction to Roman Civilization pg 66, Linda Gigante, Death and Diseases in Ancient Rome, sourced in Jan. 2006 from http://www.innominatesociety.com/Articles/Death%20and%20Disease%20in%20Ancient%20Rom e.htm 2 Lanciani Rodolfo, 1888, Ancient Rome in the Light of Recent Discoveries, Macmillan London pg 109. 3 Lanciani Rodolfo, 1888, Ancient Rome in the Light of Recent Discoveries, Macmillan London pg 111. 4 Macdonell W.R, 1913, On the Expectation of Life in Ancient Rome, and in the provinces of Hispania and Lusitania and Africa. Biometrika, Vol. 9, No. 3/4, pp. 366-380, Biometrika Trust 3 1 ancient Rome was consequent on malaria infections. If malaria infection was responsible for high adult mortality, then it must follow that child mortality would not have been less. Soren reports that in 1998, a research team from the University of Arizona excavated a Roman villa on a hillside called Poggio Gramignano, near the town of 1 Lugnano in Teverina in southern Umbria, Italy. This villa was built in about 15 B.C when Augustus was Emperor. At the time it was built it was massive anYd impressive and it was fitted out with elegant mosaic-paved quarters and it was located on the hillside. Because the building was established on jerky or shRaking substratum, it began to crack rendering the building useless in thRe mAid third th century A.D. By the mid 5 century A.D., the building had beenB converted to a cemetery exclusively for infants. It was in this building that thLe sIkeletal remains of fetuses, neonates and those of two or three year old child ren were discovered. Soren assumes that the burial suggests the possibilityA of Nan epidemic leading to the deaths of these children. In attempting to discovDer the probable cause of death, he asserts that Brucella a bacteria which can inAfect dairy products and Toxoplasma gondii which can also be found in uncooIkBed red meat could cause fetuses to abort. In spite of the effects of these bacteFria e, he claims they were not potent enough to cause such an epidemic. And sOo in describing the process and effects of malaria, he believes that only plaYsmodium falciparum commonly known as Blackwater 2Fever has the capacitIyT to wreck such havoc with regard to the skeletal remains excavated at Lugnano in Teverina. S EA Rmosquito transmits the disease by drawing out parasite- IV tainted blood from one individual and depositing the N parasites in another. The parasite invades the liver eight to U twelve days after the bite, and multiplies to hundreds of parasites, which enter the blood stream, attacking red blood cells and invading them in a three- to four-day 1 Lugnano in Teverina is in the flood plain of the Tiber, or more accurately, and safely, on the top of a hill overlooking it, on the road from Amelia (11 km southeast) to Guardea, Baschi and Orviete, th (9 km, 18 km and 28 km northwest, respectively. Sourced on the 5 of March 2008 from http://penelope.uchicago.edu/Thayer/E/Gazetteer/Places/Europe/Italy/Umbria/Terni/Lugnano_in_T everina/Lugnano_in_Teverina/home.html. 2 Soren David, 2003, Can Archaelogists Excavate the Evidence of Malaria? Archaeology of Epidemic and Infectious Diseases, vol 35: (2) 193-209. Routledge London. 3 2 synchronized cycle. The process, which can clog capillaries and affect the kidneys and spleen, produces symptoms which include, initially, anorexia, headache and nausea. As the disease progresses, the individual experiences paroxysms, chills and fever, severe headache, nausea and vomiting, and severe gastric pain, and exhibits an emaciated and gaunt appearance. There may be tertiary (three-day) cycles of symptoms or a daily fever. The victim Y is left anaemic and weak, with an enlarged spleen. The R disease can be fatal, especially when the blood vessels arRe A occluded by masses of infected red blood cells. BIt is particularly lethal to infants and can cause abortedL foIetuses in pregnant mothers, for it can lead to intra-uNterin e death of 1the foetus and toxaemia or blood poisoninAg for the mother. D From the above passage, the ―tertiary cycles‖A suggest somewhat that which fit the description of what the Romans called thIeB tertian fever. Another reason Soren wouldF be lieve that the deaths were probably caused by plasmodium falciparum waOs the discovery of other items at the burial site. Among the objects was aY toa d which was placed on the body of an infant. He buttresses his point bIy Tquoting from Pliny‘s Natural History XXII.49 which refers to these objects asS remedies used to treat the tertian or quartan fever (of malaria). The toad mayR have been placed on the body of the infant with the hope that the child woulEd be healed but the child died and the toad was buried with the infant. It was aIlsVo likely that the fever was so severe that it also killed the toad and so the toNad was buried with the child. Another item discovered at the burial site was a Uconsiderable measure of honeysuckle known as lonicera caprifolia, the ancient periclymenon. Soren believes that the cause of death was malaria because, as indicated above, Pliny advises that it should be dissolved in white wine and taken for thirty days in order to cure the tertian or quartan fevers. (NH XXX. 42). Soren affirms that honeysuckle was used to cure a medical condition known as 1 Soren David, 2003, Can Archaelogists Excavate the Evidence of Malaria? Archaeology of Epidemic and Infectious Diseases, vol 35: (2) 193-209. Routledge. 3 3 splenomegaly or enlarged spleen, and this medical condition can be caused by plasmodium falciparum malaria. Because honeysuckle flourishes in summer he suggests that the epidemic may have occurred in later July or August, principal time for malaria epidemic. However this new theory about malaria being the probable cause of death of the fetuses, the neonates and the two or three year old children whose skeletal remains were discovered at Lugnano in Teverina, stirred up some controversy and came under attack. To disagree, Marshall Becker of the West Chester College anYd a forensic anthropologist, claims that the infant cemetery was a normal gravReyard which showed no suggestion of malaria as a number of diseases coulRd haAve led to the death of the infants. As a result of these arguments, RIoBbert Sallares, a molecular biologist from the University of Manchester, who wLas undertaking new developments in DNA analyses, took specimens of the bo nes discovered at this graveyard. In applying new contemporary scientifiAc teNchniques in biomolecular biology to human skeletal remains excavated Dfrom this archaeological site of 1 Lugnano in Teverina, Umbria, Italy, he coAmpared the specimens of the bones from the site with bones of children inI Bour contemporary times that have been exposed to plasmodium falciparumF malaria. The results showed that the children 2 at Teverina did succumb to the Omost virulent of malaria, plasmodium falciparum. Sallares (2002) ideYntifies about two hundred species of malaria, but only four attack humans. TIhTe four identified species of this parasite causing malaria in human, include; pSlasmodium vivax, plasmodium falciparum, plasmodium ovale 3and plasmodiuRm malariae. Plasmodium falciparum is transmitted by the female anopheles Emosquito. Soren (2003) mentions plasmodium malaria and plasmodium vivax IaVs species of malaria that affected people in Lugnano, and claims that they N 4were not quite as severe and probably endemic. U 1 Lugnano in Teverina is in the flood plain of the Tiber, or more accurately, and safely, on the top of a hill overlooking it, on the road from Amelia (11 km southeast) to Guardea, Baschi and Orviete, th (9 km, 18 km and 28 km northwest, respectively. Sourced on the 5 of March 2008 from http://penelope.uchicago.edu/Thayer/E/Gazetteer/Places/Europe/Italy/Umbria/Terni/Lugnano_in_T everina/Lugnano_in_Teverina/home.html. 2 Sallares Robert, 2002, Malaria and Rome, A History of Malaria in Ancient Italy, Oxford University Press. 3 Sallares Robert, 2002, Malaria and Rome, A History of Malaria in Ancient Italy, Oxford University Press. 4 Soren David, 2003, Can Archaelogists Excavate the Evidence of Malaria? Archaeology of Epidemic and Infectious Disease, Vol. 35, No. 2, pp. 193-209, ed. Peter Mitchell, Taylor & Francis, Ltd. 3 4 Among other diseases also responsible for child death in ancient Rome is consumption otherwise known as tuberculosis. 3.2 Consumption This malady exterminated children. In The Hippocratic Writings, (Epidemics I), consumption attacked its victims especially from early summer to winter. Y During the period beginning in early summer and lasting R into the winter, many patients with long standinRg A consumption took to their beds, for in many cases in wBhich the diagnosis had been dubious, it was then coLnfIirmed. Some whose constitution showed a tendenc y towards consumption first began to suffer from tAhe Ndisease at that time. Many died including most of tDhe latter, and of those who took to their beds, I doubtA if any survived even a moderate time. Death occurIreBd more quickly than is usual in such cases. Other dFise ases, even the longer ones and those accompanie dO by fever, proved neither serious nor fatal . . . onlyY consumption was fatal and caused a large 1number ofI dTeaths. RS 3.3E Paralysis IVIt is also described in the Hippocratic writings. This disease seemed to haNve been prompted by hot weather U Thence, until the [rising of] Arcturus, the summer was hot. This hot spell began suddenly and was both continuous and severe. There was no rain and the elesian winds blew. 1 The Hippocratic Writings, Epidemics I, pg 88, translated by Chadwick J. And Mann W.N., ed with introduction by Lloyd G.E.R., 1978, Penguin Books, London. 3 5 About the time of Arcturus, southerly rains began and continued until the equinox. Under such circumstances, cases of paralysis started to appear during the winter and became common, constituting 1 an epidemic. It seemed probable that paralysis prompted by the weather worked in 2 synergy with causus (ardent fever). Celsus also mentioned paralysis and iYts consequences. AR R 3.4 Diseases Common to the Weather 3 B Many diseases were prevalent in different seasons iLn aIncient Rome and they did play a part in causing child mortality. The Hippo cratic Writings states that various diseases occur in the different weathers Aof aNncient Rome and some of these diseases prove to be fatal. ―Damp mild Dwinter followed by a dry spring causes miscarriage in pregnant women approAaching term and when parturition is accomplished the babies are weak aIndB sickly resulting in immediate death 4 5(neonatal deaths) or if they survive Fthey are thin and fall ill frequently.‖ , Also, in winter, diseases such as ―pleu riOsy, pneumonia, lethargy, catarrh, cough, pain in the 6chest, pains in the side andY loins, headache, vertigo and apoplexy all occur‖ New born infants suffered Tfrom ―aphthae, vomiting, cough, insomnia, nightmares, 7 inflammation of thSe uImbilicus and discharging ears.‖ With teething came ―painful gums, fevers, convulsions and diarrhea. As the children grew older diseases such as ―tonsillEitis,R deflexions of the vertebrae of the neck, asthma, stone, infections with IroVund worms and ascaris, pedunculated warts, priapism and scrofulous 8swNellings in the cervical glands‖ attacked them and caused mortality. U 1 The Hippocratic Writings, Epidemics I. III, translated by Chadwick J. And Mann W.N., ed with introduction by Lloyd G.E.R., 1978, Penguin Books, London. 2 A. Cornelius Celsus, De Medicina, Book II, 8:40, translated W.G. Spencer, 1938, Loeb Classical Library 3 In the Aphorisms diseases which are common to the different seasons are mentioned. 4 Aphorisms Section III, pg 214 5 A. Cornelius Celsus, De Medicina, Book II.8: 14 translated translated W.G. Spencer, 1938, Loeb Classical Library. 6 Aphorisms Section III, pg 215 7 Aphorisms Section III, pg 215 8 Ibid 3 6 A dry summer with northerly winds and a wet autumn with southerly winds were associated with ailments such as, ―winter headaches, coughs, hoarseness, 1 running at the nose and wasting.‖ All the aforementioned ailments, especially when they work in synergy with the fevers, caused child mortality in antiquity. An autumn devoid of rain and with northerly winds came with ―dry 2 opthalmia acute fevers, running noses and melancholy.‖ Many of the summer ailments occurred in autumn and other diseases that occurred in autumn were ―quartan fevers, irregular fevers, diseases of the spleen, dropsy, consumptioYn, strangury, enteritis, dysentery, pains in the hip, sore throats, ileus, epilepsyR and 3 melancholy.‖ RA In spring and full summer ―children and young people do Bbest, in summer and up to a point in autumn, the old do best, while winter suitLs bIest those between 4 these two groups.‖ And ―it is in autumn that diseases Ntend to be most acute and 5most likely to prove fatal.‖ In other words, many chAildren were more likely to die from diseases that occurred in autumn. It is impDortant to note that ―every disease occurs at all seasons of the year but some of tAhem more frequently occur and are of 6 greater severity at certain times.‖ IB Common diseases of the spFring included ―madness, melancholy, epilepsy, hemorrhages, sore throats, catarOrh, hoarseness, coughs, leprosy, vitiligo, ulcerative 7 eruptions, tumours and arYthri tis.‖ Summer produced ―continued fevers, causus, tertian fevers, vomitinTg, diarrhea, ophthalmia, earache, ulcers in the mouth, 8 gangrene of the gSeniItalia and heat spots.‖ These diseases attacked and killed people, young and old, in ancient Rome. RaiEny Rperiods produced ―chronic fevers, diarrhea, gangrene, epilepsy and 9 sore tIhrVoats. Consumption, ophthalmia, strangury and dysentery‖ were peculiar to drNought. All of these diseases caused child mortality. Diseases such as ophthalmia, Ustrangury, dysentery and epilepsy caused child death when they worked in synergy with chronic fevers and consumption. The doctor writes; ―All the diseases 1 Ibid 2 Ibid 3 Ibid 4 Aphorisms Section III, pg 215 5 Aphorisms Section III, pg 213 6 Aphorisms, section III, 19, pg 215 7 Ibid 8 Ibid 9 Aphorisms Section III, pg 214 3 7 described caused death, but the greater number was among those suffering from this continued fever and especially children, including infants, older children (eight 1 and ten year olds) and those approaching puberty.‖ In spite of all these diseases there were instances when people were cured by the doctor of whatever disease they were infected by. However in the Aphorisms the doctor concludes with the following: What drugs will not cure, the knife will, what the knife will Y not cure, the cautery will; what the cautery will not cure R 2 must be considered incurable. RA B 3.5 Infanticide LI Another factor responsible for child mortality iNs in fanticide. Infanticide was a widespread and accepted practice in the GreacoA-Roman world. As a matter of fact, the practice of infanticide was justified bDy The Twelve Tables of the Law (451-450 B.C,). The Twelve Tables of RomanA Law held: “cito necatus tamquam ex 3 XII tabulis insignis ad deformitatem pueIr.B” ―As it were, from the twelve tables of law, a deformed boy was instantly Fkill ed.‖ Cicero (106-43 B.C.) quoting from the same Twelve Tables of the La wO affirms in his De legibus, "We drown children at 4birth who are weakly and abnormal." For the Romans infanticide was not considered a crime. AT letYter taken from an Oxyrhrnchus papyrus (1 B.C.) written by a husband toS hiIs wife corroborates the practice of child exposure and abandonment.R As long as they thought it was not necessary to keep such infants alive, theyE were exposed. Hilarion writing to his sister Alis without any qualms of conscIieVnce commanded: N U . . . If – good luck to you! – you bear offspring, if it is a male, let it live; if it is a female, expose it. . . 1 he Hippocratic Writings Epidemics, Bk 1, pg 93. 2 The Hippocratic Writings Epidemics Aphorisms Section VIII. translated by Chadwick J. And Mann W.N., ed with introduction by Lloyd G.E.R., 1978, Penguin Books, London. 3 Duodecim Tabularum Leges, in Fontes iuris Romani antiqui I, ed. Georg Bruns et Otto Gradenwitz Tübingen, 1909, sourced Dec., 2007 from http://www.hs- augsburg.de/~harsch/Chronologia/Lsante05/LegesXII/leg_ta00.html 4 M. Tulli Ciceronis De legibus, Libri Tres. http://www.thelatinlibrary.com/cicero/leg.shtml 3 8 th 1 The 29 year of Caesar. Pauni 23. The only aim for this yet-to-be-born was that it should be condemned to death by exposure if it was born, not a deformed female, but a female. The Special Laws, written by Philo Judaeus (20 A.D.) a Jewish writer proves beyond doubt that child mortality via infanticide was a common practice in antiquity. Philo speaks against it, condemning peoples of other cultures for this 2 infamous unjustified practice. He laments: Y R Some of them do the deed with their own hands; witRh A monstrous cruelty and barbarity they stifle and throttlBe the first breath which the infants draw, or throw theLm Iinto a river or into the depths of the sea, after attac hing some heavy substance to make them sink moreA quNickly under its weight. Others take them to be expDosed in some desert place, hoping, they themselves sayA, that they may be saved, but leaving them in actuIalB truth to suffer the most distressing fate. For all Fthe beasts that feed on human flesh visit the spot and fOeast unhindered on the infants, a fine banquet providYed by their sole guardians, those who above T 3all others Ishould keep them safe, their fathers and mothers. He goes on toR sayS that one may attempt to consider and justify the killing of an adult by bEringing up so many excuses for the act of murder which is against the law bIuVt the killing of an infant child who is innocent of offences should not even beN considered. He supports the Mosaic Law (the Law of Moses) which imposes Uthe death penalty on anyone who carries out the practice of infanticide. 1 Soured from Lefkowitz Mary R., 1992, Women‘s Life in Greece and Rome, A source book in nd translation; 2 Edition, The John Hopkins University Press, Baltimore. 2 Philo Judaeus, The Special Laws. III, XX.117, Volume VII, pp. 118, 551, 549, 1968, translated by F. H. Colson, William Heinemann Ltd, London. 3 Philo Judaeus, The Special Laws III, XX, 114-115, 1968, translated by F. H. Colson, William Heinemann Ltd, London. 3 9 1 Justin Martyr (100-165 A.D.) an early Christian Apologist and canonized a saint after his death, wrote against the practice of infanticide: But as for us, we have been taught that to expose newly- born children is the part of wicked men; and this we have been taught lest we should do any one an injury, and lest we should sin against God, first, because we see that almost all so exposed (not only the girls, but also the males) are Y brought up to prostitution. And as the ancients are said to R have reared herds of oxen, or goats, or sheep, or grazing A horses, so now we see you rear children only forB thiRs shameful use; and for this pollution a multitude oLf feImales and hermaphrodites, and those who commit unm entionable iniquities, are found in every nation. And yNou receive the hire of these, and duty and taxes from Athem, whom you ought to exterminate from your realDm. And any one who uses such persons, besides thBe gAodless and infamous and impure intercourse, may poIssibly be having intercourse with his own childO, or Frelative, or brother. And there are some who prostit ute even their own children and wives, and some arYe openly mutilated for the purpose of 2 sodomSy...I T VTheE R Histories of Tacitus (AD 124), confirms and even supports infanticide. WhileI speaking against the customs of the Jews such as circumcision, frowning at anNy association with foreigners as abominable, Tacitus condemns the Jews because Uthey did not partake in the act of infanticide. 1 He is also known as Justin the Martyr, Justin of Caesarea, Justin the Philosopher, in Latin his name reads Iustinus Martyr or Flavius Iustinus sourced in February 2009 from http://en.wikipedia.org/wiki/Justin_Martyr. 2 Justin Martyr, The Fist Apology Chapter XXVII, Guilt of Exposing Children, sourced February 2009 from http://www.earlychristianwritings.com/text/justinmartyr-firstapology.html 4 0 . ..they take thought to increase their numbers; for they 1 regard it as a crime to kill any new-born child. Observed in the text below by Tertulian a Christian writer in A.D 200 are criticisms against the practice of infanticide, abortion and any kind of murder. He actually considers very malicious, murder through drowning and through exposure and abandonment. He speaks firmly against the afore-mentioned practices and advises people to desist from such acts. RY [6] Sed bestiarii, inquitis. Hoc, opinor, minus quamR A hominis? An hoc turpius, quod mali hominis? certe taBmen de homicidio funditur. O Iovem Christianum Let Isolum patris filium de crudelitate! Sed quoniam de i nfanticidio nihil interest sacro an arbitrio perpetreturA, licNet parricidium homicidio intersit, convertar ad populDum. Quot vultis ex his circumstantiAbus et in Christianorum sanguinem hiantibus, ex i pIsiBs etiam vobis iustissimis et severissimis in nos praeFsidibus apud conscientias pulsem, qui natos sibi liberoOs enecent? 7] Siquidem etY de genere necis differt, utique crudelius in aqua spirituTm extorquetis aut frigori et fami et canibus exponSitis.I Ferro enim mori aetas quoque maior optaverit. [8]R Nobis vero semel homicidio interdicto etiam conceptum Eutero, dum adhuc sanguis in hominem delibatur, dissolvere IV non licet. Homicidii festinatio est prohibere nasci, nec N refert natam quis eripiat animam an nascentem disturbet. U Homo est et qui est futurus; etiam fructus omnis iam in semine est. 6] But since in the case of infanticide it matters nothing whether it be committed under religious sanctions or out of 1 Tacitus, Histories 5.13. Translated by C.H. Moore, Loeb Classical Library, Harvard University Press. 4 1 mere caprice (although it does matter whether it is parental child-murder or manslaughter), I will appeal to the people. How many of those who stand around panting for the blood of the Christians,—how many, think you, of yourselves even, magistrates most just and severe against us, shall I prick in their consciences, who are in the habit of strangling the children born to them? [7] Since there is a difference, too, in the kind of death, Y surely that is the more cruel method by which you squeeze R out their breath under water, or expose them to cold anRd A hunger and the dogs; for an adult, too, would chooseI dBeath by the knife in preference. L [8] But to us, to whom murder has once fo r all been forbidden, it is unlawful even to destroAy thNe fetus in the womb whilst the blood is still forminDg into a human being. Prevention of birth is premature Amurder; nor does it alter the question whether one takIeBs away a life already born, or destroys one which is inF pr ocess of formation. That also is a human being, whiOch is about to become one, just as every 1 fruit exists alreYady in the seed. ITLactantius, also a Christian writer, between the late third century and early fourth centuryR A.DS comments that parents strangle their own children, or expose them to thEeir fate if they are too pious for such. Lactantius worrying about these infantIs Vaffirms that, even if they are picked up by other people and survive the 2prNobability that they would be brought up in brothels and slavery was high. Here, ULactantius is corroborating Justin Martyr. After his conversion in about 320 A.D., Emperor Constantine the Great enacted two laws against child murder. The first law was to remove temptation to commit infanticide. To this end he provided funds out of the imperial treasury for 1 Tertulian Apology 9:6-8, Translated by Bindley T. Herbert, M.A., 1890, Merton College, Oxford. Parker And Co. 6, Southampton-Street, Strand, London and Broad-Street, Oxford. 2 Lactantius, Divine Institutes Book V.15., trans. Anthony Bowen and Peter Garnsey, 2003, Liverpool: Liverpool University Press. 4 2 parents who were over-burdened with children. The second law accorded all the rights of property of exposed infants to those who had the charity to save and 1 nurture them. The wide-spread practice of infanticide, or exposure and abandonment in the Greaco-Roman world definitely contributed to child mortality. Children disposed of were considered unfit to live. In ancient Rome the patria potestas of the father empowered the father to expose a child he deemed unfit to live. IndeeYd, Sparta as far back, instituted a council of elders whose responsibility was to inspect newly born babies and decide which was fit to live. A baby born weak orR with 2 th serious congenital deformities, was exposed and left to die. In SoRphoAcles‘ (5 century B.C) Oedipus Rex, Oedipus was exposed and left to dieB because of the prophecy from the Delphic oracle, which pronounced that he LwoIuld kill his father and then marry his mother. He was exposed to die because he was considered an aberration. The exposure led to the fulfillment of theA proNphecy. Macdonell mentions “strict selection in cDhildhood” among others as one of the reasons for a high rate of life expectatiAon for Ancient Africans beyond 40 3 years. This “strict selection in chIiBldhood,” presupposes the practice of infanticide, which as Williamson,F an Anthropologist, writes, was a common feature in well studied ancient cOultures of the world. Little wonder it was widely practiced in ancient Rome.Y T InfantiScideI has been practiced on every continent and by peRople on every level of cultural complexity, from hunter Egatherers to high civilizations, including our own ancestors. IV 4Rather than being an exception, then, it has been the rule. N U It is pertinent to note that babies who were victims of infanticide were not mourned, therefore putting up epitaphs for such children was out of the question. Attempts were not made towards ensuring that babies born weak survived, 1 Infanticide sourced in January 2009 from http://www.newadvent.org/cathen/08001b.htm 2 French Valerie, 1986, Midwives and Maternity Care in the Roman World, Rescuing Creusa: New Methodological Approaches to Women in Antiquity, Helios, New Series, 13(2), pp. 69-84). 3 Macdonell W.R, 1913, On the Expectation of Life in Ancient Rome, and in the provinces of Hispania and Lusitania and Africa. Biometrika, Vol. 9, No. 3/4, pp. 366-380, Biometrika Trust. 4 Williamson, Laila, 1978, Infanticide: An Anthropological Analysis, Infanticide and the Value of Life, ed. Marvin Kohl, Prometheus Books, New York. 4 3 probably because of the relationship between parents and children. Dixon (1988) argues that relationships with parents were often formal and unemotional therefore, 1 it was easy to dispose of unwanted infants. The Columbia Encyclopedia defines infanticide as, ―the putting to death of 2 the newborn with the consent of the parent, family, or community.‖ Infanticide is synonymous to exposure and abandonment. Boswell (1984) defines abandonment as ―voluntary and permanent relinquishing of control over children by natal parents or guardians, whether by leaving them somewhere, selling them, or legallYy 3 consigning care and control to some other person.‖ In other words, he wAriteRs that exposition is not necessarily infanticide; it is more of putting out tRhe child and hoping that the child would be picked up by strangers. If that haBppened, then the epositio should not be defined as infanticide, rather, it shouldL beI defined as an act that relinquished responsibility of the child from the parent s to strangers. In the same vein, Harris (1994) makes a distinction betweAen eNxposer A and Exposer B, where the former was one who hoped for the rDescue of the infant and the later 4 looked towards the death of the child. A Dianne R. Moran, affirms thIatB evidences from both historical and contemporary data indicate that 10 F– 1 5 percent of all babies were killed by their 5 parents. However, the girl infOant suffered more from infanticide, as there was a high rate of female infanticid e practiced in ancient Rome. Milner (1998) claims that the saying that; “IETverYyone raises a son, including a poor man, but even a rich 6man will abandonS a daughter," was a common Roman expression. Boswell and Harris suggestR economic reasons for the practice of female infanticide in the sense that a dowEry was required from females to their prospective husbands. It was probaIbVly common with the vast majority of the low income earners. UN 1 Dixon Susanne, 1988, The Roman Mother, Norman and London: University of Oklahoma Press. 2 The Columbia Encyclopedia, sixth Edition, 2008, sourced in June 2008 from http://www.highbeam.com/The+Columbia+Encyclopedia,+Sixth+Edition/publications.aspx 3 Boswell John Eastburn, 1984. Expositio and Oblatio: The Abandonment of Children and the Ancient and Medieval Family, American Historical Review 89, 12 4 Harris, W.V, 1994, Child-Exposure in the Roman Empire, The Journal of Roman Studies 84, 9, Cambridge University Press. 5 Dianne R, Moran, Infanticide, http://www.deathreference.com/Ho-Ka/Infanticide.html 6 Milner, Larry S. 1998, Hardness of Heart Hardness of Life: The Stain of Human Infanticide. Kearney, NE: Morris Publishing. 4 4 Donald Engels (1980) declared that infanticide (exposure of infant 1 children) was of “negligible importance” to the people. He claims that female infanticide could not have been common in many cultures as well as the Greaco- Roman world. He depends on ―. . . a few, demographic principles concerning ancient human populations, and these show a high rate of female infanticide was 2 impossible.‖ He claims that the ratio of newborn babies is about 1 female to 1.05 males, and that the natural increase of a population depends on the difference between its birth rates and death rates. He assumes that life expectancy iYn antiquity was quite low, less than thirty, but greater than twenty. With Rthese principles Engels gives a calculation which shows that the birth and dReathA rates in antiquity would be between 34 and 50 per 1000 per year, with an Baverage of about 40 per 1000 per year of birth and death rates. Engels then eLxplIains that with the above principles and calculations, it was highly unlikely t hat female infanticide was practiced in the Greaco-Roman world. DetailinAg thNe consequences of female infanticide, he gives the example that if one-fifthD of the females born a year were killed, it would have two effects on the popuAlation. The first being that the death rate would change to about 44 per 100I0B per year, and the second effect would occur between forty-five to forty-niFne y ears later. At this time, the first generation of girls who survived the scourOge would have reached the age of menopause and there would only be four-fif ths of these women. Therefore, there would be a reduction in the numbIeTr ofY children born in the next generation by this one-fifth of women. The birthS rate would be reduced to 32 per 1,000 per year and raise the death rate to 4R4 per 1,000 per year. He suggests that this would give a negative rate of natEural increase of 12 per 1,000 per year, so that the population would be reducIedV by half in only 57.75 years, and by three-quarters in 115.5 years and fiNnally down to seven-eighths in only 173.25 years. Engels supposes that even if Uthe death rates increased to about 40 and 50 per 1,000 per year the demographic consequences of a high rate of female infanticide would be catastrophic. Engels 1 Engels Donald, 1980, The Problem of Female Infanticide in the Greaco-Roman World, Classical Philology 75: 112-120. 2 Engels Donald, 1980, The Problem of Female Infanticide in the Greaco-Roman World, Classical Philology 75: 112-120. 4 5 then concludes that a rate of about ten percent of female infanticide in the Greaco- 1 Roman society was highly unlikely. With Engels‘ conclusion one is tempted to agree that infanticide, predominantly female infanticide, could not have been practiced in antiquity. However, the truth of the matter is that it was practiced. Facts from classical authors make nonsense of Engels‘ calculations and conclusion. If Engels had not disregarded the ample information supplied by classical authors and other ancient sources on child exposure and abandonment, his thought on infanticide and iYts impact on the population may have been different. R 2 William Harris (1982) also disagrees with Engels. He statesR thaAt Engels‘ thoughts on the practice of female infanticide in the Greaco-RoBman world have been misleading. He argues that Engels‘ dependence on tLhe Iworks of authors whose works border on demography and population study c overing the periods of antiquity, was not presented in his (Engel‘s) reportA. FNor these authors have all stated that female infanticide was practiced inD many ancient societies. Harris wonders why Engels would conclude thatA female infanticide could not have occurred in the Greaco-Roman worl dI. B Harris states that the practice had considerable effect on the populaFtion. He also substantiates his opinion from results of his other studies a s Owell as studies of other Classicists whose works border on the demographyY of ancient Greece and Rome. They include those of 3 4Harris, V.W. (1980)I,T Duncan-Jones, R.P (1980), Brunt, P.A. (1971), and 5Pomeroy, S. B. (1S975). Having gone through the aforementioned works, Harris concludes that the extensive practice of infanticide especially female infanticide in the GreacEo-Roman world had considerable ―demographic, economic and 6 psychIoVlogical‖ effect on the society. N Golden (1981) also disagreeing with Engels attests to the practice of female Uinfanticide in several ancient societies including those of the Greaco-Roman. He 1 Engels Donald, 1980, The problem of Female Infanticide in the Greaco-Roman World, Classical Philology 75: 112-120. 2 Harris V. William 1982, The Theoretical Possibility of Extensive Infanticide in the Greaco- Roman World, Classical Quarterly 32, N0 1, 114-116. Cambridge University Press. 3 Harris W.V., 1980, Towards a Study of the Roman Slave Trade, Memoirs of the American Academy in Rome 36 pp. 123-4. 4 Brunt, P.A., 1971, Italian Manpower, 225 B.C.-A.D. 14 pg 148-54, Oxford. 5 Pomeroy, S. B.., 1975, Goddesses, Whores, Wives, and Slaves, pp 140, 164-5, 228, New York. 6 Harris V. William 1982, The Theoretical Possibility of Extensive Infanticide in the Greaco- Roman World, Classical Quarterly 32, N0 1, 114-116. Cambridge University Press. 4 6 affirms that, ―a study of ethnological reports on three hundred and ninety-three (393) widely scattered cultures shows that one hundred and seventy-nine (179) commonly and twenty-nine (29) occasionally practiced infanticide, predominantly 1 of girls.‖ 2 Cadwell states that literary sources, tombstones inscriptions as well as remains from skeletons have all been utilized by Classicists to prove that there was a reduction in population because of a deliberate control of family numbers through contraception and infanticide or child exposure. Y 3 According to Christopher Price (2004), ancient Romans and GreeksR were pagans therefore, practicing infanticide was unproblematic, but thRe aAdvent of Christianity brought to the fore the evils of infanticide. Some Bof the measures adopted by Christians in attempting to put an end to the prLactIice of infanticide included; rescuing and adopting babies exposed, and strictly making sure that their members did not partake in the practice. Price AcoNncludes that Christianity contributed greatly to the opposition of infanticidDe and its eventual prohibition. In sum, infanticide was widely practiAced in the Greaco-Roman world and was generally accepted. Infanticide als oI hBad considerable effects on the population of ancient Roman territories. It sFeems probable that since it was common, the authorities did not worry abou tO its effect on the population. Perhaps it was better to have a solid base of Ya healthy populace than to have a large number of incapacitated and unheTalthy citizens. And so unhealthy and deformed babies were abandoned or expSosedI to die. It is estimated that twenty (20) to forty (40) percent 4of babies wereR exposed in the later Roman Empire. It is pertinent to note here that in spite of Ethis practice, parents loved new born babies and took care of them as it is obsIeV 5rved in the satires of Persius, where the description is shown of the dotting grNandmother who smears the baby with prophylactic spit. U 1 Golden, Mark, 1981, Demography and the Exposure of Girls at Athens, 35: pp 316-331, Phoenix. 2 Cadwell, John C, 2004, Fertility Control in the Classical world: Was there an Ancient Fertility Transition. Journal of Population Research. 3 Christopher Price, 2004, http://www.christiancadre.org/member_contrib/cp_infanticide.html 4 http://www.deathreference.com/Ho-Ka/Infanticide.html 5 Horace: Satires and Epistles, Perseus: Satires, Persius, Satire 2.31-37, pg 214, 1973, a verse translation and notes by Niall Rudd, Penguin Books, London. 4 7 3.6 Lead Poisoning Of the various causes of child death in ancient Rome, lead poisoning is one. Lead is a metal that was in high demand in ancient Rome because of its usefulness in the production of many items necessary for daily use ranging from industrial to architectural and domestic application. Continuous contact with this deadly substance results in slow but sure deterioration of human body system. In the mid-second century B.C, Nicander in the Alexipharmaca (II.74ff) gives a description of lead poisoning. He writes: “there is a gleaming, deadly whiYte 1 lead whose fresh colour is like milk which foams all over." Nicander also poRrtrays the following as the effect of lead: low temperature, a foaming mouthR, terAseness of the tongue, a throat that is dry as well as a dry retching, halluBcinations, and a th crushing fatigue. Paul of Aegina, a Bzyantine physician in LtheI 7 Century A.D, also mentions lead and its effect. He comments: AN I am of the opinion that the colic Daffection which now prevails is occasioned by such huAmours; the disease having taken its rise in the coun trIy Bof Italy, but raging also in many other regions of thFe Roman empire, like a pestilential contagion, which i nO many cases terminates in epilepsy, but in others in Yparalysis of the extremities, while the sensibilityI oTf them is preserved, and sometimes both these 2afflictiSons attacking together. It sEeemRs probable therefore that on many occasions when people, children and aIdVults were infected with paralysis and epilepsy, the illness started as colic inNfection and was caused by lead poisoning. It probably was not common U th rdknowledge by the 4 and 3 century B.C. that lead poisoning was taking its toll on people especially children through intense colic infection. Therefore, children who were infected with colic were in actual fact infected with lead poisoning, for more 1 Nicander, Alexipharmaca, II.74-74, sourced in Hune 2008 from http://penelope.chicago.edu/grout/encyclopaedia.romana/wine/leadpoisoning.html 2 The Seven Books of Paulus Aegineta (III.64), translated by Francis Adams, 1844, Penguin Books, London. 4 8 often than not the disease degenerated to paralysis or epilepsy as the case may be and eventually, death. Marcus Vitruvius Pollio who was a Roman writer, an architect (ca 70 – ca 50 B.C) and an engineer, in De Architectura indicates an awareness of the danger of lead by Romans. He gives explanations on the destructive effects of water found near lead mines as well as its effect on the human body system (VIII.3.5, 6.11). He suggests the use of earthen pipes in place of lead pipes to convey water. He states that the water conveyed in earthen pipes has a better flavour thanR thYat conveyed in lead pipes. RA habent autem tubulorum ductiones ea commoda. primuBm in opere quod si quod vitium factum fuerit, quilibetL id Ipotest reficere. etiamque multo salubrior est ex tubulis aqua quam per fistulas, quod plumbum videtur esAse Nideo vitiosum quod ex eo cerussa nascitur, haec auteDm dicitur esse nocens corporibus humanis. itaque quod Aex eo procreatur id est vitiosum, non est dubi umIB quin ipsum quoque non sit salubre. F exemplar autem Oab artificibus plumbariis possumus accipere, quod palloribus occupatos habent corporis colores. nIamTquYe cum fundendo plumbum flatur, vapor ex eo insSidens corporis artus et in diem exurens eripit ex meRmbris eorum sanguinis virtutes. itaque minime fistulis Eplumbeis aqua duci videtur, si volumus eam habere IV salubrem. saporemque meliorem ex tubulis esse cotidianus N potest indicare victus, quod omnes structas cum habeant U vasorum argenteorum mensas, tamen propter saporis integritatem fictilibus utuntur. Water conducted through earthen pipes is more wholesome than that through lead; indeed that conveyed in lead must be injurious, because from it white lead is obtained, and this is said to be injurious to the human system. Hence, if 4 9 what is generated from it is pernicious, there can be no doubt that itself cannot be a wholesome body. This may be verified by observing the workers in lead, who are of a pallid colour; for in casting lead, the fumes from it fixing on the different members, and daily burning them, destroy the vigour of the blood; water should therefore on no account be conducted in leaden pipes if we are desirous that it should be wholesome. That the flavour of that Y conveyed in earthen pipes is better, is shewn at our daily R meals, for all those whose tables are furnished with silveRr A vessels, nevertheless use those made of earth, fromB the 1 purity of the flavour being preserved in them. LI AN If the people heeded this warning, lead poDisoning may not have occurred in ancient Rome. Obviously Vitruvius knows wAhat he is warning about. He takes his time to study lead and its deadly effec tsI oBn people, especially people whose daily occupation was working with lead.F From the above quotation, Vitruvius proves beyond reasonable doubt that leOad poisoning may have had considerable effect on the populace including childre n. In the same veIinT, CYelsus supports the use of rain water. Because rain water S 2has little contamination, he agrees to its use as “Aqua levissima pluvialis est . . .” (Rain-water isR the lightest. . .) meaning that it contains little or no impurities, but just water Ein its purest form, therefore, it is most suitable to the body's health, and can be Vregarded as exceptionally good if it is conveyed through earthen pipes into coNverIed cisterns. The ancients had an awareness of the poisonous nature of lead. UTherefore they may have adopted various methods of avoiding its use as much as was possible. 1 MarcusVitruvius Pollio De Architectura (VIII.6.10-11). sourced in December 2007 from http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Vituvius/9‘.html 2 A Cornelius Celsus, De Medicina, II.18.12, translated by Spencer, W.G., 1938, Loeb Classical Library. 5 0 1 Pliny states that lead (plubum), a by-product of silver mining was obtained from galena ore which was crushed and smelted. Although diseases such as colic, 2 gout, dropsy have been associated with lead poisoning, there is no evidence from 3 The Hippocrates Writings that these diseases were caused by lead poisoning. However, there is the need to understand that Hippocrates practiced medicine th rd between the 4 and 3 centuries B.C long before Pliny, Columella and Cato began to write. It seems probable then that Hippocrates and the other philosophers of hYis day were yet to discover the poisonous nature of lead or the deadly effect of lead on the human body system. R Another possible channel of lead poisoning was through the RconAsumption of defratum or sapa, a product of unfermented grape juice (mIuBstum) boiled to concentrate its sugar. Defratum was used as a sweetener for soLur wine or wine that has almost lost its nutritious or alcoholic value and alsoN as a preservative. When mustum is boiled and reduced to one half then it is cAalled defrutum and when it is boiled and reduced to one third of its volume, thDen it is called sapa. Defrutum or sapa gets contaminated by lead in the procesAs of metamorphosis from mustum to defrutum and from defrutum to sapa. M IoBre often than not the boiling was done in pots made of lead. Cato, ColumellFa and Pliny describe the process. In De Agri Cultura, the directions for reduOcing must are proffered by Cato. ―Boil must in a copper or lead vessel, over a slow fire, stirring constantly to prevent scorching; 4 continue the boiling, TuntYil you have boiled off a half." On the other hand, Columella gives aS detIailed description of its preparation. ESoRme people put the must in leaden vessels and by boiling IV reduce it by a quarter, others by a third. There is no doubt N that anyone who boiled it down to one-half would be likely U to make a better thick form of must and therefore more profitable for use. . . But, before the must is poured into the 1 Pliny, NH XXXIII.95, 159. (1945) translated by H. Rackham, Loeb Classical Library. 2 Dan Montgomery, 1971, Lead, Floride, the Roman Empire and the Decline of Academic Achievement in the United States. Sourced in Feb., 2006 from http://sonic.net/kryptox/environ/lead/romans.htm. 3 Waldron H.A. 1973, Lead Poisoning in the Ancient World, Journal of Medical History, 17, 391- 399. 4 Marcus Porcus Cato, De Agri Cultura, CVII, 1935, translated by William Davis Hooper, revised by Harrison Boyd Ash, Loeb Classical Library. 5 1 boiling-vessels, it will be well that those which are made of lead should be coated inside with good oil and be well- rubbed, and then the must should be put in. . . The vessels themselves in which the thickened and boiled-down must is boiled should be of lead rather than of brass; for, in the boiling, brazen vessels throw off copper-rust and spoil the flavour of the preservative. . . Must of the sweetest possible flavour will be boiled down to a third of its original volume Y and when boiled down, as I have said above, is called R 1 defrutum. RA B While writing on the production of wine concentrates,L PlIiny advises that in order to obtain the best of concentrates, mustum shoulNd b e cooked with vessels made of lead. A Also boiled-down must and must ofD new wine should be boiled when there is no mooAn, which means at the conjunction of that planet, aInBd not on any other day; and moreover leaden and nFot copper jars should be used, and some walnuts shouOld be thrown into the liquor, for those 2 are said to absoYrb the smoke T If the advicSe toI cook mustum in leaden vessels was adhered to, then it must follow that a Rgradual process of lead poisoning through this item may have been possible, cEonsidering the fact that mustum was used as a condiment for food as well aIsV a sweetener, even for wines. The Natural History provides evidence that linNks this issue to child death in ancient Rome. U However, Scarborough notes that the boiling period was short therefore mustum could not have been contaminated by the lead pots that were used in the boiling. He also suggests that one should read some of the texts carefully, and that in so doing, one would notice that a preference for copper and bronze objects are mentioned and as a result of that advice, ancient Romans utilized bronze cauldrons 1 Columella: On Agriculture XII.19.1, 19.6, 20.1, 21.1, 1954, translated by E. S. Forster and Edward H. Heffner (Loeb Classical Library) 2 Pliny NH XIV.136 ,1945, translated by H. Rackham (Loeb Classical Library 5 2 rather than lead vessels. But, Gout postulates that copper and bronze also were contaminated by lead in the process of production. Quoting from Pliny‘s Natural History XXXIV.160 and XXXIV 95 respectively, he declares that copper vessels coated with stagnum (a lead alloy), gives the contents a more agreeable taste and prevents the formation of destructive verdigris. And also, the best bronze was alloyed with ten percent lead and tin. Eisinger and Patterson et al. discovered that mustum reduced to defrutum, that is one-third of its volume, contained more or less 1000 milligrams of lead peYr 1 litre. Heeding Columella‘s recommendation (XII.20.3), which is a mixture oRf one sextarius of defrutum with one amphora of wine, or of Cato‘s, (XRXIVA) would produce a concentration that would certainly induce lead pIoBisoning. Nriagu presupposes Rome‘s aristocrats as well as their children to ha vLe been exposed to it. 2The children consumed water from pipes made of lead asN well as diluted wine, the aristocrats consumed both water from leaden pipes Aand about two litres of such wine on a daily basis. Children and parents wereD poisoned by lead, since children were less resistant, child mortality was ineviAtable. The parents were poisoned by lead content-water and wine, the resul tsI bBeing internal weakness characterized by ineffective governance which, accoFrding to some contemporary authors, brought about the eventual fall and tota lO collapse of the ancient empire of Rome. An anonymous RoYman Hermit in the mid second century A.D. describes the result of lead poisoInTing with poetic vividness: HeRnceS gout and stone afflict the human race; EHence lazy jaundice with her saffron face; IV Palsy, with shaking head and tott'ring knees. N And bloated dropsy, the staunch sot's disease; U Consumption, pale, with keen but hollow eye, And sharpened feature, shew'd that death was nigh. 1 Patterson C.C., Shirahata H., Ericson J.E., 1987, Lead in Ancient Human Bones and Its Relevance to Historical Developments of Social Problems with Lead, Journal of the Science of the Total Environment, 61, 167-200. 2 Celsus in De Medicina 3: 32, 13, 14, while discussing issues that pertain to age, he advises that children should not fast as long as adults; children and the aged should bathe with warm water and also children should be given diluted wine, while adults should drink undiluted wine. It is highly probable that this advised was adhered to because it was coming from a medical practitioner and also children were wont to be present when adults drank wine. 5 3 The feeble offspring curse their crazy sires, 1 And, tainted from his birth, the youth expires. Indeed the ‗youth,‘ the child, tainted from his birth, expires. The Wikipedia gives a concise and interesting description of lead poisoning as well as its effects. Lead poisoning is a medical condition, also known as Y saturnism, plumbism or painter's colic, caused by increased R blood lead levels. Lead may cause irreversible neurologicaRl A damage as well as renal disease, cardiovascular effectsB, and reproductive toxicity. The symptoms of chroLnicI lead poisoning include neurological problems, suNch as reduced cognitive abilities, or nausea, abdominaAl pain, irritability, insomnia, metal taste in oral cavityD, excess lethargy or hyperactivity, headache and, in eAxtreme cases, seizure and coma. There are also assoc iIatBed gastrointestinal problems, such as constipation, Fdiarrhea, vomiting, poor appetite, weight loss, which Oare common in acute poisoning. Other associated effYects are anaemia, kidney problems, and reproductiIvTe problems. A direct link between early lead exposuSre and extreme learning disability has been coRnfirmed by multiple researchers and child advocacy 2groups. IV E N The above descriptions of lead poisoning are indeed frightening. If they are Uanything to go by, certainly, people in antiquity must have greatly suffered from its effect especially children. Lead is very poisonous, adults are vulnerable, but children are most susceptible. They are easily attacked because their nervous 3 systems and brains are still developing. When 1 Lead poisoning by an anonymous Roman hermit, Translated by Humelbergius Secundus, 1829 2 Lead Poisoning, sourced June 2006 from http://en.wikipedia.org/wiki/Lead_poisoning 3 http://www.healthscout.com/ency/407/287/main.html, retrieved April 2008 5 4 …ingested or inhaled, it enters the bloodstream and inhibits the production of hemoglobin, which is needed by red cells to carry oxygen, and locks onto and inactivates essential enzymes in the brain and nervous system. Lead‘s toxicity is 10 micrograms, or greater, per deciliter of blood. Blood levels as low as 10-15 micrograms per deciliter can be associated with diminished intelligence, impaired behavioral development, impaired hearing, and inhibited Y 1 growth. R RA Vazifdar (2007) claims that the toxicity of lead had beeBn identified and documented about 2000 B.C and that lead poisoning came Lto Ibe known as the ailment of the wealthy in ancient Rome. The Romans, as demonstrated above, used lead for the production of many materials suchA as Npot, wine urns, plumbing, 2 cosmetics as well as enhancing the colour and taDste of wine. Vazifdar mentions the following as some of the symptoms of leadA poisoning: IB Insomnia, lack of energFy, s luggish feeling, loss of appetite and weight, anemOia, colic, constipation, weakness in muscles; increase d aggressive and hostile behavior, increased IiTrritYability, headaches, nausea and vomiting, seizureSs, weakness of muscles, coma, lowered IQ in chRildren, learning difficulties in children and kidney E 3problems. V NI According to Jack Lewis, a former Editor of the Journal of the UEnvironmental Protection Agency (EPA) in the United States of America, ancient Romans were aware of the effects of lead; they knew it could lead to insanity or even death. They were also aware of its usefulness. To the ancient Romans lead was the father of all metals and it was associated with the god, Saturn, who ate up 1 http://www.healthscout.com/ency/407/287/main.html, retrieved April 2008 2 Vazifdar Lena, 2007, Retrieved 28th April, 2008 from http://www.divinecaroline.com/article/22182/26720-toxic-truth-lead-poisoning/2.. 3 Vazifdar Lena, 2007, Retrieved 28th April, 2008 from http://www.divinecaroline.com/article/22182/26720-toxic-truth-lead-poisoning/2 5 5 1 his young. The Longman Dictionary of Contemporary English defines saturnine as looking sad and serious, especially in a threatening way. Saturnine was a word used to describe someone whose temperament had become gloomy, cynical and taciturn due to lead intoxication. The use of lead was copious and it was accessible to almost everyone. It was used as a spermicide for birth control. Soranus in his Gynecology (I.19.61) advises that in order to prevent conception, the mouth of the uterus should be smeared with white lead. Celsus (ca 25 B.C – ca 50 A.D) and Claudius GaleRn (cYa AD 129 to ca A.D. 216) writing in his De Antidotis, (XIV.144), both provide an antidote for poisoning by white lead (V.27.12b). Lead was also used Rin pAroducing powder and mascara. It was used, as shown above, as a condBiment for food seasoning. It was used as a wine preservative to impede fer mLenItation. The piping system that supplied water to the vast majority of the pNopulace of ancient Rome and her environs became a reality as a result of lead. A The word plumbing has its root in the LDatin plumbum which means lead. 2 Montgomery (1971) argues that people espAecially aristocrats and their families who had access to water from pipes and IcBonsumed the soft water, especially of the kind that had sat on lead pipes oveFrni ght, were in actual fact consuming poison; lead poison, one of whose effeOcts is apathy. The children in these families may 3 have been worse hit. ItY is Nriagu, a geochemist (1983) who comes to the conclusion that one oIf Tthe major causes of the decline of the Roman Empire was lead poisoning mentioned above. In corroborating Nriagu, Montgomery suggests that aristocratsR whSo were the Leaders of the society, exhibited poor leadership and managemeEnt skills due to chronic lead poisoning which impaired intelligence and behavIioVural abilities. According to him, children of people especially aristocrats N 4 5were likely to be underachievers and infants suffered more death. , . U 1 Jack Lewis, (1985), Lead Poisoning: A Historical Perspective (EPA Journal), Ohio, USA. 2 Dan Montgomery, 1971, Lead, Floride, the Roman Empire and the Decline of Academic Achievement in the United States. 3 Nriagu Jerome O., 1983, Saturnine Gout Among Roman Aristocrats: Did Lead Poisoning Contribute to the Fall of the Empire? New England Journal of Medicine, 308, 660-663. 4 Dan Montgomery, 1997, Lead, Floride, the Roman Empire and the Decline of Academic Achievement in the United States. Sourced from http//sonic.net/kryptox/environ/lead/romans.htm 5 However, Scarborough a Pharmacist and a Classicist does not agree that lead caused the fall of the ancient empire of Rome. He claims that ancient authorities were aware of lead as poison, but the poisoning was not endemic. Also, in reviewing a book Lead and the Fall of Rome written by Nriagu, Scarborough postulates that it was ―full of false evidence, miscitations, typographical errors, and a blatant flippancy regarding primary sources that the reader cannot trust the basic 5 6 3.7 Plagues In antiquity there were records of plagues that affected the people. Livy documented plagues that occurred at two different periods in ancient Rome. The first of this plague recorded by Livy occurred from 463 to 462 B.C. The plague was so devastating that majority of the soldiers who were affected could not take up arms to defend the city against the invading enemy. The plague sent the consul Aebutius to his untimely grave and also left his colleague Servilius, in a ―lingerinYg 1 state.‖ Livy writes, ―. . . her strength gone and with no one to lead her, RomRe lay 2 helpless. Only her tutelary gods could save her – and her own abidingR ForAtune.‖ There was the plague and epidemics recorded by ThucydidBes (c 460-c400), an Athenian General, a historian and a political critic, who himLseIlf was a victim of this deadly plague. It is called the Athenian plague and it occurred between 430 and 426 B.C. in Athens and probably spread to RomeA. TNhis plague claimed the life of Pericles of Athens and the lives of many peopDle without discriminating between young and old. A The second plague which Livy dIeBscribes as serious epidemics occurred in 435 and lasted through to 432 B.C.F It seems probable that what Livy describes as ―serious epidemics‖ is the AtOhenian plague which may have spread to Rome. These serious epidemics Yclai med the lives of very many soldiers and civilians. Livy writes that this sIecTond plague occurs when Gaius Julius and Lucius Verginius are consuls. The Seffect of this plague destroyed all enterprise. Raids and thoughts of aggressive Roperations were not considered because of its effect. People of all classes weEre affected. It also encouraged raids from the invading enemy who came from IFVidenae. It took the generalissimo and military strategy of Aulus Servilius DNictator to beat and completely defeat the enemy. Livy records in 432 that the Uepidemics grew worse, therefore men were distracted from political agitations. As a result of the epidemic, a temple was vowed to Apollo in order to secure public health. The reason was to placate the wrath of the gods so that the epidemics arguments"( Scarborough John, 1984, The Myth of Lead Poisoning Among the Romans: An Essay Review. Journal of the History of Medicine, 39, 469-475,) 1 Livy, The Early History of Rome, Books 3, 3.6 pg 190, translated by Audrey De Selicourt, 1973, Penguin Books, England. 2 Livy, The Early History of Rome, Books 3, 3.6 pg 190, translated by Audrey De Selicourt, 1973, Penguin Books, England. 5 7 would be abolished and the populace healed. It seems probable that the people believed that the plague was caused by supernatural beings. . . . 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 1 far as Sicily. Y While Livy discusses the effect of both plagues, he does not mentioRn the effect on children. The reason is obvious. Livy is writing about poliRtics,A war and consolidation of the ancient empire of Rome. However it is easy, fBrom this history, to infer that while this plague claimed the lives of consuls, solLdieIrs, men, cattle and even farmers, the lives of children could not have been spare d by this plague. Other plagues are the Antonine, the Cyprian aAnd Nthe Justinian plagues. The Antonine plague occurred between 165 and 180D A.D when Marcus Aurelius was Emperor. The Antonine plague claimed the Alives of two Emperors, Lucius Verus (AD169) and his co-Regent Marcus IABurelius Antoninus (AD 180). In his Meditations Marcus Aurelius writFes that the plague was less deadly than the corruption of the intellectual aOspect of the existence of man. If the intellectual aspect of man was corruYpt, depravity would set in and the harm that would emanate from it woulIdT have devastating effects more than what the plague could ever muster. He was not in actual fact treating the plague and its intricacies; rather he was lookingR at Sthe falsehood and wickedness of man which he believed were far worse thanE the plague that was affecting the populace during this period. V NI It were the more desirable lot, to depart from among men, U 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 1 Ibid, Book 4: 4.25 pg 296. 5 8 surrounding fluid which we breathe. The one is only a pestilence to animals, as they are animals; but the other to 1 men, as they are men. Marcus Aurelius probably had access to the best of doctors, yet he could not survive the attack of this plague, a medical care which no other person or child could have. 2 Dio Cassius the Roman Historian writes that the disease broke out agaiYn nine years later and claimed the lives of about two thousand people. R 3 Lucian of Samosata (c A.D 125 –c A.D. 182) was an RAssAyrian, a rhetorician and a satirist. He is noted for his witty and scoffingB nature. While describing the character of Alexander of Abonoteichus (born iLn cI 105 A.D), as that of a false and fraudulent prophet, he mentions the Antonine plague. He states that people especially commoners believed in AlexAandNer‘s magic which was nonetheless ineffective against the plague wDhile also pinpointing peoples‘ carelessness in dealing with the plague becausAe of their belief in Alexander and his antics. His record of desolate houses suIgBgests that the occupants, both adults and children, were wiped out irrespectivFe o f the so called magic chant supplied by the false prophet and which was h uOng in front of such houses. His fingeIr TonYce in the Italian pie, Alexander devoted himselSf to getting further. Sacred envoys were sent all over theR Roman Empire, warning the various cities to be on their Eguard against pestilence and conflagrations, with the IV prophet's offers of security against them. One oracle in N particular, an autophone again, he distributed broadcast at a U time of pestilence. It was a single line: Phoebus long-tressed the plague-cloud shall dispel. 1 Marcus Aurelius, 1991,“Meditations” IX.2. Translated by George Long sourced from the Internet Classics Archive at http://classics.mit.edu//Antoninus/meditations.mb.txt 2 Cassius Dio, Roman History, Book 71:2.4, Translation by Earnest Cary. Loeb Classical Library, Harvard University Press, 1914 through 1927. 3 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. 5 9 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 Y carelessly without troubling to help the oracle against its R foe; were there not the words fighting their battle, anRd A long-tressed Phoebus discharging his arrows aIt Bthe 1pestilence? L The Cyprian Plague occurred about 259 A.DA. aNnd it was documented by Saint Cyprian, the Assyrian. He was a Bishop anDd a Christian writer. This plague of Cyprian, a pandemic, probably of smallpoxA, broke out in A.D. 251 in Rome and even had devastating effects on the peIopBle in Roman Carthage. The plague is named after Saint Cyprian. He not oFnly witnessed it but also vividly documented it 2 as well. It is believed that abOout 5,000 people died everyday in Rome. Below Saint Cyprian describes the pl ague and its devastating effects. This is a plague that definitely decimated thTe pYopulation at Rome during this period. In later verses of this volume, he affirIms that the plague affected everyone, pagan, Christian or Epicurean; boRys, Sgirls and adults. The description below proves that it had a painful effEect and its victims were a sorry sight to behold. V NI This trial, that now the bowels, relaxed into a constant flux, U 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 1 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. 2 Plague of Cyprian, sourced in June 2009, from http://en.wikipedia.org/wiki/Plague_of_Cyprian 6 0 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 Y have no hope in God; but rather to rejoice, and to embrace R the benefit of the occasion; that in thus bravely showinRg A forth our faith, and by suffering endured, going forwaBrd to Christ by the narrow way that Christ trod, we maLy rIeceive the reward of His life and faith accordinNg to His own 1judgment!. DA Pontius of Carthage, also a Christian Awriter, wrote the biography of Saint Cyprian shortly after Cyprian‘s death i n IaBbout A.D. 259. He gives a vivid account of the effect of the plague on its vicFtims in Carthage. Pontius‘ description is much more vivid than that of CyprianO. It brings to the fore how lethally this disease was. Works of other classical auYtho rs corroborate this fact. It is quite clear that Cyprian and Pontius did not IseTt out to write about causes of child mortality, but these excerpts clearly shSow that one can infer that this plague caused child mortality in nd rdancient RomeR between the 2 and 3 centuries A.D. A disease that could destabilizeE and kill many people as is noted in the passage below, would not been sparinIgV of the lives of children less than six. N U 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, 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. 6 1 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 Y at the remembrance of a similar event. No one did to R 1 another what he himself wished to experience. RA B LI The Justinian plague on the other hand happened between 500 and 650 2 A.D when Justinian was the emperor of the ByAzanNtine Empire. This plague affected Asia Minor, Africa and Europe. 3 D Otto Seeck argues that more than hAalf of the population of the ancient empire perished. Littman and Littman I(1B973), having studied information about the Antonine plague maintain thatF the plague was an outbreak of hemorrhagic 4 5 small pox. McNeill also sta teOs that the plague was an outbreak of small pox . Other modern authors sugYgest that it was either an outbreak of small pox or of measles which caused sTevere devastation on the population. Smith (19S96) Iwrites that the Antonine plague was introduced into the Italian PeninsRula by soldiers, who were returning from Seleucia. He claims that this plagueE wiped out a whole town. In other words, every inhabitant of this town, male IanVd female, boy and girl, infants inclusive did not outlive the disease. Smith 6coNncludes that the plague destroyed about one third of the Roman population. U 1 Pontius of Carthage, Life of Cyprian, sourced in June 2009 from http://en.wikipedia.org/wiki/Plague_of_Cyprian 2 The plague indeed lasted for fifty years. A report with this caption: Italy: Plague victims discovered after 1500 years, sourced from the Adnkronos e-news website attests to it. The website is http://www.adnkronos.com/AKI/English/CultureAndMedia/?id=1.0.2059849995 3 Otto Seeck, 1910, Geschichte des Untergangs der antiken Welt 4 Littman, R.J. and Littman M.L., 1973, Galen and the Antonine Plague, American Journal of Philology 94 : 254-55. 5 McNeill, William H. 1976, Plagues and Peoples. Bantam Doubleday Dell Publishing Group, Inc., New York, NY 6 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 6 2 Hass suggests that from the description of the diseases with regard to the Antonine 1 plague, it was an outbreak of small pox. He writes that the plague killed 2 innumerable number of people. Gillian 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 roleYs as killers of peoples, sackers of cities and most importantly, causes of Rchild mortality in ancient Rome. RA B 3.8 Superstitious/Religious Beliefs LI Ancient Romans were known to be superstitious and this superstition may have led to child death. We have seen above in HoAraceN who believes that if that woman‘s child is healed by luck or the hard woDrk of the doctor, she would carry out her vow to the god whom she believed haAd cured her son. That singular action would lead to the death of the child. ForI iBt is unhealthy to put a young child out in the cold and in effect bring back theF fev er that had earlier been cured. Hippocrates also speaks of the sacred diseaOse which is also known as epilepsy; a disease he believed was termed sacreYd b y witch doctors, quacks and charlatans who thought the disease was brougTht upon people by the gods. Since they believed it was caused by the goSds, Irather than administer the proper remedy, sacrifices were offered in the Rname of religion, therefore deaths, especially those of children, were recorded. ELanciani has also provided evidence that suggest that people in antiquity worshIipVped deities of diseases probably because they thought it was better to deal wNith diseases from a spiritual stance. Therefore, they set up altars to the god of Umicrobes and the goddess of typhoid, believing that worshipping these beings would also prevent or cure the diseases. Therefore, the need for scientific cure was not in high demand and hence resulting in a large number of deaths that could have been prevented. 1 Hass Charles, The Antonine Plague, http://lib.bioinfo.pl/pmid:17195627 2 J. F. Gilliam, 1961, The Plague under Marcus Aurelius, American Journal of Philology 82, 228-29 6 3 Although the Romans were a religious set of people, their religion did not approve the killing of children in order to appease gods or goddesses. But child sacrifice is known in other cities such as Carthage. Classical authors such as 1 2 3 Plutarch, Tertullian, Diodorus Siculus, allude to child sacrifice in Carthage, although some modern historians and archaeologists disagree (on the accuracy or 4 authenticity of child sacrifice in Carthage). 3.9 Social Deprivation Y In ancient Rome, parents neglected their children and left them in theR care 5 st of wet nurses. Soranus a medical practitioner in the 1 century A.DR advAised that mothers should breastfeed their own children for this would pBroduce optimal results, especially for the children. Where there was a def icLienIcy in this kind of care child mortality was bound to occur. Also Pliny the Elder complained of doctors AwhNo had become careless in their attitude towards the good health of the peoplDe. A Atque haec omnia med icIi B— quod pace eorum dixisse liceat — ignorantF. parent nominibus: in tantum a conficiendis Omedicaminibus absunt, quod esse proprium mYedicinae solebat. nunc quotiens incidere in libellosI, Tcomponere ex iis volentes aliqua, hoc est inpSendio miserorum experiri commentaria, credunt RSeplasiae omnia fraudibus corrumpenti. iam quidem E facta emplastra et collyria mercantur, tabesque mercium IV 6aut fraus Seplasiae sic excitetur! N U 1 Plutarch, De superstitione 171. 13, The Loeb Classical Library 1928, sourced from http://penelope.uchicago.edu/Thayer/E/Roman/Texts/Plutarch/Moralia/De_superstitione*.html 2 Tertullian, Apologeticus IX: 4 translated by Alexander Souter, The Loeb Classical Library. Sourced from http://www.tertullian.org/articles/mayor_apologeticum/mayor_apologeticum_07translation.htm 3 Siculus, Diodorus, The Library of History, Vol 1, Book XX.14, translated by Oldfather, C.H. 1935, The Loeb Classical Library. Harvard University Press. 4 Human Sacrifice, http://en.wikipedia.org/wiki/Human_sacrifice retrieved 28th September 2008. 5 Soranus, Gynaecology, 2:18-20, translated by Temkin O.G., 1948, Oxford. 6 Elder Pliny, Natural History 34.25.108., 1945, translated by H. Rackham, Loeb Classical Library. 6 4 But of all these facts the doctors are ignorant, if they will permit me to say so, – they are governed by names; so detached are they from the process of making up drugs, which used to be the special business of the medical profession. Nowadays, whenever they come on books of prescription, wanting to make up some medicines out of them, which means to make trial of the ingredients in the prescriptions at the expense of their Y unhappy patients, they rely on the fashionable druggists‘ R shops which spoil everything with fraudulenRt A adulterations, and for a long time they have been buBying plasters and eye-salves ready made; and LthIus is deteriorated rubbish of merchandise and tNhe f raud of the 1druggist‘ trade put on show!. A D Pliny the Elder is decrying the doctAors of his time. These doctors had become ignorant of their duties, rather tIhaBn get involved in the process of making drugs; they depended on drugs obtaFined from druggists‘ shops which had already been adulterated. The doctorOs were fraudulent because they encouraged this fraudulent practice by patroni zing the druggists. The doctors then dispensed these drugs to their ―unhappyT‘ pYatients. Whether the patients were aware or not did not make any differenSce. I They received this unfair treatment from doctors. The above criticism fromR Pliny confirms reckless abandon by the doctors towards their profession Ewith dire consequences to their patients old and young. IVEven then, the poor were not able to afford the services of midwives or mNedical doctors. Trained midwives were few in antiquity. Therefore, child Umortality occurred. In the words of Valerie French: It seems probable, therefore that the rates of . . . infant mortality in the Greaco-Roman world varied with the socio economic class of the family and with the family‘s 1 Elder Pliny, Natural History 34.25.108., 1945, translated by H. Rackham, Loeb Classical Library. 6 5 choice between traditional folk medicine and 1 professionalized obstetric care. Sanitation in ancient Rome was very poor, especially for the low income class, which was about 95% of the population. Private drains, which were the responsibilities of the property owners, were neglected and kitchens were located near the household latrines. These latrines were little more than culverts or cesspits. People emptied their rubbish on the streets and since there were nYo cleaning services, the overcrowded neighborhoods were putrid and beleagRuered 2 with flies and dogs, which spread diseases. Also, the public RbathAs, where everyone bathed both the sick and the healthy, was a place whereB diseases spread. Doctors recommended the bath for their patients because LtheIy believed in its potency and its therapeutic value. Considering the overcrowded neighborhoodAs, thNe poor sanitation and of course malnutrition, the mortality rate of the peoDple especially children would be high. And so, plagues claimed the lives of maAny people. Indeed, social deprivation is the key factor that caused child morta lIitBy. F 3.10 Deprivation by OParents In ancient Rome, itY see med a normal phenomenon to employ wet nurses to look after new born bIabTies. A woman writes about a daughter who had just put to bed. She just did Snot want her daughter to breast feed. It could be consequent on the idea that she thought that breast feeding was not good for the mother of the baby or it EmuRst have just been the norm, especially among women of high social standiInVg. UN 1 See Valerie‘s French Midwives and Maternity Care in the Roman World, “Rescuing Creusa: New Methodological Approaches to Women in Antiquity," Helios, New Series 13(2), 1986, pp. 70, th sourced on 28 Jan., 2007 from http://www.indiana.edu/~ancmed/midwife.HTM 2 Gigante Linda, 2004, Death and Diseases in Ancient Rome, University of Louisville. Sourced in Jan. 2006 from http://www.innominatesociety.com/Articles/Death%20and%20Disease%20in%20Ancient%20Rom e.htm 6 6 . . . I hear that you have forced her to breast feed. If you wish let the baby have a wet nurse. I do not want my 1 daughter to breast feed . . . The letter below demonstrates qualities to look for when hiring a wet nurse. . . . Chose a proper and clean wet nurse, a modest woman who is inclined neither to drowsiness nor to drunkenness. Y Such a woman can make the best judgments about how to R care for children appropriately, particularly if she has milRk A to nourish them and is not easily persuaded to B sleep with her husband, for it is in this that shLe hIas an important part, foremost and prefatory to thNe wh ole of the child‘s life . . . A The wet nurse should not Dbe temperamental or talkative or uncontrolled in heAr appetite for food but orderly and temperate, pr aIctBical, not a foreigner but a Greek . . . F She should nOot give him (baby) continual baths; it is better to have Yoccasional temperate ones. Along the same lines, the IatTmosphere around the baby should have an even balancSe of hot and cold, and his housing should be neither tooR airy nor too close. Moreover his water should not be Etoo hard nor too soft, nor his bed too rough, rather it should IV 2be comfortable on his skin. UN These qualities seem important considering the well being of the child. However it seems probable that more often than not the wrong wet nurses got the job. There were wet nurses who often got drunk, who were ill-tempered, who were not considerate, who were talkative, who did not look after the babies as they 1 rd Letter from a woman whose daughter had just had a baby. Egypt Mid. 3 Century. A.D (London Papyrus 951) sourced from Lefkowitz Mary R., Fant, Maureen B., 1992, Women’s Life in Greece and Rome A source Book in Translation, The John Hopkins University Press, Baltimore. 2 rd nd Hiring a Wet Nurse. Italy, 3 /2 Century B.C (Thesleff, pp. 123-4) sourced from Lefkowitz Mary R., Fant, Maureen B., 1992, Women’s Life in Greece and Rome A source Book in Translation 6 7 should, who were given to drowsiness, who had uncontrolled appetites among all the vices that a wet nurse should not possess. Babies, who were entrusted to wet nurses with these deficiencies above, had no good chance of survival. st And as Soranus, (1 Century A.D) advised: To be sure all things being equal, it is better to feed the child with maternal milk, for it is more suited to it, and the Y mothers become more sympathetic towards the offspring, R and it is more natural to be fed from the mother afteRr A parturition just as before parturition. But if anytBhing prevents it one must choose the best wet nurseL, leIst the mother grows prematurely old, having spe nt herself through the daily suckling. AN One should choose a wet nurse notD younger than twenty nor older than forty years, whoA has already given birth twice or thrice, who is he alIthBy, of good constitutions, of large frame and of goodF colour . . . She should be selOf controlled, sympathetic and not ill- tempered, a Greek and tidy . . . She shoulIdT beY in her prime because youger women are ignoraSnt in the rearing of children and their minds are still soRmewhat careless and childish . . . EShe should be healthy because healthful and nourishing IV milk comes from a healthy body . . N The wet nurse should be self-controlled so as to abstain U from coitus, drinking, lewdness and any other such pleasure and incontinence . . . 1 She should be sympathetic and affectionate . . The above letter from Soranus and the other letters above suggest one important matter which is that breast feeding the child by the biological mother 11 Soranus Gynaecology 2 18-20 Translated by Temkin O.G. John Hpkins University Press. 6 8 increases chances of survival of children. Another factor is that it creates bonds and a strong relationship between mothers and babies and increases the intelligence quotient of babies. It seems highly probable that in situations where there were lack of these and much more, the death of the child occurred. To buttress this 1 point, modern authors view this idea of wet nursing from the perspective that child mortality may have occurred because parents distanced themselves from their children and left them in the care of wet nurses. They think that parents did not desire to become attached to their children because the parents thought childreYn had little chances of surviving before age five. The parents graduallyA beRcame attached to them when it became obvious that the children life‘s expRectation was high. And so wet nursing may have been a common phenomenonI eBspecially among the upper class. L And with Aulus Gellius, AN . . . I pray you, woman, let her be comDpletely the mother of her own child. What sort of halfA-baked, unnatural kind of mother bears a child and thIeBn sends it away? To have nourished in her womb Fwith her own blood something she could not see and noOw that she can see it not to feed it with her own milk, Ynow that its alive and human, crying for its mother‘s aItTtention? Or do you think‘, he said, ‗that women have Snipples for decoration and not for feeding their baRbies? . . E ‗Why in heaven‘s name corrupt that nobility of IV body and mind of the new born human being, which was N off to a fine start, with the alien and degraded food of the U milk of a stranger? Especially if the person you use to supply milk is, as is often the case, from a foreign and barbarian nation, or if she is dishonest, or ugly, or 1 Schediel, Rawson, Bradley, etc all suggest this fact as one among others that probably led to child death in ancient Rome. 6 9 immodest, or unchaste, or a drinker; usually the only 1 qualification for the post is that of having milk . . . 2 Graxia Alexandria nursed her children with her own breasts. 3.11 Conclusion The causes of child mortality in antiquity include malaria, consumption, paralysis, dropsy, cough, jaundice, cholera, wasting diseases, racking painYs, agonies of thirst; hunger, feebleness of limbs, privation of bodily sensesR and epilepsy. Of all the above diseases mentioned fevers predominantly RcauAsed child death. Others causes of child death include infanticide, lead poiBsoning, plagues, superstitious and religious beliefs and social deprivation. N LI DA BA OF I ITY ER S V UN I 1 Aulus Gellius, Attic Nights 12.1 translated by Rolfe, J.C., 1927, The Loeb Classical Lbrary. Cambridge. 2 CIL VI, No. 19128. 7 0 CHAPTER FOUR CHILD MORTALITY IN IBADANLAND 4.0 Introduction In the first chapter above a brief introduction on the origin and growth of Ibadan land has been established. Ibadan land is an autonomous phenomenon, thYe exploration of whose historical, cultural economic and political ramifications Ris not only intellectually exciting, but also contributes immensely to our undRerstaAnding of 1 2 the larger society. The growth of this city has brought luxuries IanBd opportunities and these attractions have caused the city to grow at a rate thLat may have become difficult to manage, such that matters regarding heaNlth of people especially children have constituted serious challenges. A This chapter will treat in some details theD most important causes of child mortality in Ibadan from 1980 to 2005. WoArks of contemporary authors will be consulted and cited in the course of disc uIsBsions. F 4.1. Lack of Access to Pot aOble Water and Effective Sewerage System In Ibadan, predomiYnantly in the dense and unplanned parts of the city, there is, to an extent, a lackI Tof access to potable water, lack of effective waste disposal management systeSm and lack of effective sewerage connection. These have indeed caused a glut Rof illnesses that have led to death, especially among children under E 3five years of age. A study by Shi Anqing (1999), demonstrates factors that influeInVce child mortality in 237 cities in 100 countries. Ibadan and Onitsha are twNo of the 237 cities in 100 countries indicated in that research. Shi used a 1993 U 4city level data from Global Urban Indicators, to prove that lack of access to potable water, as well as lack of effective sewerage connection cause child 1 Labinjo, J (2002): Ibadan and the Phenomenon of Urbanization in Ibadan; a Historical, Cultural and Socio-Economic Study of an African City in G.O. Ogunremi (Ed.), 2 Tomori M. A. ―Ibadan Metropolitan Area and the Challenges to Sustainable Development‖ th retrieved from http://macosconsultancy.com/Ibadan%20metropolitan.html on 6 May, 2013. 3 Shi, Anqing, 2000, How Access to Urban Potable Water and Sewerage Connections Affects Child Mortality, World Bank Development Research Group, World Bank Policy Research Working Paper No 2274, Social Science Electronic Publishing, Washington D.C, United States. 4 This is a product of the United Nations Center for Human Settlements (UNCHS). 7 1 mortality. In other words, if a high percentage of the populace in Ibadan has access to potable water and effective sewerage connection, then child mortality rate would be reduced. In the same vein, if the government participates fully in delivering potable water and effective sewage connection, Ibadan 62 per 1000 1 child mortality rate would be drastically reduced. Osinusi (2007) writes that twenty percent of the over one billion people of the world who lack access to clean water live in sub-Saharan Africa and that 2.4 2 3 billion people lack access to proper waste disposal. Since about 50% of IbadanY‘s population lack access to potable water, people are left with the option of obtaRining water from unhygienic sources. The consequence is an increase inR deAbilitating illnesses such as typhoid fever and cholera, and, therefore, an increBase in the rate of child death in Ibadan. LI One of the unhygienic sources which people obtain water from is water vendors. Although, Water Tankers‘ Operators claiAm tNhey obtain the water they vend from hygienic sources, it is a well known Dfact that majority of them collect water from nearby streams. The water from Astreams is contaminated by bacteriae that cause infectious diseases that lead toI Bchild death. It is to avoid such mortality that nursing mothers are strongly adFvised not to feed their babies with water, but to 4 breast feed them exclusively forO the first six months. In a conversation with Popoola Oluwafemi, a medical practitioner at the University College HIoTspitYal Ibadan, he explains that nursing mothers are advised to desist from feeSding their babies with baby milk formula, and other food items until the babieRs are four months old. The reason is that many illiterate women are likely to uEtilize water collected from wells and other unhealthy sources to feed their IbaVbies without purifying it. The children soon get infected with diarrhea or chNolera, which, according to Popoola Oluwafemi, are leading causes of child Umortality in Ibadan. 1 Shi, Anqing, 2000, How Access to Urban Potable Water and Sewerage Connections Affects Child Mortality, World Bank Development Research Group, World Bank Policy Research Working Paper No 2274, Social Science Electronic Publishing, Washington D.C, United States. 2 Osinusi Kikelomo, 2007, Environment and Child Health, Archives of Ibadan Medicine vol 8, 2 3 Ibid 4 This does not negate the fact that nursing mothers should naturally breast their babies exclusively for the first six months because breast milk contains all the necessary nutrients a baby needs for that period. 7 2 As a matter of fact, Popoola Oluwafemi further explains that a high incidence of child death recorded at the University College Hospital between 1980 and 1990, resulted from diarrhea and cholera. Majority of the children who succumbed to these diseases belonged to illiterate mothers. These women are not knowledgeable about the dangers involved in utilizing water obtained from unhealthy sources. Other unhygienic sources where people collect water from, are wells and nearby streams. Although water from deep wells is pure, the case is different wheYn the wells are in overcrowded areas of Ibadan in which the housing is typicaRlly in bad conditions. People obtain water from these sources, especiallRy wAhen they cannot afford buying water from water vendors. Many people whBo use water from these sources do not purify it. Therefore it becomes easyL foIr children to get infected with water-borne diseases. Another point to consider is that majority of tAhe Npeople in Ibadan who lack access to potable water and effective seweraDge connections also lack other infrastructures such as effective sanitation seArvices, adequate housing conditions, free education, regular power supplies aInBd free medical services for children less than 6. These are infrastructures Fthat should cushion the effects of health and economic challenges facing thOe people. These sets of people who live in the densely populated areas of Iba dan such as Oje, Bere, Mokola and Sango are worst hit. And Shi concludesT: peYople who live in cities enjoy clean and potable water as well as other infraSstruIctures such as needed for survival. And people who live in rural areas laRck infrastructures such as effective sanitation services, adequate housing cEonditions, free education, regular power supplies and free medical servicIeVs for children less than 6. Therefore, their health is negatively affected. TNhis is to say that although Ibadan is a city; some of these densely populated and Uunplanned areas in Ibadan can be compared to rural areas, in terms of the unavailability of social amenities such as pipe-borne water and electricity. 1 The World Health Organization shows that lack of access to potable water in sub-Saharan Africa, and other continents, is known to be a cause of child death. 1 UN-Habitat Collaborative agencies: WHO (World Health Organization)/ UNDESA (United Nations Department of Economic and Social Affairs), 2003, Cities: Competing Needs in an Urban Environment, pg 160-187. Earthscan Publications, London. 7 3 1 Puffer, R.R. and C.V. Serrano (1973) also demonstrate that a high percentage of households in Latin American cities with cases of child death do not have access to 2 3 potable water supply. The World Health Organization (1978), Schultz (1980) 4 and Feachem (1981) link access to potable water, effective sewerage system and child mortality. These are causes of child mortality, in Ibadan. 4.2. Environment The environment can have negative impact on the health of the child iYn various ways. Last (2001) defines the environment ―as all the physical, cheRmical and biological factors external to the human host and all related beRhavAiors, but 5 excluding those natural environments that cannot be reasonablyI mBodified.‖ The 6World Health Report informs that the greatest environmentLal factors that affect child health, apart from safe drinking water and sanitation include air pollution. 7 Also the WHO affirms that many households in deAveloNping countries depend on unprocessed biomass fuel, which includes wooDd and coal. These contribute to 8 environmental factors that cause child mortalAity in Ibadan. Osinusi (2007) shows that indoor cooking with this unprocess eIdB biomass fuel, often takes place in poorly ventilated areas: hence, indoor pollFution. In addition, Osinusi further shows that indoor kerosene burning ―lead sO to the accumulation of volatile organic compounds 9and polyaromatic hydrocYarbons which are injurious to health.‖ These are situations that occurI Tin Ibadan every day. Children (under five) are most vulnerable. Other eRnviSronmental factors which cause child mortality in Ibadan, are lead content paEints and lead content gasoline. Children are more exposed to leaded I V 1 Puffer, R.R. and C.V. Serrano. 1973. Patterns of Morality in Childhood, Pan American Health ONrganization, Washington, D.C. 2U World Health Organization. 1978. Main Findings of the Comparative Study of Social and Biological Effects on Perinatal Mortality. World Health Statistics 31(3). 3 Schultz, T. P. 1980. Interpretation of Relations among Mortality, Economics of the Household, and the Health Environment. World Health Organization, Geneva.. 4 Feachem, R. 1981. The Water and Sanitation Decade. Journal of Tropical Medicine and Hygiene, Vol 84 (2). 5 th Last J.M, 2001, A Dictionary of Epidemiology, 4 edition. New York: Oxford University Press, International Epidemiological Association 6 World Health Report, 2002, Reducing risks, Promoting Healthy Life. Geneva, World Health Report 7 World Health Report, 2002, Reducing risks, Promoting Healthy Life. World Health Report, Geneva. 8 Osinusi Kikelomo, 2007, Environment and Child Health, Archives of Ibadan Medicine Vol 8, 2 9 Osinusi Kikelomo, 2007, Environment and Child Health, Archives of Ibadan Medicine Vol 8, 2 7 4 1 paints than leaded petrol. Adebamowo et al (2006) show that children are at greater risk of exposure to leaded paints than leaded petrol in Nigeria. Having measured lead levels of locally produced paints from nineteen samples, they discover that lead levels in paints are high. Children are wont to put items in their mouth. They peel dry paints from walls and chew them. Leaded paints and gasoline have been completely phased out in many developed countries of the world but not in Nigeria. Until lead free paints are produced locally, child mortality would continue to occur in Ibadan. Y 2 Osinusi emphasizes that leaded gasoline is responsible for about 90R% of airborne lead pollution in countries where it has not been banned. In RIbadAan, only high content leaded gasoline is used; and yet there is a dearth Bof the resources needed to evaluate the percentage of lead in the environmenLt. IAlso, no law has been passed to phase out completely lead conteNnt gasoline in Ibadan. 3Corroborating Adebamowo et al, Anetor (2008) alsAo affirms that leaded gasoline is in use in Ibadan. He shows that high lead coDntent has been discovered in fish sold in Nigeria markets. Lead is knownA to contribute to hypertension and reproductive disorders. It is also an enIdBocrine disruptor. It reduces intelligence quotient. It causes anemia; shortenFs lo ngevity; causes hearing loss; compromises immunity and causes congenitaOl malformation. It also causes deficit in growth and 4 development. Although Ysom e of these ailments have been mentioned in the third chapter of this thesis IinT regard to Rome, it is necessary to restate them here. Lead is very poisonous.S If it gets into the body system, death is inevitable. When lead poisoning occuRrs, it is usually difficult to diagnose and put a finger on it until it has done its daEmage. Leaded petrol contributes greatly to lead exposure in general. In 1980,I AVfrica contributed 5% worldwide. In 1996 its contribution increased to UN 1 Adebamowo E.O, Agbede O.A, Sridhar M.K.C., Adebamowo C.A., 2006, An Evaluation of Lead Levels in Paints for Residential Use Sold in the Nigerian Market. Indoor and Built Environment, Vol. 15, No. 6, 551-554. 2 Osinusi Kikelomo, 2007, Environment and Child Health, Archives of Ibadan Medicine vol 8, 2 3 Anetor, J.I., 2008, Lead Exposure from use of Lead Petrol in Nigeria, A presentation at a one-day symposium on Environmental lead exposure organised by The Institute for Advanced Medical Research and Training (IMRAT). 4 Anetor J. I., 2005,. Decreased total and Ionized Calcium Levels and Haematological Indices in Occupational Lead Exposure as Evidence of Endocrine Disruptive Effect of Lead. Journal of Occupational and Environmental Medicine. 9:15-21 7 5 1 20%. Anetor concludes that about 90 percent of Nigerian children are exposed to 2 lead poisoning. Therefore lead poisoning has caused and is still causing child mortality in Ibadan. 4.3. Cholera 3 Falade and Lawoyin (1999) carried out a study which shows that cholera leads to child mortality. This is evident in the 1996 cholera epidemic. They agree that of the cases of cholera seen, 95 percent were children of people who lived iYn the unplanned, densely populated areas of Ibadan. They believe that the provRision of clean and potable water to the residents of these areas should helpR in Ano small way to arrest the spread of cholera. Studies have also shown thaBt child mortality 4 rates are less in privileged areas. Residents who live in pLlanIned and sparsely populated areas of Ibadan, such as the Old and New Bod ija enjoy better social facilities and of course better health conditions than pAeopNle who live in places such as Oje, Bere and other unplanned, densely poDpulated areas of Ibadan. Some Residents who live in these planned and spAarsely populated areas have private boreholes and wells providing clean IaBnd potable water. They also acquire pumping machines for effective wFater circulation in their homes. Those having wells keep the water clean wi thO purifying agents. They even boil the water before drinking it. The story is Yusually the opposite in densely populated areas. Wells that are in such placeIsT are polluted with dirty bathroom slippers, chewing sticks, toothbrushes and sSilt. Water from them is not boiled before drinking. ER I V 1 ANnetor, J.I., 2008, Lead Exposure from use of Lead Petrol in Nigeria, A presentation at a one-day Usymposium on Environmental lead exposure organised by The Institute for Advanced Medical Research and Training (IMRAT). 2 Anetor ,J.I. & Adeniyi F.A.A. (2000).Lead poisoning in Africa: A silent epidemic. Journal of African Science. Vol. 1, pg 28. 3 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. 4 Timaeus, Ian M. and 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. 7 6 4.4. Measles In Ibadan measles also account significantly for child death. Lagunjun et al (2006), examined the period January 2000 to December 2004, to determine change/s in the pattern of this disease. They reviewed record of cases admitted into the Oni Memorial Hospital in Ibadan on account of measles and discovered that the annual occurrence of the disease from 2000 to 2002 was fairly consistent but by the year 2003, there was an obvious increase. Between 2000 and 2004, oYf the 667 patients admitted for measles, majority of them (74.1%) were chiRldren under 2 years of age. Others, (25,9%) were infected by the diseRase Abefore 9 months of age, the stipulated time for measles vaccination. B With measles came other complications such as L―brIonchopneumonia, protein-energy malnutrition, tuberculosis, keratopathy, otiti s media, heart failure and tension pneumothorax.‖ Of the 667 admittedA, fifNty-six patients who died constitute a death rate of 8.4%. Lagunju et al caDtegorically states that, of patients who died from measles, children under two Ayears of age and children who were malnourished were in the majority. In cIoBnclusion, they suggest that immunization policies should be reviewed, immuFniz ation practices should be strengthened, and 1 living standards should be imOproved. These would aid in the eradication of measles, and of course, a sYhar p reduction, in child death. More research should be carried out to make iTt possible to immunize children who are less than nine months. My own SchilId was infected with measles before nine months. R 4.5E. Malnutrition IV 2A study carried out by Rossington reveals that Protein Energy MNalnutrition (PEM) is a major health problem among children who reside in the UOje area of Ibadan. The study considers the effects of economic, demographic and socio-cultural factors on the growth and nutrition of a small group of children. The children are aged between one and five years and they belong to poor families in 1 Lagunju I.A,, Orimadegun A E, Oyedemi D G, Dec., 2005, Measles in Ibadan: a continuous scourge. African Journal Of Medicine And Medical Sciences,34(4):383-7. 2 Rossington Christine E., Environmental aspects of child growth and nutrition: A case study from Ibadan, Nigeria, http://www.springerlink.com/content/j411340633671u40/ 7 7 1 Ibadan. Also, Bamgboye and Familusi studied the trends and levels of pediatric death at the children emergency ward of the University College Hospital (UCH) at Ibadan. They demonstrate that between 1978 and 1986, Malnutrition and low birth weight among neonates also led to their death. They also mention, alongside malnutrition; measles, tetanus, jaundice, gastroenteritis and bronchopneumonia as diseases that led to child death. Akinyole et al (2004) discovered that sixty percent of child deaths in Nigeria are related to Protein Energy Malnutrition (PEM) making it the greateYst single cause of child mortality. They write, ―if no action is taken, PEM will bRe the underlying cause of about 2.5 million child deaths between now and thRe yAear 2015. This is about 700 deaths everyday in the next 5 to 6 years, which Bis five times the estimated number of child deaths that are attributable to HIV/LAIIDS over the same 2 3 period of time.‖ Akinyele (2005) also believes that as a result of malnutrition people who are infected by HIV/AIDS tend to sucAcumNb quickly to the disease. Children under five, succumb easily to these situDations especially if malnutrition is involved. However Akinyole et al and AkinAyele suggest that economic poverty, poverty of information, which in othe r IwBords is lack of information necessary to inhibit the spread of HIV/AIDS, abeFt mortality. O 4.6. Apathetic Atti tude of Health Workers Oyedeji (2005)T subYmits that when health workers become efficient, their efforts would have cIonsiderable effect on what he terms the 5Ds which include Death, DiseaseR, DSisability, Discomfort and Dissatisfaction. It seems probable that this attitudEe is correlated to wrong attitude to work. That is, health workers reportIinVg late for duty; and not carrying out their duty with all sense of reNsponsibility and conscientiousness. Visiting some hospitals in Ibadan four or Ufive years back, the nonchalant attitude of health workers was conspicuous. Since the patient could not do anything about it, they tended to appease the workers by offering some financial inducement to get better attention. Patients who could not 1 Bamgboye EA, Familusi J.B, 1990, Mortality pattern at a children's emergency ward, University College Hospital, Ibadan, Nigeria. African Journal Of Medicine And Medical Sciences, 1990 Jun;19(2):127-32. 2 Akinyole, I.O., Amire, F.T. Ajayi, O.A., Sanusi, R.A., (2004). PROFILES: A nutritional advocacy tool for Nigeria. Technical Committee of ANG Working Group IITA/USAID. 3 Akinyele, O., 2005, Poverty, Malnutrition and the Public Health Dilemma of Disease. University of Ibadan Postgraduate School Interdisciplinary Research Discourse. Ibadan. 7 8 give remained at the mercy of these workers. However, this attitude seems to be changing, thanks to recent administrative efforts by Chief Medical Directors of various hospitals, where these practices have hitherto been prevalent. 4.7. Lack of Genuine Concern Oyedeji maintains that there is a need to carry out certain activities to lift the burden that diseases have placed on us. One of his suggestions is that everyone should be genuinely concerned about the problems of diseases and child death iYn Ibadan. We should emulate developed nations in the aspect of disease controRl, and hospitals should become more involved in effective medical trainRing. AMedical practitioners and other health workers should get involved inB training others especially, unorthodox medical practitioners. Information LneIcessary for good 1 health should be disseminated to everybody. If concerted ef forts are made to ease the burden of diseases, then more children would be sAaveNd in Ibadan and in Nigeria as a whole. AD 4.8. Out-of-Hospital Births IB Orimadegun, et al (2008) Fcarr ied out a study on out-of-hospital births. They collected data on the pla cOe of birth, morbidity and outcomes of all neonates admitted into the EmergeYncy Ward of the University College, Ibadan. They discover that of the I54T1 babies admitted, 61.8% are delivered outside hospitals while 38.2% are Sdelivered in hospitals. Children born outside hospitals are categorized anRd the percentages of these categories are given as follows; babies born in reEligious houses 46.7%; those delivered in residential homes, traditional birth IatVtendants homes and on the way to the hospitals, 38.0%, 8.4%, and 6.9% reNspectively. Orimadegun et al also show that out-of-hospital births are Usignificantly associated with complications such as hypothermia, perinatal asphyxia, hemorrhage, cephalhematoma, prematurity and neonatal tetanus. These complications lead to child death. They also assert that more than half of these out-of-hospital deliveries are handled by untrained personnel and facilities. They claim that illiterate women and those from the lower social class are more likely to 1 Orimadegun A.E, Akinbami, F.O; Tongo, O.O;.Okereke, J. O, 2008, Comparison of Neonates Born Outside and Inside Hospitals in a Children Emergency Unit, South West of Nigeria, Pediatric Emergency Care. 24(6):354-358.June 2008. 7 9 deliver their babies out of hospital. In comparing neonates born outside and inside hospitals in Ibadan, Orimadegun, et al, conclude that the neonatal mortality in the out of hospital group of 12.6% is significantly higher than that obtained in the 1 hospital birth group of 6.3%. It is important to note here that it is not only illiterates and women in the lower social class that deliver their babies outside hospital settings. A lot of literate women in the middle social class also employ the services of these out-of- hospital birth attendants and midwives. There is therefore the need for effectivYe monitoring and retraining of birth attendants and midwives in this out-of-hoRspital group, in order to save the lives of babies born outside hospitals. RA It is known that many expectant mothers, especially thosIe Bof lower classes prefer the services of traditional midwives who utilize traditioLnal or local methods in treating their patients, rather than go to a medical centre. It is known that some of the medications prescribed by many of thesAe tNraditional midwives, are 2 extensively herbal, and pharmacologically benDeficial to patients . Traditional healers cannot be ignored. They enjoy large pAatronage for they have been a part of the Nigerian society from time immeImBorial. Barriers between modern and traditional health providers are fasFt b reaking down and so attempts to prevent people from patronizing tra dOitional medical practitioners are bound to fail. Therefore they need to be mYonitored and retrained to reduce child death. 4.9. Table IT1 Babies admitteRd S 541 % of BabieEs born outside hospitals 61.8% NumbIeVr of Babies born outside hospitals 334 DNeaths 68 U% of deaths 12.6% % of Babies born in hospitals 38.2% Number of Babies born in hospitals 207 1 Orimadegun A.E, Akinbami, F.O; Tongo, O.O;.Okereke, J. O, 2008, Comparison of Neonates Born Outside and Inside Hospitals in a Children Emergency Unit, South West of Nigeria, Pediatric Emergency Care. 24(6):354-358.June 2008. 2 Erinosho O.A, 1998, Health Sociology pg 64, Sam Bookman Educational and Communication Services, Ijebu-Ode, Nigeria. 8 0 Deaths 34 % of deaths 6.3% Total death 102 % of total death 18.9 Total survivors 439 % of total survivors 81.9 The table demonstrates that babies born outside hospitals were more iYn number as against those born inside hospitals. Furthermore, babies bornA ouRtside hospitals constitute the larger number. BR 4.10. Malaria LI Malaria is known to be a killer disease. Orimadegu n et al (2008) carried out a study at the University College Hospital, IbaAdanN (UCH). The study is to determine the effects of malaria (plasmodium falDciparum) on children in particular and the society in general. They found thBat fArom 2000-2005, severe malaria cases constitute 11.13 percent of 16,031 admIissions, with 89.1 percent being children below 5 years of age. Of all the sFeve re malaria cases, cerebral malaria is 19.17 percent. They also show, fro mO malaria, a yearly mortality rate ranging from 8.7 percent to 13.2 percent, wYith significant increase from 2000-2004. And of all pediatric deaths, malaIriTa accounts for 12.14 percent. And significantly associated with deaths fromS malaria are age (less than 2 years), hypoglycaemia and 1respiratory disRtress. In conclusion therefore, they suggest that it may be necessary to update tEhe strategies on malaria control as it contributes not only to child death, but alIsVo affects, adversely, the economy and other aspects of development in the society. UN 4.11. Poverty Apart from diseases, other social factors are also responsible for child mortality in Ibadan. One of such is poverty. Nigeria is ranked as among 13 poorest nations in the world. Seventy percent of her citizens live in poverty and 1 Orimadegun A.E, 2006, Increasing Burden of Childhood Severe Malaria in a Nigerian Tertiary Hospital: Implication for Control, African Journal of Medicine and Medical Sciences. 35(2) 132- 145. 8 1 1 37.5 percent live in extreme poverty. Many families are so poor that they can barely eat three square meals a day. They also eat unbalanced diet, which leads to kwashiorkor, a fatal disease common among children of the poor. Poor people have to purchase local herbs from markets in the Ibadan metropolis to treat diseases because they cannot afford to pay for drugs prescribed by orthodox 2 medical Practitioners. The general term for the herbal preparation is agbo. Agbo herbal medications are cheap and are severely limited and no effect in curing many diseases that affect children such as neonatal septicaemia, severe birth sphyxiYa, malignancies, congenital heart disease, post neonatal tetanus infantile cholesRtasis, neonatal tetanus and HIV/AIDS. RA Agbo Jedi is used to cure dysentery and diarrhea. A type oBf agbo is used to treat meningitis; another, for sickle cell anemia; another, forL mIeasles and so on. One particular agbo is said to be a cure for all the diseases. This, of course, is not true. In spite of these, unorthodox medicines enjoy lAargeN patronage from members of the society, especially the poor. According toD Oyedeji the poor health status in Nigeria is aggravated by ―the old diseases Arefusing to go‖ and ―the old poorly controlled diseases fighting back and IwBith new incursions, and new emerging 3 threats.‖ These old diseases thaFt h ave refused to go are neonatal tetanus, meningitis, cholera, typhoid feOver and dysentery. Supporting his theories with those of Ayoola, et al, (2Y005) he mentions measles, malaria, meningitis, severe malaria, pneumonia,I Tsepticaemia, severe malnutrition, gastroenteritis, severe anaemia, tubercuSlosis, neonatal jaundice, sickle cell anaemia, renal diseases, congenital malformation, hepatitis, congenital heart disease, post neonatal 4 jaundice, inEfanRtile cholestasis and HIV/AIDS as causes of childhood deaths. NI V U 1 Nigeria, Are there new types of regulatory partnership in Nigeria that could enable poor people to obtain safe and effective treatment for Malaria? th http://www.futurehealthsystems.org/country/nigeria.htm. Retrieved on December 11 2008. 2 Agbo is a collection of several herbs used for treating various ailments. It has its traditional name in every dialect that is spoken in Nigeria. A few is mentioned here. The yorubas call it agbo. The Ibo s call it ogu iba. The Ishan man calls it ikhumhun esan 3 Oyedeji G.A, 2006, “Easing The Burden Of Diseases” Faculty Of Clinical Sciences Week Lecture University of Ibadan 4 Oyedeji G.A, 2006, “Easing The Burden Of Diseases” Faculty Of Clinical Sciences Week Lecture University of Ibadan 8 2 4.12. Other Causes of Childhood Deaths Ayoola et al (2001) carried out a five-year period research. This research was done in the six wards of the Pediatric unit of the University College Ibadan, between the period January 1996 and December 2000. The purpose of the study was to describe causes of childhood deaths and also measure the health of children. From the table below Ayoola et al demonstrate causes of child death, the number of cases of death and the percentage starting from the principal causes to the minor one. Y R Table 3 RA 4.13. Principal Causes of Childhood Deaths in Ibadan from 199B6-2000 Causes of Death Number of death PercLentIage Neonatal Tetanus 163 N13.8 Prematurity and low birth 136 A 11.5 weight D Neonatal Septicaemia 124 A 10.5 Severe Birth sphyxia 124 IB 10.5 Meningitis 87 F 7.3 Severe Malaria 73O 6.2 Pneumonia Y5 6 4.7 Septicaemia IT 55 4.6 Severe MalnutritioSn 52 4.4 Measles R 42 3.5 MalignVancEies 41 3.5 GastrIoenteritis 31 2.6 SeNvere Anaemia 29 2.4 UTuberculosis 28 2.4 Neonatal Jaundice 26 2.2 Sickle Cell Anaemia 26 2.2 Renal Diseases 13 1.1 Congenital Malformation 12 1.0 Hepatitis 11 0.9 8 3 Congenital Heart Disease 10 .8 Post Neonatal Tetanus 10 .8 Burns 7 .6 Acquired Heart Disease 6 .5 Infantile Cholestasis 5 .4 HIV/AIDS 4 .3 Other Neurologic 3 .3 Infection Y Metabolic Disorder 3 .3 AR Rabies 2 .2 R Kerosene Poisoning 3 .3 IB Drug reactions 3 .3 L Pyomyositis 2 N.1 Total 1185 A 100.0 Source: Ayoola, Orimadegun, Akinsola, OsinAusi 2D006 Of the 12,522 children admitted, 1I,1B85 deaths were recorded. This figure brought the mortality rate to 9.5%. F From the research, it was discovered that there was no marked increase in dea tOh rates in the periods under study. However 48.8 % of death occurred within Y24 hours of admission, while neonatal deaths made up 50.8 % of the 1,185 ItoTtal numbers of deaths. Ayoola et al noted that the major causes of death weSre, ―neonatal tetanus, prematurity and low birth weight, neonatal septicaemia, Rsevere birth asphyxia, meningitis, severe malaria, pneumonia, septicaVemiEa, severe malnutrition, and measles.‖ They also observed that children who dIied from sickle cell anaemia were those above 5 years of age. In conclusion, thNey agreed that majority of the deaths occurred in neonates and these deaths could U 1have been prevented. 2 In a debate between the University of Ghana and Ibadan, Acquah explicates the United Nations Millennium Development Goals as eight goals meant for 1 Ayoola O.O, Orimadegun E.A, Akinsola A K, Osinusi K, 2001, A five-year review of childhood mortality at the University College Hospital, Ibadan. West African Journal of Medicine: 24 (2):175- 9. 2 Acquah Samuel Jude, 2006/2007, The UN Millennium Development Goals are a Reality and Not a th Myth. Retrieved on 11 December 2008, from 8 4 sustainable development. These eight goals are contained in the Millennium Declaration which was adopted unanimously by the 189 members of the United Nations in September 2000. Reducing child mortality was among the eight goals to be achieved by 2015. While declaring that these MDGs can be achieved in Africa, Acquah agrees that the Acquired Immune Deficiency Syndrome (AIDS), diarrhea, malaria, measles and respiratory diseases will continue to lead to child death. He also maintains that these diseases can be prevented and or be remedied 1 by simple low-cost methods. The MDGs affect almost every facet of the health oYf the people especially children. Except the necessary equipment and facilitieRs are put in place in Ibadan, achieving the above eight goals, especially theR fouArth goal, which is reducing child mortality, may be slow and complicated. B LI 4.14. Vitamin A Deficiency (VAD) Vitamin A deficiency is another factor responAsibNle for child death. VAD is said to be the leading cause of preventable sigDht impairment and blindness in children of less than five years of age. A chiAld could become blind and die within a year due to VAD. McLaren et al (2 00I1B) affirm that VAD increases the risk of severe illness and death from commFon childhood diseases especially measles and 2 diarrhea. O th Reporting for the DYail y Champion of 26 August, 2008, Dele Ogunyemi clearly stated that the TOyo State Commissioner for Health, Dr. Isaac Babalola addressed an audSiencIe at Ikereku in the Akinyele Local Government Area of Ibadan at theR launch of Vitamin A awareness campaign. The Commissioner admitted tEhat malnutrition which accounts for 60% and Vitamin A Deficiency (VADI)V which also accounts for 25.1% of death are the major causes of under-five deNath. Dr. Babalola showed that one out of five children does not live until age Ufive. He attributed 70% of this malady to childhood diseases which include malaria, acute respiratory tract infections, pneumonia, diarrhea, measles and http://ugdebate.scientificghanaian.com/index.php?view=article&catid=34%3Aspeeches&id=45%3 Ajude&option=com_content&Itemid=53. 1 Acquah Samuel Jude, 2006/2007, The UN Millennium Development Goals are a Reality and Not a th Myth. Retrieved on 11 December 2008, from http://ugdebate.scientificghanaian.com/index.php?view=article&catid=34%3Aspeeches&id=45%3 Ajude&option=com_content&Itemid=53. 2 McLaren DS, Frigg M., 2001, Sights and life Manual on Vitamin A Disorders (VADD), 2nd edition, pg 24, Task Force Sight and Life Magazine, Basel, Switzerland. 8 5 malnutrition. Dr. Babalola stressed that the greater the intake of vitamin A in children, the greater their chances of survival. The Commissioner also demonstrated that research had shown that improving the ―Vitamin A status of children of 6-59 months dramatically increased their chances of survival by reducing all the causes of mortality by 23 per cent; reducing measles mortality by 1 50 per cent and reducing diarrhea mortality by 33 percent.‖ Maziya Dixon, Busie B. et al carried out a study on food consumption nutrition survey in Nigeria in order to formulate strategies that would addresYs VAD. The main objective of their study is to examine VAD status in childreRn less than five years. They discover that the size of children with VAD diffRer amAong the agro ecological zones of the country; 31.3% in the dry savanna, 24B.0% in the moist savanna, and 29.9% in the humid forest and VAD in childrenL leIss than 5 years is 2 25.6% in the rural sector, 32.6% in the medium sector, an d 25.9% in the urban sector. As a result they assert that Vitamin A DeficiAencNy (VAD) is a major health problem in developing countries, Nigeria incluDsive. Children less than 5 and pregnant women are the most vulnerable. TheAy also show that VAD is the primary reason for visual impairment and blind nIeBss. These are medical conditions that are preventable. They discover that VAFD‘s prevalence is higher in the rural areas than in urban areas, the reason beingO probably, higher urban income, enlightenment and access to better social infraYstru cture. They conclude that although progress is being made towards the reIdTuction of VAD, there is a need to accelerate efforts at 3combating this VASD in Nigeria with the intention of bringing it under control. HumphRrey et al (1992) calculate approximately that VAD may be 4responsibleE for as many as 1.3–2.5 million deaths annually worldwide. Rice et al reveaIl Vthat about twenty to twenty four percent of child death resulting from 5mNeasles, diarrhea and malaria can be ascribed to VAD. Beaton G.H et al (1993) U 1 Ogunyemi Dele, Daily Champion, August 2008, Nigeria: Malnutrition, Major Cause of Child Mortality, retrieved in Sept 2008 from http://allafrica.com/stories/200808260290.html 2 An area that cannot be described as rural or urban. 3 Maziya-Dixon B, Akinyele IO, Sanusi RA, Oguntana EB, Harris E., 2004, Vitamin A Status of Children under 5 in Nigeria: Results of the Nigeria Food Consumption and Nutrition Survey. Presented at the XXII International Vitamin A Consultative Group (IVACG) Meeting, Vitamin A and the Common Agenda for Micronutrients,15–17 November 2004, Lima, Peru. 4 Humphrey JH, West KP Jr, Sommer A., 1992, Vitamin A Deficiency and Attributable Mortality among under-5-year olds. Bull World Health Organ. 1992;70:225–32 5 Rice AL, West KP Jr, Black RE. Vitamin A Deficiency. Available from: http://www.who.int/publications/cra/chapters/volume1/part2/en/index.html 8 6 also suggest that if the Vatimin A status in young children in developing countries 1 is improved then child death rate could be reduced by twenty to fifty percent. The 2 WHO (2001) estimates that 250,000–500,000 who are vitamin A deficient become blind every year, and about a half of them dies within a year of becoming 3 blind. The WHO also shows that VAD increases the risk of problems such as iron deficiency, anaemia in women and children, and thereafter increases growth deficits in young children. Akinyinka et al (2001) assert that VAD and PEM (Protein EnergYy Malnutrition), which share similar aetiological factors; are public health probRlems among malnourished as well as well-nourished Nigerian children,R paArticularly those less than 3 years of age. Their study include a survey of 128B well-nourished and 230 malnourished pre-school children in order to deLterImine the factors ―associated with increased risks of VAD . . .‖ They discover that 29.3% and 70.8% of well-nourished and malnourished children respectAivelNy had incidences of VAD, and that the danger of VAD is increased followinDg measles, a history of persistent 4 diarrhea and wasting. A 5 Ajaiyeoba (2001) writes that thIeBre is high prevalence of VAD in under privileged communities in the worlFd. He assumes that the deficiency of VAD in Nigeria may cause an increase iOn blindness, child morbidity and mortality. Urgent action need to be taken bYy the government of this country to bring this disease under control. AjaiyIeoTba is also able to determine the prevalence of VAD in four geographic zones Sof the country; Northeast, Northwest, Southeast and Southwest. The result shoRws that there is prevalence of VAD among children in these zones except in Ethe Southeast zone where the prevalence is the lowest. The reason attributVed to this is that palm oil which is high in vitamin A is consumed regularly I 1 U NBeaton GH, Martorell R, Aronson KJ, Edmonston B, McCabe G, Ross AC, Harvey B., 1993, Effectiveness of vitamin A supplementation in the Control of Young Child Morbidity and Mortality in Developing countries. Nutrition Policy Discussion Paper 13: Administrative Committee on Coordination-Subcommittee on Nutrition, Geneva, Switzerland, WHO. 2 World Health Organization, 2000, Nutrition for Health and Development: a Global Agenda for Combating Malnutrition, Geneva, Switzerland, WHO. 3 Food Agriculture Organization. World Health Organization. 1992, World declaration and plan of action for nutrition. International Conference on Nutrition. Rome, Italy, Food Agriculture Organization 4 Akinyinka O.O, Usen S.O, Akanni A., Falade A.G., Osinusi K., Ajaiyeoba I.A., Akang E.E., 2001,Vitamin A Status of Pre-School Children in Ibadan (South West, Nigeria), Risk Factors and Comparison of Methods of Diagnosis, West African Journal of Medicine, Jul – Sep; 20 (3): 243-8. 5 Ajaiyeoba A.I., 2001, Vitamin A Deficiency in Nigerian Children, African Journal of Biomedical Research. Ibadan Biomedical Communication Group, Vol 4, Numb 3, 107 -110. 8 7 by people in this zone. The study also shows that children between 60 and 71 months are most susceptible to VAD, probably because at this time, the vitamin A 1 which was stored up during breastfeeding period would have been exhausted. This study demonstrates that VAD working with diarrhea, measles and malnutrition increase the risk of child mortality at that age. Sommer et al (1986) assert that if a diet is supplemented with vitamin A, there will be a reduction in child mortality which is caused by VAD related 2 illnesses. Food items such as oranges and sweet potatoes are rich in vitamin A anYd so children should be fed with this fiber plant in order to enrich their vitamRin A status. Other food items rich in vitamin A, apart from red palm oil,R whAich has a high content of beta-carotene, include: yellow fruits such as mangBoes and papaya, 3 and liver. The Department of Preventive Medicine oLf tIhe Northwestern University, Chicago, USA, writes that the following fNood , fruit and vegetables items are rich in vitamin A: liver, beef, chicken liver,A canned pumpkin, raw carrots, baby carrots, sweet potatoes, squash, butternut, Dfresh mangoes, cooked and fresh spinach, cantaloupe, apricots, collard greeAns, kale, vegetable juice, broccoli, 4 romaine lettuce and fortified skimme dI Bmilk. Some of these food, fruits and vegetable items are common here inF Ibadan. The Federal Governm Oent of Nigeria is providing children under five with vitamin A vaccine at the UYCH. The Oyo State Government under the leadership of Alao Akala should foIlTlow the footsteps of the FG. The Oyo State government should make vitaSmin A vaccines available at all state hospitals. More efforts should be madRe, especially at the local or grassroots levels, towards ensuring that children arEe not deficient of this important vitamin. People should be educated aboutI tVhe importance of vitamin A for children under 6 years of age. However, prNegnant women have been warned not to take too much of vitamin A. Food item U 1 Ajaiyeoba A.I., 2001, Vitamin A Deficiency in Nigerian Children, African Journal of Biomedical Research. Ibadan Biomedical Communication Group. Vol 4, Numb 3, 107 -110. 2 Sommer A, Tarwotio I, Djunaedi E, 1986, Impact of Vitamin A Supplementation on Childhood Mortality- A Randomized Controlled Community Trial. The Lancet Vol 1:1169-1173. 3 http://www.healthandyoga.com/html/food/effect.html, retrieved 28th Jan 2009. 4 http://www.feinberg.northwestern.edu/nutrition/factsheets/vitamin-a.html, retrieved 28th Jan. 2009 8 8 such as liver should be avoided by pregnant women, because it contains a high 1 amount of vitamin A. 4.15. HIV/AIDS 2 Vallaeys Charlotte writes that the AIDS virus has ravaged the continent of Africa and that except ―serious awareness campaigns, ideological changes, economic stability and educational opportunities for all are securely 3 implemented,‖ this virus would continue to wreck more havoc on the peoplYe. 4 WHO asserts that AIDS is presently the greatest reason for mortality in ARfrica. Eighteen million Africans have succumbed to the disease; one or boRth pAarents of twelve million African children have died from the disease. And B500, 000 babies are born HIV positive annually in Africa. Ferriman (2001) sLhoIws that presently, only twenty-five thousand (25,000) Africans have access to anti-retroviral drugs. In other words, of every ten thousand (10,000) HIVA poNsitive Africans, only one 5 6 receives apposite drugs , . D In Ibadan, the AIDS virus is a virAulent killer of children under five. Although the University Teaching HospIiBtal in Ibadan makes concerted efforts to help in reducing the risk of HIV in Fbab ies, yet this virus is still wrecking havoc on women and children. Some NOGOs in Ibadan are working hard towards the provision of aids and retroYviral services to orphans and other children who are HIV positive. However, tIheTy record losses with regard to the lives of these children. Children who liveS in the urban areas are opportune to have these aids and drugs. But those whRo live, especially in densely populated areas of Ibadan are not so fortunate inE receiving assistance, in terms of the provision of retroviral drugs, other V 1 th HNealtIhy Diet, 8 Tips for Eating Well, Retrieved January 28 , 2009 from Uhttp://www.eatwell.gov.uk/healthydiet/nutritionessentials/vitaminsandminerals/vitamina/ 2Vallaeys Charlotte, Awareness Is Not Enough: Gender in the HIV/AIDS Pandemic in Africa, retrieved January 28th, 2009 from http://www.scu.edu/ethics/publications/submitted/vallaeys/gender.html 3 Vallaeys Charlotte, Awareness Is Not Enough: Gender in the HIV/AIDS Pandemic in Africa, retrieved January 28th, 2009 from http://www.scu.edu/ethics/publications/submitted/vallaeys/gender.html 4 World Health Organization and Joint United Nations Programme on HIV/AIDS (UNAIDS), December 2001, AIDS Epidemic Update 5 Ferriman Annabel, May 2001, UN Calls for $10 billion to Wage War on AIDS, British Medical Journal 322, p. 1082. 6 This is an exaggeration. Presently, I am aware of a non-governmental organization that provides apposite drugs and vitamin enhanced products to at least 50 people; children and adults alike, in Ibadan. 8 9 aids and emotional support. Therefore, there is child death resulting from HIV infection. 4.16. Maternal Illiteracy Another social aspect to be considered is maternal illiteracy. As indicated above, this is an important feature when considering child health in Ibadan. Femi Popoola and Ehimen Aneni, medical practitioners at the University College Hospital, admit that doctors, nurses and health workers find it less challenging Yin diagnosing the disease of children whose mothers are literate. R 1 Adamson (1986), a Columnist at the New International,R wrAites that maternal literacy may be the most powerful single factor determinBing child health and survival. He asserts that Sri Lanka and the Indian State Lof IKerala are among the poorest regions of the world whose per capita Gross Na tional Income (GNPs) is less than $750 dollars per annum. He postulates thaAt alNthough they are among the poorest in the world, they record the lowest infanDt mortality. He asserts that these countries invest heavily in the education oAf girls, majority of who go beyond 2 primary institutions. IB Caldwell (1979) comparingF inf ant mortality rates in two distinct areas of the city of Ibadan, discovers thOat the death rate among children of women with elementary education is 3Y0 per cent lower than those of women with no formal education. ThereforeI, The asserts that ―maternal education is the single most 3significant determSinant of these marked differences in child mortality.‖ An educated mothRer, irrespective of her level of income, understands the necessity of immunizatEion, antenatal care, breast feeding, hand washing, weaning, home hygieIneV and the treatment of basic illnesses and injuries. With Adamson, edNucation ―tends to undermine fatalism and resignation, substituting a degree of Uconfidence, a different perception of the possible, an awareness of choice, an attitude of questioning, a belief that decisions can be made, circumstances changed 1 Adamson Peter, 1986, Why Reading Keeps Children Alive, New Internationalist, issue 164, October 1986. Retrieved in September 2008 from http://www.newint.org/issue164/reading.htm 2 Ibid 3 Caldwell J.C., 1979, Education as a Factor in Mortality Decline An Examination of Nigerian Data, Population Studies, Vol. 33, No. 3, pp. 395-413, Population Investigation Committee. 9 0 1 and lives improved.‖ In addition, an educated mother understands that the smaller the size of her family the greater the chances of survival. Also she understands the importance of child spacing, to reduce both maternal and child mortality. 4.17. Socio Cultural Beliefs a. Unhealthy Delivery Practices Unhealthy delivery practices are responsible for child mortality in Ibadan. Some people believe that the delivery of a baby must be done at home under thYe supervision of an elderly woman of the family. And after delivery, cow duRng is used in dressing the cut umbilical cord because it is believed that Rit wAould aid effective healing. Cow dung is known to have tetanBus spores and 2 microorganisms. If the cord is infected with these pathogenLs, Iit would result in the death of the child, especially if the child is not treatedN ear ly enough. A b. Figure of Authority D Another factor to consider is the delaAy of treatment for a sick child. It is believed that except a figure of authoritIy Blike the father or the head of the family gives the mother permission to takeF a sick child to the hospital or a health centre, the mother will not take the r esOponsibility. This issue is common in polygamous homes. c. The OSgbaI TY nje or Abiku Phenomenon The ORgbange (Ibo) or Abiku (Yoruba), is a cultural phenomenon that had and still hEas considerable influence on childhood mortality in many cities in NigerIiaV. An Ogbanje or Abiku is a child who dies and is reincarnated over and ovNer again until some spiritual rites are performed to arrest and bind the spirit of Uthis ogbanje or Abiku. Abiku literally means ―born to die.‖ This phenomenon is common among children between 0 and 5 years. Among the Yorubas in Ibadan, the baby or child is branded to stop his or her gimmicks of frequent deaths and reincarnation. There are certain names reserved for them such as Kasimawo, 1 Adamson Peter, 1986, Why Reading Keeps Children Alive, New Internationalist, issue 164, October 1986. 2 Kayode, Clara M., Owoaje Eme T., Omotade Olayemi O., 2007, Sociocultural Issues in Child Health Care in Nigeria, Archives of Ibadan Medicine, Vol 8, 2 9 1 Kokumo, Jitoni, Ikumapayi. It is generally believed that the late Philanthropist in Nigeria, Moshood Kasimawo Abiola, was suspected to be an Abiku because of his name. His mother had had six children who had died. He was the seventh child and was named Kasimawo. It is believed that the name prevented the baby from dying and reincarnating. As for mutilations, Pastor Oye Paul Taiwo, a Lecturer in the Department of Linguistics, University of Ibadan, recounts the story of a woman who is about forty years of age now. The mother of this woman had had six children who had died. At the death of the sixth child, the fingers of the dead babYy were chopped off. At the birth of the seventh child who happened to bRe this woman, her fingers were without nails. And she is still alive today. R In Aregard to child mortality, the abiku phenomenon is still a factor in Ibadan aBnd indeed other parts of the country. LI The issue here is that a woman would have lost thNree or more babies before the survivors. Some of these abikus or ogbange arAe a particular sex, sometimes they could be different sexes, but the incision Dwould prove that they were the babies who died earlier. A 1 Uche Madu who hailed from ItBhe Eastern part of Nigeria told of an experience. His aunt had had sixF (6) children consecutively, but they all, in exhibiting this ogbanje or abikuO trait, died after birth. The longest surviving child lived for only a year. It soY ha ppened that after the death of each child an incision was made on either thTe hand or the face. When the next pregnancy occurred everyone prayed aSnd Ihoped that the child would survive, but in vain. Asked if the babies took ilRl and were treated accordingly, he asserted that the babies were usually ill.E They developed some form of fever, and the parents took the babies to the hIosVpitals. Drugs were prescribed by medical doctors and these drugs were adNministered, but the children died after a few days. This continued until the death Uof the sixth child. The baby exhibited the same traits and died afterwards. This time, the mother of the baby decided to heed the advice of native doctors. After the death of the sixth child, Uche‘s aunt had become weary of this depressing experience and decided to put an end to it. She chopped the dead baby into bits and pieces, burnt it and threw the ashes into the bush. Some months later, she took in again and had a safe delivery. The ogbange trait has since ceased and now she 1 For the purpose of confidentiality the real name is not presented. 9 2 has four surviving children. They believed that this was possible because she heeded the advice of the native doctors. Many cases of this type still abound today, even in Ibadan although it is not on the same scale. 4.18 Taboos and Myths 1 The Nigeria Tribune of September 2008 informs that many African taboos and myths on children‘s nutrition have devastating effects on child health and are the causes of child mortality in Nigeria. Some of these taboos include the belief bYy some people that children should not eat eggs, because feeding children withR eggs is an overindulgence that would stimulate the act of stealing when theR chiAld grows up. However medical science has proven that growing children sIhBould be fed with an egg a day as it enhances the intelligence quotient of th eL child as well as his health. There is also the belief that, children who areN fed with milk especially powdered milk tend to steal from their parents, Aand eventually from others. However, it is known that milk is a rich source Dof protein and good for growing children. On the other hand, amala, ewedu, Aeba, fufu,garri, pap or ogi and tuwo alone are unbalanced diets for effective gIrBowth. Mojiroluwa Adebosin, who Fonc e lived somewhere in Old Ife Road, Ibadan related the story of one of he r Oilliterate neighbours. Iya Kafaya‘s three year old child had taken ill. MojYiroluwa advised her to take the child to the hospital. Having been convincIedT, she went to see a doctor. After examining the child, the doctor noticed thaSt the child was suffering from kwashiorkor. The doctor then 2prescribed somRe drugs for the child and told Iya Kafaya to give the child balanced but cost efEfective diet. He particularly told her to ensure that the child was fed with IfiVsh, eggs, milk, beef and chicken. She later informed Mojiroluwa that the doNctor only suggested those food items because he did not understand the root of Uthe problem. She told Mojiroluwa that her husband‘s other wife was responsible for her predicament. Having listened to her lamentations, Mojiroluwa begged her to at least change the child‘s diet. If nothing happened, then they would look for alternatives. She looked at Mojiroluwa with disbelief. She could not understand why Mojiroluwa would take the doctor‘s side. As far as she was concerned, the 1 Seye Adeniyi, Impact of taboos, myths on Children's nutrition, IQ , health , Nigerian Tribune Sept 25th, 2008 2 Not her real name 9 3 doctor‘s advice was not an option. She would administer the drugs, but not the food items because children were to be fed with these food items only on festive occasions such as Christmas, Easter and Sallah. ―I do not want this boy to become a thief when he grows up. That is exactly what would happen if I should feed him 1 with those food items. I can give him beef or pomo .‖ The poor child was given 2 3 pap in the morning for breakfast, eba with pomo and sometimes, fish in ewedu 4 soup for lunch and eko in the evening for supper. These are days when the child would have three meals a day. Some other days, he had just two. She decided tYo consult herbalists who gave her portions to ward off the evil hands of her Rmate. She kept up with this attitude until she lost her son. The docRtor Ainformed Mojiroluwa that the cause of death was kwashiorkor. There are tBhousands of Iya Kafaya in Ibadan. Mama Laide, a Cleaner, believes that childLrenI who are fed food items such as eggs and chicken grow up to become thieve s. Mr Ojo, a Trader, claims that children who are fed these food items becAomNe greedy as they grow up. Also Miss Laitan another Trader, holds the samDe view as Mama Laide. These people male and female, literates and illiteratAes, feed these myths to their children and except the children become educaIteBd enough to understand the difference between myths and realities, they Fwo uld in turn feed the same stories to their children. Malnutrition, stun teOd growth and ultimately child mortality would continue. TY 4.19. ConcSlusIion ResearRch and studies have all shown that diseases such as malaria, cholera, dysentery, Etyphoid, neonatal tetanus, neonatal Septicaemia, meningitis, pneumonia, measlIeVs, gastroenteritis, tuberculosis, neonatal jaundice, severe anaemia, prNematurity and low birth weight, infantile cholestasis, and post neonatal tetanus Uare causes of child mortality in Ibadan. Furthermore, environmental problems such as lead poisoning, air pollution, poor sanitation and lack of access to potable water and ineffective sewerage management cause child death. Vitamin A deficiency, 1 Animal skin 2 cassava flour made solid 3 blended green vegetable leaves cooked and served with stew 4 solid pap 9 4 Protein Energy Malnutrition, HIV/AIDS and socio-cultural beliefs, are also factors that have, and still cause child death in Ibadan. RY RA LI B DA N A F I B Y O T SI VE R I UN 9 5 CHAPTER FIVE CHILD FUNERARY INSCRIPTIONS 5.0. Introduction Birth and death in ancient Roman Empire were not documenteYd. Therefore, there are no records kept for the purpose of further studies or revRiews. Latin epitaphs were put up for the dead by loved ones. They constitute somAe of the 1 evidence available to elucidate infant mortality. BR Analyses of the inscriptions throw light on child dLeatIh in the society. Inscriptions typically give the name of the dead and aNge, and the name of the dedicators. The social status of the deceased and the Aemotions of the giver can also be deciphered from the inscription itself. AD 5.1. Importance of Latin InsIcrBiptions There are various Latin insFcri ptions which portray many aspects of the culture and civilization of the ancient Roman Empire. Some inscriptions depict different areas of the adYmi ni Ostration (of the affairs) of the Roman Empire. Inscriptions throw lighItT on social mobility, political careers of people, leadership of notables as well Sas roles of imperial legates and patrons in Rome and other 2territories suchR as Roman Tripolitania. The family, life history and achievements of eminentE personalities such as Septimius Severus, the African and Emperor of RomaInV 3 Empire, are brought to the fore. Other inscriptions inform about Roman 4ocNcupation and institutions in territories conquered by Rome. Through Uinscriptions religious sanctuaries which were functional areas of relevant importance in the lives of the people are brought to light. 1 See J.O. Ojoade, 1973, Health in Roman Africa Museum Africum, Ibadan 2 Aneni M.O., 2003, Social Mobility In Roman Tripolitania, M.A., Project (unpublished), Department of Classics, University of Ibadan. 3 Ibid 4 th http://www.novaroma.org/nr/Interview_the_Expert#Latin_Epigraphy, Retrieved on 25 June, 2007. 9 6 Inscriptions also throw light on the lives of people drawn from all walks of life as well as their culture. The daily lives of men and women, old and young, rich and poor, slaves and freedmen/women and citizens, Emperors and warriors are all depicted on inscriptions. Funerary and honorary inscriptions inform about the public and private profile of people, including the elite (senators, equites and city aristocracies) and simple folks (citizens without any public role, workers, women, children, freedmen, slaves). There is no gainsaying the fact that inscriptions are sources of ancient history. Therefore, the importance of Latin inscription Yin throwing light on different aspects of the history of ancient Rome, cannot be Rfar to 1 seek. Schmidt (2007) writes that Latin inscriptions ―are of inestimaRble Avalue as sources for the study of Roman life and history in all aspects.‖ 2 B Oliver (1998) writes that tombstones reveal attitudes LtowIards children and th infants in the Greaco-Roman world. He confirms an inNscri ption on a 4 Century B.C Athenian tomb which depicts Ampharete holdinAg a child. The inscription on the tombstone says; AD I hold this dear child of my IdBaughter, whom I held on my knees while we were alFive and looked with our eyes upon 3 the light of the sun , Owhom now dead, I dead hold. This inscription throwITs liYght on relationship that existed between children and adults, especially Sbetween children and parents. This inscription suggests that, in spite of infantRicide practiced in the Greaco-Roman world, a healthy relationship existed betEween children and parents on the one hand, and between children and grandIpVarents on the other hand. UN 5.2. Understanding Child Funerary Inscriptions To understand Latin inscriptions commemorating children, there is the need to understand the various characteristics that make up such inscriptions. The 1 Schmidt Manfred G, 2007, Corpus Inscriptionum Latinarum, translated by Orla Mulholland, Berlin-Brandenburgische Akademie Der Wissenschaften. 2 Oliver G.J, 2000, An Introduction to The Epigraphy of Death in the Epigraphy of Death edited by Oliver G.J, Liverpool University Press. 3 Oliver G.J, 2000, An Introduction to The Epigraphy of Death in the Epigraphy of Death edited by Oliver G.J, Liverpool University Press. 9 7 features include; the name of the child being commemorated, the age of the deceased at death, abbreviations, name of the dedicator, emotions of the commemorator and the status of the parents. 5.3. The Name of the Child Commemorated Most funerary inscriptions dedicated to children bear names of the child for whom the inscription was put up. The names are usually the praenomen followed 1 by the nomen gentilicium, and then the cognomen. The forename is the namYe 2 given to a boy or girl on the eight day after birth. Rogan (2006) asserts thaRt if a 3 child died prematurely only the praenomen would appear on the gravRestoAne. He also states that the nomen gentilicium or nomen was the name giveBn to all members of a family or clan, old Latin names had us as endings, tLhoIse with Etruscan, Umbrian or Gallic origins ended with as, anus and acus oNr auus respectively. From the names one is able to determine Awhether the recipient was a Roman citizen or the child of a freedman, or aD Greek whose country has been absorbed by the Roman Empire. The nameAs also pinpoint the sex of the child; most Roman names that are masculine IeBnd with us or ius while feminine names usually end with a or ia. ExamplesF of masculine names include Iulius sometimes written as Ivlivs, and Antoniu sO. Feminine names include Florentina, Iulia, and Pompeia. Below are examples of names of recipients while demonstrating the sex as well in inscription.I TThYe name of the person commemorated, grammatically, is usually in the dativSe case. R 5.4E. The Period of Time the Deceased Lived. IVMore often than not, as evident from inscriptions listed above, the number ofN years, months and days the recipient spent on earth is or are indicated. UHowever, after qvi vixit, there is always anni II or ann IV or ann III, M III or men III, Dies or Dieb VII. 1 Keppie Lawrence, 1991, Understanding Roman Inscriptions, The John Hopkins University Press, Baltimore 2 Ibid 3 Rogan John,2006, Reading Roman Inscriptions, Tempus Publishing Ltd, Great Britain. 9 8 5.5. Abbreviations Abbreviations are also a constant convention in Latin inscriptions. These abbreviations were used for lack of space on the writing platform. It was a common phenomenon in antiquity and it was believed that everyone who read an inscription was able to decipher the abbreviations. However, today, it is important that one must not confuse abbreviations with other letters that stand alone. These letters stand alone because the other letters needed for their completion have either been destroyed or lost. Rogan (2006) asserts: ―It is customary to print aYn inscription in full, expanding the abbreviations, and where there are missing wRords, to supply them wherever possible . . . Brackets ( ) enclose letters whiRch hAave been added to the text in order to print a word in full, rather than inB an abbreviated 1 form.‖ He shows that abbreviations in inscriptions wereL aI common feature throughout the empire and that as soon as one become s familiar with these 2 abbreviations, translating and understanding inscriptiAons Nbecome effortless. For abbreviations we find words such as DVIX, M, MEN, D, DIE, DIEB, A, AN, ANN, DM, ATQ, BMF, H, AED, PREAT.A VIX is indicative of vixit. M or MEN represents MENSIS, D or DIEB signif ieIsB DIEBUS; A or ANN stands for ANNIS; DM or DMS, letters which usually mFake up the first line, should be DIS MANIBUS or DIS MANIBUS SACRUM; AOTQ stands for ATQUE; BMF is BENE MERENTI FECIT; H represents HORUS; AED and PREAT both represent AEDILE and PRAETOR. Also for IpTropYer nouns, we find Q which stands for Quintus, or C for Gaia and CN for GSNAEUS. ER5.6. Name or Identity of the Dedicator. IVThe name or identity of the person dedicating an inscription is also another coNnvention associated with Latin epigraphy. More often than not, it is usually a Umember of the family, or put in a more emphatic sense, a loved one of the departed. In some other inscriptions, apart from the ones commemorating children, the individual dedicating, is the deceased. The inscription is put up by the deceased before his/her demise. 1 Rogan John, 2006, Reading Roman Inscriptions, Tempus Publishing Limited, Great Britain. 2 Ibid. 9 9 5.7. Emotions of the commemorator Emotion is usually displayed on inscriptions. Emotion displayed expressed sadness at the demise of a loved one. The loss of a child indeed caused considerable emotional distress. Epithets such as dulcissimus or dulcisimae, piissimus, pientissimus, are endearments that highlight this fact. Sorrowful word such as infani is also indicative of emotion at the loss of the child. Inscriptions in this chapter do prove that a wonderful relationship did exist between parents and children. Parents generally loved their children and so were sorrowful at the losYs of a child. Seneca chided Marullus for being so emotional at the loss of hAis iRnfant son. R B solacia expectas? Convicia accipe. Mollititer tu eLs mIortem filii; quid faceres, si amicum pedidisses? Decissit filius incertae spei, parvulus, pusillum temporisA perNiit. D Is it solace that you look for? LeAt me give you a scolding instead. You are like a w omIBan in the way you take your son‘s death; what wouldF you do if you had lost an intimate friend? A son, a l itOtle child of unknown promise is dead; a Y 1fragment of time has been lost. T It is imposSsibIle for parents not to grieve at the loss of a child. Marullus may have beenR aware of the ideology that shows that it was not proper to express such emotiEons at the death of a child (considering the fact that he may have been an assIoVciate of Seneca), but because of the love he had for his child, he could not buNt grieve at the loss. Seneca who was chiding him was only consoling him. UMarullus was the one who was likely to put up a monument for his child and epithets such as dulcissimus, bene merenti, or carissimus would be displayed on the headstone. Grief experienced by the parents or the dedicator which is displayed on inscriptions is genuine. As a matter of fact, while reading inscriptions dedicated to children, the reader senses the pain or grief of the dedicator/s. The aforementioned epithets prove beyond doubt that the loss of a child was very 1 Seneca, Epistula Mors, 99, translated by R.M. Gummere Loeb Classical Translation 10 0 painful. As have been earlier mentioned, it is only natural for parents to express grief at the loss of a dear one, even a child. These epithets go a long way to 1 explain child mortality in ancient Rome. King does argue that although an aspect of the culture of the Romans may not have supported the idea of expressing grief openly at the loss of a child, grief must have been the motivating factor for erecting a headstone in the first place. Some modern historians doubt the sincerity of the grief displayed on inscriptions. Shaw claims that grief that is seen on inscriptions is an artificial andY a cultural act rather than true expressions of loss felt by the dedicator. He wAriteRs; R The erection of a permanent memorial to the deceasBed, a practice with nothing naturally, or biologically nLecIessary about it, is a distinctly artificial and culturNal a ct; not an automatic response triggered by death, buAt a cultural act . . . 2 even more artificial than the relationsDhips that it records. A Susini (1973) postulates that ―iInBscriptions helps to reconstruct, not the history of the individual as it actualFly w as, but the individual as he wanted them to 3 appear viv-a-vis both contemOporary and future society.‖ Dixon claims that ―sepulchral inscriptions reYpre sent the fulfillment of a duty and, by definition the T 4display of proper seIntiment.‖ Nielsen, 1997, suggests that the language that display grief usedS by parents on inscriptions is an ―. . expression of the broken 5expectations aRnd hopes of parents of their now dead children.‖ TheE aforementioned authors may argue in the above manner, because very little IisV known, through the works of classical authors, of relationship that existed beNtween parents and children. But inscriptions are informing and bringing to light; Uamong many aspects of the society, parent/child relationship. Taking an in-depth look at the inscriptions in this chapter, there is no doubt that the sentiments displayed on the inscriptions are a proof of the sorrow felt by parents at the loss of 1 Op cit 2 Shaw B.D, 1987, The Age of Roman Girls at Marriage, Some Considerations, JRS 77, pp 30-67. 3 Susini Giancarlo, 1973, The Roman Stonecutter: An Introduction to Latin Epigraphy, Oxford. 4 Dixon S., 1992, The Roman Family, Baltimore and London. 5 Nielsen H. S., 1997, Interpreting Epithets in Roman Epitaphs, in the Roman family in Italy, ed Rawnson B., Canberra and Oxford, pg 169-204. 10 1 a child. These epithets are a constant feature in most of the inscriptions cited in this study. 5.8. The Symbol of the Cross + + This is a convention also discovered on Latin epigraphy and it suggests that the people who put up these inscriptions were Christians. Inscriptions of this kind 1 date to the first centuries A.D. Carroll (2006) explicates that these type of inscriptions offer insights into the belief system, social structures, and forms oYf expressing the identity of the deceased. Christianity became the officialR state religion in AD 392 under Emperor Theodisius, and consequently alRl paAgan cults were outlawed. This religion spread rapidly from this period espBecially after the conversion of the Frankish king Clovis in AD 496. It spreLad Iin the Gallic and German provinces, and in Germany beyond the empireN‘s f ormer frontier. There are about 30,000-35,000 surviving epitaphs. This cAonstitutes the largest body of Christian inscriptions and it comes from Rome. D The inscriptions are a variety of inscribed, incised, or painted texts on simpAle stone slabs. Others are tiles, and mortar seals on the niches (loculi) of iInhBumation burials in the more than sixty 2 underground catacombs, inscribed sFton e stelae and sarcophagi. O 5.9. The StatusY of P arents From the inscIriTptions presented in this chapter, the status of parents who put up epitaphs caSn be deduced. People in the lower class were wont to use limited materials to convey their messages. People in the upper class were accustomed to make elaboEratRe epitaphs such as those found on arches and statues. Sussini asserts that iIt Vwas expensive to put up inscriptions for the dead. Therefore, the poor utNilized materials small in size and within their means to convey their messages. UOne may conclude that inscriptions of five lines and less were installed by the lower class. The table below displays the number of children that were commemorated 1 Carroll M., 2006, Spirits of the Dead Roman Funerary Commemoration in Western Europe, Oxford Studies in Ancient Documents. Oxford. 2 Carroll M., 2006, Spirits of the Dead Roman Funerary Commemoration in Western Europe, Oxford Studies in Ancient Documents. Oxford. 10 2 th in the 10 volume of the CIL used in this study. This does not indicate the population during the period in antiquity. However, it does present some important issues that can be considered. 5.10. Table 1. The number of male and female children below age 6 commemorated Males Females Total Age 0-12 months 2 - Y Age 1 16 2 AR Age 2 14 14 R Age 3 19 8 B Age 4 15 6 LI Age 5 13 9 N Total 79 39 118 DA This table demonstrates that oBf tAhe 118 inscriptions analysed, 39 commemorated female while 79 were pIut up for males. Broad meanings can be drawn from this. F a. 67% of males w eOre commemorated and 33% of females were remembered evYen in CIL X. b. PreferenceI fTor the male child may have necessitated commemorating more mSales than females. c. MRore male children succumbed to death than females d. EFemales were probably more susceptible to diseases and any other IV cause of child death at the age of two. UN 5.11. Inscriptions Below are some of the inscriptions detailing child death in ancient Rome. It is important to note that from the inscriptions here one can easily decipher and understand them as they indicate the name, age and sex of the child, the period of time the child lived, abbreviations, name and identity of the dedicators, emotions of the commemorator, the symbol of the cross and the status of parents. 10 3 D M CN IVLIVS FE LIX CN IVLIO FELICI FILIO QVI VIX ANN II MEN VIIII 1 DIE VNO Y To the divine shades. Gn(aeus) Julius Felix dedicate this monument Rto the son Gn(aeus) Felix the son, who lived for two years nine months and oRne dAay. B D M LI NARCISSVS VIXIT ANN III AN DIEB XXVIII D 5. THALLYS ET A 2 PANNYCHIS IB FILIO DVLCIS F SIMO FECER 3 OS.T.T.L TY To the spirits Iof the departed. Narcissus lived for three years and twenty- eight days. TRhallSys and Pannychis erected this monument in memory of a very charming sEon. Rest in peace. V CNOELIIAE COMAE COELIUS COMINUS ET SECUN- UDILLA PARENTES FILIAE KARISSIMAE FECERUNT 4 UIXIT ANNOS V MENS UII D III H II 1 CIL Vol X, 7601, pg734 2 The names Thallys and Pannychis are Greek. As Rome conquered territories beyond the Italian peninsular, many foreign names were introduced. Discharged auxiliary soldiers and others gaining Roman citizenship could, and many did, continue to use at least a portion of their former names for themselves and their children. Most were of Greek or Etruscan origin, while others came from regions that were brought under Roman influence. 3 s(it) t(ibi) t(erra) l(evis)] 4 CIL Vol X, 989 pg 44 10 4 Coelius Cominus and Secundilla, who are the parents, erected this monument to a charming daughter by the name of Coelia Coma. She lived for five years, seven months, three days and two hours. BONO ET INOCENTI IS SPIRITO RESPECTO QVI VI XIT AN I ME IIII ROGATVS Y LECTOR FILIO PIISIMO R 1 FECIT IN HIS. A BR I give respect to the good and harmless spirit. RogatLus ILector made this monument for his pious son who lived for one year and fNour months. He lies here, buried. A D D M S A L OVIVS MI IB NICIVS FLA F VIANVS VIX O 5. ANN IIII ME NS VII D VI P 2 TY ATER F SI To EtheR divine shade. Lovius Minicius Flavianus lived for four years seven monthIsV and six days. His father erected the memorial. UND M FLABIAE LESTVTIAE ET FLAVIO RESPECTO FILIS DVLCISSIMIS FEMIN VIXIT ANNIS 5. III M. X. D. XXI PVER VIXIT ANNO I 1 CIL Vol X, 7610 pg 787 2 CIL Vol X, 33 pg 7 10 5 M. VI D XVI FLAVIVS RESPCLVS PATER FILIS VENE VENE 1 MERENTIBVS TVMVLV FECIT. To the divine shades. To Fabia Lestutia and Flavius Respectus, very charming son and daughter who lived for three years ten months and twenty-one days. The boy lived for one year six months and sixteen days. Worthy of the best, the father Flavius Respclus made the headstone for the children. RY D M S RA GAVIAE DONATAE FILIAE DVLCIS B SIMAE QVAE VIX ANN II. M. V LI DIEBVS XI GAVIVS QVINTILI 2 5. ANVS ET ELBIA DONATA PARENTES AN D To the divine shades. To Gavia DoAnata a very charming daughter who lived for two years five months and elevIeBn days. Gaius Quintilianus and Elbia her parents donated the headstone. F O IN NOMINE X HIM OPPIO PAVLO DVL TY CISSIMO FILIO QVI VIXIT AN V M XSI D II 5. DEPOSE VIRII IDVS MAIAS IV 3+ B M + UN In the name (of God) from here onwards. To Oppius Paulus, a very lovable son who lived for five years eleven months and two days. Laid here on the eight Ides of May. He is worthy of the best. D M 1 CIL Vol X, 2454 pg 266 2 CIL Vol X, 2472 pg 262 3 CIL Vol X, 8140 pg 967 10 6 L IVNIO RUFO VIXIT 1 ANNIS III. To the divine shades. Licius Junius Rufus lived for three years. puer in birco sedens seticam tenet. DIS MANIBVS Y P RABIRIVS HYMNVS V. M. VIII D. V. R 2 RABIRIA PHOEBE MATER. RA B While sitting on a horse, the boy is holding garlands. LI To the divine shades. P(ius) Rabirius Hymnus lived for eight months and five days. Rabira Phoebe is the mother. N DA D M A TI ANT VRBANV IB QVI VIX ANNO I F M. VII. D.XII VRBICVS O 5. ET FAVSTINA FILIO T3DVLCISSIMO B.M.F I. Y To theR divSine shades. T(iberius) Ant(oninus) Urbanus who lived for one year sevenE months and twelve days. Faustina made the monument for a very sweet son. WIVorthy of the best. UNC. VETTIAE GRA TE C. L. QVAE VI XIT ANNIS DVO BVS MENSIBVS 5. DVOBVS DIEBVS 1 CIL Vol X, 2620, Pg 276 2 CIL Vol X, 2908 pg 280 3 CIL Vol X, 2080 pg 244 10 7 VIII SANCTISSI ME AC DVLCISSI ME BENE MEREN TI AVRELIVS 10. CENTICIHVS 1 NVTRITOR. To G(aia) Vettia Grate G(aia) L(ucia) who lived for two years two monthYs and eight days. A very holy and sweet daughter worthy of the best. Ti(Rerius) Aurelius Centichus brought her up. RA B C. TERENTIVS RA LI RVS VIXIT ANNIS III DIEBVS XVIII AN C. TERENTIVS CAR D 5. POFORVS ET TE A RENTIA FORTVNATA IB FILIO SANCTVS 2 F SIMO. O G(aius) terentIiuTs RYarus lived for three years and eighteen days. G(aius) Terentius CarpofoSrus and Terentia Fortunata made it for a very holy child. D M ER CC. HIEVLVIIS MARCIA NNO Q. V. ANN IIII M. VI D. UXXVII EVPHORIANVS Q. V. 5. ANN III M. I D. XXII C HEL VIVS MARCIANUS PA 3 TER DVLCISSIMIS POSVIT. 1 CIL Vol X, 648 pg 74 2 CIL Vol X, 642 pg 72. 3 CIL Vol X, 2501 pg 269 10 8 To the divine shades. To G(aius) Helvius Marcianus who lived for four years six months and twenty-seven days. Euphorianus who lived for three years, one month and twenty-two days. G(aius) Helvius Marcianus the father put up the memorial for his very sweet children. D M L. LOL SEVERO EVSEBIO QVI VIX ANN V Y M IIII D. IIII L. LOL SE R 5. VERVS ET OTACILIA RA APOLLONIA FIL DVL B CISSIMO BENEME I 1 L RENTI FECERVN. AN To the divine shades. For L(ucius) LoliuDs Severus Eusebius who lived for five years four months and four days. L(Aucius) Lollius Severus and Otacilia Apollonia, made the memorial for a sw eeItB son worthy of the best. F 5.12. Conclusion O The inscriptions anal yzed in this chapter have shown that in spite of infanticidal practices,I pTeoYple were concerned about the lives of children. They went ahead to ereSct epitaphs for children irrespective of the age. This is a socio-cultural systemR that is common to ancient Rome. Also, various conventions associated Ewith Latin epigraphy have also been explained here. These convenVtions, when well understood, are effective tools in seeing meanings coNnveIyed on inscriptions commemorating children. U Inscriptions commemorating children between the ages of 0 and 5 have been treated here. It is highly probable that inscriptions with five lines and less, indicate that the dedicators may have belonged to the lower class. Sentiments of dedicators (parents) who put up inscriptions for their loved ones can also be deduced from inscriptions treated in this chapter. Of the eleven inscriptions selected and used in this chapter only one indicates the death of a female child. 1 CIL Vol X, 2665 10 9 This is a general trend with these inscriptions. This implies that male children were more valued than female consequently more males were commemorated than females in ancient Rome. Indeed causes of death are not indicated on inscriptions. That gap must be filled from classical sources outside epigraphy as shown in the third chapter. AR Y R LI B N AD A F I B Y O IT ER S IV UN 11 0 CHAPTER SIX SUMMARY AND CONCLUSION Classical authors and writers may not have been concerned with child death as much as they were involved in philosophy, politics, education, mathematics, war, annexation of territories, architecture to mention a few. However through bits and pieces from the works of ancient authors, this study shows causes of chilYd mortality. With regard to Ibadan, not one contemporary author has documRented altogether causes of child death. However, having sourced the works oAf diverse authors, this study has put together side by side with that of ancieBnt Rome, causes of child mortality in modern Ibadan. Similar factors led toL chIild death in both societies: diseases, infanticide and child exposure, leadN poisoning, consumption, social-cultural beliefs and social deprivation. A D Of the diseases, fever features prominentlAy. The ancients gave various names such as tertian, quartan and quotidian ItoB fever. Evidence has shown that these fevers are unmistakably malaria. FMalaria wreaked great havoc on children in ancient Rome. It worked ha nOd in hand with other diseases such as dropsy and consumption. It occurredY more frequently than other diseases and caused more death. In antiquity, cIlaTssical authors gave various pieces of advice on how to treat the fevers and esSpecially, how to avoid being infected. Some of the advice included employing traditional methods such as the use of herbs, placing objects on patientsE infRected with these fevers, deforestation and building living quarters on approIpVriate places. In Ibadan land, there were frequent attacks from the disease anNd children below six were the worst hit. In antiquity, consumption U(tuberculosis) which ranked second to malaria killed children. It occurred in Ibadan as frequently as it did in antiquity. Some modern authors assume that the plagues that occurred in antiquity were outbreaks of cholera. Others associate the plagues with small pox or chicken pox. The plagues devastated the populace at the time of occurrence and remedy proffered was more or less ineffective. Although some victims survived, majority 11 1 succumbed to the disease. Cholera was a killer disease in Ibadan. One of the means of stemming the attack was the advice by medical practitioners to nursing mothers to breastfeed their babies exclusively for the first six months. Also people were encouraged to source for clean water and purify the water through boiling. Yet, not all nursing mothers adhered to the advice, and some people neglected to get water from hygienic sources. In ancient Rome also, cholera and measles, under similar unwholesome environment undoubtedly occurred and caused child death as it did in modern Ibadan. Y R Some diseases associated with the weather such as dropsy, epiRlepsAy usually worked with various fevers. These occurred frequently. MediBcal practitioners offered what they could to deal with these problems. SometiLmeIs they succeeded, some other times the patients died. This situation led people into seeking the aid of the supernatural. In Ibadan, other diseases caused chAild Nmortality. These diseases included; neonatal tetanus, neonatal septicDaemia, meningitis, pneumonia, gastroenteritis, neonatal jaundice, severe aAnaemia, prematurity and low birth weight, infantile cholestasis, and post n eIonBatal tetanus. F In ancient Rome, lead pOoisoning led to child death directly and indirectly. In Ibadan, lead poisoning iYndirectly caused child death through leaded gasoline and paints. Classical authoTrs such as Vitruvius, the Roman architect, and Columella advise that drinkiSng wIater should not be pumped through leaded but clay pipes. They suggest Rthat rain water should be consumed because it was purer than that conveyed iEn leaded pipes. On the other hand, lead poisoning which caused child deathI iVn Ibadan directly and indirectly occur through leaded gasoline and paints. RNecently, evidence of lead poisoning among illicit miners of lead in Zamfara State U 1led to the death of about 163 people including 111 children . Medical evidence in antiquity was not advanced enough to recognize Vitamin A deficiency in patients. However, it may have worked hand in hand with other ailments and brought about the kind of blindness that caused child death as in 1 th Retrieved on 12 August 2010 from http://en.wikipedia.org/wiki/Zamfara_State_lead_poisoning_epidemic 11 2 modern Ibadan. The Human Immuno Virus/Acquired Immune Deficiency Syndrome is a modern phenomenon and did not occur in antiquity. In Ibadan, it occurred and was a cause of child death. Infanticide was a cultural practice to abandon unwanted children with the intention of killing them in ancient Rome. The authority of the pater familiaYs ensured that babies born weak or sometimes female babies were abandoAnedR and left to die. Many authors in the pre-Christian era supported this cultRural practice. rd The practice was opposed by Christian writers in antiquity. ByB the 3 century A.D., Emperor Constantine enacted laws that proscribed infaLntiIcide. In different areas of Ibadan land, some children who have been expo sed and abandoned in refuse bins have been found dead by passer-bys. OAtherN abandoned children have been rescued and taken to homes where they are Dbeing catered for. More fortunate are babies abandoned by their mothers in hosApitals where they were born. There is no documented information that is acce sIsiBble to researchers with regard to the rate of death as a result of this abandonFment. One has to depend on oral tradition and eye witness accounts. Howev eOr, this practice is not widespread in Ibadan land. One may argue that the exYposition and abandonment in Ibadan that does not lead to the death of the child IcTannot be termed infanticide; for some women abandon such babies in places wShere the babies stand the chance of survival because the mothers felt incapacitaRted financially. However, it is important to note that the act of separating Ea baby from its mother for unacceptable reasons is, psychoanalytically, infantIicVide. N U Wet-nursing also contributed indirectly to child mortality in antiquity. Various Classical authors mention that many women, probably those of the upper class are accustomed to employing wet-nurses. Other authors advise that a woman should breast-feed her own child so that the child may not get contaminated by the milk of a stranger. Also, women are advised to get the best wet-nurses if they must engage their services. These authors do not mention expressly that wet-nursing caused the death of a child. However, one can infer that child death occurred when 11 3 one engaged the services of the wrong wet-nurse and when mothers disengaged early from breastfeeding their own children. A woman who breastfeeds her own child tended to be more sympathetic and loving towards that child. In modern Ibadan, wet-nursing is not common. However people, especially career women, engaged the services of nannies to cater for their children when they are off to work. They leave the children in their care for the better part of the day, to return home when the children are already asleep, and even if they awake, these mothers spend, possibly, an hour or two with their children. Child mortality occurred wheYn these nannies demonstrate indifference towards these children for diffRerent reasons. Some of these nannies have even stolen these children and RsoldA them to the highest bidders in Ibadan. Little wonder today, many careBer women now engage their retired mothers and aunts in taking care of their cLhilIdren. Also, it is a well-known fact that many women take on jobs that w ould afford them the opportunity to care for their children. Some are evAen Nknown to have chosen to become full-time housewives, in order to spend tDime with their children especially in their formative years. A IB Religion in antiquity was pFoly theistic in nature; people worshipped gods and goddesses of their choice.O They also believed in the existence of demons. They believed that gods and demons were responsible for calamities such as epilepsy and plagues. T ThYerefore, many patients turned their backs on orthodox medicine and offeSredI sacrifices to these deities. In the Hippocratic Writings, the doctor attempted to explain that the disease, which the people called sacred, was indeed notE sacRred. He went on to describe the disease and explained its cause. In modeIrnV Ibadan people also practice different religions. There are adherents to the CNhristian and Islamic faiths. There are also African Traditionalists, i.e. Ifa Uworshippers. Some people believed that diseases, especially the ones that normally should have been treated by orthodox medicine were caused by demons. Therefore, adherents of different faiths solicited and still solicit the aid of supreme beings. Also people who believe they are victims of Abiku or Ogbanje phenomenon, seek the help of Christian pastors, or traditional healers. In ancient Roman times, parents grieved freely at the death of their children 11 4 and went ahead to erect memorials to them. In Ibadan parents also cried without restraint at the loss of children but building commemorative plaques in their honour is not the norm. The few that exist are not lavishly displayed. Indeed, children especially neonates are buried in forests. 1 Social deprivation goes hand in hand with child mortality. In ancient Roman times, there was the subject of child neglect. It also occurs in modern Ibadan. In both, children suffered this deprivation resulting from acts of omission oYr commission by parents, doctors and the society. R Finally, more research is necessary in the area of identifying, in moRderAn names, ancient diseases and correlating both the ancient and modern. B LI AN BA D F I Y O T SI VE R I UN 1 Manning B, Brewster B, Bundred P, Social Deprivation and Admission for neonatal care, 2005, Archives of Disease in Childhood – Fetal and Neonatal Edition, 2005; 90: 337-338, Liverpool University Press. 11 5 APPENDIX I Represented in this part are illustrations of epitaphs erected for children. These illustrations are not from CIL X, but from other volumes of the CIL. CIL X does not present images of epitaphs commemorating children and displaying relationships in a family. Therefore, in order to further provide a demonstration of some commemorating plaques for children in antiquity, these visuals sought from other relevant sources are sited here. RY RA LIB AN BA D Figure 1. This inscription here is forF De cIentius a five year old child. Decentius, in peace O who lived 5 years 6 monthYs. L aid to rest 1 on the 14th of the KalIenTds of April (i.e., March 19th). ER S IV UN 1 http://penelope.uchicago.edu/Thayer/E/Gazetteer/Places/Europe/Italy/Lazio/Roma/Rome/churches/ S.Sabina/interior/narthex/inscriptions/Decentius.html 11 6 RY Figure 2. Freeborn son, P Servilius Q.f Globulus (wearing bulla), freeRdmaAn father, Q. Servilius Q.L. Hilarus and freedwoman wife of Hilarus, SemIprBonia C.L. Eune. 1CIL 6.26410. L N AD A IB O F ITY RS VE UN I 1 Figures 2-7 were sourced from Rawson B, 1991, Marriage, Divorce and Children in Ancient Rome, Clarendon Press Oxford. Between p 114 and 115. 11 7 RY RA LI B AN BA D OF I SI TY VE R FigurIe 3. Boy with goat, A Egrilius A.f. Pal Magnus (freeborn) who died aged five. CNIL 14.4899. U 11 8 RY RA LI B DA N BA F I O Figure 4. Marble altar Tset Yup by Julia Venusta (with her freedman) for her patron, husband, son and dSaugIhter. CIL 6.20819. ERV UN I Figure 5. Sarcophagus of a young girl, with veiled parents, surrounded by mourners. British Mesuem Sc., 2315. 11 9 Y AR Figure 6. Sarcophagus of a boy, Aemilius Daphnus, showing boys Rplaying with nuts. British Museum, Sc. 2321. LIB N AD A F I B O ITY ER S NI V U Figure 7. Marble altar set up by state slave Papias for his spouse (contubenalis) of free status, Grania Faustina. Sculpture shows child between them. CIL 6.2365. 12 0 RY RA LI B AN AD Figure 8. Gravestone of a young womanI Bset up by her husband in Cologne, c AD 20. The baby in swaddling clothFes in her arms may indicate that she died in childbirth. Y O T SI VE R I UN 12 1 RY RA LI B N DA Figure 9. Funerary altar of Julia HomullinBa, hAer husband, her son, and her brother ndin Nimes, 2 century AD. Musee arch eoIlogique, Nimes. O F TY SI VE R UN I 12 2 RY RA LI B N AD A B OF I Figure 10. TombstoneT ofY Odenwald marble of a baby girl commemorated by Telesphoris and her hIusband with an epitaph and depiction of a baby girl from Mainz, mid secondS century AD. Rheinisches Landesmuseum, Mainz. R IV E UN 12 3 RY RA LI B DA N A IB O F Figure 11. Sandstone monYument of a baby girl commemorated by Telesphoris and her husband in MainIzT, mid second century AD. Rheinisches Landesmuseum, Mainz. S VE R NIU 12 4 RY RA LI B N Figure 12. Gravestone of the nine day old VernacluAs, buried by his father Lucius nd rd Cassius Tacitus in Cologne, 2 or 3 centuDry AD. Romisch-Germanisches 1 Museum, Cologne. BA I O F TY RS I E NI V U 1 Figures 8-12 were sourced from Carroll M., 2006, Spirits of the Dead, Roman Funerary Commemoration in Western Europe, Oxford University Press. P 7, 116, 170, 171, 172. 12 5 RY RA LI B DA N A IB O F ITY ER S V UN I 12 6 APPENDIX II The following pictures go a long way to demonstrate social deprivation among some other conditions that have caused child mortality in Ibadan land, as th discussed in the 4 chapter. RY RA LIB AN AD This is an area in Ojoo. Thi sI iBs an evidence of lack of proper waste disposal. There are houses around tFhis dump. O SI TY ER IV UN This is a dilapidated house yet the occupants, including children live here. 12 7 RY RA B This area of Beere in Ibadan shows derelicts houses N LI DAA F I B O SI TY R VThiEs picture demonstrates lack of access to effective sewage system. I UN 12 8 RY RA A water vendor in Ibadan. His physical outlook and hisI Bwater containers should be noted. L DA N IB A O F ITY This isR theS kind of house and environment that encourage factors that can 1cause childE death in Ibadan. V UN I 1 The above pictures were sourced from Makinde, O.O, 2012, Housing: Central City Slums, A Case Study of Ibadan, Journal of Environment and Earth Science, Vol 2, No.9. 12 9 BIBLIOGRAPHY CLASSICAL AUTHORS A. Cornelius Celsus, De Medicina, 1938, translated W.G. Spencer, 1938, Loeb Classical Library. Apuleius, Florida 17, 2001, Translated by Harrison S.J., Hilton J.L., Vincent Hunink, Oxford University Press. Y R Aulus Gellius, Attic Nights 12.1, 1927, translated by Rolfe, J.C., The LoebA Classical Lbrary. Cambridge. R Cassius Dio, Roman History, Book 71:2.4, 1914 through 1927, tranBslation by Earnest Cary. Loeb Classical Library, Harvard Unive rsLityI Press. Columella: On Agriculture, 1954, translated by E. S. ForNster and Edward H. Heffner (Loeb Classical Library) A Cyprian of Carthage, On the Mortality (or PlAaguDe), 14:1-7. Translated by the Rev. Ernest Wallis, Ph.D., http://www.eBwtn.com/library/PATRISTC/ANF5-15.TXT. I Duodecim Tabularum Leges, in Fontes iuris Romani antiqui I, ed. Georg Bruns et Otto Gradenwitz TübingOen, F1909. Sourced Dec. 2008, from http://www.hs-augsburg.de/~harsch/C hronologia/Lsante05/LegesXII/leg_ta00.html Elder Pliny, Natural HiTstoYry, 1945, translated by H. Rackham, Loeb Classical Library. I Galen, The ThRerapSeutic Method: Books 1 & 2 (De methodo medendi), 1991, edited andE translated by R.J. Hankinson. Clarendon Press, Oxford. 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