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2015v1.0
Abeloff’s
CLINICAL
ONCOLOGY
This page intentionally left blank
Abeloff’s
CLINICAL
ONCOLOGY
SIXTH EDITION
JOHN E. NIEDERHUBER, MD
Executive Vice President, Inova Health System
President and CEO, Genomics and Bioinformatics Research Institute
Fairfax, Virginia;
Professor, Department of Public Health Sciences
Member, Center for Public Health Genomics
University of Virginia School of Medicine
Charlottesville, Virginia;
Adjunct Professor, Oncology and Surgery
The Johns Hopkins University School of Medicine
Deputy Director
Johns Hopkins Clinical Research Network
Baltimore, Maryland
JAMES O. ARMITAGE, MD JAMES H. DOROSHOW, MD

Joe Shapiro Professor of Medicine Bethesda, Maryland
University of Nebraska Medical Center
Omaha, Nebraska
MICHAEL B. KASTAN, MD, PhD JOEL E.TEPPER, MD

Executive Director, Duke Cancer Institute Hector MacLean Distinguished Professor of
William and Jane Shingleton Professor, Cancer Research
Pharmacology and Cancer Biology Department of Radiation Oncology
Professor of Pediatrics UNC Lineberger Comprehensive Cancer Center
Duke University School of Medicine University of North Carolina School of Medicine
Durham, North Carolina Chapel Hill, North Carolina
ABELOFF’S CLINICAL ONCOLOGY, SIXTH EDITION ISBN: 978-0-323-47674-4
Copyright © 2020 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each product
to be administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Previous editions copyrighted 2014, 2008, 2004, 2000, and 1995.
Library of Congress Control Number: 2018953655
Executive Content Strategist: Robin Carter

Content Development Manager: Laura Schmidt
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Amanda Mincher
Design Direction: Bridget Hoette
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
1600 John F. Kennedy Blvd.

Ste 1600
Philadelphia, PA 19103-2899
To my son, Matthew, and my wife, Kathy, who have and continue to make sacrifices so that I might pursue my passions in
medicine and research. To my colleagues at the National Cancer Institute, University of Virginia, Johns Hopkins, and across the
country, whose selfless dedication to patient care and cancer research is truly an inspiration to all. To the many students who have
trained with me over the years, to my patients, and to my colleagues at the Inova Translational Medicine Institute, who have given
me the opportunity to have this tremendously rewarding career. Lastly, to Tracey, and to Marty, who, in memory, inspire all who
knew them to work a little harder each day toward the elimination of the pain and suffering from this disease.
JOHN E. NIEDERHUBER, MD
To my wife, Nancy, for her love and support over 49 ½ years.

JAMES O. ARMITAGE, MD
To my wife, Robin Winkler Doroshow, MD, my classmate and greatest supporter, for her love, dedication, and commitment and
for the remarkable joy and caring she brings to her patients and to all around her. To my remarkable daughter, Deborah Doroshow,
MD, PhD, who is completing her training for a career in academic oncology; my fondest hope is that you will enjoy sharing with
and learning from those you help as much as I have. To my patients and colleagues at the City of Hope and the National Cancer
Institute who have all contributed so much of themselves to my continuing education as a physician and investigator, please accept
my appreciation and utmost gratitude.
JAMES H. DOROSHOW, MD
To my wife, Kathy, and my sons, Benjamin, Nathaniel, and Jonathan. You are the lights of my life. I also acknowledge all of my
mentors, colleagues, and patients, who have taught me so much. A special note of gratitude goes to Marty Abeloff, a mentor and an
inspiring role model for career and for life.
MICHAEL B. KASTAN, MD, PhD
To my wife, Laurie, who has been my soul mate for many years and has constantly reminded me of life’s priorities. To my family
including my daughters, Miriam and Abigail, and my grandchildren, Zekariah, Zohar, Samuel, Marcelo, Jonah, and Aurelio. They
have been an inspiration. To my many teachers through the years who have helped define and foster my professional career, but
especially Herman Suit and Eli Glatstein.
JOEL E. TEPPER, MD
Memoriam
Martin D. Abeloff, MD (1942-2007)
Martin D. Abeloff, a founding editor of Clinical Oncology, dedicated that would be as valuable to the practicing oncologist as to the primary
his life to caring for patients with cancer and to teaching his art to care physician and physicians-in-training. The first edition of Clinical
fellows, residents, and students. He was a brilliant and caring clinician, Oncology was published in 1995 to a gratifying response. It is now
an extremely effective leader, and a beloved mentor to many trainees established as a cornerstone reference for those caring for patients
and young faculty. with cancer.
Marty was born on April 4, 1942, in Shenandoah, Pennsylvania. He In the sixth edition, we continue Marty’s vision for an ever better,
received his BA from The Johns Hopkins University in 1963 and his unique, and accessible text so that future generations of oncologists
MD from The Johns Hopkins University School of Medicine in 1966. will remember his inspiration and leadership.
He spent the next year as an intern at the University of Chicago Hospitals The editors again dedicate this text, which is already a recognized
and Clinics. His legacy in medicine was established on his return to tangible aspect of his legacy in medicine, as a living memorial to him.
Baltimore in 1971 as a fellow in clinical oncology. He would spend the Abeloff ’s Clinical Oncology will continue to serve as a reminder to all
rest of his career at The Johns Hopkins Hospital, achieving the rank of its users of this extraordinary person and exemplary physician who
Professor of Medicine in 1990. At various times, he served as the fel- went before them.
lowship training program director, chief of medical oncology, clinical
director of the cancer center, oncologist in chief at The Johns Hopkins John E. Niederhuber, MD
Hospital, and in 1992, was appointed the second director of The Johns James O. Armitage, MD
Hopkins Oncology Center, later renamed, thanks to Marty’s efforts, the James H. Doroshow, MD
Sidney Kimmel Comprehensive Cancer Center. Michael B. Kastan, MD, PhD
It was during his time as cancer center director that Marty brought Joel E. Tepper, MD
to life the idea of a comprehensive, user-friendly textbook of oncology
vii
Contributors
James L. Abbruzzese, MD, FACP, FASCO, DSc (hon) Dara L. Aisner, MD, PhD
Duke Cancer Institute Distinguished Professor of Medical Oncology Associate Professor of Pathology
Chief, Division of Medical Oncology, Department of Medicine CU Anschutz Medical Campus
Associate Director for Clinical Research, Duke Cancer Institute University of Colorado
Duke University Medical Center Aurora, Colorado
Durham, North Carolina
Michelle Alonso-Basanta, MD, PhD
Omar Abdel-Wahab, MD Helene Blum Assistant Professor
Associate Attending Department of Radiation Oncology
Department of Medicine University of Pennsylvania
Leukemia Service Philadelphia, Pennsylvania
Memorial Sloan Kettering Cancer Center
New York, New York Jesus Anampa, MD, MS
Assistant Professor
Ghassan K. Abou-Alfa, MD Department of Oncology
Attending Physician Montefiore Medical Center
Memorial Sloan Kettering Cancer Center Albert Einstein College of Medicine
Professor of Medicine Bronx, New York
Weill Cornell Medicine
New York, New York Megan E. Anderson, MD
Assistant Professor
Janet L. Abrahm, MD Department of Orthopaedic Surgery
Professor of Medicine Harvard Medical School
Harvard Medical School Attending Orthopedic Surgeon
Member, Division of Palliative Care Department of Orthopedic Surgery
Psychosocial Oncology and Palliative Care Boston Children’s Hospital
Dana-Farber Cancer Institute Attending Orthopedic Surgeon
Boston, Massachusetts Department of Orthopedic Surgery
Beth Israel Deaconess Medical Center
Jeffrey S. Abrams, MD Boston, Massachusetts
Associate Director, Cancer Therapy Evaluation Program
Division of Cancer Treatment and Diagnosis Emmanuel S. Antonarakis, MD
National Cancer Institute Associate Professor of Oncology
Rockville, Maryland Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins University School of Medicine
Jeremy S. Abramson, MD, MMSc Baltimore, Maryland
Director, Center for Lymphoma
Hematology/Oncology Richard Aplenc, MD, PhD
Massachusetts General Hospital Department of Pediatrics
Assistant Professor Section Chief, Hematologic Malignancies
Department of Medicine Chief Clinical Research Officer
Harvard Medical School Children’s Hospital of Philadelphia
Boston, Massachusetts Philadelphia, Pennsylvania
ix
x Contributors
Frederick R. Appelbaum, MD Karen Basen-Engquist, PhD, MPH

Executive Vice President and Deputy Director Professor of Behavioral Science
Fred Hutchinson Cancer Research Center University of Texas MD Anderson Cancer Center
Professor Houston, Texas
Division of Medical Oncology
University of Washington Lynda Kwon Beaupin, MD
Seattle, Washington Director, Adolescent and Young Adult Program
Roswell Park Cancer Institute
Luiz H. Araujo, MD, PhD Buffalo, New York
Scientific Director
COI Institute for Research and Education Ross S. Berkowitz, MD
Brazilian National Cancer Institute William H. Baker Professor of Gynecology
Rio de Janeiro, Brazil Department of Obstetrics and Gynecology
Harvard Medical School
Ammar Asban, MD Director of Gynecologic Oncology
Surgical Resident Department of Obstetrics and Gynecology
Department of Surgery Brigham and Women’s Hospital
University of Alabama at Birmingham Boston, Massachusetts
Birmingham, Alabama
Donald A. Berry, PhD
Edward Ashwood, MD Professor of Biostatistics
President and CEO Department of Biostatistics
ARUP Laboratories The University of Texas MD Anderson Cancer Center
Professor of Pathology Houston, Texas
University of Utah
Salt Lake City, Utah Therese Bevers, MD
Professor of Clinical Cancer Prevention
Farrukh T. Awan, MD, MS Medical Director, Cancer Prevention Center
Associate Professor of Medicine The University of Texas MD Anderson Cancer Center
Hematology Houston, Texas
The Ohio State University
Columbus, Ohio John F. Boggess, MD
Professor of Obstetrics and Gynecology
Juliet L. Aylward, MD University of North Carolina
Associate Professor of Dermatology Chapel Hill, North Carolina
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin Julie R. Brahmer, MD, MSc
Professor of Oncology
Arjun V. Balar, MD Department of Oncology
Associate Professor of Medicine Johns Hopkins Kimmel Cancer Center
Division of Hematology/Oncology Baltimore, Maryland
Director, Genitourinary Cancers Program
New York University Perlmutter Cancer Center Janet Brown, MD, FRCP, MSc, MBBS, BSc
New York University Langone Medical Center Professor
New York, New York Academic Unit of Clinical Oncology, Oncology, and Metabolism
Weston Park Hospital
Courtney J. Balentine, MD University of Sheffield
Assistant Professor of Surgery Sheffield, United Kingdom
Dallas VA Hospital
University of Texas Southwestern Karen Brown, MD
Dallas, Texas Attending Physician
Stefan K. Barta, MD, MS, MRCP(UK) Professor of Clinical Radiology
Associate Professor Weill Medical College at Cornell University
Hematology and Oncology New York, New York
Fox Chase Cancer Center
Philadelphia, Pennsylvania Powel Brown, MD, PhD
Professor and Chairman
Nancy Bartlett, MD Clinical Cancer Prevention
Professor of Medical Oncology The University of Texas MD Anderson Cancer Center
Washington University School of Medicine Houston, Texas
St. Louis, Missouri
Contributors xi
Ilene Browner, MD Stephen J. Chanock, MD

Assistant Professor Director
Department of Oncology and Division of Geriatric Medicine Division of Cancer Epidemiology and Genetics
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins National Cancer Institute
and Johns Hopkins Bayview Bethesda, Maryland
The Johns Hopkins University
Baltimore, Maryland Claudia I. Chapuy, MD
St. Elizabeth’s Medical Center
Paul A. Bunn, MD Dana-Farber Cancer Institute
Distinguished Professor of Medical Oncology Boston, Massachusetts
CU Anschutz Medical Campus
University of Colorado Vikash P. Chauhan, PhD
Aurora, Colorado Massachusetts Institute of Technology
Boston, Massachusetts
William R. Burns, MD
Assistant Professor of Surgery Herbert Chen, MD, FACS
University of Michigan Health System Chairman and Fay Fletcher Kerner Endowed Chair
Ann Arbor, Michigan Department of Surgery
University of Alabama at Birmingham
John C. Byrd, MD Surgeon-in-Chief
Professor of Internal Medicine–Hematology University of Alabama at Birmingham Health System
The Ohio State University Birmingham, Alabama
Columbus, Ohio
Ronald C. Chen, MD, MPH
Karen Cadoo, MD Associate Professor
Attending Medical Oncologist Department of Radiation Oncology
Gynecologic Medical Oncology and Clinical Genetic Services University of North Carolina at Chapel Hill
Memorial Sloan Kettering Cancer Center Chapel Hill, North Carolina
Weill Cornell Medical College
New York, New York Nai-Kong V. Cheung, MD, PhD
Enid A. Haupt Endowed Chair in Pediatric Oncology
David P. Carbone, MD, PhD Department of Pediatrics
Professor of Medicine Memorial Sloan-Kettering Cancer Center
Director, James Thoracic Center New York, New York
James Cancer Center
The Ohio State University Medical Center Jennifer H. Choe, MD, PhD
Columbus, Ohio Medical Instructor
Division of Medical Oncology
H. Ballentine Carter, MD Duke Cancer Institute
Professor of Urology Durham, North Carolina
Baltimore, Maryland Michaele C. Christian, MD
Cancer Therapy Evaluation Program (Retired)
Jorge J. Castillo, MD National Cancer Institute
Physician Rockville, Maryland
Hematologic Malignancies
Dana-Farber Cancer Institute Paul M. Cinciripini, PhD
Assistant Professor Professor and Chair of Behavioral Science
Harvard Medical School The University of Texas MD Anderson Cancer Center
Boston, Massachusetts Houston, Texas
Alfred E. Chang, MD Michael F. Clarke, MD

Hugh Cabot Professor of Surgery Professor of Medicine
University of Michigan Health System Division of Oncology
Ann Arbor, Michigan Stanford School of Medicine
Palo Alto, California
Eric Chang, MD, FASTRO
Professor and Chair of Radiation Oncology Robert E. Coleman, MBBS, MD
Keck School of Medicine of USC Academic Unit of Clinical Oncology
Los Angeles, California Weston Park Hospital
University of Sheffield
Sheffield, United Kingdom
xii Contributors
Robert L. Coleman, MD Jeffrey Crawford, MD

Professor and Executive Director, Cancer Network Research Professor of Medicine
Department of Gynecologic Oncology and Reproductive Medicine Division of Medical Oncology
The University of Texas MD Anderson Cancer Center Duke Cancer Institute
Houston, Texas Durham, North Carolina
Adriana M. Coletta, PhD, RD Kristy Crooks, PhD

Department of Behavioral Science Assistant Professor of Pathology
Center for Energy Balance in Cancer Prevention and Survivorship CU Anschutz Medical Campus
The University of Texas MD Anderson Cancer Center University of Colorado
Houston, Texas Aurora, Colorado
Jerry M. Collins, PhD Daniel J. Culkin, MD

Associate Director Professor
Division of Cancer Treatment and Diagnosis Department of Urology
National Cancer Institute University of Oklahoma Health Sciences Center
Bethesda, Maryland Oklahoma City, Oklahoma
Jean M. Connors, MD Brian G. Czito, MD

Hematology Division Professor of Radiation Oncology
Brigham and Women’s Hospital Duke University Medical Center
Dana-Farber Cancer Institute Durham, North Carolina
Harvard Medical School
Boston, Massachusetts Piero Dalerba, MD
Assistant Professor of Pathology and Cell Biology
Michael Cools, MD Assistant Professor of Medicine
Department of Neurosurgery Division of Digestive and Liver Diseases
University of North Carolina Columbia University College of Physicians and Surgeons
Chapel Hill, North Carolina New York, New York
Kevin R. Coombes, PhD Josep Dalmau, MD, PhD

Professor of Biomedical Informatics ICREA Research Professor
The Ohio State University Hospital Clínic/Institut d’Investigació Biomèdica August Pi i Sunyer
Columbus, Ohio (IDIBAPS)
Barcelona, Spain
Jorge Cortes, MD Adjunct Professor Neurology
The University of Texas MD Anderson Cancer Center University of Pennsylvania
Houston, Texas Philadelphia, Pennsylvania
Mauro W. Costa, MSc, PhD Mai Dang, MD, PhD

Research Scientist Instructor in Neurology
The Jackson Laboratory Children’s Hospital of Philadelphia
Bar Harbor, Maine Philadelphia, Pennsylvania
Anne Covey, MD Michael D’Angelica, MD

Attending Physician Attending Physician
Memorial Sloan Kettering Cancer Center Memorial Sloan Kettering Cancer Center
Professor of Radiology Professor of Surgery
Weill Medical College at Cornell University Weill Medical College at Cornell University
New York, New York New York, New York
Kenneth H. Cowan, MD, PhD Kurtis D. Davies, PhD

Director, Fred and Pamela Buffett Cancer Center Assistant Professor of Pathology
University of Nebraska Medical Center CU Anschutz Medical Campus
Omaha, Nebraska University of Colorado
Aurora, Colorado
Christopher H. Crane, MD
Vice Chairman
Attending Physician
New York, New York
Contributors xiii
Myrtle Davis, DVM, PhD James H. Doroshow, MD

Chief, Toxicology and Pharmacology Branch Bethesda, Maryland
Division of Drug Treatment and Diagnosis
National Cancer Institute Jay F. Dorsey, MD, PhD
National Institutes of Health Associate Professor of Radiation Oncology
Bethesda, Maryland University of Pennsylvania
Philadelphia, Pennsylvania
Nicolas Dea, MD, MSc, FRCSC
Spinal Neurosurgeon Marianne Dubard-Gault, MD, MS
Clinical Associate Professor Medical Genetics Fellow
Department of Surgery Department of Medicine
Vancouver General Hospital Memorial Sloan Kettering Cancer Center
University of British Columbia New York, New York
Vancouver, British-Columbia, Canada
Steven G. DuBois, MD, MS
Ana De Jesus-Acosta, MD Associate Professor
Assistant Professor of Oncology Department of Pediatrics
Sidney Kimmel Comprehensive Cancer Center Harvard Medical School
The Johns Hopkins University School of Medicine Attending Physician
Baltimore, Maryland Department of Pediatrics
Boston Children’s Hospital
Angelo M. DeMarzo, MD, PhD Dana Farber Cancer Institute
Professor of Pathology Boston, Massachusetts
Baltimore, Maryland Dan G. Duda, PhD, DMD
Associate Professor
Theodore L. DeWeese, MD Harvard Medical School
Professor and Director of Radiation Oncology and Molecular Boston, Massachusetts
Radiation Sciences
Johns Hopkins University School of Medicine Malcolm Dunlop, MD
Baltimore, Maryland MRC Institute of Genetics and Molecular Medicine
The University of Edinburgh
Maximilian Diehn, MD, PhD Western General Hospital
Associate Professor of Radiation Oncology Edinburgh, United Kingdom
Stanford University
Palo Alto, California Linda R. Duska, MD
University of Virginia Health System
Subba R. Digumarthy, MD Emily Couric Clinical Cancer Center
Massachusetts General Hospital Charlottesville, Virginia
Madeleine Duvic, MD
Angela Dispenzieri, MD Professor and Deputy Chairman
Professor of Medicine and Laboratory Medicine Department of Dermatology
Mayo Clinic The University of Texas MD Anderson Cancer Center
Rochester, Minnesota Houston, Texas
Khanh T. Do, MD Imane El Dika, MD

Assistant Professor of Medicine Assistant Attending Physician
Harvard Medical School Memorial Sloan Kettering Cancer Center
Medical Oncology Instructor of Medicine
Dana-Farber Cancer Institute Weill Medical College at Cornell University
Boston, Massachusetts New York, New York
Konstantin Dobrenkov, MD Hashem El-Serag, MD, MPH

Clinical Director, Oncology Margaret M. and Albert B. Alkek Chair of the Department
Merck & Company, Inc. of Medicine
Kenilworth, New Jersey Professor of Gastroenterology and Hepatology
Baylor College of Medicine
Jeffrey S. Dome, MD, PhD Houston, Texas
Vice President, Center for Cancer and Blood Disorders
Children’s National Medical Center
Washington, D.C.
xiv Contributors
Jeffrey M. Engelmann, PhD Debra L. Friedman, MD, MS

Assistant Professor of Psychiatry and Behavioral Medicine Vanderbilt-Ingram Cancer Center
Medical College of Wisconsin Nashville, Tennessee
Milwaukee, Wisconsin
Arian F. Fuller, Jr., MD
David S. Ettinger, MD, FACP, FCCP Winchester Hospital
Alex Grass Professor of Oncology North Reading Medical
The Sidney Kimmel Comprehensive Cancer Center at Johns North Reading, Massachusetts
Hopkins Hospital
The Johns Hopkins University Lorenzo Galluzzi, PhD
Baltimore, Maryland Assistant Professor of Cell Biology in Radiation Oncology
Weill Cornell Medical College
Lola A. Fashoyin-Aje, MD, MPH New York, New York
Medical Officer
Office of Hematology and Oncology Products Mark C. Gebhardt, MD
Center for Drug Evaluation and Research Frederick W. and Jane M. Ilfeld Professor of Orthopaedic Surgery
U.S. Food and Drug Administration Harvard Medical School
Silver Spring, Maryland Surgeon-in-Chief
Department of Orthopedic Surgery
Eric R. Fearon, MD, PhD Beth Israel Deaconess Medical Center
Maisel Professor of Oncology Orthopedic Surgeon
Professor of Internal Medicine Department of Orthopedics
University of Michigan Medical School Children’s Hospital
Ann Arbor, Michigan Boston, Massachusetts
James M. Ford, MD Daniel J. George, MD

Professor of Medicine, Pediatrics, and Genetics Professor of Medicine
Division of Oncology and Medical Genetics Duke University Medical Center
Stanford University School of Medicine Durham, North Carolina
Stanford, California
Mark B. Geyer, MD
Wilbur A. Franklin, MD Assistant Attending
Professor Emeritus of Pathology Department of Medicine
CU Anschutz Medical Campus Leukemia Service and Cellular Therapeutics Center
University of Colorado Memorial Sloan Kettering Cancer Center
Aurora, Colorado Instructor in Medicine
Joan and Sanford I. Weill Department of Medicine
Phoebe E. Freer, MD Weill Cornell Medical College
Associate Professor New York, New York
Radiology and Imaging Sciences
University of Utah Hospitals/Huntsman Cancer Institute Amato J. Giaccia, PhD
Salt Lake City, Utah Jack, Lulu, and Sam Willson Professor of Cancer Biology
Department of Radiation Oncology
Boris Freidlin, PhD Stanford University School of Medicine
Division of Cancer Treatment and Diagnosis Stanford, California
National Cancer Institute
Bethesda, Maryland Mark R. Gilbert, MD
Senior Investigator and Chief
Alison G. Freifeld, MD Neuro-Oncology Branch
Professor of Internal Medicine National Cancer Institute
Infectious Diseases Division Bethesda, Maryland
Omaha, Nebraska Whitney Goldner, MD
Associate Professor of Internal Medicine
Terence W. Friedlander, MD Division of Diabetes, Endocrinology, and Metabolism
Associate Clinical Professor University of Nebraska Medical Center
Medicine Omaha, Nebraska
UCSF Medical Center
San Francisco, California
Contributors xv
Donald P. Goldstein, MD Missak Haigentz, MD

Professor of Obstetrics, Gynecology, and Reproductive Biology Montefiore Medical Center
Harvard Medical School Bronx, New York
Senior Scientist
Department of Obstetrics and Gynecology John D. Hainsworth, MD
Brigham and Women’s Hospital Chief Scientific Officer
Boston, Massachusetts Sarah Cannon Research Institute
Nashville, Tennessee
Annekathryn Goodman, MD
Massachusetts General Hospital Benjamin E. Haithcock, MD
Boston, Massachusetts Associate Professor of Surgery
University of North Carolina at Chapel Hill
Karyn A. Goodman, MD, MS Chapel Hill, North Carolina
Professor of Radiation Oncology
Grohne Chair in Clinical Cancer Research Christopher L. Hallemeier, MD
University of Colorado School of Medicine Assistant Professor of Radiation Oncology
Aurora, Colorado Mayo Clinic
Rochester, Minnesota
Kathleen Gordon, MD
Medical Director of Ophthalmology Samir Hanash, MD, PhD
IQVIA Evelyn & Sol Rubenstein Distinguished Chair for Cancer Prevention
Co-Chair Professor of Clinical Cancer Prevention
IQIVA Ophthalmology Center of Excellence The University of Texas MD Anderson Cancer Center
Clinical Associate Professor of Ophthalmology Houston, Texas
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina Aphrothiti J. Hanrahan, PhD
Assistant Lab Member
Laura Graeff-Armas, MD, MS Human Oncology and Pathogenesis Program
Associate Professor of Internal Medicine Memorial Sloan Kettering Cancer Center
Division of Diabetes, Endocrine and Metabolism New York, New York
Omaha, Nebraska James Harding, MD
Assistant Attending Physician
Alexander J. Greenstein, MD, MPH Memorial Sloan Kettering Cancer Center
Associate Professor of Surgery Assistant Professor of Medicine
Icahn School of Medicine at Mount Sinai Weill Medical College at Cornell University
Stuart A. Grossman, MD Michael R. Harrison, MD

Professor of Oncology, Medicine, and Neurosurgery Assistant Professor of Medicine
The Sidney Kimmel Comprehensive Cancer Center at Johns Division of Medical Oncology
Hopkins Medicine Duke Cancer Institute
The Johns Hopkins University Durham, North Carolina
Baltimore, Maryland
Muneer G. Hasham, PhD
Stephan Grupp, MD, PhD Research Scientist
Section Chief, Cellular Therapy and Transplant The Jackson Laboratory
Director, Cancer Immunotherapy Frontier Program Bar Harbor, Maine
CCCR Director of Translational Research
Children’s Hospital of Philadelphia Ernest Hawk, MD, MPH
Philadelphia, Pennsylvania Boone Pickens Distinguished Chair for Early Prevention of Cancer
Vice President and Division Head
Arjun Gupta, MD Division of Cancer Prevention and Population Sciences
Assistant Instructor The University of Texas MD Anderson Cancer Center
Department of Internal Medicine Houston, Texas
University of Texas Southwestern Medical Center
Dallas, Texas Jonathan Hayman, MD
Department of Internal Medicine
Irfanullah Haider, MD, MBA Johns Hopkins Bayview Medical Center
Breast Imaging Baltimore, Maryland
Brigham and Women’s Hospital
Boston, Massachussetts
xvi Contributors
Jonathan E. Heinlen, MD Clifford A. Hudis, MD

Assistant Professor Chief Executive Officer
Department of Urology American Society of Clinical Oncology
University of Oklahoma Health Sciences Center Alexandria, Virginia
Oklahoma City, Oklahoma
Stephen P. Hunger, MD
N. Lynn Henry, MD, PhD Jeffrey E. Perelman Distinguished Chair
Associate Professor Department of Pediatrics
Internal Medicine Chief, Division of Oncology
University of Utah Pediatrics
Salt Lake City, Utah Children’s Hospital of Philadelphia
Joseph Herman, MD †
Professor and Division Head ad-interim Arti Hurria, MD
Department of Radiation Oncology Professor
The University of Texas MD Anderson Cancer Center Department of Medical Oncology and Therapeutics Research
Houston, Texas City of Hope Comprehensive Cancer Center
Duarte, California
Brian P. Hobbs, PhD
Associate Staff David H. Ilson, MD, PhD
Quantitative Health Sciences and The Taussig Cancer Institute Attending Physician
Cleveland Clinic Gastrointestinal Oncology Service
Cleveland, Ohio Department of Medicine
Memorial Sloan-Kettering Cancer Center
Ingunn Holen, BSc, MSc, PhD New York, New York
Oncology
University of Sheffield Annie Im, MD
Sheffield, United Kingdom Assistant Professor of Medicine
Department of Hematology and Oncology
Leora Horn, MD, MSc UPMC Hillman Cancer Center
Associate Professor of Medicine Pittsburgh, Pennsylvania
Medicine–Hematology Oncology
Vanderbilt University
Gopa Iyer, MD
Assistant Attending Physician, Genitourinary Oncology Service
Department of Medicine
Neil S. Horowitz, MD
New York, New York
Department of Obstetrics and Gynecology
Division of Gynecologic Oncology
Elizabeth M. Jaffee, MD
Brigham and Women’s Hospital
The Dana and Albert “Cubby” Broccoli Professor of Oncology
Dana Farber Cancer Institute
Deputy Director, Sidney Kimmel Comprehensive Cancer Center at
Johns Hopkins
Steven M. Horwitz, MD Baltimore, Maryland
Associate Attending
Department of Medicine, Lymphoma Service Reshma Jagsi, MD, DPhil
Memorial Sloan Kettering Cancer Center Professor and Deputy Chair
Assistant Professor of Clinical Medicine Radiation Oncology
Weill-Cornell Medical College University of Michigan
New York, New York Ann Arbor, Michigan
Odette Houghton, MD Rakesh K. Jain, PhD

Associate Professor A.W. Cook Professor of Tumor Biology
Department of Ophthalmology Department of Radiation Oncology
Mayo Clinic Harvard Medical School
Scottsdale, Arizona Director
E.L. Steele Laboratory for Tumor Biology
Scott C. Howard, MD, MSc Department of Radiation Oncology
Professor of Acute and Tertiary Care Massachusetts General Hospital
University of Tennessee Health Sciences Center Boston, Massachusetts
Memphis, Tennessee
†
Deceased.
Contributors xvii
William Jarnagin, MD, FACS Hagop Kantarjian, MD

Winchester Hospital The University of Texas MD Anderson Cancer Center
North Reading Medical Houston, Texas
North Reading, Massachusetts
Giorgos Karakousis, MD
Aminah Jatoi, MD Assistant Professor of Surgery
Professor of Oncology University of Pennsylvania
Mayo Clinic Philadelphia, Pennsylvania
Maher Karam-Hage, MD
Anuja Jhingran, MD Professor of Behavioral Science
The University of Texas MD Anderson Cancer Center The University of Texas MD Anderson Cancer Center
Houston, Texas Houston, Texas
David H. Johnson, MD Nadine M. Kaskas, MD

Chairman, Department of Internal Medicine Resident Physician
University of Texas Southwestern Medical School Department of Dermatology
Dallas, Texas The Warren Alpert Medical School of Brown University
Providence, Rhode Island
Brian Johnston, MD
Royal Victoria Hospital Michael B. Kastan, MD, PhD
Belfast, United Kingdom Executive Director, Duke Cancer Institute
Director, Cancer Immunotherapy Frontier Program
†
Patrick G. Johnston, MD William and Jane Shingleton Professor, Pharmacology and
Center for Cancer Research and Cell Biology Cancer Biology
School of Medicine, Dentistry, and Biomedical Sciences Professor of Pediatrics
Queen’s University Belfast Duke University School of Medicine
Belfast, United Kingdom Durham, North Carolina
Kevin D. Judy, MD Nora Katabi, MD

Professor of Neurosurgery Department of Pathology
Thomas Jefferson University Memorial Sloan-Kettering Cancer Center
Jefferson Medical College New York, New York
Daniel R. Kaul, MD
Lisa A. Kachnic, MD Associate Professor of Infectious Disease
Professor and Chair of Radiation Oncology University of Michigan
Vanderbilt University Medical Center Ann Arbor, Michigan
Scott R. Kelley, MD, FACS, FASCRS
Orit Kaidar-Person, MD Assistant Professor of Surgery
Ramban Medical Center Division of Colon and Rectal Surgery
Haifa, Israel Mayo Clinic
Sanjeeva Kalva, MD, RPVI, FSIR
Chief, Interventional Radiology Nancy Kemeny, MD
Associate Professor of Radiology Attending Physician
University of Texas Southwestern Medical Center Memorial Sloan Kettering Cancer Center
Dallas, Texas Professor of Medicine
Weill Medical College at Cornell University
Deborah Y. Kamin, RN, MS, PhD New York, New York
Vice President
Policy and Advocacy Erin E. Kent, PhD, MS
American Society of Clinical Oncology Scientific Advisor
Alexandria, Virginia Outcomes Research Branch
Healthcare Delivery Research Program
Division of Cancer Control and Population Sciences
National Cancer Institute
Rockville, Maryland
ICF, Inc.
Fairfax, Virginia
†
Deceased.
xviii Contributors
Oliver Kepp, PhD Daniel A. Laheru, MD

Metabolomics and Cell Biology Platforms Ian T. MacMillan Professorship in Clinical Pancreatic Research
Gustave Roussy Cancer Campus Department of Medical Oncology
Villejuif, France The Johns Hopkins University School of Medicine
Baltimore, Maryland
Simon Khagi, MD
Assistant Professor Paul F. Lambert, PhD
University of North Carolina School of Medicine Professor of Oncology
Lineberger Comprehensive Cancer Center University of Wisconsin
Chapel Hill, North Carolina Madison, Wisconsin
Joshua E. Kilgore, MD Mark Lawler, PhD

Division of Gynecologic Oncology Chair in Translational Cancer Genomics
University of North Carolina School of Medicine Centre for Cancer Research and Cell Biology
Chapel Hill, North Carolina School of Medicine, Dentistry and Biomedical Sciences
Queen’s University Belfast
D. Nathan Kim, MD, PhD Belfast, United Kingdom
Associate Professor
Department of Radiation Oncology Jennifer G. Le-Rademacher, PhD
University of Texas Southwestern Medical Center Associate Professor of Biostatistics
Dallas, Texas Health Sciences Research
Associate Professor of Oncology
Bette K. Kleinschmidt-DeMasters, MD Mayo Clinic
Professor of Neurology, Neurosurgery, and Pathology Rochester, Minnesota
CU Anschutz Medical Campus
University of Colorado John Y.K. Lee, MD
Aurora, Colorado Associate Professor of Neurosurgery
University of Pennsylvania
Edward L. Korn, PhD Philadelphia, Pennsylvania
Biometric Research Program
National Cancer Institute Nancy Y. Lee, MD
Bethesda, Maryland Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
Guido Kroemer, MD, PhD New York, New York
Team 11, Centre de Recherche des Cordeliers
Paris, France Susanna L. Lee, MD, PhD
Massachusetts General Hospital
Geoffrey Y. Ku, MD Boston, Massachusetts
Assistant Attending Physician
Gastrointestinal Oncology Service Jonathan E. Leeman, MD
Department of Medicine Department of Radiation Oncology
Memorial Sloan Kettering Cancer Center Memorial Sloan-Kettering Cancer Center
Shivaani Kummar, MD Andreas Linkermann, MD

Professor of Medicine Department of Internal Medicine III
Director, Phase 1 Clinical Research Program Division of Nephrology
Stanford University University Hospital Carl Gustav Carus at the Technische
Palo Alto, California Universität Dresden
Dresden, Germany
Bonnie Ky, MD, MSCE
Assistant Professor of Medicine and Epidemiology Jinsong Liu, MD, PhD
Division of Cardiovascular Medicine Professor of Pathology
Senior Scholar The University of Texas MD Anderson Cancer Center
Center for Clinical Epidemiology and Biostatistics Houston, Texas
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania Simon Lo, MD, FACR
Professor and Vice Chair for Strategic Planning
Department of Radiation Oncology
Professor of Neurological Surgery
University of Washington School of Medicine
Seattle, Washington
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the conflict with Zeus. An amiable but obsolete person, he wishes to
release Prometheus (without running into danger himself) and urges
submission. The prisoner listens with disdainful courtesy, refuses the
advice, and hints to Oceanus that he had better not associate with a
malefactor. His visitor soon bustles away, and the chorus sing how all
the nations of the earth mourn over the torments of their deliverer.
Prometheus then tells of the arts by which he has taught man to
alleviate his misery. The Nymphs ask if he has no hope of release
himself; he hints at the possible downfall of Zeus. Another lyrical
passage hymns the power of that god and expresses surprise at the
contumacy of the Titan. Then appears Io, the heifer-maiden, who at
the request of the chorus describes her strange ill-fortune. Beloved
of Zeus, she has incurred the wrath of his queen, Hera, who has
changed her into a heifer and sent her roaming wildly over the earth
pursued by a gadfly. Prometheus prophesies her future wanderings,
which shall end in Egypt. He speaks more clearly of the fall of Zeus,
who is preparing to wed one who shall bear a child greater than his
father. Then he narrates the story of Io’s course up to the present
hour, ending with the prophecy that in Egypt she shall bear to Zeus
a son named Epaphus. He speaks of the history of this man’s line,
particularly of one “courageous, famed for archery” who shall release
Prometheus. Io, in a sudden paroxysm, rushes from the scene. The
chorus sing of the dangers which lie in union with the Gods.
Prometheus again foretells the overthrow of Zeus by his own son.
Hermes, the messenger of Zeus, enters demanding that the prisoner
reveal the fatal secret. Prometheus treats his message with defiance.
Hermes warns him of still more fell tortures: the “winged hound of
Zeus” will come each day to tear his liver; a convulsion of the earth
will hurl him into Hades. The nymphs again urge submission, but
when the messenger declares that unless they leave Prometheus
they will perchance suffer too, they haughtily refuse to listen. Amid
an upheaval of the whole of Nature, the Titan, still defiant, sinks
from sight.
The Prometheus Vinctus has impressed all generations of readers
with wonder and delight; in particular it has inspired poetry only less
magnificent than itself. Shelley’s Prometheus Unbound is a gorgeous
amplification of its spiritual and material features. The sinister and
terrific figure which dominates the early part of Paradise Lost is but
Prometheus strayed at an untoward hour into Christian mythology.
Again, this play is the noblest surviving example of the purely
Æschylean manner. The Oresteia is greater, perhaps, certainly more
interesting to us; but there Æschylus has reacted to the spirit of
Sophocles. Here, the stark hauteur of the Supplices has developed
into a desolate magnificence. The lyrics which, since the Seven, have
again dwindled in size, have yet grown in beauty, variety, and
characterization. On the other side, there is a development of the
dialogue which is amazing. Long speeches are still the rule, but line-
by-line conversations are frequent. Characters in the Supplices and
the Seven talk as if blank-verse dialogue were a strange and difficult
art—as indeed it was till Æschylus forged it into shape. Throughout,
whether in lengthy speeches or in conversation, the iambic metre
has found a grace and suppleness which is too often ignored by
those who come to the Prometheus fresh from the Medea or the
Œdipus Tyrannus. Above all, the maturity of Æschylus’ poetic
strength is to be seen in the terrific perspectives which he brings
before us—perspectives of time, as the voice of the tortured prophet
carries us down a vista of centuries through the whole history of Io’s
race to the man of destiny; perspectives of scenery, as the eye of
the Ocean-Nymphs from the summit of earth gazes down upon the
tribes of men, horde behind horde fading into the distance, all
raising lament for the sorrows of their saviour; perspectives of
thought, as the exultant history of civilization leaps from the lips of
him who dies hourly through untold years to found and uphold it,
telling how that creeping victim of his own helplessness and the
disdain of Heaven goes from weakness to strength and from
strength to triumph.
No less wonderful is the strictly dramatic economy of the play. The
action is slight. Prometheus works no more; it is his part to endure.
All the secondary characters act as a foil to bring the central figure
into massive relief. Each has some touch of Prometheus:
Hephæstus, pity without self-sacrifice; Cratos, strength without
reflection; the Nymphs, tenderness without force; Oceanus,
common-sense without dignity; Io, sensibility to suffering without
the vision which learns the lesson of pain; Hermes, the power to
serve without perception of the secret of sovereignty. Most essential
of all these is Io. The only human participant in the action, she
reminds us that the hand of Zeus has been heavy upon innocent
mortals as well as rebel gods, and thus gives fresh justification to
the wrath of Prometheus. Still more, she is vital to the whole trilogy.
As Hephæstus links the Fire-bringer to the second play, so does she
join the second play to the Prometheus Unbound. It is her
descendant Heracles who after thirteen generations will free
Prometheus and reconcile him to Zeus; the hero of the last drama is
brought in a sense upon the scene in the person of his ancestress.
Prometheus himself suggests to us the thought of Christ; and yet (as
has been said) the Satan of Milton is like him too. This double
kinship is made possible by the conception of Zeus which here
obtains. Under the sceptre of a god who hates mankind it is possible
for the saviour of men to be a rebel and an outcast. Right or wrong,
the Titan is godlike in his goodness, his wisdom, his courage. At one
point only does his deity show a flaw; he endures his pangs not as a
god, but as a man; he agonizes, he laments his pains, he utters
exclamations of fear. Rightly, for if the actors in this world-drama are
immortal, the spectators are not. To have portrayed Prometheus as
facing his punishment without a quiver would have been perhaps
sounder theology, but worse drama; the human audience must be
made to understand something at least of these pangs, or the
greatness of the sacrifice will elude them. A parallel on which we
must not dilate cannot escape the reader. One strange outcome of
his rebellion is generally overlooked. Zeus had wished to destroy
mankind and create a new race. That is, he meant to treat men as
he treated the Titans—or would have treated them had they been
mortal. Prometheus thwarted this plan, so that we men are a
survival of that pre-moral world which the new ruler supersedes. We
are the younger brothers of the Titans and (so to put it) have all
survived the Flood. Our pettiness and futility condemned us in the
eyes of Zeus, who wished for progress; but Prometheus loved us in
spite of our miserable failings, and so insisted on carrying us over
into the new and nobler world at the cost of his own age-long agony.
The basic question must be briefly discussed—the relation of
Prometheus to the new King of Heaven. Zeus is here described as a
youthful tyrant, blind to all rights and interests save the security of
his recent conquest. This cannot have been the picture presented by
the whole trilogy. Not only is enough known of Æschylus’ religious
views to make such a theory impossible; though the Prometheus
Unbound is lost we know the story in outline. Heracles in his
wanderings came upon Prometheus, now released from Hades, but
still chained to his rock and gnawed by the vulture. The hero slew
the bird with an arrow, and procured the release of Prometheus by
inducing the wounded Centaur Chiron to go down to death in his
place, and by reconciling the Titan to Zeus, who promised to free
him on hearing the secret of the fatal marriage.[229] Prometheus, to
commemorate his captivity, assumed a ring of iron. The authority of
the King of Gods was thus for ever established. It is only in a
different atmosphere that any inconsistency can be felt. For
Æschylus there was a progress in the history of Heaven as in the
civilization of earth. Even Zeus in the early days of his dominion
seeks to rule by might divorced from wisdom, a severance typified
by his feud with Prometheus. He has his lesson to learn like all
others; if he will not govern with the help of law, bowing to Fate,
then the hope of the Universe is vain and the blind forces of
unguided Nature, the half-quelled Titans, will bring chaos back. But
youthful and harsh as he is, his will has a moral foundation, unlike
theirs; and so perhaps it is that Prometheus cannot but exclaim “I
sinned” in opposing that will. Upon the reconciliation between Zeus
and his antagonist, Prometheus became a local Attic deity and no
more. That eternal wisdom which he embodied is mysteriously
assimilated into the soul of Zeus. This is the consummation;
omnipotence and omniscience are at one.
We arrive finally at the trilogy which bears the name Oresteia and
which obtained the prize in 458 b.c. This is the only instance in which
the whole series has survived; the satyric play, Proteus,[230] has
perished. The name Oresteia was applied to the whole tetralogy.
The background of the Agamemnon[231] is the palace of King
Agamemnon at Argos. A sentinel is discovered upon the roof; he is
watching for the beacon which shall signify that Troy has at length
fallen. While waiting he broods, dropping hints that all is not well at
home. Then the beacon flashes forth, and he shouts the news to the
Queen Clytæmnestra within the house. On his departure the chorus
enter, aged councillors of Argos, who have not yet heard the tidings.
They sing of the quarrel between Greece and Troy and describe the
sacrifice of Iphigenia, Agamemnon’s daughter, who was offered up
to Artemis in order to obtain a favourable wind for the fleet. All the
altars are blazing with incense; Clytæmnestra enters, and they ask
her the reason. Troy, she replies, was taken last night; a system of
beacons has been arranged; the signal has spread over sea and land
before dawn. She ponders over the state of the captured city and
hopes that the victors have not sinned against the gods of Troy. The
old men sing praise to Heaven and moralize on the downfall of
human pride. A herald appears, announcing that Agamemnon has
landed and will soon reach the city; he dilates on the miseries of the
campaign, till the queen sends him away with her welcome to
Agamemnon. The chorus call him back and ask news of Menelaus,
the king’s brother; Menelaus, he replies, is missing: as the Greeks
were sailing home a tempest arose which scattered the fleet.
Agamemnon’s ship has returned alone. The elders, after he has
gone, sing of Helen and the deadly power of her beauty.
Agamemnon arrives, accompanied by the daughter of the Trojan
King Priam, Cassandra the prophetess, who has become his
unwilling concubine. Clytæmnestra greets him with effusiveness, to
which he responds haughtily. She persuades him against his will to
walk into the palace over rich carpets like an Oriental conqueror, and
accompanies him within doors. The chorus express forebodings
which they cannot understand. The queen comes forth and orders
Cassandra within, to be present at the sacrifice of thanksgiving, but
the captive pays no heed and Clytæmnestra in anger retires. The
elders attempt to encourage the silent girl, who at last breaks forth
into incoherent cries, not of fear but of horror, and utters vague but
frightful prophecies of bloodshed and sin, punctuated by the
bewildered questions of her hearers. She tells them that they will
see the death of Agamemnon, bewails her own wretchedness,
greets her death, and prophesies the coming of an avenger. She
passes into the house. After a lyric on wicked prosperity, the voice of
the king is heard crying within that he has been mortally wounded.
Another shriek follows, and then silence. The chorus are in a tumult,
when the doors are flung open and Clytæmnestra is seen standing
over the corpses of Agamemnon and Cassandra. She has slain the
king with an axe, entrapping him in the folds of a robe while in his
bath. In reply to the furious accusations of the elders she glories in
her act—she is the personification of the ancestral curse; and she
has avenged the murder of Iphigenia. The altercation has for the
moment reached something like calm, when Ægisthus appears. He is
the cousin of Agamemnon, but between the two families there is a
murderous and adulterous feud; Ægisthus himself is the lover of
Clytæmnestra and has shared in the plot. The Argives turn on him in
hatred and contempt, which he answers with tyrannical threats.
They remind him that Orestes, the king’s young son, is alive and
safe abroad. Swords are drawn, but Clytæmnestra insists that the
quarrel shall cease; she and Ægisthus must rule with dignity.
A novel theory of the plot has been put forward by the late Dr. A.
W. Verrall in his edition of the play.[232] He finds the following
difficulties in the usual acceptation: (i) Agamemnon lands in Argos
on the morning after the night in which Troy was captured, though
as a matter of course and a matter of “history” several days (at the
very least) must have elapsed before the Greek host so much as
embarked; and though a storm has befallen the fleet on its way. (ii)
The story given by Clytæmnestra about the beacons is absurd. Why
has the arrangement existed for only one year of the ten? Why make
an arrangement which would depend so entirely on the weather?
How could the beacon on Mount Athos have been seen from Eubœa
(a hundred miles away) when a tempest was raging on the
intervening sea? (iii) This mystery, that Agamemnon reaches home
only two or three hours after his signal, is never cleared up: neither
he nor the queen mentions it when they meet. (iv) Thus the whole
affair of the beacons is gratuitous as well as incredible. (v) We are
not told how Agamemnon was slain. That is, though the poet is
precise enough about the details of the actual murder, we are not
enlightened as to how a great and victorious prince could be killed
with impunity by his wife and her lover, who thereupon, with no
difficulty, usurp the government. (vi) What does Ægisthus mean by
claiming to have contrived the whole plot? On the face of it he has
done nothing but skulk in the background. Dr. Verrall’s explanation,
set forth with splendid lucidity, skill, and brilliance, may be briefly
summarized thus. For a year Clytæmnestra and Ægisthus have been
joined in a treasonable and adulterous league, Ægisthus knows what
is happening at Troy and has the first news of Agamemnon’s landing
(at night). He lights upon Mount Arachnæus a beacon which tells
Clytæmnestra that all is ready. (Her story of the fire-chain is a lie to
deceive the watchman and the elders.) Agamemnon thus naturally
arrives only an hour or two after the news that Troy has fallen. The
assassination-plot succeeds for various reasons. During the ten
years’ war many citizens of Argos have been alienated from the king
by the enormous loss of Greek lives. Hence the usurpers have a
strong body of potential adherents. In fact, several passages which
our texts attribute to the chorus really belong to conspirators. Next,
Agamemnon by the accident of the storm has with him, not the
great host, but a single ship’s company. Finally, though he has heard
much ill of his wife—this only can account for the brutality
wherewith he greets her—he does not suspect her resourcefulness,
wickedness, and courage. Verrall’s theory should probably be
accepted.
This tragedy is beyond compare the greatest work of Æschylus.
The lyrics surpass those of any other drama. To the majesty and
scope familiar everywhere in Æschylean choric writing, and to the
tenderness which diffuses a gentle gleam through the Prometheus,
are now added matchless pathos and the authentic thrill of drama.
The picture of Iphigenia (vv. 184-249) is not merely lovely and
tearful beyond words; it is a marvel that this gloomy colossus of the
stage should for a moment have excelled Euripides on Euripides’
strongest ground; it is as if Michelangelo had painted Raffaelle’s
“Madonna of the Grand Duke” amid the prophets and sibyls of the
Sistine Chapel. Even more poignant, because more simple, are the
brief lines (vv. 436-47) which tell how the War-God, the money-
changer of men’s bodies, sends back from Troy a handful of charred
dust, the pitiful return for a man who has departed into the market-
place of Death. Best known of all perhaps is the passage (vv. 402-
26) which portrays the numb anguish of a deserted husband.
Further, these lyrics are dramatic. The choric songs do not suspend
the action by their sublime elucidations; the comments enable us to
understand the march of events, giving us the keynote of the scene
which follows each lyric. For instance, when the first stasimon
dilates, not upon the glory of conquest, but upon the fall of pride
and the sorrows of war, we are prepared for the herald and his tale
in which triumph is overborne by the memory of hardship and
tempest. The misgivings which brood over the third stasimon, in
spite of the victorious entry of the king which has just been
witnessed, is a fit prelude to the terrible outbreaks of Cassandra.
The characterization shows a marked advance on the Prometheus
in variety and colour. This is not so much because three actors are
needed as against two in the earlier play; for though they are
necessary, comparatively little use is made of the increased facilities.
But, while Clytæmnestra is technically as great a creation as
Prometheus, the secondary persons are much more interesting in
themselves than in the earlier drama. They do of course form a
series of admirable foils to the queen, but they are worthy of careful
study for their own sakes, which cannot be said very heartily for the
lesser personages of the Prometheus. The sentinel is excellent,
sketched in a few lines with a sureness of touch which is a new thing
in this poet’s minor characters. The sense of impending trouble
mixed with expected joy, the flavour of rich colloquialism about his
speech, and the hearty dance upon the palace-roof wherewith he
hails the beacon, make him live. Even more commonplace,
theoretically, is the part given to the herald, but him again Æschylus
has created a real man. The passionate joy with which he greets his
native soil, and the lugubrious relish wherewith he details the
hardships of the army before Troy, make him our friend at once, and
present us with that sense of atmosphere which is often lacking in
Greek tragedy. Agamemnon may seem a disappointing figure; very
naturally, for it is the poet’s purpose to disappoint us. To depict a
great and noble king would have spoiled the splendid effect of
Clytæmnestra. Agamemnon’s murder must be made for the moment
as intelligible as may be, therefore the dramatist shows us a
conceited, heavy-witted, pompous person who none the less reveals
certain qualities which have made it possible for such a man to
overthrow Troy.
Clytæmnestra is Æschylus’ masterpiece—not indeed a masterly
picture of female character; such work was left to others—but a
superb presentment of a woman dowered with an imperial soul,
pressed into sin by the memory of her murdered child, the blind
ambition of her husband, and the consciousness of an accursed
ancestry. Here, as elsewhere in these three tragedies, the
architectural skill with which Æschylus plans his trilogy invite the
closest study. In this first part, all the justification which
Clytæmnestra can claim is held steadily before the eyes. The
slaughter of Iphigenia, which killed her love for Agamemnon, is
dwelt upon early in the play and recalled by her once and again
during her horrible conversation with the chorus after the king’s
death. Another wrong to her is brought visibly upon the scene in the
person of Cassandra. The sordid side of her vengeance, her amour
with Ægisthus, remains hardly hinted at until the very end, where it
springs into overwhelming prominence—but at the very moment
when we are preparing to pass over to the Choephorœ, the second
great stage of the action, in which the mission of Orestes is to be
exalted. Clytæmnestra has been often compared to Lady Macbeth.
But Shakespeare’s creation is more feminine than that of the
Athenian. She evinces inhuman heartlessness and cynicism till the
task is accomplished; before the play ends she is broken for ever.
Clytæmnestra never falters in her resolution, hardly a quiver reveals
the strain of danger and excitement upon her nerves while success
is still unsure. When the deed is accomplished and the strain
relaxed, then, instead of yielding to hysterical collapse, she is
superbly collected.[233] Years after, she re-appears in the
Choephorœ, but time, security, and power have, to all seeming, left
little mark upon this soul of iron. At the last frightful moment when
she realizes that vengeance is knocking at the gate, her courage
blazes up more gloriously than ever: “Give me the axe, this instant,
wherewith that man was slain”.[234] It is a superb defiance; for
thrilling audacity this passage stands perhaps alone until we come to
the splendid “Stand neuter, Gods, this once, I do invoke you,” with
which Vanbrugh[235] rises, for his moment, into the heights where
Æschylus abode. Yet next moment the knowledge that her lover is
dead brings her to her knees.
Cassandra and Ægisthus have not yet been considered, for they
belong also to the next topic—the method in which the unity of the
play is so handled that it does not interfere with, but helps to effect,
the unity of the whole trilogy. The indescribable power and thrill of
Cassandra’s scene may easily blind us to the slightness of the
character-drawing. Simply as a character, the princess is no more
subtly or carefully studied than the herald; the extraordinary interest
which surrounds her arises not from what she is or does but from
what happens to her. She is the analogue of Io in the Prometheus.
The mere structure of both plays allots to Io and Cassandra precisely
the same functions. Passive victims of misfortune, they are the
symbol and articulation of the background in the particular drama;
further, they are vital to the economy of the whole series, in that
they sum up in themselves the future happenings which the later
portions of it are to expound. So far, they are the same; but when
we go beyond theoretical structure and look to the finished
composition, Cassandra far outshines Io. The Argive maiden suffers,
shrinks, and laments in utter perplexity. The Trojan suffers, but she
does not quail; her lamentations are hardly lamentations at all, so
charged are they with lofty indignation, and the sense of pathos in
human things. Io is broken by her calamity; Cassandra is purified
and schooled. The poet who in this very play sings that suffering is
the path to wisdom has not made us wait long for an example.
There is, too, a definite technical advance in this, that Io merely
hears the prophecy of justification and the possibility of revenge,
while Cassandra in her own person foretells the return of Orestes.
Ægisthus also, but less obviously, is important to the progress of
the trilogy. His appearance and his speeches are no anti-climax to
the splendid scene of Clytæmnestra’s triumph. The queen and
Cassandra have talked of the Pelopid curse; Ægisthus is the curse
personified. It is through ancient wickedness that he has passed a
half-savage life of brooding exile; the sins of his fathers have turned
him into a man fit to better their instruction. Again, this last scene
brings before us in full power that aspect of Clytæmnestra which has
been almost ignored—her baser reason for the murder of her
husband. This is done precisely at the right place. To dwell on the
queen’s intrigue earlier would have deprived her of that measure of
sympathy which throughout this first play she needs. Not to have
depicted it at all would have left that sympathy unimpaired, and we
should have entered upon the Choephorœ fatally unable to side with
Orestes in his horrible mission.
The story of the Choephorœ[236] (Χοηφόροι, “Libation-Bearers”) is
as follows. The back-scene throughout probably represents the
palace of Argos; in the orchestra[237] is the tomb of Agamemnon.
Something like ten years have elapsed since the usurpation of
Ægisthus. Orestes, son of the murdered king, accompanied by his
friend Pylades, enters and greets his father’s grave, laying thereon a
lock of his hair in sign of mourning; they withdraw. The chorus (led
by Electra) enter—attendants of Electra carrying libations, to be
poured in prayer upon Agamemnon’s tomb. Their song expresses
their grief, hints at revenge, and explains that they have been sent
by Clytæmnestra herself, who is terrified by a dream interpreted to
signify the wrath of Agamemnon’s spirit. Electra discusses the
situation with her friends, and pours the libations over the mound in
her own name, not on behalf of her mother, calling upon the gods
and Agamemnon’s spirit to bring Orestes home and punish the
murderess. Electra discovers the tress of hair left by Orestes. That it
has come from him she knows, as it resembles her own;[238] he
must have sent it. In the midst of her excitement, she perceives
footprints; these, too, she recognizes as like her own. Suddenly
Orestes appears and reveals himself. She still doubts, but he exhibits
a piece of embroidery which she herself worked long ago. Electra
falls into his arms; Orestes explains to his friends that Apollo has
sent him home as an avenger. In a long lyrical scene (κομμός), the
chorus, Electra, and Orestes invoke Agamemnon to assume life and
activity in aid of his avenger.[239] The chorus leader tells Orestes of
Clytæmnestra’s vision. She dreamed that she gave birth to a snake,
which drew blood from her breast. He expounds this as foretelling
the death of the queen at his hands. Explaining that he and his
followers will gain admission to the palace as travellers, he departs.
The maidens raise a song of astonishment at the crimes of which
mortals are capable, dwelling especially upon the treachery of an evil
woman. Orestes comes back accompanied by his followers, and tells
the porter that he brings news for the head of the house.
Clytæmnestra appears, and receives the feigned message that
Orestes is dead. The queen is apparently overwhelmed, but bids the
visitors become her guests. While the chorus utter a brief prayer for
success, the aged nurse of Orestes comes forth, in grief for the loss
of her foster-son. She tells the chorus she has been despatched by
Clytæmnestra to summon Ægisthus and his bodyguard, that he may
question the strangers. They persuade her to alter the message; let
Ægisthus come unattended. When she has gone, they raise another
lyric in passionate encouragement of Orestes. Ægisthus enters and
goes into the guest-wing of the house; in a moment his scream is
heard; the chorus retire.[240] A servant of Ægisthus bursts forth,
proclaiming the death of his master. He flings himself upon the main
door, desperately shouting for Clytæmnestra, who in a moment
appears. His message, “The dead are slaying them that live,” is clear
to her: doom is at hand, but she calls for her murderous axe.
Orestes rushes out upon her with drawn sword. His first words
announce the death of Ægisthus, and she beseeches him piteously
for mercy. Orestes, unnerved, asks the counsel of Pylades, who for
the first and last time speaks, reminding the prince of his oath and
the command of Heaven. Clytæmnestra is driven within to be slain
beside her lover. After a song of triumph from the chorus, the two
corpses are displayed to the people; beside them stands Orestes
who brings forth the blood-stained robe wherein Agamemnon was
entangled. The sight of it brings upon the speaker a perturbation
strange even in such circumstances. It is the coming of madness. He
sees in fancy the Furies sent by his mother’s spirit, and rushes away
to seek at Delphi the protection which Apollo has promised. The play
ends with a few lines from the chorus lamenting the sinful history of
the house.
The Choephorœ is less popular with modern readers than either of
its companions. This is owing partly to the difficulty of perusal, for
the text of the lyrics is often corrupt; it is still more due to no
accident, but to technique. The second play of a trilogy was usually
more statuesque than the other two. There is, of course, a progress
of events, not merely a Phrynichean treatment of a static theme; but
the poet carefully retards his speed. Thus the Choephorœ should be
compared rather with the Prometheus than with the Agamemnon.
We then observe an improvement—if we wish to call it so—in
construction. The great Commos keeps the play almost[241] at a
standstill; but the rest of the work is full of dramatic vigour.
It is true that none of the characters has the arresting quality of
those in the Agamemnon. The nurse is a worthy companion to the
watchman—her quaint and explicit references to the trouble caused
her by Orestes when a baby are the most remarkable among the
few comic touches found in our poet; and the part of the slave who
gives the alarm, minute indeed, is yet the finest of its kind in Greek
tragedy. But the persons of greater import—Electra, Ægisthus, and
Pylades—would not have taxed the skill of a moderate playwright.
Clytæmnestra is magnificent, but less through her present part than
through the superb continuation of her rôle in the Agamemnon; her
scenes are brief, like the glimpse of a fierce sunset after a lowering
day. She is the only person characterized, except, indeed, Orestes,
and even he through most of the drama is not a character, but a
purpose and a few emotions speaking appropriate sentences. This is
true even of the scene where he condemns his mother. The only
touch of genuine drama is the instant where he quails before her
entreaty; but though this is real enough, it is not great. The
undoubted power of the scene is due not to dramatic skill, but to the
intrinsic horror of the situation, Æschylus has given us almost as
little as we could expect. But turn the page and study Orestes’
address to the Argive state—the increase in dramatic force is
appalling. He begins by stately, vigorous, and impassioned
eloquence equal to almost anything in the Agamemnon. The blood-
stained robe is displayed, and the hideous sight seems to eat into his
brain. His grip on what he means to say slips; he struggles to
recapture it; one can see his failing mind stagger from the mother of
whom he strives to speak to the garment of death before him. A
word rises to the surface of his thoughts, he snatches at it, but it
brings up with it the wrong phrase. The horror passes into us; this
half-madness is not lunatic incoherence but the morbidly subtle
coherence of a masterful mind struggling against insanity. The
deadly net entangles his brain as it entangled his fathers body. By a
final effort he collects himself and declares that he goes to Delphi to
claim the protection and countenance of Heaven. Then his doom
settles upon him; the Furies arise before him and he flees
distraught.
That such immense force should be manifested only at the end of
the play, that until and during the crisis Æschylus exerts only
sufficient dramatic energy to present his situations intelligibly, is the
most significant fact in the Choephorœ. This is deliberate in an artist
who has composed the Agamemnon and the Eumenides. In the
opening stage it is human sin and courage which provide the rising
interest; in the third the righteousness and wisdom of the Most High
unloose the knot and save mankind; at both periods personality is
the basis of action. But in the middle stage the master is not
personality, but the impersonal Fury demanding blood in vengeance
for blood, a law of life and of the universe, named by a name but
possessing no attributes. This law may be called by a feminine title
Erinys; it is called also by a phrase: “Do and Suffer”;[242] it is the
shade of Agamemnon, thirsting—is it for blood as a bodily drink or
for death as expiation?—and sending the dark progeny of his soul up
from Hades. This fact, then, and no person, it is which dominates
the play, and that is why the persons concerned are for the time no
magnificent figures of will or valour or wisdom, but the panting
driven thralls of something unseen which directs their movements
and decides their immediate destiny.
The plot of the third play, the Eumenides[243] (Εὐμενίδες, “the
Kindly Ones,” an euphemistic name of the Furies) is as follows.
Outside the shrine at Delphi, the Pythian priestess utters a prayer to
all the deities connected with the spot, after which she enters the
sanctuary. Almost instantly she returns in horror, and tells how she
has seen a blood-stained man seated upon the Omphalos and round
him a band of sleeping females, loathly to the sight. She departs.
From the temple the god appears[244] with his suppliant Orestes,
whom he encourages and sends forth (led by the god Hermes) on
his wanderings, which are to end in peace at Athens. When the two
have disappeared, the ghost of Clytæmnestra rises and awakens the
sleeping Furies. They burst forth from the temple in frenzy at the
escape of their victim. In the midst of the clamour Apollo, with
words of contemptuous hatred, bids them begone. The scene now
changes to Athens, where Orestes throws himself upon the
protection of the goddess Athena, whose statue he clasps. In a
moment the chorus of Furies enter in pursuit; they discover Orestes
and describe the horrible doom which he must suffer. He defies them
and calls upon the absent Athena. But they circle about him chanting
their fearful “binding-song”—the proclamation of their office and
rights as the implacable avengers of bloodshed and every other sin.
As their strains die away Athena enters. She hears the dispute in
outline, the Furies insisting that for matricide there can be no
pardon, Orestes declaring that he has been purified ritually by Apollo
who urged him to his deed. The goddess determines that the suit
shall be tried by a court of her own citizens. Meanwhile the Furies
sing of the danger to righteousness which must result if their
prerogatives are withdrawn: “terror has a rightful place and must sit
for ever watching over the soul”.[245] The court of justice is now
assembled on the Areopagus. Athena presides; with her are the
jurymen (generally supposed to number twelve); before her are the
Furies and Orestes; behind is a great crowd of Athenian citizens. A
trumpet blast announces the opening of the session, and Apollo
enters to aid Orestes. The trial begins with a cross-examination of
Orestes by the Furies, in which he is by no means triumphant. Apollo
takes his place and gives justification for the matricide, under three
heads: (i) it was the command of Zeus; (ii) Agamemnon was a great
king; (iii) the real parent of a child is the father, the mother being
only the nurse. To prove this last point Apollo instances the president
herself, Athena, born of no mother but from the head of Zeus. He
ends by promising that Orestes, if acquitted, will be a firm and
useful ally to Athens. The goddess now declares the pleading at an
end, but before the vote is taken she delivers a speech to the jury,
proclaiming that she now and hereby founds the Areopagite Court
which shall for ever keep watch over the welfare of Athens by the
repression of crime. The judges advance one by one and vote
secretly; but before the votes are counted Athena gives her ruling
that if an equal number are cast on either side Orestes shall be
acquitted, for she gives her casting vote in his favour.[246] The votes
are counted and found equal, and the goddess proclaims that
Orestes is free. Apollo departs, and Orestes breaks forth into
thanksgiving and promises that Argos shall ever be the friend of
Athens. He leaves Athena and her citizens confronted by the Furies,
who raise cries of frantic indignation, turning their rage upon Athens
and threatening to blight the soil, the flocks, and the people. Athena
seeks to placate them by offering a habitation and worship in Attica.
For a time they refuse to listen, but after their fourth song of
vengeance they relent. Athena promises that they are to become
kindly earth-deities[247] domiciled in Attica, blessing the increase of
crops, of herds, and of the family. The citizens, with torches in their
hands, form a procession led by Athena, and conduct the new
divinities to their dwelling in a cave beneath the Acropolis.
It remains to deal with the literary and religious aspects of the
play. The poet sketches Orestes in but a rudimentary style. There is,
indeed, hardly any character-drawing in him; he is simply any brave,
sensitive, religious man. The “human interest” is almost confined to
the gods, without our forgetting that they are surrounded by human
auditors. Athena and the Furies are made to live by a few noble
sweeping strokes; Athena, the majestic presentment of Olympian
wisdom and the visible head of her favoured city; the Furies majestic
in their rage, unanswerable in their claim that punishment of crime
cannot be done away if the world is to endure. Apollo is a curious
study, less sublime than we expected. His manner under cross-
examination by the Furies is a little too human; indeed he loses his
temper. The fact is that, though Æschylus has no desire to treat
Apollo irreverently, he is by no means concerned to depict a perfect
being; and for two reasons. Firstly, he insists on reminding us that
Apollo is but the minister of Zeus; it is Zeus only whom he is bent on
exalting. Secondly, he knows well that his audience, as between the
Furies and Apollo, have a strong bias in favour of the latter. The poet
does acquit Orestes, but it is of the deepest importance in his eyes
that we should not complacently regard the Furies as mere malicious
fiends, routed by a gloriously contemptuous Olympian; the Furies
may be wrong, perhaps, but prima facie they have a terribly strong
case. Therefore in the scene of the pleadings they at least hold their
own. Apollo may be more right than they; he is emphatically not
their superior, his personal fiat is not a spiritual sanction profounder
than theirs. Neither party has got to the root of things. The Furies
say: “This man shed the blood of a kinswoman; he must be for ever
damned”. Apollo says: “He has not sinned, for Zeus bade him act
thus”. The acquittal of Orestes is not the solution of this
disagreement, it is but the beginning; we can hardly understand the
dispute as yet.
We thus come to the religious aspect of the Eumenides. Æschylus
is of course too sincere to be satisfied, or to allow us to be satisfied,
with the fact that Orestes actually escapes. His pursuers attack not
the Argive prince only; much of their language is an indictment of
Apollo, and ultimately of Zeus. It is very well for Apollo to revile
them as “beasts detested by the gods,”[248] but the gods are
themselves arraigned. The earth-powers stand for the principle that
sin, especially bloodshed, must be punished; this demand is
recognized as just by Athena,[249] and is not repudiated by Apollo.
Yet Zeus, the Sovereign of all things, extends his hand over the man
who has fallen under their sway by his act. How shall these claims
be reconciled?
The solution of Æschylus is not unlike that which (it appears) he
offered at the end of the Prometheus-trilogy. We are to imagine that
we witness the events of a time when Zeus himself has not attained
to full stature. His face is set towards the perfection of
righteousness, but development awaits even him. In the instance of
Orestes, the jar between Furies and Apollo, or more ultimately
between the earth-powers and Zeus, shows that neither party is
perfectly right. None the less, it is essential that there should be but
one master of the universe, and the Furies are compelled to submit.
But Æschylus does not lay down his pen at this point; nothing does
he avoid more carefully than an ending which might appear as
desirable as obvious to a vulgar playwright, some showy tableau of
grovelling fiends and triumphant goddess. The Furies themselves
look for nothing less than moral annihilation[250] as the result of
defeat. But something of which they have never dreamed—of which,
probably, no Greek in the theatre has dreamed—is in store for them;
neither victory nor defeat, but recognition by the power to which
they have been forced to bow, assimilation to that religion from
which they have kept themselves so jealously sundered. They are
still to be mighty powers of earth, yet their function is to be cursing
no more, but blessing only.
But is this a solution at all? Is it enough to hint at the thunderbolt,
to offer a bribe of power and worship that the Furies may forget
their rage against Attica?[251] What is to become of their function as
inflexible champions of righteousness, which has been the moral
safeguard of men? This duty the goddesses leave as a legacy to the
newly-formed court of chosen Athenians:—[252]
τὸ μήτ’ ἄναρχον μήτε δεσποτούμενον

ἀστοῖς περιστέλλουσι βουλεύω σέβειν
καὶ μὴ τὸ δεινὸν πᾶν πόλεως ἔξω βαλεῖν.[253]
“Loyalty and worship do I urge upon my citizens for a polity neither

anarchic nor tyrannical; fear must not be banished utterly from the
State.” These are the words of Athena; they are also the words of
Æschylus—a solemn warning to his fellow-citizens; finally, they are
the words of the Furies themselves—the very phrases which they
have used are here borrowed—and go far to explain why they
consent to relinquish their prerogative. First they have regarded the
Areopagus with misgiving as a possibly hostile tribunal; then with
hatred as an enemy; at the last they look upon it with benevolence
as their heir to those stern duties which must not be suffered, under
whatever ruler of the world, to fall into oblivion. It is true at the
same time that the poet wished, for reasons of contemporary
politics, to impress upon his countrymen the sacredness of this
ancient court, then threatened with curtailment of its powers and
prestige at the hands of the popular party led by Pericles and
Ephialtes; and the manner in which he weaves this consideration of
temporal interests into the fabric of a vast religious poem is
magnificently conceived. What in a smaller man would have been
merely a vulgar dexterity is sanctified by religious genius. It is not
the degradation of religion, but the apotheosis of politics. The close
of the Eumenides is anything but an anti-climax. It is closely knit to
the body of the whole trilogy, showing the manner in which the
playwright supposes the necessary reconciliation between Zeus and
the Furies to be made possible and acceptable. The King of Heaven
is mystically identified now and for ever with Fate.[254] The joyful
procession of προπομποί is the sign not only that the moral
government of the world has been set at last upon a sure basis, but
also that this government is already in operation and sanctifying
human institutions.
These seven plays are all that survive complete of the eighty[255]
tragedies and satyric dramas written by Æschylus. Our knowledge of
the lost works rests upon some hundreds of fragments and scattered
mention or comment in ancient writers.
Most interesting and important are those plays which were
associated with the extant dramas; these have been already
discussed. Next in attractiveness is the Lycurgea (Λυκουργεία, or
trilogy of Lycurgus), to which the Bacchæ of Euripides had close
affinity in subject. Lycurgus was a king of the Edoni, a Thracian
people, who opposed the religion of Dionysus when it entered his
realm, and was punished with death. The first play, the Edoni
(Ἠδωνοί), depicted the collision between Dionysus and his enemy.
There was an interview in which Lycurgus taunted the god with his
effeminate looks,[256] and which apparently closed with the
overthrow of his palace by the might of the god.[257] The longest
fragment gives an interesting account of the instruments of music
used in the bacchic orgies. The name of the second play is not
certain; it was either Bassarides (Βασσαρίδες) or Bassaræ
(Βασσάραι)—the Women of the Fawn-Skin. Here the anger of
Dionysus fell upon Orpheus the musician, who neglected the new
deity and devoted himself to Apollo. He was torn to pieces by the
Bacchantes and the Muses gathered his remains, to which they gave
sepulture in Lesbos. The Youths (Νεανίσκοι) formed the last piece of
the trilogy; practically nothing is known of it. It was the chorus
which gave its name to the play in all three cases. The satyric drama
was called Lycurgus; if we may judge from one of the three
fragments the tragic treatment of wine was transformed into a comic
discussion of beer.[258]
Another celebrated trilogy had for its theme the tale of Troy. The
Myrmidons (Μυρμιδόνες), named from the followers of Achilles who
formed the chorus, dealt with the death of Patroclus. Achilles,
withdrawn from battle because of his quarrel with Agamemnon, is
adjured by the chorus to pity the defeat of the Greeks. He allows
Patroclus, his friend, to go forth against the Trojans. After doing
valiantly, Patroclus is slain by Hector. The news is brought by
Antilochus to Achilles, who gives himself up to passionate lament.
This play was a favourite of Aristophanes, who quotes from it
repeatedly. In this drama occurred the celebrated simile of the eagle
struck to death with an arrow winged by his own feathers, which
was cited throughout antiquity and which Byron paraphrased in one
of his most majestic passages.[259] The story was apparently
continued in the Nereides (Νηρηίδες). Achilles determined to
revenge Patroclus. The magic armour made for him by Hephæstus
was brought by his mother Thetis, accompanied by her sisters, the
sea-nymphs, daughters of Nereus, who formed the chorus. The last
play was the Phrygians (Φρύγες) or Ransom of Hector (Ἕκτορος
Λύτρα) in which Priam prevailed upon Achilles to give up the corpse
of Hector for burial. It appears likely that in the two preceding plays
Æschylus followed Homer somewhat closely. But in the Ransom he
did not. Besides the detail to which Aristophanes[260] makes
allusion, that Achilles sat for a long time in complete silence, no
doubt while the chorus and Priam offered piteous and lengthy
appeals, there are differences of conception. In Homer, one of the
most moving features of the story is that Priam goes to the Trojan
camp practically alone. He is met by the God Hermes who conducts
him to the tent of Achilles. Then, solitary among his foes, he throws
himself upon the mercy of his son’s destroyer. No such effect was to
be found in Æschylus. The chorus of Phrygians accompanied their
king, and we find in a fragment of Aristophanes[261] a hint of much
posturing and stage-managed supplication.
The Women of Etna (Αἰτναῖαι) was produced in Sicily at the
foundation of Hiero’s new city. In the Men of Eleusis (Ἐλευσίνιοι)
Æschylus dealt with the earliest struggle of Athens—the war with
Eleusis, his own birth-place. More ambitious in its topic was the
Daughters of the Sun (Ἡλιάδες) which dealt with the fall of
Phaethon. A pretty fragment alludes to that “bowl of the Sun” so
brilliantly described by Mimnermus, in which the god travels back by
night from West to East. It seems that the geographical
enumerations prominent in the Prometheus-trilogy were found here
also, tinged less with grimness and more with romance. In the
Thracian Women (Θρῇσσαι) Æschylus treated the same theme as
Sophocles in the Ajax. It is significant that the death of the hero was
announced by a messenger. Possibly, then, it was a desire for
novelty which caused the younger playwright to diverge so strikingly
from custom as to depict the actual suicide. The Cabiri (Κάβειροι)
was the first tragedy to portray men intoxicated. In the Niobe
(Νιόβη) occurred splendid lines quoted with approbation by Plato:—
Close kin of heavenly powers,

Men near to Zeus, who upon Ida’s peak
Beneath the sky their Father’s altar serve,
Their veins yet quickened with the blood of gods.[262]
The Philoctetes is the subject of an interesting essay by Dio

Chrysostom.[263] All the three great tragedians wrote plays[264] of
this name, and Dio offers a comparison. Naturally, but for us
unfortunately, he assumes a knowledge of these works in his
readers; still, certain facts emerge about the Æschylean work. Men
of Lemnos—the island on which Philoctetes had been marooned—
constituted the chorus. To them the hero narrated the story of his
desertion by the Greeks, and his wretched life afterwards. Odysseus
persuaded him to come and help the Greeks at Troy by a long recital
of Hector’s victory and false reports of the death of Agamemnon and
Odysseus. Neither Neoptolemus nor Heracles (important characters
in Sophocles) seems to have been introduced by Æschylus. Dio
comments on the style and characterization. The primitive grandeur
of Æschylus, he remarks, the austerity of his thought and diction,
appear appropriate to the spirit of tragedy and to the manners of the
heroic age. Odysseus is indeed clever and crafty, but “far removed
from present-day rascality”; in fact he seems “absolutely patriarchal
when compared with the modern school”. That the play is named
after one of the persons and not the chorus, leads one to attribute it
to a comparatively late period in the poet’s life. Finally, the Weighing
of the Souls (Ψυχοστασία) is remarkable for the scene in Heaven,
modelled upon a passage in the Iliad, where Zeus, with Thetis,
mother of Achilles, on one hand, and Eos, mother of Memnon, on
the other, weighed in a balance the souls or lives of the two heroes
about to engage in fight before Troy.
In attempting a general appreciation of this poet one should avoid

making the error of judging him practically by the Agamemnon
alone. Otherwise we cannot hope to understand the feeling of fifth
century Athens towards him. Most of his work has vanished, but the
collection we possess seems fairly representative of his
development; if we give weight to his comparatively inferior plays
we may understand the feeling of two such different men as
Aristophanes and Euripides. Incredible as it may seem, by the end of
that century Æschylus was looked on as half-obsolete. Euripides
thought of him much as Mr. Bernard Shaw now thinks of
Shakespeare; Aristophanes, lover of the old order as he was, seems
to have felt for the man who wrote the Agamemnon a breezy half-
patronizing affection; while putting him forward in the Frogs to
discomfit Euripides, he handles the older poet only less severely than
he handles the younger. He and his contemporaries viewed Æschylus
as a whole, not fixing their eyes exclusively on his final trilogy.
Let us consider him first as a purely literary artist, a master of
language, leaving his strictly dramatic qualities on one side. We find
that his three great notes are grandeur, simplicity, and
picturesqueness. To describe the grandeur of Æschylus is a hopeless
task; some notion of it may be drawn from the account of his
individual works just given, but the only true method is of course
direct study of his writings. The lyrics, from the Supplices to the
Eumenides, touch the very height of solemn inspiration and moral
dignity; as it has been often said, his only peers are the prophets of
Israel. The non-lyrical portions of his work, stiff with gorgeous
embroidery, are less like the conversations of men and women than
the august communings of gods; that majestic poem which has for
auditors the Sun himself, the rivers, the mountains, and the sea, and
for background the whole race of man, is not merely written about
Prometheus: it might have been written by Prometheus. But such
magnificence has its perils. The mere bombast for which Kyd and
even Marlowe are celebrated, and which has given us such things as
The golden sun salutes the morn

And, having gilt the ocean with his beams,
Gallops the zodiac in his glistering coach,[265]
was not unknown to Æschylus, as his wayward supporter

Aristophanes with much relish demonstrates. It seems that such
extravagances, “the beefy words, all frowns and crests, the frightful
bogey-language,”[266] occurred entirely in the lost plays. But in those
which survive we have much bombast of phrase, if not of words; the
“thirsty dust, sister and neighbour of mud,”[267] Zeus, “chairman of
the immortals,”[268]
Typhos, who belcheth from fire-reeking mouth

Black fume, the eddying sister of the flame,[269]
“drill these words through thine ears with the quiet pace of thy
mind,”[270] “breathe upon him the gale of blood and wither him with
the reeking fire of thine entrails”.[271] Æschylus, indeed, like all
poets, understood the majesty of sounding words, apart from their
meaning. As Milton gloried in the use of magnificent proper names,
so does the Athenian delight in thunderous elaboration. Therefore,
not possessing the chastity of Sophocles, he is occasionally
barbarous and noisy; Aristophanes[272] jests at his lyrics for their
frequent exhibition of sound without sense.
Oddly combined with this occasional savagery of phrase is the
second quality of simplicity. Æschylus, so far as we know, was the
creator of tragic diction. However greatly his successors improved
upon him in flexibility, grace, and subtlety, it was he who first
worked the mine of spoken language, strove to purify the ore, and
forged the metal into an instrument of terror and delight. But even
the creator needed practice in its use. He has a giant’s strength, and
at times uses it like a giant, not like a gymnast. In his earlier work
he seems muscle-bound, clumsy in the use of his new-found powers.
He wields the pen as one more familiar with the spear; the warrior
of Marathon does fierce battle with particles and phrases; he strains
ideas to his breast and wrestles with elusive perfection; we seem to
hear his panting when at last he erects as trophy some noble speech
or miraculous lyric. This stiffness of execution persists faintly even in
the Oresteia. The earlier tragedies, both in the characters and in the
language, are rough-hewn, for all their glory. In the Supplices this
stark simplicity is actually the chief note. Here, more than elsewhere,
the poet has a strange way of writing Greek at times as if it were
some other language. The opening words of the Egyptian herald—
σοῦσθε σοῦσθ’ ἐπὶ βᾶριν ὅπως ποδῶν[273]—can only be described as
barbaric mouthing. Throughout this play the complete absence of
lightness and speed, the crude beginnings of greatness, a certain
bleak amplitude, are all typical of a new art-form not yet completely
evolved. The poet, himself the beginner of a new epoch, fills us with
an uncanny impression of persons standing on the threshold of
history with little behind them but the Deluge. In the Persæ and the
Septem there is the same instinct for spaciousness, but the canvas
shows more colour and less of the bare sky, for we are now more
conscious of background, the overthrow of Persia and the operations
of human sin.
The third characteristic, picturesqueness, is the most obvious of
all. The few instances of bombastic diction noted above are but the
necessary failures of a supreme craftsman. Homer does not stay to
embroider his language with metaphor, which belongs to a more
reflective age; Pindar’s tropes are splendid and elaborate, a
calculated jog to the attention. For Æschylus, metaphor seems the
natural speech, unmetaphorical language a subtlety which requires
practice. Danaus in his perplexity ponders “at the chess-board”;[274]
when the assembly votes, “heaven bristles with right hands”;[275] an
anxious heart “wears a black tunic”;[276] heaven “loads the
scales”[277] to the detriment of Persia; the trumpet “blazes”;[278]
misfortune “wells forth”;[279] Amphiaraus “reaps the deep furrow of
his soul”;[280] “the sea laughs in ripples without number”;[281] the
snow descends “with snowy wings”;[282] for an intrepid woman
“hope treads not the halls of fear”;[283] “Fate the maker of swords is
sharpening her weapon”;[284] Anarchy in the State is the “mixing of
mud with water”.[285] The best example of all is the celebrated
beacon-speech in the Agamemnon: “The flame is conceived as some
mighty spirit.... It ‘vaults over the back of the sea with joy’; it ‘hands
its message’ to the heights of Macistus; it ‘leaps across’ the plain of
Asopus, and ‘urges on’ the watchmen; its ‘mighty beard of fire’
streams across the Saronic gulf, as it rushes along from peak to
peak, until finally it ‘swoops down’ upon the palace of the
Atreidæ.”[286]
Allied to this picturesqueness of phrase is a picturesqueness of
characterization: Æschylus loves to give life and colour even to his
subordinate persons. Attic literature is so frugal of ornament that the
richness of this writer gains a double effect. The watchman of the
Agamemnon has the effect of a Teniers peasant; Orestes’ nurse in
the Choephorœ is a promise of the nurse of Juliet; the Egyptian
herald conveys with amazing skill the harem-atmosphere—one
seems to see that he is a negro; Hermes in the Prometheus is the
father of all stage courtiers. Again, direct appeals to the eye were
made by various quaint devices—the winged car of the Ocean
Nymphs, their father’s four-legged bird, and the “tawny horse-cock”
(whatever it was) which so puzzled Dionysus.[287] Such curiosities
were meant merely as a feast for the idle gaze, at first; but the
serious mind of the poet turned even these to deeper issues. The
red carpets of the Agamemnon, and the king treading upon them in
triumph, provided a handsome spectacle to the eye; but the mind at
the same instant fell into grimmer bodements as the doomed man
seemed to walk in blood. So, too, the word-pictures which please the
ear are raised by genius to an infinitely higher power, as in that
same scene, when Agamemnon complains of the waste of purple
stuffs, and the queen seems but to say that there is dye enough left
in the sea: “There is a sea, and who shall drain it dry?” The meaning
of the words is as inexhaustible as the ocean they tell of, revealing
abysses of hatred and love hellishly intertwined, courage to bear any
strain, an hereditary curse whose thirst for blood is never sated, a
bottomless well of life.
If we now consider Æschylus on his purely dramatic side, as a
builder of plays, we find again the three distinctive notes, grandeur,
simplicity, and picturesqueness. The grandeur of his architecture is
an authentic sign of his massive genius—it by no means depends on
his selection of divine or terrific figures; the Persæ and the Septem
are witnesses. It is the outcome of his conception of life as the will
of God impinging upon human character. Æschylus knows nothing
about “puppets of fate.” Around and above men is a divine
government about which many things may be obscure, but of which
we surely know that it is righteous and the guardian of
righteousness. Man by sin enters into collision with the law. The
drama of Æschylus is his study of the will and moral consciousness
of man in its efforts to understand, to justify to itself, and to obey
that law. Supreme justice working itself out in terms of human will—
such is his theme. Another source of grandeur lies in the
perspectives which his works reveal. This, perhaps most evident in
the Prometheus, runs through the other plays; and a technical result
of this power is the skill with which the whole trilogies are wrought.
To compose trilogies rather than simple tragedies shows indeed the
instinct for perspective working at the very heart of his method.
Again, if this instinct likens his work to painting, still more are we led
by historical considerations to make a comparison with sculpture. It
has been said[288] that the earliest play is “like one of those archaic
statues which stand with limbs stiff and countenance smiling and
stony.” This brilliant simile is full of enlightenment. Just as those
early Greek statues which seem to the casual observer merely
distressing are to be contrasted, not with the achievement of
Praxiteles but with non-Hellenic art, the winged bulls of Assyria and
the graven hummocks which present the kings of Egypt, whereupon
we perceive the stirrings of life and beauty; so should the Supplices,
were it only in our power, be compared to the rigid declamations
from which, to all seeming, tragedy was born. In the Supplices
tragedy came alive like the marble Galatea. Dædalus was reputed to
have made figures that walked and ran; it is no fable of Æschylus,
but the history of his art.
Simplicity, the second note of Æschylus, needs little demonstration
after the detailed account of his plots. The four earlier works contain
each the very minimum of action. The characterization is noble, but
far from subtle. All the persons are simply drawn, deriving their
effect from one informing concept and from the circumstances to
which they react. Euripides in the Frogs[289] fastens upon this,
remarking, “You took over from Phrynichus an audience who were
mere fools”. A later generation demanded smartness and subtlety;
Æschylus was anything but artful, and so the same critic accuses
him of obscurity in his prologues.[290] The Oresteia exhibits a
marked advance in construction. Leaving on one side the vexed
question of the plot in the Agamemnon,[291] we observe in the
Choephorœ what we may call intrigue. Orestes has a device for
securing admission to the palace; the libations by which
Clytæmnestra intends to secure herself are turned into a weapon
against her; the chorus intercept the nurse and alter her message so
as to aid the conspiracy. This ingenuity is perhaps due to the
influence of Sophocles.
Thirdly, what may be termed picturesqueness in structure is a
matter of vital import for Æschylus. To write dramatically is to
portray life by exhibiting persons, the vehicles of principles, in
contact and collision. For an artist of the right bent, it is not difficult
to select a scene of history or an imagined piece of contemporary
life which under manipulation and polishing will show the hues of
drama. But the earliest of dramatists turns aside in the main from
such topics. His favourite themes are the deepest issues, not of
individual life, but the life of the race, or the structure of the
universe. What is the relation between Justice and Mercy? Why is
the omnipotent omniscient? May a man of free will and noble
instincts escape a hereditary curse sanctioned by heaven? Such
musings demand surely a quiet unhurried philosophic poem, not the
decisive shock of drama. Æschylus devoted himself, nevertheless,
not to literature in the fashion of Wordsworth, but to tragedy. How
was he to write a play about Justice and Mercy, to discuss a
compromise between the rigidity of safe government and the
flexibility of wise government? Justice and Mercy are both essential
to the moral universe, says the theologian—but they are
incompatible. Friendship and strife are both essential to the physical
universe, says Empedocles—but how can they be wedded? This
impossibility is everywhere, and everywhere by miracle it is
achieved. This union of opposites pervades the world, from the
primitive protoplasm which must be rigid to resist external shock but
flexible to grow and reproduce itself, to the august constitution of
the eternal kingdom in which “righteousness and peace have kissed
each other”. Where, then, is the playwright to find foothold? His
innumerable instances merge into one another. Æschylus, with noble
audacity, lifts us out of the current of time and imagines a special
instance, an instance which presents the problem in dual form—for
example the human tangle of the Atridean house and the
superhuman conflict between Zeus and the powers of earth. It is
assumed that there has been no earlier, less decisive, jar. In the
future, there will be no more. The great question is raised once for
all in its completest, most difficult form. The gradual processes of
time are abolished. Thus Atlas[292] is punished by condemnation to
the task of upholding heaven for ever; how it was sustained before
his offence is a question we must not raise. Hypermnestra[293] is put
on trial for disobeying her father that her husband may live. She is
saved by Aphrodite; and the innumerable cases of conflicts of duty
which have broken hearts in days past are summed up (rather than
disregarded) by this ultimate example. In the Oresteia a man is
hunted well-nigh to death by fiends because he has obeyed the will
of God. Why? It can only be said that until the judgment in the
Eumenides all is nebulous, the world is being governed desperately
as by some committee of public safety; morals, justice, and equity
are still upon the anvil. After this one case no man will ever again be
tortured like Orestes; nor indeed, we may conjecture, will the oracles
of Zeus issue behests so merciless as that which he received.
Finally, something should be said about Æschylus’ views on
religion. Other subjects had an interest for him, geography, history,
and politics,[294] but his never-failing and profound interest in
religion overshadows these. Not only was he interested in the local
cults of Athens, as were his great successors; he is at home in the
deepest regions of theology. Even more than this, he brings back
strange messages from the eternal world, he seeks to purify the
beliefs of his fellows by his deep sense of spiritual fact; he writes the
chronicles of Heaven and bears witness to the conquests of the Most
High. Among Greek writers he is the most religious, and, with Plato
and Euripides, most alive to the importance of belief to the national
health. He is not ashamed of the traditional gospel when he thinks it
true: “the act comes back upon him that did it; so runs the thrice-old
saw”.[295] Still less is he ashamed to denounce false maxims: “From
of old hath this hoary tale been spread abroad among men, that
when prosperity hath grown to its full stature it brings forth offspring
and dies not childless; yea, that from good hap a man’s posterity
shall reap unendingly a harvest of woe. But I stand apart from

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To my wife, Nancy, for her love and support over 49 ½ years.

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τὸ μήτ’ ἄναρχον μήτε δεσποτούμενον

“Loyalty and worship do I urge upon my citizens for a polity neither

Close kin of heavenly powers,

The Philoctetes is the subject of an interesting essay by Dio

In attempting a general appreciation of this poet one should avoid

The golden sun salutes the morn

was not unknown to Æschylus, as his wayward supporter

Typhos, who belcheth from fire-reeking mouth

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