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March 28th, 2007, 06:42 PM
Plague of Athens
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The Plague of Athens was a devastating epidemic which hit the city-state of Athens in ancient Greece during the second year of the Peloponnesian War (430 BC), when an Athenian victory still seemed within reach. It is believed to have entered Athens through Piraeus, the city's port and sole source of food and supplies. The city-state of Sparta, and much of the eastern Mediterranean, was also struck by the disease. The plague returned twice more, in 429 BC and in the winter of 427/6 BC.

Sparta and its allies, with the exception of Corinth, were almost exclusively land based powers, able to summon large land armies which were very nearly unbeatable. Under the direction of Pericles, the Athenians retreated behind the city walls of Athens. They hoped to keep the Spartans at bay while the superior Athenian navy harassed Spartan troop transports and cut off supply lines. Unfortunately the strategy also resulted in adding many people from the countryside to an already well populated city. In addition, people from parts of Athens lying outside the city wall moved into the more protected central area. As a result, Athens became a breeding ground for disease.

In his History of the Peloponnesian War, the contemporary historian Thucydides described the coming of an epidemic disease which began in Ethiopia, passed through Egypt and Libya, and then to the Greek world. The epidemic broke out in the overcrowded city. Athens lost perhaps one third of the people sheltered within its walls. The sight of the burning funeral pyres of Athens caused the Spartan army to withdraw for fear of the disease. It killed many of Athens's infantry, some expert seamen and their leader Pericles, who died during one of the secondary outbreaks in 429 BC. After the death of Pericles, Athens was led by a succession of incompetent or weak leaders. According to Thucydides, it was not until 415 BC that the Athenian population had recovered sufficiently to mount the disastrous Sicilian Expedition.

Modern historians disagree on whether the plague was a critical factor in the loss of the war. However, it is generally agreed that the loss of this war may have paved the way for the success of the Macedonians and, ultimately, the Romans.

Social implications
Accounts of the Athenian plague graphically describe the social consequences of an epidemic. Thucydides' account clearly details the complete disappearance of social mores during the time of the plague. The impact of disease on social and religious behavior was also documented during the worldwide pandemic best known as the Black Death.

Fear of the law
Thucydides stated that people ceased fearing the law since they felt they were already living under a death sentence. Likewise people started spending money indiscriminately. Many felt they would not live long enough to enjoy the fruits of wise investment, while some of the poor unexpectedly became wealthy by inheriting the property of their relatives. It is also recorded that people refused to behave honourably because most did not expect to live long enough to enjoy a good reputation for it.

Role of women
The plague changed the role of women in Athenian society. The women were temporarily liberated from the strict bounds of Athenian custom. The plague forced Athens to appoint a magistrate called gynaikonomos to control the behaviour of women.

Care for the sick and dead
Another reason for the lack of honorable behavior was the sheer contagiousness of the illness. Those who tended to the ill were most vulnerable to catching the disease. This meant that many people died alone because no one was willing to risk caring for them. Especially poignant are descriptions of how people were not cared for due to the overwhelming numbers of sick and dying. People were simply left to die in buildings or on the streets, and the dead were heaped on top of each other, left to rot or shoved into mass graves. There were cases where those carrying the dead would come across an already burning funeral pyre. They would dump a new body on it and walk away. Others appropriated prepared pyres so as to have enough fuel to cremate their own dead. Those lucky enough to survive the plague developed an immunity, and so became the main caretakers of those who later fell ill.

A mass grave and nearly 1,000 tombs, dated to between 430 and 426 BC, have been found just outside Athens' ancient Kerameikos cemetery. The mass grave was bordered by a low wall that seems to have protected the cemetery from a wetland. Excavated during 1994-95, the shaft shaped grave may have contained a total of 240 individuals, at least ten of them children. Skeletons in the graves were randomly placed with no layers of soil between them.

Excavator Efi Baziotopoulou-Valavani, of the Third Ephoreia (Directorate) of Antiquities, reported that "(t)he mass grave did not have a monumental character. The offerings we found consisted of common, even cheap, burial vessels; black-finished ones, some small red-figured, as well as white lekythoi (oil flasks) of the second half of the fifth century B.C. The bodies were placed in the pit within a day or two. These [factors] point to a mass burial in a state of panic, quite possibly due to a plague."

Religious strife
The plague also caused religious strife. Since the disease struck the virtuous and sinful alike, people felt abandoned by the gods and refused to worship them. The temples themselves were sites of great misery, as refugees from the Athenian countryside had been forced to find accommodation in the temples. Soon the sacred buildings were filled with the dead and dying. The Athenians pointed to the plague as evidence that the gods favoured Sparta and this was supported by an oracle that said that Apollo himself (the god of medicine) would fight for Sparta if they fought with all their might. An earlier oracle had stated that "War with the Dorians [Spartans] comes and at the same time death".

Thucydides was skeptical of these conclusions and believed that people were simply being superstitious. He relied upon the prevailing medical theory of the day, Hippocratic theory, and strove to gather evidence through direct observation. He noted that birds and animals who ate plague-infested carcasses died as a result, leading him to conclude that the disease had a natural rather than supernatural cause.

Plague description
Thucydides himself suffered the illness, and survived. He was therefore able to accurately describe the symptoms of the disease within his history of the war.

"As a rule, however, there was no ostensible cause; but people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath."
"These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress."
"In most cases also an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later."
"Externally the body was not very hot to the touch, nor pale in its appearance, but reddish, livid, and breaking out into small pustules and ulcers. But internally it burned so that the patient could not bear to have on him clothing or linen even of the very lightest description; or indeed to be otherwise than stark naked. What they would have liked best would have been to throw themselves into cold water; as indeed was done by some of the neglected sick, who plunged into the rain-tanks in their agonies of unquenchable thirst; though it made no difference whether they drank little or much."
"Besides this, the miserable feeling of not being able to rest or sleep never ceased to torment them. The body meanwhile did not waste away so long as the distemper was at its height, but held out to a marvel against its ravages; so that when they succumbed, as in most cases, on the seventh or eighth day to the internal inflammation, they had still some strength in them. But if they passed this stage, and the disease descended further into the bowels, inducing a violent ulceration there accompanied by severe diarrhea, this brought on a weakness which was generally fatal." "For the disorder first settled in the head, ran its course from thence through the whole of the body, and even where it did not prove mortal, it still left its mark on the extremities; for it settled in the privy parts, the fingers and the toes, and many escaped with the loss of these, some too with that of their eyes. Others again were seized with an entire loss of memory on their first recovery, and did not know either themselves or their friends."
Translation by M.I. Finley The Viking Portable Greek Historians, pp. 274-275:

Cause of the plague
Historians have long tried to identify the disease behind the Plague of Athens. The disease has traditionally been considered an outbreak of the bubonic plague in its many forms, but re-considerations of the reported symptoms and epidemiology have led scholars to advance alternative explanations. These include typhus, smallpox, measles, and toxic shock syndrome. Others have suggested anthrax, tramped up from the soil by the thousands of stressed refugees or concentrated livestock held within the walls. Based upon descriptive comparisons with recent outbreaks in Africa, Ebola or a related viral hemorrhagic fever has also been considered.

Given the possibility that symptoms of a known disease may have mutated over time, or that the plague was caused by a disease which no longer exists, the exact nature of the Athenian plague may never be known. Due to crowding caused by the influx of refugees into the city, inadequate food and water supplies, and the increase in insects, lice, rats and waste, conditions would have encouraged more than one disease in the outbreak. However, the use of more modern science is revealing clues.

Epidemic typhus
In January 1999, the University of Maryland devoted their fifth annual medical conference, dedicated to notorious case histories, to the Plague of Athens. They concluded that disease that killed the Greeks and their military and political leader, Pericles, was typhus. "Epidemic typhus fever is the best explanation," said Dr. David Durack, consulting professor of medicine at Duke University. "It hits hardest in times of war and privation, it has about 20 percent mortality, it kills the victim after about seven days, and it sometimes causes a striking complication: gangrene of the tips of the fingers and toes. The Plague of Athens had all these features." In typhus cases, progressive dehydration, debilitation and cardiovascular collapse ultimately cause the patient's death.

This medical opinion is supported by the opinion of A. W. Gomme, an important researcher and interpretator of Thucydides' history, who also believed typhus was the cause of the epidemic. This opinion is expressed in his monumental work "Historic Comments on Thucydides", completed after Gomme's death by A. Andrewes and K. J. Dover. Angelos Vlachos (Άγγελος Βλάχος), a member of the Academy of Athens and a diplomat, in his "Remarks on Thoucydides" (in Greek: Παρατηρήσεις στο Θουκυδίδη, 1992, Volume I, pages 177-178) acknowledges and supports Gomme's opinion: "Today, according to Gomme, it is generally acceptable that it was typhus" ("Σήμερα, όπως γράφει ο Gomme, έχει γίνει από όλους παραδεκτό ότι ήταν τύφος").

Typhoid fever
A different answer was found in a recent DNA study on teeth from an ancient Greek burial pit, led by Manolis Papagrigorakis of the University of Athens, found DNA sequences similar to those of the organism that causes typhoid fever. Symptoms generally associated with typhoid resemble Thucydides' description. They include:

a high fever from 39 °C to 40 °C (103 °F to 104 °F) that rises slowly;
bradycardia (slow heart rate)
myalgia (muscle pain)
lack of appetite
stomach pains

in some cases, a rash of flat, rose-colored spots called "rose spots"
extreme symptoms such as intestinal perforation or hemorrhage, delusions and confusion are also possible.

Other scientists have disputed the findings, citing serious methodologic flaws in the dental pulp-derived DNA study. In addition, as the disease is most commonly transmitted through poor hygiene habits and public sanitation conditions, it is an unlikely cause of a widespread plague, emerging in Africa and moving into the Greek city states, as reported by Thucydides.


March 28th, 2007, 06:59 PM

The Thucydides Syndrome: Ebola Déjà Vu? (or Ebola Reemergent?)

To the Editor:

The plague of Athens (430-427/425 B.C.) persists as one of the great medical mysteries of antiquity. Sometimes termed “the Thucydides syndrome” for the evocative narrative provided by that contemporary observer, the plague of Athens has been the subject of conjecture for centuries. In an unprecedented, devastating 3-year appearance, the disease marked the end of the Age of Pericles in Athens and, as much as the war with Sparta, it may have hastened the end of the Golden Age of Greece. Understood by Thucydides to have its origin “in Ethiopia beyond Egypt, it next descended into Egypt and Libya” and then “suddenly fell upon” Athens’ walled port Piraeus and then the city itself; there it ravaged the densely packed wartime populace of citizens, allies, and refugees. Thucydides, himself a surviving victim, notes that the year had been “especially free of disease” and describes the following major findings: After its “abrupt onset, persons in good health were seized first with strong fevers, redness and burning of the eyes, and the inside of the mouth, both the throat and tongue, immediatelywas bloody-looking and expelled an unusually foul breath. Following these came sneezing, hoarseness . . . a powerful cough . . . and every kind of bilious vomiting . . . and in most cases an empty heaving ensued that produced a strong spasm that ended quickly or lasted quite a while.” The flesh, although neither especially hot nor pale, was “reddish, livid, and budding out in small blisters and ulcers.” Subject to unquenchable thirst, victims suffered such high temperatures as to reject even the lightest coverings. Most perished “on the ninth or seventh day . . . with some strength still left or many later died of weakness once the sickness passed down into the bowels, where the ulceration became violent and extreme diarrhea simultaneously laid hold (2.49).” Those who survived became immune, but those who vainly attended or even visited the sick fell victim.

By comparison, a modern case definition of Ebola virus infection notes sudden onset, fever, headache, and pharyngitis, followed by cough, vomiting, diarrhea, maculopapular rash, and hemorrhagic diathesis, with a case-fatality rate of 50% to 90%, death typically occurring in the second week of the disease.
Disease among health-care providers and care givers has been a prominent feature. In a review of the 1995 Ebola outbreak in Zaire, the Centers for Disease Control and Prevention reports that the most frequent initial symptoms were fever (94%), diarrhea (80%), and severe weakness (74%), with dysphagia and clinical signs of bleeding also frequently present. Symptomatic hiccups was also reported in 15% of patients.

During the plague of Athens, Thucydides may have made the same unusual clinical observation. The phrase lugx kene, which we have translated as “empty heaving,” lacks an exact parallel in the ancient Greek corpus. Alone, lugx, means either “hiccups” or “retching” and is infrequently used, even by the medical writers. Although contexts usually dictate “retching,” we note unambiguous “hiccups” in Plato’s Symposium (185C). In his thorough commentary on the Thucydides passage, the classicist D. L. Page remarks: “Hiccoughs is misleading, unless it is enlarged to include retching.” Regarding “empty, unproductive retching [he] has noted no exact parallel . . . in the [writings of the] doctors, but . . . tenesmus comes very close to it” . A CD-ROM search of Mandell, Bennett, and Dolin discloses no reference to either “hiccups” or “singultus” in the description of any disease entity.

The profile of the ancient disease is remarkably similar to that of the recent outbreaks in Sudan and Zaire and offers another solution to Thucydides’ ancient puzzle. A Nilotic source for a pathogen in the Piraeus, the busy maritime hub of the Delian League (Athens’ de facto Aegean empire), is clearly plausible. PCR examination of contemporaneous skeletal and archaeozoological remains might test this hypothesis against the 29 or more prior theories.


March 28th, 2007, 11:12 PM
how many estimated deaths worldwide ?
I couldn't find it. Why are they not addressing this question,
why not speculating about it ?

March 29th, 2007, 03:38 AM
Originally Released: January, 1999

Plague of Athens: Another medical mystery solved at University of Maryland

Another medical mystery -- the Plague of Athens, which contributed to the end of the Golden Age of Greece -- may have been solved at the fifth annual medical conference dedicated to notorious case histories of the past.

It was probably typhus fever that killed the Greeks and their military and political leader, Pericles, according to "detectives" David Durack, M.B., D.Phil., and Robert Littman, M.Litt. Ph.D.

Each year since 1995, the University of Maryland School of Medicine and the Veterans Affairs Maryland Health Care System have held a special historical "clinicopathologic conference," an exercise in which the history of an unnamed patient's illness is presented to an experienced clinician for discussion in an academic setting. This method teaches medical students and residents how experienced clinicians would approach a difficult or challenging case.

"We present an unusual modern case on a weekly basis, but once a year we stray from our modern lives and discuss a historical figure," said Philip A. Mackowiak, M.D., professor and vice chair of medicine at the University of Maryland School of Medicine and director of medical care at the VA Maryland Health Care System. "Over the past four years we have discussed the deaths of Edgar Allan Poe, Alexander the Great, and Ludwig van Beethoven, as well as the mental health of General George A. Custer." This year, the historical figure was Pericles, the military and political leader of the Golden Age of Athens.

For the first time, the conference was broadcast over the World Wide Web, with the help of Condor Technology Solutions, Inc. and SOBO Video Productions, Inc., as an interactive forum for hundreds of medical investigators around the world. It was broadcast from the School of Medicine's Davidge Hall, the oldest building in the United States continuously used for medical education, dating to 1812.

Dr. Durack is consulting professor of medicine at Duke University, where he had been chief of the Division of Infectious Diseases before becoming vice president, medical affairs at Becton Dickinson Microbiology Systems. Dr. Littman is Professor of Classical Languages at the University of Hawaii, Manoa. His expertise is in ancient medicine and the social and political history of Athens.

Both scholars doubt previous theories that the Plague of Athens was caused by ebola, bubonic plague, dengue fever, influenza or measles because the symptoms described in ancient historical records do not match those diseases. Despite evidence that it was typhus fever spread either by lice or by air, Dr. Durack and Dr. Littman do not rule out the possibility the Plague of Athens was caused by something else.

"Epidemic typhus fever is the best explanation," said Dr. Durack. "It hits hardest in times of war and privation, it has about 20 percent mortality, it kills the victim after about seven days, and it sometimes causes a striking complication: gangrene of the tips of the fingers and toes. The Plague of Athens had all these features."

Dr. Durack explains: "The Plague of Athens is a medical and historical classic, which has fascinated doctors and historians for centuries. Even if we can never be absolutely sure what caused the plague, the story is still relevant today because we continue to experience the outbreak of new emerging infectious diseases. The Plague of Athens can give us insights on how to respond to AIDS, Legionnaire's Disease, drug-resistant organisms, toxic shock, hantavirus infections and other emerging diseases."

Dr. Littman elaborates: "Plagues are a recurring phenomenon in human history and they are something that is a constant fear of mankind ? being struck by an unknown disease. This plague was of tremendous importance because it signaled the downfall of the Golden Age of Athens, caused the death of Pericles and 25 percent of the population, weakened Athens at the beginning of its 27-year war with Sparta and became the first medical outbreak so thoroughly recorded by historians.""

This kind of medical detective work on famous cases is interesting and even fun, yet it is no more important than the kind of intensive scrutiny that goes on every day for every patient at an academic medical center like Maryland," said R. Michael Benitez, M.D., assistant professor of cardiology and cofounder with Dr. Mackowiak of the event.

Here are the facts of the case given to Dr. Durack and Dr. Littman for their diagnosis:

A 65 year old man is seen because of fever, headache, sore throat and vomiting. He had been in excellent health until approximately one week earlier when he noted a sudden onset of a headache, ocular erythema and halitosis. On the third day of his illness, he began sneezing and coughing, and noted bilateral pleuritic chest pain. On the sixth day of his illness, the patient began projectile vomiting productive of dark bilious fluid.

At this time, he complained of fever so intense that he would not allow himself to be covered with even the lightest clothing. He also complained repeatedly of insatiable thirst. Although he drank copious amounts of water, he obtained little relief from his thirst, at least in part, because of persistent vomiting. The patient has had no prior serious illnesses. He drinks wine in moderation and does not use tobacco. He is taking no medications and has no known allergies.

The patient is a resident of Athens, Greece, where he has lived his entire life, except for short excursions throughout the eastern Mediterranean. His early years were spent in the military where he rose to the rank of commanding general of the armed forces. In recent years he has devoted himself to politics.

The patient is married. Both of his children by this marriage, sons aged 30 and 25 years, have died recently of illnesses similar to the patient's. Another son (by his mistress), aged 10 years, is alive and well. The patient's father died in battle at 47 years of age. The condition of his mother is unknown. He has a brother and a sister. His sister recently died in her mid-60s of an illness similar to the patient's. The condition of his brother, who is also approximately 60 years of age, is unknown.

An illness similar to the patient's has afflicted large numbers of his fellow residents of Athens. The epidemic began roughly a year prior to the onset of the patient's illness, one year after the outbreak of hostilities with a neighboring city state. Interestingly, although enemy forces have besieged Athens continuously during this period, their troops appear not to have been affected by the illness raging within the city proper. Refugees entering the city from the surrounding countryside, however, have been quickly affected.

The disease attacks all age groups and socioeconomic strata, with the highest attack rates occurring among physicians and other care givers. The illness, which is reported to have originated in sub Saharan Africa, had not been seen in Athens prior to the current epidemic. It is believed to have entered Athens through Piraeus, the city's port. In addition to Athens, much of the eastern Mediterranean is now afflicted with the disease.

The current epidemic has waxed and waned since its appearance without apparent seasonality. Of those who have contracted the disease, approximately a quarter have died. Persons recovering exhibit immunity to further attacks of the disease. Unfortunately, such persons are sometimes permanently disabled by residua of the disease, such as encephalopathy, blindness, and/or distal necrosis of extremities. Although there have been reports of dogs and birds dying after feeding on the corpses of those succumbing to the illness, these reports are unsubstantiated.

The patient is alert and oriented and extremely weak. He appears well nourished, although moderately dehydrated. The pulse is rapid and thready. Respirations are deep. The patient complains of an intense fever, and yet his skin is moist and normothermic to the touch. The head is dolichocephalic. The conjunctivae are injected. The oropharynx is red, inflamed and covered with clotted blood. The breath is fetid. Diffuse rales, ronchi and wheezes are heard throughout both the lungs. There is a generalized, erythematous, maculopapular rash.

Supportive therapy consisting of cool baths is administered without relief. On the 9th day of illness, the patient develops profuse diarrhea, which unfortunately, is not examined for blood or inflammatory cells. Progressive dehydration and debilitation ensues. Cardiovascular collapse occurs on the 11th day of illness, and the patient dies.


March 29th, 2007, 04:21 AM
THE PLAGUE IN ATHENS DURING THE PELOPONNESIAN WAR --------------------------------------------------------------------------------


In the early fifth century, the Greeks, apparently against all odds, managed to defeat the numerically far superior forces of the expansive Persian empire in two invasions, in 490 (the battle of Marathon), and again in 480. This sobering experience led a number of Greek cities to join together with Athens in a sea league for the dual purpose of punishing the hubris of the Persians and gaining some recompense for the destruction's of the war. Over time, however, Athens turned this league into an instrument of its own imperial power, enforcing its will upon its allies, now become subjects, and openly appropriating the funds of the league for the creation of monuments of imperial splendor (notably, the Parthenon). This naturally provided a focal point for the jealousies and rivalries of the various Greek poleis, and especially for the Spartans, the acknowledged masters of infantry (hoplite) warfare. The result was an extended war, lasting from 431 to 404 BCE, that pitted the hoplite forces of the Peloponnesus, Sparta and its allies, against the maritime superiority of Athens and its allies.

Thucydides is our primary source for this war. He was an upper-class Athenian and lived through the war (or nearly though it -- it is unclear when he died, but he left his work unfinished). While serving as general he was exiled for coming late to an engagement, and as a result he spent much of the war in exile in the northern Aegean where his family had land -- the same territory in which the doctors who composed the Epidemics were traveling. He was highly aware of the intellectual currents of the time, and both medicine and rhetoric have influenced his presentation of the war.

According to Thucydides, at first enthusiasm for the war was high. Large numbers of young men on both sides who had no experience of war saw it as an adventure and a potential source of profit. But even the first year of the war brought losses and hardship to the Athenians, much of it caused by the radical strategy advocated by the Athenians' current political leader, Pericles, to rely mainly on Athenian naval supremacy: bring all the people in Attica into the city and abandon the outlying countryside to destruction by the Spartans, relying upon the navy to supply the city with food and other necessities that would be carried through the fortified corridor from the port of the Pireus into the city itself (the Long Walls).

In the winter following the first year of the war, morale had fallen considerably in Athens. It was at the year's public funeral (held annually for men who had fallen in battle in the course of the year) that Pericles pronounced the famous funeral oration that is so often quoted as summing up the greatness of Periclean Athens (Thuc.2.34-46). Pericles' speech was an encomium on Athenian democracy and it provided the high point of Thucydides' account of the war. It is immediately and dramatically followed in his account by the description of the plague which struck the city in the following summer, as the Spartans again invaded Attica. Crowded together in the city as the result of Pericles' strategy, the Athenians fell victim to the virulent sickness that was spreading throughout the eastern Mediterranean. People died in large numbers, and no preventive measures or remedies were of any avail. It has been estimated that a quarter, and perhaps even a third, of the population was lost. The plague returned twice more, in 429 and 427/6, and Pericles himself died during this time, probably as a result of the disease.

By 415 the military rolls were full again (Thuc. 6.26), but the thirty-plus generation that filled offices and provided leadership had not yet been replenished.

Thucydides' himself suffered from the plague and recovered; thus he was an eyewitness to the catastrophe (might this have affected his reportage of it?). His expressed intention was not to suggest causes or to identify the illness, but to provide as complete and accurate a description as possible so that the illness could be recognized should it ever recur in the future (in this he showed the influence of the Hippocratic emphasis on prognosis). But the reader cannot be unaware of the dramatic contrast to the idealism that had just been expressed in the Funeral Oration. Thucydides lived in an era in which rhetoric was a highly praised and widely practiced skill, and its effect on his work can often be noticed. Unfortunately, none of our other sources mentions the outbreak, and we cannot confirm his account directly. While it is true that the lack of other notices in literature or archaeological evidence such as mass graves is somewhat puzzling, nevertheless, Thucydides was writing for an audience that included many who had lived through the events themselves, so that we cannot suspect outright invention on his part.


Ironically, despite Thucydides' detailed description, modern scholars are still not able to agree on the identity of the disease. It was clearly not the bubonic plague of the Black Death in the 14th century, for the characteristic symptom of the bubo is not found in Thucydides' description. Other candidates that have been suggested are measles, typhus, ergotism, and even toxic shock syndrome as a complication of influenza. The case for typhus seems strongest both epidemiologically -- the age group is similar -- and from the standpoint of the symptoms. Typhus is characterized by fever and a rash, gangrene of the extremities occurs, it is known as a "doctors' disease" from its frequent incidence among care-givers, it confers immunity, and patients during a typhus epidemic in the First World War were reported to have jumped into water tanks to alleviate extreme thirst. But the fit is not exact. The rash is difficult to identify on the basis of Thucydides' description (modern medical texts often employ pictures to differentiate rashes), and the state of mental confusion may not fit Thucydides' description. In the long run, all such attempts at identification may be futile, however. Diseases develop and change over time, and it may be, as A.J.Holladay and J.C.F.Poole argue (Classical Quarterly 29 (1979) 299ff.), that the plague of the 5th century no longer exists today in a recognizable form. In the course of their argument they provide a full bibliography for the various candidates up to that time. New suggestions continue to be made: toxic shock complicated by influenze: A.D.Langmuir, et al, "The Thucydides Syndrome," New England Journal of Medicine (1985) 1027-30; Marburg-Ebolu fevers: G.D.Scarrow, "The Athenian Plague. A possible diagnosis," Ancient History Bulletin 11 (1988) 4-8. Holladay and Poole credit Thucydides for first recognizing the factor of contagion; for another view on this issue, see J.Solomon, "Thucydides and the recognition of contagion," Maia 37 (1985) 121ff.; on the intellectual effects of the plague, see J.Mikalson, "Religion and the plague in Athens 431-427 BC," Greek, Roman and Byzantine Studies 10 (1982) 217ff.

Thucydides' emphasis on the social and moral effects of the Athenian plague may be augmented by studies of the effects of the Black Death in Europe (for example, Millard Meiss, Painting in Florence and Siena after the Black Death, 1978). Perhaps a third of the population died, and a large number of these were sudden and untimely deaths, occurring indifferently to those of both good and bad character. Appeals to the gods were fruitless. Normal expectations were upset as distant relatives of the wealthy suddenly found themselves the possessors of unexpected fortunes, and the normal pool of aristocratic candidates for political office was swept away. (For example, both of Pericles' legitimate sons died, and he made a special plea to set aside the citizenship law, which he himself had sponsored in 451, so that his son by the Milesian Aspasia could be declared a citizen.)


March 30th, 2007, 04:21 PM
The Athenian Plague: 430 B.C. - 426 B.C.
By William Sutherland


As the Peloponnesian War (431-404 B.C.) loomed with the worsening of the cold war between Athens and Lacedæmonia (Sparta), an ancient oracle was said to have provided a warning to Athens and inspiration to Lacedæmonia: “A Dorian war shall come and with it death… “When the god was asked whether they (Lacedæmonia) should go to war, he answered that” if they put their might into it, victory would be theirs…” At the time Athens was in its golden age (479-431 B.C.) under the enlightened leadership of Pericles (495-429 B.C.) who had introduced the world’s first form of democracy under which individual rights, literature and the arts thrived.

According to Thucydides (460-400 B.C.), an Athenian general, political critic and historian, enthusiasm and support for the Peloponnesian War among Athenians “was high” when the conflict erupted. Many, especially the young, “saw it as an adventure and a potential source of profit.” However, support and enthusiasm for the war quickly waned when Athens was hit by misfortune (the Peloponnesians led by Lacedæmonia invaded Attica committing some of the “worst ravages”) and the plague that decimated much of the City’s population.

As the Attica countryside was overrun in April 430 B.C., Athenians following Pericles’ instructions – “bring all the people… into the city” took shelter in “parts… that were not built over and in the temples and chapels of the heroes… and other such places as were always kept closed” including the Pelasgian citadel (just south of the Acropolis) where residence “had been forbidden by a… Pythian oracle which [read]: ‘Leave the Pelasgian parcel desolate, Woe worth the day that men inhabit it!’” The Attica countryside was abandoned to Lacedæmonian destruction, which targeted “not merely [Athenian] corn and fruits, but even the garden vegetables near the city, [which] were rooted up and destroyed” as Athenians placed sole reliance upon the supremacy of their navy to provide “food and other necessities.” As crowds packed within Athens’ confines, the city’s existing “sanitation and drainage” infrastructure could not accommodate the bloated population, creating “appalling” conditions on top of those left in the wake of 431-430 B.C. winter as described by Greek historian Diodorus Siculus (90-30 B.C.)

As a result of heavy rains… the ground had become soaked with water, and many low-lying regions, having received a vast amount of water, turned into shallow pools and held stagnant water, very much as marshy regions do; and when these waters became warm in the summer and grew putrid, thick foul [vapors] were formed, which, rising up in fumes, corrupted the surrounding air, the very thing which may be seen taking place in marshy grounds which are by nature pestilential.

In addition, the immune systems of Athenians were also compromised due to the lack of quality food within the City. “Contributing to the disease was the bad character of the food available; for the crops which were raised that year were altogether watery and their natural quality was corrupted,” Diodorus Siculus stated. In short, the situation was optimal for the outbreak of a deadly epidemic.

“Not many days after [the arrival of the Peloponnesians] in Attica the plague… began to show itself among the Athenians. It was said that it had broken out in many places previously in the neighborhood of Lemnos and elsewhere; …first… it is said in the parts of Ethiopia above Egypt, and thence descended into Egypt and Libya and into most of the king’s country [as well as in parts of the Persian empire]… but a pestilence of such extent and mortality was nowhere remembered. Suddenly falling upon Athens, it first attacked the population in Piræus – which was the occasion of their saying that the Peloponnesians had poisoned the reservoirs, there being as yet no wells there – and afterwards appeared in the upper city, when the deaths became much more frequent.” The plague attacked all regardless of “class, sex, or age,” Thucydides wrote.

As the outbreak began, physicians, including Hippocrates (460-377 B.C.), often referred to as the “Father of Medicine,” and priests rushed to the aid of the stricken. Yet their efforts were futile. Thucydides recounted their heroic efforts – “Neither were the physicians at first of any service, ignorant as they were of the proper way to treat it, but they died themselves the most thickly, as they visited the sick most often; nor did any human art succeed any better. Supplications in the temples, divinations, and so forth were found equally futile, till the overwhelming nature of the disaster at last put a stop to them altogether [when it was shown that ‘the oracles had no useful advice to offer’ and prayers went unanswered].”

Per Diodorus Siculus, “Athenians… ascribed the causes of their misfortune to [Apollo, a] deity. Consequently, acting upon the command of a certain oracle, they purified the island of Delos, which was sacred to [him] and had been defiled, as men thought, by the burial there of the dead. Digging up, therefore, all the graves on Delos, they transferred the remains to the island of Rheneia, as it is called, which lies near Delos. They also passed a law that neither birth nor burial should be allowed on Delos. And they also celebrated the festival assembly, the Delia, which had been held in former days but had not been observed for a long time.” Yet the plague continued unchecked, leading to panic and great despair.

With the medical efforts, “the usual remedies” being administered in Athens to no avail and the plague spreading north, the Thessalians grew fearful. “No remedy was found that could be used as a specific; for what did good in one case did harm in another.” Out of desperation they urged Hippocrates to return to Thessaly with promises of unlimited riches as recounted by Hippocrates’ son in the “Speech of the Envoy.”

In the time in which the plague was running through the barbarian land north of the Illyrians and Pæonians, when the evil reached that area, the kings of those peoples sent to Thessaly after my father [Hippocrates] because of his reputation as a physician, which, being a true one, had managed to go everywhere. He had lived in Thessaly previously and had a dwelling there then. They summoned him to help, saying that they were not going to send gold and silver and other possessions for him to have, but that he could carry away all that he wanted when he had come to help. And he made inquiry what kind of disturbances there were, area by area, in heat and winds and mist and other things that produce unusual conditions. When he had gotten everyone’s information he told them to go back, pretending that he was unable to go to their country. But as quickly as he could he arranged to announce to the Thessalians by what means they could contrive protection against the evil that was coming.

Hippocrates had good reason to avoid Thessaly. “Physicians were among the first to die, since they contracted the disease from its earliest victims. …the mortality among [physicians] was unusually high, because they most frequently came into contact with the disease.”

When the plague began, despite word of similar outbreaks in North Africa, Persia and Rome, the latter in about 446 B.C., it was still unexpected by Athenians. “That year then is admitted to have been otherwise unprecedentedly free from sickness; and such few cases as occurred all eventuated in this. As a rule, however, there was no ostensible cause; but people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath,” Thucydides began. “These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind… ensued, accompanied by very great distress. In most cases… an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later. Externally the body was not very hot to the touch, nor pale in its appearance, but reddish, livid, and out into small pustules and ulcers. But internally it burned so that the patient could not bear to have on him clothing or linen even of the very lightest description… What they would have liked best would have been to throw themselves into cold water; as indeed was done by some of the neglected sick, who plunged into the rain tanks in their agonies of unquenchable thirst… though it made no difference whether they drank little or much. Besides this, miserable feeling of not being able to rest or sleep never ceased to torment them. The body meanwhile did not waste away so long as the distemper was at its height, but held out to a marvel against its ravages; so that when they succumbed, as in most cases, on the seventh or eighth day to the internal inflammation, they had still some strength in them. But if they passed this stage, and the disease descended further into the bowels, inducing a violent ulceration there accompanied by severe diarrhea, this brought on a weakness, which was generally fatal. For the disorder first settled in the head, ran its course from thence through the whole of the body, and even where it did not prove mortal, it still left its mark on the extremities; for it settled in the privy parts, the fingers and the toes, and [even the] eyes,” he added. Generally, even though there were survivors, including Thucydides, as well as some who “were seized with an entire loss of memory on their first recovery, and did not know either themselves or their friends,” the disease was fatal. “Seven to nine days the disease lasted, and when it passed it left behind it a terrible weakness, so that many perished of exhaustion.”

To compound matters, Athenian soldiers were also hindered by the outbreak as Diodorus Siculus wrote – “As for the Athenians, they could not venture to meet [the Lacedæmonians] in a pitched battle, and being confined as they were within the walls, found themselves involved in an emergency caused by the plague; for since a vast multitude of people of every description had streamed together into the city, there was good reason for their falling victim to diseases as they did, because of the cramped quarters, breathing air which had become polluted.” As an indicator of the plague’s severity and the adverse impact it had on the Athenian military, Pericles had “started with 150 triremes (ancient ships utilizing three banks of oars and sails for mobility) and a large number of hoplites and horsemen” to attack the Peloponnesus states when it initially broke out. After being joined by plague-infected reinforcements, this Athenian force returned a few years later “in a pitiable condition” having suffered a great loss of life.


[B]PART 2:

~Continued From Part 1~

Before long Athenian morale had fallen sharply. In an attempt to boost his peoples’ sagging spirits and restore the confidence they had lost, Pericles spoke about the City’s greatness during the annual “public funeral” that was held to honor her war dead.

“Our form of government does not enter into rivalry with the institutions of others. We do not copy our neighbors, but are an example to them. …we are called a democracy, for the administration is in the hands of the many and not the few,” the Athenian leader declared. “There is no exclusiveness in our public life… we are lovers of the beautiful, yet simple in our tastes, and we cultivate the mind without loss of manliness. Wealth we employ, not for talk and ostentation, but when there is a real use for it. To avow poverty with us is no disgrace; the true disgrace is in doing nothing to avoid it. An Athenian citizen does not neglect the state because he takes care of his own household; and even those of us who are engaged in business have a very fair idea of politics,” he added before addressing the courage of the City’s defenders who had fallen in battle. “Methinks that a death such as theirs… gives the true measure of a man’s worth; it may be the first revelation of his virtues… And when the moment came they were minded to resist and suffer, rather than to fly and save their lives; …on the battle-field their feet stood fast, and in an instant, at the height of their fortune, they passed away from the scene, not of their fear, but of their glory. Such was the end of these men; they were worthy of Athens.”

Yet the epidemic was too great for Athenians to bear, which was made even worse by the hot summer as described by Diodorus Siculus – “the etesian winds… by which normally most of the heat in the summer is cooled failed to blow; and when the heat intensified and the air grew fiery, the bodies of the inhabitants, being without anything to cool them, wasted away.”

Social order collapsed as many abandoned the dead along with their sick friends and family since “strong and weak constitutions proved equally incapable of resistance...” To Thucydides, this was the worst part of the epidemic – “By far the most terrible feature in the malady was the dejection which ensured when any one felt himself sickening, for the despair into which they instantly fell took away their power of resistance, and left them a much easier prey to the disorder; besides which, there was the awful spectacle of men dying like sheep, though having caught the infection in nursing each other. …On the other hand, if they were afraid to visit each other, they perished from neglect; indeed many houses were emptied… for want of a nurse: on the other, if they ventured to do so, death was the consequence.”

At the same time, as mentioned earlier, many suffering from the affects of the plague threw themselves into cisterns and water tanks – “…all the illnesses which prevailed at the time were found to be accompanied by fever, the cause of which was the excessive heat. And this was the reason why most of the sick threw themselves into the cisterns and springs in their craving to cool their bodies,” Diodorus Siculus added. Some even amputated extremities such as fingers and toes in a desperate attempt to survive. “[N]umerous unburied bodies were left lying here and there.”

Per Thucydides, “The bodies of dying men lay one upon another, and half-dead creatures reeled about the streets and gathered round all the fountains in their longing for water. The sacred places also in which they had quartered themselves were full of corpses… for as the disaster passed all bounds, men, not knowing what was to become of them, became utterly careless of everything… All burial rites before in use were entirely upset, and they buried the bodies as best they could… [Wood used for pyres, became scarce.] Sometimes getting the start of those who raised a pile, they threw their own dead body upon the stranger’s pyre and ignited it… Fear of the gods or law there was none to restrain them… No one expected to be brought to trial for his offenses, but each felt that a far severer sentence had been already passed upon all.” Even beasts and birds of prey avoided the dead – “All the birds and beasts that prey upon human bodies, either abstained from touching them, or died after tasting them. In proof of this, it was noticed that birds of this kind actually disappeared; they were not about the bodies, or indeed to be seen at all,” Thucydides wrote.

With no one certain that they would survive since it seemed like everyone regardless of the precautions they took, fell ill – “Athenians avoided each other but perished anyway,” most ignoring the “moans of the dying” as they “hastened to gratify their tastes, and abandoned themselves to the greatest moral depravity.”

Per Thucydides, “Men now coolly ventured on what they had formerly done in a corner, and not just as they pleased, seeing the rapid transitions produced by persons in prosperity suddenly dying and those who before had nothing succeeding to their property. So they resolved to spend quickly and enjoy themselves, regarding their lives and riches as alike things of a day. Perseverance in what men called honor was popular with none, it was so uncertain whether they would be spared to attain the object; but it was settled that present enjoyment, and all that contributed to it, was both honorable and useful. Fear of gods or law of man there was none to restrain them. As for the first, they judged it to be just the same whether they worshipped them or not, as they saw all alike perishing; and for the last, no one expected to live to be brought to trial for his offenses, but each felt that a far severer sentence had been already passed upon them all and **** ever over their heads, and before this fell it was only reasonable to enjoy life a little.”

At the same time, with 25% of the City’s population dead, the people turned on their leader. They blamed Pericles, whom they viewed as “the author of the war” for the outbreak (because of his strategy of bringing everyone within the City’s walls even though he “had had no [viable] alternative… since it would have been suicidal to engage the larger and better-trained [Lacedæmonian] infantry” in the Attica countryside) and even urged capitulating to Lacedæmonia’s demands. According to Diodorus Siculus, “Athenians, now that the trees of their countryside had been cut down (by the Lacedæmonians who ravaged their lands) and the plague was carrying off great numbers, were plunged into despondency and became angry with Pericles…” This emboldened Pericles’ political opponents, Kleon, Simmias, and Lakratidas, to bring suit against him on frivolous grounds of “mismanagement of public funds.”

When addressing the charges, Pericles spoke with determination, offering no apologies – “I was expecting this outburst of indignation; the causes of it are not unknown to me… I allow that for men who are in prosperity and free to choose it is great folly to make war. But when they must either submit and at once surrender independence, or strike and be free, then he who shuns and not he who meets the danger is deserving of blame. For my own part, I am the same man and stand where I did. But you are changed; for you have been driven by misfortune to recall the consent which you gave when you were yet unhurt, and to think that my advice was wrong because your own characters are weak… Anything which is sudden and unexpected and utterly beyond calculation, such a disaster for instance as this plague coming upon other misfortunes, enthralls the spirit of a man.” As he spoke to the Athenian Ecclesia, Pericles still urged courage and strength while appealing for understanding – “…being the citizens of a great city and educated in a temper of greatness, you should not succumb to calamities however overwhelming, or darken the luster of your fame… You must not be led away by the advice of such citizens as these [Pericles’ accusers], nor be angry with me; for the resolution in favor of war was your own as much as mine. What if the enemy has come and done what he was certain to do when you refused to yield? What too if the plague followed? That was an unexpected blow… I am well aware that your hatred of me is aggravated by it. But how unjustly…”

By then the anger was so strong that Pericles’ defense fell on deaf ears. He was fined between 15 to 80 talents and removed from power. Afterwards per Telemachus Timayenis, Pericles “calmly submitted to this terrible trial, his physical nature now succumbed to the most frightful sufferings. The pestilence, which spared no one, carried away many of his best friends and many of his relatives, including [his first wife], his sister and his sons Xanthippus and Paralus. He who had so many times insisted upon courage and fortitude in his fellow citizens, and had shown himself worthy of his words, when he saw his dear son Paralus dead, and had drawn near in order to place a wreath on that beloved head, could not restrain himself, and, for the first time in his life, wept bitterly.” He also held the same warm regard for his close circle of friends, whom he also mourned as they fell victim to the plague, demonstrating that “behind his almost icy reserve there was a warm and affectionate heart.”

However, by September 430 B.C., Athenians had had a change of heart “overcome with remorse,” especially when they “saw how much inferior were his successors.” They elected Pericles, who had also begun to suffer from the affects of the plague back to his former office of “Strategos.” However, only the persuasion of his closest friends convinced Pericles to again “take the helm of affairs,” which he then used to gain the permission of Athenians to bypass the citizenship law he had enacted in 451 B.C. to grant his “illegitimate” son, whom he loved to his last breath, Athenian citizenship. Pericles had requested an exception because this surviving son had been born to his mistress, a beautiful educated Milesian woman, Aspasia (470 B.C.-410 B.C.), who had defied the stereotype of the day by taking advantage of her non-Athenian status to become “a great writer… and philosopher.”

Afterwards with Pericles back in charge, the war appeared to go well. The siege of Potidæa, triggered by a popular revolt against Athens came to an end in January 429 B.C. when the Athenian military allowed its inhabitants to depart for neighboring states. Athens laid siege to Platæa two months later (which ultimately surrendered in 427 B.C.) while Admiral Phormio brought the City a “remarkable victory” in the Corinthian Gulf, after engaging with only 20 ships against a Peloponnesian force that had almost three times that number as they attempted to “wrest Acarnania from the Athenian alliance.” It also helped that in 429 B.C., Lacedæmonian forces, unlike in 430 B.C. and every year afterwards, refused to enter and ravage Attica because “the condition of the plague-stricken city made approach [too] dangerous.”

By this time, Pericles’ devoted “service [to] his country was approaching its end” as his life slowly wasted away from the affects of the fever he was suffering from the plague. “He was dying” in sorrow because his “house had been left desolate by the plague” with the deaths of the aforementioned family members and many relatives.

Then as he lay dying, slipping in and out of consciousness, Pericles, according to an account by Mestrius Plutarchus known as “Plutarch” (c. A.D. 46-127), a Greek historian and biographer, “roused himself from the slumber… he had fallen” to scold his friends who spoke “of the victories that he had gained, the power that he had held, and his nobleness of character,” stating that “these were not his chief titles to fame.” He was proudest of Athens’ democratic system of government and a man who disliked all but necessary wars, held humanity in the highest esteem, and harbored a “complete absence of vindictiveness.”

When he passed away at 64 in the autumn of 429 B.C., Pericles was the essence of Athens – a great statesman and general, “a man of action, a philosopher, [and] a lover of art” who had “lived an austere life” never “adopting the tactics of a demogogue,” so much so that in the words of Arthur Grant, “it may be doubted indeed whether any great popular leader ever had so little recourse to flattery.”

Pericles’ death, though, did not bring an end to the plague. It lingered for another three years resulting in an incalculable loss of life, leaving tens of thousands dead. By the time the plague finally lifted in 426 B.C., a third of the Athenian population had perished and the Delian confederacy headed by Athens was crumbling, sparked by the Lacedæmonian capture of Lesbos in 428 B.C. that left Chios the last independent member of the Athenian alliance. Amidst the great loss of life and chaos, Athenian “women were temporarily liberated from the strict bounds of [the City’s] custom” so that they could perform vital functions previously carried out by men. A magistrate called “gynaikonomos” was appointed to supervise their activities.

However, by this time, the very City that Pericles loved, was also nearing its end as “normal expectations were upset as distant relatives of the wealthy suddenly found themselves the possessors of unexpected fortunes, and the normal pool of aristocratic candidates for political office was swept away.” Accordingly, despite the replenishment of Athens’ military by 415 B.C., the City lacked vision and competent leadership to bring victory. In August 405 B.C., Athens suffered a crushing defeat at the hands of Lacedæmonian admiral Lysandros, who “captured most of [her] fleet’s triremes.” With the City’s fate sealed by this devastating loss, “Athens was forced to capitulate. Lysandros immediately tore down the Long Wall and the walls around Piræus” before handing power over to a proxy government.

Yet, Pericles proved prophetic when he declared that the memory of Athens’ “glory will always survive. So long as the literature of Greece calls forth admiration, and so long as the pillars of the Parthenon remain upon the Acropolis” the spirit of Pericles and Athens lives as symbols of democracy and the Hellenic golden age.

While the history and devastating affects of the Athenian plague have been known for more than 2000 years, it was not until 1994 that the disease that consisted of headaches, conjunctivitis, a rash which covered the body, and fever” with victims suffering from extremely painful stomach cramps, coughing up blood “followed by vomiting and ‘ineffectual retching’” could be retrospectively and thoroughly investigated. It was proven to be Typhoid based on DNA collected from the teeth of “at least 150 bodies, including those of infants” that had been piled hastily and haphazardly one on top of the other in a mass grave that also consisted of “a small number of [funery] vases” dating back to 430 to 429 B.C. “deep beneath Kerameikos cemetery.”

When the mass grave consisting of close to 1000 tombs that may have held 240 bodies including those of ten children, that had been “randomly placed with no layers of soil between them,” was discovered during excavation work for a subway station, Efi Baziotopoulou-Valavani immediately knew that there was something different about it since it “did not have a monumental character. The offerings we found consisted of common, even cheap, burial vessels; black-finished ones, some small red-figured, as well as white lekythoi (oil flasks) of the second half of the fifth century B.C.,” she stated in describing the grave. “The bodies were placed in the pit within a day or two. These [factors] point to a mass burial in a state of panic, quite possibly due to a plague.”

When conducting their tests, “Manolis Papagrigorakis and her colleagues at the University of Athens” selected “three random teeth samples… and extracted the pulp,” which “can store pathogens and other information about the body for centuries” and tested them for a range of bacteria – “bubonic plague, typhus, anthrax, tuberculosis, cowpox and catscratch disease before finding a match in Salmonella enterica serovar Typhi – the bacteria responsible for typhoid fever.” To guard against possible “false results,” the team also tested “two modern teeth” for the same pathogens.

Based on the test results made possible by recent advances in technology, namely “molecular biology tools (DNA PCR and sequencing techniques) which can provide retrospective diagnoses” and through historical accounts, especially by Thucydides and Diodorus Siculus, the mystery has been solved. “Typhoid fever – transmitted by contaminated food or water – [caused the] fever, rash and diarrhea” while the “quick onset” was due to the “possible evolution of typhoid fever over time.”



William Sutherland:

William Sutherland is a published poet and writer. He is the author of three books, "Poetry, Prayers & Haiku" (1999), "Russian Spring" (2003) and "Aaliyah Remembered: Her Life & The Person behind the Mystique" (2005) and has been published in poetry anthologies around the world. He has been featured in "Who's Who in New Poets" (1996), "The International Who's Who in Poetry" (2004), and is a member of the "International Poetry Hall of Fame."
He is also a contributor to Wikipedia, the number one online encyclopedia.