The Plague of Athens

The Plague of Athens occurred during the early years of the Peloponnesian War; the first outbreak was in the summer of 430-429B.C. which lasted two years and the second outbreak in the winter of 426 which lasted no less than a year . During this time the city was under siege by Sparta so the population had been moved within the city walls, which would have led to overcrowding and with the humid temperature, poor water supply and no sewerage. Any virus would have spread very quickly which could explain why the disease spread so quickly and was so deadly. Our account for the disease is Thucydides who also suffered from it and observed other sufferers, and so his aim was to produce a precise scientific account which could assist others if the disease should occur again. What is particularly interesting about the disease is that it affected not just children and the elderly but young men as well, which is quite uncommon as young men are usually the least susceptible to disease. One explanation for this could be that the men were the only ones who left the household and would visit other people. Therefore if they were going out and mixing with other people and visiting people who were dying of the disease, this could explain why they also suffered from it. The death rate from the plague is also very alarming, as in the first outbreak there was a mortality rate of 33% and in the second outbreak 26%. A reason why the death rate was higher in the first outbreak could be because the humid temperatures helped it to spread faster and by the second outbreak initial sufferers had become immune to the disease. The disease also affected birds and dogs showing that the disease was not just limited to humans. Such mortality rates are very uncommon now due to better medical practice and preventative drugs, both of which were not available in Athens at that time, as well as the fact that the Greeks didn’t understand about contagious diseases. It has been suggested that Thucydides made up the disease to add drama to his text, however, this theory can be ruled out as his description is so detailed, and as he says his aim was to write an account so that if it occurred again people would be able to recognize the symptoms and act faster, therefore I believe this view can be discredited. What is also apparent from Thucydides account is that survivors of the disease had a good immunity to it, and no one who had it suffered from it again. This shows that is was a single strain of bacteria or virus. It seems that the disease spread from Ethiopia to Egypt to Libya and then to Athens, this was a known trade route but interestingly it only affected Athens so perhaps the density of the city could have been a crucial factor. The problem we have in trying to recognize the disease with diseases today is that some of Thucydides symptoms will match up to certain diseases but other telltale symptoms are not present. This means that in trying to recognize the disease there are four possibilities, which Poole and Holladay suggest, firstly the disease is extinct today or was a mixture of two or more diseases, therefore Thucydides has made a number of mistakes in his account so we will never know. Secondly it still exists today in remote places, but is unknown to the medical profession. This is extremely unlikely as a disease, which is so contagious and deadly and with such unusual symptoms is not going to stay unrecognized. Thirdly it is now extinct which in theory is quite possible as Thucydides says it had lasted for three years by 427B.C. Therefore the population in Attica would either be dead or immune from it, so this theory is quite possible. Lastly the disease has changed so much it can no longer be recognized. Most scholars today recognise that it is either options three or four, the reason being that Thucydides account was good as he not only noticed the process of contagion, he recognized that sufferers acquired immunity or reduced severity of further attacks from the plague but not against other diseases. This shows that Thucydides had a good understanding of the disease and so produced an account to aid others in case of future outbreaks, so I agree with modern scholars view on these possibilities. If we view Thucydides description of the plague , we see that the principal symptoms of the disease were a feverish sensation in the head, inflammation of the eyes, redness of the tongue and throat, fetid breath. After this sneezing and hoarseness would occur followed by violent coughing, vomiting bile and general distress. Throughout this period the skin would be flushed, with blisters and sores occurring along with internal heat, unquenchable thirst, restlessness and insomnia. Following this if the patient suffered in the next 7- 9 days they would suffer from diarrhea, weakness and exhaustion, following in death. If they survived that they would then suffer from gangrene of the extremities, loss of sight and in some cases amnesia. From Thucydides account it is not clear if every sufferer had all the symptoms mentioned above or if Thucydides was giving an overview of the symptoms patients had suffered in that timescale. There have been many suggested diseases for the plague of Athens, which I will now look into. The first one I shall look at is smallpox. Smallpox is a highly contagious, febrile illness with a skin rash. Its mortality rate can be as high as 30%, which is very similar to the percent of Athens first outbreak. However, this disease can be easily discredited as a possibility because sufferers of smallpox are left with indented pockmarks on the skin and the stigma that would have gone with this is impossible not to mention, especially as his intention was to provide an account, which would prove useful in the future. In addition to this factor it doesn’t cause gangrene in the extremities, sufferers build up immunity to smallpox and don’t suffer from it again. Another factor to discredit smallpox is the fact that it affects mostly children under the age of five and it is not contagious to animals . The bubonic plague has been another disease to be put forward, however, the account by Thucydides has little resemblance to the bubonic plague, as there is no mention of buboes swelling around the groins and armpits plus it is described as an open wound. Another discrediting factor is that rats to man by rat fleas spread most outbreaks of the bubonic plague. There is no mention in Thucydides to suggest that there were rats in Athens at that time, and it is not spread by directly from person to person but from infected rats or mammals. These factors enable us to conclude that the plague of Athens was not the bubonic plague. Another suggestion is measles, but this only attacks man, however, it is possible it could have descended from a wider range host. The scholar Shrewsbury has proposed measles as the plague of Athens as he thinks that the early symptoms of the plague; sneezing, headache, hoarseness, fever and restlessness are very similar to measles. After this on the 4th or 5th day the skin erupts, there are red spots covering the body and can cause gangrene of the mouth, cheeks and other body parts in extreme cases. Shrewsbury tries to add further weight to his argument by describing how when measles invaded the Fiji Islands for the first time in 1875 out of 100,000 people 25,000 died in a few months and they too threw themselves in water to try and cool down. However I do not believe that measles was the plague of Athens and so do not support Shrewsbury’s view. As measles does not cause loss of extremities, diarrhea, and amnesia, another factor, which discredits measles, is the fact that measles was not a disease of the great antiquity. Some scholars have believed it could have been scarlet fever, due to the fact that it causes red tongue and throat, fever, headache and vomiting. This is transmitted through secretions and is a rapid moving organism. But scarlet fever can be discredited, as it doesn’t cause loss of extremities, amnesia. In addition to this scarlet fever causes enlarging of the glands and an acute brightening in the face, symptoms which Thucydides would have failed not to have observed or mentioned. Another possibility is Typhus fever; there are two types of typhus fever , firstly epidemic typhus caused by Rickettesia Prowazeki and secondly endemic typhus caused by Rickettesia Mooseri. Rickettsia Prowakezi is spread from man to man by body louse, which gets infected from biting an infected mouse, which in turn bites a human. However, humans and lice are its only hosts and it has a 100% mortality rate. The other typhi fever is Rickettsia Mooseri, which is spread by rat to person through rat fleas and is relatively harmless to either. The symptoms of both are relatively similar as they both cause fever, headache, dulls and general pains followed by a rash. These symptoms take about 1- 2 weeks to appear. I believe that endemic typhi can be ruled out immediately as we know that there were no rats in Athens. Many scholars have been in favour of supporting epidemic typhus as the plague of Athens. However, there has been some confusion, as it is believed that epidemic typhus can only be caught through contact with flying squirrels. This is a major problem because as far as we know there were no flying squirrels in Athens, and it is difficult to see where they could have come into contact with them. This is a shame because there are a lot of features of epidemic typhus, which match up with the plague, for example in instances of complication it can cause loss of fingers, toes and gangrene. In addition to this it hits areas hardest in times of war and privation exactly like those that were being experienced in Athens at that time. Further evidence that would appear to support that it was the plague of Athens is the fact that it has a mortality rate of about 20% and kills it victims after about 7 days very similar to the plague. However the fact that it can only be caught through flying squirrels is such a massive factor in discrediting it as the plague of Athens, as well as the fact that it doesn’t affect birds or dogs. Another option has been typhoid fever, which again shows similarities to Thucydides description. Typhoid fever is caused by infection with Salmonella Typhi, which can be transmitted through water contamination if it contains faeces or urine from the sufferer. Thucydides in his account does suggest that Sparta could have poisoned the water supply but this is very unlikely, as it would have meant that the sufferer would have had to go to all the water wells around Athens to ensure total contamination. Typhoid can also be spread through food sources or bad hygiene, crowded conditions could also increase the transmission rate, all of which Athens would have suffered from as they were under siege. However, Typhoid can only be transmitted from person to person and does not affect animals, in addition to this, major symptoms of the disease are not mentioned by Thucydides such as nosebleeds and abdominal pain, features that could hardly be missed from being described. Another discrediting factor, which shows that typhoid could not have been the plague of Athens is the fact that we know that it was a disease of viral origin where as typhoid fever, is a bacterial infection. Some have believed that it could have been the Ebola virus, however, this can also be easily discredited as it had a mortality of 92%, which is extremely high and is too deadly to have been the plague of Athens. As well as this with the Ebola virus the sufferer has an enlarged face, which is not apparent in the plague and would have been hard to miss as a symptom, and there is no loss of limbs so we can confidently dismiss this disease as the plague. Salway and Dell have suggested ergotism largely because of the fact that Athens imported such a large amount of grain. It is noticeable that three sets of Athenians suffered from the plague, those in the naval expedition to Laconia in 430, those at Potidaea the same year and after their arrival the men besieging Potidaea. Ergotism is a toxin caused by careless milling and produced a variety of symptoms, which can be separated into two, gangrenous and nervous. There was an outbreak of it in France at Pont Saint-Espirit in 1951 where the two were combined and are extremely similar to Thucydides account as they suffered from depression, abdominal pains, and cold at the extremities. After this they suffered from mental disturbance and tried suicide, also animals that had eaten the bread died too. Salway and Dell argue that it couldn’t have been due to the corn from the Pontus area as no other state was affected. They suggest that perhaps Attic crop was used which was hurriedly harvested and mixed with the main batch of corn, which led to the outbreak. There would appear to be a very good case for it being ergotism, if it were not for one major discrediting factor, that it is implicitly said by Thucydides that the plague was contagious meaning that it must have been a microbial infection. The diseases I have mentioned so far are the most regularly suggested ones, but as has been shown whilst certain symptoms of Thucydides account can be matched up to every one of those mentioned, there is always one major factor which stops it from being it. Therefore I believe that the plague is not one of those mentioned above. The next disease I will look at is Rift valley fever, this is a disease that affects livestock and humans but is usually only apparent in Africa. It is caused by a bite from an infected mosquito and other blood-sucking insects. Humans can get the disease if they are exposed to the blood or other body fluids of infected animal, this can happen through slaughtering or by handling infected animals. Humans can also catch it if they sleep outdoors at night in areas where the outbreak occurred. Presumably in Athens at that time since there were lots of refugees, people would have had to sleep outdoors. The symptoms of the illness are flu like, with fever, weakness, and back pain, dizziness and weight loss. Infected people usually get better within 1-2 weeks after the start of the illness. In severe cases the patient may suffer from bleeding, inflammation of the brain and partial blindness. So as is evident there are features of the disease which fit in with Thucydides account, but I believe this disease should be discounted as features such as open sores and loss of extremities do not occur from Rift valley fever, as well as the fact that it only has a mortality rate of about 1%. Another possibility has been Leptospirosis which is a bacterial disease affecting both humans and animals, caused by contamination of the water supply by urine of animals such as pigs, horses and dogs. The symptoms of the disease are high fever, headache, chills, muscle ache, vomiting, diarrhea, red eye and abdominal pain. But there is no loss of limbs or loss of sight, which leads me to conclude that this was not the plague of Athens. The disease is not known to spread from person to person, and so as it is considered that the plague was a viral infection this suggestion can be discredited. An alternative disease is Dengue fever, which is an infectious disease carried and spread by mosquitoes. After a person is bitten within 5-6 days the patient will suffer fever, headache joint and muscle pain, vomiting, nausea and a rash. I believe that Dengue can be discredited, as a possibility for the disease as it occurs in tropical areas doesn’t cause loss of sight, amnesia and loss of limbs and Thucydides does not mention a rash. Anthrax is another suggestion; this is an infection which occurs in cattle and sheep, which affect humans when they are exposed to infected animals. The disease is spread by handling infected animals, inhaling anthrax spores or by eating undercooked meat from infected animals. Most of the symptoms from the disease will occur within 7 days. If the patient has inhaled the anthrax spore the initial symptoms will resemble a common cold, after several days the symptoms will progress to severe breathing problems and shock. If the sufferer has inhaled the spore then there is a very high risk that they will die. Also if they touch the animal they can get infected but in order to be infected they need to have a break in the skin. The other way is through the intestines from contaminated meat, the sufferer will get inflammation of the intestinal tract, nausea, loss of appetite, vomiting, fever, diarrhea and abdominal pain. The mortality rate is between 25-60%, however, infection from person to person is unlikely. I believe that anthrax is an unlikely possibility for the plague of Athens as key symptoms, which are apparent in Thucydides account, are not present in anthrax such as loss of limbs. Another suggestion has been Glanders disease. This is a disease, which primarily affects horses but can also affect dogs. It is also able to infect humans through contact with infected animals. In order for the person to become infected the bacteria needs to enter the body through the skin and through mucosal surfaces of the eyes and nose. The symptoms of the disease are fever, muscle ache, chest pains, and headaches. It can be spread from person to person either through sexually transmitted diseases or if family members are caring for the ill patient. The latter would have been the most likely in Athens; however, the reason I believe that this can be discredited is because it can take weeks or months before manifestations of the disease are apparent. Therefore as Thucydides says that people who were in good health suddenly became ill, this does not really fit in with the length of time that it takes Glanders to infect people. In addition to this, there are key symptoms missing linking Glanders and the plague for example the loss of extremities, diarrhea, and vomiting and open sores. As there are so many principal symptoms missing I think Glanders can easily be dismissed as the plague of Athens. The final possibility I will look at is Influenza. Influenza is a respiratory infection spread from person to person and to animals through sneezing and coughing. The symptoms of the disease are fever, headaches, cough, shortness of breath, fatigue and sweating. In extreme cases the illness could cause eye infections, acute respiratory disease and death. A factor that makes it difficult to link influenza with the plague is the fact that such were the cramped conditions in Athens at that time that if it had been influenza it would have spread like wildfire but it lasted for four years, which complicates matters somewhat as cases of influenza are normally short sustained periods of outbreak. To sum up I think it has been shown that it is very difficult to associate the plague of Athens with a disease today, as whilst many of today’s diseases show similarities to the plague there are always major key symptoms which are not present in the description of the plague. The most notable of these are the loss of extremities and sight and amnesia. It is because of this that I have to agree with Poole and Holladay in their assumption that the disease does not exist today because such are the unique symptoms of the plague it would be impossible not to recognize it. I also believe that the conditions that the Athenians were suffering at that time of cramped conditions, malnutrition through their food supply being cut off and poor sanitation should not be underestimated and would have enhanced the effects of the plague. However if I were to make a suggestion of what I believe the plague of Athens was with regard to today’s diseases, I would have to point to some sort of Influenza. The reason I believe this is because Influenza is spread through sneezing and coughing, now if we imagine the cramped conditions at that time this would fit in with the disease being some kind of Influenza which could easily be transmitted through these conditions. Additional evidence that I believe adds weight to this claim is the fact that the men were the ones who met people outside the household and visited the dying so they could become infected through the infected person coughing and sneezing. Thucydides tells us that those who visited the dying were condemning themselves to death . Consequently if the disease was of such strength added with the dense population, poor sanitation and lack of food, healthy adult males immune system would be lower anyway and this could explain why they also suffered from the disease and why it was not just restricted to the young and old. As is evident there have been cases of Influenza epidemics in the 20th Century, which have had deadly effects, and considering that we have a much greater knowledge of contagious diseases and have antibiotics and treatment to treat them, the Athenians did not. I believe this is further proof that it could have been some kind of Influenza epidemic. Particularly if we consider outbreaks that have occurred, for example the “Spanish Flu” in 1918-1919, which was transmitted by pigs, killed about 500,000 people in America and about 20-50 million worldwide. More recently there has been avian flu in Hong Kong in 1997, which was found to transmit from birds to humans, and as Thucydides says it did kill a lot of birds The reason it could have killed more birds than dogs in Athens is maybe because birds were less immune to it, or dogs learnt not to eat the bodies of infected humans. However, I am not prepared to say that the plague of Athens was some kind of avian flu, as I do not know enough about it to make such a bold claim. However, what I am suggesting is that it is evident that there have been influenza epidemics, which affect both humans and animals. Indeed it has been suggested that the plague was influenza with a staphylococcal super infection of the toxic shock syndrome that can cause noninvasive toxin producing strains of staphylococcus, which can cause extreme severe diseases . Therefore I would suggest that it is possible that the plague was some kind of super infectious influenza virus, which does not exist today. However, regardless of this the plague of Athens will continue to intrigue scholars for centuries and it is quite likely that unless DNA evidence from bones becomes evident we will never accurately know what the plague was and it will always be nothing more than pure speculation.

Bibliography:

Ancient Sources:

Thucydides, The Peloponnesian War, tr.R.Crawley.(London 1974)

Secondary Sources:

Holladay,A. Occasional Notes-The Thucydides Syndrome: Another View, The New England Journal of Medicine,Vol.315, No.18,1986

Hooker,E.M. Buboes in Thucydides?, Journal of Hellenic Studies,78,1958,pp 78-83

Langmuir, et al. Occasional Notes- The Thucydides Syndrome-A New Hypothesis for the Cause of the Plague of Athens, The New England Journal of Medicine, Vol.315, No.16, 1985

Longrigg,J. Greek Medicine from the Heroic to the Hellenistic Period, Duckworth, 1998

Longrigg,J. The Great Plague of Athens, History of Science, 18,1980,pp209-225

Page,D.S. Thucydides’ Description of the Great Plague of Athens, Classical Quarterly,n.s.3,1953

Parry,A. The Language of Thucydides’ description of the plague, Bulletin of the Institute of Classical Studies, 16,1969,pp106-118

Poole,J.C.F.& Holladay,A.J. Thucydides and the Plague of Athens, Classical Quarterly,29,1979,pp282-300

Salway,P.& Dell, W. Plague at Athens, Greece and Rome,24,1955,pp62-70