Plague of Athens

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. Much of the eastern Mediterranean was also struck by the disease. The plague returned twice more, in 429 BC and in the winter of 427/426 BC.

Background
Sparta and her 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, causing lack of food and other supplies. In addition, people from parts of Athens lying outside the city wall moved into the more protected central area. Due to the close quarters and poor hygiene exhibited at that time Athens became a breeding ground for disease and countless citizens were killed including Pericles, his first wife, and his sons Paralus and Xanthippus.

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 the Athenian 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 leaders Thucydides described as 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. It is generally agreed however 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 morals 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.[citation needed]

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.[citation needed]

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.[citation needed]

Care for the Sick and Dead
Another reason for the lack of honorable behavior was the sheer contagiousness of the illness. Lasting for four years, almost a quarter of the population died. 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. [citation needed]

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 5th century BC. 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 without regard to a person's piety toward the gods, people felt abandoned by the gods and there seemed to be no benefit to worshiping 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 disease and 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.[citation needed]

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 in The Viking Portable Greek Historians, pp. 274-275.

Titus Lucretius Carus provides a second historical description, in his treatise on Epicureanism titled 'On the Nature of the Universe', the final section of which (Book IV Part IV) deals with (inter alia) disease. In this, he provides a graphic description of the symptoms and effects of the Plague of Athens. Whilst Lucretius' description generally matches closely that provided by Thucydides, the former identifies a further symptom of the disease, which, he states, accompanies the ulceration, setting in around the eight or ninth day. In translation, the additional symptom reads thus:

"If any then

Had 'scaped the doom of that destruction, yet

Him there awaited in the after days

A wasting and a death from ulcers vile

And black discharges of the belly, or else

Through the clogged nostrils would there ooze along

Much fouled blood, oft with an aching head"


 * Viewed at http://www.poemhunter.com/poem/book-vi-part-04-the-plague-athens/ on 15.11.12.

The inclusion of the detail of 'black discharges' from the stomach and nostrils suggests hemolyzed blood of gastrointestinal tract hemorrhages and that the Plague of Athens might be more closely similar to Hemorrhagic than to Typhus or Typhoid fever (see Cause of the plague, below).

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 striking descriptive similarities with recent outbreaks in Africa, as well as the fact that the Athenian plague itself apparently came from Africa (as Thucydides recorded), Ebola or a related viral hemorrhagic fever has 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. In addition, crowding caused by the influx of refugees into the city led to inadequate food and water supplies and an increase in insects, lice, rats and waste. These conditions would have encouraged more than one epidemic disease during the outbreak. However, the hopes were on that advancing scientific technologies may reveal new clues.

In 2005 a positive match was made between DNA extracted from dental pulp of three teeth recovered from the Kerameikos cemetery (excavated 1994-5 ) in Athens and a known pathogen - typhoid fever.

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"). Other researchers disagree, noting, amongst other discrepancies, the absence in typhus of dramatic gastrointestinal symptoms as described by Thucydides.

Typhoid fever
A different answer was found in a DNA study on teeth from an ancient Greek burial pit, led by Manolis Papagrigorakis of the University of Athens, which 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;
 * chills
 * bradycardia (slow heart rate)
 * weakness
 * diarrhea
 * headaches
 * myalgia (muscle pain)
 * lack of appetite
 * constipation
 * 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.

As Typhoid 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. Other scientists have disputed the findings, citing what they claim are serious methodologic flaws in the dental pulp-derived DNA study. Howevee, the authors of the original study pointed out that the objections were on a flimsy basis, and the methodology used to produce the disproof has been previously shown to give conflicting results.

Viral Hemorrhagic Fever
Thucydides' narrative refers to dramatically increased risk among caregivers, more consistent with the person-to-person contact spread of Viral Hemmorhagic Fever (eg. Ebola/Marburg) than typhus or typhoid. His symptom and disease course descriptions invite careful comparison with VHF. Outbreaks of VHF in Africa in 2012 reinforced previous observations of increased risk among caregivers and the necessity of barrier precautions in preventing disease spread related to funerary rites. Ancient Greek intimacy with African sources is reflected in accurate renditions of monkeys in art of frescoes and pottery (notably guenons, the type implicated in the inadvertent importation of Marburg virus disease to Germany and Yugoslavia when that disease was first characterized in 1967). Circumstantially tantalizing is the requirement for the large quantity of ivory used in the Athenian sculptor Phidias’ two monumental chryselephantine statues (one of which was one of the ‘Seven Wonders’), which were fabricated in the same period.

DNA sequence-based identification is limited by the inability of some important pathogens to leave a 'footprint' retrievable from archaeologic remains after several millennia. The lack of a durable signature by RNA viruses means some etiologies, notably the viral hemorrhagic fever viruses, are not testable hypotheses using currently available scientific techniques.