Plague of Athens

Alex Rover | November 14, 2022

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Summary

The plague of Athens is the traditional name given to an epidemic that affected ancient Greece in waves from 430 to 426 B.C. It broke out at the beginning of the hot and dry season of 430, weakened and moderated its attacks for two years, was endemic in 428 and 427, with a recrudescence at the beginning of the winter of 427, and disappeared in the last months of the year 426. It was reported by Thucydides, in Book II of his History of the Peloponnesian War, in a text of emblematic importance that has not ceased to arouse the interest of philosophers, historians and physicians.

It caused several tens of thousands of deaths, including that of Pericles, a quarter to a third of the population, marking the end of a privileged era. Its exact nature has not been discovered, typhus is the most likely cause, among more than fifteen proposed for discussion.

Between 6000 and 3000 B.C., the Neolithic revolution took hold in Europe, with agriculture, animal husbandry, sedentarization and the resulting demographic growth. These new conditions lead to a disruption of the previous eco-epidemiological balance, causing the appearance of numerous infectious or parasitic diseases. These diseases could not appear before, because of the very low density of hunter-gatherer societies.

Urbanization in classical Greece

During classical antiquity, increasing urbanization reached critical thresholds for the emergence of new infectious diseases, especially since they were facilitated by the greater frequency of contact in war and trade. An infectious disease, in order to appear or to maintain itself, requires population groups of a certain size (more than a few thousand, tens or hundreds of thousands, depending on the disease).

In the 5th century B.C., Athens had more than 200 000 inhabitants (and almost as many in Attica, territory of the city-state), and engaged in a war against Sparta, it underwent a siege, having in its bosom refugees from the surrounding countryside.

At the beginning of the classical period, the urban environment was characterized by narrow tortuous streets (4.5 m wide on average), rarely paved, with natural outlets for rainwater and wastewater. Most of the houses are made of wood and cob, with 3 to 4 small rooms, with small openings exposed to any wind, difficult to heat, and often smoky in winter. The houses are crammed together, with no regular plan.

Towards the end of the classical period, the built-up area improves. The ring of walls widens, new or renovated districts adopt a regular plan proposed by Hippodamos of Miletus. Thus, one finds large houses approaching 1000 m2, more than a third of which are not used for living, equipped with bathrooms and private latrines. However, the increase of the urban surface is translated by an aggravation of the inequalities: it benefits the rich houses, the monumental space, the collective buildings but not the old and poor districts which do not evolve hardly.

Athens did not yet have a centralized water network, it was supplied by 400 fountains from wells. A sewage system will be developed only from the 4th century BC. At the time of the epidemic, the cesspools must have been innumerable, and larvae and insects must have found favorable hatching sites in the cisterns.

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The strategy of Pericles

The policy of the Athenian leader and strategist Pericles consisted in avoiding a frontal clash in open country against the Spartans. He abandoned the defense of the rural areas to defend Athens behind its walls. It counts entirely on a maritime strategy: raids of its war fleet against Sparta, economic support of the seat by its commercial fleet. The situation is then favourable to an epidemic in time of war: urban overpopulation by refugees, lack of hygiene, undernourishment, exposed to many contacts (maritime connections with the Mediterranean world). The city was connected to its port, Piraeus, by a fortified corridor of several kilometers, the “Long Walls”.

On the eve of the plague of Athens, the city is a “living lesson for Greece” (Thucydides, II, XLI), the citizens of Athens enjoy a great reputation for their intellectual and moral value. In the 21st century, it is still considered as the founder of Western culture, and the mother of philosophy, history, arts, sciences and democracy. The occurrence of the catastrophe is all the more resounding for the contemporaries, as for the following generations.

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Presentation

Thucydides is the only direct chronicler of the plague in Athens, a contemporary observer, he was sick himself; he reports the facts about 25 years later, but he can describe it from the inside as a victim, and from the outside as a witness. Considered as “a father of History”, he refuses to explain the course of events by the Gods. He rejects myths and rumors, in order to try to understand the course of events, through explanations or rational causes. He thus makes a break with Homer, poet, and not historian, of the Trojan War.

He interrupts his book on the history of the Peloponnesian War to describe in detail the plague in Athens. He differs again from Homer, for whom the disease is not a natural process, but a sending of the Gods according to their whims. His text is very close to the rational Hippocratic model. He goes to the point, describing the symptoms with order and method, using the technical medical vocabulary of his time.

He shows a sceptical positivism, seeking first to describe the facts, without pronouncing on their cause. The text is “trans-historical”, because he wants to do a useful work by addressing directly the future generations, by counting on the repetition of the destiny and the permanence of the human nature: “I leave to each one – doctor or layman – the care to say his opinion on the disease, by indicating from where it could probably come, and the causes which, in his eyes, explain in a satisfactory way this disruption, as having been able to exert such an action. As for me, I will say how this disease presented itself, the signs to be observed in order to be able, if ever it recurred, to profit from a prior knowledge and not to be in front of the unknown; here is what I will expose – after having, in person, suffered from the evil, and having seen, in person, other people affected – ” (II, XLVIII).” J. de Romilly writes about the general work of Thucydides: “By seeking to present each event in its objective rigor, but also in what it could involve of human, general and instructive, he succeeded in shaping a mirror where all those who have the desire to understand saw a little of their own image (…) he knew how to overflow his time to go ahead of all the others”.

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Description of the disease

Thucydides indicates that the epidemic was born in Ethiopia to pass in Egypt and Libya before reaching the Greek world, in various areas, in particular on the side of Lemnos, this disease appears suddenly in Athens in the port of Piraeus, before spreading. It has thus reached the heart of Athens, densely populated.

It appears to be totally new: “Nothing like this had ever been remembered as a plague, nor as the destruction of human life. All forms of medicine or religion are impotent, everything remains ineffective: “In the end, they (the Athenians) gave it up, abandoning themselves to evil.”

After pointing out the rarity of previous diseases in that year, and the fact that those that remained turned into this disease, Thucydides describes the clinical manifestations of the disease thus (II, XLIX):

“In general, one was affected without any precursory signs, suddenly in full health. One felt violent heat in the head; the eyes were red and inflamed; inside, the pharynx and the tongue became bloody, the breathing irregular, the breath fetid.

– Thucydides.

Thucydides then specifies that dogs and scavenging birds do not approach corpses, and that those who try to devour them die (that the disease strikes everyone, the weak as well as the robust, that the disease is communicated by contagion by bringing help and assistance, that those who escape from it are not reached a second time in a mortal way (that the evil strikes at first the refugees without shelter, piled up in stifling huts in this season, “there were some who rolled on the ground, half dead, on the ways and towards all the fountains” (II, LII).

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Social collapse

The deaths being counted in thousands, social upheavals see the day. Thucydides reports a “growing moral disorder” and worries about it: the sacred places are not respected any more, one does not respect any more the customs relating to the burial of the dead, the fear of the laws decreases, upheavals in the social hierarchy take place. Thucydides describes the attitude of his compatriots thus: “Fear of the gods or law of the men, nothing stopped them. (II, LIII).

According to Thucydides, the Athenians lose of disease 1050 hoplites on 4 000 in 40 days (II, LVIII) at the time of the first epidemic wave which lasted two years. 4 400 hoplites and 300 horsemen die at the time of the second epidemic wave which lasted one year (III, LXXXVII). It does not provide a figure concerning the civilians, the losses being too important. But one can estimate that Athens lost a third of its population. Arnold Wycombe Gomme, commentator of Thucydides, estimates the number of victims between 70 000 and 80 000.

In 1860, Hugh Andrew Johnstone Munro (en), a Scottish academic, published a critical edition of Lucretius” poem De rerum natura, which contained Thucydides” description. He asked numerous English, French and German medical luminaries to give their opinion on the nature of the disease. Almost all of them, he wrote in his commentary, praised Thucydides for his accuracy, but gave different diagnoses to refute those of others. Munro therefore lists the diagnoses he has collected: typhus, scarlet fever, putrid fever, yellow fever, camp fever, hospital fever, prison fever, black plague, erysipelas, smallpox, oriental plague, unknown disease gone…

Nearly a century and a half later, the historian Vivian Nutton considers, in 2008, that the disease described by Thucydides defies any modern identification, and that hundreds of publications by doctors and historians have raised a host of hypotheses, each one showing its weaknesses only to be immediately criticized. Others even consider that any attempt at diagnosis, on the part of doctors, is a “self-indulgent parlour game”.

However, the historian Mirko Grmek considers the search for a retrospective diagnosis from ancient texts to be legitimate, although difficult and fragile. He tries to give some rules: “We consider satisfactory a retrospective diagnosis that takes into account all the symptoms mentioned, explains the main ones, and does not contradict any of them; moreover, it must be in agreement with the epidemiological conditions brought to light by the medical-historical exegesis. Such a diagnosis is not necessarily the only one possible. Most of the ancient clinical descriptions are inadequate from the point of view of modern medicine and allow for several labels of current pathology to be attached to them.”

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Value and limits of the text

The value of the text has been judged to be close to that of the Hippocratic Corpus, in particular treatises such as Of Airs, Waters and Places, The Prognosis or Epidemics. Thucydides places disease in its environmental context. Although he was not a physician, Thucydides was sometimes more perceptive than the doctors when he recognized the existence of contagion through close contact, and especially when he noted that the survivors did not have a second fatal attack. This is the first historical observation of acquired immunity, which made Thucydides say that he was the most brilliant observer and the first epidemiologist of all times.

However, from the modern point of view, this description remains insufficient. Thucydides does not specify the age, the sex, the categories most affected, the beginning and the course of the epidemic, saying only that the disease strikes everyone, especially the refugees, from the port to the city. The most important lack is the description of the rash, whose evolution and distribution on the body is not clear.

This description itself is open to question. Thus J. de Romilly points out that this passage is a “bizarre and perhaps corrupted text”. Thucydides uses two words in ancient Greek: φλυκταίναι

In fact, these ambiguities widen the field of possibilities. The medical vocabulary of ancient Greek was a technical vocabulary in formation, using metaphor from everyday life (simple terms with a broad meaning). This broad meaning is different from the same terms, which have become learned, precise and fixed, still used (in medicine, zoology, and botany) at the beginning of the 21st century. Thus, some authors have questioned the reliability of Thucydides, as a non-medic reporting facts 20 or 25 years later. Others wonder whether Thucydides did not dramatize for historiographical purposes, to give an explanation for the death of Pericles and the defeat of Athens; but these critics are in the minority.

Proposed diagnoses

Despite its name, the plague of Athens has not been identified with certainty. At the beginning of the 21st century, the most plausible hypotheses are typhus, smallpox and malignant measles; recent publications also propose typhoid and Ebola fever.

Already proposed in the 19th century, typhus (transmitted by body lice) remains the first plausible hypothesis for researchers working in a multidisciplinary way (historians, philologists, epidemiologists, infectious diseases specialists…), such as D. Durack and R. Littman. The main arguments are the epidemic context (arrival by ship, wartime, overcrowding and promiscuity, undernourishment), the duration of the disease and the description of the symptoms, which correspond at best to a typhus epidemic.

The main criticism is the lack of explanation of its apparent disappearance and reappearance (from the sixteenth century BC), hence the existence of many alternative hypotheses.

This hypothesis is probably the oldest, as it was proposed in 900 BC by Rhazes. J.C. by Rhazès. It remains plausible in the 2000s, provided that one considers that the plague of Athens was a combination of classical and hemorrhagic smallpox, in a non-immune population, while extrapolating somewhat the description of the outbreak by Thucydides, which limits its scope.

This hypothesis was suggested by classical and medical authors in the 1950s, and is still defended in the 2000s. It would be malignant measles, occurring in a virgin population (non-immunized, because of the absence of measles circulation). In this situation, measles affects adults in its most severe form. His main argument is to draw a parallel with the epidemic of malignant measles that occurred in Fiji in 1876, during its colonization by the British, and which caused the death of more than 25% of the islanders. The sick had the behavior described by Thucydides: they plunged themselves into cold water to relieve themselves.

The main criticisms are that malignant measles does not explain the combination of diarrhea and loss of extremities described by Thucydides, and that the epidemic lasted four years, the size of the affected population being insufficient to sustain a measles epidemic of this duration.

This hypothesis received renewed interest in 2006 with the publications of Papagrigorakis, only to be immediately challenged. Unlike the previous hypotheses, which were based on the analysis of Thucydides” description, it is based on the analysis of DNA from the dental pulp of three skeletons found in a mass burial site contemporary with the epidemic. The divergence of views is then fueled by the problems of dating the site, sequencing and contamination of the samples.

This hypothesis is held to be highly unlikely and remains so for most authors, since typhoid fever hardly matches Thucydides” description. Advocates of this hypothesis are content to suggest that typhoid fever is only a probable cause, or that it was present within an unidentified major epidemic. Their work focuses more on ancient strains of Salmonella and typhoid fever in ancient Greece than on the particular epidemic described by Thucydides.

Other possibilities are much less popular. The last publication defending the plague hypothesis dates from 1958, and it has been regularly rejected since then, whereas it seemed very likely in the first third of the 20th century.

Ebola fever was proposed again in 2015, it had already been proposed at the end of the 20th century. The author considers that the term Æthiopia also refers to sub-Saharan Africa in ancient Greek, that the disease reaches Greece through the slave trade, corresponding to the text of Thucydides (close transmission during care and funerals, clinical signs such as hiccups).

Thucydides having indicated that animals were affected, anthrax, leptospirosis, meliodosis, tularemia were put forward.

There are still many proposals such as Mediterranean dengue, influenza with toxic shock syndrome, etc.

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Issues

The plague of Athens can also be seen not as a single disease epidemic, but as an epidemic ensemble consisting of different diseases. This approach has been used for the interpretation of Hippocratic texts. Thus the “Thucydides syndrome” would be a viral infection complicated by bacterial superinfection with toxic shock; or an epidemic of typhus as a main component, accompanied by other diseases.

R. J. Littman uses modern epidemiological methods that take into account available historical data (area of Athens behind its walls, population numbers, duration of the epidemic, number of victims, etc.) to find characteristic mathematical patterns. The aim is to identify possible diagnoses by process of elimination. He concludes that the plague of Athens is consistent with what would be expected for typhus, an arbovirosis, plague and smallpox.

In addition to problems related to philology or paleomicrobiology, there is the more general problem of the historical evolution of infectious diseases, which do not keep the same aspect over the centuries. Viruses and bacteria evolve, as do genetics and the immunity of human populations. The problem remains that the plague of Athens is also an extinct disease, or even to be re-emerged in view of the interest that it still arouses in the 21st century (confrontation with recently discovered infections).

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Hippocrates in Athens

The Greek physician Hippocrates, who was 30 years old at the time of the Athens plague, stayed in this city in 427; it is said that he hastened the end of the epidemic by making large fires of aromatic plants (hyssop, lavender, rosemary, savory), but this is part of the legends of Hippocrates that have been built up progressively since the Roman period. However, this legend was put into action during the plague of Marseille in 1720, from August 2 to 5, with large fires on the ramparts and throughout the city. Although Hippocrates and Thucydides were about contemporaries, Thucydides does not mention Hippocrates in his texts. But the Hippocratic Corpus contains a reference to a rather large epidemic that developed in a northern region where the physician of Cos was in 430. The symptomatology described by Hippocrates is similar to that of Thucydides: “In the summer, extensive pustular eruptions were seen, in many, large vesicular eruptions.”

J. Pinault was interested in the role of the Hippocratic legends. That of Hippocrates in Athens would have allowed (from Galen onwards and until the Middle Ages) to forge the image of the exemplary healing physician, to counterbalance Thucydides who put medicine and religion on an equal footing for their inefficiency. This would also show Thucydides” independence from physicians.

Galen, commentator of Thucydides

Throughout his work, the physician Galen quotes Thucydides extensively for his medical expertise, especially in his treatise On the Doctrines of Hippocrates and Plato. Galen”s explanations of two medical terms used by the historian, (καρδία and ἀποκάθαρσις), prove the authority Thucydides enjoyed with him: in the question of the relationship between Thucydides and contemporary physicians in his description of the plague in Athens, this position of Galen “would allow one to question the judgment of some moderns who see in Thucydides” refusal to cite the different varieties of bile named by physicians an aristocratic disdain for technical terms. “

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Influence of a model

Because it was one of the causes of the end of the century of Pericles, the plague in Athens left its mark on ancient and humanist minds, which referred to Thucydides” account. The most famous example can be found in Lucretius” De rerum natura, which surely remained unfinished, ends abruptly with an evocation of this epidemic (VI, 1138-1286).

The text of Thucydides becomes so famous that the satirist Lucian, in the 2nd century BC, can make great quotations from it as a joke. J-C., can make great quotations of it as jokes.

The Byzantine historian Procopius describes Justinian”s plague in the sixth century, using Thucydides as a model, especially in regard to the social consequences of the epidemic. Most chroniclers drew on each other, and a real historical appreciation of plagues did not begin until the late eighteenth century. For historians, Thucydides serves as a reference for noting what is original or personal observation in a chronicler.

“There is only one Thucydides; and as long as there are men, he will remain an Athenian”, thus begins the foreword of the authors of Marseille, ville morte, la peste de 1720 (Marseille, dead city, the plague of 1720). According to Jacques Ruffié, one must retain the exemplary value of Thucydides” text, the first historical account of a great epidemic that now has archetypal value.

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Sources

Peste d”Athènes
Plague of Athens
J.-P. Béteau 1935, p. 22.
^ a b Thucydides, History of the Peloponnesian War 2.48.1
^ a b Manolis J. Papagrigorakis, Christos Yapijakis, and Philippos N.Synodinos, ‘Typhoid Fever Epidemic in Ancient Athens,’ in Didier Raoult, Michel Drancourt, Paleomicrobiology: Past Human Infections, Springer Science & Business Media, 2008 pp. 161–173.
^ a b History of the Peloponnesian War 2.48.3
^ Numero complessivo di casi confermati e sospetti.
^ Tucidide, La guerra del Peloponneso 2.48.1
^ Olson PE, Hames CS, Benenson AS, Genovese EN. “The Thucydides syndrome: ebola deja vu? (or ebola reemergent?)” Emerging Infectious Diseases 2(1996): 155–156. ISSN 1080-6059.
^ Gomme, A. W., A. Andrewes e K. J. Dover. An Historical Commentary on Thucydides, Volume 5. Book VIII, Oxford University Press, 1981. ISBN 0-19-814198-X.
^ Papagrigorakis, Manolis J., Christos Yapijakis, Philippos N. Synodinos, and Effie Baziotopoulou-Valavani. “DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens,” International Journal of Infectious Diseases 10 (2006): 206-214. ISSN 1201-9712.
Beispielsweise Lukrez, de rerum natura 6,1090ff. mit explizitem Bezug auf die Attische Seuche. Thukydides 2,48,3 enthält sich der Spekulation über die Genese und verweist stattdessen auf zeitgenössische medizinische Abhandlungen. Diodor 12,58–59 macht das feuchte Klima für die Genese verantwortlich.
Thukydides 2,47-55 (englisch) (Memento vom 16. Mai 2009 im Internet Archive)