History of the Plague of Athens

Hello everyone, I hope you are well, and I welcome you in this new episode of La Science, Quelle(s) Histoire(s)! Today we will talk about the first great epidemic in history:  The Plague of Athens.

This epidemic took place during the 5th century BC, commonly known as the “Century of Pericles.” In this podcast, there is no need to talk about the famous Athenian statesman and strategist. Moreover, from a very scientific point of view, this fifth century BC might as well have been called the “Century of Hippocrates.”  This period of history, very often present in school curricula, was particularly marked by the Peloponnesian War, which saw two leagues clash: that of Delos, led by Athens, and that of the Peloponnese, led by Sparta. In -430, Spartan forces invaded and ravaged Attica, the region surrounding Athens, causing a mass migration of the local population who came to take refuge within the city walls. The intramural population of Athens then increased considerably, deteriorating hygiene conditions. This was followed by a long siege that completely isolated the city.  This was Pericles’ strategy: to take shelter behind the walls of the city, and therefore pushing the Spartans, formidable in the land battle, to go face the Athenians where they were most comfortable: on the waters of the Aegean Sea. But not everything went according to plan and as often, a glitch turned an already complicated situation for the Athenians into a real catastrophe. In the same year -430, a new evil spread. First in the port of Piraeus, then quickly within the city, where it wreaked havoc. The famous Greek Historian Thucydides, contemporary of the epidemic and citizen of Athens, reported the progression of the disease which he himself eventually contracted, in the second book of The Peloponnesian War. A true gold mine, Thucydides’ report is extremely precise, complete, and allows us to immerse ourselves in this health crisis that marked history.  It began in early May 430 BC and lasted between 4 to 5 years. Many epidemic waves emanated from these crisis years, especially in the summer 428 and in the winter 427-426 BC.

1. A very complicated situation

As stated in the introduction, in 430 BC, the situation was therefore very complicated in Athens. Thucydides tells us how the beginnings of the epidemic, combined with the arrival of the refugees from Attica and the high temperatures, created chaos inside the city:

“The situation of the Athenians, already overwhelmed by the epidemic, was further aggravated by the heaping of the countrymen in the city. The refugees were particularly distressed. In the absence of housing to accommodate them, they lived in barracks where the atmosphere at this time of year was irrespirable. The dead and the dying lay in the way. You could see agonizing people staggering through the streets…”

Athens was already suffering from sanitation problems and a lack of access to safe drinking water for all.  In July 430 BC, this sharp increase in the density of people in the city exacerbated these problems. The lack of food was also felt. So, the situation quickly worsened. In addition to the epidemic, there were many hygiene problems, lack of food, and a terrible heatwave.

Today, we know that the Plague of Athens was in fact a pandemic. Our Greek historian tells us in his accounts that before reaching the present Greek capital, the disease had already spread to Egypt, Libya, and much of the territory of the Persian Empire. Like many other pandemics in history, the disease crossed many areas, following the commercial routes, land and sea, and eventually settled in the port of Piraeus. This evil, according to Thucydides, had its origin in Ethiopia.

2. Thucydides, the first health crisis reporter

Thucydides contracted the disease himself. A citizen of Athens, he was in his thirties during the events. It should also be noted that he was not a doctor, which was far from preventing him from doing a remarkable job as a historian. He documented and recounted the great moments of the crisis, but also gave us a valuable insight into the daily lives of Athenians during this difficult period. Thucydides also had another goal:  he hoped that his description of the symptoms would help to recognize this evil if it were to resurface:

“I leave it to anyone other than myself, a doctor or a layman, to offer a valid explanation of the origins of this evil and to specify the causes that may cause such disturbances in the body. For my part, I will describe its symptoms and give details that, if it comes to unleash again, will allow as much as possible, not to be unprepared and to recognize its nature.”

Already at that time, Hippocrates and his school of Kos were in the process of allowing medicine to become a profession in its own right. In ancient Greece, it was often associated with other fields such as philosophy. In particular, the school of Kos recommended precise observations of symptoms, which made it possible to know, and thus predict the progression of the disease in patients. In his  Treatise, Hippocrates told us about this: “the best doctor seems to me to be the one who knows in advance”, before adding “we must tell the history of the disease, know the present state, predict future events, exercise on these objects, have with diseases two things in mind: to be useful, or at least not to harm.” Thucydides had clearly incorporated these principles well, which can widely be felt in his writings.

At the time, and for many centuries to come, when such an evil struck, it was common to think that it was divine anger. But as it would be the case for example for the plague of Justinian or the Black Death, the gods were not sensitive to prayers and offerings. The city of Athens was therefore no exception, and Thucydides tells us:  “As  for the prayers that were made in the temples, the consultations of oracles and other means of this kind, all this was of no recourse, and as evil was stronger, it was finally stopped.”

3. Terrible symptoms

As for the symptoms, again, Thucydides showed great skill in describing them. Alice Gervais, in her excellent research paper entitled Thucydides and the Literature of the Epidemic, perfectly summed up the symptoms described:

“The first signs: a feeling of warmth in the head, accompanied by rhino-pharyngeal phenomena, oppressed breathing, eye inflammation, as well as a symptom that doctors of the future would quite often take as characteristic of the real plague: namely alterations of the tongue, which has a red-blood color.”

Thucydides’ account allows us to understand that this evil was unknown and so brutal that it would seem that no disease of ancient times had been so appalling. According to our Historian, “words are powerless to describe the characteristics of this evil. It inflicted on those who were touched an ordeal beyond human forces.” In addition to the symptoms already mentioned, there was also nausea, very serious digestive problems, and above all, the feeling that patients were burning from the inside, without this occurring on their body temperature. This intense burning sensation, absolutely unbearable, prompted many patients to carry out desperate actions:

“The sick felt such a devouring fever that the lightest and thinnest clothing of flax were unbearable; they wanted to remain naked and their greatest desire was to throw themselves into the cold water. This is what they often did when they had no one to watch over them: in the grip of an inextinguishable thirst, they would throw themselves into the water tanks.”

During this terrible phase of the disease, finding sleep also seemed impossible. So, we had, by the hundreds, sick people suffering from heat, fatigue and disease. Other symptoms could also be found like the appearance of purple and blue blisters and patches. If at the end of the seventh or eighth day of symptoms the patient was still alive and had some strength left, he usually survived. But in most cases, the after-effects were numerous, and the disease continued to progress. Some patients reported necrosis that required amputations, others had such diarrhea that many died of exhaustion. Even more mysterious, Thucydides also informs us that in some patients, total amnesia took place. This wide variety of symptoms from one patient to another did not help to find treatments and ways to alleviate the suffering of those affected:

“As for the treatments used to relieve the sick, none of them, let us say, could prove themselves. What was good for one, aggravated the condition of the other. No constitution, strong or weak, was able to withstand the evil, which indifferently carried everyone off, including those who were treated in every way possible.”

4. Towards the understanding of immunization

As far as caregivers were concerned, they represented the profession most affected by the crisis. For our historian, there was no doubt that this high mortality rate was linked to proximity to patients: “It was even among them that mortality was highest, because they had more frequent contact with the sick.” In addition to its virulence, Thucydides thus underlined the  high contagiousness of the disease, which quickly wreaked havoc, and which clearly affected a very large majority of the  Athenian population:  “By caring for others, they also contracted the disease and… thus herds of people perished.” The devastation caused by the epidemic was increased tenfold. This extreme contagiousness led many inhabitants to stop approaching the sick, who found themselves left to their own devices. Often “watched over” in the early days of the sickness, they were at the height of the crisis, sidelined, and the chances of survival were very low. Many died alone, after a slow agony.

This plague lasted several years, and Thucydides was unable to give a real estimate of the losses in the population. On the other hand, he reported the heavy losses of the Athenian army, which lost many hoplites and horsemen during the crisis. According to many historians, nearly one third of the Athenian population was decimated, which would represent 80,000 deaths in five years. This huge figure also explained a certain distrust of Athenians towards those affected. Indeed, according to Thucydides, “those who approached patients were fatally affected.”

As terrible as it was, the Plague of Athens did not kill all the people it made sick. Some people resisted it, including Thucydides. Our Greek historian then noted that those who had survived the disease were no longer affected by the next epidemic, which implies that they had acquired immunity through their previous exposure.  This is one of the first times in history where the idea of immunity is evoked. The survivors often took over from the health care workers to care for the sick:

“One was more compassionate towards the unfortunate who died or who suffered when one had overcome the ordeal himself, for, knowing from experience what it was, one now felt safe from danger. Indeed, the evil did not hit the same man twice, or at least the relapse was not fatal. »

As medicine was still in its infancy, no one was able to identify this evil at the time. It was given the name “Plague of Athens”, a name which, with hindsight, is far from adequate. But it seems important to point out that, in many cases, many epidemics that had not yet been identified were called “plagues”. The Antonine Plague, which struck the Roman Empire in the 2nd century AD, is now widely regarded as a smallpox epidemic. No trace of the infamous bubons, typical of the plague, was present in Thucydides’ accounts. Thus, the “plague of Athens” was neither bubonic, nor pneumonic, nor septicaemic. Today, opinions still differ, and it will probably be impossible to identify the infectious disease with certainty. Possible candidates are typhus, measles, typhoid or smallpox. According to Alice Gervais, “the enigma remains”… Although it can be possible to reproach Thucydides for the lack of  description of the age, sex and social status of the sick, his writings would nevertheless be fundamental in the description of future epidemics, and served as the basis for many contemporaries of epidemics, such as Procopius of Caesarea, who remember, recounted with great precision, the appalling daily life of the inhabitants of the city of Constantinople during the plague of Justinian. In Athens, the epidemic was one of the causes of the end of the “Pericles century.” It occurred during the period when the city was at its peak and steered it in a lightning way towards decline.  A human tragedy that invites us to reflect on the fragility of human societies in the face of epidemics.

Thank you all for listening to this science podcast, what stories. Don’t hesitate to send us your questions, ratings and small stars on the various podcast platforms, as well as on our website fondation-ipsen.org or our Facebook page Live Lab Foundation Ipsen. If many of you send us your questions and comments, then we can do a little question-and-answer session. Thank you all for your support and I’ll be giving you an appointment very soon.

Sources:

1. Alice Gervais. About the “Plague” of Athens: Thucydides and the literature of the epidemic. In: Guillaume Budé Association Bulletin: Letters of Humanity, No. 31, December 1972. pp. 395-429.

DOI: https://doi.org/10.3406/bude.1972.3490

2. Beteau J.-P. The plague of Athens. In: Guillaume Budé Association Bulletin,No.47, April 1935. pp. 14-28.

DOI: https://doi.org/10.3406/bude.1935.6021

3. Horgan, J. (2016, August 24). The Plague at Athens, 430-427 BCE.  Ancient History Encyclopedia. Retrieved from https://www.ancient.eu/article/939/
4. RJ Littman. The plague of Athens: epidemiology and paleopathology. Mt Sinai J Med. 2009;76(5):456-467. doi:10.1002/msj.20137
5. Longrigg, J. (1980). The Great Plague of Athens. History of Science, 18(3), 209-225. https://doi.org/10.1177/007327538001800303