Summary

The plague of Athens is the name given to an epidemic that affected ancient Greece in waves from 430 to 426 B.C. It broke out at the start of the hot, dry season of 430, weakened and moderated for two years, became endemic in 428 and 427, with a recrudescence at the start of winter 427, and disappeared in the last months of 426. It was reported by Thucydides, in Book II of The Peloponnesian War, in a text of emblematic importance that has never ceased to arouse the interest of philosophers, historians and physicians.

It caused tens of thousands of deaths, including that of Pericles, a quarter to a third of the population, and put an end to a privileged era. Its exact nature has yet to be discovered, but typhus is the most likely cause, among more than fifteen proposed for discussion.

Between 6000 and 3000 BC, the Neolithic revolution took hold in Europe, with agriculture, livestock breeding, sedentarization and the ensuing demographic growth. These new conditions disrupted the previous eco-epidemiological balance, triggering the appearance of numerous infectious and parasitic diseases. These diseases were previously unavailable due to 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, all the more so as they were facilitated by the greater frequency of contact in warfare and trade. To emerge or persist, infectious diseases require population groups of a certain size (more than a few thousand, tens or hundreds of thousands, depending on the disease).

In the 5th century BC, Athens had a population of over 200,000 (and almost as many in Attica, the territory of the city-state) and, engaged in a war against Sparta, was besieged by refugees from the surrounding countryside.

In the early Classical period, the urban environment was characterized by narrow, winding 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 three or four small rooms and small openings exposed to the wind, difficult to heat and often smoky in winter. The houses are crammed together, with no regular layout.

Towards the end of the Classical period, the built environment improved. The ring of walls widened, and new or renovated neighborhoods adopted the regular plan proposed by Hippodamos of Miletus. This led to large mansions approaching 1,000 m2, more than a third of which were not used as living quarters, with private bathrooms and latrines. However, the increase in urban surface area led to a worsening of inequalities: it benefited wealthy houses, monumental spaces and collective buildings, but not the older, poorer districts, which hardly changed at all.

Athens did not yet have a centralized water system, being supplied by 400 fountains from wells. A sewage system was not developed until the 4th century BC. At the time of the epidemic, there must have been innumerable cesspools, and larvae and insects must have found the cisterns favorable places to hatch.

Pericles' strategy

The policy of Athenian leader and strategist Pericles was to avoid a head-on clash with the Spartans in open country. He abandoned the defense of rural areas in favor of defending Athens behind its walls. He relied entirely on a maritime strategy: raids against Sparta by his war fleet, and economic support for the siege by his commercial fleet. The situation was ripe for a wartime epidemic: overcrowding of the city with refugees, poor hygiene, malnutrition, exposure to numerous contacts (maritime links with the Mediterranean world). The city was linked to its port, Piraeus, by a fortified corridor several kilometers long known as the "Long Walls".

On the eve of the Athens plague, the city was a "living lesson for Greece" (Thucydides, II, XLI), and its citizens enjoyed a high reputation for their intellectual and moral worth. In the 21st century, Athens is still considered the founding city of Western culture, and the mother of philosophy, history, the arts, science and democracy. The occurrence of the catastrophe is all the more resounding for contemporaries and future generations alike.

Presentation

Thucydides is the only contemporary chronicler of the plague in Athens, from which he suffered. He reported the events some 25 years later, but was able to describe the plague from the inside, as a victim, and from the outside, as a witness. Considered "a father of history", he refused to explain the course of events by the gods. He rejects myths and rumors, and seeks to understand the course of events through rational explanations and causes. In so doing, he broke with Homer, the poet, not the historian, of the Trojan War.

He interrupts his book on the history of the Peloponnesian War to describe in detail the plague in Athens. Again, he distances himself from Homer, for whom disease is not a natural process, but a dispatch from the gods according to their whims. His text is very close to the rational Hippocratic model. He gets straight to the point, describing symptoms in an orderly, methodical fashion, using the technical medical vocabulary of his day.

He displays a skeptical positivism, seeking first and foremost to describe the facts, without commenting on their cause. The text is "trans-historical", as it aims to be useful by directly addressing future generations, relying on the repetition of destiny and the permanence of human nature:

"I'll leave it to everyone - doctor or layman - to give their opinion on the illness, indicating where it was likely to have originated, and the causes which, in their eyes, satisfactorily explain this upheaval, as having been capable of exerting such an action. As for me, I'll tell you how this illness presented itself, the signs to observe so as to be able, should it ever recur, to take advantage of prior knowledge and not be faced with the unknown; this is what I'll set out - after having, in person, suffered from the ailment, and having seen, in person, other people afflicted - (II, XLVIII)."

J. de Romilly writes of Thucydides' general work:

"By seeking to present each event in all its objective rigor, but also in all that was human, general and instructive, he succeeded in shaping a mirror in which all those with a desire to understand saw a little of their own image (...) he knew how to go beyond his own era to reach out to all others."

Disease description

Thucydides indicates that the epidemic originated in Ethiopia, then moved on to Egypt and Libya, before reaching the Greek world in various regions, notably Lemnos. The disease suddenly appeared in Athens, in the port of Piraeus, before spreading. It then spread to the heart of densely populated Athens.

It appears to be totally new: "Nowhere was anything like this remembered as a plague, nor as the destruction of human life." All forms of medicine or religion are powerless, everything remains ineffective: "In the end, they (the Athenians) gave it up, abandoning themselves to evil."

After pointing out the rarity of previous illnesses that year, and the fact that those that remained have turned into this ailment, Thucydides describes the clinical manifestations of the disease as follows (II, XLIX):

"In general, you'd get it without any warning signs, suddenly in full health. The head would heat up violently; the eyes would be red and inflamed; inside, the pharynx and tongue would become bloody, breathing irregular, the breath fetid.

- Thucydides.

Thucydides goes on to explain that dogs and scavenging birds stay away from corpses, and that those who try to eat them die as a result (that the disease strikes everyone, the weak as well as the strong, that it spreads through contagion by bringing help and relief, that those who escape are not fatally affected a second time (that the evil first strikes homeless refugees, crammed into sweltering huts at this time of year, "there were some rolling on the ground, half dead, on the paths and towards all the fountains" (II, LII).

Social collapse

As the dead numbered in the thousands, social upheavals began. Thucydides reports a "growing moral disorder" and expresses his concern: sacred places are no longer respected, customs concerning the burial of the dead are no longer observed, fear of the law diminishes, and social hierarchies change. Thucydides describes the attitude of his compatriots: "Fear of the gods or law of men, nothing stopped them". (II, LIII).

According to Thucydides, the Athenians lost 1,050 of their 4,000 hoplites to disease in 40 days (4,400 hoplites and 300 cavalrymen died in the second epidemic wave, which lasted a year (III, LXXXVII). No figures are given for civilians, as the losses were too great. But we can estimate that Athens lost a third of its population. Arnold Wycombe Gomme, a commentator on Thucydides, puts the number of victims at between 70,000 and 80,000.

In 1860, Scottish academic Hugh Andrew Johnstone Munro (en) published a critical edition of Lucretius' poem De rerum natura, containing Thucydides' description. He asked numerous British, French and German medical luminaries to give their opinion on the nature of the disease. Almost all of them, he writes in his commentary, praise Thucydides for his accuracy, but give different diagnoses to refute those of others. Munro thus 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 extinct disease...

Nearly a century and a half later, historian Vivian Nutton (2008) believes that the disease described by Thucydides defies modern identification, and that hundreds of publications by doctors and historians have raised a slew of hypotheses, each of which has its own weaknesses, only to be immediately criticized. Others even consider any attempt at diagnosis by doctors to be a self-indulgent parlour game.

However, historian Mirko Grmek considers the search for retrospective diagnosis based on ancient texts to be legitimate, albeit difficult and fragile. He sets out a few rules: "We consider a retrospective diagnosis to be satisfactory if it takes into account all the symptoms mentioned, explains the main ones, and does not contradict any of them; furthermore, it must be in line with the epidemiological conditions revealed by medico-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 several labels of current pathology to be attached to them."

Value and limits of the text

The value of the text was judged to be close to that of the Hippocratic Corpus, notably treatises such as Des airs, des eaux et des lieux, Le pronostic and Des épidémies. Thucydides places disease in its environmental context. Although not a physician, Thucydides is sometimes more perceptive than the doctors when he acknowledges the existence of contagion through close contact, and especially when he notes that survivors do not suffer a second fatal attack. This is the first historical observation of acquired immunity, which has led to Thucydides being called the most brilliant observer and first epidemiologist of all time.

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

The description itself is open to question. 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 increase uncertainty. Ancient Greek medical vocabulary was a technical vocabulary in the making, 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 in use (in medicine, zoology and botany) at the beginning of the 21st century. Some authors have therefore questioned Thucydides' reliability as a non-physician reporting facts 20 or 25 years later. Others wonder whether Thucydides may have dramatized the story for historiographical purposes, to explain the death of Pericles and the defeat of Athens; but these critics are in the minority.

Proposed diagnostics

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

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

The main criticism is the lack of explanation for its apparent disappearance and reappearance (from the 16th century AD onwards), hence the existence of numerous alternative hypotheses.

This hypothesis is probably the oldest, having been proposed in 900 AD by Rhazès. It remains plausible in the 2000s, provided we consider that the plague of Athens was a combination of classical and hemorrhagic smallpox, in a non-immune population, while extrapolating Thucydides' description of the eruption somewhat, which limits its scope.

This hypothesis was suggested by classical and medical authors in the 1950s, and is still defended in the 2000s. This would be malignant measles, occurring in a virgin population (non-immunized, due to 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, when it was colonized by the British, and which caused the death of over 25% of the islanders. The sufferers behaved as Thucydides described: 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 gained renewed interest in 2006 with the publications of Papagrigorakis, only to be immediately challenged. Unlike previous hypotheses, which were based on the analysis of Thucydides' description, it is based on the analysis of DNA from dental pulp from three skeletons found in a mass burial site contemporary with the epidemic. Differences of opinion are fuelled by problems of site dating, sequencing and sample contamination.

This hypothesis is considered highly improbable by most authors, as 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 back to 1958, and it has been regularly dismissed ever since, even though it seemed highly probable in the first third of the 20th century.

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

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

There are still many proposals, such as Mediterranean dengue fever, influenza with toxic shock syndrome, and so on.

Issues

The plague of Athens can also be seen not as an epidemic of a single disease, but as an epidemic of different diseases. This approach has been used to interpret Hippocratic texts. For example, the "Thucydides syndrome" is thought to be a viral infection complicated by bacterial superinfection with toxic shock; or an epidemic of typhus as the main component, accompanied by other ailments.

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 in Athens is consistent with what would be expected for typhus, arbovirosis, plague and smallpox.

In addition to the problems associated with philology and paleomicrobiology, there is the more general problem of the historical evolution of infectious diseases, which do not retain the same appearance over the centuries. Viruses and bacteria evolve, as do genetics and the immunity of human populations. It remains to be seen whether the plague of Athens is also an extinct disease, or whether it is about to reappear, given the interest it still arouses in the 21st century (confrontation with recently discovered infections).

As one of the causes of the end of Pericles' century, the plague in Athens left its mark on ancient minds such as Lucretius and Plutarch. The most famous example is Lucretius' De rerum natura, which ends abruptly with a reprise of Thucydides' text (VI, 1138-1286).

This abrupt ending has been the subject of several interpretations: Lucretius' De rerum natura is said to be an unfinished work, due to Lucretius' death or anguish (madness or suicide at the end of his life). This type of interpretation was first proposed by Saint Jerome, for whom the interruption of De rerum natura and Lucretius' madness represent divine punishment for a denial of providence.

Other interpretations emphasize that the plague in Lucretius is indeed in its significant place as a moral and philosophical problem in an Epicurean context. If the plague is a physical disease, it is also a disease of the soul, due to the uncertainty of its origin, the disorder of values it brings to the city, the relationship with others that must be rethought, its total injustice through the death of the just and the innocent, the plague is an "athymia" (sadness, affliction...) that is opposed to euthymia (happiness and joy of living).

Lucretius insists on the fortuitous nature of the event, and sees no necessity or purpose in it. The phenomenon is caused by a morbid air that comes from elsewhere and insinuates itself into each of us. The plague of Athens is a counter-myth in which everyone dies, the just as well as the unjust, the innocent as well as the guilty. By placing the description of the plague at the end of his poem, Lucretius uses it as radical and irrefutable proof of the absence of providence.

To the problem of the origin of evil posed by tragic consciousness or theodicy, Lucretius replies that evil does not exist, only disease; and disease is not a myth, it is. The plague is a historical event and a natural phenomenon, a physical and moral entity that is a radical test of the soul in the face of the absence of providence. The plague is the occasion for a catharsis in which the soul must heal itself of its essential illness: the fear of death.

Hippocrates in Athens

The Greek physician Hippocrates, who was 30 years old at the time of the Athens plague, stayed in the city in 427; he is said to have hastened the end of the epidemic by lighting large fires of aromatic plants (hyssop, lavender, rosemary, savory), but this is part of the Hippocrates legends gradually built up from Roman times onwards. However, this legend was put into practice during the Marseilles plague of 1720, from August 2 to 5, when large fires were lit on the ramparts and throughout the city. Although Hippocrates and Thucydides were almost contemporaries, Thucydides makes no mention of Hippocrates in his texts. But the Hippocratic Corpus does contain a reference to a rather large epidemic that developed in a northern region where the physician of Cos was present 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 examined the role of Hippocratic legends. The legend of Hippocrates in Athens (from Galen until the Middle Ages) helped forge the image of the exemplary healer, counterbalancing Thucydides' claim that medicine and religion were equally ineffective. This would also demonstrate Thucydides' independence from physicians.

Galen, commentator on Thucydides

Throughout his work, the physician Galen quotes Thucydides extensively for his medical expertise, particularly 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 make it possible to cast doubt on 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".

Influence of a model

Thucydides' text became so famous that the satirist Lucian, in the 2nd century AD, was able to quote from it in jest.

The Byzantine historian Procopius describes Justinian's plague in the 6th century, taking Thucydides as his model, especially with regard to the social consequences of the epidemic. Most chroniclers drew inspiration from one another, and a true historical appreciation of plagues only began to emerge towards the end of the 18th century. For modern historians, Thucydides is a point of reference for noting what is original or personal in a chronicler's observations.

"There is only one Thucydides, and as long as there are men, he will remain an Athenian," begins the foreword by the authors of Marseille, ville morte, la peste de 1720. According to Jacques Ruffié, the text by Thucydides is exemplary, the first historical account of a major epidemic to take on archetypal status.

Sources

1. Plague of Athens
2. Peste d'Athènes
3. J.-P. Béteau 1935, p. 22.
4. ^ Littman, Robert (2009). "The plague of Athens: epidemiology and paleopathology". The Mount Sinai Journal of Medicine, New York. PubMed. 76 (5): 456–467. doi:10.1002/msj.20137. PMID 19787658. Retrieved November 15, 2023.
5. ^ a b Thucydides, History of the Peloponnesian War 2.49
6. ^ Numero complessivo di casi confermati e sospetti.
7. 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.
8. Thukydides 2,47-55 (englisch) (Memento vom 16. Mai 2009 im Internet Archive)
9. Francesco M. Galassi, Luigi Ingaliso, Elena Varotto: The Covid-19 pandemic as a communication responsibility and opportunity for paleopathology. In: Flinders University. Juni 2020, abgerufen am 3. Mai 2021 (englisch).