‘The disease began, it is said, beyond Egypt in Ethiopia… then it suddenly fell upon the city of Athens’
Between 430-426 BCE, the Greek city state of Athens suffered a mysterious and devastating plague. Highly contagious and often fatal, the disease is reputed to have reduced the population of Athens by up to a quarter. Although the cause of the epidemic is unknown, bubonic plague, smallpox, measles, anthrax and influenza have all been suggested as possible culprits. The symptoms exhibited in Athens however, do not exactly match those of any known disease and speculation as to the nature of the epidemic continues to the modern day.
Our sole contemporary source for information on the plague is the historian Thucydides, who claimed to have suffered from the condition himself, and catalogued its symptoms and effects in minute detail. Although the objectivity of Thucydides’ account has been called into question, his description of the sufferings endured by plague victims and the effects of the epidemic upon Athenian society as a whole have proven of great interest to both physicians and historians.
The Plague according to Thucydides
‘Men were seized first with intense heat of the head, and redness and inflammation of the eyes… both the throat and the tongue immediately became blood-red and exhaled an unnatural and fetid breath’
Thucydides’ account of the plague is found within the second book of his History of the Peloponnesian War, a conflict between the Athenian Empire and the Spartan-led Peloponnesian League which was fought between 431 and 404 BCE. According to the author, it is after the first year of fighting, and the subsequent public funerals that ‘the plague began for the first time to show itself amongst the Athenians.’
Thucydides describes the disease descending through the victim’s body, causing vomiting, convulsions, blisters, ulceration of the bowels, diarrhoea and eventually death. For those who endured the peak of the illness, said to occur around the 7th day, survival was believed to have been more likely but the ordeal itself, far from over. The departing disease is reported to have then attacked the extremities; survivors often lost fingers, toes, eyes or even their genitals (2.49).
As the true extent and harrowing nature of the epidemic became apparent, Thucydides tells us that a desperate and terrified population gave way to barbarous, hedonistic impulses that ‘no fear of gods or law of men’ could restrain (2.53). ‘Bodies of dying men lay upon one another and half-dead people rolled about in the streets’ as the infected were abandoned, burial customs ignored and the city descended into chaos.
Explaining the Plague
‘The character of the disease proved such that it baffled description, the violence of the attack being in each casetoo great for human nature to endure’
Both historians and doctors have a long tradition of speculating on the nature of the plague of Athens. Although obvious parallels can be drawn with later epidemics such as the Black Death, the lack of the pustulent swellings associated with bubonic plague amongst Thucydides’ otherwise extensive list of symptoms would seem to rule this particular bacterium out. Perhaps a more likely explanation can be found in examples of ‘virgin soil epidemics’, in which a condition that is mild for one group of people proves devastating to those with no previous exposure to it and thus no immunity against it. With only Thucydides’ descriptions to go on however, it is unlikely we will ever know the identity of the Athenian plague with any certainty, but how did doctors explain the epidemic at the time?
Medicine in ancient Greece was based upon the humoural system in which sickness was believed to be caused by an imbalance between the fluids, or humours of the body. According to the Hippocratic Corpus, attaining the correct balance of the humours was a highly personal affair, dictated by a patient’s natural constitution, lifestyle and the environment. Using such an individualist system, Greek doctors found it difficult to account for epidemic diseases such as the plague, which Thucydides tells us struck the ill and the healthy, men and women, the young and the old from all walks of life, seemingly out of the blue.
One theory suggested by ancient writers was that the plague was caused by bad air. Plutarch, writing 500 years later in the first century AD, claimed that a doctor called Acron treated victims at Athens by lighting a fire in the city and thus cleansing the air of disease. Thucydides however makes no mention of this, writing instead that physicians were unable to cope with the plague, and that ‘mortality among them… [was the] greatest because they were most exposed to it’ (2.47).
In recording the epidemic in such detail, Thucydides tells us he aims to describe its course and explain its symptoms so that future generations might have ‘knowledge of it beforehand, to recognise it if it should ever break out again’ (2.49). Over two and a half centuries later the identity and origin of the plague of Athens remains a mystery, but the detail of Thucydides’ account and the warning contained within it still have the power to both terrify and enthral.
Liam is the author of Ancient Medicine: Sickness and Health in Greece and Rome.