PERICLES, THE PELOPONNESIAN WARS AND THE PLAGUE OF ATHENS

1. Historical Background

The fifth century B.C. is considered the Golden Age of Greece. In fact it was the Golden Age of Athens. The century is framed by two wars, which lasted most of the century. In 490 B.C. the Persian Empire, in an attempt to expand Westward, attacked Greece. The Persians were defeated by the Greeks at Marathon, and kept out of Greece for a decade. In the years 481/80, the Persians with perhaps 100,000 men under their king Xerxes, invaded and defeated the Greeks at Thermopylae and killed the Spartan king Leonidas. All central Greece was lost. The Persians swept south, and set fire to Athens, before they were decisively defeated at Salamis and Plataea. The war with Persia forced an amalgamation of Greek city states into two great alliances, one headed by Athens, which was called the Delian League, and the other by Sparta, called the Peloponnesian League. The war with Persia continued sporadically, until it was finally settled in 449 B.C. by the Peace of Callias.

The militarization of the Greek world and the development of two major military and political forces, Athens and Sparta, led to the second great conflict of the century, the Peloponnesian Wars, which broke out in 431 B.C. and lasted until 404 B.C. The war was a territorial struggle, but also an ideological one. On one side was Athens, dedicated to democracy, or the rule of the people. On the other was Sparta, an oligarchy, which restricted the franchise and rule to a few individuals. As each side conquered other city states, it imposed its form of government.

The ruler of Athens at this time was the Athenian general Pericles. Born five years before Marathon, from an Aristocratic family, he emerged as a political leader in 463. In 454-3 he became Strategos or general, and dominated Athenian politics until his death in 430 -29. Not only was Pericles a political and military leader, but he was a cultural leader as well. The Golden Age of Athens is thus also called Periclean Athens. In 447 B.C. he inaugurated the building of the Parthenon, the temple to Athena Parthenos on the Acropolis at Athens. He created a circle of intellectuals around himself, which included the sculptor Pheidias, the philosopher Anaxagoras, and his own mistress, Aspasia. When war with Sparta was threatening, Pericles became a staunch advocate of an aggressive war policy. When war broke out in 431 B.C., Pericles was the architect of Athenian strategy. The Spartans invaded Attica and besieged Athens in 430. While the city was under siege, a plague struck, which over two years killed around 25% of the population, including Pericles.

2. The Effect of the Plague on the Peloponnesian Wars

The Peloponnesian Wars lasted from 431 to 404 B.C. In the end Sparta defeated Athens, and installed a puppet government in the city. The Plague of Athens contributed to the defeat of Athens. Wars in fifth century Greece were dependant on the size of armies and number of ships. A smaller, well-trained force could defeat a larger force, as the Greeks demonstrated in the earlier part of the century against the Persians. However, in the Peloponnesian War with well trained Greek against Greek, size of army did matter. When Athens lost 25% of its population during the plague, this severely curtained the power of its army. Without the plague, Athens might have won the war. Furthermore, the loss of Pericles, the leading statesman and commander-in-chief of the Athenian forces, contributed to this defeat. Pericles was replaced by lesser men, of less military and political ability.

While the Athenians lost the war, within a few years of their defeat they had regained control over their own city, and their power. They were again strong enough to combat the Spartans and through the fourth century B.C., we see a jockeying for power by Athens, Sparta and Thebes.

While I am not one to play the "What if" game of history, if the plague had not occurred and Athens had not lost the war, the result in the end would have been much the same: mainland Greece would have fallen to Phillip and Alexander of Macedon in the fourth century. The Macedonians were simply too strong and aggressive militarily, to be defeated by Athens.

However, had Athens won the Peloponnesian War, the cultural life might have been very different. Fifth century Athens saw the greatest period of creativity in our western history, save for Renaissance Italy and our present 20th century. The great playwrights, Aeschylus, Sophocles and Euripides wrote during this period. The great works of architecture and sculpture were fashioned by Pheidias. The science of history began with Herodotus, who lived in Athens for a time, and Thucydides, who wrote a history of the Peloponnesian War. While the 5th century nourished the philosophers Socrates and Plato, they both died in the 4th century. Had Athens won the war, the creative impulse might have continued for another half century. But we will never know.

While the river of history would continue on its course, whatever the outcome of the war, the struggle of Athens against Sparta, and its recording by Thucydides, became a paradigm in history of the struggle of democracy versus oligarchy, enlightened and an open society against a dark and repressive society. Pericles in his Funeral Oration over the dead who perished in the first year of the war, called Athens "the School of Hellas". His words became the credo of not only Athens, but the Enlightenment in the 18th century, and the intellectual basis of America's founders, like Thomas Jefferson and Ben Franklin.

3. Thucydides

Our account of the Plague of Athens is preserved in the writings of the Greek historian Thucydides. Thucydides was born around 460 B.C. and died around 400 B.C. He caught the Plague in Athens, and survived. In 424 he became a general, but failed in his attempt to save besieged Amphipolis from the Spartans. For his defeat, he was exiled and only returned to Athens 20 years later, after the end of the war in 404 B.C. and died shortly thereafter. While in exile, Thucydides wrote a monumental history of the war, which became a standard for historical writers in Greek and western history. The Peloponnesian Wars covers the war years down to 411 B.C. Presumably, Thucydides died before he could complete the work. Thucydides sought to remove the supernatural from his work, to provided an accurate description of events themselves, and the motivations for the events. He along with Herodotus founded the genre of historical writing.

Thucydides saw the plague as a significant event in Athens, and he gives an extremely detailed account of the disease in order that "if it should break out again, it could be recognized." Thucydides, however, leaves out the important fact that Pericles died from the plague, and we only learn this from other sources. In the fifth century, Greek medicine in the form we know it, was just beginning under Hippocrates. Hippocrates was a rationalist. He believed that disease was not caused by the gods' displeasure.

He was among the first to seek rational explanations, with some physical basis that did not include divine causation.

The attempts of the ancient Greeks to search for rational causes of disease resulted in the miasmatic theory, the earliest surviving explanation of disease causation with a physical/scientific basis. The miasmatic theory held that an epidemic disease was acquired from an unknown but harmful elements in the air, a miasmus. How the air became poisoned was not known, but later explanations included gases exuded from the ground, or from diseased or dead bodies, that spread widely and whose movements were influenced by climatic, atmospheric and astronomical phenomena. Though technically incorrect, the miasmatic theory had a rational basis, and was linked to empirical observation. Since to a great extent disease theories in ancient Greece came from observations of airborne communicable diseases, transmitted between persons in close proximity who had no other close physical contact, the miasmatic theory is comfortably close to our current understanding of transmission of some of the same diseases (e.g., measles, varicella).

Just as the religious theories of previous eras seemed to fit the meager "facts" of the observable universe, the miasmatic theory appeared to fit the non-religious facts of the physical universe as they were understood in ancient Greece. It was observed that when flesh rots due to putrefaction (whether of meat, or in a gangrenous limb, or at death) it gives off a strong odor detectable at a great distance. If death can somehow cause an alteration in the air, even at a distance from the decaying object, some invisible element in the air must be responsible for it. The same can be said for decaying leaves and other vegetable matter. That these odiferous elements released upon disease or death might be among those that cause disease, death, and decay did not require great imagination.

We know today that most of the highly contagious diseases (e.g., measles, varicella, influenza), are airborne, i.e., that they are spread from person to person via droplets of moisture that are either exhaled, coughed, or sneezed into the open air, to be inhaled by the next victim. Though contagion, as currently understood, was not appreciated by the ancient Greeks, they did observe and intuitively understand that some diseases tend to occur in persons who had been in close proximity to others, and who had thus breathed the same air, even though these other persons had not had direct physical contact, or shared food, water, or clothing. They observed that people who shared more of the same air (e.g., in closed crowded conditions) were more likely to become ill. Though in reality bad smelling air was simply more likely to be present in closed spaces populated by too many people (coincidentally) exhaling too many germs, the ancient Greeks reasoned that bad smelling air caused disease. They also identified the non-contagious mosquito-borne disease malaria ("bad air") and correctly associated it with foul-smelling swamps. Thus, in many ways, the miasmatic theory was a way of classifying disease on the basis of non-causal phenomena associated with the circumstances surrounding disease acquisition, rather than as a theory that identified a singular mode of transmission/acquisition. Because the miasmatic theory seemed to be the best explanation for many available observations, it dominated western scientific and medical thought for over 2,000 years.

We should bear in mind an important similarity between the older religious theories and the new miasmatic theory of disease causation: in neither case did the theory address or predict the timing and the attendant circumstances of disease onset. Thus, there was neither obligation nor opportunity to prevent it. Stated in another way, neither the religious nor the miasmatic theory supposed any pattern to the occurrence of disease. Without a pattern of occurrence there could be no rationale for seeking interventions, and no motivation for doing so. Furthermore, this lack of pattern placed the theory squarely within a theoretical and intellectual rather than a practical context.

5. Information from other Sources

Thucydides is the only contemporary source which gives information about the plague. Some late classical sources from the Roman period, 1st B.C. to 2nd A.D. give some information, but much of this is based on Thucydides and possibly contaminated from other sources.

6. Geographic Distribution

Thucydides says the plague was said to have originated in Ethiopia, to have spread through Egypt and Libya and the territory of the King of Persia; it finally reached Piraeus and Athens where it raged intermittently for 3 years. We learn that it did not attack the rest of Greece with the same severity. We find from the Roman historian Livy that a plague attacked Rome in 436/5 B.C. and again in 433/32. A temple to Apollo Medicus ("physician") was build in 431 B.C.

7. Problems of Thucydides' Description

Although Thucydides himself was afflicted with the plague, and he wrote his description in order that those in the future might identify it if it should break out again, we must keep in mind various limitations of the account. The first is that Greek medical history and theory was in its infancy in the 5th century B.C. Indeed, it was at this time that Hippocrates was engaged in his work, which was to prove the basis for medical theory and practice for the next two thousand years. Technical medical language was just beginning to be created in the fifth century in the works of Hippocrates. Furthermore, even had technical language been available, as a layman Thucydides would not necessarily have been aware of it, nor trained in its use. To give a modern example, we find the lay term "heart attack", which could describe anything from an aneurysm to a coronary arterial thrombosis; or a stroke which could be described as a cerebral hemorrhage or a cerebral arterial thrombosis. In other words, lay term may provide only generalized information about disease conditions. saying little about signs and symptoms and less about the pathogenesis.

Thucydides was a layman. Galen, writing in the second century A.D., described Thucydides as a layman (idiotais) writing for a lay audience. As an historian and a laymen, Thucydides emphasized signs and symptoms that a modern medical writer would not. At times he stresses unimportant signs and symptoms while slighting important ones. For instance, his description of the rash is inadequate. He says nothing of its duration, its various stages, whether the phlyctaenae and helke existed simultaneously or sequentially, or whether one developed into the other, or what was the process of resolution of the rash. As discussed above Page (000) surveyed the language of Thucydides and concluded that the terms he used in describing the Athenian plague included standard medical terms of the fifth and fourth centuries. But this does not mean that Thucydides' account is a contemporary medical one. Parry (0000) demonstrated that most of the words Page discusses were also in common everyday usage, and that not until the Hellenistic period did a real technical medical language develop.

As a layman, Thucydides may not ask the right questions, may not give proper emphasis to various symptoms, and gives a description that is fraught with many other difficulties. Even in his Peloponnesian War Thucydides is selective about certain types of information. For example, he fails to mention Aspasia, Pericles' mistress. Nor does he relate that Pericles died of the epidemic. We have to turn to the pages of Plutarch, writing 500 years later to learn this. While certain types of intentional selection in his history lead him to omit what later generations consider relevant information, his description of medical phenomena become doubly problematic, first because of his status as a layman, and second because of his tendency as a historian to omit material he finds irrelevant. Unfortunately, modern theorists on the disease have often committed the same errors as Thucydides. Thucydides focuses on certain signs and symptoms he considers important, and upon ancillary phenomena. Some of these are irrelevant to the differential diagnosis of a disease. To cite one example, Thucydides described people throwing themselves into wells to gain relief from their fever. Page draws upon this observation to argue for measles, noting illogically that during a (probable) measles epidemic in Fiji in 1875, threw themselves into the ocean. While this account of reaction to fever is interesting from an anthropological viewpoint, from a medical viewpoint it is meaningless. Immersion in water to reduce fever is a cultural response to the symptom and is widely practiced by different cultures today. But the symptom was fever and the culturally based parallels in reaction to fever tell us nothing relevant about either disease.

Because of the similarities of infectious diseases and because of great variation in symptoms of the same disease, the physician uses differential symptoms to make his diagnosis and tends to search for key symptoms. On the other hand, a laymen would tend to assign equal importance to all symptoms described. In his attempt to provide a complete description Thucydides often fails to differentiate on what symptoms are important. Many of the minor signs and symptoms have been given much too much importance by those wishing to seek a one to one correspondence between the various diseases.

There are several possibilities to be considered, among them that the disease still exists somewhere, but has never been recognized. In the past 10 to 15 years we have identified a number of "new" diseases, including: (1) those that have probably existed for a long time, but were not recognized because they only occurred under unusual epidemiologic conditions (e.g., legionellosis); (2) those that may have long existed but only became epidemic as spillovers from complex ecologic/zoonotic cycles (e.g., the hemorrhagic fevers -- Korean hemorrhagic fever, Rift Valley fever, the Filoviral hemorrhagic fevers -- Marburg and Ebola, and the Arenaviral hemorrhagic fevers -- Lassa, Bolivian, and Argentine hemorrhagic fever), and (3) those that may actually have arisen de novo (acquired immunodeficiency syndrome; acute hemorrhagic conjunctivitis). Could the Plague of Athens exist somewhere now, unidentified but still viable? As time goes by and our complex human ecosystems invite more and more diseases out into the open, particularly in Africa, this seems increasingly unlikely. The world is getting crowded with humans, and there are fewer and fewer places for a micro-organism to hide.

Another possibility is that the plague of Athens still exists, but we have not identified it because we misinterpret Thucydides' original description. We know that Thucydides had access to a non-technical medical vocabulary and, as Page (1953) and others have pointed out, his usage of various terms and constructions suggests familiarity with Hippocrates and other contemporary physicians. But was Thucydides, who was not himself a physician, able to appropriately apply medical terms to signs and symptoms he could have observed, but with which he had no familiarity otherwise? For example, does his use of formulaic constellations of stock symptoms apparently taken from Hippocrates betray an attempt to achieve credibility among contemporary medical men at the expense of accuracy? Furthermore, we must ask how Thucydides, with the limited vocabulary available to him, would have described features of diseases we know exist today.

A third possibility is that the plague at Athens exists, but we have not identified it because Thucydides was wrong in his original description. Thucydides seems to be a precise and accurate historian, dispassionately reporting on the times he lived through. Could he, then, have made mistakes in his description of the Plague of Athens?

A fourth possibility is that the plague of Athens has died out entirely, or that its symptoms have so changed that it either cannot be recognized or that for all intents and purposes it no longer exists.

8. Method of Approach

There are three possible approaches to the identification of the plague of Athens

1. Clinical
2. epidemiological
3. palaeo-archaeological

Today, we are discussing the clinical and epidemiological. From the archaeological standpoint, last year 160 skeletons were discovered in Athens by the German School of Archaeology, which can be dated to 430 B.C., the year of the plague. Some scientific analysis of these bones may give us new clues, but for today, as a historian, I have presented some of the historical background and some of the problems I leave it to the physicians among you to look at the clinical and epidemiological approach.