Download The Plague of Athens - Family Medicine Residency Program

The Plague of Athens
Hans House, MD, FACEP
Vice Chair for Education
Department of Emergency Medicine
University of Iowa
Objectives
• Discuss a historical case presentation and
explore the differential diagnosis of an
unknown infectious disease
• Understand the impact infectious diseases
may play in the course of human history
• Try to learn almost as much ancient Greek
culture as my 6 year old daughter
Marathon: 490 BC
Thermopylae
479 BC
300
“Come back with your shield or on it”
Themistocles and
the Battle of Salamis
Themistoclian walls
No longer united by the threat of Persia, alliance
between Sparta and Athens deteriorates
Pericles
• c495 – 429 BC
• Dominated Athenian
politics for 30 years
• Athens had great navy
• No match for Sparta in
open battle
• Utilize walled port to
resupply and stage raids
• Intended to fight war of
attrition
Summer of 430 BC:
plague begins
Thucydides
Plague in an Ancient City, Michael Sweerts, 1652
‘‘It first began, so it is said, in Ethiopia above Egypt,
and then descended into Egypt and Libya and into
most of the King’s land. Suddenly falling upon
Athens, and first attacked the population at
Piraeus, so that they themselves said that the
Peloponnesians had thrown poison into their
wells: for there were, as yet, no cisterns there.
But afterwards it came to the upper city as well,
and from that time the deaths became much
greater.”
‘‘It first began, so it is said, in Ethiopia above Egypt,
and then descended into Egypt and Libya and into
most of the King’s land. Suddenly falling upon
Athens, and first attacked the population at
Piraeus, so that they themselves said that the
Peloponnesians had thrown poison into their
wells: for there were, as yet, no cisterns there.
But afterwards it came to the upper city as well,
and from that time the deaths became much
greater.”
“But suddenly, healthy men were seized first with
mighty heats in the head, and redness, and
inflamed eyes, and the inside, both the throat
and tongue, immediately became blood-red and
emitted an atypical, foul breath.’’
‘‘After which came sneezing and hoarseness, and in
not much time the pain descended into the chest,
and produced a severe cough; and when it fixed
in the stomach, it upset it, and vomiting of bile of
every kind named by physicians ensued,
accompanied by great suffering; and in most
cases nonproductive retching followed, giving
way to violent spasms, which sometimes abated
soon after, in others, long after.’’
“But suddenly, healthy men were seized first with
mighty heats in the head, and redness, and
inflamed eyes, and the inside, both the throat
and tongue, immediately became blood-red and
emitted an atypical, foul breath.’’
‘‘After which came sneezing and hoarseness, and in
not much time the pain descended into the chest,
and produced a severe cough; and when it fixed
in the stomach, it upset it, and vomiting of bile of
every kind named by physicians ensued,
accompanied by great suffering; and in most
cases nonproductive retching followed, giving
way to violent spasms, which sometimes abated
soon after, in others, long after.’’
“But suddenly, healthy men were seized first with
mighty heats in the head, and redness, and
inflamed eyes, and the inside, both the throat
and tongue, immediately became blood-red and
emitted an atypical, foul breath.’’
‘‘After which came sneezing and hoarseness, and in
not much time the pain descended into the
chest, and produced a severe cough; and when it
fixed in the stomach, it upset it, and vomiting of
bile of every kind named by physicians ensued,
accompanied by great suffering; and in most
cases nonproductive retching followed, giving
way to violent spasms, which sometimes abated
soon after, in others, long after.’’
‘‘Externally, the body was not very hot to the touch,
and was not pale, but reddish, livid, and flowering
with small blisters and wounds. But internally was
it such a heat that the patients could not bare
garments or fine cloths being laid on them, nor be
anything but naked, and would have liked best to
hurl themselves into cold water, as in fact, many
of those neglected did, throwing themselves into
cisterns, tormented by unquenchable thirst. And
it was the same whether they drank much or
little.’’
‘‘Externally, the body was not very hot to the touch,
and was not pale, but reddish, livid, and
flowering with small blisters and wounds. But
internally was it such a heat that the patients
could not bare garments or fine cloths being laid
on them, nor be anything but naked, and would
have liked best to hurl themselves into cold water,
as in fact, many of those neglected did, throwing
themselves into cisterns, tormented by
unquenchable thirst. And it was the same
whether they drank much or little.’’
‘‘Also, they were ceaselessly tormented by the inability to
rest or sleep. And the body, while the disease
flourished, did not whither, but withstood the ravages
of the disease; so that when they died, as most did, on
the seventh or ninth day from the burning heat, they
still had some strength. But if they escaped this, the
disease descended into the bowels, creating a great
ulceration, and at the same time, accompanied by
acute diarrhea, and many later died from exhaustion
because of this. . . it left its mark on the extremities.
For it fell upon the genitals, and the tips of the hands
and the feet, and many escaped, being deprived of
these, some also lost their eyes. Others again were
taken with a complete loss of memory after recovery,
and they failed to know either themselves or friends’’
‘‘Also, they were ceaselessly tormented by the inability to
rest or sleep. And the body, while the disease
flourished, did not whither, but withstood the ravages
of the disease; so that when they died, as most did, on
the seventh or ninth day from the burning heat, they
still had some strength. But if they escaped this, the
disease descended into the bowels, creating a great
ulceration, and at the same time, accompanied by
acute diarrhea, and many later died from exhaustion
because of this. . . it left its mark on the extremities.
For it fell upon the genitals, and the tips of the hands
and the feet, and many escaped, being deprived of
these, some also lost their eyes. Others again were
taken with a complete loss of memory after recovery,
and they failed to know either themselves or friends’’
Durack DT,.. Am J Med 2000;109:391
Cunha. Infect Dis Clin N Am 2006; 20: 253–272
Asclepius, son of Apollo
Chiron, the great tutor
1998
Typhoid Fever
•Insidious onset over weeks
•Abd pain, Rose Spots follows
•Progressive sepsis
•Ulceration and perforation
at site of Peyer’s Patches
•Neurological sx possible
•Diarrhea in about half
•Pulse- fever dissociation
•Pneumonia seen in children
•15% mortality w/o Abx
Impact of the Plague
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•
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•
Killed Pericles and 25% of the population
Athens rebuffed peace offer by Sparta in 425 BC
Sicilian expedition
Sparta victorious 404 BC, Socrates executed 399 BC
Ended Athens’ golden age, replaced with anarchic,
live for the moment existence
• Ended ancient world’s experiment w/ democracy
Summary
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•
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Marathon
300 Spartans
Pericles and Thucydides
Staff of Asclepius vs Caduceus
Hippocratic Oath
Greatest medical mystery in
history lives on…maybe…
Raining 300 Men
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