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CALIFORNIA STATE UNIVERSITY SAN MARCOS
“THE BIG HISTORY OF INFECTIOUS DISEASE
AND THE ATHENIAN PLAGUE”
A THESIS SUBMITTED TO THE FACULTY OF THE COLLEGE OF HUMANITIES, ARTS,
BEHAVIORAL & SOCIAL SCIENCES IN CANDIDACY FOR THE DEGREE OF MASTER
OF ARTS IN HISTORY
DEPARTMENT OF HISTORY
BY
BREE FOTH
SAN MARCOS, CA
DECEMBER 2013
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Table of Contents
Introduction ..................................................................................................................................... 3
Chapter 1: Plague in Prehistory .................................................................................................... 12
Chapter 2: The Athenian Plague ................................................................................................... 21
In Conclusion ................................................................................................................................ 30
Appendix ....................................................................................................................................... 32
Appendix A ............................................................................................................................... 32
Appendix B ............................................................................................................................... 33
Appendix C ............................................................................................................................... 34
Bibliography ................................................................................................................................. 35
Primary Sources: ....................................................................................................................... 35
Secondary Sources: ................................................................................................................... 35
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Introduction
It is not widely known that infectious disease predates human existence. Cellular
interactions that resemble what modern scientists now consider “infection” has been present in
the universe since the first appearance of life. These earliest interaction existed as a relationship
between two or more cells that resulted in a positive, negative, or neutral result. As life forms
became more complex on earth, microbes also evolved and increased in complexity. The
appearance of mammals presented optimal host organisms for infectious microbes, and
environmental changes created regions with warm, humid climates near the equator, allowing
bacteria to thrive. In prehistory, disease affected only small populations of humans due to their
living in small, nomadic groups. As humans slowly transitioned to living in sedentary
communities where populations became denser the nature of infectious microbes also evolved;
infectious microbes became more virulent as their hosts were now able to develop natural
immunities to the diseases that were common in the regions they inhabited. Outbreaks became
more deadly, causing mass destruction of life as dense populations and changes in living
conditions allowed for microbes to be easily transmitted among individuals; these destructive
outbreaks are considered plagues. The Athenian plague is the first recorded plague in human
history and was a significantly destructive outbreak of what was likely Typhoid fever during the
Peloponnesian War from 430 B.C.E. to 426 B.C.E. While there is a large amount of secondary
literature available about the Athenian plague, few historians have taken an interdisciplinary
approach by incorporating prehistory and the science of infectious disease in their analyses.
However, there is one field of history that focuses entirely on applying multidisciplinary
perspectives in examining historical trends and events and that would be particularly useful for a
study of the Athenian plague; this field is big history. An application of the multidisciplinary
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approach of big history to an analysis of the Athenian plague allows me to illustrate the gradual
evolution of infectious disease outbreaks throughout prehistory, shedding new light on the
various causes of the Athenian plague and the biological and cultural reasons for its lethality.
Big history and other fields of historical study that examine large scales of time or large
geographic areas have become increasingly relevant since the late twentieth century.
Contemporary global crises such as anthropogenic global warming, environmental destruction,
and overpopulation have encouraged scholars to study the past in a broader timeline in order to
better understand how earth and mankind have come to be as they are and how mankind is
disrupting the natural order. As Daniel Smail recently wrote in Perspectives on History, “The
urgency of the contemporary situation, moreover, exposes the inadequacy of the short view.” 1
Big historians have not yet studied infectious disease, and classical historians have yet to apply
interdisciplinary fields, such as ecological and environmental history, to the narrative of the
Athenian plague. My project will fill a gap in the existing big history historiography as I utilize
the big history timeline, as well as biological sciences, to contribute to a more complete history
for the Athenian plague than exists currently.
This thesis studies a substantial period of time beginning with the Big Bang, or the birth
of the universe, approximately fourteen billion years ago and concluding with the end of the first
breakout of the plague in Athens in 426 B.C.E. Studying this large span of time and area will
allow me to emphasize the gradual changes that occurred during this period. The geographic
region of my study emphasizes the unique expanse of big history; geographically, the scope of
my thesis will begin as an examination of the universe in its entirety for several billion years
1
Smail, Daniel L, "Beyond the Longue Duree: Human History in Deep Time." Perspectives on History 50,
no. 9 (December 2012): 59.
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following the Big Bang. My focus will narrow to planet Earth at its formation 4.5 billion years
ago and the emergence of life four billion years ago. Finally, I will narrow my examination to the
Athenian Empire as it existed in 450 B.C.E.
My work applies the framework of big history and the historical timeline of the
universe’s existence that has been established by historians and scientists as I consider the
Athenian plague in terms of its geographic, ecological, and biological causes. In studying the
history of mankind as a species, I first explore how pathogens have evolved throughout
prehistory and how they affected the development of mankind up to the first occurrence of the
Athenian plague. Secondly, I discuss how Athenian culture, such as the cultural reason for the
increased population density of Athens during the outbreak, contributed to the scale of
devastation caused by the plague and how Athenian culture was temporarily transformed by the
plague. Finally, I examine how several environmental factors affected this particular occurrence
of the plague, such as the dense human and animal populations of Athens, the migration of
peoples during the Peloponnesian War, and the climate of Athens. Studying environmental and
biological factors in the plague’s level of devastation is an interdisciplinary approach that
provides a more complete discussion of how the plague occurred than previously published. Big
history is not necessarily meant to provide new information about an event specifically, but
rather creates a better understanding of the entire picture of an event and its historical
significance. Studying environmental factors in the spread of disease, as well as how infectious
disease evolved as the lifestyles of humans transformed, provides a unique and all-encompassing
perspective of the Athenian plague.
This thesis includes a supplementary website. Visual representations of the evidence will
be very beneficial for readers when considering the geographic and chronological span of my
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project. The website includes a short documentary and interactive timeline, which provide an
overview of the general ideas that big history has been founded upon. An interactive map that
illustrates the location and age of infectious disease victims from prehistory is also included in a
subpage of the website. It includes information regarding the age, ethnic identification, and cause
of death of the individuals that are being represented. My site can be accessed at
http://www.csusmhistory.org/faulk006/.
When studying ancient history, scholars are constantly challenged by the extremely
limited number of available primary sources. By utilizing the ideas, timeline, and existing
publications in the field of big history, I have access to a large amount of material that has never
before been applied to ancient Greek history; material that is applicable to studying the Athenian
plague in terms of geography, ecology, environmental history, and world history. Simply, my
main argument is that in studying the history of the universe, planet earth, and life on earth, and
the historical, biological, and environmental trends that span these histories, I provide an original
perspective of the Athenian plague and its causes. In my study of the plague I set out to answer
the following questions: What biological and ecological factors contributed to how the plague
came to and spread through Athens? What environmental factors contributed to the scale of
devastation caused by the plague from 430 B.C.E.-426 B.C.E.? Did the geographic location and
climate of Athens affect how the plague occurred and resolved? How did environmental and
biological factors interact with political, cultural, and social factors to contribute to the extent
and severity of the plague? According to the writings of Thucydides, invading Spartan forces
that had been exposed to the disease (which I argue was typhoid fever) during military
campaigns on the African continent introduced the infection to the Athenian Empire. The
Mediterranean climate in Athens, the well water supply, and dense population within the city
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walls are a few environmental factors that contributed to the severity of the outbreak. Pericles’
decision to move the countrymen of Athens within the city walls during the Peloponnesian War
created optimum conditions for the transmission of the disease, contributing to the extremely
high mortality rate of Athenian citizens. The likelihood of imminent death transformed the
behavior of Athenians, as there was wide disregard for lawfulness and traditional morality.
As it intervenes into the historiographies of big history and environmental history, my
thesis contributes to existing cultural history discussions of the Athenian plague. Big history is a
considerably new field of history, the first publications appearing in the 1970s and the term “big
history” being coined in the 1990s. The field has thus far been dominated by astrophysicists and
geologists, giving it a strong scientific foundation. However, historians have taken great interest
in investigating the relationship between humans and what we consider “nature” in an attempt to
find answers to the elementary questions of human life: “How did we get here?” and, “Why are
we here?” Big historians have managed to organize all of history into a more manageable
structure for study and have established the timeline of threshold moments. Despite its incredible
scale, big history has proven valuable in studying specific elements of Earth’s development and
events in human history, e.g. Jonathan Markley’s big history of grass. 2 Markley creates a history
of grass species, specifically the dominant and invasive ones of North and South America,
spanning approximately one thousand years, and his article serves as a model for my application
of big history themes as I study the Athenian plague.
My thesis contributes to the environmental history discussion of infectious disease as I
join historians such as David Christian, Alfred Crosby, and Harold Morowitz in studying how
2
Markley, Jonathan, “A Practical Compromise to Teaching World History: Thematic Bridges, Standards,
and Technology.” World History Connected 6, no. 3 (2009).
http://worldhistoryconnected.press.illinois.edu/6.3/markley.html.
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the ecosystems of earth developed and why life exists on earth as it does today. As a leading
environmental historian, Alfred Crosby provides a global perspective of the biological evolution
of flora and fauna species on earth, and how certain species evolved superior defenses to
pathogens which allowed them to dominate large regions of land masses in his book Ecological
Imperialism: The Biological Expansion of Europe, 900-1900. Jonathan Markley followed the
Crosbian model in his article “A Practical Compromise to Teaching World History: Thematic
Bridges, Standards, and Technology,” as he creates a history of grass species, specifically
dominant and invasive grass species of the North and South American continents, spanning
approximately one thousand years. These two publications will serve as models for my thesis.
Both environmental history and big history are interdisciplinary fields are founded upon
evidence provided by the studies of experts in several scientific fields, such as physicist Isaac
Asimov and astrophysicist Stephen Hawking. I have found several publications by these
scientists especially relevant to this thesis. Isaac Asimov’s Beginnings: The Story of Origins of
Mankind, Life, the Earth, the Universe and Chronology of the World: the History of the World
from the Big Bang to Modern Times examine the formation of the universe, our solar system,
Earth, and humans throughout all of time. They help to provide a scientific framework for the
timeline big history follows and the trends that span all of history. Asimov’s publications are
more popularized and accessible for scholars with knowledge of astrophysics, and include
several diagrams that help the reader visualize the complexities of the universe. Stephen
Hawking’s A Brief History of Time examines the history of the universe, but the language and
theories are less accessible to an unprofessional scientist. However, his discussion of the
beginning of life is very influential and relevant to my examination of how pathogens are spread
among mammals. To supplement these environmental and scientific publications, I will also
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examine publications in biology and disease journals in order to provide information for my
readers about the physiology of pathogens (bacteria and viruses) and how they spread. Two
biological publications that I find relevant to my thesis are: an article in the PNAS: Proceedings
of the National Academy of Sciences of the United States of America journal 3 regarding the
effects of climate on plague bacterium and the outbreak severity, and an Ecological Applications
article which examines the spread of plague in mammal communities. 4
This thesis briefly discusses the cultural causes and effects of the plague on Athenian
society as it contributes to current debates among cultural historians. Athenian religious and
medicinal practices played an undeniably paramount role in how the plague infected Athens, and
the death rate greatly affected cultural and social standards in the city-state for the duration of the
outbreak. For example, traditional gender roles were ignored; inheritance practices were
performed according to necessity despite traditional social norms, and economic behavior, such
as spending and investments, changed drastically as death became more and more likely for
citizens. The only existing primary source that discusses the Athenian plague is Thucydides’
History of the Peloponnesian War. Thucydides was an Athenian general who lived from
approximately 460 B.C.E. to 395 B.C.E. who wrote about his experiences of the Peloponnesian
War and Athenian plague beginning when he was a young man. He himself writes about being
afflicted with the plague and surviving. Thucydides provides an extremely vivid and
considerably impartial depiction of the events he describes. Several classical historians of the
3
Ari, Tamara Ben, Chang, Kung-Sik, Fang, Xiye, Qiyong Liu, Stenseth, Nils Chr., Stige, Leif Chr.,
Shuchun Wang, Xu, Lei, and Zhang, Zhibin, "Nonlinear effect of climate on plague during the third pandemic in
China." PNAS: Proceedings of the National Academy of Sciences of the United States of America 1073, no. 10 (June
2011). http://www.pnas.org/content/early/2011/06/02/1019486108.short.
4
Antolin, Michael F., Laurel M. Hartley, Robin M. Reich, Lisa T. Savage, and Paul Stapp, "Climate, soils,
and connectivity predict plague epizootics in black-tailed prairie dogs (Cynomys ludovicianus)." Ecological
Applications 21, no. 8 (2011): 2933-43: Although this article discusses plague in black-tailed prairie dog
communities, its analysis of the spread of plague bacterium among mammals who live in close proximity could be
relevant to studies of plague outbreaks within human communities. The methods of pathogen transfer and the
physiology of the bacterium are similar among mammal species.
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twentieth and twenty-first centuries have written about Thucydides and his account. Donald
Kagan’s book The Peloponnesian War offers a more historically complete analysis of the three
decades of the war while quoting the ancient text many times. In his article “Thucydidean
Chronology Anterior to the Peloponnesian War" Allen West creates a well-organized historical
timeline of the Peloponnesian war, which will greatly assist me in mapping the plague outbreak.
Other historians who have taken an interdisciplinary approach to the Athenian plague are J.C.F.
Poole and A.J. Holladay, who in their article “Thucydides and the Plague of Athens" discuss the
possible diseases that could have been the Athenian plague. In his book The Ecology of the
Ancient Greek World, Robert Sallares provides a cultural examination of the Athenian plague
with some applications of evolutionary theory.
The greatest contribution of this thesis is to the field of big history. Beginning in the
1980s, as environmental degradation became a topic of international debate, historians began to
study history on a broader scale than before as they wrote about the 14 billion years of our
universe’s existence. This allowed historians to study how our world came to exist in its modern
state and the role humans have played in its considerably recent history. In the early twenty-first
century, climate change also became a controversial topic of scientific debate, emphasizing how
humans have intervened in the natural order of our planet. Several historians have emerged as
leading scholars in the field of big history. David Christian, who began his career as a Russian
historian, essentially founded this young field with his article “The Case for ‘Big History’” in
1991, establishing the importance of studying the history of the universe in order to better
understand events in human history. He later published Maps of Time: An Introduction to Big
History, This Fleeting World: A Short History of Humanity, and several journal articles that have
been essential contributions to his growing field of study. Craig Benjamin, Cynthia Stokes
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Brown, and Fred Spier have also published several monographs and articles regarding more
specific historical and scientific topics in the scope of big history such as gender studies, Asian
history, economic history, and geological studies. While big history is a quickly growing and
evolving field, no big historians have yet studied infectious disease in the scope of big history;
this creates a gap that my thesis will fill. One cannot study and fully understand disease in human
history without examining the entire history of disease which begins more than four billion years
ago.
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Chapter 1: Plague in Prehistory
While there is a large amount of existing literature about the Athenian plague, very few
historians examine the biology of infectious microbes, climactic factors in disease outbreaks, or
evidence of prehistoric disease in their research. By taking this interdisciplinary approach and
studying occurrences of disease over a large span of time, it is possible to identify how infectious
microbes likely appeared in the universe and how they have changed throughout earth’s history
on the cellular level. In studying evidence of outbreaks over the four billion years of life’s
existence on earth, it becomes clear that human behavior in recent history (10,000 BCE to
present) has greatly affected the evolution of microbes as well as the severity of disease
outbreaks. The Athenian plague is a quintessential case study as evidence of this phenomenon
and is a paramount point in the history of infectious disease as it is the earliest recorded outbreak
that is considered a plague based upon the devastation that occurred. Utilizing biological
research techniques such as DNA technology allows me to form a hypothesis on what bacterium
caused the Athenian plague, which can then be applied in determining likely causes of the plague
and how it was transmitted within the walls of ancient Athens. Studying disease transmission in
prehistoric human and livestock remains and comparing the remains to those of Athenian plague
victims in terms of death tolls, burial practices, and attempts at treatment illustrates how plague
outbreaks in modern civilizations differed from prehistoric outbreaks. If one does not study
disease from its first appearance in life, one cannot completely understand the causes and effects
of outbreaks in human history including the Athenian plague.
The many historians who have studied infectious disease know that it has threatened
human populations since the beginning of human civilization more than twelve thousand years
ago, but scientists understand infection as a process that has occurred since the first eukaryotic
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cells appeared in the universe. The first cells are theorized to have formed over twelve billion
years ago, but there is currently only evidence to support that cells came into existence on planet
earth approximately four billion years ago, identified by big historians as Threshold Moment 5. 5
The first occurrence of cellular interactions is believed to have been a parasitic relationship
amongst two, single cells, but not as we consider infection today. Charles Greenblatt defines the
modern concept of infection as “one life form within another doing its host damage,” 6 but the
earliest cellular interactions likely resulted in positive, negative, and neutral effects on the host
organism. 7 These early occurrences were considered “prion diseases,” or a relationship where a
protein catalyzes a conformational change in a normal protein, but this change was not
necessarily negative. 8
After the Big Bang, the universe continuously expanded and cooled which allowed for
elemental molecules and early life forms to become increasingly complex. As organisms in the
universe became more complex from the first self-replicating organisms of life’s existence, the
effects of infectious microorganisms included more possibilities between beneficial, benign, and
detrimental and in varying degrees. Infectious microorganisms could affect a single organelle of
a cell, and as organisms became larger and more complex, the many cells of a larger organ
system. As earth’s atmosphere developed, it created a gaseous, warm environment which
allowed for life to flourish on the planet. Organisms adapted to the varying environments that
occurred over nearly four billion years, but the tropical climate that developed in the equatorial
regions of the planet in particular allowed for unrestricted growth and sustenance of parasitic
microorganisms. Larger host organisms were more abundant in these regions, and the warm,
5
Greenblatt, Charles, and Mark Spigelman, eds, Emerging Pathogens: Archaeology, Ecology, & Evolution
of Infectious Disease. New York: Oxford University Press, 2003, 4-5.
6
Greenblatt, 6.
7
Ibid.
8
Greenblatt, 7.
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humid climate allowed for more efficient transmission of microorganisms among larger species, 9
especially hominid species after their appearance approximately twenty million years ago. 10
With each Ice Age, 11 hominids were forced to adapt to the colder climate or migrate to warmer
regions of the planet; these climactic changes led to the evolution of some parasitic microbes,
resulting in more resilient species of pathogens. Those species that did not evolve and adapt died
out completely. 12 The microorganisms that were best able to survive depended upon vector
transmission (the most effective method of transmission among organisms), medium-sized hosts
(moderately sized organisms had higher chances of survival in challenging environments due to
their mobility and moderate food consumption), and durability in characteristics that allowed
them to survive during rare mass extinctions. 13 This process of natural selection through
evolution among infectious microbes isolated those species most able to evolve quickly, making
them more resilient against mammal immunities and later medicinal treatments. This increasing
virulence among microbes contributed to the lethality of later disease outbreaks that would
devastate modern civilizations, such as the Athenian plague.
Cyclical changes in climate greatly influenced the evolution of parasitic microbes on
earth for over four billion years, and especially as species became more complex, living in small
groups or solitarily dispersed over large regions with the most favorable environments. The
dispersal of the human population across the planet in small, nomadic groups limited the
frequency of contact between different populations, therefore limiting disease transmission and
the destruction of life caused by infectious diseases. Approximately twelve thousand years ago
9
Greenblatt, 7.
Greenblatt, 8.
11
Ice Ages have occurred on planet earth approximately every forty thousand years in regular years until
very recently; Crosby, Alfred W. Ecological Imperialism: The Biological Expansion of Europe, 900-1900. New
York: Cambridge University Press, 1986.
12
Greenblatt, 10.
13
Ibid.
10
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there was a major shift in how the homo sapien species lived; there was a gradual transition from
living in small, nomadic groups to living in one central location in larger populations. This
transition, or Threshold Moment 7, was extremely beneficial for modern human species,
allowing humans to climb to the top of the food chain. Humans domesticated a variety of
vegetable and animal species, providing a constant food supply to support larger populations and
a more nutritionally complete diet; a more balanced diet improved human health and produced
stronger, more resilient individuals. Living in larger groups provided humans with security and
protection from attacks by predatory animals and other human groups. The domestication of food
sources and security provided by this sedentary lifestyle allowed humans more leisure time to
develop superior tools, weaponry, and structures and to progress intellectually. Improvements in
human health and intellect posed many threats to the parasitic microbes that existed on earth
before human civilization. With an improved diet, safer food and water sources, and a better
understanding of human illness and natural remedies, humans gradually became less susceptible
to pathogens forcing microorganisms to evolve and become more virulent in order to infect
human hosts. 14 The domestication of animal species, specifically livestock, meant that humans
spent their lives in closer proximity to animals than ever before in history; this continual contact
between humans and livestock allowed for microorganisms that had only infected livestock
species historically to be transmitted to humans. Several plagues throughout recorded history are
believed to have originated among livestock or rodent species which then transmitted the
infection to humans due to their living in close proximity.
Evidence of these transmissions is found by studying the remains of prehistoric disease
victims; anthropologists and paleoepidemiologists are able to evaluate outbreaks of infectious
diseases by studying the skeletal remains of humans and livestock. Bone material from skeletal
14
Greenblatt, 10.
16
remains must be radiocarbon dated to determine the age of the remains; radiocarbon dating does
this by examining the decay of carbon-14 in ancient tissue according to the isotope’s half-life.
When DNA material can be obtained from skeletal remains, scientists are sometimes able to
identify specific bacteria that are present; one genus of bacteria that has been identified as a
cause of several infectious diseases such as tuberculosis and leprosy is mycobacterium. 15 Before
DNA technology was developed, anthropologists performed physical examinations on skeletal
remains and identified signs of infection; finding ancient DNA material that has been preserved
well enough to be studied is rare, and the physical examination and disease identification skills
developed before DNA technology remain extremely useful. It is this technology that has
allowed anthropologists to determine that the Athenian plague was typhoid fever, though this
continues to be a topic of debate among experts.
Although modern antibiotics and vaccines have nearly eliminated the deadly effects of
disease that caused devastation in antiquity, the examination of the physical symptoms of
disease-stricken individuals in modernity has allowed paleoepidemiologists to identify specific
diseases in ancient human remains. In his monograph co-written with Charlotte Roberts The
Archaeology of Disease, Keith Manchester discusses the challenges in finding skeletal remains
that clearly exhibit skeletal damage from infection:
“If we consider the infections from which we all suffer today, it is apparent that the vast
majority affect the soft tissues of the body… Even without treatment, most of these
infections resolve within a short time, …or in more sinister infections, the death of the
15
Spigelman, Donoghue
17
individual occurs fairly rapidly and long before the infective process will have spread to
the bones.” 16
As human civilizations became more sophisticated and population densities rose, infectious
microbes became more virulent, causing death more quickly in victims. This accelerated process
of infection destroyed soft tissue in various ways, but did not allow the infection to reach bone
tissue before the victim perished. While ancient skeletal remains are rarely well preserved due to
environmental conditions, the factor of less bone damage in later remains makes it even more
difficult for disease to be identified as a cause of death. Paleoepidemiologists have developed
methods of identifying signs of infection in skeletal remains despite environmental damage.
Paleoepidemiologists are able to determine which bacterium infected an individual
according to skeletal evidence of specific symptoms. Inflammatory bone lesions, or the
inflammation of bone cells, are a characteristic of several infectious diseases, and can help
scientists identify from which infectious disease the victim suffered according to their location
and appearance in skeletal remains. Inflammatory bone lesions are caused by long-standing,
chronic infection, and do not appear “when infection resolves considerably quickly through
recovery or death.” 17 When a victim recovers quickly or perishes quickly from disease, the
infection does not reach the bone tissue and only affects the soft tissues, therefore leaving no
evidence of the infection on the skeleton. If bone lesions are present, paleoepidemiologists are
able to determine what type of infection affected the individual. “By and large, these infective
bone lesions of antiquity were created by bacterial and not viral infection, since these latter were
more rapidly resolved or fatal, and did not lead to the chronic invasive process as did bacteria.” 18
16
Manchester, Keith, and Charlotte Roberts, The Archaeology of Disease. Ithaca: Cornell University Press,
1995, 125.
17
18
Manchester & Roberts, 125.
Ibid.
18
The location and formation of bone lesions indicates which specific bacterium caused the
infection, or in other words, the disease from which the individual suffered. 19 For example,
leprosy causes deformation in the extremities and inflammation of the joints or of the entire
skeleton depending upon the severity of the infection. 20 Again DNA analysis is the most accurate
determination of what bacterium are present in remains, but DNA material rarely survives from
antiquity.
Osteomyelitis is the term used by paleoepidemiologists to identify particular signs of
infection on bone tissue: pitting or irregularities of the bone surface or cavity formation caused
by pus-containing abscesses. 21 Signs of bone reparation or regrowth, evident in the presence of
osteoblasts (woven, less-organized microstructure of new bone tissue), likely indicates that the
individual perished during the infection process because the bone tissue did not have sufficient
time to fully repair the abscessed damage. Another symptom indicative of death during the
infection process is signs of infection in other parts of the body where the bacteria have been
carried by the bloodstream, and the abscessed infection has spread. While secondary infection in
the organs is very common with severe bacterial infections, it is not present in skeletal remains
after the soft tissue has decomposed. However, the throat, ears, sinuses, and chest are areas of the
body where secondary infection does damage bone tissue, and can be identified in modernity. 22
The tibia and femur are also areas of the body where secondary infection occurs quickly due to
the abundant blood stream supply in these large bones, which carry bacterium in the blood
stream to this area quickly. 23
19
Ibid.
Ibid.
21
Manchester & Roberts, 126.
22
Manchester & Roberts, 127.
23
Manchester & Roberts, 129.
20
19
Changes in human lifestyle throughout history are also evident in skeletal remains. There
is an abundance of remains exhibiting evidence of lower leg trauma and advanced infection in
earlier agricultural societies due to accidents with equipment or animal attacks, but these
infections are not what epidemiologists consider to be “infectious diseases.” The word “disease”
in this phrase indicates a spread of bacterium from one creature to another, whether it be
transmission between human beings or between humans and other animal species. As discussed
by biologist John Lallo, who works primarily on the North American continent, there is evidence
of increased occurrences of infectious diseases as humans began to live in more dense population
groups approximately twelve thousand years ago; “It has been shown in an examination of early
American populations that the frequency of bone-infective lesions increases with an increased
population density.” 24 Lallo also identifies the likely cause of this increase as being “associated
with an increasing population of increasing social and economic complexity there is an extension
of trade networks.” 25 As human populations grew in these more complex social and economic
centers around the world, individuals experienced more frequent encounters with individuals
from other geographic regions, exposing them to pathogens that they may not have encountered,
having been a nomadic group in earlier times. For example, war allowed for disease to be carried
by armies from the African continent across the Mediterranean to the Athenian and Spartan
Empires where individuals had never before encountered such microbes and therefore had
developed no natural immunity. 26
Coinciding evidence of prehistoric disease outbreaks and changes in human lifestyles
illustrates the role of human activities in the evolution of infectious microbes. Bacterium became
more virulent at the same point in history when humans began living in denser populations,
24
Ibid.
Ibid
26
Thucydides, History of the Peloponnesian War. New York: Penguin Group, 1954, 118.
25
20
providing them with securities that allowed them to become stronger against infection. However,
the development of more complex economic and social structures among human civilizations
also exposed large populations to diseases that they had not encountered historically and
therefore had no natural immunity against. As human populations grew, changes in living
conditions created an environment that served as an excellent host for infectious microbes and
efficient transmission of infection, especially in equatorial regions such as Athens.
21
Chapter 2: The Athenian Plague
Plague, in the context of this thesis, refers to an outbreak of disease which results in a
great loss of life, and often has devastating effects on a culture and economy. The earliest written
record of plague can be found in the book of Exodus of the King James Bible. According to
scripture, God struck Egypt with ten “plagues,” but disease was present in only two of them. The
“plague against livestock” is said to have killed a great number of livestock across Egypt, and the
“plague of boils” caused boils on the skin of all of the people and livestock of Egypt; specific
diseases have never been identified as the causes of these plagues. 27 There is physical evidence
of infectious disease occurring in Egypt due to humans living in such close proximity to
livestock in large economic centers, but not with such devastation as was caused by the Athenian
plague. 28 Thucydides writes of the earliest plagues to his knowledge in History of the
Peloponnesian War; in antiquity, it was believed that the first plagues originated in Ethiopia and
spread through Egypt and Libya likely on trade routes or during military conquests. 29
Paleoepidemiologists have found evidence of infectious disease in human remains throughout
the territories of ancient Egypt. Damage to the auditory ossicles and walls of the middle ear in
Egyptian mummies serve as evidence of severe ear infections; there is also evidence of eardrum
perforation procedures being performed to relieve pain for individuals suffering from severe ear
27
Exodus 9: 1-12.
Filer, Joyce, Disease. Dallas: First University of Texas Press, 1996.
29
Thucydides, 118.
28
22
infections, identified by perforations in the eardrum with smooth, concise edges in the tympanic
membrane caused by an instrument. 30 The low air humidity, frequency of sandstorms carrying
sand particles in the wind, and unsterile water sources (oases or rivers often containing microbes
that can cause infection when trapped in the middle ear) of ancient Egypt are factors recognized
by modern physicians to increase the risk of ear infection. 31 Evidence of tuberculosis and
pneumonia has been found in many Egyptian mummies manifested as lesions in the rib bones,
suggesting prolonged and severe infection, and swelling of the joints. The mummy of Rameses V
shows evidence of what is likely the smallpox infection; soft tissue is present in the wellpreserved remains, showing blisters on the skin and infection that has reached the bone tissue
beneath the blisters. 32 All of these Egyptian remains exhibit symptoms of bacterial infections, or
the damage of infectious diseases, supporting Thucydides’ claims of plagues predating the
Athenian plague, but there is no physical evidence or written accounts of a plague that occurred
before the Athenian plague that wreaked such devastation.
It is currently estimated that the Athenian plague resulted in the deaths of one fourth to
one third of the Athenian population; there was one outbreak in 429 BCE and a second in 427
BCE. It is estimated that three hundred and fifteen thousand Athenians lived within the city walls
for long periods of time during the Peloponnesian War; the walls enclosed approximately three
and a half square kilometers. 33 There is only one surviving account of the events surrounding the
plague: the collection of historian and Athenian general Thucydides. Thucydides’ history ends
abruptly in the twenty-first year of the twenty-seven year Peloponnesian War, spanning from 431
30
Cockburn, A, "Autopsy of an Egyptian Mummy." Science 187, no. 4182 (1975): 1156; See Appendix A.
Ibid.
32
Zimmerman, M.R., "Examination of an Aleutian mummy." New York Academy of Medicine 47, no. 1
(1971): 133.
33
Murphy, Charles T., "Aristophanes, Athens and Attica." The Classical Journal 59, no. 7 (April 1964):
306-23.
31
23
BCE to 404 BCE. The Peloponnesian War was a conflict between the Peloponnesian League led
by Sparta and the Delian League led by Athens. 34 The writings of Thucydides were organized by
later historians into eight books and are considered a first-hand account and literary work;
physical evidence is limited to confirm some of Thucydides’ accounts, but his writings are
considered to be accurate by modern historians and anthropologists, making them extremely
valuable as a rare account of an Athenian’s experiences during the war. Thucydides describes his
goal in recording the war’s events as creating an accurate account of the Peloponnesian War so
that posterity may learn and avoid repeating the events in order to save them from the near
destruction that Athens and Sparta had suffered. 35 His writings are considerably unique from
most fifth century Greek texts in that he does not discuss divine influence or intervention in
human actions and conflicts; his efforts to present an objective account of historic events are
evident.
Thucydides first mentions the plague in Chapter I of the first book of his history as he
describes extraordinary natural phenomena that began occurring in succession shortly after the
Lacedaemonian invasion of Attica, beginning the second year of the Peloponnesian War; 36 he
writes, “…there were earthquakes of unparalleled extent and violence; eclipses of the sun
occurred with a frequency unrecorded in previous history; there were great droughts in sundry
places and consequent famines, and that most calamitous and awfully fatal visitation, the
plague.” 37 Chapter VII of Book II discusses the plague in great detail, much of which is drawn
from Thucydides’ personal experience, since informs us that he himself contracted the disease
but was able to survive it. The second year of the war began with the invasion of Attica by
34
Kagan, Donald, The Peloponnesian War. New York: Penguin Group, 2004. See Appendix B.
Thucydides.
36
Thucydides, 16.
37
Ibid.
35
24
Archidamus, king of Sparta, and the plague struck soon after for the first time. According to
Thucydides, “Not many days after their arrival in Attica the plague first began to show itself
among the Athenians. It is said that it had broken out in many places previously in the
neighborhood of Lemnos and elsewhere; but a pestilence of such extent and mortality was
nowhere remembered.” 38 According to the writings of Hippocrates, an Athenian doctor who
lived before the plague in Athens, Athenian doctors practiced methods of treating the disease in
its early stages, such as cold baths and herbal remedies to reduce swelling. 39 Unfortunately,
doctors were killed themselves early in the outbreak after visiting and treating the ill, which
contributed to the final death toll and attests to the virulence of the disease; Thucydides does not
specify which treatments were used by physicians to combat the outbreak but describes some
methods used in attempts to relieve the symptoms, such as individuals bathing themselves in
public fountains and drinking from the fountains to reduce their fevers. 40 Like medicinal
practices, offerings of Athenians praying for the Gods to end the plague at the temples were also
futile against the disease (this is Thucydides’ only mention of divinities). 41
It was rumored at the time that the plague originated in Ethiopia and spread through
Egypt and Libya where trade brought the disease to Sparta and the Spartan forces carried the
disease to Athens. However, in considering that the Spartans participated in very little trade
outside of their own empire, it is unlikely that the Spartan forces would have carried the disease
from the African continent. Also disputing this claim is the unlikelihood that the Spartan forces
would not have experienced the death toll that Athens later experiences when they were exposed
to the disease. There is no scientific evidence that Spartan peoples would have developed a
38
Thucydides, 118-119.
39
Hippocrates, "On Ancient Medicine." In Hippocrates on Ancient Medicine (Studies in Ancient Medicine), edited by
Mark J. Schiefsky, Leiden: Brill Academic Publishers, 2005.
40
41
Thucydides, 118.
Ibid.
25
natural immunity to any disease that Athenians would not have also developed. The true origin
of the outbreak remains a mystery at this point. The first occurrence of the disease in Greece was
in Piraeus, where there were claims that the Lacedaemonians had poisoned the water supply. 42
After contracting the disease himself and surviving, Thucydides describes the symptoms
of the plague in great detail according to his own experience and events that he witnessed as a
resident of Athens. In the first week, a plague victim experienced a high fever, red and inflamed
eyes, and a bloody throat or tongue that expelled a “fetid odor.” 43 At the end of the first week
sneezing, a heavy cough, and chest pain manifested; it was after this stage that some victims
recovered, while others continued to suffer, knowing that death was imminent. In the second and
third weeks of infection, vomiting and muscle spasms due to dehydration set in; the skin became
hot to the touch, red, and small pustules or ulcers appeared all over the body. An unbearable
“hotness” motivated victims to remove all of their clothing and submerge themselves in cold
water, as some “plunged into the rain-tanks in their agonies of unquenchable thirst.” 44 In the
third and fourth weeks of infection, victims experienced violent diarrhea and ulceration of the
bowels. It was this stage that caused severe malnutrition and weakness, killing most victims.
Many survivors lost fingers and toes or their eyes, and a small percentage experienced a
complete loss of memory. 45 While the Athenians were unable to identify which disease was
causing such devastation, I will later discuss how modern scientists have classified the plague.
The first breakout of the plague lasted two years (430 BCE-428 BCE), and the second
spanned one winter from 427 BCE to 426 BCE; when Athens was finally free of the disease,
42
Thucydides, 118-119.
Thucydides, 119.
44
Thucydides, 120.
45
Ibid.
43
26
approximately one fourth of the Athens population had been killed and many others disfigured. 46
Due to the war, there had been an influx in city populations, especially Athens, as Greeks fled
the country. 47 Pericles, the ruler of Athens during the Peloponnesian War, convinced Athenian
countrymen to move their families and “moveable property” within the city walls to protect
themselves from invading forces and to protect the city. His political motivation in moving
citizens within the city was to conserve forces in order to reserve resources for the Athenian
naval fleet. Pericles understood that Athens could not defeat the invading Spartan army in land
battles and that Athens’ military strength lied with its naval fleet; Athens had “insufficient
manpower to both man a fleet large enough to maintain the empire and fight the Peloponnesians
on land.” 48 In his essay Thucydides, Pericles, and the Strategy of Defense, Josiah Ober offers a
unique insight into Pericles’ motivation for relocating Athenian citizens: “If the Athenians were
islanders they would be perfectly secure, therefore they should act as if there city were an island
and abandon their land and homes in the countryside.” 49 By protecting the city of Athens and its
harbor, Pericles was able to maintain a steady supply of resources to his citizens and his fleet. 50
Pericles was able to provide his citizens with food and military protection within the Athens
walls, but the overcrowded living conditions of more than three hundred thousand people living
within less than four square miles created favorable conditions for a severe outbreak of infectious
disease. By continuing trade relations in the port city, Pericles unknowingly and continuously
exposed his citizens to new sources of disease that originated in other regions.
46
Thucydides, 209.
Thucydides, 122.
48
Ober, Josiah, The Athenian Revolution: Essays on Ancient Greek Democracy and Political Theory.
Princeton: Princeton University Press, 1996, 74.
49
Ibid.
50
Ober, 76.
47
27
The crowding within the walls of Athens allowed for bacteria to be passed between
individuals very efficiently in bodily fluids and improperly disposed waste, and the
Mediterranean climate of Athens further promoted the growth of bacteria. When water wells
were contaminated by individuals dumping waste into wells or through ground water
contamination, thousands of people were infected. There was a shortage of housing in Athens,
and so the lower class countrymen were forced to live in crowded “cabins” with no protection
from the summer heat, making these individuals especially susceptible to infection. As people
were infected and perished by the thousands, bodies piled up in the poor neighborhoods of the
city and around the public fountains, as victims tried to get water and cool their feverish bodies.
Many perished inside the temples where they lay praying to the gods for salvation from the
disease. 51 Scavenger birds and animals left the dead bodies untouched, and as the number of
dead increased rapidly, Athenians were forced to bury them in shallow mass graves with little
regard for Greek burial tradition; there were simply too many bodies to perform traditional burial
ceremonies. There were even instances of piles of bodies being set fire without any personal
grave markers or ceremony. 52
Burial traditions were not the only Athenian morals abandoned during the plague; many
characteristics of pre-plague Athenian culture evolved as the death toll rose. The growing
mentality that death could be near at any time greatly affected how Athenians conducted their
lives. People spent their money as quickly as possible and indulged in luxuries or activities that
had not been deemed appropriate before the plague arrived. Lawlessness struck Athens, as “…no
one expected to live to be brought to trial for his offenses, but each felt that a far severer sentence
had been already passed upon them all and hung over their heads, and before this fell it was only
51
52
Ibid.
Thucydides, 120, 123.
28
reasonable to enjoy life a little.” 53 Morality was no longer a concern to those violating civil laws
or religious edict in their desperate indulgences “No fear of Gods or law of man deterred a
criminal.” 54 The devastation of the plague even forced Athenian commanders to reconsider their
military decisions against Sparta in the years of the outbreak. Losing so many able bodied men,
“no less than four thousand four hundred heavy infantry in the ranks died of it and three hundred
cavalry, besides a number of the multitude that was never ascertained,” to the disease forced the
Athenian army to add Lesbos’ forces to their fleet, a move that had been avoided before the
plague arrived. 55 In examining the cultural effects of the Athenian plague, it is clear that the shift
of humans living in small, nomadic groups to large, densely populated economic, cultural, and
military centers greatly intensified the devastation caused by infectious disease outbreaks, and
the large geographic regions that were affected.
The mass graves of the Athenian plague period were discovered in and near the modern
city of Athens; the best preserved mass grave was excavated by Greek archaeologist Efi
Baziotopoulou-Valavani in 1994 when it was discovered during the construction of a subway
station. 56 It contained at least one hundred and fifty skeletons that were buried in a rushed and
careless fashion with some traditional burial artifacts such as pots and oil flasks. 57 From the
skeletal remains found in the mass grave, scientists were able to isolate DNA material that could
identify the specific bacterium that caused the plague infection. Manolis Papagrigorakis of the
University of Athens is the leading researcher in the Athenian plague DNA investigation; he has
identified the DNA of typhoid fever bacterium (Salmonella Typhi) in dental pulp samples from
the remains unearthed in the Athens mass graves; the remains were first carbon dated to confirm
53
Thucydides, 123.
Thucydides, 122.
55
Thucydides, 209.
56
See Appendix C.
57
Axarlis, Nicos, Archaeology Archive. 1998. http://archive.archaeology.org/online/news/kerameikos.html.
54
29
that they were in fact from the plague era. 58 Despite some debate among scientists regarding the
accuracy of their determination, Papagrigorakis has successfully supported his identification of
Salmonella Typhi bacterium in the bone tissue of the ancient remains. 59
The usefulness of Thucydides’ description of the symptoms of the plague for identifying
the disease that caused it has been a topic of debate among historians as the best resource for
identifying the specific infectious disease. Since the publication of Papagrigorakis’ DNA results,
many historians and modern epidemiologists have supported his findings based on modern
diagnoses of typhoid fever. Extremely high fever, bloody nose, painful swelling in the abdomen,
sores on the skin, diarrhea, intestinal ulcers and abscesses, and delirium are all currently
recognized symptoms of typhoid fever, all of which are described by Thucydides. 60 Optimum
environmental conditions and climate for the transmission of typhoid fever includes: improper
disposal of feces which then contaminates the water supply (this often occurred in crowded,
ancient cities), high temperatures that promote fly reproduction (flies often transmit bacteria
from fecal matter to livestock or humans), and crowded living conditions where transmission
between humans via bodily fluids would be extremely efficient. 61 All of these conditions existed
in Athens during the first plague outbreak in the summer of 430 BCE, further supporting the
theory that the Athenian plague was typhoid fever.
58
Baziotopoulou-Valavani, Effie, Manolis J. Papagrigorakis, Philippos N. Synodinos, and Christos
Yapijakis, "DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the
Plague of Athens." International Journal of Infectious Diseases 1, no. 10 (2006): 206-14.
59
See Rambaut, Andrew, and Beth Shapiro, "No proof that typhoid caused the Plague of Athens (a reply to
Papagrigorakis et al.)."International Journal of Infectious Diseases 1, no. 10 (2006): 334-40, and aziotopoulouValavani, Effie, Manolis J. Papagrigorakis, Philippos N. Synodinos, and Christos Yapijakis. " Insufficient
phylogenetic analysis may not exclude candidacy of typhoid fever as a probable cause of the Plague of Athens
(reply to Shapiro et al.)." International Journal of Infectious Diseases 1, no. 10 (2006): 335-41.
60
Centers for Disease Control and Prevention. CDC Health Information for International Travel 2014. New
York: Oxford University Press; 2014. http://wwwnc.cdc.gov/travel/page/2014-yellow-book-about.
61
ibid
30
In Conclusion
Examining the origins of infectious disease and environmental factors in how outbreaks
have occurred throughout history gives historians a more complete understanding of how global
changes in human lifestyle have affected the occurrence of plagues. The shift from humans
living in small, nomadic groups to large, densely populated civilizations allowed for the
domestication of vegetables and livestock, a generally more nutritious diet for prehistoric
humans. Living in large civilizations also provided security and leisure time for residents. These
improvements in quality of life and human health led to the evolution of some infectious
bacterium, creating more virulent pathogens that were stronger against human immunities; these
increasingly deadly microbes and increasingly dense human populations caused the level of
devastation caused by disease outbreaks to intensify. With the preservation of Thucydides
account, the Athenian plague is the earliest recorded plague that killed thousands in only four
years and can be documented by physical evidence. Structuring my examination of the Athenian
plague within the framework of the threshold moments of big history, combined with an
interdisciplinary perspective has allowed me to contribute a new discussion of the plague to the
existing scholarship on infectious disease and the ancient Athenian plague.
31
32
Appendix
Appendix A
A diagram of the human inner ear.
Benitez, J.T. "Otopathology of Egyptian mummy Pum II: Final Report." The Journal of Laryngology & Otology.
33
Appendix B
A map of the territories involved in the Peloponnesian War and the war strategies of the
conflict.
Meigs, Peveril. "Some Geographical Factors in the Peloponnesian War." Geographical Review.
34
Appendix C
A photograph of a mass grave in Athens dating to the era of the Athenian plague. The
grave was unearthed during the construction of a subway station.
Holladay, A.J., and J.C.F. Poole. "Thucydides and the Plague of Athens." The Classical Quarterly.
35
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