Plague of Athens—Fungal Poison? Author(s): JANE BELLEMORE, IAN M. PLANT and LYNNE M. CUNNINGHAM Source: Journal of the History of Medicine and Allied Sciences, Vol. 49, No. 4 (OCTOBER 1994), pp. 521-545 Published by: Oxford University Press Stable URL: http://www.jstor.org/stable/24623552 Accessed: 06-09-2017 03:39 UTC

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected].

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at http://about.jstor.org/terms

Oxford University Press is collaborating with JSTOR to digitize, preserve and extend access to Journal of the History of Medicine and Allied Sciences

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms PlaguePlague of Athens—Fungal of Poison?Athens—Fungal Poison?

JANE BELLEMORE, IAN M. PLANT, and LYNNE M. CUNNINGHAM

(N 431 b. c. a war broke out between Athens and Sparta which continued with minor interruptions until Ath ens was defeated in 404 b. c. Sparta and her allies, the Peloponnesians, had land-forces far superior to those of Athens, and with these the Peloponnesians invaded Attica, the territory of Athens, almost every year dur ing the first part of the "." Particularly devastating to Attic life and agriculture were the two invasions of 430 and 427-26. Athens, enclosed by huge walls leading down to the sea, was seem ingly unassailable by land and sheltered within her fortifications almost the whole of the population of Attica during the periods of invasion— hundreds of thousands of people during the summer months in confined conditions. While not daring to meet the invaders by land, Athens did retaliate against the Peloponnesians by sea, since she had a huge fleet and enjoyed at first an unchallenged naval superiority , the democratic leader of Athens, had decided on this policy, that the Athenians not commit themselves to open warfare but use the fact of their huge reserves of money and their naval superiority to outstay the Peloponnesians. For the Athenians to win such a war of attrition, they had to ensure that nothing went wrong, and that they had sufficient reserves of food to feed themselves, since they could not be sure that they would be able to draw any supplies from their own fields, perhaps for some years. , a contemporary of these events, has written in detail about the Peloponnesian War, recording the martial activities of the period, and also giving us a description of other major factors which affected the way the Athenians prosecuted the war. He tells us that a deadly plague reached Athens in the second summer of the Peloponnesian War, in 430 B.C., and that this plague lasted on and off there for four

© 1994 BY THE JOURNAL OF THE HISTORY OF MEDICINE AND ALLIED SCIENCES, INC. ISSN 0022-5045 VOLUME 49 PAGES 521 TO 545

[ 52i ]

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 522 Journal of the History of Medicine : Vol. 49, October 1994

years.1 The most severe attacks of plague occurred in 430 and in 427-26, the years when the farmlands of Attica were almost totally destroyed by the Peloponnesians and when the people of Attica had been forced to rely to a large extent upon imported food. Thucydides has provided a detailed description of many aspects of the Plague, since nothing like it in his experience had been seen before and he was concerned that posterity be forewarned in case it re-appeared, but there has been no record of a plague of such a kind appearing again in the ancient or modern world. Other plagues did occur, but none quite like that of the great Plague of Athens.2 The accuracy of Thucydides' description of the Plague has been gen erally accepted without question, since he himself suffered from this disease and he is esteemed highly as a "scientific observer. "3 Let us review the specific symptoms of the disease as given in his work, The Pelopon nesian War 2.48.3-49.8:4

48.3 Each person, whether or not he is a doctor, may state what he knows about the probable origin of the plague and the reasons he believes were sufficient for such a great disturbance of nature. But I will state what it was actually like and describe its symptoms. Knowledge of these will enable it to be recognized if it should ever break out again. I had the disease myself and also saw other people suffering from it. 49. i It is generally agreed that the year was, as it happened, especially free of other kinds of illness. But if anyone was already ill in some way, in every case it turned into this disease. 49.2 In other cases, however, there were no early clinical symptoms;5 but sud denly, first of all, an intense heat of the head and both redness and burning of the eyes seized perfectly healthy people. The insides of the mouth, both throat and tongue, were bloody and emitted an abnormal and foul-smelling breath. 1. See, e.g., Thucydides, The History of the Peloponnesian War, trans. I. Scott-Kilvert (Har mondsworth and Baltimore: Penguin, 1970). 2. E. Lieber, "Galen on contaminated cereals as a cause of ," Bull. Hist. Med., 1970, 44, 332-45; R. J. Littman, "The plague at Syracuse: 396 b.c.," Mnemosyne, 1984, 57, 110-16; M. Gwynne-Morgan, "Politics, religion and the games in Rome, 200-150 B.c.," Philologus, 1990, 134, 14-36. On Thucydides as a model for historians, seej. Longrigg, ", ideas and classical Athenian society," in Epidemics and Ideas, ed. T. Ranger and P. Slack (Cambridge: Cambridge University Press, 1992), pp. 21-44, p. 27. 3. Some reservations have been expressed about the accuracy of his reporting. See Longrigg, (n. 2), pp. 27-28, 32-33. 4. Translation by I. M. Plant. 5. "No early clinical symptoms" is the phrase we have used to translate "prophasis." For this understanding of prophasis, the first appearance or precipitant of an illness, see H. R. Rawlings III, A Semantic Study of prophasis to 400 B. C. (Wiesbaden: Franz Steiner, 1975), pp. 74-75; also F. Robert, "Prophasis," Revue des Etudes Grecques, 1976, 8g, 317-42, p. 333, who translates "prophasis" as "phase préparetoire."

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 523

49.3 Next there was a development from these symptoms to sneezing and hoarseness. Before long the trouble descended to the chest accompanied by coughing. Whenever it settled in the stomach it upset it, and there ensued the vomiting of every kind of bile named by physicians, along with a great deal of pain and discomfort. 49.4 In most cases there were bouts of dry retching which produced severe spasms. In some cases this was soon after the abatement of the previous symptoms, but in other cases it was much later still. 49.5 On the outside, the body was not unduly hot to the touch nor pale, but reddish and purple, and there were tiny blisters and open sores scattered upon it. But their insides burnt so much that the patients could not endure contact with anything, even the lightest clothing or linen sheets, and preferred to be naked. Most of all they wanted to throw themselves into cold water . . . constrained by a thirst which could not be quenched. It made no difference whether they drank much or little. 49.6 An inability to rest quietly and to sleep affected them without respite. During the period when the disease was at its height, the body was not wasted, but, surprisingly, resisted the distress. So people died with some strength left (most on the ninth or seventh days, from the internal heat). If they survived this, most died later from weakness because the disease descended to the bowels where there was severe ulceration along with uniformly fluid diarrhoea. 49.7 For the evil thing, which first settled in the head, proceeded down through the whole body, attacking the extremities of anyone who got over the worst and leaving its mark.6 49.8 It attacked the genitals, fingers and toes. Many people survived because they lost these parts of the body, though some also lost their eyes. Additionally, some suffered a total loss of memory temporarily,7 when they recovered, failing to remember not only their close friends, but also who they actually were themselves.

In modern times the reported virulence of the Athenian Plague has been matched by the liveliness of the debate engendered by Thucydides' de scription of the symptoms, but arguments over the identification of the disease have now raged virtually to a standstill. The generally accepted position amongst ancient historians is that the Athenian Plague was

6. Thucydides describes the "descent" of the disease through the body. He seems to have thought of the disease as likely to move in a logical pattern. 7. We have translated to nafxnrriKCt as "temporarily," as does R. Sallares, The Ecology of the World (New York: Cornell University Press, 1991), p. 264, not as "immediately," as, say, the revised Loeb translation by C. F. Smith does ("subito," cf. F. Ferrari, Laguerra del Peloponneso (Milano: Rizolli, 1985), ad loc.). We should note that Thucydides, at any rate, did not suffer from a permanent loss of memory! For translation and notes on the medical vocabulary, see D. L. Page, "Thucydides' description of the Great Plague of Athens," Classical Quarterly, 1953, 3, 97-119.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 524 Journal of the History of Medicine : Vol. 49, October 1994 caused by a pathogen which has long since ceased to exist or exists in a form which is no longer readily recognizable.8 This has not prevented new theories being proposed, but none has yet provided a satisfactory explanation of all the features of the Plague as described by Thucydides.9 The following major diseases have been seriously considered as possi ble etiologies. Let us review briefly the reasons why some of the more likely causes have been discredited. —The bubo is the main clinical manifestation of bubonic plague. This salient feature is not mentioned by Thucydides, and this fact alone makes bubonic plague an unlikely cause of the Athenian Plague.10 In addition, the course and timing of the disease differ from those de scribed by Thucydides. —There is a poor correlation between the features of smallpox and those of the Athenian Plague, the main one being that small pox rarely causes gangrene of the extremities.11 As pointed out by Kobert, smallpox would have to be complicated with some other disease, such as ergotism, to account for most of the features described by Thucydides.12 —rickettsia prowazeki and mooseri (epidemic and endemic forms, respectively)—The popularity of typhus has relied upon the fact that it can produce gangrene in the extremities. In general terms, this disease is a poor fit with the description of the Plague.13 Typhoid —Like typhus, it is a poor fit in overall symptoms, and it requires a contaminated source, usually a common water-supply, for its dissemination.14

8. On whether an infectious disease can be identified at this distance, see, e.g., W. H. McNeill, Plagues and People (New York: Anchor Books, Doubleday, 1976), pp. 54-55; J.C.F. Poole and A.J. Holladay, "Thucydides and the Plague of Athens," Classical Quarterly, 1979, 29, 282-300, pp. 282-86; but cf. Sallares, (n. 7) The Ecology of the Ancient Creek World, pp. 244-45. The question of whether or not the Plague of Athens was unique has been raised by Littman, (n. 2), pp. 110-14. 9. Rift Valley fever (cf. A. J. Holladay, "New developments in the problem of the Athenian Plague," Classical Quarterly, 1988, 38, 247-50, p. 250) and Marburg- Fever (G. D. Scarrow, "The Athenian plague: a possible diagnosis," Bulletin, 1988, 2, 4-7) have been recently proposed as possible causes. Neither disease causes gangrene of the extremities, and there are a number of other features of these lesser known diseases which do not correlate with the disease as described by Thucydides. 10. Poole and Holladay, (n. 8), pp. 287-89; Sallares, (n. 7) The Ecology of the Ancient Greek World, pp. 247, 265-71. For a description of Bubonic Plague in the ancient world, see Procopius, History of the Wars, 2.22, where buboes are a significant feature. 11. Sallares, (n. 7) The Ecology of the Ancient Greek World, pp. 247 ff. 12. R. Robert, "Ueber die Pest des Thukydides,"J

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms BeUemore et al. : Plague of Athens 525 and Scarlet Fever—There is very little correlation between these diseases as recognized today and the disease outlined by Thucydides.15 Anthrax—Again, one of its main diagnostic features, the black scar, is not noted by Thucydides, and it would seem in any case that it was a disease recognized in antiquity.16 Influenza—Influenza complicated by a toxin-producing strain of non invasive staphylococcus combined with bullous impetigo has been re cently proposed and subsequently discredited, mainly on the grounds that such a combination of diseases is not likely to occur in epidemic form.17 It is impossible to state categorically that the Plague of Athens was not caused by an earlier form of any one of the above diseases. Instead of pursuing this line of inquiry, however, we shall return to an idea that was suggested first late last century as a partial solution to the problem. Rudolf Kobert, like many others, felt that an infectious disease was actually responsible for the Plague, but, since he could not match all the symptoms reported by Thucydides, particularly the reports that many Athenians lost their extremities, he suggested that the Athenians might also have been experiencing ergot poisoning.18 Robert's solution has been criticized for a number of reasons,19 but a major problem with the theory of ergot-poisoning is that the fungus responsible for this disease is found mainly on rye which the Athenians did not eat.20 We should like to propose, however, that the Athenians may have been suffering a simi larly fungus-induced disease, Alimentary Toxic Aleukia (ATA), which they could have developed from eating contaminated wheat. This is a stance we can defend on two main grounds. First, there is a close match between the symptoms of the Plague of Athens and those of ATA, which should surely be the main criterion in any attempt to identify the disease causing the Plague. We feel that the correlation in symptoms between the Plague and ATA impels us to look more critically

15- Poole and Holladay, (n. 8), pp. 289-91; see also Sallares, (n. 7) The Ecology of the Ancient Greek World, p. 247. Sallares also suggests that scarlet fever was known in ancient , since diseases similar to it, caused by group A streptococci, are well attested in the Hippocratic corpus. 16. Ibid., pp. 287-88. 17. A. D. Langmuir, T. D. Worthen, J. Solomon, C. G. Ray, andE. Peterson, "The Thucydides' syndrome," N. Engl.J. Med., 1985,313,1027-30. On the unlikelihood of this solution, see Sallares, (n. 7) The Ecology of the Ancient Creek World, pp. 244-45; Holladay, (n. 9), pp. 247-49. 18. Kobert, (n. 12), pp. 289-99. 19. Poole and Holladay, (n. 8), pp. 292-94. 20. N. Jasny, "Competitions among grains in classical antiquity," Am. Hist. Rev., 1941-42, 47, 747-64. Cf. P. Sal way and W. Dell, "Plague at Athens," Greece and Rome, 1955,2, 62-70, where it is stated that the Athenians may have had access to Thracian rye.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 5 26 Journal of the History of Medicine : Vol. 49, October 1994 at the context and meaning of Thucydides' account where it seems to suggest that an infectious disease was responsible for the Plague. Secondly, there is an unusual feature of the Plague which cannot be explained on the assumption that it was a contagious disease: that it struck the upper classes out of all proportion to the overall numbers of people in Athens. Thucydides tells us that approximately 30 percent of all the men comprising the heavy infantry and cavalry died, men who were drawn exclusively from the upper classes.21 Figures given elsewhere for the total number of people who died suggest that a maximum of only 5 percent of the rest of the population died. This discrepancy can readily be explained by assuming that ATA was responsible for the Plague, because only the rich of Athens could afford to eat wheat. In this paper we shall open and close with Thucydides. In the first place, we shall establish a modus operandi for dealing with the text of Thucydides, one which allows us to question the impression that Thucydides gives that the Plague of Athens was a contagious disease. This will open the way for our identification of the Plague as a disease caused by fungal poisoning. Then we shall compare and contrast the symptoms of the Plague of Athens with those of ATA. Having dem onstrated that ATA, in terms of its medical description, could have been the cause of the Plague, we shall establish a link between the geographical areas most often subject to outbreaks of ATA and Attica, and we shall suggest the precise mechanism through which the Athenians contracted this disease. In conclusion, we shall return once again to Thucydides to deal with some further problems of interpretation and to suggest possible explanations for his possible misunderstanding of the information at his disposal. thucydides' account of the plague

Thucydides is the only first-hand source we have for the Plague.22 He suffered it himself, as he tells us, and also observed those around him who were affected (2.48.3). He is therefore a very useful eyewitness, but his account of the Plague raises some problems. In the first place, if he

21. 4,4°°°f the former and 300 of the latter (Thucydides 3.87); cf. S. Hornblower, A Commentary on Thucydides (Oxford: Clarendon Press, 1991), ad loc. There were approximately 13,000 heavy armed infantry and 1,200 cavalry (with 16,000 reserve infantry) in Attica (Thucydides 2.13). Plutarch, Pericles 37.4 verifies these claims. Although Thucydides writes that he has no idea how many of the other classes were affected, Diodorus Siculus 12.58.2 gives the figures: approximate ly 10,000. 22. It is surprising that it is not mentioned by other contemporaries of this period. See Longrigg, (n. 2), p. 28.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 527 relied heavily on his own case-history for his description of the Plague, we cannot be sure how typical his own case was nor how extensive his information about other cases may have been. Secondly, he claims to have selected which symptoms to recount and he stresses that he has not given all the symptoms (2.51.1).23 Thus, his is a subjective interpretation of the worth of the medical evidence at his disposal, and he may have omitted crucial information. In addition, his acquaintance with Hippo cratic medical theory may have colored his account, leading him, for example, to give weight to incidental factors, such as the weather condi tions of the year (2.49.1), and, more importantly, to search for the "com mon nature" of the disease. The latter perhaps prompted him to find set days for the time of crisis of the Plague (2.49.6), as in similar accounts in the Hippocratic corpus.24 The apparent time of crisis, "on the ninth or seventh days," is not in fact the only crisis, since he records that there were also later periods of danger (2.49.6), but he does not specify the timing of the periods involved. Thucydides' subjective assessment of the course of the disease is, how ever, not the worst of our problems.25 The account of the Plague has a larger thematic purpose within Thucydides' account of the Peloponne sian War, serving as a paradigm for the overall suffering brought about by the war and illustrating the sharp decline in behavioral standards which the war heralded for the Greek world.26 Thucydides concludes his account of the events of 430 b.c. (the year in which the Plague first struck) with a passage that looks ahead to the end of the war in 404 B. c.27 He complains that, despite all the advantages that the Spartans held, Athens could have been successful if it had not utterly destroyed itself by its citizens turning on each other. Thucydides sees the seeds of Athens' self-destruction planted at the time of the Plague, and he has clearly subordinated narrative details to the broader moral perspective. The Plague thus serves as a lesson in the

23. Sallares, (n. 7) The Ecology of the Ancient Greek World, p. 246. For Thucydides as a prejudiced writer, see E. Badian, From Plataea to Potidaea (Baltimore: Johns Hopkins, 1993), Chapter 4. 24. Hornblower, (n. 21) A Commentary on Thucydides, pp. 316-19; cf. Sallares, (n. 7) TheEcology of the Ancient Greek World, pp. 245-46. 25. A similar instance of Thucydides' subjectivity can be found in his claim from 2.49.8, that some people survived because they lost their extremities. 26. See J. Bellemore and I. M. Plant, "Thucydides, rhetoric and plague in Athens," Athenaeum, 1994, 72, i—17; F. Dupont, "Pestes d'hier, pestes d'aujourd'hui," Histoire Economie et Société 1984, 3, 511-24, pp. 519-24; Longrigg, (n. 2), pp. 37-40. 27. See 2.65.12. Consider also his similar treatment of the same moral and ethical issues in the account of revolution at Coreyra in 3.82-85.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 528 Journal of the History of Medicine : Vol. 49, October 1994 way that civic responsibility disintegrated in the face of disaster and how, in the end, a city like Athens, without morals, could not stand. We must, therefore, be careful not to accept uncritically the impression that Thu cydides conveys of the virulence of the Plague and its devastating effect upon the population of Athens. While not usually prone to excessive exaggeration, Thucydides wants his reader to believe that the Peloponnesian War was the greatest war of all, since this would justify the time and effort he has put into recounting it (1.21.2). He "proves" the greatness of the war, not just by the military and political actions and casualties of the war, but also by the number of disasters that occurred. The Greek world during this war, he claims, experienced worse earthquakes and more frequent eclipses of the sun than ever before, terrible droughts, famines, and also the great Plague of Athens (1.23).28 The Plague is thus one of a string of "worst-ever" disasters which make Thucydides' war the greatest of all. This special pleading to justify his work in the eyes of his readers reminds us that Thucydides is not a modern historian, and that his editing of material, including selection, arrangement, and emphasis, has an important cre ative element attached to it, making it perhaps more akin to modern historical fiction than to history.29 Other thematic problems are in evidence. Thucydides has embedded his report of the precise symptoms of the Plague within a description and analysis of its immediate moral, religious, and political effects upon the Athenian populace. In the wider context of Book Two, he seems to have arranged with careful deliberation the material surrounding the descrip tion of the Plague. He depicts first the "Funeral Oration" delivered by Pericles (2.35-46), then follows the description of the Plague (2.47-54), and he concludes with a morale-boosting speech, again by Pericles. These three passages form striking contrasts: the first, the "Funeral Oration," highlighting the idealized, civilized behavior of the Athenians; the Plague, underlining the total abandonment of all standards of civilized behavior; and lastly, the speech of Pericles, giving the Athenians the will to continue. These reveal an Athens at its best, at its worst, and at its most practical.30

28. 1.23.3, with i.i, 1.3. See A. J. Woodman, Rhetoric in Classical Historiography (London: Croom Helm, 1988), pp. 32-40. 29. On the difference between Thucydides the reporter and Thucydides the editor, see V. J. Hunter, Thucydides the Artful Reporter (Toronto: Hakkert, 1973), passim. 30. See especially 2.53 and 2.37, 40-41; cf. Thucydides, The Peloponnesian War, Book II, ed. J. S. Rüsten (Cambridge and New York: Cambridge University Press, 1988), pp. 152-61, 179;

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 529 For these reasons, many aspects of Thucydides' account must be treated first and foremost as literature, a product of his notions of what was demanded of his artistic skill. What he says is not always to be considered in the nature of a scientific or medical report. The actual symptoms of the Plague described by Thucydides must be freed from their literary context. Rhetorical narrative designed to convey an "artist's impression" of the Plague must not be confused with genuine, medical observations.31 Scholars still persist in using details from the broader narrative sur rounding the list of symptoms as if they also were observations of the same, relatively objective kind. This is clearly not the case. They are rhetorical efforts designed to create an atmosphere of suffering and the breakdown of society, and so are not admissible as historical evidence. The methodological principle, of separating the creative from the factual, is not difficult to put into practice. Thucydides has clearly marked off the description of the symptoms of the Plague from his more "impres sionistic" material. He in fact pointedly invites the reader to try to identify the disease (2.48.3-49.8). It is this material alone, divorced from the larger perspective, that should form the basis of any attempt to identify the Plague. Let us examine some examples of the way that the literary craft of Thucydides has misled the uncritical reader. One example of this type arises in 2.50.1-2, where he records a significant difference between his disease and any other: "For all the birds and four-footed animals that eat human flesh, although there were many bodies lying around unburied, either kept away from them or died after tasting them." This statement has been taken as important evidence of the nature of the Athenian Plague: that it must have been common to both animals and humans.32 The ancient writers, however, believed a priori that diseases affected both human and animal alike. Moreover, the literary association of animals and humans suffering alike from the same disease had an influential

Thucydides, A History of the Peloponnesian War, Book 2, ed. P. J. Rhodes (Warminster: Aris and Phillips, 1988), ad 48.1-2; Longrigg, (n. 2), pp. 32-33. 31. This technique of separating genuine medical observations from fictional elements has been applied by other medical historians to ancient texts. See, e.g., J. R. Pinault, "How cured the Plague," J. Hist. Med. Allied Sei., 1986, 41, 52-75, pp. 65-66. 32. As evidenced in Aristotle HA 604b 25-27; Heracleitus, Questiones Homericae XIV, p. 2, well discussed by Sallares, (n. 7) The Ecology of the Ancient Greek World, p. 289 and n. 407, n. 408. Diseases shared by human and animal are not usually spread through consumption of diseased flesh, although poisons can be passed on through the food chain. See Holladay, (n. 9), pp. 247-50.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 530 Journal of the History of Medicine : Vol. 49, October 1994 precursor. Thucydides' reference to the Plague striking animals is a liter ary allusion made to augment the horror of the Athenians' suffering, inviting comparison with the plague recorded by Homer.33 As such, it should not be used as evidence for the nature of the Plague.34 We must view in the same light Thucydides' similarly broad generali zations about the effects of the Plague on various groups of people. He states that no one died of the disease if he caught it a second time (2. $ 1.6). Does this prove that some people acquired immunity? He claims also a high mortality-rate among doctors (2.47.4) and among those who cared for the sick (2. $ 1.4-5). Does this prove contagion? If taken at face-value, these details seem to provide evidence that the Plague was a highly infectious disease, since its transmission was easy and some people ac quired immunity.35 Yet there was no way that Thucydides could have gathered statistically significant information on which groups suffered most from the Plague and which groups survived. No such numbers were recorded in Athens in the fifth century b.c.36 He gives no specific examples in support of his claims, and we must suppose that he has based his evidence on just a few examples. His rhetorical purpose, however, is clear: to note the moral condition of those who survived the Plague, since these acted as if they would live forever, and to record that no single group in the community, however good or useful, was immune from this disease. Modern assumptions about the contagious nature of the Athenian Plague have been derived from generalizations of such a kind about various groups in Athens, including animals, which cannot and never could have been based on any statistical information, nor which arose from Thucydides' superior understanding of the type of illness attacking Athens. Let us consider further what Thucydides himself actually states about the contagious aspects of the Plague.

Previously it [the plague] had broken out in many other places too, so the stories go, including around Lemnos and other places, but no one anywhere remembered a plague of the virulence of this one nor one so destructive of the human life (2.47.3). [Emphasis added.] It [the plague] originated, so the stories go, in in Upper , and

33- Inthe Iliad, dogs and mules are affected by plague as well as humans (1.43-54). See Woodman, (n. 28) Rhetoric in Classical Historiography, pp. 32, 38. 34. See Sallares, (n. 7) The Ecology of the Ancient Greek World, pp. 288-90. 35. Cf. Hornblower, (n. 21) A Commentary on Thucydides, ad loc. 36. There were public records made of citizens and foreign residents for legal, military, and taxation purposes, but there were none which could support these broad claims of Thucydides.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 531 then moved down into Egypt and and most of the territory of the King of Persia (2.48.1). [Emphasis added.]

These records of contemporary rumors have been used to argue that the Plague had spread widely around the Mediterranean; yet they are re ported only as hearsay.37 Thucydides was not sure enough of his informa tion to present it as fact, as was his usual practice. Indeed, he seems almost deliberately disdainful of the stories of the origin and cause of the disease, and he refuses to be drawn into the debate (2.48.3): "Each person . . . may state what he knows about the probable origin of the plague and the reasons he believes were sufficient for such a great disturbance of nature. But I will state what it was actually like and describe its symptoms." He distances himself from these stories, which should put us on our guard against treating this information as proof that the Athenian Plague was widespread and thus highly contagious. Incidentally, Thucydides notes that the Athenian Plague was reputedly substantially different from the plague around Lemnos. No one, he says, could remember a plague as virulent as the Athenian one. Such comments cannot be used to estab lish the contagious nature of the Plague, since they are based only on the recollections of unnamed sources, which in any case are stressing the difference between other plagues and the Athenian one. These sentiments again serve a literary function—to enhance the im portance of the Plague. Thucydides uses them in two ways: to suggest that a huge area might have been affected by plague; and to claim that the Athenian Plague must have been greater still than any other outbreak. He has simply linked reports of different plagues for comparative pur poses, using mere hearsay for its rhetorical effect, to "prove" the greatness of the Plague of Athens.38 Let us look now at further specifics concerning contagion. In 2.51 Thucydides records local instances of contagion, but in this section of his account his rhetorical skills are to the fore, and we cannot be sure of the accuracy of any of the claims he makes. He deliberately juxtaposes con

37- See Dupont, (n. 26), pp. 519-24; but cf. Sallares, (n. 7) The Ecology of the Ancient Greek World, p. 253, who thinks we ought to accept Thucydides, but he does not substantiate this position. 38. Cf. 1.23.3, with 1.1, 1.3. Woodman, (n. 28) Rhetoric in Classical Historiography, pp. 32-40; and Hornblower, (n. 21) A Commentary on Thucydides, ad loc. ". . . the claim is huge and perhaps doubtful." On 2.54.5 and late sources for the Plague outside Attica, see Bellemore and Plant, (n. 26), n. 19. On the autochthonos origin, see Diodorus 12.58.1-5 cf. 12.45.2; also Plutarch, Pericles 3 4.4 cf. 35.3, 38.1-2. For a comparable analysis of the account of an animal plague in Virgil's Georgics 3.474-566, see L. P. Wilkinson, The Georgics of Virgil (Cambridge: Cambridge University Press, 1969), pp. 206-07.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 532 Journal of the History of Medicine : Vol. 4g, October 1994 trary and at times mutually exclusive images to create a grim picture of suffering: that the strong succumbed as easily as the weak; that no matter how a patient was treated, he died; that people nursed the sick, yet that people generally were afraid to nurse the sick; that there was no recog nized method of treating the sick, doctors were helpless and all human skills were to no avail (cf. 2.47.4),39but some were helped and treatments did work in particular cases. Thucydides claims that what caused most deaths was in fact fear of contagion, which led the victim to depression, self-neglect, and death (2.51.4), rather than that the disease itself was responsible for the deaths. Does he mean then that the Plague was not really very virulent and that people could have survived if they had had the correct mental attitude?40 The Athenians were clearly afraid of catching the Plague from the sick, as the Peloponnesians were afraid of catching it from the Athenians, but, because many believed that the Plague was contagious, does this constitute proof of contagion? Many of Thucydides' assertions are demonstrably exaggerations, for the Athenians continued to rule their empire and to pursue the war with the Peloponnesians vigorously. The pessimistic views given within the dramatic context of the description of the Plague are clearly contradicted by Thucydides' own later narrative, from 2.54 onwards. So, points derived from the "general picture" of the disease should not be seized upon as facts.41 His description of the transmission of the Plague is obviously not based on any real understanding of the nature of disease, nor did he have public or private records at his disposal upon which to base his claims of the effects of the Plague on different groups within Athenian society. A case for the Plague being a contagious disease, based on passages such as these, cannot be substantiated. Thucydides has clearly revealed the fictional elements of the picture he has drawn of the state of affairs in Athens by means of his description of what actually did happen (2.54 ff.). The way in which he has dealt with this part of his account inspires confidence in the factual nature of the evidence. He presents the symptoms of the Plague in an almost

39- See A. W. Gomme, A Historical Commentary on Thucydides, 5 vols. (Oxford: Clarendon Press, 1945-81), ad 2.47.3 (T° Trponov.). 40. Note also that Thucydides claims both that most people who caught the Plague died (oi TrXeiOTOi 2.49.6), and that many survived (iroKkoi 2.49.8). Again he wishes to exaggerate the effects of the Plague. 41. Thucydides, History of the Peloponnesian War, trans. R. Warner (Harmondsworth: Penguin, 1954), 2.50.1.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Belïemore et al. : Plague of Athens $33

"medical" fashion, quite different from the rhetorical lines adopted else where (2.49.2-8).42 This, and this alone, forms the basis of our diagnosis of the Plague.

ALIMENTARY TOXIC ALEUKIA (ATA)

As already indicated, our thesis is that the Plague of Athens may well have been the result of the ingestion of fungus-contaminated wheat. The Athenians ate barley and wheat, much of the latter imported.43 It is possible that this wheat may have been contaminated by a fungal myco toxin from the Fusarium genus of the sub-genus Sporotrichella. Its po tentially fatal mycotoxins are termed T-2 toxins (a naturally occurring form of trichothecene mycotoxins).44 The disease resulting from the ingestion of wheat contaminated by T-2 toxins is called Alimentary Toxic Aleukia (ATA).45

Description of The Plague of Russia46

Large areas of Russia/U. S. S. R. for many years have been subject to inter mittent outbreaks of an unusual disease. Recordings of the symptoms of this plague began only last century but it would seem that the plague had long been found in Russia.47 In some areas in the 1930s, the disease reached almost epidemic proportions, and it was thought at first, by virtue of the huge numbers affected, that the outbreak was a highly infectious disease, perhaps diphtheria or cholera. In the 1940s almost the whole of the U.S.S.R. was affected, from the Ukraine, through central European Russia, Central Asia, to far Eastern Siberia. Mortality peaked in the period 1942-44, years of extreme privation, when whole families or even entire villages were wiped out, particularly in agricultural areas.

42. Cf. C. N. Cochrane, Thucydides and the Science of History (Oxford: Oxford University Press, 1929), passim. This is not to say that the language of the description of the Plague is regarded as "scientific," as A. Parry, "The language of Thucydides' description of the Plague," Bulletin of the Institute of Classical Studies, 1969, 16, 106-18. 43. Jasny, (n. 20), pp. 751-52, 755, 758; P. Garnsey, Famine and Food Supply in the Graeco-Roman World (Cambridge: Cambridge University Press, 1988), pp. 116-17. 44. M. J. Ellenhorn and D. G. Barceloux, Medical Toxicology: Diagnosis and Treatment of Human Poisoning (New York: Elsevier, 1988), pp. 1312-14. 45. Ibid., p. 1312. 46. See A. Z. Joffe, "Fusarium Poae and Fusarium Sporotrichioides as principal causal agents of alimentary toxic aleukia," in Mycotoxic Fungi, Mycotoxins, Mycotoxicosis, 5 vols., ed. T. D. Wylieand L. G. Moorehouse (New York: M. Dekker, 1978), III, 21-108. 47. It has been suggested that ATA has been recorded by chroniclers of the fifteenth century; cf. J. T. Alexander, Bubonic Plague in Early Modem Russia (Baltimore: Johns Hopkins University Press, 1980), pp. 15-16.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 534 Journal of the History of Medicine : Vol. 4g, October 1994

Mortality rates reached levels of 60 percent in some areas. In 1948 and later, when food supplies were abundant, the disease was absent. This disease did not conform to the usual pattern shown by , since it was largely confined within particular geographical limits and usually affected only agricultural areas. Detailed study eliminated the hypothesis that the Russian disease was of infectious origin, and defi ciencies in diet were then advanced as a possible source of this disease; yet, although patients exhibited vitamin deficiencies, it was soon seen that their diets were not necessarily lacking essentials.48 Eventually the data on diet showed that the people affected by the disease had eaten grain (or grain-products) which had been left over winter in the fields, then later collected for consumption. The grain had been covered by snow during the winter, and, because of rather unusual climatic and ecological conditions, alternating thaws and frosts and par ticular soil conditions, it had been contaminated by toxic fungi. It was only when food was scarce that the peasants had to scavenge grain from the fields in this way.49 The consumption of overwintered grains, how ever, in many years did not lead to problems, since the climatic and ecological conditions had not always been conducive to widespread de velopment of toxin-producing fungi.50 It has been found that wheat and, to a lesser extent, barley are likely to be affected by toxic fungi of the Fusarium genus. The fungal toxins do not invade the grain from the outside, but are produced within the embryo; then the mycelium infuses the whole grain. The fungus is there fore, unlike ergot, not visible to the naked eye. High levels of toxicity can persist in stored grain for up to seven years. Normal methods of milling and cooking usually have no effect on the toxicity of infected cereals.51 Grains contaminated by these toxins, although less likely to germinate, tend to be lighter than other grains and more powdery, and are probably easier to grind than others and may contaminate flour all the more easily. There is often a time-lag from the point of consumption of the grain to the development of symptoms—usually two to three weeks. This hiatus may mask the connecting link between the poison and its effects. Death usually occurs some six to eight weeks after consumption, depend

48. Joffe, (n. 46), pp. 21-25. 49. Ibid., pp. 41-45. 50. Ibid., p. 51. 51. Ibid., pp. 45-49. See also M. K. Matossian, Poisons of the Past: Molds, Epidemics and History (New Haven: Yale University Press, 1989), p. 17.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 535 ing on the amount of toxic grain consumed and its toxicity. Individuals can respond differently to the toxin, and a poor nutritional status can make the victim more susceptible.52

Clinical Symptoms of ATA

In studies of epidemics of ATA in the U.S.S.R., it has been shown that there may be immunosuppression and severe bone marrow depression in its victims, and these lead to hemorrhage and opportunistic infections. Symptoms may be very like those of radiation sickness.53 The clinical features of the disease have been divided into four stages:54 Stage One — The first stage may pass without being noticed, but in serious cases the symptoms usually last from three to nine days. After ingestion of the toxin, the mouth and gastrointestinal tract of the patient are affected; there is a burning sensation and the tongue feels stiff and swollen. After a few days, there is inflammation of the gastrointestinal tract, which leads to vomiting, diarrhoea, and abdominal pain. The pa tient may experience excessive salivation, , dizziness, weakness, and fatigue, as well as fleeting pains in the back and joints. The temper ature usually remains normal or there may be a low grade fever.55 There may be a complete recovery at this stage, or, if there is a further accumu lation of the toxin, the disease may progress to the second stage. Stage Two — This is a latent stage of two to four weeks when the patient feels relatively well, although he may experience mild-to-serious , palpitations, vertigo, and fatigue. During this period there may be bone marrow suppression with leukopenia. The appearance of petechiae on the body indicates progression of the disease to Stage Three. Stage Three — By this stage, the patient will usually have a lowered resistance, and, as Stage Three evolves, there is further damage to the hematopoietic and reticuloendothelial systems, (a) The petechiae and larger hemorrhages on the skin extend to cover the trunk and limbs and involve the head and neck in severe cases. These spread with minimal trauma. Pustules and skin eruptions often occur.56 (b) There is bleeding

52. Joffe, (n. 46), pp. 25-26. Ellenhorn and Barceloux, (n. 44) Medical Toxicology, pp. 1312-14, have noted that, in a more recent example of ATA in action, a victim died within two weeks of the ostensible onset of the disease. 53. Since T-2 toxin (trichothecene) is easily absorbed orally, and trichothecenes art to inhibit protein synthesis, particularly in eukaryotic cells; cf. Ellenhorn and Barceloux, (n. 44) Medical Toxicology, pp. 1312-14. 54. Ibid. 55. Matossian, (n. 51) Poisons of the Past, pp. 16-17. 56. Ibid.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 536 Journal of the History of Medicine : Vol. 49, October 1994 and subsequently necrosis in the mucous membranes of the mouth, nasal passages, gastrointestinal tract, and lungs. Areas of necrosis may also develop in the extremities and orbits, (c) Secondary bacterial of the mouth results in severe halitosis, (d) Regional lymphadenopathy is often present and may be marked in the cervical region, (e) The central nervous system is often affected. The patient suffers delirium, stupor, convulsions, depression, and disorientation. There may also be involve ment of the autonomic nervous system, (f) Further complications in clude a generalized hemorrhagic diathesis and sepsis from opportunistic infections. Involvement of the pharynx and larynx is prominent, and death often occurs from obstruction to the upper airway, from ulcerative pharyngitis, laryngeal edema, or laryngeal compression secondary to cervical lymphadenopathy. Other well recognized pulmonary complica tions include: bronchopneumonia, lung abscesses, and hemorrhage. Death may occur at this stage, or there may be progression in some cases to Stage Four, a period of recovery. Stage Four — Recovery may take place over a period of some months, when bone marrow recovery occurs first with an improvement in white cell count. Complete recovery is possible, but some patients may be sus ceptible to recurrence, particularly if toxic grain is eaten again. Animals are also affected by ATA, sometimes reproducing those symptoms seen in man, sometimes differing, but similarly being affected in direct proportion to the amount of toxic grain consumed.57

COMPARISON OF THE PLAGUE OF ATHENS WITH ATA

A direct comparison can now be made between the symptoms of the Plague of Athens and those found with ATA. It produces many similarities: Stages One and Two — Thucydides records, on two separate occasions, that there were some people who developed the Plague after suffering what seemed to him to be other illnesses (2.49.1-2, 2.51). These people allegedly exhibited a variety of symptoms of uncertain duration before developing the Plague in its more recognized forms. Patients may show

57- Joffe, (n. 46), pp. 65-69. We shall not pursue the effect of ATA on animals, although this is a feature of the Thucydidean description. As we have noted, we feel that Thucydides has included animals for literary purposes. He wants the reader to get the impression that the Plague lashed out blindly in all directions, encompassing both the good and the bad in Athens, and mowing down even animals. Animals, however, even now, often suffer the effects of ATA when their fodder has been contaminated. See, e.g., W. B. Buck and L.-M. Cote, "TricotheceneMycotoxins in Toxicology of Plants and Fungal Compounds," in Handbook of Natural Toxins, 9 vols., ed. R. F. Keeler and A. T. Tu (New York, Basel: M. Dekker, 1991), III, 523-55.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 537 minor symptoms during Stage Two of ATA, which is a latent period lasting two to four weeks. Thucydides notes that there were differential rates of the development of the symptoms of the Plague (2.49.2), since he mentions, on the one hand, that some patients developed severe symptoms of the Plague seemingly with no warning, but, on the other hand, that others had experienced minor symptoms previously. The account of Thucydides is consistent with Stages One and Two of ATA. Stage Three — Let us look specifically at the symptoms (a)-(f ) of this stage of ATA: (a) fits the description by Thucydides in 2.49.5 of the skin appearing red and purple with tiny blisters and open sores.58 (b) can account for the bleeding from the mouth and throat (2.49.2),59 and the attack on the gastrointestinal tract, which resulted in vomiting, diarrhoea, and abdominal pain (2.49.3-4, 2.49.6).60 There may also be ulceration of the bowel.61 Necrosis in the extremities and orbits is compatible with symptoms noted by Thucydides: the loss of genitals, fingers, toes and eyes (2.49.8).62 (c) gives rise to foul smelling breath, a symptom clearly noted by Thucydides (2.49.2). (d) cervical lymphadenopathy may cause symptoms such as coughing and hoarseness, as reported in 2.49.3. (e) can account for the overwhelming thirst (2.49.5)63 and severe agitation and convulsions (2.49.6),64 signs that the central nervous system is involved. Also, Thucydides records that in some cases there was a loss of memory after the crisis (2.49.8),65 which could be accounted for by the delirium and disorientation which is found with ATA. (f) the attack on the upper and lower respiratory tract (2.49.3) could certainly lead to sneezing (TTTapfLos), hoarseness (ßpayxos), and coughing (/i€rd /3t)X<>S Icrxypov), all symptoms recorded by Thucydides (see also (d) above). In many respects, therefore, an epidemic of ATA can account for the

58. to σώμα . . . ύπέρυθρον, πελιτνόν, φλύκταινας μικραϊς και ΐλκεσιν εξηνθηκός. 59· και τά έντός, ή η φάρυξ και ή γλώσσα, ίύθνς αίματώδη ή ν. 6ο. και οπότε ές την καρδίαν στηρίξεων . . . ύστερον (2.49· 3~4); · · · έπικατιόντος τον νοσήματος ές την κοιλίαν . . . ΐπιπιπτούσης . . . (2.49-6). These symptoms may have appeared in severe cases in Stage One (as above); desire for systematization of the course of the Plague (since Thucydides admits that he has only given a generalization in 2.51.1) accounts for Thucydides' simplification. 61. One immediate impression of those first affected by the Plague was that they had been poisoned by means of the water supply (Thucydides 2.48.2), and this also fits well with the initial symptoms of an outbreak of ATA. 62. κατίσκηπτε yàp 'eç αιδοία και ές άκρας χείρας και πόδας, και πολλοί στίρισκόμίνοι τούτων διίφειτγον, είσί δ' οϊ και τών οφθαλμών. 63. τά δΐ έντός ούτως «καίίτο . . . rfj δίψγ) άπαύστψ ξννεχόμενοί και έν τφ όμοίψ καθειστήκίΐ τό re πλέον και έλασσον ποτόν. 64. και ή απορία τοΰ μή ήσνχάζαν και ή αγρυπνία έπέκειτο δια παντός. 65. τους δέ και λήθη ϊλαβε τό παραυτίκα.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 538 Journal of the History of Medicine : Vol. 49, October 1994 wide range of symptoms detailed for us by Thucydides. In particular, we should note the specific signs: low-grade fever—unusual rash with blisters and open sores—necrosis, particularly that of the orbits and ex tremities—vomiting and diarrhoea—hemorrhage and ulceration of the respiratory and gastrointestinal tracts—disorientation, loss of memory— respiratory tract infections—halitosis, a prominent feature of ATA. The timing of the course of the Plague cannot be determined with accuracy. In 2.49.4, Thucydides gives evidence that the rates of the development of certain symptoms varied: "In most cases there were bouts of dry retching which produced severe spasms. In some cases this was soon after the abatement of the previous symptoms, but in other cases it was much later still." Further, he says that in most cases death was around the seventh day (2.49.6), but, as we have noted, his pre conceived view of illness has led him to search for a time of crisis.66 He has been forced to admit that the crisis was by no means universally fatal and that death sometimes did not occur until some unspecified time later (2.49.6). He also gives a loose maximum period of time for the first occurrence of the Plague, the forty days the Peloponnesians spent in Attica in 430 (2.57). Nothing in his account is necessarily incompatible with the time required for a serious outbreak of ATA to manifest itself. Since Thucydides has not connected the earlier symptoms (Stages One and Two) with the later, fierce onset of the disease (Stage Three), we cannot assess the length of this period. Stages One and Two of ATA may last three to nine days and two to four weeks respectively, but then Stage Three heralds a rapid deterioration in the patient with a quick onset of symptoms. One to two weeks to crisis in Stage Three would be normal, although again the precise duration of this stage is indeterminate, as complicating factors such as the initial health of the patient, the treatment being given, and the onset of secondary infections make a change in the length of this stage.67 If Thucydides has recognized only Stage Three, his crisis on or after the seventh day approximates the range of seven to fourteen days experienced by sufferers of ATA.

FROM RUSSIA TO ATHENS

ATA has never been recorded in the Mediterranean region on the scale mentioned by Thucydides, although modern studies have shown that

66. Cf. Hippocrates, Epidemics 1.26, Prognostic 20. 67. See Ellenhorn and Barceloux, (n. 44) Medical Toxicology, p. 1312.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 539 T-2 toxins do occur naturally worldwide and infect wheat in France and Italy now,68 and almost certainly did so in the past.69 Diodorus Siculus 12.58.3-5 states that the grain that the Athenians were eating in 426 b.c. was bad, an off-hand reference to spoilt grain which hints that such an occurrence was not unusual; so problems arising from poor storage must always have existed and were recognized. ATA probably occurred natur ally from time to time in the Mediterranean region, and there is no reason why it might not have been present in classical Athens in the fifth century B.C. Without indisputable evidence of ATA in Greece now or in the time of Thucydides, we must look for another way in which the Athenians might have received contaminated grain. The only major outbreaks of ATA on record have occurred in Russia/U.S.S.R. in the nineteenth and twentieth centuries of our era, but the disease has almost certainly existed there for a much longer period.70 In the classical period, Athens imported wheat from the Ukraine, a region where ATA seems to have been endemic.

Feeding Attica

The staple cereal of the people of Attica, as for most of Greece during the classical period, was barley.71 Some wheat was also grown, but few other grains were cultivated in Greece at this time. On poor soils, such as the alkaline soils of Attica, barley yielded up to 50 percent more per plot than wheat. Wheat, being a less productive crop and therefore more expensive to grow, was very much a product for the wealthy of Attica. In addition to the home-grown cereals, we know that, by at least the end of the sixth century b.c., Attica had begun to import grain to feed

68. On modern contamination, see Buck and Cote, (n. 57) Handbook of Natural Toxins, III, 525, 541. The U.S. military has admitted that it may have been used in chemical warfare in more recent times, perhaps dropped from low-flying aeroplanes on civilian populations in Cambodia, Laos, and Afghanistan; see Ellenhorn and Barceloux, (n. 44) Medical Toxicology, p. 1312. 69. ATA has been suggested as the plague which occurred in Italy in 174 B.c. (Livy 41.21.5-7); see Gwynne-Morgan, (n. 2), pp. 22-24; Lieber, (n. 2), pp. 332-45. ATA has also been canvassed as one factor perhaps contributing to deaths in Italy in the fifteenth century, cf. A. G. Carmichael, Plague and the Poor in Renaissance Florence (Cambridge: Cambridge University Press, 1986), p. 24. For possible occurrences during the seventeenth and eighteenth centuries in Spain and Italy, see Matossian, (n. 51) Poisons of the Past, pp. 60-61. 70. A long-term presence of the disease in Russia has been suggested by Alexander, (n. 47) Bubonic Plague in Early Modem Russia, pp. 15-16. That two and a half thousand years have elapsed since the Plague is also not an insurmountable objection, since fungi, unlike viruses, do not alter over time, and if the fungus had been present in the soil during the twentieth century, it could easily have been in that given area for the millennia required. See Lieber, (n. 2), pp. 341 ff. 71. Jasny, (n. 20), pp. 751-52, 755, 758.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 540 Journal of the History of Medicine : Vol. 49, October 1994 its burgeoning population,72 and wheat was the preferred import.73 Wealthy Athenians developed a taste for the white bread made from wheat. The bulk of the population of Attica, however, could not afford locally produced wheat, let alone imported wheat, and these poorer citizens must have subsisted on barley or vegetables alone. This pluto cratic distinction in eating patterns no doubt continued during times of crisis, even during the Peloponnesian War. If imported wheat was sub sidized by the state during the War (and we have no evidence for this) and more people than usual bought this cereal, the poorest citizens may still not have been able to afford this wheat, particularly if their livelihoods had been taken away from them because of the war. Wheat must have always been a product for the wealthy or relatively wealthy. In the first few years of the Peloponnesian War, because of the continu ing invasions of its territory by the Peloponnesians, Athens was forced even more than usual to rely upon imports of grain.74 Dependence on imports during this period was heavy but not total, since in some years, when invasion did not take place or there was only partial devastation of local crops, the people of Attica were able to rely on their own resources. The Athenians were, however, particularly at risk in 430 and 427-26 b.c., when the Peloponnesians wreaked havoc on their countryside. These were the years when the Plague was at its worst because, as we propose, many people had to rely solely upon reserves of food imported from the region of the Black Sea. Later, in 424-23 b.c., Athens forced the nearby island of Euboea to supply it with food, and it may also have forced its other subjects to supply tribute in kind,75 so its surplus requirements in later years prob ably came not only from the Black Sea, but also from the islands of

72. Garnsey, (n. 43) Famine and Food Supply in the Graeco-Roman World, pp. 105-19. 73. We know of the preference of the Athenians of the fifth century B.c. for white wheat from Pliny, Natural Histories 18.65. F°r disappointment by members of the hoplite class on being offered barley instead of wheat, see Aristophanes Wasps 715-18. Barley, because of its bulk, was seldom exported, cf. Jasny, (n. 20), p. 756. That there were wheat-eaters as opposed to barley-eaters, who normally had distinct diets, see Hippocrates, Regimen in Acute Diseases 37. 74. The Plague reached Athens in the second summer of the Peloponnesian War, in 430 B.c. (Thucydides 2.47.2-3 cf. 1.23.3; Diodorus Siculus 12.45.2) and lasted intermittently for four years (Thucydides 3.87; Diodorus Siculus 12.58.1-7). Its most severe attacks occurred in 430 b.c. and in 427-26 b.c., coinciding with the years when the farmlands of Attica were particularly devastated by the Peloponnesians (Thucydides 2.57, 3.26). These peaks in the severity of the Plague may also have been directly related to the fact that the people of Attica had been driven within the walls of Athens and were living in crowded and unhealthy conditions; see Garnsey, (n. 43) Famine and Food Supply in the Graeco-Roman World, pp. 132-33. 75. Ibid., pp. 125, 132-33.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 541 Euboea, Lemnos, Imbros, and Skyros.76 After the first few years of the war, therefore, Athenian dependence upon grain imported from the Black Sea region decreased substantially, and soon Attica was in any case freed from invasion because of the altered military situation. The particu lar circumstances that existed in 430-26 b.c., the time when the Plague ravaged Attica, were extremely unusual.

Southern Russia: A Source of Athenian Wheat

Herodotus tells us that some of the peoples who dwelt along the shores of the Hypanis River, those who lived north of Greek Olbia, grew grain for sale.77 Their products may have ended up in Attica, traded directly with Greece or traded via the Greek settlements on the northern shores of the Black Sea, towns such as Olbia. There is much evidence in these regions, both in Scythia and the Greek settlements, for trade with Attica at this period.78 The Athenians also had a favored trading relationship with Satyrus, the king of the Bosporus, and our documentary evidence for this relation ship dates to the period just before the beginning of the Peloponnesian War.79 Outright war between Athens and the Peloponnesians took some time to develop, but, at least by 43 3 b. c., two years before the war broke out, the Athenians were anticipating invasion, since at that time they brought to the Acropolis of Athens the contents of temples from the countryside of Attica, clearly realizing that these would be vulnerable when war broke out.80 In addition, Pericles made an expedition into the Black Sea region at about this time, or perhaps a year or two earlier, to secure supplies of grain from this area.81 Because of this expectation of invasion, it seems reasonable to suggest that Satyrus and others in the regions around the Black Sea were asked to supply huge amounts of

76. Ibid., p. 147. 77. Herodotus 4.17. See M. Rostovtzeff, Iranians and Greeks in South Russia (Oxford: Clarendon Press, 1922), pp. 52-60. 78. There is much evidence for trade between Attica and Olbia in the fifth century B.c., and it has even been suggested that Athens made pots bearing motifs particularly aimed at markets in the Black Sea region; cf. E. Belin de Ballu, Olbia: cité antique du littoral de la mer Nord (Leiden: E. J. Brill, 1972), pp. 58-60. 79. Garnsey, (n. 43) Famine and Food Supply in the Graeco-Roman World, p. 124. 80. R. Meiggs and D. Lewis, A Selection of Greek Historical Inscriptions to the End of the Fifth Century B.C. (Oxford: Clarendon Press, 1988), number 58A. 81. Plutarch, Pericles 20. See R. Meiggs, The Athenian Empire (Oxford: Oxford University Press, 1972), pp. 197-99. For other evidence of supply of grain to Athens from the Black Sea region, see Pseudo-Xenophon 2.7; Isocrates 17.4, 20, 52, 57. For modern discussion, see Garnsey, (n. 43) Famine and Food-Supply in the Graeco-Roman World, pp. 120-3 3; and H. Knorringa, Emporos (Chicago: Ares, 1987), pp. 77-79.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 542 Journal of the History of Medicine : Vol. 49, October 1994 grain.82 In these circumstances, wheat may have been sent to Athens which in normal times would not have been sent. Some of this wheat may have been contaminated.

THUCYDIDES AND ATA

Numbers and Types Affected Diodorus Siculus in 12.45.4-5 tells us that approximately 10,000 from the general population (including slaves) died. It has been suggested that the total population of Attica, most of whom seem to have been en camped within the walls of Athens during the summer of 430 b.c., was probably as high as 420,000,83 and thus we observe the percentages of these people who died to have been in the region of 2-5 percent.84 The figures are, however, substantially different for the Athenian propertied classes.85 From the figures given earlier for the numbers of hoplites and cavalrymen who died, it is estimated that 25-30 percent of wealthy, active young men died. This represents a serious discrepancy, one based on class alone. The hypothesis that there was a clear distinction in the way that the Plague attacked various classes in Athenian society can also be substan tiated by further remarks made by Thucydides. The naval power of Athens, entirely dependent as it was upon rowers derived from the lowest class of the city, was apparently wholly unimpaired by the Plague. Thucydides states that Athens had as many ships in active service in 428-27 b.c. as it had had at the beginning of the war.86 This indicates

82. It was normal practice to stock up on grain when war looked probable. When the island of Lesbos was preparing for war in 428 B. c., it sent to the Black Sea region for its supplies (Thuc. 3.2). 83. Gamsey, (n. 43) Famine and Food Supply in the Graeco-Roman World, pp. 89-91; M. D. Grmek, Diseases in the Ancient Greek World (Baltimore: Johns Hopkins University Press, 1989), p. 98. If Diodorus is wrong here, he has surely overestimated the number dead, probably settling on a large number rather than erring on the side of caution. On the use of numbers by Diodorus, see Meiggs, (n. 81) The Athenian Empire, pp. 447-52. 84. A calculation using the rate of death given by Thucydides for the infantrymen and cavalrymen (25-30 percent), if applied to the total population, would give a staggering number of dead (105,000 to 13 8,000) which would surely have prevented Athens from continuing the war. Political opposition to the war in Athens was ineffectual, which farther suggests that the impact of the Plague on the demos of Athens can not have been devastating (Thucydides 2.59.1-2, 2.65.1-3; cf. Diodorus 12.45.4-5). Cf. Sallares, (n. 7) The Ecology of the Ancient Greek World, pp. 259-61. Thucydides himself admits that many people survived the Plague. 85. The Athenians were divided into four classes based upon family wealth which was tradition ally calculated from the amount of food produced on the holdings of the family. Of the three propertied classes, two were named after the roles their members played in the citizen army of the state—the cavalry and hoplites (armored infantry). The lowest class of citizen served as unarmored skirmishers or as rowers on warships. See Aristotle, Athenian Constitution 7.1-4. 86. It had, in fact, almost as many as it had ever had; see Thucydides 3.17; also cf. 3.6, where the Athenians prove that they are not weak.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 543 that the lowest census class had not been seriously, if at all, affected by the Plague, and it counters the assumption that an infectious disease was responsible, since it should have affected the poor to some measurable degree.87 As far as the Athenian army was concerned, it would seem that those from the upper classes ate wheat, while the lower ate barley. Athenian troops in the field usually had to purchase their own food, and they could choose between wheat and barley.88 Since cavalrymen and heavy infan trymen were paid substantially more than other troops, these were more likely to be able to afford the more expensive cereals.89 There is some evidence that upper-class fighters were affected on cam paign, perhaps because they were eating contaminated wheat. The in stance of the Athenian general Hagnon is a case in point. He was sent in 430 b.c. to help the Athenians besieging the town of Potidaea and is said by Thucydides to have taken the Plague with him. On this expedition, 1,050 out of 4,000 hoplites reputedly died of Plague over 40 days (2.58). This incident has been used to show that the Plague was contagious; yet Diodorus Siculus reports that Hagnon took with his army to Potidaea sufficient supplies for all, the reinforcements and those already there (12.45.2).90 There is no apparent reason why all classes of Athenians should not have exhibited comparable mortality-rates when struck by the Plague, given that Athens was completely enclosed by city-walls constructed in the aftermath of the Persian invasions two generations previously. Those from the upper classes, however, who seem to have been more suscepti ble to the Plague, could afford wheat, the suggested source of the Plague, whereas the lower classes could not. This factor may explain why the rich died in relatively higher percentages than the poor.

Accounting For Thucydides

There are a number of factors that should be considered when trying to understand how it is that Thucydides could have believed that the Plague

87- Some diseases do confer "herd immunity" among the poor; e.g., poliomyelitis. This phe nomenon, however, is found in communities that have been repeatedly subjected to outbreaks of the same infection. From everything that Thucydides says, the Athenian Plague was unique. 88. We have record of both grains being available to troops on campaign. See Thucydides 8.95, cf. 6.22. 89. On differential rates of pay, see W. K. Pritchett, The Greek State at War, 2 vols. (Berkeley: University of California Press, 1971), I, 3-29. 90. Cf. Salway and Dell, (n. 20), p. 69. During this same period, Thucydides reports losses to Plague in the Athenian expeditionary army which Pericles had led against the Peloponnese (Thucydides 2.55-57).

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms 544 Journal of the History of Medicine : Vol. 49, October 1994 was infectious, if in fact it had been caused by contaminated wheat. Apart from the fact that he may have been oblivious to lack of illness among the lower classes because of his aristocratic background,91 and that his impressions may have been affected or even impaired by his own suffer ings during the Plague, he may have been hampered by being unable to recognize the symptoms of ATA. If ATA had been responsible for the Plague, it is easy to understand why Thucydides and other Athenians did not identify infected grain as a possible source of disease. First, there is quite often a time-lag between consumption of infected grain and an outbreak of ATA.92 In the cases cited from the U.S.S.R., a connection between consumption of infected grain and the consequent disease was either not noticed or ignored at first. There it was felt that ATA was a highly infectious disease, a belief not countered until intensive surveys had been carried out. Food-poisoning in general may have seemed far-fetched to the Athe nians. The first instinct of the people of the had been indeed to suspect poison as the cause of the disease. They feared that the Pelopon nesians had put poison in their water cisterns (2.48.2). Thucydides clearly rejects this hypothesis on the grounds that the Plague later appeared in Athens itself (which had independent sources of fresh water). This seems to have been the general opinion of the Athenians: that poison cannot have been responsible for the disease. They were looking elsewhere for the source of this plague.93 Because the systematic study of medicine was in its infancy, concepts of medical theory were often only vaguely understood or even incorrect. It has been suggested that Thucydides was acquainted with contempo rary medical theories, but this idea has not won general approval;94 yet, even if he had been well acquainted with medical matters, he would not have known of ATA. Fungal poisons as a possible source of disease (the toxins associated with ergot, for example) were not scientifically recog nized until the sixteenth and seventeenth centuries.95 Inappropriate diag

91. Thucydides was extremely wealthy and from one of the aristocratic families of Athens (e.g. 4.105). His interests seem to lie almost exclusively in the affairs of the upper classes, since he seldom even mentions the lower classes; see G.E.M. deSte. Croix, "The character of the Athenian empire," Historia, 1954-55. 3, 1-41. PP- 31-37 92. The first stage of the disease may pass unnoticed. 93. Salway and Dell, (n. 20), pp. 65 ff. 94. For: Cochrane, (n. 42) Thucydides and the Science of History, p. 16 and passim-, Page, (n. 7), pp. 98-119. Against: Parry, (n. 42), pp. 106-18; and more recently: M. Marshall, "Pericles and the Plague," in Owls To Athens, ed. E. Craik (Oxford: Clarendon Press, 1990), p. 164. 95. F. J. Bové, The Story of Ergot (Basel and New York: S. Karger, 1970), pp. 153 ff.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms Bellemore et al. : Plague of Athens 545 nosis and treatment would also account for the difficulty doctors and others allegedly experienced in helping the sick (2.47.4). This would have only further encouraged the impression that the Plague was unlike any other infection the Athenians had ever encountered. They would have felt totally at a loss, unable to be helped by man or god. Thucydides clearly conveys this helplessness through his literary skills. The population of Athens in general, and Thucydides in particular, may have believed that Athens was suffering a "normal" disease, since they were not in a position to understand all the evidence.96 Thucydides' experience of large-scale disease would have been with epidemics of a contagious nature,97 creating for him a natural preconception of conta gion even in instances where perhaps there was none. He provides clear evidence that he, the Athenians, and the Peloponnesians (2.57) fully believed that the Plague was contagious.

CONCLUSION

Only once in her history did Athens suffer the peculiar conditions of 430-427-26 b.c.: that of siege, that of the desperate need to rely upon food imported from the region of the Black Sea where ATA has been prevalent, and that of the Plague. From a historical perspective, ATA must surely be viewed as a possible cause of the Plague. From a medical point of view, our comparison between the symptoms Thucydides pre sents and those exhibited by sufferers of ATA has demonstrated that the Plague and ATA are certainly not incompatible. Together the historical and the medical evidence suggests that the Plague of Athens could well have been an outbreak of Alimentary Toxic Aleukia.

96. Holladay, (n. 9), p. 250. Sallares, (n. 7) The Ecology of the Ancient Greek World, pp. 225, 229 ff., believes that the ancient Greeks had a very clear idea of the concept of contagion. 97. [Aristode], Prohlemata 1.7, Diodorus Siculus 14.70 ff., and Livy 25.26 ff. know that contact with the sick can spread disease. Sophocles, Oedipus Rex 181 refers to contagion; see J. C. Kamer beek, The Plays of Sophocles (Leiden: E.J. Brill, 1967), adloc.,andR. Dawe, Oedipus Rex (Cambridge and New York: Cambridge University Press, 1982), ad loc. On acceptance of contagion, see Thucydides 2.57, 2.58.2; cf. Diodorus Siculus 12.45.2; Plutarch, Pericles 35.3; Thucydides 2.47.4. Even animals are said to have had an instinctive understanding of contagion (Thucydides 2.50). Contagion is also the impression to be gained from Plutarch, Pericles 34.4, 35.3.

This content downloaded from 165.82.124.26 on Wed, 06 Sep 2017 03:39:25 UTC All use subject to http://about.jstor.org/terms