(30) TARRANT COUNTY PHYSICIAN
March/April 2021
This epidemic started in the second
year of the Peloponnesian War, after the
Spartan invasion and siege of Athens in
430 B.C. As reported by Thucydides,
this disease appeared suddenly, with
high fever, red eyes, sore throat and
tongue, hoarseness and cough, vomiting
bile, severe diarrhea, restlessness,
purplish cutaneous pustules and ulcers,
and also lesions over fingers and toes,
sometimes with gangrene. Recent review
articles suggest that the most likely
epidemiological diagnosis was smallpox,
with typhus being less probable.5 It did
not appear to be bubonic plague.
Thucydides described the
overcrowding in the walled city of Athens
where he proposed the important
concept of contagion of disease. He
defined it as the transmission of illness
from a sick person to a healthy individual.
He was then influenced by the ideas
of Hippocrates, who claimed that the
secretions of a sick individual would
contaminate the air during an epidemic.6
This proposal anteceded by
thousands of years Pasteur’s and Koch’s
observations on germ transmission.
Thucydides also noted that death could
occur on the seventh or eighth day of
disease but observed that those who
recovered might acquire partial immunity
and did not die from a second round of
disease.
Waves of infection affecting the local
population led to the death of one-third
of Athens’ inhabitants. So many of the
dead remained unburied that at times
the corpses piled up on the street.
Thucydides blamed this on lack of
humanitarian response of the survivors.
He himself, who got the disease
and recovered, suggested avoiding
overcrowding and exposure to the sick;
however, Pericles, who was leading
Athens at the time of the infection,
suggested the transfer of rural refugees
to the walled city. This increased the risk
of their contagion. He also became a
victim of the illness, from which he did
not survive.
Euripides, who also lived at the time
of the war in 415 B.C., described in an
allegorical drama, “The Trojan Women,”
a prophecy for a tragedy that predicted
the disaster that would befall Athens after
the failed Sicilian campaign when Athens
lost her entire fleet, and a large number of
young sailors became enslaved. This was
a message on bad war planning in a Greek
drama written in the fifth century B.C.7
As Rome conquered Greek territories,
the Roman Empire in turn was deeply
influenced by Greek culture, which
became integrated into buildings and
sculptures. The Roman Empire was also
influenced by their religious beliefs and
images. Hellenistic centers created in
Alexandria and in cities of Asia Minor
were later absorbed and integrated into
Rome.
Antonine Plague
The first recorded epidemic in Roman
times was called the “Antonine plague.”
It appeared in A.D. 165 to 180, and
waves of disease followed between 211
and 266. To Galen, the observant Greek
physician, the victims presented with
fever, chills, sore throat, bloody diarrhea
turning black, and a pustular rash on
the ninth day consistent with smallpox.
The acute phase of the disease lasted
two weeks. It affected large numbers
of Roman residents, with high mortality
due to the density of population and
excess of waste and sewage.4 It killed
Marcus Aurelius Antoninus and Lucius
Verus, the two reigning emperors.8 It is
believed that the Roman soldiers brought
the organism from Egypt and the Middle
East into Rome.
In those times, early Christians were
persecuted for refusing to honor the
Roman gods. However, they endeared
States controlled by Athens (blue) and Sparta (red) at war1
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