Plus ça change, plus c'est la même chose: pandemic insights from fifth century B.C. Athens

COVID-19 has prompted reflection on many previous pandemics, above all the outbreaks of plague in the 17^{th century} and the Black Death in the 14^th. I want to go still further back to the great plague of Athens in the fifth century B.C., which hit the Athenians shortly after they began the great Peloponnesian War against Sparta and her allies in 431 B.C.

The Athenian plague prompted the historian Thucydides to offer in his History a full medical and secular description, so that if it occurred again, people 'would not fail to recognise it', as he cautiously put it. Thucydides also offered a brilliant and searing analysis of the plague's social and mental effects, a devastation of the social order which has been noted after other pandemics. As a survivor himself, he offered as his own observation that survivors acquired immunity, the first attested (written) observation of this phenomenon. This was an absolutely catastrophic plague with a massive death-toll; the precise disease is not clearly identifiable. Can we learn anything from his account?

The 'Athenian plague' was not only Athenian, though we have the account of its impact only for Athens. It also hit Egypt and much of the Persian King's territory, according to Thucydides, and it came to Athens via the Piraeus, and to the northern Aegean. The death rate was far higher, of course, than our current pandemic: of the 4,000 Athenian soldiers who sailed to northern Greece, 1,050 were lost in 40 days.

Thucydides tells of the symptoms of high fever, inflammation, sneezing, retching and spasms, and unbearable thirst, with people throwing themselves into rain-tanks, others recovering but losing extremities and even their sight or memory. He describes the dying gathering around wells, and piles of the dead lying in the streets and even in the temples. Thucydides spoke from personal experience.

There are aspects of the Athenian plague which touch our own current experience, and others which Thucydides as a student of human nature meant future generations to ponder – and to look out for again. First, there was no cure: what worked for some failed for others, and the doctors could not help.

Thucydides refers somewhat acidly to the treatment by regimen (diet etc.) which was the new Hippocratic method of the time: it had no effect and doctors died even more frequently than their patients. Second, it was made worse by the crowded conditions in Athens and in 'the most populous places', as Thucydides carefully pointed out.

The leading statesman Pericles had persuaded the Athenians at the outbreak of war to evacuate the countryside to within the walls of Athens, and not venture out to fight the invading army; ironically, his determination on war with Sparta but not engaging on land made the plague more destructive. Moreover, it was entirely unexpected. Even Pericles, praised for wisdom and forethought, could not foresee it, and he urged on the Athenians their hard-line stance to protect the Athenian empire, at the very height of their confidence. The plague was no respecter of persons – rich and poor died. Pericles himself died. The hoplite soldiers (fairly well-off) died and infected others. Thucydides was careful to make clear, against Hippocratic medical theory, that this was infection and had little to do with one's way of life, medical care, or humours; nor was it affected by religious remedies.

Thucydides offered an entirely secular vision of the plague. Its cause was terrifyingly unknown: he would leave speculation as to its causes to others, 'if causes can be found adequate for such an upheaval'. Its nature was 'beyond logos' (beyond description or understanding). Many Greeks, however, would have believed that it was the god Apollo who sent the plague as punishment, and by offering a full-scale scientific description of symptoms and the course of the disease, as in the new Hippocratic methods of objective observation, Thucydides was saying that it was amenable to human enquiry and observation, and the new science of medicine (he says there was no cure, but perhaps one might hope for one eventually). His emphasis was on this detailed description, and on the social and moral effects.

For he stresses first that the most dangerous element was the despair or dejection (athumia) which hit whenever someone felt themselves sickening, weakening their power of resistance. He stresses that those who tried to nurse the sick fell ill themselves, while those left alone died of neglect.

Thucydides then traces the corrosion of the social order and moral values as people abandoned the proper formalities of burial. There was the onset of 'anomia', literally 'lawlessness' or unconcern for customs and tradition. This passage has had deep influence on later plague descriptions: 'men dared to do what formally they had done in secret', seeing the same disaster hitting all alike, 'those of good fortune dying suddenly and those with nothing taking their possessions'.

Bodies and possessions were alike ephemeral and so men turned to enjoyment: 'neither fear of the gods nor human law held people back', no one feared eventual coming to justice, for they would probably not live to see it. And so in this darkest of passages, Thucydides re-calibrates contemporary debates about the nature of religious belief and the purpose of punishment to trace the beginnings of the decline of social order.

It should be stressed how remarkably original this analysis was at the time: no writer had tried to analyse the collapse of social norms in this way. It is such an uncompromising picture that some scholars have thought it must be a little exaggerated, but that denies the value of the astute eye-witness. We recall that this occurred at the height of Athenian prosperity and confidence: the era of the Acropolis temples and the intellectual ferment visible in Athenian tragedy, comedy, philosophy and the radical democracy. Not everything collapsed, though there was an immediate effect of acute demoralisation, while longer-term effects might be harder to calibrate - what Thucydides saw as a long-term malaise and loss of integrity.

The contrast with our own experience is stark. The Coronavirus has brought out a vast reservoir of individual sacrifice for others, mutual respect and responsibility for the greater good (some, no doubt, taking advantage also). But two points stand out. Even in Thucydides' dark description, there was humanity: he does say that the doctors tried to tend the sick (only they died too – as now); he does say that friends and family tried to look after each other (only they died). Indeed in a ray of hope, he explains that people were best tended and cheered by those who had the plague and survived, for they 'knew in advance' and were unafraid, and indeed the survivors entertained the 'empty hope' that they would never again fall ill. So there were numerous self-sacrificing and pitying helpers and they were only brought low by the disease itself. He hints perhaps that at least if you know in advance, it might not be so unbearable next time.

And finally, there was no state response, no health system, no public health knowledge or policy: the Athenian democracy was sophisticated, but on the matter of the plague, this was a do-it-yourself, entirely private response. As far as we know, the only public, official response on the part of the Athenians was to purify the sacred island of Delos and introduce the cult of the healing god Asclepius.

It was through close observation that Thucydides deduced the operation of what we call 'acquired immunity', and he was surely offering a rival theory to the nascent science of medicine around Hippocrates.

The other lasting lesson from this historian who wished readers to interpret the future by means of an accurate knowledge of the past, was about human nature: the reactions of human beings in the face of catastrophe and inexplicable death, and the wider effects on social values, morality and the scaffolding of justice. He was careful to say later that war itself also had corrosive effects, but that was humanly contrived and in some respect avoidable; the plague was completely unexpected and a force of nature. So in the end he teaches us to expect profound changes on the level of individuals' reactions and wider social values in the face of huge upheaval; and on the state level to expect the unexpected – and hope for good government when it hits. The Athenians continued the war anyway.

Professor Rosalind Thomas, Balliol College Oxford University

https://www.ox.ac.uk/news/arts-blog/plus-change-plus-cest-la-m-me-chose-pandemic-insights-fifth-century-bc-athens