“The normal population of the [ancient] city [Athens] was around 150,000. Scholars estimate that 200,000 – 250,000 farmers and townsmen; and, their families, came streaming in, bringing everything they could carry with them — down to the woodwork of their farmhouse walls. But, Pericles made no provision for the newcomers, who were used to their country manors, their quiet towns, their open fields,” Ms. Orent elegantly writes. A few had homes, or relatives within the walls. But, most had no where to go, and huddled in stifling huts, or tents flung up in the narrow spaces between the walls. The crowded encampments were ripe for a virulent infection,” she writes.
“Physicians and attendants died quickly, and the only people who could care for the sick, were survivors immune to further infection.”
“The infection came from the sea,” Ms. Orent notes, “the portal that Pericles had left open to feed the Athenian people and bring in enough money to keep the war effort alive. The Athenian historian Thucydides tells us that the disease originated in Ethiopia, travelled northward into Egypt, and Libya, moved across the Mediterranean to the island of Lemnos, and on to Athens. ‘There was no record of the disease being so virulent anywhere else, or causing so many deaths as it did in Athens,’ wrote Thucydides; and, we have no reason to doubt him. This is a critical bit of information,” Ms. Orent contends. “It tells us,” she argues, “that The Great Plague evolved: it became much more lethal in the great refuge camp of wartime that Athens had become. Thucydides continued: “People in perfect health, suddenly began to have burning feelings in the head; their eyes became red and inflamed; inside their mouths, there was bleeding from the throat and tongue, and the breath became unnatural and unpleasant. The next symptoms were sneezing and hoarseness of voice, and before long, the pain settled on the chest and was accompanied by coughing. Next, the stomach was affected, with stomach-aches; and, with vomiting of every kind of bile that has been given a name by the medical profession, and this being accompanied by great pain and difficulty. In most cases, there were attacks of ineffectual retching, producing violent spasms; this sometimes ended with this stage of the disease, but sometimes continued long afterwards.”
“Thucydides goes on to describe rashes, delirium, mental confusion and, among the survivors, blackened, dead tissue on the extremities and sometimes blindness. This was a highly transmissible, virulent, systemic disease. Physicians and attendants died quickly, and the only people who could care for the sick — were survivors immune to further infection.”
Ms. Orent concludes that “the Athenian plague shows how a disease of mild to moderate virulence can heat up in what we can only call a ‘disease factory’ — a place where the sick are trapped together with well, causing infection to spread with wildfire. If the Athenian infection was typhus, the most likely culprit,” Ms. Orent argues, “it would normally be spread by the human body louse and its infected faeces. There must have been body lice among the Athenian squatters.” she observes. Usually, just scratching lice bites, thus digging louse faeces inadvertently into the skin, causes transmission. But, in crowded conditions, transmission of typhus can be more direct. For instance,” she notes, “in the Serbian prison camps of World War I, where typhus was rampant, transmission through the air – possibly caused by aerosolized louse faeces — was known to occur. The right conditions, in other words, can cause the short-term evolution of a louse-borne disease into something explosive.”
“As Ewald has shown,” she writes, “a similar evolutionary process gave rise to the 1918 flu, propelled by the trench-warfare system of the Western Front. In the Spring of 1918, a first wave of mild flu broke out in the U.S.; and, spread across the country to the troop ships loading for Europe. From those ships, the infection spread into the trenches, where it swiftly heated up to deadly virulence in the disease factory conditions of the Front: the trenches, the trains, the trucks moving the wounded and the sick together, where virus from the people immobilized by illness was able, over and over, to infect the well. The whole system was a giant viral delivery service. The disease left the Western Front by several ports and exploded across the planet, killing about 2.5 percent of those it infected — and, it infected hundreds of millions.”
“This predatory influenza was not caused by some random combination of bird flu genes, as the new plague paranoia predicts. Both the Athenian plague and the 1918 flu evolved in predictable Darwinian fashion,” Ms. Orent writes. “Germs that ravage the body more swiftly, and effectively, will out-compete milder strains. If those lethal strains have repeated access to fresh hosts, the brakes on virulence are off, and deadly disease evolves and spreads.”
“Looking at epidemics, and pandemics through this evolutionary lens makes it clear that the most important condition necessary for the evolution of virulent, transmissible disease is the existence of a disease factory. Without social conditions that allow the evolution of virulent, transmissible disease, deadly outbreaks are unlikely to emerge,” Ms. Orent says.
“Deadliness itself, isn’t all that uncommon: SARS, or severe acute respiratory syndrome, which terrorized China in 2002 and 2003, killed ten percent of its victims; Ebola kills 60-90 percent; untreated rabies kills close to 100 percent, as does pneumonic plague, caused by Yersinia pestis, the bacterial agent of The Black Death, the worst pandemic in human history. But, to be both deadly, and efficiently transmissible — requires exacting circumstances,” Ms. Orent observes. Even the Black Death — though to originally have come from Central Asian marmots — must have evolved in a chain of human-to-human transmission, to become as lethally effective as it was.”
“Fighting existing pathogens is more urgent than hunting for possible new ones — less exciting, but more likely to ease real suffering in the world.”
“So, what is wrong with listening to the drumbeat, to the endless calls to protect ourselves against the coming plague — against Ebola from Africa to bird flu from Asia? Is it possible that a huge pandemic could erupt from some as-yet unknown pathogen? Is apocalypse lurking out there, among rats, or monkeys, or bats or flying squirrels, or birds? The Black Death shows that you can never say never: there might be an animal pathogen out there that, under the right circumstances, can evolve and maintain both virulence and transmissibility among humans as well as animals.”
“The Central African Monkey Pox virus (so-called because it was first identified in macaques in 1958) has dangerous attributes: like smallpox virus it is often deadly, and it’s also a ‘sit-and-wait pathogen,’ in Ewald’s terms — highly durable in the outside environment. Yet the evolution of monkey-pox into a human disease such as smallpox seems, at this point, unlikely: some strains of monkey-pox have transmitted from person-to-person for several iterations, but, the chains of transmission have easily been broken; and, the evolutionary processed stops in its tracks,” Ms. Orent wrote.
“Instead, people continue to die of human-adapted disease,” Ms. Orent adds. “Malaria kills more than one million children annually. Tuberculosis, in its ugliest, drug-resistant forms, is well-entrenched worldwide. Polio, despite our noblest efforts, continues to cripple and kill children. Fighting existing pathogens seems more urgent than hunting for possible new ones — less exciting, but more likely to ease real suffering in the world.”
Interesting and thoughtful articles. The increase prevalence and emergence of antibiotic-resistant infections is certainly a very worrisome, unfolding “train-wreck.” We definitely need to incentivize pharmaceutical companies to explore and develop a new generation of antibiotic medicines — or, we will indeed be heading down a path that Pericles did — so many, many years ago. V/R, RCP