April 15, 2019History of Medicine
Toxigenic fungi and mycotoxins entered human food supplies about the time when mankind first began to cultivate crops and to store them from one season to the next, perhaps 10,000 years ago. The storage of cereals probably initiated the transition by mankind from hunter-gatherer to cultivator, at the same time providing a vast new ecological niche for fungi pathogenic on grain crops or saprophytic on harvested grain, many of which produced mycotoxins. Grains have always been the major source of mycotoxins in the diet of man and his domestic animals. In the historical context, ergotism from Claviceps purpurea in rye has been known probably for more than 2000 years and caused the deaths of many thousands of people in Europe in the last millennium.
It is suggested that the outbreak of the ?plague' in Athens in the 5th century BCE was caused by moldy food containing immunosuppressive mycotoxins, including the irritant T-2 toxin produced by certain Fusarium micro-fungi. Attica, a small hilly, coastal city-state, had to import its cereal grains from overseas. However, because of the Peloponnesian war and the occupation of its port, Peiraeus, by enemy forces, scarcity of food may have forced the population of the overcrowded Athens to consume any food, even when moldy. This happened in the Orenburg district of the USSR during World War II, when an outbreak of ?alimentary toxic aleukia' caused a great number of fatalities. The Plague of Athens was an epidemic that devastated the city-state of Athens in ancient Greece during the second year of the Peloponnesian War (430 BCE) when an Athenian victory still seemed within reach. It is believed to have entered Athens through Piraeus, the city's port and sole source of food and supplies. Much of the eastern Mediterranean also saw outbreak of the disease, albeit with less impact. The plague returned twice more, in 429 BCE and in the winter of 427/426 BCE. Some 30 pathogens have been suggested as causing the plague.
Sparta and its allies, with the exception of Corinth, were almost exclusively land based powers, able to summon large land armies that were very nearly unbeatable. Under the direction of Pericles, the Athenians pursued a policy of retreat within the city walls of Athens, relying on Athenian maritime supremacy for supply while the superior Athenian navy harassed Spartan troop movements. Unfortunately, the strategy also resulted in adding many people from the countryside to an already well-populated city, introducing a severe crowding factor as well as resource shortages. Due to the close quarters and poor hygiene exhibited at that time Athens became a breeding ground for disease and many citizens died including Pericles, his wife, and his sons Paralus and Xanthippus. In the history of epidemics the ?Plague' of Athens is remarkable for its one-sided affliction and bias on the ultimate outcome of a war.
In his History of the Peloponnesian War the historian Thucydides, who was present and contracted the disease himself and survived, describes the epidemic. He writes of a disease coming from Ethiopia and passing through Egypt and Libya into the Greek world:
a plague so severe and deadly that no one could recall anywhere its like, and physicians ignorant of its nature not only were helpless but themselves died the fastest, having had the most contact with the sick.
In overcrowded Athens, the disease killed an estimated 25% of the population. The sight of the burning funeral pyres of Athens caused the Spartans to withdraw their troops being unwilling to risk contact with the diseased enemy. Many of Athens' infantry and expert seamen died, as well as their general Pericles. After the death of Pericles, Athens was led by a succession of leaders Thucydides described as incompetent or weak. According to Thucydides, not until 415 BCE had Athens recovered sufficiently to mount a major offensive, the disastrous Sicilian Expedition. Accounts of the Athenian plague graphically describe the social consequences of an epidemic. Thucydides' account clearly details the complete disappearance of social morals during the time of the plague. Thucydides states that people ceased fearing the law since they felt they were already living under a death sentence. Likewise, people started spending money indiscriminately. Many felt they would not live long enough to enjoy the fruits of wise investment, while some of the poor unexpectedly became wealthy by inheriting the property of their relatives. It is also recorded that people refused to behave honorably because most did not expect to live long enough to enjoy a good reputation for it. Another reason for the lack of civilized behavior was the sheer contagiousness of the illness. Those who tended to the ill were most vulnerable to catching the disease. This meant that many people died alone because no one was willing to risk caring for them. The dead were heaped on top of each other, left to rot, or shoved into mass graves. Sometimes those carrying the dead would come across an already burning funeral pyre, dump a new body on it, and walk away. Others appropriated prepared pyres so as to have enough fuel to cremate their own dead. Those lucky enough to survive the plague developed an immunity and so became the main caretakers of those who later fell ill. A mass grave and nearly 1,000 tombs, dated between 430 and 426 BCE, have been found just outside Athens' ancient Kerameikos cemetery. The mass grave was bordered by a low wall that seems to have protected the cemetery from a wetland. Excavated during 1994-95, the shaft-shaped grave may have contained a total of 240 individuals, at least ten of them children. Skeletons in the graves were randomly placed with no layers of soil between them.
Excavator Efi Baziotopoulou-Valavani, of the Third Ephoreia (Directorate) of Antiquities, reported that:
[t]he mass grave did not have a monumental character. The offerings we found consisted of common, even cheap, burial vessels; black-finished ones, some small red-figured, as well as white lekythoi (oil flasks) of the second half of the 5th century BC. The bodies were placed in the pit within a day or two. These [factors] point to a mass burial in a state of panic, quite possibly due to a plague.
The plague also caused religious uncertainty and doubt. Since the disease struck without regard to a person's piety toward the gods, people felt abandoned by the gods and there seemed to be no benefit to worshiping them. The temples themselves were sites of great misery, as refugees from the Athenian countryside had been forced to find accommodation in the temples. Soon the sacred buildings were filled with the dead and dying. The Athenians pointed to the plague as evidence that the gods favored Sparta, and this was supported by an oracle that Apollo himself (the god of disease and medicine) would fight for Sparta if they fought with all their might. An earlier oracle had warned that:
A Dorian [Spartan] war will come, and bring a pestilence with it .
Thucydides is skeptical of these conclusions and believes that people were simply being superstitious. He relies upon the prevailing medical theory of the day, Hippocratic theory, strives to gather evidence through direct observation. He notes that:
Carrion-eating birds and animals disappeared as a result, though he leaves it an open question whether they died after eating the corpses or refused to eat them and were driven away. All the birds and beasts that prey upon human bodies, either abstained from touching them (though there were many lying unburied), or died after tasting them. In proof of this, it was noticed that birds of this kind actually disappeared; they were not about the bodies, or indeed to be seen at all.
Historians have long tried to identify the disease behind the Plague of Athens. The disease has traditionally been considered an outbreak of the bubonic plague in its many forms, but reconsiderations of the reported symptoms and epidemiology have led scholars to advance alternative explanations. These include typhus, smallpox, toxigenic fungi, measles, and toxic shock syndrome. Based upon striking descriptive similarities with recent outbreaks in Africa, as well as the fact that the Athenian plague itself apparently came from Africa (as Thucydides recorded), Ebola or a related viral hemorrhagic fever has been considered. Given the possibility that profiles of a known disease may have morphed over time or the plague was caused by a disease that no longer exists, the exact nature of the Athenian plague may never be known. In addition, crowding caused by the influx of refugees into the city led to inadequate food and water supplies and a probable proportionate increase in insects, lice, rats, and waste. These conditions would have encouraged more than one epidemic disease during the outbreak. However, advancing scientific technologies may reveal new clues. Unfortunately, DNA sequence-based identification is limited by the inability of some important pathogens to leave a footprint retrievable from archaeological remains after several millennia. The lack of a durable signature by RNA viruses means some etiologies, notably the hemorrhagic fever viruses, are not testable hypotheses using currently available scientific techniques.
Recent research has led to our current understanding of the formation of aflatoxins in grains and nuts, due to the growth of Aspergillus flavus and its role, in synergy with the hepatitis B virus, in human liver cancer. During a period of climate change and greatly reduced crop diversity on a global basis, researchers tasked with monitoring the food system need to be aware of fungal toxins that might have been rare in their working careers that can reappear. Sources: NIH.gov (Schoental, R.); WebMD.com; Medline.com; Wikipedia