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Chicago Bulls at Los Angeles Lakers

Chicago Bulls at Los Angeles Lakers

Background - The History & Archaeology

• Environmental Microbial Forensics and Archaeology of Past Pandemics - Antonio Fornaciari
• Palaeomicrobiology: current issues and perspectives - Michel Drancourt & Didier Raoult
• Diagnosing Ancient Disease - Sarah Everts

The Plague of Athens

1. "Heats in the head" (unclear if fever or pain), redness and inflammation of the eyes, throat and tongue becoming reddened or even bloody, breath becoming foul;
2. Sneezing, hoarseness, pain in the chest, coughing;
3. Gastrointestinal distress, with diarrhoea and retching/vomiting;
4. Reddish skin with small pustules and ulcers;
5. Feeling of being overheated, to the point of desiring nudity or immersion in cold water;
6. Extreme thirst;
7. Restlessness and insomnia;
8. Death at around the seventh or eighth day after illness onset.

1. "Violent" diarrhoea that could become fatal;
2. Some people faced the loss of fingers, toes, eyes or genitals (unspecified method, usually speculated to be gangrene);
3. Amnesia.

The Social Effects

The Clues

• Contagion - Thucydides describes how doctors and caregivers were most likely to be infected.
• Acquired/Adaptive Immunity - it is Thucydides, once again, who discusses how those who caught the disease and survived were the ones to nurse the sick, because they could not get sick again. This suggests that the disease gives acquired immunity, though it is not known whether the immunity was lifelong (like measles or rubella) or temporary (pertussis at 4 to 20 years, SARS CoV2 within months), complete or partial. Thucydides is considered to be the first to write down evidence of acquired immunity.
• Mortality Rate - in Athens, the mortality rate is estimated at around 25%, but conditions in the city were overcrowded and poor, and Thucydides notes that this is worse than was seen elsewhere. It is likely this rate was worsened by lack of available care, poor living conditions, and potential comorbidities in some of the sufferers. Thucydides mentions how military age men are affected, but does not otherwise note a bias in sex or age in terms of death.
• Skeletal Signs - the excavator of the 1994-5 has since published on the bones found, and has not made note of any skeletal anomalies that could relate to specific diseases. This is perhaps not a surprise, since most diseases that can develop skeletal signs are long-term (e.g. tuberculosis or syphilis) but is still worth noting.
• Zoonosis? - due to Thucydides's observations about scavenging animals, with his implication that dogs were affected by the epidemic, some have suggested that the disease was zoonotic and could pass freely between humans an animals. Others have suggested it was anthroponotic, that is a primarily human disease that could pass occasionally to animals, while still others think that Thucydides may have just seen dogs sickening from eating rotted meat.

The Prime Suspects

1. Epidemic typhus (Rickettsia prowazekii) is a bacterial infection passed along through tick faeces getting into open wounds. After exposure, the disease presents at 7-14 days with high fever, sickness, diarrhoea, coughing and joint pain; at 5-9 days after presentation a rash spreads across the entire body except for the face, palms and soles of the feet. Signs of meningioencephalitis (infection of the brain and/or membranes around it) follow, including sensitivity to light, altered mental status, and coma. Estimated 10%-60% mortality rate. Proposed in 1956 by historian A W Gomme; in 1992 by Vlachos; January 1999 by University of Maryland staff. This matches with symptoms of fever, chest pain, coughing, gastrointestinal issues, "reddish skin" and rare gangrene, but not eye inflammation, pustules/ulcers, or insomnia. Dogs can catch typhus but do not show symptoms. The timeline does not fully match.
2. Typhoid fever (Salmonella enterica serovar Typhi) is a bacterial disease that spreads through the fecal-oral route. After exposure, the disease presents at 6-30 days with a slowly building fever, malaise, headache, cough and nosebleeds; during the second week of symptoms, the fever plateaus, delirium occurs, rose spots (small red macules) appear, the abdomen is distended and painful, and there may be constipation or diarrhoea. In the third week, the patient may experience intestinal bleeding, pneumonia, encephalitis, or sepsis. Proposed in May 2006 by Papagrigorakis et al based on dental DNA from the mass grave discussed above (though some consider typhoid fever endemic to ancient Greece, which is possible as Typhi is likely at least older than the Neolithic.) This matches with symptoms of fever and coughing, and may match with pustules (if misidentified macules - Thucydides was a historian, not a doctor) and gastrointestinal distress (diarrhoea is much more noticeable than constipation), but does not match with vomiting, insomnia or rare gangrene. Thucydides does not mention any delirium-related symptoms. Dogs cannot develop typhoid. The timeline does not match.
3. Smallpox (Variola minor) was a viral disease that spread through respiratory droplets or fomites. After exposure, the disease presented at 7-14 days with fever, muscle pain, headache, and gastrointestinal distress; at 12-15 days after symptoms appeared, lesions appeared on the mucous membranes (inside of mouth, nose and throat), then 1-2 days later a rash would start at the forehead and spread rapidly across the body, developing into pustules that slowly scabbed over and scarred. Estimated 30% mortality rate. Proposed in 1969 by Littman & Littman. This matches with symptoms of fever, coughing, gastrointestinal distress, and pustules, but does not match with insomnia. Dogs could not contract smallpox. Smallpox could cause blindness, which could explain the loss of eyes that Thucydides mentions. However, it is notable that Thucydides did not mention the very distinctive scarring that results from smallpox, in contrast with the Antonine Plague (165-180 CE) which is believed to be smallpox in part because Galen specifically recorded that 65-85% of survivors bore scarring.
4. Measles (Measles morbillivirus) is a viral disease that spreads through respiratory droplets or fomites. It is the most contagious virus known. After exposure, the disease presents at 10-14 days with high fever, cough, sneezing, red eyes and a rash which starts on the back of the ears and covers the head before spreading downwards. Complications can include diarrhoea, pneumonia, encephalitis, corneal scarring, and immune system suppression. Fatality rates as high as 28% have been recorded. Proposed at least since 1953 (as per this rebuttal), and more recently in 2004 by Cunha. This matches with symptoms of fever, conjunctivitis, bad breath, coughing, pustules (if misidentified, as typhoid) and loss of eyes (if blindness), but does not match with symptoms of gastrointestinal distress, insomnia, or rare gangrene. Dogs cannot contract measles. Timeline may match. Note that there is disagreement over the age of the measles virus: some calculate that it evolved around 1100-1300 CE (Furuse et al 2010) while others calculate 700-600 BCE (Düx et al 2020 [Manuscript without paywall]).
5. Plague (Yersinia pestis) is a bacterial disease that spreads through the bite of infected fleas (bubonic) or through respiratory droplets (pneumonic). After exposure, bubonic plague presents at 2-7 days with fever, chills, malaise, and buboes (swelling of the lymph nodes, especially those of the groin or armpits) and can progress to seizures and gangrene of the extremities. 30-90% mortality rate. Pneumonic plague can develop from bubonic plague, with the infection spreading into the lungs, or can be caught and will present after 3-7 days with rapidly developing pneumonia and fever that can cause death in as little as 36 hours. Near 100% mortality rate. It is difficult to find who first proposed plague, but it seems to go back at least as far as the 1940s. This matches with symptoms of fever, malaise, coughing and rare gangrene, but not with symptoms of gastrointestinal distress. Dogs can, in rare circumstances, contract plague. Timeline may match. It is generally considered unlikely that Thucydides's reference to "pustules" could possibly refer to the very distinctive swollen, blackening buboes that mark bubonic plague throughout history, which are therefore not mentioned. There is also no mention of an influx of rats, which is common (though not universal) to later histories of plague.

Secondary Suspects

1. Viral Haemorrhagic Diseases - including Lassa Fever (Lassa mammarenavirus), Dengue Fever (Dengue virus), or a disease from the Ebolavirus or Marburgvirus genuses. These are all viral diseases with varied methods of transmission (Lassa Fever from mouse droppings, Dengue Fever by mosquito, Ebolaviruses and Marburgviruses from bodily fluid contact) which present in short times with fever and bleeding (as small bruises, flushing, or "VHF syndrome" which is extreme full-body bleeding and circulatory shock). Mortality rates range from 1% (Lassa Fever) to 90-100% (early Ebola outbreaks). Due to the range of illnesses covered by this label, it is difficult to survey them all, but while Thucydides discusses "reddish, livid" skin he does not seem to discuss massive haemorrhagic events.
2. Ergot Poisoning - much like Lupus in House, Ergot poisoning or ergotism seems to crop up regularly in discussing historical mysteries. Ergotism comes from consuming grain infected with the fungus Claviceps purpurea which produces an alkaloid toxin. Ergotism can be convulsive (with seizures, spasms, diarrhoea, mania/psychosis, headaches, nausea and vomiting) or gangrenous (causing dry gangrene of the peripheries). Frankly, ergotism does not match many of the symptoms of the Plague of Athens, and it seems highly unlikely that a large proportion of the city would all become ill from infected grain at the same time, or that it would recur in following years.
3. Anthrax (Bacillus anthracis) is a bacterial disease which can spread through skin contact, ingestion, or inhalation. Cutaneous anthrax (of the skin) causes skin redness around an ulceration that can become necrotic, fatality rate 20%. Ingestion anthrax causes diarrhoea, sometimes bloody, and occasional vomiting of blood, fatality rate 25-75%. Inhalation anthrax causes fever, fatigue, coughing, shortness of breath, may develop nausea or altered mental status, and when the infection reaches the lungs a heightened fever, circulatory shock, and death in as little as 48 hours. Fatality rate near 100%. Proposed in 2003 by Holmes. While Holmes describes how anthrax can answer all of the primary symptoms discussed by Thucydides, the three types of anthrax do not typically overlap, and anthrax persists in the soil for up to decades yet the Plague of Athens is not described as having lingered or recurred in this way. Moreover, the largest recorded outbreak of inhalation anthrax is known to have killed at least 66 people, following a breach of the Biological Warfare facility in Sverdlovsk in the USSR (now in Russia) - and while Soviet secrecy means the number may have been higher, and vaccines were administered, it is still a long way from 100,000 deaths.
4. Scarlet Fever (Streptococcus pyogenes) is a bacterial disease which is a relatively rare complication of either strep throat or streptococcal skin infections. It presents with fever, coughing, and reddening of the skin with flat spots that develop into rough-feeling bumps. When untreated, the infection can spread to other areas of the body, most dangerously as encephalitis or endocarditis (infection of the heart's inner layers), and in some cases can cause acute rheumatic fever or severe kidney infections. Most cases resolve within 5-10 days, but fatality rate 15-20%. Proposed historically but viewed with doubt by the 1920s. Matches symptoms of fever, coughing and reddened skin, but not gastrointestinal distress, and is a complication of strep throat or of skin infections rather than a condition that will effect every infected person.
5. Syphilis (Treponema pallidum pallidum) is a bacterial disease which is transmitted sexually or from parent to foetus during pregnancy. I cannot find any source that actually proposes this as a reason, only sources refuting it, which seems eminently sensible given that large proportions of the city were supposed to have been infected at once.
6. Malaria (Plasmodium) is a parasitic disease transmitted by Anopheles mosquitoes (at least one subspecies of which historically inhabited Greece). It presents with a cyclic fever, vomiting, headaches, and in severe cases can cause jaundice, seizures, coma or death. However, malaria does not have anything like the death rate of the Plague of Athens, and as early as 1907 (Jones) it was considered that malaria was more likely to have been or to have become endemic in the region around this time. Hippocrates (who was born around 460 BCE, so was around 30 when this epidemic took place) wrote later in life on identifying fevers that had three-day or four-day cycles, which are specific to different forms of malaria. While Thucydides is not a doctor, it seems unlikely that he would miss the cycling nature of the fever, especially having experienced it himself, and malaria would not explain gastrointestinal distress.
7. Cholera (Vibrio cholerae) is a bacterial disease transmitted by the fecal-oral route. To be honest, I didn't even look deeply into this suggestion, because cholera has very distinctive "rice-water stool", or diarrhoea so extreme that it looks like cloudy water. Fever is rare in cholera (to the point that fever usually points at a secondary infection) and the throat/chest are not affected.
8. Influenza (Alphainfluenzavirus or Influenza A) is a viral disease transmitted by respiratory droplets. It presents with fever, coughing, and can cause gastrointestinal distress, but does not match with the reddish skin and pustules described by Thucydides. Moreover, most human flu strains are very rarely fatal - even the 1918-20 influenza pandemic is estimate to have had 2-3% mortality. Strains with higher fatality, such as H5N1 ("bird flu"), do not show human-to-human transmission and have fewer than 1,000 recorded cases altogether.
   1. An argument was at one time put forward that the Plague of Athens was caused by epidemics at the same time of influenza and staphylococcus infections (dubbed "Thucydides Syndrome"), which seems to have been generally rebuffed and occasionally mocked. While 2022 has shown that multiple epidemics or pandemics can be present at once, it is much rarer for individuals to be affected by both at the same time, let alone for a large percentage of individuals to be so affected. While influenza can leave people vulnerable to secondary infections, it does not do so reliably enough to sustain this argument.
9. Alimentary Toxic Aleukia (ATA) is a disease caused by ingesting grain infected by fungus (seemingly from the Fusarium genus) and was identified in 1945. It presents with nausea, vomiting, diarrhoea, bleeding, skin inflammation, pustules, depression, and death in up to 60% of those affected within 3-5 weeks of symptom onset. Proposed in 1994 by Bellemore et al. While it matches with some symptoms, it does not cause a fever, and though conditions were overcrowded and unpleasant in Athens it does not seem that they were desperate or approaching starvation - the Spartans only ever besieged the city for a few weeks at a time, and throughout Athens maintained her port and therefore connection to the outside world. ATA has only been rarely recorded among communities with entirely shared food sources. (Efremov, in 1984, provides a thorough coverage of the condition.)
10. Glanders (Burkholderia mallei) is a bacterial disease primarily associated with horses, but which can be contracted by humans. Proposed in 1962 by Eby and Evjen. Symptoms depend on the manner of exposure, similar to anthrax, but human infections are rare. Glanders as it is currently known seems an impossible match for the Plague of Athens; the authors of the paper point out that symptoms and fatality rates may vary from outbreak to outbreak, but do not outright suggest that this was a different subspecies as would seem to be necessary for transmission to occur.

• The Plague at Athens, 430-427 BCE - John Horgan. Covers a number of views of potential causes.

Outstanding Questions

1. Was it one disease which caused the Plague of Athens, or multiple?
2. Was this the first recorded outbreak of this disease?
3. Was it a disease which still exists today?
4. What disease or diseases most appropriately explain the symptoms and course laid out by Thucydides in his description of the epidemic?

• Surviving the Unsurvivable: How can some people recover from rabies after developing symptoms? And are there some who can survive infection unharmed without medical intervention?
• The "Mother of all Flu Pandemics" - Where did the 1918 H1N1 Influenza Pandemic Originate?
• Guinea Worm in Animals: New Trait, or Hidden History? Guinea worm is on the brink of eradication thanks to Jimmy Carter, but now reports are being made of the disease in animals. Is this new, or have they been there all along?
• What caused Encephalitis Lethargica? Was it autoimmune or viral? Does it continue to occur? And why did L-DOPA cause such incredible improvements in patients - only to end in such terrible declines?

Memphis Grizzlies at Atlanta Hawks

LEC 2023 SPRING