It's a mystery that has stumped doctors and historians for almost 2,500 years: What killed Pericles, the leading statesman of ancient Athens, and helped to crush one of the greatest cultures the world would ever see?
You'd think the clues were all there. Historians were left with a detailed account of the symptoms that claimed not only Pericles but a quarter of the city's population in 429 B.C. -- fever, pustules, chest pain, and a thirst that drove crazed victims to leap into rain barrels.
Over the years, doctors have suggested 29 diseases that might have caused the epidemic. The list includes smallpox, influenza, bubonic plague, measles, dengue and scarlet fever.
Yesterday, about 150 doctors, students and invited scholars filed past the tall Doric columns of Davidge Hall at the University of Maryland School of Medicine to hear a leading medical authority dissect the mystery and suggest a solution.
"Typhus," said Dr. David Durack, former chief of infectious diseases at Duke University.
"The three best fits are smallpox, Lassa fever and typhus, but I think it's typhus," said Durack, vice president of medical affairs at Becton Dickinson Microbiology Systems. "It hits hardest in times of war and privation, it has about 20 percent mortality, it kills its victims after about seven days and it sometimes causes a striking complication: gangrene of the tips of the fingers and toes."
Pericles, whose early symptoms included headache and bad breath, suffered for 11 days before his heart failed. The man who brought art, democracy and military power to Athens was dead at 65.
Typhus, caused by a microorganism similar to bacteria, has largely disappeared from the world except for parts of tropical Africa. Since ancient times, it has preyed upon people during natural disaster, famine and war. It flared in the Balkans during World War I, in Russia during World War II. Typhus is not to be confused with typhoid fever, an unrelated scourge.
Durack and Robert Littman, a professor of classical languages at the University of Hawaii, were the guest "detectives" at an annual conference in which experts attempt to identify the disease that afflicted an historical figure.
In the past four years, they have proposed answers to the deaths of Edgar Allan Poe (rabies), Alexander the Great (typhoid fever) and Beethoven (syphilis).
The exercise is a twist on a traditional teaching tool in which a doctor is provided a chronology of symptoms for a patient who just died, and asked to determine the cause.
"We selected this plague because it is one of the most famous and mysterious of all time," said Dr. Phillip A. Mackowiak, vice chairman of medicine at the UM medical school and medical director at the Veterans Affairs hospital in Baltimore, the two sponsoring institutions.
Littman said the plague has intrigued historians because it contributed not only to the downfall of Athens but also to the end of Greece's Golden Age. Historians were left an exquisite description that later served as a model for how cultures would observe and record future scourges such as bubonic plague.
The account was given by the historian Thucydides, a contemporary of Pericles who contracted the disease but survived. "All speculation as to its origin and its causes I leave to other writers, whether lay or professional," wrote Thucydides in his "History of the Peloponnesian War."
"For myself, I shall simply set down its nature and explain the symptoms by which perhaps it may be recognized if it should ever break out again."
The epidemic broke out early in the Peloponnesian War, as a quarter of a million Athenians crowded into a 4.4 square mile area to escape the attacking Spartans.
"The disease had a lot of dramatic features: fever, headache, vomiting, conjunctivitis, cough, wretching, an inflamed throat," Durack said. "Also, a rash of some kind, though it's hard to be sure what rash." Many diseases cause many, if not all of, those symptoms.
One popular candidate is influenza, which is known to cause epidemics such as the one that swept the world in 1918, killing more people than perished in World War I. But killer flus tend to strike suddenly and disappear.
"This one went on for a year, died back to a low level and came back three years later," Durack said. "Flu wouldn't do that."
Another possibility is a plant toxin -- say, a fungus similar to ergot -- that could have entered the food supply. "But plant toxins don't tend to come in epidemics," he said. "They tend to be here and there," persisting over a longer period of time.
Spinal meningitis causes many of the symptoms but kills within a day or two.
Smallpox, said Durack, is a close match because it causes a rash, produces large epidemics and had a nasty tendency to break out during wars. "It's not a bad theory, but you either die from it or you get better with scars." Thucydides never mentioned scars, and he was too careful an observer to miss an obvious detail like that.
Lassa fever was a tempting choice; rodents aboard ships could have brought the disease from Africa. But Lassa doesn't cause three remarkable symptoms that struck many of the Athenians: blindness, amnesia and gangrene that caused some people to lose their fingers, toes and genitals.
Typhus causes all three, and its mode of transmission -- body lice -- makes sense considering the miserable conditions under which the besieged Athenians were living.
"I think it's a pretty good fit," said Durack, who allowed that he could be completely wrong. The answer might be another animal-borne disease that has since disappeared, he said.
A scholar of ancient medicine, Littman said puzzles like these inspire people to think more sharply about the plagues that strike fear today -- AIDS, Ebola, even the possibility of another killer flu.
"We're all scared of unknown diseases that will come and strike," Littman said. "The reason people fear it is that it's happened in history. When we know what it is, we understand it, we can put a name to it. We have power."
Pub Date: 1/30/99