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American Journal of Epidemiology Vol. 140, No. 7: 621-628
Copyright © 1994 by The Johns Hopkins University School of Hygiene and Public Health

research-article

"Thucydides Syndrome" Reconsidered: New Thoughts on the "Plague of Athens"

David M. Morens1, and Robert J. Littman2

1Department of Tropical Medicine, School of Medicine, and Department of Public Health Sciences, School of Public Health, University of Hawaii Honolulu, HI
2Department of European Languages and Literature, University of Hawaii Honolulu, HI

Reprint requests to Dr. David M. Morens, School of Medicine, University of Hawaii, Biomedicine D103, 1960 East-West Road, Honolulu, HI 96822

A recently published theory (N Engl J Med 1985;313:1027–30) argues that the famous Athenian epidemic of 430 B.C. was caused by a combination of influenza and toxin-producing staphylococci (the "Thucydides syndrome"). Although it is accepted by some medical authorities, and ostensibly supported by identification of modern cases, the theory's plausibility has not been carefully examined. The authors used an epidemiologic approach supplemented by historical and clinical observations to ex amine the likelihood that a "Thucydides syndrome" could have caused the Athenian epidemic. Arguing against the influenza theory are epidemiologic and clinical features of the disease, mathematical models of the spread of influenza, and empirical obser vations of epidemic influenza in premodern populations of known size and crowding. The authors conclude that neither influenza nor a "Thucydides syndrome" could have produced the Athenian epidemic. Epidemiologic features suggest either a zoonotic or vectorborne disease, a disease associated with an environmental source, or a respi ratory infection with unusual alternative mechanisms of spread.

epidemiology; history of medicine; influenza; shock; septic; Staphylococcus


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