Fluorosis a problem for ancient Palmyrans and Herculaneum victims

A history resource article by Mary Harrsch © 2015

The great archway leading to the grand collonade in Roman Palmyra.  Image
courtesy of Wikimedia Commons.

A study suggests Palmyra's waters may have been ruinous in the end for the city's inhabitants. Palmyra, today, is a World Heritage Site, a designation bestowed by the United Nation Educational, Scientific and Cultural Organization in 1998. About 140 miles southeast of Damascus, the trading town known as Tadmor (also spelled Tadmur) to the ancients, later Palmyra, had been a center of trading since around 2000 B.C.E. But the town really bustled during the Roman Empire, and was filled with magnificent buildings throughout the 1st and 2nd century, beginning with the reign of Roman emperor Hadrian in 129 A.D.

Hadrian renamed the oasis town "Palmyra Hadriana." Modest guys, those Roman emperors. The city's wealth faded with the decline of Roman influence in ancient Syria.

Starting in 1990, Japanese archaeologists began excavating the southeast necropolis of Palmyra and examined remains from the Roman era. Despite Palmyra's prosperity, "skeletal remains uncovered from the underground tombs of Palmyra have been found to retain an arthropathy of the joints, especially in the knee joint, bone fracture, marked bone lipping, spur formation, and eburnation (smoothed bone cavities)," reports the team led by Kiyohide Saito of the Archaeological Institute of Kashihara in the Journal of Archaeological Science.

Funerary Portrait of Yarkhai, Son of Ogga and Balya his Daughter
from Palmyra in Roman Syria 150-200 CE Limestone.  Photographed at the
Portland (Oregon) Art Museum by Mary Harrsch © 2012.

Fluoride in small concentrations is thought to deter microbes that cause tooth decay, the reason why about 66% of public water supplies in the United States are now fluoridated, according to the federal Centers for Disease Control and Prevention. But the Palmyrans' symptoms, along with discolored teeth, point to "fluorosis," a skeletal and enamel-damaging syndrome caused by ingesting too much fluoride over a long time, the researchers note. Looking at two large tombs for example, 25 of 33 individuals (76%) had discolored teeth in one, and 45 out of 65 (69%) had discolored teeth in the other.

Palmyrans drank, and still drink, water from wells tapped from ground water by long tunnels called "qanats" (an excellent Scrabble word). The area's geology and water table has been stable for about 7000 years, meaning water conditions now aren't greatly different from those during Roman times. In a bid to estimate the fluoride burden suffered by the town's ancient inhabitants, the researchers analyzed the water from these wells. Fluoride levels were as high as three parts per million in the water, a level that a National Academy of Sciences report in March warned could lead to fluorosis.

Archaeologists also ground up seven discolored teeth from tomb inhabitants, and compared them to seven others without discoloration, to reveal their fluoride concentration. In a chemical reaction, fluoride tends to replace some calcium in tooth enamel, making overexposure to fluoride particularly worrisome for children with growing teeth and bones. The ground-up teeth revealed that in the most discolored ones, about 22% of the calcium had been replaced by fluoride. "Thus, it was possible to directly verify that the ancient inhabitants of Palmyra did suffer from fluorosis," they conclude.

Update, 2/19/2015:

Vesuvius still hovers threateningly over the remains
of Herculaneum near Naples, Italy.
Photo by Mary Harrsch © 2007.

In 1981 when skeletal remains of victims of the Vesuvius eruption were found in the boat chambers on the shore of Herculaneum, researchers were provided with another opportunity to study dental conditions of Roman residents in a different ancient setting. In The Lancet, researchers Gino Fornaciari, M. Rognini and M. Torino reported finding only 3.8% of teeth recovered from 41 adults and 12 children damaged from tooth decay.

"This percentage is very low for both modern and ancient populations, in which values were between 8.5%, as in classic Magna Graecia and 11.4%, as in Roman Britain," the researchers stated.

However, the researchers also discovered a high percentage of individuals with calcium-deficient tooth enamel - a condition often resulting from starvation at an early age but also found in well nourished individuals suffering from fluorosis.

"To elucidate this hypothesis, we examined thin sections of permanent teeth enamel (first molar) from 8 individuals found in the Herculaneum arches site and from a present-day patient from Pisa without evidence of fluorosis, as control," the researchers explained, "Enamel was analysed by energy dispersion system (EDS) with an SEM (Jeol) 6400 connected to a microanalysis system (EDS) (Noran-Tracor) with a detection of Z-MAX 30. Enamel fluorine concentrations were greater than 10-fold higher than normal (1500-3600 parts per million [ppm]) were recorded in 6 individuals."

Skeletal remains of 32 victims awaiting evacuation in the boat chambers of
Herculaneum.  Image courtesy of Tom Huesing via Flickr.

However, the condition was not found uniformly throughout all individuals in the sample and no fluorine was found in soil samples. But, researchers did find a strong concentration of fluorine in the water-bearing stratum of Herculaneum (3-8 mg/mL), with a calculated intake of 11.4-19.0 mg a day per person at the time of the volcanic eruption.

Researchers concluded that some of the sampled remains may have been visitors to the area, since the Roman aristocracy maintained vacation villas in the area.

Mary Queen of Scots Miscarriage Points to Collusion in Death of Lord Darnley

Mary Queen of Scots at Madame Tussaud's Wax Museum in
London.  Photographed by Mary Harrsch © 2006

A history resource article by Mary Harrsch © 2015

Interesting article in the Times Online about research by modern gynecologists:

"Mary Stuart, Queen of Scots, was an “adulteress and liar” who plotted to kill her husband in order to marry her lover, a study by modern gynecologists has suggested.

An intriguing medical analysis claims that Mary, the cousin of Elizabeth I, concocted a story of kidnap and alleged rape to justify her marriage to her third husband – potentially shedding light on a 400-year-old royal murder mystery.

Far from being the saintly and wronged Roman Catholic monarch portrayed in portraits and films, Mary was actually a “moral loose cannon”, whose striking beauty and sex appeal gave Elizabeth other reasons to imprison and execute her, the researchers suggest.

The study revolves around the report by Claude Nau, Mary’s adviser and secretary, that on July 24, 1567, at Loch Levan Castle, Kinross, Mary miscarried twins. Information about the miscarriage is scant, but in May 1567, just 12 weeks after the murder of Mary’s second husband, Lord Darnley, the Scottish Queen married James Hepburn, fourth Earl of Bothwell, who had abducted and “ravished” her at Dunbar Castle, in April, some sources say.

Henry Stuart (Lord Darnley) with his wife/cousin, Mary Queen of Scots circa 1565
by unknown artist.  Image courtesy of Wikimedia Commons.

Mary later claimed that her pregnancy began after her marriage but experts now say this is impossible.

In a study published in the Journal of Family Planning and Reproductive Healthcare, Lesley Smith, a medical historian, claims that it would have required modern microscopes and knowledge about fetal development to identify that the miscarriage was of twins after the seven weeks of pregnancy that Mary claimed.

It would also have been an “astonishing coincidence” if conception occurred at the time of the “rape”, and even then the twins would have been just 12 weeks old and hard to identify upon miscarriage.
Instead, it is more likely that “the widowed Mary had an affair with Bothwell, became pregnant and had used the abduction story as a cover for her condition and justification for marriage,” Ms Smith says.

Along with other historians, she believes both Mary and Bothwell to have been implicated in the death of Darnley, a drunken and controversial figure who was found strangled at Kirk O’Fields, Edinburgh, after being married to Mary for just 19 months.

Bothwell was a prime suspect but was acquitted at what is now regarded as a sham trial.

James Hepburn, the 4th Earl of Boswell c. 1535-1578.
Image courtesy of Wikimedia Commons.

“Mary had an undoubted passion for Bothwell, her supposed kidnapper, and did not try and escape from him despite ample opportunity. By contrast, she hated Darnley and was publicly separated from him by the time of his murder. The suspicion of an affair is not a new idea,” Ms Smith says, “but the medical evidence brings us very much closer to the likely truth.”

Tony Roberts, a consultant obstetrician at Queen’s Hospital, Burton on Trent, says that it would have required “a sensible and weathered eye” to identify a twin miscarriage at 12 weeks.

“If you want to prove pregnancy, a midwife in those days should have been able to do this, but standards were low, even for a queen,” he adds.

As such, Claude Nau’s report of the miscarriage implies that Mary became pregnant by Bothwell well before the abduction. The unlikely possibility that Darnley was the father would have left the Queen at least five months pregnant with the twins, a condition which would have been “hardly unnoticeable”, Ms Smith says.

The researcher, who is the curator of Tutbury Castle in Staffordshire, where Mary was held prisoner, says her theory further explains the animosity between Mary and Elizabeth I.

Remains of Tutbury Castle in Staffordshire, England where Mary Queen of Scots
was held prisoner.  Image courtesy of Wikimedia Commons.

“Mary Stuart was a remarkable specimen of humanity,” she writes. “She was 5 ft 11 in when the average woman was around 4 ft 11 in, so she was the equivalent of 6 ft  5 in by modern standards. [She] was also beautiful and very sexually attractive. “All in all, Mary Queen of Scots was a very dangerous creature to the unmarried Protestant Elizabeth, and her physical presence made her positively intoxicating to anyone who met her.”

She said: “All the available evidence creates a damning impression. Elizabeth probably considered Mary to be a moral loose cannon and fool for men. It is also interesting that, while Mary was prisoner in England there was no Catholic nation that made a serious attempt to release her: was there a more widely held view that she was better out of the way?”

Queen of plots

December 1542 Mary born to James V of Scotland. Her father dies when she is six days old and Mary becomes Queen of Scotland

1548 Henry VIII begins his “rough wooing” — a military campaign designed to impose marriage to his son on Mary. Instead she promises to marry the French Dauphin and flees to France

1559 Marries François II

1561 She returns to Scotland following François’s death

1565 Marries Henry Stuart, Lord Darnley, her first cousin, below. Their son, James I of England, is born the following year

February 1567 Darnley found dead. James Hepburn, 4th Earl of Bothwell, bottom, is prime suspect

April 24 1567 Mary visits her son for the last time at Stirling but is abducted by Bothwell and taken to Dunbar Castle, where she is allegedly raped

May 15 1567 She marries Bothwell, a Protestant, to preserve her honour, but is condemned by the Scottish nobility

July 24 1567 Imprisoned at Loch Levan Castle by her own people, she miscarries twins and is forced to abdicate the Scottish throne

May 1568 Mary escapes but is defeated at Battle of Langside and flees to England, where she is captured and spends the next 19 years as a prisoner

1578 Bothwell dies, insane and imprisoned in Denmark

1587 Mary is found guilty of treason and executed.

Shakespeare's Portraits Point to Mikulicz Syndrome and Systemic Sarcoidosis

A history resource article by Mary Harrsch © 2015

Several years ago I posted an abstract from an article about the controversy surrounding a death mask identified as William Shakespeare. I received an email from University of Mainz academic Hildegard Hammerschmidt-Hummel, who is a champion of the mask, pointing out that she has written a book about the mask entitled "The True Face of William Shakespeare. The Poet's Death Mask and Likenesses from Three Periods of His Life". In it, she explains the scientific methods she used to analyze the mask and compare it to four Shakespearean portraits.

She also includes information about how the portraits and mask point to the cause of Shakespeare's early death at 52 years old.

"By combining exhaustive academic research with the latest technology and collaborating over
many years with specialists from the most varied disciplines - including forensic experts from the German Federal Bureau of Criminal Investigation (BKA=CID), Professors of Medicine, 3D imaging engineers, archivists and an expert on old masters - Hildegard Hammerschmidt-Hummel has proved the authenticity of the Chandos portrait, the Darmstadt death mask and the Flower portrait (recently incorrectly dismissed as a ‘fake’ by the National Portrait Gallery, as shown by the author's latest evidence). Her revolutionary research has also authenticated another true face of Shakespeare - the Davenant bust. This haunting sculpture has resided in the Garrick Club since 1855 and was thought to be the work of an eighteenth century sculptor. According to the author’s new documentary sources, it derives from the collection of Sir William Davenant (1606-1668), Shakespeare’s godson, who also owned the Chandos portrait.

William Shakespeare at Madame Tussaud's
Wax Museum in London.  Photo by Mary Harrsch
© 2006

By tracing the development of certain signs of illness in each of the images, first noticed by
Hildegard Hammerschmidt-Hummel, the author’s medical experts have identified and verified the most probable cause of Shakespeare’s death. The conspicuous growth on the upper left eyelid, they interpreted as Mikulicz Syndrome (a probably cancerous abnormality of the tear glands), the swelling in the nasal corner of the left eye as a fine caruncular tumour, and the considerable swelling on the forehead (in conjunction with the other pathological symptoms) as systemic sarcoidosis, an inner disease that affects the organs and takes a very protracted course, but proves to be fatal."

Beethoven: A Symphony of Illness

A history resource article by Mary Harrsch © 2015

Portrait of Ludwig Van Beethoven by Joseph Karl Stieler, 1820.
Image courtesy of Wikimedia Commons.

"A 56-year-old Beethoven sought medical care after suffering chills, fever, respiratory distress, and spitting up blood. He complained of chest pain on the right side. He said he had been in good health until two weeks before when he noted a loss of appetite, diarrhea, weight loss, increased thirst, and a swelling of his feet and abdomen. He admits he had been working in the cold at his brother's country home dressed in only flimsy clothing and returned in an open-air cart."

Thus begins a study to determine what may have caused Beethoven's death as a clinical exercise at a 1999 clinical pathologists' conference at the University of Maryland School of Medicine. Each year, a team of practicing pathologists select a famous individual from the past whose manner of death remains speculative and attempt to derive a definitive cause of death.

Beethoven's case is examined by Drs. Michael S. Donnenberg, Michael T. Collins, R. Michael Benitez and Philip K. Mackowiak with their results entitled "The Sound That Failed" ultimately published in The American Journal of Medicine in 2000 (Volume 108, p. 475-480).

The pathology team continues:

"In addition to suffering from progressive deafness that began in his early twenties, the patient suffered recurrent bouts of depression, social isolation and personal neglect. He also began suffering from abdominal pain that he relieved with alcohol. The patient had survived smallpox as a child as well as typhus or typhoid fever. He subsequently claimed to have intermittent winter attacks of "asthma" since the age of 17. In his late forties he noted the onset of chronic headaches and recurrent joint pains which were thought to be rheumatism or gout. At age 51 he suffered an episode of jaundice that lasted six weeks. He also developed a painful eye affliction that was resolved after nine months of patching and noted that he experienced increasing swelling of the lower extremities accompanied by intermitten bouts of nosebleeds, vomiting blood, and coughing or spitting of blood."

"Physical examination revealed a stocky, powerfully built but somewhat emaciated man of swarthy complexion. His face was flushed and prominently pockmarked. His lips were thin and parched, his tongue dry and coated. The skin was hot, flushed , and dry and showed evidence of hair loss."

What was the instrument of the famous composer's death?  (PDF of original article reprinted with permission)

Did the Roman Emperor Claudius accidentally die of poison mushrooms or marital treachery?

A history resource article by Mary Harrsch © 2015

Bust of the Roman Emperor Claudius
Photographed at the Museo Archaeologico
Nazionale di Napoli in Naples, Italy
by Mary Harrsch © 2007

"He ate and drank in excess regularly, rarely leaving his dining room until he was "stuffed and soaked". This caused him to gain considerable weight in later years and produced heartburn so severe that it is reported that he contemplated suicide as his only means of relief."

Thus begins a study to determine what may have caused the Roman Emperor Claudius' death as a clinical exercise at a 2001 clinical pathologists' conference at the University of Maryland School of Medicine. Each year, a team of practicing pathologists and historical consultants select a famous individual from the past whose manner of death remains speculative and attempts to derive a definitive cause of death.

Claudius' case is examined by Drs. William A. Balente, MD, Richard J. A. Talbert, PhD, Judith P. Hallett, PhD and Philip K. Mackowiak, MD.

The researchers continue:

"Born prematurely after only 7 months of gestation, he suffered from a succession of disorders including milk allergy, malaria, measles, deafness, and colitis. He suffered from weakness in both legs to the extent that he noticeably limped and could not walk more than a short distance without assistance. He had longstanding tics and jerks of his head and hands, as well as a stammer and drooling, which were most pronounced when he was excited. He was also prone to fits of inappropriate laughter."

Claudius cowers behind a curtain after the murder of his younger brother,  the
Roman emperor Gaius (Caligula) Caesar.  He is astonished when the Praetorian
Guard declare him Emperor instead of murdering him as well.  "A Roman
Emperor AD 41" by Sir Lawrence Alma-Tadema courtesy of Wikimedia.

"A physical examination revealed that his temperature was normal butt his abdomen was mildly tender throughout."

"An attending physician induced additional vomiting by placing a feather in the back of the patient's throat. Shortly thereafter, the emperor became confused and exhibited signs of unremitting abdominal pain and fecal incontinence. He died 12 hours later."

Was it a case of the "cure" being worse than the disease? (PDF of original article reprinted with permission)

Although the team ends up suspecting that a particular variant of mushroom was a contributor to Claudius' death, surprisingly, the researchers point to Claudius' existing physical disabilities as the reason the episode is ultimately fatal.  In fact, the researchers suspect if Claudius had not be otherwise impaired, the assassination attempt probably would have failed.

I found Dr. Valente's  discussion of possible causes of Claudius' long list of physical defects to be most interesting.  He eventually arrives at a conclusion that Claudius suffered from congenital dystonia caused by abnormal basal ganglia - brain cells interconnected with the cerebral cortex, thalamus, and brainstem - the result of an extremely premature birth. Typical of this disorder, Claudius suffered from a twisting of the foot, involuntary cranial and cervical muscle contractions, an inability to control salivation at times and hypertrophy of the neck muscles as seen in some of his portrait sculptures.  Claudius' excellent cognitive function, however, enabled the researchers to eliminate a number of other conditions.

Pericles: What plague killed the father of the Parthenon?

A history resource article by Mary Harrsch © 2015

Portrait of Pericles 1st century BCE Roman
copy of 5th century BCE Greek original from
Lesbos.  Image courtesy of Wikimedia Commons

"Fever, headache, sore throat, and vomiting developed in a 65-year-old man.  He had been in excellent health until approximately 1 week earlier, when he had sudden onset of headache, ocular erythema, and halitosis.  On the third day of illness, he began to sneeze and cough, and noted bilateral pleuritic chest pain.  On the sixth day, he developed projectile vomiting of dark, bilious fluid.  At this time, he complained of fever so intense that he would not allow himself to be covered with even the lightest clothing.  He also complained repeatedly of intense thirst.  Although he drank copious amounts of water, his thirst persisted, worsened by frequent vomiting."

Thus begins a study to determine what may have caused the death of the famous Athenian stateman, Pericles, as a clinical exercise at a 2000 clinical pathologists' conference at the University of Maryland School of Medicine. Each year, a team of practicing pathologists and historical consultants select a famous individual from the past whose manner of death remains speculative and attempts to derive a definitive cause of death.

The death of Pericles is examined by Drs. David T. Durack, MD, Robert J. Littman, PhD, R. Michael Benitez, MD and Philip K. Mackowiak, MD. Their paper, Hellenic Holocaust: A Historical Clinico-Pathologic Conference was published in the American Journal of Medicine in 2000 (Volume 109: pages 391-397).

Phidias showing the Parthenon frieze to Pericles, Aspasia, Alcibiades and Friends
by Sir Lawrence Alma-Tadema, 1868.  Image courtesy of Wikimedia Commons.

Thucydides reported that desperate patients racked with thirst and fever plunged into cisterns and wells seeking relief. Of the few survivors, some lost fingers and toes from peripheral gangrene, others suffered blindness, and there were also reports of survivors experiencing a complete loss of memory.

Bust of the Greek general and
historian, Thucydides at the
Royal Ontario Museum.  Image
courtesy of Wikimedia Commons.

Research indicates the disease originated in Africa then spread to the Persian Empire and ultimately to a beseiged Athens via the port of Piraeus where it attacked a population of almost 400,000 condensed into 4 square miles. But which variety of plague was it?

What do the experts say? (PDF of original article reprinted with permission)

Update: In 2006, a research group led by Manolis Papagrigorakis of the University of Athens extracted pathogen DNA from three teeth recovered from skeletal remains found in the ancient necropolis of Kerameikos dated to approximately 430 BCE and assumed to be victims of the great plague.  The only pathogen Papagrigorakis and his team could identify was a strain resembling Salmonella enterica serovar Typhi (typhoid fever).  Papagrigorakis' report that appeared in May 2006 in Volume 10, Issue 3, Pages 206–214 of the International Journal of Infectious Diseases entitled DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens (full text) was immediately refuted by Beth Shapiro and Andrew Rambaut of the Henry Wellcome Ancient Biomolecules Centre at Oxford University as well as M. Thomas P. Gilbert of the Niels Bohr and Biological Institutes, University of Copenhagen in a letter (full text) to the same journal.

Shapiro points out, "The authors’ diagnosis is based on a similarity score, resulting from BLAST comparisons between their amplified fragments and published sequences. Specifically, the authors report a 7% divergence between their sequences and S. enterica serovar Typhi, and 8% divergence between their sequence and the next most closely-related Salmonella strain, S. typhimurium. Based on the closer match to S. enterica, the authors conclude that ‘‘[if] another, yet unknown pathogen... was the actual cause of the Plague of Athens, it would have to be closely related to S. enterica and definitely closer than S. typhimurium.’’

Greek warriors depicted on a 5th century BCE gravestone.
Permanent collection of the British Museum.
Photographed by Mary Harrsch © 2012

"This statement, however, is simply not true. Although the Athens sequence is indeed slightly more similar to S. enterica, the two cited Salmonella species are actually much more closely related to each other, with less than 1% divergence for the sequenced gene. In fact, if a simple phylogenetic analysis is performed, the ancient sequence is shown to fall outside both S. enterica and S. typhimurium, as well as several other Salmonella species (Figure 1). While this analysis confirms that the Athens sequence is possibly Salmonella, it demonstrates clearly that it is not typhoid (97% bootstrap value). Based on the evolutionary timescale inferred for Salmonella and E. coli, the Athens sequence and typhoid would have shared a common ancestor in the order of millions of years ago."

Then, in 2013, a thesis, entitled A novel offering of Avian Influenza as the causative agent of the Plague of Athens: contextual and paleopathological analysis of the 5th century BCE Plague of Athens via primary resources and modern DNA sequence-based identification strategies of dental pulp from a mass grave at Kerameikos, was published by Karen Spence.  Although Spence was less critical of the Papagrigorakis team's conclusions, she pointed out that the sequencing procedure used would not have identified any RNA-based pathogens.  She acknowledged the Maryland pathologists' conclusions that human-to-human communicated influenza would not have had a high enough mortality rate to be a good match for the Athens pathogen (which had an estimated mortality rate of 25%).  But, she proposes that zoonotic avian influenza passed from domestic poultry to humans would have.  Spence points out that when refugees from the surrounding countryside flooded into Athens, they probably brought smaller animals with them like pigs and chickens.  She proposes that some of the poultry were carriers and quickly infected other birds in the confined quarters.  The animals then passed the disease to their human caregivers.  Birds often carry the pathogen without succumbing to the disease themselves.  Even if some of the birds died, they were probably eaten, due to the conditions of the siege.  She postulates that an infected reservoir of birds would have retained the pathogen over a long period of time accounting for several years of plague rather than a flare up that would quickly die down as in the case of human-to-human transmitted influenza.

Roman mosaic of doves drinking from a bowl from 2nd century BCE
Greek original by Sosos recovered from Pompeii.
Photographed at the Capitoline Museum in Rome, Italy by Mary Harrsch
© 2009 

Although Spence makes a convincing case, she indicates in her table comparing symptoms of  the Athenian plague with Typhoid Fever and Avian Flu that neither pathogen usually results in the survivor pathologies described by Thucydides.  It is the survivor pathologies that are carefully addressed by the Maryland pathologists in their conclusion that the most likely causative pathogen was typhus and why I find the Maryland analysis most convincing.

Since avian flu cannot be transmitted from human to human, I was also skeptical that Pericles, a wealthy statesman, would have had contact with chickens, other than to eat one.  Likewise, I would doubt his household steward would resort to obtaining a dead chicken from a lower class meat market that may have procured diseased carcasses. I also question why the disease would first appear in Piraeus, the port, as most refugees came from the surrounding countryside. The affliction was also reported as previously occurring in Ethiopia and Persia.  Neither location suffered from siege concentrations where poultry may have been in particularly close contact with humans.

Of course there is the possibility the besieged Athenians imported poultry as a protein food source since they no longer had access to cattle that were left behind in the fields. But it is more likely that being a seafaring people, they would have relied upon fish instead.

However, I appreciated the comparative table Spense uses to clearly demonstrate typhoid fever's lack of many of the attributes of the plague described by Thucydides.  I would have liked to have seen such a table covering all 29 pathogens that have been proposed over the last 150 years of study.

In my research I also found an interesting article about new DNA extraction techniques developed in just the last five years that were used on victims of the Justinian plague at the Ancient DNA Centre of McMaster University in Hamilton, Canada.  It made me wonder if the new method would be more successful with the Athenian samples.  I would also like to see an attempt made specifically on adult females from the Kerameikos remains. Thucydides recorded that caregivers suffered an extremely high rate of infection and mortality and in ancient Athens, as today, most caregivers would have been female. There did not seem to be any reference to gender in the Papagrigorakis report. If gender was not considered I think this could be a significant barrier to more conclusive results.

The idealized Spartan warrior, Leonidas
Image courtesy of Wikimedia Commons.  Edited by Mary Harrsch.

At the time of the plague, Athens was besieged by Sparta and male corpses from the ongoing conflict could have been included in the mass burial. Some historians would disagree on this point because death in battle would have a significant element of honor involved and mass burial of such individuals would have been particularly impious. But, a community in the grip of a severe plague where there were large accumulations of unburied corpses and a shortage of able bodied men to dispose of corpses, could have resorted to mass burial of at least some war casualties.  Thucydides said the population of Athens was so morally distressed by the plague that funerary rituals were "universally violated" (History of the Peloponnesian War - 2.52.3) - clearly supporting the possibility of mass burial, even of war casualties. Also, the Papagrigorakis study was conducted on only three teeth from randomly chosen victims apparently without regard to gender.  I would feel much more confident in the results if more victims were sampled.

Of course, we cannot even be sure the mass burial at Kerameikos was even a result of the so-called Athenian plague. Although excavators dated the burial fairly precisely to 430 - 426 BCE, dating methodologies are not so precise. The burial could be from an epidemic occurring before, concurrent with, or after the plague onset. The crowded siege conditions could have easily resulted in several concurrent diseases that would not necessarily include the pathogen responsible for the symptoms reported by Thucydides and observed in Pericles.