Target Health Blog

First Plague of the Roman Empire

May 11, 2020

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History of Medicine
Source:

A group of physicians in an image from the Vienna Dioscurides, named after the physician Galen shown at the top center.
Graphic credit: by Unknown author - Scan au's: Pedanius Dioskurides -- Der Wiener Dioskurides, Codex medicus Graecus 1 der Osterreichischen Nationalbibliothek. Graz: Akademische Druck- und Verlagsanstalt 1998 (Glanzlichter der Buchkunst; Band 8) fol. 3 verso. Erlauterung: Kommentar von Otto Mazal S. 19 f. ISBN 3-201-01699-3, Public Domain, Wikipedia Commons

During the Imperial Period of Rome, disease was a harsh reality of life. As the borders of the empire continuously expanding and the population steadily growing, cities in the Roman Empire were exposed to a multitude of diseases. The afflictions ranged in severity, some being catastrophic and others being not quite as deadly. The most infinite of plagues during this period was the Antonine Plague (165-180 CE). According to the Roman physician Galen, “This populous city, where daily ten thousand people can be discovered suffering from jaundice, and ten thousand from dropsy.“ While there are few documents remaining from the time period documenting demographics, there are many modern technologies that provide more data as to why certain diseases were much more deadly than others.

The Antonine Plague is certainly one of the most infamous plagues in Roman history. Having no immunity to the plague, which was brought from soldiers returning form campaign in Western Asia, lead to catastrophic results for the Romans. The main symptoms included diarrhea, skin sores and irritations and sore throats. The legions were hit by the plague hard, with cramped conditions and living quarters, the disease spread violently, reportedly decimating the Roman forces. Evidently, the plague hit the civilian population of the City and Empire of Rome. Emperor Marcus Aurelius implemented several changes which suggest the sire status of the Empire. This included loosening the regulations for membership of higher councils in multiple important settlements throughout the empire, including Athens.

Egypt was another region that saw catastrophic loss in the populations of their cities, this was demonstrated in the papyrus scripts documenting the loss in revenue from the massive decrease in population. The entire empire was facing hardship from the plague. Public building projects ceased in many of the provinces' major cities, including London. This all simultaneously happening while the empire faced attacks from the Sarmatians in the east. It is estimated that up to 15% of the Roman population was wiped out during the ten year plague, including Emperor Marcus Aurelius in 180 CE. It is estimated that the Antonine Plague's impact on the Roman Empire was devastating and the effects lasted for centuries after the fact, some historians arguing that it permanently crippled the Empire and assisted in its destruction and downfall.

The Antonine Plague was named after the emperor whose reign it originated in, Aurelius Antoninus according to Louise Cilliers and Francis Retief. Historical sources suggest that Roman soldiers returning from campaign in Mesopotamia spread the disease. Including substantial army deaths, the outbreaks decimated an estimated two thirds of the Roman population, killing roughly 2000 people per day. The epidemic may have claimed the life of a Roman emperor, Lucius Verus, who died in 169 CE and was the co-regent of Marcus Aurelius Antoninus, whose family name, Antoninus, has become associated with the epidemic. The disease broke out again nine years later, according to the Roman historian Dio Cassius (155-235), and caused up to 2,000 deaths a day in Rome, one quarter of those who were affected, which gives the disease a mortality rate of about 25%. The total deaths have been estimated at 5 million, and the disease killed as much as one third of the population in some areas and devastated the Roman army.

Ancient sources agree that the epidemic appeared first during the Roman siege of Seleucia in the winter of 165-166. Ammianus Marcellinus reported that the plague spread to Gaul and to the legions along the Rhine. Eutropius asserted that a large population died throughout the empire. The plague affected Roman culture and literature and may have severely affected Indo-Roman trade relations in the Indian Ocean.

In 166, during the epidemic, the Greek physician and writer Galen travelled from Rome to his home in Asia Minor and returned to Rome in 168, when he was summoned by the two Augusti, the co-emperors Marcus Aurelius and Lucius Verus. He was present at the outbreak among troops stationed at Aquileia in the winter of 168/69. Galen briefly recorded observations and a description of the epidemic in the treatise Methodus Medendi, and he scattered other references to it among his voluminous writings. He described the plague as “great“ and of long duration and mentions fever, diarrhea and pharyngitis as well as a skin eruption and sometimes dry and sometimes pustular that appeared on the ninth day of the illness. The information that was provided by Galen did not clearly define the nature of the disease, but scholars, as mentioned above, have generally preferred to diagnose it as smallpox.

The historian William McNeill asserts that the Antonine Plague and the later Plague of Cyprian (251-ca. 270) were outbreaks of two different diseases, one of smallpox and one of measles but not necessarily in that order. The severe devastation to the European population from the two plagues may indicate that people had no previous exposure to either disease, which brought immunity to survivors. Other historians believe that both outbreaks involved smallpox. The latter view is bolstered by molecular estimates that place the evolution of measles sometime after 500 CE.

Impact on the Arts

In their consternation, many turned to the protection offered by magic. Lucian of Samosata's irony-laden account of the charlatan Alexander of Abonoteichus records a verse of his “which he despatched to all the nations during the pestilence... was to be seen written over doorways everywhere“, particularly in the houses that were emptied, Lucian further remarks.

The epidemic had drastic social and political effects throughout the Roman Empire. Barthold Georg Niebuhr (1776-1831) concluded that “as the reign of Marcus Aurelius forms a turning point in so many things, and above all in literature and art, I have no doubt that this crisis was brought about by that plague.... The ancient world never recovered from the blow inflicted on it by the plague which visited it in the reign of Marcus Aurelius.“ During the Marcomannic Wars, Marcus Aurelius wrote his philosophical work Meditations. A passage (IX.2) states that even the pestilence around him was less deadly than falsehood, evil behavior and lack of true understanding. As he lay dying, he uttered the words, “Weep not for me; think rather of the pestilence and the deaths of so many others.“ Edward Gibbon (1737-1794) and Michael Rostovtzeff (1870-1952) assigned the Antonine plague less influence than contemporary political and economic trends, respectively.

Military Concerns

Some direct effects of the contagion stand out. When imperial forces moved east, under the command of Emperor Verus, after the forces of Vologases IV of Parthia attacked Armenia, the Romans' defense of the eastern territories was hampered when large numbers of troops succumbed to the disease. According to the 5th-century Spanish writer Paulus Orosius, many towns and villages in the Italian Peninsula and the European provinces lost all of their inhabitants. As the disease swept north to the Rhine, it also infected Germanic and Gallic peoples outside the empire's borders. For a number of years, those northern groups had pressed south in search of more lands to sustain their growing populations. With their ranks thinned by the epidemic, Roman armies were now unable to push the tribes back. From 167 to his death, Marcus Aurelius personally commanded legions near the Danube, trying, with only partial success, to control the advance of Germanic peoples across the river. A major offensive against the Marcomanni was postponed to 169 because of a shortage of imperial troops.

Indian Ocean Trade

Although Ge Hong was the first writer of traditional Chinese medicine who accurately described the symptoms of smallpox, the historian Rafe de Crespigny mused that the plagues afflicting the Eastern Han Empire during the reigns of Emperor Huan of Han (r. 146-168) and Emperor Ling of Han (r. 168-189) - with outbreaks in 151, 161, 171, 173, 179, 182, and 185 CE - were perhaps connected to the Antonine plague on the western end of Eurasia.

De Crespigny suggests that the plagues led to the rise of the cult faith healing millenarian movement led by Zhang Jue (d. 184), who instigated the disastrous Yellow Turban Rebellion (184-205). He also stated that “it may be only chance“ that the outbreak of the Antonine plague in 166 coincides with the Roman embassy of “Daqin“ (the Roman Empire) landing in Jiaozhi (northern Vietnam) and visiting the Han court of Emperor Huan, claiming to represent “Andun“ (a transliteration of Marcus Aurelius Antoninus or his predecessor Antoninus Pius).

Raoul McLaughlin wrote that the Roman subjects visiting the Han Chinese court in 166 could have ushered in a new era of Roman Far East trade, but it was a “harbinger of something much more ominous“ instead. McLaughlin surmised that the origins of the plague lay in Central Asia, from some unknown and isolated population group, which then spread to the Chinese and the Roman worlds. The plague would kill roughly 10% of the Roman population, as cited by McLaughlin, causing “irreparable“ damage to the Roman maritime trade in the Indian Ocean as proven by the archaeological record spanning from Egypt to India as well as significantly decreased Roman commercial activity in Southeast Asia. However, as evidenced by the 3rd-century Periplus of the Erythraean Sea and the 6th-century Christian Topography by Cosmas Indicopleustes, Roman maritime trade into the Indian Ocean, particularly in the silk and spice trades, certainly did not cease but continued until the loss of Egypt to the Muslim Rashidun Caliphate. Chinese histories also insist that further Roman embassies came to China by way of Rinan in Vietnam in 226 and 284 CE, where Roman artifacts have been found.

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