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Diseases and Pandemics in Ancient Rome

Diseases and Pandemics in Ancient Rome

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During antiquity, Rome was an international metropolis, a melting pot bustling with people from all four corners of the empire. The city had impressive marble structures towering over overcrowded buildings called insulae, and different dialects rang out in the streets, packed with people from various backgrounds. The Romans grasped the connection between hygiene and health (the word ‘hygiene’ comes from Greek hygeia which means health) and built a large number of public baths throughout the city in order to keep the population clean. Nevertheless, diseases were quite prevalent in ancient Rome and many people suffered from various illnesses across the empire. Rome was struck with a number of pandemics which lasted for years and killed millions.

Plague in an Ancient City by Michiel Sweerts (1652)

Hygiene In Ancient Rome

Hygiene and health go hand in hand, and the Romans understood the importance of keeping the population clean. They maintained public bathing facilities and built magnificent aqueducts and water systems which carried water from far away springs and mountains into cities and towns. It can be said that the ancient Romans were cleaner than many Europeans living centuries later.

For example, in 18th-century Europe, there was a prevailing belief that taking baths was exposing the pores of the skin to illnesses. As a result, kings living in magnificent palaces would rarely bathe and used perfumes profusely to cover bad odors. Most Europeans and even kings had no proper access to bathrooms and would use chamber pots that were to be emptied outside on the streets. In contrast, public toilets or latrines were common in ancient Rome. Wealthy Romans even had their own private baths and they would spend much leisure time in these baths conversing with other upper-class Romans, relaxing or even conducting business.

Hologram projections at the Roman Baths, Bath, England ( Britishfinance/ CC BY-SA 4.0 )

It must be noted that even though many plebeians would regularly use the public baths, the standards of cleanliness were much lower than the standards that are accepted today. For example, the heated water was not disinfected with chlorine as it is today and bacteria thrived in the pools, often times causing illness. Yet this was a better trade-off than having people never bathing themselves. The complete absence of hygiene could lead to fatal diseases and generate viruses that could spread and kill large numbers of people.

Even though there were laws that required cities to remove waste from the streets, Rome was far from a clean city. For example, during heavy rain storms the sewer system could overflow with human waste.

How Ancient Rome Managed a Pandemic

It’s understandable to look to crises of the past when confronting a crisis in the present. Looking at how infectious diseases spread in the past can offer some insight into the present moment, for instance. And in seeing how others coped with life during a plague, we might be able to derive some inspiration from their actions. It’s an understandable reason to delve into history.

A new article by Edward Watts at Smithsonian Magazine travels back to the time when smallpox ravaged through the Roman Empire. Watts writes that it began in the year 165, and is generally known as the Antonine Plague. From there, Watts writes, the epidemic “waxed and waned for a generation, peaking in the year 189 when a witness recalled that 2,000 people died per day in the crowded city of Rome.”

The plague shows up in various historical accounts of ancient Rome — it’s sometimes referred to as the Plague of Galen, due to the role that the aforementioned doctor played in treating the infected. The plague also coincided with the imperial reign of Marcus Aurelius — also known as the last of the “Five Good Emperors.” In his article, Watts — a professor of history at the University of California, San Diego — holds out plenty of praise for the emperor’s handling of the crisis.

[Marcus Aurelius] filled the abandoned farmsteads and depopulated cities by inviting migrants from outside the empire to settle within its boundaries. Cities that lost large numbers of aristocrats replaced them by various means, even filling vacancies in their councils with the sons of freed slaves. The empire kept going, despite death and terror on a scale no one had ever seen.

Watts notes that the Antonine Plague was much more lethal than COVID-19, and struck a population with far fewer medical resources. But there’s also plenty to be learned from the example of resilience that Romans showed in the face of adversity.

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Diseases and Pandemics in Ancient Rome - History

Editor's Note:

This is not the first time that humans have been confronted by pandemic disease. Historians have long studied these pandemics, taught their lessons, and preached to be prepared for the next one. In summer 2020, Origins has embarked on a special project to help us better understand COVID-19 by running a series of essays, podcasts, and videos putting the pandemic in historical perspective. This month, historian Jim Harris provides an overview of pandemics from the ancient world to the modern. We invite readers to learn more about coronavirus and pandemics by visiting this page and to do so regularly as we will keep adding new stories. Stay safe.

The emergence of the novel coronavirus COVID-19 (SARS-CoV-2) has been a grim reminder of the role that disease-causing microbes such as bacteria and viruses have played across the long span of human history, despite tremendous advances in biomedicine in recent years.

Three of our &ldquodeadly companions.&rdquo Poliovirus (left), Influenza (center), and COVID-19 (right).

Our &ldquodeadly companions,&rdquo to use Dorothy Crawford&rsquos apt term, are presently responsible for 14 million deaths per year, and they have profoundly shaped human history and even human evolution. These microbes have assumed many forms, from plague, influenza, and HIV to cholera, smallpox, polio, and measles. And now coronavirus.

COVID-19 has&mdashas ofJune 2, 2020, approximately six months since the pandemic began&mdashclaimed 377,460 lives around the world (though that number is surely inexact).

It has dramatically altered patterns of behavior: necessitating social and physical distancing closing businesses, houses of worship, and schools and forcing the cancellation of large public gatherings. All of these measures have been hard on humans as social animals who need jobs, education, and faith.

A house in Des Moines, Iowa sharing messages of encouragement to passing cars during the Stay at Home Orders of 2020.

COVID-19 has brought renewed light to the impact our &ldquodeadly companions&rdquo can have&mdasha lesson that has been largely forgotten since the deadliest outbreak to date, the global influenza pandemic of 1918.

For most of human history, our relationship with deadly microbes has been invisible. Scientists have only been able to identify specific disease-causing pathogens for the past 140 years.

German physician Robert Koch identified the first disease-causing bacteria in 1882 when he reported that Mycobacterium tuberculosis was responsible for causing tuberculosis. Two years later, he then identified another bacterium, Vibrio cholerae, which causes cholera. Viruses were not observable until the development of the electron microscope in 1931.

Despite their imperceptible nature, the impact of our &ldquodeadly companions&rdquo is clear in the historical record. And the history of pandemics helps us better appreciate the current COVID-19 experience.

It highlights for us how an increasingly global society makes us more susceptible to pandemics. It also shows how relatively recent advances in medicine have shaped our current epidemiological response, public health institutions, and global disease surveillance systems, as well as the development of vaccines, masks, and social segregation.

By studying the history of pandemics, we gain an appreciation for the economic as well as the social costs they bring to bear. History also offers an opportunity to learn from our past mistakes, such as stigmatizing patients in ways that were often as punishing as the disease itself. It reminds us to offer abundant empathy for patients suffering from COVID-19 and their families.

Pandemics in the Ancient World

Migration of large numbers of people, especially during wartime, has been a significant factor in the spread of pandemics throughout human history. In the ancient Mediterranean world, we find written accounts of three of the earliest recorded pandemics, and in all three cases military campaigns across their &ldquoworld&rdquo contributed to the proliferation of the pandemic.

In the History of the Peloponnesian War, Thucydides described the sudden onset of a disease in people who were otherwise in good health: the Plague of Athens (430-426 BCE). The disease, he wrote, spread into the Greek world from across the Mediterranean in North Africa.

"Plague in an Ancient City" (1652-1654) by Michiel Sweerts depicts the epidemic that ravaged Athens.

&ldquoThe disease began with a strong fever in the head and reddening and burning in the eyes the first internal symptoms were that the throat and tongue became bloody and the breath unnatural and malodorous.&rdquo By the time it afflicted the heart, it &ldquoproduced every kind of evacuation of bile known to the doctors, accompanied by great discomfort.&rdquo

While the specific disease that caused the Plague of Athens remains a mystery, this early pandemic reveals how humanity has been, historically, highly susceptible to and largely powerless to stop pandemic disease.

Amid ongoing wars with Sparta, the Athenians were forced to shelter behind their protective city walls. Confined Athenians were easy prey to the plague that swept through their overcrowded city, killing as many as 100,000, including the leader Pericles.

Pericles, an Athenian statesman who died during the Plague of Athens in 429 BCE.

The results were devastating.

Men &ldquobecame indifferent to every rule of religion or law,&rdquo according to Thucydides, and the bodies of victims were often buried in mass graves. In the end, the plague of Athens may have also contributed to its eventual defeat in the Peloponnesian War, as the city did not fully recover for a generation. This, in turn, weakened Athenian influence throughout the Greek world.

As Roman soldiers returned from campaigning in 165 CE, they too brought another ancient pandemic back with them: the Antonine Plague (165-180 CE). Based on records kept by the physician Galen, we know that this pandemic, which would ultimately claim five million lives, spread throughout Italy, Greece, Egypt, and Asia Minor and was most likely an outbreak of either measles or smallpox (and if the latter, then it would be the first recorded epidemic of smallpox in Europe) .

According to Galen, the disease afflicted young and old, rich and poor, as it subjected its victims to fever and thirst, vomiting and diarrhea, and black rash. Killing between a third and half its victims, the Antonine Plague contributed to a severe decline in the population of the Roman Empire and, in turn, the onset of a period of economic and military decline in the longer history of the empire.

The Justinianic Plague, named after the Byzantine Emperor Justinian (r. 527-565), is perhaps the most consequential pandemic in the ancient world. It is important both for its longevity (c. 541-750 CE), but also because this was the first (of three) clearly documented pandemics of Yersinia pestis, the bacteria responsible for bubonic/pneumonic/septicemic plague.

St. Sebastian pleads with Jesus for the life of a gravedigger afflicted by the Justinianic Plague (left). A sixth-century mosaic depiction of Justinian I from San Vitale in Ravenna (right).

Until recently historians have thought this plague, which killed an estimated 30 to 50 million people across the Eastern Roman empire over the course of two centuries, brought about the end of these great ancient Roman societies. However, emerging scholarship and new data reveal that this pandemic, while certainly deadly, may not mark the &ldquoend of the [ancient] world.&rdquo

According to a recent study in the Proceedings of the National Academy of Sciences, people in late antiquity adjusted to two centuries of a recurring pandemic. Economic data show relative stability through these plague centuries, as do land-use data, which suggest that despite enormous losses of life, the ancient Mediterranean world learned to live with the plague.

We face a similar challenge today.

The Black Death

In October 1347, bubonic and pneumonic plague returned to Europe by way of the port of Sicily. From 1347-1353 most of Europe suffered from the Black Death.

Estimates on the total death toll during this second plague pandemic range considerably and suggest that between 30 and 60 percent of Europe&rsquos population died in a near cataclysmic disaster. Globally, the second plague pandemic may have claimed anywhere from 75 to 200 million lives.

A depiction of the Black Death in a 15th-century Italian miniature.

The history of the second plague pandemic teaches us several important lessons&mdashfrom the way diseases reach pandemic levels to lessons about how societies recovered from past pandemics and the earliest forms of public health.

Perhaps carried by the fleas in the fur of rodents or via human fleas or head lice, the second plague pandemic followed trade routes out of Central Asia and into Europe via the Mediterranean ports, from the isle of Sicily to the Italian peninsula in Pisa, Venice, and Genoa, and into France from the port of Marseilles.

From there, the pandemic spread indiscriminately across the continent, especially in growing European cities, inciting considerable panic as it inflicted dramatic symptoms (especially the large, painful swellings of the lymph nodes, the characteristic &ldquobuboes&rdquo) and enormous loss of life.

In The Decameron, Giovanni Boccaccio described &ldquofathers and mothers [who] fled from their own children, even as if they no way appertained to them.&rdquo Many believed that this plague was the wrath of an angry God and marked the very end of the world.

The plague of Florence in 1348, as described in Boccaccio's Decameron. Etching by L. Sabatelli.

Jews and lepers, both groups considered outsiders in Christian society, were accused of maliciously spreading the disease. European Jews were subjected to especially cruel tortures and murder as a &ldquoprophylactic measure,&rdquo which ranged from being sealed in wine casks and rolled into the Rhine River to being burned at the stake.

Depending on regional conditions and mortality rates, the social order during the Black Death was restored more quickly in some cities than in others. Careful city governance helped. For example, in the Tuscan city of Siena, economic and political activities ceased nearly entirely in the summer of 1348, but the community rebounded rapidly, rebuilding its cloth industry after only a matter of months.

But Siena was just one part of the story. Elsewhere in Europe, the larger-scale social consequences of the massive loss of life lasted centuries. With this tremendous depopulation, the value of labor increased while the cost of land depreciated, forcing existing social hierarchies to adapt.

Francesco Rosselli&rsquos 1480 "View of Florence" shows the city&rsquos population decimated by the plague. The walls, built in the 13th century at the population peak, are too large for the diminished 15th-century population.

The Black Death accelerated the decline of feudalism in England. In the estimation of historian Dorothy Porter, plague increased &ldquogeographic mobility&rdquo and created the &ldquobasic economic conditions for free-market labor mobility.&rdquo Landowners could no longer tie workers to the land and prevent them from moving to better-paid employment elsewhere.

Elsewhere, containment of the plague required more lasting interventions, particularly the development of public-health institutions with the authority to intervene in communities to mitigate disease.

In Venice, an ad hoc committee was established to &ldquopreserve public health and avoid the corruption of the environment.&rdquo By 1348, this committee closed all ports and imposed quarantines on newly arriving ships and travelers.

The etymology of the term quarantine comes from the Italian quaranta giorni (forty days),the duration of these plague quarantines.

A 1720 view of the Lazzaretto on Manoel Island near Malta. It was first built in 1592 to control an outbreak of plague with strict quarantine and remained the quarantine complex for all incoming ships.

Other Italian and French port cities followed suit as the plague continued to ebb and flow periodically through Europe over the course of the early modern period, establishing medical commissions to eliminate &ldquocorruption in the air&rdquo that they believed to be the cause of disease.

By the 15 th century, these early health commissions focused their efforts especially on monitoring early-modern mass gatherings&mdashschools, church services, processions&mdashfor signs of plague. When outbreaks were found, strict quarantines were imposed. Special fortresses, lazarettos, were built to house plague patients.

Here we find the historical roots of tried-and-true public health measures, which are still necessarily employed today: public health commissions and enforced social isolation.

Such public health strategies are complex, and do not come without costs. Many fear the economic consequences of prolonged &ldquostay at home&rdquo orders during the COVID-19 pandemic, and rightly so.

Citizens of Tournai, in the present-day Netherlands, bury plague victims, 1353. Plague pits, like these, led to several public health reforms in cities.

The economic consequences of quarantine (and the mortality rate) during the plague years were notable. Cordoning off household manufacturing had economic consequences that rippled through early-modern supply chains.

In parts of rural England, such as the village of Cuxham (near Oxford), mills fell into disuse and livestock wandered untended. Manors went unmanaged as landholders fled and laborers died.

The population of Cuxham would not recover for decades, and scholars believed that the economic recovery from the plague took even longer: until the 15 th century.

Pandemics in Modern History

The history of pre-modern pandemics demonstrates the devastating demographic and social impacts that past pandemics had and the fears that invisible &ldquodeadly companions&rdquo created. The demographic threats of pandemics remain. But medical advances in the past 200 years&mdasha relative blip in the long history of humanity and its relationship with pandemic-inducing pathogens&mdashgive us reason to be less fearful.

Modern epidemiology and the germ theory of disease both developed in response to not one, but six cholera pandemics over the course of the 19 th century (1817-1824, 1829-1837, 1846-1860, 1863-1875, 1881-1896, 1899-1923).

This 1888 Life magazine cartoon, symbolically illustrates the threat of a cholera epidemic rising up out of the London slums, and crossing the Atlantic to threaten New York City, while &ldquoScience&rdquo, which is metaphorically depicted as a sleeping soldier on the docks, lies unaware of the impending doom (left). An 1832 engraving from J. Roze depicting the treatment of victims of the cholera epidemic in Paris (right).

During these cholera pandemics, which like plague followed trade routes out of Central Asia into Europe, the medical presumption was that a poison in the air, a mal aria (&ldquobad air&rdquo in Italian) or &ldquomiasma,&rdquo was responsible for pandemic.

The first modern epidemiological investigation into a pandemic, however, disproved the miasma theory of disease.

During the third cholera pandemic, in 1854, Dr. John Snow observed in the Soho neighborhood of London that a single (infected) water pump was the epicenter of a ring of infections of cholera. When its handle was removed, the infections ceased. From this Snow correctly inferred that cholera was waterborne disease, not one carried in the air, although the Vibrio that caused the disease was not identified for several more decades.

Understanding the epicenters of infection, like the case of the Broad Street Pump, became a vital component of pandemic response and containment, as well as the basis for modern contact tracing.

An 1852 illustration from the magazine Punch showing where cholera was thought to spread. The "Court for King Cholera" was the slums, largely due to overcrowding and poor hygienic conditions.

The history of pandemic response has been far from perfect, however.

In 1889-1890, an influenza pandemic spread outward from Russia, killing approximately a million people around the globe. Comparatively, this pandemic was small in mortality, but its rapid spread across the northern hemisphere in less than four months revealed how susceptible the world was to a major pandemic because of new travel technologies (especially railways and steamships).

More significantly, during the Russian flu pandemic, German physician Richard Pfeiffer began to take samples of nasal discharge from his patients and ultimately misdiagnosed the pathogen responsible for influenza, which he attributed to the opportunistic bacterium Haemophilus influenza (often referred to as &ldquoPfeiffer&rsquos bacillus&rdquo) rather than the yet undiscovered influenza virus.

US Army Camp Hospital No. 45 Aix-Les-Bains, France, Influenza Ward No. 1. C. 1918.

This misdiagnosis had serious consequences during the next, and greatest, influenza pandemic in human history when doctors sought to find a therapeutic or vaccine for Pfeiffer&rsquos bacillus to slow the spread of the flu pandemic in 1918.

The 1918 flu pandemic, the first and by far the most severe of five major flu pandemics in recent history (1918, 1957, 1968, 1976, 2009), afflicted 500 million patients and killed approximately 50 million people around the world between spring 1918 and its final recession in 1920. Like the pandemics in the ancient world, the 1918 influenza pandemic followed the movement of soldiers around the world in the final months of World War I.

Amid the COVID-19 crisis, there are important lessons learned from 1918, such as the utility of wearing a mask and the importance of social distancing. People who neglected to do so or were slow in implementing quarantine measures suffered from far higher mortality rates.

Children ready for school during the 1918 flu pandemic (left). Nurse with mask and patient, 1918 in the Spanish Flu Ward of the Walter Reed Hopsital (right).

At the same time, the wartime context greatly exacerbated the spread and severity of the pandemic because the mobilization of a war economy made real quarantine nearly impossible.

Furthermore, the misdiagnosis of the Pfeiffer&rsquos bacillus as the cause of the pandemic led public health officials on a futile search for a flawed therapeutic to stem the tide of death. Only after three waves of influenza did the pandemic naturally run its course and the search for the virus and vaccine begin, a process that did not culminate until World War II made the need for an effective vaccine a medical imperative.

In the latter half of the 20 th century, public health has made considerable advancements with the establishment of rapid vaccine deployment and global disease surveillance networks, such as the World Influenza Centre (chartered in September 1947), a subsidiary of the World Health Organization.

Two public health technicians carry out a vaccination campaign inside a Dekalb County, Georgia, elementary school, 1966.

During the 1957-1958 &ldquoAsian flu&rdquo pandemic, for example, the swift spread of news of the pandemic through global surveillance systems allowed Maurice Hilleman at the Walter Reed Army Institute to begin rapid deployment of a vaccine that kept the death toll considerably lower (1 million worldwide) than most other pandemics in human history.

Yet other emerging pandemics in the past 50 years have continued to leave a deadly legacy.

Since the disease gained worldwide attention in the early 1980s, HIV has killed approximately 35 million people worldwide. At its outset, infection with HIV was nearly a death sentence for the patient. Since the 1990s, the development of anti-retroviral drug therapies has greatly increased the lifespan of HIV-positive patients.

Perhaps more significantly, the history of HIV reveals how pandemics can still carry a cruel stigma with them despite greater medical understanding.

The 1990 ACT-UP protest at the National Institutes of Health sought to bring awareness to the AIDS crisis in America.

Before scientists isolated the HIV virus in 1984, the pandemic was pejoratively termed &ldquoGRID&rdquo (Gay-related Immune Deficiency), because, in the United States, it disproportionately appeared among gay men and was found with greatest frequency in centers of gay culture. As an already marginalized group in the 1980s, gay HIV patients were accused of spreading a &ldquogay cancer,&rdquo which led to their further social marginalization.

Pandemics in the 21 st Century

Before COVID-19, we had been lucky in the 21 st century. Indeed, we had not seen a pandemic cause such massive disruptions to global society since 1918.

In 2003, another coronavirus, SARS, reached pandemic levels because it followed our global travel networks, but cases only totaled 8,098. Tried and true public health strategies like quarantines and contact tracing swiftly contained it.

A SARS patient and their doctor in China during the 2003 outbreak.

Our most recent pandemic occurred in 2009. H1N1 was another influenza pandemic of the same strain that caused the 1918 flu.

In the United States alone it infected as many as 60.8 million residents and caused 12,469 deaths, according to the CDC. It disproportionately killed children and young adults, unlike a typical flu that tends to kill the elderly with greatest frequency. From this pandemic we learned that the H1N1 strain must annually be included in our flu vaccine.

We should pause and appreciate why we have largely forgotten these deadly companions. Medical knowledge in 2020 is vastly improved when considered across the fullness of recorded history.

The billboard in the background of this 1963 photo is from the Polio Eradication Campaign of the early 1960s. (In the foreground, a member of what had been the Oklahoma City, OK, Emergency Citizens Group is radioing information to his headquarters.)

During the past hundred years we have made considerable advances, including the ability to identify viruses such as measles and polio, and in turn to develop crucial vaccines. In the case of SARS, and now COVID-19, we are able to isolate pathogens and gene sequence them in a matter of months.

But with our advanced-medical-science world of the 21 st century, the general populace has become somewhat complacent, uninformed about the many past pandemics. Forgetting our history has made the death toll from COVID-19 feel all the more shocking.

Yet scientists are optimistic about the current pandemic. Projections foresee a vaccine for COVID-19&mdashvaccines are the &ldquoholy grail&rdquo of pandemic mitigation&mdashpotentially being developed in a record 12 to 18 months.

A drive through COVID-19 testing site in Louisiana, 2020.

To date the fastest vaccine developed has been the original (and now discontinued) inactivated mumps vaccine, which took three years (1945-1948) to produce. If a COVID-19 vaccine is developed on this remarkable timeline, it will show just how far we have come in responding to pandemics from past to present.

Let us hope we do not see pandemic preparedness and community awareness falter along the way.

Read, Listen to, and Watch more from Origins on Pandemics and Coronavirus.

Suggested Reading

Dorothy H. Crawford, Deadly Companions: How Microbes Shaped Our History. Oxford: Oxford University Press, 2007.

John P. Davis, Russia in the Time of Cholera: Disease under Romanovs and Soviets. London: I.B. Tauris, 2018.

George Dehner, Influenza: A Century of Science and Public Health Response. Pittsburgh: University of Pittsburgh Press, 2012.

J.N. Hays, The Burdens of Disease: Epidemics and Human Response in Western History, Revised Edition. New Brunswick: Rutgers University Press, 2009.

Lee Mordechai et al., &ldquoThe Justinianic Plague: An Inconsequential Pandemic?&rdquo Proceedings of the National Academy of Sciences 116 (December 2019): 25546-25554.

William McNeill, Plagues and Peoples. New York: Anchor Books, 1976.

This content is made possible, in part, by Ohio Humanities, a state affiliate of the National Endowment for the Humanities. Any views, findings, conclusions or recommendations expressed in this content do not necessarily represent those of the National Endowment for the Humanities.

Disease mechanisms

The paper focuses on case studies of four vector-borne diseases – plague, malaria, yellow fever and trypanosomiasis – from 2.6 million years ago to present day. These case studies revealed five mechanisms by which these illnesses shape human society. Below are examples of each:

Killing or debilitating large numbers of people

The plague, caused by bacteria Yersinia pestis, is transmitted by fleas carried by rodents. The Black Death, the most famous plague pandemic, wiped out 30% of Europe’s population in the Middle Ages and drastically changed its economy. The plummet in labor helped overturn the feudal system, allowing surviving serfs to enjoy greater wages and power.

Differentially affecting populations

Yellow fever, a vector-borne disease transmitted by mosquitoes, is closely connected to the enslavement of Black people. On the island of Barbados, the most affluent British colony, English settlers came to rely on slave labor. In 1647, a yellow fever epidemic broke out as slave vessels introduced mosquitoes and the yellow fever virus. Because African people were twice as likely to survive yellow fever due to immunity gained from viral exposure while living in Africa, exploiting their forced labor was especially profitable. As a result, the exploitation of enslaved people grew into Barbados’ main labor system and expanded to other British colonies.

Weaponization of disease to promote hierarchies of power

In ancient Rome, poor agricultural workers worked in low-lying fields and lived in unsanitary housing. This greatly increased their risk of being bit by malaria-infected mosquitoes compared to wealthier Romans. Malaria may have also enforced gender inequities in ancient Rome, as some pregnant women may have been confined indoors to avoid risks associated with malarial infection, including miscarriage and fetal abnormalities.

Catalyzes change in society

In 1793, a yellow fever outbreak struck Philadelphia, killing half of all those afflicted. Although the Philadelphia government did not yet understand how yellow fever was transmitted, they eventually realized that cleaning up dirty water reduced the spread. The illness prompted the city to provide clean drinking water and construct sewage systems for its residents, and in the process lay the foundation of the modern public health system.

Changing human relationships with the land and environment

Trypanosomiasis, carried by the tsetse fly, is a parasite that infects wildlife, livestock and humans in Africa. In Africa’s pre-colonial history, the disease limited the use of domesticated animals in affected areas, preventing intensive farming and large-scale agriculture and impeding the ability to grow economically and urbanize.

“We were taken aback by the extent to which the impacts of vector-borne disease have historically splintered across racial and societal lines,” said Athni.

Structural racism, including what neighborhoods people can live in and their access to intergenerational wealth, is linked to disparities in rates of diabetes, hypertension and other chronic diseases associated with stress, Mordecai explained. These disparities are also apparent in the COVID-19 pandemic, where the disease’s outcomes are more serious for individuals suffering with these conditions. This disproportionate burden further amplifies the vulnerability of already disadvantaged communities.

“When you layer on an emerging pandemic with existing health disparities, it disproportionally affects Black and Hispanic communities,” said Mordecai.

Racial disparities also put historically marginalized communities at greater risk of being exposed to the virus. These communities, for instance, are more likely to be essential workers, lacking the luxury to safely shelter in place or have their groceries delivered.

“It’s easy to think that communities of color aren’t social distancing enough or not practicing proper hygiene,” said Roberts, who is a co-author on the paper. “But that thinking completely neglects the social conditions that have made those communities more vulnerable to begin with.”

The relationship between COVID-19 and structural inequality is unfortunately not limited to just modern times or the U.S. This too is a pattern that has repeated throughout history and across the globe. Outbreaks of leishmaniasis, a vector-borne disease spread by phlebotomine sand flies, have impacted hundreds of thousands of Syrians within refugee camps, a result of overcrowding in areas with poor sanitation. And when the first few cases of the Ebola outbreak popped up in 2014 in Africa, scientists in the United States were slow in finding ways to combat it until it showed up closer to home.

The authors hope that this paper will motivate scientists to be more proactive in protecting people in historically disadvantaged communities from disease.

“The paper does a spectacular job documenting the problem,” said Roberts. “Now it will be important to maintain an interdisciplinary focus that can dismantle it.”

Diseases and Pandemics in Ancient Rome - History

I’m not a student or scholar but I subscribe to Biblical Archaeology. I could have listened to her all night. I would have liked to know what the medical training was like. I guess I learned about dissections and anatomy they didn’t happen. I was wondering about that before she gave her lecture. I wonder if they had schools of medicine. Class lectures. Internships.

It was interesting that they were a lot more sophisticated medically than I thought they were. I’m going to have to kick my butt and read my Marcus Aurelius that’s in my Great Books.

Features of the Two Spices Offered to Jesus

Both frankincense, or olibanum, and myrrh came from resinous gum that was obtained by making incisions in the bark of small trees or thorny shrubs.

The frankincense tree grew along the southern coast of Arabia, and the myrrh bush thrived in the semidesert countries of present-day Somalia and Yemen. Both spices were highly esteemed for their fragrance. Jehovah himself chose them in connection with his worship—myrrh was a component of the holy anointing oil, and frankincense of the holy incense. (Exodus 30:23-25, 34-37) But they were used differently.

Frankincense, commonly used as incense, had to be burned to release its fragrance. The resin extracted from myrrh, on the other hand, was used directly. Myrrh is mentioned three times in accounts about Jesus: as a gift when he was a baby (Matthew 2:11), as an analgesic offered with wine when he was hanging on the stake (Mark 15:23), and as one of the spices used in the preparation of his body for burial (John 19:39).

Sarah Yeoman’s presentation was absolutely fascinating and one item got me thinking. The account of the magi in Matthew makes it clear that they were looking for the “the King of the Jews” because they wanted to “worship” him. Athough it also says they leave gifts of frankincense and myrrh, it does not say to what purpose these aromatic gums were to be put. Could the magi have intended the frankincense and myrrh for Mary as a protection against postpartum infection?

[…] [ad_1] During this time of the year, the world celebrates the resurrection of Jesus Christ. Around t… Magdalene and Mary went to the gravesite, the angels outside His tomb proudly declared those words […]

Very interesting! I really enjoyed your thorough understanding of ancient Rome! God bless!

Thanks for this enlightening lecture. One surgical instrument was not present among those presented from Rimini archaeological finds that I assumed would be there, the pipettes for draining fluid from crushing wounds.

Very interesting and informative lecture. Many thanks to Sarah Yeomans. Hopefully we will be able to view a lecture next year on her findings regarding religion and Christianity during this era.

Fascinating – ironically I go to Rimini every year, next time I’ll be sure to go to the Domus del Chirurgo!

The Bible—A Book of Accurate Prophecy, “The Last Days”
Prophecy: “In one place after another pestilences.”—Luke 21:11.
Fulfillment: Despite medical advances, millions still die each year as a result of infectious diseases. International travel and the world’s growing urban population have increased the likelihood that disease outbreaks will spread rapidly.
What the evidence reveals:
● Smallpox killed an estimated 300 million to 500 million people in the 20th century.
● The Worldwatch Institute reports that during the past three decades, “more than thirty previously unrecognized diseases such as Ebola, HIV, Hantavirus, and SARS have emerged as new threats.”
● The World Health Organization has warned of the rise of drug-resistant germs, saying: “The world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, [will] kill unabated.”

Interesting lecture. Well organized.

Fascinating and most interesting – however one point is that the Egyptian Oxyrhynchus records of just about all periods show the village inhabitants ‘ran away’ (anachoresis) when ever things got sticky – from too high tax demands to local bandits and even when a Roman grandee came visiting (locals did not want to bear the cost), so I’d like to see more evidence the records show the absences were due to the plague at that period. The other thing that worries me are the ‘arguments from a negative’ – simply because records stop does not mean the practice stops (the Balkan Roman army discharges), only that the records are not there, so I’d like to know there was other positive evidence that this cessation was due to stopping discharges. But, despite these minor thoughts, again many thanks for a most interesting lecture.

Ms. Yeomans has given a fascinating talk. Well presented. I learned a great deal. Thank you.

The Diseases that Kill Republics: Insights from Ancient Rome’s Epidemics

New York, NY. COVID-19 has given the world’s most sophisticated nations a glimpse of premodern life, where uncontrollable plagues could unexpectedly sweep through the land, dealing out death and destroying the livelihood of survivors. Italy’s tragic status as one of the worst-hit nations is a reminder of its predecessor, the Roman Republic, which endured dozens of epidemics in a history that lasted from 509 to 42 BC. Rome’s survival amidst so much death and disease shows how epidemics, both biological and political, threaten republics.

Few people knew the Roman Republic better than Titus Livy. Livy wrote a monumental history of Rome, and what survives of his 142 books tells the story of Rome’s perseverance through many crises, including epidemics. Livy also extensively employed the metaphor of civic diseases. He had personally witnessed the republic’s fall and believed the public body had become so ill in its final days that it didn’t have the strength to take the cures that might save it.

So what did epidemics look like for our ancient republican counterparts? How often did they occur? How did they impact civics and the lives of citizens?

Romans would expect to see a plague at least once a decade and sometimes several times a decade or over several years. The 430s, for example, saw recurring outbreaks, with a vicious cycle of bad weather, disease, and famine making it exponentially worse than previous outbreaks. Another particularly long bout occurred in the 170s. People were dismayed by the length of the pestilence, especially because it was killing off leading citizens and crippling the republic’s ability to function.

Any time Livy details a plague’s effects, he describes scenarios familiar to Americans today. Elections are disrupted. Political processes are stalled. Panic and superstition abound. The longer the epidemic lasts, the more the economy suffers, with famine and shortage setting in from bad crop returns.

Sometimes an epidemic disrupted peace and prosperity. At other times it added to other woes like war or domestic strife. Pestilence always endangered Rome’s national security given that its citizen-soldiers were already balancing civic duties with managing farms. Epidemics could topple this balance.

Wise statesmanship could mitigate their effects but only partially. Elected officials bought grain from abroad or took other measures to assist, but oftentimes an epidemic’s consequences were outside their control. A pestilence in 412-411 presented the safety/economy dilemma Americans are hotly debating today. People prioritized caring for the sick over tending their farms. Lives were saved, but the resulting crop failure proved worse than the disease. Only quick action by the magistrates to import grain averted a complete catastrophe.

Another example of critical decision-making occurred in the midst of Rome’s fight for survival against Carthage. In 205 an epidemic struck both sides in southern Italy. The Roman commander, already ill himself, recommended disbanding the army because he feared if he left them in the camp not a single man would survive. He quickly dispatched a letter to the Senate, which approved his decision to implement this ancient form of social-distancing.

As these last examples illustrate, Rome could not predict when an epidemic might strike, but when statesmen acted decisively, they could lessen its impact. In every epidemic, the people looked to the Senate for leadership and guidance. They expected that their leaders would neither give in to popular pressure nor ignore the gravity of the situation.

If the Senate didn’t seek out seers, perform rituals, consult physicians, or take practical steps to ameliorate the outbreak and its effects, panic would ensue. Charlatans would take advantage of the people. Conspiracy theorists would accuse innocent citizens of poisoning or witchcraft. Lawlessness would break out in the streets of Rome. Famine and shortage would result. The republic would cease to function.

America is experiencing a modern version of these ancient struggles firsthand. We are used to a financial shock or recession every decade, but not one so deeply impacted by a disease. This is why Livy’s history is particularly relevant right now.

Livy’s introduction includes a medical analogy about the health of the republican body. Any state is bound together by a common set of beliefs, but republics require a particularly strong set of convictions that define its “civic life and communal morals.” This public life of the spirit is only healthy when citizens exhibit virtue.

So what are the viruses of vice that threaten to destroy republican life? In Rome’s early days, Livy identifies factionalism and selfishness as particularly virulent. Commenting on events in the 5 th century, Livy describes troublemakers and fearmongers who use a crisis to stir up factions. He compares them to quack doctors who invent false sicknesses or take advantage of real ones for personal gain.

Livy argued that factional strife was more deadly than wars, famine, or plague. He was right. The republic survived many wars, famines, and plagues but was killed off by self-serving politicians—like Sulla, Julius Caesar, and Mark Antony—and the mobs that were attracted to such men.

Our own republic can learn from this example. COVID-19 has been deadly and tragic, but it will end. American life will return to normal, even if it is a somewhat different normal. But the factionalism that the pandemic has revealed will remain with us. Those more eager to attack their rivals (the focus of many Democratic congressional leaders), assert “total authority” (as explicitly stated by the President), or exercise their own petty tyranny (as seen by some governors) exhibit the true disease that might destroy our republic.

Livy also identifies greed, luxury, and self-indulgence, by which he means the pursuit of personal pleasures in place of civic responsibility and the duty to one’s neighbor. In a speech Livy gives to Cato, he condemns such things as “plagues that have ruined all the great empires.” Cato calls on private citizens and statesmen to embody the industry, austerity, and simplicity that made the republic a world power.

Commenting on an event 10 years later in the 180s, Livy describes how foreign rituals, the Bacchanalia, had infiltrated Rome like a disease. Rome was typically tolerant of new religions, but these festivals were practiced by a secret society that corrupted Rome’s youth. Participants engaged in sexually violent and sometimes deadly ceremonies. They spread immodesty and debauchery and disturbed public order. Because of their secretive nature, scholars still argue today over the details. In Livy’s mind, however, not only did they threaten their participants and young initiates, but the Bacchanalia also weakened the citizenry at large by luring citizens away from their civic duty.

Livy’s critique of wanton hedonism, an undisciplined youth, and sexual violence strike a chord today. We are still reeling from ongoing revelations of sexual depredations by notable figures, but self-indulgence has manifested itself in other ways during the pandemic. Leaders have faced difficulty restraining some who insist on pursuing their own desires despite the risks to others. The most obvious example was the flood of spring breakers who flouted good counsel and journeyed to popular vacation destinations, exacerbating the spread of the disease in the mere pursuit of pleasure.

Livy was right to insist that young citizens are vulnerable to the pestilence of civic selfishness. It is harmful to teach them an ethic of self-discovery and personal gain. New generations must be habituated to serve higher causes and make sacrifices for the broader community.

This habituation is important because choosing to be selfless is often difficult. Rome’s most revered commander, Scipio Africanus, had to deal with an outbreak of selfishness that took the form of mutinous troops. In 206, these citizen-soldiers had understandable grievances. Far from their farms, they had spent years fighting a fierce and fluid enemy in Spain during Rome’s desperate war with Carthage.

When Scipio himself fell mortally ill, some of them took advantage and led a rebellion. Scipio recovered, however. After arresting the ringleaders, he gathered the troops and reminded them of Rome’s long history, which always featured citizens willing to suffer any misfortune and brave any danger for each other and their republic. He asked them to return to this sense of sacrifice and solidarity. The average citizen’s republican duty is what saved Rome even when generals like himself had died in the war: “The Roman people live on, and will live on, though a thousand more generals should perish through sickness or the sword.”

Scipio’s warning remains with us today. Our republic is under great strain and political liberties will have to be set aside temporarily, but this means that citizens must demonstrate the resilience to sacrifice for each other and then regain our liberties when the crisis has ended.

Pandemics do not change a culture as much as they test it, revealing its strengths and weaknesses. We must do what is right to preserve life during the pandemic, but we must also heal the political vices that afflict our republic. Only then will our body politic be strong and ready for the next crisis that comes.

Pandemics and Plagues in Antiquity

This webinar series is part of the course ARCH 1765: Pandemics, Pathogens, and Plagues in the Greek and Roman Worlds taught by Tyler Franconi. All talks are free and open to the public. Use the links below to register for each talk in the series.

All talks will be held via Zoom and a link to join each talk will be sent to those who have registered. If you’re not familiar with Zoom visit to learn what you’ll need to get started and how to join a meeting.

All talks will be recorded and links to the recordings will be posted on this page as they become available.

Tuesday, October 27, 202012:00-1:30pm EDT

History, Biology, and the Antonine Plague
Kyle Harper, University of Oklahoma

Kyle Harper is Professor of Classics and Letters and Provost Emeritus at The University of Oklahoma. Dr. Harper is a historian of the ancient world whose work has spanned economic, environmental, and social history. He is the author of three books Slavery in the Late Roman World, AD 275-425 (2011) which was awarded the James Henry Breasted Prize by the American Historical Association and the Outstanding Publication Award from the Classical Association of the Middle West and South From Shame to Sin: The Christian Transformation of Sexual Morality (2013) which won the Award for Excellence in the Study of Religion in Historical Studies from the American Academy of Religion and The Fate of Rome: Climate, Disease, and the End of an Empire (2017) which has been translated into twelve languages. He is currently writing a global history of infectious disease.

Thursday, November 5, 202012:00-1:30pm EST

The Economic Impact of the Antonine Plague
Andrew Wilson, University of Oxford

Andrew Wilson is Professor of the Archaeology of the Roman Empire in the Faculty of Classics and a Fellow of All Souls College at the University of Oxford. Professor Wilson’s research interests include the economy of the Roman Empire, ancient technology, ancient water supply and usage, Roman North Africa and archaeological field survey. He co-directs, with Alan Bowman, the Oxford Roman Economy Project (OxREP) and edits the Oxford Studies on the Roman Economy series with Oxford University Press. He also co-directs the Coin Hoards of the Roman Empire project with Chris Howgego. He also leads, together with Bob Bewley, Graham Philip, and David Mattingly, the Endangered Archaeology in the Middle East and North Africa (EAMENA) Project, using satellite imagery to assess threats to archaeological sites. He has excavated numerous sites in Italy, Morocco, Tunisia, Libya, Syria, and Cyprus, and is currently involved in excavations at Aphrodisias (Turkey) and Utica (Tunisia).

Tuesday, November 10, 202012:00-1:30pm EST

Quisquamne regno gaudet? Politics and Plague in Seneca’s Oedipus
Hunter Gardner, University of South Carolina

Hunter Gardner is Professor of Classics at the University of South Carolina. She is an affiliate of Women’s and Gender Studies and recently joined the core faculty of both the Comparative Literature Program and the South Carolina Honors College. Prof. Gardner is the author of two monographs, Gendering Time in Augustan Love Elegy (2013) and Pestilence and the Body Politic in Latin Literature (2019). This most recent book explores the development of plague narratives in the western tradition and, in particular, looks to Roman epic poets writing in the late Republic and early Principate as significant contributors to depictions of contagion. Like her work on Latin love elegy, the project draws in part from an understanding of the social upheavals and civil discord that characterized this period of Roman history, with its shift from aristocratic governance to quasi-monarchy under Augustus.

Dr. Gardner also regularly teaches and publishes in the area of reception studies. She recently co-edited a collection of essays on adaptations of the Odysseus myth in various media (novels, visual arts, television) and teaches a course on the reception of Greco-Roman antiquity in cinema and popular culture.

Tuesday, November 17, 202012:00-1:30pm EST

Palaeogenetic Insights into the First Plague Pandemic (541-750)
Marcel Keller, University of Tartu

Watch a recording of Marcel Keller’s talk here:

Doctor Marcel Keller is a Post-doctoral Researcher at the Institute of Genomics at the University of Tartu in Estonia. He completed his PhD at the University of Jena in Germany, where he worked with the Max Planck Institute for the Science of Human History in the department of Archaeogenetics in 2019. He is an expert on palaeogenetic traces of Yersinia pestis in the First and Second Pandemics, better known to some as the Plague of Justinian from the sixth to eighth centuries, and the Black death in the 14th century. This work explores the biology and dispersal in space and time of this deadly pathogen with genomic and phylogenetic approaches on ancient DNA from skeletal remains. He has published two ground-breaking articles on this work in 2019, including a paper in the Proceedings of the National Academy of Sciences entitled ‘Ancient Yersinia pestis genomes from across Western Europe reveal early diversification during the First Pandemic (541–750)’, and ‘Phylogeography of the second plague pandemic revealed through analysis of historical Yersinia pestis genomes’ in Nature Communications.

The cholera pandemics

Deaths: 1 million • Cause: V. cholerae bacteria

Few societies have been spared by this highly infectious bacteria, which is transmitted via feces-contaminated water and causes severe diarrhea and vomiting. The epidemic that swept London in 1854 spawned the sort of epidemiological investigations that take place in disease outbreaks today. That’s thanks to John Snow, an English physician who almost single-handedly took on the bacteria. While some scientists suspected cholera was transmitted through the air, Snow thought otherwise. “Through carefully mapping the outbreak, he finds that everyone affected has a single connection in common: they have all retrieved water from the local Broad Street pump,” according to a CDC history. He ordered the pump-handle turned off, and people stopped getting sick.

Late 1800s

The Plagues That Might Have Brought Down the Roman Empire

Bioarcheologists are getting better at measuring the toll of ancient pathogens.

What brought down the Roman Empire? By the end of his The Decline and Fall of the Roman Empire, even the great historian Edward Gibbon was sick of the question. He noted that instead of speculating about the reasons for Rome’s long, slow collapse between (depending on whom you ask) the third and seventh centuries C.E., we should instead marvel that it lasted so long in the first place.

Still, something keeps historians fascinated by the fall of Rome. Proposed explanations include mass lead poisoning (mostly disproved) and moral decay (somewhat difficult to test). One hugely influential revisionist theory holds that Rome never fell at all—it simply transformed into something unrecognizable. In response to this “transformation” interpretation, historians have more recently insisted that late antiquity was characterized above all by violence, death, and economic collapse—an idea most aggressively championed in Bryan Ward-Perkins’ 2005 book, The Fall of Rome and the End of Civilization.

While we may never be able to pinpoint one reason for the death of the Roman Empire, historians are inching ever closer to understanding what life was like for its residents as their world crumbled. Two especially innovative papers published in the latest issue of the Journal of Roman Archaeology ask what role epidemic disease played in the twilight of the Roman Empire. The first, by University of Oklahoma historian Kyle Harper, addresses the so-called Plague of Cyprian in the middle of the turbulent 3rd century C.E. The other, written by Harper’s former professor Michael McCormick, a professor of medieval history at Harvard University, takes on the 6th-century C.E. Plague of Justinian.

In the case of the latter plague, we know the offending pathogen. In a blitz of research over the past decade, three teams of scientists have positively and independently identified DNA from Yersinia pestis—the same bacterium responsible for the Black Death—in skeletons known to date from the time of the Justinianic plague.

Ancient sources make the Justinianic plague sound positively apocalyptic. According to one account, the people of Constantinople—which was by that point the capital of the Eastern Roman, or Byzantine, Empire—died at such enormous rates that the emperor Justinian had to appoint a special officer in charge of coordinating the removal of corpses from the city’s streets. The unlucky appointee, whose name was Theodore, arranged to have the bodies carted across the Golden Horn to Galata, which is now an upscale Istanbul neighborhood. In a gruesomely vivid passage, eyewitness John of Ephesus describes the process.

“[Theodore] made very large pits, inside each of which 70,000 corpses were laid down. He thus appointed men there, who brought down corpses, sorted them and piled them up. They pressed them in rows on top of each other, in the same way as someone presses hay in a loft . Men and women were trodden down, and in the little space between them the young and infants were pressed down, trodden with the feet and trampled down like spoilt grapes.”

Despite the overwhelming numbers of corpses described in this and other textual sources, no ancient mass graves have yet been found by archaeologists in Galata or, indeed, in any other neighborhood of Istanbul. In fact, no burial pits containing anywhere near 70,000 skeletons have been found anywhere in the Mediterranean, whether dating to the 6th century or to any other period. Historians have good reason to be skeptical of any numbers mentioned in ancient texts, but there’s no doubt that the Justinianic plague claimed enormous numbers of victims across the Mediterranean. Where have all the corpses gone?

As McCormick points out, the incompleteness of archaeological excavations—and especially those in major cities, where obtaining permits and digging around modern infrastructure presents serious challenges—must contribute to the lack of known Justinianic “plague pits.” In fact, the one major Roman city of the 6th century that has been thoroughly excavated, Jerusalem, has been found to contain several mass graves, three of which held over a hundred individual skeletons.

But even if such pits could be found, they wouldn’t account for the full scale of the Justinianic Plague. While cities tend to dominate the historical record due to their concentration of the rich and powerful, the ancient world was overwhelmingly agrarian.

Influenced by the archaeology of the Black Death in London, generations of archaeologists have assumed that mass mortality events go hand in hand with large, communal burials. A close examination of the textual sources reveals, however, that even in London plague pits were not employed until the city’s usual burial places were exhausted. It follows, then, that smaller settlements in the countryside may never have faced the same burial crises as large cities: The combination of more open space and fewer people would have meant that the majority of the population may never have had to change its burial practices.

One case described by McCormick illustrates and supports this hypothesis beautifully. While analyzing DNA taken from skeletons found in a seemingly unremarkable 6th-century cemetery in the German town of Aschheim, just outside of Munich, scientists were shocked to find that eight individuals’ bones contained traces of Y. pestis DNA. Genetic material degrades over time, so finding six separate, securely identifiable instances is, in fact, a huge deal: It’s likely that many more of the individuals buried in the cemetery were also victims of the Justinianic Plague.

Because the Aschheim cemetery served as the primary burial spot for residents of the small town before, during, and after the Justinianic Plague, the bones found within it are likely to reflect the actual population of the settlement with a high degree of accuracy. As a result, archaeologists can use the skeletal evidence to get a sense of the effect the plague had on this discrete population. The resulting model is shocking: based on cemetery data, “this small rural settlement will have lost a minimum of 35-53 percent of its population within the space of a few months” in 555 C.E., a loss from which it would never fully recover.

The Aschheim case proves that archaeologists should be looking for victims of the Justinianic Plague in any 6th-century settlement that was connected to the late Roman world, regardless of how small or far from Constantinople it is. The work involved will be enormous, but the data collected from this newly exploded pool of potential plague burials will begin to fill in the gaps in our understanding of how devastating the Justinianic Y. pestis outbreak really was.

By contrast, the microbe responsible for Harper’s chosen epidemic, the 3rd-century Plague of Cyprian, remains stubbornly unidentifiable despite various historians’ guesses ranging from smallpox to measles. Tissue taken from skeletons buried around the time of the epidemic in mass graves recently uncovered in Egypt and Rome will surely be analyzed thoroughly. The micro-bioarchaeological methods integral to McCormick’s research, however, seem unlikely to bear fruit for the Plague of Cyprian: relying on ancient descriptions of the disease, Harper argues that the epidemic was probably an outbreak of a viral hemorrhagic fever similar to Yellow Fever or Ebola.

To be sure, the frightening list of symptoms provided by Cyprian (the Carthaginian bishop and eyewitness for whom the plague is named) will sound familiar to anyone who followed the recent West African outbreak of the Ebola virus.

“As the strength of the body is dissolved, the bowels dissipate in a flow a fire that begins in the inmost depths burns up into wounds in the throat. the intestines are shaken with continuous vomiting . the eyes are set on fire from the force of the blood . as weakness prevails through the failures and losses of the bodies, the gait is crippled or the hearing is blocked or the vision is blinded . ”

Unlike bacteria, the majority of viruses—including the Arenaviruses, Flaviviridae, and Filoviruses responsible for viral hemorrhagic fevers—transmit their genetic information via RNA alone. The single strands of RNA are much more fragile than DNA’s double helix, and so are poorly equipped to survive the ravages of time.

Faced with the unlikelihood of genetic evidence, Harper relies on less high-tech methods to figure out how severe the Plague of Cyprian really was. Instead of bones, his evidence is a body of 23 textual sources—some contemporary with the plague and some written much later—that largely frame the epidemic in terms of religious polemic. Plagues in the Mediterranean antiquity, as in many other periods of history, were frequently understood to be supernatural as well as physical disasters. Because the 3rd century was a crucial time of growth and definition for the early Christian church, the Plague of Cyprian came to take on a deep spiritual meaning for pagan and Christian alike.

For Bishop Cyprian, the plague that came to bear his name was hard proof of the superiority of Christianity over traditional Roman religion. Seeing the pestilence as an opportunity to put their most deeply-held beliefs into action, early Christians beatifically set about caring for the sick and giving proper burials to the dead.

On the other side of the religious divide, the pagan establishment was overwhelmed with fear. Traditionally, Roman priests interpreted epidemics as a sign of displeasure from the gods. Evidence in the form of new iconography on coins and references to extraordinary state-organized sacrifices suggests that the Plague of Cyprian was no different. As Harper notes, sources agree that, “the epidemic undermined the social fabric of pagan society” while “the orderly response of the Christian community, especially in the burial of the dead, presented a stark contrast.”

The clearly biased language of both Christian and pagan sources has caused many scholars to discount them as religious propaganda—despite the fact that, if you strip away the pontification, the Christian and pagan accounts agree on all major points, most importantly how contagious, painful, and deadly the disease was. The tendency of some witnesses to slip into stock phrases taken from classic literary descriptions of plagues in Thucydides and Vergil has similarly worked to discredit the textual evidence—unfairly, as Harper argues, because quoting major cultural touchstones was an extremely common way of processing and even emphasizing the severity of shared trauma in antiquity. The disease, he concludes, was one of the nails in the Roman Empire’s coffin, and an important milestone in the growth of early Christianity.

Distinct as their methods are, Harper’s and McCormick’s articles both open up stunning, if gruesome, new vistas on the biological landscape of late antiquity. McCormick’s reevaluation of plague burials makes it clear that the Justinianic Plague spread far beyond major cities, reaching well into Europe’s hinterland—and that historians and archaeologists have likely severely underestimated of the scale and scope of ancient epidemics.

On the other hand, Harper’s careful reanalysis of religious screeds makes clear the necessity of revisiting old textual evidence to reconstruct plagues for which physical evidence is likely to remain elusive. What’s more, the spiritual nature of Harper’s texts reveals how genuinely terrifying the disease regime of late antiquity was. For early Christians, the devastation was something of an opportunity, but for adherents of Rome’s traditional religion, the waves of disease that unrelentingly crashed down on the Mediterranean world were nothing less than the end of the world.

Pandemics: Now and Then

As human populations expand and their exploitation of the globe increases, so does their vulnerability to certain diseases.

The Greek roots of endemic, epidemic and pandemic give them a patina of scientific precision, which is misleading. The uses and connotations of the terms have changed radically over time and even today they lack crisp definition. In ancient Greek, pandemic meant ‘relating to all the people’, in the sense of vulgar. Pandemic music, for example, was popular music, more Beyoncé than Brahms. It was not a medical term and never became the vernacular word for a pestilence, which was loimos from the Iliad on. When the term pandemic (or ‘pandemick’) was revived in early modern science, it was often used as a synonym for epidemic, but with a sense closer to the current meaning of the word endemic, as a disease that is permanently established in a population, rather than one that suddenly falls upon a population.

Into the 19th century, pandemic and epidemic remained synonyms. In the 1828 edition of his dictionary, Noah Webster defined pandemic as ‘Incident to a whole people epidemic as a pandemic disease.’ (At the same time, the ‘k’ of ‘pandemick’ was lost as spelling became regularised, to the disappointment of people like Andrew Jackson, who sniped ‘It is a damn poor mind indeed which can’t think of at least two ways to spell any word.’)

Emerging paradigm

In the late 19th century, the definition of pandemic, with its now familiar connotations of ‘sudden’ and ‘geographically widespread’, came into focus. Two diseases above all are thought to have sharpened the distinction: cholera and influenza. Acute and highly contagious, they swept the globe in repeated waves, carried on expanding transportation networks. The emerging paradigm of germ theory made it easier to conceive of diseases as phenomena caused by specific, mobile agents. European imperialism gave birth to the fields of ‘medical geography’ and ‘tropical medicine’, allowing diseases to be imagined in planetary terms. The 1870s and 1880s saw the word pandemic used more widely and then, as David Morens, Gregory Folker and Anthony Fauci argued in 2009, the violent spread of the 1889-92 influenza pandemic brought the term ‘into general use’. By the time of the 1918 flu it was a ‘household’ word.

The rather forgotten pandemic of 1889-92 ‘came as a total surprise there had been no major epidemic since 1847-8’. It raced around the world with stunning speed in an age of rail and steamship. Believed to have originated in Central Asia or Russia, it reached Western Europe and the US by late December. Patients suffered fever, chills, sweating, malaise and intense respiratory symptoms, progressing in some cases to pneumonia. Morbidity was high: estimates reckoned that half of France and almost half of Germany contracted the illness. Mortality fell disproportionately on the elderly. The first wave came and went quickly, but new waves of the disease returned the following two winters.

The causative agent of this pandemic is conventionally identified as influenza. This hypothesis rests on contemporary clinical descriptions, as well as the pattern of its diffusion and recurrence. The case for influenza remains strong. But it is worth calling attention to the suggestion, made by a group of geneticists more than a decade ago, that the pandemic of 1889-92 represents the emergence of a different respiratory virus: Human Coronavirus OC43.

This is one of seven species of the family coronavirus known to infect humans. It is a cousin of the current scourge, SARS-CoV-2. Infection with OC43 causes the common cold and it is one of the most widespread respiratory pathogens on the globe. It is also a very modern creature.

Microbiologists use a tool known as the ‘molecular clock’ to estimate the timing of evolutionary events, using the mutation rate to measure the amount of time it took for one strain or species to diverge from another. Such analysis dates the emergence of OC43 to around 1890 the pandemic of 1889-92 may have been the debut of this new coronavirus.

Relentless and recent

This ubiquitous pathogen emerged only 130 years ago, around the time the word pandemic came into popular currency. It underscores that the history of human disease is the story of relentless and recent pathogen evolution, driven by our own rapid and remorseless alteration of planetary ecologies.

As a Roman historian I have lost count of how often in recent months I have disappointed inquisitive journalists, hoping for juicier parallels from the fall of Rome. But the history of infectious disease does not offer ‘parallels’ or ‘instructive examples’, so much as perspective grounded in biological realism and the opportunity to deepen our sense of the pervasive and ongoing interplay between human social development and pathogen evolution.

Take, for example, the Antonine Plague, which struck the Roman Empire during the reign of Marcus Aurelius. The ancient texts date its outbreak to AD 166 and claim that it was dispersed throughout the Empire by armies returning from campaign in Parthia. It is notable that even though the Greeks and Romans lacked a medical equivalent to our word pandemic, the sources clearly and credibly describe one: a sudden, explosive and geographically widespread infectious disease event. Ancient sources depict a pestilence that struck ‘the world’, the ‘whole world’, the ‘entire army’. It ‘polluted everything with contagion and death, from the frontiers of Persia all the way to the Rhine and to Gaul’. In the words of a contemporary inscription, quoting the oracle of Apollo: ‘Many are the cities which are grieved at the wrathful displeasure of the gods.’ For the doctor Galen, an eyewitness, it was simply the ‘greatest’ and ‘longest-lasting’ pestilence. Remarkably, too, there are inscriptions from beyond the Empire, in Arabia, in years leading up to the Antonine Plague, testifying to a frightening mortality that swept ‘the whole land’.

It can be tempting to diminish the literary sources as hyperbolic or rhetorical, but they testify, independently and consistently, from every conceivable genre and point of view, through various media and languages, that this pestilence was a major event.

In other words, a pandemic was something unfamiliar. The societies comprising the Roman Empire bore a heavy burden of infectious disease at all times. Endemic diseases like malaria, tuberculosis, typhoid and a range of gastroenteric infections haunted the Roman population and were made worse by the urbanisation and connectivity that the Empire fostered. Life expectancy at birth was possibly in the low to mid-20s. As in any society where infectious diseases rule, the death rate fluctuated from season to season, year to year. If ancient Italy was like medieval Italy, then diseases such as malaria were both endemic and epidemic: a constant background presence, but capable of flaring up at intervals, when the weather promoted mosquito abundance, or harvest failure rendered hungry bodies susceptible to infection.

In a society that lived on thin margins and with virtually no effective biomedical interventions, people were accustomed to expect sharp interannual variations in mortality. Some years were sickly, others healthy. But explosive, geographically coordinated mortality events remained rare. Ancient chronicles and histories are not full of wild reports of global death. A comprehensive effort to retrieve all written testimony for epidemic disease in the Roman world, from the late Republic to the high Empire, finds only indications of regional mortality events. There was a pestilence across ‘nearly all of Italy’ in the year following Julius Caesar’s assassination, for example. But an episode as ideologically loaded and rhetorically rich as the killing of Caesar witnessed only a regional epidemic. We do not find florid accounts of widespread disease outbreaks or lurid descriptions of hideous symptoms. So, too, with every other epidemic for the next two centuries, until the Antonine Plague.

What pathogenic agent caused such a staggering disease event remains a point of frustrating uncertainty. The issue will remain ambiguous unless and until there is paleo-molecular evidence, as we now have for the Justinianic Plague. Given the speed, force and geographic scope of the Antonine Plague, the agent was probably a novel pathogen, introduced from outside the pool of diseases endemic in the ancient Mediterranean. The Antonine Plague was thus an event at the conjuncture of biological evolution and human structures, such as the trade networks that connected Roman producers and consumers to the world beyond. It was a pandemic avant la lettre, one of the first that we can follow in detail.

Genome sequencing

Even though we don’t know what germ caused the Antonine Plague, we are learning more about the evolutionary history of human pathogens from genome sequencing. In his Plagues and Peoples (1976), William McNeill established a narrative in which the Neolithic Revolution was the fulcrum of disease history. Sedentary lifestyles and domesticated animals allowed new diseases to establish in human populations across the Old World. These discrete disease pools then came into contact during the rise of the classical civilisations, with explosive consequences, such as the Antonine Plague. That story is not so much wrong as incomplete. With vast troves of genetic data now to hand, we can see much more clearly that wild animals (especially bats and rodents, but also primates and birds) have been a predominant reservoir of new infectious diseases and that the spin-off of evolutionary novelties has been a recurring pattern and source of instability in the history of human health.

The Roman experience, then, offers not lessons but perspective. The growth of human numbers (300 million at the time of the Antonine Plague, now racing towards eight billion) is part of a long-term acceleration of human expansion and exploitation of the planet. As we multiply, we broaden our exposure to potential new pathogens and increase the payoff for infecting us. Our current pandemic is part of this deeper pattern. The history of infectious disease does help us see why it should not have been a surprise. Like a tornado on the Oklahoma plains come springtime, a pandemic such as this one was inevitable, though hard to forecast precisely. It won’t be the last.

Kyle Harper is Professor of Classics and Letters at the University of Oklahoma and author of The Fate of Rome: Climate, Disease and the End of an Empire (Princeton, 2018).