Following on last week's surprisingly popular "Imperial Rome and the Antonine Plague"—must be our "thinking about Rome" and "I'm feeling a bit under the weather" sub-demos, here is the London Review of Books, August 15:
Age of Hypochondriacs
Pox Romana: The Plague That Shook the Roman World
by Colin Elliott.
Princeton, 304 pp., £28, April, 978 0 691 21915 8Sometime in the late 160s CE, the Roman doctor Galen suffered a great misfortune: the loss of almost all his slaves to a disease he called (in Greek) ‘the protracted plague’ – a term used for any major epidemic. In a treatise discovered in a Thessaloniki monastery in 2005, Galen boasts that he was not at all moved by this tragedy, nor indeed by one far worse in 192, when a fire destroyed his library. But he did take a great interest in the sickness itself, which assailed the Roman Empire in waves for a decade or so after the first cases were reported in 165 CE. He provides our only detailed account of the symptoms: first fever, then a few days later diarrhoea or the coughing up of blood, and in the second week a pustular dry rash with black sores which would crust over and fall off. It ‘spreads over entire cities and destroys them horribly’. It was seasonal, striking in the colder parts of the year. Efficacious treatments included soil from Armenia or the island of Lemnos, Stabian milk and ‘theriac’, a paste made up of opium and ingredients such as saffron, myrrh, cinnamon and vipers. Galen championed theriac, becoming the sole supplier to the emperor, but he also recommended the administration of young boys’ urine to the sores. The immunity conferred on survivors presumably made it worth it.
Galen doesn’t provide enough information for modern doctors to diagnose the illness now known as the Antonine Plague, named for the emperor at the time, Marcus Aurelius Antoninus. As Colin Elliott explains in his lively account of the outbreak, the fact that sores appeared all over the body seems to rule out the disease that we call plague, where the buboes are concentrated at the groin, neck and armpits (boubon is Greek for ‘groin’). Suspects include measles and scarlet fever, but most specialists now think it was a form of smallpox, so called since the 16th century to distinguish it from the ‘great pox’, or syphilis, and a member of the same virus family as horsepox, cowpox and camelpox.
This supposition is based above all on Galen’s descriptions of his patients’ rashes, but no ancient source mentions the permanent scarring traditionally associated with smallpox, and sequencing of smallpox DNA found in the mummified remains of a Lithuanian child buried around 1650 has shown that Variola major, the vicious form of the disease that devastated much of the world in modern times, only emerged after 1500. But a genetically related orthopoxvirus, an ancestral cousin of smallpox, has been found in Viking-era burials in northern Europe, and it may have been this or something like it that affected the Romans.
As Elliott notes, the smallpox theory is largely responsible for the scholarly consensus that the Antonine Plague was a very big deal: modern smallpox killed a third of its victims – between 300 and 500 million in the 20th century alone – and blinded a quarter. (In 1980 it became the first human disease certified as eradicated by the World Health Organisation.) Elliott himself is a minimalist, at least by recent standards: he is prepared to contemplate total mortality in the region of between one and two million across the Roman Empire rather than the twenty million some have suggested. But he still agrees that it was ‘the worst disease event in human history up to that time’.
The outbreak as described by later Roman writers was certainly pretty bad. Eutropius reported that it had affected most of the empire’s inhabitants and almost all Rome’s military forces. Other commentators tell of thousands of deaths, the devastation of Italy and difficulties in recruiting soldiers for the Marcomannic wars that inconveniently broke out on the German border in 166. But these authors were writing two centuries or more after the event, and some were given to sensation. References in contemporary sources are hazier. There are vague reports of sudden flight from illness, and of excess death. Sickness became a metaphor: a senator in the 170s described rising gladiator prices as ‘a great disease’. But Galen is the only eyewitness to discuss the epidemic in any detail.
Galen may himself be responsible for the later fame of this particular plague. He had every reason to exaggerate the sickness that helped to make his name and it wouldn’t be his only piece of showmanship. He began his career tending to the wounds of gladiators (excellent medical training in a society where human dissection was frowned on), spent most of it as official physician to the emperor, and courted notoriety with public vivisections. His voluminous writings make up an estimated 10 per cent of surviving literature in ancient Greek, much of it memoir, pop philosophy or self-help.
This means we can’t be sure how dangerous the Antonine sickness really was, how many lives it claimed or whether it affected rural areas as well as cities. We don’t even know when it ended. Galen mentions further waves after the initial crisis, and the hyperbolic theologian Jerome later claimed that an outbreak in 172 almost wiped out the Roman army, but nothing more is heard of the disease after the mid-170s. Nor do we know where it came from. Ancient sources insist that Roman soldiers brought it home after sacking the Parthian city of Seleucia in the autumn of 165. This sounds like the medieval theory that linked the arrival of the Black Death in Europe with the return of Genoese traders from the Black Sea city of Kaffa. A Mongol army had besieged Kaffa, supposedly catapulting their infected dead over the city walls. But the story about Seleucia is different: the Romans were said to be infected not by enemy soldiers, but by the anger of the god Apollo. When they ransacked his temple in Seleucia and stole the cult statue, they inadvertently broke open a bound casket and unleashed a deadly cloud of infected air....
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