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The Antonine Plague, sometimes referred to as the Plague of Galen, erupted in 165 CE, at the height of Roman power throughout the Mediterranean world during the reign of the last of the Five Good Emperors, Marcus Aurelius Antoninus (161-180 CE). The first phase of the outbreak would last until 180 CE affecting the entirety of the Roman Empire, while a second outbreak occurred in 251-266 CE, compounding the effects of the earlier outbreak. It has been suggested by some historians that the plague represents a useful starting point for understanding the beginning of the decline of the Roman Empire in the West but also the underpinning to its ultimate fall.
Galen (129 - c. 216 CE), a Greek physician and author of Methodus Medendi, not only witnessed the outbreak but described its symptoms and course. Among the more common symptoms were fever, diarrhea, vomiting, thirstiness, swollen throat, and coughing. More specifically, Galen noted that the diarrhea appeared blackish which suggested gastrointestinal bleeding. The coughing produced a foul odor on the breath and an exanthema, skin eruptions or rash, over the entirety of the body distinguished by red and black papules or eruptions:
Of some of theses which had become ulcerated, that part of the surface called the scab fell away and then the remaining part nearby was healthy and after one or two days became scarred over. In those places where it was not ulcerated, the exanthem was rough and scabby and fell away like some husk and hence all became healthy. (Littman & Littman, p. 246)
Those infected suffered from the illness for roughly two weeks. Not all who caught the disease died, and those who survived developed immunity from further outbreaks. Based on Galen's description, modern researchers have concluded that the disease affecting the empire was most likely smallpox.
Cause & Spread of the Disease
The epidemic most likely emerged in China shortly before 166 CE spreading westward along the Silk Road and by trading ships headed for Rome. Sometime between late 165 to early 166 CE, the Roman military came into contact with the disease during the siege of Seleucia (a major city on the Tigris River). Troops returning from the wars in the East spread the disease northward to Gaul and among troops stationed along the Rhine River.
Two different legends arose discussing the exact origins of how the plague was released into the human population. In the first story, the Roman general, and later co-emperor, Lucius Verus opened a closed tomb in Seleucia during the subsequent sacking of the city thus releasing the disease. The tale suggests that the epidemic was a punishment as the Romans violated an oath to the gods not to pillage the city. In the second story, a Roman soldier opened a golden casket in the temple of Apollo in Babylon allowing the plague to escape. Two different 4th-century CE sources, Res Gestae by Ammianus Marcellinus (c. 330-391 – 400 CE) and the biographies of Lucius Verus & Marcus Aurelius, ascribe the outbreak to participating in a sacrilege, violating the sanctuary of a god and breaking the oath. Other Romans blamed Christians for making the gods angry precipitating the outbreak.
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Death Rate & Economic Effects
There is much ongoing debate amongst scholars regarding the effects and consequences of the epidemic on the Roman Empire. This debate is focused on the methodology used to compute the actual number of people who died. The Roman historian Dio Cassius (155-235 CE) estimated 2,000 deaths per day in Rome at the height of the outbreak. In the second outbreak, the estimate of the rate of death was much higher, upwards of 5,000 per day. It is most probable that the extreme death toll was due to this disease exposure being new to people living around the Mediterranean. Mortality rises when infectious diseases are introduced into a 'virgin population', that is a population which lacks acquired or inherited immunity to a specific disease. All told it has been suggested that a quarter to a third of the entire population perished, estimated at 60-70 million throughout the empire. What is undisputed is that Lucius Verus, co-emperor with Marcus Aurelius, died from the illness in 169 CE; Marcus Aurelius died 11 years later from the same illness. Ironically, it was Verus' soldiers who contributed to spreading the disease from the Near East to the rest of the empire.
It has been suggested that a quarter to a third of the entire population perished, estimated at 60-70 million throughout the empire.
At the outbreak of the plague, Rome's military consisted of 28 legions totaling approximately 150,000 men. The legions were well-trained, well-armed, and well-prepared, none of which prevented them from catching the disease, falling ill, and dying. Regardless of their posts, the legionaries contracted the disease from fellow soldiers who had been on leave returning to active duty. The ill and dying caused manpower shortages especially along the German frontiers thus weakening the Romans' abilities to defend the empire. The lack of available soldiers caused Marcus Aurelius to recruit any able-bodied man who could fight: freed slaves, Germans, criminals, and gladiators. Depleting the supply of gladiators resulted in fewer games at home, which upset the Roman people who demanded more, not less, entertainment during a time of intense stress. The patchwork army failed in its duty: in 167 CE, Germanic tribes crossed the Rhine River for the first time in more than 200 years. The success of the external attacks, especially by the Germans, facilitated the decline of the Roman military, which, along with the economic disruptions, contributed ultimately to the decline and fall of the Empire.
Effect on Religion
The effect of the illness was not confined to the military and economy. Marcus Aurelius launched persecutions against Christians who refused to pay homage to the gods which, the emperor believed, in turn angered the gods whose wrath made itself known in the form of a devastating epidemic. Ironically the anti-Christian attacks produced the opposite effect amongst the general population.
Unlike adherents to the Roman polytheistic system, Christians believed in an obligation to assist others in a time of need, including illness. Christians were willing to provide the most basic needs, food and water, for those too ill to fend for themselves. This simple level of nursing care produced good feelings between Christians and their pagan neighbors. Christians often stayed to provide assistance while pagans fled. Furthermore, Christianity provided meaning to life and death in times of crisis. Those who survived gained comfort in knowing that loved ones, who died as Christians, could receive the reward of heaven. The Christian promise of salvation in the afterlife attracted additional followers, thus expanding the growth of monotheism within a polytheistic culture. The gaining of adherents established the context in which Christianity would emerge as the sole, official religion of the empire.
Fall of the Empire
Any discussion of the collapse of the Roman Empire in the West begins with Edward Gibbon's The History of the Decline and Fall of the Roman Empire. Gibbon did not rule out the role of the effects of disease outbreaks; in regard to Justinian's Plague (541-42 CE), Gibbon argues early in his multi-volume work that “Pestilence and famine contributed to fill up the measure of the calamities of Rome”(Vol. 1., p. 91). Gibbon pays scant attention to the Antonine Plague, arguing instead that barbarian invasions, the loss of Roman civic virtue, and the rise of Christianity played the most important roles in the empire's decline.
More recently, researchers and historians, such as A. E. R. Boak, suggest that the Antonine Plague, along with a series of other outbreaks, represents a useful starting point for understanding the beginning of the decline of the Roman Empire in the West. In Manpower Shortage and the Fall of the Roman Empire, Boak argues that the outbreak of plague in 166 CE contributed to a decline in population growth, leading the military to draft more peasants and local officials into its ranks resulting in lower food production and a lack of support for day-to-day affairs in administering the towns and cities, thus weakening Rome's abilities to fend off the barbarian invasions.
Eriny Hanna, in The Route to Crisis: Cities, Trade and Epidemics of the Roman Empire, argues that “Roman culture, urbanism, and the interdependence between cities and provinces” facilitated the spread of infectious disease thus creating the underpinnings for the collapse of the empire (Hanna, 1). Overcrowded cities, poor diets leading to malnutrition, and a lack of sanitary measures made Roman cities epicenters for disease transmission. The contagions easily spread along the land and sea trade routes which connected the cities to the outlying provinces.
Most recently, Kyle Harper suggests that "the paradoxes of social development and the inherent unpredictability of nature, worked in concert to bring about Rome's demise" (Harper, 2). In other words, climate change provided the environmental context for the introduction of new, more catastrophic diseases including the Antonine Plague which arrived at the end of a most favorable climate period and introduced the world to smallpox. Harper argues that the Antonine Plague was the first of three devasting pandemics, including the Plague of Cyprian (249-262 CE) and the Justinian Plague (541-542 CE), which rocked the foundations of the Roman Empire largely due to the high mortality rates. The very strengths which often characterize flattering descriptions of Rome's empire - the Roman army, the extent of the empire, the extensive trade networks, the size and number of Roman cities - ultimately provided the basis for devastating disease transmissions leading to the fall of the empire.
The Antonine Plague of 165 to 180 AD, also known as the Plague of Galen (after Galen, the physician who described it), was an ancient pandemic brought to the Roman Empire by troops who were returning from campaigns in the Near East. Scholars have suspected it to have been either smallpox  or measles.   The plague may have claimed the life of a Roman emperor, Lucius Verus, who died in 169 and was the co-regent of Marcus Aurelius. The two emperors had risen to the throne by virtue of being adopted by the previous emperor, Antoninus Pius, and as a result, their family name, Antoninus, has become associated with the pandemic.
Ancient sources agree that the plague appeared first during the Roman siege of the Mesopotamian city Seleucia in the winter of 165–166.  Ammianus Marcellinus reported that the plague spread to Gaul and to the legions along the Rhine. Eutropius stated that a large proportion of the empire's population died from this outbreak.  According to the contemporary Roman historian Cassius Dio, the disease broke out again nine years later in 189 AD and caused up to 2,000 deaths a day in Rome, one quarter of those who were affected.  The total death count has been estimated at 5–10 million,   and the disease killed as much as one third of the population in some areas and devastated the Roman army. 
How Early Christians Saved Lives and Spread the Gospel During Roman Plagues
Christians facing the coronavirus today would do well to remember how the selfless love of the early church helped spread the gospel in a world much more hostile to Jesus’ message than our world is today. Christianity spread in the face of persecution for many reasons, but in two cases it spread in the midst of deadly plagues — because Christians risked their lives to save others.
Two historic plagues ravaged the Roman Empire: the Antonine Plague (165-180 A.D.) and the Cyprian Plague (249-262 A.D.). The plagues killed roughly a quarter to a third of the population, striking down emperors (Marcus Aurelius, Hostilian, and Claudius II Gothicus), and ravaging the empire. As in the case of the coronavirus today, panic spread because the society did not understand the disease.
As sociologist Rodney Stark noted in The Triumph of Christianity: How the Jesus Movement Became the World’s Largest Religion, Christians responded to the plagues differently than their pagan neighbors.
“During the first plague, the famous classical physician Galen fled Rome for his country estate where he stayed until the danger subsided. But for those who could not flee, the typical response was to try to avoid any contact with the afflicted, since it was understood that the disease was contagious. Hence, when their first symptom appeared, victims often were thrown into the streets, where the dead and dying lay in piles,” Stark wrote.
Bishop Dionysius recounted the events in Alexandria, Egypt, during the Cyprian Plague: “At the first onset of the disease, they [pagans] pushed the sufferers away and fled from their dearest, throwing them into the roads before they were dead and treated unburied corpses as dirt, hoping thereby to avert the spread and contagion of the fatal disease.”
Yet Christians sought to help the sick, even risking their own lives. As Cyprian, bishop of Carthage, put it, “Although this mortality had contributed nothing else, it has especially accomplished this for Christians and servants of God, that we have begun gladly to seek martyrdom while we are learning not to fear death.”
“Heedless of danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy for they were infected by others with the disease, drawing on themselves the sickness of their neighbors and cheerfully accepting their pains,” Dionysius recalled of his fellow Christians. “Many, in nursing and curing others, transferred their death to themselves and died in their stead … [a death that] seems in every way the equal to martyrdom.”
The Resurrection of Jesus Christ Is the Most Important Event In History
Even basic care likely powerfully reduced the death rate. As William McNeill pointed out in Plagues and Peoples, even “quite elementary nursing will greatly reduce mortality. Simple provision of food and water, for instance, will allow persons who are temporarily too weak to cope for themselves to recover instead of perishing miserably.” It is entirely plausible that Christian care for the sick would have reduced mortality by as much as two-thirds, Stark argued.
This Christian charity did not just save lives — it also spread the gospel. Historians have long struggled to understand how a small group of Christians after Jesus’s ascension — Acts puts the numbers at 120 and 5,000 — eventually outnumbered all other faiths in the Roman Empire (with an estimated population of 60 million).
Using estimates from historical sources, Stark found that growth from 1,000 Christians in 40 A.D. to 33 million Christians in 350 A.D. required a growth rate of 40 percent per decade. While this growth seemed miraculous to Christians at the time and historians afterward, it can also be explained through the expansion of social networks.
When Christians risked their lives to help their pagan neighbors during the plagues, two things happened. Pagans who did not come into contact with Christianity were more likely to die, and pagans who received Christian charity were more likely to live — and to develop relationships with the Christians who saved them. A pagan saved from death may befriend the Christians who saved him, and he may have lost his previous friends from the plague. By saving pagans, Christians not only demonstrated the love of Jesus but also spread social influence.
Stark has long found that social networks are essential to religious conversion. While new believers say they are satisfied by true doctrine, friendships with other believers are also essential when it comes to choosing a faith. This is not to say that faith doesn’t matter or that the Holy Spirit is not involved in conversion — the process in each person’s heart is still a mystery — but from a social science standpoint, relationships are key to understanding a person’s decision to publicly identify with a religion.
Christians in the second and third centuries A.D. lived countercultural lifestyles. They stood out because they refused to sacrifice to Roman emperors (who were considered gods) and they stood out because they cared for the sick, the orphans, and the widows. They saved children who were left to die (an early form of abortion/infanticide) and they founded the first hospitals.
When early Christians risked their lives to save pagans during the plagues, they lived out the teachings of Jesus Christ, providing concrete evidence that their lives had been changed by the Holy Spirit of charity. Their sacrifice was a witness to those around them, and it helped spread the gospel by expanding their social networks.
Christians today should adopt the same spirit of charity, although it may look entirely different in practice. Social distancing helps limit the spread of the coronavirus, and Christians should value the lives of others more than the comfort and social opportunities of daily life.
Christians can also support charitable enterprises doing God’s work in this difficult time. The Christian charity Samaritan’s Purse airlifted a field hospital and other supplies to Italy on March 17 to help that country’s overwhelmed health system care for coronavirus patients. Samaritan’s Purse’s DC-8 aircraft carried roughly 20 tons of medical equipment, a respiratory care unit developed for the coronavirus, and 32 disaster relief personnel, including doctors, nurses, and respiratory specialists, who will stay in Italy for at least a month.
“We are going to Italy to provide life-saving care to people who are suffering,” Franklin Graham, the charity’s president, said in a statement. “There is a lot of fear and panic around the country, but we trust that God is in control. We continue to pray for everyone affected by this global health crisis and for our medical team as they respond.”
Edward Graham, youngest son of Franklin Graham and assistant to the vice president of programs for Samaritan’s Purse, put it succinctly: “Medicine is a magnet for the Gospel.”
Not every Christian can or should get up and fly to Italy to help with the crisis — there will be work to do in your own homes and neighborhoods. But Christians around the world should help however they can, with the same spirit as the early church. Acts of charity can reap a tremendous harvest for the gospel.
[The Antonine Plague and the decline of the Roman Empire]
The Antonine Plague, which flared up during the reign of Marcus Aurelius from 165 AD and continued under the rule of his son Commodus, played such a major role that the pathocenosis in the Ancient World was changed. The spread of the epidemic was favoured by the occurrence of two military episodes in which Marcus Aurelius himself took part: the Parthian War in Mesopotamia and the wars against the Marcomanni in northeastern Italy, in Noricum and in Pannonia. Accounts of the clinical features of the epidemic are scant and disjointed, with the main source being Galen, who witnessed the plague. Unfortunately, the great physician provides us with only a brief presentation of the disease, his aim being to supply therapeutic approaches, thus passing over the accurate description of the disease symptoms. Although the reports of some clinical cases treated by Galen lead us to think that the Antonine plague was caused by smallpox, palaeopathological confirmation is lacking. Some archaeological evidence (such as terracotta finds) from Italy might reinforce this opinion. In these finds, some details can be observed, suggesting the artist's purpose to represent the classic smallpox pustules, typical signs of the disease. The extent of the epidemic has been extensively debated: the majority of authors agree that the impact of the plague was severe, influencing military conscription, the agricultural and urban economy, and depleting the coffers of the State. The Antonine plague affected ancient Roman traditions, also leaving a mark on artistic expression a renewal of spirituality and religiousness was recorded. These events created the conditions for the spread of monotheistic religions, such as Mithraism and Christianity. This period, characterized by health, social and economic crises, paved the way for the entry into the Empire of neighbouring barbarian tribes and the recruitment of barbarian troops into the Roman army these events particularly favoured the cultural and political growth of these populations. The Antonine Plague may well have created the conditions for the decline of the Roman Empire and, afterwards, for its fall in the West in the fifth century AD.
The Church and the Plague - The Early Centuries (Part two of four)
One of the world’s first epidemics, a form of smallpox or measles, was first brought to Rome by legionnaires returning from a siege in modern-day Iraq. At its peak, the disease may have killed up to 2,000 people a day.
The first pandemic in the Christian era was the “Antonine Plague” of 165-180, perhaps smallpox, which ravaged the Roman empire and caused more than five million deaths. Soon after, in 249, the so-called “Plague of Cyprian” broke out, amidst an already chaotic time in the Empire and lasted until well into 271. It could have been smallpox or perhaps a disease similar to Ebola, but at its peak, it caused 5,000 deaths per day in Rome alone and set off the political anarchy of the 3rd century.
St. Dionysius of Alexandria witnessed the pagan reaction to the plague: “At the first onset of the disease, they pushed the sufferers away and fled from their dearest, throwing them into the roads before they were dead and treating unburied corpses as dirt, hoping thereby to avert the spread and contagion of the fatal disease but do what they might, they found it difficult to escape.”
In his view, the plague was a providential schooling and testing of Christians. And their response was up to the test:
Most of our brother Christians showed unbounded love and loyalty, never sparing themselves and thinking only of one another. Heedless of danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy for they were infected by others with the disease, drawing on themselves the sickness of their neighbors and cheerfully accepting their pains. Many, in nursing and curing others, transferred their death to themselves and died in their stead.
An early biographer tells us that St. Cyprian of Carthage encouraged the faithful to minister to the needs of all:
There is nothing remarkable in cherishing merely our own people with the due attentions of love, but that one might become perfect, he who should do something more than heathen men or publicans overcoming evil with good, and practicing a merciful kindness like that of God, he should love his enemies as well…Thus the good was done to all men, not merely to the household of faith.
But St. Cyprian also pointed out the providential effect of these calamities:
By the terrors of mortality and of the times, lukewarm men are heartened, the listless nerved, the sluggish awakened deserters are compelled to return heathens brought to believe the congregation of established believers is called to rest fresh and numerous champions are banded in heartier strength for the conflict, and having come into warfare in the season of death, will fight without fear of death, when the battle comes.
In the pagan empire, the Christian attitude towards the sick and the dying, believers and unbelievers alike, triggered an explosive growth of Christianity. Because of their compassion during the plague, the Christians’ deeds were on everyone’s lips, with admiration and gratitude, and such actions brought many to the Faith.
Even the last pagan emperor, Julian the Apostate, rebuked the pagan priests for falling short of the example given by Christians during another great plague, in 362. He recognized that the Christian compassion and sacrificial service was one cause behind the ascendancy of the Church.
Later, in the 6th century, “The Plague of Justinian,” the bubonic plague – accompanied perhaps by other plagues, pneumonic and septicemic – arrived in Constantinople in 542. The outbreak lasted four months, but the plague continued to sweep intermittently throughout the Mediterranean world for another 225 years, with the last outbreak reported in 750. (Justinian Plague) It is estimated that, throughout the last half of the 6th century, the population of the Byzantine Empire and its neighbors declined by as much as 40%. There would be no more large-scale outbreaks of the plague until the Black Death of the 14th century. (Sixth Century Plague)
In 590, Rome was ravaged by “The Plague of Justinian” – it even claimed the life of Pope Pelagius II. As soon as St. Gregory the Great was elected Pope, he called on God’s mercy for the end of the plague by organizing a massive procession around the city, carrying an image of Our Lady and chanting the litanies. When the procession reached the Mausoleum of Hadrian, " The pope saw an angel of the Lord standing atop the castle of Crescentius, wiping a bloody sword and sheathing it. Gregory understood that that put an end to the plague, as, indeed, happened." (Plague of Justinian)
In thanksgiving, St. Gregory had a statue of St. Michael placed atop the castle, as a constant reminder of the mercy of God and how He responded to the prayers and supplications of His people.
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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1. This modern term for the second-century plague in Rome comes from the dynastic name of the emperors at the time. Marcus Aurelius and his co-emperor Lucius Verrus were both members of the Antonine family. Because of Galen’s surviving case notes that documented the symptoms of the disease, the epidemic is sometimes referred to as the “Plague of Galen.”
2. Galen, Aelius Aristides, Lucian and Cassius Dio were all first-hand witnesses to the epidemic.
3. Richard P. Duncan-Jones, Structure and Scale in the Roman Economy (Cambridge: Cambridge Univ. Press, 1990), p. 72 Richard P. Duncan-Jones, “The Impact of the Antonine Plague,” Journal of Roman Archaeology 9 (1996), p. 124.
4. James H. Oliver, Greek Constitutions of Early Roman Emperors from Inscriptions to Papyri (Philadelphia: American Philosophical Society, 1989), pp. 366–388.
5. For further discussions of papyrological evidence, see R.J. Littman and M.L. Littman, “Galen and the Antonine Plague,” American Journal of Philology 94 (1973), pp. 243–255 Duncan-Jones, “Antonine Plague” R.S Bagnall, “Oxy. 4527 and the Antonine Plague in Egypt: Death or Flight?” Journal of Roman Archaeology 13 (2000), pp. 288–292.
6. The same cessation of construction is not, however, evident in Spain or in the North African provinces outside of Egypt, possibly indicating that certain areas of the empire were more affected than others. See Duncan-Jones, “Antonine Plague.”
7. Dominic Perring, “Two Studies on Roman London. A: London’s Military Origins B: Population Decline and Ritual Landscapes in Antonine London,” Journal of Roman Archaeology 24 (2011), pp. 249–268.
8. Until recently it was thought that the Antonine Plague could possibly have been a measles epidemic. However, recent scientific data have eliminated this possibility. See Y. Furuse, A. Suzuki and H. Oshitani, “Origin of the Measles Virus: Divergence from Rinderpest Virus Between the 11th and 12th Centuries,” Virology 7 (2010), pp. 52–55.
9. Dio Cassius 73.14.3–4 for a discussion of the smallpox pathologies, see Littman and Littman, “Galen.”
The pandemic emerged before 155CE in China and then spread westwards along the Silk Road. Several sources confirm that the Romans came into contact with this pandemic between late 165 CE and early 166CE during the siege of Seleucia-on-Tigris. The soldiers traveling from the East spread the illness northwards to the legions along River Rhine and Gaul.
During the pandemic, Galen, the Greek writer hand physician, had traveled to Asia-Minor in 166. However, he was summoned back to Rome in 168 by Lucius Verus and Marcus Aurelius and presented with the outbreak among the Roman soldiers who were stationed at Aquileia. Galen observed the sick soldiers and recorded the pandemic in the treatise Methodus-Medendi. Galen described the epidemic as great and noted a few symptoms, including pharyngitis, diarrhea, and fever. He also noticed skin eruptions (sometimes pustular and sometimes dry), which appeared on the ninth day of the sickness. The description given by Galen doesn’t define the nature of the illness, but numerous scholars have diagnosed it as smallpox.
MacNeill William asserts that the Plague-of-Cyprian and the Antonina Plague were outbreaks of 2 different illnesses. He claims that one was measles while the other was smallpox. The severe devastation caused by these two plagues in Europe suggests that the population had no previous exposure to the first plague (Antonine Plague). Other historians claim that both plagues were smallpox. The second view proves to be more likely since the molecular estimate puts the evolution of measles around 500AD.
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 behaviour 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.
Antonine Plague - History
BY RYAN HOLIDAY
It began in the East. At least, that’s what the experts think. Maybe it came from animals. Maybe it was the Chinese. Maybe it was a curse from the gods.
One thing is certain: it radiated out east, west, north, and south, crossing borders, then oceans, as it overwhelmed the world. The only thing that spread faster than the contagion was the fear and the rumors. People panicked. Doctors were baffled. Government officials dawdled and failed. Travel was delayed or rerouted or aborted altogether. Festivals, gatherings, sporting events—all cancelled. The economy plunged. Bodies piled up.
The institutions of government proved very fragile indeed.
We’re talking, of course, about the Antonine Plague of 165 CE, a global pandemic with a mortality rate of between 2-3%, which began with flu-like symptoms until it escalated and became gruesome and painfully fatal. Millions were infected. Between 10 and 18 million people eventually died.
It shouldn’t surprise us that an ancient pestilence—one that spanned the entire reign of Marcus Aurelius —feels so, well, modern. As Marcus would write in his diary at some point during this horrible plague, history has a way of repeating itself. “To bear in mind constantly that all of this has happened before,” he said in Meditations . “And will happen again—the same plot from beginning to end, the identical staging. Produce them in your mind, as you know them from experience or from history: the court of Hadrian, of Antoninus. The courts of Philip, Alexander, Croesus. All just the same. Only the people different.”
This pattern of disease is nauseatingly familiar. It’s a pattern that has repeated itself like a fractal across history. Indeed, we could be talking about the Bubonic Plague (aka the Black Death), the Spanish Flu of 1918, or the cholera pandemics of the late 19th and early 20th centuries, just as easily as we are talking about the Antonine Plague and thinking about the coronavirus pandemic that is spreading across the globe. As Marcus would say, all we’d have to do is change a few dates and names.
It can be a very jarring mental exercise for some—thinking about the way the history of disease repeats itself—because we like to view the evolution of human civilization as moving inevitably in some new, unique direction. We like to see history as steady progress. Then when bad things happen, when catastrophe strikes, we feel like the world is coming apart. We suffocate ourselves with breathless shouting about the sky falling and give ourselves heart attacks over not being prepared for what is to come.
It’s the same story, unfolded as if from an ancient script, written on the double helix of human DNA. We make the same mistakes. Succumb to the same fears. Endure the same grief and pain… then eventually exult in the same heroism, the same relief, and hopefully, the same kind of emergent leadership .
And that, really, is the key to survival, to persevering for the better: Just because history repeats itself is not an excuse to throw up your hands and give yourself up to the whims of Fortune. The Stoics say over and over that it is inexcusable not to learn from the past. “For this is what makes us evil,” once wrote Seneca , who lived two generations before Marcus and watched Rome burn. “We reflect upon only that which we are about to do. And yet our plans for the future descend from our past.”
So what can we learn from the Antonine plague? What can we find—in ourselves, in other people, in the lessons of the past—that can guide us today as the reality of this current pandemic crisis sets in?
First, we should count our blessings. We’re lucky that the coronavirus (COVID-19) is but a sneeze compared to the bubonic plague which killed 25 million people in just a few months in the sixth century, or smallpox which consistently killed some 400,000 people every single year of the eighteenth century, or when measles killed 200 million people in the nineteenth and twentieth centuries, or when the Spanish Flu claimed 50 million souls in 1918. Indeed, precisely what so worries scientists about COVID-19 is actually a blessing: The disease is particularly contagious because it doesn’t quickly debilitate and kill most of its victims. No one with an active case of SARS was playing shuffleboard on a cruise ship or skiing in the Alps. They were suffering until death within hours.
We should count our blessings, but we should not count ourselves lucky—at least not in equal measure. We have to make our own luck, as all survivors do. If Marcus Aurelius had his choice, he would not have chosen to lead in crisis. In fact, he wouldn’t have chosen to lead at all. He wanted to be a philosopher, not emperor. And that was “the essential tragedy of Marcus Aurelius,” biographer Frank McLynn wrote . “No man could have been less equipped to deal with the crisis that now broke over the empire.”
Yet, like all great heroes, he surprised everyone by rising to the occasion. He had no ego, and had a keen eye for surrounding himself with brilliant public servants. As McLynn explains, Marcus Aurelius’s “shrewd and careful personnel selection” is worthy of study by any person in any position of leadership. He searched for and brought in the best. He broke the mold and filled his staff with talent, not aristocrats or cronies. He actually listened to advice. He empowered people to make decisions. He hired Galen, the most famous physician and polymath of antiquity, to lead medical lectures and anatomy demonstrations, wanting to elevate “the intellectual tone” of his court. It was Galen who he empowered to lead the efforts to combat the plague, the smartest medical mind of his time.
Once his team was in place, Marcus shifted his focus to the growing economic crisis. Longstanding debts owed to the government were cancelled. Fundraising efforts began with a masterstroke of inspirational leadership. As McLynn writes , Marcus “conducted a two-month sale of imperial effects and possessions, putting under the hammer not just sumptuous furniture from the imperial apartments, gold goblets, silver flagons, crystals and chandeliers, but also his wife’s silken, gold-embroidered robes and her jewels.” Funerals for plague victims were paid for by the imperial state. Reluctantly but unavoidably, Marcus Aurelius also confiscated capital from Rome’s upper-classes, knowing that they could afford to pay. He also audited his own officials and allowed no expenditures without approval. In a crisis, people must trust that their leaders are doing the right thing and that they are bearing the same burden as the citizens—if not a greater one.
It would be difficult to overstate the fear that must have pervaded the empire. The streets of Rome were flooded with corpses. Danger hung in the air and lurked around every corner. Knowing little about the spread of germs or disease, prone to superstitions, waking up each day must have been terrifying for children and adults alike. Romans burned incense which they thought could keep them safe, instead it blanketed the city in thick smoke and odors, which mixed in with the smells of the recent dead and a city in lockdown.
Certainly, no one would have faulted Marcus if he had fled Rome. Most people of means did.
Instead, Marcus stayed, at enormous personal cost. He braved the deadliest plague of Rome’s 900-year history, never showing fear, reassuring his people by his very presence.
He was Churchill during the Blitz, inspiring the people to keep calm and carry on, except instead of lasting for a few months, he endured the siege for years without complaint. Even as he lost several young children and his fortune dwindled away.
He was not Xi Jinping, who is rarely seen in public. He locked down his citizens, but he did not lock them out. His doors were always open. He summoned priests of every sect and doctors of every specialty and toured the empire in an attempt to purge it of the plague, using every purifying technique yet known. He attended funerals. He gave speeches. He showed up for his people, assuring them that he did not value his safety more than his responsibility.
In this he was the perfect embodiment of what “stoicism” means to us today. He didn’t get rattled. He didn’t panic. He kept himself strong for others. He insisted on what was right , never what was politically expedient. He was resolute.
That’s not to say he was delusional, or that he reassured the people with false hope or misleading numbers, as some leaders have. In fact, Marcus was deeply moved by the suffering of the people. We are told quite vividly by historians of the sincere weeping of Marcus Aurelius in public after he overheard someone argue, “Blessed are they who died in the plague.” A good leader is strong, but feels deeply the pain of others.
In 180 CE, having led the people through the worst of the crisis, which stretched on for some 15 years of his reign, and having never hidden or neglected his public duties, Marcus Aurelius began to show symptoms of the disease. It was a fate that was inevitable given his style of leadership. By his doctors’ diagnosis, he knew he had only a few days to live, so he sent for his five most-trusted friends to plan for his succession and to ensure a peaceful transition of power. Bereft with grief, these advisors were almost too pained to focus. “Marcus reproached them for taking such an unphilosophical attitude,” McLynn writes. “They should instead be thinking about the implications of the Antonine plague and pondering death in general.”
“Weep not for me,” began Marcus’s famous last words, “think rather of the pestilence and the deaths of so many others.”
It is here that the past provides its most powerful and sobering lessons. Far too often, the first time civilizations realize just how vulnerable they are is when they find out they’ve been conquered, or are at the mercy of some cruel tyrant, or some uncontainable disease. It’s when somebody famous—like Tom Hanks or Marcus Aurelius—falls ill that they get serious. The result of this delayed awakening is a critical realization: We are mortal and fragile and that fate can inflict horrible things on our tiny, powerless bodies.
There is no amount of fleeing or quarantining we can do to insulate ourselves from the reality of human existence: memento mori— thou art mortal . No one, no country, no planet is as safe or as special as we like to think we are. We are all at the mercy of enormous events outside our control, even (or especially) when that enormity arrives on a wave of invisible, infinitesimally small microbes. You can go at any moment, Marcus was constantly reminding himself and being reminded of the events swirling around him. He made sure this fact shaped every choice and action and thought.
Be good to each other, that was the prevailing belief of Marcus’s life. A disease like the plague, “can only threaten your life,” he said in Meditations , but evil, selfishness, pride, hypocrisy, fear—these things “attack our humanity.”
Which is why we must use this terrible crisis as an opportunity to learn, to remember the core virtues that Marcus Aurelius tried to live by: Humility. Kindness. Service. Wisdom. We can’t waste time. We can’t take people or things or our health for granted.
Even if we may now lack the kind of sacrificial leadership who can show us the way by example—we can turn to the past to tell us what that leadership looks like and to teach us about all these things we must cherish.
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History's 5 deadliest pandemics and epidemics
A little more than 100 years before the coronavirus outbreak, the world was in the grips of the Spanish Flu, which was believed to have infected about one third of the global population at the time.
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Before coronavirus, other deadly pandemics and epidemics ravaged the globe, resulting in horrific death tolls. Here are 5 of the deadliest in history.
5) ANTONINE PLAGUE (165-180 AD): 5 MILLION DEAD
Like the coronavirus, the Antonine Plague is believed to have originated in China. Soldiers marching to Rome from Mesopotamia in late 165 AD were ill, many covered in red and black papules that eventually would scab over and fall off. The plague would soon spread across the Roman Empire. Also similar to the current pandemic, not everyone who caught the virus -- which researchers believe was probably smallpox -- died, and those who survived became immune. However, by the time the plague was under control in 180 AD, it had killed millions of people and had practically wiped out Rome’s 150,000-man military. It also claimed the life of Emperor Marcus Aurelius.
The symptoms, described by famous Roman physician Galen, were unpleasant: diarrhea, coughing, fever, dry throat and the aforementioned papules.
One legend floating around during the time had it that the disease was released when a Roman soldier accidentally opened a golden casket in the temple of Apollo, freeing the cursed plague from confinement. Either way, many were certain that they had done something to anger the gods, such as the sack of the ancient Mesopotamian city of Seleucia. Christians also were blamed for angering the gods.
4) PLAGUE OF JUSTINIAN (540-542 AD): AT LEAST 25 MILLION DEAD
Believed to have been brought over by rat-infested merchant ships sailing into Egypt, at one point the Plague of Justinian (named after the ruling Byzantine emperor at the time) is said to have killed up to 100,000 people a day on average. Recently these figures have been called into question, but researchers have said the Bubonic Plague (Yersinia pestis) spread and continued to pop up from time to time in Europe, Asia, and Africa for years after its arrival in 541 AD, killing millions of people.
Byzantine Greek scholar Procopius wrote of the plague’s beginnings, “It began with the Egyptians who live in Pelusium. It divided and part went to Alexandria and the rest of Egypt, and part to the people of Palestine, the neighbors of the Egyptians, and from there, overran the whole earth.”
The bubonic plague can be transferred from rats to humans through flea bites. Pus filled buboes then grow on parts of the body -- generally in the armpit and groin area -- and a fever develops. Though the Black Death was caused by the same disease, researchers have determined that a different strain caused the Justinian Plague.
3)HIV/AIDS (PEAK YEARS 2005-2012): 36 MILLION DEAD
Thought to have originated in the Congo when the virus was transmitted from chimpanzee to human in 1920, HIV -- the virus that causes Acquired Immunodeficiency Syndrome (AIDS) -- didn’t begin to spread in America until the early ’80s, though some research indicates it may have arrived in New York City from Haiti as early as 1970. In 1981, gay men began being hospitalized for rare cancers and lung infections. Doctors didn’t know how these rare diseases were cropping up, though they believed some condition must have been causing them. In 1982, heroin users began getting these diseases as well, and that year they named the condition AIDS. HIV was isolated in a lab and identified in a French lab in 1983.
The World Health Organization characterizes HIV/AIDS as a global epidemic, whereas the CDC describes it as a pandemic.
According to UNAIDS, an estimated 36 million people are estimated to have died from AIDS-related causes, the peak occurring in 2005 with 2.3 million deaths. The worst area hit was Sub-Saharan Africa, where in 2005, an estimated 2.7 million people became infected with HIV and 2 million adults and children died of AIDS.
In the years since, while antivirals and preventative medication PrEP have helped to prevent transmission of the disease, the number in the United States has leveled off since 2013 with around 39,000 new HIV infections annually.
2)SPANISH FLU PANDEMIC (1918-1920): 50 MILLION DEAD
The 1918 Spanish Flu pandemic was the worst in recent history, with one-third of the earth’s population becoming infected with the H1N1 virus, eventually killing 50 million people. Researchers still can’t pinpoint what made the virus so deadly, but like the current coronavirus pandemic, there was no vaccine at the time. People were instructed to quarantine, maintain social distance, wash hands and sterilize, which was basically all they could do. Some U.S. cities, such as San Francisco, also passed ordinances forcing people to wear masks.
The disease is believed to have first appeared in 1916 in a British army hospital, located in Étaples, France, and like the H5N1 Virus, may have been caused by birds. This severe pneumonia-like influenza festered and spread in the cold, wet trenches of World War I, and from there, it circled the globe.
1) THE BLACK DEATH (1347-1353 AD): 50 to 200 MILLION+ DEAD
Some figures of the Black Death’s toll range from 50 million, others 200 million or higher, which arguably would make it the most deadly pandemic in world history.
Many scholars believe that, like COVID-19, the Black Death originated in Asia. It was spread by the movement of Batu Khan’s Golden Horde. During the horde’s siege of Caffa (A major seaport on the Black Sea), the Mongols -- who were losing numbers rapidly to the disease -- catapulted buboe-riddled bodies over the city walls. It spread to the fleeing populace, whose merchants then took it over the Black Sea.
The nightmare began for Europe one October day in 1347 as 12 ships from the Black Sea arrived in Sicily. Porters greeting the ships found a grisly sight: a few ill sailors, their bodies ravaged with black, oozing buboes, standing on deck among their dead crewmates. Despite soon banishing the ships from the port, the damage already was done.
From Sicily, the disease spread like wildfire, ravaging the European population until 1353. Symptoms included high fever, chills, vomiting and diarrhea. It also caused the aforementioned pus-filled buboes as well as parts of the body (nose, fingers, toes, etc.) to become black with gangrene. While it has long been maintained that the Black Death was spread through fleas from rats, many now believe it was spread through human fleas and body lice. Dr. Samuel K. Cohn, a medieval history professor at the University of Glasgow and author of "The Black Death Transformed" (2002), was one of the original proponents of the theory that it was spread via human-to-human transmission.
“It spread very quickly,” Cohn told Fox News. “It was not spread by the inefficient mechanism of fleas on rats, although the textbooks demand that that must be the case, especially now with ancient DNA which shows with a strain of Yersinia pestis - however as we know from diseases like SARS and syphilis, different pathogens can be very closely related and produce completely different diseases.”
In his book, Cohn noted that people developed a resistance to the Black Death, which was a medical impossibility with the “classic” Bubonic Plague. Also, the Black Death thrived in temperatures and seasons when rat fleas were at their lowest ebb. What exactly the Black Death was remained unknown, though one thing was sure- it spread fast and would spread even faster today than COVID-19 thanks to modern modes of transportation.
“I would say the Black Death was even faster spreading [than coronavirus] in some ways given its track-record in circumnavigating Europe,” Cohn explained. “The Black Death could only move as fast as people and horses could move, so it couldn’t spread faster than an airplane can carry people. But, the whole dissemination seems to have been from 1348-49, a more quickly spreading disease within a certain area over time, and the disease knocked out anywhere from a half to 3/4 of the population of Florence in the space of three or four months.”