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Infect Dis Clin N Am 18 (2004) 6577

The plague under Marcus Aurelius


and the decline and fall of the Roman
Empire
J. Rufus Fears, PhD
Department of Classics, University of Oklahoma, Kaufman Hall, Norman, OK 73019, USA

In 166 AD, in the reign of the emperor Marcus Aurelius, a plague of


exceptional virulence broke out in the Roman Empire. The infectious
disease was brought back by Roman troops campaigning in what is now
Iraq. The pandemic ravaged the entire extent of the Roman Empire, from its
eastern frontiers in Iraq to its western frontiers on the Rhine River and
Gaul, modern France, and western Germany. The mortality rate was high,
with deaths among peasants and aristocrats, poor and rich alike.
The plague of 166 AD was one of three great plagues to strike the
classical world. The rst plague occurred in Athens under the rule of Pericles
in 430 to 429 BC. The second plague is sometimes called the Antonine
plague after the full name of the emperor Marcus Aurelius Antoninus. The
third plague broke under the rule of the emperor Justinian in 542 AD. The
Athenian plague [1] and the Justinianic plague are well known to historians
of infectious diseases [2]. The Antonine plague is much less familiar,
especially to medical scientists. In discussing the history of plagues in GrecoRoman antiquity, medical scientists tend to focus on the Athenian plague
and the Justinianic plague. Two studies of the history and impact of plagues
are the book by Susan Scott and Christopher J. Duncan called Biology of
Plagues (2001) [3] and the article by Michel Drancourt and Didier Raoult
entitled Molecular Insights into the History of Plague in the 2002 volume
of Microbes and Infection [4].
Both of these studies ignore the plague of 166 AD, which gives the
impression that the classical Greco-Roman world was plague free for 1000
years, from 430 BC to 542 AD; however, outbreaks of plagues of varying
intensity were a fairly constant feature of life in ancient Greece and Rome
[5,6]. The plague of 166 AD occurred in a historical and social context that
E-mail address: jrfears@ou.edu
0891-5520/04/$ - see front matter 2004 Elsevier Inc. All rights reserved.
doi:10.1016/S0891-5520(03)00089-8

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J.R. Fears / Infect Dis Clin N Am 18 (2004) 6577

is more comparable to current society than is the Athenian democracy of


Pericles or the Byzantine Empire of Justinian.
In 166 AD, the Roman Empire was at its height. The plague marked the
onset of a century of decline. Barbarian invasions and warfare, economic
distress, political instability, famine, and recurrent outbreaks of plague
reduced the empire to a nadir by 266 AD. In that year, the emperor Valerian
was taken prisoner by the Iranians, and large portions of the empire in the
east and west had broken away. In the later parts of the third and fourth
centuries, the empire recovered to a certain degree economically, militarily,
and politically. In the fth century, however, renewed barbarian invasions
led to the collapse of the empire in western Europe. In the eastern
Mediterranean, centered on Constantinople, the Roman Empire remained
strong. Under Justinian (527565 AD), the Romans attempted to reconquer
the western portions of their empire, including Italy. With the death of
Justinian, the empires recuperative powers were at an end. The empire was
shattered by renewed barbarian invasions and by the rise of Islam in the
early seventh century. Western Europe, the Middle East, and North Africa
were lost permanently. Much of the Balkans, including Greece, was depopulated, and a much transformed and truncated Roman Empire included
little more than Asia Minor (modern Turkey).
Historians term these events as the decline and fall of the Roman Empire.
Edward Gibbon described these events as that awful revolution, and its
consequences in politics, religion, and culture, are with us still today [7].
This article discusses the role of epidemic diseases in bringing about the
decline and fall of the Roman Empire. Its goal is to understand the nature of
the great plague that began in 166 AD. The authors try to determine the
impact of this epidemic in terms of population loss. They also examine
whether such epidemics and population loss had a discernible eect on the
strength and resiliency of the Roman Empire.
The lessons of the plague of 166 AD lie in the remarkable parallels
between the Roman Empire of the rst and second centuries AD and
current society [8,9]. The Roman Empire of the Caesars and the United
States of the early 21st century are arguably the only complete superpowers
that have ever existed. Rome, like the United States, was absolutely dominant in culture, economics, politics, and the military. Rome also governed
a world state.
Marcus Aurelius was a philosopher, warrior, and humanitarian and was
the last of the ve great emperors who raised the Roman Empire in the
second century to an unprecedented apogee of peace and prosperity. These
emperors were Nerva (9698 AD), Trajan (98117 AD), Hadrian (117138
AD), Antoninus Pius (138161 AD), and Marcus Aurelius (161180 AD).
Edward Gibbon described this period as the happiest and most prosperous
period in the history of the human race [10].
The Roman Empire of the rst and second centuries stretched from the
moors of Scotland to the Tigris and Euphrates River valleys of modern Iraq,

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and from the forests of Germany and the North Sea to the sands of the
Sahara. A tour of what was once the Roman Empire would start in the
United Kingdom and go through France, Belgium, and western Germany;
into Switzerland, Austria, and Hungary; and on to Rumania, Bulgaria,
Greece, Turkey, Syria, Lebanon, Israel, and Jordan. The tour would
continue across North Africa, Egypt, Libya, Tunisia, Algeria, and Morocco.
The tour would end in Spain before returning to Italy and the capital of
Rome, a city with a population of more than 1 million.
Such a trip would require knowledge of a dozen languages and currencies
and twice as many visas. Some areas of the former Roman Empire do not
permit travel or are high-risk areas. In the age of the Caesars, one language,
Latin, was used throughout the empire. One law, the law of Rome,
guaranteed equal protection and individual rights to every citizen of the
empire. These facts are illustrated best in the New Testament Book of Acts.
The apostle Paul, a Roman citizen, was arrested. The soldier who had
arrested him did not know this and was preparing to beat him for causing
a disturbance.
You may not beat me, Paul declared.
Who is going to stop me, the ocer snarled.
These citizenship papers, Paul said. I am a Roman citizen. As you
well know, it is illegal to og a Roman citizen who has not been convicted of
a crime.
Having ascertained that Paul was a Roman citizen, the soldier was afraid
that Paul would bring him up on a charge of violating the civil rights of
a Roman citizen. Such was the equal protection aorded by Roman law,
even in a distant province such as Judaea.
Paul was a Jew and a Roman citizen The Roman Empire and the great
emperors who guided it recognized and fostered cultural diversity. It was
a multicultural, multinational empire in which local traditions, languages,
and religions were tolerated and generally encouraged. At the same time, the
emperors bound their vast empire together by a common set of cultural,
social, religious, and moral values, based on the legacy of classical Greece.
The Roman Empire was peaceful, tolerant, and auent. Under a freemarket economy, the empire was bound together by a superb system of
roads. Roman merchants sailed the seas in peace, traveling as far as India,
Southeast Asia, and China to trade. Commerce ourished, and the trade
goods of the world lled the markets and malls of Roman towns such as
Pompeii in Italy, Leptis Magna in North Africa, and Londinium in Britain.
Making money was regarded as a social good. The empire rested on
a large, prosperous, and public-spirited middle class that took pride in its
philanthropic activities. The emperors provided a safety net so that the
children of the poor did not starve. This welfare system did not dampen
the entrepreneurial spirit. The free-market economy provided economic
opportunity. A person could begin life as a slave and still become a wealthy
and inuential Roman citizen.

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The Roman Empire of the rst and second centuries was governed
eciently. It produced a series of great leaders, including Augustus,
Vespasian, Trajan, Hadrian, and Marcus Aurelius, who kept the empire on
such a steady course that not even the eccentricities of a Caligula could
seriously shake it. During this time, the empire was administered by a small,
ecient bureaucracy that attracted dedicated public servants. The multifaceted Pliny the Elder exemplies the Roman civil servant at his best. He
was a capable administrator and a scientist. His Natural History was a
massive encyclopedia of scientic knowledge, including medicine. He served
as Admiral of the Fleet and lost his life in 79 AD in a heroic eort to rescue
fellow citizens from the lava ow of Vesuvius.
The Roman Empire had the nest and most cost-ecient military force
the world has ever seen. Only 360,000 soldiers were needed to guard the farung borders of the empire during the age of the Pax Romana. This army
kept the empire so peaceful that the historian Tacitus, in the second century,
bemoaned the fact that there were not any great wars to write about in his
own day, and he was denied the opportunity to describe the kind of martial
grandeur that had marked the old, free Republic.
The peace, prosperity, and tolerance of the Roman Empire unleashed
a burst of cultural creativity that is comparable with the scientic and
technologic revolution of the 20th and early 21st centuries. During the rule
of the Caesars, the cultural foundations were laid for the next 1500 years of
European civilization, especially for art, architecture, literature, law, science,
and medicine. The sculptural reliefs of the Column of Trajan in Rome depict
the emergence of artistic forms that created the model for the glories of
Christian narrative art in the mosaics, frescos, and sculptures of Byzantium
and medieval Western Europe. Hadrians Pantheon in Rome heralds the
architecture of space, and it receives its most triumphant statement in the
Gothic cathedrals of Europe in the Middle Ages. The emperor Hadrian and
the jurists of the second century shaped Roman law into a vehicle that still
renders justice in most Europe and Latin America. In Roman Alexandria,
Ptolemy charted the course of European astronomy and geography until the
time of Columbus.
During the rule of Marcus Aurelius, Greco-Roman medicine reached
its apogee in the practice and writings of Claudius Galenus, Galen (131
200 AD) [11]. Along with Hippocrates, Galen ranks as one of the two
greatest medical writers of antiquity. Galen acknowledged his indebtedness to Hippocrates but surpassed this doctor from the 400s BC. Galen
combined a holistic approach to medicine with careful physiologic and
anatomic research. He was a medical practitioner and a researcher. He
began his medical career as a physician to gladiators (a sports doctor). He
went on to become the personal physician to the emperor Marcus
Aurelius. His voluminous writings formed the foundation of medical
knowledge in Europe and the Islamic world until the 16th century, the age
of Vesalius.

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Despite his critical attitude toward his colleagues, Galen represents the
relative high quality of Roman medicine in the second century [12]. Better
care was available to ordinary inhabitants of the Roman Empire than it was
to citizens of France and England at the end of the 18th century. A Roman
gladiator received better medical care in 91 AD than George Washington
did 1700 years later. The Roman emperors felt an obligation to provide their
citizens with medical care. There were state-supported medical schools,
district medical inspectors, and state-supported physicians in the numerous
cities of the empire. Through public works like the aqueducts, the cities were
supplied with a larger supply of pure water per capita than many cities of
Europe and America had at the beginning of the 20th century. The
numerous public baths were considered to be important elements in the
imperial policy of state-supported hygiene.
The Roman Empire enjoyed a cultural, economic, and political unity that
was unparalleled in history until the 20th century. In relative terms,
globalization was as characteristic of the Roman Empire as it is of current
society. People, trade goods, ideas, and diseases moved unhindered over
a large part of the known world.
In this world of peace, prosperity, and stability, the great plague of 166
AD erupted. It origins lay in the Middle East, and its spread to the Roman
world was the product of Romes military intervention in Iraq.
Like the United States, Rome faced its most serious and unyielding
foreign policy problems in the Middle East. Rome ruled directly the areas
that constitute the modern nations of Turkey, Syria, Israel, Lebanon
Jordan, and Egypt and all of North Africa. The Middle East was of
enormous strategic and economic importance to Rome. As the oil of the
Middle East fuels the economic life of the United States, the grain of Egypt
fed the economic life of Rome. The cities of Asia Minor (modern Turkey)
were among the richest and most cultivated parts of the empire. The key to
Egypt and Asia Minor was Judaea, modern Israel. To maintain its control
over the Middle East, the Roman emperors followed a twofold policy of
nation building and military intervention.
Like the eorts by the United States, Roman eorts in the Middle East
were not always appreciated. Roman rule was supported most vigorously by
the wealthy and Romanized (an ancient equivalent of westernized) upper
class. Rome faced opposition from religious fundamentalists and nationalists. Roman soldiers and civilians were the objects of terrorist attacks.
Guerrilla warfare at times developed into major campaigns. The struggle of
the Jewish people for independence led to two great wars in 66 to 73 AD and
133 to 135 and to the destruction of the Temple in Jerusalem.
The great challenge to Rome in the Middle East came from Iran,
the kingdom of the Iranian people known to the Romans as Parthians.
Parthia was a well-administered, economically important, and militarily
powerful empire that stretched from the borders of Iraq to Afghanistan.
Roman policy toward Iran alternated between containment and military

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intervention. In 114 AD, the emperor Trajan sought to end the threat of
Parthia by a military campaign. Despite initial success, it ended in failure
and the death of Trajan in 117 AD. Early in the reign of Marcus Aurelius, in
162 AD, Parthia struck back, invading Roman Syria. Marcus declared war,
entrusting the campaign to his brother and joint emperor Lucius Verus. The
campaign was successful, and the Parthian king was driven into hiding. The
Romans captured the Parthian capital of Ctesiphon, on the Tigris River,
near modern Baghdad.
Although the Roman army returned in triumph, the war settled nothing.
The Iranians quickly recovered and continued to be a constant threat to
Rome for 450 more years. The Roman military achieved a sham peace, but
the plague it brought back was real.
According to two fourth-century sources, the history of Ammianus
Marcellinus and the biographies of Lucius Verus and Marcus Aurelius
found in the collection of imperial lives known as the Historia Augusta, the
Romans thought about the origins of the plague of 166 AD. For the
Romans, the plague was the result of sacrilege, the violation of the sanctuary
of a god, and the violation of an oath.
Ammianus Marcellinus was a Roman general and aristocrat who wrote
a history of Rome. He is highly regarded for his accuracy. According to
Ammianus, the plague could be traced to the capture of the city of Seleucia,
which was located on the Tigris River near modern Baghdad [13]. The city
was captured and sacked by the Roman general Lucius Verus in 165 AD.
The act of sacking the city violated the Roman generals oath to the gods
not to sack the city. According to Ammianus, during the sack, the temple of
the god Apollo was plundered. A statue of the god was stolen from his
temple in Seleucia and brought to Rome. In plundering the temple, the
soldiers discovered an ancient tomb. It had been closed up much earlier by
the magic of the priests of the ancient gods. The soldiers believed that it held
buried treasure. Ammianus stated that When the Roman soldiers opened it
up, the pestilence issued forth, bringing contagion and death all over the
empire, from the borders of Iran to the Rhine River and Gaul.
The ancient biographer of Lucius Verus in the Historia Augusta is less
highly regarded for accuracy than is Ammianus [14]. The biographer gives
a slightly variant story, in which the plague issued forth from a temple in the
more ancient and mysterious city of Babylon, also captured by Roman
forces in 165 AD. A Roman soldier was said to have found a golden casket
in the temple of Apollo. When he broke it open, a pestilence erupted that
spread over the world.
To the skeptical modern mind, these stories may sound like an early version
of movies like The Mummy and The Mummy Returns. The Romans took oaths
and religion more seriously than most people currently do. It was also the
common belief of the Romans that plagues were the product of noxious air.
The Roman view of the supernatural origins of the plague in 166 AD does
not need to be accepted; however, the fact that the Romans believed that the

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plague had a supernatural origin in the anger of the gods needs to be taken
seriously. The second century was preeminently an age of religion,
spirituality, and magic. It might be called the age of magic, as the current
age is called the age of science. The supernatural provided the common
means by which all classes of Romans, from emperor to peasants, understood
their world. In the same way, the scientic outlook dominates current world
views. It was natural for the Romans to attribute such a medical catastrophe
to divine anger. People in current society want to nd a scientic explanation,
identify the plague medically, and demonstrate scientically its impact on the
population. Sources that can give such information are wanted.
Readers might wonder why there are so few and unsatisfactory sources
for an event as important as the plague of 166 AD. For the inuenza epidemic of 1919, there are voluminous source materials, historical accounts,
medical records, demographic studies, and newspaper accounts. It would
take years to read all the sources relating to that inuenza epidemic. It takes
only 15 minutes to read in translation all that is known from the ancient
sources regarding the plague of 166 AD.
This lack of information is not caused by the Romans lack of historians
and record keeping. The numerous histories by contemporary Romans and
the massive archives were lost and destroyed in the aftermath of the fall of
the Roman Empire. All that remain is the tiniest remnant of the sources that
would have been available to a medical student in 200 AD attempting to
evaluate the impact of the plague.
In terms of the sources, the plague of 166 AD diers in one signicant
regard from the more famous Athenian and Justinianic plagues. For the
plague at Athens and the plague under Justinian, there are relatively detailed
historical accounts by excellent and careful observers. Thucydides wrote
a narrative of the plague at Athens that is believed to have inuenced the
style of all subsequent ancient historians of plagues. Procopius shows that
inuence in his description of the Justinianic plague.
Despite these accounts, there is no agreement on the identication of the
plagues at Athens and in the Byzantine world. The identity of the plague at
Athens has been debated for more than a century. Classical scholars and
medical scientists continue to arrive at sharply opposed conclusions.
Theories of typhus, smallpox, scarlet fever, measles, bubonic plague,
inuenza, arboviral disease, toxic shock syndrome, Ebola, and anthrax have
been suggested, attacked, and defended. The most detailed recent classical
commentator on Thucydides, Simon Hornblower, states that the identication of the disease in Thucydides is an insoluble problem [15]. Solutions
continue to be proposed, however. The same is true of the plague that
occurred during the Byzantine Empire of Justinian in the sixth century.
Bubonic plague has been a reasonable suggestion as the causative agent of
this plague; however, this idea also is disputed.
For the plague of 166 AD, there is no extended narrative comparable with
that by Thucydides or Procopius. There is, however, a set of contemporary

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observations by the most skilled medical observer of the time: the physician
Galen. These observations are brief and scattered throughout his medical
writings. Galen had rst-hand knowledge of the disease, because he treated
patients who had suered from it.
Galen called the plague a fever plague. As in the case of the plague at
Athens, the patients complained of feeling hot and had an insatiable thirst.
They were not hot to the touch. Vomiting occurred in many cases. Diarrhea
was common, and the excrement was black, which can be taken as sign of
gastrointestinal bleeding. Fetid breath was a symptom in many cases. There
was cough with catarrh and, in at least one case, ulceration of the trachea
and larynx.
The most characteristic symptom was a black exanthema that covered the
entire body. The exanthema was black, ulcerated, and dry. The blackness,
according to Galen, was:
[D]ue to a remnant of blood, which had putreed in the fever blisters, like
some ash that nature had deposited on the body. Of some of those who
became ulcerated, the 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 exanthema was
rough and scabby and fell away lie some husk and hence all became
healthy.

The crisis of the disease came on 9 to 12 days after the onset of the
symptoms. One survivor could get out of bed on the 12th day.
Galen believed that the plague he treated was similar to the plague at
Athens, which Thucydides described. The 10th century Persian doctor
Rhazes was the author of a treatise on smallpox and measles. Rhazes may
have been the most distinguished physician of the great age of Islamic
medicine. He identied Galens plague as smallpox, which he treated with
frequency. Rhazes discussion of the symptoms of smallpox in the 10th
century corresponds closely to the 20th-century description of smallpox.
This observation has led to the conclusion that smallpox seems to have
undergone little change in its basic symptomatology over the course of
history.
The plague of 166 AD, described by Galen, has been identied most
commonly as smallpox and was identied as smallpox in 19th-century
medical textbooks. This conclusion also was made in the most detailed
recent (1973) treatment of the medical aspects of Galen and the Antonine
plague of 166 AD by R.J. Littman and M.L. Littman, a collaborative study
by a classical scholar and a medical scientist [16]:
Although Galens description of the plague is incomplete, it is adequate
enough to enable rm identication of the disease as smallpox because of
the excellent description of the most important diagnostic sign, the
exanthema. The hemorrhagic nature of the exanthema and the intestinal
bleeding strongly suggest that there was a very high incidence of the

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hemorrhagic phase of smallpox, as well as the purpuric phase, which are the
diseases most virulent form. In the Minneapolis outbreak of 192425, 164
deaths occurred out of 196 cases of hemorrhage and purpuric smallpox,
while there were only 165 deaths out of 386 cases of unclassied, discrete,
and conuent smallpox.

In addition to smallpox, typhus also has been suggested as a possible


cause. Doctors have treated epidemics of smallpox and typhus state that in
the early stages, typhus and smallpox exhibit such similar symptoms that it
may be impossible to distinguish between the two diseases. Bubonic plague,
which has been suggested, seems a more unlikely candidate, because Galen
makes no mention of the characteristic buboes.
It generally is agreed that the plague under Marcus Aurelius was
smallpox. This view was accepted in recent standard reference works on the
Roman Empire [17]. Identication of the disease is crucial to drawing
conclusions about its impact based on projected mortality rates. It is not
clear that smallpox is consistent with the evidence for high mortality rates
over a long period of time, which is characteristic of the plague under
Marcus Aurelius. This nding is based on comparative evidence from
smallpox epidemics in late 17th- and early 18th-century England. According
to Scott and Duncan [18]:
Once recovered, people were immune to the smallpox virus for a long time
so that each new epidemic swept with high infectivity only through the
children who had been born in the interim, of whom about 20% died. This
is the typical pattern in a population that has suered from a disease in its
milder and more severe form for over 100 years.

The pattern of the plague in the Roman Empire was dierent. The
ultimate solution for identifying the great plagues of antiquity (Athenian,
Antonine, and Justinianic plagues) may lie in DNA samples [19].
Archaeologists, historians, and medical scientists working together can
tap the rich reservoir of scientic evidence available in human remains. In
the past decade, archaeologists have discovered two mass burials in Athens,
dating from the plague years of 430 to 4298 BC [20,21]. One burial
reportedly held 90 skeletons, and the other burial contained 160. The
character of the burials conrms the report of Thucydides that the number
of victims was so great that the ordinary funeral rites, such as cremation,
were abandoned. By the second century, burial was the normal funeral rite
in the Roman Empire. DNA samples oer the best key to identifying the
plague under Marcus Aurelius. The mummies of Egypt and the large
number of skeletal remains from cemeteries such as Isola Sacra at Ostia, the
port city of Rome, are rich reservoirs for study.
It is worth exploring the possibility that the plague of Marcus Aurelius is
similar to the current threats of anthrax outbreaks and bioterrorism. The
story that the plague issued forth from the ground might be reminiscent of
anthrax. The symptoms described by Galen are not inconsistent with such

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a diagnosis. The plague reoccurred in 189 AD under Commodus, the son of


Marcus Aurelius. Its eects are described by two historians who lived
through the plague, Cassius Dio and Herodian. According to eyewitness
accounts, the plague killed humans and animals, specically livestock. The
plague was accompanied by a famine [22].
Dios account of this plague is reminiscent of modern fears of
bioterrorism: Then, too, many others died in Rome and throughout the
entire empire. They perished at the hands of criminals, who smeared some
deadly drugs on small needles and for pay infected people with the poison
by means of those needles. According to Dio, there had been a similar
occurrence of this bioterrorism 100 years earlier [23].
A variety of sources make it clear that a high mortality rate was
associated with the plagues under Marcus Aurelius and Commodus. The
plague was still raging when Marcus Aurelius died in 180 AD. The ancient
biographer of Marcus Aurelius stated that thousands died at all levels of
society and that the dead were carried out in carts. According to the fourthcentury historian Eutropius, a large part of the population of the empire
died during the course of the plague. This view also was presented by the
pagan historian Ammianus Marcellinus. Christian writers, such as St.
Jerome and Orosius, credit the plague under Marcus Aurelius with
a devastating loss of life among civilians and soldiers.
Such accounts are not dismissed easily as wild exaggerations. Many such
accounts exist, and they are often consistent. The most recent studies of the
scattered documentary evidence establish that the plague that began under
Marcus Aurelius was prolonged, widespread, and severe. There was a heavy
loss of life that had important economic, social, and political ramications.
The severe loss of life led to decreased numbers of taxpayers, recruits for the
army, candidates for public oce, and members of corporations. Land was
left fallow because there was no one to cultivate it.
The plague was worldwide. Chinese records indicate an upsurge in the
occurrence of plagues during this period. The spread of the plague was
facilitated by the economic unity of the world in the age of the Roman
Empire. There were trade and other contacts between China and Rome. The
epidemic spread along the route of the Silk Road through Inner Asia to the
Middle East and the Mediterranean. It was carried on board the ships that
brought goods from China to India and the Roman Empire [24].
The plague was a recurrent epidemic that occurred over a long period of
time. It broke out in 166 AD and was still raging in 180 AD. In 189 AD,
a severe plague was attested. From 251 to 170 AD, it seems that the plague
was a constant factor in the Roman Empire, killing the son of the emperor
Decius in 251 AD and the emperor Claudius II in 270 AD [25,26].
The plague under Marcus Aurelius was a worldwide pandemic. It had
a major political and spiritual impact on the decline and fall of the Roman
Empire. The empire never recovered from the loss of manpower incurred by
a century of plague [27,28,29,30]. As current society is fueled by petroleum,

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the Roman Empire was fueled by manpower. To feed the empires numerous
cities, massive amounts of farm labor were required. The situation was the
exact reverse of today, when one farm can feed numerous city dwellers. In
the cities and on the farms, the loss of manpower meant a loss in taxation
revenues for the empire. In the plague years, the revenue shortage had
become so severe that Marcus Aurelius was forced to auction o the
imperial jewels rather than levy new taxes on the already exhausted
provinces.
The outbreak of the plague in 165 to 166 AD was accompanied by
renewed threats from the Germanic tribes of central Europe. Encouraged
perhaps by the manpower losses resulting from the plague, these Germanic
tribes formed new coalitions and began to attack and devastate the empire.
A total of 160,000 Roman citizens were taken as prisoners. In a series of
campaigns, Aurelius was able to beat back the Germans. Peace terms
allowed the Germans to settle in the frontier provinces of the empire, which
had been depopulated as a result of the plague and barbarian invasions.
Because of the manpower losses, the Roman army increasingly began to use
Germans as mercenary troops. Germans in the Roman army and invasion
of the empire by other Germanic tribes became permanent features.
Ultimately, these Germanic invasions were to be the most direct single cause
of the collapse of Roman power in western Europe. By the end of the fth
century, Germanic chieftains dwelled in the half-ruined places of the
Caesars.
Taking advantage of the problems of the Romans, the Iranians began
a series of wars that would last intermittently for more than 4 centuries and
leave both nations exhausted. In the seventh century, the armies of Islam
conquered Iran and the Roman Middle East.
The plague carried o the rich and powerful and pious people and sinners
alike. In an age in which antibiotics were lacking, there was no cure. As in
the plague at Athens, a profound anxiety swept over the inhabitants of the
Roman Empire. There was an intensication of the spiritual trends that had
been developing slowly for almost 2 centuries. These trends are centered on
monotheism and an increased concern with the salvation of the individual
soul. Religions like Mithraism and Christianity promised immortality
through belief in an individual savior divinity, the son of the one true god of
the universe. Marcus Aurelius fostered the belief that the plague was the
result of divine anger. He oversaw a variety of religious rites, Roman and
foreign, aimed at purifying the city. He also instituted a persecution of the
Christians, a favorite target of the charge of bringing about divine wrath by
their refusal to worship the gods of Rome.
This religious fervor and anxiety is revealed in the art of the later part of
the reign of Marcus Aurelius. Transformations in artistic style, again long
developing, became permanent. The classical naturalism and canons of
Greek art, once dominant in Roman ocial art, was subordinated to the
symbolic. Portrait busts show individuals, even emperors, marked by intense

76

J.R. Fears / Infect Dis Clin N Am 18 (2004) 6577

anxiety and worry. Romans felt powerless in the face of this divine scourge.
A century of plague had a central role in establishing the religious climate in
which Christianity ultimately emerged as the ocial religion of the Roman
Empire.

Summary
The plague that broke out in the Roman Empire under Marcus Aurelius
in 166 AD was a pandemic of worldwide proportions. The plague generally
is believed to have been smallpox. Anthrax is another possibility. DNA
samples may aord the clue to a denite identication. Whatever the disease
was, the plague was recurrent and produced a high mortality rate over more
than a century. The impact was profound in the political, economic, social,
and spiritual lives of the Roman Empire. Along with military defeat and
political instability, the plague was a signicant factor in the decline and fall
of the Roman Empire.

References
[1] Durack DT, Littman RJ, Benitez RM, Mackowiak PA. Hellenic holocaust: a historical
clinico-pathologic conference. Am J Med 2000;109(5):3917.
[2] Sarris P. The Justinianic plague: origins and eects. Contin Chang 2002;17(2):16981.
[3] Scott S, Duncan CJ. Biology of plagues. Cambridge: Cambridge University; 2001. p. 26.
[4] Drancourt M, Raoult D. Molecular insights into the history of plague. Microbes Infect
2002;4:1059.
[5] Duncan-Jones RP. The impact of the Antonine plague. Journal of Roman Archaeology
1996;9:10811.
[6] Salares JR. The ecology of the ancient Greek world. Ithaca (NY): Cornell University; 1991.
[7] Gibbon E. The decline and fall of the Roman Empire. London: Methuen; 1909. p. 175.
[8] Fears JR. Antiquity: the example of Rome. In: McLean E, editor. Essays on the pursuit of
Liberty. Wilmington (DE): Intercollegiate Studies Institute; 1997. p. 138.
[9] Fears JR. The lessons of the Roman Empire. In: Boren D, Perkins E, editors. Preparing
Americas foreign policy for the twenty-rst century. Norman (OK): University of
Oklahoma; 1999. p. 36972.
[10] Gibbon E. The decline and fall of the Roman Empire. London: Methuen; 1909. p. 856.
[11] Sarton G. Galen of Pergamum. Lawrence (KS): University of Kansas; 1954.
[12] Jackson R. Doctors and diseases in the Roman Empire. Norman (OK): University of
Oklahoma; 1988.
[13] Rolfe JC. Ammianus Marcellinus, vol. 2. Cambridge (MA): Harvard University; 1940.
p. 363.
[14] Magie D. The Scriptores Historiae Augustae, vol. 1. Cambridge (MA): Harvard
University; 1921. p. 223.
[15] Hornblower S. A commentary on Thucydides. Oxford: Oxford University; 1991. p. 316.
[16] Littman RJ, Littman ML. Galen and the Antonine plague. Am J Philol 1973;94:24355.
[17] Sallares JR. Plague. In: Oxford Classical Dictionary. 3rd edition. Oxford: Oxford
University; 1996. p. 1188.
[18] Scott S, Duncan CJ. Biology of plagues. Cambridge: Cambridge University; 2001. p. 376.
[19] Drancourt M, Raoult D. Molecular insights into the history of plague. Microbes Infect
2002;4:1059.

J.R. Fears / Infect Dis Clin N Am 18 (2004) 6577

77

[20] Online News article for April 15, 1998: Plague Vitims Found: Mass Burial in Athens.
[21] Durack D, Littman RJ, Benitez RM, Mackowiak. Hellenic holocaust: a historical clinicopathologic conference. Am J Med 2002;109(5):3917.
[22] Cary E. Dios Roman history, vol. 9. Cambridge (MA): Harvard University; 1927. p. 101.
[23] Whittaker CR. Herodian, vol. 1. Cambridge (MA): Harvard University; 1969. p. 735.
[24] Mayor A. Greek re, poison arrows, and scorpion bombs: biological and chemical warfare
in the ancient world. London: Duckworth; 2003. p. 1267.
[25] Duncan-Jones RP. The impact of the Antonine plague. Journal of Roman Archaeology
1996;9:10936.
[26] Scheidel W. A model of demographic and economic change in Roman Egypt after the
Antonine plague. Journal of Roman Archaeology 2002;15:97114.
[27] Stathakopoulos D. Famine and pestilence in the late Roman and Byzantine Empire. In:
Birmingham Byzantine and Ottoman monographs. Aldershot (UK): Ashgate; 2004.
[28] McCormick M. Rats, communications, and plague: towards an ecological history. Journal
of Interdisciplinary History 2003;34(1):125.
[29] Boak AR. Manpower shortage and the fall of the roman Empire in the west. Ann Arbor
(MI): University of Michigan; 1955.
[30] Niebuhr BG. The history of Rome, vol. 6. London: Taylor and Walton; 1844, p. 282.

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