by Sean Martin
The severity of the plague suggests that it was a disease previously unknown in Europe (and therefore probably wasn’t the same disease as the Athenian Plague, despite Galen’s efforts to compare the two). The historian Cassius Dio claimed there were 2,000 fatalities a day during one of the later outbreaks of the epidemic (in AD 189), ‘a figure that has the dubious merit of being at least theoretically possible.’95 Although numbers cited by ancient writers tend to be more symbolic than literal, we can be certain that a lot of people were dying; it is thought that between a quarter and a third of Rome’s population died. The army was also devastated to such an extent that Marcus Aurelius’s campaigns against the Marcomanni tribes in the Danube had to be delayed. With Imperial forces seriously weakened, the Marcomanni, and other peoples, were able to slowly encroach on Roman territory. Estimates of fatalities range from between one and five million.
If it wasn’t bubonic plague or typhus, what was the Antonine Plague? Smallpox – ‘or something similar or ancestral to it’96 – has long been thought to be the most likely culprit; or smallpox working alongside another disease new to Europe, measles. A combined attack of two diseases on a virgin population would certainly have been far more deadly than an epidemic of a disease to which people had had time to build up resistance.
A similar mystery surrounds the Plague of Cyprian, which raged across the Roman Empire between 251 and c. 270:
… there broke out a dreadful plague, and excessive destruction of a hateful disease invaded every house in succession of the trembling populace, carrying off day by day with abrupt attack numberless people, every one from his own house. All were shuddering, fleeing, shunning the contagion, impiously exposing their own friends, as if with the exclusion of the person who was sure to die of the plague, one could exclude death itself also. There lay about the meanwhile, over the whole city, no longer bodies, but the carcases of many...97
So wrote Pontius the Deacon, in his hagiography of St Cyprian, Bishop of Carthage, after whom the epidemic was named. Cyprian (c. 210–258) described the symptoms in his tract De Mortalitate:
... that now the bowels, relaxed into a constant flux, discharge the bodily strength; that a fire originated in the marrow ferments into wounds of the fauces; that the intestines are shaken with a continual vomiting; that the eyes are on fire with the injected blood; that in some cases the feet or some parts of the limbs are taken off by the contagion of diseased putrefaction; that from the weakness arising by the maiming and loss of the body, either the gait is enfeebled, or the hearing is obstructed, or the sight darkened… (De Mortalitate 14)
These symptoms – diarrhoea, a raging sore throat, vomiting, losing limbs to what sounds like gangrene, general weakness – make it sound as though smallpox was at work, although, as with the Antonine Plague, it could well have been an ancestral variant, or smallpox and measles working together. Bubonic plague has even been conjectured. Whatever it was, it was utterly deadly, with a mortality rate possibly as high as 50 per cent in some areas. Cyprian also noted that ‘this Disease attacks our people equally with the heathens’ (De Mortalitate 8). Historian William McNeill believes this second plague was even more deadly than the Antonine. ‘This time reported mortality in the city of Rome was even greater [than the Antonine Plague],’ he wrote, ‘five thousand a day are said to have died at the height of the epidemic, and there is reason to believe that rural populations were affected even more sharply than in the earlier epidemic’.98
The impact of the Plague of Cyprian is difficult to assess with accuracy, but we can certainly count severe population decline as being among its more debilitating legacies. (Whatever the Plague of Cyprian was, outbreaks were said to have recurred, including a severe one in the British Isles in the mid fifth century. The Venerable Bede claimed that, in some places, there were hardly enough people left to bury the dead.) The Cyprian Plague was also a major factor in the so-called ‘Crisis of the Third Century’, caused by economic depression and what almost constituted open season on the emperor’s throne, with over twenty claimants during a fifty-year period (AD 235–85). While the empire was falling apart, Rome remained the hub of the western world, attracting scores of immigrants, pilgrims, mercenaries and merchants, all bringing their diseases with them.
Aside from its depleting of the strength of Rome’s armies and weakening her lengthy borders, and thus possibly beginning the decline of Rome, the plague of Cyprian had another lasting consequence. Cyprian’s De Mortalitate was not a medical tract: it was consolatory. Addressed to fellow Christians, Cyprian reminded his congregation of the tribulations of Job, Abraham and Paul, whose faith was not shaken by adversity:
… as it is written, “The furnace trieth the vessels of the potter, and the trial of tribulation just men.” [Ecclesiasticus 27:6] This, in short, is the difference between us and others who know not God, that in misfortune they complain and murmur, while adversity does not call us away from the truth of virtue and faith, but strengthens us by its suffering. (De Mortalitate 13)
Cyprian welcomed the plague, telling believers it was a test of their faith. For those yet to be converted, Christianity offered refuge in a world that, as Cyprian admitted, ‘is changing and passing away, and witnesses to its ruin not now by its age, but by the end of things’ (DM 25). With the world changing and passing away, people flocked to the Church for solace. This happened despite renewed persecution of Christians by the emperor Valerian (among whose victims was Cyprian himself).
Not only did the Cyprian Plague swell the Church’s rank-and-file, it also helped establish the image of Christ the physician, and with it, Christian influence on medicine and care of the sick. Of the thirtyplus miracles Jesus performs in the New Testament, around two-thirds are healing miracles – curing blindness, leprosy, lameness and cases of possession by demons and evil spirit, which modern medicine would probably classify as psychiatric disorders, although one could be a case of epilepsy.99
As Roy Porter reminds us, ‘“holiness” and “healing” stem from the same root, meaning “wholeness”’.100 St Luke the Evangelist is traditionally held to be a doctor, ‘the beloved physician’ (Colossians 4:14). At Pentecost, Christ’s disciples are filled with the Holy Spirit and able to heal; Peter cures a lame beggar at the temple gates in the very next chapter (Acts 3:1–10). Thus began a long tradition of healing miracles, often associated with saints, replacing the earlier tradition of incubation, temple sleep and cure by the touch of the (pagan) god. Indeed, so similar was Christianity to paganism in this respect, that EM Forster once remarked it was ‘carrying on the work of the earlier firm’.101 Seeing healing as a religious duty, Christians also established the first western hospitals and hospices in the fourth century, caring for pilgrims and lepers.102 Hostels and almshouses followed. Despite Christianity’s hostility to all things pagan, Christian doctors happily adopted the theory of the four humours, and continued to regard disease, especially epidemics, as a sign of divine displeasure with a sinful humanity. In this way, the ‘work of the earlier firm’ was carried on unchallenged in the West until the Renaissance.
The Plague of Justinian
Antiquity is sometimes seen as ending with the closure of the Academy in Athens in the year 529. In his wisdom, the emperor Justinian (527–565) had taken it upon himself to persecute pagan philosophers (amongst others). It was meant to be part of a larger plan to eradicate paganism and heresy from the eastern Roman Empire, which would then be reunited with the western half of the empire, lost to various pagan tribes in the previous century. While Justinian and his general, Belisarius, were busy with this ambitious and ultimately doomed plan, something happened that possibly has a better claim to ‘ending antiquity’ than the closure of the Academy: the first pandemic of one of the most deadly and feared diseases in history, bubonic plague.
Plague is a rodent disease, most frequently associated (in Europe at least) with the black rat. It is endemic to a number of regions of the world, including parts of Africa, Central Asia, par
ts of South America and the more temperate regions of the North. It is possibly also endemic in Europe, but on a vastly lesser scale. The plague bacillus, Yersinia pestis, lives in the bloodstream of small rodents such as rats, marmots, squirrels or mice. Originally a harmless bacteria in their stomachs, the bacillus evolved over time, enabling it to enter the animals’ bloodstream, and becoming lethal in the process.
Rodent fleas are the disease’s main vector. When a flea (usually the rodent’s familiar, Xenopsylla cheopis) feeds on an infected host, the plague bacillus multiplies inside the flea’s body, blocking its oesophagus and making it chronically thirsty. Its compulsion then is to bite continually to slake its thirst. When the rodent it has been feeding on dies, it will look for another host to drink from, but, because its foregut is full of undigested, infected blood, it will pass the plague bacillus into the bloodstream of whatever animal it tries to feed on next. The flea becomes, as it were, a highly effective syringe, administering potentially lethal doses of Y. pestis to each new host, and with the number of potential hosts diminished due to a plague outbreak, large numbers of fleas would end up living on the same animal; a single rat could have hundreds of plague-infested fleas living on it. With such large numbers of fleas feeding from the same animal, it would hasten the end of the unfortunate host far quicker than if normal numbers of fleas were present, and X. cheopis would be forced to go further afield to seek sustenance. That it’s also a hardy insect, able to survive for up to six weeks without a host, would help explain why the disease could traverse such huge distances and still remain lethally effective.
X. cheopis does not particularly like human blood but, in the absence of any other host, it will bite. Bubonic plague attacks the lymphatic system, and produces boils or buboes in the groin (the word derives from the Greek word for groin, boubon), armpits or neck, usually depending on where the victim was bitten. Bites on the leg would result in buboes in the groin, upper body bites in the armpit or neck, often resulting in the victim developing a limp, a raised arm or a head permanently cocked away from the bubo. Regardless of where they develop, the buboes can vary in size, from that of an almond to that of an orange, are extremely painful and sometimes noisy, being known to make strange gurgling sounds. Most victims will only develop one bubo, appearing between two and six days after the initial infection; if more develop, they will normally be on the same chain of lymph glands. If the buboes suppurate within a week, the victim will usually recover. If not, as happened in the majority of cases, the victim will die. Untreated, bubonic plague has a mortality rate of around 60 per cent.
Although buboes are the most well-known symptom of plague, the victim will likely first become apathetic, quickly developing a high fever, with vomiting, extreme headaches, giddiness, intolerance to light, pains in the abdomen, back and limbs, sleeplessness and acute diarrhoea being not long in following. Contemporary chroniclers also recorded three other symptoms: bruise-like blotches on the skin (possibly caused by subcutaneous haemorrhages) which were termed ‘God’s Tokens’; severe delirium, which often led to episodes of manic shouting and laughing or, if the victim was still able to stand, dancing or walking aimlessly around in a trance until they collapsed; and, finally, an all-pervasive malodorousness that affected everything the victim’s body produced, from breath, sweat and blood to faeces, urine and pus. Plague also has two variants, pneumonic and septicaemic (see the Black Death in Chapter 3), which attack the lungs and bloodstream respectively. These are even more deadly than the bubonic form of the disease.
Why endemic diseases such as plague become epidemics and pandemics is still a matter for research. Usually, a variety of factors will cause the host to leave its native habitat and seek new territories. In the case of the Justinian plague, we can conjecture that rodents in the disease’s African reservoir – possibly Ethiopia – were forced out of their natural habitat due to natural factors (drought, for instance), and then travelled north with trade caravans. Trade routes would have continued to play a major part in disseminating the disease once it had gained a foothold in Egypt.
Plague – as an endemic, rather than epidemic, disease – seems to have been known to a number of ancient writers. Aretaeus of Cappadocia (fl. 60–80 AD), Rufus of Ephesus (fl. 100) and Oribasius (c. 325 – c. 400) all refer to plague (or something that sounds very much like it), but the major epidemics of their times seem to have been a probable mixture of smallpox, measles, typhus and the ever-present malaria. In the Bible, aside from the ten plagues of Egypt, there was the Plague of Ashdod in the First Book of Samuel. This is more interesting, as it mentions rats.
After capturing the Ark of the Covenant and taking it to the city of Ashdod, the Philistines experienced that old disease chestnut, divine displeasure: ‘The Lord’s hand was heavy upon the people of Ashdod and its vicinity; he brought devastation upon them and afflicted them with tumours’ (1 Samuel 6). The Septuagint and Vulgate versions of the Bible make it clear what this plague is, adding: ‘And rats appeared in their land, and death and destruction were throughout the city.’ A few verses later, ‘the Lord’s hand was against that city, throwing it into a great panic. He afflicted the people of the city, both young and old, with an outbreak of tumours.’ Once again, the Septuagint is more explicit, by replacing ‘tumours’ with ‘tumours in the groin’. The connection between rats and tumours is reinforced in Chapter 6 where, to placate the wrath of the Almighty, the Philistines have to make gold replicas of five rats and five tumours, as there were five Philistine rulers ‘because the same plague has struck both you and your rulers’. Despite these tantalising references to rats and tumours in the groin, the Plague of Ashdod isn’t supported by archaeological or paleopathological evidence. The events of 1 Samuel remain in that hinterland between history and myth, like all the other diseases mentioned in the Bible. The same cannot be said, however, for what became known as the Plague of Justinian.
It began in the Egyptian port of Pelusium in the summer of 541, and ‘is the first time that we can correctly use the term “plague”, for the sickness was undoubtedly bubonic plague.’ Prior to DNA analysis confirming Y. pestis as the cause of the Plague of Justinian,103 our chief sources were chroniclers such as the Byzantine historian and lawyer Procopius, whose History of the Wars contains an eyewitness account of plague. (As Belisarius’s legal adviser, Procopius accompanied the general on many campaigns, where he saw the plague at work.) Procopius describes how the plague started in Egypt, and spread to the rest of the Byzantine Empire, Europe, Persia and the ‘barbarian hinterland’, by which he probably means the British Isles. Egypt and Asia Minor (modern-day Anatolian Turkey) were particularly badly affected.
Procopius noted that fever was the first sign of plague, with buboes forming after a few days. ‘He reports that the mortality rose alarmingly, eventually reaching more than ten thousand each day.’104 Although we should take ten thousand deaths a day with a pinch of salt, Procopius was voicing the feelings of many when he wrote that Plague of Justinian was ‘a pestilence by which the whole human race came near to being annihilated.’105
Other chroniclers reported equally grim news. The lengthiest account of the plague is found in the Ecclesiastical History of John of Ephesus (c. 507–588) who was, even more than Procopius, better placed to witness the annihilation. He was on a diplomatic mission from Constantinople to Alexandria when the plague broke out. Returning home through Palestine, Syria and Asia Minor, he found to his alarm that the plague seemed to be travelling with him:
During the tumult and intensity of the pestilence we journeyed from Syria to the capital. Day after day we, too, used to knock at the door of the grave along with everyone else. We used to think that if there would be evening, death would come upon us suddenly in the night. Although the next morning would come, we used to face the grave during the whole day as we looked at the devastated and moaning villages in these regions, and at corpses lying on the ground with no one to gather them.106
John saw people carrying corps
es all day, while others were engaged in the apparently endless task of digging fresh graves. One monastery buried eighty-four of its monks. Houses lay abandoned. Animals wandered untended in streets and on farms.
Crops of wheat in fertile fields located in all the regions through which we passed from Syria up through Thrace, were white and standing but there was no one to reap them and store the wheat. Vineyards, whose picking season came and went, shed their leaves, since winter was severe, but kept their fruits hanging on their vines, and there was no one to pick them or press them.107
The plague seemed to spare no one. John believed that, terrible as it was, it was divinely ordained. As translator Amir Harrak commented, ‘John believed that there was a divine plan in the fact that the poor were struck first, so that they might be appropriately buried by the rich, and in the fact that, by the time the rich were struck, there were no survivors to bury them, so that they might rot in the streets, houses and palaces – as in fact happened.’108
The emperor Justinian ordered the digging of mass graves, but was then himself stricken; he recovered to rule for another twenty years. Pope Pelagius II was not so fortunate, succumbing to a recurrence of plague in 590. His successor, Gregory the Great, organised public processions ‘to demonstrate collective penance’.109
