The Plague in Antiquity: Two Ancient Lessons for the Post-COVID World

When the Coronavirus first surfaced in late-2019, people worldwide were forced to adjust their lives to accommodate it. Only later, long after the first lockdowns were enforced, was it possible for us to come to terms with this “new normal.” That COVID’s arrival made such a difference to our lives should not, however, come as too much of a surprise; pandemics and plagues have always been instigators of social, political, and behavioral change.

The Plague of Athens (430-426 BCE) and the Antonine Plague (165-180 CE) are notable examples from classical history of how disease shaped the Greco-Roman world. As hard as it is to believe, hearing about the plague from other eras may even make you grateful for the sort of virus COVID is, how the world has responded, and the relative luxuries of lockdown.

The Background: The Peloponnesian War

The Plague of Athens occurred primarily as a result of the generation-long conflict between Athens and Sparta called the Peloponnesian War. It began with the invasion of the Attic region surrounding Athens by the Spartan king, Archidamus. He came with his army from the south and swept over the land, torching villages and crops as he went.

Although it was one of the most populated cities in the Mediterranean (with anywhere between 100,000 to 150,000 people), Athens was not equipped to handle the sudden influx from the surrounding Attic countryside, which had a population of between 300,000 and 400,000 people. As a result, most of these rural refugees were forced to live in the confines of the Long Walls. These stretched from the Piraeus to the center of the city and had been built fifty years before by the Greek General Themistocles to ward off the Persians. 

In theory, Pericles’ plan was a good one. But he did not account for what else the harbor could channel into the city besides food and fresh water. In 430 BCE, one of the many daily ships entering the Piraeus from all over the empire sailed into the harbor carrying a vicious and deadly plague. The confined and unsanitary conditions that this disease found there, suited it perfectly.

Most of our best information about the plague (where it came from, what it was like, and who its victims were) comes from The History of the Peloponnesian War, a book written by the Athenian general Thucydides (460-400 BCE). In this book, the writer documented the events of the war as they were happening, making it the earliest surviving example of eye-witness history. When it comes to the Plague of Athens, Thucydides’ account is especially exact, since he was one of the lucky few to contract it and survive.

Thucydides claims that the plague “first began, it is said, in the parts of Ethiopia above Egypt, and from there descended into Egypt and Libya and into most of the king’s country. Suddenly falling upon Athens, it first attacked the population in Piraeus…and afterwards appeared in the upper city, when the deaths became much more frequent.” (2.48.1-2)  

The identity of the disease has long been contested and suggestions have included bubonic plague, typhoid fever, smallpox, or some form of measles. Up until recently, our guesses were mostly based on the lengthy list of symptoms described by Thucydides — apologies in advance.

According to Thucydides, the process from the first infection to death was rapid and gruesome. People who were apparently healthy suddenly began to have swollen eyes and mouths, developed hacking coughs, started vomiting violently, and broke out in ulcers and sores. They were incapable of sleep, and so unquenchably thirsty that some of the sick (very hygienically) even threw themselves into the communal water supply in an attempt to slake their thirst. If these first seven or eight days weren’t enough to kill them, the diarrhea that followed generally was. Even if a person survived, he writes, they often did so with the loss of various bodily extremities. All in all, pretty horrific.

It was not until 2005 that a study of dental pulp taken from a mass grave of plague victims in the Keramaikos district of the city produced results that “clearly implicate typhoid fever as a probable cause of the Plague of Athens.”

As is often the case with numbers in ancient history, trying to come up with any sort of plausible demographics for the plague is always going to be tricky. While the exact number of deaths can never be ascertained because of disagreements about overall population size, it is estimated that about 25% of the population in Athens and its armies died from the plague. Among these were numerous high-ranking politicians, most notably Pericles, whose original plan to save Athens had not gone quite to plan. To make it worse, according to Plutarch in his Life of Pericles, before he died, he also lost both of his legitimate sons, as well as his sister and “most of his relations and friends.”

The plague made an impact on every section of society and some of its lasting effects led, in the end, to the Athenians’ defeat. On a personal level, we are told by Thucydides, the despair and desperation of some citizens led to the neglect of laws and rituals and a breakdown in social order. He writes: “For as the disaster pressed more heavily, men, not knowing what would happen to them, became contemptuous of everything, both  utterly careless of everything, both sacred and secular.”

At the highest level, the extent of the fatalities meant that Athens simply didn’t have enough citizen men to form an army capable of defeating the Spartans. Not until 415 BCE, eleven years after the last flare-up of the plague, was Athens able to mount any sort of counter-attack against the Peloponnesian forces. This assault, known as the Sicilian Expedition, ended up being a total fiasco, and the knock-on effects of its failure led, in 404 BCE, to the final collapse of the Athenian Empire and a Spartan victory.

The Background: The Age Of The Five Good Emperors

Roughly six centuries after one highly infectious disease contributed to the downfall of an empire, another began to do the same, though on a much grander scale. This time, the victim was not a single city weakened by siege, but the entire Roman Empire.

In 165 CE, the empire was about as big as it would ever get (about 40,000,000 people) and it was entering the twilight of the era of ‘the five good emperors’. This period, beginning with Emperor Nerva in 96 CE was, at least in Roman terms, one of relative peace and prosperity. At the time of the death of the fourth of these emperors, Antoninus Pius (r. 138-161 CE), for the first time the empire had come under the control of two co-emperors, who ruled as equal Augusti. These young men were Antoninus’s adopted sons Lucius Verus (r. 161-169 CE) and Marcus Aurelius (161-180 CE) and, despite historical precedents, their joint rule seems to have worked better than it usually does.

In 165 CE, however, soldiers returning from the East, where the Romans were at war with Parthia, brought back with them some sort of highly contagious and fatal disease. Within a year, it had spread over much of the Empire, following Rome’s enormous army wherever it went and creating far more fatalities than even they could ever hope to inflict.

Galen’s Plague 

The plague, named for the Antonine dynasty of which Lucius Verus and Marcus Aurelius were a part, is often also called the Plague of Galen, after the Greek physician whose descriptions of it have survived. Having returned from Rome back to his home in Pergamum in 166, Galen was summoned back to the city by the emperors not long afterward. There, as an army doctor, he was present at an outbreak of plague at the legionary base of Aquileia in Italy in 169. He was also the emperors’ personal physician, but in that same year one of the two, Lucius Verus, died in circumstances that suggest he had succumbed to the plague too. The empire was now in Marcus Aurelius’s sole command.

Galen’s description of the disease survives in one of his many medical treatises and, although it is not as detailed as some of the explanations he gives of other ailments, it gives us some idea of what a plague victim would have gone through.

The first symptom was a bad rash that spread all about the body, scabbing over and becoming a sort of scale that sloughed off. This was generally followed by a range of other signs, most commonly fever, diarrhea, an inflamed throat, and coughing up blood, with some patients also showing nausea, vomiting, and bad breath (something that Thucydides also noted). As for its duration, in fatal cases (about a quarter of them) death occurred between the ninth and the twelfth days, though those who did survive would generally begin to improve after the fifteenth day.

For identifying the virus behind this pandemic, as with the Plague of Athens, Galen’s descriptions are too vague for us to make any certain claims about what caused the Antonine Plague. There has, of course, been lots of debate and the two main contenders have generally been measles and smallpox, of which the latter seems most likely.

The extent of the plague’s effects and whether these can be seen as the initial cause of the Roman Empire’s decline and fall is, as expected, a debated topic.

It was a continuing issue until about 180 CE, when Marcus Aurelius died, and had its last major flare-up in Rome in 189 CE. Dio Cassius, a contemporary historian, claims that at one point that year it was responsible for over 2000 deaths a day in the city, which is a plausible figure.

In simple numerical terms, it would seem that the mortality rate for the whole empire was somewhere between 7-10%. This would mean that, between its introduction in 165 CE and our last extant evidence of it in 189 CE, the plague would have accounted for between 7,000,000-10,000,000 deaths, over and above the usual mortality rate. In particular, the army, where the disease had first entered the Roman world, was disproportionately affected, leading to a shortage of manpower.

Marcus Aurelius’s successor was his son Commodus, the first person to inherit this position from their father in over 100 years, and the results were disastrous. His tenure as emperor was marked by a total neglect of state affairs, which he delegated to various (equally useless) subordinates so that he could get on with a life worthy of Nero. As was commonly the case with emperors of this sort, his reign ended abruptly in 192 CE when he was assassinated by his closest friends and family.

What followed immediately after was the notorious Year of the Five Emperors, not to be confused with the earlier Year of the Four Emperors (69 CE), or the later Year of the Six Emperors (238 CE). This was only the first of many imperial power struggles during the “crisis of the third century,” which led eventually to Diocletian’s East/West division of the empire a century later. This constant civil strife, as well as the struggle to control the northern and eastern borders with a diminished imperial army, led to an economic collapse. Each contestant for the rule of Rome debased the coinage in order to try and pay his way to power, leading to mass inflation and high levels of unemployment.

By the time that the Western Empire fell in 410 CE, it would have been as difficult then as now to pinpoint any single cause. All that can be said for certain, though, is that Rome’s future might well have been very different, had the Antonine Plague not occurred.

If there was ever something to dampen the enthusiasm of people who occasionally wish they had been born into the ‘civilized’ and noble worlds of Classical Athens and Imperial Rome, descriptions of the Plague of Athens and the Antonine Plague might just be it. Hard at the best of times for most people, life got a whole lot harder under the shadow of these deadly diseases. With no medication or vaccines, no knowledge of germ theory, or the possibility of self-isolation, hope for the future was a luxury few could afford.

Like the plagues of antiquity, COVID has changed the shape of our world. But, if there’s anything that makes it unprecedented, it is that, when we compare it to previous pandemics, we see that it could have been a lot worse.

This sort of statement, quite understandably, offers little comfort to those who have lost loved ones, or their jobs, due to COVID. In fact, it’s not unlike a Roman soldier in 170 CE turning to his friend and saying, ‘Well, at least we’re not besieged inside Athens!’

And yet, though we don’t know what the future holds and it is impossible to predict what historians will one day write about COVID or the events it put into motion, for those who want it there can still be some comfort in seeing our lives through the past’s eyes — and at the very least, be grateful for the internet.