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Exploring the Darker Side of Everything

Antonine Plague: The Roman Empire’s First Pandemic

In the Second Century AD, the Roman Empire was at its glorious peak. Stretching from the misty borderlands between present-day England and Scotland and the sweltering deserts of Egypt and Mesopotamia, what had begun as a small state in Italy, was now the largest empire ever seen. 

Rome was a city quite unlike anywhere on the planet. Littered with extraordinary buildings; the Colosseum, the Pantheon, the Forum – it had its own sewer system and a staggeringly complex method of bringing clean water into the city from nearby hills. This was a stunning ancient city that was by far the most modern of its age but also the epicentre of a colossal empire that had a peak landmass of around 5 million square kilometres (1.9 million sq miles) – which is roughly half the size of Canada. 

Rome was experiencing its glittering heyday, but as we all know, nothing follows a glittering heyday quite like a shocking turbulent decline. The collapse of the Roman Empire was caused by numerous factors, including corruption, bad governance, over-expansion and of course numerous tribes or groups that wanted nothing more than Roman blood on their hands. 

However, there was one particular event that, while it may not have been the most significant factor in the long run, did shake this glorious empire to its very core. In 165 AD, a disease thought to be either measles or smallpox arrived that not only swept through Rome but decimated the empire, killing between 5 and 10 million people. 

The Antonine Plague was the Roman Empire’s first major pandemic and it butchered indiscriminately with a fatality rate of around 25% – rich or poor, soldier or slave, old or young – the resulting carnage battered an empire enjoying its illustrious golden age and acted as catalysts that helped to usher in Rome’s eventual decline. 

Pax Romana  

Throughout history, there have been numerous instances of civilizations collapsing in on themselves, either through overpopulation, mass migration, disease, famine or blind ambition and poor leadership. We may never fully understand what happened to the Maya, the Indus Valley and the Anasazi civilizations, but one empire that collapsed spectacularly, we do know a whole lot more about. 

The term Pax Romana – meaning ‘Roman peace’ – loosely correlates to a 200-year period in which the Roman Empire reached its peak in terms of size, influence and power. Roughly beginning in 27 BC and ending with the death of Marcus Aurelius in 180 AD, Pax Romana represented the dizzying high-note to a story of expansion and conquest that began all the way back in 5th Century BC. 

From what is today Scotland in the North, Portugal in the West, Egypt in the South and Iraq in the East, the Roman Empire had grown to colossal proportions and now included roughly 70 million people – nearly a quarter of the world’s population. 

Roads built around the empire meant trade had blossomed, with the Silk Road providing an ancient superhighway, bringing the riches of the East to the gates of Rome. Broadly speaking, most of the empire was also now at peace, with the Roman authority well and truly stamped across their land.

It is therefore perhaps paradoxical that a period of such glorious decadence and all-conquering power was interrupted by the most significant outbreak of disease seen across the entire history of the Roman Empire. But looking back on this period, there were numerous factors that not only allowed the disease to spread but in some ways even sped up the horror. 

In an age when average life expectancy hovered in the 20s and 30s, and when many lived in Roman cities that, despite their glorious monuments, were still cesspits with huge overpopulations, poor housing and sanitation that had long become overburdened. Then there were the people themselves. The expansion of Rome had brought with it a level of decadence that had brought serious effects on the general health of the population. These were no longer the battle-hardened Romans of centuries before and their lifestyles and diets had proved a wonderfully fertile landscape for a deadly disease to run rampant. 


It’s almost impossible to say where exactly the Antonine Plague began, though we certainly have a good idea of which direction it travelled. Some say it originated in China and made its way along the Silk Road and into Europe, but it’s thought the first recorded case came in Smyrna – now Izmir in Turkey – in 165 AD. There, it nearly claimed its first high profile casualty when Aelius Aristides, a well-known Greek orator and author, contracted the disease and came within a hair’s breadth of death. Other sources claim that Roman soldiers first came into contact with the disease during the lengthy siege of the Mesopotamian city of Seleucia in the winter of 165–166 AD.

The angel of death striking a door during the plague of Rome. Engraving by Levasseur after J. Delaunay.
The angel of death striking a door during the plague of Rome. Engraving by Levasseur after J. Delaunay. is licensed under CC-BY

There are two legends surrounding the release of the Antonine Plague – and I do want to stress that word legends. One involves the then co-emperor Lucius Verus opening a closed tomb in Seleucia during the sacking of the city which released the disease, while the other follows a similar story but with a Roman soldier opening a golden casket in the temple of Apollo in Babylon, allowing the plague to emerge. Now, both of these stories are probably a long stretch, but whether they are true or not, they do show us just how the Romans struggled to explain the mystery devastation that unfolded.       

At this point, it is worth mentioning that disease and pestilence were common themes of life during this period. With medical knowledge rudimentary to say the least, illnesses were not only frequent but often deadly. Only around half of children born during this period made it to adulthood and this wasn’t simply the poor. Emperor Marcus Aurelius fathered 14 children during his life, only four of whom reached adult age. And while nothing like the Antonine Plague had ever been seen, the Roman Empire has seen its fair share of smaller epidemics. 

Slowly rumours began drifting west of a savage disease in the east. The terrible irony of the Roman Empire’s wonderful road system and connectivity that allowed it to expand to such proportions, also significantly sped up the spread of the disease. Symptoms included fever, diarrhoea, vomiting, thirstiness, swollen throat, and coughing, while red and black swellings often appeared throughout the patient’s body.    

Arrival in Rome

In 166 AD, the first case began appearing in Rome itself, leading to widespread panic throughout the population. One of the first people to address the plague in any concise way was Aelius Galenus – often known simply as Galen – who was a Greek physician, surgeon and philosopher in the Roman Empire. We commonly refer to this outbreak as the Antonine Plague, but it is sometimes also called the Galen Plague.   

Galen began documenting the illness, which he concluded must involve gastrointestinal bleeding because of the black colour seen in the diarrhoea. He also noted that a foul smell was present on the breath and that exanthema could be seen around the body. 

It often took two weeks for any sign of illness to emerge followed by another two weeks as the patient battled the disease, either recovering, now with immunity, or becoming one of the millions who lost their lives to the Antonine Plague. 

The disease arrived in the capital with such force and speed, there was little that could be done. But even if the spread had been slower, this was long before any ideas of large-scale disease control emerged. Sadly for the Romans, and the millions that lived throughout their Empire, they represented a ‘virgin population’ meaning that there was absolutely no natural immunity and the disease was able to rampage at will.        

Of course, quarantines, isolating and working from home were neither possible nor even considered during this time. In the initial stages, many rich Romans simply fled the city for their country villas, but this was often simply a short term solution.  

In many ways, Rome had to continue on the best it could considering the circumstances. For the overwhelming majority, the best they could do in terms of countermeasures were home remedies, amulets, which were said to bring good luck, and prayers. While there was next to no idea of how the disease was spread, people nevertheless put two and two together and deemed that close contact with somebody coughing and vomiting was probably not a great idea. Those who were visibly ill were often shunned by society who would also treat their houses as plague pits and avoid them at all cost.

And just to show you that harmful misinformation appeared nearly two thousand years before Facebook and Twitter, the eruption of the Antonine Plague brought with it a whole host of shady characters either eager to place the blame or announce that they had the answer to defeat the disease. This often came in the form of charms that were sold and perhaps the most famous case was that of Alexander of Abonoteichus who sold disease-repelling charms that he promised would keep the wearer safe. Just to give you a better idea of the integrity of this man, he was said to lead a cult named Glycon, which was a snake God that periodically whispered magical words into the ear of good old Alexander who was then kind enough to repeat what said snake had uttered to anybody willing to listen. Sometimes he penned what he had been told into poetry and one of his most famous, which was shared throughout the Roman Empire, was a single line that read, ‘Unshorn Phoebus, keep away the cloud of plague’       

At its peak, it’s thought that around 2,000 people were dying in Rome each day and it didn’t take long for the first major high-profile death to appear. Co-emperor Lucius Verus, who if you remember might have started it all by opening the tomb in Seleucia, was struck down by the plague in 169 AD.    

The Spread

The spread around the Roman Empire was rapid and done so because of a variety of reasons. Returning soldiers from the East brought it with them, while trade both on land and at sea acted as a remarkably efficient way to bring the disease to all corners of the empire. 

The Roman Army suffered horribly during the Antonine Pandemic. At the onset of the outbreak, the Roman military was composed of 28 legions, totalling around 150,000 men. These were superb, battle-hardened troops who had smashed all before them, but the plague decimated their numbers and began to cause serious shortages throughout the empire, most notably on the border with Germania. Rightly fearing the Germanic tribes, Emperor Marcus Aurelius sanctioned the significant widening of recruitment, allowing gladiators, slaves and even criminals to join the hallowed legions. It didn’t work and during the Marcomannic Wars, Germanic tribes pushed south in Roman territory for the first time in roughly 200 years. It would take a few years before the Roman army would build up its strength enough to throw the invaders back. 

Around the empire, the plague had a devastating effect. The massive loss of life could soon be felt in a reduction of tax coming into the Roman coffers. Businesses began to struggle and there was a huge shortage of workers, while construction projects were cancelled across the empire. With numbers dwindling, crop scarcity increased, which in turn led to higher prices across the land. Town councils and public organizations often struggled to fill the required numbers of seats, while abandoned settlements began appearing throughout the Roman empire. Emperor Aurelius attempted to counter this by encouraging migrants from outside the empire to settle within its borders – but in reality, any form of migration could barely keep up with the loss of life.        


One area that saw dramatic changes as a result of the Antonine Plague was religion. As the disease spread, enormous efforts were made to appease the gods whose wrath was said to have brought the pandemic. Cities across the Roman Empire began sending delegations to the Temple of Apollo in Delphi, Greece, seeking to either make amends for whatever wrongs had led to the pandemic or for solutions that might help. 

This was very much seen as a matter of necessity to the Roman population and it didn’t take long for the anger to be directed at Christians, who of course had absolutely no intention of going to Greece to pray to a God they didn’t believe in. Persecutions quickly erupted, led in part by Emperor Aurelius, and it’s believed that the term ‘throw the Christians to the lions’ originated during this period.     

It was not a good time to be a Christian, however, in a roundabout way, the Antonine Plague proved excellent for the spread of Christianity throughout the Roman Empire, which came down to two factors. The first was that, unlike the pagan Romans who were more than happy to hightail it out of the cities and as far away from the ill as possible, Christians retained their obligation to help those in need. Instead of every man and woman for themselves, it was the Christians who provided food and care for those unable to look after themselves. And remember, this was while they were being persecuted for their apparent role in angering the god who had brought the plague. 

The second reason was that Christianity provided meaning to life and death that many craved in such a time of crisis. The idea of salvation and the afterlife suddenly became hugely important to those either battling the illness themselves or watching their loved ones die. The Antonine Plague may have been a shattering experience, but for the Christian faith, it helped cement its place as the principal religion in the years after the pandemic.    

The Empire Emerges & Falls 

By 180 AD, it appeared as if the empire had weathered the storm, but just nine years later it returned with a vengeance, and in fact deaths peaked during this second major outbreak. 

Whether or not the Antonine Plague was a major contributing factor, it was at this point that the Roman Empire began its steady decline. 

Marcus Aurelius Louvre
Marcus Aurelius Louvre. By Louvre Museum , is
licensed under CC-BY

Emperor Marcus Aurelius died in 180 AD, some say from the plague though that’s never really been confirmed and his son Commodus assumed full power. If you’ve seen Gladiator you’ll have a rough idea of what kind of Emperor this man was, and while the story may have been massaged for Hollywood’s artistic needs, he really was a crap Emperor who may or may not have had a thing for his sister, who tried unsuccessfully to have him killed, but was eventually strangled by a wrestler in the bath in 192 AD – Games of Thrones, eat your heart out.         

There is plenty of debate over whether the Antonine Plague was one of the key catalysts of the fall of the Roman Empire, or whether it was simply another bump in the road. It was certainly a huge bump, but Roman’s good times were now well behind it. Over the coming centuries the Empire sank into corruption and bad governance while the move away from the pagan hegemony was one key cultural unmooring that led to the downfall of Roman society. Gradually borders began to be tested and Rome’s distant frontiers were slowly rolled closer to home.

Just over fifty years after the Antonine Plague finally died out, the empire was hit again, this time by the Plague of Cyprian, which may have been smallpox, pandemic influenza, or viral hemorrhagic fever, that reportedly killed 5,000 per day in Rome at its peak. But that was still absolutely nothing compared to the Plague of Justinian which exploded in the 6th Century. Caused by the bacterium Yersinia pestis, which was the same that led to the Black Death in the 14th Century, this disease ran riot through the Mediterranean Basin, Europe, and the Near East between 541 AD and 549 AD, killing an estimated 30-50 million people. But by this point, the glorious Roman Empire had been divided, and while the Eastern Empire staggered on, the west had long since completely collapsed.  

The Antonine Plague currently sits eighth in the deadliest pandemics of all time, but it is notable that despite a few exceptions, namely the 1350 BC Plague of Megiddo, the Plague of Athens that began in 429 BC, and the 412 BC epidemic, also in Greece, every single one of the major pandemics to ravage the world came after the Antonine Plague. Those that came before it were certainly deadly and killed thousands, but this was the first time such a disease ranged so far and killed so many. When compared to the Black Death, which killed 75 – 200 million, and the Spanish Flu, which killed between 17 and 100 million, the 5-10 million dead during the Antonine Plague may seem small – but in terms of global pandemics, it simply provided the horrifying start of what was to come.  

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