Public health

Hannibal, whose Carthaginian forces return to Sicily, dies during the campaign in a plague that had broken out during the siege of Akragas in 406 BCE, but his brother Himilco forces the city's surrender after eight months, following which the Carthaginian troops plunder and destroy the city.

The siege of Syracuse had met with great success throughout 397 BCE, but in 396 BCE, plague again ravages the Carthaginian forces.

This plague, bearing similarities with the Athenian plague, may have been caused by bad hygienic practices on marshy grounds, and malaria may have played a part also.

The result is that scores of soldiers and sailors succumb to the disease, burial parties are overwhelmed, bodies are hastily buried, new burials are almost impossible, and the stench of decaying bodies hangs in the air.

Fear of infection may have prevented proper care being given to the sick.

The cause of this calamity is attributed to the desecration of Greek temples and tombs.

At the Siege of Akragas (406 BCE) Himilco had dealt with a similar situation by sacrificing a child and various animals to appease this alleged divine anger.

Whatever measures (if any) Himilco takes at Syracuse to combat the plague prove ineffective; Punic forces are decimated and the fleet readiness is diminished.

Himilco and the Carthaginians stubbornly stand their ground and remain in the camp, but the morale of the Carthaginians plummets as a result of the plague, along with the combat effectiveness of their forces.
 

Rome's war with Parthia had ended successfully in 166, but its unforeseen consequences for the Empire are great: the returning troops bring with them a plague (the so-called Antonine Plague) that will eventually kill an estimated five million people, severely weakening the Empire.

The Antonine Plague is a pandemic believed to be either of smallpox or measles, and will ultimately claim the lives of two Roman emperors—Lucius Verus and Marcus Aurelius, whose family name, Antoninus, is given to the epidemic.

The disease will break out again nine years later, according to the Roman historian Dio Cassius, and cause up to two thousand deaths a day at Rome, one quarter of those infected.

Total deaths have been estimated at five million.

The Devastation of the Antonine Plague (165–180 CE)

The Antonine Plague, which struck the Roman Empire between 165 and 180 CE, was one of the deadliest pandemics of antiquity, causing widespread depopulation. According to the fifth-century Spanish historian Paulus Orosius, many towns and villages in the Italian Peninsula and across the European provinces were completely abandoned due to the sheer number of deaths.

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Impact on the Roman Empire

• Massive depopulation:

  • The plague is estimated to have killed between 5 and 10 million people, including one-quarter to one-third of the population in some areas.
  • Many rural villages and urban centers were left deserted, severely impacting agriculture and trade.

• Spread of the disease:

  • Likely introduced by Roman soldiers returning from campaigns in the East, the plague spread rapidly along trade routes.
  • Major cities such as Rome, Alexandria, and Lugdunum (Lyon) suffered severe outbreaks.

• Impact on the Roman military and economy:

  • Legions stationed on the frontiers were decimated, weakening Rome’s ability to defend against Germanic and Parthian incursions.
  • The economic system suffered due to a shortage of laborers, declining tax revenues, and inflation.

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Long-Term Consequences

• Weakened Roman defenses: The loss of manpower in the military contributed to border instability.
• Economic strain: The plague exacerbated existing financial pressures, leading to increased taxation and reliance on mercenary forces.
• Precedent for future pandemics: The Antonine Plague was one of the first major epidemics in Roman history, later followed by the Cyprian Plague (249–270 CE) and the Justinian Plague (541–542 CE).

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Conclusion: A Turning Point in Roman Stability

The Antonine Plague marked a critical moment in Roman history, signaling the beginning of long-term demographic and economic decline. Although Rome recovered militarily, the loss of population and shaken stability foreshadowed the challenges the empire would face in the coming centuries.

The Antonine Plague and Its Impact on Rome’s Northern Frontier (165–180 CE)

As the Antonine Plague spread northward toward the Rhine frontier, it not only ravaged Roman populations but also infected Germanic and Gallic tribes outside the empire's borders. The epidemic weakened both Rome and its adversaries, but the consequences were particularly severe for Roman frontier defenses.

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1. The Spread of the Plague Beyond Roman Borders

• The Roman military campaigns along the Rhine and Danube facilitated the spread of disease to Germanic and Gallic tribes.
• These tribes, already pressing southward for more fertile lands, suffered heavy losses, disrupting their population growth and expansion efforts.
• However, despite their own losses, they were not as dependent on complex urban infrastructure as the Romans, meaning they could recover more easily.

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2. The Weakening of Rome’s Defenses

• Roman armies, severely reduced in numbers, struggled to defend the northern frontiers.
• The traditional cycle of recruiting and replenishing legions was disrupted, leaving gaps in border security.
• The empire’s reliance on local auxiliaries and barbarian foederati increased as native Roman populations declined.

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3. Increased Germanic Pressure on the Empire

• The Germanic and Gallic tribes, despite their own losses, took advantage of Rome’s weakened state to increase raids and incursions into imperial territory.
• The Romans, unable to push back these invasions effectively, saw a gradual erosion of control along the Rhine and Danube frontiers.
• This period of instability set the stage for later large-scale migrations and conflicts between Rome and Germanic peoples, culminating in the Marcomannic Wars (166–180 CE).

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4. Long-Term Consequences

• The Antonine Plague's devastation played a key role in reducing Rome’s ability to defend its frontiers, forcing later emperors to rely more heavily on diplomacy and fortifications.
• The weakened military set a precedent for later barbarian pressures, foreshadowing the migrations and invasions of the 3rd and 4th centuries CE.
• This epidemic was one of the first major factors in Rome’s long-term decline, demonstrating how disease, population loss, and military strain could weaken even the mightiest empire.

The Roman Empire survived the Antonine Plague, but it emerged significantly weakened, its frontiers permanently more vulnerable to external threats.

The returning Roman army carries with them a plague, afterwards known as the Antonine Plague, or the Plague of Galen, which will spread throughout the Roman Empire between 165 and 180, severely depopulating the provinces.

Historian William McNeill will assert that the Antonine Plague and the later Plague of Cyprian (251–ca. 270) were outbreaks of two different diseases, one of smallpox and one of measles, not necessarily in that order.

he severe devastation to the European population from the two plagues may indicate that people had no previous exposure to either disease, which brought immunity to survivors.

Other historians believe that both outbreaks involved smallpox.

The latter view is bolstered by molecular estimates that place the evolution of measles sometime after CE 500.

The Greek physician and writer Galen had traveled from Rome to his home in Asia Minor in 166, during the epidemic, and returns to Rome in 168 when summoned by the two Augusti—the co-emperors Marcus Aurelius and Lucius Verus; he is present at the outbreak among troops stationed at Aquiléia in the winter of 168/69.

Galen briefly records observations and a description of the epidemic in the treatise Methodus Medendi, and his other references to it are scattered among his voluminous writings.

He describes the plague as "great" and of long duration and mentions fever, diarrhea, and pharyngitis, as well as a skin eruption, sometimes dry and sometimes pustular, appearing on the ninth day of the illness.

The information provided by Galen does not clearly define the nature of the disease, but scholars have generally preferred to diagnose it as smallpox.

The Antonine Plague, named after Marcus Aurelius’ family name of Antoninus, is also later known as the Plague of Galen and holds an important place in medicinal history because of its association with Galen, who had first hand knowledge of the disease.

He was in Rome when it stuck in 166, and is also present in the winter of 168–69 during an outbreak among troops stationed at Aquileia.

Marcus Aurelius and his colleague Lucius Verus were in the north fighting the Marcomanni.

During the autumn of 169 CE when Roman troops were returning to Aquileia, the great plague had broken out and the emperor had summoned Galen back to Rome, ordering him to accompany Marcus and Verus to Germany as the court physician.

In the following spring Marcus is persuaded to release Galen after receiving a report that Asclepius, the god of medicine and healing in ancient Greek religion, is against the project.

He is left behind to act as physician to the imperial heir Commodus.

It is here in court that Galen writes extensively on medical subjects.

Ironically, Lucius Verus died in 169, and Marcus Aurelius himself will die in 180, both victims of the plague.