This piece is part of HWO’s feature on ‘Apocalypse Then and Now’. The feature brings together radical reflections and historic perspectives on catastrophe and calamity. How have crises (both real and imagined), and responses to them, shaped our world?

Here Pippo Carmona discusses historic instances of epidemics, and ways in which war has often served as a vector for viral disease. 

Out on the front against Germanic “Barbarians”, the Roman army of 168 AD – led by emperors Marcus Aurelius and his co-ruler Lucius Verus – encountered an unexpected enemy. This enemy had yet to invent weaponry but was as destructive as any other army. Galen, the Roman empire’s foremost medical authority, had just arrived at the camp in Aquileia to assess the situation. The onslaught of the unknown enemy was already devastating. In fear of being its next victims, both emperors sped their horses back to Rome. The younger, Lucius Verus, died on the way. At the camp, Galen wrote that the remaining soldiers “struggled for a long time to stay alive.” Worse, “a great many died” because “these things were happening in the middle of winter.”

The Romans didn’t know who or what it was that was killing them. But Galen had a name in mind: plague. Today, the pandemic is remembered together with the emperor that survived its rampage: the Antonine Plague.

Jules-Élie-Delaunays ‘Plague in Rome’ (1869). PHOTO: JOSSE-/LEEMAGE/GETTY

It is easy to get lost in discussions of past epidemics by focusing solely on epidemiology. By reducing our analyses to an outbreak’s source, we will know the culprit — bacteria or virus — and come up with possible ways to contain it. But we will be limited in our understanding of the dynamics involved that helped it explode. Because diseases happen in real time and space, history is a treasury of information from where we can fully understand infectious diseases in their proper context. This is why Thucydides’ History of the Peloponnesian War merits a timely review as it not only contains what is arguably the first epidemiological account of infectious diseases in its report of the Plague of Athens (430 BC), but it also contextualises the disease in the bigger framework of history. Especially crucial in Thucydides’ text is his appreciation of the role of military aggression in accelerating contagions.

The Plague of Athens was a rapid killer. Thucydides notes that “not many days after their [Spartans] arrival in Attica the plague first began to show itself among the Athenians.” Like the Antonine Plague, the season when it started plays an important role in the disease’s proliferation. Thucydides reports that the invasion occurred in the first days of summer, implying high agricultural and commercial activity within the region. With the hot weather and Spartan threat looming nearby, people sought safety from hunger and the blade within the walls of Athens, some of them unknowingly bringing the contagion and all of them increasing the population density of the city, creating the perfect conditions for an outbreak. Many were infected, and current estimates say that about 25%, around 75,000 – 100,000, of Athens’ inhabitants perished from the plague.

The Antonine Plague shares a similar beginning. Returning soldiers from the Parthian front are believed to have carried the virus to Rome. Their military success in the east did little to assuage the imperial ambitions of Rome, as security and possible expansion on the German front were of high importance at that time. So while the veteran legions were resting their wounds, with some retiring from military service, preparations for the next campaigns were already in motion. This meant that little time and resources were spent on public health and medical rehabilitation of the army. Exhausted, bruised, and wounded, these soldiers would’ve been highly vulnerable to the disease, making them the perfect hosts. Roman authorities looked beyond the empire’s horizons not knowing that a bigger danger was already brewing at home.

At its height, the Antonine plague ravaged the Roman empire. Mark Welford writes in Geographies of Plague Epidemics that at a certain period, the plague managed to kill about 2,000 people a day. In Roman Egypt (as historian Susan Mattern writes in Prince of Medicine), “whole villages practically disappear from the tax rolls, wiped out by a combination of mortality and the flight of whatever inhabitants managed to survive.”

Both events demonstrate the subtle yet critical reciprocity of factors in outbreaks magnified by military aggression. The social conditions shaped by the politics of war not only provided diseases with opportunities to spread, but it also gave them pathways to kill unimpeded. Perhaps a better health policy would’ve helped contain the contagion in Rome, but public health wasn’t a priority, and rarely has been in times of war. And when was Rome ever not engaged in warfare?

While paintings and modern imaginations of Rome depict a pristine city, it was not always that way. It is estimated that Rome once housed a million citizens, a population record that stood for centuries until London achieved it much later. With so many people, a well-maintained sewer and waste disposal system would’ve been necessary to keep its population healthy. But the demands of war were paramount, thus other needs were left slighted, including city sanitation. Rubbish, refuse, body wastes, and even corpses were left on the streets, some ending up in the Tiber river. Mattern describes the actual situation best: “Rome was, then, an ideal environment for any disease spread by vermin, flies, mosquitoes, faeces, or (because of its densely packed population) through the air, as well as for respiratory illnesses caused by indoor air pollution.”

Roman historian Edward Gibbon never cited diseases as a prominent influence in the collapse of the empire. Maybe it never really was. But it cannot be denied that the impact of plagues exacerbated the problems already experienced by Rome. The same was true in Athens. But no martial empire would ever admit defeat to diseases. Often silenced by patriotic military rhetoric are the coughs, sighs, and groans of ordinary citizens.

Two thousand years later and CoviD19, which was recently elevated to pandemic level by WHO, is spreading globally without any signs of slowing down. Italy, where the Roman empire once stood proudest, is now on its knees from the disease. Its healthcare system is fast imploding, with hospitals unable to accommodate the growing number of patients. Its healthcare providers, too, are suffering, making up 9.1% of the total number of positive cases. But the danger of the virus hasn’t stopped states from issuing threats of war. Two of the world’s superpowers, the USA and China, are continually locking horns, going as far as condemning each other for the outbreak. Russia and Saudi Arabia are also engaged in an “oil-war” in the middle east, setting the prelude for military conflict in an already war-ravaged region.

Caught between wars and diseases are the ordinary citizens left to scrap for survival, while the powerful few engage in their games of supremacy to protect private property and power. These powerful few are often nowhere to be found on the front lines – they watch from the safety of their ivory towers. Infectious diseases may affect us all, but they do not affect us all equally.

 

Pippo Carmona (Raniel Carmona Ponteras) is a Filipino biologist and historian of medicine. He runs the history of medicine blog, SCALPEN, and you can find him @scalpenhistory.

CoviD19 is fast spreading in the Philippines and healthcare professionals are scrambling to save as many lives as possible with what little means they have. Hospital workers lack the necessary masks, PPEs, alcohols, transportation services, and food supplies to help them heal the sick. Pippo is fundraising on behalf of the University of the Philippines College of Medicine to procure much needed N95 masks, alcohol, and other protective materials for interns at the Philippine General Hospital. The University of the Philippines College of Medicine fundraising page can be found here

 

Leave a Comment

Your email address will not be published. Required fields are marked *