The ‘Great Lockdown’ versus the Plague of Cyprian: Have we learned anything?
Sitting here in the midst of the ‘Great Lockdown’, I am forced to conclude that we got lucky. Doubtless both the survivors of Covid-19 and the families of those who have sadly succumbed will not share my relief. But if Roman history teaches us anything about pandemics, it is that it could always have been worse. When Covid-19 jumped from its animal host to humans it encountered a world seemingly tailor made for a global pandemic event. Gone is the time when the fastest ship-bound journey between Italy and Egypt took nine days on average, and when a Mediterranean population of 75 million seemed incomparably vast. When the Coronavirus found us, it found billions of unwitting hosts intimately interconnected by a planet-wide web of roads and railways, airports and sea-lanes. In the modern world, what breaks out of its cage in Wuhan today will inevitably be chewing on Worcester tomorrow.
But, as I said, we got lucky. Gruesome though it undoubtedly is, the average 1-2% mortality rate of Covid-19 is comparatively low, and the current evidence suggests that over half of those who contract it will not even make it as far as being symptomatic. As uncomfortable as it is to admit it, there are far worse things quietly nibbling on the insides of the animal kingdom than the Coronavirus.
But the real saving grace is the quantum leap in our understanding of medical science and epidemiology in the millennia that separate us from the Romans. To give them credit, the Romans did have a basic understanding of contagion - the knowledge that diseases can spread from person to person. Outbreaks of disease were habitually attributed to ‘bad air’ - miasma - or to ‘seeds’ circulating in the atmosphere that could cause air to putrefy. Responses to disease operated on two fronts. Unsurprisingly, the religious element takes pride of place - communal prayer and sacrifice were the overwhelming reactions to epidemic events, and the most common institutions dealing with health were the temples of deities such as Apollo or Aesculapius. The Romans also practiced medicine, and whilst it is possible to be impressed by both the pragmatism and the persistence of Roman medicine, large sections of it were evidently largely ineffective or actively dangerous. The Romans tended to believe that the health of the human body was tied to the four humours laid out by Hippocratic theory, which were themselves connected to the movement of the celestial bodies. Medical practice aimed at a rebalancing of these four humours to achieve the optimal temperature in the human body: this usually meant either bleeding or purging the patient.Given that there were no qualifications needed to pursue a medical career, which doubtless encouraged the proliferation of the quacks and mountebanks we see in contemporary satire, I feel justified in saying that you were probably more likely to survive sickness in the Roman empire if you didn’t go anywhere near a doctor.
The concept of quarantine did not exist. Indeed, quarantine as a response to disease only appears in the medieval period, and was still a relatively unorthodox approach when the Black Death made landfall in Europe in the fourteenth century. Roman cities were comparatively much larger than their medieval counterparts, with potentially hundreds of thousands crammed into unsanitary wooden apartment buildings. Diets were poor, epidemics were rife, and life expectancy was low: most Romans will never have seen the age of forty.
The Roman world was the greenhouse in which grew the first pandemics. Its interconnectedness, like our own today, allowed diseases to transform from purely local events into global catastrophes. There were three recorded pandemics in the history of the empire: the Antonine Plague (c.165-180), the Plague of Cyprian (c. 249-262), and the Plague of Justinian (c. 541-549). It is on the second, the Plague of Cyprian, that we shall focus, in order to see what exactly we have learned and, indeed, what we might learn.
The plague is named after Cyprian, bishop of Carthage, from whom we get our most complete description of the symptoms:
“as the strength of the body is dissolved, the bowels dissipate in a flow; that a fire that begins in the inmost depths burns up into wounds in the throat; that the intestines are shaken with continuous vomiting; that the eyes are set on fire from the force of the blood; that the infection of the deadly putrefaction cuts off the feet or other extremities of some; and that as weakness prevails through the failures and losses of the bodies, the gait is crippled or the hearing is blocked or the vision is blinded.”
Cyprian, Bishop of Carthage - Print by François de Poilly, 1665
Kyle Harper, in his excellent book The Fate of Rome: Climate, Disease, and the End of an Empire (2017) - which I would thoroughly recommend - tentatively identifies the Plague of Cyprian as a hemorrhagic fever caused by a filovirus. If you think that you have never heard of a filovirus before, you are sadly mistaken. Between 2013-2016 there was an outbreak of the most famous of the filoviruses - Ebola - in West Africa. On average, Ebola has a 90% mortality rate. As I said, there are worse things than Covid-19.
The arrival of the Plague of Cyprian in the Roman empire was an epochal cataclysm. It is impossible to know what the actual death toll was, but our best estimates suggest that it may have been as high as 50-70% in some cities. The empire buckled in the face of the onslaught. The political system imploded; the silver currency crashed; the frontiers collapsed, and the empire fragmented. It is a testament to the ability of the leaders of the late third century that the empire survived at all. But the empire that staggered from the wreckage of the plague into the light of the late antique was a different beast to the one that had gone in: to paraphrase Stephen Williams, it had been transformed from a dignified civic forum into a fortress built to withstand a permanent siege.
“Chaos”, as Lord Baelish so astutely observed, “is a ladder”. The challenge posed by the plague of Cyprian quickly demonstrated the inadequacy of the Roman system in dealing with massive mortality incidents. It therefore provided an opportunity for groups who had a better system to step into the void. In the event, the Christian church proved to be the main beneficiary of imperial incapacity, and in the decades after the plague the church went from being a socially isolated sect to a mass phenomenon. The question is: why?
The straightforward answer is that the early church proved far more effective at offering care to the sick than any other social entity within the Roman empire. The reason for this is that the social obligation of caring for the sick because they were sick was alien to traditional hellenistic society. It was a world dominated by patronage: charity did not yet exist. The state fed the massive city of Rome at its own expense, but not because they needed it: Rome was a political stage for imperial magnificence, and its citizens were both actors and audience. The rich and the powerful might fund the construction of a healing temple, but they did so as a political advertisement of their munificence. The wealth accumulated by the handful of genuinely competent medical professionals suggests that their services were only available to a highly restricted group of the very wealthy. Healing temples might offer care, but this was for the aggrandisement of the deity, not for the wellbeing of the sick: it was for this reason that both the dying and those undergoing child-birth were not permitted within Aesculapius’s temples.
Christianity changed that. Its internal levelling of social relations created a network of individuals mutually obliged to come to each other's aid regardless of wealth or status. The particular attitude towards death - salvation attained through earthly self-sacrifice - was probably a powerful impetus in getting Christians to check in on their sick neighbours when others would not dare to do so. This is important because, in a world where good medical advice was probably in very short supply and help was rarely forthcoming, the possibility of someone simply stopping in to provide you with bread and water will have significantly cut the death rate. The willingness of the Christians to face down the worst of the disease and tend to their fellow believers likely proved a powerful contrast in the face of the collapsing temple regime.
It was an impression that proved to be lasting, and would have a powerful impact on the development of the Christian Church. The hospital is a distinctively Christian phenomenon. The spread of hospitals throughout the towns and cities of the empire in late antiquity is evidence for a change in attitudes. The well-being of the sick became the responsibility of the whole community because salvation was thought to be attained through caring for those in need. This was, at the time, a revolution in social relations.
So, what have we learned since the Plague of Cyprian? The most striking feature is the gulf that exists between the experiences of the Romans and of ourselves today. Electricity, scientific medical knowledge, pharmaceuticals, tax-funded healthcare, the superabundance of food, the absence of human waste, the internet, industrialisation, Amazon and Deliveroo: we live in a world that the Romans could not have conceived of. We have come a long way from the first hospitals to the NHS.
The most obvious lesson we might draw from the Plague of Cyprian is the importance of mutual aid and comfort, particularly in the urban context. This comes with some caveats, of course: the words “social distancing” spring to mind when one considers those ancient Christians hopping from house to house. However, as interconnected as our world has become, we now have the capacity to live our lives entirely through the medium of our screens. Work can be done remotely; food delivered to our doors; answers to everyday technical problems can be found with ease after a few seconds on Google. Ironically, we are more isolated from each other than the Romans would ever have been. Urban-dwelling Romans would certainly have found the concept of not knowing all their neighbours names very strange indeed. This gap between us is only exacerbated by the existence of state-funded aid: why go check on your neighbours when an ambulance or a care-worker is only a phone-call away? In the developed world, at least, we have made it frighteningly easy to not have to care what is happening in the apartment downstairs.
Nothing lasts forever, and the Romans found out to their cost that the system in which they lived was not up to scratch at precisely the moment that it buckled. As I said before, we got lucky. The Coronavirus has caused - and will continue to cause - a great deal of hardship, but it will not collapse the social order on which we all depend. But Ebola is still out there, as are any number of truly awful pathogens. All of the advances I described that separate us from the Romans could easily be rendered negligible in the face of a truly catastrophic pandemic. On that day, should it ever come, the difference between life and death may well be bread, water, and the kindness of strangers.