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The Antonine Plague, the great epidemic that first swept across the Roman Empire in AD 165, and recurred in waves over the following decades, ‘is widely agreed to have been smallpox’ (Sallares: 2007, 37). This identification has been argued for and assumed in the most recent sustained treatments of the topic (Gourevitch: 2013; Lo Cascio (ed.): 2012), building on the key article by the Littmans published in 1973. It has fed into the lively debates on the demographic and economic impact of the plague (see e.g. Elliott: 2016; and essays in Lo Cascio: 201); following Duncan-Jones: 1996). But this move rests on shaky foundations, and requires much more serious scrutiny than it currently receives; some scholars are less certain (e.g. Harper: 2015; Mattern: 2013, 197-204) but no real contest has been offered.

This paper challenges the identification of the disease involved in the Antonine Plague as smallpox. It does so on three main grounds:

(1) The omission of any reference to the indelible scarring, the disfiguring facial pockmarks—the signature of smallpox—from the descriptions of symptoms provided by the great physician Galen, who lived and worked through the various surges of the pestilence in Rome and Italy, and whose accounts are heavily relied on by the Littmans and Gourevitch. Both attempt to explain away this absence, but unconvincingly: as this paper will show, if such scarring resulted there is every expectation that it would be mentioned by contemporary sources, medical and otherwise.

(2) The lack of epidemiological fit with current views of smallpox in history, or, at least pre-modern history. If the Antonine Plague marked the first appearance of the variola virus, the causative agent of smallpox. in the Mediterranean world, then further outbreaks would be expected across the Roman Empire, and its successor states over the next centuries. There are some hints of more localised disease events, and, of course, the evidential record is patchy, but there is nothing resembling the recurrent epidemics that ravaged medieval Japan following the initial ravages of smallpox in 735 (Ferris: 1985; Suzuki: 2011), or the much more complex pattern now being demonstrated for the post-1492 Americas (Alchon: 2003; Cameron, Kelton and Swedlund (eds): 2015).

(3) The greater variability and uncertainty about historical diseases engendered by much recent palaeopathological and phylogenetic work on pathogen presence and evolution. Smallpox, the variola virus, has so far featured little in ancient DNA surveys, and molecular clock dating studies, but investigations up to this point (Duggan at al.: 2016) confirm the general picture of genetic changeability and pathological instability.

This last point, the new palaeopathological landscape which is now emerging, suggests that a rather different approach needs to be developed to the whole business of retrospective diagnosis, including to debating the identification of the disease implicated in the Antonine Plague. This paper will conclude with some ideas about how that new approach might be developed for the future.