Reactions to Plague in the Ancient & Medieval World


Joshua J. Mark
published on 31 March 2020
Available in other languages: French, Portuguese, Spanish

Throughout history, epidemics and pandemics of plague and other diseases have caused widespread panic and social disorder even, in some instances, when the people of one region were aware of a pervasive infection elsewhere. In the case of the Plague of Justinian (541-542 CE and after), for example, the people of Constantinople were aware of plague in the Near East for at least two years before it arrived in the city but made no provision because they did not consider it their problem.

Once the disease struck, the people felt overwhelmed as it seems as though they believed that what had happened to others elsewhere could not possibly happen to them. Since there was no concept of germ theory, no one understood the cause of these outbreaks or how they spread and so they were attributed to supernatural causes and the wrath of the gods or God.

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Franciscan Monks Treat Victims of Leprosy
Franciscan Monks Treat Victims of Leprosy
Unknown Author (Public Domain)

The major epidemics and pandemics of the ancient and Medieval world for which eyewitness accounts exist are:

Of these, the first three may not have been plague but smallpox or typhus. Even so, the eyewitnesses to the earliest epidemics referred to them as plagues – the Roman physician Galen (l. 130-210 CE), in fact, is credited with coining the word plague in defining the Antonine outbreak – and so they are usually considered in discussions along the same lines as later events known to have been plague, especially in terms of people's reactions to the crises.

The responses differed little over the centuries &, in every instance, similar paradigms emerged.

These responses differed little over the centuries from the Plague of Athens (429-426 BCE) through the Black Death (1347-1352 CE) and, in every instance, similar paradigms emerged including drawing strength from, or rejecting, religion, distancing or becoming closer to others, and embracing either hope or despair. The one major difference between earlier plagues and the Black Death, however, was the aftermath as there was a shift in the religious and social paradigm following the plague of the 14th century CE which would eventually lead to the Renaissance movement.

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Plague of Athens

The primary source for information on the Plague of Athens is the historian Thucydides (l. 460/455-399/398 BCE) who claims the disease entered Athens through the port of Piraeus and spread quickly through the city. Athens was engaged in the Second Peloponnesian War (431-404 BCE) with Sparta at this time and the statesman Pericles (l. 495-429 BCE) had recently ordered a retreat behind the walls of the city, inadvertently providing an ideal environment for the disease to spread.

As more and more people became infected, hopelessness among the populace rose with the death toll. In his History of the Peloponnesian War, Thucydides writes:

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The most terrifying aspect of the whole affliction was the despair which resulted when someone realized that he had the disease: people immediately lost hope, and so through their attitude of mind were much more likely to let themselves go and not hold out. ... If people were afraid and unwilling to go near to others, they died in isolation, and many houses lost all their occupants through the lack of anyone to care for them. Those who did go near to others died, especially those with any claim to virtue, who from a sense of honor did not spare themselves in going to visit their friends. (Thucydides II.vii.3-54; Grant, 78)

Plague in an Ancient City
Plague in an Ancient City
Los Angeles County Museum of Art (Public Domain)

Thucydides further reports that many came from the countryside into the city seeking help but had nowhere to live and so set up huts close together which only encouraged the outbreak to spread further. Panic, as well as the overwhelming nature of the epidemic, led quickly to a breakdown in social custom and tradition as well as observance of law:

The sanctuaries in which people were camping were filled with corpses…the disaster was overpowering, and, as people did not know what would become of them, they tended to neglect the sacred and the secular alike. All the funeral customs which had previously been observed were thrown into confusion and the dead were buried in any way possible…In other respects, too, the plague marked the beginning of a decline to greater lawlessness in the city. People…thought it reasonable to concentrate on immediate profit and pleasure, believing that their bodies and their possessions alike would be short-lived. (Thucydides II.vii.3-54; Grant, 79)

The epidemic finally wore itself out – after a death toll of 75,000-100,000 – and afterwards life resumed in Athens, more or less, as it had before. This would be the paradigm of later regions struck by disease but religion would assume a larger role beginning with the Antonine Plague.

Antonine Plague

The Antonine Plague (165 - c. 180/190 CE) is chronicled primarily by Galen but mentioned by Cassius Dio (l. c. 155 - c. 235 CE) and others. It struck the Roman Empire during the co-rule of Marcus Aurelius (r. 161-180 CE) and Lucius Verus (r. 161-169 CE) and is so-called after Aurelius' family name, Antoninus. Conservative estimates place the death toll at 5 million though it could have been as high as 7-10 million and included both Aurelius and Verus. The disease, probably smallpox, was brought back to Rome by soldiers campaigning in the East, specifically those who had been engaged in the siege of the city of Seleucia in the winter of 165-166 CE.

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Although Galen is the primary source, he focuses almost exclusively on the treatment of the disease rather than its effects. Thucydides wrote in order to “give a statement of what [the plague] was like, which people can study in case it should ever attack again” (Grant, 77) but Galen, as a physician, recorded his treatments in the same way he did for any other curative measures.

Portrait of Seven Notable Greek Physicians & Botanists
Portrait of Seven Notable Greek Physicians & Botanists
Lewenstein (Public Domain)

There was little to be done for many of Galen's patients, even though he continued to treat any who came to him, because he did not understand how to deal with the affliction itself and could only apply himself to the symptoms, many of which he lists in detail.

Cassius Dio describes the outbreak as “the greatest plague I know of” and cites 2,000 people dying daily from it (Parkin & Pomeroy, 54). He does not, however, give details of how people reacted to the disease. Galen's notes are more informative on this as he recorded his patients' histories which give evidence of the high levels of anxiety and depression in the populace. Scholar Susan Mattern comments:

Galen recognized emotional states as factors in disease. Some problems were for Galen purely emotional in origin [while others were exacerbated by one's emotional state]. Anxiety is, along with anger, the emotion Galen mentions most often as a cause of disease. Anger and anxiety could cause or exacerbate [problems]; along with diet, temperament, lifestyle, and environmental factors, they could contribute to any number of feverish illnesses; anxiety in particular could trigger a sometimes-fatal syndrome of insomnia, fever, and wasting. (479)

The people, naturally, were experiencing high levels of anxiety over the plague along with frustration over how it could be stopped – or at least treated – and anger at what was happening. These negative feelings were compounded by the economic effects of the plague as so many people died that tax revenues decreased and the government struggled to maintain itself while crops went unharvested, decreasing the supply of food while causing an increase in prices for what was available.

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Christians cared for the sick & their courage in the face of widespread disease & death drew more converts to Christianity.

Although it is not specifically recorded, anger was also directed toward the gods. Roman religion was state-sponsored and operated on the concept of quid pro quo (“this for that”): the people worshiped and sacrificed to the gods and the gods took care of the people; in this case, the gods had clearly failed to live up to their side of the bargain.

Aurelius blamed the Christians for angering the gods by refusing to participate in religious rituals and so initiated persecutions against them. Christians responded by caring for the sick and dying, showing no fear of death because their faith assured them unconditionally of an eternal life beyond their present existence. Their courage in the face of widespread disease and death drew more converts to Christianity, weakening the state religion, which in turn weakened the state itself. This paradigm would repeat itself during Cyprian's plague.

Plague of Cyprian

The Plague of Cyprian (250-266 CE) is so-called from the Christian cleric who recorded it. St. Cyprian (d. 258 CE), in his work On the Mortality, describes the symptoms of the plague, people's reactions to it, and encourages Christians not to fear because death is only a transition from the present world of sin and pain to everlasting life in paradise. Cyprian gives the symptoms in detail at the same time he encourages his fellow Christians to see the disease as an opportunity to live their faith fully:

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What greatness of soul it is to fight with the powers of the mind unshaken against so many attacks of devastation and death, what sublimity to stand erect amidst the ruins of the human race and not to lie prostrate with those who have no hope in God, and to rejoice rather and embrace the gift of the occasion, which, while we are firmly expressing our faith, and having endured sufferings, are advancing to Christ by the narrow way of Christ. (Chapter 14)

The epidemic proved difficult to deal with because it struck during the period now known as the Crisis of the Third Century (235-284 CE) when Rome had become destabilized, large territories had broken away to form their own polities, and strong leadership was lacking. During this era, the so-called barracks emperors were elevated by the military and deposed just as quickly when it seemed they had not lived up to their initial promise and this contributed to the instability.

Icon of St. Cyprian
Icon of St. Cyprian
Unknown Artist (Public Domain)

Throughout this crisis, the Christian community again assumed the responsibility of care for the sick and dying – further encouraging conversion and support for the religion – and, further, since so many of the pagan clergy died, it was left to Christian clerics such as Cyprian to interpret and write of the outbreak in Christian terms. As with the Antonine Plague, it seemed as though the traditional gods of Rome had failed the people but, this time, no emperor had the time or resources to devote to a persecution and Christianity spread further than before.

The outbreak is estimated as costing 5,000 lives daily while it raged, further weakening the Roman Empire while empowering the Christians. More artisans, farmers, and soldiers were lost in this epidemic than in the Antonine Plague but an even worse onslaught would come with Justinian's Plague.

Plague of Justinian

The Plague of Justinian is the first documented case of bubonic plague. The cause was identified only in 1894 CE as the bacterium Yersinia pestis which was carried by the fleas of rodents, mainly rats, transported along with goods through trade routes and by the supply trains of troops. It is named after the Byzantine emperor Justinian I (r. 527-565 CE) who ruled from Constantinople at this time and recorded by the historian Procopius (l. 500-565 CE) who wrote on his reign.

Three Doctors Attend a Man with the Plague
Three Doctors Attend a Man with the Plague
Historical Medical Library of The College of Physicians of Philadelphia (CC BY-NC-SA)

This plague is thought to have originated in China (as the earlier two were also) and traveled via the Silk Road to the West. It is thought to have first struck the Near East – especially Persia (Iran) - before coming to Constantinople and would eventually take 50 million lives. Procopius attributes the outbreak to supernatural causes, specifically God's anger toward Justinian I for his unjust and incompetent reign, and, in his History of the Wars, claims many victims were first visited by a vision:

Apparitions of supernatural beings in human guise of every description were seen by many persons, and those who encountered them thought that they were struck by the man they had met in this or that part of the body, as it havened, and immediately upon seeing this apparition they were seized also by the disease. ... But in the case of some the pestilence did not come on in this way, but they saw a vision in a dream and seemed to suffer the very same thing at the hands of the creature who stood over them, or else to hear a voice foretelling to them that they were written down in the number of those who were to die. But with the majority it came about that they were seized by the disease without becoming aware of what was coming either through a waking vision or a dream. (II.xxii.11-17; Lewis, 470-471)

This plague also encouraged Christian devotion since the faith was well-established by this time. Even so, it appears the new-found zeal of many only lasted as long as the pestilence raged. Procopius reports:

At that time, too, those of the population who had formerly been members of the factions laid aside their mutual enmity ... those who in times past used to take delight in devoting themselves to pursuits both shameful and base, shook off the unrighteousness of their daily lives and practiced the duties of religion with diligence ... but then all, so to speak, being thoroughly terrified by the things which were happening, and supposing that they would die immediately, did, as was natural, learn respectability for a season by sheer necessity. Therefore as soon as they were rid of the disease and were saved, and already supposed that they were in security, since the curse had moved on to other peoples, then they turned sharply about and reverted once more to their baseness of hearts ... altogether surpassing themselves in villainy and in lawlessness of every sort. (II.xxiii.15-19; Lewis, 476)

The only effective measure was what is known today as social distancing and quarantine of the sick but, according to Procopius, this was done voluntarily by individuals as Justinian I was too preoccupied with his own interests to assume responsibility for taking care of his people. The plague severely weakened the Byzantine Empire in the same way earlier outbreaks had damaged their respective regions but, unlike the epidemics of the past, there is no suggestion of a widespread loss of religious faith.

Near East & Roman Plague

Having exhausted the people of the Byzantine Empire, the plague returned to the Near East and raged almost continuously between 562-749 CE. Unfortunately, few eyewitness accounts have survived and later histories of the plague are incomplete. Scholars usually focus on the most famous outbreak, the Plague of Sheroe (627-628 CE), which killed the Sassanian king Kavad II (birth name, Sheroe, r. 628 CE) and contributed to the fall of the Sassanian Empire.

Pope Gregory the Great decreed the disease was a punishment from God for humanity's sins & people needed to repent & show contrition.

Better documentation exists for the Roman Plague of 590 CE. Religion again played a central role in attempting to resist this plague but, since records of it come only from Christian clerics, there may have been other measures taken which were not recorded or have been lost. As with Justinian's plague, this outbreak was a combination of the three lethal types: bubonic, septicemic, and pneumonic.

There is little written on this epidemic – even the death toll is unknown – outside of Christian commentary which reports that the pope Gregory the Great (l. 540-604 CE) decreed the disease was a punishment from God for humanity's sins and people needed to repent and show contrition. Accordingly, penitential processions wound their way through the streets of Rome to the shrine of the Virgin Mary begging for intercession and mercy. These processions spread the plague further but, as no one understood germ theory, they were credited with ending the disease once it had run its course in the same way that people initially placed their hopes in religious rituals during the Black Death.

Black Death

The Black Death is the most famous outbreak in history. Although modern-day accounts of the disease routinely focus on Europe, it also devastated the Near East between 1346 - c. 1360 CE. This outbreak was also a combination of all three types of plague and was referred to as “the pestilence” by those who lived through it; the term Black Death did not exist prior to 1800 CE and was coined in reference to the black buboes – growths – which appeared on the skin in the groin, armpits, and around the ears as the result of swollen lymph nodes. The disease claimed the lives of an estimated 30 million people in Europe and possibly as many as 50 million or more worldwide. Regarding people's reactions, historian Barbara Tuchman cites the writer Agnolo di Tura of Sienna, who lived through the pandemic:

Father abandoned child, wife husband, one brother another for this plague seemed to strike through the breath and sight. And so they died. And no one could be found to bury the dead for money or friendship. And I…buried my five children with my own hands and so did many others likewise. (96)

Tuchman continues:

There were many to echo his account of inhumanity and few to balance it, for the plague was not the kind of calamity that inspired mutual help. Its loathsomeness and deadliness did not herd people together in mutual distress, but only prompted their desire to escape each other. (96)

Further, countries or nationalities which were not yet infected, seized on the misfortune of others, planning invasions when their neighbors were at their weakest instead of offering help. As Tuchman observes, however, “Before they could move, the savage mortality fell upon them too, scattering some in death and the rest in panic to spread the infection” (97). The plague spread so quickly, and killed so many people, that burial rites and mortuary rituals were abandoned and people sought whatever means seemed best to either survive or enjoy the little time they had left.

Spread of the Black Death
Spread of the Black Death
Flappiefh (CC BY-SA)

The Italian writer and poet Giovanni Boccaccio (l. 1313-1375 CE), author of The Decameron which recounts the tales of a group of ten trying to escape the plague by seclusion, describes in his introduction the main ways in which people reacted to the pestilence:

There were some people who thought that living moderately and avoiding any excess might help a great deal in resisting this disease, and so they gathered in small groups and lived entirely apart from everyone else. They shut themselves up in those houses where there were no sick people and where one could live well by eating the most delicate of foods and drinking the finest of wines, allowing no one to speak about or listen to anything said about the sick and dead outside…Others thought the opposite: they believed that drinking excessively, enjoying life, going about singing and celebrating, satisfying in every way the appetites as best one could, laughing, and making light of everything that happened was the best medicine for such a disease…Many others adopted a middle course between the two attitudes just described: They did not shut themselves up, but went around carrying in their hands flowers, or sweet-smelling herbs, or various kinds of spices and they would often put these things to their noses, believing that such smells were wonderful means of purifying the brain, for all the air seemed infected with the stench of dead bodies, sickness, and medicines. (7-8)

However people chose to react in their own lives, the communal response was a crisis of faith since it seemed God – who was thought to have sent the plague – refused to respond to any pleas to alleviate or end it. People blamed the devil for the outbreak as well as marginalized groups like the Jews – who lived apart from Christians in their own communities, were therefore not as susceptible to infection, and so were suspected of causing it – but, God was held chiefly responsible.

People saw the priests, physicians, and caregivers – who placed themselves in danger for the sake of others – dying daily and lost faith in a God who would take those he had seemingly chosen to help the most in the crisis. This turning from faith would eventually focus people on the human experience rather than the divine plan and would find expression in the Renaissance. Unlike the city of Athens after the plague centuries before, the world did not resume its former state but was transformed by survivors into something new.


Every witness to these outbreaks describes the experience as the worst event of their lives or the end of the world – as it must have seemed, of course – and yet afterwards people adapted to the loss and continued on. The world these people had known was completely altered but they persevered and managed to build a new one for themselves. As the American poet Theodore Roethke (l. 1908-1963 CE) puts it, “In a dark time, the eye begins to see” and the people who survived the Black Death saw the possibility of a new way of living and understanding the world and each other.

Each new reality created by these plagues, however harsh the experience, offered survivors the opportunity to change their way of thinking and living and embrace some new paradigm. In the plagues of Rome, this was a transition from the traditional religion of the state to the new faith of Christianity while, with the Black Death, it was a shift away from that faith, which had by that time become institutionalized, to a newly discovered humanistic view of the world. In every case, however, survivors were left with a choice as to the kind of world they wished to live in after the crisis: to continue on with their prior understanding or to embrace a new one.

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About the Author

Joshua J. Mark
Joshua J. Mark is World History Encyclopedia's co-founder and Content Director. He was previously a professor at Marist College (NY) where he taught history, philosophy, literature, and writing. He has traveled extensively and lived in Greece and Germany.


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Mark, J. J. (2020, March 31). Reactions to Plague in the Ancient & Medieval World. World History Encyclopedia. Retrieved from

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Mark, Joshua J.. "Reactions to Plague in the Ancient & Medieval World." World History Encyclopedia. Last modified March 31, 2020.

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Mark, Joshua J.. "Reactions to Plague in the Ancient & Medieval World." World History Encyclopedia. World History Encyclopedia, 31 Mar 2020. Web. 29 May 2024.