How America Got So Sick

[Nevilledog]

https://www.theatlantic.com/magazine/2026/03/american-public-health-democracy/685727/

No paywall link
https://archive.li/bgNhE

In the winter of 168 C.E., the famed Greek physician Galen arrived in Aquileia, an Italian city on the northern edge of the Adriatic. The city had grown large since its founding as a Roman colony, but during the 200-year Pax Romana, its fortifications had been allowed to deteriorate. After an armed group of migrating Germanic peoples had crossed the Danube a year earlier, the Roman co-emperors, Marcus Aurelius and Lucius Verus, had rushed to the city, raising two legions and rebuilding its defenses; they planned to use it as a base of operations against the invaders.

Galen had been summoned, however, to help fight a different kind of invader. A plague, likely an early variant of smallpox, had traveled to Aquileia with the troops, and held the city in its grip. The emperors fled, but Verus succumbed to the disease on the road to Rome. Galen tried to slow the wave of illness, but most of the people in Aquileia perished.

They represented just a sliver of the eventual victims of the Antonine Plague, also known as Galen’s Plague, which killed at least 1 million people throughout the Roman empire. It was possibly the world’s first true pandemic, and haunted the empire for the rest of the Pax Romana, which ended in 180 with Aurelius’s death. The details of the pandemic—the exact pathogen, the true number of victims—are subjects of debate, and might never be fully settled. But some research has cited the Antonine Plague as part of a vicious cycle that hastened Rome’s long fall. Food shortages, internal migrations, and overcrowding had already signaled a slippage in imperial power, and created a fertile environment for disease. The pandemic, in turn, spread panic and left behind mistrust, weakening faith in civic and religious authorities.

Men famously think about Rome every day, and political commentators have been nervously comparing Rome’s fall to a potential American collapse since before America even had a Constitution. But Rome’s example really does merit consideration in light of recent events. One of the better measures of a society’s vitality is its ability to protect its citizens from disease, and the two often move in tandem; a decline in one may produce a reduction in the other.

*snip*