E.’s Pox Romana focuses on the so-called Antonine plague, which struck the Roman world in the mid-160s ce, as troops returned from the Parthian war. The book has appeared in the Princeton University Press series Turning Points in Ancient History, which clearly aims to attract a wider readership than merely the academic world. In the foreword (by the series editor B. Strauss) the strengths of E.’s work are outlined: ‘a historical detective story of the first order. Elliott takes us through the meager data with a masterful hand’, while Strauss does not deny the challenges: ‘Direct evidence of the disease is hard to come by’ (p. ix).

The success of the work can be taken for granted. Proof of the topic’s popularity is K. Harper’s best-selling and prize-winning The Fate of Rome. Climate, Disease, and the End of an Empire (2017), which spurred a lively and still ongoing debate. E.’s work is clearly inspired by Harper (who is thanked in a postscript and read the manuscript) in that much of the book is dedicated to a discussion of general features of the Roman world during the first two centuries ce: climate and climate change, sanitation and health, and levels of daily caloric intake among the population. E. contributed to this approach to Roman pandemic scholarship already before the publication of Harper’s monograph (‘Climate Change, Plague and Local Violence in Roman Egypt’, Past & Present 230 [2016], 3–31).

Of the eight chapters, the two initial ones are dedicated to a description of the situation in the Roman empire on the eve of the Antonine plague, which reached Rome in the fall of 166 ce. The content is familiar from existing accounts of ‘everyday life in the Roman world’, except that E. emphasises the misery, the filth, the waste of resources and the inequality of the times. It is truly a ‘Read and feel good about living in the present day’ experience for the wider readership (cf. L. Nissin, ‘Smellscape of a Pompeian Neighborhood’, JRA 35 [2022], 621–35, for a nuanced view of some ancient realities). The theme returns in Chapter 6, ‘An Empire Exhausted’, which emphasises how the sufferings of the population were acerbated because of a scarcity of resources. For readers with previous knowledge of the Roman world and of current scholarship the pace sometimes appears too fast and one-dimensional. Unfortunately, the footnotes are at the back of the book, which makes it a cumbersome process to check what E.’s interpretations are based on. This is particularly regrettable when the main subject is the Antonine plague; probably no topic within Roman history has generated more discussion these past decades.

An early, minor example: ‘Aged, sick, or disabled slaves were tossed out even before they died – left to slowly expire alone in the slimy streets’ (p. 11). The sole reference is Suetonius, Life of Claudius 25.2. There we are only told that, because certain slaveowners abandoned their sick slaves at the sanctuary of Aesculapius on the Tiber Island in Rome (a famous site of healing), the emperor Claudius ruled that such slaves, in case they recovered, should be free. Here, E. appears as the author of imaginative and creative detective work, to borrow from Strauss’s foreword.

The health of the empire depended on the daily caloric intake of its inhabitants, and in Chapter 2 E. focuses on Egypt, a major breadbasket for the capital Rome. Taxation in kind was the main concern of the provincial administration, which from the mid-second century onwards seems to have been facing increasing problems: ‘the starving and overtaxed Egyptians rioted, taking the extraordinary step of killing the Egyptian prefect – the de facto [Roman] governor’ (p. 32). No ancient source is cited for this incident, but E. refers to the Cambridge History of Egypt I (1998), p. 16, where likewise no source is given. Further digging through modern lists of praefecti Aegypti and PIR ² M 723 and S 358 reveals that the source is the late and often misleading author Malalas, who has transposed events from Caracalla’s reign to that of Antoninus Pius, as already shown by F. Schehl (Hermes 65 [1930]) and clearly stated by A. Jördens (Statthalterliche Verwaltung in der römischen Kaiserzeit. Studien zum praefectus Aegypti [2010], pp. 452–4) and C. Michels (Antoninus Pius und die Rollenbilder des römischen Princeps [2018], p. 272) in more recent times. E.’s bibliography is rich but does not cite these works. The prefect was not killed; instead, in 154 ce he welcomed back, without penalties, farmers who had left their fields. Jördens shows that problems undoubtedly existed in Egyptian agriculture at the time, while E. uses D. Bonneau’s figures (from 1971) for the frequently insufficient flooding of the Nile from the 150s to the mid-170s as proof of an agricultural crisis. The purpose is once again to argue that in such a context the effect of any disease must have been dire.

Chapter 3 discusses the arrival of the Antonine plague. The Roman empire appears as the final destination for a pandemic that inexorably marched westward from China, where the earliest suitable report of a disease is from 151 ce. A path for the transmission of the disease from China to the Parthian empire is outlined by pointing to evidence from the Kushan empire and from the southern tip of the Arabian peninsula. The evidence from Kushan rests on A.D.H. Bivar 1970 alone, an article already listed in Harper 2017 (where it appears not to be cited), but Bivar’s chronology of both the Kushan rulers and Gandharan art is outdated (J. Rhi, in: W. Rienjang and P. Stewart [edd.], Problems of Chronology in Gandharan Art [2017], pp. 35–51). E.’s view (p. 62) that the goddess Hariti, always shown with children and known as their protector, really was a ‘plague demon’, frequently represented in the period 156–165 ce and thus documenting an early Kushan stage of the pandemic, appears untenable.

Chapters 4 and 5 (‘Plague Unleashed’, ‘The Age of Angst’) use some 65 pages to discuss epigraphic and literary evidence for events that E. links to the Antonine disease (c. 165–c. 190). Most, if not all, the evidence is well known and has been discussed in earlier studies, often with the same intention as E. Other scholars have argued, often persuasively, that various texts and inscriptions marshalled by the ‘maximalists’ contribute little or not at all to the understanding of the Antonine plague and its effect. For the most part, E.’s footnotes are slim, and he avoids engaging in detailed discussions about the value, or not, of the evidence; undoubtedly the opposite approach would slow down the pace and impact the overall argument. Readers who know the discussion are aware that the current debate is not about whether a pandemic-like phenomenon struck Rome in 166 – nobody denies this –, but is wholly about the severity of the disease and its effect, the local and empire-wide mortality during the ensuing period. In this perspective, even the existence – or not? – of a pre-pandemic in the Kushan empire, which apparently did not have any severe consequences – or did it? –, is of relevance.

All participants in the debate suffer from the fact that the pathogen causing the ‘plague’ has not been identified. Students of the Antonine plague are worse off than colleagues who study the early sixth-century Justinianic plague, which according to genetic material was caused by the yersinia pestis bacterium, while mass graves provide some idea of the mortality. To date only one known mass grave may contain victims of the Antonine plague (Rome, Cemetery of Saints Peter and Marcellinus), and recent reports concerning some 2,500 burials identify three periods of deposition based on C-14 dating: 28/132, 80/250 and 140/380 ce (see D. Castex, ‘Détection et interpretation de crises sanitaires en archéologie: examples d’une épidémie dans la Rome antique’, in: F. Clément [ed.], Épidémies épizooties. Des représentations anciennes aux approches actuelles [2017], pp. 157–70, esp. 165–8; not cited by E.).

E. cautions from time to time that he is presenting hypotheses and that alternative interpretations are possible, but the purpose is clear, and the overall result is more like the opening statement by a district attorney, as seen on TV, than the careful detailed testimony delivered under oath by the investigating detective. Reading Pox Romana might make readers want to engage more deeply with the subject, which is a positive outcome.