The Plague of Justinian

Procopius was living in Constantinople when the disease arrived in the spring of 542. He traced it to Pelusium in Egypt, where it had broken out the year before, and wrote that it moved one way to Alexandria and the other into Palestine, always arriving from the coast and working inland. By the winter of 543 it had reached North Africa, Italy, Spain and the present border of France and Germany.

The illness began with a sudden fever, so mild that neither the patient nor a physician who touched him suspected danger. Within a day or a few days a swelling rose in the groin, the armpit, beside the ears or on the thighs. Some patients sank into a deep coma, others into violent delirium. Some broke out in black pustules the size of a lentil and died within a day; others vomited blood. Physicians who opened the swellings of the dead found a strange carbuncle growing inside, and patients whose swellings grew large and discharged pus tended to survive. Procopius also saw that those who nursed the sick or buried the dead did not seem to catch it from them.

In Constantinople the epidemic lasted four months, with its worst phase about three. Deaths rose to 5,000 a day and then to 10,000 and more, by his count. Justinian assigned palace soldiers and money to an official named Theodorus and put him in charge of burying the dead. When the tombs and then the trenches around the city were full, workers packed corpses into the towers of the fortifications at Sycae and roofed them over again. The emperor himself fell ill with a swelling of the groin.

Plague persisted within the territory of the Roman Empire until the middle of the 8th century. Its cause stayed in dispute: some written descriptions did not fit Yersinia pestis infection, and earlier DNA findings of plague had not been independently replicated. In 2013 Harbeck and colleagues tested teeth from 19 people in 12 multiple graves of the 6th century at Aschheim, an early medieval cemetery in Bavaria. Laboratories in Munich and Mainz, working independently, found Y. pestis DNA. The team placed the strain on the bacterium's family tree and suggested that the first pandemic, like the second and third, began in Asia.