All that great learning of Galen and Hippocrates, those physicians that taught that disease was caused by pathogenic agents was laid to waste during my reign of terror and the early Christian Church eagerly rushed to fill the medical void, becoming doctor to body and soul and consequently held up the advancement of medical science until probably late in the seventeenth century. The Church, in its new role as healer equated disease with vice and sin, the punishment for people leading an errant life and not listening to the voice of Rome. Their writers, whose literary plague model was the Book of Revelation, promoted and prolonged this idea. There was John of Ephesus who clearly said that the end of the world was at hand, or Zachariah of Mytilene who said that the plague was a scourge from Satan and even the more reasonable Gregory of Tours said people could only be saved by praying to St. Gall. Well, add in a few wonders like the collapse of the original dome of Hagia Sophia during the earthquake of Constantinople and it's little wonder that the religiosity of the Byzantine Empire dramatically increased during this period. It was like the twin towers falling without a valid reason.

Anyway, to get back to poor Justinian after whom I am so nobly called. Let me tell you a little about him. In his day he was also known as Flavius Petrus Sabbatius Justinianus, the great Byzantine Emperor whose architectural monuments still lie strewn around Instanbul and beyond. Thank God, they didn't call me after his real name. In 525, at the age of 42, he received the title of Caesar and two years later the rank of Augustus. It was a time of great splendour as Justinian erected magnificent buildings, recruited armies and formed codes of laws, which became the basis of European Justice. People followed the teachings of progressive physicians who were creating the discipline of medical science. Into this noble world, I came wreaking destruction and forming the worst pandemic that has harrowed human kind. Today, the record of my destruction remains amongst three main sources, John of Ephesus, who wrote Historia Ecclesiastica, while wandering around the empire, the lesser known Evagrius Scholasticus and last but not least, Justinian's archivist, Procopius, who published the History of the Wars, in 550.

I started my long march around the Empire in 540. In that year I befriended people in Pelsium, Lower Egypt and within a month traders and itinerant scholars had carried me to Alexandria and Palestine. Now I won't argue with Procopius, when he said that the death toll in Constantinople, in spring of 542 became 10,000 a day, but allowing for a small exaggeration, this was more people than Justinian was losing in his battles against Italy and Persia. At any rate, following my sojourn in Constantinople, I spread throughout the empire along trade and military routes from the coastal cities to the interior provinces. I surfaced in Italy in 543, and from there, migrated to Persia, to infect the Persian army and King Khusro himself, causing them to retreat east of the Tigris to the plague-free highlands of Luristan. Gregory of Tours tells how St. Gall saved the people of Clermont-Ferrand in Gaul from me in 543, and I visited Ireland for a sort period in 544. I left as the barmen told me Guinness wouldn't be around for another 1225 years. At least they couldn't blame the Black Stuff on the Dubliners that were breaking out in black blisters, vomiting blood and some others seized by madness. And the poor doctors, not knowing what to do, just lanced the buboes and looked at the withered thighs and tongues and hoped they were living in 1784, when a few of the lads from the newly opened Royal College of Surgeon's could help them in their work. But these were other days, when in typical apocalyptic literature style, John of Ephesus seen hallucinations as apparitions from another worldly realm, when men wore identification tags with the fear of being left unburied and ships floated aimlessly at sea, later washing up to shore with all of their crew having become my friends.

Although the emperor Justinian contracted the disease himself, he valiantly attempted to minimise the disaster. Following the outbreak in Constantinople, Justinian commanded the palace guard to dispose of the corpses. But soon all the gravesites were filled beyond capacity, and the living resorted to throwing the bodies of victims out into the streets or piling them along the seashore to rot. He responded to this problem by having huge pits dug across the Golden Horn in Sycae and hiring men to collect the dead. Although these pits reportedly held 70,000 corpses each, they soon overflowed and Justinian ordered that the bodies should be placed inside the towers of the city walls and to pour lye down the shafts. When the decaying corpses caused a stench that pervaded the entire city, he ordered that the rotting dead should be put on ships and set fire at sea. Procopius also recorded the human dimension of the tragedy. The first day the person could feel the hard nodes or 'buboes' in the armpits and groin. By the second and third day the fever produced violent delirium in which the victims hallucinated, seeing 'phantoms of death'. He astutely observed that a person who coughed and spit up phlegm died quickly, usually by the fifth day. Students from the Royal College of Surgeons today, God bless 'em, would tell you that I actually came in three forms bubonic, pneumonic (also called pulmonary), and the septicaemic.

The bubonic form, which must exist before the other two strains can become active, is not directly contagious unless the patient harbours fleas. Since Procopius did not state that those who cared for the sick necessarily contracted the disease, it is inferred that the bubonic form was most active in the Justinianic plague. The pneumonic plague occurred whenever I decided to invade the lungs. This variety is highly contagious from one person to another, and is spread by airborne droplets. Due to Procopius' observation that the plague was not directly contagious, and the absence of the major symptoms of pneumonic plague in the accounts, namely shallow breathing and tightness in the chest, this form was probably not very active. Septicaemia occurs when the infection enters the bloodstream, and death is swift, usually before buboes are able to form. In his account, Agathias reported some of my friends dying as if by an attack of apoplexy and from this some scholars would deduct that my septicaemic form did exist during the Justinian outbreak. But either way, I wreak disaster as bubonic plague results in 70% deaths; pneumonic plague in 90% and septicaemic plague leaves no survivors. To live for ten days was considered a miracle and gave time for one to offer additional prayers for an inevitable end.

It was common for entire families and professions to be wiped out, their lineage ended and their professions to be lost to history. During the half century that the Justinian plague raged, no village or town was spared and one hundred million people died of the disease. This meant that recruits for the Roman Army became difficult to find, with the result that the empire was mostly served by barbarian mercenaries. In Justinian's final years, there were virtually no men either to volunteer or to be impressed into the service. Because he was spared, he withdrew from public life and devoted himself to theological problems. He believed that Christ was entirely divine and that his incorruptible human body was just a delusion. This blasphemy didn't suit the Christians of the period and nobody was surprised when he died two years later. Fortunately for the Romans themselves, the plague had also attacked and weakened the Persian Empire. In Italy, the Ostrogoths resumed the war, and new revolts broke out in the previously subdued African provinces. Needless to say, the Justinianic plague, apart from its devastating immediate impact, undermined the political and economical structure of the late Roman Empire, creating conditions ripe for disaster. Coupled with the other disasters, the plague reduced the population of the Mediterranean world by 40% by the year 600. Such a massive mortality rate caused depopulation of the urban centres and created a structural imbalance in favour of the desert Arabs. But before I go down that road, let us just say that I was a microbe that truly changed the history of the world!

Dr. Patrick Treacy is a cosmetic expert. He is Medical Director of Ailesbury Clinics Ltd and the global Cosmetic Medical Group. He is Chairman of the Irish Association of Cosmetic Doctors and is Irish Regional Representative of the British Association of Cosmetic Doctors. He is European Medical Advisor to Network Lipolysis and the UK's largest cosmetic website Consulting Rooms. He practices cosmetic medicine in his clinics in Dublin, Cork, London and the Middle East.

Dr. Treacy is on the Specialist Register in the UK and Ireland and holds higher qualifications in Dermatology and Laser technology and skin resurfacing. He was amongst the first doctors worldwide to use the permanent facial endoprosthesis BioAlcamid for HIV Lipodystrophy patients. He was also the first person to introduce many techniques such as Radiofrequency assisted lasers, Fibroblast transplant and Contour Threads to Irish patients.

Dr. Treacy is an advanced aesthetic trainer and has trained over 300 doctors and nurses from around the world. He is also a renowned international guest speaker and features regularly on national television and radio programmes. He was invited to speak about stem cells and cosmetic medicine at the World Aesthetic Conference in Moscow this year.

The Irish College of Cosmetic Doctors
The British Association of Cosmetic Doctors
The British Medical Laser Association
The American Society for Aesthetic Medicine
The American Society for Lasers in Medicine and Surgery The European Society of Laser Dermatology
The European Society for Dermatological Surgery (ESDS)
The International Society for Dermatologic Surgery
The International Academy of Cosmetic Dermatology

Dr. Treacy is the European Representative for the NetWork-Lipolysis where he is on the Medical Advisory Board and the Scientific Advisory Board.
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