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Sports
Cardiology
Care of the Athletic Heart
from the Clinic to the Sidelines
David J. Engel
Dermot M. Phelan
Editors

123
Sports Cardiology
David J. Engel • Dermot M. Phelan
Editors

Sports Cardiology
Care of the Athletic Heart from the Clinic
to the Sidelines
Editors
David J. Engel Dermot M. Phelan
Division of Cardiology Sports Cardiology Center
Columbia University Irving Medical Center Hypertrophic Cardiomyopathy Center
New York, NY Atrium Health Sanger Heart &
USA Vascular Institute
Charlotte, NC
USA

ISBN 978-3-030-69383-1    ISBN 978-3-030-69384-8 (eBook)

https://doi.org/10.1007/978-3-030-69384-8

© Springer Nature Switzerland AG 2021

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
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Preface

Participation in organized sports across the globe has markedly increased over the
past decade, and, in parallel, the clinical practice and research activity centered on
the cardiac care for athletes within the field of sports cardiology has expanded expo-
nentially. Recognizing the unique diagnostic and management challenges in opti-
mizing the heart health of athletes and reflective of the increasing importance
assigned to protecting the hearts of athletes, the American College of Cardiology
(ACC) in 2011 launched the ACC Section of Sports and Exercise Cardiology.
A foundation in the growth of sports cardiology has been the development of a
refined and enhanced understanding of the physiological manifestations of exercise
on the heart. This improved characterization of exercise-induced cardiac remodel-
ing, recognizing the relative influence of such modifiers as sport type, duration and
intensity of training, age, gender, race, size, and genetics, has vastly improved our
ability to screen for subclinical cardiac disease and differentiate normal physiology
from pathology. It is essential for healthcare providers who screen and treat athletes
at all skill levels to have a firm grasp of the tenets of sports cardiology and readily
available reference data encompassing the key elements within this growing field.
The cumulative clinical experience gained from caring for athletes training and
competing with existing cardiac conditions has resulted in the rapid evolution of
recommendations guiding sporting participation and the recognition of the impor-
tance of shared decision-making. A contemporaneous challenge has been the devas-
tation wrought by the COVID-19 pandemic. Sport and health organizations now
confront significant challenges designing and implementing safe athlete return to
play (RTP) strategies. In this textbook, we will review the critical issues and data
surrounding concerns of potential cardiac sequelae of COVID-19, and their impact
on athlete screening and RTP plans, as the newest element in the field of sports
cardiology.
Finally, the field of sports cardiology has pushed the practicing cardiologist from
the clinical facilities to the sports training facilities where they must participate in
the acute evaluation and management of athletes in addition to provide guidance on
effective emergence action plans.

v
vi Preface

Reflecting these challenges, this textbook is divided into three parts:

1. Pre-participation Cardiac screening of Athletes
2. Management and Recommendations for Athletes with Existing Cardiac
Disorders
3. Sideline Management of Acute Cardiac Conditions in Athletes
The purpose of this textbook is to assist healthcare providers manage the cardiac
care of athletes across the spectrum of these essential components. We will review
best practices for using and interpreting diagnostic tests commonly employed in the
cardiac evaluation of athletes, including the 12-lead electrocardiogram, advanced
cardiac imaging, and genetic testing. Treatment of cardiac disorders, ranging from
acute symptoms that develop suddenly during competition to chronic conditions
that require longitudinal management and assessment, will be reviewed with incor-
poration of latest guideline recommendations. This textbook will provide a frame-
work to aid in the provision of optimal care for athletic patients of all ages both on
and off the playing field.

New York, NY, USA David J. Engel

Charlotte, NC, USA Dermot M. Phelan
Contents

1 The Cardiovascular History and Examination ������������������������������������    1

John DiFiori, Chad Asplund, and James C. Puffer
2 Using an Electrocardiogram as a Component of
Athlete Screening ������������������������������������������������������������������������������������   13
David J. Engel
3 Diagnostic Approach after Initial Abnormal Screening ����������������������   31
Matthew W. Martinez
4 Practical Use of Genetic Testing in Athletes������������������������������������������   53
Isha Kalia, Farhana Latif, Muredach P. Reilly, and Marc P. Waase
5 Management of Hypertension in Athletes����������������������������������������������   69
D. Edmund Anstey and Daichi Shimbo
6 Valvular Heart Disease����������������������������������������������������������������������������   85
Tamanna K. Singh
7 Hypertrophic Cardiomyopathy��������������������������������������������������������������   97
Dermot Phelan and John Symanski
8 Other Cardiomyopathies������������������������������������������������������������������������ 111
Bradley Lander and David J. Engel
9 Inflammatory Cardiac Disorders in the Athlete ���������������������������������� 129
Kenneth G. Zahka, Nishant P. Shah, and Kara Denby
10 Atrial Fibrillation������������������������������������������������������������������������������������ 143
Kyle Mandsager and Dermot M. Phelan
11 Sports Participation in Patients with Congenital
Long QT Syndrome �������������������������������������������������������������������������������� 157
Salima Bhimani, Jared Klein, and Peter F. Aziz

vii
viii Contents

12 Other Arrhythmic Disorders: WPW, CPVT,

Brugada and Idiopathic VF/VT�������������������������������������������������������������� 171
Jeffrey J. Hsu and Eugene H. Chung
13 Cardiovascular Implantable Electronic Devices in Athletes���������������� 195
Benjamin H. Hammond and Elizabeth V. Saarel
14 Diagnosis and Management of Coronary
Artery Disease in Athletes ���������������������������������������������������������������������� 211
Prashant Rao and David Shipon
15 Marfan Syndrome and Other Genetic Aortopathies���������������������������� 227
Jeffrey S. Hedley and Dermot M. Phelan
16 Congenital Heart Disease: Approach to Evaluation,
Management, and Physical Activity ������������������������������������������������������ 245
Silvana Molossi and Hitesh Agrawal
17 Sleep Disorders in Athletes���������������������������������������������������������������������� 275
Meeta Singh, Michael Workings, Christopher Drake,
and Thomas Roth
18 Chest Pain and Dyspnea�������������������������������������������������������������������������� 297
David C. Peritz and John J. Ryan
19 The Evaluation of Palpitations and Dizziness in the Athlete �������������� 321
Brad Witbrodt and Jonathan H. Kim
20 The Collapsed Athlete������������������������������������������������������������������������������ 343
Justine S. Ko and George Chiampas
21 Cardiac Arrest in Athletes���������������������������������������������������������������������� 361
Brian J. Cross, Shayna Weinshel, and Marc Estes
22 Commotio Cordis in Athletes������������������������������������������������������������������ 375
Mohita Singh and Mark S. Link
23 The Impact of COVID-19 on Sports Cardiology���������������������������������� 383
Bradley Lander, David J. Engel, and Dermot M. Phelan
Index������������������������������������������������������������������������������������������������������������������ 395
Contributors

Hitesh Agrawal, MD, MBA, FSCAI Department of Pediatric Cardiology,

University of Texas, Austin, TX, USA
D. Edmund Anstey, MD, MPH The Columbia Hypertension Center, Columbia
University Irving Medical Center, New York, NY, USA
Chad Asplund, MD, MPH Department of Orthopedics and Sports Medicine,
Mayo Clinic, Minneapolis, MN, USA
Peter F. Aziz, MD Cleveland Clinic Children’s, Cleveland, OH, USA
Salima Bhimani, MD Cleveland Clinic Children’s, Cleveland, OH, USA
George Chiampas, DO, CAQSM, FACEP Departments of Emergency Medicine
and Orthopedic Surgery, Feinberg School of Medicine, Northwestern University,
Chicago, IL, USA
Eugene H. Chung, MD Department of Medicine, University of Michigan, Ann
Arbor, MI, USA
Brian J. Cross, MD Division of Cardiology, VA Pittsburgh Health System,
Pittsburgh, PA, USA
Kara Denby, MD Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, USA
John DiFiori, MD Sports Medicine Institute, Hospital for Special Surgery, New
York, NY, USA
Christopher Drake, PhD Department of Sleep Medicine, Henry Ford Health
System, Detroit, MI, USA
David J. Engel, MD, FACC Division of Cardiology, Columbia University Irving
Medical Center, New York, NY, USA
Marc Estes, MD Heart and Vascular Institute, University of Pittsburgh,
Pittsburgh, PA, USA

ix
x Contributors

Benjamin H. Hammond, MD Division of Pediatric Cardiology, Cleveland Clinic

Children’s and Pediatric Institute, Cleveland, OH, USA
Jeffrey S. Hedley, MD Department of Cardiovascular Medicine, Section of
Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation,
Cleveland, OH, USA
Jeffrey J. Hsu, MD, PhD Department of Medicine (Cardiology), University of
California, Los Angeles, CA, USA
Isha Kalia, MS, MPH Division of Cardiology, Columbia University Irving
Medical Center, New York, NY, USA
Jonathan H. Kim, MD, MSc Emory Clinical Cardiovascular Research Institute,
Atlanta, GA, USA
Jared Klein, MD, MPH Cleveland Clinic Children’s, Cleveland, OH, USA
Justine S. Ko, MD Department of Emergency Medicine, Feinberg School of
Medicine, Northwestern University, Chicago, IL, USA
Bradley Lander, MD Division of Cardiology, Columbia University Irving Medical
Center, New York, NY, USA
Farhana Latif, MD Division of Cardiology, Columbia University Irving Medical
Center, New York, NY, USA
Mark S. Link, MD Department of Medicine, Cardiology Division, Cardiac
Electrophysiology, UT Southwestern Medical Center, Dallas, TX, USA
Kyle Mandsager, MD Centennial Heart, TriStar Centennial Heart and Vascular
Center, Nashville, TN, USA
Matthew W. Martinez, MD, FACC Director of Sports Cardiology, Morristown
Medical Center, Atlantic Health System, Morristown, NJ, USA
Silvana Molossi, MD, PhD Department of Pediatric Cardiology, Texas Children’s
Hospital, Baylor College of Medicine, Houston, TX, USA
David C. Peritz, MD Heart and Vascular Center, Dartmouth Hitchcock Medical
Center, Lebanon, NH, USA
Dermot M. Phelan, MD, PhD, FASE, FACC Sports Cardiology Center,
Hypertrophic Cardiomyopathy Center, Atrium Health Sanger Heart & Vascular
Institute, Charlotte, NC, USA
James C. Puffer, MD Division of Sports Medicine, Department of Family
Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Prashant Rao, MBBS, MRCP(UK) Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA, USA
Muredach P. Reilly, MBBCh, MSCE Division of Cardiology, Columbia
University Irving Medical Center, New York, NY, USA
Contributors xi

Thomas Roth, PhD Department of Sleep Medicine, Henry Ford Health System,
Detroit, MI, USA
John J. Ryan, MD Division of Cardiovascular Medicine, Department of Internal
Medicine, University of Utah, Salt Lake City, UT, USA
Elizabeth V. Saarel, MD Division of Pediatric Cardiology, St. Luke’s Health
System, Boise, ID, USA
Nishant P. Shah, MD Department of Cardiovascular Medicine, Cleveland Clinic,
Cleveland, OH, USA
Daichi Shimbo, MD The Columbia Hypertension Center, Columbia University
Irving Medical Center, New York, NY, USA
David Shipon, MD, FACC Thomas Jefferson University Hospital,
Philadelphia, PA, USA
Meeta Singh, MD Department of Sleep Medicine, Thomas Roth Sleep Disorders
Center, Henry Ford Health System, Detroit, MI, USA
Mohita Singh, MD Department of Medicine, Cardiology Division, Cardiac
Electrophysiology, UT Southwestern Medical Center, Dallas, TX, USA
Tamanna K. Singh, MD, FAAC Sports Cardiology Center, Heart, Vascular and
Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
John Symanski, MD Sports Cardiology Center, Hypertrophic Cardiomyopathy
Center, Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC, USA
Marc P. Waase, MD, PhD Division of Cardiology, Columbia University Irving
Medical Center, New York, NY, USA
Shayna Weinshel, BS, MS Department of Medicine, University of Central Florida,
Orlando, FL, USA
Brad Witbrodt, MD Emory Clinical Cardiovascular Research Institute,
Atlanta, GA, USA
Michael Workings, MD Department of Family Medicine, Henry Ford Health
System, Detroit, MI, USA
Kenneth G. Zahka, MD Department of Pediatric Cardiology, Cardiovascular
Medicine, Cleveland Clinic, Cleveland, OH, USA
Chapter 1
The Cardiovascular History
and Examination

John DiFiori, Chad Asplund, and James C. Puffer

Introduction

A comprehensive preparticipation evaluation (PPE) is recommended prior to the

initiation of training and competition for organized sports at the high school level,
the NCAA, professional sports organizations, and most national and international
sport governing bodies [1–6]. While the PPE is felt to be an important first step to
ensuring athlete health and well-being, there is variation in how the PPE is per-
formed among state scholastic programs and even among higher levels of sport
competition [1, 7–10].

The Cardiovascular Component of the PPE

Given that the primary goal of the PPE is to promote the health and safety of the
athlete [1], the cardiovascular (CV) screening portion of the PPE is perhaps the
most essential piece of this assessment. The CV component aims to identify and
evaluate symptoms or exam findings that may lead to the diagnosis of underlying

J. DiFiori (*)
Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
e-mail: [email protected]
C. Asplund
Department of Orthopedics and Sports Medicine, Mayo Clinic, Minneapolis, MN, USA
J. C. Puffer
Division of Sports Medicine, Department of Family Medicine, David Geffen School of
Medicine at UCLA, Los Angeles, CA, USA
e-mail: [email protected]

© Springer Nature Switzerland AG 2021 1

D. J. Engel, D. M. Phelan (eds.), Sports Cardiology,
https://doi.org/10.1007/978-3-030-69384-8_1
2 J. DiFiori et al.

cardiac conditions that could result in cardiac morbidity, sudden cardiac arrest, or
sudden cardiac death. The American College of Cardiology and the American Heart
Association state that “the principal objective of screening is to reduce the cardio-
vascular risks associated with organized sports and enhance the safety of athletic
participation; however, raising the suspicion of a cardiac abnormality on a standard
screening examination is only the first tier of recognition, after which subspecialty
referral for further diagnostic testing is generally necessary” [11].
Consensus statements and recommendations for the PPE include specific details
for the cardiac history and physical examination [1, 11–13]. Despite these published
standards, there remains a lack of consistency in their implementation [7–10].
Further, it is important to understand that there is debate about the ability of the CV
history and physical exam to detect significant CV conditions during PPEs.
However, it is well recognized that no screening algorithm is capable of detecting
all clinically relevant cardiac disorders [2, 12]. These important issues are beyond
the scope of this chapter and are discussed in detail in other sections of this
publication.
With these issues in mind, the goal of this chapter is to delineate the key features
of the CV history and physical examination of the PPE.

Organization and Planning

A successful CV screening process is dependent upon planning. Organization

should begin several months in advance. Planning meetings should include team
physicians, team athletic training staff, coaching staff, and administrative staff (e.g.,
staff from the school, athletic department, and/or sport operations). Setting the date
for the PPE with the key stakeholders is the first order of business. The date will
need to consider the timing of the onset of the training and the travel schedules and
availability of the athletes. For PPEs that are intended to be performed for a group
of athletes at a set time, the availability of medical facilities should be confirmed.
Key consultants in cardiology and radiology should be identified and informed of
the dates of the screening, so that their availability for athletes potentially requiring
further evaluation can be established, which will then help expedite the process for
follow-up testing.
The organization process should also include the development of policies regard-
ing issues such as liability coverage (for physicians, athletic trainers, and any other
clinical staff), medical record documentation, and the use of chaperones. If an
online medical history questionnaire is being used, information technology staff
should ensure that the site is secure. Testing of the online process should be per-
formed to identify any technical issues so that they can be resolved in advance.
The personnel needed to perform the CV screening should be identified. In many
cases, especially at the collegiate and professional levels, the CV history and exam
are performed by designated team physicians who are board certified in a primary
specialty and also have completed fellowship training and are certified in sports
1 The Cardiovascular History and Examination 3

medicine. In other situations, it may be ideal for an athlete who has an ongoing
relationship with a personal physician to have that physician perform the screening
examination [1]. This may be the best approach for children and adolescents who
are participating in programs that do not have an identified team physician.
Cardiologists may be used to perform the screening CV history and exam, but they
are more commonly relied upon to evaluate concerning findings. In some cases, a
nurse practitioner or a physician assistant may perform the screening [1]. Regardless
of the certification of the clinician, it is critical that the individual performing the
CV history and exam has had clinical training in this component of the PPE, an
intimate knowledge of the nuances of CV screening in athletes, and the necessary
clinical experience to identify a potential concern in this population.
Once the screening date is set, the athletes (and if minors, their families) should
be notified well in advance. This will allow sufficient time to complete the CV his-
tory (especially if performed online) and obtain any pertinent documents related to
prior screening and/or records involving CV diagnoses and treatment. In cases
where athletes will have the PPE performed by a personal physician or provider, this
provides ample time to arrange the examination.
Finally, the planning should occur with the understanding that the history and/or
physical examination may raise suspicion for the presence of a cardiac condition
that then requires additional evaluation. In such cases, screening events that occur
immediately prior to the planned start of training could result in removal from par-
ticipation while further investigations are performed. To lessen the likelihood of an
athlete needing to be withheld from their training program for sports that have des-
ignated start periods (e.g., high school or collegiate sports), it is recommended that
exams occur several weeks prior to the anticipated start date for that sport. As men-
tioned above, communication with consultants in cardiology and radiology should
take place in advance so that they will be prepared to examine athletes who have had
a concern raised based upon the history and exam.

Setting and Implementation

If the PPE is conducted in a location other than the office of the athlete’s personal
physician, the organizers should arrange a setting that ensures privacy, is comfort-
able for the athletes, and is conducive to maximizing the ability to perform the
examination. For CV screening of groups of athletes from a school, program, or
team, securing the use of patient examination areas in a medical facility is ideal. An
individual exam room is preferred for reasons of privacy and the ability to have
quiet space for auscultation. The use of gymnasiums, auditoriums, locker rooms,
and other non-private areas is not recommended. Attempting to create a level of
separation within a large room by using a “pipe and drape” setup is likewise not
recommended.
In order to conduct a thorough exam, an appropriate amount of time should be
allocated for each athlete being screened. The amount of time needed to conduct an
4 J. DiFiori et al.

exam for an individual athlete, the total number of athletes needing to be screened
in a given time period, and the number of available examination rooms should be
determined in advance. This will indicate the number of examiners needed and the
total time required to perform a complete CV history and exam for a group of
athletes.
Other factors to consider include whether an online questionnaire was completed
in advance or a hard copy was completed on site. Online questionnaires must be
completed on a secure website, and then viewed within an electronic medical record,
or uploaded or printed and scanned to become part of the athlete’s official medical
record. If an online questionnaire or hard copy is to be completed on site, a private
space should be provided for the athlete to complete the document. In either case,
the athlete (or parent/guardian) must sign and date the questionnaire attesting to its
accuracy.
Although uncommon, an athlete (or his parent/guardian) may withhold or mis-
represent important medical information due to a concern that providing such infor-
mation could jeopardize medical clearance for sport participation. Thus, it is
important that the physician confirm that the acknowledgment is signed. In some
cases, an athlete may view the history and exam as an unnecessary burden or “rub-
ber stamp” process prior to the beginning of training. In these circumstances, an
athlete may choose to select negative responses throughout the questionnaire in
order to expedite the screening. This leads to substandard screening that could place
the athlete at risk. In order to recognize if an athlete is not reading and responding
to each question individually, and simply checking the “no column,” it may be help-
ful to embed a question that requires a positive response. An example of such a
question is “have you ever played a competitive sport?” Should the clinician feel
that the athlete is providing inaccurate information, they should proceed to perform
the history using a primary “interview” format, asking each question and clarifying
each response verbally.

Personal and Family History

A detailed history and physical examination have been the cornerstones of the pre-
participation evaluation of athletes in the United States for decades. However, given
the high degree of variability and lack of standardization of cardiovascular assess-
ment, the American Heart Association (AHA) convened an expert panel in 1996 to
make recommendations for a standardized process for this component of the prepar-
ticipation evaluation [14] with an updated review of the recommendations in 2007
and 2014 [2, 11]. The result of this work was the development of a 14-point evalu-
ation, which has now been widely embraced for the cardiovascular preparticipation
screening of athletes (Table 1.1).
Perhaps the most important component of this 14-point evaluation is the personal
and family history, since athletes with underlying yet undetected cardiovascular
disease may present with warning signs (e.g., syncope or chest pain during exercise)
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which formed a second exception to the precept of Augustus, was
about thirteen hundred miles in circumference,” i. 4. Speaking of
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lamented with a sigh that his advanced age scarcely left him any
hopes of equalling the renown of the son of Philip. Yet the success
of Trajan, however transient, was rapid and specious. The
degenerate Parthians, broken by intestine discord, fled before his
arms. He descended the river Tigris, in triumph, from the mountains
of Armenia to the Persian Gulf. He enjoyed the honour of being the
first, as he was the last, of the Roman generals who ever navigated
that remote sea. His fleets ravaged the coasts of Arabia; and Trajan
vainly flattered himself that he was approaching towards the
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intelligence of new names and new nations that acknowledged his
sway. They were informed that the kings of Bosphorus, Colchis,
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had accepted their diadems from the hand of the emperor; that the
independent tribes of the Median and Carduchian hills had implored
his protection; and that the rich countries of Armenia, Mesopotamia,
and Assyria were reduced into the state of provinces.” Of such a
reign what more appropriate symbol could there be than the horse
and the rider of the first seal? If Mr. Gibbon had been writing a
designed commentary on this, what more appropriate language
could he have used in illustration of it? The reign of Hadrian, the
successor of Trajan (A.D. 117‒138), was comparatively a reign of
peace—though one of his first acts was to lead an expedition into
Britain: but though comparatively a time of peace, it was a reign of
prosperity and triumph. Mr. Gibbon, in the following language, gives
a general characteristic of that reign:—“The life of [Hadrian] was
almost a perpetual journey; and as he possessed the various talents
of the soldier, the statesman, and the scholar, he gratified his
curiosity in the discharge of his duty. Careless of the difference of
seasons and of climates, he marched on foot, and bareheaded, over
the snows of Caledonia and the sultry plains of Upper Egypt; nor
was there a province of the empire which, in the course of his reign,
was not honoured with the presence of the monarch,” p. 5. On p. 6
Mr. Gibbon remarks of this period: “The Roman name was revered
amongst the remote nations of the earth. The fiercest barbarians
frequently submitted their differences to the arbitration of the
emperor; and we are informed by a contemporary historian that he
had seen ambassadors who were refused the honour which they
came to solicit, of being admitted into the rank of subjects.” And
again, speaking of the reign of Hadrian, Mr. Gibbon remarks (i. 45):
“Under his reign, as has been already mentioned, the empire
flourished in peace and prosperity. He encouraged the arts, reformed
the laws, asserted military discipline, and visited all the provinces in
person.” Hadrian was succeeded by the Antonines, Antoninus Pius
and Marcus Aurelius (the former from A.D. 138 to 161; the latter
from A.D. 161 to the accession of Commodus, A.D. 180). The general
character of their reigns is well known. It is thus stated by
Mr. Gibbon: “The two Antonines governed the world forty-two years
with the same invariable spirit of wisdom and virtue. Their united
reigns are possibly the only period of history in which the happiness
of a great people was the sole object of government,” i. 46. And
after describing the state of the empire in respect to its military and
naval character, its roads, and architecture, and constitution, and
laws, Mr. Gibbon sums up the whole description of this period in the
following remarkable words (vol. i. p. 47):—“If a man were called to
fix the period in the history of the world during which the condition
of the human race was most happy and prosperous, he would,
without hesitation, name that which elapsed from the death of
Domitian to the accession of Commodus. The vast extent of the
Roman empire was governed by absolute power, under the guidance
of virtue and wisdom. The armies were restrained by the firm but
gentle hands of four successive emperors, whose characters and
authority commanded involuntary respect. The forms of the civil
administration were carefully preserved by Nerva, Trajan, Hadrian,
and the Antonines, who delighted in the image of liberty, and were
pleased with considering themselves as the accountable ministers of
the laws. Such princes deserved the honour of restoring the republic,
had the Romans of their days been capable of enjoying a rational
freedom.” If it be supposed now that John designed to represent
this period of the world, could he have chosen a more expressive
and significant emblem of it than occurs in the horseman of the first
seal? If Mr. Gibbon had intended to prepare a commentary on it,
could he have shaped the facts of history so as better to furnish an
illustration?

(2) The particular things represented in the symbol. (a) The bow—
a symbol of war. Mr. Elliott has endeavoured to show that the bow at
that period was peculiarly the badge of the Cretians, and that Nerva,
who succeeded Domitian, was a Cretian by birth. The argument is
too long to be abridged here, but, if well founded, the fulfilment is
remarkable; for although the sword or the javelin was usually the
badge of the Roman emperor, if this were so there would be a
peculiar propriety in making the bow the badge during this period.
See Elliott, vol. i. pp. 133‒140. But whatever may be said of this, the
bow was so generally the badge of a warrior, that there would be no
impropriety in using it as a symbol of Roman victory. (b) The crown
—στέφανος—was, up to the time of Aurelian, A.D. 270 (see
Spanheim, p. 60), the distinguishing badge of the Roman emperor;
after that, the diadem, set with pearls and other jewels, was
adopted and worn. The crown, composed usually of laurel, was
properly the badge of the emperor considered as a military leader or
commander. See Elliott, i. 130. At the period now under
consideration the proper badge of the Roman emperor would be the
crown; after the time of Aurelian, it would have been the diadem. In
illustration of this, two engravings have been introduced, the first
representing the emperor Nerva with the crown, or στέφανος, the
second the emperor Valentinian, with the diadem.

Medal of the Emperor Nerva wearing Crown.

 Medal of the Emperor Valentinian wearing Diadem.
(c) The fact that the crown was given to the rider. It was common
among the Romans to represent an emperor in this manner; either
on medals, bas-reliefs, or triumphal arches. The emperor appears
going forth on horseback, and with Victory represented as either
crowning him, or as preceding him with a crown in her hand to
present to him. The engraving on p. 146, copied from one of the
bas-reliefs on a triumphal arch erected to Claudius Drusus on
occasion of his victories over the Germans, will furnish a good
illustration of this, and, indeed, is so similar to the symbol described
by John, that the one seems almost a copy of the other.
 Symbolic Bas-reliefs from a Roman Triumphal Arch.
Except that the bow is wanting, nothing could have a closer
resemblance; and the fact that such symbols were employed, and
were well understood by the Romans, may be admitted to be a
confirmation of the view above taken of the meaning of the first
seal. Indeed, so many things combine to confirm this, that it seems
impossible to be mistaken in regard to it: for if it should be supposed
that John lived after this time, and that he meant to furnish a
striking emblem of this period of Roman history, he could not have
employed a more significant and appropriate symbol than he has
done.
 3 And when he had opened the second seal,
I heard the second beast say, Come and see.
3. And when he had opened the second seal. So as to disclose
another portion of the volume. Notes, ch. v. 1. ¶ I heard the second
beast say. The second beast was like a calf or an ox. Notes, ch. iv. 7.
It cannot be supposed that there is any special significancy in the
fact that the second beast addressed the seer on the opening of the
second seal, or that, so far as the symbol was concerned, there was
any reason why this living creature should approach on the opening
of this seal rather than on either of the others. All that seems to be
designed is, that as the living creatures are intended to be emblems
of the providential government of God, it was proper to represent
that government as concerned in the opening of each of these four
seals, indicating important events among the nations. ¶ Come and
see. See Notes on ver. 1.

4 And there went out another horse that was

red: and power was given to him that sat
thereon to take peace from the earth, and that
they should kill one another: and there was
given unto him a great sword.
4. And there went out another horse. In this symbol there were,
as in the others, several particulars which it is proper to explain in
order that we may be able to understand its application. The
particular things in the symbol are the following: (a) The horse. See
this explained in the Notes on ver. 2. (b) The colour of the horse:
another horse that was red. This symbol cannot be mistaken. As the
white horse denoted prosperity, triumph, and happiness, so this
would denote carnage, discord, bloodshed. This is clear, not only
from the nature of the emblem, but from the explanation
immediately added: “And power was given to him that sat thereon to
take peace from the earth, and that they should kill one another.” On
the colour, compare Bochart, Hieroz. P. i. lib. ii. c. vii. p. 104. See
also Zec. i. 8. There is no possibility of mistaking this, that a time of
slaughter is denoted by this emblem. (c) The power given to him
that sat on the horse: and power was given to him that sat thereon
to take peace from the earth, and that they should kill one another.
This would seem to indicate that the condition immediately
preceding this was a condition of tranquillity, and that this was now
disturbed by some cause producing discord and bloodshed. This idea
is confirmed by the original words—τὴν εἰρήνην—“the peace;” that
is, the previously existing peace. When peace in general is referred
to, the word is used without the article: Mat. x. 34, “Think not that
I am come to send peace—βαλεῖν εἰρήνην—upon the earth.” Comp.
Lu. i. 79; ii. 14; xix. 38; Mar. v. 34; Jn. xiv. 27; xvi. 33; Ac. vii. 26;
ix. 31, et al. in the Greek. In these cases the word peace is without
the article. The characteristics of the period referred to by this are:
(a) that peace and tranquillity existed before; (b) that such peace
and tranquillity were now taken away, and were succeeded by
confusion and bloodshed; and (c) that the particular form of that
confusion was civil discord, producing mutual slaughter: “that they
should kill one another.” (d) The presentation of a sword: and there
was given unto him a great sword. As an emblem of what he was to
do, or of the period that was referred to by the opening of the seal.
The sword is an emblem of war, of slaughter, of authority (Ro.
xiii. 4), and is here used as signifying that that period would be
characterized by carnage. Comp. Is. xxxiv. 5; Re. xix. 17, 18; Le.
xxvi. 25; Ge. xxvii. 40; Mat. x. 34; xxvi. 52. It is not said by whom
the sword was presented, but the fact is merely referred to, that the
rider was presented with a sword as a symbol of what would occur.

In inquiring now into the period referred to by this symbol, we

naturally look to that which immediately succeeded the one which
was represented by the opening of the first seal; that is, the period
which followed the accession of Commodus, A.D. 180. We shall find,
in the events which succeeded his accession to the empire, a state
of things which remarkably accords with the account given by John
in this emblem—so much so, that if it were supposed that the book
was written after these events had occurred, and that John had
designed to represent them by this symbol, he could not have
selected a more appropriate emblem. The only authority which it is
necessary to refer to here is Mr. Gibbon; who, as before remarked,
seems to have been raised up by a special Providence to make a
record of those events which were referred to by some of the most
remarkable prophecies in the Bible. As he had the highest
qualifications for an historian, his statements may be relied on as
accurate; and as he had no belief in the inspiration of the prophetic
records, his testimony will not be charged with partiality in their
favour. The following particulars, therefore, will furnish a full
illustration of the opening of the second seal: (a) The previous state
of peace. This is implied in the expression, “and power was given to
him to take peace from the earth.” Of this we have had a full
confirmation in the peaceful reign of Hadrian and the Antonines. See
the Notes on the exposition of the first seal. Mr. Gibbon, speaking of
the accession of Commodus to the imperial throne, says that he
“had nothing to wish, and everything to enjoy. The beloved son of
Marcus [Commodus] succeeded his father amidst the acclamations
of the senate and armies; and when he ascended the throne, the
happy youth saw around him neither competitor to remove, nor
enemies to punish. In this calm elevated station, it was surely
natural that he should prefer the love of mankind to their
detestation; the mild glories of his five predecessors to the
ignominious fate of Nero and Domitian,” i. 51. So again, on the same
page, he says of Commodus, “His graceful person, popular address,
and imagined virtues attracted the public favour; the honourable
peace which he had recently granted to the barbarians diffused an
universal joy.” No one can doubt that the accession of Commodus
was preceded by a remarkable prevalence of peace and prosperity.
(b) Civil war and bloodshed: to take peace from the earth, and that
they should kill one another. Of the applicability of this to the time
supposed to be represented by this seal, we have the fullest
confirmation in the series of civil wars commencing with the
assassination of the emperor Commodus, A.D. 193, and continued,
with scarcely any intervals of intermission, for eighty or ninety years.
So Sismondi, on the fall of the Roman empire (i. 36), says, “With
Commodus’ death commenced the third and most calamitous period.
It lasted ninety-two years, from 193 to 284. During that time, thirty-
two emperors, and twenty-seven pretenders to the empire,
alternately hurried each other from the throne, by incessant civil
warfare. Ninety-two years of almost incessant civil warfare taught
the world on what a frail foundation the virtue of the Antonines had
reared the felicity of the empire.” The full history of this period may
be seen in Gibbon, i. pp. 50‒197. Of course it is impossible in these
Notes to present anything like a complete account of the
characteristics of those times. Yet the briefest summary may well
show the general condition of the Roman empire then, and the
propriety of representing it by the symbol of a red horse, as a period
when peace would be taken from the earth, and when men would
kill one another. Commodus himself is represented by Mr. Gibbon in
the following words:—“Commodus was not, as he has been
represented, a tiger, born with an insatiate thirst of human blood,
and capable, from his infancy, of the most inhuman actions. Nature
had formed him of a weak, rather than a wicked disposition. His
simplicity and timidity rendered him the slave of his attendants, who
gradually corrupted his mind. His cruelty, which at first obeyed the
dictates of others, degenerated into habit, and at length became the
ruling passion of his soul,” i. 51. During the first three years of his
reign “his hands were yet unstained with blood” (Ibid.), but he soon
degenerated into a most severe and bloody tyrant, and “when
Commodus had once tasted human blood, he was incapable of pity
or remorse,” i. 52. “The tyrant’s rage,” says Mr. Gibbon (i. 52), “after
having shed the noblest blood of the senate, at length recoiled on
the principal instrument of his cruelty. While Commodus was
immersed in blood and luxury he devolved the detail of public
business on Perennis, a servile and ambitious minister, who had
obtained his post by the murder of his predecessor,” &c. “Every
sentiment of virtue and humanity was extinct in the mind of
Commodus,” i. 55. After detailing the history of his crimes, his follies,
and his cruelties, Mr. Gibbon remarks of him: “His cruelty proved at
last fatal to himself. He had shed with impunity the best blood of
Rome: he perished as soon as he was dreaded by his own
domestics. Marcia, his favourite concubine, Eclectus, his
chamberlain, and Lætus, his pretorian prefect, alarmed by the fate
of their companions and predecessors, resolved to prevent the
destruction which every hour hung over their heads, either from the
mad caprice of the tyrant, or the sudden indignation of the people.
Marcia seized the occasion of presenting a draught of wine to her
lover, after he had fatigued himself with hunting some wild beasts.
Commodus retired to sleep; but while he was labouring with the
effects of poison and drunkenness, a robust youth, by profession a
wrestler, entered his chamber, and strangled him without resistance,”
i. 57. The immediate consequence of the assassination of Commodus
was the elevation of Pertinax to the throne, and his murder eighty-
six days after (Decline and Fall, i. 60). Then followed the public
setting-up of the empire to sale by the pretorian guards, and its
purchase by a wealthy Roman senator, Didius Julianus, or Julian,
who, “on the throne of the world, found himself without a friend and
without an adherent,” i. 63. “The streets and public places in Rome
resounded with clamours and imprecations.” “The public discontent
was soon diffused from the centre to the frontiers of the empire,”
i. 63. In the midst of this universal indignation Septimius Severus,
who then commanded the army in the neighbourhood of the
Danube, resolved to avenge the death of Pertinax, and to seize upon
the imperial crown. He marched to Rome, overcame the feeble
Julian, and placed himself on the throne. Julian, after having reigned
sixty-six days, was beheaded in a private apartment of the baths of
the palace, i. 67. “In less than four years Severus subdued the riches
of the East, and the valour of the West. He vanquished two
competitors of reputation and ability, and defeated numerous armies
provided with weapons and discipline equal to his own,” i. 68.
Mr. Gibbon then enters into a detail of “the two civil wars against
Niger and Albinus”—rival competitors for the empire (i. 68‒70), both
of whom were vanquished, and both of whom were put to death “in
their flight from the field of battle.” Yet he says, “Although the
wounds of civil war were apparently healed, its mortal poison still
lurked in the vitals of the constitution,” i. 71. After the death of
Severus, then follows an account of the contentions between his
sons, Geta and Caracalla, and of the death of the former by the
instigation of the latter (i. 77); then of the remorse of Caracalla, in
which it is said that “his disordered fancy often beheld the angry
forms of his father and his brother rising into life to threaten and
upbraid him” (i. 77); then of the cruelties which Caracalla inflicted on
the friends of Geta, in which “it was computed that, under the vague
appellation of the friends of Geta, above twenty thousand persons of
both sexes suffered death” (i. 78); then of the departure of Caracalla
from the capital, and his cruelties in other parts of the empire,
concerning which Mr. Gibbon remarks (i. 78, 79), that “Caracalla was
the common enemy of mankind. Every province was by turns the
scene of his rapine and cruelty. In the midst of peace and repose,
upon the slightest provocation, he issued his commands at
Alexandria in Egypt for a general massacre. From a secure post in
the temple of Serapis he viewed and directed the slaughter of many
thousand citizens, as well as strangers, without distinguishing either
the number or the crime of the sufferers,” &c. Then follows the
account of the assassination of Caracalla (i. 80); then, and in
consequence of that, of the civil war which crushed Macrinus, and
raised Elagabalus to the throne (i. 83); then of the life and follies of
that wretched voluptuary, and of his massacre by the pretorian
guards (i. 86); then, after an interval of thirteen years, of the
murder of his successor, the second Severus, on the Rhine; then of
the civil wars excited against his murderer and successor, Maximin,
in which the two emperors of a day—the Gordians, father and son—
perished in Africa, and Maximin himself, and his son, in the siege of
Aquileia; then of the murder at Rome of the two joint emperors,
Maximus and Balbinus; and quickly after that an account of the
murder of their successor in the empire, the third and youngest
Gordian, on the banks of the river Aboras; then of the slaughter of
the next emperor Philip, together with his son and associate in the
empire, in the battle near Verona:—and this state of things may be
said to have continued until the accession of Diocletian to the
empire, A.D. 284. See Decline and Fall, i. 110‒197. Does any portion
of the history of the world present a similar period of connected
history that would be so striking a fulfilment of the symbols used
here of “peace being taken from the earth,” and “men killing one
another?” In regard to this whole period it is sufficient, after reading
Mr. Gibbon’s account, to ask two questions: (1) If it were supposed
that John lived after this period, and designed to represent this by
an expressive symbol, could he have found one that would have
characterized it better than this does? (2) And if it should be
supposed that Mr. Gibbon designed to write a commentary on this
“seal,” and to show the exact fulfilment of the symbol, could he have
selected a better portion of history to do it, or could he have better
described facts that would be a complete fulfilment? It is only
necessary to observe further, (c) that this is a marked and definite
period. It has such a beginning, and such a continuance and ending,
as to show that this symbol was applicable to this as a period of the
world. For it was not only preceded by a state of peace, as is
supposed in the symbol, but no one can deny that the condition of
things in the empire, from Commodus onward through many years,
was such as to be appropriately designated by the symbol here
used.

5 And when he had opened the third seal,

I heard the third beast say, Come and see. And
I beheld, and lo, a black horse; and he that sat
on him had a pair of balances in his hand.

6 And I heard a voice in the midst of the four

beasts say, 217A measure of wheat for a penny,
 and three measures of barley for a penny; and
see thou 218hurt not the oil and the wine.
5, 6. And when he had opened the third seal.. Unfolding another
portion of the volume. See Notes on ch. v. 1. ¶ I heard the third
beast say, Come and see. See Notes on ch. iv. 7. It is not apparent
why the third beast is represented as taking a particular interest in
the opening of this seal (comp. Notes on ver. 3), nor is it necessary
to show why it was so. The general design seems to have been, to
represent each one of the four living creatures as interested in the
opening of the seals, but the order in which they did this does not
seem to be a matter of importance. ¶ And I beheld, and lo, a black
horse. The specifications of the symbol here are the following: (a) As
before, the horse. See Notes on ver. 2. (b) The colour of the horse:
lo, a black horse. This would properly denote distress and calamity—
for black has been regarded always as such a symbol. So Virgil
speaks of fear as black: “atrumque timorem” (Æn. ix. 619). So
again, Georg. iv. 468:

“Caligantem nigra formidine lucum.”

So, as applied to the dying Acca, Æn. xi. 825:

“Tenebris nigrescunt omnia circum.”

Black, in the Scriptures, is the image of fear, of famine, of death. La.

v. 10: “Our skin was black like an oven, because of the terrible
famine.” Je. xiv. 2: “Because of the drought Judah mourneth, and
the gates thereof languish; they are in deep mourning [literally,
black] for the land.” Joel ii. 6: “All faces shall gather blackness.” Na.
ii. 10: “The knees smite together, and there is great pain in all loins,
and the faces of them all gather blackness.” Comp. Re. vi. 12; Eze.
xxxii. 7. See also Bochart, Hieroz. P. i. lib. ii. c. vii. pp. 106, 107.
From the colour of the horse here introduced we should naturally
look for some dire calamity, though the nature of the calamity would
not be designated by the mere use of the word black. What the
calamity was to be must be determined by what follows in the
symbol. Famine, pestilence, oppression, heavy taxation, tyranny,
invasion—any of these might be denoted by the colour of the horse.
(c) The balances: and he that sat on him had a pair of balances in
his hand. The original word here rendered a pair of balances, is
ζυγὸν. This word properly means a yoke, serving to couple anything
together, as a yoke for cattle. Hence it is used to denote the beam of
a balance, or of a pair of scales—and is evidently so used here. The
idea is, that something was to be weighed, in order to ascertain
either its quantity or its value. Scales or balances are the emblems of
justice or equity (comp. Job xxxi. 6; Ps. lxii. 9; Pr. xi. 1; xvi. 11); and
when joined with symbols that denote the sale of corn and fruit by
weight, become the symbol of scarcity. Thus “bread by weight” (Le.
xxvi. 26) denotes scarcity. So in Eze. iv. 16, “And they shall eat bread
by weight.” The use of balances here as a symbol would signify that
something was to be accurately and carefully weighed out. The
connection leads us to suppose that this would appertain to the
necessaries of life, and that it would occur either in consequence of
scarcity, or because there would be an accurate or severe exaction,
as in collecting a revenue on these articles. The balance was
commonly the symbol of equity and justice; but it was also,
sometimes, the symbol of exaction and oppression, as in Ho. xii. 7:
“The balance of deceit is in his hands; he loveth to oppress.” If the
balances stood alone, and there were no proclamation as to what
was to occur, we should look, under this seal, to a time of the exact
administration of justice, as scales or balances are now used as
emblems of the rigid application of the laws and of the principles of
justice in courts, or in public affairs. If this representation stood
alone, or if the black horse and the scales constituted the whole of
the symbol, we should look for some severe administration, or
perhaps some heavy calamity under a rigorous administration of
laws. The reference, however, to the “wheat and barley,” and to the
price for which they were to be weighed out, serves still further to
limit and define the meaning of the symbol as having reference to
the necessaries of life—to the productions of the land—to the actual
capital of the country. Whether this refers to scarcity, or to taxation,
or both, must be determined by the other parts of the symbol.
(d) The proclamation: And I heard a voice in the midst of the four
beasts say. That is, from the throne, ch. iv. 6. The voice was not that
of one of the four beasts, but it seemed to come from among them.
As the rider went forth, this was the proclamation that was made in
regard to him; or this is that which is symbolized in his going forth,
to wit, that there would be such a state of things that a measure of
wheat would be sold for a penny, &c. The proclamation consists
essentially of two things—that which refers to the price or value of
wheat and barley, and that which requires that care shall be taken
not to injure the oil and the wine. Each of these demands
explanation. ¶ A measure of wheat for a penny. See the margin. The
word rendered measure—χοῖνιξ, chœnix—denotes an Attic measure
for grain and things dry, equal to the forty-eighth part of the Attic
medimnus, or the eighth part of the Roman modius, and
consequently was nearly equivalent to one quart English (Rob. Lex.).
The word rendered penny, δηνάριον—Lat. denarius—was of the
same value as the Greek δραχμή, drachmē, and was equivalent to
about fourteen cents or sevenpence. This was the usual price of a
day’s labour, Mat. xx. 2, 9. The chœnix, or measure of grain here
referred to, was the ordinary daily allowance for one man [Odyss.,
xix. 27, 28). See Stuart, in loco. The common price of the Attic
medimnus of wheat was five or six denarii; but here, as that
contained forty-eight chœnixes or quarts, the price would be
augmented to forty-eight denarii—or it would be about eight times
as dear as ordinary; that is, there would be a scarcity or famine. The
price of a bushel of wheat at this rate would be about four dollars
and a half or 18 shillings—a price which would indicate great
scarcity, and which would give rise to much distress. ¶ And three
measures of barley for a penny. It would seem from this that barley
usually bore about one-third the price of wheat. It was a less
valuable grain, and perhaps was produced in greater abundance.
This is not far from the proportion which the price of this grain
usually bears to that of wheat, and here, as in the case of the
wheat, the thing which would be indicated would be scarcity. This
proclamation of “a measure of wheat for a penny” was heard either
as addressed to the horseman, as a rule of action for him, or as
addressed by the horseman as he went forth. If the former is the
meaning, it would be an appropriate address to one who was going
forth to collect tribute—with reference to the exact manner in which
this tribute was to be collected, implying some sort of severity of
exaction; or to one who should distribute wheat and barley out of
the public granaries at an advanced price, indicating scarcity. Thus it
would mean that a severe and heavy tax—represented by the scales
and the scarcity—or a tax so severe as to make grain dear, was
referred to. If the latter is the meaning, then the idea is that there
would be a scarcity, and that grain would be dealt out by the
government at a high and oppressive price. The latter idea would be
as consonant with the symbol of the scales and the price mentioned
as the other, if it were not for the additional injunction not to “hurt
the oil and the wine”—which cannot be well applied to the idea of
dealing out grain at a high price. It can, however, be connected, by a
fair interpretation of that passage, with such a severity of taxation
that there would be a propriety in such a command—for, as we shall
see, under the explanation of that phrase, such a law was actually
promulgated as resulting from severity of taxation. The idea, then, in
the passage before us, would seem to be, (a) that there would be a
rigid administration of the law in regard to the matter under
consideration—that pertaining to the productions of the earth—
represented by the balances; and (b) that that would be connected
with general scarcity, or such an exercise of this power as to
determine the price of grain, so that the price would be some three
times greater than ordinary. ¶ And see thou hurt not the oil and the
wine. There has been a great variety of interpretations proposed of
this passage, and it is by no means easy to determine the true
sense. The first inquiry in regard to it is, to whom is it addressed?
Perhaps the most common impression on reading it would be, that it
is addressed to the horseman with the balances, commanding him
not to injure the oliveyards and the vineyards. But this is not
probably the correct view. It does not appear that the horseman
goes forth to destroy anything, or that the effect of his going forth is
directly to injure anything. This, therefore, should not be understood
as addressed to the horseman, but should be regarded as a general
command to any and all not to injure the oliveyards and vineyards;
that is, an order that nothing should be done essentially to injure
them. If thus regarded as addressed to others, a fair and congruous
meaning would be furnished by either of the following
interpretations: either (a) considered as addressed to those who
were disposed to be prodigal in their manner of living, or careless as
to the destruction of the crop of the oil and wine, as they would now
be needed; or (b) as addressed to those who raised such
productions, on the supposition that they would be taxed heavily, or
that large quantities of these productions would be extorted for
revenue, that they should not mutilate their fruit-trees in order to
evade the taxes imposed by the government. In regard to the things
specified here—oil and wine—it may be remarked, that they were
hardly considered as articles of luxury in ancient times. They were
almost as necessary articles as wheat and barley. They constituted a
considerable part of the food and drink of the people, as well as
furnished a large portion of the revenue, and it would seem to be
with reference to that fact that the command here is given that they
should not be injured; that is, that nothing should be done to
diminish the quantity of oil and wine, or to impair the productive
power of oliveyards and vineyards. The state of things thus
described by this seal, as thus interpreted, would be, (a) a rigid
administration of the laws of the empire, particularly in reference to
taxation, producing a scarcity among the necessary articles of living;
(b) a strong tendency, from the severity of the taxation, to mutilate
such kinds of property, with a view either of concealing the real
amount of property, or of diminishing the amount of taxes; and (c) a
solemn command from some authoritative quarter not to do this.
A command from the ruling power not to do this would meet all that
would be fairly demanded in the interpretation of the passage; and
what is necessary in its application, is to find such a state of things
as would correspond with these predictions; that is, such as a writer
would have described by such symbols on the supposition that they
were referred to.
 Now it so happens that there were important events which
occurred in the Roman empire, and connected with its decline and
fall, of sufficient importance to be noticed in a series of calamitous
events, which corresponded with the symbol here, as above
explained. They were such as these: (a) The general severity of
taxation, or the oppressive burdens laid on the people by the
emperors. In the account which Mr. Gibbon gives of the operation of
the Indictions, and Superindictions, though the specific laws on this
subject pertained to a subsequent period, the general nature of the
taxation of the empire and its oppressive character may be seen
(Decline and Fall, i. 357‒359). A general estimate of the amount of
revenue to be exacted was made out, and the collecting of this was
committed to the pretorian prefects, and to a great number of
subordinate officers. “The lands were measured by surveyors who
were sent into the provinces; their nature, whether arable, or
pasture, or woods, was distinctly reported; and an estimate made of
their common value, from the average produce of five years. The
number of slaves and of cattle constituted an essential part of the
report; an oath was administered to the proprietors, which bound
them to disclose the true state of their affairs; and their attempts to
prevaricate or elude the intention of the legislature were severely
watched, and punished as a capital crime, which included the double
guilt of treason and of sacrilege. According to the different nature of
lands, their real produce in the various articles of wine or oil, corn or
barley, wood or iron, was transported by the labour or at the
expense of the provincials to the imperial magazines, from whence
they were occasionally distributed for the use of the court or of the
army, and of the two capitals, Rome and Constantinople,” i. p. 358.
Comp. Lactant. de Mort. Persecut., c. 23. (b) The particular order,
under this oppressive system of taxation, respecting the preservation
of vineyards and oliveyards, may be referred to, also, as
corresponding to the command sent forth under this rider, not to
“hurt the oil and the wine.” That order was in the following words:
—“If any one shall sacrilegiously cut a vine, or stint the fruit of
prolific boughs, and craftily feign poverty in order to avoid a fair
assessment, he shall, immediately on detection, suffer death, and
his property be confiscated” (Cod. Theod. l. xiii. lib. xi. seq.; Gibbon,
i. 358, note). Mr. Gibbon remarks: “Although this law is not without
its studied obscurity, it is, however, clear enough to prove the
minuteness of the inquisition, and the disproportion of the penalty.”
(c) Under this general subject of the severity of taxation—as a fact
far-spreading and oppressive, and as so important as to hasten the
downfall of the empire, may be noticed a distinct edict of Caracalla
as occurring more directly in the period in which the rider with the
balances may be supposed to have gone forth. This is stated by
Mr. Gibbon (i. 91) as one of the important causes which contributed
to the downfall of the empire. “The personal characters of the
emperors, their victories, laws, and fortunes,” says he, “can interest
us no farther than they are connected with the general history of the
decline and fall of the monarchy. Our constant attention to that
object will not suffer us to overlook a most important edict of
Antoninus Caracalla, which communicated to all the free inhabitants
of the empire the name and privileges of Roman citizens. His
unbounded liberality, however, flowed not from the sentiments of a
generous mind; it was the sordid result of avarice,” &c. He then
proceeds at length to state the nature and operations of that law, by
which a heavy tax, under the pretence of liberality, was in fact
imposed on all the citizens of the empire—a fact which, in its
ultimate results, the historian of the Decline and Fall regards as so
closely connected with the termination of the empire. See Gibbon, i.
pp. 91‒95. After noticing the laws of Augustus, Nero, and the
Antonines, and the real privileges conferred by them on those who
became entitled to the rank of Roman citizens—privileges which
were a compensation in the honour, dignity, and offices of that rank
for the measure of taxation which it involved—he proceeds to notice
the fact that the title of “Roman citizen” was conferred by Caracalla
on all the free citizens of the empire, involving the subjection to all
the heavy taxes usually imposed on those who sustained the rank
expressed by the title, but with nothing of the compensation
connected with the title when it was confined to the inhabitants of
Italy. “But the favour,” says he, “which implied a distinction, was lost
in the prodigality of Caracalla, and the reluctant provincials were
compelled to assume the vain title, and the real obligations, of
Roman citizens. Nor was the rapacious son of Severus [Caracalla]
contented with such a measure of taxation as had appeared
sufficient to his moderate predecessors. Instead of a twentieth, he
exacted a tenth of all legacies and inheritances; and during his reign
he crushed alike every part of the empire under the weight of his
iron sceptre,” i. 95. So again (Ibid.), speaking of the taxes which had
been lightened somewhat by Alexander, Mr. Gibbon remarks: “It is
impossible to conjecture the motive that engaged him to spare so
trifling a remnant of the evil; but the noxious weed, which had not
been totally eradicated, again sprung up with the most luxuriant
growth, and in the succeeding age darkened the Roman world with
its deadly shade. In the course of this history we shall be too often
summoned to explain the land-tax, the capitation, and the heavy
contributions of corn, wine, oil, and meat, which were exacted from
the provinces for the use of the court, the army, and the capital.” In
reference to this whole matter of taxation as being one of the things
which contributed to the downfall of the empire, and which spread
woe through the falling empire—a woe worthy to be illustrated by
one of the seals—a confirmation may be derived from the reign of
Galerius, who, as Cæsar, acted under the authority of Diocletian;
who excited Diocletian to the work of persecution (Decline and Fall,
i. 317, 318); and who, on the abdication of Diocletian, assumed the
title of Augustus (Decline and Fall, i. 222). Of his administration in
general Mr. Gibbon (i. 226) remarks: “About that time the avarice of
Galerius, or perhaps the exigencies of the state, had induced him to
make a very strict and rigorous inquisition into the property of his
subjects for the purpose of a general taxation, both on their lands
and on their persons. A very minute survey appears to have been
taken of their real estates; and wherever there was the slightest
suspicion of concealment, torture was very freely employed to obtain
a sincere declaration of their personal wealth.” Of the nature of this
exaction under Galerius; of the cruelty with which the measure was
prosecuted—particularly in its bearing on Christians, towards whom
Galerius cherished a mortal enmity (Decline and Fall, i. 317); and of
the extent and severity of the suffering among Christians and others,
caused by it—the following account of Lactantius (De Mort.
Persecut., c. 23) will furnish a painful but most appropriate
illustration:—“Swarms of exactors sent into the provinces and cities
filled them with agitation and terror, as though a conquering enemy
were leading them into captivity. The fields were separately
measured, the trees and vines, the flocks and herds numbered, and
an examination made of the men. In the cities the cultivated and
rude were united as of the same rank. The streets were crowded
with groups of families, and every one required to appear with his
children and slaves. Tortures and lashes resounded on every side.
Sons were gibbeted in the presence of their parents, and the most
confidential servants harassed that they might make disclosures
against their masters, and wives that they might testify unfavourably
of their husbands. If there were a total destitution of property, they
were still tortured to make acknowledgments against themselves,
and, when overcome by pain, inscribed for what they did not
possess. Neither age nor ill-health was admitted as an excuse for not
appearing. The sick and weak were borne to the place of inscription,
a reckoning made of the age of each, and years added to the young
and deducted from the old, in order to subject them to a higher
taxation than the law imposed. The whole scene was filled with
wailing and sadness. In the meantime individuals died, and the
herds and the flocks diminished, yet tribute was none the less
required to be paid for the dead, so that it was no longer allowed
either to live or die without a tax. Mendicants alone escaped, where
nothing could be wrenched, and whom misfortune and misery had
made incapable of farther oppression. These the impious wretch
affecting to pity, that they might not suffer want, ordered to be
assembled, borne off in vessels, and plunged into the sea.” See Lord
on the Apoc., pp. 128, 129. These facts in regard to the severity of
taxation, and the rigid nature of the law enforcing it; to the sources
of the révenue exacted in the provinces, and to the care that none
of those sources should be diminished; and to the actual and
undoubted bearing of all this on the decline and fall of the empire,
are so strikingly applicable to the symbol here employed, that if it be
supposed that it was intended to refer to them, no more natural or
expressive symbol could have been used; if it were supposed that
the historian meant to make a record of the fulfilment, he could not
well have made a search which would more strikingly accord with
the symbol. Were we now to represent these things by a symbol, we
could scarcely find one that would be more expressive than that of a
rider on a black horse with a pair of scales, sent forth under a
proclamation which indicated that there would be a most rigid and
exact administration of severe and oppressive laws, and with a
special command, addressed to the people, not for the purposes of
concealment, or from opposition to the government, to injure the
sources of revenue. It may serve further to illustrate this, to copy
one of the usual emblems of a Roman procurator or questor. It is
taken from Spanheim, De Usu Num. Diss., vi. 545. See Elliott, i. 169.
It has a balance as a symbol of exactness or justice, and an ear of
grain as a symbol employed with reference to procuring or exacting
grain from the provinces.

Emblem of a Roman Procurator.

 7 And when he had opened the fourth seal,
I heard the voice of the fourth beast say, Come
and see.
7. And when he had opened the fourth seal. See Notes, ch. v. 1.
¶ I heard the voice of the fourth beast say. The flying eagle. Notes,
ch. iv. 7. As in the other cases, there does not appear to have been
any particular reason why the fourth of the living creatures should
have made this proclamation rather than either of the others. It was
poetic and appropriate to represent each one in his turn as making
proclamation. ¶ Come and see. See Notes, ver. 1.
 8 And I looked, and behold a pale horse; and
his name that sat on him was Death, and Hell
followed with him. And power was given 219unto
them over the fourth part of the earth, to kill
220
with sword, and with hunger, and with death,
and with the beasts of the earth.
8. And I looked, and behold a pale horse—ἵππος χλωρὸς. On the
horse, as an emblem, see Notes on ver. 2. The peculiarity of this
emblem consists in the colour of the horse, the rider, and the power
that was given unto him. In these there is entire harmony, and there
can be comparatively little difficulty in the explanation and
application. The colour of the horse was pale—χλωρὸς. This word
properly means pale-green, yellowish-green, like the colour of the
first shoots of grass and herbage; then green, verdant, like young
herbage, Mar. vi. 39; Re. viii. 7; ix. 4; and then pale yellowish (Rob.
Lex.). The colour here would be an appropriate one to denote the
reign of death—as one of the most striking effects of death is
paleness—and, of course, of death produced by any cause, famine,
pestilence, or the sword. From this portion of the symbol, if it stood
with nothing to limit and define it, we should naturally look for some
condition of things in which death would prevail in a remarkable
manner, or in which multitudes of human beings would be swept
away. And yet, perhaps, from the very nature of this part of the
symbol, we should look for the prevalence of death in some such
peaceful manner as by famine or disease. The red colour would
more naturally denote the ravages of death in war; the black, the
ravages of death by sudden calamity; the pale would more obviously
suggest famine or wasting disease. ¶ And his name that sat on him
was Death. No description is given of his aspect; nor does he appear
with any emblem—as sword, or spear, or bow. There is evident
scope for the fancy to picture to itself the form of the destroyer; and
there is just that kind of obscurity about it which contributes to
sublimity. Accordingly, there has been ample room for the exercise of
the imagination in the attempts to paint “Death on the pale horse,”
and the opening of this seal has furnished occasion for some of the
greatest triumphs of the pencil. The simple idea in this portion of the
symbol is, that death would reign or prevail under the opening of
this seal—whether by sword, by famine, or by pestilence, is to be
determined by other descriptions in the symbol. ¶ And Hell followed
with him. Attended him as he went forth. On the meaning of the
word here rendered hell—ᾅδης, hades—see Notes on Lu. xvi. 23,
comp. Notes on Job x. 21, 22; Is. xiv. 9. It is here used to denote
the abode of the dead, considered as a place where they dwell, and
not in the more restricted sense in which the word is now commonly
used as a place of punishment. The idea is, that the dead would be
so numerous at the going forth of this horseman, that it would seem
as if the pale nations of the dead had come again upon the earth.
A vast retinue of the dead would accompany him; that is, it would be
a time when death would prevail on the earth, or when multitudes
would die. ¶ And power was given unto them. Marg., to him. The
common Greek text is αὐτοῖς—to them. There are many MSS.,
however, which read αὐτῷ—to him. So Professor Stuart reads it. The
authority, however, is in favour of them as the reading; and
according to this, death and his train are regarded as grouped
together, and the power is considered as given to them collectively.
The sense is not materially varied. ¶ Over the fourth part of the
earth. That is, of the Roman world. It is not absolutely necessary to
understand this as extending over precisely a fourth part of the
world. Comp. Re. viii. 7‒10, 12; ix. 15, et al. Undoubtedly we are to
look in the fulfilment of this to some far-spread calamity; to some
severe visitations which would sweep off great multitudes of men.
The nature of that visitation is designated in the following
specifications. ¶ To kill with sword. In war and discord—and we are,
therefore, to look to a period of war. ¶ And with hunger. With famine
—one of the accompaniments of war—where armies ravage a
nation, trampling down the crops of grain; consuming the provisions
laid up; employing in war, or cutting off, the men who would be
occupied in cultivating the ground; making it necessary that they
should take the field at a time when the grain should be sown or the
harvest collected; and shutting up the people in besieged cities to
perish by hunger. Famine has been not an unfrequent
accompaniment of war; and we are to look for the fulfilment of this
in its extensive prevalence. ¶ And with death. Each of the other
forms—“with the sword and with hunger”—imply that death would
reign; for it is said that “power was given to kill with sword and with
hunger.” This word, then, must refer to death in some other form—
to death that seemed to reign without any such visible cause as the
“sword” and “hunger.” This would well denote the pestilence—not an
unfrequent accompaniment of war. For nothing is better fitted to
produce this than the unburied bodies of the slain; the filth of a
camp; the want of food; and the crowding together of multitudes in
a besieged city; and, accordingly, the pestilence, especially in
Oriental countries, has been often closely connected with war. That
the pestilence is referred to here is rendered more certain by the
fact that the Hebrew word ‫ֶּד ֶבר‬, pestilence, which occurs about fifty
times in the Old Testament, is rendered θάνατος, death, more than
thirty times in the Septuagint. ¶ And with the beasts of the earth.
With wild beasts. This, too, would be one of the consequences of
war, famine, and pestilence. Lands would be depopulated, and wild
beasts would be multiplied. Nothing more is necessary to make them
formidable than a prevalence of these things; and nothing, in the
early stages of society, or in countries ravaged by war, famine, and
the pestilence, is more formidable. Homer, at the very beginning of
his Iliad, presents us with a representation similar to this. Comp.
Eze. xiv. 21: “I send my four sore judgments upon Jerusalem, the
sword, and the famine, and the noisome beast, and the pestilence,”
‫—ֶד ֶבר‬Sept., as here, θάνατον. See also 2 Ki. xvii. 26.

In regard to the fulfilment of this there can be little difficulty, if the

principles adopted in the interpretation of the first three seals are
correct. We may turn to Gibbon, and, as in the other cases, we shall
find that he has been an unconscious witness of the fidelity of the
representation in this seal. Two general remarks may be made