Wednesday, 11 April 2012


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History is dotted with epidemics and plagues, but a certain number of them stand out as unique for their severity and impact on future generations. This is a list of the worst plagues in man’s recorded history.

1. Smallpox (430 BC? - 1979)

Smallpox killed more than 300 million people worldwide in the 20th century alone, and most of the native inhabitants of the Americas.

Smallpox (also known by the Latin names Variola or Variola vera) is a contagious disease unique to humans. Smallpox is caused by either of two virus variants named Variola major and Variola minor. The deadlier form, V. major, has a mortality rate of 30–35%, while V. minor causes a milder form of disease called alastrim and kills ~1% of its victims. Long-term side-effects for survivors include the characteristic skin scars. Occasional side effects include blindness due to corneal ulcerations and infertility in male survivors.

Smallpox killed an estimated 60 million Europeans, including five reigning European monarchs, in the 18th century alone. Up to 30% of those infected, including 80% of the children under 5 years of age, died from the disease, and one third of the survivors became blind.

As for the Americas, after the first contacts with Europeans and Africans, some believe that the death of 90 to 95 percent of the native population of the New World was caused by Old World diseases. It is suspected that smallpox was the chief culprit and responsible for killing nearly all of the native inhabitants of the Americas. In Mexico, when the Aztecs rose up in rebellion against Cortés, outnumbered, the Spanish were forced to flee. In the fighting, a Spanish soldier carrying smallpox died. After the battle, the Aztecs contracted the virus from the invaders' bodies. When Cortes returned to the capital, smallpox had devastated the Aztec population. It killed most of the Aztec army, the emperor, and 25% of the overall population. Cortés then easily defeated the Aztecs and entered Tenochtitlán, where he found that smallpox had killed more Aztecs than had the cannons.

Smallpox was responsible for an estimated 300–500 million deaths in the 20th century. As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease and that two million died in that year. After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in 1979. To this day, smallpox is the only human infectious disease to have been completely eradicated from nature.

2. Spanish Flu (1918 - 1919)

The Spanish Flu killed 50 to 100 million people worldwide in less than 2 years.

In 1918 and 1919, the Spanish Flu pandemic killed more people than Hitler, nuclear weapons and all the terrorists of history combined. (A pandemic is an epidemic that breaks out on a global scale.) Spanish influenza was a more severe version of your typical flu, with the usual sore throat, headaches and fever. However, in many patients, the disease quickly progressed to something much worse than the sniffles. Extreme chills and fatigue were often accompanied by fluid in the lungs. One doctor treating the infected described a grim scene: "The faces wear a bluish cast; a cough brings up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood."

If the flu passed the stage of being a minor inconvenience, the patient was usually doomed. There is no cure for the influenza virus, even today. All doctors could do was try to make the patients comfortable, which was a good trick since their lungs filled with fluid and they were wracked with unbearable coughing. The "bluish cast" of victims' faces eventually turned brown or purple and their feet turned black. The lucky ones simply drowned in their own lungs. The unlucky ones developed bacterial pneumonia as an agonizing secondary infection. Since antibiotics hadn't been invented yet, this too was essentially untreatable. The pandemic came and went like a flash. Between the speed of the outbreak and military censorship of the news during World War I, hardly anyone in the United States knew that a quarter of the nation's population - and a billion people worldwide - had been infected with the deadly disease. More than half a million died in the U.S. alone; worldwide, more than 50 million.

3. Black Death (1340 - 1771)

The Black Death killed 75 million people worldwide.

The Black Death, or The Black Plague, was one of the most deadly pandemics in human history. It began in South-western or Central Asia and spread to Europe by the late 1340s. The total number of deaths worldwide from the pandemic is estimated at 75 million people; there were an estimated 20 million deaths in Europe alone. The Black Death is estimated to have killed between a third and two-thirds of Europe's population.

The three forms of plague brought an array of signs and symptoms to those infected. Bubonic plague refers to the painful lymph node swellings called buboes, mostly found around the base of the neck, and in the armpits and groin. The septicaemic plague is a form of blood poisoning, and pneumonic plague is an airborne plague that attacks the lungs before the rest of the body. The classic sign of bubonic plague was the appearance of buboes in the groin, the neck and armpits, which oozed pus and bled. Victims underwent damage to the skin and underlying tissue, until they were covered in dark blotches. Most victims died within four to seven days after infection. When the plague reached Europe, it first struck port cities and then followed the trade routes, both by sea and land. The bubonic plague was the most commonly seen form during the Black Death, with a mortality rate of thirty to seventy-five percent and symptoms including fever of 38- 41°C (101-105°F), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Of those who contracted the bubonic plague, 4 out of 5 died within eight days. Pneumonic plague was the second most commonly seen form during the Black Death, with a mortality rate of ninety to ninety-five percent.

The same disease is thought to have returned to Europe every generation with varying virulence and mortalities until the 1700s. During this period, more than 100 plague epidemics swept across Europe. On its return in 1603, the plague killed 38,000 Londoners. Other notable 17th century outbreaks were the Italian Plague (or Great Plague of Milan) of 1629-1631, the Great Plague of Seville (1647-1652), the Great Plague of London (1665–1666), the Great Plague of Vienna (1679). There is some controversy over the identity of the disease, but in its virulent form, after the Great Plague of Marseille in 1720–1722 and the 1771 plague in Moscow, it seems to have disappeared from Europe in the 18th century. The fourteenth-century eruption of the Black Death had a drastic effect on Europe's population, irrevocably changing Europe's social structure. It was a serious blow to the Roman Catholic Church and resulted in widespread persecution of minorities such as Jews, foreigners, beggars and lepers. The uncertainty of daily survival created a general mood of morbidity influencing people to "live for the moment", as illustrated by Giovanni Boccaccio in The Decameron (1353).

4. Malaria (1600 - today)

Malaria kills about 2 million people per year.

Malaria causes about 400–900 million cases of fever and approximately one to three million deaths annually - this represents at least one death every 30 seconds. The vast majority of cases occur in children under the age of 5 years; pregnant women are also especially vulnerable. Despite efforts to reduce transmission and increase treatment, there has been little change in which areas are at risk of this disease since 1992. Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years. Precise statistics are unknown because many cases occur in rural areas where people do not have access to hospitals or the means to afford health care. Consequently, the majority of cases are undocumented.

Malaria is one of the most common infectious diseases and an enormous public-health problem. It's parasites are transmitted by female Anopheles mosquitoes. The parasites multiply within red blood cells, causing symptoms that include symptoms of anaemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death. The disease is caused by protozoan parasites of the genus Plasmodium. It is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa.

5. AIDS (1981 - today)

AIDS killed 25 million people worldwide.

Acquired Immune Deficiency Syndrome (AIDS) has led to the deaths of more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed approximately 3.1 million (between 2.8 and 3.6 million) lives in 2005 (an average of 8,500 per day), of which 570,000 were children. UNAIDS and the WHO estimate that the total number of people living with the human immunodeficiency virus (HIV) has reached its highest level. There are an estimated 40.3 million (estimated range between 36.7 and 45.3 million) people now living with HIV. Moreover, almost 5 million people have been estimated to have been infected with HIV in 2005 alone.

The pandemic is not homogeneous within regions with some countries more afflicted than others. Even at the country level there are wide variations in infection levels between different areas. The number of people living with HIV continues to rise in most parts of the world, despite strenuous prevention strategies. Sub-Saharan Africa remains by far the worst-affected region, with 23.8 million to 28.9 million people living with HIV at the end of 2005, 1 million more than in 2003. Sixty-four percent of all people living with HIV are in sub-Saharan Africa, as are more than 77% of all women living with HIV. South and South East Asia are second most affected with 15%.

The key facts surrounding this origin of AIDS are currently unknown, particularly where and when the pandemic began, though it is said that it originated from the apes in Africa.

6. Cholera (1817 - today)

8 pandemics; hundreds of thousands killed worldwide.

In the 19th century, Cholera became the world's first truly global disease in a series of epidemics that proved to be a watershed for the history of plumbing. Festering along the Ganges River in India for centuries, the disease broke out in Calcutta in 1817 with grand - scale results. When the festival was over, they carried cholera back to their homes in other parts of India. There is no reliable evidence of how many Indians perished during that epidemic, but the British army counted 10,000 fatalities among its imperial troops. Based on those numbers, it's almost certain that at least hundreds of thousands of natives must have fallen victim across that vast land. Cholera sailed from port to port, the germ making headway in contaminated kegs of water or in the excrement of infected victims, and transmitted by travellers. The world was getting smaller, thanks to steam-powered trains and ships, but living conditions were slow to improve. By 1827 cholera had become the most feared disease of the century.

The major cholera pandemics are generally listed as: First: 1817-1823, Second: 1829-1851, Third: 1852-1859, Fourth: 1863-1879, Fifth: 1881-1896, Sixth: 1899-1923: Seventh: 1961- 1970, and some would argue that we are in the Eighth: 1991 to the present. Each pandemic, save the last, was accompanied by many thousands of deaths. As recently as 1947, 20,500 of 30,000 people infected in Egypt died. Despite modern medicine, cholera remains an efficient killer.

7. Typhus (430 BC? - today)

Typhus killed 3 million people between 1918 and 1922 alone, and most of Napoleon's soldiers on Russia.

Typhus is any one of several similar diseases caused by louse-borne bacteria. The name comes from the Greek typhos, meaning smoky or lazy, describing the state of mind of those affected with typhus. Rickettsia is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field.

The first description of typhus was probably given in 1083 at a convent near Salerno, Italy. Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history. During the second year of the Peloponnesian War (430 BC), the city-state of Athens in ancient Greece was hit by a devastating epidemic, known as the Plague of Athens, which killed, among others, Pericles and his two elder sons. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is one of the strongest candidates for the cause of this disease outbreak, supported by both medical and scholarly opinions. Epidemics occurred throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. A major epidemic occurred in Ireland between 1816-19, and again in the late 1830s, and yet another major typhus epidemic occurred during the Great Irish Famine between 1846 and 1849.

In America, a typhus epidemic killed the son of Franklin Pierce in Concord, New Hampshire in 1843 and struck in Philadelphia in 1837. Several epidemics occurred in Baltimore, Memphis and Washington DC between 1865 and 1873. During World War I typhus caused three million deaths in Russia and more in Poland and Romania. De-lousing stations were established for troops on the Western front but the disease ravaged the armies of the Eastern front, with over 150,000 dying in Serbia alone. Fatalities were generally between 10 to 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. Following the development of a vaccine during World War II, epidemics occur only in Eastern Europe, the Middle East and parts of Africa.

8. Ebola (1976 - Present)

Ebola may not have killed millions like smallpox and AIDS, but with mortality rates as high as 90%, and a myriad of horrific symptoms (bleeding from every orifice as well as bloody diarrhoea and vomit) make it a contender for this list.

In addition, there's no known cure or standard treatment for Ebola, which essentially limits medical personnel to comforting the patient while keeping their fingers crossed.

Lastly, the origin of Ebola is unknown, making preventative measures impossible, and solidifying Ebola as one of the worst plagues Earth has ever known.

Apart from the above disease-specific epidemics or pandemics, there are other incidences in history (listed below) which occurred either in specific regions or specific periods of time and which, in most cases, were caused by multiple diseases.

9. The Third Pandemic (1855 – 1950s)


“Third Pandemic” is the name given to a major plague pandemic that began in the Yunnan province (pictured above) in China in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately killed more than 12 million people in India and China alone. According to the World Health Organization, the pandemic was considered active until 1959, when worldwide casualties dropped to 200 per year. The bubonic plague was endemic in populations of infected ground rodents in central Asia, and was a known cause of death among migrant and established human populations in that region for centuries; however, an influx of new people due to political conflicts and global trade led to the distribution of this disease throughout the world. New research suggests Black Death is lying dormant.

10. Plague of Justinian (541 – 542 AD)

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The Plague of Justinian was a pandemic that afflicted the Byzantine Empire, including its capital Constantinople, in the years 541–542 AD. The most commonly accepted cause of the pandemic is bubonic plague, which later became infamous for either causing or contributing to the Black Death of the 14th century. Its social and cultural impact is comparable to that of the Black Death. In the views of 6th century Western historians, it was nearly worldwide in scope, striking central and south Asia, North Africa and Arabia, and Europe as far north as Denmark and as far west as Ireland. The plague would return with each generation throughout the Mediterranean basin until about 750. The plague would also have a major impact on the future course of European history. Modern historians named it after the Eastern Roman Emperor Justinian I, who was in power at the time and himself contracted the disease. Modern scholars believe that the plague killed up to 5,000 people per day in Constantinople at the peak of the pandemic. It ultimately killed perhaps 40% of the city’s inhabitants. The initial plague went on to destroy up to a quarter of the human population of the eastern Mediterranean.

11. American Plagues (16th Century)


Before the European arrival, the Americas had been largely isolated from the Eurasian–African landmass. First large-scale contacts between Europeans and native people of the American continents brought overwhelming pandemics of measles and smallpox, as well as other Eurasian diseases. These diseases spread rapidly among native peoples, often ahead of actual contact with Europeans, and led to a drastic drop in population and the collapse of American cultures. Smallpox and other diseases invaded and crippled the Aztec and Inca civilizations in Central and South America in the 16th century. This disease, with loss of population and death of military and social leaders, contributed to the downfall of both American empires and the subjugation of American peoples to Europeans. Diseases, however, passed in both directions; syphilis was carried back from the Americas and swept through the European population, decimating large numbers.

12. Plague of Athens (430 – 427 BC)

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The Plague of Athens was a devastating epidemic which hit the city-state of Athens in ancient Greece during the second year of the Peloponnesian War (430 BC), when an Athenian victory still seemed within reach. It is believed to have entered Athens through Piraeus, the city’s port and sole source of food and supplies. The city-state of Sparta, and much of the eastern Mediterranean, was also struck by the disease. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Modern historians disagree on whether the plague was a critical factor in the loss of the war. However, it is generally agreed that the loss of this war may have paved the way for the success of the Macedonians and, ultimately, the Romans. The disease has traditionally been considered an outbreak of the bubonic plague in its many forms, but re-considerations of the reported symptoms and epidemiology have led scholars to advance alternative explanations. These include typhus, smallpox, measles, and toxic shock syndrome.

13. Antonine Plague (165 – 180 AD)

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The Antonine Plague (also known as the Plague of Galen, who described it), was an ancient pandemic, of either smallpox or measles, brought back to the Roman Empire by troops returning from campaigns in the Near East. The epidemic claimed the lives of two Roman emperors - Lucius Verus, who died in 169, and his co-regent who ruled until 180, Marcus Aurelius Antoninus, whose family name, Antoninus, was given to the epidemic. The disease broke out again nine years later, according to the Roman historian Dio Cassius, and caused up to 2,000 deaths a day at Rome, one quarter of those infected. Total deaths have been estimated at five million. Disease killed as much as one-third of the population in some areas, and decimated the Roman army. The epidemic had drastic social and political effects throughout the Roman Empire, particularly in literature and art. Pictured above is a plague pit containing the remains of people who died in the Antonine Plague.

[Edited. Some links and images added.]

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