Universal Outbreaks That Changed History
Universal Outbreaks That Changed History

Universal Outbreaks That Changed History

Larry Holzwarth - March 12, 2020

**Disclaimer: History Collection is aware of the current pandemic concerning COVID-19. The facts and opinions expressed in this article are not an official source of information on the current outbreak or how it will trend. For the most up to date information on the current pandemic, please find your resources on the CDC or WHO websites.**

An epidemic is the spread of an infectious disease within a given population. It becomes a pandemic when it spreads across international borders. Throughout recorded time epidemics and pandemics altered human history, not solely through illness passed between humans. Pandemics have affected the animal kingdom, reduced the food supply, and led to famine and starvation. For centuries mankind had little means of protecting itself from pandemics; superstition, racism, and ignorance supplanted medical thought and practice. Though in truth, much of medical thought was based on the same failings.

Universal Outbreaks That Changed History
An emergency ward established during the Spanish Flu pandemic in Camp Funston, Kansas. Wikimedia

Some pandemics of the past are well known, though often misunderstood. The Black Plague which decimated Europe is one example. The Spanish Flu pandemic near the end of the First World War is another. Epidemics altered American history as the nation grew, with diseases such as cholera, typhus, yellow fever, and malaria changing populations, particularly in the southern states. Smallpox killed thousands of American Indians, their primitive medical practices unable to cope with what many called the white man’s disease. European history is similarly marked by the ravages of disease. Here are some of the epidemics and pandemics which changed world history.

Universal Outbreaks That Changed History
Galen described the symptoms of the plague but did not specify the disease. Wikimedia

1. The Antonine Plague ravaged the Roman Empire for decades

The famous physician Galen described the Antonine Plague. Most of what is known of it comes from his records. The pandemic swept the empire for at least fifteen, and according to some up to 25 years. The actual disease at the core of the pandemic remains debated. Smallpox is regarded as the disease by some, others claim it was measles. Galen’s descriptions of symptoms include fevers, skin eruptions (of different types), and gastric disorders. Other medical scholars define the evolution of measles occurred more than three centuries after the pandemic, which, if correct, eliminates measles as the culprit. Nearly all agree that troops returning to Rome from the east carried the disease with them, which spread rapidly throughout the empire.

About 25% of people who contracted the disease died. The pandemic ravaged the Roman Legions in Gaul and the Germanic lands, and claimed the life of Lucius Verus, co-emperor with Marcus Aurelius. From 165 to 180 AD (some say 190 AD) at least 5 million died. During the height of the pandemic in Rome 2,000 people died per day, according to the historian Dio Cassius. The weakened Roman Legions were unable to contain the Gauls and Germanic tribes south of the Danube River. Trade with Han China and in the Indian Ocean was curtailed. Eventually, 10% of the Roman population succumbed during the pandemic.

Universal Outbreaks That Changed History
St. Sebastien pleads for the life of a plague victim during the Plague of Justinian. Wikimedia

2. The Justinian Plague killed 40% of the populations affected in 541-542 AD

The Eastern Roman (Byzantine) Empire was stricken by a plague which killed an estimated 25-50 million people in 541 AD. The pandemic struck hardest at Constantinople, and spread to various Mediterranean port, carried by ships involved in international trade. The ships also carried rats, infested with fleas which were the source of the disease. The pandemic spread from China across the Eastern Empire. Though its first wave lasted until late 542 AD, additional outbreaks occurred sporadically until well into the eighth century. The Byzantine historian Procopius estimated that 10,000 deaths occurred in Constantinople daily when the plague was at its height.

The weakened Byzantine Empire was unable to maintain the union with the Western Empire when the Lombards in Northern Italy invaded. Another historical impact of the plague was the settlement in Great Britain by Anglo-Saxons. Following the plague’s initial outbreak, grain prices skyrocketed in the Eastern Empire, as men strong enough to tend crops were scarce. The Byzantine Armies, hard-pressed by enemies from all directions, including Goths, Huns, Lombards, Persians, and Arabs, suffered a series of setbacks which shrank the empire. Justinian, for whom the plague was named, contracted the disease, though he survived.

Universal Outbreaks That Changed History
Known by many names, the Great Plague changed the history of Europe in innumerable ways. Wikimedia

3. The Black Death in Asia, North Africa, and Europe

The bacterium which caused the Plague of Justinian was yersinia pestis. The Justinian plague was a different strain than that which is commonly known as the Black Plague, though the same virus. The Black Plague was bubonic plague, entered Europe from Asia, and then spread to North Africa. It originated in China, spread to the west via the Silk Road and in the hulls of merchant ships, carried by infested rats. By the middle of the 14th century it was in the Russian steppes and Ukraine. It was so deadly two full centuries were required to recover the loss of population it caused. At least 75 million people succumbed; some estimate the deaths to have numbered over 200 million, which included up to 60% of the people of Europe.

One hundred thousand people died in Paris. Germanic and English settlements suffered death rates of 60% and up. The death rate obviously depleted the work force. Crops rotted in the fields in the absence of workers to harvest them, costs of food increased, and starvation ensued. Monasteries and convents often served as hospitals. The priests, monks, and nuns who served the sick were struck down, and clerical establishments abandoned. There are climatologists who speculate the Black Death contributed to the Little Ice Age, when fields formerly in crops returned to their wooded state. The added forests contributed to cooling. The plague led to Christian attacks on Jewish communities throughout Europe, believed by some to be divine retribution of sins.

Universal Outbreaks That Changed History
Anne, Duchess of Suffolk, died of the mysterious sweating sickness only hours after contracting it. Wikimedia

4. The sweating sickness pandemic in the British Isles and Continental Europe

Beginning about 1485, and continuing for about 66 years, a strange disease swept England before leapfrogging to the continent. The infectious disease killed suddenly, usually within a few hours of initial symptoms. Medical personnel couldn’t identify it at the time, and have not identified it with certainty since. It was described by a physician in Shrewsbury, England, in 1552. The symptoms began with anxiety, followed by a cold stage, then a hot stage. The cold stage included chills, tremors, and severe headache, along with pain in the limbs. The hot stage included heavy sweating, fever, delirium, and death. It did not always kill, and those surviving an attack were not immunized from subsequent bouts with the disease.

Historians and medical professionals have proposed several possibilities in attempts to identify the disease, which vanished as mysteriously as it appeared. Anthrax was considered a possibility. So was a form of hantavirus. Poland, Russia, Switzerland, Scandinavia, the Low Countries, France, the Germanic lands, and other isolated pockets of settlements all suffered from the disease, which eventually killed an estimated 100,000, and possibly many more. By 1551, the disease had run its course. Isolated outbreaks of similar symptoms occurred well into the 17th century, but the sweating sickness pandemic was considered over in Europe by the end of 1552.

Universal Outbreaks That Changed History
The Spanish conquistadores encountered a pandemic of unknown origins across most of New Spain. Wikimedia

5. An unknown illness killed half of the indigenous population of Mexico in the 16th century

In the 16th century a series of severe droughts plagued Mexico. In their aftermath a recurring disease struck the indigenous peoples, their Spanish conquerors, and the African slaves the conquistadores imported to New Spain. The Aztecs called the disease cocoliztli. For centuries speculation was that the disease was a form of hemorrhagic fever, carried by the vesper mouse, which flourished in the rains which followed the droughts. More recent scholarship identifies the illness as a form of salmonella enterica. The disease spread throughout Mexico, and similar symptoms emerged in other regions of New Spain, suggesting to some the disease originated with the Spaniards, who brought it from Europe.

The symptoms suffered were similar to some of those presented in other diseases, known to the Spanish doctors. They included typhus, measles, smallpox, and yellow fever. Cocoliztli presented other symptoms not shared with the above, and was invariably fatal. Spanish physicians and priests identified the disease as “God sent down such sickness upon the Indians that three out of every four of them perished”. That estimate of the death rate may be low. Some scholars estimated that 90% of the indigenous peoples of Mexico died of the disease combined with the effects of droughts, and the Spanish conquest of New Spain. Modern estimates attribute 2-2.5 million deaths, 50% of the population, to the disease itself.

Universal Outbreaks That Changed History
The Wampanoag were a people ravaged by disease by the time the Pilgrims and Puritans arrived in Massachusetts. Wikimedia

6. The Great Dying in New England, 1616-1619

Among the discoveries of the Pilgrims in what became Plymouth Colony were dozens of abandoned towns, surrounded by cleared fields empty of crops. Evidence of a once-thriving population was a stark comparison to the relative lack of natives. For some of the English settlers it was evidence of a providential miracle. God had swept the natives away before the arrival of the English, an act which made the land, “much the more fit for the English Nation to inhabit”. Before the arrival of the Pilgrims European explorers had visited the region, and reported a large population of Indians, including Wampanoag and Abenaki, occupied the lands.

Between 1616 and 1619, a disease of an unknown nature spread through the region along the woodland paths used by the Abenaki to trade with their neighbors to the south. Up to 90% of the Wampanoags were killed by the epidemic. Historians agree that the disease was European in origin, brought to New England by explorers or fishermen. Some symptoms were reported, which included severe headache, bleeding from nose and ears, a filling of the lungs, muscle pains, and finally death. Meningitis, smallpox, leptospirosis, typhus, and other diseases have been proposed as the source of the epidemic. It changed history by ensuring the arriving Pilgrims had access to land, in which to develop Plymouth Colony, and eventually Massachusetts.

Universal Outbreaks That Changed History
The diseases brought to America by the Europeans was one of the many causes for Indian attacks on settlements. Wikimedia

7. The North American epidemics of the 17th and 18th centuries

Throughout the 17th century the newly arrived Europeans and the American Indians suffered a series of epidemics. Most of them were of smallpox or measles. The Europeans were better equipped to resist the illnesses, though they were often fatal to children and the elderly. For the Indians, they were almost always fatal. Near the end of the century yellow fever joined the previously mentioned diseases. Indians in contact with settlers carried the diseases far into the hinterlands, where it spread among the various tribes, carried by traders and warriors. In 1732, the year George Washington was born in Virginia, a major flu epidemic swept the European settlements, killing thousands of settlers as well as the local Indian tribes.

The new settlement of Savannah in the Georgia colony was changed by the several epidemics which struck there in its first decade of existence. The colony adopted a policy in inclusion, allowing Jewish settlers to remain in the settlement. Initially the colony’s founder, James Oglethorpe, opposed Jewish settlers. When a group including a doctor, a Portuguese-Jewish physician named Samuel Nunes, proved to be useful in treating settlers suffering from various diseases they were allowed to stay. Georgia was founded as a haven for debtors freed from England’s prisons; by the 1740s it became tolerant of religious refugees including French Huguenots and Lutherans from Germany. Opposition to Catholics continued, largely out of fear of Catholic Spain.

Universal Outbreaks That Changed History
Washington was one of the first – if not the first – commanders to order his men inoculated from smallpox. Wikimedia

8. The small pox epidemic of the American Revolution

During the American Revolution smallpox threatened the health of the armies of both sides. George Washington, commander of the Continental Army, survived smallpox in his youth. He ordered the troops under his command inoculated during the war, which undoubtedly saved lives and the fighting ability of the troops. In 1775, British occupied Boston and the American armies in Canada suffered outbreaks of the disease. By the end of that year smallpox raged in epidemic proportions across the continent, from Upper Canada to New Orleans, and from the Eastern Seaboard to the trans-Mississippi. At the end of the decade, a smallpox epidemic stretched from Alaska into Mexico, carried by the migratory tribes of the plains.

The Native American population of the Pacific Northwest was reduced by about a third from the disease. The Sioux, Cheyenne, and Apache felt a similar effect. In the east, Washington’s efforts directed against the disease led to the introduction of mandatory inoculations and quarantine of the afflicted. The Indians had no such programs, nor any idea of what afflicted them. Tens of thousands, and probably hundreds of thousands, died across what became the United States and Mexico. Smallpox struck the Plains Indians several additional times during the 19th century, including through the deliberate distribution of infected blankets and other items in a primitive form of biological warfare.

Universal Outbreaks That Changed History
A depiction of a death from cholera in Paris, date unknown. Wikimedia

9. The First Cholera Pandemic, 1817-1824

Cholera is a bacterial infection of the small intestine, most frequently spread through contaminated water or food. Of the animal kingdom, only humans are infected by the disease. It spreads quickly, transmitted by contact with feces from those carrying the disease. Thus, hygiene, or more accurately the lack thereof, is a critical component in its spread. In late 1816 or early 1817 cholera broke out along the Ganges River in India. Local residents and British troops carried it across the subcontinent. Cholera was nothing new to India, but the strain which emerged in 1817 was particularly virulent. By the end of the decade it had spread into central Asia and China. Ships of the East Indies Companies of England and the Dutch carried it to the islands of the South Pacific.

By 1822 the disease spread into the Caucasus, across Northern Africa, through the Mid-East, and along the Mediterranean coast of Europe. It appeared in Japan, Indonesia, and Polynesia. In Java, the Dutch port at Semarang suffered over 1,200 dead in less than two weeks. Estimates of world-wide death tolls from the pandemic differ wildly. Several hundred thousand died on the Indian subcontinent alone. Java reported over 100,000 dead. The numbers of dead in China and across central Asia are anybody’s guess. As its name implies, the Cholera Pandemic which ended in 1824 (due to abnormally cold temperatures) was the first of several which occurred in the 19th and 20th century, each bearing horrors of their own.

Universal Outbreaks That Changed History
Before it was linked to contaminated water, many believed burning fires would clean the air of choleric miasmata. Wikimedia

10. The Second Cholera Pandemic, 1829-1851

Cholera killed more people than any other form of disease in the 19th century, and was extraordinarily well-suited to be carried by the transportation systems of the time. Cholera thrives in areas with crowded conditions, poor sanitation facilities (particularly sewers) and contaminated drinking water. In 1829 a second cholera pandemic emerged, significantly larger than the first which ended five years earlier. It again originated in India, and spread rapidly to cover nearly the entire globe, including most of Africa, Eurasia, Japan and Australia, and both the North and South American continents. By 1831 over 100,000 deaths from the disease had occurred in Russia, and its troops had delivered the contagion to Europe.

At the end of 1831 the disease appeared in the British Isles, first appearing in port cities. In France, over 100,000 died of cholera during the pandemic. It appeared in the United States, in Philadelphia, Detroit, Cincinnati, and other cities, reaching the West Coast in 1833. In the United States a movement developed which blamed the spread of the disease on immigration, focused on the Irish in particular. They were supported by doctors in France who published findings that the disease was clearly associated with poverty. Cities across American warned their citizens to avoid cold water, both for drinking and physical contact.

Universal Outbreaks That Changed History
Hippocrates made note of flu symptoms, but did not classify it as a specific disease. Wikimedia

11. Influenza pandemics have been common throughout history

The first medical practitioner to encounter and describe illness resembling influenza – commonly called the flu – was Hippocrates. Another ancient Greek physician described a similar illness which ravaged the Athenian Army in the Mediterranean Sea. Not until 16 centuries passed would the ailment acquire the name of influenza. When it did it was named for a superstition. Influenza was derived from the Italian word for influence. The physician making the discovery and dispensing the name believed that the disease he described was influenced by the stars, particularly those of the winter sky. In terms of disease, influenza is one of the most prolific killers of all time.

In 1580 a strain of influenza emerged in Asia, crossed into Europe and the Mid-East via the Silk Road, and devastated the world’s population. Approximately 90% of the global population contracted the disease. Doctors resorted to the tried and true medical practice of the day – bleeding – and weakened already ill patients further. The pandemic killed over 8,000 in Rome, similar numbers in cities across Spain, and further afflicted the Ottoman Empire. In the New World, the population of the Antilles was all but wiped out in an earlier epidemic in 1493, probably introduced by the crews of Columbus. The natives had no naturally developed immunity, and little defense against the disease.

Universal Outbreaks That Changed History
Original conception of the Plague Tower in Vienna, built to honor the victims of the Great Plague. Wikimedia

12. The Great Plague of Vienna in 1679

Vienna was a key link in the trade routes between Western Europe and the Middle East and China, then referred to collectively as the Orient. Vienna was a crowded city, huddled along the Danube River, with commercial buildings and residential structures abutting each other on narrow streets. The city offered no public sewers; gutters in the streets served as drains for rainwater and offal. The detritus of a crowded city piled in the streets and alleyways, eventually finding its way to the river. Rats abounded. The city’s many warehouses, piled with goods from the east and west, also teemed with rats and mice, as did the wharves along the waterfront.

In 1679 an outbreak of plague, believed to have been bubonic plague, ravaged the crowded city. It spread to other cities in towns in Europe, where it became known as the Viennese Death. In Vienna, the bodies of the dead were disposed of in mass graves dug outside of the town. Once the death pits were filled the bodies were burned; during the interim rats roamed the pits, which allows the disease to continue to spread. The plagued crippled the city and European trade, as merchants and traders from East and West shunned Vienna as the disease ran its course. By the time it subsided at least 76,000 Viennese had succumbed. The city’s famous Trinity Column, also known as the Plague Column, was erected to honor them.

Universal Outbreaks That Changed History
Monument to the Irish victims of typhus at Grosse Ile, Quebec, Canada. Wikimedia

13. The Canadian typhus epidemic of 1847

In 1847 Ireland struggled with the Great Famine. Thousands of Irish families fled their homeland, with many arriving in British Canada. The British shipped them to North America with little regard of their health, some boarding ships already suffering from typhus. The disease spread to previously healthy passengers during the voyage. On May 17, 1847, the first of the “fever ships” arrived at Grosse Isle in the Saint Lawrence River. The ships were quarantined, healthy passengers removed and placed in isolation wards hastily erected for the purpose. At the end of May, 40 ships moored in line in the Saint Lawrence River, and others were still on their way.

During the epidemic, at least 5,000 passengers died of typhus during their voyage to the New World. Many of them contracted the disease aboard ship, and the weak and infirm succumbed quickly. At the fever sheds erected at Grosse Isle (and other Canadian ports) the death rate was high. Those that died at sea were buried at sea, those who died in the Canadian ports were taken to isolated burial grounds for interment. Well over 20,000 Irish and Canadians died during the epidemic, including at least 40 clergymen who contracted the disease while ministering to the sufferers in the isolation sheds and ships. The epidemic also affected the Irish arriving in New York, where the death rate was much lower.

Universal Outbreaks That Changed History
Former President James K. Polk was one of the many to die from cholera when it swept through his native Tennessee. Wikimedia

14. The third cholera pandemic, 1846-1863

As did its predecessors, the third cholera pandemic which struck in the mid-19th century originated along the Ganges in India. Before it ended it claimed more lives than any of the other 19th century epidemics around the world. Over 1 million died in the Russian Empire between 1847 and 1851. The epidemic spread to the United States, carried to North America during the Gold Rush. Ships arrived at New Orleans carrying the disease, which spread up the Mississippi River to Memphis, Saint Louis, and Vicksburg. Former American President James K. Polk was among the fatalities from the disease when it ravaged Nashville, Tennessee, in 1849-50. The pandemic reached Japan, China, Korea, Australia, and the South Pacific islands.

Mexico and South America were not immune. Nor was Great Britain, where approximately 55,000 died from cholera, over 14,000 of them in London. Total deaths from the pandemic exceeded 2 million, and were likely much higher. The pandemic changed the way many nations looked at issues such as immigration and trade. In the United States, some physicians and politicians associated the disease with the American south and the blacks enslaved there. In North Africa, the natives blamed the disease on the Europeans. During the third cholera pandemic Britain’s John Snow postulated the disease was carried in contaminated water, rather than in the air as previously believed.

Universal Outbreaks That Changed History
Dr. John Snow refuted the idea that cholera was transmitted through the air. Wikimedia

15. The Broad Street cholera epidemic of 1854

During the third cholera pandemic an outbreak of the disease occurred in London. At the time, the medical community broadly agreed that cholera was carried in the air, in particles called miasmata. During the London outbreak, physician John Snow noted a concentration of cases reported in a community in London’s Soho district. Using a dot map, Snow established a circle of cases in an area served by a single water pump, from which the residents extracted their drinking water. The water was drawn from the River Thames. Snow postulated the water was source of the disease, and lobbied the city to shut down the pump by removing its handle.

As Snow wrote, “The result of the inquiry then was, that there had been no particular outbreak or prevalence of cholera in this part of London except among the persons who were in the habit of drinking the water of the above-mentioned pump-well”. Snow’s efforts led to the birth of the science of epidemiology, and created the double-blind experiment, though the latter was a happy accident of his method of research. It was the breakthrough against cholera, up to then one of the world’s most feared illnesses. The proof that cholera was spread by contaminated water rather than “bad air” changed science, medicine, and public health services in cities around the globe, though some more swiftly than others.

Universal Outbreaks That Changed History
A dot map showing the concentration of cholera cases surrounding the Broad Street pump. Wikimedia

16. The fourth cholera pandemic, 1863-1875

Though by the end of the third cholera pandemic contaminated water had been identified as the manner in which the disease was spread, the disease was far from eliminated. Beginning in 1863 another pandemic, again born along the Ganges, spread around the world. It struck in London in 1866, where it remained localized. British epidemiologist William Farr noted its confinement to London’s overcrowded East End. The East End section of the city’s newly built water treatment and sewage system was incomplete. Contaminated water provided by the East London Water Company was identified as the source of the outbreak.

The fourth cholera pandemic claimed the lives of 165,000 citizens of the Austrian Empire, in part due to the poor sanitation conditions caused by the Austro-Prussian War. The disease spread around the world, carried by infected passengers and crews travelling on ships and trains. Few cities and even fewer small towns had established water treatment systems. Once cholera established itself in a community it thrived, its victims unaware that simply boiling drinking water protected them from the disease. The fourth cholera pandemic killed about 600,000 people, victims of the lack of systems to process human waste and establish clean water.

Universal Outbreaks That Changed History
A US Navy hospital corpsmen inoculating civilians against cholera in Vietnam. Wikimedia

17. Additional cholera pandemics occurred into the 21st century

Cholera epidemics continued through the 19th, 20th, and 21st centuries. In 2010, the World Health Organization declared a cholera pandemic in effect which continues, though the disease is rare in developed nations. It continued to appear in Africa, Asia, the Middle East, and in isolated nations around the globe. Cholera frequently appeared following other natural disasters which affected the water supply, such as earthquakes, floods, hurricanes, and of course the man-made disaster of war. It is nearly always associated with water contaminated with human fecal matter, though it is also caused by uncooked seafood, or poor personal hygiene habits among those preparing food and beverages.

Cholera kills through the effects of dehydration and fever. In areas where the water is contaminated death is almost assured unless access to clean water is available. In areas with disrupted drinking water systems, drinking contaminated water simply hastens the progress of the disease. During the first decade of the 21st century alone, cholera epidemics killed in South Africa, Nigeria, Bangladesh, Senegal, Angola, Ethiopia, India, Iraq, Vietnam, Zimbabwe, and several other countries. The following decade cholera killed more than 10,000 people in Haiti alone, and nearly 4,000 in Yemen.

Universal Outbreaks That Changed History
Prince Baudouin of Belgium was a victim of the Russian flu in 1891. Wikimedia

18. The Russian Flu pandemic of 1889-1895

In December, 1889, a new strain of influenza reared its deadly head in St. Petersburg, the seat of the Russian Tsars and the capital of the Russian Empire. Hitching a ride on railroads to the west, and then aboard merchant and passenger ships, the virus spread around the globe with jarring rapidity. By January there were reports of the disease in the United States, across the European continent, and in Japan and Asia. Virtually every nation of the world north of the equator were stricken with the influenza commonly referred to at the time as the Russian Flu (though it was referred to as the Asian Flu as well). Within five weeks of the first reported case in Russia the pandemic reached its peak mortality rates.

The flu’s worst damage was done by the end of 1890, but sporadic outbreaks continued until 1895. Patent medicine manufacturers touted curatives specifically formulated to prevent Russian Flu or to treat its symptoms, none of which had any effect on the disease. Over 1 million succumbed to Russian Flu during the pandemic and the recurrent outbreaks which followed. Among them were Prince Baudouin, heir presumptive to the throne of Belgium, and John T. Ford, manager of Ford’s Theater when Abraham Lincoln was shot there in 1865.

Universal Outbreaks That Changed History
Edvard Munch painted this Self-Portrait with the Spanish Flu in 1919. Wikimedia

19. Spanish Flu, 1918-1920

The Spanish Flu pandemic coincided with the latter days of World War I and the early days of the peace which followed. Estimates of up to 100 million deaths attributable to the pandemic are considered by some to be low. At least 500 million contracted the disease, more than a quarter of the population of the globe. During the first year of the pandemic the average life expectancy in the United States reduced by a more than a decade. Wartime censorship prevented the press from describing the spread of the flu and its virulent nature in 1918. In neutral Spain censorship did not apply, and the wide reporting of the disease there led to its identification as Spanish Flu. In truth, the disease was likely born in France, its epicenter the troop staging camps at Etaples.

The virus spread quickly among the troops, in part due to the crowded conditions in the camps and trenches across Europe. Infected troops moving about the continent hastened its spread. In the United States, troops in training contracted the disease, likely from contact with instructors from Europe, and as the troops moved to the seacoast for shipping to Europe, the disease spread with them. Over 30 million Americans contracted the flu, an estimated 650,000 died. By comparison, just under 117,000 Americans died in combat or later of their wounds during World War I. Just over 63,000 additional American troops died during the war, the overwhelming majority of them from Spanish Flu.

Universal Outbreaks That Changed History
Adolf Hitler may have contracted encephalitis lethargica in his youth, leading to his tremors later in life. Wikimedia

20. The encephalitis lethargica pandemic, 1915-1926

Encephalitis lethargica is also known as “sleeping sickness”, though not the same illness as that transmitted by the tse-tse fly. The disease renders its victims motionless, speechless, and inert, though fully conscious and aware of their surroundings and condition. Some victims never fully recover from the disease, remaining aware but indifferent after the acute stage of the disease passed. Others recover only to exhibit forms of psychosis not present before the disease. Recurrent tics and symptoms of Parkinson’s disease, including tremors and hallucinations, were reported among some survivors of encephalitis lethargica.

Beginning in 1915 and for the decade which followed, approximately 5 million people around the world were stricken with encephalitis lethargica. About a third of the victims died during the disease’s acute stages. In recent years, some have postulated that Adolf Hitler had encephalitis lethargica in his youth, leading to his Parkinson tremors later in his life. Scientists and doctors have yet to identify the cause of the disease. Since 1926, isolated cases have occurred, but there was no recurrence of the worldwide outbreak of the disease such as occurred during and following the First World War. The pandemic was considered a medical mystery, a description which it retains in the 21st century.

Universal Outbreaks That Changed History
A Swedish teacher addresses her lone student during the 1957 Asian Flu pandemic. Wikimedia

21. The Asian Flu pandemic, 1957-1958

The Asian Flu which struck the United States in 1957 originated the preceding year in Guzhou, China. Some medical professionals believed it mutated from a virus affecting ducks, melding with another form of the human influenza virus. Others dispute its origin. It spread rapidly from China around the world, arriving in the United States in June, 1957. By the end of the year a vaccine was developed to contain the spread of the disease. Just under 70,000 Americans succumbed to the Asian Flu before it was contained in 1958. The majority of victims were the very young, the very old, and those with weakened immune systems. Around the world more than 2 million died, with some estimates up to 4 million.

In 1958 vaccines brought the pandemic under control. The Asian Flu virus mutated from an H2N2 to H3N2, making it undeterred by the vaccine and a second pandemic erupted in 1968-69. The second pandemic of Asian Flu was not as widespread, nor were the symptoms as severe. Known as the Hong Kong Flu, it killed another 1 million people worldwide, including about 33,000 in the United States, with those over the age of 65 representing the largest number of victims. Daisy and Violet Hilton, conjoined twins and entertainers who performed with Bob Hope in the 1920s, were among the victims of the Hong Kong Flu. Violet died some days after the death of her sister, alone at their home.

Universal Outbreaks That Changed History
A CDC publication addressing the HIV pandemic from 2011. CDC

22. The HIV/ AIDS pandemic

How the human immunodeficiency virus (HIV) mutated and evolved from the simian immunodeficiency virus (SIV) is debated among scientists and researchers. Numerous theories have evolved, none proven, and many controversial. It is generally accepted that HIV evolved from a strain developed in what was at the time the Belgian Congo in the early 20th century. The global pandemic which evolved from it is surrounded by myths, including the identities of its earliest victims. For many years David Carr, a printer from Manchester, England, was considered one of its earliest victims, dying of complications of AIDS in 1959. Recent research indicated he was not.

HIV/AIDS is a global pandemic with profound societal influences. It is a subject of debate over morality, social responsibility, religious implications, sexual orientation, drug use, and government’s responsibilities in combatting the disease. The deaths of many notable celebrities, including film star Rock Hudson, singer and musician Freddie Mercury, tennis player Arthur Ashe, and many, many more has kept the pandemic in the forefront of public attention. There are also many urban myths regarding HIV, including one which claims the US government developed it as a biological weapon. Another claims that HIV does not cause AIDS, a pseudoscience widely promoted on the internet. To date, approximately 30 million have died as a result of contracting HIV/AIDS.

Universal Outbreaks That Changed History
A cow with BSE has lost its ability to rise to its feet. Wikipedia

23. Variant Creutzfeldt-Jakob Disease (vCJD), 1996-2001

VCJD emerged in 1996, with the majority of cases since reported in Great Britain, though it has also been reported in Canada, Asia, the United States, Western Europe, Japan, and Saudi Arabia. Researchers in the United Kingdom identified its primary cause as the consumption of beef with bovine spongiform encephalopathy (BSE), commonly referred to as mad cow disease. The first symptoms include vague sensations of pain in limbs and extremities and psychiatric disorders leading to behavioral changes, including delusions. The time between exposure to the disease and its early symptoms presenting is unknown, though British researchers speculated that it is many years. Once the symptoms present average life expectancy is a little more than one year.

Speculation that the disease is transmitted through blood transfusions changed blood donor policies of several governments during the early 21st century. The United Kingdom, United States, New Zealand, Canada, Poland, the Czech Republic, Finland, and other countries instituted restrictions on blood donors based on their travel histories and other factors. Work to develop a screen for blood supplies was ongoing as of 2018. In the United Kingdom researchers claimed that one person in 2,000 is a carrier of the disease, which continued to make sporadic appearances around the globe in the second decade of the 21st century.

Universal Outbreaks That Changed History
Dr. Alois Alzheimer, the first to chart the course of the disease which bears his name. Wikimedia

24. Alzheimer’s disease

Medical practitioners as far back as Hippocrates associated an increase in dementia with aging. Not until 1906 was a study of the disease reported, by psychiatrist Alois Alzheimer, in Germany. His report followed the course of the disease over the last five years of a patient’s life. He named the disease after himself. Through most of the remaining 20th century a diagnosis of Alzheimer’s was reserved for those over the age of 45 who exhibited the symptoms. By the end of the century the diagnosis of Alzheimer’s extended to all who presented the symptoms regardless of age. The disease is present across the globe, with no cure, and little in the way of treatment to arrest its course.

It became one of the most costly diseases in developed countries. Social, psychological, and economical aspects of the disease affected, and continues to affect, societies at large. Burdens upon caregivers, often family members, can be measured emotionally and financially. Often caregivers require ongoing psychological care themselves. Despite extensive research, the causes of Alzheimer’s remained elusive in the 21st century. In 2015, nearly 30 million people around the world were diagnosed with Alzheimer’s disease, and 1.9 million died. The number of undiagnosed sufferers of the disease can only be imagined, and the pandemic is expected to continue to grow with the aging of societies in the developed nations of the world.


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