Plagues in Pre-European Americas?

Plagues in Pre-European Americas?

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Are there any historical accounts that those living in the Americas encountered a plague or plagues that proved to be as devastating on the population as that of the Bubonic (black) plague in Europe? Specifically I am interested in sickness prior to contact with Europeans.

NOTE: I am not looking for the Black plague to have existed in the Americas but rather any type of sickness that may have had devastating affects on the population(s) throughout the Americas.

The one pandemic disease we know of that has a good chance for having an origin in the Americas is syphilis.

When it first hit Europe in 1494 it spread rapidly and the mortality rate was very high (as is typical with new diseases that hit an immunologically naieve population).

As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." The disease then was much more lethal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today."

Given the history of other pandemic diseases, it isn't too much of a stretch to speculate that it would have been even more devestating when it first broke out in the Americas, at least among the more densely settled communities, before both disease and host evolved to live with each other better.

I'm unaware of any archeological proof of this though (skeleton bone studies, etc). Most of the evidence behind the Americas theory of syphilis is currently circumstantial.

You can find the answer to that question in Jared Diamond's book Guns, Germs and Steel. He states that people get infected by their pets and that all great epidemics (variola, tuberculosis, malaria, plague, influenza… ) evolved from animals. Microbes needs a mass of people to spread around so big societies, living in cities and connected with good trading roads, were is the best place for them. They can't survive in small societies because they kill anyone who isn't resistant and therefore fails to spread. Those who survive develop antibodies. Microbes can't survive in small communities of farmers and hunters.

Because american Indians didn't have antibodies to European diseases so many died - sometimes the whole villages. In this diseases it is also success in Pizarro's and Cortes' success. Some scientist believe that there were 95 % decrease in population in 200 years after Columbus.

The only infectious disease coming from America to Europe was syphilis. In America there were great civilizations living in big cities: Aztecs, Incas and Indians who lived in Mississippi. But this cities were never connected with trading paths so microbes couldn't spread as they did in Europe and Asia. The main reason for lack of infectious diseases is that there were no animals, living in herds. There were only five domestic animals: a turkey, a lama, a cavy, some bird and a dog - and they were no source of microbes as cows, sheep.
It doesn't mean that there are no infectious diseases, but there are not so many. But epidemics, diseases of masses, can appear only in dense crowd. This started with agriculture 10.000 years ago and increased with building cities. People live close to each other, they also have pets…

If I sum it up: according to Jared Diamond there were no epidemics in Americas before 1492.

When I was out west a number of years ago, a friend asserted that the disappearance of the "Anasazi" civilization of native Americans could have occurred for any number of reasons, including disease. Unfortunately, I don't think modern scholarship on the subject agrees with his assertion.

Widespread disease generally requires a lot of people to reside in close proximity (cities). While there is evidence of cities of 20,000 to 30,000 among native Americans, the major population centers of Europe during the Black Plague were likely far larger (over 100,000). I would assume that since there were cities, there was also trade, so disease could have been spread from city to city. I'm not at all familiar with the cities or the culture, so have no idea whether sanitation, animal-keeping, large numbers of rodents or other contributing factors were similar to the European experience.

History's 5 deadliest pandemics and epidemics

A little more than 100 years before the coronavirus outbreak, the world was in the grips of the Spanish Flu, which was believed to have infected about one third of the global population at the time.

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Before coronavirus, other deadly pandemics and epidemics ravaged the globe, resulting in horrific death tolls. Here are 5 of the deadliest in history.


Like the coronavirus, the Antonine Plague is believed to have originated in China. Soldiers marching to Rome from Mesopotamia in late 165 AD were ill, many covered in red and black papules that eventually would scab over and fall off. The plague would soon spread across the Roman Empire. Also similar to the current pandemic, not everyone who caught the virus -- which researchers believe was probably smallpox -- died, and those who survived became immune. However, by the time the plague was under control in 180 AD, it had killed millions of people and had practically wiped out Rome’s 150,000-man military. It also claimed the life of Emperor Marcus Aurelius.

The symptoms, described by famous Roman physician Galen, were unpleasant: diarrhea, coughing, fever, dry throat and the aforementioned papules.

One legend floating around during the time had it that the disease was released when a Roman soldier accidentally opened a golden casket in the temple of Apollo, freeing the cursed plague from confinement. Either way, many were certain that they had done something to anger the gods, such as the sack of the ancient Mesopotamian city of Seleucia. Christians also were blamed for angering the gods.


Believed to have been brought over by rat-infested merchant ships sailing into Egypt, at one point the Plague of Justinian (named after the ruling Byzantine emperor at the time) is said to have killed up to 100,000 people a day on average. Recently these figures have been called into question, but researchers have said the Bubonic Plague (Yersinia pestis) spread and continued to pop up from time to time in Europe, Asia, and Africa for years after its arrival in 541 AD, killing millions of people.

Byzantine Greek scholar Procopius wrote of the plague’s beginnings, “It began with the Egyptians who live in Pelusium. It divided and part went to Alexandria and the rest of Egypt, and part to the people of Palestine, the neighbors of the Egyptians, and from there, overran the whole earth.”

The bubonic plague can be transferred from rats to humans through flea bites. Pus filled buboes then grow on parts of the body -- generally in the armpit and groin area -- and a fever develops. Though the Black Death was caused by the same disease, researchers have determined that a different strain caused the Justinian Plague.


Thought to have originated in the Congo when the virus was transmitted from chimpanzee to human in 1920, HIV -- the virus that causes Acquired Immunodeficiency Syndrome (AIDS) -- didn’t begin to spread in America until the early ’80s, though some research indicates it may have arrived in New York City from Haiti as early as 1970. In 1981, gay men began being hospitalized for rare cancers and lung infections. Doctors didn’t know how these rare diseases were cropping up, though they believed some condition must have been causing them. In 1982, heroin users began getting these diseases as well, and that year they named the condition AIDS. HIV was isolated in a lab and identified in a French lab in 1983.

The World Health Organization characterizes HIV/AIDS as a global epidemic, whereas the CDC describes it as a pandemic.

According to UNAIDS, an estimated 36 million people are estimated to have died from AIDS-related causes, the peak occurring in 2005 with 2.3 million deaths. The worst area hit was Sub-Saharan Africa, where in 2005, an estimated 2.7 million people became infected with HIV and 2 million adults and children died of AIDS.

In the years since, while antivirals and preventative medication PrEP have helped to prevent transmission of the disease, the number in the United States has leveled off since 2013 with around 39,000 new HIV infections annually.


The 1918 Spanish Flu pandemic was the worst in recent history, with one-third of the earth’s population becoming infected with the H1N1 virus, eventually killing 50 million people. Researchers still can’t pinpoint what made the virus so deadly, but like the current coronavirus pandemic, there was no vaccine at the time. People were instructed to quarantine, maintain social distance, wash hands and sterilize, which was basically all they could do. Some U.S. cities, such as San Francisco, also passed ordinances forcing people to wear masks.

The disease is believed to have first appeared in 1916 in a British army hospital, located in Étaples, France, and like the H5N1 Virus, may have been caused by birds. This severe pneumonia-like influenza festered and spread in the cold, wet trenches of World War I, and from there, it circled the globe.

1) THE BLACK DEATH (1347-1353 AD): 50 to 200 MILLION+ DEAD

Some figures of the Black Death’s toll range from 50 million, others 200 million or higher, which arguably would make it the most deadly pandemic in world history.

Many scholars believe that, like COVID-19, the Black Death originated in Asia. It was spread by the movement of Batu Khan’s Golden Horde. During the horde’s siege of Caffa (A major seaport on the Black Sea), the Mongols -- who were losing numbers rapidly to the disease -- catapulted buboe-riddled bodies over the city walls. It spread to the fleeing populace, whose merchants then took it over the Black Sea.

The nightmare began for Europe one October day in 1347 as 12 ships from the Black Sea arrived in Sicily. Porters greeting the ships found a grisly sight: a few ill sailors, their bodies ravaged with black, oozing buboes, standing on deck among their dead crewmates. Despite soon banishing the ships from the port, the damage already was done.

From Sicily, the disease spread like wildfire, ravaging the European population until 1353. Symptoms included high fever, chills, vomiting and diarrhea. It also caused the aforementioned pus-filled buboes as well as parts of the body (nose, fingers, toes, etc.) to become black with gangrene. While it has long been maintained that the Black Death was spread through fleas from rats, many now believe it was spread through human fleas and body lice. Dr. Samuel K. Cohn, a medieval history professor at the University of Glasgow and author of "The Black Death Transformed" (2002), was one of the original proponents of the theory that it was spread via human-to-human transmission.

“It spread very quickly,” Cohn told Fox News. “It was not spread by the inefficient mechanism of fleas on rats, although the textbooks demand that that must be the case, especially now with ancient DNA which shows with a strain of Yersinia pestis - however as we know from diseases like SARS and syphilis, different pathogens can be very closely related and produce completely different diseases.”

In his book, Cohn noted that people developed a resistance to the Black Death, which was a medical impossibility with the “classic” Bubonic Plague. Also, the Black Death thrived in temperatures and seasons when rat fleas were at their lowest ebb. What exactly the Black Death was remained unknown, though one thing was sure- it spread fast and would spread even faster today than COVID-19 thanks to modern modes of transportation.

“I would say the Black Death was even faster spreading [than coronavirus] in some ways given its track-record in circumnavigating Europe,” Cohn explained. “The Black Death could only move as fast as people and horses could move, so it couldn’t spread faster than an airplane can carry people. But, the whole dissemination seems to have been from 1348-49, a more quickly spreading disease within a certain area over time, and the disease knocked out anywhere from a half to 3/4 of the population of Florence in the space of three or four months.”


The Black Death, a pandemic caused by the bacterium Yersinia pestis that spread across Asia, Africa and Europe beginning in 1346, was “without question the most catastrophic health crisis in recorded history,” Mark Bailey, a historian and the author of “After the Black Death: Economy, Society, and the Law in Fourteenth-Century England,” said in an interview. In England, it killed around 50 percent of the population in 1348 and 1349 in Europe as a whole, estimates range from 30 to 60 percent. The sheer scale of mortality was an enormous shock, though its effects went far beyond that. As Monica Green, a historian of medicine who specializes in medieval Europe, put it, “Who will bring in the harvest if half the people are gone?”

Different societies responded in different ways. In many parts of northwestern Europe, such as Britain and what is now the Netherlands, the sudden death of a huge share of working people meant it was easier for the survivors to get work and acquire land. “You get an increase in wealth per head and a reduction in wealth inequality,” Mr. Bailey explained. Economically, at least, “ordinary people are better off.”

The reverse was true in much of eastern Europe, where lords consolidated their power over the now-scarce peasantry to reimpose serfdom, forcing them to work the land on terms favorable to landowners. There, inequality flatlined or actually increased in the wake of the plague.

There are many competing explanations for the split, but one possibility is that “the Black Death tends to accelerate existing trends,” like a movement toward a less feudal, more consumer-based economy in northern Europe, Mr. Bailey said. But that region didn’t magically become a bastion of equality post-plague — the English government imposed wage caps in the mid-14th century to keep pay from going too high. The result was widespread unrest, culminating in the Peasants’ Revolt of 1381, which brought together people of a wide variety of social backgrounds in an expression of “pent-up frustration” at government mismanagement of the economy, Mr. Bailey said.

Over all, if “resilience in a pandemic is coping,” he continued, “economic and social resilience subsequently is adapting.” The modern lesson: “Adapting to the new reality, the new paradigm, the new opportunities, is key.”

9. Third Cholera Pandemic 1846-1863

Before the development of purification techniques, water supplies were frequently the source of devastating epidemics. And cholera, a water-borne bacteria originating from India, was often the culprit when it came to global outbreaks. The disease enters the body through drinking water and kills its victims through severe diarrhea, vomiting and dehydration.

One of cholera’s most devastating spells occurred from 1846 to 1863. The infection spread from India to Afghanistan in 1839, and then there were sporadic outbreaks over the next six years before it reappeared in India and the Middle East in 1845. It worked its way across the world to Russia, where it is estimated that it caused at least a million deaths. And by 1848, it was wreaking havoc on Europe. In 1854, more than 23,000 died in Britain alone. It seemed no one was safe, as the disease hit Africa and made its way through the Americas as well.

On the other hand, the London cholera outbreak also played an important role in the founding of epidemiology. In 1854, physician John Snow analyzed cholera’s fatalities and noticed that a large number of cases in Soho were clustered around the pump in Broad Street.

He concluded that the pump’s water was somehow contaminated with “cholera poison” and requested that the local authorities remove its handle. This was one of the first times that modern methods like statistics had been used to combat a disease outbreak. As such, John Snow has been dubbed the “father of modern epidemiology.”

A Brief History of Plagues and Pandemics: From the Black Death to COVID-19

Daily life in the age of coronavirus has affected us in different ways. For science writers, it means that many of the physicians and scientists we would in normal times talk to are too busy saving lives. At the same time, the science and medical journals are spewing articles faster than we can keep up, peer review necessarily delayed.

For the first half of March, I wrote breaking news articles and quickly burnt out. No one was giving interviews as the publication cycle continually compressed, sometimes doubling back to correct errors as new information flooded in.

And then the webinars began, some for media, some for physicians. I&rsquove been doing as many as I can, from government agencies, patient advocacy groups, and the journals. This is my sixteenth piece on the novel coronavirus, thanks largely to these constant updates from the experts. My favorite webinar series is the Live Stream Q&A sessions from The Journal of the American Medical Association&rsquos editor-in-chief Howard Bauchner, MD.

I especially liked the webcast on April 2 with Frank Snowden, PhD, professor emeritus of history of medicine at Yale and the author of Epidemics and Society: From the Black Death to the Present, published fortuitously this past fall. Listening to him reminded me of my favorite books about plagues and pandemics, which I&rsquoll list at the end.

Dr. Anthony Fauci, who needs no introduction with his face plastered on tee shirts and donuts (I&rsquove joined his Facebook fan club), does the JAMA webinar regularly, most recently on April 8. So I&rsquom going to pretend that both gentlemen are sitting here with me and my cats in my living room, briefing me on the past and future of COVID-19, and how it fits into the grand sweep of epidemiology.

&ldquoAn Extraordinary Convergence of Events&rdquo

Dr. Snowden attributes the current pandemic to an &ldquoextraordinary convergence of events.&rdquo

&ldquoNumber one, I am struck by the ease with which it has spread throughout the world, which is partly because of the kind of world we&rsquove built. Number two, I am struck by the lack of preparedness. The world was totally unprepared in ways that are difficult to comprehend, because since 1997, when we had avian influenza, a surge of epidemiologists and virologists were saying that another pandemic challenge is an inevitable part of our future.&rdquo He expanded on the issue.

In 2005 and 2006, in the wake of the SARS epidemic, the US Congress, the World Health Organization (WHO), and companies began working on preparedness plans. But they dropped the ball when the epidemic faded, &ldquoeven after Anthony Fauci said to Congress that if you are living in the Caribbean, you&rsquod expect a meteorologist to say a hurricane is inevitable, but couldn&rsquot say when it would hit or how powerful it would be. Virologists could tell you another epidemic was coming. We didn&rsquot know how powerful or when, but it was inevitable,&rdquo Dr. Snowden recalled.

By the time Ebola struck in West Africa in 2014, the world once again wasn&rsquot ready. &ldquoIn 2018, WHO appointed a commission to look at global preparedness and they produced a report in 2019, &ldquoA World at Risk,&rdquo Dr. Snowden said. He was amazed that the report predicted that millions could die in a pandemic, yet some countries (names unmentioned) cut their preparedness and public health budgets.

Viruses are no longer named by presumed place of origin, but by taxonomic classification. This is SARS-CoV-2.

&ldquoThirdly, the lack of taking science seriously is what disturbs me the most about the onset of the pandemic,&rdquo Dr. Snowden said, pointing out that skepticism about science persists in many nations. He brought up calling the new pathogen &ldquothe Chinese virus&rdquo long after the WHO had officially named it the more scientifically meaningful SARS-CoV-2. &ldquoIn addition to being stigmatizing, that is saying to the scientists of the world. &lsquowe&rsquore not taking your concerns seriously,&rsquo&rdquo he added.

Comparison to 1918 Influenza

Which past pandemic most resembled the current one? Dr. Snowden immediately answered &ldquo1918 influenza.&rdquo

&ldquoThere is still debate about where and how it started: China or Kansas or at the British military base at Étaples in the north of France. It spread quickly from Étaples with forced movement of troops to the western front. From November 1918 into the new year, it caused 50 million to 100 million deaths, many times more than the number of deaths from the first world war.&rdquo

An important factor, ironically, was the peace that followed the war. Returning soldiers brought the disease to the U.S., where welcome-back parties fueled the fires of contagion. After a parade in Philadelphia, hundreds of thousands of people fell sick. &ldquoOther major cities took measures that look like what we&rsquore doing today: masks, social distancing, canceling major events like church services where people congregate,&rdquo Dr. Snowden said. Did the mayor of New Orleans know about the Philadelphia parade when Mardi Gras 2020 happened?

Another striking feature is that the 1918 pandemic was largely forgotten. &ldquoHow could a disease that caused 100 million deaths not sear a long-term memory into our institutions and economy? It was overshadowed by war, and then by peace, and it didn&rsquot besiege communities like bubonic plague, but swept and left devastation and was gone in a few weeks,&rdquo Dr. Snowden said. He pointed out that Britain has many monuments to remember the first world war and the bravery of the soldiers, but just one monument to remember &ldquothe heroes of the 1918 influenza, the doctors and nurses who put their lives on the line to care for patients and their colleagues.&rdquo

Influenza virus. (credit: CDC)

The influenza virus circled the globe in three undulations. &ldquoThe early waves were in the spring of 1918 and were rather benign, not a major cause of mortality. Probably the virus mutated between the spring and the autumn, when it became catastrophic and coincided with the end of the war. The curve of mortality was pronounced,&rdquo Dr. Snowden said.

Curiously, the influenza pandemic of 1918 spared the very young and the elderly, creating &ldquoa W-shaped curve and not a U, with that spike in the middle the young people, like the soldiers,&rdquo Dr. Snowden explained. The soldiers died of an overactive immune response that filled their lungs rapidly with fluid, the &ldquocytokine storm&rdquo that today is ravaging lungs infected with SARS-CoV-2.

In 1918 the young were vulnerable because they were crowded in the hellish environment of war, on transport ships and in military camps. Their elders may have been protected from having survived previous flu epidemics and building up a strong antibody response to similar viruses.

Will COVID-19 follow a path similar to the 1918 flu? If so, it will do so over a landscape vastly different from the scattered towns and cities of the U.S. a century ago.

&ldquoThere was extraordinary morbidity and mortality in 1918, and yet it didn&rsquot affect the world in the way that this coronavirus seems to be doing. The new virus may be having a more lasting effect, we don&rsquot yet know. Clearly there will be major long term effects on the economy, on the relationships between industrial countries and emerging markets, international supply links, and all sorts of things,&rdquo Dr. Snowden said.

The famous Broad Street pump.

&ldquoEach epidemic, each pandemic, is unique. Pandemics are not interchangeable. Each is experienced by society a different way. It&rsquos interesting to think about why some have left a huge footprint and others seem not to have,&rdquo Dr. Snowden said. He recalled the classic epidemiology tale of London&rsquos Broad Street water pump handle, to which local physician Dr. John Snow and Reverend Henry Whitehead traced a fierce epidemic of cholera in September, 1854 that would have lasting effects on public health.

Patient zero was a baby girl who lived at 40 Broad Street and developed severe diarrhea on September 28. Her mother washed her nappies out a few feet from the pump, sending bacteria-laden stool into the neighborhood&rsquos water supply. Ten percent of the street&rsquos residents died within two weeks. Cholera kills in days.

The cholera outbreak &ldquohad a huge impact on the sanitary movement: making drinking water safer and instituting housing regulations paved the road towards the idea of the germ theory of disease. These accomplishments emerged out of this major cataclysm that was much smaller than the 1918 flu,&rdquo Dr. Snowden said.

The Black Death and Tuberculosis Breed Blame

Parallel to the spread of a pathogen may be the spread of discrimination.

Bubonic plague, caused by the bacterium Yersinia pestis, is perhaps the most long-lasting and pervasive example. Dr. Snowden spoke softly of the horrors.

A depiction of the burning of Jews in Strasbourg in 1349, accused of having poisoning the wells with plague bacteria.

&ldquoThe Black Death was a time of extraordinary violence. In Strasbourg (on the border of France and Germany, in 1349) 12,000 Jews were rounded up and taken to a Jewish cemetery and given the option to convert or be killed on the spot. Half refused and were burned alive.&rdquo The Jews had been accused of poisoning wells with plague bacteria.

A novel published in 1827 and set in 1630 Milan, The Betrothed, by Alessandro Manzoni, illustrated another plague-driven travesty. &ldquoThe Spaniards were innocent, but in the wrong place and time and were rounded up and tortured until they confessed. Their bodies were broken on the wheel and they were burned alive, accused of spreading a disease by poisoning the wells,&rdquo Dr. Snowden said.

Tuberculosis also seemed to bring out the worst in frightened people. &ldquoWith TB it began, paradoxically, when people understood that it wasn&rsquot hereditary but caused by a germ, which they associated with filth. Working classes were held responsible. Social tension and stigma arose on a class and ethnic basis in places like New York because immigrants were more likely to be dangerous,&rdquo Dr. Snowden said.

Closer to our own time, Dr. Snowden pointed out, is the horrific stigmatization of the &ldquo4H&rdquo groups that emerged as high risk in the early days of the HIV/AIDS pandemic: in the language of the time, homosexuals, Haitians, hemophiliacs, and heroin addicts.

Dr. Fauci was on the frontlines back then. He recalled:

&ldquoI got involved with HIV a week after the first report in the MMWR (CDC&rsquos weekly newsletter) in June 1981. I completely turned my lab around to delve into a disease that had no name, no known etiology, and we didn&rsquot know what we were doing. In the early years of HIV/AIDS, 30,000 to 35,000 people died a year. It was insidious then, seeming to involve a very circumscribed demographic.&rdquo

He compared HIV/AIDS&rsquo stealth trajectory to the stunning speed of COVID-19:

&ldquoHIV/AIDS didn&rsquot instill fear for awhile. It was only when we found out, through antibody testing, that ill patients were the tip of the iceberg did people realize it was turning into a global problem that would extend four decades and at the end of the day would kill infinitely more people than COVID-19. With COVID the timeline is truncated into weeks. It explodes and everyone is vulnerable all over the world, in real time, and all are afraid.&rdquo

Will We Be Ready Next Time?

My grandfather met my grandmother in the midst of the 1918 influenza pandemic &ndash she was his nurse. He rarely got so much as a sniffle in his remaining years, dying at age 103. Those antibodies must have been powerful.

We don&rsquot remember the 1918 influenza. Plague is now exceedingly rare, and cholera and TB no longer seen in many parts of the world.

But people my age remember the &ldquochildhood diseases&rdquo of measles, mumps, chickenpox, and rubella, the empty classrooms, the &ldquoparties&rdquo parents held to expose their little ones to get the diseases over with, for only rarely were they dangerous (see &ldquoVaccine Memories&rdquo).

We can all recall recent outbreaks of influenza, and the vaccines that might not seem to have worked, partly because other types of viruses, like rhinovirus, adenovirus, syncytial virus, and other coronaviruses, cause respiratory infections too. The shared symptoms reflect the responses of our immune systems, not weapons that the pathogens directly deploy.

We&rsquove all heard of HIV/AIDS. And SARS.

So anyone who didn&rsquot think a pandemic was possible just wasn&rsquot paying close enough attention &ndash to the clues from history and to the informed predictions of today&rsquos scientists, medical researchers, clinicians, and others.

Will we let a pandemic sneak up on us again? Is the warning from COVID-19, enough?

Dr. Anthony Fauci, director of the NIAID

Dr. Fauci thinks this crisis is a game changer. &ldquoI hope when we get out of this that we take a look at long term investment in public health. We have a habit of when we get over a challenge, we say &lsquolet&rsquos move on.&rsquo We should never be in a position to be hit like this again and have to scramble to respond. This is historic.&rdquo

Deadly Diseases:

Experts warn a global pandemic will halt humanity as we know it in the next 20 to 30 years. Past epidemics may offer some insight into what the future holds. Here’s a look back at some of them.

Smallpox is caused by the variola virus, which spreads through skin-to-skin contact or contact with bodily fluids. It can also be spread through the air.

In 430 B.C., smallpox killed more than 30,000 people in Athens, Greece, reducing the city’s population by at least 20%.

The Plague of Justinian, which began in 541 and continued on and off for nearly 200 years, killed 50 million people in the Middle East, Asia and the Mediterranean basin, according to some estimates. The plague is caused by bacteria that are spread by rats that were bitten by infected fleas.

What's known as the Great Plague of London actually started in China in 1334 and spread along trade routes, wiping out entire towns. Florence, Italy, lost a third of its 90,000 residents in the first six months. Overall, Europe lost 25 million people.

There were approximately 25 million people living in what is now called Mexico when Hernando Cortes arrived in 1519. A smallpox epidemic killed between 5 and 8 million of the native population in the following two years. Over the next century, less than 2 million would survive this and other communicable diseases brought by European explorers.

Smallpox reached Massachusetts in 1633, brought by settlers from France, Great Britain and the Netherlands. It quickly spread to the Native American population, which had up until now been free of this communicable disease. It’s unclear how many were killed by smallpox, though historians estimate some 20 million may have died after the Europeans landed.

Philadelphia was struck with a yellow fever epidemic in 1793 that killed a 10th of the city's 45,000-person population.

The Modern Plague began in the 1860s and killed more than 12 million people in China, India and Hong Kong. It wasn’t until the 1890s that people figured out how the bacterial infection was being spread and a vaccine was created.

A smallpox epidemic in Boston infected 1,500 people in 1901. There were 270 reported deaths.

The largest plague outbreak in the 20th century occurred in Manchuria between 1910 and 1911. Approximately 60,000 people died. The plague still occasionally causes smaller outbreaks in parts of sub-Saharan Africa.

The great flu pandemic of 1918 and 1919 is estimated to have killed between 30 million and 50 million people worldwide. Among them were 675,000 Americans.

Polio peaked in the US. Nearly 60,000 children were infected and more than 3,000 died. Three years later vaccination began to prevent the communicable disease.

In 1984, scientists identified the human immunodeficiency virus, or HIV, as the cause of AIDS. That same year the deadly disease killed more than 5,500 people in the United States. Today more than 35 million people around the world are living with an HIV infection. More than 25 million people have died of AIDS since the first cases were reported.

Severe Acute Respiratory Syndrome, better known as SARS, was first identified in 2003 in China, though the first case is believed to have occurred in November 2002. By July more than 8,000 cases and 774 deaths had been reported.

The global H1N1 flu pandemic may have killed as many as 575,000 people, though only 18,500 deaths were confirmed. The H1N1 virus is a type of swine flu, which is a respiratory disease of pigs caused by the type A influenza virus.

An epidemic of cholera killed at least 10,000 people in Haiti in 2010 following a deadly earthquake that paralyzed the nation. The outbreak hampered efforts to rebuild. The United Nations would later apologize for initially denying claims that Nepalese peacekeepers brought the deadly disease to the country following the earthquake.

In 2012, approximately 122,000 people worldwide died from the measles, a highly contagious disease caused by a virus. Typhoid fever kills around 216,000 people a year. Tuberculosis, an infectious bacterial disease, killed an estimated 1.3 million in 2012. These are some of the infectious diseases that most concern health officials today.

The 2014 epidemic of Ebola hemorrhagic fever in West Africa was the largest Ebola outbreak on record. The virus killed more than 11,300 people before it was declared over in 2016.

The World Health Organization declared a public health emergency of international concern over Zika virus predicting 3 to 4 million would be infected within a year as it was “spreading explosively” throughout the Americas. Zika is the first mosquito-borne disease to cause a birth defect. The devastating birth defect is microcephaly. The virus is also associated with miscarriage, stillbirth and other neurological deficits. While not deadly in the way other epidemics are, there is a big impact on future generations when fewer children are born because parents are afraid of the virus.

6 Cholera - 1832 - 1848

First showing up in Europe and in North America around 1831, Cholera is thought to have come from India. The disease, which causes violent cramps, vomiting and diarrhea usually causes death through dehydration so severe that the blood thickens and the skin turns blue. Cholera victims can die within a matter of hours, though these days the CDC considers it treatable with re-hydration. However, during the 1800s, it claimed the lives of many thousands of people.

Black Death comes to America

What was called the Black Death in medieval times was then raging across Asia. Millions had died, and U.S. public health officials had long feared that it could make its way across the Pacific to West Coast ports. The highly infectious disease, typically carried by rodents, was usually fatal.

But then, two days after Gin’s body was found, the San Francisco Chronicle published a front-page story with the headline, “Plague Fake is Part of a Plot to Plunder.” Local businessmen feared that news of a plague outbreak would ravage the economy, and they hotly disputed the claim by the city’s Board of Health. Under their pressure, the city lifted the quarantine the next day. The newspaper celebrated the decision, complaining that it had caused “vast injury to business.”

Another local publication, the Bulletin, at the same time insisted that plague was, in any case, less dangerous than “measles, mumps, or any of the common ills we know of.” The newspaper added with alarm that news of the plague was diverting both tourists and cargo from the bustling port.

On March 11, a federal official named Joseph Kinyoun confirmed that Gin had died of plague. Kinyoun led the port’s Marine Health Service, the federal office responsible for dealing with disease threats that could enter through the nation’s ports. A respected physician, he had helped found the U.S. Hygienic Laboratory that led to the National Institutes of Health.

More deaths from plague followed. In May, Kinyoun warned the surgeon general that the outbreak was turning into an epidemic. “I have to request the matter be brought to the attention of the President,” the surgeon general wrote to his superior, the Secretary of the Treasury, on May 21. He asked that the president approve “such regulations as may be necessary to prevent the spread of this disease.” (This is how some cities "flattened the curve" when the flu pandemic hit 18 years later.)

President William McKinley agreed to the request that day. But the federal government was reluctant to take dramatic steps that might anger California’s Republican governor, Henry Gage, and the state’s powerful business community. Its actions were limited to re-imposing the quarantine on Chinatown while using armed patrols to halt movement of all Chinese into and out of the city.

San Francisco’s supervisors continued to insist that there was no epidemic, only a few isolated cases that had been contained. And the Chinese community fought back against what its leaders saw as blatant discrimination. A court ordered the quarantine lifted on June 15, siding with a Chinese business association that claimed it was based on race rather than science. The judge also ruled that there was insufficient evidence to prove the plague’s existence. Even the Pacific Medical Journal denied there was an epidemic, claiming that the plague tests were faulty.

The stakes were high: Other nations were considering halting trade with California, and tourism was slumping. Newspapers like the Chronicle continued to insist that claims of plague were part of a secret effort to undermine the city’s economy.

Kinyoun quickly became the prime target of the naysayers, despite his sterling credentials. He had studied with plague experts in Europe—including one of the two men who discovered the bacillus that caused the disease—and had been put in his position specifically to safeguard California from the expected arrival of plague. When he refused to accept bribes to falsify his data, he was mercilessly attacked in print as corrupt and incompetent, and even suspected of planting the bacillus on Gin’s corpse.

Kinyoun continued to report to the surgeon general on the epidemic. In October, he noted three more individuals with plague. “All cases terminated fatally,” he wrote. “The area of infection is gradually growing wider.”

The following January, Governor Gage publicly castigated “the plague fakers” and accused Kinyoun by name of giving a “post-mortem inoculation” using “imported plague bacilli.” Such a crime, he added, was a felony with a punishment of life imprisonment. Kinyoun was later briefly arrested by state officials.

20 of History’s Most Devastating Plagues and Epidemics

The January 12, 1890, edition of the satirical magazine Le Grelot, depicting an influenza sufferer followed a parade of hysterical hangers-on. By Pépin E. Guillaumin (c. 1889. Wikimedia Commons.

3. Originating in the Russian city of Saint Petersburg, the flu pandemic of 1889-1890 rapidly spread throughout the globe to kill more than a million people within two months

Sometimes referred to as &ldquoRussian flu&rdquo or &ldquoAsiatic flu&rdquo, although not to be confused with the Russian flu strain known as H1N1, the pandemic of 1889-1990 was a worldwide outbreak of influenza. Assisted by the advancement of modern transport infrastructure, with the largest nineteen nations of Europe possessing a collective two hundred thousand kilometers of railway by the late-19th century, influenza, for the first time, was provided the opportunity to become truly global in scope. First recorded in Saint Petersburg in December 1889, within four months the virus had spread throughout the Northern Hemisphere.

Demonstrating the rapidity of its spread, the peak of the pandemic in the United States was the second week of January 1890. Taking just five weeks to reach peak mortality, more than one million people worldwide were killed by the outbreak. Originally thought to have been a strain of the H2N2 influenza virus, known as Asian flu and mutated from birds, modern medical analysis has cast doubt on this claim. Instead, it is widely suggested today that the pandemic was a result of the broader H3N8 strain, more commonly found in ducks, dogs, and horses.

Future Epidemics

The next global epidemic is the fear of many public health professionals. Given the ease of mobility and absolute globalization of today, a rapidly spreading disease that could wipe out the population is easy to imagine. The likelihood that this epidemic would come from animals is very high. New infectious pathogens are being discovered every day. Large farms pose the greatest danger because of the constant contact between animals and people the potential of cross-contagion is increased. It is important that governments and public health officials maintain a strong, vigilant network to prevent widespread diseases in the future.

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