Epidemics and Pandemics: The History

BACKGROUND

Deaths from infectious diseases have generally declined since records began in the late 19th century. In the 1870s infectious diseases accounted for a third of all deaths. By 1900 the proportion was down to 15%, and by 2000 infectious diseases caused fewer than 7% of all deaths. 

Though epidemics have become less frequent, studies have found that hospital admission and discharge rates for infectious diseases have increased since at least the 1980s. This counters the prevailing wisdom that these diseases have become less of a burden.  

In 2009 there was widespread concern about the ‘swine flu’ pandemic. While there were 20 deaths in New Zealand, this was a tiny fraction of the 9,000 who died in the 1918 flu pandemic. Since the advent of vaccination, antibiotics and better sanitation, epidemics have been more readily controlled.   

Source: Epidemics, Te Ara - the Encyclopedia of New Zealand.

CONTENTS

• Epidemics, pandemics & endemic disease
• Early beliefs about disease
• Bacterial diseases
• Diseases caused by viruses
• Life during epidemics & pandemics
• Disease during war
• Glossary
• Supporting resources.

EPIDEMICS, PANDEMICS AND ENDEMIC DISEASE

An epidemic is the abnormally high level of a disease at a particular time. It usually refers to infectious diseases, but it is also possible to have epidemics of non-infectious diseases such as heart disease and diabetes, and conditions such as obesity.

A pandemic occurs when an epidemic spreads from one country to another and becomes prevalent around the world. New Zealand has experienced three pandemics – all influenza – in 1890–94, 1918 and 2009.

An endemic disease is continually present in a population at a low rate, or with a low death rate. An example of this in New Zealand in the 21st century was hepatitis B.

Source: Epidemics, Te Ara - the Encyclopedia of New Zealand.

QUICK FACTS

• One of the first recorded pandemics was the Antonine Plague or the Plague of Galen, centred in the Mediterranean and beginning in 165 CE.
• The pandemic known as the Black Death or Bubonic Plague is believed to have killed 200 million people throughout Europe.
• Smallpox is thought to have caused the death of 90% of Native American peoples when it was introduced to America by European settlers.
• The fall of the Roman Empire may have happened more quickly due to the Plague of Justinian that lasted for 225 years.
• HIV/AIDS is an ongoing pandemic that has so far killed between 25 and 35 million, many of those children. Two thirds of the deaths have been in the African continent, but HIV/AIDS has killed more people in India than any other country.

EARLY BELIEFS ABOUT DISEASE

Today we are able to draw on the knowledge of the work of the many scientists who have helped us understand disease. However, in the past, people have not always been so fortunate. For a long time, it was believed that epidemics and pandemics were caused by such things as committing acts that offended god(s), spirits, or even important rulers. 

There are few substances that have not been used as a cure for disease at some time in history. Many bogus 'cures' have been created, for example during the Influenza pandemic of 1918. Interesting inventions included the influenza inhaler, a device that sprayed zine sulfate down the throat as a preventative.

QUICK FACTS

• In some cultures it was believed that disease could be banished by offering human sacrifice to the god(s).
• Ancient Greek physicians believed that an imbalance of the bodies four 'humours' could bring about disease.
• The cities of Baghdad (in current Iran) and Cairo (in Egypt) had hospitals providing a range of treatments for disease as early as 800 CE.
• Alchemists practicing in Greece, Egypt and China tried to create medicines from natural compounds to treat diseases; this was known as alchemy.
• A documented cure for malaria in England was to wear shoes stuffed with the leaves of the tansy plant or to eat spiders webs before breakfast!

BACTERIAL DISEASES

Epidemics and pandemics are caused by microorganisms and are most commonly the result of infection by either bacteria or a virus. Bacterial diseases can now be treated with antibiotics, however, this is a modern invention.

The most famous bacterial pandemic was the Black Death, also known as the Bubonic Plague. Other bacteria that have caused epidemics or pandemics throughout history are cholera, diphtheria, pertussis (whooping cough) and TB or tuberculosis.

QUICK FACTS

• Killing 75 million in Asia alone, the highly contagious Black Death was transmitted by fleas and arrived in England in 1348.
• A cholera pandemic was first recorded in the 19th century and there have been seven more since then; it is now considered endemic in many countries, mostly in impoverished communities with poor water quality.
• An antitoxin for diphtheria was developed in Germany in the 1890s and involved injecting horses with the disease so their immune systems would produce white blood cells which were then extracted and made into the treatment.
• Whooping cough (Pertussis) has been known as quinte, dog bark, chin cough and the 100-day cough.  Pertussis was given its scientific name in 1679, which is derived from Latin - 'per' meaning violent, and 'tussis' meaning cough.
•  A current pandemic is Tuberculosis (TB). In 2019, 10 million people fell ill from TB and there were 1.5  million deaths.

LIFE DURING EPIDEMICS AND PANDEMICS

During times of epidemic or pandemic, communities come together and people often find themselves undertaking unfamiliar tasks such as becoming ambulance drivers or distributing medicine. Throughout history these times were often devastating, and some people lost their entire family. Many children became orphaned.

Children were often called upon to play their part in helping their communities for example by delivering food. Many children, too young to understand the significance of the tragedy unfolding around them, enjoyed these times because schools were often closed.

QUICK FACTS

• In Australia, masks were compulsory in public during the 1918 flu pandemic. Generally, they were used repeatedly and not washed.
• During the polio epidemic of 1916, New Zealand children were sent away from their families to the countryside for safety.
• Inhalation chambers were set up during the 1918 flu pandemic. People were shut in a chamber for around 5 minutes to breath in gas to cure influenza, however, it was quickly stopped when it was found to be ineffective.
• Families tried to shield their children from the realities of the 1918 flu pandemic in Spain, by closing the curtains when funeral processions passed by.
• City streets became very eerie places under COVID-19 lockdowns. It was described as feeling like the end of the world by residents of Wuhan in China.

DISEASES CAUSED BY VIRUSES

Viruses behave differently from bacteria, often being more difficult to fight partly because they are able to mutate quickly. The best defence against viruses is immunisation (also known as vaccination), however, like antibiotics, this a modern invention that hasn't always been available.

Viruses that have caused epidemics or pandemics include influenza, cholera, malaria, polio and smallpox. Countries that have maintained high rates of immunisation in recent history have been able to eliminate these diseases from their populations. 

However, in poorer countries, where health systems are often inadequate and there is a lack of access to clean water, food and shelter, these diseases persist and still cause many deaths.

QUICK FACTS

• Polio is also known as infantile paralysis and 'the crippler' because if the virus is able to enter the bloodstream, it can damage the spinal cord resulting in paralysis. 
• Polio is a disease which became more prevalent because of improved hygiene and sanitation in the 1800s, as babies did not develop immunity as they had done previously.
• The world's first vaccine was developed to fight smallpox which was finally eradicated in 1979.
• Rabies is a disease transmitted through the bite of infected animals, usually mammals such as bats, dogs and foxes. In countries that can afford it, a highly effective vaccine is available that was developed in 1885 by Louis Pasteur and Emile Roux. 

DISEASE DURING WAR

Throughout history, the training grounds and battlefields of war have been breeding grounds for disease. Vaccination did not exist, soldiers lived in close quarters so the transmission was almost inevitable, and conditions in the trenches for poorly fed men were highly unsanitary.

However, advancement in the treatment of diseases became more rapid during the world wars as scientists strove to reduce the loss of soldiers lives.

QUICK FACTS

• In 1914 during World War 1, British and French soldiers were routinely given an antiserum if they had dirt-contaminated wounds, and as a result, tetanus was almost eradicated.
• Lice were prevalent in the trenches during the First World War and were responsible for spreading the bacterial disease trench fever.
• As a result of the lessons learnt about sanitation, fresh air and overcrowding during the Crimean War, the British opened a specialised training school for army doctors.
• Mass-production of penicillin began in America in 1940 during the Second World War. The drug made a huge difference in the treatment of battlefield infections.
• The 1918 influenza pandemic, that killed an estimated 500 million, spread quickly among First World War troops. It then spread around the world when soldiers returned to their home countries.

GLOSSARY

Definitions below taken from the Oxford Learner's Dictionary and the Oxford English Dictionary.

advent — the coming of an important event, person, invention, etc. 

antitoxin — a substance which has the property of counteracting the effect of a toxin; one of the antibodies capable of neutralizing toxins. 

antiserum — a serum containing a high level of antibodies, esp. one that can be used in the treatment of disease.

bogus — pretending to be real or true.

contagious — if a person is contagious, they have a disease that can be spread by close contact with other people.

eradicated — to destroy or get rid of something completely, especially something bad.

hygiene — the practice of keeping yourself and your living and working areas clean in order to prevent illness and disease.

impoverished — very poor; without money.

mutate — to develop or make something develop a new form or structure, because of a genetic change. 

obesity — the quality or fact of being very fat, in a way that is not healthy.

paralysis — a loss of control of, and sometimes feeling in, part or most of the body, caused by disease or an injury to the nerves. 

prevalent — that exists or is very common at a particular time or in a particular place.

sanitation — the equipment and systems that keep places clean, especially by removing human waste.

SUPPORTING RESOURCES

GENERAL HISTORY

Belief and medicine — in many ancient societies the spirits and gods were believed to make their presence known through disease. 

Brought to life: Exploring the history of medicine — an extensive resources for the exploration of the history of medicine from the British Science Museum.

Could 'zombie pathogens' threaten humanity? — now there are some tantalizing hints that the Arctic is filled with pathogens even more dangerous than anthrax.   

Disease in the Middle Ages — common diseases in the Middle Ages included dysentery (‘the flux’), tuberculosis, arthritis and ‘sweating sickness’.  

Epidemics — an epidemic is when many people have the same disease at the same time. They are usually caused by infectious diseases, such as influenza (flu).

Epidemics — epidemics can bring devastation to a community. But past epidemics have taught us valuable lessons about how to deal with infectious diseases and about the communities that experienced them.  

Fighting infection timeline — this timeline provides a look at some of the historical aspects of fighting infections.

History of Quarantine — the practice of quarantine, as we know it, began during the 14th century in an effort to protect coastal cities from plague epidemics.  

Mass grave of plague victims unearthed in London — archaeologists believe they may have uncovered a mass grave of victims of the great plague.  

Outbreak: Epidemics in a Connected World Digital Exhibit — our world is connected more than ever before—by global travel and trade, by technology, and even by infectious diseases.  

Pandemic — a pandemic is a disease epidemic that has spread to a large group of people across a sprawling region, or across multiple nations or continents.  

Photos from a century of epidemics — the fears from the latest pandemic are rooted deep in history.   

Twenty of the worst epidemics and pandemics in history — plagues and epidemics have ravaged humanity throughout its existence.  

What wiped out the Aztecs? — Salmonella could be partially to blame for a 16th century epidemic that killed millions. 

BACTERIAL DISEASES

Black Death Facts — the Black Death was one of the most feared diseases of the 14th century.

Bubonic Plague: the first pandemic — the impact of the bubonic plague epidemics of the past still echo across the centuries, reminding us of the devastation that disease can inflict on communities. 

Cholera — during the 19th century, cholera spread across the world from its original reservoir in the Ganges delta in India.  

Diphtheria — Diphtheria is a bacterial infection transmitted through close contact with infected individuals.

Fast and lethal, the Black Death spread more than a mile per day — roughly one out of three people died as this medieval plague quickly traveled along European trade routes, devastating communities along the way.

Pertussis (Whooping Cough)  —  a bacterial infection that is of most concern among young children.  

TB is a Pandemic — Tuberculosis (TB) is a global disease, found in every country in the world. It is the leading infectious cause of death worldwide. 

DISEASES CAUSED BY VIRUSES

A Brief History of Measles — measles made its appearance somewhere between the 11th and 12th Centuries.    

AIDS 101 — about 37 million people around the world are currently living with AIDS. 

Dengue Fever — the World Health Organisation says 2019 was worse than usual for dengue fever in the Pacific.  

Global Ebola Response — details the UN response to the Ebola outbreak in West Africa in 2014. 

Human Influenza A (H1N1) (Swine Flu)  — in June 2009 the UN declared the spread of the influenza virus around the world had reached pandemic levels.  

Influenza —  the flu, or influenza, is a highly contagious viral infection that mainly affects the respiratory system.   

Malaria — the disease chiefly affects lowland tropical regions, where conditions favor mosquitoes, which carry the malaria parasite.  

Polio —  also known infantile paralysis, Polio is a viral disease that can cause damage to the spinal cord.

Polio: a 20th century epidemic  —  while many infectious diseases began to decline by the end of the 1800s, incidents of polio increased to epidemic proportions.   

Responding to Rabies —  a viral disease that infects the nervous system, rabies is transmitted through saliva, as well as brain and nervous system tissue.  

SARS (Severe Acute Respiratory Syndrome) Response Timeline  — SARS was first discovered in Asia in February 2003.   

Smallpox and the story of vaccination — Edward Jenner developed the first vaccine to prevent smallpox infections, and this success led to the global eradication of smallpox and the development of many more life-saving vaccines. 

STORIES FROM SURVIVORS

Cures - the 1918 influenza pandemic — all sorts of remedies were tried to cure victims of the pandemic. 

"Hold your breath" — presents the story of Russian artist Paulina Siniatkina’s fight against tuberculosis (TB).

‘I can’t wait to hold my kids again’: Life inside Wuhan’s quarantine — a father, a doctor, and other residents recount the coronavirus outbreak’s deadly first month.

Inhalation chamber during the 1918 influenza epidemic — hear one man's description of being subjected to inhalation treatment. 

John Snow's account of the cholera outbreak  —  in 1854 in Soho, London, cholera killed 127 people in three days and 616 in total within a month.

Letters — a personal account of a visit to Oruawharo marae during the smallpox epidemic.

Masks, Soap and Courage — hear stories from Australia of the 1919 influenza pandemic from the voices of those who experienced it first-hand.

One family's story - the 1918 influenza pandemic — one man tells of the terrible effect of the influenza pandemic on his family.  

Pepe's story: How I survived Spanish flu — still living in his native Luarca, Mr Ameal is believed to be the oldest flu survivor in the country that gave its name to the virus.

"The most unlikely people survived" — an Australian epidemiologist recounts her time in Sierra Leone.

DISEASE DURING WAR

Diseases in World War 1 — in many ways, the years before World War One marked the beginning of the conquest of infectious diseases. 

Diseases at the Battlefield — World War One marked the way into the understanding that infectious diseases are caused by microorganisms, which contributed to the development of preventive treatment such as vaccines and antimicrobial drugs. 

The deadly disease that killed more people than WW1 — a deadly illness took hold as  World War One ended and killed an estimated 50 million people globally. 

Sickness in the ranks — keeping troops fighting fit means preventing and dealing with outbreaks of disease, and each theatre of war brings its own challenges. 

This story was curated and compiled by Te Puna Mātauranga o Aotearoa | National Library of New Zealand, Services to Schools staff, April 2020.