Diseases

The term natural disaster most often evokes images of earthquakes, hurricanes, and floods, but history offers evidence that disease can be the most deadly of disasters. When the Spanish flu pandemic of 1918–19 struck, infecting one-fifth of the world's population, the response techniques of public health officials in Europe and the United States could be traced back to the Middle Ages.

Social distancing through quarantines and suspension of public gatherings were primary tools in the battle against the spread of infection. These tools are still used in the 21st century, along with more sophisticated measures like vaccines, antiviral drugs, and a level of international cooperation unconceivable in earlier times. Despite advances in medicine and public health [Page 118]practices, however, the devastation wrought by uncontrolled infectious disease remains unchanged. The Black Death and smallpox epidemics decimated populations. The Spanish flu of 1918–19 killed between 25 and 40 million people worldwide, and AIDS has killed more than 25 million since 1981.

One of the most famous of disastrous diseases was the bubonic plague, or the Black Death. An epidemic erupted as early as the 6th century, but the disease remained dormant for centuries. In the late 1320s, an outbreak spread from its origins in the Gobi Desert. China's population declined by 35 million over the 14th century, largely due to the plague. The disease followed the caravan routes, moving westward. It reached the Caucasus and the Crimea by 1346, and Constantinople a year later. The disease could travel by ship as well. Sicily, Cyprus, and Italy were infected the same year as Constantinople. In the spring of 1348, 1,000 people died in Alexandria. As Cairo's death count approached 7,000, France, England, Germany, and the low countries were bowing under the power of the relentless plague. The worst year was 1348, but even then there was no end. Norway counted its dead in 1349, and the eastern European countries did the same the following year. By 1351, the plague had reached Russia.

Cities bore the heaviest toll. Milan walled up plague-infested houses with the dying and the healthy inside. Venice isolated incoming ships. Fewer died in these cities as a result of their efforts, but the Black Death continued. Some declared the disease punishment from God; others blamed the alignment of the stars. The plague revisited areas it had already devastated, and each generation of the 14th century suffered under the onslaught of the disease. Twenty million Europeans died in a single, four-year outbreak that began in 1346. Outbreaks lessened in the 15th century, but for another 200 years, the disease struck in local epidemics. During the 14th and 15th centuries combined, bubonic plague wiped out an estimated third of the population of Europe—as many as 35 million people. The total number of victims is estimated at nearly 100 million.

Some sources estimate that a similar number of Native Americans perished between 1492 and 1900, when Europeans unknowingly carried diseases into the Americas. Historians suggest that measles, influenza, and malaria may all have contributed to the decimation of the Native American population, which carried no immunity to these nonnative diseases. Various

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