The Seven Pandemics

1. The Seven Pandemics

2. The Seven Deadly Pandemics“Pan” = All “Demos” = People • Peloponnesian Plague 430 BC • Antonine Plague 165 • Plague of Justinian 541 • The Black Death 1347 • Cholera Epidemics (7) 1800’s • The Spanish Flu 1918 • The Asian Flu 1957-58 and 1968-69

3. Peloponnesian Plague 430 BC /Anthrax • Began in Ethiopia • At its Height During Athens War With Sparta • Fatal After 7-8 Days • Killed 33% of the Athenian Population

4. Peloponnesian Plague • "As a rule, however, there was no ostensible cause; but people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath." • "These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress." • "In most cases also an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later."

5. "Externally the body was not very hot to the touch, nor pale in its appearance, but reddish, livid, and breaking out into small pustules and ulcers. But internally it burned so that the patient could not bear to have on him clothing or linen even of the very lightest description; or indeed to be otherwise than stark naked. What they would have liked best would have been to throw themselves into cold water; as indeed was done by some of the neglected sick, who plunged into the rain-tanks in their agonies of unquenchable thirst; though it made no difference whether they drank little or much."

6. "Besides this, the miserable feeling of not being able to rest or sleep never ceased to torment them. The body meanwhile did not waste away so long as the distemper was at its height, but held out to a marvel against its ravages; so that when they succumbed, as in most cases, on the seventh or eighth day to the internal inflammation, they had still some strength in them.

7. But if they passed this stage, and the disease descended further into the bowels, inducing a violent ulceration there accompanied by severe diarrhea, this brought on a weakness which was generally fatal."

8. "For the disorder first settled in the head, ran its course from thence through the whole of the body, and even where it did not prove mortal, it still left its mark on the extremities; for it settled in the privy parts, the fingers and the toes, and many escaped with the loss of these, some too with that of their eyes. Others again were seized with an entire loss of memory on their first recovery, and did not know either themselves or their friends." Thucydides

9. Antonine Plague 165 / Smallpox • Carried by Roman Soldiers Returning From Campaign • 25% Mortality Rate

10. Antonine Plague • In 166, during the epidemic, the Greek physician and writer Galen traveled from Rome to his home in Asia Minor. He returned to Rome in 168 when summoned. • Galen's observations and description of the epidemic, found in the treatise "Methodus Medendi", is brief.

11. He mentions fever, diarrhea, and inflammation of the pharynx, as well as a skin eruption, sometimes dry and sometimes pustular, appearing on the ninth day of the illness. • The information provided by Galen does not clearly define the nature of the disease, but scholars have generally preferred to diagnose it as smallpox.

14. Justinian Plague 541/ Bubonic Plague • The disease was first noticed in an Egyptian harbor town, which was infected with a huge rat problem (as was most of Europe at this time). • It then ripped through Alexandria on its northern invasion towards Syria and Palestine via ships. • 40%-60% Mortality Rate

15. Procopius wrote "From there it seemed to spread all over the world, this catastrophe was so overwhelming that the human race appeared close to annihilation." • The problem with this plague was that no one was sure of what caused it. • In later years we have found out that the disease was caused by bacteria and parasites that used rats as hosts. These rats would then infect our drinking and eating sources, thus spreading the bacteria to hundreds of thousands of people.

16. It was written by Procopius that all victims appeared to experience similar symptoms. "They had a sudden fever, some while sleeping, some while walking, and others while engaged without any regard of what they were doing." Soon after, the symptoms would escalate into a type of swelling. The abdomen, armpits, thighs, and ears were the most common body parts affected. The lymph glands were also commonly affected. They were called buboes and for this part of the body the illness was named.

17. Modern scholars believe that the plague killed up to 5,000 people per day in Constantinople at the peak of the pandemic. It ultimately killed perhaps 40 percent of the city's inhabitants. The initial plague went on to destroy up to a quarter of the human population of the eastern Mediterranean.

18. The Black Death /1347 Bubonic Plague • Coming out of the East, the Black Death reached the shores of Italy in the spring of 1348 unleashing a rampage of death across Europe unprecedented in recorded history. By the time the epidemic played itself out three years later, anywhere between 25% and 50% of Europe's population had fallen victim to the pestilence.

19. "The symptoms were not the same as in the East, where a gush of blood from the nose was the plain sign of inevitable death; but it began both in men and women with certain swellings in the groin or under the armpit. They grew to the size of a small apple or an egg, more or less, and were vulgarly called tumours. In a short space of time these tumours spread from the two parts named all over the body. Soon after this the symptoms changed and the black or purple spots appeared on the arms or thighs or any other part of the body, sometimes a few large ones, sometimes many little ones. These spots were a certain sign of death, just as the original tumour had been and still remained.

20. No doctor's advice, no medicine could overcome or alleviate this disease, An enormous number of ignorant men and women set up as doctors in addition to those who were trained. Either the disease was such that no treatment was possible or the doctors were so ignorant that they did not know what caused it, and consequently could not administer the proper remedy. In any case very few recovered; most people died within about three days of the appearance of the tumours described above. A plague victim revealsthe telltale buboe onhis leg. From a14th century illumination

21. The violence of this disease was such that the sick communicated it to the healthy who came near them, just as a fire catches anything dry or oily near it. And it even went further. To speak to or go near the sick brought infection and a common death to the living; and moreover, to touch the clothes or anything else the sick had touched or worn gave the disease to the person touching. “

22. "One citizen avoided another, hardly any neighbor troubled about others, relatives never or hardly ever visited each other. Moreover, such terror was struck into the hearts of men and women by this calamity, that brother abandoned brother, and the uncle his nephew, and the sister her brother, and very often the wife her husband. What is even worse and nearly incredible is that fathers and mothers refused to see and tend their children, as if they had not been theirs. Giovanni Boccaccio Italian Writer Who Lived Through the Plague

25. A physician visits a patient with the plague. Notice how he and others are holding their noses.

26. Carrying Out the Dead

27. Excavated Mass Graves Dating From the Black Death in London

28. Cholera7 Separate Pandemics with 6 Occurring During the 1800’s • Endemic in India • Spread Along Trade Routes • Hit Every Continent Except Antarctica • Most Recent in 1961

31. Chicago Epidemic • In 1849 the disease was brought to the city on the emigrant boat John Drew April 29 and raged until late October. That year 678 persons died, a rate of 2,897 per 100,000. This is the worst death rate for any cause since Chicago began keeping health statistics. • Although the germ theory of disease was still unknown, Chicago did undertake a number of sanitary improvements which markedly reduced cholera and other diseases. • The entire city was quarantined.

32. In the 1850's, a piped Lake Michigan water supply was introduced cutting reliance upon unsanitary wells and buckets of water from the sewage filled Chicago River.

33. An expanded drinking water tunnel--two miles out into the lake – was built in 1867 and effectively reduced the amount of sewage from the river in the water supply. • Sewers were constructed starting in 1856 and expanded after the cholera epidemic of 1866. As sanitation efforts increased, the epidemic decreased.

34. As Cemeteries Filled, Bodies Were Burned Not Buried

35. Some, looking for a point of origin of the so-called Spanish influenza that would eventually take the lives of 600,000 Americans, point to Monday, March 11, 1918. Company cook Albert Gitchell (Fort Riley, Kansas) reported to the camp infirmary with complaints of a "bad cold." Right behind him came Corporal Lee W. Drake voicing similar complaints. By noon, camp surgeon Edward R. Schreiner had over 100 sick men on his hands, all apparently suffering from the same malady.

36. The Spanish Flu1918 • The 1918 flu pandemic (commonly referred to as the Spanish flu) was a category 5 influenza pandemic that started in the United States, appeared in West Africa and France and then spread to nearly every part of the globe. It was caused by an unusually severe and deadly Influenza A virus strain of subtype H1N1.

37. Many of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients.

39. The Spanish flu pandemic came in three waves (March 1918 to June 1920), spreading even to the Arctic and remote Pacific islands. • While older estimates put the number of killed at 40–50 million people, current estimates are that 50 million to 100 million people worldwide died, possibly more than that taken by the Black Death, and higher than the number killed in World War I. • This extraordinary toll resulted from the extremely high infection rate of up to 50% and the extreme severity of the symptoms.

40. When Hospitals filled in the area, nurses set up in the Oakland Municipal Auditorium and used it as a temporary hospital.

44. Street car conductor in Seattle not allowing passengers aboard without a mask. 1918.

47. While possible origins of this influenza were debated and investigated, one fact remained inescapable: it was deadly. Lacking reliable medical defenses against influenza, public health officials and private citizens poured their energies into taking preventative measures.

48. The United States Public Health Service faced the challenge of educating the public about an illness that was largely a mystery. • To that end, the Red Cross, Post Office, and Federal Railroad administration all did their part to assure that instructive posters adorned the entire nation.

49. Surgeon General Rupert Blue, the nation's Chief Public Health Officer, ordered the printing and distribution of pamphlets with titles like, "Spanish Influenza," "Three-Day-Fever," and "The Flu."

50. The Colgate company pitched in by placing ads detailing twelve steps to prevent influenza. • Among the recommendations: chew food carefully and avoid tight clothes and shoes.