Plague!

No hurricane, earthquake, or bomb has equaled the ruin caused by epidemics. With existing threats like AIDS and looming threats like avian flu, the human race continues to be at greater risk from viruses than from flashier natural phenomena or even bombs. And while epidemics and pandemic diseases cause illness and death, historically, most have also changed societies.

Plagues date almost to prehistoric times. In 430 BCE, during the Peloponnesian War between Athens and Sparta, a plague broke out in Athens and reportedly killed one-quarter of the city's population (about 150,000). Whatever the plague was, Athens was weakened and ultimately surrendered to Sparta in 404 BCE.

In 532 CE, the Emperor Justinian embarked on a massive program to rebuild the Roman Empire, and might have succeeded, had it not been for what has been termed the Plague of Justinian. The epidemic struck Constantinople in the spring of 543, and before it was over, it had killed as many as half the citizens of the Eastern Roman Empire. With the loss of so many people, tax revenues could no longer support Justinian's wars. Fewer citizens also meant fewer soldiers, so Justinian was forced to hire barbarian mercenaries. And since mercenaries are notoriously unreliable (and costly), the imperial aims failed.

The (In)Famous Black Death

Although, through the years, there had been periodic outbreaks of various types of plague, nothing rivaled the Black Death of 1347–1348. The Black Death, also known as the Black Plague, was the bubonic plague, and it was more virulent than anything seen before.

In the fall of 1347, bubonic plague sailed into European seaports along with the latest in Eastern goods. It was a disease that was able to spread thanks to newly thriving trade routes. The causative agent, Yersinia pestis, was carried by fleas, which in turn were carried by rats. Rats infested sailing ships and trading caravans, so every port city and trading center throughout Europe and Asia was affected.

There were no known treatments, although many were tried. Officials quarantined ships and caravans from any city where the plague had been reported. Church bells were rung in the hope that the loud noises would drive away the plague. Travelers were quarantined. Preachers taught that the plague was God's punishment for sin, and when it was pointed out that the good were dying as well as the sinners, the preachers replied that the plague was punishment for tolerating sin in others.

In the space of two years, on average, one out of every three people was dead. But in some cases, the mortality was even higher: Venice lost 60% of its population and Florence perhaps 75%. It has been argued that the plague was responsible, at least in part, for the end of feudalism and the start of the Protestant Reformation. In the case of feudalism, the high number of deaths among the poor left fewer laborers and artisans. Where once the feudal barons had been able to hold the serfs to the land, the shortage of labor created competition, which led to the rise of the wage system.

Meanwhile, the Catholic clergy had either stayed to care for the sick, thereby becoming infected themselves, or they had fled. Either alternative was bad for the Church. The deaths of priests led to their replacement by less qualified persons. Where once the Church had a monopoly on learning, some of the new priests were illiterate and many were poorly trained. And of course, public recollection of those who had abandoned their flocks and survived the plague, caused survivors to doubt the sincerity and devotion of the Church. Either way, people became more willing to accept the teachings of the reformers.

Smallpox

While a Eurocentric view of historical epidemics focuses on the Black Death, the Smallpox Epidemic of 1837 caused comparable destruction among the Native Americans. There is ongoing debate about whether this epidemic was genocide, planned by the United States Army, and perpetrated by distribution of infected blankets, or whether it was an accident. There has been, however, no question that government indifference, and the greed of wealthy fur traders delayed or prevented vaccination programs that could have saved lives. The Chouteau family, which had partnered with John Jacob Astor to form the American Fur Company, blocked a vaccination program because it would have delayed the hunters from heading out on their hunting trips.

The nations hit hardest by the new epidemic were the Mandan, Hidatsa, and Arikara. The Mandan, perhaps because they lived in earthen lodges, may have been even more at risk from the airborne infection than nomadic tent dwellers. When the infection finally ended in 1840, only 31 Mandan survived.

While the number of people killed by the smallpox epidemic is in doubt, and may have been relatively small compared to other major epidemics, it is clear that it effectively destroyed whole nations, people with their own culture and language. While Italy, France, and England ultimately survived the Black Plague, the smaller Mandan nation did not survive smallpox.

The Influenza Pandemic of 1918

Strangely, one of the greatest epidemics in human history, the Influenza Pandemic of 1918, had minimal effect on history or culture. This was a truly global epidemic, with deaths in every continent. Twenty-five percent of the United States population, and 20% of the world population were infected. The disease, perhaps caused by a mutated strain of influenza, killed an estimated 20 million people in one year. This means more people were killed in one year by influenza than were killed by the Black Death in four years. It's also more people than were killed in World War I, which raged from 1914–1918.

In contrast to the usual pattern of influenza mortality, which is most lethal to the very young and very old, this disease was most deadly to patients aged 20 to 40. Public health orders required people to wear masks, forbade stores from having sales (since sales draw crowds), and limited the length of funerals to 15 minutes.

Yet, as deadly as the influenza pandemic was, it had less effect on history and culture than smaller, relatively localized epidemics of the past. One historian has suggested that because the timing of the influenza epidemic coincided with the Great War (World War I), people had become accustomed to restrictive rules.

AIDS/HIV

The AIDS pandemic may be even worse than the influenza pandemic, although, by comparison, HIV disease works in slow motion. According to estimates from UNAIDS, 34.3 million people in the world have AIDS – 24.5 million of them in sub-Saharan Africa. The total number of AIDS deaths between 1981 and 2003 has been estimated at 20 million, implying that the record set by the 1918 influenza pandemic has already been passed.

An estimated 850,000–950,000 persons in the United States are living with HIV, including 180,000–280,000 who do not know they are infected, and so could be infecting many others. In the developed world, where medications, while costly, can be obtained, HIV has receded from the public mind, but in Zimbabwe, where the life expectancy has dropped from 61 years to 33 years, it's impossible not to be aware of the epidemic. Most of the people dying of AIDS are between the ages of 20 and 50. Astonishingly, South Africa, which has an estimated 5 million people infected with HIV, cut its budget for treatment from $42 million in 2003 to $13 million in 2004.

Epidemics are not simply a medical problem. Unchecked, they have destroyed nations, like the failed imperial dreams of Justinian, and the decimation of the much smaller Mandan culture. They have caused seismic shifts in culture, like precipitating the end of the institution of European feudalism. While the Black Plague was beyond the scope of the knowledge of its time, vaccinations were available during the time of the smallpox epidemic, and treatments and preventive measures – if not a cure – are available for AIDS.

Tragically, though, history does repeat itself.

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