Outbreak!: 50 Tales of Epidemics that Terrorized the World

by Beth Skwarecki

We will mourn for the dead, fear for the living, and applaud the helpers who risked their lives to care for the sick. With each century, it seems, we manage to steal a little more power from our foes the germs.

This isn’t a medical account, some scholars have argued, but a story about morality. The people who cared for the sick stand in contrast to those who chose to enjoy life while they could, frittering away money they couldn’t take with them, breaking the law because they believed they wouldn’t live to stand trial.

The disease struck so heavily that, to the historian, no explanation was possible. It did not prefer a certain season, or country, or people of a given occupation or sex or age.

At first, each family buried their own dead in the usual ways. Soon enough, there were more bodies than places to put them. Families stuffed bodies into other people’s tombs. The local government, committed to making sure all the bodies were buried even if they had no family left to do the job, made new cemeteries on every scrap of available land. Soon there were not enough gravediggers to keep up with the enormous task. The city’s walls had towers, so that archers could stand at the top to shoot when the city was under attack. Procopius writes that the gravediggers ripped the roofs off these towers, piled bodies inside, and replaced the roofs. When the wind blew, the city was filled with an “evil stench.”

Fatality rate: An estimated one-third of the population died Threat level today: Gone. Smallpox has been eradicated.

The emperor was able to make special grants of rice available in bad times, as a form of emergency relief when harvests failed. In 735, he issued grain for a new reason—to the victims of the epidemic. The government of Kyushu made a special request that the island population’s tax be forgiven for that year, because “the whole populace is bedridden.” The request was granted.

A diplomatic mission from the Japanese capital crossed through plague-worn areas on their way to Korea. They never made it to their destination. The group’s leader died and was buried on Tsushima Island, the halfway point, and the survivors straggled back, spreading smallpox to new areas and to the ruling classes. The powerful Fujiwara clan was headed by four brothers, and all four caught smallpox and died.

Unlucky peasants could lose their limbs to ergot poisoning, hallucinating all the while—giving new meaning to the phrase “watch what you eat.”

For centuries, it wasn’t a big deal that some of the rye would occasionally be black at harvest time. That’s just how rye sometimes was. Among the grains clustered at the top of each stalk, the black ones would be extra long, sometimes three times as long as the regular grain. Maybe some people tried to pick them out before grinding the rye into flour; others, especially in times of famine, would eat them anyway. One German word for the black grains was Hungerkorn.

In 1095, with no cause or cure in sight, some religious people opened a hospital dedicated to treating the disorder. They would eventually run an international network of more than 300 hospitals.

Later, scientists figured out that ergot was the cause of Saint Anthony’s fire. In 1938, a chemist investigating ergot made a synthetic drug that mimicked some of its properties. This was the famous LSD. Hippies flocked to it for the psychedelic effects, leaving ergotism’s agonizing symptoms—the burning and the gangrene—to the dustbin of history.

Crusading knights knew their trip would be dangerous, but they probably weren’t expecting their bodies to literally fall apart. If only they’d known about vitamins!

Fatality rate: 100 percent if untreated

Scurvy is bad, but scurvy plus typhus or dysentery would be worse. Joinville had a priest say a mass for him when he thought he was on his deathbed. The priest, also sick, collapsed in the middle of a song. Joinville leaped out of bed to hold the priest tight and tell him he must finish the mass. The priest did, and perished. Joinville lived.

Notable fact: Legends say that in China and India just before the plague, the earth shook and frogs and serpents rained down.

Just one year after Christopher Columbus set foot in North America, his crew had unleashed the continent’s first European-derived epidemic. Death toll: Unknown; estimated at 1 million or more

Within a few years, the enemy’s disease—whatever name you wanted to use—was widespread. Maybe it came from a Roman brothel, maybe from a victim of war crimes in Naples, or maybe it was carried in from the homeland of one of the mercenaries. Whatever it was, it was horrible. The German scholar and poet Ulrich von Hutten contracted the disease in the early 1500s, and wrote about dark green boils as big as acorns, filled with a foul stench. The accompanying pain was like being laid on a fire.

Compatible theories included the idea that people who had the disease were contagious, but also the idea that the disease was a punishment for sinful deeds. Rape would be a sinful deed. Breaking a vow of chastity, if you were a member of the clergy, would be a sinful deed. But for a while, sex within the confines of marriage was not seen as a way to pass on the disease. And so a man who contracted syphilis from a sex worker would not see any problem in having sex with his wife, even if his penis was covered in sores.

This is just what it sounds like: people danced until they died of exhaustion. Instead of a virus or parasite, the cause of this one was all in their heads.

The Spanish conquistadors had many weapons on their side when they invaded Tenochtitlán: horses, guns, and swords were the obvious ones. But one of the most instrumental weapons was an invisible one, brought by accident: smallpox.

Suffering from a lumpy, swollen, painful neck? Don’t worry, your local king can cure you.

The English remarked on the Native Americans’ odd habit of bathing—at the time, many Europeans didn’t.

Other treatments tended toward the spiritual. One sixteenth-century remedy involved writing the the made-up mystical word “Abracolam” over and over with letters missing, until finally you just wrote the letter “A.” This scrap of paper would then be tied to your neck by a virgin while she recited three Our Father prayers and three Hail Mary prayers. But even as people ventured farther from malaria’s original birthplace in Africa, they found themselves closer to an amazing thing: a specific, pharmaceutical cure.

The first death was unremarkable. A woman in one of London’s outlying parishes, St. Giles-in-the-Fields, died of plague on Christmas Eve in 1664.

Nobody wanted to be associated with a plague victim. Plague houses were boarded up, with healthy family still inside, as a form of quarantine. The door would be painted with a red cross and the words “Lord have mercy upon us.” Nobody would be allowed to enter or leave until the residents died, or until forty days had passed.

“A white man threatened to shoot us if we passed by his house with a corpse,” the authors wrote. “We buried him three days later.”

The nineteenth century had a lot of awful ways to die. By comparison, consumption was almost glamorous.

Edgar Allan Poe made a whole genre out of lamenting the deaths of young women with all the outward signs of the disease: waifish, ghostly pale, angelic.

It was common, too. Consumption claimed the lives of many of the same poets and painters who glamorized the disease. It killed all three literary Brontë sisters, plus their other siblings. Poe’s very young wife died of the disease, and Poe himself may have had it too.

But while consumption provided a tragic end to these illustrious lives, it also slaughtered the poor and working class, children included. Millions perished without a single sonnet to their name.

The Ganges River begins with melting snow from the Himalayan Mountains, and it winds 1,500 miles east through the tropical climate of northern India as its tributaries combine to form the river that the Hindu religion considers the sacred territory of the goddess Ganga. Bathing in the river, and drinking from it, transform an ordinary routine into a religious experience. People from all over India travel to the Ganges, following wide steps down into the river. A bottle of the water, taken home, is part souvenir and part holy relic.

The first recorded pandemic of cholera traces back to 1817, when it started in the Bengal region—or possibly in Jessore in Bangladesh—and ultimately toured half the world. It was the first of many; so far the world has survived at least seven cholera pandemics, and an eighth may be emerging.

Neither British nor Indian physicians had any good ideas about how to treat or stop cholera. (Even today, our best treatment is to simply keep the person hydrated until the disease runs its course.) The British were still working from a theory about needing to balance the four humors, and their main medical tools were bloodletting and drugs that would cause vomiting and even more diarrhea. Indians weren’t as big on bloodletting, but otherwise their approach was similar, based on an idea about three humors that needed to be balanced: air, bile, and phlegm. Neither approach explained, or stopped, the rampage of Vibrio cholerae. The disease spread west, too. In 1821, a battle in Oman, near the southeast corner of Saudi Arabia, involved British soldiers that had been in India. The disease spread from there, into modern-day Iran, Syria, Iraq, and parts of Russia. Eventually it fizzled out, perhaps stopped or slowed by a cold winter in 1824. But the world would not be so lucky for long. A few years later, in 1827, a new pandemic started, at first tracing the westward steps of the first one. From the Middle East, a branch infected parts of Africa. Another branch proceeded through Russia to western Europe and from there to the Americas. This was not the last we would see of cholera.

John Snow had been trying for years to prove that stinky air was not the cause of cholera. He had proposed that water was the culprit, and pointed out that people who die in outbreaks tend to share the same water source. On the other hand, his critics pointed out, those people also live in the same stinky neighborhoods.

Thought leper colonies were a thing of the past? Think again. Hawaiians with leprosy were imprisoned even in recent times.

People with leprosy were to be taken to a hospital near Honolulu for treatment, and those deemed incurable would be taken to Kalaupapa, where houses and farm fields would be waiting for them. They were allowed to bring family members with them to help with chores and provide medical assistance. And so the first group of patients arrived in January 1866. The men were given an axe or shovel and a blanket; the women were just given a blanket. There had been months of delay in finding a boat and waiting for the seas to calm down enough to get to the island. In the meantime, the crops in the field had rotted. The patients suffered from starvation and infection. Leprosy is not a fatal condition, but in the first five years, 46 percent of the exiles died.

The island’s massive graveyard only has about 1,000 readable stones. A group of former patients and family members is now working to collect residents’ names, photographs, and stories. In the 103 years of the colony’s existence, thousands of couples had married, and thousands of children had been born. After 1931, babies were taken away from their parents, for fear they would contract leprosy. When the residents of Kalaupapa became free to leave, many did not.

Threat level today: Measles still kills over 100,000 people each year. An effective vaccine is available. Notable fact: The outbreak could have been prevented if the ships carrying people infected with measles had observed the traditional quarantine protocol of putting up a yellow flag.

Measles isn’t just catchy; it’s explosively contagious. If nobody in the population is immune, each measles-infected patient will spread the disease to twenty others, on average. The comparable number in AIDS is two to five, and in smallpox, five to seven. Meanwhile, if you haven’t had measles (or a measles vaccine) you have a 90 percent chance of contracting the disease if you’re exposed to it. In a familiar population, measles can spread quickly from child to child, until everyone is infected and immune—or, in a small percentage of cases, dead. In a fresh population that has never seen the disease before, nearly everyone will catch it.

Instead of sleeping peacefully onboard the ship each night, he had been sneaking out and exploring Sydney’s brothels. He came down with a case of gonorrhea. When the boat arrived in port, officials onboard were deep in discussions about political damage control, should word of the young man’s gonorrhea get out to the press. Timoci was recently married, and the last thing the British officials wanted was a sex scandal.

“On my return here, I found death, desolation, and starvation . . . Whole families have been carried off, and, but for the incessant beat of the death-drum, one might fancy the place deserted.” By the time the disease completed its tour of the island, the estimated death toll was at least a quarter of the archipelago’s total population.

Deworming treatments helped, too, but the most effective change was just to provide “sanitary facilities” for the workers—even something as simple as a bucket would do the job.

Rabies was never a disease that passed from person to person as a plague. But it was terrifying, on both a medical and metaphorical level. Your sweet pet dog could turn on you, biting the hand that feeds it and delivering certain death. Mad dogs also had a way of going on rampages.

Beriberi was a puzzle, but more than that, it was a major logistical problem for the Japanese army and navy. How could you fight when a quarter or a third of your men were weakened or even paralyzed?

The disease had been described in ancient times, and the Japanese knew it well. Their name for it was kakke, but they recognized it was the same disease internationally known by the name it had in southeast Asia: beriberi. The name reportedly means, in the Sinhalese language, “I can’t, I can’t.”

Southern politicians were eager to solve the problem of pellagra—until the cause turned out to be poverty.

This outbreak of flu turned deadly, killing more people than the war itself did. It struck the young and healthy, leaving their deceased bodies a discolored shade of blue.

Later on the trail, a storm blew over a musher’s sled, dumping the package into the snow. The musher dug through snowdrifts with his bare hands and finally found it.

The disease didn’t get much attention from the public at first—and when it did, it was branded as a “gay plague” or “gay cancer.” An early name for the disease was GRID, for gay-related immune deficiency, but that didn’t stick.

SARS cases are now gone from the wild, but public health officials still worry about the potential for a fatal, highly contagious coronavirus to star in another epidemic.