Outbreak!: 50 Tales of Epidemics that Terrorized the World

by Beth Skwarecki

We like to think it’s people that rule the earth, but germs wield much more power.

Our closest animal cousins, chimpanzees, have their own, closely related malaria parasite. This disease is so dangerous, and knows us so well, that even after half a million years it still takes credit for one of every six child deaths in Africa. Worldwide, that’s a child every minute. It’s not very kind to adults either.

In all, one of every fourteen people on earth has some kind of genetic mutation that protects them from malaria—a sign that their ancestors were survivors in a long-ago fight against the disease.

The Fiery Serpent: Guinea Worm, Red Sea, 1495 B.C.E. A worm that burrows through your body until it chews its way out through your toe; clearly this is the stuff of nightmares.

The Israelites are finally saved from the serpents when Moses makes a brass sculpture of a serpent on a pole. This may be an early public health effort, a visual aid to teach the proper treatment for guinea worm. Because when that yard-long piece of spaghetti begins to emerge from the painful, fiery blister it causes, the best course of action—even today—is to wrap the worm around a tiny stick. This keeps it from slinking back into the body. With careful wrapping, over the course of weeks, the fiery serpent can be drawn out and removed.

Villages that used to boast a few ponds or a wide well as their water source can wipe out the infection by switching to a type of well that you don’t stick your feet into. Methods like this brought infection rates down from 40 million in the middle of the twentieth century to 3.5 million in 1986, when the World Health Organization and the Carter Center began an anti–guinea worm campaign, and to just 22 reported cases in 2015.

If the guinea worm goes extinct, the disease it causes will be gone forever. It will be only the second human disease to be eradicated. (The first was smallpox.)

Notable fact: In an effort to placate the people and the gods, the emperor provided emergency food relief and forgave taxes during plague years.

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.

People with Hansen’s disease often have roommates or family members who take years to get sick, if they even get sick at all. Ninety-five percent of people can’t even catch the disease.

A flea will stay for life on a warm, hairy body. When that animal dies and the body goes cold, the flea jumps off, with plague-infected gut or mouthparts, to find its next meal.

“Father abandoned child, wife husband, one brother another,” writes a chronicler in Siena, Italy, “for this illness seemed to strike through breath and sight. And so they died.”

In Milan, three households were found to have plague, and the people walled up those houses and left the inhabitants for dead.

That decree came along with another saying that funeral bells would no longer be rung (presumably they were already ringing nonstop). A later update banned funeral candles, since the city was running out of wax.

Infants were supposedly dying of teething, which was then thought to be a deadly condition.

They got syphilis and gonorrhea, and the general ordered the massacre of 400 sex workers.

That bacterium was known for a time as the “tubercle bacillus,” giving the disease its still-current nickname: TB.

After she has digested the blood, she lays 100 to 200 eggs on a damp surface that’s likely to flood. In rainforests, that might be a hole in a tree. On a ship, or in a city, the mosquito can breed in rain barrels, tin cans, swamps, or anywhere the water is still. They will hatch in two days if they stay wet and the weather is warm; they can survive for two months if they dry out. If the mother mosquito bites someone who has yellow fever, she takes up the virus along with the blood. The virus replicates inside her gut, and migrates through her body to her salivary glands. She’ll inject that saliva into her next victim, because mosquitoes’ saliva contains chemicals that keep blood from clotting. In doing so, she will pass on the virus. The female Ae. aegypti needs a new blood meal for each batch of eggs, so over her lifetime she may have several opportunities to spread disease. The virus can also spread inside of her, colonizing her ovaries so that when she lays eggs, the young are already infected.

Researchers estimate that if everybody washed their hands, including outside of hospital settings by washing after using the bathroom and before eating, 1 million deaths per year (mostly from diarrheal disease) could be prevented.

Doctors in Dr. Snow’s time hadn’t figured out the simple cure: water. In modern cholera outbreaks, patients are laid on a cot with a hole cut out and a bucket placed underneath it. Nurses check the amount of watery stool in the bucket and make sure the patient gets the same amount of fluid. This low-tech treatment reduces the fatality rate to just 1 percent.

Everybody who showed symptoms of rabies would die from it, but—as the historical accounts show—not everybody who was bitten by a rabid animal ended up getting sick.

The rabies virus works agonizingly slowly, making the victims wait weeks or months to find out if they have the fatal illness. During that time, some may have tried to improve their odds by using medical or magical procedures, such as those found in a list of dubious cures that had been compiled by Pliny the Elder, a scholar in ancient Rome. One of those cures specified inserting ashes into the wound, obtained by burning the hair of the dog that bit the patient.

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

The infected louse finds its way to the next person, but it does not inject the germ into the person’s bloodstream. Its mouth is clean, but as it eats it defecates. The bite itches, so you scratch, and rub the typhus-infected feces into the tiny wound.

The amoeba turned out to be a species of Naegleria, which normally lives in soil and doesn’t bother anybody. But in a few rare cases—and we still don’t know why—it can infect a person through his nose. Drinking infected water or breathing tiny droplets, like spray in the shower, won’t do the trick. For Naegleria to infect you, you need to get the amoeba-containing water inside your nose. Maybe you snorted some seawater while you were swimming. Your nose is lined with millions of nerve cells for smelling, and a nerve runs a short distance from there to the brain. This is the highway the amoebas travel.

It only takes a tiny whiff of spores to infect a single person. Based on the number of people who got sick, Meselson and his team calculated that the amount released was less than a gram. It could have been as low as 2 milligrams. Although thousands of spores are needed to infect the average person, tests on monkeys suggest that 2 percent of the population can be infected with just nine microscopic spores.

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.

Well then

It may seem startling that, with all modern science and medicine have to offer, an epidemic can still take us by surprise. The high death rates and abandoned villages of 2014 West Africa aren’t very different from what Europe must have looked like in the days of the Black Death; not very different from Squanto’s hometown in illness-stricken Massachusetts.