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As the discussion of swine flu dominates the media, it is worthwhile to look back at some of the other pandemics that have affected the human race throughout history. A pandemic is an illness that spreads from person to person and affects a large, dispersed population. It usually creates an enormous amount of fear among those not affected. The skeleton on the right represents “Doctor Death” from an engraving made in the 1500s, when the Black Death or Bubonic Plague was common in Europe. It was one of the worst pandemics to ever strike on earth, responsible for tens of millions of deaths.

One of the first known epidemics dates to the 5th century, when typhoid is said to have killed one out of four residents of ancient Athens. The next major plague, known as the Plague of Justinian, was probably the first appearance of the bubonic plague. It lasted for 200 years! It is named after the Byzantine Emperor who ruled from Constantinople (now Istanbul in Turkey), and is thought to have been brought over in grain ships from the southern Mediterranean. The prime carriers of the Bubonic Plague are fleas and the rats. Fleas carry the bacterial infection, which they transmit when they bite their host, rat or human. The bacteria, known as Yersinia pestis, goes straight for the lymph nodes, responsible for our ability to fight infections.

Once these nodes are compromised by the bacteria, they swell up and the host’s immune system is quickly destroyed. Horrible swellings can result. One out of two afflicted persons dies in a matter of days. Some historians report that 5,000 to 10,000 people a day passed away in Constantinople at the height of the plague, crippling the Byzantine Empire and altering the course of history in ways we can hardly imagine.

From what historians can tell, the Bubonic Plague died out until another virulent outbreak hit Europe in the 14th century. In the early 1300s, Europe was beset by poor harvests and other problems that may have provided a fertile ground for the this plague to establish itself again in the continent, possibly by way of travelers from Central Asia and the Mongols. It was worst in Europe during the 1340s. Up to 50 million people are said to have died in in the continent. It was called the Black Death for the black-spotted swellings that tormented the afflicted. Other sources dispute this, indicating that the term only became common in the 19th century. The lymph node swellings called buboes is what gave the more scientific name Bubonic Plague to the pandemic. Once again fleas were critical, taking the disease from the infected rats to humans. Once again, the larger social effects of the plague were substantial, encouraging the persecution of minorities believed to harbor the plague, which found prime targets in the poorest, dirtiest section of town where rats and fleas were most at home. To top it off, just before the Black Plague started, England and France commenced the Hundred Years War! Clearly irrational human actions and policies did little to help stem the enormous toll taken by disease.

The Italian writer Giovanni Boccaccio wrote in The Decameron, a story of people who escaped the plague during the 1340s,

“. . . such terror was struck into the hearts of men and women by this calamity that, the 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.”

One of the most popular children’s rhymes from Mother Goose, “Ring around the rosies/A pocket full of posies/Ashes, ashes/We all fall down” is said to have been inspired by the Bubonic Plague. Rosies are said to have represented the first sign of the plague, and posies, the flowers put into pockets to either ward off the plague among the living or as a warning to others in the clothes of the dead. Ashes could refer to the burning of the dead. The words fit the explanation, except that there is little sign of the song before the 19th century.

The plague continued to haunt Europe after the Black Plague during the 14th century. It is staggering to read how in a single year during the 17th century, for example, large swaths of the population in cities like London and Venice or Moscow and Vienna could be wiped out. In other parts of the world the ravages of the plague were no less horrific, In India a century ago millions died during one of the Bubonic Plagues final mass outbreaks. There is little doubt that the battle against infectious diseases was, until recently, often a losing and costly one.

Given this long and lamentable history, it makes sense that any talk of a plague or pandemic still makes headlines today. Even though we know so much more about disease, increased population, travel between places and contact with animals makes the spread of infectious diseases something no one can take lightly. Fortunately we have better tools, medicines and practices to help isolate and contain outbreaks.