Infectious Diseases


Gravure d'un contemporain de la Peste de Marseille en 1720 l'actuel Quatier Belsunce.

Historical Epidemics and Pandemics

Bubonic plague is an infectious disease that is believed to have caused several epidemics or pandemics throughout history. Bubonic plague is the most common form of plague, and is characterized by swollen, tender, inflamed lymph glands (called buboes); other forms are Septicemic plague, which occurs when plague bacteria multiply in the blood, and Pneumonic plague, which occurs when the lungs are infected.

Historical epidemics

The first Western literary account of a possible outbreak of plague is found in the book of Samuel V of the Hebrew Bible. In this account, the Philistines of Ashdod were struck with a plague for the crime of stealing the Ark of the Covenant from the Children of Israel. These events have been dated to approximately the second half of the eleventh century B.C. The word "hemorrhoids" is used in English translations to describe the sores that came upon the Philistines. The Hebrew, however, can be interpreted as "swelling in the secret parts". The account indicates that the Philistine city and its political territory were struck with a "ravaging of mice" and a plague, bringing death to a large segment of the population.

In the second year of the Peloponnesian War (430 B.C.), Thucydides described the coming of an epidemic disease which began in Ethiopia, passed through Egypt and Libya, and then came to the Greek world. Athens was decimated by this plague, losing a possible third of its populace, including Pericles (Speilvogal, J, 1999, pp. 56). In spite of the loss in population, this did not affect the progress and outcome of the war. This epidemic has long been considered an outbreak of bubonic plague. However, from Thucydides' description, some modern scholars dispute the assignment of plague, feeling that smallpox or measles may be better candidates.

In the first century AD, Rufus of Ephesus, a Greek anatomist, refers to an outbreak of plague in Libya, Egypt, and Syria. He records that Alexandrian doctors named Dioscorides and Posidonius described symptoms including acute fever, pain, agitation, and delirium. Buboes large, hard, and non-suppurating developed behind the knees, around the elbows, and "in the usual places." The death toll of those infected was very high. Rufus also wrote that similar buboes were reported by a Dionysius Curtus, who may have practiced medicine in Alexandria in the third century B.C. If this is correct, the eastern Mediterranean world may have been familiar with bubonic plague at that early date. (ref. Simpson, W.J., Patrick, A.)

The last significant European outbreak of bubonic plague occurred in Russia in A.D. 1877-1889 in rural areas near the Ural Mountains and the Caspian Sea. This outbreak is sometimes seen as an extension of the Third Pandemic (see below). Efforts in hygiene and patient isolation reduced the spread of the disease, with approximately 420 deaths in the region. Significantly, the region of Vetlianka in this area is near a population of the "bobak", a type of small marmot considered a very dangerous plague reservoir.

Historical pandemics

There have been three major outbreaks (pandemics) of plague.

1st Pandemic:  Plague of Justinian (541-542)

In the years 535 and 536, several remarkable aberrations in world climate took place. The Byzantine historian Procopius recorded of 536, "during this year a most dread portent took place. For the sun gave forth its light without brightness... and it seemed exceedingly like the sun in eclipse, for the beams it shed were not clear.". Tree ring analysis by dendrochronologist Mike Baillie, Queen's University, Belfast, shows abnormally little growth in Irish oak in 536 and another sharp drop in 542, after a partial recovery. Similar patterns are recorded in tree rings from Sweden and Finland, in California's Sierra Nevada and in rings from Chilean Alerce trees.

Further phenomena reported by a number of independent contemporary sources:

  • low temperatures, even snow during the summer
  • dark clouds, only a few hours of sunlight during the day
  • floods in formerly dry regions
  • crop failures

It has been conjectured that these changes were due to ashes or dust thrown into the air after the impact of a comet or meteorite, or after the eruption of a volcano (a phenomenon known as "volcanic winter").

The Plague of Justinian which followed these climatic changes is the first known pandemic on record, and it also marks the first firmly recorded pattern of bubonic plague. This outbreak may have originated in Ethiopia or Egypt and moved northward until it reached the large city of Constantinople. The city imported massive amounts of grain to feed its citizens mostly from Egypt and grain ships may have been the original source of contagion, with the massive public granaries nurturing the rat and flea population.

The Byzantine historian Procopius records that, at its peak, the plague was killing 10,000 people in Constantinople every day. The Byzantine Emperor Justinian I ensured that new legislation was swiftly enacted so as to deal more efficiently with the glut of inheritance suits being brought as a result of the plague deaths (Moorhead, J., 1994).

Justinian had expended huge amounts of money for wars against the Vandals in the Carthage area and the Ostrogoth kingdom of Italy. He had also dedicated significant funds on the construction of great churches like the Hagia Sophia. Coming on the heels of these great expenditures, the effects this epidemic had on tax collection was disastrous. As the plague spread to port cities around the Mediterranean, it gave the struggling Goths new opportunities in their conflict with Constantinople. The plague weakened the Byzantine empire at the critical point when Justinian's armies had nearly wholly invested Italy and could have credibly reformed a Western Roman Empire. The long term effects on European and Christian history would have been enormous. As it was, the gamble Justinian took backfired and the overextended troops could not hold on. Italy was decimated by war and fragmented for centuries as the Lombard tribes invaded the north.

It should be noted that ancient historians, and Byzantine historians in particular, and Procopius above all, did not hold to modern standards of fact-checking or numerical accuracy. The actual number of deaths will always be uncertain. Modern scholars believe that 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 plague went on to destroy up to a quarter of the human population of the eastern Mediterranean. A second major plague wave in 588 spread through the Mediterranean into what is now France. A maximum figure of 25 million dead for the Plague of Justinian is considered a fairly reasonable estimate.

A major pandemic would not appear again in Europe until the Black Death of the 14th century, almost 1000 years later.

2nd Pandemic:  Black Death (more recently known as the Black Plague)

This was a devastating pandemic that first struck Europe in the mid-14th century (13471350). The plague continued to strike parts of Europe throughout the 1400s, 1500s, and 1600s with varying degrees of intensity and fatality.

See: Black Death and

3rd Pandemic:  mainly in Asia, but all continents affected (1850s-1959)

The initial outbreak of the third pandemic was in China's Yunnan Province in the 1850's. The disease was stable within the province, but was spread due to a Moslem rebellion which resulted in population disruption. Refugees from the conflict moved south, into regions of China with larger populations. The plague went with them, producing an increasing number of casualties. In the city of Canton, beginning in March 1894, the disease killed 60,000 people in just a few weeks. Daily water traffic with the near by city of Hong Kong rapidly spread the plague. Within two months, after 100,000 deaths, the death rates dropped below epidemic rates, although the disease continued to be endemic in Hong Kong until 1929.

Casualty patterns indicate that waves of this pandemic may have been from two different sources. The first was primarily bubonic and was carried around the world through ocean-going trade, transporting infected persons, rats, and cargos harboring fleas. The second, more virulent strain was primarily pneumonic in character, with a strong person-to-person contagion. This strain was largely confined to Asia, particularly Manchuria and Mongolia. Researchers during the "Third Pandemic" identified plague vectors and the plague bacillus, leading in time to modern treatment methods.

With the bubonic plague spreading to all inhabited continents, it ultimately killed more than 12 million people in India and China alone. The network of global shipping ensured the widespread distribution of the disease over the next few decades. Recorded outbreaks include:

19th Century 20th Century
  • Pakhoi, China 1882.
  • Canton, China 1894.
  • Hong Kong, China 1894.
  • Formosa (Taiwan), China 1896.
  • Bombay, India 1896-1898.
  • Calcutta, India 1898.
  • Madagascar, 1898.
  • Egypt, 1899.
  • Manchuria, China 1899.
  • Paraguay, 1899.
  • South Africa, 1899-1902.
  • Hawaii, United States, 1899.
  • San Francisco, United States, 1899.
  • Australia, 1900-1905.
  • Russia/Soviet Union, 1900-1927.
  • Fukien Province, China 1901.
  • Thailand, 1904.
  • Burma, 1905.
  • Tunisia, 1907.
  • Trinidad, Venezuela, Peru and Ecuador, 1908.
  • Bolivia and Brazil, 1908.
  • Cuba and Puerto Rico, 1912.

Each of these areas, as well as Great Britain, France and other areas of Europe, continued to experience plague outbreaks and casualties until the 1950's. The last significant outbreak of plague associated with the pandemic occurred in Peru and Argentina in 1945. According to the World Health Organization, the pandemic was considered active until 1959, when worldwide casualties dropped to 200 per year.

Contemporary cases

The disease still exists in wild animal populations from the Caucasus Mountains east across southern and central Russia, to Kazakhstan, Mongolia, and parts of China; in Southwest and Southeast Asia, Southern and East Africa (including the island of Madagascar); in North America, from the Pacific Coast eastward to the western Great Plains, and from British Columbia south to Mexico; and in South America in two areas: the Andes mountains and Brazil. There is no plague-infected animal population in Europe or Australia.

Globally, the World Health Organization reports 1,000 to 3,000 human cases of plague every year.

In September 2005 the Associated Press reported that three mice infected with the bacteria responsible for Bubonic plague apparently disappeared from a laboratory. The mice were unaccounted-for at the Public Health Research Institute, which is on the campus of the University of Medicine and Dentistry of New Jersey and conducts bioterrorism research for the United States federal government.



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Created: Monday, September 26, 2005: Last Updated: Wednesday, February 03, 2016
Copyright 1998, USA