Death on a Grand Scale

Life does not cease to be funny when people die any more than it ceases to be serious when people laugh. –George Bernard Shaw (1856–1950)

We all remember the global hysteria over SARS 2003, and more recently, the lesser SARS 2004. I live in Toronto, Ontario, which, in the first round of the outbreak, was a "SARS-affected area." From the media reports, I got the impression that if I stepped outside, I would see body-filled carts in the street driven by robed figures crying, "Bring out your dead!" and belled, hooded people roaming about yelling, "Unclean! Unclean!"

Ah, media.

People were quarantined (of course, you never saw them, since they were quarantined). Hospitals did boost precautions, including making temperature checks, questionnaires, and hand-washing the routine. You'd see the occasional person wearing a mask in public – but you can see that in Toronto at any time of year. Forty-four people died in the Toronto outbreak; the average age of the victims was 69, and many of them had other health issues.

Overall, according to World Health Organization (WHO) statistics from September 26, 2003, between November 1, 2002 and July 31, 2003, there were (worldwide) 8,098 probable cases of SARS and 774 deaths. The deaths were extremely unfortunate, but – in the grand scheme of human plagues, diseases, wars, and disasters – not even a blip on the radar screen.

Plague

I looked, and there before me was a pale horse! Its rider was named Death, and Hades was following close behind him. They were given power over a fourth of the earth to kill by sword, famine and plague –Revelation 6:8

Plagues are nothing new. 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 (conjecturally, about 150,000 total) including men, women, foreigners, and slaves (as well as the famous leader Pericles). Historians aren't sure what the Plague of Athens was, but suggestions include smallpox and Ebola virus hemorrhagic fever. Whatever it was, Athens was weakened and ultimately surrendered to Sparta in 404 BCE.

Then there was the Plague of Marcus Aurelius (the old Roman emperor who dies in Gladiator), also called the Antonine Plague, which raged from about 165 to180 CE. In 165, the Roman army, while fighting the Parthians (an empire that occupied areas in Iran and environs), contracted something contagious (maybe smallpox), which caused them to give up on the battle and go home. In doing so, they spread the plague throughout the Empire (the area of the Mediterranean basin including parts of Asia Minor, the Middle East, Africa, and Europe). The leader of the plague-ridden army was Lucius Verus, who was co-emperor with Marcus Aurelius. Conveniently for Marcus Aurelius, Lucius Verus himself succumbed to the plague a few years later, leaving Marcus Aurelius as sole emperor. The plague killed an estimated 25 to 35% of those in the worst affected parts of the Empire.

But perhaps the greatest plague of the (not so) ancient world was the Plague of Justinian (named for the emperor Justinian), which started in the mid-540s CE. Its origin is not certain, likely Egypt or Ethiopia (or perhaps the steppes of Central Asia), but, wherever the disease came from, it followed trade routes and military movements, thus successfully spread throughout the Empire (as above). From historical descriptions, it was likely the bubonic plague (which kills roughly 60 to 70% of its victims). Constantinople (modern day Istanbul), the seat of Justinian's empire, was very hard hit. According to Justinian's court historian Procopius, when it struck in the spring of 542 and raged for four months, it killed up to 10,000 a day just in Constantinople. This claim is unlikely. Nonetheless, the plague ravaged the cities and the army and probably put an end to Justinian's hopes to reestablish the Roman Empire to its former glory.

Of course, the Black Plague, also called the Black Death or the bubonic plague, which began in Europe in 1347, is the most famous. After approximately 800 CE, as Europe emerged from the Dark Ages, commerce and trade revived and the population grew – a great combination for bringing disease via trade routes to a large number of people. The plague is believed to have arisen in Asia and then brought to Europe via the Genoese trading station at Kaffa on the Black Sea. Of course, the traders weren't really the problem – it was their stowaways: fleas and rats. The fleas had bacteria (Yersinia pestis) in their stomachs and were feeding on rats. The bacteria prevented blood from reaching the flea's stomach, so, as the flea sucked, it disgorged infected blood back into its victims. The disease spread to rats and to other fleas. As the rats died, the fleas had to look elsewhere (e.g., to people) for food.

The plague would visit an area, last for about a year, kill about one-third of the population, and move on. Many in Christian Europe blamed the Jews and thus killed or otherwise persecuted them; others blamed themselves and started groups like the excessively penitent Brotherhood of Flagellants, who wandered about whipping themselves. This edition of the plague ended in 1351, but there would be waves of it in future years. Most historians believe that between 1347 and 1351, at least one-third of Europe's total human population (20 to 30 million people) died. In The Coming Plague: Newly Emerging Diseases in a World out of Balance, Laurie Garrett points out another thing that died with the plague: leprosy in Europe!

The Black Plague created new attitudes toward life and death, changes in religious practice, and economic changes resulting from a loss of laborers. In art, the Danse Macabre (Dance of Death) became a popular image. Additionally, literature in national languages (instead of Latin) became the mode of expression – one example being Boccaccio's Decameron of c.1350, which is set in a country house inhabited by a group of young aristocrats who have fled plague-ravaged Florence and occupy themselves by telling (often bawdy) stories.

The plague's later appearances were of varying severity. Some were severe enough to close the public theatres of London several times during Shakespeare's day: 1582, 1592 to 1594, 1603, and 1607. And in 1665, a bad outbreak occurred in London and spread throughout England. Women known as nurses (with no training) were paid to visit the homes of plague victims to check on them and to take them food – if they could afford it. Famous diarist Samuel Pepys claimed these women were only robbing the homes they attended. Meanwhile, searchers were paid to find the dead and collect bodies and to find new plague victims. The death toll for London was reportedly 68,000.

The Great Fire of 1666, which officially claimed six lives (probably many more) may have been responsible for saving London. In burning the most squalid, cramped, and filthy areas of the city, the fire put an end to the plague. And, interestingly, except for a minor outbreak in 1679 (a major plague year in central Europe) the plague never again appeared in England.

Other Disease

Pale Death with impartial tread beats at the poor man's cottage door and at the palaces of kings. –Horace (65–8 BCE), Odes

So those were spectacular diseases, but what about the mundane?

According to August 2002 WHO figures, tuberculosis kills two million people each year. (Incidentally, Garrett says that in the periods of the Great Plague and Great Fire, one out of every five London citizens had active tuberculosis.)

Or how about smallpox – already mentioned as the likely bug in the Marcus Aurelius plague? Smallpox claimed the lives of millions in China (49 CE), Japan (552 CE), and Europe (700 to 800 CE). And it caused large numbers of deaths among the native populations in the Americas following contact with the Europeans. Even more sinister, smallpox was used as a biological weapon against the native peoples, as in the 1763 delivery of infected blankets to the Pontiac peoples, which wiped them out (W.M. Denevan, The Native Population of the Americas in 1492). The good news is that the last naturally occurring case of smallpox in the world was in Somalia in 1977, and now it exists only in labs. The bad news is that smallpox, considered a Category A agent by the Centers for Disease Control (CDC) (along with bugs like anthrax, plague, and viral hemorrhagic fevers), still poses a threat as a biological weapon. The CDC reports that death occurs in up to 30% of cases but that many smallpox survivors have permanent scars over large areas of their body (especially the face) and some are left blind.

And what about influenza, the annual winter visitor in North America? According to W.I.B. Beveridge ("The Chronicle of Influenza Epidemics," in History and Philosophy of Life Sciences 13 (1991): 223–35), "Influenza is an ancient microbe that has appeared in millions of different forms over the millennia, periodically producing devastating epidemics …." Among the most famous are the Spanish Flu or the influenza pandemic of 1918 to 1919, which killed an estimated 20 to 40 million people worldwide – that's more deaths than in World War I (1914 to 1918). Garrett writes, "Among factors said by prominent American physicians to be responsible for influenza in 1918 were nakedness, fish contaminated by Germans, dirt, dust, unclean pajamas, Chinese people, open windows, closed windows, old books, and 'some cosmic influence.'"

Water-borne cholera had been confined to India for at least 2,000 years before appearing in England in 1831. By the next year, it was in the Americas. Garrett reports that in 1832, cholera killed 500,000 in New York. But it's not a thing of the past: in 1991, a cholera epidemic began in Peru and spread to several South American countries, and, in 1994, an outbreak of dysentery and cholera in Rwandan refugee camps in Goma (Democratic Republic of Congo) killed an estimated 25,000 people.

And then there's typhus, which is also known as "camp fever," "ship fever," or "jail fever," since it is transmitted by body lice and fleas particularly in places where people are in close quarters for a long period of time (military camps, refugee camps, concentration camps, ships, and prisons) without a chance to bathe and change clothes. For example, in 1489 in Spain, during fighting between the Christians and Muslims in Granada, the Spanish reportedly lost 3,000 to war casualties and 20,000 to typhus. Historians say typhus was one of the reasons Napoleon's Russian invasion failed. And it was typhus that killed 15-year-old Anne Frank in Bergen-Belsen in March 1945.

And we're all afraid of the c-word. According to the WHO, in 2000 alone, 6.2 million people died from cancer.

And then there's AIDS. The National Institute of Allergy and Infectious Disease of the National Institutes of Health reports that as of the end of 2002, an estimated 42 million people (including 3.2 million children younger than 15) were living with HIV/AIDS, and about 70% of them are in Sub-Saharan Africa. Meanwhile, the UK-based international HIV/AIDS charity AVERT calculates the total number of AIDS deaths since the beginning of the epidemic until the end of 2001 to be 21.8 million people.

Scared of Ebola because of films such as Outbreak? Don't be. According to the WHO (excluding the most recent outbreak), though Ebola has a high mortality rate, there have been only about 1,500 cases with slightly more than 1,000 deaths since the virus was discovered.

Politics, War, Dictators, and Genocide

A single death is a tragedy; a million deaths is a statistic. –Joseph Stalin (1879–1953)

Look at what the world has seen even in the past 100 years (and, unfortunately, this list is not complete):

For more details and for other countries, see works such as the two-volume The Encyclopedia of Genocide or websites such as Human Rights Watch.

Famine

Must not all things at the last be swallowed up in death? –Plato (427–347 BCE), Dialogues, Phaedo

Here are some famous famines – excluding those referred to above.

Only a few decades before the Black Death (1347 to 1351), Northern Europe experienced the Great Famine (1315 to 1317, with smaller famines up until about 1322). In the centuries leading up to 1300, the population of Europe had increased, but farming practices meant that the land could only provide enough food for the population if conditions were optimal.

The turn of the 14th century was the beginning of what has now been called a Little Ice Age. As if the unusual cold was not bad enough, in 1315, a wet spring prevented full plowing and caused seed grains to rot. The crops were small, so people supplemented their diet with edible roots, grasses, nuts, etc., from the forests. Again, the winter was cold. Few died but many suffered from malnutrition. So when the spring of 1316 was also wet and cool, people had less energy to work, fewer seeds to plant, and little reserved food to eat. Farm animals were slaughtered for food, and grain to be used for planting was eaten, which compounded the problem. In addition to starvation, it is estimated that 10 to 15% of the population died from diseases such as pneumonia, bronchitis, and tuberculosis. And, even with fewer mouths to feed, Europe took several years to recover.

The Irish Famine began with reports of a widespread, but not total, blight in the potato crop harvested in fall 1845. With the blighted crop, subsistence farmers had trouble feeding themselves and paying their landlords, thus many were evicted from their farms. The peasants ate the rotten food and became ill, and the weakened people were susceptible to diseases like influenza, cholera, and typhus. It was not until the 1850 harvest that the crop was generally healthy, though the yield was low. In the five years, famine, disease, and emigration reduced Ireland's population from eight million to five million, and of these about one million died.

To those of us living today, the Ethiopian famines are the most well known. Between 1982 and 1984, northern Ethiopia suffered extreme drought, which was added to by politics: the ruling party did not act right away because they wanted to prevent their political rivals from obtaining food and supplies. With the resulting famine, approximately one million Ethiopians died. Unfortunately, in 2003, Ethiopia was again ravaged by drought, and, as early as March 2003, the United Nations were asking for food aid to prevent a famine worse than in 1984.

Since 1983, a combination of famine and civil war has killed over 1.5 million people in Sudan. The situation is showing no signs of improving; if anything, it is less stable. For example, in June 2004, aid workers in the Sudanese province of Darfur predicted 300,000 deaths in that province alone if aid does not arrive very soon ….

Natural Disasters

Think not disdainfully of death, but look on it with favor; for even death is one of the things that Nature wills. –Marcus Aurelius Antoninus (121–180), Meditations

And now for something different: let's look at natural disasters – not including famine.

How about earthquakes? Worldbook.com lists the most deadly earthquakes in history. Here are the top 10.

The December 26, 2004, Indian Ocean tsunami, which resulted from a massive undersea earthquake off Indonesia, may have a place on this list, since estimates of the death toll range from the mid-100,000s to 283,000.

And volcanoes? The University of North Dakota Grand Forks hosts Volcano World, which has a list of the most deadly volcanoes. Here are the top 10:

So, as we tourists gaze up in awe from our cruise ship decks in the caldera of Santorini, do we wonder how many people died when the center of that once-round island blew in about 1650 BCE? Or as we bask in the sun at a cafe in Naples or Sorrento, sipping our cappuccino and munching our biscotti, do we wonder what will happen to the heavily populated area of the Bay of Naples when Vesuvius chooses to awaken again?

Conclusion …

Well, I'm sure the above was both depressing and thought provoking. But we can conclude that with SARS, the people of planet Earth got off lucky.

Go home. Kiss your loved ones. Take a long walk with your dog. Have some of your favorite junk food. Read a good book.

The world hasn't gotten rid of us yet.

Death is more universal than life; everyone dies but not everyone lives. –A. Sachs

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