Malaria. Smallpox. The bubonic plague. Their very names send shivers down the spines of countless individuals. What are history´s deadliest epidemics? Put on your hazmat suit as Business English Magazine´s Jonathan Sidor enters the hot zone.

Deadly outbreaks of deasese are as old as human history. While our medcial knowledge has exploded by leaps and bounds in the modern era, the phantom of another pandemic is always lurking around the corner. History´s worst medical crises, though, may offer some cold lessons needed to stave off some future catastrophe.

Ancient Ailments

Some of the world´s first pandemics struck Europe centuries ago. One of the earliest recorded ones is known as the Antonine Plague. It lasted from 165 to 180 AD and afflicted the Roman Empire. The disease was brought into Europe by Roman soldiers who were returning from military campaigns in the Asia Minor region. Experts suspect that the disease was either smallpox or measles, but the actual cause has never been formally verified. The mortality rate of the plague was about 25 percent. On certain days, 2,000 people succumbed to the illness in Rome itself. In total, estimates say the Antonine Plague took 5 mln lives. The outbreak was named for Anoninus, the family name of Emperor Marcus Aurelius.

Rome´s successor, the Byzantine Empire, wasn´t spared from a disaster of its own. The Plague of Justinian hit from 541 to 542 AD and returned for a few additional waves in later centuries. The city of Constantinople was profoundly affected, after merchant ships entered ports harbouring flea-infested rats that carried bubonic plague. Recordings from the time indicate that necrosis of the hand was a typical sign of the disease´s ferocity. Scholars disagree, but conservative guesses put the outbreak´s death toll at 25 mln souls. The plague´s namesake was Justinian I, who ruled as the Byzantine emperor during the initial epidemic.

When it comes to cataclysm that have shaken Europe, the Black Death needs no introduction. The bubonic plague reared its ugly head once again, this time peaking from 1347 to 1351. This time, the bacteria likely originated from Central Asia and made its way to Italy by following the Silk Road. Genoese ships further carried the plague to Italy´s ports, and from there it was just a matter of time until the Black Death made its way to the rest of Europe. The outbreak killed off at least one-third of Europe´s population at the time, and it was responsible for anywhere between 75 mln and 200 mln deaths in Eurasia overall. The plague´s impact was so devastating that it took two centuries for Europe´s population to return to pre-outbreak levels. Places like Florence, however, didn´t fully recover until the 19th century.

Recent Rashes

Petrifying pandemics aren´t just things in ancient history textbooks. Even with the advent of modern nation states and sophisticated science, the world of yesterday was still a frightening place. The third cholera pandemic of 1846-1860 clearly exhibits this. Although the illness originated from India, a high number of fatalities occurred in Asia, Africa, Europe and North America. Great Britain tallied 23,000 deaths, while the death toll in Russia exceeded 1 mln. Physicians in London were able to determine that the disease was transmitted by contaminated city water. By blocking access to water pumps, the phycisians were able to greatly mitigate the epidemic´s effects.

Following this, the world saw two terrifying flu pandemics that struck less than thirty years apart. The first one, from 1889-1890, is commonly known as the Russian flu, The first recorded cases of the outbreak took place in St. Petersburg, but industrialized means of transportation like railroads and transatlantic ocean liners helped the outbreak spread to Europe and North America in a matter of weeks. Deaths across the globe surpassed 1 mln. A number of wealthy or influential people worldwide were among the victims, further fuelling public frenzy and causing widespread panic.

Three decades later, in 1918, an outbreak known as Spanish flu was even less forgiving. This strain of the flu infected 500 mln individuals, which was roughly one-quarter of the world´s population at the time. The Spanish flu was especially virulent because it had a high mortality rate for young children, the elderly and seemigly healthy young adults. It claimed the lives of anywhere between 20 mln and 50 mln people worldwide.

The name ”Spanish flu” is a bit of misnomer. The outbreak began during World War I, but warring powers of Europe and North America were unwilling to report on the rising cases of infections in order to maintain national morale. Spain, which had remained neutral, was free to report on the epidemic, so much of the world believed that Spain had been particularly hard hit. While inaccurate, the name stuck. The epidemic finally died down in 1920.

Modern Maladies

It´s tempting to think of epidemics as a thing of the past, but the world remains a pernicious place to this day. While many of us may not consider it one, the recent AIDS crisis technically qualifies as a pandemic. HIV/AIDS was first identified in Africa in 1976. Throughout the last four decades, HIV/AIDS has taken the lives of 36 mln people. Another 31 to 35 mln individuals are still living with HIV/AIDS to this day. Most cases occur in impoverished areas of Africa. The good news is that the annual number of deaths caused by HIV/AIDS has been gradually dropping for years. HIV is far more manageable today than it has ever been, so certain people who have it are still capable of leading productive lives.

From 2013 to 2016, an Ebola virus epidemic ravaged countries in West Africa. The total number of deaths is comparatively small, but the virus devastated populations in Liberia, Sierra Leone and Guinea. The outbreak had a crippling 40 percent mortality rate, and its effects were some of the most horrendous ever seen. Symptoms brought on by Ebola include severe  aches, vomiting, diarrhoea and internal haemorrhaging. Outside of Africa, isolated cases made their way into Italy, the UK and the USA. These never amounted to much, but they stoked panic throughout the public and media. The virus´s rapid spread and its vicious consequences still make Ebola one of the most feared words in medicine.

Despite these chilling pandemics, T.S. Eliot told us the world ends ”not with a bang but a whimper”. A series of outbreaks have threatened the world´s population in the early years of the 21st century. They may not be the most spectacular, but they remain menacing nonetheless. The 2002-2004 SARS outbreak infected people on six continents and eventually took 774 lives. The 2009 swine flu terrorized the entire globe. About 1 bln cases were confirmed, and the death toll is estimated to be as high as 575,000. With new variation of flu-type illnesses popping up every couple of years, the true threats to humanity´s well-being may be the ones we suspected the least.

Perilous Pandemics

For all of our scientific advancements, we humans are still fragile creatures. The world certainly feels safer today than at any other point in history, but recent outbreaks indicate we are far from invulnerable. Will our medical genius shelter us from upcoming diseases, or is humanity, with all its hubris, in for a rude awakening? Since we can´t know for sure, washing our hands a tad  more thoroughly doesn´t seem like such a crazy idea.