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icliniq.com - Malaria: Symptoms, Causes, Diagnosis, Prevention and Treatment

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icliniq.com - Malaria: Symptoms, Causes, Diagnosis, Prevention and Treatment

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Malaria is an infectious disease (mosquito-borne) caused by Plasmodium parasites. This parasitic infection in humans occurs mainly due to five parasitic species; they are, Plasmodium vivax, Plasmodium falciparum, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi. Globally around 1.5 to 3 million people die each year due to malaria, and the greatest threats are posed mostly by Plasmodium falciparum and Plasmodium vivax.

How Is Malaria Transmitted?

Malaria is transmitted from one person to other through the bite of infected female Anopheles mosquitoes. As these parasites affect red blood cells, malaria can also be transmitted through infected blood via,

What Are the Symptoms of Malaria?

The approximate incubation period is 12 days in the case of Plasmodium falciparum, 14 days for Plasmodium vivax and Plasmodium ovale, and 30 days for Plasmodium malariae. During that time, people will not develop any symptoms, but the malarial parasite will be multiplying. Following that, the typical symptoms seen are fever with chills and rigor.

This may also be associated with,
Nonspecific Symptoms: Abdominal Symptoms:
Initially, there will be shaking chills for a few hours (cold stage), followed by high fever (hot stage) and marked sweating (sweating stage). The fever is intermittent, which may occur every other day in Plasmodium vivax and Plasmodium ovale infection (tertian malaria), and in the case of Plasmodium malariae, fever occurs every third day (quartan malaria). However, Plasmodium falciparum has no specific pattern of fever. The patients may have anemia and mild jaundice due to the breakdown of red blood cells. As well as, there are chances for enlargement of the spleen when this occurs, mild liver enlargement may also be seen.

How Is Malaria Caused?

Malaria occurs with the bite of infected female Anopheles mosquitoes. When it bites, the uninfected humans undergo various stages with the breakdown of red blood cells to transmit malaria. The below flow chart will explain in detail how a mosquito causes malaria.

In the case of Plasmodium vivax and Plasmodium ovale infections, it is said that some sporozoites remain in a dormant form in the liver as hypnozoites for upto a year or more. These hypnozoites can get reactivated later and cause delayed primary infection or relapses. Relapse can also occur if treatment is not given to eradicate hypnozoites.

In the case of Plasmodium falciparum, it invades red blood cells of all ages, whereas Plasmodium vivax and Plasmodium ovale preferably invade immature red blood cells, and Plasmodium malariae invades the developing red blood cells (normoblasts). Parasitemia is most severe in Plasmodium falciparum infection, where more than 2 % of all red blood cells can be infected. Hence the breakdown of red blood cells is most severe in Plasmodium falciparum infection.

The red blood cells infected with Plasmodium falciparum get adhered to capillary endothelium and agglutinate with other infected RBCs and form into clusters with uninfected red blood cells. This leads to ischemia and dysfunction of various organs such as the brain, liver, kidney, lungs, and gut.

How Is Malaria Diagnosed?

Early diagnosis is highly essential for recovery from malaria. When there are signs and symptoms, it is better to reach the doctor at the earliest and get treatment accordingly. The World Health Organization (WHO) says that it is better to confirm the diagnosis through microscopic laboratory testing to identify the parasite, or a rapid diagnostic test can be performed depending on the facilities available.

If there is a combination of symptoms, malaria cannot be distinguished only by the symptoms available. In order to distinguish, a parasitological test is essential to identify and treat the disease. In malaria-endemic areas, the severity of the disease causes a large proportion of the population with mild immunity. So, some people will carry the parasite through the bloodstream but may not fall ill.

How Can Malaria Be Prevented?

Several ways to prevent malaria are,
Vaccination:
Research is ongoing to develop safe vaccines for malaria. One vaccine has already been licensed in Europe; however, it is not licensed in the United States. So, consult a doctor when there are suspected symptoms.
Advice for Travelers:

Check if there is any risk for malaria in the traveling country.

Seek the doctor's help for a precautionary prescription to prevent the disease before visiting the country or place.

Have antimalarial drugs with you before leaving home or while traveling.

Before traveling, consider the risk for pregnant women, children, and elderly patients.

Things to Carry:
People who travel should carry prevalent tools such as,

All these are not harmful to humans as the concentration of pesticides kills only the mosquitoes and does not pose any risk to humans.
Precautions:
Avoid situations that may increase the risk of getting a bite by mosquitoes. Things to remember are:

Choose an air-conditioned room.

Do not stay near stagnant waters.

Wear clothes that cover the whole body.

Up to around six months after traveling, a person may be able to develop symptoms, so it is not advisable to donate blood for some period.

How Is Malaria Treated?

Treatment of malaria mainly aims to eliminate the Plasmodium parasite from the blood. People without symptoms are treated to reduce the risk of disease transmission. There are several drugs for the treatment of malaria, and they are:
Conclusion:
Malaria is a life-threatening disease leading to thousands of deaths yearly. In order to avoid this, we should create awareness and educate people properly to eradicate this disease. When immediate and proper treatment is given, the person will be able to recover from malaria. So reach out to the doctor when you notice any symptoms.

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Malaria | Symptoms | Causes | Diagnosis | Prevention | Treatment

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Malaria is a common disease that mostly develops during the monsoon. Both adults and children are affected by this disease. Read the article to know more.

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When you think of the most deadly creature in the world, your instinct is probably to imagine a shark, bear, crocodile, or some other massive animal with big claws or huge teeth. In fact, when it comes to killing people, the most deadly animal in the world is a tiny insect: the mosquito! Unlike other dangerous creatures, mosquitoes do their deadly work by spreading diseases - one of the worst of these is malaria.

Malaria is an infectious disease caused by a parasite, called Plasmodium that invades red blood cells and liver cells. The parasites are transferred to humans by the bite of an infected Anopheles mosquito.

How does malaria cause disease?

Four different species of Plasmodium parasites cause most of the malaria in humans: Plasmodium vivax, Plasmodium falciparum, Plasmodium ovale, and Plasmodium malariae, with some species causing more severe symptoms than others.

If you are unlucky enough to get bitten by an infected mosquito, it not only gives you a nasty bite, but also transfers the malaria parasites from its saliva directly into your blood. To better understand the symptoms of malaria, we need to take a look at the life cycle of the malaria parasite.

1. If you are bitten by a mosquito carrying malaria parasites, it injects them into your bloodstream in the form of sporozoites (a spore-like form). Sporozoites travel in your blood until they reach and infect your liver cells.

2. Over 5-16 days, the time depends on which species of malaria you have, the sporozoites multiply and mature, producing tens of thousands of young adults, called merozoites, inside each liver cell. For some species, the merozoites remain dormant, but may reactivate weeks or months later.

3. When they are ready, the young adult parasites leave your liver cells for your bloodstream where they infect red blood cells. This begins a cycle of asexual reproduction in which broods of thousands of newly formed merozoites are produced and released over 1-3 days (again, the time depends on which species of malaria you have). It is the cyclical release of broods of merozoites into your bloodstream during this stage that causes the periodic feverish symptoms of malaria. Importantly, not all merozoites are destined for an asexual existence, some develop sexually instead. This produces male and female forms (gametocytes) that your blood cells carry around in your bloodstream.

4. Now when another mosquito bites you, it ingests blood cells containing gametocytes. The mosquito digests the blood cells, releasing the male and female gametes, which fuse together and burrow into the mosquito's gut wall, where they mature inside oocysts.

5. After 8-15 days (depending on the species) the oocysts burst and sporozoites are released into the body cavity of the mosquito. From there, they travel to the salivary glands, leaving the mosquito primed to transmit malaria parasites to new hosts.

What are the symptoms of malaria?

When you get bitten by an infected mosquito, it will most likely seem like any other mosquito bite. However, usually after a week or two, as the infection has takes hold, the first noticeable symptoms start to appear. All four species of malaria can cause early, or prodromal "flu-like" symptoms such as headache, slight fever, muscle pain, and nausea, which coincide with increasing numbers of parasites in your bloodstream. A few days later these symptoms are often followed by periodic febrile attacks, also known as malarial paroxysms. Paroxysms typically last 4-8 hours and have 3 stages; a 15-to-60 minute cold stage when you shiver and feel very cold, a 2-6 hour hot stage when your fever may reach as high as 41C, and finally, a 2-4 hour sweating stage during which your fever drops rapidly. The febrile attacks are likely to leave you feeling exhausted, although after some sleep, you may feel quite well, until the next paroxysm.

In all types of malaria, paroxysms occur when many infected blood cells burst at the same time, releasing thousands of merozoites into the bloodstream all at once (stage 3 of the lifecycle). Malarial paroxysms occur periodically - 48 hours for P. vivax, P. ovale, and P. falciparum, and 72 hours for P. malariae. The 72 hour cycles with P. malariae is due to its slower growth and maturation.

The severity of malaria symptoms depends upon the species. Although P. vivax, P. ovale, and P. malariae may make you quite ill, and sometimes cause additional complications, unlike P. falciparum, they are rarely lethal. Although you usually develop some immunity to malaria that may make the paroxysms less severe, this does not provide full protection, so all forms of malaria tend to be chronic. This means that regardless of species, if you don't get treatment, your malaria may relapse weeks or months later, due to activation of dormant merozoites in the liver, and these relapses may continue for decades.

Situations that increases your chances of getting malaria

Although mosquitoes can be found on every continent, malaria is only found in specific parts of the world - mosquitoes that transmit malaria like warm, wet tropical and subtropical regions. The biggest risk factor is to live in, or visit places where malaria is common. Places with the highest malaria risk and infection rates include:

Sub-Saharan Africa,

The Indian subcontinent

South Pacific Islands (Solomon Islands, Papua New Guinea)

Haiti (in the Caribbean)

Every year, tens of millions of people from malaria-free countries travel to countries where it commonly occurs, and tens of thousands of people go home with malaria. Certain groups of individuals are particularly susceptible, including young children, pregnant women, and people with weak immune systems, as well as people who have no immunity to malaria parasites.

How likely are you to get malaria?

Worldwide estimates tell us that over a billion people are currently at high risk of malaria, and around 600,000 people die of this disease every year. Many people who are exposed to malaria live in regions where poverty, lack of knowledge, and a shortage of healthcare are barriers to life-saving treatment.

Risk of malaria around the world

What steps can you take to prevent malaria?

We do not yet have an effective vaccine that protects against malaria parasites. Nevertheless, if you live in, or are visiting tropical or subtropical regions, there are several ways you can protect yourself from this pervasive, potentially life-threatening disease.

Assess your risk. The chances of getting malaria are largely based on when and where you are going - May to December are prime months for contracting malaria, particularly in sub-Saharan Africa, the Indian subcontinent, and Southeast Asia, and especially during and after the rainy season. Before you leave, check out your local disease control center for disease prevention information. You need to know the level of risk and the recommended type of prevention to deal with the risk. Then, get prepared.

Take personal protection. Your first lines of defense against mosquito bites are mosquito repellent and mosquito nets. These are recommended wherever and whenever there is any risk of malaria. Apply insect repellent in the early evening, before the mosquitos are out looking for dinner, and sleep behind insecticide-treated bed nets. These are around twice as effective as untreated nets, and this combination approach gives you the maximum personal protection against mosquito bites.

Take additional measures. Not all malaria parasites are created equal, so if you are traveling to a region that is known to have mosquitos with the more prevalent and dangerous types ( P. vivax and P. falciparum) you will need additional defenses to protect you. These come in the form of preventative medications that can stop the parasites in their tracks after they get into your bloodstream. You may have to take these medications before, during and after you return from your travels, and to have them work properly, you need to be sure to take them as directed.

What treatments are available for malaria?

Flu-like symptoms are very common and may be caused by all sorts of infectious diseases, but if you have been in country where there is malaria, your doctor will likely want to test for it. The simplest and most common way to do this is by looking in your blood. The Plasmodium parasite can be visualized by adding a special stain to a drop of your blood on a microscope slide. Using a microscope, a trained healthcare professional can often identify which type of Plasmodium you are infected with.

Malaria parasites under the microscope

The best treatments for malaria are combinations of antimalarial drugs known as artemisinin-based combination therapy, or ACT, to which other drugs may be added if necessary. Deciding which drug combinations to use to treat your malarial infection depends on a number of factors:

the type of parasite you are infected with

where and when you got infected

how severe your symptoms are

if you have other illnesses or conditions, are taking other medication, and/or have drug allergies

whether or not you are pregnant

whether or not the parasites in the region where you were infected are resistant to any of the available antimalarial drugs (is the parasite resistant to treatment?).

Early diagnosis and treatment of malaria can reduce your symptoms and prevent death, so if you do develop a fever, and have been in a malaria risk area at any time during the previous 12 months, you need to go to the doctor for a proper diagnosis just in case.

Consider the following:

People who were born and raised, or who lived as a child in a region where malaria occurs, but who as adults are living in a malaria-free country, are often at extremely high risk of getting malaria when they return for a visit. Why would that be? First, any immunity to malaria that they may have gained through childhood exposure decreases with time. Although they may not realize it, this means that like other non-immune travellers they are very vulnerable to the disease if they get bitten by an infected mosquito. Second, people visiting friends and family are more likely to travel to remote regions where malaria transmission rates may be particularly high. Lack of awareness of the need to take precautions against mosquito bites puts travelers visiting friends and family at particularly high risk of disease.

If you are bitten with P. vivax malaria, you may feel fine between attacks, and even without treatment, the paroxysms will most likely subside in a few weeks. However, if you get P. falciparum malaria, you are likely to feel unwell even between attacks and, without treatment, you may die. Why do you think this might be? One explanation is that the P. falciparum malaria infects red blood cells, regardless of whether they are young or old, producing very high numbers of parasites in the blood. P. vivax, on the other hand, only infects young red blood cells, which limits the number of parasites that can accumulate.

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What is malaria? (article) | Malaria | Khan Academy

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Learn for free about math, art, computer programming, economics, physics, chemistry, biology, medicine, finance, history, and more. Khan Academy is a nonprofit with the mission of providing a free, world-class education for anyone, anywhere.

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kids.britannica.com - Students - Malaria

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kids.britannica.com - Students - Malaria

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Mikiyas Tesfaye-President's Malaria Initiative/USAID

A serious and ancient disease caused by one-celled Plasmodium parasites, malaria is spread to humans by the bite of infected Anopheles mosquitoes. The symptoms of malaria include periodic chills, fever, headache, and sweating. Complications affecting the kidneys, liver, brain, and blood can be fatal. Malaria is a major health problem in the tropics and subtropics. Worldwide, the disease afflicts about 250 million people every year. It is responsible annually for the deaths of about 900,000 people-most of them young children in Africa. The World Health Organization runs an extensive malaria-control program. However, the carrier mosquitoes and the parasites themselves have developed resistance to insecticides and drugs, thus making it more difficult to control the spread of the disease. International efforts to develop an effective vaccine against malaria have been under way for decades.

There are five species of parasite that cause human malaria: Plasmodium falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. The incubation period is usually one to two weeks but can be as long as 10 months if the person had been taking antimalarial drugs, which can delay the onset of the disease. The classic characteristic of malaria is a fever cycle that coincides with the life cycle of the Plasmodia parasites. The fever occurs when the rupture of the red blood cells releases more Plasmodia parasites into the bloodstream. The fever cycle has three stages: a stage with chills and uncontrollable shivering, a stage with a high temperature of up to 105° F (41° C), and a stage with sweating that brings down the temperature. Each cycle lasts four to 10 hours and repeats every two to three days or more frequently, depending on the parasites involved.

Commonly, the destruction of red blood cells causes anemia. In addition, dead cells may block blood vessels in major organs, often resulting in an enlarged spleen, kidney failure, and liver failure. Infection due to P. falciparum is by far the most dangerous. Unless it is diagnosed and treated promptly, it can progress rapidly from causing only mild symptoms to coma and death. After the first episode of infection, P. vivax and P. ovale can remain inactive in the liver for months or even years. When they emerge and attack red blood cells, they cause a relapse of the disease.

Malaria parasites have been infecting humans for thousands of years. The ancient Egyptian king Tutankhamen, who reigned in the 1300s bc, may have had malaria. In the 5th century bc the ancient Greek physician Hippocrates identified malarial fevers and divided them into three types. In China the leaves of the sweet wormwood plant have been used to treat malarial fevers since ancient times.

The link between malaria and bodies of water had been recognized early on, but it was not known that mosquitoes (which breed in bodies of standing water) or parasites were involved. In 1880 Alphonse Laveran, a French army surgeon, became the first to describe the malarial parasite and name it as the cause of the disease. British physician Sir Ronald Ross proved by 1898 that bird malaria is transmitted by Culex mosquitoes. In that same year, Italian researchers Amico Bignami, Giovanni Battista Grassi, and Giuseppe Bastianelli proved that Anopheles mosquitoes transmitted malaria parasites to humans. In rare cases, the disease can also be transmitted by common use of a hypodermic needle or by blood transfusion from infected donors.

Malaria is diagnosed by observing the parasite in a sample of the patient's blood, in a stained blood smear under a microscope. A treatment for malarial fevers-the bark of the cinchona tree, whose principle ingredient is quinine-has been known since the 1600s. For some three hundred years, quinine was the only effective malaria remedy available in Western medicine. Today, patients are commonly treated with synthetic quinine-based drugs-including chloroquine, primaquine, pyrimethamine, and amodiaquin-or with artemisinin, which is derived from the sweet wormwood plant. These medicines usually destroy the parasites in the bloodstream. Primaquine also inhibits the development of the parasites in the liver, thus preventing relapses. Unfortunately, many strains of the parasites have developed a resistance to chloroquine and some other antimalarial drugs. Combinations of medications including artemisinin or quinine are often used in such cases. Antimalarial drugs are also used to prevent or suppress malaria infection in travelers visiting areas where malaria is common.

Measures to reduce mosquito populations or to prevent mosquito bites are an important part of malaria prevention. Nets treated with insecticide, for instance, are placed over beds to protect people from getting bitten in their sleep. Other measures include spraying insecticides and draining and filling marshes, swamps, stagnant pools, and other bodies of standing water that are the mosquitoes' breeding places.

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A serious and ancient disease caused by one-celled Plasmodium parasites, malaria is spread to humans by the bite of infected Anopheles mosquitoes. The symptoms of malaria...

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Trusted information on everyday and complex child health conditions from The Hospital for Sick Children.

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web.archive.org - from MSN Encarta: Smallpox Through History Table

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web.archive.org - from MSN Encarta: Smallpox Through History Table

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Smallpox Through History - Table - MSN Encarta

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Variolation (deliberate infection with weakened smallpox virus to induce immunity) is introduced in Europe and North America, with mixed success. Full-blown smallpox develops in about 3 percent of cases.

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web.archive.org - Silent Killers of the New World

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web.archive.org - Silent Killers of the New World

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The European conquest of the New World was not caused by guns, swords, or barbaric type behavior but by the invisible danger-germs

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pbs.org - The Story Of... Smallpox – and other Deadly Eurasian Germs

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pbs.org - The Story Of... Smallpox – and other Deadly Eurasian Germs

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The Story Of... Smallpox - and other Deadly Eurasian Germs

Much of the credit for European military success in the New World can be handed to the superiority of their weapons, their literary heritage, even the fact they had unique load-bearing mammals, like horses. These factors combined, gave the conquistadors a massive advantage over the sophisticated civilisations of the Aztec and Inca empires.

But weapons alone can't account for the breathtaking speed with which the indigenous population of the New World were completely wiped out.

Within just a few generations, the continents of the Americas were virtually emptied of their native inhabitants - some academics estimate that approximately 20 million people may have died in the years following the European invasion - up to 95% of the population of the Americas.

No medieval force, no matter how bloodthirsty, could have achieved such enormous levels of genocide. Instead, Europeans were aided by a deadly secret weapon they weren't even aware they were carrying: Smallpox.

Smallpox acted as a form of biological weapon

Smallpox is a viral infection which usually enters the body through the nose or throat. From here the virus travels to the lungs, where it multiplies and spreads to the lymphatic system. Within a few days, large pustules begin to appear all over the victim's skin.

Starting with the hands and the face, and then spreading to cover the rest of the body, each blister is packed full of smallpox DNA. If punctured, these blisters become highly infectious, projecting fresh smallpox particles into the air and onto surrounding surfaces -such as someone else's skin. It is a disease that requires close human contact to replicate and survive.

The total incubation period lasts 12 days, at which point the patient will will either have died or survived. But throughout that period, if gone unchecked, they may have passed the disease to an enormous number of people. But the disease requires close human contact to replicate and survive.

Smallpox is a remarkably effective, and remarkably stable, infection - research has shown that over the course of 10 years, as few as three individual bases may change in a strain's DNA. The disease found an effective formula thousands of years ago, and there's no reason to change it.

So where does this deadly disease come from, and why was it linked to Europeans?

For thousands of years, the people of Eurasia lived in close proximity to the largest
variety of domesticated mammals in the world - eating, drinking, and breathing in the germs these animals bore. Over time, animal infections crossed species, evolving into new strains which became deadly to man. Diseases like smallpox, influenza and measles were in fact the deadly inheritance of the Eurasian farming tradition - the product of thousands of years spent farming livestock.

These epidemic Eurasian diseases flourished in dense communities and tended to explode in sudden, overwhelming spates of infection and death. Transmitted via coughing, sneezing and tactile infection, they wreaked devastation throughout Eurasian history - and in the era before antibiotics, thousands died.

But not everyone.

With each epidemic eruption, some people survived, acquiring antibodies and immunities which they passed on to the next generation. Over time, the population of Europe gained increased immunity, and the devastating impact of traditional infections decreased.

Yet the people of the New World had no history of prior exposure to these germs. They farmed only one large mammal - the llama - and even this was geographically isolated. The llama was never kept indoors, it wasn't milked and only occasionally eaten - so the people of the New World were not troubled by cross-species viral infection.

When the Europeans arrived, carrying germs which thrived in dense, semi-urban populations, the indigenous people of the Americas were effectively doomed. They had never experienced smallpox, measles or flu before, and the viruses tore through the continent, killing an estimated 90% of Native Americans.

Smallpox is believed to have arrived in the Americas in 1520 on a Spanish ship sailing from Cuba, carried by an infected African slave. As soon as the party landed in Mexico, the infection began its deadly voyage through the continent. Even before the arrival of Pizarro, smallpox had already devastated the Inca Empire, killing the Emperor Huayna Capac and unleashing a bitter civil war that distracted and weakened his successor, Atahuallpa.

In the era of global conquest which followed, European colonizers were assisted around the world by the germs which they carried. A 1713 smallpox epidemic in the Cape of Good Hope decimated the South African Khoi San people, rendering them incapable of resisting the process of colonization. European germs also wreaked devastation on the aboriginal communities of Australia and New Zealand.

More victims of colonization were killed by Eurasian germs, than by either the gun or the sword, making germs the deadliest agent of conquest.

Where to next?

Find out more about germs go to the Story of... Malaria.

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Guns Germs & Steel: Variables. Smallpox | PBS

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The Story Of... Smallpox - and other Deadly Eurasian Germs Much of the credit for European military success in the New World can be handed to the superiority of their weapons, their literary heritage, even the fact they had unique load-bearing mammals, like horses.

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BBC News - Past pandemics that ravaged Europe

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BBC News - Past pandemics that ravaged Europe

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news.bbc.co.uk

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By Verity Murphy
BBC News

In 430BC, during the Peloponnesian war against their great rival Sparta, the people of Athens were hit by a deadly disease that has defied diagnosis to this day.
The Greek historian Thucydides survived a bout of this unknown killer and left a vivid account of its symptoms, which make for frightening reading.

"People in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath," Thucydides starts by saying.

But that was just the beginning - sneezing and coughing were next, then diarrhoea, vomiting and violent spasms.

Next came livid skin, covered in pustules and ulcers, and a burning, unquenchable thirst.

Most died around the seventh or eighth day, but if not the disease moved to the bowels, where violent ulceration and worsening diarrhoea, combined with exhaustion, was usually enough to prove fatal.

A handful did survive, but the disease left its mark - toes, fingers, genitals and sight were often lost.

For others the legacy was an entire loss of memory, so that, as Thucydides says, they "did not know either themselves or their friends".

The world's first recorded pandemic had arrived.

Rome reduced

Thucydides says the disease began in Ethiopia, spreading through Egypt and Libya, then into the Greek world.

Over the next four years it killed almost a third of the Athenian population and its armed forces, along with the city's leader and mastermind of Athenian glory, Pericles.

It is unsurprising perhaps that the word pandemic is derived from Greek - "pan" meaning all, and "demos" meaning people.

By the 2nd Century AD, the mantle of European power had passed to Rome, largely thanks to the might of its army.

But this army almost proved the civilisation's downfall, when in AD165, troops returning from campaigns in the east of the empire brought back a disease which killed an estimated five million people.

Known as the Antonine Plague, after Marcus Aurelius Antoninus, one of two Roman emperors who died from the disease, it killed a quarter of those who caught it.

In AD166, the Greek physician and writer Galen travelled from Rome to his home in present-day Turkey and recorded some of the disease's symptoms.

In his treatise Methodus Medendi, he describes fever, diarrhoea, and inflammation of the pharynx, along with dry or pustular eruptions of the skin after nine days, symptoms which has led scholars to conclude the disease was most likely smallpox.

A second outbreak occurred between AD251 and 266, and at its height some 5,000 people were said to be dying in Rome every day.

Age-old tale

But even this extraordinary toll was surpassed when in the 6th Century AD, under the reign of the Byzantine Emperor Justinian I, a plague hit the city of Constantinople.

The disease is thought to have begun in Ethiopia or Egypt and spread northwards via ships transporting huge quantities of grain to the city's great public granaries.

A now familiar tale of disease-ridden fleas, carried on the backs of ship-borne rats, the Plague of Justinian, as it came to be known, was in fact the first great pandemic of the bubonic plague.

From AD541 to 542 it killed 40% of Constantinople's population, with the Byzantine historian Procopius claiming that at its peak the plague was killing 10,000 people in the city every day.

The disease fanned out across the eastern Mediterranean, wiping out a quarter of the region's population.

A second major outbreak in AD588 went further, spreading up into France, leaving an estimated final death toll for the disease of about 25 million.

Blackened skin

For the next 800 years, Europe was spared the misery of another pandemic, but in the middle of the 14th Century, the Plague of Justinian disease returned - only this time it bore another name.

Now known as the Black Death, thanks to the blackening of the skin which victims suffered through haemorrhaging under the skin, the disease arrived from Asia.

People fled in its path, but instead of escaping as they had hoped, they merely aided its spread across the continent.

From 1347 to 1350, the Black Death killed at least a quarter of Europe's population - an estimated 25 million people.

There were similar bubonic plague outbreaks in Asia and the Middle East at the same time, indicating that it was a global pandemic.

Bubonic plague outbreaks occurred repeatedly in Europe, reportedly gathering strength with each generation, until the 1700s.

By then the estimated worldwide death toll for the bubonic plague had reached a dizzying 137 million.

Cities under threat

Urban areas were particularly affected by the Black Death, with the disease often claiming 50% of the population in cities.

The next pandemic was also worse in cities, where poor sanitation provided a perfect breeding ground.

Cholera had been described by Portuguese physician Garcia de Orta in the 16th century, but it was in 1816 that the disease went truly global.

Already endemic to India, the disease now spread along trade routes into Russia and Eastern Europe, before shifting to Western Europe and even North America.

The world has been ravaged by no less than seven cholera pandemics, six of them starting in the 19th Century, with every continent except Antarctica suffering outbreaks.

The most recent occurred in 1961, starting in Indonesia, and though modern sanitation has curbed the disease's power, it is still a killer today.

Young people hit

Cholera may have been the scourge of the 19th century, but in the 20th Century it was influenza.

During the last century there were three flu pandemics. The first and worst, the Spanish flu, started in 1918 in three far-flung locations: Brest, in France; Boston in the US; and Freetown in Sierra Leone.

The disease had an incredibly high mortality rate and unusually people aged 20-40 were its victims rather than the old and weak.

It also moved across the globe with breathtaking speed, killing 25 million people in the course of six months; a fifth of the world's population was infected.

The disease disappeared almost as fast as it had appeared, but by then it had killed an estimated 40 million people, more than had died in World War I, which was coming to an end at the time.

For many years the precise strain of flu could not be identified, but new research conducted by the US Armed Forces Institute of Pathology indicates that it most probably originated in birds.

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BBC NEWS | Health | Past pandemics that ravaged Europe

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By Verity Murphy BBC News In 430BC, during the Peloponnesian war against their great rival Sparta, the people of Athens were hit by a deadly disease that has defied diagnosis to this day. The Greek historian Thucydides survived a bout of this unknown killer and left a vivid account of its symptoms, which make for frightening reading.

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Includes some primary source photographs with captions.

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Smallpox ranks among the most devastating illnesses ever suffered by humankind. It dramatically altered the course of human history, even contributing to the decline of civilizations. Officially the deadly virus no longer exists. After a final outbreak in the United States in 1949, the virus was declared eradicated in 1980 following a successful vaccination program regarded as one of the greatest triumphs of modern medicine.

Smallpox is an acute contagious disease caused by the variola virus. It gets its name from the Latin word for "spotted," referring to the raised, pustular bumps that break out over the face and body of those affected. Historically the virus killed around 30 percent of people who caught it. Those who survived were often left blind, sterile, and with deep pitted scars, or pockmarks, on the skin.

Spread through direct contact with infected people, body fluids, or contaminated objects such as bedding, the disease had two main types. Variola major was the most common form-and most lethal. Variola minor produced a milder disease, which was fatal in less than one percent of cases. Two other, rarer forms also existed: hemorrhagic and malignant. Both invariably resulted in death.

Early Victims

Smallpox is thought to have originated in India or Egypt at least 3,000 years ago. The earliest evidence for the disease comes from the Egyptian Pharaoh Ramses V, who died in 1157 B.C. His mummified remains show telltale pockmarks on his skin.

The disease later spread along trade routes in Asia, Africa, and Europe, eventually reaching the Americas in the 1500s. Indigenous peoples there had no natural immunity. An estimated 90 percent of indigenous casualties during European colonization were caused by disease rather than military conquest.

Smallpox contributed to the decline of the Aztec Empire, in what is now Mexico, following the virus's arrival with Spanish conquerors in 1519. More than three million Aztec succumbed to the disease. Severely weakened, the Aztec were easily defeated. Likewise, smallpox claimed the life of an Inca emperor and wiped out much of the Inca population in western South America.

In Europe, smallpox is estimated to have claimed 60 million lives in the 18th century alone. In the 20th century, it killed some 300 million people globally.

Vaccination Victory

The human fight against smallpox dates back some 2,000 years. In Asia, a technique known as variolation involved deliberately infecting a person by blowing dried smallpox scabs up their nose. Those who received this treatment contracted a mild form of the disease, developing a lifelong immunity.

A key breakthrough came in 1796 when an experiment by English doctor Edward Jenner showed that inoculation using closely related cowpox could protect against smallpox. Jenner's discovery paved the way for later vaccination programs-especially crucial since there is no effective treatment for smallpox.

In 1967, a year when some 10 million to 15 million people contracted smallpox, the World Health Organization launched a worldwide eradication campaign based on vaccination. Gradually, the disease was pushed back to the Horn of Africa, and the last known natural case occurred in Somalia in 1977.

Despite being consigned to the history books, there's still a chance of smallpox coming back to haunt us-as a biological weapon. Such fears escalated dramatically in the United States following the September 11, 2001, terrorist attacks. While the risk of such a bioterror attack is considered very low, the U.S. has since stockpiled enough of the vaccine to inoculate every citizen.

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Smallpox ranks among the most devastating illnesses ever suffered by humankind. It dramatically altered the course of human history, even contributing to the decline of civilizations. Officially the deadly virus no longer exists. After a final outbreak in the United States in 1949, the virus was declared eradicated in 1980 following a successful vaccination program regarded as one of the greatest triumphs of modern medicine.

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History of Smallpox - Center for Disease Control and Prevention (cdc.gov)

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History of Smallpox - Center for Disease Control and Prevention (cdc.gov)

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Origin of Smallpox

The origin of smallpox is unknown. The finding of smallpox-like rashes on Egyptian mummies suggests that smallpox has existed for at least 3,000 years. The earliest written description of a disease like smallpox appeared in China in the 4 th century CE (Common Era). Early written descriptions also appeared in India in the 7 th century and in Asia Minor in the 10 th century.

Spread of Smallpox

Historians trace the global spread of smallpox to the growth of civilizations and exploration. Expanding trade routes over the centuries also led to the spread of the disease.

Highlights from History:

6th Century-Increased trade with China and Korea brings smallpox to Japan.

7th Century-Arab expansion spreads smallpox into northern Africa, Spain, and Portugal.

11th Century-Crusades further spread smallpox in Europe.

15th Century-Portugal occupies part of western Africa, bringing smallpox.

16th Century-European settlers and the African slave trade import smallpox into:

The Caribbean

Central and South America

17th Century-European settlers bring smallpox to North America.

18th Century-Explorers from Great Britain bring smallpox to Australia.

Early Control Efforts

Smallpox was a terrible disease. On average, 3 out of every 10 people who got it died. People who survived usually had scars, which were sometimes severe.

One of the first methods for controlling smallpox was variolation, a process named after the virus that causes smallpox (variola virus). During variolation, people who had never had smallpox were exposed to material from smallpox sores (pustules) by scratching the material into their arm or inhaling it through the nose. After variolation, people usually developed the symptoms associated with smallpox, such as fever and a rash. However, fewer people died from variolation than if they had acquired smallpox naturally.

The basis for vaccination began in 1796 when the English doctor Edward Jenner noticed that milkmaids who had gotten cowpox were protected from smallpox. Jenner also knew about variolation and guessed that exposure to cowpox could be used to protect against smallpox. To test his theory, Dr. Jenner took material from a cowpox sore on milkmaid Sarah Nelmes' hand and inoculated it into the arm of James Phipps, the 9-year-old son of Jenner's gardener. Months later, Jenner exposed Phipps several times to variola virus, but Phipps never developed smallpox. More experiments followed, and, in 1801, Jenner published his treatise "On the Origin of the Vaccine Inoculation." In this work, he summarized his discoveries and expressed hope that "the annihilation of the smallpox, the most dreadful scourge of the human species, must be the final result of this practice."

Vaccination became widely accepted and gradually replaced the practice of variolation. At some point in the 1800s, the virus used to make the smallpox vaccine changed from cowpox to vaccinia virus.

Global Smallpox Eradication Program

In 1959, the World Health Organization (WHO) started a plan to rid the world of smallpox. Unfortunately, this global eradication campaign suffered from a lack of funds, personnel, and commitment from countries, and a shortage of vaccine donations. Despite their best efforts, smallpox was still widespread in 1966, causing regular outbreaks across South America, Africa, and Asia.

The Intensified Eradication Program began in 1967 with a promise of renewed efforts. Laboratories in many countries where smallpox occurred regularly were able to produce more, higher-quality freeze-dried vaccine. Other factors that played an important role in the success of the intensified efforts included the development of the bifurcated needle, the establishment of a case surveillance system, and mass vaccination campaigns.

By the time the Intensified Eradication Program began in 1967, smallpox was already eliminated in North America (1952) and Europe (1953). Cases were still occurring in South America, Asia, and Africa (smallpox was never widespread in Australia). The Program made steady progress toward ridding the world of this disease, and by 1971 smallpox was eradicated from South America, followed by Asia (1975), and finally Africa (1977).

Last Cases of Smallpox

In late 1975, three-year-old Rahima Banu from Bangladesh was the last person in the world to have naturally acquired variola major. She was also the last person in Asia to have active smallpox. She was isolated at home with house guards posted 24 hours a day until she was no longer infectious. A house-to-house vaccination campaign within a 1.5-mile radius of her home began immediately. A member of the Smallpox Eradication Program team visited every house, public meeting area, school, and healer within 5 miles to ensure the illness did not spread. They also offered a reward to anyone who reported a smallpox case.

Ali Maow Maalin was the last person to have naturally acquired smallpox caused by variola minor. Maalin was a hospital cook in Merca, Somalia. On October 12, 1977, he rode with two smallpox patients in a vehicle from the hospital to the local smallpox office. On October 22, he developed a fever. At first healthcare workers diagnosed him with malaria, and then chickenpox. The smallpox eradication staff then correctly diagnosed him with smallpox on October 30. Maalin was isolated and made a full recovery. Maalin died of malaria on July 22, 2013, while working in the polio eradication campaign.

Janet Parker was the last person to die of smallpox. In 1978, Parker was a medical photographer at England's Birmingham University Medical School. She worked one floor above the Medical Microbiology Department where staff and students conducted smallpox research. She became ill on August 11 and developed a rash on August 15 but was not diagnosed with smallpox until 9 days later. She died on September 11, 1978. Her mother, who was providing care for her, developed smallpox on September 7, despite having been vaccinated two weeks earlier. An investigation suggested that Janet Parker had been infected either via an airborne route through the medical school building's duct system or by direct contact while visiting the microbiology corridor.

World Free of Smallpox

Almost two centuries after Jenner hoped that vaccination could annihilate smallpox, the 33 rd World Health Assembly declared the world free of this disease on May 8, 1980. Many people consider smallpox eradication to be the biggest achievement in international public health.

Stocks of Variola Virus

Following the eradication of smallpox, scientists and public health officials determined there was still a need to perform research using the variola virus. They agreed to reduce the number of laboratories holding stocks of variola virus to only four locations. In 1981, the four countries that either served as a WHO collaborating center or were actively working with variola virus were the United States, England, Russia, and South Africa. By 1984, England and South Africa had either destroyed their stocks or transferred them to other approved labs. There are now only two locations that officially store and handle variola virus under WHO supervision: the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (VECTOR Institute) in Koltsovo, Russia.

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smallpox (variola major and variola minor)

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Smallpox - Britannica Kids article for Students

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Smallpox - Britannica Kids article for Students

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Once one of the world's most dreaded plagues, smallpox is an acute infectious disease caused by the virus Variola major, a member of the orthopoxvirus family. The disease has been known for thousands of years-it was described as early as 1122 in China and is referred to in the ancient Sanskrit texts of India. Evidence of smallpox was found on the mummified head of the Egyptian pharaoh Ramses V, who died in approximately 1156 bc. A vaccine for the disease was discovered in 1796 by Edward Jenner, an English physician. Less than 200 years later, the disease was eradicated, thanks to a worldwide vaccination campaign. By the end of the 20th century, however, the possibility of the virus being used as an agent of bioterrorism or in biological warfare became an increasing threat.

Smallpox is spread by inhaling saliva or mucus droplets from an infected individual. After about 7 to 17 days, flulike symptoms begin; these include high fever, body aches, and fatigue. Within a few days a body rash develops that quickly evolves into pus-filled blisters, or pustules. By the second week the pustules form crusts, which dry out and turn into scabs. After a week or so the scabs fall off, leaving deep and often disfiguring scars. The mortality rate of smallpox is very high-up to 30 percent of its victims die from the disease. Those who do not die may suffer from complications of the disease, which include blindness, pneumonia, and kidney damage. No adequate treatment is available to fight the virus, though antibiotics may be prescribed to hinder secondary bacterial infections. The virus is remarkably stable and can exist in the environment and on bedding and clothing for extended periods of time.

Large outbreaks of smallpox have occurred throughout history, affecting individuals from all walks of life. Smallpox was responsible for the deaths of Queen Mary II of England, Emperor Joseph I of Austria, King Luis I of Spain, Tsar Peter II of Russia, Queen Ulrika Elenora of Sweden, and King Louis XV of France. Although the vaccine discovered by Jenner in 1796 was effective, it was not used consistently; by the 1950s, roughly 50 million cases of smallpox still occurred worldwide each year.

Centers for Disease Control and Prevention (CDC) (Image Number: 7073)

In 1956 the World Health Organization implemented a global vaccination campaign to eradicate smallpox. By 1967, the program was showing its effect, and infection with smallpox had fallen to approximately 10-15 million cases annually around the world. The disease was eradicated in the Western Hemisphere in 1971; routine vaccination in the United States was halted in 1972, and in the rest of the world by the early 1980s. The last naturally contracted case of smallpox in the world occurred in 1977, and in 1979 the World Health Organization declared the disease extinct. Despite the disease's eradication, the United States and Russia continued to maintain live cultures of variola for research purposes at the U.S. Centers for Disease Control and Prevention (CDC) and the Russian State Center for Research on Virology and Biotechnology, respectively. It is not known if cultures are secretly maintained in clandestine laboratories.

The variola virus has all the characteristics of an effective biological weapon: it can be produced in large quantities, is relatively stable-meaning that it can live in the environment for moderate periods of time-and can be spread in aerosol form. The use of smallpox as a biological weapon is not a recent idea. During the French and Indian War of the mid-18th century, British forces gave Native Americans blankets that had been intentionally contaminated with the disease. The virus may also have been used by the Japanese against Chinese prisoners during World War II.

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Once one of the world's most dreaded plagues, smallpox is an acute infectious disease caused by the virus Variola major, a member of the orthopoxvirus family. The disease has been known for thousands of years-it was described as early as 1122 in China and is referred to in the ancient Sanskrit texts of India.

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Video - Scientists Finally Discover the Origin of the Black Death

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Video - Scientists Finally Discover the Origin of the Black Death

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Scientists Finally Discover the Origin of The Black Death

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Video: The Plague of Athens - Past Pandemics

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Video: The Plague of Athens - Past Pandemics

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Video - Pandemics in History: The Plague of Athens

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Video - Pandemics in History: The Plague of Athens

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Pandemics in history: The Plague of Athens

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These days, quarantined in our homes and ever alert to the media's latest reports on COVID-19, infectious disease is never far from our thoughts. Athenians, however, have been through all this before, more than 2,400 years ago. And even then, in the Classical late 5th c. BC, there was quarantine, panic, heroic self-sacrifice by the city's health-care workers and fake news.

Something bad happened in ancient Athens in 430 BC, on that everyone agrees. Already the city was embroiled in a grueling "World War" against Sparta and its allies, whose hostilities had broken out the year before, and would rage on for nearly three decades. But Athens had a new problem, according to the historian Thucydides, at a time when many rural citizens had fled the Attic countryside and taken refuge inside the city-state's walled "asty."

A plague, appearing first in Piraeus, swept mercilessly through the confined Athenian population. To add insult to injury, Athens' great leader, Pericles, died in the autumn of 429 BC. Thucydides himself became ill, but survived to tell a tale of epidemic disease and grim misery that gripped Athens in the early years of the Peloponnesian War. Yet it seems there was much more to the story than what Thucydides reported. And it now is clear that the respected historian - on whom everyone since has relied for details of the plague - may have simplified, blame-shifted and exaggerated.

In the end, we have to ask, was there actually an Athens "plague"? And can we really conclude Pericles was among its victims?

An Eyewitness Account

Remarkably, Thucydides is the only ancient author who describes the late-5th c. BC plague in Athens (2.47-54, 2.57-58). The word "plague" is somewhat ambiguous, as it can be used to describe an epidemic generally, or the specific disease known as (bubonic) plague - the illness "caused by... Yersinia pestis, a zoonotic bacteria usually found in small mammals and their fleas," according to the World Health Organization. In the case of Athens, Thucydides writes "the plague" (Anc. GR: h nosos), meaning "the illness/disease."
"As soon as summer returned [430 BC], the Peloponnesian army...invaded Attica... They had not been there many days when the plague broke out at Athens for the first time. A similar disorder is said to have previously smitten many places, particularly Lemnos, but there is no record of such a pestilence occurring elsewhere, or of so great a destruction of human life" (2.47.2-3).
The historian is clearly referring to a single outbreak of disease, an epidemic, involving one illness. Since then, for more than two millennia, other historians and writers have followed suit, describing "plague in Athens," "a city riddled with plague," "the inhabitants' fear of plague," etc. But what sort of disease was it exactly?

Thucydides reports the symptoms and signs exhibited by the victims as if they all arose from one ailment. To emphasize this point, he states: "If any man were sick before, his disease turned to this" (2.49.1). His description of the illness' indicators and progression is long and detailed (2.49), including extreme headache; red, inflamed eyes; throats and tongues growing bloody; breath noisome and unsavory; sneezing; hoarseness; chest pain and cough; stomach upset and vomiting; hiccups with strong convulsions; reddening skin with welts; internal heat (fever); insatiable thirst; dysentery; and finally death in 7-9 days.

Extreme cases, which nevertheless some patients survived, also involved gangrene, affecting the "privy parts," fingers and toes; loss of the eyes (blindness); and an onset of "forgetfulness" (confusion, dementia). Altogether very unpleasant and speedily fatal, especially in an age long before antibiotics and other modern medicines.

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What We Know About the Plague of Ancient Athens - Greece Is

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These days, quarantined in our homes and ever alert to the media's latest reports on COVID-19, infectious disease is never far from our thoughts. Athenians, however, have been through all this before, more than 2,400 years ago. And even then, in the Classical late 5th c.

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The Plague of Athens was an epidemic which hit the city-state of Athens in ancient Greece during the second year of the Peloponnesian War ( 430 BC), when an Athenian victory still seemed possible. Many historians believe that it entered Athens through Piraeus, the city's port and sole source of food and supplies. The city-state of Sparta, and much of the eastern Mediterranean, was also struck by the disease. The plague returned twice more, in 429 BC and in the winter of 427/6 BC.

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The Plague of Athens was an epidemic which hit the city-state of Athens in ancient Greece during the second year of the Peloponnesian War ( 430 BC), when an Athenian victory still seemed possible. Many historians believe that it entered Athens through Piraeus, the city's port and sole source of food and supplies.

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Greektraveltellers.com - Plague of Athens

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Greektraveltellers.com - Plague of Athens

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The Great Plague of Athens

The year is 430 BC. Athens is currently at its "Golden Age" with the great Pericles at the wheel. The democratic state has known an era of splendor and a standard of living higher than any previously experienced. However, the Athenian supremacy in the Aegean Sea and the Mediterranean is now highly disputed. Athens has been in a state of war for the second consecutive year with Sparta, a Greek civil conflict that is known in history as "the Peloponnesian War". We are still at the beginning of a bloody war that will last 27 (!) whole years! The outcome of the war still remains uncertain, but an invisible enemy will alter the balance significantly; a very deadly epidemic, known as the "Great Plague of Athens".

Thucydides' narrative

The course of the history of many ancient cultures has been greatly influenced by the emergence of epidemics. Among them, the pestilence that hit Ancient Athens was undoubtedly one of the major contributors to the outcome of the Peloponnesian War, hastening the collapse of Athens' Golden Age and the Athenian domination in the Mediterranean. It is because of the efforts of one great man and the father of the "scientific history", the Athenian historian and general Thucydides, that we can shed light today to the events that occurred about 2500 years ago.

"A plague as great as this and with such devastating consequences that it had no similarity in nothing else in human history".

Thucydides' work focuses on the History of the Peloponnesian War. His description of the plague that struck Athens in 430 BC follows on from his renowned account of Pericles' Funeral Oration, the speech that was given by Pericles in Kerameikos cemetery during the public funeral in honor of the war dead. Pericles fell victim to the disease shortly after his speech, however, Thucydides survived it.

Athens in crisis

The disease erupted at the beginning of the summer of 430 BC and by the summer of 428 BC it had literally decimated the population of the city. After a brief period of recession, the epidemic broke out again during the winter of 427 BC and lasted until the winter of 426 BC. It is estimated that about one in three residents of Athens was lost in the epidemic, including Pericles, the city's leader. The loss of a large proportion of the human resources and a significant portion of the city's leaders, coupled with the sharp decline in the morale of its surviving civilians, led to significant errors in the city's political and military choices, which resulted in unconditional defeat and capitulation. After the end of the Peloponnesian War, Athens did not regain in the future even a part of its former power and glory.

The nature of the disease: symptoms and casualties

The reason that caused the Plague of Athens was one of the greatest mysteries of the History of Medicine to this day. The only evidence about the Plague is confined to the narrations of Thucydides, who himself contracted the disease but survived. In his history of the Peloponnesian War, the Athenian historian describes quite precisely the conditions prevailing in Athens during the period of the Plague, as well as the main signs and symptoms of the disease:
"I let everyone, doctor or ignorant, explain, as far as he knows, where he came from and what was the cause of the disease that caused such disorder in the body, leading him from health to death. I, who got sick myself and saw with my own eyes getting sick, will describe the illness and its symptoms so that if it ever happens, everyone will have it in mind and know the illness to get well measures of...".
The historian mentions North Africa as the likely origins of the disease, which spread in the wider regions of Athens. The disease was very infectious, with high mortality among doctors and relatives who cared for patients. It is estimated that about a quarter or a third of the population of Ancient Athens was lost to the epidemic. Thucydides describes the symptoms in some detail: the burning feeling of sufferers, stomachaches and vomiting, the desire to be totally naked without any linen resting on the body itself, insomnia and restlessness. If the patient survived this first stage, after seven or eight days, the pestilence would descend to the bowels and other parts of the body (genitals, fingers and toes). Some people even went blind. According to Thucydides:
"Words indeed fail one when one tries to give a general picture of this disease; and as for the sufferings of individuals, they seemed almost beyond the capacity of human nature to endure. The most terrible thing was the despair into which people fell when they realized that they had caught the plague; for they would immediately adopt an attitude of utter hopelessness, and by giving in in this way, would lose their powers of resistance. As for offenses against human law, no one expected to live long enough to be brought to trial and punished: instead everyone felt that a far heavier sentence had been passed on him."
We can see from the recounts of the historian the devastative effects the epidemic had on the Athenian society and the breakdown in traditional values where self-indulgence replaced honor and where there existed no fear of God or man.

Modern theories about the cause of the plague

Based on Thucydides' description, many leading scholars from around the world have at times formulated a series of theories and hypotheses, but have failed to reach safe conclusions as to the cause of the Athens' Great Plague. The inability to substantiate any hypothesis about the cause of the infection is due to the difficulty of identifying an individual or combination of pathogens as the cause of the epidemic, based on the clinical picture described. Thucydides' description of the symptoms does not fit into any of the modern forms of infections. Although the credibility and accuracy of Thucydides' references are not disputed, it should be noted that he wrote his famous book some 10 years after the time when the events took place. Indeed, as he did not have specialized medical knowledge, he could have emphasized some of the signs and symptoms of the disease that impressed him most, to the detriment of others, but which may be pathognomonic features for specific diseases. On the other hand, the same disease may not appear the same way today as it did in antiquity. Until recently, about 30 different diseases have been posited as possible causes of the plague, with ebola, malaria and cholera amongst them. However, a recent DNA analysis of dental pulp from teeth recovered from a group tomb in Athens, led by the orthodontist Dr. Manolis Papagrigorakis of the University of Athens, found DNA sequences similar to those of Salmonella enterica, the organism that causes typhoid fever. Nevertheless, the methodology of that study was disputed by other scientists, stating that it led to false conclusions before.

Research on the tomb of Kerameikos

The skeletal material needed to carry out an investigation on the victims of Athens' Plague was discovered in a relatively recent archaeological excavation of the period 1994-5, which took place in the area of the ancient cemetery of Athens, in Kerameikos. During this excavation, a mass grave of irregular shape was discovered containing about 150 dead, including several children, in the same area where Pericles delivered his famous oration about the war dead and where he was later buried as well, having fallen victim to the disease. This group tomb was dated to the evaluation of archaeological finds between 430-426 BC, that is, in the time of the Great Plague of Athens. According to archaeologists' estimates, the tomb was not of a monumental nature, as the bodies of the dead were found stacked in places suggesting that they were hurriedly buried, without the usual burial customs and respect for the dead. On the basis of these findings, a team of Greek scientists formulated the theory that they were victims of the Great Plague.

Epilogue of an epidemic

The lessons we will learn from today's pestilence and the coronavirus crisis will come from our own experience of it, not from reading about the Athens Plague. But Thucydides offers us a unique and useful view into a society in war with an invisible enemy and how people face that threat. Quoting Thucydides, "Through knowledge, patience and science we can prevail." To all out there fighting coronavirus or staying home, humanity has seen countless destructions and survived. Keep strong and keep safe.

If you are interested in discovering more about Greek history and culture, you can see more of our blog articles here. Coronavirus is a global crisis, but like others before, it will pass. Nothing is stopping you from making dreams and plans for your next getaway to Greece. If you visit Athens, make sure to join a guided tour in Kerameikos, to delve deeper into the splendor and the humanity of Ancient Athenians. Until then, stay home and stay safe.

*Papagrigorakis MJ, Yapijakis C, Synodinos PN, Baziotopoulou-Valavani E (2006), "DNA examination of ancient dental pulp incriminates typhoid fever as a probable cause of the Plague of Athens", International Journal of Infectious Diseases, 10 (3), 206-14.

Main photo credit: Michiel Sweerts [Public domain]

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The Great Plague of Athens: Lessons from the Past

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The year is 430 BC. Athens is currently at its "Golden Age" with the great Pericles at the wheel. The democratic state has known an era of splendor and a standard of living higher than any previously experienced. However, the Athenian supremacy in the Aegean Sea and the Mediterranean is now highly disputed.

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National Geographic - The Plague of Athens

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National Geographic - The Plague of Athens

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Two of the most powerful city-states in ancient Greece-Sparta and Athens-went to war in 431 B.C. Tensions between the two had been simmering for decades before boiling over into war. Occupying the lands of the Peloponnese (mainland Greece's southern-most peninsula), Sparta enacted a land-based strategy, relying on their disciplined hoplites to defeat the Athenians in the open field. When Spartan troops would invade Attica (the peninsula where Athens and its allies were located), Athenians responded with naval attacks on politically sensitive points in the Peloponnese. Rural populations in Attica would be forced to take refuge within Athens's city walls when Sparta invaded.

The Peloponnesian War broke out in 431 b.c. Despite the devastation caused by the plague, the war lasted for more than 25 years.

Photograph by NG Maps

The Peloponnesian War would end by fundamentally shifting power in the Mediterranean, but neither Athens's navy nor Sparta's soldiers could claim to be the determining factor of the conflict. That honour belongs to an event that nobody could have predicted or planned for: the plague of Athens, which broke out in the war's second year. A medical mystery to this day, this ancient epidemic would be the most influential factor to shape the war and decide which city-state would be the final victor.

Outbreak

In spring 430 B.C. locals in Piraeus, the port area of Athens, began to fall ill with a disease no one had seen before. The malady spread quickly. Reports circulated of similar outbreaks on the island of Lemnos, in the north Aegean, and other locations.

In Piraeus, rumours spread that when the Spartans had arrived they had poisoned the wells there so that Athenians were sickened by drinking contaminated water. In a matter of weeks, the disease had spread to the heart of the city and was affecting people of all ages and backgrounds and in unprecedented proportions. The strategy of the Athenian leader Pericles to bring people from rural Attica into the walled city of Athens, only increased the rate of contagion. The illness, whatever it was, did not affect the Spartans to the same degree as the Athenians. In total, it is estimated that between 25 and 35 percent of the population of Athens would perish as a result of the plague when it ended five years later. (Discover how ancient Sparta created a deadly military machine.)

Dedicated to Athena, patron goddess of Athens, the Parthenon overlooks the city from its perch on the Acropolis. The temple was finished in 432 B.C., shortly before the start of the Peloponnesian War.

The main source of information about the epidemic comes from the historian Thucydides, who not only witnessed the events first-hand but survived the disease himself. In his History of the Peloponnesian War, Thucydides believes the plague originated in eastern Africa, in the lands of ancient Ethiopia (present-day Sudan). From there, the sickness travelled north to Egypt and Libya and east to the Persian Empire before reaching Greece.

Early in his account, Thucydides writes: "I shall give a statement of what it was like, which people can study in case it should ever attack again." His descriptions chart how the disease progressed in its victims, from the first symptoms: "[P]eople in good health were all of a sudden attacked by heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and foetid breath." Symptoms included "sneezing and hoarseness" before the disease attacked the chest, causing "a hard cough," and then the stomach, where it triggered "discharges of bile," "ineffectual retching," and "violent spasms." By this point the victim was in "very great distress."

Thucydides describes the appearance of the patient's skin: "reddish, livid, and breaking out into small pustules and ulcers." Sufferers described intense fevers, feeling as though a fire was consuming them inside, so they would remove all their clothes. They experienced an "unquenchable thirst," which led some to plunge themselves into water tanks as well. Extreme insomnia followed.

Thucydides reports that many patients died within seven to nine days of being infected. If they made it through the first stage, they might then suffer severe ulceration of the bowels accompanied by diarrhoea; the ensuing weakness generally proved fatal. The main problems in treating the disease was its novelty and its contagiousness. Doctors had never experienced anything quite like it, leaving their expertise powerless against the epidemic. "No remedy was found that could be used as a specific," writes Thucydides, "for what did good in one case, did harm in another." Regardless of the treatment given, he writes, "strong and weak constitutions proved equally incapable of resistance, all alike being swept away."

The contagious disease took a toll on those who cared for the sick. Physicians were badly hit early on. Indeed, anyone who nursed their sick loved ones paid a high price: "[I]f they ventured to do so, death was the consequence." If they did not, the patients "perished from neglect; indeed many houses were emptied of their inmates for want of a nurse." Thucydides notes that "it was with those who had recovered from the disease that the sick and the dying found most compassion. These knew what it was from experience." (Here's why 17th-century plague doctors wore those strange beaked masks.)

Infection seems to have brought with it some immunity: "The same man was never attacked twice-never at least fatally." Those who had been infected but had come through might experience a brief, euphoric feeling that they could survive anything. Even so, the plague, whatever it was, could leave those who recovered with severe aftereffects. Some people were "seized with an entire loss of memory on their first recovery, and did not know either themselves or their friends." Many survivors suffered lasting damage to their fingers and toes, genitals, and eyes.

As well as its impact on health, the epidemic caused radical disruption to everyday life for Athenians. According to Thucydides, "the bodies of dying men lay one upon another, and half-dead creatures reeled about the streets." Corpses piled up and, given the urgency of the situation, there was no time to perform even the most elementary rites when burying the dead. Several bodies would be cremated at the same time on the same pyre. (Medieval burials reveal that pandemics spawned fears of the undead.)

What is a Virus?

Viral outbreaks can become deadly pandemics in a matter of days. To prevent catastrophe, courageous scientists are fighting back with new treatments and vaccines. Images from the show "Breakthrough".

The plague had a radical effect on Athenian society. Traditional hierarchies were turned upside down: Wealthy citizens might see their livelihoods destroyed from one day to the next, while poor ones might get rich by appropriating a dead man's assets. Thucydides describes how moral conventions were abandoned and people tended to live each day as if it were their last: "[A]s the disaster passed all bounds, men, not knowing what was to become of them, became utterly careless of everything, whether sacred or profane." Nobody feared justice, as death by plague seemed more imminent than any pending court case.

Spiritual concerns loomed large as well. Many believed something had angered the gods, who unleashed the disease as punishment. According to Thucydides, the elders spoke of an ancient oracle that had predicted a great epidemic would ensue after a "Dorian war"; the Spartans were Dorians, descendants of an ancient people who had settled in the Peloponnese. It was also rumoured that the Spartans had consulted the oracle at Delphi about the outcome of the war; through prophecy, the god Apollo had promised his support to Sparta. The Athenians themselves sought counsel of the gods and sent emissaries to Delphi and other sanctuaries for divine guidance on the epidemic.

As an epidemic ravaged the city, Athens looked to the gods for help and sent delegations to the oracle in the Temple of Apollo at Delphi. The colonnade standing at the site today dates to the fourth century B.C.

Photograph by JESSE PEET/GETTY IMAGES

Overwhelmed by the impact of the plague on their loved ones and on their way of life, Athenians began to turn against their leader, Pericles. While the move may have seemed practical at the time, with hindsight, his war strategy of encouraging the population to shelter from Sparta's attacks within Athens's city walls had worsened the sanitary conditions in the city. As Thucydides records:

An aggravation of the existing calamity was the influx from the country into the city, and this was especially felt by the new arrivals. As there were no houses to receive them, they had to be lodged at the hot season of the year in stifling cabins, where the mortality raged without restraint.

Pericles' political rivals went further, accusing him of calling down the misfortune upon them through his determined support for the war. After more than a decade of often adoring support, Athens turned against Pericles: A heavy fine was levied against him, and he was not reelected as official strategist.

Having been thrown out of office for mishandling the epidemic, Pericles would then suffer the ravages of the disease firsthand. According to the historian Plutarch, Pericles' eldest son, Xanthippus, who had a rocky relationship with his father, succumbed to the plague, as did Pericles' sister shortly after. His second son, Paralus, also fell ill and died, a tragedy that ended up breaking the legendary self-control of Pericles, who died from the plague himself in fall 429 B.C.

The epidemic greatly weakened Athens and brought an end to its Golden Age. By the time the plague ended around 425 B.C., it is estimated that nearly a third of the city's people died, with between 75,000 to 100,000 lives lost. Sparta and Athens would strike a truce around 421 B.C. Sparta would ultimately win the Peloponnesian War, destroying the Athenian fleet at sea in 405.

Mystery malady

Historians have still not identified the epidemic's exact source. Because of Thucydides' use of the word "plague," some have hypothesised that it was an outbreak of the bubonic plague, cause of the Black Death in the 14th century. However, close reading of Thucydides shows no mention of the Black Death's most notorious symptoms: the "buboes," the swollen lymph nodes that blackened and sometimes burst.

In 1994 a mass grave dating to 430-420 B.C. was identified. Within it were 150 bodies that appeared to have been hastily buried. A team of researchers led by Manolis J. Papagrigorakis analysed DNA from the dental pulp of three individuals. Publishing their results in 2006, they found the presence of a pathogen with a 93 percent similarity to typhoid fever. Other scholars, however, have challenged the theory that the plague was caused by that illness because typhoid was common at the time. Thucydides' account is of an ailment the likes of which had never been seen before in ancient Greece, a so-called virgin soil epidemic.

Located northwest of the Acropolis, the Kerameikos district was home to a public cemetery where many war dead were buried. According to Thucydides, Pericles gave a funeral oration there in 431 B.C.

Photograph by Shutterstock

Many of Thucydides' symptoms match those of Ebola. Unlike illnesses of bacterial origin (like typhoid or bubonic plague), finding genetic evidence of viruses like Ebola or measles is more challenging. To identify them, geneticists must study RNA, which is more unstable than DNA and degrades more easily over time. Finding a viable sample from fifth-century B.C. Athens is very unlikely, so if the plague of Athens was caused by a virus, its precise identity will remain a mystery for now.

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The Plague of Athens killed tens of thousands, but its cause remains a mystery

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Killing nearly a third of the population, an epidemic ripped through Athens in 430 B.C. Historic accounts and new technology are helping identify the true...

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panama.lindahall.org - Fighting the Fever

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panama.lindahall.org - Fighting the Fever

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"Experience here has exploded the theory that white men cannot stand labor in the tropics, and also the notion that the natives are immune from tropical diseases." -A.B. Nichols

Over 22,000 workers died during the French effort to build the Canal, many of them from malaria and yellow fever. The symptoms of yellow fever were terrifying: fever, headaches, back pain, extreme thirst, and black vomit from internal bleeding. The disease could progress to kidney failure, seizures, coma, and death. It was called yellow fever because patients took on the yellow tinge of jaundice when the illness attacked the liver.

When the U.S. took over building the Canal in 1904, Theodore Roosevelt appointed Colonel William Gorgas to the post of Chief Sanitary Engineer. Gorgas had successfully eradicated yellow fever from Cuba in 1901 after the discovery that the mosquito Aedes egyptii was the carrier of the disease. Though discovered in 1881 by Dr. Carlos Finlay and proven through repeated experiments by Dr. Walter Reed in 1900, the mosquito theory was not yet widely accepted in America. Most people, including the members of the Isthmian Canal Commission (I.C.C.), still believed yellow fever was caused by "bad air" resulting from filth and decomposing matter, and that it was spread by "fomites," which were things likely to be contaminated by the fever victim, such as bedding and clothing.

The I.C.C believed Col. Gorgas was wasting time and money by going after mosquito breeding areas and initially resisted giving him the full complement of men, medicines, and supplies that he had requested. After several deaths in early 1905 caused some 500 American workers to flee in panic from the Canal Zone, the I.C.C. asked President Roosevelt to replace Gorgas, blaming him for concentrating on mosquitoes and not on cleaning up filth. Roosevelt, instead, threw his support behind Gorgas, enabling him to deploy 4,000 people to fumigate homes, put up screens, eliminate standing water, and spray drains and pools with oil to kill mosquito larvae. By the end of December 1905, there were no more deaths from yellow fever in Panama.

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Fighting the Fever - Panama Exhibit Site

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"Experience here has exploded the theory that white men cannot stand labor in the tropics, and also the notion that the natives are immune from tropical diseases." -A.B. Nichols Over 22,000 workers died during the French effort to build the Canal, many of them from malaria and yellow fever.

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What is malaria? Facts, symptoms, and how to help

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World Malaria Day is April 25. You can help children and families at risk of this deadly mosquito-borne disease. Learn symptoms, prevention, and treatment.

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Malaria is a serious disease spread by mosquitoes. It affects people in tropical parts of the world. Most people who get malaria recover. Still, at least 1 million people die from malaria each year. Most of them are children in Africa.

Malaria is caused by tiny living things called protozoans. Mosquitoes carry the protozoans. When an infected mosquito bites a person, the protozoans enter the person's blood. They live inside red blood cells as parasites. They take everything they need to live from the cells, which kills the cells.

The symptoms, or signs, of malaria usually begin between one week and one month after the mosquito bite. They include high fever, chills, and headache. A condition called anemia is another common effect of malaria. A person with anemia does not have enough red blood cells. Malaria can also affect the organ called the spleen, which filters the blood. It can cause the spleen to grow too large.

Malaria can be prevented by keeping down the number of mosquitoes in tropical areas. People can spray chemicals to kill mosquitoes. They can also drain swamps and ponds where mosquitoes breed. People can also take medicines that fight the disease.

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Malaria is a serious disease spread by mosquitoes. It affects people in tropical parts of the world. Most people who get malaria recover. Still, at least 1 million people die from malaria each year. Most of them are children in Africa. Malaria is caused by tiny living things called protozoans.

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Life Cycle of Plasmodium - Youtube video

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Life Cycle of Plasmodium - Youtube video

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Life Cycle of Plasmodium | Malaria and the Life Cycle of Plasmodium | Video for Kids

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Malaria in Children -  Causes, Symptoms & Treatments

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What Causes Typhoid? | The Dr. Binocs Show | Best Learning Videos For Kids | Peekaboo Kidz

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What Causes MALARIA? The Dr. Binocs Show | Best Learning Videos For Kids | Peekaboo Kidz

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The Story of Malaria by Science Videos for Kids

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The Story of Malaria by Science Videos for Kids

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The Story Of MALARIA | Malaria Lifecycle | Basic Science Videos for Kids | Flowbook Learning App

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Tuberculosis, or TB, is a disease that usually affects the lungs. Tuberculosis used to be a leading cause of death in Europe and North America. Today tuberculosis is…

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Médecins Sans Frontières Australia & New Zealand

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Yellow Fever: A closer look at the disease

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Youtube - Why Hygiene Has Changed Over the Decades - BrightSide

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Youtube - Why Hygiene Has Changed Over the Decades - BrightSide

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Why Hygiene Has Changed Over the Decades (People Washed Only One Body Part!)

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Youtube - The 1850s map that changed how we fight outbreaks - Vox

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Youtube - The 1850s map that changed how we fight outbreaks - Vox

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The 1850s map that changed how we fight outbreaks

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Many of the methods Americans used in 1918 to try to prevent the spread of the flu are similar to what people began doing during the COVID-19 pandemic: Close schools. Wear masks. Don't cough or sneeze in someone's face. Avoid large events and hold them outside when possible. And no spitting.

Health and city officials got the word out about these guidelines in all kinds of ways. In Philadelphia, streetcar signs warned "Spit Spreads Death." In New York City, officials enforced no-spitting ordinances and encouraged residents to cough or sneeze into handkerchiefs (a practice that caught on after the pandemic). The city's health department even advised people not to kiss "except through a handkerchief," and wire reports spread the message around the country.

In western states, some cities adopted mask ordinances, and officials argued wearing one was a patriotic duty. In October 1918, the San Francisco Chronicle ran a public service announcement telling readers that "The man or woman or child who will not wear a mask now is a dangerous slacker"-a reference to the type of World War I "slacker" who didn't help the war effort. One sign in California threatened, "Wear a Mask or Go to Jail."
WATCH: World War I Documentaries on HISTORY Vault
'Wear a Mask and Save Your Life!'

The PSA in the Chronicle appeared on October 22, just over a week before San Francisco had scheduled its mask ordinance to begin on November 1. It was signed by the mayor, the city's board of health, the American Red Cross and several other departments and organizations, and it was very clear about its message: "Wear a Mask and Save Your Life!"

For the most part, San Franciscans listened.

"Red Cross headquarters in San Francisco made 5,000 masks available to the public at 11:00 A.M., October 22. By noon it had none," wrote the late historian Alfred W. Crosby in America's Forgotten Pandemic: The Influenza of 1918. "By noon the next day Red Cross headquarters had dispensed 40,000 masks. By the twenty-sixth 100,000 had been distributed in the city... In addition, San Franciscans were making thousands for themselves."
READ MORE: "When Mask-Wearing Rules in the 1918 Pandemic Faced Resistance"
People Followed Make-Your-Own Mask Instructions

Newspapers printed instructions for how people could make their own masks at home. People who didn't comply might face prison time, fines or having their name published in the paper, revealing they were a "mask slacker."

Crosby writes that flu cases in San Francisco declined in early November. Residents continued to wear their masks through the November 5 midterm elections. After armistice on November 11, San Francisco ended its mask order. A spike in January 1919 led the city to implement a second masking order, but this one faced more resistance.
PHOTOS: Innovative Ways People Tried to Protect Themselves From the Flu
'Keep Your Bedroom Windows Open!' and Other Advice

Cincinnati Museum Center/Getty Images

Around the same time the San Francisco Chronicle ran its mask PSAs, newspapers around the country published a cartoon of a man hacking in public that warned, "Coughs and Sneezes Spread Diseases: As Dangerous As Poison Gas Shells"-again linking fighting the flu to fighting World War I. Newspapers used the cartoon to illustrate coverage of a special bulletin from Surgeon General Rupert Blue about the flu and how Americans could protect themselves from it.

"The value of fresh air through open windows cannot be over emphasized," Blue said. "When crowding is unavoidable, as in street cars, care should be taken to keep the face so turned as not to inhale directly the air breathed out by another person. It is especially important to beware of the person who coughs or sneezes without covering his mouth and nose."

Many newspaper carried large-print PSAs with similar advice. One announcement featuring a large picture of a masked woman urged, with unusual phrasing, "Do not take any person's breath." In Cincinnati, a board of health sign posted on streetcars told everyone to "Keep Your Bedroom Windows Open!" Like many other PSAs, the sign emphasized that precautions against the flu could also prevent the spread of other deadly infectious diseases like pneumonia and tuberculosis.

Messaging in 1918 also emphasized that special health measures weren't just important because they kept the person who followed them safe. They were also important because they helped protect those around them. Cartoonist Clifford T. Berryman highlighted this in an illustration of a sneezing little boy and an older man who stood in for "The Public." Looking at the little boy, the man said: "Use the handkerchief and do your bit to protect me."
See all pandemic coverage here.

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'Mask Slackers' and 'Deadly' Spit: The 1918 Flu Campaigns to Shame People Into Following New Rules

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Many of the methods Americans used in 1918 to try to prevent the spread of the flu are similar to what people began doing during the COVID-19 pandemic: Close schools. Wear masks. Don't cough or sneeze in someone's face. Avoid large events and hold them outside when possible. And no spitting.

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Youtube - How the Real John Snow Stopped an Epidemic - Weird History

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Youtube - How the Real John Snow Stopped an Epidemic - Weird History

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How the Real John Snow Stopped an Epidemic

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Historical Guide to Yellow Fever | American Experience | PBS

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Learn more about the transmission, symptoms and preventive treatment of yellow fever.

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Paul I. Howell, MPH; Prof. Frank Hadley Collins/Centers for Disease Control and Prevention (CDC) (Image Number: 9534)

An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of mosquitoes. Yellow fever is one of the great epidemic diseases of the tropical world, and in earlier centuries it was one of the great plagues of the New World. At one time the tropical and subtropical regions of the Americas were subjected to devastating epidemics, and serious outbreaks occurred not only as far north as Philadelphia, New York, and Boston but also as far away as Spain, France, England, and Italy.

The course of yellow fever is rapid. After the bite of the infecting mosquito, there is an incubation period of several days while the virus multiplies within the body. The onset of symptoms is then abrupt, with headache, backache, rapidly rising fever, nausea, and vomiting. Jaundice (yellowing of the skin and eyes) is a common sign in persons and gives rise to the name yellow fever. This acute stage lasts two or three days, after which the patient either begins to recover or gets worse. Death may occur six or seven days after the onset of symptoms.

The yellow fever patient's recovery is long, but, when it does occur, it is complete and is accompanied by a lifelong immunity. For reasons not yet understood, the mortality rate of yellow fever varies greatly. Many persons may experience only a mild infection that lasts a few days.

There is no specific treatment for those with yellow fever beyond good nursing and supportive care. The disease, however, is completely preventable. People can be rendered immune to the virus through vaccination, and outbreaks can be contained by eliminating or controlling mosquito populations. Thanks to such measures, the great yellow fever epidemics of the late 19th and early 20th centuries are no more. Nevertheless, the disease is still present in tropical Africa and South America, where access to vaccine is sometimes lacking. ( See also vaccine.)

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An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of mosquitoes. Yellow fever is one of the great epidemic diseases of the tropical world, and in earlier centuries it was one of the great plagues of the New World.

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Yellow Fever, Causes, Signs and Symptoms, Diagnosis and Treatment.

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Yellow Fever Eradication Program (Aedes Aegypti)

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Yellow Fever Eradication Program (Aedes Aegypti)

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Texasstandard.org - The Doctor who made The Panama Canal Possible - WF Strong

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Texasstandard.org - The Doctor who made The Panama Canal Possible - WF Strong

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I'm walking on the veranda of the Gorgas Building at Texas Southmost College in Brownsville. It's named for the famous Army physician, William Gorgas, who was sent here to Fort Brown in 1882. This building was already here when he was. It was the hospital he ran. What he would learn here, and what would happen to him, would change the world.

Gorgas was just 27 years old when arrived at Fort Brown. There was a full-blown yellow fever epidemic raging at the time. It was so named because it turned eyes and skin yellow. About half the people who came down with it, died. Yellow fever was not only deadly, it was quick. You could feel fine on Wednesday morning, have symptoms kick in that afternoon, and be dead by Saturday.

Gorgas fought yellow fever head on. He didn't yet know that mosquitoes spread it, but he did know that good sanitation and quarantining patients was useful. He launched public health measures that helped cut short the epidemic. Perhaps the best thing that happened to him during this time, and it will seem a strange thing to say, is that he came down with yellow fever himself, but it gave him lifelong immunity. He vowed to make fighting the disease his life's work.

His next significant posting in his war on yellow fever was to Cuba. It was there that the research of the Cuban doctor, Carlos Finlay, had laid out a convincing case for mosquitoes being responsible for transmitting the illness. Walter Reed, a name you likely recognize, tested Finlay's theories and proved without a doubt that mosquitoes were responsible. Then Gorgas put the knowledge to practical use with fumigation, screening and outlawing open cisterns and standing water. Astoundingly, those efforts virtually wiped out yellow fever in Havana in a couple of years, reducing cases from thousands a year to fewer than 20.

Then Dr. Gorgas made his big leap onto the world stage. You will remember the French had tried to dig the Panama Canal but failed miserably because they lost thousands of workers to yellow fever. Disease drove them out and silenced the steam shovels. The Americans, in a cannot-fail bid to do what the French couldn't, resumed the dig. But in the first years, yellow fever and malaria threatened to drive the Americans out, too. Some said it would have taken 50 years and 80,000 lives to finish the canal under those conditions.

Gorgas was brought in to solve the problem. But the political leaders in charge didn't want to hear anything about his mosquito theory. They told him to keep that crazy theory to himself because "everyone knew that those tropical illnesses came from miasma - bad air." Hell, the word "malaria" itself came from Italian, translating, verbatim, "mal" and "aria" - translation: bad air.

Gorgas learned as Galileo did that getting the world, even scientists, to ditch a centuries old belief system in favor of a new one, has always been unfathomably difficult.

Gorgas wanted to take what he had learned in Brownsville and Cuba and put it to work on a grand scale in Panama. He applied for a million dollars to protect Panama. The U.S. gave him $50,000. But with such poor funding, hundreds of workers were dying each month and the Americans risked being embarrassed by failure, just like the French. Teddy Roosevelt himself intervened and more or less said, "Give Gorgas what he wants."

So it was then that Gorgas screened all the houses, buildings and particularly the hospitals in the Canal Zone. This was essential because a patient could only get yellow fever from a mosquito that had bitten someone with yellow fever. Gorgas also had an army of fumigators at work across the isthmus every day.

As he had in Cuba, Gorgas got rid of standing water and required covers on cisterns. He also drained swamps and treated undrainable waters with oil to keep larvae from forming. Within two years yellow fever had been completely eradicated from Panama.

Gorgas was considered the medical hero of the canal because, without his work, the engineers and diggers and construction workers could never have done their work. Gorgas, without question, made the canal a reality.

After Panama, Gorgas eventually became Surgeon General of the U.S. Army and was knighted by the King of England for his work in tropical diseases, from which the British greatly benefitted.

So here I sit on the veranda of his old hospital at Fort Brown in Texas. The building still bears Gorgas' name. I also admire the fact that his name has a place of honor 8,000 miles away on the side of the London School for Hygiene and Tropical Medicine.

Here at Texas Southmost College, funded from this very building, are many fine programs in nursing and health professions active today. I think Gorgas would be pleased.

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The Doctor Who Made The Panama Canal Possible

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I'm walking on the veranda of the Gorgas Building at Texas Southmost College in Brownsville. It's named for the famous Army physician, William Gorgas, who was sent here to Fort Brown in 1882. This building was already here when he was. It was the hospital he ran.

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Dr. William Gorgas and his war with the mosquito - Robert Patterson

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Dr. William Gorgas and his war with the mosquito - Robert Patterson

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When Was the Panama Canal Built?

The idea of creating a water passage across the isthmus of Panama to link the Atlantic and Pacific Oceans dates back to at least the 1500s: After explorer Vasco Nuñez de Balboa realized that a narrow strip of land separated the two oceans, King Charles I of Spain tapped his regional governor to survey a route along the Chagres River.

The realization of such a route across the mountainous, tropical terrain was deemed impossible at the time, although the idea remained tantalizing as a potential shortcut from Europe to eastern Asia. The only other route was to sail around South America via the stormy, unpredictable Strait of Magellan, or use the Panama Railroad to transfer goods and people from one ocean to another.

France was ultimately the first country to attempt the task. Led by Count Ferdinand de Lesseps, the builder of the Suez Canal in Egypt, the construction team broke ground on a planned sea-level canal in 1880.

The French quickly comprehended the monumental challenge ahead of them: Along with the incessant rains that caused heavy landslides, there was no effective means for combating the spread of yellow fever and malaria. De Lesseps belatedly realized that a sea-level canal was too difficult and reorganized efforts toward a lock canal, but funding was pulled from the project in 1888.

Teddy Roosevelt and the Panama Canal

Following the deliberations of the U.S. Isthmian Canal Commission and a push from President Theodore Roosevelt, the United States purchased the French assets in the canal zone for $40 million in 1902. When a proposed treaty over rights to build in what was then a Colombian territory was rejected, the U.S. threw its military weight behind a Panamanian independence movement, eventually negotiating a deal with the new government.

On November 6, 1903, the United States recognized the Republic of Panama, and on November 18 the Hay-Bunau-Varilla Treaty was signed with Panama, granting America exclusive and permanent possession of the Panama Canal Zone.

In exchange, Panama received $10 million and an annuity of $250,000 beginning nine years later. The treaty, negotiated by U.S. Secretary of State John Hay and French engineer Philippe-Jean Bunau-Varilla, was condemned by many Panamanians as an infringement on their country's new national sovereignty.

Seemingly not grasping the lessons from the French effort, the Americans devised plans for a sea-level canal along the roughly 50-mile stretch from Colón to Panama City. The project officially commenced with a dedication ceremony on May 4, 1904, but chief engineer John Wallace encountered immediate problems.

Much of the French equipment was in need of repair, while the spread of yellow fever and malaria was frightening off the workforce. Under pressure to keep construction moving forward, Wallace instead resigned after a year.

John Stevens

A railroad specialist named John Stevens took over as chief engineer in July 1905 and immediately addressed the workforce issues by recruiting West Indian laborers.

Stevens ordered new equipment and devised efficient methods to speed up work, such as the use of a swinging boom to lift chunks of railroad track and adjust the train route for carting away excavated material. He also quickly recognized the difficulties posed by landslides and convinced Roosevelt that a lock canal was best for the terrain.

The project was helped immensely by chief sanitary officer Dr. William Gorgas, who believed that mosquitoes carried the deadly diseases indigenous to the area. Gorgas embarked on a mission to wipe out the carriers, his team painstakingly fumigating homes and cleansing pools of water. The last reported case of yellow fever on the isthmus came in November 1905, while malaria cases dropped precipitously over the following decade.

Although construction was on track when President Roosevelt visited the area in November 1906, the project suffered a setback when Stevens suddenly resigned a few months later. Incensed, Roosevelt named Army Corps engineer Lt. Col. George Washington Goethals the new chief engineer, granting him authority over virtually all administrative matters in the building zone.

Goethals proved a no-nonsense commander by squashing a work strike after taking charge, but he also oversaw the addition of facilities to improve the quality of life for workers and their families.

Panama Canal Dangers

Goethals focused efforts on Culebra Cut, the clearing of the mountain range between Gamboa and Pedro Miguel. Excavation of the nearly 9-mile stretch became an around-the-clock operation, with up to 6,000 men contributing at any one time. Despite the attention paid to this phase of the project, Culebra Cut was a notorious danger zone, as casualties mounted from unpredictable landslides and dynamite explosions.

Construction of the locks began with the pouring of concrete at Gatún in August 1909. Built in pairs, with each chamber measuring 110 feet wide by 1,000 feet long, the locks were embedded with culverts that leveraged gravity to raise and lower water levels.

Ultimately, the three locks along the canal route lifted ships 85 feet above sea level, to man-made Gatún Lake in the middle. Hollow, buoyant lock gates were also built, varying in height from 47 to 82 feet. The entire enterprise was powered by electricity and run through a control board.
READ MORE: Why the Construction of the Panama Canal Was So Difficult-and Deadly
Panama Canal Completed

The grand project began drawing to a close in 1913. Two steam shovels working from opposite directions met in the center of Culebra Cut in May, and a few weeks later, the last spillway at Gatún Dam was closed to allow the lake to swell to its full height. In October, President Woodrow Wilson operated a telegraph at the White House that triggered the explosion of Gamboa dike, flooding the final stretch of dry passageway at Culebra Cut.

The Panama Canal officially opened on August 15, 1914, although the planned grand ceremony was downgraded due to the outbreak of WWI. Completed at a cost of more than $350 million, it was the most expensive construction project in U.S. history to that point.

Altogether, some 3.4 million cubic meters of concrete went into building the locks, and nearly 240 million cubic yards of rock and dirt were excavated during the American construction phase. Many people, however, died building the Panama Canal: Of the 56,000 workers employed between 1904 and 1913, roughly 5,600 were reportedly killed, though the actual number is probably much higher, since the French only recorded deaths that occurred in hospital.

The Panama Canal cost the United States around $375,000,000-this figure includes the $10,000,000 paid to Panama and $40,000,000 paid to the French when they abandoned the project. At the time, it was the most expensive construction project in U.S. history.

Impact of the Panama Canal

Bolstered by the addition of Madden Dam in 1935, the Panama Canal proved a vital component to expanding global trade routes in the 20th century. The transition to local oversight began with a 1977 treaty signed by U.S. President Jimmy Carter and Panama leader Omar Torrijos, with the Panama Canal Authority assuming full control on December 31, 1999.

Recognized by the American Society of Civil Engineers as one of the seven wonders of the modern world in 1994, the canal hosted its 1 millionth passing ship in September 2010.

The United States continues to be the heaviest user of the Panama Canal: 66 percent of the Canal's cargo traffic began or ended its journey at a U.S. port, while cargo from or to China made up 13 percent of its traffic, according to 2019 data.

Sources

Learn about the history of the Panama Canal. Panama Canal Authority.
Building the Panama Canal, 1903-1914. U.S. Department of State, Office of the Historian.
Key Decision Point Coming for the Panama Canal. Center for Strategic & International Studies.

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Panama Canal: History, Definition & Canal Zone - HISTORY

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The Panama Canal is a massive engineering marvel that connects the Pacific Ocean with the Atlantic Ocean through a 50-mile series of shipping canals and locks.

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Youtube - Demolition, disease, and death: Building the Panama Canal - Alex Gendler

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Youtube - Demolition, disease, and death: Building the Panama Canal - Alex Gendler

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Demolition, disease, and death: Building the Panama Canal - Alex Gendler

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Youtube - Death, Disease, and Discrimination: The Building of the Panama Canal - by Katherine Giroux

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Youtube - Death, Disease, and Discrimination: The Building of the Panama Canal - by Katherine Giroux

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Death, Disease & Discrimination: The Building of the Panama Canal

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Youtube - Yellow Fever in Panama Canal Public Health Story

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Youtube - Yellow Fever in Panama Canal Public Health Story

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YELLOW FEVER IN PANAMA CANAL  PUBLIC HEALTH STORY

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Primary Resource: Letter written by a student during the 1918 Flu Pandemic - Time.com

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Primary Resource: Letter written by a student during the 1918 Flu Pandemic - Time.com

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What We Can Learn From a Letter Written During the 1918 Flu Pandemic

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"Ralph and I are fine, and have not gotten the 'flue' yet altho it is pretty bad down here at present"

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SchoolNutrition.org - Pandemics & School Closures: A History Lesson

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SchoolNutrition.org - Pandemics & School Closures: A History Lesson

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Pandemics & School Closures: A History Lesson

In its June/July 2020 issue, School Nutrition looked at how kids of different ages were coping with the extensive school closures of the COVID-19 pandemic (“SY2019-20: A Most Unusual Year”). Did you know that this is not the first time U.S. schools have closed in response to a pandemic?

More than one hundred years ago, many schools were closed in the U.S. and around the world during the Spanish flu outbreak of 1918-19. In particular, urban communities closed public schools for an extended period, according to a 2009 study published in Health Affairs. The study looked at data from 43 cities that closed schools during the second and third waves of the flu outbreak, some for as long as 15 weeks! Despite the fear of contagion, schools in New York and Chicago remained open, given a prevailing philosophy that in these communities, it would be best for children to remain in schools.

Alexandra Stern, PhD, Associate Dean for the Humanities, University of Michigan, Ann Arbor, with others, researched the effects on the progression of the illness by closing schools during that period. She acknowledges that the experiences of the time offer little insight on how closures affected students. “There was next to no follow-up from the schools that closed about ‘learning outcomes,’” she reports, noting that educators think more in these terms today. In addition, there was obviously no online learning alternative. “What is interesting about 1918, though, is how the correspondence courses that teachers put together, often dropping off packets at students' homes, was the precursor to remote learning.”

Stern studied the Spanish flu pandemic while researching the effect of closed schools during the much-more recent H1N1 outbreak in Spring 2009. You might be surprised to learn that 726 U.S. schools, affecting 463,282 students, during this viral event just a decade ago. The period of closures varied, with the longest being two weeks.

A year earlier, a particularly virulent strain of the flu forced schools to close in Kentucky in February 2008. A Kentucky Department of Health survey found that 97% of respondents supported the short closure of schools at that time. One other pandemic, the Hong Kong flu of 1968, did not prompt any school closures.

Back to the top

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Pandemics & School Closures: A History Lesson

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In its June/July 2020 issue, School Nutrition looked at how kids of different ages were coping with the extensive school closures of the COVID-19 pandemic ("SY2019-20: A Most Unusual Year"). Did you know that this is not the first time U.S. schools have closed in response to a pandemic?

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CNN.com - More than 100 U.S. schools closed because of swine flu - by Kate Bolduan

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CNN.com - More than 100 U.S. schools closed because of swine flu - by Kate Bolduan

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WASHINGTON (CNN) -- At least 74 schools have closed across the country because of confirmed or probable cases of swine flu and 30 more have closed as a precautionary measure, the Department of Education said Wednesday.

The elementary, junior high and high schools have closed because of the H1N1 virus, Department of Education spokesman Massie Ritsch said.

The closures of public and private schools across eight states affect about 56,000 students out of an estimated 55 million students attending the nation's 100,000 kindergarten through 12th grade schools, Ritsch said.

Some of the schools that were closed had already reopened, he said.

In addition to closures announced earlier Wednesday, the Fort Worth Independent School District in Texas said it will temporarily close all of its schools until further notice, affecting roughly 80,000 students, according to its Web site.

Schools will likely not reopen any sooner than Monday, May 11, the district said.

School officials said they made the decision after receiving official confirmation of one case of swine flu at one campus and news of three other probable cases at three more schools.

"We have been diligently following the recommendations of our local public health authorities since this crisis first began," Superintendent Melody Johnson said. "We will continue to work with the senior-most staff of the local health department."

The Madison County, Alabama, Schools district, which includes Huntsville, will also close its schools Thursday and Friday due to two probable cases at an elementary school.

On Wednesday, President Obama called on schools with confirmed or possible swine flu cases to "strongly consider temporarily closing so that we can be as safe as possible."

Education Secretary Arne Duncan said Wednesday that everyone involved in schools needs to "pitch in and do our part to prevent the spread of this flu virus."

"Use the same common sense and courtesy that you would use during winter flu season: Wash your hands, cover your mouth when you cough and stay home if you are sick," Duncan said.

The secretary said the department is closely monitoring the flu outbreak and urged schools to follow guidance from the Centers for Disease Control and Prevention.

"Do what is appropriate for the health of your communities, your schools and your students," Duncan said.

Department of Education officials and experts from the CDC held a conference call Monday with more than 1,700 people from national education associations, state school offices, individual schools and school districts.

The Department of Education emphasized the need for "common sense" preventative measures among students and faculty in school facilities, an official said.

Education officials also stressed the need for people showing any flu-like symptoms to stay away from school and called on administrators to report any suspected or confirmed cases to local public health authorities as well as the Department of Education.

If a school has a confirmed case of swine flu, the CDC recommends closing the facility for about seven days.

All About Influenza * U.S. Department of Education * Centers for Disease Control and Prevention

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centers for disease control and prevention

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More than 100 U.S. schools closed because of swine flu

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WASHINGTON (CNN) -- At least 74 schools have closed across the country because of confirmed or probable cases of swine flu and 30 more have closed as a precautionary measure, the Department of Education said Wednesday. The elementary, junior high and high schools have closed because of the H1N1 virus, Department of Education spokesman Massie Ritsch said.

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The New Humanitarian - Schools closed in cholera outbreak - by IRIN News

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The New Humanitarian - Schools closed in cholera outbreak - by IRIN News

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Right now, we're working with contributors on the ground in Ukraine and in neighbouring countries to tell the stories of people enduring and responding to a rapidly evolving humanitarian crisis.

We're documenting the threats to humanitarian response in the country and providing a platform for those bearing the brunt of the invasion. Our goal is to bring you the truth at a time when disinformation is rampant.

But while much of the world's focus may be on Ukraine, we are continuing our reporting on myriad other humanitarian disasters - from Haiti to the Sahel to Afghanistan to Myanmar. We've been covering humanitarian crises for more than 25 years, and our journalism has always been free, accessible for all, and - most importantly - balanced.

You can support our journalism from just $5 a month, and every contribution will go towards our mission.

Support The New Humanitarian today.

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Right now, we're working with contributors on the ground in Ukraine and in neighbouring countries to tell the stories of people enduring and responding to a rapidly evolving humanitarian crisis. We're documenting the threats to humanitarian response in the country and providing a platform for those bearing the brunt of the invasion.

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Their World.org - Zambia shuts down all schools to combat cholera outbreak

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Their World.org - Zambia shuts down all schools to combat cholera outbreak

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Right to education, Teachers and learning

10 Jan 2018

Children will stay at home until at least the end of January and authorities will check that schools have safe water and sanitation facilities.

The start of the school year in Zambia has been postponed by a cholera outbreak that has killed 61 people and affected thousands.

Children, who were due to return to classrooms this week, will be staying at home until at least the end of January.

All public gatherings have been banned, street vending has been outlawed and nightclub hours reduced, officials said yesterday. The army has been patrolling the streets to ensure compliance with tightening restrictions.

President Edgar Lungu said authorities need to urgently provide people with safe and clean drinking water and talk to communities about proper waste management.

No date has been set for schools to return, although this will be reviewed by January 30.

Health Minister Dr Chitalu Chilufya announced last week that the reopening of schools nationwide would be postponed to help prevent the outbreak spreading.

Cholera is a water-borne diarrhoeal disease that can kill within hours if left untreated (Susana Secretariat )

He added: “This period will allow us to work with the authorities in the schools to look at water and sanitation facilities and correct them where need be.”

Chilufya said that before schools reopen, the education ministry would broadcast key messages to raise awareness about improving school children’s personal hygiene. A vaccination programme will also be rolled out.

He said children coming from areas described as the epicentres of the epidemic would have been mixing with children from other areas – which could escalated the problem.

The outbreak began in October and mainly affected Lusaka province but has since spread to other parts of the country.

Cholera is a water-borne diarrheal disease that can kill within hours if left untreated. But it is easily cured with oral rehydration, intravenous fluids and antibiotics. Clean water and sanitation are critical to controlling transmission.

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Zambia shuts down all schools to combat cholera outbreak - Theirworld

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Children will stay at home until at least the end of January ​and authorities will check that schools have safe water and sanitation facilities.

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Oxfam International - School in a time of cholera? Health risk threatens return to school for Zimbabwe children

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Oxfam International - School in a time of cholera? Health risk threatens return to school for Zimbabwe children

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Zimbabwean children and their families are being forced to choose between an education and immediate survival, with cholera adding yet another obstacle to today's scheduled return to school, warned international agency Oxfam. The disruption could blight the future of millions of children, said Oxfam.Schools were closed for much of 2008, with teachers stating that their meager salaries, paid in Zimbabwean dollars, were not even covering their transport costs to work. Now the school year starts again, Oxfam is warning that the return to classes might lead to a new upsurge in cholera.Nearly 3,000 people have died so far in Zimbabwe's worst-ever cholera epidemic, and over 50,000 people are infected by the disease. There are fears that numbers could exceed 60,000 in the coming weeks. Many schools are dilapidated and do not have clean running water or basic toilets, which are vital to prevent them from becoming breeding grounds for the disease.Peter Mutoredzanwa Oxfam Country Director in Zimbabwe said: "It is a tragedy that children and their families are facing this impossible choice: risk their lives or compromise their futures. Education is just one of many casualties of the political and humanitarian crisis in the country."An education is a route out of poverty - but that route is being shut off. Donors and the government need urgently to work together to find a way to resuscitate the education sector and rehabilitate schools. This crisis cannot be allowed to steal childrens' futures."Even without the additional obstacle of cholera, education in Zimbabwe is facing tough times. Official reports from teachers' unions suggest that many teachers will stay at home until their pay dispute is resolved. Teachers are currently getting the equivalent of $2 a month - just enough to get a few loaves of bread. Likewise many families can no longer to afford to send children to school - they are selling livestock and other valuables just to get food.Mutoredzanwa, said: "Families are facing impossible dilemmas. With no food on the table and the risk of cholera, it is no surprise that children will be staying away from school, but the immediate crisis may have repercussions for years to come. We risk a whole generation trying to "catch up" on education. We need urgent donor and government action to save our children's futures."Oxfam is responding to the cholera outbreak by providing clean water, soap and disinfectant to 620,000 people. It is building toilets in schools in Gutu, Masvingo province. There is an urgent need to re-build water and sanitation systems to halt the spread of the epidemic."The dilapidated state of sanitation in schools is mirrored at the community level and this is fuelling the epidemic. In many communities, children play near open sewers and there is no running water at all. Funding is desperately needed to put this infrastructure back together to slow the spread of cholera and prevent further outbreaks."

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School in a time of cholera? Health risk threatens return to school for Zimbabwe children | Oxfam International

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Zimbabwean children and their families are being forced to choose between an education and immediate survival, with cholera adding yet another obstacle to today's scheduled return to school, warned international agency Oxfam.

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PBS News Hour - What history revealed about cities that socially distanced during a pandemic - By Dr. Howard Markel

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PBS News Hour - What history revealed about cities that socially distanced during a pandemic - By Dr. Howard Markel

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In 2005, in response to the threat of Avian influenza (or H5N1), a flurry of pandemic preparedness planning began in Washington and across the nation that would set the groundwork for what's happening now. This work was notable for a goal that may be most resonant today: mitigating the spread of respiratory viruses in communities before too many people get ill. Back then, the community mitigation methods were seen as so socially and economically disruptive they would only be deployed in worst-case scenarios, such as that seen during the 1918-1919 influenza pandemic. Enter 2020.

The hypothesis behind these community mitigation strategies is now popularly known as "flattening the curve."

The idea is that by shifting the epidemic curve to the right with a series of non-pharmaceutical interventions (prevention measures like social distancing or hygiene when a vaccine isn't available), one would hopefully see a delay in the outbreak's peak; a decompression of the burden on hospitals and infrastructure; a diminution of overall cases and health impacts; and more time to develop new medical therapies and preventive vaccines.

And for an entire year - from 2006 to 2007 - a team of medical historians at the University of Michigan Center for the History of Medicine and the Centers for Disease Control and Prevention's Division of Quarantine and Global Migration scrambled to prove this hypothesis. I was part of that history-making historical research, and was one of the authors of the resulting paper.

We studied the strategies employed during the 1918-1919 influenza pandemic, which killed at least 40 million people around the globe and 500,000 to 750,000 Americans. We visited over 130 libraries, archival repositories and special collections across the nation to gather tens of thousands of pages of newspaper articles, public health reports, federal, state and municipal bulletins, and multiple other types of documents.

We looked at old newspapers, local bulletins and public health reports for far more than merely the dates when these NPIs were turned on or off. Equally important was gaining insight on the context surrounding such decisions. For example, how did various branches of government work together at the municipal, state and federal level? What were the citizens' response to such disruptive measures? Did people protest or push back against NPI orders? All these questions, and many more, can be approached only by such a deep, fine-grained and careful analysis of the pandemic that took place last century.

With those materials collected and organized, we evaluated the nonpharmaceutical interventions (NPIs) employed in 43 large U.S. cities during the fall and winter waves of the pandemic. Specifically, they were:

isolating the ill, or quarantining suspected cases in hospitals or at home

banning public gatherings and in some cases, shutting down roads and railways

school closures

Our research successfully demonstrated that cities that did three things enjoyed far lower morbidity and mortality numbers than those cities that did not act in such a manner. They acted early, before the virus had a chance to spread widely in a community. They acted in a layered manner, using more than one NPI at a time. And they used the interventions for long durations, because the NPIs do not prevent cases, they merely delay viral spread and buy time. In other words, for the worst-case and most deadly case scenarios, social distancing measures could help flatten the curve - results that have since been reproduced in several historical, modeling and epidemiological studies.

This work became an important part of the evidence base for the CDC's 2007 " Pre-pandemic Planning Guidance," and the 2017 update.

It has also been tested in real life. During the first days of the 2009 H1N1 influenza pandemic, the Mexican Health Ministry ordered a wide-reaching menu of NPIs, similar to those that worked in 1918. Sick people were isolated and their not-yet-ill contacts quarantined at home. Public gatherings were canceled, including a major soccer match, and schools were closed. The measures did contain the spread of influenza but were abandoned within 18 days, once it became clear that the H1N1 influenza virus, albeit widespread in pandemic numbers, was not much more lethal than seasonal influenza. In that case, the measures were thus too costly in terms of loss of revenue and social disruption to proceed.

But the new coronavirus is a different story.

As we apply these community mitigation strategies today, on a global level never before seen in human history, time will tell us how much they helped reduce the threat of the COVID-19 pandemic. But we are already seeing evidence that NPIs, when properly implemented and followed, flatten the curve - not only in American communities but all around the world.

To be sure, these policies are incredibly disruptive to the social fabric of our nation, not to mention the global economy. But the COVID-19 crisis is so easily spread and deadly, especially for those in the high-risk categories, that our public health and medical experts are prescribing the adage: It is far better to be safe than sorry. The cost of human life, especially for our own loved ones, far outweighs the drive to reopen the economy as soon (indeed, too soon) as possible.

When the challenging crisis we find ourselves battling right now passes, we must remember, remember and remember again the three key lessons of both pandemics past:

We never really conquer microbes-at best, we wrestle them to a draw.

An outbreak anywhere can easily go everywhere.

And, it is no longer an issue of if we are going to have another contagious catastrophe in our new world order, it's a matter of when.

That means we start preparing for the next infectious battle as soon as we are done with this one. If anything good comes out of this global crisis, it will be that we had the opportunity to study and develop other life-saving measures for when we face newly emerging infectious diseases, epidemics and pandemics in the future.

Watch more

Why does "flattening the curve" work? PBS NewsHour spoke with mathematical biologist Alun Lloyd to better understand how our actions can affect the reproduction rate of the virus, and how a slower curve can affect our economy.

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What history revealed about cities that socially distanced during a pandemic

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In 2005, in response to the threat of Avian influenza (or H5N1), a flurry of pandemic preparedness planning began in Washington and across the nation that would set the groundwork for what's happening now. This work was notable for a goal that may be most resonant today: mitigating the spread of respiratory viruses in communities before too many people get ill.

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PBS News Hour - Analysis: Why some schools stayed open during the 1918 flu pandemic - by Dr. Howard Markel

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PBS News Hour - Analysis: Why some schools stayed open during the 1918 flu pandemic - by Dr. Howard Markel

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Long before the coronavirus pandemic, public health officials worried about opening schools in times of contagious crisis, and how to strike the right balance between children's well-being and protecting families from life-threatening illness.

During the 1918-1919 influenza pandemic, when an estimated 675,000 people died in the United States alone, the majority of public schools were closed for weeks to months on end. But three major cities - New York City, Chicago, and New Haven - kept their schools open amid valid questions and concerns about safety.

When COVID-19 first emerged, many pediatricians - including me - vociferously warned parents that their children were safer at home. In March, school districts across the nation shut their doors and more than 50 million American students finished the 2019-2020 school year through a variety of remote learning and home-schooling programs.

At the turn of the 20th century, improving school facilities and sanitary conditions for students became of great concern.

Then the American Academy of Pediatrics made headlines by recommending that elementary through high school students return to school this fall, a move that surprised government officials and parents alike. (Disclosure: I am a Fellow of the AAP.)

Much has since changed in our understanding of the novel coronavirus since it first emerged - especially when it comes to youngsters. A few months ago, we assumed that, as with other respiratory transmitted viruses like influenza, school-aged children would play a major role in spreading the disease.

We now don't believe this to be the case. Children, especially those under the age of 12, appear far less likely to contract and spread the virus. To a lesser extent, the same appears to be true for older children. Although school-age children make up about 24 percent of the American population, they have thus far accounted for only 4.7 percent of the reported COVID-19 cases in the United States. According to Centers on Disease Control and Prevention data, only 4.4 children per 100,000 have had to be hospitalized for COVID-19, a rate that is strikingly lower than the 161.7 per 100,000 adults in the age range of 50 to 64 years of age who have been hospitalized.

READ MORE: How should schools reopen? Pediatricians offer these guidelines

Not all the new information is rosy, however. We still do not know the actual or total infection rate among children because relatively few healthy kids have been tested for the virus. We do not know how many of these children are asymptomatic carriers of COVID-19. There are also the rare cases of a COVID-related, post-inflammatory syndrome that concerns many pediatricians and parents. And while relatively few children have died of COVID-19 when compared to older Americans, any death at any age is unwelcome.

Some of the reasons the AAP has suggested children return to school in the fall has to do with their educational, social and developmental needs. That includes better means of learning in the classroom under the tutelage of a skilled teacher, the critical role of play in the daily lives of children, access to school-based health and meal programs, and disparities of internet and computer access for many American families without the financial resources to purchase such commodities. This doesn't even begin to account for the many issues related to child care and supervision that work-at-home parents have struggled with over the past several months.

Worse, many American children live in abusive or unsafe homes, and millions of school-aged students are homeless. All of these kids would likely be far safer with regular classroom attendance.

At the turn of the 20th century, improving school facilities and sanitary or health conditions for students became of great concern in the U.S. Back then, public schools often conducted classes in dirty, poorly lit and poorly ventilated buildings, before school medical inspection programs began during the 1890s.

Some of the larger American cities, such as Boston and New York City, founded school health teams who made daily rounds through the public schools to determine the health status of individual children and entire classrooms. Although their first priority was the diagnosis of contagious diseases, district doctors and school nurses also examined children for musculoskeletal deformities, poor eyesight, hearing problems, environmental poisonings, dental hygiene, diabetes and other chronic ailments.

READ MORE: What history revealed about cities that socially distanced during a pandemic

When influenza struck New York City in the fall of 1918, its school system comprised more than a million children, 75 percent of whom lived in crowded and unsanitary tenement houses. Dr. Royal Copeland, the commissioner of the Department of Health at the time, insisted that the clean environment of the modern school buildings, combined with medical inspections and examinations, was far safer than keeping them at home in places like the Lower East Side. Indeed, Copeland became irritated over the closing of his son's private school, the School for Ethical Culture, in mid-October of 1918 and used his son's apathy at home as "evidence that children are better off in school, under supervision, than playing about in the streets." His management of the city's health during the flu pandemic was so successful that four years later he was elected the U.S. senator from New York, a post he held until his death in 1938.

In Chicago, Health Commissioner John Dill Robertson had a similar philosophy. Fighting off angry parents and teachers, Robertson held fast against school closure. In 1919, he reported that "with respect to the schools, it was remembered that the sanitation is quite uniformly good and that the hygienic conditions of environment were better than those which would have obtained among the children if classes were discontinued." Even without school closures in Chicago, the classrooms were fairly empty due to high rates of absenteeism of 30 percent in early-to-mid-October, to nearly 50 percent by the end of the month. Robertson concluded that many students were being unnecessarily kept home by parents stricken with "fluphobia." But then as now, parents had legitimate concerns about sending their children back.

Meanwhile, the New Haven health commissioner, Dr. Frank Wright, enjoyed wide respect among the citizens and other city officials. Like New York and Chicago, New Haven also intensified school-based medical inspection programs to quickly diagnose the children who were infected with the flu and isolated them as soon as possible from their peers and teachers. Working with parents, the school board and the mayor, Wright developed an amicable plan to keep children in schools where physicians and nurses worked full-time to identify sick children and send them home for proper care. This plan also helped keep students from congregating in the streets and reduced their exposure to ill adults.

For many school districts today, this autumn's school term remains unsettled. As new cases of coronavirus hit record highs, President Donald Trump, Vice President Mike Pence and Secretary of Education Betsy DeVos have insisted, without legal authority or scientific data backing them, that schools reopen in the fall. The Centers for Disease Control and Prevention, however, has determined that before that can happen, a series of safe practices, social distancing measures and public health guidelines must first be in place. Last week, the president of the AAP lamented that its guidance had been "politicized" and noted that the original recommendations did not advocate "a universal return to school no matter what."

READ MORE: 'The Plague' perfectly captures the risk in returning to normal

Everywhere, teachers, school staff and parents are concerned about the next best course to take. The Los Angeles and San Diego school districts announced on Monday that they will teach remotely in the fall, while New York City hopes to adopt a hybrid model of social distanced in-class and remote-at home teaching.

Whatever plan a local school district ultimately adopts, we must all keep several things in mind.

We need to get a better handle on how widespread COVID-19 is, especially in the fall, and then we must apply the best scientific evidence. We need to be creative, nimble and flexible as new information develops. And if a new surge in cases arises, we must be prepared to consider another round of school closures. We must keep our children's health and welfare as our highest priority, whether they continue to stay at home or go back to school. We have to protect the adults working in these schools and keep them healthy, too. More broadly, we must protect against the risk of infected children, teenagers and college students from potentially infecting Americans at high risk for the ravages of COVID-19. There is no one-size-fits-all plan for all communities or all students of different ages, backgrounds and development. Parents will need to participate in the planning process. Social distancing, face masks, hand washing and excellent hygiene remain paramount.

And when a safe and effective coronavirus vaccine is finally developed, we - child and adult alike - must all roll up our sleeves and get a shot.

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Analysis: Why some schools stayed open during the 1918 flu pandemic

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During the 1918-1919 influenza pandemic, when an estimated 675,000 people died in the U.S. alone, the majority of public schools were closed for weeks to months on end. But three major cities kept their schools open amid valid questions and concerns about safety.

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CNN - Here's what happened when students went to school during the 1918 pandemic by Theresa Waldrop

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CNN - Here's what happened when students went to school during the 1918 pandemic by Theresa Waldrop

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Here’s what happened when students went to school during the 1918 pandemic

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This isn’t the first time leaders have struggled with deciding whether to keep schools open in a pandemic.

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"Experience here has exploded the theory that white men cannot stand labor in the tropics, and also the notion that the natives are immune from tropical diseases." -A.B. Nichols

Over 22,000 workers died during the French effort to build the Canal, many of them from malaria and yellow fever. The symptoms of yellow fever were terrifying: fever, headaches, back pain, extreme thirst, and black vomit from internal bleeding. The disease could progress to kidney failure, seizures, coma, and death. It was called yellow fever because patients took on the yellow tinge of jaundice when the illness attacked the liver.

When the U.S. took over building the Canal in 1904, Theodore Roosevelt appointed Colonel William Gorgas to the post of Chief Sanitary Engineer. Gorgas had successfully eradicated yellow fever from Cuba in 1901 after the discovery that the mosquito Aedes egyptii was the carrier of the disease. Though discovered in 1881 by Dr. Carlos Finlay and proven through repeated experiments by Dr. Walter Reed in 1900, the mosquito theory was not yet widely accepted in America. Most people, including the members of the Isthmian Canal Commission (I.C.C.), still believed yellow fever was caused by "bad air" resulting from filth and decomposing matter, and that it was spread by "fomites," which were things likely to be contaminated by the fever victim, such as bedding and clothing.

The I.C.C believed Col. Gorgas was wasting time and money by going after mosquito breeding areas and initially resisted giving him the full complement of men, medicines, and supplies that he had requested. After several deaths in early 1905 caused some 500 American workers to flee in panic from the Canal Zone, the I.C.C. asked President Roosevelt to replace Gorgas, blaming him for concentrating on mosquitoes and not on cleaning up filth. Roosevelt, instead, threw his support behind Gorgas, enabling him to deploy 4,000 people to fumigate homes, put up screens, eliminate standing water, and spray drains and pools with oil to kill mosquito larvae. By the end of December 1905, there were no more deaths from yellow fever in Panama.

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Fighting the Fever - Panama Exhibit Site

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"Experience here has exploded the theory that white men cannot stand labor in the tropics, and also the notion that the natives are immune from tropical diseases." -A.B. Nichols Over 22,000 workers died during the French effort to build the Canal, many of them from malaria and yellow fever.

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El Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES) es una institución de salud pública establecida en Panamá dedicada principalmente a la investigación de la salud y prevención de enfermedades.

Fue creado en 1921 por el presidente de Panamá Belisario Porras, como tributo al doctor William C. Gorgas, quien había erradicado la fiebre amarilla durante la construcción del Canal de Panamá. En 1928 se inauguraron sus instalaciones en la ciudad de Panamá. El instituto fue administrado por los Estados Unidos hasta 1990 con el nombre de Laboratorio Conmemorativo Gorgas.

Su área de investigación como laboratorio abarcó el tratamiento de problemas de la medicina tropical que a su vez podían solucionar problemas sanitarios en Panamá. Han realizado investigaciones de control y prevención en enfermedades parasitarias como la malaria, la toxoplasmosis, la leishmaniasis y la enfermedad de Chagas; así como enfermedades producidas por arbovirus, retrovirus, robovirus, papilomavirus, virus respiratorios, etc.

Dentro del instituto existe un banco de sueros con una cantidad estimada de 50 mil sueros. También posee una biblioteca con alrededor de 1.139 publicaciones hechas por investigadores del instituto.

Hacia 1990, fue traspasado al gobierno panameño y pasó a ser una unidad ejecutora del Ministerio de Salud. En 1994 fue cambiado su nombre a Centro Conmemorativo Gorgas de Información e Investigación y hacia 1997 a su nombre actual mediante el Resuelto Ministerial Nº 5101 del 9 de septiembre de 1997. Con los Resueltos Ministeriales 276 del julio 9 de 1998 y 201 del 6 de agosto de 1999, se crea su estructura organizativa, sus políticas y normas y el anexo del Laboratorio Central de Referencia en Salud Pública (LCRSP).

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El Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES) es una institución de salud pública establecida en Panamá dedicada principalmente a la investigación de la salud y prevención de enfermedades. Fue creado en 1921 por el presidente de Panamá Belisario Porras, como tributo al doctor William C.

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DK Find Out! | Fun Facts for Kids on Animals, Earth, History and more!

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Visit DK Find Out! to learn about dinosaurs, space, animals, nature & more. Fun learning activities for kids with videos, quizzes & galleries at DKFindOut.com

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Nature of the Disease
Cholera is spread when people eat food or drink water that has been contaminated with the cholera bacterium. Shellfish and other seafood, especially if eaten raw, are a frequent culprit in this illness. Other foods that commonly transmit cholera are fruits and vegetables that are grown in contaminated soil or washed in contaminated water. Cholera frequently occurs in countries that do not have modern facilities for treating water before people can drink it or wash with it.

Cholera begins with the sudden onset of severe diarrhea, usually 12 to 28 hours after exposure to the bacterium. The diarrhea is often accompanied by vomiting. The extreme loss of fluids and salts can quickly cause dehydration. The patient is very thirsty and may have painful muscle cramps. If untreated, the patient may die within a few hours.

Treatment for cholera consists mainly of rehydration. The patient is given fluids and minerals through an intravenous tube or, if vomiting is not too severe, in a solution taken by mouth. In some cases, antibiotics are given to the patient. With fluid and mineral replacement, the disease passes in two to seven days-sooner if antibiotics are taken the first day.

The key to cholera prevention is a clean water supply. Improved sanitation and food handling methods are also important. A cholera vaccine can provide short-term protection against the disease, usually for about six months, to travelers in areas with poor sanitation. Boiling all drinking water or drinking only bottled drinks is another precaution against the disease.

The recorded history of cholera is relatively short and remarkable. Although reports of cholera-like diseases date back to ancient Greece and India, cholera did not become a disease of global importance until modern times.

Six great cholera pandemics swept through the world in the 19th and early 20th centuries. The first began in India in 1817 and spread to Burma (Myanmar), Ceylon (Sri Lanka), and Southeast Asia. It expanded eastward as far as the Philippines and westward into the Middle East and Turkey before subsiding in 1823.

The second cholera pandemic began in India in 1829. The disease arrived in Russia in 1830 and continued on to western Europe, making its first appearance in England in 1831. The next year it arrived in the Western Hemisphere, striking southern Canada before spreading to the United States, Mexico, and Cuba.

The third pandemic is generally considered to have been the deadliest. It is thought to have erupted in 1852 in India; from there it spread rapidly through Persia (Iran) to Europe, the United States, and then the rest of the world. Eastern Africa was severely affected. Perhaps the worst single year of cholera was 1854, when 23,000 died in Great Britain alone.

The fourth and fifth cholera pandemics (beginning in 1863 and 1881, respectively) are generally considered to have been less severe than the previous ones. However, some areas had extraordinarily deadly outbreaks: some 60,000 people died in the provinces of Valencia and Murcia in Spain in 1885, and perhaps as many as 200,000 died in Russia in 1893-94. In the port of Hamburg, Germany, repeatedly one of the European cities most severely affected by cholera, almost 1.5 percent of the population perished during an outbreak in 1892. The last quarter of the 19th century saw widespread infection in China and particularly in Japan. In the early 1890s, the disease spread throughout South America.

The sixth pandemic lasted from 1899 to 1923 and was especially lethal in India, in Arabia, and along the North African coast. More than 34,000 people died in Egypt in a three-month period, and some 4,000 Muslim pilgrims were estimated to have died in Mecca, Saudi Arabia, in 1902. Russia was also struck severely, with more than 500,000 people dying of cholera during the first quarter of the 20th century. The pandemic failed to reach the Americas and caused only small outbreaks in some ports of western Europe. Even so, extensive areas of Italy, Greece, Turkey, and the Balkans were severely affected. After 1923, cholera subsided in most of the world, though cases continued in the Indian subcontinent.

Cholera did not spread widely again until 1961, the beginning of the seventh pandemic. This pandemic began in Indonesia and spread throughout Asia during the 1960s. During the next decade the disease spread westward to the Middle East and reached Africa, where cholera had not appeared for 70 years. In 1991 cholera appeared unexpectedly in Peru, on the western coast of South America, where it had been absent for 100 years. From there it infected Ecuador, Colombia, Brazil, and Chile and leaped northward to Central America and Mexico. By 2005 cholera had been reported in nearly 120 countries.

The seventh pandemic, which continues today, has struck Africa especially hard. A particularly large outbreak of cholera occurred in 1994 among the many hundreds of thousands who fled widespread killing in Rwanda and occupied refugee camps in Zaire (now the Democratic Republic of the Congo). In the late 1990s, while the incidence of cholera in developed countries decreased significantly, the disease remained prevalent in Africa. In the early 2000s, many African countries-including Mozambique, the Democratic Republic of the Congo, and Tanzania-experienced outbreaks that often involved more than 20,000 cases and several hundred deaths. Zimbabwe experienced a severe cholera epidemic in 2008-09 that resulted in some 97,000 cases and 4,200 deaths.

The worst cholera epidemic in recent history, however, occurred not in an African country but rather in the Caribbean country of Haiti. The disease emerged in October 2010, 10 months after an earthquake devastated the country. By April 2013, more than 650,000 cases of cholera had been reported in Haiti, resulting in more than 8,000 deaths.

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Nature of the Disease Cholera is spread when people eat food or drink water that has been contaminated with the cholera bacterium. Shellfish and other seafood, especially if eaten raw, are a frequent culprit in this illness. Other foods that commonly transmit cholera are fruits and vegetables that are grown in contaminated soil or washed in contaminated water.

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England: The Broad Street Pump - You Know Nothing, John Snow - Extra History - #1

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The Polio Epidemic - FDR & The March of Dimes - Extra History

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The 1918 Flu Pandemic - Emergence - Extra History - #1

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Smallpox is a dangerous disease caused by a tiny germ called a virus. Smallpox once killed or scarred many people. However, in the late 20th century scientists fought the disease successfully. There have been no naturally occurring cases of smallpox since the 1970s.

People who have the smallpox virus can spread it to other people through their breath or saliva. The virus also can live on bedding or clothing. Once a person is infected by the smallpox virus, there is no cure for the disease.

People with smallpox get a high fever. They also get body aches and become very tired. A rash appears on the skin. The rash changes into blisters. People can die from smallpox. People who survive may suffer permanent damage such as scars or blindness.

Smallpox existed for thousands of years in Europe, Asia, and Africa. Explorers brought the disease to the Americas after 1492. Many Native Americans died from it.

In 1796 an English doctor named Edward Jenner discovered a smallpox vaccine. A vaccine is a substance that prevents people from getting a disease. In 1967 a group called the World Health Organization began giving the smallpox vaccine to people around the world. The project was a success. By 1979 there were no cases of smallpox anywhere in the world.

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Smallpox is a dangerous disease caused by a tiny germ called a virus. Smallpox once killed or scarred many people. However, in the late 20th century scientists fought the disease successfully. There have been no naturally occurring cases of smallpox since the 1970s.

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History of Vaccines - Killing Smallpox - Extra History

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0:00 / 6:24•Watch full video

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The Last Major Smallpox Outbreak in America

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How we conquered the deadly smallpox virus - Simona Zompi

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Smallpox is the infectious disease produced by Variola major. It was the first infection for which a preventive measure, vaccination, was introduced; it is the first infectious disease that has been eradicated from the wild.

By world agreement, only two stocks of the smallpox pathogen exist: in high-security government laboratories in Russia and the United States. There are concerns, however, that there may be cultures elsewhere, and, since it is transmissible from human to human and has substantial morbidity and mortality, there are worldwide preparations for containing and treating an outbreak. The vaccine, while having significant side effects, can reduce the severity of an active case as well as prevent the disease. At least one antiviral drug, cidofovir, is believed active against it, but has not been used in humans.

Smallpox is believed to have originated in Africa from a rodent that lived along the south Nile River in the crescent green forests. From Africa it then spread to china and India thousands of years ago. During the Egyptian-Hittite war in 1350 B.C. was the first recorded epidemic of Smallpox. Almost Two Thousand years later this disease reached Europe where it plagued the countries from the fifth century until the nineteenth century. From Europe the disease spread to major cities all around the world including the American colonies in the seventeenth and eighteenth centuries.

Smallpox has played a major role in shaping the way western civilization prospered and grew during the middle ages and into modern times. From the tenth century until the eighteenth century Smallpox accounted for more the four-hundred thousand deaths per year. The estimated death toll ranges from 300 to 500 million.

Vaccination

The demise of smallpox came about with the realization that survivors of the illness were immune for the rest of their life. This brought about the practice of Variolation. Variolation is the process of exposing a healthy person to the infected substance in the chance that the healthy person would develop a milder form of the disease and then receive immunity.

After centuries of this type of inoculation eventually it was refined by professional doctors and turned into a very effective and "safe" process. A study was done in Boston where 12,000 people contracted the disease. Of these fourteen percent that were not inoculated died. Of those who had variolation performed only two percent died from naturally contracted the disease. These statistics dramatically increase the number of people who had variolation performed on themselves.

After centuries of the practice of inoculation by variolation had developed it was time for a new era to come about.

It all started when a young boy name Edward Jenner's was inoculated with the virus along with thousands of other boys. Edward spent his life studying many different fields of science and was very successful. He developed new ways of thinking and new forms of scientific method. However his most meaningful study came from his interest in the idea that cowpox brings immunity to smallpox. He had heard many rumors that dairy maids, after being infected with cowpox, a lesser virus similar to smallpox, received immunity from both diseases. After studying a dairy maid with fresh cowpox lesions on her hand he saw that she was immune to smallpox. After much thought and careful planning he decided to inoculate a boy with fresh cowpox lesions. After a mild case of cowpox occurred he decided to take fresh smallpox and place it on an open wound on the boy. After a few weeks no smallpox had shown up and Edward Jenner concluded that immunity was complete. This discovery paved the way for the eventual eradication of this disease from the world.

Smallpox was named from the small lesions that form on the victims skin.

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Smallpox is the infectious disease produced by Variola major . It was the first infection for which a preventive measure, vaccination, was introduced; it is the first infectious disease that has been eradicated from the wild. By world agreement, only two stocks of the smallpox pathogen exist: in high-security government laboratories in Russia and the United States.

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Polio, called poliomyelitis in full, is a disease caused by a tiny germ called a virus. In the past, polio attacked many children and left them paralyzed, or unable to move their muscles.

The first symptoms, or signs, of polio can be very mild. In fact, many people who get the disease feel fine. Others think they have caught a cold. In serious cases people complain of having pains in their neck, back, and legs. The pains are a sign that the polio virus has attacked the spine. The spine has nerves that control the muscles of the body. If the virus damages those nerves, the muscles become weak.

Some people recover their muscle strength. Others become permanently paralyzed. If the virus damages the nerves controlling the leg muscles, the person can no longer walk. If the virus attacks the nerves controlling the lungs, the person cannot breathe without the help of a machine. There is no cure for polio.

As recently as the 1950s polio affected thousands of people in the United States. Polio affected mostly children, but some adults got it as well. The U.S. president Franklin D. Roosevelt was paralyzed by polio as an adult.

In the early 1950s the medical researcher Jonas Salk made a substance called a vaccine to protect people from the virus that causes polio. Polio has disappeared from most countries because almost every child is vaccinated.

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Polio, called poliomyelitis in full, is a disease caused by a tiny germ called a virus. In the past, polio attacked many children and left them paralyzed, or unable to move their muscles. The first symptoms, or signs, of polio can be very mild. In fact, many people who get the disease feel fine.

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Details

Disease

Bubonic plague epidemic

Dates

1665-1666

Spread by

Fleas who bit infected rats,
then bit people

Victims

Deaths

About 100,000 (1/4 of London's population.

Killed more of England's population than
World War I or World War II.

During the Great Plague of London (1665-1666), the disease called the bubonic plague killed about 100,000 people in London, England. In seven months, almost one quarter of London's population (one out of every four Londoners) died from the plague. At its worst, in September of 1665, the plague killed 7,165 people in one week. After this, the number of people dying from the plague began to slow down.

Around September of 1666, the great outbreak ended. The Great Fire of London, which happened on 2-3 September 1666, may have helped end the outbreak by killing many of the rats and fleas who were spreading the plague.

Though most of the people who died during the Great Plague lived in London, the plague also killed people in other areas of England. By the time the Great Plague ended, about 2.5% of England's population had died from the plague. To compare, about 2% of the entire United Kingdom's population (including soldiers and civilians) died in World War I, and about 1% of the entire United Kingdom's population died in World War II.

The Great Plague of 1665 was the last major plague in England. Before the Great Plague, England had had outbreaks of plague (meaning many people got the disease) every few decades. For example:

The 1603 plague killed 30,000 Londoners;

The 1625 plague killed about 35,000 people; and

The 1636 plague killed about 10,000 people.

Historians think the plague spread to England from the Netherlands. Dutch trading ships carrying cotton from Amsterdam may have brought the plague to England. Amsterdam was badly hit by the plague in 1663-1664; the disease killed about 50,000 people.

In London, the first places hit by the plague were the dock areas outside of the city and the parish of St Giles in the Fields. In these places, poor workers lived crowded together in bad conditions. Nobody kept records about the deaths of very poor people, so nobody knows how many of these people may have died from the plague. However, records say the first person to die of the plague in London was Rebecca Andrews, on 12 April 1665.

The plague hits London

By July 1665, plague was in the city of London itself. Many of the people who could afford to leave the city left for the countryside. King Charles II of England, his family, and his court left the city for Oxfordshire. Most wealthy merchants and professionals left the city, so most businesses were closed. As the plague got worse, more and more people left. London got so empty that grass started to grow on the streets.

However, most of the city's government officials stayed in London. So did the Lord Mayor of London, Sir John Lawrence. As the plague got worse, more and more people left, but a small number of clergymen, physicians and apothecaries chose to stay. Also, people who were too poor to move to the countryside had no choice but to stay in the city.

Some of the people who stayed in London wrote about the Great Plague. Samuel Pepys's diary about living through the plague has given historians a lot of information about what the plague was like. Henry Foe, a saddler who lived in East London, also decided not to leave the city. Years later, in 1722, Foe's nephew Daniel Defoe wrote A Journal of the Plague Year, a story about the plague, which he may have based on Foe's journals.

People in London tried many different things to try to treat the plague and stop it from spreading. At the time, nobody understood what caused the plague, how it spread, or how to treat it. Antibiotic medications, which are the only treatment for plague, would not be discovered for another 300 years. People were so afraid of catching the plague from other people that they threw dead plague victims' bodies in overcrowded pits and buried them all together, as quickly as possible. In one parish in London, 1,114 dead plague victims were buried together in a hole that was fifty feet long and twenty feet wide.

As the plague got worse, people began to do worse things. Some people refused to help sick family members. Other people forced sick servants to leave, even though they had nowhere to go. Eventually, if one person in a home got the plague, the whole family was forced to stay in the home. A red cross and the words "Lord have mercy upon us" would be painted on the door. Samuel Pepys wrote in his diary: "the plague [is] making us cruel as dogs to one another."

Government officials tried several public health programs to prevent more people from getting the plague. For example:

They hired doctors

They ordered fires to be kept burning night and day, hoping they would clean the air. Things that gave off strong smells, like pepper, hops, or frankincense, were also burned.

They made it illegal to go to theatres, football games, and other group entertainment activities. Thus people would not spread the plague to each other.

They urged people to smoke tobacco, because they thought it prevented the plague.

Because people thought that animals might spread the plague, government officials ordered that stray dogs and cats should be killed. About 40,000 dogs and about 200,000 cats were killed. This was a bad decision, since those animals, mostly the cats, helped control the population of rats (which carried the fleas that spread the plague).

"Plague doctors" walked the streets diagnosing victims, although many of them were not actual doctors. Wearing special costumes, they tried to treat plague victims with bloodletting, frogs, and leeches.

Though the plague was worst in London, it also affected other parts of England. Perhaps the most famous example was the village of Eyam in Derbyshire. Nobody knows for sure how the plague got to Eyam. However, stories say that a merchant carrying cloth from London accidentally brought the plague with him. The villagers quarantined themselves - kept themselves apart from other people and other villages - to make sure the disease would not spread any further. This kept the plague from spreading outside Eyam. However, about 80% of the people in Eyam died from the plague within a little over a year.

The plague dies out

As time went on, more and more people died from the plague. This continued until the week of 19-26 September, 1665. This was the worst week of the Great Plague: 7,165 people died from the plague in that week. After that, the number of deaths from the plague began to slow down. By February 1666, the King and his court decided it was safe enough to return to London.

Some people - though not nearly so many - continued to get the plague until September 1666. Around that time, the plague outbreak ended. The Great Fire of London, which destroyed most of the centre of London, may have helped.

Images for kids

Rattus rattus, the black rat. Smaller than Rattus norvegicus, the brown rat, which later supplanted it, it is also keener to live near humankind. Timber houses and overcrowded slums provided excellent homes. The link between the rat as reservoir of infection and host to fleas which could transfer to man was not understood. Efforts were made to eliminate cats and dogs: if anything, this encouraged the rats. Body lice were also important plague vectors.

In Spanish: Gran peste de Londres para niños

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Learn Great Plague of London facts for kids

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Influenza 1918 | Article

A typist attempts to maintain her daily routine during the influenza epidemic. Courtesy: NARA

While possible origins of this influenza were debated and investigated, one fact remained inescapable: it was deadly. Lacking reliable medical defenses against influenza, public health officials and private citizens poured their energies into taking preventative measures. The United States Public Health Service (U.S.P.H.S.) faced the challenge of educating the public about an illness that was largely a mystery. To that end, the Red Cross, Post Office, and Federal Railroad administration all did their part to assure that instructive posters adorned the entire nation. Surgeon General rupert Blue, the nation's Chief Public Health Officer, ordered the printing and distribution of pamphlets with titles like, "Spanish Influenza," "Three-Day-Fever," and "The Flu." The Colgate company pitched in by placing ads detailing 12 steps to prevent influenza. Among the recommendations: chew food carefully and avoid tight clothes and shoes. Alfred Crosby, in "Epidemic and Peace, 1918," his definitive history of Spanish influenza, observed that if influenza could have been smothered by paper, many lives would have been spared.

The Committee of the American Public Health Association (A.P.H.A.), believing the disease extremely communicable, strongly advocated legislation that would prevent the use of common cups and utensils and would ban public coughing and sneezing. The A.P.H.A. implored the public to develop the habit of washing their hands before every meal and paying special attention to general hygiene. They cautioned that nervous and physical exhaustion should be avoided and encouraged exposure to fresh air. A more controversial method of flu prevention, disputed by the A.P.H.A., involved gargling with a variety of dubious elixirs. Various physicians advised rinsing with everything from chlorinated soda to a mixture of sodium bicarbonate and boric acid.

Efforts to get the word out to the people concerning influenza, as ambitious as they were, still left whole sectors of the population in the dark. Citizens of rural outbacks, especially, found themselves relying on folk remedies to fend off or cure the flu. Tales abounded of mothers insisting that their children stuff salt up their noses and wear goose grease poultices or bags of garlic-scented gum around their necks. For some, onions were looked upon as a potential savior. A Pennsylvania woman boasted of serving up onion omelets, onion salads, and onion soup with every meal. Not one of her eight children contracted the flu. Meanwhile, a four-year-old girl from Portland, Oregon was said to have recovered fully from the flu after her mother dosed her with onion syrup and buried her from head-to-toe for three days in glistening raw onions. Those with an aversion to onions swore by a shovelful of hot coals sprinkled with sulfur or brown sugar, which enveloped every room in a noxious blue-green smoke. While evidence that any of these measures had any positive effect was anecdotal, they were in keeping with the belief that doing anything to fend off influenza was better than sitting idly by, waiting to become a statistic.

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Searching for Cures | American Experience | PBS

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Influenza 1918 | Article While possible origins of this influenza were debated and investigated, one fact remained inescapable: it was deadly. Lacking reliable medical defenses against influenza, public health officials and private citizens poured their energies into taking preventative measures. The United States Public Health Service (U.S.P.H.S.)

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The Polio Crusade | Article

Dr. Isabel Morgan

The daughter of two accomplished biologists (her father won a Nobel Prize in 1933), Dr. Isabel Morgan was an early and important player in the race to find a polio vaccine. "Isabel Morgan is really one of the unsung heroes of the polio fight," says author David Oshinsky. "She was a brilliant researcher."

The Killer-Virus Vaccine
After earning a PhD in bacteriology, Morgan worked at the Rockefeller Institute for six years before moving to a top-notch lab at Johns Hopkins in 1944. There, with March of Dimes funding, her team strove to immunize monkeys against polio. At the time, most other prominent virologists believed a vaccine could only be achieved using a live virus, but Morgan thought otherwise. After five years of work, her team became the first to successfully inoculate monkeys with a killed-virus vaccine.

Dr. Isabel Morgan (center)

After the War
Morgan's research looked incredibly promising to those hoping for a human vaccine, but in 1949, at the height of her career, Morgan surprised the scientific community by leaving polio research behind forever. Morgan reportedly told friends that she quit the field because she was afraid of the next step: testing the vaccine on human children. Like many American women in the years after World War II, much of her energy went into being a homemaker for her husband and stepson. In Morgan's case, this may have been a serious blow to the scientific community. "She was probably a year or two ahead of Jonas Salk in the race for a vaccine," says Oshinsky. "Had she stayed the course, there's a good chance today we'd be talking about the Morgan vaccine and not the Salk vaccine."

Morgan's Legacy
Dr. Morgan spent the following years as a homemaker and stepmother, also working for 11 years at the Westchester County Department of Laboratory Research. After her stepson died in a plane crash in 1960, Dr. Morgan earned a masters degree in biostatistics and consulted at the Sloan-Kettering Cancer Institute in New York City. She died in 1996.

"The important thing to remember about her is that the science of polio was the science of building blocks," says Oshinsky. "It wasn't just Jonas Salk and Albert Sabin... Other people did so much of the research that these two scientists built upon."

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Isabel Morgan | American Experience | PBS

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The Polio Crusade | Article The daughter of two accomplished biologists (her father won a Nobel Prize in 1933), Dr. Isabel Morgan was an early and important player in the race to find a polio vaccine. "Isabel Morgan is really one of the unsung heroes of the polio fight," says author David Oshinsky.

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The Polio Crusade | Article

Dr. Isabel Morgan

The daughter of two accomplished biologists (her father won a Nobel Prize in 1933), Dr. Isabel Morgan was an early and important player in the race to find a polio vaccine. "Isabel Morgan is really one of the unsung heroes of the polio fight," says author David Oshinsky. "She was a brilliant researcher."

The Killer-Virus Vaccine
After earning a PhD in bacteriology, Morgan worked at the Rockefeller Institute for six years before moving to a top-notch lab at Johns Hopkins in 1944. There, with March of Dimes funding, her team strove to immunize monkeys against polio. At the time, most other prominent virologists believed a vaccine could only be achieved using a live virus, but Morgan thought otherwise. After five years of work, her team became the first to successfully inoculate monkeys with a killed-virus vaccine.

Dr. Isabel Morgan (center)

After the War
Morgan's research looked incredibly promising to those hoping for a human vaccine, but in 1949, at the height of her career, Morgan surprised the scientific community by leaving polio research behind forever. Morgan reportedly told friends that she quit the field because she was afraid of the next step: testing the vaccine on human children. Like many American women in the years after World War II, much of her energy went into being a homemaker for her husband and stepson. In Morgan's case, this may have been a serious blow to the scientific community. "She was probably a year or two ahead of Jonas Salk in the race for a vaccine," says Oshinsky. "Had she stayed the course, there's a good chance today we'd be talking about the Morgan vaccine and not the Salk vaccine."

Morgan's Legacy
Dr. Morgan spent the following years as a homemaker and stepmother, also working for 11 years at the Westchester County Department of Laboratory Research. After her stepson died in a plane crash in 1960, Dr. Morgan earned a masters degree in biostatistics and consulted at the Sloan-Kettering Cancer Institute in New York City. She died in 1996.

"The important thing to remember about her is that the science of polio was the science of building blocks," says Oshinsky. "It wasn't just Jonas Salk and Albert Sabin... Other people did so much of the research that these two scientists built upon."

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Isabel Morgan | American Experience | PBS

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The Polio Crusade | Article The daughter of two accomplished biologists (her father won a Nobel Prize in 1933), Dr. Isabel Morgan was an early and important player in the race to find a polio vaccine. "Isabel Morgan is really one of the unsung heroes of the polio fight," says author David Oshinsky.

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The Polio Crusade | Article

Larry Becker

Larry Becker's experience of a feared disease and its aftermath
Larry Becker fell ill with infantile paralysis in summer 1952, when he was 13 years old. Becker spent two and a half years in the hospital undergoing intensive rehabilitation. The March of Dimes paid roughly $20,000 (nearly $155,000 in today's dollars) toward his rehabilitation, and Becker participated in numerous publicity efforts for the health charity. He grew up to find success in academia. Here, he shares memories of his experience.

Getting Sick
In the summer of 1952, I sold ice cream from a pedal cart. At noon on August 22nd I wasn't feeling well, and my legs gave out as I was pedaling home for lunch. I was sick with flu-like symptoms through the weekend... then I got very ill during Monday evening, developing muscle weakness in both arms and both legs, along with a high fever and a stiff neck. On Tuesday morning I was admitted to the hospital.

About three weeks after I was admitted and diagnosed with polio, I was out of isolation... but still gravely ill, and not able to take even one breath on my own... I was still hoping for a full recovery.

How an Iron Lung Works
The iron lung was a "negative pressure" ventilator. Outward movement of the leather bellows at the foot of the cylinder created a partial vacuum around the patient's torso inside the "tank." This would cause the patient's chest wall and lungs to expand. Because the air pressure in the patient's lungs would then drop below the ambient air pressure around the patient's head outside the tank, air would flow into the lungs, given an unobstructed airway. Thus negative pressure inside the tank produced inhalation, and when the bellows reversed and pushed inward into the cylinder, the pressure would change from a partial vacuum back to normal room pressure or a small amount of "positive" pressure, compressing the chest wall and producing exhalation. The respiration rate was adjustable, and mine was usually set at 14 per minute.

An Improved Iron Lung
Emerson ingeniously added a positive pressure dome to its iron lungs in the early Fifties. It made patient care much safer and easier. When the dome was locked in place and the tray was pulled out, air was pumped in and out of the dome by the bellows through a telescoping tube running under the tray. Increased positive pressure under the dome forced air downward into the patient's lungs; decreased pressure allowed exhalation. Nursing care became much more leisurely, and much less stressful for the patient. The dome essentially reversed the normal action of the iron lung, turning a "negative pressure" respirator into a positive pressure one.

Relearning to Breathe
By the fall of 1952... I could breathe (with great effort) for several hours on my own. My diaphragm was paralyzed, but I had some neck muscles that worked, and I gradually discovered that I could use them to rhythmically lift and lower my shoulders and chest enough to take small breaths. We practiced regularly several times a day, using a stopwatch at first. When I could reliably breathe for one minute I got a new chess set to mark the occasion. Three minutes got me something else, as did five, and 15. Once I got to 30 minutes I reluctantly agreed to spend that time on a hospital bed, and that greatly increased progress because when I lifted my shoulders with my neck muscles, the iron lung didn't interfere with the effort. But I had no desire to change iron lungs, or to try the dome.

In fact, at the end of one exhausting day, after I was back in the iron lung and getting some rest, I firmly declined to be transferred to the new iron lung given to the hospital by a union local. This was a disappointment to the publicity people, but for me it was driven by fear as much as exhaustion. For one thing, during the first few weeks, I was sure that any change to my machine would be life-threatening. I trusted that machine, and didn't want to leave it.

Larry Becker with his siblings

Help from Family
A picture was taken sometime in November, and was used on our family Christmas card that year. By that time sister Sharyn (age 8) and brother Mic (age 6) were pretty comfortable around my iron lung - though I am less sure about how comfortable I was with their hands on the locking mechanism. I was feeling a good deal better by then, and was able to spend several hours each day on a hospital bed, breathing on my own. The weight loss was starting to be pretty obvious by this point, but not yet as problematic as it would become by the spring. My mother rarely left my side during the daylight hours, and my father was a daily presence as well - usually early in the morning.

The nurses taught Sharyn how to pump the iron lung by hand in case of a power failure. Although the hospital had emergency generators, Sharyn tells me she was worried about what would happen if the generators failed. She remembers asking a nurse about this and being told "If the power goes out, don't come running for us. We will already know about it, and we will be running to help you. Your job is to disengage the clutch on the motor, back here. Like this. And then you begin to pump the bellows, like this." They then rehearsed the procedure.

The Rocking Bed
I was introduced to the rocking bed when I was transferred to the newly opened Respiratory Rehabilitation Center at St. Joseph's Hospital in Omaha, Nebraska on July 13, 1953 - courtesy of the March of Dimes, which funded the center. It was one of 13 such centers in the United States. I was its third patient, and the plan was for me to stay there as long as I was making substantial progress. The day I arrived in Omaha I was put on a rocking bed to rest from the 160 mile ambulance trip. I liked it a lot. It rested me, and the sense of freedom was compelling...

I was weighed, and given a pulmonary function study. It turned out that my vital capacity was a mere 250 cc and my tidal volume was identical - meaning that each time I breathed on my own, I was taking deepest breath I could take, which was less than 10% of what would be expected for someone my age (14) and height (about 5'6" or so, with the beginnings of a scoliosis). And I weighed 62 pounds - down from about 125 before my illness. Great consternation ensued, and I was put on a routine of 10-hour overnights in the iron lung and 14-hour days out on a rocking bed. The rocking bed was turned off for therapy and various other procedures, but it was turned on for most of the day - and always for meals. That meant that my eating didn't have to compete with my breathing, and my appetite started to improve.

Therapies
I was given some foul tasting high calorie supplements each day, which I think I had been getting in Hastings as well, and various kinds of injections. Specialized exercises began to strengthen my breathing. I remember especially several weeks when we were required to blow through a system of glass straws to force a gallon of water from one large bottle into another.

A few months later we were shown a training film about glossopharyngeal breathing ("frog-breathing") made at Rancho Los Amigos, the rehab center in Los Angeles. I learned how to do it immediately, within hours, and it has become an indispensable supplementary technique.

The polio rehabilitation ethic was relentless, and could be cruel for people who were too sick, or too frightened, or too depressed to cooperate fully. Whining and moping around were not encouraged. Patients and staff were not sympathetic to it. We were all well beyond the initial stages of the disease, and were expected to face forward and get on with recovery.

First Trip Home
Thanksgiving 1954 was my first overnight visit away from the hospital since August 26, 1952. Cumbersome respirators and unaccommodating houses were the problems that delayed this. But on the other hand, there was not much point in getting my hopes up if it was never going to happen for good...

I was fitted out with a portable chest respirator for sleep, since the rocking bed was too cumbersome to transport, and my parents rented a hospital bed (actually, borrowed it, I think, from a mortuary that also ran an ambulance service and a home health supplies store) and set it up downstairs in the dining room of the parsonage.

This trip was a fact-finding mission in preparation for my eventual discharge from the hospital. Finally, my improvement was accelerating. My legs were stronger, my balance was getting better, my vital capacity was improved, and my weight was no longer medically alarming. Managing the respiratory equipment at home was a big problem, since modifying the parsonage was apparently not an option. I was going to have to be able to walk well enough to get up the stairs to my bedroom, and either not need any respiratory assistance at all, or be able to use the chest respirator. The only shower stall in the house was in the basement, off the recreation room. I could take a tub bath upstairs only if someone could lift me in and out of the tub (and in fact it turned out my father could do this, since I still weighed well under 100 pounds). It turned out that I was within striking distance of these goals if I could get strong enough to climb stairs, and not have to rest so much during the days. I went back to the rehab center with a burningly clear agenda for the next few months.

The goal of changing the world so that it accommodated people with various disabilities was still a long way off. Rehabilitation operated on the principle of coping with the world as you found it.

Chest Respirator
By the time I came home my vital capacity had stabilized in the range of 850 to 1000 cc, depending on body position, tiredness, etc. I could pump up my lungs to triple that number by way of frog breathing. Those two forms of vital capacity have remained the same ever since.

I came home without any respiratory assistance. No rocking bed. No chest respirator. No iron lung. This required a good deal of deception on my part. I knew that my blood gases would be tested during the day, and I hoped they would be good. They were. So I was soon moved to a room without a rocking bed, and convinced myself that I could sleep unassisted. I was discharged without a respirator, but several months later (after I became uncontrollably sleepy during the day and had several episodes of tachycardia), I went back to Omaha for evaluation and was told I would have to use a chest respirator for sleep, indefinitely. ("Indefinitely" turned out to mean the next 40 years. In the summer of 1995, the symptoms of respiratory insufficiency from 1955 returned, and I exchanged the chest respirator for a nasal positive pressure unit called a "BiPap.")

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Interview: Larry Becker | American Experience | PBS

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The Polio Crusade | Article Larry Becker's experience of a feared disease and its aftermath Larry Becker fell ill with infantile paralysis in summer 1952, when he was 13 years old. Becker spent two and a half years in the hospital undergoing intensive rehabilitation.

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The Polio Crusade | Image Gallery

In the mid-twentieth century, the National Foundation for Infantile Paralysis (the predecessor to today's March of Dimes) pioneered a new approach to philanthropy, raising money a dime at a time from millions of small donors. The nonprofit enlisted poster children, celebrities, presidents, and other partners in their high-profile campaigns.

By 1954, the National Foundation was the nation's leading health charity, capturing nearly half of all charitable donations to those causes. However, with 100,000 cases per year, polio was a smaller public health threat than tuberculosis, heart disease, cancer, cerebal palsy, or muscular dystrophy.

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The Polio Crusade | American Experience | PBS

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The Polio Crusade | Image Gallery In the mid-twentieth century, the National Foundation for Infantile Paralysis (the predecessor to today's March of Dimes) pioneered a new approach to philanthropy, raising money a dime at a time from millions of small donors. The nonprofit enlisted poster children, celebrities, presidents, and other partners in their high-profile campaigns.

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Narrator: The summer of 1950 started like most summers in the small town of Wytheville, Virginia. School let out, the town pools opened, and kids flocked to the soda fountain on Main Street. Almost 40 percent of the town's 5,500 residents were under the age of 18.

John Johnson: Wytheville was more or less a lazy type, laid back town. Everyone knew everyone. It got really hot in the summertime. And we would go swimming. We were happy go lucky kids.

Eleanor Sage: I had a pair of my grandfather's rubber boots on and I was wadin' in the creek. And when I went to get out I felt like something pulled in my leg. I went home and hadn't been home too long till I started runnin' a temperature and was real nauseous and just kept goin' higher and higher.

Betty Cook Brown: I was outside playing, I just didn't feel right. By the time I got inside the house to my mother, I told her I was sick. I had a headache. I was so dizzy. And after that, I just passed out.

Anne B. Crockett-Stark: The doctor came to do a spinal tap on my brother, and he screamed. And my mother ran downstairs with a bed pillow, went out in the back yard and covered her head with a pillow, and laid there and screamed.

Eugene Warren: We only had two ambulance services in Wytheville. One would come in to the clinic with a suspected case while the other one would be coming out of the clinic and leaving for either Roanoke or Richmond in, out, in, out, in, out, in, out. Mr. Williams' tote board was right across the street from where I worked and it was always visible, and every once in a while we'd go to the front door and look out and then every time another one came in with diagnosis, well, they changed the count.

Anne B. Crockett-Stark: Daddy and Mama took everything Sonny owned, all of his clothes, his bed, his chest of drawers, and he had a fabulous comic book collection. And they took everything out to the middle of the garden, and they just made a pile and burned everything he owned. They were told to do that, so that we would not get it.

Narrator: Polio was hitting Wytheville harder that year than any place in the country.

Eugene Warren: It became more and more evident that we were really in trouble, and without knowing what to do - or how to stop it, or how to get away from it - we were just stuck with it. You-you just couldn't pick up everybody and leave and you couldn't set the whole town on fire. So it was a, it was almost, not hopeless, but it was gettin' pretty close that way.

Narrator: Since the turn of the 20th century polio, also known as infantile paralysis, had become an increasingly menacing fact of American life. Highly contagious, the polio virus tended to strike during the summer.

Samuel L. Katz, scientist: It was very reliable. Come June, July you began to see cases of polio and they continued on through September.

Narrator: The symptoms ranged from a mild headache and nausea, to muscle weakness, paralysis or death.

Kathryn Black, writer: One never knew, how it would go. Would it pass through the body and the person would get up out of bed, few days later, just fine? Would there be one leg damaged? Would both arms?

Julius Youngner, scientist in Salk's lab: The paralytic effects would last for life. And you didn't have to look very far, to see people who had been crippled with polio, and crippled in-in terrible ways.

Narrator: In 1921, the disease struck an especially prominent citizen just as his political star was on the rise. Polio usually targeted children, but Franklin Delano Roosevelt was 39. After contracting a sudden fever and chills, he lost the use of both of his legs.

Kathryn Black, writer: FDR was an enormous landmark in the whole history of polio. The fact that he came down with polio changed the course of the disease in this country.

Narrator: Roosevelt worked to restore both his body and his career. He bought a remote Georgia resort whose spring-fed baths were reputed to have healing powers, and turned it into the Georgia Warm Springs Foundation, committed to rehabilitating polio patients from around the country. In 1928 a still paralyzed but vital FDR fought his way back onto the national political stage. To keep the fight against polio alive Roosevelt turned to his law partner, Basil O'Connor - a man who knew little about polio, but a great deal about power and persuasion. "I was never a public do-gooder," O'Connor declared, "and had no aspirations of that kind." Short tempered and relentless, he was a working class Irishman who had to dig and fight for everything he had achieved.

David M. Oshinsky, author, Polio: Basil O'Connor has no interest in being the head of the Warm Springs Foundation. But he is so loyal to Franklin Roosevelt, and he really believes the only way to ensure FDR's political career, is to take over this institution that is so close to FDR's heart.

Narrator: With Roosevelt now in the White House, O'Connor worked tirelessly to keep the organization afloat. America was experiencing the worst economic depression in its history, and charities' traditional source of funding - donations from the rich - had completely dried up. Worse still, the number of cases of polio continued to rise.

David M. Oshinsky, author, Polio: What made polio so questionable, what made it so hard for people to get a grip on, was that at the very time America was becoming a cleaner, more antiseptic society, the polio rates were going up dramatically.

Narrator: In time, scientists would unlock some of polio's mysteries: they would learn the virus entered the body through the mouth; that it passed from person to person through contaminated water, food or physical contact. They would come to understand that modern sanitation actually helped explain the prevalence of the disease - infants in clean environments were less likely to be exposed to the virus and develop life-long immunity.

Paul A. Offit, scientist: Before improvements in sanitation, all children were born with antibodies against polio. When we had improved sanitation, children started to become exposed to polio later and later in life, at a time when those antibodies they had received from their mother had already disappeared. And that's why you saw an emergence of the disease.

Narrator: In 1938, O'Connor didn't know much about the science of polio. What he did know was that polio patients depended on private charities like his, not the government, for help. Without a new way to raise money, his foundation could offer little more than hope. It was time, he decided, to try something bold.

Eddie Cantor (archival): The only way to fight infantile paralysis is with money. And so I'm asking you tonight to send a dime to President Roosevelt at the White House.

Narrator: Enlisting celebrities to the cause, O'Connor made an unprecedented appeal to the American public.

Mickey Rooney (archival): Judy when I spend a dime on myself for some little luxury like this, I always think about those unfortunate kids and how far just a dime will go towards helping.

Judy Garland (archival): Gee Mickey, we don't know how lucky we are and how much we have to be thankful for with our health and our happiness....

Narrator: The campaign was dubbed the March of Dimes.

Judy Garland (archival): Can I put a dime in your envelope?

Mickey Rooney (archival): Oh, you know that you can. And that's what every good American should do - join the March of Dimes, send yours to president Franklin Roosevelt in the White House.

Judy Garland (archival): Washington, DC.

Narrator: O'Connor waited anxiously to see if his gamble would pay off. The March of Dimes campaign exceeded all expectations, raising 1.8 million dollars, a staggering sum.

David M. Oshinsky, author, Polio: What O'Connor realized was that this was a fundraising gold mine. This turns the fundraising on its head. You no longer want big donations from the few. You want small donations from the millions. No one is too poor to give a dime to help a kid walk again.

Narrator: O'Connor pledged to provide care for every polio patient in America - to pay for doctors, nurses and the most up to date rehabilitation. He would even invest in scientific research aimed at stopping polio forever.

David M. Oshinsky, author, Polio: Basil O'Connor was no scientist, but he was a great administrator. He knew how to organize, he knew how to centralize, he knew how to focus.

Narrator: Every summer more and more children were infected with polio. O'Connor understood that he was in a race against time.

Larry Becker: I was very active and outgoing, and grew up in a time and a place when kids had lots of independence and minimal supervision. Just a few inflexible rules, like "be home for dinner." I was 13. I was just starting to lean out and get kind of fast on the tennis court, and I was pretty happy with the way things were going.

Narrator: Larry Becker grew up in Hastings, Nebraska. He was a boy scout, delivered newspapers and played trumpet in the school band.

Larry Becker: My legs gave out as I was pedaling my ice cream cart home for lunch.

Narrator: Larry became delirious with fever as the polio virus penetrated his central nervous system, infecting and destroying the nerve fibers that controlled his muscles.

Larry Becker: It's like every muscle in your body is extremely sore. It's very sensitive to the touch, and just aches. I lost not only my leg muscles, but I lost also neck muscles and, most importantly, the diaphragm. I began to have trouble breathing, and I remember the last straw for me was when I lost the use of my biceps. I was afraid of not so much of pain, but of loss of control. My parents were in and out of the room. They were being given very bad news. There wasn't much hope that I was going to survive.

Film narrator (archival): You've never seen me but I'm sure you've seen my shadow. I'm never invited but I've been an invisible guest in practically every kind of home. This is what I've been looking for....

Narrator: To keep up the fundraising momentum, O'Connor shifted tactics.

Film narrator (archival): As you probably know, I'm very fond of children, especially little children. I have no prejudices. I'm quite impartial.

Narrator: The March of Dimes' new message was a frightening one: polio could strike anyone, anytime.

Julius Youngner, scientist in Salk's lab: You went to a movie and there was a little short subject about polio.

Doctor (archival film): Memorial Hospital please, Infantile Paralysis.

Julius Youngner, scientist in Salk's lab: They would pass a cup row by row something to put whatever change you had in it. Polio was brought home every day to families all over the United States.

Newsreel narrator (archival): In New York the March of Dimes campaign is inspired by Basil O'Connor, Jimmy Durante, Larry and Barry Pelliteri... during the past few years the polio epidemic has been on the increase... fight polio tonight with your porch lights at seven.

Narrator: The campaign worked. The March of Dimes grew to 3,000 local chapters, creating a network that reached millions, and raised millions - by the late 1940's as much as 22 million dollars per year. But O'Connor's campaign told only part of the story. While polio could be devastating, the chances of contracting an acute case were quite small; of being paralyzed, smaller still... of dying from polio, extremely remote. Many more Americans died from car accidents, or tuberculosis.

David M. Oshinsky, author, Polio: What the March of Dimes did was to turn an awful but relatively uncommon disease into our national disease and our national crusade. Basil O'Connor's feeling was: We've got to raise money for this. The best way you raise money was basically to scare the hell out of the American public.

Kathryn Black, writer: It's hard to imagine today I think how pervasive the fear was, and how embedded in the American psyche.

Narrator: The fear overwhelmed common sense. Every summer, in Wytheville and hundreds of towns across the country, people took extraordinary measures to avoid polio. They even sprayed the pesticide DDT despite the fact scientists had proved flies did not spread the virus.

Eugene Warren: Not knowing which way to turn, what's causing it, people looked for all sorts of places to put the blame. Some of 'em were ludicrous and some of 'em weren't.

Anne B. Crockett-Stark: Daddy said people just rolled up their car windows and put bandanas around their faces and zoomed through our town.

John Johnson: We didn't go on Main Street. We didn't go anywheres near town during the polio epidemic.

Betty Cook Brown: For the longest time, no one would bother to call, come, or get anywhere near our house. They were afraid. They didn't want to catch polio.

Eleanor Sage: They didn't want my mother and daddy to come in some of the stores. They just didn't want 'em around.

Anne B. Crockett-Stark: People did as little as possible, isolated themselves, and just prayed they wouldn't get it.

Narrator: In 1949, O'Connor took the campaign against polio to a new level. For more than a decade scientists funded by the March of Dimes had focused on developing the only viable solution to stop polio - a vaccine. Now, O'Connor declared, the long-awaited miracle was "in sight." His message raised hopes, and dimes, from an anxious public. But within the scientific community there was a very different reaction: a vaccine, most researchers believed, was still years away - if it worked at all.

Kathryn Black, writer: We lived in this little housing development in Phoenix. It was young families everywhere, and the population was just booming. Couples just like my family - father back from the war, mother had had a career and let it go to have children. I was four years old, my brother was six, my parents were 28. Life was pretty simple, pretty happy. One day my mother came down with a backache. And the doctor examined her, and my father remembers the doctor saying, "I think she has polio, but don't worry. It doesn't look like a serious case, but we have to put her in the contagious ward, where she'll be isolated." And things only got much, much worse from there. She survived that night, but she was paralyzed from the neck down. I have no memory of her going away. She disappeared overnight. We went to bed one night and our mother was in the next room. We woke up the next morning and she was gone.

Narrator: In 1951, two years after his promise of an imminent polio vaccine, O'Connor had little to show. Then, in September, traveling home from a conference in Europe, he met a scientist as driven and impatient as O'Connor himself. Jonas Salk was a 36-year-old researcher at the University of Pittsburgh.

Julius Youngner, scientist in Salk's lab: He was somebody who had great confidence in himself. "Ambitious" is too mild a word. He was super-ambitious.

John Troan, journalist: He was very aggressive on what he was doing. When I first met him, he looked very intense and he remained that way. I mean, never changed. Real intensive personality.

Narrator: O'Connor and Salk hit it off right away.

Peter Salk: Their personalities just meshed. Both shared big dreams, they shared big goals, and they saw in each other someone who was complementary

Narrator: Salk's big goals included plans for an unorthodox polio vaccine. Up until now, leading edge polio researchers had focused on making a vaccine from a live virus, like the vaccines for yellow fever and smallpox - a complex and time consuming process.

Julius Youngner, scientist in Salk's lab: Live virus vaccines were the gold standard of virus vaccine. The whole scientific community of experts said that the only vaccine that would work for polio would be a live vaccine.

Narrator: Jonas Salk disagreed. His experience developing a flu vaccine told him that a killed virus vaccine was both possible, and faster to produce.

David M. Oshinsky, author, Polio: Salk had been trained to believe with influenza and other viruses that if you took the virus and you killed it and injected it into someone's arm, you could, trick the body's immune system into believing that an invader had come, and the body would produce strong and lasting antibody protection.

Narrator: Proponents of the live virus vaccine dismissed Salk's ideas as ill-conceived scientific heresy. Most notably, Albert Sabin.

Samuel L. Katz, scientist: Dr. Sabin had already established a reputation as a sound and imaginative innovative investigator. He was a little bit bombastic. He was a little bit intolerant of other people's ideas. He was always convinced that his own were correct and most of the time he was right.

David M. Oshinsky, author, Polio: Albert Sabin had been working for a number of years on his live-virus vaccine. Sabin believed that his vaccine was the perfect polio vaccine. He also knew that it would take longer to develop, and the constant conflict he had with Basil O'Connor was over time. "I need the time to perfect my vaccine." Basil O'Connor wanted everything done now. Albert Sabin simply believed that science went by its own clock. And that the March of Dimes should wait until his vaccine was ready.

Narrator: Salk was a mere "kitchen chemist," Sabin would say, whose hasty work posed a lurking danger to human health. But Basil O'Connor didn't listen. Salk's lab would become a leading recipient of March of Dimes support.

David M. Oshinsky, author, Polio: What made Basil O'Connor so strong about Jonas Salk, was that O'Connor finally believed he had met a scientist who understood that kids were dying every day, and that speed was important.

Julius Youngner, scientist in Salk's lab: Jonas was swimming against the current. He was a young whippersnapper who came out of nowhere, and suddenly is taking on this responsibility, and not only that, but getting the support of Basil O'Connor, because Jonas convinced Basil O'Connor that we were going to do it.

Narrator: At his lab at the University of Pittsburgh, Salk's race to find a polio vaccine took off.

Samuel L. Katz, scientist: Dr. Salk's laboratory was like a factory in that he had a large number of people. They were all doing what he dictated they do. In contrast, many laboratories were more interested in expanding scientific perspective and not necessarily as goal driven.

Narrator: The pressure he put on his staff was unrelenting. "Salk thought big," one colleague observed. "He wanted to leap, not crawl."

Julius Youngner, scientist in Salk's lab: This was a heavily, heavily financed, expensive project. We used thousands of monkeys. We had resources beyond, those that, any of the other researchers had.

David M. Oshinsky, author, Polio: He almost immediately could see that his killed-virus vaccine, at least in animals, was very, very successful. His tests with monkeys were extraordinary. They had high antibody levels. None of them seemed to get polio. He knew he was on the track of something very important.

Narrator: With the success of his trials on monkeys, Salk pressed for the next necessary, but risky step - to test his vaccine in humans. O'Connor eagerly agreed. But Sabin issued a warning: Salk was moving too quickly; his plan posed a serious threat to innocent lives. O'Connor ignored Sabin's objections. Salk's human trials would proceed as planned. On July 2, 1952 assisted by the staff at the D.T. Watson Home for Crippled Children Jonas Salk injected 43 children with his killed virus vaccine.

Samuel L. Katz, scientist: The idea of going into institutions where there were children who were damaged by various diseases and using or exploiting them as subjects for these studies was not regarded in the same way it is today.

David M. Oshinsky, author, Polio: There was no real sense of what we would call informed consent. If you wanted to test, as Jonas Salk did, you went to the director of an orphanage, or what was called a home for the feeble minded, and you tested.

Narrator: A few weeks after the Watson tests, Salk injected children at the Polk State School for the retarded and feeble minded. Then he administered the vaccine to his family and received a shot himself. No one got polio. Blood tests showed that, like his lab monkeys, his human subjects had elevated levels of polio fighting antibodies. A vaccine, Salk believed, was within reach. 1952 saw the outbreak of America's worst polio epidemic. More and more older children and adults were contracting the disease. The older you were, the greater the risk of paralysis or death. Hospital wards were crowded with machines that helped paralyzed patients breathe. They were called iron lungs.

Larry Becker: My father came in to explain to me that they wanted to put me in the iron lung and simultaneously one was moved into my room. It's a huge piece of equipment, and looked scary, and I didn't know what it meant. Your head is disconnected from your body. You can't see your body. And in my case, I couldn't move anything at first. And I was very uncomfortable because of the pain in my muscles. You have to get used to the fact that you don't control your respiration rate. And when you're first put in, at least it was the case for me, since I was struggling so much to breathe, I just relaxed right into it.

Kathryn Black, writer: The development of the iron lung was a great scientific advancement in medical care. It saved plenty of lives. It certainly saved my mother's life, but it also was its own terrible existence. My mother was flat on her back, being breathed by a machine, tended by people through little portholes on the side of the machine, seeing nothing of the world except what she could see through a mirror above her face. What happens to your mind, day after day, night after night?

Narrator: For most the iron lung was a temporary measure to help them survive during the most acute phase of the disease. For others, it was permanent.

Woman in iron lung (archival): Hello there. This is a wonderful day for me. Five minutes out of my iron lung. Five minutes out of my little prison. My kind and friendly prison.

Larry Becker: The first time I got out of the iron lung I saw the doctor cry because of the difficulties I was having on the bed. That was a shock, and that soon turned into a kind of a self-disgust, I think, or shame which I didn't articulate, but I just wanted to hide. I was 13 years old. I thought I was immortal. I don't ever remember being afraid that I would die. I was afraid I wouldn't get better.

Narrator: Surveys showed that, apart from the atomic bomb, Americans' greatest fear was polio.

Kathryn Black, writer: People had put up with polio for a really long time, and they wanted it over. They wanted it done with. The American public wanted that vaccine.

Narrator: On November 16, 1953 Basil O'Connor made a stunning announcement; The March of Dimes would finance, plan and coordinate an unprecedented human experiment, testing Salk's vaccine on hundreds of thousands of school children. Reaction from within the scientific community was scathing. Injecting Salk's vaccine, Albert Sabin warned, might cause polio, not prevent it.

John Troan, journalist: Sabin was very aggressive. And he could be very abrasive. He was trying everything to postpone the field trial, to downgrade the Salk vaccine. He said, "This vaccine isn't ready to be tested. We should wait five more years. We should wait 10 more years."

Narrator: O'Connor refused to wait. With another polio season looming, he would let nothing stop the trials. "This is one of the most important projects in medical history," he wrote to parents across the country. "We feel sure you'll want your child to take part."

Kathryn Black, writer: As a parent today, it's unimaginable that I would be one of those people pushing my child to the front of the line, saying, you know, "Put the polio vaccine in my child first, and let's see if it works."

David M. Oshinsky, author, Polio: You are asking the parents of American to line up their kids for a vaccine that no one is sure how well it works, and no one is certain that it is perfectly safe. It has really not been tested that much on humans. This is an enormous leap of faith.

Narrator: On April 26th, 1954, The March of Dimes began field trials. Randy Kerr, a six-year-old in McLean, Virginia was the first to receive Salk's vaccine. By June nearly two million children had taken part. It was the largest human experiment in American history. Parents would have to wait for nearly a year to learn the results. On the morning of April 12th, 1955, the March of Dimes made their announcement.

John Troan, journalist: There was a build-up to the report on the field trial. Everybody was interested. Everybody was waiting, waiting, waiting. Does it work? Does it work?

Kathryn Black, writer: There was no bigger story at that time. It was held in secrecy like no state secret ever could be. This news was awaited around the world.

Narrator: A press release would reveal the findings everyone was waiting for.

John Troan, journalist: They were going to bring it up on an elevator. The press room was over crowded. We were elbow to elbow. The public relations man steps off the elevator with the dolly, and he can't move into the press room. Everybody ganging around him, guys were jumping over desks. The fellow climbed up on the dolly and he began flinging these things out left and right. It was bedlam.

Announcer (archival): CBS News presents a Special Report

Winston Burdett (archival): The Salk polio vaccine is a success. The vaccine works.

Narrator: Factory whistles blew, school children cheered, parents wept.

John Troan, journalist: Everybody was so happy. It was the most satisfying story I would cover in 44 years in journalism.

Peter Salk: The relief that was brought about by all of a sudden having something that could be done to stop this, it was- I think that was just overwhelming.

Paul A. Offit, scientist: Jonas Salk was viewed as an American hero. This awful disease had now been conquered by this man who we had funded, this scientist who was us.

David M. Oshinsky, author, Polio: This vaccine vindicated 20 years of giving dimes, 20 years of volunteering. It was a victory for millions of faceless people who had done what they could to end the scourge of polio.

Narrator: Five years before the disease had raged through Wytheville. Now, the community, like thousands of others across the country, would finally receive the vaccine.

Anne B. Crockett-Stark: I remember hearing about Dr. Salk, Dr. Salk, and how exciting it was. That man saved the world from polio.

Narrator: Less than a month after vaccinations began, the nation's triumphant polio crusade was brought to a screeching halt.

Leonard Scheele (archival): As surgeon general of the public health service, I recommended the day before yesterday that vaccination programs against poliomyelitis be temporarily postponed....

Narrator: Thousands of children vaccinated with the new Salk vaccine had become sick. Hundreds would be permanently paralyzed. A handful would even die.

David M. Oshinsky, author, Polio: We have gone from this amazing situation of euphoria, a disease on the run, to the vaccine itself producing additional cases of polio. All polio vaccine is taken off the market until the government can pinpoint exactly what has gone wrong.

Narrator: Investigators soon learned that all the sick children had been injected with a bad batch of vaccine, made in Berkeley, California. After a hasty and poorly staffed government screening process the vaccine had been deemed safe. In fact it had contained virulent live polio virus. Cutter Laboratories wasn't alone - all the pharmaceutical companies were having difficulties mass-producing Salk's formula. One scientist especially, felt vindicated - Albert Sabin.

David M. Oshinsky, author, Polio: Sabin had always been of the mind that not only was the Salk vaccine not effective but potentially was unsafe. After Cutter, Albert Sabin simply went around to anyone who would ask - and many people did - saying, "I told you so."

Narrator: Despite the crisis, O'Connor's confidence in Salk's vaccine never faltered.

Reporter (archival): What do you see for its future?

Basil O'Connor (archival): Well I can only say to you that I see that its future is still a good sound, safe vaccine, that will protect the people....

Paul A. Offit, scientist: The Salk vaccine was licensed at a time when we basically didn't have vaccine regulation in this country. The government learned that having 10 people oversee vaccines, and frankly doing it on a part-time basis, was not good enough. The Cutter incident was a painful lesson about the fact that we needed much better oversight.

Narrator: In the wake of the tragedy, manufacturing standards would be tightened, and government regulation increased. But, only eight days after the surgeon general announced a halt, the nation's polio vaccination program resumed. Americans continued to vaccinate their children. They had waited years for the polio vaccine. They were not about to wait any longer. The nation's polio vaccination program, lead by the March of Dimes - now supported by the United States Government - proved safe and overwhelmingly effective. Within just a few seasons the number of polio cases in the United States decreased by 50 percent. Memories of summers filled with fear began to fade. By 1962 Albert Sabin's live virus vaccine was finally ready. An oral vaccine, it was easier to administer and cheaper to produce than Salk's. The years to come would see the scientific efforts of both Salk and Sabin pay off dramatically. Polio, once one of America's most feared diseases, became largely a thing of the past.

Kathryn Black, writer: Nobody cared about polio anymore. It was over. My mother, coming home from the rehab center, it is not the story of triumph and conquering. It is the story of defeat. After a year of treatment, it didn't fix her. It didn't fix our family. Our family had disintegrated around her.

Narrator: When Kathryn Black was six years old, her mother died. Larry Becker spent two and a half years in the hospital. He learned to breathe on his own by using the muscles in his neck. His arms remained paralyzed but after slowly regaining the use of his legs, he was finally ready to move home.

Larry Becker: There were three steps up to the house, and then my bedroom would be upstairs. This is the 50's, if your bedroom was going to be upstairs, then you had to learn to climb the steps. When I graduated from college and when I got my Ph.D., local newspapers published a picture of me writing with my feet, I don't know what the headline is exactly. I always think of it as Polio Boy Makes Good, you know that kind of... and I thought, "Whoa, this is going to follow me for the rest of my life." So... but you know. Here I am whining. It's not- It's no big deal.

Narrator: In 1994, 44 years after the epidemic hit Wytheville, Virginia and nearly 60 years after Basil O'Connor first called upon Americans to send their dimes to the White House, polio was declared eradicated in the United States.

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The Polio Crusade | American Experience | PBS

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The story of the polio crusade pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that continues to be felt today.

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Hunting the Plague | American Experience | PBS

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In 1900, doctors raced to save San Francisco from a disease that had killed hundreds of millions around the world.

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1900 Plague Pandemic in San Francisco, California

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1900 Plague Pandemic in San Francisco, California

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Plague at the Golden Gate | Digital Short

War on Rats

In 1900, the first case of bubonic plague to ever be confirmed in North America was diagnosed in San Francisco. Scientists did not understand how the disease was transmitted but had long theorized that rats played a role.

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Plague at the Golden Gate | Digital Short In 1900, the first case of bubonic plague to ever be confirmed in North America was diagnosed in San Francisco. Scientists did not understand how the disease was transmitted but had long theorized that rats played a role.

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Plague at the Golden Gate | Digital Short

Rupert Blue

Rupert Blue was a physician in the Marine Hospital Service, the precursor to the modern U.S. Public Health Service. In 1901, Blue launched a public health campaign that ended a deadly bubonic plague outbreak in San Francisco.

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Plague at the Golden Gate | Digital Short Rupert Blue was a physician in the Marine Hospital Service, the precursor to the modern U.S. Public Health Service. In 1901, Blue launched a public health campaign that ended a deadly bubonic plague outbreak in San Francisco.

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Introduction
Between 1347 and 1351 a great outbreak of disease known as the Black Death ravaged Europe. This pandemic took a proportionately greater toll of life than any other known epidemic or war up to that time. The Black Death is widely believed to have been the result of plague that was caused by infection with the bacterium Yersinia pestis. Most scientists think that this bacterium was first passed from infected rodents to humans through the bite of fleas. Then it spread quickly from one person to another.

The Disease
Plague is an infectious fever that takes three forms in humans: bubonic, pneumonic, and septicemic. The bubonic type is the mildest, accounting today for virtually no deaths and in the past killing about half of its victims. It is named for one of the disease's characteristics, the formation of buboes, or inflamed lymph glands. Pneumonic plague attacks the lungs and is often fatal in three or four days without treatment. In septicemic plague, bacteria overwhelm the bloodstream and often cause death within 24 hours, before other symptoms have a chance to develop. The pandemic was called the Black Death because of the black spots that appeared on the skin of many victims.

It is believed that the Black Death was a combination of bubonic and pneumonic plague. Bubonic plague does not pass directly from person to person. The bacteria are carried from rodent to person or from person to person by infected fleas. Pneumonic plague, however, is highly infectious. The bacteria can be passed from person to person in droplets from coughs or sneezes. The living conditions in medieval cities and towns encouraged the spread of the disease. Poor sanitation in cities such as London and Bristol, England, created breeding grounds for rats that carried the disease. In addition, overcrowded housing in the cities encouraged the spread of plague from person to person.

Reach of the Black Death
Plague is an ancient disease that has been verified as occurring as early as the 6th century ad. The epidemic of the 14th century originated in China and Central Asia. It was transmitted to Europe in 1347, when a Eurasian army besieged the Genoese trading post of Kaffa in the Crimean Peninsula. The army catapulted plague-infested corpses into the town in an effort to infect the enemy. From Kaffa, Genoese ships carried the disease westward to Mediterranean ports, and from there it spread inland. Plague reached Sicily in 1347; North Africa, mainland Italy, Spain, England, and France in 1348; Austria, Hungary, Switzerland, Germany, and the Low Countries in 1349; and Scandinavia and the Baltic lands in 1350. There were recurrences of plague in 1361-63, 1369-71, 1374-75, 1390, and 1400.

Death rates from the Black Death varied from place to place. The rate of contagion was greater in the more populated towns than in the countryside. Even the great and powerful, who were more capable of flight, were struck down. Eleanor, queen of Peter IV of Aragon, and King Alfonso XI of Castile succumbed. Joan, daughter of the English king Edward III, died at Bordeaux on the way to her wedding with Alfonso's son. Canterbury lost two successive archbishops, John de Stratford and Thomas Bradwardine. The writer Petrarch lost not only Laura, who inspired so many of his poems, but also his patron, Giovanni Cardinal Colonna. The papal court at Avignon was reduced by one-fourth. Whole communities and families were annihilated.

J. Paul Getty Museum (object no. 86.PC.463); digital image courtesy of the Getty's Open Content Program

The death rate was especially high in monastic communities. Plague spread rapidly through monasteries because monks lived in close contact with one another. Monasteries received many visitors ranging from royal delegations to poor pilgrims, offering many chances for disease to enter the community. Although monks took good care of the sick, they could only do so much to combat an illness as contagious as plague. The Black Death wiped out whole monasteries. Others, with only a few survivors, shut their doors. Historians have estimated that monasteries in England lost about half of their residents during the epidemic. Priests who cared for the sick and administered last rites to the dying were also very vulnerable. As the disease took the lives of clergy, there were not enough priests to tend to the dying. Pope Clement VI responded by granting remission (forgiveness) of sins to everyone who died of the Black Death. He also declared that the dying could make their final confessions to anyone and still achieve salvation. Before that, only clergy could perform last rites.

Courtesy of the National Library of Medicine

The study of contemporary archives suggests that the death rates varied in the different regions between one-eighth and two-thirds of the population. The French chronicler Jean Froissart 's statement that about one-third of Europe's population died in the epidemic may be fairly accurate. The population in England in 1400 was perhaps half what it had been 100 years earlier. In that country alone, the Black Death certainly caused the depopulation or total disappearance of about 1,000 villages. A rough estimate is that 25 million people in Europe died from plague during the Black Death. The overwhelming number of victims led to the development of a grim ritual in which the dead were collected each night and hauled off to mass graves known as "plague pits."

Responses to the Black Death
The people of the time struggled to understand the catastrophe they faced. Medieval medicine was not advanced enough to determine the causes of the Black Death or to prevent it. In keeping with prevailing theories of the Middle Ages, doctors turned to astrology and superstition in their attempts to explain the disease. They could provide only ineffective treatments such as herbs and bloodletting.

Some people considered the disease to be an expression of God's wrath. In an effort to appease God, people known as flagellants held processions throughout Europe in which they whipped themselves while praying for forgiveness. Other people devised conspiracy theories in which the Jews were poisoning wells to harm Christians. Such anti-Semitism led to deadly attacks on Jewish communities in Europe.

Effects of the Epidemic
The Black Death was an unprecedented epidemic that brought about many consequences. In the short term, wars stopped and trade slumped. A more lasting consequence was the drastic reduction of the labor force. The shortage of labor proved to be the ruin of many landowners. Hired laborers began to demand higher wages and better food. Peasant tenants, also fewer in number, asked for better conditions of tenure when they took up land. These changes began to blur the lines between the social classes. The English government's attempt to set maximum wages during the labor shortage led to the Peasants' Revolt of 1381.

Another lasting consequence of the Black Death was a decline in the status of the Roman Catholic Church. Disillusioned by the church's inability to stop the epidemic, people increasingly turned to heretical movements or mysticism to save their souls.

In some areas the psychological effects of the Black Death were reflected by a preoccupation with death and the afterlife, as displayed in poetry, sculpture, and painting. The most famous literary work to use the Black Death as a backdrop is Giovanni Boccaccio's Decameron. This collection of tales begins with the flight of a group of young people from plague-stricken Florence in 1348.

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Between 1347 and 1351 a great outbreak of disease known as the Black Death ravaged Europe. This pandemic took a proportionately greater toll of life than any other known...

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What Caused The Black Death? | Bubonic Plague | The Dr Binocs Show | Peekaboo Kidz

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What Made The Black Death (The Plague) so Deadly?

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Rupert Blue was a physician in the Marine Hospital Service, the precursor to the modern U.S. Public Health Service

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Rupert Blue was a physician in the Marine Hospital Service, the precursor to the modern U.S. Public Health Service

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Plague at the Golden Gate | Digital Short

Rupert Blue

Rupert Blue was a physician in the Marine Hospital Service, the precursor to the modern U.S. Public Health Service. In 1901, Blue launched a public health campaign that ended a deadly bubonic plague outbreak in San Francisco.

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Plague at the Golden Gate | Digital Short Rupert Blue was a physician in the Marine Hospital Service, the precursor to the modern U.S. Public Health Service. In 1901, Blue launched a public health campaign that ended a deadly bubonic plague outbreak in San Francisco.

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Dr. Joseph Kinyoun was a leader in the diagnosis and prevention of infectious diseases in America.

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Dr. Joseph Kinyoun was a leader in the diagnosis and prevention of infectious diseases in America.

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Plague at the Golden Gate | Digital Short

Dr. Joseph Kinyoun

Dr. Joseph Kinyoun was a leader in the diagnosis and prevention of infectious diseases in America. He created the Hygienic Laboratory, the nation's first federal laboratory of medical bacteriology which later became the National Institutes of Health.

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Dr. Joseph Kinyoun | American Experience | PBS

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Dr. Joseph Kinyoun was a leader in the diagnosis and prevention of infectious diseases in America. He created the Hygienic Laboratory, the nation's first federal laboratory of medical bacteriology which later became the National Institutes of Health.

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Influenza 1918 | Article

The 1918 Influenza Pandemic and COVID-19

Much has changed since the influenza pandemic of 1918, yet our responses to COVID-19 must still rely on many of the century-old lessons.

The source of the influenza illness remained a mystery to scientists as viruses were too small and obscure for the optical microscopes available in 1918. Credit: Naval Historical Society

Pandemic. The word originates from the Greek word pandēmos - meaning from 'all' ( pan) 'people' ( dēmos). Today, the word conjures many frightening images but holds similar meaning - a geographically widespread or global malady, generally with regard to infectious disease outbreaks. Indeed, for centuries, novel diseases and pathogens have emerged to produce pandemics in human populations, causing widespread illness and death, as well as economic, social and political disruptions.

The ancient Greeks believed diseases to be of a spiritual origin - a punishment from the gods for wrongdoings. In the 5th century BCE, an outbreak characterized by sore throat, aches and respiratory distress was noted by Hippocrates and named " The Cough of Perinthus." In doing so, Hippocrates may have provided the first documented experience of perhaps the most notorious pandemic pathogen: influenza. Although it is unlikely that the Cough of Perinthus was the first influenza outbreak in humans, it is the first chapter or at least the prologue to a dramatic history of significant human influenza outbreaks. Medical historians believe large scale influenza outbreaks occurred in 1510 and 1557 that may have been pandemics, but an outbreak in 1580 marks what is widely regarded as the first true influenza pandemic. This pandemic caused upwards of 8,000 deaths in Rome and devastated cities in Spain - literally decimating some by killing one out of every 10 residents. Since that time, we have documented two additional influenza pandemics in the 18th century, another two in the 19th century, three in the 20th century and one thus far in the 21st century.

Of these, an influenza pandemic occurring in 1918 is the most infamous. Fueled by the transport of soldiers in the final stages of World War I, the outbreak quickly spread around the world in three distinct waves, infecting up to one-third of the people on earth and killing an estimated 50 to 100 million people. Infections were complicated with high rates of bacterial pneumonia, and the pandemic was characterized by a uniquely high mortality rate in young adults between 20 and 40 years of age. By the time the pandemic ended in 1920, it was the worst acute infectious disease outbreak in modern history and the greatest mortality event in the world since the Black Death - a 14th-century pandemic caused by the plague.

When young, healthy soldiers began getting sick by the dozens in March, 1918, military physicians were baffled by what might be causing it. Credit: National Archives and Records Administration

The 1918 pandemic had profound impacts on life in the United States. In October of 1918, some 195,000 Americans were killed by the outbreak. By the time it ended, over 600,000 had lost their lives, and thousands of children were orphaned. So dire was the situation that many cities including Boston, Richmond, St. Louis and others mandated quarantines and social-distancing measures. In San Francisco and Seattle, laws were passed forcing people to wear masks covering their mouths and noses while in public. The public health commissioner in Chicago told police to arrest anyone seen sneezing without covering their face in public.

These horrors were exacerbated by a number of factors. Many physicians and nurses were enlisted in the armed forces to aid in the efforts to win the First World War, leaving a depleted healthcare workforce. The outbreak stoked nativist reactions and the stigmatization of certain ethnic groups - such as anti-Italian sentiments in Denver - which limited the effectiveness of efforts to curtail the outbreak. There were also restrictions on communication and the flow of information. President Woodrow Wilson created the Committee on Public Information when the United States entered World War I, and at Wilson's urging, Congress passed the Sedition Act in 1918, which allowed for up to 20 years of imprisonment for criticizing the government or spreading information that could hamper the production of materials necessary for the war effort. To this end, the government printed materials urging people to report anyone " who spreads pessimistic stories...cries for peace, or belittles our effort to win the war" to the Justice Department. These greatly limited communication and delayed the public health response to the emerging health crisis For example, newspapers in Washington, D.C. did not begin reporting on the outbreak until the last week of August - months after it had begun.

Much has changed for the better since 1918. For one, after Dr. Richard Shope isolated the influenza virus in his laboratory in 1931, we now know that influenza is caused by a virus. We no longer need to exclusively rely on non-pharmaceutical interventions to respond to influenza pandemics because we have developed and refined our ability to create and produce safe and efficacious vaccines. Sir Alexander Fleming discovered penicillin in 1928, which opened the door for developing antibiotics that can help treat complications from influenza, such as pneumonia. There is now an entire field of diplomacy dedicated to health and responding to the global threats posed by infectious diseases. And we no longer name pandemics after geographic locations, people, animals or cultural references in efforts to avoid stigmatization.

However, there have also been changes since 1918 that complicate the responses to pandemics. A growing body of evidence suggests pandemics may occur more frequently due to changes in land use, exploitation of the natural environment and demographic trends like urbanization-all of which increase the risk of infectious disease outbreaks. Today's society is also undoubtedly more globalized than that of 1918. The World Health Organization estimates that our world is so interconnected, a pathogen could conceivably spread around the world in 36 hours. Simulations suggest that if a highly contagious and lethal pandemic similar to the 1918 influenza were to occur today, approximately 33 million people could die in 6 months.

Presently, we find ourselves in the midst of another pandemic. In December of 2019, a novel virus emerged in China and quickly spread throughout the country and the world, causing a disease called COVID-19, which stands for Coronavirus Disease 2019. Similar to the 1918 influenza, COVID-19 is a respiratory disease and pneumonia can be a complication. It has emerged in a time characterized by rising sentiments of nationalism and isolationism, and one in which the role of the media is in the spotlight. The spread of the disease has been fueled by the transportation of people around the world. And while we currently do not know exactly how contagious or deadly COVID-19 is, because we do not yet know the true number of persons infected, estimates based on available data suggest that it has the potential to rival the 1918 influenza.

The United States Public Health Service issued this pamphlet in October of 1918 as part of a public education campaign to slow the progress of the disease. Credit: Library of Congress, Rare Book and Special Collections Division

In the absence of pharmaceutical treatments and therapies for COVID-19, the response to the virus has relied heavily on non-pharmaceutical interventions and supportive treatment, much like the response to the 1918 influenza. Similarly, the response to COVID-19 has also witnessed the implementation of dramatic social distancing measures in cities, the passing of new policies designed to curtail the spread of disease and the stigmatization of people and culture that hinder the public health response.

The 1918 influenza pandemic was a pandemic in every sense of the word - global and affecting all people, from poor factory workers to world leaders like President Wilson. However, for all of the horrors that the 1918 influenza pandemic brought with it, the outbreak eventually came to an end and brought opportunities to learn and prepare for future pandemics. While our current situation is frightening, COVID-19 can be controlled through public health interventions, much as the influenza pandemic was eventually contained. The century-old lessons are clear: we must act swiftly, intentionally and implement multiple interventions simultaneously to curb the spread of disease.

Matthew Boyce

Matthew Boyce (@mattrbo) is a Senior Research Associate at the Center for Global Health Science & Security at Georgetown University. His research is focused on global health security, sustainable capacity development, and public health preparedness-especially at the local and sub-national levels.

Rebecca Katz

Dr. Rebecca Katz (@RebeccaKatz5) is a Professor and Director of the Center for Global Health Science and Security at Georgetown University Medical Center. She teaches courses on global health diplomacy, global health security, and emerging infectious diseases in the School of Foreign Service. Since 2007, much of her work has been on the domestic and global implementation of the International Health Regulations as well as global governance of public health emergencies.

[1] These restrictions also contribute to why 1918 influenza pandemic is commonly called the 'Spanish Influenza.' Spain was neutral in the First World War and did not censor its press. Thus, it was one of the only countries reporting on the pandemic at the time and as a result, thought to be where the outbreak began in 1918 despite the fact that modern evidence suggests the outbreak likely began at a U.S. Army camp in Kansas and had already been circulating in the United States of America for months.

Sources

Georgios PappasabIsmene, J.KiriazeacMatthew, E.Falagas,Insights into infectious disease in the era of Hippocrates (ScienceDirect)

Patrick R. Saunders-Hastings and Daniel Krewski,Reviewing the History of Pandemic Influenza: Understanding Patterns of Emergence and Transmission(Pathogens)

C.W. Potter,A history of influenza (Journal of Applied Microbiology)

Andrew Milsten, 1918 Influenza Pandemic: A United States Timeline (American College of Emergency Physicians)

J. Alex Navarro, Alexandra Stern, Howard Markel (eds.), The American Influenza Epidemic of 1918: A Digital Encyclopedia

Alan M. Kraut, Immigration, Ethnicity, and the Pandemic (Public Health Reports)

David W. Seitz, World War I, Mass Death, and the Birth of the Modern US Soldier: A Rhetorical History

WHO, World Health Organization Best Practices for the Naming of New Human Infectious Diseases

Global Preparedness Monitoring Board, A World at Risk: Annual report on global preparedness for health emergencies

Bill Gates, Shattuck Lecture

Helen Branswell and Andrew Joseph, WHO declares the coronavirus outbreak a pandemic (STAT)

Howard Markel, Harvey B. Lipman, J. Alexander Navarro, et al, Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic (JAMA)

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The 1918 Influenza Pandemic and COVID-19 | American Experience | PBS

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Influenza 1918 | Article Much has changed since the influenza pandemic of 1918, yet our responses to COVID-19 must still rely on many of the century-old lessons. Pandemic. The word originates from the Greek word pandēmos - meaning from 'all' ( pan) 'people' ( dēmos).

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Major epidemics and pandemics - Summary on a Map

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6 Diseases That Have Shaped Human History

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This post was written in collaboration with Kevin Quinn, Sarah Lepianka, and Katherine Stinson - Archives Technicians in the Still Photos Branch.
The 1918 Influenza Pandemic, also known as the Spanish Flu, was one of the deadliest events in human history. While fighting between the Allied Powers and the Central Powers raged on in Europe, the disease knew no borders. Conservative estimates place the worldwide death toll at 30 million people, with reported cases in large cities and remote regions of the world alike.*

Photographs held at the National Archives illustrate the pervasiveness of the disease and the unsuccessful attempts to inhibit its spread. All images in this blog come from the American Unofficial Collection of World War I Photographs, which have been digitized in full as part of the Wartime Films Project.

More photos from the Spanish Flu can be viewed on the National Archives Catalog, as well as additional documents on the "Deadly Virus" online exhibit.

___________________

*Due to lack of records, estimates of the number of deaths attributed to the flu range anywhere from 30 to 100 million people.

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This post was written in collaboration with Kevin Quinn, Sarah Lepianka, and Katherine Stinson - Archives Technicians in the Still Photos Branch. The 1918 Influenza Pandemic, also known as the Spanish Flu, was one of the deadliest events in human history.

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England: The Broad Street Pump - Epidemiology Begins! - Extra History - #2

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@AlanPlotzker @JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner A picture can be worth 1,000 words
History of polio in the US
Cases and deaths
Salk injection vaccine 1955
Sabin oral vaccine 1960

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@AlanPlotzker @JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner A picture can be worth 1,000 words
History of polio in the US
Cases and deaths
Salk injection vaccine 1955
Sabin oral vaccine 1960 https://t.co/BmIoB704nK

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@JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @Willard1951 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner You might want to look into how many kids in the US were dying from varicella, mumps, measles, or rubella prior to those vaccines

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Don’t miss what’s happening

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A picture can be worth 1,000 words
History of polio in the US
Cases and deaths
Salk injection vaccine 1955
Sabin oral vaccine 1960 pic.twitter.com/BmIoB704nK
— James William Owens (@Willard1951) February 5, 2022

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@AlanPlotzker @JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner A picture can be worth 1,000 words
History of polio in the US
Cases and deaths
Salk injection vaccine 1955
Sabin oral vaccine 1960 https://t.co/BmIoB704nK

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@JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @Willard1951 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner You might want to look into how many kids in the US were dying from varicella, mumps, measles, or rubella prior to those vaccines

# data[].attributes.attachment_link.metadata.attachment_props.original_text
@AlanPlotzker @JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner A picture can be worth 1,000 words
History of polio in the US
Cases and deaths
Salk injection vaccine 1955
Sabin oral vaccine 1960 https://t.co/BmIoB704nK

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@AlanPlotzker @JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner A picture can be worth 1,000 words
History of polio in the US
Cases and deaths
Salk injection vaccine 1955
Sabin oral vaccine 1960

# data[].attributes.attachment_link.metadata.attachment_props.referenced_tweets[].text
@JimeeLiberty @EFudman @tatsandfats @IdunsDaughter @AndrewLazarus4 @skepticalprune @ogilville1 @JonathanHannah @mhunt081266 @zeetubes @SallyJiggles @MatthewNewell67 @Monstercoyliar @ConsequentialBr @doritmi @DeckardJodi @kath2cats @PLHartungRN @andylumm @provaxtexan @SkepticalMutant @tomsirolimus @3dogrunner @MagnoliaHoney2 @CHSdoctor @chimera414 @Nockit1 @raouldukeerik @LandonNTooke @sammy44231 @mcfunny @SeamusMacSuibh1 @Willard1951 @richykirsh @Fannyi5 @jallen1315 @45Kerri @BtotheC67 @volpiranyas @bibbydebob @doom37455413 @J_EmpyreanGoals @TonyBaduy @MdRisette @GotAntibods @AbsoluteGnosis @paco7320 @MeddlinMegs @RedSoxMVP @hubie_greiner You might want to look into how many kids in the US were dying from varicella, mumps, measles, or rubella prior to those vaccines

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Famous musicians affected by Polio when they were children

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Famous musicians affected by Polio when they were children

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Here is Joni Mitchell's description of how the disease afflicted both of them

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Joni Michell was discovered by David Crosby of Crosby, Stills, Nash, & Young. Neil Young, like Mitchell, had contracted polio in the last Canadian epidemic before the vaccine was available. Here is Mitchell's description of how the disease afflicted both of them:

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Joni Michell was discovered by David Crosby of Crosby, Stills, Nash, & Young. Neil Young, like Mitchell, had contracted polio in the last Canadian epidemic before the vaccine was available. Here is Mitchell's description of how the disease afflicted both of them: https://t.co/1nPmG45yev

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Mitchell was partially paralyzed by polio, including in her left hand. She learned to play the guitar in a way that compensated for this, which ultimately influenced her distinctive song-writing style." Her compensation was, she said, "a tool to break free" of standard structure https://t.co/W6vBYzzvSj

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Don’t miss what’s happening

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Joni Michell was discovered by David Crosby of Crosby, Stills, Nash, & Young. Neil Young, like Mitchell, had contracted polio in the last Canadian epidemic before the vaccine was available. Here is Mitchell's description of how the disease afflicted both of them: pic.twitter.com/1nPmG45yev
— Magdi Semrau (@magi_jay) January 29, 2022

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
Joni Michell was discovered by David Crosby of Crosby, Stills, Nash, & Young. Neil Young, like Mitchell, had contracted polio in the last Canadian epidemic before the vaccine was available. Here is Mitchell's description of how the disease afflicted both of them: https://t.co/1nPmG45yev

# data[].attributes.attachment_link.metadata.attachment_props_source.includes.tweets[].text
Mitchell was partially paralyzed by polio, including in her left hand. She learned to play the guitar in a way that compensated for this, which ultimately influenced her distinctive song-writing style." Her compensation was, she said, "a tool to break free" of standard structure https://t.co/W6vBYzzvSj

# data[].attributes.attachment_link.metadata.attachment_props.original_text
Joni Michell was discovered by David Crosby of Crosby, Stills, Nash, & Young. Neil Young, like Mitchell, had contracted polio in the last Canadian epidemic before the vaccine was available. Here is Mitchell's description of how the disease afflicted both of them: https://t.co/1nPmG45yev

# data[].attributes.attachment_link.metadata.attachment_props.text
Joni Michell was discovered by David Crosby of Crosby, Stills, Nash, & Young. Neil Young, like Mitchell, had contracted polio in the last Canadian epidemic before the vaccine was available. Here is Mitchell's description of how the disease afflicted both of them:

# data[].attributes.attachment_link.metadata.attachment_props.referenced_tweets[].text
Mitchell was partially paralyzed by polio, including in her left hand. She learned to play the guitar in a way that compensated for this, which ultimately influenced her distinctive song-writing style." Her compensation was, she said, "a tool to break free" of standard structure https://t.co/W6vBYzzvSj

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And how they had to adjust the way they had to play their instruments.

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Mitchell and Young are from a whole generation of musicians who were afflicted by polio as children. The disease shaped American musical history in ways we do not always recognize.

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Mitchell and Young are from a whole generation of musicians who were afflicted by polio as children. The disease shaped American musical history in ways we do not always recognize. https://t.co/hgiWTX0ZrJ

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Here are Neil Young and The Band in 1978 playing "Helpless." Joni Mitchell is in the shadows, contributing back-up vocals. It's an astonishing performance. Listen hard for Joni, as she really elevates the song: https://t.co/Sw8Q4bEV4h

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The Last Waltz (1978) - Helpless Scene (3/7) | Movieclips

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The Last Waltz - Helpless: Neil Young joins The Band on stage for a take on the song "Helpless" with Joni Mitchell in the shadows lending background vocals.B...

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Mitchell and Young are from a whole generation of musicians who were afflicted by polio as children. The disease shaped American musical history in ways we do not always recognize. pic.twitter.com/hgiWTX0ZrJ
— Magdi Semrau (@magi_jay) January 29, 2022

# data[].attributes.attachment_link.metadata.attachment_props_source.data.text
Mitchell and Young are from a whole generation of musicians who were afflicted by polio as children. The disease shaped American musical history in ways we do not always recognize. https://t.co/hgiWTX0ZrJ

# data[].attributes.attachment_link.metadata.attachment_props_source.includes.tweets[].text
Here are Neil Young and The Band in 1978 playing "Helpless." Joni Mitchell is in the shadows, contributing back-up vocals. It's an astonishing performance. Listen hard for Joni, as she really elevates the song: https://t.co/Sw8Q4bEV4h

# data[].attributes.attachment_link.metadata.attachment_props_source.includes.tweets[].entities.urls[].title
The Last Waltz (1978) - Helpless Scene (3/7) | Movieclips

# data[].attributes.attachment_link.metadata.attachment_props_source.includes.tweets[].entities.urls[].description
The Last Waltz - Helpless: Neil Young joins The Band on stage for a take on the song "Helpless" with Joni Mitchell in the shadows lending background vocals.B...

# data[].attributes.attachment_link.metadata.attachment_props.original_text
Mitchell and Young are from a whole generation of musicians who were afflicted by polio as children. The disease shaped American musical history in ways we do not always recognize. https://t.co/hgiWTX0ZrJ

# data[].attributes.attachment_link.metadata.attachment_props.text
Mitchell and Young are from a whole generation of musicians who were afflicted by polio as children. The disease shaped American musical history in ways we do not always recognize.

# data[].attributes.attachment_link.metadata.attachment_props.referenced_tweets[].text
Here are Neil Young and The Band in 1978 playing "Helpless." Joni Mitchell is in the shadows, contributing back-up vocals. It's an astonishing performance. Listen hard for Joni, as she really elevates the song: https://t.co/Sw8Q4bEV4h

# data[].attributes.attachment_link.metadata.attachment_props.referenced_tweets[].entities.urls[].title
The Last Waltz (1978) - Helpless Scene (3/7) | Movieclips

# data[].attributes.attachment_link.metadata.attachment_props.referenced_tweets[].entities.urls[].description
The Last Waltz - Helpless: Neil Young joins The Band on stage for a take on the song "Helpless" with Joni Mitchell in the shadows lending background vocals.B...

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Interesting “guidelines” re polio back in the day: already with the anti-social distancing, etc. NFIP poster, 1950s.

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Vaccines and the Immune Response: How Vaccines Work

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How do vaccines work? - Kelwalin Dhanasarnsombut

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Anti-Polio vaccine propaganda of the times

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Anti-Polio vaccine propaganda of the times

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https://www.nytimes.com/2022/01/31/opinion/covid-pandemic-end.html?unlocked_article_code=7ObvDuP3abaPZPprThJ5K3wWEZL_H9qY02LlOkcpji-2LWII1xkBi6IXZH1R1ixFwAO_mNI-DHWKxFqwQ0wYwJxy3eAP-lMIoFP9BQe1A_9OI596BDON0Hq2wjUQCsvaG_k4nw89y5IYgG4kFvsKDKzZ99UT_smjG1HfWi_4-eRQLHVYf4R8vN5K4K5-5hnpnP9psWlYl5-j8gvInVaxQaDYFGsfs7ccsWij9H72Pjk6ma5VpKQYTbX_D8iR-o9m9optQUAu-cPz3C_89QwjGLMm1s7Oh1_dDOgjBtGnM9IWn-MLgTKXl8OtVfe6u50_A0Obk9D7cTqKNI7rMA&smid=url-share

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Opinion | What We Can Learn From How the 1918 Pandemic Ended (Published 2022)

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Overconfidence, indifference and weariness are perhaps the biggest dangers.

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Built on a collection of 40,000+ popular, high-quality books from 250+ of the world's best publishers, Epic safely fuels curiosity and reading confidence for kids 12 and under.

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online access fun thousands children great kids ebooks books

# data[].attributes.attachment_link.title
Pandemic History Book Collection on Epic

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Built on a collection of 40,000+ popular, high-quality books from 250+ of the world's best publishers, Epic safely fuels curiosity and reading confidence for kids 12 and under. Get Started