Pandemics That Changed History: Timeline

Deadly Diseases That Plagued People In Ancient Times Are Similar To Those Of Today

For many people in the ancient world, life was no casual stroll around the Forum. Today, many diseases can be treated with modern medicine or prevented entirely, thanks to the development of myriad vaccines to help rid us of the risk of infection (though major inequalities still mean such lifesaving shots are not available to all).

In ancient times, however, these advances simply were not available, making disease an ever present and deadly risk. Kyle Harper, professor of classics and letters at the University of Oklahoma, says that in ancient times life expectancies were so low in part because infectious diseases were such a powerful force.  

"They didn't have the biomedical and public health resources that we enjoy today," he adds. Healthcare to some degree did exist in the ancient world and medical advances were made, but treatment often revolved around dubious remedies, charms, and superstitions.

"The class of diseases that are caused by some kind of microbial invader were one of the most fundamental facts shaping every premodern society," Harper says.

Tuberculosis and Malaria in Ancient Times

(Credit: Everett Collection/Shutterstock)

Today, the average global life expectancy is around 70 years of age and continues to increase, but centuries ago, that was hardly the case. In ancient Egypt, it's believed that the average age at death was as low as 19, mainly due to high infant death rates. The average lifespan of a man is thought to have been around 25. In ancient Greece and Rome, people fared little better as some estimates place the expectancy range between 20 and 35 years.

Attributing to these low life spans, many of the diseases that ancient peoples faced are still recurrent health problems today. Tuberculosis, for example, has ravaged human populations for thousands of years. Egyptian mummies from around 2400 B.C.E. Show deformities similar to TB and ancient texts from China and India may refer to it, according to research.

The disease was known as phthisis to the ancient Greeks and the physician Hippocrates reports that many in his homeland succumbed to the illness. Today, over a million people continue to die of TB each year, even though it is both curable and preventable.

Malaria too was likely endemic in ancient Egypt and Nubia, alongside other diseases such as leishmaniasis and schistosomiasis. Two mummies buried around 3,500 years ago likely died of malaria, making them the two earliest known cases of the mosquito-borne disease. 

It's also known that malaria was prevalent in certain regions of the Roman Empire and DNA evidence shows that the malaria was present across Italy in ancient times.

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A range of other diseases hammered ancient civilizations, including cancer, which Hippocrates described, ultimately giving it its name. Similarly, one of the first descriptions of rabies dates back to Greece around 500 B.C.E.

The Roman writer Pliny the Elder describes how those who are bitten by dogs with "canine madness" develop a deadly horror of water, and outlines curious remedies to combat the disease. 

Parasites and Pandemics

Tapeworms. (Credit: Rattiya Thongdumhyu/Shutterstock)

On top of this massive health burden came others, such as gastrointestinal diseases and parasites such as worms, the impact of which are easy to underestimate, says Harper. Studies indicate that people living in the ancient world were regularly exposed to and riddled with different kinds of intestinal worms.

Read More: The Biggest Parasite Can Grow Up to 30 Feet Long, and Live in Your Stomach

Pandemics also rocked the ancient world. Back in 430 B.C.E., a plague hammered the besieged city of Athens. Over the course of three years, it's estimated that as many as 100,000 people may have died, representing around one quarter of the city's population at that time. What caused this particular plague remains somewhat of a mystery.

"The Roman world seems to have experienced a number of really explosive, consequential pandemic disease events," adds Harper, who has authored books on that same subject.

The Antonine Plague – which occurred between 165 and 180 C.E. – is estimated to have killed around 2,000 people per day in Rome at its peak, even claiming the life of Lucius Verus, co-emperor alongside Marcus Aurelius. It's unclear what caused the outbreak, says Harper, but suggestions include measles or an ancestral form of smallpox.

Similarly, the Plague of Cyprian occurred between 250 and 270 C.E. It originated in Ethiopia before spreading across the Mediterranean region and beyond; its death toll may have reached as high as 5,000 people per day in Rome, according to estimates. Like the Antonine Plague before it, there is speculation about its cause.

Harper says that it may have been viral hemorrhagic fever, while other possibilities include typhus, measles or meningitis. "Until we get DNA evidence, we are going to have trouble saying what caused the plague," he notes.

Another Plague, Same as the Black Death

Yersinia pestis bacteria which caused Bubonic Plague. (Credit: Everett Collection/Shutterstock)

Such evidence does exist for the later, and far more devastating, Plague of Justinian. This erupted in 541 C.E. And continued to claim lives across the Mediterranean for over 200 years. 

"The Plague of Justinian in the 540s is the only one where we know with absolute certainty what caused it," Harper says. "It was bubonic plague."

Spread by black rats, this plague is the same culprit behind the infamous Black Death that rocked Medieval Europe between 1347 to 1351, killing millions of people. Harper describes it as "the most explosive pandemic disease in human history."

By the time the outbreak ended, it's believed that between 25 to 50 million may have died across the Mediterranean, though this is debated.

Read More: Scientists Reveal the Black Death's Origin Story

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Ancient Egyptian Mummies Are Riddled With Malaria, Worms, And Lice

The inhabitants of ancient Egypt were infested with parasites, many of which caused anemia and other debilitating conditions. According to a new meta-analysis of prior research on Egyptian mummies, around two-thirds suffered from worms of various kinds, while 22 percent had malaria and 40 percent had headlice.

In the famous Valley of the Kings, for instance, four out of 16 mummies tested for Plasmodium falciparum – the microbe responsible for a deadly form of malaria – were positive. One of these was Tutankhamun, who was found to be infected by two different strains though probably died from falling from his chariot rather than as a result of malaria.

According to study author Piers D. Mitchell from the University of Cambridge, 49 of the 221 Egyptian mummies analyzed for malaria tested positive.  "As such, we would expect malaria to have had a major impact upon child deaths and debilitating anemia in all ancient populations along the Nile."

Indeed, 92 percent of malaria-infected mummies display porous bones and other signs of anemia, which is characterized by a reduced number of red blood cells or depleted hemoglobin levels. "Such a disease burden must have had major consequences upon the physical stamina and productivity of a large proportion of the workforce," writes Mitchell.

Other parasites detected in ancient Egyptian mummies include the mind-altering pathogen toxoplasmosis, which has been linked to schizophrenia and, bizarrely, an increased likelihood of dying in a car crash. "As toxoplasmosis can be caught by humans when they are in close contact with cats, it is possible that the disease occurred due to the role of cats as cult animals which were often mummified and used as religious offerings in ancient Egypt," explains the author.

Mitchell also estimates that around 10 percent of mummies are positive for visceral leishmaniasis, which has also been linked to anemia and is fatal in around 95 percent of untreated cases. Stomach worms such as fish tapeworm have also been detected in two mummies and were probably caught by eating undercooked fish from the Nile.

Another type of worm known as trichinosis was identified in the chest muscles of the mummy of an individual called Nakht, who has been identified as a weaver from the royal funerary chapel at Thebes. Typically contracted by eating undercooked pork, this nasty little nematode encysts inside muscle tissue and can cause death if it enters the heart.

Poor old Nakht was also found to be riddled with worms that infect both the blood vessels and the urinary tract. Like 65 percent of other mummies, he suffered from schistosomiasis, an acute parasitic illness caused by worms known as blood flukes.

Another mummy housed at the Manchester Museum even had worms in its brain, while 40 percent of 218 mummies analyzed for headlice turned out to be positive.

Explaining this high prevalence of microscopic nasties, Mitchell suspects that "the River Nile acted as a conduit for tropical water-born parasites that would not normally be found in arid regions." Malaria-carrying mosquitoes and other harmful pathogens could therefore have flourished in ancient Egypt despite low levels of rainfall.

However, as well as bringing death, the Nile may also have helped to fertilize agricultural fields by depositing sediment during annual floods. As a result, farmers didn't have to fertilize their crops with human poop, which may explain why ancient Egyptian mummies show very low rates of whipworm and roundworm, both of which were common throughout the Middle East and Mediterranean.

The study is published as a chapter in the book series Advances in Parasitology.

Malaria Makes A Scary Comeback

PETALING JAYA: The spike in the number of malaria cases in several parts of the country so far this year is causing concern among public health experts, who cite climate change as among the contributory factors.

According to the figures, the number of cases so far this year has already exceeded the 404 reported in the whole of 2022.

There were 215 cases reported in Kelantan this year and 840 cases in Sabah as of June, while Terengganu reported 26 cases over the first five months of the year.

ALSO READ : WHO sounds alarm over rise in malaria case numbers

These are worrying statistics after the country recorded zero human malaria infections from 2018 to 2021.

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The rise in malaria cases also comes as the country is having to deal with an increase in dengue cases due to the hotter and drier weather caused by the El Nino phenomenon.

Malaria is caused by a parasite transmitted through the bite of an infected female anopheles mosquito.

Health experts said zoonotic malaria – carried by monkeys and spread to humans through mosquito bites – remain a concern and they have called for mass blood screening in affected areas.

The zoonotic transmission of malaria usually occurs among individuals residing near forest fringes, plantations and agricultural sites, affecting those involved in activities such as logging, fishing, planting and hunting-gathering.

Public health expert Datuk Dr Zainal Ariffin Omar said climate change and deforestation could be among the contributing factors.

"It could also be due to people moving nearer to places that are a source of malaria," said the former Health Ministry official.

Universiti Kebangsaan Malay-sia's Prof Dr Sharifa Ezat Wan Puteh said warmer temperatures and changes in rainfall patterns due to climate change, as well as changes in the behaviour of mosquitoes carrying malaria could have also led to the increase in cases.

"In Kelantan, however, this could be more due to human- animal conflict," she added.

She said while Malaysia has entered the phase of eliminating the indigenous transmission of malaria, zoonotic malaria transmitted from macaque monkeys remains a public health problem.

"Indigenous transmission" is the mosquito-borne transmission of malaria in a geographic area where malaria occurs regularly.

"The parasite known as Plasmodium Knowlesi is usually carried by macaque monkeys and spreads to people when a mosquito bites an infected macaque and then bites a person.

"This happens during logging, fishing, planting, deforestation or when entering a jungle.

"Monkeys also travel to nearby houses and villages and spread the parasite. It is also known as simian malaria," she added.

Prof Sharifa Ezat said delays in seeking medical attention and a lack of preventive measures such as putting up mosquito nets might lead to a further increase in cases.

She said the disease could also be transmitted via the migration of people from malaria-prone countries to Malaysia.

She proposed the government conduct mass blood screenings to detect the malaria parasite among workers in the afflicted areas in Kelantan.

"We also need to keep a watchful eye on full-blown malaria cases, especially among children."

Prof Sharifa Ezat said the resistance of malaria parasites to anti-malaria treatment drugs has also heightened the threat of the disease.

On Sept 25, Kelantan Health Department director Datuk Dr Zaini Hussin said the state had recorded 215 malaria cases this year, an increase of 84% – or 98 – cases compared with the same period last year.

Of this, 53 were human malaria infections and 162 involved zoonotic transmissions. However, there have been no malaria-related fatalities reported in the state so far.

Dr Zaini said frequent exposure to forests and plantations were among the factors leading to the increase in malaria infections in Kelantan.

Of Sabah's malaria cases, 816 involved zoonotic malaria, followed by 14 imported human malaria cases, and 10 human-introduced malaria infections.

On March 14, Health Minister Dr Zaliha Mustafa said the country is facing a new threat in the form of rising zoonotic malaria cases.

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