Outbreaks of disease have impacted the lives of individuals and communities throughout history. Whether it's an epidemic (a somewhat localized influx of cases) or a pandemic (a global phenomenon), illnesses that upend daily life, social activities, political institutions, and economic livelihoods leave an indelible mark on those who live through them. Historically, epidemics and pandemics provide guidance about how to manage diseases, perhaps offering instructive lessons on what to do - and what not to do - when illness strikes.
The length of an epidemic or a pandemic doesn't dictate the number of cases of a disease, nor does it determine the number of casualties. The Black Death of the Middle Ages, for example, lasted about seven years and took as many lives as the 1918 Spanish flu pandemic of the early 20th century.
Determining how long epidemics and pandemics last is difficult. How long pandemics last can vary based on the type of disease and responses to it. Some of history's most notable outbreaks have lasted for hundreds of years, while others subsided within a matter of months. Here's a roundup of several prominent epidemics and pandemics in human history, the number of lives lost, and what happened from beginning to end.
Plague of Athens: Around Three Years
Lives lost: Roughly 100,000
Locations affected: The eastern Mediterranean and Greece, with extensive casualties in Athens
What happened: The Plague of Athens struck the city in 430 BC, just two years into the Peloponnesian War between Athens and Sparta. Writing in the fifth century BC, historian Thucydides claimed, "It first began, it is said, in the parts of Ethiopia above Egypt, and thence descended into Egypt and Libya... suddenly falling upon Athens." Thucydides described the affliction:
There was no ostensible cause; but 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. These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress. In most cases also an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later.
One of the contributing factors to the devastation felt in Athens was the order by Pericles (495-429 BC) for all countryside residents to move into the city for protection during the entanglement with Sparta. Sparta, for its part, decided against a planned assault on the city due to the disease.
Casualties from the plague resulted in seven to nine days. It spread due to troops leaving Athens as part of the war, but generally, no other Greek city-states saw outbreaks of the disease. As a result, Athenians considered the illness to be a punishment from the gods.
By the time the epidemic initially subsided, Pericles had perished from the disease, along with thousands of Athens residents and Athenian military forces. A second outbreak in 427 BC contributed to the long-term devastation that resulted from the disease.
Historians have yet to determine exactly what the Plague of Athens was, with theories ranging from measles to smallpox to typhus. Some scholars believe it was a combination of diseases.
Antonine Plague: 15 Years
Locations affected: The Roman Empire, especially the Mediterranean and Gaul, with additional outbreaks in China and across Asia
What happened: Many historical sources recount the events of the Antonine Plague, although there is no single uniform version of its devastation. Also called the Plague of Galen, the disease seems to have spread from China across the Silk Road, coming into contact with Roman soldiers in the eastern Mediterranean before making its way into Roman Gaul.
According to another version of the plague's spread, Roman general and future emperor Lucius Verus unleashed the illness after opening a tomb in Seleucia (Mesopotamia), while still another telling indicates a Roman soldier violated a temple in Babylon, angering the gods and bringing on the disease in the process. Regardless, the plague ravaged the Empire from 165 to 180 AD.
Galen of Pergamum described the symptoms of the Antonine Plague. A fever, vomiting, extreme thirst, and diarrhea were accompanied by "lesions that changed into ulcers," leading many modern physicians to believe the disease was smallpox.
During a second outbreak of the plague in 189 AD, Roman historian Cassius Dio reported as many as 2,000 casualties per day in Rome. The Roman military and economy suffered heavily as a result of the disease, as did the Christian population in the empire. Because they refused to worship the Roman gods, they were persecuted for bringing on the illness.
Plague of Justinian: 226 Years
Locations affected: The Byzantine Empire, China, India, Africa, and Europe
What happened: As one of the first recorded outbreaks of the bubonic plague (caused by the bacterium Yersinia pestis), the so-called Plague of Justinian arrived in Constantinople in 542 AD. The disease is believed to have spread from China to India and into Egypt before entering the Byzantine Empire.
According to the sixth-century historian Procopius, "There was a pestilence, by which the whole human race came near to being annihilated," running its course in Constantinople in four months. There were so many casualties that burial rites were neglected, confusion and terror ran rampant, and all work within the city stopped, with Emperor Justinian himself taking ill.
Despite a seemingly quick outbreak in Constantinople, the Justinian Plague reappeared numerous times for more than two centuries. Historians have identified up to 18 waves of the plague from 541 to 767 AD.
Justinian's goal of reuniting the Mediterranean world under one ruler facilitated the spread of the plague, as troops carried the disease with them. This simultaneously brought an end to Justinian's plan, however, as his military forces and economic resources were drained as a result of the plague.
The Black Death: Seven Years
Locations affected: Europe and Asia
What happened: As the second documented widespread outbreak of the bubonic plague, the Black Death arrived in Europe via trade ships that landed in Italy in 1347. The plague spread to North Africa soon after, moved into France and England by 1348, and was taking lives in Scotland and Scandinavia by 1350, extending into Germany and Russia, as well.
The initial onset of the Black Death in Europe ran its course by 1353. The term Black Death was derived from the color of the buboes or hemorrhages that appeared on, in the words of Italian poet Giovanni Boccaccio, "men and women alike... either on the groin or under the armpits... waxed to the bigness of a common apple, others to the size of an egg, some more and some less, and these the vulgar named plague-boils."
Much like the bubonic plague pandemic that devastated the population of the Byzantine Empire during the sixth, seventh, and eighth centuries, the outbreak of the plague in Europe brought with it political instability and economic strife. Doctors had no knowledge of what caused the disease, attempting various techniques like bloodletting, lancing of the buboes, and herb-based treatments. Fear of an angry God led to the scapegoating of Jews, while devout Christians flagellated themselves in the hopes of repenting for perceived sins.