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When Plagues Rewrite History: The Dark Side of Humanity's Greatest Challenges
In a world where we casually joke about "phone addiction plagues," we've largely forgotten what real plagues look like-those horrifying moments when people break out in sores and everyone dies. We're living in an extraordinary age of medical luck, with nearly thirty years without a major disease decimating developed countries. But this good fortune might not last forever. Throughout history, how ordinary citizens respond to outbreaks largely determines whether civilizations survive these crises. By examining the past, we can better prepare for future pandemics. Jennifer Wright's "Get Well Soon" has become a cultural touchstone for understanding epidemic history, praised by celebrities from Neil Gaiman to Chelsea Handler for its darkly humorous yet deeply informative approach to humanity's deadliest enemies. As Bill Gates noted in his recommendations, "Understanding the failures of our past responses to disease is essential for creating better solutions in the future."
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The Fall of Rome: How Disease Toppled an Empire
Contrary to popular belief, Rome didn't fall because of moral decay or sexual liberation. Its decline began with the Antonine plague in the 160s CE, when the empire stretched from Scotland to Syria at the height of its power. Rome maintained this vast territory through its massive military force-28 legions of 5,120 men each, plus auxiliary forces. These soldiers enjoyed generous pensions after 25-year terms, and those serving between 135-160 CE might never even see combat during their entire service.
Despite Rome's military superiority in numbers, equipment, and training, they soon began losing battles to Germanic tribes who were vastly inferior in equipment but possessed incredible courage. These tribes, who fought nearly naked with only light wooden shields and spears against Rome's heavily armored legions, had one powerful ally: the Antonine plague.
The plague arrived in Rome around 165-166 CE, carried by troops returning from Mesopotamia. Victims suddenly developed small red spots that turned into a rash, followed by fever blisters that would swell for two weeks before scabbing over. According to physician Galen's records, victims also suffered high fevers and throat rashes, with many coughing up blood.
With a death toll estimated between 10-18 million people (possibly 2,000 deaths daily in Rome at its peak), the plague devastated Roman society. Rather than embracing Emperor Marcus Aurelius's Stoic philosophy, citizens turned to mystics selling protective charms and blamed Christians for angering the gods, leading to widespread persecution.
The plague fundamentally weakened Rome's military, emboldened external threats, damaged the national psyche, created economic crisis, and led to Marcus Aurelius's untimely death. By 410, Rome itself was sacked by Visigoths, then again by Vandals and Ostrogoths, until only a few hundred people remained in a city that once housed over a million. The real terror that ends civilizations isn't moral decay or even foreign attacks-it's plague, waiting somewhere to strike.
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Dancing to Death: Mass Hysteria as Physical Manifestation
In July 1518, amid the misery of famine, plague, and war in Strasbourg, a woman named Frau Troffea began dancing uncontrollably in the street. By the third day, blood oozed from her shoes as she danced without stopping. Soon dozens of townspeople mysteriously followed her lead, dancing frantically until they collapsed from exhaustion, suffered heart attacks, or died from dehydration. Their feet bled until bones were visible through the flesh. This wasn't celebration-witnesses described the dancers as entranced, experiencing terrifying visions, dancing with wild abandon.
While modern sources sometimes blame ergot (a hallucinogenic mold growing on rye), this explanation fails to account for the precise dancing movements described. The townspeople believed St. Vitus, the patron saint of dancers, was punishing the afflicted. Remarkably, rather than burning them as witches (as might have happened elsewhere), Strasbourg attempted to help them.
The 1518 outbreak wasn't unique-seven similar dancing plagues had occurred in Europe since 1017. In 1247, about one hundred children danced out of Erfurt, Germany, many dying before being found. In 1278, two hundred people danced over an unstable bridge that collapsed, killing them all. These weren't voluntary performances but compulsive, miserable movements that modern physicians might classify as mass psychogenic illness or conversion disorder-unconscious transformation of unbearable emotional thoughts into physical symptoms.
Strasbourg's initial response was bizarre-they provided music and dance floors, believing the disease was caused by "putrefying blood cooking normally moist and cool brains" that could only be cured through continued movement. When this approach failed (with fifteen people reportedly dying daily), authorities changed tactics. They banned gambling and prostitution, outlawed dancing except for specific occasions, and ordered afflicted individuals to stay home.
The cure ultimately came through pilgrimages to St. Vitus's shrine. Dancers were transported to Hellensteg where priests performed mass, giving them crosses and red shoes marked with holy oil. After these rituals, many simply stopped dancing and returned to normal life. Unlike during the bubonic plague, Strasbourg officials showed extraordinary kindness to the afflicted, which may have been equally healing. Many sufferers had experienced years of neglect and exploitation, but suddenly received earnest attention from authorities who would normally treat them with contempt.
Mass hysteria didn't disappear after the sixteenth century. Similar outbreaks still occur today, often related to terrible circumstances-the mind's disordered attempt to make unbearable conditions tolerable. Cambodian survivors of the Khmer Rouge developed hysterical blindness, their minds refusing to see more death and torture. In 1962, a laughing epidemic struck a Tanzanian girls' school, spreading to 217 people. Even in modern America, teenage girls in Le Roy, New York experienced simultaneous twitching tics in 2012. While we often consider physical wellness separate from emotional states, treating patients kindly may be as important as medicine.
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The Smallpox Conquest: How Disease Toppled Civilizations
While European civilization endured the Black Death despite tremendous losses, smallpox had a far more devastating impact on the Americas. The Aztec and Incan societies were utterly devastated almost instantly upon exposure. One year they ranked among the world's greatest civilizations; the next they essentially ceased to exist.
The Spanish conquest of indigenous American civilizations was aided by smallpox more than military might. When a Cuban native was told by Spanish friars he must convert to Christianity or burn in hell, he cleverly replied he'd "rather be with the devils in hell" than with Spaniards in heaven. Despite the Spaniards' belief that their victory came from divine favor, their success against the Incas wasn't primarily due to guns and horses. The devastating smallpox epidemic that killed Emperor Huayna Capac in 1527 created a succession crisis between his sons Huascar and Atahualpa, leading to civil war that weakened the empire. Pizarro himself admitted that had Huayna Capac lived, "we could not have won for he was greatly loved by his people."
The Aztecs suffered a similar fate when Hernan Cortes arrived in 1519. Initially welcomed by Emperor Montezuma II (possibly because Cortes's arrival coincided with prophecies about the god Quetzalcoatl), the Spaniards were eventually driven out during "La Noche Triste." However, they left behind smallpox, which ravaged the population. Aztec accounts described "the great rash" where victims were "covered with agonizing sores from head to foot" and "could only lie on their beds like corpses." The disease killed approximately 90% of native Americans, with cities like Texcoco reduced to just 4% of their former population. The few surviving Aztecs created a new calendar, counting time from the year of "the Great Leprosy," dividing their history into before and after this catastrophe.
The true explanation for this devastation was immunological: indigenous Americans had no exposure to diseases that originated from domesticated animals like cattle. Unlike Europeans who developed partial immunity over generations, the Amerindians had no such protection, as their llamas weren't kept in close quarters with humans.
The practice of variolation-deliberately infecting people with mild smallpox to prevent severe cases-originated in the Ottoman Empire, where it was performed on harem girls to preserve their beauty. Despite its 2-3% fatality rate, it was preferable to natural smallpox's higher death rate and disfigurement. Lady Mary Wortley Montagu introduced this practice to England after observing it in Turkey.
Edward Jenner's breakthrough came when he noted milkmaids' immunity to smallpox after contracting cowpox. In 1796, he successfully vaccinated a boy with cowpox matter, proving his immunity by later injecting him with smallpox. This safer vaccination technique, named from "vacca" (cow), became the foundation for modern vaccines despite opposition from anti-vaccination movements-a resistance that continues today, often based on fraudulent science.
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The Romantic Disease: Tuberculosis and Cultural Delusion
Throughout history, people have wrongly glamorized certain diseases, particularly tuberculosis in the 19th century. But diseases don't make people cool, poetic, sexy, classy, or genius-they make people dead. Despite this reality, tuberculosis (often called consumption) was romanticized in literature and art as a beautiful, gentle way to die.
Nineteenth-century literature portrayed tuberculosis as the death of choice for beautiful, angelic women who died peacefully while looking radiant. In Harriet Beecher Stowe's Uncle Tom's Cabin, little Eva dies serenely after distributing locks of her hair. Edgar Allan Poe called it a "glorious" and "gentle disease." Victor Hugo described Fantine in Les Miserables as having an "ineffable serenity" with wings ready to bear her away. Even Verdi's opera La Traviata featured Violetta dying with a high B-flat note that no actual tuberculosis sufferer could possibly achieve due to compromised lungs.
Those who actually suffered from tuberculosis strongly disagreed with the romantic portrayal. The reality of Keats's death was far from peaceful-his friend Joseph Severn's private letters revealed the horror: "Five times the blood has come up in coughing, in large quantities... Not a single thing will digest. The torture he suffers all and every night and best part of the day is dreadful in the extreme."
Despite this gruesome reality, tuberculosis gained a reputation for beauty. Physicians from Aretaeus of Cappadocia to Dr. Edward Barry described consumptives as having "a clear florid Complexion," "prominent cheekbones," "brilliant eyes," and "long necks"-though tuberculosis doesn't actually elongate necks. By the late 18th century, even healthy women wanted to look consumptive, using whitening powder to achieve the pale, sickly appearance associated with the disease.
Despite being portrayed as a disease of the elite, tuberculosis affected all social classes. The glamorization of the "tubercular aesthetic" led to tragic outcomes like that of Lizzie Siddal, the famous Pre-Raphaelite model known for her pallor and slimness. Though celebrated for looking "deathlike and beautiful," Siddal likely suffered from anorexia and opiate addiction rather than tuberculosis, eventually dying of a laudanum overdose at age thirty-two.
As the 19th century progressed, romantic depictions gave way to more realistic portrayals, like Tolstoy's graphic description in Anna Karenina of his character dying in constant agony. The disease's romantic appeal further dissipated when Robert Koch identified the tuberculosis bacilli in 1882, proving it was caused by bacteria, not by "having feelings" or being beautiful. By the early 20th century, tuberculosis was recognized as a public health crisis rather than a fashionable ailment, leading to vaccines like the Bacille Calmette-Guerin (1921) and eventually antibiotics. Despite these advances, tuberculosis still kills millions annually in developing countries, though it's now entirely treatable.
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Typhoid Mary: When the Carrier Becomes the Enemy
Mary Mallon, an Irish immigrant, had built a successful life in America by 1907. At thirty-seven, her cooking skills earned her employment with wealthy families on Park Avenue, making $45 monthly (equivalent to $1,180 today). She specialized in desserts, particularly peach melba-vanilla ice cream with peaches and raspberry sauce-which was fashionable following Agnes Marshall's popular ice cream cookbooks.
Unknown to Mary, her body carried Salmonella typhii bacteria, which causes typhoid fever. The disease spreads when infected people don't thoroughly wash their hands after using the bathroom, contaminating food they prepare. It can also spread through contaminated drinking water or shellfish. At the turn of the century, typhoid killed about 60% of untreated patients, though today antibiotics make it rarely fatal. The disease was typically associated with poor urban areas, not the wealthy households where Mary worked.
As an asymptomatic carrier, Mary never showed symptoms but infected people everywhere she worked. From 1900-1907, she left a trail of typhoid across wealthy households: one death in Mamaroneck; an infected laundress in New York City; seven of nine household members in Maine; four servants in Sands Point; six of eleven people in Oyster Bay; another laundress in Tuxedo Park; and a fatal case in a Park Avenue home. In total, she infected twenty-two people-not enough to constitute a plague, but an alarming pattern centered around her movements.
Sanitation engineer George Soper was hired to investigate the Oyster Bay outbreak after water tests came back negative. Initially suspecting contaminated clams, he realized the disease was confined to just one household. Discovering that Mary had started working there three weeks before the first illness, Soper traced her employment history and found typhoid outbreaks at each previous workplace. By March 1907, he located Mary at her new Park Avenue job and requested specimens to test for typhoid bacteria. Mary, perfectly healthy and unfamiliar with the concept of asymptomatic carriers, refused his request and chased him away with a carving fork.
After Mary rebuffed Soper, he appealed to the New York Health Department, which sent Dr. Sara Josephine Baker to investigate. Baker, who had lost her father and brother to typhoid, was also attacked by Mary with a carving fork. Mary fled and hid in a closet for five hours before being discovered "fighting and swearing" with "appalling efficiency." Police subdued her and took her to Willard Parker Hospital.
Tests confirmed Mary's stool and blood were filled with typhoid bacteria. She was moved to an isolated house on North Brother Island in New York's East River, where she lived as a virtual prisoner for three years. Mary claimed she was "treated like a leper" with only a dog for company, living in what was variously described as a "shack," "pig-sty," or "lonely little hut." Her isolation caused her such distress that her left eyelid became paralyzed for six months.
In 1909, the New York American dubbed her "Typhoid Mary," noting she was imprisoned despite committing no crime. With legal help possibly financed by William Randolph Hearst, Mary filed a writ of habeas corpus, taking her case to the New York State Supreme Court. Despite public support for Mary's freedom-surprisingly valuing "freedom for all" over "safety for some"-the judge ruled she was too dangerous to release.
When Ernst Lederle became the new Board of Health commissioner in 1910, he released Mary, believing "she has been shut up long enough to learn the precautions that she ought to take." However, the Board had never taught Mary new job skills or proper hygiene precautions. Desperate to make a living, Mary resumed cooking under the pseudonym "Mrs. Brown." By 1915, she was working in the Sloane Maternity Hospital kitchen where typhoid broke out, causing two deaths among twenty-five cases. Dr. Baker found her there "spreading typhoid germs among mothers and babies and doctors and nurses like a destroying angel." Mary was quarantined again on North Brother Island, this time with little public sympathy.
Mary's case sparked public discourse about asymptomatic carriers, with medical journals and newspapers debating how to handle "people who are fountains of germs." Her case created lasting anxieties about food preparation hygiene that persist in modern restaurant practices, like food handlers wearing gloves. Other asymptomatic carriers were treated more leniently than Mary, who remained confined at North Brother Island for life, eventually working in the hospital laboratory. After her death at age 70, Dr. Baker wrote that Mary had been "of great service to humanity" as the first charted typhoid carrier case, though she paid with lifelong imprisonment.
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The Hero of Molokai: Father Damien's Sacrifice
Mother Teresa observed that feeling unwanted and deserted by society is worse than diseases like leprosy or tuberculosis. While the ideal response to disease outbreaks would be communities rallying around the afflicted-providing care, raising funds, and preserving dignity while science seeks cures-such compassionate collective action "almost never happens." Instead, individuals like Father Damien of Molokai emerge as beacons of compassion, living among and serving the afflicted despite personal risk.
Father Damien chose to live among Hawaiian lepers, contracted the disease himself, and was later canonized. Leprosy, caused by Mycobacterium leprae bacteria, manifests as either tuberculoid or lepromatous forms, with loss of sensation being a key symptom leading to injuries and deformities. Though treatable today with antibiotics, historical fear of the disease led to harsh isolation policies like Hawaii's 1865 "Act to Prevent the Spread of Leprosy," which forcibly quarantined sufferers on Molokai island. The colony became a lawless "hellhole" where crime, alcoholism, and prostitution flourished amid deplorable medical conditions, with doctors who refused to touch patients.
Born Jozef de Veuster in Belgium in 1840, Damien was a mischievous but kind-hearted youth who once stole ham from his mother's kitchen to feed a beggar. Initially rejected by the Congregation of the Sacred Hearts of Jesus and Mary for his "rudeness in manner" and lack of Latin, he was eventually admitted as a choir brother through his older brother Auguste's intervention. Surprising everyone, Damien mastered Latin rapidly and was selected for priesthood training. When Pamphile fell ill with typhus before his missionary assignment to Hawaii, Damien eagerly took his place.
Damien immediately disobeyed the bishop's instructions upon arriving at the leper colony, accepting fruit from a leper and visiting their homes. Finding a young girl covered in worms, he began changing bandages by hand, knowing he risked infection. He transformed the squalid Chapel of St. Philomena into a community center, organizing a congregation, conducting proper funerals, and forming a choir where members with missing fingers adapted to play instruments together. With the healthier lepers, he built a dam for water collection, planted crops, and constructed dormitories for orphans. By 1886, 90% of residents were farming.
In 1884, Damien discovered his own leprosy when spilled tea on his foot caused no pain. He continued working until his death in 1889 at age 49, telling a priest at his bedside that his mantle couldn't be inherited because "it's full of leprosy." Despite critics like Hyde calling him headstrong and careless, Robert Louis Stevenson defended him vigorously. Mother Teresa later asked that Damien be made the saint for her congregation, citing his miracles as removing fear from lepers' hearts and transforming the Molokai community. Damien proved that kindness, love and compassion can overcome even the fear of death, inspiring others to fight against disease through genuine human connection.
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When Everyone Works Together: The Victory Over Polio
Every so often, humanity triumphs when everyone works together against a common enemy. The story of polio's defeat isn't just about Jonas Salk, but about people uniting like soldiers against a terrible disease. During the 1940s, "no disease drew as much attention, or struck the same terror, as polio." It struck without warning, killing some victims and marking others for life with wheelchairs, crutches, leg braces and deformed limbs. By 1952, there were 57,879 cases in America, and a national poll listed polio as Americans' second greatest fear after the atomic bomb.
Polio operates similarly to cholera-the virus enters through the mouth from feces-contaminated sources. Children were particularly vulnerable while playing in lakes, water holes, and swimming pools with antiquated filtration systems. The virus breeds in the small intestine and can attack the brain stem and central nervous system, destroying nerve cells that regulate muscle control. In about one in two hundred cases, like President Franklin Roosevelt's, paralysis resulted, generally affecting the legs. In more severe cases (bulbar polio), breathing muscles were affected, requiring massive "iron lungs" that forced air in and out of patients' lungs.
FDR, paralyzed by polio at age thirty-nine, became an unwitting hero to thousands affected by the disease. Despite his efforts to minimize his disability-rarely being photographed in his wheelchair and bobbing his head during speeches to project vitality-he transformed public perception of polio victims. Roosevelt personally responded to countless letters from sufferers and their families, offering encouragement and praise for their "fine courage and determination." His establishment of the Warm Springs Foundation in Georgia created a therapeutic haven where polio survivors could rehabilitate and reclaim their humanity.
Roosevelt revolutionized polio fundraising through "Birthday Balls" beginning in 1934, where communities nationwide held parties with the slogan "We dance so that others might walk." In 1938, he established the nonpartisan National Foundation for Infantile Paralysis (NFIP), which eventually attracted donations from two-thirds of Americans and enlisted 7 million volunteers-more than any non-war cause in American history.
Born to Jewish immigrants in New York in 1914, Jonas Salk grew up during the 1916 polio epidemic that killed 2,343 New Yorkers. His mother's fear of disease shaped his childhood, perhaps influencing his medical ambitions. A brilliant student, Salk attended City College at fifteen and NYU Medical School at nineteen. By 1947, with NFIP funding, Salk turned his attention to developing a killed-virus polio vaccine, while his rival Albert Sabin pursued a live-virus alternative.
In an unprecedented display of public trust, American parents volunteered 1.8 million children for nationwide vaccine trials in 1954, with 600,000 receiving either the placebo or experimental vaccine. Approximately 325,000 adults-the largest peacetime volunteer group in U.S. history-helped administer the tests. Five pharmaceutical companies produced the vaccine on a nonprofit basis, a selfless moment that seemed almost utopian.
When asked by Edward R. Murrow about patenting the vaccine, Salk famously replied, "Well, the people, I would say. There is no patent. Could you patent the sun?" By giving away the formula for free, Salk sacrificed between $2.5-7 billion in potential earnings. Many Americans were actually outraged he didn't benefit financially, writing to the president suggesting government compensation.
President Eisenhower implemented a comprehensive vaccination program, providing free vaccine for children in early grades. He urged Congress to approve $28 million for states to purchase vaccine, ensuring no child would be denied vaccination due to cost. This Republican war hero's push for free medical treatment aimed not just to provide peace of mind but to increase herd immunity-the principle that if enough people are vaccinated, outbreaks can be prevented.
In 1961, Albert Sabin's live-virus oral vaccine became available, eventually replacing Salk's in many contexts. Administered orally (sometimes hidden in sugar cubes) and providing lasting immunity with a single dose, Sabin's vaccine was cheaper to manufacture despite causing polio in extremely rare cases. Today, Salk's vaccine remains predominant in the United States and Europe, while Sabin's is more popular in developing nations.
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The Lessons of History's Plagues
When asked about future plagues, we must remember we've just experienced one-AIDS-though it didn't match our dramatic expectations of hazmat suits and quarantines. The mishandling of the AIDS crisis exemplifies what happens when we ignore history's lessons about disease. While strong leaders like Marcus Aurelius and FDR confronted epidemics head-on, the Reagan administration initially laughed about AIDS, waiting until 1987 to address it publicly after nearly 21,000 Americans had died. The stigma rivaled that of syphilis, with families abandoning their dying children.
Despite this frustrating pattern of society repeating past mistakes with disease, we find hope in progress like polio's near-eradication and the development of penicillin, reminding ourselves that humanity does advance, however unevenly. We must believe that one day we will see diseases as what they truly are-enemies of all humanity, not just of perceived sinners or those different from us. When we fight plagues instead of each other, we will not only defeat diseases but preserve our humanity in the process.
