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Pandemics and Health Care: Pandemics in History

This guide will investigate the definition of pandemics vs epidemics, historic incidences of pandemics, societal and health care providers' response, and safety.

Pandemic Facts

From, "Pandemics That Changed History":


"Communicable diseases existed during humankind’s hunter-gatherer days, but the shift to agrarian life 10,000 years ago created communities that made epidemics more possible."


"The earliest recorded pandemic happened during the Peloponnesian War (431-404 BCE). After the disease passed through Libya, Ethiopia and Egypt, it crossed the Athenian walls as the Spartans laid siege. As much as two-thirds of the population died. The symptoms included fever, thirst, bloody throat and tongue, red skin and lesions. The disease, suspected to have been typhoid fever, weakened the Athenians significantly and was a significant factor in their defeat by the Spartans."



(Microscopic image of the bubonic plague (Pinterest)).

In the 1350s, the Black Death (or bubonic plague) was responsible for the death of one third of the world population.


Late 15th century: "following the arrival of the Spanish in the Caribbean, diseases such as smallpox, measles and bubonic plague were passed along to the native populations by the Europeans. With no previous exposure, these diseases devastated indigenous people, with as many as 90 percent dying throughout the north and south continents. Research in 2019 even concluded that the deaths of some 56 million Native Americans in the 16th and 17th centuries, largely through disease, may have altered Earth’s climate as vegetation growth on previously tilled land drew more CO2 from the atmosphere and caused a cooling event."


In 1665, the bubonic plague reappeared in London and claimed the lives of over 20% of London's population at the time. "As human death tolls mounted and mass graves appeared, hundreds of thousands of cats and dogs were slaughtered as the possible cause and the disease spread through ports along the Thames."


1817 brought the first cholera pandemic. Originating in Russia, it killed one million people. "Spreading through feces-infected water and food, the bacterium was passed along to British soldiers who brought it to India where millions more died. A vaccine was created in 1885, but six more cholera pandemics occurred over the next 150 years.""


"The first significant flu pandemic (the "Russian flu") started in 1889 Siberia and Kazakhstan, traveled to Moscow, and made its way into Finland and then Poland, where it moved into the rest of Europe. By the following year, it had crossed the ocean into North America and Africa. By the end of 1890, 360,000 had died."



(Microscopic image of the 1918 influenza virus (Flickr)).

"The avian-borne flu that resulted in 50 million deaths worldwide, the 1918 flu was first observed in Europe, the United States and parts of Asia before swiftly spreading around the world. The flu threat disappeared in the summer of 1919 when most of the infected had either developed immunities or died."


In 1957, the "Asian flu" started in Hong Kong and swept across China, soon reaching the world. "A second wave followed in early 1958, causing an estimated total of about 1.1 million deaths globally, with 116,000 deaths in the United States alone. A vaccine was developed, effectively containing the pandemic."


"First identified in 1981, AIDS destroys a person’s immune system, resulting in eventual death by diseases that the body would usually fight off. AIDS was first observed in American gay communities but is believed to have developed from a chimpanzee virus from West Africa in the 1920s. The disease, which spreads through certain body fluids, moved to Haiti in the 1960s, and then New York and San Francisco in the 1970s. Treatments have been developed to slow the progress of the disease, but 35 million people worldwide have died of AIDS since its discovery, and a cure is yet to be found."

Nurses during the 1665-1666 Great Plague of London

Nurses during the Great Plague of London (1665-1666) (from "Women of the plague," History Extra):

Women were assigned the role of nurses: "When plague broke out, individual parishes were expected to enforce city-wide Plague Orders, which stipulated that two women be appointed to serve as ‘keepers’ (or nurses) to those found to be infected."

They were elderly, widowed, poor, and even prisoners who "took on the role of nurse in exchange for a reprieve." Their backgrounds gave them a bad reputation overall. "More than 200 years after the Great Plague had claimed its last victim, Florence Nightingale was lamenting the fact that nursing had traditionally been left to 'those who were too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else.

It was, unfortunately, a thankless job. "...They inspired fear and revulsion among a terrified population. They were described by a physician as 'wretches [who] out of greediness to plunder the dead, would strangle their patients and charge it to distemper in their throats'. Nurses were also accused of 'secretly convey[ing] the pestilent taint from sores of the infected to those who were well.'

Despite their reputation, "those who cared for the sick weren’t exclusively 'old,' 'weak,' and 'drunken.' In fact, women of all classes were well-versed in the secrets of medicine....In the 1660s, London was home to at least 60 unlicensed female medical practitioners. It’s unclear if they all remained in the capital when plague broke out, but it is interesting to note that, during the outbreak of 1607, a nurse called Alice Wright did stay in the city and had 'many flock to her every day' near Newgate prison."


("UNSPECIFIED - CIRCA 1754: Judith Malmayns, the wicked plague nurse, contemplating the murder of Amabel Bloundel, which she accomplishes by puncturing the girl's neck with a needle infected with the plague." Plague of London (1665). Illustration by John Franklin (active 1800-1861) for William Harrison Ainsworth Old Saint Paul's, London 1855 (first published 1841). Engraving (Photo by Universal History Archive/Getty Images)


Nurses during the 1918 Spanish Flu Pandemic


(Emergency hospital during influenza epidemic, Camp Funston, Kansas, circa 1918. | National Museum of Health and Medicine)

From "Nursing During the Deadliest Influenza Pandemic of 1918" (NurseLabs):

"Where there was no effective medical intervention, nursing skills could provide comfort and basic care – monitoring vital signs, ensuring proper ventilation, disinfecting, bathing and changing linen, personal hygiene, feeding, emotional support, educating, and more – until the patient recovered or passed away."

"By 1918, nursing education had become well established – in the US there were already 1129 training schools by 1910. Despite this, there was an acute shortage of trained nurses to meet the demands of the Spanish Flu."

"Besides working in hospitals, thousands of nurses served communities as health visitors in cities as well as in remote areas. Nurses were often the only health care providers as doctors were unable to reach everyone that was ill. Nurses reported that they worked up to 18 hours a day, or until they could no longer stand."

"Various isolation and infection control measures were used in hospitals. These included ensuring good ventilation, separation of beds, reducing the number of beds in wards, arranging the beds so that patients faced head to foot, and hanging sheets between beds."

"Further measures included disinfection of bedding and rooms, staff disinfecting their hands with antiseptic hand solution, and the introduction of gauze masks.The special improvised masks are of particular interest. The wire frame was made from a gravy strainer to fit each individual’s face so that the gauze covering didn’t touch the mouth or the nose. Staff were not allowed to touch the outside of the masks and they were replaced, sterilized and covered with fresh gauze every two hours."

From "Calm, Cool, Courageous: Nursing and the 1918 Influenza Pandemic," Penn Nursing:

"Nursing care was critical in the day-to-day battle against influenza. Visiting nurses provided nursing care in the home, and took on some of the earliest cases of the flu and were soon overwhelmed. By the end of the first week of October, these nurses would see on average 20-30 cases in a day, with the highest at 40 cases in a single day."

"Patient care in hospitals remained the same. In an apprenticeship that provided hospitals with free labor, student nurses received on the job experience by caring for hospital patients while also attending various lectures on procedures, medications, and nursing care."