Disease has followed trade, exploration, and conflict, and has magnified their consequences. The middle of the eighteenth century saw few great shifts in patterns of disease but the advent of what would become a near global conflict between the European powers, the Seven Years' War, brought heavy mortality to the affected regions. By 1801, the disease had crossed the Atlantic, where it intermittently ravaged the Mediterranean coast of Spain for two decades, severely affecting cities such as Cadiz and Barcelona. As cholera disappeared from the developed world, a new and more terrifying threat emerged from the Orient. Epidemic diseases such as cholera remained a problem in the most deprived parts of Asia and Africa, particularly at times of famine and unrest. Civilian populations suffered as a result of infection and destruction of sanitary infrastructure. The influenza of 1918-1919 marked the end of a century of pandemic disease, but the great upheavals of previous decades affected many species other than humans.