143. Variolation, Clean Water, Infectious Diseases, and Ducks in Kansas

Maybe one of the reasons that we have so much disagreement in our country about vaccinations is that we learned so little about disease in our history classes. Our textbooks were full of kings and queens, emperors, presidents, and generals. We named wars and religions, charted Columbus and Magellan on their journeys—and fixed dates to them. It was a story of progress from the ancient Greeks and Romans through Luther, the Enlightenment, the New World and the “American Century.” 

The 14th century plague in Europe and the great Irish potato famine got little notice; yet the impact of the plague—the dying of 25 million, a third of Europe’s population was tremendous. We learned about Irish immigration, but the cause of the potato famine—a blight due in part to the reliance on only two of hundreds of varieties of potato brought from the “new world,” was not part of our learning. 

Maybe some teachers passed on the story of Washington using variolation—dried smallpox scabs were blown into the nose of an individual who then contracted a mild form of the disease—to fend off smallpox at Valley Forge, but I doubt any in our generation knew that the technique went back to Asia and migrated to England in the early 1700s, or that it was brought to America by African slaves. How many of us know now about the British Doctor, Edward Jenner, who found in 1796 that English milkmaids, having been exposed to cowpox, seemed relatively immune to smallpox, and promoted vaccinations? How many of us know that the vaccination efforts of the World Health Organization have now eradicated smallpox from the globe?

Covid vaccine proponents are more likely to point to the success of the polio vaccine in the 1950s and 60s. They don’t explain that the discovery of polio and its transmission—fecal contamination in water—was a long process, or that a higher and stronger incidence of an old infectious disease grew as public sanitation improved. Clean water erased the small contaminations that helped develop immunity in children; new and more virulent infections rose in America in the 1900s with sanitation, and were finally laid to rest by Sabin and Salk vaccines beginning in the 1950s. 

Our new pandemic seems an echo of 1918, and scholars still probing the misnamed Spanish Flu now think that it moved across the world with soldiers, that it struck some 500 million world-wide, and killed 25-50 million, and that it began in Kansas where it passed from ducks to humans.

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132. Visible signs

When Smallpox ravished the earth, those who didn’t die were left with terrible pockmarks. English Queen Elizabeth’s came down with smallpox in 1562. She nearly died from the disease, and her skin was so scarred that she covered the pockmarks with heavy white makeup made of white lead and vinegar, which slowly poisoned her.

 

When polio stormed across the US in the 1950s, pictures of children in iron lungs were ubiquitous. And when August’s “dog days” hit in my northern Minnesota town, the bus no longer took us to the nearby lake to swim. 

 

We were afraid of polio, and the pressure to help those in the iron lungs and to find vaccines and cures impelled a national March of Dimes campaign. As a boy scout in Southern California, I and my fellow scouts solicited dimes from passersby and marched them up the curb along one of Oceanside’s main streets. Meanwhile, mothers went door to door in their March of Dimes. Defeating polio was not left to the scientists and doctors; we all participated. Nationwide empathy—as well as fear—raised money which contributed to the development of the vaccine. 

 

Covid is a trickier customer. For those who survive, it leaves no lasting marks—with the possible exception of the wasting bodies of some of the “long-haulers.” There are no pockmarks or limps to mark the survivors you encounter on the street, in schools, and the marketplace. 

 

I was talking with our smart, short-term cataloger, Charlotte, who has a degree in medical history, about the difficulties this poses. Maybe if the faces of survivors all turned bright red, or their head and body hair all fell out, vaccinations would be an easier sell.

 

The reinstatement of empathy is an even tougher task. We have watched TV screens show New York workers get bodies from homes and unload them into freezer truck temporary morgues. We’ve listened to exhausted doctors and healthcare workers describe their days and their patients. And still there are deniers, some of them working in health care. 

 

The way out of the current Covid crisis is still unclear, and the unintended consequences of the lengthening world-wide event are as unimaginable as the danger of lead poisoning must have been to Queen Elizabeth almost 500 years ago.

 

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125. “Freedom"

You—the unvaccinated—are free from the fear of smallpox, because I and millions of others around the world were vaccinated against it.  It is now gone—after centuries; after killing millions of American Natives when the first Europeans arrived with it; after George Washington gave his troops at Valley Forge a crude form of vaccination against it; after milkmaids in England showed milder cases of it and the first modern vaccines were developed; after the World Health Organization made it a priority to vaccinate the world, and enough were vaccinated so that the last major outbreak in the US was in 1949, and the world was declared free of smallpox in 1980.

You—the unvaccinated—are free of the fear of polio, because polio vaccines and massive polio vaccination programs were mounted in the 1950s and 1960s, and because the Gates Foundation and Rotary International have conducted major vaccination programs around the world—through wars, droughts, and objections by some that the vaccinations caused sterility and all manner of side effects. Polio hangs on in our midst, believe it or not, with many, including people in our own community, who survived the disease as children and now live with “post-polio syndrome,” a consequence of polio-weakened muscles that become debilitating with age. 

You probably don’t worry about measles, as I and my parents did when I was five or six and was put in a darkened room for a week lest eyes be damaged, an outcome that sometimes accompanied the disease. You were likely vaccinated against measles and other childhood diseases as children, even though you will not pass that gift on to your own children. 

If you are under 40, you probably didn't get or need vaccinations against smallpox and polio, and if you got measles, mumps, etc, or not, enough of your neighbors did to keep those diseases at bay.

The lesson is that your—and my—freedom often rests on the good work of others, and it always goes back to some common consensus among a broader community that we are all in this world together, and it is our obligation to consider the well-being of our fellow humans as we consider our own. 

In fact, it can be argued that if we look out for our fellow human-beings we will in the long run be looking out for ourselves. Vaccinating myself and my family members gives the Covid less room to run in our community—and in the world. Less opportunity to mutate and become deadlier (it’s already happened once, with delta now raging). Less likely to come back to me.

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111. Rats, Guns and History

I just finished reading Hans Zinsser’s 1935 classic, Rats, Lice and History. In it the Harvard biologist writes the “biography” of Typhus Fever, with side chapters on the Plague, Smallpox, Syphilis, sanitation, and the role of infectious diseases in the history of humankind. His reading of medical research and history is prodigious—an interesting side-note is that the medical profession has continually shared information across political and military lines through wars and revolutions. A continuing message is that the impacts of diseases—and the rats, lice, mosquitos, teste flies, and all that carry them—have been greater than those of the generals. 

 

Wars and revolutions have had symbiotic relationships with the major infectious diseases—crowded armies in cold, wet, hot, dry, dirty conditions have been good breeding grounds, and armies and individual warriors great transmitters of plague and typhus and influenza. (In our Civil War, two-thirds of the estimated 620,000 deaths were due to disease.) In other books I’ve followed the influenza of 1918 from a Kansas military base to the East Coast on a troop train, across the sea on a troop ship, into battle, across enemy lines and then across the world. It came back again with the troops to the US, where it killed more than the War—and as many or more than had died in the Civil War: over 600,000 Americans.

 

Zinsser talks about the endemic stages of major diseases—the lie low periods when there are enough rats, lice, and proximate humans to keep a disease alive on a shoestring, infecting just enough human carriers to keep it vital and ready for the next opportunity to explode into pandemic. 

 

Our Covid has ripe conditions in many places—hunger, famine, and filth are friends to infectious diseases, and the military upheavals in Yemen, Myanmar, and Israel are making conditions even more inviting to the germs and viruses of the day. Add in crowded conditions that exist in India and in major cities everywhere, and the drought that is forcing people in the Middle East, Africa, and Central America northward in swarms—and one can only speculate on when and where the next covid outbreak will be. 

 

Vaccinate, yes. But it’s a mobile world, and our safe nation cannot exist as an island; we’d best get going on vaccinating the rest of the world. It’s worked with Smallpox and Polio.

 

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