The story of the 1918-1919 flu pandemic is fascinating on its own terms and is superbly recounted by John M. Barry in his book, “The Great Influenza.” But did you know that this flu was the direct cause of the rise of Adolph Hitler and World War II? Here’s the story.
The virus itself was probably circulating before 1918, most notably in Etaples, France in 1916. Be that as it may, the pandemic itself was enhanced by the congregation of vast numbers of immunologically naive young men in camps such as Fort Riley, Kansas, its site of first appearance in the U.S., and then spread by them as they were deployed to Europe. Somewhere in its migration from birds to pigs to humans, the influenza virus (H1N1) most likely mutated to its ultimate virulent form. Regardless, there were three waves of infection: In the spring of 1918, the fall of 1918 and again in the spring of 1919.
Why this flu pandemic preferentially targeted young people is still debated. One suggestion is that prior epidemics of flu were immunologically similar enough that older citizens still had some residual resistance. The other obvious suggestion is that forcing large numbers of immunologically naive young men into close proximity in military camps was an ideal scenario for rapid spread. If it started in France or in Kansas, why was it known as “The Spanish Influenza”? Seems the Spanish press was uncensored at the time since Spain was not a participant in the World War. Therefore most of the news was printed in Spanish newspapers and it became “The Spanish Flu.”
Why is it that dogs can drink out of mud puddles with impunity but tots cannot? Or maybe we could but just don’t know it. I’m not about to suggest that we perform that experiment, but it does intrigue me that within the past several years there has been a lot of talk about the “hygiene hypothesis.” Since it doesn’t promote the wisdom of “hygiene,” maybe it should be called “antihygiene” or “lowgiene.” We have all observed with fear our little rug-rats wrapping their gums around all kinds of debris they have picked up off the non-hygienically approved floor. Do they survive in spite of—or because of—this activity?
The hygiene hypothesis claims that we are getting all kinds of diseases, such as asthma and Type I diabetes, because we are not training our immune systems adequately. How? By avoiding exposure to all the germs that used to visit us in early childhood before we began bathing in soap and alcohol twenty times a day.
World population was 2 billion when I was born and is now 7 billion. Would the 1918 flu pandemic have gotten off the ground in the absence of crowded military camps containing thousands of potential hosts waiting for the virus to arrive? Probably not.
Pandemics seem to be one of Mother Nature’s favorite strategies for population control. Earth could support several times its current people load if we went to a vegan diet, but does a world population of 20 billion humans sound like fun?
On our present course it seems certain that global warming will produce widespread effects that will not, in general, be desirable. But are we also setting ourselves up for a global pandemic that will prune the population to where it might have been in the first place if we had listened to those who have been warning us for some decades? Or will medical science give us enough vaccines and new antibiotics to shield us from whatever bugs come along?
Given our penchant for not doing anything until it is too late, I suspect that our experiment will continue but with Mother Nature at the controls—population controls. Keep your fingers crossed and your seat belt fastened. It may be a bumpy ride.
Gordon Short, MD
If you are a WWII history buff, you probably recognize the name of Josef Mengele, the ethically challenged Nazi physician who was known as “The Angel of Death.” Dr Shiro Ishii was his Japanese analog.
Dr Ishii, who later became a Lt General, was in charge of Unit 731 of the Imperial Japanese Army located in a suburb of Harbin, Manchuria. This was the most famous biological warfare death camp but not the only one. Others included even Nanking. Human subjects were inoculated and thousands died. The list of organisms included such delights as anthrax, meningococcus, influenza, smallpox, tetanus, typhoid, typhus, tuberculosis, plague and many others.
For effective Biological Warfare one has to know how to weaponize and disseminate the organisms. Aerosols? Bombs? Water supply? It was a difficult challenge. The heat of exploding bombs would kill organisms and those that survived that challenge would die off in the atmosphere from drying and UV exposure. This was also true of aerosols. Would there be person-to-person spread and could an epidemic be controlled? Many questions.
After the war, Ishii was captured. But instead of being executed for killing thousands of Chinese citizens and POWs, he was offered amnesty in return for turning over the records of his experiments to the Americans. Although medical ethics did not allow American researchers to perform experiments on living human beings, ethics did allow American authorities to exonerate the person who did the experiments.
General Ishii thus lived until October 9, 1959 dying at the age of 67. (“The Angel of Death” lived until February 7, 1979 also dying at the age of 67 in Sao Paulo, Brazil although assiduously hunted by the Israeli Mossad.)
Makes me wonder, what is ethics anyway?
Gordon Short, MD
24 Mar 2014
“Kate Moran was an only child” may not compete with “Call me Ishmael” or “It was the best of times, it was the worst of times” as an opening salvo, but it will do. In this novel, Richard Preston wanders from the arena of fact into fantasy. But when one deals with viral hemorrhagic fevers, the distance is very small. The “Cobra” virus in the story is a genetically engineered combination of a rhinovirus and smallpox that attacks the brain and liquefies it and is meant to be an agent of bioterrorism..
It’s reported that President Bill Clinton read the book and was so unnerved by it that he called his science advisers together for advice. That led to Donald Ainslie Henderson forming the Johns Hopkins University Center for Civilian Biodefense Studies. D.A., as he was always known, was the person mainly responsible for organizing the highly successful campaign to eradicate smallpox and was also one of my mentors in the Epidemic Intelligence Service course I took at CDC in 1957. At that time he was one of Alexander Langmuir’s bright young acolytes. Since the conclusion of the smallpox crusade around 1980, he has been a leading light in promoting bioterrorism defense.
Richard Preston, who is known for his meticulous reporting, has popularized the bioterrorism threat in a way that will get the public’s attention with books such as “The Hot Zone” and “The Cobra Event.” Especially when turned into a movie such as “Outbreak.”
If you have always longed for curly (or curlier) hair, you might check them out.
Gordon Short, MD
27 Mar 2014
Few diseases conjure up as much dread as Ebola hemorrhagic fever. If you’re tired of watching sitcoms and romantic comedies, take a look at “Outbreak,” a 1995 film with a stellar cast. It explores the ethical dilemma of a government that faces the decision whether to annihilate a small town where there is an outbreak of a new airborne mutant of Ebola with a mortality of close to 100% in order to prevent escape into the general population with millions of deaths or just try to contain the virus and hope for the best. The science is a bit speculative but the basic premise is more or less believable. The action, including some of the helicopter flying, is almost unbelievable.
Ebola has been the subject of a number of good books including “Ebola” by William Close MD, father of the actress Glenn Close, who was personal physician to Zaire’s infamous President Mobutu. He was a first-hand witness to the original human outbreak originating in the Belgian Catholic Yambuku Mission Hospital. Of 318 cases, 280 died (88%). The use of unsterilized needles and syringes was blamed for the rapid spread but person-to-person spread also occurred in those with close contact with patients alive or deceased.
Ebola and the related filovirus, Marburg, live in monkeys of various species and only rarely jump into humans. Fortunately. Since mortality is still on the order of 50% or more. Genetically engineering these viruses to produce a bioweapon is a distinct possibility. As we saw with the anthrax attack, there are enough adequately trained scientists lying around to do this if one of them should lose his/her grip on basic humanity. This might be especially true of Russian scientists who worked on the very extensive biological warfare program that went on in the Soviet Union up through the tenures of Gorbachev and Yeltsin and who lost their employment after the national collapse.
If you’re sick of counting sheep at night, you might try counting all the ways some madman might come up with to do us all in. Bugs, nukes, poisons, etc. Or you could think of all the ways chocolate has been made irresistible. As for me . . . .
Gordon Short, MD
28 Mar 2014
Did you ever wonder what the population of North and South America was before Columbus made his big “discovery”? As Charles C. Mann shows in his book “1491,” there is a wide diversion of opinions. The “Low Counters” estimate about 10 million while the “High Counters” guess it is more like 100 million. Why the high level of uncertainty? Seems native Americans – Aztecs, Mayans, Incas, Iroquois, Cherokees et alia – saw no need for taking censuses. Only when the Spanish arrived did the idea of taking body counts of the living become accepted.
And while the Spaniards certainly knew how to count, what they were counting were those who remained after smallpox, measles, influenza and other pandemics had decimated the various populations they were estimating. The idea that the western hemisphere was an empty continent waiting to be occupied by needy Europeans has been laid to rest along with the millions of native Americans who were killed off in short order by European diseases, particularly smallpox. In 1542 Bartolome de Las Casas, Spanish historian, Dominican friar, and American explorer, said that the Americas were so thick with people “that it looked as if God has placed all of or the greater part of the entire human race in these countries.” (Mann)
Zinnser, in his delightful book, “Rats, Lice and History,” comments on the relative unimportance of generals as compared with microbes. The outcome of more campaigns was determined by epidemic pathogens than by the brilliance of generals. How else could a piddly number of conquistadors and colonists have “opened” up the Americas for settlement and exploitation?
Although the science is disputed, it is not unreasonable to believe that the native Americans attempted to upstage the European invaders – both human and microbial – and their “Small Pox” by exporting back to Europe the “Great Pox.” (Syphilis, in case you didn’t know) Poetic justice? You decide.
Gordon Short, MD
7 Apr 2104
Now there’s a title to arouse one’s curiosity.
The training of the immune system so that it can distinguish “self” from “non-self” is something we take for granted. Maybe we shouldn’t. It begins to appear that for many, if not all people, exposure to worms in early life is a significant part of that training. Without it we may end up with autoimmune diseases such as Crohn’s, asthma, autism, MS, etc.
Many patients with Crohn’s disease are now being treated successfully with worms such as the whipworm, Trichuris trichiura. It’s a long story but excitingly told by Rob Dunn in “The Wild Life of our Bodies” and by Moises Velasquez-Manoff in “An Epidemic of Absence.” Evolution has a curious bag of tricks and we would do well to pay attention to the entire ecosystem of which we are only one small part. That includes all the microbes we are so familiar with but also our helminth friends that we tend to think so revolting. Maybe our exquisite public health and sanitation systems have given us a back-handed slap by eliminating these “parasites.”
Have you taken a worm to lunch lately? (They don’t eat very much.)
Gordon Short, MD
In the book of Samuel in the Old Testament is the following text: “But the hand of the Lord was heavy upon them of Ashdod, and he destroyed them, and smote them with emerods, even Ashdod and the coasts thereof.” 1 Samuel 5:6 (KJV)
What are Biblical “emerods” (KJV)? “Hemorrhoids” as in some other translations? “Tumors” as in more recent translations? Or buboes?
Most people know about the Black Death, the plague that killed a third to a half of the population of Europe in a few years around 1350 AD. But how many know of the plague among the Philistines about 1320 BC? In 1 Samuel 5 & 6 there is a description of a plague of swellings in the groins of the victims (“they had emerods in their secret parts”). When the Philistines interpreted the plague as a result of their angering the God of the Israelites by their capturing of the Ark of the Covenant, the Philistines determined to send the Ark back with a guilt offering consisting of five gold “emerods” and five gold rats. Obviously they associated rats with the plague which certainly suggests that this was indeed bubonic plague.
Now if only they had known of the rat fleas, they might have sent an offering of five gold fleas instead of the rats and saved themselves considerable gold!
Gordon Short, MD
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