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Notes on Pandemics and Vaccination

By Ira Spar, MD

The American pandemic of Yellow Fever lasted 250 years, and neither its cause by virus nor transmission by mosquitoes was known. High fevers, severe jaundice, and seizures led to mortality rates between 25% and 50%. Those who survived the epidemic were immune for life, making immigrants the focus of disease and death. Its treatment was limited to good nursing care, and the standard purgatives, emetics and antiphlogistics mercury, quinine, and blood-letting served mainly to empty apothecary shelves and fill cemeteries. Quarantine of incoming ships was effective but controversial as business interests were strictly opposed and the quarantining of a ship full of bananas in New Orleans Harbor for three weeks resulted in banana soup epidemics.

The Polio Pandemic through the Eyes of a Child

Another viral disease that struck both fear and despair was polio, afflicting communities rather than just individuals. In the summer months, children and adults became crippled for life. Treatment was supportive with physical therapy and bulky braces made of leather and iron. For years nationwide drives with the March of Dimes aimed to fund research against this dreaded disease.

In the summer of 1954, I was ten years old living in Bayside, Queens. The baby boom necessitated new schools to house swarms of yearlings. I attended the spanking new Public School 46 one block off the Horace Harding Boulevard, soon to become the Long Island Expressway infamously defined as the longest parking lot recorded in human history. Attached to the school building was the schoolyard, an open space surrounded by a 20-foot chain-link fence. Punch ball, stickball, softball, basketball, two-hand touch football, chess, checkers, and hanging out was its dominion, and where I spent summers. On rainy days, the school gymnasium was opened for ping pong and knock hockey.

That summer heralded the last polio epidemic. First, the neighborhood pool closed as a seven-year-old boy contracted acute polio. Next, the schoolyard was locked down, and a city-wide quarantine was imposed. I was not to cross the street, confined to the front stoop where I soulfully gazed up and down an otherwise deserted 58th Avenue. This was a bustling blue-collar neighborhood of small one-story ranch houses that now seemed like a ghost town. I watched with fear and trepidation for the Grim Reaper who appeared on the evening TV horror show “Lights Out,” a skeleton covered in black shroud carrying a sickle to harvest the newly deceased.

“Not so fast,” I swore. My dukes were up, ready for mortal combat. The regular catcher of the Hatton’s Little League baseball team was not giving up without a fight, shouting, kicking, and biting. Hatton was the local funeral parlor, and sponsor of a team whose uniform was white with a black cap and trim. “You play like a bunch of stiffs,” was the comment often heard while pedaling my bicycle home after an unfortunate defeat.

Just as Moses with the Lord’s blessing performed a miracle splitting the Red Sea, the heavens opened up and Jonas Salk, a descendant of the chosen people working in a virology lab in Pittsburgh, produced a polio vaccine making not a dime in profit for himself. It seemed the human race had suffered enough, and a great blessing was forthcoming. Men, women, and children who lined up for blocks in front of schools to receive their blessing were fearful of needles but gladly waited along with everyone else. Though the disease was eradicated in the United States, for decades its victims walked the streets with crutches and leg braces. Seeing a girl with a new dress swinging and a brace covering a withered leg was a reality check. For years well into adulthood, I had a recurring nightmare, my little body was locked in an iron lung, paralyzed from the neck down, only my head exposed covered in sweat, crying out for help that never came. Bulbar Polio affected the base of the brain and breathing centers, this machine altered pressure to assist the diaphragm and intercostal muscles to facilitate respiration. After each episode, I awoke greatly relieved it was just a dream, but for too many, it remained a reality.

Battling War and Illness

When I was a battalion surgeon in the Mekong Delta in the Republic of Vietnam in 1969, I saw my only case of acute polio. A nearby farmer brought to the aid station his five-year-old son who had a fever, malaise, and paralysis of his lower extremities. I could only offer him aspirin. At the time, their country had a primitive medical system without vaccinations. On a trip to Saigon, Sergeant J.D. Ruckard of Alabama and myself sought vaccines to start our program, but only plague vaccines were available. In basic training, multiple vaccinations were given, including yellow fever and plague, both 100% effective. Refusal to be inoculated was unheard of.

Plague was endemic in that country, with pneumonic plague affecting infants and being 100% fatal. The bubonic plague was treatable with tetracycline alone, and I saw cases of each. No American soldier ever got the disease. I started a plague vaccination program in local schools whose sessions normally included Saturday. On the weekend, I and the medical platoon gave shots, recording names in a book that totaled over 1,500 before leaving the area. All students and teachers received a shot, only the water buffalo escaped. They did not respond to rational discussion and scientific facts.

Today’s Truth about Vaccines

I am a practicing orthopedic surgeon and bought my first Campbell’s Operative Orthopedic Surgery book set in 1971. It was a two-volume set, its largest chapter fifty pages long on polio describing a host of ingenious procedures to improve the life of the afflicted including joint fusions and tendon transfers. Today’s edition has no chapter on polio.

The first vaccination was given in the 18th century by a general practitioner in Great Britain who noticed that cowpox could be used to inoculate and prevent smallpox whose mortality rate was 25 percent, the survivors suffering facial scarring, an additional trauma for the fair sex. In America, future Presidents Washington and Jefferson sought and received vaccination for themselves and their slaves. Britain’s parliament gave the good doctor 50,000 pounds for his great discovery.

During the civil war, the New Haven Palladium newspaper described the departure of the 15th Connecticut Volunteers, a regiment of 960 local boys who were off to the Southern battlefields, on Aug. 26, 1862. Lincoln had asked the North for 300,000 more volunteers, Connecticut’s quota was 6,000. Governor William Buckingham asked Nutmeggers to leave their factories, businesses, homes, and families, to make the grand sacrifice in life or limb. 7,000 volunteered. The departure was delayed one week because smallpox vaccinations induced considerable sickness. Over the next three years, they had no deaths from smallpox. Connecticut’s two black regiments were not vaccinated, some contracted smallpox, and were admitted to the military hospital in New Haven resulting in a few deaths. The 15th was ultimately stationed in Newbern, North Carolina in the summer of 1864, suffering through a yellow fever epidemic that killed 55 of their members.

The pharmaceutical houses of today do not need or warrant financial aid, but their scientists who bestowed a miracle on short notice deserve at least a thank you and not derision. The yeoman work of nurses, doctors, and health care para-professionals risking their lives and sanity dealing with the discouraging numbers of casualties that still afflict ICUs and ERs ought to be beribboned and rewarded. We cheer Olympic gold medal winners and amateur and professional basketball players, as we should, but the real achievers and heroes work long hours with sore backs, cocooned in gowns, headgear, and masks risking their own lives and their families.

Be sure to check out Dr. Spar’s key insights on pandemics past and present.