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Epedemic
continued from page 29
the lung to collapse the cavity. This was often accomplished
by taking out ribs and squeezing down the chest cavity (a
thoracoplasty). Medical personnel are at risk of contracting it.
One of my fellow residents did, and was in a sanitarium for a
while. In those days one or more residents would be diagnosed
with TB every year. My father (a surgeon) was diagnosed with it
in 1946, was treated with streptomycin, and spent several months
in a sanitarium. He lived 55 more years.
By 1955 effective anti-TB antibiotic regimens using several
drugs came into widespread use, resulting in cures of most cases,
and leading to the closure of the sanitaria because they were no
longer needed. Newly diagnosed cases of TB have their contacts
traced to track down other possible cases. TB remains a serious
cause of mortality around the world, even if it is relatively well
controlled in USA. However, there are immunocompromised
individuals whose TB is inadequately treated, who are treated
inadequately and sequentially with several different regimens of
antibiotics and develop multi-drug resistant tuberculosis. Such
individuals may be spreading these organisms among us, and it is
possible TB will again be a serious infection for us to deal with.
Infantile Paralysis (polio) is caused by a virus. It produces a
febrile illness with muscle aches and pains, and may leave a person
with paralysis of one or more muscles. If the paralyzed muscles
are for breathing or swallowing, the person may die and some did.
When I was growing up, there were epidemics of it every summer
and early fall. My sister and I were each in a high school class of
60, and we each had a classmate who needed braces or crutches to
ambulate. My college roommate thought he had lost one muscle
in his leg from polio. A medical school classmate needed both
braces and crutches. One of my wife's roommates had spent time
in an iron lung. FDR was wheelchair-bound as a result of polio.
Most people probably got a mild case of the disease and recovered
without sequelae. Immunizations against it became available in
the 50s, and the last major epidemic was in 1955. Today there is a
world-wide campaign to eradicate polio as we eradicated smallpox.
It is sponsored by WHO, the Rotary Foundation, and others,
with substantial funding from the Gates Foundation. At the most
recent report it has been eliminated everywhere except Pakistan
and Afghanistan where there were about a dozen or two cases in
the last year.
HIV came upon us in the 1980s. It is a viral disease that is
thought to have come from a reservoir among monkeys. It attacks
the immune system, and allows unusual infections and tumors to
grow, which are fatal. It is spread sexually, and by blood. Patients
receiving blood transfusions, and people who share needles have
been at risk. Homosexual men have been particularly at risk. I
have had a colleague and a college classmate (class size 100) die of
it. There are now sensitive blood tests for it and blood banks have
screened it out of the blood supply. There are now effective drug
regimens to arrest, but not cure it. Because it attacks the immune
system, some of these patients may also have TB, sometimes multidrug resistant TB. Even after more than thirty years we still do not
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York County Medicine | SUMMER 2020

have a vaccine against it. Contact tracing is critical in controlling
it.
Measles is a highly contagious viral disease, usually of
childhood. It is characterized by a high fever, rash, and lung
infection, and in rare cases may leave a person with a long-term
deficit such as deafness. My brother had a temperature of 105
degrees. My sister and I were given some immune serum and had
modified cases. In populations of healthy persons, it has a case
fatality rate of perhaps one in four hundred. Among malnourished
populations it has a much higher fatality rate. Among measlesnaïve populations, such as indigenous peoples, it has had a much
higher case fatality rate. Since the 1960s we have had safe and
effective immunization against it. Reports that the immunization
against measles caused autism have been shown to be false,
and were eventually withdrawn as not being true in the first
place. Measles may be a candidate for worldwide eradication by
immunization going forward, especially if polio can be shown to
have been eradicated.
Influenza (flu) is a collection of viral diseases, different strains
of the influenza virus. We are all familiar with it: body and joint
aches, headache, fever, sore throat, runny nose, cough, lassitude,
maybe GI symptoms. It lasts a week or two, sometimes longer,
and the vast majority of people survive it. Sometimes there are
lung complications or, pneumonia. An influenza epidemic comes
around every fall and winter. Many are sick. The ER and the
hospital are full and strained. Occasionally there are days when
elective surgery must be curtailed. It is not benign: every year tens
of thousands of deaths are attributed to it. Symptomatic persons
sometimes are careful not to get too close to others. We never
have engaged in society-wide social distancing for it. Each year a
vaccine is made against it. There are many strains of flu, and the
vaccine makers have to start a year ahead, and have to guess which
strains to make the vaccine against, before it is known which strain
will be circulating; so, they have variable effectiveness.
Some years the strain is more virulent than others. My first
encounter with a more virulent strain was 1957. I had a girl friend
who started nursing school in New York in a class of 100. During
the flu season she wrote that the class was decreased by two.
Independently, I learned from my father, who talked to colleagues
at that hospital, that two of their nursing students had died of the
flu.
The most dangerous influenza epidemic in modern memory
occurred in 1918-19. It is described at length in a book entitled
Flu. Worldwide, tens of millions died. The corpses were piled
up "like cord wood." Probably everybody was infected, and
most survived, but the fraction that succumbed was unusually
large. Many of the dead were otherwise healthy young adults.
It was a true pandemic: all the people were affected. There
was no treatment, no ventilators. Either one survived, or died.
The impact of this pandemic remains in the consciousness of
physicians and public health authorities. Each year when a flu
starts to spread, there is anxiety that it might be like the pandemic


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