Column: The Pox

Forgive my nostalgia, but I yearn for those golden years when we had no more than one epidemic at a time. Perhaps it never truly existed: when polio crippled rich and poor alike, we still had thousands stricken each year by measles, mumps, rubella, influenza, and chicken pox. We even had some diphtheria and pertussis (whooping cough.) Polio was just so much more horrible than the other diseases we needed to suffer through that it seemed like the only truly formidable foe. Modern medicine rid our country of polio and complacency only recently allowed it to return. Despite our worry that killer diseases, like polio, will be brought in by the “huddled masses yearning to be free” wading across the Rio Grande River, our reality is that most epidemic diseases are arriving to our country courtesy of business class passengers aboard regularly scheduled flights landing at major metropolitan airports.

Polio has been diagnosed in a man living in Rockland County, New York, who recently returned home from a foreign location where he apparently acquired the virus. The virus has already been found in sewage in locations where he does not live, which indicates that other individuals have picked up the virus and may still be asymptomatic carriers. As with other vaccines, there are numerous towns and villages in New York where efforts to get children and adults vaccinated against polio have been met with resistance. Mythical tales of vaccine side effects are spread by mass media outlets hoping to get viewers or subscribers who thrive on a daily dose of fear. Our neighbors quickly forget or are too young to be familiar with the unspeakable horrors visited by the polio virus on unprotected communities. Those who scoff at the need for vaccinations may soon be clamoring for a repeat of the chaotic hospital expansion that became necessary after the delayed and inadequate response to the Covid-19 pandemic.

An outbreak of polio would be especially inconvenient since we are still dealing with a Covid-19 pandemic and are trying to blunt a monkeypox epidemic. Monkeypox is new to our country but familiar enough from outbreaks in other countries to have a vaccine already available to protect the communities at risk. Unfortunately, we appear to be experiencing a resurgence of indifference to the disease previously evident with HIV, the virus responsible for AIDS. This indifference with HIV and now with monkeypox is because the first American group identified as most vulnerable to these viruses is the community of men having sex with men. As our friends and neighbors died of AIDS, crackpots like Pat Robertson, declared the spread of the disease was “God’s harvest of sinners.” Our subsequent and current experience with HIV reveals that those who declared the victims of this horrible disease “sinners” were irredeemably stupid. Once again, those “holier than thou,” which include Congresswoman Marjorie Taylor Greene, scoff at the suggestion that aggressive measures be taken to halt the spread of the monkeypox virus.  Apparently, the citizens, most of whom are men, currently infected and the rest of us, men, women, and children at risk for acquiring the disease, are “children of a lesser god.”

We have a vaccine on hand for monkeypox because of its similarity to its much more lethal cousin, smallpox, and its much more benign relative, cowpox. The vaccine for smallpox, which was eradicated in the 1970s, protects against monkeypox.  Prior to widespread access to the smallpox vaccine, the death rate from smallpox was about 30 percent.  The death rate from monkeypox is closer to 3 percent. Although monkeypox does not have the lethality of smallpox, it does share a number of unfortunate characteristics. The skin lesions with both poxviruses are transiently painful and permanently disfiguring.  If an eye is affected, the virus lesions may cause blindness.

Although skin lesions, often referred to as shingles, are caused by re-emergence of a virus routinely referred to as chickenpox, that virus is unrelated to smallpox, cowpox, and monkeypox. Similarly, the cause of the original holder of the title “The Great Pox” is also unrelated to these poxviruses.  In fact, it is not a virus at all. It is syphilis, a primarily sexually transmitted, bacterial disease. It was called the great pox, in contrast to the smallpox, because it could produce horribly deforming skin lesions, especially about the face. The inflammatory lesion caused by syphilis, known as a gumma, could blast away the nose, the ear, or destroy the eye of the affected individual. Unlike smallpox, which would infect an individual and kill them outright or give them immunity if they survived the weeks or months the disease was active, syphilis could produce damage to numerous organs, including the brain, which would progress over the course of years.

In Shakespeare’s play Romeo and Juliet, the character Mercurio utters the curse, “A pox on both your houses.” Whether he was referring to smallpox or syphilis is unimportant (and certainly beyond Shakespeare’s medical expertise), since wishing either of these diseases on the rival factions whose bickering led to his death was nasty. Shakespeare’s queen, Elizabeth I of England, nearly died from smallpox and was left with a pock-riddled complexion that prompted her application of thick, white make-up. What ultimately led to the development of a treatment for smallpox was the observation by some English physicians, including Edward Jenner, that milkmaids had remarkably smooth complexions as a consequence of not developing smallpox.  Jenner suspected that these women were protected from smallpox by being exposed to a common infection of dairy cows, usually referred to as cowpox.

With an Eighteenth Century disregard for informed consent, Dr. Jenner took material from a milkmaid’s cowpox blister and scratched it into an eight-year-old boy’s skin. The child developed a blister at the inoculation site but was otherwise unaffected by the procedure. Six weeks later, Jenner repeated the procedure using debris from a smallpox lesion. Fortunately for the boy and Dr. Jenner, the child did not develop any signs or symptoms of smallpox.  Following Jenner’s lead, other physicians developed and promoted “vaccination” (from the Latin term for cow…vacca) to protect against smallpox.

As we confront various poxes and polio, it would be wise to recall the bad old days when the best doctors could do little more than bleed, induce vomiting, or inject a variety of herbal concoctions into the rectum of the afflicted. We have tools that our ancestors could not imagine. They did what they could with the remedies they had on hand. We should do likewise and not debate the “worthiness” of our fellow citizens at risk.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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