The Fourth History of Man: History of Man Series, #4

By John Bershof, MD

In the spirit of medieval writer Chaucer, all human activity lies within the artist's scope, the History of Man Series uses medicine as a jumping off point to explore precisely that, all history, all science, all human activity since the beginning of time. The jumping off style of writing takes the reader, the listener into worlds unknown, always returning to base, only to jump off again. History of Man are stories and tales of nearly everything.

The Fourth History of Man continues with virus infections where The Third History of Man left off hashing-out those specks of genetic schmutz, covering the R-naught of those naughty infectious scoundrels. Some big hitters will be considered, from polio and the famous celebrities that had it, through fifty shades of hepatitis, rabies and the hair of the dog, and the monkey business of HIV and AIDS. Leaving viruses, we'll delve into a study of parasites, including the parasite of all parasites, Sigourney Weaver's alien. Opening up a can-of-worms we'll launch a nerd rumble: who would win between Weaver's Alien and Schwarzenegger's Predator. Other topics include the sociology of a social death preceding the actual death, the sociology of sexual cannibalism, and the sociology of colors, not just of yellow fever, but of other emotions under the rainbow, hopefully not making you feel positively blue. On the science side we'll flip the script on the infamous Krebs cycle fleeced of the boring jargon that usually flows from the lecture hall and our road will scrutinize nuclear bombs, nuclear footballs and weapons of mass destruction, the secret of Ondine's curse, and lessons in global warming.

• Language: English
• Publisher: John Bershof, MD
• Release date: May 31, 2024
• ISBN: 9798990792036

Book preview

1

¡AY, CARAMBA, BART SIMPSON HEAD ON T. REX

Thomas Peebles was born in Newton, Massachusetts, in 1921. He received his undergraduate degree in the French language from Harvard University, just down the street, and was a bomber pilot for the US Navy during World War II, stationed in the Pacific, where he earned the Distinguished Flying Cross. How do you go from being a French language major to becoming a bomber pilot? After dusting up his undergraduate requirements for medical school—he needed to because he was, after all, a French language major—he received his medical degree from Harvard under the G.I. Bill. Peebles was one pretty smart fellow and a Navy aviator at that. He had all the right stuff.

The G.I. Bill, formally known as the Servicemen’s Readjustment Act of 1944, provided educational assistance to servicemen and veterans. Being a Harvard man, for both undergrad and medical school, the gifted Peebles completed his internship and residency at the Massachusetts General Hospital in Boston, one of Harvard’s teaching hospitals. This is where he specialized in pediatrics.

While on a pediatric fellowship at the Boston Children’s Hospital, another Harvard teaching hospital, Peebles worked in the laboratory of John Franklin Enders. Enders was a biomedical scientist who had received the Nobel Prize in Medicine in 1954 for his pioneering work in successfully growing the poliovirus. Enders was born in 1897 in Hartford, Connecticut, and was a Yale man for his undergraduate work and a Harvard man for his PhD in infectious diseases. Recall from earlier our discussion about Enders, who, along with Thomas Weller and Frederick Robbins, invented the successful in vitro culture technique to grow the poliovirus in chick embryos—a technique Jonas Salk then used to create the first polio vaccine. Enders, Weller, and Robbins together won the Nobel for their pioneering polio culturing work; Salk and Sabin, along with their polio vaccines, did not receive Nobels despite saving millions of lives.

Anyways, Thomas Peebles, while working in Enders’ lab, helped him to successfully grow the measles virus using the chick embryo medium. As the story is told, Peebles was dispatched by Enders to Fay School in Southborough, Massachusetts—Fay School being a classic New England kindergarten to grade nine preparatory school—where Peebles obtained blood and tissue cultures from a thirteen-year-old boy who had come down with the measles. Peebles then worked to grow the virus in the chick embryo. By 1963, Enders, using Peebles’s measles viral isolate, successfully developed a measles vaccine. Along with helping to develop a measles vaccine and fighting off the Axis powers during World War II as a bomber pilot in the Pacific theater, Thomas Peebles is also known for investigating the tetanus toxoid vaccine, demonstrating that a tetanus vaccine is effective for ten years and that the yearly boosters of tetanus, which up until then had been the standard of care, were no longer required.

Measles—or rubeola in German, which means red rash—is a viral infection of the skin and respiratory passages. It’s spread by inhaled respiratory droplets and mostly targets children. The incubation period is one to two weeks after exposure. It’s an illness that lasts several days, with a contagious period of seven to ten days, implying that one can spread the infection before symptoms even appear and still be contagious for a few days after symptoms have dissipated. The rash can linger several days after the acute respiratory infection has resolved, and even after the person is no longer contagious.

The prodrome stage of measles—prodrome in medicine means early symptoms heralding an infection that is ready to pounce—includes fever, cough, runny nose, and red-injected eyes. These early signs are followed by the full-blown illness, which is a worsening of the symptoms already at play, coupled with the classic rash. As you might recall, measles involves a gravity rash: it starts at the head and descends into the trunk and then out along the extremities. As a reminder, the rash of chickenpox is, by distinction, centripetal—beginning on the extremities and pulled onto the trunk—and a centrifugal rash is roseola, starting on the trunk and moving outward to the extremities. Treatment, as for most viral exanthem infections of this type, is supportive, meaning fluids, rest, a humidifier, acetaminophen for fever, and, of course, isolation with a mobile phone on which to play Minecraft. Exanthem, which includes many viral infections, is from the Greek exanthema and means breaking out.

Minecraft is a sandbox video game. Sandbox describes how it’s a single-user game where the player has universal control over creativity and the course of the game. In particular, Minecraft allows the player, using building blocks and other resources, to construct their own worlds, only limited by their imagination. There are no rules.

Although we’ll cover these in more detail later, the classic four childhood viral exanthems are measles, German measles (rubella), chickenpox and roseola. Other viral exanthems not necessarily limited to childhood and involve rashes that can occur with adenovirus and enterovirus head colds and mononucleosis.

The best part of isolation for a child with measles, or chickenpox, or any number of viral scourges, is staying home from school, and watching daytime TV soaps (especially those close to PG-rated). In my day, staying home also meant a new toy, a coloring book, and of course a sixty-four-pack of Crayola Crayons. And if you lacked imagination as I did, despite having sixty-four colors to choose from, you ended up using only a handful of the crayons. In today’s childhood quarantine bedroom, however, nothing short of playing Minecraft or the multi-user online game Fortnite will suffice. This, of course, is interspersed with staying in touch with your BFFs through texting, updating your social media status, playing Snapchat, and especially posting pictures of your viral rash online, then sharing everything on TikTok. The only thing today’s virus-quarantined kids have in common with my generation and the Gen Z kids is Lego. Lego just seems to bridge all generations.

Lego originated in 1949 in Denmark, when the Lego Group began manufacturing their irresistible interlocking plastic bricks. Which of course over the decades has expanded from a simple array of colorful bricks, plain windows, doors, and roofs (like when I was a knucklehead kid) to unbelievably complex Lego themes and such brand cross-overs as Lego Star Wars, Lego Ghostbusters, Lego Batman, Lego Dinosaur, Lego Harry Potter, Lego Hobbit, Lego Simpsons … the list goes on. There’s probably even a Lego Measles Boy!

There are two underlining, inviolable principles of Lego. The first is that the parts are universally interchangeable, they’re intentionally designed that way, which means at some level you can put Bart Simpson’s head on a T. rex’s body, and, knowing Bart Simpson, he’d delightfully say ¡Ay, caramba! The other irrefutable principle of Lego is that if you step on a Lego piece barefoot it really, really hurts. Same was true with jacks, back in the day.

In addition to the aforementioned Gen X, other American generation names include the one I hail from: the Baby Boomers, also known as the Beat Generation, as in rock ‘n’ roll and the Beatles, those born after World War II, from 1946 to 1964. Between those soldiers lost during the war, coupled with less procreation during wartime, American couples knew it was time to get busy after the war, resulting in the birth of a lot of little Americans during that period, the boomer generation. The group is characterized by a strong work ethic, competitiveness, a goal-centered mindset, and independence, especially their proclivity to challenge the status quo of their parents. The Free Speech Movement of 1964 centered on the campus of the University of Berkeley in California, under the central leadership of Mario Savio is a classic example. It represented the first large-scale college student civil disobedience, reflecting the then blossoming consensus among college-aged Baby Boomers that they should be afforded the same free speech and political rights on college campuses as US citizens enjoyed in general. It was also a repudiation of some of the values and beliefs of their parents, as demonstrated by college student support for the Civil Rights Movement and the Anti-Vietnam Movement.

Generation X, or Gen X came next, encompasses those born from the mid-1960s to the early 1980s. It is unclear what headlines this group of Americans and exactly how the X moniker arose, since it had also been used in previous ages. Perhaps the simplest definition is that X in math, as in X equals, is an unknown. Gen X members were born at a time when shifting societal values were occurring in America, meaning here X = indeterminate or unknown characteristics. This generation is generally more like the cohort that preceded them, the Boomers, than the one that followed them, Generation Y. Although to hear a Gen X tell you, they were nothing like their Boomer parents. Generation X is the cast from The Breakfast Club, John Hughes’s wonderful 1985 film, struggling to be understood by adults, and by each other. Other monikers for Gen X include latchkey kids, as they were the first generation where both parents worked and kids came home from school to empty houses, and the MTV Generation, since they were influenced by the then brand-spanking-new MTV, the music television channel that launched in 1981.

Generation Y, or Gen Y, are also known as the Millennials, born between the mid-1980s and the late 1990s. They are the children of the Baby Boomers. They are the first true international generation; that is to say, Gen Y around the world share similar qualities, largely thanks to the internet, making them also known by the moniker digital natives. They grew up learning computers as a second language and surfing the internet as a walk in the park. And in opposition to their parents who were goal-oriented Boomers, Millennials tend to be more family oriented and willing to sacrifice career for family, or at least to seek a better balance. This is why they are sometimes referred to as the Baby Boomlets.

Why you ask do Gen X hate Boomers. For starters they resent the success oriented, destroy the environment to horde cash that they feel typifies the Boomers. The conspicuous Boomers’ consumption really irked Gen X. There were also a zillion Boomers—post-war procreations—and not nearly as many Gen X, the Xs were sort of lost in the shuffle, drowned out by Boomers and the children of Boomers, Gen Y. Sometimes Gen X is referred to as the Lost Generation, as in X-ed out. They were the latch-key kids, both parents working, they had to fend for themselves. In steps Gen Y, the Millennial, a large group of kids, children of Boomers, who were over-supervised, micromanaged by their parents, whereas Gen X feel they were largely ignored by their parents. And if you were wondering who were the parents of this lost Gen X? It was either older Baby Boomers born right after the war but mostly it was The Silent Generation. And who were these Silent Generation demographic cohorts? They were born at the beginning of the Great Depression 1928, lived as children through the Depression and fought during the Korean War. The inklings of the Civil Right movements and the early beats of rock ‘n roll find their roots in this generation, although it would be an understatement to say the Boomers were the ones who really took civil rights and rock ‘n roll to new heights.

Just to finish the earlier demographic cohorts, The Silent Generation was preceded by the Greatest Generation, a bit on the nose as they must have named themselves that. They were born between 1901 and 1927, were shaped by living as children through World War I, learning to survive during the Great Depression, learning to do without, and they fought World War II. They placed the United States on the map as the World leader and their children were the Boomers. There was a different lost generation then the one we previously described, the Gen X, and that was the demographic group that were born in the last two decades of the 1800s, appeared aimless and disoriented, and fought in World War I. It is probably why the great author Ernest Hemingway typed out The Sun Also Rises in 1926, a novel that describe his band of misfits that came of age during World War I, a story that embodied the illusions of a truly lost generation. Their lives lacked any meaningful foundations, and their romantic relationships were often so fleeting.

We’ve covered in order the Lost Generation, the Greatest Generation, the Silent Generation, The Baby Boomers, Gen X also sometimes called a lost generation, and Gen Y. Still have a few more letters to go.

Generation Z, or Gen Z, is the group born in the late 1990s until around 2010. Also known as digital natives, they tend to be deliberately slower paced than previous generations, especially the highly motivated Baby Boomers, preferring risk aversion—a quality that might be interpreted as being lazy, but which is not. Gen Z is the most ethnically diverse generation in America, and they are tech addicted and keen on social justice. They feel they have the most hurdles trying to enter the workforce, which makes then a tad bitter and sound like complainers and are savvier communicating digitally than face to face, a circumstance that might breed a great deal of anxiety. Other monikers for the group include iGeneration—as in iPhone, iPod, iPad, and everything iApple—and the Homeland Generation, which refers to 9/11, the day the US lost its innocence with the establishment of increased Homeland Security measures. They must worry about school shootings; all I had to worry about is if my dog ate my homework.

Generation Alpha is the newest generation—with X, Y, and Z ending the American or Latin alphabet, demographers have started at the top of the Greek alphabet—Gen Alpha comprising those born after 2010. What is in store for them is only speculative. One thing, though, is for certain: they are beyond being digital natives; they are, rather, totally emersed in technology. Whereas all previous generation, even the Boomers, look upon technology as a means to an end, as a way to achieve goals, Gen Alpha conceives of technology as deeply integrated with their sense of self. Not that they’re cyborgs, or anything like that, but where their psyche ends, and a computer’s psyche might at times be blurred. It’s more that technology is not external to them; it’s integrated within them.

OK, Boomer is a catchphrase that found fuel as an internet meme and is used by younger generations as a cutting and dismissive insult of the Baby Boomers. It’s hurled to let a Boomer—or even a Gen X—know that they are out of touch with the world, at least according to Gen Y and Gen Z. When and where it exactly originated is open to argument, but the basic premise is that one fine day, a Baby Boomer was ranting about lazy younger Gen Y and Z people, and those younger Gen Y and Z responded dismissively to the rant with OK, Boomer.

Edward was bornin 1912, making him squarely a member of the Greatest Generation. He was a child during World War I so austerity programs designed to support the war effort undoubtedly hit home. He was a teenager during the Roaring Twenties, so the excitement of a prospering America was right at his fingertips. Yet his father, who ran a liquor store never seemed to be able to prosper when all those around him blossomed. It was a troubling home life. When the Wall Street Crash hit in 1929, and stockbrokers were jumping out of Manhattan windows, fortunately for Edward his academic performance and some money from his older brother and sister allowed him to weather-out the economic downturn of the 1930s as a college student. Edward graduated the University of Colorado School of Medicine in 1938, just about the time the Great Depression came to a grinding halt. Then the winds of war brought Edward into the U.S. Army as a Captain in the Medical Corp where he saw duty in Hawaii and The Philippines. With the war over, and as luck would have it, he met on a blind date Arlene, although fourteen years younger, she was born within the demographic group the Greatest Generation.

What characterizes this so-called Greatest Generation? They tend to take responsibility for their lives and don’t blame others for hardships. Especially living through two world wars and one great depression, they know of adversity and humility, the live modestly and tend to save. With everything that shaped their youth and young adulthood, they developed a strong work ethic. They had no choice, work hard or perish. Commitments in relationships were strong, bound by more than just love; in fact, loyalty and faithfulness in marriage were more important than fondness. As a group, they married for life.

It was from this backdrop that two members of the Greatest Generation—Edward born 1912, Arlene born 1926—married in 1946 after Edward’s discharge from the Army. They then proceeded to have five children, five Baby Boomers, over a seven-year stretch 1948 to 1955. I think it would be fair to say that Edward and Arlene did their bit to proliferate the U.S. population after the loss of so many young American men during the conduct of World War II, 405,399 U.S. soldiers lost their lives during that conflict.

Rubella is not rubeola; it’s not measles. Rubella, from the Latin meaning reddish or little red, is a different viral infection, and despite sharing part of its name—often called the German measles—and its overall look, it is distinct from measles. Measles equals rubeola; German measles equals rubella. Despite those confusing linguistic overlaps, despite being similar in presentation, they are two different viral exanthem infections.

Friedrich Hoffmann, born in 1660 in Halle, Germany, was a physician and chemist from a long line of German physicians. He is credited with providing one of the first complete descriptions of rubella, although an earlier German physician, Daniel Sennert, described elements of rubella. Either way, it was only fitting that a German champion the early name for rubella, dubbing it röteln or rötheln. But despite having those Deutsch names as well as the anglicization rubella, it is often called German measles in the English-speaking world, simply because it was described by a German physician. It is a viral rash infection not limited to Germany and nor did the virus originate in Germany.

By the early 1800s, three childhood exanthem infections were hanging about the human arena that bore such similar presentations, so much so that they were often thought to be one and the same disease: measles, German measles, and scarlet fever. The latter of which is a rash from a bacterial strep throat infection, not a virus. In 1814, the British physician William George de Maton, as the philosopher Descartes would have encouraged, doubted the three clinical presentations were the same beast, instead positing that the three rashes were produced by three distinct illnesses.

British army surgeon Henry Veale described an outbreak of German measles in India in 1866. Being British, and not German, it was Veale who coined the anglicized version rubella or little red. Big red was the more impressive red rash of measles; little red was the less impressive red rash of German measles. Up until that time, the cause of any of these viral exanthems was unknown, as scientists had not yet identified viral particles. Why? Viruses are not like bacteria, which could easily be seen with Leeuwenhoek’s microscope and effortlessly coaxed to grow on Petri’s dishes.

In 1914, the American physician Alfred Fabian Hess correctly determined that German measles was a viral infection. Hess was quite an accomplished medical researcher and a graduate of both Harvard College and Columbia University’s College of Physicians and Surgeons. He is also credited with helping to demonstrate that the nutritional deficiency in the disease known as scurvy is vitamin C, and that the deficiency in rickets is vitamin D.

How are vitamin C and scurvy connected? The cause of scurvy was first considered during Captain James Cook’s epic voyage in the 1770s. Before the Age of Discovery, sailors did not sail all that long at sea, so they never or rarely acquired scurvy. Most sailors from antiquity up until the Age of Discovery tooled around the Mediterranean, they were not at sea long enough to acquire a nutritional deficiency. Even Homer’s epic poem The Odyssey written around sixth century B.C. chronicling the ten-year lost-at-sea exploits of Greek hero Odysseus trying to find his way home to Ithaca, he was not at sea the entire ten years. He was even held prisoner for seven of those years on the island of Ogygia, home to the beautiful Greek nymph Calypso. I don’t know about you but being held prisoner by a beautiful nymph doesn’t sound like too much of a hardship, especially giving the fact Calypso wanted to make Odysseus her immortal husband and in turn getting to enjoy her sensual pleasures … for eternity. I know Odysseus, King of Ithaca and wedded to his beautiful wife Penelope, would be the driving force for him to make his way back to his kingdom and to his wife, but come on, eternity with Calypso?

All that high seas disease-free adventures changed during the Age of Discovery when mariners were put to sea for months at a time, no land in sight, trying to reach the Far East without sailing over the edges of the map. During the 1500s and well into the 1700s, long ocean voyages regularly resulted in scallywags developing scurvy. Its signature symptoms are tender, swollen legs, arms, and ribs, easy bleeding and bruising, bleeding gums, loose teeth, rough, dry skin, weakness, fatigue, mental changes, and increased susceptibility to infection. When sailors went ashore during their seafaring adventures and their symptoms improved, recovery was incorrectly attributed to Galen’s second-century bad-air miasma theory: that is, that going ashore meant the sailors breathed in fresh air that cured the scurvy, as opposed to the stale air of a ship’s hold. It took quite some time for scientists and ship captains to connect scurvy to a dietary deficiency.

During that first voyage of Captain Cook’s in 1768–71, sailing from Britain into the South Pacific, he lost many men to scurvy, and still many more were made infirm by the disease. Vitamin C is needed for a robust immune system. During Cook’s second voyage in 1772–75 to circumnavigate the globe, he bought fresh fruits whenever he ported, including and especially lemons and limes. That second voyage not a single man died from scurvy. James Lind, a Scottish doctor in the service of the Royal Navy, used Cook’s journals as well some other captions to declare that citrus fruits cured scurvy and, more importantly, prevented it. Supplements, that is all supplements like vitamin C were unknown at the time—it was not as though one could jaunt down to the local grocery and grab a bottle of vitamins off the shelf. The word vitamin didn’t even exist—but Lind suspected something vital was in the fruit. Despite Cook’s observations and Lind’s recommendations, the medical establishment took its time accepting the data, and so perhaps another twenty years or so passed before lemon juice (well, lime juice) was a required ration for the entire British Navy. The two words lemon and lime were sort of interchangeable back in Cook’s day, perhaps because lemons were greenish-yellow and limes yellowish-green, not having the distinct color and size difference they do today. British captains took on barrels of limes for long voyages, and British sailors dutifully consumed their ration of lime juice, and the rest of the seafaring world laughed at them and started calling British sailors limeys. They laughed and laughed and laughed at all the British limey sailors—that is, until their teeth fell out.

Vitamin C plays multiple integral roles in the immune system—which is why the popular twentieth-century American chemist and educator Linus Pauling was a strong believer in a daily diet that includes ample amounts of it. Vitamin C is an important player in wound healing and connective tissue collagen synthesis. Without connective tissue, our bodies would fall apart into a goo of cells, oozing all over the floor.

Rickets, or vitamin D deficiency, mostly targets our bony frameworks. In adults, a vitamin D deficiency results in bones that are tender and fracture easily. In children, the bones don’t grow straight, and once crooked bones are established, the resulting deformities cannot be undone. Instead, the bones bow from the burden of weight, like a bow-legged cowboy in the saddle too long. The origin of the word rickets is surprisingly unknown, but the likeliest argument is that it comes from the Old English word wrickken, which meant twisted, as in twisted, rickety bones. A group of bacterial infections covered in a previous volume of this series, caused by the Rickettsia genus of bacteria—typhus being the most notorious example—should not be confused with the vitamin D deficiency disease, despite yet another set of similar names.

Rickets, with one T, is vitamin D deficiency, whereas ricketts or rickettsial, with a double T, is named after Howard Ricketts, an Ohio boy who did pioneering work in rickettsia infection; a group of bacterial infection that we covered in The Second History of Man. The most famous of the rickettsial infections, typhus, is transmitted to humans by the bite of an arthropod, especially ticks, fleas, lice, and chiggers. This bacterial family is obviously named after Howard Ricketts who, while in Montana in 1906 investigating Rocky Mountain spotted fever, another rickettsial infection, demonstrated that the bacterial microbe transferred to humans through the bite of a tick—a classic vector transfer. Howard Ricketts, the leading authority on rickettsial infections at the time, became interested in a murine typhus-like infection, murine from the Latin meaning mouse. So, in 1910, he traveled to Mexico City to investigate an outbreak of murine typhus, transmitted to humans by fleas that were living on mice. Within days of isolating the causative bacteria, now named Rickettsia typhi, Ricketts became ill and died from the very murine typhus he was studying. He was only thirty-nine years old.

Alfred Hess, besides his work with German measles, is also known for inventing the Hess test, which is a tourniquet test used to assess capillary vessel fragility—a fancy way of saying how easy a person bruises. If you apply a tourniquet to the upper arm of someone suffering from abnormal easy bruisability, the arm below the tourniquet bruises quickly due to increased blood vessel pressure coupled with easy bruising. Today, when a patient complains of bruisability that seems out of the ordinary, their physician orders a battery of blood tests, such as bleeding time and platelet count and thrombin levels, as all these are involved in successful clotting (a lack of which causes bruising). But in 1914 no such blood tests existed; that’s why the Hess’s tourniquet test was so useful.

While not so common today in the West, the Hess test is still used as an easy triage test in certain areas of Africa and other equatorial places where specific viral infections associated with easy bruisability percolate. The basic premise is this: if a patient shows up at a remote village medical clinic complaining of intestinal symptoms, the Hess test helps to sort out garden-variety gastroenteritis (which doesn’t exhibit bruisability) from more ominous viral infections that do exhibit both GI disturbance and bruisability, such as dengue fever and yellow fever. If a patient exhibits a positive Hess test, their illness will be taken more seriously and they’ll be ushered along to a hospital; if negative, they’re patted on the head and sent home.

In 1933, after giving a graduation speech, Alfred Hess chatted a bit with colleagues, walked to his car in the parking lot, got in it, and then slumped over dead, presumably from a stroke or heart attack. He was just fifty-eight.

In 1940, the Australian physician Norman McAlister Gregg described many cases of congenital cataracts in newborn infants. A cataract is a clouding of the eyeball lens, and congenital means the patient is born with the condition. Not all congenital conditions are evident at birth. Being born with six fingers or a cleft lip are both quite evident at birth, while other congenital issues, especially diseases like cystic fibrosis, might take days, weeks, or months to rear their ugly heads, yet despite the time lag until presentation, they’re still considered congenital.

As for Gregg, after witnessing a series of these congenital cataracts in newborns, he traced the cause to German measles infection among their mothers during the first trimester of pregnancy. Gregg also described other infantile congenital problems that result from German measles, a constellation of symptoms that we now call congenital rubella syndrome, the classic triad of which is deafness, eye cataracts, and a heart murmur. In addition to that primary triad, German measles congenital anomalies can and often do include mental retardation, a small brain (termed microcephaly), a small jaw (termed micrognathia), cognitive developmental delay, an autism spectrum disorder, growth retardation, and, somewhat oddly, schizophrenia.

A US rubella epidemic occurred from 1962 through 1965. This epidemic began in Europe and traveled across the Atlantic, most likely through immigration, which would classify it as a pandemic. By the time the US epidemic had run its course over those three years, twelve million German measles cases were documented. Tragically, in New York City alone, 1 percent of all births during those years resulted in congenital rubella syndrome.

By 1969, several German measles vaccines had been developed and approved, alongside the already developed and approved mumps vaccine (1967), measles vaccine (1963), Sabin polio vaccine (1961), and Salk polio vaccine (1955). In 1971, Morris Hilleman, that Montana farm boy whose daughter Jeryl Lynn provided dad with the first mumps viral strain—the Jeryl Lynn strain still in play today—combined all three vaccines (mumps, measles, rubella) into the single inoculation we know and love today by the acronym MMR. Interestingly, an MMRV vaccine, which adds the varicella chickenpox vaccine, has more recently been developed, and despite some early results that showed an increase in complications with the four-vaccine load—notably a slight increase in the incidence of febrile seizures—additional testing has largely disproved an increase in risk. That is to say, the ever-so-slight increase in febrile seizures in children taking the MMRV vaccine over the MMR vaccine is greatly overshadowed, from a public health viewpoint, by the overwhelming benefits of a four-valence vaccine.

Hilleman was simultaneously a forceful individual and a modest man. It is said he ran his laboratory at Merck Pharmaceutical like a military unit and was not at all shy about firing employees who did not measure up. He had a bad habit of yelling and using profanity to advance his opinion during arguments. When Merck ran a mandatory course for management to help facilitate teamwork, Hilleman saw it as nothing more than a charm school, and he refused to attend. But the thing is this: for Morris Hilleman and his employees, with or without that pharmaceutical charm school, those who kept up with the team kept their jobs; Hilleman and his highly productive employees at Merck were fiercely loyal to each other.

As for the other trivalent childhood vaccine of DPT (diphtheria, pertussis, and tetanus), Grace Eldering, Pearl Kendrick, and Loney Gordon, working at the Western Michigan Laboratories, later called the Kent Community Hospital, in Grand Rapids, developed that combined vaccine. This vaccine is against three bacterial infections, not viral like with the MMR shot. Polio is a separate vaccine, working against the poliovirus, that is usually given as a standalone.

Grace Eldering was born in 1915 in Rancher, Montana. She contracted and survived pertussis at age five, and that experience likely galvanized her desire to pursue a career in science, and especially a devotion to vaccine development. She received her doctorate in bacteriology at Johns Hopkins University in Baltimore in 1942. Pearl Kendrick was born in 1890 in Wheaton, Illinois, and was trained as a bacteriologist, doing her undergraduate at Syracuse University in New York State and her doctorate in bacteriology also at Johns Hopkins, in 1934. Loney Clinton Gordon was born in Arkansas in 1915. She received her bachelor’s degree in home economics and chemistry—quite the combo—from Michigan State College. Initially interested in being a hospital dietician, Gordon was refused work at hospitals in the Grand Rapids area because she was African American: the hospitals told her that white hospital chefs wouldn’t take dietary orders from a Black female dietician. Gordon was instead hired by Kendrick to work in her lab.

There are five, maybe six, classic childhood infections whose most obvious presentation is a rash—an exanthem. When I was in medical school rotating on the pediatric service, I remember needing to regularly look up what those six exanthem rash infections were because I could only remember the classic three: measles, German measles, and scarlet fever (mumps does not present with a rash). And, in so doing, I came upon a reference to fifth disease. What the heck was fifth disease? And for that matter, what were the fourth and sixth rash infections of childhood?

Fifth disease was and still is a viral infection that is caused by a parvovirus—not the kind of parvo dogs get, which in the case of our canine friends is spread through their poop—but a human variety. This human parvo has a characteristic rash and clinical presentation. But why the heck was it called fifth disease? Certainly, a child didn’t acquire the infection by drinking a fifth of whisky. We hope. Quite simply, many years earlier, even before viruses were identifiable in chick embryo assay, fifth disease was literally that, the fifth most common rash infection in children. Since it didn’t have a proper name like measles, German measles, or scarlet fever, medical folks merely referred to it as, you know, that fifth most common rash infection. And it stuck! Rather than calling it something like parvo rash or parvo fever, it was simply christened fifth disease.

At that time, the first most common rash infection was measles, the second was strep scarlet fever, the third was German measles, the fourth was a thing called Dukes’ disease, and then fifth disease—which has finally been bestowed a proper name: erythema infectiosum. The sixth rash infection on the list was the viral infection roseola infanatum, which is neither rubeola nor rubella. If you’re wondering why chickenpox is not on the list of most common rash exanthem infections, it’s because the pox of chickenpox is not a rash, per se. They’re rather vesicular skin eruptions—blisters.

Interestingly, Dukes’ disease, the fourth disease on the list, is no longer even on the list. Not because vaccines wiped it out or anything like that, but because it never actually existed in the first place. It is now believed that, in years gone by, children who presented with what doctors’ thought was Dukes’ disease likely had a bacterial strep or staph infection—not scarlet fever, but still a bacterial infection that gave a rash. Examples of a bacterial rash infection besides strep scarlet fever include scalded skin syndrome, which results from a staphylococcus bacterial infection somewhere, nearly anywhere, on the body. The rash of scalded skin syndrome, like the rash of scarlet fever, is not due to the bacteria but to a toxin that the offending bacteria releases.

In the end, Dukes’ disease was dropped from the list and that fourth disease slot is now left blank. Neither the fifth slot infection, erythema infectiosum nor the sixth, roseola infanatum got to move up a notch. The fourth spot has been left blank presumably for nostalgic reasons. Sort of like the seven vacated Tour de France overall wins by Lance Armstrong from 1999 to 2005. When, in 2012, Armstrong was stripped of all those victories due to doping, the next guys down on the Tour de France list, the runners-up for all those seven years, did not get to move up as champion. There are simply no Tour de France winners for those seven years. Seems strange. Why the next guys didn’t get to move up perhaps has to do with the psychology of that race: the various decisions made by individuals and by teams would have been different had Armstrong never raced. In other words, the second-place finisher in those seven Tour de France events might not actually, have come in first with Armstrong removed from the equation. Another way of looking at it is this: for a single bicycle race event, a single-day race, you can be more assured that the second-place guy would’ve been first, had the actual first-place winner not raced. But for the Tour de France—which has twenty-one stages—that assurance just isn’t there.

Roseola infanatum, or the sixth infection, is a viral exanthem caused by a strain of herpes virus similar to chickenpox, and it, too, is different from both rubeola and rubella. But truth be told, it took me a little while to realize that there were these three viral exanthem infections that all begin with the letter R and sort of all sounded the same—rubeola, rubella, roseola—when in fact they were three distinct viruses. I’m a slow learner, but I do learn. Roseola infanatum can result in a high fever that, in turn, can trigger seizures. The rash is mild and seems to develop as the fever subsides. I had roseola as a child. I didn’t have the seizures or the high fever, but I got to stay home from school and play with a new coloring book and that most-coveted new box of sixty-four crayons from Crayola. Before I could even use some of the cool colors, I would have already broken, or lost, or dulled into a small piece the most common colors: blue for the blue sky, yellow for the sun, black for the pastoral house, green for the grass, and red for the blood of my enemies. (Not!) When it came to the most treasured 64-color Crayola box, I wasn’t very imaginative, with some 54 colors likely never used.

From a historical perspective, before viruses were identifiable and perhaps before bacteria were identifiable, all these infection rashes were clumped together as a single rash infection called exanthem. Physicians didn’t know at the time much about all the various bacteria out there, let alone the viruses, many of which had a rash associated with the course of the disease. The first bacteria seen under a microscope was espied by Leeuwenhoek in the Netherlands around 1670. The germ theory of infection was not proposed until the latter half of the 1800s, following on from the works of Pasteur and Koch. An agent other than bacteria causing infection—a virus—was not suspected but indirectly demonstrated in 1892 by Dmitri Ivanovsky, and it wasn’t until around 1939 that an electron microscope was able to image the first virus. But that didn’t stop viruses from running amok since antiquity. No—viruses, like bacteria for most have human history, might have been out of sight, but most definitely not out of mind.

2

POLIO VACCINE AND NO NOBEL?

Julius Caesar was not a Roman emperor, though many people mistakenly think he was. Nor did he have polio—another common but erroneous thought—but someone in his world did. At least within the world of the Caesars.

The title of Roman emperor had not yet been created when Julius Caesar ruled the world. Caesar was initially a general and a gosh darn good one at that. When he seized control of Rome, his title was technically Roman dictator—the result of Caesar overthrowing the Roman Republic along with its Senate in 48 B.C., which therefore marked the beginning of the Roman Empire. After Caesar was unceremoniously murdered on the Ides of March, 44 B.C.—ides in Latin meaning the middle of the month—there was a lull in leadership, with squabbling among the Roman Senate … precisely the ones who had assassinated Caesar. The infighting continued until Augustus Caesar took over in 31 B.C., taking on both the title of Caesar after the great man and also the title of Roman emperor, making him the first to be known as such. With Augustus, Caesar became a noble title, not just a surname, and Emperor likewise became a new title.

That is, Augustus Caesar wasn’t born with that flashy surname. Rather he came into this world as Gaius Octavius, the same name as his father, and was later adopted by Julius Caesar as a son. I think adoption back in Roman times meant something entirely different than what it means today, or to borrow a phrase from Inigo Montoya of The Princess Bride (1987): You keep using that word. I do not think it means what you think it means. To you and me, adoption means placing an orphaned or worse, an abandoned, child into a loving, nurturing home with new legal guardians. But to the Roman wealthy, it meant that the patriarch did not have a suitable male heir to carry on his family name, wealth, and power. The key word here is suitable male heir. Even if the patriarch had one or several male heirs, guys like Caesar would trade up through adoption to find the best, most promising heir. Gaius Octavius was adopted by Julius Caesar after impressing him in battle. In 46 B.C., on the way to fight a battle in Africa against Caesar’s new enemy, Pompey, Octavius became shipwrecked. He pushed on, saved his companions, and delivered them to Caesar’s camp across hostile territory to assist in the defeat of Pompey. Soon after this feat, he was adopted by Julius Caesar and made the prime beneficiary of his