Where lies mercy, and where is understanding to be found?


The world cowers as it now confronts yet another pestilence originating in some remote forest. In recent years, humanity has been affronted by a succession of alien infectious diseases, novel forms of environmental intoxication and eccentric ways of inflicting harm upon its inhabitants (e.g., the occasional use of poison gases). Yet, it wonders now, nervously, what unspeakable sins must have been undertaken by people to justify the terrors wrought by wave upon wave of new contagions.

Collective memories are poor, and so people speculate why the past seemed so blissful and innocent, conveniently ignoring such recent calamities as HIV/AIDS, Legionnaires’ disease, Lyme disease, toxic shock syndrome and Hanta fever – all emerging in the last few decades. And now, some have concluded, there is the imminence of Ebola virus, the microbiological prelude, they fear, to a global Armageddon (in Hebrew, har Megiddo).

Many of these known infectious diseases, such as West Nile, Hanta, Rift Valley, Malta, Marburg, Lassa or Ebola, bear names of exotic geographic sites, hinting that such alien infections could only have arisen in steaming jungles without a trace of “civilization.” Ebola received its name from an undistinguished river tributary in northeastern Congo, where the first case was identified. Of course, people conveniently forget such infectious entities as Lyme disease, Rocky Mountain spotted fever, St. Louis encephalitis, San Joaquin fever and Colorado tick fever, all bearing names of geographic sites within the United States.

Yet, solely in terms of infectious, communicable disease, men and women have never been healthier. Within their lifetimes, many readers might remember the relentless scourges of diphtheria, measles, smallpox, pertussis and rubella, all now controlled (and, in most of the world, eradicated). Poliomyelitis, once global in distribution, has now been confined to northern Pakistan, neighboring Afghanistan and parts of northern Nigeria. The remainder of the world is polio-free, and our school children learn that the disease, sometimes called infantile paralysis, is a bygone affliction of medieval days such as the Dancing Mania or King’s Evil.

And smallpox? It is now 37 years since the last case of natural smallpox was documented in an East African health worker. Only the very elderly of physicians, such as this writer, have ever seen a case of smallpox. And, similar to the Lindy Hop and men’s vests, it has been relegated to the distant past.

But not all encounters with pestilence have been joyous victories. Consider a disease, presumed to be infectious, that was first documented in the April 1917 issue of a Viennese medical journal, written by a neurologist named Constantine von Economo.

This mysterious disease ultimately afflicted close to one-half million humans, particularly in Europe and the U.S. The ailment began, innocently, with moderate malaise, low-grade fever, headache and some muscle aches. But, within days, these banal symptoms were superseded by deepening confusion, paralysis of eyeball movement and, often, an inappropriate sleepiness. And so it was initially called encephalitis lethargica (EL). Many physicians noted a curious resemblance of EL to Parkinson’s disease, although the latter was more globally distributed, much slower in clinical progression and affecting the elderly, in general.

The EL epidemic coincided, in the U.S. with the 1917-20 pandemic of influenza, and many then thought that the two disorders were somehow related, perhaps EL representing a late sequel of the flu. This etiological thought has not been verified, and EL remains a two-fold mystery: First, what caused it? A virus, a bacterial agent, perhaps? And second, what factor(s) accounted for its essential disappearance since 1927?

Our globe is a vast biological jungle populated with countless organisms – unicellular, invertebrate and vertebrate – all competing for survival against other creatures, as well as contending with climate changes that, randomly, make survival and propagation easier for some species but not for others. Many humans, nurtured in the naïve belief that the world was expressly created solely for them, now wonder why they feel so afflicted. These folk are trapped within a dream – the obsessed, contentious interval between the womb and the grave sometimes called life. But with all of life’s hazards and imponderables, those who are now contending with the horrors of new pestilences may ask, is life really worth living? That is a question for a newborn, not for an adult.

STANLEY M. ARONSON, M.D. (smamd@cox.net) is dean of medicine emeritus at Brown University.