Influenza

          In 1742, a febrile illness erupted in Rome, spread to the Italian countryside, and ultimately ravaged most of Europe. It was accompanied by fever, cough, and muscular discomfort, and bequeathed an exceptionally high mortality. Physicians were unable to explain the origin of this frightening and obscure illness, but many believed the disease was provoked by some malevolent astral interference. In other words, the disease was under the influenza (Italian: the “influence”) of the stars. And thus a disease was named.

          Prior to the age of enlightenment and the discoveries of a burgeoning scientific culture, the revelations of crystal-gazers, astrologists, palmists, auspex, and other diviners, often tendered (foolish) explanations for otherwise incomprehensible phenomena. For example, the Rickettsial disease Typhus was originally believed to arise from malignant atmospheric fumes (Greek typhos: “smoke, vapor”). And the Plasmodial disease Malaria was thought to originate from the miasmic gases rising from fetid, decaying swamps (Italian mal: “bad” + aria: “air”). Unfortunately, the taxonomists had missed the true malarial vector, the Anopheles mosquito, whose larvae were silently growing in those putrid swamps. To this day, many diseases have been stamped with their original misconceived names, remnants of medicine’s imprecise youth.

          Contagious diseases that affect a percentage of the population greater than is customary, particularly those with numbers of patients that grow exponentially, are called epidemic (Greek epi: “upon” + demos: “people”, that is, “prevalent within the population”). Demos may be found in democracy (Greek kratia: “power or rule”, that is “rule by the people”) and demography (Greek graphein: “to write”, that is vital statistics or “writing about people”). A pandemic indicates a disease that has spread over the entire world, a global illness (Greek pan: “all” + demos: “people”), such as the 1918 influenza, and the HIV contagion (Latin contangere: “to contact”, which in turn derives from com: “together” + tangere: “to touch” – that is, to “touch together”, a common means of infectious spread, especially among sexually transmitted diseases). Tangere: “to touch” may be found in such words as tangent (“touching a point along a line”) and tangible (“discernible by touch”).

          An earlier pandemic, the infamous “Black Death”, erupted in 1348. Italian merchants, returning from China, were ambushed by Tartars in the village of Caffa, a trading post on the Black Sea. The Tartars, were suddenly decimated by an outbreak of plague, and they were forced to withdraw. Before leaving, however, they catapulted their dead over the barricades and onto the streets of Caffa. Thus infected, and incubating the dread pathogen, the unwitting merchants sailed back to the port of Venice. As a consequence, Plague was introduced into Italy and quickly spread across the European continent. Before that pandemic ended, fifty percent of Europe’s population had died of the disease.

          The most malignant form of plague is septicemia, which often causes disseminated intravascular coagulation (DIC). Dark ecchymotic blotches usually appear on the victim’s face and hands, giving rise to the epithet the “Black Death”. The etiology of this illness was unknown to the 14th century physicians. However, they quickly realized that, following exposure to plague, an incubation period was fundamental to its development. Therefore, the port of Venice imposed a period of detention on all incoming ships - impounding cargo, crews, and passengers for forty days before permitting them to disembark. Italian, quaranta (giorni): forty (days) eventually evolved into the term quarantine.

          Giovanni Boccaccio captured the essence of that plague in his celebrated book “The Decameron”, which narrates the plight of ten young men and women during the pandemic of 1348. His book recounted ten days in their lives, during which they escape the city of Florence, and flee to the relative safety of the countryside. On each day of that sojourn, members of the group told one story – ten stories for ten days, ultimately creating a book comprised of one hundred tales. The title Decameron is therefore explained - from Greek deca: “ten” + hemera: “days” - ten days of the plague. (Greek: epi: “upon or about” + hemera: “day” results in the term ephemeral, something that is transient, lasting “about a day”.)

          Another terrifying disease was smallpox, a pestilence described by the Chinese as early as the 12th century B.C. By the year 1700, Turkish physicians had demonstrated that inoculation of purulent material from a smallpox patient into a healthy individual, usually prevented the disease. These physicians used pyogenic matter from patients with the milder form of smallpox, variola minor. Unfortunately, the healthy recipients would occasionally develop full-blown variola major. This technique, known as variolation, was introduced into England and its North American colonies, with limited success. Benjamin Franklin was one of its most enthusiastic supporters. However, the dangers of variolation, and the familiar medical caveat: “primum non nocere” – first of all do no harm - kept most physicians from utilizing the procedure.

          (Latin variola: from varius: “varied or spotted”, from which we also derive such terms as various, variant, and variety. The term pox is an alternate spelling of the plural pocks, a pock being an Old English term for a “pocket or bag”. This word alludes to the skin marks left in the wake of the disease, which resemble small bags. The obsolete term poke [“pocket or purse”] derives from the same source – as found in the old expression “a pig in a poke”).

          Fortunately, about this time in England, a rural practitioner made an astute observation. Edward Jenner, a former student of John Hunter, recognized that a milkmaid who had previously experienced cowpox, did not develop smallpox when exposed to it. Jenner deduced that immunity to cowpox simultaneously conferred immunity to its more virulent relative. In May 1796, he examined a milkmaid, Sarah Nelmes, who had developed fresh cowpox lesions on her hands. Jenner removed purulent material from some of those lesions and inoculated Jamie Phipps, a healthy eight year old child.

          Over the next nine days, the Phipps child developed a low grade fever, mild discomfort, and a few cowpox lesions. Following the boy’s complete recovery, Jenner inoculated the child with purulent material from a small pox patient. (A clinical trial that certainly would not be permitted today.) After a week of anxious scrutiny, Jamie Phipps remained healthy – his inoculation with cowpox had bestowed immunity to smallpox. Jenner performed this experiment on several individuals, all with identical results. He then published his historic paper : An Inquiry into the Causes and Effects of the Variolae Vaccinae. (1802)

          Smallpox vaccinations were soon standardized and ultimately have resulted in the complete elimination of that dread disorder. In 1977 the last case of natural smallpox occurred in Somalia, and in 1979 the World Health Organization officially declared the disease eradicated.The term inoculate derives from botany, referring to the transplantation of a bud or an “eye” onto a second plant. (from Latin in: “onto” + oculus: “eye”). Subsequently, the term has developed a metaphorical sense, to engraft a “budding” germ onto a host. The word vaccine and the disease vaccinia both derive from cattle - Latin vacca: “cow”. (There is a familiar cliché often heard in western films, which derives from Spanish vaquero: “cowboy” (from Latin vacca). Vaquero was apparently difficult for Americans to pronounce, so it was transfigured and rendered into American English as buckeroo.)

          Finally, a word about the origin of the term virus. Borrowed directly from Latin, the word meant “slimy liquid or poison”. In 1883, the German scientist Alfred Mayer was studying a disease of plants known as Tobacco Mosaic Disease. A plant infected with this virus develops stunted growth and a prominent mottling of its leaves (thus the name “mosaic”). Mayer clearly demonstrated that the disease was infectious, by transmitting it from plant to plant. However, he was unable to identify any bacterial agent. In 1889, Martinus Beijerinck, a Dutch microbiologist, filtered material from an infected plant through a sieve with micropores too small to permit the passage of bacteria. Nonetheless, the ultrafiltrate was still able to infect healthy plants. Beijerinck called the infectious vector a filterable “virus” – a “poison” too small to be seen under light microscopy. It was not until 1933, when the first electron microscope was built, that a virus particle could be visualized. The influenza virus was the first to be photographed by humans.

            It certainly will not be the last.