The word plague is versatile, whether used as a noun to describe the assault of a communicable disease on a population or as a verb to convey chronic emotional distress. The first category may best be exemplified by the endemic Black Plague that devasted human life in late Medieval and Renaissance Europe. One historical account in the journal Bulletin of the History of Medicine led to an estimate that the mortality rate from the Black Death and its collateral effects devastated 60% of the entire European population (50 million of its estimated 80 million inhabitants).

Often referred to as the White Plague, during the first half of the 20th century in the U.S., large county tuberculosis (TB) hospitals across the nation housed patients requiring specialized care. A most deadly disease, a provisional total of only 9,029 TB cases were reported in the U.S. in 2018, (an incidence of 2.8 cases per 100,000 persons). The rate among patients born outside this country, however, was more than 14 times higher than that of individuals born here. Risk factors include HIV infection status, a history of homelessness, and residence in a congregate setting.

Until the mid-1950s, polio outbreaks triggered fears of becoming a patient confined for the rest of one’s life in an iron lung. When the Global Polio Eradication Initiative (GPEI) began in 1988, cases of poliomyelitis were reported from 125 countries. Since then, only Afghanistan, Nigeria, and Pakistan have experienced uninterrupted transmission of wild poliovirus (WPV).

Although declared eliminated in the U.S. in 2000, total cases of measles nationwide as of April 11, 2019 already have surpassed those of 2018 and likely soon will eclipse totals for 2017 and 2018 combined, according to the CDC. During the 1940s and early 1950s, the editor of this newsletter in his youth was afflicted with mumps, measles, whooping cough, German measles, chickenpox, and scarlet fever. None of those conditions was considered rare back then, which happily is quite the opposite of the present day, reflecting the current widespread availability of vaccines, effective drugs, and improved standards of living.

Meanwhile, the relative disappearance of some diseases has been replaced by the emergence of other conditions primarily associated with a sense of being plagued by doubts and uncertainties about the purported advantages of modern day life. For example, despite evidence of the positive role that vaccines play in preventing disease, some parents refuse to have their children immunized because of a fear that it causes autism. According to a recent national Pew Research Center study, when Americans peer 30 years into the future, they see a country in decline economically, politically, and on the world stage. Such grim predictions reflect a sour public mood while more extreme forms of hopelessness contribute to suicide continuing to remain among the top 10 causes of mortality in the U.S. since 2008.

Nevertheless, poking through a cloud of despair is a hearty ray of sunshine in the form of knowledge that the health professions remain a sound career choice. An aging population characterized by chronic ailments will require health care services that are not easily transportable to other countries or replaceable by robots.

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VARIETIES OF PLAGUES BOTH OLD AND NEW

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