In Epidemics, Leaders Play a Crucial Role


Lessons in heroism and horror as a famed flu pandemic hits a milestone

A century ago this week, an army cook named Albert Gitchell at Fort Riley, Kansas, paid a visit to the camp infirmary, complaining of a severe cold. It’s now thought that he was America’s patient zero in the Spanish Flu pandemic of 1918.

The disease killed more than 40 million people world-wide, including 675,000 Americans. In this case, as in so many others throughout history, the pace of the pandemic’s deadly progress depended on the actions of public officials.

Spain had allowed unrestricted reporting about the flu, so people mistakenly believed it originated there. Other countries, including the U.S., squandered thousands of lives by suppressing news and delaying health measures. Chicago kept its schools open, citing a state commission that had declared the epidemic at a “standstill,” while the city’s public health commissioner said, “It is our duty to keep the people from fear. Worry kills more people than the epidemic.”

Worry had indeed sown chaos, misery and violence in many previous outbreaks, such as the Black Plague. The disease, probably caused by bacteria-infected fleas living on rodents, swept through Asia and Europe during the 1340s, killing up to a quarter of the world’s population. In Europe, where over 50 million died, a search for scapegoats led to widespread pogroms against Jews. In 1349, the city of Strasbourg in France, already somewhat affected by the plague, put to death hundreds of Jews and expelled the rest.

But not all authorities lost their heads at the first sign of contagion. Pope Clement VI (1291-1352), one of a series of popes who ruled from the southern French city of Avignon, declared that the Jews had not caused the plague and issued two papal bulls against their persecution.

In Italy, Venetian authorities took the practical approach: They didn’t allow ships from infected ports to dock and subjected all travelers to a period of isolation. The term quarantine comes from the Italian quaranta giorni, meaning “40 days”—the official length of time until the Venetians granted foreign ships the right of entry.

Less exalted rulers could also show prudence and compassion in the face of a pandemic. After the Black Plague struck the village of Eyam in England, the vicar William Mompesson persuaded its several hundred inhabitants not to flee, to prevent the disease from spreading to other villages. The biggest landowner in the county, the earl of Devonshire, ensured a regular supply of food and necessities to the stricken community. Some 260 villagers died during their self-imposed quarantine, but their decision likely saved thousands of lives.

The response to more recent pandemics has not always met that same high standard. When viral severe acute respiratory syndrome (SARS) began in China in November 2002, the government’s refusal to acknowledge the outbreak allowed the disease to spread to Hong Kong, a hub for the West and much of Asia, thus creating a world problem. On a more hopeful note, when Ebola was spreading uncontrollably through West Africa in 2014, the Ugandans leapt into action, saturating their media with warnings and enabling quick reporting of suspected cases, and successfully contained their outbreak.

Pandemics always create a sense of crisis. History shows that public leadership is the most powerful weapon in keeping them from becoming full-blown tragedies.

The Quest for Unconsciousness: A Brief History of Anesthesia

The ancient Greeks used alcohol and opium. Patients in the 12th century got a ‘soporific sponge.’ A look at anesthetics over the centuries


Every year, some 21 million Americans undergo a general anesthetic. During recent minor surgery, I became one of the roughly 26,000 Americans a year who experience “anesthetic awareness” during sedation: I woke up. I still can’t say what was more disturbing: being conscious or seeing the horrified faces of the doctors and nurses.

The best explanation my doctors could give was that not all brains react in the same way to a general anesthetic. Redheads, for example, seem to require higher dosages than brunettes. While not exactly reassuring, this explanation does highlight one of the many mysteries behind the science of anesthesia.

Although being asleep and being unconscious might look the same, they are very different states. Until the mid-19th century, a medically induced deep unconsciousness was beyond the reach of science. Healers had no reliable way to control, let alone eliminate, a patient’s awareness or pain during surgery, though not for lack of trying.

The ancient Greeks generally relied on alcohol, poppy opium or mandrake root to sedate patients. Evidence from the “Sushruta Samhita,” an ancient Sanskrit medical text, suggests that Indian healers used cannabis incense. The Chinese developed acupuncture at some point before 100 B.C., and in Central and South America, shamans used the spit from chewed coca leaves as a numbing balm.

Little changed over the centuries. In the 12th century, Nicholas of Salerno recorded in a treatise the recipe for a “soporific sponge” with ingredients that hadn’t advanced much beyond the medicines used by the Greeks: a mixture of opium, mulberry juice, lettuce seed, mandrake, ivy and hemlock.

Discoveries came but weren’t exploited. In 1540, the German alchemist and astrologer Paracelsus (aka Theophrastus Bombastus von Hohenheim) noted that liquid ether could induce sleep in animals. In 1772, the English chemist Joseph Priestley discovered nitrous oxide gas (laughing gas). Using it became the thing to do at parties—in 1799, the poet Coleridge described trying the gas—but no one apparently tried using ether or nitrous oxide for medicinal purposes.

In 1811, the novelist Fanny Burney had no recourse when she went under the knife for suspected breast cancer. She wrote later, “O Heaven!—I then felt the Knife rackling against the breast bone—scraping it!”

Despite the ordeal, Burney lived into her 80s, dying in 1840—just before everything changed. Ether, nitrous oxide and later chloroform soon became common in operating theaters. On Oct. 16, 1846, a young dentist from Boston named William Morton made history by performing surgery on a patient anesthetized with ether. It was such a success that, a few months later, Frances Appleton Longfellow, wife of Henry Wadsworth Longfellow, became the first American to receive anesthesia during childbirth.

But these wonder drugs were lethal if not administered properly. A German study compiled in 1934 estimated that the number of chloroform-related deaths was as high as 1 in 3,000 operations. The drive for safer drugs produced such breakthroughs as halothane in 1955, which could be inhaled by patients.

Yet for all the continuous advances in anesthesia, scientists still don’t entirely understand how it works. A study published in the December 2017 issue of Annals of Botany reveals that anesthetics can also stop motion in plants like the Venus flytrap—which, as far as we know, doesn’t have a brain. Clearly, we still have a lot to learn about consciousness in every form.