Demics - En, Epi, and Pan
By Elwood L. Schmidt
This past year’s COVID-19 pandemic caused me to remember my experiences with epidemics as a practicing physician.
After completing a rotating internship (a series of months of training in medicine, surgery, obstetrics, and pediatrics) I reported to the U.S. Public Health Service Indian Hospital, Keams Canyon, Arizona, on July 1, 1957. The medical officer in charge gave me a briefing. “You will see trachoma (a contagious eye infection that is very irritating and gradually causes blindness) in many of our patients. You need to keep the diagnosis in mind when you look at someone’s eyes and check for it regularly. Keep in mind that a lot of our patients don’t have access to or utilize clean water, so hepatitis is around all the time. Oh, and we see a lot of tuberculosis in our patients.”
This constellation of diseases was present in the population at all times—it was endemic. In early September of 1957, we were made aware that the Asian flu, originating in China, was spreading throughout the world and our country. Our isolated population was not going to be spared. While the COVID-19 infection has had its highest killing rate among those people 65 and older, the Asian Flu caused its greatest relative damage in the 15- to 24-year-olds. We had a boarding school for Navajo and Hopi students in town, eating together, sleeping in large dorm rooms; an infected person quickly led to much of the school population becoming infected. Our clinics were crowded with more and more patients experiencing fever, body aches, headaches, and general fatigue. Every patient needed screening so that other causes of many of these symptoms—ear infections, bacterial pneumonia, kidney infections, etc., that were treatable with specific medications—were not casually called “the flu” and given just supportive care, which was all we had to offer the flu patient. The medical officer in charge and I both became ill with influenza before the illness had run its course in our clinics.
In October we saw a patient or two or three per day with scarlet fever, a treatable bacterial infection that increased to numbers such that we felt an epidemic was indeed present. I developed scarlet fever also, but fortunately did not communicate it to my wife and infant son.
As this small epidemic passed we started to see people, usually young teenagers and children, with meningococcal meningitis (often called “spinal meningitis”). The disease was frightening to behold because untreated death often occurred in 24 to 48 hours after onset. Many of the children had been taken to a “sing,” a Navajo healing ceremony where many people were crowded into a small hogan while the ceremonies were conducted. This was a great way for large numbers of people to be exposed. Fortunately, there were a number of public health nurses who doggedly pursued every family who attended these sings where the meningitis germ was being spread. They would hand out bags of sulfa tablets and persuade people to take the pills to prevent further spread of this epidemic. (Sulfa for prophylaxis and penicillin for treatment are no longer nearly as effective as the germ has developed resistance to those drugs.) This horrific epidemic also “burned out” with the passage of time and the efforts of the public health nurses.
Springtime brought an outbreak of measles, a viral disease for which there was no treatment. The Navajo were particularly susceptible to and affected by the measles. They were much sicker, and they would more frequently die from the measles than Anglicized populations. A number of times I was deeply saddened when I would see a Navajo child with early measles, prescribe supportive measures, and then see the child die in a day or two. This epidemic also “burned out” to our intense relief as a medical community.
In the intervening years clever scientists have devised vaccines against measles, mumps, chickenpox, two types of hepatitis, shingles (a derivative disease of chickenpox), infantile diarrheas, and polio, which are all viral diseases with the ability to cripple or kill their victims. Vaccines have also been developed to prevent several kinds of bacterial pneumonia and the bacteria responsible for the deadly meningitis we saw that year. Now we have the near miracle of effective vaccines to prevent the spread of the coronavirus responsible for COVID-19 and our past year of turmoil.
I practiced medicine for another 50+ years and never again did I experience such a maelstrom of maladies. I have been a bystander as COVID-19 has struck the world, our country, and our state. My wife and I isolated ourselves and took multiple precautions against acquiring the disease as dictated by some experts and our government officials.
The Hopi and the Navajo survive(d) the epidemics. The United States and Nevada will survive, stronger in many ways I believe, because of the isolation measures we undertook, we have learned how much we need each other. Surely we have also learned that we are all Americans and all Nevadans without hyphens. That knowledge may be our biggest benefit from the year and travail of COVID-19. We have survived the same storm, albeit in different boats, but with the same destination, to live our lives fully without fear.
Photo/Elwood L. Schmidt.
Elwood L. Schmidt, MD is a doctor, author, and historian from Reno, Nevada. He studied premed at Texas A&M and graduated from the University of Texas Medical Branch in Galveston in 1956. He interned at the White Cross Hospital in Columbus, Ohio, served two years in USPHS, Division of Indian Health in Keams Canyon, Arizona, serving Hopi and Navajo, and in Schurz, Nevada, serving Paiute, Shoshone, and Washoe. Dr. Schmidt was in private practice in Slaton, Texas; Jal, New Mexico; Yuma, Arizona; and practiced locum tenens in multiple Nevada towns. He is the author of The Doctor's Black Bag: 51 Years as a General Physician in the Rural West, and his other stories and publications can be found at elwoodschmidt.com.
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