The Science of Handwashing

We all know that keeping hands clean helps keep us from getting sick, but how does handwashing actually work?  Can we really get rid of all the germs on our hands?  Is there a single best technique for handwashing?  Do antibacterial soaps really work?  Scientists have studied these questions, and some of the answers may be surprising.

What exactly are germs?  Can handwashing really get rid of them?

Microbes, microscopic organisms, are everywhere, including on human skin.  Many of the microbes on hands are single-celled bacteria.  Many of the bacteria are always there, living harmless and unnoticed; these are called resident bacteria.  Other bacteria are picked up from the environment; these are called transient bacteria.  Transients can persist on skin for days to months, but can’t live there forever.  They may include pathogens — disease causing organisms, or germs.

Handwashing can never completely remove resident bacteria; there may be 10,000 or more individual bacteria on each hand, and they are adept at sticking to skin and slithering down between the cracks in skin cells to avoid removal.  Transient bacteria are present in fewer numbers and are not adapted to living on skin surfaces; they can be completely removed by handwashing.  Therefore, the purpose of handwashing is not to make hands sterile; it is to get rid of any potential pathogens that have hitched a ride.  However, handwashing technique can vary, and as we will see, some variables are more important than others in making sure pathogens have been removed.     

Does it matter if the water is hot or cold?

Although germs aren’t likely to be destroyed by water temperatures we can tolerate, health experts have long recommended washing hands with warm or hot water.  The reason is that warmer water should help dissolve oils and other substances coating skin, helping to wash away germs with them.  Unfortunately, recent studies comparing the numbers of bacteria on hands washed with cold, warm, and hot water have shown no difference in the results — just as many bacteria remain no matter what water temperature is used.  Since using hot water uses more energy and might irritate the skin if handwashing is frequent, cold water might be a better option.

What does soap actually do?

In general, soap doesn’t kill germs.  In fact, populations of bacteria have been found thriving in liquid soap dispensers in public restrooms.  Instead, the purpose of soap is to help remove contaminants and bacteria from the skin surface.  There is an extra benefit as well; some studies have examined how thoroughly volunteers washed their hands with and without soap; the volunteers using soap did a much more thorough job.  Using water alone will reduce the number of germs on hands, but using soap is more effective.  

Should antibacterial soap be used?  What about other sanitizers?

Although antibacterial soap is everywhere, there is no scientific evidence that it is any better at removing germs from hands than regular soap.  There is also concern that triclosan, a common ingredient in antibacterial soap, could cause bacteria to become resistant to antibiotics.

For how long should hands be washed?

The length of handwashing depends on the circumstances; for example, very dirty hands or hands exposed to more pathogens need a longer period.  In general, studies show that 20-30 seconds of handwashing is all it takes to remove most germs.  To help time handwashing, you can hum the “Happy Birthday” song two times – this should take approximately 20 seconds.

Which areas get missed?

Worldwide, the same areas are missed again and again when hands are washed.  Fingertips, cuticles, between the fingers, and the back of the hand, especially the thumb and ring finger, are areas which get the least attention; therefore, these are the areas where most germs remain.

GlitterBug is designed to disclose where hand washing can improve.

Research-based handwashing technique

In order for handwashing to work, proper technique is a must.  Begin handwashing by wetting hands with warm or cool water.  Apply soap and lather hands; remember commonly-missed areas such as around the nails, between the fingers, and the backs of the hands.  Scrub hands together for at least 20 seconds (or two rounds of the “Happy Birthday” song) before thoroughly rinsing and drying.

As long as the proper technique is used, handwashing is an excellent way to reduce or eliminate transient bacteria, including disease-causing pathogens.  

What Everyone Should Know about Hand Sanitizers

Hand sanitizers have been a popular commodity since the emergence of Covid-19 in the Spring of 2020. There was even a shortage for a while, as everyone rushed to stores to stock up. As sales continue to rise consumers should be aware of the ingredients of the product and the marketing techniques that manufacturers use to increase sales.

Alcohol Content

According to the FDA, in order to be effective, hand sanitizers should contain at least 60% alcohol. The label may list this as ethanol, ethyl alcohol, or isopropyl alcohol. If the label does not show the percentage of alcohol contained in the product, do not buy it. 

Some types of alcohol are extremely dangerous, and it is doubtful that a manufacturer would list these on the label if they are present, but the FDA has found contamination with methyl alcohol or 1-propanol in some hand sanitizers manufactured in Mexico and sold in the U.S. Methyl alcohol, or wood alcohol as it is sometimes called, is used to make antifreeze. 1-propanol is an ingredient of industrial solvents.

False Claims

Claims that hand sanitizers can prevent Covid-19, influenza or other diseases are misleading. Any product making these claims should be avoided. Hand sanitizers, when used properly, can only kill germs that are on your hands, and only lasts until you touch something else.

Misleading Marketing Practices

Some hand sanitizers on the market are scented with appetizing smells such as chocolate or strawberries. If a child smells these, he or she may think they are good to drink. Hand sanitizers packaged in containers that resemble beverage cans, water bottles or food pouches can also mislead young children into thinking that the contents are edible food products.

There have been cases where a person has mistakenly believed that a product that contains alcohol is OK to drink. Since alcoholic beverages contain alcohol, why not drink Nyquil, extract of Vanilla, mouth wash, or hand sanitizer and get a similar “buzz”?  Ingesting any of these products could produce headaches, diarrhea, vomiting, irregular heart rate, seizures and if a very large quantity is consumed, possibly coma or death could result. 

Since hand sanitizers seem to be everywhere these days it is important to understand what the ingredients are. Make sure the contents are clearly labeled and contain a minimum of 60% alcohol. Ignore claims made on labels that the hand sanitizer you are buying will prevent influenza, Covid-19 or anything else. It does not. Never ingest hand sanitizer. It is not safe for human consumption. Small children should be supervised when using hand sanitizers. When shopping for hand sanitizers, avoid packaging that could be mistaken for food products. Steer clear of those with appetizing scents. 

Teach people how to apply hand sanitizer correctly with Glitterbug Gel.

Three Easy Ways to Avoid the Flu

Flu season is no longer coming–it is here. No one wants to stay at home with fever, nausea, and the other unpleasantries that come with being sick. Even if you got the flu shot, with the dismal effective numbers for this year’s vaccine, odds are pretty good you’ll still get sick. It never hurts to do your part when you want something. If good health is high on your list, check out the tips below. Practicing these three tips can help reduce the possibility of becoming a victim of this year’s debilitating strain of influenza.

Wash Your Hands: Everyone hears that handwashing is important but what most people don’t hear frequently enough is how to do it right. To avoid infection, hands must be scrubbed with soap for at least twenty to thirty seconds. Thirty seconds is approximately the time it takes to sing the ABC song. Rinse your hands thoroughly with clean water and dry them well. Regular handwashing is by far the easiest, cheapest, and most convenient protection against contracting the flu.

Avoid Germ-Laden Surfaces: You don’t have to refuse to use your hands to open doors or wear gloves everywhere to protect yourself from germy fixtures. A little knowledge about germ hotspots can help you decide what to touch and what you’d rather not handle. Gas pump dispensers are much dirtier than toilet seats and wiping down shopping carts is definitely a good idea. Carrying a small container of hand sanitizer in your pocket will allow you to instantly zap any germs. However, keep in mind that sanitizers kill good germs that help build your immune system as well as bad germs that make you sick, so use it sparingly.

Flu Posters

Stay Away From Crowds: Chilly winter weather makes indoor activities much more appealing. Unfortunately, it is much easier to pass germs around in close quarters. If at all possible, avoid venues that you know will be crowded. Do your grocery shopping at times that are less busy, such as the middle of the week. Try to stay away from locations such as malls, crowded theaters, or events where a lot of people will be in a confined space.

The tips above do not guarantee you’ll make it through the season illness-free but they can certainly decrease your chances of getting sick. As an added bonus, protecting yourself from the flu also prevents you from spreading it to others. When you consider the loss of time, money, and the terrible feeling of having the flu, a little handwashing or grocery shopping at odd hours seems like no big deal.

How do you know if a surface has been properly cleaned?

Quality control in surface disinfection has always been a challenge. Jim Mann, a Brevis associate, sent us a nifty device to check for surface cleaning. It is called MarX and Brevis is now marketing it as the GlitterBug MarX.This is a stamp device that leaves an invisible circle X mark on stamped surfaces that can be visualized with UV light. It will be simple for quality control personnel to check whether surfaces have been cleaned by shining a UV source, such as the very popular GlitterBug GlowBar LED, on stamped surfaces. In this SARS-CoV-2 pandemic world, knowing that surfaces have been cleaned is more important than ever. And will be in the future when the next pandemic after Covid 19 rears its ugly head, as surely it will.

For decades Brevis has been a world leader in the teaching of hand hygiene with its GlitterBug UV product line and instructional videos. The GlitterBug MarX product is a great addition to this popular family. The MarX device is very portable – and pocketable – at about 1.0 by 2.5 inches (2.5 x 6.3 cm). It is probably capable of at least a thousand stampings if kept covered between uses.

Surface cleaning detection kit with invisible stamper and UVA lamp

Surface cleaning matters even more than ever. Use the MarX to mark surfaces with an invisible mark then use the SpotShooter8 Lamp to see if those marks were properly cleaned off. Easy method to Trust but Verify.

If only the Marx Brothers (Groucho, Harpo, Chico and Zeppo) had known about this, vaudeville may have taken a different turn back in the early 1900s. There is a story, which I can’t verify, that explains why Harpo never talks. Seems that the brothers were on tour and in one particular town, their act was not well received. So as they were walking out of town to get to the train station, Harpo turned around and said something like, “I hope your town burns down.” The next day when they looked at the newspaper, what do they see but an item about how that town had been mostly destroyed by a large fire. Of course, they had nothing to do with starting the fire, but Harpo’s curse was so prescient that the other brothers prevailed on Harpo not to talk any more. And he never did in their acts including when they got into movies. The story may be apocryphal but I like it anyway. If it didn’t happen, it should have.

Buy Now

Meanwhile, GlitterBug MarX has happened and is available now for your consideration and use. Check it out. You will be impressed with its simplicity and effectiveness.

Thank you,

Gordon Short, MD
Brevis Corporation

Epidemic Intelligence Service

EIS, Epidemic Intelligence Service
The most important organization you may never have heard of

Of course if you are an OCD reader of my previous blogs, you have seen my references to the Epidemic Intelligence Service of the Centers for Disease Control and Prevention (CDC) and its legendary founder, Dr. Alexander Langmuir. Although I had been assigned to audit the course upon entering active duty in the US Public Health Service in 1957 on my way to becoming a “toxicologist” in the Technical Development Laboratories of the CDC in Savannah, GA, and had an abiding interest in this remarkable organization, I hadn’t a clue as to its amazing reach and influence around the world until I read the book, “Inside the Outbreaks, The Elite Medical Detectives of the Epidemic Intelligence Service” by Mark Pendergrast (Houghton Mifflin Harcourt, 2010).

CDC is remarkable for both its geographic and illness span. Although it started as the Communicable Disease Center, with a major focus on all kinds of infectious disease epidemics, it now embraces subjects such as gun violence and environmental toxins such as lead and mercury in culinary water supplies. EIS officers are mostly MDs but the program also includes veterinarians, dentists, statisticians, nurses, anthropologists, sociologists, microbiologists, epidemiologists, etc.

Thanks to the stellar reputation of Dr. Langmuir and his success in attracting only top students to participate in the EIS course, EIS officers have been in high demand throughout the world. EIS officers only go where they have been invited, but their assistance has been requested around the world. These hardy souls have answered the call to places that bear little resemblance to conditions in the US. That can mean eating what the natives eat (Use your imagination) and sleeping in primitive huts. And traveling by whatever is available: bicycle, dogsled, elephant, camel, boats, you name it. They are hardy adventurers who will go anywhere to do what is necessary even at the risk of their own lives. And there have been a few who paid the ultimate price.

Langmuir stressed the importance of doing “shoe leather” epidemiology by which he meant getting out into the field and talking with those most affected by any outbreak. You can’t learn the essentials by staying in your hotel and watching TV and reading the local newspapers. How is the disease spread? Direct contact with bodily fluids (as in Ebola) or droplet and/or airborne as in influenza. What is the incubation period? What percentage of patients are asymptomatic? What percentage fatal? What age distribution? How do you tell when the peak incidence will occur?

The answers to these and other questions requires people in the field collecting data from all appropriate sources. Who are these people? A surprising number come from the ranks of the Epidemic Intelligence Service. These are the frontline troops who merit more attention than they get.

Gordon Short, MD
Brevis Corporation

COVID19: Show people what they should know to protect themselves from (Coronavirus)

Inform people about how to protect themselves from the acquisition viruses and germs such as Corona Virus. One cannot watch the news lately without being inundated with stories about the latest deadly virus outbreak. Scenes showing the dire situation in China where the outbreak seems to have started are prevalent in the media. Closed borders, sequestered or isolated travelers, cruise-ship customers in lock-down. Investigators are working feverishly to determine the sources of these viruses and the routes of transmission especially from one person to the next.

New Posters: Coronavirus in Public Places

Stay Safe Poster Protect Yourself Poster

The usual routes to infection are the most likely suspects. Touching surfaces in public and then touching our portals of entry (eyes, nose and mouth), breathing in of airborne germs or ingesting contaminated food. Of course we are  concerned with preventing illness amongst the population at large but must also realize that protecting oneself is of primary importance. In that vein Brevis presents new posters to inform people about the basic steps that can help to protect themselves.

What’s Nu with Flu?

I previously wrote about influenza at the end of 1918. But I couldn’t resist adding a bit more to the story based on the December, 2018 book “Influenza” by Jeremy Brown, MD.

So what’s “nu”? Brown tells the well-known story of 1918, the search for the original virus, etc., but then adds to the melodrama. For example, the truth about Tamiflu. Therein hangs a tale. Seems that Tamiflu (or oseltamivir if you prefer generic names) is only marginally effective. Supposedly it can shorten the symptomatic period by only a day and only if it is taken within 48 hours of the onset of symptoms. OK, well something is better than nothing I suppose.

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But the story doesn’t end there. Seems that governments around the world, including the US government, bought into the Hoffman-LaRoche inspired hype that Tamiflu was the best hope the world has to abort any impending influenza pandemic. With that in mind, the Strategic National Stockpile of emergency medicine, maintained by the CDC, added millions of doses of Tamiflu to its warehouses.

But the Cochrane Collaborative, an independent scientific critic, as quoted by Jeremy Brown said that Tamiflu was marginally effective in treating influenza and a little more effective in preventing it, but came with its own list of side effects that could imitate the symptoms of flu itself.

So, what to do? Hand hygiene, barrier protection, avoiding sick people if possible, and, of course, vaccination. Vaccination is only about 50% effective in prevention but may possibly lower the severity of an infection. I get my flu shot every year and don’t forget to cross my fingers. So far, so good.

Keep smiling!

Gordon Short, MD
Brevis Corporation

TB (What, you say?)

As a pathologist I had a visit from TB. Typical story: autopsy on undiagnosed case. The case? A woman about age 60 or 70 who was to be discharged from the hospital the following day, but decided to die first. This was about 50 years ago and I don’t remember too many details about what her organs looked like, but apparently not too alarming. In any event, my exposure was apparently sufficient to change my skin test to positive. (I was lucky and did not medicate or ever have any positive chest X-rays.)

The second case was quite different. A middle-aged lady entered the emergency room and was tentatively diagnosed as a possible carcinoma of the esophagus. Why? Because she was about 5 ft 6 in tall and weighed 60 lbs. At autopsy she looked like those pictures one sees of holocaust survivors who have starved in Nazi concentration camps. Every rib clearly visible. When her chest was opened, her lungs were composed of numerous golf ball size cavities. (And yes, I was wearing a mask.) The clinical story was that for some reason, she refused to see doctors, in spite of the fact that her husband worked in food service at our hospital. She died within 24 hours after admittance. What this case illustrated most clearly was why tuberculosis was called “consumption,” it literally consumes the flesh. Also why the famous Dutch and other artists often portrayed beautiful female subjects as what we would today consider too plump. They were obviously the healthy ones who didn’t have consumption.

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After these experiences with undiagnosed TB, I decided to do a limited chart study of the previous decade in our hospital. One case stands out in my memory. The patient was before my time. He was perhaps in his fifties and was admitted with symptoms of a chest infection. Several features stood out. He was in the hospital, I believe, for 23 days before he expired. During that time he was in a half dozen or so rooms, all semi-private in those days and presumably moved pair him with another male patient. The nurses’ notes all mentioned that he was coughing a lot. But what most caught my attention was that he had two X-rays, one upon admittance and one shortly before he expired. Both were described as showing “a diffuse micronodular infiltrate.” But there was no mention of the possibility of miliary TB, which is, of course, what he had at autopsy. All of which aptly illustrates the old medical axiom that most diagnoses are missed, not because the physician was not capable of making the diagnosis, but just because he didn’t think of it.

Gordon Short, MD
Brevis Corporation

Image by CDC.org

Syphilis, the Great Imitator

I wouldn’t put any money on the accuracy of my memory as to the attitude of Alexander Langmuir about Tuskegee. What I think I remember distinctly is that the Tuskegee Syphilis Study was briefly mentioned and discussed in the Epidemic Intelligence Service course I audited in the summer of 1957at the CDC. It was discussed as if it were an ordinary investigation to discover more about the natural course of syphilis.

Syphilis, the Great Imitator, has 4 phases: Primary (chancre), Secondary (rash– the Great Pox), Latent, and Tertiary. Each has its own unique characteristics that help to make syphilis “The Great Imitator.” Treponema pallidum, the causative agent is a sneaky devil that can go underground for decades clinically while eating away at vital organs. In 1932, when the Tuskegee Study began, there was considerable uncertainty about many aspects of the natural history of this disease. For example, when syphilis enters its latent stage, is it inevitably going to end in tertiary syphilis with aortic aneurysms or general paresis of the insane or tabes dorsalis or gummas? Or might there be a spontaneous cure? And what is a “cure”? A negative Wassermann test (which was known to be unreliable at that time)? Since the latent phase could last for several decades, there would be a good chance that the patient would die of some unrelated condition such as stroke or heart attack. So what effect would syphilis have on life expectancy?

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In 1930 there was considerable speculation about these questions and so it seemed desirable to study the disease prospectively over an extended period of time. And so the Tuskegee Syphilis Study was begun in 1932. But why Tuskegee and who were the subjects?

It had been observed that in Macon county, home of the famous Tuskegee Institute founded by Booker T. Washington, about 35% of the male, Negro population had a positive Wassermann test for syphilis. (About 80% of the Macon County population was black.) These men were mostly sharecroppers, many illiterate. They were poor and unlikely to be able to afford antisyphilitic therapy. Therefore this population represented a group that could be observed for an extended period without ethical concerns about “doing no harm” since they weren’t going to be able to afford treatment anyway.

Incidentally, the study was later heavily criticized because the subjects were treated as “guinea pigs” and not as humans. But may I remind any gentle readers that Negro slaves were defined in the US Constitution (Article 1, Section 2) as 3/5 of a white person. Negro slaves were further defined as “property” and could not become citizens (See Dred Scott decision and Roger Taney , Chief Justice of the US Supreme Court). Thank you, Founding Fathers (who were mostly slave-owning southerners). Not guinea pigs but maybe like upright beasts of burden. This attitude did not disappear immediately after the Emancipation Proclamation.

The plan was to recruit about 400 men with a positive Wassermann who were in the latent, asymptomatic phase. Those who were in the early stage, roughly five years after the primary chancre, would be referred for treatment and were not eligible for the study. About 200 men with negative Wassermanns would be recruited as controls. But what does it mean to “observe”? The patients had to be given physical exams periodically and also have repeat Wassermanns and spinal fluid exams to look for neurological changes. That’s heavy-handed “observation.”

The study has been criticized because the subjects were not treated with a full course of the prevailing antisyphilitic drugs. (They were treated with a suboptimal course of several months.) But before the late forties when penicillin became the accepted treatment, the standard treatment was the arsenicals, arsphenamine or neoarsphenamine. These treatments consisted of painful intramuscular injections administered monthly for at least a year. All aside from the possibility of a Jarisch-Herxheimer reaction, an asymptomatic patient had a right to to question this procedure. Furthermore, from a medical perspective it was unclear as to the effectiveness of treatment at this stage of the disease and what benefit might ensue. The youngest subjects recruited in 1932 were age 25. By 1948 the subjects were then at least 41 and most were older. At this point the ethical situation begins to become murky. Would treatment be beneficial? But there was much uncertainty and that is why the study was being done. There was considerable incentive to continue as before.

In studies such as this, the investigators have been criticized for treating the subjects as guinea pigs and not as human beings. How could this be so if the study was utilizing some black doctors and the Tuskegee Institute and the indomitable black nurse, Nurse Rivers?

I got some insight into this by my experience living in the South, first from February 1942 to June 1943 on Parris Island, the Marine boot training camp. The top medical officers for the Parris Island base hospital consisted of a Commanding Officer, a Chief of Surgery, an Executive Officer, and a Chief of Medicine (my father). The separate houses were lined up in a row and behind each pair was a maid’s quarters. One weekend when our maid, Lucy, was at her home on the mainland, I looked into these quarters. These consisted of two plain bare rooms each containing a bed and a dresser and bare wooden floor. Between the rooms was a “bathroom” with a sink and toilet. If there was a tub or shower, I didn’t notice it. To the eyes of this 11-year-old kid, raised in an upper middle class suburb of New York, this was a shock, to use a mild expression. But Lucy was always cheerful with nary a complaint. I guess she “knew her place.”

It took me a bit longer to learn mine. One time I had occasion to ride by myself on a public bus some where off the island. At age 11 I wasn’t very tall and when I got on the bus, it looked like every seat was taken. Except that straight down the aisle there was a vacant seat in the middle of the back row. To which I headed.
After I sat down and started looking around, I noticed that all the people sitting around me were highly pigmented and all the palefaces were in the front half. What to do? Nothing that seemed reasonable. So I sat there. The black people around me were too polite to say anything and I was too bashful. But I couldn’t help wondering what they were thinking.

Fifteen years later with a wife and baby son, I returned to the deep South to begin my service as a medical officer with the USPHS in Savannah from August 1957 to August 1959. We attended a small Adventist church, membership about 100, that was on a side street that wasn’t paved. The church itself was clean but definitely showing its age. Not antebellum but certainly not modern. However, we soon fell in love with the members there, all delightful, kind souls. In Savannah at that time there was a new, black Adventist church with a membership of around 400. Sometime in 1958 or 59, Little Richard came to town during his sojourn in the Adventist church and was the featured guest at the black church. My wife and I decided to go hear him. For some reason we were a minute or two late and the place was packed. But immediately a smartly dressed usher wearing immaculate white gloves approached us and ushered us down to seats in the front of the church. Why? What was so special about us? I wasn’t wearing a uniform. We were just a young couple with no VIP markers. Except white skin. It made me distinctly uncomfortable. Especially since the black choir, when guests of the white church, was required to enter via the back stairs into the church rather than the front entry.

In those presegregation days, restrooms were always “Men,” “Women,” and “Colored.” And, of course, the “Colored” were always consigned to the back of the bus.

My job was as a “toxicologist” at CDC’s Technical Development Laboratory on Oatland Island. The building was originally constructed as a retirement home for railway workers. Later it was acquired by the government to be used as a rapid treatment center for syphilis. After the arrival of penicillin, it was turned into TDL. As if the swampy southern east coast didn’t raise enough mosquitoes in the great outdoors, TDL raised millions more in its own mosquito vivarium. The purpose was to study the biology of different species. This was undoubtedly an improvement of my observation that whenever I patted one on the back it left a red splotch as a reminder of why I observed that mosquitoes suck.

So, after all this rambling, let’s get back to is my bottom-line assessment of the Tuskegee Syphilis Study. This is how this one observer sees it:

In 1932 the study was reasonable and justifiable given the current state of knowledge about syphilis.
The study was flawed from the beginning because the participants were treated with arsenicals although in a suboptimal dosage.
When penicillin became widely available and accepted circa 1950, the youngest subjects were at least in their forties and it was unclear whether treatment would significantly alter their health status.
In 1957 (when I was at CDC), it was deemed advisable to continue the study because there was much more to be discovered. But by then it was a bit like holding a tiger by the tail.
The participants were generally well treated, if Nurse Rivers story is to be believed. And I believe her.
But it is true that the participants were treated as guinea pigs in the sense that they did not give “informed consent.” But how does one “inform” uneducated sharecroppers?
The study helped result in more stringent ethical guidelines – as it should have – but it is unfair to retroactively apply those guidelines.
Others may disagree (and have) but these are my tentative conclusions. What think you?

P.S.: The best definitive study is “Bad Blood. The Tuskegee Syphilis Experiment” by James H. Jones. (1993)

Gordon Short, MD
Brevis Corporation

The Deadly Plum

If history is correct, there was a day when there were plum trees on Plum Island. But the history of Plum Island is so convoluted that it is hard to say. Anyway, it got its name and who really cares how.

Some years ago a good friend, Jay Dirksen, PhD, (pharmacology and bionucleonics) said that I might enjoy Nelson DeMille’s book “Plum Island.” Although I love good fiction, I’m always frustrated by not knowing how much is based on fact and how much is made up. Although I grew up in Queens, Long Island, I had never heard of Plum Island and had trouble believing much of what DeMille described.

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An internet search led me to a book by Michael Christopher Carroll called “Lab 257, The Disturbing Story of the Government’s Secret Plum Island Germ Laboratory” (2004). In this factual account I learned that essentially everything that DeMille said about Plum Island was true and that the story of Plum Island is frightening in the extreme. Or at least should be.

Plum Island is an 840 acre island that is only a mile away from the north fork at the eastern end of Long Island. It has a long and unremarkable history going back to when it was owned by native Americans. Whites took over before the Spanish American War and the military built the large Fort Terry there and also a lighthouse.

With the military still in charge after World War II, the story becomes more interesting. The military imported a Nazi scientist, Dr Erich Traub, through Operation Paperclip, to be a founding father of a biological warfare laboratory on Plum Island. Traub had worked for the Nazis (reporting to Heinrich Himmler) in the arena of biological warfare. When the USDA took over management of Plum in 1954, it was ostensibly to do research on diseases that could be a threat to domestic animals – cattle, horses, sheep, chickens, etc. Such diseases as foot and mouth disease and many others. But the dividing line between research to protect domestic livestock and to disable the same (of an enemy) is blurry.

While Carroll’s book well describes all that has been wrong with the operation of the Plum Island Animal Disease Center, the more encyclopedic history of the island from its earliest days called “A World Unto Itself, The
Remarkable History of Plum Island, New York” by Bramson, Fleming and Folk (2014) takes a less histrionic viewpoint and describes some of the scientific discoveries that were developed by PIADC scientists under the direction of Drs. Maurice Shahan, Jerry Callis, Roger Breeze and others.

Nevertheless, the history of Plum Island has enough mystery associated with it to have generated a plethora of fantastic fables, urban legends, conspiracy theories or whatever. Such as the Montauk Monster or that Lyme Disease was actually invented on Plum Island and released on an unsuspecting public.

Plum Island operates at a BS-3 level, some would say at an enhanced BS-3 level that approaches BS-4, the highest level. There are BS-4 labs at Fort Detrick, MD and at CDC in the Atlanta area. BS-4 means that the disease being studied is very serious in its potential to harm humans – usually deadly – and there is no vaccine or reliable treatment. It requires the researcher to wear a fully enclosed space suit connected to a hose that keeps positive pressure inside the suit. Strict protocols are observed with decontamination before exit from the suit and return to outside clothing. It was hoped by the Plum Island scientists that such a lab could be built on the Island but this did not happen.

Which reminds me of an experience I had many years ago here in Salt Lake City. At the time I was chairman of the Environmental Health Committee of the Utah State Medical Association. I was no longer in the practice of pathology, but I continued to pay my dues so that I could be on this committee. (My interest at the time was in trying to influence legislation to restrict smoking in public places.) One of the other members of the committee (Dr. Buchi?) said that he had heard that there were plans to build a BS-4 lab at the Dugway Proving Ground southwest of Salt Lake City. With the previous history of the Skull Valley sheep kill of 1968 (where several thousand sheep were killed, apparently from VX nerve gas that drifted east from Dugway during a test, it seemed to our committee that building a BS-4 lab upwind from Salt Lake City was undesirable. We strenuously opposed the plan and the lab was never built. But I’m not sure there was a cause and effect relationship to our opposition.

Dugway is to Utah what Area 51 is to Nevada. Secrecy prevails. However, I had a tenuous connection to Dugway when I was at CDC’s lab in Savannah. When I was engaged in the malathion study in the Federal Correctional Institution in Tallahassee, Florida, I used a micro method for determining serum cholinesterase activity that was developed by a scientist at Dugway. (I get a kick out of watching the expressions on people’s faces when I mention that I was in a Federal Prison in Florida.)

Well, I have wandered a ways away from Plum Island Animal Disease Center in New York to Utah and Nevada and then down to Georgia and Florida. But that is the prerogative of old men so perhaps I can be forgiven. (Are you familiar with “The Story of the Old Ram” by Mark Twain? You should be. )

Happy Meanderings! (But I don’t recommend going to Plum Island in search of plums. Unless you want the deadly variety.)

Gordon Short, MD
Brevis Corporation

Image by WikiMedia

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