How I Came Not To Be (Almost)

My father was raised on a farm in western New York near Canandaigua in the Finger Lakes region. On the farm he had a dog (I think his name was Shep). One day a neighbor said that he thought Shep had rabies. Dad begged to differ and to prove that Shep was OK, he put his hand up to Shep’s mouth. When Shep did not not bite him, he said, “See. He is normal. Nothing wrong with him.” However, the next day Shep disappeared and a neighbor related seeing him running wildly away (“furious rabies”). If Shep had bitten Dad, the Short genealogy would have been even shorter and I would not be writing this story.

Some 20 years ago or so, my wife and I went up to Sandpoint, ID to visit my wife’s folks, who had retired there. Their house was a bit out in the country and one day I took a walk down a country road past widely scattered homes. Just as I was walking past one house, a medium size mutt of indeterminate breed, ran out and before I knew what was happening, it bit me on the back of my right thigh. It was not a serious bite – I hoped – but it did break the skin. I called the sheriff so that we could go to the house to determine if the dog had received the normal shots including, of course, rabies. The lady of the house was quite hostile to think that I would call the sheriff. But we got her calmed down enough to tell us that she was just caring for the dog who actually belonged to her offspring who was away on vacation. She assured us that she was sure the dog had received all its immunizations, but the dog had no collar and there was no confirmation.

That left me to decide what my next step should be. What were the considerations? The bite had just barely gone through the fabric of my heavy pant’s leg, but it had been enough to draw a little blood. I seemed to recall from medical school that the virus was in the saliva, but if the cloth absorbed the saliva, it might not get into the bite wound. A slightly encouraging thought (if true), but that still left considerable doubt. I should have insisted that the dog be quarantined for observation for a couple of weeks, but I guess I was too distraught to think of that and anyway Sandpoint was a small town where they may not have had the appropriate facilities.

Incidentally, the sheriff told me that in Idaho a dog that bites you is considered “vicious” by law and you are entitled to shoot the critter. Not knowing, and not having a weapon on me (I never carry), I didn’t exercise that option. Which, of course, is not a good option anyway if rabies is suspected.

Well, I opted not to do anything, beside cross my fingers and hope. And I never became rabid (although some who know me well might dispute that). Anyhow, just remember, don’t let the bed bugs bite. Or rabid canines for that matter.


Visit Brevis.com

Parris Island

I was born in lower Manhattan (just a few blocks from where the World Trade Center would later be built) in October of 1931. My earliest memories are of growing up in Forest Hills, an upper middle class, pleasant neighborhood on Long Island. Life was simple, enjoyable, worry-free.

My father was an internist with an office on Park Avenue. He had deep patriotic instincts and was inspired to join the Naval Medical Reserve about the time I was born and was commissioned a Lieutenant Commander. Life took a dramatic change on December 7, 1941. In what seemed like a matter of minutes, Dad received orders to report for active duty early January in the Marine boot training camp on Parris Island, SC. Within days he had to get his new uniform from Brooks Brothers, arrange for another doctor to take over his practice, get ready for Christmas for my sibs and me, and get himself out the door and down Highway 17 to South Carolina. Meanwhile Mother had to pack all her dishes, etc. in barrels in the basement, rent the house and get ready to move my sister and brother and me to follow at the semester break the end of January.

What I remember most that a friend drove us to Pennsylvania Station on a miserable evening with freezing rain to give us a cold send-off. My mother and sister slept on the lower bed of a pullman car while my younger brother and I slept on the upper bunk. But in the morning when I looked out the window, we were in Virginia and the sun was shining. Wow! That afternoon the train arrived at the whistle-stop town of Yemassee, SC where Dad was there to meet us in his trusty 1941 black Dodge sedan. He drove us to our new home on the island. It was a single story affair with a screened porch on two sides where I slept in the warmer weather and listened to the buglers around the island play a nameless tune at 9:00 PM and taps at 10:00.

Although I was only 10, I remember how impressed Dad was when he came home and reported that there was a case of spinal meningitis in a recruit. At that time it was not only highly contagious but essentially untreatable and with a very high mortality rate. No antibiotics then. But there was sulfadiazine and this was given prophylactically to everyone(?). Anyway, Dad was mightily impressed with that seeming miracle of stopping a threatened epidemic in its tracks. I’m sure he well remembered the influenza pandemic beginning in September, 1918 that exploded in a similar military camp in Camp Funston, KS, since he graduated from medical school about the same time.

My mother, who was raised in New York City, used to tell about meeting a friend who would say something like, “Did you hear that Bill died last Tuesday.” And Mother would say, “How could that be? I just saw him a week ago and he looked fine.” It is hard for me to imagine what it was like to live when the possibility of a random strike of lightning could hit you with a rapidly fatal illness like influenza. We can be happy that we live in an age where that does not happen in this country while continuing to remind ourselves that the possibility of a new pandemic hangs over our heads like the Sword of Damocles. Carpe diem! Make every day count.

Cheers!


Visit Brevis.com

Image by USMC Archives, Platoon 903, Parris Island, 1942

Dead Mosquitoes and Live Lice, Part 2

Continued from “Dead Mosquitoes and Live Lice, Part 1

So what about the live lice? When I went into the US Public Health Service in 1957, it was to fulfill my draft obligation after student deferments. Recall that the Korean War was from 1950 to 1953. Also that during WW II, DDT dusting powder was widely used to kill lice, especially in conquered civilian populations, to prevent the spread of typhus. But by the Korean War some lice had sneer at DDT and so something else was needed. Enter Dr. Wayland J Hayes and yours truly. Dr Hayes arranged for prisoner volunteers at the Federal Correctional Institution in Tallahassee, FL to be recruited to test the toxicity of malathion formulated as a dusting powder substitute for DDT. Malathion is an organophosphorus compound unrelated to DDT and was thought to have similar effectiveness and human toxicity.

Dr Hayes was the lead researcher and I was the lackey who did the cholinesterase analyses, etc. in the prison. (I have always enjoyed watching the expressions on people’s faces when I say I was in prison once.) The prisoners were told the possible adverse effects of the program and were given “good time” (reduced sentences) for participation. (After this one prisoner opted out but was later found to be consuming his own brew made with a smuggled, homemade still. Was that less toxic?)

The results were published in the Bulletin of the World Health Organization, (1960, vol 22, page 503-514) and on review I was impressed by one observation: “Although one of us (J.G.S.) had received, without injury, a 30-hour application of 10% malathion powder in preparation for the study of volunteers, . . . .” My small contribution to the advancement of science. Well, in retrospect I have to say that it was safer than dodging bullets in the Vietnam War, which was waging at that time.

Human infestation with lice is uncommon in this country and typhus is really rare. We have a lot to be thankful for in this country in spite of the vicissitudes of politics and the stock market. But there are still enough problems with antibiotic resistance and the lack of proper hand hygiene, etc. Maybe our watchwords should be Thankfulness, Vigilance, and Diligence. “May the Force be with you!”


Visit Brevis.com

Dead Mosquitoes and Live Lice, Part 1

Having recently talked about pigs from Jersey and trichinosis, I decided to see what other stories Berton Roueche had that might be of interest. Looking at the table of contents in his compendium called “The Medical Detectives” (1980), my eye was caught by “The Dead Mosquitoes.” Why did “dead mosquitoes” catch my eye? Therein lies a tale.

In August, 1957, having finished the course for the Epidemic Intelligence Service at the CDC in Atlanta, I headed down the road to Savannah and the Technical Development Laboratories, a branch of the CDC, on Oatland Island. (The drive, without air conditioning in those days, when the temp and humidity both hover around 90 is another story.)

TDL, as the lab was called, was set on a marshy island that bred mosquitoes in impressive battalions that found my blood especially delicious and inviting. I therefore found it ironic that inside the lab mosquitoes of several species were being raised by the millions. Why? To study their habits. Such as, how far do they range. Radioactively tagged mosquitoes of different species were released from a central spot and collection traps were spaced at a variety of distances. Turns out some species do not fly more than several feet high and have small ranges while others fly much higher and get caught by wind currents and travel much farther. (Thought you would like to know that.)

Mosquito larvae are so sensitive to insecticides that they were used for bioassays. Except when they weren’t. Also indigenous to the lab were great hordes of American cockroaches. (American cockroaches are up to 2 inches long vs the puny German variety at 1/2 inch). TDL was in a 240 foot long building. Someone at one end of the building decided to attack the roaches with a pyrethrum spray. The spray traveled 200 feet down the hall and wiped out the mosquito larvae in the bioassay lab. After that all insecticides were strictly verboten in the building which must have made the cockroaches deliriously delighted.

Anyway back to the Medical Detectives. It’s a complex story of poisoning by an organophophorus insecticide that was accidentally spilled on some blue jeans that were subsequently sold at discount in Fresno, CA. A pair of these were worn by a boy who then rapidly became violently ill. Another boy wore another pair of the blue jeans with the same result. (He was diagnosed by a classmate of mine, Merritt Warren, MD, who had heard about the first case.) Pinpoint pupils, low cholinesterase levels in blood and rapid response to atropine cemented the diagnosis. But which insecticide? While waiting for a chemical analysis in a research lab, the pants were left overnight in a room with some mosquito-laden cages. In the morning the mosquitoes were all stone cold dead, killed by insecticide vapors.

The insecticide was determined to be Phosdrin and it was later shown to have come from a leaking container being transported on the same truck as the package of blue jeans. One lesson to be drawn from this episode is that if the jeans had been laundered before being worn (they were not), the Phosdrin would have been washed out.


Continue reading (Part 2)

A Pig from Jersey

The last Saturday of June, 1957, having finished my internship, I left Lansing, MI, about midnight in my little VW with orders to report to CDC in Atlanta at 8:00 AM Monday to begin my two years of service in the US Public Health Service. I was to audit the course for the Epidemic Intelligence Service before reporting to the Technical Development Laboratory in Savannah, GA. The EIS course was founded and taught by Alexander Langmuir. Langmuir was a bigger than life, charismatic story teller who quickly made me feel that epidemiology was the most fascinating subject available to mere humans. There were maybe 40 or 50 of us taking the course and in front of our assigned seats there was a stack of reading material that looked generally pretty serious. But on the top of the stack there was a small paperback book with the title “Eleven Blue Men” by Berton Roueche. It looked strangely out of place and unserious and I put it aside for later.

I don’t remember when “later” arrived, but when it did, I was treated to a series of fascinating articles of which the Jersey pig was the first. It concerned a schlachtfest being held at the New York Labor Temple, a German-American meeting-and-banquet hall. A schlachtfest, for those of you uninitiated, is a pork feast. The pig in question was purchased by a butcher in Staten Island and the carcass was taken to the Labor Temple in Manhattan where it was converted into sausage among other things. One of the men involved in this escapade had eaten some of the raw sausage to check on the seasoning, and the rest is history. The man became very ill with fever (he later died) and the physician, a Dr Levy, came to the diagnosis when he discovered an elevated eosinophil count in his blood smear. It was then confirmed by a muscle biopsy which showed numerous Trichinella spiralis parasites.

Trichinosis is one of the many parasites one studies about in Microbiology, but I had never seen a case until some years ago when I was assisting in an outpatient laboratory here in Salt Lake City. I didn’t see the patient myself but I heard her story second-hand. This young lady had been on vacation in Hawaii and had been invited to a luau. The luau was the genuine thing apparently with a whole roast pig on a rotisserie above a fire. Everybody enjoyed the fresh roast pork. Except that the young lady in question arrived somewhat late to the proceedings and her portion of pork was from a more interior portion of the carcass that had not been adequately heated to kill the larvae.

Here the details are sketchy but she apparently had the usual GI symptoms followed by severe muscle pain. By this time she was back home in Salt Lake City and her doctor ordered the usual lab tests including a CBC. Thus the blood smear that showed more eosinophils than I had ever seen before. This was some time in the 1970s and I don’t remember the percentage of eosinophils
but I think it may have been around 30%, about 10 times normal. The smear was lit up with red lights like a Christmas tree. That number of eosinophils doesn’t define trichinosis but it certainly is highly suggestive.

Today trichinosis is very rare, but it is just the rare diseases we don’t think of that can rear their ugly heads and bite us in the rear. Tricky trichinosis. Maybe the ancient Hebrews knew something important. Whatever. May Trichinella spiralis rest in peace and bother us no more.

Gordon Short, MD
Brevis Corporation


Visit Brevis.com

Contributing Factors to the Flu Season

Except for it being “Flu Season”, I love the winter months.

If you live near 40°′N like I do, undoubtedly you’ve experienced some snow this season, to which not a single person has a neutral opinion. Personally, I’ve crossed zero several times in my life. Starting with love for fluffy white playful snow as a child, moving swiftly into a deep hatred for a biting, slushy, wintery death while walking to school in canvas shoes, and finally back to love for a nostalgically snowy day as an adult.

Currently I’m a huge fan of snow, though not for any of the reasons I could have predicted, much less reasons good enough to write a blog article, but here we go anyway. I like driving in the snow (though I hate when other people drive in the snow), I like watching the accumulation of a winter wonderland as snow falls across the streetlamps at night, and I enjoy the human surrender to nature as we dig all of our heavy clothing out of storage and attire ourselves ritualistically for the smallest tasks. I won’t go anywhere without my boots. If you see me in snow without them, destroy the imposter, or check for signs of meningitis.

New Posters

Heating Your Home

The heat in my house is off until the first sunny day in March. Some people find that strange. Nearly all others think it’s criminal. This habit serves me twice: I save quite a bit of money on utilities, and it dissuades nearly all pesky pop-ins. I own plenty of warm clothing that stays in storage most of the year, and I like to use it occasionally. I won’t go as far as to say I’m reclusive, but I do spend the majority of my time alone, in the dark, trying to stay warm. On the plus side, I rarely get sick. With so few people coming in and out of my house, the opportunity for germ transfer in these sickly winter months is highly reduced.

So why am I completely miserable, smelling like an herbal tea factory, sweating and shivering at the same time? Well it turns out that it could be my fault. Whoever said I can’t take accountability for my actions?

All About Germs

I didn’t grow up knowing a lot about germs, then again I didn’t grow up knowing a lot about most things. It turns out there are several factors that contribute to what we affectionately call “flu season”. Among these are the usual suspects: 

I don’t doubt the contributions of these well studied factors, but my lifestyle leads me to believe there’s another player in the game. I don’t spend time with anyone else, and it’s not like I see a lot of sun during the hot months anyway.

Winter Gear

It turns out that my beloved winter gear that keeps me alive for three months of the year, forgotten for nine, is a suitable suspect. It’s generally agreed, or at least intuitively good practice, that coats, hats, and gloves should be washed more often than most most people likely do. Not because you’re gross (though you probably are), but because those are often overlooked items that live in the back of a closet, emerging only in desperate times, and forgotten again just as quickly. I would venture a guess that most people don’t think to properly wash and store their winter clothing. Partly because the winter season often still makes brief and occasionally devastating appearances all the way through a stormy Spring, and partly because it’s not the kind of thing that comes to mind during the first blissfully warm day of the year.

While performing average activities during an unremarkable day, people have been shown to touch their faces up to 16 times per hour. That seems high initially, but I’ve been very conscious of my face since I started writing this article and at this point I think the number could easily be much higher. Most people could stand a reeducation on hand-washing. And though folks aren’t washing their hands well enough, or often enough, they’re certainly washing their hands more often than they’re washing their gloves.

Remember as you go about your day, touching things, that the same germs that you would normally collect on your hands are now on your gloves. The germ accumulation on gloves over the period of a few weeks is surely much higher than even improperly washed hands. So what can you do? Wash your gloves, hats, and coats! And while you’re at it, brush up on your hand washing habits in general.

I’ll be under the blankets until this whole thing blows over.

Can the holidays make you sick?

What makes us get sick more often during the holiday season?

Many theories have been postulated and studied over the years and many factors are blamed for being virus enablers. Closer proximity of hosts (us) within closed spaces makes transmission easier due to the shared air we breathe while indoors and the common surfaces we touch as people share confined areas. Further, foods are presented and ingested in areas with higher germ populations due to the foregoing.

Other theories suggest that inactivity and depression generally increases with the cold and gloomy weather and this coupled with decreased exposure to the sun may tend to inhibit our immune systems.

We suspect that all of these factors and more contribute to the seasonal spike in illnesses. But, there are some commons sense actions that can help reduce your chances of being the next holiday (infection) host. The most effective way to reduce your risks of seasonal sickness is to wash your hands often, especially after shaking hands, touching surfaces in common areas such as handrails and countertops and especially before eating.

In the spirit of holiday cheer (and microbial fear) check out these funny new flu and handwashing posters meant to remind with mirth and good cheer.

Healthy holidays to all.


New Flu & Handwashing Posters

 

Image of flu close up by cdc.gov.

Flu Education – Another Anniversary?

2018 – Another Anniversary?

Anniversaries. To celebrate or just to observe?

2018 is the fortieth anniversary of the incorporation of Brevis. Yeah!

2018 is the anniversary of the end of World War One.

Great Influenza Pandemic

But 2018 is also the one-hundredth anniversary of the Great Influenza Pandemic. And a dramatic start of a hundred years war that has no end in sight. World-wide this pandemic claimed somewhere between 20 and 100 million victims in 1918-1919. Pick your source to pick your number.

In previous essays we have shown how the flu predisposed us to World War II by disabling Woodrow Wilson during the writing of the Treaty of Versailles. We have also talked about the search by intrepid scientists for the original virus which took them to frozen corpses in Brevig Mission, Alaska. The virus may have been identified but that does not explain how the original epidemic starting in Fort Funston, Kansas was quite mild and then became much more virulent in subsequent outbreaks. One thing is clear: Army forts were crowded with new recruits who were destined for Europe. Crowding was ideal for spread of this virus.

The highly mutable virus appears to have a natural host in ducks and ducks seem happy to share with chickens and pigs. Of which multitudes reside in China. So we go to China to discover each year which strains are on the current hit parade so that we can develop effective flu vaccines. Maybe this is how China is demonstrating the importance of their trade with the US. Or is it just a free gift as a way of saying Thank You for all the other goodies we import from them?

Wash Your Hands

Regardless of all the ins and outs of influenza – and all other infectious diseases – the best we can come up with for prevention are proper hand hygiene and vaccination. As the decades roll by replete with outbreaks of new often more virulent strains of nasties the most effective strategy remains the same. Wash your hands. Wash them often. Wash them well.

Happy Anniversaries!

Gordon Short, MD
Brevis Corporation
13 November 2018


New Flu Posters

 

International Infection Prevention Week 2018, IIPW

Well Friends,

It’s October again and that means it’s International Infection Prevention Week again. With the fall colors also come dropping temperatures and increasing incidents of Colds, Flu and other illnesses. As temperatures drop we collectively spend more time indoors where germs can transfer from host to host more readily. Increased readiness can help with infection control and  prevention which is always easier than recovery. Sanitize commonly touched objects and places often and remember to wash your hands frequently. Stay ahead of the germs and encourage prevention with robust emphasis. Brevis products help you lead the way with posters, mugs and of course GlitterBug® Hand-Washing and Hand-Sanitizing training aids.

Save 20% with code “IIPW”

Also to aid your budget and just in time for International Infection Prevention Week – for this week only receive 20% off all Brevis products . Just type IIPW in the promo code field in the shopping cart to receive your discount. Jump-start your IIPW program with fun colorful handwashing swag and don’t forget to re-stock your GlitterBug® supplies.

Sale ends at midnight Saturday Oct 6.

GlitterBug handwashing products

IIPW Games and Activities (apic.org)

Help Prevent Infections

Sometimes a patient develops an infection while being treated in the hospital or other medical facility. It could be an infection from germs that enter the body at a surgery site. It could be an infection that develops from germs carried on a piece of medical equipment. There are many possible causes.

Infections like these are called healthcare associated infections, or HAIs, and we take them very seriously.

The good news is that we can prevent…  Download the full PDF from Apic.org

September is Food Safety Month

September is National Food Safety Month and because everybody eats, everybody should be reminded about the importance of safe food handling. Safe food handling is critical of course for those who prepare your food, but the food-consumer should be careful not to introduce microbial pests while eating. Proper hand-washing is the common denominator of effective infection prevention. To help you with your mission of promoting food-safety and infection prevention Brevis is holding a September Special.

Sick Facts

  • Foodborne illnesses cost the U.S. about $78 billion per year.
  • Each year, approximately 1 in 6 Americans gets foodborne illness.
  • Foodborne illnesses result in over 3,000 deaths each year.
  • 68% of outbreaks occur at restaurants.
    Sourced from CDC.gov

10% off all GlitterBug products

Just enter promo code “Educate” while checking out your shopping cart.

Clean hands, safe food, healthy people.

GlitterBug handwashing products

Food Safety (CDC.gov)