Category Archives: Dr. Gordon Short weighs in

Dr. Gordon Short is now weighing in on topics lofty and low-down when he feels inspired. Interested in infection control, pathogens, epidemics and how they have affected our history and shaped our lifestyle? Join him as he discusses these and other topics here.

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.


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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!


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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!”


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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)

Ah, the Staph of Life! Ether Frolics & Gas Gangrene…

Gangrene and Glory Book Cover

I have found very few good books on Civil War medicine. One of the better ones is “Gangrene and Glory” by Frank Freemon (1998). With an MD and a doctorate in American History, Freemon fills in many of the blanks. In the last post I mentioned that battlefield amputations were often done with only a shot of whiskey for anesthesia. While whiskey was ubiquitous and available, both armies supposedly had access to ether and/or chloroform.

“Ether frolics” were popular entertainments during the 1830s. Traveling lecturers dispensed diethyl ether to any audience member who wanted to test its mind-altering effects, which were similar to those of nitrous oxide.

William Edward Clarke (1819-1898) participated in these events. When he became a medical student, he administered ether to a Miss Hobbie to assist in a dental extraction, thereby establishing himself as the first to use an inhaled anesthetic for a surgical procedure.

In 1842 Crawford Long (1815-1878) used ether before removing a neck tumor from a James Venable. Later he used ether for limb amputations. A hospital in Atlanta is named after him and is now a part of Emory University.

In 1846 William T. G. Morton (1819-1868), a New England dentist, used ether as a general anesthetic at Massachusetts General Hospital.

In 1847 Scottish obstetrician James Young Simpson (1811-1870) used chloroform for general anesthesia. Chloroform became very popular thereafter at least partly because it was non-flammable, but its popularity waned after its toxicity to heart and liver was discovered.

During the Civil War (now there’s an oxymoron!) those dripping ether or chloroform had little, if any, training. But they did have one advantage I supposeif the patient died on the table they always had the excuse that it was because of their battle injuries and not their incompetent anesthetist. Under those primitive conditions it is a miracle that any patient survived. Yet thousands did.

With luck, the patient developed “laudable pus” instead of gas gangrene. Infection was expected, and if it was just staph the patient was considered well on the road to recovery (of course, in those days they didn’t know staph from staff). So that was the staph of life? How times have changed!

Civil War Medicine: Surgeons With Saws & A Stiff Shot of Whiskey

Civil War Polaroid Transfer_s

On April 29, I had a right half-knee arthroplasty. The procedure was done with epidural anesthesia and some additional propofol. I requested a minimal dose of the latter so that I could be more or less awake during the procedure — which happened — and I remember hearing the electric saw doing its thing and also apparently a mallet and chisel. The procedure went smoothly and with dozens of people taking care of me in the hospital, and several more from home health care, I am making a good recovery ahead of schedule.

What a contrast from Civil War medicine! If you have ever been to a Civil War battlefield, you may have seen what passed for a hospital then. At the Battle of Bull Run I believe it was a little one-room schoolhouse that was pressed into service by the Union army. The “service” consisted mainly of a surgeon with a saw who knew how to separate limbs from injured soldiers. Anesthesia was a stiff shot of whiskey and some helpers to hold the screaming patient immobile.

How the patient was sewed up didn’t attract much attention in the few books on the subject, but the suturing and dressing had to have been pretty primitive. If the patient was lucky, he was transferred to an “ambulance” for a very bumpy trip back to Washington or wherever and a “respectable” hospital. Pictures show some of these hospitals to have been large tents with hundreds of bunks lined up cheek by jowl.

How anyone could have survived this level of care boggles the bean, but thousands did from all accounts. The alternative to surgery they learned early, was likely to be gas gangrene with certain death. Why this nasty bacterial infection? Those noxious Clostridium spore formers lived largely in the guts of horses. And horses — the engines of the Civil War — were ubiquitous. They contaminated the soil and the soil contaminated soldiers.

I once did an autopsy on a case of gas gangrene. The man had been kicked on the shin by a horse with an injury that just barely broke the skin. When crepitation was first detected around the knee, a hindquarter amputation was performed immediately. The patient still showed up in the morgue a couple of days later. Makes one a believer in the power of Clostridium.

So, how did those survivors survive? They must have been some tough dudes!

There’s an interesting audio quiz and history lesson on the Public Radio International website about first responders and the Civil War. Have a listen here.

Win the war on food-borne bugs in 20 seconds

Call Homeland Security—there’s an invasion on restaurants and kitchens everywhere. We’re talking about bugs. Bacteria, viruses, fungi, parasites…the ones you savor during mealtime then pay a big price for later. These microorganisms would just love to ruin your day with a good case of accelerated peristalsis, forward or reverse (you know it as vomit, upchuck, puke and the Aztec two-step, Montezuma’s revenge, or the Greek’s own diarrhea). Don’t let them win. Declare war on these bugs.

The culprits have many names, so we’ll just refer to them collectively as food-borne illnesses. The Centers for Disease Control and Prevention (CDC) estimates that each year roughly one in six Americans (or 48 million people) get sick, 128,000 are hospitalized, and 3,000 die of food-borne illnesses each year. While outbreaks of this and that get a lot of attention and spur concerns over food processing and food imports, the reality is that as much as 70 percent of food poisoning cases originate in the kitchen.

That’s right—people, not products, are the main cause of food-borne illnesses—and they can be avoided by following some basic principles of food safety. That’s where we come in. The CDC says the first line of defense to protect against food-borne illness is to wash your hands the correct way: 20 seconds with soap and running water. And be sure to scrub the backs of your hands, between your fingers, and under your nails. Most people don’t wash their hands right but winning this war means that changes.

We’re a longtime partner with the Handwashing for Life® to advocate and teach correct hand washing techniques. You can buy a DVD that demonstrates the why, when and how of good handwashing practice to motivate your employees and more. Of course you can use our products to check that you’ve washed correctly, too. Ready to fight the invasion of food-borne bugs? Reach for the soap and water and leave the anti-diarrheal medication on the shelf.

The fickle finger of fate at the Treaty of Versailles

The Big Four
The Big Four at the Treaty of Versailles, photo courtesy of Wikipedia

This is the second post of a two-part article on The Great Influenza’s impact on World War II:

The war ended with an armistice on the eleventh hour of the eleventh day of the eleventh month in 1918 (who said generals don’t have a sense of humor?) In spring of 1919 the allies gathered to hammer out a peace agreement with “The Big Four” (or Council of Four) in attendance: David Lloyd George of Britain, Georges Clemenceau (“The Tiger”) of France, Vittorio Orlando of Italy, and Woodrow Wilson of the US. Wilson was for treating Germany kindly and allowing it to recover its place among the community of nations.

But not Clemenceau. Now aged 77, “The Tiger” wanted to destroy and humiliate Germany so that it could never again be a threat to France. Wilson fought back and was so disgusted with Clemenceau that on occasion he threatened to leave the peace talks altogether.

But then the fickle finger of fate in the form of flu touched Wilson. He recovered sufficiently to continue with the peace conference, but he was but a mere shadow of his former self. He quickly acquiesced to Clemenceau. Germany was forced to accept the humiliating Versailles Treaty with its demands for huge reparations.

Germany sank into a severe depression. When Hitler showed how it would be possible to rebuild Germany’s economy and military, the German public enthusiastically looked upon him as their savior. And when Germany overran France in 1940, Hitler rubbed France’s nose in it by forcing the French to sign the surrender document in the same railway car in which Germany had been forced to sign the 1918 armistice agreement. But what was the explanation for the mental collapse of Woodrow Wilson? One of the sequelae of influenza is mental illness or deterioration (and in some cases even schizophrenia). This combined with pre-existing cerebral arteriosclerosis did the trick. Wilson’s will to fight Clemenceau disappeared. His brain was incapacitated. Wilson had a severe stroke only four months later and he never recovered.

Once again the 1935 wisdom of Hans Zinnser (American physician, bacteriologist, and prolific author) that the history of humanity is more often determined by microbes than by men is shown to be on the mark.

The rise of Hitler & World War II: The impact of The Great Influenza

The Great Influenza by John M. Barry

The story of the 1918-1919 flu pandemic is fascinating on its own terms and is superbly recounted by John M. Barry in his book, “The Great Influenza.” But did you know that this flu was the direct cause of the rise of Adolph Hitler and World War II? Here’s the story.

The virus itself was probably circulating before 1918, most notably in Etaples, France in 1916. Be that as it may, the pandemic itself was enhanced by the congregation of vast numbers of immunologically naive young men in camps such as Fort Riley, Kansas, its site of first appearance in the U.S., and then spread by them as they were deployed to Europe. Somewhere in its migration from birds to pigs to humans, the influenza virus (H1N1) most likely mutated to its ultimate virulent form. Regardless, there were three waves of infection: In the spring of 1918, the fall of 1918 and again in the spring of 1919.

Why this flu pandemic preferentially targeted young people is still debated. One suggestion is that prior epidemics of flu were immunologically similar enough that older citizens still had some residual resistance. The other obvious suggestion is that forcing large numbers of immunologically naive young men into close proximity in military camps was an ideal scenario for rapid spread. If it started in France or in Kansas, why was it known as “The Spanish Influenza”? Seems the Spanish press was uncensored at the time since Spain was not a participant in the World War. Therefore most of the news was printed in Spanish newspapers and it became “The Spanish Flu.”

Mystery of the Misery

bug-eyes-narrow

Why is it that dogs can drink out of mud puddles with impunity but tots cannot? Or maybe we could but just don’t know it. I’m not about to suggest that we perform that experiment, but it does intrigue me that within the past several years there has been a lot of talk about the “hygiene hypothesis.” Since it doesn’t promote the wisdom of “hygiene,” maybe it should be called “antihygiene” or “lowgiene.” We have all observed with fear our little rug-rats wrapping their gums around all kinds of debris they have picked up off the non-hygienically approved floor. Do they survive in spite of—or because of—this activity?

The hygiene hypothesis claims that we are getting all kinds of diseases, such as asthma and Type I diabetes, because we are not training our immune systems adequately. How? By avoiding exposure to all the germs that used to visit us in early childhood before we began bathing in soap and alcohol twenty times a day.

World population was 2 billion when I was born and is now 7 billion. Would the 1918 flu pandemic have gotten off the ground in the absence of crowded military camps containing thousands of potential hosts waiting for the virus to arrive? Probably not.

Pandemics seem to be one of Mother Nature’s favorite strategies for population control. Earth could support several times its current people load if we went to a vegan diet, but does a world population of 20 billion humans sound like fun?

On our present course it seems certain that global warming will produce widespread effects that will not, in general, be desirable. But are we also setting ourselves up for a global pandemic that will prune the population to where it might have been in the first place if we had listened to those who have been warning us for some decades? Or will medical science give us enough vaccines and new antibiotics to shield us from whatever bugs come along?

Given our penchant for not doing anything until it is too late, I suspect that our experiment will continue but with Mother Nature at the controls—population controls. Keep your fingers crossed and your seat belt fastened. It may be a bumpy ride.

Gordon Short, MD
March 2014