Army Medicine on the Eve of D-Day

In the Great House Clean Up the ratio of Trash to Treasure runs strongly to the former.  By about 1000:1.  But a few family treasures are being wrested from the attentions of the Mice.  And some things that just deserve a few minutes of thought.

My dad did an accelerated college-Med School program during WWII.  He graduated from the latter just after the war ended.  So this item would have been part of his reading material about half way through Medical School.

This is the June 1944 edition of THE BULLETIN of the U.S. Army Medical Department.  So, what was actually on their collective minds as the troops were heading onto Omaha Beach?

Well, its 119 pages long.

The first page covers this new fangled stuff called Penicillin, and various articles on this first of the real antibiotics total 14 pages including a delightful account by Dr. Fleming on its semi-accidental discovery.

But that takes a back seat to the various things that could go wrong with any army's most important bit of equipment, the feet of their soldiers!  Combing the totals for Trench Foot, fungal infections, injuries from obstacle courses and such, these add up to 30 pages, about a quarter of the publication.

Actual combat related material does appear, as US troops had been in action in the Pacific and North Africa.  But I got the sense that academic discussion of how to best debride and clean up wounds was a bit perfunctory.  Seems like one of those things you just have to do in real life to learn.

There are lots of little oddities to be found.  Three pages, with lots of illustrations, on how to construct a latrine system in an area where you can't dig pits.  A page on sting ray injuries.  And, given that this publication was created by merging Army medical, dental and veterinary publications, two pages devoted to "CORONARY OCCLUSION IN A RACE HORSE".

And how about ten pages on how to fumigate barracks with highly toxic cyanide gases?!

All pretty interesting stuff, but sometimes it just raises more questions.  For instance:

This was obviously another high priority subject for military medicine, but I always thought the concern was mostly that our boys in uniform - or actually out of same - would consort with  bimbos and perhaps the occasional Mata Hari type.  Indeed, one of my dad's few anecdotes on his military career involved doing what was called "short arm inspections" on the troop ship coming back from Europe!

That the Women's Army Corps were in need of similar moral education came as a surprise.  Were the Army docs worried about the gals consorting with himbos and Mata Harrys???

Help Wanted, President. Looking for a Qualified Applicant in 2024

Every four years, starting in 2011, I've posted my thoughts on politics under the title: Help Wanted, President.  I usually rank contenders on a point scale, giving them credit for various things that ought to help them govern wisely.  And Lord knows, it's a hard job and they'll need that help.  An ideal candidate might for instance have served in the military, had a career in business, and then gone into politics.  Again, in an ideal scenario, he or she would have started out small, perhaps as a State Assembly Person, and worked their way up to a responsible executive role.  Governor of a mid sized, politically diverse state would be very appealing.  I'm not into Historic Firsts as much as some, but I'll give a few bonus credits to a qualified candidate who brings unique perspectives into the Oval Office.  

Well, that's not the kind of election we're gonna have this time around.  There has been effectively no Primary process by which candidates are tested and the field winnowed.  Biden and Trump are both very well known, and each man is loathed by approximately 50% of the electorate.  

And its hard to look to the VP's as a tie breaker.  I believe Kamala Harris is considerably sharper than she is portrayed.  Some of this is the unenviable role of a Veep....don't show up The Boss.  If I were to apply my standard criteria to rating her she does come up a bit light.  She got her prior jobs as Attorney General and US Senator by political patronage in the One Party State that is California.  Her Presidential bid in 2020 was so lame that she had to bail before the first actual votes were cast.  You'd like to think that she's learned a few things in the last three and a half years.  But of course the question for her, and indeed for Biden and Trump, is whether she's learned the right lessons.

Trump's VP selection is not yet known, but will in the tradition of the day immediately be derided as some combination of evil and stupid, somehow even worse than he is, and that's sayin' something.  Who this person is, and what her (?) qualifications actually are will not be relevant.

So we have a classic Lesser of Two evils scenario.  I don't like these.  I've voted over the years for Democrats, Republicans and Independents.  I've had times when my choice won and disappointed me, and others when their opponent has won and turned out to be quite good.  Those who have been sworn in as President since my first rodeo in 1976 have varied wildly in both character and in competence.  The last genuinely good men I've seen in the White House were Ford and probably Carter.  The most effective politician was, despite his moral failings, Bill Clinton.  I'm leaving Obama aside for now....it takes a while for the perspective of history to come into focus.

When I posted Help Wanted in 2016 I described then longshot candidate Trump as "..a large angry man with orange hair."  He is without question an objectionable man with dubious morals and a tendency to bully.  His record is hard to judge due to the distortions of Covid and the continuous efforts of what is referred to as The Deep State to sabotage him.  He also made many poor choices in selecting people for his Administration.  He remains large, orange and angry, and he will want to get even with some people.  Some of whom, in my opinion, have it coming.  But pre-Covid the economy was good, we did not engage in many foreign misadventures and whether you liked it or not, we did have leadership.

President Biden on the other hand, is cognitively and perhaps physically impaired.  The clues have been abundant in the last couple of years.  Sheltered from demanding appearances, slurring and misspeaking, confusing the names of world leaders.  When the real villains of the world see the Commander in Chief stumbling and falling repeatedly they take notice and are emboldened to greater malicious actions.  The real time implosion of the myth of Biden Competence in the recent debate was shocking even as it was unsurprising.  It can't be unseen.  Softball taped and edited interviews with friendly journalists won't help.  Moderate ability to read off a teleprompter is not enough.  Every time he now appears wearing his Cool Dude aviator sunglasses the instinctive reaction is going to be that he is hiding weird, unblinking eyes.  I have a career in medicine and the experience of two parents with dementia, I've seen this movie.  It never has a happy ending.

We've had impaired presidents before, and it has gone badly.  Ronald Reagan was not well during the latter part of his second term.  We got Oliver North running an illegal, spooky foreign policy on the side.  Woodrow Wilson seriously botched the reorganization of the world in 1918-19.  We are still paying the price for that.  The parallels between Edith Wilson and the current First Lady are unsettling.

Oh, but we've always muddled through.  Yes, but in times that were less complex and in which the power of the Presidency was more constrained.

I think the current administration - and it is with difficulty I avoid the term regime - has seen this coming for a long time.  And like all desperate factions has been willing to do anything to stay in power.  We've never had a President send armed agents to raid the home of his main rival.  Professions of non-involvement aside, the efforts to keep Trump off the ballot, tied up in court, maybe actually in jail, are the stuff of  banana republics.  Once normalized by success they would be repeated.

So I'm hoping for the best.  As of now Biden vows to fight on.  It's about even money whether that will soon change and Vice President Harris gets to make her case.  Ideally she'd tap a running mate to reassure those of us whose votes can be swayed.  Trump could and should do the same.  He's sharper than Biden, but he's not young either.

Perhaps we'll see  Harris-Beshear vs. Trump-Stefanik.  Each team would have a fair bit of baggage to unload, but our Republic would be better served by this option than what is barreling down the road at us presently.

My previous Help Wanted posts....

For the 2012 election

For 2016....what happened???

2020 The Covid Election - with bonus Woodrow Wilson insights

I feel a little left out

I'm going to go out and tempt fate here*.  With the CDC basically saying that Covid-19 is just another respiratory virus I now feel just a little cheated that I never got it. **

I know many people who did.  Their recoveries had an element of nobility to them.  They took on the greatest malady of our times and prevailed.  Sometimes they got to get up on their soap box and gripe about some person they encountered who DID NOT WEAR A MASK!

I just went through life figuring if I got it I got it, and that beyond a certain point all these precautions and masks would prove to be exercises in futility.  And so it has come to pass.

I think most people took this all in stride.  The small percentage of the population that just went nuts over this were probably unreasonable about other things before Covid and will now move on to being unreasonable about other things.

It is a shame that the whole darn thing got politicized, and that the measures to counter the disease were - in retrospect - so draconian.  I've been working with middle and high school students for 25 years and counting, and can tell you that the damage to academic achievement and to their world generally has been profound and malign.

Oh, something will get me eventually.  That's probably the truest thing I or anyone else could ever write.  But it is my intent to just carry on.  I'm not going to do anything that is clearly stupid....no motorcycles in my future  But while I won't live forever I certainly won't live in fear.

________________________

*Fate being duly tempted I did get dismal-ill on the trip to Florida.  Cough, runny nose, fatigue.  Covid?  Who knows, I just slept it off and treated it - per CDC now - as a poorly timed case of the crud.  Fate....it's always Hubris then Nemesis, isn't it?

** Realistically I probably got Covid in early March of 2020, too early to have testing available.  36 hours of scratchy throat and fatigue.  Nothing that rest and beer could not overcome.

An ER Miracle

If you are expecting a heart warming tale of a miraculous recovery from a serious illness, sorry.  That sort of thing is actually pretty common.  Oh, sure, the first few times you see an apparently comatose patient wake up and look around after you give them a dose of Narcan (reverses opioid overdose) or glucose ( 'cause having a blood sugar near zero ain't healthy),  its pretty impressive.  But this story is about something far, far less probable.

It was a night about this time of year.  There is usually a cold, dark, unhopeful stretch right after the holidays.  It was snowing.  And I was the only doctor working a small ER in Northern Wisconsin.

The ambulance brought in a man suffering from severe depression.  This is of the "no hope, suicidal" variety and as such not something that a pep talk and a prescription for anti depressants that will start working next week is in order.  No, this man needed inpatient psych care.

But there was a problem.  He was a VA patient.

Things have gotten better in recent years but for a long time the Veteran's Administration health care system was legendary for its callous, inefficient, slow nature.  Patients could not get in the door, and if they did they could expect to sit on gurneys in the hallways for a very long time.  Probably it started with the attitude that "You GIs are used to waiting in lines and obeying orders, so just keep waiting around and do what we say".  This of course is not being fair to the many VA employees who cared a lot, nor is it unreasonable to note that some segments of their clientele are patients of the most challenging sort.  For a long time, if you had "better" health care options you used them.  Those who did not, had much higher rates of homelessness, mental health and substance issues.

But that's not relevant to our story.  

The patient was a nice guy.  He was trying to do his best in a situation where he had little support.  He was not one of our "regulars", that challenging cohort whose creativity and tenacity in seeking narcotics was as impressive as it was aggravating.

What I'm about to say next will not be believed by anyone who has ever worked in an ER, or who has had extensive contact with the VA healthcare system.  I understand your disbelief.

Within 90 minutes I had spoken to the nearest VA hospital that had inpatient psychiatric services.  It was in Minneapolis, probably three hours away in good weather, longer under current conditions.  I had him approved for admission, the receiving resident briefed on the details, the records faxed and the ambulance putting wheels to slick pavement.

How is this possible?  That would be a longer story.  But it is always important to know who makes the decisions in any system and what motivates them.  It never hurts to be relaxed and pleasant in your conversations....none of which should be delegated to others.  Most inefficient systems are actually staffed by good people, you just have to appeal to that goodness and encourage them to do the little bit of extra work that their protocols don't strictly require.  

I hope the old soldier did OK.  I never saw him back in my ER, so most likely things worked out.  As a victory over bureaucratic inertia this was way up there in the difficulty level.  But I don't gloat over this one as I have on a few other occasions*.  A simple and sincere thank you from the patient, which I duly passed along to the VA, was sufficient reward on a cold, bleak night.                            ---------------------------------------------

Medical Software Gone Wild

Bureucraticus Victrix

Tales of the Old Lieutenant

Now and then I do a bit of housekeeping, cleaning out drawers and such.  Recently I came across a big stack of cards.  It was a mixed batch.  Sympathy cards after my dad's death.  Thank you cards from families of robotics students.  Well wishes on my retirement from family practice 16 years ago.  When you switch over to the less personal ER work you don't get quite as much in the way of personal thank yous.

One note was about 20 years old.  It was from the family of a long time patient and thanked me for a story I had told at his visitation.  This was something I had entirely forgotten about, but I sure remember both the patient and the story.

The Old Lieutenant was a classic example of The Greatest Generation.  Small town boy.  Joined the Army.  Became a combat officer in Italy.  Came home, started a career, married his sweetheart and had a bunch of great kids.

Unfortunately he also was of the "smoke 'em if you got 'em" generation, and carried his pack a day habit with him when he took off the olive drab and put on civvies.  He had emphysema, and bad.

I took care of him for many years.  After a while he and I both had things pretty well figured out.  What combination of breathing treatments, steroids, antibiotics and oxygen would pull him through a flare up.  Usually we were on the same page.  But the man could be stubborn.

Once I had him in the office and could see that he was heading for trouble.  His color was not good. He was breathing a little faster than he should.  The long ago sweetheart and I both wanted him admitted but he refused.  Well I was always of the opinion that I work for him not the other way around, so we opted to try him with home treatment.

I was expecting to get a late night call that he was on his way in by ambulance but instead he turned up a few days later in the office doing better.

He did admit that it was touch and go for a while.  Between lack of sleep, low oxygen levels and the side effects of big doses of steroids he was both short of breath and feeling confused.  He found that at least the breathing aspect of this was better if he sat in his lawn chair in his garage with the door open.  A gentle breeze, a little cool air.....it was a minor bit of relief but a welcome one.

And then he looked up and saw a large, hostile raccoon staring at him.

Now, when you have been hallucinating there are limited options for deciding whether a sinister apparition like this is real or not.  He yelled at it.  Nothing.  He waited for it to go away.  It did not.  Finally he decided that either the raccoon was imaginary or it was a seriously ill and deranged critter.  The raccoon perhaps had a similar notion.

But what the raccoon did not have was a shovel.

Mustering his considerable determination he stood up, grabbed the nearest garden tool and beat the potentially rabid raccoon to death.

That's how he knew he'd make it through this flare up, and in fact I had the privilege of caring for him for several years after that.

Nutritious Drinks on the House

In the interest of not being an Old Grump I'm going to say something positive about the modern world.  Man, we get lots more fun packages.  Makes sense of course.  Its the internet and Amazon and the decline of in person shopping.  See it, click on it, money you never actually touch flies away somewhere else and minions show up to leave things on your porch.

Sometimes they are real surprises.  Hmmm, this one is heavy.  I didn't order anything like that.

Lets peek inside.....

What you see first is a huge stack of coupons for money off of Ensure.  If you are under say, 60, you might not know what that is.  Sold as a nutritional supplement for Weak and Elderly folk its kind of like Energy Drink for Geezers.  And under the layer of paper....

The good folks at Ensure decided to ship me 12 pounds worth of Nutrition shakes.  They do this on an intermittent and seemingly random basis.

Of course it is because I was a primary care physician quite a few years ago.  They hope I'll hand the coupons out to my elderly patients.  Who gets the actual bottles of stuff I'm not sure.  Interesting the things that still turn up 16 years after I left primary care and 7 since I retired from medicine entirely.  

Or is this not random at all?  Does some devious computer program keep track of retired physicians and send them boxes of Geezer Juice every once in a while?

Signs of Spring - Taste of Novacaine

On a day with the first real promise of Spring, my view from the dentist's chair.

I'm not a great patient.  It's not my dentist I'm grumpy with, he's great.  No, I am unhappy with my teeth.

We expect our teeth to be loyal, durable soldiers.

Deserters have throughout history been regarded with contempt and shot at sunrise.

A Rare Product Review. Actually a Warning.

One branch of the family is in on a sort of "subscription pantry" deal.  They pay a fee and every few weeks go and pick up a bunch of food.  Lots of it.  Some of it is great.  There's always ice cream.  Some items are perishable.  The warehouse is clearly getting oversupply from restaurant suppliers.  Hope you like bananas.  Or kale.  Or both, 'cause you'll be eating a lot of it for a few days.  And then making banana kale bread with the left-left overs.

Some of the stuff is near or even a titch past expiration date.  A fairly high percentage has Spanish themed packaging.  

But overall it is great stuff, and a family with two ravenous kids does well.

A few things they don't care for or want the tykes to consume.  Give that stuff to grandpa.  This includes most of the soda pop.  Some of the pop is normal stuff.  Oh, maybe the cans are a bit dented or some such, but just fine.  Some of it is odd stuff.  And then there was this:

Here, take a closer look:

It is officially called Mtn DEW Flamin' Hot.  Caffeine, chili peppers, citrus flavor,  fluorescent red dye and who knows what else.  I assume the target audience is a demographic that communicates - after a fashion - in chopped up word fragments and abbreviations with minimal punctuation.  The demon on the label really should have tipped me off, but I was thirsty and took a big swig.  That was forgivable.  The second swig was just stupidity.

This stuff immediately gave me symptoms that back in my clinical days I'd have said suggested an inferior wall myocardial infarction.  Rapid heart rate.  Upper abdominal discomfort.  Mild nausea.  I felt crummy for a couple of hours.  You may notice that the bottle is empty.  I poured it down the sink and sluiced it through with a lot of water.  Straight up I think it would burn through the pipes.

Evidently this was a trial product, only available for about six months.  Its appearance in the sometimes outdated but usually very palatable food pantry stocks may well have been its final, vengeful appearance in the marketplace.

Good riddance.

"A Pox Upon You!" - Modern Sensitive Edition.

In the odd news of last week I found this: "Monkeypox to get a new name, says WHO".  Why?  Well it is the usual strange modern sensibilities. 

'It comes after more than 30 scientists wrote last week about the "urgent need for a non-discriminatory and non-stigmatizing" name for the virus and the disease it causes.'

Wikipedia image: credit Carlos Delgado

This of course begs the question of exactly what stigma and potential discrimination is involved.  Presumably the semantic gymnastics here have arrived at the conclusion that Monkeypox will cause offense to the continent of Africa and the inhabitants thereof.  Never mind that monkeys are also found in South and Central America, Asia, a few hanging on at Gibraltar and some colonies of escapees thriving in Florida.  

I don't make light of any disease, but you have to admit that Monkeypox is a funny concept.  I recall David Letterman going on at length about it back when he was entertaining.

But if that is how the World Health Organization wants to play ball then fine.  Did you know that there are lots of other "pox" diseases?  Here's a partial listing with, as necessary, my comments on why they MUST BE CHANGED NOW.

1. Camelpox.  Clearly offensive to various nations and ethnicities in the Middle East.  It must go...even though the only human transmission of the infection occurred in India.

2. Cowpox.  As a citizen of Wisconsin - America's Dairy Land - I am profoundly triggered and offended.  

3.  Goatpox.  Given the initial reports of Monkeypox turning up at STD clinics I'm not goin' there.

4. Horsepox.  A Pox upon My Little Pony?  I'm on board for that one.

5. Raccoonpox.  Masked thieves.  Offensive to the "justice involved" demographic? 

6. Sealpox.  The Inuit People of the Artic rise up in outrage.

7. Sheeppox.  Not goin' there either.

8. Squirrelpox.  Since this is a disease brought in by immigrant grey squirrels that is wiping out native populations of reds squirrels in the UK, any mention of it must be anti-immigrant MAGA disinfo.

9. Skunkpox.  Fine. A species whose reputation can go no lower.

10. Swinepox.  Certainly offensive to the great state of Iowa.

11. Volepox.  If you know what a vole is feel free to comment and raise the battle standard for Vole Rights.  If you have a Voter Rights flag a few bits of duct tape will suffice.

Special Dishonorable Mention number one:  not a specific vector but Lumpy Skin Disease Virus is in the same family.  It is clearly stigmatizing to most of us over 50.

Special Dishonorable Mention number two:  There is an entire subfamily of pox viruses that affect birds.  To keep my screed short I've left these off.  But Canarypox is obviously a dog whistle reference to the Monkeypox outbreak that got well and truly up and running at a wild party on the Canary Islands.  And somehow somebody will take offense at Penguinpox.  

Observant readers will note that I am giving a free pass to a couple of better known pox diseases.  Chickenpox, while perhaps offensive to those with social anxiety disorder, is actually named not for the domestic chickens but for chick peas.  This admirably Vegan legume does look a bit like chickenpox lesions, at least until they hit the oozing and crusting stage.  And Smallpox.  Oh sure quite offensive to Little People but the disease is extinct, no longer found in the wild and known to be held under the tightest security in a single US lab.  Oh, and also one in Russia which should be OK because they have not had a major biolab Ooopsie in roughly fifty years.  Not bad by the standards of geographically unspecified Communist countries....

Here's the CDC's full list of pox virus diseases.  Expect it to be tidied up shortly.

Covid 2022 - A Look at the Stats while we still can.

Stuff you read on the internet should always be checked, especially things that seem remarkable.  So when I heard that hospitals would no longer be required to report Covid 19 deaths I was pretty skeptical.  But I did find the source, a very dense document from January 9th of this year advising hospitals that as of February 2nd the Department of Health and Human Services would no longer be requiring them to report Previous Day's Deaths from Covid 19.  

There are several possible interpretations of this.  On the one hand it is pretty clear that deaths "from" and "with" Covid have been so blended together that the statistic is not that helpful.  Or if you are of a more cynical point of view the acknowledgment that Covid has not been eradicated is "not that helpful" to the political fortunes of the current beleaguered Administration.  Of course we will still get daily rations of Scary News regards record "cases" and increases in subcategories such as pediatric cases.

Soon we'll be consuming a steady diet of frightening anecdotes. So, while we still have the numbers lets have a look at incidence and fatality.  In most northern states the omicron variant has resulted in record numbers of cases, most of whom - allowing for a whole lot more testing - are younger than in prior waves and are not getting particularly ill.  Deaths are also up but far from earlier peaks.  The demographics of fatalities in places that actually report useful data are worth a look.  Here's my home state of Minnesota.  It's a bit hard to make out, but all those lines near the bottom indicate a very low death rate in people under 60.  Under 20 does not even register.

Digging deeper into their stats you find that the average "case" is 36 years old, the average ICU hospitalized patient is 63 and the average age of those dying from Covid is 80.  That stat caught my eye.  To have an average age of 80 there must be some real oldsters in the sample set.  Indeed, deaths were recorded in patients ranging from age 1 to age 109.  As an aside I can say that other information mined from the Minnesota data indicates that virtually all recent deaths under 30 have significant co-morbid conditions or are just fanciful.  Several were fentanyl overdoses with an incidental positive Covid test noted.

Northern states are always disease ridden in the Winter months.  That's why people move to, oh I don't know, Florida maybe?  And Florida might, hopefully, be showing us the future.  There have been some bad stretches down in the Sunshine State.  All of them gleefully reported.  But through some combination of weather, prior disease, immunization and who knows what else, Florida has massive numbers of positive tests and, well, have a look.

Cases:  Averaging 61,500 a day.  Pretty bad....

And deaths.  While acknowledging that each death is tragic to the families involved, a rolling seven day average of 9 deaths a day suggests to me that barring some new, horrid variant, Covid is nearly over.  I don't have age breakdown for Florida cases by week, but their overall stats since the beginning of this horror mirror those of Minnesota closely.

Sorry to bring up a subject that everyone is tired of and that makes a lot of people uncomfortable.  But if even imperfect statistics are soon going to be discarded, 'cause Science or something, this is our last chance to see beyond the Scary News.

 

Endemic - 2021

Right about now we are at the two year mark for Covid-19.  There are so many things we still don't know for sure, despite spending time, money and other societal resources in unimaginable amounts, but I think it is fair to say that it started in the last few months of 2019.

I should note up front that there are things that you are not permitted to say in various versions of the Public Square.  I'll try not to stumble close to any of them, but to be honest in some cases information has gone from Fake! to Misinformation, to Plausible, to Probable....and back again.  I'm going to assume anyone who has bothered to read this far is not the mindless sheep that the Guardians of the Internet assume us to be, and is capable of weighing competing viewpoints and actually pondering them.

So, what's going on with this data:

These graphs are from Worldometer the morning of 15 November.  They are specific to Wisconsin but are similar to data from across the Northern US.  They indicate a rise in "cases" and a simultaneous near disappearance of deaths.  I'm putting cases in parentheses because that is a grab bag of things from sudden, severe illness down to feeling punk, further down the ladder to runny nose, and ending up with no symptoms or even potentially false positives.  Death is the ultimate in unambiguous and so gets no quotation marks.  Although even there the issue of dying of versus with Covid is a fair question.

At the time of the above graphs Wisconsin stood at just above 60% of the population vaccinated.  The numbers are somewhat opaque, and don't specifically indicate the percentage of eligible people vaccinated.  With the recent increase in the eligible pool coming from approval in younger children there should have been some jumping around of these percentages if they accounted for that approval.  So like many Covid numbers all you can say is that lots of people are getting immunized.  It is reasonable to infer that in the demographic actually at risk for serious illness the numbers are much higher.  I've seen stats suggesting 98.5% rates in seniors with about a third already getting the much vaunted booster.

So, to return to the two graphs - one grim one cheery - I'd conclude the following.  Covid rates are still significant.  But the percentage that are getting seriously ill has dropped to almost nothing.  It is only back of the envelope math, but the overall rate of US Covid mortality is around 2%.  On November 9th three people died of Covid in Wisconsin.  With the usual two weeks or so lead time between infection and demise, and roughly 3000 cases a day in that time frame, the current mortality rate is .1%.  A twenty fold drop.  So how's that possible?

Lots more testing increases the cases number.  Especially in advance of holiday travel.  This is not entirely good or bad, but mostly good.  You should be tested before you go see grandpa in Keokuk.  More testing, especially in the younger demographic, more results and more positive results.

I also strongly suspect that the number of "breakthrough" cases in the vaccinated is considerably higher than reported.  Heck, the acknowledged rate is already much higher than what was being reported a few months back.  Are the increased case numbers 10% breakthroughs?  20%? Higher?

But at least Covid is no longer causing deaths at the rates seen a year ago.  There are multiple factors in play, some optimistic, some not.

Treatment has gotten better.  We were supposed to have a two week lockdown to help the medical system prepare.  If two years has not done it, well we'll never be ready.  And there actually have been some much improved treatment options.

Immunity, both from vaccine and from getting the darn stuff, does seem to protect from more serious disease.  Better data on the specifics (acquired vs natural, various vaccine combinations, assorted age demographics) would be nice, but again after inconceivable expenditure the answers on this as in so much else, are elusive.

And finally, sadly, the cohort of people most likely to die of Covid has already been hit hard.  The ranks of frail elderly people with co-morbidities has been clobbered, with deaths from the disease, from an over strained health care system, from deferred screening for other things, and from just plain loneliness and isolation.

Well that's how it all looked on the morning of 15 November.  I got my booster yesterday*.  I got pretty loopy from the last one and for a brief shining moment understood the complete inner workings of quantum physics, Cosmology and the Drake Paradox.  So maybe all the above data makes total sense to me this morning.

Above is a scene from Time Bandits.  The weird midgets have stolen the map that shows the complete structure of the Universe including all the holes and patchwork.  Those of you who know me, feel free to comment on which dwarf you think I most resemble.

-------------------------------------

 *That's my decision.  If yours is different I'll respect it.  If the opinions I express above make you unhappy I'll respect that too.  In the end it's about our own Mortality.  This is the most uncomfortable of all subjects.  We are, all of us, in a fight against Time.  It is a fight that we must inevitably lose.  Sooner or later we all end up on our own personal Last Stand Hill.  So how will you be remembered by those left behind?  Keep in mind that Bravery, although laudable, may not always be the ideal stance.  Don't be like George Armstrong Custer and lead those around you to disaster.  But keep in mind equally that Lack of Bravery, while understandable in flawed humans, will give you no advantage against the ultimate enemy.  Time flies the Flag of No Quarter.

Forgotten Brewery Caves - Rochester Minnesota

As I mentioned in the recent series on Mayville Wisconsin brewery caves, off site storage caves are the toughest to research.  Breweries are relatively visible, well documented and usually in predictable locations.  But what if the brewery had a cave somewhere on the edge of town?  There would be nothing on the maps and if you think about it they would not want to advertise that there was a cellar full of beer tucked away out of sight!

Similar to Mayville this story begins with a house for sale.  At this point it is probably best that I just turn this over to my friend Gabe, one of my Underworld Contacts.  His video is used with permission.  Feel free to skip over the parts that don't interest you.  Like the $500,000 price tag for the house.

Well.  It's hard to know what to make of that.  It is clearly in an area of previous stone quarrying.  But that's not a deal breaker...where else would you find the geology to build a storage cave?  The general configuration and the multiple vents make it difficult to buy this as say, a sand mine.  The visible pick work looks 19th century.  The water tower and the Plummer House above are 20th century.  It is a bit confusing to have the newer pipes running through but that's part of what makes this one interesting.

There were three breweries in Rochester during the 19th century.  There is, alas, little to point to one as a prime suspect for this cave.  My Google Earth fly through suggests that all three were on flat ground and would be candidates for off site caves.  By size alone I should think the Schuster brewery which was around from circa 1857 up to Prohibition would be the best candidate.  Alas, none of the maps of 19th century Rochester extend this far out into what looks to have been a dreary industrial area.

Now of course it is quite tony.  In fact this neighborhood having once been called Quarry Hill has become in local slang "Pill Hill" as it is where the physicians of Mayo Clinic have built and maintained some very nice houses over the years.  I'm out of that world now but there was a time when it was a major status symbol to own a home built by an early Mayo physician.  And near the pinnacle of social standing, and of the hill physically, was the Plummer House.

The property with the caves behind it was once the pump house for the Plummer Estate.  Dr. Henry Plummer built the house in the style of an English Manor house in 1924.  The water tower on the property is said to be earlier, circa 1919.  The pump house proper was built a couple of years later in 1926.  With the Plummer house being so over the top architecturally it is of course possible that they could have hand excavated a cave just for the heck of it in the mid 1920's, but the otherwise pointless side tunnels make it unlikely that it was simply a place to run pipes.  A much smaller service tunnel could have been drilled mechanically and with much less effort in the 20th century.  One small detail from the video that caught my eye was an abortive attempt to hand drill a vent.  It's something I've seen a time or two - Brownsville for instance - and has always struck me as very labor intensive.

A definitive answer?  We might not get one.  The enigma of the cave has attracted some attention and I did find a commentary that references information from the local historical society.  On the one hand a Plummer daughter opined that her father intended to grow mushrooms but never got around to it.  On the other hand the son of a man who helped design the house wrote in a 1980 letter that the cave was pre-existing.  I find this more plausible.

A couple of side notes.  Gabe is clearly a kindred spirit.  His Youtube channel shows a man having a great deal of fun in life.  I recommend it as a day brightener.

And I mentioned that the Plummer House was near the pinnacle of Rochester social circles.  At the very top of course was Mayowood, an elegant mansion built on 3000 acres by Charles Mayo in 1911.  In the Mayoverse this is something akin to the Vatican or the Pantheon.  Many years ago in an interesting phase of my career I was actually invited to a private reception at Mayowood.  I thought it was OK, they served some very nice wine.  I don't recall much else, in fact I found it rather boring.  But our friends employed by Mayo Clinic were astonished.  My blasé attitude aside a private invite to Mayowood apparently was an honor to which many aspired but few were accorded.  

Meh.  The wine was good.

Rather a Wrong Number

Today a story that I think happened.  I suppose I should know, I was there after all.

It was 1983.  I was starting my second year of residency.  I and another fellow were doing a medicine rotation at the local VA hospital.  They have a new one now but at the time it was exactly what you think of when you conjure up an image of a VA.  Old.  Red brick construction.  Inefficient.

Being free labor for them Joe and I were given all sorts of jobs normally done by others.  We ran stress tests for instance.  Oh, and all post discharge planning and arrangements were our responsibility.

We had a patient who needed to be discharged to a nursing home in another part of the state.  And of course it fell to us to make the necessary calls.  

Now the VA at this time was using something called the Federal W.A.T.S. system.  The acronym stood for wide area telephone system and it was a way to make long distance calls without long distance charges.  Or helpful operators.  It was, well did I mention the inefficient part?

So I dialed the number of the nursing home.  The phone was answered on the second ring with the words "White House".  Now, I was not born yesterday so my first thought was that there might be a "White House Bar" in - as I recall it - Spenser South Dakota.  So I asked "Um, you mean the actual White House?"  

There was a pause before an entirely humorless voice assured me that I had indeed called THE White House.  And it wasn't the gift shop either.

That conversation was over quickly.

So, what actually happened?  Given the clunky nature of the VA specifically and the Federal Government generally I believed at the time that indeed, I had inadvertently called 1600 Pennsylvania Avenue.  But if instead I was being punked then I belatedly salute the unknown Master who pulled it off.  No imitating Ronald Reagan, no emotion other than palpable annoyance.  Perfect timing.

No, I still believe that I accidently called The White House.  Lordy I hope the phone that rang on that end was not red.

Staph and Staff

I have a fondness for homonyms, words that sound alike.  Strictly speaking what I'm going to discuss today are mere homophones, words that sound alike but have different spellings.  There are rules for this sort of thing I guess, and some would insist on having their entrants be of completely different etymologies.  But the more word sleuthing you do the more common ancestors you turn up.

Consider staph and staff.

Staph, or if you are on less familiar terms, staphlococci, are a family of bacteria notorious for causing infections.  They show up under a microscope in cozy little clumps.  This gave them their name, which comes from the Greek staphyle meaning a bunch of grapes.  

Staff is a much more complicated word.  It may go back to an even older Paleo-Indo-European word, stebh.  The Greek word probably comes from this root, and incorporates both the concept of the cluster of grapes and the grape vine proper.

Other linguistic variants of the word cover assorted pillars, posts and poles including walking sticks/herding tools that we refer to as staffs.  

By the 1700's it became a term for a group of military officers who assist a commanding officer.  This is a German variation and seems to be based on the baton as a badge of office for the highest ranked officers.   Germany is the only nation in recent years to issue batons to Field Marshals but it used to be more common.  The Duke of Wellington supposedly held the rank of Marshal in the ranks of eight different Allied armies and got a baton from each of them to add to his two British ones!

The non martial use of the term staff to describe a group of civilian employees is pretty recent, dating to 1837.

On occasion the two words come into conflict.  After all, the last thing the people staffing your ICU want is....staph.

Random Internet picture of an ICU staffer.  Apparently from Tree Frog General Hospital.

Disease Etymology II - Under the Influence

The Current Unpleasantness is without precedent in our life times but has some analogs in past Influenza epidemics.  1918 struck with a ferocity nobody saw coming.  Ever since we've been nervously worrying that it might hit us that hard again.  So we've devoted a lot of resources to vaccines, medications, surveillance, etc.

Influenza is another very interesting word, so much so that to clip it down to "flu" is a grave disservice.

I have to confess this one surprised me a bit.  I had assumed that the term only went back as far as 1918.  That bug got called Spanish Influenza not because it had much to do with Spain but simply because the news media there were able to report it without the wartime censorship of other nations.  Influenza sounds vaguely Spanish so I assumed the term began there.

Oh goodness no.  It goes much farther back and is of Italian origin.  Tracing words is a bit like tracing epidemics.

At least as far back as the early 1500's the term influenza is used in reference to diseases.  This was on the basis of then prevalent thinking that there were astrological "influences" of the stars and planets on such matters.

It comes from the Latin influentia, meaning to stream outward from.  Astral influences will sorta do that I guess.

 Oddly the word "fluent" which sounds the same and also implies a sort of "flowing" seems to have different roots altogether.  Go figure.

Etymology of Corona Virus - Naming names....

As the Current Unpleasantness drags on I struggle to find things to write about.  It's not as if I'm doing anything fun.

So how 'bout a week of Disease Etymology, starting with everyone's fave, Corona Virus.

Corona viruses are so called because under an electron microscope they have projections going out in all directions.  This reminded early investigators of the "corona" in the sense of light radiating out from the sun.  But the word is very old and generally means other things.

In Latin corona means "crown".  If you picture a stock image of a medieval king with that pointy headgear you get a bit of a sense of radiating things, but in Roman times it was a bit more explicit, with the "rays" being in addition an emanation of wisdom, or power or noble worth.  You see this on assorted coins of the era...

Of course the Romans had some original words and ideas but swiped both on a wholesale basis from the Greeks.  In Greek the word is korone.  It meant "curved", and likely was a reference to the laurels that were often used to honor the worthy in ancient times.  Of course there are coins for that also...

The concept of a laurel wreath as a badge of honor still lingers on in odd corners of our world.  Consider for instance the title Poet Laureate.  

There is some debate as to how the curved part of the word came to be.  Some hold that the beaks of crows have that kind of shape and that it carried over.  Crows have been designated as the genus Corvus and given their reputation for being harbingers of ill fortune this might be an appropriate and millennia long curving around to get to the modern covid-19.

As always there are parallel words that also come down to us from the same source.  Cornice for the "crowning" portions of a building.  Also, oddly, coronary which initially referred specifically to the arteries supplying the heart.  Anatomists in the 1600's noted that they curved down around the muscular portions of the heart as they supplied it with blood.

With a word this ancient and with largely positive, regal connotations, it is no surprise that advertisers have latched onto it.  Some are now regretting this.  On a vital supply run I did inquire and learned that sales of Corona Beer are down 50%.  I have no data on the resale value of Toyota Corollas. 

Pandemics and Me.

Like all of you I am being inconvenienced by the corona virus pandemic.  Well, that's hardly fair.  I'm being inconvenienced but a lot of people are having their paychecks, retirement accounts and small businesses severely tested.

This too shall pass, although nobody knows exactly when.  Everyone hopes that days of sunshine and warmth will cause the virus to slink off the stage.

There's a lot of anxiety out there.  More than I remember in the previous such incidents.  Oh yes, this is not the first time I've been around when the First Horseman is supposedly galloping into town.

I have vague memories of polio.  This now extinct disease was once among the great terrors of parenthood.  It hit young children.  It paralyzed them.  They died or lived in iron lungs.  In its own way this was far scarier than old people dying.  I would jump in front of a bus for my grandchildren.  I would do the same for yours.

I recall when still very young hearing that you should not run through a water sprinkler on a hot day.  Because that caused polio.  At the time this was just the lingering "after rumor" from an earlier era where it was only vaguely understood that the virus could be water borne.   I might have gotten the first inactivated polio vaccine in the late 1950s.  I do remember getting the oral "attenuated virus" vaccine when it became available circa 1961.  There was a tiny paper cup half full of pink liquid.  I was in the basement of a school.  I swigged the stuff down and wondered why it did not taste much like medicine.

My next brush with Pandemic was in 1976.  A strain of the H1N1 influenza appeared out of nowhere and killed a military recruit in Fort Dix New Jersey.  It was feared that this was the same strain as had caused the great 1918 Spanish Influenza pandemic that had killed unimaginable numbers of people.

Then President Gerald Ford took action.  A vaccine was rolled out.  His own sleeve was rolled up, and he publically got vaccinated.  I did too, in the student union of my college.  I remember very little of this.  Just standing in line.  And that the student union building was so aesthetically atrocious that it offended my sensibilities even at a time when I  sported large sideburns and wearing way too much polyester....

The Swine Flu pandemic never got off the ground.  Did the vaccine turn the tide?  One hopes so, as it had a legacy of - still controversial - causing a number of cases of vaccine related paralysis.

Since then the science has gotten better and the general nature of mankind has gotten sillier.  

I don't know if we are over reacting this time around.  As in 1976 it is an election year, that hardly helps the situation.  But everyone now is taking this seriously and it is encouraging to see the country united in this effort.

Hope you are all well prepared to ride this out.  Me, I've got some backlogged writing to do and a few books I need to get onto.  Several speaking gigs are or will be cancelled but they can be done another day.  Digging in England in May.....not looking too great at the moment.  Betting on a swift and effective response from the NHS.  Dubious.

But having shaken off a few non Covid-19 maladies this winter I'm doing great.  And I've laid in a supply of decent beer.  I can live on ramen noodles if necessary.  But life is precious, uncertain and always too short to drink bad beer.

Plague Stone

Last time I mentioned that on a visit to Penrith the author Daniel Defoe inspected various historic features including The Giant's Grave.  I wonder, no, I quite suspect, that he might have visited another obscure site on the edge of town.

This is a Plague Stone, to be found on what would have been the outskirts of the community.

Some background is needed here.  Penrith being a border town in the north of England had to endure frequent unrest due to uprisings of Scots, Rievers and assorted ruffians.  Unfair as it may seem, they also had periodic bouts of Bubonic Plague.  The most serious episode occurred over 1597 and 1598.  About one third of the population perished, with the victims ranging from the heir to the local Lordship down to the humblest of citizens.

There was at the time some understanding of contagion, and this posed a problem.  In towns you had money, a need for food....but you also had the Plague.  In the thinly populated countryside you had food, usually little or no Plague, but also.... no money.  Markets were closed for obvious reasons.

The answer was to set up Plague Stones at the edges of towns.  These were stones with carved hollows in the top.  The depression would be filled with vinegar, thought to be an antiseptic.  Townspeople would approach, put their coins into the vinegar, then step back.  Farmers would come, take the money, and leave produce.  A rather effective triumph of capitalism if you think about it.

Here I am pretending to toss a coin or two in, expecting lunch to turn up.

Surprisingly it did.  A nearby house keeps chickens and despite the presence of a busy road behind me they were allowed to be loose.  They promptly marched over to see what I was up to.

mmmm, Chicken dinner...

No, I did not have a nice lunch at their expense, I doubt the local magistrate would have been impressed by my knowledge of local history.  But lets get back to Daniel Defoe for a moment.

Defoe has possibly the greatest biography of any writer ever.  He was a merchant and a ship owner.  For a while he owned civet cats to make perfume.  He spent time in prison for both his problematic political beliefs and his frequent debts. He at various times ran a brick factory and was appointed a government inspector deputized to collect the tax on bottles. He is known to have been a spy for King William III.  He wrote on an amazing range of topics using 198 known pseudonyms.  When he died of "lethargy" in 1731 he was probably hiding out from his creditors.

Defoe is of course best known for Robinson Crusoe, but he wrote many other memorable tales including Moll Flanders.  Two of his lesser known works have a bearing on our tale.

Between 1724 and 1727 he penned "A Tour Thro' the Whole Island of Great Britain", a very early form of travel literature.  In it he describes Penrith in detail.  He is known to have visited at an unclear date; many entries in the Tour seemingly based on his earlier journeys as a merchant.

In 1722 he had published "A Journal of the Plague Year".  In it is contained a highly detailed account of the London Plague of 1665. Now Defoe was only five years old at the time and was evacuated from the city quite promptly.  His narrator for the tale is listed as the enigmatic "H.F.".  This is generally considered to be his uncle Henry Foe. Perhaps nephew Daniel had access to an unknown memoir, although other interesting theories have been put forward including one that has DeFoe coming into possession of the contemporary diary of Samual Pepys and managing to break the encryption in which it was written!

The Bubonic Plague must to have fascinated Defoe; it is a topic he touched upon often prior to writing his "Journal" (if we assume it is at least partly his creation).  So I assume he would have to be interested in a Plague Stone when he visited Penrith.

Does the concept make it into his writing?

Yep.  

"It is true, People us'd all possible Precaution, when any one bought a Joint of Meat in the Market, they would not take it of the Butcher's Hand, but take it off of the Hooks themselves.  On the other Hand, the Butcher would not touch the Money, but have it put into a Pot full of Vinegar which he kept for that purpose.  The Buyer carry'd always small Money to make up any odd Sum, that they might take no Change."

Plague Stones appear to be reasonably common in England.  At least stones for which the claim is made are common.  Some are just hollowed out rocks.  Others, such as the Penrith example, are early cross bases repurposed for this role.  Likely the Penrith specimen originated at the same church where Defoe viewed The Giant's Grave.