All posts by Gordon Short, MD

Dr. Gordon Short is a trained pathologist and the founder, chief designer and inspirator of Brevis Corporation since 1977.
Dr. Gordon Short weighs in

What Good Are Hands, Anyway?

Leave a comment

As a physician I performed many medical exams which consisted of using my hands to examine patients. I delivered babies, performed pelvic exams and other procedures that involved using my hands or fingers. Very personal and invasive stuff. Yet no one complained because the context was correct.

But surely hands are more useful for everyday activities. Like the thumb. “No” when pointed down, as Senator McCain famously demonstrated. Up for “Yes” or “Good.”

And the index finger. A pointer, as in “Uncle Sam Wants You” posters that I remember from World War II. And the middle finger. Need I explain? Then there’s the fourth finger of the left hand. A convenient parking place for a commitment ring. (Some cynics might say it would better be a nose ring.) And what little can be said about the little finger. Just “pinky.”

And what can we say about the palm? I suppose in political parlance one “greases the palm” of the politician from whom one wants a favor. Ask any successful lobbyist. And, of course, one can suggest certainty by saying “you know something like the palm of your hand.” (Like the efficacy of grease?)

Kismet. It’s a movie that I pull out and watch every few years. Exotic places, times, music, dancers. But what I really enjoy is the soliloquy on hands that Hajj the beggar and storyteller sings just before his hand is about to be chopped off. Here are some lines:

“Dear hand, deft hand, clever and facile extremity, boon companion to me from my birth; sweet hand, swift hand, spinner of fable and fantasy, faithful friend of my art, would they rend us apart, leaving no finger or fist there, but just the hint of a wrist there? Is this a tale? Are you convinced? For the facile finger, listeners will linger. Reiterate. Gesticulate.”

To which the Wazir’s wife responds, “Rather clever, you must admit.”

Here we are 2022 years into the Common Era and we are still obsessed with our hands — or should be. These biomechanical marvels continue to amaze and amuse, to caress and insult, to feed faces and pull triggers, to cure cancer with deft scalpels and spread infections with careless equanimity. But if they offend us, should we lop them off?

Spread infections? As my groping digits search for keys that will make some printed sense, Joshua Bell is bringing Brahms back to life by making the strings on his wooden box vibrate just the way the concerto was intended. How can the hands that make heavenly music also spread hellish disease?

GlitterBuddy™ Handwash Kit

Technology astounds us. Stainless steel can be converted into a hostile venue for microbes by the addition of a few silver ions (Agion steel). Plastic toys are similarly treated to decrease the probability that child A will share his Shigella with child B at preschool. The country is drowning in alcohol. It’s applied externally and also internally in both biological and mechanical devices. We’re coated with antiseptics. And still the happy little hitchhikers sneak on to our hands and jump off where they are least wanted.

A 100 kg human weighs 100,000,000,000,000,000 times as much as a MRSA and yet our invisibly insignificant coccus outsmarts us in seemingly reverse proportions. Mercy! How can that be? Why can’t we germproof our hands with some magic nanotech coating that will sock it to the germs and end all our miseries? Maybe mañana?

On the other hand. . . .

Where do clean hands leave off and disease carriers begin? For many years, when we were younger, my wife of 68 years, Lovina, and I had many backpack adventures in the mountains of Utah, Idaho and Wyoming. We ate what we ate, but never scrubbed our hands with soap and warm water. Not even after we went to the “bathroom” (strange name for a toilet facility). Mostly because there weren’t any such. Unless one took the broad view that the whole earth is a toilet. And we never got sick. Luck? Good antibodies? No bad germs in the wild?

Back in “civilization” we worry about germs incessantly. Especially in hospitals. That’s where folk with serious infections go for treatment. Not because they want to become reservoirs of bad bugs to share with other innocent bystanders. But that is why hospitals can become concentration camps for germs looking for new hosts. And hands are convenient carriers of these bugs. (Not to mention droplets from coughing, sneezing and even speaking)

What to do?

Be considerate. Set a good example. Teach the next generation especially that proper hand washing is the single most important means for preventing the spread of infection. Here at Brevis we still believe that Cleanliness Is Next to Godliness. Not next to impossible as the cynics would say.

Check out our GlitterBug products that demonstrate the ins and outs of good hand hygiene. Clean hands are not the final solution, but they are the first step in being responsible and happy, healthy citizens.

Dr. Gordon Short weighs in, Ebola outbreak

Bats

Leave a comment

Love them or hate them, you have to admit that there is something fascinating about bats. (Also arachnids, such as tarantulas, and snakes. But later for these)

My spouse, Lovina, – and spice – for the last 2/3 of a century, has a Master’s degree in organ performance from the University of Utah. Some years ago she was invited to play the beautiful pipe organ for a concert in the Assembly Hall on Temple Square in Salt Lake City. This is an impressive structure separate from the Tabernacle and Temple. It had been discovered that the building had bats in its attic (belfry?). Before the day of the concert, that structure had been fumigated. With the result that during the concert, many displaced bats were flying around overhead making their little squeaking chirps. I was sitting in the balcony so as to have a good line of sight to the organ. And Lovina. And also to a performance I have never seen before or since. A small troop of ushers with 20 foot poles and butterfly nets traipsing up and down the aisles catching bats. When they were lucky. All the while attempting to be as inconspicuous as possible. With less than the desired results in either endeavor.

In spite of the side show, the concert was a resounding success. And memorable.

Friend or Foe

With this introduction, we come to the main purpose of this essay. Recently there was a TV special on bats by NOVA. As a physician, I was aware, of course, of the reputation of bats (and rats and cats) as carriers of various nefarious diseases. Think rabies, especially, but bats have been implicated in Ebola and histoplasmosis and are thought to maybe be the main reservoir of our friend, the coronavirus.

But is a bat a friend or foe? In war it is a life or death decision to know what the other guy is. (In the Civil War, the outcome may have been altered if Stonewall Jackson had not been mortally wounded by friendly fire.)

But how about bats? This essay is not intended to be an attempt to educate on the biology of the Order Chiroptera. For that I happily refer you to the delightful book by Merlin Tuttle, PhD, called, “The Secret Lives of Bats: My Adventures with the World’s Most Misunderstood Mammals” (2015).

As NOVA pointed out, bats have certain unique features that may lead to discoveries about human diseases. For example, longevity. Most bats are in the size range of mice which live about 2 or 3 years. But bats have been documented to live for 10 times as long, into their 30s and 40s. Is their secret hidden in their telomeres? Furthermore, they may actually be carriers of various deadly viruses such as Ebola and, of course, the coronaviruses. They may also carry rabies but this hazard to humans has been blown way out of reason. But how do they carry these viruses without being killed by them? If our immune systems were as effective as those of bats, we would be a happier, healthier society.

Bats may, or may not, be important vectors of virulent human viruses, but what are they good for? While a few of the larger bats prefer to feast on fruit and some have a taste for frogs, most are insectivorous. They come out of their caves every evening by the millions and devour ton quantities of insects that otherwise devour food crops. Farmers are saved from expense, and society is saved from the ravages of pesticides distributed to the environment.

That is not all. The insects are converted into commercially valuable fertilizer, guano. And bats are champs in the pollination sweepstakes. And while they are at it, they disperse undigested seeds over wide areas. Which is important for reforestation after forest fires. And as if that were not enough, they can boost the local economy through tourism, as in the Congress Bridge bat colony in Austin, TX.

But despite their proven benefits to humanity, bat populations are plummeting in many areas because bats are considered to be pests and therefore foes to be annihilated. Tuttle is out to reeducate the world. And he makes a powerful case. I wish all the “batophiles,” such as Dr Tuttle and many other “batty” scientists and enlightened citizens great success.

Gordon Short, MD
Brevis Corporation

References:

  • Merlin Tuttle: The Secret Lives of Bats, My Adventures with the World’s Most Misunderstood Mammals. Houghton Mifflin Harcourt (2018)
  • Michael J. Harvey, Scott Altenbach, Troy L. Best: Bats of the United States and Canada. Johns Hopkins University Press (2011)
  • Marianne Taylor & Merlin D. Tuttle: BATS, an illustrated guide to all species. Smithsonian Books (2019)
  • The Secret World of Bats: Bat Conservation International (2005) DVD, 48 minutes.
  • BAT Superpowers, The Amazing Biology of Bats: NOVA (2021) DVD, 55 minutes.

Ebola Virus Giant Microbe

Superbugs

The “Superbug” Civil War

Leave a comment

A few days ago I was thinking of the coincidence that the American Civil War had a widely reported military death toll of 620,000 and that is about the same as the death toll from Covid-19 in this country since the pandemic began.

Then magically an article appeared in Time magazine by Rachel Lance, PhD, that summarizes the situation better than I could. I draw pertinent information from her article. (Incidentally, Rachel has written a fascinating book on the Hunley story called, “In the Waves: My Quest to Solve the Mystery of a Civil War Submarine.” I would hope Clive Cussler, who discovered the final resting place of the Hunley, approves. I certainly do. It’s a fascinating story.)

In recent years our civilization has been confronted with a dizzying array of new, or at least newly discovered, diseases Many of these are viral hemorrhagic diseases such as Hanta, Marburg and Ebola. And then there are other viruses such as SARS and its offspring, SARS-CoV-2. And along came ZIKA to join the well known influenza and diarrhea and common cold viruses. Get rid of smallpox and polio and there are always other volunteers to fill their ranks.

And unless we think we are so smart, our old bacterial friends have become antibiotic resistant to keep us humble. That old scourge, Mycobacterium tuberculosis hangs around waiting to catch the unwary. Not wanting to be ignored, fungi are represented by Candida auris along with Cocidioides and Histoplasma. And parasites like the Plasmodium family have never gone away.

So lets compare the Civil War scourges with our current crop.

Here in no particular order are some prominent Civil War diseases (The list is not exhaustive.):

  • Typhoid fever
  • Typhus
  • Malaria
  • Yellow fever
  • Cholera
  • Gas gangrene
  • Gonorrhea
  • Syphilis
  • Diarrhea and Dysentery
  • Measles
  • Mumps
  • Whooping cough (Pertussis)
  • Chickenpox
  • Pneumonia
  • Erysipelas
  • Smallpox

Giant Microbes

It’s worth noting that malnutrition exacerbated the pathogenicity of these bugs. Accounts of the diets of many Civil War soldiers makes one wonder how they were able to function at all. Salt pork? Hardtack? Ugh! And “sanitary” facilities were worse than primitive. A bench across a latrine ditch excavating in one direction with the dirt filling in behind. And handwashing facilities? Are you kidding? It’s no wonder diarrhea and dysentery were rampant. And also why an army on the march was much healthier (think Sherman’s “March to the Sea”).

In spite of vaccines for many of these diseases, especially the childhood diseases, all of these delights are still of current interest.

Here are some current goodies to brighten your day:

  • C difficile (Clostridioides difficile)
  • Covid-19 (SARS-CoV-2)
  • MRSA (methicillin resistant Staph aureus)
  • C auris (Candida auris)
  • VRE (Vancomycin resistant enterococci)
  • CRE (Carbapenem resistant Enterobacteriaceae)
  • Zika virus
  • Malaria
  • Tuberculosis
  • Ebola virus
  • Influenza
  • Diarrhea
  • Pneumonia
  • Venereal diseases
  • Hanta virus

Standard Precaution Signs

This, of course, is just a sampling and many more could be listed. But you get the point. While it is still true that most microorganisms are harmless, or even beneficial, there are many that lurk around ready to pounce. If you’re not familiar with it already, you owe it to yourself to look up that old song, “Some little bug is going to find you someday.” (Google it.) The poem dates back to the late 1800s and a number of people have put it to music.

And with that cheery note. . . .

Gordon Short, MD
Brevis Corporation

Superbugs

Mercy, Mersa! Where did you come from?

Leave a comment

Methicillin resistant Staphylococcus aureus may always have been with us. It appears to be a genetic variant whose origins are unknown. But ever since those intrepid Brits, Fleming and Florey, discovered that some microorganisms may produce substances that inhibit the growth of other organisms, we have become dependent on these miraculous substances to treat all our infections. So far, so good. But Penicillium notatum probably never intended to be the savior of mankind. Furthermore, P. notatum is not the best critter to produce significant quantities of the magic substance.

Contact Precautions Signs & Labels

In the Sept 2021 Scientific American there is a little item about the related P. rubens. Fleming discovered penicillin in 1928 and its usefulness was appreciated by the beginning of World War II. How to ramp up production? Here is the story as told by Jim Daley in the article on page 22:

Andrew Moyer, a microbiologist there [Peoria, Ill], took on the problem. Moyer’s fellow researcher Mary Hunt found a moldy cantaloupe at a Peoria market and brought it to the lab for analysis. . . .As was the case with many women conducting research in that era, Hunt’s contribution to the discovery and study of that mold – which turned out to be Penicillium rubens – was diminished at the time. Moyer’s 1944 publication on P. rubens mentions Hunt only in the paper’s acknowledgments, and the press referred to her as “Moldy Mary.” P, rubens could better tolerate a new fermentation process that let it quickly produce hundreds of times more penicillin than previously studied strains, which let the Allies massively scale up antibiotic production. The same strain is still used to manufacture penicillin today.

Clean Up the Staph Button

But what does this have to do with MRSA? As the susceptible strains of Staph aureus have been killed off, the resistant strains that have maybe always been lurking around in small numbers have been allowed to flourish. Hence the search for modifications of penicillin that would still be effective. Methicillin has been the last candidate in the congregation to do the job. When bugs resistant to it showed up, we were in trouble. Which we still are. Especially since MRSA has an increased incidence in hospitals. What that means is that it is especially important to practice excellent hygiene procedures such as surface disinfection and frequent, good handwashing. Guess what. Brevis can help.

Gordon Short, MD

Back To School, Food-borne illness, Infection prevention

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

Image Leave a comment

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

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

Surface cleaning detection kit with invisible stamper and UVA lamp

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

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

Buy Now

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

Thank you,

Gordon Short, MD
Brevis Corporation

Outbreaks

Epidemic Intelligence Service

Image Leave a comment

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

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

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

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

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

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

Gordon Short, MD
Brevis Corporation

Flu

What’s Nu with Flu?

Leave a comment

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

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

Visit Brevis.com

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

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

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

Keep smiling!

Gordon Short, MD
Brevis Corporation

Infections of History

TB (What, you say?)

Leave a comment

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

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

Visit Brevis.com

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

Gordon Short, MD
Brevis Corporation

Image by CDC.org

Dr. Gordon Short weighs in, Syphilis

Syphilis, the Great Imitator

Image Leave a comment

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

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

Visit Brevis.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Gordon Short, MD
Brevis Corporation

Dr. Gordon Short weighs in

The Deadly Plum

Image Leave a comment

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

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

Visit Brevis.com

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

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

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

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

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

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

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

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

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

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

Gordon Short, MD
Brevis Corporation

Image by WikiMedia