A history of disinfected mail

As soon as humans became aware that infectious diseases could be transmitted by fomites (inanimate objects), attention was directed to developing methods of disinfection. Postal and public health authorities had to deal with a wide variety of extremely dangerous infections (cholera, yellow fever, smallpox, leprosy, anthrax), and applied a surprising variety of techniques to letters and packages sent through the mails, beginning as early as the 15th century in Venice.

A very informative philatelic exhibit presents examples of how the U.S. has dealth with potentially dangerous items.  Shown at the top, for example, are two letters from locations where yellow fever was present; they have been punctured to allow fumigating agents to reach the inside of the envelope.  The bottom envelope in this image -

- had its corners clipped off so that formaldehyde gas could be introduced to kill smallpox.  Other letters and postcards were autoclaved or steam sterilized, which could be deleterious to the letters inside.

These precautions were not limited to the preantibiotic era.  In 2001 threats of anthrax attacks were made in the United States, and a variety of special precautions, including x-irradiation, had to be undertaken, beginning at this page of the exhibit and continuing for a dozen pages thereafter.  And these letters from Hawaii in 1900 show how holes were punched in the envelopes -

- so that sulfur fumes could be insufflated before they were sent from areas quarantined for bubonic plague.  Other examples are shown of disinfection of mail from the Hawaiian leper colony.

Philatelic exhibitions are conventionally mounted on a series of glass-fronted frames, with up to 16 letter-size pages in one frame, and in this case spread onto six frames.   This award-winning exhibit was created by William A. Sandrik of Arlington, Virginia.  The entire exhibit may be viewed at Exponet (frame 1, frame 2, frame 3, frame 4, frame 5, frame 6).

And those interested in philately (stamp and postal history collecting) should browse the Exponet site beginning at this index page.  Over 600 exhibits are accessible, on a huge variety of topics, in a wide variety of languages.

Reposted from 2011 because of its timely subject matter.   Today a New York Times article addresses the question of transmission of coronavirus by mail:

A representative for the U.S. Postal Service was unwilling to discuss current sanitization protocols. But the agency’s website reports that the only mail items receiving treatment are letters and parcels sent to ZIP codes beginning in 202, 203, 204 and 205, which serve federal government agencies in Washington, D.C. In a process that began shortly after the 2001 anthrax attacks, the Postal Service sends mail destined for those ZIP codes to New Jersey, where they are put on a conveyor belt and passed under a high-energy beam of ionizing radiation that kills bacteria and viruses. The letters and packages are then “aired out” for a while, before being forwarded to their destinations. The paper is left slightly faded and somewhat crispy, but sterile.

Should mail irradiation be extended beyond these exclusive ZIP codes, to help prevent the spread of the coronavirus? On CBS News’s Face the Nation on Sunday morning, Scott Gottlieb, the former commissioner of the Food and Drug Administration, warned that SARS-CoV-2 could potentially be transmitted by contaminated objects. “This is a sticky virus,” he said. The structure of the coronavirus’s protective envelope helps it bond tightly to certain surfaces: skin in particular, as well as fabric and wood, but also plastic and steel...

David Partenheimer, a spokesman for the Postal Service, noted that the surgeon general, Dr. Jerome M. Adams, along with the Centers for Disease Control and the World Health Organization, has “indicated that there is currently no evidence that COVID-19 is being spread through the mail.”..

Then again, contact transmission is notoriously difficult to study and document...

Reposted from 2020 to accompany a newer and related post. 

U.S. to screen soldiers for testosterone deficiency

"Pete Hegseth announced Wednesday that the Department of Defense will offer testosterone deficiency screening for soldiers 30 and older.

The US defense secretary unveiled plans for a new screening program for testosterone deficiency among troops that will work to ensure service members have the “right testosterone levels” to perform at their optimal conditions in a video posted to X...

“Warfighters” aged 30 and above will undergo annual tests as part of their health assessments, while those under 30 can choose to opt in, Hegseth said. Treatment, including testosterone replacement therapy, is voluntary and aimed at “restoring and optimizing” natural capabilities...

Hegseth is not the first member of the Trump administration to address the so-called “crisis” of low testosterone, or “low T”. Robert F Kennedy Jr, the 72-year-old health secretary, has spoken about injecting testosterone as part of his personal “anti-ageing regimen”. In October, he warned, without evidence, that today’s American teenagers have “50% of the testosterone of a 65-year-old man”.

Testosterone, and concerns about a shortage thereof, has become a political fixation on the right. Alternative media commentators such as Tucker Carlson have decried a crisis of masculinity in films such as The End of Men, while influencers promote “T-maxxing” and direct-to-consumer testosterone injections...

According to research published in the journal Social Science & Medicine, young men are being aggressively targeted online by influencers and wellness companies promoting hormone tests and treatments as essential to being a “real man”, despite screening for low testosterone being medically unwarranted in most people in this age group.

I do hope there is one sane person in the armed forces administration who will understand that half the men in the world have testosterone levels below average.

Trichromacy vs. dichromacy

Not sure I trust the image, but the principle appears to be valid.

Until the 1960s, popular belief held that most mammals outside of primates were monochromats. In the last half-century, however, a focus on behavioral and genetic testing of mammals has accumulated extensive evidence of dichromatic color vision in a number of mammalian orders. Mammals are now usually assumed to be dichromats (possessing S- and L-cones), with monochromats viewed as the exceptions.

The common vertebrate ancestor, extant during the Cambrian, was tetrachromatic, possessing 4 distinct opsins classes. Early mammalian evolution would see the loss of two of these four opsins, due to the nocturnal bottleneck, as dichromacy may improve an animal's ability to distinguish colors in dim light. Placental mammals are therefore – as a rule – dichromatic.

The exceptions to this rule of dichromatic vision in placental mammals are old world monkeys and apes, which re-evolved trichromacy, and marine mammals (both pinnipeds and cetaceans) which are cone monochromats. New World Monkeys are a partial exception: in most species, males are dichromats, and about 60% of females are trichromats, but the owl monkeys are cone monochromats, and both sexes of howler monkeys are trichromats.

Trichromacy has been retained or re-evolved in marsupials, where trichromatic vision is widespread. Recent genetic and behavioral evidence suggests the South American marsupial Didelphis albiventris is dichromatic, with only two classes of cone opsins having been found within the genus Didelphis.

Excerpt from the dichromacy entry of Wikipedia (see also trichromacy).  I didn't realize this.  You learn something every day.

Found in the hair of a trauma victim...

The patient's wife posted this image in the whatisit subreddit, where I learned that this is a modern xray marker.  I spent 30 years reviewing chest xrays, and back in the previous century the xray markers were less elaborate.  Classically the orientation was indicated with a lead "R" or "L" (or full word "LEFT") -

- sometimes with a movable pellet inside to indicate upright, supine, or decubitus positioning...

Nowadays apparently the standard is to have the xray technician's initials incorporated into the marker, which the technician can (?has to) buy from sites like Etsy -

You learn something every day - even stuff you thought you knew.

Medical movie mistakes

Screencap from an otherwise enjoyable movie I watched recently.  This scene has not been recorded at the classic Movie Mistakes website, but I can guarantee that the height of those IV fluids is worthy of mentioning.

Reposted from 2024 to add this howler:

Those are screencaps from a decent program I watched recently (the name of which I can't recall).  Documented because the medical error is so egregiously bad that even non-medical people in the viewing audience must have cringed.  Does nobody fact-check scripts any more??

See also Incorrect masks used in the movie 'Alien'.

My first hospital bill

When I was two years old I fell ill while my family was visiting relatives in the small town of Ada, MN (west of Leech Lake and Itasca, near the ND border). I was hospitalized for four days. Above is the complete hospital bill (I've photoshopped out my mom's name, but the rest is undoctored). How things have changed, not just re pricing, but in terms of the complexity of billing.....

Reposted from 2007, because the more I think about this, the staggering change is in the complexity of billing.  

Addendum:  I may have posted this one before as well.  It's from 13 years later (1961) for orthopedic surgery at the Mayo Clinic to correct some of my polio deformities:

Surgeons fees $375.  Three xrays $54.  Seven blood tests $29.  Grand total $648.  Balance due after Blue Cross Blue Shield insurance: $75.   How things have changed...

Very interesting

Copied from Facebook.  I hope I or a reader can find reliable documentation online.

Just realized it gives new meaning to the old phrase "you can't step into the same river twice" previously meaning the river changes.  But now it also means "the you changes..."

Parents are refusing Vitamin K for newborns

"For most of his 10 years as a neonatologist, Dr. Timmy Ho encountered one or two parents per week who didn’t want their newborns to receive a vitamin K injection, a standard step to prevent bleeding.  Recently, in just one week, he saw three or four per day — numbers, he said, that were becoming more common.

One of the babies suffered a type of bleeding in the brain that vitamin K could have prevented, said Dr. Ho, who practices in Boston. He had never seen that before.

Vitamin K plays a crucial role in blood clotting but doesn’t pass to the baby through the placenta effectively, and there isn’t much of it in breast milk. Infants are deficient in it until they can eat solid foods. This can lead to bleeding, from minor oozing from the umbilical cord to potentially life-threatening gastrointestinal or brain hemorrhages.

One injection immediately after birth is very effective at fixing the deficiency, and it has been routinely administered in the United States for more than 60 years.

Now, the shot appears to have been swept up in broader anti-vaccine sentiment, even though it isn’t a vaccine..."

The story continues at The New York Times.

Anti-vaxxers are now in charge

Offering a startlingly candid view into the philosophy guiding vaccine recommendations under the Trump administration, the leader of the federal panel that recommends vaccines for Americans said shots against polio and measles — and perhaps all diseases — should be optional, offered only in consultation with a clinician.

Dr. Kirk Milhoan, a pediatric cardiologist who is chair of the Advisory Committee on Immunization Practices, said that he did have “concerns” that some children might die of measles or become paralyzed with polio as a result of a choice not to vaccinate. But, he said, “I also am saddened when people die of alcoholic diseases,”.. 

In the case of an infectious disease, a personal choice to decline a vaccine may also affect others, including infants who are too young to be vaccinated or people who are immunocompromised. But a person’s right to reject a vaccine supersedes those risks, Dr. Milhoan said.

“If there is no choice, then informed consent is an illusion,” he said. “Without consent it is medical battery.”

I'm a polio survivor with residual impairment.  The attitude of this man in a position of authority is deplorable.

Relevant:  Polio was that bad

Nasogastric tube insertion into the brain

A lethal complication in a patient who who had undergone microscopic transoral transsphenoidal surgery for a pituitary tumour.  That's already more information than most readers want to know, so I'll just provide the link to the Science Direct article with information from a 2021 publication in Interdisciplinary Neurosurgery.

An interesting side effect of piercing

The pale region "fades in and out during the day."  You can read an informed discussion in the comment thread at the piercing subreddit.

Monteggia fracture

A 26-year-old woman with elbow pain after falling on her outstretched hand while ice skating.  The radiograph shows a dislocated radial head and a fracture of the proximal ulna.  There are a few details on differential diagnosis and treatment at Wikipedia.

Chest of a man taking a diuretic

This 76-year-old man has a history of coronary artery disease, as evidenced by the old midline thoracotomy scar from a coronary bypass.  I'm posting the image to feature his amazing gynecomastia, which developed as a side effect of his taking the prescribed diuretic spironolactone (physical exam and laboratory evaluation ruled out other potential causes).

A diagnosis of spironolactone-induced gynecomastia — an adverse drug effect seen more frequently in men taking more than 100 mg per day — was made. The mechanism is multifactorial and includes androgen-receptor blockade and increased peripheral conversion of testosterone to estradiol. 

An abstract at PubMed lists other causes of drug-induced gynecomastia:

"The drugs definitely associated with the onset of gynecomastia are spironolactone, cimetidine, ketoconazole, hGH, estrogens, hCG, anti-androgens, GnRH analogs and 5-α reductase inhibitors. Medications probably associated with gynecomastia include risperidone, verapamil, nifedipine, omeprazole, alkylating agents, HIV medications (efavirenz), anabolic steroids, alcohol and opioids."

Trivial/juvenile comments will be blocked.

The sad slow death of the CDC

"A Centers for Disease Control and Prevention website that previously said that vaccines do not cause autism walked back that statement, contradicting the agency’s previous efforts to fight misinformation about a connection between the two.

The agency’s webpage on vaccines and autism, updated on Wednesday, now repeats the skepticism that Health Secretary Robert F. Kennedy Jr. has voiced about the safety of vaccines, though dozens of scientific studies have failed to find evidence of a link.

A previous version of the webpage said that studies had shown “no link between receiving vaccines and developing autism spectrum disorder.” It cited a 2012 National Academy of Medicine review of scientific papers and a C.D.C. study from 2013.

On Thursday, the live version of the page stated: “The claim ‘vaccines do not cause autism’ is not an evidence-based claim because studies have not ruled out the possibility that infant vaccines cause autism.”"

Arm of man who fell off a bicycle

Note that not only are the radius and ulna broken, but the metal plates inside the bones (from repair of previous fractures) are bent at a 90 degree angle.  The victim explains:

Was on a nice leisurely bike ride - shoe laces got stuck on my bike pedal and wrapped around multiple times over. Fell off as I was braking to get them unstuck. I never want to get on a bike again 😫

Embedded image cropped for size and emphasis from the original at Reddit, via Neatorama, where the appropriate advice is offered: "Always double tie your shoes before riding a bike, and tuck the ends into the shoe."

Humans were never hypercarnivores. Neanderthal consumption of maggots clouds the data.

Excerpts from an interesting paper in Science Advances.

Reconstructions of Eurasian Neanderthal diets based on stable nitrogen isotope ratios (δ15N) typically place hominins at the top of the food web, together with, or above, hypercarnivores, such as lions and wolves. We suggest that these high δ15N values may, in part, reflect the regular consumption of 15N-enriched fly larvae (maggots) occurring in stored animal foods. The ethnohistoric record contains countless examples of Indigenous peoples routinely consuming putrefied animal foods with maggots... We suggest that frequent consumption of animal foods laced with maggots should be considered as a contributor to the high δ15N values observed in Late Pleistocene hominins...

Indigenous peoples almost universally viewed thoroughly putrefied, maggot-infested animal foods as highly desirable fare, not starvation rations. Many such peoples routinely, often intentionally, allowed animal foods to decompose to the point where they were crawling with maggots, in some cases even beginning to liquify, and inevitably emitting a stench so overpowering that early European explorers, fur trappers, and missionaries were sickened by it. Yet such foods were viewed as “good to eat,” even a delicacy, and when asked how they could tolerate the nauseating stench, they simply responded, “we don’t eat the smell”. While our Western sensibilities might abhor the thought of maggot-infested foods, one even finds vestiges of larvae consumption in Europe with the delicacy of casu marzu, a traditional Sardinian cheese replete with the larvae of cheese flies (Piophila casei)...

Our principal goal in this study was to determine whether 15N enrichment occurred in maggots raised on putrid tissue and whether the degree of enrichment was of sufficient magnitude to account for, or at least contribute notably to, the unusually elevated δ15N values observed in Eurasian Late Pleistocene hominins...

Many nitrogen isotope studies place Late Pleistocene hominins alongside hypercarnivores, giving the misleading impression that both had broadly similar diets. They did not. Hominins are primates with largely vegetarian-derived digestive and metabolic systems, not specialized flesh eaters. While it is possible for humans to subsist on a very “carnivorous” diet, many traditional northern hunter-gatherers such as the Inuit subsisted mostly on animal foods, hominins simply cannot tolerate the high levels of protein consumption that large predators can. A modern human weighing ~80 kg, the estimated body weight for a robust cold-adapted Neanderthal male, cannot consume more than ~300 g of protein per day (<4 g/kg of body weight) without serious health consequences. At sustained intakes above that level for as little as 1 to 2 weeks, the individual becomes vulnerable to a debilitating and potentially lethal condition known to early explorers as “rabbit starvation”...

In modern medical terms, the consumption of such high levels of protein exceeds the capacity of the liver to up-regulate enzymes involved in the synthesis of urea, with the result that the liver can no longer effectively deaminize the amino acids, leading, in turn, to a buildup of ammonia and excess amino acids (hyperaminoacidemia) in the blood. In notable contrast, a modern African lion can readily subsist on protein intakes that would probably prove lethal to a human in a matter of a few weeks. Thus, northern hunter-gatherers were carnivorous only in the sense that they relied heavily on animal foods, but most of what they ate was fat, not muscle...

To stay below the critical protein threshold, hunters deliberately targeted the fattest prey available at a given time of year and harvested mostly the “choice parts” of their kills, i.e., the brain, tongue, briskets, ribs, adipose tissue, fatty organs and entrails, marrow, often the carbohydrate-rich chyme and partly digested stomach contents, and, time and fuel permitting, also the grease in the cancellous tissue of the bones...

...meat and fish surpluses were procured in the summer and fall; processed by drying, salting, or freezing; and cached for later use…. The preparation of food surpluses was an intrinsic part of the seasonal round.” Such reserves were often repeatedly tapped over periods of weeks or months, many over multiple seasons, and some for a full year or more. Foods were often already maggot infested before they were placed in caches (i.e., in summer and autumn), and, by the time that the contents were lastly exhausted (commonly in winter and/or spring), they were almost invariably in an advanced state of putrefaction and filled with both living and dead maggots...

I think this is absolutely fascinating, so I've excerpted way too much, but I encourage interested readers to go to the primary source for more data and discussion.  The general public will focus way too much on the "ick" factor of eating maggots, but there are serious matters to consider here re components of a healthy diet, limitations of protein intake, and the consumption of fat.  In particular, this report gives me new insight into the well-known use of "buffalo jumps" to slaughter entire herds of large animals, such as at the Itasca (Minnesota) Bison Kill site and the more famous Head-Smashed-In Buffalo Jump in Canada.  I had always viewed such hunting techniques as extravagantly wasteful, but now I understand that humans could return to the kill site months later to harvest meat, fat, and maggot.

You learn something every day.

Polio was the "autumn ghost"

So named because of its seasonality, poliomyelitis was the cause of worldwide epidemics in the 1950s.  This new book presents a detailed look at the 1952 epidemic (in which I was an unwilling participant) with a focus on its effects in Denmark.

"... until quite recently in medical history, there was no intensive care.  Seventy years ago anyone who struggled to breathe, whose heart gave out, or whose kidneys shut down would be kept comfortable and left to die.  There were no ventilators, no monitors keeping track of vital signs minute to minute, no expertise of nurses and physicians to keep critically ill patients alive, and no dedicated units in hospitals for the care of such patients... This is the story of how we got from 1952 to now."

The story in Denmark begins at Blegdam ["Blei-dahm"] Hospital in Copenhagen, created in the 1860s as a "fever hospital" for quarantine purposes in a busy port city.  Cases of cholera and various febrile illnesses arriving by ship would be sequestered here for isolation until resolution or death.  Polio patients came here for "care," but not for "treatment" - which was nonexistent.  

By 1952, some iron lungs were in use, especially in the United States, but those devices were immense, expensive, and difficult to use.  In response to a massive epidemic which was killing their children, the Danes discovered the utility of "bagging" via an endotracheal tube.  But no automated ventilators existed, so medical students were recruited to bag patients continuously, 24/7.  Chapter 13 "Student Ventilators" details the development and implementation of this policy.

Nursing care in that era "was rooted in the tradition of a life given over to the work - long shifts, residence at the hospital for life, and no marriage."  That also had to change.  Analysis of blood gases and arterial pH - never before attempted (or considered) - was also invented, as was the concept of an "intensive care unit," (a term first used in 1958).

This book will not be of interest to everyone.  It will have special meaning to current polio survivors, and should be a must-read for respiratory therapy students who want to learn about the invention of their profession and its tools.

Reposted from 2023 because today is World Polio Day (and because some U.S. states are using medieval thought processes to roll back polio immunization requirements).  If any readers of TYWKIWDBI have a post-polio syndrome (as I do), please check out the information at Post-Polio Health.

Trump offers medications at 654% discount

Ponder for a moment the widespread extent of abysmal ignorance that went into this public presentation.  Someone assembled those data, then calculated multiple discounts over 100%.  Then someone with graphic design skills created the poster.  Someone sets the poster on the easel.  Camera crews gather around.  And then this "very stable genius" says (and believes) he is offering a 654% discount FFS.  Isn't there anybody in the chain of command with the brains (or the balls) to say "this isn't possible."*  It's embarassing.  Makes me ashamed to be an American.

The TrumpRx website is of course a Potemkin village, giving no details and promising results in 2026.

Images from The Guardian.

*addendum - what I should asked was whether there was anyone willing to tell the emperor the truth about his new (or absent) clothes.  I'll blog that fairy tale separately, after this weekend's football games.

"Butterfly" hemivertebrae

I've probably viewed 100,000+ chest xrays and CT scans in my life, but I've never before encountered this anomaly.  You learn something every day.  

Embedded images from the New England Journal of Medicine.  A concise summary of the radiographic features, associated clinical syndromes, and ddx is available at Radiopaedia.

This medication capsule is full of little rings

Image via the mildlyinteresting subreddit, where the discussion is mostly trivial.  These are not "timed-release Spaghetti-O's.  The explanation can be found at this pediatric gastroenterology page, with radiographic images at Radiopaedia.

You learn something every day.