| From: Jon Koplik | 3/20/2020 2:11:16 AM | | | | | | WSJ -- The Unsung Pioneer of Handwashing .................................................................................
March 19, 2020
The Unsung Pioneer of Handwashing
In 19th-century Vienna, Ignaz Semmelweis fought to convince his fellow doctors that washing their hands could save patients’ lives.
By Lindsey Fitzharris
It’s difficult to feel any sense of optimism during the Covid-19 pandemic, but one source of encouragement is that simple soap and water can be a powerful defense. The coronavirus that causes the disease is enveloped in fatty layers that are easily dissolved by detergents, exposing the core of the virus and causing it to perish. That’s why public health authorities keep stressing the importance of washing our hands.
Handwashing to kill germs might seem like basic hygiene today, but it is a relatively recent discovery in the history of medicine. In the early 19th century, even hospitals had no inkling of the importance of cleanliness. They were breeding grounds for infection, often referred to as “houses of death.” Hospitals provided only the most primitive facilities for the sick and dying, many of whom were housed on wards with little ventilation or access to clean water. In 1825, visitors to St. George’s Hospital in London discovered mushrooms and maggots thriving in the damp, dirty sheets of a patient recovering from a compound fracture. Mortality rates for hospital patients were three to five times higher than for people treated in domestic settings.
The first doctor to understand the importance of hygiene in stopping the spread of infectious disease was Ignaz Semmelweis, a Hungarian physician, who in the 1840s was working in the maternity department of Vienna’s General Hospital. At the time, the idea that the squalid conditions in hospitals played a role in spreading infection didn’t cross many doctors’ minds. Among those most at risk were pregnant women. When they suffered vaginal tears during delivery, the wounds provided openings for the bacteria that doctors and surgeons carried on them wherever they went.
Semmelweis, then in his late 20s, noticed an interesting discrepancy between the hospital’s two obstetric wards. One was attended by male medical students, while the other was under the care of female midwives. Although each ward provided identical facilities for its patients, the one overseen by the medical students had a mortality rate that was three times higher. Those at the hospital who noticed the imbalance attributed it to the idea that male students handled patients more roughly than female midwives did, thus making the new mothers more susceptible to developing puerperal fever, a dangerous postpartum infection.
Semmelweis wasn’t convinced. In 1847, he had a breakthrough when one of his colleagues became ill after cutting his hand during a postmortem examination. Semmelweis noticed that the man’s symptoms were remarkably similar to those of women suffering from puerperal fever. What if doctors working in the dissection room were carrying “cadaverous particles” with them onto the wards when they assisted in the delivery of babies?
At the time, doctors didn’t wear protective gear such as gloves when dissecting the dead, or take care to wash their hands afterward. Perhaps the big difference between the students’ ward and the midwives’ ward was that the students were the ones performing autopsies.
Believing that puerperal fever was caused by “infective material” from dead bodies, Semmelweis set up a basin filled with chlorinated lime solution in the hospital and required all doctors to wash their hands in it before attending to patients. In April 1847, the mortality rate for new mothers on the students’ ward was 18.3%. After handwashing was instituted in May, it fell to just over 2%
Semmelweis’s results were compelling, and no doubt he saved the lives of many mothers during that period. However, he was not able to convince his colleagues that puerperal fever was caused by contamination through contact with dead bodies. Even doctors willing to carry out trials of his methods often did so inadequately, producing discouraging results. And Semmelweis himself could never completely eliminate cases of puerperal fever, even when his protocols were strictly enforced. After a number of negative reviews of a book he published on the subject, in 1861, Semmelweis lashed out at his critics, going so far as to call doctors who didn’t wash their hands “murderers.”
Semmelweis’s theories about hygiene and infection never won acceptance beyond the walls of his own hospital.
In time his behavior became erratic, an embarrassment to the hospital. Later historians have suggested he may have been suffering from the effects of Alzheimer’s disease or syphilis. On July 30, 1865, one of Semmelweis’s colleagues lured him to a Viennese insane asylum, under the pretense that he would be visiting a new medical institute. When Semmelweis surmised what was happening and tried to leave, he was severely beaten by several guards, secured in a straitjacket and confined to a darkened cell. Two weeks later, he died of a wound on his right hand that had become gangrenous.
Semmelweis’s theories about hygiene and infection never won acceptance beyond the walls of his own hospital. It wasn’t until the 1880s that pioneers of germ theory such as Louis Pasteur, Joseph Lister and Robert Koch proved to the world that disease really could be transmitted by microscopic particles, leading to a revolution in sanitary practices. Only then was the crucial importance of handwashing widely accepted and Semmelweis’s contribution acknowledged.
Today, the term “Semmelweis reflex” is used to refer to the knee-jerk tendency to reject new evidence because it contradicts established norms.
As a new pandemic tests the world’s medical systems and its ability to mount a coordinated response, our minds need to remain open to creative solutions that don’t necessarily fit accepted methodologies. Even in 2020, it remains a challenge to convince people that washing their hands is one of the most effective ways to combat Covid-19. If any positive change comes from the pandemic, it may be that hand-washing will at last become as universal as Semmelweis hoped.
-- Dr. Fitzharris is a historian of medicine and the author of “The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine.”
Copyright © 2020 Dow Jones & Company, Inc.
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| From: Jon Koplik | 3/25/2020 11:37:51 AM | | | | | | WSJ -- Is the Coronavirus as Deadly as They Say ? ..................................
Opinion
Commentary
March 24, 2020
6:21 pm ET
Is the Coronavirus as Deadly as They Say?
Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.
By Eran Bendavid and Jay Bhattacharya
If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise -- and projections of the death toll could plausibly be orders of magnitude too high.
Fear of Covid-19 is based on its high estimated case fatality rate -- 2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.
The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases -- orders of magnitude larger -- then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.
Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.
Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.
In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.
The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.
How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.
The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.
This does not make Covid-19 a non-issue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.
If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.
A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lock-downs.
Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford. Neeraj Sood contributed to this article.
Copyright © 2020 Dow Jones & Company, Inc.
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| From: 3bar | 4/23/2020 9:46:35 AM | | | | | | What a Rainbow looks like up close .
Setting - A ranger cabin on a remote lake in Norther Ontario . Step inside a barren cabin to get out of the rain on a canoe trip .
As the rain slowed walked to the edge of the lake and to my surprise saw a rainbow about 50 yards away moving maybe 10 to 15 mph .
Unlike the flat image from a distance you could look into it . It resembled a large and billowy nylon curtain on a living room window . If you moved the curtain changed shape . The colors moved .
Each individual drop was lit by its own color so that it looked like a coat of mail . Packed closely but not so close so as not to see its make up .
Back of the cabin was a moose eating willows . |
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| From: Jon Koplik | 6/13/2020 1:44:46 AM | | | | | | Bloomberg -- FAA Warns of Tail Strikes, Off-Course Flying by Near-Empty Jets ................................
June 12, 2020
FAA Warns of Tail Strikes, Off-Course Flying by Near-Empty Jets
Incidents in pandemic show risks of light planes, parked craft
Regulator, industry have increased vigilance to reduce hazards
By Alan Levin
One nearly empty passenger jet “climbed like a rocket,” prompting the pilots to exceed their assigned altitude. Others have scraped their tails on takeoff, gone off course or strayed close enough to other aircraft to prompt mid-air collision alerts.
The common thread: the massive disruptions to the U.S. airline industry caused by the Covid-19 pandemic.
While the plunge in travel has in many ways eased pressure on roads and the aviation system, it has at times had the opposite effect on safety. The rate of highway deaths has actually risen as motorists speed on empty roads. And the drop in airline passengers has triggered an unusual spate of incidents that are challenging flight safety, according to publicly available reports as well as government, industry and union officials.
Moreover, the slow rise in air traffic is creating its own demands as parked aircraft are restored to service and pilots who may have missed training sessions are recalled.
The Commercial Aviation Safety Team, comprised of the U.S. Federal Aviation Administration, unions and airline officials, last month issued more than 50 warnings to carriers on the unusual factors they need to monitor more closely during the recent industry disruptions, according to documents reviewed by Bloomberg.
They include tracking safety data related to unusually light aircraft, the stresses from employees fearing they could become infected by Covid-19 and possible fuel contamination on planes that were parked.
“These dynamic changes are creating stress points on our systems and processes,” the group said in one of the documents.
Details of incidents have begun to trickle out through NASA’s Aviation Safety Reporting System, which posts anonymous field reports after validating their authenticity.
They include pilots reporting that unusually light airliners behaved unexpectedly, such as climbing so fast that they exceeded assigned altitudes or couldn’t maintain cabin air pressure. Others said the boarding process went so fast they forgot to finish safety paperwork.
Thousands of airliners are parked, some of them on runways at major airports. Normal flight routines are being disrupted. Training is being postponed. And airline crews face the looming threat of infection and a loss of job security.
“There is certainly a concern that all of these things could be a distraction to crews and could result in an undesirable situation,” said Hassan Shahidi, president of the nonprofit Flight Safety Foundation.
There have been no significant incidents, said Shahidi and others familiar with data collected by airlines.
“Despite the challenging circumstances, the agency continues to provide the same high level of safety oversight of airlines and other operators that the public expects and deserves,” the FAA said in a statement. “We are closely monitoring the data we receive from voluntary reporting systems and have increased the number of information-sharing meetings we’re holding with operators.”
Indeed, the reason that concerns are being raised at the agency and the safety team is that the industry’s early warning system -- which tracks flight data, thousands of reports from individual employees and internal airline audits -- has been adept at spotting issues before they become serious, according to FAA and industry officials.
Ali Bahrami, the FAA’s associate administrator for aviation safety, said during a recent online panel that the agency has increased its interactions and oversight of airlines as a result of data it has seen and the threat of financial disruption to the industry.
Among the incidents raising concern, Bahrami said, were so-called “tail strikes,” in which a jet on takeoff or landing hits its tail on the runway. These impacts, which may be associated with a lighter-than-usual aircraft, can severely damage a plane and lead to costly repairs.
The air-traffic control system has faced similar stresses, said Teri Bristol, the chief of FAA’s Air Traffic Organization, speaking at another webinar. Scores of controllers, who operate in close quarters and can’t work from home, have tested positive for the virus. That has prompted the temporary closing of facilities and rerouting of flights.
“Change and unpredictability is not a good thing in our system,” Bristol said.
With so many aircraft parked -- airlines took more than half of their fleets out of service before beginning to return some planes in recent weeks -- the FAA has been paying close attention to safety incidents on the ground, such as the threat of collisions on runways.
“We are seeing surface issues where we just wouldn’t expect to see them,” Bristol said.
NASA’s repository of reports from pilots, air-traffic controllers and others reflect what Bahrami and Bristol have said. Reports of incidents in March have only become public in recent days:
An airline captain landing at Pittsburgh International Airport complained that planes were “parked all over” one of the runways, but it had not been marked as closed with lighted signs.
A captain reported that an automated warning system ordered them to “climb” to avoid colliding with another plane. The pilot blamed it on another jet that was climbing faster than usual with a lightly loaded plane.
An airline crew said they got a warning that the cabin wasn’t properly pressurized. They had been climbing so quickly with an unusually light load at high altitudes that the plane’s pressurization system couldn’t keep up, they said.
Confusion over a missed radio call allowed two planes to fly too close to each other. A controller said that a nearby sector had been shut after another employee tested positive for the virus. “We were working abnormally complex traffic at a very high volume,” the controller said.
After aborting a landing due to gusty winds, an airliner at takeoff power climbed so quickly that it exceeded its maximum assigned altitude. “To say I was rattled would be an understatement,” a pilot on the plane said. “I am concerned that we are flying these aircraft too light.”
More than a dozen additional reports raised concern about personal safety from the virus, as a result of lack of disinfection kits or people working closely together.
Such anonymous reports from NASA’s system should be viewed cautiously because they can’t be verified, said Roger Cox, a former airline pilot who also served as an accident investigator with the National Transportation Safety Board.
Previous crises in the airline industry, such as the Sept. 11, 2001, attacks and the 2008 financial crisis, didn’t lead to demonstrable increases in accidents, Cox said. Nevertheless, pilot distractions repeatedly show up as a factor in crashes around the world and should be watched closely, he said.
While passenger counts have rebounded since early April, when they were at less than 5% of last year, they still averaged only 16% over the past week, according to Transportation Security Administration data.
Financial assistance to carriers required no job cuts, but only through Sept. 30. Many carriers are saying they will have to trim employees in the fall.
“We have all kinds of people who are worried about their carriers, their mortgage, their family, all kinds of things,” said Russ Leighton, vice president of the Coalition of Airline Pilots Associations who participates in FAA-industry safety work.
Air-cargo operations have been up during the crisis, but that creates its own stresses, Leighton said. Cargo crews aren’t protected by the same pilot-fatigue regulations as passenger pilots, for example, he said.
Pilot unions have been emphasizing that it’s better for crews to leave discussions about seniority lists and job security behind when they enter the cockpit, said Steve Jangelis, aviation safety chair at the Air Line Pilots Association.
“Everyone is stressing the same point,” Jangelis said. “This is not a normal situation. We’re going to see our way through it. We need to make sure we’re slow, methodical and safe.”
© 2020 Bloomberg L.P.
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| From: Jon Koplik | 6/20/2020 7:38:45 PM | | | | | | CBS News -- North Korean defectors sometimes struggle to adjust to new life in South Korea .............
June 20, 2020
North Korean defectors sometimes struggle to adjust to new life in South Korea
This year marks seventy years since North Korea invaded South Korea, igniting the Korean War. There is still no peace treaty -- just a truce that left North Korea's repressive Kim family in power.
Over the decades, more than 30,000 defectors have escaped through China, some paying thousands of dollars to brokers. They come to South Korea hoping for a new beginning, but as Barry Petersen reports from Seoul, adjusting to life there is not always easy.
North Koreans are accustomed to food shortages in their home country. When they successfully make it to South Korea, they are sometimes overwhelmed by the abundance they encounter.
Hannah Song, who runs an NGO called "Liberty in North Korea" from an office in Long Beach, California, told Petersen that some defectors say coming to South Korea is like getting in a time machine and fast forwarding 60 years.
Song said one defector she met "froze" when he encountered a buffet -- "not only overwhelmed just by the abundance of food but by the abundance of choice."
"He ended up simply eating rice and leaving," she said.
Back in North Korea, propaganda of Kim Jong Un instills a cult of the supreme leader into the heads of every child.
"A lot of young North Koreans who come to South Korea and want to study will say how frustrated they are because so much of what they had to learn in North Korea was about stories of the Kim family," Song said. "And they are like 'what a waste of brain space'… and it puts them on this incredible unlevel playing field."
Jung Gwang Il fights back against the regime from his kitchen table with a laptop and flash drives where he dubs over movies and TV shows. The flash drives then go into plastic bottles and are tossed into the river that flows north, to be picked up by North Korean fishermen who sell them as a much-sought commodity.
Jung Gwang Il spent three years in a political prison camp on espionage charges. "I defected holding great hostility towards the North Korean regime," he said.
Some defectors will never adjust, never become a part of South Korea's high-tech, hurried society. But still, they come.
Song said there are parallels between what American immigrants face and what defectors from North Korea face when they flee south.
"Just like my parents came here and made an incredible amount of sacrifice so that my brothers and I could live here, could grow up here, and have all the privilege and opportunity that we have … it is the exact same for North Koreans," she said.
"They may struggle, but for their children that will grow up, that may be born there ... their lives will be significantly different."
© 2020 CBS Interactive Inc.
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| From: Jon Koplik | 7/10/2020 12:39:22 AM | | | | | | WSJ -- The Delicious Evolution of Mayonnaise .......................................................
July 9, 2020
The Delicious Evolution of Mayonnaise
Ancient Romans ate a pungent version, but the modern egg-based spread was created by an 18th-century French chef.
By Amanda Foreman
I can’t imagine a summer picnic without mayonnaise -- in the potato salad, the veggie dips, the coleslaw, and yes, even on the french fries. It feels like a great dollop of pure Americana in a creamy, satisfying sort of way. But like a lot of what makes our country so successful, mayonnaise originally came from somewhere else.
Where, exactly, is one of those food disputes that will never be resolved, along with the true origins of baklava pastry, hummus and the pisco sour cocktail. In all likelihood, the earliest version of mayonnaise was an ancient Roman concoction of garlic and olive oil, much praised for its medicinal properties by Pliny the Elder in his first-century encyclopedia “Naturalis Historia.” This strong-tasting, aioli-like proto-mayonnaise remained a southern Mediterranean specialty for millennia.
But most historians believe that modern mayonnaise was born in 1756 in the port city of Mahon, in the Balearic Islands off the coast of Spain. At the start of the Seven Years’ War between France and Britain, the French navy, led by the Duc de Richelieu, smashed Admiral Byng’s poorly armed fleet at the Battle of Minorca. (Byng was subsequently executed for not trying hard enough.) While preparing the fish course for Richelieu’s victory dinner, his chef coped with the lack of cream on the island by ingeniously substituting a goo of eggs mixed with oil and garlic.
The anonymous cook took the recipe for “mahonnaise” back to France, where it was vastly improved by Marie-Antoine Careme, the founder of haute cuisine. Careme realized that whisking rather than simply stirring the mixture created a soft emulsion that could be used in any number of dishes, from the savory to the sweet.
It wasn’t just the French who fell for Careme’s version. Mayonnaise blended easily with local cuisines, evolving into tartar sauce in Eastern Europe, remoulades in the Baltic countries and salad dressing in Britain. By 1838, the menu at the iconic New York restaurant Delmonico’s featured lobster mayonnaise as a signature dish.
All that whisking, however, made mayonnaise too laborious for home cooks until the invention of the mechanical eggbeater, first patented by the Black inventor Willis Johnson, of Cincinnati, Ohio, in 1884. “Try it once,” gushed Good Housekeeping magazine in 1889, “and you’ll never go back to the old way as long as you live.”
Making mayonnaise was one thing, preserving it quite another, since the raw egg made it spoil quickly. The conundrum was finally solved in 1912 by Richard Hellmann, a German-American deli owner in New York. By using his own trucks and factories, Hellmann was able to manufacture and transport mayonnaise faster. And in a revolutionary move, he designed the distinctive wide-necked Hellmann’s jar, encouraging liberal slatherings of mayo and thereby speeding up consumption.
Five years later, Eugenia Duke of North Carolina created Duke’s mayonnaise, which is eggier and has no sugar. The two brands are still dueling it out. But when it comes to eating, there are no winners and losers in the mayo department, just 14 grams of fat and 103 delicious calories per tablespoon.
Copyright © 2020 Dow Jones & Company, Inc.
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| From: Jon Koplik | 7/13/2020 1:34:42 AM | | | | | | WSJ obituary of William Dement, Stanford professor saw urgent need to treat insomnia, apnea, etc. ............
[ Check out the part I underlined, near the end. Jon. ]
********************************************************************
July 10, 2020
William Dement Diagnosed America as Sleep-Deprived
Stanford professor saw urgent need to treat insomnia, apnea and other disorders
By James R. Hagerty
William Dement, a medical professor at Stanford University, spent his career trying to wake Americans up to the dangers of not getting enough sleep.
In 1970, Dr. Dement opened what he called the world’s first sleep-disorders clinic at Stanford. He established the treatment of those disorders as a board-certified medical specialty, lectured across the nation and taught a hugely popular undergraduate course called Sleep and Dreams. Typing with two fingers, he wrote books and more than 500 scientific articles.
Dr. Dement, who died of heart failure June 17 at the age of 91, kept his message simple for laypeople. On Johnny Carson’s “Tonight Show” in 1974, he told the late-night audience that “sleepiness is a signal to go to bed.”
Even so, in a 2007 speech, he said too few people were seeking or being offered medical treatment for insomnia, sleep apnea and other ailments that deprived them of adequate sleep. Failing to treat those ailments increases the risks of falling asleep at the wheel and can lead to a weakened immune system and heart disease, among other health problems.
“We are not a sleep-aware society,” Dr. Dement said. “The challenge today is education.”
As a sleep doctor, he was always on duty. On a commercial flight, he once noticed a man snoring. Later, spotting the same man in an airport restroom, Dr. Dement warned him of the risks of sleep apnea. The snorer stalked off without thanking Dr. Dement for his advice.
Rafael Pelayo, a Stanford professor of sleep medicine, said many others did heed his messages, and countless lives were saved as a result.
William Charles Dement was born July 29, 1928, and grew up in Walla Walla, Wash., where his father was a bookkeeper. Stationed by the Army in Japan after World War II, he edited a regimental newspaper.
While studying basic medical science at the University of Washington, he lived on a houseboat and played the string bass in jazz bands.
He wanted to become a psychoanalyst and enrolled in graduate school at the University of Chicago. There he met a physiologist, Nathaniel Kleitman, and a graduate student, Eugene Aserinsky, and worked with them on research illuminating what became known as rapid eye movement, or REM, sleep, the phase most associated with dreams. Dr. Dement earned a medical degree in 1955 and Ph.D. in neurophysiology two years later.
As a research fellow at Mount Sinai Hospital in New York, he conducted sleep research in his own Manhattan apartment. To find people willing to be monitored while sleeping, he advertised in a newspaper and attracted members of the Radio City Rockettes dance troupe.
His studies included electroencephalography, or EEG, tests in which electrodes were attached to the scalp to chart brain activity. Aside from the Rockettes, he ran tests on his wife, the former Eleanor “Pat” Weber, and himself.
When Congress created a national commission on sleep disorders, he was selected as chairman and held public hearings in the early 1990s. The commission estimated that 40 million Americans suffered from chronic sleep disorders.
The consequences, Dr. Dement argued, included deadly automobile and industrial accidents, along with impairment of “intellectual and emotional capacity.” The commission said fatigue helped cause the Exxon Valdez oil spill in 1989 and the Three Mile Island nuclear-plant accident in 1979.
During his Sleep and Dreams courses at Stanford, he sometimes used a squirt gun to rouse those who nodded off. In recent years, he navigated the Stanford campus in a customized golf cart known as the Sleep and Dreams Shuttle.
He is survived by three children and six grandchildren, including Zaniel Zaiden Zooey Dement, whose initials, ZZZ, honor his grandfather. His wife, Pat Dement, died in 2014.
When he had trouble sleeping, Dr. Dement said, he resorted to watching dull television programs or listening to the radio.
One mystery he couldn’t solve was the purpose of dreams. “It’s very puzzling,” he once said. “What can it be for? Can it be some kind of cosmic joke?”
Write to James R. Hagerty at bob.hagerty@wsj.com
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| From: Jon Koplik | 8/7/2020 12:45:47 AM | | | | | | Bloomberg -- Your Old Radiator Is a Pandemic-Fighting Weapon .........................................
August 5, 2020
Your Old Radiator Is a Pandemic-Fighting Weapon
Turn-of-the-century faith in ventilation to combat disease pushed engineers to design steam heating systems that still overheat apartments today.
By Patrick Sisson
The coronavirus pandemic has revived interest in the role design has played fighting infectious diseases. Most famously, the trailblazing modern architecture of the early 20th century -- open to nature and filled with light and air, as practiced by designers such as Alvar Aalto and Richard Neutra -- reflected au courant ideas about health and wellness, especially in combating the scourge of tuberculosis (which also influenced bathroom design).
The battle against pathogens reshaped the inner working of buildings, too. Take that familiar annoyance for New Yorkers: the clanky radiator that overheats apartments even on the coldest days of the year. It turns out that the prodigious output of steam-heated buildings is the direct result of theories of infection control that were enlisted in the battle against the great global pandemic of 1918 and 1919.
The Spanish Influenza, which caused just over 20,000 deaths in New York City alone, “changed heating once and for all.” That’s according to Dan Holohan, a retired writer, consultant, and researcher with extensive knowledge of heating systems and steam heating. (Among his many tomes on the topic: The Lost Art of Steam Heating, from 1992.) Most radiator systems appeared in major American cities like New York City in the first third of the 20th century. This golden age of steam heat didn’t merely coincide with that pandemic: Beliefs about how to fight airborne illness influenced the design of heating systems, and created a persistent pain point for those who’ve cohabitated with a cranky old radiator.
Health officials thought (correctly) that fresh air would ward off airborne diseases; then as now, cities rushed to move activities outdoors, from schools to courtrooms. When winter came, the need for fresh air didn’t abate. According to Holohan’s research, the Board of Health in New York City ordered that windows should remain open to provide ventilation, even in cold weather. In response, engineers began devising heating systems with this extreme use case in mind. Steam heating and radiators were designed to heat buildings on the coldest day of the year with all the windows open. Anybody who’s thrown their windows open in January, when their apartment is stifling, is, in an odd way, replicating what engineers hoped would happen a century ago.
Leeds claimed that the “spent breath” of the occupants of poorly ventilated homes contributed to 40% of the deaths in the country.
The memories of the flu pandemic lingered. Engineering books from the 1920s often mentioned this need to design heating systems, notably the boilers and radiators, to operate with all windows open, a requirement of the “fresh air movement,” Holohan says. This health crusade, which has its roots in the post-Civil War era, saw fresh air as a necessity for good health; adherents believed that rooms with closed windows and tight airflow meant that others would breathe in your vapors and catch disease. The theory originated before modern germ theory, at a time when tuberculosis was a significant health threat. “They called unventilated air the ‘national poison,’” Holohan says.
A key proponent of the idea was Lewis Leeds, a health inspector for Union Army field hospitals who came to the conclusion that “vitiated,” or spoiled, air was the cause of the many diseases. The “spent breath” of the occupants of poorly ventilated homes contributed to 40% of the deaths in the country, he claimed, and often said “man’s own breath is his greatest enemy.” He would spend decades promoting the cause, designing ventilation schemes for buildings, penning a 1869 book, Leeds on Ventilation, and lecturing across the country. He explained his ideas with the aid of a “ magic lantern” projector -- think old-timey Powerpoint presentations. He’d show slides of a family in their drawing room, then add a slide showing red air coming out of the father’s mouth. The child crawling on the floor would eventually fall over. It “scared people to death,” Holohan says.
Leeds was joined in his fervent ventilation campaign by author Harriet Beecher Stowe, of Uncle Tom’s Cabin fame. With her sister, Catherine, Stowe would coauthor a 1869 book, The American Woman’s Home, that claimed “tight sleeping-rooms, and close, air-tight stoves, are now starving and poisoning more than one half of this nation.” It also introduced terrifying scenarios to shock American readers into action, such as this passage about the impact of vitiated air on a child:
Little Jim, who, fresh from his afternoon’s ramble in the fields, last evening said his prayers dutifully, and lay down to sleep in a most Christian frame, this morning sits up in bed with his hair bristling with crossness, strikes at his nurse, and declares he won't say his prayers -- that he don't want to be good. The simple difference is, that the child, having slept in a close box of a room, his brain all night fed by poison, is in a mild state of moral insanity.
These ideas would become more formally accepted by architects and engineers during the beginning years of the 20th century. The 1901 New York State Tenement House Act mandated that every room have an outdoor facing window. New York City Health Commissioner Royal Copeland, who, as a U.S. senator in the 1920s proposed redesigning the Senate Chamber to deal with deadly, stale air, would praise the tenement laws as having a significant impact during the flu pandemic.
By the time the Spanish Flu hit, the maxims of the fresh air movement had become popular enough to impact building designs. The toll of the pandemic solidified this thinking, says Holohan. Having robust steam boilers that could keep apartments and dwellings comfortable with open windows became standard in New York City, as well as other northern cities in cold climates, such as Detroit, Chicago, Denver, Boston and Philadelphia.
The pandemic abated in 1920 but these standards had become locked into place. The architecture firm KPF found that nearly 75% of Manhattan’s existing square footage was built between 1900 and 1930. And since steam heat systems are incredibly durable, they’ve lasted for generations.
In the ensuing decades, shifts in building practice and fuel usage made the problem of over-indexed steam heat worse. The type of fuel used to heat the steam boilers changed, from coal to heating oil to natural gas, and during the changeover, Holohan says, they didn’t properly resize boilers or systematically change design standards to account for the changing power source; replacement boilers were kept big to err on the side of caution. Better windows, especially double-pane varieties, would provide the benefit of better insulation and less heat loss, but only served to lock in the impact of overly aggressive radiators. (If you own an old radiator-equipped house, you might have noticed how overpoweringly effective they can be after you replace leaky older windows with more well-insulated modern replacements.)
By the 1930s, Holohan says, a few common remedies to mitigate excessive radiator heat came into practice that last to this day. Researchers at the National Bureau of Standards found that if radiators were painted with a special kind of bronzing paint -- specifically, the silver tone found in many radiators today -- it would reduce some of the heat transfer. Same goes with “radiator cozies,” knitted covers sometimes placed over the ribs of radiator pipes. They have the added benefit of protecting kids from getting burned, but one reason they became commonplace was as a way to blunt excess heat.
Roughly 80% of residential buildings in NYC are still heated by steam, and surveys with tenants found that 70 % are chronically overheated in winter, according to Demystifying Steam, a 2019 report by the Urban Green Council. The durability of steam “has locked into place technical limitations of a century ago, ” the report noted; their role as disease-fighters forgotten, radiators are now seen as energy-sucking dinosaurs. “Many tenants open windows for relief, even on the coldest days,” the report found, “but steam systems are so unbalanced that other residents in these same buildings don’t receive enough heat.”
Steam’s grip on the city’s building stock has made the challenge of meeting environmental goals much harder, in effect overheating more than merely the buildings in which they operate. According to John Mandyck, CEO of the Urban Green Council, 70% of the climate emissions in New York City are generated by buildings, with the biggest share from the fossil fuels used for heat and hot water in large, multifamily buildings.
Steam might get a bad rap now, but Holohan notes that its inefficiencies can be traced to poor maintenance and long out-of-date building codes. (It’s not supposed to clank either.) “The banging and clanging wasn’t normal,” he says. “Steam heat was fast and silent when it was first installed. When it’s properly tended, it can be an efficient way to heat. Most people just don’t know how to do it right.”
As a Covid-haunted winter looms, residents of steam-heated buildings may get another opportunity to crank their radiators up and put them to their intended use. Holohan says he’s bemused to see his field of expertise reemerge in connection with the current pandemic, as ventilation is being again promoted as a key strategy to cut infection.
“I’ve been talking about this for like 30 years or more,” he says. “And suddenly I’m living it.”
© 2020 Bloomberg L.P.
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