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February 25, 2009
The Seven Deadly Sins of my spam trap
Posted by Abi Sutherland at 04:32 PM *

Lust: Phwaar! snort

Rita invite You
to: abi
from: Betty Jorgensen

To look through Rita (19 Y/O, Latvia) profile and photos, please, follow the link…

Gluttony: Lose weight forthwith! Not a myth!

Want To Fit Into Your “Skinny” Jeans Again?
to: abi
from: Skinny Patch

(content blocked by virus checker)

Greed: Show me the money!

to: undisclosed-re
from: Barr. Adreas Vlachos

Attention: Sir/Madam,

We do not know each other, but you are one of the three persons I sent this email with hope to get a positive and sincere response, in order to go into a deal that would bring life fortune to both of us…

Sloth: Give me the good stuff, but don’t make me work for it.

Want the degree but can’t find the time ?
to: abi
from: Hawk Yancho

If you are more than qualified with your experience, but are lacking that prestigious piece of paper known as a diploma that is often the passport to success…

Wrath: Grr! Arrgh!

to: Abi, [other friends and family members]
from: [loopy acquaintance of long standing, all of whose emails go straight to spam]

did you ever wonder? I couldn’t figure out why would the Congress let some firms go under and then bend over backwards to help others. This makes sense now!!!!!! This sounds almost too logical…… why hasn’t it gotten national press coverage?

Envy: I want what you have

Get Bigger Pennis
to: abi
from: Coy Britton

Hello! Tired of wasting your time and money on ineffective pumps, weights and exercises…?

Pride: I am a special and unique snowflake!

to: undisclosed-re
from: LOPEZ

YOUR EMAIL ID HAS WON $1,500,000.00(ONE Million,Five Hundred Thousand Dollars) in the first category of our computer ballot lottery…

Hugo Awards nomination deadline
Posted by Patrick at 11:59 AM *

If you’re eligible to nominate for this year’s Hugo Awards—which is to say, if you were a member of last year’s World Science Fiction Convention in Denver, or if you’re a member of this year’s Worldcon in Montreal—this is just a reminder that the deadline for nominations is midnight, this Saturday, February 28, and that if you wait until the last minute, Murphy’s Law may well have its way with you. Act now, act without thinking, go nominate a bunch of stuff today.

Making Light: European Tour 2009
Posted by Patrick at 11:38 AM *

Along with all the challenges of the last few months, this has been a season of significant round-number anniversaries for Teresa and me. December 1 was my 20th anniversary working full-time for Tor. On January 2 I turned 50. This coming Sunday, March 1, we’ll have lived in New York City for 25 years. And most significantly, March 23rd will be our 30th wedding anniversary.

In recognition of this, about three weeks from now, we’re going to get on a plane and fly off for an actual vacation…first, in Amsterdam (where I’ve been before, but without Teresa), and then Rome (where Teresa’s been before, but without me). We’ll return about a week into April.

In Amsterdam, we’ll be staying with Abi Sutherland and her family, thus creating a concentration of fluorospheric energy not previously seen on the European mainland— which brings me to the reason for this post. We know we have at least a few readers and commenters in that part of the world, and we’d love to meet them. Arbitrarily, we’ve decided that we’d like to arrange some kind of public meetup on the afternoon of Sunday, March 22, and what we need is suggestions for a venue—ideally, an informal eating-and-drinking establishment in (broadly defined) central Amsterdam, with flexible seating and a decently low level of background noise.

Comments are open. We zien jullie reacties graag tegemoet!

February 22, 2009
About Friggin’ Time
Posted by Jim Macdonald at 09:39 AM * 203 comments

Part of the friggin’ point of Making Light is supposed to be friggin’ “knitting.” I mean, it’s right up there on the masthead, beside “language” and “fraud.” Therefore, it is with great joy that I promote from Open Thread 119:

#650 ::: siriosa ::: (view all by) ::: February 21, 2009, 11:33 PM:

Open threadiness: for the knitters.

Especially the fourth strip down. Anybody know the tune?

#651 ::: James D. Macdonald ::: (view all by) ::: February 22, 2009, 12:57 AM:

You want the tune? Your wish is my command!

February 20, 2009
What is it with the zombies?
Posted by Abi Sutherland at 04:31 PM * 253 comments

A recent IM exchange:

Abi: I am coming to the conclusion that I am not minded to rewrite “In the Navy”
        as “In the graveyard”, despite the earworm potential.
        Maybe the next time zombie filking comes up.
        Why are zombies so fashionable at the moment, by the way?
        Shawn of the Dead?
        I gather they’re waning a little in the face of another onslaught of vampires
        but every time I think they’ve faded into obscurity they come lurching back.
        And won’t anyone give lycanthropes a little airtime?
        Or are they too close to Furries these days?
PNH: I do not get the zombie thing myself, alas.
Abi: You assume there’s a thing to get.
        I have always presumed the thing with zombies was mostly the lack of thing.
PNH: You may be right.
Abi: A little frisson about death in there, but really
        once you’ve grasped the shambling, moaning and brains, you’re there.
        The perfect monster for the Twitter attention span
PNH: Harrumph. I’m starting to feel positively contrarian about all the Twitter hate lately. :-)

The conversation wandered from there into a discussion of Twitter, poetry, the interactions of young people and lawns and whether editors ever rode unicorns. But the question stuck with me. What is it with the zombie stories?

Vampires are evil in sexy and interesting ways, so of course people keep writing stories about them. Aliens allow us to play with, well, alienation, the concept of the Other, and the eternal question of who, really, is the weirdo in any given situation? But zombies, they just lurch around and moan.

I mentioned this puzzle to my better half, who happens to be in the middle of a reread of World War Z. His answer?

Zombies scale.

Not as in walls; they haven’t the coordination for that. What he meant is that you can have any proportion of zombies and humans and come up with an interesting story. Vampires, by contrast, reach a peak population, after which their food supply runs out. And aliens are too complex to scale: once the population of nonhumans passes 50% the worldview just flips so that the humans are the aliens.

But zombies? You can have a fascinating story about a single zombie in a world of humans or the last human in a world of zombies. You can do one on one human-zombie interactions, or set entire armies against each other. They work differently as individuals (stupid and clumsy) and in crowds (lucky by means of what sheer numbers can do with probability theory). A group of them is as impersonal as a natural disaster; a single one is as intimate as death or betrayal.

Zombies scale.

Why We Immunize
Posted by Jim Macdonald at 01:09 AM * 916 comments

There’s a manual that every Navy gunnery officer was required to read or re-read every year: OP 1014; Ordnance Safety Precautions: Their Origin and Necessity. It’s a collection of stories about, and photographs of, spectacular accidents involving big guns and ammunition. Gun turrets that have fired on other gun turrets on the same ship. Holes in the coral where ammunition ships were formerly anchored. That sort of thing. It’s simultaneously grim and fascinating.

Nowadays there’s some kind of movement afoot for claiming that immunizations against common childhood diseases are unnecessary. That they cause disease. That they’re harmful. It is true that rare adverse reactions to immunizations occur. It is also true that adverse reactions to the diseases themselves are not at all rare if you don’t immunize. So let’s call this post Immunizations: Their Origin and Necessity.

Still, we have people fighting against immunizations. Observe:

Kids Vaccinations in general

Advantages: none

Disadvantages: enormous

I suppose that depends on whether you feel “Didn’t have to buy a teeny-tiny headstone” is an advantage.

Fair warning: If anyone shows up here to say “Immunizations Cause Autism,” that person will be flamed hairless.

The link between autism and immunization was based on faked research by a man who stood to profit if MMR was discredited. It has been completely exploded.

Here’s the US Government’s recommended schedule for childhood vaccinations:

  • Birth to 2 months: hepatitis B.
  • 2 months: polio; diphtheria, pertussis, tetanus (D.P.T.); Haemophilus influenzae type B (Hib).
  • 2 to 4 months: hepatitis B.
  • 4 months: polio; D.P.T., Hib.
  • 6 months: D.P.T, Hib.
  • 6 months to 18 months: hepatitis B and polio.
  • 12-15 months: D.P.T.; Hib, measles, mumps, rubella (M.M.R.).
  • 12-18 months: chicken pox.
  • 4-6 years: polio; D.P.T., M.M.R.

Let’s look at those diseases.


Hepatitis B

In the USA, 4,480 liver disease deaths per year are due to hepatitis B virus. Another 3,000 deaths per year in the USA are Hepatocellular carcinoma deaths due to hepatitis B.

Acute Hep B is usually fully cured, fairly quickly. The folks with chronic Hepatitis B are generally people who caught it as children, manifesting years later. The signs and symptoms of hep B include:

  • Loss of appetite
  • Nausea and vomiting
  • Weakness and fatigue
  • Abdominal pain, especially around the liver
  • Dark urine
  • Yellowing of the skin and the whites of the eyes (jaundice)
  • Joint pain
Most children who catch Hep B are asymptomatic (but are infectious).
Hepatitis B infection may be either acute — lasting less than six months — or chronic, lasting six months or longer. If the disease is acute, your immune system is usually able to clear the virus from your body, and you should recover completely within a few months. When your immune system can’t fight off the virus, HBV infection may become lifelong, possibly leading to serious illnesses such as cirrhosis and liver cancer.

Most people who acquire hepatitis B as adults have an acute infection. But the outlook isn’t nearly as hopeful for infants and children. Most infants infected with HBV at birth and many children infected between 1 and 5 years of age become chronically infected. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.


Why should I vaccinate my newborn child if I know that I am not infected with hepatitis B virus?
Before the hepatitis B virus vaccine, every year in the United States about 18,000 children were infected with hepatitis B virus by the time they were 10 years old. This statistic is especially important because people are much more likely to develop liver cancer or cirrhosis if they are infected early in life, rather than later in life (most people are infected with hepatitis B virus when they are adolescents and young adults).

About 9,000 of the 18,000 children infected in the first 10 years of life caught the virus from their mother during birth. However, many young children didn’t catch the disease from their mother. They caught it from either another family member or someone else who comes in contact with the child. Because the disease can be transmitted by casual contact, and because many people who are infected with hepatitis B virus don’t know that they have it, it is virtually impossible to be “careful enough” to avoid this infection.

For these reasons, all young children are recommended to receive the hepatitis B vaccine. The best time to receive the first dose is right after birth. This will ensure that the child will be protected as early as possible from catching the disease from someone that doesn’t know that they are infected with the virus.

Let’s talk about the immune system a little bit. This will be a super-simplified overview.

Essentially, the immune system is what keeps us from rotting while we’re still alive. And it does this by being able to tell “us” from “not us” down at the cellular level and destroying the “not us” stuff. Most of us have immune systems that can do this. (Folks who can’t tell “us” from “not us” have their own immune systems attacking them and are said to have auto-immune diseases. Folks who can’t tell “not us” from “us” can’t defend themselves against invaders, and are said to be immunocompromised. This can be either from disease process, or done deliberately, for example in folks who have received organ transplants to keep them from rejecting their foreign tissues.)

You must know that all cells, including our body’s cells, and the cells of bacteria, are made of protein, and the exterior capsule of a virus is also made of protein. And proteins have shapes. The way the body recognizes us from not-us is by the shapes of the proteins.

Specialized blood cells, white cells, go around testing things for their protein shapes. When they find things that don’t belong, they destroy them.

Early in an infection, foreign proteins may not be recognized as “not us.” The viruses or bacteria use this time window to multiply, perhaps beyond the level that the body can cope with. But once the body has been sensitized to the unique protein shapes associated with specific invaders, it remembers them, it produces antibodies specific to them, and if that shape ever appears again is ready to instantly overwhelm the foreign proteins.

If the body’s defenses are so tuned that they destroy the foreign proteins before any signs or symptoms develop, the person is said to be immune.



Polio is the reason the Iron Lung was invented.

Most people who catch polio don’t get sick and are never aware that they were infected. Nevertheless, they can still shed the virus for others to catch for several weeks or months. Photo. Photo. Photo.

Of those who are symptomatic, most show vague flu-like symptoms (e.g. fever, headache, sore throat) associated with any number of viral diseases.

5-10% of those infected develop nonparalytic aseptic meningitis. This lasts from two to ten days. Signs and symptoms include:

  • Fever
  • Headache
  • Vomiting
  • Diarrhea
  • Fatigue
  • Back pain or stiffness
  • Neck pain or stiffness
  • Pain or stiffness in the arms or legs
  • Muscle spasms or tenderness

In paralytic polio, the most common form is spinal polio. In children under five, this most commonly results in paralysis of one limb; in adults paralysis of both arms or both legs is most common. Limb paralysis can occur in any combination, however, and paralysis of the muscles that allow breathing is also possible. It used to be that everyone knew someone who’d been affected; one of my sister’s classmates, for example.

There’s bulbar polio. In bulbar polio, the brainstem is infected, and the cranial nerves are affected. These nerves control your ability to eat, speak, and breathe; seeing, hearing, taste, may be affected, as may the heart, lungs, and digestion.

Ten to forty years after a polio infection, the patient can develop post-polio syndrome. This includes sleep-related breathing disorders, muscle weakness, joint pain, and difficulty with breathing or swallowing. Doyle’s mother has post-polio syndrome. Of polio itself, all she remembers is having to learn how to walk—twice.

Perhaps the best-known polio victim was president Franklin Roosevelt. Used to be that everyone knew at least one person who’d been partly paralyzed by polio. Not so much, now. Wild polio was eradicated in the Americas in 1999. But polio could come back at any time if the immunization rate drops. Polio spreads via the fecal-oral route.

An essay on polio from Elizabeth Moon, below the cut.

Way back in the 18th century, Edward Jenner noticed that milkmaids generally didn’t catch smallpox. What Jenner didn’t (and couldn’t) know at the time was that the surface proteins of cowpox are similar enough to the surface proteins of smallpox that the antibodies specific to one also protected against the other. What he could, and did, notice was that an infection with cowpox translated into an immunity to smallpox.

Jenner published An inquiry into the causes and effects of the Variolae Vaccinae, a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cow-pox, in 1798. He called deliberately infecting someone with cowpox in order to grant immunity to smallpox “vaccination” after the Latin word for cow, vacca.

The practice of vaccination caught on rapidly. Still, there was opposition:

Christian Charles Schieferdecker, M.D.
Dr. C. G. G. Nittinger’s Evils of Vaccination.
Philadelphia: the editor, 1856.

Because of the lack of clear scientific explanation of its effects, the frequent side-effects, and contaminated vaccines, vaccination itself remained controversial throughout the nineteenth century. It certainly carried risks for the infants being vaccinated, and this volume, playing on parental fears, argued, inter alia, that vaccination was nonsensical, unscientific, criminal, and even sinful. Shown here is a satiric vignette of a protective mother’s discussion with the family doctor.



Here’s a nasty. Diphtheria is highly contagious and potentially life-threatening. Signs and symptoms include the lining of the throat turning into a thick, gray, moist membrane that can block breathing, requiring either intubation or a tracheostomy. The bacteria also creates a toxin that that circulates in the blood stream and can damage the heart and kidneys, and cause nerve damage leading to paralysis. Before the diphtheria immunization became common, the United States had some 200,000 cases and 15,000 deaths per year from the disease, 80% of them children. Post-immunization: 41 total reported cases in the US from 1980 to 1995.

Early signs and symptoms include:

  • difficulty breathing or swallowing
  • double vision
  • slurred speech
  • signs of shock

When the diphtheria anti-toxin was first used successfully in Berlin, Germany, Christmas 1891, it was the first time any disease anywhere had actually been cured. Up until then, all that medicine had ever been able to do was support a patient until that patient’s own immune system either worked—or didn’t.

Diphtheria is why Balto, The Bravest Dog Ever, has his statue in Central Park, and why the Iditarod is run every year, in memory of the run that brought diphtheria anti-toxin to Nome.

Diphtheria doesn’t just kill; it kills grotesquely (“bull neck”).

She wrung her hands and groaned and cried
And gnawed her tongue before she died.
Her nails turned black, her voice did fail
She died and left this lower vale.
Wicked Polly

It’s highly contagious. When you see in an old graveyard an entire family of children dead inside a week, think of diphtheria. Here’s a picture of a diphtheria lesion on a leg. (Teresa, don’t look.)

By the second half of the 19th century, the germ theory of disease was gaining ground. Robert Koch, the German bacteriologist, came up with some requirements of what would be necessary to show that a particular bacterium caused a particular disease.

First, the same bacterium had to be found in every victim of the disease.

Second, the bacterium had to be cultured, and when the culture was given to healthy patients, they had to develop the disease.

Third, each of those patients had to be cultured, and the same organism again recovered.

Louis Pasteur was trying this with chicken cholera. With one batch of chickens he used an old culture. The experiment failed: none of the chickens got sick. He tried again with a fresh, strong culture. The experiment failed again; still those chickens didn’t get sick. Even though the same fresh culture was sure-enough sickening other chickens who hadn’t previously gotten doses of old, dead bacteria.

“Holy Mackerel!” Pasteur said (or words to that effect in French), “I think I may be on to something.”

He called his process of creating immunity by inoculation with killed or weakened pathogens “vaccination” in honor of Jenner’s pioneering work with smallpox.



Pertussis is the fancy name for whooping cough. Here’s what it sounds like. Photo.

The course of the disease runs like this: One to two weeks of symptoms that resemble the common cold, followed by two to four weeks of severe coughing. What do I mean by severe? I mean coughing so hard that it can break ribs, cause cerebral hemorrhage, rectal prolapse, or seizures due to hypoxia. I’m talking about vomiting and aspirating the vomitus. That kind of coughing. Complications include pneumonia. Following that stage comes a recovery stage that can last months.

Pertussis was once a leading cause of infant mortality. Between the 1930s, when immunizations became available, and the 1970s, the rate of pertussis in the USA fell 99%.

In England, the percentage of people vaccinated over the last 4 decades decreased to less than 30%. This decline has resulted in thousands of cases reported recently, a rate that approaches the incidence in the prevaccination era. Similar epidemic outbreaks have recently occurred in Sweden, Canada, and Germany. Nearly 300,000 deaths from pertussis in Africa are thought to have occurred over the last decade.
Since the seventies, as rates of vaccination have gone down, the pertussis rate has been rising again, with a spike of 25,000+ cases in 2005. Pertussis is the most commonly reported vaccine-preventable disease in the United States in children younger than 5 years. It is highly contagious. Pertussis can be treated with antibiotics, and with mechanical ventilation and suctioning. Untreated, it has a mortality rate of around 50%.

Community immunity (AKA “herd immunity”) is when so many people are immune to a disease that the disease has no way to reach the rare non-immune patient. Think of those immune individuals as firebreaks. Enough firebreaks and the fire just won’t spread. And there will always be individuals who aren’t immune, no matter how rigorous the immunization schedules: Some will be immuno-compromised. There will be others for whom the immunization doesn’t “take.” Yet others will be unable to receive the immunization due to allergies. But enough firebreaks and they’ll be protected too, by the “herd”—the disease will have no way to reach them.

Pertussis is one of the diseases for which community immunity works well. Its only transmission route is human-to-human (by airborne droplets). But in order to develop community immunity between 92% and 94% of the population must be immune. Among those who are not immune: on average one index case creates 12-17 other cases.

Since Pertussis only exists in humans, like smallpox, it could be eliminated in the wild by sufficiently complete immunization.



Community immunity won’t help you with tetanus (AKA “lockjaw”). The bacteria that cause tetanus are common in the environment. Any contaminated wound can have a nice case of tetanus associated.

Tetanus causes prolonged contractions of the skeletal muscles. That’s what locks the ol’ jaw. That’s also what can bend you over backwards like a bow until you’re supported by just your heels and your head. (Photo) (Another photo) (Painting) (Child with tetanus, Photo) (Infant with tetanus, Photo)

I’ll fix your feet til you can’t walk
I’ll lock your jaw til you can’t talk
I’ll close your eyes so you can’t see
This very hour, come and go with me
I’m death I come to take the soul
Leave the body and leave it cold
To draw up the flesh off of the frame
Dirt and worm both have a claim
O Death

Signs and symptoms may include:

  • Difficulty swallowing
  • Sore muscles
  • Spasms in the facial muscles
  • Muscle spasms (may be strong enough to break bones or dislocate joints)
  • Difficulty breathing

Tetanus is life-threatening. Once the patient is symptomatic, in the US, the mortality rate is 25%. Worldwide it’s 50%.

We routinely inquire about a patient’s tetanus immunization status any time a tetanus-prone wound shows up, and routinely give the immunization any time the patient isn’t 100% sure he/she has had the shot within the past five years.

One of the early signs of tetanus is the rictus sardonicus, a smile like the Joker in the comic books. A highly accurate (and highly specific) test for tetanus is this: tickle the back of the patient’s throat with a tongue depressor. If the patient coughs, gags, or chokes, that’s negative. If, on the other hand, the patient bites down on the tongue depressor, that’s a positive: he’s got lockjaw.

If you have a deep or dirty wound, particularly a puncture wound, get it seen in an Emergency Room. If you have a wound and subsequently start feeling muscle cramps in the area … get to an Emergency Room now. We have people standing by.


Haemophilus influenzae type B

This is the disease that inspired this post. The news story read, Rare sickness kills child; officials urge vaccination

A childhood illness that has mostly been curbed through vaccinations has killed one child and sickened four others in Minnesota, health officials said Friday.

The five children were infected with a bacterial infection known as Hib: Haemophilus influenzae type b.

Three of the affected children had not received any vaccinations, including the 7-month-old who died, according to the Centers for Disease Control and Prevention.

“The situation is of concern,” said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Disease at the CDC. “It could be happening elsewhere, and of course it’s tragic that one of the children actually died from a preventable disease.”

One of the infected children, a 5-month old, had not completed the three-dose series of the vaccination, and a 15-month old child had received all doses but had an immune deficiency.

Before the immunization was developed, 43 per 100,000 children got meningitis associated with Hib.

Of those 43, 20% would die. 8.6 out of those 43. One in five.

So, you see, five sick and one dead falls right into the expected mortality rate. It’s a mortality rate that’s worse than you’d get playing Russian Roulette (where the odds are one in six that you’ll die).

How about the ones who get Hib meningitis and don’t die?

15%-30% of survivors suffer some permanent neurologic damage, including blindness, deafness, and mental retardation.

Another 17% of invasive Hib cases include epiglottitis, an infection and swelling in the throat that can cause life-threatening airway blockage. Other forms of invasive Hib disease include: joint infection (8%), skin infection (6%), pneumonia (15%), and bone infection (2%).

With Hib vaccine, the rate of Hib meningitis is 0.11 per 100,000.



Complications of measles are comparatively rare. But given that measles’ infection rate is around 90%, a small percent of a large number is still a large number. And in third-world countries, the fatality rate for measles runs around 28%. Among immuno-compromised folks right here, measles is around 30% fatal. (That’s where community immunity comes in handy—if the immuno-compromised folks never run into measles because everyone else is immune, they skate.) Photo. Photo. Photo.

Measles is comparatively mild in children; it can be devastating in adults. The 1911 measles epidemic killed 5% of the US Army.

And even “comparatively mild” is still nothing to laugh at. Those complications can include blindness and deafness from scarring. In The Five Little Peppers and How They Grew the children all get the measles, and there’s quite a bit of concern that Polly will go blind.

But Polly’s eyes didn’t get any better, with all the care; and the lines of worry on Mrs. Pepper’s face grew deeper and deeper. At last, she just confronted Dr. Fisher in the kitchen, one day after his visit to Polly, and boldly asked him if they ever could be cured. “I know she’s—and there isn’t any use keeping it from me,” said the poor woman—“she’s going to be stone-blind!”

“My good woman,” Dr. Fisher’s voice was very gentle; and he took the hard, brown hand in his own—“your little girl will not be blind; I tell you the truth; but it will take some time to make her eyes quite strong—time, and rest. She has strained them in some way, but she will come out of it.”

To poor Polly, lying in the darkened room, or sitting up in the big rocking-chair—for Polly wasn’t really very sick in other respects, the disease having all gone into the merry brown eyes—the time seemed interminable. Not to do anything! The very idea at any time would have filled her active, wide-awake little body with horror; and now, here she was!

Signs and symptoms of measles include:

  • Fever
  • Dry cough
  • Runny nose
  • Inflamed eyes (conjunctivitis)
  • Sensitivity to light
  • Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek, called Koplik’s spots
  • A skin rash made up of large, flat blotches that often flow into one another

Complications include:

  • Ear infection. Measles causes an ear infection in nearly one out of every 10 children.
  • Encephalitis. About one in 1,000 people with measles develops encephalitis, an inflammation of the brain caused by a viral infection, which may cause vomiting, convulsions and, rarely, coma. Encephalitis can closely follow measles, or it can occur years later during adolescence as a result of a slow virus infection. The late form, called Dawson’s encephalitis, is rare.
  • Pneumonia. As many as one in 15 with measles gets pneumonia, which can be life-threatening.
  • Diarrhea or vomiting. These complications are more common in infants and small children.
  • Bronchitis, laryngitis or croup. Measles may lead to inflammation of your voice box (larynx) or inflammation of the inner walls that line the main air passageways of your lungs (bronchial tubes).
  • Pregnancy problems. Pregnant women need to take special care to avoid measles, because the disease can cause miscarriage, premature labor or babies with low birth weights.
  • Low platelet count (thrombocytopenia). Measles may lead to a decrease in platelets — the type of blood cells that are essential for blood clotting.

In 2007, there were 197,000 measles deaths globally - nearly 540 deaths every day or 22 deaths every hour, mostly children under the age of five.

It remains a leading cause of death among young children globally, despite the availability of a safe and effective vaccine.
EBER DIED OCT 27, 1802 AGED 7 MO 16 DS


Mumps is caused by a virus. The usual route of transmission is through droplets (coughing and sneezing). Photo. Photo. The most common presentation is a parotitis (inflammation of the major salivary glands located on either side of the face), which occurs in 30-40% of patients. Other reported sites of infection are the testes, pancreas, eyes, ovaries, central nervous system, joints, and kidneys.

  • Central Nervous System involvement is common, but symptomatic meningitis only occurs in about 15% of patients. It usually resolves without complications, but adults are at a higher risk for sequelae. Encephalitis is rare and is seen in fewer than 2 per 100,000 cases. It has a mortality rate of 1.4%.
  • Orchitis (inflammation of the testicles) can occur in 50% of postpubertal males. It causes testicular atrophy in as many as 50% of persons affected but rarely causes sterility.
  • Pancreatitis occurs in 5% of persons infected with mumps. The hyperglycemia that results is usually transient, but a few cases of diabetes mellitus have been reported. It is not conclusive that the mumps virus has been the definitive cause.
  • Deafness has been reported in 1 per 20,000 cases of mumps. In 80% of cases, the hearing loss is reported to be unilateral.
  • Some deaths due to myocarditis (inflammation of the heart muscle) have been reported. The incidence of this complication is reported to be up to 15%, but it is usually asymptomatic.
  • The risk of spontaneous abortion is increased in a woman who contracts mumps in the first trimester.
  • Other complications reported are chronic arthritis, arthralgias (joint pain), and nephritis (inflammation of the kidneys).

Serious complications are more common in adults.

One of the objections to the germ theory of disease was that not everyone who’s exposed to the germs gets sick. (Some debunkers deliberately ingested pure cultures of disease germs with no ill effects and used this as proof that germs don’t cause illness.) But it isn’t necessary for everyone to become ill for a contagious disease to be a serious public health problem. In order to have a pandemic as few as 15-40% of the population need to be affected.



Mild in children (a rash, low-grade fever, and aching joints), rubella (AKA German measles, three-day measles) is devastating in pregnant women.

In the first trimester, there’s a 90% chance that rubella would pass from the pregnant woman to her fetus, causing congenital rubella syndrome (CRS). In 20% of cases this results in spontaneous abortion.

Among those born alive:

Signs and symptoms in the infant may include:

  • Cloudy corneas or white appearance to pupil (43%)
  • Deafness (58%)
  • Developmental delay
  • Excessive sleepiness
  • Irritability
  • Low birth weight
  • Mental retardation
  • Seizures
  • Small head size
  • Skin rash at birth
  • Heart defects (50%)
  • Meningitis
  • Encephalitis
  • Learning disabilities
  • Schizophrenia

It is important for women to become immune to rubella before they reach child-bearing age. Herd immunity is also important to protect those who are either not immune or whose immunity is not complete. Photo. Photo.

Rubella is a virus; it is transmitted by contact or airborne droplets.

If you are pregnant and suspect you have rubella, do not visit your OB/GYN directly. Call ahead, to avoid contact with other pregnant women.

HIRAM BORN JAN 14, 1827 DIED FEB 14, 1827
CHESTER G. BORN MAY 5, 1832 DIED FEB 19, 1833
SUSAN BORN APRIL 14, 1836 DIED DEC 10, 1836

Chicken Pox

Chicken pox (AKA varicella). A red itchy rash marked with blisters, low-grade fever, and aching joints that lasts for a few days. The rash appears primarily on the torso. Caused by a virus and spread by droplets or direct contact. Photo. Photo. Photo.

When a woman who is not immune catches chicken pox any time during pregnancy, but particularly in the first 28 weeks of pregnancy, the virus can infect her fetus, resulting in fetal varicella syndrome:

  • Under-developed fingers and toes
  • Anal and urinary bladder sphincter abnormalities
  • Spinal cord malformation
  • Damage to the eyes
  • Brain damage
  • Absent deep tendon reflexes
Maternal infection at any time in pregnancy exposes the fetus to a high risk of transplacental contamination and is indicative of fetal follow-up. The risk of fetal anomalies, however, is higher during the first and second trimesters. Sonographic signs of fetal disease include fetal demise, growth restriction, musculoskeletal abnormalities such as clubfeet and abnormal position of the hands (caused by both necrosis and denervation of the affected tissue), limitation of limb extension due to cicatrices formation, cutaneous scars, limb hypoplasia, chorioretinitis, congenital cataracts, microphthalmia, hydrops, polyhydramnios, hyperechogenic hepatic foci, cerebral anomalies such as ventriculomegaly or atrophy, and microcephaly, disseminated foci of necrosis and microcalcifications, encephalitis, echogenic bowel in the second trimester. The placenta can show a multifocal chronic villitis with multinucleated giant cells. Fetal infection can be demonstrated by detection of varicella-zoster virus DNA by polymerase chain reaction (PCR) in fetal blood and amniotic fluid or by detection of the specific IgM antibody, in the same fluids.

You don’t want that, now do you?

Immunization prevents it.


Chicken pox is the gift that keeps on giving. It never goes away—it just becomes inactive living along the nerve pathways in the body. It can return in the form of shingles later on, when the patient is under stress, immunocompromised, or otherwise has reduced resistance.

People who have had chickenpox (varicella zoster) in their youth can develop shingles (herpes zoster) in later years. During an acute attack of the chickenpox virus, most of the viral organisms are destroyed, but some survive, travel up nerve fibers along the spine, and lodge in nerve cells where they may lie dormant for many years. A decrease in the body’s resistance can cause the virus to reawaken decades later. It then travels back down the nerve fibers to the skin’s surface. Photo. Photo. Photo.

The reawakened virus generally causes a vague burning sensation or tingling over an area of skin. A painful rash usually occurs two to five days after the first symptoms appear. A cluster of small bumps (1) turns into blisters (2) that resemble chickenpox lesions. The blisters fill with pus, break open (3), crust over (4), and finally disappear. This process takes four to five weeks.

A painful condition called post-herpetic neuralgia can sometimes occur. This condition is thought to be caused by damage to the nerves (5), and can last from weeks to years after the rash disappears.


Why do we immunize? Because if we don’t…these diseases come back.

More from the CDC

Index to Medical Posts

February 19, 2009
Beef in Harpoon Cider
Posted by Teresa at 01:10 PM * 67 comments

1-2 pounds of hanger steak or other lean beef
2 bottles of Harpoon cider
a pound of dry noodles or pasta
1 package of good-quality frozen mixed vegetables
butter, salt, pepper, cornstarch

Put a knob of butter in a heavy saucepan and use it to brown your meat on both sides, then cut the meat into bite-size pieces and return to the pan. Pour an entire bottle of Harpoon cider over it and set it to simmer at a low temperature. When the cider is reduced to about a fourth of its previous volume, add the second bottle of cider and keep simmering. By the time the cider and pan juices are down to about the half the volume of a bottle of cider, the beef should be fairly tender. Add salt and pepper to taste, and turn the fire way down.

Get a pot of noodles cooking. (For the record, I used Grand’Mère seven-egg spaetzle, which Patrick is fond of, but any butterable pasta will do. For that matter, so will an equivalent quantity of gnocchi, rice, or new potatoes.) Add the frozen vegetables to the beef, put a lid on it, and turn the fire up far enough for the vegetables to be cooked before the noodles are ready. Thicken the pan juices with cornstarch.

Drain the noodles and toss them with some butter. You can serve the beef and vegetables on top of the buttered noodles, or side-by-side with them, as you prefer.

Notes: Yes, of course you can use a different brand of cider, but Harpoon works well with this recipe. You may want to add a little chopped onion if your vegetable mix doesn’t include it. I wouldn’t put mushrooms in this, as it would blunt the effect.

Addendum: What Andrew Plotkin’s Been Cooking

(This is just to say what I did this evening:)

Swirling and churning in a pan on the fire,
A can of mango puree and a cup of sugar;
While two cups of ricotta sizzle alongside,
Perhaps in ghee, or oil, or some butter.

The two pans sit and glower, side by side;
Instructions say the ricotta should be browned
And the mango thick. I’m not convinced:
The one lacks all color, the other’s full of passion
But no consistency. Surely some burnination is at hand.
Things boil down, the saute cannot hold.

The final mixing! (I’ve run out of patience
and anyway I have to work on Monday.)
Trouble’s in sight — I took it off too soon —
Not thick enough. Back on the heat it goes.

Well, now I know. A second recipe’s at hand;
It wants farina?! I’ve got oatmeal. Shush.
Vanilla, a bit of ginger, cardamom seed
Ground to powder by a rocking pestle.
Mix, stir, thicken, turn out at last,
Mango burfi is loosed upon the world.

(…What recipe, so delicious and so sweet
Slouches towards the icebox to be breakfast?)

[Recipe Index]

February 14, 2009
Generous to a fault
Posted by Abi Sutherland at 05:57 AM *

SitePoint, an Australian publisher of computing books and websites, decided to raise some funds in aid of the victims of the recent Australian bushfires. They advertised, and started, a three-day sale of five PDF books for US$29.95, with all proceeds to be donated to the Red Cross Victorian Bushfires Appeal. They hoped to raise US$100,000.

After overwhelming response, they shut the promotion down early, when it reached US$50,000.

Customers who had delayed ordering their books were irate, and were just getting up a good head of complaining steam on the thread that announced the closure, when one of the SitePoint crew posted an explanation.

Apparently, Consumer Affairs Victoria contacted SitePoint to explain that you can’t raise more than a certain amount without being a registered fundraiser. The process of registration takes 28 days (allowing time for things like criminal background checks). Penalties for non-compliance are stiff:

The penalty is $25,783 in the case of a corporation and $12,892 for an individual - and/or 12 months imprisonment.

You can see why SitePoint backed off.

There’s certainly a nice juicy “government interference” story in here which, if this were not such a techie niche matter, would make good copy in libertarian circles. It’s certainly tempting to get annoyed at the lost opportunity to help; I was, at first.

But, upon consideration, I can’t stay vexed. The law is clearly in place for good reason; unregulated charity collection is a magnet for fraud. How much less would people give if they didn’t know that the companies they were donating to were registered and checked?

This anecdote of the pain incurred while finding a balance between practicality and idealism is proffered in lieu of detailed commentary on the early days of the Obama administration.

Open thread 119
Posted by Abi Sutherland at 05:55 AM *

From Basin and Range, by John McPhee

I once dreamed about a great fire that broke out at night at Nasser Aftab’s House of Carpets. In Aftab’s showroom under the queen-post trusses were layer upon layer and pile after pile of shags and broadlooms, hooks and throws, para-Persians and polyesters. The intense and shriveling heat consumed or melted most of what was there. The roof gave way. It was a night of cyclonic winds, stabs of unseasonal lightning. Flaming debris fell on the carpets. Layers of ash descended, alighted, swirled in the wind, and drifted. Molten polyester hardened on the cellar stairs. Almost simultaneously there occurred a major accident in the ice-cream factory next door. As yet no people had arrived. Dead of night. Distant city. And before long the west wall of the House of Carpets fell in under the pressure and weight of a broad, braided ooze of six admixing flavors, which slowly entered Nasser Aftab’s showroom and folded and double-folded and covered what was left of his carpets, moving them, as well, some distance across the room. Snow began to fall. It turned to sleet, and soon to freezing rain. In heavy winds under clearing skies, the temperature fell to six below zero. Celsius. Representatives of two warring insurance companies showed up just in front of the fire engines. The insurance companies needed to know precisely what had happened, and in what order, and to what extent it was Aftab’s fault. If not a hundred percent, then to what extent was it the ice-cream factory’s fault? And how much fault must be — regrettably — assigned to God? The problem was obviously too tough for the Chicken Valley Police Department, or, for that matter, for any ordinary detective. It was a problem, naturally, for a field geologist. One shuffled in eventually. Scratched-up boots. A puzzled look. He picked up bits of wall and ceiling, looked under the carpets, tasted the ice cream. He felt the risers of the cellar stairs. Looking up, he told Hartford everything it wanted to know. For him this was so simple it was a five-minute job.

One day I want McPhee to dream about software testing.

February 13, 2009
So outlandish a proposition
Posted by Avram Grumer at 01:59 AM * 3 comments

Just in time for Valentine’s Day, Calamity Jon Morris presents Deadwood Valentines! (No, not work-safe.)

(Also, he’s made some of the world’s best Deadwood fan art.)

February 07, 2009
“Let me through, I know Unix”
Posted by Patrick at 11:12 AM * 129 comments

Request for help with, yes, procmail—below the fold.

February 06, 2009
Twenty-Five Random Things About You
Posted by Patrick at 01:05 PM *

Rules: Once you’ve been tagged, make up 25 facts, habits, goals, philosophical principles, recipes, shell scripts, sestinas, web comics, stained glass windows, or rotating bow ties. At the end, choose 25 people to “tag,” which is to say, draw on with cans of spray paint. When you have finished your “tags,” “Twitter” the results to your “Facebook” and run away.

1. You’ve been to Alaska twice, but you’ve never visited any state in New England.

2. The sight of potatos with “eyes” creeps you out.

3. Once, on an hours-delayed red-eye flight home, you met the Reverend Jesse Jackson. He was much taller than you expected.

4. When you were small, your uncle worked for the Pennsylvania Department of Agriculture, causing you to imagine that all the grocery-store products marked “Reg. Penna. Dept. Agric.” had been personally inspected by him.

5. You love hot water, and would conduct your entire professional life from the bath if you could get away with it.

6. In college, your father played the bassoon.

7. Like George Orwell, you can’t stand the smell of cooking cabbage.

8. You’re a smart, thrifty clothing shopper; you love helping friends upgrade their wardrobes. Given everything else about your personality, nobody expects this, but it’s true.

9. Once, while setting up outdoor lights for a lawn party, you and a friend once managed to give yourselves the kind of bruising electric shock that leaves you briefly paralyzed and stunned. You pretended it wasn’t a big deal, but for the rest of the evening, everything you tried to eat or drink promptly came back up. Since the party was being hosted by your boss, you covered. But even before then, you always hated dealing with electrical equipment.

10. For several years, as a child, you were allergic to eggs. Eventually the allergy went completely away; nobody knows why.

11. You like math and you don’t see why anybody finds it hard.

12. Riding a bicyle, now, that’s hard. You have a long, funny riff about this in which you explain that nobody really rides a bicycle and that it’s all actually an optical illusion pulled off with wires and mirrors.

13. You remember when the cartoons in the New Yorker were funny.

14. You carry a smartphone, but as an act of secret rebellion, you turn it off every chance you get.

15. You like moving house, particularly the part about getting rid of old, outdated, no-longer-useful personal effects.

16. You tend to get behind on laundry. Sometimes you wear the same pair of socks two days in a row.

17. You’ll watch anything with Eleanor Bron in it. You own multiple copies, in multiple formats, of Help!, the original Bedazzled, and the 1979 Doctor Who serial “City of Death.”

18. Despite your bad luck with electricity, you’re a pretty good home carpenter.

19. You took piano lessons as in your teens. You got pretty good, but as an adult you don’t own any kind of keyboard instrument and you have no desire to.

20. You’ve been mistakenly arrested for shoplifting—twice. You were completely innocent both times, but you don’t talk about it because people don’t believe you.

21. On the other hand, there’s that much worse crime you got away with scot-free. You don’t talk about that one, either.

22. Patchy hair loss runs in your family, affecting both males and females. You keep thinking you should shave your head before it kicks in.

23. You’re tired of your best friend’s blog.

24. You were an extra in the 1973 Jack Nicholson vehicle The Last Detail.

25. You like airports. One bright morning, you’ll fly away.

[Tagged: Abi Sutherland, Kevin Maroney, Xopher, Elisa Peimer, Linkmeister, Beth Meacham, Neil Gaiman, Robert Rossney, Boris Johnson, Henry Farrell, Paul Krugman, Nouriel Roubini, Stephen Maturin, Mary Dell, Joe Biden, Edmund Wilson, St. John of the Cross, Silvio Berlusconi, Ian M. “Biff” Banks, the guy who yells about 9/11 in Union Square, Mr. Boston, Mr. Clean, Mr. Norrell, Norman Mailer, Maxwell Taylor, that’s the hand I use, well, never mind]

February 05, 2009
Trilchy wings
Posted by Abi Sutherland at 06:16 PM * 408 comments

You know, one of the things I’ve always assumed about these introspective threads is that everyone there is telling the truth, or some interesting variant of it. Of course I know that’s not necessarily the case; that, as I said once, lies between each of us and his or her conscience.

But now let’s play with it. Show us, please, a butterfly moment from a character out of fiction.

Usual rules, please; all answers should be ROT-13‘d. Feel free to add to the canon as you do so, inserting scenes the author inconveniently skipped, but make it plausible.

- o0o -

G always said he knew I’d accept, that I was somehow destined for it. But frankly, I wasn’t going to. I had other engagements that week, you know, and I really didn’t fancy the bother of it all. The last thing I wanted was to spend more time with that obnoxious, ill-mannered and greedy set of characters.

It was the map that changed it for me. I’ve always loved maps. My father never did, thinking them rather a waste of good paper. My mother was of a different mind, and she and I used to draw them together when I was a lad. We’d invent roads and villages where really there were only fields, and fall to describing the lives of the families who lived there. Our maps and stories were never that exciting, really—the places and the folk were merely echoes and mirrors of the ones that we saw every day. But, looking back, I saw a hunger in her to stretch the boundaries of our little world, though she hid it even from herself.

So when they brought the map out, I saw it not in T’s hands, or G’s, but in my mother’s, laid out on the same table where we had drawn our own imaginary places years before. When I decided to go, the choice was not so much mine as hers. And all of the time I was gone, every step I took, I did it as her son, walking the Road that she never took.

(Trilchies? Like space butterflies. Sort of.)

February 03, 2009
Posted by Patrick at 07:42 PM *

Clay Shirky observes: “The internet is done now.”

February 01, 2009
TIME magazine to readers: “Interact with us” means nothing more than “promote us for free”
Posted by Patrick at 10:50 AM *

At the end of every story on their web site, here’s Time magazine’s idea of how you should “interact with” it:

Let’s see, you can promote Time by recommending their story on Yahoo Buzz. You can promote Time by recommending their story on Facebook. You can promote Time by recommending their story on Digg. And you can email a link to the story to your friends.

What’s notably missing from the list of ways to “interact” is, you know, interaction. I wanted to let someone at Time know that their story mistakenly spells my conglomerate’s name “MacMillan” throughout (it’s Macmillan). I suppose that somewhere on their vast site there must be a link for feedback of this sort. But it says volumes that it’s not one of the options under “interact with this story.” In Time’s world, “interaction” evidently means you do them favors, little person, not that you talk back.

I don’t remember who it was that originally said it—Merlin Mann? Someone like that—but I keep coming back to the observation that when a marketing person asks “How can I better use social media?”, what they’re actually asking is “How can I spam more effectively?” It’s not categorically true—the marketing people I work with are generally smarter and more clued-in than that—but it’s true in all too many organizations, including big, powerful media operations that should have started learning better a long time ago.

“Principles of the American Cargo Cult”
Posted by Patrick at 10:26 AM *

One of those pieces of web writing, by someone about whom you know nothing, that hits you directly amidships. I don’t even remember how I found it.

I wrote these principles after reflecting on the content of contemporary newspapers and broadcast media and why that content disquieted me. I saw that I was not disturbed so much by what was written or said as I was by what is not. The tacit assumptions underlying most popular content reflect a worldview that is orthogonal to reality in many ways. By reflecting this skewed weltanschauung, the media reinforces and propagates it.

I call this worldview the American Cargo Cult, after the real New Guinea cargo cults that arose after the second world war.

The outlined principles divide up alarmingly well into “stuff I recognize as generally true about the way Americans think” and “stuff I just now realized I think.” Damn.
Certainty is strength, doubt is weakness
Admitting alternatives is undermining one’s own belief.
Changing one’s mind means one has wasted the time spent holding the prior opinion.
Your opinion matters as much as anyone else’s
When a person has studied a topic, he has no more real knowledge than you do, just a hidden agenda.


You can succeed by emulating the purported behavior of successful people

This is the key to the cargo cult. To enjoy the success of another, just mimic the rituals he claims to follow.
Your idol gets the blame if things don’t work out, not you.


If it’s good for you, it’s good

Society is everyone else.
Good intentions suffice
You can always apologize.
There is no long term
Don’t miss an opportunity.


There will be justice

Bad people get punished.
You, however, will be forgiven.
I’m doing it a disservice by quoting chunks outside of the author’s elegant outline format. Read the original.

Web advertising fail
Posted by Patrick at 09:42 AM * 103 comments

I’ve never used adblocking software. For a bunch of reasons: Making Light runs ads, Teresa works for a site that’s supported by ads, and in general it seems like a good idea to keep current on the whole business of web advertising if I want to be all new-media-savvy in this brave new world we have no choice about living in. Also, some ads are interesting.

But the sudden presence of the World’s Ugliest Ad on every goddamn site I read has turned me around. Hello, Adblock Plus; so far so good.

I wonder how many other people have finally installed an adblocker because of this travesty? Well done, 2 Rules To a Flat Stomach people. There really isn’t any social arrangement that someone won’t eventually ruin by pushing it to the limits.

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