Carbon monoxide poisoning

 Carbon monoxide is a silent killer. And this case on Homicide Hunter starts out as a ritual suicide and an investigation finally revealed it was an accident in venting the furnace because the landlord did a DIY instead of paying for an expert.

smallpox and... yogurt in ancient Japan

reading the Tale of Genji has made me curious about that era.

 I am working my way through this book because it gives information on disease in Haien period Japan

before the Haien period, there was a lot of trade and immigration from Korea and even China, and this included the introduction of diseases and Buddhism. 

Buddhism and an unknown disease that caused an epidemic, probably smallpox arrived at the same time, but it wasn't until 200 years later in 735 that a verified smallpox epidemic depopulated Japan and much of the aristocracy (25 percen mortality).

and I ran into a quote describing the household of  a rich guy during the Haien period, whose servants include.... a  yogurt maker.

Yogurt? as in milk based yogurt? Yup. Apparently along with small pox and sutras, yogurt and ghee came to Japan with Buddhist monks. After all, Buddhism was originally an Indian religion, and yogurt and ghee were commonly used in India.

the use of milk products died out in Japan, but continued in some parts of China. But milk products continued to be used as medicine. 

LINK

Dairy was also known to early Chinese civilization. Huang (2002, p. 809) states that “oracle-bone and bronze inscriptions suggest that the collecting of milk from cows and mares was not an unfamiliar art during the Shang Dynasty (ca. 1520–1030 b.c.)”. We might ask the extent to which dairy was consumed not only in China in later centuries—particularly during the first millennium CE—but also whether contemporary Japan had a comparable industry. Buddhism, medicine, astronomy and the Chinese script were transmitted from the mainland to Japan, but what about cattle rearing and the production of dairy products? The role of dairy in premodern China is slowly becoming recognized today, despite some past preconceived notions that peoples in East Asia seldom enjoyed milk and cheese until the twentieth century. Miranda Brown recently published a study of a text from 1504 that includes a recipe for cheese-stuffed pasta by a certain Mr. Song. The use of cheese in Chinese culture, particularly in premodern periods, is generally not recognized today by historians of food

there are several papers out there about trade between China Korea and Japan, which introduced Buddhism and disease among other things. This one states;

Smallpox was first introduced to the islands of Japan by merchants and Buddhist missionaries from the Korean kingdom of Paekche in the sixth century CE. Once it reached the shores of Japan, smallpox did not disappear but emerged in waves that were sometimes manageable and were at other times catastrophic. In 735, a second smallpox epidemic afflicted Japan, reducing the population by 30 percent and resulting in labor shortages and declines in agricultural production and tax revenue for the court

and periodic epidemics continued: The author of Tale of Genji lost her husband to small pox. But there is not a lot of information about epidemics in either that novel or the diaries and books of other court ladies, nor is there any mention of smallpox scars....

 in Genji several deaths are described: Post partum eclampsia death of Genji's wife  (such seizures can occur up to six weeks post partum), the lingering death of the seducer of the Third princess that sounds like Beri beri, and the lingering death of Murasaki, probably from tuberculosis.

But no mention of yogurt or ghee/clarified butter.

so how was smallpox treated?

 

At the height of the epidemic, Emperor Shomu consulted his officials at the Bureau of Medicine. They recommended various remedies and guidelines, including a prohibition against drinking water, an encouragement to eat boiled rhubarb, and a recommendation to apply powdered silkworm cocoons to boils. 

When these guidelines did not help to quell the disease, Emperor Shomu ordered Buddhist monks and nuns to read sutras to the afflicted and prayers to kami, whom he interpreted to be deities that were part of the Buddhist universe.

 

....

....

So what does Grok say

about all of this?

In Heian period Japan (794–1185), yogurt and butter were rare and valued mostly for their medicinal uses, mainly among the aristocracy and in Buddhist practices. Dairy was not widely consumed due to Buddhist prohibitions on animal products, but it held a special place in elite and religious contexts.

**Medicinal Yogurt**: A yogurt-like product called *raku* (possibly fermented milk) was documented in texts like the *Ishinpō* (984 CE), a medical treatise. It was considered a health-promoting food, used to aid digestion and treat illnesses, especially among nobles. Its use was influenced by Chinese medicine, where dairy was seen as beneficial for vitality. *Raku* was likely consumed in small amounts by the elite, as dairy production was limited and tied to imperial or aristocratic estates.[](https://www.incrediblediscourse.com/post/dairy-in-japan)[](https://traditional-foods.maff.go.jp/en/bunrui/chikusankakohin)

**Medicinal Butter**: Butter, referred to as *so* or *gyuuraku*, was also a luxury item, primarily supplied to the imperial court, as noted in the *Engi Shiki* (927 CE). It was used medicinally to support health and digestion, often prescribed in Chinese-influenced medical practices. Butter was sometimes processed into forms like *hakugyūraku* (a condensed milk product) for its nutritional value. Its production was overseen by the Bureau of Medicine, showing its link to health rather than everyday diet.[]>

(https://www.incrediblediscourse.com/post/dairy-in-japan)[]

(https://www.thechinastory.org/dairy-the-deep-historical-link-between-china-and-japan/)[](https://gochisohistory.com/cheese-dairy-in-japan/)

**Buddhist Context**: Dairy, including yogurt and butter, was used in Buddhist rituals, inspired by Indian traditions via China. Texts like the *Vairocanābhisambodhi* mention dairy in offerings, such as yogurt rice or butter in magical rituals. While direct evidence of ritual use in Japan is limited, the influence of Chinese Buddhism suggests dairy was likely part of similar practices, especially in aristocratic temples.[](https://www.incrediblediscourse.com/post/dairy-in-japan)[](https://www.thechinastory.org/dairy-the-deep-historical-link-between-china-and-japan/)

**Limitations**: Dairy was scarce, expensive, and mostly inaccessible to commoners. Its use declined toward the end of the Heian period as aristocratic power waned and Buddhist vegetarianism grew stronger, reducing dairy’s presence until the modern era.[](https://www.incrediblediscourse.com/post/dairy-in-japan)

In summary, yogurt and butter were elite, medicinal products in Heian Japan, tied to Chinese medical traditions and Buddhist rituals, with limited use beyond the aristocracy.

Diptheria

This is an old article from AlJezeerah about the measles epidemic a couple years ago here in the Philippines. 

What caused it? Hysteria about complications from an experimental Dengue vaccine given to children which if given to people who had never had dengue exposure made them more prone to get severe dengue.

all the cases of so-called “severe dengue” were relatively mild. Sanofi’s definition of “severe dengue” also contained much milder symptoms than other international definitions.

So none of the more than 30,000 children in the clinical trial died of dengue:

 yes there were some deaths in children that were blamed on the vaccine, but public health authorities said their deaths were from other causes but the damage had been done, and many parents refused to let their kids get even the routine vaccines that had been around for decades.

 

......, '

Fast forward to today.

A lot of hysteria about measles vaccine in the USA, but I wondered why the autism epidemic blamed on measles vaccine waited 30 years to start causing problems. But never mind. Parents want answers. Hopefully RFKJr will figure it out.

Measles is rarely fatal in well nourished Americans, but it is highly fatal in Africa and Asia, where a lot of children have borderline malnutrition... 

But with millions of unscreened migrants let in by Biden's policies, it may be only a matter of time that we start seeing diseases not seen in the US for a century start popping up.

 

 there has been cases of Diphtheria in migrants in Europe. because many of these were not vaccinated in their own country. But ironically many who caught diphtheria caught it  in Europe, meaning that there are clusters of mild cases, carriers, i.e. patients who carry the germ and spread it to others, or cases treated with antibiotics but not diagnosed as diphtheria in certain communities of migrants.

and so cases will continue to occur. And if the anti vax hysteria stops people from getting these vaccines that have been around since the 1920s, well, it is an epidemic waiting to happen.

so far, unlike Europe, the USA seems to be safe from epidemics:

from Grok:

Diphtheria is extremely rare in the United States due to widespread vaccination. ... a few cases have been noted in recent years: - In 2012, one provisional case was reported. - In 2019, two cases were reported, the most recent data available from sources like Our World in Data (https://ourworldindata.org/grapher/diphtheria-cases-in-the-united-states) - A 2020 case report described a 33-year-old unvaccinated man in Georgia with respiratory diphtheria, likely linked to his recent incarceration and lack of childhood vaccinations.[](https://pmc.ncbi.nlm.nih.gov/articles/PMC7753149/)[](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753149/) These cases are exceptions, often tied to unvaccinated or under-vaccinated individuals, international travel, or contact with travelers from areas where diphtheria is more common, like parts of Africa, Asia, or conflict zones. The disease remains under control in the U.S. thanks to high vaccination coverage with DTaP, Tdap, or Td vaccines.[](https://www.cdc.gov/diphtheria/about/index.html)[](https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/diphtheria)[](https://www.hhs.gov/immunization/diseases/diphtheria/index.html)

more here.

 and the bad news is that unless your doctor worked or trained overseas, they might not recognize it in time for the correct treatment. Of course, if you go to an old fashioned doctor who gives antibiotics for sore throats, you might have it cured before you develop proper symptoms.

what inspired this blog post was a book I ran across while checking Project Gutenberg: a 1919 describing the public health approach to diphtheria.

 And there was a cure: Anti toxin. 

Depending on the way it is treated, diphtheria is one of the least dangerous or one of the most dangerous diseases. It is one of the least dangerous when promptly treated with antitoxin; it is one of the most[8] dangerous when the antitoxin treatment is not given, or is delayed or insufficient.

In the days before we had antitoxin one out of every three children who had diphtheria died. Now, if antitoxin is used on the first or second day of the disease ninety-eight out of every hundred children recover. The sooner diphtheria is attended to the more certain is a cure.

The toxin is the reason for those tough membranes that cause choking. 

Breathing problems. Diphtheria-causing bacteria may produce a toxin. This toxin damages tissue in the immediate area of infection — usually, the nose and throat. At that site, the infection produces a tough, gray membrane made up of dead cells, bacteria and other substances. This membrane can obstruct breathing.

there is also a real danger of myocarditis and neurological complications from the toxin produced by the germ.

Nowadays, there is treatment: antibiotics and anti toxin.

 

Alas, diphtheria is still present here in the Philippines, and seen in various Asian and African countries:    right now there is an outbreak of diphteria in the Rohingye refugees in Bengladesh

Luckily, antibiotics will help stop the infection, but the problem is the toxin produced by the germ: For this we still use anti toxin. Here is Grok's answer to diphtheria before treatment available:

In the 19th and early 20th centuries, diphtheria was a major cause of death, especially in children, with mortality rates as high as 20-50% in some outbreaks.

....Antitoxin and antibiotics, developed later in the 1890s and 1940s respectively, drastically reduced mortality, but before these, diphtheria was a terrifying and often fatal illness.

when I first started medical school in the 1960s, we still had an infectious disease hospital in our city and outside there was a bell. We were told if a child came in choking from the membrane, they could be saved by immediate tracheostomy, so they would ring the bell and any doctor in the area would come to the ER and do it.

In Dr. Versghese's book The Covanant of water, there is a description of a child being saved from choking by one of the young protagonists who does a tracheostomy under supervision of a local doctor can't do it due to hand injury.

I am surprised that there isn't more descriptions of this in various historical dramas: Dr Quinn series had one episode, but not a lot of clinical details.

 

The history of treatment is here:

In 1890, an effective treatment for diphtheria – antitoxin – was discovered by Shibasaburo Kitasato and Emil von Behring in Germany...

more HERE. 

it was made by giving the toxin to horses, starting with a small dose then increasing the dosage until the horse provided lots of antibodies, which then were removed and purified to give to people

Horse serums have a danger of severe allergic reactions that can be fatal, so now newer technology is used to produce antibodies. 

Horses were given gradually increased doses of diphtheria toxins, and their bodies built up antitoxins (antibodies) to neutralize those toxins. The horses were only weakly affected by the toxins, yet their bodies were capable of producing large amounts of antitoxin serum. The horses were bled, and the antitoxin serum was harvested from the blood and processed. When given to a human diphtheria patient, the horse’s antibodies neutralized the toxins poisoning the patient. The Department’s laboratories had a stable of serum production horses with which they provided New York and other areas of the country with diphtheria antitoxin.

what brought the treatment to the attention of the public was the outbreak in Nome Alaska:

 

Balto, one of the dogs who carried the serum, became the poster child for publicizing that there was a treatment for sipheria, (but some purists correctly point out that Togo was actually the first dog to arrive with the serum)

Wikipedia article has a lot of details: not a one time delivery, but several deliveries of the needed vaccine.

And Balto became the poster dog for those who risked their lives to save the children of Nome.

This blog has the photo of Balto's statue in Central ParkA low-relief plaque bears the words 

“Dedicated to the indomitable spirit of the sled dogs that relayed antitoxins 660 miles over rough ice, across treacherous waters, through Arctic blizzards from Nenana to the relief of stricken Nome in the winter of 1925.”

the lucky needle stick prank

 there is a story out there that a bunch of girls were stuck with needles in France, supposedly the needles was connected to a syringe. Probably an idea spread via the social media and a prank, but the cops are checking if the syringes were injecting drugs or poisons.

But of course, even a simple needle stick can spread HIV and Hep B, if the needle is used more than once. 

So who knows.

Well, anyway, this reminded me of a story of when I was in private practice 30+ years ago. My partner had a child patient with type I diabetes who carried her syringe with her to Middle school, and one day one of the boys asked to see it, and when she showed it to him, he grabbed an (empty) syringe and went around stabbing several of the girls nearby.

So we had to test our patients who were victims for Hep B and HIV, and arrange a retest in three months if any of those involved tested positive ( these viruses could have spread via needle stick if any one was positive). Luckily they were all negative, so end of the problem.

But one of the girls I saw looked a bit, uh, fat. She had thyroid problems, said mom, so mom was not worried at her putting on weight. 

But she was 14, and even though she had not missed a period, I did a pregnancy test, which was negative.

Now, I wondered if it was an ovarian cyst, 

Usually you can feel the edge of an ovarian cyst, but ten years earlier I had another case where the edge of the cyst was right under the liver, and could not be defined by examination. And in this young lady the examination was similarly vague.

So we did an MRI, which did show it was a cyst. A huge cyst that filled her abdomen, about the size of a seven month pregnancy.

So I sent her to the local Gyn who operated and removed a huge ovarian cyst, luckily non cancerous. And  she kept photos of the cyst so she could show her friends to prove she was not pregnant.

small cysts are common, but these huge cysts are rare: as I mentioned, I only saw two cases in 40 years of practice.

 

The surgery is tricky because you have to remove them intact, so you don't spill the fluid into the abdomen...and serous cystadenoma tumors have a thin wall. Luckily neither patient had a cancerous ovarian cyst, and did well.

But I wonder: there are no coincidences, and what would have happened if the girl hadn't been stuck with a needle in a middle school prank? She was active in sports, so what would have happened if she fell  and the cyst burst?

Back then, the surgery was a regular laporotomy (big incision on the abdomen) but now apparently they can safely drain the tumor and remove it via laporoscopy.

video  here.

 

Down's syndrome

 

drugs: the back story

 

so where is this discussion in the MSM?

Leprosy predates Colombus

from Science Daily:

Scientists from the Institut Pasteur, the CNRS, and the University of Colorado (USA), in collaboration with various institutions in America and Europe, reveal that a recently identified second species of bacteria responsible for leprosy, Mycobacterium lepromatosis, has been infecting humans in the Americas for at least 1,000 years, several centuries before the Europeans arrived.

Leprosy is a neglected disease, mainly caused by the bacterium Mycobacterium leprae, affecting thousands of people worldwide: approximately 200,000 new cases of leprosy are reported each year.

 

Although M. leprae remains the primary cause, this study focused on another species, Mycobacterium lepromatosis, discovered in the United States in 2008 in a Mexican patient, and later in 2016 in red squirrels in the British Isles. Led by scientists from the Laboratory of Microbial Paleogenomics at the Institut Pasteur, also associated with the CNRS, and the University of Colorado, in collaboration with Indigenous communities and over 40 scientists from international institutions including archaeologists, this study analyzed DNA from nearly 800 samples, including ancient human remains (from archaeological excavations) and recent clinical cases presenting symptoms of leprosy. The results confirm that M. lepromatosis was already widespread in North and South America long before European colonization and provide insights into the current genetic diversity of pathogenic Mycobacteria.