How many holes you have to drill in a coffin for a burial at sea

Early in my military career, a significant part of my work, like that of every medical person in the military, involved public health.  You learn what temperature dishes have to be rinsed at (100F if the water is chlorinated, 160F if not), how many holes have to be drilled in a coffin for a burial at sea (at least six, each one two inches across), and the symptoms of gonorrhea (genital discharge and burning on urination, unless you got it from oral sex, in which case swollen glands in the neck and sore throat).

The two main components of public health in a military context are hygiene (see above about washing dishes and disposing of corpses) and vaccination.  If there were a deployment coming up, I might vaccinate 200 Marines in a single day.  The vaccinations were usually against the same two diseases: cholera, and plague.  You got your plague vaccine every six months, typically.  The Marines complained; the sailors were professional or laughed, depending on their personalities and moods; everyone went off to do their duty in relative security, at least from an infectious diseases perspective.

Both of the diseases against which we routinely vaccinated are serious threats in some contexts.  According to the World Health Organization (WHO) web page on cholera, it can kill within hours and spread explosively through a population, and it kills from 28,000 to 142,000 people a year.  The good news is, up to 80% of cases can be treated successfully with oral rehydration salts.  (The bad news is that 28,000 to 142,000 people are dying every year because they don’t have access to clean water and pennies’ worth of oral rehydration salts, but let’s return to that another time.)

Plague is another story.  Plague is caused by the bacterium Yersinia pestis.  Plague was the disease of the Black Death, which killed tens of millions of people in the 1300s (maybe as many as 200,000,000) and changed the social structure of Europe.  Types of plague in humans include bubonic plague and pneumonic plague.  There is an outbreak of pneumonic plague going on in Madagascar.  According to the WHO web page dated September 6, 2015, there had been 10 deaths as of August 30th.  Unlike the more typical bubonic plague, the pneumonic plague infection is in the lungs (hence the name pneumonic).  It is more virulent than bubonic plague, with a fatality rate of near 100% if it is not treated.

Pneumonic plague, unlike bubonic plague, can be spread without an animal vector.  Bubonic plague is spread by infected fleas–pneumonic plague can be spread by an infected human, too.  Without treatment, the death rate for pneumonic plague approaches 100%.  But, the treatment is easy—antibiotics.  Remember that death rate of 28,000 to 142,000 people a year for cholera?  In 2013, 126 people died from plague.  Treatment is cheap—I found one of the top-two Centers-for-Disease-Control-recommended antibiotics for plague on for about $7.  That’s $7 for the total amount to cure one person—not $7 a day, not $7 a dose.  Let’s suppose that what I found on eBay was crap, and you have to pay twice as much for the good stuff: that would work out to $140 to save all ten of the people who had died as of August 30th of this year.

Of course, there’s a French connection to the Madagascar pneumonic plague outbreak, and it’s in addition to the obvious one, i.e. the great work of the Institut Pasteur (Pasteur Institute) and its world-wide network of infectious disease research and treatment centers (including an outpost in Madagascar).  I found out about the current Madagascar outbreak on an iPhone app that gives me French-language news stories with transcriptions, so of course Zipf’s Law showed up.  Before scrolling down to the related vocabulary, think about where you might donate $7 today–enough to save the life of one person with a bacterial illness.

  • la peste: plague.  Also a nuisance, pest, or pain in the neck.
  • le soulagement: relief.  It’s a relief to two of the patients in the video that they’re going to leave the hospital alive.
  • guérir: to cure, heal, make better; but, also, to heal (intransitive), get better, recover from.
  • avoir le vertige: to be dizzy.
  • le cas: case.  At the time that the news story was shot, there had been 14 cases of pulmonic plague in Madagascar.
  • se propager: to spread (oneself, e.g. fire, a disease); a doctor in the story points out that pulmonic plague se propage par l’air—spreads through the air.

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