Nuclear Accidents,Fire Hazards, Electrical Supply and Global Warming

 April 4, 2011

I post this as  a reminder to the guys in the Electricity Board who are all political crooks.

Nuclear Accidents, Fire Hazards, Electrical Supply and Global Warming
 

Please not these mini computers for Gamers are a real fire Hazard without proper coolers.

Now that the Cricket World Cup is over, it is time for me to concentrate on more important issues relevant to safety at home and on the road. 

It is with deep sadness I edit this page that one of my students died and other seriously injured, a motor bike accident. 

 

I always say more people die on the road than the death toll in a tsunami.
 
Before that I would like to make some passing reference to why we lost.

I should pen it down here since our journalist are the worst stooges of the politicians and won’t make the comments I make below as points of reference in their daily chores.
I may become very unpopular but I am not a politicians vying for votes rigged or otherwise.

First reason is that in Ceylon we never were united after the war whereas Indians were all behind the Indian Team and Sachin.
Indian papers were critical but were not destructive.

1. In our case one of the government channels run by political stooges raised a claim that Mahela played to the hands of Pakistan deliberately. 

What I understand now is that this comment was done by players rejected or not selected to the team with political intent.

Of course, Mahela answered the critics with his bat like Ponting and that was the very best of Mahela after his 167 odd runs in his first appearance against India in home soil.

What is important this time is, it is on Indian soil with nobody behind him except his team mates.

2. We were not ready for the world cup and we did not have a regular team up for the finals and poor Sanaga had to fiddle round and use his gut feelings. While playing on the round robin stage he had to select the players in best form from the makeshift team given to him by the selectors. There were only  five or six who were worth the mettle and naming them here is not appropriate and others were filling the numbers from 6 or 15.

3. Then come the crunch game and politicians get activated and like after the war they want to reap benefit at the expense of cricketers and bloat their image while failing in their duties at ground and grass root level.

4. Now come the big political manoeuvre and Randive catapults into World Cup stage and comes home wicketless.

5. I have my praise for Gary Kirsten, graceful South African opener who did all the ground work for the victory after 2008 debacle. 

There were no politicos influencing him. 

Similarly the praise should go to Alan Donald the South African fast baller lifting the New Zealand team up to the Semifinals.

The difference here is everything form ground construction to ground preparation to celebrations have to be sanctioned by politicos or their stooges.

Everything is politicized and corrupt.

6. I feel sorry for army man Ajantha and poor but Big Ball Boy Dilhara who was worse than a political stooge. He was the one who could have taken the wicket of Tandukar in a crunch game. Yes, he might give some extras and few no balls but we did not want him to ball full quota of 10 overs. Three overs form him would have been better than full quota of Randive.

This whole episode destroyed both the big boy Dilhara and new find Randive.

Who is to blame I leave it open.

Lesson from Dhoni is that he took the full responsibility of Srisanth’s selection and he managed him accordingly but did not break his backbone like what we Ceylonese do.

 
We win the war and then break the backbone of soldiers.

That is the way we go up the ladder.

It is cut throat politics, even in sports.

This one for the Indians.

In the built up to the semifinals there is a little consensus among few of the intellectuals that if we win the World Cup, the government will increase the price of petrol and with it all the other commodities and Ceylon should not win.

I also subscribe to this especially as a teaser, something that I enjoy when spirits are high and I was the only one in Ceylon who supported New Zealand on the day. I went on to say to irritate my close friends, if we played on a neutral ground we would lose knowing very well New Zealand would not make it through.

This is like a Ceylonese government officials who vote for the opposition on the day of the election and goes to work on the next day attired in a blue dress and a red or gray tie.

In my case if somebody volunteered money I would have put a bet for Ceylon to win and support New Zealand in front of the TV.

Here money and win matters but usually it is the Santhosum or political bribes that do the job.

In India the commodity prices may not go up but cricket corruption and betting will surge with this win.

 
Even though, I subscribed to the view that petrol will go up in price after New Year and before New year if we win the World Cup as a teaser for my friends, I was of the strong opinion that our politicians are only sensitive to the voter only before and during election, that they are so insensitive they will increase the prices whether we win or lose.
In that context it is better to support our team irrespective of political realities and that is what we should do come finals.
I am of the strong opinion politicians and religious dignitaries should not get involved in sports.
Leave them to sports specialists and the coach and pay them well and on results basis like top CEOs and not to political bum suckers.
And come win or lose be prepared to tighten our belts for another 5 or 10 years and the promised land may never come true with global realities and food prices going up by the minute and production not keeping up with the demand from banis, bananas to political bana.

Safety First
That is almost like a lecture in point form but we never correct our mistakes but the one I am going to write below if you do not take notice one might lose everything including life.

It is the fire hazard that we go through in March to May.
 

There are two factors one is external and other is internal.

External one is global warming and Ceylon included and exaggerated by our Coal Power Plant going into full operation soon.

The other is lightening and fire crackers.

I was happy that we lost the Cricket and if we won the fire crackers would have ignited a few fires burning even our precious forest reserve.

I am the one for banning fire crackers in entirety.

It serves no purpose and many of our dogs die of fear during New year festivals when owners go out on holidays leaving vulnerable dogs to fire crackers and thieves (they poison dogs).

Other one is internal.

That is our Electricity Supply which fluctuate in voltage. 

This risk is increased with thunder that accompany rain.

 
One computer and two voltage stabilizers busted from the month of January to now.

This not the first time and some time ago, I lost almost everything (electrical equipment that included a TV, a tumbler dryer and a washing machine) including 20 odd bulbs in one night and morning due to power surge going above 400. 

My investigation revealed that guys put hooks on the live wire and pilfer electricity and two of them were in contact to raise the voltage to 400 or more.

The has become a perennial problem now. If not fire one can get electrocuted.
The only way I have saved few equipment is by using UPS not voltage stabilizers (two of the Ceylonese voltage stabilizers caught fire and there is no alarm. system). 

At least the UPS has the alarm that goes up and we cannot buy any imported voltage stabilizers in Ceylon, now.

This New Year I decided to work on reducing fire hazard.

1. I have three or four digital thermometers.
One is on top of the computer I am working now. The other is on top of the switched off computer. The temperature difference is 7 degree F and time is mid night.

2. I do not switch on any equipment if the outside temperature is above 88 degree F except the fridge.

3. I use the computer in the night and who is going to go for air conditioning with electricity bill above Rs.6000/=

4. I use UPS. 

Recent ones have better quality internal circuits and integraters.

5. Check all the connectors and replace them with sturdy not cheap ones.

6. Be vigilant and safety first from kitchen to to bed room to living room.

7. No fire crackers.

8. Switch off all the equipment not in use.

9. Emergency lamps with all diodes and keep them charged for an emergency.

10. Keep an eye on the meter and the monthly bill which is going up by the minute.

Pathology at its BEST

My last book is on doctors and their mistakes. I will publish it in my death bed so that I won't leave a doctor to administer a lethal dose of sedatives.

As a True Buddhist I need to die in a "Lucid State" with a proper Gathi Nimitta (which I deserve) and having no control  of mine.

Assumption was every illness was related to infection in the pre-antibiotic era. 

Viral infection did not excite inflammation to begin with.

Diagnosis pneumococcal bacterial pneumonia needed specific signs without and X-ray.

Viral pneumonia in infants can be missed unless an X-ray is take at the precise time.

28, 32, 40 ratio was unknown.

28% could be diagnosed without ancillary investigations

32% with the help of investigations.

40% missed by even learned professors.

They end up at the pathologist and the pathologist knows he cannot fill up the 40% in all his life. This was told to me my professor to which I am grateful to this day.

That put me off completely.

This is the list I put in my histology class and nobody could define the word definition.

I use tuberculosis as a model disease which only 5% show symptoms. In 95% the patients it heals by itself leaving a site of calcification which vary from where the bacteria enters the body.

1. Definition, 

2. Incidence, 

3. Etiology,

4. Bacteriology, (applies this only to bacterial infections)

5. Morbid anatomy,

6. Symptoms, 

7. Diagnosis, 

8. Complications, 

9. Prognosis, 

10. Treatment and 

11. Prophylaxis.

Russell LaFayette Cecil (1881-1965).

 Russell LaFayette Cecil (1881-1965)

At the time of his death in 1965, Russell LaFayette Cecil could plausibly be called “the best known American physician in the world”  due to his editorship of his Textbook of Medicine . 

He was born on 13 October 1881 in Nicholsville, Kentucky, son of the Reverend Russell Cecil DD, and Alma Miller Cecil. Cecil’s father became pastor of the Second Presbyterian Church in Richmond, Virginia and his son Russell graduated from Princeton University in 1902 and from the Medical College of Virginia in 1906. Cecil’s Princeton graduation yearbook describes the typical member of his class as male, Presbyterian, Republican, a history major, and a baseball fan . The class’s favorite teacher was Woodrow Wilson who later became President of the United States. Their favorite authors were Scott, Dickens and Thackeray.

Cecil described himself as a 150 pound, 5 feet 10 ½ inches tall, Presbyterian Democrat, whose favorite author was Dickens, favorite study was biology, and favorite sport was tennis. During each of his four years in the class he made the ‘second honors’ group list. His classmates reported their best friends (‘Kid’, ‘Bunt’ and ‘Charlie’ for example), but unlike them, Cecil said his ‘familiarity’ was his mother .

In his class report seven years after graduation (1910) he had the following to say about his life:

The story of my life since leaving Princeton can be told in brief and simple measures. I took up the study of Medicine in the fall of 1902 and pursued it with considerable strenuosity for four years.

Cecil spent the summer of 1906 in Vienna and the winter and summer of 1907 at Johns Hopkins. He then became resident pathologist at Presbyterian Hospital in New York, where he had a junior clinical faculty appointment at Columbia University Medical School from October 1911 to June 1916,  when he joined the faculty at Cornell University Medical School in New York City.

He remarked at the time: “The truth is I have been working too hard during the last seven years to give the matter of matrimony its proper consideration. He’s promising a reform and an early desertion from the ranks of bachelorhood.”. It took him another 13 years to decide to marry Eileen Cumming, a native of Sydney, Australia on Sept. 20, 1923. They had one son, Russell Cumming Cecil, who was born on 6 October 1926  and became an architect in New York.

Cecil joined the US Army on 16 June 1917. He was approached by the Surgeon General to study pneumonia, and carried out two very large trials of vaccination. He was creative in conducting these trials in difficult circumstances, beyond his control, including one of history’s greatest wars and pandemics. Cecil left the Army on 30 September 1919 as a Major, and returned to the faculty of Cornell Medical School (where he became a full professor in 1933 and became Emeritus Professor in 1950).

Cecil’s experience with large controlled vaccine trials in the army was relevant when he became a visiting physician at Belleview Hospital, New York, between 1921 to 1932. He took advantage of the great size of this hospital to pioneer the development and implementation of controlled trials. Cecil was also one of the first physicians in the United States to decide that rheumatic disease would be his area of special interest. In 1922, he opened one of America’s first arthritis clinics, based at the Cornell Medical Center,  and his interest in arthritis and rheumatism became central in the second half of his life (he was a founder of the American Rheumatism Association and its president from 1937 to 1938, and founder of the Arthritis and Rheumatism Foundation, and its medical director from 1954 to 1958).

Cecil was elected to the Inter-urban Clinical Club in 1923.  This group, founded by Sir William Osler, consisted of a small group of America’s elite clinical medicine researchers. This can be seen as a clear indication of respect by the leaders of academic internal medicine. By 1928, he had received an honorary doctorate of science from the Medical College of Virginia.

In the 1920’s Cecil found himself still using Sir William Osler’s monumental Principles and Practice of Medicine.   Although this had been revised in 1919, it was becoming dated . Osler may have been the last physician who could hope to cover all of internal medicine by himself. Cecil’s response to the challenge presented by the new era of medical specialization was brilliant in its simplicity. He invited 130 experts to write chapters covering their fields for the textbook he edited. Reviewing the first edition of Cecil’s textbook, it is clear that there is a strong editorial hand at work. Most of the hundreds of entries about an illness or health condition are organized in a similar way with sections titled:  

Definition, Incidence, Etiology, Bacteriology, Morbid anatomy, Symptoms, Diagnosis, Complications, Prognosis, Treatment and Prophylaxis. 

 

At the time of his death the 12th edition was in preparation, and the 22nd edition was published in 2004. Cecil’s textbook seems likely to last until it is succeeded by an on-line Wikipedia for internal medicine, which can be revised constantly and is not limited by the economics of the printed page.

After practicing medicine for over 50 years and receiving the American Medical Association’s Distinguished Service Award in 1962, Cecil died on 1 June 1965 at the age of 83, in New York City. He had many interests outside medicine, including Greek classicism, golf, poetry, painting, sailing, walking and swimming. He was described as an “urbane and witty man” with an uncanny ability to note the strengths in others that stood him in good stead in his work . His wife said of him, “He is impatient with stupidity, unforgiving of unreliability and deeply resentful of careless medical practice.” .

Dr. Robert F. Loeb (1895-1973)

 Dr. Robert F. Loeb (1895-1973)

 A common phrase heard at many medical centers is “Days of the Giants”, referring to an earlier era in which legendary physicians supposedly strolled the wards. In its most common usage, the term implies that these earlier doctors were somehow superior, either due to their dedication, knowledge, or teaching skills. For decades, medical school alumni magazines have promoted this idea by publishing laudatory feature stories and obituaries about past professors. These articles provide fond memories for alumni and reflect on past accomplishments by the institutions in question. As time marches on, virtues are recalled and blemishes forgotten. 

Lately, however, alumni publications have begun to publish pieces that recount darker episodes in the history of medical centers and that even criticism renowned physicians.
The study of medical history is inextricably intertwined with the reverence of earlier physicians. The first historians of medicine were themselves doctors, often retired, who decided to document past medical achievements, many of which they themselves had witnessed. Characteristic of these works was the assumption that as each new generation of physicians marched forward, they stood on the shoulders of the previous one. Among the best known of such works is the Pulitzer Prize-winning 1925 biography of the acclaimed early 20th-century physician William Osler by his former trainee and colleague Harvey W Cushing, himself a renowned neurosurgeon. Occasional scholars, most notably Swiss-born physician-historian Henry E Sigerist, bucked this trend, studying both “great men” as well as the economics and politics of medicine, but it was not until the rise of social history in the 1970s that equating historical progress with the achievements of great doctors was formally challenged. These social historians not only situated medical history in a social and cultural context, but often criticized past physicians as having been autocratic, sexist, and racist.
For the most part, medical school alumni magazines have been immune from this historiographical trend. But over the past several years, this has begun to change. For example, in 2004, Dartmouth Medicine published an article on a 1966 episode in which eleven Dartmouth professors resigned in protest of organizational decisions made by an “authoritarian” dean, Gilbert Mudge. 2 years later, Yale Medicine ran a piece on Cushing, whose family was donating his collection of brain specimens to Yale, stating that many of the revered neurosurgeon's contemporaries saw him as “an egotistical, hard-driving, selfish, mean son-of-a-bitch”. Nevertheless, it was surprising when, in 2007, the P&S Journal (now Columbia Medicine, the alumni magazine of the Columbia College of Physicians and Surgeons), began to publish a series of frank assessments of the career of Robert F Loeb, a legendary physician and professor who was the chairman of Columbia's Department of Medicine from 1947 to 1960. Not only are there physicians still at Columbia who worked directly with Loeb but his son, John, remains on the faculty. The writers—largely alumni—have fiercely debated Loeb's legacy, terming him, among other things, “abusive” and “scornful”. What lessons can be learned by revisiting the past in such a provocative and honest manner?
Loeb was born into a medical family. His father was German-born Jacques Loeb, a world-renowned physiologist and a founding member of the Rockefeller Institute for Medical Research. After completing medical school at Harvard and training in internal medicine at the Massachusetts General Hospital and Johns Hopkins Hospital, Loeb moved to Columbia-Presbyterian Medical Center, where he would spend 37 years until becoming an emeritus professor in 1960. In his early years at Columbia, Loeb spent much time in the laboratory, where his seminal studies of Addison's disease clarified how the adrenal gland and kidney maintained electrolyte balance in the body. With enormous ramifications for diabetes mellitus and many other diseases, Loeb's research, many believed, warranted a Nobel Prize. Meanwhile, Loeb climbed the academic ladder at Columbia, becoming the Bard Professor and Chairman of Medicine in 1947. He was often the first physician to arrive in the morning and spent many weekends on the wards, expanding his encyclopedic knowledge of medicine, mentoring house officers and students, and paying extra visits to ward patients he had met during rounds. Loeb was for years the co-editor of the Cecil-Loeb Textbook of Medicine, the bible to generations of internists. In addition, Loeb had an uncanny ability to remember patients he had not seen in many years. In one case, he not only remembered a 35-year-old woman he had treated 25 years before when she was a child, but what bed she had been in and who her residents were. One former student called Loeb the “mentor of mentors” and credited him with his own “life-long dedication to scholarship and the pursuit of knowledge”. With this sort of biography, how could Loeb's legacy become so tarnished?
The critical assessments in the P&S Journal began with a remembrance by Clifton K Meador, who had trained with Loeb and had written a book on famous physicians. Meador painted a complicated picture of Loeb, describing how the senior physician had first effusively praised him for making a diagnosis of Budd-Chiari syndrome but then unfairly turned on him for failing to examine a diabetic patient expeditiously. Meador also described how he later redeemed himself by preventing unnecessary surgery in another patient, but his image of Loeb as arbitrary and judgmental nevertheless persisted. Meador's article inspired other negative recollections by former Columbia medical students and residents who recalled having been put on the spot when making rounds with Loeb on the wards. For example, Alex Caemmerer, Jr, wrote that Loeb had taught by “humiliation and intimidation”, treating students as “the lowest of the low”. When Ollie Cobb suggested that a patient might have Rocky Mountain spotted fever, Loeb responded with a booming “Fiddle-De-Dee”, the phrase he used when a reply did not meet his standards. David Marshall recounted a story in which Loeb told a student who had missed a question to “go down and see the dean and tell him you are through at P&S”. Although Loeb quickly called the student back, the event was nonetheless disturbing. This type of behaviour, Norman Spencer wrote, showed Loeb's “very public and destructive personality failure”. Another anecdote came from Lawrence W Norton, who wrote an article commemorating the 50th anniversary of Loeb's retirement. Although Norton's patient, who had lung disease, felt perfectly fine and had been diagnosed by chance, Loeb repeatedly demanded that Norton describe the patient's symptoms. This interchange apparently infuriated the patient, who barked at Loeb to “leave my doctor alone, you old man!”

What can we learn from this discussion of Loeb's faults? 

 

For one thing, such dialogue can produce a more honest assessment of past medical practice and education. As Dana C Grossman, former editor of Dartmouth Medicine, wrote: “There is surely no P&S alum of the Loeb era who didn't know both sides of his character.” 

Such candour thus avoids whitewashing the past. 

But more importantly, Loeb's story reminds us of the importance of placing physicians and medicine in proper historical context. Decades ago, it was common for medical students to be drilled with questions, often uncomfortably. Professors genuinely believed that such hazing helped students learn to think on their feet and thus become better doctors. Presentations had to be memorized, again as a way to show mastery of knowledge. The large, impersonal type of rounds that Loeb led, in which dozens of physicians, students, and distinguished visitors crowded around the bedside, often uninterested in the patient's input, also happened routinely. 

Paternalism ruled medicine. 

Expectations were also drastically different 50 years ago. Physicians, taught to have an almost fanatical devotion to their patients, spent most of their waking hours either in the hospital or reading about diseases.  

They spun their own haematocrits and made their own Gram stains. 

The terms “house officer” and “resident” bespoke the idea that physicians-in-training were expected to reside in the house—that is, the hospital.
In retrospect, Loeb took this philosophy to its zenith. He had “extremely high standards for himself”, Wendell Hatfield wrote, and believed that all doctors (and nurses) under his command should show the same dedication. When students, residents, or even attending physicians made mistakes or—even worse—cut corners, Loeb saw this as an affront not only to himself but, more importantly, to the patients who deserved their doctors' complete and utmost attention and devotion. “There is no such thing as a dull patient,” he liked to say, “only a dull physician”. 

Indeed, Loeb cherished—and remembered—particularly good diagnoses made by young physicians under his tutelage, especially ones that he himself had missed. Years later, he walked by one such doctor and said “You really got me on that one.”

Robert F Loeb (1895–1973)
Copyright © 2012 Archives & Special Collections, Columbia University Health Sciences Library
Medicine today has changed vastly from the mid-20th century. Concerns about excessive workload and sleep deprivation have led to the institution of night floats and the use of physician assistants. Having an outside life is now seen as crucial to the professional development of physicians. Meanwhile, patients are active participants on rounds; members of the team are expected to introduce themselves and never treat patients as “teaching material”. Perhaps Loeb's “true” legacy is to remind us that great doctors, like other heroic figures, often have character flaws. While we should reject how Loeb taught students, we should remember why he acted as he did: his fanatical devotion to the care of patients.

Dr. Robert F. Loeb Dead at 78; Metabolic Expert, Noted TeacheR

Dr. Robert F. Loeb, Bard Professor of Medicine Emeritus and former chairman of the department of medicine at the College of Physicians and Surgeons of Columbia University, who was considered one of the nation's leading medical teachers, died Sunday at his home, 950 Park Avenue. He was 78 years old.

Dr. Loeb was a specialist in diseases of metabolism and was widely known as a foremost clinician and clinical investigator. In 1922 he was one of group of physicians at Columbia who administered the first insulin treatment for diabetes.

Ten years later, Dr. Loeb first demonstrated the role of the adrenal glands in control of Salt and water metabolism. He went on to demonstrate that patients with Addison's disease could be maintained indefinitely by having large quantities of salt their Until then Addison's disease was invariably fatal.

In one of Dr. Lobb's bestknown studies at Columhia, he and other members of the department of medicine undertook a detailed examination of the fluid and electrolyte, abnormalities that accompany the withdrawal of insulin from diabetic patients. The group was able to provide a rational basis for the modern management of diabetic acidosis.

Research on Malaria

During World War II, Dr. Loeb served as chairman of the Board for Coordination of Malarial Studies. Studies under his direction led to the development of chloroquine and a number of other important antimalarial drugs still in use today.

Dr. Loeb served for many years as vice chairman of the board of trustees of the Rockefeller University, as a trustee of the Rockefeller Foundation, as an overseer of Harvard College and as a member of the President's Scientific Advisory Committee under Presidents Truman, Eisenhower and Kennedy.

He was a past president of the American Society for Clinical Investigation, the Assodirtion of American Physicians and the Harvey Society, and was a member of the National Academy of Sciences, the American Philosophical Society and the Century Association.

Born in Chicago on March 14, 1895, Dr. Loeb studied at the University of Chicago. After two years he entered Harvard Medical School, from which he graduated magna cum laude in 1919. He served his interneship at Massachusetts General Hospital and in 1921 after a year at Johns Hopkins Hospital joined the staffs of Columbia University and Presbyterian Hospital.

Co‐editor of Textbook

Dr. Loeb continued to teach and do research at ColumbiaPresbyterian Medical Center until his retirement as chairman of the department of medicine in 1960. From 1947 to 1960 he was co‐editor of the Cecil‐Loeb Textbook of Medicine. He was editor of Martini's “Principles and Practice of Physical Diagnosis,” and in 1962 he served as Regius Professor of Medicine at Oxford University.

The recipient of honorary degrees from numerous universities, including Harvard, Columbia, Oxford, Rockefeller and the Universities of Paris and Strasbourg, Dr. Loeb was cited by Harvard in 1969 as “a man whose career epitiomizes both the compassion and the brilliance of medical science.”

Surviving are his widow, the former Dr. Emily Guild Nichols; a son, Dr. John N. Loeb; a daughter, Miss Elizabeth G. Loeb; a brother, Prof. Leonard B. Loeb of Berkeley, Calif., and a sister, Mrs. Anne L. Osborne of Hampton, Conn.

A funeral service will be held Thursday at 2 P.M. at the Brick Presbyterian Church, Park Avenue and 91st Street.