Why Vaccinate? Pertussis

Apropos of the sudden influx of self-righteous antivax parents suddenly popping up at Greg’s, it’s time for another of these posts.

Our local paper noted earlier this year that we were possibly in for a peak year of pertussis, or whooping cough cases in the state. Pertussis is one of those lovely diseases where herd immunity counts for a lot.

Pertussis is a highly contagious bacterial infection that causes intense and persistent coughing in older children and adults. In infants it can be fatal.

Babies routinely get vaccinated for it at 2, 4 and 6 months, but they are not fully protected until after their third shot. Young children get another dose before entering school.

But the vaccine wears off, and older children can become infected. For most of them the illness can result in weeks of coughing, and they can infect vulnerable infants. Last year in Minnesota 11 infants were hospitalized for pertussis.

Since 2005 doctors and health officials have recommended a new vaccine for adolescents and adults, largely to protect infants. But nationally only about a third of adolescents and teenagers have received it, according to the Centers for Disease Control and Prevention.

Only a third of the most common vectors for the disease are vaccinated. But hey, keep your infants away from teenagers and they should be fine, right? Of course, you won’t have a babysitter for six months.

Luckily most parents do vaccinate their infants as soon as possible, but when they don’t, what are they potentially letting their children in for?

The baby was 9 months old, his birth weight was 8 lbs 5 ounces. At six months he weighed just shy of 20 pounds. Today he weighed 15 pounds – he was a skeleton and he was dying.

Mom had brought him in after treatment by his naturopath had failed. Constant coughing had made it impossible for him to take in adequate nutrition and starvation, coupled with a raging bacterial pneumonia were conspiring to shortly end his very short life.

We worked feverishly. Intubation, IV boluses, major antibiotics, vasopressors. All futile.

The end of the story is at ERNursey, but do you really have to read it? Just get those kids stuck.

Why Vaccinate? Pertussis
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Coming Out

In case the new addition to the sidebar doesn’t say it loudly enough, I’m an atheist.

This won’t surprise anyone who knows me well, but this blog is here in part because few people know me well. It may not surprise regular readers of the blog. I do, after all, use rationality as a label for posts. It’s utterly unlikely to surprise anyone I’ve argued with online. But I think it’s still important to say, because a lot of people don’t think they know any atheists, which leads directly to the kind of idiocy we saw in North Carolina.

What does this mean for you? Aside from having a face (or another face) to put to atheism that is hopefully prettier than Christopher Hitchens‘, not much–necessarily. Yes, if you’re religious, I think some of the things you do and believe are irrational, but this is coming from someone who built a shrine for a jar of expired jelly (another story). Humans are irrational critters, and there’s something deeply satisfying about being irrational sometimes.

So, Why Atheism?
Nobody comes to atheism because it’s the popular choice. They come to it because none of the gods are any less silly or self-contradictory than the rest. They come to it because a non-arbitrary world is what they see when they open their eyes and look around them. They come to it because faith requires so many mental accommodations that it uses energy better spent on living. They come to it because every idiot they know (as opposed to just some of the smart people) is telling them to jump on the bandwagon.

Me? I was raised atheist, although it disturbed my mother somewhat when I told her so.

I was born to parents raised in a strict Methodist tradition. How strict? They got married because they wanted to have sex. No exaggeration. They had their big church wedding all planned and went through with it as scheduled, but they eloped a few weeks before because they were tired of waiting.

By the time I was born, they seem to have figured out that this was problematic (and thus, I may owe my existence to religion), because they decided to raise their kids outside any church and leave it up to us to choose once we grew up. I attended church services fewer than a dozen times as a child, mostly weddings and funerals, a couple of times after sleepovers with friends.

There were no prayers, no grace at meals. Christmas and Easter were strictly secular holidays (with the standard cartoony adopted pagan trappings). There was a bible in the house, but it had been a confirmation gift or something and lived in its gift box. It was never read.

So, Super-Rationalist Baby, Then?
Uh, no. The Christmas after I turned two, I was taken to see The Nutcracker ballet. I was mesmerized. (Christmas is still largely a mix of The Nutcracker and the Island of Misfit Toys for me.) This was followed by a long, late-night car trip to a destination coated and shiny with ice from a recent storm. I’m told that as I looked around me, I declared to my parents that I believed in magic.

Okay, I was two. Magic was probably a bit abstract for me to understand. I probably meant beauty. I conflated the two for a very long time, but I kept believing in them.

Oh, what didn’t I believe in? I believed in faeries and mermaids, trolls and djinn. I believed in Norse and Greek and Egyptian and Japanese gods and in tricksters from just about any tradition. I believed in beasties under the bed. If it was in my books, I thought I might just find it in the real world if I turned the right corner or opened the right door or found the right place in the woods. That’s how it worked in the books.

I believed longer than most children, I think, at least in those things. Even after I gave up believing in specifics, I had reasons to need to believe in a different world, and I didn’t know yet that adulthood would be that world.

So, What Happened?
I stopped needing to believe so much some time in high school. I still can’t tell you how I ended up changing, since my circumstances didn’t, but I did. Blame it on hormones, maybe. I got happier, even amid all the drama, and I started living in this world.

I still thought it was cool that there was real weird stuff out there, like ghosts and glimmers of ESP. I’d never seen them, not really, but they were in books that weren’t fiction. I looked forward to science figuring out how they worked. Oddly, though, even then I knew that I could make myself see them if I wanted to, just like the Ouija board could spell out something other than nonsense if I was half-willing to make it happen.

I went off to college around then, hung out at the pagan desk in the student center. With my dawning understanding of the role that desire played in belief, I was with the pagans but not of them. They were just a cool group of weirdos.

Then my favorite of the weirdos gave me Flim-Flam! as a present right around the time I was really getting into research design, and I realized that not all “nonfiction” is created equal. The whole experience rather shook up my standards for “proof.”

So, Then You Were an Atheist?
Nah. I considered myself a militant agnostic for a long time–when I thought about it at all. Being raised without religion, my beliefs on the subject didn’t seem terribly important. They still don’t, really, except when someone else’s views intersect with my life. But over time, I came to realize that I wasn’t exactly agnostic, either.

I call myself a practical atheist. I don’t believe we can prove there is nothing that we would ever call a god. However, every attempt at defining a god I’ve seen is either disproved or of no general human relevance or consequence whatsoever. On that, I am not agnostic. I’m not ignorant, either, as I spent a good chunk of my life reading all the world mythology I could get my hands on.

Nor am I agnostic on the question of whether religion should have any influence on important decisions. The ideas and philosophy of any religion must stand on their own, without the shield of religion, or they must be ignored in public life. The only weight that religion should be given is its cultural weight, and that only with all possible consideration for the question of privileging the culture of the majority. There is some use in recognizing that many of us want Christmas off from work because of family rituals that have sprung up around it but none in assuming everyone has these same family rituals.

It’s the question of privilege, really, that’s making me join the Out Campaign. It’s too easy to denigrate and mistreat people based on their minority status when no one knows who they are. If you read my blog, you know me, at least a bit. So now you know an(other) atheist.

Coming Out

A Letter of Protest

Submitted here. Reasons here. More information on the two undesirables here and here. Feel free to adapt this for your own protest letter.

Dear President-Elect Obama:

By now you have begun to hear concern from the scientific community over the potential appointments of Larry Summers as Treasury Secretary and Robert F. Kennedy, Jr. as head of the Environmental Protection Agency. I am not a scientist. I am merely a citizen who must also express her objection to these candidates.

One of the hallmarks of the Bush administration has been the unprecedentedly political nature of appointments. Party and personal loyalty have trumped all considerations of competence, and the country has paid the price in Iraq, in Louisiana and on Wall Street. This can’t be allowed to happen again, but serious consideration of Summers and Kennedy would represent a continued triumph of politics over competence.

Summers has demonstrated a persistent inability to present his ideas with any kind of diplomacy. He cannot lead. Considering the scope of the changes that must come to American markets and the resistance those changes will face, a lack of tact and the inability to inspire others are fatal flaws. In addition, the choice of Summers, even for Treasury, would signal that your administration is not serious in its desire to encourage more women to go into STEM.

Kennedy has done some excellent work for the environment, and he deserves to be recognized for his service. However, he too is unsuited for a leadership role in your administration. His understanding of science is led by his ideology instead of his ideas being shaped by science. This is most apparent in his championing of anti-vaccination conspiracy theories, but it applies in his understanding of environmental cause and effect as well. Whoever heads the EPA must be guided by the science instead of choosing which science to believe.

Either of these picks would continue the current administration’s embrace of incompetence and ideology. Neither would represent the change we were promised. And either would lead to a distracting and embarrassing confirmation fight that you cannot afford in the early days of your administration. I have already asked my congressional representatives to support your agenda of change. Please, avoid these candidates and others like them so that I don’t have to ask them to work against you. We don’t have the time for that.

I thank you for your consideration.

A Letter of Protest

What Is Race Good For?

Greg Laden posted a nice review of a traveling science museum exhibit on race and racism. His post touched on a couple of points of disagreement between him and the creators of the exhibit, but all the argument that followed was over this:

First, the parts we agree with: There is no such thing as race (biologically), race is a social construct used as a political and economic tool, even efforts to use race in a “positive” way such as in medicine or forensics are doomed to failure because of the lack of biological validity of the concept, and so on and so forth.

This brought out the racists, as has been the case every time I’ve seen a statement like this made, but unlike in the past, I got involved in the argument. I learned a lot doing so, and I want capture and summarize that here, for myself and others.

Definitions
These get to be pretty important in any argument like this, especially for avoiding accusations of ad hominem attacks. These are the relevant definitions from the Websters Third New International Dictionary of the English Language, Unabridged.

 

Racism: the assumption that psychocultural traits and capacities are determined by biological race and that races differ decisively from one another, which is usually coupled with a belief in the inherent superiority of a particular race and its right to domination over others. [emphasis mine]

Valid: based on distinctive characteristics of recognized importance: founded on an adequate basis of classification.

I emphasized “usually” in the definition of racism because belief in racial superiority is not necessarily part of racism, although it is important in explaining racism’s negative effects. It is, however, the piece that people who defend the concept of race focus on when you use the first part of the definition to classify them as racists.

The Argument for Race
There were four main arguments made for the biological validity of race:

  1. Genetic testing allows for grouping by country of ancestor origin.
  2. Race may not predict the things it’s been used to predict in the past, but it’s an important proxy for genetics in medicine.
  3. Yes, assignment of humans to racial categories is an arbitrary procedure, but we use arbitrary names for parts of other continua. Why not race?
  4. You’re just being PC, Marxist wankers.

I think we can ignore #4, but the rest were addressed in the discussion.

Where to Start
Most of the racists started with the assumption of race and told the rest of us to disprove it. However, as Greg pointed out, that’s the wrong base assumption. We don’t assume that each bird that we see that is slightly darker than its fellows or is missing a tail feather is a new subspecies. If we want to claim that they represent a group distinct from another group, we have to define the boundaries of the group and prove their validity.

We expect genetic variation. We expect changes in the frequency of alleles across types of environments, across distances from the point of origin of a mutation. Human history is in part a history of trade and conquest, so we also expect changes in frequency across trade routes and distances from trade routes, across distances from imperial centers.

The key word is “across.” As noted before, people trade and fight and have sex and produce offspring with their neighbors. Greg likened this to a game of genetic telephone. What you hear at any two widely separated points may sound distinct, but there is a chain of changes between them. We can divide up our players, but why?

The burden is on the person wanting to impose categorization to show that the categories are valid–both accurate and useful. The existence of a distinct genetic population of humans is not an impossibility, but what we know of human history makes it quite unlikely.

Genetics of Origin
The racists brought up studies that showed that, starting from a knowledge of the region of origin of a test population’s ancestors, researchers could find genetic markers that, in combination, could sort the test subjects into clusters by region of origin. This was given as evidence of the underlying genetic validity of race. There are three problems with these studies.

The first is a sampling problem. Remember that game of telephone? One of the racists in the thread suggested sampling whites from Sweden, blacks from Nigeria, and Asians from China. Researchers in one study cited excluded subjects who gave “other” for their race. If you cut out the parts of your sample that don’t unambiguously fit into your racial mold, it’s much easier to point to the remaining subjects as supporting it.

The second problem is related to how the genetic data was chosen. Researchers used a program for analysis that searched for sites among the hundreds sampled on the genome that could be used to sort the population into a specified number of groups. That means that sites that didn’t covary weren’t used in the analysis. Variation was again discarded on the path to finding distinct populations, and even then, the one of these studies cited in its entirety was not able to differentiate between two Asian groups without restricting their data further. Other studies that haven’t discarded data have found that there is much more variation within races than between them.

Third, nothing about these studies suggested that there were any real-world correlates of any note to the genetic sites used to separate the populations, thus failing to demonstrate any importance in the differences that were found. Relying on self-reported data on origin, they did not even show that the genetics they were testing correlated to any traits typically used to sort people into races.

Race for Medicine’s Sake
One of the more seemingly benign arguments for clinging to the concept of race is that it can provide a clue to underlying genetics that can be useful in diagnosing or treating disease. After all, we know that Ashkenazi Jews get Tay-Sachs and that Africans get sickle-cell anemia. Again, there are multiple problems with this argument.

Both Tay-Sachs and sickle-cell anemia are genetic disorders with well-defined mechanisms, but environmental factors play a role in many diseases. Many of the other disorders that are often linked to race, such as skin cancer and hypertension, do not have such well-defined causes. Limiting diagnosis and treatment advice based on race in these cases is risky at best.

Even among known genetic disorders, inheritance is not based on race as we know it. There are no races that all get one disease that no one else gets. The gene for sickle-cell anemia is adaptive in areas with high rates of malaria. This means that there are areas of Africa with almost no instance of the gene and areas of Europe and Asia with fairly high rates. Tay-Sachs is prevalent among one population of Jews but not others. It is also prevalent among Cajuns. French Canadians also have a higher than average prevalence, but the underlying genetics among Quebecers is different than among Cajuns, who share a mutation with the Ashkenazi Jews. As in the studies on population genetics, single genetic markers show very little correlation with race or point of ancestor origin.

Continua and Complexity
“Erm, okay,” say the racists, finally. “Maybe the underlying genetics do vary smoothly. That doesn’t mean they don’t vary. We use arbitrary names for other continua, like color. Why not for races?”

While this is once again starting from the assumption that race has validity–that it already measures something–and thus, the wrong question, it does raise a couple of issues that are worth talking about. Color, an example used in the discussion, is provocative. The underlying continuum is smooth, but we do use divisions of it, frequently and successfully, in communicating with each other. Why can’t we do the same with race?

The answer is complexity. To the extent that we agree on a definition of a name, saying that something is a particular color tells us what wavelength(s) it reflects or emits. What does race tell us? What is the underlying continuum that we’re measuring?

Of course, we can’t reduce humans to a single continuum of variability. We even have difficulty finding traits once considered to be racial traits that vary with geography in ways a racial model would predict. Skin color varies with average sun exposure as much as it does with any known pattern of migration. Analysis of skeletal remains, now and in the past, does not reliably indicate group identity. Facial features and body proportions are both too variable and too consistent across groups.

The continua that race tries to measure are not single, smooth gradations around the world. They don’t always follow the same paths, so that if we overlaid one trait on another, the resulting map would look somewhat like plaid but much fuzzier. A third overlay, accounting for just one more trait, would produce an even more muddled map. Where do we stop and still see anything that look like groups without the groups being larger than an extended family–or even an individual? We would have to reduce the number of traits to the point that we would only be measuring trivial differences between us.

Still No Answers
The question I kept asking during the discussion is, “What does race tell us?” It still goes unanswered after all the debate. If someone wants to claim that race has biological validity, race has to not only be based on biological measurements that distinguish the categories used, which current racial classifications are not. It also has to tell us something about the biology of race that is nontrivial. Importance is a critical part of the definition of validity.

After this discussion, I’m much better aware of what race does not tell us. I’m still waiting to be shown what it does.

What Is Race Good For?

Common Wisdom

I’m not sure what’s happening this year. Whatever it is, it isn’t what happened four years ago, or eight, or more. The things that everyone knows about politics and elections are turning out to be false. This year.

Joe Biden and Sarah Palin had a debate. Everyone knew that the expectations had been lowered so far for Palin that it would be hard for her to lose. She was folksy. Biden spoke in long words and obscure allusions–the kiss of death. Everyone knows that should have cost him.

People ate it up. Biden won the debate.

Locally, Senator Coleman has been running nothing but attack ads against Al Franken. Everybody says they hate them, but everybody knows they work. So he runs them.

Except this time. Coleman is down in the polls and has decided to withdraw the ads. He says it’s because we can’t afford to be negative with the economy in shreds. It’s because the ads are costing him votes.

I’m not sure what’s going on. Voters are behaving differently, unprecedentedly–dare I say rationally? I’m completely confused, but I have only one question.

Can we keep it?

Update: As usual Comrade PhysioProf says far more succinctly, even with all the swearing.

Common Wisdom

What Is Rebalancing?

I am not a finance expert. I am not an investment expert. I am someone who pays attention when one of these people makes a suggestion that will affect my retirement investments, however, which means I rebalanced my 401(k) last week.

Yesterday, I was talking to someone who received the same advice I did. She said, “I haven’t rebalanced yet. Maybe I don’t understand, but it seems to me like a way to lock in losses.”

She was right. She didn’t understand. And if she didn’t understand, despite having a background in math, someone reading this probably doesn’t understand either. I think she got it after I explained it to her, so I’ll throw my explanation out here too.

You can ignore this if you have your retirement investments in a target-date fund. They do the rebalancing for you. You can also ignore it if the idea of looking at what the stock market plunge has done to your money makes you queasy. If so, get into a target-date fund and forget about the money for a while.

In short, rebalancing between stocks and stable value (usually bond) investments means that when stocks grow, you squirrel away some of your gains in the stable value funds to protect them in case the market goes down. If stocks decline in value, bonds usually get more attractive to investors, so rebalancing is your way of using some of the bonds’ increased value to buy stock on the cheap, while it’s possibly undervalued.

Let’s say you’re an investor with 30 years to go before retirement. You set your investments up so new funds coming in go into 10% stable value, 40% large cap stocks, 30% small cap stocks, and 20% international stocks. At the end of a year in which all your investments are growing but domestic stocks have a large upswing in value, your actual funds might be 7% stable value, 42% large cap stocks, 35% small cap stocks, and 16% international stocks. If you rebalance to your original allocations, you move 2% of your funds out of the large cap and 5% out of your small cap to stick 3% in your more-protected stable value fund and 4% in international stocks, which can outpace domestic stocks in growth in the next year just by catching up to them in value.

The numbers aren’t quite as dramatic, but that’s more or less what I did at the end of 2007. That means I moved money out of stocks before they started falling in January. Last week, after the panic sell-off of stocks, I rebalanced again. I ended up buying cheap stocks. Sure, I did it before another round of panic, but it beat waiting until they were going up again.

If you have an investment adviser, by all means, ask them what you should do. If you don’t, well, the advice I got was that now is the time to rebalance. What are you waiting for?

What Is Rebalancing?

Why Vaccinate? Fighting Mutants

It’s flu vaccination season again, and we’ve all heard the excuses not to take the stick: It hurts. (briefly) I never get the flu. (yet) I don’t hang around with old people or babies. (you never go out in public?) I’m healthy; I can take it. (better than you can take a needle, huh?)

We all know the reasons to be vaccinated too, or at least we know some of them. We know that, even if we’re not vaccinated against the exact strain we’re exposed to, vaccination can reduce the severity of the flu. We know that a barrier of vaccinated people is the best way to keep the flu virus from reaching vulnerable populations, whose bodies can be overwhelmed by the virus.

You may not know that getting vaccinated makes you a scifi hero. Why? You get to fight mutants.

Okay, you actually get to fight mutations, but it’s still a heroic thing to do. You see, every time a copy of the flu virus infects one of your cells, it marshalls the cell to start producing more copies of the virus. Each of those copies has the potential to be a bad copy, a mutation. Once produced, a mutation may die on its own, your immune system may zap it, or it may infect another cell and start cranking out copies of the mutation.

These mutations, just like most scifi mutants, are bad news. Why? Because each bad copy that survives is one step further away from the strain of the virus to which people have some immunity. That makes the virus spread better, because it gets to more cells. So, if you don’t get immunized and you get the flu, the flu virus you shed may be more likely to make someone else sick than the flu shed by the person you got it from.

Also, although it’s an unlikely event, each mutation–or a combination of rapid mutations–has the potential to turn the flu into something no one’s immune system recognizes. That means it can get into anyone’s cells and multiply. That means people fighting to develop an immune response before the mutant virus kills them. That means pandemic.

Unlikely, as I said (the next pandemic flu is almost certain to come from animals), but not impossible. Why chance it when you can be a hero?

Why Vaccinate? Fighting Mutants

Why Vaccinate? For the Youngest

Measles is back in Minnesota.

The Minnesota child, who lives in Hennepin County but who has not been identified, is 10 months old — too young to have received a measles vaccine that is typically given at 12 months.

The child became ill on July 29 and was in two clinics, an emergency room and around the community before being diagnosed.

From today’s local paper.

All it takes is one baby being exposed. How many play dates did the child have before being diagnosed (contagious four days before the rash appears)? How much time in child care? How many other babies were in those clinics? How many unvaccinated older children and adults who later came in contact with babies?

Between January and July, 127 measles cases in 15 states were reported to the Centers for Disease Control and Prevention, the largest number in the past seven years. So far, no child has died. Most cases have occurred in children whose parents decided against having them vaccinated for religious reasons or because of concerns about the safety of vaccines.

So far….

If you want to know what this baby could be in for, here’s a good place to start.

Why Vaccinate? For the Youngest

Why Spook Bugged Me

I’m reading Mary Roach’s Bonk, her new book about sex research, in between, oh, everything else. It’s quite good, and I’m relieved.

I read her first two books, Stiff (about the treatment of human cadavers) and Spook (about the search for proof of an afterlife). Stiff was wonderful, but Spook left a bit to be desired. I wasn’t sure whether it was sophomore slump, a rush to capitalize on the success of Stiff, or something else. After Bonk, I finally get it.

Roach’s trick is to take her readers inside an alien culture, strip away taboos, and expose the humanity that’s left. She acknowledges her own limited frame of reference, then uses humor, matter-of-fact reporting and sympathy to get beyond it.

This worked for Stiff, where she introduced us to people who treat the dead with respect but not fear. We got to know and understand morticians and researchers at the body farm. We saw the ups and downs of their jobs. These are scientists and technicians who are like you and me but without the squeamishness. Nice folks. Cool. Glad to meet them.

Then the same thing happened in Spook, only this time it was the ultra-credulous who got the treatment. They were still nice folks and all, but I could never shake the desire to shake them and ask why they weren’t turning their talents to something useful. What I had mistaken in Stiff for Roach’s respect for reason and rationality was really respect for her subjects.

Luckily, with Bonk, we’re back on useful territory. The history of inquiry moves from interesting but bizarre belief to understanding based on reality. We’re back in my world.

And I know now to check the subject before picking up Roach’s next book. I’ll probably still buy it, whatever the subject, but I’ll know whether to expect something enjoyable, or just something interesting.

Why Spook Bugged Me

Why Vaccinate? Diphtheria

Over on the denialism blog, PalMD is asking people to brainstorm about countering the anti-vaccination message. I’m not sure I have much to say to parents who are trying weigh what’s best for their children, but I know some people who do. They lived with these diseases and survived to write about them, although their loved ones may not have.

The following is an excerpt from Rilla of Ingleside by L. M. Montgomery. The croup they’re fighting is diphtheria.

Then, the third night after father and mother went away, Jims suddenly got worse–oh, so much worse–all at once. Susan and I were all alone. Gertrude had been at Lowbridge when the storm began and had never got back. At first we were not much alarmed. Jims has had several bouts of croup and Susan and Morgan and I have always brought him through without much trouble. But it wasn’t very long before we were dreadfully alarmed.

‘I never saw croup like this before,’ said Susan.

As for me, I knew, when it was too late, what kind of croup it was. I knew it was not the ordinary croup–‘false croup’ as doctors call it– but the ‘true croup’–and I knew that it was a deadly and dangerous thing. And father was away and there was no doctor nearer than Lowbridge–and we could not ‘phone and neither horse nor man could get through the drifts that night.

Gallant little Jims put up a good fight for his life. Susan and I tried every remedy we could think of or find in father’s books, but he continued to grow worse. It was heart-rending to see and hear him. He gasped so horribly for breath–the poor little soul–and his face turned a dreadful bluish colour and had such an agonized expression, and he kept struggling with his little hands, as if he were appealing to us to help him somehow. I found myself thinking that the boys who had been gassed at the front must have looked like that, and the thought haunted me amid all my dread and misery over Jims. And all the time the fatal membrane in his wee throat grew and thickened and he couldn’t get it up.

Oh, I was just wild! I never realized how dear Jims was to me until that moment. And I felt so utterly helpless.

And then Susan gave up. ‘We cannot save him! Oh, if your father was here–look at him, the poor little fellow! I know not what to do.’

I looked at Jims and I thought he was dying. Susan was holding him up in his crib to give him a better chance for breath, but it didn’t seem as if he could breathe at all. My little war-baby, with his dear ways and sweet roguish face, was choking to death before my very eyes, and I couldn’t help him. I threw down the hot poultice I had ready in despair. Of what use was it? Jims was dying, and it was my fault–I hadn’t been careful enough!

Just then–at eleven o’clock at night–the door bell rang. Such a ring –it pealed all over the house above the roar of the storm. Susan couldn’t go–she dared not lay Jims down–so I rushed downstairs. In the hall I paused just a minute–I was suddenly overcome by an absurd dread. I thought of a weird story Gertrude had told me once. An aunt of hers was alone in a house one night with her sick husband. She heard a knock at the door. And when she went and opened it there was nothing there–nothing that could be seen, at least. But when she opened the door a deadly cold wind blew in and seemed to sweep past her right up the stairs, although it was a calm, warm summer night outside. Immediately she heard a cry. She ran upstairs–and her husband was dead. And she always believed, so Gertrude said, that when she opened that door she let Death in.

It was so ridiculous of me to feel so frightened. But I was distracted and worn out, and I simply felt for a moment that I dared not open the door–that death was waiting outside. Then I remembered that I had no time to waste–must not be so foolish–I sprang forward and opened the door.

Certainly a cold wind did blow in and filled the hall with a whirl of snow. But there on the threshold stood a form of flesh and blood–Mary Vance, coated from head to foot with snow–and she brought Life, not Death, with her, though I didn’t know that then. I just stared at her.

‘I haven’t been turned out,’ grinned Mary, as she stepped in and shut the door. ‘I came up to Carter Flagg’s two days ago and I’ve been stormed-stayed there ever since. But old Abbie Flagg got on my nerves at last, and tonight I just made up my mind to come up here. I thought I could wade this far, but I can tell you it was as much as a bargain. Once I thought I was stuck for keeps. Ain’t it an awful night?’

I came to myself and knew I must hurry upstairs. I explained as quickly as I could to Mary, and left her trying to brush the snow off. Upstairs I found that Jims was over that paroxysm, but almost as soon as I got back to the room he was in the grip of another. I couldn’t do anything but moan and cry–oh, how ashamed I am when I think of it; and yet what could I do–we had tried everything we knew–and then all at once I heard Mary Vance saying loudly behind me, ‘Why, that child is dying!’

I whirled around. Didn’t I know he was dying–my little Jims! I could have thrown Mary Vance out of the door or the window–anywhere–at that moment. There she stood, cool and composed, looking down at my baby, with those, weird white eyes of hers, as she might look at a choking kitten. I had always disliked Mary Vance–and just then I hated her.

You can read the book to find out what happened to Jims. Wikipedia has more information on the disease, including additional complications, which vaccine prevents it, and the trivia that “diphtheria was cited in the Guinness Book of World Records as ‘most resurgent disease.'”

Why Vaccinate? Diphtheria