Placentas and pizzas

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Placenta

Mrs Windsor née Middleton is pregnant. It’s in the newspapers so it must be true.

First, I have to get this hobbyhorse off my chest. The correct spelling of fetus is fetus, not foetus, the word being related to felix, femina, etc. The incorrect spelling occurs first in the late writer Isidorus (570-636 AD) who fancied that the word could be derived from foveo (I cherish) instead of feo (I beget). So there.

Now to the hard stuff.

Is it an embryo that is taking root in Mrs Windsor’s genital system? Yes indeed. Is a fetus? Is it a baby? Is it a child? Embryo and fetus are defined by convention: you can look them up if you like. Baby is a meaningless term. Is it a parasite? Well, it steals mama’s nutrients and dumps its rubbish on her. It guzzles into her flesh so that its placenta can plug itself in to mammy’s tissues and get up close and personal with her blood vessels. It consumes the contents of parental wallets for at least two decades. Make up your own mind.

Some people worry about when the fetus becomes human. Not I. It’s human because the spermatozoön and ovum that produced it came from gonads belonging to humans. Reputedly. Anyhoo, however royal this fetus may be, it’s also a chordate, a vertebrate, a mammal, an ape and a primate. This is much more important than royalness.

The royalness will doubtless induce the Church of England to produce a prayer for the royal products of conception—it may already have done so—the usual crass, meretricious, tendentious, wordy drivel that comes from Lambeth. Products of conception include placenta, amnion, chorion, umbilical cord. Are they royal too? Are we to have a prayer for the royal placenta? Will a specially consecrated pair of scissors be used to cut the royal umbilical cord?

Killing the fetus

When do you think it should be permissible to kill the fetus? Or perhaps, when should it no longer be permissible? Well here’s the thing as I see it. Despite what the law may say, there is no single moment during the whole course of pregnancy at which the fetus is significantly different from what it was the moment before. There is no event that takes place that sufficiently differentiates what the fetus was before that event from what it is after the event. Fetal development is a continuum. From this point of view, if it’s permissible to kill a fetus at 18 weeks, then it’s permissible to kill a postnatal child or an adult. For those of us who have a little list of people not one of whom would be missed, this is comforting.

Why are we born when we are born?

The short answer is nobody knows. Brain size must have something to do with it. If we stayed inside any longer, our heads would grow so big that we wouldn’t be able to get through mama’s pelvis. But like I say who knows?

We are born very immature. A newborn horse can canter off pretty soon after birth, but not a newborn human. Unfortunately. Neurologically (spinal cord tract myelination—look it up), some of us mature more quickly than others. If earlier, we shall be better at physical activity and sport at an earlier age. If later (like me, dear reader), we shall have the shit kicked out of us at school for being physically inept.

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Pizza

Placenta

Placenta in Latin means flat cake. It is a most interesting organ, much under-researched. Its evolution is fascinating. Some mammals have lots of little placentas. Some, like mice and humans, have a single placenta. A primate (therefore human) placenta is about the size of a small pizza. Looks like one too. Some twins have separate placentas, some share.

A mouse placenta is similar in size to the head of a small drawing pin. Believe me, I know. I’ve dealt with hundreds of them in my time. When our three products of conception were little, the eldest drew a picture of me at work with the caption “my daddy studies mices kidneys”. Adrenals, actually, and fetal ones at that, but the gist was spot on. She had not mastered the apostrophe by that stage (like an increasing number of adults, but don’t get me going), but had grasped that plurals are normally formed by the addition of a terminal s, and that in conjugating the verb ‘to study’, y sometimes becomes ies. Pretty good, huh?

Please understand, dear reader, that the placenta is fetal. Entirely fetal. The only bit of maternal tissue that comes out with the placenta is that which is torn away from the uterine lining when the placenta detaches itself, hopefully after birth. This is why bleeding may occur.

The placenta, like the infant that it nourishes, is a foreign organism as far as the mother’s immune system is concerned. Why is the placenta, which comes into intimate contact with maternal tissue, not rejected? Well, sometimes it is. And so arise spontaneous abortions and other obstetric headaches.

A bit of history

In the fourth, fifth and sixth Egyptian dynasties the placenta was held to be the seat of the external soul. There existed the ceremonial position of Opener of the King’s Placenta. Some have suggested that in Abigail’s flattery of King David (1 Samuel 25:29) she calls on this image, the ‘bundle of life’ (KJV) being the placenta, though this is not mentioned in recent Biblical commentaries. Some societies suppose the placenta to be ‘the twin brother or sister of the infant whom it follows at a short interval into the world’ — and in a way, it is. In central Africa a belief in reincarnation leads to the afterbirth being buried at the doorway, or under the threshold of a hut, practices connected with the divine doorkeeper and the widespread custom of carrying the bride over the threshold.

The great fry up

And now, children, finally for today’s “Listen with mother”, remember that the placenta is a most nutritious organ. It’s not that different from black pudding: blood, connective tissue and other bits and pieces.

Fried with eggs, mushrooms bacon and tomatoes it would make a right royal breakfast.

Four in 10 students say university not good value

drainWhat a surprise!

During my quarter of a century teaching at the University of Nottingham and the Royal College of Surgeons in Ireland I’ve seen the growth of ‘educationalists’. They purport to improve teaching standards by fostering an interest in the ‘discipline’ of ‘pedagogy’ (why do they insist on pronouncing this ‘pedagodjee’?)

Have they done so?

No.

They manufacture more and more hoops for those at the chalk-face to jump through.

They spin all sorts of guff about improving the student experience. They do this by giving the students questionnaires to fill in every week about this, that and the other. They are asked to grade individual staff on the basis of quality of handouts, or use of technology, or approachability, and much more.

They write garbage such as:

  • purposeful reflection (thinking, but at €100 an hour);
  • impactful research (difficult, since Medical Education Journals are pretty risible);
  • student centered e-portfolios (students do something online, the teachers ignore it);
  • the flipped classroom (getting students to read ahead and then asking questions during a ‘lecture’);
  • dynamic/personalized/bespoke Learning Environments (A place online to dump powerpoints);
  • student-led teaching, peer teaching (letting the students do the work while the staff do experiential research into different varieties of coffee);
  • interprofessional education (talking to each other).

As sociology was once defined as the study of those who don’t need to be studied by those who do, so medical education is the study of those who teach by those who can’t, won’t, and certainly shouldn’t.

And the sad thing is that the tail now wags the dog. Educationalists now call the shots. The result is that students are not now taught anything much. Students must reinvent the wheel for themselves. They are lectured about the ‘science’ of learning—in truth not a science at all, merely tendentious opinion.

University ‘teachers’ are appointed to lectureships on the basis of knowing a great deal about hardly anything. What matters for their career advancement is how many publications they produce, and in what journals. Chances are that to them the teaching and nurturing of students is a distraction. The ability to distil complex concepts as an introduction for the neophyte matters not one jot.

Students pay fees. At the College of Surgeons medical school (despite the name, for undergraduate medics not just surgeons), a medical student now pays over €50K a year. Just think what could happen if the students started to use this power. Oh yes, of course, silly me, what would happen is that they would not get their degrees, so they would not be able to earn enough money to pay off their student loans.

What is the solution?

Simples, as Aleksandr Orlov might say:

  • separate teaching and research and fund research separately;
  • abolish student fees.
  • let students pay teachers directly, on the spot: they would flock to the good ones who would be suitably rewarded.

O taste and see

Camel_in_Singapore_ZooAnother avenue of pleasure closed off. The World Health Organisation tells us not to drink camel’s urine.

I was wondering why I was tired. I’m overweight. I was 64 (65 now). It’s very tiring to have people dumping their expectations on one—the lot of the Vicar. Then, listening to SWMBO, a type 2 diabetic (when I say listening, I mean being aware of faint buzzing sound somewhere to the left), I wondered if I was developing diabetes. That would account for tiredness. It would mean that I was drinking a lot. Now, I’m a copious tea drinker, though not in Bennite quantities, so how would I know? It would mean I was peeing a lot, and given the amount I drink, I don’t. And it would mean that my urine would taste sweet.

O taste and see. So I did. Nothing really. A bit salty perhaps, but I am a salt lover. I’ve never been a sugar lover. As a child I was known as the odd one who likes sandwiches not cakes. So no diabetes. Why bother with expensive tests when taste buds come free?

As a medical student I learnt the importance of always checking piss (in the Bible, don’t moan at me) and dung (also there, but less likely to provoke moaning). Here, boys and girls, is what to look for.

First, blood. This might be pinkness or redness or blackness from huge quantities of the stuff. Mind you, chances are you’ll already be at death’s door if it’s black—unless you’ve just returned from a night on Arthur’s best in Dublin. Blood in wee means something wrong with kidneys, bladder or connecting tubes. Blood in poo means something wrong with large intestine. Blood on poo means probably piles, which are kind-of blood blisters. Don’t sit on radiators or you’ll get thermopiles. Blood is a danger sign. Blood is good, but only confined to blood vessels. End of.

Now urine: colour, smell, pain. Note any change in what’s normal for you. I drink a lot, so mine is anything between clear and a delicate Piesporter. It doesn’t smell. Smelly dark urine often means infection, unless you’ve been perilously convivial the night before and have a head like a constipated turnip. If you’ve recently partaken of asparagus, your pee will smell pretty vile. It soon passes. If you’ve recently had a bum-burner, it might well sting a bit to pee. Don’t fret unnecessarily: use your common sense, should you have any left after last night.

Poo: colour, consistency, pain. Again, note any change from normal for you. Poo colour comes mainly from bile, which digests fats. If bile is unable to flow into the intestine, fats will not be digested so poo will be fatty, chalky coloured, smelly, and will float. In such cases, the bile is excreted from the body not in poo but in urine, so urine is dark. Pale stools and dark urine—always bad news: bile tubes are blocked. You’d be amazed how many doctors miss this, though not if they’ve been through my hands they shouldn’t.

Consistency: the function of the colon is to remove water from stools. So runny poo means that stuff is hurrying, or being hurried, through. There are several reasons why this might happen, often an infection by some of God’s non-human creatures. I once had a dreadful episode at Johannesburg airport that made the check-in lady enquire if I was well enough to board. I crossed my legs I can tell you. Read about it: Letter from Malawi. Parishioners who have had part of their colons removed have always responded well to being addressed as semi-colons (“oh no, it hurts to laugh”). I could go on, but maybe you’ve had enough for today. I shall deal with the ear next, I think. Quite fascinating.

From now on, look and sniff before flushing. Leave the tasting to others. Or machines.

Keeping an eye on people

Imago deiThe Mission office emailed us with ‘tools’ for keeping track of people who come to church. There are detailed spreadsheets to be filled in for every Sunday of the year, spreadsheets for names of regulars, names of visitors, space for notes as to what they do where they come from, where they go to, and why they came or went. And more.

It’s reassuring to know that Diocesan workers have parish clergy in mind as they create forms for us to fill in. We only work half a day a week, if that, and so there’s plenty time to make notes on where Mrs So-and-so was last week, and where her grandchildren were the week before. After the blessing at the 9;30 Mass, as I leave for the 11.00 service elsewhere, I brush aside people who wish to talk to me in order that I can fill in the forms before the memory fades.

This is an effort, I’m told, to make my job easier and help me keep watch over my flock. The Stasi were good at that. A correspondent wonders how this sits with Data Protection legislation. I really can’t think why the anonymity of Cathedral worship attracts more and more people.

But I am puzzled as to why properly trained clergy should need to be told pastoral practice. I’m put in mind of Medical Educationalists who are supremely gifted in the ability to tell others how to teach, despite never having taught themselves.

Little Weed

scaulbandbWatch with Mother on Wednesday afternoons in the 1950s and 60s (the BBC) was Bill and Ben the Flowerpot Men. It was set in the garden shed down at the bottom of the garden. When the gardener went for lunch, Bill and Ben came to life spouting curious gobbledegook like ‘Babap ickle Weed’ and ‘flobble-op’ (like church and university committees). Bill and Ben seemed strangely attracted to Little Weed that grew between them, though perhaps it’s better not to delve too deeply into the nature of the relationship. Maybe weed is not unrelated to the Flowerpot Men’s speech patterns.

Little Weed in the form of tobacco officially gets short shrift here in Ireland, for there is unalloyed joy at 10 years of the ban on smoking in the workplace. This includes pubs. Yes, pubs. Wikipedia tells me that the republic was the first state in the world to introduce such a ban.

We are told that as a result, the death rate from lung cancer is falling. Wonderful. But since we all die of something, the death rates from other things must be rising. Mind you, treatment for heart disease has come on so much that folk who used to die of heart disease now die of something else—cancer probably—so maybe not. The success of cardiologists must have caused deaths from cancer to rise.

While I’m on this little scherzo, I don’t understand all the fuss about fat in food. I am fat. I like fried eggs. Low fat food is chock full of sugar, so if you don’t get heart disease from too much fat, you’ll get kidney disease and have your feet chopped off because of the diabetes from too much sugar. And then you’ll die of cancer.

There’s another way of dealing with the tobacco problem, and it’s quite simple. If everyone were forced to smoke, lots of people would die from cancer, but all those who were genetically resistant to developing lung cancer would survive and reproduce. So then everyone would be resistant. The tobacco industry would have nothing to worry about, and the government could take more and more revenue from tax on tobacco. Problem solved. Simples.

I like salt too. I don’t like food police. There’s a lot of them about.

Bleeding rain

red_white_blood_cells‘Been thinking about you all morning.’

A siren song assailed my left ear as I was in the filling station waiting to pay. It’s not something I expect to hear from ladies in queues. She’d been deliberating about whether or not to go for her morning run, and was just about to settle on ‘no’ because the weather was so vile, when her daughter piped up ‘Stanley said yesterday it didn’t matter if you got wet because once you were wet you wouldn’t get any wetter and anyway you’d soon dry.’ So she went.

That’s the first evidence that anybody ever listens to anything I say.

Yesterday’s Maryborough School Assembly was about water. My views about wetness come from experience from the age of 10 onwards. When you’ve grown up around Penrith, and got soaked most mornings walking the mile or so from King Street bus stop to the Grammar School, you get used to rain, and you realise pretty quick that once you’re wet through (after about 20 seconds, I recall), you don’t get any wetter. Furthermore, before long you dry out. Never mind that the first 35 minute class is endured amidst steam rising from damp uniforms and viewed through steamed up specs.

I also said how magic our dog’s coat was for it was self-cleaning. And maybe our skin was. And maybe we shouldn’t wash so much because being too clean did nothing for our immune systems. This did not go down well with the teachers.

After assembly I took the seniors for a short biology discussion about blood. There had been a recent death from leukaemia, so we did types of blood cells, what they do, and what goes wrong when they don’t. And a bit of Greek with erythro and leuko and cyte and aemia. As far as I can judge from their attitude and lack of fistling, they were seriously interested. They certainly asked intelligent questions.

There’s a market for public lectures about how the body does and doesn’t work.

A nose that runs in the family

Workhouse, then City General, then University (so full circle)

Workhouse, then City General, now University (so full circle)

Carlisle hospitals saw quite a bit of me when I was young. Chatsworth Square Nursing Home took my tonsils when I was about 5. All I can remember is dark green walls and glass partitions. The Ear, Nose and Throat fraternity made me one of theirs after that, with a sinus job, two nasal polypectomies and an operation on the nasal septum when I was about 17. Somewhere in all this came appendix, two teeth operations (they’re wonky at the front), and an arm job. Mostly, I was at the City General, but the appendix and arm were done at the (old) Cumberland Infirmary where for the appendix in 1960 I was in Ward 18 opposite grandfather W P Monkhouse, then in his 80s.

For one of the nose jobs I was in a side room with a boy from Workington whose sister was called—and this is what it sounded like to me—Hughery. I’d never heard of that name and asked him to say it again, just to be sure. Yes, it sounded like Hughery. So that’s what I said. It wasn’t until years later that it dawned on me that it was Hilary, and he was probably in for a palate operation, so pronouncing ‘l’ was a problem. He thought he was saying Hilary and I heard Hughery. No wonder he was cross with me: I suppose he thought I was making fun of him.

One thing illness does for you, popular wisdom has it, is make you patient. It makes you take each moment as it comes. It teaches you not to have too many expectations. You learn that when doctors say you might be home at the weekend, you equally well might not. You learn to laugh off these little disappointments. When you expect to be going for an operation on Tuesday, and it’s cancelled because you have a chest infection, you learn to take it in your stride. That’s what popular wisdom says illness does for you.

Let me tell you that popular wisdom is piffle. Complete twaddle. Especially if you’re a child. As is well known, I am the most patient and even tempered of God’s creatures, but not even I was able to bear with equanimity the unpredictability of illness. I was in despair when some sign of progress did not materialize as I thought it should.

Dangerous rubbish

Dangerous rubbish

My nose would have been less inclined to run in the family had I not had cow’s milk shoved down my throat ‘when I were a lad’. It should come in bottles marked ‘poison’. Cow’s milk for cows, human’s milk for humans. It’s a snot generator. In the 1990s an Ear, Nose and Throat colleague told me my nose would be better if I stopped milk. I have, except in tea, and it is. The other thing that affected me was grain and meal that, since my father ran an agricultural feed manufacturing plant, put money in our pockets.

Milk and wheat are not good for Rambling Rector. I wonder how different my life would have been if I’d known sooner. As for cats, which always know that I’m allergic to them, the best place for them is under the wheel of a heavy truck.

One of Grimm’s Fairy Tales has a man whose nose grows so long that people trip over it.

Pigeon ‘pie’

From the BBC website

From the BBC website

Something to cheer the drooping spirit on a cold and gloomy January day.

Frances Wadsworth-Jones makes brooches using crushed precious and semiprecious stones and sells them for up to £2,500. ‘Nothing special about that’ you may say. Oh yes there is. They’re inspired by pigeon droppings. She says ‘I like to try and find beauty in the unexpected and I quite often look at the floor. Ealing is great for inspiration.’

The streets of Ealing must be paved with—err—gold.

‘People must think I’m mad’ … surely not … ‘because I have to take pictures of poo too. I’ve got hundreds.’ There’s no law against it, apparently. Do you suppose they’re stored on computer?

I’m very childish. There’s nothing quite like talking about poo to bring on a smile, though maybe talking about farting does too. I was taught that before flushing it away one should always inspect poo for colour, smell, consistency, and ‘does it float’? Note particularly any changes. Poo is a good indicator of inner health.

Actually, the intestines aren’t ‘inner’ – they’re outer’ because the ‘inside’ of the tube is continuous with the outside world through mouth and anus. This is the basis on which rests the distinction between carcinoma and sarcoma. But this is not supposed to be a pathology tutorial.

Pigeon poo isn’t just poo. That’s the black stuff in the middle. The light stuff round the edge is, in our terms, urine.  Whereas we eutherian mammals have separate holes for wind and piss (though you wouldn’t think so listening to some people – and piss is in the King James Bible so don’t moan at me), birds have only one. Everything gets mixed together, so. The evolution of the sphincters and sex region is utterly fascinating.

I watched an episode of Benidorm the other day (I’m a recent convert to this wonderful, wonderful series) in which a turd is found floating in the swimming pool. I wonder if this will interest Frances. If pigeon poo brings luck, as she says, what will human poo bring?