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?

Of mice and men

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Animal experimentation is certainly an issue that polarizes. I wonder how many opinions are based on facts and experience rather than sentiment and propaganda. How many of those vehemently opposed are principled enough to refuse antibiotics, or question how they were tested?

For several years I worked on the mammalian adrenal gland. The mouse Mus musculus was the creature of choice. I could not have done the work without killing. The question is: was it worthwhile?

Zhou Enlai, when asked about the importance of the French revolution, is reported to have said that it was too early to tell. I feel rather the same about much research in general, and mine in particular. I certainly don’t claim it to have had any impact, but this is not to say that in the future someone will not build upon it in a way that enlightens us about endocrine processes.

Headline-grabbing results are rare. Scientific research is like chipping fragments from a stone, a sculpture gradually emerging. Researchers build upon the work of others, and slowly, slowly knowledge accumulates. After a great deal of accumulation, conclusions can perhaps be drawn. It is dangerous to draw them too soon.

Yes, there are alternatives to animal experimentation, and they are increasingly used. More will be developed. But, in the words of my friend Andy, ‘at the moment they can’t simulate the real deal because mammals are so delightfully complex and still so poorly understood—despite the hubris of the scientific community.’

Is animal experimentation evil, immoral, bad? It concerns me that too much is done simply as CV boosting, as truthfully in my case, and there are problems with the way that research is politicized by factions and industry, but that’s another story.

I suspect that opposition to animal experimentation is most vociferous among those who are furthest removed from living and working with animals. You won’t find much opposition in the agricultural community. If you hold that all creatures are God’s creatures like us, then the only logical position is Jainism: non-violence towards all living beings. How do you define living? Plants? Fungi? Bacteria? Slime moulds? Clergymen?

Much of what we know of how the inner ear works comes from research that was done on human subjects in 1930s and 1940s Germany, in circumstances that may well appall us. We have benefited from that research not least in the development of hearing aids and cochlear implants. Knowledge of some neurological conditions comes from experiments on monkeys and apes. It’s all very well to object—until, that is, you get the disease.

When we lived in Nottingham, our children attended a school patronized by sandal-wearers, amongst whom there were more than a few objectors. Our children said “my daddy works with mice’s kidneys” (kidney/adrenal confusion understandable at that age) and drew pictures of my office. I did rather fear reprisals.

I was a reluctant researcher—a disappointment to the eminent Professor Rex Coupland, I didn’t enjoy the nitty-gritty of research and much preferred teaching, scholarship and administration. Rex was a big man with a long stride, so there was warning of his approach as he stomped along the echoing corridors. When professorial footsteps were heard in the distance, one could either dodge into the Dissection Room, or dash into the khasi, or else nip downstairs, along the corridor on the floor below, and then up again at the other end. Silly or what?

Medical ‘exams’?

I hope he knows where to put that finger

I hope he knows where to put that finger

Over the last 15 years, I’ve witnessed the introduction of exam regulations such that examiners may not penalize students for bad spelling, bad grammar, and the inability to muster arguments.

Now, let it be known that I yield to no one in my enthusiasm for the worship of mediocrity, but there are consequences for medicine.

One letter altered in a word can change meaning: it could be the opposite of what was intended. One letter or syllable altered can mean an entirely different drug. One letter or symbol altered can increase or decrease a dosage by a factor of 100. An inability to organize thoughts logically signals an inability to formulate a treatment plan. And so on.

Students with certain conditions are allowed extra time in exams. I wonder how they will manage when they are on duty in the emergency room. Is it unreasonable of me to hope that they will not be there when I need attention? I know of one who claimed extra time on the basis of being able to read only the first syllable of a word, then guessing the rest. Tolerating that doesn’t have much to recommend it when over 70 drugs begin with ‘chlor’.

What drives this? Partly political correctness, and partly disability legislation.

Medical education is not alone in suffering from the baleful influence of theorists who lack common sense and practical experience, but it is one of the few areas where the consequences of such idiocy can be fatal. The public needs to know. When I need the services of a medical professional, I would like them to be competent and knowledgeable.

I think I shall form a new society: the Association for Restoration of Sanity in Education. ARSE. Also a new blog for the exposure of such lunacy. I am seeking a title for the blog. A colleague suggests Rumbling Rectum. Other ideas welcome.

A fairy story

clavicle_plate02Manchester airport last night on the way back from a funeral. For the first time EVER my metal right clavicle (collar bone) caused the metal detectors to go off. The rather grumpy security man (he’d had a long day, I expect) poked and prodded me, and seemed unwilling to accept my explanation. I was taken off and almost stripped (not a pretty sight). Eventually, he had to let me go. He could find nothing. The cupboard was bare. I was rather pleased. Such things give a warm glow of satisfaction. Beating the system.

Once upon a time in the mid 1980s Jack was cycling home in Nottingham. Jack was returning to the nest after a particularly tedious University Senate meeting followed by several particularly refreshing jars. The sky was moonlit, but the street was ill-lit. A motorcycle parked transversely was sticking out into the road. The motorcycle and Jack’s cycle became embroiled in discussion. The motorcycle fell down, and Jack fell down and broke not his crown but his clavicle. A fall onto the outstretched hand damaged not the scaphoid nor the radius nor the humerus, but the clavicle.

The treatment, a mere sling, was utterly inadequate. Any fool could see that. Jack needed a figure of 8 bandage to pull the shoulder back. Would A and E staff listen to Jack? No, they would not. So the clavicle ‘healed’ in the form of a Z.

Weeks and months went by. Drinking tea became fraught, for as the arm moved, the two mobile edges of the clavicle jammed up against each other, their sudden springing apart causing the cup to jerk and the tea to spill. Jack was not happy and neither was Jill.

So by and by Jack had had enough. Jack was cut open, part of the clavicle was replaced by a piece of metal from the planet Krypton, and chips of bone grafted in from Jack’s iliac crest.

And they all lived happily ever after. Until Manchester airport yesterday. The moral of the story is: brace yourself with jars before meetings, not after them.

Eyes have they, and see not …

Communication problems

Communication problems

I’ve been fiddling with fonts and colours.

I was ‘short sighted’ by the time I was 8 and I’ve had specs ever since. About 10 years ago I found I needed them less and less for distance vision, and could often do without them altogether. Now they’re most likely perched on my forehead, and I forget about them. I go looking round the house for them for ages before realizing where they are. Like Mrs Richards in Fawlty Towers.

In 2008 some of my left retina became detached. It was operated on fairly pronto, but despite that most of it died within 6 months, leaving me with only a central field of view. This might have been OK but for a subsequent cataract on the same side. It too was operated on, but with no perceptible improvement.

So it’s right eye only. Fortunately, I was told there was no risk of retinal detachment there. As eyes go, though, it’s not what it used to be. Now, I need a magnifying glass, especially in the evening. I’m thankful for computer screen and Kindle where text can be ’embiggened’.

I’m conscious of the legibility (is that the right word?) of websites. I need contrast. I prefer dark type on light background than light type on dark background. I find sans serif fonts like this easier to read than serif fonts, though I think the serif fonts more elegant. Nobody with even the slightest smidgeon of good taste would tolerate jokey fonts, and I don’t find it easy to read italics. Size matters, of course. If it’s too small, I don’t bother with the website; if it’s too big, it’s like being in the infant class, and if it’s CAPITALS it’s like being shouted at. It’s no easy matter to get things right.

What about colour? Bright white is, well, too bright. I’ve gone here for a sort-of Cambridge blue—not for any reason of loyalty, but because SWMBO said it looked well and went with Wider than the heavens (see the bar at the top).

Something’s going on with the hearing too. Is it me, or do people talk too quickly and without proper enunciation? Mangled vowels, inaudible consonants. I’m not talking accents here – I like the Birmingham accent, the Dublin accent etc – but about articulation. People could start by opening their mouths a bit more. Speech discrimination, I suppose, is what the audiologists might call my problem. Or maybe I’ve got a brain tumour. Or maybe I’m just a grumpy sod.

If you have any constructive criticism about fonts and colours on this blog, I’d be glad to have it. Comments about my grumpiness you can keep to yourselves.

Letter from Malawi

Ryall's - not this posh when i was there

Ryall’s – not this posh when I was there

I’ve been to Blantyre three times, once to discuss setting up a new medical school, and design the science building, once to see the first graduates, and once as external examiner. The first time was in Hastings Banda days. I stayed at Ryall’s Hotel. On the second, Banda still alive, Susan was with me and we stayed in a hospital house just off Mahatma Gandhi road with some postgrads from the US. Servants lived in a shack at the bottom of the garden. The third time was after Banda. I was on my own at Ryall’s again.

Tuesday 14 November 2000, room 33, Ryall’s Hotel, Blantyre. Sunny, breeze outside, blue sky, white clouds like Simpsons opening credits. Yesterday was thundery; the plane from Lilongwe couldn’t land and had to return to wait for an hour before setting out again. Second time lucky.

I’ve just read about the botfly that lays its eggs on clothes, then larvae burrow into the skin and after 8 weeks or so of growth and development, they wriggle out of what seems like a pustule. Oh joy. The bedroom walls don’t reach the ceiling, I’ve just noticed.

Tuesday evening. More thunder. I’ve been marking exam scripts all day and now find – quite inexplicably – a Malawi gin and tonic inside me. I seem to have sleepwalked across the road to the Africa Commodity Traders ‘superstore’ where my eye lit upon a bottle of the said substance at 414 Kwacha (approx £3) labelled ‘drink me.’ Quite delicious. Is it the gin or the tonic or both? There must be importers somewhere.

Medical College now

Medical College now

Wednesday evening. 22 candidates, mostly very good or good. Nobody inadequate. Why spend a lot of money on educational resources when people who have so little are every bit as good? Another majestic thunderstorm. No tap water in the hotel or, more importantly, no bog-flushing water. The electric sockets in the bedroom don’t work today though they did yesterday.

Thursday morning. When it rains, water pours through the roof of the hotel corridor. So they move all the pot plants under the leaks. Brilliant! Water off again after a brief window of opportunity for bog flushing. Day off today, exam conference tomorrow. Writing this is displacement activity: I should be getting on with work that I brought that must not be allowed to wreck the Christmas break (again). Never quite fathomed why, when we are so near the equator, it’s not hotter than it is. We are high above sea level – perhaps that has something to do with it.

Saturday. No thunder since Thursday. Economy grim, set to get grimmer. Racial tension mounts – not blacks/whites, but blacks with money/blacks without. Bring back Banda from the grave say some. Home soon, Air Malawi south to Jo’burg in a plane with propellers and elastic bands, then sardine tin to London with my knees in my chin. Queasy belly. Something suspiciously like dysentery gurgling away.

Monday. Jo’burg check in, asked for aisle seat so I could rush to bog if necessary. Lady says perhaps you should stay here until you’ve recovered. Had a bit of a job (no pun intended) to persuade her that I was well enough to travel. Should’ve kept my mouth shut. I must have looked better than I felt because I’m just about to board the London flight. Fingers crossed. And legs.

Do the what-comes-naturally

U0WxlThis week’s New Scientist has an article debunking some widely held notions about nutrition. Here are four of them.

1. It is not necessary to drink eight glasses of water a day. It is not necessary to drink pure water at all. It just isn’t true that by the time we are thirsty we are already dehydrated. ‘So relax and trust your body.’ If you visit any primary school, chances are you’ll see children clutching their water bottles like comforters (well, I hope it’s water). Are these for the comfort of the children or the parents, I wonder?

2. Sugar does not make children hyperactive. Children go to parties where (A) they eat sugary things and (B) are excited. It does not follow that A causes B. Sugar rots the teeth though.

3. Being a bit overweight is—wait for it, wait for it—good for you and will stave off the grim reaper for a bit! Deo gratias. Yes, yes, I know I’m more than a bit overweight, but still ….

4. The notion that we should eat like cavemen is bunkum. Crops and animals then were quite different from crops and animals now. There is no evidence that cavemen were healthier than we are. Evolution ‘doesn’t care if we drop dead once we’ve raised our children and grandchildren’.

Why does it give me such joy that these are debunked?  I suppose because I find zealots tiresome. The nanny state goes too far. People tell us what to eat, what to drink, how to eat and drink, when to eat and drink, how to sit, how to stand, how to exercise, how to walk, what to think … and more. Do-gooders used to tell us that eggs were bad. Eggs are now good. I heard a whisper recently that salt wasn’t the satanic substance that we had been led to believe, and that maybe if I think I need salt it’s because my body is telling me I do (or perhaps I’m addicted to it).

When I was in my 30s I became fascinated by the Mitford sisters (novelist, farmer, fascists, communist, writers) and remember that their mother, Lady Redesdale, believed that ‘the good body’ would heal itself more effectively without the intervention of doctors or medicine. Was she barmy? She took this to the point of having the doctor remove a child’s appendix on the kitchen table. Maybe a bit barmy. I think I’m remembering right that in my early days as a clinical medical student, an eminent surgeon told us that in his opinion people should let the body do the what-comes-naturally. Amen, amen!

Registering intersex

What sex would you say the baptismal candidate was?

What sex would you say the baptismal candidate was?

Very soon in Germany it will be possible to register a child as being of indeterminate gender—neither male nor female, but indeterminate.

Off you go to the Register Office. You have to say whether the little darling is male or female. No problem usually. But occasionally it’s fraught: the little darling’s gender is ambiguous because the anatomy of the nether regions is neither one thing nor the other. Usually, surgery is soon done to ‘regularize’ the situation. Making the baby look like a female is the easiest thing to do for the obvious reason that it’s easier to chop things off than stick things on. (This can lead to psychological problems later when, for example, the person grows up feeling like a male, yet having no dangly bits.)

Being neither one thing nor the other, or having bits of both, means intersex. This is a natural phenomenon. It’s not something the baby chooses, and certainly not something parents choose. They are, doubtless, in shock and perplexity. But the fact is that sometimes, more often than we recognize or admit, nature goes awry.

I know, I’ve blogged about this stuff before, here and here. The German initiative means I’m doing it again. There will be some delicious issues for the institutional church. It’s full of rules. If we say marriage is between man and woman, then we have to define man and woman. If we say ordinands have to be heterosexual, then we have to lay down criteria of maleness and femaleness. If only men may be ordained, how will manhood be assessed? Is it an absence of some things or a presence of others? If it’s a chromosomal thing, then what will assessors do about chromosomal anomalies? It seems to me that none of the church’s rules can be enforced. If it’s not possible to enforce them, there’s no point having them.

You may say I’m being silly. Perhaps you think that the institutional church is on the way out, and that what the churches say or do is irrelevant. You might be right. But if you think that the church could be, should be, and basically is, a force for good in the world, then it does matter. The trouble is that the churches generally are run by people who seem blind to what biology has to tell us about the human condition, and who tend to look backwards rather than forwards. A biological Galileo saga in the making.

Biologically, legal recognition of intersex is long overdue.

Click here for more about the development of sexuality.