Monthly Archives: December 2014

Which Accidental Deaths Were Most Common 400 Years Ago?

Dalrymple’s pieces on Pajamas Media often focus on medical topics that many of his usual readers may find of little interest, but they are worth reading for the introductions alone, such as this one:

It is easier to advise than to have or to retain a sense of proportion, especially when it is most needed. I have never known anyone genuinely comforted by the idea that others were worse off than he, which perhaps explains why complaint does not decrease in proportion to improvement in general conditions. And he would be a callow doctor who tried to console the parents of a dead child with the thought that, not much more than a century ago, an eighth of all children died before their first birthday.

Still, it is well that from time to time medical journals such as the Lancet should carry articles about medical history, for otherwise we might take our current state of knowledge for granted. Ingratitude, after all, is the mother of much discontent. To know how much we owe to our forebears keeps us from imagining that our ability to diagnose and cure is the consequence of our own peculiar brilliance, rather than simply because we came after so much effort down the ages.

A little article in the Lancet recently was written by two historians who are in the process of analyzing the results of 9000 coroners’ inquests into accidental deaths in Tudor England. It seems astonishing to me that such records should have survived for more than four centuries, but also that the state should have cared enough about the deaths of ordinary people to hold such inquests (coroners’ inquests had already been established for 400 years at the time of the Tudors.) In other words, an importance was given to individual human life even before the doctrines of the Enlightenment took root: the soil was already fertile.

Peshawar Forever!

The adventurousness of Dalrymple’s life is no doubt one of the major attractions to his work for many of his readers. In Taki’s Magazine, he now gives a more detailed description of his youthful trip through Turkey, Iran, Afghanistan and Pakistan that he referenced in his classic essay “When Islam Breaks Down”:

When, a little more than 45 years ago, we arrived in the city of Peshawar from Afghanistan, it seemed a peaceful and romantic place. True enough, the Khyber Pass had not been safe to travel after dark, but the danger was from brigandage of an almost folkloric rather than of a political or religious kind. Brigandage was to Afghanistan what beer was to Belgium. It was still the age of the bandolier and Lee-Enfield rifle rather than of the Kalashnikov and the suicide bomb (I bought a Lee-Enfield as a souvenir in Kabul market)…

That first night in Peshawar we slept under the stars on charpoys (wooden-framed beds with rough jute matting suspended between the sides) in the garden of a college. We thought we had arrived in the middle of a Mughal miniature painting.

In the aftermath of the disgusting attack on a Pakistani school by Islamists, he re-examines the assumptions of his youth and sees in Pakistan something that many of us have noticed in the West: reactionary progressives.

So the rise of Islamism, whether Sunni or Shia—the belief that there is an Islamic answer to all of life’s little problems, and that those who do not accept Islam are the cause of those problems—is the consequence not only of religious doctrine that contains within itself the necessary justifications or rationalizations for violence, but also of an encounter with the Western idea that material change for the better is the natural order of things and the only ideal worth pursuing. This idea has been deeply, if not consciously, absorbed. Where such material progress has not been rapid, which is to say, not as rapid as hoped or expected, wickedness and sin must be the explanation, so that the removal of the wicked and sinful is the logical solution.

Imagine No Religion

Here we go again. A man in France attacked three policemen with a knife. He was an Islamic convert, shouted “Allahu akbar!” during the attack, and had posted a picture of the flag of the so-called “Islamic State” on Facebook. And yet…

Monday, the left-leaning newspaper, Libération, carried the following headline: JOUÉ-LÈS-TOURS: “THIS AFFAIR HAS NOTHING RELIGIOUS ABOUT IT.” The story went on to say that those close to Nzohabonayo do not believe his motive was terrorism. According to the newspaper’s special correspondent, there is a rumour in the suburb that Nzoahabonayo did not go to the police station of his own accord with a plan of attack, but was taken there under arrest by the police, where he defended himself with his knife. And two people interviewed by the correspondent, called Samir and Nourdine, wondered why the fourth policeman had killed him rather than merely shoot him in the legs. For them, that was the most burning question about the affair.

CLASSIC DALRYMPLE: Sweet Waist of America, excerpt (1990)

It’s been far too long since we posted another Dalrymple classic, and the last chapter of his fifth book, Sweet Waist of America, certainly qualifies. Summing up his 8-month stay in the country after the conclusion of its extraordinarily brutal civil war, he finds universal themes of progress, intellectual dishonesty, and the search for meaning in the particulars of one of Latin America’s most violent conflicts.

For anyone who has lived in Guatemala, other countries, by contrast, are lacking in savour. The problem confronting the people who want to promote a prosperous tourist industry is how to take out this over-strong flavour so that only the safely picturesque remains.

-Norman Lewis, The Volcanoes Above Us

I had spent eight months in Guatemala, and it was time to leave. The longer I stayed, the less certain was I that I understood the country I had chosen to write about; I left before the increasing intricacy of what I found there sapped my confidence altogether. Indeed, I began to wonder what it meant to understand a country. Did it mean to have a nodding acquaintance with all its social classes, to have interviewed its president, to know its past, to predict its future? Suppose a Guatemalan were to write a book about England after a stay of only seven months: should I not laugh at his errors, were I not angered by the presumption of his enterprise? Continue reading

Does Brain Damage Make a Case for Ending Sports?

Dalrymple seems to think so, though I can’t tell if he’s being sarcastic. His experience certainly does make him skeptical of medical trials:

When I was working in Africa I read a paper that proved that intravenous corticosteroids were of no benefit in cerebral malaria. Soon afterwards I had a patient with that foul disease whom I had treated according to the scientific evidence, but who failed to respond, at least as far as his mental condition was concerned – which, after all, was quite important. To save the body without the mind is of doubtful value.

I gave the patient an injection of corticosteroid and he responded as if by miracle. What was I supposed to conclude? That, according to the evidence, it was mere coincidence? This I could not do: and I have retained a healthy (or is it unhealthy?) skepticism of large, controlled trials ever since. For in the large numbers of patients who take part in such trials there may be patients who react idiosyncratically, that is to say, differently from the rest.

Do Drug Trials Often Fail to Reveal the Harmful Side Effects They Discover?

For a variety of reasons and in many ways, doctors and medical researchers often fail to investigate the harms caused by medical treatments.

This is the royal road to over-treatment: it encourages doctors to be overoptimistic on their patients’ behalf. It also skews or makes impossible so-called informed consent: for if the harms are unknown even to the doctor, how can he inform the patient of them? The doctor becomes more a propagandist than informant, and the patient cannot give his informed consent because such consent involves weighing up a known against an unknown.

Read the details at Pajamas Media

The strange case of Robert Louis Stevenson

Doctors figure prominently in the works of Stevenson — unsurprising perhaps, since it was true of his life too.

Stevenson’s life and work is always of great interest to doctors. He grew up in the most medical of all British cities, Edinburgh, he was surrounded by doctors and medical students, and he was ill from childhood. He was driven abroad not only by romantic, bohemian restlessness, but by the search for a curative climate for his chronic ill-health.

He spent months on the island of Abemama, in the Gilbert Islands in the central Pacific, where I once worked for three years. Abemama, which in Stevenson’s day was under the sway of a petty tyrant, is still very remote today; and it inspired some of his later writing.

 

Slavoj Žižek, the Ideal Fraud

Slavoj Žižek is the archetypal intellectual, in his inscrutability, his charlatanry, his black t-shirt emblazoned with “I WOULD PREFER NOT TO”:

I want to avoid all misunderstanding: this is no condemnation of Professor Žižek; on the contrary…I am not against charlatans; I even admire them if they are amiable, as of course the vast majority of them are (an unamiable charlatan is almost an oxymoron). To be able to glide through life in the knowledge that one is bogus is a great achievement, far greater than that of the majority of genuinely earnest people. If the world, including academia, were to be purged of its charlatans, how dull life would be!