to wit, an Inarguably Wise but Jaded Forensic Psychiatrist Expatiating on Topics Medico-Legal, Historical, and Scientific, with a Few Non-Sequiturs for Good Measure
When attending on a modestly-sized, community-based, high-volume psychiatric crisis unit, it isn’t always possible to immediately access the full-spectrum of diagnostic resources that are available at the big tertiary centers. For example, if a patient is admitted to a large university inpatient ward and shows signs of forgetfulness, a battery of neuropsychological testing can be readily ordered as a first step to see if, in fact, the patient is suffering from measurable cognitive decline, and if so, to determine the best course of action. The academic centers, because of their focus on education and training, are quick to do ‘the million dollar work-up,’ and many patients who probably don’t need it are nevertheless blessed with the attention of numerous mental health sub-specialists.
But if you are in a small town, short-staffed, and have no neuropsychologist on your treatment team, you may have to rely on simple screening tools that can be administered at bedside; only if there persists evidence of cognitive impairment on such screenings would you then make the (sometimes outside) referrals to further delineate what is ongoing.
The Mini Mental Status Exam (MMSE) is a relatively quick 30-point questionnaire that examines cognitive facets such as short term memory, word recall, object identification, and simple task performance. But if you’re backed-up with six admissions, the ten minutes to perform a MMSE on each subject means an hour of extra work in your already chaotic day.
You’re blessed if you have a medical student or resident to do an MMSE for you, but if you don’t, you need the simplest basic memory/ concentration screening possible.
Just ask the patient where they are. Ask the day, date, month, year, and season. Ask the most recent holiday. And ask who is the U.S. President. No, this isn’t the most sensitive tool, but a person with delirium or dementia will usually stumble, and throw up the requisite red flag indicating the need for referral for more detailed examination.
In this current election cycle, though, I’ve added for fun one add’n question of my own design: name any one person who is running for President (recall at one point, there were more than 16 declared candidates between the two parties). For all but the truly addled, it’s nigh impossible to live in America of 2016 and not be aware, even in passing, that primaries and caucuses are brewing.
In asking this specific question of hundreds of patients with every imaginable mental disorder over the past six months, I’ve observed a very interesting phenom.
Young. Old. All races. Every level of education. Both genders. Psychotic. Neurotic. Organic. On Rx or off. I hear it every day.
“Trump”
Now, there are variations. Sometimes it’s just his surname. Other times, unmistakable descriptors such as “the crazy guy with all the money, the fake tan, and the hair,” or “that dude who thinks the Mexicans are going to pay for a wall.” But there’s no doubt whom they mean.
Even the ones whom I suspected had early dementia answered as the rest.
A couple of times, I thought I had uncovered a heretofore unheard reply, only to have my hopes dashed at the very end with a compound answer:
“Rubio… and then there’s that guy Trump.”
“Christie… and that rich bastard with the Atlantic City casino.”
“Bernie… and that slick New York billionaire with the big mouth.”
“Cruz… boy I wish he’d put the Donald in his place.”
Only once – ONCE – in the past months did someone say “Hillary.” And then stop. I must have appeared expectant (“and…?”) as the patient looked at me quizzically, breaking my train of thought and resulting in the fumbling of papers.
My point in all of this? Probably nothing. And come November 2016 it’ll be back to the simple vanilla questions. But in the meantime, I can’t help but appreciate the late great P.T. Barnum’s old saw that “there’s NO such thing as bad publicity.”
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[I’m engaged in a segue to a new job and state, which hopefully explains the relative dearth of fresh material recently. In the meanwhile, this post, from early 2014, remains one of my favorites]
As a psychiatric resident in the late 1980s, I didn’t sleep much (at least for the first couple of years), my diet consisted of carry-out or unhealthy hospital fare, and I was paid a pittance. This was the expected rite-of-passage through medical specialty training. But because of the hardships, seemingly minor things took on great significance: a girlfriend who would cook for you, a freebie from a drug rep, an afternoon of total peace and quiet – all are lovely, but all are even more lovely for those who feel so deprived.
thank you, Mastercard
Which is why taking blatant advantage of our chairman’s credit card was so much darned fun.
In the autumn of each year, we would host senior medical students from around the country who were looking for places at which to do their post-graduate residencies. These were important visits in the eyes of program faculty everywhere. If potential applicants enjoyed their visits, they were more likely to rank the program highly on their ‘match list.’ If the visit were a disaster, though, the program would get ranked lowly, or not at all. This directly effected the quality of the incoming class at every residency program in the country. Thus, heads of departments of all specialties everywhere wanted to see happy visitors at the end of the day.
Enter the credit card lunch scam.
At UVa, we had potential applicants come to the medical center on Mondays, Wednesdays, and Fridays during ‘the season,’ which stretched from September through early December. A sign-up sheet would be posted near our on-call room for those residents who were interested in going to lunch with the visitors on any given day. Because the season stretched for more than three months, and there were several designated days per week, it was not uncommon to host relatively small groups of visitors – three constituted a busy day, and more often than not there might only be one potential applicant visiting.
But for that one visitor? Many times half-a-dozen or more residents would sign up to take her to lunch. I recall once that there was a single interested party… and thirteen residents going to eat.
And as we were taking said prospective applicant out to eat, the chairman’s secretary always handed over the gold MasterCard and told us to bring back the receipt. That was it. No other instructions. No limits. No preferred restaurant list. Just go and enjoy.
So naturally we were cost-conscious and went to modest restaurants. Not.
It was during one of these junkets that I first sampled escargot. Seafood bisque was ordered around the table more often than not – often with seconds. Can’t decide on which appetizers to order? Heck, get them all. And while I don’t recall any ‘Surf and Turf,’ that wasn’t because we couldn’t have done so – it was because the restaurants in town didn’t serve such on their lunch menus.
Hundreds of dollars later, we’d return to the secretary that well-worn credit card, only to repeat the sanctioned theft later in the week.
We thought we were pulling the wool over our chairman’s eyes, and marveled that he didn’t put a stop to it when he saw the bills. But he never did.
Actually, I realized much later that we were doing his bidding without knowing it.
Happy well-fed residents put across the best faces possible for potential applicants. Smiles and laughter were all around. I know that research grants and faculty-to-resident ratios are important, but when those same applicants were later sitting at their homes, finalizing their match lists, they remembered how contented were the residents at the various programs and not necessarily how many papers were published by a particular medical center.
Thus, UVa always had a bumper crop of excellent residents back then. And I think that the chairman’s credit card and our ‘abuse’ of same were in no small part responsible.
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[today’s post is sponsored by Lisa S. Kaplan RN, the best nurse practitioner with whom I’ve ever had the pleasure to work. As she is also skilled in those aspects of the time-space continuum not of this plane, what follows seems an appropriate article to which to affix her name… ]
“The Zombies Are After Brains. Don’t Worry, You’re Safe”
~seen recently on a coffee mug at the office
bon apetite!
Ask any teen, or horror movie aficionado, and they’ll tell you that zombies of modern western pop culture – not those of Caribbean or African folklore – eat brains. Why that is odd is because the cinematic masterpiece that jumpstarted the whole modern zombie craze, George Romero’s Night Of The Living Dead (1968), makes no mention of brain-eating. As a matter of fact, none of Romero’s six ‘Of The Dead’ films do.
So from where did this near-diagnostic facet of zombie behavior arise?
When asked, even Romero didn’t know. In a 2010 interview with Vanity Fair, he noted, “whenever I sign autographs, they always ask me [to write], ‘Eat Brains!’ I don’t understand…. I’ve never had a zombie eat a brain. But it’s become this landmark thing.”
He went on to say that while his zombies do feast on flesh in general, he is amused that people even care about the specifics of it all (i.e., if they actually have favorite body parts or cuts of human meat). He closed by asking rhetorically if the next question will be, “do zombies shit?”
Turning back the clock, mention of brain-eating didn’t first appear, and then only fleetingly, until Return Of The Living Dead (1985). You’re forgiven if you thought that Romero had a hand in that film, but he didn’t. You see, like an amicable marital divorce, when Romero and his erstwhile collaborator John Russo parted ways in the 1970s on good terms, they agreed that all subsequent releases with ‘Living Dead’ in the title would be Russo’s, while those ‘Of The Dead’ belonged to Romero.
[sidebar: the two split over their differences re: zombies. Romero’s can be killed, whereas Russo felt that his should be essentially immortal]
So that 1985 release was Russo’s. Fans asked him about it vis a vis brain-eating.
He professed ignorance too about the etiology of the whole cerebrum schtick.
But his chief writer and director, Dan O’Bannon, once made a flip comment – one that would have unforeseen cultural consequences – that zombies probably eat brains to “ease their pain.” This was seconded by Bill Stout, the production designer of the 1985 film, who, when ambushed by interviewers, said that such an explanation “made sense” to him. Those with way too much time on their hands took these clues and offered that zombies are merely trying to boost their serotonin levels to produce the desired analgesia, and brains are a great source of that particular neurotransmitter.
Romero has expressed surprise/ amusement at the attention to such zombie detail, especially as he has noted repeatedly that the focus of his movies was always on us, and how we react to the zombies, not on the zombies themselves. He has frequently criticized those who “take it all too seriously.”
And although the definitive answer may never be known, it has been suggested by film and TV critics that neither O’Bannon nor Stout are directly responsible for the focused brain-eating craze. Paradoxically, Matt Groening of The Simpsons may have earned the honor of popularizing what is now universally held. And Groening ain’t talking.
You see, in his 1992 Halloween classic, Dial Z For Zombies (itself a parody of Return of the Living Dead), Groening had his cartoon zombies eat brains, perhaps as a nod to Russo, et al., or perhaps for entirely silly and comedic effect. But as Matthew Belinki of OverThinkingIt.com has since opined, “millions of kids saw [Dial Z For Zombies] before they were old enough to see a real zombie film. I suspect that for a whole generation, [the cartoon] was the first zombie story [they] ever saw. And that, my friends, is why we think that zombies eat brains, even though most of us have never seen a movie where this is actually the case.”
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Just as my generation never knew of the automat except in cultural history books, the current crop of young adults likely has no first-hand experience with public coin-operated telephones. Given that cellphones are ubiquitous, who now would ever need to drive around town looking for [one of the very few extant] coin-op examples on which to make a call? Were it not for Maxwell Smart reruns, Bill & Ted, retro Superman comics, and Dr Who, I doubt anyone younger than 40 would even know that payphones and their booths once existed @ drug stores, bus stations, libraries, and street corners nationwide.
As I prepare for my own relocation to a far-away desert location in coming months, two observations are unavoidable. First, truth really is stranger than fiction. And second, the American Southwest is a very odd place.
the Mojave Phone Booth
Enter the Mojave phone booth.
California instituted a network of what were called ‘policy stations’ after WWII in an attempt to bring infrastructure – in this case, telephone service – to remote parts of the state. A public phone booth was installed in 1948 not far from the Cima Cinder Mine in eastern San Bernadino County. This was done at the behest of one Emerson Ray, owner of the mine, in order to provide payphone service to the (very few) local employees in the area. The phone booth was located at the intersection of two remote dirt roads – 35° 16′ 40” North, 115° 43′ 53” West, to be exact – eight miles from the nearest pavement, and fifteen miles from the nearest numbered road.
At first, the phone inside the booth was a hand-cranked magneto, but that was replaced by a rotary coin-op in the 1960s, and then a touch-tone model in the 1970s.
The only problem? The mine closed.
The phone and booth remained.
In the late 1990s, the nascent Internet took notice of the isolated booth, located inside what had since become the Mojave National Preserve. A hiker from Los Angeles spied a ‘telephone icon’ on his map of the expanse and, in disbelief, decided to visit the site. Yes, there it was. He made note of the phone’s number, and when he got back to LA, wrote an article for an underground paper telling of his adventure and publishing the number. Before long, a reader created a website dedicated to the phone, and soon fans were calling the number. Others went to see the phone and to answer any incoming calls; a reporter from the Los Angeles Times visited and found a man camped there who had been at the site for a month and had answered over 500 incomings, including one from an individual who identified himself as “Sergeant Zeno at the Pentagon.”
The booth, in the middle of nowhere, became covered in graffiti, and detritus of the visitors from all around the world littered the site. Its days were numbered. PacBell removed it on 17 May 2000 at the request of the National Park Service, largely because of vocal environmentalists unhappy with the effects of all of the increased traffic.
PacBell is said to have destroyed the booth. A headstone-like plaque was installed on the empty site, but that was later removed by the park service as well… but not before an eponymous indy rock back, short film (Dead Line), documentary (Mojave Mirage), full-length movie (Mojave Phone Booth), and extensive coverage by National Public Radio guaranteed the phone’s pop-cultural apotheosis.
All is not lost. The phone booth’s number is no longer owned by PacBell, instead having been acquired by a small regional provider. And that number now rings into a conference call, sometimes. The idea is that strangers can once again connect just as when the phone booth was still active. But if there is no one else on the line, it’s often just static.
BTW, the number is (760) 733-9969. And if you get through, ask for Sergeant Zeno.
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Three caveats before I dive into this very strange topic:
First, I own a pet Lesser Sulfur Crested Cockatoo which was rescued from a meth lab outside Gastonia NC (where she was being employed as the proverbial ‘canary in a coalmine.’) As her subspecies is critically endangered in the wild, it’s almost certain that she was hatched here in the U.S. Because of that, Koko has never seen any of the predators that would normally populate her home in East Timor. But she totally ‘loses it’ when one of my family approaches her cage wearing a leopard print blouse. Evolutionarily, Koko knows that such a pattern is bad news, and she reacts quite viscerally to it.
Second, looking back over my medical training and subsequent career, I’ve encountered some fairly disgusting things. Self mutilations? Check. Head traumas? Been there. Major abdominal surgeries? Yup. Autopsies? Yawn. But far and away, the most revolting cases came from… dermatology. To really churn one’s stomach, nothing compares with skin diseases.
Third, I still, to this day, remember a vivid and upsetting dream I experienced as an adolescent. It involved seeing a classmate, nameless, faceless, with her arms bandaged. In the dream, she removed the wrap, and underneath, both of her forearms were covered with deep holes, and inside of each one was an insect. I don’t have any idea what triggered this thought in my subconscious, but the dream occurred years before I had ever heard of the subject matter of today’s post, and it has obviously stayed with me all of these years.
Keeping those observations in mind, I now present you with Trypophobia, the fear of small irregularly shaped cavities (or blisters, fissures, and bumps, from the Greek root trypo, for hole). This may sound like a joke, but to those who are purported to suffer from it, the condition is anything but funny. And from a quick Google search online, there seem to be a lot of folks out there who are afflicted – or at least who talk about it. Which is even more odd given that in my 27+ years of clinical work, I’ve never encountered a single patient who endorsed these symptoms, nor was I ever instructed that the condition may even exist!
Specifically, trypophobes say that certain images are ‘triggers’ that reliably produce gastrointestinal symptoms (e.g., diarrhea, nausea, vomiting) as well as more classically psychogenic ones (e.g., sheer panic, dread, diaphoresis, tachycardia, vertigo).
If you look online, you will see frequent mention of triggers both innocuous and nightmarish:
skin conditions, such as severe athletes foot, chicken pox, measles, and deep cystic acne;
maggots doing their thing;
plants with cystic structures or reproductive pods, such as lotus seed heads, cantaloupes, or pomegranates;
porous coral formations;
soap foam;
the honeycombs of bees;
pancakes with little bubbles in them;
circular shower drains;
popcorn (and bumpy popcorn-finishes on ceilings);
sponges;
gross
weathered sandstone;
gasp!
and pregnant Surinam Toads, the dorsal aspects of which are pockmarked by gestating young under the skin – and then those little buggers squeeze out of holes in mamma’s back when developed.
There are researchers who claim that some people’s repulsion to certain stimuli is an unconscious evolutionary association vis a vis dangerous animals/ organisms or infectious conditions that have ‘the look,’ and from which we’re wired to stay far far away, for our own safety.
Others, however, state that so-called trypophobia is nothing more than conditioned yet over-generalized disgust to possible contaminants and unpleasant images – think rotting corpses – fanned by pop psychology, photoshopping, armchair diagnosis, and the internet.
[sidebar: and we all know that if something is on the internet, it must be true]
Anyone who has read my blog for a length of time will be aware of my jaundiced view of ever-increasing disease categories in the Diagnostic and Statistical Manual. That noted, there is a lag-time between identifying a condition and having it gain wide acceptance within the profession (e.g., Seasonal Affective Disorder, about which Scandinavians have known for centuries, but which didn’t make ‘the cut’ in early editions of the DSM).
Will trypophobia also make ‘the cut,’ or instead join the ranks of far more suspect ailments like sex addiction and multiple personalities? I’m not sure yet. Either way, don’t now go to YouTube and look for videos of parasitic bot fly infestations. You have been warned.
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As the political season heats up, there once again have begun the perennial rumblings that the media is “too intrusive” or doesn’t treat one candidate as fairly as another. I don’t worry about this much; there are as many publications on the left as on the right, and if one politician gets heat from a certain sector, you can rest assured that the politician’s opponents will be similarly scrutinized by partisans of the other camps. It can be loud and messy, but I’m convinced it all balances out in the end.
However, and invariably, as the political microscope becomes more focused, there will be more talk about what is ‘fair game’ for journalists. A politician’s family? Dumb things that person may or may not have done in college half-a-century prior?
With HIPAA and Protected Health Information (PHI) in mind… are politicians owed privacy as the rest of us? And if so, to what degree?
Would FDR’s polio be pertinent today to the landmark legislation he championed and his stewardship of the nation through WWII?
Should Thos Eagleton’s history of depression have removed him from contention for the second highest position in the land?
I read recently that, the week following his inauguration in 1961, John F. Kennedy appointed his personal doctor, Janet Travell, M.D., as presidential physician, marking the first time that a woman had held that important post.
This breaking of the glass ceiling, though, came with some additional baggage. Dr Travell had an impressive professional resume, including prestigious academic appointments in pharmacology, orthopedics, and cardiology. She then-already enjoyed an established reputation as a pioneer in the treatment of chronic pain conditions.
[sidebar: it is said to have been her recommendations on ergonomics that later resulted in the iconic images of JFK sitting in rocking chairs]
But when expressly asked about rumors of JFK’s health during the 1960 campaign, she stated that he did not have Addison’s Disease and that she had never treated him for same – both statements found after his death to be inaccurate.
In short, she lied.
Additionally – though this may be a reflection of the times and not as much the clinician – Dr Travell prescribed for JFK an astounding array of potentially habituating agents to treat his pain, including high doses of Luminal, Librium, Miltown, Laudanum, Meperidine, and Dolophine. Add to that his frequent, sometimes nightly, use of Nembutal for sleep. Though the Kennedy family credited Dr Travell with enabling a determined JFK to maintain his punishing schedule in the face of physical difficulties, Dr Jeffrey Kelman, who later researched and published a book on Kennedy’s health, has since stated that the president’s ailments probably would earn him social security disability benefits were he were alive today. And as one who had seen combat, he’d also arguably be 100% service connected through the Veterans’ Administration for such serious and chronic debilities.
All of this occurring concurrently with the Bay of Pigs and the Cuban Missile Crisis!
However, one might say, he successfully navigated those challenges. Yes, others will add, but what if his sensorium had been clouded by that potentially stupifying drug cocktail?
As physicians, we deal with the headaches of HIPAA daily, the near-constant concerns over aspects of privacy – presumed, expressed, implied – that any/ all practitioners can readily appreciate. We worry about minutiae like names on the spines of filed charts being visible from a distance.
The media has no such worries in reporting on the body politic. Or should it?
All points worth keeping in mind as we enter the nominating primaries.
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For Christians, December 25th by tradition marks the birth of Jesus of Nazareth, and therefore the start of a new year in their calendar.
[sidebar: that the Western new year actually begins a week after Christmas goes back to Julius Caesar and, by necessity of length, will be fodder for another post]
From where, then, do we get ‘BC’ (‘Before Christ’), ‘BCE/CE’ (‘Before/Common Era’), and ‘AD’ (Anno Domini, or ‘In The Year Of Our Lord’)? That’s not as simple a question as it may seem; no one in what would later come to be known as, say, 10 AD called the year thus, since Jesus was by then merely an unknown pre-adolescent in Judea.
The Christian calendar got off to a rocky start as the society from which it sprang, that of the Romans, measured the passage of time from pagan emperors and events. There were two competing Roman calendars, that of Anno Mundi (‘In The Year Of The World’) which counted from the founding of Rome (753 BC), and later that of Anno Diocletiani, created by its namesake (244-311 AD), which narcissistically measured time from his ascension to the purple robe.
Diocletian fomented numerous persecutions of Christians. He particularly enjoyed Damnatio ad Bestias, what the Romans called the amusement of throwing Jesus’ followers to the wild animals. Little wonder, then, that those potentially facing the lions didn’t want to measure the passage of their lives in reference to the man who so hated them.
Fast forward several centuries. Christians, along with everyone else, had been forced by lack of reasonable alternative to use the calendar of Diocletian. For a while, some tried to employ an Anno Adami system (‘In The Year Of Adam’), but it was confusing, impossible to accurately measure, and never caught on. In 525 AD, though, a monk, Dionysius of Scythia Minor (Romania), was tasked with creating a liturgical table to determine on what dates Easter was to occur in subsequent years.
[sidebar: recall that Easter is the Sunday following the first full moon after the spring equinox, which is why it changes every year]
Dionysius decided to be rid of all association with the Christian-hating Diocletian once and for all. He is the first author of whom we know whose extant work measured time from Jesus’ birth. He listed the first year of his table as 532 Anno Domini; why he didn’t use 525 AD is unclear, but as modern scholars believe that Jesus was actually born sometime between 6 BC and 4BC, not in 1 AD, Dionysius wasn’t actually far off.
But the Anno Domini system didn’t catch fire until after the Venerable Bede authored The Ecclesiastical History Of The English Peoples (731 AD), and used it throughout his discourse. Bede’s writings were also notable for introducing the concept of ‘BC’ (what he called Ante Incarnationis Dominicae, or ‘Before The Time Of The Lord’s Incarnation’) and setting 1 BC to have been the year immediately prior to 1 AD, ignoring any potential Year Zero.
After Bede’s landmark tome, both Emperor Charlemagne (742-814 AD) and the Holy See (11th century AD) officially adopted the Anno Domini system to measure the passage of time. From that point forth, it quickly became widespread in Christendom.
[sidebar: for some odd reason, in English, ‘Before Christ’ didn’t appear in writing until the late 17th century – ‘Before The Lord’s Incarnation’ was used instead – and one doesn’t see the published abbreviation ‘BC’ until the early 19th century]
So that explains BC and AD, but what of BCE and CE? Are they strictly used by non-believers, just as Christians eschewed the use of Diocletian’s calendar? Not entirely (and to no small degree because the modern conservative political prism and the so-called War on Christmas were still years in the future!)
While BCE/CE have been popular amongst Jewish authors since at least the mid-19th century (when Rabbi Morris Raphall published his widely read Post Biblical History Of The Jews), the nomenclatures’ uses far predate the middle of that century.
The German astronomer Johannes Kepler adopted his own terminology, Vulgaris Aerae (‘Vulgar Era’), freely interchangeably with Anno Domini in his scientific treatises of the early 17th century. This was in part because, in Kepler’s time, the Latin root of ‘vulgar’ was closer in meaning to ‘ubiquitous’ – that is, Kepler was merely employing a Christo-centric view of the civilized world. Later in that century, though, when ‘vulgar’ came to mean ‘uncouth’ in the non-academic English vernacular, many Western authors, staying true to Kepler’s intent but desiring to apply terminology that was not potentially pejorative, employed ‘Common Era’ in lieu of ‘Vulgar Era,’ both interchangeably with Anno Domini.
So despite what modern Christian apologists maintain – that ‘CE’ is short for ‘Christian Era’ – that is not borne by the historic record. And over the very years it was designed to measure, reference to the Common Era has gained much traction in modern scholarly circles in an attempt to sever the documentation of time from its semantically parochial roots.
Merry Christmas!
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A (foreign-born) relative of mine – one with extensive medical training – has chronic difficulty sleeping. X has attempted all of the usual sleep-hygiene techniques. X has also tried the rather traditional drug/ health food store aids (e.g., Tylenol PM, Benadryl, Melatonin, l-Tryptophan) and much of the prescription stuff (e.g., Seroquel, Remeron, Ambien). X often sleeps in fits and spurts regardless, and has become frustrated, tired of going to the family doctor for help that doesn’t actually help.
One day recently, X and I were going through the belongings of another relative who had visited the U.S. and then departed, inadvertently forgetting some personal items and then asking for smalls to be mailed to her. In reviewing what to send and what to keep for the next visit, X came across a small bottle of liquid. X sat down, looking at the label, and smiling.
Corvalol
“What did you find?”
“Ah, this is what we used in [the Old Country]. It’s great stuff.”
“For what?”
“It’s a nerve medication. And a heart medication, for high blood pressure, angina, and tachycardia. It calms you down. It even works for gastrointestinal cramping. But most people also use it for sleep. Old people love it. You mix it with water and maybe some sugar. I used it years ago. It’s great.”
Intrigued by this rather vague and all-inclusive description from a fellow medical professional, I asked for translation, as the label was written in a tongue I do not speak.
C-O-R-V-A-L-O-L
Before I go further, let me remind readers that much-vaunted Western Medicine (and culture) has a long history of employing stuff back in the day that we wouldn’t be caught dead using now. Freud was a vocal proponent of cocaine, a sanguine view shared by the original recipe for Coca Cola. 7-Up at one time contained lithium. The Victorians freely employed alcohol for colicky children. Before it was outlawed in the 1960s, many residency programs employed LSD as a means of teaching budding psychiatrists about psychosis. Benzodiazepines (e.g., Valium and its brethren) were handed out like candy by some practitioners when first on the market, as a “safe” alternative to other sedative-hypnotics. You get the picture.
So, a MedPub search of Corvalol turns up some very interesting information.
It is OTC in many central and eastern European nations and in former Soviet states, and there is a booming market for it in immigrant communities. Usually brought into this country in small amounts as personal Rx (and with labels that can’t be read by customs anyway), it is available as scored tablets, though it is more often found as a (liquid) tincture to be mixed with a beverage of choice before consumption.
It is neither approved nor legal in the U.S. in its traditional formulation. It can be obtained online, but is then missing some of its key ingredients when shipped via approved channels, rendering it, in the words of one disgusted user, “piss water.”
Okay, so what comprises this wonder drug? As brewed by its two manufacturers – Farmak Pharmaceutical Manufactory of Kiev, Ukraine, and Krewel Meuselbach GmbH of Frankfurt, Germany – it contains myriad inactive ingredients (i.e., lactose monohydrate, magnesium stearate, β-cyclodextrin, potassium acesulfam, peppermint oil), and then
• Alcohol (the tincture 96% by volume) which needs no introduction;
• Ethyl ether of α-bromizovalerianate, a combination of bromide and herbal valerian root extract;
• Phenobarbital.
Bromides have been employed as flame retardants, gasoline additives, and pesticides – appetizing, yes? – though in humans, they have a long and storied history as anxiolytics and anticonvulsants starting in the 19th century.
[sidebar: for those readers from Baltimore who are familiar with the city’s landmark Bromo-Seltzer tower, that widely-known medicinal agent lost its namesake ingredient in 1975 by U.S. Food and Drug Administration fiat]
Valerian started as perfume in the 16th century Mediterranean basin. It has been historically used for insomnia and conditions associated with anxiety. It has also been applied in folk medicine for infantile convulsions, epilepsy, attention deficit, chronic fatigue, joint pain, asthma, migraines, menstrual cramps, and symptoms associated with menopause. Despite minimal scientific data that valerian can reduce coronary vessel spasm in certain cases, the remainder of these therapeutic claims are unsupported by any research at present.
As for Phenobarbital, it is an anticonvulsant barbiturate and DEA schedule IV controlled substance. There are no clinical trials supporting its use in cardiovascular or bronchospastic states. It can also alter the metabolism of other Rx when taken in combination – thus, gerontologists oppose its use in the elderly due to the high rate of physical dependence and risk of toxicity even at low doses.
And yet, the lack of controlled studies notwithstanding, in a number of countries, Corvalol is widely available – sometimes even mandated – in first aid kits (e.g., those accessible on public transportation), alongside aspirin, nitroglycerin, and activated charcoal, and freely dispensed as needed.
Sleep tight!
[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]
“The past is never dead. It’s not even past.” ~Requiem For A Nun
I have always loved Faulkner’s oft-recounted quote, since it is true on so many levels.
With that in mind, here is an odd present-day story that started almost a century ago, and is neither dead nor past.
Adolf Hitler wrote the draft for his 720-page autobiographical manifesto, Mein Kampf (My Struggle), while imprisoned after the failed coup of 1923. It represented his vision and blueprint for a National Socialist world, and was not at first a best-seller when released in 1925 (9000 copies). Once Hitler rose to prominence, however, the Nazis mandated its distribution to soldiers, newlyweds, and schools nationwide, and it started to generate large sums in royalty. Over Hitler’s lifetime, it is estimated that the book sold 10M copies (and ~$430M for its author, adjusted for inflation, all of it tax-free since he was in charge and made the rules).
Fast forward to May 1945. Hitler was dead and the war was fast closing. Bavaria, as the jurisdiction of Hitler’s official residence (Munich), seized all of his property, including the rights to the book. None of Hitler’s distant surviving heirs cared to contest this confiscation. And through assertive de-Nazification efforts, the Bavarian government promptly prohibited the publication of Mein Kampf, now their book, anywhere in (then-West) Germany.
But of course, that had little binding effect on other countries, where the tome continued to be printed and sold to varying degrees, both by previously-licensed publishing houses and bootleg operations [strangely, it has enjoyed strong sales in both Turkey and India]. Those international licensees then generated royalties for the legal copyright holder – the reluctant Bavarian state.
[sidebar: Bavaria holds the copyright for most of the world, but things are a little different in the U.S. and U.K. More on that in a moment…]
So, what to do with the tainted gains? Bavaria started to quietly donate all proceeds to charity.
In the U.S., Houghton Mifflin purchased the rights to Mein Kampf in 1933. The U.S. government seized the copyright in 1942 under the Trading With The Enemy Act – even though Houghton Mifflin is an American company based in Boston – and amazingly held it until 1979, placing the $139,000 generated in sales over those years in the War Claims Fund. In 1979, with no fanfare or press release, Houghton Mifflin bought back the rights from Uncle Sam for $37,254, and then proceeded to pocket over $700,000 in sales over the next two decades. When this was publicly revealed in 2000, the chagrined publisher said that they were distributing the monies to charities that promote “diversity and cross-cultural understanding,” and a host of other things that Hitler would have hated. Still, many of those charities – the Red Cross amongst them – refused to take the cash, leaving Houghton Mifflin wondering if buying back the rights was such a good business idea after all.
In the U.K., Hurst & Blackett (Random House) had purchased the rights to a translated English version from Hitler’s publisher also in 1933, still retaining that right in the post-war years; as with the Bavarians, H&B gifted all proceeds to charity. Interestingly, the Jewish charities initially selected didn’t want the money, so H&B started gifting anonymously (and it remains uncertain if the recipients ever knew the source of the donations).
Under U.K. law, the copyright on Mein Kampf expired in 1995. And under both U.S. and German copyright law, Mein Kampf is scheduled to enter the public domain in seven weeks, on January 1st, 2016. But while that will sever any direct connection between the text and Hitler’s estate, publishers, or those who directly dealt with them, it doesn’t mean that the book will not still be printed and sold.
Meaning that, ninety-two years after first conceived, the hate-filled diatribe of a fallen dictator dead for seventy years is still churning out income… that no one wants.
[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]
[this missive first appeared from The Alienist in early 2013]
“Bones are all that survive of the body. They are keys to our collective past and reminders of our own mortality, so it is no mystery that they have a magic aura for artists, for the faithful of many religions, for collectors, for all of us.”
~Barbara Norfleet (1993)
In the winter of 1983 I engaged in that time-honored rite of passage known as the campus visit. In this case it was pursuant to my applications to medical school. Of the schools I had tentatively chosen, all of the curricula were similar, and the work load at each appeared predictably onerous. But one thing that stood out almost immediately was the manner in which the respective schools addressed and dealt with the dead. And I don’t necessarily mean dead patients. I mean dead teaching tools and specimens.
Case in point: at one public university, as part of the prospective students’ tour, we were brought through the anatomy lab. I remember that it was a large antiseptic room with gurneys, tables, and bodies in zipped bags, along with some articulated skeletons on stands next to the walls. I didn’t sense anything lurid about the showing of this area to the applicants; it was just another part of the tour: “on your left, you see some cadavers, and over here on your right….”
However, later at a private university, it was entirely different. The prospectives’ tour stopped outside the doors to the anatomy lab, and the tour guide said, “here is the anatomy lab. I can’t take you inside because it would violate the sanctity of the area. Every day before we begin our dissection, we have a moment of silence and introspection to thank the deceased for their priceless gift to us and our ability to learn from them and assist in the care of those who are still living.”
What a contrast! It’s not that I’m advocating for disrespect, but the second institution struck me as utterly dour. Being accepted at both, I wound up going to the first school, and I didn’t regret the choice. And yes, I did later give my cadaver a name, one rather tongue-in-cheek and in keeping with the usual ‘whistling past the graveyard’ approach to death employed by many in the health professions.
So much for that moment of silence and introspection.
But I’ve pondered at length since then the manner in which we collectively interact with the dead in the 21st century. I’m not a policy-maker, a mortician, a crime scene investigator, or a hospice-worker. But I do think our society’s approach is rather schizophrenic, perhaps reflecting our own conflicted feelings.
Another case in point: later, as a second year medical student, one recurrent exercise in pathology class was known affectionately as the “pot case” or, better, “the man in a can.” Teaching assistants would obtain the leftovers from recent autopsies performed in the medical center and would place the offal in large plastic buckets. Hearts, livers, pertinent bones, brains, kidneys. Any part of a human body was potentially sloshing around inside. After pots were distributed, we would divide into groups and dump out the contents. We’d be told that we had an hour to look through the contents and then to report on our findings. It seemed entirely scientific and not in the least lurid. But while I remember the pathologies encountered in the pots quite well, I have no recollection of ever having pondered the ultimate question: “who WAS this person, and did she ever think that she was going to wind up like this?”
When one looks, human remains are everywhere. There are medical museums – the Armed Forces Institute of Pathology in Washington DC and the Mutter in Philadelphia come to mind – with vast collections of bizarre wet and dry specimens. The Smithsonian has anthropological exhibits of human skulls from around the world, and other academic and research centers possess similar holdings. There are the Capuchin ossuaries in Italy, charnal houses in Egypt, and bone chapels in Portugal that are filled with piles of skulls and stacks of femurs and pelvic bones upon which we gaze. Extant life-sized statuary of saints from the Middle Ages often employ real bones as accessories. And as a lapsed Freemason, I can personally attest that human crania do indeed find their way into lodge ritual more often than not.
So then there is the unavoidable question: how to treat those remains that are not in the ground? It’s not as easy a question as it might at first seem. Many answer by waffling on the age and apparent anonymity of the original owners – specimens from ancient Paleolithic sites rarely stir visceral emotions, whereas that difficult grey zone is encountered, skirting frank grave-robbery, when the remains at issue are nearly identifiable or at least bear an association with someone(s) still living.
For example, at legislative hearings in the 1990s over the fate of the Dickson burial mound in Illinois (active 9thc – 13thc CE), Professor Raymond Fogelson of the University of Chicago spoke for (a distinct minority within) the scientific community when he characterized the curated display of human remains from that site as “obscene pornography.” I prefer to think that another academic who testified, Professor William Sumner, also from the University of Chicago, was closer to accurate when he said that the display “fires the imagination of school children and adults alike…. It inspires a striking recognition of how the past is a continuation with the present and leaves a lasting impression that leads to an enriched intellectual life.”
Besides, it’s not as though such academic collections are spread out to gawkers like a carnival side show. As author Christine Quigley noted in 2001, “the bulk of institutional collections of human remains is rarely visible to the public, despite the fact that displays of [such] are among the most effective tools for luring people into museums.”
And admittedly, not all displays of human remains fall into the academic realm. The successful Bodies tour that has been viewed by hundreds of thousands in cities all across the U.S. is one example of the (some would say crass) commercialization of the dissected dead. There are businesses that specialize in providing “osteological specimens” – certainly a sanitized description – to just about anyone with interest and cash. Prominent auction houses have sold remains when they have historical interest. And human skulls and other bones are freely available online to anyone, no questions asked, as long as the items are listed as “medical teaching tools” to circumvent purported bans on selling body parts on the Internet.
This dichotomy is perhaps easier to understand when viewed through the prism of the early modern age, a time when the scientific method was blossoming alongside P.T. Barnum. Or as Alberti and Hallam presciently noted, “the macabre seeds sewn in the Enlightenment bore their morbid fruit in the Victorian era. Medical collections founded in the late 18th and 19th centuries were at the intersection of a number of cultural and scientific currents: the development of pathology and comparative anatomy as disciplines, the formalization of medical education, European colonial expansion, and the spread of popular shows and exhibitions.”
There is a wonderful book entitled Dissection: Photographs of a Rite of Passage in American Medicine, 1880-1930, by Warner and Edmonson. Based on the vintage collection of the Dittrick Museum of Case Western Reserve University, the book illustrates a surprisingly common form of group photography that became popular around the turn of the 20th century – medical students and house staff posing with skeletons and cadavers. If you search ‘cadaver’ and ‘antique’ and ‘photograph’ on Google Images, you’ll find dozens of these pictures. It seems that just about every American medical school and hospital of the day had students and staff posing openly with the dead.
This ‘art form’ died out after WWII – students would risk expulsion were they to try this today – but even when viewed through the lenses of modern sensibilities, the photos, at least to me, do not seem exploitative or pornographic. Instead the scenes appear innocent, good natured, and in a manner, curious and inquisitive.
But the question remains answered, if at all, unsatisfactorily. It is still unclear what has changed in our collective consciousness of, and appreciation for, the dead. Is it political-correctness run amok? Or something deeper that we are only now coming to understand?
[Have an idea for a post topic? Want to be considered for a guest-author slot? Or better, perhaps you’d like to become a day-sponsor of this blog, and reach thousands of subscribers and Facebook fans? If so, please contact the Alienist at vadocdoc@outlook.com]
