Friday, January 28, 2011

The Poor Ye Have Always With Thee [Or At Least The Irish]

I just got home from a whirlwind tour of some of my favorite blogs.  Perhaps because I am in the middle of making some very serious medical decisions, I chose to visit the best of the medical blogosphere. 

I have no idea what is fuelling my sudden urge to revisit one of the best and bravest attacks on entrenched hypocrisy and state-supported systemic squalor, Swift's civic-minded Proposal.   Praise the Maker, though, that we are safely at great historical remove from such circumstances, making his temperate suggestions that much more tolerable when applied to our present day trifles. 

In no way did the irresistible desire to reprint this centuries-old tract reflect on anything [ever] written over at Crass-Pollination: An ER Blog.  I do honestly admire Nurse K, although it is difficult to articulate that sometimes, as her satirical powers can approach swiftian dimensions.  She can also, however, be so rude -- a comportmental flaw that would never be ascribed to Jonathan Swift.  No sir!

Too bad we don't have the Irish to kick around any more.

Illustrated by Jeremy McHugh

A Modest Proposal

For Preventing The Children of Poor People in Ireland
From Being Aburden to Their Parents or Country, and
For Making Them Beneficial to The Public

By Jonathan Swift (1729)

It is a melancholy object to those who walk through this great town or travel in the country, when they see the streets, the roads, and cabin doors, crowded with beggars of the female sex, followed by three, four, or six children, all in rags and importuning every passenger for an alms. These mothers, instead of being able to work for their honest livelihood, are forced to employ all their time in strolling to beg sustenance for their helpless infants: who as they grow up either turn thieves for want of work, or leave their dear native country to fight for the Pretender in Spain, or sell themselves to the Barbadoes.

I think it is agreed by all parties that this prodigious number of children in the arms, or on the backs, or at the heels of their mothers, and frequently of their fathers, is in the present deplorable state of the kingdom a very great additional grievance; and, therefore, whoever could find out a fair, cheap, and easy method of making these children sound, useful members of the commonwealth, would deserve so well of the public as to have his statue set up for a preserver of the nation.

But my intention is very far from being confined to provide only for the children of professed beggars; it is of a much greater extent, and shall take in the whole number of infants at a certain age who are born of parents in effect as little able to support them as those who demand our charity in the streets.

”I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed is at a year old a most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled ...”

As to my own part, having turned my thoughts for many years upon this important subject, and maturely weighed the several schemes of other projectors, I have always found them grossly mistaken in the computation. It is true, a child just dropped from its dam may be supported by her milk for a solar year, with little other nourishment; at most not above the value of 2s., which the mother may certainly get, or the value in scraps, by her lawful occupation of begging; and it is exactly at one year old that I propose to provide for them in such a manner as instead of being a charge upon their parents or the parish, or wanting food and raiment for the rest of their lives, they shall on the contrary contribute to the feeding, and partly to the clothing, of many thousands.

There is likewise another great advantage in my scheme, that it will prevent those voluntary abortions, and that horrid practice of women murdering their bastard children, alas! too frequent among us! sacrificing the poor innocent babes I doubt more to avoid the expense than the shame, which would move tears and pity in the most savage and inhuman breast.

The number of souls in this kingdom being usually reckoned one million and a half, of these I calculate there may be about two hundred thousand couple whose wives are breeders; from which number I subtract thirty thousand couples who are able to maintain their own children, although I apprehend there cannot be so many, under the present distresses of the kingdom; but this being granted, there will remain an hundred and seventy thousand breeders. I again subtract fifty thousand for those women who miscarry, or whose children die by accident or disease within the year. There only remains one hundred and twenty thousand children of poor parents annually born. The question therefore is, how this number shall be reared and provided for, which, as I have already said, under the present situation of affairs, is utterly impossible by all the methods hitherto proposed. For we can neither employ them in handicraft or agriculture; we neither build houses (I mean in the country) nor cultivate land: they can very seldom pick up a livelihood by stealing, till they arrive at six years old, except where they are of towardly parts, although I confess they learn the rudiments much earlier, during which time, they can however be properly looked upon only as probationers, as I have been informed by a principal gentleman in the county of Cavan, who protested to me that he never knew above one or two instances under the age of six, even in a part of the kingdom so renowned for the quickest proficiency in that art.

I am assured by our merchants, that a boy or a girl before twelve years old is no salable commodity; and even when they come to this age they will not yield above three pounds, or three pounds and half-a-crown at most on the exchange; which cannot turn to account either to the parents or kingdom, the charge of nutriment and rags having been at least four times that value.

I shall now therefore humbly propose my own thoughts, which I hope will not be liable to the least objection.

I have been assured by a very knowing American of my acquaintance in London, that a young healthy child well nursed is at a year old a most delicious, nourishing, and wholesome food, whether stewed, roasted, baked, or boiled; and I make no doubt that it will equally serve in a fricassee or a ragout.

I do therefore humbly offer it to public consideration that of the hundred and twenty thousand children already computed, twenty thousand may be reserved for breed, whereof only one-fourth part to be males; which is more than we allow to sheep, black cattle or swine; and my reason is, that these children are seldom the fruits of marriage, a circumstance not much regarded by our savages, therefore one male will be sufficient to serve four females. That the remaining hundred thousand may, at a year old, be offered in the sale to the persons of quality and fortune through the kingdom; always advising the mother to let them suck plentifully in the last month, so as to render them plump and fat for a good table. A child will make two dishes at an entertainment for friends; and when the family dines alone, the fore or hind quarter will make a reasonable dish, and seasoned with a little pepper or salt will be very good boiled on the fourth day, especially in winter.

I have reckoned upon a medium that a child just born will weigh 12 pounds, and in a solar year, if tolerably nursed, increaseth to 28 pounds.

I grant this food will be somewhat dear, and therefore very proper for landlords, who, as they have already devoured most of the parents, seem to have the best title to the children.

Infant's flesh will be in season throughout the year, but more plentiful in March, and a little before and after; for we are told by a grave author, an eminent French physician, that fish being a prolific diet, there are more children born in Roman Catholic countries about nine months after Lent than at any other season; therefore, reckoning a year after Lent, the markets will be more glutted than usual, because the number of popish infants is at least three to one in this kingdom: and therefore it will have one other collateral advantage, by lessening the number of papists among us.

I have already computed the charge of nursing a beggar's child (in which list I reckon all cottagers, laborers, and four-fifths of the farmers) to be about two shillings per annum, rags included; and I believe no gentleman would repine to give ten shillings for the carcass of a good fat child, which, as I have said, will make four dishes of excellent nutritive meat, when he hath only some particular friend or his own family to dine with him. Thus the squire will learn to be a good landlord, and grow popular among his tenants; the mother will have eight shillings net profit, and be fit for work till she produces another child.

Those who are more thrifty (as I must confess the times require) may flay the carcass; the skin of which artificially dressed will make admirable gloves for ladies, and summer boots for fine gentlemen.

As to our city of Dublin, shambles may be appointed for this purpose in the most convenient parts of it, and butchers we may be assured will not be wanting; although I rather recommend buying the children alive, and dressing them hot from the knife, as we do roasting pigs.

A very worthy person, a true lover of his country, and whose virtues I highly esteem, was lately pleased in discoursing on this matter to offer a refinement upon my scheme. He said that many gentlemen of this kingdom, having of late destroyed their deer, he conceived that the want of venison might be well supplied by the bodies of young lads and maidens, not exceeding fourteen years of age nor under twelve; so great a number of both sexes in every country being now ready to starve for want of work and service; and these to be disposed of by their parents, if alive, or otherwise by their nearest relations. But with due deference to so excellent a friend and so deserving a patriot, I cannot be altogether in his sentiments; for as to the males, my American acquaintance assured me, from frequent experience, that their flesh was generally tough and lean, like that of our schoolboys by continual exercise, and their taste disagreeable; and to fatten them would not answer the charge. Then as to the females, it would, I think, with humble submission be a loss to the public, because they soon would become breeders themselves; and besides, it is not improbable that some scrupulous people might be apt to censure such a practice (although indeed very unjustly), as a little bordering upon cruelty; which, I confess, hath always been with me the strongest objection against any project, however so well intended.

But in order to justify my friend, he confessed that this expedient was put into his head by the famous Psalmanazar, a native of the island Formosa, who came from thence to London above twenty years ago, and in conversation told my friend, that in his country when any young person happened to be put to death, the executioner sold the carcass to persons of quality as a prime dainty; and that in his time the body of a plump girl of fifteen, who was crucified for an attempt to poison the emperor, was sold to his imperial majesty's prime minister of state, and other great mandarins of the court, in joints from the gibbet, at four hundred crowns. Neither indeed can I deny, that if the same use were made of several plump young girls in this town, who without one single groat to their fortunes cannot stir abroad without a chair, and appear at playhouse and assemblies in foreign fineries which they never will pay for, the kingdom would not be the worse.

Some persons of a desponding spirit are in great concern about that vast number of poor people, who are aged, diseased, or maimed, and I have been desired to employ my thoughts what course may be taken to ease the nation of so grievous an encumbrance. But I am not in the least pain upon that matter, because it is very well known that they are every day dying and rotting by cold and famine, and filth and vermin, as fast as can be reasonably expected. And as to the young laborers, they are now in as hopeful a condition; they cannot get work, and consequently pine away for want of nourishment, to a degree that if at any time they are accidentally hired to common labor, they have not strength to perform it; and thus the country and themselves are happily delivered from the evils to come.

I have too long digressed, and therefore shall return to my subject. I think the advantages by the proposal which I have made are obvious and many, as well as of the highest importance.

For first, as I have already observed, it would greatly lessen the number of papists, with whom we are yearly overrun, being the principal breeders of the nation as well as our most dangerous enemies; and who stay at home on purpose with a design to deliver the kingdom to the Pretender, hoping to take their advantage by the absence of so many good protestants, who have chosen rather to leave their country than stay at home and pay tithes against their conscience to an episcopal curate.

Secondly, The poorer tenants will have something valuable of their own, which by law may be made liable to distress and help to pay their landlord's rent, their corn and cattle being already seized, and money a thing unknown.

Thirdly, Whereas the maintenance of an hundred thousand children, from two years old and upward, cannot be computed at less than ten shillings a-piece per annum, the nation's stock will be thereby increased fifty thousand pounds per annum, beside the profit of a new dish introduced to the tables of all gentlemen of fortune in the kingdom who have any refinement in taste. And the money will circulate among ourselves, the goods being entirely of our own growth and manufacture.

Fourthly, The constant breeders, beside the gain of eight shillings sterling per annum by the sale of their children, will be rid of the charge of maintaining them after the first year.

Fifthly, This food would likewise bring great custom to taverns; where the vintners will certainly be so prudent as to procure the best receipts for dressing it to perfection, and consequently have their houses frequented by all the fine gentlemen, who justly value themselves upon their knowledge in good eating: and a skilful cook, who understands how to oblige his guests, will contrive to make it as expensive as they please.

Sixthly, This would be a great inducement to marriage, which all wise nations have either encouraged by rewards or enforced by laws and penalties. It would increase the care and tenderness of mothers toward their children, when they were sure of a settlement for life to the poor babes, provided in some sort by the public, to their annual profit instead of expense. We should see an honest emulation among the married women, which of them could bring the fattest child to the market. Men would become as fond of their wives during the time of their pregnancy as they are now of their mares in foal, their cows in calf, their sows when they are ready to farrow; nor offer to beat or kick them (as is too frequent a practice) for fear of a miscarriage.

Many other advantages might be enumerated. For instance, the addition of some thousand carcasses in our exportation of barreled beef, the propagation of swine's flesh, and improvement in the art of making good bacon, so much wanted among us by the great destruction of pigs, too frequent at our tables; which are no way comparable in taste or magnificence to a well-grown, fat, yearling child, which roasted whole will make a considerable figure at a lord mayor's feast or any other public entertainment. But this and many others I omit, being studious of brevity.

Supposing that one thousand families in this city, would be constant customers for infants flesh, besides others who might have it at merry meetings, particularly at weddings and christenings, I compute that Dublin would take off annually about twenty thousand carcasses; and the rest of the kingdom (where probably they will be sold somewhat cheaper) the remaining eighty thousand.

I can think of no one objection, that will possibly be raised against this proposal, unless it should be urged, that the number of people will be thereby much lessened in the kingdom. This I freely own, and 'twas indeed one principal design in offering it to the world. I desire the reader will observe, that I calculate my remedy for this one individual Kingdom of Ireland, and for no other that ever was, is, or, I think, ever can be upon Earth. Therefore let no man talk to me of other expedients: Of taxing our absentees at five shillings a pound: Of using neither cloaths, nor houshold furniture, except what is of our own growth and manufacture: Of utterly rejecting the materials and instruments that promote foreign luxury: Of curing the expensiveness of pride, vanity, idleness, and gaming in our women: Of introducing a vein of parsimony, prudence and temperance: Of learning to love our country, wherein we differ even from Laplanders, and the inhabitants of Topinamboo: Of quitting our animosities and factions, nor acting any longer like the Jews, who were murdering one another at the very moment their city was taken: Of being a little cautious not to sell our country and consciences for nothing: Of teaching landlords to have at least one degree of mercy towards their tenants. Lastly, of putting a spirit of honesty, industry, and skill into our shop-keepers, who, if a resolution could now be taken to buy only our native goods, would immediately unite to cheat and exact upon us in the price, the measure, and the goodness, nor could ever yet be brought to make one fair proposal of just dealing, though often and earnestly invited to it.

Therefore I repeat, let no man talk to me of these and the like expedients, 'till he hath at least some glympse of hope, that there will ever be some hearty and sincere attempt to put them into practice.

But, as to my self, having been wearied out for many years with offering vain, idle, visionary thoughts, and at length utterly despairing of success, I fortunately fell upon this proposal, which, as it is wholly new, so it hath something solid and real, of no expence and little trouble, full in our own power, and whereby we can incur no danger in disobliging England. For this kind of commodity will not bear exportation, and flesh being of too tender a consistence, to admit a long continuance in salt, although perhaps I could name a country, which would be glad to eat up our whole nation without it.

After all, I am not so violently bent upon my own opinion as to reject any offer proposed by wise men, which shall be found equally innocent, cheap, easy, and effectual. But before something of that kind shall be advanced in contradiction to my scheme, and offering a better, I desire the author or authors will be pleased maturely to consider two points. First, as things now stand, how they will be able to find food and raiment for an hundred thousand useless mouths and backs. And secondly, there being a round million of creatures in human figure throughout this kingdom, whose whole subsistence put into a common stock would leave them in debt two millions of pounds sterling, adding those who are beggars by profession to the bulk of farmers, cottagers, and laborers, with their wives and children who are beggars in effect: I desire those politicians who dislike my overture, and may perhaps be so bold as to attempt an answer, that they will first ask the parents of these mortals, whether they would not at this day think it a great happiness to have been sold for food, at a year old in the manner I prescribe, and thereby have avoided such a perpetual scene of misfortunes as they have since gone through by the oppression of landlords, the impossibility of paying rent without money or trade, the want of common sustenance, with neither house nor clothes to cover them from the inclemencies of the weather, and the most inevitable prospect of entailing the like or greater miseries upon their breed for ever.

I profess, in the sincerity of my heart, that I have not the least personal interest in endeavoring to promote this necessary work, having no other motive than the public good of my country, by advancing our trade, providing for infants, relieving the poor, and giving some pleasure to the rich. I have no children by which I can propose to get a single penny; the youngest being nine years old, and my wife past child-bearing.

The End

Thursday, January 27, 2011


i'm too tired to go into it at the moment, but it looks like i may have a chance to get ketamine infusion treatments (the "awake" version) for crps. 

the problem? 

(and you know there has to be a problem.)

the two docs doing it are... less than pristine, far from stellar, not exactly objects of admiration. 

as the referring health practitioner put it, they are "cowboys."

one had his license revoked for a few years and has multiple medmal settlements.

the other is a D.O. not well liked by his patients, and is really into the ka-ching-side of pain management -- procedures, procedures, procedures. costly intervention!

 however, on the plus side?  the referring health practitioner reports that he "used to be cute."
(well, that settles it.)

additional problems?

(and you know there have to be additional problems.)

getting anyone in my life on board to be supportive about ketamine infusions.  i will need support -- logistically, physically, emotionally.  also a problem?  pitching this to my "go-to" group of doctors, all of whom are less than keen about ketamine anything, much less intravenous infusions of it done on purpose, repeatedly!  i expect resistance based on the unresolved osteomyelitis/infected prostheses and a couple of other persnickety comorbidities.

should i start a petition?  a write-in campaign? 

if i want this treatment, if i can get insurance coverage for it (oh, yeah, i forgot to mention that as a potential problem... mwa ha ha), what does it matter what my "team" thinks?  or my life partner? 

or even la bonne et belle bianca castafiore

i remember when the prospect of "only" receiving temporary and incomplete pain relief was a prospect not deemed worthy of pursuing.  now that i have a good dozen viable suicide plans, "temporary and incomplete" sounds downright enticing.

fred's only comment thus far relates to the probability of hallucinations during treatment... i keep trying to tell him that i doubt he'll be able to notice much of a change.

i'm grateful to the kind practitioner who told me about this today.  she risks putting herself in the middle of an uncomfortable and unsupported referral.  i am enormously grateful that she took the risk. 

i don't quite understand why the availability of "awake" ketamine infusions for crps/rsd in this region of tête de hergé isn't being shouted from our elevated medieval slate rooftops... but if it works out for me, i'll be yodelling the news throughout hill and dale.

from the Holy Wikipedia entry on CRPS:
Ketamine, a potent anesthetic, is being used as an experimental and controversial treatment for Complex Regional Pain Syndrome. The theory of ketamine use in CRPS/RSD is primarily advanced by neurologist Dr Robert J. Schwartzman of Drexel University College of Medicine in Philadelphia, and researchers at the University of Tübingen in Germany, but was first introduced in the United States by Doctor Ronald Harbut of Little Rock Arkansas. Doctor Harbut and Doctor Graeme Correll (of Queensland, Australia) first began studying the use of ketamine in the treatment of CRPS patients. Dr Harbut's first CRPS patients in the USA were successfully treated in 2002 with the low-dose ketamine infusion; also called the "Awake Technique" and he soon began work with FDA on an approved protocol. In early 2003 Dr Harbut began sharing his treatment methods with the Doctors at Drexel University College of Medicine, including Doctor Schwartzman. The hypothesis is that ketamine manipulates NMDA receptors which might reboot aberrant brain activity.

A 2004 article discussing ketamine infusion therapy states, "Although ketamine may have more than one mechanism of action, the basis for using it to treat CRPS may reside in its strong ability to block NMDA receptors. Experimental evidence suggests that a sufficiently intense or prolonged painful stimulus causes an extraordinary release of glutamate from peripheral nociceptive afferents onto dorsal horn neurons within the spinal cord. The glutamate released, in turn, stimulates NMDA receptors on second-order neurons that produce the phenomena of windup and central sensitization. It is reasonable to consider that, by blocking NMDA receptors, one might also be able to block cellular mechanisms supporting windup and central sensitization [4–7,15]. Ketamine is the only potent NMDA-blocking drug currently available for clinical use. Our interpretation is that an appropriately prolonged infusion of ketamine appears to maintain a level of ketamine in the central nervous system long enough to reverse the effects of the sensitization process and associated pain."[41]

There are two treatment modalities; the first consist of a low dose subanesethesia Ketamine infusion of between 10–90 mg per hour over several treatment days, this can be delivered in hospital or as an outpatient in some cases. This is called the awake or subanesethesia technique.

Tuesday, January 25, 2011

Good morning. This is God.

Hopefully, I will play "catch up" today and get some things posted -- some newly published CRPS research comes most to mind.  My hands and feet have been undergoing drastic CRPS-related changes and while I enjoyed a brief respite from spasticity, my jerks and massive spasms are back and... well, getting me deeply down. 

I'm fighting back, though.  It may not be obvious, but I am.  I am grimly cheerful.  I am cooking up a storm, despite many close calls with knives in these clumsy hands, and near catastrophes with rippling oils in very hot pans.  I am reading with wild abandon, hours at a time. Dobby and Uncle Kitty Big Balls have been subjected to training sessions worthy of the smartest border collie, the most ingenious of poodles.  (Sadly, but predictably, Miss Marmy Fluffy Butt proved resistant to training, at least *group* training.  She will show off in private.)  Then, of course, there are all the seasonal tasks inherent to Manor maintenance and the many requirements of keeping a large domestic staff working hard and free of revolutionary sentiment.  An insurrection is all I need right now.

So I celebrated my birthday yesterday!

A good part of it was spent sleeping, as I started the third round of antibiotics on Saturday, and for some reason, the stuff exhausts me.  Last week, my body decided to engage in some irrational weirdness involving the bones and joints of my hands -- trying to match the grim state of my lower extremities.  Though I suppose it's likely coincidence, my hands have steadily improved since I started Round 3, and that has been a huge relief.  Meaning that -- even though I snoozed through some of it -- I had a fine b'day! 

(This go-round of abx will last a month... Why we are doing a month instead of the usual two weeks, I dunno.  I ain't the doctor.  I just take the pills.  Maybe because, beyond a beneficial effect on blood sugars
-- that are elevated by infection -- my blood work reflecting the infection and inflammation from osteomyelitis was unaffected by the first two treatments, even as it was unaffected by seven orthopedic surgeries.  Yeah, duh, that might be why we've doubled the treatment duration, eh?  It shows a little bit that we are winging it based on some vague suggestions from the Infectious Disease consult back in... when?  October?  My go-to-guy MDVIP Dood is so intent on finding me some relief from daily fevers, weakness, bone pain, and sweats that I am almost ready to lie to him.  I know, I know, that is some messed up thinking.  I just tire of... well, you know.  Blah blah blah!  I'm sure you're tired of it, too!)

I wanted to share with you one of Fred's cards * .  Technically not of the birthday card genre and pretty silly, it made me laugh and want to hug and kiss the guy.  Which I promptly did.

* The card was based on a series of magnets by Claire Vohman.  You can see her cards, shirts, painted windows, magnets, and prints at her website, HERE.

Monday, January 24, 2011

From the Buckeye Surgeon: American Exceptionalism Needs a New Heart

Jeffrey Parks MD, also known as blogger Buckeye Surgeon, has posted some wonderfully clear pieces about Dick Cheney. 

I appreciate clarity. 

And I am with him on this sentiment, as well:


Former Vice President (and still war criminal) Dick Cheney may soon place himself on the list for a heart transplant, according to this WSJ article. Usually heart transplants are restricted to those patients younger than 70 (Cheney turns 70 next week). I say, let the old bastard get on the list, on the condition that he submits to being waterboarded as a live, pay per view event on HBO. He doesn't have to get the full KSM treatment (i.e. 187 waterboardings). Just once is good enough for me.

KSM = Khalid Sheikh Mohammed

You can enjoy more of the Buckeye Surgeon's analysis of Dick Cheney's general son-of-a-bitchedness by clicking HERE.

For some excellent additional background, read Andy Worthington's December 2008 piece, The Ten Lies of Dick Cheney.