A desire to take medicine is, perhaps,the great feature which distinguishesman from other animals.- William Osler (1849-1919)
Fallen MenThe Seychelles was a veritable island para-dise where nothing happened very quicklybut everything got done. By virtue of itsstrategic location there was a big newairport extension (courtesy of Uncle Sam)and a spanking new hospital (courtesy ofthe French) where my colleague and Iwhiled away our student elective. Thepatients had the usual mixed bunch ofconditions, but a small sub-group soonbecame apparent: men in their late thirtiesto early sixties who had been brought inwith head injuries and broken bones andwho, to a man, were inebriated to the pointof being anaesthetised and smiled some-what incongruously during the assessmentof their injuries. We naively assumed theyhad been victims of the rather haphazardlane discipline of the local drivers, so wererather sceptical when one of them took usinto his confidence and, with furtiveglances all around, told us he had fallen outof a tree. We had been warned not to situnder coconut trees for fear of fallingobjects, but had always assumed the objectsin question to be coconuts, so we had thedistinct impression we were being hood-winked. However, discrete inquiries ofseveral highly trustworthy locals suggestedthat the man may have been telling thetruth. Alcohol is heavily taxed in theSeychelles, so some of the more enterpris-ing locals brew their own potion fromcoconut juice. To reduce the risk ofdetection, the more adventurous brew thealcohol in a fruit that is still on the tree,returning a week or so later to drink theirspoils. Unfortunately controlling fermen-tation is somewhat difficult when the vat is20-30ft above your head, so the strengthcan be a bit variable, with the consequencethat occasional batches are extremelypowerful indeed, producing rapid intoxi-cation and making the descent from the bara trifle hazardous. Inevitably accidentsoccur, hence the appearance of a steadytrickle of inebriated men with fractures,although they were never so inebriated as toadmit their crime to the waiting police.
TJ J tacit Harrogate, UK
How many trees did youkill today?Your grant application is finally ready to besent off, an impressive bundle of paper; wasit really necessary to prepare that manycopies? Well, at least not 36, as yourcolleague had to do to satisfy the hunger ofthe American Heart Association. Howmany trees had to die for the ritual that youhave observed so dutifully?
: Let us look at the United States. Thetypical competitive grant proposal for theNational Institutes of Health consists of: 7application-form pages plus extension(whose curriculum vitae fits on a singlepage?), at least 10 pages; the researchproposal itself, a maximum of 25; thereference list (1 at least); an average appli-cant will include one publication, say 7pages; and one preprint covering, say, 30pages. So far our total is 70 pages, single-sided. Now, the applicant is required tosubmit 6 copies of the application. Ourestimate has run up to 420 sheets of 8-5 x 11inch 20 lb white office paper.
: 420 sheets of paper, what is that in trees?Its not easy to find out, and the estimatesdiffer by a factor of 30. According to theHandbook for Pulp and Paper Technologyissued by the US paper industry, a tree 3feet in diameter, 50 feet tall, would yield393 000 sheets of 8-5 x 11 inch white officepaper, or 935 NIH grant applications. TheChicago Recycling Coalition estimates12 000 sheets (or 28 NIH grant applica-tions) per tree. But why dont grant-awarding agencies follow the good exampleof some scientific journals and allow sub-mission of files stored on diskettes? Thiswould lead to much, much less paperprinted, carried, duplicated, xeroxed again,bound, mailed, received, carried, filed, andthrown away. Fewer trees felled. Lessenergy used to recycle paper. Less landfillspace used (33 cubic yards per ton ofpaper). Fewer lower back injuries and cutsfor those who have to carry and bind thebundles. More space in the notoriouslycrammed research offices. Worried aboutjobs in the paper industry? I dont thinkthat the contribution of the scientific com-munity will seriously endanger a commer-cial venture with an annual productionvolume of 80 million tons (no more treeequivalents at this point). And could, ahem,somebody please calculate the environ-mental costs of producing a computer and,say, a hundred diskettes?
Gerald Zernig Ann Arbor, USA
Never believe what a patient tells youhis doctor has said.William Jenner (1815-1898)
Headlong rush to the21st centuryThose of us who reside on the west coast of .the United States tend to take a somewhatambivalent pleasure in the reputation ofour area as the birthplace of the new. Beingon the cutting edge is all very well, but onedoes occasionally long for the comforts ofthe familiar and customary. Which bringsme to The Lancet and its headlong rushtowards the 21st century. :
First, you abandoned the India paperedition airmailed to your American sub-scribers. I still miss its peculiar odor, andrecall wistfully the exotic flavor of the
advertisements; my favorite was one for asulfonamide suggested for use in "Fridayafternoon fevers". Then, barely 30 yearslater, your format began to change. Morewhite space, octets, colored captions, Talk-ing Points, signed editorials ... traditionstrembled. But of greatest concern to me wasthe apparent slow strangulation of InEngland Now. As a loyal reader and occa-sional contributor, I watched with dismayas its regular 1 to 3 columns per weekshrank. When some issues arrived withouteven a paragraph from Peripatetic Corre-spondents, the prognosis seemed evident:medical humor in The Lancet was mo-ribund.
: The announcement that Diverticulumwould replace In England Now was reass-uring, but the newcomer is still a shock.Cartoons? And signed contributions? Well,we Westerners who crave tradition willclearly have to look elsewhere for stodgysameness. The Lancet is no longer in thebusiness.
Elmer R Grossman Berkeley, USA
When the balloon goes upEarlier this year, having undergone abarium enema and, as a result, been diag-nosed as suffering from diverticulitis, Ithink I can offer an operational definition ofan iatrogenic disease: if you inflate the largeintestine with compressed air to a highenough pressure, quite clearly any weak-nesses in the bowel wall will be revealed tothe delight of the radiologist.
Robert T Green London, UK
A pointed remarkAs a junior doctor, Im not a frequentpatron of the store in Knightsbridge,London, that sells everything from a pin toan elephant.The commissionaire couldnt be certain,
but suggested I try millinery. "No, Imterribly sorry. There isnt really anydemand for them, but perhapshaberdashery could help."
"Yes, of course", said the elderlyhaberdashery lady, producing a box ofthem. "Is it white, red or both that youwant?" I took a rather nice red one. "Thatwill be eighty pence please." I gave her themoney."Thank you very much indeed doctor,
and the best of luck. Where are you doingthe exam?" inquired the shop assistant. Ilooked rather surprised. "Nowadays, weonly really stock the hatpins for doctorstaking the membership."Simon Dover Glasgow, UK
Life is the art of drawing sufficientconclusions from insufficientpremises.-Samuel Butler (1835-1902)