27.Lucky Friday the 13th, and an enjoyable weekend

Friday the 13th was certainly not unlucky. I had forgotten all about it and did not stay in bed. Then we had some good news, and like the old Jew in the Catholic church, "I am telling everybody". (if you do not know this joke, and you are over 18, ask me).

First thing, Ruth had received the exam marks for the spring semester. Professor Langley-Evans congratulated her. He told her that, 'once again, it was an amazing performance'. Ruth was top of the Biosciences students for year one (by a country mile), as she had been in the autumn semester.
She emailed us saying that she was so pleased, that she might not be able to squeeze her oversized head out of the building. I consoled her by pointing out that as a result, her hat would now be big enough to contain the entire week's shopping.

Then we heard from Heather, who is losing her job due to 'downsizing' at Camden. Gordon Brown needs all their money, to repair his idiocy with the 10p tax rate. So he has to squeeze the local authorities. Her employers and colleagues at Camden had been extremely generous as a token of their appreciation of her work there. Very heartening. My own pride is tinged with sorrow concerning the loss of the occasional lunches at her nearby Caf, where they serve excellent falafel...

It was David's birthday. Rather than possibly wake him up, we had phoned him the previous evening. Later Heather told us, that she had in fact woken him up - so we need not have worried.

Then we drove to Harlow for the Wansfell-2 weekend course on Symbolism in Art. It was an excellent series of slide talks and I learned much more than I had expected. Clare Ford-Willie knows her subject very well and spoke clearly and fluently, aided by abundant good slides. The fellow students were a nice bunch of people, including some former students from my own Wansfell courses. The good food included the customary treat of bacon at breakfast - not obtainable at home.

26.Egypt and Canaan

Last night I attended a very good lecture at the monthly meeting of the West Essex Archaeology Group [WEAG] at Woodford County High school. I now only attend when the topic is of interest to me - and this certainly turned out to be most enjoyable. Using PowerPoint, Rachel Sparks from the Institute of Archaeology surveyed and illustrated the evolution of the links between Egypt and Canaan in the middle and late bronze ages [MBA & LBA], roughly the second millenium BC. She divided the period into three parts:

In the MBA I [= 2,000 - 1,800 BC] there were sporadic trade exchanges ['trading and raiding']. The route was overland along the 'way of Horus' and by sea - to the ports along the Levant coast. The Egyptians did not penetrate far inland. They still regarded Canaanite cities as potentially hostile, as evidenced by the execration texts: plaster effigies covered with the names of Canaanite cities, then cursed and smashed them. But bearded semitic men bearing merchandise were portrayed.

In the MBA II & III [= 1,800 - 1,200 BC], there was deeper Egyptian penetration inland, and an increase in trade and significant cultural exchange. At that time the Hyksos resided in the delta - foreigners probably from the Aegean. The delta site of Avaris was inhabited by Canaanites. Many storage jars of Canaanite origin were found there, whereas burials in Canaan contained many scarabs of Egyptian design - but often produced in Canaan. When skeletal remains could be analyzed, the male were often Asiatic/Canaanite and the females local Egyptians - there was intermarriage.

In the LBA [= 1,550 - 1,150 BC], the Egyptians actually conquered Canaan. The Egyptians mounted concentrated annual campaigns into Canaan, gradually extending their rule northward - despite a Canaanite revolt - the battle of Kadesh. The loot was taken back to Egypt, where such Items can be recognized. The siege of Askelon illustrates the action. In the delta, the Hyksos were expelled and all traces of their culture were obliterated. Tribute was also extracted from the conquered Canaanite cities. Loyal rulers were appointed by the Egyptians, and their sons were usually taken to Egypt as hostages. When these princes later returned home, they spread the Egyptian culture that they had absorbed. There is a theory, that Joseph was such as hostage prince. [ Incidentally, the Romans employed a similar method ].

Local fortresses in Canaan were built by local labour. Burials included antropoid coffins, that contained shabtis in the Egyptian style - so these were probably Egyptian dead. To remain in power, the Canaanite elite had to behave like Egyptians. Beit Shean was completely Egyptianized - they even imported Egyptian potters to work there. [ And I'm reminded of the Egyptian governors' style mansions at Dir es-Saidiyeh and Tel Afek - there must be others ].

The ethnicity of the inhabitants can be identified from various criteria: the images [beards, clothing, skin colour, tattoos], the texts and language, the names of individuals, and the style of their possessions.

The questions after the lecture confirmed my own views of the Biblical narrative. That part of the Old Testament was only written around the 5th century BC, or maybe later. The whole story, from the Patriarchs to Joshua's conquest, is a later 'spin'; the 'Apiru' that are mentioned in some extra-biblical texts refer to stateless vagabonds and terrorists, not to 'Hebrews'.
The topic of the Exodus was not mentioned at all in yesterday's non-Jewish forum. Its historical existence has now been convincingly rejected by contemporary scholars. Although Canaanites obviously resided in the delta at that time - during the LBA, they were not Israelite slaves. The Egyptians kept no slaves, except for prisoners of war. Public works were performed by 'corvee' labour - Egyptians who served the king during the period of the Nile's inundation, while these farmers could not engage in agriculture.
During the period of the postulated Biblical exodus, Canaan in the LBA was entirely under Egyptian rule: so where could Moses and the Israelites escape to?
The Old Testament is a very well constructed literary work. But I personally no longer celebrate Passover, its festival and its ceremony.
But then, I'm agnostic: I do look forward to encountering Tony Blair in Hell.

25.A New Book

For over 50 years, Zvi Alexander has built up a most significant collection of Holy Land postal history - that is not just stamps but postmarks and entire letters and postcards. It is probably THE most important and comprehensive such collection in existence.
For the last 24 years Zvi has exhibited various parts of his collection internationally, and has been awarded Grand Prix and numerous large gold medals - the highest philatelic accolades.

Rather than selling his unique items, he has generously donated the entire collection to the Eretz Israel Museum in Tel Aviv on a 50 year loan. The museum's philatelic pavilion has been named after him and he has endowed it for onward displays and education.

To mark its opening earlier this year, the Museum produced a sumptuous glossy hardback catalogue. In some 200 pages it illustrates and briefly describes (in Hebrew and English) a selected fraction of these postal history items, beginning in the 15th century, through the Turkish post, the European postal agencies of Austria, Germany, Italy and Russia, to the British Mandate, and finally the war of independence in 1948. The postal items are linked by selected historical photographs and thus form a marvelous overview of the history of the country and its postal services.

Even for a lay person, the material provides a fascinating and vivid survey. But if you know the philatelic background, the wealth and quality of these items (not to mention their market value) are astonishing. Quite a number are described as unique - 'the only recorded item'. My personal friendship with Zvi has given me additional exciting insights into his hard work in locating, researching and acquiring these rare gems.

As Amazon would say, five stars plus!
It is sold at the Museum for 150 sheqel - about £23.

24.The General Medical Council (GMC)

To practise medicine, doctors have to pay the GMC an annual fee, to remain on the Register. Only doctors who have no income from any source worldwide, including from pensions and investments, are exempt. But until now, no more payments were required after the age of 65, whether or not one engaged in gainful medical work. The GMC now claims, that the 2006 law against age discrimination prohibits them from exempting the over-65s.

So for the time being, the cunning lawyers and the greedy GMC councilors have actually been provided with a golden opportunity to rake in a great deal of extra money from elderly doctors.

In my opinion, the spirit of this law is intended to prevent older persons from being more disadvantaged, and not the reverse. To prove this and clarify the law would require very high and expensive legal authorities. I wonder: what about my old-age advantage of travelling free on London transport? And my exemption from prescription charges, and concessions on entrance tickets? Will all this be abolished now to avoid discrimination against the young?

The GMC should have changed their regulations in a different way to comply with the 2006 law - as interpreted by their lawyers. Instead of the exemption by age, which is now allegedly illegal, they could have introduced an exemption for those who do not engage in any gainful medical work, irrespective of age, and irrespective of non-medical income. But that would have demanded logical, intelligent and compassionate thinking by a body that is notorious for its archaic habits. Rumour has it, that they still use quill pens and are not particularly computer literate.

After I reached 65 and no longer had to pay my GMC fee, I did no gainful medical work of any kind. The only use that I made of my ongoing GMC registration was for private prescriptions for a short course of antibiotics for relatives of friends who visited from abroad. On several occasions I provided emergency help on airplanes or during meetings. Presumably all this will have to stop. When needed, my GP or a former colleague would write me a private prescription. To resume paying the annual GMC fee - currently £390 - just to allow me to perform these trivial actions is naturally out of the question.

I have my own personal bad experiences with the GMC.

When newspapers print a report that the GMC have 'struck off ' a delinquent doctor, their full personal particulars are always reported. But when these episodes are later reported in the GMC newsletter, they are left anonymous. No medical reader would be able to recognize such a culprit, if they were to seek work despite their ban and endanger more patients - it has happened. The GMC newsletter invites readers' comments - but my letters were totally ignored twice.
The GMC logo used to include the term 'protecting patients'. No more. They changed the motto to: 'Regulating doctors, ensuring good medical practice'. They should add 'ignoring doctors, endangering patients'.

When I arrived in Britain in 1962 my qualification, MD (Jerusalem), was registered by the GMC on my Temporary Registration. But as the medical school in Jerusalem was not interested in foreign accreditation and did not apply for it, my degree was not recognized by the GMC for full registration. I had to re-qualify. After making enquiries I chose to get the simplest 'recognized' qualification - from the Apothecaries' Hall in Dublin. The procedure was a farce - maybe I'll describe it in another blog - so I was not surprised to learn a few years later that the GMC had withdrawn its accreditation from the Apothecaries' Hall in Dublin. Nevertheless, my licence of LAH remained a 'kosher' degree. I ignored it when I provided my personal details: it was secondary to my original MD.

Imagine my surprise in 1996, when I was notified by the GMC that after 36 years they had decided to re-designate my qualifications. Henceforth I was no longer registered 'MD', only 'LAH'. I tried to reason and to protest, but the dinosaur refused to budge.
Later I passed the membership exam of the Royal college of physicians and was subsequently elected a fellow.

So as of this morning, sod the GMC registration:
I am still MD, FRCP.

23.Anatomy

Last week Daphne, Jane and I Visited the Wellcome exhibition 'Medicine Man', with its model of a lesson in anatomy. It reminded me of my study of this subject in Jerusalem.

In the early 1950s, before I began my studies, students had to go abroad for their pre-clinical studies - and for anatomy in particular. Similar to the 18th - 19th centuries in Europe, corpses were scarce in Israel. There were no executed criminals, or abandoned vagabonds; and the orthodox Jewish institutions insisted on the Biblical commandment of burial before sunset, and of the complete body - to ensure its resurrection intact, when the Messiah comes.
If the law demanded a coroner's autopsy, a trained rabbinical expert had to be present, to ensure that every organ was replaced in the body, possibly excepting some tiny fragments for essential microscopy.

After Israel's independence in 1948 a new source of corpses became available: Arab terrorists who had been killed by the army in ambushes. In the 1950s they were still called infiltrators. Their existence was denied by the Arabs who had sent them; and their bodies were not reclaimed. So now anatomy could be studied at the medical school in Jerusalem. The city was divided, of course, without access to the university departments on mount Scopus. We were scattered in various buildings around western Jerusalem, and the anatomy department was in an old Arab house behind the municipal 'garden' - an oval area with flowers and trees, not far from the demarcation wall with the Old City beyond.

On the first day we all assembled in the large room, sitting silently around the dissecting tables. The bodies were covered with red rubber tarpaulins. There was a strong smell of formaldehyde. Professor Itzkovitch and Dr Gershon Gitlin introduced us to the subject - I remember it very well. First and foremost, they emphasized, these were human beings. They were dead, but they had to be treated with respect. No smoking was allowed in the room, and no eating. Second, we were reminded that there was some opposition to human dissection among the population. We were forbidden to talk about the activity there. No photographs, or visitors, were allowed.

It took me a while to realize, that there was another reason for the secrecy. All the bodies were middle aged men, with a swarthy appearance, and all were circumcised. Some had puncture wounds, or evidence of internal bleeding. Clearly, only more or less intact Arab bodies were chosen, and all bullets had been carefully removed. The delivery of bodies, and their embalming with formaldehyde, obviously took place at night. Soon, we had named out corpse Ahmed.

The course was intensive - we spent very many hours dissecting, for a whole term. Our textbook was Cunningham's manual and we followed its instructions to the letter. Each table of 5 or 6 student worked on one body. We began by laboriously teasing out the nerve strands under the skin of the scalp and face. Then we removed and dissected the brain. Then we turned to the chest, the abdomen and the limbs. We also received lectures about osteology, as well as embryology - it was Dr Gitlin's favorite research subject. The female reproductive organs were brought in on separate trays - presumably they were from patients who had undergone the relevant surgical removal, or perhaps 'unofficial' post-mortem dissections of non-orthodox women. We never asked.

With hindsight, anatomy was grossly overrated and over-taught in 1954. This imbalance was later recognized, and the topic of anatomy in the curriculum was gradually modified and shortened. Different specialists obviously required different aspects of anatomy - and psychiatrists needed none. So why burden their limited brain capacity?

22.Through the Retrospectoscope

With hindsight, I think that several of my close relatives were medically misdiagnosed. In this post I have decided to include some medical terms: email me if you cannot find them in Google. If you are squeamish, then do not read this post.
But I suppose that this warning will just whet your appetite...
- - -
My [maternal] grandfather had his prostate operated at Hadasa in late 1955. He came back to our flat in Jerusalem to recover, but developed a very severe urgency to open his bowels. He kept running to the toilet, day and night. It exhausted him. Our GP kept prescribing anti-diarrheal medicine. But he did not do a rectal examination.
When he was readmitted to the hospital after several weeks of deterioration, they quickly diagnosed 'spurious diarrhea': he was actually severely constipated, aggravated by the GP's medication.
So they cleared his large bowel manually and with enemas. But when they tried to get him out of bed he collapsed - I suspect that he actually suffered a stroke. He died within a fortnight - in 1956. The GP's wrong initial diagnosis finally killed him.
- - -
In 1961 my aunt Valli, the mother of Amos, died suddenly. She had been perfectly well. One evening she developed severe chest pain and the cause of death was given as a heart attack. There was no autopsy.
Later I remember two facts. Those who had looked at her body [I didn't] commented on curious bruising under the skin at the base of her neck. And shortly before her death, she had had a chest Xray - I think it related to a claim for reparations from Germany. She was informed that there was 'something wrong' and that she should seek medical advice. But no details were given to her.
I think the chest Xray showed widening of the mediastinum due to a dilated thoracic aorta, and that it ruptured, to cause her rapid death. Aneurysm of the upper aorta is less common that in the abdominal aorta. Rupture is almost invariably fatal within minutes. Even now, almost 50 years later, it is still operable only if it is discovered before it ruptures, and even then it has quite a high mortality. The BMJ obituaries of doctors mention quite a number of these fatalities. The government is planning to measure the aortic diameter in elderly men by ultrasound - I had mine done last week, and it is normal: I shall have to choose a different cause of death...
- - -
From the second floor landing of their block of flats in Jerusalem, my father had arranged a string dangling down the central stair well to the level of the house entrance, with a clip at its lower end. First thing in the morning, the newspaper boy would clip the paper to the lower end, and my father would 'fish' the paper up, without having to descend and then climb the two flights of stairs.
In 1968 my parents were visited overnight by my [paternal] aunt Martha. In the morning, my father went out to fish for the newspaper. There was some noise, and my mother noticed that he had not returned. Going out and looking over the banister, she saw my father lying on the stone floor of the basement - three storeys down - a fall of some 30 feet.
It was assumed that when he retrieved the paper clipped to the string, he had overbalanced and fallen over the banister. My brother soon arrived, and he told the police investigators that, as a doctor, he could certify our father's accidental death. So there was no autopsy or inquest - clearly there had been no foul play.
But our father had been prone to depression from time to time. And one of his slippers was found one flight further up - above the flat. So I was sure that he had climbed further up the stairs, to make sure of the total height of his fall, and that he had jumped. I think that being the kind and considerate husband that he was, he had used the opportunity of his sister's visit, when his wife would not be on her own when he died. But apart from the stigma associated with suicide, the diagnosis does not matter.
- - -
In 1976 Daphne and I visited my mother in Israel. It was an enjoyable tour. On the way back from Ein Gev to Jerusalem, we stopped off at Ramat David to visit Judith's cousin Iona and her husband. Then we walked to the highway to catch the bus. The bus was approaching and I ran across the road to stop it. At the last moment, my mother decided to cross the road too. The bus hit her a glancing blow and knocked her down - her leg was fractured above the knee.
The bus driver stopped a passing car and arranged to drive us to Afula hospital - Daphne stayed with Iona. I kept checking her pulse - bleeding into the thigh could have tipped her into haemorrhagic shock. The Xray showed, that the break was just above the knee - routine plating would not be possible. So she was immobilized in skeletal traction with a pin through the upper tibia, to wait for the fracture to unite.

Somehow, by sheer luck, I was aware of the regulations of the Sick Fund that insured my mother: In cases of traffic accidents, the patient had to pay all expenses and then claim back from the driver through the court. But in cases of 'illness', the Sick Fund paid for everything. So in Casualty at Afula, we claimed that she had 'fallen in the road'. I impressed on my mother the crucial financial need to stick to this story. The bus driver had reported the accident, but when the police asked us, we said that the bus had not hit her: she had fallen. That saved her [and us] many hundreds of pounds, because the accident had been entirely her fault: there would have been no possible claim against the bus driver.

The following day, I suggested to my mother, that she should ask for a mid-thigh amputation. It would heal rapidly, and if Afula did not have IPOF = 'immediate post-operative fitting' of a prosthesis, I would take her to Roehampton. But my mother was appalled at the thought of becoming 'a cripple'. Still, I discussed it with the orthopaedic consultant. He preferred to order a customized fixing plate from England.
Weeks later the plate arrived. She almost died during the operation and needed resuscitation. In 1976 the risk, and the prevention, of deep vein thrombosis was not well recognized - my own concern had been for rapid rehabilitation. I had not thought of deep vein thrombosis at the time. She was not on any anti-thrombosis measures. Later I understood, that during the operation, an elastic bandage is wound upwards along the limb to leave a bloodless field for the incision. This had obviously squeezed the clots in her leg veins, like toothpaste, up into the larger veins - causing the clots to travel to her lungs.
But she survived this undiagnosed, and untreated, pulmonary embolus.

More weeks passed. They waited for the fracture fixed under the plate to unite and heal. Finally they decided to try to mobilize her. But the radiographers were on strike, so they got her up without taking an Xray. The leg buckled - it had not healed. They decided to transfer her to a rehabilitation unit near Tel Aviv. After some weeks there, I received a frantic letter from one of her friends, who had visited. She could hardly recognize the remaining shadow of her former self.
Before this letter reached me, she died, from a 'heart attack'. Clearly, showers of pulmonary emboli from the on-going leg vein thrombosis had finally overwhelmed her.

I flew from London for the funeral. As a Jerusalem resident, her death had to be registered there. The death certificate said 'heart attack', and when the registrar asked me about contributory causes, I said nothing. Had I raised my opinion of a pulmonary embolus related to the accident and to the operation, they would have ordered an autopsy and possibly even an inquest. The funeral, and my departure, would have been delayed for no good reason - she was dead. So the Israeli mortality statistics for 1977 are incorrect by 1 case.

For years, we had written weekly letters to my parents, and later to my mother, to report about events. Riding back from the funeral in Amos' car, the bizarre thought crossed my mind: 'I must tell my mother who was at the funeral'...

Unlike others, I do not believe in life after death. I can remember my relatives without the need to visit their graves. I shall not visit Kiriat Shaul, or Bat Yam.
But in the Holy Land, there has been an alleged risk of resurrection. So when the undertaker asked me what kind of tombstone I wished to order for my mother, I said 'the heaviest you've got'.

21.Birthday

Last summer at the start of my U3A course on Herod I had mentioned that I usually read from the script of my text during my slide talks. Actually, I do try to formulate it, and to present it, as a 'live' spoken text, with added incidental humorous remarks - often based on contemporary news of our political liars and clowns.
On a previous occasion - at Madingley - my habit of reading from the script had been commented on: they clearly liked their tutors to be word-perfect. So I explained to my U3A group, 'That at the age of 83, I could not remember it all without referring to my notes...'

During the next interval, a couple of my students came to compliment me on my impressive youthful appearance 'at your age of 83'. So in the following talk I had to confess, that I was really only 74...

So this year, our daughters decided that we should have a proper celebration of my three quarters century. I had two requests: roast duck, and some home-made music. We agreed to assemble at Heather's flat, because there is a tested and approved Chinese take-away nearby, and also to save on the traveling distance for Daphne's crowd.
Ruth was in London for the weekend, and Andy came specially from Leamington. Only David was missing.

A few days beforehand I emailed them as follows:

Dear All,

I have just been contacted by the duck, whose turn it is to be roasted for Saturday.

She sounded extremely upset.
As far as I could understand (and I do not speak Mandarin well, my language is more Grapefruit) - she feels that our occasion is not worthy of her sacrifice; that it is an unlucky date; that she will miss her swimming, etc etc.

I suggest that we ignore the silly goose - but don't tell her that I said so.
She is attempting to avoid her destiny!

In the event, the food was delicious, although the bird did not say anything: remember the joke? Daphne had brought a yummy orange cake, and the Perrys' card illustrated an elderly man instructing his tattoo artist: 'I just want my address, my pin numbers, and oh yes - my name'. Heather had found a card showing Les Dawson reporting his doctor's advice for persistent wind: he gave him a kite.

Then it was time for music. They got out their recorders and played some old time duets and trios. It was very enjoyable, although some of it sounded quite shrill. I suspect that the sound actually drove Andy away, although he is actually quite busy at the moment.

Ruth drove us back home, prior to her class reunion - as reported in her own blog.
As we used to write in our school reports: We returned home tired but satisfied.

Hugh had phoned to wish me happy birthday. We do admire the devoted way he looks after Bernadette. And Oded & Adi phoned from Israel. [ I added this fact during editing, when I had remembered...]
A recorded telephone birthday message awaited us from Ehud Netzer in Jerusalem: he keeps a data record, and we do keep in touch - since our primary school days together in Jerusalem. There was also an email congratulation from David Roskin and his clan: another well organized relative - unlike me: I had accidentally deleted his email - unread and and unanswered! Luckily I found it again over a fortnight later and thanked them. I often quote David's explanation for the dinosaurs, millions of years old, when according to the Bible the world was created less than 6,000 years ago: the dinosaurs were created old.

Maybe I was created old too?