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Sticky: Changes to the blog

There has recently been a major update of the software I use for this blog (Serendipity). In the process of upgrading I had problems with the (pretty old) frontend theme I was using previously, hence this new one. It's plain and functional, which I like.

More important, it will now, I hope, be easier to search and navigate the blog. I'm particularly pleased to have the list of tags in the right-hand margin. I tend to come back to certain topics over the months and years but up to now I didn't have any easy way of linking posts on the same theme together. Now I have. I've already made a start on setting this up and I intend to increase the links in the future.

Book review: Do No Harm, by Henry Marsh

Henry Marsh is a neurosurgeon who has headed his department at a London hospital for many years and has worked in the Ukraine to help set up neurosurgery there. In this book he provides an extraordinarily vivid account of his work and its emotional impact both on himself and on his patients and their relatives. The book consists of a large number of short chapters, each of which tells a story usually linked to a particular kind of brain abnormality. Some chapters are autobiographical and tell us about events in Marsh's own life and how he came to study medicine and become a neurosurgeon.

Patients, Marsh says, invest their doctors with superhuman qualities as a way of overcoming their fears when undergoing surgery.

The reality, of course, is entirely different. Doctors are human like the rest of us. Much of what happens in hospitals is a matter of luck, both good and bad; success and failure are often out of the doctor's control. Knowing when not to operate is just as important as knowing how to operate, and is a more difficult skill to acquire.


Book review: The Big Fat Surprise, by Nina Teicholz

This book covers quite a lot of the same ground as Gary Taubes's The Diet Delusion, although with different emphases. Another similarity is that Teicholz, like Taubes, is a science journalist. This may give professional researchers who disagree with her an excuse to dismiss her conclusions, but she has undoubtedly done her reading of the original material with great thoroughness and she has interviewed a number of the best-known people in the field. More

Book review: How I Killed Pluto, by Mike Brown

Before reading this book I hadn't thought much about whether Pluto should be classed as a planet and the question seemed rather trivial, but Mike Brown does a good job of explaining why it matters. He is an astronomer who specialises in the study of the outer part of the solar system where Pluto resides. Following its discovery by Clyde Tombaugh in 1930 it was accepted as the ninth planet, although its orbit was odd and it was very small. Could there be other planets even further out? [More]

Oliver Sacks on his cancer diagnosis

Oliver Sacks has written about his diagnosis with terminal cancer in the New York Times. He finds himself in agreement with David Hume, who in a similar situation accepted it with equanimity. His mood, he tells us, is one of detachment though not indifference.

Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life.

He tells us he has completed an autobiography, to be published in the spring, and several other books are nearly finished. Something still to look forward to, then.

Book review: Dawn Wind, by Rosemary Sutcliff

This is a historical novel set in Britain in the fifth century. The Romans have left and Saxons have occupied much of the southern half of the country. The British have just fought their last great battle against the Saxons, close to Aquae Sulis (Bath), in which they have been decisively defeated. One of the few survivors is Owain, a fifteen-year-old boy who was wounded in the arm and struck unconscious, so that he missed most of the fighting. He finds the bodies of his father, a British nobleman, and his brother, and then sets off north for Viroconium (Worcester), where he hopes to rejoin whatever British forces still exist. As he leaves the battlefield he is accompanied by another survivor, a war hound, whom he names simply Dog. [More]

Anne Atkins on the Virgin Mary

Anne Atkins has often figured in these pages for her Thoughts for the Day. In her latest offering she was talking about female role models; she mentioned several, concluding with the Virgin Mary. She poured scorn on the sentimental representation of Mary we find in school Nativity plays and then went on to produce her own version of Mary that was equally remote from the facts. Mary, we were told, was "a girl of extraordinary learning ... profoundly versed in the history of her race and faith." I can't imagine how Ms Atkins arrived at this remarkable estimate of Mary's educational attainments, for which there is no evidence in the canonical literature. We know, in fact, almost nothing about the historical Mary, but we can hardly suppose that this peasant girl became a bluestocking.

Book review: Hornblower in the West Indies, by C.S. Forester

Hornblower is the hero of many of Forester's historical novels of the navy. In this book he is a rear-admiral, serving as Commander-in-Chief of the British Squadron in the West Indies. He is also now Lord Hornblower and regards himself as an old man, although in fact he is only forty-five. He is glad to have obtained employment, now that Napoleon has been defeated at Waterloo and is confined to St Helena, but he misses his wife, Barbara, at home in England. [More]

Book review: Winter Quarters, by Alfred Duggan

The narrator of the story is a Gallic nobleman who was captured by the Parthians while fighting as a mercenary for the Romans, He is now being used by his captors to lead patrols against hostile tribesmen. With the onset of winter he is confined to quarters for the next four months, and decides to dictate his life story to a friend so that his son can read it later. He calls himself Camul, but he doesn't want to reveal his full name for fear that it would be used to cast spells on him.

He was born in the Pyrenees. A close friend, called Acco, killed a bear that was sacred to the goddess, Pyrene. Her resultant enmity made it essential for him to leave his homeland as an exile, so the two friends decide to join the Roman cavalry. Camul hopes to return home after some years, but Acco knows he will never do so. Throughout their travels they feel pursued by the goddess, who appears under different names in different places. [More]

Linux, OpenBSD, FreeBSD

The Debian users' list currently has reams and reams of posts, mostly furious, about the change to systemd. A switch to BSD is quite often suggested as an escape route but that wasn't my reason for thinking about it. I've got used to systemd on Arch, and although I don't find it better than sysvinit I can live with it. But I like the BSD philosophy. The notion of having the system as an integrated whole rather than a lot of bolted-together packages as in Linux is attractive.

That's why a year ago I installed FreeBSD, with mixed results. The ports system didn't work too well and for this and other reasons I decided to stick with Linux. Recently I had another go with the new version of FreeBSD (10.0), hoping it would be better, but it was if anything worse. Getting X to work was particularly annoying; I did get it running more or less as I wanted it but each time I tried to close it or change to a text terminal it locked up the computer and I needed to do a hard reset. The reviewer on Distrowatch reported problems with X too.

(Why not try PC-BSD, you ask, since that is FreeBSD for the desktop? Because this would install a desktop environment (Gnome, KDE etc.) by default, which I don't want. I'd need to mess around a lot to get things as I want them, so why not start with native FreeBSD?)

I hadn't thought too much about OpenBSD because I supposed it was only of interest to people running servers. Then I chanced to read this article in Distrowatch. It suggested that OpenBSD can, in fact, be useful as a desktop, at least if you don't want anything too fancy (that's me). So I decided to try it out.

OpenBSD was probably the easiest OS to install that I've ever tried. By simply following the defaults (except to install the uk keyboard) I found myself, after about 15 minutes, with a working system including X. Everything else worked as expected too, including sound, which is often something you have to struggle with in Linux.

Installing third-party applications such as Firefox was equally easy. OpenBSD does have ports via a scheme borrowed from FreeBSD, but you don't need to use them since all the ported stuff also exists on OpenBSD as packages, and you are encouraged to use those instead of ports. (You only need ports when you want to modify a supplied program.) I found that nearly everything I wanted existed as a package so getting my system into order was pretty easy.

At this point I was even contemplating installing it on all my machines. But of course nothing is ever as simple as it seems at first.

Possible drawbacks with OpenBSD
1. Some of the packages are somewhat out of date. In this respect OpenBSD is different from my preferred Linux distribution (Arch), which is a rolling release giving you rapid updates of all the packages you have installed. Having slightly older versions of things doesn't usually matter, but sometimes it does: e.g. I needed to modify some files made with a later version of Lyx under Linux and these were incompatible with the older version in OpenBSD.

2. Updating OpenBSD itself is different from what you might expect. There is an offcial "-release" every 6 months, in May and November, from which you can upgrade your system. There is a "-stable" branch which only gets serious errata and security fixes; you have to compile this yourself from source and there's nothing new. There is also a "-current" branch, in which the developers post their new code. This is updated frequently both as code and as "snapshots". There are differing opinions about the desirability of using this. You can read dire warnings about the possibility of finding yourself with an unusable or even unbootable system, but plenty of people do use -current on production machines. A recent poster on the OpenBSD misc list wrote:

It may sound bad coming from Linux world, but the fact is that a lot of the people using -current in production just fine, because -current in OpenBSD means something like LTS (from point of view of stability) elsewhere.

For companies -release/-stable is something what they are looking for mostly to show management that they are using "stable" OS. Here updates once a 6 months or once a year are fine for them (or after every security fix in base OS, if you have proper infrastructure you can make it easily without downtime.

I've now done several upgrades on two machines (using snapshots, not compiling from source) and there have been no problems. I'll post details of how I did this shortly though it may have to wait until my wrist heals.

3. Some things I want simply don't work on OpenBSD. One of these is the BBC iPlayer, which requires Flash. There is no Flash for OpenBSD and most people who use the system don't want it anyway because of safety considerations. A possible way round this is to use get_iplayer, although unfortunately the BBC seem to be trying to sabotage this valuable program and there is no guarantee that it will go on working indefinitely. Skype is also not available for OpenBSD. It might be possible to get it to work via Linux emulation but I think it would be difficult. I've compiled a few things myself (qsf, sitecopy).

4. My flatbed scanner (Epson Perfection v330) needs proprietary software that isn't available for OpenBSD. So I brought back my Epson Perfection 1650 from abroad and this works out of the box with the sane backend. Incidentally, I think this now-superseded model is a better scanner than the v330.

5. To get round these and similar difficulties it would seem logical to install OpenBSD and Linux on the same machine and dual boot, but although this is technically possible it's a lot harder to do than you might expect. You are probably better off using at least two machines rather than attempting to dual boot.

6.. Finally, if you want to use OpenBSD you have to be willing to learn a lot of new things. (You might say that's a feature not a drawback since it helps to keep your brain alive!) At first glance OpenBSD is quite similar to Linux but on closer acquaintance numerous differences appear. The OpenBSD folk pride themselves on their documentation and are right to do so, but you need to read it carefully and do a lot of googling rather than ask newbie questions on the mailing lists, which are a lot more technical in tone than those of most Linux flavours. (DaemonForums may be a better place to ask beginners' questions.) Absolute OpenBSD (2nd edition) by Michael Lucas (ISBN-13 978-1-59327-476-4) is certainly worth getting if you decide you want to run OpenBSD regularly on one or more machines.

I like OpenBSD a lot and want to use it as much as possible, but I need to have Linux as well, for the reasons I've described. I have 4 laptops (all Thinkpads of various kinds, mostly bought from Ebay). My desktop has just broken so I'm using the laptops exclusively. At present these are running the following systems and they are kept in sync with unison.

Thinkpad Z61M: OpenBSD

Thinkpad T42: Debian Wheezy (for my wife to use when she goes abroad).

Thinkpad T60: OpenBSD

Thinkpad T60: ArchLinux

Book review: The Making of a Philosopher, by Colin McGinn

Colin McGinn is probably best know to the non-specialist reading audience with an interest in philosophy as a leading "mysterian". That is, he thinks that the philosophical difficulty of explaining consciousness is due to inherent limitations in the human mind, which means that it can never be accomplished. But that is not his main topic here.

McGinn tells us that his purpose in writing this book was to explain philosophy in a personal, engaging way. He found that the autobiographical format was the best way of doing this. He thinks that this brings out the drama and excitement of the subject but he has not sought to write a full autobiography and personal topics are included only in so far as they affected his intellectual development. But the tone is quite light generally and McGinn is an engaging writer so the book is very readable. [More]

Book review: Lord Geoffrey's Fancy, by Alfred Duggan

Sir William Briwerr is writing about his youthful adventures for his grandchildren to read. He was born in 1233, the third son of a knight who held land on the Welsh March. The family he belonged to had come over with William the Conqueror and had once been great, but now it had fragmented owing to the lack of male heirs and William's father held only enough land for one son. So William, once knighted, sets forth to make his fortune. [More]

In Memoriam: Felix Mann 1931-2014

Felix Mann

The death earlier this month of Felix Mann after a long illness marked the end of an era for me, as it no doubt did for many doctors who learnt acupuncture from him in the 1970s. I first met him when I attended his course in 1977. At that time I was interested in oriental ideas and that made me want to learn acupuncture, but I had no idea how to go about it. Then I happened to talk to a consultant who was head of the Migraine Clinic and who had recently done Felix's course. She told me it was worth while, so I registered for it.

The course was held in Felix's consulting rooms in the large house he had bought in Devonshire Place, in the West End of London. It lasted five days. There were fourteen of us. We sat in a semicircle on rather hard chairs while Felix stood in the middle and talked to us. From time to time patients would arrive to tell their stories and be treated. This was what I was expecting, but there was an early surprise.

Before starting the course we were supposed to read Felix's books. At that time they were based on traditional Chinese acupuncture and I don't think that any of us made very much of them. But this didn't matter because the first thing that Felix said to us was "I don't believe this stuff any more."

I have to admit that my initial reaction was disappointment, since, as I've said, it was an interest in Eastern ideas that had prompted me to learn acupuncture in the first place. But it was undoubtedly a relief to hear that I didn't need to struggle with all this complicated esoteric stuff, and later I was very grateful to Felix. Probably I should have come to a similar conclusion eventually, but he saved me a great deal of time. After the course I set up an acupuncture service at The Royal London Hospital for Integrated Medicine using the methods I had learnt from Felix. Modern medical acupuncture is still one of the main forms of treatment used there.

From our present standpoint in the second decade of the 21st century it is perhaps difficult to realise just how radical Felix's "acupuncture revolution" was. In the late 1950s people thought of acupuncture - if they thought of it at all - wholly in traditional Chinese terms. To describe it in the way he did required Felix to rethink everything he had been taught about acupuncture by all the 'experts' he had encountered.

Felix's acupuncture career

Acupuncture had been practised by quite a number of British doctors in the 1820s but had later fizzled out. By the twentieth century it was virtually unknown here, although it was still used quite extensively in mainland Europe, especially France and Germany. By this time it had become quite traditional, although that had not been the case in the nineteenth century.

As a young doctor Felix travelled abroad to widen his experience; this was easy for him because he was a good linguist and had plenty of contacts. He saw acupuncture being used and was impressed by the results, which made him want to learn it himself. He studied at Montpellier in the south of France and at Munich and Vienna. Later, he even studied Chinese with the help of sinologists in Britain so as to be able to read the classic texts. So his subsequent abandonment of the traditional system wasn't due to lack of knowledge. It was based instead on fresh thinking and exact clinical observation.

By the time I met him in 1977 he had rejected practically all the traditional ideas about acupuncture. He now regarded it as a means of altering the activity of the nervous system and as a treatment that could be explained in terms of the modern understanding of anatomy and physiology. There was no need to talk about qi or yin and yang.

According to his new view, neither acupuncture points nor the so-called meridians exist as they are usually understood. Great precision in locating 'points' is unnecessary; instead we should be thinking of areas. In many cases these could be quite large: for example, in some patients needling anywhere below the knee might have the same effect as using the classic point Liver 3 (Felix's favourite site).

He introduced other departures from tradition as well. One was the use of periosteal (bone) needling, both to treat joint pain such as that due to arthritis and also to produce more generalised effects in a wide area. Another was his recognition of a subset of patients who responded particularly strongly to acupuncture, whom he designated strong reactors. Disorders that usually don't respond to acupuncture might do so in a strong reactor. But if a strong reactor were treated too vigorously the result could be a worsening of the symptoms or a feeling of general malaise lasting for some hours or even days. <

As time went by Felix came to believe that many traditionalists over-treated their patients. Increasingly he favoured very gentle treatment, with the insertion of few needles - sometime only one - and the duration of needling being brief: seldom more than a minute or two and quite often just a few seconds.

While these ideas usually horrified traditionalists they were certainly easier for doctors trained in modern medicine to understand and accept. This was fortunate because more now wanted to learn. Felix had started teaching acupuncture to doctors in the 1960s although at first few came forward to learn. But in the 1970s the numbers increased, partly because attitudes to unorthodox treatments were beginning to change but also because advances in the scientific understanding of pain were making acupuncture seem more comprehensible in modern terms. Another influence was President Nixon's visit to China in 1972, which aroused interest in acupuncture on the part of a number of prominent British and American doctors.

Felix's former students constituted an informal medical acupuncture society. He used to circulate a yearly newsletter and each year, in November, he held an acupuncture meeting in his rooms for 70 doctors. There would be seven or eight speakers, usually including Peter Nathan, a well-known neurologist, and Felix provided an excellent lunch, with wine. Attendance was free to his former students; others paid a small fee which cannot have come even near to covering Felix's expenditure.

In 1980 matters were made more formal when the British Medical Acupuncture Society, constituted mainly by Felix's former students, was founded; he was its first President. It now has over 2000 members.

Felix's legacy

The fact that the acupuncture practised today by British health professionals is mostly non-traditional is largely thanks to Felix. Outside Britain the change has been more gradual. In much of Europe, apart from Sweden and Portugal, and in North and South America, traditional ideas are still influential. But the journal of the British Medical Acupuncture Society, Acupuncture in Medicine, is now a BMJ publication, so Felix's aim of making acupuncture an accepted form of treatment within mainstream medicine has mostly been accomplished. Perhaps most striking of all is the fact that an increasing number of the papers being submitted to the journal now come from China itself.

Felix wrote several books about his later view of acupuncture. The most important of these was Reinventing Acupuncture: A New Concept of Ancient Medicine. The first edition appeared in 1993 and the second in 2000. Here he described how his understanding of the treatment evolved and gave practical details of his methods. I still dip into it from time to time and continue to be impressed by how much my own experience agrees what he describes. All of us who use acupuncture today in a modern context are deeply indebted to him.