Via Laudator Temporis Acti, a couple of quotes from Edmund Hill’s “Religious Translation” (Blackfriars 37.430 [January 1956]:19-25):
Contrition is an example of those many words whose meaning, though accurate enough, is poor and colourless compared with what they signify in Latin. It is a technical word for sorrow for sin. Many people, perhaps, who could well manage to be really and truly sorry for their sins, find the complicated business of making a perfect act of contrition too much for them. The Latin word means literally crushing or grinding or bruising; but the English ear, taking the metaphorical sense for the proper one, misses the metaphor completely, and metaphor is the very sap of an effective religious language. ‘Make a good act of contrition while I give you absolution’; what would be wrong, except that it would be unfamiliar, with saying, ‘Try and bruise your heart for your sins’ (or simply ‘Be really sorry for your sins’), ‘while I untie you from them’?
[…]There is a fetish here that needs exorcising, called Dignity of Language. By all means keep it where it is found in the original, as in St Leo’s sermons for example, or the canon of the Mass. But not all, nor yet the greatest, religious works are written in dignified language. To impose elevated diction on St Augustine’s sermons or even on the Gospels is to mistranslate them. ‘Peace, be still’ is a beautiful dignified phrase. But what our Lord actually said to the wind and the sea was literally ‘Be gagged, be quiet’; much nearer the undignified but vigorous shut up of colloquial English. If street smells have invaded the original, do not drive them out with incense from the translation.
The Gilleland post adds the original Greek of Mark 4:39: “σιώπα, πεφίμωσο.”
πεφίμωσο
Phimosis. “Pucker up!”
rebuked the wind
Luther has bedrohte den Wind, which is much stronger than tadelte would have been, and not the same thing.
I see muscular christianity in the wings.
Perhaps “can it,” “put a sock in it,” or “stifle yourself” would strike the vernacular note Hill sought for the command to the sea? I don’t know the range of Latin usage in the relevant (or some relevant) century well enough to be sure, but starting a sentence with “The Latin word means literally …” feels like someone may be about to fall into the Etymological Fallacy. Plenty of lexemes in a given language will have extended senses that are so well-established that the word, in that sense, just means what it means, without the reader/hearer being particularly consciously aware of the “metaphor” originally embedded in the extended sense. That said, “contrition” and “contrite” are fancy enough words in English that a vernacular synonym for the relevant sense without any connection to the Latin etymon could well be a more useful rendering.
This is a problem that Bible translators frequently struggle with. It’s difficult (even for translators who actually realise that it is a requirement for accuracy) to convey the difference between the highly wrought poetic style of the Prophets and the very plain Greek of the Gospels, for example.
It works both ways: in the far-off days when Anglophones were raised on the Authorised version, it gave them a wholly wrong idea of the style of much of the New Testament, whereas the more aggressively cheerful and demotic modern versions give a highly distorted notion of much of the Old.
The Message, for example, has for Proverbs 22:6:
Point your kids in the right direction, and when they’re old they won’t be lost.
I don’t think it’s over the top to describe this as an actual mistranslation (as opposed to a merely painfully lame rendering.) [For the benefit of those who don’t want to look it up, the Authorised Version has “Train up a child in the way he should go: and when he is old, he will not depart from it.”]
At the very least, they could have tried to turn it into a limerick …
What does Kusaal do about σιώπα, πεφίμωσο?
And in general how do they deal with the difference in registers?
feels like someone may be about to fall into the Etymological Fallacy
Yes indeed. The Latin meaning of contritus is completely irrevelant to understanding the English word “contrite.”
I do not feel it compromises my impeccable Calvinist orthodoxy to call something a “disaster” …
Coming to the Greek Testament having previously learnt classical Greek was helpful in letting me see that one is not dealing with aspiring belle-lettristes there, but it probably also tended to make me misinterpret perfectly normal Koine as “substandard” Greek in some cases when it was actually no such thing in contemporary terms. I get the impression that quite a lot of commentary on the New Testament (of the kind that turns up in sermons delivered by preachers wanting to show off that they remember some Greek) involves overinterpreting quite everyday Koine terms as striking metaphors or whatever because that’s what they would have been in fifth-century Attic, whereas in Koine they’ve just become the normal expressions for things.
I would exonerate The Message from the charge of mistranslation by saying it’s not any sort of translation to begin with. It’s a paraphrase of the gist of the Scriptures as understood by one pastor trying to evangelize a culture that he perceives to have minimal Biblical literacy. Such paraphrases can potentially be quite useful tools for mission work and catechesis. Unfortunately such non-translations (I think including The Message) often fail to admit forthrightly what they are and what they aren’t. My working thesis is that certain insoluble conceptual tensions within the community of more strictly Protestant Bible translators in the 20th century made many of them insane and largely untrustworthy as translators.
Actually, the 1545 text has: “Vnd er stund auff / vnd bedrawete den Wind”.
According to Georges’ Handwörterbuch, the word seems to have been introduced by Christian writers and doesn’t seem to exist in Classical Latin. Note the collective Eccl. for these writers — 19th century dictionary authors obviously didn’t care very much for early Christian literature. As for the 20th century, the OLD simply ignored anything after the 2nd century.
certain insoluble conceptual tensions within the community of more strictly Protestant Bible translators in the 20th century
When my mother was over 70, she announced that she was learning New Testament Greek because she was convinced she would find her doctrinal views confirmed In The Original. She wanted it to be a feather in her cap of righteousness.
I don’t know how far she got with that enterprise, since we were not really on speaking terms. She already understood me well enough to know that I did not share her views.
Actually, the 1545 text has: “Vnd er stund auff / vnd bedrawete den Wind”.
No it doesn’t. You’ve modernized the font, as others have modernized the spelling.
Picky, picky. But those who wish to see it in a more impressive font can do so here.
Nothing is original except in locked vaults – altered spelling, altered font, the excision of Cranach’s illustrations (see Pettegree, The Book in the Renaissance, as recommended by Y). That “actually …” business builds on the Original Fallacy, the Dach-fallacy for the Etymological Fallacy and others.
Proverbs 22:6
The KJV is the correct one, The Message is not. KJV is not quite accurate, though. naʽar is an age-unspecific ‘young person’, here as elsewhere contrasted with a form of the root zqn ‘be old’. So ‘child’ is too constrained.
What does Kusaal do about σιώπα, πεφίμωσο?
The 2016 Bible has Gu’om, ka an baanlimm, where gu’om is from gu’oe “refrain, restrain, stop doing something” and an baanlimm means “be still” (in the sense “motionless.”*) Neither word necessarily implies not making a sound; they’re both perfectly ordinary vocabulary. “Be silent” is sin.
I think the register question is particularly difficult in Kusaal because there is no literary tradition, so that register just doesn’t exist. There are traditional poetic forms, but they don’t lend themselves to Bible transation: things like call-and-response chants, and so on.
The actual style of the translation has been simplified in certain respects since the original 1976 New Testament, but this mostly takes the form of replacing hypotaxis by parataxis. Even quite everyday Kusaal (as in folk tales, etc) is actually quite given to complex subordination, though, sometimes several layers deep: the language rather lends itself to that, and what looks like parataxis is quite often subordination after all: the ubiquitous clause linker ka means “and” sometimes, but is actually more often either formally subordinating, not meaning “and” at all, or used in in narrative, where starting tense-unmarked clauses with ka specifically marks them as carrying on the narrative thread, as opposed to being flashbacks or digressions or descriptions. It’s rather reminiscent of all those vav-consecutives in Biblical Hebrew.
The 1996 translators sometimes seem to have got a bit carried away with these possibilities, though. Just because you can do that in correct Kusaal, doesn’t always mean that you should do that …
A very striking difference in the revised version is that all cases of “indirect speech” have been replaced by direct. This must have been a deliberate editorial strategy, because it’s been carried through so consistently. It actually reflects a divergence from traditional style, in which very long stretches of reported speech are conveyed as subordinate content clauses with all the pronouns altered to reflect the speech context in which the utterance is made. So I think this is actually “translationese”, though the translators could reasonably argue that, well, they’re actually creating a whole new genre here, so why not?
There are some detectable stylistic differences between the BIble translation and, say, folk tales, over and above things like vocabulary choice which obviously just reflect the subject matter. The Bible, for example, has few clauses within narrative which lack explicit tense marking and are also not introduced by ka, but this is relatively common in folk tales. It seem to have the same sort of vibe as the “historic present”, not of high-style English but very colloquial English: “So I go up to him and I say ..”
* Ah me! Brings back memories. How many times did I shout An baanlimm! at a patient when I was operating on his eye under local …
How many times did I shout An baanlimm! at a patient when I was operating on his eye under local …
Scary. I suppose being paralyzed with fear (shouted into submission) is a useful adjunct to a local anesthetic in that situation.
I sometimes have to apply similar techniques with the dog Sparky on walks when he misbehaves (crosses behavioral boundaries drawn by mutual agreement, after all). But shouting has no effect. I have to do a Lady Bracknell voice in a histrionic whisper.
I suppose being paralyzed with fear (shouted into submission) is a useful adjunct to a local anesthetic in that situation.
Indeed. One of the first things they teach you at medical school.
The Lady-Bracknell-voice thing sounds like a useful tip.
going back to the OP, it’s also the case that a “perfect act of contrition” is a very specific thing with a fairly technical meaning as a workaround to the usual implications of the whole Vatican system of sacramental theology. Basically the theory is that:
A: Under usual circumstances in order to be properly forgiven for your sins you really need to go to confession and be absolved by a priest; but
B. Under emergency circumstances where it may not be feasible to get to a priest and especially when in danger of imminent death, there is still something you can do on your own that will give you the same spiritual benefit as the priest’s absolution would have.
It’s a conceptual cousin to the https://en.wikipedia.org/wiki/Baptism_of_desire notion, that similarly provides a happy-outcome solution for apparent hard cases, but it’s not a particularly colloquial/vernacular sort of concept. That said, in circumstances where laity may find themselves in need of the benefit of a perfect act of contrition it will be good if they have been given advance pastoral guidance as to when and how to do it. How colloquial or vernacular that explanation needs to be to be pastorally effective is something I personally would think may vary by context and circumstance and I would defer to the practical judgment of the pastors involved.
they could have tried to turn it into a limerick
When training your kids to be holy,
Give them but one true path solely,
Keep this always in mind
And by God you will find
When they’re old they will fall for no folie
<* applause *>
Blank verse for the win!
David L is clearly channelling the Psalmist, his namesake …
There’s a fossil starfish out there called Disaster.
Obligatory link to the idea that the entire point of the Gospel of Mark is opposition to Homer – in the lesson and in the language.
there is still something you can do on your own that will give you the same spiritual benefit as the priest’s absolution would have
Indeed. The minimal sacrament (or not, as you may think) of penance in articulo mortis is to think to yourself, “O God, for all my sins I am most heartily sorry!” Then God absolves you directly, and you die and spend the next several hundred years in Purgatory. (According to Dante, you first go to Ante-Purgatory, where you just sit or stand around for a time equal to the length of your mortal life before you can even start actually purging your character defects in Purgatory proper. Presumably this is to teach you not to procrastinate.)
Obligatory link to the idea that the entire point of the Gospel of Mark is opposition to Homer – in the lesson and in the language.
Very interesting!
Do you know how widely accepted this is?
It reminds me of all those cod-structuralist notions that there are only Seven Plots (or three, or twelve. PIck a number – any number …)
I think you could make a large proportion of all world literature into versions of the Odyssey with this sort of technique.
A thing’s a phallic symbol if it’s longer than it’s wide …
https://www.azlyrics.com/lyrics/melanie/psychotherapy.html
As a child when I heard “You came to heal the contrite” I had no idea what a contrite was.
Gladly, my cross-eyed bear …
Bug review meeting transcript.
Sin: Works as designed.
@David Eddyshaw: One* of the hilarious scenes in the interactive (Choose Your Own Adventure style) finale of The Unbreakable Kimmy Schmidt has the character of Jacqueline get buttonholed by a pompous scriptwriter who wants to explain the basic story types. However, his list goes on and on, and veers away from things like “man versus man” into story structures such as “dog too big” and “smart shark.”**
* Actually, there are two different versions of the scene. There are doublets of many of the scenes, and which one you get depends on precisely how you found your way there. In this case, the main difference is that in one version of the scene, you also get Jacqueline’s internal monologue about how nuts the screenwriter is.
** In fact, there actually are a surprising number of films about dangerously intelligent sharks—hence the joke.
@LH (I’m asking you personally, because you can compare):
Does not this post mean that Slavonic Greek calques, just because they are calques, enter Russian seamlessly compared to Latin borrowings in English?
And for “peace, be still”:
Weirdly for a Russian, English does not make the distinction between molchat’ “to say nothing” and to keep tishina “absence of sound”. Perhaps his suggestions (“shut up”) are rude just because English does not have a neutral word in this meaning.
Yes, I think you’re right about both.
LH, thanks.
That never occurred to me (and of course it does not imply that one method is better, rather they are just different), but the post is basically describing new words for new concepts (similar to professional vocabulary), disattached from everything in the langauge and destroying metaphors.
Russian religious register is a register of course: archaic and initially I think it was full of totally obscure words composed of Slavic elements. But this specific issue is rather uncommon.
For “don’t speak” (as opposed to “don’t make a sound”) we have a variety of options in different registers:
umolknut’ is an elevated register.
zamolchat’ is casual. As an imperative it is of course direct and rude, but you can say it to your friend when you need to listen to something, and if she trusts you, there is a chance that she won’t be offended. Impossible with “shut up”.
The more polite option is of course, “wait, pomolchi a second, I heard soemthing” – the form which means “don’t speak for a while”.
molchat’ is imperfective (as imperative it rather means keep abstaining from speaking).
It’s sad that English doesn’t use hush in casual speech anymore.
if she trusts you, there is a chance that she won’t be offended.
Impossible with “shut up”.
Actually not. You can say Shut up! to mean ‘Be quiet, you don’t want (s/o) to hear you say that!’ It is more urgent than Be quiet! Like many expressions, it is quite different if you say it in anger or not.
It’s sad that English doesn’t use hush in casual speech anymore.
U.S. Southerners use it with friends (Oh, hush! e.g. can mean ‘Don’t flatter me!’), and anyone can use it with babies.
Brief 2015 discussion here.
DE:
How many times did I shout An baanlimm! at a patient when I was operating on his eye under local …
You have touched on one of just two issues I have with the ophthalmological profession at large. (Well, the other is more to do with optometry.)
My wife and I have undergone cataract surgery (lens replacement surgery) twice each, with wonderful life-enhancing results. But not once in the lead-up were we told exactly what to expect during the operation. Nothing spoken, by anyone in the team; nothing in the copious print material we were offered about the procedure.
What does “local anaesthetic” mean to most of us? It means a treatment that will remove sensation, including sensation of pain. To most of us it does not suggest (not etymologically, not in common use) loss of ability to move the treated part. Nor does it suggest the loss of vision in the treated eye. Nor, for that matter, does the promise of “sedation” hint that one will be wafted among celestial lights oblivious to any misinformed concern to keep one’s (actually disabled, actually blinded) eye rigidly still at all costs – and not have to struggle to ignore the looming image of a scalpel in the worst conceivable location (shades of Un chien andalou).
My wife went first; she was so frightened of what was to come that she almost insisted on a general anaesthetic. All such angst could be so easily avoided. Always, always, assure the patient clearly: you will feel nothing, but also see nothing. You will be unable to move your eye, or anything near it.
So much for communication in our otherwise excellent Australian health care system. The Welsh must do this so much better; and imagine how easy it would be if we all spoke Navajo.
It is actually perfectly possible to do modern cataract surgery with topical anaesthesia, viz eye drops to numb just the surface of the eye, without the loss of eye movement, the loss of vision from “numbing” the optic nerve and the (somewhat variable) loss of sensation around the eye.
The big plus for the patient is avoiding the peribulbar/retrobulbar injection at the beginning, which can be pretty damn unpleasant if you’re unlucky. The downside is that you then have to keep your eye still yourself: most people don’t seem to find that too hard, but it’s yet another thing for the already freaked-out patient to worry about. It also makes things potentially more difficult for the surgeon, which is Bad, though most cataract surgeons get so much practice that a little extra difficulty doesn’t bother them too much. And it saves a significant amount of time, which matters if you’ve got fifteen patients on your list.
The patient can then also see what’s going on during the operation to some extent, which can be freakout material too. (In practice, the operating light tends to be too dazzling for you to see much, but then that is not very pleasant either.) On the other hand, the immediate post-op recovery is a lot faster.
There have been actual studies to find out which is preferable for the patient: they tend to show a slight preference for the local rather than topical, but there’s not much in it overall. (Which surprises me a bit: I would definitely go for the local myself, but people are all different.) There’s been a tendency for surgeons to revert to local nowadays, after a period when topical was very trendy.
… undergone cataract surgery (lens replacement surgery) twice each, with wonderful life-enhancing results. But not once in the lead-up were we told exactly what to expect during the operation. Nothing spoken, by anyone in the team; nothing in the copious print material we were offered about the procedure.
Seconded. I had lens replacement a couple of months ago. I think from @DavidE’s descriptions, that was under topical anaesthetic (drops, no needles); but that was the surgeon’s decision.
The patient can then also see what’s going on during the operation to some extent, which can be freakout material too.
It was certainly puzzling why there were such copious jets of water. And I was admonished intermittently to stop trying to focus on the whatever-they-were’s in the periphery of my vision. As if anybody wouldn’t be concerned about stuff that close to their face.
My strong impression was I was on a conveyor-belt (reinforced by being flat on my back on a gurney). The surgeon’s got the theatre for only a few hours; maximise throughput.
There have been actual studies to find out which is preferable for the patient:
Huh? You mean patients go through two operations to discover which they prefer?
I’m in favour of going with the surgeon’s preference — on the grounds avoiding their screw-ups will have more beneficial impact on the outcome than the patient’s awkwardness. But it would have been nice to go through the appearance of being asked.
During my two cataract surgeries (three years apart, because the original-equipment eyes failed at different times) I was put under so-called https://en.wikipedia.org/wiki/Twilight_anesthesia, so I have no recollection whatsoever of the actual procedure, which may be all for the best. I don’t know what the range of standard practice is in the U.S. and how much it varies by region and/or individual eye surgeon.
Huh? You mean patients go through two operations to discover which they prefer?
Many people have two eyes these days.
It was certainly puzzling why there were such copious jets of water.
That’s to keep the cornea from drying out (you’re not blinking to keep it moist.) Apart from being bad for it, drying out stops the surgeon from being able to see through it to what they’re actually doing inside the eye.
And I was admonished intermittently to stop trying to focus on the whatever-they-were’s in the periphery of my vision.
That’s because if you’re looking at the periphery you’re moving your eye (while the surgeon is trying to perform microsurgery inside it.)
I’m sorry to hear of the uncommunicative habits of my antipodean colleagues. I’ve only ever worked with one Australian opththalmologist (why would they come here, when they can earn so much more back home?) He was an arsehole, but I was reluctant to draw conclusions from such a small sample. (He was, however, very competent technically.)
Australia has (or had) a rather different approach to postgrad qualifications. In the UK, you pass your Fellowship exams by attaining the standard set by the examiners; but in Australia, there is (or was) a quota: a limited absolute number pass each year. (Bad luck if your contemporaries are all very good.) This may account for a certain arrogance on the part of the Chosen Few (a feature much in evidence in my sample.)
ROFL
I mean … d’uh you know what I mean.
In fairness, I should say that Australia has a high reputation in the world of ophthalmology, especially in certain subspecialties. Many a Brit retinal surgeon has made the Pilgrimage to Melbourne for advanced training.
I’ve also worked with some perfectly delightful Australian anaesthetists (or anesthesiologists, as the USians call them.) But anaesthetists as a group tend to be nicer than surgeons as a group. They doubtless learn patience from working with surgeons all the time.
the uncommunicative habits of my antipodean colleagues.
Actually, my surgeon is a Brit.
(why would they come here [to Britain], when they can earn so much more back home [in Aus/NZ]?)
The surgeon’s point exactly. his fellow opth-whatever surgeon is also a Brit.
My contribution to Ophthalmic Surgery Hat: local anesthesia plus sedation. I remember a needle in my arm administering the sedation, but I don’t know how they anesthetized the eye. I was surprised that my vision went dark in that one eye, but didn’t care. I was awake but didn’t realize I was sedated. I felt normal, just couldn’t get worked up about anything. The nurse told me that some people, having had one cataract surgery, opt out of sedation if they have a second one, so they can get discharged an hour quicker.
My experience of sedation from the other side is that, if the patient is scared, you end up with a patient who is now scared and confused. There are better ways (like, er, explaining what to expect beforehand, and what’s going on during the process.)
It actually surprises me that medical staff aren’t better at doing this. Even if you don’t personally care about the patient at all, being communicative and reasonably sensitive is the most objectively effective way of proceeding (and not just in this context, either.)
I suspect that it doesn’t help that the intense competition for medical school places leads to the survival of the nerdiest. In the Good Old Days you got into (London) medical schools by being
(a) the son (yup) of a doctor or
(b) good at Rugby or
(c) ideally, both.
Nowadays, you get in by having the very best A-Level results, and admissions people are terrified of being accused of bias, so they avoid even a suspicion of using a criterion that is not quantifiable.
Ghastly swots are often quite sensitive, communicative and charming, but I don’t think the features correlate strongly …
I have cataracts that are not yet bad enough to justify surgery, so I can’t talk about that.
Many people have two eyes these days.
Even those do, however, have one eye each, as Lewis Carroll said in the Chelsea Pensioners (wounded veterans in AmE) problem in A Tangled Tale, Knot X. The problem is, concisely stated, “If 70 per cent. [of the pensioners have lost an eye, 75 per cent. an ear, 80 per cent. an arm, 85 per cent. a leg: what percentage, at least, must have lost all four?” Note that Carroll uses a dot after the abbreviation cent.
anesthesiologists, as the USians call them
Hereabouts, anesthesiologists are M.D.’s with comprehensive training who specialize in anesthesia. Anesthetists (in full, certified registered nurse anesthetists) are what it says on the tin. The difference between them is about $130,000 a year, or $60 an hour; studies show the quality of care to be the same.
I always make a point of telling my an***ists that whereas it is my surgeon’s job to do this, that, or the other to my various body parts, it is their job to keep me alive during the process, which makes their job by far the more important one. Their reactions to this are various.
Yes, there’s no close UK equivalent to US “anesthetists”, though our wonderful inspirational government is trying to change that. There are nurses trained to give anaesthetics, but they don’t do so by default in the American manner (and highly trained specialist nurses are as scarce a resource as doctors, owing to years of maltreatment by the aforesaid inspirational government. Harder to import from abroad, too …)
It’s the UK which is the exception in this. It’s said to be the result of the fact that Queen Victoria made chloroform respectable by allowing it to be made known that it had been used on herself; Brit doctors thus tended to use chloroform, which offers a relatively narrow window between anaesthetising someone and er, killing them by overdosage. Americans used ether, which is much more forgiving in this respect (it’s also explosive, but having a qualified doctor administer it doesn’t make it any less explosive.) So Americans early on got used to the idea that you didn’t need to be a doctor to administer general anaesthesia.
Incidentally, nobody actually knows how general anaesthetics work.
(A comforting reflection for the next time you have one.)
Nobody knows how acetaminophen/paracetamol, CBD, lithium, or metformin work either, but at least they are single drugs. What on earth do propofol, opioids, nitrous oxide, and (of all things) xenon have in common?
A Nobel Prize awaits for the first correct answer (it really does …)
Come on, gang, if we put our heads together I know we can figure this out!
What on earth do propofol, opioids, nitrous oxide, and (of all things) xenon have in common?
The letter o. See, that wasn’t so hard!
Invaluable observations from “the other side”, DE.
It is actually perfectly possible to do modern cataract surgery with topical anaesthesia, …
… and indeed, Arab surgeons were doing cataract surgery without even topical anaesthesia (so far as we know) centuries ago. Didn’t it involve simply dislodging the lens and pushing it away within? Useful when the lens is severely opacified, we might think.
Local and topical being etymologically the same in meaning (locus and τόπος), even learnèd folk (Hatters among them) will be excused for not grokking a difference between local and topical anaesthesia (assuming they’ve even heard of the latter). In medicine it appears to be just a matter of convention.
I have always known the difference, and have often used topical in dialogue with physicians. But then, most who know topical and local in general medical contexts will be clueless when it comes to the eye. Not knowing the geography of afferent and efferent connectivities around the orbit, and not having turned our mind to the matter (why should we?), how could we form any useful idea of what to expect from a promised “local anaesthetic” in lens placement surgery?
A case study concerning the missing Rumsfeld element: not knowing what one knows. That is, not knowing that some particular item of knowledge is ours specifically and not common to humanity at large. An ophthalmologist knows about ocular innervation what even a generalist or a renal physician might not know; so what hope is there for the rest of us? Perhaps relatedly, I overheard a surgeon telling a post-op patient that the area was “still friable”; he was unable to paraphrase for his puzzled interlocutor.
In four encounters with distinct teams at two unconnected operating facilities, there was no talk of topical anaesthesia for me or my wife. The choice was between local and general. At my wife’s first encounter she was quite seriously offered general if she preferred, since she was so anxious. Ridiculous. Someone should obviously have been prompted to explain what local would involve. General comes with greater risks, ugye? Especially for cataract surgery in which patients are typically older. To say nothing of costs.
When I assist with grant applications I see “not knowing what one (specially) knows” everywhere. We all come across it, almost daily. When medical researchers want my help, I tell them I’ll listen to them about the placement of a comma on condition that they respect my views about their own field. Sometimes they are inaccurate in a basic matter they haven’t thought about since Physiology 101. More often they don’t communicate clearly. Better for me to capture that, rather than some assessor who is deciding whether they will receive $3,300,000 in funding.
Many people have two eyes these days.
Now that we don’t speak of gemination, jednook (“one-eyed”) is the classic example of a rare Serbian or Croation word with a doubled vowel.
JC:
What on earth do propofol, opioids, nitrous oxide, and (of all things) xenon have in common?
Yes, a good question. And the mystery concerning how anaesthetics work is taken as a licence among anaesthesiomavens to set themselves up as having something deep to say about “hard-problem consciousness”. For me it’s about as useless as the ignotum per ignotius efforts of quantum physicists in that domain. Penrose and his kind.
Damn. Croatian, not Croation.
Didn’t it involve simply dislodging the lens and pushing it away within?
Yep. “Couching” is the usual name for it in English. There are apparently pictures inside the Pyramids of people performing it: one of the oldest operations known to mankind.
It’s still going on. It’s mostly illegal now, which makes it difficult to study, but what evidence there is suggests that, if you have no chance of getting a cataract operation (the case for most people in the world who have significant cataract) you should get it done if you have the opportunity, if your vision is bad enough that you can’t cope with everyday activities. On balance, you’re more likely to improve than get worse if you do.
I used to see a lot of the results of it in Ghana. Locally, it’s a specialty of nomadic Fulɓe (meaning that, if goes wrong, they’ve already gone away …)
The impression I got is that practitioners vary quite a bit in skill. Some of the results looked beautiful, like expertly performed old-style “intracapsular” cataract surgery, of the sort I am just old enough to have been trained to do in my youth. (There are still potential problems further down the line, as leaving the lens in the vitreous humour can, for obscure reasons, later cause intractable glaucoma.) Some looked pretty grim; on the other hand, I presume that I never got to see lots of delighted couching customers who saw no reason to visit me because they were just fine.
It’s expensive: the Fulɓe ask for a cow in payment, which is a lot more (converted into SI units) than we did. But it’s culturally familiar, unlike going to a Western-style hospital and being operated on by aliens.
It was also the usual operation in Europe right up until the eighteenth century. Cutting into the eye to remove cataracts was extremely controversial when it was first introduced, and some of the early practitioners were pretty shady types. It was an unsafe procedure before modern(ish) suture materials became available (much later.)
Penrose and his kind
Yes indeed. Oh dear …
Classic case of a very clever man blissfully unaware the limits of his area of expertise. (I was just thinking of Murray Gell-Mann the other day, too …)
Etymology aside, local and topical anesthesia are clearly distinct (to my very humble knowledge): topical is administered on the skin, local under it. For tooth procedures you first get a topical anesthestic rubbed on your gums, to numb them against the painful injection administering the local.
They are indeed distinct: a demonstration of the etymological fallacy (and possibly also a demonstration of ignorance of Latin and Greek on the part of medical practitioners in these Latter Days of the Law. O tempora! O mores! … whatever …)
Brett can be right that P. does not understand quantum mechanics: Brett did not specify what P.’s mistake is, and I in turn don’t understand the math as well as P. likely does (but there’s not much of it in the book) – and know decisively nothing about interpretation.
But consciousness?
Queen Victoria made chloroform respectable by allowing it to be made known that it had been used on herself
By John Snow in 1853 and 1857, who founded epidemiology by tracing the London cholera epidemic of 1854 to a contaminated water pump and stopped the spread cold by removing the pump handle.
So Americans early on got used to the idea that you didn’t need to be a doctor to administer general anaesthesia.
Indeed, they expected you to be a dentist, though the first American to use ether was a medical student named William Clarke in 1842. William T. G. Morton, the first to demonstrate general dental anaesthesia publicly and successfully in 1846, was a dentist-turned-doctor (at the insistence of his in-laws, who considered dentistry infra dig.) Chloroform was first used in Scotland in 1847 for childbirth; it had been discovered simultaneously in the U.S., France, and Germany (by Justus von Liebig, the father of modern organic chemistry) in 1831.
Local and topical being etymologically the same in meaning
Medically, though, topical has always meant ‘outside the body’; the OED’s first quotation is from 1608 and is “First I will speake of such meanes as are topicall, or such as are outwardly applyed.”
one of the oldest operations known to mankind
Trepanning is of Neolithic age. While I’m at it, this timeline of anaesthesiology says that the Assyrians knew of carotid compression and used it specifically for cataract surgery. At least it’s fairly obvious why that works.
can, for obscure reasons, later cause intractable glaucoma
I should think that averaged over time people don’t outlive their cataract surgeries by all that long. In the U.S. today the average age of the first surgery is 73, and life expectancy at that point is 12-14 years.
I never got to see lots of delighted couching customers who saw no reason to visit me because they were just fine
As A. P. Herbert told us, couples do not come into divorce court to tell the judge that they are getting along swimmingly. Or words to that effect.
In the U.S. today the average age of the first [cataract] surgery is 73
I’m surprised. Almost everyone I know who had it, had it quite before then.
In West Africa, people get significant cataract about a decade earlier than in Europe, on average.
It’s not clear why this is (but then, it’s not clear why people get cataract either.)
Theories have included solar damage and/or frequent dehydration.
“Significant” is also pertinent: quite often I was operating on people who were blind (by WHO criteria) from cataract. That is rarely the case in the UK, where people get surgery when the potential gain is enough to justify the risk, which is much earlier than blindness.
In rich countries, we are prisoners of our own success, too: cataract surgery has become so good that it makes sense to operate at stages where the patient has less and less problem with the sight. (This has changed noticeably over my professional lifetime.)
Glaucoma is about four times as common in West Africans as Europeans. Again, the reason is unknown (although we know it’s genetic, rather than environmental. We don’t know why people get glaucoma either.)
Not only is it commoner: it’s more aggressive. Starts younger, progresses more rapidly.
Life expectancy in the areas I used to work is less than in the UK (though our visionary government is working on closing the gap.) But this is mostly due to very high mortality in childhood. The trick in West Africa is to get to be five years old: if you do, you;ve a good chance at your three score years and ten (or more.)
So glaucoma after couching is a real problem.
but then, it’s not clear why people get cataract either
Indeed. And why bad enough in one eye only to justify operating? (Solar damage or dehydration would presumably not be lop-sided in effect.) Although my surgeon claims my ‘good’ eye also has cataracts. (IMO it’s functioning as well as the operated-upon eye.) My theory: the poorly eye got thumped by the school bully when I was age ~13.
My theory: the poorly eye got thumped by the school bully when I was age ~13
That is actually quite possible. An expert in cataractogenesis I once knew was very keen on the idea that in cases of very asymmetrical cataract formation, old trauma was usually responsible (the main difficulty with this, it seems to me, is that you can usually elicit some history of trauma from practically anybody with enough effort. Still …)
Again, the reason is unknown (although we know it’s genetic, rather than environmental.
It may indeed be both, as in the case of myopia (per Peter Medawar), which depends on a confluence of a genetic factor and early use of close-up vision such as sewing or reading. Where almost everyone learns to read while young, it looks totally genetic; where reading is less common, it is primarily environmental.
And why bad enough in one eye only to justify operating?
I think (though of course I may be talking nonsense) that it’s a matter of random failures by bits of lens that add up to “bad enough to operate” on a normal curve rather than a uniformly applicable deterioration. Somewhat similarly, Gale had four separate cases of ductal carcinoma in situ[*], not because of any metastasis, but simply because at some random place within the breast a cell would go to the bad and start to spread. She finally decided she was fed up with local surgeries and increasingly nasty chemo, and had a mastectomy[**]. Hey presto, no more cancers.
Her breast surgeon (with whom we became pretty close) said Gale was a poster child for early and consistent mammography: she had been having them annually for years before the first cancer popped up[***]. Another year might well have brought a very different outcome, but she survived another decade and a half until the stroke and its nasty sequelae (including Covid and IV-induced kidney failure).
Gale, the indomitable[****]. “La Garde meurt mais ne se rend pas!” (l’autre mot de Cambronne).
=======
[*] Well, the first was a little past “in situ” because she hadn’t had a mammogram for almost a year; after that, they put her on an every-six-months schedule.
[**] Actually a double mastectomy; the healthy breast was removed in the same operation by a plastic surgeon, or she would have walked lopsided for the rest of her life. Fortunately, insurance covered both of them.
[***] And it was debatable; another radiologist might have decided it was nothing, as her breasts were pretty lumpy and nodular in general, not to mention just plain large. She was always in terrible pain from the “horrible breast-squishing device”, enough to make her cry out, or just cry, and she wasn’t one to cry out from pain, having lived with continuous back pain since she was 40.
Her pain was made barely tolerable in later years by continuous-release low-dose oral morphine (40 mg every 12 hours, or 3.33 mg/hour). This became harder and harder to get, until I was making three-hour journeys by bus once a month to reach a pharmacy that could consistently make it available. Our local pharmacists were very decent, but their hands were tied: (a) they couldn’t stock morphine for fear of robbery, (b) they couldn’t order it without a prescription in hand, and (c) Gale couldn’t wait 3-5 days (sometimes longer; such it is to live on an island supplied through always-crowded tunnels and bridges) for a shipment to arrive, as (d) she couldn’t get the prescription written until her previous prescription was within two days of being exhausted. And these are “business days”, which take no account of weekends, even though the morphine has a different opinion. Latter Days of the Law indeed.
Indeed, she slipped into withdrawal several times, which she characteristically toughed out. Oddly, in her youth she had worked in a methadone clinic dispensing the stuff for addicts, and was all too familiar with the early symptoms, yet she became so accustomed to ignoring her own restive body’s misbehavior that if she missed a dose by accident[*****] she would be completely puzzled why she felt “so bad this morning” until I figured it out each time, usually from the sweats. Fortunately, she kept a week’s worth of meds in little compartments (I still do this for myself), so the evidence was unequivocal.
Eventually her pain clinic, in defiance of all decent medical principles, told her they were casting her off as a patient and she had a month to find a new practitioner, because her paperwork gave them too much trouble with the Drug Exclusion Agency. After searching, I finally found someone who would administer ketamine, and her last few years were at least untroubled by anxiety about getting her medication, though unfortunately the analgesic wore off after about two days, like essentially all interventions from regular opiates to physical therapy. As I say, l’indomptable (la indomptable?)
[****] I just noticed that for some reason I malaprop this into indominable, both in speech and in writing. Wikt calls this form “nonstandard”; I wonder where and how I picked it up.
[*****] Sometimes a blessing in very deep disguise, as it gave her an extra pill at the end of a pharmaco-legally problematic month. It turned out that if she missed a dose, the next dose gave no relief; it was the dose after that what done it, presumably because her blood level had built back up.
you can usually elicit some history of trauma from practically anybody with enough effort
It doesn’t necessarily hurt to ask. What’s not clear is that you have elicited something when you get an answer. I imagine many patients are anxious people, thus anxious to please, and thus suggestible.
But anxiety can also make people speechless. A 43-year-old, otherwise well-spoken friend of mine was struck dumb at appointments with doctors. I went with him to make sure that things that had happened were reported, and questions he had were put. He had Aids, and this was in the mid-80s, when there was a lot of uncertainty on all fronts.
Those who know their lines by heart are a rather small portion of the general population, it seems to me.
The trick (from the doctor’s POV) is to shut up and listen.
“Listen to the patent: he is telling you the diagnosis.”
(I always thought this was Richard Asher, a medical attribution-magnet, but it was actually William Osler, an even more powerful attribution-magnet, who does, however, seem to have actually said it. Often.)
It sounds very new-age-y and social-worker-y, but actually it’s sound practical advice. I quite often had the experience when a teenage mutant ninja doctor of asking my boss to see a patient who I couldn’t diagnose, only to be miffed by said patient then volunteering some key piece of information to said boss that made everything clear.
Initially, I attributed this to the machinations of a malignant Fate, but eventually I realised that it was due to the ability of good diagnosticians to do the aforementioned shutting up and listening and giving the patient space to think and talk.
In rich countries, we are prisoners of our own success, too: cataract surgery has become so good that it makes sense to operate at stages where the patient has less and less problem with the sight. (This has changed noticeably over my professional lifetime.)
I recently had a rather testy exchange with an ophthalmologist who wanted to operate on my cataracts after he’d just diagnosed me (age 75) with them, to my complete surprise (I’m unaware of any effect on my eyesight; maybe I’m just used to a light fog).
@JC:
A close relative of mine is also dependent on opiate pain relief to maintain any sort of quality of life. I don’t get the impression that this causes as many problems as it would in the US*, but it creates quite enough to be going on with. Doctors are uneasy with these issues, and it’s their patients who all too often pay the price.
* In the US, the criminal Sackler family seems to have exacerbated the problem greatly, first by their drug-pushing and corruption, and then by the ill-considered government reaction to the problem those racketeers had created.
I recently had a rather testy exchange with an ophthalmologist who wanted to operate on my cataracts after he’d just diagnosed me with them, to my complete surprise
I would say that it is unwise to operate on someone who is not aware of having any actual problem …
(Though I have quite often had the experience of patients telling me post-operatively that they had no idea how much they were being affected by their cataracts until they’d experienced what it was like without them.)
That’s when you strap the whimpering patient down, reach for the knife, and say (cackling loudly) “You’ll thank me later!”
We do that a lot.
“Listen to the patient: he is telling you the diagnosis.”
That’s often difficult for me outside a medical context. I get calls from programmers who don’t know what to do about a certain bit of Java code I have flagged in a code review as problematic. My (silent) diagnosis is usually that they seem to have large holes in their knowledge of Java basics. On the other hand it’s a complex subject, so what is “basic” ?
Where to begin with an answer ?
Although I can say vicious things whenever I want, apparently I am gifted with your basic Father Christmas tone of voice in all cases. So I can ask them kindly if they know about X and Y, and they answer “no” without any resentment (at the imputation of ignorance). I then write a few lines of code to show how it works.
One of my bosses once ventured the opinion that I spend too much time during reviews writing code that corrects developers’ mistakes. In my Father Christmas voice I corrected his mistake in no uncertain terms.
(Though I have quite often had the experience of patients telling me post-operatively that they had no idea how much they were being affected by their cataracts until they’d experienced what it was like without them.)
Yes – replacing “post-operatively” by “post-phone-call”, and “cataracts” by “obstacles épistémologiques“.
Eddyshaw for cataracts, Clayton for epistemological obstacles!
Hat for King !
#
“Whenever I go out,” the King complained, “I get an impression of raised hats.”
It was seldom King William of Pisuerga spoke in the singular tense, and Doctor Babcock looked perturbed.
“Raised hats, sir?” he murmured in impressive tones.
“Nude heads, doctor.”
The Queen commenced to fidget. She disliked that the King should appear more interesting than herself.
“These earrings tire me,” she said, “take them out.”
#
Yay, Firbank!
(Now, where did I put my woolly armousk?)
My eyes developed cataracts several years apart from each other, so even if I might have gotten habituated to a “light fog” that was equally present on both sides, the contrast before operation #1 from looking at something with one eye shut and the other open and then switching which was which was striking enough to make the diagnosis convincing. I just saw in my “facebook memories” a picture from three years ago in which I was wearing eyeglasses (as I habitually had done back to ’74 or ’75), which must mean it was shortly before cataract operation #2.
the contrast before operation #1 from looking at something with one eye shut and the other open and then switching which was which was striking enough to make the diagnosis convincing
Gale reported basically the same thing after her first (and only) knee replacement: the titanium knee was painless and incredibly endurant, the bone knee was neither.
To pull out the two ObHat questions that may have gotten lost in my tl;dr screed:
1) Why do I (and some others) say and even write “indominable” for “indomitable”?
2) Is ‘the indomitable one-F’ best expressed as l’indomptable, la indomptable, or will either do?
DE:
Invaluable insights. Scales are falling from our eyes (euw).
It’s expensive: the Fulɓe ask for a cow in payment, which is a lot more (converted into SI units) than we did.
Yes, the little-known metric ox or oxxe. I can’t tell you how often I must correct infelicity with such fringe SI units, for my engineering clients. In daily use it’s near enough not to matter of course.
Unlike some others here, for me the need for lens replacement came comparatively fast and ineluctably. Fortunately I was travelling in China a good deal then, and could pick up crazily thick eyeglasses for a metric pittance. Diplopia (well, I mean double vision even in a single eye) was among the more interesting developments. I genuinely had to look closely in a musical instrument shop to tell that those were six-string and not twelve-string guitars.
Listen to the patient: he is telling you the diagnosis.
Rings true, but the parallel doesn’t work in editing. Not reliably anyway.
So anyway: Listen for the diagnosis; say the treatment options – with good understanding of what a patient will not understand unless you say it.
I have no idea, but:
That I doubt. Here’s another quote from the review (brackets in the original):
…and another:
I’m guessing nerdview: graduates of medicine assuming everyone knows that sensory and motoric nerves work the same way, so they’re shut down the same way, and wherever they happen to be close enough together, they’re shut down together. If the entire eye is anaesthetized, inevitably the sensory nerves, the motoric nerves that operate the eye muscles, and the optic nerve will all be out of service.
The one idea I’ve encountered is that they insert themselves between the two layers of the cell membranes, increasing their total thickness so that the ion channels nerves use to propagate signals end up too short, if I understood that right. No chemical reaction is involved, just hydrophobia; that allows xenon to have an effect.
And that’s not a long vowel – it’s two identical vowels with a syllable break in between.
In that domain it’s just Penrose, AFAIK. Gell-Mann has been on a few papers on long-range comparative linguistics, but not proposed anything novel there (and hasn’t claimed to).
L’.
If the entire eye is anaesthetized, inevitably the sensory nerves, the motoric nerves that operate the eye muscles, and the optic nerve will all be out of service.
It’s also the case, from what I understand, that if you immobilize the eyeball even mechanically, the brain starts to ignore the unchanging signal from the retina due to habituation, and so we can’t see anything. You can demonstrate this with modeling clay.
Hat for King !
As far as I know, the only royalist-anarchist was Tully Bascomb, Duke-Consort of Grand Fenwick. And he had abandoned anarchism some years before. I mean, Charles II was an anarchist, in the sense that he rejected the law, but only with respect to himself.
No chemical reaction is involved, just hydrophobia
Indeed, hydrophobia seems to cause anaesthesia, as when you shoot a rabid dog and he keeps coming.
L’
T.
DM:
And that’s not a long vowel – it’s two identical vowels with a syllable break in between.
Correct.
I’m guessing nerdview: graduates of medicine assuming everyone knows …
Exactly. My point.
In that domain it’s just Penrose, AFAIK.
Others too, I think. But Penrose gets lots of airtime. In Australia there was a judge of the New South Wales Supreme Court who while commuting to work wrote a book on that same Penrosicrucian theme. I’ve got it somewhere; I forget his name. Very smart physicist, hopeless philosopher of mind – in my biased but sufficently learnèd opinion (in that division of philosophy). Full of formulae and fury, signifying nothing of worth.
JC:
… if you immobilize the eyeball even mechanically, the brain starts to ignore the unchanging signal from the retina due to habituation
Subject to correction by DE: Not the brain. This time it’s all in the retina. As psych majors we did it with a small mirror mechanism coordinated to the tiny continual jittering movements of the eye – and the stabilised retinal image would bleach out within seconds.
Ah. I could reply, “The retina is a part of the brain that resides in the eye”, which is actually true embryologically speaking; the retina and the so-called optic “nerve” are on the brain side of the blood-brain barrier. But that would be pedantry.
I agree, on all counts. And you had already forfeited any right to such an appeal by your mention of a signal from the retina to the brain.