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26 SEPTEMBER, 2012

The History of Medicine in 250 Milestones

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From witch doctors to human cloning, a visual chronology of the human quest to master health.

Last year, futurist and author Clifford Pickover brought us The Physics Book — a lavish chronology of physics milestones, from the Big Bang (13.7 billion BC) to Quantum Resurrection (> 100 trillion), and one of the 11 best science books of 2011. This season, he follows up with The Medical Book: From Witch Doctors to Robot Surgeons, 250 Milestones in the History of Medicine (public library) — an equally impressive tome inviting us on “a vast journey into the history of medicine that includes eminently practical topics along with the odd and perplexing.” From practical inventions like eyeglasses (1284), condoms (1564), and cochlear implants (1977) and to era-defining innovations like hospitals (1784), the discovery of viruses (1892), and psychoanalysis (1899) to politicized subjects like abortion (70 A.D.), health insurance (1883), and the birth control pill (1955), the short entries, arranged chronologically from 10,000 B.C. (“witch doctor”) to 2008 (“human cloning”), offer a concise introduction and overview of each medical milestone, alongside a full-page image — ranging from an archeological artifact to a Renaissance painting to bleeding-edge photomicroscopy –that captures its essence and cultural significance.

Pickover writes in the introduction:

When colleagues ask me what I feel are the greatest milestones in medicine, I usually offer three events. the first involves the use of ligatures to stem the flow of blood during surgeries, for example, as performed by the French surgeon Ambroise Paré (1510-1590). he promoted ligature (e.g., tying off with twine) of blood vessels to prevent hemorrhage during amputations, instead of the traditional method of burning the stump with a hot iron to stop bleeding. The second key milestone includes methods for decreasing pain through general anesthetics such as ether, attributed to several American physicians. The third breakthrough concerns antiseptic surgery, which was promoted by British surgeon Joseph Lister (1827-1912), whose use of carbolic acid (now called phenol) as a means of sterilizing wounds and surgical instruments dramatically reduced postoperative infections.

The Medical Book comes as a fine complement to Hidden Treasure, which explored 10 centuries of visualizing the human body in medicine, and The Art of Medicine, a 2,000-year visual journey into our collective corporal curiosity.

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25 SEPTEMBER, 2012

William James on Habit

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“We are spinning our own fates, good or evil, and never to be undone. Every smallest stroke of virtue or of vice leaves its never so little scar.”

“We are what we repeatedly do,” Aristotle famously proclaimed. “Excellence, then, is not an act, but a habit.” Perhaps most fascinating in Michael Lewis’s altogether fantastic recent Vanity Fair profile of Barack Obama is, indeed, the President’s relationship with habit — particularly his optimization of everyday behaviors to such a degree that they require as little cognitive load as possible, allowing him to better focus on the important decisions, the stuff of excellence.

I found this interesting not merely out of solipsism, as it somehow validated my having had the same breakfast day in and day out for nearly a decade (steel-cut oats, fat-free Greek yogurt, whey protein powder, seasonal fruit), but also because it isn’t a novel idea at all. In fact, the same tenets Obama applies to the architecture of his daily life are those pioneering psychologist and philosopher William James wrote about in 1887, when he penned Habit (public library; public domain) — a short treatise on how our behavioral patterns shape who we are and what we often refer to as character and personality.

When we look at living creatures from an outward point of view, one of the first things that strike us is that they are bundles of habits. In wild animals, the usual round of daily behavior seems a necessity implanted at birth in animals domesticated, and especially in man, it seems, to a great extent, to be the result of education. The habits to which there is an innate tendency are called instincts; some of those due to education would by most persons be called acts of reason. It thus appears that habit covers a very large part of life, and that one engaged in studying the objective manifestations of mind is bound at the very outset to define clearly just what its limits are.

James begins with a strictly scientific, physiological account of the brain and our coteries of ingrained information patterns, exploring the notion of neuroplasticity a century before it became a buzzword of modern popular neuroscience and offering this elegant definition:

Plasticity … in the wide sense of the word, means the possession of a structure weak enough to yield to an influence, but strong enough not to yield all at once.

He then bridges the body and the mind to shed light on how “habit loops” dominate our lives:

What is so clearly true of the nervous apparatus of animal life can scarcely be otherwise than true of that which ministers to the automatic activity of the mind … Any sequence of mental action which has been frequently repeated tends to perpetuate itself; so that we find ourselves automatically prompted to think, feel, or do what we have been before accustomed to think, feel, or do, under like circumstances, without any consciously formed purpose, or anticipation of results.

He eventually brings this lens to social science, painting a somewhat ominous picture of habit as a kind of trance:

Habit is thus the enormous fly-wheel of society, its most precious conservative agent. It alone is what keeps us all within the bounds of ordinance, and saves the children of fortune from the envious uprisings of the poor. It alone prevents the hardest and most repulsive walks of life from being deserted by those brought up to tread therein. It keeps the fisherman and the deck-hand at sea through the winter; it holds the miner in his darkness, and nails the countryman to his log cabin and his lonely farm through all the months of snow; it protects us from invasion by the natives of the desert and the frozen zone. It dooms us all to fight out the battle of life upon the lines of our nurture or our early choice, and to make the best of a pursuit that disagrees, because there is no other for which we are fitted, and it is too late to begin again. It keeps different social strata from mixing. Already at the age of twenty-five you see the professional mannerism settling down on the young commercial traveller, on the young doctor, on the young minister, on the young counsellor-at-law. You see the little lines of cleavage running through the character, the tricks of thought, the prejudices, the ways of the ‘shop,’ in a word, from which the man can by-and-by no more escape than his coat-sleeve can suddenly fall into a new set of folds. On the whole, it is best he should not escape. It is well for the world that in most of us, by the age of thirty, the character has set like plaster, and will never soften again.

This brings us to the question of education, whose responsibility it is to chaperone the formation of habit and curtail the very daily deliberations of which Obama has gladly rid himself:

The great thing, then, in all education, is to make our nervous system our ally instead of our enemy. It is to fund and capitalize our acquisitions, and live at ease upon the interest of the fund. For this we must make automatic and habitual, as early as possible, as many useful actions as we can, and guard against the growing into ways that are likely to be disadvantageous to us, as we should guard against the plague. The more of the details of our daily life we can hand over to the effortless custody of automatism, the more our higher powers of mind will be set free for their own proper work. There is no more miserable human being than one in whom nothing is habitual but indecision, and for whom the lighting of every cigar, the drinking of every cup, the time of rising and going to bed every day, and the beginning of every bit of work, are subjects of express volitional deliberation.

He proceeds to offer three maxims for the successful formation of new habits:

  1. The acquisition of a new habit, or the leaving off of an old one, we must take care to launch ourselves with as strong and decided an initiative as possible. Accumulate all the possible circumstances which shall reenforce the right motives; put yourself assiduously in conditions that encourage the new way; make engagements incompatible with the old; take a public pledge, if the case allows; in short, envelop your resolution with every aid you know. This will give your new beginning such a momentum that the temptation to break down will not occur as soon as it otherwise might; and every day during which a breakdown is postponed adds to the chances of its not occurring at all.
  2. Never suffer an exception to occur till the new habit is securely rooted in your life. Each lapse is like the letting fall of a ball of string which one is carefully winding up; a single slip undoes more than a great many turns will wind again. Continuity of training is the great means of making the nervous system act infallibly right … It is surprising how soon a desire will die of inanition if it be never fed.
  3. Seize the Very first possible opportunity to act on every resolution you make, and on every emotional prompting you may experience in the direction of the habits you
    aspire to gain. It is not in the moment of their forming, but in the moment of their producing motor effects, that resolves and aspirations communicate the new ‘set’ to
    the brain.

Of course, as is often the case with famous advice, James immediately follows up with a disclaimer that echoes Joan Didion’s eloquent definition of character:

No matter how full a reservoir of maxims one may possess, and no matter how good one’s sentiments may be, if one have not taken advantage of every concrete opportunity to act, one’s character may remain entirely unaffected for the better. With mere good intentions, hell is proverbially paved. And this is an obvious consequence of the principles we have laid down. A ‘character,’ as J. S. Mill says, ‘is a completely fashioned will’; and a will, in the sense in which he means it, is an aggregate of tendencies to act in a firm and prompt and definite way upon all the principal emergencies of life. A tendency to act only becomes effectively ingrained in us in proportion to the uninterrupted frequency with which the actions actually occur, and the brain ‘grows’ to their use.

He makes a case, once again, for the consistency of effort, offering one final maxim:

Just as, if we let our emotions evaporate, they get into a way of evaporating; so there is reason to suppose that if we often flinch from making an effort, before we know it the effort-making capacity will be gone; and that, if we suffer the wandering of our attention, presently it will wander all the time. Attention and effort are … but two names for the same psychic fact.

[…]

Keep the faculty of effort alive in you by a little gratuitous exercise every day. That is, be systematically ascetic or heroic in little unnecessary points, do every day or two something for no other reason than that you would rather not do it, so that when the hour of dire need draws nigh, it may find you not unnerved and untrained to stand the test. Asceticism of this sort is like the insurance which a man pays on his house and goods. The tax does him no good at the time, and possibly may never bring him a return. But if the fire does come, his having paid it will be his salvation from ruin.

He cautions about the gravity of our habitual choices, however small they may seem:

The physiological study of mental conditions is thus the most powerful ally of hortatory ethics. The hell to be endured hereafter, of which theology tells, is no worse than the hell we make for ourselves in this world by habitually fashioning our characters in the wrong way. Could the young but realize how soon they will become mere walking bundles of habits, they would give more heed to their conduct while in the plastic state.

We are spinning our own fates, good or evil, and never to be undone. Every smallest stroke of virtue or of vice leaves its never so little scar. … Nothing we ever do is, in strict scientific literalness, wiped out.

James concludes with a timeless validation of grit as the secret to success:

Let no youth have any anxiety about the upshot of his education, whatever the line of it may be. If he keep faithfully busy each hour of the working-day, he may safely leave the final result to itself. He can with perfect certainty count on waking up some fine morning, to find himself one of the competent ones of his generation, in whatever pursuit he may have singled out. Silently, between all the details of his business, the power of judging in all that class of matter will have built itself up within him as a possession that will never pass away. Young people should know this truth in advance. The ignorance of it has probably engendered more discouragement and faint-heartedness in youths embarking on arduous careers than all other causes put together.

Habit is now in the public domain and is available for free in its entirety in multiple formats.

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25 SEPTEMBER, 2012

Measurement: Exploring the Whimsy of Math through Playful Patterns, Shape and Motion

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“What makes a mathematician is not technical skill or encyclopedic knowledge but insatiable curiosity and a desire for simple beauty.”

Math, as Vi Hart’s stop-motion doodles, Robin Moore’s string portraits, and Anatolii Fomenko’s stunning black-and-white illustrations have previously shown us, can be the conduit of great fun and great beauty. In Measurement (public library), mathematician Paul Lockhart invites us to “make patterns of shape and motion, and then [try] to understand our patterns and measure them.” (Because, lest we forget, we have a natural penchant for patterns.) What results as we step away from physical reality and immerse ourselves in the imaginary — and imaginative — world of mathematical reality is a thing of infinite beauty and infinite fascination.

Lockhart writes in the introduction:

Physical reality is a disaster. It’s way too complicated, and nothing is at all what it appears to be. Objects expand and contract with temperature, atoms fly on and off. In particular, nothing can truly be measured. A blade of grass has no actual length. Any measurement made in the universe is necessarily a rough approximation. It’s not bad; it’s just the nature of the place. The smallest speck is not a point, and the thinnest wire is not a line.

Mathematical reality, on the other hand, is imaginary. It can be as simple and pretty as I want it to be. I get to have all those perfect things I can’t have in real life. I can never hold a circle in my hand, but I can hold one in my mind.

[…]

The point is I get to have them both — physical reality and mathematical reality. Both are beautiful and interesting… The former is important to me because I am in i, the latter because it is in me.

Lockhart underpins this excitement with a fair warning:

Mathematical reality is an infinite jungle full of enchanting mysteries, but the jungle does not give up its secrets easily. Be prepared to struggle, both intellectually and creatively.

And yet, he’s quick to reassure that the gold standard of math, not unlike that of science, isn’t the answer but the driver of curiosity:

What makes a mathematician is not technical skill or encyclopedic knowledge but insatiable curiosity and a desire for simple beauty.

But what makes Lockhart particularly compelling is his ability to relate mathematics to parallel concepts from disciplines and aspects of life that are more familiar, more comfortable, more ingrained in our everyday understanding of the world — for instance, in comparing math to storytelling:

A mathematical argument [is] otherwise known as a proof. A proof is simply a story. The characters are the elements of the problem, and the plot is up to you. The goal, as in any literary fiction, is to write a story that is compelling as a narrative. In the case of mathematics, this means that the plot not only has to make logical sense but also be simple and elegant. No one likes a meandering, complicated quagmire of a proof. We want to follow along rationally to be sure, but we also want to be charmed and swept off our feet aesthetically. A proof should be lovely as well as logical.

In a nod to the value of “useless” knowledge and figuring things out, Lockhart argues:

People don’t do mathematics because it’s useful. They do it because it’s interesting … The point of a measurement problem is not what the measurement is; it’s how to figure out what it is.

He ultimately offers several pieces of advice on engaging with math:

  1. The best problems are your own. Mathematical reality is yours — it’s in your head for you to explore any time you feel like it… Don’t be afraid that you can’t answer your own questions — that’s the natural state of the mathematician.
  2. Collaborate. Work together and share the joys and frustrations. It’s a lot like playing music together.
  3. Improve your proofs. Just because you have an explanation doesn’t mean it’s the best explanation. Can you eliminate any unnecessary clutter or complexity? Can you find an entirely different approach that gives you deeper insight? Prove, prove, and prove again. Painters, sculptors, and poets do the same thing.
  4. Let a problem take you where it takes you. If you come across a river in the jungle, follow it!
  5. Critique your work. Subject your arguments to scathing criticism by yourself and others. That’s what all artists do, especially mathematicians… For a piece of mathematics to fully qualify as such, it has to stand up to two very different kids of criticism: it must be logically sound and convincing as a rational argument, and it must also be elegant, revelatory, and emotionally satisfying. [But don't] worry about trying to hold yourself to some impossibly high standard of aesthetic excellence.

Lockhart elaborates on the latter point with a poignant reflection that applies to math just as much as it does to life itself:

Part of the problem is that we are so concerned with our ideas being simple and beautiful that when we do have a pretty idea, we want so much to believe it. We want it to be true so badly that we don’t always give it the careful scrutiny that we should read. It’s the mathematical version of ‘rapture of the deep.’ Divers see beautiful sights that they forget to come up for air. Well, logic is our air, and careful reasoning is how we breathe.

Indeed, much of math sounds an awful lot like the art of living itself: Take for instance, that same old fear of failure that often stands in the way of creativity, which also holds us back from immersing ourselves in the art of figuring things out:

The important thing is not to be afraid. So you try some crazy idea, and it doesn’t work. That puts you in some pretty good company! Archimedes, Gauss, you and I — we’re all groping our way through mathematical reality, trying to understand what is going on, making guesses, trying out ideas, mostly failing. And then every once in a while, you succeed… And that feeling of unlocking an eternal mystery is what keeps you going back to the jungle to get scratched up all over again.

Here’s a little teaser for the whimsical jungle of mathematical reality and the logical aesthetic of math:

Measurement, from Harvard University Press, comes seven years after Lockhart’s exquisite critique of math’s tragic fate in contemporary education, A Mathematician’s Lament: How School Cheats Us Out of Our Most Fascinating and Imaginative Art Form.

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