April 2010

What role does an artist have in the debate about the environment?   Surely it all depends on scientific data and predictions.  The solution must be based on interpretation of evidence and engineering solutions, mustn’t it?   But it is not as easy as all that.   There are so many factors to consider.  Take the coastline for example.  Up until now,  the initiatives have all been about  defence; holding the line, building sea walls, putting in flood gates.  It’s a siege mentality.    But now it’s different.  Rising sea levels is something we cannot oppose.   It was King Canute, who reputedly  demonstrated the limits of human potential with regard to time and tide.   A thousand years later, it seems we are discovering it all over again. 

Sea levels are going to rise, coastal erosion is going to take place all along East Anglia,  land is going to be lost.  You cannot stop it.  All you can do is try to accommodate it and limit the damage so it does not affect certain resources that just have to be sustained, like Sizewell B Nuclear Power Station, like Southwold, Lowestoft, Felixstowe and Woodbridge.   But to do this, other things may have to go.  Farmland may have to left to revert to salt marsh,  but protected by baffles and breakwaters  so that the run-off from high tidal shifts does not encourage further erosion.  Lighthouses and other coastal structures like Martello towers may have to go.  Land below sea level may have to be allowed to flood.   A controlled breach may have to be made in the elbow of the River Alde where fifty yards or so of shingle just separate from the sea,  but this would silt up Orford so that after 1000 years it would be landlocked like Winchelsea.   

But there are so many factors to consider in trying to think what might happen,  the height of the tides, the extent of coastal drift, the topography and geology of the land,  the bathygraphy,  and of course human activity.  Mr Peter Boggis, local engineer and landowner,  had taken matters into his own hands and dumped thousands of lorry loads of hard core onto the foreshore above Southwold to prevent the erosion of the soft sandy bedrock of his land, but the sea has just continued to undermine his efforts, eroding the underlying soft sand so that the hard core subsides and is also  washed away and the erosion continues.   In other placed they have tried to protect the Martello Towers and other coastal amenities, like Felixstowe Golf Course, by depositing a band of large blocks of Norwegian granite  (rock armour) along the shoreline, but rock armour is only as firm as the ground it is dumped on or leans against.  In any case, eddies are set up where the granite ends causing accelerated erosion down the coast.  There are always knock on effects.  

So where does the artist come in.  Well, as Simon expressed it,  the informed artist is an observer,  he applies a prepared mind to explore contingencies and consequences.   He has no vested interest and can therefore afford to have an  unbiased perspective and promote a conversation among other stakeholders;  environmentalists, engineers, landowners and politicians.  The perspective of the artist differs from that of the scientist because it is by necessity, exploratory and speculative and gives free rein to the imagination.  The informed artist has no idea what will happen, but, lacking vested interests, is in a good position to work out what might.  The scientist is programmed by Popperian philosophy to set up a hypothesis and try to disprove it.  He has already decided what will happen.  This scientific approach is much more rigid and focussed;  its methodology and statistics offer a ‘semblance’ of proof, but only under the rigid conditions of the ‘experiment’.  They tend to  foreclose discussion. 

In reality, we need both approaches.  The artist and scientist should work more together. The exploratory models, based on the intuition and imagination of the informed artist can help to focus and structure the scientific investigation so that it takes into account all contingencies and creates a much tighter null hypothesis that will lead to less ambiguous conclusions and more effective strategies.   

We are talking here about chaos and meaning.   Natural phenomena, like the patterns of flow that create the weather, the rivers and sea, growth and even human emotion and illness, appear chaotic and can all to readily escape the arbitrary rules we try to impose on them.   We need to make fully informed responses to them in the sure knowledge that while we cannot hope to control, we can understand and contain.  Philosophy requires the integration of imagination and reason, intuition and fact, information and speculation to achieve a more meaningful and effective response.  

 But philosophy requires freedom of thought and matters such as coastal management are highly political; people stand to lose or gain enormous sums of money.   The conversation can all too easily be railroaded by the political manipulations of landowners, farmers, entrepreneurs, developers,  powerful stakeholders with sufficient resources to employ lawyers to find loopholes.  The project could so easily be stalled and then abandoned by an incoming government, the ability to plan productively will be lost, and when the disaster occurs, the losses will be catastrophic. 

And all the while, the  unexpected can  happen.   This week there has been a massive volcanic eruption in Iceland, pumping ash high into the atmosphere and grounding all aircraft coming in and out of the UK.   Simon informed me that the last time this happened, it caused widespread famine in France and initiated the French Revolution. 

On April 15th, Simon Read, my brother,  talked about his latest exhibition of drawings to an audience at The New Cut Arts Centre in Halesworth, Suffolk.  He explained how he had abandoned the creation of works of art for their own sake many years ago, developing  his artistic intuition and skill to explore phenomena; light, movement, growth, the flow and turbulence and water; the essential meaning of things.  He has utilised the insights this has given him in the service of the debate on coastal management.                          

Easter passed me by this year.  It’s not because I’m an atheist.  I think beliefs, faiths, meanings are essential to our well being, but very personal and for me not to be culturally regulated.   I believe in love, metaphysics, forgiveness, wild places and regular exercise.  No, it was because I spent Easter in the Intensive Care Unit of the Oulu University Hospital,  fighting off Malaria.  I’ve already described the circumstances in my previous blog (But they don’t get Malaria in Finland,  10th April).  What I want to think about in this piece is the why I can hardly remember anything about it, just odd glimpses of green, a male nurst who was a professional strong man, and somewhere in there the thought that I may not get through this.  I was never unconscious (except for the brief periods when I was asleep) but I was terribly tired.     

Maybe it was the tiredness.  Maybe my body was physiologically in a state of conservation and repair.  I’d stopped fighting or thinking.  I was just existing.   With the first few bouts of fever, the sensitivity of my scalp, the persistent headache, the shivering, induced a state of despair.  I was  delirious and repeating, ‘ Oh my God, Oh my God, Oh my God’, worryingly reminiscent of my mother’s  anxiety dementia.  But then I seemed to give up and accept whatever would happen. 

 Such states of body and mind correspond to Hans Selye’s  General Adaptation Syndrome (1936),  in which he documented a stereotypical responses to stressors of all kinds, physiological, medical and psychological.   They all, he concluded, tap into the same mechanism. 

The first response to a stressor is to fight it with the sympathetic nervous system; hence the anxiety, the pain, the shivering  but this gives way to a state of sweating and sleep; a state of conservation  dominated by the parasympathetic nervous system.  You see the same response in animals, whose ultimate response to overwhelming stress is to curl up in the corner of their cage and ‘play possum’.   But both people and animals vary according to whether or how quickly they exhibit which response.     

Post Traumatic Amnesia is a kind of dissociation.  It is a response to overwhelming trauma and could be thought of as a mechanism that protects the individual from the knowledge that would destroy their sense of self, like risk of death, abuse, or the collapse of a key relationship.   It is often associated with other aspects of the post-traumatic stress reaction, such as nightmares, bodily weakness, and a variety of somatic symptoms.   If you cannot remember or deal with what has happened, then nightmares and somatic symptoms often remain to express the trauma in coded form. 

But what is the mechanism?   The stress response not only involves the autonomic nervous system (sympathetic and parasympathetic), it also includes the hypothalamo-pituitary adrenal (HPA) system, which releases a cascade of transmitters and hormones (CRF, ACTH, cortisol, aldosterone) as a compensatory mechanism to offset the damaging effects of excessive and sustained  sympathetic arousal on the body.  The HPA system maintains the function of the organism in the face of overwhelming stress, maintaining energy supplies, damping down the immune system, suppressing inflammation and pain and blocking memory.  

So can it all be explained by activation of the HPA axis?   If so, why are Chronic Fatigue Syndrome and Alexithymia (the disconnection of the emotional and rational expression), which may both coexist as part of the post traumatic reaction, associated with diminished cortisol responses.   Does this represent a state of exhaustion or switching off?  There is never an easy answer to anything. 

With a days of the Malaria being treated, the tiredness disappeared is.    I became frustrated with  being in hospital and although still weak began, to devise strategies for discharge.  The will to live had reasserted itself.  What would have been the point of remembering what it was like?

You cannot go to Cambodia and not see Angkor Wat, Suzanne responded, wide eyed and incredulous that I could even think about it.  But I wasn’t so sure.  Maybe it was the tourist thing.  I don’t like being shown around by a guide, the same inane chatter, the same non- information, the same  inability to answer any question with any depth, the air conditioned car, the inevitable tourist traps; the souvenir sellers -the same whiny pleading tone, just one dollar mister, look 10 post card – one dollar, the feelings of guilt – the amputees,  the exploitation of it all.  

Don’t get me wrong.  Angkor Wat is part of a truly magnificent and beautiful complex of temples that was hidden away in the jungle for many years until rediscovered by the French archaeologist, Henri  Mouhot in 1859.   It is a candidate for the 10th wonder of the modern world, the advertising posters proclaimed.   Some of the temples, particularly the Roulos group and Bateus Reay are so lovely especially when viewed in the evening when most of the tourists have gone, the sun is low in the sky and birds are singing – mellow russet stones amid the dense green foliage.   And then there’s the Jungle Temple, its walls and columns completely overwhelmed by the giant muscular roots of  strangler figs, a mysterious and eerie setting for the film Tomb Raider starring Angelina Jolie. 

Angkor Wat is not so much a church but a house for the Gods.  There are no big spaces.  People just walk round and visit, maybe talk to the monks.   The carved friezes on the outer wall depict scenes from the Ramayana as well as beautiful illustrations of everyday life ten centuries ago. 

I always marvel at the sheer complexity and sophistication of life so long ago.  It reminds me of the triumphant columns of ancient Rome,  the reliefs on the Temple in the Valley of the Kings in Egypt or the magnificent Assyrian reliefs in the British Museum, but you need time to reflect on such things away from the press of tourists and the self congratulatory chatter of Nak, our increasingly irritating guide. ‘I am very fit, I love fast cars, I go cycling.  I cycle back to Siem Riep in 20 minutes.’  Oh really, that’s very good, I reply for the umpteenth time, hoping he might just pick up the note of sarcasm in my voice and desist.  But he’s completely oblivious.  ‘I very strong and handsome.  I love beautiful women.’  ‘You rascal, you.’   

And then there are  the terraces of the Leper King (so named because his image has been overgrown with moss and bits of toes and earlobes are missing) and of the Elephants in Angkor Thom.  These are situated at the edge of a massive arena, larger even than the Circus Maximus in Rome and dominated by massive carvings of Garuda (which until now I thought was just the name of the Indonesian airline). 

What is interesting is not the differences of the Angkor Wat complex, but the connections, the similarities with other cultures; ancient Rome, classical Greece, the Egypt of the pharaohs, the Tigris- Euphrates valley, and of course numerous sites in India.  It’s like convergent evolution; the same patterning is built into human culture but may come to fruition at different times without any obvious link between them.  But could the Khmer kingdom have been aware of classical western civilisations?  Might there have been a link through India; Alexander the Great?   It makes you think, but you have to have time to think.  You need the mental space to discover things for yourself, to pause and reflect.  Another group of flag waving, chattering Korean tourists completely negates that.  But Nak was getting the message.

So I now know what the Nagas are and appreciate that the churning of the sea of milk by the Gods pulling on opposing nagas around Mount Meru threw up all kinds of mythical creatures including the beautiful half Goddess Apsara dancers.  I understand how each ritualised step of the Apsara dance carries a particular emotional significance.  I know about conflicts of Vishnu in his incarnation as a monkey general against the demons.  But I struggle to find any deeper significance in these myths.  So they’re relegated to the back burner.  I know about the life of Buddha, his birth into privilege, his marriage to a princess, the great renunciation, the long years of meditation under the Boddihava Tree until he attained the beatific state of Nirvana.   I find out that Angkor Wat was a garrison for the Khmer Rouge and another temple a field hospital.  I understand how the temple complex was built between the 8th and 12th centuries by workers in exchange for their food and lodging and that there were only 4 classes of people at the time; soldiers, farmers, workers and monks – a bit like in mediaeval England.  Facts at the periphery of awareness become fleshed out awaiting  further enlightenment.      

But I guess that’s what travel is about, opening the mind to possibilities, doing some work to try and understand the context, associations and meanings; a  voyage of self discovery.   I’m afraid a guided tour can prevent that.  It’s a bit like eating fast food; it disempowers and is not very nourishing, but if time is short, it can at least provide an awareness for further  study .  So despite Nak, twenty thousand Koreans and Japanese, the whining post card sellers, the guilt at being a rich tourist bastard,  I guess this was a positive experience.  Next time I shall do it free lance and on a bike.

The most serious emergency we had to deal with at Villa Maria was the lady who was brought in on the back of a bicycle, having ruptured her uterus during childbirth. We could feel the baby’s legs clearly under the abdominal wall. She needed an emergency laparotomy.  More usual procedures included lancing of breast abscesses, setting fractures, tooth extractions and treatment of gonococcal strictures.  The male ward was full of gonococcal strictures. When Dr Ivanovich, exiled from Yugoslavia for some dark reasons, marched into the ward, he would announce in his stentorian voice,  ‘Oomkoomkoomala  Booroongi?’ (Do you pass urine well?) whereupon all the patients would raise their sticks or whatever and call out, ‘Booroongi!’  The last thing they wanted was the hockey stick, a particularly nasty curved stainless steel bougie that was inserted into the urethra and forced into the bladder rupturing the strictures on the way!  What they really desired was a ‘Murphy’, a magic injection of coloured fluid that would make everything well.   

This was Uganda in 1967.  Medicine was a two tier system.  The shaman or local witch doctor looked after most illness with a combination of herbs, spells and hope.  The western doctor dealt with the rest; mainly surgical conditions. 

But much the same situation exists in Cambodia in 2010.  In Phnom Penh,  traditional medicine exists alongside conventional medicine. So when Trevor, an Australian ex-pat working for an NGO,  had a bad back he was given Clysters or cupping, where you heat the cups up, put them on the back so that the skin is sucked into the cups.  Clysters were abandoned in England by the middle of the nineteenth century.  Chinese herbs are used quite frequently. Acupuncture is used as well. But when a child fell down and started talking gibberish he was said to be suffering with the forest spirits and taken to an animist or shaman for healing.  Others would seek help from the pharmacy, some would might even go to a health clinic.     

Too many doctors in Phnom Penh  rely on tests and shiny equipment than on good clinical practice.  But equipment often breaks down, you cannot get the reagents or the parts, disposables are expensive.  Local substitutes and simple sterilisation techniques tend not to be used.  It’s  like being in a deep pit with a broken ladder, with no money to repair the ladder.

And then there are deeply entrenched prejudices to overcome.  Often a woman will not allow herself to be examined by a male doctor and will refuse Western treatment.  There is a terror of surgery.  Still too many people die because they refuse modern treatments or they can’t afford it. 

If the patient is admitted to hospital, nursing is done by the relatives who supply food, bring in the drugs, test the urine, administer  the bedpans and generally looked after the patients.  The nurses, as they are today, are  more like technicians.  This was what it was like in Villa Maria Hospital in 1967.  In Cambodia they felt that they weren’t being treated properly unless they got an intravenous infusion. 

It’s different  in the country.  Most people go to herbalists.  It’s much cheaper.  Herbalists understand the relationship between the illness, the person, the circumstance and the illness and select appropriate herbs and advice to treat them. 

In  rural Laos, patients prefer to keep their troubles to themselves, but if they fall sick, first the village elders are consulted, then the local healer or shaman.  Great faith is placed in the remedies handed down through generations.  And faith is a great healer!  Only if the disease does not respond to the shaman and time, might they think of contacting a doctor or nurse, but that takes money and a long journey into town.

There is just one doctor for every 9000 patients in rural Laos and most  want to be like western style specialists.  But there is at least one healer in every village and most women have a home spun knowledge or herbs, potions and illness.  Surely some kind of practical educational programme that recognises the best of both systems would be very valuable.  After all, the healers understand the patient and can put in the illness into a context where a combination of herb, home remedy and placebo may prove all that the patient needs, but if they also understood when the illness is not  just the result of circumstance but an infection, a cancer, a chronic inflammation that needs western medicine, then the skills of the western trained doctor can be focussed where they are most needed.             

When it comes down to it, a lot could be achieved by the application of good clinical medicine and simple bench testing,  combined with a working collaboration with local healers.

I think I was in love with her from the start as she gazed steadily at me with moist lips and knowing  eyes from the flickering monochrome  screens of Casablanca, Notorious or Spellbound.    Her face expressed vulnerability and innocence, yet also courage;  a lonely, shy girl next door trying to survive in a dangerous world.  That was her appeal.  Clearly, she needed me and only me to love and look after her.   Aa-ah!   But that was before the brisker virtues of Julie Andrews and the smouldering hot house appeal of Julie Christie.   

Ingrid Bergman was for my sixpence, the greatest film actress there ever was.  She was a natural, right from the start.  She loved the camera; it held no fears for her.  Maybe it was because she enjoyed posing for her photographer father, Julius, so much.  He once commented that one of the children he photographed would some day become famous.  Little did he know that this would be his beloved Ingrid. 

It was perhaps the tragedies of her early life that gave Ingrid that look in the eyes, that orphan appeal for love, that came straight through the camera and said ‘Hold me, look after me.  I love only you and I need you so badly!   It was irresistable!   

Ingrid was deeply affected by the story of  her parents romance. Her beautiful mother, Friedel, had fallen in love with Julius at the age of 15 when she saw him sketching in the park but had to wait seven years before her parents considered his prospects sufficient to look after daughter.  The marriage was blissfully happy, tinged only with a wistful sadness when Frieda’s first two children died in infancy.  Then Ingrid arrived and was adored by both her parents, but just two years later Freida died.  Ingrid had little recollection of her mother, and was loved and cherished by her father, but when she was  just 12, her beloved father died of stomach cancer.  At the time she consoled herself by reading  Friedel’s love letters to Julius during their long period of waiting.  This may well have implanted the longing for romantic love that shines through her eyes in all her screen parts. 

The eyes have it.  Ingrid was not an iconic beauty, she was tall, had slightly prominent teeth , refused to pluck her full eyebrows, but she looked healthy, had flawless skin and that look.  Always the look!  And she was a chum, the girl next door you could lark about with.  She had a mischievous penchant for practical jokes.  

After her father died, Ingrid was looked after by aunts and uncles, who deeply opposed her  ambitions to be an actress, but relented after exacting a promise that if she failed the auditions for the Royal Stockholm Theatre at her first attempt, she would abandon all notions of the stage as a career.  She didn’t.  She was a natural.  Film roles followed and by the age of 21 she was a celebrity.  

 Over the next ten years she moved to Hollywood and made a sequence of films.  She was an instant box office success.  People loved her natural beauty, her innocence, her girlishness, her intelligence, her sense of fun.  But Ingrid was a young woman who knew what she wanted and how to get it.  She was a bird with balls.  She would deliberately take on the difficult roles which didn’t always cast her in the best light.  She loved acting.  She loved the challenge and the celebrity.  She loved being loved.

But in real life she was always looking for that special romance, that perfect bond of intimacy, that constant warmth of feeling;  the man who would adore her, cherish her and keep her safe enough to pursue her ambitions.  She wanted the consistency of a deeply intimate relationship to give her the confidence to risk the excitement of the challenge of a new part.  The two were not always compatible and her men did not necessarily want to play house husband to the famous actress. 

She married Petter Lindstrom, who was a dentist, when she was just 22.  He was her first long term relationship and was somewhat older – maybe that was part of the attraction for her;  Petter could look after her.  But he was a bit cool and distant and tried to curb her exuberance, control her behaviour, watch her weight.   He didn’t like the way she frowned and somewhat  jealous of her relationships with her leading men, although she took her responsibities as wife and mother very seriously and was not unfaithful.   By 1943, at the height of her fame, she suggested to Petter they might get divorced.  There was nobody else but the marriage had rigidified and her career had left it behind.    

Then she met the mercurial maverick director, Roberto Rossellini.  It was love at first sight.  He was married with two children, she with one.  There were difficulties getting divorces.  People were scandalised when she moved to Rome and began living openly with Rossellini and was so soon and so  obviously pregnant.   She got terrible letters.  Offers of parts in America dried up overnight.  Besides, Rosselini made it clear that he wouldn’t allow her to go back to America or to work for any other director but him.  Their professional association arrested both their careers.  Their affair turned her from goddess to whore overnight.   She needed to draw on great reserves of courage to withstand the scandal and the separation from her adored daughter, Pia.  But she was in love and at times of her greatest loneliness and fear, she could always escape into her role in the play.    

She had three children very quickly by Rosselini, a boy,Robin and the twin girls, Isabella and Ingrid Isotto,  but her relationship with Rosselino was becoming difficult.  He worked like an artist, he wasn’t disciplined.  He used amateurs and never knew the script in advance, expecting the actors to improvise. He would suddenly leave the set and retire to his bed for days.  Ingrid was a professional, she needed consistency.  He gave her the kind of controlling inconsistency where only he knew the answers, when he was inspired enough to find them.  Ingrid longed to work with other directors, but Ingrid was his property.   Eventually after seven years, he went on an extended project to India.  He etruned after a  year with his own Indian family. 

Ingrid’s subsequent marriage with the Swedish producer, Lars Schmidt went much the same way.  She was working again, rebuilding her career and may have neglected the marriage a bit, taken Lars for granted.  There was an element of self destruct in Ingrid.  When she had the love she craved, the consistency she needed, she became insecure and bored and needed to escape into another role.  She couldn’t hang on to the marriage.  It sort of drifted away.  ‘The greatest loneliness’, she once said, ‘was the loss of intimacy with someone you had once been close to, of being with them and finding you have lost the ability to connect.’  Ingrid was always comfortable with acting.  It was life that made her nervous.

Ingrid ignored the lump in her breast because she was in a play and about to start a new film.  But by the time she got it treated, it had spread, but she carried on acting, often in great pain.  Her last project was a  portrayal  of Golda Meir; she kept her grossly swollen arm elevated all night so she could do the scene where she was required to lift both arms up in a typical Golda Meir gesture – she was that professional.  As she got older she became more forthright, if she didn’t want to do something, she didn’t. 

Impulsive, amusing, needy, sentimental,  though at the same time kind and generous and loyal to her friends,  Ingrid was never the celebrity; she could not be aloof.  She needed to connect to people too much.  But there was always something of the orphan about her, clinging on to her previous emotional securities, meaningful objects, letters, photographs, friends and dreams.   She was the beautiful empty princess.  ‘My life was always concerned with finding and holding on to love,’ she commented towards the end.  She never stopped looking for the quality of intimacy her parents had enjoyed but  never quite realised that their relationship too would have transformed into something more mundane had it lasted.  Better for us, the millions who fell  in love with the image that Ingrid expressed,  that it didn’t.  

 Ingrid Bergman died of breast cancer in 1982 on her 67th birthday.  The English edition of Charlotte Chandler’s biography ‘Ingrid’ was published by Simon and Schuster in 2007.




It lurks tucked up behind the stomach, a soft black leather purse moulded to the contours of adjacent organs like a dark shadow, the sort of organ you’d ignore, a remnant, a vestige, a redundancy.  No wonder surgeons removed the spleen with impunity if they were operating on the stomach.  But this ain’t no vestige.  Remove it at your patients peril.  People without a spleen have six times the risk of getting pneumonia and other infections and a fifty percent increase in heart attacks.  Be it ever so ‘umble,  the spleen is none the less important.  

Cut into its surface.   A red black pulp like raspberry jelly oozes out and between the pulp islands of white tissue so called Malpighian tubercles. 

The red pulp is composed of large blood spaces or sinuses lined with columns of cells.  The blood passes slowly though the sinuses and the cells filter it, destroying  bacteria, viruses, protozoa .  Similar arrangements of fixed macrophages exist in the sinuses of the liver (Kupffer Cells) and in the lymph nodes.  Together they comprise what is known as the body’s ‘reticulo-endothelial system’.  But the spleen also destroys tired red blood cells, worn out and dysfunctional after their 120 day journey round the vascular system,  recycling the haemoglobin to bile pigments and iron stores.   

The white nodules contain lymphoid follicles rich in B lymphocytes, which produce antibodies and sheaths of T lymphocytes, responsible for ‘hand to hand’ cellular conflict.  They are also major producers of monocytes, which are despatched to sites of injury where they transform into dendritic cells and macrophages and assist wound healing.  So both white and red components of the spleen are important parts of the immune system.  The same functions can be carried out in other parts of the body, but without a spleen, immunity is seriously compromised.      

In other mammals, the spleen is also an important reservoir of blood.  In the horse, 30% of the blood is stored in the spleen; in the dog 15%. Operate on a dog and you can see the spleen shrink before your eyes.  The spleen used to produce new red blood cells but loses that ability just before birth when that function is taken over by the bone marrow.   

Doctors have known about the spleen since ancient times.   It was, they thought, the origin of black humours, the source of melancholy (literally black bile) and hypochondria (below the ribs).   In the eighteenth century, women were often diagnosed as suffering from The Spleen when they were sad, bad tempered and out of sorts in mind, body and spirit.  Alternatively they might be said to be suffering from the Vapours (of the Spleen).   The term splenetic indicated that somebody was in a foul mood, though the same term in French meant sad and melancholic. 

So don’t ignore the spleen or provoke it, for if it ever gets ‘vented’, take cover immediately!

The little bastards that that bloody insect injected into me have swollen my spleen from 11cm to 15cm.  The insurance company seem to think it will explode in the low pressure environment of the aircraft cabin. It’s a solid organ, I insist!  Physics doesn’t work like that!  It’s enough to give anybody The Spleen!          

Certainly not in the north in late winter, they don’t.   How on earth would a mosquito survive temperatures of -10?  

But this illness was strange.   I know it’s cold here, but shivering that starts when you are sitting in  a warm room; the shaking that won’t stop despite going to bed in a balaclava and polar gear and covering yourself in layers of blankets; that’s not right.  And the headache, not so much a tension that twangs the muscles at the back of your neck or the throbbing nauseous pounding above the temples, but a persistent dull ache that makes your scalp so sensitive you can’t bear anyone to touch it. Then the sweating starts, the covers come off, and you have to get up in the middle of the night and wring out your cotton top and put it on the soapstone stove to dry.  

I’d been ski-ing the previous day.   A lot of falling over, frustration and swearing, but it’s a steep learning curve.  Did I really expect it to be any different on the first day?  I got very cold but lit the stove and put the heater on in the sauna.  Ah, what bliss to sit in the hot moist heat up until the temperature  was unbearable and then run outside, roll in the snow and then pick up handfuls and scrub down before returning to the hot room.   But is that what started it?  Did the exhausting day travelling, the frustrations and cold of learning to ski and the physiologic stresses of the sauna,  light up some lurking infection?  I was already harbouring a crop of cold sores.  Had something else lit up? 

It was still snowing when we awoke, light powder, blown by the wind into sharp edged slopes.  I cleared the veranda, relit the fire and generally tidied up before settling down to write.  Eero had cleared the tracks but it didn’t look inviting enough to go ski-ing.  Then about 11 o’clock, I started to shiver.  It was warm enough in the house, but my body felt cold.  The only thing to do was to get into bed.  The sweating came later that evening.  By the middle of the night my top was soaked.  What is going on.  There is nothing obvious to explain it. 

The next day I felt better enough to go ski-ing again.  I accomplished the push and glide movement and was even able to go downhill without falling over.  I skied down to the hut in the woods – such a special place.  Eero had skidooed a track along the river but the water was coming through in places.  Ice got into the ski clasps.  More delays.  I cooled down, but a simmer in  the sauna followed by a roll in the snow and another spell in the sauna  did the trick. 

It was not a good night.  My headache wouldn’t clear and I had a had to get up several times. In the morning, the shivering returned, followed by sweating.  It was late afternoon by the time the headache and fever receded, but I felt very tired.  So what was going on?  Why did the fevers seem to be coming every other day.  My God; it couldn’t be Malaria, could it?   The periodicity of the illness would fit and I didn’t taking the Malarone all the time in Indochina. I put the thought to the back of my mind and carried on.

I felt better the next morning and the outside temperature had dipped to minus 10.  The skis ran well though I was a little clumsy and fell a few times.  Upon reaching the Russian border, the headache and shivers returned.  I could not get back so phoned for a skidoo.

The paramedics were perplexed but agreed it might be Malaria, but it was Easter, I wasn’t unconscious and they wouldn’t get tests and treatment in north eastern Finland.  They left a bag of Paracetamol and advised me to drink plenty of fluid.  My urine was a very strange colour – fluorescent orange. 

Another sleepless night with headache and fever and I’d had enough.  At Kajaani District Hospital, they plated out a blood film and confirmed the diagnosis, but had to send me further across the country to Oulu University Hospital for treatment.

But Malaria? How?  I came back from South East Asia six weeks ago.  Why did I not get it out there?  Why has it come on now?   And how did I get it when I was taking prophylactics.  The last is easiest to answer.   I had agreed with the practice nurse that I only needed to take Malarone in the high risk zone and since it was not the rainy season, this was Laos.  But I also went to the jungle in Cambodia – down near the coast in the Cardamom Hills.  And there I know the buggers got me!   So was I just too fit and eager for them to get a hold then?  Did they lurk in wait somewhere in my reticulo-endothelial system until that unique Finnish combination of exhaustion and physiological stressors made them sit up.  ‘Hey, guys, it’s the sauna again.  Now’s our chance!’    

What did I know of Malaria before this?   I had learnt about it during the medical students course on Tropical Medicine I took at the London School in Keppel Street, but that’s book learning – absolutely no substitute for the real thing.  And then there are all those films where the hero, crossing Africa, gets Malaria but is saved by the care of the local tribes.  Mind you, travellers in Africa were given a concoction of Senna, Cascara and Julap, called Livingstone’s Rousers , to take for ‘everything’.  This was commonly acknowledged to be the source of the term, ‘The White Man’s Burden’.  But Malaria isn’t a romantic or even a humorous condition.  It’s a multi-system disease.  The little bastards get everywhere.   They invade the blood cells then explode them.  This releases haemoglobin which can clog up the counter current system in the kidneys and encourage the platelets to aggregate in the blood.  These mini-clots can then lodge in small blood vessels particularly in the brain where they can cause oedema, tiredness, psychosis, dementia and coma.   The parasites invade the spleen, the liver the gut, the lungs and everywhere they and their destructive debris lodge they set up inflammation.  So Malaria can result in multi-organ failure.  They used to say that a normal healthy person could stand only five bouts of fever before systems would decompensate, mechanisms run down.  That’s why I became so anxious when on my fourth bout, they kept me waiting in Oulu Triage for 7 hours before seeing a doctor.     

It might seem strange that for one of the most serious diseases, we are still using traditional treatments.   Quinine, in various derivative forms,  is still the classic treatment for Malaria.   It comes from the bark of the Cinchona tree, which grows in the Andes of South America and is named after the Duchess of Cinchon, the wife of the governor of Peru, who became ill with malaria 350 years ago, but who, after drinking a sample of infusion of drink of tree bark in water, made a full recovery.  The Jesuits spread the name of Cinchona’s healing properties throughout the tropical world, but it affected the ears causing slight deafness and tinnitus – the song of the Jesuit.   The Indians used to take quinine as tonic water.  Englishmen still enjoy a G&T on hot summer evenings. 

 Artemesinin comes from a Chinese tree.  In the year 341 AD Mr T Heng published a book on the treatment of medical emergencies in which he recommended the use of the medical herb Qinghao  from annual or sweet Wormwood for the treatment of fevers.  But it wasn’t until 1972, when Chinese scientists extracted an active principle with considerable anti-malarial activity called Qinghaosu.   

In Northern Laos, they use the tuber of the Tarot plant.  They boil up the milky flesh and drink it.  At first, it tastes sweet but when the mouth starts to itch, they know the parasite is gone. 

Each to his own.  They gave me Quinine intravenously then switched it to Artemesininin, which seemed to do the trick.   

Today, the pieces of this puzzle fell into place.  The consultant arrived in some state of animation.  ‘We have the answer.  You have Vivax Malaria.  Plasmodium vivax can have an incubation period that can vary from 17 days up to as long as a year.   It is a milder disease than falciparum but cannot be completely eradicated.  It can lurk in the liver for years, though apart from a tendency to tiredness,  does not cause undue debility and any flare ups can be promptly treated.   The enlarged spleen is a bit of a risk but should go down.

Bloody ‘ell!

Some women just have it, that magic; the ability to evoke adoration in others.  Violet did.  How else could she make four men fall in love with her so deeply that they devoted their lives to her.  First there was Gordon, whom she married, then Bill, the love of her life and then Max and finally Dennis.  With interruptions, they all lived together in a ménage a cinq until separated by death.  Apparently, they didn’t seem  unhappy with the ‘arrangement’, which for a time scandalised the sensitivities of others. It seems that they got on famously and each in their unique way serviced Violet’s needs.   Gordon expressed fidelity, Bill romance, Max intellect and Dennis courage.  We don’t know how ‘intimate’ she was with her four men, though it was an agreement between Gordon and Violet that their marriage would be celibate, and there was no indication that she granted sexual favours to Max or to Dennis.  Max it seems was charmed by her direct, risqué conversation and fascinated by her unattainability.  It was only Bill, who might have enjoyed sexual privileges, though Violet’s skill at combining ice with fire and intimacy with distance might have encouraged an addiction without ever needing to consummate the relationship.   One suspects she was more than a little fearful of intimacy.  She had the flirt’s skill of focussing her attention on a person and making them feel that for that moment they mattered more than anyone else in the world.   

The fact that she was a celebrity helped, of course.  Violet Gordon Woodhouse was one of the greatest musicians of her generation,  a virtuoso on the keyboard, who did so much to recapture the unique qualities of the harpsichord and clavichord  and interpret the compositions of Bach, Beethoven, Mozart and  Scarlatti.  People would be enraptured by her musicianship.  It was not only technically perfect, but she seemed to have a unique insight into the mind of the composer.  Hearing her play was a rare and exquisite emotional experience. She put the whole of herself into the  performance, expressing every nuance without sentimentality.  But she expended the same emotional intensity to her relationships as she did to her music.  Her vivacity could enthral her audience and leave them feeling  they had been touched by fairy dust.   Not only men but women too fell in love with her often for years.   

But it wasn’t her virtuosity that attracted people.  And it wasn’t her beauty either. She was as petite as a Dresden figurine and beautifully clothed, but she had a receding chin, large dark eyes  and a somewhat swarthy complexion inherited from her grandmother who was a Sumatran princess (although that was a closely guarded secret).  It was perhaps a certain imperiousness,  a sense of personality that made people feel they were in the audience of somebody special, a presence that demanded attention, devotion and adulation.  Her music was the expression of her personaility.  She was a Queen.  

These days we would recognize Violet as having a narcissistic personality.  Although she could be kind and compassionate when it suited her, it was her needs that always took precedence.  Violet did what she wanted, how she wanted and with whom she wanted.  She had known that she possessed a special gift from a very young age and expected to be spoilt.  She was the only one of her siblings who could charm their irascible father, and her musical gift meant, like other gifted musicians – Yehudi Menuhin comes to mind – she was set apart as the centre of attention at an early age.  Violet could always get her way though willpower and childlike magnetism.   Dorothy, her sister, was the sole repository of envy. 

But selfishness does not come without a dark side.  Violet could be autocratic and even vicious when people opposed her.  She tended to encourage the submissiveness in women she had despised in her mother and if she felt she was not being given the deference she deserved, she would create such a mood of disapproval that it would reduce those around her to a state of misery.  But she didn’t hold a grudge for long.  She always saw the best in people and had an impulsive, bubbly nature, a, provocative gaiety that was irresistible and tended to bring out the same in others.  She made people feel good – and if people feel good they tend to hang around.   She needed affirmation and she was clever enough to know how to get it and keep it. 

 Violet never had children, and could be criticised for not giving her ‘husbands’ the freedom to have families of their own.  One wonders what kind of men they were.  Some have even suggested they might have been gay, though there is no indication of that.  And they did not seem weak men.  Bill, Max and Dennis served with great bravery and distinction in the Great War, all three attaining the rank of Lt. Colonel.   No, the arrangement seemed to suit them.  And once Violet had decided she wanted something, she would not give it up.            

Violet Gordon Woodhouse was an expert. She knew how to get her needs met without compromising herself.  She had the brass neck to lead her life as she wished but still avoid the condemnation of society.  She had an imperiousness that would brook no opposition.  But as long as she got her own way, there was little malice in Violet and she gave more than she received.  She was one of these rare charismatic personalities who bring joy into people’s lives and leave the world a better place than they found it.      

As her biographer, Jessica Douglas-Home wrote,  ‘Life enhancing people are rarely perfect – their flaws are part of their vitality and their fascination. Violet possessed an exquisite selfishness, but despite her well-deserved reputation for generosity, friendship and warmth, she could also be cold and critical.  But those who loved her forgave her everything. 


Violet, the biography of Violet Gordon Woodhouse, was written be her niece, Jessica Douglas Home and published in 1996.  It’s a good read!   

Mao Tse Tung said “first the mountains, then the countryside, then the cities.” But he left out the fourth: the home front.  If you can attack the enemy at their soft under-belly, their home front, using behavioural psychology, stirring up feelings against the immorality of war, then this is a very powerful weapon.  The Vietnamese War was the first war that was waged in the lounge, on television.

The Vietcong were very good at exploiting contradictions in the enemy camp. They launched their devastating Tet Offensive at the time of the American election, bringing home to the American people, the escalating human cost of the war. Too many soldiers were being killed, too many were taking drugs; there were too many atrocities, too many massacres.  This was no longer an honourable war. The politicians, the commanders and even the soldiers were not glorified.  The draft of 300,000 young man to fight in Vietnam was already deeply unpopular.  There were student revolutions.  “Hell no, won’t go!”  Even the leaders became disenchanted.  Robert McNamara, the Minister of Defence, was one of these. Johnson could not bring himself to run for re-election; he pulled out.  This was seen by the Vietcong as a great victory.

The Americans didn’t really understand this war. They were using military solutions to fight a political war; a war of ideologies. They didn’t understand communism. They saw the world as divided, with themselves as the leader of the free world and the Russians as the leader of the enslaved world. Theirs was a mythical conflict, the stuff of romance; the American Crusaders against the Evil Empire; Uncle Sam against the wicked Uncle Ho. Communism was an informed conspiracy of hungry revolutionaries that threatened to engulf all of Asia. But there was no question they wouldn’t win it. There had not been a war that the Americans had not actually won with honour. Weren’t they always the good guys, who rode out in the sunset and defeated the evil enemy?   Remember the Alamo!  Remember their victorious intervention in both European conflicts!  And surerly God was on their side in this war.

The Americans never tried to expose their enemy’s flaws.  The North Vietnamese were committing terrorist acts against their own people all the time but the Americans never really exploited this.  And they also created  divisions in their own ranks.  They first supported Ngo Dinh Diem, then turned against him when he persecuted the monks and sacked the monasteries and did nothing to prevent his assassination by his own troops. They just failed to understand that that was the way things were done there. Politics never has been a branch of morality, but in the Camelot Court of JF Kennedy, people came to believe it was.

And they were shocked to discover their popular image in Indochina.   They were seen as the unwanted imperialist invader.   When they weren’t trying to destroy the country with bombs they were taking over its infrastructure, its water, its power supplies, its transport. They should have showed more political wisdom, less naivety, less arrogance.  They should have never have gone there in the first place.  Do these arguments have a familiar ring to them? They should!  The war in Iraq, the unwinnable war against terror – had all the same elements. 

The Americans were in Vietnam very early.  It was Eisenhower, who committed resources to support Diem and the French colonial war, picking up 70% of the bill in 1954.  But the French were defeated; they committed more and more troops, suffered unacceptable casualties, the war became unpopular in Paris, and they could not win.  Why did the Americans not read the runes? Arrogance?  Hubris?  Paranoia? 

So Kennedy pledged to prop the dominos up.  Johnson escalated the commitment,  claiming this was a war on poverty, a war on ignorance, a war on discrimination, Nixon began to withdraw troops but sent in the bombers. It was left up to Gerald Ford to disengage. But even he tried to get Congress to agree more military aid for Southeast Asia.  They refused; one suspects he was relieved.

The war in Vietnam was the longest in America’s history, and second only to World War II in terms of blood and money. So the American leaders went to war because of paranoia and they failed to end the war because they needed to save face.  The Americans realised early on that the war was unwinnable, but they wanted peace with honour. After so much bloodshed, the electorate would not accept the humiliation of defeat and it was political suicide for a president to suggest it. That’s why it went on so long.   

The Vietnam War was started without a formal declaration and ended with a false peace.  It  had no clear objective, no obvious moral imperative, no identifiable enemy.  America underestimated the task, they never issued a formal declaration of war and mobilisation took place by stealth. Air strikes would never win hearts and minds.  The draft was deeply unpopular at home.  There were too many gadgets that did not function in the jungle. But there were lessons: helicopters add mobility to jungle warfare; atrocities happen when conditions are wretched and the priority is survival.  Amid booby traps, chaos and confusion, conventional moral standards are eclipsed; any Vietnamese, even children, can be seen as the enemy.  It’s them or us.

But a war was being waged on the home front between the soldiers, who were just doing their duty and an ever growing corps of politically informed student peace demonstrators (the brutes and the draft dodgers). Besides, Uncle Ho was more of an iconic leader than LBJ, and successive American presidents failed to hang on to the hearts and minds of their own citizens. There were no heroes in this war, no victories, no spoils, just amputees and body bags. .

‘I was out walking with two friends.  The sun began to set.  Suddenly the sky turned blood red.  I paused, feeling exhausted, and leaned on the fence.  There was blood and tongues of fire above the blue black fjord and the city.  My friends walked on  and I stood there trembling with anxiety, as I sensed an infinite scream passing through nature.’ 

The Scream, Edvard Munch’s most dramatic and important work, is a potent symbol of terror, but terror of what; an existential loneliness?  – the death of God? – the meaninglessness  of materialism?   Whatever, Munch projects this unbearable dread and isolation into this painting. 

But artists always project their innermost feelings into their work.  All creative people do.  So why was Munch so anguished?   Was it the death of his mother from TB, the combination of love and fear he felt for his father, the death of his older sister from the same dread disease, his own brush with death, or his feelings of guilt and devastation from two failed love affairs?   That’s enough trauma for anybody, particularly one as sensitive as Edvard Munch.  Love and death dominate his work,  but representations of love were never joyous; they were always linked in his art with threat and death.  And it was his experience of home and family that provided the inspiration for his creative expression.     

As he wrote, ‘When I cast off on the voyage of my life, I felt like a ship made of old, rotten material sent out into a stormy sea by its maker with the words.  If you are wrecked, it’s your own fault and you will be burnt in the eternal fires of hell.’  Not the most inspiring message to set sail on.     

Edvard Munch came from the bourgeois suburb of Christiania, just outside Oslo, a society redolent of protestant hypocrisy.  The state controlled brothels were regularly inspected to ensure that their upright clients did not take VD back to their protestant wives.   But the Munches were more bohemian;  middle- class priests, scholars, artists and poets with elements of genius and  degeneration.   His father  was an impoverished army doctor.  His wife, Laura, was one of his patients and  half his age, but she shared the same deep religious convictions.  They had five children in seven years but it exhausted Laura.  She died of TB when Edvard was just 5.  Karen, Laura’s sister, brought a breath of fresh air into the family home.  It was she who encouraged Edvard to draw.  By the age of 12, he was spending many hours a day drawing.  But Edvard’s father was not consoled by Karen; he sank into his own introspections and used to frighten the children with stories of Edgar Allen Poe and warnings that their mother was watching them.  Edvard suffered from nightmares and nearly died of TB when he was 13, and the following year his elder sister, Johanna died. 

But Edvard found solace in drawing and painting and confidence in his success.  At 22 he exhibited his work at the World Fair in Antwerp and was embarking on an affair with a married woman.  ‘Young and inexperienced from a monastery like home, knowing nothing of this mystery, I met a salon lady and stood before the mystery of women.’   No doubt this ‘education’ informed  his depictions of women as  vampires, creatures that would seduce, tempt and destroy men.  ‘Behind the prettiness lies death; the medusa’s head.’   Whereas Ibsen was writing about the entrapment of women by marriage, Munch saw men as the victims.   

In 1889 he went to Paris, where he came into contact with the Impressionists, but it was Van Gogh’s suicide that probably had the greatest impact on him.  The  shock opened up a space in Edvard’s painting.  He came to believe that painting should not just be about representation, it should express those feelings, emotions, states that you couldn’t see.

‘People will understand  what is sacred in them and will take off their hats as if in church  I shall paint living people who breathe and feel and suffer and love’. 

In 1892, Munch was invited to exhibit his paintings in Berlin, but his exhibition upset the sensibilities of the narrative, romantic style of German art.  Munch painted it as it was.  His Frieze of Life, depicted the trajectory of a love affair through the kiss, love, pain, jealousy, betrayal and despair.    Painting for Munch did not express one moment, but could, like a poem or a novel, illustrate an unfolding narrative.   The exhibition was withdrawn after a week.  This pleased the entrepreneur in Munch immensely as he realised that the negative publicity would do him nothing but good. 

But appeals to his darker needs were never far away.  His relationship with Tulla Larson, the 30 year old unmarried daughter of a rich wine merchant  was one from which neither would ever recover.  He was shocked and frightened by the strength of Tulla’s passion.  He expressed his regret that this on-off affair has robbed him of 3 years of creative life and the use of his left hand, which was wounded when his pistol was accidentally discharged  during their final argument.  Bereft and traumatised, he threw himself into excesses of work, drink and gambling.  He became ill, paranoid, developed hallucinations and in 1908 broke down and was admitted to Dr Jacobsen’s clinic.  In time, he recovered and carried on working until his death in 1944, though some said that the life, the intensity had gone out of his work.                      

Before I knew anything about Munch, I was using his images to illustrate my talks on the bodily expression of human emotion.  His  expressive paintings  capture the anguish of emotion more clearly than any other artist I know.  He was a man on a mission, a mission to discover meaning through the depiction of love, fear,melancholia and death.  He believed that you had to spill your guts for art.  So Munch made art from his life, his depressed sick childhood, the deaths of his mother and sister, his morbidly introspective father, his tortured romances.  He marketed the flaws in his personality for people to recognise and identify with.  He offended people, of course.   Even Adolf Hitler regarded his work as degenerate art.  With such enemies, however, he had no need of friends.  His legacy was assured. His emotionally charged landscapes had launched the German expressionist movement while his ability to get under the skin to the raw bleeding core of his subjects inspired such contemporary masters as Frances Bacon and Lucian Freud.      

Schopenhauer once wrote,  ‘The limit of the power of art is its inability to reproduce a scream.’  Perhaps Munch wished to show him his error.

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