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An interesting paper, possibly relevant to acupuncture

Structure and Distribution of an Unrecognized Interstitium in Human Tissues

This paper is very interesting in its own right and I think may have relevance to acupuncture. Although the focus is mainly on internal organs the findings also relate to the skin and connective tissue generally. The authors describe a previously unknown but widespread system of fluid-carrying channels of potential clinical significance.

"We propose here a revision of the anatomical concepts of the submucosa, dermis, fascia, and vascular adventitia, suggesting that, rather than being densely-packed barrier-like walls of collagen, they are fluid-filled interstitial spaces. The presence of fluid has important implications for tissue function and pathology. Our data comparing rapidly-biopsied and frozen tissue with tissue fixed in a standard fashion suggest that the spaces we describe, supported and organized by a collagen lattice, are compressible and distensible and may thus serve as shock absorbers."

This mechanism is thought to occur in the skin under mechanical compression and in the musculosketal system during activity.

"In sum, while typical descriptions of the interstitium suggest spaces between cells, we describe macroscopically visible spaces within tissues – dynamically compressible and distensible sinuses through which interstitial fluid flows around the body. Our findings necessitate reconsideration of many of the normal functional activities of different organs and of disordered fluid dynamics in the setting of disease, including fibrosis and metastasis."

Whether this discovery will ultimately prove to have relevance for acupuncture remains to be seen, but it's certainly something we need to be aware of. For example, it may be an additional reason for rejecting skin pressure as a valid control in acupuncture trials. So watch this space (literally).

Book review: Christian Beginnings, by Geza Vermes

See my 570 other reviews

Geza Vermes, who died in 2014, was an advocate for the view that Jesus can only be properly understood in a Jewish context, something he argued in more than twelve books; see, for example, The Changing Faces of Jesus. He portrays Jesus as a rural Galilean prophet, exorcist and healer who preached the imminent arrival of the Kingdom of God but made no claim to divine status.

Christian Beginnings, as Vermes explains in his introduction, takes the story further. It is "an attempt to sketch the historical continuity between Jesus portrayed in his Galilean charismatic setting and the first ecumenical council held at Nicaea in AD 325, which solemnly proclaimed his divinity as a dogma of Christianity".

Vermes is not the first to describe this extraordinary transformation, of course, but he does so in an unusual way. Naturally he uses the New Testament sources, especially Paul and the Fourth Gospel, but he also draws on other sources that are likely to be unfamiliar or even unknown to most non-specialists. These include, for example, the Didache, or Teaching of the Apostles. Written in the late first century, it describes the initiation of new church members and the organisation of the infant church. It has been said to be one of the most significant literary discoveries in primitive Christianity. A little later than the Didache we have the Epistle of Barnabas, which was nearly included in the New Testament.

The two documents present differing views of Jesus. For the Didache, whose author was evidently Jewish, Jesus is the Servant of God but not himself divine. He is a great teacher but not a superhuman being. Barnabas, in contrast, refers to Jesus as Son of God, who is pre-existent from eternity; this is similar to the Jesus of the Fourth Gospel. The author of Barnabas was apparently a Gentile and there is an implied criticism of Judaism in the way the text is framed as a dispute between 'us' and 'them'.

Between the end of the first century and the middle of the second century there is a group of writers known as the Apostolic Fathers: 1 and 2 Clement, Ignatius, Polycarp, Hermas and Diognetus. They provide an idea of how the church was developing at this time and of progressive changes that were occurring in Christians' view of Jesus as he moved towards full divinity.

In the late second and early third centuries we find the "Three Pillars of Wisdom": Tertullian, Clement of Alexandria, and Origen. All made important contributions to Christianity although both Tertullian and Origen were later declared to have been heretical. At this period Christianity faced danger externally, from the hostility of Rome, and also internally, from conflict with Gnosticism. Both problems were addressed by these writers.

Origen is particularly interesting because although he was very influential in early Christianity he is little known to non-specialists today except perhaps for having castrated himself for religious motives at the age of eighteen.

The power and the originality of the teaching of Origen were bound posthumously to inspire conflicting attitudes towards the great Alexandrian. His admirers worshipped him and his critics subjected his name to vituperation. Attacks on Origenism, on ideas some of which he actually held and others erroneously attributed to him, continued for centuries. The chief points of controversy concerned the doctrine of the pre-existence of souls, Origen's purported rejection of the literal sense of the Bible in favour of allegorical exegesis and his denial of the eternity of hell. … The greatest mind and most creative thinker of early Christianity was anathematized by the church of second-rate followers.

Like other Christian writers at this time, Origen struggled with the theology of the Trinity. The Trinitarian conundrum is in fact surely insoluble; the modern Roman Catholic church describes it as a Mystery, which seems to mean it resembles a Zen koan (the sound of one hand clapping). The problem is to explain why saying that God contains three Persons, Father, Son, and Holy Spirit doesn't imply there are three Gods.

The only escape route away from the trap of suspected formal polytheism was by denying equal status to the various persons within the single Deity. Only the Father was fully the God; the Son was only the second or lower God and the Holy Spirit, something vague and unspecific, floating somewhere below the Son.

This idea, Vermes thinks, was what prevailed in the whole church before Nicaea and was already foreshadowed by Paul and John. It was expressed clearly and logically by Arius, the founder of the Arian heresy. But it "was challenged, attacked and finally overturned by a minority of bishops with the backing of the emperor at the Council of Nicaea".

Even so, the arguments continued for over half a century, until the Emperor Theodosius declared Arianism illegal in 381. Divergent opinions were no longer tolerated.

Christianity, as generally understood in the light of its Gentile development, is focused not on the genuine existential spiritual legacy of the Jewish Jesus, but on the intellectual acceptance of the divine Christ and his superhuman existence within the mystery of the church's triune Godhead.

The book provides a readable if rather detailed account of the arguments that shaped Christianity in the first few centuries. Its chief interest will probably be to Christians who are curious about the early years of their faith and are prepared to look at the question through critical but not hostile Jewish eyes. Secularists may well find the whole subject esoteric and obscure, but given the continuing importance of religion in general and Christianity in particular in the modern world, some will probably feel it worth while to explore this unfamiliar territory.

%T Christian Beginnings
%S From Nazareth to Nicaea (AD 30–325)
%A Vermes, Geza
%I Allen Lane
%C London
%D 2012
%P xvi+243pp
%K religion
%O kindle version downloaded from, 2018

Book review: This is Going to Hurt, by Adam Kay

See my 570 other reviews

Adam Kay is now a comedian and writer for television and film. Before that he was a junior doctor in the NHS for six years and this book contains the diaries he kept at that time. We follow him as he embarks on his career after qualifying, and quickly finds that his medical training has not prepared him for what awaits him: not just responsibility for the lives of his patients but frequent relocations, substandard accommodation, and above all lack of sleep. The experiences he describes will no doubt surprise anyone whose idea of hospital medicine has been formed by a diet of medical soaps but will be entirely familiar to readers who have been there themselves.

Like all other British doctors, after qualifying he became a House Officer (the lowest rank in the medical hierarchy); a year later, as a Senior House Officer, he had to decide what direction his future career should take. He chose obstetrics and gynaecology, known as 'obs and twats' at his medical school, thereby ensuring four or five more years of sleeplessness (he should have chosen dermatology). All this is vividly described; the tone of the writing is racy and witty with lots of good jokes and well supplied with expletives (not deleted)—more MASH than Holby.

Eventually Adam reached the rank of Senior Registrar, meaning he was one step away from becoming a consultant. Then came disaster. He carried out a caesarian section which went wrong. The patient had an undiagnosed placenta praevia (the placenta blocking the exit from the womb). The baby was dead and the mother bled heavily and was saved only at the cost of a hysterectomy (this was her first pregnancy).

No one blamed Adam for what happened, but he was unable to come to terms with it and, a few months later, decided to quit—a victim of 'burn-out'. Particularly in the more stressful specialties such as obstetrics this isn't an unusual story, as he makes clear.

Throughout the book there is an underlying thread of barely restrained anger at the way the good will of the junior doctors is being exploited, and this culminates in an open letter to the Secretary of State for Health printed at the end of the book, in which this is made explicit. Everyone who holds this office, Adam suggests, should have to work some shifts alongside junior doctors.

Not the things you already do, when a chief executive shows you round a brand-new ward that's gleaming like a space station. No: palliate a cancer patient; watch a trauma patient have their leg amputated; deliver a dead baby. Because I defy any human being, even you, to know what the job really entails and question a single doctor's motivation.

The book exemplifies Horace Walpole's epigram: life is a comedy to those that think, a tragedy to those that feel. Adam both thinks and feels, but the feeling won out in the end.

%T This is Going to Hurt
%S Secret Diaries of a Junior Doctor
%A Kay, Kay
%I Picador
%C London
%D 2017
%G ISBN 978-1-5098-5864-4
%K autobiography, medicine
%O electronic edition
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Book review: Somewhere Towards the End, by Diana Athill

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This book was written in old age, when Athill was about to turn 90 (she is now 100). But although the experience of growing old and facing death is one of her themes, it is far from the only one. She writes perceptively about people she has known and objectively and frankly about herself and her earlier life, including her many love affairs. Hers has been a pretty full life, one would think, but she wishes it could have been even fuller—one regret is that she would have liked to learn modern Greek and to have lived and worked in Greece.

Although she had previously published a collection of short stories and a novel, she didn't think of herself as a writer, and discovering in old age that she could produce memoirs that people wanted to read came as a delightful surprise. It shouldn't have done. She is more of a 'writer' than are many of those who ostentatiously describe themselves as such.

I enjoyed the book but it wasn't until I started to write this review that I realised whom she reminded me of as a writer: the sixteenth-century French essayist Montaigne, which is praise indeed. Sarah Bakewell, in her biography of Montaigne, writes:

Whereas most of his contemporaries struck literary postures and tried to impress their readers, Montaigne wrote in a colloquial informal style. Reading him, we are admitted to his innermost thoughts and emotions. He made no attempt to follow a train of argument or put forward a philosophy, and the titles of his essays often have little connection with their content.

All this could be said of Athill too (except that her chapters don't have titles). The book is quite short, because she favours simplicity and brevity (something she says she learned in her working life as an editor). Of her plan for an earlier book, about her life in publishing, she says: "It would be short, but that wouldn't matter because to my mind erring on the side of brevity is always preferable to its opposite." If only more writers thought this!

She is objective about her own character and what some might see as faults. For example, she is not a natural carer; she has had to take on this role at least twice, once for her mother and once for a former lover, but she didn't enjoy it and felt she could have done better. In the case of the lover she found herself acting like a wife although they weren't married; in fact, she never wanted to be married and preferred to be 'the other woman'.

She felt nothing for babies and didn't want children herself—she terminated an unwanted pregnancy on one occasion. Yet when she became pregnant again, at the age of forty-three, she found to her surprise that she was overjoyed at the prospect of becoming a mother. But it didn't happen. In the fourth month she had a miscarriage that almost killed her.

As she recovered from her near-fatal haemorrhage Athill experienced "a great wave of the most perfect joy [which] welled up and swept through me. I AM STILL ALIVE! It filled the whole of me, nothing else mattered. It was the most intense sensation I have ever experienced." So intense was the joy that it almost completely overwhelmed regret at the loss of the pregnancy.

Once again I'm reminded of Montaigne. He too had a near-fatal illness after a riding accident. Outwardly he appeared to be in agony yet he was inwardly completely at peace. Something similar happened again in later life, when he suffered a good deal from kidney stones; he experienced a spiritual liberation after the attacks passed, and even when the pain was severe he preserved a sense of inner freedom.

A third possible similarity to Montaigne is in Athill's view of religion. She is an atheist and doesn't believe in an afterlife.

I can't feel anything but sure that when men form ideas about God, creation, eternity, they are making no more sense in relation to what lies beyond the range of their comprehension than the cheeping of sparrows.

(I say 'possible similarity' because we know little of what Montaigne really thought about religion. Wisely, in view of the times in which he lived, he took refuge in silence, saying only "what do I know?".)

Wikipedia comments on the "remarkable modernity of thought in Montaigne's essays. The same could be said of Athill's writing. She may, as she acknowledges more than once, be old, but her writing is fresher and more enjoyable to read than that of many younger people.


%T Somewhere Towards the End
%A Athill, Diana
%I Granta Books
%C London
%D 2008, 2009 (ebook version)
%G ISBN 978-1-84708-158-2
%K autobiography
%O kindle version downloaded from, 2017

Book review: Candide, by Voltaire

Voltaire's satirical novel Candide is probably known by reputation to more people, at least in the English-speaking world, than have actually read it. This is a pity, because it scores very highly for readability as well as importance. It is quite short and the narrative moves along at a cracking pace so there is no time to be bored.

Many of the events it describes, such as the Lisbon earthquake and the public burning of heretics that followed, were recent news items at the time the book was written, but this doesn't make it appear dated. It works as satire because it is so firmly based in human nature.

There is a lot of cruelty and savagery in the story. Horrible things happen to Candide and to those around him, and he himself kills a couple of people, although in self-defence. But all this is described in near-farcical terms, so that the horrors strike you almost as an afterthought, in a double take; you find yourself thinking, "This is absurd", and then you realise that such things really do happen.

This double-take effect is enhanced by the abundance of impossible coincidences that occur, making the narrative into a fable. There are other impossibilities too. The characters are like those in a Walt Disney cartoon; they are hanged or mutilated or burnt alive, yet they don't die but reappear later—horribly disfigured and at first unrecognisable, but still alive.

The characters are also cartoon-like in not developing psychologically, no matter what they experience. They are two-dimensional mouthpieces for philosophical views. The prime example is Candide's tutor Pangloss, who maintains his optimistic philosophy (based on Leibnitz) throughout all the misfortunes he suffers. Only Candide himself is a partial exception; he remains almost (but not quite) as kindly and good-natured throughout as he was at the beginning of his adventures, but he does lose his naivety and gains a measure of worldly wisdom by the end.

This e-book version doesn't credit the English translation to anyone but from the style I think it is by Tobias Smollet, who translated all Voltaire's works in the 1760s.

%T Candide
%A Voltaire
%K fiction
%O downloaded from, 2017
%O English version; French version also available

Book review: Ultimate Questions, by Bryan Magee

See my 570 other reviews

In Confessions of a Philosopher, published twenty years ago, Magee described his thoughts about the possibility of survival after physical death and said that this was a question that troubled him deeply. In his new book he returns to this theme, whose importance for him is now even greater than it was when he last wrote because of its greater immediacy (he is now in his late eighties). The book could be described as an extended meditation on the nature of the self and what this means for our future prospects, if any.

Many people would turn to religion for answers to questions of this kind but not Magee; he has no religious faith. The alternative is often taken to be the view that there is nothing beyond the empirical world—what we know or can know. But this is wrong too, according to Magee, who holds, on rational grounds, that we cannot know the whole of reality.

We can know (and I think we do know) that aspects of reality exist that are permanently outside the possibility of human apprehension. We can raise questions about them which, as questions, have enormous significance; but unless we can make contact with a source of information which is outside the range of human apprehension we cannot get answers on which we can rely.

Religious people think that God is such a source of information but Magee does not find this credible, although he is agnostic about the existence of God as he is about practically everything else, including our own nature.

Science is important in helping us to shape our view of ourselves and the world but it is not sufficient. Magee names three philosophical mentors who have done most to guide his thinking; he sees them as links in a continuous chain of development extending over 200 years.

There is a tradition within Western philosophy that has irradiated these questions with light, even though it has not and cannot provide them with definitive answers. This tradition began with Locke, proceeded through Hume, and reached its highest development in the works of Kant and Schopenhauer.

The lack of definitive answers may make some readers feel that this is a bleak outlook. Magee himself seems to feel this. Now that he is in his eighties he finds that his attitude to the search for truth has changed somewhat.

I used to regard commitment to this kind of truth-seeking as the overriding value—the need to discover and live in the light of as much truth as we can find out about whatever it is we are—and it is still how I would like to live as much as I can. But I have discovered that there are things that I cannot bear.

But this not his ideal position—it is a compromise, as he makes clear later.

What I find myself wanting to press home more than anything else is that the only honest way to live and to think is in the fullest possible acknowledgement of our ignorance and its consequences, without ducking out into a faith, whether positive or negative, and without any other evasions or self-indulgences.

This is a deeply personal book. Although Magee occasionally quotes other philosophers he provides no references or lists for further reading. Perhaps for this reason, I found it impressive but rather claustrophobic. Not everyone is as appalled by the thought of extinction as Magee is. In Confessions of a Philosopher he mentioned that Karl Popper was not troubled by it; nor was David Hume, and there are plenty of other examples among philosophers. In fact, the late C.D. Broad said that he would be more annoyed than surprised to find he had survived the death of his physical body.

As always, Magee writes clearly, without jargon, and he makes his case for profound agnosticism with considerable force. I find it difficult to disagree with him, but I think the distress he describes himself as feeling is probably an individual quirk of character.

%T Ultimate Questions
%A Bryan Magee
%I Princeton University Press
%C Princeton and Oxford
%D 2016
%K philosophy
%O kindle version downloaded from, 3017

OpenBSD after 3 years' use

Why I'm posting this
I switched to OpenBSD from Linux (Arch and Debian) for my desktop a little over three years ago and I thought it might be useful to summarise my experience over that time and the main differences from Linux that I've found. I've blogged a lot about this previously (see the bsd tag) so this is really just an update.

In brief, I still like OpenBSD and have no thought of going elsewhere. I use the -current flavour and update the system about once a week. OpenBSD -current is roughly the equivalent of Debian Sid or Arch; in other words, it's a moving target. This may suggest that you need a lot of experience to use it and that doing so is rather risky, but I've found it to be more stable than either of the linux distributions.

There have been occasional hiccups, mainly with packages rather than the base system (these are separate in the BSDs, of course), but there have been no show-stoppers and I've been able to solve problems with help from various kind people on the internet. But OpenBSD differs from Linux when it comes to finding help.

Getting help
OpenBSD users are always advised to read the (excellent) man pages, which often provide the answer, so that's usually the place to start. The online FAQ is also essential reading.

All the Linux distributions I've used have mail lists and these are probably the most widely accessed resources for help with the different distributions. OpenBSD has a general mail list ( but this is not the place to ask newbie questions. Most of the discussion is more technical than what you will find on a typical LInux list and many of the topics are not relevant to desktop users. I read it daily and learn from it, but even after 3 years much of it still goes over my head.

A better place to go when starting out with OpenBSD is There are some very knowledgeable people there who kindly and patiently answer beginners' questions. Remember to search the site before you ask your question; you'll often find that it's already been answered.

Google (or in my case duckduckgo) might seem like an obvious place to go for help but be careful. A lot of what you find there is out of date or misleading so this should be a last resort. In any case, you won't find too much about OpenBSD in that way.

If you think you've found a bug either in the base system or in a package you probably haven't, but if you're fairly sure you have you can submit a bug report. Even if you don't do this it can be useful to search the bug reports at If the problem is with a package you can email the package maintener whose address is given in the man page; I've had very helpful responses in this way.

If you are following -current you should certainly keep an eye on

Finally, anyone who has decided they want to use OpenBSD regularly should get a copy of Absolute OpenBSD by Michael W. Lucas.

Book review: Confusion, by Elizabeth Jane Howard

This book continues the story of the Cazalets from the point it reached at the end of Marking Time. It covers the period from March 1942 to the end of the war in Europe in 1945. The main characters are the same as in the previous volume except that Sybil, who had terminal cancer, has died. Read more

Water companies use dowsing to find leaks

Today's Daily Mirror reports that an engineer working for the Severn Trent water company used dowsing to search for a leak at a property. The property owners' daughter, who is studying for a Ph.D in evolutionary biology at Oxford University, contacted the water company; they confirmed that some of their engineers practise dowsing and they have no objection. She then wrote to other water companies and found that nine of them used dowsing.

Dowsing is generally regarded as pseudo-science. Wikipedia lists a number of scientific studies of the practice that have been conducted since the early twentieth century; they have almost uniformly found the results were no better than chance.

A number of homeopaths use dowsing, usually with a pendulum, to choose their medicines. In the 1980s, when I was a physician at The Royal London Homeopathic Hospital (now The Royal London Hospital for Integrated Medicine), I contacted a dowsers' society to ask if their members were willing to take part in a trial to see if they could distinguish real homeopathic medicines from placebos. They agreed to do this and I started to set up the trial, but unfortunately they then backed out.

Book review: How Language Began, by Daniel Everett

Everett is an anthropological linguist who has lived for extended periods with the Pirahãs, a small group of Amazonian natives (see Don't Sleep, There Are Snakes). His new book presents his view of how language has developed in the course of human evolution.

There is a wide range of opinions about the antiquity of language. Some, notably those influenced by the theories of Noam Chomsky, think that it is quite recent, perhaps only 50,000 years old, and is due to a new brain adaptation to construct and understand grammar. Language is therefore confined to Homo sapiens, and recent Homo sapiens at that. Everett is at the other end of the scale; he finds that language is more than one million years old and arose in Homo erectus. No sudden mutation was required for this; it resulted from a progressive increase in brain power linked to more complex culture. Language is a cultural invention, not primarily a biological phenomenon. Continue reading.

A shocking story

This morning I happened to hear On Your Farm on BBC R4, in which Caz Graham was talking to a Herefordshire tenant farmer, Steve Clayton, who with his partner Joyce is being forced to leave his farm and home because the local council has sold the land. Steve couldn't raise enough money to buy it himself, and so he's left with no option but to sell up and move out. Now in his 50s, and after a lifetime in farming, he's not sure what may lie ahead. He has no work and nowhere to live. We heard the sounds of his farm equipment being auctioned off.

I found this a truly shocking story to listen to. I know councils are strapped for cash but surely this situation could have been managed better.

Book review: The Disappearance of God: A Divine Mystery, by Richard Elliott Friedman

In a sense this is a sequel to Friedman's earlier book, Who Wrote the Bible?, but its focus is different and more personal, particularly in the later chapters. Like the first book, it has a detective story element, which is signalled by its being framed in the form of three Mysteries. The first of these, which takes up the first half of the book, is about the progressive hiding of God's face in the course of the Bible: the second and third mysteries concern what this implies for the modern world and its future.

Many people probably think of the Bible as a collection of stories and other texts of varying kinds but not as having a unifying plot. But Friedman says that if we read it as a whole, instead of, as usual, in small extracts, we see that it is really a coherent drama which traces the history of the Jewish people and their relation to God as it developed over a long period. What gives it dramatic unity is precisely the theme of God's progressive withdrawal. This is certainly a surprising idea—Friedman himself finds it "astounding". But he demonstrates it with ample citations. [Read more]

Book review: The Meaning of Belief, by Tim Crane

In 2007 Tim Crane was invited to give the Bentham Lecture at University College London. The lecture is sponsored by the Philosophy Department at UCL and the British Humanist Association. His lecture was badly received. The reason, Crane thinks, is that the audience members were expecting an attack on religion of the kind they were used to, whereas what they got was a call for understanding and toleration.

Crane identifies himself as an atheist, but he disagrees with those he describes as the New Atheists: Richard Dawkins, Daniel C. Dennett, A.C. Grayling, Sam Harris, and the late Christopher Hitchens. The combative attitude of these writers and others who think like them has, he believes, been counter-productive; they want to eliminate religion but they are unlikely to succeed. [Read more]

Book review: The Winter King, by Bernard Cornwell

This is the first book in a trilogy, The Warlord Chronicles, telling the story of Arthur. As Cornwell concedes in a pThis is the first book in a trilogy, The Warlord Chronicles, telling the story of Arthur. As Cornwell concedes in a postscript, we know very little about Arthur—his very historical existence is in doubt—so this is largely a work of imagination.

It is set in the Dark Ages, in the early years of the sixth century. The Romans left Britain a hundred years previously and now the Britons are fighting the invading Saxons. Unfortunately they are also fighting one another.This is the first book in a trilogy, The Warlord Chronicles, telling the story of Arthur. As Cornwell concedes in a postscript, we know very little about Arthur—his very historical existence is in doubt—so this is largely a work of imagination. [Read more]

Strange medical term in Casualty

In the last episode of 'Casualty' the surgeon Connie Beauchamp described a patient as suffering from cor pulmonale. She pronounced this in such an odd way, with the stress on the final 'e', that for a moment I didn't understand what she had said. The stress is normally on the 'a' (third syllable).

It isn't the first time that Connie has come up with odd things in this show. Some time ago, as I noted here, she told a patient to complain about her to the BMA - she should have said the GMC.