CONTENTS

~ Food: A History by Felipe Fernandez-Arnesto
~ Salt: A World History by Mark Kurlansky
~ Counting Sheep: The Science of Sleep by Paul Martin
~ The Greatest Benefit to Mankind: A Medical History of Humanity by Roy Porter

# FOOD: A HISTORY

>> Chapter 1: The Invention of Cooking

Uniquely in the repertoire of modern western cuisine, the oyster is eaten uncooked and unkilled. It is the nearest thing we have to 'natural' food - the only dish which deserves to be called 'au naturel' without irony.

Cookery was the first chemistry. The cooking revolution was the first scientific revolution: the discovery, by experiment and observation, of the biochemical changes which transmute flavour and aid digestion.

Because of the perishable nature of basketware, it is impossible to date the origins of cookery in manufactured pots. A simpler option, however, was called into use earlier: filling skins, tripes, cauls or stomachs for cooking in - the internal organs are nature's cooking vessels, relatively impermeable and elastic.

At their most solemn feasts most peoples tend to eat their most traditional foods... and among the steppeland nomads this means reverting to cooking in skins and stomachs and guts.

Today, the prejudice in favour of what is 'natural', and therefore supposedly pre-cultural, makes raw food attractive to modern urbanites repelled by our over-contrived lifeways, seeking readmission to Eden. Civilization seems ossified and one way of transcending its limitations is to reach for the recovery of the raw. Romantic primitivism allies with ecological anxiety.

Cooking was a precious invention because of the way it forged community. Contemporary eating habits threaten to unpick this achievement. Food on the fly feeds the values of hustle, nourishes the anomie of post-industrial society. People eat while they are doing other things, with eyes averted from company.
The loneliness of the fast-food eater is uncivilizing. Food is being desocialized... the microwave should not be underestimated as a device with the power to change society. Eaters can choose to heat up whatever ready-mades are to hand. No reference to community of taste needs to be made. No matriarch or paterfamilias had an opportunity to arbitrate for a family. No one in a household has to defer to anyone else. Moreover, no two people need to eat at the same time or table. This new way of cooking is staggeringly counter-revolutionary. It reverses the cooking revolution, which made eating sociable, and returns us, in this respect, to a pre-social phase of evolution.

>> Chapter 2: The Meaning of Eating

Everywhere, eating is a culturally transforming, sometimes a magically transforming, act. It functions like ritual. It becomes ritual. It can make food divine or diabolic. It can proclaim identity. A change as revolutionary as any in the history of our species happened when eating stopped being merely practical and became ritual too. From cannibals to homeopathists and health-foodies, eaters target foods which they think will burnish their characters, extend their powers, prolong their lives.

Most societies have foodways which belong to the sphere of the sacred: there are substances you consume to make yourself holy or intimate with the gods or ghosts, others which interpose between the flesh and the spirit and increase divine distance.

In the past, despite persuasive advocates, vegetarianism captured whole societies or whole religious traditions only as part of a system of taboos, recommended by religious sanctions. Pythagoras and Buddha were credited with vegetarian messages, but they were also believers in the transmigration of souls: all meat-eating might be cannibalism and parricide in a world where 'the soul of my grandam might happily inhabit a bird'. Now, in the modern, secular west, the growth of vegetarianism is recommended by a different kind of magic as a means to health (though never entirely without concomitant appeals to morality and, increasingly, to ecological anxiety).

Abundance, perhaps because it liberates us from dependence on food for nourishment, seems to have brought about a new age of food magic.

>> Chapter 3: Breeding to Eat

Snails, together with a few other similar molluscs, represent the key and perhaps the solution to one of the greatest mysteries of our story: why and how did the human animal begin to herd and breed other animals for food?
Snails are relatively easy to cultivate. Snails are grazers and do not need to be fed with foods which would otherwise be wanted for human consumption. Snails can be readily managed... without any special equipment, without personal danger. They are an efficient food, self-packaged in a shell. They are close to being a complete food, useful as rations for traders' journey, pilgrimages and campaigns. Some varieties, such as eremina, contain water for several days' travel as well as plenty of meat.

>> Chapter 5: Food and Drink

Food became a social differentiator - a signifier of class, a measure of rank - at a remote undocumented moment when some people started to command more food resources than others. It happened early. There was never a golden age of equality in the history of humankind. Inequality is implicit in evolution. Wherever hominid remains survive in sufficient quantities and in states of preservation good enough to ermit conclusions to be drawn, there are differences in nutrition levels among members of what seem to be the same communities. Paleolithic burials show, in many cases, correlations between levels of nutrition and signs of honour. At that stage, as far as we know, it was quantity that mattered, rather than the dishes selected or the way they were prepared.

There are three ways of reconciling the ideals of austerity with excess. The first is by selecting choice, rare or frankly bizarre foods, conspicuous enough in themselves to count as ennobling in small quantities. The second is by elaborate presentation of unostentatious amounts. Both these methods encourage what is now called foodism - connoisseurship, which can 'pinpoint a sea-urchin at a glance' and which makes eating esoteric. The last method is by developing peculiar rules of etiquette, which can be practised only by select initiates: this liberates the eaters from eating particular sorts of food, served in large quantities or prepared by special means. What matters instead is how it is eaten.

Brown and white bread have swapped social profiles in a way that would surely bewilder the anthropologist from another planet. White bread has enjoyed, for most of history, universal esteem because it seems to embody refinement: compared with its brown and black cousins, it is the product of a longer process, a more intense use of labour, a greater degree of waste and a demand for subtler flavour. In Britain the superiority of white bread was an unquestioned assumption until industrial baking made it universally available. The upper classes then discovered the virtues of bread the workers would no longer eat. Coarse texture was redefined as 'fibre' and to eat it became a sign of discrimination.

>> Chapter 7: Challenging Evolution

Until the 16th century, ever since the continents began to drift apart, evolution followed a broadly divergent course. Developing in isolation, the biota of each continent grew ever more distinctive. When European voyagers traversed the world and linked formerly sundered regions by sea routes, the process went into reverse. Biota were shifted around the globe on a convergent pattern. Now the descendants of merino sheep graze the southern hemisphere. Coffee, which originated in Ethiopia, is sought from Java, Jamaica and Brazil. Chocolate and peanuts, both formerly peculiar to the New World, are among the most important products of West Africa. The staple of the Incas sustains Ireland.
There were, of course, foodstuff migrations throughout history. The diffusion of the great staples of early farming presupposes ecological as well as cultural transmission... (yet) it remains unquestionable that the great ocean-borne exchange of biota of the last 500 years constituted the biggest human intervention in environmental historu since the beginnings of species domestication.

At every stage of colonization of new worlds, the remarkable thing is not the high rate of failure, but the perseverance which led to ultimate success.

New Zealand was an outstanding example of what Al Crosby called 'New Europes': lands in outer hemispheres where the environment resembled Europe's enough for European migrants to thrive, European biota to take root and a European way of life to get transplanted.

>> Chapter 8: Feeding the Giants

In the developed world, no trend in the nutrition revolution has been more marked that the equalization of diet between regions and classes. Daily meat consumption in mid-19th century Paris was double that of Caen, Le Mans, Nantes and Toulon, and between 20 and 40% higher than in a range of other cities including Marseilles, Toulose, Reims, Dijon, Strasbourg and Nancy. Today, these differences have disappeared.
Between the two surveys of the life of the poor in his native York which R. Seebohm Rowntree, scion of another Quaker chocolate-making family, undertook in 1899 and 1935, the working class had, to an amazing degree, closed the nutrition gap which formerly separated it from its employers. What is really remarkable is that whereas the subjects of his earlier study had a monotonous diet with only traces of animal protein on a regular basis, the menus he collected in the 1930s showed that even his poorest families were able to achieve some variety and to include roast beef once a week, fish once a week and another fresh source of animal protein, such as liver or rabbit or sausages at least twice a week.

Together with salt, sugar and butter form an unholy trinity, anathemized by fashionable dietary orthodoxy. None of them deserves that obloquy flung by health scaremongerers. Like most foods, they are good for you in normal quantities. Salt has a seriously adverse effect on the blood pressure of a small minority of people - 8% in America, where the statistics are probably most reliable. Though saturated fats, including butter, are statistically associated with heart disease, normal consumption rates do no harm except to the small numbers of people who have exceptionally high cholesterol. Sugar contributes no more to disorders for which it is commonly blamed - such as fatness, hyperactivity and bad teeth - than other fermentable carbohydrates; most people probably eat no more than is good for them, without having to be restrained by officious dietetics. The idea that health generally is served by ingestion of laboratory concoctions such as artificial sweeteners, margarines and sucrose polyester is offensive to brain and palate alike. Untargeted health advice on these matters from governments and health-education agencies does no good, except to vested interests. In the long run, it subverts rational public health policy by inducing a cry-wolf mentality and discrediting health campaigns generally. In consequence, people probably take less notice of official advice about hygiene, smoking and sexual behaviour - all of which are genuinely important.

People still eat, ever less regularly, at home but mealtimes are atomized; different family members choose to eat different things at different times.

It is comforting to reflect that fast food is not in itself a new phenomenon. Hot ready-to-eat meals have served the urban poor in almost every city-dwelling culture in history. Flats in ancient Rome rarely had any cooking space or apparatus on the premises: people bought their meals ready-made from vendors. On the streets of Becket's London public kitchens were open day and night for food to suit all purses, selling game, fish and poultry roasted, fried or boiled.
Nevertheless there are obvious differences between what might be called the fast food of tradition and the convenience eating of today. The street vendors of antiquity and the Middle Ages were for the most part small, artisanal, human-scale enterprises, providing very localized services to supply households with the means of common meals. The fast-food industry of today is dominated by the products of industrial processing, designed to be eaten 'on the fly' or in front of the television or computer screen. Instead of a bond, meals are becoming a barrier. 'Convenience' enjoys a higher priority than civilization or pleasure of nourishment.

Fusion food is Lego cookery. The revolution in availability makes it possible to mix and match elements delivered - often in processed form - to a kitchen which resembles an assembly point.

The Campell's soup can has become a post-modernist icon. This is a double irony, because canned foods no longer seem to the fists of the food giants: they have lost any sense of mechanist menace they might once have had in competition with fresh foods. They have become part of an old-fashioned, comforting repertoire of home cooking, defying the quick-frozen, irradiated or instantly infused alternatives. Indeed, that is exactly how Campbell's advertise their product.

# SALT: A WORLD HISTORY

The real price of every thing, what every thing really costs to the man who wants to acquire it, is the toil and trouble of acquiring it.
        - Adam Smith, "The Wealth of Nations"

Salt is so common, so easy to obtain, and so inexpensive that we have forgotten that from the beginning of civilization until about 100 years ago, salt was one of the most sought after commodities in human history. Salt preserves. Until modern times it provided the principal way to preserve food. Egyptians used salt to make mummies. This ability to preserve, to protect against decay, as well as to sustain life, has given salt a broad metaphorical importance.

The parallels between preserving food and preserving mummies were apparently not lost on posterity. In the 19th century, when mummies from Saqqara and Thebes were taken from tombs and brought to Cairo, they were taxed as salted fish before being permitted to enter the city.

It is a sad fate for a people to be defined for posterity by their enemies. Even the name, Celt, is not from their own Indo-European language but from Greek. 'Keltoi', the name given to them by Greek historians, among them Herodotus, means 'one who lives in hiding or under cover'. The Romans, finding them less mysterious, called them Galli or Gauls, also coming from a Greek word, used by Egyptians as well, 'hal', meaning 'salt'. They were the salt people. Their land was in what is now Hungary, Austria and Bavaria.

Anglo Saxons called a saltworks a 'wich', and any place in England where the name ends in 'wich' at one time produced salt. Hellath Wenn became Nantwich, and between Nantwich and Northwich was Middlewich.

For the British, salt was regarded as of strategic importance because salt cod and corned beef became the rations of the British navy. It was the same with the French. In fact, by the 14th century, for most of northern Europe the standard procedure to prepare for war was to obtain a large quantity of salt and start salting fish and meat.

The Irish, starting in the Middle Ages, traded for salt at Le Croisic, France. They bought salt for herring, salmon, butter, leather curing and especially beef and pork. Their salted beef, the meticuously boned and salted forerunner of what is today known as Irish corned beef, was valued in Europe because it did not spoil. The French shipped it from Brest and other Breton ports to their new and fabulously profitable sugar colonies of the Caribbean - cheap, high protein, durable slave food. This was later replaced with even cheaper New England salt cod. But the Irish corned beef still travaled far, in part because it was adopted by the British navy - competing with salt cod as a provision. Irish corned beef became a staple in Pacific islands visited by the British navy, where it is called keg.
It was the 17th century English who gave corned beef its name - corns being any kind of small bits, in this case, salt crystals. But they did more harm to the name than the Pacific island trade, by canning it in South America. The Irish continued to make it well, and it has remained a festive dish there.

The booming medieval salt fish market was low end - lenten food for poor people. Upper class people had their fish sped to them fresh, or if they lived too far from the water, had their royal fish ponds and holding tanks, or farmed fish such as carp. But from the 16th to the 18th centuries as estimated 60% of all fish eaten by Europeans was cod, and a significant portion of the remaining 40% was herring.

Salt made it possible to get the rich bounty of northern seas to the poor people of Europe. Salt cod by the bail, along with salted herring by the barrel, are justly credited with having prevented famine in many parts of Europe. The salt intake of Europeans, much of it in the form of salted fish, rose from 40 grams a day per person in the 16th century to 70 grams in the 18th century.

Between 1250 and 1350, a grouping of small associations in northern German cities formed. Known as the Hanseatic League, from the Middle High German word 'Hanse', meaning 'fellowship', these associations pooled their resources to form more powerful groups to act in their commercial interests. They stopped piracy in the Baltic, initiated quality control on traded items, established commercial laws, provided reliable nautical charts, and built lighthouses and other aids to navigation.
By the 14th century, the Hanseatics controlled the mouths of all the northerly flowing rivers of Central Europe from the Rhine to the Vistula. The had organizations in Iceland, in London, and as far south as the Ukraine and even in Venice.
At the height of their power in the 15th century, the Hanseatics were believed to have had at their command 40,000 vessels and 300,000 men. For a time, the Hanseatics were well appreciated as honorable merchants who ensured quality and fought against unscrupulous practices. They were known as Easterlings because they came from the east, and this is the origin of the word 'sterling', which meant 'of assured value'. But in time they were seen as ruthless aggressors who wanted to monopoloize all economic activity, and the merchant class rebelled against them.

In 1682, John Collins, an accountant to the British Royal Fishery, wrote a book called 'Salt and Fishery, Discource Thereof'. Among his many recipes was the following for cured salmon. The recipe would still be good today, assuming a 15-year-old boy were available for long periods of jumping...

When early New England settlers hunted, they would leave red herring along their trail because the strong smell would confuse wolves, which is the origin of the expression 'red herring', meaning 'a false trail'.

By 1660, King Louis XIV regared the gabelle, the salt tax, as a leading source of state revenues. One of the gabelle's most irritating inventions was the 'sel du devoir', the salt duty. Every person in the Grande Gabelle over the age of 8 was required to purchase 7 kilograms of salt each year at a fixed high government price. This was far more salt than could possibly be used, unless it was for making salt fish, sausages, hams, and other salt-cured goods. But using the sel du devoir to make salted products was illegal.
By the late 18th century, more than 3000 French men, women and even children were sentenced to prison or death every year for crimes against the gabelle. The salt law in France, was would later happen in India, was not the singular cause of revolution, but it became a symbol for all the injustices of government.

As generals from George Washington to Napoleon discovered, war without salt was a desperate situation. In Napoleon's retreat from Russia, thousands died from minor wounds because the army lacked salt for disinfectants. Salt was needed not only for medicine and for the daily ration of a soldier's diet but also to maintain the horses of a cavalry, and the workhorses that hauled supplies and artillery, and herds of livestock to feed the men.

In exchange for Chinese salt, which they believe will help with their goiter problem, the tribesmen in the remote highlands of Myanmar offer rare, endangered wildlife species. The Chinese value these animals for folk medicine. Rare Himalayan black bears are killed for their gall bladders, which are used to treat liver and stomach ailments. The commerce across the Myanmar border is especially tragic because much of this black market Chinese salt is in fact not iodized and so will not help them with their goiter problem.

The Chinese have been slow to part not only with their emperors but with many ancient ideas. Among the lingering old ways in modern China are attitudes to food - about salt and seasoning and how to construct a meal. Many of these ideas, though notably different from current Western thought, did exist in the pre-Renaissance West. The differences between China and the West on food are far greater today than 1000 years ago.
The 4th century BC Chinese belief that the world is made up of two opposing forces, yin and yang, has long been applied to cooking. The Chinese classify foods into worm and cold according to their attributes, not their temperature, similar to the way Europeans classified and balanced foods in the Middle Ages.

Salt consumption is declining in most of the world. The average 20th century European consumed half as much salt as the average 19th century European. But there is still a love of salt cod, herring, hams, sausages, olives, pickles, duck, and goose preserved in salt - foods that are no longer necessary.

"The laziest of stomachs and the sleepiest of appetites are obviously forced to awaken at the first mouthful of this stimulating slice of bread, made golden with olive oil, awaiting anchovy fillets anc chopped garlic, that the culinary mosaic maker has so perfectly placed on top."
        - M Mochard, commenting on the Provencal speciality of 'anchoiade'

The medieval rivers of Europe were full of egg-bearing sturgeon. Strurgeons, which can weigh up to two tons, have little resistance to industrial pollution. Even the Gironde, the last holdout of French sturgeon, became too polluted, as did the Hudson and other great sturgeon rivers of North America. Evem in the 19th century, American rivers had sturgeon. Caviar was served as a free bar snack, in the hope that as with peanuts, the saltiness would encourage drinking. During World War I, British soldiers were fed cans of pressed caviar, which they called 'fish jam' and mostly loathed.
The price of caviar has been leaping upward since the beginning of the 20th century. As industrial pollution and oil spills killed off sturgeon around the world, commercial caviar fishing was largely reduced to the Caspian Sea... but the Caspian and the Russian rivers that feed it have also been besieged by pollution.

The United States is both the largest salt producer and the largest salt consumer. It produces over 40 million metric tons of salt a year, which earns more than $1 billion in sales revenue. But little of this is table salt. In the US, only 8% of salt production is for food. The largest single use of American salt, 51%, is for deicing roads.

Uniformity was a remarkable innovation in its day, but it was successful that today consumers seem to be excited by any salt that is different.

Gray salts, black salts, salts with any visible impurities are sought out and marketed for their colors, even though the tint usually means the presence of dirt. Many consumers distrust modern factory salt. They would rather have a little mud than iodine, magnesium carbonate, calcium silicate, or other additives, some of which are merely imagined. There is no evidence that such chemicals are harmful, and, in the case of iodine, a great deal of evidence that it is healthy. Now there is talk of adding flouride to salt for its health benefits. But modern people have seen too many chemicals and are ready to go back to eating dirt.

The relative value of the white and gray salt is a question of supply, demand, and labour, but also culture, history, and the fashion of the times.

>> Read the full text of the first chapter [external link]

# COUNTING SHEEP

>> Chapter 1: A Third of Life

Sleep is an active state, generated within the brain, not a mere absence of consciousness. You are physiologically capable of sleeping with your eyelids held open by sticking plaster, bright lights flashing in your eyes and loud music playing in your ears.

Sleep is far more than just a biological necessity. It is also a neglected source of pleasure. Consider this. Activities that are biologically important for survival and reproduction tend to be enjoyable: think of sex, or eating, or drinking or being successful. Pleasure is one of nature's ways of ensuring that animals do enough of the right things. Whatever happened to sleep?

The champion sleepers are two-toed sloths, which dedicate an average of 20 hours a day, or more than 80% of their entire lives, to sleep.

Sleeping is such an overriding biological imperative that evolution has found ingenious ways of enabling animals to do it in the face of formidable obstacles. Nature, it seems, will do almost anything to ensure that animals sleep.
Dolphins are air-breathing mammals like us, so they must swim to the surface each time they want to take a breath. Evolution has produced an elegant solution - only one half of the dolphin's brain goes to sleep at a time. Dolphins are capable of what is known as unihemispheric sleep, in which one hemisphere of the brain submerges in deep sleep while the other hemisphere remains awake.

>> Chapter 2: Sleepy People

"The mere presence of an alarm clock implies sleep deprivation, and what bedroom lacks an alarm clock?"
        - James Gleick, "Faster"

"Life is one long process of getting tired."
        - Samuel Butler, "Notebooks" (1912)

"My whole body argues dully that nothing, nothing life can attain, is quite so desirable as sleep."
        - Charles Lindbergh recalls fighting sleep during his crossing of the Atlantic

William Dement, a pioneering scientist in the field, believes that we now live in a sleep-sick society. Sleepiness is a major cause of accidents of injuries. In fact, sleepiness is responsible for far more deaths on the roads than alcohol or drugs.

We are the great unslept. Sleep has become the cultural equivalent of a 1950s British canteen meal: an inadequate and faintly unhealthy affair, indifferently concocted and consumed with more haste than enjoyment.

We live in an era when many people work long hours, where we have vastly more opportunities for entertainment and leisure, and where sleep is widely regarded as the poor relation to other pursuits. Humanity has inadvertently created lots of reasons for not sleeping. Boredom is a modern concept. Being alone with our thoughts and dreams is no longer enough for us.

Some people seem to find being at work easier than living a real life.

Sleep deprived people are bad at making decisions and communicating those decisions to others. Their judgment is impaired, they are easily distracted, they respond poorly to unexpected information, the lack flexibility, they persist with inappropriate solutions to problems and they are prone to taking foolish risks.

We now pack all of our sleep into a single block of time during seven or eight hours of darkness. This pattern of sleeping is biologically unusual: in most other species, sleep is split into two or more separate episodes in each 24-hour period.

With sufficient stimulation and will power, military personnel can usually keep going without sleep for three or four days before they keel over.

Many parents think nothing of packing their family into a car and then driving long distances to a holiday destination while they are seriously tired. They would be horrified at the thought of doing this while drunk, but the effects of tiredness and alcohol on their ability to drive safely are strikingly similar.
Sleepy drivers not only have more accidents, they also have worse accidents. The hallmark of an accident caused by a driver falling asleep at the wheel is the absence of skidmarks.

In a more sleep-conscious world it would no longer be socially acceptable, let alone admirable, for people to drive or turn up for work suffering from severe fatigue, anymore than it is now acceptable to be drunk in the workplace or behind the wheel of a car.

Even changing the clocks can be dangerous. The extra sleepiness generated by the switch to daylight-saving time each spring is enough to generate a statistically significant seasonal rise in traffic accidents.

When the next big crisis erupts on the world stage, remember this. The politicians and officials who will be handling that crisis will be getting little sleep, perhaps for days at a time, and they will consequently become even more sleep-deprived that they already were. Their reactions, judgment, rationality, mood, memory, creativity and social skills will deteriorate, and they will become more prone to taking inappropriate risks.

>> Chapter 5: The Shapes of Sleep

During REM sleep your breathing is irregular and there are marked fluctuations in your heart rate and blood pressure. Your metabolic rate and blood pressure have all risen. The temperature of your brain has also risen. If you are male, your penis will be erect. If you are female, your nipples will be erect.

Periodically throughout the night, you will partially awake, briefly bobbing up to shallow sleep or the edge of wakefulness before sinking down into deeper sleep again. These arousals are usually too brief and incomplete for you to remember. They enable your brain to scan your environment for signs of potential danger before submerging back into deeper sleep. They have been likened to a submarine periodically rising to periscope depth to check out the surface. During these partial awakenings you shift your body position. You will change your whole posture 30 or 40 times during the course of a night's sleep without ever noticing.

Most people are capable of waking themselves at a predetermined time without the aid of alarm clock to within 20 minutes of the target time.

The empirical evidence, such as it is, suggests an altogether different function for yawning - namely, that yawning prepares us for a gear-change in activity level. There is a systematic tendency for yawning to occur about 15 minutes before a period of increased behavioural activity. Yawning bears no relationship to sleep patterns. Yawning seems to have nothing to do with tiredness nor boredom, quite the reverse, but it does precede a change of gear.
The gearing-up theory even fits with the observation that yawning is socially infectious. Mass yawning makes sense if everyone in the group is preparing for action. Indeed, the prime function of yawning may be to act as a social signal.

In the 1980s, scientists noted that rats of a strain that had been specially bred to yawn frequently (don't ask why) also developed erections whenever they yawned. The more the rats yawned, the more erections they had - a strange and potentially troublesome pairing. Comparable effects have been found in humans as well.

>> Chapter 8: Friends and Enemies of Sleep

"If there's any illness for which people offer many remedies, you may be sure that particular illness is incurable."
        - Anton Chekhov, "The Cherry Orchard" (1904)

The length of time it takes you to fall asleep, once you have lain down and shut your eyes, is known as your sleep latency. Very short sleep latencies usually indicate sleep deprivation, whearas very long sleep latencies may signify other problems.

Your body temperature has a big influence on how fast you fall asleep. A night's sleep is normally preceded by a drop in core body temperature, and this drop actively facilitates the onset of sleep. Under normal conditions, the maximum rate of decrease occurs about one hour before the onset of sleep.

Benjamin Disraeli found that he was more comfortable when sleeping in hot weather if he used two beds, moving periodically from the hot, sweaty bed into the cooler one. Benjamin Franklin lit upon the same trick years earlier, but Franklin reckoned he needed four beds to be really cool.

"Lord Monboddo told me he awaked every morning at four, and then for his health got up and walked in his room naked, with the window open, which he called taking an 'air bath'; after which he went to bed again, and slept two hours more."
        - James Boswell

A less irksome way of achieving a similar effect is to take a hot bath an hour or two before bedtime. The bath will temporarily raise your body temperature. Over the following hours, your temperature will drop again, and, all being well, this will help to trigger sleep. Warm feet also assist the onset of sleep.
The importance of declining body temperature means that articifial heat sources like electric blankets can disturb sleep.

The human species is awash with a mind-altering drug. This drug is taken daily by billions of people and it is by far the most widely consumed psychoactive substance in the world. It helps us to stay alert and get through the day when we have not had enough sleep. It is, of course, caffeine.

Lloyd's of London, the world's largest insurance market, began life in 1688 as a London coffee house catering mainly to merchants and mariners. Other London coffee houses spawned the London Stock Exchange and several newspapers.

Tea also contains substansial amounts of caffeine, and is as effective as coffee in maintaining alertness, but had a slightly less disruptive effect on sleep.

Several experiments have shown that an extract of valerian root can slightly improve subjective sleep quality. The control subjects in this study, who unknowingly received an inert placebo instead of valerian, also displayed improvements in their sleep - yet again demonstrating the awesome power of the placebo effect to make the world a better place.

There is a school of thought that says you should try tackling the causes of insomnia before reaching for drugs to suppress its symptoms.

>> Chapter 10: A Second Life

"Dream is a second life."
        - Gerard de Nerval, "Aurelia" (1851)

"There are some among us who claim to have lived longer and more richly than their neighbours; when they lay asleep they claim they were still active; and amond the treasures of memory that alll men review for their amusement, these count in no second place that hervests of their dreams."
        - Robert Louis Stevenson

"For what person who aims at a mark all day will not hit it? We sleep every night, and there are very few on which we do not dream; can we wonder then that what we dream sometimes comes to pass?"
        - Cicero

"Through the combined action of attention and will during dreams, you can take the first steps in directing and modifying the course of dreams as you wish."
        - Hervey de Saint Denys, "Dreams and How to Guide Them" (1867)

"Sleep deprivation is a popular torture device used by the Indonesian secret polics and small babies."
        - John O'Farrell, "The Best a Man Can Get"

The foetus spends most of its time immersed in REM sleep, dreaming about who knows what. The mechanism for suppressing muscular activity during REM sleep has not yet developed at this early stage, so the dreaming foetus kicks and twitches in its mother's womb.

>> Chapter 12: The Reason of Sleep

A reasonable conclusion is that NREM sleep, which emerged first, originally evolved as a way of ensuring that animals are inactive during periods in the 24-hour cycle (usually the dark hours) when inactivity is the optimal strategy.

Currently, the most convicing scientific theories about the biological function of REM sleep revolve around the idea that it is a special state in which the brain processes newly acquired information and consolidates memories.
The learning of new information is followed by a transient rise in REM sleep in humans. New information acquired during the day is processed and stored during the ensuing night's sleep.

>> Chapter 16: And So to Bed

Someone once said that no human being believes that any other human being has a right to be in bed when he himself is up.

Modern technology is helping to soften the brutal behaviour of alarm clocks, even if their very existence remains regrettable. One friendlier device is designed to simulate the dawn, by gradually increasing the intensity of a light over a period of half an hour before the chosen time of awakening.

# GREATEST BENEFIT TO MANKIND

I devote most attention to what is called 'western' medicine, because western medicine has developed in ways which have made it uniquely powerful and led it to become uniquely global. Its ceaseless spread throughout the world owes much, no doubt, to western political and economic dominance. But its dominance has increased because it is perceived, by societies and the sick, to 'work' uniquely well, at least for many major classes of disorders. To the world historian, western medicine is special. What began as the medicine of Europe is becoming the medicine of humanity.

Whereas most traditional healing systems have sought to understand the relations of the sick person to the wider cosmos and to make readjustments between individual and world, or society and world, the western medical tradition explains sickness principally in terms of the body itself - its own cosmos.

The historical record is like the night sky: we see a few stars and group them into mythic constellations. But what is chiefly visible is the darkness.

Trade, war and empire have always sped diseases transmission between populations, a dramatic instance being offered by early modern Spain. The cosmopolitan Iberians became subjects of a natural Darwininan experiment, for their Atlantic and Mediterranean seaports served as clearing-houses for swarms of diseases converging from Africa, Asia and the Americas. Survival in this hazardous environment necessitated becoming hyper-mmune, weathering a hail of childhood diseases - smallpox, measles, diptheria, gastrointestinal infections and other afflictions rare today in the West. The Spanish conquistadores who invaded the Americas were, by consequence, immunological superman, infinitely more deadly than 'typhoid Mary'; disease gave them a fatal superiority over the defenceless native populations they invaded.

[Traditional Text of Hippocratic Oath]
I swear by Apollo the physician, by Aesculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath: To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction. I will prescribe regimens for the good of my patients according to my ability and my judgement and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

The Black Death is the most catastrophic epidemic ever to have struck Europe, killing perhaps 20 million people in three years. Absent from Europe for 800 years since the plague of Justinian, it was endemic for the next three centuries. The Great Pestilence of 1347-51 probably originated in China; in 1346 it migrated from beyond Tashkent in Central Asia to the Black Sea, where it broke out among the Tatars fighting Italian merchants in the Crimea. A chronicler tells how the Christians took refuge in the citadel at Kaffa, where they were besieged. Plague forced the Tatars to raise the siege, but before withdrawing they invented biological warfare by catapulting corpses of plague victims over the citadel walls, causing the disease to flare among the Christians. When they in turn escaped, it travelled with them into the Mediterranean, breaking out in Messina and Genoa and raging throughout the rest of Europe. Within a couple of years, plague killed around a quarter of Europe's population - and far more in some towns.

"How many valiant men, how many fair ladies, breakfasted with their kinsfolk and that same night supped with their ancestors in the other world."
        - Contemporary account of scale of Black Death

Faced with plague, physicians had no power to effect public-health measures; that was the magistrate's business. In Venice a committee of three nobles laid down burial regulations, banning the sick from entering the city and jailing intruders. In Milan, the council sealed in the occupants of affected houses and left them to die (perhaps this draconian measure worked: Milan had only a 15% death rate). In Florance a committee of eight was given dictatorial powers, though ordinances requiring the killing of dogs and cats ironically removed the very animals that might have conquered the rats. At that time, no one had any reason to suspect rats.

In 1377 Ragusa (Dubrovnik, Croatia) insitituted a regular 30-day isolation period on a nearby island for all arriving from plague-infected areas; in 1397 this was increased to forty, thus becoming a true quarantine (quarantenaria, forty days).

The most momentous event for human health was Columbus's landfall in 1492 on Hispaniola. The Europeans' discovery of America forged contact between two human populations isolated from each other for thousands of years, and the biological consequences were devastating, unleashing the worst health disaster there has ever been, and precipitating the conquest of the New World by the Old World's diseases.

"I hope that Lord Grey and you are well - no easy thing seeing that there are above 1500 diseases to which Man is subjected."
        - Sydney Smith to Lady Grey (1836)

"The medical profession as it might be was the finest in the world; presenting the most perfect interchange between science and art; offering the most direct alliance between intellectual conquest and the social good."
        - Tertius Lydgate, in George Eliot's "Middlemarch"

In 19th century Britain, reform stalled because Parliament regarded medical regulation as a minefield. But gradually laissez-faire yielded to the neo-paternalism of a Victorian administative state prepared to shoulder greater responsibilities, in part to placate a more democratic electorate.

In the century from Pasteur to penicillin one of the ancient dreams of medicine came true. Reliable knowledge was finally attained of what caused major sicknesses, on the basis of which both preventions and cures were developed. In the general euphoria created by the microbe hunters and their champions, some of the wider conditions of life contained within the evolutionary struggle were easily disregarded, the prospects of killing off diseases being too precious to ignore. In retrospect, far from the bacteriological and antibiotic paradigns then adopted becoming the basis for the progress of all future medicine, the period between Pasteur and Fleming may one day be nostalgically recalled as an anomalous, if fortunate, exception to medicine's sisyphean strife.

For its fans, modern medicine, with its microbe-hunters and microchips, has enabled westerners to escape from the valley of the shadow of death, living longer and healthier lives; for critics this is the era of the Holocaust and the Gulags, in whose unspeakable outrages doctors and psychiatrists were hardly reluctant participants. Scientific medicine may be the knight in shining armour or a new body-snatcher. What Shaw called "The Doctor's Dilemma" is humanity's.

Medicine has now turned into the proverbial Leviathan, comparable to the military machine or the civil service, and is in many cases no less business- and money-oriented than the great oligopolistic corporations. A former chairman of a fast-food chain who quit to head the Hospital Corporation of American (Nashville) explained his move thus; "The growth potential in hospitals is unlimited, it's even better than Kentucky Fried Chicken".

In the 20th century it became accepted that the smooth and efficient functioning of intricate producer and consumer economies required a population no less healthy than literate, skilled and law-abiding; and in democracies where workers were also voters, the ampler provision of health services became one way of pre-empting discontent. Health also moved centre-stage in propaganda wars - questions of national fitness came to the fore in the great Darwinist panices over racial decline around 1900. Between the wars, fascist Italy, Nazi Germany and the communist USSR each glorified the trinity of health, power and joy, rejoicing in macho workers and fecund mothers while unmasking social pathogens who supposedly endangered national well-being. The Nazis did not merely seek to exterminate what they called the cancer of the Jews; they encouraged cults of personal fitness and launched the first crusade against cigarette smoking. Smoking was banned in the Luftwaffe.

The 20th century ship of state thus took health on board.

Patrick Jenkin, then secretary of state for Social Services in Mrs Thatcher's first administration said "We have been spending money in ever-increasing amounts on the NHS for thirty years and it has not actually had much effect on increasing people's health". Certainly, it is far from clear that the way to end social differentials in health is the provision of more medicine.

In 1974, a Senate investigation reoprted that 2.4 million unnecessary operations were performed in the United States per year, and that they caused 11,900 death and cost about $3.9 billion. More deaths, it was noted, were caused annually by surgery than  the yearly toll of military deaths during the Vietnam war. In 1954 the Yale Hospital was performing 48,000 lab procedures; by 1964 the figure was 200,000.

At the close of the 20th century, new horizons are visible, but so are new problems. Westerners are now living longers. But longevity means more time for illness, and implies that greater effort and resources will need to be devoted to keeping well.

We live in an age of science, but science has not eliminated fantasies about health; the stigmas of sickness, the moral meanings of medicine continue.

Ignorance may be as lethal as complacency.

We have invested disproportionately in a form of medicine ('Band Aid' salvage) whose benefits often come late, which buy a little time, and which are easily nullified by external, countervailing factors. Curative, interventionist medicine has played a modest part in shaping wider morbidity and mortality patterns within the community, but in terms of its professed aims - the greatest health of the greatest number - the olympian verdict must be that much medicine has been off target.
Until the last 150 years, the role of clinical medicine in the improvement of health was tiny. Whether populations grew or shrank, were robust or suffered 'the thousand shocks that flesh is heir to', had little to do with medicine, despite its best efforts. That has changed, though not in simple or predictable ways. In the form of contraceptive pills, medical research is today responsible for capping some populations, while, in the form of rehydration kits and measures against infant diarrhoea, it raises others. Medicine's role in the future of homo sapiens on this planet is unforseeable, because the Darwinian evolutionary battle between mankind and microbes is itself unpredictable. It is unlikely that medicine will play a role as important as politics, economics or disease. Its standing is now highly contested. Never has it achieved so much or attracted such great suspicion. The breakthroughs of the last 50 years have saved more lives than those of any epoch since medicine began.

But if medicine is expanding almost beyond the bounds of imagination, the euphoria of the age of penicillin or the 'pill' has turned to anxiety. Today's headlines are much more likely to be of fears about a new cholera epidemic sweeping South America or plague in India, the cloning of sheep today and maybe tomorrow. For all medicine's successes, who would deny a certain malaise? The atmosphere is one hollow conquest. The age of infectious diseases gave way to the age of chronic disorders. Longer life means more time to be ill, and medicine is more open to criticism.

Medicine has become the prisoner of its success. Having conquered many grave diseases and provided relief from suffering, its mandate has become muddled. What are its aims? Where is it to stop? Is its prime duty to keep people alive as long as possible, willy-nilly, whatever the circumstances? Is its charge to make people lead healthy lives? Or is it but a service industry? In "Gulliver's Travels" (1726), Jonathan Swift exposed, through his portrait of the wretched Struldbrugs, the follies of hankering after immortality. It may be that medicine has to learn that lesson all over again.

The irony is that the healthier western society becomes, the more medicine it craves - indeed, it regards maximum access as a right and duty. Especially in free market America, immense pressures are created to expand the diagnosis of treatable illnesses. Scares are created. Thanks to diagnostic creep or leap, ever more disorders are revealed.
The root of the trouble is structural. It is endemic to a system in which an expanding medical establishment, faced with a healthier population, is driven to medicalizing normal events like menopause, converting risks into diseases, and treating trivial complaints with fancy procedures.
Medical consumerism - like all sorts of consumerism, but more menacingly - is designed to be unsatisfying. The law of diminishing returns necessarily applies. Extending life becomes feasible, but it may be a life exposed to degrading neglect as resources become overstretched and politics turn mean. What an ignominous destiny if the future of medicine turns into bestowing meagre increments of unenjoyed life!

The close of my history thus suggests that medicine's finest hour is the dawn of its dilemmas. Medicine will have to redefine its limits even as it extends its capacities.

>> Return to Society index, or Site homepage.