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Loire canoeing

March 4, 2017

Nevers to Blois

(Not paddled most of this – cribbed from the internet – but I will in May). This stretch passes medieval Orleans, the china factories of Gien, three of the four Loire nuclear power stations, and some magnificent canal engineering at Briare. The big chateaux are mostly set well back, but the river touches many vineyards; the famous Pouilly and Sancerre, and the less famous Coteaux du Giennois, Orleans-Clery, and Cheverny. The finish at Blois is just upstream of the Coteaux de Touraine and three more famous Appellations of Vouvray, Chinon and Borgeuil, as well the source of sparkling Crémant de Loire, at least as nice, and quite a bit cheaper than champagne. The Canal latéral à la Loire has followed the left bank from Digoin and continues to do so till crossing at Briare.

carte_vignoble_val_de_loire

0 km – Nevers-sur-Loire. Camping left bank (click here), upstream of the bridge (1832). A few yards from the campsite, the Nevers branch of the canal latéral ends in a marina.

Tricky step below bridge. Launch downstream or shoot right (click here).

nevers-pont_sur_la_loire-cathedrale_saint_cyr_et_sainte_julitte-20160502  nevers-weir1 nevers-weir2

nevers-weir3 nevers-weir4

200 metres – Nevers Railway bridge (1946)

nevers_railway-bridge

7 km – River Alliers joins left With similar length and flow to the main river, some argue that the Loire is a tributary of the Allier!

allier-loire-confluence

8 km –  Iles-de-Marzy Main channel left.

13.5 km – Fourchambault Givry bridge  Givry left. Fourchambault right.  Camping de la Loire right bank just above the bridge (click here)

givry-forchambeux-bridge    fourchambault-givry-bridge

14 km – Canal du Givry joins left. A branch of the canal lateral

givry-canal-loire-junction

21 km – Marseilles-les-Aubigny left The canal du Briare, running along the left bank, is close here.

28 km – La Marche right

Iles-du-Voluray. I think main channel right

LaBlancherie left. Weir. Shoot channel left to pass left of Charité island and under the new bridge. Stay right for the beautiful old bridge, the oldest crossing of the Loire.

31 km – N151 bridge. New bridge (1951) over left channel.  Old bridge (original 1520. This one 1731) right. La Charité right. The Abbey was an important stop on the Camino de Santiago pilgrimage route from Scandinavia and Germany.  Shoot 3rd arch from right.

charite-new-bridge   charite-sur-loire-grand-pont

charite-weir1 charite-weir2 charite-weir3

Camping (click here) on the island downstream of the bridges

45 km – Pouilly-sur-Loire bridge (1902) P-s-L right. The vineyards right behind the town mostly grow sauvignon blanc for Pouilly-Fumé. A minority grow the chasselas grape for the slightly inferior Pouilly-sur-Loire wine. (Click here for more)

pouilly-sur-loire-bridge pouilly-sur-loire-bridge2 pouilly-sur-loireview-from-bridge   pouilly-fume-chateaux-de-tracy

55 km – Saint-Thibault-sur-Loire bridge The walled town on the hill left is Sancerre, surrounded by the famous vineyards.

saint-thibault_sur_la_loire-bridge2 saint-thibault-sur-loire-bridge sancerre  sancerre-les-monts-damnee

55.5 km – Junction canal left The river lock is no longer working and the junction canal is now a marina. Followed immediately on left bank by Flower Camping Les Portes de Sancerre (click here)

60 km – Port Aubry railway bridge (1893)

viaduc_de_port-aubry

63 km – Cosne-Cours-sur-Loire suspension bridge (1959) Camping left bank just upstream of the bridge (click here)

cosne-cours-sur-loire-bridge   cosnee-sur-loire-camping-de-lile2-2-900x450

75 km – Belleville nuclear power station left The beautiful cooling towers, among the largest ever built put most of the water it uses back in the river.

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76 km – Pont de Neuvy-sur-Loire (1984) Bellevue power station left

neuvy-sur-loire-bridge

82 km – Bonny-sur-Loire suspension bridge (1902) Bonny-s-L right. Beaulieu-sur-Loire left

bonny-sur-loire-bridge

86 km – Ousson-sur-Loire right  Weir left. Main channel right.

87 km – Mantelot lock left Prior to the opening of the Briare aqueduct, boats coming from the south on the Canal Lateral a Loire crossed the river here to reach the Canal de Briare on the other bank.

chatillon-lock-mantelot chattelot-eclusemantelot-w580

88 km – Chatillon-sur-Loire bridge (1951)

chatillon-sur-loire-bridge

91 km – Aqueduct de Briare (1896)  Briare right

briare-aqueduct briare-aqueduct2 briare-aqueduct3

92 km – Briare canal lock right No longer in much use since the aqueduct opened. But looks like it still functions

briare-canal-loire-lock2 briare-loire-lock

The vineyards on the low hills to the right are the Coteaux de Giennois, the tiniest Loire appellation. The red and white wines are collector’s pieces according to Hugh Johnson, but ery little ever leaves France. The winery Domaine Poupat in Briare (click here) is the place to buy them.

98 km – Gien D951 bridge (1980) Home of Gien china (click here)

gien-bypass-bridge

99 km – Gien bridge (1734)

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Camping Gien left bank 200 metres downstream of bridge. (Click here)

100 km – Railway bridge (1893)

gien-railway-bridge

106 km – Weir. Inflow channel to Dampierre nuclear power plant right. I think you can portage/line down left end of the weir. See below taken from here

dampierre-portage  dampierre dampierre2

117 km – Sully-sur-Loire road bridge (1986). Followed by rail bridge. S-s-L left. Saint-Pere-sur-Loire right

sully-sur-loire-bridge  sully_bridge    sully-sur-loire-rail-bridge    sully-sur-loire-railway-bridge

Le Clos d’Argerie right

132 km – Chateauneuf sur Loire bridge (1946)  Chateauneuf sur Loire right. Campsite La Maltournee left bank about 100 metres upstream of the bridge (click here). No good local wine is made here, but one of the few small breweries on the upper Loire, La Brasserie des Ecluses (click here) is a couple of miles up the road at Vitry aux Loges.

chateauneuf-sur-loire_bridge

138 km – Jargeau bridge (1988)  Jargeau left. Saint Denis de l’Hotel right

jargeau-bridge2     OLYMPUS DIGITAL CAMERA

146 km – Checy right. Camping municipal right (click here) between the river and canal D’Orleans. (Click here)

148 km – Combleux right.  The canal d’Orleans runs along the right bank from here to Orleans. The right bank of the river is the Orleans Appellation Controlle. A few small vineyards around Checy. Not a very special AC (details here), although a few locals are making an effort (click here)

152 km – Vierzon railway bridge (1947) followed by Pont Rene Thinat (1977)

vierzon_railway-bridgeorleans     rene-thinat-bridge_orleans

Canal d’Orleans junction right

153 km -George V bridge (1763) Orleans centre right.

george_v_bridge-orleans

154 km – Marshal Joffre bridge (1958)

marechal_joffre_bridge-orleans

155.5 km – Europe bridge (2000)

europe-bridge-orleans

Camping right about 200 metres upstream of motorway bridge (click here)

157 km – A71/E9 motorway bridge (1980)

a71-loire-bridge

Saint Ay right. The right bank from here on is AC Orleans again. Left bank AC Orleans-Clery (red wine mainly from cabernet franc). One of the best is Clos Saint Fiacre.  None of the vineyards are along the bank. Most are located in or around the village of Mareau-aux-Prés.

orleans-clery

168 km – Meung-sur-Loire bridge (1948) Meung-sur-Loire right. Chateau Meung-sur-Loire (click here)

Shallows at site of old bridge/ford about 200 metres above the new suspension bridge

meung-sur-loire-site-of-old-bridge-ford    meung-sur-loiresite-of-old-bridge    SONY DSC

meung-sur-loire-bridge meung-sur-loire-bridge2 meung-sur-loire-bridge3

174 km – Beaugency bridge (14th century)  Beaugency right. Camping on left bank just upstream of the bridge (Click here)

beaugency-bridge beaugency-bridge2

179 km – Weir. Not sure how to portage. Suspect portage right. Saint-Laurent Nuclear Power station left.

saint-laurant-weir

La Pouperie right

186 km – Muides-sur-Loire bridge (1932). Left bank is now AC Cheverney. Domaine du Croc du Merle, farm and vineyard (click here) lies on the left bank. There is also a special Appellation Cours-Cheverney for wine made from the traditional grape, Romorantin, not found anywhere else.

muides-sur-loire-bridge2   muides-sur-loire-bridge

200 km -Blois. Charles-de-Gaulles (D174) bridge (1970)

blois-charles-de-gaulle_bridge

201 km – Blois Jacques Gabriel bridge (1724)

blois-jacques-gabriel-bridge blois_pont_jacques_gabriel

201 km – Francois Mitterand (D766) bridge (1994)

blois_francois_mitterrand_bridge

Jim Thornton

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“Never Event” at the Oscars

February 28, 2017

Or, why didn’t Beatty “stop the line”?

oscar-muddle

How could La La Land get called, when Moonlight had won? I mean, it’s not hard! Count the votes, put the result in an envelope, and hand it to Warren Beatty. Surely a “never event”.

But how do operations get done on the wrong patient, or on the wrong side? How do swabs get left behind? That’s not hard either.

It’s not that the Oscar organisers are slapdash; more interested in getting the red carpet just so. They fret mightily over envelope checking. Instead of putting them on the rostrum for Beatty to pick up, they pay someone to hand them to him. In fact they pay two people, one each side of the stage, each with duplicate sets, to ensure the show runs smoothly. I bet they had rehearsals and procedures. But still Beatty got the wrong envelope.

It’s easy to guess why. At the critical moment someone distracted the envelope carrier; perhaps he had to restrain a previous winner from rushing back to thank his mum. Whatever the cause, he failed to do one simple task, remove the spare envelope.

The situation could still have been saved. Beatty realised he’d got the wrong envelope, “Best actress” instead of “Best picture”. But instead of stepping back to check, he handed it to Faye Dunaway anyway. She, caught up in the moment, ploughed on and announced the wrong winner.

Why didn’t Beatty “stop the line” for Oscar safety? Why don’t nurses “stop the line” for patient safety? Perhaps he thought it was a stunt, or he didn’t want to slow the show; it was running late, just like operating lists sometimes do. Whatever the reason, the wrong film got the Oscar, and “never events” happen. Three lessons I guess.

  1. Don’t over complicate. One set of envelopes, or one patient ID wristband, is plenty.
  2. Don’t distract people doing the checks.
  3. Teach everyone, from theatre orderlies to Warren Beatty, it’s OK to “stop the line”.

But “never events” won’t disappear. They don’t matter in Hollywood, but they do in hospital. So do you really need that operation? Will it do enough good to balance the risk of the surgeon maiming you by some simple, stupid, “never event”? Think about it.

Jim Thornton

Unrequited Desire

February 25, 2017

At the Real Marigold Hotel

sheila-ferguson-bill-oddie  rusty-lee

Touching scenes in episode two yesterday (BBC One); a group of elderly luvvies plonked in Kerala, on the unlikely premise that they might one day retire there, were fretting about their health and wondering if they might still get laid.

Divorcee Sheila Ferguson, ex Three Degree and still a great voice, was the most randy, telling the first fellow she met at an expatriate cocktail party that she was looking for a new man. Instead of flirting back, the terrified chap muttered “plenty around”, and ran away.

Bill Oddie was grumbling about his bipolar disorder, so a local healer recommended some cream to rub on his pecker; a non sequitor I agree, but I guess a wank can’t do much harm. Ever the comedian, Oddie asked if the woman on the packet came too!

Back at the hotel he told the TV chef Rustie Lee about it. She was obviously interested and commented; “We women better keep our doors locked tonight!” Cue another flirt back. But “Sheila better watch out!” was all poor Rustie got for her troubles.

It’s lovely watching old people flirt, and their dis-inhibitions, albeit mugged for the camera or created in the editing room, should move things on. But love remains tricky. Although Rustie wants to help Bill rub his cream on, Bill wants Sheila to do it, and when Sheila hits on her own target, the poor man’s too intimidated to respond. It doesn’t get easier.

Jim Thornton

Is this the end for independent midwives?

January 17, 2017

Malpractice insurance problems

In Britain midwives and obstetricians care for normal and abnormal pregnancies respectively and are regulated by the Nursing & Midwifery Council (NMC) or the General Medical Council (GMC). In the NHS, they work on broadly similar pay scales, (midwives £22 – £99K, obstetricians £26 – £102K), albeit with more of the latter at the upper points.

Not so in the private sector.  Celebrity obstetricians cater to princesses and footballers’ wives in The Portland or St Mary’s Lindo Wing, and make serious money, while most independent midwives, driven by a desire to encourage natural childbirth, or to help mothers let down by the NHS, charge low fees for their 24/7 availability. Few earn even as much as their NHS sisters, making it difficult to afford personal indemnity insurance.

The issue came to a head for obstetricians about 20 years ago.  Until then all doctors paid the same premium, a few hundred pounds, but in the early 1990s birth injury awards rose steeply and insurance companies introduced differential premiums; for obstetrics about £10,000 a year. The taxpayer picked up the tab; crown indemnity for all NHS doctors. The Duchess of Cambridge’s private obstetrician still has to pay a whacking great premium, but he can afford it!

NHS midwives had always had crown indemnity. Independent midwives had a modestly priced insurance scheme through their Royal College and rarely got sued; few of their patients would have dreamt of it. But as medical malpractice claims, often backdated many years, went through the roof, underwriters got nervous and ramped up premiums. For cover equivalent to that in the NHS, the premium would now be about £1,000 per birth supervised; more than most independent midwives could afford.

Some gave up. Others put their homes in their partner’s name, so if they got sued for millions, they could declared bankruptcy. So long as they were open about their lack of cover their patients could either go back to the NHS, or take the risk of missing out on compensation. As far as I know things went OK – patients don’t like suing individuals, and lawyers follow the money – until a few years ago, when the Department of Health ruled that they must have insurance. This seems to have been partly to comply with an EU directive (click here) and partly in response to a review by a fellow called Findlay Scott (click here), although Scott simply recommended how best to achieve the politically driven aim of mandatory insurance.

The independent midwives association, IMUK, found an affordable scheme. The details seem to be secret; at least I’ve not seen them. Presumably the levels of cover are rather low. Soon someone persuaded the NMC to investigate the scheme’s financial viability. Some say it was the Department of Health, others disgruntled patients who’d missed out on damages. I’ve even heard it claimed that private birth centres, hoping to do down the competition, were behind it. We may never know. But whatever the cause, the NMC, prodded into action, has just ruled (details here) that the IMUK scheme is underfunded, and that midwives depending on it face removal from the register. Eighty or so independent midwives must close shop forthwith, and send their patients back to the NHS.

Views on this matter depend partly on whether you believe that informed adults should be allowed to take risks, go rock climbing, smoke cigarettes, or give birth at home under the care of an uninsured midwife, without the nanny state interfering. The answer is of course yes, unless your action endangers others. Rock climbing is fine but smoking in an enclosed public space is not. What about endangering your unborn baby?

To over simplify. The legal (and many feminists’) view is that, unless the mother deems it so, an unborn baby is of no consequence up to the moment of birth; she can smoke, go rock climbing, even abort it, and it’s no-one else’s business. An informed adult woman should be free to have a home vaginal breech birth after Caesarean (HVBBAC) under the care of of her uninsured neighbour trained on Wikipaedia!  I think this is broadly the view of Birthrights, the human rights in childbirth organisation (click here), who buttress their philosophical stance with the claim that if independent midwives are forced out of business, some women will give birth without any health professional present.

Others argue that the baby is the person most likely to get damaged. It deserves protection not only from incompetent midwives, who should be forced to get proper insurance, but also from feckless parents who take the risk of employing uninsured midwives. If independent midwives are driven out of business, and unhappy mothers get forced back into the NHS, or deliver alone, that’s tough. Get over it.

I fear the latter view will prevail; we Brits seem to rather like collective government-mandated solutions to our problems. But my sympathies are with Birthrights. The case of HVBBAC above, is fictitious. Women don’t choose independent midwives for trivial reasons, and rarely take unreasonable risks with their baby. Even if things turn out badly, the baby will still get the full panoply of UK health and social care, albeit without any extra financial compensation.

But women must be fully informed about their midwife’s insurance cover, or lack of it. If I can’t find out the details, how can a mother? IMUK’s website simply says “All members hold mandatory professional indemnity insurance” (click here). That’s not good enough.

The ramifications of this extend beyond the tiny numbers directly involved. Independent midwives are a huge benefit to the rest of us who work in that monolithic monster, the NHS.  They make us question our assumptions, keep us on our toes, and look after the women we’ve failed.

Come on IMUK. Be open and honest about your level of indemnity cover. Please don’t price them out of business NMC.

Jim Thornton

Walking the Dog

December 23, 2016

By Howard Nemerov

Most animal poems are sentimental tosh, but there are exceptions. A Blessing by James Wright is one. Here’s another.

I’m not sure it’s even really about dogs. We all think shit is interesting, and Connected by love and a leash and nothing else must be about something else. Showing who’s master I guess.

Walking the Dog

Two universes mosey down the street
Connected by love and a leash and nothing else.
Mostly I look at lamplight through the leaves
While he mooches along with tail up and snout down,
Getting a secret knowledge through the nose
Almost entirely hidden from my sight.

We stand while he’s enraptured by a bush
Till I can’t stand our standing any more
And haul him off; for our relationship
Is patience balancing to this side tug
And that side drag; a pair of symbionts
Contented not to think each other’s thoughts.

What else we have in common’s what he taught,
Our interest in shit. We know its every state
From steaming fresh through stink to nature’s way
Of sluicing it downstreet dissolved in rain
Or drying it to dust that blows away.
We move along the street inspecting shit.

His sense of it is keener far than mine,
And only when he finds the place precise
He signifies by sniffing urgently
And circles thrice about, and squats, and shits,
Whereon we both with dignity walk home
And just to show who’s master I write the poem.

Howard Nemerov

Symphysiotomy in Ireland

December 13, 2016

The Clark report

A dozen or so years ago a group of people in Ireland got the idea that between the 1940’s and 80’s Irish obstetricians had systematically abused young women by inflicting an outdated and cruel operation on them; dividing the ligaments joining the pubic bones to enlarge the pelvis and facilitate birth. The claim was that although doctors knew symphysiotomy was agonisingly painful and had a high rate of life-altering complications, they did it in preference to Caesarean section as a form of punishment for women pregnant out of wedlock. As a result of their Catholic religious zeal, hundreds, maybe thousands, of women suffered terrible lifelong injuries. Click here for the main pressure group’s website.

aahomesmush2   state1    sos

A few women went to court for civil redress, but with little success; there was little objective evidence of serious injury. Nevertheless a campaign for “no fault” compensation gained momentum, and at least four enquires were set up. Two ran into the sand under partisan criticism, but two others (available here) suggested there might be a problem and, in view of the difficulties of pursuing negligence claims so long after the event, recommended a state redress scheme overseen by a high court judge, Maureen Harding Clark.

Her report (click here) (alternative here the-surgical-symphysiotomy-ex-gratia-payment-scheme-report) was released on 19 October. She confirmed that symphysiotomy was indeed used more often in Ireland than other similar developed countries; the rationale being unavailability of contraception and the risks of repeat Caesareans for women with large families. The prohibition on contraception was driven by Catholic teaching, but Clark found little evidence that the symphysiotomy itself was done for religious reasons or to punish single mothers. Rather she unearthed some evidence to the contrary; the doctors used the procedure sparingly, and were driven by a desire to avoid the morbidity and mortality associated with Caesarean section in that era.

“While evidence of religious motivation […] is found in the 1949 NMH [national Maternity Hospital] Annual Clinical Report and in a study by A P Barry, Master of the NMH, it was absent from any other report although the issue of large families and no contraception was commonly raised during the annual discussions known as the Transactions Meetings. There appeared to be a high degree of support for Catholic teaching on contraception among those present and contributing to discussion.” (para 32)

Perhaps now is rather late to second guess motivation. Obstetricians like me* will be more interested in learning what complications actually occurred, particularly in the long term.  This is not straightforward because Judge Clark’s primary interest was not in causation; her criterion for making an award was any contemporaneous documentation of any injury or symptom which could plausibly ever be an effect of symphysiotomy. But let me try. Of 589 alleged cases submitted for review, at most 404 had actually undergone symphysiotomy.

“It is highly probable that several applicants received awards in error. In 3 extremely troublesome cases, notwithstanding very extensive investigations, even with the assistance of specialists, I was simply unable to exclude the possibility that the applicants had undergone a symphysiotomy procedure. In those cases, the birth records were either incomplete or unavailable and medical evidence was unsatisfactory. I formed the view that it was better to err in making an award to an elderly applicant convinced of the truth of her claim than to be wrong and refuse an award to a deserving applicant. In approximately 6 other cases, earlier reliance on scar and in one case, radiology evidence led me into error. I take responsibility for my errors. In 2 cases where reliance was placed on medical opinion, records which were not available at the time of assessment subsequently became available from stored archives. They confirmed earlier suspicions that no symphysiotomy procedure had been performed.”

The true number of cases is therefore likely to be 393 (404-11). About 100 of these agreed that they had suffered no injury beyond the immediate pain of the procedure, and were given “compensation” of £50K. This left about 300 women who claimed to have long term injury. Of these, Clark eventually judged that 142/404 (35%) had suffered something; excessive separation of the pubic bones, pubic pain, pelvic instability, incontinence, psychological/psychosexual difficulties or sacroiliac pain. On the face of it a high rate, but this assumes all documented problems which could plausibly be an effect of symphysiotomy, were caused by it. In the real world pubic bones separate spontaneously during birth, separation is often asymptomatic, and other symptoms are common anyway, particularly after forceps, which many women had also undergone. Clark, realising this, writes:

“No general pattern of immediate or developmental injury was seen. The evidence did not confirm that symphysiotomy inevitably leads to lifelong pain or disability or those symphysiotomy patients aged in a manner which was different to those of non-symphysiotomy women. The majority of applicants who underwent symphysiotomy made a good recovery and went on to have normal pregnancies and deliveries and to lead a full life. Most applicants had at least 4 normal deliveries after the symphysiotomy. A small number of applicants suffered from pelvic pain and a slightly larger group [24 cases] from urinary issues. Whether the conditions were associated with prolonged labour, the use of forceps, parity or the symphysiotomy procedure or a combination of all three was not possible at this remove to determine. It was noted that many symphysiotomy procedures were carried out after a ‘failed forceps’.” para 22

Here is judge Clark describing her process for evaluating if incontinence had resulted.

“I first determined that the test for finding incontinence constituting significant disability would be evidence of any mention of any degree of incontinence or urinary tract infections on the available notes relating to the symphysiotomy birth and the next pregnancy. The cases were so few that the threshold was lowered again to any mention of incontinence or multiple urinary tract infections in GP records in the first decade following the symphysiotomy birth. Even when the threshold was set at the low level of any possible temporal association with symphysiotomy, little was found to match complaints in the majority of cases.”(para 179)

In only five of the 24 cases of urinary incontinence associated with symphysiotomy was there a close temporal or other relationship such that causation was likely.

“[These five] had suffered bladder / urethral damage or fistula at the time of symphysiotomy. The injury was identified within hours of the symphysiotomy and repaired at the first opportunity. All five applicants were thereafter predisposed to urinary tract infections and in one case, continuing incontinence.” (para 24).

Here is Judge Clark on unstable pelvis/ arthropathy etc.

“The appearance of the pubic symphysis was abnormal in 80 cases with variable degrees of other musculo-skeletal conditions. 12 applicants demonstrated what were described as grossly
abnormal findings. The abnormal radiological findings included continuing diastasis (separation of the bones of the symphysis) of 15mm or more and included a small number of cases of severe sclerosis, fluid in the joint, large osteophytes, capsular hypertrophy, vertical misalignment or the presence of bone fragments. Sometimes the wide diastasis was associated with sacroiliac joint arthropathy but in several instances, the sacroiliac joints were normal. There were very few cases of pelvic instability, that is, evidence of movement in the joint. For the purposes of the Scheme, if the appearance of the joint was abnormal, this was always taken as evidence of either inflammation or movement at the joint occurring in the immediate aftermath of the symphysiotomy procedure. There were very few cases of hip degeneration at an inappropriate age and no documented cases of difficulty with walking after about 3 months.” (para 23).

To summarise, 404 (or 393) symphysiotomy procedures resulted in five cases of urinary tract damage, one of whom was left with incontinence, and, despite 80 women ending up with radiological signs of pelvic damage, no documented cases of difficulty with walking after about 3 months. Until the campaign drew their attention to the “harms” of symphysiotomy, the women who had undergone it had gone on to have more children, to have backache, sexual difficulties and troublesome periods at pretty much the same rate as their sisters. Nevertheless:

“On countless occasions, it seemed that once the symphysiotomy procedure was identified (usually in 2003/2004), new complaints previously absent from the records spanning decades were made and every health ailment was attributed to symphysiotomy.” (para 112)

Lawyers and psychiatrists dealing with other types of alleged historical abuse will be interested in the 185 women who had not undergone symphysiotomy. Experimental psychology has shown that false memory is real – if you see what I mean – but no-one knows how common it is in real life. Here is Justice Clark:

“Almost a third of applicants did not undergo symphysiotomy. This is a very significant number. Even if applications made on behalf of those who simply did not know whether they underwent symphysiotomy or where  family members thought their mother might have undergone such a procedure are excluded, the number (185 in total) still begs some examination and scrutiny. How could these don’t knows and so many other women wrongly believe that they had undergone this procedure with its highly publicised adverse effects?” (para 220)

“It is very possible that advertising by some legal firms to encourage women who “may” have undergone symphysiotomy to bring claims resulted in many of the unfounded applications. The applications may have been submitted simply in order to comply with the application time period before the necessary supporting medical records were obtained. While there may have been a vexatious element to their applications, many of these applications were withdrawn once their records were examined. In others, misunderstanding between episiotomy and symphysiotomy was evident.” (para 224)

“The publicity surrounding the activism for the Government to set up a compensation scheme for symphysiotomy victims was quite intense. There can hardly be a person in Ireland who has not been exposed to reports of the procedure described as butchery akin to Nazi medical experimentation;, aggravated sexual assault; a form of female genital mutilation causing life long disability, chronic pain, mental suffering and family breakdown and much more. These reports have been so persistent and frequent that they have created something akin to a knee jerk reaction to the word symphysiotomy. It is viewed as a procedure synonymous with barbarism and pain; but not just barbaric and painful but unnecessary and unwarranted, creating a legacy of countless victims whose lives were permanently ruined. […] Some of those […] women who did not undergo symphysiotomy have been prominent, vocal and long time activists as victims of symphysiotomy. (para 225)

“After much thought, I concluded that it is very probable that the combination of a traumatic birth experience and exposure to other women’s stories has created a self convincing confabulation of personal history. Another inference is that the possibility of financial payment has influenced suggestible women and their family members into self-serving adoption and embracing of the experiences described by others or in the media and created psychosomatic conditions.” (para 226)

Obstetricians and lawyers will be studying this report for some time.

Jim Thornton

*Disclosure. Over a four year period in rural Kenya in the early 1980s I performed a couple of symphysiotomy operations. My hospital had good facilities for Caesarean, albeit under ether anaesthesia, so the need was small.  A colleague in a less well-staffed hospital nearby, where Caesarean was often impossible, performed the operation more regularly and taught me.

Poet’s Corner at last

December 4, 2016

Philip Larkin

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Tom Courtenay in the tourist bookshop, Edward Fox by the Great West Gate, Grayson Perry chatting in the queue. Too timid to tackle such eminences, I struck up conversation with an unknown. “I’m a Larkin” he said, a cousin once removed, or something like that, come up from Truro for the occasion. His ancestor had been the brother of Sidney Larkin, Philip’s father.

We trooped in and settled among the choir. I found myself next to an Arts Council fellow who’d sat on poetry committees with Larkin. Together we pointed out more celebrities. Melvyn Bragg and Alan Bennett opposite. Anthony Thwaite and Alan Johnson over there.

Choral evensong celebrated the 50th anniversary of Barbados’s independence. The ambassador read the lesson, and the choir sang unaccompanied; no congregational singing for once. Psalm 78 had God repeatedly saving the ungrateful Israelites from their folly, finally knocking them into shape, picking David as ruler, and letting them live in peace and tranquillity ever after. I couldn’t see much of a link with either Barbados or Larkin; perhaps it was just psalm of the day.

After the Barbadians and the public had been ushered out, the Larkin crowd moved to the south transept for the dedication. Virginia Bottomley read Solar, The Trees, and Water, Grayson Perry read from Larkin’s 23rd October 1962 letter to Monica about harvest thanksgiving, Blake Morrison gave the address (click here), Anthony Thwaite read the final verse from Church Going. Sir Tom Courtenay read Days, and Reference Back; a real actor showing the amateurs how it should be done. Someone played a recording of King Oliver’s Riverside Blues, a few prayers and it was over.

The Philip Larkin Society (click here) have been pushing this for years. Hull being City of Culture for 2017 helped. So, while Will Gompertz and the BBC filmed a piece for Newsnight, the rest of us milled about, and listened to a few more words from Professor Edwin Dawes, chair of the Philip Larkin Society, and Rosie Millard from the City of Culture. I chatted to a GP from Kent who was chair of the Thomas Hardy Society – the two societies have recently organised some joint events, and of course Larkin was a great admirer of Hardy. I fear I upset one archivist by foolishly saying I thought Larkin’s archive was in Oxford; he put me right that the Bodleian have only a few letters. But I hope I cheered up another, by getting appropriately excited when he told me he had Larkin’s lawnmower in his collection.

Here is that poem. With those wonderful, terrible, unconsoling lines, “The mower stalled twice,” … “I’d even fed it, once.” … “we should be kind/While there is still time.” Yes, he’s deservedly in Poet’s Corner.

The Mower

The mower stalled, twice; kneeling, I found
A hedgehog jammed up against the blades,
Killed. It had been in the long grass.

I had seen it before, and even fed it, once.
Now I had mauled its unobtrusive world
Unmendably. Burial was no help:

Next morning I got up and it did not.
The first day after a death, the new absence
Is always the same; we should be careful

Of each other, we should be kind
While there is still time.

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