Life in a changing world

I lived through three quarters of the 20^th century and (so far) the first eighth of the 21^st. It’s been a period in which the world has changed in more remarkable ways than ever before in history. What an exhilarating, ominous, wonderful, frightening time it has been! How lucky I’ve been, to observe so many historically memorable events, many of them horrible it has to be said, mostly as a distant bystander well out of harm’s way, unscathed while wars, genocides, massacres killed and maimed millions in other parts of the world – millions who included increasing proportions of non-combatant children, women and frail elderly people. At least 100 million people have died in wars, genocides, massacres, in my lifetime. So has a great deal of the natural world died.  I’ve seen crystal-clear seas teeming with life turn into turbid, dead zones in which only jellyfish survive. Tropical rain forests, boreal forests, green and pleasant land everywhere has been wantonly destroyed. I’ve seen the London and Edinburgh air transformed from murky sulfurous smog to crystal-clear skies with distant horizons clearly visible – although the air may be unpleasant to breathe because of the diesel emissions with which it is heavily contaminated. I’ve reaped the benefit of the inventions, social innovations, and changes in values and behaviour that, like a recurrent gold rush, have made the world a better place for those with the money and leisure time to enjoy it.    

Professionally I chose a mix of acquired epidemiological skills and hands-on clinical experience, a combination of epidemiological know-how and clinical competence that was scarce and in great demand just as I was ready to supply it; and I had a wholly supportive wife, compliant children, and the courage, faith in my own ability, recklessness or willingness to take chances, follow leads, seize passing opportunities while they were there for the taking, that led to success. In that way I rose to a prominent position in my chosen field, so I became well known to and a friend of my peers all over the world.

Occasionally I’ve fantasized about having a time machine that could take me to other interesting times and places. To go with the time machine I’d be magically fluent in the colloquial speech of the group into which I would blend: Athens in the circle of young men who gathered around Socrates; Renaissance Florence (with antidotes to Lucrezia Borgia’s delectable but deadly recipes); Paris at the height of Louis XIV’s regime; London when William Godwin and Mary Wollstonecroft flourished, or a half century and more later when the London Epidemiological Society’s members were exchanging ideas about causes and control of epidemics; or where and when a few dozen other game-changing groups of unconventional innovators strode the world’s stage, did and said things that changed the world for the better. But no matter how exciting it would have been to be a bystander or a participant in those events, I always conclude when I reflect on it, that there has never been a period in history as exciting, as eventful, as laden with technical innovations and transformations of values and behavior, as the time I’ve been alive.  Every aspect of life, every facet of society and culture has been affected, often transformed beyond recognition, by social innovations, new discoveries, technological ingenuity, and (perhaps most important) changes in values and behaviour.

Consider my profession, medicine, medical care, and public health science and practice. We can prevent and effectively treat and cure dozens of conditions that were rapidly and invariably fatal when I was a medical student in the 1940s. My own youngest son was born with a congenital heart defect that would have reduced his life expectancy to 10 years or less before advances in heart surgery, anesthesia and intensive care only a few years before his birth made possible the complicated operation he had at age 7. Financial barriers between sick people and the care they need have been greatly reduced, and in a few nations have been obliterated. Jonathan’s open heart surgery would have cost several hundred thousand dollars in the USA. It was done in Auckland, New Zealand, by one of the two best experts in the world at the time, and fully paid for by Canadian ‘medicare’ because it cost a little less there than if it had been done in Canada. The medical profession was almost exclusively restricted to white men in suits in the 1940s.  Now the medical profession attracts more women than men, and skin colour other than white is no longer a barrier to entry. Other professions too have opened their doors to women and to people who are visibly different from white folk of European ethnicity: law, banking, engineering and the church (many denominations, but not the Church of Rome) admit women – although a glass ceiling often blocks their way to the top.  Other changes for the better have sometimes been more subtle, often facilitated by technical innovations and inventions. The greatest of these is reproductive freedom for girls and women. This revolution, facilitated by the contraceptive pill was just too late for Wendy and me, and is still in progress and incomplete, obstinately resisted and obstructed in patriarchal societies and conservative Christian sects, but girls and women have the momentum, ultimate victory will come, I’m confident, within a generation or two, even in culturally confused nations like the United States. A small but significant effect of this newfound reproductive freedom that young women enjoy is that nowadays it’s often the women, not the men, who take the initiative in selecting a mate. I believe two of my grandsons have benefited from this social and cultural change: both were chosen by their young women, and the partnerships appear stable, secure and happy.

I’m fascinated by other changes in values and behavior that have transformed the society into which I was born 87 years ago. I’ve observed these changes in values and behavior in myself as well as in other people and in society at large. As a young man in the 1950s I had no sympathy for homosexuals. Without knowing any, having only vague notions of ways they express affection for each other, the very idea filled me with revulsion. As my friendship and acquaintance networks expanded, my professional and collegial horizons widened, I met some gays and lesbians; my knowledge of their contributions to medical science, literature, music, visual arts, grew wider and deeper and I developed empathy. Now I support without reservations the complete equity and equality of the LGBTQ community with the rest of humanity. My conversion to this cause occurred over several years in the 1960s, well ahead of public opinion. It was gratifying to see public opinion catching up with me. My views on reproductive freedom, on the right of girls and women to choose whether to become and remain pregnant, have moved in the same direction and at about the same pace.  In Canadian society these have become majority views. Likewise as a young man I believed in harsh punishment of violent criminals. I even supported the death penalty. My conversion to a lenient, tolerant view may resemble Saul’s conversion on the road to Damascus, and was evidence-based – literally so, when DNA evidence demonstrated unequivocally that alleged perpetrators had been wrongfully convicted. Here also Canadian society has caught up with me, and a substantial majority now shares my view that the death penalty is barbaric, has no place in civilized society.

I summarized some health-related ways the world has changed during my lifetime in “Human Health in a Changing World” which was Chapter 11, pp 395-425 in the second edition of my book  Public Health and Human Ecology (New York: McGraw Hill, 1997). That chapter was as much about human well-being and contentment as health, about the varieties of changes that can disrupt the even tenor of a contented life. In many talks and formal lectures since that book was published I refined my ideas about our changing world, emphasized the fact that these changes are ongoing, that humankind must adapt to the changes or risk extinction, just as many other species have become extinct because they failed to adapt to the changes in the world around them.

The global changes I discuss in seminars are: Physical (the atmosphere, the air we breathe, the pH of lakes, seas and oceans); Biological (ecosystems, distribution and abundance of species, pathogens); Demographic (numbers, distribution, migrations of people); Social (family structure and function, occupations); Cultural (media have replaced faith-based institutions as the main driver of our values); Political (volatile, frequently changing rather than prolonged stable regimes, makes long range planning difficult if not impossible); Economic (widening gaps between wealthy and poor people); Industrial (new players, India, China, Brazil etc. add to energy demands); Technological (electronic innovations from photocopiers, TV, computers and word processors to the internet and the web have transformed the worlds of work and leisure).

These are the most obvious changes. Some have had more profound impact than others. Probably the demographic changes matter most. When I was born in 1926 there were about 1.8 billion people in the world. In 2013 the world’s population passed 7 billion, more than a fourfold increase in one lifetime, an increase that is obviously unsustainable. More than half live in cities, compared to one in 20 when I was born. Half or more of those who didn’t live in cities when I was born were engaged in producing food for themselves and for the rest of us; it was a predominantly youthful population, half or more below the age of 30, in contrast to the present in which half or more are over age 50. Families are smaller too, reproductive rates are lower than replacement level, which worries economists but gladdens me. This is one of a very small number of social trends that bodes well for the future of the human species.

Some of these ways the world is changing have greater impact than others, some are at least partly a consequence of more fundamental, more basic changes.  All are inter-connected. Moreover there are other changes not included or even implied in the above list.  The most obvious of these is the amazing series of recent technological changes that I’ve observed, taken part in, and benefited from. When Wendy and I and Rebecca and David were preparing to go to England from Australia in 1961 I wrote down a list of valuables to be insured, and took it to my insurance company. The young woman behind the counter took my list, thanked me for it, and a few minutes later, gave it back to me. I asked her, “Don’t you want to keep this on file?” She answered, “Oh, I made a photocopy” and she showed me a flimsy, slightly brownish sheet of paper with my hand-written list faithfully reproduced. That was the first time I encountered a photocopy, which I soon learnt to call a Xerox. It was among the first of the astonishing range of technological innovations that changed the world in the second half of my life. After experimenting with a few electric typewriters in the late 1970s, I bought my first word processor in the early 1980s and launched into the internet, sent and received my first email in 1985. By the time I started work on the 4^th edition of the Dictionary of Epidemiology in 1987, the internet was becoming the main, almost the only line of communication between me, my associate editors and the other contributors.  In the Epilogue to the second edition (1997) of Public Health and Human Ecology, I wrote (p. 429):  “I have made the revisions for this book in the comfort of my office at home. I have hardly set foot in the medical library except to socialize with colleagues. Seated at my computer I have visited medical libraries and other rich learning resources all over the world, restricted only by my lack of imagination and energy, and unfamiliarity with the key words required to find all, rather just some, of the information that could have made this book as current as today’s newspaper.” I went on to say that a textbook, even a monograph as provocative as I tried to make this one, doesn’t need to be as current as today’s newspaper: it’s the ideas in it, the questions it raises rather than the questions it answers, that make it worth reading. A few years after that edition was published I had a letter from a young woman in a provincial city 300 Km from Montevideo, Uruguay, just beginning her career as a rather lonely public health specialist, the only one in her city.  She wrote to thank me for what I had written, said how my words had encouraged her to use the Internet and the Web to stay connected.  I love getting feedback like that! It makes all the hard work worth while.

Scanning newspaper headlines is a habit I’ve had since I was about 10. Now I scan a widening range on my computer screen or my iPad every day: the New York Times, the Guardian, le Monde, Al Jazeera, the Globe and Mail, the 100% electronic Daily Beast, Huffington Post and Slate and often a few others. I don’t think these make me any wiser but at least they persuade me that I’m getting several viewpoints on events that matter. Without doubt the ability to do all this in a few minutes every day is another of the beneficial changes in the world in my lifetime.

Faith, beliefs and values

My mother’s parents were the only Jewish family in the small town of Orroroo, about 250 km north from the nearest synagogue in Adelaide. They were closer to secular humanists than observant Jews. Their oldest 4 or 5 children had bar or bat mitzvahs, but my mother, the second youngest of 10, and the 4 or 5 siblings nearest her age didn’t.  Only one selected a Jewish marital partner and none of their descendants are practising or conforming Jews.  My maternal grandfather ran the general store and was a notable figure in Orroroo, where he had what is still the grandest house. When they were children, my mother and several siblings attended Sunday School at the Methodist church in Orroroo.  In her middle age she was baptized and confirmed into the Church of England, formally adopting the religion of the Anglican boys’ college that my brother Peter and I attended, both of us on scholarships. For the rest of her life, she participated in Anglican church services and regularly took communion. 

When my father was a child, he and his parents attended a Baptist church but he abandoned Christianity in early adult life and was agnostic or atheist in all the years I knew him. He was opinionated and intolerant but I never heard him speak ill of anyone solely on the basis of their religious beliefs.  He was able to accept the fact that other people held firm spiritual faiths and beliefs that mattered to them.

As a child I was baptized and in early adolescence confirmed as a member of the Church of England, but even at the time of my confirmation when I was in my early teens I had begun to question the creed I was obliged to recite in chapel at school and at church on Sundays. By my late teens my skepticism about the basic tenets of Christian belief – the trinity, virgin birth of Jesus, life everlasting, heaven and hell, resurrection, the bread and wine that we consumed symbolizing the body and blood of Christ – had evolved into outright disbelief.  I went through the motions, attended church occasionally. By the time our 3 children were born I had stopped attending church.  Mere attendance, I decided, was hypocrisy, and therefore unacceptable. Instead I abided by Polonius’s advice to Laertes:

      “This above all, to thine own self be true, and it must follow as the night the day thou canst not then be false to any man.”   

In contrast to me, my brother Peter is a devout Christian. I find it curious and interesting that we two brothers, three years apart in age and with identical upbringing, should have evolved such different spiritual beliefs. We differ in scientific beliefs too: I, having carefully studied the scientific evidence on human action as the main cause of climate change, believe it. Peter, relying on what he reads in newspapers, does not.

Throughout the 60 years since I rejected Christianity I have upheld values common to most religious beliefs, at least in theory: honesty, integrity, empathy, compassion, tolerance. Under Wendy’s gentle influence and my own conscience, my adherence to these values has strengthened throughout my life. I’ve observed, sometimes with disgust, that devout believers, whether Jewish, Christian, or Moslem, do not necessarily possess these values or practise what their religion preaches. 

The tolerance that most religions preach is the opposite of the behaviour that some members of particular faiths exhibit towards those who hold different religious beliefs.  Violent, often murderous intolerance has occurred throughout history, punctuated by genocides, pogroms, the inquisition, the Thirty Years War, Hindu and Moslem bloodbaths in India at the time of Partition in 1947, catholic-protestant ‘Troubles’ in Northern Ireland, Serbian-Croatian-Bosnian warfare in the former Yugoslavia, Sunni-Shia conflicts in Iraq, and innumerable other bloody conflicts fought in the name of clashing religious beliefs.

Wendy remained Christian (Anglican) for most of her life, attended church, took communion, and did some of her altruistic volunteer work under the auspices of St Mathias church in the suburb where we lived when we arrived in Ottawa in late 1969. In the last 10-15 years of her life, she became disillusioned by the hypocrisy of some members of the church to which she belonged throughout our time in Ottawa. She stopped attending church in the early 1990s, but remained in the Family Life group for social reasons, increased her commitment of time and energy to volunteer activities, and was recognized for her exemplary work when she received the Governor General’s Caring Canadian Award. By the time she fell ill with the motor neuron disease (ALS) that took her life, she had lost her faith, wanted no words of comfort or funeral service from the Anglican church of Canada.  Over the course of our 55 years together we drew closer together, ultimately became almost identical in values and beliefs. She transmitted her empathy, altruism and kindness to strangers to me, I transmitted my skepticism and disbelief to her.

Of our three children, only David has some spiritual sensibility. As far as I can tell Rebecca and Jonathan have no religious beliefs. David’s first wife was Roman Catholic and David converted to Catholicism at her request. Two of their three children were confirmed into the Catholic church; but the family started attending the Anglican Church when Christina and Peter were old enough to ask unanswerable questions about the sex abuse scandals affecting the Catholic church.  David’s second wife is Jewish, and he has been exploring Judaism since he entered that marriage; but I think his interest is more intellectual than spiritual, as it is also for his youngest son, my grandson and namesake John Last Junior: he is now in his third year of a combined religious studies and early modern history honours degree at Kings College, Dalhousie University in Halifax, Nova Scotia; he is spending his third year at Bogazici University in Istanbul, learning Arabic and Turkish, aiming ultimately to become an expert on the Middle East; his religious studies are part of his interest in the Middle East, rather than an indication of religious beliefs. He is as interested in the gods and goddesses of Classical Greece and Rome and the Hindu gods as he is in modern mainstream monotheist religions. In an email (Nov 7, 2013) John wrote:

Though my interest in religion is still primarily intellectual, that is something I do want to change, as I am interested in the spiritual aspect of Christianity as found in the practice of the liturgy and the philosophy of Christian life, not to mention Christian mysticism which was regrettably excised from the faith by the prudes of the Protestant reformation (fortunately Anglicans, without developing or encouraging this strand of belief in any way, have left the door propped open with their latent Catholicism). I am still interested in studying all religions to find their common validity in the genuine expression of human faith, but if I were to specialize these days (as I'm coming to the end of a degree it's something I should keep in mind), I think I would focus on Christology, neo-Platonism and Christian philosophy, or the Church of the East, though further study in Hinduism is pretty tempting (just because of the vastness of the field and the satisfyingly orientalist undertones of studying eastern religion). 

This is a fascinating statement and I regret that I don’t have enough remaining years of life to observe for long how John’s spiritual journey will evolve.

  

David’s other two children, Christina (now Charles) and Peter, are agnostic or atheist I think; my grandson Peter seems to be, like me, a committed atheist.   I don’t know whether Peter’s partner Sylvie, or John’s partner Emily, adhere to any religious faith.  My limited acquaintance with them suggests that if they hold spiritual or religious beliefs, these are a minor feature of their lives.

Most humans appear to have a need for belief in some sort of power greater than their own free will, whether individually or collectively. People in all societies throughout history have expressed a need for someone or something to worship, to set rules and standards of behavior. Even those of us like myself who are committed atheists must have codes of conduct, rules of behavior to which we adhere, if we are to function harmoniously in human society. These codes and rules may be constructed by ourselves, or like mine, derived in part or entirely from precepts of someone else who acts as a moral compass. Although I rejected the absurdities of Christian faith I believe I have a strong and effective moral compass, partly derived from values that are integral to our culture and traditions, partly from empathy I owe largely to Wendy’s gentle influence, perhaps partly hard wired into my brain. (I've commented before on the mutability of values in our culture, and will have more to say in a future post). There is no place in my belief system for hypocrisy that I have observed in others who claim to be devout Christians. It’s a good combination that has served me well and enabled me to do some good for others too. I am content with this.

When the CIOMS Working Group was meeting in Geneva to revise guidelines for ethical conduct of human experiments and developing guidelines for ethical conduct of epidemiological studies I met and got to know representatives of all the world's major faith groups. I took part in some fascinating conversations with Hindu, Buddhist, Moslem, Jewish and Christian scholars. Specific proscriptions and customs like avoidance of pork and circumcision (or not) of boys didn't arise in the context of our work on ethical conduct. I think the only failure to reach consensus was the question of when a foetus becomes a person: at fertilization among Jesuits, at 'ensoulment' (when foetal movements are detected) among Moslems, and this is rarely an issue in medical research. Otherwise ethics and human values are virtually identical in all the major faiths, and among atheists too.

It doesn't matter whether you're Hindu, Buddhist, Jewish, Christian, Muslim, Wiccan, Agnostic, Atheist, or all or none of the above. What matters is to have Aristotle's virtues and Shakespeare's values. It's hard to go far wrong with these.

Annual Report 2013

Here is my "Annual Report" - a seasonal e-greeting that went into cyberspace, aimed at several hundred friends and colleagues scattered about the world -

Annual Report 2013

 Dear friends,

The year got off to a good start in January when Oxford University Press published Global Public Health; Ecological Foundations, by Frank White, Lorann Stallones and John Last. This began as a 3^rd edition of my monograph, Public Health and Human Ecology. I recruited Frank White and Loran Stallones as co-authors because they had fulsomely praised my 2^nd edition and asked me to get on with a 3^rd edition. I’d fallen behind the cutting edge of public health science and needed support by up-to-date friends. Then my beloved Wendy fell ill with motor neuron disease (ALS) and after an illness lasting just over a year, she died. I was in no emotional or intellectual shape to write even part of a book, so I left most of it except a few ideas to Frank and Lorann.  It was almost my final flutter as a medical writer. ‘Almost’ because 2013 is the 50^th anniversary of my most important original article, The Iceberg; "Completing the clinical picture" in General Practice, Lancet 1963, 2:28-31 and it is republished this year (with commentaries) in the International Journal of Epidemiology, Vol 42, No 6, Dec 2013, pp 1613-1615.  I'll probably post some of this on my blog or on Facebook eventually.

 But I can’t quit writing cold turkey: I’ve been writing memoirs, and I’ve written more this year. I’ve recycled bits on my blog (http://lastswords.blogspot.com). If the universe unfolds as it should, in 2014 I’ll publish my entire memoirs as an e-book, with my writing reinforced by ideas I’ve picked up in workshops, discussion groups and a creative writing course.  Stay tuned for more on this, or follow my blog.

 What else happened to the Last family in 2013? There is still a raw wound where Janet Wendy used to be, but the scar tissue over that wound is less inflamed. I keep her memory alive and every day I speak to her, to one or more of the photos of her that are scattered throughout my apartment. Rebecca and Richard feed me once or twice every week, David phones nearly every day, and Jonathan drives me when we eat at R & R’s home.  I am blessed to have such caring children.  I hear pretty often from my grandchildren too. Christina is progressing with gender reassignment, has now become Charles.  Peter has completed his environmental science degree and like his partner Sylvie, he has a steady job. John is spending his third undergraduate year at Bogazici University in Istanbul, progressing with Arabic, learning Turkish, pressing on with religious studies early modern history, dipping into journalism. He aims to become an expert on the complex problems of the Middle East, and judging by posts on his blog (http://johnlast.wordpress.com) he is making good progress towards that goal. I and his partner Emily hope he doesn’t get caught in the crossfire of any of the conflicts or localized unrest in the region.

As for me, I shuffle where once I walked briskly, can’t open jars as easily as I did when younger, but my mind still seems to work and I can usually find the right words to express what I want to say as I go about the task of compiling my memoirs.

Peace, Love and seasonal greetings to all!     John 

 

The biochemistry and neurology of memory

My juices have been flowing.  Sluggishly, it has to be said, but flowing, and restoring to conscious memory a few odd facts about the nature of memory that I’ve come across over the years. I’ve cattle-prodded my faulty memory too with a brief surf over several websites.

One intriguing fact came (I think) from an essay by Lewis Thomas in his sparkling series called “Notes of a Biology Watcher” that ran for several years in the 1980s in the New England Journal of Medicine, and collected in books, twice won the Pulitzer Prize. Lewis Thomas told the story of a very primitive organism, a member of the Fluke species, that can be “taught” (or conditioned) to avoid a small electric shock.  I think this organism is called Planaria but I’ve forgotten, and can’t go to the source to check because I gave the book to my grandson Peter; I’ll ask him to look it up and let me know. Once the organism has been conditioned to avoid the small electric shock, it is ground into microscopic fragments in a blender, and fed to a living organism of the same species. The living organism “remembers” how to avoid the unpleasant electric shock. This demonstrates that memory is a biochemical substance, or at any rate, it is in this particular species. When I first came across this intriguing fact I suggested to Wendy, who remembered a social occasion I’d totally forgotten, that if I reduced her to molecular elements in a blender and ate the blended bits, maybe I’d remember the social occasion I’d forgotten. She retorted that if she ate my blended bits and pieces she’d “remember” all the phone numbers I had in my head that she always had to look up. (According to Wikipedia, the research that demonstrated this intriguing observation on Planaria can’t be replicated, so it’s discredited. Pity).

Neuroscientists have demonstrated that in humans the hippocampus, amygdala, and mammillary bodies in the base of the brain are involved in processing and storing particular aspects of memory. In early September 2005 I had a TIA (transient ischemic attack) a vascular lesion that was shown by MRI (brain scan) to have caused multiple small infarcts (regions where tissue died because it was deprived of blood supply) in the base of my brain. Since then my memory has been defective in at least two distinct ways. The first is that I lost all my rather mediocre proficiency in languages other than my mother tongue: my ability to receive and transmit in German and Italian, which had been enough to enable survival in Germany and Italy, vanished altogether; so did my ability to understand spoken French. I’d never been able to speak in French to other people but could understand spoken French quite well. The second defect is loss of memory of whole chapters in my life experience. Reading my letters to Wendy in 1955-56 I came across several about a trip I made to the Gippsland, a district south-east of Melbourne, in Victoria, early in 1956. I’d completely forgotten this trip, was fascinated to read my description of it, but I am mystified about why I went there. Was it work-related or a holiday? I have no idea. All memory of it has been expunged and my letters don’t say. 

My ability to remember things I've read seems to be better than my ability to remember experiences I've had. This is very odd and quite disconcerting. What, if anything, does it say about how (and where in the brain) memories are stored? Maybe a reader of this post can enlighten me.

That defined regions in the base of the brain are involved in processing and storing memories explains why we don’t have any memory of events in the first few years of life: these regions don’t fully develop until several years after birth. People who say they “remember” life in the womb or “remember” being born are exercising their imagination or have brains that developed abnormally early. There’s much more about memory on the web but I’ve said enough, indeed probably too much to clutter my memoirs with technical details. It’s been fun and it’s been interesting to delve into a few details, but that’s all Folks!

How does memory work?

Assembling my memoirs has led me to reflect on the nature of memory, and how the process of storing and retrieving memories actually works.

I started in medical school aged 17 in February 1944 - 70 years ago - so the little bit of knowledge I picked up all those years ago is buried deep and isn’t much help.  When I was a medical student I learnt a smattering of neurology and read a few books on neuropsychology and psychiatry. Reflecting on the rather haphazard recollections that comprise my memoirs I am aware that my reading over the years since I graduated in 1949 hasn’t added enough current knowledge of brain function to know where to begin. I understand in a vague sort of way how the brain is structured. How the brain functions, however, is unknown territory to me. Nerve cells are connected to each other at synapses where information is exchanged. The number of synapses, connections of one nerve cell to other nerve cells, is prodigious, estimated to be in the billions. These interconnections are involved in all forms of intellectual function, including memory, There are specialized centres to process and arrange particular kinds of information, for example about what we see, hear, smell, taste, and feel.  Stimulation of any of these senses can evoke memories.

I’m intrigued by the fact that sensory input can sometimes instantly evoke a particular memory; but at other times, for instance connecting a name to a face, an author to a recently read book, or the name of a former politician whose decisions come up in conversation, retrieval of particular personal names the specific parts of the memory may take days. What does this tell us about the nature of the process, the extent to which it is electrical (which ought to be instantaneous) and chemical (which if complex chemicals are involved, might well take hours or even days)?  

Here are some of my observations that touch on how my memory works.

Sensory input – things I see, hear, smell, taste, feel – can trigger memories. Snatches of music sometimes remind me of episodes from the past. The strongest trigger may be the sense of smell, which is a reminder that this sense is mediated through the most primitive part of the brain. Strong smells don’t necessarily evoke memories but occasionally a subtle smell can induce an overwhelming flood of recollection of an episode from the past, something that hasn’t entered conscious memory for years, or even decades. For instance when I had my car serviced recently I caught a distant whiff of hot engine oil. It triggered a recollection of the diesel engines on the Adelaide Star, the cargo ship that in 1954 carried me from Tilbury Docks in East End London to Tenerife in the Canary Islands then on around the Cape of Good Hope and across the Southern Ocean to Adelaide. Not just a general memory of that splendid journey but a particular occasion when I climbed down the companion way to the engine room where one of the engineers had crushed his fingers in the moving machinery.  I administered first aid on the spot, then took him to the ship’s surgery, which was in the stern just above the propeller shaft, where I cleaned up his fingers and put in a few stitches to hold the split skin in place until it healed.

Throughout the1980s and early 1990s I coordinated and taught in a delightful course called Human Dimensions of Health and Illness. I had about 72 hours of contact time with the class of 84 first year medical students and saw many of them frequently in small groups, some of them one-on-one for counseling or in the role of mentor. I got to know many students very well, was on first-name terms with almost all of them. As they walked towards me on the path leading to the entrance to the health sciences building I could greet each of them by name. In the early 1980s when the synapses engaged promptly, I could greet them as they approached me; by the late 1980s, my synapse time had increased and I could greet them by name as we were passing each other; and by the 1990s, I retrieved their names only after we had passed each other. The memory function that links names to faces took longer as I grew older. The process of retrieving stored memories takes longer with advancing age. I think many people observe this. Does this reveal whether neural synapse connections are chemical or electrical? Or does it indicate other characteristics of neural synapse connections? It reveals something about the memory function of linking names to faces but I’m not sure what this is.

At the international scientific meeting of the International Epidemiological Association in Los Angeles in 1990, I convened and ran a workshop on ethical problems in epidemiological practice, research and teaching. About 100 people attended this workshop. They came from many countries, and I had met about two thirds of them before; about a dozen were old friends. The workshop took place in an auditorium with gently sloping rows of seats.  I chaired two lengthy discussion sessions in which I stood at the front and was able to call upon almost everyone by name – impressing myself as much as everyone else. Reflecting on this now, I think it indicates that this kind of memory function worked most efficiently when I was on an adrenalin ‘high’ that made my juices flow better than usual.

So I have – or formerly had – the ability to connect names to faces, which is a rather specialized memory function.  I could remember places too and their relationship to each other, in cities that I visited again after a long interval. When I returned after several years to London, Edinburgh, Paris, Geneva, New York, San Francisco, Boston, Sydney I could unerringly find my way back to a favourite book shop, a favourite restaurant (or where it had been) even when in the interim there had been drastic changes – newly imposed one-way streets, demolition and rebuilding that obliterated familiar landmarks. 

Like almost everybody, I find now in my late 80s that when names of politicians or authors of books come up in conversation, these names usually escape me, at least for a time, only to bubble back into consciousness hours or days later when the moment to drop them into conversation has long passed.  This suggests that a slow chemical reaction rather than electrical impulses which are virtually instantaneous, must be involved in memory storage and retrieval. Yet we know that electrical impulses are involved in brain function, because we can record and measure them by attaching electrodes to the skull and observing and measuring the discharge of tiny electrical currents that take place when people are thinking, using their brain to perform various types of intellectual activity, or experience various emotions.

Going back to the distant past, when I was a school boy and when I was a medical student, I had to learn innumerable facts but always, always, I tried not to adopt rote learning – that is, learning by memorizing without necessarily understanding. Very early in grade school, in Grade 1 or Grade 2, I can remember 80 years later, that I tried consciously as we learnt the multiplication tables, to understand why 2 x 2 = 4 and 12 x 12 = 144, not just to memorize as we recited them in unison in class in a sing-song way I can recall as clearly as if it were yesterday. I’m told we use a different part of the brain to reason things out, rather than memorizing them. Does the part of the brain involved affect ability to remember?

In the six years of the medical course, we had to learn the vocabulary of medical practice, about 14,000 new technical terms, the equivalent of three modern languages. Knowledge of Latin and Greek used to be a mandatory requirement for admission to medical school until well after my father’s time in the 1920s, because anatomical and pathological terminology are derived from these 2 classical languages. It was no longer essential by my student days in 1944-49, but it helped that I’d taken Latin to Intermediate level: I understood words like anterior, posterior, ventral, dorsal, and why the mitral and tricuspid valves are so named. But daily use that led to familiarity was how I learnt the languages of biochemistry, physiology, pathology, and the clinical names for many diseases and the symptoms they cause. Many of my classmates swotted for exams by memorizing vast arrays of facts – by using mnemonics or rote learning – but I never did that. I studied by trying to reason things out. Many of my classmates learnt by rote that some conditions, such as chronic lung infections and congenital heart disease that deprives the extremities of oxygenated blood, cause the ends of fingers to swell like drumsticks.  I tried to learn by reasoning out why this happened (the explanation is far from straightforward). Nevertheless, whether memorizing vast numbers of facts or trying to use reason and logic, successful passage through medical school demands prodigious feats of memory. And that’s just the beginning: staying abreast of the rapidly advancing frontiers of medical science requires never-ending surveillance of medical journals, regular and frequent attendance at formal courses of continuing medical education, and, of course, remembering this newly acquired knowledge.     

More than this I can’t say with any confidence. I know if I consulted Google or Wikipedia I would learn more about how memory works. But I’m not writing a scholarly monograph, merely my memoirs. These memoirs are all about things I remember from a long, most enjoyable, and very interesting life. It’s not for me to say more than I have said here, about how or why I remember the assortment of facts and episodes I’ve reported here.