I am aware of half a dozen reviews of my book, Chief Complaint, having appeared in print or online, all enchantingly positive, I have collected those in a Word file that I treasure and keep expanding. But I haven't posted them on my blog. This is different. It has a certain value added at source; it is from a Harvard Medical School class mate (1968) who is the world expert on the subject of kinship and fertility. He posted his review to the class listserve. I expect some noise to be generated by this review. But noise is always good for sales. I hasten to add that the esoteric few last paragraphs left me less than clear about what my dear classmate exactly means. I visited his website and emerged not much clearer about his aim though, on the whole, it sounds positive. But that is Harvardese for you and I have been weaned from it for near half a century. Still, I am happy to gloat about all the praise and the bright spotlights that my classmate shines on my book in his first few paragraphs. Here it is for your (and my) enjoyment:
Review of
Chief Complaint:
I have had the
great pleasure of reading Chief Complaint by Hatim Kanaaneh MD (Just World
Books, Alexandria, Virginia 2015 and available from Amazon).
It is with
some trepidation that I discuss a book that touches on such sacred
things. It is a
collection of short stories, which is like saying a Mozart sonata is a
collection of notes. The stories are partly fictionalized, as the author
points out, with most of the names being changed and some episodes that
happened to different people being linked in one person. The book is
disarmingly simple in its organization, being the tales of people who came to
Dr. Kanaaneh put together by chief complaint in the routine order of a systems
review by a good clinician.
Beneath that
inviting cover I found a narrative of different levels, which I shall try to
describe.
The easiest
level for me is the political. Let me quote the first two sentences from
“The Gray Champion” by Nathanial Hawthorne. “There was once a time when
New England groaned under the actual pressure of heavier wrongs than those
threatened ones that brought on the Revolution. James II, the bigoted
successor of Charles the Voluptuous, had annulled the charters of all of the
colonies, and sent a harsh and unprincipled soldier to take away our liberties
and endanger our religion.” Chief Complaint makes clear that British rule
was not improved by time, nor was the puppet government they installed.
As with Hawthorne, the doctor’s tale is one of the persecuted as seen by the
persecuted – in flagrant defiance of the commonplace that history is written by
the victors. This is Palestine under Israeli rule, British Mandate rule
and even Ottoman rule. The protest is most clear.
The second
level is still manageable for me. That is the narrative style. I
graduated with high honors in English from Wesleyan University, so if this next
paragraph is folly, at least it is by a fool with credentials. There are
multiple themes woven into the tale. It is like spending days on a
sailboat accompanied by an enormous pod of many-colored cetaceans.
Sometimes one passes submerged and the is only the hint of color gliding below
the surface followed by another and another or more than one. Then one of
them breaches clear of the water and for a time all too brief shines
resplendent in the sun. And there are characters, many characters.
I think I have met more people of the village of Arrabeh than I can recall with
such distinctness and understanding from my childhood plus present life.
We see them at their best and at their worst, their injuries and ailments,
their deepest woes and their highest dreams, through the attentive eye of the
clinician.
At the third
level I panic. Long years among many different cultures have taught me
that some things are fair game for conversation with anyone: family, weather,
sports, ghosts, machinery and so forth. One might not agree, but at least
one knows the lie of the land. But when one ventures into what is
precious, sacred memory or dream, table manners and alcohol or tobacco, things
immediately in touch with the physical body, one may all unintentionally
offend. The story is set with the constant presence of a wistful, mistful
past when the people owned land, the land was bounteous and mouthwatering
delicacies were available in their season. It took hard work to wrest a
living from the soil, from the goats and especially from the trappable wild
things. I have no doubt that these sweet memories are valid. My own
experience has been that the past is forgotten or seen through a distorting
lens such that friends who seemed to be bounding with joy when they were with
me recall later unfairness, squalor and privation I do not recall. And yet
the dream of this lost past summons problems; what would fix things?
Arrabeh is now a city of over twenty thousand. It could never support
itself on the produce of the land. Nobody could possibly, any longer, be
friends with every adult. Natural increase has dimmed the dream.
Some things could be fixed, obviously, but all?
The fourth
level takes me where others might not choose to venture. So if you have
problems, let me say, “READ THIS BOOK.” Now you can bolt any time you
like. The thing is that I see in this book not only the past but the
future. The rich countries of the world have an unsustainably low birth
rate. That is common coin. My own work suggests that the middle
class the world over will have a birth rate fall that will be extremely abrupt
and profound. But I do not see that in Arrabeh. A large proportion
of the Palestinians are highly educated and highly skilled. They make
money. And they make babies. Nobody else seems to be able to do
both. I imagine the reason is that there is such a close emotional
attachment to the land, to the place, to the community, that they marry cousins
frequently enough to keep the babies coming. So the rest of us (I can’t
even get a date, and that is really no new thing.) will not leave the world to
the places that still have substantial growth: Yemen and Afghanistan I’m
thinking, and sub-Saharan Africa. Nice folk. Love ‘em all.
Not so keen on the education thing. But the Palestinians will endure.
And the fifth
and final level is a voice that says, “Why wait?” Marrying cousins,
specifically third and fourth cousins, maximizes your birth rate. Tell
them. Ah, but high birth rate is already a problem; don’t blame global
warming on the Palestinians, but just maintaining their society is difficult.
And I, after years of study, can’t tell you just what to do. Go to my
last summary of January 1, 2015 on nobabies.net and you can verify in the
Iceland study that those third and fourth couple pairings are the most fertile,
first cousins less so in the second generation and that distant ones, say ninth
cousin or greater, even less so still. Incidentally there is no
difference between ninth cousin and somebody from the far side of the
world. Nature doesn’t care how distant your distant kinship is; what
matters is how many generations it goes on. (It doesn’t matter how far
from the building you jump, it’s how long you fall.) The Icelanders have
looked at children and grandchildren, and it is the same story. They have
not seen fit to extend, as it seems they could, their study to great
grandchildren. I’ve written to encourage that.
Again on the
web site I mentioned there is a Swedish study showing that rich people (who
presumably leave forever their ancestral villages) have the same decrease in children
and grand children and the decrease in great grandchildren is greater than the
first two generations of outbreeding combined.
Ah but people
keep track of such things in Arrabeh. Do memories go back that far into
the Ottoman regime? Do the elders still chat? Could they put
together their own genealogies and see whether the rule holds, “Each generation
of mating outside ninth cousin cuts fertility in half?” That does not
seem to be exactly the case, but something close to it. Even so, it’s
tricky. The family trees will not be symmetrical at any level. But
we are talking about people intelligent and well educated who like to use their
minds. Maybe they can work it out.
But this
summons another demon. Now you know. What do you do about it?
In the end,
thank you, Dr. Kanaaneh, for this warm hearted, gripping and well woven
book.
Linton
