Health Care

The Erector Set

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This is my maiden post as a new Chicago Boy so I thought I would recycle a post from my own blog that might be of interest.

My grandson’s birthday was two weeks ago, and his father’s is next weekend. I thought I would give him (the grandson) a toy that I was sure he had never heard of, an Erector Set. I have a medical connection, as well as a childhood connection, with this toy, now largely forgotten. I had Lionel trains when I was a child in Chicago and eventually had HO gauge trains, as well. When I had sons old enough to play with trains, I built an elaborate train set in my garage. Then I learned that southern California is not the place for toy trains. The boys were outdoors all the time and the train set gathered dust.

Few kids today will have the chance to enjoy the Erector Set. Like so many cold climate toys, it is never seen in southern California. I wonder how many sets are sold in Chicago ? There   is still a small source for this toy; but the glory days of the Erector Set were long ago. The toy was invented by A.C. Gilbert; in 1913. The story is interesting. Gilbert was a Yale Medical School graduate and had also won a gold medal, for the pole vault, in the 1908 Olympic Games. He built a new design bamboo pole that he used in his winning vault and he sold these, as well as other toys.

Like many residents of New Haven, Connecticut, he often took the train to New York City; and on one trip in 1911 he was inspired with what would be the most popular of his dozens of inventions.

Watching out the train window as some workmen positioned and riveted the steel beams of an electrical power-line tower, Gilbert decided to create a children’s construction kit: not just a toy, but an assemblage of metal beams with evenly spaced holes for bolts to pass through, screws, bolts, pulleys, gears and eventually even engines. A British toy company called Meccano Company was then selling a similar kit, but Gilbert’s Erector set was more realistic and had a number of technical advantages — most notably, steel beams that were not flat but bent lengthwise at a 90-degree angle, so that four of them nested side-to-side formed a very sturdy, square, hollow support beam.

Gilbert began selling the “Mysto Erector Structural Steel Builder” in 1913, backed by the first major American ad campaign for a toy. The Erector set quickly became one of the most popular toys of all time: living rooms across the country were transformed into miniature metropoles, filled with skyscrapers, bridges and railways. Those kids who already owned a set would beg Santa annually for an upgrade, aiming for the elusive “No. 12 1/2” deluxe kit that came with blueprints for the “Mysterious Walking Giant” robot. It is difficult for anyone under the age of 35 today to appreciate just how popular the Erector set was for over half a century.

Now, it happens that I have a personal connection to the Erector Set. In the early 1970s, a patient was referred to me with an esophageal stricture. He was in his 90s and had been told he was too old for a major operation like that. He and his wife had emigrated from England in 1913 and he was looking for a job as an engineer, when he met A.C. Gilbert, who was having trouble selling his new toy. Gilbert had invented the Erector Set and had built a few samples of what could be constructed using the new kit of materials but the set consisted of lots of perforated metal pieces and machine screws and nuts. The challenge was to design structures that children, with some parental help perhaps, could build. I had a set at the age of six and spent hours with it.

Gilbert needed someone to build sample structures using the set and write instructions on how to build them. He took the job and spent years working on new designs and instruction books. The first Christmas after he began work for Gilbert, the giant New York City department stores, Macy’s and Gimbel’s, wanted sample structures to help sell the toys. My patient built a huge suspension bridge for one store, that crossed over the cash registers, which in those days were arranged like the check-out lines in today’s supermarkets. The bridge was over 20 feet long. As soon as the other store saw his bridge, they wanted one just like it. He built another and the toy’s popularity took off. For years, he worked for Gilbert although, when I knew him, he had been retired to San Clemente for years.

He and his wife were in good health with the exception of this stricture that was so tight that he could only swallow liquids. It was a consequence of esophageal reflux and the scarring that chronic reflux produces.   He was very lucky that it had not developed a cancer.   He subsisted on apple sauce and other pureed food that would not pass through the stricture until he jumped up and down while standing against the wall. Every few mouthfuls, he had to stand up and jump until the food went down. He had been told he was too old to have it fixed, or even dilated, and his only option was some sort of feeding tube. Needless to say, he was skinny and the operation seemed to be feasible to me. Larry Mathis, a long time GP surgeon in San Clemente was his GP and Larry and I decided to try to fix his stricture. At surgery, his esophagus, just above the stomach where most benign strictures occur, was so tight that it split when I tried to dilate it from below with my finger. There is a procedure called a Thal Patch(pdf). It is used to close esophageal perforations such as traumatic tears and ruptures, like the Boerhaave’s Syndrome. In this case, I had created the hole in the esophagus by tearing open the stricture. I made a Thal patch from his stomach and closed the hole without recreating the narrow section. The surgery worked and he recovered very well. He hadn’t been able to eat solids in over five years. As a reward, he told me his story.

A few years later, he presented with symptoms of acute cholecystitis but at surgery I found a cancer of the colon next to the gallbladder. About   a year later he died of the cancer, having nearly reached the age of 100.

A.C. Gilbert also invented a number of other toys that were Christmas traditions for half a century. They included chemistry sets, physics sets and even a nuclear radioactivity set that included a Geiger counter. I had several of these, including the radioactive set. Those were the days before TV when children played with educational toys and were not so self-conscious about it. Today, the ATF would probably raid the basement of a child who had one of those sets.

Quote of the Day

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There is one aspect of the change in moral values brought about by the advance of collectivism which at the present time provides special food for thought. It is that the virtues which are held less and less in esteem and which consequently become rarer are precisely those on which the British people justly prided themselves and in which they were generally agreed to excel. The virtues possessed by Anglo-Saxons in a higher degree than most other people, excepting only a few of the smaller nations, like the Swiss and the Dutch, were independence and self-reliance, individual initiative and local responsibility, the successful reliance on voluntary activity, noninterference with one’s neighbor and tolerance of the different and queer, respect for custom and tradition, and a healthy suspicion of power and authority.

F.A. Hayek, The Road to Serfdom

The Self-Reflecting Mirror of Good Intentions

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“The most interesting, under-discussed, and potentially revolutionary aspect of the law is that it doesn’t pretend to have the answers. Instead, through a new Center for Medicare and Medicaid Innovation, it offers to free communities and local health systems from existing payment rules, and let them experiment with ways to deliver better care at lower costs. In large part, it entrusts the task of devising cost-saving health-care innovation to communities like Boise and Boston and Buffalo, rather than to the drug and device companies and the public and private insurers that have failed to do so. This is the way costs will come down—or not.” – Atul Gawande, The New Yorker (via Real Clear Politics)

Or not? Or not? Or not?

Wait a minute. Proponents of Health Care Reform insisted that a crisis existed in American medicine – a crisis of steadily increasing costs and the uninsured. Forget for a moment the pages and pages and pages of regulation: the essential steel-frame structure at the heart of the bill consists – it seems to me! – of committees that have yet to write the myriad of rules that will govern the future of health care in this country. Isn’t that the case? Am I getting it wrong? And if I am, it’s not like the authors of the legislation took care to write something a layperson like me could understand. Do even the authors know what is in it?

I respect the good Dr. Gawande very much, but I cannot understand how any physician or scientist – who ought to pride him or herself on evidence-based medicine – would sign off on something like this? It’s all supposition. It’s all promises. It’s all the self-reflecting mirror of good intentions.* There’s no there there. Not really. Not if you look beyond the gimmicks.

Hey, if I’m being unfair, or misunderstanding, drop a line in the comments box, okay?

* I used the above phrase in this comment at zenpundit on an entirely different subject. I’m pretty sure I made it up on the spot, but somehow, I always have a subterranean fear that I am plagiarizing someone a lot more clever than I am. Not sure what that is about, but now, thanks to my penchant for TMI, you all know that about me!

Update: I am not saying the uninsured or costs are not a serious problem. What I am arguing is that the very legislation intended to solve the problem of cost is a roll of the dice in that regard. Why do we need an oxymoronic government “department of innovation” anyway? Why not break down government-set barriers and allow the experimentation to take place in the absence of said barriers? Honestly, I couldn’t understand a bit of the logic behind that article.

Another Update: “Two Views On Health Care From The New Yorker,” Peter Suderman (Reason – Hit and Run)

Images, Analogies, and Cooties

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In a comment, Mishu linked to “The Lie of a Liberal Arts Education.” Jeff Goldstein, of Protein Wisdom, tells us after a political cartoon was posted at his site, an old teacher e-mailed him, requesting that his name be struck from the list of Goldstein’s teachers. That we are responsible for those who have studied under us would make neither my raft of old teachers very happy nor me about many of my students. (Jonathan’s need to fix my comma splices, for instance, must make one of them spin in his grave.)

I’d seen the comment (for the usual reason, groggy in the morning and late at night, I check out Instapundit). And I’d remembered it clearly, since it brought home the adolescent and enforced homogeneity of academic thinking but also because the cartoon was especially memorable, disturbing the way political cartoons can be. The visual and analogous are powerful weapons. The Muslims realize that – and we should, too. That doesn’t mean, of course, that we follow the actions of either the Jihadists or the average college faculty. When I went back later to show it to my husband, the cartoon was linked but no longer at the top of the page. It provokes, but it has a certain rightness. I found it and my husband was repelled. He felt it was in bad taste. His explanation for that gut reaction was not a defense of Obama nor of the content or the process of Healthcare legislation as would any sentient being, he sees those as pretty bad. Nor did he see it as racist indeed, worrying about that label would make any criticism difficult.

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To be clear….

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“To be clear: it is not sufficient for those of us in the opposition to await a reversal of political fortune months or years from now before we advance action on health care reform. Costs will continue their ascent as the debt burden squeezes life out of our economy. We are unapologetic advocates for the repeal of this costly misstep. But Republicans must also make the case for a reform agenda to take its place, and get to work on that effort now.” – Paul Ryan in the New York Times

Is that “to be clear” intended as a little dig at the rhetorical style, or stylings, of our President? Gentle jokes aside, this is a very good Op-Ed.

*Because there’s more to life than Health Care Bills, here is a link about the William Eggleston photo exhibit at the Art Institute of Chicago. The exhibit is running until May 23.