As anyone surely knows by now, family history research has become big business. Knowing your family's background, where they came from, what they did, "who" they were has immense appeal for millions of people - at least in the first world. In part that is because so many families emigrated from Eurasia to North America and the Antipodes leaving behind forebears and their stock of familial knowledge. In part it derives from some sort of popularized belief that culture is genetically and usually paternally determined; and this sense that we are what our male forebears were no matter where we were born and raised has been well nurtured by the pluralism of the multicultural movement. In part it flows from the desire to understand the intersection between personal histories and public history: what were our ancestors doing at this or that time in history; how were they affected by this or that historical event?
Once upon a time only the rich and titled were able to chart their families' pasts. Now it is within the compass of most us in the first world to learn something about the peoples who made up and made our families. The internet and the ever-growing digitization of public and private records have made possible what today what would have been all but unthinkable ten to fifteen years ago (I'm guessing here!). A treasure trove of archives can be searched with a few clicks of the mouse - and, of course, usually a credit card! The click of the mouse allows everyone to be a historian and a genealogist; and, as tellingly, able to determine their own past.
It is this last reason behind much of family history research - structuring one's own past - with which this blog is concerned. Unfortunately, genealogy does not have too high a reputation among academic historians - and, equally unfortunately, all too frequently for good reason. Reputable genealogists, like other historians, recognize the need to read the records with care and in the knowledge that little in the archives can be taken at face value; that the further back you go the more tenuous the evidential links and so the unreliability of making claims; and that the vast majority of ordinary people left behind little or no evidence of their existence, certainly prior to the late sixteenth century in England. Now that everyone and anyone can be their own genealogist - which is as it should be - the restraints are off!! Everybody seems to claim a Family Crest for at least one line in their background; every other family appears to have a connection to royalty, or the nobility, or even petty aristocracy! There are those who have staked their claim to a genetic link to Charlemagne (not a few) and to sundry Anglo-Saxons, Danes and whatnots. How and where they have been able to find the records that make these connections and how they have been assured of their reliability is, well, beyond me! I suspect that much of the chronologically distant research for these "family trees" was the work of paid researchers who understood what their clients wanted: a claim to their family's historical significance. An understandable wish, but not one that makes for reliable history or genealogy. And a desire that misunderstands the social historical significance of ordinary people's lives in the making of public history.
Let me make my disclosure here: I am by training a historian; I am researching my own family history; and I should like to work as both a historical and genealogical researcher for others. Historical research and writing about the past in the light of what the available evidence does and does not say are my passions. Since leaving university, not having found any other outlet for these twinned passions, I have indulged them through looking into my own family's past. As for so many another, the internet and its ever-growing digitized store of personal historical records have proved a wondrous boon. Best of course would be to do the digging in the repositories themselves; but when you live thousands of miles away from the pertinent ones, the internet's incomplete but burgeoning crop are almost as good. So long as you have the money to pay for viewing the digitized manuscripts.
It is absolutely necessary to check the indexed and transcribed information against the manuscript. You should not trust other people's transcription of documents. However, many appear to do so - perhaps because of the extra cost involved in viewing the ms. Many of the transcribers of, for example, British census records for some of the best known genealogical subscription websites are volunteers. Some of them do not appear to be familiar with 18th and 19th century handwriting styles; nor do many appear have much if any knowledge of British place names. Other transcription or manuscript errors abound. The manuscripts of the British census records as we see them on our computer screens are themselves transcribed copies of the original forms that either the enumerator or the literate householder filled out on the night of the census (more likely the latter filled out the form at some point in time before the night of the census). The original forms were destroyed after their information had been copied down into the census return books, so there is no possibility of double-checking the census books, as we have them, against the original forms.
If all that the family history researcher had to worry about were transcription errors, it would be a simple matter of being willing and able to pay to view the manuscripts either in virtual or tangible formats. If that were all there were to researching the records, it would far far less fascinating than historical research intrinsically is. It is to those other absorbing problems that I shall turn in the next blog - and what they tell us about how we understand our families' pasts and their place in our public histories. And I shall touch on the problems that beset the family historian once the 19th century is left behind for earlier periods.
Sunday, October 5, 2008
Wednesday, January 9, 2008
Living With Diabetes Number One.
I am the partner of a type one Diabetic. We became aware of his disease in early January, 1994, when not only was he urinating every 45 minutes throughout the day and night, but his vision also grew blurry. We were living in Casablanca, Morocco at the time. There one could take oneself off to a Laboratoire and have tests done without the initial step of visiting a doctor. So, off he went, without breakfast and before going to work, to check out our fears. The results of both blood and urine tests were positive for high blood glucose and the presence of ketones, this latter marking the type of diabetes that had developed. The laboratory owner and head chemist, also the husband of the then Principal of the international high school where both my spouse and I worked, advised on an internist. An appointment was made and insulin treatment and diet instituted.
Initially, my spouse was put on animal insulin, but within a few months he was using a fast acting human insulin via an insulin pen for his mealtime doses and a 22-24 hour ultra long-acting human insulin via hypodermic at night for the 'housekeeping' dose. This regimen together with careful attention to diet, though not extending to the exclusion of wine, worked admirably. Little did we know then how much of a honeymoon phase those three years of diabetes in Morocco were. There were no hypoglycemic comas or near comas; boiled sweets satisfied his self-recognized low blood glucose episodes; his blood glucose seemed under control. We had, thankfully, no need of para-medical aid, or of glucose tablets or glucose jelly (anyway unobtainable in Casablanca at the time). (Glucose is something of a misnomer as the vital ingredient is dextrose.)
After six years of life in Morocco, we left in 1997 for Louisville, Kentucky. The first couple of months went smoothly enough, diabetically speaking, as my spouse had taken enough insulin with him to carry him through the initial period in a new place, with new doctors. When trouble arose it came from unanticipated quarters: the insulin and comas.
In the States, the overwhelming majority of insulin used comes from one company, Eli Lilly. Both insulins used by my spouse had been from the major European supplier, Novo-Nordisk. He was able to continue to use his regular fast-acting mealtime insulin by NN without any difficulty, as that was readily available; but the NN ultra long-acting, housekeeping insulin was not. To replace that, his endocrinologist prescribed the longest acting insulin then in Eli Lilly's formulary. None of us, including his doctor, knew that the Novo Nordisk ultra long- acting and the Eli Lilly long-acting did not act similarly, at least in my spouse. While the former achieved a steady state action within 30-60 minutes after injection and stayed in that state for 22-23 hours, the latter peaked and fell over a period of twelve hours. Thus, unbeknownst to us, there was little long-acting housekeeping insulin activity going on during the daytime. The consequence of this was high blood glucose readings from mid morning onwards. His doctor prescribed a medium acting insulin to replace the long acting - with disastrous results: his second coma.
Back in 1994, just two days after we had learnt of his diabetes, I flew off to England to see my father (for the last time as it turned out) who had suffered two heart attacks in as many weeks. The day before I flew back to Casablanca I spent a few hours in Leeds, visiting book shops and generally wandering around soaking up home ground vibrations. At one of the book stores I found and bought an excellent guide for diabetics, written by an endocrinologist. The book was wonderfully explanatory and did not treat its readers as if they were barely literate children. It became our 'bible' on matters diabetic. Among its many important sections was a diagram which illustrated the peaking time and duration of each and every insulin available at the time. From this more detailed diagram, I drew up my own illustrating the working of the insulins that my spouse was using in the States and that did not seem to be controlling his blood glucose levels satisfactorily. This diagram made apparent the shortfall of the available long-acting insulin. To rectify the problem caused by the insulin's shorter working time, he would have to take two smaller doses, each about twelve hours apart. It worked.
Our first coma occurred when we were staying with friends over our first Thanksgiving. We had driven over to Missouri, spending a night in a hotel on the way to reduce the physical strain on him (I can't drive). At two o'clock that first night in Columbia, however, we all got a shock. When my partner's jerking around in bed became obviously more than restlessness and he didn't respond to my questions, I turned on the bedside light and promptly went into panic mode, as I had never seen anyone in a hypoglycemic coma before, with its convulsions, heavy, heavy sweats and autonomic urination. And this was all happening to the man I loved. But at least I remembered enough from my student nurse training (four months before I dropped out) in another lifetime, to make sure that his airway was clear and that he was on his side. Then, I ran out of the bedroom screaming for help, for an ambulance. Our friends called EMS and the minutes waiting for it to arrive seemed like years. Our friends were pure gold and we were so thankful to have their support that first time; without them I do not know what would have happened. There have been many comas and near comas since then, all of them still scary but some scarier than others.
Since that night in 1997, we have tried not to be without a Glucagon kit or glucose jelly. That jelly has saved him from many full-blown comas and when that has been too dangerous to give, then the Glucagon kit has often been the life-saver.
The availability and price of glucose, in jelly or tablet form, is anything but uniform across countries and continents. In the US, glucose tablets are available at many pharmacies. But I have only found glucose jelly, in packs of three at $12 a pack, in one pharmacy chain. In the UK, glucose tablets are readily available in a variety of stores; glucose jelly, also in packs of three but at the staggering price of 11 pounds sterling/pack (!), has to be bought at chemists (equivalent of pharmacies). But there you could on occasion find dextrose energy tubes for 99p each and small tubs of dextrose (used in making certain types of icing for cakes) at a similar price. The drawback to the confectioner's dextrose is its consistency: very stiff and so difficult for the hypo diabetic to swallow. In Germany, the glucose jelly comes in re-sealable tubes, at 1 Euro 76 cents per tube. The glucose tablets are 49 cents a tube in drugstores (two are equivalent to one US glucose tablet) and other dextrose tablets are available in most grocery stores. The US and UK glucose jelly prices are iniquitous; and doubly so given that the tubes in both countries are not re-sealable. Nor are their tubes easy to open for the low blood glucose diabetic, whose hands are likely to be somewhat uncoordinated and greasy with sweat.
But where we now live, glucose jelly is unavailable; and glucose tablets cannot be bought with any regularity or certainty. They were non-existent during our first year here; then they appeared on the shelves of the nearest hypermarket for about six months but have since disappeared again.
This constitutes the first blog on living with diabetes.
Initially, my spouse was put on animal insulin, but within a few months he was using a fast acting human insulin via an insulin pen for his mealtime doses and a 22-24 hour ultra long-acting human insulin via hypodermic at night for the 'housekeeping' dose. This regimen together with careful attention to diet, though not extending to the exclusion of wine, worked admirably. Little did we know then how much of a honeymoon phase those three years of diabetes in Morocco were. There were no hypoglycemic comas or near comas; boiled sweets satisfied his self-recognized low blood glucose episodes; his blood glucose seemed under control. We had, thankfully, no need of para-medical aid, or of glucose tablets or glucose jelly (anyway unobtainable in Casablanca at the time). (Glucose is something of a misnomer as the vital ingredient is dextrose.)
After six years of life in Morocco, we left in 1997 for Louisville, Kentucky. The first couple of months went smoothly enough, diabetically speaking, as my spouse had taken enough insulin with him to carry him through the initial period in a new place, with new doctors. When trouble arose it came from unanticipated quarters: the insulin and comas.
In the States, the overwhelming majority of insulin used comes from one company, Eli Lilly. Both insulins used by my spouse had been from the major European supplier, Novo-Nordisk. He was able to continue to use his regular fast-acting mealtime insulin by NN without any difficulty, as that was readily available; but the NN ultra long-acting, housekeeping insulin was not. To replace that, his endocrinologist prescribed the longest acting insulin then in Eli Lilly's formulary. None of us, including his doctor, knew that the Novo Nordisk ultra long- acting and the Eli Lilly long-acting did not act similarly, at least in my spouse. While the former achieved a steady state action within 30-60 minutes after injection and stayed in that state for 22-23 hours, the latter peaked and fell over a period of twelve hours. Thus, unbeknownst to us, there was little long-acting housekeeping insulin activity going on during the daytime. The consequence of this was high blood glucose readings from mid morning onwards. His doctor prescribed a medium acting insulin to replace the long acting - with disastrous results: his second coma.
Back in 1994, just two days after we had learnt of his diabetes, I flew off to England to see my father (for the last time as it turned out) who had suffered two heart attacks in as many weeks. The day before I flew back to Casablanca I spent a few hours in Leeds, visiting book shops and generally wandering around soaking up home ground vibrations. At one of the book stores I found and bought an excellent guide for diabetics, written by an endocrinologist. The book was wonderfully explanatory and did not treat its readers as if they were barely literate children. It became our 'bible' on matters diabetic. Among its many important sections was a diagram which illustrated the peaking time and duration of each and every insulin available at the time. From this more detailed diagram, I drew up my own illustrating the working of the insulins that my spouse was using in the States and that did not seem to be controlling his blood glucose levels satisfactorily. This diagram made apparent the shortfall of the available long-acting insulin. To rectify the problem caused by the insulin's shorter working time, he would have to take two smaller doses, each about twelve hours apart. It worked.
Our first coma occurred when we were staying with friends over our first Thanksgiving. We had driven over to Missouri, spending a night in a hotel on the way to reduce the physical strain on him (I can't drive). At two o'clock that first night in Columbia, however, we all got a shock. When my partner's jerking around in bed became obviously more than restlessness and he didn't respond to my questions, I turned on the bedside light and promptly went into panic mode, as I had never seen anyone in a hypoglycemic coma before, with its convulsions, heavy, heavy sweats and autonomic urination. And this was all happening to the man I loved. But at least I remembered enough from my student nurse training (four months before I dropped out) in another lifetime, to make sure that his airway was clear and that he was on his side. Then, I ran out of the bedroom screaming for help, for an ambulance. Our friends called EMS and the minutes waiting for it to arrive seemed like years. Our friends were pure gold and we were so thankful to have their support that first time; without them I do not know what would have happened. There have been many comas and near comas since then, all of them still scary but some scarier than others.
Since that night in 1997, we have tried not to be without a Glucagon kit or glucose jelly. That jelly has saved him from many full-blown comas and when that has been too dangerous to give, then the Glucagon kit has often been the life-saver.
The availability and price of glucose, in jelly or tablet form, is anything but uniform across countries and continents. In the US, glucose tablets are available at many pharmacies. But I have only found glucose jelly, in packs of three at $12 a pack, in one pharmacy chain. In the UK, glucose tablets are readily available in a variety of stores; glucose jelly, also in packs of three but at the staggering price of 11 pounds sterling/pack (!), has to be bought at chemists (equivalent of pharmacies). But there you could on occasion find dextrose energy tubes for 99p each and small tubs of dextrose (used in making certain types of icing for cakes) at a similar price. The drawback to the confectioner's dextrose is its consistency: very stiff and so difficult for the hypo diabetic to swallow. In Germany, the glucose jelly comes in re-sealable tubes, at 1 Euro 76 cents per tube. The glucose tablets are 49 cents a tube in drugstores (two are equivalent to one US glucose tablet) and other dextrose tablets are available in most grocery stores. The US and UK glucose jelly prices are iniquitous; and doubly so given that the tubes in both countries are not re-sealable. Nor are their tubes easy to open for the low blood glucose diabetic, whose hands are likely to be somewhat uncoordinated and greasy with sweat.
But where we now live, glucose jelly is unavailable; and glucose tablets cannot be bought with any regularity or certainty. They were non-existent during our first year here; then they appeared on the shelves of the nearest hypermarket for about six months but have since disappeared again.
This constitutes the first blog on living with diabetes.
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