Conflict, coitus, conversation: the eternals

What's on the mind of BMJ authors and readers as this tired old millennium closes down? The Christmas issue always offers an insight because of the way it accumulates—like a cairn, article piled on article. Very little is commissioned. Rather, somebody somewhere, perhaps very far away, is inspired by passion, anger, despair, or silliness to write a piece or conduct a study. In contrast to the routine BMJ, most of the studies are silly and much of the prose profound.

Ulster is on the mind of many and is the source of three pieces. The past 30 years have seen unremitting “troubles” in Ulster. Some 3600 have died, but peace finally seems to be breaking out. Jenny Firth-Cozens and others report a study of doctors who coped with the aftermath of the Omagh bombing when 29 people, including nine children, died and over 300 were injured (p 1609). A quarter of the doctors suffered post-traumatic stress disorder. Moira Stewart describes what it was like to practise paediatrics on the front line in Belfast, where a 10 foot fence meant that Catholics from the Falls Road came in through one door and Protestants from the Shankill Road through another (p 1648).

Peter Froggatt draws a comparison between Ulster doctors working through the troubles and Irish doctors working in the great 19th century famine, which in five years accounted for a quarter of the population through death or emigration (p 1636). Some 4% of doctors died from “fever” during the famine. Ulster doctors, as the Omagh study shows, have been damaged by the troubles, but they have kept going with minimal fuss—and perhaps as a result, argues Froggatt, have not received their due credit. The BMJ agrees.

Conflict provides a whole section in this Christmas issue, which is appropriate not only because medicine is driven forward by war but also because the millennium has begun and ended with war and the 20th century has seen more deaths from war than ever before. Sex crops up repeatedly but most remarkably in a study of men and women having sex in scanners (p 1596). The living anatomy of coitus is understandably tricky to study, but this new investigation shows that Leonardo da Vinci didn't get it quite right in his famous drawing. In fact the penis seems to be shaped like a boomerang during intercourse.

But perhaps the most remarkable paper in this issue is that by Theodore Zeldin on how new methods of conversation can produce real change (p 1633). “Conversation,” writes Zeldin, “can be recognised as the principal instrument of change now that we realise that laws and guns are incapable of altering mentalities.” What better to wish for after a millennium of conflict than a millennium of conversation.