Blake Charlton's Blog, page 6

On the Cutting Room Floor: Historical Research

This post is not funny. Well…maybe it's funny if you're also an academic type and have had to cut massive swathes of a paper, but then it's a laugh-so-you-don't-cry kinda funny. (Men, for a similar experience, try surfing all day without a shirt and showering the next morning. You shall remember that males also have nipples and you will laugh so you don't…well…you get the point.)

Anyway, what follows has been cut from a historical paper I have been working on with Dr. Verghese. The overall topic of our research is "The History of Physical Diagnosis Texts in the West." As, maybe you've noticed, I'm very into text, books, history, medicine. It has been a wonderful project. However, it turns out, all the stuff relevant to modern medical practice that we discovered was in the modern era. As such, the following excerpt, which details the course of ancient physical examination texts had to be cut. Wasn't fun to do, but the two papers that will come out of the research are now far stronger. And there were one or two snarky bits that were going to have to be cut anyway. So, rather than letting the prose vanish into the æther, I thought I'd post it on my blog readers who are also history buffs—coincidentally, ::both:: of you might want to check out the final papers when their out. I'll post them over my on medicine page.

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Ancient Texts and the Foundations of the Logical Diagnosis

Medical diagnosis requires a belief in the natural, rather than supernatural, origin of disease. Hippocrates, born on the island of Kos near present-day Turkey, founded the first school of professional physicians who separated themselves from contemporary healing cults. The master himself is not known to have written any particular text; rather, a collection of treatises likely authored by him and his students has survived. Written in Ionic Greek—rather than Hippocrates's native Doric—the treatises were compiled in Alexandra into the Hippocratic Corpus, the first manuscript that might be considered a textbook for the physical examination. Among the surviving treatises are the original Hippocratic Oath and forty-two case histories; some of which demonstrate history taking, inspection, palpation, direct auscultation, succession[1], and examination of the sputum and urine.[2] Here we find that bedside diagnosis and remote diagnosis share the same origin; no history of physical diagnosis exists independent of a history of remote (or later, laboratory) diagnosis.

By combining an understanding of disease as natural with both direct and remote examination, the Hippocratic Corpus established the fundamental principles on which Western medicine would be constructed. However, that construction was long in coming. Classical anatomy was inaccurate and based largely on zoological dissection, while pathophysiology was centered on humorism (imbalance of blood, phlegm, etc). When Rome came to dominate the classical world, Galen—a Greek physician settled in Rome—combined these erroneous understandings with equally invalid Pythagorean theory. Worse, the extensive Galenic Corpus, containing over 500 treatises, came to so dominate the ancient medical mind as to become dogma, thereby arresting rational medical advancement. After the fall of Rome, even the conception of disease as a natural phenomenon declined; many medieval civilizations reverted to the perception of disease as a manifestation of the supernatural—this time invoking demons and devils of the Christian tradition rather than the ancient gods and spirits of the pagan tradition.

Fortunately, Islamic civilizations both preserved and expanded classical medical knowledge, including knowledge of bedside and remote diagnosis. The most important author of this movement was Abu ibn Sina, a Persian polymath and physician often known by his Latinized name, Avicenna. His Cannon of Medicine served as an Arabic medical encyclopedia that drew heavily upon both the Hippocratic Corpus and the Galenic Corpus. Many other physicians throughout the Middle East, North Africa, and the Iberian Peninsula also wrote important medical treatises in Arabic. Most authors were both Arab and Muslim, but there were exceptions: Witness the colorful example of Egyptian-born Isaac Israeli ben Solomon, a Jewish philosopher, former occultist, and physician to a Tunisian Caliph who wrote extensively on uroscopy, a practice that became widespread across the Mediterranean. Ornate flasks, some of them quite beautiful, were crafted to carry urine over great distances for remote diagnosis. The translation of Arabic medical texts into Latin provided non-Muslim European civilizations with access to this learning and therefore the Hippocratic knowledge of patient examination. In particular, the Latin translation of Abu Ibn Sina's Cannon of Medicine became a standard medical text throughout Europe. Although Arabic medical texts maintained and expanded the classical capacity for diagnosis, they were burdened by the dogma of Galen's zoological anatomy and a pathophysiology based on humorism.

Hampered by these misconceptions, Western diagnosis remained relatively static and wholly inaccurate for much of the early modern period. Before diagnosis could advance, the Western conception of the body and disease had to evolve. This it did only slowly. In Padua in 1543, Andreas Vesalius defied contemporary Catholic doctrine by publishing On the Structure of the Human Body, establishing a study of anatomy based on human dissection. A hundred years later, a former parliamentary cavalry captain in the English Civil War, Thomas Sydenham, became a physician and published dissertations on the classification of diseases. Observing the result of the period's deadly plagues, Sydenham argued that diseases could be divided into categories and that a particular disease might manifest differently in different patients save for a few constant and observable characteristics. Over the next century these ideas would develop into the discipline of nosology—the study of disease classification. A nosological conception of disease is so fundamental to the modern mind that most present day physicians would never have heard the word 'nosology' and would be hard pressed to imagine a time when classifying diseases was controversial. However, once informed of Sydenham's contribution, physicians might be tempted to romanticize the pre-nosological past, especially when searching for obscure ICD9 codes.

Starting midway through the seventieth century, similar advancements were made in the understanding of specimen examination. Athanasius Krcher, a Jesuit priest in Germany, applied a microscope to human blood, noting differences in samples taken from patients with plague. Later the writings of Robert Hooke in England and Marcello Malpighi in Italy popularized microscopic examination of tissues. However, little headway was made regarding the clinical application of these developments. Indeed, the era's most remarkable advance in remote diagnosis came from Thomas Willis, an English physician better remembered for his description of cerebral vasculature. Since ancient times, medical authors had noted that insects would often eat the urine of diabetics. They also discovered—and here one might wish to refrain from imagining exactly how—that this same urine tasted sweet. Willis borrowed the Latin word for honey, 'mel,' and named the disease 'diabetes mellitus.' This was to be contrasted to those diabetics who produced urine judged to be (relatively, we assume) tasteless or insipid, ergo 'diabetes insipidus.' Although pediatricians would later correlate unusually salty sweat with cystic fibrosis, Willis's discovery marked the apex of the diagnostic sense of taste. One might reasonably celebrate the demise of this particular diagnostic modality; had it been otherwise, modern clinicians might find the current obsession with laboratory diagnosis harder to swallow.

Less sensationally but more importantly, the final foundation of modern diagnostic understanding was created by Giovanni Battista Morgagni, who for more than fifty years carefully correlated patients' case histories to postmortem findings. In 1761, Morgagni published The Seats and Causes of Diseases, and for the first time, it was possible for a trained physician to inspect a patient's body or specimen and correctly apply the faculties of deduction or correlation.

[1] A maneuver in which the patient is shake while being auscultated to determine the presentence of a 'succession splash'—the sound of fluid and air splashing around in a body cavity. This maneuver is still used today in the bedside diagnosis of gastric outlet obstruction, hydropneumothorax, and pyopneumothorax

[2] Walker, H.K. (1990). The Origins of the History and Physical Examination. In Walker, H.K., Hall, W.D., & Hurst J.W. (Eds.), Clinical Methods, 3rd edition (pg 5) Boston, Butterworths.

Top 7 Reasons Why Dating a Pediatric Intern is like Dating a Rockstar with a Lot Less Money

(In the following post I will use the term 'partner' to mean significant other, boyfriend, girlfriend, costar, dearly beloved evil genius, etc, etc. I will assume said partner is female for no better reason than mine is.)

7) Many people see a lot more of your partner than you do.

6) A day that involves only one observed instance of projectile vomiting is a slow one.

5) Planning quality time together becomes a logical puzzle that could appear in the math section of the SAT.

4) Sleep deprivation makes subject-verb agreement optional.

3) You both suffer from the vague sensation that someone is making too much money off her hard work.

2) During most work hours, a variable number of people will be screaming at your partner.

1) Most conversations revolve around drugs and bodily functions.

Spellbound Cover Art Making-of Video

The amazingly gifted Todd Lockwood has put up a making-of video for some cover art for Spellbound over on his website. As viewed on his site, it's very impressive! I wanted to show it off here, but could only reproduce a very compressed version on youtube. It goes by waaaay too fast. Hence the flash-in-the-pan preview below. For the real thing, click on the link above for the view of click here for a page dedicated to the Spellbound artwork.

Starhaven Illustrated

Dearly Beloved YOU GUYS:

I've been fortunate over the past two years to work with Rhys Davies, an up-and-coming cartographer and illustrator of books. Readers of Spellwright are already familiar with Rhys's work in the form of his map of the Six Human Kingdoms that appears in the book. Lately, I've been working with Rhys on a map of the city of Avel, which is the seat of most of the action for Spellbound–we've a way to go before we can share it, but I can guarantee, it's going to look _very_ cool. Meantime, Rhys has been expanding his repertory with some illustrations of Starhaven from Spellwright. The perspective and color scheme remind me of some pieces by Rodney Matthews and Roger Dean. Check out Rhys's work !

What Rough Draft, It's Hour Come Round at Last

Deadlines make me moody.

This year it so happened that the production deadline for Spellbound landed only a few days after the convention for my regional meeting of the American College of Physicians. I could have played hooky…if I weren't on the meeting's planning commit and if I weren't helping Dr. Verghese teach a CME version of a Stanford 25 session at the meeting. So for the past 80 hours I've been driving up and down the peninsula, helping teach physical exam skills, sitting on council meetings, and/or editing as fast as I could. Medicine and publishing and sleep-deprivation, three weird flavors that taste even weirder when mixed together.

I think most people take naps when they're sleep-deprived. Me, I like to write mash-ups of apocalyptic Irish poems and publishing life. Practical, right? Sometime around 2AM last night the following (inspired by an fbook exchange with Megan a year ago) started bouncing around in my head. Though I'm feeling post-submission light and fluffy now, back then I was a ball of deadline moodiness. Let's all take a moment for derivative snark.

The Second Book!

by W.B. Yeats B.R. Charlton

Turning and turning in the widening plot

The author cannot hear the editor;

Denouements fall apart; the chapters cannot hold;

Mere action sequences are loosed upon the world,

The blood-dimmed typos are loosed, and everywhere

The ceremony of editing is drowned;

The best lack all punctuation, while the worst

Are full of passionate inconsistencies.

Surely some revision is at hand;

Surely the Second Book is at hand.

The Second Book! Hardly are those words out

When a vast image out of the PR Department

Troubles my sight: somewhere in the lands of printers

A shape with dragon body and the protag of a man,

A gaze blank and pitiless as the sun,

Is moving its slow bindings, while all about it

Reel shadows of the internet book critics.

The darkness drops again; but now I know

That twelve months of my sleepless writing

were vexed to nightmare by internet piracy,

And what rough draft, its hour come round at last,

Slouches towards production to be published?

Spellbound Synopsis

While I'm cranking away at getting the Spellbound manuscript into production, I thought I'd share a Spellbound synopsis cooked up by my friend and ace-beta reader Megan. Enjoy!

Francesca DeVega is a successful healer in the city of Avel, wielding magical text to close wounds and disspell curses, but her life is thrown into chaos when a dead patient suddenly sits up and tells her to run. Now Francesca is in the middle of a game she doesn't understand, one that ties her to the notorious rogue wizard, Nicodemus Weal, and brings her face to face with demons, demigods, and a man she thought she'd never see again.

It has been ten years since Nicodemus Weal escaped the Starhaven Academy, where he was considered disabled and useless, where he battled the demon who stole his birthright and killed his friends. Unable to use the magical languages of his own people, Nico has honed his skills in the dark language of the kobolds, readying himself for his next encounter with the demon. But there are complications: his mentor suffers from an incurable curse, his half-sister's agents are hunting him, and he's still not sure what part Francesca DeVega will play. He certainly doesn't know what to make of Francesca herself….

Introducing new twists to the unique magical system of Spellwright and uncovering more sinister dangers, Spellbound is sure to please Blake Charlton's fans and earn him new ones.

Personally, I Welcome Our New Speculative Fiction Overlord

Dearly Beloved YOU PEOPLE:

It's go time with the last revision of Spellbound. As such, until we put this manuscript into production in a few weeks, I'm gonna  pretty much not be on the internets. Till then, I'm going to leave this post up as a diversion-until-I-return post.

And what better place to divert you to than to the man who clandestinely and benevolently has poised himself to take over speculative fiction with a plush-covered iron first of sensitive and compelling prose OF DOOM. I'm speaking of course of Daniel Abraham. In the spirit of full disclosure, I admit to being an Abraham fanboy. Daniel is a friend and I was nothing less than humbled that he write a puff for Spellwright. Here's a picture of Daniel and me at the backstage pre-Hugo Award party, in Denver 2008. Daniel was up for a Hugo; I snuck in.

So this is not an objective assessment. However, I gotta lot of evidence why you should be a DA fanboy as well. Let's start with his short fiction. Daniels' novelette Flat Diane was nominated for the Nebula . While his The Cambist and Lord Iron: a Fairytale of Economics was nominated for the Hugo Award and the World Fantasy Award.

Then there are his books. The The Long Price Quartet is the best epic fantasy series (and it's _completed_) I have read in the past ten years, hands down. If you're serious about epic fantasy and you haven't read this books woe and book shopping upto you, my friend. Top of my reading list for the coming year is Daniel's forthcoming epic fantasy series, The Dagger and Coin. But epic fantasy is too small to hold Daniel, so he's written some acclaimed urban fantasy series The Black Sun's Daughter under the name MLN Hanover, and along with Ty Franck is about to publish a kick-ass space opera (Ye right and honorable GRRM said so, so it must be true) Leviathan Wakes.

Incase you weren't counting that's Epic Fantasy, Urban Fantasy, and Space Opera. See what I mean about the plush-covered iron first of sensitive and compelling prose OF DOOM? Personally, I welcome our new speculative fiction overlord.

While you marinate on all the above, you can check out his casually brilliant blog posts:

On Urban Fantasy and Sexual Violence
The Cover of Leviathan
On the Death of Genres

Is There Such a Thing as YA Crossunder?

Dearly Beloved Y'ALL,

Forgive me if this post comes from a lack of knowledge about the publication industry. I try to learn of the 'industry' only so far has it helps a project along. I salute those folks who become experts in the byzantine ins and outs of marketing, distribution, packaging, etc. But lately, I've been curious about one question: Is there an established subgenre called something like "YA Crossunder."

First off, lemme define my term "crossunder." We're all aware of what "YA crossover" is because we're all aware of Harry Potter. I love YA crossover books. The term "crossover" in general is sought after in publishing. Who wouldn't want to write a mystery that "crosses over" to appeal to romance readers. Or a SciFi book that crosses over to historical fiction, etc. But regarding YA, I've only ever heard folks talk about it going in one direction; crossing "over" from younger people to older people. Hence my question about "YA Crossunder": is there a subgenre of books written for old fogies like me but with the intent to also appeal to younger folks.

Before we go too far, I need to plead a lot of ignorance about how YA works. Because I didn't learn to read until I was about 13, I avoided the stuff that my classmates had been reading before…not wanting to showcase my disability. As such, I focused on reading books shelved in SFF as 'YA crossunder.' This changed my life in a wonderful way. I suspect a bunch of folks do this but aren't hyperaware of it as I was.

There's another (self serving) reason I'm interested in this phenomenon. Presently, Spellwright will be published by eight different publishing houses in seven different languages: six are shelving it as "adult fantasy" (no, not that kind of adult fantasy), and two of them are publishing it as YA crossover fantasy. I'm very cool with all of this, especially since I envisioned the series as a YA crossunder (though, on occasion, I do fret about publishing not making books more attractive to young men). It'll be interesting to how the different shelving does or doesn't change anything.

Anyway, off the top of my head, I can think of two pretty cool examples of folks trying to work with what I'm now thinking of a YA crossunder. A few years back, Tor split Robert Jordan's first Eye of the World into two mass market paper backs and given more YA-ish covers. I think that worked out pretty well for them . Secondly, there are Alex Awards, given by the ALA to "ten books written for adults that have special appeal to young adults, ages 12 through 18." Personally, I think this award is the epitome of an awesome idea and do a small devotional dance every morning to influence the people involved to consider Spellwright. If you know a librarian involved in the ALA and if you liked Spellwright, give them a some flowers (because, hey, what librarian doesn't deserve flowers?) and then point them to the section of their libraries containing SFF books written by bald people whose names rhyme with Flake Barlton. Small section, only one book there; they can't miss it.

Okay, but back to my real question. Are you aware of other books that 'crossunder?' Is this actually a large subgenre I should have know about already? Are there particular examples I should be checking out?

Lemme know what you think, and I'll go back to editing Spellbound.

WFC2010 Epic Fantasy Panel

For your viewing convenience, here's the complete WFC2010 Epic Fantasy Panel video, featuring David B. Coe (m),  Freda Warrington, John Fultz, David Drake, & Yours Truly.  (Click through to check out the SciFiFantasyBooks Channel.)

World Fantasy Convention 2010 Report

The World Fantasy Convention is like summer camp for fantasists: a yearly reunion to see how everyone's changed, hear news of projects completed and underway, and leave daily life behind for a little ridiculousness. The major difference between summer camp and WFC seems to be the lack of canoe lessons and the presence of a hotel bar.

This was my third WFC, and the tone felt very different. Last year, I talked to several different professionals about the declining economy and the potential dangers of ebooks. While I did catch notes of such sentiments this year, such apprehension seemed largely absent. The death of publishing did not happen after all. Or, maybe, it hasn't happened yet. Most pros I talked to seemed cautiously optimistic.

Now for the blow-by-blow / shameless-namedrop recount of the Con.

I didn't make it to the Con until late Thursday night. After short run and shower to sweat and then wash off the airport grime, I made it to the hotel bar and caught up with some of my most favorite people in the world: Paolo Bacigalupi, Liza Trombi, Liz Gorinsky, Liz Argall, Peter V. Brett, Deanna Hoak, Myke Cole, Brit Mandelo, John Joseph Adams, Jayne Gates, Christina Yant. Also had the pleasure of sharing a few drinks with one of the fantasists I admire most, Scot Lynch.

Friday kicked off with a reading by my roommate Matt Kressel. Matt did a great job reading a creepy, epic piece that I could call a mash of a Peter S. Beagle fable with Nightmare on Elm Street. It'll publish in Beneath Ceaseless Skies in December. After I sat down with Brent Bowen and had a whole lot of fun recording an interview for Adventures in Sci-Fi Publishing. We're not sure when that podcast will run, likely when the pre-sales for Spellbound open (more on that in a second). Thereafter I joined Peter V. Brett, Deanna Hoke, and Myke Cole for dinner and met artist Lauren Cannon, who designed a kick-ass bookplate for Pete. Depending on the state of Blake's Med Student Debt, I'm thinking about commissioning one such for the Spellwright Trilogy. Afterward we crashed the "group signing event." Sam Sykes and I goofed off while the lines stacked up behind Guy Gavriel Kay, Gene Wolf, and the other rockstars. Then real function of the con got started in the bar. The gurus of the internet represented themselves strongly in the presence of John DeNardo, Daniel Goodman, John Anelio, and Pactrick Hester. Staying up late is easy to do with so much great company…and it's double extra special easy to stay up late when one's mind is still on Pacific time. My head didn't hit a pillow until 3:30am.

Saturday, I managed to sleep through my alarm and wake up only 40 minutes before my 11o'clock panel. Speed shower, shave, gulp a cup of coffee and jog to the convention center. The panel was titled "The Continued Viability of Epic Fantasy," the wording of which of course calls into question the genre's viability and its continuation. Put another way, there was no panel entitled "The Continued Viability of Urban Fantasy." Put yet another way, the panel was gentler revision of the title "Epic Fantasists, Why Aren't You Dead Yet?" Naturally, this sparked some strong comments from those of us on the panel, all epic fantasists. The resulting conversation was wonderful fun for me, and I think the audience seemed to agree.

Moderating the panel was my good friend, talented fantasist, and king of snarky remarks, David B. Coe. Perhaps I've never seen a panel moderator do such a good job as David did. He included everyone and kept the conversation on subject and moving forward without being overly controlling. Freda Warrington provided great insight based on her publishing career on both sides of the Atlantic. I was happy to sit next to John Fultz, who knew a good deal about both epic fantasy and comic books. The most strongly stated perspective came from the renowned David Drake. The two Davids were in rare form. The whole panel was filmed and I'll be sure to post it here.

After the panel, had the pleasure of meeting James Enge, whose Blood of Ambrose was nominated for a World Fantasy Award. James and I sat down with John Anelio of the Functional Nerds podcast to talk about maters linguistic, literary, and musical. Really fascinating conversation.

Four years ago, at the World Con in Anaheim, I accidently spilled beer on Paolo Bacigalupi's shoes while he was talking to Liz Trombi. Back then Paolo had published only a few short stories, Liza was an assistant editor for Locus, and I had just started applying to medical schools and was negotiating a contract with Tor to rewrite a book called Spellwright. Time brings wonderful changes. Nowadays, Liza is the Editor and Chief of Locus; I've half of an MD and one published novels, and Paolo published some book about some springs or something. It might have won an award or two. I can't remember just now…but the dinner this year was crazy always and included Paolo's attempt to apply his steak knife to my bicep, for reasons that are still mysterious to me.

Saturday night was party night. The one I spent the most time at, naturally, was the Tor party, where I got to shake hands and exchange a few words with _the_ Tom Doherty. Also notable, our fearless Lord of SFWA was kind enough to fondle Spellwright's artwork. Now, witness the powers of this fully operational battlestation Scalzi.

Sunday was, as the last day of the con always is, like the last day of summer vacation. Spent the morning packing, watched the awards ceremony with some friends, and then sprinted to the airport.

Unmentioned above was a three hour business meeting with my editor, in which we ironed out the finer points of how to make Spellbound the best possible book it can be. We also talked possible publication schedules; however, much of it hinges on how quickly I can execute the desired changes. We're both optimistic because so few major changes are needed. But even so, I can't give any specific news about publication dates until I send this manuscript in for production. So, looks like the next few weeks I'm going to be busting my tail to do just. Hope to have more good news there soon…