THE NEW ENGLAND JOURNAL OF MEDICINE CHRISTMAS

Unique Case of Aerial Sleigh-Borne Present-Deliverer's Syndrome 
Source: North Pole Journal of Medicine, vol 1 no.1, December 1997 Author: Dr. Iman Elf, M.D. 

On January 2, 1997, Mr. C, an obese, white caucasian male, who appeared approximately 65 years old, but who could not accurately state his age, presented to my family practice office with complaints of generalized aches and pains, sore red eyes, depression, and general malaise. The patient's face was erythematic, and he was in mild respiratory distress, although his demeanor was jolly. He attributed these symptoms to being "not as young as I used to be, HO! HO! HO!", but thought he should have them checked out.

The patient's occupation is delivering presents once a year, on December 25th, to many people worldwide. He flies in a sleigh pulled by eight reindeer, and gains access to homes via chimneys. He has performed this work for as long as he can remember. Upon examination and ascertaining Mr. C's medical history, I have discovered what I believe to be a unique and heretofore undescribed medical syndrome related to this man's occupation and lifestyle, named Aerial Sleigh-Borne Present-Deliverer's Syndrome, or ASBPDS for short.

Medical History: Mr. C. admits to drinking only once a year, and only when someone puts rum in the eggnog left for him to consume during his working hours. However, I believe his bulbous nose and erythematic face may indicate long-term ethanol abuse. He has smoked pipe tobacco for many years, although workplace regulations at the North Pole have forced him to cut back to one or two pipes per day for the last 5 years. He has had no major illnesses or surgeries in the past. He has no known allergies. Travel history is extensive, as he visits nearly every location in the world annually. He has had all his immunizations, including all available vaccines for tropical diseases. He does little exercise and eats large meals with high sugar and cholesterol levels, and a high percentage of calories derived from fat (he subsists all year on food he collects on Dec. 25, which consists mainly of eggnog, Cola drinks, and cookies).

Family history was unavailable, as the patient could not name any relatives.

Physical Examination and Review of Systems, With Social/Occupational Correlates: The patient wears corrective lenses, and has 20/80 vision. His conjunctivae were hyperalgesic and erythematous, and Fluorescein staining revealed numerous randomly occurring corneal abrasions. This appears to be caused by dust, debris, and other particles which strike his eyes at high velocity during his flights. He has headaches nearly every day, usually starting half way through the day, and worsened by stress. He had extensive ecchymoses, abrasions, lacerations, and first-degree burns on his head, arms, legs, and back, which I believe to be caused mainly by trauma experienced during repeated chimney descents and falls from his sleigh. Collisions with birds during his flight, gunshot wounds (while flying over Chicago) and bites consistent with reindeer teeth may also have contributed to these wounds. 

Patches of leukoderma and anesthesia on his nose, cheeks, penis, and distal digits are consistent with frostbite caused by periods of hypothermia during high-altitude flights. He had a blood pressure of 150/95, a heart rate of 90 beats/minute, and a respiratory rate of 40. He has had shortness of breath for several years, which worsens during exertion. 

He has no evidence of acute cardiac or pulmonary failure, but it was my opinion that he is quite unfit due to his mainly sedentary lifestyle and poor eating habits which, along with his stress, smoking, and male gender, place him at high risk for coronary heart disease, myocardial infarction, emphysema and other problems. Blood tests subsequently revealed higher-than-normal CO levels, which I attribute to smoke inhalation during chimney descent into non-extinguished fireplaces. He has experienced chronic back pain for several years. A neurological examination was consistent with a mild herniation of his L4-L5 or L5-S1 disk, which probably resulted from carrying a heavy sack of toys, enduring bumpy sleigh rides, and his jarring feet-first falls to the bottom of chimneys. Mr. C. had a swollen left scrotum, which, upon biopsy, was diagnosed as scrotal cancer, the likely etiology being the soot from chimneys. 

Psychiatric Examination and Social/Occupational Correlates: Mr. C's depression has been chronic for several years. I do not believe it to be organic in nature-rather, he has a number of unresolved issues in his personal and professional life which cause him distress. He exhibits long-term amnesia, and cannot recall any events more than 5 years ago. This may be due to a repressed psychological trauma he experienced, head trauma, or, more likely, the mythical nature of his existence. Although the patient has a jolly demeanor, he expresses profound unhappiness.

He reports anger at not receiving royalties for the widespread commercial use of his likeness and name. Although he reports satisfaction with the sex he has with his wife, I sense he may feel erotic impulses when children sit on his lap, and I worry he may have pedophillic tendencies. This could be the subconscious reason he employs only vertically-challenged workers ("elfs"), but I believe his hiring practices are more likely a reaction formation due to body-image problems stemming from his obesity.

The patient feels annoyed and worried when he is told many people do not believe he exists, and I feel this may develop into a serious identity crisis if not dealt with. He reports great stress over having to choose which gifts to give to children, and a feeling of guilt and inadequacy over the decisions he makes as to which children are "naughty" and "nice". Because he experiences total darkness lasting many months during winter at the North Pole, Seasonal Affective Disorder (SAD) may be a contributor to his depression.

Treatment and Counseling: All Mr. C's wounds were cleaned and dressed, and he was prescribed an antibiotic ointment for his eyes. A referral to a physiotherapist was made to ameliorate his disk problem.

On February 9, a bilateral orchidectomy was performed, and no further cancer has been detected as of this writing. He was counselled to wash soot from his body regularly, to avoid lit-fire chimney descents where practicable, and to consider switching to a closed-sleigh, heated, pressurized sleigh. He refused suggestions to add a helmet and protective accessories to his uniform.

He was put on a high-fibre, low cholesterol diet, and advised to reduce his smoking and drinking. He has shown success with these lifestyle changes so far, although it remains to be seen whether he will be able to resist the treats left out for him next Christmas. He visits a psychiatrist weekly, and reports doing "Not too bad, HO! HO! HO!".

Conclusions: Physicians, when presented with aerial sleigh-borne present-deliverers exhibiting more than a few of these symptoms, should seriously consider ASBPDS as their differential diagnosis. I encourage other physicians with access to patients working in allied professions (e.g.Nightly Teeth-Purchasers or Annual Candied Egg Providers) to investigate whether analogous anatomical/ physiological/psychological syndromes exist. The happiness of children everywhere depend on effective management of these syndromes.
http://www.dezert-rose.com/humor/christmas/ 

THANKS FOR READING ALL YEAR LONG

AND

MERRY, MERRY CHRISTMAS

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KISSING GEORGE WASHINGTON Part Three

I favor the theory that “Boxing Day” began when servants, required to serve their masters at Christmas Day banquets, were sent home the day after with boxes of leftovers and presents, and allowed a day of rest. And to the Hessian soldiers in Trenton, the dawn of Boxing Day, 26 December, 1776, promised some blessed peace. Only about half of the German “Soldatenhandel” serving the British in the American Revolution were from the poor small state of Hesse-Kassel But to the American soldiers marching 8 miles through the snow in the cold and wind, every German in Trenton was a hated Hessian.

The village of Trenton over looked the Delaware River and was bisected by Assunpink Creek to the southeast. At the northern apex of the town, on high ground, a right hand road led 20 miles north to Princeton, while a left hand road led 19 miles west to Pennington, New Jersey. From the apex square two parallel streets angled down hill into the town, forming an “A”. King Street ran to the west and Queen Street to the east. Both crossed three numbered streets and Front Street, before King Street terminated at the “River Road”, that led directly 9 miles north to McConkey's ferry. Queen Street angled east before crossing Assunpink Creek over an arched stone bridge. The poorer third of Trenton was south of the creek, while the road continued south toward Bordentown, 20 miles down the Delaware River.

Three regiments of Hessians had occupied Trenton just since 14 December, one in the south and the other two in the north end of town. Most here were crammed into the “Old Barracks” (above), built by the colony of New Jersey to shelter 300 of the King's soldiers during the French and Indian War - 2 men to each bunk, 12 men in each of the 20 rooms

 But in 1776, 36 year old Colonel Johann Gottlieb Rall (above), was pressed to find living space for all 1,500 of his men, a task made more difficult after evacuating patriots set fire to many of the village's 100 buildings. And within 3 days of their occupation, it was clear the Hessians in Trenton were under siege.

Almost every day and every night, rebels took pot shots at the German sentries, and threatened to burn down the buildings the Hessians and their families were sleeping in. Picket duty, such as the roadblock at the village apex, and the road block on the River Road, which would have normally been the duty of ten men, now required fifty. Colonel Rall was forced to rotate his regiments, keeping one always on alert, even ordering those men to sleep in uniform, with their weapons. The alert regiment could expect to answer at least one alarm most nights, rushing to reinforce the pickets, or even chase down gangs of arsonists. 

This constant interruption of the men's sleep was no harmless game. Just the week before two couriers were attacked on the road to Princeton, and one was killed. Rall sent fifty mounted men to ensure his dispatches got safely to headquarters. After two weeks of this constant tension, one junior officer confided to his diary, “...our people begin to grow ragged…. We have not slept one night in peace since we came to this place.”

In fact, the first night Colonel Rall felt secure enough to allow his men to relax, was during the storm on Christmas night. But even then, the evening did not begin peacefully. Shortly after sunset, the picket guarding the apex traded hots with a mounted rebel party - it was, probably, Lt. Monroe's raiding party. Six Hessians were wounded. In response an ensign led 30 men up the Pennington Road, in search of the raiders. But the wind and sleet drove them back, and as the storm strengthened and the temperature plunged, Rall ordered most of the men back to their barracks, leaving a scant guard to suffer the storm out of doors in two hour shifts.

There were no Hessian parties that miserable Christmas night, and very little drinking. There was only the sound and smells of 1,500 exhausted, bored and nervous men in very close quarters, snoring, coughing, mumbling in their sleep and using chamber pots. As if by divine will, the Nor'easter had blown its last cold gust just as General Washington launched his two pronged assault.

The first hint of disaster came to Colonel Rall in his sleep, shortly after eight in the morning of Boxing Day. It was gunfire, again, muffled this time because of the 12 inches of fresh wet snow on the ground.. Rall was unsure at first , but when he and his wife heard pounding on the front door of his headquarters, the colonel clambered out from his warm bed, and threw open the second floor windows. He demanded of young Lt. Andreas von Wiederholdt standing in in the snow, “Vas ist loss?” The nervous Lieutenant stammered almost apologetically, that the Americans had the town surrounded and were firing artillery from the high ground at the the north end of town. Johann Rall called for his horse to be brought out and threw on his clothes.

In fact, the town was not surrounded. The militia which was supposed to land south of Trenton the night before and complete the circle, had never made the crossing. But a junior Hessian officer, hearing the firing from the top of the village (1) , pulled the pickets who had been huddling in houses along the River Road, and led them north to help with what he assumed was another American raiding party. The front door to Trenton was now unguarded

And it was not a mere raid. Rhode Island's Nathaniel Green, at the head of over half the American forces, about 800 men, had pushed the few unfortunate pickets suffering outside off the high ground at the pinnacle of the “A”, and cut the road to Princeton. 

Within a few minutes, Henry Knox's field pieces were blasting down both King and Queen streets (above), while Green's frozen infantrymen occupied houses, and began firing from windows and doorways. The hail of shot and shell ensured the newly arrived Colonel Rall could find no room to organize his regiments. There would be no counterattack up either street.

And just as the Hessian River Road pickets had abandoned their post, a column of about 600 men under New Hampshire General James Sullivan arrived on River Road, and pushed unopposed across the broad base of the “A”, even filtering to the Queen Street approach of the stone bridge over Assunpink Creek (above). Now Rall's command really was surrounded, and a third of his strength was cut off. Out of contact with their commander, the Hessian regiment south of Assunpink Creek, did little more than trade occasional musket fire with the Americans at the bridge

But there was an easy solution to the Hessian's problem. There was another bridge over Assunpink Creek, the Fourth Street Bridge, higher up the stream, north of the village. A road from here also ran to Princeton. Had the officer commanding the third Hessian regiment shown the initiative to look for a way around the American snipers at the Queen Street bridge, had he taken the chance of leading an attack around his own right flank, he would have fallen on the American left flank from the rear, just as Rall was finally leading a desperate attack against the front of that same American position.

Circumstances had forced Rall out into the open, to the field east of Queens street. Here his men had room to form up and maneuver in formation, and here he could bring the weight and discipline of his professional soldiers to men bear on the Americans. So, about an hour after the American attack began, and about 40 minutes after he had been awakened from a dead sleep, Colonel Rall raised his sword and commanded about 600 of his men to advance toward the American line with the bayonet.

It was the climax of the battle. Washington knew his men did not have the stamina for a long fight, and was pushing them forward, determined not to give the Hessians, or his own men, time to think. So even as Rall was leading his men into the field, American infantry were slipping into houses along Queen's Street, whose back doors gave them clear shots at the flank and rear of the Hessian assault. And by chance one of those shots hit Colonel Johann Rall in the abdomen. He did not fall from his horse, but he did slump in the saddle. It was clear instantly he had been gravely wounded, and immediately the Hessian attack fell apart.

Sensing the enemies' sudden collapse, the Americans pressed forward, driving the remaining Hessians back, into an orchard along the River Road. Colonel Rall asked for quarter, and a relieved Washington immediately agreed to accept his surrender. It was just about 10 in the morning, Boxing Day, Thursday, 26 December, 1776. The most important single battle of the American Revolution had been won.

Total American casualties for the operation were three wounded (one of whom was Lt. Monroe) and 2 men who had begun the march without shoes, fell asleep on the road to Trenton, and died of exposure. The Hessians suffered 22 dead – Including Colonel Johann Gottlieb Rall who died the next day - , 83 wounded and almost 1,000 soldiers and 23 officers, 1,000 muskets and 8 cannon captured. Most the third Hessian regiment managed to retreat 20 miles to Bordentown, although some stragglers were later taken prisoners as well.

Washington wasted no time in New Jersey. Aware now that his supporting units had not made the crossing, he had his weary men and their prisoners slipped back across the Delaware River by nightfall. The next day he informed Congress of his amazing victory. Two weeks before, Washington had warned Congress “Ten more days will put an end to the existence of our Army.” Instead, his Christmas Day crossing of the Delaware, and his Boxing Day assault on Trenton, had saved the American Revolution at almost the very moment of its birth.

Sometimes history is just that simple.

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THE TWELVE DAYS OF CHRISTMAS

I have two favorite Christmas chorals; the haunting Carol of the Bells, composed in 1904 by Ukrainian Mykola Leontovych, and the seemingly nonsensical Twelve Days of Christmas, which is old enough that we have no idea who composed it. In fact, the Twelve Days of Christmas might even predate Christianity in France, where it originated. And that makes this English carol more interesting - to me, anyway – because it speaks to the evolution of the holiday. Remember, it wasn't until 137 years after the death of Jesus, give or take a couple of years, that the Bishop of Rome ordered a “Christesmaesse” - Christ's Mass, to celebrate Jesus' birth. You see, the twelve disciples did not celebrate Christmas, partly because they were Jewish, but mostly because until fairly recently anything from 60 to 80% of infants died within hours of their birth. Nobody celebrated their birth day, not even Pope Julius I, who around 345 A.D. picked December 25^th for Christmas. For all humans, even for the Messiah, life did not officially begin until their epiphany, (meaning, according to thesaurus.com -the announcement, the display, the exhibition or the showing of the child), which was not held until you were pretty sure the child was going to live. And Jesus' epiphany is traditionally celebrated on January 6th – 12 days after Christmas.

This English Christmas Carol began as a medieval midwinter festival “memories and forfeits game”, a sort of musical chairs in a world without very many chairs. We know the game began in France because

the Red-legged (or French) partridge, widespread in medieval Europe, commonly perches in trees, unlike the the English (or grey) partridges which, while common today, were not introduced to England until the 18^th century, and prefer ledges or cliffs. And in all three medieval French versions of the song that we know of, and all surviving English versions, “a partridge in a pear tree” is the first and final present always received by the lead singer.

In the game the leader sings a verse, and each participant repeats what they have just heard, and everybody then takes a drink of wine or mead. Then the leader sings another verse, adding an item, the players repeat, and then everybody drinks again. The rounds we have inherited begin “On the first day of Christmas, my true love gives to me, a partridge in a pear tree.  On on second day of Christmas, my true love gives to me, two turtle doves and a partridge in a pear tree.”

The game continues (with variations) to three French Hens, four colly birds, five gold rings, six geese a-laying, seven swans a-swimming, eight maids a-milking, nine ladies dancing, ten lords a-leaping, eleven pipers pipping, and twelve drummers drumming. A player who forgets an item is eliminated and forced to offer a kiss to the leader, or eat a less than appealing food item. The game would continue until all 12 verses were done, or all the players but one had been eliminated. Sound familiar?

And yes, the line is “four colly birds”, as in a colliery, meaning a coal pit or a mine. The birds referred to were as black as coal – the common European black bird. When this song was translated into English, crows and ravens were only referred to as fowl. But the 4 ½ ounce Turdus merula (the black thrush), was small enough to be called a bird . In the winter black birds were easy to attract with seed and easy to catch with a net, and they were a common part of the diet. Peasants sang about “four and twenty black birds baked in a pie”. It is a reminder that there are huge chunks of our culture based on now forgotten starvation repeatedly suffered in each life time. And “break fasts,” like the midwinter festival, were fond memories, which Christianity had to adopt and adapt.

In fact, birds play a major role in this song, as if the leader was scanning the banquet table for the next noun to use in the next verse. The partridge is followed by turtle doves, french hens, the Colly birds, geese and swans. The five gold rings seem out of place unless they refer to the ring-necked pheasant, the male of which (above) has a golden brown plumage and a white ring around his neck. There would have been pheasants on any well stocked midwinter festival table, along with the other bird protein

There would also have been cheese (made from milk), and about the room, men and women dancing - but not in pairs, that would not become common until the 10^th century. And of course there would be musicians accompanying the song-game with the world's oldest instruments, a flute (or a pipe) and a drum. Music was as vital a part of pagan religious and social celebrations, as they are of Christian services. And that brings up the recent myth that this game was used to preserve Catholicism in a hostile Protestant England. That might be true, except there is not even of hint of it until 1979. However, the success of this myth across the Internet since, does offer an insight into the methodology Christianity used to snatch Christmas from the happy pagans getting drunk at their winter solstice break fast. I am not suggesting a conspiracy, but rather a well meaning application of religiously influenced logic .That is also probably how Mithra over came Apollo, and how Jupiter conquered Zeus. It would be wise for all born again Christian evangelicals to remember that religions practices never really die, they just become adopted and adapted.

The same can be said about a certain odd mathematical aspect of the carol. If you add up all the gifts – 1 partridge, 2 turtle doves and 1 partridge, 3 french hens, 2 turtle doves and 1 partridge, etc., etc. – they add up to 364 gifts in total. It seems there ought to be some connection between the gifts and the length of the year. The only problem is a year is 365 ¼ days long, not 364, and that length has been well known since, well, since forever. And while it seems the number of gifts, like some sort of Christmas carol kabbalah, ought to mean something, it really doesn't. And that seems to me to be the difference between religion and science. In religion the possibility of meaning is the meaning, while in science the possibility is theory and subject to testing. Religion gave us the pyramids and Michelangelo's "David". Science gave us a modern infant mortality rate in industrial nations of less then 1%.  Both have value.

Which brings us to the Christmas Price Index, created in 1984 by the chief economist for PNC Financial Services Group, of Pittsburgh, Pennsylvania, as “a humorous commodity price index to measure the changing cost of goods over time” using the gifts in The Twelve Days of Christmas. Each year in late November, PNC analysts consult with the Cincinnati Zoo and Botanical Garden and the National Aviary in Philadelphia to price most of the birds in the song. However, for some reason, rather than a European black bird, PNC uses the price of a canary at Petco. Gordon Jewelers, a division of Zale Corporation out of Irving, Texas, prices five gold rings for the Index, even tho, as I said earlier, the gift probably refereed to was five ring-necked pheasants. The maids-a-milking are assumed to be earning federal minimum wage, and the Philadelphia Dance Company and their Ballet Company provide the cost of leaping and dancing ladies and lords. The Pennsylvania Musicians Union provides the cost of the drummers and pipers, and the fruit tree has always been priced by Waterloo Gardens, an upscale Philadelphia plant nursery catering to the local 1%.

In 2012 the partridge and the pear tree together cost $189.99, the turtle doves $125 for the pair, the French Hens $165, the 4 Colling birds (actually Petco canaries) $519.96, the five gold rings $750, the 7 swans $7,000, and the 8 maids the same as last year at a mere $58 (which says something depressing about the minimum wage). The nine ladies and ten lords also cost  the same as last year, at  $6,294 and  $4,766, respectively. The musicians were  $2,562 for the wind instruments and $2,776 for the percussionists. In 2011 for the first time the cost for the Twelve Days of Christmas topped $100,000, up 4% over the year before. And in 2012 the total was $107,300. Surprisingly, the cost of buying the 12 days shopping on-line was 16% higher than buying the same gifts at a mortar and brick store. But then, PNC does not endorse their index as a valid gauge of the economy.

PNC admits they use the index to “engage clients”, which means they are trying to entertain bankers, a profession not known for their humor or humility. But, PNC also admits this annual nonsense economic measure has become “one of PNC’s most popular and anticipated economic reports.” I suspect that is in large part because it is “filler” used by media types to add a Christmas hint to their newscasts. However, this year, the results may have a slightly more telling comment on a changing America. In June of 2012, after 70 years in business, the “nationally renowned Waterloo Gardens” went bankrupt. It seems even the 1% are tightening their belts, which means their gardeners are beginning to starve.

Have a Merry, merry, Capitalist Christmas.

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