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,  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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A VISIT FROM ST. NICHOLAS

 

'Twas the night before Christmas, when all through the house

Not a creature was stirring, not even a mouse;

The stockings were hung by the chimney with care,

In hopes that St. Nicholas soon would be there;

The children were nestled all snug in their beds,

While visions of sugar-plums danced in their heads;

And mamma in her 'kerchief, and I in my cap,

Had just settled down for a long winter's nap,

When out on the lawn there arose such a clatter,

I sprang from the bed to see what was the matter.

Away to the window I flew like a flash,

Tore open the shutters and threw up the sash.

The moon on the breast of the new-fallen snow

Gave the lustre of mid-day to objects below,

When, what to my wondering eyes should appear,

But a miniature sleigh, and eight tiny reindeer,

With a little old driver, so lively and quick,

I knew in a moment it must be St. Nick.

More rapid than eagles his coursers they came,

And he whistled, and shouted, and called them by name;

"Now, Dasher! Now, Dancer! Now, Prancer and Vixen!

On, Comet! On Cupid! On, Donder and Blitzen!

To the top of the porch! to the top of the wall!

Now dash away! dash away! dash away all!"

As dry leaves that before the wild hurricane fly,

When they meet with an obstacle, mount to the sky,

So up to the house-top the coursers they flew,

With the sleigh full of toys, and St. Nicholas too.

And then, in a twinkling, I heard on the roof

The prancing and pawing of each little hoof.

As I drew in my hand, and was turning around,

Down the chimney St. Nicholas came with a bound.

He was dressed all in fur, from his head to his foot,

And his clothes were all tarnished with ashes and soot;

A bundle of toys he had flung on his back,

And he looked like a peddler just opening his pack.

His eyes -- how they twinkled! his dimples how merry!

His cheeks were like roses, his nose like a cherry!

His droll little mouth was drawn up like a bow,

And the beard of his chin was as white as the snow;

The stump of a pipe he held tight in his teeth,

And the smoke it encircled his head like a wreath;

He had a broad face and a little round belly,

That shook, when he laughed like a bowlful of jelly.

He was chubby and plump, a right jolly old elf,

And I laughed when I saw him, in spite of myself;

A wink of his eye and a twist of his head,

Soon gave me to know I had nothing to dread;

He spoke not a word, but went straight to his work,

And filled all the stockings; then turned with a jerk,

And laying his finger aside of his nose,

And giving a nod, up the chimney he rose;

He sprang to his sleigh, to his team gave a whistle,

And away they all flew like the down of a thistle.

But I heard him exclaim, ere he drove out of sight,

"Happy Christmas to all, and to all a good-night."

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THE LIGHT FANTASTIC - Hanukkah

 

I wish I had been in the Alexandrian suburb of Eleusis, Egypt,  in July of 169 B.C. when for a few brief moments the past and future were divided by a single line in the sand.  

On one side stood the royal egomaniac Antiochus IV (above), whose army was just four miles from capturing the Pharaoh of Egypt. Standing in his way was one old man, the Roman ambassador, Gaius Popillius, armed with just a piece of parchment - a decree from “the Senate and the People of Rome”.   It ordered the upstart Syrian to turn his Slecuid army around, and go home.  

Antiochus IV was infuriated, and bluntly told the old Roman he had to consult his advisers.  Probably he intended on riding back to his cavalry and ordering them to run the old man down.  But Gaius would have none of that. Grabbing a stick the old man drew a circle around the King and insisted, if Antiochus stepped over that line without first agreeing to turn his army back,  it would mean war with Rome.  

It was the original line drawn in the sand, and for maybe the only time in history, it actually worked.   Antiochus IV turned tail and sulked off home. It came to be called the “Day of Eleusis”, and because of that day, we celebrate a holiday – just not the one you're thinking about, probably.

Antiochus IV was King of the Slecuid Empire, centered in Syria and stretching from India on the east and now to the border with Egypt on the west. He called himself Anticochus  Epiphanes, “God Manifest”, but behind his back he was called Epimanes -  “The Mad One”.  And as he sullenly retreated eastward across the Sinai, he got madder and madder.  

You see, some jackass in Judea had spread a rumor that Antiochus IV (above) had been  killed in battle.  Maybe the Romans had spread the story to weaken Antiochus in his rear, and maybe Antiochus had spread it himself, to flush out any trouble makers among his conquered peoples.  But whoever spread it, the hottest hot head in Judea, a religious fanatic named Mattathias ben Johanan, gathered about a thousand of his followers, and came came charging out of the hills to capture the Jewish temple in Jerusalem and drive the high priest Menelaus into the wilderness

Now, few people in Jerusalem would miss Menelaus. He had become high priest because his brother Onias had been high priest before him.  But when Onias had sent Menelaus to deliver the yearly taxes to Antiochus IV,  Menelaus had included a little extra from himself, as a bribe, and suddenly  Onias was no longer high priest,  Menelaus was. So you can see why Antiochus IV tended not to think very highly of the high priests of Judaism, and now, neither did the people of Jerusalem. Menelaus slipped a little more in public opinion when his brother Onias died while cleaning his sword (above) -  bad luck.  So the Jews of Jerusalem were not really sorry to see Menelaus now running for the hills.

But King Antiochus IV(above) was sorry.  Menelaus might have been a sniveling bottom feeder, but he was the King's sniveling bottom feeder.  And then there was that whole “got to show them whose the boss” dynamic going on.   And Antiochus IV had an army which  had been expecting a rich sacking of Alexandria, which the Romans had put the kibosh to.  So in the dog days of August 169 B.C., everything was pointing toward a very bad day for Jerusalem. And it came.

It seems – oops - somebody had left the city gates open. So the Slecuid army marched right in, as the hot headed Mattathias slipped out the back door.  First the Slecuid  soldiers stripped the Jewish temple of everything of value -  everything not already sold to pay taxes to Antiochus IV, or stolen earlier by the Babylonians and the Egyptians when they each sacked Jerusalem.  Really there couldn't have been that much left to steal.  But whatever was left, Antiochus IV took it. 

And then, according to the holy text, Second Macabbees, “And he commanded his soldiers to cut down relentlessly every one they met and to slay those who went into the houses.” That sounds like pretty much everybody.

The primary non-religious source for what happened was the Jewish radical turned Roman informer, Josephus.  He says that over three days Antiochus IV murdered 44,000 people in Jerusalem,  and sold another 44,000 women and children into slavery.  Antiochus IV then built a citadel right next to the Jewish temple, which he stocked with a permanent garrison.  Then he had the Jewish temple re-dedicated.  On the altar where Menelaus had sacrificed goats to honor Yahweh, the Greek priests now sacrificed pigs to honor Zeus.  Antiochus IV also issued a decree forbidding circumcision - (who was the lucky guy who got to check on that? ). It seemed the Jews had finally ticked off one King too many. Surely they had finally learned their lesson.

But, a year later human nature, or maybe it was Yahweh,  intervened.  In 168 BC, the rising empire of Parthia captured the Afghanistan city of Heart (Hair-it)(above). This was important because  the region around Herat was the bread basket of  Slecuid empire, and sat astride their primary trade route with India. We're talking a major loss of taxes, here.  So Antiochus IV had to turn eastward to deal with the upstart Parthians.  But he did not forget the troublesome Jews.  

He ordered his governor of Syria, a nobleman named Lysias  “to conquer Judea, enslave its inhabitants, utterly destroy Judea and abolish the whole nation." And in 167 B.C. Lysias dispatched four divisions to accomplish this task.

As they marched on Judea, Mattathias, who had reappeared (above),  now organized the faithful.  However, because he was a religious fanatic, Mattathias insisted that all his soldiers strictly adhere to Jewish law - that's what they were fighting for, wasn't it?  Unfortunately the Slecuid army did not recognize the Jewish Sabbath, and on a Saturday they attacked the first Jewish village in their way.  Following the law, and Mattathias' orders, the villagers refused to do any work on the sabbath, even refusing to lift a weapon to defend themselves.  All 1,000 of them were slaughtered. 

After this Mattathias was replaced as leader of the revolt by his son, Judah (above). And under him, the Jews decided to compromise on the religious issues and fight, twenty-four, seven.

It turns out Judah ben Mattathias was pretty good at it.  In 166 B.C. Judah fell on the Slecuid supply base at Emmaus, killing its 3,000 man garrison, capturing a huge cache of weapons and food, and forcing half the Seleucid army to retreat.  

A year later he beat the other half of the Slecuid army at Beth-zur, forcing them, again, to retreat.  It was battles like this that earned him the nickname of Judah the Hammer, or in Hebrew, Judah Maccabees.   

Shortly after this victory, word again arrived that Antioschus IV was dead.  Except this time he really was.  He'd been in Babylon, struggling to prepare a counter attack against the Parthians, when he suddenly went sick and dropped dead (above). He might have caught the plague, lots of people did then, , or maybe he got drunk and fell out of his chariot, or maybe it was Yahwah's payback,  but I think it even more likely, he'd been poisoned by the Parthians. In any case, his young son, Antiochus V, now inherited what was left of the empire.

Lysias immediately had himself declared Antioschus V's guardian, which put the Governor in charge of the entire empire. Or what was left of it. Lysias ordered an end to efforts to retake Heart, and in 165 B.C. he marched for a third time on Jerusalem. Third times the charm, right? 

This time Lysias came by the southern road, catching the Hammer off guard. This time Lysias actually laid siege to Jerusalem. This time it looked as if the clock had run out for the Jews. This time there was nobody to save them. 

And then out of nowhere appeared a guy named Phillip, (the royal governor of Babylon, actually), who claimed that on his death bed Antioschus IV had asked him, Phillip, to raise the king's son, now known as Antioschus V, AKA as The Eupator - son of a good father..  That would make Phillip the regent, not Lysias.  Lysias did not believe a word of it. Would you?  But the Romans did. So Lysias would have to deal with Philip’s army.  And one morning Judah looked out from walls of Jerusalem, and saw...nobody. The entire  Slecuid army and all their siege machines had mysteriously disappeared. It was a miracle. As long as you forgot about the whole Slecuid civil war going on.

Judah Maccabees ordered a a new altar built for the temple, and declared 8 days of “sacrifice and songs” for its re-dedication. The pigs and Zeus were out, The lambs and Yahweh were  back in. 

There was only one problem. Tradition said in re-dedicating the Temple required the temple's  menorah lamps to burn every night, all night, during the celebration.  But there was only enough olive oil for one night. What to do?

Now if it was me, I would have ordered the nine lamps on the menorah to be publicly lit at sundown each night, as usual. And then after the faithful had gone home to bed, the priests would quietly extinguish the lamps. This way, instead of burning through all the oil in one 12 hour winter's night, the lamps would burn for a about an hour each night, for eight nights. And I think that maybe that was what the Hammer did. But then, I am a non-believer. And priest are in the business of believing in miracles. And the truth is, miracles don't usually happen without a little help from somebody. Who that help comes from depends on who and what you believe in. Anyway....

It was the first Hanukkah, the first festival of the lights. Two thousand years later it is not a very important Jewish holiday, and about the only one in which women play a leading role. Each of the eight nights a woman first lights the “shamash”, the central candle or lamp, used to illuminate the entire ritual. On each successive night , the shamash is then used to light one more candle each night until all eight are burning. In each Jewish home they are displayed in a window or an exterior door, “to illuminate the house outside” the home. And as they do so, the women recite the Hanukkah prayer.

“We light these lights for the miracles and the wonders, for the redemption and the battles that you made for our forefathers, in those days at this season, through your holy priests. During all eight days of Hanukkah these lights are sacred, and we are not permitted to make ordinary use of them except for to look at them in order to express thanks and praise to Your great Name for Your miracles, Your wonders and Your salivations.”

Lysias defeated and killed Philip in 163 B.C.. But in 162 B.C. Lysias was defeated by Demetrius I, who had been Antiochus IV's older brother and Antiochus V's uncle. Being the older brother, Demetrius was supposed to have been made King first. But when their father died, Demetrius was being held as the official hostage in Rome. So it turned out Antiochus IV had been a usurper, which made his defeat in 162 B.C.,  payback. Demetrius executed both Lysias, and the boy king Antiochus V. Demetrius then tried to reconquer the Jews, but the Fighting Maccabees  held him off for ten years, until Demetrius was killed by a new usurper in 150 B.C. And that was finally the end of the Slecuid empire.

The next empire to come marching down the coast road of Judea would be the Romans. And they and the Jews would have their own problems, strongly reminiscent of the ones the Jews and Slecuid's had shared. They say some people never learn. But I think most people never learn, certainly not in the middle east.

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