The Case for Wagner

The beginning of Tristan und Isolde

I fell in love with classical music at an early age. My parents in the early 1960s purchased a combined Magnovox record player and TV, a so-called console, and in addition to the records of movie sound tracks that they liked to play, such as My Fair Lady and The Music Man, they had a nice record of Rimsky-Korsakov’s Scheherazade. That symphonic tone-poem struck a chord with me, so to speak. I decided that I liked that kind of music, and that I didn’t like Dick Clark and his American Bandstand that were à la mode at the time. Soon, armed with a Sony transistor radio tuned to WFLN, the classical music station of Philadelphia, and a reel-to-reel tape recorder, I was building up my library of classical music. I saved my quarters and bought a cheap portable turntable, and then I started buying vinyl records. Eventually I graduated to a slightly more respectable record player with two small external speakers. In my high school years I immersed myself in music.

My musical tastes were firmly planted in the 19th and early 20th centuries. But I had a curious blind spot when it came to opera. Perhaps it was because opera performances were rare on the radio, or the fact that the plots were largely lost on me due to the foreign language of the libretti, or the lack of the visual component. Or maybe it was their length. An opera recording would be a boxed set of 5 or 6 or more LPs, pretty much outside of my budget in those days. And so it was that I was listening to pretty much only instrumental music up until sometime in my junior or senior year of high school. Then I discovered Gilbert and Sullivan.

By accident I tuned into a performance of Gilbert and Sullivan’s Patience playing on the radio. Here was an opera (or operetta perhaps) in English that was easy to follow and quite funny to boot. I bought a recording (D’Oyly Carte, of course) and ended up over the next few years through college and med school listening to every available G&S opera I could find, either on record, or in performance (by the same D’Oyly Carte company, in Boston). Eventually saturated with Gilbert and Sullivan, I became curious about other examples of this novel art form. This led me to Richard Wagner.

In reading about 19th century music, the name of Richard Wagner appears everywhere. He was the one, according to some, who destroyed classical tonality and led to the musical excesses—to the tone rows and atonality—of the 20th century. Others, like my namesake Thomas Mann and Friedrich Nietzsche, admitted to being totally seduced by Wagner’s music, only to later reject it, like a drug addict kicking the habit. Few would argue with the idea that Wagner was a pivotal composer in the history of music. However, as he wrote almost exclusively operas, or music-dramas as he called them, it was difficult to understand what all the fuss was about without actually listening to his operas.

My first Wagner record set

So I bought a record set of Tristan und Isolde, with the Vienna Philharmonic conducted by Georg Solti and Brigit Nilsson in the role of Isolde. I listened to it straight through, with the libretto on my lap. I learned that evening what all the fuss was about.

Regardless of what you can say about Wagner the man (and you can say a lot, much of it negative), it is difficult to deny that Wagner the composer was a genius. This was recognized even by his critics. His music is not to everyone’s taste. Mark Twain famously, though apparently not originally, said that “Wagner’s music is better than it sounds.” It is not music for those with a short attention span. Today with our smart phones, our video games, and our 24 hour news cycle, who has time to listen to or watch a four hour long opera? But back in the late 1960s when these distractions hadn’t been invented yet, I fell under the spell of the music of Tristan und Isolde. It was like musical crack cocaine in my veins.

Wagnerian scores, as well as other goodies on my bookshelf
Some books on Wagner

Over the years, I listened to his operas many times, either on the radio, TV, LP, CD, DVD, or in live performance. I remember my first taste of the Ring cycle, listening to a performance of die Walküre on the radio in my car, driving home from the hospital in Philadelphia. I was a cardiology fellow. I still remember the haunting sound of the “Curse” motif on the car radio. In the 1980s there were some broadcasts of the Ring on TV, which I dutifully recorded on my VCR. All of Wagner’s mature operas, the four Ring operas, die Meistersinger von Nürnberg, Tristan und Isolde, and Parsifal, are favorites. As you can see, I have copies of their scores and piano reductions, as well as many books on Wagner and the operas. Just the other day I watched a wonderful Meistersinger on YouTube by the Glyndebourne opera company. The music still gets to me, just like it got to my youngest daughter, who, not able to read the subtitles or understand German, while watching a video of the third act of die Walküre, asked me, “why does the music make me cry, Daddy?”

All that said, history has not been kind to Wagner. He was a virulent anti-semite, as evidenced by his essay Judaism in Music. The producers of his operas, including some of his own descendents, have gone out of their way to stage them in silly or political ways: das Reingold in outer space with the gods wearing space suits, for example. Wagner also was posthumously unfortunate in that one of his biggest fans turned out to be a genocidal madman who nearly destroyed Europe. There are certainly those who on this basis will never ever listen to Wagner’s music. If anything, in the 21st century, the era of political correctness, he is more of an misfit than ever, and perhaps is heading towards irrelevancy. Most of the books I have on Wagner were written in the 20th century, though performances of his operas continue. Have the critics lost interest in Wagner. Has his music been analyzed to death? Do his anti-semitic views make him anathema to our time?

The past is the past. There is nothing we can do about it. We have to take the good with the bad, and get what enjoyment we can from the good and learn what we can from the bad. The world of the 19th century is as alien to people today as our world would be to Victorians if they were frozen and then thawed out in the present. As with any alien culture, I believe it is important to study them dispassionately, and not judgmentally. The “woke” people of today are only woke because they are living today. Transport any of them back to the 19th century and odds are they would have turned out just as racist or anti-semitic as the average person of that time. Moreover if we are to judge the past, we must be willing to be judged by future generations. To think that this present era is the end of the moral evolution of humanity is another example of not learning from the past. Will future generations look back on our most progressive voices dismissively, because, for example, they casually ate the flesh of animals tortured and slaughtered in factory farms? Will the most moralizing woke person alive today be cancelled by a future generation because they ate a hamburger at McDonalds? Who knows? Judge not, lest ye be judged.

This was a round-a-bout way to say that I enjoy Wagner’s music despite his flaws. Not all the time. The music-dramas can be emotionally draining. But despite Wagner’s awful anti-semitic screeds, there is much humanity and wisdom in his operas. In the Ring cycle, the Rhine gold is a symbol of wealth and domination. The Ring created from the gold is supposed to give its wearer unlimited power. But the Ring sets off a series of betrayals and murders. Power corrupts. This corruption infests the whole of time and space, as represented by the Norse gods and goddesses. Walhall (Vahalla), the home of the gods, is built on a rotten foundation. Even love falls victim to the Ring, as Wotan, king of the gods, is forced to exile his own beloved daughter due to the events set in play by his coveting the Ring for himself. And that daughter, when she tries to use the Ring to protect herself against an attacker, finds it to be useless. It is greed itself, and not the substance of gold, that wields power in the world. In die Götterdämmerung, the Norns, weaving the fabric of space and time, see that fabric rip apart when the unknown variable of the Ring enters the equation. Like an uncaught division by zero error that brings a computer to its knees, the future becomes unstable and unpredictable. In the end the gods perish, but the Universe, and hope, live on.

Spread out over four evenings, with “special effects” written into the libretto that could not be realized at the time, and can be barely instantiated today, the Ring was the big spectacle of its era. Multimedia–music, song, drama, impossible stage directions–this was far beyond the traditional opera of the day. And the music, continuous, always modulating, never resolving, was a revelation at the time, and still is. Wagner was a master psychologist. He invented leitmotifs, short phrases that represented characters, ideas, places, every component of the drama, and then varied them, combined them, and used them to add emotion to the sung text. The motifs are often related to each other, resulting in very subtle emotional shading to the ongoing action. For example the Sword motif that appears at the end of das Rheingold is derived from the Rhine motif at the beginning of the opera.

Sword motif
Rhine motif

Wagner’s real progeny are not the 12 tone serialists starting with Schönberg, but the film composers, from Erich Wolfgang Korngold to John Williams, who used the same concept of leitmotifs in their music. This technique is commonplace and obvious today, but at the time it was an innovation. Wagner was a force to be reckoned with in the 19th century. All composers that came after Wagner were influenced by him and either sought to emulate him, outdo him, or rebel against him. Of course he did not create his musical innovations ex vacuo. Starting from Beethoven, and going through Liszt, there were musical innovators and iconoclasts throughout the century, but it all came together with Wagner, the polymath who wrote his own librettos and invented a new musical language and a new form of opera.

There are debates about how much of his anti-semitism leaked into his music. As in all drama, there are good guys and bad guys in his operas. It is tempting especially after the Third Reich and Hitler’s fondness for the operas to feel that the bad guys were intended to represent Jews. Books pro and con have been written on the subject. I am impressed by how weak the evidence is that Mime in Siegfried, or Sixtus Beckmesser in Meistersinger represent Jewish characters. The first is one of the Nibelungen, mythological creatures living in mythological times. If he is Jewish, then wouldn’t all the Nibelungen also be Jewish? If so, their oppression and sad lot outlined in das Rheingold would indicate a more sympathetic portrayal of the Jewish people than one is willing to credit to Wagner. Beckmesser is the town clerk and member of the Meistersinger guild of Nürnberg during medieval times, hardly a position that one would expect to be filled by someone who was Jewish. I think that Wagner left his anti-semitism behind when he constructed the fantasy worlds of his operas. The themes are universal, not racist. I don’t doubt that his anti-semitic views had some influence on his work. But before we get too deep into an argument about Jewish stereotypes in 19th century operas, consider that just 20 years ago George Lucas put a flying alien merchant who was an obvious Jewish stereotype into the Star Wars film The Phantom Menace. We haven’t come as far as we think we have.

If I had a family member killed in the Holocaust I might feel differently about Wagner. He is inextricably tangled up with Hitler and the Nazis. How much blame should he receive for that? He died six years before Hitler was born. It’s interesting that Hitler didn’t celebrate his anti-semitic writings. It was the operas he enjoyed, probably at the same visceral level others enjoy them. These great works were an example of German art that fed into his nationalistic ideals about Germany. But his admiration has tainted these masterpieces for many people, which is understandable but sad. We expect our heroes to live pure, uncomplicated lives, and then go on to produce something as complex as der Ring des Nibelungen. Maybe that’s not possible. Maybe the nice, unprejudiced, non-revolutionary imaginary version of Wagner would have been a better person, but would have died in obscurity, a bank clerk or choir master long forgotten. Artists tend to be complicated, flawed people. Not just artists. People tend to be complicated and flawed. Nowadays our social media profiles often represent the Platonic ideal of our true selves. It’s bad enough to project that idealism on each other, worse to project it onto the past. By its nature the past can never live up to the ideals of the present. Nor will the present live up to the ideals of the future. In the case of Wagner, he has bequeathed to us many hours of wonderful, thought-provoking music and drama, and we can be thankful for that. Can’t we be satisfied with that? Shouldn’t that be enough?


My Reading Adventure

I owe my love of reading to Scrooge McDuck, Tom Swift Jr., Lord Greystoke and John Carter of Virginia, Holmes and Watson, Kimball Kinnison, Podkayne Fries, Mithrandir, Steerpike and Fuschia, Conan the Barbarian, Cthulhu, Paul Janus Finnegan, Clark Savage Jr., and a host of other characters. Or, more properly, to Carl Barks, the Stratemeyer Syndicate, Edgar Rice Burroughs, Sir Arthur Conan Doyle, Edward E. Smith, Robert A. Heinlein, J.R.R. Tolkien, Mervyn Peake, Robert E. Howard, H. P. Lovecraft, Philip Jose Farmer, Lester Dent, and a host of other authors.

My reading career started inauspisciously in the 1950s. In First Grade I was placed, by whatever placement process existed for kids so young, into the lowest reading group, the Robins. My fellow group members and I sat around in a circle, attempting to puzzle out the intricacies of Dick and Jane, while we secretly envied the more literate kids in the highest reading group, the Blue Jays.

I grew up in a brand new post-war suburb, Melrose Park, in a small brick house one block from the Philadelphia city line. Outside my bedroom window facing Philadelphia there was a large empty lot that I watched turn into a shopping center, anchored by a Grants department store. Along Front Street, running at right angles to my street a block away, was a Penn Fruit supermarket and another chain of stores, including a drug store, a cleaners, and Nick’s Barbershop. My Dad would joke about how that was a great name for a barbershop.

My Dad worked, and my Mom would take me to the Penn Fruit with her to do the food shopping. In the back corner of the supermarket was a rack of comic books. I would go there while my Mom shopped and look at the comics. Child care was easier in those days and no one worried about letting kids roam the neighborhood or a supermarket comic book section unsupervised. There I was introduced to the world of Carl Barks‘ Duckburg, the Beagle Boys, Magica de Spell, Gyro Gearloose, the Junior Woodchucks, and of course Scrooge himself with his giant Money Bin in which he would induge in his favorite pastime of money diving. This detailed universe was very attractive to my young mind, and more often than not I left the store with one of the 10 cent Dell comics. So I spent my formative years reading comics, until I had a drawer full of them. Oddly, superhero comics didn’t appeal to me, though I read them sometimes, especially when waiting in Nick’s Barbershop for a haircut. Nick had piles of Marvel and DC comics, though all with covers missing for some reason. Most important for me, I was reading, and within little time I climbed the reading group ladder, landing among the Blue Jays, and never looking back.

My Mom didn’t have a drivers license. About once a week or so she went department store shopping, taking a cab all the way to the other end of our township to the Gimbels department store. There she plopped me in the book section of the store. I was about 10 then, and was moving beyond comic books. I was enthralled by books in general. In the book section there was, along one wall, books for children, what we would call young adult fiction today. These were the Hardy Boys, Nancy Drew, and Tom Swift Jr books. I liked science. I had an erector set, a chemistry set, and watched Mr. Wizard on TV. The Tom Swift Jr. books, with their yellow spines and bright exciting covers, were just my cup of tea. And so I, or rather my mother, who liked to encourage me to read, bought me Tom Swift Jr books. I spent many happy hours reading them, hoping one day to be a clever inventor just like him.

There were paperback books at Gimbels, and I looked at them, especially the science fiction books. I was attracted to their covers, showing rocket ships and aliens and what-not. I bought a few, but found I was not quite up to their reading level yet. However it wasn’t long before I outgrew comics and Tom Swift Jr. and graduated to what I thought of as “real books.”

This was the 1960s, well into the so-called paperback revolution. Paperbacks were cheap then, even considering inflation. Most were 50 cents, some 40 cents or even 35 cents. Copyright laws were more lax, and books long out of print were reprinted for new generations of readers. Two book companies, Ace Books and Ballantine Books, decided to reprint nearly the entire corpus of the adventure and scientific romance author Edgar Rice Burroughs. Stories of the jungles of Africa, Mars, Venus, the Earth’s Core, the Moon, the Land that Time Forgot, and Beyond the Farthest Star—all with brilliant cover artwork by Roy Krenkel, Frank Frazetta, and others—were available and easily affordable. My parents would go shopping along Fifth Street in Philadelphia, where, on one corner, there was the Universal Bookstore. I remember going there in the muggy heat of a Philadelphia summer, with the windows open and fans on, perusing the treasures on the wire shelves, trying to decide which to buy. Eventually I bought and read them all.

A special treat was a trip downtown to Leary’s Bookstore. This old store, unfortunately long gone now, contained thousands of books. Down in the basement were the paperbacks. Since it was a rare pilgrimage for my parents to go downtown to center city—we took the train—I was permitted to purchase several books at a time. Afterward we went to lunch at Bookbinders Restaurant, and I would sneak a peak at the cover art and back cover blurbs of my new books during lunch. It was at Leary’s, surrounded by books, that I came to the realization that no matter how many books I read, there would always be more to read. Reading could entertain me my whole life.

You shouldn’t assume that I was unusually introverted as a child and spent all my time reading. I played outside, watched TV, went to school and did my homework like other kids. There wasn’t as much to do back in those days as there is now: three channels on TV, only one TV (black and white) that my parents monopolized at night, though it was mine to monopolize on Saturday morning. There were board games but no video games. No mobile phones. No social media. Books were a solace and an escape. They still are. Book stores have always been sanctuaries to me, though less so now, with the loss of independent stores, and chains that sell more toys than books. I have mixed feeling about Amazon and ebooks, but that’s a story for another post.

My reading branched out with maturity. My science fiction evolved from the “hard science” stories of Asimov, Clarke, and Niven to the droll works of Jack Vance and the social commentary of Philip K. Dick. I grew to appreciate the poetry of Thomas Hardy’s prose, the urbane wit of James Branch Cabell, and the darkness of the Brontë sisters. It would not be an exaggeration to say that I learned 19th century history from Harry Flashman and George MacDonald Fraser. I read everything from the pulps to philosophy. I am not a particulary fast reader, but I am steady. Recently, having studied French since retirement, I have had the joy of reading books by the father of science fiction, Jules Verne, in the original French.

As I realized long ago in Leary’s Bookstore, I know that there will always be for all practical purposes an infinite number of books left to read. This makes me both happy and sad at the same time.

Books Language

Ebooks for Learning a Foreign Language

I prefer reading real books. I love their feel, their heft, even their smell–musty and old, or inky and new. Some books have beautiful bindings, dust-covers with wonderful artwork, high-quality paper and lovely fonts. They are a pleasure to read. Even the lowly paperback with its fragile binding and quickly deteriorating paper can spark joy. But I have mixed feelings about ebooks. Certainly they are convenient when traveling. But I don’t like being dependent on a battery, or trying to see past the glare when reading on a bright sunny day.

There is one domain in which ebooks shine–learning a foreign language. This is so evident to me now that I am surprised when I come across language learners who are unaware of their utility.

Reading a book in a foreign language is a frustrating experience. You keep a dictionary nearby and stop to look up words. This takes time and slows down the flow of text. In theory this might provide an incentive to memorize words faster to avoid the constant interruptions. In reality effective memorization seems to be more a function of repetition than how “hard” one tries to memorize. The end result is that unknown words are often just skipped or guessed, perhaps inaccurately, from context and you may give up from frustration.

This is where ebooks shine. I’m talking about ebook software like Kindle, Apple Books, and Google Books, running on phones, tablets, computers or dedicated ebook readers. The beauty of these devices is the ability to quickly look up words. This is functionality I rarely use while reading books in English. When reading a book in a foreign language, however, this ability become very useful.

Touch a word and the definition appears instantly (from La Place du Mort by Pascal Garnier).

When I press on a word a short definition pops up. Select Full Definition and the full dictionary entry appears. This works whether or not there is an internet connection. With an internet connection, a Google translate box appears as well as a Wikipedia entry. You can highlight a whole phrase or paragraph and the Google translate box will perform a translation. The whole process is nearly instantaneous, barely interrupting the flow of reading. In addition you can highlight words and review the highlighted words and phrases at any time.

Full dictionary definition. Oxford Hachette French-English online dictionary.

All this works very well, at least with books in French. I also read some books in German, where the process is not quite so easy. German often splits its verbs, throwing the verb prefix to the end of the sentence, so just highlighting the main part of the verb and translating it isn’t so useful. The prefixes make a difference. For example, aufhören means “stop.” If hören and the auf are separated you might end up just highlighting and translating hören which means “listen.” Confusing! Someone should write a German dictionary extension that allows one to highlight and then look up both parts of the verb simultaneously.

This limitation doesn’t exist with French, and probably with many other languages as well. Even in German it is far easier to read an ebook than a paper book.

So even if you prefer physical books, you will have an easier time and probably learn more if you read foreign language books in ebook format.


A New Look

It was about time. The EP Studios website was soooo 2013. An overhaul was long overdue.

As you may have noticed, the site looks different now. I upgraded to the WordPress Twenty Twenty theme, nicely mobile-friendly. I flattened out the menu–no more submenus. I eliminated some outdated pages. I upgraded the remaining pages with new screenshots of the apps.

A big difference is that the landing page is now a static web page showcasing the apps. The blog still exists (obviously; you are reading it), but it has been relegated to a menu item. This change reflects the change of emphasis of this site over time. It started out as a blogging site with the apps as a sidelight. The situation now is reversed. I note that the last blog post before this one was over a year ago. This decrease in blogging frequency reflects the decreased interest in blogs in general, at a time when podcasts, tweets, and YouTube videos are becoming increasing popular means of media consumption. Who blogs anymore?

Yet, now that the site is tidied up, I’m thinking that maybe it is time to start blogging again. I’ve got some ideas forming in my head, to quote the film Time Bandits. Some of these ideas have been percolating for some time. For example: I’ve been reading a lot of Jules Verne in the original French. I’ve been working on an app to draw ladder diagrams. I’ve been using ledger and Emacs ledger-mode for my personal finances and budgeting and have found it very useful. I would like to give a 5 year update on my post on retiring as a physician. And, although I no longer have a dog in the fight and others have picked up the mantle, I have further thoughts on electronic heath records and how needlessly bad they are. All these topics deserve posts. And I might inflict some more short stories on you. These stories will eventually be gathered in a volume entitled Unpublishable Tales, a very loose play on Lovecraft’s Unaussprechlichen Kulten. So be warned! Ph’nglui mglw’nafh Cthulhu R’lyeh wgah’nagl fhtagn!


The Bittersweet Life of Clara Bow

Clara Bow

For some reason I became fascinated by the actress Clara Bow. Like so many of the tangents I go off on, this one started with some clips on YouTube. Delving more deeply, I purchased some DVDs and read David Senn’s biography of Clara: Clara Bow, Runnin’ Wild. Clara’s life is both inspiring and sad—a glimpse into a Hollywood sodden with sexism long before the enlightenment of the #MeToo movement.

Clara was born in Brooklyn, New York in 1905. She was born into abject poverty. Her father Robert was a serial philanderer, constantly out of work. Her mother Sarah was mentally ill, probably schizophrenic. She was born in a rat and roach infested tenement, after her mother’s two previous pregancies had resulted in two dead children. Miraculously Clara survived her birth and grew up in the worst of environments: her father absent and her mother becoming more and more unstable and violent. Clara was a tomboy and learned to fend for herself by using her fists. At school she got good grades, but was bullied by classmates who made fun of her stammer. When she was nine years old a sad episode occurred. Her best friend was a little boy named Johnny. He lived in the same tenement and one day she heard him screaming her name. She ran to his room and found him on fire. She used a carpet to put out the fire but he died in her arms. Later in life directors were astounded that Clara could show emotion and cry at will for the camera. She told people that all she had to do was think about her childhood.

Clara’s one escape was the movies. She went to them as often as possible and read the movie magazines. She would imitate Mary Pickford in front of a mirror. In 1921 Motion Picture magazine announced a Fame and Fortune contest with a prize of a part in a motion picture. Over her mother’s objections she entered the contest. Entry required two photographs, and Clara couldn’t afford them. To her gratitude her father paid for the photographs. She had one dress, which she wore to all the try-outs. Photos of some of the contestants were published and when she saw the expensive clothes and jewelry some of them wore she knew her chances were not good. But, oddly enough, it was her acting ability that got her into the finals. She was a totally self-taught actor, but her natural abilities far out-shown her rivals. To her immense surprise and shock, she won the contest.

Sixteen year old Clara was as promised given a part in a movie shot locally on Long Island called Beyond the Rainbow. She invited her friends to the premiere only to be ridiculed by them. Her footage had been cut from the film! Worse, Clara’s mother, who was becoming more and more insane, was incensed that Clara wanted to become a film star. She screamed that Hollywood actresses were whores. Clara awoke one morning with her mother standing over her with a kitchen knife, saying it would be better if Clara were dead than for her to become an actress. Sarah Bow, prone to seizures, then lost consciousness. She died in an asylum shorly thereafter.

Clara had another chance in her second film, Down to the Sea in Ships. In this film she finally appeared on-screen and, although having a secondary role (which included a scene in which she indulges in some realistic fisticuffs—drawing on her tough upbringing), this time she  was definitely noticed by viewers and critics alike. Clara moved to Hollywood, and film after film came out, at least four a year. In short order she was the most sought-after star in Hollywood.  Despite her popularity and all the money she made for the studio,  her agent B.P. Schulberg ruthlessly exploited her. She was the most overworked and underpaid actor in Hollywood. She was also the most unorthodox actor in Hollywood.  She didn’t play the Hollywood games. Stars at the time signed “morality” clauses, and generally gave the impression of being morally upstanding, though in real life they were constantly sleeping around and having affairs. Clara had open liasons with various male stars and directors (including Gary Cooper and Victor Fleming, later the director of The Wizard of Oz) and so she regularly appeared in a bad light in the gossip magazines. Of course the men she went out with didn’t suffer the criticism she did! Clara was unmarried, and the men she went out with, with one exception (a doctor who was on the verge of divorce), were too. Yet since she was so open about her sex life she was widely condemned, generally by hypocrits who were engaging in the same activities, but lying about it.

Nevertheless Clara was loved by the movie-going public. She dyed her hair red with henna and when this fact leaked out, sales of henna went through the roof. Seeing her in the films that survive (about half of her silent films are lost due to neglect) it is no wonder. In her films she makes the other actors look like wooden robots. She is incredibly natural and alive. In her biggest hit, It, she plays a shop girl who has the mysterious quality “It.” In viewing the film, there is no doubt that Clara had “It,” both in the film and in real life. Her appearence is strangely modern. She looks like someone sent back in a time machine from our own time. Her acting is spontaneous and natural. Her face is incredibly expressive, which of course is essential in a silent film. As she is laughing uncontrollably while rolling around in the rotating barrel in Coney Island, it is impossible not to feel a connection with her. Audiences at the time certainly did.

She went through many engagements, but finally married an actor in cowboy movies, Rex Bell, who later became a Nevada politician, in 1932. By this time her short but bright career was already near its end. Her last film was released in 1933. She was only 28 years old. Plagued by scandals, defrauded by her best friend, denied her earned salary by the movie studio because of purported violation of her morality clause, Clara retired early in life. Adding to these factors, she did not like the “talkies”: she was spooked by the microphone over her head (she kept looking up at it, ruining takes) and her Brooklyn accent was criticized, though listening today it’s clear she could suppress it almost completely when needed. Moreover there was mounting evidence of mental illness. She would have outbreaks on the set. She became hypochondriacal. And so she retired forever from film and went to live on a Nevada ranch with her husband, Rex Bell.

Unfortunately, she seems to have inherited her mother’s schizophrenia. She had two children, but in time grew so unstable that her husband separated her from the children and she was institutionalized. Her psychiatric examination revealed more disquieting facts about her childhood.

Clara idolized her father, and supported him when she became a star. Yet it came out that he had repeatedly sexually abused her as a teenager. Her mother, who had repeated called Hollywood actresses whores had herself been a prostitute.

Clara lived out the rest of her life in isolation, accompanied only by a live-in nurse. She attempted suicide. Eventually she died in 1965 of a heart attack. She was alone, except for her nurse.

Today she survives in her films. She was beautiful, and a good and honest person. She personified the 1920’s “flapper” girl, but she was more complex than that. Her life was tragic, but for a brief moment in time her star shone as brightly as few others. It is sad that so many of films are lost, due to the unconscionable neglect of the film studios, who used copyright laws to prevent copies of these films to be made, while at the same time allowing the originals to rot in warehouses. Nevertheless through her films we can still, nearly a century later, get a glimpse of the phenomenon that was Clara Bow.

Computers & Software Electrophysiology Medicine

Hacking the QTc

Long QT, torsade de pointes

The QT interval—a measure of the duration of the overlapping action potentials from two billion ventricular muscle cells—has fascinated physiologists since the dawn of electocardiography.  Too long or too short, it can be a harbinger of ventricular arrhythmias and sudden death. Sensitive to electrolytes, drugs, and autonomic tone, susceptible to congenital ionic channel mutations, difficult to measure (which lead? where does it end? what about the U wave?), and markedly varying with heart rate—the QT interval is clinically important and, at the same time, elusive.  To distill the essence of the QT interval and separate out the volatile heart rate dependent components,  the corrected QT interval (QTc) was devised.   Succumbing like everything else to automation, the QTc has become just another number printed in the upper left corner of a digital electrocardiogram, along with the PR and QRS intervals, the QRS axis, and the patient ID. Lulled into complacency by its automatic generation via algorithm (despite the lurking disquiet engendered by the knowledge that the very same algorithm occasionally reads normal sinus rhythm during complete heart block), few bother to ask: Where does that number come from? What formula was used to derive it?  Is the corrected interval actually correct?

For those who care about such questions, the QT can be manually measured and the QTc calculated. Most use the hoary Bazett formula dating from 1920, relating the QT to the square root of the cardiac cycle length. Some are aware of a few other formulas: Fridericia, Hodges, or Framingham. There are many online and native app QTc calculators–in fact my apps EP Mobile and EP Calipers have built-in calculators for all four formulas. There seems to be little need for yet another QTc calculator app.  Nevertheless I have written one, EP QTc, and I should explain how that came about.

Formulas, formulæ

There are more QT corrective or predictive formulas in the medical literature than you might imagine—at least 40.   Rabkin et al. collected 31 of these formulas and worked out a standard nomenclature and classification scheme. Rabkin does not actually give the mathematical equations involved. In fact, nowhere are these formulas collected in a single source.  And what good are formulas if you can’t apply them?  On a whim I thought it would be interesting to write an app that would calculate the QTc using not just one or four formulas, but all the formulas given by Rabkin. The app would also provide details about each formula and statistics and graphs of the results.  I wasn’t sure who would be interested in such an app (probably no one), but at the same time I saw it as a simple project that might make QTc calculating more fun while putting this mass of QT correction literature into perspective. It turns out, it wasn’t such an easy matter.

Paywalls galore

Starting at the beginning, I looked up Bazett’s original article published in 1920. The only online source for the Bazett article is the Wiley Online library.  The site says the article was first published on October 27,  2006.  No, the article is from 1920, and this is a reprint of the original.   According to US copyright law, anything published before 1923 is in the public domain. I’m sorry, but reprinting an article that is in the public domain does not restart the copyright clock.  Nevertheless, the only way to get a digital copy of this historically important article is to pay an extortion fee of $38 to the wily racketeers at Wiley who have managed to kidnap this article and hold it hostage for almost a century.

What was true of Bazett was also true of the vast majority of the articles I was seeking.  The QT correction literature like most science is locked up behind paywalls.  Lacking institutional access and repelled by the idea of shelling out vast quantities of cash for papers many of which were in the public domain, I faced a major obstacle. Fortunately I enlisted some colleagues with digital library access to help liberate these publications, and I eventually managed to get nearly all the primary sources for the different QT formulas.  Beyond these paywalls, there were other lesser hurtles to leap over, but we’ll get to them later.  In the meantime, you may be asking…

What’s wrong with Bazett?

Most every QTc calculator uses the Bazett formula. Why not? It’s simple and can be solved with any device (slide rule or something more advanced perhaps) that does square roots. It was the first QTc formula developed. So why were 30 or more other investigators dissatisfied with Bazett and felt the need to develop their own formulas? What’s wrong with classic Bazett?

Reading the original Bazett article is interesting (though still not worth $38). We travel back to a simpler time when the ECG was relatively new, and the only leads were I, II, and III.  Bazett was interested in the dependence of the duration of mechanical systole on heart rate, and, lo, this particular interval on the ECG, the QT, seemed like a good surrogate to study this. Professor Bazett was able to gather a grand total of 39 healthy subjects, 20 men and 19 women, aged 14 to 53 (though one subject’s age is listed merely as “Boy”) and measure their heart rates and QT intervals.  In some cases individual values were given, in others averages of several values were used. Several  subjects were not his own, but data borrowed from Dr. Thomas Lewis. From this small selection of messy data points Bazett came up with what is still considered the gold standard QTc formula used today:

QTc = QT/√RR.

QTc or QTp?

Well, not exactly. Bazett and most of the early investigators did not create QTc formulas, i.e. formulas intended to give an idealized QT interval independent of heart rate. Bazett and his colleagues were interested in predicting what the QT interval should be at different heart rates. This is the QTp, the predicted QT interval.1 Bazett’s published formula was:

QT = K √RR where K = 0.37 for men and 0.40 for women with units in secs

Similarly the Fridericia formula, also published in 1920 was:

QT = 8.22 ∛RR with units in 0.01 sec

Yes, you read that right. The units are hundreds of seconds. Ugh.

As it turns out one can mathematically convert any QTp formula to a QTc formula, given the assumption that the QTc is independent of heart rate and the QTc equals the QTp at a heart rate of 60. The process is left as an exercise for the reader :).  Later authors took the Bazett, Friedericia and many other QTp formulas and converted them to clinically more useful QTc formulas.

In search of a better Bazett

No one was able to reproduce Bazett’s results. Many authors found that Bazett’s QTc formula tended to overcorrect the measured QT interval at high heart rates, and undercorrect it at low heart rates (e.g. see here). Certainly with such a low N and primitive methodology, Bazett may have mischaracterized the QT vs RR curve. Perhaps the exponent in the formula is not 0.5, or perhaps relating the QT to a power of the RR is not even the right kind of function to use.  The disturbing fact is that each group of investigators who has studied the relationship between the QT interval and heart rate has come up with a different formula.

Linear, power, logarithmic, exponential—oh my!

In reviewing the QT papers, including some studies using 10s of thousands of patients, it is remarkable how inconsistent the findings are with regard to the shape of the QT vs RR curve. Some authors find a straight line, with a linear function underpinning the relationship. Others find curvature at either end of the heart rate spectrum.  The resultant equations are sometimes logarithmic or exponential.

Rabkin uses a classification that I used in the EP QTc app.

linearQT = b + a*RR QTc = QT + a(1-RR)
rationalQT = b + a/RR QTc = QT + a(1/RR - 1)
powerQT = b RR^aQTc = QT/RR^a
logarithmicQT = b + a*ln(RR) QTc = QT - a*ln(RR)
exponentialQT = b + a*e^-RR QTc = QT + a*(e^-RR - 1/e)

(* = multiplication, ^ = raised to the power.  Table modified from Malik et al.)

This table also shows how each QTp formula can be converted to a QTc formula. Any QTp formula can be converted to a QTc formula, so theoretically there are as many QTc formulas as QTp formulas.  Rabkin lists many more QTp formulas than QTc formulas.  Evidently in many cases the conversion has not been considered worth the effort to do.

Typos and unit confusion

Back to the vicissitudes of creating the EP QTc app.  The tale of woe continues with multitudes of typographical errors in the sources and inconsistency of units in the formulas. Typos include mistranscribing formulas in secondary sources (e.g. reading 7 instead of 1 in a tiny exponent), rounding errors, and just plain poor proofreading. I will not mention specific sources, but these types of mistakes seem to be common in the medical literature.  Sure glad we’re paying those publishers all that money for quality control.

As to unit confusion, we already alluded to the use of 0.01 sec as the base unit in the Fridericia formula. Various authors use heart rate as opposed to cycle length in their formulas.  They are inversely related and the use of different terms makes it hard to compare formulas to each other.   Adding to the confusion is that formulas almost invariably use an RR interval measured in seconds, but then sometimes in the same formula require a QT in milliseconds.   Sometimes the units used for the dependent variables aren’t made clear.   Most authors also don’t seem to realize that the results of non-linear QTc formulas aren’t really in units of sec or msec. For example, Bazett QTc units are sec/√sec, i.e. √sec (or worse, msec/√sec).  To be fair, I sidestep this issue in the EP QTc app as well.  To my mind this unit confusion just emphasizes what an artificial thing a QTc is.


Having obtained sources for all the formulas mentioned in Rabkin (and a few more), I applied Rabkin’s proposed nomenclature. This consists of a 6 letter code for each formula: the first 3 letters QTc or QTp, and the last three based on the first author’s last name. Thus Bazett’s QTc formula is QTcBZT. The Framingham study QTc formula, less well known by its first author (Sagie) is QTcFRM. There are some inconsistencies in the nomenclature which I have tried to correct. For example, Kligfield’s formula is given as QTpKLN in Rabkin, since Kligfield is misspelled as Klingfield. Oh well.

Sex and age

Some formulas differ depending on the sex or age of the subject, or both. The QT interval tends to increase with age and is longer in adult women. So some formulas require entering the age and/or sex. These formulas will simply refuse to give a result if these parameters aren’t present.

A tough question is how to apply QT formulas to subjects that don’t match the study population. I excluded formulas that were derived only from children. All of the study populations are predominantly based on adults, but in a few children were also included. Some studies used men only as subjects.  Is it reasonable to apply a formula derived from data from only men to a woman? In the EP QTc app I avoid such issues and leave it up to the user to deal with this question.

What is normal?

Here is another Pandora’s Box. Just as there are many QTc formulas, there are many papers dealing with establishing the normal QTc. Given syndromes of sudden death related to short QT intervals, both boundaries of normal need to be considered. I have gathered these papers together along with their QT interval cutoffs. These are often sex-specific, and sometimes gradations of abnormality are assigned, e.g. borderline and abnormal, or mildly, moderately, or severely prolonged. In the app the user can select from among these published criteria to define whether a result is normal or not.  In practical clinical use, the QTc interval is only one component in the risk scales needed to establish the diagnosis of long or short QT syndrome.

What about QTp intervals?

By definition a QTp interval is normal. Rabkin proposes that, since QTp formulas were derived from multiple different populations, QT intervals outside the range of all defined QTp intervals may be considered abnormal. I have implemented this algorithm in the EP QTc app. One objection to this approach is that QTp formulas (with some exceptions) give mean values for normal QT intervals.  Thus one would expect the range of normal QT intervals to be somewhat larger than the range of all possible QTp intervals. One should probably take this into account when interpreting the QT vs QTp interval statistics and graphs.

QT library and EP QTc app

All of the data on QTc and QTp formulas have been incorporated into a QTc library. This library is open source and free to use. It can be used with any iOS or macOS project. The library includes functions that make it easy to calculate the QTc or QTp by any formula, using any input (RR or heart rate, sec or msec). In addition information such as references and DOI links, notes, equations, and study populations can be easily assessed. For technical use of the QTc library see the README.

The EP QTc app was originally intended just as a demo app for the QTc library, but it has numerous features making it useful in its own right. Use it to calculate the QTc and QTp using 33 formulas. Graph and do statistics on the results. Copy the results to spreadsheet programs. Options to change precision, sort the results, use different QTc cutoffs from the literature and others are all available.  The source code is on GitHub, and I hope the app will soon be on the Apple App Store.


I’m not sure who will use the EP QTc app. Maybe no one. It is certainly overkill. If you just want an occasional Bazett QTc it may not be worth it. If you want to explore this minor corner of the literature further, it may interest you. At worst, you can at least impress your friends when you tell them the QTpMRR for your patient.

Some screenshots

Main calculator screen

QTc graph

Statistics screen

QTc results screen

Details screen

QTc limits screen

QT, QTp vs heart rate

Preferences screen

QTp graph


Cruises, Then and Now

The old Nieuw Amsterdam. Source: Public Domain,

[Author’s Note:  This post got completely garbled when I tried to transmit it to the server using the terrible shipboard internet service in the middle of the Pacific Ocean.  If you tried to read it before and gave up, convinced I had downed a few too many Bloody Marys, you might want to give it another shot.]

As I write this I am in the middle of the Pacific Ocean, just east of Hawaii, heading home on the final leg of a cruise on the Star Princess, 5 days from landfall. I am not an expert on cruising, as I found out during dinner conversations with other passengers, who casually admitted that this was their 20th cruise. Nevertheless I have bookended my life with cruises, starting out when I was a child, and ending up in my retirement. In between was work, and no time for chunks of vacation taking up more than a week of my time. But I do have fond albeit remote memories of those old ships and cruises, and would like to compare and contrast that era with today.

Back in the 50s, 60s, and 70s, I traveled transatlantically or cruised in the Carribean on the Homeric, the Nieuw Amsterdam, the Rotterdam, and the Queen Elizabeth II. The Nieuw Amsterdam was the ship I went on the most, going on two Carribean cruises in the 1960s and a transatlantic crossing around 1970, just before it was retired from service. It was a vessel built in the 1930s and is typical of the design of the older ships. Staterooms were below, with portholes, not balconies. The public areas of the ship were on the superstructure: the Promenade Deck, Sun Deck, Lido Deck, and the like. The dining room was located in the middle of the ship, without windows, at the center of gravity to minimize rocking and presumably broken plates. Over the dining area a string quartet played on a little balcony. The ship had a gray and white hull, with two yellow, green and white striped stacks. It was a beautiful ship–seaworthy and sleek in design, unlike the topheavy behemoths of today.

In the public areas were shops, lounges, a movie theater, and a dance floor. There was no continuous buffet as is de rigeur on current ships. Nevertheless there were little buffets around the ship and no lack of food. There was no lack of activities, sports, and entertainment. In what would be considered an environmental horror today, I remember my father driving golf balls off the deck of the ship in a competition to see who had the best golf swing.

There was an open deck on which you could circumnavigate the ship and get fresh air, and a similar deck below, the Promenade Deck, on which you could do the same while protected from the wind and cold by windows. On this deck were pingpong tables and places to sit and play card or board games. I remember on my first cruise circa 1960 all the crew and sailors were Dutch (this was the Holland-America line), but even by 5 years later the economics of cheap labor had replaced them with crew from Thailand and Indonesia. Today the crew stem mostly from the Philippines and Eastern Europe, though the officers on this particular ship are Italian for some reason.

In contrast to the sleek ships of yesteryear, today’s ships are squat and topheavy with row after row of balconies. I like having a balcony (I am sitting on it now, watching the waves go by), but the result is an ugly ship. Life on the modern cruise ship is centered around the buffet, which operates non-stop and is always filled with people. Eating, drinking, and more eating and drinking seem to be the major activities on board. Because of the design of the ship, there is no deck that you can walk all the way around in the open air, without climbing up and down stairways. There is no Promenade Deck in the traditional sense. However, despite these changes over the years, the ocean is still the same, magnificent and mysterious. It has a vast calming influence and makes it all worth while.

Of the different modern cruise lines I have been on, Princess, Royal Carribean, Celebrity, and Cunard, only Cunard makes an attempt to uphold the sailing traditions of old. My experience is based on their ship the Queen Mary 2 (QM2), on which I have made several transatlantic crossings since retiring. The ship has clean lines and a better design. There are balcony decks, but there is also a deck around which you can walk in a continuous circle in the open. The ship has a large, beautiful library with comfortable chairs that face windows overlooking the sea. The ship I am on now, the Star Princess, has a puny library with just a handful of books. The QM2 has a tasteful decor, with less kitsch than usual. Overall it feels more like a real ship than a floating hotel, or floating buffet.

Make no mistake, I’m not complaining (too much)! Being gently rocked by the silvery Pacific Ocean and listening to the white noise of the waves is akin to Paradise. So enough of this! Back to the buffet!

Medicine Misc

Cutting Down on Coffee

Not coffee

This morning as I write this, there is on my desk a steaming hot cup of fake coffee. The ingredients are roasted barley, roasted malt barley, roasted chicory, and roasted rye. This is the sort of stuff people drank as a coffee substitute during wartime rationing. It smells odd. It is hot and black and looks like coffee. It tastes kind of meh–not bad, not good.  It has a depression era vibe.

As someone whose very life energy used to be fueled by coffee, the transition from coffee to not-coffee was difficult. I drank at least 5 or 6 cups per day. When I was working as a physician I depended on it to keep going. I usually took it black, never added sugar, and completely eschewed Starbucks overwrought concoctions. I loved simple espresso based drinks, particularly Americanos, but, like a true addict, any bottom of the pot leftover coffee would do the trick. But then I was forced to go cold-turkey.

I was having some epigastric pains. The doctor told me to cut out coffee and spicy foods (that’s another saga). So I did.

The day after I quit coffee was filled with headaches and fatigue. The next day was a little better. By the third day I felt fine.

After quitting coffee and a course of omeprazole, my stomach felt better. I also felt pretty good energy-wise sans caffeine. So I cautiously reintroduced some coffee into my life.

I don’t drink it every day. When I do drink it I limit myself to one or two cups. Afterwards I feel a distinct “high” that I hadn’t really appreciated when I was a chronic imbiber. In the past I drank coffee just to feel normal. Doubtless I had built up a tolerance to it. If I didn’t drink it I felt bad.

Now when I don’t drink it I feel normal. When I do drink it I feel a burst of energy. But I don’t need to feel that way all the time. So most of the time I am drinking a coffee substitute or an herbal tea rather than coffee. It works for me.

Your mileage may vary.

Medicine TV

The Death of Dr. Shock

Dr. Shock
By Source (WP:NFCC#4), Fair use,

The call came from one of my attendings at night during my cardiology fellowship. It had a touch of the black humor that medical persons don’t like to admit bubbles up to the surface from time to time.

“You know Dr. Shock, the guy on TV? He’s being transferred. He’s having a big infarct and is in cardiogenic shock.”

I was at home. I quickly pulled myself together and got into my car to drive to the hospital. During the drive I reflected on the call.

Of course I knew who Dr. Shock was. He was a staple on local Philadelphia UHF television. Back in the 1960s and 70s, before cable TV with its hundreds of channels, there was just broadcast TV. In Philadelphia I still remember the channels: 3 (NBC), 6 (ABC), 10 (CBS), and 12 (PBS). However, beyond this VHF set of channels there was also UHF TV. Instead of the usual rabbit-ears antenna, these channels used a circular antenna. They also tended to be fuzzy and staticky. The shows were low budget and local, but well worth watching after school as a kid growing up in the Philadelphia suburbs. Local TV personality Wee Willie Webber introduced me to Ultraman and 8th Man on his show. Sally Starr presented Popeye cartoons and Three Stooges shorts.  Dr. Shock hosted Horror Theater while prancing around in a Dracula get-up and presented old black and white monster movies. He was a funny, silly host, defusing the scariness of the movies in a tongue-in-cheek manner that later hosts, like Elivra, Mistress of the Dark, and Joel and Mike in Mystery Science Theater 3000 would come to perfect. So, yeah, I certainly knew who Dr. Shock was.

When I saw him in the hospital, I myself was shocked. This was a young looking man. Without his makeup, he didn’t at all resemble TV’s Dr. Shock. I found out his real name was Joseph Zawislak. He was just 42 years old. He was in the CCU with a big MI and low blood pressure. He shook my hand and was polite, dignified, and deferential. “Do what you can, Doc.” I had been directed by my attending to place a Swan-Ganz catheter.

This was 1979. I was a first year cardiology fellow. There wasn’t a whole lot we could do for someone in cardiogenic shock from a big myocardial infaction back then. It was the dawn of the thrombolytic and angioplasty age and those treatments were not readily available. Infact size limitation was all the rage, using nitrates, balloon pumps, and various magic potions. Practically speaking though, a large infarct with cardiogenic shock was usually a death sentence.

So it was that poor Dr. Shock arrested that night and couldn’t be resuscitated. Now, almost 40 years later, after so many forgotten patient interactions, I still remember him and that night clearly.


The End of Cardiostim

A few days ago I received an announcement by email that the Cardiostim meeting for 2018 has been cancelled. The Cardiostim website confirms this, and it looks like the meeting is gone for good.

Back in June, 2000, while still an academic electrophysiologist at the University of Colorado, I attended my first Cardiostim meeting in Nice, France. I loved it. The beautiful weather, the azure Mediterranean, the restaurants and cafés, and the charm of “Old Nice” were a relaxing break from work. The abstract presentations, poster sessions, and workshops were not too different from those of the Heart Rhythm Society back home, though obviously the European influence was greater. For good or ill, the lack of an FDA meant the Europeans got to play with new technology sooner than we did. Sure, industry was there in a large hall with all their exhibits, just like at HRS. But when they realized I was an American they didn’t really bother me. Their targets were the Europeans.

An electrophysiologist in Nice

The coffee, bread, and pastries were excellent.

Two years later, I brought a couple of my fellows with me back to Cardiostim. They presented a poster and a couple of abstracts. I went swimming out to the buoys off-shore. I ran a 5K sponsored by Biosense-Webster along the Promenade des Anglais. It was a great experience for the fellows and another enjoyable visit for me.

In 2003 I went into private practice with a large cardiology group in Kentucky. Nevertheless in 2004, and every two years after that (the meeting was biannual), I attended Cardiostim. Along the way I dumped HRS, tired of the conflict of interest between its mission to represent electrophysiologists and its industry support, whose goal was to expand device implantation by recruiting non-electrophysiologists to implant. And so Cardiostim became a biannual bright spot to look forward to during the drudgery of private practice.

The last Cardiostim I attended was in 2012. In 2014 I returned to Nice during Cardiostim, but I didn’t attend the meetings. I had retired from medicine. Nevertheless it was fun to see the city invaded one more time by the nerdy guys in their blue blazers (and women in equivalent uniforms) carrying their Cardiostim bags. It was clear the electrophysiologists were in town.

Cardiostim swag

In 2016 I didn’t visit during Cardiostim.   Later that year, in November,  I was in Villefranche-sur-mer, the town next door, at the Institut Français, pursuing my post-retirement goal of learning French. The Institut had fewer than their usual number of students that year. Enrollment had dropped after the terrorist truck attack in Nice on Bastille Day. That had occurred after Cardiostim. We visited Nice. Hundreds of hand-made memorials had been placed in a park adjacent to the Promenade des Anglais. The Promenade itself was in disarray. Areas of fencing and pavement were being repaired. New pylons were being put up, as an after-the-fact defence against a sickness that can’t be cured by putting up pylons. Nevertheless people were stretched out on the rocky beach as usual, joggers and cyclists plied the pavement, and business carried on as usual.  Although this attack had nothing to do with the end of Cardiostim (which was apparently due to Europace splitting off from them and lack of industry support), it seems like a sad coincidence that the meeting died after that vile attack.

So, goodbye Cardiostim.  Thanks for the memories.

Informal memorial to the Bastille Day victims

Nice on the Côte d’Azur