Wednesday, April 22, 2009

Crazy medical practices in history

Crazy medical practices in history, article.
Some of them in very recent history, like the lobotomy. Did you know the inventor of the lobotomy got a nobel prize for it?
I wonder if electroshock therapy (electroconvulsive therapy or E.C.T.) will follow soon in being regarded as barbaric mistake? It seems to me to be only maginally more sane than a lobotomy. You don't flood your computer with thousands of volts to fix it crashing. I'm reading Wishful Drinking, an autobiographical tale by Carrie Fisher (played princess Leya and wrote the wonderful and funny film Postcards From The Edge). She has/had big problems with depression, and she tells she has had E.C.T. I did not get a clear impression of how much it has helped her, but she is clear that it has wiped huge portions of her memory away. That can't be a good sign.

Update:
Pascal, a medical doctor, gives perspective and information in the comments section of this post.

27 comments:

Anonymous said...

Stephen Fry interviewed her for this special he did about bipolar disorder. She is still very messed up. I doubt anyone would opt for electroshock treatment if they weren't desperate.

You don't flood your computer with thousands of volts to fix it crashing. Maybe not, but then computers are still nowhere near being as sophisticated as a human brain. For right now, thumping a computer seems to work fine. Works for TVs too.

Eolake Stobblehouse said...

Thanks.
It seems it's on youtube

http://tr.im/jr4W

I'll watch it.

Anonymous said...

You should also check out "Stephen Fry in America". Nothing to do with crazy medical practices in history, or bipolar disorder, but quite interesting.

Joe said...

" It's generally believed Mozart was poisoned by mercury-based syphilis cures

Calm Your Cough with Heroin

Lobotomies were a popular fad for the first half of the 20th century and were floated as a "cure" for pretty much any mental issue you can name, from conditions as serious as schizophrenia to something as mild as depression or anxiety.

Bloodletting

Trepanation is a fancy word for drilling holes in your head"

It seems the cure was much worse than the illness. It is no wonder the life span was shorter in the good old days.
Joe

Anonymous said...

#1 seems pretty harmless! lmao! ;-)
Pretty amazing that ANYONE went along w/the labotomy idea...among the others! Must have been HORRIBLE to have been a patient for these crazy treatments!

I happen to trip on this blog that has several sites listed for more info. on ECT.

Anonymous said...

Lobotomies were a popular fad for the first half of the 20th century and were floated as a "cure" for pretty much any mental issue you can name, from conditions as serious as schizophrenia to something as mild as depression or anxiety.It was a cure for those things! ;-)

Joe said...

TC said
"I happen to trip on this blog ..... on ECT."

From reading this blogg on electrical shock therapy. It is still being used when drugs don't work, as a treatment of last resort.

Even though some brain damage is almost always associated with the treatment.

When you are desperate you will try anything no matter what the cost.
Joe

Anonymous said...

Joe said...
"...When you are desperate you will try anything no matter what the cost."

Yes. Sad but true. Seems like a pretty desperate measure...especially knowing that your brain will be fried in the process! Seems like better alternatives do need to be found! :-(

Chris S. said...

I know most native-English people have heard this quip because it's so old but I thought just in case Eolake you haven't:

I'd rather have a frontal labotomy then a bottle in front of me!He he, couldn't resist.

Chris S. said...

Or maybe it's the other way around. Yes, that's it. Must be better to have a bottle in front of me!

Chris S. said...

See what rubbish you get when sitting in front of the computer drinking Thai beer!

Anonymous said...

Seems like better alternatives do need to be found! :-( Well asking Jesus isn't a better alternative. Scratching your ass would achieve as much.

Anonymous said...

Anonymous said...
"Seems like better alternatives do need to be found! :-( Well asking Jesus isn't a better alternative. Scratching your ass would achieve as much."

Whatever floats your boat, Anon. Just make sure you do a good job washing yer butt cheeks; wouldn't want you stinkin' up yer theory too much! ;-)

Pascal [P-04referent] said...

[Grrr!] I was preparing this comment yesterday, but then, guess what? Electri-sickly failed me! On this one of all topics. :-P
BTW, this is also the reason why I'm not properly following the comments on all the treads. I'm trying, guys and dudettes...

"You don't flood your computer with thousands of volts to fix it crashing."
You do fix some heart arrest conditions by sending hundreds of volts through it. In fact, it works impressively.

"it has wiped huge portions of her memory away. That can't be a good sign."
Well, if forgetting was what she needed to heal from her depression... Sometimes that's just the thing.
My Psychiatry professor told us that ECT once saved the life of a patient with a massive medication overdose (from the patient's own doing). Nothing else had worked, but the electric shock stopped the patient's brain from going into coma and death. The docs just said: "He's a goner anyway, why not try an ECT and cross our fingers?"
It should be noted that the shock itself (at least in the West, I never checked with soviet gulags) isn't intrinsically cruel. The patients receive a small dose of general anaesthesia, just like surgery. They don't feel a thing, no pain, no consciousness.

I'm not especially trying to defend ECT, but neither the opposite. Perspective, my friends. Bear in mind that surgery itself is a VERY violent act, strictly speaking. You ever witnessed a major operation? Only an official doctor is allowed what would otherwise be prosecuted as assault and wounding, allowed to deliberately INFLICT certain wounds on another person. In the strict frame of a healing gesture, naturally.

The very principle of lobotomy, from the moment I knew about it, felt sickening to me. And yet... Perspective, again. War is horrible too, yet we still haven't overcome the necessity for it sometimes.
Before the huge advances in chemical psychotropic drugs, there were only two possibilities to handle a peson with violent insanity without killing that person: a lifetime in chains in a cell, or lobotomy to render them harmless.
I have a relative who's had the unintended equivalent of a partial lobotomy, as a consequence of a car accident. So I know firsthand how dramatic it can be. But it was once the most humane PERCEIVED alternative to killing people not responsible for their eventual crimes.
There are also cases of dementia where the patients need to be protected from self-mutilation. Sometimes, ther are no good choices, only choices less bad than others. Doing nothing would feel wrong, wouldn't it? It's not like delirious schizophrenia leaves one with freedom of choice. Not when it removes freedom of thought, by some patients' own admittance.

A Touchstone/Disney movie (the name escapes me) tells the true story of "the boy with the split brain". Another example of how wonderfully civilized Medicine has become TODAY, to spare us such choices. Here's the topic:

Epilepsy is, in a way, the natural (i.e. "not artificial") equivalent of ECT. A massive neuronal discharge of electricity spontaneously happening in the brain of those afflicted by this condition. There are several types.

Petit Mal epilepsy ("small illness", or "small evil") is localized, and in the most benign form causes simple "absences". The person blacks out, while apparently still being awake, and some automatic movements remain during the fits, like walking or turning the pages of a book. But it's already highly dangerous when you lose awareness of what you're doing: driving, walking near water, crossing a street, etc. Already rather dramatic.

Some specific locations of Petit Mal give very odd signs, and sometimes these are the only symptom. In the brain area of smell, it'll give olfactory hallucinations, generally the perception of very foul smells which nobody else can perceive. (Naturally!) In the temporal lobe, it can gravely disturb the emotional behaviour. How gravely? Well, in some instances, patients become extremely violent, homicidal, uncontrollably, for no reason. And when the epileptic access is over, they don't even remember what happened! Some very peaceful people have become terrifying criminals that way, and none of their fault.
Hence the need for psychiatric expertise in all murder prosecutions.

Grand Mal (need I translate that one?) is a generalized crisis, sometimes from Petit Mal access which THEN spreads to the whole brain. Symptoms: the classic seizure, google it to know how to differenciate it from other pathologies.
Countless poor saps have been burnt at the stake for "demonic possession" who were only suffering from epilepsy, and victims of it. To outsiders the Grand Mal seizure is as spectacular as it is HARMLESS. Not so much for the patient.
"And they brought him unto him: and when he saw him, straightway the spirit tare him; and he fell on the ground, and wallowed foaming.
And he asked his father, How long is it ago since this came unto him? And he said, Of a child.
And ofttimes it hath cast him into the fire, and into the waters, to destroy him: but if thou canst do any thing, have compassion on us, and help us."
[Mark 9, 20-22]
Classic Grand Mal epileptic seizure description right there.

Back to our movie. GM can, not only immediately threaten a person through accidents, but degenerate into its scariest complication: status epilepticus. A crisis that doesn't stop. Permanent. I've seen one. [Yahve, I've really seen a lot in that ragged life of mine!]
Don't worry too much, if untreated it's rapidly fatal, through direct damage to the brain cells. Literally a short-circuit.
And seizures only hurt in their aftermath, remember that the patients are completely unconscious and have full amnesia of the happenings at the moment.
Now, before anti-epileptic drugs made such formidable progress, brain surgery had found a rather decent solution. Still used today in the rare cases refractory to all known medication. Section of the corpus callosum. The arc-shaped thick bridge of fibers connecting the two hemispheres of the cortex. What it accomplishes, is that a GM fit, which always has SOME point of origin, finds itself limited to half of the brain. It cannot cross to the other side to do global damage. Literally, you cut the bridge in front of a riot. You'd be surprised at how little handicap this procedure causes to a person.
The movie told the true story of a 17 y/o boy with GME, to whom the doctors had recommended such a procedure. He himself agreed, but his parents were scared of it and refused. Rather than wait a whole year for his majority, and endure a year more of his generalized seizures, he opted to sue them. The court ruled in his favor, he was operated at 17, and led a far better life. With his girlfriend at his side. :-)

Remember that scene in Star Trek IV(? I think), when Mister Sulu receives a severe blow to the head while time-traveling in the 20th cebtury? Taken to a hospital, they find he's having an extra-dural hematoma. A small bleeding outside the brain, but the mass effect of this abnormal volume can kill rapidly. Treatment when too important: trepanation. A small hole drilled through the skull to evacuate the blood collection, and eventually repairing of the torn blodd vessel. Kirk and Bones rush into the hospital and the operating room, stopping the operation in extremis. Bones exclaims to the surgeon: "What were you about to do, man? Bore a HOLE into his head? [tsk!] Barbarians." Then he uses a small portable device with blinking lights, placed over the injured area, and fixes the problem in seconds with his futuristic technology, Sulu immediately awakening to the amazement of the doctors.

So, perspective, always. "Treating" the "disease" of masturbation by castration was always barbaric and psychotic. For that "condition", like homosexuality, was spontaneously deemed a mental illness without ever bothering to check whether this was correct, until recently. But some more intelligently concerned treatments were, at one time, the best and most humane option.
Extremist anti-abortionists, refusing even its therapeutic indications for life-threatening conditions, had better think about this before judging what they know too little.
Did you know that Benedictus XVI beatified some nutty woman for that precise reason? She was pregnant, and had a health problem that threatened her life with certainty. For "religious" reasons, she refused to have an abortion. And she died.
So did the foetus...
To the Vatican, this deserved beatification.

Read my latest blog post [the date Blogger gave it is wrong, I only STARTED composing it in March] for more about my opinion on clergies, Good and Evil.

I've always had an acute awareness of the great responsibilities that stem from the power that medical knowledge brings, and which people grant us with their trust and body and life.
So, as scary as ECT may seem, it's not scarier than cutting open somebody's abdomen, pushing aside the intestines that are coming out, and diving in there with both hands and sharp steel tools to cure that person.

Never forget how fortunate we have it all, that Medicine has become so much more advanced than in the still recent days of our parents. Healing so many terrible things, more efficiently and less painfully. The deaf are hearing again, the blind seeing, the cripple walking, amputees can have hands grafted, and MANY cancers can be beaten, including the terrifying name of Leukemia. Even better, many cancers are actually nipped in the bud, never to bother us.
And yet, modern scientific medical progress still has so much to accomplish. This is only the beginning of the futuristic revolution.
The biggest challenge ahead, in my view, is actually ensuring that the majority of Earthlings who are very poor can actually AFFORD that care. Some pathologies like Leprosy are ridiculously easy and cheap to cure (or prevent, like measles, polio, cholera)... and still they prosper.

Health is invaluable, you cannot put a price tag on it. But it does have a cost. :-(

P.S.: Oh, and maybe I should read that article you link to. I'm sure there are some things far less "perspectivous" to enjoy. See you tomorrow.
Oh, wait, we ARE tomorrow now. Darn slingshot effect.

Pascal [P-04referent] said...

Time to comment on the comments now.

Jimbo,
Right. Desperate measures are for desperate times.
At least, in PROPER medical practice.
Ritalin for the children of all tired/busy parents, I do NOT call proper. ):-P

"Calm Your Cough with Heroin"
Actually, Joe, the active substance in your average cough syrup TODAY is an opiate derivative, similar to heroin. "May cause drowsiness" is no coincidence! Alhough they're carefully designed and tested to minimize the addiction risks (the relative dosage is very small, anyway), they're counter-indicated for people who have overcome a drug addiction.

Notorious morphin. Invaluable, and still unmatched today, for relief of intense pain. Just needs to be used properly and with great caution, same as all drugs which, one way or another, can be toxic.

Cocaine. Formidably efficient for controlling nasal bleeding in facial surgery. With very small doses.
The same effect, rendered chronic, is responsible for perforations of the septum in coke addicts. Constant vasoconstriction causes tissular necrosis. Translation: cut off the blood flow all the time, and your flesh will die.

Chocolate. Actually, chocolate isn't a narcotic, but it still works wonders to recover from a Dementor encounter. So this isn't really off-topic! ;-)

TC sailed...
"Whatever floats your boat, Anon"...

HAHA, good one about the wash!
Does Thai beer float boats well?
I'd opt more to soothe a sore throat with an oat gut-rotter than vote to float a boat in a moat in an old petticoat. Or wot not.
Waste not, want not, and tip yo' hat to the green mat.

If you can say it five times fast, Constable, not only are you not drunk, but you're not human!

Anonymous said...

"Whatever floats your boat, Anon. Just make sure you do a good job washing yer butt cheeks; wouldn't want you stinkin' up yer theory too much! ;-)"

I thnk the idea was that you'd be the one doing the ass scratching! ;-)

"Ask your Jesus to save you, Black Robe."
-from the movie "Black Robe"

Anonymous said...

Jimbo said...
"...I thnk the idea was that you'd be the one doing the ass scratching! ;-)"

Uh...thanks for cluing me in, Jimbo. I thought Anon [whatever your name is] was just trying to throw out as helpful a suggestion as [s]he could come up with...for ALL of us! And...I was just stating *each to his own* in my own way. I didn't know that it was exclusively for me! lol! ;-)

Eolake Stobblehouse said...

"[Grrr!] I was preparing this comment yesterday, but then, guess what? Electri-sickly failed me!"

I hope you write comments in a tex app, and save for at least every paragraph?

Eolake Stobblehouse said...

(If electricity supply was very unreliable where I live, I'd probably use a laptop computer or a USP (uninterruptible power supply).)

Eolake Stobblehouse said...

"The patients receive a small dose of general anaesthesia, just like surgery. They don't feel a thing, no pain, no consciousness."

In the book "An Angel At My Table" by Janet Frame (which was filmed), she said that each of her many involuntary ECT treatments was "like torture".

And Heimingway said about his treatments that they were talking away his life and his livelihood (memories).

Eolake Stobblehouse said...

"So, as scary as ECT may seem, it's not scarier than cutting open somebody's abdomen, pushing aside the intestines that are coming out, and diving in there with both hands and sharp steel tools to cure that person."

yeah. I'm not keen on letting anybody do that either, without dire need.

Anonymous said...

Don't worry even in England they don't cut somebody open like that just for fun.

Pascal [P-04referent] said...

"Ask your Jesus to save you, Black Robe."
True bumper sticker (my brother saw it) in the USA:
"Our God is an awesome God."
Needless to add "while yours stinks", because that's rather obvious.
How about Crazy religious practices in history? Nearly EVERYBODY mistakes religion and God. No wonder there's so much incomprehension in the world...
Nurse, lobotomies for all fanatics in the waiting room, stat. Oh, wait, cancel that: they're ALREADY lobotomized! :-(
Where are we with these researches on brain transplant to make people intelligent?
(sigh) I should've guessed. It's ALWAYS the same problem : not enough donors. The shortage is especially acute for politicians' brains. That's why the transplant is so expensive with them. Offer and demand...

As for the Anon bottom-scratching issue (isn't it better to do the OPPOSITE, scratch one's head?)...
I saw a French documentary a few days ago, pretty awesome, named Les Petits Explorateurs. Pre-teen children are taken from France to Africa, each to spend two weeks in an unknown country discovering the daily life of an African child. Wonderfully mind-opening discoveries, for all these children, gave them a lot of perspective.
Anyway, one was in Mauritania. One thing he disliked in this very traditional muslim country, is the separation between genders. Not too problematic at his age, but this he didn't admire. Mauritania is, basically, deserts. In the morning, he asked about the toilets: "Where's the paper?"
No paper. There isn't. The host's mother explained to him: "You clean up with your hand, then wash your hand with water."
(I sure hope he brought some soap with him! ;-)

This gave ME some added perspective. In Muslim tradition, you only hold the Koran, the holy Book, with your right hand. The left hand is considered impure, "because it serves for body hygiene".
Well, if they used to all do the same as Mauritanians in Muhammad's days, this taboo starts making a lot of sense!
The thing is, even palm tree leaves are rare in Mauritania. Yes, they're VERY poor. (Even more than you think: the advancing desert is slowly swallowing the villages everywhere. And the drought keeps worsening...)
I know, I digress, but it WAS interesting to share, I thought.

"I hope you write comments in a tex app, and save for at least every paragraph?"
Talk about stating the obvious! :-)
I use batteries, of course. Or a UPS, to be accurate. But because my monitor uses up too much, it's plugged directly to the sector. I compose in Outlook Express, so by hitting "Esc" and "Enter" the email closes and I've opted "yes" to saving changes, even if my screen has turned off.
The batteries can maintain the PC alone for more than half an hour (probably four times that, but I haven't tried). More than enough to turn on our generator. But then I only use it to close evrything and shut down. Fuel-oil is expensive, to be used only when necessary.
Another glimpse in the daily life of a Lebanese. :-)
Still, we're better off than the people who subscribe to the neighborhood generator. Which, in a nutshell, charges very expensively for a very lousy service. That generator was worth its price, be it only for our peace of mind. And the stable voltage...

Here's a back-on-topic joke for y'all:
Before the war, in the Sixties and early Seventies, Lebanon decided to be as modern as the USA and use an electric chair for applying the death penalty. One day, when they pushed the switch, the power went off. After a few minutes, the witnesses to the execution heard from inside the room atrocious screaming. The priest came out, his face white as chalk, and explained: "They're trying to finish him off with candles!"Heimingway said about his treatments that they were talking away his life and his livelihood (memories).
Well, see, there's a double reason for that. Both general anaesthesia and epileptic seizures can cause amnesia of recent events, by blocking the short-term memory circuits during unconsciousness.
And, of course, there's the probable direct neuronal damage affecting long-term memories. A bit like early Alzheimer's, I suppose.
I never heard about such complaints myself (especially "torture"). Then again, my internship in Psychiatry only lasted two weeks. (Added to full college courses, naturally.)
But I'd like to mention something, precisely about those courses. One of my comrades, asked the professor about straight-jackets. He said: "These are a thing of the past. Nowadays, for violent patients, we have very efficient CHEMICAL straight-jackets." There's a specific pharmaceutical protocol when receiving an incoming "agitated" psychotic.
BTW, the majority (probably more than 50%) of all psychiatric institution cases are schizophrenia in its various aspects. So, alas, the rate of non-responsive cases to drugs warranting ECT, or of violent irresponsible ones likely to hurt even themselves, may be low, but it still amounts for a sizeable number overall.

I find Schizophrenia fascinating, because so far, apart from some occasional cases associated with brain malformations, Medicine still doesn't know what causes it. It's not proven to be hereditary, and no exposition factors have been found. What so terribly torments the human soul? I'd LOVE to know.
Then, maybe I/we could to something about it.
So far, all treatments are symptomatic. Neuroleptics and the likes, by adequately tuning the brain chemistry, can bring the clinical disturbances down to a level compatible with "normal" life outside an institution, but for anything chronic like schizo, the underlying disturbance remains for life, like hot coals under the ashes.
Also a note of interest, is that the vast majority of psychotics are harmless to anybody but themselves. Most of them are essentially liable to commit suicide. Those who commit slaughters in public places are something like 1%.

Remember Asperger's syndrome? Schizo-autistic low-level personality trait, like Bill Gates? These are not clinically ill. But it's all about the degree of intensity.
[Note to self: time to publish that article about anxiety and psychiatry.]
We all know people with schizoid tendancies. And many of us probably know a few schizophrenes. If life doesn't get harsh on them, they may very well renmain undiagnosed until their natural death.
Like with all things, knowledge of insanity brings immense power. And to begin with, the power to stop fearing what we don't know.
But the Lebanese in general are ignorant. Any mental case, even any mentally challenged person, is very often treated with a mixture of mockery, aggressiveness and fear.
Then again, so are the animals. Literally treated like dogs...

Me, it's been more than 25 years since I've been last stung by a wasp. Leave them in peace, don't sit on them or gesticulate hysterically, and they'll leave you in peace too.
Insect behavior 101.
I *love* knowledge, don't you?
Let's all become a planet of superhumans through learning.

Not that I'd want to learn in person how Mauritanians shower. Probably with sand...

"I'm not keen on letting anybody do that either, without dire need."
You and me alike, buddy.
I deeply resent "convenience" operations, or as I call it FUTILITY surgery.
Here's another bit of knowledge which I may have already mentioned: the surgical risk. EVERY TIME you go through surgery, there is some risk involved. Post-op complications are carefully prevented, but may still occur even in the world's bestest impeccablest hospital and with Doctor Barbie operating you in her pink uniform. And then there's the unpredictable anaesthesia accident.
What's it about? Well, in one out of 1,600 cases if memory serves me well, a person receives general anaesthesia, and dies for some unknown reason. I know a woman who's become vegetative after a flawless -and successful- gall-bladder surgery, a very routine procedure.
Scary? Yes, undoubtedly. The thing is, when compared to the consequences of NOT performing any surgical operations, that risk is PRACTICALLY insignificant.
But it's still there.
Operating an appendicitis, a fracture, a gunshot, absolutely. Any warranted surgical pathology has a rate of potentially fatal complications far higher.
But do you really need to take that chance for the sake of bigger boobs, puffy lips or a ridiculously formatted nose?...

Local anaesthesia brings no such risks. It's not a journey in the mysterious and dark realm of Hypnos, twin brother of Thanatos, respective gods of Sleep and Death.
It's still likely to cause you allergies, though...
Taking an aspirin or paracetamol isn't 100% safe, either. Only 99,97% (roughly).
Medicine knowledge brings with great power great responsibility. It's not a game for dilettantes, impostors or spoiled kids whining that they're not gorgeous enough to star in a porno.

The Law specifically prohibits and sanctions illegal practice of Medicine. Every responsibility needs to be officially acknowledged.
A bit like parenting. Except any analphabetic dope can have sex and babies. It's not illegal.
(But thankfully, the duties of a parent are ALSO legally defined. :-)

"Don't worry even in England they don't cut somebody open like that just for fun."Unless a couple of seven-pound implants à la Lolo Ferrari is your idea of fun...
[The wikipedia article says less, but 3.5 kilos on each side is what she once said on TV]

I'm very happy with the recent progresses (which happened precisely during my formation) of laparoscopy and other minimally invasive endoscopic surgery. If for no other reason than that the less you cut open, the less complications, and the swifter the patient's recovery.
Nowadays, the main reason left for cutting open the abdomen is to extract a baby from it. :-)

Pascal [P-04referent] said...

****POSTING, UPDATE***
I've just foud how to avoid the quotes ending up stuck to the following text. I just type a space after the italics and before he next line.
In the lower paragraph of my previous post, the one with the Lolo Ferrari link, I had forgotten the space.

The wonders of computering will never cease... ;-)

Anonymous said...

"You clean up with your hand, then wash your hand with water."

That's the most disgusting thing I've ever heard!

I've just foud how to avoid the quotes ending up stuck to the following text. I just type a space after the italics and before he next line.

Thanks for the tip, guv.

Pascal [P-04referent] said...

Jimbo retched...
"That's the most disgusting thing I've ever heard!"

Wait-wait-wait, I've got better!
Remember: this is a sand desert, fertilizer is also very rare.
Three guesses what they do with the contents of their septic tanks...

I know that dried camel dung is used to start up the fire. Very combustible. Makes preparing the bivouac tea much easier...
And it really wouldn't be polite to refuse a cup. Trust me on that.

So, what do they live of in Mauritania? Well, tourism. Westerners pay consistent money to go roaming the desert and share the local culture. You know, "rough it up a bit, and what not, jolly good fun I say".
:-)

Fancy a vacation trip, guv'nor?

Or maybe you'd prefer leisure sailing off the scenic coast of Somalia?...

Anonymous said...

"rough it up a bit, and what not, jolly good fun I say"

Oh, I say, old boy, that's a bit thick, what?

Or maybe you'd prefer leisure sailing off the scenic coast of Somalia?...Maybe if I had about five dozen buddies in the Royal Marines!