Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

The narrator of the novel Lost Horizon is a neurologist who has written a book on amnesia, which is one of the reasons why the story of Conway interests him. Conway, a veteran of the trench warfare of the First World War, is a British consul in Afghanistan who disappears and finds peace in Shangri-La, a Tibetan lamissary, where the secret of the good life has been found and as a consequence that of longevity also. When he leaves Shangri-La, however, he loses his memory, recovers it briefly to recount his story, and then loses it again.

The author of Lost Horizon was James Hilton (1900 – 1954) and his book gave not only a name but a whole concept to the English-speaking world. Strangely enough, he appended a dateline to it: Woodford Green (Oak Hill Gardens, to be exact), 1933. This raises the interesting question of whether there are people in Shangri-La (or rather, Shangri-La-like places) dreaming of semi-detached houses in Woodford Green.

Lost Horizon was not really a success until after the publication of Goodbye, Mr Chips a year later: both were then publishing phenomena, it often being said that Lost Horizon was the first mass-market paperback best-seller in the United States.

Mr Chips – short for Chipping – is a school-master aged 85. He was a teacher at Brookfield School for sixty-three years until his retirement in 1913, when he went into lodgings near the school. He looks back on his life as he dozes in his chair:

When you are getting on in years (but not ill, of course), you get very sleepy at times, and the hours seem to pass like lazy cattle moving across a landscape.

His doctor, Merivale, visits him every fortnight or so and drinks a glass of sherry with him. Dr Merivale is the epitome of the reassuring family doctor:

My dear fellow, you’re fitter than I am. You’re past the age when people get these horrible diseases; you’re one of the few lucky ones who’re going to die a really natural death. That is, of course, if you die at all.

By natural death, I suppose, he means old age, terminal decay, rather than anything like cancer or heart attack; but this jocular reassurance is immediately belied by what he tells Mr Chips’ landlady on his way out:

Look after him, you know. His chest… it puts a strain on his heart.

The puritan modern sensibility would no doubt find this disjunction between what the doctor says to the patient and what he says to the person looking after him shocking, but I am not certain that it is inhumane.

Illness quietly pervades the book. An outbreak of German measles – German measles, who can remember it? – affects half the school and turns much of it into a hospital ward. Everyone thinks of Mr Chips as a confirmed bachelor, but in fact he was once, briefly, married. In 1898, his beloved wife died in childbirth, along with the child, presumably of a prolonged labour. In 1916, Chatteris, the headmaster in his late thirties, and who looks very ill, confides guiltily in Mr Chips, who is now retired, that he, Chatteris, is indeed ill. He has diabetes.

Chatteris fell ill during the winter of ’17… Then in April, [he] died.

Without intending to, Hilton reminds us of how far we have come, medically. Will our own best-selling authors do the same for our descendants?