Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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.

It is hard to understand it now, but in 1938 five-year plans had a certain cachet, thanks to the prestige of the Soviet Union. Even the International Institute of African Languages and Cultures had one, according to the preface to a volume of anthropological papers published that year. Of course it was a success, as all five-year plans must be:

The Five Year Plan of the International Institute of African Languages and Cultures has given an immense impetus to the study of culture change in modern times…

My copy of this admittedly obscure work once belonged to Edward Joseph Lister Lowbury (1913 – 2007). Lowbury, whose father was a doctor, was named after the great surgeon, and his own work as a bacteriologist was in the control of hospital infection, an example of life imitating a name rather than art. Early in his career, though, he was a pathologist in East Africa, hence his possession of this book.

Lowbury was an extremely cultivated man, an accomplished pianist and a poet who won the Newdigate Prize for poetry at Oxford, as did Matthew Arnold and Oscar Wilde. On the inside cover of his copy of Methods of Study of Culture Contact in Africa are two sonnets in his own hand, written at Moshi in Tanganyika in October 1945, and not included in his published works. One is called From the Train to Moshi and the other Road to Kibo. (As it happens, I have been to Moshi.)

There is nothing specifically medical in the two poems. The second half of the first expresses revulsion against the colonial life in Africa, comparing the whites unfavourably with the Masai:

For laughter these are best
Value, as also for lolling at their ease,
The Masai! And again, who is so impressed,
So smiling even when shouted at as these
Whom nothing will persuade man is unblest
And sex is wicked – especially witnesses
Of the white man at his worst, drunken, depressed,
Stealing their women, catching their disease?

This is dated 30 October, 1945; the second poem (written in a surprisingly clear hand) the following day. Here Lowbury extols the children whom he sees:

The children line the road, click heels, salute,
And have the last word in every greeting.
Their eyes are deep, expressive, never mute;
They meet yours roundly, never flinch at meeting…
Their charm is so great that even their vices are forgiveable:
What matter if they lie and laze and steal?
When chances offer? – That’s reflected too.
You’ll soon forgive them when you see how real,
Under the lying and the ballyhoo,
Are the fine nerves, the touch fit like a glove
By the light fingers of the God of Love.

Either Lowbury – who wrote the poems with only a few crossings out, for he was famed for his fluency – forgot these sonnets, or did not think them good enough to be published. No doubt they resort to stereotypes, but which of us never does so, indeed goes a day without doing so?

Under the lying and the ballyhoo,
Are the fine nerves…

The feeling of the young pathologist is real enough, unmistakable I should say, and my experience of the Tanganyikans was like his. They were the best-mannered people I have ever met.

This piece in Taki’s Magazine, on the refugee crisis, contains an excellent proverb of which I was unaware (“fine words butter no parsnips”), a new maxim of Dalrymple’s own making (“there is no social phenomenon without its bureaucratic opportunity”) and a number of laugh-out-loud moments:

It was obvious to me that the British authorities reasoned thus: If a man preferred to stay in Rotherham rather than beg to be repatriated, his life must really have been in danger and he was a true refugee.

…in these multicultural times, it is fair to assume that no one, and certainly no Director of Diversity, has any interest in, let alone knowledge of, remote countries or other cultures.

the only Syrian asylum seeker I met was a man who had already been granted it. He said that he had been in the Syrian army, where his job was that of torturer; unfortunately for him, his work was not up to scratch, so to speak, and he went from being a producer of torture to a consumer of it.

I had never met any Kosovar refugees until NATO liberated Kosovo and made it safe for democracy.

But as always in Taki’s Magazine, you will definitely want to avoid reading the comments. My goodness.

Arguing that “No plaintiff should have nothing to lose”, Dalrymple shares the results of a frivolous lawsuit resulting from medical research:

The purpose of research is to discover what was previously unknown. Research wouldn’t be necessary if we knew everything there was to know, but that will never be the case so research will always be a necessity, so long as knowledge remains preferable to ignorance. And while wisdom may be folly where ignorance is bliss, you can never know that to be true until after you’ve become wise.

Apparently, all of this is perfectly obvious except to certain trial lawyers, whose job it is to exploit the corrupt and corrupting tort system.

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.

One shouldn’t judge a book by its cover, of course, nor by its title; but when 200,000 books are published each year, this is the counsel of perfection, and you have to judge by something. Some titles are more intriguing than others; recently, for example, I came across one that seemed to sum up the human predicament pretty succinctly: Until Further Notice, I Am Alive.

This was a quotation from an e-mail that Tom Lubbock, the author of the book and former art critic of a major newspaper, sent to a friend on learning, in 2008, that he had a neuroblastoma multiforme and that his expectation of life, with treatment, was only two years. Prognosis is an imperfect art, but in this case proved accurate. Diagnosed in October 2008, he died in January 2011.

Dr Johnson said that when a man knew that he was to be hanged in a fortnight it concentrated his mind wonderfully. But what about when he knew that he would die in two years, with the possibility of the dissolution of his mind before that of his body? The site and growth of the author’s tumour gave him increasing difficulties with language; the last entries in the diary of his illness, three months before he died, are short and fragmentary.

Lubbock quotes the French writer, Charles Péguy: “A word is not the same with one writer as with another. One tears it from his guts. The other pulls it out of his overcoat pocket.” Although the mystery of where our words and thoughts come from is perennial, we seldom think about it; but for Lubbock the problem became an almost physical one, as he struggled to pull words from, and form thoughts, somewhere in his mind.

He is complimentary on the whole about the medical profession, but he meets an arrogant neurosurgical registrar who, mistaking him for someone else, asks him whether he still experiences strange smells (he never experienced strange smells). There is nothing like being mistaken for another patient to make you feel small and insignificant; and the registrar also tells him he is lucky to have any speech left at all.

Lucky? What does the word “luck” mean here? Naturally the author asks himself why he should have a rare fatal disease, and the only answer he can find is that, if the disease exists, someone must have it. But was he lucky that it was initially operable, that it gave him no pain, that it preserved his intellect nearly until the end? Perhaps what the registrar meant was “Most people with a tumour such as yours in the same position in their brain would not be able to speak, therefore you are lucky.” This is a very restricted and inhuman notion of luck. How easy it is for a doctor to wound with a few thoughtless words! Let us all read, mark and inwardly digest.

Lubbock had a son eighteen months before he was diagnosed, the child of his heart; the author’s knowledge that this much-loved boy would remember nothing of him in his later life is poignantly expressed, and is all the more poignant because it is obvious to the reader that he would have been a very good father.

On the whole, I do not like memoirs of illness as a genre; I had a surfeit of them when a magazine once sent me seven of them for review. But at the end of this slender book, I felt a real sense of loss, almost of grief, as if I had known the author personally.

Dalrymple recently wrote a series of four pieces at The Library of Law and Liberty against what he calls the “extreme libertarian” case for drug legalization. Patrick Lynch, senior fellow at Liberty Fund, wrote a response, and now Dalrymple has replied to it. As usual in these matters (but very unusual for most writers), he is quick to concede that his interlocutor makes some good points, but he again argues against some of the positions of John Stuart Mill to which he says his opponents adhere.

It’s a long, detailed reply. Read the whole thing here.

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.

There was a time when I should have despised the sermons of seventeenth and eighteenth century divines, but perhaps it is a sign of advancing age that I no longer do. The sermons are often exceedingly well written and full of sense, even if one does not necessarily share the underlying religious standpoint. If one read only that with which one was in complete agreement, one would read very little.

Joseph Butler (1692 – 1752), Lord Bishop of Durham, was considerable as a philosopher (his most famous dictum being “Everything is what it is, and not another thing,” which is actually more metaphysically profound than might at first appear), and he also wrote memorable sermons. He was a deeply charitable man, and believed in hospitals for the poor: he was the most generous contributor to the founding of an infirmary in Newcastle.

The preface to his Fifteen Sermons opens with words that could hardly be less congenial to the spirit of our age:

…it is scarce possible to avoid judging, in some way or other, of almost everything which offers itself to one’s thoughts…

Personally, I am with Butler there, and against the spirit of the age.

The other sermons are subtle explorations of human psychology, still well worth the reading; while the sixth of his Six Sermons Preached upon Public Occasions, before the Duke of Richmond and the Governors of the London Infirmary for the Relief of Sick and Diseased Persons, Especially Manufacturers and Seamen in Merchant-Service, of 1748, is of surprising contemporary relevance.

For example, he treats of the question of whether those whose illnesses are self-inflicted should be treated on the same basis as those whose illnesses are not. Butler believes that they should be; not surprisingly as a bishop, he uses the argument that “we have divine example for relieving those distresses which are brought upon persons by their own faults.”

But he goes further:

Though the natural miseries which are foreseen to be annexed to a vicious course of life are providentially intended to prevent it… yet those miseries, those natural penalties admit of and receive natural reliefs, no less than any other miseries, which could not have been seen or prevented. Charitable providence then… leads us to relieve, not only such distresses as were unavoidable, but also such as people by their own faults have brought upon themselves.

The example he gives is of the diseases brought on by drunkenness, and not so long ago I was asked by a newspaper to write an article denouncing (which I declined to do) the second liver transplant given to a late drunken footballer.

Butler even deals with the economic problems of health care. The infirmary’s rules stated that “none who are judged to be in an asthmatic, consumptive, or dying condition be admitted on any account whatsoever.” Harsh as these words sound, says Butler, they proceed out of the mouth of Charity itself, for:

Charity pronounces it to be better, that poor creatures, who might receive much ease and relief, should be denied it, if their case does not admit of recovery, rather than that others, whose case does admit of it, be left to perish.

The need to ration is nothing new.

My edition of Butler’s works, incidentally, was edited by W E Gladstone in retirement: hard to imagine a recent Prime Minister on such a task in retirement.

If a depressing film on an important subject doesn’t dull our appetite for dinner, are we any the less conscientious? On distrusting extravagant shows of sensibility, in Taki’s Magazine:

I have seen some terrible things in my life—the remains of massacres and so forth—but I am afraid that even they have failed to put me off my dinner, though I have of course not been unmoved by what I saw. Is this fortitude of mind or stark insensibility? I ease my conscience by telling myself that refusal of dinner will help no one.

On the web site of the Library of Law and Liberty Dalrymple looks at the live-TV murders in Virginia and identifies three of the perpetrator’s flaws that contributed to the crime: paranoia, a desire for fame and anger:

It ought to be obvious that those who love justice ought not to commit injustice themselves. But anger makes matters worse even than La Rochefoucauld suspected when he wrote that love of justice in most men is merely fear of suffering injustice. Anger makes us love injustice, provided that it is we who are committing it. An atmosphere of rage is concomitantly one of righteous (or self-righteous) cruelty.

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.

Patrick McGrath (born 1950), the distinguished novelist, is the son of Dr Patrick McGrath (1916 – 1994), Physician Superintendent of Broadmoor Hospital between 1957 and 1981. Alas the latter, though he led a dramatic and varied life, committed very little to paper: not more, he said, than a few occasional medical papers and some letters to The Times. His life story would have been the stuff of legend.

In the first third of his novel Asylum, McGrath gives a lyrical picture of what it was like to grow up in the precincts of an institution for the criminally insane as the son of the superintendent, an upbringing half-prelapsarian and half-sinister. There may be better contemporary prose than this account, but if so I do not know it.

Though not a doctor himself, McGrath junior was clearly marked by the medical environment in which he grew up and absorbed the medical atmosphere for later use in his work. The protagonist of his novel Dr Haggard’s Death is a young registrar in surgery at a London teaching hospital just before the outbreak of the war (when McGrath’s father qualified) who fails to make the grade. His irascible boss, Vincent Cushing, does not think much of him; on one occasion he, Haggard, makes a hash of an appendectomy.

Dr Haggard has a passionate affair with the beautiful wife of the chief pathologist, the arrogant and unsimpático Dr Ratcliff Vaughan, who never manages – or even tries – to rid himself of the smell of cadavers and formalin. When Vaughan discovers the affair, he strikes Haggard across the face at the head of the hospital stairs, down which Vaughan falls and breaks his hip. He cannot reveal what Vaughan has done because to do so would harm his lover. In those days, neither adultery nor divorce were as lightly-regarded as they are now.

Dr Haggard remains in traction for three months: a Smith-Petersen nail is inserted into his femur by his boss, Cushing, who then dismisses him from his service. At the same time Mrs Vaughan brings the affair, the one great love-affair of Haggard’s life, to an end. He has lost everything, and knows that he will never recover from it. Nothing remains to him but general practice in a dispiriting seaside town on the South Coast, where senior civil servants and retired professionals go to die.

Haggard gives a name to the metal rod in his femur: Spike. Spike gives him trouble when the weather is damp and cold, or when disagreeable emotions and memories come to the fore in Haggard’s mind. He then injects himself with morphine; investigated by the Home Office for the practice’s high usage of narcotics, he succeeds in persuading the inspector that it is because of the nature of his patients, who are mostly decrepit or close to death.

On one occasion Haggard tries to defeat the habit by abstention, and there follows the usual exaggerated literary depiction of withdrawal effects from morphine; yet it is only too plausible that Haggard should himself be a victim of the mythology of withdrawal. Altogether, the novel is a sensitive depiction of loss and failure, so much more interesting than that of unbroken success: and more frequently encountered, too.

Deliberate destruction is not the only means of vandalism, says Dalrymple in Taki’s Magazine. The consciously incompatible design of some modern construction accomplishes the same purpose, and for ideological reasons:

Nothing has shaken me more (and, be it remembered, I was professionally involved in talking to burglars, muggers, blackmailers, kidnappers, rapists, and murderers) than the utter indifference or even hostility to the achievements of the past and the need to preserve and pay them honor of many educated young people in Britain and France. Nor is this indifference or hostility spontaneous; rather, it has been programmed into them by indoctrination that the past is nothing but the slave trade and the oppression of women. Moreover, their visual education has been crude, as a visit to any modern toy shop or modern municipal playground will confirm. Aesthetically illiterate and ideologically convinced that the past was nothing but a moral mistake that they will correct, it is little wonder they do not care for the fabric of the past or worry much about its disappearance.