Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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

In his Lettres Persanes, first published in 1721 and reprinted many times during his lifetime, Charles-Louis de Secondat, better known as Montesquieu (1689 – 1755), used the device of letters from fictional Persian visitors to Paris to examine French (and European) manners, assumptions and prejudices. Among the subjects which he treated with irony, perhaps not surprisingly, was the medicine of his time.

For example, he relates the story of a doctor who had a patient who suffered from insomnia for thirty-five days. He prescribed him opium, but the patient, reluctant to take it, asked whether he might try an idea of his own first, on the promise that if it did not work he would then take the opium.

His idea was to try some of the books in a local bookseller as a soporific. “Monsieur,” he asks him, “would you not have in your shop some book of (religious) devotion that you have not been able to sell, for often the rarest remedies are the most effective?” The bookseller replies “Monsieur, I happen to have the Holy Court of Father Caussin. I will send it to you.”

It duly arrived. “The dust was shaken from it and the son of the ill man, a young schoolboy, began to read it. He was the first to feel the effect; at the second page, he began to mispronounce, and everyone felt tired; a moment afterwards, everyone was snoring except the ill man who, after long resisting, finally succumbed.”

The doctor visits the next day and assumes that the patient, who has slept well, has taken the opium he prescribed. He is quickly disabused, and begins his researches into the medical effects of boring books. A footnote gives his prescriptions:

Purgative infusion: Take three pages of Aristotle’s logic in Greek; two pages of the most acute treatise of scholastic theology, as for example that of Duns Scotus; four pages of Paracelsus; one of Avicenna; six of Averroes; three of Porphyry; as many again of Plotinus. Infuse them for
twenty-four hours, and take four times a day.

In order not to make his medicines as cheap as possible, and in order not to cause his patients financial embarrassment, the doctor decides not to use rare ingredients, such as dedicatory epistles that cause no one to yawn, prefaces that are too short, Jansenist works not highly-regarded by other Jansenists and not despised by Jesuits. As for a good vomit, six funeral orations, a collection of new operas, fifty new novels and thirty new memoirs, distilled in an alembic, should be sufficient.

As for asthma:

Read all the works of the Reverend Father Maimbourg, taking care not to stop before the end of every sentence; and you will feel the ability to breathe return little by little, without the necessity to repeat the cure.

As to the medical books of the time, Montesquieu was hardly more complimentary:

The textbooks of medicine: these monuments to the fragility of nature and the power of the art; which make us tremble when they treat of even the slightest illnesses, so close to death do they make us seem; but that reassure us completely when it comes to the value of remedies, so that it is as if we had become immortal.

Dalrymple’s latest piece in the New Criterion is something I have been hoping for: his review of Between the World and Me, Ta-nehisi Coates’s monograph on racism in America, which has been praised to high heaven by the left and ripped to shreds by the right:

When Coates tells his son “Never forget that for 250 years black people were born into chains,” he does not dilate on what, exactly, he means by “Never forget.” There is more than one possible interpretation of the phrase. In the context of the whole book, I think it means “Keep it always in the forefront of your mind,” rather than never forget it in the sense of not being able to remember what you had for dinner seventeen days ago. While it is perfectly right, and indeed vitally important, that historical memory should be available to anyone who wants to interpret the modern world, for without it history becomes nothing but a series of unconnected moments, neither should it be a distorting lens through which everything and everybody is seen. My mother was a refugee from Nazi Germany, and while she never forgot it—how could she?—in the sense of remaining able to call it to mind, she did not interpret all her subsequent problems in the light of that catastrophic experience, even though it had obviously changed her life course in a very fundamental way. She didn’t think that a rude shop assistant was a Nazi.

On the evidence of this book Coates wants to raise up in his son an ideological resentment, to querulous monomania. He repeatedly extols what he calls the “struggle,” though he does not tell his son what it is a struggle for. He makes explicit his disbelief in the likelihood of real change, given that America is ruled by what he so elegantly calls “majoritarian pigs,” so that it cannot be for any concrete or tangible political or economic goal. There is not a single call to his son to expand his horizons beyond “the struggle,” which is really that of giving a meaning to life in the absence of any other…It does not occur to him that, even in America, outrage cannot be the way forward for millions of people, or indeed that dwelling exclusively on injustice, real or supposed, may not be the best advice to an adolescent (adolescence being, in any case, the great age of resentment).

On Pajamas Media Dalrymple describes a recent, surprising realization:

Although I have spent much of my career exploring the less meritorious aspects of human conduct, there is a type of research fraud that I had not suspected to exist until I recently read an article in the New England Journal of Medicine. Once you know that volunteers for pharmacological experiments are paid, it becomes obvious, and I feel slightly foolish for not having realized it before: the volunteers also commit fraud.

Dalrymple observes a Saudi woman reluctant to reveal her face to an immigration officer, and wonders what she’s thinking:

I felt my gorge rising as I watched (discreetly). But my curiosity was also aroused. What imaginary threat was obviated by this vestimentary rigmarole? More important still, what were the woman’s true feeling during this episode? Clearly she was afraid, for fear was on her face when I saw it, but fear of what, exactly? The wrath of God of her husband? That anyone catching a glimpse of her would assault her sexually? Or was it only the fear of a creature of the night when exposed to full daylight?

Dalrymple recently discovered that, measured by convertible assets (he seems to mean net convertible assets), he is a member of the infamous “one percent”, but he considers this distinction utterly meaningless:

This belief is no doubt the last gasp of dialectical materialism’s law of transformation of quantity into quality. According to this law, when a man grows rich enough he suddenly ceases to be a man like others and becomes—what, exactly?

…

My pattern of consumption and mode of life are not conspicuously different from those of many of my peers, except in so far as I have no television and buy many more books than most. It is true that my interests and amusements are not the same as those of most citizens, but that was so long before I joined the One Percent and would have been the case had I not joined it (or them). If it is really necessary to divide me from others by possession of some characteristic or other, my different tastes and interests would seem to me to be a better way to do it. The fact that I sometimes write art criticism, for example, distinguishes me far more clearly from my neighbors than do my assets.

…

The division of people by income or assets into One Percent versus 99 Per Cent as if they were creatures of different species is not so much descriptive or explanatory as incitement to those two most unattractive and destructive emotions: envy and resentment.

Dalrymple explains on Pajamas Media why a new insulin pump, which seems to control blood sugar better, may or may not be as helpful as hoped:

It seems to stand to reason that if the complications of such diabetes are caused by poor control of the level of blood sugar, and if the new pump assists in producing better control of that level, then it ought to help in reducing the level of those complications. However, this type of reasoning is always hazardous in medicine: the proof of the pudding is always in the eating. It is all too easy to treat biochemistry rather than patients. The better control of blood sugar levels is not an end in itself. It is worthwhile only if it actually leads to clinical benefit, and that has yet to be shown, and this will take a long time.

A street conversation with a man and his dog raises an interesting question:

He himself was a teacher and worked with children ‘in difficulty:’ that is to say disobedient and delinquent. At the suggestion of the school psychologist five years before, he took the dog to school with him where the dog exerted a very beneficial effect on the behaviour of the children, an effect that was lasting.

This was a phenomenon worth reflecting on. Why did the dog have such an effect?

Read the whole thing on the Salisbury Review website for the answer.