Author Archives: Theodore Dalrymple

On Dr Lazarus Ludovic Zamenhof

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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

Dr Lazarus Ludovic Zamenhof (1859 – 1917) studied at the medical faculty of Moscow University at the same time as Anton Chekhov, but completed his studies in Warsaw because of the political situation in Russia after the assassination of Tsar Alexander II. He then went to Vienna to study ophthalmology, which he subsequently practised.

But his real passion was language. He was born in Bialystok, and the entry about him in the Jewish Encyclopaedia of 1906 says:

Four different languages are spoken there, and to this fact he attributed the constant dissensions and misunderstandings which disturbed the city.

A brilliant linguist himself, he set about devising a universal language that would, in effect, reverse the consequences of the destruction of the Tower of Babel (he wrote a tragedy in five acts, titled The Tower of Babel, when he was 10 years old). In 1885, he published his first pamphlet on the universal language that was to become known as Esperanto under the pseudonym Doktoro Esperanto, which hardly needs translation.

The Esperanto idea caught on – to a degree. I have before me my only Esperanto book, the Esperanto Pocket Dictionary, seventeenth edition, 1939, formerly owned by Ernest Whittler of 548 Whitworth Road, Rochdale (the north of England was apparently always keener on Esperanto than the south). According to the preface, this little book had sold 48,000 copies between the first edition in 1915 and seventeenth in 1939 – far more than any book of mine.

I know it is very wrong of me to do so, but I cannot help smiling when I learn that antraks is the Esperanto for anthrax, ezofag for oesophagus and strut for ostrich. Altogether I have derived much plezur and amuzado from this little book, which cost me £1 in a charity shop.

Many books have been translated into Esperanto and the British Esperanto Association in Stoke-on-Trent has about 15,000 of them. You can buy Esperanto books online from the Association, including Winnie-la-Pu, which again needs no translation.

There is a terrible tragedy in the history of Esperanto. Dr Zamenhof hoped by his supposedly universal language to unite humanity. He devised a doctrine that he called homaranismo, according to which peoples would become friendly by the use of the same language. At the First International Esperanto Congress held at Boulogne-sur-mer in 1905, he concluded his speech by “a Prayer under a Green Flag,” which went:

A green flag held high
Means goodness and beauty.
The secret power of the light will bless us,
And we will achieve our aim.
We will break down the walls among the nations,
And the walls will creak and groan,
And will fall down forever and love and truth will reign on earth.

I think the goodness and sincerity, if not necessarily the realism, of Dr Zamenhof are obvious. Alas, he died of heart failure in 1917 in Warsaw, which was then under German occupation in the midst of the First World War. He was said to have been very anxious about the future of humanity, and with very good reason. All three of his children were killed in the Holocaust when Warsaw was once again occupied.

Esperantists celebrate December 15, Dr Zamenhof’s birthday, as Zamenhof Day.

An Introduction to the Real Psychiatry by Dr M S Rao

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

Boastfulness is not a pleasant characteristic, but it is an increasingly necessary one for getting on in the world. Not only must one not hide one’s light under a bushel, but one must pretend, and make others believe, that one’s penny candle is actually a laser of such penetration that it will illuminate the far side of the universe. Gone are the days when a world expert on a subject would claim to know a little about it; nowadays even an eighteen year-old applicant for medical school is expected to produce a list of achievements filling several pages.

The other day, though, I came across a case of boastfulness disarming in its innocence. It was in a book called An Introduction to the Real Psychiatry: The Science that Studies and Corrects the Malfunctioning of the Fine Human Brain, by Dr M S Rao, published in Jaipur in 1971. Among the author’s previous books were From Utter Weakness and Impotence to the Supreme Sexual Power, 5th revised edition, 1969, 224 pages.

Dr Rao has nothing but contempt for other psychiatric texts:

It is remarkable how, in spite [of the lack of agreed facts or principles in psychiatry], the books on psychiatry are regarded as science books, simply because they have a rich get-up, are voluminous, made of superior paper with high-class printing, more especially because they are highly priced like other medical books, and because they are taught in medical colleges and their authors have many high medical degrees after their names.

Religion is no better. Sometimes he sounds like the Richard Dawkins of his day. Not only did Darwin for him pluck out the heart of the human mystery, but belief in God is a “silly childish belief” that leads to sexual frustration and thus to mental malfunctioning.

Luckily, Dr Rao has come to put us all right. Having quoted Pope’s famous epitaph to Sir Isaac Newton:

Nature and Nature’s laws lay hid in night;
God said Let Newton be, and all was light!

Dr Rao continues:

Mother Nature got busy in creating a new brain which was destined to illuminate schizophrenia, etc., etc.; and I was then ushered into the world, rather silently… Mother Nature urged me to show up, and I was declared the topmost student of my class in my state, getting by far the highest marks and winning the highest merit scholarship…

Mother Nature was not yet finished with Dr Rao:

Mother Nature later on seemed to say in my ears, “The brain (cerebrum) constructed by me is a purely mechanical brain. It is as prone to work in a wrong way as in the right way… and the wrong ways are innumerable, and the humanity has been using this brain mainly in the wrong ways… ever since I gave this brain to humanity, some 10,000 generations ago, – simply because I forgot to enclose the operating instructions with this mechanism I constructed (as is now usually done by the thoughtful engineers who construct various sorts of machines – they tell people in a leaflet how to operate their particular machine).

Fortunately, Dr Rao has discovered the operating instructions of the human brain, and:

…thus I could make Newton’s genius flourish far far more fruitfully if that unfortunate and psychologically ignorant boy could somehow come in contact with me…

For some reason, this boastfulness is endearing (perhaps because it is so eccentric) rather than off-putting, unlike our own which is merely crude and grasping.

Suicide in Antiquity and in Modern Times by Gaston Garrisson

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

Suicide remains an elusive problem, both clinically and philosophically. Indeed, Camus said that suicide was the only philosophical problem of any real importance; but that is an exaggeration, if an excellent opening line to the philosophical treatise in which he makes the claim.

French writing on suicide is extensive; Émile Durkheim’s study on suicide is still a standard work. Twelve years earlier, in 1885, a lawyer called Gaston Garrisson published a book entitled Suicide in Antiquity and in Modern Times, full of the most fascinating and recondite information on the subject: for example, that under the Justinian code, it was permissible for a debtor to commit suicide if he could not pay his debts. This was because if he did not pay his debts he could be enslaved to his creditor; to avoid the shame of this was deemed a good reason for him to kill himself. It is perhaps as well that the Justinian code no longer applies.

Garrisson also mentions the Suicides’ Club that existed in Paris and Berlin at the beginning of the nineteenth century, and which probably inspired Robert Louis Stevenson’s novella, The Suicide Club. The rule of the Paris and Berlin clubs was that every member should be willing to kill himself if chosen by lot to do so. Membership of the clubs, unsurprisingly perhaps, was never very extensive, twelve in Paris and six in Berlin. The last member to kill himself did so in 1819.

Garrison was an early supporter of assisted suicide, though mainly for legal reasons; for if suicide was not a crime (as it was not in post-revolutionary France), how could assisting it be a crime? Before the Revolution suicide was a crime, the corpse was punished, and a man’s property was forfeit; there was a long historical struggle between the king and the nobles over which of them got the suicide’s belongings.

Britain is referred to throughout the book as the classic land of spleen and suicide. The fact that the statistics showed that the French were more prone to suicide was explained by the hypocrisy of the British coronial system, which rarely found that a man had killed himself, thus preventing the forfeiture of his goods to the crown, a regulation that was then still nominally in force though in effect a dead letter. Garrisson quotes Henry Maudsley, the founder of the hospital.

My copy of Garrison’s book serves as a memento mori. One is inclined to suppose that, when one possesses an old book, it has found its final resting place, its true owner. But in fact, one is only ever its temporary guardian.

The first identifiable owner of the volume was a Dr Revertégat, who owned a psychiatric clinic in the town of Sannois, where he several times treated the painter, Maurice Utrillo, for his alcoholism. The second was Dr Gregory Zilboorg (1890 – 1959), the Russian born psychoanalyst and historian of medicine among whose patients were the writer Lillian Hellman and the composer George Gershwin. When Zilboorg emigrated from Russia to the United States in 1919, he lived by means of translation while pursuing a medical degree at Columbia University, among the books he translated being Yevgeny Zamyatin’s early dystopia, We, which is said to have inspired George Orwell’s Nineteen Eighty-Four.

Who will own the book after me?

The Surgeon by Alan Thomas

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

Even bad or mediocre novels are not without interest, especially when they have aged a little and so tell us something about times gone by. They are like symptoms.

But symptoms of what, exactly? Do such novels tell us about the past as it actually was, as the author wanted or believed it to be, or as he thought it ought to have been? Do such novels tell us the truth of the age or the illusions of the age, or some combination of the two?

Recently I picked up a novel titled The Surgeon. It was the medical title that drew me to it; it was by Alan Thomas and published in 1964. Although 48 years is not exactly an historical epoch ago, and is well within the memory of people now living, the world depicted would be almost as remote to a young person as that of, say, the court of Frederick the Great.

The author, Alan Ernest Wentworth Thomas, was born in 1896 and died in 1969. He had a varied career, as classical scholar, army captain (wounded four times in the First World War), barrister, crime novelist, employee of the League of Nations, editor for nineteen years, between 1939 and 1957, of The Listener, and finally as a reasonably successful novelist. His first book was published in 1928 and his last, posthumously, in 1970.

The surgeon of the title is Larry Balneath, young, accomplished, handsome, successful and flawed. One day he is called to the hospital because a minor Conservative politician, Sir Humphry Halland, Bart., has had a car crash and fractured his lumbar vertebrae, on which Balneath operates with his customary brilliance. In those days, if the novel is to be believed, titles still inspired awe; when Halland’s young wife asks to be called Gloria instead of my lady it is a sign of her broadminded and democratising informality.

Balneath and Lady Halland fall in love while Halland is flat on his back in hospital. They do so very chastely, I must say, despite Lady Halland being twenty years younger than her husband. He is referred to throughout the book as if he were an old man, though in fact he is only 53, and the marriage was never a successful one.

Unfortunately, when Halland recovers he has a further accident, falling off a podium and injuring his back so badly that he suffers paraplegia (despite Balneath’s second brilliant operation on him). Lady Halland asks Balneath to kill Halland, partly for his own sake because he will be so miserable as a paraplegic, but partly so that Balneath and she can marry. Balneath refuses, and she thereafter discovers an affection and duty towards her husband. It is Lady Chatterley in reverse. Balneath, in the meantime, marries his utterly devoted Harley Street receptionist and secretary.

The world that Thomas portrays is one in which hospital consultants are gods, nurses are ministering angels, divorce is an utter scandal, porters and butlers are deferential, Daimlers are chauffer driven, sex occurs only at the end of an elaborate pas de deux, if even then, and the rich smoke as a matter of course. Did this world ever really exist? Fled is that music: do I wake or dream?

Two Plays by Augy Hayter

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

Augy Hayter (1940 -2004) was an actor, translator, poet and playwright who lived on the fringes of the avant-garde. His father, Stanley William Hayter, was a famous artist who lived in Paris and knew such painters as Picasso and Miró. In 2002 Augy Hayter published five one act plays; by then he had given up “voiced-based activities” after an operation on his throat, presumably for cancer, for he died two years later.

In two of the plays, not connected in any other way, a children suffers from a cerebral haemorrhage, which not surprisingly has a profound effect on the father of each, though each child survives without sequelae. Since such haemorrhages are not very common, one might surmise an autobiographical element. One of the fathers describes the experience:

I never had a religious education, I didn’t even know the Lord’s Prayer. And then I said, Oh God, and the words came, Oh God, if you need a brain, take mine.

Electro-convulsive therapy plays a large part in two of the other plays, and again I surmised a personal connection. In the first play, Fit to Be Tied, a patient who has escaped from an asylum returns to his former office, where he was the boss, and advertises for an employee. A young man applies for the job, but in the middle of his interview a doctor (described as having “the arrogance of insecurity”) and a nurse arrive to haul him back to the asylum.

The male nurse returns to the office to reassure the applicant who asks “Is it true he is being given shock treatment?” The nurse replies that it is and it isn’t; he goes through the motions of having it, but the apparatus has been deliberately disabled so that no electricity goes through his brain. The doctor doesn’t know this, but is nevertheless satisfied with the result. The play seems to have been inspired by the commonly repeated story of the ECT clinic in which the machine had broken down but nobody noticed: to which one can only say they cannot have been very observant.

In the second play, called Sheherazade, a man gets into a train compartment with a young girl and tells her that he is going to rape her, cut her throat and throw her from the carriage before they reach Clapham Junction. However, they start talking, and he relates his experience of ECT, seeing other people have it while waiting for his own:

The eyeballs turn up, the teeth snap together, the eyelids are trembling, the eyes are white and while the body is convulsing they’re holding your arms and legs so you don’t knock over the equipment. You see, the hospital Bursar gets very shitty about that sort of expense. If they kill you on the operating table, no problem, but if they lose an electrode, the doctor won’t be let go of for months.

The dedication of the play is at the end. “The play is dedicated to… the memory of my mother, who received such treatment.”

Hayter translated Jean-Luc Lagarce’s play It’s Only the End of the World, written in 1990 five years before Lagarce died of AIDS, about a man long estranged from his family who returns with a fatal disease, and exposes the family’s secrets and mutual hostilities. In literature, one is never more than a degree or two of separation from medicine.

Not Guilty by Llewelyn Powys

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

The life of Llewelyn Powys (1884 – 1939) was considerably shaped by tuberculosis. He had his first pulmonary haemorrhage in 1909 and went to a sanatorium in Davos and then to Kenya as a plantation manager in an unavailing attempt at a cure. Life in the sanatorium and in Kenya were the background of some of the stories in his first book, Ebony and Ivory, published in 1923.

Powys detested the Kenyan colonists, whom he saw as greedy philistine brutes. In one of the stories, a farm labourer is so badly treated by his employer, but has so little chance of escape, that he decides not to kill himself but simply to lie down and die – and he does, his corpse being burned as “Rubbish,” the title of the story. In another story, a young man just out to the colony starts out better and more refined than the other colonists but is gradually coarsened by them. He takes a local girl as a lover but contracts syphilis from her, so virulent that the doctor tells him that even salvarsan cannot help him. He takes a pistol and shoots himself in the head.

The story Not Guilty starts “No, I have never deceived a living man but, by Jove! I came near to doing so once.” As might be surmised, this turns out to be ironic.

The narrator is in a Swiss sanatorium for a cure of his relatively mild tuberculosis. There he meets a prosperous, slightly vulgar but very rich British boot manufacturer, whom he befriends, and whose beautiful young wife comes out to visit him. The manufacturer is very ill and close to death. The narrator and the wife are attracted to one another, and on one occasion find themselves alone, as they think, in the manufacturer’s bedroom, where they take the opportunity to make love. Suddenly, however, they realise they are not alone:

The doors leading on to the balcony were ajar and through the narrow open space I could see the end of my friend’s couch. Judge then of my horror on catching sight of one of the well-known brown boots! He had been there all the time and had doubtless been a witness of our illicit love! What were we to do?

The man’s wife decides to brazen it out; but on reaching the balcony realises that her husband is dead.

All the stories in the book are short and powerful, written with the greatest economy. Powys’ philosophy of life (his father was a clergyman, but he had no faith himself) is summarised in one of the stories and is clearly that of a man who had looked mortality in the face:

If, if our days in the garden of the earth are in reality so uncertain, if indeed as was made clear to me then, death cannot be gainsaid, then surely the secret of so sorry and insecure an existence must lie in detachment, for he who would lose his heart to a life so beset with tragedy had best have a care for his wits.

I suppose, when you come to think of it, that this is a little analogous to the doctor’s attitude to the human suffering with which he inevitably comes into contact. The introduction to this volume, which was written by Edward Shanks, says:

From these stories sensitive reader is not to expect anything but pain. But there is a pain in the realisation of truth which is a sort of ecstasy.

The Mountebank’s Mask

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

Idling, as I so often seem to be these days, in a second-hand bookshop, I came across a book published in 1849 about Inigo Jones, the hero of a close friend of mine. One is interested in the heroes of one’s friends, and so I leafed through it. The book had once belonged to Major Inigo W Jones, Inigo’s descendent of the book’s era, to whom Van Dyck’s magnificent portrait of the great architect then still belonged.

Inigo Jones was not only a great architect but famous as a stage designer of masques, those strange and elaborate royal entertainments (costing the modern equivalent of nearly £1 million for a single night), half theatrical, half musical, wholly allegorical, that I think would probably bore us stiff, were it not that they would strike us as so bizarre. Ben Jonson wrote many but not all of them; and the text of one masque not written by him, The Mountebank’s Mask, the least boring by far, appears in this book.

This masque was once firmly attributed to John Marston (1576 – 1634), a writer of satiric plays who described his own writing as “lifting up his leg and pissing against the world,” an activity not unknown among writers to this day, and whose tomb carried the words Oblivioni sacrum. Marston’s last recorded literary act was trying to get his name removed from the title page of his own collected works. By then he had become a clergyman.

The Mountebank of the title is a quack, and the first part of the masque is taken up by some rather racy verses, and then a recitation of his prescriptions for various ills to which the flesh is heir:

If any Lady be sick of the Sullens, she knowes not where, let her
take a handfull of simples, I know not what, and use them I know
not how, applying them to the part grievde, I knowe not which, and
shee shall be well, I knowe not when.

I am not sure what the Sullens were in the early seventeenth century, but walk into any street today and you will see that they have become quite prevalent in the meantime, as have the Poutings. Mountebank, thou shouldst be living at this hour. England hath need of thee!

The Mountebank begins his address to King James and his courtiers as follows:

The greate Master of medicine. Aesculapius, preserve and prolong
the sanitie of these Royall and Princely Spectators. And if any here
present happen to be valetundinarie, the blessed finger of our
grand Master Paracelsus bee at hand for their speedie reparation.

Then the chorus breaks into song, as in an Indian film:

This powder doth preserve from fate;
This cures the Maleficiate;
Lost Maydenhead this doth restore,
And makes them Virgins as before.

Heers cure for tooth ache, feaver, lurdens,
Unlawfull and untimely burthens:
Diseases of all Sexe and Ages
This Medicine cures or els asswages.

I have receipts to cure the gowtye,
To keepe poxe in, or thrust them owte;
To coole hot bloods, cold bloods to warme.
Shall doe you good, if noe good, no harme.

The Mountebank takes up the song:

Is any deffe? Is any blinde?
Is any bound, or loose behind?
Is any fowle, that would be faire?
Would any Lady change her haire?
Does any dreame? Does any walke,
Or in his sleepe affrighted talke?
I come to cure what ere you feele,
Within, without, from head to heele.

The desire for a pill for every ill, then, is not new.

Sax Rohmer and Dr Fu Manchu

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

In the extensive annals of published drivel, the name of Sax Rohmer stands high – or low. His real name was a somewhat less propitious one for a writer of pulp novels, Arthur Ward, and he was born and raised in Birmingham, though he lived much of his life (1866 – 1959) in New York. One may not always be able to tell a book by its cover, but one can often tell the kind of writing by a pseudonym.

Both Rohmer’s narrator and his hero, if hero is the word for supposedly the most evil man in the world if not in history, were doctors. The narrator is Dr Petrie and the hero is Dr Fu Manchu. The former is a general practitioner with a very small practice, the latter a shadowy figure of brilliant intellect who is intent upon taking over the world on behalf of China. Dr Petrie’s practice is small because he is constantly scurrying about assisting Nayland Smith, an upper-class Englishman charged by the Secret Service with frustrating the plans and plots of Dr Fu Manchu. Petrie takes notes of Smith’s activities à la Watson for later publication; indeed, so close are the parallels between Petrie and Watson, Nayland Smith and Sherlock Holmes (Nayland Smith is tall, clever, ascetic and smokes a pipe), and Dr Fu Manchu and Professor Moriarty, that it is hard not to believe that Sax Rohmer did not intend his books as a spoof on Conan Doyle’s.

I regret to say, though, that Rohmer was in earnest, and he intended his books to be exciting rather than funny. But whereas Conan Doyle (a doctor) was a genius, Rohmer (a journalist) was a mediocrity, albeit one who for decades was very successful. My edition of The Devil Doctor, for example, subtitled Hitherto Unpublished Adventures in the Career of the Mysterious Dr. Fu-Manchu, was the seventeenth in as many years.

Dr Fu Manchu’s medical accomplishments were unconventional, indeed one might call him a practitioner of alternative medicine. His therapeutic armamentarium included obedient and well-trained Australian death adders, equally well-trained and obedient poisonous scorpions and centipedes, and immensely strong and malicious Ethiopian baboons. In his temporary laboratory in Museum Street, WC1, he manages to extract a gaseous anaesthetic from the common puffball. He also performs what sounds like genetic modification on various dangerous organisms that might later come in handy for him.

But though possessed not only of these weapons but of ferocious cunning and ruthlessness, his skull being so high-domed that it must contain a great brain, he seems quite unable to kill the rather hapless and bumbling Dr Petrie even when he has him in front of him, trussed up like a chicken (which he has, about every eighty pages or so). Dr Petrie always escapes at the last moment to live another, equally terrible book. For his part, Dr Petrie is unable to shoot Dr Fu Manchu even at point-blank range. It isn’t a very flattering picture of the medical profession, either from the moral or the practical aspect.

Rohmer probably influenced George Orwell, however. The idea of Room 101 in Nineteen Eighty-four, in which Winston Smith faced starving rats in a cage tied to his face, was probably derived from the scene in The Devil Doctor in which Dr Fu Manchu tries to get Dr Petrie to kill Nayland Smith with a samurai sword to prevent him from being eaten alive by Fu Manchu’s starving Cantonese rats – the most ravenous in the world, according to Fu Manchu.

At the beginning of The Living Death, Dr Petrie writes:

I believe a sense of being followed is a recognised nervous disorder; but it is one I had never experienced without finding it to be based on fact.

That, of course, is what they all say.

Shakespeare’s greatest psychopath

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

Is character destiny, as the ancient Greeks thought, or is it the other way round? Are people made, or do they make themselves? About this question there is still no universal agreement: it is the heart of our mystery, that I believe shall never be plucked out, as Hamlet put it.

Richard III is Shakespeare’s greatest psychopath. He seems to be that disconcerting character, the natural born criminal, who delights in evil. In Act IV, scene IV, his mother, the Duchess of York, says to him:

Thou cams’t on earth to make the earth my hell.
Tetchy and wayward was thy infancy,
Thy schooldays frightful, desp’rate, wild and furious;
Thy prime of manhood daring, bold, and venturous;
Thy age confirm’d, proud, subtle, sly, and bloody:
More mild, but yet more harmful, kind in hatred.

This is the perfect encapsulation of the career of the intelligent psychopath; to the end, Richard remains what he has always been, and therefore true (if that is quite the word) to type:

Conscience is but a word that cowards use,
Devis’d at first to keep the strong in awe.

This sounds distinctly Nietzschean, as does the following chilling line:

Our strong arms be our conscience, swords our law.

Nearly four hundred years before the so-called Me-Decade, Richard exclaims:

Richard loves Richard, that is, I and I.

Richard tells us that ‘All unavoided is the doom of destiny,’ yet his very opening speech suggests that he has choice in the matter of how to live. Of course, he cannot help that he was born:

Deform’d, unfinish’d, sent before my time
Into this breathing world scarce half made up –
And that so lamely and unfashionable
That dogs bark at me, as I halt by them –

But yet his villainy is freely chosen:

And therefore, since I cannot prove a lover
To entertain these fair well-spoken days,
I am determined to prove a villain,
And hate the idle pleasures of these days.

Well, you might say, that is only too understandable in his circumstances; and yet, in the play, Richard, despite the fact that he has:

No delight to pass away the time,
Unless to spy my shadow in the sun,
And descant on mine own deformity…

…he proves, in fact, an ardent and successful wooer of women. He seduces not one, but two, women whose husbands or children he has killed. After he has seduced Anne, he exults with all the pride of his evil:

Was ever woman in this humour wooed?
Was ever woman in this humour won?

Before dismissing this as preposterous caricature, it is worth recalling that serial killers of woman seldom lack for declarations of love or offers of marriage immediately afterwards. The same is not true of serial burglars.

Shakespeare gets an astonishing number of things right, but some things change nevertheless, for example forensic science. When Richard is in the presence of the corpse of Henry VI, whom he stabbed to death, the wounds open up and begin to bleed anew, indicating that the murderer is near. Now, of course, we have DNA, to say nothing of the polygraph machine. Richard III wouldn’t get away with it today – or would he?

On Mistress Quickly’s Description of Falstaff’s Death

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

When people speak of Shakespeare’s clinical acuity, the first exhibit is usually Mistress Quickly’s description of Falstaff’s death in Henry V. The very fact that Shakespeare puts so moving and sensitive a speech in the mouth of the hostess of a pub, The Boar’s Head, which is a den of persons of ill-repute, and whose very name is redolent of a certain sexual looseness, is testimony to the broadness of Shakespeare’s sympathies, his human understanding, his heartfelt rather than merely doctrinal tolerance.

The speech in its universally accepted form goes (in part) as follows:

A’ made a finer end and went away an I had been any Christom child; a’ parted even just between twelve and one, even at the turning o’ the tide: for after I saw him fumble with flowers and smile upon his fingers’ ends, I knew there was but one way; for his nose was as sharp as a pen, and a’ babbled of green fields.

I suppose this description will be familiar to any doctor who has attended a delirious patient; and in 1985, Dr Abraham Verghese, the celebrated physician and writer, published an article in which he said that Mistress Quickly’s depiction of Falstaff’s death was quite probably that of “the muttering delirium” of typhoid fever. Certainly such delirium is common in patients with typhoid: in one series of 959 successive cases 57 per cent displayed it.

But the symptomatology of Falstaff’s death is not pathognomonic of typhoid, for we have all seen delirious patients “fumble at flowers and smile at their fingers’ ends,” and “babble of green fields” from causes other than typhoid. And, interestingly, one of the symptoms in the description, the babbling of green fields, was the result of an emendation of the first printed text. The words “a’ babbled of green fields” might, or might not, have been Shakespeare’s.

The orginal text read “for his nose was as sharp as a pen, and a’ table of greene fields,” which hardly makes sense; it was Lewis Theobald (1688 – 1744), one of the first great Shakespeare scholars, who suggested the emendation which most people accept as inspired (seldom has a man’s lasting literary fame, or at least reputation, rested so importantly on a single word). And in the first edition of Theobald’s edition of Shakespeare, the emendation appears as “a’ babled of green fields.” The extra letter ‘b’ is a later accretion.

Theobald scored more than one hit in his numerous emendations of the texts that came down from the sixteenth and seventeenth centuries, but it is by “a’ babbled of green fields” that he is remembered. One of the methods he used was to imagine the text in Shakespeare’s sixteenth century handwriting and then imagine the errors that the compositors might have made in transferring what he had written to printers’ type.

I suspect (and hope) that Theobald was right, for his speculative version was inspired, but we will never know for certain. There is another interesting point, however. Mistress Quickly’s description, even without the emendation, is wonderfully accurate as well as sympathetic; and when she says “I knew there was no other way [except towards death],” she implies an intimate acquaintance with the process of dying. And since Shakespeare was nothing if not a very close observer of the world around him, and a realist, it must be supposed that the Mistresses Quickly of the time knew death as few people other than doctors and nurses know it nowadays. Knowledge, especially by acquaintance, can be lost as well as gained.