Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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 writer Anna Kavan (1901 – 1969) was a heroin addict for most of her adult life. She was born Helen Woods and published six novels under her married name of Helen Ferguson before changing her name by deed poll to Anna Kavan. The choice of surname was odd, since she had used it in one of her novels to depict her husband as a drunken, sadistic, violent brute.

For many years she was dependent on Dr Karl Theodore Bluth, a psychiatrist who had been an exile from Nazi Germany and came to live in England. She found in him a soul-mate, and it was he who supplied her, legally, with her heroin, sometimes injecting her with it. Dr Bluth was himself a writer, having published essays in the highly-literary magazine, Horizon, edited by Cyril Connolly, and a book on the philosophy of Leibnitz. Of their relationship Kavan wrote (in fictional form):

Their relationship had not been clearly defined. It had seemed to achieve itself spontaneously, without effort on either side, and with no preliminary doubts or misunderstandings. To her it was both inevitable and invested with dreamlike wonder that, among all the earth’s teeming millions, she should have met the one being complementary to herself.

Clearly not the usual doctor-patient relationship, then; and when he died, in 1964 (there was an obituary in The Times), her behaviour became increasingly erratic and she described herself as waiting to die.

Her best book, probably, was the first written under her new name, Asylum Piece, which was published in 1940. It is a series of thematically connected short stories, very sparely written, and some have compared it with Kafka, whom she had almost certainly by this stage read.

The stories are told in the first person by someone who is either paranoid or very nearly so. The characters appear mostly under an initial, R or H or D. This in itself lends the atmosphere something mysterious and sinister; in the story Machines in the Head she is woken early in the morning by the sound of distant machinery of the reality of whose existence we are never quite certain, but which seem directed at her.

In The Enemy, she describes the atmosphere of hostility by which she believes she is surrounded. The story opens in a way reminiscent of Kafka:

Somewhere in the world I have an implacable enemy although I do not know his name. I do not know what he looks like, either. In fact. If he were to walk into the room at this moment, while I am writing, I wouldn’t be any the wiser.

All she knows is that he exists and in the end will come for her in a white coat, take her away and inject her with tranquillisers.

In fact, she had been in and out of private sanatoria, and in the story Asylum Piece she describes what she witnessed. The asylum is “a charming eighteenth-century house” by a Swiss lake on the French border. It was in the days of authority rather than of evidence-based medicine; the “chief doctor” arbitrarily forbids the mother of a patient from visiting her, and when the patient discovers that her mother has come to the asylum without seeing her, an omission that she ascribes to her mother’s wishes, she runs far out into the grounds:

Her heart breaks, she clutches handfuls of the sharp pine needles which pierce her flesh, while from between her thick lips, smeared with saliva and rouge, issues a desolate keening that soon leads her pursuers in the right direction.

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.

Eric Ambler (1909 – 1998) was a master of English prose, underestimated perhaps because of the genre in which he wrote: the spy thriller. He did not regard popularity and intelligence as antithetical, and his success proved that he was right. Here, for example, is the opening sentence of his book, Judgment on Deltchev, published in 1951:

Where treason to the state is defined simply as opposition to the government in power, the political leader convicted of it will not necessarily lose credit with the people.

An academic political scientist of today would make heavy weather of such a thought.

The protagonist of Doctor Frigo (1974) is Dr Ernesto Castillo, the son of an assassinated Central American social-democratic politician, who studied medicine in Paris and practices on a fictional French Antillean island. He is known as Dr Frigo because he is, outwardly at least, a cold and unemotional person, and frigo is colloquial French for refrigerator. Against his will, for he has no interest in politics, he becomes involved in a plot to mount a coup in his homeland against a corrupt junta: and he is useful to the plotters for two reasons. First he bears the name of his father, who was, retrospectively at least, very popular; and second he is a Spanish-speaking doctor on the French island where the head of the plot, and future president, Manuel Villegas has taken refuge but falls ill.

Behind the coup is a shadowy group of people interested in the offshore oil that has been found in the country’s territorial waters. Among them is a man called Rosier, supposedly an insurance underwriter, who tries to recruit Dr Frigo as medical assessor for Villegas, whose life an oil consortium wants to insure for $50 million. Rosier tries to explain the principles of insurance to Frigo by reference to a woman’s fur coat that might be stolen, damaged by moths if not stored properly, or lost in a fire. Dr Frigo says to him:

“You must know a lot about fur coats.”

Rosier replies:

“Me, Doctor. Not a thing. The equity I’m concerned with is life.”

“Then,” says Frigo, “you must know a lot about life.”

To which Rosier, giving him a coy look, replies:

“More about the other thing, really.”

This is beautiful, witty and intelligent dialogue. I have read a lot worse in novels deemed to be masterpieces.

Villegas begins to suffer from tiredness and finds that, after a few minutes of talking, he has difficulty in pronouncing consonants. Dr Frigo diagnoses amyotrophic lateral sclerosis and gives an account of the disease that could have come out of Brain’s Diseases of the Nervous System. But in those days it was not customary to tell patients that they were fatally ill right up until the last five minutes of their life; besides, Villegas has to be kept going until he can return to his country as the new president.

Dr Frigo, who is charged with looking after him, discovers that Villegas, far from having been an ally of his father, is the one responsible for having assassinated him. He decides to take no revenge because Villegas will soon die anyway, and he is torn between rage at and pity for the man. But Villegas is soon assassinated in the same way as Dr Frigo’s father, by a man who is supposedly a political ally.

Apart from the ruthlessness of politicians, the moral of the story, if there is one, is that if you are not interested in politics, politics will sooner or later be interested in you.

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.

From time to time I am asked to a weekend intellectual conversazione in a beautiful country house, where I confess that my first thought is not for the topic under discussion but that the house would make a wonderful setting for a crime novel. By the time each of the participants has spoken he has given all the others a motive to kill him, and so the conditions are just right.

The murder weapon has to be poison, of course, for as Professor Glaister put it at the beginning of his book, The Power of Poison, published in 1954, “Murder by poison is a crime of devilish wickedness and inhumanity which no language can adequately describe,” and is therefore entirely and uniquely appropriate for intellectuals to commit.

I prefer old-fashioned murder books to modern ones because they are really fairy stories or comedies of manners rather than works of gritty social realism: and where murder is concerned, I have had, in my professional life, quite enough of gritty social reality.

One of the last practitioners of the old-fashioned English comedy of manners type murder-stories is Robert Barnard. His Little Victims of 1983 takes place in a seventh-rate and down-at-heel private school for the boys of local parents who do not want to send their children to the local comprehensive but cannot afford anything better, run by the pedantic, pompous, ignorant, small-minded, snobbish, avaricious but splendidly named Edwin Crumwallis and his even more mean-spirited and cheese-paring wife, Enid, who acts as matron and doles out medicine to the boys on the following medical principles, enunciated to the detectives who are investigating the death by poison of one of the boys at the school:

Cold tea and aniseed! I put it in old bottles. Mostly these boys are putting it on, you know, or just imagining things. The cold tea does as good as anything, and the aniseed makes it taste nasty, as they expect. It’s well known people take too much medicine. Did you know that when doctors go on strike the death rate always goes down? People these days are just soft, running along for a packet of pills every time they think they’ve got an ache.

The dead boy is called Hilary Frome, son of the local general practitioner, a man greatly respected even though there are rumours of two bad diagnoses he made, or failed to make, some years before. Young Hilary, handsome, intelligent and charming, and destined by his father for the medical profession, is, alas, a psychopath who foments trouble wherever possible and, for reasons too complicated here to go into, decides to poison his young acolyte, disciple and admirer at the school, a boy called Malcolm Pickerage. Unfortunately for young Hilary, he accidentally takes the poison destined for Malcolm and dies.

The poison in question is aconite, to which Hilary is said to have had access through his father. But why would a general practitioner in 1983 have had aconite, or anything containing aconitine, about his person? However, it is important when reading comedies of manners or fairy tales to suspend disbelief and not to be too literal-minded. Who can resist a character such as Enid Crumwallis, whose first thought on finding broken glass in the school’s shepherd’s pie is the terrible waste to which it will lead?

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.

One of the most absurd, as well as potentially sinister, definitions known to me is that of health according to the World Health Organisation: a state not merely of the absence of illness, but of the actual presence of complete physical, mental and social well-being. I have only to re-read it for my own complete mental well-being, and therefore my health, to break down.

The young German novelist, Juli Zeh (born 1974), spotted the totalitarian implications of this definition and used it as the opening sentence of her dystopian novel, The Method, recently published in English.

In the new state imagined by Zeh, existing some time in the middle of this century, health as defined by the WHO has become the ideology of the state – all other ideologies, religious, social, political and economic having failed miserably. Like many dogs today, citizens of the new state are implanted with a chip under their skin; they are obliged, under pain of prosecution, constantly to monitor their blood pressure and biochemical parameters. They are not permitted to stray beyond the limits of areas that have been bacteriologically sanitised, and if they do so they are punished. The death penalty having been abolished, the worst penalty to which they are subject is the vita minima, the minimal life, which is a state of suspended animation under freezing conditions.

The protagonist of the book, Mia, a bacteriologist, is in rebellion against the supposedly beneficent dispensation that is called simply The Method. There is no leader of, no personality cult in, The Method; but it is opposed by a shadowy, and probably fictitious, terrorist organisation called the PRI, the People’s Right to Illness, of which she is eventually accused of being a member.

The Method’s ideological justification is succinctly summarised at Mia’s first trial for having consumed illicit substances such as caffeine and tobacco, and for not having turned in her regular blood pressure and biochemical results. The judge asks her:

What would happen if you fell ill?

To which Mia answers:

I’d see a doctor.

The judge then asks:

Who would pay for the doctor?

Mia replies that she would pay, but the judge then asks whether, if she could not do so, society would let her die. The answer, of course, is No, though Mia is silent; and the judge then says:

Good sense dictates that society should look after your health in times of need. By the same token, the onus is on you to ensure such circumstances do not arise.

This gives The Method the locus standi to interfere in absolutely everything, to make claims to a right of surveillance that even the most totalitarian regimes hitherto have not made. And all supposedly (and plausibly) in everyone’s best interest, that of his health.

The book makes uncomfortable reading for doctors who are apt to suppose that their own goal, the health of the population in general and that of their patients in particular, is the highest ethical goal possible, and that everything else should be subordinate to it. Juli Zeh’s book is a reduction ad absurdum of public health as the highest good. I suppose the question her book raises is one of the nature of slippery slopes: must every slippery slope be slid down to the bottom, or is it possible for humanity to call a halt when it has slid down far enough?

Opinions differ.

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 first doctor ever to be revalidated was Simon Forman (1552 – 1611), in 1603. It was in that year that Cambridge granted him an MD though he had never studied there. Until then he had been arrested and imprisoned many times for having practised in London without a licence. However, his mixture of astrology and herbalism became popular among the powerful and well-connected, who prevailed upon the university to grant him a degree. He was never molested by the authorities thereafter.

Among his patients was Mrs Turner, who consulted him in order to obtain a philtre for her employer, the Countess of Essex, such that the Earl of Essex would fall out of love with her. She could then divorce him and marry Robert Carr, Earl of Somerset and lover of James I (which she duly did). Mrs Turner and the Countess of Somerset then poisoned Sir Thomas Overbury, who had been against the marriage, possibly using the pharmacological advice of Forman who, however, was by then dead. Mrs Turner was hanged, but the Countess was pardoned.

The famous, learned, productive, irascible and arrogant historian, A. L. Rowse, wrote a book about Forman, whose papers contain the first references to some of Shakespeare’s plays, including Macbeth. Rowse believed, using these papers, that he had identified the Dark Lady of Shakespeare’s Sonnets.

In an essay titled Simon Forman and the Dark Lady, published in 1975, Rouse has this to say:

There is a fairly full account of Forman in the Dictionary of National Biography; but he is treated there as a quack and a charlatan. In Shakespeare’s time everybody believed, more or less, in astrology; certainly Forman did, and he was a very successful practitioner.

Quackery is usually defined as the ignorant or fraudulent pretension to medical skill that is not actually possessed. A recent medical writer on the subject wrote that quackery is “the promotion of unsubstantiated methods that lack a scientifically plausible rationale”, so that a quack would be a person who promoted such methods.

Objectively, then, Forman was a quack; and the fact that everyone of his time believed what he believed is neither here nor there. Indeed, for quacks to be successful they must persuade a substantial number of others that they possess knowledge; nor is it a necessary condition for quacks to be fraudulent, that is to say to know that what they are saying and doing is without reasonable foundation. According to most definitions of quack, then, it is the Dictionary of National Biography (whose entry was written by Sir Sidney Lee, the greatest Shakespearean scholar of the late Victorian era) and not Rouse who was right. This is ironic, because at the end of his career Rouse accused practically everyone who had ever taken a different view of things from his own of being “third-rate.” He almost alone was first-rate.

In fact for a fastidious scholar Rouse was rather loose in his use of terms such as psychotic and paranoia.

Forman was a bit of a psychotic type… So he developed signs of paranoia too – but that gave him a sharper understanding of human beings in general.

Referring to an unfavourable review of one of his books about Shakespeare, Rouse wrote of the reviewer:

He had never written a book himself and so was possessed with envy of those who can and do. This was all too boringly recognisable – one can smell it a mile off…

As one can smell paranoia querulans a mile off.

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 only important politician whom I have ever treated was the vice-president of a small country who complained of having difficulty in reading state papers after lunch. I advised him not to take three or four beers with his repast, as was his habit, and the problem was solved. Whether the country benefited from this radical cure, I cannot say. Superficially, at any rate, things went on much as they had before.

The diseases of the powerful are a perpetually interesting subject, combining as they do the pleasures of historical understanding with those of prurience. In 1969 and 1980, Dr Hugh L’Etang, editor of The Practitioner, published two books on the subject, titled The Pathology of Leadership and Fit to Lead? respectively. The point at which the search for power itself becomes pathological is inherently uncertain; but no doubt every senior hospital doctor will have his own opinion or experience of the matter.

In 2008, David Owen, a doctor and practising politician, published a book, In Sickness and in Power, in which he proposed a new syndrome, the Hubris Syndrome. No doubt he had seen it close up: a man or woman in power for so long that he or she loses contact with reality and any sense of personal fallibility. A medical case is graphically described in The Dismissal: The Last Days of Ferdinand Sauerbruch, Surgeon by Jűrgen Thorwald. Sauerbruch, a brilliant but arrogant surgeon, began to dement and did not realise his own powers were declining; persisted in operating, though he started to kill patients. He did this with the complaisance of the authorities because, after the war, the East Germans were pleased, for reasons of propaganda, that he continued to work in Berlin; Thorwald’s book contains one of the most chilling epigraphs imaginable, quoting Dr Josef Naas, the Administrative Director of the East German Academy of Sciences:

In the coming struggle of the proletariat, in the clash between socialism and capitalism, millions will lose their lives. In the face of this fact it is a trivial matter whether Sauerbruch kills a few dozen people on his operating table. We need the name of Sauerbruch.

Recently I read a book about the illnesses of the Presidents of the Fifth Republic of France, The Last Taboo: Revelations about the Health of the Presidents by two journalists, Denis Demonpion and Laurent Léger. It seems that being president is not very good for the health, and perhaps not even very good for the health care the presidents receive. For example, when Sarkozy fainted while jogging, an argument broke out about how to transport him to hospital. Someone was of the opinion that, as he was President, the least they could do was take him by helicopter, even if ambulance was quicker. Importance has its drawbacks as well as its prerogatives.

Mitterand, who survived practically his entire presidency of 14 years with secondaries from prostate cancer (latterly unable to fulfil many of his duties) resorted to quacks, though he never abjured orthodox medicine. As usual, alternative medicine was additional rather than truly alternative.

In de Gaulle’s day, the medical establishment surrounding the president was much more modest: a couple of inexperienced housemen constantly on call for him. At one point, however, de Gaulle travelled everywhere with a portable ventilator. Some curare had gone missing from a hospital, and the security service feared an assassination attempt with curare-tipped arrows. How glad I am not to be powerful!

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.

Jean Reverzy (1914 – 1959) was a general practitioner in Lyon whose first book, Le Passage (translated into English as The Crossing), was published in 1954. It was a best-seller, my copy from the year of its publication saying on the cover that it was one of the first forty-thousand printed, and it won the Prix Renaudot. Reverzy was a very good writer whose work, however, was largely forgotten until republished in a single volume in 2002. Literary neglect is not necessarily the consequence of absence of worth, however: which is the hope, or excuse, of all failed scribblers.

The narrator of Le Passage is a general practitioner in Lyon, and its protagonist is Palabaud, a Frenchman who returns home to his native Lyon from the South Seas, where he has kept a small hotel, to die. Though not a drinker, he suffers from cirrhosis; his illness starts with what sounds like hepatitis – sudden loss of appetite, nausea at the presence of smells – but there is no indication of how he might have caught the variety that could have progressed to cirrhosis.

Death, its meaning and how to meet it, was an important subject for Reverzy. He wrote in a letter, “If you want to write, learn to die.” His father had been killed in the First World War when he was one year old, and shortly before he wrote the book Reverzy suffered a prolonged attack of anxiety with the apprehension (correct as it turned out) that his own life would be a short one. He went on a journey to Tahiti for several months, and wrote the book on his return.

The Passage is not only that of Palabaud’s from France to Tahiti and back again, but that of all of us from life to death. Reverzy captures much in this comparatively short book with great sensitivity and exquisite simplicity. There are also moments of comedy, if of the somewhat painful variety. Here Palabaud is visited on his deathbed by his landlord and landlady who not long before had suspected him, on no grounds at all, of being a criminal on the run, and are now doubly embarrassed in the face of death:

“You’re not any worse?”
“You’ve got a very nice room…”
“I never knew that hospitals were so comfortable…”
“You have a nice view of the hill…”
“They’re doing a lot of building over there.”

Palabaud is the patient of Professor Joberton, one of the “great” doctors of Lyon whose reputation is in excess of his actual accomplishment. He arrives in Palabaud’s room with an entourage of acolytes, and examines him summarily. He and the entourage leave the room and Palabaud can hear him say to them outside:

I have there a patient in such a condition that I hope that none of you will disturb him. Let us leave him to die in peace. He arrived from the other end of the world, from Haiti. The diagnosis presents no great difficulty, it is a cirrhosis in the terminal phase. What is worthy of note and reflection is the deep decay of the patient that you no doubt noticed from the door, which is much greater than mere cachexia…

As it happens, I once returned from the South Seas with an enlarged liver, about 30 years after the publication of Le Passage. The professor entered my hospital room with a large entourage and started to talk of the prognosis of the illness of the Nigerian in the bed opposite mine, first saying to the patient, “Now don’t you listen to any of this.”

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.

Doctors in fiction tend, like those who appear in contemporary newspapers, to be heroes or villains; but Dr Edward Rider, in Margaret Oliphant’s novella, The Doctor’s Family, is neither. He is good, but not very good; his very defects are those of weakness rather than of malice. If I had to use a single word to describe his character, it would be wet.

Dr Rider has an older brother, Fred, who was also a doctor and who, at least according to himself, was much more talented than Edward, whose paltry practice in the little town of Carlingford he despises. If he had not given himself up to drink and parasitising his brother, his own career would have been, in his estimate, very much more spectacular than Edward’s; as it is, he ends up falling drunk into a local canal and drowning, mourned by no one.

Margaret Oliphant (1828 – 1897) actually had a brother very like Fred Rider, but he was a clergyman rather than a doctor. His drinking became incompatible with his preaching and he was forced to resign. Thereafter he was supported by his sister in a sluggish life of alcoholism and reading novels, though he did manage to pass off at least four books of his sister’s as his own. Perhaps coincidentally Mrs Oliphant, a prodigiously productive writer, had two sons of the same feckless disposition.

Among Dr Edward Rider’s purely medical shortcomings is an inability to distance himself from his own emotional state. When finally he finds a bride he is so happy that:

Those patients who had paid for Dr Rider’s disappointments in many a violent prescription, got compensation today in honeyed draughts and hopeful prognostications.

No doctor nowadays, of course, treats a patient according to which side of the bed he gets out of. We maintain our scientific objectivity in all circumstances.

The Doctor’s Family was published in 1861 and, together with some other stories of the fictional town of Carlingford, made Mrs Oliphant popular for a time. A story published in the same year about Carlingford, called The Rector, is perhaps of even more medical interest than The Doctor’s Family, though it concerns a rector rather than a doctor.

Morely Proctor has spent many years as a Fellow of All Souls’, Oxford, producing dry-as-dust studies of ancient Greek verbs, but for family reasons decides to take the rectorship of Carlingford. Having spent his entire adult life among bachelor male academics, he is intimidated by the normal society of men and women; and one day he happens to be passing a house in which a woman is on the point of death. Called in to give her religious consolation, he finds he can say nothing except what she knows is not true, that perhaps she is not dying after all, and that she should call the doctor.

By happy chance, a young curate called the Reverend Wentworth, inferior in rank, seniority and education to the Reverend Proctor, happens to be passing also, and he finds at once the words to console the dying woman and ease her passing.

Are communication skills and human sympathy innate or taught? The Reverend Proctor concludes that they are the former, and that he will never be any good at them; he is happier with his Greek verbs and therefore, being a man of probity, resigns his rectorship to go back to All Souls. These days, of course, no dean of any medical school would dare to agree with him.

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.

Patrick Kavanagh (1904 – 1967) was an Irish poet who rejected with contumely Eamon de Valera’s vision of a perpetually rural Ireland inhabited by a simple, religious, wise, self-sufficient and contented peasantry. Kavanagh had the inestimable advantage of knowing what he was talking about, having been brought up and worked in the countryside of County Monaghan. This was more than enough to destroy any inclination to the utopian rural longings that come so easily to the minds of urban intellectuals, and in his longest poem, said to be his masterpiece, The Great Hunger, Kavanagh describes compassionately but without sentimentality the life of Paddy Maguire, an unmarried peasant who toils all his life on a few stony acres. It is an emotionally stunted, permanently frustrated, aesthetically ugly, life that he leads, with no compensations whatever. The poem, published in 1942, made Kavanagh briefly the object of police attention.

Maguire’s mother is the main figure in his life. She survives until the age of ninety-one, by which time Maguire is well past the marrying age. Kavanagh describes her death:

The mother sickened and stayed in bed all day,
Her head hardly dented the pillow, so light and thin it had worn,
But still she enquired after the household affairs…

She dies with thoughts of calves and chickens on her mind, and when Maguire himself dies, Kavanagh speaks of:

…the apocalypse of clay
In every corner of this land.

A few years later, across the water in Wales, the poet and clergyman, R S Thomas, wrote of the death of a hill farmer:

You remember Davies? He died, you know,
With his face to the wall, as the manner is
Of the poor peasant in his stone croft
On the Welsh hills.

Davies dies…

Lonely as an ewe that is sick to lamb
In the hard weather of mid-March

In 1955, Kavanagh underwent an operation for lung cancer, surviving it by 12 years. His close brush with death gave him an appreciation of the joys of the quotidian, even the ugly quotidian, as being the meaning of life. In The Hospital (1956) he writes:

A year ago I fell in love with a functional ward
Of a chest hospital: square cubicles in a row
Plain concrete, was basins – an art lover’s woe,
Not counting how the fellow in the next bed snored.
But nothing is by love debarred,
The common and the banal her heat can know.

Thenceforth Kavanagh has what might be called a mystical immersion in the everyday. After his operation, convalescing, he sat by the Grand Canal in Dublin, between the Baggot and Leeson Street Bridges (an area I know well):

And everything seemed over bar the shouting
When out of the holy mouth came angelic grace
And the will that had fought had found new merit
And all sorts of beautiful things appeared in that place.

I suppose the wise man lives as if he is on day-release from death, seeing ‘all sorts of beautiful things’ wherever he might be. But man is made for wisdom as dormice are for coal-mining. Kavanagh was an alcoholic who quarrelled with almost everyone, and my best resolutions are those that are soonest broken.

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.

Literary fame is capricious: for it would not follow from the fact (if it were indeed a fact) that no bad book is remembered that no good book is forgotten. If there were literary justice in the world, the name of Peter Greave (1910 – ) would stand considerably higher than it does, but he is almost entirely forgotten.

He published two novels and a memoir of his life, The Seventh Gate. The latter, published in 1976, bears the following words on the back cover:

The Seventh Gate was written over a period of two years, after he had been totally blinded and immobilised by his illness, dictated month by long month to a series of helpers.

That illness was leprosy.

Few books capture the joys and miseries of human life more strongly than this memoir. Greave was born in India to a father with a large and expansive personality, an infinite capacity to delude himself and others about business schemes that varied from the merely fantastic to the outright fraudulent, and an unfortunate propensity for sexual exhibitionism. He would disappear for long periods, deserting his family and then re-appear unexpectedly. His mother, who died when Peter Greave was sixteen, was utterly devoted to her husband even though he proved himself unworthy of her over and over. Greave conveys this tragic relationship with a reticence that makes the tragedy of it all the more vivid.

So irresponsible was Greave senior that his son spent time in orphanages and in various down-at-heel and cruel boarding schools in the India of the Raj. His escape from one of them reads like an adventure story, combining exotic romance with many thrills. His education was spotty, interrupted and short; his subsequent life in India, going from one absurd job to another, was rackety, unstable and precarious, and yet he was happy.

He first noticed his leprosy (without knowing what it was) in 1938. When he looked one day in the mirror “about an inch and a half above my right eyebrow a small reddish lump was visible.” 28 years old at the time, he disregarded it: “My body, my physical well-being, was the one thing that had never failed me yet, and I possessed the illogical conviction that it never would do so.” By coincidence, I was 28 when, on precisely the same grounds, I disregarded an illness that could have killed me.

A year later, a third doctor whom he consulted finally diagnosed leprosy; and “some time in 1942,” when he was living in a rented room in Calcutta, “I lost the sight of my right eye, and almost immediately the other eye became severely infected.” He continues:

I suffered weeks of excruciating pain, wincing uncontrollably whenever the pupil was exposed to light. Eventually even the flicker of a match as I attempted to light a cigarette produced a second of pure agony, forcing me to duck my head swiftly as though avoiding a blow.

Greave left India a few days before independence, on the (false) promise of a cure in England. He wrote his book, which is full of humour and of the joys as well as of the pains of existence, a quarter of a century later, and is testimony to the indomitability of the human spirit. It deserves to be much more widely known.