Category Archives: Essays

The Latin Grammar of Pharmacy by Joseph Ince

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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

Time was, not so very long ago, when medical students were expected to know Latin: indeed it was, if I may coin a phrase, a sine qua non (or what a doctor friend’s doctor father used to call a without-which-not) of becoming one.

I discovered just how much Latin medical students were once expected to know when I looked into The Latin Grammar of Pharmacy, 8th edition (and 10th thousand), 1903, by Joseph Ince, Lecturer in Pharmacy to the Pharmaceutical Society of Great Britain. The preface, written from the author’s home, Number 13, Alfred Road, Acton, takes the need for such knowledge for granted, since it does not explain it; and the author later points out that “a classical education alone will not prove sufficient to master the purely technical details involved in deciphering medical formulae.”

Here, for example, is a directive that a doctor is supposed to make to a pharmacist for a charcoal poultice:

Panem prope ignum macera in aqua horae sextam partem dein misce, lini farina gradatim addens inter agitationem ut fiat ctaplasma molle. Cataplasmate carbonis dimidium imsisce et reliquum supra consperge.

Macerate the bread in the water for ten minutes near the fire, then mix and add the linseed meal gradually, stirring the ingredients, that a soft poultice may be formed. Mix this with half the charcoal, and sprinkle the remainder on the surface of the poultice.

Or:

Ne nimis amarum sit dentifricium.

Let not the tooth powder be too bitter.

Or:

Panni linnei solutione madefacti applicanda.

Let woollen cloths moistened in the solution be laid on.

There are exercises in the book for translation into Latin, which unintentionally give us an insight into the medicine that was practised in 1903:

A blister of Spanish Fly to be placed on the region of the stomach (epigastric) for ten minutes, unless there is too much pain.

Or:

Mix, and make an ointment, of which let a piece the size of a nutmeg be rubbed on the painful forehead night and morning until pustule break forth.

(The ointment, incidentally, was to be made of tartrate of antimony and spermaceti from sperm whales).

Or again:

Mix, and make a solution to be applied to the painful part by means of a camel’s-hair pencil.

Oddly enough, the few Latin abbreviations that we still use in prescribing do not appear in the list that the book supplies. Which among us knows what V.O.S. or Donec alv. bene. respond. once meant (vitello ovi solutus, dissolved in yolk of egg, donec alvus bene responderit, until the bowels have been well opened)?

One may wonder why the use of Latin persisted so long. Perhaps in the absence of a real ability to make a difference to outcomes, impressiveness was the most important medicine of all. Certainly Sit emplastrum fuscum; vetustum recenti praeferendum is more impressive than Let the plaster be brownish-yellow; the old is to be preferred to the fresh-made.

The use of arcane language, such that all who hear may not understand, is a permanent temptation of those whose claims to special knowledge or skill are ill-founded, doubtful or insecure. Who, reading a circular emanating from management, has not wondered why the matter contained in it is not put more simply? The fact is that we must always take what management says cum grano salis.

Royal Burdens

This review of the Netflix series The Crown briefly reverses the view toward the viewers themselves…

…what human beings set up as the dream of perfection they want also to pull down to their own level. We exalt only to humiliate; pedestals are erected to be stood on by feet of clay. Our gods and goddesses live on an Olympus in which sordid intrigue flourishes, ambition overcomes principle, and unhappiness is as much the lot of the gods as it is of lesser beings.

…and offers an important corrective to the image of the royal family that prevails, at least among us rebel colonists west of the Atlantic:

Elizabeth Alexandra Mary, who has reigned since 1953 as Elizabeth II, was thrust into the role of heir to the throne at the age of 10, and that of monarch at age 26, all without choice, consultation, or personal inclination. She was reared to be a function incarnate. Her wishes counted for nothing, except in the most trivial matters. Supremely unfree, bound to obey dictates of the government that acted in her name, Elizabeth was nonetheless grovelled to as if she were the most fearsome dictator.

Imbued with an iron sense of duty by an adored father who died at a comparatively early age,…she was obliged repeatedly to make emollient speeches and appear always to be deeply interested in the dullest of dignitaries. The highest standard of living in the world was probably insufficient recompense for the sacrifice—that of herself as an individual human being—that she had to make.

Kipling’s Ballads of Army Life

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.

Rudyard Kipling (1865 – 1936), who won the seventh Nobel Prize for literature, is generally regarded as the praise singer of imperialism; and since imperialism went out of fashion, so has his poetry. But his ballads of army life seem to me considerably more nuanced than this would suggest.

For example in the poem Loot, first published in 1890, he speaks through the voice of a private soldier who is motivated in the imperial wars in which he serves by the prospect of loot; there is no suggestion that this is either laudable or glorious.

Perhaps the Tommy loots because he is so badly paid. A retiring sergeant-major who has seen action the world over is paid a pension of a Shillin’ a Day, and the poem ends ironically:

Think what ‘e’s been,
Think what ‘e’s seen,
Think of his pension an’ –
GAWD SAVE THE QUEEN!

In the most famous of all the ballads, The Road to Mandalay, the British soldier, now returned to London, has no doubts about the superiority of the East and its inhabitants:

Tho’ I walks with fifty ‘ousemaids outer Chelsea to the Strand,
An’ they talks a lot o’ lovin’, but wot do they understand…
I’ve a neater, sweeter maiden in a cleaner, greener land!

In Danny Deever a soldier is hanged in front of the regiment for having killed a fellow soldier in an argument; it is as great a poem as The Ballad of Reading Gaol.

Among the hazards of soldiering in Kipling’s day was cholera. In The Young British Soldier, an older man gives advice to the recruits:

When the cholera comes – as it will past a doubt –
Keep out of the wet and don’t go on the shout,
For the sickness gets in as the liquor dies out,
An’ it crumples the young British soldier.

In Cholera Camp, a soldier describes the epidemic:

We’ve got the cholerer in camp — it’s worse than forty fights;
We’re dyin’ in the wilderness the same as Isrulites.
It’s before us, an’ be’ind us, an’ we cannot get away,
An’ the doctor’s just reported we’ve ten more to-day!

The sense of helplessness is conveyed in two lines:

We’ve got the cholerer in camp — we’ve got it ‘ot an’ sweet.
It ain’t no Christmas dinner, but it’s ‘elped an’ we must eat.

The only response is to strike camp and move on, but it is no use:

Since August, when it started, it’s been stickin’ to our tail,
Though they’ve ‘ad us out by marches an’ they’ve ‘ad us back by rail;
But it runs as fast as troop trains, and we cannot get away;
An’ the sick-list to the Colonel makes ten more to-day.

Kipling wrote the poem thirteen years after Koch discovered (or rediscovered) the cholera germ; are we to take it that the British army authorities took no notice of medical knowledge, or that Kipling was behind the times? In fact there was a lot of hostility towards Koch in India, as the scientific agent of German expansionism; attempts to disprove Koch’s theory continued in India until 1897.

One cannot help but recall Kipling’s general epitaph to those who died in the First World War (in which his own son was killed):

If any question why we died,
Tell them, because our fathers lied.

Not only in 1914, of course.

Beer Street, Gin Lane, and Blurred (Moral) Vision

“Potential harm to others can be alleged in practically any human action,” says Dalrymple, writing for The Library of Law and Liberty. And it increasingly is alleged, not only concerning human actions but also words, and not just regarding the public sphere but even the private. He cites this recent article in the Guardian as an example.

Read it here

Humble Pie in Short Supply

On seeing a photograph in a newspaper of a little girl at the Women’s March in Washington holding a sign that says, “I am kind, smart and important,” Dalrymple has many criticisms of a parent who would use their child in this way:

…a person who went round proclaiming, “I am important, I am important” would seem to us either pathetic, as if he were whistling in the wind of his own complete insignificance, or, if he used his supposed importance to push his way to the front of a line, say, in order to be served before everyone else, very unpleasant indeed.

All Quiet on the Western Front by Erich Maria Remarque

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 narrator of All Quiet on the Western Front, the famous, semi-autobiographical novel of the First World War by Erich Maria Remarque (1898 – 1970), states that by 1918 war had come to seem so perpetual, so inescapable a fact of existence, that it was just another cause of death, “like cancer or tuberculosis or influenza or dysentery.” As to the latter, the German soldiers were so accustomed to it by the end of the war that they thought it was not worth pulling up their trousers; and the shirt tails of their Russian prisoners of war were stained with blood.

There are several hospital scenes in the book. Near the beginning a soldier in the narrator’s company, called Kemmerich, has been wounded. His companions visit him in the clearing station where he suffers phantom limb pain:

“How’s it going, then Franz,” asks Kropp.

Kemmerich’s head drops back. “OK, I suppose. It’s just that my damned foot hurts so much.”

We glance at his bed-cover. His leg is under a wire frame, which makes the coverlet bulge upwards. I kick Müller on the shin, because he would be quite capable of telling Kemmerich what the orderly told us before we came in; Kemmerich no longer has a foot. His leg has been amputated.

Nevertheless, his life has not been saved; he is clearly dying. He is so close to death, in fact, that his companions have already forgotten what he looked like when he was healthy. Müller is interested in his excellent boots for which, unlike Müller, he no longer has a use. Müller is not callous or unprincipled; he would never dream of taking the boots if Kemmerich still had a use for them; but Müller is anxious that the ward orderlies will appropriate them first if he does not preempt them. The war strips away all superfluous refinement of feeling, turns everyone into a raw utilitarian and makes survival the highest good.

Towards the end of the book the narrator is wounded and is sent to a hospital run by Catholic nuns. He is so exasperated by the sound of their prayers that he throws a bottle at the wall and it smashes. One of the other patients owns up to this breach of discipline because he bears a certificate of head injury saying that his behaviour might become erratic and is therefore to be excused.

When patients in the hospital are certain to die they are taken to the Death Room which, however, is not large enough to contain them all. New wounded arrive constantly:

Our room gets two blinded soldiers. One of them is very young, a musician. The nurses never use knives when they feed him; he’s already grabbed one once out of the nurse’s hand. In spite of these precautions, something still happens. The sister who is feeding him one evening is called away, and leaves the plate and fork on the side table while she is gone. He gropes across for the fork, gets hold of it and rams it with all his force into his chest, then grabs a shoe and hammers on the shaft as hard as he can.

Doctors are not heroes to the narrator; “there may be good ones,” he says sceptically, but many of them simply do the military’s bidding and, as in George Grosz’s famous picture, declare the crippled and the skeletal to be A1, that is, “Fit for active service.”

How many of us have the strength to resist the pressure of authority?

A Modern Macchu Picchu

At Salisbury Review, Dalrymple writes of a building in Peru that has been favorably compared to Macchu Picchu and been deemed “the best new building in the world”, when it very clearly is not. He takes particular umbrage at the statement by one of the building’s architects that, “For us, the enjoyment of architecture is the sense of weight being borne down or supported, the feeling of moving with the forces of gravity. It’s a very primal need.”

Does anyone arrive in Venice or see the Taj Mahal for the first time and say, ‘Oh, what a wonderful sense of weight being borne down or supported’? And could anything be a primal need, of all things, that is to say a need that precedes all other needs?

Shake your head bitterly by reading this