Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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 1960, John Havard, later secretary of the BMA, published his book The Detection of Secret Homicide, and in 1962 Anthony Burgess published his fictional depiction of gratuitous adolescent violence, The Clockwork Orange. Pamela Hansford Johnson (1912 – 1981) combined the two themes in her novel An Error of Judgement, also published in 1962.
The main character of her novel, though not the narrator, is Dr William Setter, a Harley Street specialist whom the narrator consults over simultaneous pain in his right shoulder and the back of his left knee. Setter tells him he could have a cardiograph if he wanted, but that this would be a waste of everybody’s time. Having paid his four guineas, the patient-narrator is reassured and feels better. Payment is a wonderful placebo.
Setter and the narrator become friends, or at least social acquaintances. This was in the days when middle-class women still wore hats when leaving the house and people had to behave badly, or pretend to behave badly, to get a divorce.
Setter is an odd man who starts a club in Soho where he acts in a Mephistophelean manner to bring strangely assorted people together in a discussion group. For some reason not explained, he decides to give up medicine in the middle of his successful career, which was certain to have ended in a knighthood, and do nothing much; but he continues to prescribe for selected people.
The book casts an interesting light on the prescribing habits of the time. When the narrator’s mother-in-law, who lives with the narrator and his wife, dies unexpectedly, Dr Setter prescribes Dexedrine for the narrator’s wife to help her get over her grief quicker than the Diagnostic and Statistical Manual of the American Psychiatric Association can say depression.
More importantly (for the plot), Dr Setter prescribes phenobarbitone three times a day for a young man called Sammy Underwood who has joined his discussion group and who, by the rather tame standards of the time, is something of a rebel. No reason is given for this prescription, but presumably it is to quieten him down, for Sammy is not epileptic. He comes from Clapham, from a respectable working class home, and his bad language would now strike us as almost ladylike in its gentility. Intelligent but badly educated, he has some slight intellectual pretensions; but Dr Setter suspects him of being responsible for the kicking to death of an old inebriate woman in Clapham, as yet unsolved by the police. Sammy is indeed guilty and confesses to Dr Setter, who comes to the conclusion that Sammy is so lacking in remorse, contrition and conscience that he is likely to do it again. And so, for the public good and also because he has always enjoyed inflicting harm (it is one of his reasons for having gone into medicine in the first place), Dr Setter decides to kill him, but subtly.
Sammy complains of insomnia and Dr Setter suggests that he ask his own doctor for some sodium amytal to help. He then suggests a small bottle of brandy to be taken with the pills just to make sure he gets a good night’s sleep, though with the stern warning that Sammy should take no more, absolutely no more, than four fifths of the bottle. Next morning, of course, Sammy is dead.
Setter is never brought to book and disappears. His secret homicide goes undetected. Was – is – this social realism?
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