Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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

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.

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.

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.

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?

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.

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.

Every author, I suppose, is familiar with the experience of realising the mistakes he has made the very moment that what he has written has been committed irrevocably to print. And this was so with a book of mine published in 2012 titled The Policeman and the Brothel. I had overlooked something that should have been obvious to me, at least as a possibility.

My wife, who is a doctor, was doing a locum on the island of Jersey and I went with her. Finding myself with nothing to do there for three or four months, I researched three murders that took place there between December 1845 and February 1846, the last of them of a policeman called Le Cronier by a brothel-keeper called Madame Le Gendre, and wrote a book about them. Among other things I discovered in the course of my researches that about a half of all the newspaper proprietors or editors of provincial newspapers in Britain were also vendors of patent medicines, a case of commercial synergy, since patent manufacturers were by far the largest advertisers in their newspapers. And half of the advertisements were for remedies for syphilis, ergo… well, I don’t need to point out the moral.

One of the murders was by a man called Thomas Nicolle, the scion of a respectable family. Not sober, he went to a café in St Helier late at night, there had a quarrel with the owner over the cost of two bottles of champagne previously consumed by him (six shillings), and was thrown out by the owner who followed him and knocked him down in the street. Nicolle went back to his lodgings, fetched a gun, returned to the café and shot at random through the shutters, killing a man called Simon Abraham who was having a late night game of cards there.

Nicolle was sentenced to death, but his advocate went to London to obtain a reprieve from the Home Secretary, who granted it on the grounds that Nicolle had in the past been mad. I quote now what I wrote about some of the evidence at his trial:

According to [his landlady], his behaviour appeared strange and completely inexplicable on a number of occasions. For example she had seen him beating the walls with his fists until they bled… One night he slept in a box in his room instead of on his bed. [She] had never seen him drunk, and said that he was known… as Mad Nicolle.

At the time of his madness he was learning his trade which was that of… a hatter. Obviously, he was a mad hatter, but astonishingly and mortifyingly I missed this in my book. His symptoms, which fitted no commonly-seen pattern nowadays, were those of erethism caused by mercury poisoning. H A Waldron, in an article on the Mad Hatter in the BMJ in 1983, said the psychotic symptoms of erethism were excessive timidity, diffidence, increasing shyness, a desire to remain unobserved and an explosive loss of temper when criticised.

The treatment in those days was plenty of fresh air. Nicolle’s sentence was commuted to transportation for life to Van Diemen’s Land, where he presumably got plenty of fresh air. And it might have cured him, because he does not appear in the criminal records of Van Diemen’s Land or New Zealand, where he died.

How could I possibly have overlooked so obvious a diagnosis? But of course kind readers will point out that I have overlooked something in this article too.

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.

Of late I have observed my pension fund shrink as my Heberden’s nodes have grown. I should have preferred, of course, if it had been the other way round; but there is nevertheless a certain fascination, and indeed a strange consolation, in watching the progress of pathology in oneself, if it is not too serious of course.

My nodes have given me an interest in William Heberden (1710 – 1801) who – apart from being the first to describe such nodes – wrote one of the best early descriptions of angina. When I found a little book by Austin Dobson (1840 – 1921) called Later Essays, which was published in the year of the author’s death and which contained an essay about Heberden titled An 18th Century Hippocrates, I knew I should have to buy it.

Dobson was only a spare-time litterateur, working for 45 years at the Board of Trade. His first book other than some poems was The Civil Service Handbook of English Literature, not exactly a title to set the heart racing. It is strange how many clerks in such offices were men of letters: Sir Edmund Gosse, by far the most eminent critic of his day was Dobson’s contemporary at the Board of Trade, and of course Charles Lamb worked as a clerk for the East India Company. Lamb was not an enthusiastic bureaucrat, and when his boss complained that he always arrived late at work, lamb replied, “Yes, sir, but to make up for it I always leave early.”

The Dictionary of National Biography says rather unkindly of Dobson’s writing that “his mastery of artificial rhythms was excellent, but at his lightest he lacked gaiety; at his gravest he lacked weight; as a poet he lacked personality.” But his knowledge of the Eighteenth Century was unparalleled. He knew everybody who was anybody, and quite a few beside.

His essay on Heberden is more concerned with the latter’s literary pursuits than with his medical ones. Heberden, he tells us, was a classical scholar of great accomplishment, and when a young man contributed a chapter to a book called Athenian Letters which was long considered the finest commentary on Thucydides ever written. He was also a learned Hebraist, and assisted the eminent bishop, William Newcome, in the production of his An Attempt towards an Improved Version and a Metrical Arrangement, and an Explanation of the Twelve Minor Prophets.

Heberden was not only physician to George III, but to the leading literary figures of his day. He attended Doctor Johnson during his last illness, who called him “the last Roman” though he also called him “the most timid of the timid” when it came to treating dropsy (Johnson eventually sliced the skin of his legs to let some of the fluid out). Although Johnson had a high regard for Heberden, he quoted lines from Jonathan Swift’s Verses on His Own Death with Heberden ironically in mind:

The doctors, tender of their fame,
Wisely on me lay all the blame:
‘We must confess, his case was nice;
But he would never take advice.
Had he been ruled, for aught appears,
He might have lived these twenty years,
For when we opened him we found
That all his vital parts were sound.’

Heberden treated, among other literary figures, the poet William Cowper. He recommended that Cowper, who suffered bouts of madness, remove to Margate, but this was not altogether a success. Heberden’s description of my nodes, however, was very accurate.

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.

Anyone who shares with me the strange desire to buy and possess old books will have noticed that many of them now on sale come from the collections of public institutions or learned societies. So it was with On the Mortality of Childbed and Maternity Hospitals, by J. Matthews Duncan, published in 1870, that I bought recently. It had formerly belonged to the library of the Royal College of Surgeons in Ireland.

The need for space, the advances of digitisation, and the fact that many books are no longer consulted by anyone, are the reasons the librarians give for what is known as deacquisitioning. In the case of this book, it is true that no one had consulted it for more than 140 years: I know this because its pages were still uncut.

In fact, Duncan (1826 – 1890) was a considerable figure in his day; when he died, Queen Victoria told his widow that “the country and Europe at large have lost one of their most distinguished men.” He is regarded as one of the founders of the statistical study of fecundity and sterility.

On the Mortality of Childbed makes very interesting reading. Although there is much about puerperal fever, the name of Semmelweis is not mentioned in it. Indeed, Duncan did not believe that the fever was either epidemic or infective. Having demonstrated that it was twice as common in primiparae as in multiparae, at all ages, except after the birth of the ninth child, he wrote:

I shall not enter further than to say that the occurrence of puerperal fever specially among primiparae, and women who have borne large families, – its pretty close correspondence in relative amount to the general mortality of parturition after different pregnancies – its subjection also to the law of the duration of labour [that the longer the labour, the greater the mortality], – do not appear to me to lend support to the views hitherto generally entertained regarding it, and expressed in the words accidental, fever, contagious, epidemic.

Duncan was an early collaborator of James Young Simpson, the discoverer of chloroform, and indeed took part in the famous party when Simpson demonstrated the effects of the new anaesthetic; but in this book Duncan loses no opportunity to take his old boss to task, particularly for his assertion that large hospitals are more dangerous than small. He derides Simpson for his assertion, “on deceitful grounds,” and using statistics that “are really so insecure as to be quite worthless,” that the mortality in childbed had declined from one in 44 in 1680, to “only” one in 107 in 1820, thanks to supposed advances in obstetric practice.

Simpson, who died in the year the book was published, had his posthumous revenge. Duncan was widely expected to follow him as Professor of Obstetrics, but Simpson’s nephew, Alexander Russell Simpson, was elected to it instead. Duncan then moved to London.

In the book, Duncan defended maternity hospitals against the attack of a French writer called Le Fort, who claimed that one in 29 women who gave birth in them died (at the Charité it was one in 7). All that this showed, said Duncan, was “how bad they may be, and little more.” The figure for the Dublin Maternity Hospital, for 190,000 births over a century, was one in 72.

Duncan did very well financially. He left an estate of £86,436 11s. 8d., the equivalent, perhaps, of between £5and £8 million in our money.