Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of about 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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

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.

Not so very long ago facial transplants would have been the stuff of science fiction, but now they are the stuff of reality. At the moment they are performed on people whose faces have been horribly injured, but in L P Hartley’s dystopian novel, Facial Justice, published in 1960, they were performed for political rather than for medical or aesthetic reasons.

Hartley (1895 – 1972) is now mainly remembered for one novel, The Go-Between, a fine evocation of traumatic sexual awakening in the upper reaches of the Edwardian society to which Hartley remained forever attached. In all, he wrote sixteen novels whose quality, says the Dictionary of National Biography, declined as their frequency of publication increased. Hartley, who was invalided out of the army by Sir Frederick Treves in 1916 without ever having seen action, died of the complications of alcoholism: by no means the first or the last author to let himself be mown down by the bottle.

Facial Justice takes place after the Third World War, when the surface of the earth has been more or less completely laid waste. Some of humanity survives, but underground; in England half the population, dissatisfied with its subterranean lot, makes the daring move to go above ground.

There the New Society is created, ruled by an otherwise nameless Dictator. It must be admitted that Hartley’s imagination was not strong enough to make his dystopia come alive, as do, say, Brave New World and Nineteen Eighty-four, for neither the details nor the history of the New Society are consistent or plausible. I suppose that is why the books remains relatively unknown and unread.

Another reason, perhaps, is that it is a satire on the notion of equality that is now so dear to us. In the New Society there is a Ministry of Facial Justice which works towards the equalisation of women’s faces by means of surgery. Divided on grounds of natural beauty into three categories, alpha, beta and gamma, plastic surgeons operate to give alphas and gammas entirely new beta faces according to a pre-ordained pattern, so that there should be no envy because of the possession of unfair natural advantages or disadvantages: for in the New Society envy is seen as the root of human evil, especially violence. Mediocrity in all things is the goal of the society, and a series of slogans – beta is best and alpha is anti-social – are inculcated into the population to drive the message home.

After an accident, the main character in the book, an alpha woman called Jael, undergoes involuntary betafication (the local equivalent of beatification) carried out by the plastic surgeon Dr Wainewright. She revolts against this and indulges in a conspiracy to bring about the downfall of the Dictator, whose identity no one knows. The result is chaos and violence, in which Dr Wainewright is killed: the message or warning of the book, in so far as any story so unconvincing and ill-constructed may be said to have a message or carry a warning, is that once democratic mediocrity is thoroughly installed in a society, there is no going back and the alternatives are worse.

Harley obviously intended the book to be a satire on what he saw as the mediocrity of the England of his time: and whether this has any meaning today for you depends crucially, I suppose, on whether you think that NICE should really be renamed NICM, the National Institute of Clinical Mediocrity.

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?

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

Could it be, I wonder, that Mr Micawber derived his great dictum about happiness and misery from having read Edwin Chadwick’s Report to Her Majesty’s Principal Secretary of State for the Home Department from the Poor Law Commissioners, on an Inquiry into the Sanitary Condition of the Labouring Population of Great Britain of 1842, only five years before the publication of David Copperfield?

Dickens, after all, read such literature, and on pages 139 and 140 would have seen a tabulated comparison of those who lived providently and improvidently:

William Haynes, of Oakamoore (wire drawer), wages £1 per week; he has a wife and five children; he is in debt, and his family is shamefully neglected.

John Hammonds, of Woodhead (collier), wages 18s. per week; has six children to support; he is a steady man and saving money.

This great book is, to me at any rate, inexhaustibly fascinating. Chadwick was a barrister, not a doctor, and though most of his information came from doctors (unpaid for their work, incidentally) he had no exaggerated respect for their wisdom or understanding. Pages 148, for example, are headed Irrelevancy of Controversy on the Generation of Fever, as against Practical Means of Prevention. Contagion or infection, it was all the same to him; he was the Deng Xiao Ping of public health, to whom it mattered not whether the cat was black or white, so long as it caught mice. A note of impatience and exasperation creeps in:

The medical controversy as to the causes of fever; as to whether it is caused by filth and vitiated atmosphere, or whether the state of the atmosphere is a predisposing cause to the reception of the fever, or the means of propagating that disease, which has really some superior, independent, or specific cause, does not appear to be one that for practical purposes needs to be considered, except that its effect is prejudicial in diverting attention from the practical means of prevention.

And he quotes from an episode from a French report about the small town of Prades (through which, as it happens, I have often passed) in the Ariège, which suffered a disastrous epidemic:

The physicians of Ariège, in order to prove that the disease was not contagious, and to re-assure the inhabitants, lay in the beds from which the invalids had been removed.

Arguing for sanitary reform, Chadwick points out the advances made in the navy. In 1779 one in eight employed on ships died in a year; from 1830 to 1836, it was one in 72. This improvement he attributed to sanitary measures, even though he quotes the case of the expedition of HMS Centurion in which, a hundred years earlier, 200 of 400 men were lost to scurvy. It is interesting to note that although in the latter years lemon juice was by Chadwick’s time in general use, it was still uncertain in 1842 as to whether it, or better conditions in general, was responsible for the prevention of scurvy.

The book contains sanitary maps of Leeds and Bethnal Green of great beauty: were it not vandalism to do so, I would tear them out and frame them. And Chadwick provides illustrations of workmen’s housing, infinitely better, aesthetically-speaking, than almost anything built for the last hundred years. If there is one thing that has not improved, it is architecture.

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

In his Lettres Persanes, first published in 1721 and reprinted many times during his lifetime, Charles-Louis de Secondat, better known as Montesquieu (1689 – 1755), used the device of letters from fictional Persian visitors to Paris to examine French (and European) manners, assumptions and prejudices. Among the subjects which he treated with irony, perhaps not surprisingly, was the medicine of his time.

For example, he relates the story of a doctor who had a patient who suffered from insomnia for thirty-five days. He prescribed him opium, but the patient, reluctant to take it, asked whether he might try an idea of his own first, on the promise that if it did not work he would then take the opium.

His idea was to try some of the books in a local bookseller as a soporific. “Monsieur,” he asks him, “would you not have in your shop some book of (religious) devotion that you have not been able to sell, for often the rarest remedies are the most effective?” The bookseller replies “Monsieur, I happen to have the Holy Court of Father Caussin. I will send it to you.”

It duly arrived. “The dust was shaken from it and the son of the ill man, a young schoolboy, began to read it. He was the first to feel the effect; at the second page, he began to mispronounce, and everyone felt tired; a moment afterwards, everyone was snoring except the ill man who, after long resisting, finally succumbed.”

The doctor visits the next day and assumes that the patient, who has slept well, has taken the opium he prescribed. He is quickly disabused, and begins his researches into the medical effects of boring books. A footnote gives his prescriptions:

Purgative infusion: Take three pages of Aristotle’s logic in Greek; two pages of the most acute treatise of scholastic theology, as for example that of Duns Scotus; four pages of Paracelsus; one of Avicenna; six of Averroes; three of Porphyry; as many again of Plotinus. Infuse them for
twenty-four hours, and take four times a day.

In order not to make his medicines as cheap as possible, and in order not to cause his patients financial embarrassment, the doctor decides not to use rare ingredients, such as dedicatory epistles that cause no one to yawn, prefaces that are too short, Jansenist works not highly-regarded by other Jansenists and not despised by Jesuits. As for a good vomit, six funeral orations, a collection of new operas, fifty new novels and thirty new memoirs, distilled in an alembic, should be sufficient.

As for asthma:

Read all the works of the Reverend Father Maimbourg, taking care not to stop before the end of every sentence; and you will feel the ability to breathe return little by little, without the necessity to repeat the cure.

As to the medical books of the time, Montesquieu was hardly more complimentary:

The textbooks of medicine: these monuments to the fragility of nature and the power of the art; which make us tremble when they treat of even the slightest illnesses, so close to death do they make us seem; but that reassure us completely when it comes to the value of remedies, so that it is as if we had become immortal.

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

It is hard to understand it now, but in 1938 five-year plans had a certain cachet, thanks to the prestige of the Soviet Union. Even the International Institute of African Languages and Cultures had one, according to the preface to a volume of anthropological papers published that year. Of course it was a success, as all five-year plans must be:

The Five Year Plan of the International Institute of African Languages and Cultures has given an immense impetus to the study of culture change in modern times…

My copy of this admittedly obscure work once belonged to Edward Joseph Lister Lowbury (1913 – 2007). Lowbury, whose father was a doctor, was named after the great surgeon, and his own work as a bacteriologist was in the control of hospital infection, an example of life imitating a name rather than art. Early in his career, though, he was a pathologist in East Africa, hence his possession of this book.

Lowbury was an extremely cultivated man, an accomplished pianist and a poet who won the Newdigate Prize for poetry at Oxford, as did Matthew Arnold and Oscar Wilde. On the inside cover of his copy of Methods of Study of Culture Contact in Africa are two sonnets in his own hand, written at Moshi in Tanganyika in October 1945, and not included in his published works. One is called From the Train to Moshi and the other Road to Kibo. (As it happens, I have been to Moshi.)

There is nothing specifically medical in the two poems. The second half of the first expresses revulsion against the colonial life in Africa, comparing the whites unfavourably with the Masai:

For laughter these are best
Value, as also for lolling at their ease,
The Masai! And again, who is so impressed,
So smiling even when shouted at as these
Whom nothing will persuade man is unblest
And sex is wicked – especially witnesses
Of the white man at his worst, drunken, depressed,
Stealing their women, catching their disease?

This is dated 30 October, 1945; the second poem (written in a surprisingly clear hand) the following day. Here Lowbury extols the children whom he sees:

The children line the road, click heels, salute,
And have the last word in every greeting.
Their eyes are deep, expressive, never mute;
They meet yours roundly, never flinch at meeting…
Their charm is so great that even their vices are forgiveable:
What matter if they lie and laze and steal?
When chances offer? – That’s reflected too.
You’ll soon forgive them when you see how real,
Under the lying and the ballyhoo,
Are the fine nerves, the touch fit like a glove
By the light fingers of the God of Love.

Either Lowbury – who wrote the poems with only a few crossings out, for he was famed for his fluency – forgot these sonnets, or did not think them good enough to be published. No doubt they resort to stereotypes, but which of us never does so, indeed goes a day without doing so?

Under the lying and the ballyhoo,
Are the fine nerves…

The feeling of the young pathologist is real enough, unmistakable I should say, and my experience of the Tanganyikans was like his. They were the best-mannered people I have ever met.

Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor. We are posting one each Wednesday to coincide with the schedule of his old BMJ column. We hope you enjoy them.

One shouldn’t judge a book by its cover, of course, nor by its title; but when 200,000 books are published each year, this is the counsel of perfection, and you have to judge by something. Some titles are more intriguing than others; recently, for example, I came across one that seemed to sum up the human predicament pretty succinctly: Until Further Notice, I Am Alive.

This was a quotation from an e-mail that Tom Lubbock, the author of the book and former art critic of a major newspaper, sent to a friend on learning, in 2008, that he had a neuroblastoma multiforme and that his expectation of life, with treatment, was only two years. Prognosis is an imperfect art, but in this case proved accurate. Diagnosed in October 2008, he died in January 2011.

Dr Johnson said that when a man knew that he was to be hanged in a fortnight it concentrated his mind wonderfully. But what about when he knew that he would die in two years, with the possibility of the dissolution of his mind before that of his body? The site and growth of the author’s tumour gave him increasing difficulties with language; the last entries in the diary of his illness, three months before he died, are short and fragmentary.

Lubbock quotes the French writer, Charles Péguy: “A word is not the same with one writer as with another. One tears it from his guts. The other pulls it out of his overcoat pocket.” Although the mystery of where our words and thoughts come from is perennial, we seldom think about it; but for Lubbock the problem became an almost physical one, as he struggled to pull words from, and form thoughts, somewhere in his mind.

He is complimentary on the whole about the medical profession, but he meets an arrogant neurosurgical registrar who, mistaking him for someone else, asks him whether he still experiences strange smells (he never experienced strange smells). There is nothing like being mistaken for another patient to make you feel small and insignificant; and the registrar also tells him he is lucky to have any speech left at all.

Lucky? What does the word “luck” mean here? Naturally the author asks himself why he should have a rare fatal disease, and the only answer he can find is that, if the disease exists, someone must have it. But was he lucky that it was initially operable, that it gave him no pain, that it preserved his intellect nearly until the end? Perhaps what the registrar meant was “Most people with a tumour such as yours in the same position in their brain would not be able to speak, therefore you are lucky.” This is a very restricted and inhuman notion of luck. How easy it is for a doctor to wound with a few thoughtless words! Let us all read, mark and inwardly digest.

Lubbock had a son eighteen months before he was diagnosed, the child of his heart; the author’s knowledge that this much-loved boy would remember nothing of him in his later life is poignantly expressed, and is all the more poignant because it is obvious to the reader that he would have been a very good father.

On the whole, I do not like memoirs of illness as a genre; I had a surfeit of them when a magazine once sent me seven of them for review. But at the end of this slender book, I felt a real sense of loss, almost of grief, as if I had known the author personally.