Note: When Dalrymple’s long-running BMJ column ended in 2012, he had a backlog of around 50 or 60 unpublished pieces, and he kindly gave them to us to post here at Skeptical Doctor.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.

Among the many writers whose father was a doctor was Giorgio Bassani (1916 – 2000). He was also one of those writers whose work was intensely local: other writers wander the world in search of inspiration. The universal can be found either in the strange or in the familiar; it is a matter of temperament where writers seek it.

His novels and stories are set in the beautiful Italian city of Ferrara but at the time of the deep moral squalor of Mussolini’s regime. The contrast between the aesthetic and moral qualities of the setting heightens the drama.

The protagonist of his short novel, The Gold-Rimmed Spectacles, is a doctor, Dr Athos Fadigati. Dr Fadigati is an ENT surgeon from Venice who sets up an elegant clinic in Ferrara just after the end of the First World War. As such, he becomes a member of the local haute bourgeoisie, but he also becomes the subject of local gossip, increasingly malevolent. The gold-rimmed spectacles of the title are those that the doctor wears and are characteristic of him.

Dr Fadigati is noticed to have odd habits. At the cinema, for example, he sits in the cheap seats, among the poor, for example among the soldiers, rather than in the circle where his fellow bourgeois sits. He is unmarried, and eventually the penny drops: he is homosexual.

His ruination begins when he is seen only too openly in the company of a handsome young man from Ferrara, Eraldo Deliliers, at the Adriatic resort of Riccione, where the entire Ferrarese bourgeoisie spends its summer holidays. A scandal occurs when Eraldo has an argument with his rich, ageing and plump lover in the lobby of the hotel, and punches him.

Dr Fadigati’s practice declines and then dwindles practically to nothing. At the end of the story he is found drowned (by suicide) in the River Po in Pontelagoscuro, a suburb of Ferrara.

The narrator is a young student from Ferrara who, like Bassani himself, studied at the University of Bologna, and belongs to the Jewish bourgeoisie of the city. At the time of Dr Fadigati’s suicide, Mussolini – whom some of the Jewish bourgeoisie had strongly supported in the early days of his regime – opportunistically enacted anti-semitic laws in order to curry favour with his ally, Hitler. Later, after the time in which the novel is set, 96 of the 300 Ferrarese Jews were to be deported to Poland, and only 5 survived.

Clearly, Bassani intends the reader to draw a parallel between the way in which Dr Fadigati is treated and the increasing persecution of the narrator and his co-religionists. The latter is not presented as a plaster saint or an immaculate victim: in the story he has behaved indiscreetly and even foolishly. But he is clearly not a bad man and does not deserve his fate.

Bassani did not deserve his fate either. He had been briefly imprisoned in 1943 for his anti-fascist activities, the regime fortunately collapsing before worse could befall him; but in the last two years of his life there was an unseemly dispute among his relatives as to his capacity to dispose of his property, which depended upon whether he suffered from Parkinson’s disease, which was at least partially treatable, or Alzheimer’s, which was not. Ill-will comes in many guises, perhaps infinitely many.

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.

Some writers are better known abroad than in their own countries: among them is Charles Morgan (1894 – 1958), the British novelist who has long been more highly appreciated in France than in Britain. Perhaps this is because he is a novelist of ideas, and the British do not really like ideas; he is also accused by certain critics, from whom I would not entirely demur, of more than occasional descent into flatulent portentousness. He is also that rara avis, a writer who not only had no sense of humour, but was positively opposed to humour.

In 1941 he published a short novel called The Empty Room. It was set in the war, at a time when its outcome could not have been known. The book opens as follows:

On the last Saturday in November, the third month of the war, Richard Cannock performed, on a woman’s eye, a bold and subtle operation that gave him the satisfaction a writer may have in a flawless paragraph.

One suspects that this was a pleasure to which Morgan himself was more than usually susceptible. The above is Maugham without the irony or easy elegance.

The operation over, Cannock takes himself to the Garrick Club for lunch, where ‘the wine steward brought his pint of claret.’ Pint of claret at lunch! It is just as well, perhaps, that Cannock tells a younger surgeon, also lunching at the Garrick, that the operation he performed that morning was probably his last for a long time – thanks to the war, not to drunkenness or the alcohol withdrawal symptoms.

Cannock appears from his character to be an oldish man, and one learns with surprise that he is only forty-four. He is deputed to a research establishment where he helps to develop better bomb-sights. While at this establishment he stays at the house of a friend of his, whose wife, Venetia, deserted him early in their marriage while he was a prisoner-of-war in Germany during the First War. More than twenty years later she returns to him, he having told the only daughter of the marriage that her mother was dead.

Alas, she is not the woman she was, but ill:

While she was in London, she had faced her illness alone; for many days it would leave her free, then there would be a pain in her foot and in the upper part of her nose; it would spread across her left brow, and grip her head, and at the same time her strength, even her will would go from her…

I confess that I thought of a patient whose pain started in her foot and finished in her hair, where it was at its worst. It was far from comic, for she ended up one day by throwing herself, fatally, from the roof.

Venetia, too, kills herself, with the ‘eleven and a half grains of morphia that a young doctor, whose name she did not know, had given her as payment in kind.’ Her intermittent illness, then, was probably a tabetic crisis, and it always left her weak and exhausted.

In the matter of Charles Morgan I think the British rather than the French are right. But even in Britain he had his enthusiasts. My copy of his book was given to its first owner, according to the inscription, in January 1942. In the back, in pencil, is the following:

Re-read Feb. 1977
Re-re-read May 1984

Of how many books is such the fate?

Nigel Balchin (1908 – 1970) was a popular novelist in his day but is now nearly forgotten. He studied science at Cambridge, then industrial psychology, before joining a famous chocolate company in York, the output and marketing of whose chocolate bars he helped to improve.

He enjoyed initial success as a writer too. His novels of wartime (published during the War itself) spread, if they did not actually coin, two expressions that are still in use: boffin and back-room boys. When one considers the number of novels that are published, it is clear that few novelists leave so lasting a legacy.

His novel, Mine Own Executioner, was published just after the end of the War in 1945. Its protagonist is a lay psychoanalyst called Felix Milne who has chucked up his medical degree in order to study with a famous Viennese analyst before coming home to London to practice. Like many a religious person, he suffers from scruples: does he really believe or not?

The author himself appears not to be able to make up his own mind. At first he is satirical: the first of Milne’s patients he depicts is Lady Maresfield, a rich, spoilt and lonely woman whose marriage is unsatisfactory and who uses Milne merely as a shoulder to cry on, almost as a paid companion. Her name is surely significant: when Freud came to live in England, his address was Maresfield Gardens.

Later, however, the satirical tone is dropped. Another of Milne’s patients is Lucian, a former prisoner-of-war of the Japanese. He comes to Milne for help because, on his return to England, he nearly strangled his wife to death. Milne injects him with sodium thiopental to get him to speak of his experiences as a prisoner-of-war about which he has previously been unable to speak. After this abreaction Lucian feels a lot better and wonders why. Milne replies, ‘Haven’t you ever had a boil lanced?’ Emotions are like what the British used to say of their teeth: better out than in.

Alas, Lucian has a relapse owing to an unresolved Oedipus complex that Milne has failed to spot or do anything about. Lucian shoots his wife who for him symbolises his mother, who has so betrayed his love for her by allowing herself to have sex with his father (whom he has already slain symbolically in the person of a Japanese guard in the prison camp). After killing his wife Lucian commits suicide, and not surprisingly, perhaps, Milne begins to lose faith in his capacity as a healer.

The book ends in the Coroner’s Court. The coroner is a doctor, Dr Lefage, a pompous, shrivelled-up pedant full of prejudices in favour of doctors. ‘An inquest,’ remarks a character, ‘is a place for arriving at a comfortable verdict that no blame attaches to anybody.’

When I read that, I recalled the first coroner’s inquest I attended as a witness more than thirty years ago. I arrived early and sat in on the previous inquest. It was a tale of woeful incompetence. The deceased had taken an overdose and gone to hospital, where she was told that nothing was wrong with her and to go home, where she died a few hours later. The coroner, a doctor, said, ‘I want to assure the family that all that could have been done was done.’

Of course, things are completely different now.

Recently I spent a few months in the Forest of Dean, where Dr John Sassall, the protagonist of John Berger’s famous extended essay, A Fortunate Man, published in 1967, worked as a general practitioner.

The Forest, to my surprise, retained a little of the geographical and social isolation that it had when Berger wrote his book. Some of the Foresters, as they called themselves (and for some reason Berger chose not to capitalise the word, as if the Foresters were foresters, which most of them were not), had scarcely ever travelled further in their lives than Gloucester. By comparison with the rest of the county, the Forest is still impoverished; but its relative isolation gives it a character and spirit of its own.

A Fortunate Man turned out to be an unfortunate title, because Dr Sassall killed himself some years after its publication. Of course, this is not to say that he was not fortunate at the time it was written; fortunes, after all, change. A man may start lucky in life and end up unlucky, and vice versa; but re-reading this book, which seems to me to have been over-praised, I am struck not by the good fortune of its protagonist but by his tormented nature.

Dr Sassall was a hard-working single-handed rural general practitioner who did everything from operations on the kitchen table to psychotherapy. He was not able to achieve what, in our horrible manner of reducing everything to inelegant jargon, we now call ‘a work-life balance.’ His life, we are told, was otherwise empty; and he worried over the point of human existence, if any:

He is incapable of waiting and doing nothing. He is incapable of resting. He sleeps easily but, at heart, he welcomes being called out at night.

This is surely the mark of a man in flight from something. We are told that he was a slave to his quest for certainty, a certainty that he knew in advance that he could not reach. He was tormented by his inadequacy to relieve all suffering and prevent all death. This may well be a sign of great honesty, and such honest men may be necessary; but fortunate is not the word for them. Moreover, while to be constantly at the service of others is good and admirable, it is not the only good or the only just cause for admiration. There needs to be moderation in self-sacrifice as in other things:

Dost thou think, because thou art virtuous, there shall be no more cakes and ale?

Some of the writing in A Fortunate Man strikes me as portentous, as cliché dressed up as philosophy. The book begins (under a photograph of the rural calm of Gloucestershire):

Landscapes can be deceptive. Sometimes a landscape seems to be less a setting for the life of its inhabitants than a curtain behind which their struggles, achievements and accidents take place.

I look out of my study window at the houses opposite. What do I know of what went on in them last night, what is going on in them now? Nothing. But a life without curtains, real or metaphorical, were it not in fact impossible, would be horrible. The use of the word ‘sometimes’ in the above passage disguises the obviousness of the underlying thought.

John O’Hara (1905 – 1970), the American novelist and short-story writer, was the son of a surgeon, Dr Patrick O’Hara. The father wanted the son to follow in the profession, but he would have none of it, even rejecting his father’s offer of $10,000 (a lot of money in those days) if he would do so. O’Hara junior said that he wanted to be a writer; his father said that no good would come of it.

O’Hara’s father died leaving the family impoverished, and it was this, O’Hara always claimed, that prevented him from going to Yale. Whether he would have gone if his father had lived is doubtful; he had been expelled from three schools for bad behaviour. But he resented it for the rest of his life.

O’Hara’s bad behaviour also lasted. He was a snob and a social climber, but also a nasty drunk inclined to bullying and violence. One critic said that no one who knew him ever liked him, although others have denied this. It is rare for anyone to be disliked by everyone.

Critical opinion is divided over the value of his work, some calling it little more than pulp fiction, but John Updike equated him with Chekhov. Certainly O’Hara himself had few doubts: he thought he ought to have won the Nobel Prize and arranged for an inscription on his tomb that he was the finest and most truthful writer of his age.

His first book, Appointment in Samarra, a fine portrayal of self-destruction, is regarded as his best; it was followed by his first collection of short stories, The Doctor’s Son, in the title story of which the great ’flu epidemic of 1918 in his home-town, Pottsville, is depicted with such accuracy that many of the inhabitants were not pleased. The doctor of the title is O’Hara’s father, who works himself to the point of exhaustion, though really he can bring little more than succour.

By 1956 O’Hara had mellowed a little, and his novella, A Family Party, consists entirely of the speech made at the retirement dinner of Dr Samuel G Merritt, who has worked as a doctor in the town of Lyons, Pennsylvania for forty years. The speech is made by his best friend, Mr Albert W Shoemaker, but is not without an undertow of acid, despite the predominantly elegiac tone. After an enumeration of the doctor’s virtues, we expect some final and dramatic revelation of a serious moral lapse or crime.

There is revelation, but of tragedy. Shoemaker speaks of Alice, the doctor’s wife, who is absent from the dinner. She had two children, one stillbirth, one premature. After the second, ‘her strength must have been more seriously affected than anyone realized’ and ‘she was subject to depression.’

In and out of a private hospital, she returned one day:

Sam brought a trained nurse back and we all made believe that the nurse was there to help Sam in the office, but then I guess the truth got to be known publicly when what we all know happened. One of her moods of depression and she jumped out of the second-story window. Broke both her legs, one arm.

For twenty-five years she has been asylum-bound and the doctor on his own.

There is an interesting period detail in the tale of quiet heroism. O’Hara wrote it at the height of the craze for frontal leucotomies, and Shoemaker says credulously:

Now they have operations that they can cure the kind of illness Alice had, but they didn’t have them then…

Among the medical fictional detectives is Dr Eustace Hailey of Harley Street, specialist in nervous diseases. He was introduced to the world by his creator, Dr Robert McNair Wilson, under the pseudonym Anthony Wynne, in 1925, who subsequently wrote twenty-six novels and many short stories in which Dr Hailey solved previously insoluble crimes.

McNair Wilson (1882 – 1963) was a man of parts. Originally destined for the church, he had no vocation and studied medicine instead. Then he took to journalism, first for Lord Northcliffe and then for the Times as medical correspondent. During the First World War, he worked as a research assistant to Sir James Mackenzie, the cardiologist, studying the effect of ‘trench fever’ on the heart. He subsequently wrote two books of cardiology, The Hearts of Men and The Nervous Heart: Its Nature, Causation, Prognosis and Treatment.

After the war, he became a busy cardiologist, while remaining at the Times. He wrote extensively on economic matters, excoriating the banking system in two books and advocating a return to a type of feudalism. Two of his sons became Members of Parliament.

In a short story called The Cyprian Bees (1926), Dr Hailey solves a mysterious murder committed, as it turns out, by his old medical school friend, the eminent bacteriologist Dr Michael Cornwall. Dr Cornwall is in a financial fix; he needs to kill three people, including one very expensive paramour, a cousin and an uncle, in order to inherit the money that will set him right again.

The paramour is found dead in her car in Piccadilly, having been stung to death by a single bee sting in the forehead from a Cyprian bee. The finding of a little box nearby containing three such bees gives the game away, at least to Dr Eustace Hailey.

He surmises that the paramour has died of anaphylactic shock, having previously been sensitised to the bee sting of this particular breed. From this he concludes that the murderer must be a doctor, who has sensitised the victim under cover of immunising her.

So it turns out; and at the climax of the story, Dr Cornwall’s uncle (from whom he is second in line to inherit after his cousin, and who has also been sensitised to the bee-sting) is also stung anaphylactically to death. But the heroic Dr Hailey prevents the cousin from being similarly stung, and Dr Cornwall, the bacteriologist, knows the game is up and blows out his brains.

I read this story in a huge compilation put out by Daily Express Publications in 1934, called The World’s Greatest Detective Stories, 1024 pages long. I couldn’t help wondering, if The Cyprian Bees was one of the world’s greatest detective stories, what the worst ones were like. Oddly enough, a pedant had owned the copy of this book before me, I suspect soon after publication, and had annotated it with corrections of the authors’ grammar and exposures of their non sequiturs. I think he was probably a prickly person, for scattered through the book are comments at the end of stories such as ‘Wretchedly told – deliberately incoherent’ or ‘Unconvincing and in parts obscure.’ Against particularly egregious nonsense he writes the single testy word ‘Rot’.

He makes no such comment on The Cyprian Bees and its absurd plot. But probably he was in awe of doctors.

Copyright 2013 Anthony Daniels

We do not know what Shakespeare really believed, save that he liked money and feared the mob: for he was a stern creditor, and whenever a mob appeared in his plays it was sure to be foolish, fickle and stinking, at the mercy of the last orator it heard. So it is in Julius Caesar: the mob first believes Brutus, then Mark Antony, and tears the old poet Cinna limb from limb simply because he bears the same name as one of the conspirators against Caesar, a different Cinna. Thus Shakespeare recognised that people in crowds may do what they would not do as individuals.

But did Shakespeare really believe that joining a political plot could cure the ague, presumably (considering the proximity of the action to the Pontine Marshes) malaria? In Act 2, scene I, Brutus successfully persuades Caius Ligarius, who is sick of the ague, to join the conspiracy against Caesar. Ligarius says:

By all the gods that Romans bow before,
I here discard my sickness.

And he does.

Likewise, did Shakespeare really think that plague (a disease rampant in London while he was writing the play) was truly the reward of morally reprehensible behaviour? Reproaching members of the mob for welcoming Caesar into Rome after his defeat of Pompey, whereas shortly before they had welcomed Pompey, Marullus says:

Run to your houses, fall upon your knees,
Pray to the gods to intermit the plague
That needs must light upon this ingratitude.

We do not know whether Shakespeare thought that epidemics really were divine vengeance upon men’s wickedness, or whether he simply used the trope because it would have been highly plausible to his audience.

Brutus opposes Caesar, though he is Caesar’s close friend and acknowledges his virtues, because he fears that he will soon turn into a tyrant; the other conspirators in the plot to kill him are more self-interested. Cassius decries Caesar for a weakling by describing his behaviour while ill in Spain:

He had a fever when he was in Spain,
And when the fit was on him, I did mark
How he did shake; ’tis true, this god did shake;
His coward lips did from their colour fly,
And that same eye whose bend doth awe the world
Did lose his lustre; I did hear him groan;
Ay, and that tongue of his that bade the Romans
Mark him and write his speeches in their books,
“Alas!” it cried “Give me some drink, Titinius,”
As a sick girl.

This is authentically callous and patently unfair; but Shakespeare intends it to be.

Caesar, of course, ‘hath the falling sickness,’ but it is a manifestation of Shakespeare’s clinical acumen that he should make Caesar have a fit, fall unconscious and foam at the mouth precisely at a moment of high emotion, when – unwillingly – he turns down the crown offered him for the third time.

Perhaps the strangest medical incident in the play is the suicide of Portia, Brutus’s wife. Missing her husband, and fearing that he will be killed by Octavius and Mark Antony in their struggle for power:

… with this she fell distract.
And her attendants absent, swallowed fire.

North’s translation of Plutarch, from which Shakespeare took his plot, has this to say:

She, determining to kill herself, took hot burning coals and cast them into her mouth, and kept her mouth so close that she choked herself.

As for her friends, they were negligent; knowing her to be sick, ‘they would not help her, but suffered her to kill herself.’

Negligence is nothing new.

Copyright 2013 Anthony Daniels

There are some names that do not seem suited to ring down the ages with literary fame, however worthily their possessors write, and Percy Robinson probably is one of them. But his play, To What Red Hell, first performed in 1926, was successful and twice made into a silent film, one of them with Sibyl Thorndyke in a starring role.

It is a melodrama concerning the death penalty. In the prologue, the body of a woman is found in a boarding house. At first she appears to have gassed herself, but the policemen who are called eventually twig to the fact that she has been strangled. The gas has been left on to mislead people into thinking she has killed herself.

She is what the char-lady calls, in stage Cockney, ‘a painted ’arlot.’ A young Irishman called Tim Nolan who has befriended her and against whom there is a lot of circumstantial evidence is arrested, charged, found guilty of murder and sentenced to death. But the real culprit is Harold Fairfield, a middle class young man who, disappointed in love, takes to drink and prostitutes and strangles the young woman while drunk. In the end he prevents a miscarriage of justice by shooting himself after having written a letter of confession to the Home Secretary, and Nolan is reprieved at the last moment.

Fairfield gives an account of what happened that will be familiar to anyone who has prepared a medical report on the average murder:

I don’t remember much what happened… All the damned drink I’d been taking must have got to me head! I just remember her lighting the gas when we got in. After that, everything seems – hazy. I don’t know whether we quarrelled – or what. Then there’s a sudden blank altogether.

But later, a little while before he shoots himself, Fairfield has the satisfaction of learning that, while he might actually have killed the young woman, he was not morally responsible for having done so. His uncle asks him whether he remembers the fainting fits he had as a child, and then continues:

They weren’t – fainting fits – but – another kind – seizures. We all thought you’d grown out of them, but – you hadn’t! You killed that girl in one… So you needn’t blame yourself as you’re doing, you weren’t responsible for what you did!

Unfortunately this could not be proved in a court of law because the doctor who diagnosed the seizures had died in the meantime. Nor does it explain why he left the gas on to mislead people as to the cause of death.

Harold Fairfield decides that there is no alternative to suicide because, if he strangled one person in the course of an epileptic fit, he might strangle another.

In those days, medical diagnosis was obviously a somewhat inexact affair. In one of the scenes of the play a general practitioner by the name of Barton – whose daughter has refused the hand of Harold Fairfield, thus driving him to drink – is called away from a dinner party (where, incidentally, he hasn’t done so badly for drink himself, despite being on call) to a patient, ‘an infernal woman’ who ‘persistently gives birth to twins,’ thereby getting double value for money for attendance at a confinement, but who luckily turns out to have only ‘a chill on the liver:’ for then Dr Barton can resume his drinking where he left off.

Copyright 2013 Anthony Daniels

Ugo Betti (1892 – 1953) was the son of a doctor who was the director of the hospital in Parma, and is widely considered to have been the second most important Italian playwright of the modern era after Pirandello. In 1955 three of his plays were to be seen on the London stage, though he seems to have been largely forgotten today.

He was a jurist by profession and worked as a judge throughout the Fascist era, though he was accused by the Fascists of being an opponent. After the war, he was accused by the anti-Fascists of having been a fascist but was cleared of all charges.

His outlook was largely pessimistic and he tackled such questions as that of collective, or societal, guilt, for example in his play, Landslide. First performed in 1932, it portrays an investigation into the causes of an industrial catastrophe that reveals moral failings at every level of society. It has something in common with J B Priestley’s An Inspector Calls, first performed thirteen years later.

A doctor is one of the principal characters in Summertime, first performed in Italy in 1937, and in England in 1955 with Dirk Bogarde as Alberto.

Alberto is a charming but worthless, frivolous and not very intelligent young man who cannot make up his mind between two women, Francesca who was his childhood playmate and Noemi who is the sister of the director of the bank in which he hopes to be given a good post.

The doctor, aged 30, is also courting Francesca after his fashion, which is a very dull one. He is so aware of his professional status that throughout he allows nothing but clichés and platitudes to escape from his mouth, and possibly to enter his mind. He treats the world as if it were one large bedside. At the climax of the play, when finally asking for Francesca’s hand (having first cleared it with her maiden aunt), he tries to entice her by offering her his mackintosh because it is damp outside. That is the nearest he can come to a romantic flight of imagination.

He cannot break his habit of pompous and platitudinous solemnity even when, at the last minute, Francesca chooses Alberto rather than him. When she points to Alberto, who coughs nervously, she asks the doctor whether the cough could be anything serious. His is the final speech before the curtain comes down:

As a general rule, such coughs are of but little moment. Nonetheless and unfortunately, one can occasionally begin by having a slight cough… and that slight cough can quickly lead to the grave.

He courteously lifts his hat to Francesca and then concludes:

And should that happen in this case, Miss Francesca, if you would like me to… then I will, all patiently, wait.

I am reminded of the uncle of a friend of mine whose conversation was so dull (for example, on seeing the Mona Lisa for the first time he would immediately wonder out loud how it was kept clean) that at home his wife turned up the volume of the wireless to drown out the sound of what he was saying.

Are doctors, because of their need to be so frequently on their best behaviour, more prone than others to utter oracular banalities? The doctor comments on the weather as if it were his patient with a doubtful diagnosis of some severity:

The wind has changed. We can no longer exclude the possibility of a storm, I fear.

Or is the doctor only Ugo Betti’s father?

Copyright 2013 Anthony Daniels