The adjective “Dickensian” is more laden with connotation than the adjective that pertains to any other writer: Jamesian, for example, or Joycean, even Shakespearian. We think of workhouses, of shabby tenements with bedding of rags, of schools where sadistic and exploitative schoolmasters beat absurdities into the heads of hungry children, of heartless proponents of the cold charity, of crooked lawyers spinning out their cases in dusty, clerk-ridden chambers. We think of Oliver Twist asking for more, of Wackford Squeers exclaiming, “Here’s richness for you!”, as he tastes the thin slops his school doles out to his unfortunate pupils, of Mrs. Gamp looking at her patient and saying, “He’d make a lovely corpse!”

If he had been only a social commentator, though, Dickens would have been forgotten by all except specialist historians of his age. But he is not forgotten; he survives the notorious defects of his books—their sometimes grotesque sentimentality, their sprawling lack of construction, their frequent implausibility—to achieve whatever immortality literature can confer. Over and over again, in passage after passage, the sheer genius of his writing shines from the page and is the despair of all prose writers after him.

When Dickens called himself “the Inimitable,” he was speaking no more than the truth; he was the greatest comic writer in his, or perhaps in any other, language. And the comedy runs deep: it is not trivial, for while it depicts absurdity, pomposity, and even cruelty, it has the curious effect of reconciling us to life even as it lays human weaknesses out for our inspection.

Wilkie Collins (1824-1889) was addicted to laudanum (tincture of opium in alcohol) for much of his life, but that did not prevent him from producing a vast corpus of work. Among his novels is Heart and Science, published in 1883, known (in so far it is known at all) for its protest against vivisection.

It is not a good novel, to put it mildly, and it would take several pages of convoluted prose to summarise its preposterous plot. But it has much, from character to incident, to interest the medical reader.

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Heart and Science is not so much an attack on science as on the supposed all-sufficiency of science; it is not very effective, however, because it is such a bad book.

The Mini-Mental State Examination (MMSE) is a questionnaire that has been used by doctors throughout the world for more than thirty years to test the cognitive function of those suspected to suffer from dementia. It is very simple and quick to administer, consisting of 30 items, and must by now have been used millions, if not hundreds of millions, of times.

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It is only in 2000, 25 years after it was first published, that the authors, or inventors, of the MMSE tried to assert their copyright....Many doctors in all parts of the world have photocopied the questionnaire hundreds of times. In strict law they may be guilty of having infringed copyright and therefore liable, in theory, to penalties according to the copyright laws of their country. In the United States, unwitting infringement of copyright carries a fine of up to $30,000, and willful infringement up to $150,000, with the possibility of a prison sentence to boot.

Courage is a virtue and heroism is admirable, but do we have a right to demand them? Which of us cannot look back on his or her own life and remember decisions, or compromises made, or silences kept because of cowardice, even when the penalties for courage were negligible?

If we are cowardly in small things, shall we be brave in large? Have we the right to point the finger until we have been tested ourselves? When we read of the seemingly lamentable conduct of the captain of the Costa Concordia, Francesco Schettino, who left his passengers to their fate, do we say, “There but for the grace of God go I”?

Of course, leadership entails an obligation to be courageous – morally, physically or both. It is the price of leadership; it is why leaders are more highly regarded and rewarded than the rest of us. But even subordinates in certain professions have the duty to be brave, as the rest of us do not. A soldier is expected unquestioningly to put himself in the way of bullets as a civilian is not.

My late mother suffered a severe rash a few years before she died. She had to wait an age to consult a dermatologist, even privately, and then she saw several in swift succession. All their prescriptions made her rash much worse; the prescriptions were so bad that even stopping them did her no good.

Then she went to a homoeopath, took homoeopathic medicine for a week and recovered almost immediately. The rash melted away as the snow in sunshine. I was very pleased for her, of course, but kept a little corner of my heart free for the irritation that I felt. She, however, was delighted that there were more things in heaven and earth than are dreamt of in most doctors’ philosophy.

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[In Chekhov's story, the homeopathy practitioner] notices that a little packet of red paper falls from his pocket as he speaks. After he has gone, she examines it, and finds that it contains the very pilules that she has prescribed for him. He has taken none of them, and a doubt begins to enter her mind. This doubt is confirmed when all the patients who follow him praise her curative skill extravagantly—and then ask for economic assistance [as he had].

Chekhov draws a short moral: “The deceitfulness of Man!” Yet in the case of my mother . . . well, reality is a complex thing.

The authors of the editorial suggest that people like the Zimbabwean physicians migrate because of “push and pull” factors, or carrot and stick. With the mealy-mouthed delicacy of the politically-correct diplomat and careerist bureaucrat, they delicately refrain from describing the stick in any detail. The nearest they come to doing so is the following: “unstable working environments.” This reminds me a little of the Emperor Hirohito description of the dropping of the atom bombs: “The war has developed not necessarily to Japan’s advantage.”

With regard to Zimbabwe, the authors see reason for optimism:

In a draft national policy currently awaiting parliamentary approval, Zimbabwe addresses factors contributing to health workforce shortages; supports mechanisms and processes for stakeholder coordination and collaboration; and defines stakeholders’ roles and responsibilities in ensuring timely financing, implementation, and monitoring of national human resources for health and in promoting the development and retention of the health workforce.

Have the authors ever been to Africa in general, and Zimbabwe in particular? And if they have, did they ever see anything from anywhere other than through the tinted windows of an air-conditioned official car? Here again one cannot help but think in analogies, this time with Beatrice and Sidney Webb, who read the Stalin Constitution for the Soviet Union with minute attention (coming to the conclusion that it was the most democratic in the world), and every official statistic ever to emerge from Moscow, and then wrote a vast tome about the Soviet Union including everything they had read, missing only the twenty or thirty million deaths that were taking place there while they read it.

In City Journal Dalrymple reports on the uncovering of a corruption scandal in the British educational bureacracy:

The Times Educational Supplement is Britain’s most important journal for the teaching profession. In the January 6 edition, it described the methods school principals use to deceive the official inspectorate of schools. The inspectorate’s reports, in the words of the TES, “are vital checks on the performance of schools, relied on and trusted by parents and those running and working in the system.” The precise extent of the principals’ cheating is, in the nature of things, difficult to measure. But once the principals know that an inspection is coming, many employ techniques such as paying disruptive pupils to stay home, sending bad pupils on day trips to amusement parks, pretending to take disciplinary action against bad teachers, drafting well-regarded teachers temporarily from other schools, borrowing displays of student work done in other schools, and so forth. It’s Gogol’s Government Inspector translated to the educational sphere.

Read the whole, sad thing.

He said that many of the patients he sees “are people who are poor because they just don’t want to work. They’ve never had a job and they never will have a job. They’re fine with that.”

He said that the general public has no idea how much money is wasted on medical fraud and abuse by members of the underclass, and on treating people who have no intention of being anything other than dependents on the state, and who will demand treatment “if they as much as stub their toe” because they don’t have to pay for it. He said that if the health care system here in Louisiana had the money it threw away on fraud by and unnecessary treatments for the poor, “we could build a brand-new hospital to replace Earl K. Long.”

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He said that most people in society never have to spend any time in the world of the American underclass, so it’s easy to sentimentalize them. That can go both ways of course, and it can be easy to think of all the poor as brutish, etc. But Dr. Smith’s Dalrympian view is that our discussion of health care in this country, especially for the poor, is uninformed by a realistic understanding of the lives many of the poor lead, and the lack of moral scruple and sense of responsibility to themselves and to the wider community.

...it has become increasingly difficult to distinguish between the sound of young British people enjoying themselves and the sound of young British people committing murder in the street. I do not exaggerate. Twice in recent years I have heard the “normal” sound of drunken revelry outside in the early hours of the morning, only to discover later that it was the sound of someone being stabbed or beaten.

The euro is in danger, and with it the European Union, but President Nicolas Sarkozy and his party, the Union for a Popular Movement, want to pass a law forbidding the public denial in France of the Ottoman genocide of the Armenians. This is not the kind of politicking of which Europe has deep need just at the moment.

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Of course he resembles all his European colleagues in his ambitious frivolity: he is neither better nor worse than they. Faced by the greatest economic crisis of the past 60 years or more, they are patently more concerned with their own political survival than in undoing the damage that they and their ilk have wrought in the past decades. A crisis brings out the mediocrity in them.

But let us return to the questions of justice, mercy and forgiveness, tackling the latter first. The willingness and ability to forgive or overlook is essential to good human relations because we are none of us angels, we all do things we should not, and some of us even have habits irritating to those closest to us (in my case that of never passing a bookshop without buying a book, which my wife finds very irritating). If we did not have the capacity to forgive, every argument would end in divorce or murder, or at any rate in some very unpleasant consequence.

But it does not follow that what is necessary in some circumstances is necessary in all, any more than it follows that a medicine that is good for you in a certain does must be twice as good for you in double the dose (though I have met patients in my medical career who did believe that, often with near-disastrous consequences).

In order to have the locus standi to forgive, the harm that someone does must be done, at the very least in part, to oneself. If someone robs you in the street, I have no right to forgive him; only you have that right. Moreover, even if you do forgive the robber, your forgiveness, morally grand as it might be (though it might just as well be cowardly or pusillanimous), has no claim to determine the treatment of the robber by the law, any more than your vengeful feelings, if you had them, would have done. Revenge, said Bacon, is a kind of wild justice, which the more man’s nature runs to, the more ought to weed it out; the same might be said of forgiveness, except perhaps that wild would not be the qualifying word to use of the justice that would result from it. The law is instituted precisely to supersede the effects of incontinent emotion, whether it is of the punitive or sentimental kind.

Forgiveness, then, unlike mercy, has no place in the law. A pardon is not forgiveness, it is an exceptional act which in no way lessens the guilt of the pardoned.

For myself, having worked in a prison for many years, I have a soft spot for criminals – or at least, for some criminals. I am among those who would be inclined personally (and within reason) to give them a chance, if I had jobs at my disposition. I would even be prepared to be disappointed, to find that the thief whom I had found charming and thought wanting to turn over a new leaf had actually stolen from me. I would pat myself on the back because I would think that I had performed a good and charitable act by employing him. But I would also think it the grossest act of tyranny to require my neighbour to behave in precisely the same way. I can take a risk myself that I have no right to demand that others take. It is typical of governments that they should not understand the distinction.