The Skeptical Doctor

And eating it, too

Steve — Sun, 13 May 2012 14:21:34 GMT

In the new edition of the New Criterion, Dalrymple reviews a new biography of Margaret Sanger by Jean H. Baker. Sanger founded the organization that later became Planned Parenthood, the largest provider (by far) of abortions in the United States and a focus of political controversy. Dalrymple praises the biography, and while his criticism of Sanger herself is firm, it is not quite as scathing as one might expect:

She... ended up, with Marie Stopes, as the most famous advocate of contraception in the world, whom writers and prime ministers courted and flattered. She was brave, intelligent, a good administrator, and determined to the point of monomania. She was also egotistical, selfish, and not always a devotee of the truth.

He also notes Sanger's embrace of eugenics, common among the early 20th Century American progressives who were the forerunners of modern liberals. A famous quote from Sanger: “More children from the fit, less from the unfit — that is the chief issue of birth control".

Update: I forgot the link! The review is here (subscription required).

Taking on the litterbugs: hurrah for the heroine keeping Britain tidy

Steve — Sun, 13 May 2012 14:18:52 GMT

Dalrymple praises Alice Arnold for upbraiding a litterer -- and discusses his own similar experiences.

Intoxication of one kind or another

Clinton — Sat, 12 May 2012 12:26:38 GMT

Dalrymple notes Kipling's youthful opium use in a discussion of his first published work (BMJ subscription required):

It is not surprising, then, that opium dreams, and illusions and hallucinations, are important in his first works of fiction—for example in The Phantom Rickshaw. The very first of his fictional works, written and published when he was only 19, is “The Gate of a Hundred Sorrows,” an account of an opium den in Lahore narrated by a Eurasian habitué of it. Very brief, it is an astonishingly assured piece of work.

The narrator, Gabral Misquitta, is in receipt of a legacy that yields sixty rupees a month, which he entrusts to the owner of the opium den known as the Gate of a Hundred Sorrows, an old Chinaman called Fung-Tching. In return Misquitta has unlimited access to opium, which he calls the Black Smoke. Under the influence of the drug, the black and red dragons “and things” that adorned the pillows “used to move about and fight.”

Misquitta’s notion of happiness is that of many people today, and perhaps explains why they go in for intoxication of one kind or another:

Sometimes when I first came to the Gate, I used to feel sorry for it; but that’s all over and done with a long time ago, and I draw my sixty rupees fresh and fresh every month, and am quite happy. Not DRUNK happy, you know, but always quiet and soothed and contented.

Nothing but wickedness

Clinton — Fri, 11 May 2012 12:34:20 GMT

This BMJ column (subscription required) offers an excellent description of Dr. Johnson's beliefs about suffering:

Johnson, whom Voltaire (wrongly) called a superstitious dog, believed that science would help to relieve mankind of much misery, but not of misery as such. Living at a time when poverty meant not an income lower than 60% of the median income but having little to eat and rags to wear, it was perhaps prescient of him to realise that, notwithstanding the horrors of poverty that he never underestimated, material progress would not mean full and final happiness.

A religious man, or perhaps (better) a man striving to keep his religious belief intact, one of his preoccupations was the problem of how an infinitely wise, powerful, knowing, and benevolent God could permit such suffering in the world. Among the great causes of suffering, of course, were disease and illness. When Johnson was writing his great Rambler, Idler, and Adventurer essays, half of all children in London died before their fifth birthday, and the city was so unhealthy that its population grew only because of migration from the countryside. The search for good health is not a cause of mass migration.

In one of his lay sermons, Johnson tackled the question of how much suffering was attributable to God’s will. He wrote:

In making an estimate, therefore, of the miseries that arise from the disorders of the body, we must consider how many diseases proceed from our own laziness, intemperance, or negligence; how many the vices or follies of our ancestors have transmitted to us; and beware of imputing to God, the consequences of luxury, riot, and debauchery. There are, indeed, distempers which no caution can secure us from, and which appear to be more immediately the strokes of heaven; but these are not of the most painful or lingering kind; they are for the most part acute and violent, and quickly terminate, either in recovery or death; and it is always to be remembered, that nothing but wickedness makes death an evil.

The last sentence makes sense, of course, only if there is a future state of being whose felicities are handed out according to our desert in this life; and perhaps pedantically inclined philosophers might say that otherwise it is not death itself that is an evil, but only the truncation of existence that might have been more prolonged and is foregone by the intervention of death.

The Limits of Patient Autonomy

Clinton — Tue, 08 May 2012 12:41:26 GMT

Dalrymple describes the apparently successful program of compulsory application of an anti-parasite drug to new American immigrants, in discussing the difficult balance between patient autonomy and medical paternalism, at Pajamas Media:

Circumstances, then, alter both medical conduct and ethics.

Of course, 16 percent of the refugees given the drug benefited from it, in that their worms were eliminated and infestations are deleterious for health. Moreover, there would have been possible public health benefits to the administration as well, because people who do not have worms cannot spread them to others.

It is difficult to work oneself into a lather of indignation about the whole business; but from the point of view of medical ethics, the paper is certainly not without theoretical interest.

For a few dollars more

Clinton — Thu, 03 May 2012 20:16:16 GMT

Dalrymple recounts an infamous medical malpractice trial in this BMJ column (subscription required):

In 1870 the man who was to become the first professor of orthopaedic surgery in the United States, Lewis A Sayre (1820-1900), was sued by the parents of Margaret Walsh, a little girl on whom he operated in 1868. He published at his own expense the proceedings of the trial, which vindicated him, under the title The Alleged Malpractice Suit of Walsh v Sayre.

....

Samuel Gross, professor of surgery at the Jefferson Medical College and the subject of Thomas Eakins’s great painting of Gross operating, The Gross Clinic, wrote a congratulatory preface to Sayre’s transcript of the trial...: “Some members of the American bar are, unfortunately, too prone, for the sake of a paltry fee, to encourage and engage in such prosecutions.”

I am glad to say, however, that not everything has remained the same: the fees are no longer paltry.

Fairly Just

Steve — Tue, 01 May 2012 02:49:30 GMT

Dalrymple's new essay for the New English Review is summed up nicely by a couple of its closing lines.

It is important first to distinguish between unfairness an injustice, but it is also necessary to be aware that the righting of injustice has to be weighed against other considerations. It is possible – I think likely – that a totally just society would be a horrible one. One that was fair would be intolerably dull, for it would eliminate difference.

It also includes a good description of what surely animates many crusading reformers: not correcting injustice exactly, but the meaning in life to be found by correcting perceived injustice.

Sometimes reformers are right; glaring anomalies are susceptible to correction. It is not difficult to find historical examples, nor is it difficult to find examples of necessary reforms in all contemporary societies. Unfortunately, however, reform can easily become a substitute religion, giving meaning to the lives of reformers. As a substitute religion it is not a very satisfactory one...

Read it here

Do Nicotine Patches Actually Work?

Steve — Tue, 01 May 2012 02:43:34 GMT

Dalrymple's answer is simple: So long as the user is human, probably not.

Is It Ever Right to Put a 13-Year-Old Girl on the Pill?

Steve — Mon, 30 Apr 2012 00:03:26 GMT

The Daily Express asks the question, and Dalrymple grudgingly answers yes. It is far from the best solution to the problem of teen sexual relations, he says, but it is the only realistic option for a doctor.

If a doctor is presented with a girl of 13 who tells him she is having sexual intercourse how can he not prescribe the Pill?

He has to do what he thinks is best for his patient and he cannot possibly think it best that she should become pregnant, much less have a baby.

That would certainly not be in her interest, nor in society’s (though the latter cannot be the doctor’s main consideration).

He has little option but to prescribe, though this puts him in the awkward situation of conniving at what the law says is a sexual crime.

Read the whole piece here

Erecting a Tomb to Irish Sovereignty

Clinton — Sat, 28 Apr 2012 13:23:31 GMT

This story in City Journal (h/t Joel U.) demonstrates at least one thing that the euro is actually good for:

In Dublin, the artist Frank Buckley has constructed the interior walls of his flat with bricks made of shredded, de-commissioned Euro bank notes—with a face value of 1.4 billion Euros—that the Irish mint gave him for this purpose. All the furniture in the flat, including the microwave and the lavatory, is also lined with the shredded notes. He calls the lavatory “the Bertie bowl,” after Bertie Ahern, the now- discredited prime minister who presided over and benefited politically from the Irish property bubble that has indebted the country for decades to come....

Ireland having since been placed more or less under the tutelage of the European Central Bank, the European Union, and the International Monetary Fund, Buckley has erected a tomb to Irish sovereignty in one of his flat’s three rooms. Initially intended as a private home—Buckley has praised shredded Euro bank notes for their heat-insulating quality—his flat, literally made of money, soon had so many visitors that he decided to open it as a museum.

Too young to retire, too old to keep the job

Steve — Fri, 27 Apr 2012 16:37:48 GMT

Dalrymple has a new article in the Telegraph (h/t Teddy Msigwa) that points to growing conflict between older and younger workers. Because the economic crisis has reduced older workers' savings, they are increasingly postponing retirement and working later in life. Younger citizens, who already face a tough job market, are finding it even more difficult to land a job now because of the glut of more experienced and capable workers remaining in the market. Older workers are now facing a growing chorus of social critics calling for them to step aside and let the youth take over.

I thought we would see much more of this kind of intergenerational conflict by now. Our older generations have voted themselves a flood of benefits and entitlements for decades, and they've stuck youngsters with the tab. And yet the youth thus far have expressed outraged at any suggestion that the benefits be scaled back, no doubt because they cling to the hope that the shell game will continue through their own retirement. Still, I think we are going to see more of this kind of conflict.

Leniency and Its Costs

Steve — Fri, 27 Apr 2012 14:49:32 GMT

Dalrymple has a short piece for City Journal on George Thompson, the man whose act of arson helped kickoff the 2011 London riots and who was just sentenced to over 11 years in prison as a result. Dalrymple notes that Thompson had already had an extensive criminal record long before the arson.

What, you might ask, was such a man doing at liberty? Well, most importantly, he was providing a living for the lawyers who defended him when he was caught: he was what one might call a criminal Keynesian. And he was providing ammunition for penological liberals who argue that prison doesn’t work. After all, he had been to prison and still he set fire to the furniture store, endangering the lives of so many people!

Read it here

Aspirin: The Elixir of Life?

Steve — Wed, 25 Apr 2012 02:52:31 GMT

A medical piece at Pajamas Media:

Three recent papers in The Lancet propose the benefits of low-dose aspirin both in the prevention of certain cancers and in their spread once they have developed...

Does this mean that those of us who have reached the age of cancer — the incidence of cancer rises with age — should all be taking low-dose aspirin prophylactically? There is no indubitably correct answer to this question, and it all depends on your scale of values.

Dictators and their doctors

Clinton — Tue, 24 Apr 2012 15:50:34 GMT

Dalrymple in the British Medical Journal (subscription required):

There is something fascinating about the memoirs of the servants or confidants of great dictators. They allow us to see raw power close up, and to thrill to its horror. Personally, I can never resist a book with the title I Was X’s Y, where X was a dictator and Y was his maid, secretary, or chauffeur.

Doctors have written memoirs of dictators. Among the most famous, or infamous, are those of Dr Li Zhisui, The Private Life of Chairman Mao. When they were published there was a controversy as to how genuine they were, with both translator and publisher accused of spicing them up to attract sales. The author himself was accused of claiming a closer relationship than he really had with the Great Helmsman, whose insatiable sexual appetite and deficient personal hygiene, an unfortunate combination, he describes in horrifying detail.

Hitler’s doctor, Theodor Morell, kept a secret diary in which he recorded his master’s manifold symptoms and his unconventional treatment of them (he was known sarcastically as the chief Reich injection officer)—treatment which is thought by many to have hastened Hitler’s physical deterioration. Once in US captivity, Morell himself claimed to have applied such treatment precisely for that end; but then he would, wouldn’t he?

Franco’s dentist, Julio Gonzalez Iglesias, wrote a memoir called Los Dientes de Franco (Franco’s Teeth), a dental biography of the Caudillo, in which we learn the effect Franco’s continual dental problems—he suffered greatly from toothache—had upon his temper and hence upon his decisions.

The Ugly Brutishness of Modern Britain

Steve — Tue, 24 Apr 2012 00:10:03 GMT

Dalrymple had an Op-Ed in last Friday's Wall Street Journal (h/t: Joel U.) on incivility in modern Britain and its "militant or ideological edge":

Even middle-class people now behave in an increasingly uncouth and rough fashion in Britain because they think that by doing so they are expressing their solidarity with the lower reaches of their society. Imitation, they think, is the highest form of sympathy. This, of course, is an implicit insult to many of the poor, for poverty and unmannerliness are by no means the same thing.

Read the piece and its 183 comments (some of which are not filled with outrage) here.

Innocent tumours

Clinton — Thu, 19 Apr 2012 12:26:04 GMT

Dalrymple profiles a noted physician-author in the British Medical Journal (subscription required):

Sir John Bland-Sutton (1855-1936) was a most remarkable man. The force of his personality emanates almost palpably from his entry in the Dictionary of National Biography and its accompanying photograph. He was a small man who was said to have resembled Napoleon. As a surgeon he was dextrous and decisive. He had a ferocious—but constructive—determination to succeed, and he was generous to his juniors.

....

Two things puzzled me about Bland-Sutton’s Tumours (his double-barrelled name, incidentally, was assumed by deed poll, the union of his middle name and his surname): firstly, the dramatic nature, or grossness of the pathology, of the cases illustrated; secondly, the recognisability of the people who suffered from that pathology.

As artistic artefacts, the illustrations, though of the ugliest possible phenomena, are beautiful, and of enormously skilful draughtsmanship. But do such extreme cases, does such gross pathology (for example, of chondromata), exist nowadays? If not, is it because it does not occur in the first place, because surgical alleviation always attenuates it or because we hide it away, as the Victorians were supposed to have hidden piano legs?

Arrested hydrocephalus and the Round Britain Quiz

Clinton — Thu, 12 Apr 2012 11:55:37 GMT

In the British Medical Journal (subscription required) Dalrymple recounts the difficult life of the poet Algernon Charles Swinburne:

According to the pathologist William B Ober, who wrote many essays on the pathography of authors, Swinburne experienced anoxic brain damage at birth as a result of his large head (a state of arrested hydrocephalus). This anoxic damage manifested itself in Swinburne’s lifelong choreiform movements, his dysgraphia, tics, and hyperkinesis, as well as in his masochism. Portraits of Swinburne indeed show him as having a massive upper head by comparison with the rest of his body.

The lines quoted above are from “The Triumph of Time,” the long lament that he wrote after his one and only disappointment in love, after which he swore that he would never marry. And he never did. According to Harold Nicolson’s book Swinburne (1926), and other sources, the loved one was Jane Faulkner, the foster daughter of Sir John Simon—surgeon, public health pioneer, and later author of English Sanitary Institutions. Jane was fostered because her mother, Sir John’s sister, had died when she was young.

Sir John, whose sanitary reports were quoted by Karl Marx, kept a literary salon that luminaries such as John Ruskin attended, as did Swinburne. The latter addressed verses to Jane, who was scarcely more than 10 years old at the time. According to legend, he offered to marry her but she laughed at him; there was an altercation between them and he fled the house never to return. He then wrote his poem that quivers with misery: “I shall go my ways, tread out my measure, / Fill the days of my daily breath / With fugitive things not good to treasure . . .”

Bringing Nightingale down to size

Clinton — Wed, 11 Apr 2012 12:23:11 GMT

In the British Medical Journal Dalrymple calls F B Smith’s Florence Nightingale: Reputation and Power "[o]ne of the great works of historical debunking":

We all love heroes and heroines, but even more so do we enjoy the exposure of their hidden faults. I will not speculate on why this should be so: perhaps it is that, our lives being mediocre, we fear to contemplate unmitigated the heights of human accomplishment.

The greater is the reputation; the more guiltily delicious is the debunking. When I was a child, Florence Nightingale was an untouchable heroine, like Elizabeth Fry. Before her, nurses were Dickens’ Mrs Gamp; after her, they were ministering angels. Soldiers were eternally kissing her shadow as she went by.

....

Smith chronicles her manipulations, deviousness, evasions, and lies, but he admits that, overall, she did an immense amount of good. His aim is to disabuse us of the romantic idea that people who do good must themselves be good, but let us hope that his readers do not take this as a licence actually to be bad.

His explanation as to why Miss Nightingale did not destroy documentation that was unflattering to her memory is memorable:

Florence Nightingale, like Mr Richard Nixon and his tapes, was so possessed of the habit of deceit and the conviction that the full record would compel posterity to vindicate all her actions, that she could not bring herself to destroy material which had become part of her identity. Having brazened out lies in life she would brazen them out in death.

A Little “Respect” Goes a Long Way

Clinton — Tue, 10 Apr 2012 12:48:07 GMT

Dalrymple has a few paragraphs in City Journal about George Galloway's recent, successful, Islamist-based candidacy for parliament.

When the election results were announced, Galloway exclaimed, “All praise to Allah!,” to which his supporters responded, “Allah! Allah!” But the biggest cheer went up, at least according to the Guardian’s report, when he exclaimed: “Long live Palestine!”

Four days later, in the same newspaper, the political commentator Seumas Milne wrote that “the central thrust of Galloway’s pitch in Bradford was in fact about cuts, tuition fees, unemployment, poverty and the decline of a city.” This is a little like saying that when some of the people of Bradford marched through the streets calling for Salman Rushdie’s death after the publication of his Satanic Verses, they were protesting against the magic realist school of fiction.

The Policeman and the Brothel now available

Clinton — Mon, 09 Apr 2012 13:17:18 GMT

Monday Books has published the new Dalrymple book The Policeman and the Brothel: A Victorian Murder, the good doctor's account of the only killing of a police officer ever on the island of Jersey:

Deep in the bleak winter of 1846, Jersey is a very different place from today. It is home to tens of thousands of rough-and-ready sailors, who spend their time drinking, chasing loose women and gambling through the teeming and chaotic streets. The job of keeping order still falls to elected 'centeniers' - such as the respected and feared George Le Cronier. There have already been two brutal murders on the island over the last few weeks. Now Le Cronier is on his way to arrest the madame of a notorious brothel. This is the true story of what happened next...

The really interesting point here is that the book appears to be written as a narrative, which would be Dalrymple's first such work (or second, depending on how one categorizes So Little Done), and it will be fun to read him telling a story.

Buy the book at the bargain price of £8.99 here. Note the request for non-UK readers to contact them at info@mondaybooks.com before ordering.