Literature and Medicine

ANUMS

 

Personal and Professional Development Program

 

Notes on Literature and Medicine

 

 

37 on-line tutorials written and collated by

 

Tim Metcalf

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

© Tim Metcalf 2004-2005

 

 

 


 

 

Weekly PPD Postings 2005

 

 

Year 1

Biography and Medicine (first half of 2005)

 

McCann, Medicine Man

Clyde Fenton, Flying Doctor

Poidevin, The Lucky Doctor

Lindsay Rogers, Guerrilla Surgeon

 

Poetry and Medicine (twenty weeks in second half of 2005)

 

Introduction

Asclepius and the relatives he couldn’t choose: The Greek gods of Medicine.

Heap Big Medicine Man: readings in Amerindian medicine

John Keats

Dannie Abse

Andre Breton and Gertrude Stein

Omar Khayyam

William Carlos Williams

Grace Perry

Spike Milligan and Francis Webb

Shen

Jack Hibberd

Glen Colquhoun

Philip Hodgins and Michael Dransfield

Jennifer Harrison and Craig Powell

Australia and its convicts

The War Poets

Ovid and Clement Marot

John West, Saxby Pridmore

Miroslav Holub

 

 

Year 2

 

Literature and Medicine (20 weeks in second half of 2005)

 

*Clyde Fenton, Flying Doctor

*Lindsay Rogers, Guerrilla Surgeon

*Heap Big Medicine Man: readings in Amerindian medicine

Rabelais: Gargantua and Pantagruel; and Bertholt Brecht: Life of Galileo

*Omar Kayyam: Rubaiyat

Anton Chekhov: Ivanov

Shakespeare: King Lear

HG Wells: The Island of Dr Moreau

FJ Thwaites: The Mad Doctor

*Jack Hibberd: plays and poems

* Glenn Colquhoun: Playing God

*The Gods of Medicine

Robin Cook: Vector

Han Suyin: A Splendoured Thing

Ben Jonson: poems and The Alchemist; Christopher Marlowe: Dr Faustus

Somerset Maugham: Sheppey

J Bowman: Dr Angel

AJ Cronin, The Citadel

G Bernard Shaw, The Doctor’s Dilemma

George Eliot: Middlemarch

 

 

 

* will require replacement in 2006

 

 

 

 

A note on this program

 

These 37 compilations of literary fragments, and questions to stimulate discussion of contemporary ethical, moral, scientific and other issues, was developed over 2004 and 2005.

 

It has taken me at least a full day per week over these years to achieve this. On average the reading is about 10-12 hours, and the note taking and making 4-6 hours to create each piece. There is much peripheral reading, especially in poetry, that is not represented. There is some overlap of the two years, hence the apparent omission of  some second year pieces.

 

If I am invited to continue developing these pieces I would deepen my reading, especially into the historical and literary academic fields. I would extend the biography section and complete an outstanding 7 tutorials (I have already commenced the reading for this). I would hope to begin direct student contact, and thus further refine the usefulness of the pieces, with an aim of at the five year mark (end of 2008) have a coherent and tested text for the use of ANUMS and hopefully export to other educational facilities.

 

I have already submitted some sample essay questions for a proposed humanities option for 3rd or 4th year PPD essays.

 

I hope you find the postings interesting. I will be modifying them in first year as a result of my own remarks on the PPD program that I made after the journal marking I completed in August.

 

 

Tim Metcalf

 

Brogo, NSW, December 2005

Medical Biography 1: McCann ‘Medicine Man’

 

Over the next few weeks I will present a few short extracts from some books by Australian medical biographers and autobiographers. I hope these extracts will both stimulate your own entries into your PPD journal, and illustrate good writing styles. At the end of each reading I have placed a few extra points to consider making a note upon.

 

Our first extract is from Frank McCann’s “Medicine Man”,  which primarily concerns the story of a doctor in the remote NT between the two world wars. It has an easy, humourous style with some strong patriarchal language. McCann introduces his book as stories he has told so often his friends had him publish them, in the hope of shutting him up.

 

pp11-12 (on corpses for dissection)  I must admit I was always diffident about enquiring too closely as to the source of supply of these objects for study, and was intrigued by the readiness with which an attendant could supply at a price “a very nice set of brains” or “a lovely leg” for private study. The occasional carelessness of students in leaving such gruesome objects in public places has led to more than one false murder scare.

It is quite understandable why medical students, working under such conditions, periodically feel an urge to let of steam in some mad way or other…but there was one form of exuberance which always repelled me. That was the so-called ‘meat fight’.

Naturally, one’s regard for the sacredness of the human body is somewhat weakened by the familiarity of dissection, but even what little remains is revolted by the sight of pieces of bodies being thrown in all directions and one does not have to be squeamish to dislike being hit in the face with a lump of human fat. I understand, and hope, that such practices are now practically things of the past.         

 

 

p13 (of the stethoscope)…Occasionally it is handy for listening to some obscure sound in the chest, provided you can distinguish the sound when you hear it, but there are much more important uses. In order of importance I would list them as follows

  1. As a distinctive badge of office which clearly distinguishes the doctor from lesser mortals. It can be worn loosely round the neck or twirled casually in the hand as you walk from car to house and is particularly efficacious in letting the neighbours know that Mrs Brown is now “under the new doctor.”
  2. As something to use when you cannot think of anything else to do.
  3. As a means of gaining a little time to think what on earth you are going to tell the patient when you have no clue as to what is wrong with him.
  4. As a splendid toy for the kids when engaged in that popular game of “hospitals” or to distract the attention of a baby while its tummy is being prodded.
  5. In case of emergency the rubber tubing is handy for siphoning petrol.

 

 

p14 Stethoscopes notwithstanding, our reception at the hospital hardly came up to expectations, for the only people who took our arrival seriously were ourselves. The hospital staff, tired by years of seeing hordes of students come and go, were certainly not excited, and as for the ward sisters, we might easily have been a plague of noxious insects descending on their orderly domain. These amazons lost no time in issuing their official lists of “don’ts”, which ranged from a ban on talking to the nurses unnecessarily to strict warning about upsetting the tidiness of the beds.  

        We certainly were left with no illusions as to the place we occupied in the life of the ward, the lowest…

 

 

p16 One method of acquiring knowledge which almost assumed the nature of a sport was the hunt for interesting new cases, and the race to examine them before the crowd arrived. One might be fortunate to get a whisper ‘There’s a beautiful new heart in Ward Ten’, and if one hurried there was a chance of an uninterrupted ten minutes of examination with even the possibility of hearing one of those strange noises, indicative of certain heart diseases, which one had often heard described. A little delay in arriving at the scene would mean joining a queue. Pity for the patient who was being subjected to such prolonged amateurish examination often made me leave or conduct a perfunctory investigation. And so another opportunity of learning the mysteries of medicine would pass.

 

Consider: What are your current thoughts on medical school?

      How much do you already know about your future profession?

      What do you think about McCann’s first point about the usefulness of the stethoscope? The power relations of the stethoscope in the workplace have changed since McCann wrote this. It has also been appropriated, like many other symbols, by the advertising industry.

            Have a look at these two comments about working with the aboriginal people. Do you think there are any circumstances in which people should be rounded up for medical treatment?

 

p154 (rounding up aboriginal lepers for treatment) When a leper was located there was often the problem of what to do with him while we proceeded further in search of others. Sometimes it was necessary to resort to the primitive method of confinement I mentioned previously- the use of a light chain to secure him to a tree where, in the care of a trustworthy native and with a plentiful supply of food, he would pass a few comfortable days until we could pick him up on our return for transport into town.

 

p180 (taking aboriginals in the train to Darwin) The blacks were confined to their own compartments, but as far as the rest of the train was concerned, any such stupid distinctions as first and second class meant nothing.

 

 

References and Further Reading

 

McCann F (1959) Medicine Man         Angus and Robertson
Medical Biography 2 Clyde Fenton

 

Clyde Fenton made a name for himself as the first flying doctor in the Northern Territory. He flew from 1934 to 1939, very often making precarious landings on unimproved ground. Evidently he was considered something of a nuisance by the Civil Aviation Department, but he got what he wanted because of the unparalleled emergency service he offered in a place where ‘Usually the patient either died or recovered before the doctor reached him’.

 

His autobiography is entertaining, but focussed on the aviation aspects of his work. He will relate a tale of getting in and out of an isolated station over two or three pages, but dismiss the patient with one or two lines. Here is an account of a tooth extraction typical of the humour and practicality of the times:

 

p3 “Well,” I said, “if your toothache is really bad, you had better forget your cattle. I can’t possibly do the job here. I have no tools.”

“Aw, Gorblimey, Doc, haven’t you got a toolkit in that old crate of yours? What’s wrong with a ruddy pair of pliers?”

This staggered me a bit, but the drover was very insistent, and his mate piped up and said he wanted one extracted also. It was crude job, I’m afraid. There was, of course, no anaesthetic, not even a swig of whisky. The bite of the pliers was too wide for the tooth, and overlapped (and loosened) the one on either side. The patient sat on a log while I went to work with the greasy implement, and after a struggle which was painful for both of us, removed the offending fang. Encouraged by this success I called for the next victim, but found that his enthusiasm had rapidly waned. His tooth wasn’t so bad after all, and he thought he could wait until he got to the hospital at Wyndham.

 

Evidently there was a spat between Fenton and the Australian Inland Mission, founder of the Royal Flying Doctor Service under the Reverend John Flynn. Fenton records that ‘I tried to interest one of its leaders-Rev. John Flynn- in my scheme as far back as 1928, but his reply was ‘One man, One job’.  (ie: The Pilot flies, the Doctor stays in the back with the patient). Page* records that ‘Fenton was a dedicated flyer, expert and adventurous, but he was a high-spirited young man of unorthodox behaviour. He enjoyed the good things of life and had an amused disdain for authority. Possibly Flynn thought these characteristics would not fit the flying doctor image, and so established the “One man, One job” rule by way of polite refusal.

 

Fenton’s anxiety about epileptics establishes the wisdom of Flynn’s rule: “It was a ghastly prospect: what in hell should I do if he threw a fit in the air? There was only one thing I could think of; I sneaked into the hangar and procured the largest spanner available.”

 

Fenton describes the aborigines as satisfying patients who only attended if something was actually wrong. Describing a spearing of an aborigine as ‘casual’, Fenton’s white sense of superiority makes him miss what I observed myself in the Territory: that spear wounds were communally prescribed punishments inflicted in specific body regions by expert marksmen. It was not so miraculous that his patient survived.

 

 

 

Fenton describes vomit bags flying in your face in the old open cockpit planes, and trying to land with a brown snake between his legs in the cockpit. Another amusing flight saw him trying to get a patient with a homemade splint on a broken leg into and out of the cockpit of his biplane Gypsy Moth. “Seldom, I suppose, has anyone had a more interesting or exciting occupation.” “Many people have expressed surprise that I survived to tell this story; no-one is more amazed than I.” After a crash at Darwin airport he writes “The perils were past; the humorous aspects stood out in high relief. And there is no greater tonic to the soul than tragedy narrowly averted.”

 

Despite the daredevil bravado, Fenton gets more worried and cautious as the narrative proceeds, and reveals some anxiety. He admits ‘I was frequently involved in arguments with various authorities’; and that he found alcohol helpful. The story closes as he enlists in WWII.

 

For your journal? In the first quote Fenton advises a drover ‘you had better forget your cattle’. Is that good advice?

In the bush today you will find many farmers difficult to coax into hospital. Why is this? Have you encountered anyone who said their occupation made them reluctant to enter the hospital system? Take note of how doctors win over reluctant patients and comment on their techniques.

 

Evidently the Rev. John Flynn thought about occupational safety. Is there an aspect of occupational health that strikes you as in need of reform- for either the general public, or the medical profession in particular? Glaring contemporary examples of gross negligence are collapsed buildings, with no concrete supports between floors, in Bangladesh; and underground mine safety in China. What roles could a doctor possibly take after such disasters?

 

What might increasing conflict with authorities and plentiful alcohol consumption tell us about Clyde Fenton’s state of mind? What should authorities do when faced with such a doctor? What should you do?

 

References and Further Reading

 

Fenton C (1947) Flying Doctor  Georgian House Melbourne

 

*Page M (1977) The Flying Doctor Story 1928-1978 Rigby, p138

 

Medical Biography 3: Poidevin

 

 

In this fourth book of his recollections, Leslie Poidevin calls himself lucky because of his wife, ‘R.M.’ His medical career begins when his father, a doctor, dies on the night of his first leaving certificate (HSC) exam, and the Medical Benevolent Society helps him into the University of Sydney in 1932.

 

The best parts of The Lucky Doctor concern student days, and time as a POW (Prisoner of War) in East Timor then Indonesia under the Japanese in WWII. However, there is a separate book about the war entitled ‘Samurais and Circumcisions’ (In Chifley library D811.P65 1985). At the end of his life his anger at the human rights abuses in Timor surfaces as a hatred for the Japanese that his training as a physician cannot contain.

 

Like McCann, the first auto-biographer we looked at, Poidevin enjoyed dissection. There being a black market run by a dissecting room attendant, he was able to purchase an arm to work on at home. When the scheme was exposed, he panicked and stuffed his arm behind a locker. He claims he never returned for it! On another occasion a student found a penis in her handbag, but retaliated by stuffing it into the carburettor of the perpetrator’s new car (No need to try these tricks at home).

 

Poidevin also acquired the vices of smoking and nail-biting, and tells of his anxiety at the possibility of failure in final year. He lost weight, taking Fisher’s Phosphorine, an arsenical and strychnine type tonic highly regarded for ‘nerves’; and he was anxious to the point of vomiting over his Haematology viva.

 

In his description of a ward round with HH Schlink, a senior honorary in O&G, he recreates a bedside manner that is hopefully becoming a thing of the past:

 

“How long have you been bleeding?”

“Well doctor when Gran was staying with us at Easter…”

“I didn’t ask who was staying with you. How long have you been bleeding?”

“I’m not sure, doctor.”

“Oh for Christ’s sake get a proper history from this stupid woman. I’ll see the next patient.”  (p53)

 

Consider: What is going on in this dialogue? Who is failing to say what, and why? Have you noticed any examples of failed communication between doctor and patient that you can make some general observations about in your PPD journal?

 

Poidevin is next found with his colleagues sniffing ethyl chloride as 1939 grinds on and World War 2 becomes inevitable. In my reading of his text, his anxiety partly manifests itself as a passion for surgery. He talks of doing others’ call, of being almost unbalanced in his enthusiasm. When war breaks out he notes that nurses were ‘straining at the bit’ to get into the services, and he was in a quandary as to his own best course of action.

 

After a period of general practice in Scone, in 1941 he joins ‘Sparrow Force’ for East Timor, in Darwin, with the 2/12th Field Ambulance. Reinforcements were held back as 22,000 Japanese invaded…and all 2,000 Allied were captured or killed, and their 100 bed hospital and staff seized.

 

Clearly the war gave Poidevin nightmares for many years, but he focuses on the excellent opportunity to hone his surgical skills. In the POW camps for three years he keeps psychologically healthy by keeping busy: becoming surgeon to British (captive) forces in Java, and running a private practice in circumcision for the Japanese- to whom the operation was like getting a free ‘master card at a brothel’. Being a POW was his greatest lesson in life.

 

Consider: Personally, I hope never to become embroiled in somebody else’s armed conflict. What about you? What would you do, for examples, if your government called you up, or the enemy kidnapped you and forced you to work on their wounded?

 

Later in the book Poidevin calls the specialist consultants of Adelaide’s North Terrace ‘Jack Russells’, but goes on to laud the system of commercial competition for patients, acquired through honorary positions at hospitals and private contacts, that perhaps created those personalities he was affronted by. He also denounces tie-less academics and the Whitlam Medicare program.

 

Consider: This doctor makes a number of asides about stress in his younger days and the medications he tries to combat it. If this is a problem for you at any time in your career, talk to someone about it, instead of suffering until it is time to write your memoirs!

 

References and Further Reading

 

Poidevin L (1988) The Lucky Doctor  Self-Published ISBN 0 9588361 2 4

 

NB: curiosity…Rabelais 468, 476 Poidevin mentioned as red-faced Picts

Medical Biography 4: Lindsay Rogers

 

 

“We soon ran out of Steinman pins for fractures, and used ordinary four inch nails, and for our ligatures there was always the unravelled silken cord from parachutes. Gowns we had none, gloves we had none…”

 

Lindsay Rogers was a New Zealander awarded the MBE (Member of the British Empire) and the Orders of Merit and Bravery of Yugoslavia for his part in treating Tito’s wounded partisans, often behind German lines, in WW2.  His autobiographical account is very well written: he gives a good account of the countryside, the people, the military bureaucracy, and the constant ethnic and political turmoil, without overlabouring the surgical parts of his story. This is good technique: surgery alone would make for a rather dry read. He finds the dramatic contrasts and illuminates them: peasant women singing ancient songs as, armed 24 hours a day with grenades and Sten guns, they negotiate the mountainous terrain on their way to kill the Germans and their Chechen and Utashi allies. As the book goes on the source of their hatred becomes clear, though Rogers remarks that “The German occupation merely fomented the existing troubles”.

 

After the Germans were pushed out of North Africa, Rogers found life too boring in Tunisia, so volunteered to be inserted by the British SOE (Special Operations Executive) into occupied Yugoslavia in 1943. This nation was born after WW1, at President Wilson’s League of Nations conference. With the Italians already in the Balkans, Dalmatia, and Croatia, Hitler invaded on 13th of April 1941. Churchill tried to unify the Greco-Balkan region into a single army, but found it could not be done. Ultimately it is Tito who achieves something approaching this ideal, but with him came Russian Communist power politics. Indeed, the climax of the book is the Anti-Fascist Youth Congress, attended by Tito, and Churchill, who learnt his speech in Croatian. Great cries of ‘Zivio Tito! Zivio Marshal Stalin’ make for an enthralling historical moment: “I knew the power of youth; I knew the power of resistance and the fever of hope which drove them on. Yugoslavia will be free.” As the war comes to a close, the British find themselves less and less welcome capitalists, and leave with some resentment at the lack of gratitude for their assistance during the war.

 

The war in this region was brutal and there were many civilian atrocities:

 

“…they lined up four hundred of the old people in front of the partisan headquarters and shot them all “because of the resistance.” Girls were taken, if found, and put into the German brothels for use until such times as nature or disease intervened. Then they were shot.”

 

“I remembered a courier patient of mine who had escaped from a German unit. He had been caught by a patrol and taken to a headquarters and asked about the movement of partisan groups. He didn’t answer. They struck him on the face with their rifles and said “Answer, you dog!” He was only seventeen. They struck him again and again until he fell. He was pulled out and locked in a room. Next day the same thing happened. No answer. Then they tied his arms with wire to a beam above his head, and from his testes they hung a brick tied with copper wire. Gradually his bladder filled, but he couldn’t pass anything because of the wire. Gradually the weight strangled his genitals. The pain was terrific; not so much the blackened strangulated testes and penis, but the awful tension in his bladder. A sudden pain and the abdominal agony ended. His bladder burst and he swooned away. The next thing he recalled was a peasant lifting him down at night and carrying him into the darkness. Luckily I was near at hand and operated. But his gangrenous genitalia I couldn’t replace.”

 

In the end, Rogers has to confront the Hippocratic oath. With wolves eating patients who had to be hidden in the forests for days or weeks; operating theatres hung with icicles as thick as thighs; gross surgical injuries; the enemy hunting them so that they used amputated limbs to put Nazi bloodhounds off the scent; and after seeing a hospital burnt to the ground, the remaining bones of the patients shrouded in white ash; he joins a patrol upon which they ambush some of the alleged hospital burners. Here he is euphemistic: “The forest rang with the music of victory, and five of the hospital hunting hunters were gone.”

 

For your journal?: Take your pick of contemporary wars. Is there anything you have read of medical conditions there? Which has the better technology: weapons or surgery? What non-military ways are employed to debilitate the local population? You could look at the Medecins Sans Frontieres website for ideas: www.msf.org

 

 

This is the last of the notes on Medical Biography. For the break I will provide you with a short list of web sites in the Medical Humanities, in case you are interested.  After the block break we will commence our brief but fascinating overview of the poetry of medicine.

 

 

References and Further Reading

 

Rogers, Lindsay (1957) Guerilla Surgeon   Collins, London

(Hancock Library R674.R6A3 1957)

 

Poetry and Medicine?

 

Introduction

 

Poetry, like the other arts, forms bridges between our intellectual and emotional worlds; between rational and irrational, planned and instinctual; between science and suffering, doctor and patient.

 

Poetic language is a necessary tool in human communication. Patients, for example, in order to describe what is happening under their skin (the point at which their knowledge of the body often stops) must revert to the devices of simile and metaphor: ‘It felt like a brick pressing on my chest’. A clenched fist over the sternum, which is a visual body language simile, is also unconsciously adopted by many people with cardial ischaemic pain.

 

Similarly, there is no need for a doctor to learn these languages. There are quite a few new words and signs to become familiar with, but no new language.

 

A fundamental property of poetry is its ability to contain ambiguity, paradox, or absolute contrariness. This is how it can function as a useful art in the field of medicine. The science of medicine acts upon human beings embedded in a complex society. Patients and doctors in their everyday thoughts and actions are motivated by many more priorities and desires than can be described by the scientific model. Hence a doctor might save a life with a kidney dialysis machine, which is one thing, but then have to work with a depressed patient who wants to die, which is another.

 

Over the next 20 weeks I will post once a week a note like this concerning the poetry of medicine, including an introduction to Australia’s finest doctor-poets. I hope you enjoy the posting, either alone or in company, and think about the questions raised by the poems. Responding to a poem might include writing one of your own: we would love to see them on the discussion group!

 

A number of journals publish poetry by doctors. These include The Lancet, JAMA, BMJ, Progress in Palliative Care, The British Journal of Medical Ethics, Journal of Medical Humanities, Australasian Psychiatry, and I am poetry editor for Australian Family Physician, and on the look out for new talent!

 

Poems

 

Here are two poems of mine that appeared in The Lancet and the Br J Med Ethics respectively. Consider them in the light of my introductory remarks. What do you see going on here? And please, give us your stethoscope poem!

 

can’t…breathe

 

In tense moments

I wish my stethoscope

was all they want it to be:

two steely serpents

unwound from the physician’s staff,

whispering answers

in my ears.

 

Reflected in the sterile metal

I see this differently:

forehead tethered to a frown

by ostentatious earrings

weighing me down

like question-marks

in lead.

 

 

 

 

These dead in their studied sections

 

We were introduced, respectfully,

to the volunteer dead

who turned their bodies over to the scalpel-blades

of science and education.

Their leisurely dissection afforded ample time

to feel the cold silken fat beneath skin;

the pickled flesh textured like old steak.

We sketched potted body bits,

horror-drawn to the woman

slivered head to toe in one-inch slabs.

I reckoned she was close

to bearing her grey baby.

 

These dead in their studied sections

left their impressions in our young minds

but never so incisively as those

who struggled in our newly graduated hands

with their trauma: the violent head-shot,

the car-smashed and knife-struck;

the steel-gouged, truck-ruptured and train-cut;

from farms the cow-crushed, horn-gored,

back-snapped and power-take-off-shafted;

the grey burnt-alive in their ghastly cloud;

the blood-blistered sand-suffocated;

and the drowned, reef cut and swilled in body bags.

 

Most who die don’t struggle.

Death has humbler ways:

failed and fevered organs, numb comas,

cancer’s flesh-plug pulled and lives drained away;

the prompt departure of hearts long-caged

in hard-artery nets drawn suddenly tight;

the master-strokes that kill the brains.

 

The professional endures, with their patient

frustrated incapacity

the flop of limbs and organs;

waits until some industrious micro-organism

claims the body for its temporary citadel

and coughs its tiny satellites of death

into a hospital ward thick already

with its spores.

 

Death, seen so often, takes nothing from us,

miraculously kills none

of our own death’s desire:

to find our body in its bed, at home

one early bird filled morning,

woken up, as they say,

dead.

 

 

                                               

and finally…

 

I am sure you will find the postings interesting. Not all the poems will be serious!

I especially hope that from time to time you will choose to respond with a remark or poem of your own.

 

By the way, next year we will be looking at some classic novels and plays in the medical humanities. This will be, I trust, a second pleasant, fascinating and relaxing part of your exploration into the art of medicine.

 

Tim Metcalf

 

Further reading

 

Lakoff G and Johnson M (1980) Metaphors we live by. Chicago University Press

 

Sontag S (1983)  Illness and Metaphor   Penguin  Chifley PN56.T82S6 1983

 

pm2 

 

Asclepius, and the Relatives he couldn’t choose.

 

“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgement this oath and this covenant.” So begins the Hippocratic oath.

 

Dr Gillie Bolton at the University of Sheffield has written “Poetry and Medicine have gone hand in hand since Apollo was god of both.” These two imperatives of the human species extend far into prehistory, and have not been distinguishable until recent times. 

 

In modern India, for example, it has been estimated that there are 300,000 household deities, predominantly of the Hindu pantheon, to whom people each day offer prayers (sacred poetry) flowers and food, in order to secure health, wealth, or continuity of the family. In contemporary Australia too, it is a rare person indeed who when threatened with dying does not ask their ‘god’ for help. Clearly the gods of medicine are alive and well.

 

Asclepius

 

Consider this description of the Greek god of healing:

 

‘A gentle craftsman who drove pain away,

Soother of cruel pangs, a joy to men,

Bringing them golden health.’

 

The choice of words here is profound. Poetry is being used to define Medicine. Pain is driven away; health (which is golden) is brought back. Here there is motion, and separation. Diseases can be pulled from the body, and health reinserted, by a gentle craftsman.

 

This is profound because other models of health do not use this metaphor. For examples, they might regard the body as a central embodiment of spirit, as a harmonic element of a vast cosmos, or as a place the soul is confined to as punishment. Thus the scientific model will inevitably generate conflict if it is applied unthinkingly.

 

Asclepius ( ‘unceasingly gentle’) was the bastard son of Apollo by a mortal woman Coronis (crow). He was hidden from his angry grandfather Zeus in the cave of Chiron the Centaur, who was a second cousin, and who taught him the art of healing, especially with herbs. Asclepius, according to Homer, had two sons who became the field surgeons at the siege of Troy. Eventually Zeus struck him dead with a thunderbolt for committing the crime of returning the mortal Hippolytus, son of Theseus, to life, because Hades, god of the underworld, was infuriated at having his subjects stolen in this way.

 

The centre of Asclepius’ cult can be visited today at the famous site of Epidavros in the Peloponnese. His cult was associated with the snake in particular, and the god is often represented with a staff with an entwined snake: a symbol adopted by many medical institutions. This is the point of the steely serpents in the poem on the stethoscope I posted last week. Exactly why serpents have become associated with Asclepius is not known, though it may be because they shed their skin, appearing to regenerate each year. We do know they were kept in some temples.

 

Eventually Zeus relented and returned his immortality to Asclepius. He set his image, holding a curative serpent, in the starry heavens for all people to see. The cult of Asclepius was brought to Rome in 293 BC after a Sybilline prophecy on the pestilence in the city. Therefore the Latinised form of his name, Aesculapius, is often seen.

 

More on the Relatives

 

Apollo has many attributes as a god, and there are many stories about him which can easily become confusing. For our purposes it is interesting to note that his cult probably suppressed pre-Hellenic cults of the oak, the moon-goddess, and the raven; and that there was much ‘ecclesiastic politics’ involved in the mythology of the ancient world.

 

Thus Apollo’s seduction of the tree nymph Dryope may be a record of the absorption of the oak cult: Fraser speculates that he became a ‘personification of the curative power resident in the dismembered genitals of the sacrificial oak hero’. Similarly, Apollo kills Coronis, the raven, when she is unfaithful to him, but rescues Asclepius from her body as it burns on the funeral pyre. The willow tree had powerful moon magic, and a bitter drug was prepared from its bark. Do you know what it was?

 

The case of Hygieia, goddess of health, daughter to Asclepius, and the root of our modern word hygiene, is also revealing. Her cure-all, (panacea in Greek), was mistletoe, which grew on the oak, and was called ixias. Ixion was the God who engendered Chiron and was condemned to revolve forever, tied to a giant wheel (Life). Hygieia has been found at prehistoric shrines entwined with snakes, and in ancient Greece was often depicted feeding snakes a saucer of milk.

 

Imhotep

 

Imhotep, ‘the one who comes in peace’, is considered the world’s first doctor, and was architect of one of the great pyramids. He lived around about 2600BC and seems to have become deified by the Greeks as well as his own people. His work came to be performed by priests in his temples, called Asklepion,  with a sleeping patient. Though there were many ways of divination, it seems dream interpretation supplanted them in his cult.

Sir William Osler, however, says that Imhotep was the:

"..first figure of a physician to stand out clearly from the mists of antiquity." Imhotep diagnosed and treated over 200 diseases, 15 diseases of the abdomen, 11 of the bladder, 10 of the rectum, 29 of the eyes, and 18 of the skin, hair, nails and tongue. Imhotep treated tuberculosis, gallstones, appendicitis, gout and arthritis. He also performed surgery and practiced some dentistry. Imhotep extracted medicine from plants. He also knew the position and function of the vital organs and circulation of the blood system.

It is interesting in this light to ponder what forces caused Imhotep’s followers to turn to temples and dream interpretation.

 

Something to consider

 

Pick a god, any god. What aspect of that god is manifest in health care today?

 

 

References and Further Reading

 

Graves R (1955) The Greek Myths  Pelican  chapters 21, 50, 63

 

Fraser, Sir James (1914) The Golden Bough  Macmillan  v 88 n1

 

Howaston MC and Chilvers I (1993) The Concise Oxford Companion to Classical Literature  Oxford University Press

 

Carmichael AG and Ratzan RM (1991) Medicine in Literature and Art   Konemann  pp 31-36

 

www.touregypt.net/featurestories/imhotep.htm

 

homepage.mac.com/cparada/GML

 

Bolton G. Opening the Word Hoard  (this is a regular column) J Med Ethics: Medical Humanities  2000; 26; 55-57

 

pm3

 

Heap Big Medicine Man

 

The study of so-called ‘primitive’ cultures is both fascinating and of the greatest benefit to those who plan a career working with people; not least because Australia is home to the oldest culture of all.

 

Over several hundred years the white colonisers of the Americas set about destroying the native cultures. In the US after World War Two the process took on the far more insidious and successful forms of sedation by TV and junk food, ‘dumbing down’, and obsessive money and personal health cultures that were working on the whites. One apparent outcome of this was the emergence into the media of Medicine Men from across the country. These men, and women, revealed certain fragments of American Indian teachings on the subjects the white dominators were seriously failing in: spirit; environment; wealth creation; medicine.

 

There are many books and readings from the 16th century on. To me it seems that more and more is being steadily revealed to us. Sometimes Medicine men and other Indians mock the consumer society and white people in general. However, ‘white man’s’ literature has spiritual roots as deep and complex as anyone else’s. In the Buddhist world-view, which like ancient Chinese thought has much in common with Amerindian teachings, this attitude represents a small failure of compassion.

 

Compassion is different to empathy: it is the ability to allow all things to be as they are. Our so-called ‘white man’s’ culture is a voracious assimilator of the intellectual treasures of other cultures. It has taken many beliefs and practices from around the world, and is continually integrating these into an increasingly sustainable world-view. Practically, as a doctor, you will frequently meet people who embrace a different world-view to that of your own. This may, by the way, manifest as an expressed hatred of scientific medicine (whilst submitting to the treatment). It would be helpful to consider how you are going to accept people’s ideas, no matter how strange. The famous psychoanalytic theorist Melanie Klein calls this ability the ‘suspension of disbelief’.

 

The whole point of this listening. The more you listen as a doctor, the more you will hear. In other words, if patients trust you not to laugh at their world-view of health, they will tell you, for example, what other treatments they are taking from ‘alternative’ practitioners. This will help you avoid drug interactions. It will also teach you about a given patient’s health network. Good communication is vital to recovering health!

 

With that in mind, enjoy some brief readings:

 

This fragment from a ‘Change Song’, is a modernised translation of a ritual chant from an unknown tribe published early last century:

 

Death’s first snows are drifting on my cheek…

…sing my kinsman, when the oldest man

takes his lone trail through the forest

He will wear no mourning-blanket when he comes home again tomorrow!

He will say “Rejoice-

I have borne your grief afar,

I have buried it deep,

the place is not known.”

 

It is clear that only fragments of much longer holy stories were revealed to early collectors. Anthropology, often condescending, was very popular after Darwin’s Origin of the Species, and no doubt Indians revealed fragments to get people off their backs! This piece of a Doctor’s Song of the Chippewa, for example, reveals a world of Shamanistic practice. Perhaps this was brought over the Bering land-bridge from Russia in prehistoric times.            

 

I am singing and dreaming in my poor way

over the earth

I who will again disembark

upon earth

 

 

This is a record of the Blackfeet of the Great Plains in the 1830’s:

 

“The fur traders in this country are nearly all French. In their language, a doctor or physician is called “Medecin.” The Indian country is full of doctors. They are all magicians, and skilled, or professed to be skilled, in many mysteries. The word ‘medecin’ has become habitually applied to anything mysterious or unaccountable. The English and Americans, who also trade and pass through this country, have easily and familiarly adopted the same word, with a slight alteration, to convey the same meaning. “Medicine- men” means something more than merely a doctor or physician. Medicine-men are supposed to deal in mysteries and charms, which are aids and handmaids in their practice. Yet it was necessary to give the word or phrase a still more comprehensive meaning, as there were many personages among them, and also among the white men who visit the country, who could deal in mysteries, though not skilled in the application of drugs or medicines. All such men who deal in mysteries are included under the comprehensive and accommodating phrase ‘medicine-men’. For instance, I am a ‘medicine-man’ of the highest order among these people*, on account of the art which I practice, which is a strange and unaccountable thing to them, and of course called the greatest of ‘medicine’. My gun and pistols, which have percussion locks, are great medicine. No Indian can be prevailed on to fire them off, for they say they will have nothing to do with white man’s medicine.

 

The Indians do not use the word medicine, however. In each tribe they have a word of their own construction, synonymous with mystery or mystery-man.

 

The ‘medicine bag’, then, is a mystery-bag. Its meaning and importance must be understood, as it may be said to be the key to Indian life and Indian character. These bags are constructed of the skins of animals, or birds, or of reptiles, and ornamented and preserved in a thousand different ways, as suits the taste or freak of the person who constructs them. These skins are generally attached to some part of the clothing of the Indian, or carried in his hand. They are oftentimes decorated to be exceedingly ornamental to his person, and always are stuffed with grass, or moss, or something of the kind. Generally there are no drugs or medicines within them, as they are religiously closed and sealed, and seldom, if ever, to be opened. I find that every Indian in his primitive state carries his medicine bag in some form or other, to which he pays the greatest homage, and to which he looks for safety and protection through life. Feasts are often made, and dogs and horses sacrificed, to a man’s medicine. Days and even weeks of fasting and penance of various kinds are often suffered to appease his medicine, which he imagines he has in some way offended.

 

 

Professor Jack Coulehan at Stonybrook in New York is an internationally renowned poet and doctor with strong ties to Australia. He is a major contributor to the NYU database on literature and medicine.

 

“As a young doctor [he] headed out to a Navajo Indian reservation, in the central arid region of the USA. Like the Greek physician Asclepius, the Navajo believe that illness is a disharmony between the inner and outer cosmos. Healing rituals take days, and involve lengthy sessions of chanting poetry, singing sacred sequences and the construction of complex sand paintings. The purpose of this is to retell the life story of the ill person so that it follows a right path, along which the behaviour that causes the illness does not occur.”


”Traditional medicine men coexist with physicians and hospitals on the 25,000 square mile Navajo Indian Reservation. Most seriously ill Navajos utilize both systems of health care. This natural experiment of coexistence emphasizes several general characteristics of all healing. Traditional ceremonies are successful because they are integrated into Navajo belief systems and meet needs of sick people not dealt with by the available Western medicine. ..Reductionism limits the spectrum of obstacles considered relevant (eg, causes of illness), but an alternate model might include emotional, social, or spiritual phenomena …”

 

In the early 1930s Black Elk, a great Sioux Medicine Man who witnessed the battle of Little Big Horn and the massacre at Wounded Knee, spoke about the healing ceremony performed around a sick person in a tepee:

 

“You want to know why we always go from left to right like that. I can tell you something of the reason, but not all. Think of this: Is not the south the source of life, and does not the flowering stick truly come from there? And does not man advance from there toward the setting sun of his life? Then does he not approach the colder north where the white hairs are? And does he then not arrive, if he lives, at the source of light and understanding, which is the east? Then does he not return to where he began, to his second childhood, there to give back his life to all life, and his flesh to the earth whence it came? The more you think about this the more meaning you will see in it.”

 

In 1972 Lame Deer, also of the Sioux, spoke with a sharp wit and, especially considering the decimation of his people, a wonderful humour:

 

“I believe the only real medicine man in the wicasa wican- the holy man, Such a one can cure, prophesy, talk to the herbs, command the stones, conduct the sun dance, or even change the weather, but all of this is of no great importance to him.”

 

“The Sioux have a name for white men. They call them wasicun: fat-takers. It is a good name, because you have taken the fat of the land. But it does not seem to have agreed with you. Right now you don’t look so healthy- overweight, yes, but not healthy. Americans are bred like stuffed geese- to be consumers, not human beings.”

 

“ I would like to talk about one more thing. I have been to New York, Chicago and some other big places, stayed in your house many times, met a lot of people and kept my eyes open. So I know a little about what you call psychology. I have heard about group therapy and encounter meetings and found out that some white people have a way of acting out their troubles as in a play. Well, I must tell you that we Indians knew about these things a long time before you did. For longer than anyone can remember, many Sioux ceremonies always ended with a kind of Indian ‘group therapy’- with everybody taking his turn in a circle, talking about his problems, about what’s wrong with him. And a heyoka, a thunder-dreamer and clown, always has to act out his dreams in public, no matter how embarrassing that may be. At least it doesn’t cost him 35 bucks an hour.

I also think that it is a very wise sort of Indian psychology that a medicine man doesn’t dress up fancy with feathers and war bonnet when he performs a ceremony.”

 

Lame Deer also gives us a sketch of herbal lore with his charactersitic sense of humour:

 

“Tate canuga-a kind of snakeroot- is for treating poor appetite. But with no jobs and no money on the reservations, that’s one herb we don’t need right now.

 

Can hlogan wastemna- a ragweed- helps a woman during a bad child-bearing. It will also make a man fall asleep so that you can steal his horses, but it’s no good for stealing cars.”

 

 

References and further reading

 

Caitlin G (183?)Letters and Notes on the North American Indians in Carmichael AG and Ratzan RM (1991) Medicine in Literature and Art   Konemann  pp176-7

 

Coulehan JL. Navajo Indian medicine: implications for healing.  J Fam Pract. 1980 Jan;10(1):55-61.

 

Coulehan J www.uhmc.sunysb.edu/prevmed/mns/imcs/contexts/

altmed/coulehan.html  (essay on Navajo experience and alternative medicine good and bad)

 

Coulehan J: His poetry books are The Heavenly Ladder and Medicine Stone.


Cronyn GW(ed.) (1918/1991) American Indian Poetry: An Anthology of Songs and Chants  Fawcett Columbine NY There are numerous fragments in this collection.

 

Lame Deer & Erdoes R (1972) Lame Deer Seeker of Visions   Washington Square Press  chs 3 and 9

 

Neihardt JG (1932, 1972) Black Elk Speaks  Pocket Books NY p180

 

Sarris G 1993  Keeping Slug Woman Alive    University of California Press

 

 

A holiday?

 

If you feel like being swept away by all this stuff, why not go rafting down the Grand Canyon on the Hero’s Path with Zen poet and paediatrician Ted McMahon. It’s on the web. His book of poems is called ‘The Uses Of Imperfection’ (2003 Cat’n’Dog Productions, Seattle)

pm4

 

Drinking your own blood

 

John Keats is arguably the most famous physician-poet. He was born in 1795. In 1810 he was apprenticed to a surgeon, and in 1816, after passing his Licentiate at Apothecary Hall in London, began work as a dresser at Guy’s Hospital.

 

His first book ‘Endymion’ is perhaps a patchy, even tedious, piece of 19th century romanticism, but it begins famously:

 

‘A thing of beauty is a joy forever:

It’s loveliness increases, it will never

pass into nothingness, but still will keep

a bower quiet for us, and a sleep

full of sweet dreams, and health, and quiet breathing.’

 

Keats is famed for his lyrical poetry, but also for remaining optimistically passionate about Nature, Truth, and Beauty through a sad and short life. He very soon gave up medical practice to devote his life to literature. He died of consumption in 1821, when he was only 25.

 

Consider: What was consumption? Why was it called that?

                 What is it like to be a patient with a thorough knowledge of one’s condition?

 

Here are parts 2 and 3 of John Keats’ ‘An Ode on Melancholy’

 

2

But when the melancholy fit shall fall

Sudden from heaven like a weeping cloud,

That fosters the droop-headed flowers all,

and hides the green hill in an April shroud;

Then glut thy sorrow on a morning rose,

or on the rainbow of the salt-sand wave,

or on the wealth of globed peonies;

Or if thy mistress some rich anger shows,

emprison her soft hand and let her rave,

and feed deep, deep upon her peerless eyes.

 

3

She dwells with Beauty-Beauty that must die;

and Joy, whose hand is ever at his lips

bidding Adieu; and aching Pleasure nigh,

turning to poison while the bee mouth sips:

Ay, in the very temple of delight

veil’d Melancholy has her Sovran shrine,

though seen of none save him whose strenuous tongue

can burst Joy’s grape against his palate fine:

His soul shall taste the sadness of her might

And be among her cloudy trophies hung.

 

Consider: Is to ‘glut thy sorrow on a morning rose’ a worthwhile treatment for melancholy?

                  Is there something healthy about nature? Have you had an experience you can write about?

 

John Logan was a prominent poet in the United States in the 1960’s. This is part of his elegy ‘On the Death of Keats’:

 

“How long is this posthumous life of mine

to last”, you said.

What is a poet without breath enough?

The doctor made you swallow cupfuls of your blood

when it came up

out of your rotten lungs again.

Your study of medicine

made you suffer more the movements

of your death. One tiny fish

and a piece of black bread

to control the blood

every day you died. You starved for food

and air. For poetry. For love.

 

 

Consider:  Look up the treatment Logan mentions: drinking your own blood: what was the purpose of this?

                        Try writing your own poem in which you imagine what it is like to be a doctor who suffers a particular medical condition.

 

 

There is a lot of literature about tuberculosis. Next year we will look at The Magic Mountain, the novel that confirmed Thomas Mann for the Nobel Prize.

           

 

References and further reading

 

Keats’ work can be found anywhere.

 

Logan, John (1969)  The Zig-Zag Walk : Poems 1963-1968

 

Mansfield, Katherine   Journal extract in Carmichael AG and Ratzan RM (1991) Medicine in Literature and Art   Konemann p228 

 

 

pm5

 

Dannie Abse

 

Born in 1923, Abse is a retired chest physician famous for his poetry. He is the author of a long list of books and lives in the US.

 

‘His lifetime work as a doctor has given him a grounding in human frailty and reality that many poets lack’ (www.contemporarywriters.com/authors)

 

A Welsh Jew who trained and lived in London, his heritage is clear in his poetry:

Case History

'Most Welshmen are worthless,
an inferior breed, doctor.'
He did not know I was Welsh.
Then he praised the architects
of the German death-camps--
did not know I was a Jew.
He called liberals, 'White blacks',
and continued to invent curses.

When I palpated his liver
I felt the soft liver of Goering;
when I lifted my stethoscope
I heard the heartbeats of Himmler;
when I read his encephalograph
I thought, 'Sieg heil, mein Fuhrer.'

In the clinic's dispensary
red berry of black bryony,
cowbane, deadly nightshade, deathcap.
Yet I prescribed for him
as if he were my brother.

Later that night I must have slept
on my arm: momentarily
my right hand lost its cunning.

 

Consider: How important is tolerance of other’s viewpoints in medical practice?

     How does one go about becoming tolerant of one’s patients?

 

 

 

 

 

 

 

Here’s a terrific spooky story, should you like that sort of thing…

 

 

In the theatre

 

(a true incident)

 

Only a local anaesthetic was given because of the blood-pressure problem. The patient, thus, was fully awake during the operation. But in those days, in 1938, in Cardiff, when I was Lambert Rogers’ dresser,- they could not locate a brain tumour with precision. Too much brain tissue was destroyed as the surgeon crudely searched for it, before he felt the resistance of it…all somewhat hit and miss. One operation I shall never forget…

                                    (Dr Wilfred Abse)

 

Sister saying- ‘Soon you’ll be back in the ward,’

sister thinking – ‘Only two more on the list,’

the patient saying- ‘Thank you. I feel fine’;

small voices, small lies, nothing untoward,

though, soon, he would blink again and again

because of the fingers of Lambert Rogers,

rash as a blind man’s, inside his soft brain.

 

If items of horror can make a man laugh

then laugh at this: one hour later, the growth

still undiscovered, ticking its own wild time;

more brain mashed because of the probes’ braille path;

Lambert Rogers desperate, fingering still;

his dresser thinking ‘Christ! Two more on the list,

a cisternal puncture and a neural cyst.’

 

Then suddenly, the cracked record in the brain,

a ventriloquist voice that cried, ‘You sod,

leave my soul alone, leave my soul alone,’-

the patient’s dummy lips moving to that refrain,

the patients eyes too wide, and, shocked,

Lambert Rogers drawing out the probe

with nurses, sister, students petrified,

 

‘Leave my soul alone, leave my soul alone,’

that voice so arctic and that cry so odd

had nowhere else to go- till the antique

gramophone wound down and the words began

to blur and slow,’…leave …my…soul…alone…’

to cease at last when something other died.

And silence matched the silence under snow.

 

 

 

Abse has said that ‘Poetry shouldn’t be an escape from reality, rather an immersion in reality’, and noted that few doctor-poets can sustain both professions: he believes because the poet has ‘too much empathy with creatures and things to become a good doctor’.

 

At school he didn’t like poetry. It was polemical left-wing poetry, in his brother’s pamphlets on Franco’s 1937 Spanish civil war, that set him going. Another brother put his name down for medical school. Abse claims he was a hopeless student.

 

Complimented on his reassuring honesty, and asked ‘what is the essential quality of a poet?’ he replied ‘Don’t know’.

 

Further reading and references

 

‘White Coat: Purple Coat: Collected Poems 1948-88’ is available in Chifley at PR6001.B7W45 1989

 

www.contemporarywriters.com/authors

 

Penguin Modern Poets Vol 26 1975 pp63-4

 

lidiavianu.scriptmania.com/dannie-abse.htm  Incidentally this is a good example of a bad interview.

pm6 Soluble Fish: Andre Breton, Gertrude Stein; W A Osborne

 

Andre Breton (1896-1966) is generally credited with the founding of Surrealism in 1919. Many also consider him the founder of Dada in 1915. Just as it was for millions of his fellow citizens, the First World War entirely disrupted his life. He was a medical student at its outbreak but spent the war as an orderly in a military mental hospital. Here he met Sigmund Freud, and used his techniques on some patients. Though Breton claimed that the war did not affect the evolution of human thought towards Surrealism, it is likely that the experience affected him powerfully.

 

After the war he became an art dealer and in 1924, after experimenting with automatic writing and dream imagery, published the famous ‘First Manifesto of Surrealism’ along with a short surrealist novel ‘Soluble Fish’. In the Manifesto he says that:

 

‘Man proposes and disposes. He and he alone can determine whether he is completely master of himself, that is, whether he maintains the body of his desires, daily more formidable, in a state of anarchy. Poetry teaches him to. It bears within itself the perfect compensation for the miseries we endure. It can also be an organiser, if ever, as the result of a less intimate disappointment, we contemplate taking it seriously. The time is coming when it decrees the end of money and by itself will break the bread of heaven for the earth! There will still be gatherings on the public squares, and movements you never dared hope participate in. Farewell to absurd choices, the dreams of dark abyss, rivalries, the prolonged patience, the flight of the seasons, the artificial order of ideas, the ramp of danger, time for everything!’(1).

 

Breton wrote a small number of surrealist poems. Most of his work was in art criticism and novels. In ‘The Immaculate Conception (1930)’ he simulates the thought patterns of mania, general paralysis and dementia praecox (schizophrenia). His best known novel is Nadja (1928).

 

Here is his poem ‘Less Time’:

 

Less time than it takes to say it, less tears than it takes to die; I've taken account of everything,
there you have it. I've made a census of the stones, they are as numerous as my fingers and some
others; I've distributed some pamphlets to the plants, but not all were willing to accept them. I've
kept company with music for a second only and now I no longer know what to think of suicide, for
if I ever want to part from myself, the exit is on this side and, I add mischievously, the entrance, the
re-entrance is on the other. You see what you still have to do. Hours, grief, I don't keep a
reasonable account of them; I'm alone, I look out of the window; there is no passerby, or rather no
one passes (underline passes). You don't know this man? It's Mr. Same. May I introduce Madam
Madam? And their children. Then I turn back on my steps, my steps turn back too, but I don't
know exactly what they turn back on. I consult a schedule; the names of the towns have been
replaced by the names of people who have been quite close to me. Shall I go to A, return to B,
change at X? Yes, of course I'll change at X. Provided I don't miss the connection with boredom!
There we are: boredom, beautiful parallels, ah! how beautiful the parallels are under God's
perpendicular.

 

Breton declared that ‘nothing but the marvellous is beautiful’; and thought war an ‘incredible stupidity’ that resulted from the exploitative capitalist system. He was a Communist and a Stalinist, and founded the ‘Federation de’l’Art Revolutionnaire Independent’ with Leon Trotsky in Mexico in 1938. Surrealist philosophy could not associate itself for long with these political systems. Breton lived through two world wars and much of the cold war, and died believing man had perhaps regressed in his time, despite the best efforts of the Surrealist project for the mental liberation of humankind.

 

Breton said of his early works that ‘Poetically speaking, they are distinguished chiefly by a very high degree of immediate absurdity

 

Consider: had any strange dreams lately? You might like to write a few down, and use them to compose your own surrealist poem!

 

Gertrude Stein

 

Stein (1874-1946) was a wealthy American doctor and art dealer whose house on the side of Venice’s Grand Canal is today a famous museum and gallery. She had some poetry of a surrealist nature herself, but one gets the impression it was tolerated because of her wealth rather than any particular skill:

 

A Mounted Umbrella

 

What was the use of not leaving it there where it would hang what was the use if there was no chance of ever seeing it come there and show that it was handsome and right in the way it showed it. The lesson is to learn that it does show it, that it shows it and that nothing, that there is nothing, that there is no more to do about it and just so much more is there plenty of reason for making an exchange.

 

 

One American visitor from this period, Joseph Stella, has left this sardonic account of Saturday night at the Rue de Fleurus:

 

 Somehow in a little side street in Montparnasse there was a family that had acquired some early work of Matisse and Picasso. The lady of the house was an immense woman carcass, austerely dressed in black. Enthroned on the sofa in the middle of the room where the pictures were hanging, with the forceful solemnity of a Sibylla, she was examining pitiless all newcomers, assuming a high and distant pose(2).

 

Consider: comparing the work of Breton and Stein. Why exactly is Breton the superior writer?

 

Psychoanalysis and Surrealism

 

‘For Surrealism in 1928, when Nadja was published, psychoanalysis had re-shaped discourse on the individual as well as notions of creativity. The unconscious now convulsively intrudes into actions, words, illnesses, and art. After psychoanalysis the ‘I’ is always (at least) doubled- the self one knows stands beside the self one can only witness and marvel at- or interpret. These two selves are the same but not the same. Between them there is a strange transfiguration. Each is like a dream of the other.’

 

‘For Surrealism psychoanalysis must be a disabling and threatening discourse because its therapeutic aim is to bring the unconscious back under the control of an ego; psychoanalysis characterises artistic activity as neurotic and socially conservative; it is aimed at replacing art, or making art redundant. It is at the same time the ally of Surrealism in exposing and undermining art that seeks ultimate sanity and moral closure.’

 

W A Osborne

 

It is recorded that ‘In November 1915, Professor W. A. Osborne of the University of Melbourne lectured on the new concept of the vitamins’. He was professor of clinical pathology, and wrote a modest book of poems entitled ‘The Laboratory and Other Poems’, published in 1907. The last word on the many art movements active during his life belongs to him:

 

The Symbolist

 

I sometimes think the rose is red,

I sometimes think it’s green;

I sometimes think the cauliflower

Is the finest thing I’ve seen.

 

I sometimes think the world is round,

I sometimes think it’s flat;

I sometimes think the symbolist

Is talking through his hat.

 

If you look through some paintings by Rene Magritte, you might find an extra dimension to this poem...not to say that Osborne intended it!

 

References and further reading

(1) Breton A (1924) The First Manifesto of Surrealism

(2) Carpenter H (1987) Geniuses Together: American writers in Paris in the 1920’s  Unwin          p31-2

(3) Brophy K (1998) Creativity: Psychoanalysis, Surrealism and Creative Writing  MUP   Ch 4,   in Chifley  PN56.I45B76 1998 

 

Omar Khayyam 1048 – 1131

 

Up from Earth’s Centre through the Seventh Gate

I rose, and on the throne of Saturn sate,

And many knots unravel’d by the road;

But not the knot of human Death and Fate.   (7/1859)

 

According to some, Ghiyath al-Din Abul Fateh Omar Ibn Ibrahim Al-Khayyam was a physician of some repute. He wrote four books on mathematics, one on algebra, one on geometry, three on physics, and three books on metaphysics, all of which were greatly influential throughout the middle ages. However, it is as a poet that he is most widely read and remembered almost 900 years later.

 

Khayyam means tentmaker, possibly his father’s occupation. Omar spent his life travelling around the centres of learning near his home town Nishapur in far north-eastern Iran. Whether he was a better mathematician or poet is a source of amused debate between literary and mathematics camps.

 

He is credited with developing binomial theorem and a test for specific gravity. His algebraic work on conic sections was not proved for 750 years. He also joined a panel of scholars to revise the calendar, in 1079. Khayyam and his group measured the length of the year as 365.24219858156 days. They were out by .000008 of a day according to modern measurements!

 

The Rubaiyat of Omar Khayyam is a famous work of poetry in the English-speaking world thanks to a 19th century translation by Edward Fitzgerald. A rubaiyat is a quatrain: a four line poem, and Khayyam’s were his own versions of traditional Sufi verses. Fitzgerald translated about 100 of somewhere between 600 and 1000 ascribed to Khayyam.

 

Read for what they appear to be, the rubaiyat reflect upon life, and conclude that it should not be wasted and that it is best tolerated with a good drink of wine:

 

 

The Moving Finger writes; and, having writ,

Moves on: nor all your Piety nor Wit

Shall lure it back to cancel half a Line,

Nor all your tears wash out a word of it.       (76/1868)

 

Whether at Naishapur or Babylon,

Whether the cup with sweet or bitter run,

The Wine of Life keeps oozing drop by drop,

The Leaves of Life keep falling one by one.   (8/1868)

 

Ah, fill the Cup:- what boots it to repeat

How Time is slipping underneath our Feet:

Unborn TOMMORROW, and dead YESTERDAY,

Why fret about them if TO-DAY be sweet!      (37/1859)

 

How long, how long, in infinite Pursuit

Of This and That endeavour and dispute?
Better be merry with the fruitful grape

Than sadden after none, or bitter, fruit.         (39/1859)

 

 

As with most good poetry there is something going on beneath the surface. Here is another famous Sufi poet, Masnavi of Hafiz, also inviting drunkenness:

 

Minstrel, bring close together the harp and drum.

With a sweet melody invite all of the lovers to come.

 

Strike a path that the Sufi into ecstasy goes,

Union through drunkenness will soon end his woes.

 

The followers of the Prophet Mohammed were not the only ones to use symbolism and allegory in religious art in the middle ages. In the sublime poetic tradition of the Sufi, wine is spirit, drunkenness the intoxication of pure worship, lovers the worshippers. No doubt this double language had its uses in courtly love!

 

Naturally the modern drinker is entitled to their own interpretation! As Omar himself says:

 

Myself when young did eagerly frequent

Doctor and Saint, and heard great Argument

About it and about: but evermore

Came out by the same door as in I went.       (27/1859)

 

 

Fitzgerald’s translations are a famous case of the difficulty of translation from one time and culture to another. His own essay on the subject is most interesting. Have a look at the introductory rubaiyat from the two sets he did, from 1859 and then 1868:

 

Awake! for Morning in the Bowl of Night

Has flung the Stone that puts the Stars to Flight:

And Lo! The Hunter of the East has caught

The Sultan’s Turret in a Noose of Light.

 

and

 

Wake! For the Sun beyond yon Eastern height

Has chased the Session of the Stars from Night;

And, to the field of Heav’n ascending, strikes

The Sultan’s Turret with a Shaft of Light.

 

In allegorical terms there are great differences between the Morning and the Sun, and Night and Flight. Shaft and Noose may be sexual as well as spiritual imagery. It is an interesting exercise to try and pin down the meaning of such poems, and the psychology of their translators!

 

Consider: what is the most accurate language for medicine: mathematics or poetics? Numbers or metaphors?

            Have you found clinical situations in which translation from one language, or type of language, to another has been difficult? Or even compromised clinical care?

 

 

Ibn Sina

 

Another Islamic physician-polymath of the time was Avicenna, properly called Ibn Sina. He wrote about 450 treatises, including a lengthy poem on the practice of medicine, and is one of the most famed figures in medical history.

 

 

References and further reading

 

Fitzgerald E (1859) (trans.) The Rubaiyat of Omar Khayyam

 

Smith P (1986) The Book of the Winebringer: Masnavi of Hafiz            New Humanity Books

 

www.iranchamber.com/literature/khayyam/khayyam.php

 

www-groups.dcs.st-and.ac.uk/~history/Mathematicians/Khayyam.html

 

www-groups.dcs.st-and.ac.uk/~history/Chronology/900_1100.html

 

www.nlm.nih.gov/hmd/arabic/poetry_2.html   US National Library of Medicine Islamic Medical Manuscripts

 

 

pm8

 

William Carlos Williams

 

Equally likely to be voted top doctor-poet of all time, William Carlos Williams (1883-1963) is a famous figure in North American literature. Aside from attending medical school in Pennsylvania from 1902 to 1906, he spent his whole life in Rutherford, New Jersey. This rural township was the setting for his medical and literary practice, the latter including essays, short stories, novels, auto/biography, plays and translations.

 

Considered an imagist, he was influenced by the surrealist, cubist, futurist and Zen movements in European art between the two world wars. He loved painting, as can be seen in his poem from 1921 ‘Overture for a dance of locomotives’, but chose to use visual imagery in poetry instead.

 

He is renowned for saying that ‘Anything is good material for poetry’, and for insisting on ‘No ideas but in things’. With these maxims he created a poetry unique for its local content and speech, its brevity of expression, and its crisp use of image.

 

This poem “The Red Wheelbarrow” is famous:

 

So much depends

upon

 

a red wheel

barrow

 

glazed with

rain

 

beside the white

chickens.

 

 

He was an innovator in poetry for another reason: his rhythm, which he based upon concepts, fragments of speech or reality, and images. Each of these formed a line or a distinct unit in his poems. Rather than creating a strict metre, or beat, and combining it with rhymed words in certain places, as Keats did, Carlos Williams divides his lines into units of meaning, logical pieces from which the poem is built:

 

no defeat is made up entirely of defeat- since

the world it opens is always a place

            formerly

                        unsuspected

 

These lines from ‘Paterson’ show this technique, radical in his day, at work. How does it work in “The Red Wheelbarrow”?

 

Carlos Williams did not write much about his medical practice: a few vignettes, like Philomena Andronico about a young mother restrained by her charge; and some reflections on the social realities surrounding death as in ‘The last words of my English grandmother’ and ‘Dedication for a plot of ground’. His compassion for people is clear in his work. Here is an excerpt from ‘The raper from Passenack’:

 

 

‘…

I won’t be treated.

 

I refuse. You’ll find me dead in bed

first. Why not? That’s

the way she spoke,

 

I wish I could shoot him. How would

you like to know a murderer?

 

I suppose it’s my mind-the fear of

infection. I’d rather a million times

have been got pregnant.

 

But it’s the foulness of it can’t

be cured. And hatred, hatred of all men

-and disgust

 

…’

 

Consider: What are the ‘poethics’ of writing about the people you live and work with? What are the pitfalls? What is it that depends upon the red wheelbarrow?

 

Consider: writing your own poem based on The Red Wheelbarrow. Try using the same introduction, ‘so much depends/ upon’, and the same length, but substituting the images for those of your own: perhaps a piece of medical equipment for the wheelbarrow, and a person for the chicken.

Look at the colours in the original. They seem to be very significant. What other senses could you use in your poem to achieve a similar effect?

 

I look forward to seeing any results!

 

References and further reading

 

These are all by Williams, available in Chifley.

 

Selected poems, with an introd. / by R.Jarrell. [N.Y., New Directions, 1963       PS3545.I544A17 1963 

 

Pictures from Brueghel and other poems: collected poems, 1950-1962. / [N.Y.], New Directions           PS3545.I544P45 1967   

 

Paterson. / [N.Y.]. New Directions, [1963?]      PS3545.I544P3 1963    

 

pm9 Grace Perry: Journal of a Surgeon’s Wife

 

‘And you are proud      my love

the arduous journey

two hundred souls

and no one died

pass through the grey rock guardians

pass gaunt trees

                        scorched by other summer fires

the new green

                lifting

around the knees’

                                                                       

In the fifty-page poem ‘Journal of a Surgeon’s Wife’ (1976), Grace Perry explores the inner world of a ship’s surgeon’s wife in the convict days. Uprooted from England, she endures six months on a boat, then the disturbing realities of everyday life in the penal colony. She feels her husband is trapped:

 

‘Your stone house

is another kind of prison

colonnades and fireplace

were shaped by convicts

no less free’

 

Soon her husband leaves her, pregnant, to work on a transport: a year-long round trip at least. The bush closes in and all colour bleaches from her life. She decides to go England. As the ship waits in Sydney harbour for a favourable wind she miscarries, and misses the journey home…

 

‘And the bridge drying warped

drought disfigured many things

I gave up listening for the logs to rattle

            watching for the girl in muslin

the swim the river

walk this way

the child I have mourned

shining in her hands’

 

Grace Perry was a significant figure in Australian poetry. Founder of South Head Pres and Poetry Australia, she was a GP in the Five Dock area of Sydney for many years. Born in Melbourne in 1927, she published her first poetry book at 15, then graduated in Medicine from the University of Sydney in 1954. She was awarded the NSW Premier’s Award for Special Services to Literature in 1985, and an AM in 1986.

 

Perry kept her GP life separate from her (reportedly argumentative) poetry life. This was not the case with her rural property at Berrima, which I believe gave her the insight to write the excellent study of loneliness in the bush that the ‘Journal’ is.

 

A famous study of that subject is Henry Lawson’s short story ‘The Drover’s Wife’. Both these texts use conversation as a tool for story telling. In Lawson it is represented as dialogue in vernacular 19th century Australian English. Perry, however, uses conversation as a structural device in her poems. The lines are broken up in the way she would say them into a microphone at a poetry reading. Her ‘free verse’, then, is tightly controlled by the sound of the words. She is a lyric, naturalistic, narrative poet.

 

Consider: Can one ever truly escape the rules? Is there such a thing as ‘free’ verse?

 

      Why is Perry so concerned to record the voice of the wife? After all, surely the surgeon’s life is the interesting one?

 

Earlier poems

 

Perry wrote several other books of poetry before the ‘Journal’, often using formal verse structures. ‘Foetal Stethoscope’ comes from her 1967 book ‘Frozen Section’:

 

‘My ear to earth receives the liquid murmur

of a generation moving in its sleep;

faintly through the metal mouthpiece issue

secrets that the budding blood should keep.

 

Within the differentiating mass

the uncertain image of the future swells

while flesh repeats our seaborn heritage

in ritual patterns of dividing cells.

 

In these unruptured membranes we shall wait

the rhythmic journey to the light at last;

cockled in sealed caverns, our lives beat

against that dark wave rising from the past.

 

Consider: Which do you prefer, the free or formal verse?

 

 

References and further reading

 

‘Journal of a Surgeon’s Wife’ is available in Chifley at PR9619.3.P49J6.1976

 

Perry G (1967) Frozen Section  Edwin and Shaw

 

Lawson H  The Drover’s Wife

 

 

 

 

 

pm10: Eccles’ secret

 

Known and loved around the world for his zany Goon Show scripts, and his hilarious books about his WW2 experiences as an infantryman in Tunisia and Italy, the famous comedian Spike Milligan suffered greatly from mental illness. He had manic-depression, for which he was hospitalised several times. In 1972 he published a small book of serious poems titled “Small Dreams of a Scorpion”.

 

Milligan is often claimed to be an Australian, partly as his mother lived in Woy Woy, just to the north of Sydney. In fact he was born in India, and educated there and in England.

 

Manic Depression

 

The pain is too much

A thousand grim winters

            grow in my head.

In my ears

            the sound of

            the coming dead.

All seasons

All sane

All living

All pain.

No opiate to lock still

            my senses.

Only left,

            the body locked tenses.

 

 

                        St Luke’s Hospital

Psychiatric Wing 1953/4

 

 

Oberon

 

The flowers in my garden

            grow down.

Their colour is pain

Their fragrance sorrow.

Into my eyes grow their roots

            feeling for tears

To nourish the black

            hopeless rose

            within me.

 

 

            Nervous breakdown

Bournemouth

February 1967

 

Milligan reduced millions of people to tears…of laughter…every week for years, but few in his audience had the compassion to cry for him. This next poem can be taken as light or dark…depending on the reader’s mood:

 

The future

 

The young boy stood looking up the road

to the future. In the distance both sides

appeared to converge together. “That

is due to perspective, when you reach

there the road is as wide as it is here’,

said an old wise man. The young

boy set off on the road, but,

as he went on both sides of the

road converged until he could

go no further. He returned to ask

the old man what to do, but

the old man was dead.

 

 

Consider: Do creative people have a higher incidence of psychiatric illness? Why?

 

References and Further Reading

 

Milligan S (1972) Small Drams of a Scorpion    Penguin

 

www.bipolarpoetry.com           a site set up by a Sydney psychiatrist
pm11

 

Shen  

 

Shen, aka Stanley Sim, is an Adelaide GP. His poems arrive direct from the compassionate doctor’s heart. He has won numerous awards and published and performed widely. His book is ‘City of My Skin’.

 

Shen largely uses free verse. The technique varies from poet to poet, each struggling to ‘find their voice’. Creating good free verse is more difficult than it at first appears. A good writer gives the impression of effortlessness, just as a good athlete does. The effort that goes into the work is hidden neatly behind a smooth façade, whilst a lesser poet will show the strain. The fourth poem here, ‘Certifying the Dead’, is not his most perfect, but it records an experience many doctors have had. Non-doctors often find these poems profoundly moving.

 

I hope you enjoy these.

           

Two men

 

Two men sit quietly in a room

between a dying woman.

Both men know that she’s dying

because one has slept by her side

for twenty-seven years and he’s never

seen her sleep so soundly. The other

man has turned her file to the page where

her usual doctor has written

FOR PALLIATION ONLY, and doesn’t feel

he needs to read much more. Two men

sit on either side of a bed in which one person

is dying, and one of them asks if the other

needs anything. “I’m OK”, is the only reply

that’s given. But as if shaken out of a stupor,

the object of this concern asks

the other if the cancer that’s killing his wife is

one of those silent ones”. The correct answer

to his question is “Yes”, but saying this

won’t make this pain bearable

and won’t make more space in a bed already

crowded by a frail woman sleeping beside

the life that’s gone before her.

So before a reply is offered

the morphine pump buzzes mechanically

in the artificial space between

this conversation and empties the only

easy answer into an unseen vein.

 

                                                           

 

Indigo stains

 

“Both Bicetre and Salpetriere came increasingly to house the insane  and…both retrospectively were known as scenes of horror…..”

(from A History of Psychiatry – Edward Shorter)

 

The midnight noise of unwanted voices

just debris crowding their slumber,

spilling beyond the confines of dreams.

For those who have lived in these places

the asylum will always be hidden unease,

buried under mortar and brick.

The years make suffering strangely removed.

Clinical methods listed in old records

are disembodied though they sit alongside names ;

how in one they extracted madness

via the teeth, in another excised evil spirits from the womb

or lashed some with leather and metal.

The prescriptions of an inexact science

have become curios – as quaint as collecting remnants

of a dried-up seed or a folded butterfly.

The drive to cure pushed hands

through the curtain separating

flesh from mind and yet insanity stayed elusive –

a cunning animal which wounded

and then left only traces ;

ghostly wisps of blue ink on fingers

after case notes were closed.

 

Wounds

 

He sounds like

a normal enough bloke,

and she’s a sensible girl,

I wonder how it all came to this

as the needle leads

the thread through the hole

his wedding ring has made,

just above her eyebrow.

She sits there absolutely still,

hasn’t said much

since she came in, though

the two kids, playing catch

in the cubicle, make enough noise

for all of us. The bruises

express themselves simply

on her otherwise blank face as I probe,

dabbing only once in a while

to stop blood running down

onto the sheets.

”We’re almost there”,

I tell her, but she twitches

and winces, starts to pull away.

I tighten my grip on her shoulder,

hoping it doesn’t hurt her too much,

carefully catch the last

bit of thread that’s all that holds this

gaping wound together.

 

Certifying the dead

 

The dead are always laid out

in quiet rooms, a silence

disrupted only by the twitching

of the second hand of a wall clock.

 

With their eyes closed

it is easy to imagine them sleeping,

or resting between meals.

But when their eyes are opened,

there’s no glow, only the dull

reflection of the torch, as if

shone in a painted glass eye.

 

Prickly cold skin,

all wrinkles and calluses,

no longer invites the warmth

of a handshake, and mouths

are tombs for stilled tongues,

never to utter another greeting.

 

Their lungs draw no air, but

sometimes, I am still startled to hear

the beating of a heart

when the stethoscope is pressed

to their pallid chests.

But I realise that it’s only

the rushing of my own blood in my ears

as soon as I place a hand

over my left breast and feel

what beats there apparently beating

in perfect unison

with a dead man’s heart.

 

 

References and Further Reading

 

Shen (2001) City of my Skin                 Five Islands Press
pm12   Jack Hibberd

 

 

Death of a father

 

He didn’t know what had struck him,

            poleaxed on my bed;

Moira my mother calling out Jim,

            half of his heart half-dead.

 

Then he knew what had struck home;

            I’ve done it this time he said,

sorry, his last words an apologising groan,

half of his heart not dead.

 

 

Dr Hibberd is a senior Australian playwright. He is regarded as a grandfather of Australian popular, vernacular, colloquial, social realist theatre. His ‘popular’ plays from 1967 to 1972 encountered the phenomenon of the bloke and the sheila. Plays like ‘The Les Darcy Show’, and ‘One of Nature’s Gentlemen’ used settings considered a little seedy to confront, and to open up to question, our everyday behaviours. Audiences were shocked or amused, but either way they responded to the dramatist’s power.

 

In his introduction to his 1976 collection ‘Three Popular Plays’, he talks about his conception of the new theatre, having an entertaining digs here and there:

 

‘None of these plays stoop to psychological explanation, something I am not very good at; it also bores me to death. They strive to work emblematically through scenic action and extroversion, an agglutination of facts, fibs, images, songs, occasions, jokes, straight lefts, and inexplicable distemper.’

 

He notes that arts funding leans towards satisfying the tastes of the wealthy, and that malaise in the arts persists in Australia despite ten years of effort. 

 

‘Indeed, that this basic brand of theatre calls for general expositions, encouragement and propagation is a sad comment on the sate of our histrionics: its conservatism, snobbishness and derivativeness still endures behind token and superficial gestures towards the indigenous. The different and dangerous is quickly sprayed and blandified by the establishment, or else politely ignored.’

 

Hibberd is fascinated by humanity and it’s foibles, especially the darkest of our foibles. He has a number of historical plays that use a sort of quick collage of characters and events, distorted if necessary by the necessities of exciting writing, such as the often-performed ‘A Toast to Melba’. One imagines his favourite painters follow the style of Otto Dix; his novelists might include Christopher Isherwood with his masterpiece about pre-war Berlin ‘Mr Norris Changes Trains’. Like many others, Hibberd has a horrified fascination with the rise and fall of the Nazi regime: the artistically and politically fertile time between the two world wars; the horrors that followed.

 

In his two poetry books he has a set of poems after Charles Baudelaire, the Frenchman who dug into the depths of the human soul in his famous book ‘Fleurs de Mal (Flowers of Evil) in 1869:

 

The Wind of Madness

 

‘I have felt the wind of the wings of madness,’ wrote

Charles Baudelaire in his book My Heart Laid Bare.

Insanity is a swirl: the brain twists as if on a rope:

a tumbleweed, small round tree, whipped by violent air.

Once lunatics were frogmarched, banished, to the sea,

where another brand of wind propelled their ships of fools.

Next they were confined, like masochists in monasteries,

or half-eaten lepers, in dungeons too maggoty for ghouls.

The Age of Enlightenment saw them released on sprees

of anarchy, orgies, noonday masses, lampooning officialdom.

So, once again these putative fruitcakes were seized,

certified, manacled, and caged in humourless asylums.

More recently we have inserted needles, alcohol, and slit

lobes, tried coma, electric shock, drugs: for brains on stilts.

 

 

from Salt and Pepper Sonnets

 

Eva

grandmother

 

Eva shrivelled, following that somnolent pneumonic death.

Once indefatigably buoyant, an irreducible woman,

as pillowy as the suet dumplings she cooked. He left

her profoundly puzzled, cast adrift in some no-man’s

zone. She paddled cautiously around, or sat, a loose sack

on his frayed chair- her repartee and wit, Cork-sharp,

now blank and blunt. Her hair hung like grey flax.

Her loud gregariousness became a cloaked silent harp

at dinners, afternoons of whist, even family affairs.

She toured Australia in a bus of merry widows. A ploy

which worked for a few weeks…then that cavernous stare.

Her widowhood her biological loss had exterminated joy,

and in it’s place colonic cancer grew: a huge unexplained

tumult. Suet-white, Eva joined her husband in boiling pain.

 

The rhyme scheme here is classic Shakespearean sonnet, the scansion relaxed (ie: it is not the strict ‘di dah di dah di dah …’ of iambic pentameter). There are many versions of the sonnet to keep the specialists amused for years! Hibberd’s skill as a writer is revealed in his tanka about haiku, entitled ‘Diptych’. Recently he has been elected to the Literature Board of the federal government’s Arts Council.

 

Perhaps the poem that is most like his plays is ‘Life Forces’

 

for John McEncroe

sixty years

 

Just look at that sunset, Doctor,

said the old chap, Don,

with shingles, piles, cataracts,

priapism, torticollis, sprue,

cannonball secondaries bombarding

shot kidneys and lungs,

beaming.

It’s enough to get a coot through the night,

all that beauty and brightness,

the sky beserk with galahs,

(the sounds of a stray Pomeranian

being serviced by his St Bernard),

a distant Vivaldi of crickets,

a soft breeze tickling crinkled cheeks.

Yes, it’s enough to entice a bloke

to plonk his gnarled truncated feet

up on a cardboard suitcase

(packed with essentials),

or a gravestone,

crack an Aristotle or two of Carlton,

dream of dead Dulcie’s dugs,

sail through the oil of darkness,

since such a sunset, Doc,

infallibly heralds a miraculous dawn.

 

 

References and Further reading

 

Hibberd J (1976) Three Popular Play  Scribe

 

Hibberd J  (1998) The Genius of Human Imperfection; Black Pepper

 

Hibberd J (2004) Madrigals for a Misanthrope  Black Pepper

 

Hibberd J (2000) Selected Plays  Currency Press…. Journal of Australian Studies review of…

www.api-network.com/cgi-bin/reviews/jrbview.cgi

pm13

 

Glenn Colquhoun

 

This New Zealand GP-writer has recently won his country’s top literary prize. His second book of poems is called ‘Playing God’.

 

Colquhoun had the always edifying experience of living and working with indigenous people, in this case Maori on the west coast of the North Island. His experience has translated into a poetry with abundant use of simile, and repetitive traditional structures.

 

It is a difficult task to write so simply, yet evoke our deepest responses.

 

Teddy

for a child with leukaemia

 

Teddy was not well.

 

Teddy had been feeling sick.

 

Teddy had to go to hospital.

 

Teddy was told that he had too much blood.

 

Teddy did not miss his friends.

 

Teddy knew the thermometer was not sharp.

 

Teddy was not scared of needles.

 

Teddy said the medicine would make him better.

 

Teddy closed his eyes at night.

 

Teddy ate his vegetables.

 

Teddy’s small girl lay in the corner of his bed.

 

She was not so sure.

 

Her eyes were made from round buttons.

 

The fluff on the top of her head was worn

as though it had been chewed.

 

 

 

 

The crumbling patient

 

I glued her nose back on

with chewing gum.

Later- her hair fell out.

 

I taped her hair back to her head.

Her tongue stuck like a dagger

between my toes.

 

I wedged her tongue inside her mouth.

Her lips clung to the side of my hand.

 

Her arm clattered to the floor.

I secured it to her shoulder

with a drawing pin.

 

Her fingers came off in my hand.

I used them to hold the lips

back on her mouth.

 

Her eye bounced on the ground

and rolled underneath the bed.

I washed it in cold water

and stuck it back in place.

 

Her jaw dropped but held with

two small screws in each corner

 

which made her grin.

 

I made a spike out of her neck

and stuck her head back on.

 

A row of clips held up her skin.

 

I fastened her legs with an old hinge.

 

Her feet glued carefully

together like a broken vase.

Each crack was a vein.

 

I said goodbye.

 

And hoped she would not slam

the door on her way out.

 

 

Cartoon-like, these absurd yet arresting images are framed in snapshot stanzas. The gum sticks to the fingers, leaving one beginning to wish one had never undertaken the repair. The poem closes with the door, opening up a private world of humour without which the GP might himself fall to pieces.

 

The GP’s linguistically complex world is expressed well in this next poem:

 

She asked me if she took one pill for her

heart and one pill for her hips and one pill

for her chest and one pill for her blood

how come they would all know which part

of her body they should go to

 

I explained to her that active metabolites in each

pharmaceutical would adopt a spatial configuration

leading to an exact interface with receptor molecules

on the cellular surfaces of the target structures

involved.

 

She told me not to bullshit her.

 

I told her each pill had a different shape and that

each part of her body had a different shape and that

her pills could only work when both of these shapes could

fit together.

 

She said I had no right to talk about the shape of her

body.

 

I said that each pill was a key and that her body was

ten thousand locks.

 

She said she wasn’t going to swallow that.

 

I told her they worked by magic.

 

She asked me why I didn’t say that in the first place.

 

 

Consider: Have you had a similar experience with a patient? What of the gulf in understanding between you both? Whose responsibility is it to bridge it?

 

References and Further Reading

 

Colquhoun G (2002) Playing God     Steele Roberts

 

(All poems used by permission)

pm 14 Patient and Poet: Hodgins and Dransfield

 

This week we are looking at the medicine-related work of two young Australians who became successful poets but died young.

 

Philip Hodgins

 

Born in 1959, perhaps his best-known book is ‘Down the Lake with Half a Chook’. He was brought up on a dairy farm at Katandra and educated at Geelong then Melbourne University.

 

‘Blood and Bone’ from 1986 is the work of a 24 year-old poet diagnosed with leukaemia. In it he confronts the question of God:

 

An Education

 

At first there was a dairy farm

with subjects coming from the soil-

a grid of paddocks big with time,

about a hundred cows, one bull.

 

Regrettably it didn’t last.

The subjects got more difficult.

I studied Love but didn’t pass

and gave up God with no result.

 

I couldn’t think what else there was

until I went up to a ward

where people died, and met a face

that gently told me what I had.

 

The final subject has been set.

I’m concentrating hard on Death.

 

This poem is a Shakespearean sonnet in its rhyme scheme. Shakespeare wrote in iambic pentameter. Hodgins has trimmed it back to a tetrameter: the sound is sometimes notated thus: ‘di-dah di-dah di-dah di dah’. The emphasis is on the second, or even-numbered syllable. The opposite to this, ‘dah-di dah-di dah-di dah-di’, is called a Trochaic meter, and is most commonly used today in blues music. In poetry, in general, an iamb is held to be useful for serious subjects, the trochee for lighter verse. As the trochee is said to ‘trip along lightly’ it is commonly encountered in ballads and longer narrative structures. Consider the opening of arguably Australia’s best-loved poem, ‘The Man from Snowy River’ (A.B. ‘Banjo’ Paterson):

 

There was movement at the station, for the word had passed around

the colt from ‘Old Regret’ had got away

and joined the wild bush horses: he was worth a thousand pound

so all the traps had gathered for the fray

 

 

from ‘Apologies’, he writes

 

‘…two married people

sitting in a hospital corridor

gazing down the length of sorrow.

Their only child will not bury them.

I must tell them how sorry I am.’

 

In several poems he reflects upon animals he has killed as a boy: fish, rabbits, drowned kittens. He does not see holy revenge, or endless karmic regression; instead, he sees not much.

 

‘The book said Rilke* had

four weeks of pure, relentless pain.

I think he would have found his God

useless as morphine.’                (‘The Change’, stanza 2)

 

(*Rainer Maria Rilke, Poet, born Prague 1875)

 

 

Michael Dransfield

 

‘ a needle spelling XANADU

in pinprick visions down your arm’

 

Michael Dransfield lived to the age of 24, dying from tetanus acquired from a heroin needle. He wrote 7 books, was highly regarded as a poet in his home-town of Sydney, and was something of a darling of ‘the set’.

 

Heroin, the needle, and overdose all figure prominently in his work. I have selected a few fragments from his poems that give us an idea of what might go through the mind of some people with heroin addiction:

 

‘Solitudes. Pacing impatiently the cage of body, of self. An exit glitters brightly in my hand.’

 

‘Cooking up, tying up, shooting up

in the dim room

I look at the arm

the surface of it

a moon landscape

needle craters of old hallucinations.

‘Past’, ‘Future’, are not even terms of reference.’

 

‘Overdose. Nothing left but the

whim of survival. Consciousness

demands vigilance’

 

‘there is no real thing.

none of these things is real.

he takes another book from the shelf, glances, puts it

aside, jabs a needle in his arm, listens to the wireless, kills it

with a touch. there is no real thing. he rises, and the face of

the mirror empties.’

 

Consider: This last fragment is typical of much of his work in that he is very distant from himself. Would this have given us a clue that he might be suicidal?

 

This next poem is complete: what clinical signs does it suggest to you?

 

Fix

 

It is waking in the night,

after the theatres and before the milkman,

alerted by some signal from the golden drug tapeworm

that eats your flesh and drinks your peace;

you reach for the needle and busy yourself

preparing the utopia substance in a blackened

spoon held in candle flame

by now your thumb and finger are leathery

being so often burned this way

it hurts much less than withdrawal and the hand

is needed for little else now anyway.

Then cordon off the arm with a belt,

probe for a vein, send the dream-transfusion out

on a voyage among your body machinery. Hits you like

            sleep-

sweet, illusory, fast, with a semblance of forever.

For while the fires die down in you,

until you die down in the fires.

Once you have become a drug addict

you will never want to be anything else.

 

Consider: Your attitude to ‘junkies’: what is it and why?

 

References and Further Reading

 

Hodgins P (1986) Blood and Bone  Angus and Robertson

(in Chifley PR 9619.3.H5464B56 1986)

 

Hodgins P (    )  Down the Lake with Half a Chook   ABC Books

 

Kinsella J (2002) (ed.) Michael Dransfield: A Retrospective

(‘Fix’ © M Dransfield, reproduced for internal ANU study purposes only)

pm15: The Psychoanalysts

 

I don’t suppose it could come as a surprise that psychiatrists and psychologists are well represented amongst clinical poets. To them there is an obvious commonality between poetry and medicine: both concern the mind; our perceptions of this world. Two well known Australian psychoanalyst-poets are Jennifer Harrison and Craig Powell.

 

Jennifer Harrison

 

Hippocrates

 

He has looked into the well

and seen the unwell drowning.

Carotids bleed between his thumbs.

He listens stooped like a bean

for the hearts rumble.

His caress rescues and discards

…those pale methodical eyes

which have been indoors so long…

 

Sometimes he is afraid

of everything that ends

-the corpse falling always

into mossy flight, towards

the cool drinkable water

which resists fate

and gives death only its power

 

            Primum non nocere

first do no harm…poets, too.   

 

 

Jennifer is a Melbourne Psychoanalyst, born in Sydney in 1955. Her experience is translated into a sparse, precisely intelligent poetry. “Boston Poems”, a sequence from ‘Dear B’, concerns a diagnosis of breast cancer in that city:

 

Arriving

 

It was always arriving, although we didn’t realise

until it had arrived, how far

it had travelled, how weary the cancer must have been

to sleep so tenderly, not bothering anyone,

 

and how quickly the word

fitted our lives, easily, as the Charles river

or Thanksgiving, or the story of Martin Luther King

 

how it crept along the soul

like a shadow on Newbury St

 

and drank Paul Revere’s painted vine of blood

so that the freedom trail

would be remembered by the children who followed

            after

 

 

Her poems ‘The Society of Psychotherapists’ Fantasy Ball’ and ‘Baron von Munchausen’ have a dark humour, but like ‘Hippocrates’ have depths that cannot be fathomed verbally:

 

‘Baron von Munchausen’

 

Please don’t confuse me with that rogue Raspe.

I’m not a ‘type’ of tall story nor

would I steal the Landgraf gems

after discovering Ossian and publishing Percy.

I’m a more modest braggart something like

the marvellous lover who cannot say goodbye

or the cavalry captain always throwing a party

on the perpetual eve of leaving for Russia.

And who would insist I put down my helmet and lance

to sleep the same soft sleep as the committed man?

The truth is I exaggerate what I know

and the story I tell is the truth in disguise.

If a suspicious tree takes root in your forehead

remember that I’m rich and noble. I’m the Baron of Lies.

 

Consider: Which is the more useful therapy- Psychoanalysis or poetry?

 

Craig Powell

 

Powell was born in Wollongong in 1940 and raised in Sydney. He studied medicine and specialised in psychiatry before moving to Canada for 10 years. In this decade he trained in psychoanalysis, in which field he has practiced in Sydney since 1982.

 

He is the author of 8 books of poetry, the latest ‘Music and Women’s Bodies’ (FIP 2002) includes translations of the Russian Yelena Mikhailik. His 1968 book ‘I Learn by Going’ (South Head Press) has a strong psychiatric theme, as well as strands related to Catholicism, secret love and death. ‘Madonna and Child’ is one of his most often quoted poems:

 

An image of silence: fine dust falling on hair

where two of them sit motionless. The light

glides with a rhythmic stillness out of sight

 

yet leaves a kind of radiance upon

mother and child asleep in a warm chair,

rags stuffed under the door, the gas turned on.

 

 

His experiences as a doctor are rendered in tight poetic structures such as the sonnet and villanelle. He says in his poem ‘The Poet in Ward Two’ that ‘behind the eyeball is the silent country/inhabited by one man’. In 1968 he saw the quiet horror of despair in some patient’s lives with a rare empathy. In this ‘Poem (long overdue) for Mr Meek’, Powell uses half-rhyme in one of the sonnet forms:

 

Frederick Meek, as mild as the very name,

speaks to me with wheezed and rasping care.

Icy linoleum snickers on the floor;

there’s always a tang of urine in the room.

 

His lungs are a monument to cigarettes.

Yet he will talk by the hour, as he did one day

of his wife who died of cancer years ago,

and showed me her photo, nibbled by the rats,

 

I don’t believe he suffers much-no wild

and adolescent anguish. No, for his part

he’d chose this clenched and shuttered room, no hurt

 

except the quiet agony of small things:

the toe that hurts him when it rains, the chilled

and useless testicles and the botched lungs.

 

 

 

I suspect the word botched here is a little poet’s joke, because it describes the lungs as well as the line it is in...it doesn’t quite fit, to my ear.

 

In ‘Jack Connolly’ he asks:

 

‘…

”You know Jack Connolly’s dying?”

 

Jack Connolly doesn’t know.

Not many people do.

He gets a sickness benefit cheque each week,

best wishes from the factory.

Deep in his lung

the cancer bares its knives.

 

Forget all he said or thought.

It wasn’t all that clever.

A skinny little fellow, a forgettable face-

but God! the heart’s draining out of the world,

the wretched world, because Jack Connolly’s dying.

 

Consider:  Which is worse: cancer or loneliness? What would you rather have: a physical or a mental illness?

 

Nembutal Rock

 

One o’clock in the morning

she sat up in bed

a fist full of yellow capsules

and screaming in her head.

 

Open the door and the window,

let the stars blow in!

Her lungs are full of thunder

and there’s spittle on her chin.

 

Who cares if you didn’t love her

and you meant to go away?

Forget the slanging quarrels

you spat out every day.

 

Drag her to the ambulance,

go howling through the night,

cry like a silly schoolboy

and screw your knuckles tight.

 

But it’s no use calling the doctor.

She’s learning how to die-

face grown blue as the water,

foam on her mouth gone dry.

 

Four o’clock in the morning

they stretched her out in bed

her fist uncurled and empty,

a cold sheet across her head.

 

Another rather black piece of doctor poet’s humour? This could be Powell’s own words to a popular rock tune of the day (it has been set to music).

 

Consider: Perhaps you have a story you could relate by modifying the lyrics of a favourite song of yours?

 

Finally, for the doubters of poetry, know that most poets doubt too (in common with all serious artists).

Here’s Powell again, from ‘For Janet’

 

Sometimes I wonder what I’ve got to say,

what it is that keeps trying to spatter

outwards, out of my blood or God knows where.

And then I wonder if words could even matter.

 

References and Further Reading

 

Harrison J (1994) Michelangelo’s prisoners   Black Pepper

Harrison J (1999) Dear B   Black Pepper

Powell C (1968) I Learn By Going   South Head Press

Powell C (1984) A Face In Your Hands    South Head Press

Powell C (1972) A Country Without Exiles   South Head Press

Powell C (1993) Minga Street   Hale and Ironmonger

www.poetrytherapy.org   You might like to look at this website of the National Poetry Therapy Association, which has a small presence in Australia and New Zealand

 

 

 

pm16: The Convicts

'...and many a man from downright starvation

lies mouldering beneath the clay,

and Captain Logan, he had us mangled

at the triangles of Moreton Bay'

 

This verse from 'Moreton Bay' by Frank McNamara, the Convict Poet of the 1820's, revolves around floggings the convicts received. Much more rarely mentioned in history is the role of the doctor at the floggings: to determine whether or not it was safe to continue.

 

The prominent mid-20th century poet Robert D Fitzgerald writes of discovering that a relative of his was the first private doctor in Australia, Martin Mason. Mason arrived in 1798, and in 1801 became magistrate at Parramatta and Toongabbie. He had a reputation for cruelty. In his poem 'The wind at your door', Fitzgerald expands an infamous historical account of the floggings ordered in retribution for the Castle Hill Rebellion:

 

'My ancestor was called on to go out,

a medical man, and one such must by law

wait in attendance on the pampered knout

and lend his countenance to what he saw,

lest the pet, patting with too bared a claw

be judged a clumsy pussy. Bitter and hard,

see, as I see him, in that jailhouse yard

...

his eyes green, and for that slit, the smile

that seems inhuman,, have it cruel and stark,

but grant it could be too the ironic mark

of all caught in the system- who the most,

the doctor, or the flesh twined round that post?

 

There was a high wind blowing on that day;

for one who would not watch, but looked aside,

said that when twice he turned it blew his way

splashes of blood and strips of human hide

shaken out from the lashes that were plied...

 

...One hundred lashes more, then rest the flail.

What says the doctor now? "This dog won't yelp;

he'll tire you out before you see him fail;

here's strength to spare; go on!"...

Fitzgerald was not happy to discover such a man in his background, but fairly raises the question of the system the doctor was confined within. The poem is well worth reading in its entirety.

Consider: Doctors are sometimes asked to perform such functions, for example in the death chambers of the USA.  What would you do if the Australian state ordered you to decide if, for example, illegally detained and tortured people could withstand another day? How would you work out whether or not a prisoner could cope with more torture?

Consider: Are there any places or circumstances in which you can imagine yourself advising lay authorities on ways to inflict suffering on prisoners? Is the Hippocratic oath always inviolable?

One time when I was a GP in western Victoria, a travelling boxing show was looking for a doctor to decide who could and who could not go on. I deplore rough rural boxing as a sport, and consequently refused to support the event. They found another doctor to do the work.

Robbie Walker was one of Australia's prison poets (the most prominent of these, Max Williams, is now a well loved local poet in the Bega Valley). Robbie was half-caste, displaced and violent, but in prison he wrote poems, and even ended up on a TV special called 'Prison New Faces' in 1981. His death in custody at the age of 24 was one of many investigated by the Royal Commission into Aboriginal Deaths in Custody. Here is an extract from 'Solitary Confinement':

 

Have you ever had to strip

before half-a-dozen barking eyes

forcing you against a wall-

ordering you to part your legs and bend over?

 

Have you ever laid on a wooden bed-

in regulation pyjamas

and tried to get a bucket to talk

in all seriousness?

 

Have you ever heard the screams in the middle of the night,

or the sobbings of a stir-crazy prisoner

echo over and over again in the darkness

threatening to draw you into its madness?

 

If you've never experienced even one of these,

then bow your head and thank God.

For it's a strange thing indeed-

this rehabilitation system.'

 

pm 17: The War Poets

 

‘History’s lesson:

that we have learnt nothing from

history’s lesson.’*

 

War is so traumatic psychologically that many returned soldiers will not discuss it, ever. This has major implications for their wellbeing. WW1 and WW2 Veterans at least had an RSL or similar to join, but in this country, the Vietnam Veterans were vilified, spat on when they returned, and consequently won’t tell their stories to anyone. This is surely why more Viet Vets have suicided since 1973 than were actually killed in Vietnam (Australia lost 450 troops in action, and by the early nineties had lost more than double this figure to psychiatric illness, including drug and alcohol abuse). Poetry is one of the few mediums in which some people can express their terrible and conflicting memories of the past.

 

John McCrae

 

This Professor of Medicine from Montreal was a colonel at the second battle for Ypres in 1915. After a friend was blown to pieces he wrote the war’s most famous poem, which begins ‘In Flander’s Fields the poppies blow/ Between the crosses, row on row/…’. This is the source of the red poppies worn each Armistice Day: the eleventh hour of the eleventh day of the eleventh month.

 

I wonder how many died to allow the war to end at such a neat time? If you ever get to Belgium, consider a trip to Ypres. Here you will find one of the first war museums in the world to acknowledge the participation of women in the work of war, as well as in its suffering.

 

John Millet

 

John Millet is a retired Australian lawyer who flew in the bombers over Germany towards the end of WW2. The impact on him is still working its way out in fine poetry: here are two poems in greatly contrasting styles from ‘View from the Turret’ (Five Islands Press Associates, 1994).

 

The Cry

 

“Where is my Mother?”

            the answer- “Dead.”

            “Where is my brother?”

            the answer- “Dead.”

 

“Where is my sister, my wife, my lover?”

            “Dead. Dead. Dead.

            They are all dead.”

 

 

 

 

The X

 

July 1943:Hamburg bombed- 50,000 killed,

40,000 injured, 1,000,000 de-housed.

Allied Aircrew casualties, 1,000 killed-

86 bombers destroyed.

 

They come out of the penniless black skirts of the night sky-

Lancasters, high above Hamburg, looped together by search-

lights, tracers, throttles full bore. The city drowns under yellow

waters of incendiaries and high explosives. Big bombs distend

their bellies, blow out their loud bloomers, their hoops, inflate

their fat arses, fart into the thick soup of the streets,

broadcast their stench, adding their poisonous bulbs.

 

Squadron after squadron hangs over the “X” marked by the

Pathfinders, to lay hideous eggs- turn back into the ragged

night. Some, crippled, fall into the dead earth forever. Some are

followed by Focke-Wulfs. Messerschmitts pull others out of the

sky, break, stretch them, skin and bone them, send them to wreck.

Some fall into the torn wet shirt of the North Sea where the slow

maul and thrust of tides cancels their rot and stone weights of

war hold them under-and there they wait without knowing they

wait for anything. Others return to honeyed bases carrying

Aircrew wounded beyond repair.

 

Aircraft ‘L for Love”, coned by searchlights, drops its big,

ugly, lovely, crapped missiles. Then in the spinningtop Ack-ack

fire is hit and Air Gunner Ack-R Simpson hammerlocked by G

forces. “L” drops into “Fairytown” 15,000 feet below and Ack-R,

released, parachutes down into peacock tails of fire, hulls of

Lancasters nuzzling the sky next to him.

 

Held by the safe silk in air cold as a bathroom he watches

the calm cloud-owls drift through shellbursts, past

searchlight needles. he remembers the rocking-chair arms of an

old song: “Sleep pretty baby. Granny will sing you away.”

 

He wants to stay between friend and enemy at 10,000 feet, and not go

down into the wrecked streets below, where the widows of

Hamburg will find him- in the rubble of broken buildings- in

drains and waterpipes and sewers- on their doorsteps and

window ledges- sheltering under crumpled roofs- in ribcages of

dead children- in the cages of dead birds- in the kennels of dead

dogs. their hatred will duel with him, cut his face, parry and

thrust, scar him.

 

They will touch his eyes, his throat, his genitals, his anus hot

from the huge crap of the bombs dropped on them- bombs

spurting from his intestines- grief in their streets- blood on the

corso. He will break on their doorsteps- cracked open like a box

of dice. Thrown at will, he will come up snake-eyes. The compass

of their hatred will search him out, find him, punish him.

 

As I spider down to the fire bombings

those women of Hamburg wait for me and one

more burning than the rest

will reach through my cheek with her claw,

her beak pierce my stomach, claw

scratch through my bladder, beak

fall again and again. She will rise,

offal in her teeth trailing behind her

like aerials- my 19 years of innocence.”

 

Dense smoke, oxides, poisons, fat smells, burning bones, the

earth thrown at him. Distraught mudcovered women the owls

have mauled, the “X” in their eyes, wait for his touch on the

ground next to them. He tries to go back into the black vats of the

nightsky, climb the wind like a grandmother’s knee, return to a

time full of magic and ice cream.

 

These women are broken sticks and their skirts are burning, near

burst water mains. Burst jugulars bleed into the earth- aneurisms

smear Hamburg with blood- blood on the earth.

 

He is falling into the stick arms of the women, the axe-arms, the

pitchfork arms, the barb’-wire arms, the kitchen-knife arms, arms

made of anything a weapon is, blade, bone and pencil, arms

made for babies and men- that will pull him from the sky, cut off

his hands, excise his testicles, drain his blood, throw him to the

fires and wrecked walls.

 

In their eyes only the language of death, and he, an image

trapped in all broken cities, will hang, always just beyond

reach, as if he hangs on a gallow’s arm over a trapdoor- always

just ready to open- never sprung- the strangling cord never

tightened, but always ready.

 

He will live there with what will never be answered.

 

*          *          *          *          *          *          *          *

Consider: Australia fought in WW2, and welcomed (those were the days) the traumatised refugees of Europe in great numbers afterwards. Hence there is a large cohort, that you will encounter clinically, of those elderly who suffered in various ways. Can you think of a medical condition that can in no way be associated with psychological trauma?

 

 

 

 

RC Potter

 

Private RC Potter fought in WW1, the Great War. In his diaries he remembered first marching up to the front, to the battle of Pozieres. They marched past a huge shell crater, beside which was an army boot with a shattered tibia still laced in. Here is a segment of “Pozieres

 

(…)

 

Torn, twisted, upturned earth,

High crests and sunken craters,

Gigantic shells of Hellish birth,

Grim death’s unwearying waiters.

 

About, mounds on every side-

They mark colossal losses

And humbly plead for those who died,

Those crude, frail, falling crosses.

 

And here and there a gaping skull,

Some shreds of soldiers clothing,

a booted bone, makes one’s heart full

Of sadness and of loathing.

 

(…)

 

And here at last the victims slain

May sleep among the roses

When nature’s hand removes the stain

The breast of France discloses.

 

In the rhyme scheme, and the sentiment expressed at the end of the poem (including the European roses) and the capitalisation of the beginning of each line, Potter is technically a conventional poet, and could never reach the heights of Wilfred Owen, for example. However, this matters little to me: the whole poem is a very moving piece of poetry, and I admire Potter even more for the fact that this was written in the trenches in 1917.

Potter’s book is called Past Hell’s Portals and is available from Ginninderra Press in Canberra. Those of you who make it to Bega may encounter his granddaughter: a radiographer here.

 

Consider: Poetry poured out of people’s hearts when the World Trade Centre was demolished in 2001. A phenomenal wave of poetry swept the world. Guess which country is now a great source?

 

Evil doctors in war

 

Arguably the doctor closest to evil in recent history was Josef Mengele, an ambitious scion of Hitler who performed many ghastly experiments on the mentally and physically deficient, the Socialists , the Gypsies and the Jews in particular, during WW2. This poem from Australia in 2004 illustrates the revulsion this man’s work can easily elicit, sixty years later.

 

Dr Mengele is IN

 

He is always smiling as

he climbs the metal stairs

to the experimental wing.

 

Awaiting him, the neat rows

of instruments beckon under

the arc lights. Today should

provide excellent results.

 

The condition of two sisters

sewn together last week.

The progress of those left

in the ice tanks overnight.

 

He has a productive day,

leaves promptly at six,

dispensing his standard

command to the orderlies.

 

Of the women who live,

put the younger ones aside.

The Kapos can have them

 

until they are finished.

But ensure they are back

in their cells, conscious,

by 0900 hours.

 

(Ian McBryde)

 

 

 

References and further reading

 

McBryde I (2004) Domain   Five Islands Press

 

The Nazi Doctors

 

Potter R C (   )  Past Hells Portals   Ginninderrra

 

*Metcalf T (2003) Into the No Zone  Ginninderra

 

pm18: Two ancients

 

Here we have a look at Clement Marot of late mediaeval France; and Ovid, of the pre-Christian Roman Empire.

 

Marot

 

Clement Marot is one of France’s most famous poets. He lived from 1497-1544. Perhaps Chaucer is the English speaker’s equivalent. Here is the ‘Contreblason du Tetin’, in which we can admire the power of anaphora: the repetition of words or phrases, for emphasis, in argument

 

Tit, skinny tit,

flat tit that looks like a flag,

big tit, long tit,

tit, must I call thee bag?

Tit with its ugly black end,

forever moving tit.

Who would boast having touched you?

With their hand fondle you?

 

Burnt tit, hanging tit, withered tit,

tit that contains foul water, but no milk,

the devil himself created thee…so ugly that thou look more like a tripe!!!

Tit stolen from an old goat,

tit good enough to feed Lucifer’s brats,

tit, long tit, resembling a stick,

tit that can be thrown over a shoulder!

 

When I see you I yearn to grab you by both hands

shake you, blow my nose

over the woman that owns you.

 

Go, stinking tit, GO!

Your sweat could certainly produce a deadly perfume

that would kill many unsuspecting victims.

 

Horrid, despicable tit,

tit with a shameful past,

tit that forever oozes a lacrimous pus

tit made of peas and glue,

my God, I can no more!

Leave it alone by Jove,

my throat is tight, I can no more…

 

If the tit were to buried in the soft earth

would it grow back to its previous splendour and charm the eye?

A tit knows how to deceive many ignorant sods

that see it well exposed and inviting enough!

A tit knows how and when to be bold,

thus taking away the courage of anyone

who might be strong to resist.

 

Smelling tit under the chin,

tit that stinks like an old lamb!

Tit, what have you done to yourself?

 

(translated for me by Helene Marmoux)

 

Marot was court poet to Francis the First, and probably gained the post at the age of 20. He soon became a famous poet and lyricist. He developed several forms of poetry such as the rondeaux and ‘Parisian chansons’, and helped translate and set to music the Psalms (the Geneva Psalter). He was outspoken and was imprisoned in 1526 for Calvinist views. In 1528 he was appointed valet de chambre to Francis I.

 

At this time Marot probably invented the blason, and contreblason, style we see above. The blasons all concern body parts seen in a positive light; the contreblasons see them in a negative light.

 

Consider:  Marot’s poem about the old breast might have amused the 16th century court, but what might a doctor think was wrong with it?

                   How about your own contreblason? Pick an organ you despise and write about it!

 

Perhaps old people were rare in the sixteenth century; and the many theories of illness causation that circulated in those days might have lent one, for example, to dismiss her as a witch instead of someone with pathology.

 

For someone so ardently engaged with both poetry and religion, one might expect more compassion than shown in the above poem! Observe how it leads the modern reader along: when I read it people often laugh at first…

                  

 

Ovid

 

Aiming to end her pregnancy-so rashly-

Corinna lies exhausted, life in doubt.

To run such fearful risks without my knowledge

should make me rage, but fear’s put rage to rout.

But still, I got her pregnant-or I think so;

I often take as fact what could have been.

 

There is not a lot that Ovid does not discuss in his two books of love, the Amores I & II, and Cosmetics for Ladies and The Cures for Love.

 

Ovid lived at the heyday of the Roman Empire. Born in 43BC he knew the victories and defeats of Anthony and Cleopatra, and the great poets Virgil and Horace. He was banished from Rome by the Emperors Augustus and Tiberius for an unknown political indiscretion, perhaps some consequence of his poetry. His other great work was the Metamorphoses.

Ovid was not a doctor, or a patient in his poems, but he writes about abortion and its consequences in The Amores Book II Parts 13 and 14, and reveals in his invocation of numerous Gods one of the major approaches to healing in the Roman Empire. Someone of his education and status in Rome may have often given advice on medical matters. His poems are moralistic and opposed to abortion, but he asks the Gods, such as ‘kind Ilithyia, who take pity/when girls are locked in labour…’ to allow every girl one ‘mistake’:

 

But gentle girls do that, though not unpunished;

            killing their wombs’ young life, they often die.

Die, and they’re on the pyre with hair dishevelled’

and ‘Serve them right’ say all those standing by.

 

But may these words of mine bear no bad omen,

but vanish in the wind, and I’m content.

Ye gracious Gods let her sin once in safety;

Enough- next time impose your punishment.

 

Consider: Is there a medical procedure you have some doubts or reservations about? Can you write a few lines, from a patient’s point of view, that express why you feel this way? I suggest you try to use a common type of metaphor in medicine: comparison to some kind of food.

‘I had surgery and I felt like a slab of meat…

‘I had an x-ray and thought my insides were cooking…

‘I had a blood test. The blood looked weird, as if the blender in my heart wasn’t working properly…’

 

What sort of theories do you imagine people form about the insides of their bodies?

 

References and Further Reading

 

Marot’s book of contreblasons is available to view on line through the University of Virginia Library.

 

Ovid is in numerous editions

 

New York University maintains a Database for Literature and Art in Medicine. This I think is the best resource on the web for the medical humanities:

endeavor.med.nyu.edu/lit-med/lit-med-db/authors.html

 

 

pm19: John West, Saxby Pridmore

 

John West is a Melbourne nurse and prolific poet. Such a writer may give us helpful insights into an area of health care we might otherwise be tempted to ignore (at our peril). Studying the poems of other health care workers may help us maintain good relations with them.

 

from Portraits.

3. A Chinese Man in a Bed

 

Approaching him, holding his pills

I think how alike all old men are

taking up as little space as possible

missing their wives and children, their grandchildren

reading their newspapers over and over again

their false teeth always drooping as they snooze

off and on; throughout the afternoon

waiting for that visitor, that meal, that cup of tea

giving a little start when the nurse

taps them on the arm and hands them

another cup of pills.

 

In his book ‘All I ever wanted was a window’, there are several poems on his alcoholic/psychiatric self in middle age:

 

First AA Meeting

           

I can see them at the door, smoking

drinking coffee from styrene cups.

 

I want to be anywhere but here,

home writing down this poem,

 

Walking back along this street,

admiring the bodies of women

 

not at this meeting

not at the mercy of truth.

 

West has a number of poems about nursing care, especially on the longer-term geriatric and psychiatric wards. His verse is direct and uses simple words and phrases to communicate profound observation.

 

May Johnson

 

One nurse volunteers to sit with her because she’s done it once

before. She misses most of the handover because they wheel the girl

in just after ten o’clock. She is in a single room and we go in with

the morphine and largactil every hour; she doesn’t speak while I

am in there, just stares at the ceiling; I can still smell the kerosene.

Someone takes in the dose for three am but she doesn’t need it so

we let the nurse have a half hour break and when she comes back

she wants to help to prepare the body. “I’ve never laid anyone out

before,” she says, and then she tries to laugh.

 

 

Consider: How passé is a debate on free or blank verse, versus strictly structured rhyming verse? The first practitioner of blank verse in English was Henry Howard, Earl of Surrey, Earl Marshal of England, in his translation of Virgil’s Aeneid, written in the 1540’s. People still get passionate about this subject!

 

Saxby Pridmore

 

Professor of Forensic Psychiatry at the University of Tasmania, Pridmore is an unusual poet in so far as he has published over 200 poems in the literary press but never released a book. The following poem is remarkable for its subject matter and its intensity of honest feeling:

 

Caught on the Hop

 

You came into my house, unannounced.

We talked of school days

our second marriages, then

it got around to what we had been doing lately.

 

Without warning, you pulled up your shirt

to show

where they cut you in half to put in

the lungs of a teenage boy.

 

I was angry with you for frightening me

for being the centre of attention

for doing something I'd never done

for the teenage boy.

 

You should have given me warning.

We hadn't been introduced. Suddenly

there was a strange

pair of lungs bellowing in my living room

 

with you, grinning

between immuno-suppressed cheeks.

I didn't want you to cough or spit

I didn't want to breathe your expelled air.

 

I didn't know whose lungs you had

or how his family felt about you being there.

I am an average man

ashamed of not being good with the unfamiliar.

 

Here’s a salutary reminder of the difficulties faced by clinicians who work with the mind:

 

Influence

 

This episode of illness starts unremarkably

apparently refreshed, your voices shout

some new insults into your ears, out

to the sides grey people move, to whip

away, when you try confronting them.

I increase your medication.

 

The trajectory goes wrong. You’re not

as sad as you should be, in the face

of voices. I do your bloods again.

Another scan shows fine grained

something, of important insignificance.

Then you explain, you’re having an affair.

 

 

Consider: Has it happened to you that your pre-conceptions of someone’s illness have been misguided?           What is the risk inherent in preconception? How can a doctor avoid forming preconceptions?

 

 

References and Further Reading

 

West, John (2002) All I ever wanted was a window                  Pardalote

 

Pridmore, Saxby: numerous works in numerous journals which can be searched on the AustLit database

pm20: Miroslav Holub

 

‘There is no deep difference between the scientific and the artistic mind: both include the maximal creativity with the maximal freedom.’

 

Born in 1923, Holub was the most significant Czechoslovakian poet of the second half of the 20th century, and considered a major European poet.

 

His life’s work was twice interrupted by war. First it took him until 1953 to complete his medical studies because the Nazis shut down all higher educational facilities in Czechoslovakia (they executed many academics at the beginning of the war.) Secondly his creative writing was banned from 1970 to 1982 by the communist satellite government of Russia.

 

Holub was a Marxist-Leninist, and had a complex relationship with this government, who allowed him to travel internationally as a world-renowned clinical pathologist specialising in immunology. He published about 140 papers in immunology after gaining his PhD in 1958, whilst lesser creative writers were ignored, repressed, and sometimes imprisoned.

 

Ode to Joy

 

You only love

when you love in vain.

 

Try another radio probe

when ten have failed,

take two hundred rabbits

when a hundred have died:

only this is science.

 

You ask the secret.

It has just one name:

again.

 

In the end

a dog carries in his jaws

his image in the water,

people rivet the new moon,

I love you.

 

Like caryatids

our lifted arms

hold up time’s granite load

 

and defeated

we shall always win.

 

 

 

In his poem ‘Suffering’ the subject is laboratory rats, but he meets himself at every step:

 

But I ask no questions,

            no-one asks any questions,

Because it’s all quite useless,

Experiments succeed and experiments fail,

Like everything else in this world,

            in which the truth advances

            like some splendid silver bulldozer

in the tumbling darkness,

 

Consider: How difficult an act it is to write poetry under a repressive regime! It is perhaps rather like writing for children’s pantomime…one must be able to write to two distinct audiences, in this case entertaining preschool children as well as amusing adults with lashings of innuendo. What precisely could he mean by this next poem?

 

In the Microscope      

 

Here too are dreaming landscapes,

lunar, derelict.

Here too are the masses

tillers of the soil.

And cells, fighters

who lay down their lives

for a song.

 

Here too are cemeteries,

fame and snow.

And I hear a muttering,

the revolt of immense estates.

 

 

Incorporating a persistent play between scientific pursuit as factual progress and as metaphor, Holub’s poetry was like his Marxism a variety of bottom-up social humanism. It is as a humanist that he is celebrated:

 

Wings

 

We have

a microscopic anatomy

this

gives

Man

assurance

 

(William Carlos Williams)

 

We have

a map of the universe

for microbes,

we have

a map of a microbe

for the universe.

 

We have

a grand master of chess

made of electronic circuits.

 

But above all

 

we have

the ability

to sort peas,

to cup water in our hands,

to seek

the right screw

under the sofa

for hours

 

This gives us

wings.

 

 

A Helping Hand

 

We gave a helping hand to grass-

            and it turned into corn.

We gave a helping hand to fire-

            and it turned into a rocket.

Hesitatingly,

cautiously,

we give a helping hand

to people, to some people…

 

 

Waiting

 

The one who waits is always the mother,

all her fingers jammed

            in the automatic doors of the world

all her thoughts like

            egg-laden moths pinned out alive,

and in her bag the mirror shows

            time long gone by when

            glad cries lingered in the apples trees,

and at home the spool and the thread are whispering together:   

What will become of us?

 

The one who waits is always the mother,

and a  thousand things whose fate is

            ineluctable fall.

 

The one who waits is always the mother,

            smaller and smaller,

            fading and fading

second by second,

until in the end

no-one sees her.

 

 

Miroslav Holub died in1998.

 

References and further reading

 

Alvarez A (1967) (ed.) Miroslav Holub: Selected Poems      Penguin

 

Next Year

 

I hope you found the postings in poetry and medicine interesting. They will be collated shortly in case you feel like going over them to find some holiday reading.

 

Next year we will be looking at the wider literature of medicine. There will be novels, plays, and biographies to remind us of the art of medicine. Until then!

 

Tim Metcalf

lm4

 

Alcofribas, Abstractor of the Quintessence

 

Francois Rabelais 1494-1553 was a doctor, monk, and ‘a master of comment by parody’.  He frequently satirised and ridiculed the institutions of the church, law, politics and medicine. No theory of healing in his day, such as allopathy, naturopathy, magnetism or divine oracular intervention, is spared his wit:

 

“My mind is set in an utter whirl when I think of Pythagoras’s amazing discovery. For by the odd or even number of syllables in any proper name, he could tell on which side a man was lame, blind, gouty, paralytic, pleuritic, or otherwise defective by nature. That is to say he associated an even number with the left side of the body, an odd number with the right.”

 

“…And do not be so incredulous in future when you read about the experiments that Plutarch tells us he performed. If you see a flock of goats, for instance, running away at top speed, put a bit of sea-holly in the mouth of the hindmost, and they will all stop immediately”   …and…

“For does not the herb called Ethiopis open all locks that it is brought near? Does not the Echenisis, a very feeble fish, stop the mightiest ships afloat in spite of all the winds, and hold them back even when a hurricane is blowing? Furthermore, does not the flesh of this fish, preserved in salt, draw gold out of the deepest wells ever sounded?

Is there not also, according to Democritus’s writing and Theophrastus’s belief and experiment, a herb at the mere touch of which an iron wedge, deeply and most violently driven into a great hard log, suddenly flies out?”

 

This relentless assault on the foolishness of his society endangered his life: perhaps the most astonishing thing about Rabelais is that he was popular during the Spanish inquisition. He took very great risks indeed publishing material like this:

 

“That reminded me of the Abbott of Chastelliers, who never deigned to roger his chambermaids except in full canonicals. In his old age he was pestered by his relations and friends to resign his Abbey. But he swore and protested that he, the Reverend Father, would not take off his clothes until he went to bed, and that the last fart he would blow would be an Abbott’s fart.”

 

Little is known of Rabelais’ life until 1520 when he entered a Franciscan order. He was born about 1494 in Chinon, a still-intact and beautiful mediaeval town to the south of Paris, and his parents probably put him into a Benedictine monastery at first. He also spent time at the University of Angers, and finally became personal physician to du Bellay, the Bishop on Paris. Du Bellay protected him from charges of obscenity when his scurrilous books far outsold the Bible; but when at the Sorbonne the Faculty of Theology banned learning in Greek because it was generating heresy, Rabelais left and (after a brief return to the Benedictines) went on to Montpellier in the south of France, to the world’s first university medical school. He took his Bachelor of Medicine degree in 3 months in 1530. We know he was already reading Galen (in Greek) and other great classical medical writers, so it is surmised he was already skilled as a doctor.

After more outrageous stories about Gangantua, Pantagruel, and Panurge, he was forced into hiding from the inquisition, and was sheltered by the now Cardinal du Bellay in Paris and Germany. The accession of Henry II, who hated the power of the papacy in France, in 1547 gave him the space to write his fourth book. This period was short lived, and his book, ‘stuffed with heresies’, was condemned by the Catholics and Calvin alike: a sure sign he was on to something too close to the truth! It is thought Rabelais might have died in prison.

 

Here is an excerpt from Johnson (vide infra) to give you an idea of Rabelais’ bravery:

 

“But Spaniards of Jewish descent were duly identified by the Inquisition as Protestants, and burned, and these convictions were taken as proof of an unfounded assumption. By 1556 we find Philip II in writing: ‘All the heresies which have occurred in Germany and France have been sown by descendants of the Jews, as we have seen and still see daily in Spain’. Protestantism was thus fitted into the hate-structure of the country, and doctrinal orthodoxy was reinforced by racism. The campaign was directed against foreigners as well as Spanish Jews and intellectuals; in fact after the mass-burning of Protestants in 1559-62, conducted at grandiose ceremonies in front of the king and other members of the royal family, most of the Protestants executed were foreigners, who were assumed to be actively plotting to subvert the state. Many of these were seamen and merchants, chiefly from France, England and the Low Countries: commercial rivalry was thus reinforced by doctrinal hatred, and sea-warfare took on a new ferocity.”

 

 

At this time also Galileo provided the easily observable proof of the motions of the ‘Medicean’ moons (now the inner four Galilean moons) of Jupiter that validated Copernicus’ assertion that the sun rotated around the moon. He did this at considerable risk to himself, ten years after Giordano Bruno was burned at the stake in Rome for providing a similar proof. This was one of the great turning points in the intellectual history of Europe, and the famous German doctor and playwright Bertholt Brecht, in ‘The Life of Galileo’, has his protagonist say:

 

(Scene 14) … ‘Had I stood firm the scientists could have developed something like the Hippocratic Oath, a vow to use their knowledge exclusively for mankind’s benefit. As things are, the best that can be hoped for is a race of inventive dwarfs who can be hired for any purpose.’

 

 

Rabelais would no doubt have concurred, and his satire on inquisitory justice is thin and sharp. Asides like this one: ‘…much as they used once to whip little children in our country on the hanging of some criminal, in order that they should never forget the occasion.’ provide us with a glimpse of the (religiously rationalised) cruelty of the middle ages; and reveal the growing humanism of the Renaissance as distinct from a corrupt and vicious Catholic Church.

 

Rabelais’ incredible imagination provides us with many belly laughs. He loves to satirise science and its study as much as religion:

 

‘For as you know, wind in its essential definition is nothing more than air in movement and undulation’

 

and

 

‘A not so newly fledged graduate called to his young inspiration: ‘Hullo, hullo, it’s a long time since I saw you, dear bag.’ ‘I’m always glad to see you, my jolly pipe,’ she answered. ‘Couple them together’ said Panurge, ‘and blow up their arses. Then you’ll have a bagpipe.’

 

 

In the American Indian readings we found the heyoka: the clown-medicine man. Laughter is the best medicine they say, and by that account Rabelais must be one of the greatest doctors who ever lived. Two modern Australian examples of this phenomenon are the novelist Nick Earles, and the TV comic Rob Sitch.

 

The middle ages are notorious for cruelty, blind monarchy, and arbitrary justice. Yet there was also Rabelais. Let him have the last word:

 

“I leave you the making of my epitaph. For I shall die pickled in farts; and if someday the ordinary medicaments fail to restore her blowing power to some good woman in the last agony of a windy colic, the mummy-oil from my wretched befarted body will serve the physicians as a quick remedy. After the smallest dose imaginable, they’ll fart more than they expect.’.

 

 

To think about? What do you think about the clown doctor? Does someone like Patch Adams really have any effect on human misery?

 

                        Who was the Theophrastus (Theophrastus Bombast von Hohenheim) Rabelais mentions? What was the importance of his school?

 

 A note on reading Rabelais: Rabelais’ text comprises a mix of stories, anecdotes, poems, lists, fragments and asides, learned dissertations and made up words (neologisms). Sometimes he simply makes a long list of verbs, nouns, or adjectives, as if he wanted to use every word known in his books, but ran out of time. When considering his style it is to be recalled that the novel as an art form had not yet been developed.

 

The extent of learning of this man will soon become apparent if you take on Gargantua and Pantagruel. JM Cohen, one of the great classicist editor/translators of the 20th century, has this reminder:

 

‘Most of the quotations are only there to tease, and nothing would amuse the spirit of Rabelais, in whatever limbo he may be, more heartily than the sight of a literal-minded reader hunting up and speculating on his every allusion to his curious learning.’

 

 

 

References and Further reading

 

Cohen J M (ed., trans.,) (1955) Francois Rabelais  Gargantua and Pantagruel  Penguin Classics

 

Johnson P (1976/1987) A History of Christianity  Pelican/Penguin p307

 

Bertholt Brecht  (play)  The Life of Galileo

 

Nick Earles has several novels in Penguin, for example ‘Bachelor Kisses’, ‘48 Shades of Brown’, and ‘Headgames’.

lm6: Anton Chekhov

 

‘You know, in the first week of Lent I went to Malitskoe, because of the epidemic-spotted typhus….In the houses you could hardly move for sick people….

Dirt, stench and smoke everywhere…and calves mixed up with the sick on the floor….Young pigs there as well. I struggled with it all day, hadn’t a moment to sit down or to swallow a bit of food. But would they let me rest when I got home? No, they brought me a signalman from the railway. I laid him on the table to operate, and he went and died on me under the chloroform. And just when I least wanted it my feelings seemed to wake up again, and my conscience began to worry me as if I had killed him deliberately…I sat down, closed my eyes-just like this- and I started to think. I wondered whether the people who come after us in a hundred years time, the people for whom we are now blasting a trail- would they remember us and speak kindly of us? No, Nanny, I’ll wager they won’t!’

 

‘Uncle Vania: Scenes from country life in four acts’ was first performed in October 1899. Written by Anton Chekhov (1860-1904), a prolific and important writer, it was greatly in demand, and the theatre company that first staged it in Moscow told Chekhov after the event!

 

Chekhov was a doctor as well as writer. He famously said that medicine was his wife, literature his mistress. Practically, medicine would interrupt his writing, just as his character above, Dr Astrov, is disturbed from his forestry projects: with the needs of the people during epidemics. In the final lines of the above quote Chekhov poses a legitimate question, but answers it too: ‘I will make them remember us, through this play.’

 

To think about: Astrov’s speeches about his passion for forestry, on the other hand, have not affected our forestry practices enough:

 

‘Anyone who can burn up all that beauty in a stove, who can destroy something that we cannot create, must be a barbarian incapable of reason. (…) There are fewer and fewer forests, the rivers are drying up, the wild creatures are almost exterminated, the climate is being ruined, and the land is getting poorer and more hideous every day….’

 

Where do the limits of the power of the written word lie?

 

Ivanov

 

Based on the very sound principal of ‘writing what one knows’, there are often doctors in Chekhov’s short stories and plays. The supposed idyll of rural life in his vision suffers poverty and illness, suicide and boredom; all closed up inside dark claustrophobic houses. This is the subject of ‘Ivanov’, which was written in only 10 days in 1888; and a very interesting play from the doctor’s point of view. It even contains an aside on life in Australia!

 

Ivanov is an important councillor and landowner who married a Jewess, Anna Petrovna, for her money. Anna, however, has terminal TB, and her parents disowned her and refused any dowry. Ivanov now feels a broken man, one who, to make things worse, simply doesn’t love his dying wife. He gambles, drinks and flirts by night; and then battles despair and self loathing in the daytime:

 

‘I’m a rotten, pitiful, contemptible creature. You need to be a wretched, worn-out drunkard, like Pasha, to be able to love and respect me still. Oh, God, how I despise myself! I hate my voice, my footsteps, my hands, these clothes, my thoughts. Isn’t it ridiculous, isn’t it infuriating? It’s hardly a year since I was tough and healthy, in good spirits, too, energetic, enthusiastic…’

 

Ivanov is overworked and exposed to too much risk in his business, the rural estate part of which is managed by the annoying Shabyelsky, the bailiff. Shabyelsky makes things harder, and distracts with his endless remarks: “Scientists have been puzzling their brains since the world began, but they’ve never thought up anything nicer than a salt cucumber.” Another resident of the household is Dr Lvov, who graduated a year ago and has come to care for Anna. Shabyelsky’s greeting to Lvov is, by today, an old joke: “Doctors are just the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you too.”

 

As Lvov sees the dynamics of the family and its impact on the health of Anna, and as he fails to persuade Ivanov to let her move to a better climate, he comes to despise his employer. Lvov’s flaw is his sincerity and honesty, which is so extreme that he openly abuses Ivanov on numerous occasions: ‘I’m a doctor, and as a doctor I demand that you behave differently….Your conduct is killing Anna Petrovna.’ and ‘I used to love and respect human beings, but when I saw you…’. To Shabyelsky he honestly says ‘You are profoundly repugnant to me, Count’, and in return is regarded as a ‘narrow-minded, bigoted leech.’

 

People forgive Lvov because of his youth and well-meaning sincerity, but these qualities come with a blindness to the needs of others besides his patient. It becomes increasingly obvious that Ivanov is seriously depressed, but Lvov still wants to duel with him a year after his wife has died, on the occasion of his second wedding. The passage of time, and the complicity of the world some call forgiveness, makes him indecisive.

 

‘Melancholy! Noble anguish! Inexplicable grief! Only one thing’s lacking- I ought to write poetry!’ bewails Ivanov in a black humour. After another spat with Lvov and the family, he shoots himself dead. We have just discovered he was only 35.

 

To think about: Lvov lives in the house of this man who has over a year become profoundly depressed. Lvov assigns moral causes to this, and is therefore blinkered to the possibility that Ivanov is sick also. What conditions could he have had? Could TB be one of them?

 

Chekhov is one of history’s greatest playwrights. Reading Ivanov, observe how quickly he establishes characters, and how simple words and interactions combine to build complex emotional and narrative sequences. His plays can be read quickly and with ease, and are frequently staged around the world.

 

 

References and further reading

 

Fen E (trans.)(1951) Chekhov: Plays      Penguin Classics

 

Coulehan, J (ed) (2003) Chekhov’s Doctors   Kent State University Press

lm 7: Let’s purge this choler: Shakespeare

 

‘Wrath-kindled gentlemen, be ruled by me;

Let’s purge this choler without letting blood;

This we prescribe, though no physician;

Deep malice makes too deep incision:

Forget, forgive; conclude and be agreed.

Our doctors say this is no month to bleed’

 

King Richard II I i

 

There are many medical references in Shakespeare, whose writings begin late in the sixteenth century. At the time there were many theories of medicine. One of the most respected was that of the four humours: blood, choler (yellow bile), phlegm, and melancholy (black bile).

 

…or if that surly spirit, melancholy

had baked thy blood and made it heavy-thick

which else runs tickling up and down the veins…

 

King John III iv

 

Falstaff

 

Sir John Falstaff is one of great witty characters of the English stage:

 

‘ A man can no more separate age and covetousness than a’ can part young limbs and lechery; but the gout galls one and the pox pinches the other, and so both degrees prevent my curses. Boy!

I can get no remedy against this consumption of the purse; borrowing only lingers and lingers it out, but the disease is incurable… A pox of this gout! or, a gout of this pox! for the one or the other plays the rogue with my great toe. ‘T is no matter if I do halt; I have the wars for my colour, and my pension shall seem the more reasonable. A good wit will make use of anything; I will turn disease to commodity.’

 

King Henry IV Part II I ii

 

Madness

 

Many of Shakespeare’s plays involve madness, be it individual, group, or societal. In ‘King Lear’ the madness of the King jeopardises the state, whilst in ‘Macbeth’ the madness of the society threatens individuals. War is seen as a form of madness, as is love. In ‘Romeo and Juliet’, passion drives the protagonists to their deaths. That Shakespeare could regard love as a form of madness is evident from his sonnet CXLVII:

 

‘Past cure I am, now reason is past care,

And frantic mad with evermore unrest;

My thoughts and my discourse as Madmen’s are…’

 

The question of what is and what is not insanity, and whether indeed it even exists, is succinctly put by Polonius in ‘Hamlet’, in one of Shakespeare’s most famous lines:

 

‘Though this be madness, yet there is method in ‘t.’                   (II ii)

 

Another case of interest, that again raises the question of the nature of madness, its cause and effect, is the reaction of Lady Macbeth to the murderous self she has become. Her illness, we are to believe, is genuine, because the doctor is called. She is troubled by haunting dreams that are directly related to her guilt, and practices obsessional nocturnal hand-washing. It is quite astonishing to me that Sigmund Freud doesn’t mention this when discussing ‘Macbeth’ in his masterpiece ‘The Interpretation of Dreams’. Certainly he would have had more to say about it than the doctor in the play, who seems perplexed, but accurately observes that

 

‘More needs she the divine than the physician.’ (V i)

 

King Lear

 

The case of King Lear is our special focus. Shakespeare offers us a perfectly accurate description of an elderly man, suffering from the middle stages of Alzheimer’s dementia. Lear, we are told, is ‘four score’ years old, and Alzheimer’s affects approximately 35% of the population at this age. Shakespeare, as usual, is to be admired for his perceptiveness: octogenarians would have been uncommon in a time when the average survival was about 45 years for men. Everything we learn about Lear fits the diagnosis perfectly. His irrationality and forgetfulness interspersed with periods of painful awareness of his state, his bursts of rage and tearfulness attesting to a crippling emotional lability, and his tendency to become lost even among his companions of many years are all typical of the disease.

 

Lear is reduced to a guard of a hundred, nay fifty, nay twenty-five knights, by the secret connivance of his daughters Regan and Goneril. Addressing Goneril, Lear says…

 

‘ I prithee daughter, do not make me mad:

I will not trouble thee, my child; farewell.

We’ll no more meet, no more see one another;

But yet thou art my flesh, my blood, my daughter;

Or rather a disease that’s in my flesh,

Which I must needs call mine: thou art a boil,

A plague-sore, an embossed carbuncle,

In my corrupted blood.

 

(…)

 

You Heavens, give me that patience, patience I need!

You see me here, you Gods, a poor old man,

As full of grief as age; wretched in both!

If it be you that stirs these daughters’ hearts

against their father, fool me not so much

to bear it tamely; touch me with noble anger,

and let not women’s weapons, water-drops,

stain my man’s cheeks! No, you unnatural hags,

I will have such revenges on you both

that all the world shall- I will do such tings,

what they are yet I know not, but they shall be

the terrors of the earth. You think I’ll weep;

No, I’ll not weep;

I have full cause of weeping, but this heart

shall break into a hundred thousand flaws

or ere I’ll weep. O fool! I shall go mad.’                        (II iv)

 

At the end of this climatic and painful speech, Lear addresses an important character in the play, the king’s fool. Shakespeare’s fool is a traditional one: he gambols about the place and gets away with salacious puns and malicious gossip thanks to a lively intelligence and cunning that ensures his precarious survival at court. Lear’s fool is a devoted servant of the King:

 

Kent: Who’s there?

Fool: Marry, here’s grace and a codpiece; that’s a wise man and a fool.  (III ii)

 

The fool treads the line as finely as possible, and much good humour can be derived from this. Shakespeare provokes his audience via the medium of the fool to examine madness in the world of the play. Not only are the other characters under inspection, so too is the theatre itself. What is madness and what is acting?

 

The Duke of Gloucester has another theory about the problems of the kingdom:

 

Gloucester: These late eclipses of the sun and moon

portend no good to us;…                                   Love

cools, friendship falls off, brothers divide: in cities,

mutinies; in countries, discord; in palaces, treason…

(goes on to talk about predictions)…

 

Edmund: This is the excellent foppery of the world,

that, when we are sick in fortune, often the surfeit

of our own behaviour, we make guilty of our

disasters the sun, the moon, and the stars; as if

we were villains on necessity, fools by heavenly

compulsion, knaves thieves and treachers by

spherical predomination; drunkards liars and

adulterers by an enforced obedience to planetary

influence;…                  (I ii)

 

Edmund, the scheming son, in his false letter, is clear about the diagnosis:

 

(Gloucester reads)‘This policy and reverence of age

 makes the world bitter to best of our times; keeps

our fortunes from us till our oldness cannot relish

them. I begin to find an idle and fond bondage in

the oppression of aged tyranny, who sways, not as it

hath power, but as it is suffered. Come to me, that

of this I may speak more. If our father would sleep

till I waked him, you should enjoy half his revenue

for ever, and live the beloved of your brother, Edgar’    (I ii)

 

 

In Act VI Scene vi  there is a long scene with Lear berating everyone as treacherous. The king is fantastically dressed in flowers: ‘Oh thou side-piercing sight’, says Edgar, his good son, who later has an aside: ‘O! Matter and impertinency mix’d;

reason in madness.’

 

Finally, in Scene vii, Cordelia, Kent, and a doctor attend to the king

 

Lear: Pray, do not mock me:

I am a very fond, foolish old man,

fourscore and upward, not an hour more nor less;

and, to deal plainly,

I fear I am not in my perfect mind.

Methinks I should know you and know this man;

Yet I am doubtful: for I am mainly ignorant

what place this is, and all the skill I have

remembers not these garments; Nor I know not

where I did lodge last night. Do not laugh at me;…

 

…Am I in France?

Kent: In your own kingdom, sir.

 

In the end Lear is condemned to live on, and power remains with him, Kent, and Edgar...these are about the only survivors…the Fool and Cordelia die, along with Edmund, Goneril and Regan.

 

Consider: Have you met any patients whose mental illness is debateable? Have a look at the Thomas Szasz’s book: he was a New York psychiatrist who founded the ‘anti-psychiatry’ movement.

 

Are there any modern states with leaders whose behaviour may be considered abnormal, and who are adversely affecting the health of their citizens?

 

References and further reading

 

Szasz T S (1974) The Myth of Mental Illness   Harper and Row pp 238-49

 

Freud S (1985) The Interpretation of Dreams  Pelican  p368

 

lm8: HG Wells The Island of Dr Moreau

 

 

Doctors misusing science is a popular theme in fiction, underpinned by such classics as Frankenstein (1831), and The strange case of Dr Jekyll and Mr Hyde (1885). These books were part of a gothic revival in literature in the 1800’s. Some people see this as a nostalgic yearning for earlier times: despite their dank castles, ghosts and dungeons there was no vast industrial revolution polluting the atmosphere and enslaving workers. The medical novels relate to the newest fears of mankind raised by technology combined with the revelations of Darwin, Mendel and the other early geneticists.

 

The Island of Doctor Moreau was written in 1896, by which time Darwin’s ideas had spread around the globe, which was populated with thousands of expatriate European amateur scientists reporting on every life-form they could find. Naturally, because of the global reach of the European empire, anthropology became of great interest. Sir James Fraser’s The Golden Bough (1913) was a 13-volume summary of the interrelated customs, beliefs, and myths of the human race that is a reference book today. By the time it was compiled and published primitive art had become of great interest, as was the question it posed: what is it to be ‘civilised’. Phrenology, the ‘science’ of determining personality by detailed examination of the contours of the skull, was becoming popular, and in the eastern United States eugenics programs were commenced- the forced incarceration and sterilisation of variously deficient genes as expressed by individuals. By the 1920’s the Nazis were sending scientific advisors to America to study their racial improvement programs. Though the story of evil doctors is not over, perhaps the worst of the 20th century was the Nazi Josef Mengele.

 

Vivisection, or vividissection, means ‘live cutting’. The technique as physiological, scientific experiment is recorded in the Oxford English Dictionary from 1707, and evidently by 1711 was common practice on dogs. Surgery and science were growing, and knowledge had to be had at whatever cost for the sake of human progress. As time went by, and public social conscience began to be expressed in areas such as worker’s conditions and prisoner’s basic rights, concern for animal suffering rose in some quarters. In recent times, in Australia as well as abroad, animal liberationists have adopted increasingly aggressive tactics to stop vivisection. Indeed, they have been accused of terrorist action, notably in the UK. Together with the IRA and anti-capitalists these groups give the lie to the Bush administration’s anti-Muslim approach.

 

Back in 1896, Dr Moreau is doing vivisection on a wide variety of species on his uninhabited island somewhere in the Atlantic. A shipwrecked man with an undergraduate biology background is begrudgingly rescued. HG Wells has this man quite revolted by Moreau’s experiments on a puma “so cut and mutilated as I pray I may never see living flesh again”. The animal’s horrible screams pierce the deep black night. Moreau eventually explains himself:

 

 

 

‘These creatures you have seen are animals carven and wrought into new shapes. To that- to the study of the plasticity of living forms- my life has been devoted. I have studied for years, gaining in knowledge as I go. I see you look horrified, and yet I am telling you nothing new. It all lay in the surface of practical anatomy years ago, but no-one had the temerity to touch it…

…You begin to see that it is a possible thing to transplant tissue from one part of an animal to another, or from one animal to another, to alter its chemical reactions and methods of growth, to modify the articulations of its limbs, and indeed to change it in its most intimate structure.’ (p78)

 

 

‘I took another sheep and made a thing of pain and fear, and left it bound up to heal. It looked quite human to me when I had finished it, but when I went to it I was discontented with it; it remembered me and was terrified beyond imagination, and it had no more than the wits of a sheep. The more I looked at it the clumsier it seemed, until at last I put the monster out of its misery. These animals without courage, these fear-haunted, pain-driven things, without a spark of pugnacious energy to face torment-they are no good for man-making.

 

Then I took a gorilla I had, and upon that, working with infinite care, and mastering difficulty after difficulty, I made my first man. With him it was chiefly the brain that needed moulding; much had to be added, much changed…’ (p82)

 

Needless to say, things go wrong for Dr Moreau, who tells the narrator about ‘the stubborn beast flesh’ not long before it gets him.

 

To think about: The theme of the inventor being killed by his own work (which is a presumption against God) goes back at least to the tale of Icarus. What are the implications for following the fads of medical science today?

 

 

Eventually the narrator is left on the island with the vivisected animal-humans. They have been inculcated by fear with a basic law of civilisation, which begins to break down when punishment is removed:

 

‘…They were reverting, and reverting very rapidly.

 

Some of them- the pioneers, I noticed with some surprise, were all females- began to disregard the injunction of decency- deliberately for the most part. Others even attempted public outrages upon the institution of monogamy. The tradition of the Law was clearly losing its force. I cannot pursue this disagreeable subject. My dog man imperceptibly slipped back to the dog again; day by day he became dumb, quadripedal, hairy…

 

It would be impossible to detail every step of the lapsing of those monsters; to tell how, day by day, the human semblance left them; how they gave up bandagings and wrappings, abandoned at last every stitch of clothing; how the hair began to spread over the exposed limbs; how their foreheads fell away and their faces projected; how the quasi-human intimacy I had permitted myself with some of them in the first month of my loneliness became a horror to recall.’

 

Consider: Wells writes about the female lapsarians in three sentences, and concludes that ‘I cannot pursue this disagreeable subject’. This stimulates our imagination and obeys Shakespeare’s injunction that brevity is the soul of wit. It is a device apparently lost on many Hollywood-style scriptwriters. How in film would they portray this part of the story?

 

How does modern genetics fit into this scenario?

 

 

References and further reading

 

Darwin Charles (1859) The Origin of Species

 

Fraser, Sir James (1913) The Golden Bough 13 vols  MacMillan

 

Lifton Robert (1986/2000) The Nazi Doctors: Medical Killing and the Psychology of Genocide  Basic Books

 

Shelly Mary Wollstonecraft (1797-1851)  (1831) Frankenstein, or, the Modern Prometheus

PR5397.F7 1959

 

Stevenson, Robert Louis (1850–1894)  (1885) The strange case of Dr. Jekyll and Mr. Hyde

PR5485.A1 1990

 

Wells, Herbert George (1866-1946)  (1896) The island of Doctor Moreau

Chifley PR5774 .I8 1996b

 

 

 

 

 

 

lm9

 

The Mad Doctor

 

Anyone who prefers to doubt the existence of a White Australia policy, or who sees modern restrictions on women here as excessive, will be pushed to reconsider after reading The Mad Doctor, by the popular novelist F J Thwaites and published in Sydney in 1935. By April 1947 this book was in its 11th re-print, and Thwaites had rewritten some of it: modern literary theory would assert this tells us something about the society that produced this text.

 

To think about: What image does ‘The Mad Doctor’ bring to mind, before you know more about the story?

 

Perhaps the extreme tragedy of the novel’s background was necessary to have any dramatic impact at all after the massive and ongoing trauma of the First World War. A young surgeon is implored by his beloved sister to perform an illegal abortion on her. He agrees, she dies, he goes to prison for five years, and his reputation is ruined. Upon his release his father disowns him, so he disappears.

 

Some time later a doctor is heard of in the African jungle, apparently able to cure paralysis, one of the ancient curses of medicine. There is only one problem:

 

‘… “Where has he gone?”

 

“Up the river” she answered lifelessly. “Plague has broken out in some tribe- he’s gone to them. Will be away a day or two I fear.”

 

Sir Austin lifted himself on both elbows and stared across at his daughter like a man unable to believe his ears.

 

‘Do you mean the idiot left me here to die- that he’s gone, God knows where, to treat natives in preference to a white man?” His voice fell to a whisper as he finished. “Why it’s unbelievable. Is- is he mad?”

 

“They call him the mad doctor, Daddy.” ’

 

Later, another heroine comes to the Kasser river:

 

‘To Adele, as she watched the scene, it gave a fleeting impression that here was a great human ant-heap, swarming natives, happy because they were working.

 

An occasional flash of white mingled with the drabness and was lost, as some European in topee and drill strode masterfully through the crowd. While here and there a turbaned Indian peddled his wares along the street.’

 

The novel is proudly nationalistic, and it is ‘British Justice and the BMA [British Medical Association]’ that puts the doctor away. There are some entertaining swipes at the old country, as when the doctor is ordering his servant around:

 

‘ “No soap, master,” he said in English which, though not really fluent, was simpler and more direct than that used by many Oxford graduates.’

 

Strickland, a leading neurosurgeon, is against the brain-drain that has afflicted Australia for a century:

 

‘ “I’m able to do work in Australia, just as well as I could in New York or London, and I’m needed just as much here; so why should I leave the country of my birth?”’

 

To think about: If Thwaites is so keen on Australia, why did he not set his novel in an aboriginal community?

 

No doubt you recall the Dr Patel case early in 2005. For today’s reader this adds a sinister dimension to this conversational remark:

 

“You’re too modest Graham, and too timid. That’s why you’re still a G.P.  Given the most remote chance of success, I’m willing to operate, and, because I’ve an intense confidence in myself, I’m generally successful. Confidence, after all, is the best ally of any surgeon.”

 

However, we must remind ourselves it is a novelist, not a surgeon writing these words. Indeed, one is glad one is not a patient of F J Thwaites, who ministers to a dehydrated, collapsed old man in the African jungle:

 

‘She lifted his head and moistened the lips with brandy, then gently forced some of the life-giving drops between them. For long minutes he lay as though dead…’

 

Unfortunately ‘she’ dies of a fever, and he decides to throw himself to the crocodiles, not forgetting to beseech the doctor in a letter:

 

‘Doctor, I urge you to leave this country…England- go there…In your hands you hold a cure for thousands of crippled men and women…kill the cynic in your heart that cries to you of life’s injustice…go out into the world and return good for the evil done you…’

 

To think about: Here, Sir Austin clearly states Englishmen are more important than Africans. But what of World Wars One and Two…could Africa be a metaphor for the infested swamp of war, and England for bigoted civilisation? Perhaps people in 1946 wanted to know how to assimilate their wartime lives…how to forgive and carry on? The novel’s expression of metaphor may have had a social purpose.

 

Finally the mad doctor falls for the number two heroine. Unbelievably he is not recognised by his father, even after weeks together in the jungle with only some grime and a beard to disguise himself. The finale enforces an over-reaching moral without any attempt at literary disguise:

 

‘There was humble ring in his voice. “The mad doctor is dead, but there times when his spirit still haunts me. I must forget- only God can help me.” He drew a deep breath. “And- and you can give me back my faith in God.”

 

For a moment she was too affected to speak. Then slowly her wet eyes were lifted to his.

 

“I’ll try ever so hard, darling,” she whispered; “ever so hard.”

 

He stood very straight, his arms holding her close, his gaze lifted towards the star-encrusted heavens, and at that moment his face held a beauty that does not come from earthly things- for the mad doctor had found his way back to life- and to God.’

 

A historical footnote: ‘Doc’ Evatt

 

I suppose that thanks to this novel that Dr Evatt was called ‘the mad doctor’ from time to time. (His degrees were in Law.) Evatt was deputy prime minister under Chifley during WW2. He was president of the third General Assembly of the UN from 1948-9; the first chairman of the UN Atomic Energy Commission; and opposition leader from 1951. He retired from politics in 1960 to become a high court judge.

 

References and further reading

 

Thwaites FJ (1935 to 1947) The Mad Doctor (11 editions)  Peter Huston  Sydney

 

for a brief biography of Dr Evatt:

www.lib.flinders.edu.au/resources/collection/special/evatt/evattbiog.html

 

for a reference to Evatt as the Mad Doctor, see Voice: A Journal of Comment and Review  15/20   Canberra

 

 

 

 

 

 

 

 

 

 

lm13 How to Develop Literary Diabetes

 

Robin Cook is a New York doctor. ‘Vector’ was his 21st medical thriller, and concerns a bio-terrorist threat to his home city. Here we look at his style, and contrast US pulp fiction to high literature. Perhaps in the holidays you might like to read one of the great literary masterpieces I shall recommend, followed by a Robin Cook novel. The comparison is interesting and worthwhile…both approaches to writing have their pros and cons.

 

‘Vector’ opens with a ghastly ritualistic murder, described with the same degree of concern the US entertainment industry generally has for the suffering of minor characters. Also, a rare case of haemorrhagic mediastinitis appears for post-mortem.  Our hero Jack, who owns a dog-eared copy of Harrison’s, realises it is due to anthrax. It is not long before the FBI becomes interested and the threads come together…the PAA, or People’s Aryan Army, an ultra-right wing group dedicated to destroying what they perceive as Semitic capitalism, has found a disgruntled Russian ex-bio-weapons technologist driving a yellow cab who wants to join them in a mass murder of rich New Yorkers.

 

To think about: Cook’s plot was activated a few years after the book was released. Do you remember the anthrax sent to certain people in Washington DC? Do you think the writer can be held responsible?

 

 

Meanwhile a rather dehydrated sort of red herring surfaces...what is the mysterious dinner their friend Laurie wants them to attend? This deeply boring mystery gets two pages of ‘hmmm, gee, I just don’t know’ dialogue early on, and reappears four more times before we find it all nothing much, and finally irrelevant.

 

‘…Jack mulled over Laurie’s surprising behaviour. It was so out of character. She was always considerate and concerned about proper etiquette. She would never phone at such an hour without good reason. Jack wondered what that reason was.

 

Jack shaved and climbed into the shower while he tried to imagine why Laurie would have called in the middle of the night…’ (p 9)

 

Sentences like ‘Jack wondered what that reason was.’ are superfluous, and give the novel an air that is almost childish.

 

Here is another example, from p69: ‘She explained to Jack that Jason’s business was wholesale…She also said there were no employees at the warehouse nor at the office.

 

“Sounds like a one-man operation,” Jack said.

 

“Very much so,” Helen said.’

 

Here the word ‘nor’ is ungrammatical, and is typical of errors that creep into manuscripts when the author writes two or three novels a year, and the publishing industry is too sycophantic to the dollar to bother editing them properly. This is more common practice in the industry than non-writers realise. Publishing is very nepotistic when money becomes involved. Books like Cook’s are printed in large format with expensive glossy covers, whilst the timeless classics of literature are to be found in very modest little books, if at all. So-called ‘International Bestsellers’ are declared so on the basis of domestic sales in the US: the list cannot be trusted. For example, one can rise up the list by buying thousands of your own books, making yourself appear a bestseller. The mindless mechanism of the market, and mechanistic mind of the consumer, does the rest.

 

To think about: Poetry is an art-form that has in a way retained its purity by being almost irrelevant economically. Can you think of any others?

 

Do you think the Australian industry is safe from these fiscal pressures?

 

 

At the end of chapter three, I personally was thinking ‘I know the pattern of this story already, why bother continuing? The dramatic techniques are standard and dull, there is sure to be a car chase, a love interest, and some gun deaths. There are no long words, no concepts, no self-questioning or examination of the human complexities of motive, and no thoughtful sentences to pull one up. The book is designed to flow quickly and end with a brief thrill of the sort that makes the customer want to go out and buy the next Robin Cook. If this were food, it would give you diabetes.’

 

Anyway, the book carries on, with the words ‘Jack said’ so common as to give the impression of an irritating Jack-hammer in the novel’s background. The stupid stick-figure characters of the terrorists are set in an environment which is held to be so obvious that it needs no explanation…Cook for instance thinks we are interested in which streets his cyclist hero rides along: the name of the street is seen as all the information required for a reader to picture it. This is typical of the strange insularity which most large and egotistical metropoli manifest around the world.

 

Like a Hollywood script, everything is spelt out for us. The waking from a dream method of going back over past history is used to open two chapters. All the serious characters but one are male, with single syllable names: Jack, Steve, Curt, Chet, and Tom. Only the Russian, Yuri, doesn’t fit the pattern. His slug of vodka works like a theme tune…which is OK, but a sophisticated writer would think of more than one characteristic for a human being.

 

The characters (‘“Excuse me!” she called out to Marlene Wilson, the African American receptionist.’) use fragments of conversation which are not believable- for example, when the bad guys are talking about their plot to kill thousands-

 

‘Besides, let’s not forget he’s doing us one hell of a favour getting us a bio-weapon.’

 

Similarly, the female lead, another highly educated doctor, is shortly to get married, but it is up to her friends to find out what her fiancee does for a living…she didn’t ask. At the same time, a colleague who works in the same department every day and who is in love with her says she never mentioned to him her forensic speciality was gunshot wounds.

“I’m impressed by you two going to Paris for the weekend. I could never do that in a million years” says Jack. The Canadians have an expression for all this… “Yeah, right.”

 

To think about: In a way that is the easy bit. A more intriguing question is why these books, that neither linger in our memory or nourish our inner life, are so very popular.

 

References and Further Reading

 

Cook R (1999) Vector   Macmillan

 

Cook R…..possibly the most popular of his thrillers was ‘Coma’.

lm14: Han Suyin

 

‘Oh flower of love, rooted in joy and sorrow, perfection once known and never forgotten, the beginning and the end, and afterwards, loneliness.’

 

Born in 1917, Han Suyin is the nom-de-plume of Dr Elisabeth Comber, born Rosalie Elisabeth Kuanghu Chow the Chinese-Flemish author of The Many-Splendoured Thing, an autobiographical novel, if that is possible, hugely popular in the 1950’s. The title is a line from the English ecclesiastic poet Francis Thompson.

 

Set in Hong Kong in 1949 and 1950, the novel is famous for its exquisite portrayal of love, and its backdrop of revolution in China and war in Korea. Suyin’s lover is a barely fictionalised portrait of Ian Morrison, the foreign correspondent of The London Times and son of Times journalist George Morrison, an Australian. The difference between her characters and real people was not great enough for those she lambasted. There was a most exuberant scandal, and a Hollywood movie in 1955.

 

‘Doctors,’ I said, ‘are granted the veneration and treated with the awe once reserved to seers and priests. As a consequence our lust for power is phenomenal. Imaging how corrupting it must be to hold sway over life and death. We are all megalomaniacs.’

‘But so are journalists,’ said Mark. ‘Think of the delusions we spin for the hordes of our readers. We are the great dispensers of up-to-the –minute unrest to the millions. Folie de grandeur is our occupational disease.’

 

It is 1949, and there is a grand exodus of missionaries from China as the Kuomintang nationalist army retreats, almost without resistance, before Mao and his Communists.

Han Suyin arrives at the Church Guest House in Hong Kong, having completed her studies in England for which she received a scholarship. She is going back to China after 8 years, She considers herself mostly Chinese, but also a Eurasian outsider. Much of this book revolves around this cultural schism. Suyin works full time at the overcrowded hospital in the British colony, and manages to be a prolific author as well as the widow-mother of a confident nine year old girl.

 

One of her first patients, when she has time, is an overweight missionary:

 

 “For weeks I stood over her at meals, brandishing under her nose a written list of forbidden items. “It’s such a relief to know you are going to stay at Church Guest house for a while,” she says. “So nice to have a doctor at hand, when one’s got children.”

 

She describes a ‘jolly round American’ and his ideas that the entire communist revolution is thanks to him and his kind...he says the Americans have taught the Chinese Christian values, the communists respect their humanism, and Jesus was the first communist. Han does not pass judgement on his apparently arrogant remarks.

 

While ghastly suffering and poverty is all around, the expats are in their own little world of wealth and privilege:

 

‘My old doctor F.K. died last week…I rang him and the amah told me he was ill and couldn’t see anyone. “What, not even me? I am very ill too,” I said. “Luckily I got another doctor, a specialist from Boston, because F.K. died the day after. Just imagine if there had been no-one else to treat me!…”

“You are very lucky, Nora.”

“He’s terribly expensive,” she says, “but of course he’s a specialist.”

Suyin is a young doctor, and is guilty of perpetrating one of the most enduring myths of medicine, created by faulty terminology…her representation, in several places in the book, of the schizophrene as someone a ‘split mind’, in two worlds at once. 

 

Han is generally forgiving to the communists, and stays out of politics, despite being a widow of a Kuomintang general. She does not shrink from describing the reality of feudal China when she goes to visit her banker uncle in Chungking. Her sister Suchen, who married a foreign devil, is exiled from her family, 25 metres down the street. This si a fascinating chapter on the family in China, the tensions, Chungking and the communists, executions, violence, starvation, and her capitalistic banking family hoping it will all blow over, and that trade will be untouched. She emphasises her Taoist approach to life:

 

‘Since we are, each one of us, unequal, and equal opportunity does not exist, I have never been able to understand why one should not accept to do evil as well as good, and with just as much clarity. I have a deep suspicion of philanthropists and do-gooders generally. I believe in relationships between people, devotion to friends, sticking to principle and the pursuit of the absolute in oneself, not of perfection to impose upon others. I am a feudalist and a Taoist, and use despotism with enlightenment, for I am doctor. One has to impose upon the sick one’s own will, and anything else is hypocrisy and nonsense. Doctors use power so much and get so much pleasure out of it. They stalk in their white gowns, like prophetic kings; the stethoscope round their necks are the badges of their magic knowledge; they survey the prostrate forms of their patients, lying helpless in neat rows on their beds. They lay healing hands and save lives. This is arrant, orgiastic power, the most corrupting one to the soul, that of doing good.

 

To think about: What is your attitude to communists and why?

 

When she describes the execution of some communists watched from the balcony there is no sense of disturbance…death is their destiny, simple as that. One denounced ‘communist’ to die just before they win in ChungKing is a 12 year boy. Afterwards her family takes her to the community restaurant where there are spittoons on the tables:

 

I saw a large Chungking rat with a long, scaly, hairy tail creep out from under a chair and come and drink out of one of them in great gulping draughts. No-one shooed him away. No-one cared.

 

She describes the situation of the refugees:

 

‘Now Hong Kong is overcrowded. And now there may be another war. Poverty, dirt and disease are true internationalists.

 

There were not enough beds; there were not enough sanatoria. Hundreds of new cases went to the clinics, were seen, diagnosed, X-rayed, told to go home and to rest. How could they rest? If they stopped work they starved. So they went on until they died.

 

“I can sell my son,” said the girl. Behind her stood the little boy, hanging his head, sucking his thumb. He was very shy. “We come from a good family”, said the girl. ‘My little one is intelligent and well made. If I sell him, will there be enough money to cure my husband?”’

 

As the Communists are rehabilitating prostitutes…some into agricultural engineering and medicine at university... as part of their “New Democracy”, an American who calls Suyin “ChuChinChow” makes her pale with rage. “You guys ought to follow the American way of life” he says to her on his three week tour of six or seven Asian countries before heading home to the US backwoods to teach Asian studies. ‘Suzanne has not recovered from her sense of white superiority…’ she remarks of seeing a British woman again.

 

The Americans subsidised many Chinese Universities but now those educated there were being expelled along with the missionaries, media, and western teachers (some of whom it must be admitted were either counter-revolutionary, or spying, but most of whom called China their legitimate home). China wanted none of their propagandistic invasion of ideas...it was an ancient culture having a revolution so that it might stand on its own. Suyin reports in a detached way (after all, she is madly in love) the massacres and removals and denunciations and brutality and propaganda; alongside the fervent belief, the many things achieved, an honesty in trade that startled the businessmen from overseas, huge public works programs, great strides in equality and public health.

 

She reports the conversations in Hong Kong about stinking ‘foreign devils’ and inscrutable Chinese, and often derides the clichés the East and West have about each other. Ultimately the reader is led to consider the validity of the notion that there might be two worlds. Perhaps there is one, vast, contradictory, all-inclusive humanity, eternally bound to itself.

 

‘For we are all riveted to our own physiological landscape and the climate of our minds, unable to pry ourselves loose from the emotional evocation of the words we use, more important to us than their meaning; confusing feeling with thought, in this highly emotional and dangerously uneducated twentieth century in which we live.’

 

Her lover is killed in Korea reporting the front line with the Americans. They have, in Suyin’s eyes, sent over GI’s who call everyone Gook and kill all they see, civilians in thousands with their troops, and tens of thousands with their bombers, without finding out if they are refugees or even on their own side.

 

As The Many Splendoured thing comes to a close, she observes:

 

‘Again I realised that people bring to what they see and hear and feel the inner weather of their souls and the complexion of their minds.’

 

Consider: The implications of this for taking a good patient history.

 

Her final pass at the international situation as seen from the doctor’s point of view is a quote from a colleague when discussing the shortage of everything medical:

 

‘Tuberculosis may slaughter in its thousands, and Hongkong cannot be defended for more than a few days, but defence comes first.’

 

References and Further Reading

 

Han S (1995) The Many Splendoured Thing   Sheridan

 

There is also a well-known two volume biography of Mao Tse Tung

 

lm15: The Alchemist

 

Ben Jonson was born in 1572, and though capable of attending Oxford or Cambridge was briefly apprenticed to his step-father as a bricklayer. Perhaps this humiliating experience gave him both his depth and fury of personality. He was one the great wits of his day. His comedy The Alchemist was performed at the Globe, the theatre in London made famous by his contemporary, Shakespeare, in 1610.

 

He remains one of the great playwrights of the English literary canon, but he is just as highly esteemed as a poet. The introduction to his ‘Song: for Celia’ is famous:

 

Drink to me, only, with thine eyes,

And I will pledge with mine,

Or leave a kiss but in the cup,

And I’ll not look for wine.

 

The loss of two children, a girl at six months, and boy at 7 years, resulted in tender and outstanding epigrams; and Jonson wrote many other elegies and epitaphs. In his poem ‘To Sicknesse’, he writes:

 

‘Pray thee, feed contented, then,

Sicknesse; onely on us men.

Or if needs thy lust will tast

Woman-kinde; devoure the wast

Livers, round about the townes.

But, forgive me, with thy crowne

They maintayne the truest trade,

And have more diseases made.

What should, yet, thy pallat please?

Daintinesse, and softer ease,

Sleeked limmes, and finest blood?

If thy leanenesse love such food,

There are those, that, for thy sake

Doe enough; and who would take

Any paines; yea, think it price,

to become thy sacrifice.

 

 

This Elizabethan English is not easy: try it again! Jonson is asking Sickness to leave women alone, and to afflict only men. But if sickness must attack women, it should pick on those who waste their lives in prostitution…oops, sorry, Sickness, I didn’t mean to insult the people who work so well on your behalf. Take then their opposite, the dainty women of leisure who would enjoy a good illness for society’s sake?

 

In ‘An Epitaph on Master Vincent Corbet’, Jonson proposes a moralistic view of health promotion

 

Deare Vincemt Corbet, who so long

Had wrestled with Diseases strong,

That though they did possesse each limbe,

Yet he broke them, e’re they could him,

With the just Canon of his life,

A life that knew nor noise, nor strife:

But was by sweetning so his will,

All order, and Disposure, still.

His mind as pure, and neatly kept,

As were his Nourceries, and swept

So of uncleannesse, or offence,

That never came ill odour thence:

 

The Alchemist

 

Typically, Jonson’s characters have facetious names. Subtle is dressed as a Doctor of Alchemy; his partners in crime are Face, a spruiker, and Dol Common, a whore. They are cozening (conning) Sir Epicure Mammon and others out of their money by pretending to make various alchemical preparations. Pertinax Surly is Mammon’s protector, and does not believe the Doctor and his companions. Jonson researched contemporary practices to write his play, which is presented with tremendous humour and vitality, and ends with the downfall of the conniving charlatans. He has given us an unparalleled insight into an aspect of health practice in Elizabethan England.

 

Subtle, Face, and Dol Common are about tricking people who are rich, gullible, and vain out of their money. They are operating from the house Face’s master has left because the plague is in London again. They have Metoposcopy, Chiromancy, and Alchemy:

 

SUBTLE: The thumb, in Chiromancy, we give Venus;

The forefinger to Jove; the midst to Saturn;

The ring to Sol; the least to Mercury,

who was the Lord, sir, of his horoscope,           I iii 53-7

 

The Doctor can create familiar spirits that bestow good fortune on gamblers; and is making a Philosopher’s Stone for Sir Epicure Mammon. Just before the ‘projection’ of the final qualities into the stone a tobacconist called Drugger comes in to consult the almanac (similar to a horoscope):

 

DRUGGER: I would entreat

another favour of his worship.

FACE: What is’t, Nab?

DRUGGER: But to look over, sir, my almanac

            And cross out my ill-days, that I may neither

Bargain, nor trust upon them.                I iii 91-5

 

 

In Act II Pertinax Surly and Sir Mammon come for the philosophers stone, but are put off with alchemical mumbo jumbo for another week, and asked for more coins and metals to keep the transmutation process going. Subtle warns Mammon, who is gullible enough to believe he has a copy of ‘a treatise penned by Adam- o’the Philosopher’s Stone, and in High Dutch’, that the Stone must be put only to pious uses. Surly can see through them, but to no effect:

 

SURLY: …sir, I’ll believe

            That Alchemy is a pretty kind of game,

Somewhat like tricks o’ the cards, to cheat a man

With charming.

SUBTLE: Sir?

SURLY: What else are all your terms,

            Whereon no one o’ your writers ‘grees with other?

            Of your elixir, your lac virginis,

Your sal, your sulphur, and your mercury,

Your oil of height, your Tree of Life, your blood,

Your marchesite, your tutie, your magnesia,

Your Toad, your Crow, your Dragon, and your Panther,

Your sun, your moon, your firmament, your adrop,

Your lato, azoch, zernich, chibrit, heautarit,

And then your red man, and your white woman,

With all your broths, your menstrues, and materials

Of piss and egg-shells, women’s terms, man’s blood,

Hair o’ the head, burnt clouts, chalk, merds, and clay,

Powder of bones, scalings of iron, glass,

And worlds of other strange ingredients

Would burst a man to name?

 

SURLY: ‘Heart, this is a bawdy house! I’ll be burnt else.

MAMMOM: O, by this light, no! Do not wrong him. He’s

Too scrupulous that way. It is his vice.

No, he’s a rare physician, do him right.

An excellent Paracelsian! And has done

Strange cures with mineral physic. He deals all

With spirits, he. He will not hear a word

Of Galen, or his tedious recipes.

 

In Act III Ananias, a zealot, needs some money for his church, and is shy of transgression. Brother Tribulation Wholesome encourages him to meet Subtle, all in a good cause:

 

ANANIAS: ‘He bears

The visible mark of the Beast on his forehead.

And for his stone, it is a work of darkness,

And with his philosophy blinds the eyes of man

TRIBULATION WHOLESOME: Good Brother, we must bend unto all means

            That may give furtherance to the Holy Cause.

ANANIAS: Which his cannot. The Sanctified Cause

Should have a sanctified course.

SUBTLE: ..even the medicinal use shall make you a faction

And party to the realm? As, put the case,

That some great man in state, he have the gout,

Why, you but send three drops of your elixir,

You help him straight. There you have made a friend.

Another has the palsy or the dropsy,

He takes of your incombustible stuff,

He’s young again: there you have made a friend.

A lady that is past the feat of body,

Though not of mind, and hath her face decayed

Beyond all cure of paintings, you restore

With the Oil of Talc. There you have made a friend.

And all her friends.

TRIBULATION: It is an ignorant zeal that haunts him, sir,

But truly else a very faithful Brother,

A botcher, and a man by revelation

That hath a competent knowledge of the truth.

 

Finally, the owner of the house, Lovewit, turns up unexpectedly and the whole scam collapses in infamy.

 

SURLY: Or, he is the Faustus,

That casteth figures and can conjure, cures

Plagues, piles and pox…

 

Face tries to explain away the crowd when Lovewit invokes the name of a psychiatric facility so notorious it’s name has entered the English language. But there are aristocrats present who should not be offended:

 

LOVEWIT: The world’s turned Bedlam.

FACE: These are all broke loose,

Out of St. Katherine’s, where they used to keep

The better sort of mad-folks.

To think about: How common do you think medical charlatanism is in contemporary Australia? How would you define it? How would you deal with it if you were a politician?

                        Who was Paracelsus?

 

Dr Faustus

 

This play was written by Christopher Marlowe, the first of the great Elizabethan dramatists, the man who with The Jew of Malta created the first character play. Prior to this all stage drama was re-enactment of traditional, often religious, stories. Dr Faustus was brilliantly written but in the former mould: the tale of the alchemical doctor who sells his soul for total knowledge, which brings him total power, but is dragged down to hell at the appointed hour, came out of the forests of dark age Germany. Goethe, Germany’s great 19th century playwright, also tackled the story.

 

References and further reading

Hollander J (ed.) (1961) Ben Jonson  The Laurel Poetry Series  Dell

Jamieson M (ed.) (1966) Ben Jonson: Three Comedies   Penguin English Library

Marlowe, C  Dr Faustus           Mermaid

Goethe Faust    Penguin Classics

lm16: Somerset Maugham

 

"There are three basic rules for writing a novel. Unfortunately nobody knows what they are".

 

Somerset Maugham, !874-1965, was prolific author of novels, short stories and plays, a number of which use his medical background. He was born in Paris, but lost his mother at 8 and his father at 10, so was educated by his uncle and aunt in the UK and at Heidelberg. He graduated in Medicine from St Thomas’ in London, and by 1897 had released his first popular novel, ‘Lisa of Lambeth’. By 1908 he had 4 plays running in London alone, and had made an impressive debut as a novelist. He married Sylvia Wellcome, daughter of Dr Barnardo. He spent little time with his wife and during the Great War, after a stint as an ambulance driver in France, was posted as a secret agent to Geneva then Petrograd, where his mission was to prevent the Bolshevik revolution(!) In the early 1920’s he went to South America and the Pacific with his (boy)friend Haxton, a time that generated many tales.

 

Sheppey

 

In 1933 he wrote Sheppey, a play in some respects a return to his first novel, set in grimy, poor, cockney London. In 3 acts, it was dedicated to the famous actor John Geilgud.

 

Sheppey was first performed in 1933, at the peak of the Great Depression in England. Maugham uses his character’s illness, apparently a hypertensive stroke resulting in a paranoid, religiose mania, as a mirror in which to reflect his society’s religious and secular value judgements related to poverty. Here is an (edited) conversation in his shop one day:

 

SHEPPEY (of the thief)  …e’ ‘adn’t ‘ad a bite for two days. You couldn’t ‘ardly ‘elp feeling sorry for him really.

MISS GRANGE  You’re too soft hearted, Sheppey. All this unemployment…I believe if you really want a job you can find one.

BOLTON Of course there’s a good deal of distress about nowadays, but there’s nothing to do about it.

MISS GRANGE  That’s what I says, there’s always been rich and poor in the world an there always will be.

SHEPPEY  It seems funny in a country like this there should be a lot of starving people.

MISS GRANGE  …Be thankful I says, and don’t worry about anybody else.

 

…BOLTON You can earn good money because you’re steady and industrious.

 

…SHEPPEY  But p’raps if they’d ‘ad my chances, they’d ‘ave been just as good as me.

 

…MISS GRANGE  I hope you haven’t caught something sitting with all those dirty, unhealthy people.

 

 …MISS GRANGE: Oh, don’t harp so. Why, you might be a Socialist to hear you talk.

                                  …My belief is that a lot of those people who sleep out on the Embankment sleep there because they really like it.

                                  …And if he’s hungry I should have thought he was better in prison than outside.

 

 

Sheppey is a high-street hairdresser nicknamed after an island he wants to retire to. After he wins a lottery, his family and friends find it hard to accept his new-found religious zeal and extravagant generosity towards the underprivileged, especially when he invites a thief and a prostitute to stay in their home. When Sheppey turns down a long-cherished partnership in the business that employs him, the doctor is called in and diagnoses high blood pressure and perhaps a stroke.

 

MRS MILLER  The doctor says the shock and the excitement of the winning all that money and Sheppey ‘aving such a ‘igh blood pressure and all, ‘e’s convinced it wasn’t just an ordinary faint in the shop, but that was a sort of stroke too.

 

Surreptitiously the family and their doctor arrange a consultation with a psychiatrist, as a result of which Sheppey is to be offered voluntary or compulsory hospitalisation. 

 

MRS MILLER  E’s one of  the ‘eads at Bethlehem.

ERNIE  The lunatic asylum!

MRS MILLER  E’s going to pretend ‘e’s just dropped in for a cup of tea...and they’re going to get him in conversation…I can’t bear the idea of letting my poor old man walk into a trap like that.

 

Sheppey’s expectant son-in-law has his own view of reality:

 

ERNIE  That’s absurd. Sanity means doing what everybody else does, and thinking what everybody else thinks. That’s the whole foundation of democracy. If the individual isn’t prepared to act the same way as everybody else there’s only one place for him and that’s the lunatic asylum.

 

To think about: Why is mental illness a good dramatic medium through which to explore the contradictions inherent in any complex economy?

 

Shortly after the house-guests are moved back out, Sheppey dies in his favourite armchair.

 

One major fault-line through Christianity in particular is exposed in the play. The philosophical division between punishing and forgiving the same crime is unresolved today, reflected, for example, in the activities of the Salvation Army (there but for the grace of God go I; the meek shall inherit the earth; the vision of human progress) versus those of pro-war evangelists (the poor will never change, they deserve God’s punishment for being lazy, the righteous are capitalist). In Sheppey the crime is poverty.

 

SHEPPEY … sometimes I think the kingdom of ‘Eaven’s in me own ‘eart.

FLORRIE  You’re barmy.

SHEPPEY  Because I want to live like Jesus?

FLORRIE  Well, no one ever heard of anyone wanting to live like Jesus at this time of day? I think it’s just blasphemous.

 

References and Further Reading

 

In Six Plays (1934) William Heinemann Ltd p429-

lm17: Dr Angel; the doctor-nurse romance

 

In this variation on a tremendously popular story, Dorothy Gray is an anxious domestic mouse who acts as a full time slave and goody-two-shoes girl-scout to her invalid mother. The author tells us that:

 

‘Hysteria was a luxury in which she couldn’t indulge.’

 

Of course they are both handsome women, but Dorothy thinks she is dull and grey, whilst her mother is entirely vain, and dresses beautifully even when in bed. Dolores is confined upstairs, as ordered by the previous doctor, with some kind of cardiac disease and hasn’t been down for five years. Whenever Dolores rings her bell Dorothy runs to the mirror first, but nothing can be done with her hair, which, of course, is mouse coloured. But Dolores is manipulative, and Dorothy neurotic: she runs upstairs thinking it an emergency every time her mother’s bell rings firmly. This time, her mother has seen two strangers get out of a car across the street! Dolores it turns out is OK:

 

‘Dorothy gave a deep shuddering sigh. Thank goodness for that.’

 

It is not long at all before Dolores has another cardiac attack, and the strangers, the new doctor and his nurse, bound up the stairs to their first emergency call. Dorothy later insists her mother staged the attack deliberately when she learned Doctor Devaux, the man who confined her to bed, was leaving Lakeville.

 

‘ “She did it on purpose”… says Dorothy… Suddenly she brightened. Why, Dolores would be in the spotlight now. She had been the new doctor’s first patient. Everyone would be running to her to ask about him.’

 

As Dorothy is a slave, the doctor she has just met pops in for a cup of tea to her downstairs parlour. He actually talks to her (a clue that the book, despite its sentiments and setting, is from the US rather than the UK)! After he leaves, a few tears trickle down her face:

 

‘Here was the very man she could love, and what chance had she?’

 

To think about: This doctor-nurse romance follows a familiar pattern, but it is hardly a twentieth century structure. It is a fairy tale. Which one?

 

The girls in town, who have some awful names, such as Lovenia Cantrell and Lenore Traub, gossip that Dorothy won’t know her beauty until it is too late. This gossip in Lakeville is powerful stuff: it has put a man in ‘the incurable mental ward’ already, for a baseless rumour. Yet no hint of jealousy, or sexual desire, burdens this romance.

 

“Mother, if I’m going to do the dishes I’d better go down.”

“Can’t you show any interest in your appearance? Or do you want me to seem years older than I am?”

 

This fabulous (derived from the word ‘fable’ but has altered its meaning somewhat in the modern era) tale is most closely related to Cinderella, but there are fragments of Sleeping Beauty and The Ugly Duckling in it as well. This tried and true psychological structure makes the story compelling even though we all know the plot. Interestingly, second-hand booksellers will tell you that it is surprisingly common for men to come in and ask, rather sheepishly, for a stack of Mills and Boons; and women for two-penny Westerns. The book is unquestionably aimed at the domestic housewife of the 1950’s, with many more references to fabrics and recipes than to character development.

 

At the climactic ending to Ch 6, for example, Dorothy has collapsed from the exhaustion of serving her mother :

 

‘When Dr Angelisti decided no-one was coming to open the door, he pushed, found it blocked by something and set his shoulder to it. Something in silver and cerise lay behind it.

Quickly he knelt beside it, then straightened and looked up to leave the figure in silver and cerise and run to the one in black-dotted Swiss.’

 

Thankfully, the plot thickens. The ‘Lakeville greens’ is a springtime bowel disturbance that the public health authorities, being lazy bureaucrats, and despite the regular child mortality, have done nothing about. Dr Angelisti, the newcomer who soon becomes Dr Angel to the townsfolk, is to take them on, and the entrenched power structure, for their own good. He bravely wades in to local politics!

 

“You’ll have to move softly to win the populace” he is warned. “…the health of all is in your hands. It must make you feel like one of God’s lieutenants.”

 

The townsfolk naturally resist his challenge to the inadequate science of the outdated public health department. He finds the source of the Lakeville greens, and bravely takes the unpopular steps to save the community from itself. Our author spells it out:

 

‘ …if the Dr Angels and the other angels of history had put self first, we’d still be having mass epidemics of cholera.’

 

To think about: Our doctor has been cast as an angel, next to God. He is moving unawares in a world shaped by fairy tale. This still happens today…I recall numerous patients expressing this belief about myself during consultations. How can this interfere with patient management? Could this be damaging, even dangerous? What will you do about it when (not if) it happens to you?

 

After the party for Dolores’ new gown, replete with recipes and fabrics to break the bank, Dorothy begins to wake up. There is the suggestion that their former doctor kept Dolores and his other patients invalid for the regular income. After all, our author tells us, ‘…a nervous breakdown was the popular escape of her youth’.

 

‘I know now that Dolores is not selfish, but self-centred’ says Dorothy, showing a new skill in hair-splitting.

 

The doctor suggests diet and some exercise outside the kitchen and the attic, and ooh, Dorothy and her new friends feel so much better, and even think of talking about their own hobbies instead of their husband’s! Next, Dr Angel comes up privately with a scheme to get Dolores to hospital, to save her daughter from slavery. Proving that medicine is indeed an art, he reveals her mother’s heart is in perfectly good shape, and makes Dorothy realise her loveliness. Dorothy finds her social courage, and uses it right away to jot down some recipes.

 

To think about: This tale is from the 1950’s. How do you think a modern feminist would approach the story?

 

In today’s terms this is a tale of lies and dreadful psychological abuse by the mother (who in fairy tales is usually a wicked step-mother). Feminists believe that these fables are harmful to women, and are used to control them...but don’t so often acknowledge that women will control each other, independent of a male external to their social world. The power of the patriarchy is rightly identified, but often at the expense of recognising the power of the matriarchy. The famous American writer Angela Carter has a book called ‘The Bloody Chamber’…a reference to menstruation as well as horror…which comprises a feminist revision of selected fairy tales.

 

Dorothy comes out of her cocoon and transforms into a beautiful young woman who helps the doctor in his research. When he disappears temporarily she is worried:

 

‘But he’s all right, she assured herself “doctors always are.”

 

The townsfolk are saved from themselves, and remember those who have died from the epidemic:

 

“Maybe he’s right.” said someone. “Hearing those names, we’ll remember science has no prejudices and sickness can’t play politics.”

 

To think about: Perhaps this statement is also a fable?

 

The books ends with Dolores’ cure and joy for Dorothy, who of course becomes a nurse and gets to marry Dr Angelisti. She is to be busy all her life, serving her angel.

 

To think about: Our author has presented a fable with no real character development or revelation of human suffering. Do you think a child oppressed to the extent Dorothy was can be transformed by love?

 

It is difficult to choose my favourite quote, but I’ll leave you with a final candidate:

 

‘Darling, I’m using bromides to convince you this can be serious.’

 

References and Further Reading

 

Bowman, Jeanne (1962) Dr Angel           Horwitz

 

Carter, Angela (1979) The Bloody Chamber

 

There are literally hundreds of other books like ‘Dr Angel’. There is also an extensive feminist academic body of literature about them.

lm18: The Citadel

 

A.J.Cronin (1896-1981) was born in Scotland. He wrote over 30 books, several of which were filmed or televised, a recent example being Dr Finlay’s Case Book. He trained in various hospitals, finding himself a naval surgeon as World War One dragged on, and finally graduating from the University of Glasgow in 1919. He then moved to a mining town in South Wales. The Citadel, a tremendously popular book from 1937, is semi-autobiographical in its first sections.

 

It is an episodic sort of novel, unified by the passage of one life over time, and with a trajectory through suffering into a kind of grace. It works as a forum for Cronin’s political, socialistic conceptions of medicine, and has been credited with stimulating the creation of the famed National Health Service of the United Kingdom.

 

 

‘I got the gig here. Set in- unless ye’d rayther swim’

 

The brand new Dr Andrew Manson arrives in a bleak Welsh mining town. His first case for Drineffy Haematite Mine and Ore Works is beautifully described, as only an author who has been ‘there’ can do. He soon meets one of his colleagues, Denny, a sarcastic and bitter drunkard who is nevertheless friendly and helpful, like his dog Hawkins:

 

“Look here, Manson! I realise you’re just passing through on your way to Harley Street, but in the meantime there are one or two things about this place you ought to know. You won’t find it conform to the best tradition of romantic practice. There’s no hospital, no ambulance, no X-Rays, no anything. If you want to operate you use the kitchen table. You wash up afterwards at the scullery bosh. The sanitation won’t bear looking at. In a dry summer the kids die like flies with infantile cholera. Page, your boss, was a damn good old doctor, but he’s finished now, finished by overwork, and’ll never do a hand’s turn again. Nicholls, my owner, is a tight little money-chasing midwife. Bramwell, the Lung Buster, knows nothing but a few sentimental recitations and the Songs of Solomon. As for myself, I better anticipate the gay tidings- I drink like a fish. Oh! and Jenkins, your tame druggist, does a thriving trade, on the side, in little lead pills for female ills. I think that’s about all. Come Hawkins, we’ll go.”

 

‘Denny at first had aggravated him intensely by his weary contention that all over Britain there were thousands of incompetent doctors distinguished for nothing but their sheer stupidity and an acquired capacity for bluffing their patients’ and he ‘…never failed in his derision towards this profession to which they belonged.’

Denny soon shows his true mettle when he takes the new doctor out at night to blow up the sewer contaminating a well and causing a paratyphoid epidemic with much child mortality, but which the authorities will do nothing about. A moat of sewage surrounds the councillor’s house, with the result that construction of a new sewer commences the following Monday.

 

 Consider: Cronin uses humour to take the sting out of his story, which is one of almost inconceivable neglect of the workers in a powerfully class-driven society.

 

 

After only 3 months on the job our restless hero questions the pharmacopoeia:

 

‘And what about half, three-quarters of the other “remedies” in the pharmacopoeia? This time he heard the voice of Dr Eliot. lecturer in Materia Medica. “And now, gentlemen, we pass to elemi- a concrete resinous exudation, the botanical source of which is undetermined, but is probably Canarium commune, chiefly imported from Manilla, employed in ointment form, one in five, an admirable stimulant and disinfectant to sores and issues.”

Rubbish! Yes, absolute rubbish. He knew that now. Had Eliot ever tried unguentum elemi? He was convinced that Eliot had not. All of that erudite information came out of a book and that, in its turn, came out of another book, and so on, right back, probably to the Middle Ages.’

 

In a second mining town now, he learns about Gadge the dispenser: “He’s a miserable devil. But he knows his incompatibles.” The skilled Dr Llewellyn is one of a succession of people who rips him off, in this case by taking a fifth of his wage. Dr Urquhart, on the other hand, is a “good old type” of family doctor- shrewd, painstaking, experienced, a doctor sentimentalised by his patients and by the public at large, who had not opened a medical book for twenty years and was almost dangerously out of date.

 

He has to amputate a miner’s forearm trapped under rubble way underground, with a lamp and on his belly in the water in a 2 ft high tunnel. Next he is ‘raving beautifully’ about worker’s rights and the antiquated financial structure of the profession:

:

“That’s how fees should be paid, Chris. No money, no damned bills, no capitation free, no guinea grabbing. Payment in kind. Do you understand? You get your patient right, he sends you something that he has made, produced. Coal, if you like, a sack of potatoes from his garden, eggs maybe if he keeps hens- see my point. Then you’d have an ethical ideal! By the way, that Mrs Williams who sent us the ducks- Leslie had her guzzling pills and physic for five stricken years before I cured her gastric ulcer with five weeks’ diet. Where was I? Oh, yes! Don’t you see. If every doctor was to eliminate the question of gain the whole system would be purer-“

“Yes, dear. Would you mind handing me the currants. Top shelf in the cupboard!”

 

Consider: The fragment below demonstrates two things: the vision and influence of this book; and the considerable time it has taken for the profession to acquiesce. CME (Continuing Medical Education) has only recently been formalised:

 

“Ignorance, ignorance, pure damned ignorance. There ought to be a law to make doctors keep up to date. It’s all the fault of our rotten system. There ought to be compulsory post-graduate classes- to be taken every five years-“

 

 

Dr Manson develops an interest in occupational lung disease, and ends up in London, where money, acquired at the expense of time for his wife, begins to work upon him as the canker it is. He meets his old friend Freddie Hamson and his two partners in medical scheming, and naively questions a new technology they are discussing:

 

“I don’t think much of these lamps, you know. Did you see Abbey’s paper in the Journal on bogus heliotherapy. These Iradiums have got absolutely no infra-red content.”

Freddie stared, then laughed.

“They’ve got a hell of a lot of three-guinea content. Besides, they bronze nicely.”

 

Their old lecturer in Scotland had said “You know nothing, Mr Hamson. Your balloon-like mind is entirely filled with egotistical gas. But you’re never at a loss. If you are successful in cribbing your way through the nursery games known here as examinations, I prophecy for you a great and shining future.”

 

Eventually Andrew Manson breaks his principles for money, injecting ‘Glickert’s Eptone’ into wealthy and gullible patients. He neglects serious cases among the poor in his practice for easy money from rich neurotics; and his wife Chris dispenses for him now, anything, like the poisons he used to rail against. She withdraws into herself: there is unhappiness creeping in to their lives because of the drive to money.

 

Cronin next turns his scathing wit onto pompous surgeons whom he exposes as ignorant and fad driven, close enough to murderers:

 

“Ha!” said Sir Rumbold. “So you’ve been a victim too.” By the device of clearing his throat and placing his pince-nez upon his richly endowed nose, he gained the attention of the table. Sir Rumbold was at home in this position- for many years now the attention of the great British public had been focussed on him. It was Sir Rumbold, who, a quarter of a century before, staggered humanity by the declaration that a certain portion of man’s intestine was not only useless but definitely harmful. Hundreds of people had rushed straight away to have the dangerous section removed and, though Sir Rumbold was not himself amongst this number, the fame of the operation, which the surgeons named the Rumbold-Blane excision, established his reputation as a dietician. Since then he had kept well to the front, successfully introducing to the nation bran food, Yourghout, and the lactic acid bacillus. Later he invented Rumbold-Blane Mastication and now, in addition to his activities on many company boards he wrote the menus for the famous Railey chain of restaurants: Come, Ladies and Gentlemen, Let Sir Rumbold-Blane, M.D., F.R.C.P., Help You Choose Your Calories! Many were the muttered grumbles amongst more legitimate healers that Sir Rumbold should have been scored off the register years ago: to which the answer manifestly was- what would the register be without Rumbold?’

 

When a fake surgeon mate kills a patient Manson cries murder, and attains a sudden and painful new awareness of what he has sunk to. Corrupt, rich and falling, he is met and reassessed by two friends from his early idealistic days. At the same time, an ‘antidote to the poison of a facile success’ arrives...an appointment to the prestigious Victoria Chest Hospital. Here Doctor Thoroughgood, the chief consultant, is a good man but conservative, who gives all his patients cod liver oil and malt. Cronin paints the grey picture of an inefficient health system, manifest as such unhealthy hospitals as the Victoria, supposedly for TB and other chest complaints but located along the damp Thames, in the infested coal-smog of London. The new TB treatments are apicolysis, phrenicectomy, and massive intra-pleural injection for tuberculous empyema.

 

Manson begins to shed his former patients, rather impatiently!

 

“…But there’s nothing really wrong with you.”

“Dr. Manson!” she gasped, unable to believe her ears.

It was quite true. He realised, with cruel insight, that all her symptoms were due to money. She had never done a days work in her life, her body was soft, pampered, over-fed. She did not sleep because she did not exercise her muscles. She did not even exercise her brain. She had nothing to do but cut coupons and think about her dividends and her maid and wonder what she, and her pet Pomeranian, would eat. If only she would walk out of his room and do something real. Stop all the little pills and sedatives and hypnotics and cholagogues and every other kind of rubbish. Give some of her money to the poor. Help other people and stop thinking about herself! But she would never, never do that, it was useless even to demand it of her. She was spiritually dead and, God help him, so was he!

He said heavily:

“I’m sorry I can’t be of any further service to you, Miss Basden….”

 

The next issue Cronin takes on is that of who should and should not be on the medical register. Mr Stillman is from the US, an expert on TB alone, with no qualifications who is absolutely scientific, with no bedside manner at all, but who does successful partial pneumothoraces, and who saves his old friend’s daughter Mary. The London doctors get up a plot to ostracize Stillman and his rural clinic. Andrew is summonsed to the GMC for association with an unregistered practitioner, and he presents in court a list of the greats of scientific medicine who did not have medical degrees, including Louis Pasteur.

 

A wonderful happy ending concludes one of AJ Cronin’s most enduring works.

 

References and Further Reading

 

My copy of The Citadel is a 26th impression, 1948, published by Victor Gollancz of London

 

Illyich, I

 

 

lm19: The Doctor’s Dilemma (1906)

 

This popular play was written by George Bernard Shaw in 1906, partly to release a small portion of his tremendous creative wit and vitality, and partly to showcase some of his own ideas about medicine as it was practised in London at the turn of the century.

 

Shaw was one of Ireland’s finest sons: ‘…by birth a Dubliner, (he) detested his native city and his native city did not much care for him either.’ He was born in 1856, and became one of the most outspoken people of his time.

 

The Doctor’s Dilemma, like others of his plays, has an extraordinary preface of some 82 pages. It is both a cutting indictment of contemporary medical practice, a diatribe against the new craze of vaccination, and a crusade against the cruel researches of the vivisectionists.

 

Preface

 

Here are Shaw’s opening shots:

 

‘It is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity. That any sane nation, having observed that you could provide for the supply of bread by giving a bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid.’

 

‘Again I hear voices indignantly muttering old phrases about the high character of a noble profession and the honour and conscience of its members. I must reply that the medical profession has not a high character: it has an infamous character.’

 

To think about: Shaw was accomplished at offending people. How can being the subject of a rapacious wit in any way assist the practice of medicine?

 

In a section entitled Medical Poverty, Shaw takes the opposite position on money to that we have come to expect today:

 

‘To make matters worse, doctors are hideously poor…Any class of educated men thus treated tends to become a brigand class, and doctors are no exception.’

 

‘The surgeon, though often more unscrupulous than the general practitioner, retains his self-respect more easily…the man who does evil skilfully, energetically, masterfully, grows prouder and bolder at every crime.’

 

‘Doctoring is an art, not a science’ insists Shaw, before going on to denounce the fads of his day, one of which was vaccination.

‘The psychology of fashion becomes a pathology…fashions, after all, are only induced epidemics…’

 

‘Public ignorance of the laws of evidence and of statistics can hardly be exaggerated.’

 

‘For example, just at present the world has run raving mad on the subject of radium…Suppose every child in the world could be rendered absolutely immune from all disease during its entire life by taking half an ounce of radium  to every pint of its milk. The world would be none the healthier, because…(no-one)…could afford the treatment.’

 

His contempt for vivisection is succinctly put with a few hard examples:

 

‘Or the gentleman who starved sixty dogs to death to establish the fact that a dog deprived of food gets progressively lighter and weaker, becoming remarkably emaciated, and finally dying: an undoubted truth, but ascertainable without laboratory experiments by a simple enquiry addressed to the nearest policeman, or, failing him, to any sane person in Europe.’

 

To think about: Have things changed? How many animals die for medical progress each year?

 

After a scathing discussion on the difference between the Public Health Service and the Private Illness Service, he finishes up with some numbered conclusions: against vested interests in ill health, and for a coroner’s enquiry into every death where doctors have been sniffing about. His twelfth rule is my favourite: ‘Do not try to live forever. You will not succeed.’

 

The Play

 

O’Donovan argues that in The Doctor’s Dilemma ‘the concerto grosso passages for the doctors constitute scenes of delectable high comedy that age cannot wither nor custom stale.’

 

It opens with Dr Ridgeon being congratulated on his knighthood. It is not long before doctors are discussing opposing treatment methods and their personal ideas of disease causation:

 

SIR PATRICK Don’t misunderstand me, my boy. I’m not belittling your discovery. Most discoveries are made regularly every fifteen years; and it’s fully a hundred and fifty since yours was made last.

 

SIR PATRICK…He’s a clever operator, is Walpole, though he’s only one of your chloroform surgeons. In my early days, you made your man drunk; and the porters and students held him down; and you had to set your teeth and finish the job fast. Nowadays you work at your ease; and the pain doesn’t come until afterwards, when you’ve taken your cheque and rolled up your bag and left he house. I tell you, Colly, chloroform has done a lot of mischief. It’s enabled any fool to be a surgeon.

WALPOLE I tell you this: in an intelligently governed country people wouldn’t be allowed to go about with nuciform sacs, making themselves centres of infection. The operation ought to be compulsory: it’s ten times more important than vaccination.

 

BB (Sadly) Walpole has no intellect. A mere surgeon. Wonderful operator; but, after all, what is operating? Only manual labour. Brain- BRAIN remains master of the situation. The nuciform sac is utter nonsense: there’s no such organ. It’s a mere accidental kink in the membrane, occurring in perhaps two-and-a-half percent of the population. Of course, I’m glad for Walpole’s sake that the operation is fashionable; for he’s a dear good fellow; and after all, as I always tell people, the operation does no harm: indeed, I’ve known the nervous shake-up and the fortnight in bed do people a lot of good after a hard London season; but still it’s a shocking fraud.

 

The doctors must decide on whether to treat TB in an artist who is a cad but talented, or a fellow doctor who has no money. Dubedat, the artist, suggests he should be paid to undergo Walpole’s operation, rather than the other way about…to an amusing outrage of the medical characters.

 

Eventually they decide on who and what will treat him. He dies of the vaccination therapy of Sir BB:

 

BB Poor young fellow! How well he died! I feel a better man, really.

SIR PATRICK When you’re as old as I am, you’ll know that it matters very little how a man dies. What matters is, how he lives. Every fool that runs his nose against a bullet is a hero nowadays, because he dies for his country. Why don’t he live for it to some purpose?

 

Consider: I suspect not even Bernard Shaw would have written this line ten years later. Why?

 

Finally Ridgeon confesses his love for Jennifer the widow of Dubedat, and also confesses to her he killed Dubedat by letting his colleague Sir BB treat him. She is aghast:

 

JENNIFER I shall remember you always as a little man who tried to kill a great one.

RIDGEON Pardon me. I succeeded.

 

 

References and Further Reading

 

The play can be read online via Project Gutenberg:

 

isis.library.adelaide.edu.au/pg/etext04/dcdlm10.txt

 

O’Donovan J (1983) G.B.Shaw           Gill and McMillan

 

lm20: Middlemarch 

 

 

Middlemarch is one of the delights of English literature, set in 1832 at the time of the Land Reform Bill, when the railways were just being established, and the old life on the land was changing forever as the industrial revolution gathered steam.

 

George Eliot’s has been called the finest of all the minds of the English novelists, and Middlemarch is widely considered her masterpiece. It is surpassed only, perhaps, by Tolstoy’s Anna Karenina for its faultless plot, by James Joyce’s Ulysses for its intellectual energy, and by Melville’s Moby Dick for its single-mindedness.

 

Eliot is exquisite in her analysis of character, and her presentation of drawing room wit. In this she recalls the earlier Englishwoman Jane Austen. Her style is her own, and her sentences are to be savoured one by one, laughed at, marvelled at, repeated aloud. Remember if you read it that this book was written as a serial from 1871 to 1872, in the days before electronic media. There was plenty of time to enjoy reading, and so the book proceeds at a walking pace. Today her precision and incisiveness is seen as rather too correct.

 

Middlemarch is of interest to us because one of the central characters is a doctor in this provincial town. Lydgate arrives with a head full of ambitious plans to direct a fever hospital and to do his own private physiological researches. He soon meets Lady Chettam:

 

“For my own part, I like a medical man more on a footing with the servants; they are often all the cleverer”  she says, and George Eliot tells us that ‘Mr Lydgate had the medical accomplishment of looking perfectly grave whatever nonsense was talked to him’ – so she formed ‘the most cordial opinion of his talents’.

 

Lydgate is a young man in control of his world, and has no ambition to get caught up with family life:

 

‘Plain women he regarded as he did the other severe facts of life, to be faced with philosophy and investigated by science.’

 

The depth and variety of Eliot’s female characters mark her out as a sort of proto- feminist: a formidable intellect made more so by the prejudice of her time toward the female mind, which was believed to have restricted capacities in many fields. Eliot examines either side of the gender debate with typical wit. From the masculine point of view she notes that ‘A woman dictates before marriage in order that she may have an appetite for submission afterwards.’ From the opposing camp comes the desire for ‘a man of talent, whom it would be especially delightful to enslave.’

 

Lydgate, like many another  young professional, is soon enamoured of Rosamund Vincy, a social beauty  without affection or much of her own intellect. Later in the book he must come to terms with her shallow social vanity and manipulative emotional behaviour.  Eliot’s description of Rosamund is wonderfully cutting:

 

'Certainly, small feet and perfectly turned shoulders aid the impression of refined manners, and the right thing said seems quite astonishingly right when it is accompanied with exquisite curves of lip and eyelid.  And Rosamund could say the right thing; for she was clever with that sort of cleverness which catches every tone except the humorous.  Happily she never attempted to joke, and this perhaps was the most decisive mark of her cleverness.'

 

‘For we all of us, grave or light, get our thoughts entangled in metaphors, and act fatally on the strength of them’ says Eliot, as she entertains us with wonderful ‘drawing room’ comedy, and steers her characters towards their inevitable destinies. Lydgate has a conviction that ‘the medical profession as it might be was the finest in the world; presenting the most perfect interchange between science and art; offering the most direct alliance between intellectual conquest and the social good’. He has ambitions to change the world of provincial medical practice.

 

Eliot researched her material properly, and the great physicians of the age appear in ‘Middlemarch’. These include Bichat, the French pioneer of anatomical pathology and passionate advocate of post-mortem; Walkey, founder of The Lancet in 1823 who insisted a coroner should have medical training; Pierre Louis, an expert on typhoid fever, famed for introducing statistical analysis and becoming the first scientific epidemiologist; and Laennac; who first described the use of the stethoscope, initially a wooden funnel, in his ‘Traitè de 1'auscultation mèdecite’.

 

 Meanwhile, the Middlemarch folk have other ideas, like Mrs Farebrother on sticking with one set of rules: ‘Excuse me there. If you go upon arguments, they are never wanting, when a man has no constancy of mind. My  father never changed, and he preached plain moral sermons without argument, and was a good man- few better. When you get me a good man made out of arguments, I will get you a good dinner with reading you the cookery book. That’s my opinion, and I think anybody’s stomach will bear me out.’

 

“Does this Mr Lydgate mean to say there is no use in taking medicine?” said Mrs Mawmsey, who was slightly given to drawling.  'I should like him to tell me how I

could bear up at Fair time, if I didn't take a strengthening medicine for a month beforehand...But what keeps me up best is the pink mixture, not the brown…”

 

The townsfolk are suspicious of Lydgate’s post-mortem enthusiasm imported from the medical school in France he attended, and the case of Burke and Hare is raised. Burke was hanged in 1829 for procuring anatomical specimens for dissection while his victims were still alive: he was a real life Jack the Ripper. Lydgate persists in his plan to open a better fever hospital, infectious disease being a significant killer in England up until about World War Two (when antibiotics came along), but must now cope with the religious and civil divisions in the community. One source of conflict is another doctor:

 

“But what I contend against is the way that medical men are fouling their own nest, and setting up a cry about the country as if a general practitioner who dispenses drugs couldn't be a gentleman. I throw back the imputation with scorn.  I say the most ungentlemanly trick a man can be guilty of is to come among the members of his own profession with innovations which are a libel on their time-honoured procedure.  That is my opinion, and I am ready to maintain it against anyone who contradicts me”.  Mr Wrench's voice had become exceedingly sharp.’

 

Mr Powderell's wife has the erysipelas so he uses Lydgate's methods, in combination with the usual Widgeon's purifying pills... 'and could not abstain from mentioning to Lvdgate that Mr Peacock on a similar occasion had administered a series of boluses which were not otherwise definable than by their remarkable effect in bringing Mrs Powderell round before Michaelmas from an illness which had begun in a remarkably

hot August.'

 

Eliot suggests ‘it was as useless to fight against the interpretations of ignorance as to whip the fog.’ But this is only one frustration for Lydgate, his marriage being another. He finds refuge in his work, a common reaction among medical men:

 

'Lydgate certainly had good reason to reflect on the service his practice did him in counteracting his personal cares.  He had no longer free energy enough for spontaneous research and speculative thinking, but by the bedside of patients the direct external calls on his judgement and sympathies brought the added impulse needed to draw him out of himself. It was not simply that beneficent harness of routine that enables silly men to live respectably and unhappy men to live calmly- it was a perpetual claim on the immediate fresh application of thought, and on the consideration of another's need and trial.  Many of us looking back through life would say that the kindest man we have ever known has been a medical man, or perhaps that surgeon whose fine tact, directed by deeply-informed perception, has come to us in our need with a more sublime beneficence than that of miracle-workers.  Some of that twice-blessed mercy was always with Lydgate in his work at the Hospital or in private houses, serving better than any opiate to quiet and sustain him under anxieties and his sense of mental degeneracy.'

 

Lydgate’s story is only one thread of this magnificent novel, which I have presented last in this series on the literature of medicine in the hope you might feel inspired to take it on during the holidays. Approach Eliot with patience and she will reward you greatly.

 

Finally, enjoy those holidays coming up!

 

References and Further Reading

 

Middlemarch has been reprinted many times. I used the Penguin Classics edition.

 

Holiday reading!

 

Other major works you might be interested to tackle in the holidays are Alexander Solzhenitsyn’s ‘Cancer Ward’; Thomas Mann’s ‘The Magic Mountain’ (which confirmed him as a Nobel laureate); Anthony Trollope’s ‘Doctor Thorne’; and Boris Pasternak’s ‘Dr Zhivago’.