- Email: [email protected]
THE DOCTOR IN CONTEMPORARY LITERATURE
341 that the general practitioner’s first responsiis to detect’ cases early and refer them for proper treatment. Old Mr. Robinson is an object lesson. But I feel I’m fighting with one hand tied behind my back because there’s no X-ray department within reach to which I can send patients direct. I know your chest clinics are most helpful in seeing people for me, but I want to have chest X-rays on the faintest suspicions, and don’t feel inclined to take up your time with numbers of normal young people and bronchitic old ones. So what I should like first would be an open-access X-ray department, please ! It’s also high time that the mass miniature X-ray waggon came round our way again. If you’ll give me fair warning I’ll do some propaganda. Secondly, tuberculin testing. I now have a Heaf gun ; so the testing itself is easy. But I’m not really sure what a positive result signifies. I gather that in children under 7 it probably indicates active tuberculosis ; from 7 to 25 it calls for an E.s.R. and chest X-ray ; and most adults of over 25 are normally positive. Once I’ve notified a case, the public-health people come in to test the contacts and offer B.C.G. vaccination to the negative reactors. But I don’t seem to see very much of the public-health staff, though this is doubtless as much my fault as theirs. (The health visitor I do meet from time to time around the village ; in fact she drops in sometimes with the latest news.) It would help if the public-health department sent me a report of each investigation ; otherwise I can see myself getting excited over a positive tuberculin test in one of their vaccinated contacts. When the patient returns from the sanatorium it’s up to me to take over the day-to-day supervision. As I see it, this includes keeping him supplied with the necessary drugs, cheering him up when he is browned off, and restraining him from digging the back garden when he is meant to be up for toilet only." I
assume
bility
"
But to my mind the trickiest problem is preventing patients under treatment at home from infecting others, particularly children. The sputum-positive ones come home well grounded in hygienic measures. But on and off the sputum-negative case may, unknown to anyone, be sputum-positive, and he is the real menace. His own children will doubtless have been protected by B.C.G. ; but, anyway in our village, the patient who thinks he is better and is allowed up for a few hours a day will be having a get-together with the next-doors and their children round the T.v., or even baby-sitting to make a few shillings on the side. Once they are at home and away from your fatherly eye some patients carry on in a way that would make your hair turn grey. These contacts are more likely to come to my notice than to the health visitor’s, since everyone is on their best behaviour when she appears. Am I to refer all such contacts to you for B.C.G., keep the patient strictly indoors, or warn mothers of young children that Mr. So-and-So is a menace to their young?‘ Neither way would be popular, to say the least. Here in the country where tuberculosis is still common and everyone has time to pass the day with everyone else (unlike towns where nobody has any time for anything), an infective case can be in contact with almost the whole community. Vaccinating the family contacts is only scratching at the surface of the problem. Why can’t we vaccinate all babies soon after birth I know the vaccine must be used fresh, the immunity may not be longlasting and vaccination may have to be repeated, and there are local complications ; but all this is true of vaccination against smallpox. B.c.G. vaccination of infants has been practised in Scandinavia for years. Why not here The other day I put this to a professor of bacteriology who knows about these things. He spoke weightily of the evidence being unconvincing, of the
conditions perhaps being different in Scandinavia, and of the need for us to establish by careful trials the case for B.C.G. in the young. When he had finished I asked whether he had had his three kids vaccinated. Yes, he said, he had. This isn’t exactly dog-in-the-manger, but it seems a bit odd. What do you sayT °
Yours
sincerely,
W. B. St. C. BREWER.
Points of View THE DOCTOR IN CONTEMPORARY LITERATURE * RONALD BODLEY SCOTT M.A., D.M. Oxfd, F.R.C.P. ASSISTANT
PHYSICIAN
TO
ST.
BARTHOLOMEW’S
HOSPITAL,
LONDON
said that the esteem in which the the medical public holds profession has fallen. If this be true, the situation is one which should cause us all concern ; although we may reflect on the irony of this decline going hand in hand with an increase in our ability to control disease of which our fathers would not have dared to dream. The barometer of public opinion is, not easily read ; and any information on this subject, however trivial its source, is of value. It was with these thoughts in mind that I embarked upon the investigation which I shall here describe. IT is
commonly
*
*:
*:
Fiction holds up a mirror to life, and it should be possible to see therein a reflection of the doctor as he appears to the contemporary novelist. To obtain a concentration of experience it was convenient to study a form of fiction in which doctors appeared frequently, while it was advisable to avoid works in which a medical man was one of the major characters, because he would then be invested with attributes not necessarily regarded by the author as typical of his calling. The class of novel which most nearly fulfils these requirements is that of detective fiction, and it was to such works that I turned my attention. The detective novel in its purest form may have passed the zenith of its fashion ; but there is still an outpouring of works in which the central themes are murder, violence, and sudden death, and, as episodes of this kind are inevitably followed by the appearance of a doctor, they suit our purpose equally well. I do not propose to deal with the classics of this form of fiction, but the importance of our profession to the detective was established by the creation of Dr. Watson more than fifty years ago. This practitioner, recently described in the Times Literary Supplement as a "clot in the arteries of the Royal Colleges of Physicians and Surgeons," first met Sherlock Holmes within the walls of St. Bartholomew’s Hospital. Two years ago a plaque was unveiled there to commemorate this event. Filial piety therefore has added its stimulus to my researches. It is suitable to begin with the general practitioner because he has characteristics which separate him sharply from the class of doctor always known in novels as specialists." He is usually portrayed as competent and cheerful. A few quotations provide a clear-cut picture a big cheerful middle-aged man," " a squarely built eminently practical young man," " such a nice breezy manner," a quiet square young man with bushy black hair growing low down over his forehead," " a stolid pleasant looking square capable face." In these descriptions you will have been struck by the squareness of the "
"
"
*
Based
on an
address
given
to the Oxford division of the
British Medical Association
on
May 26,
1955.
342
general practitioner ; possibly this is symbolic, denoting the solid virtues of dependability and unimaginative competence which the novelist either sees, or wishes to see, in his medical attendant. It is, however, not every general practitioner who possesses these desirable qualities. Dr. Smith in jMo-e Work for the Undertaker is tall and stooping with a back like a camel, and although kind and professional is stigmatised as not as bright as some." Indeed intellectual capacity does not appear to be a feature of the family doctor. Another Dr. Smith is described with the ring of truth as " a thin man with a tired face." Dr. Shaw, in Death at the Bar, is a more attractive personality, dominating the scene with bright vivid blue eyes, gazing through his spectacles " and combining with " a look of serio-comic solemnity," " a certain air of distinction," while young Dr. Fettes, in Death of a Ghost, possesses the enviable gift of " looking blank without appearing foolish." Examples could be multiplied, but these are sufficient to show the impact the general practitioner makes. On the whole he may be said to emerge with credit : he has an appearance of competence ; he is stolid ; sometimes he is even distinguished. He remains unrumed by the curious situations which the novelists devise for him. The accounts of his purely professional abilities and the manner in which he conducts consultations are interesting and revealing. Mr. Todhunter, in Trial and Error is told brusquely that he has an aortic aneurysm. Well," says his doctor, what can you expect ? Your blood pressure’s been too high for years." He is, in the timeworn phrase, given six months to live, but the blow is softened by the observation that " life on the physical plane is a darned nuisance and the sooner we’re out of it the better." The methods of young Dr. Tom Croxley in She Died a Lady were more devious ; he would tell the patient " all the imposing medical terms for what was wrong with him," an approach commended by his father, who was his senior partner, as impressing, pleasing, and inspiring confidence from the, start. We must all at some time have been a little envious of the knowledge of medical jurisprudence and toxicology possessed by these fictional general practitioners. The precise time of death is announced with assurance after a cursory glance at the body. A moment’s inspection is enough to make the most obscure of country doctors suspect the most obscure of poisons. " He looks to me," says big cheerful middle-aged Dr. Burwick, " like a typical case of oxalic acid poisoning." Not content with mere impressions, he withdraws to his dispensary with the suspect bottle of sherry, carries out the tests necessary to confirm his opinion, and, on adding a reagent, " is unable to repress an exclamation as it throws down a white precipitate." We can only reflect wistfully upon our own copies of Aids to Forenasic J.1’Iedicine and Toxicology, lying in the attic beneath the dust of twenty years. "
"
"
"
I must turn now to the " specialist," who stands in marked contrast with the selfless family doctor. Many, like Dr. Mawsley in Death ii?, Harley Street, are interested only in the amassing of wealth. Dr. Eugene Arnold, of the Red TVindow ]}[urders, is an example: "as fond of money as Marlborough and as mean about it," he had a damned superior air ... as though he always had his He even " took on Ralph bank book in his hand." Bender-the most brillaint student of his year at the Royal-as a dispensary clerk to handle minor cases without fee." In matters of appearance the specialist does lead, and his manners are usually irreproachable. Dr. William Pelham, although " a bit of a pompous ass," was plump, bland, and kindly, with silver hair and " the manners of a Prime Minister "-an ambiguous description, it is true -" he could squeeze the last drop of politeness out of a "
conversation." His " only touch of professionalism was pair of black-ribboned eye glasses." This last is the hallmark of the successful consultant, for Sir Daniel Davidson, of whom it was said that " if Disraeli had taken to medicine instead of primroses, he would have been just such another," also wore glasses on a wide black ribbon. A second distinguishing feature is " elegant white hair," although its charm in the case of Sir Gordon Woodthorpe, the eminent Society physician, must have been offset by his custom of licking his lips feverishly, a nervous habit that had persisted since childhood." Perhaps it is natural that psychiatrists should play so many prominent parts in detective fiction. A man who, in the words of The Lancet’s peripatetic correspondent, goes to the Folies Bergeres to watch the audience, has a powerful dramatic appeal ; his activities are always mysterious and usually sinister ; he is cast by Nature for the role of villain. Dr. Eugene Arnold was of this specialty with " assured success and poise about him and a hard handsome face which could become kindly like the turning on of an electric light." Dr. Nicholson, a very clever Canadian, was another ; " behind his strong glasses pale blue eyes glittered reflectively and his manner suggested great reserves of power." It will astonish those who number psychiatrists among their acquaintances to learn that " he said very little," and it will increase their surprise to hear that he." contrived somehow to make every word sound significant." Surgeons enjoy less popularity with the writers of detective fiction ; they lack the machiavellian qualities of the psychiatrist and the polish of the Society physician. A striking exception, however, is Sir John Phillips of the Nursing Home murder. His background of Winchester, Cambridge, and St. Thomas’s Hospital only just falls short of being irreproachable, and he possessed that " curious quality people call personality" from which, next to actors, medical men profit most." He can be forgiven losing his temper when he learned that the Home Secretary had been away for the weekend with the theatre-sister whom he hoped to marry, and we can sympathise with him when the Minister, whose appendix abscess he was called upon to drain, died immediately after the operation. A very different character is Mr. Thoms, his assistant, fat, scarlet-faced and industriously facetious, his undistinguished but blameless career punctuated by mild scandals about women." Clearly his education at St. Bardolph’s, Essex, and Guy’s Hospital, had not fitted him for competition with such giants as Sir John. The narrower forms of specialism receive scant attention, but one instance is Dr. Mawsley, in Death in Harley Street, a specialist in glands." Although noted for his rapacity, he is in part redeemed by his interest in His investigations were prosecuted in an research. experimental laboratory which led out of his consultingroom where he made use of rats provided by the Marylebone Borough ratcatcher at a cost of 5s. a pair. Ironically enough it was his interest in the effects of coniine on the glands of these animals which led to his untimely death at the hands of his illegitimate son by a probationer at a hospital where he had been a house-physician. All specialists lead lives of elegance amongst surroundings of opulent good taste. Dr. Pelham " with a Havana between his lips and a glass of sherry at his elbow " is an example of this leisured luxury. Sir Daniel Davidson’s consulting-room in St. Luke’s Chambers, Harley Street, provides another illustration. - It had " apple green walls, an Adam fireplace and silver-starred curtains. A beautiful and expensive room, crying in devious tones of the gratitude of wealthy patients." It is possible in these glimpses to discern a certain hostility to the specialist. His appearance is too distinguished ; his manners are too perfect and he is too wellgroomed. With his beribboned eyeglasses, his white hair, a
"
"
"
"
343 and his overwhelming urbanity, he recalls an Ambassador in a play by Pinero. This glittering figure fills his patients with feelings of their own inferiority and with apprehension concerning his fees. This fear is often well founded. Behind the façade there is callous avarice. Nevertheless all specialists are " brilliant " and many have distinguished themselves in other fields than medicine. Dr. over a sporting peer by Eugene Arnold was able to win " his modest confession that he happened to be a cricket blue of some distinction." In general it may be said that that the specialist is remote and olympian ; his only concessions to human weakness are his rapacity and his habit of irregular liaisons with members of the nursing staff. The contrast between general practitioner and specialist revealed in these composite pictures is interesting. Popular notions lag behind reality and some of these features of consultant life have vanished ; the beribboned glasses have disappeared and few specialists now live like merchant princes. To most novelists, moreover, the cloistered life of the ’hospital remains a mystery. A scene in The Lift and the Drop provides convincing evidence of ignorance : the night sister at St. Bartholomew’s was behind a screen with a recently admitted casualty and the waiting detective heard the sound of a kiss, followed by a whisper of " now rest and get well for me, soonsoon." There is another role in which the medical practitioner appears in detective fiction ; it is that of the murderer. I was surprised to find him playing this part in little less than half the novels I chanced to read. It may be asked why the novelist should so frequently select the doctor for the murderer. It is widely believed that the medical student early acquires a profound knowledge of toxicology and that he has at his command poisons which leave no trace in the victim’s body and which baffle the most erudite chemists. In spite of this, however, the medical murderer is commonly recorded as choosing some mundane drug, such as hyoscine or chloral, or a traditional poison like arsenic. In Death Leaves a Diary, for instance, Dr. Furness poisons his mother-in-law with arsenic, and in The Nursing Home ]I urders Dr. Roberts makes use of hyoscine which he administers with a syringe ingeniously built into his anaesthetic apparatus. At other times there is resort to simple violence : Dr. Eugene Arnold belies his polished appearance by using a hammer ; Sir Daniel Davidson, having rendered his victim unconscious by a blow with his cigarette-case, suffocates him by holding his nose and placing his hand over his mouth. Only rarely are more ingenious methods employed : Dr. Kingston in the Case of the Late Pig, balances a stone urn on a balustrade, supporting it with a block of ice, which melts to allow the urn to fall with devastating precision on the head of a man sleeping below in a deck-chair. It might be supposed that opportunity was responsible for these doctors committing murder, but it is rarely their patients whom they kill. Dr. Roberts was an to this but he and regarded was obsessed rule, exception himself as dedicated to purification of the raceby eliminating those who were eugenically unsound. In the end he was betrayed by his custom of cutting a notch in the stem of his wooden stethoscope to celebrate each success. In the main their motives are commonplace : Sir Daniel is afraid that his blackmailing activities will be revealed; Dr. Furness is after his mother-in-law’s money ; and young Dr. Tom Croxley’s frantic passion for the wife of an alcoholic professor of mathematics drives him to murder when she surrenders to the charms of a motor-car salesman. In many instances the fact that the murderer is a doctor is irrelevant to the novel’s plot and we must seek for some occult reason for the author’s choice. It is probable that we should see in it another indication of the
hostility with which the public regards our profession. This feeling has deep roots. The medical profession is, in a sense, a priest craft with its own language, its incomprehensible code of etiquette, and its objective view of matters which engender great emotional heat in the laity. The public feels resentment at its exclusion from this secret society. The doctor again is in a position of enviable superiority ; the patient has no choice but to display to him the sordid workings of his psyche as well as the pitiful shortcomings of his body. Finally the malignant blows of fate are seldom acceptable as inevitable or as the fault of the sufferer, and the medical attendant may find himself the scapegoat. The most gracious and grateful of patients, amongst whom I am sure we may rank these novelists, have feelings towards our profession which are at best ambivalent. It is these emotions which make them unable to resist the temptation to tear away the veil of professional respectability and to reveal the ravening beast it of the conceals. At the denouement, the face " previously suave Dr. Furness... was shining with sweat, his skin was mottled and his chin thrust out to show his teeth in a humourless grin " ; Dr. Edmund Galley became a " frothing screaming homicidal maniac " and in the eyes of Dr. Kingston shone the " blood light." In these phrases the novelists stand more starkly revealed than their characters : they are hitting back at those who have unwittingly slighted them in the past and avenging critical comments on their steadily increasing weight and on their habits of eating, drinking, and smoking to excess. ...
I have attempted to present a picture of the medical profession as reflected in a small and specialised sample of contemporary literature. The portrait is, of course,
outmoded, because the National Health Service has
changed the face of medical practice in this country and changes have not yet influenced the detective novel; possibly the authors of such works earn incomes which enable them to remain private patients. Nevertheless I submit that there are points in this analysis which are instructive. The novelist makes a sharp distinction between the general practitioner and the specialist, a division which has been unhappily accentuated by the rigid framework of the National Health Service replacing the profession’s previously elastic structure. In his view, the specialist adopts a cold scientific attitude to his patients ; while the general practitioner, although rated as intellectually inferior, is I have already a warm-hearted friendly character. the out the nature of twofold pointed patients’ feelings towards the profession of medicine : admiring gratitude for the friend in need going hand in hand with rebellious dislike for the carping authoritarian who sees him in his unguarded moments and denies him his pleasures. By an unjust dichotomy the novelist diverts the first emotion to the general practitioner and the second to the specialist. The popular identification of the specialist with " science " contributes to this schism : the Englishman is properly suspicious of science and dreads the thought of being made the subject of experiment. The old-fashioned family practitioner, he believes, is as ignorant of the first
these
he would be innocent of the second. In these emotions may discern an atavistic longing for the medicine of the witch-doctor-a desire to evade responsibility for one’s own ill health, to have done with the tedium of rational explanations, and to surrender to the narcotic charms of incantations, spells, and sacrifices. From this we are driven to the conclusion that the public’s choice of doctor is dictated by the same considerations that inspired a cartoon in Punch in 1884, when a now classic phrase was first used : as
we
"
" What sort of doctor is he ? " Oh, well, I don’t know much about his got a very good bedside manner."
ability ;
but he’s
1
assume
bility
"
But to my mind the trickiest problem is preventing patients under treatment at home from infecting others, particularly children. The sputum-positive ones come home well grounded in hygienic measures. But on and off the sputum-negative case may, unknown to anyone, be sputum-positive, and he is the real menace. His own children will doubtless have been protected by B.C.G. ; but, anyway in our village, the patient who thinks he is better and is allowed up for a few hours a day will be having a get-together with the next-doors and their children round the T.v., or even baby-sitting to make a few shillings on the side. Once they are at home and away from your fatherly eye some patients carry on in a way that would make your hair turn grey. These contacts are more likely to come to my notice than to the health visitor’s, since everyone is on their best behaviour when she appears. Am I to refer all such contacts to you for B.C.G., keep the patient strictly indoors, or warn mothers of young children that Mr. So-and-So is a menace to their young?‘ Neither way would be popular, to say the least. Here in the country where tuberculosis is still common and everyone has time to pass the day with everyone else (unlike towns where nobody has any time for anything), an infective case can be in contact with almost the whole community. Vaccinating the family contacts is only scratching at the surface of the problem. Why can’t we vaccinate all babies soon after birth I know the vaccine must be used fresh, the immunity may not be longlasting and vaccination may have to be repeated, and there are local complications ; but all this is true of vaccination against smallpox. B.c.G. vaccination of infants has been practised in Scandinavia for years. Why not here The other day I put this to a professor of bacteriology who knows about these things. He spoke weightily of the evidence being unconvincing, of the
conditions perhaps being different in Scandinavia, and of the need for us to establish by careful trials the case for B.C.G. in the young. When he had finished I asked whether he had had his three kids vaccinated. Yes, he said, he had. This isn’t exactly dog-in-the-manger, but it seems a bit odd. What do you sayT °
Yours
sincerely,
W. B. St. C. BREWER.
Points of View THE DOCTOR IN CONTEMPORARY LITERATURE * RONALD BODLEY SCOTT M.A., D.M. Oxfd, F.R.C.P. ASSISTANT
PHYSICIAN
TO
ST.
BARTHOLOMEW’S
HOSPITAL,
LONDON
said that the esteem in which the the medical public holds profession has fallen. If this be true, the situation is one which should cause us all concern ; although we may reflect on the irony of this decline going hand in hand with an increase in our ability to control disease of which our fathers would not have dared to dream. The barometer of public opinion is, not easily read ; and any information on this subject, however trivial its source, is of value. It was with these thoughts in mind that I embarked upon the investigation which I shall here describe. IT is
commonly
*
*:
*:
Fiction holds up a mirror to life, and it should be possible to see therein a reflection of the doctor as he appears to the contemporary novelist. To obtain a concentration of experience it was convenient to study a form of fiction in which doctors appeared frequently, while it was advisable to avoid works in which a medical man was one of the major characters, because he would then be invested with attributes not necessarily regarded by the author as typical of his calling. The class of novel which most nearly fulfils these requirements is that of detective fiction, and it was to such works that I turned my attention. The detective novel in its purest form may have passed the zenith of its fashion ; but there is still an outpouring of works in which the central themes are murder, violence, and sudden death, and, as episodes of this kind are inevitably followed by the appearance of a doctor, they suit our purpose equally well. I do not propose to deal with the classics of this form of fiction, but the importance of our profession to the detective was established by the creation of Dr. Watson more than fifty years ago. This practitioner, recently described in the Times Literary Supplement as a "clot in the arteries of the Royal Colleges of Physicians and Surgeons," first met Sherlock Holmes within the walls of St. Bartholomew’s Hospital. Two years ago a plaque was unveiled there to commemorate this event. Filial piety therefore has added its stimulus to my researches. It is suitable to begin with the general practitioner because he has characteristics which separate him sharply from the class of doctor always known in novels as specialists." He is usually portrayed as competent and cheerful. A few quotations provide a clear-cut picture a big cheerful middle-aged man," " a squarely built eminently practical young man," " such a nice breezy manner," a quiet square young man with bushy black hair growing low down over his forehead," " a stolid pleasant looking square capable face." In these descriptions you will have been struck by the squareness of the "
"
"
*
Based
on an
address
given
to the Oxford division of the
British Medical Association
on
May 26,
1955.
342
general practitioner ; possibly this is symbolic, denoting the solid virtues of dependability and unimaginative competence which the novelist either sees, or wishes to see, in his medical attendant. It is, however, not every general practitioner who possesses these desirable qualities. Dr. Smith in jMo-e Work for the Undertaker is tall and stooping with a back like a camel, and although kind and professional is stigmatised as not as bright as some." Indeed intellectual capacity does not appear to be a feature of the family doctor. Another Dr. Smith is described with the ring of truth as " a thin man with a tired face." Dr. Shaw, in Death at the Bar, is a more attractive personality, dominating the scene with bright vivid blue eyes, gazing through his spectacles " and combining with " a look of serio-comic solemnity," " a certain air of distinction," while young Dr. Fettes, in Death of a Ghost, possesses the enviable gift of " looking blank without appearing foolish." Examples could be multiplied, but these are sufficient to show the impact the general practitioner makes. On the whole he may be said to emerge with credit : he has an appearance of competence ; he is stolid ; sometimes he is even distinguished. He remains unrumed by the curious situations which the novelists devise for him. The accounts of his purely professional abilities and the manner in which he conducts consultations are interesting and revealing. Mr. Todhunter, in Trial and Error is told brusquely that he has an aortic aneurysm. Well," says his doctor, what can you expect ? Your blood pressure’s been too high for years." He is, in the timeworn phrase, given six months to live, but the blow is softened by the observation that " life on the physical plane is a darned nuisance and the sooner we’re out of it the better." The methods of young Dr. Tom Croxley in She Died a Lady were more devious ; he would tell the patient " all the imposing medical terms for what was wrong with him," an approach commended by his father, who was his senior partner, as impressing, pleasing, and inspiring confidence from the, start. We must all at some time have been a little envious of the knowledge of medical jurisprudence and toxicology possessed by these fictional general practitioners. The precise time of death is announced with assurance after a cursory glance at the body. A moment’s inspection is enough to make the most obscure of country doctors suspect the most obscure of poisons. " He looks to me," says big cheerful middle-aged Dr. Burwick, " like a typical case of oxalic acid poisoning." Not content with mere impressions, he withdraws to his dispensary with the suspect bottle of sherry, carries out the tests necessary to confirm his opinion, and, on adding a reagent, " is unable to repress an exclamation as it throws down a white precipitate." We can only reflect wistfully upon our own copies of Aids to Forenasic J.1’Iedicine and Toxicology, lying in the attic beneath the dust of twenty years. "
"
"
"
I must turn now to the " specialist," who stands in marked contrast with the selfless family doctor. Many, like Dr. Mawsley in Death ii?, Harley Street, are interested only in the amassing of wealth. Dr. Eugene Arnold, of the Red TVindow ]}[urders, is an example: "as fond of money as Marlborough and as mean about it," he had a damned superior air ... as though he always had his He even " took on Ralph bank book in his hand." Bender-the most brillaint student of his year at the Royal-as a dispensary clerk to handle minor cases without fee." In matters of appearance the specialist does lead, and his manners are usually irreproachable. Dr. William Pelham, although " a bit of a pompous ass," was plump, bland, and kindly, with silver hair and " the manners of a Prime Minister "-an ambiguous description, it is true -" he could squeeze the last drop of politeness out of a "
conversation." His " only touch of professionalism was pair of black-ribboned eye glasses." This last is the hallmark of the successful consultant, for Sir Daniel Davidson, of whom it was said that " if Disraeli had taken to medicine instead of primroses, he would have been just such another," also wore glasses on a wide black ribbon. A second distinguishing feature is " elegant white hair," although its charm in the case of Sir Gordon Woodthorpe, the eminent Society physician, must have been offset by his custom of licking his lips feverishly, a nervous habit that had persisted since childhood." Perhaps it is natural that psychiatrists should play so many prominent parts in detective fiction. A man who, in the words of The Lancet’s peripatetic correspondent, goes to the Folies Bergeres to watch the audience, has a powerful dramatic appeal ; his activities are always mysterious and usually sinister ; he is cast by Nature for the role of villain. Dr. Eugene Arnold was of this specialty with " assured success and poise about him and a hard handsome face which could become kindly like the turning on of an electric light." Dr. Nicholson, a very clever Canadian, was another ; " behind his strong glasses pale blue eyes glittered reflectively and his manner suggested great reserves of power." It will astonish those who number psychiatrists among their acquaintances to learn that " he said very little," and it will increase their surprise to hear that he." contrived somehow to make every word sound significant." Surgeons enjoy less popularity with the writers of detective fiction ; they lack the machiavellian qualities of the psychiatrist and the polish of the Society physician. A striking exception, however, is Sir John Phillips of the Nursing Home murder. His background of Winchester, Cambridge, and St. Thomas’s Hospital only just falls short of being irreproachable, and he possessed that " curious quality people call personality" from which, next to actors, medical men profit most." He can be forgiven losing his temper when he learned that the Home Secretary had been away for the weekend with the theatre-sister whom he hoped to marry, and we can sympathise with him when the Minister, whose appendix abscess he was called upon to drain, died immediately after the operation. A very different character is Mr. Thoms, his assistant, fat, scarlet-faced and industriously facetious, his undistinguished but blameless career punctuated by mild scandals about women." Clearly his education at St. Bardolph’s, Essex, and Guy’s Hospital, had not fitted him for competition with such giants as Sir John. The narrower forms of specialism receive scant attention, but one instance is Dr. Mawsley, in Death in Harley Street, a specialist in glands." Although noted for his rapacity, he is in part redeemed by his interest in His investigations were prosecuted in an research. experimental laboratory which led out of his consultingroom where he made use of rats provided by the Marylebone Borough ratcatcher at a cost of 5s. a pair. Ironically enough it was his interest in the effects of coniine on the glands of these animals which led to his untimely death at the hands of his illegitimate son by a probationer at a hospital where he had been a house-physician. All specialists lead lives of elegance amongst surroundings of opulent good taste. Dr. Pelham " with a Havana between his lips and a glass of sherry at his elbow " is an example of this leisured luxury. Sir Daniel Davidson’s consulting-room in St. Luke’s Chambers, Harley Street, provides another illustration. - It had " apple green walls, an Adam fireplace and silver-starred curtains. A beautiful and expensive room, crying in devious tones of the gratitude of wealthy patients." It is possible in these glimpses to discern a certain hostility to the specialist. His appearance is too distinguished ; his manners are too perfect and he is too wellgroomed. With his beribboned eyeglasses, his white hair, a
"
"
"
"
343 and his overwhelming urbanity, he recalls an Ambassador in a play by Pinero. This glittering figure fills his patients with feelings of their own inferiority and with apprehension concerning his fees. This fear is often well founded. Behind the façade there is callous avarice. Nevertheless all specialists are " brilliant " and many have distinguished themselves in other fields than medicine. Dr. over a sporting peer by Eugene Arnold was able to win " his modest confession that he happened to be a cricket blue of some distinction." In general it may be said that that the specialist is remote and olympian ; his only concessions to human weakness are his rapacity and his habit of irregular liaisons with members of the nursing staff. The contrast between general practitioner and specialist revealed in these composite pictures is interesting. Popular notions lag behind reality and some of these features of consultant life have vanished ; the beribboned glasses have disappeared and few specialists now live like merchant princes. To most novelists, moreover, the cloistered life of the ’hospital remains a mystery. A scene in The Lift and the Drop provides convincing evidence of ignorance : the night sister at St. Bartholomew’s was behind a screen with a recently admitted casualty and the waiting detective heard the sound of a kiss, followed by a whisper of " now rest and get well for me, soonsoon." There is another role in which the medical practitioner appears in detective fiction ; it is that of the murderer. I was surprised to find him playing this part in little less than half the novels I chanced to read. It may be asked why the novelist should so frequently select the doctor for the murderer. It is widely believed that the medical student early acquires a profound knowledge of toxicology and that he has at his command poisons which leave no trace in the victim’s body and which baffle the most erudite chemists. In spite of this, however, the medical murderer is commonly recorded as choosing some mundane drug, such as hyoscine or chloral, or a traditional poison like arsenic. In Death Leaves a Diary, for instance, Dr. Furness poisons his mother-in-law with arsenic, and in The Nursing Home ]I urders Dr. Roberts makes use of hyoscine which he administers with a syringe ingeniously built into his anaesthetic apparatus. At other times there is resort to simple violence : Dr. Eugene Arnold belies his polished appearance by using a hammer ; Sir Daniel Davidson, having rendered his victim unconscious by a blow with his cigarette-case, suffocates him by holding his nose and placing his hand over his mouth. Only rarely are more ingenious methods employed : Dr. Kingston in the Case of the Late Pig, balances a stone urn on a balustrade, supporting it with a block of ice, which melts to allow the urn to fall with devastating precision on the head of a man sleeping below in a deck-chair. It might be supposed that opportunity was responsible for these doctors committing murder, but it is rarely their patients whom they kill. Dr. Roberts was an to this but he and regarded was obsessed rule, exception himself as dedicated to purification of the raceby eliminating those who were eugenically unsound. In the end he was betrayed by his custom of cutting a notch in the stem of his wooden stethoscope to celebrate each success. In the main their motives are commonplace : Sir Daniel is afraid that his blackmailing activities will be revealed; Dr. Furness is after his mother-in-law’s money ; and young Dr. Tom Croxley’s frantic passion for the wife of an alcoholic professor of mathematics drives him to murder when she surrenders to the charms of a motor-car salesman. In many instances the fact that the murderer is a doctor is irrelevant to the novel’s plot and we must seek for some occult reason for the author’s choice. It is probable that we should see in it another indication of the
hostility with which the public regards our profession. This feeling has deep roots. The medical profession is, in a sense, a priest craft with its own language, its incomprehensible code of etiquette, and its objective view of matters which engender great emotional heat in the laity. The public feels resentment at its exclusion from this secret society. The doctor again is in a position of enviable superiority ; the patient has no choice but to display to him the sordid workings of his psyche as well as the pitiful shortcomings of his body. Finally the malignant blows of fate are seldom acceptable as inevitable or as the fault of the sufferer, and the medical attendant may find himself the scapegoat. The most gracious and grateful of patients, amongst whom I am sure we may rank these novelists, have feelings towards our profession which are at best ambivalent. It is these emotions which make them unable to resist the temptation to tear away the veil of professional respectability and to reveal the ravening beast it of the conceals. At the denouement, the face " previously suave Dr. Furness... was shining with sweat, his skin was mottled and his chin thrust out to show his teeth in a humourless grin " ; Dr. Edmund Galley became a " frothing screaming homicidal maniac " and in the eyes of Dr. Kingston shone the " blood light." In these phrases the novelists stand more starkly revealed than their characters : they are hitting back at those who have unwittingly slighted them in the past and avenging critical comments on their steadily increasing weight and on their habits of eating, drinking, and smoking to excess. ...
I have attempted to present a picture of the medical profession as reflected in a small and specialised sample of contemporary literature. The portrait is, of course,
outmoded, because the National Health Service has
changed the face of medical practice in this country and changes have not yet influenced the detective novel; possibly the authors of such works earn incomes which enable them to remain private patients. Nevertheless I submit that there are points in this analysis which are instructive. The novelist makes a sharp distinction between the general practitioner and the specialist, a division which has been unhappily accentuated by the rigid framework of the National Health Service replacing the profession’s previously elastic structure. In his view, the specialist adopts a cold scientific attitude to his patients ; while the general practitioner, although rated as intellectually inferior, is I have already a warm-hearted friendly character. the out the nature of twofold pointed patients’ feelings towards the profession of medicine : admiring gratitude for the friend in need going hand in hand with rebellious dislike for the carping authoritarian who sees him in his unguarded moments and denies him his pleasures. By an unjust dichotomy the novelist diverts the first emotion to the general practitioner and the second to the specialist. The popular identification of the specialist with " science " contributes to this schism : the Englishman is properly suspicious of science and dreads the thought of being made the subject of experiment. The old-fashioned family practitioner, he believes, is as ignorant of the first
these
he would be innocent of the second. In these emotions may discern an atavistic longing for the medicine of the witch-doctor-a desire to evade responsibility for one’s own ill health, to have done with the tedium of rational explanations, and to surrender to the narcotic charms of incantations, spells, and sacrifices. From this we are driven to the conclusion that the public’s choice of doctor is dictated by the same considerations that inspired a cartoon in Punch in 1884, when a now classic phrase was first used : as
we
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" What sort of doctor is he ? " Oh, well, I don’t know much about his got a very good bedside manner."
ability ;
but he’s
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