by Christopher Gardner-Thorpe. Page 55 - Evolve360

24 Pages·2010·0.25 MB·English

55
Should we write Medical Biography?

*
CHRISTOPHER GARDNER-THORPE

The writing of medical biography has become increasingly popular in
recent years but we might ask the question „Should we write about other
persons at all?‟ We can explore this question and encourage thinking
about possible answers.
People fascinate us all and neurologists in particular, perhaps
because of the inextricably intertwined aspects of body, behaviour and
emotion that we explore in the writing of biography. We are bound to
study these subjects outside of our professional work as well. Some of the
most fascinating books are biographical, recording and analysing the lives
and experiences of others. This is what neurologists do in the clinic and in
the wards. They are concerned with the whole nervous system and in
relation to the brain, that remarkable organ, Koch and Laurent have
highlighted some of its products:

From the 1.5kg of flaccid matter, convoluted folds, about 100
billion neuronal components, hundreds of trillions of
interconnections, many thousand km of cabling, and a short
cultural history has emerged calculus, Swan Lake and The
Macintosh.1

In the Introduction to his Thesis for the degree of MD in the University of
Edinburgh, the Physician to Leith Hospital, William Elder (1865-1931)
wrote:

The power that man possesses of communicating his
thoughts to his fellow-men by means of language is one of
the most characteristic of the many points that distinguish
him from the lower animals. That some of the lower animals
do possess the power of communicating with each other
there can be little doubt, but it can hardly be said of them that
they possess the faculty of speech.2

In 1897 this work on speech was published in book form and it reminds
us that among the methods we use to communicate with each other are
the spoken and written word.

* Address for correspondence: [email protected]
1 C. Koch, G. Laurent, „Complexity and the Nervous System‟, Science, 284 (1999), 96-98.
2 W. Elder, Aphasia and the cerebral speech mechanism (London, HK Lewis, 1897).
56
But is it appropriate gratuitously to provide a permanent, written
record of someone else‟s behaviour and feelings - and even when life is
extinguished since friends and relatives might still be identifiable? The
practicalities of writing and publishing are not complicated but the ethics
are and, furthermore, they need to be explored, discussed and digested -
and maybe this will cause us to amend our approach.
Medical biography is part of medical history and medical history is
part of history.

History

History of all sorts is interesting to many and in his 1999 publication The
Isles, A History, Norman Davies wrote:

History is wound from many strands. The shortest and simplest of
them are individual human lives, which on close examination turn
out to be rather complicated. The largest skeins, which are made up
from the activities of whole social groups, institutions, nations, and
States, are like huge cables, wound from separate strands yet
twisted inseparably together. Some of the past, therefore, can only
be likened to a forest of those giant tropical lianas which grow
upwards out of the earth and twist their way through the jungle
cover towards the light. The history even of a single country is far
too large to be examined whole. Historians must some how reduce
the tangle to manageable and comprehensible proportions. To do
that, they can either pick out separate strands for detailed analysis
or else they can make a series of cross-sections to expose the
changing patterns within the whole. Ideally, they should try to do
both.3

Medical men have considered history in the wider sense too. William
Doolin (1887-1962), Surgeon, Editor and Medical Historian in Dublin,
wrote:

In the simplest words, history is the story of the past but is told in
the present for the future.4

Jack Lyons (1922-2007), neurologist in Dublin, Doolin‟s biographer,5
quoted further from the subject of his biography:

3 N. Davies, The Isles, A History (London, Macmillan, 1999), p. 697.
4 J.B. Lyons (ed.)., Dublin’s Surgeon Anatomists and other essays (Dublin, Royal College of Surgeons
in Ireland, 1987), frontispiece.
5 J.B. Lyons, Brief Lives of Irish Doctors (Dublin, Blackwater, 1978), pp. 155-58.
57

All human history is made up of progression and regression - it is a
tale of successes and failures. I have touched only upon the major
successes, in a series of chamois leaps from one Alpine peak to the
next. The dark valleys beneath are filled with near misses and the
failures; such are the casualties of every phase of human
endeavour.6

Medical History

Medical History has fascinated many doctors and has gained momentum
as a subject considered worthy of much time and energy. It is important
to the understanding of medicine. Quite early on, Emile Littre (1801-
1881) encapsulated this when he wrote:

If the science of medicine is not to be lowered to the rank of a mere
mechanical profession it must pre-occupy itself with its history.
The pursuit of the development of the human mind, this is the role
of the historian.7

It can be argued therefore that the study of the history of medicine is
intellectual and aesthetic and perhaps makes for better doctoring, „better‟
persons and better interactions. The occupation of doctors includes work,
study and education. However, in medicine it is easy to concentrate
extensively upon the science and the day-to-day issues of looking after
patients to the extent that the art of medicine, included in the modern
concept of the Medical Humanities, becomes neglected. In his excellent
1949 publication dealing with his subject, the librarian John Thornton
wrote:

The History of Medical Science has always had its adherents
among medical men in Great Britain, but in the past they have not
been numerous.8

Thus we may find three principal reasons why the study the history of
medicine is appropriate, namely:
 It helps us learn and understand the mistakes of the past and
encourages us to avoid them in the future;

6 Op. cit., ref 4, p. 218.
7 J. Daintith, A. Isaacs, Medical quotes, a thematic dictionary (Oxford, Facts on File, 1989), p. 89.
8 J.L. Thornton, Medical books, libraries and collectors; study of bibliography in the book trade in
relation to medical sciences (London, Grafton, 1949), p. XVII.
58
 It is an academic discipline;
 It is fun.
In an interview with the British historian Simon Schama, the journalist
Andrew Billen wrote:

The only thing protecting us from the future is the past … Our
knowledge of history, our own and our civilisation‟s, is what stops
us blundering forth in the belief, for instance, that “things can only
get better.” This is why politicians fear history; like soap opera
writers, they require us to have short memories of previous
plotlines.9

The Basis of Biography

As recorded in Chambers Dictionary, we too can say:

Biography is an account or history of the life of an individual: The
art of writing such accounts.10

In our case, the individual is man. In more flowery language in 1733,
Alexander Pope (1688-1744), acclaimed during his lifetime as one of the
great English poets, wrote:

Know then thyself, presume not God to scan,
The proper study of Mankind is Man11

and - re-iterated by the writer and poet Hilaire Belloc (1870-1953) -

The proper study of mankind is men.12

Certain prerequisites exist for the writing of biography and these include
good evidence for detail of the life about which we are writing. This may
be based on other written work or words, subject to memory with gaps
filled in and embellished for a story - but it must be a good story, perhaps
based on startling events and with humour or sadness. Biography is useful
as an historical resource but is much more acceptable when readable and
of course the more readable then the larger the audience. Fictional

9 A Billen, „The Andrew Billen Interview. The man who made history sexy explains why it is also our
freedom‟, The Times T2, 20 May 2003, pp. 14-15.
10 Chambers English Dictionary (Edinburgh, W & R Chambers, ca. 1910), p. 102.
11 D. Grant (ed.), Poems of Alexander Pope (Harmondsworth, Penguin Books, 1950), p. 121.
12 H. Belloc, Collected Verse (Harmondsworth, Penguin Books, 1958), p. 88.
59
biography and historical fiction in general fall into a special category
characterised by half-truth.
Medical biography clearly is about persons, grouped to form the
people of whom we speak. As James G Mumford (1861-1914) wrote:

The history of medicine does not depart from the history of
people.13

Confidentiality

The Professional Code of confidentiality that is part of all medical
practice does not distinguish to a major extent between the living and the
dead. The written word in notes and reports and, increasingly, in
electronic form provides a permanent record of confidential information
for, as John Murray, the Australian doctor, wrote:

Medical training puts you in the unique position of talking to
people about things that they do not usually talk about. Taking a
medical history is often a process of learning in some detail about a
person‟s daily life, their family, and about tiny details of their
physical condition and what they feel. It is a privilege. Sometimes I
have found myself more interested in a person‟s story than in their
illness. And I realised, too, that people are infinitely complex and
unique – there are more ways of seeing the world than we will ever
be able to write down.14

Coulehan and Hawkins noted in respect of the Physician-Writer:

Physician-Writers have prima facie duty to obtain their patients‟
consent to publish stories about them … In addition to keeping
faith with patients, the Physician-Writer also has an obligation to
readers and editors … The Physician-Writer can do this by striving
for transparency with readers and editors …15

The Living

Many journals, for example the Journal of Medical Biography, do not
publish papers concerning living subjects unless they feature

13 Op. cit., ref 7, p. 89.
14 J. Murray, „Dissecting Room. Physician Writers‟, Lancet, 363 (2004), 740.
15 J. Coulehan, A.H. Hawkins, „Keeping faith: ethics and the physician-writer‟, Ann. Intern. Med., 139
(2003), 307-11.
60
appropriately in an historical essay and rarely in exceptional
circumstances.
Writing about the living requires permission except of course in the
case of autobiography where the writer selects what he wishes to say
about his subject whom he knows very well, namely himself. It may be
harder to find a publisher for autobiography but there is always the
salvation of vanity publishing where the financial risks are shared with
the publisher on the basis they agree between them. The peer review
process here is a little different therefore but that is not to say it is
necessarily inadequate.
Special circumstances apply in the case of patients about whom
absolute confidentiality is essential although this is challenged when a
Court Order is invoked and also in the case of certain legally-notifiable
circumstances, for example patients who present at an Emergency
Department following knife wounds where the doctor is obliged to inform
the police in the interests of public order and safety.

The Deceased

The dead cannot check the text or answer back but their surviving
relatives can and therefore great sensitivity is needed. It may be hard for
relatives to read of matters of which they knew nothing and which might
worry or shock them. Damage can be done to the reputation of a deceased
colleague or friend. Although relatives need not necessarily be consulted,
in the desire for accuracy they should be approached and often can give
much helpful advice and additional information. An Obituary is often
written at the behest of a relative and a publishing house. Many medical
colleges keep records of their Fellows; for example, in the case of the
Royal College of Physicians, Munk‟s Roll was first published in 1861
and stems from replies sent to William Munk (1816-1898), renowned
expert on smallpox, who wrote to local newspapers seeking information
about medical worthies.
Most biography is written about the deceased whose estates are
cared for by their executors. In practice, it is rarely necessary to contact
an executor.

Beginnings in family history

Many are interested in the story of their own family and especially in the
personalities of their antecedents who had stories to tell. Some will have
been fascinated during their student days by those books that provided
historical background to persons, places, procedures, instruments and
many other areas of medical practice. Among these is the large
61
undergraduate surgical textbook by Bailey and Love. The footnotes give
interesting and sometimes quite racy details of surgeons cited in the text.
Others might have been inspired by the acquisition of an old family
medical book, perhaps the precursor of the Readers’ Digest Book of
Health of which there were many in Victorian times and even earlier; an
example might be one of the very many copies of William Buchan‟s
(1729-1805) Domestic Medicine that adorned the family bookcase.
Yet further examples came from the pen (not the computer) of
James Parkinson (1755-1824) whose name is better known in relation to
the disorder he described under the title The Shaking Palsy.16 His
monographs include Medical admonitions addressed to families
respecting the practice of domestic medicine and the prescription of
health; The Village’s Friend and Physician; Dangerous Sports, a tale
addressed to children; Observations on the excessive indulgence of
children; and even The Way to Health, Hints for the improvement of
trusses to help enable hernia sufferers to reduce their discomfort by
adjustment using this surgical appliance. He learned shorthand in his
youth and used to sit up late, no doubt reading his lecture notes. After he
died in 1824, his son John transcribed his shorthand notes and these were
published in 1833 as Hunterian Reminiscences. In the preface, John states
that his father when in practice wished to select those pathological
doctrines that were exclusively Hunter‟s. Copies of Parkinson‟s works are
scarce nowadays but some medical biographers will have been stimulated
by booksellers‟ catalogues that bring to attention the facts that famous
doctors including Parkinson had interests other than medicine which in
this instance ranged through political pamphleteering, chemistry, geology
and the Church.
The exploration of booksellers‟ catalogues can lead to a start in the
writing of medical biography and to many surprises along the way. Some
volumes are not especially expensive although many reach astronomical
figures. The zeal for collecting may take over and the ability to peruse the
works of favourite authors or personalities leads to exploration of not
only biography but also gives the chance of travel to the haunts of those
about whom one might write. Internet searching, not always accurate
though and often uncensored, has made all of this much easier and to
some extent reduced the thrill of the chase. New friendships emerge too
and ephemera enhance the knowledge of the subjects of our biographies.

16 C. Gardner-Thorpe, James Parkinson 1755-1824 (Exeter, A Wheaton & Co. Ltd, 1987).
62
Families

The study of the life of one individual may lead to interest in another.
One capable individual may beget another. The Bucklands comprise one
such family.
In the University of Oxford William Buckland (1784-1856) was
made Professor of Mineralogy in 1813 and Reader in Geology in 1819. In
1818 he was elected a Fellow of The Royal Society. He was one of the
first five Founding Fellows of the Geological Society in 1807 and
President from 1824 to 1826. It is to Buckland and his contemporaries
that we owe the discovery of the first three dinosaurs, named as such in
1813 by Richard Owen (1804-1892). In 1836 Buckland wrote the two
volumes of the sixth Bridgwater Treatise. His contribution was entitled
Geology and Mineralogy Considered with Reference to Natural
Theology. The Bridgwater Treatises formed a series of twelve volumes
published in 1833 and 1834 on scientific subjects by eight authors, each
of whom was awarded one thousand pounds from the Will of the Earl of
Bridgwater (1756-1829). A ninth, unofficial, treatise written by Charles
Babbage (1791-1871), father of the computer, was entitled On the Power,
Wisdom, and Goodness of God, As Manifested in the Creation.
No doubt with Buckland, among others, in mind Joseph Dalton
Hooker (1817-1911) wrote:

These parsons are so in the habit of dealing with the abstractions of
doctrines as if there was no difficulty about them whatever, so
confident, from having the talk all to themselves for an hour at
least every week … that they gallop over the course when their
field is Botany or Geology as if we were in the pews and they in
the pulpit. Witness the self-confident style of Whewell and Baden
Powell, Sedgwick and Buckland.17

William‟s son, Frank Trevelyan Buckland (1826-1880), was a doctor but
better known for his work as Inspector of Fisheries and for his
introduction of salmon and trout ova to New Zealand and Australia.
Another, perhaps more interesting, claim to fame occurred in January
1859 when by chance he saw a notice in The Times that an attempt should
be made to identify John Hunter‟s bones that had been buried at St
Martin-in-the-Fields privately in October of 1793. He examined 2260

17 J.A. Secord, Victorian Sensation. The extraordinary publication, reception, and secret authorship of
Vetsiges of the Natural History of Creation. Mammon and the New Reformation. (Chicago, University
of Chicago Press, 2000), p. 479 n 21.
63
coffins and the sixth from last was Hunter‟s; he informed the College of
Surgeons and the bones were re-interred at Westminster Abbey.
The study of geology seemed to be a particular pastime of doctors
in the late 18th and early 19th centuries, the early age of palaeontology and
geology. A doctor in Brighton, Gideon Algernon Mantell (1790-1852)
gave us the only known description of James Parkinson. Of Parkinson
there is not any known image since that sometimes claimed to be his is
actually of a dentist portrayed long after Parkinson had died. Mantell
wrote:

Mr Parkinson was rather below the middle stature, with an
energetic, intelligent, and pleasing expression of countenance, and
of mild and courteous manners; readily imparting information,
either on his favourite science, or on professional subjects; for he
was at that time actively engaged in medical practice in Hoxton
Square, and was the author of several valuable medical treatises.
He kindly showed and explained to me the principal objects in his
cabinets, and pointed out every source of information on fossil
remains; a department of natural knowledge at that time but little
cultivated in England, but which peculiar circumstances had
contributed to render the engrossing object of my young and ardent
mind. In after years Mr Parkinson warmly encouraged my attempts
to elucidate the nature of the strata and organic remains of my
native county, Sussex, a district which was then supposed to be
destitute of geological interests; and he revised my drawings, and
favoured me with his remarks on many subjects treated of in my
first work „The Fossils of the South Downs‟.

Mantell called on Mrs Mary Shelley (1797-1851), author of
Frankenstein; or, the modern Prometheus (1818), for a long gossip and
also described how in December 1848 he saw a new phenomenon, the
electric light. Our description of Mantell himself, echoing his description
of Parkinson, comes from an Obituary in The Illustrated London News of
4 December 1852:

Dr Mantell took great delight in imparting to others a knowledge of
his favourite science: he was fluent and eloquent in speech, full of
poetry, and extremely agreeable in manner to all who manifested
an admiration of his genius.
64
Progression

Another clergyman, William Paley (1743-1805),18,19 Archdeacon of
Carlisle, in relation to Creationism wrote:

In crossing a heath, suppose I pitched my foot against a stone, and
were asked how the stone came to be there; I might possibly
answer, that, for any thing I knew to the contrary, it had lain there
forever, nor would it perhaps be very easy to show the absurdity of
the answer. But suppose I had found a watch upon the ground, then
it would be enquired how the watch happened to be in that place; I
should hardly think of the answer which I have before given, that
for anything I knew, the watch might have always been there. Yet
why should not this answer serve for the watch as well as for the
stone? Why is it not as admissible in the second case, as in the
first? The inference, we think, is inevitable; that the watch must
have had a maker, that there must have existed, at some time and at
some place or other, an artificer or artificers, who formed it for the
purpose which we find it actually to answer; who comprehended its
construction, and designed its use.20

Paley‟s philosophical and theological discourses make fairly heavy
reading but the man himself is interesting, buried as he is between his two
(serial) wives in Carlisle Cathedral. He provided arguments that explored
obliquely the subject of evolution but he also argued for Creationism. Not
a medical doctor, Paley lived marginally later than Charles Darwin‟s
grandfather, Erasmus Darwin (1731-1802).21,22
Erasmus Darwin did qualify and practise in medicine. He
proceeded BA in 1754 and returned to Cambridge in 1755 to take the
MB. By Autumn 1756 he had completed his medical studies and set up
practice in Nottingham but soon moved to Lichfield where he became a
popular physician and there he remained until 1781, resisting the idea of
becoming a fashionable London Physician. He treated the poor free of

18 C. Gardner-Thorpe, „William Paley (1743-1805), Neuroanatomist?‟, J. Med. Biogr., 10 (2002), 215-
23
19 C. Gardner-Thorpe, „William Paley (1743-1805) and James Parkinson (1755-1824): two peri-
Erasmatic thinkers (and several others)‟, in C.U.M. Smith and R.G. Arnott (eds.), The genius of
Erasmus Darwin: science, technology and culture, 1700-1945 (Aldershot, Ashgate, 2005), pp. 63-82.
20 A. Partington (ed.), Oxford Dictionary of Quotations, Fourth Edition (Oxford, Oxford University
Press, 1996), p. 505.
21 C. Gardner-Thorpe, J. Pearn, „Erasmus Darwin (1731-1802), Neurologist‟, Neurology (Minneapolis),
66 (2006), 1913-16.
22 E. Krause, Erasmus Darwin (London, John Murray, 1879). Other biographies of Erasmus Darwin
include: C.D. Darlington, Darwin’s Place in History (Oxford, Blackwell, 1959), and S.A. Barnett (ed.),
A Century of Darwin (Heinemann, 1958; reprinted Mercury Books, 1962).