without much hope of ever being bought and even less of being read, are the essayistic reflections of doctors near or just after retirement.
were a literary genre of the ’20s and ’30s, and they are generally a summary of what life taught their authors.
Of Christopher Howard, who published his After Consulting Hours in 1930, Dalrymple knows nothing,
except that I deduce from his qualifications* and the fact that his preface was written from Harley Street that he was a practitioner in that great street.
was addressed to his fellow practitioners rather than to the general public, for it was published by William Heinemann Medical Books and contains quite a lot of technical advice.
Indeed, Howard appears to have practised from 104 Harley Street. He was to go on to publish notably Bedside Manners and Paris Prelude (both 1932) and Physic and Fancy (1937; ‘Medical observations and other observations on gardens, syphilis, etc.‘)
The After Consulting Hours blurb reads:
A medical man’s reflections after consulting hours are over on his patients, their various idiosyncrasies, the latest ideas in medical science, including such different subjects as high blood pressure, endocrine glands, vitamins, ultra violet treatment, hay fever, etc. The book is very pleasantly written and is of interest to both the layman and the doctor.
The book’s opening sentence reads:
The taking of blood pressure and the interpretation of the ﬁgures of the sphygmomanometer to the patient has become a craze which the profession as a whole would do well to endeavour to counteract.
The problem is that
there is a temptation for the busy doctor to take a blood pressure reading and, from the ﬁrst deﬁnite indication of heightened pressure that he obtains, to think that he is dealing with a case of hyperpiesia and to institute the appropriate treatment of this condition.
But if the patient’s blood pressure is consistently high,
it is most unwise to give him the exact ﬁgures
one of the commoner causes of modern phobias is based upon blood-pressure reading.
If the trend continues,
taking an undue interest in the blood-pressure reading may soon become as much a hobby in Europe as in America.
one of the major advantages which have come out of the increased interest which the profession, as a whole, during the last thirty years, has taken in blood pressure, is that bloodletting is once more coming back into usage.
Thanks to hyperpiesia,
the value of bloodletting in pneumonia or in any affection which troubles the right side of the heart, in plethoric conditions generally, is again being remembered,
it fell into disrepute because many years ago it was overdone.
The patient feels so much better after having 600ml of blood removed that he is tempted to demand repeat venesections too soon and too often.
The next ten or twenty years may produce a crop of plethoric individuals
for whom salvation blood will too often be let, bringing the operation back into disrepute.
Meanwhile, subcutaneous oxygen
may be of great value in cases of pneumonia and in some heart lesions.
Stokes-Adams attacks result when
the living liquid of the body has become a viscous substance of the consistency of treacle,
treacliness being caused by the use of arsenic in old men’s venereal diseases. Subcutaneous oxygen is contraindicated in coronary thrombosis, a condition
only comparatively lately noted
and cases of which
are still rare.
The sufferer must on no account make a voluntary movement for many days:
Even the small shock which might be associated with the passage of the needle
to give subcutaneous oxygen might prove fatal. And
it is only by frightening the attendants that an absolute state of immobility can be obtained.
What a pleasure it must have been to frighten people out of their wits. A real compensation for uselessness.
evidence-based medicine will ensure that no one will ever again write After Consulting Hours.