Category Archives: British Medical Journal

Obituary: Theodore Dalrymple

Melaten-Friedhof cemetery, Cologne

Dalrymple supposes that a doctor

is growing middle-aged when he goes straight to the obituary columns of the British Medical Journal and the Lancet instead of to the scientific papers, and starts to recognise the names that appear there.

Dalrymple is

a devotee of medical obituaries, with their mixture of post-mortem piety and snide remarks. They have a language of their own.

He recalls the Lancet obituary of a recently deceased physician,

from whose passport photograph alone it was possible to deduce that he had been a mean-spirited, bullying, pedantic stuffed shirt.

By The Death Bed, 1893. Munch Museum, Oslo

The obituary read:

Though not immediately likeable, those who knew him well detected many sterling qualities.

Dalrymple, while describing himself as one of

the highly replaceable dregs of the profession,

has not given up hope of an obituary, for this reason: he has discovered that the BMJ‘s obituary pages carry this italicised note to authors: ‘Self-written obituaries are welcome.’ What, then, he asks, should he write of himself? Perhaps

Outwardly he often appeared compassionate towards his patients, but inwardly he was seething with irritation that they should have been so feckless, foolish, ignorant, fat, importuning, immature and unrealistic.

Or

Sometimes he wanted to have an affair with a patient, but he always resisted the temptation, unlike some other doctors he could name.

The procrustean BMJ

Screen Shot 2016-05-27 at 22.38.52There is practically no liberal nostrum, writes Dalrymple, to which the British Medical Journal does not subscribe. Its pages, he writes,

are innocent of debate. When the BMJ speaks, it is ex cathedra.

A recent issue

was devoted to the subject of war. The BMJ’s attitude to war is like that of Coolidge’s to sin: it is against it. War is so bad for the health. The white man has spoken. 

Fortunately for the world, the BMJ

has discovered the causes of war. They are the same as the causes of all other evils: inequality and poverty. Eliminate these, and peace will reign.

Screen Shot 2016-05-27 at 23.08.19It seems to have escaped the BMJ’s notice, says Dalrymple,

that attempts during the 20th century to achieve radical equality were not entirely pacific or good for the health. Likewise, it has failed to notice that famine is much more likely to be a consequence of war than its cause.

The idea that wars are fought when ‘individuals are motivated to fight to seek redress‘ for their poverty

is laughable in its historical and psychological ignorance. Are Bin Laden and Saddam driven by poverty? Was Galtieri? Do Pakistan and India fight over Kashmir because of poverty?

The desire for someone else’s property

is not confined to the poor, nor need the property be of any value to be coveted. Ethiopia and Eritrea fought bloodily over scraps of land of use to neither nation.

The BMJ’s

procrustean theory of war is the liberal theory of crime writ large. Poverty makes men desperate, and desperation drives them to crime or (if they control an army) to war.

It is

up to us—the rich and contented portion of humanity—to prevent crime and war by paying more: for social welfare programmes in the case of crime, for foreign aid in the case of war.

It is, notes Dalrymple,

a tribute to the distorting power on educated minds of an abstract theory that anyone could believe such rubbish. Only someone with long years of formal training could deceive himself in this comforting fashion.

The fact that crime in Britain has risen along with income

should have been sufficient to persuade the BMJ that a more complex theory of human motivation was necessary.

Dalrymple points out:

The disregard of elementary reality is perhaps the distinguishing feature of much modern intellectual life.

Dalrymple’s quaint and archaic dialect

Compared to the prose of NHS managers, that of the British Medical Journal is as Edward Gibbon

From Fowler's Dictionary of Modern English Usage, ed. Jeremy Butterfield, 2015

From Fowler’s Dictionary of Modern English Usage, ed. Jeremy Butterfield, 2015