Category Archives: Harley Street

Sinister side of Harley Street

Waste of everyone's time

Waste of everyone’s time

In 1960, the doctor-barrister John Havard’s The Detection of Secret Homicide came out, while in 1962 the schoolteacher-novelist Anthony Burgess published A Clockwork Orange, about adolescent violence.

The two themes are combined, Dalrymple writes, in Pamela Hansford Johnson’s An Error of Judgement (1962), in which the patient-narrator consults William Setter, a Harley Street specialist, about

simultaneous pain in his right shoulder and the back of his left knee. Setter tells him he could have a cardiograph if he wanted but this would be a waste of everybody’s time. Having paid his four guineas, the patient-narrator is reassured and feels better. Payment is a wonderful placebo.

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Get over it

Setter

starts a club in Soho where he acts in a Mephistophelean manner to bring strangely assorted people together in a discussion group. He decides to give up medicine in the middle of his career, which was certain to have ended in a knighthood.

Johnson’s novel

casts light on the prescribing habits of the time. When the narrator’s mother-in-law dies, Setter prescribes Dexedrine for the narrator’s wife to help her get over her grief quicker than the Diagnostic and Statistical Manual of the American Psychiatric Association can say depression.

Setter prescribes phenobarbitone three times a day for a young man called Sammy Underwood,

That'll quieten him down

That’ll quieten him down

presumably to quieten him down, for Sammy is not epileptic.

Setter

suspects Sammy of being responsible for the kicking to death of an old inebriate woman.

Sammy is guilty and confesses to Setter,

who comes to the conclusion that Sammy is so lacking in remorse, contrition and conscience that he is likely to do it again. So for the public good and because he has always enjoyed inflicting harm (it is one of his reasons for having gone into medicine in the first place), Setter decides to kill him.

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Just what the doctor ordered

Sammy complains of insomnia

and Setter suggests that he ask his own doctor for some sodium amytal to help. He then suggests a small bottle of brandy to be taken with the pills just to make sure he gets a good night’s sleep, though with the stern warning that Sammy should take no more, absolutely no more, than four-fifths of the bottle.

Setter’s

secret homicide goes undetected.

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The days when doctors were doctors and patients were patients

Screen Shot 2016-05-06 at 13.47.45Dalrymple explains that in T.S. Eliot’s The Family Reunion (1939), Warburton

is an old-fashioned family doctor whose authority has little to do with his medical efficacy, indeed is inversely proportional to it.

Warburton is able

to order a formidable dowager duchess around like a servant. His threat to decline to treat her further is enough to bring her into line.

In Dalrymple’s copy of The Family Reunion

Screen Shot 2016-05-06 at 13.51.22I happened to find an inscription offering the book as a Christmas gift to a well-known physician who was not universally loved and who was irreverently known to his juniors by the description of the stools of some of his patients with coeliac disease, namely Pale, Bulky, and Offensive.

The signatory of the note was

another physician who, in March 1938, was a co-signatory of the letter in the British Medical Journal calling attention to the plight of Jewish and other doctors after the Anschluss.

The letter ended with the words:

We beg our colleagues in all countries to watch the progress of events with the closest attention and to do all in their power, whether by public protest or by public or private assistance, to stand by any members of our profession who may suffer hardship under the new regime.

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Why bloodletting is coming back into usage

Screen Shot 2016-05-04 at 21.01.21Mouldering on the shelves of many a secondhand bookshop, writes Dalrymple,

without much hope of ever being bought and even less of being read, are the essayistic reflections of doctors near or just after retirement.

These efforts

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.

His book

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.

Screen Shot 2016-05-05 at 07.48.56Indeed, 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.

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‘He reveals, too, how he thinks he might be tempted to consider suicide while in Cheshire, though it would never occur to him in Suffolk . . . This is a pleasant little book revealing an attractive personality.’ (from a review in the BMJ of After Consulting Hours in the year of its publication)

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

because

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.

However,

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.

Dr Howard states in a letter to a reader: 'My work lies largely among the sophisticated and the relatively well-to-do.'

Dr Howard states in a letter to a reader of his After Consulting Hours: ‘My work lies largely among the sophisticated and the relatively well-to-do.’

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,

although

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

Bloodletting device of the type probably used by Dr Howard

Bloodletting device of the type probably used by Dr Howard

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.

Screen Shot 2016-05-05 at 06.30.29Dalrymple comments:

What a pleasure it must have been to frighten people out of their wits. A real compensation for uselessness.

Alas,

evidence-based medicine will ensure that no one will ever again write After Consulting Hours.

*Member of the Royal College of Surgeons (England); Licentiate, Royal College of Physicians (London)
Bloodletting services: 104 Harley Street

Bloodletting services: 104 Harley Street, where Dr Howard practised

The questions some doctors wouldn’t dream of asking

Screen Shot 2016-05-01 at 18.15.41In John Buchan’s Sick Heart River (1941), Dalrymple explains, Sir Edward Leithen has been given a year to live by the Harley Street specialist Acton Croke.

A gas attack in the First World War has awakened tuberculosis as a delayed effect, and it is galloping through his lungs.

Although occurring only a handful of years before the discovery of streptomycin,

Sir Edward’s tuberculosis is a death sentence.

Screen Shot 2016-05-01 at 18.21.02Presumably, writes Dalrymple, Sir Edward’s tuberculosis is of the open variety, yet the appropriately named Croke

never mentions the danger of spreading it to others or shows any interest in that possibility. Was it that, in those days, certain people were so socially prominent that doctors dared not suggest to them so vulgar a matter as contagiousness?

Something similar is related in Reginald Pound’s 1967 survey Harley Street, though in this case the specialist takes a more robust approach than the general practitioner:

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94 Harley Street

94 Harley Street, where Sir James Purves-Stewart practised. Here a church dignitary consulted the neurologist about syphilis-related symptoms of paralysis affecting his palate. (94 Harley Street was once the home of Meredith Townsend, successively editor of the Friend of India, the Calcutta Times and the Spectator, and author notably of the 1901 work Asia and Europe.)

Harley Street paved with gold

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Harley Street: view from Cavendish Square

Iatrophobia is a serious medical condition (focal sepsis is very often present), though it is sometimes highly treatable — and at the very least can be managed and palliated — if the patient is constrained to undergo a colectomy and adjuvant frontal leucotomy along with inguinal orchiectomy and Metrazol-induced convulsion therapy.

The psychotic delusional condition of iatromisia, on the other hand, though it can be treated with the above methods — applied perforce with much greater intensity and with the addition of comprehensive salvage insulin coma therapy (Insulinschockbehandlung) — is sadly not so tractable.

Harley Street: view from Cavendish Square

Harley Street: view from Cavendish Square

Indeed, writes Dalrymple, carcinoma iatromisia is metastatising,

not among the general public, which on the whole retains its respect for and trust in doctors (a fact borne out by all the surveys), but among the intelligentsia — literary folk, journalists and so on.

This kind of people,

perhaps because their own crafts are held in such low public esteem, believe that doctors should be taken down a peg or two.

Harley Street: view from Cavendish Square

Harley Street: view from Cavendish Square

Dalrymple says there are two main charges against doctors, particularly hospital consultants:

  • they are on the golf course most of the time
  • they are making a fortune from their private practices

These two complaints, Dalrymple points out,

are not strictly compatible. Doctors are often quite clever people, but even they have not mastered the art of being in two places at once, and the only way of making money out of private practice is to work very hard at it. Doctors are not paid for a birdie three or an eagle two.

On the part of journalists and the literati, Dalrymple observes,

141 Harley Street

141 Harley Street

the primordial antagonism towards doctors is not fully rational: it is a little like anti-Semitism.

Jews, to the anti-Semite, are simultaneously

  • capitalist plutocrats
  • communist agitators

In the same way, doctors, to the iatromisiac, are simultaneously

  • incredibly lazy
  • ferociously avaricious
Crœsus of consultants: Thomas Horder, 1st Baron Horder, lords it over his patients in his consulting-room at 141 Harley Street. Note the photograph of Neville Chamberlain on the mantelpiece

Crœsus of consultants: Lord Horder at 141 Harley Street. Note the framed photo of Neville Chamberlain

How fortunes are made effortlessly from private practice

The golf course is to iatromisia

what ritual murder is to the anti-Semite: a myth to keep a hatred warm.

Dalrymple explains that

doctors as a group are better than many groups of comparable size.

Of his own professional circumstances he writes:

I am on duty one night in five, and have been for years. I do no private practice, apart from some medico-legal work. I never refuse to get up in the middle of the night to see a patient, and if I do get up, I still have to go to work the following morning, however tired I may feel. My pay is adequate, and I do not complain about it: my wife, who is also a doctor, and I live well but not extravagantly. Certainly, many people with less strenuous lives earn much more than we do. As far as I am aware, I have not lost a single patient through carelessness in all those years.

Harley Street looking north from Weymouth Street

Harley Street looking north from Weymouth Street

And what Dalrymple does

is only what thousands of other doctors do.

To be told that he belongs to

an avaricious, power-mad, privileged and lazy cabal by people whose prerogatives are distinctly those of the harlot sticks a little in my throat.

Dalrymple does not claim to love humanity,

Harley Street looking north from Weymouth Street

Harley Street looking north from Weymouth Street

but I do get up at 3am if I am required to do so. It is far, far easier and less demanding to write an editorial; I know because I have done both.

Iatromisia, he points out,

coheres with governments’ increasing fear of professions that escape their complete control. Disproportionate criticism of the medical profession by journalists and authors serves governments’ goal of a totally managed society.

91 Harley Street. At left, the chauffeur keeps the Bentley engine running, ready to take the consultant to the golf course or the bordello at any time of the day

91 Harley Street. Note the parked Bentley. The chauffeur keeps the engine running, ready to take the consultant to golf course, club or bordello at any time of day

91 Harley Street

91 Harley Street

13 Harley Street

13 Harley Street

Consulting-room at 13 Harley Street. Note the painting of a young Margaret Thatcher

Consulting-room at 13 Harley Street. Note the painting of a young Margaret Thatcher

73

73 Harley Street. Architect: W. Henry White

73 Harley Street. Architect: W. Henry White. The French Loire style, brick with plenty of terracotta decoration on a small, playful scale (Pevsner)

73 Harley Street. ‘The French Loire style, brick with plenty of terracotta decoration on a small, playful scale’ of which there are several specimens in and around Harley Street, ‘characterised by heavy curved door canopies, shallow bay windows, Tudor mullions and transomes, steep gables’. (Pevsner)

83 Harley Street

83 Harley Street

Fireplace in a consulting-room at 83 Harley Street. The consultant stands before it, delivers a homily — with the patient maintaining a respectful silence — on bowel regulation or the virtue of broccoli ingestion, then it’s off to the links, his club or his mistress's Belgravia flat

Fireplace in a consulting-room at 83 Harley Street. The consultant stands before it, delivers a homily — with the patient maintaining a respectful silence — on bowel regulation or the virtue of broccoli ingestion, then it’s off to see the mistress in her Belgravia flat, or else to the links or the club. Yes, life is good

88 Harley Street

88 Harley Street

88 Harley Street

88 Harley Street

92 Harley Street

92 Harley Street

92 Harley Street

92 Harley Street

Harley Street viewed from Cavendish Square

Harley Street viewed from Cavendish Square