1. VIEWS & REVIEWS
BETWEEN THE LINES Theodore Dalrymple
MEDICAL CLASSICS
Tuberculosis and genius One Fish, Two Fish, Blowfish, Blue Fish
An episode of The Simpsons
Jacobson goes on to write that the great Fox Television, 1991
external midwives of genius, especially As a medical student I was well and truly “Kübler-Rossed,”
in its literary forms, are alcohol and becoming a follower of the theory of five stages of grief outlined
tuberculosis. He does not claim that these in the 1969 book On Death and Dying. It was only some time
two factors are themselves the cause of later that I realised we were at the receiving end of an evangelical
genius, which is the throw of the genetic zeitgeist wherein conviction seemed to over-rule calmer
dice, but that, for example, “the toxins of reflection. Instead of being viewed as an important practical
tuberculosis have facilitated the creative and reflective addition to our ways of considering reactions to
serious illness and death, disciples of Elisabeth Kübler-Ross,
personalities in many notable instances,”
in their enthusiasm, often allowed the concept to assume the
including (in his opinion) Voltaire—to characteristics of dogma. Indeed in 1985 Kübler-Ross expressed
whom it also imparted his characteristic regret for having referred to them as stages, because she thought
“The toxins of tuberculosis odour, according to Madame Delaunay- that some people had come to believe that patients should
Staal, of “an embalmed corpse.” progress through the stages in a step-like manner.
have facilitated the creative No finer deflation of this inflexibility can be found than in this
Jacobson is of the opinion that the
personalities in many notable spur to creation that tuberculosis gives to early episode of The Simpsons. Homer eats some deadly fugu
instances,” including (in his the gifted is in some sense a compensa- fish, and Dr Hibbert informs him that he has only 24 hours to
opinion) Voltaire (pictured) live. In a screamingly funny sequence Dr Hibbert runs through
tion for its depredations on the human
the Kübler-Ross steps—denial, anger, fear, bargaining, and
race: “In no other disease with equally acceptance—in just under 20 seconds, gleefully ignoring
There was a time when readers had to cut extensive lesions is the psychical, and every rule of breaking bad news. Dr Hibbert, a wonderful
the pages of the books they bought, and consequently the physical, status equally characterisation of cheerful medical callousness in a tradition
real bibliophiles don’t cut the pages when exalted, or we might truly say, exalted at ranging from Sir Lancelot Spratt, through M.A.S.H., to Dr Kelso in
they find such an old book in the state in all. Potential indeed must be the driving Scrubs, also gives him a leaflet, entitled
which it was sold. To do so seems to them force which gets power out of a pitiable “So You’re Going to Die,” just as he gave
the pregnant but unmarried Marge the
almost sacrilegious, but this is to make wreck.” This is the famous “spes phthi-
leaflet “So You’ve Ruined Your Life” in
of books an object of fetish rather than a sica,” the euphoria of the dying tubercu- another episode.
tool of culture and intellect. lar patients, so well known to opera but The very casualness of the approach,
Besides, there is a satisfaction to be not so well known, apparently, to doc- the subtle reordering of the classic
had from cutting the pages with a good tors who conducted statistical surveys five stages, and Dr Hibbert’s unblinking
knife and an excitement in looking at among dying patients in sanatoriums. welcoming of Homer’s acceptance are wonderful,
a page that no one has seen before. I Written at the time of prohibition in consistent with his fantastic political incorrectness
recently experienced these joys with a the US, Jacobson’s book gives examples in another episode when he refers to Bart’s birth
as a Siamese twin. When Lisa remonstrates that they
book published in 1926, Genius: Some of writers in whom the creative impulse
prefer to be called conjoined twins, he replies,
Revaluations, by the doctor Arthur C was released, though sometimes also “And hillbillies prefer to be called ‘sons of the
Jacobson (1872-1958). destroyed, by alcohol. By prohibition, soil,’ but it ain’t gonna happen!”
Jacobson was a US doctor who “Our Kultur has razed the cathedrals of Any sensitive soul who fears that such cynical humour
practised in Brooklyn and published the mind and only the squeak of the field undermines the cause of better communication with those who
on many subjects. In 1913 he wrote mouse is heard over the ruins of our once are in serious trouble or dying definitely needs a happy meal. They
to the New York Times to suggest that mighty temples.” should in the first instance gain enormous reassurance that the
the United States followed Italy’s wise And he opposed the fashionable Kübler-Ross concept is sufficiently embedded in popular culture
to be mocked in the Simpsons—definitely a case whereby the only
course and converted disused warships eugenics of his time by pointing out
thing worse than being talked about is not being talked about.
into sanatoriums for consumptives, the how many great men had degenerate But they should also take heart in the intelligence and wit of
sea air doing them good. In 1920, dis- or drunken parents; though of course doctors and medical students: the tradition of absorbing and
satisfied with the common toothbrush, there have been many degenerate or learning from acerbic humour is of long standing, including Shaw’s
he wrote an article in the Boston Medical drunken parents who did not raise great Doctor’s Dilemma, the Doctor in the House series, and House of
and Surgical Journal that described a men or women. God. The many narratives implicit in a doctor-patient interaction
device that rinsed the teeth as it brushed, But it is the decline in tuberculosis that include that of the physician with society. Dr Julius Hibbert is now
thus improving “practical mouth embedded as one of the threads in the backdrop to this dialogue:
has perhaps had the worst cultural effect.
few will wish to follow in his footsteps, but his grinning presence
hygiene.” In 1940 Jacobson was quoted in Time: will be a caution against becoming blasé, cynical, and mechanistic
His book on genius starts with chal- “The decline in TB coincides with the with our patients—and will always raise an inner smile.
lenging words: “Ironically enough, it is decline in creative writing.” There could, Desmond O’Neill consultant physician in geriatric and stroke
in the outcast, disinherited, criminal, of course, be other reasons for our literary medicine, Dublin doneill@tcd.ie
defective, insane and generally abnor- impoverishment. Cite this as: BMJ 2011;342:d50
mal elements of humankind that genius Theodore Dalrymple is a writer and retired doctor bmj.com archive
germinates, never in the well-bred . . . Let Cite this as: BMJ 2011;342:d604 Medical Classics: The Doctor’s Dilemma (BMJ 2007;335:263)
the ‘respectable’ wince if galled by this bmj.com archive Medical Classics: Doctor in the House (BMJ 2007;334:159)
Notes on books (BMJ 1927;1:383-4) Medical Classics: House of God (BMJ 2007;334:99)
challenging truth.”
BMJ | 5 FEBRUARY 2011 | VOLUME 342 337