The trouble arises from the fact that the experts assume and presume
proprietorial rights over the bits and pieces of the physical or living
world which they happen to have studied, and about which they know a little
bit more than the rest of us.

Thus, for example, archaeologists become furious when an amateur treasure
seeker, armed with a metal detector, discovers a bunch of gold Roman amulets
half a metre below the surface of a ploughed field. They complain bitterly
that the ‘amateur’ has disrupted a site at which a skilled and careful excavation
could have revealed so much more. So archaeologists, just because they know
about archaeology, have this feeling that they, and they alone, have a right
to the discovery and handling of ancient repositories; and they ignore the
fact that, but for the enthusiastic amateur, the cache of golden relics
probably wouldn’t have been discovered at all. I suspect that astronomers
regard themselves as possessing manorial rights over the galaxies within
their ken.

But nowhere is the experts’ assumption of rights over objects and creatures
and happenings which don’t properly belong to them more apparent than in
the matter of doctors and disease. When you go to your friendly neighbourhood
gastroenterologist because you’ve been having nasty bouts of indigestion,
and when he discovers that your troubles are due to a duodenal ulcer, then
the affected patch of your digestive tract immediately becomes his property.
He will peer at it through an endoscope and show it proudly to his students.
He will slice a bit off it for a biopsy. He will dose it with drugs of his
choosing. And if it has any unusual features he may even write about it
in The Lancet. Meanwhile, your job is merely to look after it on behalf
of its new owner, and to bring it to the clinic when its presence is required,
and generally to follow its proprietor’s instructions and, of course, put
up uncomplainingly with any pain or nasty side effects of drugs which your
stewardship of the wretched thing may entail.

It’s bad enough when the doctors and the many and varied other professionals
who make their living out of dealing with the ills to which the flesh is
heir insist on taking legal and physical possession of whatever bits of
the body or mind have gone awry, but when they seek to impose their paternalistic
(or, as it might be, maternalistic) will upon people or portions of people
who or which are perfectly well, then things are going a damned sight too
far.

And that, of recent years, is what’s been happening to any woman who
becomes heavy with child. Midwives have claimed that they should be the
managers of pregnancy and delivery, with clever doctors only becoming involved
if something seems likely to go wrong. But the midwives’ desire to be in
charge has been frustrated by the fire power available to the fellows and
members of the Royal College of Obstetricians and Gynaecologists, who
insist they the top dogs of the trade, are competent to oversee a natural
happening which, previous to their evolution, had been going on for quite
some time without their aid. In the obstetrical moguls’ expert view (there
are a few honourable exceptions), a pregnant woman should be delivered
of her child in a ‘properly’ staffed and equipped obstetrical unit under
the direct control of one of their number.

This means that there’s little love lost between the midwives and their
medically qualified ‘colleagues’, for each caste regards the members of
the other as poachers. But there’s one point upon which they agree – the
manner in which the phenomenon of childbirth is handled is not the business
of the mothers. The role of mothers is to follow instructions and submit
to procedures and ‘be a good girl’. The powerlessness of the women most
closely involved in the business of parturition is even enshrined in the
law of the land. The Midwives’ Act, 1951, stipulates, among other things,
that only a certified midwife, or a midwife in training, or a doctor, is
permitted to attend a woman in childbirth except in an emergency. The Act
was designed to prevent latter-day, unqualified, and therefore potentially
dangerous Sarah Gamps from muscling in on the midwives’ trade, but has been
used more than once to prosecute loving husbands who have delivered their
wives of a baby in the privacy of their own homes because the said wives,
showing spirit, had refused to submit themselves to the manipulations of
the obstetrical mafia. Talk about Big Brother . . .

But things are looking up. Last year a Commons select committee deplored
the extent to which the experts had turned a normal and natural event into
a technocrats’ jamboree and stated that giving birth in hospital is often
a degrading experience. Thus prodded, the Department of Health has been
reviewing the obstetrical scene and now proposes to give pregnant women
a better deal. They will have a ‘personal’ midwife and much more opportunity
to give birth at home or to choose a hospital and to say who they want to
manage the event. They’ll keep their own case notes and be given proper
information about any mooted medical interventions. In short, they’ll be
in charge.

The obstetricians aren’t going to like it. But if they’d been less possessive
about other people’s pregnancies in the first place there’d have been no
need for the politicians to interfere.

Roy Calne, the famous liver-swap king of the University of Cambridge and
Adden-brooke’s Hospital, has told the Cambridge Evening News that the next
ten years could see surgeons transplanting all kinds of tissues as new ways
of controlling infection and rejection are developed. He is quoted as saying
that ‘There will be great excitement if gonads, testicles or ovaries were
transplanted. That would provide a great talking point for philosophers and
everybody in the world – but it is not something that is an ambition of
³¾¾±²Ô±ð.’

That tacked-on disclaimer may seem to provide some slight comfort to those
of us who view with apprehension the rapidly increasing ability and
eagerness of various kinds of scientists to manipulate and modify and
‘improve’ all manner of organisms, from oil seed rape to Homo sap. But it
is the sort of disclaimer which might well be subject to modification at
some future date under the influence of the market forces which are
increasingly influen-cing what labourers within the vineyard of the National
Health Service do or don’t do. In any case, it only puts Calne himself out
of the race to be the first clever doctor to burden the body of some
unfortunate man or woman with a set of alien germ cells. There are, and will
always be, plenty of other skilled and, indeed, semiskilled surgeons around
the globe who will be only too happy to exploit the latest surgical
conjuring trick for the sake of a little passing professional or popular
fame, or just to earn a few extra bucks.

The brute fact of the matter is that once something can be done within the
realms of science and technology, then somebody will set out to do it,
however dubious any justification for the exercise may be (nuclear bombs
come to mind), and surgeons are peculiarly susceptible to this
‘can-do-therefore-must-do’ proclivity. This is because for some time now
surgeons have been desperately striving to sustain for their craft and
themselves an importance on the medical scene comparable to that which they
enjoyed sixty and more years ago.

Physicians have always considered themselves to be the patricians of the
medical profession, far superior to the vulgar sawbones, the successors to
the barber-surgeons. But, in truth, once the technique of using chloroform
had been learned, and once Lord Lister had introduced his newfangled
antiseptic routine, the surgeons rapidly became the most effective members
of the healing trade.

At the start of this century the physician was a skilled diagnostician, but
the truly useful remedies he had at his command were pitifully few. He could
give quinine for malaria, morphine for pain, digitalis for a failing heart,
aspirin for fever, amyl nitrite for angina, mercury for syphilis, an
antitoxin for diphtheria, but precious little else.

His surgical colleagues, on the other hand, could save lives by treating
wounds with germicides, or by amputating damaged and gangrenous limbs. They
could take out an inflamed appendix and drain pus from an infected mastoid
or abdomen or chest. They could remove certain cancers (albeit not with much
chance of working a cure), repair hernias, deal with broken bones, and
otherwise ease physical distress. Surgical resection of the chest wall to
collapse a lung became a widely used if questionable technique for treating
tuberculosis.

Then came the therapeutic revolution. Life-threatening infections for which
surgery had often been the only hopeful therapy became easily curable by the
use of, first, the sulphonamides, and then penicillin and a rapidly growing
range of powerful antibacterial drugs. And as time went by many more
patients suffering from erstwhile ‘surgical’ conditions became the
responsibility of physicians instead. Thus, for example, the development of
H₂ blockers and other anti-ulcer drugs has virtually seen the end of the
once common surgical emergency of a perforated peptic ulcer and the equally
common but more leisurely removal of patches of ulcerated stomach or
duodenum. And so on, and so on.

Poor surgeons. While never, perhaps, in danger of becoming redundant, they
certainly faced the threat of serious underemployment and a significant
thinning of their ranks, with a consequential diminution of their collective
power and influence.

Unless, that is, they could rapidly devise new uses for their laboriously
acquired anatomical learning and manipulative skills. Which is, of course,
exactly what they did. Some of their new adventures, like open-heart surgery
and hip replacements, have proved outstandingly successful and have come as
a boon and a blessing to men, ‘just like the Pickwick, the Owl and the
Waverley pen’ – as the old advertising jingle claimed. Others, such as
heroic heart and lung and liver transplants, or the slicing up of brains in
an attempt to cure unhappiness or strange behaviour, have been of less
certain benefit to the race.

It is certain that advances in medical science will continue to make many
currently useful surgical exercises obsolete, so that surgeons will always
be searching for new conjuring tricks to add to their repertoire. But will
the pioneers of new techniques choose their targets wisely and well?

It seems to me that all manner of scientists and technologists, and not just
surgeons, should have a generous slice of their training devoted to ethics,
economics, sociology and philosophy, so that, during their working lives,
they will be in a position to ask themselves not just ‘Can it be done?’ but,
also,’Should it be done?’

Donald Gould is a past editor of 91av.

Some have, of course. When I was a lad, High Street grocery stores of the
better, or, at any rate, more expensive kind, used to have great
coffee-grinding machines in their windows. They were grand structures,
commonly enamelled red with gold piping. At the top was a large glass jar to
hold the newly roasted beans. And then came the grinding bit, ennobled by a
fascinatingly naked belt drive connecting a big wheel on the shaft of the
mill to a little wheel on the shaft of a hefty electric motor at the
instrument’s base. And there was a slide-in-slide-out catch-pan to collect
the freshly minted grounds so that they could be poured into pleasant paper
bags of a kind which we now only see holding flour and sugar.

It was good fun to watch and, better still, wonderful to smell. The aroma of
the new-ground coffee spilt out onto the pavement and must have tempted many
a passer-by with a shilling or two in their pouch to step inside a grocery
store they might otherwise have ignored.

Bakers’ shops – real ones where the loaves, rolls, cakes and tarts were made
on the premises instead of being imported from some distant automated
production line – wafted out the same aromatic bait.

But these seductive scents were a fortunate and fortuitous by-product of the
honest toil of the tradesfolk concerned, and not a sales gimmick dreamed up
by foxy marketing consultants. Now, however according to a report in a
recent issue of The Sunday Times, all manner of smells are being injected
into the air of shops because the experts have discovered that the right
kind of aroma can significantly boost the urge to buy.

It would seem that the technique was pioneered in Japan, where it has become
big business, and that it is being tested in Britain by a company called
Marketing Aromatics which is carrying out ‘secret’ trials in over 100
British stores. Apparently supermarkets in this country cottoned on to the
wheeze (at least in principle) some time ago. Realising that they had a
valuable commodity in the aromas created by their in-store bakeries they
have been blowing the bakery air down the aisles to whet their customers’
appetites for all the tasty morsels on show. But this no more than an
intelligent exploitation of an ancient and widely recognised High Street
phenomenon.

The new smell-sell technology takes matters a good deal further by
introducing scents which have nothing to do with the actual goings on
within the store concerned, but which are designed to excite and heighten
interest in the goods on sale. Thus the odour of coconut oil in travel
agencies to get the punters eager for fun in the sun, the fragrance of cut
grass in greengrocers to give customers that summery feeling and a hankering
for fruits and salads to be enjoyed alfresco, and in car showrooms the whiff
of leather to suggest a quality the vehicles on offer probably don’t
possess.

The scientific adviser to Marketing Aromatics is a George Dodd, director of
the Institute of Olfactory Research at the University of Warwick’s science
park. According to The Sunday Times, he believes that smell can affect
people’s moods and emotions. ‘It is a very exciting time. Smells have
enormous potential to influence behaviour.’ Well, as I’ve already said, I’m
just surprised that the power of smells has not been heavily exploited for
years. Smell is a sense which has long been known to play a central and
essential role in the lives and activities of all manner of birds and
beasts.

Salmon return to the precise patch of fresh water in which they began life,
after spending years many miles away at sea. They can do this because the
brains of the baby fish are imprinted by the unique cocktail of odours
generated by the animal, vegetable and mineral components of their nursery.

Mouthbreeders – fish which hold eggs and young in their mouths – are able to
distinguish their own offspring from those of their fishy mates by smell.
Agitated fish (and tadpoles) produce a warning odour or Schreckstoff
(‘fright substance’) which, even at extremely low concentrations, causes
members of their own species to flee the danger area. Almost all mammals use
marking scents to define their private plots. Sheep recognise members of
their own flock by smell. When male rhesus monkeys have their nostrils
blocked they show no interest in females on heat. And so on.

The part of the brain that handles signals from the smell nerves has a
powerful influence over the activity of the autonomic nervous system and
over the emotions. And what about we human beings? G. K. Chesterton
celebrated The Noselessness of Man in immortal verse, and we may, indeed,
have come to depend rather less upon the sense of smell than most of our
fellow living creatures on this Earth. But we are almost certainly
influenced by the messages picked up by our noses to a far greater extent
than we appreciate.

Strawberries require some 35 chemicals for their glorious aroma. If a berry
is crushed a few of those alter form, and the human nose easily detects the
consequent and subtle change of scent. Not bad for an organ which we tend to
regard as obsolete.

So never mind about using smells to boost the sales of biscuits. I look
forward to the day when we can spray sweet pacifying scents over
battlefields in place of nerve gas and napalm.

Donald Gould is a former editor of 91av.

Somewhere in Britain (unless they’ve already fled by ship or plane
to elsewhere) there are two or three or four almost certainly young or fairly
young people who mindlessly but cunningly planted the bombs which killed
those boys in Warrington, but who still, presumably, manage to make themselves
toast for breakfast at each new dawn, to wash down the food with tea, to
enjoy a satisfactory visit to the loo, to look both ways before crossing
the road, and, in every other way to go on living pretty ordinary lives
just like the rest of us.

So how do they feel in their lodgings, as they swallow their meals,
read what the papers have to say about the world in general and their own
brave exploit in particular, listen to music, make love, fret about an annoying
itch between the toes, sit in the launderette waiting for their dirty linen
to come clean, and toss back the last pint of the evening in some pub? How
do they feel about the two young boys who are now dead, and will enjoy nothing
of what they enjoy, or suffer anything of what they may suffer, because
they are beyond all joy and all suffering, and because these two or three
or four young Irish ‘ patriots’ have made them dead?

How do they feel these ‘patriots’ these ‘freedom fighters’?

Paul Magee, another IRA hero, sentenced a week or so ago to a recommended
minimum of 30 years in gaol for the murder of a special constable, and with
other murders and attempted murders to his credit, made a V for victory
sign as he left the dock. Did he really see himself as a champion of justice,
virtue and the truth, condemned to durance vile by a brutal oppressor because
of his soldierly destruction of a member of the enemy army? Did that V-sign
mean that he felt that his homicidal habit was justified, and that, partly
as a consequence of his own willingness to kill, right would eventually
triumph over wrong? The day after Magee was sentenced, a young man called
Benjamin Laing was sent to prison for a recommended minimum term of 25 years
for shooting dead a half-blind retired man and then torturing, raping and
finally strangling the daughter of the house. In Laing’s case no kind of
warped ideology lay behind the violence. He had carefully planned what he
fondly imagined to be the ‘perfect murder’, including dismemberment and
burial of the bodies, simply in order to steal. He, too, raised two fingers
as he left the dock this time not to indicate a Churchillian commitment
to eventual victory for his ’cause’, but as a contemptuous response to a
benediction (‘I hope you rot in hell, you bastard’) shouted from the public
gallery.

Then a young Palestinian recently stabbed a Jewish immigrant to death
in the Israeli town of Afula and later sought to explain his deed by saying
he had felt frustrated because of failing his exams.

Why are human animals (mostly male) so ready to slaughter one another?
Polar bears kill baby seals in order to eat them for breakfast, which is
reasonable enough. Kestrels murder voles for the same reason. And, following
the example of some of the fiercer birds of the air and some of the more
aggressive beasts of the field, we slaughter cows, pigs, chickens, plaice,
trout and many another living creature to feed ourselves, or, sometimes,
just for fun.

In the ordinary way of things, polar bears don’t kill other polar bears
and kestrels don’t dive-bomb other kestrels for fun. Most species attempt
to organise themselves for the benefit of their clan. It is true that birds
of a feather and beasts of a kind don’t always display your actual tender,
loving care toward other members of their tribe. Take, for example, those
apparently charming little robin redbreasts. These pretty lads are fiercely
protective of their territory, and will tweet the most horrible of birdy
oaths at an intruder, and fights between contestants for a patch may even
be to the death. So members of other species do sometimes kill one another,
but not very often, and when they do it’s for a pretty good reason such
as personal survival or the better propagation of an individual’s precious
genes.

But we human animals do it all the time, and have done since the beginnings
of recorded history, and probably long before that, and often on a massive
and indiscriminate scale, and often when no proportionate advantage could
be expected to accrue to the perpetrators of the violence save for the relief
of some unarticulated disturbance of the emotions, often rationalised by
a declared devotion to a religious faith, or a tribal flag, or some other
abstraction of the mind.

Why do we do it?

Britain’s Prime Minister has recently and famously declared that when
it comes to dealing with the evildoers in society we should be prepared
‘to condemn more and understand less’.

Rubbish. If only we could discover what combinations of genetic, neurological,
hormonal and other bodily mechanisms make some people good and some people
bad, then we might be able to provide prophylactics against and cures
for wickedness.

The moralists and clerics haven’t done too well so far. Perhaps it’s
time for natural scientists to have a go.

Donald Gould is a former editor of 91av.

You see, my large and excellent dictionary gives its first definition
of ‘professor’ as ‘a teacher of the highest academic rank in a college or
university, who has been awarded the title Professor in a particular branch
of learning . . .’

Definition number two? ‘Any teacher who has the rank of professor, associate
professor, or assistant professor.’ (If you are streetwise, that last quotation
may have led you to suspect that my dictionary is an American publication.
And so it is. The Random House Dictionary of the English Language is one
of the finest tools for the jobbing journalist I have ever come across.
I bought my copy some twenty years ago, and I just hope they are still at
it.)

And definition number three? Very short and simple. ‘A teacher,’ it
says.

There are a couple more uses of the noun described. It can apply to
‘an instructor in some art or skilled sport: a professor of singing; a professor
of boxing’. Or, scraping the barrel in search of the last possible employment
of the word, it can be hung around the neck of ‘a person who professes his
sentiments, beliefs, etc’. Which description, I suppose, fits all of us
– at least from time to time – so we can all call ourselves professors.

But my point is this – those clever American lexicographers define a
professor not primarily as a revered scholar and practitioner of some academic
discipline, steeped in special skills and learning, and honoured with the
title for such cause, but as someone who, whilst (presumably) having at
least a grasp of the basic elements of a subject, has the principal function
of teaching it to others.

Now then, how many of the professors littering the faculty boards and
senates of our newly multiplied ‘universities’ have achieved their status
by virtue of a teaching skill? Not one, I should not wonder.

That is not to claim that none of them is happily blessed with a natural
talent to enthuse and inform young minds. But if it does happen that the
head and director of a university department, and supposed inspirer of
students and subordinates, turns out to be a half-decent teacher and team
leader, then that is, indeed, a matter of sheer luck.

Look what goes on in medicine. Among the more serious shortcomings of
this proudly ‘self-regulating’ profession is the manner in which it fails
to train its neophytes in a manner appropriate to the functions they are
going to be called upon to fulfil.

Medical students emerge from five years of ridiculously stressful rote
learning, addle-brained, having been force-fed a superfluity of largely
irrelevant and eminently forgettable ‘facts’, but with small understanding
of how they were discovered in the first place, or how to garner and evaluate
evidence and information for themselves, and never mind the small matter
of how to establish a mutually beneficial relationship with their patients.
Newborn from the womb of their medical ‘school’, they are not much use as
doctors, and only begin, slowly and painfully, to learn their craft ‘on
the job’, and after they have ‘qualified’.

But that is what happens when you give experts in one field of endeavour
(such as diagnosing and treating heart disease) dominance over another
(like education) which they do not understand and may not even care about
very much.

If first-class honours geography graduates decide they would like to
teach their subject to ten-year-olds, they must go away for a year and get
themselves a postgraduate certificate in education before anybody will regard
them as fitted for the job. Yet it is assumed that physiologists, neurologists,
biochemists or heart surgeons, just because they know their subject well,
can stroll into the lecture room, ward or laboratory and make a proper job
of passing on wisdom and learning.

This nonsense is not, of course, specific to the sadly misnomered ‘education’
of doctors. If our brilliant young geographers choose to stay within the
cosy confines of their university, instead of venturing forth into the rough
and real world of the primary school and comprehensive, they may well become
assistant lecturers, and then lecturers, and then senior lecturers, and
then readers, and, finally perhaps, professors, without anybody ever having
bothered to consider whether they have the smallest idea of how to teach.

Of course universities need to have innovative and productive scholars
and researchers on board because the advancement of knowledge is half of
what they are all about. But they also need a decent complement of accomplished
tutors in the crew, because the advanced instruction of the young (including
introducing initiates to the techniques of learning for themselves) is
the second half of what they are all about.

So I propose the creation of two quite separate categories of labourers
in the higher-education vineyard – the professors and the savants; the teachers
and the doers. The young academic would start a university career as a
probationary assistant-savant (or ‘professor’, as the case might be), and
the successful would finally achieve the full, unmodified, rank and title
of savant or professor – of his or her caste.

But, those ‘teachers’ able to demonstrate an additional excellence in
scholarship or research, and those ‘doers’ who manage to acquire effective
teaching skills, would be admitted to the glorious company of a third and
highly honoured genus called ‘professor-savants’. And, of course, professor-savants
of all grades would earn double pay. It would not cost that much; there
wouldn’t be that many of them.

The idea struck me recently that it would be an excellent idea if New
Scientist were to provide the much needed services of its very own agony
aunt. Just imagine it, week in, week out Dr Anna Lyser would make her wisdom
and experience available to one and all who sought her help. She would,
of course, be a sociologist, and so would know far more about people than
they know about themselves, and her diagnoses and prescriptions could thus
be relied upon entirely. So here, then, are a few examples of the kind
of worries which anxious readers might reveal to our very own Dr Anna Lyser.

Worried, Cambridge writes: ‘I am a brilliant young astrophysicist (or
so my girlfriend says – the ‘brilliant’ bit I mean – I do know I’m an astrophysicist
without her having to tell me), and I love my work and wouldn’t want to
change jobs. But it doesn’t pay very well, and I want to get married to
my nice girlfriend, and buy quite a big house and have some clever children
and send them to private schools. And I would like to own a nice car and
I would quite like to have a few good paintings by artists like the late
Mr Picasso and that mad chap who chopped off his ear. I believe they cost
quite a lot of money, and you can’t get very far on a university lecturer’s
salary these days, can you? What should I do?’

DAL replies: ‘Write a book about the Universe, dear. Give it a sufficiently
jazzy title and then what’s inside won’t matter. Might I suggest something
like How God Made God. After that you can rabbit on for the necessary number
of pages with all your fancy little theories, and you won’t even have to
bother to write in terms which your average punter can understand, because
by that time it won’t matter, will it? They’ll have bought the book and
you’ll have earned your royalties. It’s the title that counts. Never mind
the contents. You should be able to afford your first van Gogh (the one
who chopped off his ear, dear) within about a couple of years. Good luck!

Excited, Slough, asserts: ‘I’ve had a frightfully good idea for a machine.
I was watching some potatoes boiling on the hob the other day when I noticed
how the steam kept lifting the lid of the saucepan. It immediately occurred
to me that it might be possible to use the power of steam to drive some
kind of engine. Can you tell me how I should go about exploiting this brilliant
·É³ó±ð±ð³ú±ð?’

DAL responds: ‘It’s been done, dear. Sorry!’

Frustrated, Westminster bemoans: ‘I am a fully qualified chemist and
a woman. Nevertheless, some 40-plus years ago, and despite my sex, I was
rapidly making a name for myself as the brains behind the formula for a
fantastic new line in ice cream desserts. But I was young and inexperienced
and, perhaps, a teeny-weeny bit overambitious. So what did I do?

‘I kicked over the traces, and abandoned my promising career in science,
and qualified as a lawyer, and entered the wild world of politics. For
a long time things went jolly well, and I rose steadily through the ranks
of my chosen party to become a very important person indeed. In fact, for
more than 10 years I was by far the most important person in Britain, if
not the world.

‘Then, suddenly, everything went terribly wrong. My fantastic achievements
and worldwide popularity had made my closest colleagues so frightfully jealous
that they hatched a despicable plot and got me thrown out of my job, since
when I’ve been desperately searching for a role consistent with my exceptional
abilities and powers of leadership. What can you suggest? I’ve got a BSc.
(Oh, and I’m also an FRS–although I’m not quite sure whether I was elected
because of my seminal work on ice cream technology or just because I used
to be such a very important person. Either way, it looks good in my CV.)
Do you think that, with my qualifications and background, I could renew
my once-promising career in science, and perhaps get to give the Royal Institution
Christmas Lectures, or win a Nobel prize, or manage one of the other things
(such as presenting The Sky at Night) which make some scientists much loved
and famous?’

DAL analyses: ‘The fact that you already have an FRS would certainly
give you a flying start should you decide to attempt a comeback in the
world of science. However, despite your nom de plume I think I can guess
who you really are, and if I’m right I fear you might find yourself not
quite so popular among your new colleagues as might be wished. I’m afraid
that, rightly or wrongly, quite a few senior scientists reckon that when
you were C-in-C you rather sold their lot down the river. And you wouldn’t
want to go through yet another peer group bust-up, would you? Perhaps you’d
be wiser just to stick to the international lecture circuit, which, I understand,
is paying you pretty well.’

Donald Gould is a former editor of 91av, now contemplating
a career as ‘Agonising of Landbeach’

I only know all this because he was recently pictured, white coat, dangling
stethoscope and all, in a full-page colour advertisement in one of those
vacuous magazines which arrive, uninvited, with the Saturday or Sunday papers.
The portrait of the good physician decorates a text proclaiming the virtues
of a certain desktop electronic filing system. ‘Every minute counts here,’
proclaims Dr Tony. ‘If a question comes up about a patient, I can raise
their file immediately on the xxxxx (system)’.

Now, I am not in immediate need of a desktop electronic filing system
because, like Sherlock Holmes, I already have ‘my methods’. I use cardboard
boxes in which to store my precious documents, and when I wish to retrieve
any information which I vaguely remember having so preserved I can quite
often (well, sometimes) do so. Mind you, it might take quite a while. Just
how much of a while is largely a matter of luck, and depends on whether
the box containing the desired piece of paper is among the first or the
last of my cardboard memory banks to be ‘scanned’. However, placed here
at the edge of the quiet Fens, and in contrast to the situation faced by
the director of the Bone Marrow Transplant Unit at University College Hospital,
I don’t find that ‘every minute counts’.

This being so I might well have passed over, with barely a glance, an
advertisement for a machine that I do not lust after and certainly could
not afford. But no – that picture of Goldstone set me thinking.

Take the matter of the uniform – the long white coat and dangling stethoscope.
In the good old days, top doctors never wore white coats. They wore black
frock coats, just like politicians, usurers, successful grocers and similar
members of their caste. And if they were surgeons of the Joseph Lister
era, they even operated in the things. Not smart ones, of course, but castoffs
which had passed their polite society ‘wear-by’ date.

The late Lord Lister is rightly venerated for his recognition of the
fact that Louis Pasteur’s new-fangled germ theory of disease might not be
unrelated to the tiresome manner in which so many clients died within hours
or days of their operations, and he achieved a dramatic reduction in his
own post-operative mortality figures by the liberal use of swabs and sprays
of carbolic acid, which, by great good fortune, proved capable of destroying
the suspected miasmic animalcules without doing in the patient or staff.

It took a little longer for the idea to sink in that it might be better
to attempt to stop nasty germs entering the body beautiful in the first
place instead of trying to evict the rotten beasts after they had sneaked
in. But once this brilliant wheeze had taken hold, what a transformation.
Hygeia became queen. Suddenly everything had to be squeaky clean. Nurses
were court-martialled when matrons found traces of fluff under a bed. Hospital
corridor floors shone with the luminescence of endlessly polished wax. Hands
were washed and nails scrubbed ten times an hour. Theatre staff donned gowns
and masks and gloves and caps. And doctors patrolled their wards and presided
over their clinics clad not in exquisitely tailored worsted jackets, but
long, white cotton coats.

I suspect, however, that the long white coats were donned to protect
the wearer rather than the client. It would not do to enter your club in
London’s Pall Mall at the day’s end wearing a jacket which had been splashed
by undesirable substances.

However that may be, the white coat rapidly became a status symbol.
When I was a lad at St Thomas’s Hospital we medical students did not wear
a white coat at all. The more junior house surgeons and house physicians
were allowed a short white jacket. But only registrars and consultants could
parade in the full-length article. We humble students were required to
wear white coats in the dissecting room, but, would you believe it, these
coats had to be fitted with green lapels so that nobody would mistake us
for proper, grown-up doctors.

We did, however, all wear stethoscopes. In my student days it was a
real tool of the trade, and proud was the day when we moved from the preclinical
kindergarten, and began to walk the wards, and acquired a stethoscope of
our very own. The murmurs and rumbles and whistles and crackles and sighs
and thumps to be heard through the magic tubes did, indeed, offer valuable
clues as to the fashion in which the engines of the body (the noisier ones,
anyhow) were functioning. But today? Today all is done much more certainly
by a wondrous range of probing and analytical machines. So why are stethoscopes
still worn? Well, they are still an important badge, aren’t they? Just like
the white coats, having a stethoscope dangling from the neck signals the
fact that you are a doctor. The point is, the white coat alone may not always
be quite enough but a stethoscope draped round the neck settles the matter.

So thank you Tony Goldstone for inspiring me to contemplate such matters,
and I hope you enjoy a profitable and ongoing relationship with your desktop
electronic filing system.

Donald Gould is a former editor of 91av.

None of these things has happened. Why not? I have often wondered, but
now I know. I am a victim of mercury poisoning.

It was a brief item printed recently in this very journal which put
me on to it. Headed ‘Danger for dentists’ (In Brief, 21 November), it described
how researchers at the National University of Singapore discovered that
dentists who use mercury in making pastes to fill up holes in teeth, and
who are thus exposed to very low levels of mercury vapour, are 14 per cent
more stupid (judged by ‘tests of mental ability’) than ‘a group of controls’.

The trouble is that the item did not identify the nature of the ‘controls’.
Were they well-matched? Were they, perhaps, fellow toothwrights of the same
age and sex and height and hair style and taste in music as their disadvantaged
colleagues, but who, on ideological or religious grounds, have always rigorously
avoided the use of mercury in their filling pastes? Or were they just a
bunch of citizens, picked at random from the city streets? You can imagine
the scene: ‘Excuse me, sir, I wonder whether you could kindly spare a few
minutes to undergo a simple mental ability test so that we can see whether
you’re brighter than the average dentist?’ Not having this vital information
l cannot feel confident that the Singapore researchers have made their
case. Is mercury truly to blame for the unhappy toothwrights’ cerebral deficit,
or could it be that dentists as a caste are a bit dimmer than their fellow
citizens from the word go, with their unfortunate proclivity for inhaling
noxious vapours having damn-all to do with it?

But no, that cannot possibly be so. You have to be a good deal brighter
than average, not 14 per cent more stupid, even to get a place in a dental
school, let alone pass all those dreadful exams. And, in any case, I am
sure that investigators at the National University of Singapore would be
quite incapable of shoddy work. So I believe them. And that is why I can
now understand my failure to fulfil my father’s cherished ambitions for
my role in the advancement of civilisation and the salvation of humankind.

You see, l was bathed in mercury vapour during my formative years. It
started in the physics lab at school where we used gallons of the seductive
metal, notably in setting up barometers made with a beaker and a length
of glass tubing. Of course we spilt generous dollops of the stuff all over
the benches and the floor, and had the greatest fun chasing the droplets
around and shepherding them into a single, satisfying glob, which was most
easily salvaged by sucking it up into a pipette. And we would nick a little
in a test tube in order to have something to play with during prep.

Then, at medical school, things got even worse. We spent many miserable
hours in the physiology lab struggling with a fiendish gas-analysis machine
invented by the Great and Good J. S. Haldane around the turn of the century.
Use of this horrible device involved pushing and sucking a sample of expired
air through a system of tubes and taps and reservoirs charged with appropriate
absorbents (caustic soda and a black witches’ brew called pyrogallol) so
that first carbon dioxide and then oxygen were removed from the mix. Checking
the reduction in the volume of your sample following each step in this tedious
manipulation gave you, in theory, a measure of the composition of your sample.
An hour’s devotion to this task would frequently yield a result which,
with any luck, was no more than 50 per cent awry from the truth.

And how was this amazing Haldane gas machine powered? Why, by mercury,
of course. It had a half-pint-sized glass goblet which you filled with the
silver poison, and this was attached by a length of pressure tubing to one
of the spouts of the machine. By lifting or lowering this primitive engine
and fiddling with the taps you either puffed or sucked at your sample in
a manner which drove it in the desired direction, or you sucked the pyrogallol
into the caustic soda solution, or vice versa, and had to spend the next
hour cleaning the whole thing out and starting again from scratch. And,
of course, there was mercury all over the place. I never did understand
how forcing us to struggle with this ghastly instrument was supposed to
equip us for the demanding task of serving the sick, but my discontent
would have been mightily reinforced had I realised that we were not only
squandering some of youth’s short and precious hours on sterile play, but
also helping to ensure for ourselves a professional lifetime playing in
the second division.

Well, the baneful effects of my early exposure to mercury vapour at,
I would guess, higher concentrations than any encountered by your average
jobbing toothwright) may have denied me the high honours and achievements
which my dear old dad had planned on my behalf, but thinking about it all
has led me to a great discovery.

Why do we have C. P. Snow’s ‘two cultures’? Why are the corridors of
power and the conclaves of the great and the good littered with historians,
classicists, economists, social scientists and lawyers and the like, with
scarcely a physicist or biologist or chemist or doctor or engineer to be
seen? It must be because arts people, when tender students, breathe the
safe air of libraries and similar musty but unreactive spaces, whereas laboratory-centred
pupils are exposed to all manner of powerful neurotoxins.

Sniffing in all that mercury as a lad may have left me a bit stupid,
but not so stupid that I cannot work that one out.

Donald Gould is a former editor of 91av and was Briefly a Professor
of physiology at the National University of Signapore when it was the University
of Malaya (Singapore).

This is not a quote from one of the numerous articles spawned by last
month’s report from Sir Bernard Tomlinson on the desirable future shape
of London’s health services. It is the opening paragraph of a piece I wrote
for the dear old New Statesman way back in 1976. Even in those days, the
need to do something about the irrational and inefficient pattern of the
capital’s medical edifice was well recognised. A concentration of great
teaching hospitals (a dozen of them, when there were then only 24 in the
entire kingdom) sat heavily on top of a system of primary care which was
often appalling, with a high proportion of residents dependent for their
immediate medical needs upon the services of lone practitioners operating
from ill-equipped lock-up surgeries sited in erstwhile shops in run-down
streets.

Wendy Savage, the eminent obstetrician and iconoclast, recently told
me that when she was a student in the late 1950s at the London Hospital
in Whitechapel, the consultants hardly knew the names of the local GPs,
and when they did it was only to complain how frightful they were. ‘I’ve
never forgotten a doctor with a lock-up shop in Cable Street. He used to
go in for an hour, then all his patients would turn up in casualty with
notes on bits of lavatory paper just saying ‘Please see and treat’,’ she
recalls.

‘One day he sent up a man with cellulitis who had a huge abscess in
his forearm which should never have been allowed to develop. Well, enough
was enough. The creature was incompetent. Then we discovered that he had
a private practice in Harley Street which he went to after his hour’s stint
for the NHS. So we began to ring him up there every time we saw one of his
patients and say ‘Thank you so much, doctor, for referring this interesting
case – we’ve done this, this and this.’ After a week we didn’t have another
case from him. He sent them all to Poplar.’

She also recalls a note which came with a patient who had been seen
by a doctor who was doing a locum in a similar practice which read ‘I’m
sorry for referring this patient to you, but in this surgery there’s a desk
and a chair and nothing else.’

So there it was. The excellent jostling with the abysmal. The enthusiastic
and the costly needlessly wasting skills and resources on tasks sloughed
off by the demoralised and cheap. The members of a profession supposed
to be acting in concert for the commonwealth divided into two halves not
just failing to cooperate, but actively antagonistic.

Why? One answer seemed to be that far too large a slice of the money
available for health care was being poured into the insatiable stomachs
of the hospital whiz kids so that they were able to enjoy the support, environment
and equipment needed for doing a good and satisfying job. This left far
too little for enabling family doctors – the front-line soldiers – to exercise
their hard and expensively won skills to the best effect. As a result of
this imbalance, too many inner-city loners, lacking an even half-decent
workplace, the proper tools of their trade and any kind of help, quickly
lost heart and drifted into evil ways, while their customers and their friendly
neighbourhood hospitals carried the can.

The remedy being canvassed at the time I wrote my piece was a substantial
reslicing of London’s share of the NHS cake. There were too many chiefs
and not enough Indians – at least, not enough Indians well- armed with tomahawks
and arrows. But the money to pay for putting the Indians on a war footing
would have to come from the budgets of the chiefs. Either they could all
be forced to do with less or, better perhaps, get rid of some of them altogether.
Even close whole hospitals.

Shock horror! What! Close down St Thomas’? What! Shut up Bart’s? The
mere suggestion provoked outraged disbelief and a torrent of declarations
that any such vandalism would presage The End of British Medicine As We
Know It.

Of course, nothing happened.

Four years later, the distinguished physicist Lord Flowers headed a
working party on the future of the London teaching hospitals. Once again
the superfluity of hospitals was deplored. It was recommended that the Westminster
Hospital Medical School should close, and that this large and relatively
new structure and centre of medical excellence should be reduced to the
status of a ‘cottage hospital’, retaining perhaps 300 beds for the continuing
care and comfort of the locals. And that all its glamour and expertise should
be sent across the river to St Thomas’.

Of course, nothing happened.

And now, here we go again. Sir Bernard wants to close 10 London hospitals
including such sacred Aesculapian temples as Bart’s and the Charing Cross
and Queen Charlotte’s. He wants Thomas’ and Guy’s, and the Middlesex and
University College Hospital to merge – physically, and not just in name
and administration. And his axe threatens other hallowed institutions. But
he wants the money saved and gained from site sales to be ploughed back
into a well-funded system of efficient community care.

Will anything happen this time?

Our caring and far-sighted government seems to enjoy the prospect of
saving and making money from closures and sales but is shy about promising
to use the profits to make community care the principal instrument of health
improvement and sickness relief, which is the whole point of Sir Bernard’s
admirable, if painful, plan.

I shall be particularly sorry if the recommendation that eight of London’s
medical schools should be detached from their teaching hospitals and placed
instead in the care of the University of London’s four multifaculty colleges
is ignored. Such a move would greatly improve the prospect of our future
doctors being educated instead of simply being ‘trained’. Ah well! This
time something may happen. But I suspect the result will be a dogs’ dinner.

The NHS is a precious and wondrous institution, but what a pity that
its fate and shape is in the hands of politicians instead of people like
Sir Bernard who really know what doctoring ought to be all about.

I’d like the NHS to become a public corporation, nominally independent
of the government, rather like the BBC. But, then, look what’s happening
to the BBC.

In Britain there are almost as many men and women making a decent and
often a rich living out of the practice of irrational, unscientific, healing
techniques as there are family doctors dispensing pukka ‘laboratory tested’,
logical therapies and cures. More-over, a fair sprinkling of registered
medical practitioners are using homeopathy, osteopathy, acupuncture, the
laying on of hands, and other treatments of a kind that do not figure in
the medical curriculum. At the same time they are making use of the pills,
potions and manipulations which they have been taught to regard as the proper
tools of their trade. Millions of citizens also seek to sustain or recover
ebullient wellbeing by swallowing a wide range of over-the-counter remedies
and ‘health’ foods and supplements or by wearing copper bangles, or by prodding
themselves with state-of-the art, electronically controlled, acupuncture
sets.

Why? Shouldn’t the powerful therapeutic weapons now avail-able to doctors,
the increasingly scientific nature of medical practice, and the emergence
of a vastly better informed and educated public, have brought traditional
and fanciful regimens into disrepute, leaving them to their place in history
as relics of when effective therapies were scant, and any promise of a cure
seemed worth a try?

The opposite has happened. The vendors of alternative therapies are
flourishing today as never before. Why?

Well, by the time you’ve finished reading American Health Quackery,
you’ll have discovered a catalogue of persuasive explanations for this apparent
paradox.

James Harvey Young is emeritus professor of American Social History
at Emory University, and has been fascinated by quackery over the course
of a working lifetime. His new book is a collection of his writings on the
subject penned during the past 25 years, and is therefore inevitably somewhat
repetitious. But it is never boring, because he has a lively and accessible
style, and the story he tells is compelling.

The bulk of the text describes a selection of the innumerable useless
and often downright dangerous nostrums that have charmed money out of the
pockets of credulous health-hungry citizens over the past 300 years. Young
details the stratagems used to promote their sale, and often examines the
careers of their hucksters. The pages are marvellously decorated by reproductions
of the advertisements used to capture custom.

These vignettes alone are worth the price of the book and the effort
of the reader, but, more importantly, Young constantly examines the reasons
behind the flourishment of quackery. Quacks are adept at latching on to
public fears and fashionable ideas. When it was thought that ‘fat is beautiful’
they promoted ‘fattening’ medicines, but when ‘slim’ became beau- tiful,
they switched to weight-reducing products (perhaps even the same nostrum
with a different label).

They have always taken full advantage of the widespread fear of cancer,
and a long chapter on Laetrile, the now discredited anticancer drug made
from apricot kernels, spells out how difficult it has been for regulatory
authorities and medical scientists to discredit a fraudulent product that
purported to deal with a fell disease not too well controlled by an orthodox
approach. Popular sentiment can be more powerful than reason.

The quacks know that there is a reaction against the ‘achievements’
of science, as typified by the development of nuclear weapons, and they
exploit this mistrust, offering a simpler and more humane approach, based
on ancient wisdoms and ‘natural’ mechanisms.

‘The public wants magic, not science,’ writes Young, quoting Victor
Herbert.

Yes – that’s the trouble.

Donald Gould is the author of Examining Doctors: Medical Practice in
the 1990s (Faber, 1991).