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Turning a blind eye to the evidence: Nelson’s Column is not a Wren Monument
- Ronald C. Smith (29 April 2004)
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Ronald C. Smith, Consultant Paediatrician Honeylands Childen's Centre, Royal Devon and Exeter Hospital NHS Trust, Pinhoe Road, EXETER, EX4 8AD
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Dear Editor, In his defence of animal research, “Evidence is all around us” [1] Bakhle makes reference to two figures from British history. In citing Nelson he finds himself in deep water, whilst his misquotation of Wren’s epitaph is monumental folly. He suggests that epidemiology research has selectively referenced primate work in support of social inequality theories, to explain the relationship between stress and coronary heart disease. He believes that this is an example of a phenomenon which he calls the Nelson syndrome. At first sighting, this is a reference to Horatio Nelson’s manipulation of a telescope to his blind eye in ignoring a signal from his flagship to disengage the enemy at the Battle of Copenhagen in 1801. However Dr Bakhle is sending out a wrong signal. Nelson’s syndrome is the clinical consequence of a pituitary adenoma following adrenalectomy for Cushing’s disease. First described over 40 years ago by Don H. Nelson (whose work seems to have included much animal experimentation) [2] it has, like many other syndromes, since lost it’s possessive. There is also a second dysmorphic syndrome described in a mother and daughter by Matilda Nelson a geneticist from Edinburgh. However the Emery-Nelson syndrome [3] is arguably just a half Nelson. I have found find no evidence for this story of Nelson’s behaviour being construed as a syndrome, but “doing a Nelson” is a concept I was introduced to as a house physician. It meant resisting the urge to revise a diagnosis or over-investigate a patient in the name of “science” when presented with new data that did not fit the clinical picture as a whole. This involved a considered judgement not to act and was not simply a matter “choosing which signals to see”. Whilst it may now seem paternalistic, doing a Nelson required courage and decisiveness and an awareness of the consequences for both patient and doctor (which I took to mean the medical equivalent of the fate of Admiral Byng) Whether the term “turning a blind eye” derives from Nelson is not certain. (Who first turned a deaf ear?) Nelson would undoubtedly have had some difficulty handling a fully extended telescope with only one arm, being a subject of vivisection himself. It is tempting to think that this was part of an elaborate pantomime that Nelson’s indulged in whenever a signal required his attention. That he had no need to read the signal is beyond dispute as he had a prior agreement with Admiral Sir Hyde Parker to use his discretion if such a signal were hoisted whilst he was engaged with the enemy. He may have been motivated by the need to save his officers from embarrassment and this all raises the suspicion that the signal was a deliberate ploy to confuse the Danish navy into thinking he was about to suddenly sail off in a different direction. Nelson did not so much choose which signals to see as ignore something that he knew to be irrelevant. His victory was his vindication. Were it not for the prior existence of the term, Bakhle’s use of the term the Nelson syndrome might provide an interesting further example of a false eponym like Job syndrome and Munchausen syndrome but there are many problems inherent in using both eponyms and acronyms for genetic diagnosis [4]. The indiscriminate rendition of cultural icons as medical syndromes in the context of serious scientific debate needs to be resisted. Dr Bakhle then selectively misquotes Christopher Wren’s son, who wrote the epitaph on his father’s tomb in St Paul’s Cathedral, London. Lector, si monumentum requiris, circumspice translates as, “Visitor, if you seek his monument, look around.” By referring in his letter to “monuments” in the plural Bakhle loses the unique sense of the quotation, which is that the Cathedral which Wren designed, and where he lies, is the only monument that is needed to his life. If that were the case with animal research, it would be dead and buried by now, not just considering a moratorium. Instead he implies that we consider the whole body of Wren’s work. This creates fresh problems of ascertainment bias. For example The Monument to the Great Fire of London (after which the tube station is named) was attributed to Wren by many, but is now believed to be the work of Robert Hooke (of microscope fame). Built in 1677 it carried a venomously anti-Catholic inscription because it was believed that Papists had started the fire which in turn moved Alexander Pope to write pointedly: “Where London's column, pointing at the skies
Where does all this leave us? There are monuments to many things other than animal research. It would be very easy to conclude from Dr Bahkle that Nelson’s column was a Wren monument. The question posed by Pound et al [5] in the columns of this journal deserves a better answer. It is hard to find evidence for the value of animal research by applying one’s blind eye to the wrong end of a stolen microscope. Ronald Campbell Smith, Consultant Paediatrician
[1] Bakhle YS Evidence is all around us BMJ 2004;328:1017 (24 April) [2] Nelson DH, Meakin JW, Thorn GW ACTH-producing pituitary tumors following adrenalectomy for Cushing's syndrome. Ann Intern Med. 1960 Mar;52:560-9. [3] Emery AE, Nelson MM: A familial syndrome of short stature, deformities of the hands and feet, and an unusual facies J Med Genet.1970 Dec;7(4):379-82. [4] Turnpenny P, Smith R. Of eponyms, acronyms and… orthonyms. Nature Reviews Genetics. 2003 Feb; 4(2) : 152-156 [5] Pound P, Abraham S, Sandercock P, Bracken MB, Roberts I. Where is the evidence that animal research benefits humans? BMJ 2004;328:514-517 (28 February) Competing interests: RCS has been asked to account for animal research by his 10 year old daughter and is allergic to most household pets. |
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