Views & Reviews Medical Classics

The Journal of a Disappointed Man

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39583.545775.4E (Published 22 May 2008) Cite this as: BMJ 2008;336:1195
  1. Robert Heys, retired consultant gynaecologist

    W N P Barbellion was the pen name of Bruce Frederick Cummings, who came from a family of journalists but rejected this profession to devote his short life to the study of natural history. Although his achievements in this field were not insignificant, his fame rests on the journal made up of extracts from the diary he kept from boyhood until his death from multiple sclerosis in 1919 at the age of 29.

    It was Barbellion’s illness that shaped his diary, and despite his lack of medical training he made many observations of clinical interest. Indeed I first read the journal when, as a student on the neurological ward at Manchester Royal Infirmary in 1951, it was recommended as giving a unique insight into multiple sclerosis as experienced by the patient.

    Barbellion first experienced signs of multiple sclerosis in 1913, at the age of 24. “In a horrible panic—I believe I am developing Locomotor Ataxy,” he wrote. “One arm, one leg and my speech are affected . . . I hope the disease whatever it is will be sufficiently lingering to enable me to complete my book [the journal].” Thenceforward the diary gives graphic accounts of the inexorable progress of his illness, with its increasingly widespread exacerbations and transient remissions. Such passages are sometimes almost of poetic sensitivity, as in the entry he wrote after he experienced a zeppelin raid on London: “This day in bed I lifted my leg and gazed wistfully along its length. My flabby gastrocnemius was suspended from the tibia like a gondola from a Zeppelin. I touched it gently with my finger, and it oscillated.”

    Barbellion’s writings also demonstrate the dilemma that doctors face in deciding whether to divulge the diagnosis to a patient with an incurable fatal disease. As was usual at this time, this was not done in his case, in the doubtless mistaken belief that his fears would thereby be allayed. He therefore remained unaware of his condition until November 1915 when, called up for wartime service, he learned of the diagnosis after being declared unfit for military duty. Regarding this discovery he bitterly wrote: “I was a fool not to have suspected serious nerve trouble before.”

    Barbellion died four years later, but not before publication of his journal, on which event he commented: “My horizon has cleared, my thoughts are tinged with sweetness, and I am content.”

    The Journal of a Disappointed Man was well received and had four repeat impressions within a year; and continuing demand saw it republished as a pocket classic in 1984. It raised public awareness of multiple sclerosis, emphasised the need for research into its causes and treatment, and paved the way for supporting organisations such as the MS Society. Introducing the journal’s first edition, H G Wells wrote, “A thread of unpremeditated and exquisite beauty runs through the story this diary tells,” and this quality alone makes the book an enthralling read to this day.

    Footnotes

    • The Journal of a Disappointed Man

    • By W N P Barbellion

    • First published 1919