Views & Reviews Between the Lines

In small town America

BMJ 2008; 337 doi: (Published 05 November 2008) Cite this as: BMJ 2008;337:a2400
  1. Theodore Dalrymple, writer and retired doctor

    There are two doctors in Winesburg, Ohio, Sherwood Anderson’s book about a fictional small town in middle America. It is an episodic novel of loosely connected stories in which Anderson depicts the lives of ordinary people for whom the American dream has not come true, partly because of circumstances and partly because of human nature—we are not made for permanent, or even for very prolonged, happiness.

    The two doctors, it must be admitted, are not the finest flower of our great profession. Neither has many patients or seems to go in much for diagnosis, let alone treatment. Indeed, Dr Parcival’s qualification as a doctor seems to be in some doubt: after all, these were the days (1919) before validation, let alone revalidation, at least in towns such as Winesburg, Ohio. Dr Parcival says only that he knows as much of medicine as anyone in the town, which is about as ambiguous as the famous reference once given to a junior doctor: you will be lucky to get this man to work for you.

    Dr Parcival doesn’t need patients, because he has enough money for his slender needs. How he came by the money is a mystery: he has a rackety past, and he implies, though never actually claims, that he came by his money in a seriously criminal fashion. It emerges that he is mad (his father died in an asylum, at least if he is to be believed).

    One day there is an accident in Winesburg and a child is killed. Dr Parcival refuses to attend and spends the rest of his life believing that a crowd of townsfolk will one day come to lynch him for his cruel indifference. “Everyone in the world is Christ,” he says, “and they are all crucified.” Nowadays, of course, we all fear lynching by coroner’s court and public inquiry.

    The other doctor is Dr Reefy. His practice, too, is exiguous, and he spends his days writing things down on scraps of paper and then screwing them up into little pills that he puts in his pocket or throws onto the floor. His life has been emptied of meaning by the deaths of two women, both patients, with whom he has fallen in love, and to one of whom he was briefly married before her death.

    The other is a woman married to the town’s hotel keeper, who in her youth dreamt of romance and adventure but who has been ground down by everyday banality. Though very ill, she goes to Dr Reefy not in search of a cure but because he is the only man who understands her. Falling in love, their one moment of passionate embrace is interrupted by an employee of the Paris Dry Goods Company Store, above which Dr Reefy has his office, as he comes up the stairs to deposit a box on the stairwell. The lovers never meet again; their sole moment of human connectedness is evanescent. The episode is reminiscent of Chekhov’s Lady with the Lapdog.

    Of course, no such thing as happened to Dr Reefy and Mrs Willard could happen nowadays, at least not in the NHS, if for no other reason than it is so difficult to get to see the same doctor twice.


    Cite this as: BMJ 2008;337:a2400

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