Views & Reviews Between the Lines

Rules and fallacies

BMJ 2011; 343 doi: (Published 28 September 2011) Cite this as: BMJ 2011;343:d6067
  1. Theodore Dalrymple, writer and retired doctor

There has long been a controversy over how the name M’Naghten, of the so called M’Naghten Rules, or criteria for legal insanity, should be spelt. Richard Moran, in his 1981 book on the case, Knowing Right from Wrong, says that there are 12 known spellings; he plumps for McNaughtan.

This, of course, is not the only controversy surrounding it. M’Naghten shot Edward Drummond, Sir Robert Peel’s private secretary, in 1843, mistaking him for the prime minister himself. (Oddly enough, Professor Moran adds to the confusion by being unable to decide whether the victim was called Edward or Edmund Drummond.) M’Naghten believed that he was being persecuted by the government and the Tory party and was found not guilty by reason of insanity. The public was outraged by this apparent leniency, regarding it as an invitation to assassination, and judges were asked to pronounce on what constituted insanity of a degree that absolved a man from criminal responsibility.

There was yet another controversy about the case, started by a doctor called Samuel Dickson. He wrote an incendiary pamphlet, published in the year of the murder, titled What Killed Mr Drummond, the Lead or the Lancet?

Dickson (1802-69) was a ferocious opponent of the practice of bloodletting with a lancet. He is scathing about the medical treatment of Drummond, who did not die until five days after he was shot: “The ball was extracted on the evening of the wound. Why this hurry to extract the ball? The unfortunate gentleman is already wounded, and a new wound must needs be made at a time like this, to extract a ball that was perfectly passive; to say nothing of the previous groping for the ball, after enlarging its point of entrance—the last place in the world where it could possibly be expected to be found! Did the unfortunate patient suffer no corporeal or mental agony while all was doing?”

Drummond was shot just before the discovery of anaesthesia, and so agony was surely not too strong a word. But worse was to follow: “What might have been expected—Fever—And what was the Treatment?—Blood-letting repeated and re-repeated—twice in One day!—leeches in numbers were also applied and bleeding AGAIN resorted to. The temporal artery was in the first instance opened! and the result of all—DEATH!”

Dickson believed that without this treatment Drummond would have survived. Dickson was a violent critic of the medical orthodoxy of his day, having been an army surgeon in India where he noticed that bloodletting, which he then applied uncritically to patients with dysentery, malaria, and cholera, usually ended in death. In his Report on the Endemic Cholera of 1829, The Fallacy of the Art of Physic of 1836, and Fallacies of the Faculty of 1839, he accused his fellow practitioners of ignorance, illogicality, and a desire to prolong illnesses in their avidity for the fees with which bloodletting provided them. Among other things he suggested a controlled trial for the efficacy of bleeding in pneumonia.

His own method of treating fever—an emetic, quinine, and cold water splashed on the body—with which he wanted to compare bloodletting was probably less dangerous. But as bloodletting declined as a practice, Dickson received no thanks and even less praise for having pointed out its dangers. He became ever more bitter, criticising in print all the leaders of the profession. His obituary in the Medical Times and Gazette said that he was a man of moderate ability with “a talent for abuse which he exercised to an unlimited extent.” But his worst offence by far was that of having been right.


Cite this as: BMJ 2011;343:d6067

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