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Views & Reviews Between the Lines

A doctor’s dramatic diary

BMJ 2010; 341 doi: (Published 21 December 2010) Cite this as: BMJ 2010;341:c7152
  1. Theodore Dalrymple, writer and retired doctor

The excellence and extent of doctors’ contributions to writing has long been recognised, so it comes as a surprise to read the following: “It is somewhat strange, that a class of men who can command such interesting, extensive, and instructive materials, as the experience of most members of the medical profession teems with, should have hitherto made so few contributions to the stock of polite and popular literature.”

The statement is made in the introduction to the 1835 edition that I possess of Samuel Warren’s Passages from the Diary of a Late Physician, first published in 1832. Warren (1807-77) was not actually a doctor, but he studied “physic” for six years, probably as an apothecary’s apprentice, between the ages of 14 and 20, before becoming a lawyer. His book, which was very popular and went through innumerable editions, certainly shows a great knowledge of clinical matters.

The Diary, which was first published anonymously, purports to be written by a deceased physician of the recent past. It is episodic in nature: a series of short stories and novellas without overall structure. The Diary was criticised at the time for having been too graphic about the sufferings of patients, while later critics found it sensationalist, melodramatic, and morbid.

I do not think this criticism is just. It is very well written; and if the stories are dramatic it is because reality was dramatic. Indeed you might say that one of the stories, “Cancer,” is understated rather than the reverse, and indeed it is very moving. The wife of a naval captain is discovered to have breast cancer while her husband is at sea. The narrator, the physician of the book’s title, calls in an eminent surgeon, who prepares to operate on her in her own home, an operation at which he, the narrator, assists. She looks away as the surgeon makes his incision and scarcely utters a sound during the operation; her only anaesthetic has been a glass of port and a steady view of her husband’s last letter home to her, which the narrator holds before her eyes at her request.

The operation over, she insists on trying to walk back to her bed but in the end has to be carried. Attended by the narrator, she makes a slow recovery over the next weeks. The story ends: “I shall not easily forget an observation she made at the last visit I paid her. She was alluding, one morning, distantly and delicately, to the personal disfigurement she had suffered. I, of course, said all that was soothing. ‘But, Doctor, my husband’—she said, suddenly, while a faint crimson mantled on her cheek—adding, falteringly after a pause,—‘I think [he] will love me yet!”

Among Warren’s other writings was The Opium Question, 1840, a pamphlet in which he denies the harmfulness of opium: “As to the fatally fascinating qualities of this drug, a vast deal has been said that is gross exaggeration.” He goes on to assert the futility of the Chinese government’s attempts to prohibit it and suggests that legalisation is the only sensible solution. Comparing opium dens to gin palaces, he asks, “Who can advocate the one and repudiate the other?” In later life he served as commissioner in lunacy.


Cite this as: BMJ 2010;341:c7152

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