IAIN BAMFORTH

A Doctor’s DictionaryWritings on Culture & Medicine

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Hast du Verstand und ein Herz, so zeige nur eines vonbeiden,Beides verdammen sie dir, zeigest du beides zugleich.

– Friedrich Hölderlin, ‘Guter Rath’, 1797

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Contents

Preface

Acknowledgements

Anecdote A Taste of Bitter Almonds

Bodies The Plastinator

Cynicism Knock! Knock!

Depression A Conspiracy of Good Intentions

Ethics Insomnia (in the Bed of Being)

Funerals An American Book of the Dead

Galen Crise de Foie

Happiness The Moral Life of Happiness

Integrity An Empty Plot

Journeys Chekhov Goes to Sakhalin

Kafka Uncle Siegfried

Language Is There Life on Earth?

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Mouth Tell Me about Teeth

Nose Hygiene of the Soul

Obit The Importance of Being an Agoraphobe

Posture The Human Position

Qi Emergent Properties

Resilience A Mining Town in Australia

Science (envy) Lamplighters and Lucefactors

Translating Machine Made of Words

Upas The Poison Tree

Vertigo Stendhal’s Syndrome

Weightlessness The War of Eye and Ear

X-rays Under the Magic Mountain

Yellow Fever The Life and Times of Ernst Weiss

(meta-)Zoology Parasites

Endnotes

Index of Names

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Preface

Anyone who decides to live on the continent (as onlythe British refer to it) has to expect to live part of thetime in the subjunctive—the verbal mood for anythingthat’s hypothetical or contingent. You can’t hope to getby as a competent speaker of French or German (whereit is called Konjunktif ) unless you know how to enterthe parallel world of things that demand someoneelse’s participation or consent, or the special time orset of circumstances to be agreed upon before apossibility can swell into the indicative. Verbs ofwishing, fearing, expressing judgement and emotionall take the subjunctive mood. The subjunctive is forpeople who like parentheses and extrapolations. Thegreat Austrian novelist Robert Musil wrote an entirenovel set in the subjunctive, and never emerged in theindicative to finish it.

The subjunctive exists in English too, but its presenceis vestigial and barely observed. Instead we have TheLife and Opinions of Tristram Shandy, Gentleman,Laurence Sterne’s seriously funny tribute to the zigzag.His novel was once described as a congeries of‘unconnected rhapsody, rambling digression, eccentrichumour, peculiar wit, petulance, pruriency andostentation of learning’; it exhibits all those qualities,and it has also been one of the most influentialEuropean novels ever. It mocks what it loves, not least

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the encyclopaedic impulse; Tristram’s father has asystem of education ‘collecting first for that purposehis own scattered thoughts, counsels, and notions, andbinding them together.’ This is his TRISTRA-paedia.

I took a leaf from Tristram’s father’s system byarranging these twenty-six essays as an abecedary ofconcept-terms, which is about as much order as I couldgive to my life. Two of these headings are not evenEnglish in origin, which is appropriate enough, and‘Posture’ has a wider purchase in French, where ‘êtreen mauvaise posture’ is to be in a tricky situation. MyBook of Patience includes magical and not so magicalbodies, eyes and ears, nose and teeth, old-style liversand the latest pills, happiness quotients and fakedoctors, Chekhov and Roget, mining towns and poisontrees, Swiss sanatoria and penal colonies, and bacteriaalmost everywhere. Some of the concept-terms could,conceivably, have been quite different: Happiness, forinstance, displaced another articleon Hands, which used to be important diagnosticextensions for doctors. ‘The War of Eye and Ear’ wascatalogued under Visions until I realised that the realconcern of the essay—in spite of what Louis-Ferdinand Céline said in a 1957 interview about ourspecies being terribly dull-witted, thick or just a drag(‘extraordinaire de lourdeur’)—is the increasingweightlessness of our experience, as if we were merebundled spoors of hygiene and charisma; this maderoom for the Vertigo of ‘Stendhal’s syndrome’, whichcould be anything from the mildest vasovagal episodeto major psychotic decompensation.

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My title ‘A Doctor’s Dictionary’ is a reminder, at leastto myself, that more of my professional life than Imight have wanted has been spent in the precincts ofweighty books, not least in France, where theunexpected difficulties of making a living as an‘omnipraticien’ (general practitioner) in Strasbourg ledto my becoming a scientific translator and editor.Many of these books have been dictionaries, lexiconsand encyclopaedias, although with digitalisation muchof their bulk and mustiness has volatilised. To befascinated by the ‘extractive industries’, like the earlyRomantics—heightened for me by a year in a gritty butfascinating Australian mining town—is perhaps a kindof nostalgia for bodily experience, and all its effort andfatigue, now that digitisation, seemingly in league withcapital, has embarked on the process of hollowing out‘all that is solid’ even more drastically andpurposefully than in Marx’s time: there are very fewjobs and professions that have not yielded to thecomputerisation of what they entail.

Losing touch is something that threatens us all. Theimplications for medicine are serious, when thisancient profession—never entirely a science and nolonger quite the art it used to be, but an empiricaldiscipline aided by, and increasingly in thrall to,technology—forgets what it owes to tact. Doctors aretranslators, interpreters and sign-readers, sure; butsometimes their simple presence counts for somethingelse, as the resident asks Robert Lowell’s persona inhis late poem: ‘We are not deep in ideas, imaginationor enthusiasm—how can we help you?’

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Acknowledgements

All of these pieces, with one exception, were firstpublished in journals and periodicals, some ascommissioned reviews, others as commentary piecesthat I cajoled the editors into publishing. Some of themstill bear the cauls of their first emergence, butgenerally I’ve attempted to coat and shoe them asliterary essays, able to stand on their own while takingtheir place in this book’s A–Z schema of things. Somefirst saw light as occasional pieces in the BritishJournal of General Practice, and I acknowledge a debtof gratitude to Alec Logan, its deputy editor, who formany years kept asking me to provide a feature onmedicine and writing for the Christmas edition of thejournal. I am also grateful to the editors of TimesLiterary Supplement, London Review of Books,Medical Humanities, PN Review, Parnassus,Quadrant, The Linguist, Lapham’s Quarterly, BritishMedical Journal, The Lancet and the Bulletin of theWorld Health Organization for allowing me to developand republish articles from their pages. ‘Crise de Foie’first appeared in German translation in the weekendfeuilleton of the Süddeutsche Zeitung thanks to theefforts of my father-in-law, Christian Schütze, whoalso translated it.

A number of the essays in this book constituted a goodpart of the manuscript Medicine and the Imagination

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submitted to the University of Glasgow in 2009 for thedegree of Doctor of Letters by publication. I wouldlike to thank Michael Schmidt and John Coyle foralerting me to the existence of a Scottish Universitiesby-law the terms of which were previously unknown tome, and for their encouragement, and not least that tooof my external referees Kenneth Boyd and PeterDavidson, whose appraisals reassured me that I wasn’tentirely on a hiding to nothing.

Thanks are also due to my helpful friend Richard Priceat the British Library, and to staff at my local institute,Strasbourg’s newly refurbished National andUniversity Library (BNUS)—a magnificent Italianateedifice built in the Wilhelmine period when Strasbourgwas Strassburg and second now in France in terms ofits collections only to the National Library in Paris—isa precious resource for me as an expatriate writer.Further thanks are also due to colleagues and friends inmedicine and the wider world, with whom I havediscussed some of the issues raised in this collectionat various times: Olivier Wong, Frank Slattery,Douglas Shenson, Carl Elliott, Bruce Charlton, Johnand Mary Gillies, Jeremy Garwood, ChristopherHarvie, Christine and Richard Thayer, David Bellos,Jim Campbell, Gerald Mangan, Les Murray, AlbertoManguel, Frederic Raphael, Marjorie Farquharson,Desmond Avery, Brian Hurwitz, William Ian (Bill)Miller, Peter and Maria McCarey, as well as to myeditors at Carcanet Helen Tookey and Luke Allan. Iwould like to thank Lewis Lapham for commissioningme to write a ‘reappraisal’ of The Magic Mountain,one of the key novels of the twentieth-century, and for

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Alastair Campbell and the medical ethics staff at theNational University of Singapore, who allowed me toexpand some of my thoughts about Hans Castorp at ameeting of their journal club. Living in Strasbourg—or‘Strasburg’ as Laurence Sterne spells it in TristramShandy, where it gets a whole chapter to itself—hasbeen to be aware of living (for twenty years now) ‘farout in the centre’, to purloin the title of a book byDannie Abse: in the heart of a Europe that has no bodypolitic. That unreality notwithstanding, my wifeCornelia was a constant presence in good and badtimes, and I feel fortunate to have enjoyed thecompanionship of my family throughout the yearscovered by this book, during which my two childrenFelix and Claire have grown up. ‘Sooner or later,’ asGermain Muller, founder of the local dialect theatre DeBarabli, noted, ‘all Strasburgers end up lovingStrasbourg.’

Needless to say (although it must be said), the opinionsexpressed in the essays engage my responsibility only.

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A Doctor’s Dictionary

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A Taste of Bitter AlmondsA STENDHAL CAPSULE

When the rotund Henri Beyle (Stendhal) dropped deadin a Paris street in 1842—‘of apoplexy’—only threemourners accompanied the coffin to its resting place inthe Cimetière de Montmartre: one of them was theyounger writer Prosper Mérimée. Incensed by the factthat no words had been spoken at this ‘pagan funeral’,Mérimée wrote a short memoir of their friendship. Factis he didn’t know much about his friend other than thathe had served in the Napoleonic campaigns and been amostly indifferent diplomat in Italy, and that he wasknown in Paris as an occasional wit (‘homme d’esprit’)and writer with a mania for disguises; what he had readof his books didn’t inspire him terribly. Perhapsbecause he didn’t know so much about the social

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figure, the sketchy portrait he left, with the bare titleHB, is a captivating one.

For a son of the post-revolutionary years like Mérimée,Beyle (born 1783) bore all the contradictory traits of aman of the previous century: ‘All his life he wasdominated by his imagination,and never did anything except abruptly and withenthusiasm. However, he got it into his head that heacted in conformity with reason. “One must be guidedin everything by LO-GIQUE”, he would say, pausingbetween the first syllable and the remainder of theword. But he had no patience for those whose logicdiffered from his own.’ In fact, Stendhal was every bita fully-fledged nineteenth-century writer of self-exploration, and he anticipated his own discovery inthe twentieth (in his autobiography La Vie de HenryBrulard he addresses readers in 1935, not hiscontemporaries). Long before Flaubert and Proust, hewas aware of the fitfulness and ambiguity of memory,its elusiveness when we try to snare it. Hence hisfamous digressive style, the comic zigzag he took fromthe celebrated author of Tristram Shandy.

Stendhal had his mnemonic devices too. As a youngboy in Grenoble he had been made to take drawinglessons by his father: this got him out of the house,which he found stifling. The 175 sketches scatteredthroughout the text of his autobiography, showingmostly street scenes or room arrangements, remindedhim of that brief moment of freedom, and served as avisual framework for his writing. Feeling that therewas truth in spontaneity, he wrote quickly (his

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autobiography was written over four months in thewinter of 1835); and although he often presents exactdates in his writings (an early talent for mathematicshad allowed him at sixteen to quit the dampprovincialism of Grenoble and enter the new Écolepolytechnique in Paris), he was often slapdash inrespect of actual chronology. What counted forStendhal was the sharp, acutely characterised,discriminating account of motive or emotion. ‘Lovehas always been for me the most important of affairs,or rather the only matter of account’, he wrote, as if theending of the sentence had only occurred to him oncehe had voiced the beginning. His famouslymineralogical book on love talked about it in terms ofa ‘crystallisation’. A thinker had to be dry, clear,without illusions: a banker, he once wrote, might havethe requisite character ‘to make discoveries inphilosophy’.

And there is his famous, light, Mozartian touch: he wasas unsparing of himself as he was of others, the youngprovincial who hoped to cut a figure in the world andbecome a celebrated Don Juan even though he didn’thave the physique (or, indeed, the inheritance) for it;writing his autobiography under an assumedname at fifty-three he is prepared to acknowledge thatall he will be able to convey about his life ofvagabondage and gallantry is the ‘chasse aubonheur’—the pursuit of happiness and not theexperience itself. There is no cynicism in the writing,only a serene wistfulness.

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Stendhal’s commitment to the brisk, discursive,associative feel of experience makes it an exhilaratingexperience to read his journals and travel books. Everysituation in his life seems to lend itself to epigrammaticexpression; and anecdotes themselves are occasions forexpansive writing: in 1837–38, on leave from hisconsular job at Cività Vecchia and visiting his owncountry, he dashed off a book called Memoirs of aTourist. Here is a nice piece of hearsay reported in itspages which he scribbled down in Lyons, on May 19:

Three days ago Mr. Smith, an English puritan who hadbeen living here for ten years, decided it was time toend his life. He swallowed the contents of an ouncebottle of Prussic acid. Two hours later after being verysick he was anywhere but on the point of dying, and topass the time rolled about on the floor. His landlord, anhonest cobbler, was working in his shop in the roombeneath: startled by the inhabitual din and fearing thathis furniture was getting a battering, he went upstairs.He knocked on the door; no reply; so he entered theroom through a boarded-up door. He was aghast to seehis tenant prostrate on the floor, and sent for M.Travers, well-known surgeon and friend of the sickman. The surgeon came, treated Mr. Smith, and veryquickly brought him out of danger. Then he asked him:‘What the devil did you drink?’

‘Some Prussic acid.’

‘Impossible, six drops would have killed you in ajiffy.’

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‘Well, they told me it was Prussic acid.’

‘Who sold it to you then?’

‘The little chemist on the Quai de Saône.’

‘But usually you get your prescriptions made up atGirard, your neighbour right across the street here, thebest pharmacist in Lyons!’

‘That’s true, but the last time I bought some medicinefrom him, I had the impression he was overchargingme.’

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The PlastinatorON THE ETHICS AND AESTHETICS OF A TRAVELLING

ANATOMY EXHIBITION

In 1997, in the space of four months, more than three-quarters of a million people—the highest attendancefor any post-war exhibition in Germany and more thanthe famous annual Dokumenta art review in Kassel hasever attracted—queued to be admitted to Mannheim’sRegional Technical and Industrial Museum. Theexhibition attracted similar attendance figures when itmoved to Japan, reportedly receiving more than amillion visitors, and to the traditional Europeancapitals of death, Vienna and Basel, where I caught upwith it. It is now showing in Cologne; here, too, it isdrawing in the crowds.

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This is no ordinary exhibition, and not the display offossilised machine tools from Germany’s long andunfinished history of industrial achievement that mighthave been expected from the museum’s name. What ison show, in fact, is a collection ofabout two hundred human anatomical specimensincluding the usual kinds of body sections, slides ofdiseased and healthy tissues, organs in glass cases, andso forth. These are standard objects in an exhibition ofthis kind. More controversial, and certainly morespectacular, are the eighteen ‘plastinated’cadavers—Ganzkörperpräparate, or whole-bodypreparations.

Anatomy exhibitions have gone on the road before,though you might have to go a long way back, to theliving human exhibits in the freak shows of theVictorian circus era, to find an exhibition which hasaroused so much curiosity and controversy. Many ofthe anatomy museums in Europe’s famous medicalschools are either accessible to the more intrepid kindof tourist or can be consulted by appointment: I spent along afternoon a few years ago in the mote-filled hallof the University of Montpellier’s junk room,examining one of its famous series of wax impressionsof syphilitic buboes and chancres from the nineteenthcentury. Montpellier’s anatomy tradition goes back to1315, when the body would be opened for inspectionby two barbers under the instruction of a magisterreciting the appropriate Galenic text.

It is a tradition that has been revived in several booksby Frank Gonzalez-Crussi, a professor of pathology in

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the Children’s Memorial Hospital at NorthwesternUniversity who has created a literary subgenre of hisown: portrayals of the unusual and the monstrousdrawn from his professional life and given a savantveneer that places them somewhere between JorgeLuis Borges and Sir Thomas Browne. In one of hisessays, ‘Bologna, the Learned’ (in the book SuspendedAnimation, 1995) he reminds us how popular publicdissections were in the fourteenth century when theywere advertised by being posted in Latin, the languageof the dissections, on the columns of the Archiginnasiodays before the event. Public dissections becameroutine only at the beginning of that century. Prisonerswere condemned pro faciendo de eo notomia—tomake an anatomy of them. The cutting, rending anddivision of a body was a chance for the demonstratorsto show the ‘image of the universe’ to the audience,and for learned members of the audience to engage inheated disputatio; it was above all an event in thesocial calendar. Hogarth’s ‘Four Stages of Cruelty’offers a very sarcastic visual commentary, in thedisembowelment of poor hanged Tom Hero by a packof doctors, on how the poorwere always being held up for scrutiny by their socialbetters.

In those days, anatomists had to work fast to avoid thedeliquescence of the body. The French surgeonAmbroise Paré (1510–90) was already recommendingthe use of alcohol to preserve tissues, but it wasceroplasty, or wax modelling, as developed in northernItaly—especially Florence—in the seventeenthcentury, that became the prized method; Gaetano

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Zummo’s technique was brought to a fine art under theabbot Felice Fontana (1730–1805), who was able toconvince artists and anatomists to work together on hiswaxes.

Ceroplasty was a highly skilled procedure requiring anintermixture of purified bees’ wax and spermaceti, ashardener, which was then pigmented to the desiredhue; special techniques such as dipping silk threads inhot wax were used to achieve the effect of finestructures—that of the lymphatic vessels or nerves forinstance. Fontana’s waxes were shown to great acclaimin 1780, when he was commissioned to prepare aseries of obstetrical specimens for the Emperor JosephII: these can still be seen in glass cases, as a permanentexhibit, in the palatial Josephinum in Vienna. It washoped that they would educate Viennese doctors in theuse of forceps as advocated by two pioneering Scots,Hunter and Smellie; Tristram Shandy, written at aboutthe same time, descants knowingly on the optimalfulcrum placement of this new technology for use byman-midwives. Along with gross anatomy, or thestudy of the body as it presents itself to the naked eye,wax models were an important means of advancing theevidence of things seen when so many concepts inmedicine had been hitherto deductive, reasoning fromthe general to the particular.

To understand the body, the body was enough—it is avery modern thought. Prior to William of Ockham,who is generally credited with giving primacy to theparticular over the universal, that modern clincher‘whose body is it anyway?’ would have been an

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inconceivable thought. Indeed, to have a body (apossession rather than an attribute, something likeLocke’s ‘first property’, extending its domain byassimilating what it can grasp) would have been anovel and disturbing heresy five centuries ago. VisitingMelanesia in the 1940s, the anthropologist MauriceLeenhardt was startled to be told by an elder that theEuropeans had ‘brought them the body’. Perhaps it wasthe body itself, as Durkheimsuggested, that served to organise the personality. Butthe epistemological strain is evident enough: after theMiddle Ages, an anchorite contempt for the flesh alliesitself with the Cartesian doubt that underwrites modernanalytical medicine; the body loses its place in thegreat panpsychia of the cosmos, and the very idea of itsincarnating the divine comes to seem absurdlyaggrandizing. What is universal in man is now a sign.

Ceroplasty and the vascular injection of fixatives anddyes remained mainstays for teaching anatomicalstructure into the twentieth century. There is clearly adifference between the two methods: the first is animitation of nature, a distancing technique, the other anattempt to preserve the corruptible body. This was notto spare the anatomist’s feelings; it was to protect himfrom the dangers of putrefaction. The lifelikeness ofprepared wax specimens can be such as to acquire a‘terrorizing’ quality, as Gonzalez-Crussi puts it,although the technique met with Goethe’s approval: hisyouthful enthusiasm for anatomy classes in Strasbourgin 1770 gave way to a suspicion that anatomists werecads of the worst kind.

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On the other hand, it is probably more accurate to saythat what most medical students remember of theirdissection classes is not a feeling of horror at having tocut up a body but an anticlimactic sense of how greyand shrunken the fixed cadaver is.

The illustrations from Andreas Vesalius’ De humanicorporis fabrica ranged in the museum outside thedissection room at Glasgow University were moredisturbing than the cadavers inside: even when subjectto terrible violence—flensed like Marsyas or hangingby a cord to keep their jaws shut—Vesalius’ studiesinsist on comporting themselves in unmistakablylifelike ways: outrage is made complete, Baudelairesuggests in his poem ‘Le Squelette Laboureur’, bytheir being ‘tricked out to look like hired hands’. Tool,image, grave: the three artifacts that take the measureof, and surpass, our ordinary human condition areassembled in the poem, yet Baudelaire’s slave labourergoes on digging even after he has cut the turf for hisgrave, refusing to move into the immaterial.Concerning Vesalius’ series, Roger Caillois remarkedin his essay ‘Au Cœur du Fantastique’ that ‘moregenuine mystery crops up in such documents, in whichprecision is of the essence, than in the wildestinventions of Hieronymus Bosch.’

In the dissection groups of six to a table that were afeature of my days in the anatomy department ofGlasgow University, imagination was stilled by theunpleasantness of the task and the pedagogicimperative: learn, learn, learn. Rote learning isdrudgery: even surgeons don’t need to know all the

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sulci, tuberosities and foramina of every bone, norevery pulley and conduit of the softer parts as detailedby Alexander Monro in his The Anatomy of theHumane Bones (1726). What isn’t clinically importanttends to be forgotten. Cynicism beckons, or you cometo grief. My own enduring memory of the anatomyclass is its smell, the pungent odour of formalin; itpenetrated clothes and gloves, and lingered in the hair,a kind of olfactory ectoplasm from a cold place inwhich people no longer mattered.

Enter Professor Doktor Günther von Hagens (the ‘von’is an affectation), who describes himself as ‘inventor,anatomist, physician and synthetic chemist’. In the mid1970s, at the University of Heidelberg, hedeveloped—and patented—a new technique forpreserving biological tissue called plastination. It hadtaken him fifteen years of experimentation withindustrial solvents.

Plastination is now used by medical schools across theworld for the teaching of gross anatomy. It requirestissues, or whole bodies, to be fixed in the standardway with formaldehyde or some other preservative.Specimens are then dehydrated, a process in which thefluid in the tissues is replaced with a chilled organicsolvent such as acetone. The next, and central, step ofthe process is forced impregnation: the solvent isreplaced under vacuum with a polymer, silicone orepoxy resin, producing an object which can then bemanipulated in ways that were quite impossible withprevious preservation techniques. The final stageinvolves hardening of the polymer. Tissues can be

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rendered pliable or hard, and with a high degree ofrealism. The essential organic architecture of the bodyis preserved, although it is now about eighty percentplastic. In all, the process takes 500–1000 workinghours. It is undoubtedly an elegant technique, andproduces specimens which are much more resistant tooxidation and decay than the old formalin-phenolinjected bodies. Plastination can give a body 500 yearsof postmortem standing.

This technique, for instance, allows the skeleton to beguddled out, leaving the rest of the body, once themuscles have stiffened after absorbing the polymer, asa self-supporting ‘shell’. Hagens has exploited thisfeature in one of his dissections on show at theMannheim museum, where the menacing musculatureof the Muscleman is displayed a step ahead of hisskeleton. The skeleton has been ‘shucked’ of itsmuscles, which have been left to stand free, theirbloatedness no doubt resulting from the sheer difficultyof extricating the cranium, rib cage and long bones—ofouting the inner man. It is a virtuoso piece ofdissection work, but the raised left arm and flailingtriceps conjure up a film image: Boris Karloff asFrankenstein’s monster.

Several other of the whole-body preparations in theexhibition are similarly ‘exploded’ to show therelationships between the internal organs, or thearterial system. Nearby, the Orthopaedic Body isdecorated with twelve different prosthetic devices, andsponsored by Johnson & Johnson.

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Another preparation suggests that the associationbetween the Muscleman and Frankenstein was notfanciful: a standing figure has been defrocked of hisskin which he holds in his right hand, all of a piece,with an imploring gesture. It is a direct ‘quote’ of thefamous flayed man published by the Spanish anatomistJuan Valverde in Rome, in 1560.

Yet other dissections have ‘windows’ cut into thebodies at various levels indicating important internallandmarks which have to be located or avoided duringsurgery. One of them is a young woman with a5-month old foetus in her uterus, the overlying rectusabdominis muscle opened in the midline to reveal thedome of the uterus pressing upwards on the intestines.Another figure, posed like a chess-player, has beenpared to the ribs to show the central and peripheralnerves as they exit in pairs from the spinal column andinnervate the skeletal muscles, a feat of dissectionbeyond the means of the traditional anatomist. Theorgans of a ‘longitudinally expanded’ preparation,which has been made to squat, shoot upwards out ofthe body, and are held in space by threads. ‘I createspace for the viewer to see the parts clearly’, saysHagans, ‘so that he can close the space up in hisimagination.’ One preparation is dissected in bandsand partitions, like Dali’s famous painting ‘Womanwith Drawers’; another is caught in the act ofrunning, all the muscles freed from their insertions andsplayed outwards. It is a dramatic portrayal of a bodyin motion, but it nods at the pioneering artists of theearly twentieth century: the Anatomical Angel, awoman with her trapezius muscles cut and suspended

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like wings, in Jacques Gautier d’Agoty’s atlasMyologie complète en couleurs, of 1746, was a fetishimage for the Surrealists. Hagens’ dissection is, in fact,a p(l)astiche restatement of Umberto Boccioni’svisionary bronze ‘Unique Forms of Continuity inSpace’ (1913).

Hagens is unbothered about blurring the distinctionbetween art and dissection. He seems to thrive on it,never being seen in public himself without his JosephBeuys fedora hat. His method of personal self-promotion stands in sharp contrast to the impersonalityof his exhibits.

The Plastinator (not the plasticator, the epithet given toPrometheus in Ovid’s Metamorphoses) is quick topoint out that some of the best early anatomists wereartists, like Leonardo da Vinci, who is thought to havedissected thirty corpses; nor is he the first anatomist tomodel his dissections on works of art. HonoréFragonard’s famous eighteenth century dissection of arider on his horse, both stripped to the bone,recapitulates Dürer’s ‘Tod und der Reiter’, and can stillbe seen in all its lacquered glory at the NationalVeterinary School at Alfort, near Paris. FrederikRuysch (1638–1731), professor of anatomy inAmsterdam and famous for his vascular injectiontechnique (he used a secret combination of wax, resin,talc and cinnabar which had to permeate the entirevascular system before it hardened), had five rooms inhis town house at the Niewe Zijds Achterburgwalconverted into a Wunderkammer for display of hismeticulously prepared specimens and mummies. They

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were baroquely adorned and placed in allegoricalscenes: playing a violin with a bow made of a driedartery, weeping into handkerchiefs made of mesenteryor meninges, or abandoned to bewail their fate on astage constructed out of gallstones and other bodycasts. Peter the Great bought the lot for the huge sumof 30,000 Dutch guilders in 1717, and had it shipped toRussia. Only half of the collection survived thejourney.

Both Fragonard and Ruysch were decidedly oddcharacters, brooders who took their discipline to apitch well beyond the necessary degree of scientificprecision or desired illusion. In theMannheim exhibition catalogue, however, Hagensattempts to play down the aesthetic element,suggesting that ‘the art is in the beholder’s eye’.

Yet the subtitle of the exhibition itself—‘dieFaszination des Echten’—spells out the nature of theconfusion: what status do these exhibits have? Whatdoes real mean here, and why should it be sofascinating? Organs and body sections aren’t reallythat interesting unless you know what you’re lookingat: without the whole-body preparations, the exhibitionwould hardly be such a scandalous success. Heatedtelevision debates accompanied the first exhibition.Hagens was arraigned for bad taste and lack of respectfor human dignity: the Mannheim theologian JohannesReiter said, ‘the person who styles human corpses asworks of art no longer respects the importance ofdeath.’ Protests about its tastelessness were made bythe heads of both main churches to the minister

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president of Baden-Württemberg, though a cool-headed sixteen-year-old pointed out in the visitors’book that the Church has a long tradition of putting itsown holy mummies on display. Hagens has recruitedLuther as his alias: everyone should have a chance tosee the plastinated body, just as everyone should beable to read the Bible without mediation. He is‘democratizing’ anatomy. ‘We are not putting deadhuman beings on public show. The whole-bodypreparations on display have been anonymised and areno longer dead human beings because they are nolonger the object of piety and mourning.’ Article 168of the German Strafgesetzbuch (on Disturbing thePeace of the Dead) has no legal force since all theseformer persons donated their bodies to the Institute forPlastination, thereby relinquishing their right to burial.

True enough: we don’t know who these people are. Wewon’t know their names, or the stories of their lives;even their features have been smoothed out byanatomical preparation, and the insertion of glass eyesmakes them look vacuous. We may be able to guesstheir age, give or take a few years. Their sex isapparent. Organ deformation may give a clue as to thecause of death. That’s about all that can be guessed ofthem in their singularity as social beings. They areempty testaments. But how can we address themexcept as social beings? Hagens believes that hisexhibition satisfies a great longing for what he callsunadulterated originality (‘unverfälschteOriginalität’)—a clumsy expression which mighttranslate more

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simply as authenticity. What does he mean? Aplastinate is not a mimetic object, like one of thoseglossy wax models of the seventeenth century which,by virtue of being a representation, keeps its distance.In the museum catalogue a whole-body plastinate isdefined as a structural model of the cadaver (it lacksmost of the water that makes up four-fifths of thehuman body). But an artefact can’t be authentic, sincean artefact is always the view of a thing, not the thingitself; nor does a cadaver have any innate structuralaptitude for self-display. Hagens has to give it form byplastinating and then modelling it before hardening, aprocedure ethically comparable to the partial intrusionon autonomy that occurs when a plastic surgeonreconstructs a face or body.

It is a peculiar form of playing to the gallery toinsinuate, as Hagens does, that visitors to theexhibition can, in a day’s viewing, locate themeaningful turnings of the very tradition which hasmade it possible to strip a body: a medical education isa long apprenticeship in which the discipline requiredto be a physician is itself re-appropriated, precept byprecept. It demands participants, not onlookers.

Twenty years ago, having to dissect a body twice-weekly over nine months in the cold hall of GlasgowUniversity’s anatomy department was, as far as I wasconcerned, a chore; it seemed odd that a sense ofmedicine’s embodied realism was acquired bydestroying the evidence. Yet the cadaver was, in asense, our first patient. The six of us around the tablewere dimly aware of the ambivalence of what we were

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doing: the body in front of us was no longer a humansubject, but neither was it wholly in the realm of thesenseless (the same cleavage attends the removal oforgans from cadavers for transplantation: the sense of‘material’ being cannibalised sits uncomfortably withthe prospect of the ‘harvested’ organs sitting inside aanother person). Our apprentice knowledge of anatomyhad already been informed by allied disciplines, andwas broadened by twice-weekly lectures on form andfunction delivered before we entered the colddissection room. It was hard to appreciate then, rakingsomeone’s gizzard, that being a good doctor wouldentail getting beyond the old Indo-Europeanconceptual metaphor ‘knowing-is-seeing’: knowing inmedicine is just as much listening and touching.(Sniffing patients is not common practice these days,though diabetes can sometimes bediagnosed from a whiff of acetone in the consultingroom; as for urine-tasting, it has fortunately becometotally obsolete.)

But what can a ‘laterally expanded’ whole-bodypreparation convey to an observer whose only previoussense-impressions of lateral expansion have been ingore movies?

The difference between Hagens’ hard plastic bodiesand a simple skeleton, bereft of the conceptually richflesh it supports, is clear enough: imagination is atwork, as Hagens knows it is bound to be; which is whyit is disingenuous of him to pretend that the aestheticaspects of his preparations are only institutional andsecond-order, ‘in the beholder’s eye’.

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Joseph Beuys could have told him why. Art ispredicated on the exclusion of death, which obliteratesthe aesthetic. The only art form I can think of whichmeaningfully includes it—a spectator sport whichculminates in an animal being put to death—is thebullfight. There the risk of failure, of being impaled onthe ‘bull’s keen horn’, is a mortal one, as noted by thatrestrained masochist Michel Leiris in L’Age d’homme;he thought it saved the torero-writer (himself) from anart of mere affectation.

The argument is one of authenticity and performance:those same strategists of liberation who had applaudedthe Anatomical Angel thought the process of self-discovery was a tauromachy. In fact, writing hisautobiography while living his life did not elevateLeiris to the level of what Nietzsche had once called‘the dignity of a great matador’; it was to become alifelong mortification.

The exhibition offers no new scientific discoveries:gross anatomy’s heyday was long ago. The number ofautopsies performed annually in hospitals has beendeclining for years to what pathologists regularly sayare ‘worryingly low levels’. Professors of anatomythese days may well be molecular biologists orbiochemists, not structural anatomists.

It is ironic too that our state-of-the-art perception of thebody is airier and less solid even than that of themedieval medici: it is a composite representation madeup of vector forces, atomic energy and sound waves.The body is as permeable as it is resonant. The more

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we see through it, the more its substance eludes us. It isa progression that would no doubt have appealed tomedievalphilosophers who believed all its fleshiness was, in anycase, accidental to our true essence. ‘Thus we aremen,’ wrote Sir Thomas Browne in Religio Medici,‘and know not how: there is something in us that canbe without us, and will be after us; though it is strangethat it hath no history what it was before us, nor cannottell how it entred in us.’

Evacuation and resurrection: the Greek wordexanastasis means both—the body cannot beresurrected unless rid of its matter—or as theunshakeable Job puts it: ‘And though after my skinworms destroy this body, yet in my flesh shall I seeGod’. Hagens’ exhibition might just conceivably be ahunt for a tertium quid. It seems to be searching for itin the same places as the contemporary Brit Packartists, who could well be defined as school-of-liferather than art school. It is, let it be said, a diminishedlife in which to go to school: reality alone counts, andreality knows nothing of representation—as if humanhistory were an animal history.

Besides, if the body is always a symbol of society, asthe anthropologist Mary Douglas insists, then societyitself must be exploding at the seams. We can’t expectto lay the world bare, cognitively speaking, and notfeel the draught: hard knowledge after Bacon’s timehas meant going in fear of anatomists. Even if we wereto adopt a minimal ethic with regard to the people whohave donated their bodies to Hagens’ institute by

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seeing them as in some way performers, the grandmaster of anatomical ceremony and director of theperformance has an obvious responsibility not todegrade or humiliate them in their unheeding act ofself-exposure.

I seem to be in a minority: most visitors to the bodyshow actually seem to applaud the idea behind it. Noobjections were raised by the churches in Vienna andBasel, both of which have a long tradition ofsocializing their own exquisite dead. Hagens nowclaims to have a waiting list of a thousand ‘donors’,and plastination will no doubt provide an ultimate fatefor some of them. Perhaps some of them are down atthe gym already, shaping up for the new symbolicorder.

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Knock! Knock!A STUDY IN MEDICAL CYNICISM

Mundus vult decipi, ergo decipiatur

– Petronius

The perfect role

In August 1923, Jules Romains (Louis Henri-JeanFarigoule), PEN activist, friend of Stefan Zweig, andone of France’s most famous and popular writersbetween the wars, wrote a play in three acts calledKnock. It was to prove his most enduring literarycreation. In those days Romains’ theatre pieces, alongwith those of Luigi Pirandello and Bernard Shaw, were

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being staged everywhere, which only goes to show thatno literary reputation is ever entirely vouchsafed.Indeed, the only other work for which Romains isremembered today is his colossal ‘unanimist’ fictionLes hommes de bonne volonté, which appeared ininstalments between 1932 and 1946, when he hereturned from war exile in New York and Mexico. Itruns to 8000 pages, and is published in 27 volumes. Ihave yet to read it all or meet anyone who has,although Richard Cobb is right to assert, in his essayMaigret’s Paris, that the first volume contains somefinely evocative scenes of the outskirts to the Frenchcapital.

Romains first thought of asking the Comédie-Françaiseto stage his piece. That idea came to nothing, but acopy of his play ended up in the hands of the actorLouis Jouvet who was bowled over by its ‘formalperfection’. A pharmacist before he became an actor,Jouvet was for three decades one of the best-knownactors of the Parisian theatre-world, a star of manyclassic French films including the famous Hôtel duNord. With his widow’s peak and suave demeanour, helooks like a svelte version of Jack Nicholson. One ofhis witticisms has deservedly been anthologised: ‘thereare performances where the public is quite withouttalent.’

After several rehearsals, Romains insisted that Jouvetplay the character close to his own persona, withoutcaricature—‘Vous avez une occasion magnifiqued’être vous-même’—but with an added touch ofcourtesy, sarcasm, and self-assurance. Jouvet worried

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that the play was going to be too ‘black’ to attract thepublic. He was wrong. On its opening night at theComédie des Champs-Elysées on 15 December 1923,André Gide went backstage to congratulate Jouvet onhis performance. From then on Jouvet was Knock. Theplay was a great success. Jouvet played the rolethroughout his acting life, and after the war playedKnock at the Athénée no fewer than eight hundredtimes. Two film versions were made: one in 1933,directed by Roger Goupillières with the screenplaywritten by Romains himself, and a better knownversion, directed by Guy Lefranc, in 1951. Such wasJouvet’s status that he was allowed to supervisecasting. In the event, his brilliant performance provedto be the ultimate record on film of a remarkable actingcareer: he died on stage at the Athénée (which is nownamed after him) rehearsing Graham Greene’s ThePower and the Glory, just months after the film’srelease.

The farce and the farceur

The film opens in the early years of the twentiethcentury with Knock, the aspirant to a medical practice,sitting in the back of an old jalopy—the kind ofautomobile the French used to call atorpédo—with Dr Parpalaid and his wife. Knock hasjust purchased Dr Parpalaid’s practice in the smalltown of Saint-Maurice, which, from the references tohilly country and the nearby presence of Lyon, wouldseem to indicate a sleepy hollow somewhere in thefoothills of the Massif Central or the Alps. Somewheredeep in dear old France, in other words: the kind of

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place lost to the world that the worthy Dr Benassisdecides would be suitable for his ministrations inBalzac’s novel The Country Doctor. All the businesshas—unusually—been concluded in advance by letter,and Knock is exercising his right to be introduced tothe clientele. Dr Parpalaid is a decent old duffer—unhomme de l’art, as the French used to call theirdoctors—a man of predictable knowledge or even of‘good intent’ in Romains’ terms, his wife a formidablematron who seems to have far more of a head forbusiness than her husband. Dr and Mme Parpalaidhave decided, after careful consideration, to move onto better things in Lyon—she has rheumatism and herhusband ‘swore he would finish his career in a bigcity’. Urban aspirations notwithstanding, they extol thevirtues of the canton to Knock: a railway far enoughaway for the clientele to stay put, no competitor, achemist who doesn’t try to do the doctor’s job, nomajor overheads. Knock seems uncommonly interestedin what kind of diseases his prospective clients mightsuffer from, and is put out to discover that the localpeople generally come ‘only for a single consultation’.There are no regular patients: it’s not like the baker orthe butcher, exclaims Madame Parpalaid, who takeshim for a bit wet around the ears. Knock is forty,Faust’s age; though he admits to having completed histhesis only the summer before. Its title? ‘On imaginarystates of health’, with an epigraph from ClaudeBernard: Les gens bien portants sont des malades quis’ignorent. Well people are sick people who don’tknow it yet.

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This is a motto about the unwitting patient in all of us,and it turns out, ominously, to be the most telling linein the play.

There are already some subtle worrying signs aboutKnock. He doesn’t know the church feast-days, noteven Michaelmas, which is when Dr Parpalaid’spatients are in the habit of paying him. (Dr Parpalaidhas roguishly sold the practice just after this date, thusgiving Knock grounds for accusing Parpalaid ofattempting to fleece him—but when did a doctor everbuy a practice withoutseeing it first?) As a child he was apparently an avidand precocious reader of the information slips tuckedaround bottles of pills: at nine he could recite entirepharmacopoeias of side-effects. He has already been aship’s doctor, he informs Madame Parpalaid, and forthe duration of the voyage had crew and passengersconfined to the sick bay: only the expediency of aroster kept the ship manned and the engines running.In short, Knock has a vocation and no ordinary one atthat; and he has a ‘method’.

Knock arranges visits with the other members of thecabal: the teacher Mr Bernard and the pharmacist MrMousquet. His language is fulsome and ingratiating.He bludgeons the former with the modern horror ofmicrobes. He describes the presentation material thatwill amplify the effect of his public lectures: ‘All ofthis illustrated with superb pictures: bacilli enlargedthousands of times, typical stool patterns of typhoidpatients, infected nodes, intestinal perforations, and notin black and white, but in colour: all the pinks, browns,

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yellows and pale greens you can imagine.’ Poor MrBernard, who is an impressionable type, isoverwhelmed, and protests that if he gets involved hewon’t be able to sleep himself. ‘That’s how it shouldbe’, retorts Knock, ‘what I mean is: that’s exactly thekind of fright we have to deliver. We have to shock theaudience to its core […]. Because their fatal error is tosleep the sleep of false security—then disease wakesthem like a thunderclap, but it’s too late, too late.’

Historically in France, pharmacists occupied thesubsidiary role of marchands-épiciers; they were themoney-hungry apothecaries and suppliers of unicorn’shorn who inspired Molière to create Purgon andFleurant. Knock flatters Mr Mousquet with talk ofcollegiality. A physician who can’t rely on a first-classchemist is ‘a general who goes into battle withoutartillery’. They discuss the low volume of tradegenerated by Dr Parpalaid, and Knock wonders‘whether he really believed in medicine’. This, forKnock, is a scandalous state of affairs when all theinhabitants of the district are potential clients.

With teacher and pharmacist now on his side, Knockengages the local odd-job man, who doubles as town-crier, to tell the country folk that consultations are tobe given free of charge at the surgery on Mondaymornings. When he asks the town crier what thetownspeople used to call his predecessor, he discoversit wasnever ‘Monsieur le docteur’, but often asoubriquet—Ravachol. Romains is enjoying a littlejoke with his audience. Ravachol was a notorious

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anarchist in nineteenth-century France (his actual namewas Kœnigstein) who ended up losing his head to theguillotine, though one of his ditties, Le Bon Dieu dansla Merde, was resurrected by the Situationists in the1960s. His name marks Dr Parpalaid out as an old-fashioned believer in anarchism as against the powerof capital and the State, though it has to beremembered that nineteenth-century anarchism was notirrationalist, and largely eschewed violence: it was themost serious utopian alternative to Marxism. It stillfinds some expression among French doctors who,rather than acknowledge the unwelcome fact that themedical profession needs the state to safeguard itsmonopoly in providing treatment, defend what theycall ‘liberalism’ as a solid defence against theintrusions of government into private life. What hadbeen hotly discussed issues in the 1840s were taken upagain, though with a weary acerbity, after the debacleof the Great War. Romains rather vaguely defined hisown philosophy of unanimism, which opposedliberalism’s concept of the individual in the belief thatit simply handed even more power to statebureaucracies, as ‘a natural and spontaneous harmonywithin a group of people who share the same emotion’.His platform was a form of syndicalism. What isinteresting about all this is that Kropotkin’scooperatives and Proudhon’s theory of ‘mutualaid’—not unlike unanimism—leaned on Darwin’s lawof natural selection just as much as Spencer’scompetitive model of evolutionary sociology and theeugenic movement that followed it, suggesting thatthere is no straightforward leap from scientific topolitical ecology. Indeed, Dr Parpalaid’s

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anarchism—of the utopian, non-bombing, moralistickind extolled by Tolstoy—looks mostly like a practicalphilosophy for smallholders.

All of this is old hat to Knock. His ideal of socialorganisation is a form of hygiene organised aroundhimself as ‘continual creator’ and saviour. His methodis finely calculated and carefully organised. Heassiduously acquaints himself with the incomes of hisclients. Blackboard, anatomical chart and reflectinglaryngoscope are used to devastating effect in hissurgery. Patients are stripped of their defences,beginning with the flimsy mantle of insouciance whichhas hitherto protected them from worrying abouttheir health. ‘Est-ce que ça vous chatouille, ou est-ceque ça vous gratouille’, he inquires of the town crier,hilariously mangling the language, splitting hairs andechoing Hamlet all in the one phrase: ‘do you have atickling feeling, or is it more a kind of prickling?’ Ifit’s an itch the poor man thinks he has, it must be amortal one. The Lady in Violet, a certain ‘dame Pons,née demoiselle Lempoumas’, gets the shock treatment:her insomnia, which Dr Parpalaid had never takenseriously—he used to tell her ‘to read three pages ofthe civil code every evening’—may now be the resultof a ‘pipestem deformity’ of the intracerebralcirculation or perhaps even a ‘sustained neuralgiformcrisis of the substantia nigra’. Or perhaps, as Knockadds in an undertone, it’s just a big black spidersucking on her brain.

Knock’s use of ‘big words’ to terrorise the Lady inViolet is one of the oldest medical tricks: think of

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Molière’s cod Latin-spouting Sganarelle in the mostfamous predecessor farce le Médecin malgré lui(1666), or the nuciform sac, a structure unknown toany anatomy textbook but wielded to good effect bythe surgeon Mr Cutler Walpole in George BernardShaw’s play The Doctor’s Dilemma (1906). Thedescription of Walpole in Shaw’s stage-directions evenresembles Jouvet’s portrayal of Knock in the film: hisface, according to Shaw in his stage directions, looks‘machine-made and beeswaxed; but his scrutinizing,daring eyes give it life and force. He never seems at aloss, never in doubt; one feels that if he made amistake he would make it thoroughly and firmly...’ Itmay be scandalous to admit it, but dissembling haslong been part of medicine’s therapeutic arsenal:Knock proffers big words, not for the sake of the curebut for the rather more pertinent issue of reinforcinghis authority.

The nuciform sac turns up in another guise in AxelMunthe’s hugely successful, if hugely self-regarding,volume of reminiscences from the same decade, TheStory of San Michele (1929), in which he tells how,when working in a private practice, the fashionablediagnosis of colitis, invented precisely to save patientsfrom the scalpels of surgeons like Mr Cutler Walpole,‘spread like wildfire all over Paris’. Munthe, a youngSwede who qualified in Paris at the unheard-of age oftwenty-two, was once called ‘the most fascinating manin Europe’: his persuasive bedside manner brought hima large clientele of largely wealthy patients whom hebelieved should be made to pay for the poorer (Knockhas a system of ‘means-testing’ too).

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Several chapters of Munthe’s memoir, a best-seller inits time, are devoted to Jean-Martin Charcot, withwhom he trained at the famous Paris hospital La Pitié-Salpêtrière. Patients, doctors (most notably SigmundFreud, in 1885), and the public flocked to see the greatman in action in the auditorium where his mostly butnot exclusively female patients obligingly assumed,when prompted, all the dramatic postures of floridhysteria. Charcot took hypnosis seriously as atechnique for healing, though the psychoanalyticmovement as a whole, fearing that transference andcounter-transference would contaminate thepsychoanalytic method, shied away from suggestiontechniques; even then, hypnosis was to stay in the bagof tricks of many psychoanalysts. Munthe’s thumbnailsketch of Charcot speaks volumes for the magicalfunction of the medicine-man in an age that proclaimsitself thoroughly rational: the following passage wasactually omitted from the French translation of SanMichele, presumably because its hint of diabolismfailed to flatter the reputation of the Maître who haddominated French medicine for more than ageneration. ‘Charcot for instance was almost uncannyin the way he went straight to the root of the evil, oftenapparently only after a rapid glance at the patient fromhis cold eagle eyes.’ This is a description of amagician, not a scientist.

Once Knock has made it explicit, danger is like thehouse dust mite: everywhere. One might call it Gettingthe Fear. Knock encourages the local schoolteacher,Mr Bernard, to indulge his little obsessive-compulsivetic—‘Do you think, doctor... I may be a carrier of

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germs?’ Mr Bernard’s phobic reaction testifies to thepower of a mystery—the invisible germ—caught in thefull glare of scientific explanation. No other scientificfigure stands with such emblematic clarity inrepublican France’s sense of itself as the bacteriologistLouis Pasteur—‘le bienfaiteur de l’humanité’. It was,after all, the French Revolution that gave rise to thebelief that where a physician worked his cures therecould be no clergy, and that illness was a matter for thecommon weal. The evil of profiteering doctors woulddisappear once equality, freedom and fraternity hadborne their true fruit. Diseases would be classified;statistics collated; clinics built. Pasteur is emblematicbecause heembodies so well the due process of the positivistformula: theoretical research plus application ofacquired knowledge makes for general well-being.

Medicine, for the nineteenth-century French, was theadvance post of Progress. Such was its prestige thatZola made his novels case-histories: he anticipates oneof Knock’s lines in his novel Lourdes with the query:‘Supposing that after all there is a Power greater thanthat of men, higher than that of science? It is theinstinctive hankering after the Lie which createshuman credulity.’ In Zola’s literary-lab view of theworld, pharmacy is on a level with semiology. Whileflattering Mousquet, the only chemist in town, Knockastutely promises to triple his income within a year.Besides, aren’t they partners in the great fight againstdisease? When Mousquet points out that people haveto fall ill first, Knock retorts with a policy statement:‘“Fall ill”—that’s an old-fashioned idea! It has been

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completely overhauled by modern scientific medicine.Health is a word which could just as well be struckfrom the dictionary. What I see are people variouslyaffected by a various number of diseases of varyingvirulence. Of course, if you insist on telling themthey’re well, they’ll be only too happy to believe you.But you’re leading them on. Your only excuse can bethat you already have too many patients to take on newones.’

So effective is Knock in medicalising the town thatwhen Dr Parpalaid returns three months later to collectthe outstanding payment for the sale of the practice, hefinds the local Hôtel de la Clef full of patients. Thechambermaid (now nurse assistant) fails to recogniseDr Parpalaid and innocently insults him by adding thatshe hadn’t known there was a doctor in town before DrKnock. Mousquet is run off his feet with work, andloving it: ‘it’s not the old cabbage patch life of the olddays’. Mr Bernard, the schoolteacher, has moved on togiving illustrated public lectures on the need forperpetual readiness against the menace of the microbe.Public health was a major concern in the France thathad lost ten percent of its male population to the GreatWar: even Louis-Ferdinand Céline—a.k.a. DrDestouches, urban nihilist and Proust’s closest rival forthe title of greatest French novelist of the century—didhis stint to improve the stock of future generations,touring Brittany in a Rockefeller-funded campaignagainst tuberculosis in the period in which Knock waswritten, when he

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would sing, to presumably startled schoolchildren, ‘va-t-en, va-t-en microbe!’ to the tune of ‘Il pleut, il pleut,bergère’.

That these campaigns against the unseen menace in themidst of the French population were not without effectcan be surmised from the habits of an unquestionablyintelligent middle-class family of the period: SimoneWeil’s biographer David McLellan reports that in the1910s her entire family (which was a medical one),lived in fear of microbes and went about obsessivelywashing hands, opening doors with elbows andgenerally shunning intimate contact.

Knock astounds his predecessor with his figures for thelast three months, and not just the consultation rates:he knows the incomes of every household in thecanton. But it’s not their money he’s after, he assuresParpalaid: he has brought people to medicine, he hasgiven their lives a medical meaning. In the longmonologue at the end of the play he introduces thepathos of 250 households où quelqu’un confesse lamédecine, not to mention the climactic prospect of 250rectal temperatures about to be read simultaneously.He asks Dr Parpalaid to reconsider the view out of thepractice window:

You were contemplating a wild landscape, barelycultivated by human hand. Now I offer it to youimpregnated by medicine, fired by the spirit of oursubterranean art. When I stood here for the first time,the day after my arrival, I wasn’t too proud: I realisedmy presence didn’t count for much. This vast expanse

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of France had the temerity to spurn me and mycoevals. But now I’m as much at ease here as anorganist sitting down to play his instrument. In twohundred and fifty of these houses—not all of which areapparent because of the distance and thegreenery—there are two hundred and fifty bedroomswhere someone’s confessing the power of medicine,two hundred and fifty beds where a recumbent bodyattests that life has a purpose, and—thanks to me—amedical purpose. At night the view is even morebeautiful, for then their lights shine out. And almost allthese lights are mine. Non-patients sleep in the outerdark. They cease to exist. But patients leave on theirnight-lights or their lamps. For me, night banisheseverything that remains outside medicine, wipes awayits irritation andprovocation. Instead of the district we know there is akind of firmament of which I am the continual creator.And I haven’t mentioned the bells. Their first office forall these people is call them to my prescriptions; thebells intone my orders. Think of it: in a few moments,ten o’clock is going to sound, and for all my patientsten o’clock is when they read their rectal temperaturefor the second time: just think, in a few moments, twohundred and fifty thermometers will be inserted at thesame time...

Knock is acting not for his own good, he tellsParpalaid, nor even that of his patients, but in theinterests of that third thing: la médecine. Parpalaid isstruck dumb, bereft of argument; though Knock’sclaim to be serving higher interests should havealarmed him: here is a physician whose ethics come

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from Plato not Hippocrates. Without an effectiveriposte, the conclusion is foregone: soon the olddoctor, who has already had to suffer the ignominy ofhis less than rapturous welcome by the hotel/hospitalstaff, and who would seem to be the person best armedthrough his culture and experience to recognise Knockfor what he is—an agent of the great Lie—and therebyresist his blandishments, is being invited by hissuccessor for a rest cure himself. Knock’smedicalisation of the canton is complete.

Progress has come to Saint-Maurice, so it believes, andit is a collective progress which nobody has the powerto resist, not even Dr Parpalaid. A self-containedsociety forms as the spectator watches; it shares thesame hopes and fears, its solidarity is such, even afterthree months, as to repulse Dr Parpalaid when hecomes to collect the remaining payment on his oldpractice. Whatever fails to fit this world as interpretedby medicine is suppressed or rejected: medicine for theinhabitants of Saint Maurice is now the very content oftheir lives. They offer Knock a seller’s market. Heleans on what he is expert at inducing—fear: acontrived dart of panic that can make laughter fromspectators sound oddly complicit and uneasy. Theinhabitants of St Maurice might be suffering frommaladies imaginaires, but Knock is a master at the artof reinforcing that particular form of fright. Hisstrategy is simple but effective: he defines the bad,dictates the good. He invokes a cosmic principle,subjecting the horizontal society ofsupposedly autonomous subjects to the verticalidea—of divinity. Perhaps he is a latter-day Dr

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Mesmer, a magnetiser who makes the instruments ofreason minister to a prospect of salvation, plumbingthat part of the mind that is ineducable, a metaphoricbut no less fateful terra incognita the Frenchpsychologist Pierre Janet termed ‘the subconscious’five years before Freud.

Hygiene and politics

What gives pause in Romains’ brilliant farce is thatwhen it appeared, in the polarised interbellum in whichthe liberal consensus seemed doomed to disappear andEurope’s cultural avant-garde lent its support to new,illiberal forms of modernisation, Knock was interpretedas a parable about demagogues who seemed able tomould entire populations to their will. Knock was atype of Great Dictator, the politician with big plans: afew years after the first stage performance of Knock,Thomas Mann published his novel Mario and theMagician (Mario und der Zauberer), the story of ahunchbacked conjurer and ‘mind-reader’ Cipolla, whoplays the audience in the southern Italian resort ofTorre di Venere with his hypnotic patter—mixed inwith a good deal of patriotic fervour and xenophobia.He tries to persuade a waiter called Mario to kiss himin public; instead Mario shoots him dead. Mann wasfascinated by ‘primitive mass-democratic funfairvulgarity’ and the sometimes dubious figure of the‘artist’. He spent his last years in Switzerland writing anovelistic version of a short story Confessions of FelixKrull, Confidence Man (Bekenntnisse desHochstaplers Felix Krull) which had first appeared inbook form in the same year as Knock, 1922. Felix

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Krull was a high-society impostor who moved easilyacross a histrionic frontier between ideology andvaudeville knavery. That had been the year, too, whenMussolini—‘Il Duce’—came to power in Italy.

There are parallels. The more daringly absoluteKnock’s demands on the Saint-Mauriciens—he evengets the Lady in Black, who exudes ‘peasant avariceand constipation’, to renounce what is clearly her onlyreal passion in life, la bouffe—the more certain theyare of his authority to impose such strictures uponthem. Their microcosm, even though it is rural, has nosocially cohesive institution to counteract medicine’sexplaining power (henceKnock’s interest in Act I in discovering whether thetownspeople regularly attend Mass—white or black).Knock lacks any sense of scruple or limit, though herepeatedly claims to be the servant of a highermorality. He plays up to his patients’ amour propre,while drastically curtailing their freedom. Sacrificesthere will have to be. Soon his patients are runningafter something they already have. Mark Twain noted,with his usual pawky humour, how little of substanceis actually offered by health messiahs: ‘There arepeople who strictly deprive themselves of each andevery eatable, drinkable and smokeable which has inany way acquired a shady reputation. They pay thisprice for health. And health is all they get out of it.How strange it is. It is like paying out your wholefortune for a cow that has gone dry.’ Or it could be thatKnock is in thrall to an impersonal will-to-diagnosis:in the last scene of the play he tells Dr Parpalaid that

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his ‘involuntary diagnosis-making’ has become sohighly developed he dare not look in the mirror.

Romains must have been familiar with the book Self-Mastery Through Conscious Auto-Suggestion (1922)by Emile Coué (‘every day, in every way, I grow betterand better’), expounder of a muddleheaded belief inthe ‘science’ of self-improvement which enjoyed amassive vogue between the wars, as well asNietzsche’s visionary portrait of the ‘great deceivers’,salesmen who end up as their own first customers:‘The point of honesty in deception: In all greatdeceivers there takes place a remarkable process towhich they owe their power. In the very act ofdeception with all its preparations, the dreadful voiceand expression and gestures, amid the whole effectivescenario, the belief in themselves overcomes them; andit is this belief which then speaks so miraculously, sopersuasively, to their audience. [...] For humansbelieve something to be true if they see others firmlybelieve in it.’ (Human, All Too Human, § 52.)

In 1923, Knock’s claims to effectiveness were mostlylaughable. The farce was still a game. Medicine lackedsufficient prestige for its authority to be recognised asanything like a law of nature, as Simone Weil pointedout in her essay The Power of Words. She commentsspecifically on the power of institutions to ‘secrete’abstractions: ‘This particular kind of secretion iswonderfully illustrated by Jules Romains’ Knock withhis maxim: “Above the interest of the patient and theinterest of the doctor stands the

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interest of Medicine.” It is pure comedy, since themedical profession has not so far secreted such anentity.’

Not so far? Exactly a decade later German doctorswere among the most enthusiastic supporters of thesocial mutations of Hitler’s New Republic, servants ofa Medicine whose aims were ideological, over andabove the interest of individuals. Doctors were feted aswarriors in white coats, for National Socialism wasnothing else but ‘politically applied biology’ (HansSchemm, 1934). The Nazi ethos was actually based ona sacred biology, its internal logic consistent with theNazi belief that the party had been ordained to shapethe world’s destiny, a destiny which itself would bebiological. Science wrote the libretto, Wagnerprovided the orchestration. Robert Proctor’s study ofpublic health policies during that period categorisesNazism as ‘a vast hygienic experiment designed tobring about an exclusionist sanitary utopia’: paranoiaabout contamination and pollution wasn’t justmetaphorical, it served as a spur to concerted attemptsat engineering the health of the German population.Studies were launched into environmental hazards, andefforts were made to improve the German diet andreduce alcoholism. Hitler, as everyone knows, was anon-smoking teetotaller. The Nazi example is extreme,but it reveals the thinness of the line betweenindividual liberty and public compulsion: in a sense,public health is medicine’s peccatum originarium,subverting its proper concern with the individual thathas come down from Hippocrates.

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But where would we be without public health anddecent living conditions? A Times editorial of 1854,when medical scientists still believed that infectiousdiseases were caused by miasma or bad air, thunderedagainst John Snow’s attempts to improve the sanitaryquality of drinking water by shutting down thecommunal pump in Broad Street: ‘We prefer to takeour chance with cholera than be bullied into health.’How many club-members folded up their newspapers,one wonders, and wandered down through Soho toBroad Street, in a London lit by the new gas, in orderto test their principles directly at source?

Knock and the future

After the war, Romains’ prescience about the greatdictators was acknowledged in the breach, though anycomfort it might have brought him—vilified in thecollaborationist press, witness to the disgrace ofFrance, and deprived of the moral support of his friendStefan Zweig, who committed suicide in 1942 inBrazil—must have been slight. Cold-war Europe wasno longer the continent he had striven to save. Heended his days, in that famous retirement home fordistinguished French writers and thinkers, theAcadémie française.

It was left to Louis Jouvet, in an article published toconclude a conference at the Université des Annales in1949, to show how well he understood the ambiguousappeal of the play and its eponymous character:‘Twenty-five years ago, in a penetrating act ofinspiration, Knock revealed the direction a new

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mentality was going to take. [...] This mentality wasInformation and its strategies, astounding advances andviolent dramatisings; abrupt and terrifying revelations;the invention of new needs, new ways of breakdown;the exalting of fresh anxieties that humankind wouldfeed upon. Jules Romains announced, though we didn’tyet know it, the mad-cap mechanisms that were goingto rule the world, suggestion and self-suggestion. InKnock, like a prophet at the gates, Jules Romainssuddenly shone a light on power, the upsurge ofguiding concepts (idées-forces) and collective theories.Humankind is a machine to make gods and everyleader of men a creator of myths. Jules Romains,philosopher, moralist and dramatist, provided anadmirable advance warning of the modern and all-encompassing mechanism of cohesion andconviction...’

Romains’ play is still read and studied by Frenchschoolchildren, which is cheering. But it seems to havehad little effect as critique on the original experimentalsociety: France is now one of the most highlymedicalised countries in the world. The post-warperiod saw the medicalisation of France in the grandstyle, a process dramatically accelerated by the eventsof summer 1968. ‘Knockisme’ has entered the Frenchlanguage, and is used occasionally in medicalanthropology as a descriptive term for popularcredulity and gullibility. Yet the play is more than astudy of dupery: the Italian philologist Guido Ceronettinoted that all the old satires on medicine and doctorslook backwards, over their shoulder;

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Knock, on the other hand, steps confidently into thefuture. It is a play that capitalizes on Marx’s idea oftragedy reinstated as farce—except that the farcecomes first and the tragedy later. The villain of thepiece allows himself a smile just once in the play (orrather the film), while reading the town crier’s mind.He has made a discovery, and it isn’t medical butmythic. In the great Lie, wrote Hitler, there is always acertain force of credibility. It is the powerful whosmile this way: it is a signal of their ironic treatment ofsocial conventions, as if laws existed only for thestupid. Knock has found a way to deflect hubris. Bydeflecting it from himself, he obliges Nemesis to visitthose who take him at his word. Nemesis is user-friendly and not at all dramatic, ladies and gentlemen,for these are modern times—Nemesis is the realisationthat desire is both prerational and manufactured to thehighest quality standards. Nemesis is the actor actedupon. Just look around. Despite all our best effortsillness refuses to disappear. It takes on new forms; itturns up where nobody left it; it gets invented by theinstitutions set up by the political and social relationsof civilisation itself, which include the medicalprofession. Then the misfortunes to which doctors owetheir livelihood—disease is, at least, a naturalevil—become ambiguous in hitherto unsuspectedways. People start to visit the doctor not so muchbecause they are ill, but because they are unable to behealthy. Soon doctors start to resemble lawyers, whoalso owe their livelihood to an evil, but not a naturalone. And before we know it, we are opening the dooron the world of Knock’s higher cynicism: with his

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right hand he accepts the fee for stilling the devil setloose with his left...

But that left hand has created a community of interests.Knock treats the people of Saint Maurice coldly, likean anthropologist. He simplifies what he says, thenrepeats himself. Isn’t it that people ask to be deceived?Alright, he will deceive them. Order requiresdomination, and domination requires a lie or two. Sohe gives their lives a medical meaning. That is: heextends the bounds of the biological, of whose oracleshe is the interpreter, so as to make illness not just abodily phenomenon but an organising principle for theeffective administration of society itself: it is, for itsadepts, a higher truth. His argument is life, for that iswhat a doctor defends. His tools are ideals, seduction,fright and—if necessary—the threat of violence. Hispower is his command of language; in that respectnothing has changed since Molière’s day: Knock is asmuch a storyteller, raconteur, bluffer, salesman and‘habile homme’ as Sganarelle, who was a subversivevalet and sham doctor. But who’s talking sham? Knockgives everyone the fever. Then he inoculates hispatients with the one idea: self-preservation, at anycost.

We have to go back to the beginnings ofEnlightenment and the twilight of the traditional worldfrom which doctors derive their sacerdotal aura to findout why. The first realisation that the equation‘knowledge is power’—Knock’s recipe—could turn inon itself, through the force of imagination, is to befound in the work of one of the wittiest and most clear-

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sighted philosophers of the period, Georg ChristophLichtenberg (1742–1799). Around the time of theFrench Revolution—that historical rupture thatchanged the role and status of the medical professionfor better and worse—he wrote a short but pregnantaphorism. ‘Health,’ he told his scrapbook, ‘iscontagious.’

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A Conspiracy of Good IntentionsPROZAC AND ITS IMITATORS

Prozac®, as Carl Elliott writes in the introduction toProzac as a Way of Life, may have begun life as abrand name for the active ingredient fluoxetine, but itis now a descriptive epithet for the entire family ofselective serotonin reuptake inhibitor drugs (SSRIs),and, by extension, a lifestyle. When people say Prozacthey may well be talking about something else, forProzac has been so successful since being launched onthe market that it has reared offspring: Paxil®(paroxetine), Luvox® (fluvoxetine), Zoloft®(sertraline), Effexor® (venlefaxine) and Celexa®(citalopram). And the number of disorders these drugsare licensed to treat has broadened well beyonddepression to include conditions all but invisible untilthe 1990s: social phobia, panic disorders, eating

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disorders, post-traumatic stress disorder and sexualcompulsions. When Eli Lilly’s patent for Prozacexpired in 2001 it was marketed under a differentname, Sarafem®, as a treatment for ‘premenstrualdysphoric disorder’. The bottom line would seem tobe: if you want to sell drugs, sell the disorder first.

Prozac as a Way of Life, eleven essays by differenthands, is an unusually literate attempt to take themeasure of the world that made Prozac and itscorollary: the world that Prozac is making. Prozac hasbeen with us long enough now for it to have gone theway of all drugs: first its acclamation as the universalpanacea, then media boosting, followed by the slowemergence of doubt, media quickening of doubt, andfinally the backlash (we are currently between stagesfour and five).

If Prozac has the ability to alter feelings and actions,reshaping what we call empathy, the bonds ofmutuality between individuals, then it has the ability toreshape the fabric of life itself. What can be said aboutthe place in society that the SSRIs have come tooccupy? Does it bear any resemblance to the situationin the 1960s, when Valium®—‘Mother’s little helper’,as the Rolling Stones mocked it—was prescribed inlarge quantities to help women endure what ErikParens in this book calls ‘patently unjust socialarrangements and attitudes’? Can Prozac truly be aliberating drug, as many of its supporters claim, whenits use increases dependency, if only the minimaldependency of patient on industry (not to mentionmedical profession)? If the bulimic consumption of

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antidepressants betrays an essential lack, what is itpeople are missing? Or do antidepressants in some asyet poorly understood way ‘recruit’ those patients whoare likely to respond to them? And then there is thelibertarian twister: if every culture has its licitpsychoactive substances, from betel nuts and kava toalcohol and nicotine, why should the medicalprofession be the sole guardian of access to SSRIs?

Depression is our contemporary diagnostic black hole.Consider the statistics: from being a rare diagnosis(affecting perhaps fifty people per million) in 1957,when the first antidepressant was discovered, by 1970the number of depressed persons was estimated by thepsychiatrist Heinz Lehmann to be one hundred millionworldwide. The Swiss pharmaceutical company Geigyactually decided not to develop imipramine in the1950s on the grounds that the market was too sluggishto provide a return on investment. In the 1980s, thenumber of depressed patients on treatment in Francealone increased by one million. In the USAprescriptions for SSRIs increased by 20.9% in a singleyear (1999– 2000). According to the World HealthOrganization, depressionand cardiovascular disease are set to be the two majorpublic health problems of the third millennium: theprevalence of depression in the world’s population isthree percent. Prozac has excited the philosophers andethicists in a way that imipramine did not (asexemplified by Peter Kramer’s best-seller Listening toProzac).

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This suggests we are facing a phenomenon not just ofmedical or sociological importance, but a radicalanthropological change, and a mutation in the way wethink about ourselves. You can’t argue with success,but it looks as if we should, and in fairly sober words.Calling Prozac ‘Zen medicine’, as Susan Squier does,merely ushers us all the more completely into a kind ofsemantic overload while obscuring the material originof signs in the bodies whose productive activitiesprovide the continuity that might help us, as subjects,to avoid full-scale medicalisation.

The key essay in the collection is David Healy’sconference paper ‘Good Science or Good Business?’ Itwas publication of this account of a possible linkbetween Prozac and suicide in the Hastings CenterReport which led, controversially, to the rescinding ofHealy’s appointment to a post in Toronto. (The eventbrought into question the very impartiality ofbioethicists in the United States, all too many of thembeing in receipt of funding from corporate bodies.)Healy outlines how the regulatory response to thethalidomide disaster in the 1960s—in which thousandsof infants were born with congenital defects after theGerman company Grünenthal marketed it as an over-the-counter remedy for nausea in pregnantwomen—gave rise to the ‘disease states’ that are nowessential to secure FDA approval for any newmedication. For years the pharmaceutical industry hasbeen putting vast resources into gathering anddisseminating information to influence treatmentlobbies and the manner in which doctors prescribe.Nearly all university research has some involvement

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with the industry, which may also be funding somepatient support groups (Eli Lilly funds the NationalAlliance for the Mentally Ill in the USA, for instance).Experts often rotate between sectors, so that agovernment adviser may previously have worked forthe private sector, or directly for the industry itself. AsLaurence Kirmayer says in his article on the quitedifferent cultural experience with Prozac in Japan,‘professional autonomy rides the tail of marketing’.The advertising budget for Prozac actually exceeds thealready bloatedbudget for Nike running shoes. Even those lastbastions of objectivity in science, the medical journals,are not protected from the pressures and forces of themarket: Richard Horton, editor of The Lancet, haswritten that ‘[they] have devolved into information-laundering operations for the pharmaceutical industry’.Studies have shown that doctors tend rathercomplacently to underestimate the hold thepharmaceutical industry has over them. Furthermore,most practitioners are naïve realists—which is to saythat they treat their patients in good faith, assumingthem to be genuinely ill—and patients present withgenuine symptoms (which must be genuine sincethey’ve just been ticked off on the symptom list).Nobody appears to be trying to put one over on anyoneelse. Yet Healy suggests that Prozac is less likely to‘work’ when its effects are evaluated using patient-based, non-specific quality of life arguments ratherthan clinician-based rating scales (as would be adoptedin a single- or double-blind trial). We also know thatapproximately one third of all depressed patientsrespond positively to a placebo, though this finding is

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manifestly of little interest to the pharmaceuticalcompanies.

So what order of phenomenon are we dealing with?Can it be that modern psychiatry is based on somethinglike a category error brought about by the triumph ofthe biological model of disease in a society that valuesindividual initiative above all else while blinding itselfto those aspects of mind that reveal it as somethingshared?

This is the contention defended by Thomas Szasz, whoin his defence of classic liberalism has repeatedly andparadoxically drawn attention to the fact that mentaldisorders are above all metaphorical illnesses. ‘Whatpeople nowadays call mental illness, especially in alegal context, is not a fact, but a strategy; not acondition, but a policy.’ If depression did have aninfectious cause, the figures quoted above would bealarming though not altogether surprising: in the lackof anything like a necessary and sufficient cause, theonly statement we can confidently venture is thecircular argument that depression is the state of mindwhich antidepressants are able to act upon.

Wherein lies the ‘contagion’ then? One possibility weare forced to consider is that the mind is a rathersusceptible receiver of electromagnetically-mediatedimage-driven consciousness ratherthan the producer of the rare and difficult predicativeknowledge (of the form ‘A is B’) that is a feature ofgenuine science. Wasn’t that precisely why Platosought to condemn the scandal of mimetic poetry and

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myth in Book 10 of The Republic? Isn’t that the wholeforce of the religious critique of idolatry?

Prozac as a Way of Life lacks the historical long view.One thread that ought to be running through it is the(American) search for the authentic self, althoughthose who chase the drug bandwagon are manifestlyslaves to a conformism that makes the whole idea ofauthenticity look like a bad joke. The body-blow dealtby the Vietnam War to the onward march of theAmerican dream surely deserves consideration: the riseof post-traumatic stress disorder (PTSD) offers anintriguing parallel with that of depression. This labelgave war veterans a kind of moral legitimacy, andguaranteed them a disability pension. The Victorianimperial personality—disciplined, rule-observant,respectful of authority and fairly sure of itsentitlements—survived until the 1950s, and perhaps afew years longer in Britain (which had its 1968 revolttwenty years after everyone else); the new individualof the age of bounty is caught on the rack betweenwhat is permitted and what is possible. Choice is themantra, although the ‘choices’ increasingly look stage-managed. One aspect of the old-fashioned bourgeoislife that is easily overlooked is its dignity, but it was adignity that insisted on making distinctions betweenrealms of experience in order to wring order from atruculent and harsh reality. The cost of contemporaryliberation from socially ascribed rituals, practices andeven family links is a kind of free-floating anxiety. Forthe one condition that describes our life is itsoptionality. Many commentators bemoan ‘the loss ofvalues’ in contemporary society, the fact that people

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don’t ‘believe’ in anything any more. Who’s kiddingwhom! Every aspect of contemporary life is boggeddown in morality, especially the morality of doing yourown thing while looking over your shoulder to makesure that next door is doing hers too. It would seemthat the desire to authenticate the stirrings of the will isessentially a form of Puritanism. Despite the rhetoricof liberation, we are still within the tight little orbits ofCalvinist self-justification.

In the old Soviet Union, people who criticised thesystem were sent to psychiatric institutions for‘correction’ or ‘re-education’:the putative citizens of the expertocracies of thetwenty-first century, on the other hand, are likely to beso well-trained that if they feel a phobic phase comingon (i.e. an urge to criticise the radiant society erectingitself around them) they won’t commit themselves toan institution—they’ll just self-medicate. Well, thatwas what radical critics used to promote in the 1960swhen almost every commodity in Western culturepretended to offer some kind of psychedelicexperience; but it is salutary to remember too whatOrwell wrote about Swift’s Houyhnynms: ‘They hadreached, in fact, the highest stage of totalitarianorganisation when conformity has become so generalthat there is no need for a police force.’

Odd as it sounds, the more private and uniform (that is,the more autistic) it becomes, the more the techno-pantheistic self is forced to model its behaviour onothers. It is a kind of liberated false consciousnessbound by the same logic as Chesterton’s brilliant quip

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in Heretics about ‘the globetrotter living in a smallerworld than the peasant’. That is why the latestgeneration of psychoactive drugs is almost certainly, toborrow a phrase from Karl Kraus, the disorder towhich it purports to be the cure.

In the ever more complex and impersonal division oflabour in modern society, depression might be seen asa kind of decompression of the individual workingpart, clueless as to its place in the meaningful whole:this decompression is one of the inevitable ‘transactioncosts’ incurred by the complexity of the system, andone which can be cynically accepted provided thesystem continues to be ever more productive.Antidepressants will therefore intensify the problemsthey appear to resolve (and that goes for other‘pharmacratic’ developments such as Ritalin® and theso-called ‘attention deficit hyperactivity syndrome’).Kraus’ aphorism restates our syllogism: supply leadsdemand, rhetoric prompts discourse, outcome trumpsgenesis. It suggests that in our society, which positsagency in terms of the individual actor makingdecisions, it is actually the robust, impersonal andpragmatic empiricism of the great social experimentembarked upon several centuries ago (look: noExperimenter!) that now carries the day: last thingscome first. Reality has become the endless speculativefairground described by Leibniz even though we stilldon’t understand anything very much at all about therelationshipbetween consciousness and its physical embodiment:who we are, where we are or even when we are.

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Prozac as a Way of Life provides some helpfulapproaches towards an understanding of howdepression has become an epidemic. As Robert Burtonsuggested, in his solid and (I presume) widely unreadclassic of the English language The Anatomy ofMelancholy, published in 1621 when the humoraltheory of disease was about to be overtaken by the newvocabulary of contagion and commodities, one of thesymptoms of melancholia is not to know its cause.That cause may be civic in origin, not just a sickness ofthe soul.

Mention of Burton reminds me that I was once moved,in what I thought was a refreshing turn of honesty butprobably came over as a brutal quirk of exasperation,to suggest to one of my patients at the end of a longand not very productive consultation, ‘You’re notdepressed, you’re unhappy, and only you know why.’My patient looked shocked: how should I know what iswrong with me when he refuses to say? That was thelast I saw of her.

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Insomnia(in the Bed of Being)

The philosophy of non-sleep

Vladimir Nabokov wrote that the world’s populationdivides into two categories: those who sleep peacefullyat night, and those who sleep badly. He himself was anotorious insomniac: he was afraid of the night, whichhe called a ‘giant’.

E. M. Cioran, the Romanian desperado who became adistinguished French writer, was of the same opinion.‘Human beings,’ he wrote in History and Utopia, ‘aredivided into sleepers and wakers, two specimens ofbeing forever distinct from the other, with nothing buttheir physical aspect in common.’ This, he thought,

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was enough to account for a person’s ‘extravagances’,although what he had in mind was surely his ownwriting style. In 1982, he wrote: ‘It’s not sooverwhelmingly bad to have suffered from insomnia inyouth, because it opens your eyes. It’s an extremelypainful experience, a catastrophe. But it makes youunderstand things which other people can’t: insomniaputs you outside theliving, outside humanity. You’re excluded. […] Whatis insomnia? At eight o’clock in the morning you’reexactly where you were at eight in the evening!There’s no progress. There’s only this immense nightaround you. And life is only possible through thediscontinuity which sleep gives it. The disappearanceof sleep creates a sort of dreary continuity.’

Cioran is clearly an ungrateful descendant of the twolittle children in Adalbert Stifter’s famous Christmasstory Rock Crystal who err in a snow-storm on theirway home to their alpine village in the next valley andend up on a glacier shelf. These ‘tiny moving dotsamong the formidable masses’ seek shelter in abedrock cave. Safe at least from the world-obliteratingblizzard outside, they dare not close their eyes for fearof freezing and becoming part of the stone and icearound them. They sit in the emptiness of the hours tocome as well as in the surrounding immensity. It is notjust the black coffee extract they drink that saves themfrom the sleep ‘whose seductiveness invariably getsthe better of reason’: something of the grandeur ofNature itself wakens in them a resistance andwakefulness strong enough to withstand its mosthostile forces. The brother and sister in Stifter’s story

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have each other for company; Cioran had only himself.(Or so he liked to pretend: his companion SimoneBoué provided for his bodily needs for the decades inwhich he was reputed not to have slept, and evenedited his notebooks, but doesn’t appear once in hisvoluminous writings.)

Cioran wasn’t suffering from simple sleep loss. He hadforfeited the right to sleep, possibly because he knewtoo intimately the chaos of history and his own role init. His insomnia was a double privation. In the severalinterviews he gave late in life he often referred to theboyhood experience of having to leave his nativevillage of Răşinari for the considerably larger city ofSibiu (also known, like everywhere else in that part ofthe world, by another two names: as Nagyszeben andHermannstadt). The Transylvanian capital was then apart of the Austro-Hungarian Empire and for centurieshad been considered one of the outposts of Europe.Little Emil cried, inconsolably, all the way to town.

Cioran’s sleeplessness in the dead time was a stylisedform of the apprehensiveness expressed by anotherwriter adopted by the French—the philosopherEmmanuel Levinas. He had an oceanic phrase for it:‘insomnia in the bed of being’.

‘A kind of closing of the eyes’

Writers, it might be thought, are typical wakers: theirimaginative life is always at a tangent to ordinarysocial life, and not only for economic reasons.Literature is often a pursuit in the counterglow: only

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night offers the quietness in which a person can schoolhimself to work in the absence of those who have longsince turned in.

Franz Kafka complained much about sleeplessness ashe wrote into the small hours. He felt like a sentry oncosmic guard duty at the boundary of consciousness, asoldier on the Great Wall between belief and unbelief,fearful he might lose his life should he fall asleep.Guarding his appended body was what he was there todo, to neutralise all threats to it and secure itsworkings. Yet with so much effort being given over tostaying awake in order to keep watch over his organs,sleep was bound to seem enticing. ‘There is, in Kafka,’observed Elias Canetti, ‘a sort of sleep-worship; heregards sleep as a panacea.’

In fact Kafka, as even his most admiring criticsconcede, could be nearly autistic in his detachmentfrom social reality. Kafka’s attention to languageneglected the etymology of the word: to be attentive(from the Latin verb attendere) means to stretch outtowards, to bend to another person’s presence. Writingis a solitary activity; insomnia had broken the tacitsocial contract with the family. Avoiding sleep offeredhim a sense of hyperarousal: that was when he feltmost able to write. Hyperarousal was insomnia’svertigo. ‘Only in this way can writing be done’, he toldhis diary in September 1913, having spent all eighthours of the night writing his first successful story TheJudgement, his legs so stiff in the morning he couldhardly dislodge them from beneath the table. He had

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been making literature out of an unclaimed portion ofuniversal sleep.

Yet chronic sleep deprivation has its dangers, as Kafkawell knew—as well as posing problems for a man whowas a civil servant and factory owner in his daytimehours. ‘There are moments at the office while talkingor dictating’, he told his correspondent Grete Bloch in1914, ‘when I am more truly asleep than when I sleep.’

Although he wasn’t past taking a tablet or two ofBenzedrine to help him meet the deadline on acommissioned piece, W. H. Auden was no night-owl,and even distrusted writing that smelled of thecandle—what his classical model Horace might havecalled‘lucubrationes’. Auden wrote in Hic et Ille, ‘if youreally wish to destroy a person […] the surest methodis not physical torture, in the strict sense, but simply tokeep him awake, i.e., in an existential relation to lifewithout intermission.’ Seeing in the dark is one thing;seeing the dark another. Try to dispense with sleepseveral nights in a row and you are likely to end upinstitutionalised, and in an appalling state of psychoticdispersion.

Auden was an avid reader of Scientific American: hewould have read about the sleep deprivationexperiments of the 1950s, the findings of which wereavidly adopted by intelligence services as a way ofobtaining cooperative detainees. Sleep deprivation wasa torture method. Nowadays we seem to be happy todo the torturing by ourselves, on ourselves. Doctors

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report a vast increase in restlessness, irritability andinability to cope at work, school or with others, notleast in children. These cases of transient insomniaaren’t army-sanctioned experiments in existentialtension; they’re the result of people spending too muchtime interfacing with their gadgets. We’ve gone intovoluntary self-detention. In fact, only a very fewpeople have a genuinely low need for sleep (and stillfeel rested during the day): they mostly end up aspoliticians, captains of industry and chefs. The rest ofus become sleep debtors.

Friedrich Nietzsche, a sensitive diviner of new culturaltrends, thought there was something pathological aboutthe nineteenth-century’s obsession with the past. Helikened it to a kind of insomnia. Sleep is a desirablestate; it allows humans not so much to repose as toforget. In his eyes the great reading public, so eager torecuperate its own history, was about to have acollective breakdown through lack of sleep—a lack ofsleep so comprehensive, at any rate, as to induceforgetfulness. He had one or two experiences of goingwithout sleep himself, until his mind gave out.Nietzsche couldn’t have anticipated that SigmundFreud, who owed so much to his writings, was about toextend civilisational memory all the way back to theclay tablets of Uruk, in Mesopotamia: Freud was tobecome one of the great modern dream-readers. It wasperhaps only there—after anamnestic descent to theLand of the Great Rivers—that memory could truly goto sleep. James Joyce, too, associated the Tower ofBabel with sleep, perhaps in consideration of that greatline from The Epic of Gilgamesh, written in cuneiform

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before almost anything else in history but first readwith new eyesjust over a century ago: ‘Sleep, which spills overpeople, overcame him.’

Gilgamesh’s epic might be over four thousand yearsold but it was our great-grandparents who read it withtrue discernment. Rainer Maria Rilke was one of thefirst writers to appreciate its originality after it wasdeciphered at the end of the nineteenth century: in1916 he wrote, ‘Gilgamesh is stupendous! I [...]consider it to be among the greatest things that canhappen to a person.’ Elias Canetti was even morefulsome: the story of Gilgamesh had a crucial impacton his intimate life ‘such as nothing else in the world’.

Narcolepsy and wakefulness

Sleep, insomnia, oneiric states: they were all in the airof the early twentieth century. Nicolas Vaschede, aprofessional physiologist, confirmed in 1914 that sleepisn’t just the absence of being awake, but an activebiological process. All animals seem to do it; somestanding erect (horses), others on the wing (migratingbirds). Herbivores sleep less than carnivores, havingmuch to fear from the stealth of the latter. Sleepcertainly has its natural archaeology, but it took untilthe 1950s for scientists to understand fully its dynamic,oscillating nature, and the importance of what is calledrapid eye movement (REM) sleep, especially in infantlife. Even then biology may well be inflected bycultural practices: people in traditional societies (whogo to bed when the light fades) often get up in the

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middle of the night to engage for a while in socialactivities, and our immediate ancestors often rose topray for an hour or two before reclining again on thepillow. The odd thing is: we don’t understand why wesleep. William Dement, the American scientist whomapped sleep architecture in more detail than almostanyone else, wrote at the end of his career that ‘theonly reason we need to sleep that is really, really solid,is that we get sleepy’—and that is less a reason than aprecondition.

Sleep begets sleep. Or rather, going to sleep is astrange ritual in which the body pretends to be sleepingin order for the mind to become dormant.

Vaschede’s contemporary, that amateur literaryscientist Marcel Proust, assures us in hiscontemporaneous giant work ofextended physiology À la Recherche du Temps Perdu,that sleep is ‘the most potent of hypnotics’. Nokidding! The opening pages of his famous work arecertainly contagious; for years I could never advancefurther into his novel because, reading it in bed, Ifound the overture, which describes his characterSwann talking about his sleep experiences, sent meinto the thing itself. And once you’re in it, thelabyrinth of sleep ignores the law of time: Swann’sattempt to wake up ‘consisted above all in an attemptto introduce the obscure, undefined block of sleep that[he] had just been living into the framework of time.’Somehow, the living daylights resume. Never havethose hypnopompic moments of wakening ‘behind avestment of oblivion’ (as the frontal lobe returns us to

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the world in the first few minutes of awakening) beenmore lyrically evoked: Proust has a fantastic word forthe illusion of hearing bells in his dreams: he callsthem ‘aeroliths’. (There have been times when Ithought I was hearing the bells of Combray too, buttheir peal always turned out to be the chime of my old-fashioned alarm clock.)

Proust was unfamiliar with rural Ireland though. FlannO’Brien made much of his country’s soporific cultureand populated his novels with narcoleptic charactersready at a moment’s notice to fall asleep, even inpublic. His savant hero De Selby in The ThirdPoliceman muses to himself that sleep is ‘animmeasurable boon’, not least on account of his ownhabit of nodding off opportunely. ‘Several times I hadgone asleep when my brain could no longer bear thesituation it was faced with.’ If only it were that easy!His assumption suggests a country where thecharacters are neither quite alive nor quite dead,although the phenomenon known as a microsleep, inwhich the mind momentarily disengages with thewaking world, is by no means uncommon or restrictedto Ireland.

It is true that a degree of disengagement or even a stateof torpor may be necessary to assimilate someexperiences. Walter Benjamin, in his famous essay onstorytelling, suggested that the repose of a sleepingperson finds an analogy in boredom, ‘the apogee ofmental relaxation’, which he thought was becoming anever less common feature of modern life. In this stateof self-forgetful reverie, we are receptive in depth.

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‘Boredom is the dream bird that hatches the egg ofexperience’, he suggested in his famous essay TheStoryteller. ‘A rustling in the leaves drives it away.’

Flann O’Brien’s sleep-blanketed Ireland could neverknow the existential pangs of Cioran’s world. Yet akind of tonelessness adheres to them both. Une nuitblanche—the French term for a sleepless night—is themost exquisite torture, according to Cioran. ‘Youemerge in fragments, stupid, absent-minded, withoutrecollections or forebodings, and without evenknowing who you are. And it’s then that the dayappears useless, the light pernicious, and even moreoppressive than the dark.’ (Cioran eventuallydeveloped Alzheimer’s disease, and there is someevidence to suggest that sleep deprivation may beimplicated in its onset.)

The physiologists, professional and amateur, are right:we have an intrinsic biological drive to sleep. Sleepbenefits mind and body, and consolidates memories. Itmight be seductive to have the freedom to work, eat ortravel as and when we want, but our bodies haveanother agenda: under the coordination of a part of thebrain called the suprachiasmatic nucleus, the organs ofthe body actually follow slightly differentphysiological rhythms. There are even special lightreceptors in the eye that are uniquely responsive to theblue light of dusk and serve to recalibrate our circadiansystem: visually blind people are still able to respondto the wax and wane of the cosmos. It is only thosewho lack ocular bulbs—for whatever reason—who aretruly blind.

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Subjugating the night, in the manner recommended byso many writers—existential heroes in their ownversion of the Grimms’ story about the boy who set outto discover fear—might seem a victory for culture overbiology, but biology is far older than the lights ofcivilisation, and it is surely an illusion to imagine thatwe can gain a fuller life by remastering the internalorder we share with other living creatures.Nonetheless, the search is on. A recent articleannouncing the search for a ‘cure’ for sleep comments:‘Just as the birth control pill uncoupled sex fromreproduction, designer stimulants seems poised toremove us yet further from the archaic requirements ofthe animal kingdom.’ Whether they know it or not,wakers who celebrate ‘enhancement’ (or ‘150% life’)are also cheerleaders for the absolute rule andconsumptive tyranny of a 24/7 society.

Sleep is the charity of being alive, much in the sameway as forgetting allows us to reconstitutethings—even at the risk of repeating ourselves in themost dim-witted, imprudent, injudiciousways. Sleep is where readers are to be found, amongaeroliths and sundogs and lucid floaters. There is kindof expansiveness in being a sleeper too. Homer knewthat: in his epic poems sleep is a sacred gift. ‘Formortals cannot go forever sleepless’, Penelope tells thereturning Odysseus.

Being permanently awake under modern artificial lightmight just be a way of withdrawing from thecomplexity of human life, not least its ethicalcomplexity. Sleep ought to foreshorten time, and

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restore us, refreshed and purified, to the clarity of anew day. Proust’s thesis was that for most of our liveswe are asleep to our own true natures, and only wakenin the instant we recognise ourselves for what we are.Then, for the length of a lightning flash, our beinggrasps ‘what it normally never apprehends, namely, afragment of time in its pure state.’

Ethics in the dark

Insomnia in the bed of being: the phrase is a distantreverberation of the first flare of consciousness in theLand of the Two Rivers, some five thousand years ago.As another ancient dream-book has it, the world beganwith the interruption of a sleep. So what on earth hashappened to us, given that most of our working daysculminate in a few weary hours staring at indiscreetimages on what James Joyce, always alive to thesignificance of new inventions, called ‘the bairdboardbombardment screen’? Surely it is better to say, withthe Italian writer Erri de Luca, who gets up eachmorning at 5 o’clock in order to study the Scriptures inthe original Hebrew: ‘These pages are not the fruit ofinsomnia, but of awakenings.’ That is the rejuvenatingfirst sentence of his novel First Light. He discoveredthe Bible while working as a jobber on building sites inParis in the 1980s, and even now, long after he hasabandoned hard manual work, still reads it, not as abeliever or even a mystic without God, but assomebody who can’t get over his surprise everymorning at being alive. The only proof of existence iswakefulness. But that doesn’t mean reality comes to usspontaneously.

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In the Mesopotamian epic, Gilgamesh doesn’t wantsleep to pour over him. His panic-stricken encounterwith death is what the Czech philosopher Jan Patočkacalled a ‘shaking’: he movesfrom the vegetative life of prehistory into theunpredictable and problematic. He becomes conscious,and consciousness is like the sky: it is no shelteringvault. Yet consciousness isn’t his final self-hood.Gilgamesh is shaken again when his friend Enkidudies. Fearful of dying himself, he goes on a quest tofind Utnapishtim (‘the Faraway’) and his wife, the onlyhumans to have been granted immortality by the godsafter having first (like the biblical Noah) survived theGreat Flood. Reaching the island at the end of theworld where they live, Gilgamesh discovers that if hewishes to be immortal, he must show he is suited to it:he must stay awake for six days and seven nights.

In spite of all his precautions, he falls asleep. Beingimmortal clearly isn’t worth the candle: nobody wantsto experience eternity as a dreary, endless continuity.When he wakens again, Gilgamesh is aghast at hisfailure to withstand the test. But on his disconsolatereturn to Uruk, the city he built, he discovers that he isgoing to enjoy a form of immortality—only it’s notgoing to be the kind he was expecting: he will beremembered as the first civic hero. He is the firstbuilder of city walls, as well of those more abstractpartitions that mark out historical eras, politicaljurisdictions and even the frontiers of finite humanlives.

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Emmanuel Levinas’ philosophy gives priority to theexistence of others, their mere presence in the worldmaking demands upon us that are prior to theconstitution of the self. Ethics trumps metaphysics.‘It’s strange to think’, says Eluned Summers-Bremner,author of Insomnia: A Cultural History, ‘that we mightmost truthfully enact our belonging to the humancommunity by the act of falling into unconsciousness,the place in which we imagine others to be blissfullydwelling.’

If you find that notion hard to accept then you’realmost certainly doing time as an insomniac. Alone,under a cone of light, in the dark.

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An American Book of the DeadLIFE STUDIES FROM THE DISMAL TRADE

About 100,000 years ago the fossil record shows ourvery distant ancestors started tucking their dead underthe topsoil. Over a somewhat shorter timescale, butlong enough to identify the four horsemen as Stroke,Coronary Occlusion, Alzheimer’s and the Big C,Lynch & Sons have kept the tradition going, theAmerican way. The Milford, Michigan end of things ishandled by Thomas Lynch, undertaker and poet(Grimalkin and Other Poems, 1995). He does theworks—embalming, casketing, flower-arranging. If hehasn’t got the box your dear departed would havewanted, his brother Tim, working in the next town, canprobably supply it. High-temperature exothermic redoxcombustion can be arranged too, for those fewAmericans who insist on the somewhat cheaper

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method of disposal preferred by more than seventypercent of the British population, though fewapparently do. The American funeral industry seems tobe quite happy to keep things the way they are,embalming and interment and grave maintenancebeing the last opportunity to fleece the consumer.

Lynch has strong views about why embalming is partof the American way of death, much as he has mordantand occasionally proprietorial views about why weshirk our own undertakings. Some people might find itquite piquant to have flayed cows’ heads in formalinlooming over them—courtesy of Damien Hirst—whilethey eat in Soho restaurants, but it would be hard todeny that while death as a shared and communal eventis pretty much the distracted reality of late-twentiethcentury consciousness it has never been moresubjectively oppressive. Necro-kitsch is one name forwhat takes its place, and I dare say it won’t take verylong to find its intellectual equivalent in academicsocial science curricula. Sure, we talk things to death,and just about every child, it seems, has witnessedthousands of formatted ‘TV deaths’, but there is noescaping the sense that the symbolic weight of this,after all, most dependable event, has been separatedfrom common life and encysted in individual fears.Perhaps the late Dr Freud might have found it solidconfirmation of his Eros and Thanatos equation,obscenity being a more literal-minded word that it usedto be.

Indeed, if humankind can be roughly divided, as theCzech poet and immunologist Miroslav Holub has

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suggested, into those who go hunting and those whoclear up the mess afterwards, then undertakersevidently don’t have much time to be Hemingways.Thomas Lynch writes about himself as one of the‘dismal traders, funeral types [...] who dress in black,and work the weekends and the holidays, who line thecars and lay the bodies out, who rise and go out in thedark when someone dies and someone calls for help.’Having cleared up a few messes and signed passportsfor the ultimate journey myself, I was curious to seehow things looked from the other end of the table,though I should add that medical qualifications are noprerequisite for reading this book: Lynch has a fewtelling comments to make about that other Michiganresident, the man who was described in last year’sBritish Medical Journal as a ‘medical hero’. Dr JackKevorkian has now, at the latest body count, had ahand in twenty-eight ‘physician-assisted suicides’.Lynch bristles at the oxymoronic notion of anyonebeing assisted ‘in [their] one and only suicide’ anddubs Kevorkian’s idiosyncratic interpretations of apathologist’s duties ‘kevorking’. Here he touches on animportant argument about a physician’s dutiesto a suffering patient, and asks the perfectly legitimatequestion: ‘Is it possible to assist the ones we love withtheir dying instead of assisting with their killing?’ Aretired pathologist on a mission with a self-styled‘Thanatron’ in the boot of his car is somehow a veryAmerican response to the challenges of providingdecent palliative care.

As such observations would suggest, Lynch is neitherdeaf to the zeitgeist nor a lugubrious croque-mort. He

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comes across as a man of deep feeling and humanitywith a keen sense of his Irish Catholic roots. And whyshouldn’t he be guild-proud, a stickler for detail?Undertaking is a job which requires decorum anddecency, a sound grasp of the difference between whathappens and what matters, and hangs on a uncommonability to give form to the messiness of emotions. For apoet, it is nearly native habitat. Lynch tells of anEpiscopalian deacon deservedly receiving a verbal cufffrom the mother of a newly deceased teenage girl hehad been attempting to free from durance with theempty vessel of the professional grief-counsellor—‘“I’ll tell you when it’s ‘just a shell’”, thewoman said, “for now and until I tell you otherwise,she’s my daughter.”’ On that scale of delicacy, goodundertakers are probably as rare as good poets; Lynchactually steals a couple of recollections of poet-friendsinto his book, notably of the hypochondriac MatthewSweeney, ‘whose headaches are all brain tumours, hisfevers meningitis, his hangovers all peptic ulcers ordiverticulitis’. Sweeney comes in for somecompanionable ribbing for having no sense of whatmight be beyond ‘reasonable doubt’: implied criticism,no doubt, but preferable to the ingratiating tone of thepraise heaped elsewhere on Lynch’s editor RobinRobertson. That minor lapse occurs in an otherwisenicely judged essay called Words Made Flesh, whichgives us a fairly close look at Lynch himself (hidingbehind the name ‘Henry Nugent’), struggling throughalcoholism, a marriage breakup and the attendantloneliness. Generally, Lynch is very astute at avoidingthe confessional or even flaunting his expertise in what

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might be called the taxonomy of decay or the morebizarre paraphernalia of his trade.

If undertaking is a calling at 5 AM, it is also a business,and Lynch has a damper for the ‘News Hound’ at thelocal television station, whose ‘scoop’, defying anykind of business sense, is that Lynch & Sons have beenselling their caskets for more thanthey paid for them: Lynch reckons his profit margin isabout five percent, which doesn’t seem much in a jobwith such terrible hours. It therefore comes as nosurprise that he should remain unperturbed by JessicaMitford’s revelations in The American Way of Deathor Evelyn Waugh’s The Loved One, and in what is atonce the funniest and harshest essay in the book hesends up the ‘What Folks Want in a Casket’ approachwith a whimsical vision of golf courses doubling ascrematoria: ‘the combination of golf and good grievingseems a natural, each divisible by the requirement forlarge tracts of green grass, a concentration on holes,and the need for a someone to carry the bags—caddiesor pallbearers’. The same piece contains a rawlymoving account of a fellow undertaker working foreighteen hours at no extra pay to reconstruct thestaved-in face and skull of a murder victim so that hermother can grieve over her daughter’s recognisableremains. ‘“Barbaric” is what Jessica Mitford called this“fussing over the dead body”. I say the monster withthe baseball bat was barbaric.’ Lynch’s comebackseems misplaced; Mitford was targetting corporatetakeovers of independent firms like Lynch & Sons,companies such as Service Corporation Internationalwith their shareholders and annual report: ‘S.C.I.

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experienced the most dynamic year in its history in1994, reaching new milestones in revenues and netincomes while establishing a solid presence in theEuropean funeral industry.’ (I quote from a March1997 edition of Vanity Fair kindly left by an Americanpatient in my waiting room.)

Recognising ourselves among small acts of kindness,and recognising what is beyond any kindness, might bewhat this book is urging us towards. Thomas Lynchrecognises himself in ‘the cardiac blue’ of hisfather—the undertaker overtaken—who had arrangedwith his sons that they would embalm him when hedied, the fearful man whose characteristic first thoughtin younger life had been to ban his kids from doing theusual things children do because he ‘had just buriedsomeone doing the very thing’. Lynch recognises hisfellow townspeople by telling them back their own lifestories as he prepares them for burial, rememberingconvivial occasions disrupted by the mixture of frightand curiosity that the profession of making a livingfrom the dead provokes. Vindicating Gladstone’sadage, he writes, ‘the meaning of life is connected,inextricably, to the meaning of death; that mourningis a romance in reverse, and if you love you grieve andthere are no exceptions—only those who do it well andthose who don’t. And if death is regarded as anembarrassment or an inconvenience, if the dead areregarded as a nuisance from whom we wreak a hurriedriddance, then life and the living are in for liketreatment: McFunerals, McFamilies, McMarriage,McValues.’

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‘One so seldom learns the end of things in life’, wroteHenry Green in one of the sad little tales in his book ofcollected short writings, Surviving. Given that he hasbeen privy, time and again, to the only end of things,Thomas Lynch’s book is almost a miracle of feeling,tact and good sense, a remarkable and unbookish studyof all the implications of the word ‘undertaking’.Lynch has, in a sense, reclaimed the innocent belief hehad of it when he was a child: that his father’s jobliterally involved taking the dead underground. Hisbook is a small classic on the most universal subject,and why the care we give to those who are past caringultimately reflects how we look to ourselves, alive andcivilised. It is a long time indeed since anyone daredwrite an ars moriendi.

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Crise de FoieFRENCH MEDICINE AND THE LIVER

FOI (f): (Lat. fides ‘bond, engagement’) A belief notfounded on rational principles.

FOIE (m): (Lat. ficatum ‘goose liver fattened withfigs’): Organ contained in the abdomen, an extensionof the digestive tube, which secretes bile and carriesout a number of functions in carbohydrate, lipid andprotein metabolism.

– Petit Larrousse illustré

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Until the twentieth-century the history of making aliving out of other people’s bad days wasn’t anedifying one. For close on twenty-two hundred yearspeople thought disease came about if their blood,yellow bile, black bile and what can only be describedas slime were not in harmony. The cure was oftenworse than the disease, yet for all those centuriesbefore the dawn of Incredible Progress doctors neverseemed to go out of business.

Now that medicine seems to be limited only by itsmeans, perhaps it’s the vestigial memory of quackery,barber-shops and that odd business with leeches thatmakes the profession unwilling to admit there arethings about the body which leave its observer,if not its tenant, nonplussed. And even though scalpelsaren’t much of a weapon compared to scythes, doctorsnow think of themselves, with the blessing of societyat large, as progressive people at the cutting edge ofthe possible; that’s surely why they get hot under thecollar when such nonplussing suggests there is lessscience in medicine than generally supposed.Particularly if this insight comes from the patient, whomay expect his physician to be a soothsayer, prophetand salesman for eternal hope, not just someoneinsisting that if the one-eyed lead the blind we’llsomehow get there.

When I started up my own practice in Strasbourg,where many of my patients speak in strange tongues(twenty-two different nationalities I once worked out),I suffered such a double embarrassment; not merely

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one over commonplace terms, but also over the kind ofbodily reality those terms expressed.

The embarrassment was due to the fact that I didn’tknow what a crise de foie was or how to deal with it.In all my time in medicine, from the mother-country toseveral of its English speaking daughters, I’d nevercome across an hepatic storm, an acute liver, bile acidbuild-up (BABU) or anything else resembling thisliverish state of being. Even my own sister, who wroteher PhD thesis on one of the major detoxificationpathways in the liver, the cytochrome P450 system,had never heard of it. Something rare like acuteintermittent porphyria, about which there’s a film (TheMadness of King George), but a crise de foie? Itseemed all the odder that such an alarmist—almostPascalian—label should be given to a condition thatclearly wasn’t in the least life-threatening or physicallyincapacitating: hadn’t the patient just walked in thedoor unaided?

So I did some reading. It’s what Cecil Helman in hisbook Culture, Health and Illness calls a folk illness, aconfiguration of symptoms with no expression inbiomedicine, and for which a culture provides both anexplanation and a method of healing. There are othersimilarly tenacious folk illnesses across the world:amok in Malaysia, windigo in north-eastern America,dil ghirda hai (‘sinking heart’) in the Punjab, brain fagin parts of Africa, nervios in Latin America and coldsand chills in the English speaking world.Each condition exists in splendid isolation, maroonedin its cultural uniqueness; and I wasn’t a jot closer to

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understanding what a crise de foie was. Like everyother medical complaint in France, it had itspolypharmacy: strange elixirs containing‘oligoelements’ in snap-open glass capsules and‘eupeptic’ granulates to be taken ante cibum that wereunknown to chemists in neighbouring countries.Before France started rationalising its drug formularyjust a few years ago, at the end of the millennium,there were over one hundred preparations on themarket for the fragile liver, most of which harked backto the nineteenth century. Fumbling his lines once in achemist’s shop in Paris, V. S. Pritchett in an amusingpassage in his autobiography Midnight Oil tells us thatinstead of condoms he ended up with liver pills, and ina wild fit of ‘faith and superstition’ swallowed twobefore losing his virginity. As the great Canadiandoctor Osler said, the real difference between humansand animals is that humans want to take pills.

Besides, that a symptom might be trivial is a valuejudgement not permitted a nation of amateur bodytheorists. As Colette Mechin says, ‘you never tell aFrenchman he’s suffering from indigestion, for thatwould give grounds for suspecting some dietaryindiscretion’. Handle the French liver with caution:sensations of fullness, fleeting twinges and malaisemay all be heralds of the great adversary.

But the symbolic weight carried by the French liverstill wasn’t obvious to me. Why should being liverishrather than being splenetic, say, be the mal national?Come to think of it, wasn’t being liverish too literary,too poetic, to be much of a symptom? For me it was

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reminiscent of port decanters and portly gentlemen inone of Cruickshank or Rowlandson’s mercilesscopperplate etchings of eighteenth-century Englishquacks and society characters.

Reading encyclopaedias can take you places wherepeople speak far stranger languages than French even.

A patient with a crise de foie has the followingsymptoms: he feels bloated, has a thick head (but notnecessarily headache), water-brash (a bad taste in themouth), lassitude and a general feeling of what Kafkaonce told his diary was ‘seasickness on dry land’. Itseems to resemble what most stolid folk would call ahangover(gueule de bois in vulgar French) and doctorsdyspepsia, arriving like bad weather the morning aftersocial surfeit. Surfeit entails disgust; and fatty foodsare particularly contaminating and disgusting by virtueof their cloying properties.

Examination of such people is usually—as the phrasegoes—unrevealing. My response is usually to showsympathy and tell him (nearly always a him) to take acouple of paracetamol and change his diet. Primumnon nocere. Some doctors even stick—more out ofcuriosity than conviction, presumably—an acupunctureneedle into the cure-all Liv 3 point which is on thedorsal side of the foot between the first two toes. Theonce famous moral tract Traité de médecine générale(still in print) recommends ‘water only for 24 hours,vegetable broths, herbal teas, light meals, no alcoholand sleep’, a regimen not likely to offend anybody’s

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common sense. But I often have the impression thatsuch a pragmatic response falls short of expectations,especially when the liver can excite such purplepassages as this: ‘Her Shen was low. This could beseen in the bronze colour of her face, the slightlyrolled-back position of her eyeballs and her fatigueddemeanour. Her pulse was wiry and rapid, indicatingUprising of Liver Fire syndrome’ (Acupuncture inMedicine 11.96).

True enough, Chinese meridians make a big deal out ofthe liver. But what turns this little outpouching ofentoderm, tucked above the yolk sac stalk, into the seatof humanity? In physiological terms, the liver is thebody’s (extremely efficient) sewage-plant, proteinproducer, and sugar and fat regulator. It’s also thebiggest organ, and its right-regal size may well explainits preponderance in cultural affairs. A ‘critical liver’ isa leftover from Galenic medicine, medieval theories ofthe spirits (in fact, Galen believed the liver was thereceptacle of the ‘natural’ spirit, as opposed to the‘vital’ and ‘mental’ spirits lurking in the heart andbrain respectively), and Plato’s suggestion in Timaeusthat it was a divining mirror for cosmic space (chora);but while a recent evening-long search throughRabelais provided me with lots of extravagantremedies and nostrums, and the splendid line ‘for Ilove you with all my liver’, nothing very clearlyemerged that might explain the quintessential liver inall its majesty, nor all the sublime hot air it has givenrise to in French medicine. I therefore concluded that,French or otherwise, the liver is a signal instance ofhow we all

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think magically about our bodies. Not that our bodiesare magical, but nobody, not even the most brick-headed enzymologist, is likely to view his liver interms which exclude its miraculous ability to exempthim from toxic lapses. My own explanation thereforeerrs towards the Promethean.

Everyone remembers one thing about Prometheus(‘fore-thinker’): he had such a rush of feeling for earlyman that he gave him a spark of fire he’d stolen fromZeus as it smouldered in a tube of fennel (a penissubstitute, according to Freud, who thought that earlyman liked to snuff out fire by urinating on it). Themyth is more intricate. Prometheus had been one of theassistants at the headbirth of Athena; later she’d taughthim all the applied arts of civilisation includingarchitecture, astronomy and navigation. Decentlyenough, he passed them on to the human creatures heso favoured.

It was an act of expediency that led to Prometheus’eventual downfall: he showed Homo sapiens sapienshow to trick Zeus by leaving him only the bones andgristle when the sacrificial animals were apportioned.After being called in to judge a dispute at Sicyon, inthe north-eastern Peloponnese, Prometheus flayed anox and made two bags of its skin; one containing allthe prime cuts but with the tripe cunningly arranged ontop (in the hierarchy of organs the stomach was alwaysthe lowest and most contemptible), the other the bonesand gristle hidden under a layer of succulent fat.Zeus—‘whose wisdom is everlasting’—chose as thedivine share the bag with the layer of fat on top and

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bones beneath. He had been duped. All the edible meathad been left for the creatures Prometheus was bent onbeing kind to, except that Zeus arranged a subtlerevenge: humans might get the ‘better share’ but itwould always be accompanied by the demands of thestomach—that imperious, shameless, all-consumingorgan. Humans would become meat-sacks, hollowbags that would have to be filled every day in order tosustain life. The imperiousness of hunger would emptyall our more noble convictions and ideals and in timesof neediness turn us into animals. We would become,in a word, appetites.

There is a coda to the myth, and a somewhatmisogynistic one at that. Prometheus stole an emberfrom the sun-chariot and wrapped it in a fennel stalkfor ready use at the ceremony of thebarbecue. Humans might be condemned to eat meat,but at least they could cook it first. According toHesiod, Zeus turned vindictive: he made the beautifulbut simpering Pandora (‘all gifts’)—a gift being, as theGerman root-word alarmingly suggests, nothing otherthan poison—and sent her to Prometheus’ seeminglyslower-witted brother, Epimetheus (‘afterthought’),whose name suggests that, like the chorus of a classicaltragedy, his role was to bemoan the consequences ofhis brother’s actions. Her receptacle contained all thespites and evils like Vice, Labour, Bipolar Disordersand Geriatric Infirmity that have subsequently plaguedthe world, and made necessary such lesser evils asdoctors.

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And once the spites had flown the jar and causedPandora and Afterthinker nearly to die fromanaphylactic shock, what was left? A booby-prizecalled Hope, which must have been heavier than air toget stuck inside; it was Hope that prevented theirdescendants, driven nearly out of their minds by thespites, from doing away with themselves. (Thenineteenth-century German philosopher ArthurSchopenhauer once suggested that Hesiod got itcompletely wrong: it wasn’t the evil but the goodthings of the world which flew away from Pandora’sjar, leaving hope behind like a kind of miasmal slurry;and Friedrich Nietzsche tried to seal the jar again,precisely because for him hope was evil: it condemnswhat exists for something better.) Prometheuspyrphoros, the Fire-Carrier, ended up clamped to arock in the Caucasus, his liver being pecked out dailyby an eagle only for it to regenerate overnight—whichsounds like the modern biomedical concept of theliver. Only the rock, insisted Franz Kafka in hisminuscule fable about Prometheus’ apprenticeship insuffering, is the really inexplicable part of the legend.

So much for Prometheus and the longwindedness ofevolution, since the descendants of the eagle stoppedpecking his liver and started nesting in his rib-cage,and Pandora’s gift, it became clear in time, was a blackbox to tell us what had happened in the heroic dayswhen the gods mixed it with humankind.

But the myth made me think of the French again,confused—as only a deeply conservative people can

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be—by their self-appointed role for the last fewhundred years as the fire-carriers of modernity.Progress is a no less exhausting idea than its opposite:to think our bodies a metaphor for the decrepitude ofthe world. A crise de foie must therefore be a kind ofchronological vertigo—a morning’s retributivevisitation for sitting down the night before to supnectar, in that sense of complete and utter well-beingthe French exude only at the dinner table, as if the payslégal ruled by Reason had given way to a pays réel ofgastronomic abandon—Cockaigne orSchlaraffia—where the day’s only order is the tripartitecall to table. Botanising with their palates, as it were,in a world hermetically sealed against phasal eatingstations, ‘buns on the run’ and the golden ‘M’.

Yet gourmandising and apocalypse come togetherrather neatly in French consumptive habits, as seen togood effect in Marco Ferreri’s painfully bulemic filmLa grande bouffe (1973), in which four men, in aparody of Jules Verne’s voracious heroes, whose aimwas that of ‘eating everything, in impossible quantities,as often as possible’, stuff themselves to death onevery gastroglobal delicacy money can buy.Diagnosis? Fast food, slow food: myths are stratagemsto enclose their opposites. And livers follow a canniballogic. We have to sleep on them and they have toprocess those terrifying opposites, faith and doubt,which they do without fuss until dawn comes out, notrosy-fingered as Homer has it, but with a grey hair ortwo.

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Now you know the answer to the biliously rhetoricalquestion once posed as a title by the sociologist ofterminal man, Jean Baudrillard. What are you doingafter the orgy? Going to see the doctor, stupid.

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The Moral Life of HappinessA GENEALOGY OF DIMINISHING RETURNS

The Western world has never been more prosperousthan it now is, even if much of its wealth seems afutures trading version of the Biblical miracle of theloaves. What to former eras were utopian fantasies(greater productivity, reduced infant mortality, longerlife expectancy) are now so taken for granted wehardly notice them. We only notice that reality is amore complicated and obscure matter than hithertoimagined when things refuse to bend to our imperiouswills: this state of affairs is called a scandal. In thegarden of earthly delights, market forces have evenmanaged to turn hedonism into a kind of militancy.Yet journalists, sociologists and historians, SigmundFreud and the occasional professional ethicist areequally of one voice: we are not happy. It is one of the

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distressing futilities at the heart of modern life, onerelated to that other contemporary concern: the lessadversity we come up against the more we feel underthreat.

But what is happiness, anyway? Why do we think it fortheasking when it more obviously steals upon us like astate of grace… or reveals itself only when our moodhas ripened into regret? Why did some of the ancientGreek philosophers—and the idea is Greek—thinkhappiness was a matter of having as few needs aspossible? Are we too far gone in materialism toconceive of a neo-Platonic contemplator (Plotinus)asserting that even a person under torture can aspire tohappiness? What inspired the German philosopherNietzsche to write contemptuously of the Benthamite‘felicific calculus’ (which, refined into the tenets ofutilitarianism, has dominated so much thinking aboutsocial justice in the English-speaking world), ‘mandoes not pursue happiness: only the Englishman doesthat’? Was it good sense or just a kind of cynicalworld-weariness that compelled François de laRochefoucauld to write, ‘We are never as happy nor asunhappy as we imagine.’ And what led the poet W. H.Auden to insist in middle-age, in keeping with theprovidential arguments of an earlier age, that happinessis a duty? ‘Be good and you will be happy is adangerous inversion’, he wrote. ‘Be happy and youwill be good is the truth.’

These are some of the questions that the London-basedwriter Ziyad Marar attempts to answer in his

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conceptual history of happiness, The HappinessParadox, an invitation to meander through the author’sstock of select quotations, urban legends, film plots,personal anecdotes and yarns. He starts with the shiftin the term’s freight in the middle of the eighteenthcentury. No longer did happiness signify a state ofright living, less still the knowledge of being blessed inour lives—for the first time it made a gesture towardsfeeling good. Happiness had once served to describethe shape of an entire life (a largely miserable lifecould still be described as ‘happy’ if it was judged tobe a good life); now it was fleet and punctual, a statemore akin to gratification. By claiming in hisDiscourse on Happiness (1750) that happiness is amental state dependent essentially on somaticconditions, La Mettrie—best known for his conflationof biology and mechanics—was able to redefine itprimarily as a medical rather than an ethical issue.Happiness was losing its public dimension andbecoming a sensation, internalised and self-spectating,even though it was still apparent to more reflectiveEnlightenment thinkers, such as Diderot, that theacceptance of a given social life had hitherto beenthe presupposition to there being moral judgements atall.

By the end of the eighteenth century, happiness couldbe actively sought, being congruent to the aspirations,and perhaps even to the acquisitive rhythm of life ofthe property-owning classes. La Mettrie’s idea of manas a self-regulating machine was followed byHolbach’s conception of happiness (felicity) as thecondition to which humans, as physical beings, were

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entitled under the terms of the ‘natural morality’ hederived from the pleasure-principle and legislated foras the rule of social utility. (‘Unnatural’ morality wasthat imposed by the Christian religion, and furtherpropagated by the political institutions of the ancienrégime.)

After the French Revolution, the firebrand lawyerSaint-Just called happiness a new idea on earth, andtried to get it into people’s heads by guillotining asmany of them as possible—until he lost his own. Itwasn’t long before liberal writers like Stendhal weretaking to the road in France and Italy in an attempt tofind out just why happiness so rarely coincided withthe desire that clamoured for it. Perhaps Stendhalought to have stayed longer in England and morethoroughly wet his whistle, since, according to DrJohnson, ‘there is nothing which has yet beencontrived by man, by which so much happiness isproduced as by a good tavern’.

Part of the deeper problem was that the old concept ofhappiness as a social good had failed to disappearentirely: a market society might have no place forordinary human sociability in its theoretical scheme ofthings, but mutuality is still necessary for theemotional economy of any society, perhaps mostespecially that of an egalitarian cargo-cult. Society isnot simply a matter of relationships between persons; itis also the consciousness of those relationships in theminds of the individuals so related. Looking out forNumber One can’t help but become the focus of anunceasing manipulative tension.

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So Marar’s paradox is actually an intensification: itattaches to the fact that rather than having to legitimisehimself before God the new individual has to justifyhimself before other men, which, as Jean-JacquesRousseau complained most loudly and bitterly, is akind of secular hell. Being modern means having tocompare and be compared, to be saddled by theknowledge that there is no escape from having toplead, as did the Scottish poet Robert Burns, for thegift to see ourselves as others see us. We proclaimourselves unique and irreplaceable, but that claimlooks ridiculous when seen in the light of the equalclaims of millions more. So we veer like weathervanesbetween the absurd solipsism of being ‘self-made’, andthe abject plagiarism of prestigious others, a habitwhich advertises that the imitating acolyte hardlyexists at all except by the force of his imitations. Whatcould be more derivative or second-hand than cribbingfrom a model? What could be a better pretext forembarrassment, shame, humiliation and all theattendant self-conscious emotions?

‘The modern sensibility both wants to break free andwants to belong’, writes Marar. The more freedom weenjoy the less approval we receive; the more approvalwe seek the less free we become. His quasi-subjectsare the latest biofeedback versions of La Mettrie’spleasure-pain machines, oscillating between the polesof control and remission. Acceptance of this polarcondition offers, in his view, the perspective ofunderstanding how going after happiness pulls us from‘disruption to conformity and back again’.

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What he’s not talking about is not an approximation tothe old idea of the Golden Mean. Our societies are toocreatively unstable, our economies too dependent onthe cycle of appetites and disappointments, to allowthat kind of harmony. Ultimate questions of whatmakes for the good life have been leached of sense in acivilisation predicated on the notion that a perpetualbounty of material goods is the best way to guaranteesocial peace: modern man has been trained tointernalise a first-person doubt about all sharedopinions, as well as to be seduced by the potentiallyilliberal thought that governments can and shouldguarantee his happiness.

The US Constitution guarantees, as Marar observes,the right to pursue happiness; it wisely refrains fromsaying anything at all about the nature of happinessitself. Carl Elliot, an American bioethicist, takes theview, in his tolerant and mildly ironic book Better thanWell—the latest instalment in a modern traditionexamining America’s obsession with therapy thatbegan with Tom Wolfe’s 1973 essay ‘The MeDecade’—that the contemporary eagerness for thetechnological fixes offered by medicine has less to dowith consumerism’s infantile prospects of instantgratification than a touch of personal evangelism: thedesire to be fulfilled. To befulfilled in America is to be a self-respecting andrespectable social actor. It is to be a puritan once theoriginal premises of Puritanism have been forgotten.

If happiness is a duty that takes the form, especiallyafter the 1960s, of ‘an obligation to the self’, then the

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self-attending individual is bound to get anxious aboutbeing seen to be so beholden to others. Authenticity isat stake, and the very spontaneity of desire. In a societyof individualists nobody dare admit to being aconformist. Indeed, the only nobility in a world wherelooking foolish (being made to look foolish) is thebasic fact of social existence is awareness of the factitself, and its strategic use to deflate the condition thatimposes it: Dostoevsky writes about almost nothingelse.

Elliott’s chapters offer a thought-provoking touraround his theoretical speculations, moving from aconsideration of the pioneering American sociologistThorstein Veblen (who came up with the term‘conspicuous consumption’ as long ago as 1899) tosuch phenomena as the post-war rise of depression as aclinical diagnosis, short-lived psychiatric syndromeslike fugue state and repressed memory, the newphenomenon of ‘apotemnophilia’ (apotemnophiliacsare otherwise well people who go to any lengths,including self-mutilation, to become amputees: theseare individuals whose felt integrity can be had onlythrough loss of their actual physical integrity), and thevarious kinds of surgical and drug-based treatmentsthat promise to transform what would formerly havebeen thought unchangeable aspects of humanpersonality and identity. ‘Why is loneliness not / Achemical discomfort…?’ queried Auden in a poem of1960, anticipating by thirty years the assumptionbehind the latest generation of serotonin reuptakeinhibitor drugs. Elliott suggests that if Americansworry about these treatments, as suggested by the

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loaded term ‘enhancement technologies’ (which drawsattention to their transformative potential whileobscuring the fact that some may be quite conventionaltreatments of the restorative kind), it is largely becausethey worry about ‘the good life these technologiesserve’. Once the purview of medicine gets extended toboosting a person’s sense of well-being, then the scopeof potentially treatable conditions can only expandenormously.

Elliott cites Wittgenstein’s famous thought experimentof thecommunity of language-users with a ‘beetle in a box’,in which every person claims to know what a beetle isby examining only his own box, and has no right topeek into his neighbour’s—a logical parable to showthat what has a public dimension cannot be private,and that what is private cannot be a language—as amechanism for the seeding of doubt about status in ademocratic society; and the need to keep up with theJoneses. Are other people playing by the rules of thegame or pulling a fast one? Desire is not a democracy;it establishes new hierarchies. Elliott is describing notso much people playing a game but the world ofStendhal’s tormented and deadly serious vaniteux. Ourworld of escalating wants is the result.

While the American sense of endlessly manipulablewell-being is spreading with the global market, a senseof diminishing possibility fed to Europeans by theirhistorical sixth sense (not so much vestigial asundeveloped, we are led to believe, among Americans)has long made us experts in self-mutilation: our

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apotemnophilia is all at the symbolic level, which is ofcourse where it really hurts. Good Europeans havenever aspired to be happy: Freud’s goal was tominimize suffering, and psychoanalysis, at least tobegin with, offered a kind of negative freedom. Ittaught members of the middle classes how to cope withthe solitude produced by a market society.

Germany is a case in point. The great nineteenth-century Prussian novelist Theodor Fontane wrote, ‘thelarge city has no time for thinking and, what is worse,it has no time for happiness. What it creates a hundredtimes over is the Hunt for Happiness, which is actuallythe same as unhappiness.’ Such perspicuitynotwithstanding, it is a terrible historical irony that thenightmare history that followed the attempts of theNazis to fabricate a happy utopia based on exclusionhas meant that more recently in Fontane’s countryhappiness was once called—no doubt with polemicintent—a crime. This position, the vigilant reader willrealise, is the switch-side of the Marquis de Sade’s.

The greatest achievement of Elliott’s book, whichdraws purposefully on literature, history, sociology andanthropology, is to show just how some trends insociety demand to be examined not in thestandard quantitative Benthamite mode but as anextended essay in the manner of Montaigne (who has achapter in his Essays that bears the Aristotelian title,‘That we should not be deemed happy till after ourdeath.’). Elliott’s book bears comparison with some ofthe best essay writing on contemporary Americansociety—even if it neglects to say much about the

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deeper historical influences on American ideas ofhappiness.

Rousseau, for instance, is the torchbearer forAmerica’s recurrent sense of itself as an innocentcounty; and his dream of being a new Adam prior tothe troubling claims of adult civilisation could veryprofitably have been brought into the discussion. ‘Onemust be true to oneself; that is the homage which thehonest man must pay to his own dignity.’ Call self-fulfilment righteousness, and the essentially religiousnature of happiness crops up again, except thatmorality is a blunt thing in a society that ostentatiouslyrejects what some of its citizens complain it lacks: asense of limit and constraint.

Such is the peculiarity of consumerist America: it hasliberalism as its orthodoxy and not its radicalism, as inEurope, while retaining all the self-righteous fervour ofa dissenting religious utopia. Neither Elliott nor Marar,being thoroughly schooled in the cultural sociology ofluminaries like Erving Goffman, devote much attentionto the mechanisms of the market, which are credited asnever before with being able to maintain social peaceby their ability to deliver the goods—even thoughthese same mechanisms are manifestly in the darkabout human wants (unless we want to credit theInvisible Hand of the market with godlike rectitude).As Robert Reich argues in The Future of Success,market society is always threatened by the success ofits own productivity, which, if it were to satisfy ourneeds in the innocently self-evident way that befell thegreat minds of the eighteenth-century (‘Enlightenment

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in all classes of society really consists in correctlygrasping the nature of our essential needs’: GeorgChristoph Lichtenberg, 1789) would be bound to putitself out of business. It therefore has to skew ourregard towards things we can never have enough of.Thus are values swallowed up by desire, which in theend seeks nothing very concrete at all.

But that would be to lurch into metaphysics, and thecompany of the types Nietzsche suggested were evenmore contemptiblethan the Englishman. He calls them ‘the last men’.They have made any kind of criticism a sin, andhappiness the outcome of a state-sponsored populationstrategy. They indulge their little pleasures for day andnight, ‘but they respect health’. For these last men theold world was quite obviously barking mad. ‘We havediscovered happiness’, they tell his prophetZarathustra. And then they blink, in the terrifyinglyguileless spirit of that line in Alexander Pope’s poemEloisa to Abelard—in the eternal sunshine of thespotless mind.

Observing the distracted state of my contemporariessometimes convinces me that Nietzsche foresaw thenature of the last men all too accurately. But in fact thedictionary provides a remedy for despair. Theetymology of the word ‘happiness’ belies the prospectof its ever being planned: its Middle Englishcognates—chance, hap, luck—are terms for what is notdesigned or projected. Happiness has no recipe. Itcannot be engineered, as in the mixed-register phraseJane Austen artfully uses in Emma to describe one of

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her pushy characters, dressed in ‘all her apparatus ofhappiness’. It is the contrary of the deal offered by theprudent evangelisers who seek to protect us from risks.In fact, it has most to do with another word that alsoanswers to those three cognates: adventure. Happinessis a dare.

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An Empty PlotEMMANUEL CARRÈRE’S NOVEL ‘THE ADVERSARY’

In the small hours of Monday 11 January, 1993, LucLadmiral, a general practitioner in Voltaire-Ferney, adormitory town for Geneva on the French side of theborder, received a call to say that the house of his bestfriend in the neighbouring town was in flames. Whenhe got there the firemen were in the process ofbringing out the charred remains of the two children,Antoine (five) and Caroline (seven), and their motherFlorence. Only Jean-Claude Romand, the father, stillshowed signs of life. He was rushed away in anambulance, unconscious, to a burns unit across theSwiss border.

Both men had been friends for nearly twenty years,since university; both were doctors; they had married

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almost at the same time; their children had grown uptogether; Luc’s eldest child was Jean-Claude’sgoddaughter. And now this. A boiler had caught fire inthe night, and a family had been destroyed. In the stillof the early morning, the distraught Ladmirals prayedtogether thatJean-Claude would never come round from his coma.

When Luc opened his surgery later that morning twopolicemen were waiting to speak to him. The threevictims of the fire had actually been murdered, thechildren shot, the mother’s skull staved in. On going tobreak the awful news to Jean-Claude’s parents in thehamlet of Clairvaux-les-Lacs, in the Jura, his uncle hadfound the house silent. They too had been shot, alongwith their dog. The police asked Luc what he knewabout Jean-Claude’s life outside his family. Did hehave any enemies? Debts? Suspicious activities? Theywanted to know more about his post as a researcher atthe World Health Organization.

Luc knew very little about his friend’s professionallife. Jean-Claude had always been the soul ofdiscretion and modesty, adept at showing others intheir best light. His wife proudly told her friends hewas a ‘superdoctor’, working quietly away in a neon-litlab in Geneva to make all those wonderful treatmentspossible (although this is not what the bureaucrats atWHO do at all). Yet there was no official record ofRomand on the WHO staff list. Nor was his nameregistered with the regional medical council. The Parishospitals where he claimed to have done his internshiphad ever heard of him. Most oddly of all, there was no

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trace at all of him as a graduate of the University ofLyon Nord, where he and Luc had trained. There hadto be some mistake: this was his best friend. Hadn’tthey gone through medical school together?

A note, a confession of sorts, was found in Romand’scar; it referred to an ‘injustice’ connected with hischildren’s school. Someone had wanted to ‘punch hisface in’ after a dispute at a board meeting. Surely thiscouldn’t be a reason to massacre a family? Then aformer lover, a divorcee who had once lived nearFerney, phoned the police. Romand had met her inParis on the Saturday evening (the autopsies showedthat the family had been killed that morning) in orderto escort her—so she believed—to dinner atFontainebleau with Bernard Kouchner, founder ofMédecins sans Frontières and one of Romand’ssupposed big-name friends; on the way he had attackedand tried to strangle her. She had asked him to returnthe savings of 900 000 francs which she had investedthrough him, at an advantageous rate of interest, in aSwiss account. In fact, he had embezzled the money,hers being the last in a series of nest-eggs sucked dryin order to fundhis middle-class lifestyle. Nobody, it seems, had everasked him for receipts. A million francs had comefrom his wife’s family to supplement what he hadalready dispensed of his parents’ capital; nowquestions were being asked about the death ofRomand’s father-in-law several years before, after afall down a staircase while alone in the house with hisson-in-law.

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Three days after being rescued from his burning house,Romand came to. He was suffering from the effects ofsmoke inhalation and the barbiturates he had takenbefore setting the house on fire after his return fromParis. The police began a detailed investigation, andthe newspapers had a field day. Having first read aboutthe murder that week, on the day he finished hisbiography of the science fiction writer Philip K. Dick(a somewhat dysfunctional personality himself),Emmanuel Carrère, cult writer, père de famille andconnoisseur of parallel worlds, finally decided that theonly person who could answer the questions that hadbegun to trouble him was Romand himself. Six monthsafter the murder he wrote to Romand in jail: ‘I shouldlike you to understand that I am not approaching youout of some unhealthy curiosity or a taste for thesensational. What you have done is not in my eyes thedeed of a common criminal nor that of a madman butthe action of someone pushed to the limit byoverwhelming forces, and it is these terrible forces Iwould like to show at work.’ Along with his flatteringconcession that Romand might be the victim ratherthan the villain of the piece, Carrère sent a copy of hisnew Dick biography, realising only after posting it thatthe title might not be an altogether happy one in thecircumstances: I Am Alive and You Are Dead.

Two years later, having meanwhile written a balefulnovel about a murderous father (published in Englishas Class Trip) and having almost forgotten hisobsession, Carrère received a reply from the prison inBourg-en-Bresse. Romand had read his novel; herecognised himself in the child it portrayed; he was

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keen to co-operate. Thrown into a quandary, Carrèredecided he would reply. There followed an oddexchange of letters, Carrère adopting a deferential tonebecause of his ‘guilt about not being guilty’, Romanddilating on the meaning of his suffering (he had begunreading Lacan). He sent Carrère a clipping from apsychiatrist’s report: ‘he was part of them and they ofhim in a cosmogonic systemthat was all-embracing, undifferentiated and closed. Atthat level, there is no longer much difference betweensuicide and murder.’ Carrère’s intervention in his lifewas ‘a sign’: he was counting on the writer to explainhis story to him better than the psychiatrists had beenable to.

The trial was set for June 1996. Carrère went off for aweek to visit the places where Romand had played outhis double life, with an itinerary which had been drawnup by the murderer himself. He saw the hamlet in theJura where Romand had grown up as the withdrawnsingle son of a forester, the burned-down house inPrévessin, the parents’ cottage in the woods. It was adesolate experience. ‘And here I was again, chosen (astrong term, I know, but I don’t see how I can say itany other way) by that atrocious story, drawn withinthe orbit of a man who had done that. I was afraid.Afraid and ashamed. Ashamed in front of my children,that their father should be writing about that.’ All ofFrance’s crime reporters were at the trial. ‘It’s notevery day you get to see the face of the Devil’,commented Le Monde. Catching sight of the strainedfaces of Florence’s family, Carrère realises he is partipris for the accused: ‘It was to him that I felt I owed

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consideration because, wishing to tell this story, I sawit as his story.’

The story which unfolded in the courtroom was aconventional enough one for a bright country boygrowing up in a quiet part of the rural France that hadbeen transformed by the country’s post-war boom:France’s flight from the land occurred in livingmemory. The Romands had been foresters in the Jurafor generations, were almost a clan; his father, Aimé,was a timber manager, respected in the trade: a man ofprobity, quiet and undemonstrative. His mother Anne-Marie worried constantly, and often took to her bed, soJean-Claude learned to ‘mislead’ her so as not to makeher worry even more. Emotions were considered acaprice in the family, whose motto ran: a Romand tellsthe truth and shames the Devil. That left white lies:‘And when you get caught in that endless effort not todisappoint people,’ he explained to the presiding judge,‘the first lie leads to another, and then it’s your wholelife.’

He was an exemplary lycien. He received top marks inthe firstpart of his baccalaureate exam. His parents wanted himto follow in the family line of business; he admired hisfather and had a real love of the forest. So in order tocram for the Forestry Commission’s competitiveexamination, he went to a preparatory class in Lyon,arriving—if Carrère is to be believed—like some kindof Kaspar Hauser among the snobbish sons of themiddle-class for whom a forester was a plouc—a hick.It was a breach with his background and Jean-Claude

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suddenly felt a need to climb the social ladder. Heannounced to his family that he wanted to studymedicine, although what might have seemed to be ayoung man striking out on his own was actually thereverse. He had never had the slightest interest inpatients, he later told Carrère, and the thought oftouching bodies was repellent to him. He was payingobeisance to a social idol. Yet rather than being takenaback or disappointed by his decision, his parents weredelighted: Aimé’s son, the village boy, was makinggood.

At the Lyon-Nord medical faculty, he got to knowFlorence, a distant cousin. She was a down-to-earth,straightforward girl who seemed destined for anuneventful life. Soon it was understood that they werea couple, though Florence was notably reluctant toembark on the relationship; he was a big lad, and a bitflabby and unprepossessing. Together they were partof a clique that included Luc Ladmiral. Then the big liehappened, the crucial failure of will, the event that led,insanely but logically, to all the others. He failed toturn up for his crucial second-year exam, the ‘barrage’for clinical placements, and though he could havesaved face in a number of ways he told his parents he’dbeen accepted into the third year. He’d run smack intoa dead-end, as Carrère says, even before he’d startedout. ‘How could he have suspected that there wassomething worse than being quickly unmasked, whichwas not to be unmasked, so that this childish lie wouldlead him eighteen years later to murder his parents,Florence, and the children he did not yet have?’

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He spent that first term shut up in a studio apartmenthis parents had bought him. Weeks went by before Lucmanaged to get through to him, having assumed thathis absence was due to a quarrel with Florence. Whatwas wrong? Instead of coming clean, Jean-Claude letthe lie metastasise. He told Luc he had a Hodgkin’slymphoma, a tumour of uncertain prognosis whichallowedlife to continue more or less normally, but was liable toflare up unpredictably. Luc had to promise not to tellFlorence. Jean-Claude patched up his relationship withFlorence, and got a doctor to sign a certificate toexplain his absence from the exam. Soon he wasexpertly manipulating the anonymity of Frenchuniversity bureaucracy: for twelve years, he registeredas a second-year student, thereby obtaining a studentID card and a letter stating that he was not eligible tosit the entrance exam in September, a charade whichcontinued until 1986 when a new dean asked thephantom student to visit her in person. (Student statuswas a useful let-out from having to pay income tax,one later supplanted by his new identity as aninternational civil servant.) He tagged along to classeswith his friends, used the library, photocopied the samenotes: in short, did everything they were doing in orderto become the genuine article. Florence had failed thesecond-year exam, and decided to studypharmacology, so they weren’t in the same classesanymore, but that didn’t stop them studying together.Jean-Claude was bright and ambitious; Florencethought he would go far. He avoided the small clinicalteaching groups and of course the exams, though hewas often to be seen mingling in the nervously

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chattering crowd outside the hall. Nobody noticed hedidn’t actually go in.

Romand put more energy into being a sham doctorthan he would have done into being a real one. Thatmight be the prerogative of the true con artist; butRomand seemed to have derived no secret pleasurefrom his act of deception. He went off to Paris,ostensibly to prepare for the competitive trainingexams, and then told everyone he had bagged a post asa researcher in Lyon. Soon he and Florence had settledin Voltaire-Ferney, which was an ideal location for hisnext job: at the Geneva headquarters of the WorldHealth Organization. The children were born, Caroline(‘Caro’) and Antoine (‘Titou’). Romand never invitedcolleagues home, never put on airs. He didn’t want thechildren to think they were anything special. Indeed,he refused to be disturbed at work: not even his wifehad his office number. An answering service relayedcalls to him. It seems a shaky facade, but nobody evershook it to see if it held. Every morning he dropped hischildren off at school, and then drove to the WHOcarpark. Sometimes he used the ground-floor facilitiessuch as the bank or travel bureau, butnever ventured to the higher levels where security wastighter. That was in the beginning; then he moved on tositting in cafés, reading the papers, or walkingaimlessly through the forest to kill time. On Thursdayshe supposedly lectured in Dijon. He would fakeoverseas trips, holing out in the airport hotel beforereturning home to complain about jet-lag. He made apoint of bringing appropriate presents for the children.

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What finally brought about the implosion was hisdefence of the headmaster at the school, who had beendismissed after having an affair with another teacher.He drew attention to himself in the community; for thefirst time ‘he had said what he thought’. For the firsttime he was also under real pressure: his formermistress in Paris wanted her money back. One weekbefore the murder of his family the president of theschool board met Florence in the street and told her hecouldn’t find her husband’s name in the internal WHOdirectory. Then Jean-Claude’s mother telephoned,upset that the bank had sent a letter reporting asubstantially overdrawn account. He promised to see toit, reassuring her that it must have been a mistake.Later that week he obtained a bottle of phenobarbitolsolution from the local pharmacy, no questions asked.In a weapons store, he purchased a silencer andcartridges. Later in the week he filled some canisterswith petrol.

Carrère is like one of those ‘no apparatus’ divers whopractise the extreme brinkmanship of gettingthemselves winched down into very deep water, whileretaining just enough air in the lungs to prevent fatalloss of consciousness on the way up. Despite this spellof self-induced apnoeia, he manages a very sober style.It is one that wraps itself in an atmosphere of greynightmare, though his willingness to suspendjudgement and let the narrative drag him downsuggests a dangerous degree of identification with thisterribly modern story of posture and imposture. Thereis no floor to Romand’s personality (although one ofthe examining psychiatrists does say it—‘Jean-Claude

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would have made an excellent psychiatrist’), no planeon which motive might relate to deed. All writerssuffer from the apparent wastage of days, and mayeven attempt to make free with necessity: if Carrèrewrites with more than the usual guilt, it must be in theknowledge that his book willbe conscripted as one of the narratives Romand uses toreconstruct the meaning of a life of which he, the manwith the ominous name, woefully refused to be author.

The most unsettling moment in Carrère’s accountoccurs when he decides to visit the Jura and explorethe setting of the subterfuge for himself: he gets suckedinto a time-warp. The sense of dread he conveys ismore authentic than any emotion experienced by hissubject—it is a loss of self, of connection to the world.Liars try too hard to be plausible, which is what givesthem away; Romand—‘the big baby’—was radicallythoughtless. He had stopped thinking in that fatefulsecond year of medical school.

Carrère shuns forensic speculation: had he written astandard clinical biopic of a sociopath with obscurelyOedipal fears and a narcissistic sense of his own worth,we would have had a far less compelling story. Henotes that, in prison, Romand has acquired a newlyabject identity as ‘the lowest possible thing in society’and with the support of some enthusiastic Catholicprison visitors ‘“condemned himself to live” so as todedicate his suffering to his family’s memory’. This,he suspects, can only be another form of self-deception, the work of the ‘adversary’ of the novel’stitle, Satan, who is first mentioned explicitly at that

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terrible moment when Romand betrays his parents’trust. Satan could be more pointedly understood as theforce behind the social order as idol. If Romand waspossessed by anything it was the passively biddabledemon of conformism. Dostoevsky would haverecognised the type instantly. The literary critic andanthropologist René Girard spells out its effects: ‘Satancould be said to incarnate mimetic desire were thatdesire not, by definition, disincarnated. It empties allpeople, all things, and all texts of their substance.’ Theyoung boy from the woods who hasn’t woken up to thenature of responsibility chooses the one profession thatmight put him beyond reproach: medicine. Altruism istwinned with egoism, or recruited as a kind ofimmunity against its effects. Moving into adulthoodseems to have been a peculiar degradation for Romand.If being a man means being an actor (Gombrowicz),then all it took for him to be a doctor was toimpersonate one. He counterfeited the virtues. And itwas his overriding need to protect this idealised selffrom being unmasked in front of those to whom itmight conceivably have mattered that finally led himto murder. In Robert LouisStevenson’s famous novella, Dr Jekyll surrenders theintegrity of his person for the sake of that other‘integrity’, a spotless reputation. He ends up not somuch ensnared by his shadow-double, Hyde, as havingceased to be anybody at all.

While another contemporary novel comes to mind onreading The Adversary, not just because of theaffectless tone they have in common, Georges Perec’s‘infra-ordinary’ first novel Things (1965), a critical

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take on France’s emerging consumer society in whichtwo characters are tracked on their travels aroundFrance and Tunisia, its geographical setting suggests amuch older precursor. It unfolds in that part of theworld where Jean-Jacques Rousseau, havingabandoned any hope of recovering natural man,tormented himself with the distinction between amourde soi, a healthy self-preserving instinct, and itscorrupting double, amour-propre or self-esteem, aninvidious feeling derived from comparison with others,an emotion both relative and reactive. He was definingthe terms for the theatre of duplicity we all inhabit.Concerning everything which touched him in themobile prison of his paranoia—whether politics,education, or relationships—Rousseau kept lancinghimself with the one question: why do things gowrong? Moral progress can only be assessed by criteriawhose authority is external to personal desire: if choicealone is authoritative, then the individual is playing agame that is arbitrary and self-enclosed (hence theimportance for Rousseau of the general will).

It is certainly remarkable that another explorer ofselfhood, Friedrich Nietzsche—whose term for amour-propre was ‘the will to power’—should pen a maximthat describes the protagonist of Carrère’s book withuncanny accuracy: ‘The most dangerous doctors arethose born actors who imitate born doctors with perfectdeceptive art.’

The Gex region, where Romand set up home, straddlesone of Europe’s internal borders. Borders can bestimulating places for those of no fixed allegiance, but

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they also provide cover for people like Romand. Hisfiscal identity was smoothly adapted to his fiction, solong as it lasted. Strasbourg, where I live, offers aparallel: not only does it boast the highest density ofpsychiatrists in any French city, some of them bent onsolving the eternal question about how Alsace, whichis culturally Alemannic (middle highGerman), belongs to the ‘one and indivisible’ Frenchrepublic; it also has quires of bureaucrats prone to thekind of ‘holier than thou’ moral exhibitionism thatonly the administration of human rights, it seems, cangenerate these days. The existence in Geneva of atransnational organisation impersonally working forthe common good made it possible for Romand to stylehimself a minor Schweitzer even though the job hesaid he was doing had nothing at all to do with realpatients. Abstract piety allowed him to play thecontemporary double-bluff: individualism andbureaucracy need each other however much they hateto admit it. And we are all implicated insofar as wechoose to pursue a specialised form of knowledge andthen allow that specialisation to blind us to the order ofreality we actually inhabit. Literature knows thisdilemma better than society; Carrère’s book hints at aproblem that has leaked out of aesthetics and infectedthe social world. Although he refused to recognise thata lie—his lie—could ever be a sufficient cause,Romand grasped with near perfect deceptive art how toprotect what looked like autonomy; and when thefaçade cracked, he was prepared, as R. D. Laing put itin The Divided Self, to abandon everything dear to himexcept the fortress of his inner self, even though it hadbeen an echo chamber for years.

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This demoralising story of harm and deprivation is arelic of the mood that descended on France in the1990s, when the pressures of the global marketthreatened to turn the country’s never very solid civicinstitutions into a franchise in which self-determinationwas the sole measure of social legitimacy and the ruleof law the only buffer to egoism. It is as if, for Carrèreat least, the slogan of May 1968, sous les pavés—laplage, has flattened out into the vision of Romand’snull existence as he drives round the countryside: ‘avast beach of dead and empty time’.

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Chekhov Goes to SakhalinA WORKING HOLIDAY IN A PENAL INSTITUTION

Of all the great nineteenth-century literary figures,Chekhov is one of the few not to have had hisreputation debunked. This may be because he did thejob himself: a travel-book about Siberia?—a far-fetched literary gag indeed.

In early 1890 Alexei Suvorin, newspaper tycoon,editor of Novoye Vremya (New Times) and sponsor forthe trip to Sakhalin, the prison colony off the pacificcoast of Russia north of Japan which, with its meanannual temperature of zero Celsius, rude geographyand ten months of winter, was a cold, inhospitable

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place to sustain any kind of reforming programme,wrote to Chekhov in bafflement—‘no one needsSakhalin, and it possesses no interest for anybody’.Chekhov replied, in a tone of feigned affront, that hiswork would yield nothing for literature or science,although he wished to repay medicine ‘towards which[...] I have been a real swine’, and that in any case he‘had been growing indolent for some time now’ andreally had to take himself in hand.

Convinced? Chekhov wasn’t. He concedes, ‘none ofthis is convincing’, and then asserts, jauntily:‘personally I’m going out there for the most trivial ofreasons’. It was as if, to quote from A Boring Story,written not long before he hatched the Sakhalinscheme, he was about to acquire the ‘ability topreserve his dignity on a wild-goose chase’.

Sakhalin is off the map, a fleck on the flank of Asia.The island had officially become Russian territory aftera dispute with the Japanese in 1875, though theRussian government had long been sending convictsthere. Tundra over much of its northern half, forestedwith spruce, birch and pine in the south, this longmountainous backbone in the sea of Okhotsk is aboutas far away from Moscow within Russia as Chekhovcould get: 5000 miles. And it wasn’t just that.Chekhov’s decision to go overland—the first sleepersfor the Trans-Siberian Railway would be sunk tenyears later—rather than follow the usual shipping routefrom Odessa around the coast of Asia (which is howeveryone got there, except the chain-gangs) is just asodd as deciding to go at all. He seems to be making an

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ordeal out of an epic: the Great Siberian Highway waslittle better than an unsealed dirt track.

Opting for sackcloth and ashes, even if only for thespace of a summer vacation, would have been toomuch like his childhood in Taganrog to appeal toChekhov; and it is difficult to match the self-imposedrigours of a coach journey to Siberia with thephilosophy of idleness he espoused but never practiseduntil his tuberculosis made it unavoidable: ‘My ideal:to be idle, and love a fat girl.’

Chekhov had no legal qualifications, and he wascertainly not a bleeding-heart liberal. If anything, hetended to mock ‘do-gooders’; he steered clear of thevocal, politically radical faction in the Moscow literaryscene and disliked the often crudely stereotypic wayEnlightenment and Reaction were portrayed incontemporary novels. Although he’d been writingsince his student days, Chekhov’s own claim to be aserious writer was at best a few years old: hiscollection In the Twilight was published in 1887 andhis most ambitious story The Steppe had appeared in a‘thick journal’, the Petersburg monthly Severny vestnik(The Northern Herald) inMarch 1888. Much of the ‘eighties had in fact beentaken up with what he called ‘balderdash’—captionsand advertisements, gossipy sketches of street life,comic calendars, literary parodies, questionnaires andeven a detective novel. Chekhov was writing for thenewly literate clerks and those who, like himself, tookthe train from Melikhovo, where he purchased a smallestate in 1892, to the capital.

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Of all his published fiction, 528 items—not includinghis weekly gossip column and other occasionaljournalism—were written between 1880 and thewatershed year 1888; a mere 60 would be written inthe remaining sixteen years of his life.

Contemporary events don’t clarify motives either.Chekhov had been deeply shaken by the ‘white plague’from which his brother Nikolai (‘Kolia’) died in June1889 and sister-in-law Anna the year before; and six ofhis medical year were to succumb to cholera andtyphus epidemics around the same time. Torpor andmorosity might have been more easily understandable.His own health, too, was increasingly undermined byparoxysms of coughing and bouts of haemoptysis,telltale signs of the TB that was formally diagnosedonly in 1897 (and from the complications of which hedied in 1904). Regarding which, his insouciance seemsflip and forced: his letter to Suvorin of 1888 is a classicin denial of a peculiarly professional kind—‘by itself,haemorrhaging from the lungs is not significant…’

In the background was Tolstoy, his literary Moses.Tolstoy had cast something of a spell over Chekhovfrom the mid-1880s; he had been involved, as aprecedent, in the visit to the wretched residents of theLyapin and Rzhanov Lodging Houses that he describesin What Then Must We Do? (1886). No book, perhaps,has better exposed the unhappy relationship betweenphilanthropy and pity in action. Resenting thecontempt of the housekeeper who supposedly looksafter them, Tolstoy’s words in defence of theprostitutes suddenly brings the place to life, in a scene

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he compares with Ezekiel’s field of bones quivering atthe touch of the spirit (a Biblical image that crops uptoo in the final paragraph of the final volume ofCharles Booth’s massive statistical survey of povertyin Victorian London); and yet their expectation of hissaying more—‘as though they had only been waitingfor that word to cease to be corpses and to becomealive’—suddenly makes him feel fraudulent. Abashed,he can say nothing at all.

‘Only a very unhappy man’, wrote Wittgenstein, ‘hasthe right to pity someone else.’

Tolstoy’s grip on the younger writer was on the wanebefore Sakhalin, but the journey may be seen as thefinal shadow cast by that influence. Yet Chekhovcheerfully neglects Tolstoyan principles throughout thejourney; in his letters to his family he worries aboutrunning out of cigarettes or vodka, and from the shoresof Lake Baikal complains to his sister Masha about thelack of fresh meat and liquor. A philosophy of self-reliance must have seemed an armchair absurdity toChekhov in Siberia, where settlers either depended oneach other or didn’t depend at all. The son of ashopkeeper who went bankrupt when he was sixteen,Chekhov had few illusions about the appeal to Tolstoyof what were, in effect, noble savages. ‘Muzhik[peasant] blood flows in my veins,’ Chekhovcommented apropos of Tolstoy’s idealising of theRussian peasantry, ‘and you can’t astonish me withmuzhik virtues.’ The peasants he writes about after hisreturn are drunk, flatly unimprovable, aggressivelythemselves, and have none of the extenuating character

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traits or dubious sancta simplicitas attributed to themby the older writer.

‘Devil take the great philosophies of this world!’ washow he dismissed the subject of the Russian soul; andhe admitted to Suvorin that Tolstoy’s The KreutzerSonata—which he had thought a great book before heleft for Sakhalin—now seemed ‘ridiculous andincoherent’. It exposed Tolstoy, in his opinion, ‘as anignorant man who has never at any point in his longlife taken the trouble to read two or three books writtenby specialists’. The difference between them isapparent in their attitude to medicine: although henever romanticised science in the grand style likePasteur or Pavlov, Chekhov had hopes for the future ofhis profession and remained a meliorist about socialprogress.

The sage of Yasnaya Polyana, on the other hand,thought doctors were scoundrels who put cleanlinessbefore godliness. Chekhov would be a better writer, heonce remarked to Gorki, if medicine didn’t stand in hisway.

The rebuttal of Tolstoy’s moralistic agenda for theascetic life is developed in his short story Ward No.6,written a couple of years after Sakhalin, whenChekhov was busy helping to build new schools on hisestate at Melikhovo and doing a fair bit of doctoring onthe side—much like Dr Pascal in Zola’s novel, whichwas serialised in Russia in 1893. Ward No. 6 offers acritique of the doctrine of non-resistance to evil: DrAndrei Yefimich Ragin is committed to his own

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mental ward after he becomes the victim of anambitious colleague’s intrigue.

The story’s turning point is Ragin’s acknowledgementof something he had been staring at for years withoutever noticing it: his patients have feelings—dear God,even he has feelings! Monotony and futility haveevidently taken their toll on Dr Ragin, who initiallybegan his career in this provincial hospital as a diligentand purposeful practitioner. He has allowed thehospital to go to seed; retreated from his duties;guarded patients rather than treated them.

One day, a thirty-three-year-old man named Gromov,incarcerated because of his persecution mania, stirsRagin’s interest. For the first time, he has extendedconversations with a patient. Gromov bluntly pointsout to him that doctors don’t know much aboutsuffering since they attempt to understand objectivelysomething that can only be felt. They live, if they liveat all, vicariously. ‘Why, it’s so obvious! The man’s adoctor and doesn’t even know a little thing like that!Contempt for suffering, permanent contentment, neverbeing surprised… it just means sinking to thatcondition.’ Ragin is a Pharisee exposed, the hypocritewho tells patients how virtuous it is to be stoical.

He takes to visiting the ‘mad ward’ daily, not becauseGromov’s words have cut him to the quick but becausehe finds their chats ‘original’. After twenty years of notvisiting his patients, this departure from the routine isenough to get tongues wagging elsewhere in thehospital. Asked to ‘take a holiday’, he is finally tricked

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into entering the asylum by his successor. Dr Ragin isnow a patient himself.

Chekhov makes this change in status utterlybelievable, and absolutely comfortless. For it is onlyafter being punched in the face by the orderly whosecasual brutality he had for so long tolerated (and whoused to call him ‘Your Excellency’) that Ragin graspsthe grim reality of his situation; the next day he is deadof a stroke. Russia’s supine history is in that story,wrote a certain Vladimir Ulianov, who as a youngrevolutionary thought he himself had been locked up inWard 6.

Thomas Mann wrote that Chekhov’s argument withTolstoy had forced the former to raise irony to openrebellion.

Chekhov’s instinct was not misplaced: he had toextend himself physically, in an absurdly pedestrianmanner, in order to win clarity for himself as a writer.A frail Gogol travels on a hazardous expedition toJerusalem, in 1848, in search of inspiration; a hardlymore robust Chekhov skirts the pot-holes on the roadto Sakhalin. His trip in fact cost him the best part of hishealth. No other piece of writing posed him suchdifficulties: he spent nearly four years revising hisaccount, and his earnings took a dive, since his absencefrom the Moscow scene deprived him of literary andmedical income.

Yet if anything was ever going to count in backwardRussia, it was the work of individuals. There are still

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things to do in the world, he tells his friends. Whowere his models? Not the great thinkers. Chekhov wasfascinated by men of action; with the African explorersand Stanley’s In Darkest Africa in particular. The1880s was the decade of unbridled Europeanenthusiasm for adventure in Africa, the decadeGermany got the ‘African bug’ and infected byTorschlusspanik—fear of missing the bus—started outon its own imperial enterprise, while giving the go-ahead to the cruellest imperial farce of all: Leopold II’s‘humanitarian’ project in the Congo Basin, thebackdrop to Conrad’s Heart of Darkness.

In 1888, Chekhov had written an enthusiastic unsignedobituary of Nikolai Przhevalsky, the explorer of Chinaand Tibet and the discoverer of Przewalski’s horse, forNew Times: his imagination was fired by the spectacleof the explorer who had abandoned his family and diedin harness, by a remote lake on the Kirgizian border.‘When European societies are seized by indolence,’ hehad written, ‘heroes are as necessary as the sun.’

All of which suggests a rather different Chekhov fromthe well-mannered, distant writer who chimes thedinner gong in the Gardens of the West—this is aBoy’s-own Chekhov. Hisjourney to Sakhalin, which gets only a passing mentionin many older biographies, controverts the standardview of him, in D. S. Mirsky’s words, as someone whocompletely rejected ‘what we may call the heroicvalues’. It makes him, rather piquantly, god-father tothe humanitarian grand gesture which has absorbed somany of Europe’s disaffected, idealistic or unemployed

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doctors since 1968, the kind of publicity-hungry NGOaction associated with a group like Médecins sansFrontières.

Having set his mind on going to Sakhalin, and more orless convinced his family and friends that he really hadno choice in the matter, Chekhov prepared himselfthoroughly. He read over a hundred publications on theisland and the penal system, as well as books onbotany, geography and tiresome government reports.He writes to Pleshcheyev: ‘All day I sit reading andmaking extracts. In my head and on paper there isnothing except Sakhalin. Mania sachalinosa.’

The need to seek official permission from suspiciousadministrators was a bug-bear. The unctuous Galkin-Vraskoy, head of the Prison Services, while apparentlygiving the go-ahead, actually circulated a memo to hisregional directors forbidding Chekhov access to thepolitical prisoners. Suvorin, on the other hand, clearlya forerunner of the twentieth-century newspapermagnate in his attitude to officialdom, ignored thepolitical sensitivity of the mission and despite his quitereasonable personal misgivings about the wholeventure gave Chekhov a press card and the financialresources needed to complete his journey. Chekhov’smethod of repaying Suvorin was to send sketches toMoscow from his overland journey east of Tyumen,across the Yenisey to Irkutsk and the last stretch alongthe Amur River to Nicolayevsk; these were publishedin instalments in New Times as they were written.

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His association with Suvorin had always aroused fiercejealousy on the part of Chekhov’s contemporaries, whoaccused him of being Suvorin’s ‘kept woman’. No oneever accused Chekhov of being politically small-minded, but New Times was an instrument of reaction;and for some of his contemporaries—the liberalreformer and engineer Garin-Mikhailovsky, forone—Suvorin was the devil incarnate. Chekhov wasastute about people. Accusedof being ‘unprincipled’ by an editor, he replied: ‘I havenever toadied, nor lied, nor insulted.’ Nor, he added forgood measure, had he ever written a line he wasashamed of. Though several of his family foundemployment thanks to Suvorin, he never allowed thisdebt to impinge on his freedom to speak his mind.Their letters are frank, and reveal a more outspokenman than the rather respectable writer cultivated bythree generations of Soviet censors; at times Chekhovis bawdy, and even frankly misogynistic. Politically,he and Suvorin agreed about almost nothing in theirletters, and were poles apart temperamentally—yettheir relationship lasted until the dispute that fannedacross Europe in the wake of Zola’s intervention in theDreyfus affair.

Chekhov almost managed to convince his close friend,the painter Isaak Levitan, to accompany him at leastpart of the way to Siberia. Levitan finally backed out,saying that he didn’t want to abandon his mistress forsuch a long time. He was a landscape painter who likedto include elements of social history in his work: oneof his widescreen paintings, Vladimirka (1892), depictsthe bare dirt track on which so many convicts died on

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their way into exile. Chekhov was no less an enthusiastof the steppe: ever since his childhood in Taganrog,where ‘those boundless plains of waving grasses,streams and gullies’ started on the far side of thecemetery, it had represented freedom for him.

What is most noticeable about Levitan’s painting,however, is that the giant outdoors itself is a kind ofprison.

The nine instalments Chekhov wrote for Suvorin’spaper and posted back to Moscow from Tomsk, Irkutskand the Baikal region (they are collected under the titleAcross Siberia) are breezy travel sketches. Chekhovrecounts how his horse-driven tarantass, anuncomfortable springless carriage, came within a hair’sbreadth of colliding with three post troikas racing inthe opposite direction, drivers asleep at the reins.Thomas de Quincey’s giddy exercises in divagationcome to mind: ‘We heard our speed, we saw it, we feltit as thrilling; and this speed was not the product ofblind insensate agencies, that had no sympathy to give,but was incarnated in the fiery eyeballs of the noblestamong brutes, in his dilated nostril, spasmodicmuscles, and thunder-beating hoofs.’

Siberia, no less than Sakhalin, was less a physicalplace than an imaginary topos for most Russians, andChekhov takes an almost perverse delight in stressingits humdrum qualities, the bandits and wild animalsconspicuously absent, his revolver unneeded. Floodsand ferries slowed his progress. Once he had to waitfifteen hours before his tarantass could be repaired.

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Boredom, not fear, seems the taiga’s prevailingquality: ‘The Siberian Highway is the longest, and Ishould think, the ugliest road on earth.’ But there areexpansive moments too: ‘The power and enchantmentof the taiga lie not in titanic trees or the silence of thegraveyard, but in the fact that only birds of passageknow where it ends.’ The Yenisey River, he thought,was a ‘mighty, raging Hercules’.

The high point of the journey seems to have been thelast stretch: a thousand miles by steamer on the riverAmur to Nikolaievsk on the Pacific coast. As if toconfound his own intention of demystifying Sakhalin,he notices that the captain of the boat, The Baikal,taking him over the Tatar Strait to the Alexandrovsk,the island’s main port, ‘does not trust the official chartsand follows his own, which he draws up and correctswhile sailing’.

Perhaps the captain had been supplied with one of themaps in Jonathan Swift’s Travels into Several RemoteNations of the World, which advertises a group ofstrangely named islands in the north Pacific betweenthe coasts of Japan and California. The legend ofBelovode, a kind of divine realm located in anarchipelago at the edge of the known world, persistedin Russian religious memory until well into thetwentieth century: it periodically attracted theattentions of members of a sect called The Wanderers,and of parties of religiously-inspired peasants.

A distant bush fire makes Chekhov’s first impressionsof the island sound quite ominous: ‘I could not see the

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wharf and buildings through the darkness and thesmoke drifting across the sea, and could barelydistinguish the dim lights at the post, two of whichwere red. The horrifying scene was compounded ofdarkness, silhouettes of mountains, and beyond themountains, a red glow which rose to the sky, fromremote fires. It seemed that all of Sakhalin was inflames.’ We were wanderers on prehistoric earth: thisis the tone of Marlow’s slow symphony of eeriness ashe penetrates further and further into the heart ofdarkness.

If Chekhov is crossing over into a territory that is alsoa placeof the mind, it is not a landscape out of Dante or one ofSwift’s previsions of a totalitarian society, butsomething like the heath in a Shakespeare play, thatunpatrolled tract of land beyond the city walls wherenot even a wandering Cynic philosopher wouldventure. Convicts are bare men living on the floor ofbasic need. Abject, badly clothed, foul-smelling, theyare poor Toms. At this level their needs are animal.Chekhov seems to be pursuing the question thathumbles Lear when he loses his crown: what is naturalman? What is a human being anyway, outside thewalls of the city?

When he disembarked on 9 July 1890, having leftMoscow on 21 April, Chekhov found that his visitcoincided with the quinquennial visit of the Governorof Eastern Siberia. He also had the luck to meet ajunior doctor at the hospital who was a fierce critic ofthe administration. ‘I’m glad you’re staying with our

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enemy,’ the island commandant remarked to him, ‘nowyou’ll learn about all our little shortcomings.’ Then heset to work.

Where a present-day epidemiologist would save hisfeet by using applied statistical techniques onrepresentative subgroups, Chekhov had ten thousandindex cards printed in the local police sweat-shop. Hehad come like the biblical census-taker. Each cardcomprised entries for legal status—convict, settled-exile (those who had completed their prison term buthad to remain on the island), and peasants-in-exile(who could leave Sakhalin but had to remain inSiberia)—and items for surname, patronymic,settlement, age, religious persuasion, occupation andmarried status. Diseases were recorded; diet andfinancial support; the mortality rate. Why they hadbeen convicted was not his concern.

Seven-and-a-half thousand of these cards can still beconsulted in the Chekhov Archives in Moscow.

For the next few months, he went from shack tobarracks and on to the next settlement accompanied bya single guard who carried his inkstand and warned thehouseholders of his imminent arrival. ‘The people wholive there are a tattered and famished bunch ofRussian, Polish, Finnish, Georgian rogues, throwntogether by chance, like the survivors of a shipwreck.’Most of the settlementswere scattered along the river Tym, and in the westernand southern parts of the island; by September 10,having visited all the settlements in the north, Chekhov

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joined The Baikal to sail down to Korsakov, the maintown in the milder south.

His work schedule was gruelling, starting at five in themorning and continuing until late at night. He wrote toSuvorin that when he went to bed he was in a state ofextreme tension, haunted by what still remained to bedone. When he wasn’t gathering information he wasbusy studying the prison records, or drawing up aninventory of equipment lacking in the hospitals. Heappears to have enjoyed carte blanche from theGovernor General, who asked Chekhov to pay a visit:they hit it off, which was just as well, since Galkin-Vraskoy hadn’t bothered to inform him that atroublesome writer was on his way.

Only the political prisoners, a mere forty out of theisland’s population of ten thousand, were out ofbounds to Chekhov, a fact which irked him but didn’tstand in the way of his main objective: to document theisland’s penal conditions. At the end of his stay, hewas able to say, with only slight exaggeration, that‘there is not a single convict or settled-exile onSakhalin who hasn’t had a chat with me’. Many ofthem continued to correspond with him long after hisdeparture.

Writing it all up proved more difficult, indeed turnedout to be his own ball-and-chain; which must havebaffled him, since his apprentice work had itself been aconcession to the documentary. He warns a friend hisreport will be ‘tedious, specialised, and consist ofnothing but figures’: in fact, the few statistics in his

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book seem largely incidental to the burden of anarrative which keeps the reader, like the obliginginkstand carrier, fully in view. Vladimir Nabokov onceremarked that Chekhov had a poor dictionary and onlya few verbal effects, yet managed to be one of the mostsubtle writers.

Chekhov was appalled that lip service should be paidto reform, while actual conditions showed up theblatant lack of interest in ‘civilising’ the prisoners.Some prisoners were assigned to fell and lug timber, agruelling occupation which exposed them, becausethey were shackled to the logs, to the risk of freezingto death.How were these men to become good householders oncompleting their prison terms, he wondered, if thebrutalising conditions of their prison sentence forcedthem to abandon any domestic habits they hadacquired in their earlier life?

More than once he mocks himself as the ‘write-writeman’ (as the indigenous Galyaks call him):disembarking at the pier he noted that ‘all 50 [convicts]took off their caps—very likely no such honour hasever been accorded a single literary figure to this day’.Reasonable, unruffled, not put out bycircumstances—Chekhov’s journey might hint at hiswish to earn the right to mock himself ‘doing time’.

That impression should not go unchallenged. Ourconviction that life lived at the extremes is somehowmore authentic than ordinary life (a revival of Hobbes’belief in mortal danger as the ideal condition for self-

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knowledge) wouldn’t have been Chekhov’s. ‘Only inthe settlers’ barracks near the mine and here inDerbinskoye, on that raining, muddy morning,’ hewrote in this abyss of neglect, ‘did I live throughmoments when I felt that I saw before me the extremelimits of man’s degradation.’

The moral lesson of human life lived at the zoologicallevel—Lear’s lesson—is dreadfully simple: it has noneto offer. It isn’t sympathy and respect that attend thespectacle of natural man, but revulsion. Natural man isthe shame of nature.

For all that he attempted to suppress subjective turns, alyric surge is never far from the lull of Chekhov’sprose. His descriptions of the kale-gatherers on thecoast and the simple funeral ceremony inAlexandrovsk where the gravediggers talk ‘about somebusiness of their own’ and a recently bereaved orphanlaughs grotesquely at his mother’s graveside revealhim trying to suppress his own narrative gift.

Soon after his arrival, for example, he visits theAlexandrovsk hard-labour prison, reserved mostly forprisoners who had done a runner from the island acrossSiberia. In winter they could escape over the pack icethat joined Sakhalin to the mainland, and risk frostbiteand death by exposure; in summer they had to stowaway on a boat. It seems an utterly desperate act;Chekhov estimates that two out of three prisoners hadtried to escape at one timeor another. Hope, as the Russian proverb goes, isalways last to die. Most would be recaptured within a

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few weeks, or perish in the wilds. Those who wererecaptured got the lash. In his history of Australia’ssettlement, The Fatal Shore (1986), Robert Hughesmentions that whenever the early Botany Bay convictsescaped inland they often headed north, thinking theywould come eventually to ‘China’: the geographicsense of prisoners on Sakhalin was probably no moreacute.

Yet even in such dingy, stunted circumstancesChekhov’s lists are exuberant with ordinariness, withwhat the British Empire’s version of deportatio ininsulam called bags and iron: ‘On the boards lie caps,boots, bits of bread, empty milk bottles stopped upwith a bit of paper or old rag, and shoe-trees; under theboards are chests, filthy sacks, bundles, tools andvarious bits of old clothing [...] On the walls hangclothes, pots and tools, and on the shelves are teapots,loaves and boxes of something or other.’

Further down the west coast, in Dooay—‘a dreadful,hideous place, wretched in every respect, in whichonly saints or profoundly perverse people could live oftheir own free will’—hardened prisoners were chainedto wheelbarrows. The company of five men in StPetersburg who ran the mines, he notes, wasguaranteed an annual profit of 150,000 roubles.

For all Chekhov’s evident disgust at the kulakism of itscoal-quarries, the moral censure and sensationalismthat stalk so many contemporary Victorianphilanthropic reports on urban living conditions arequite alien to his approach. ‘Their crimes’, he remarks,

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looking at these supposedly hardened recidivists, ‘wereno more clever and cunning than their faces’.

Even unspeakable places can become home. Walkingdown Main Street with him, it is hardly the penalreformer we hear:

It is always quiet in Dooay. The ear soon growsaccustomed to the slow, measured jangling of thefetters, the thunder of the breakers on the sea and thehumming of telegraph wires, and because of thesesounds the impression of dead silence grows stillstronger. Severity and rigorousness lie imprinted notmerely on the striped posts. If somebody shouldunexpectedly burst into loud laughter in the street, itwould sound harsh and unnatural. Life here has takenon a form which canbe communicated only through hopeless andimplacably cruel sounds, and the ferocious cold windwhich on winter nights blows in the cleft from the seais the only thing which sings precisely the right note.

Chekhov’s interest in other people’s lives never flags.Underlining the island’s parodic relationship tometropolitan Russia, he lists the convicts’ adopted oracquired names: Ivan don’t-remember-my-name andMan-whose-title-no-one-knows, or epithets like thenames of the devils in Dante’s hell: Limper, Stomach,Godless, Bone-idle. Gogol has names like those too, inDead Souls.

These epic names are followed by an exploded-viewdrawing of the Russian water closet and the theory of

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‘reverse draught’. To his disgust there was no latrine atall at Kosov, where the prisoners were led out ingroups to relieve themselves on the street. Hisdescriptions of giant burdocks and umbellates in Novo-Mikhailovka are lengthy and botanically exact. On oneoccasion, straying into Dostoevskian territory, hisaccount of the flogging of a vagabond calledProkhorov contrasts fascinatingly with the otherwriter’s sensationalism, and is chilling in its spareness:

‘Prokhorov does not utter a single word, but simplybellows and wheezes; it seems as if, since thepunishment began, a whole eternity has passed, but theoverseer is calling only: “Forty-two! Forty-three!”There is a long way to go to ninety. I walk outside.’

Most other writers would have lingered on thevoyeuristic scope of an incident like that—notChekhov. This is a foretaste of the mature writer whohas learned that less is more. Chekhov’s intention toimmerse us, and himself, in the grittiness of life onSakhalin fails him completely at one point in the book.The fact-gatherer gets his pockets picked, as it were,by the lyric dramatist. An unexpected safari view ofthe island rears out of the dark on an evening driveabove Alexandrovsk: ‘the gigantic burdock leavesseemed like tropical plants, while the dark hills loomedin on all sides. Away in the distance were fires wherepeople were burning coal, and there would be a lightfrom a forest fire. The moon would rise. Suddenly, afantastic picture: trundling to meet us along the rails,on a small platform, a convict leaning on a pole,dressed all in white.’

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This passage escaped the revisions of what he calledhis ‘purplepatches’; it is one which gets close to the heart of whatmakes A Journey to Sakhalin so compelling.

Expanding his comments on Chekhov’s language,Nabokov wrote that he ‘keeps all his words in the samedim light and of the same exact tint of grey, a tintbetween the colour of an old fence and that of a lowcloud’. Low-wattage moments of odd intensity are tobe found in the mature œuvre too, mingled with aweight of felt experience that is all the more painfullyvivid for its drab and formless surroundings: at theclose of Ward No.6, on the afternoon after beingbeaten up, Dr Ragin grasps that he is dying: suddenlyhe sees dart past in the gathering dark, ‘a herd of deer,extraordinarily handsome and graceful, of which hehad been reading on the previous day’. Hisconsciousness does not end there. ‘A peasant womanstretched out her hand to him with a registered letter.’But its contents are not revealed, either to us or to DrRagin.

‘You need equanimity in this world’, Chekhov toldSuvorin, ‘only people with equanimity can see thingsclearly, be fair and work’. Work is what Conrad’sMarlow calls ‘efficiency’, the device for gettingthrough a life with dignity. Chekhov’s insight—part-social, part-psychological—into that ‘grey, ordinary’life was to see it as a kind of bookkeeping that neverreally adds up. ‘You confuse two things,’ he wrote toSuvorin, ‘solving a problem and stating a problem

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correctly. It is only the second that is obligatory for theartist.’

Yet literature must have form, even a literature ofloose ends. Like Turgenev, Chekhov understood thatlife has its own forms of being, and that they are morecomplex than our schemes for understandingthem—‘for all things in nature influence one another,and even the fact that I have just sneezed is not withoutits influence on surrounding nature’. This was theattentive contemporary of Henri Poincaré whosefamous article in Acta Mathematica in 1889anticipated what is now called chaos theory; Chekhovhimself asserted often enough that his medical traininghad moulded him as a writer. It is surprising that sofew critics have taken him at his word, though one whodid, the philosopher Lev Shestov, accused him of‘killing human hopes’.

Randomness and contingency are major forces inChekhov’sart, in its almost brutal lack of sentimentality: the greatcrisis of Victorian theism was already behind him—hesaw no compelling reason to deny the existence of Godbecause he never saw any overriding reason to affirmit. As he told Suvorin, a writer should know better thanto speculate about the existence of God. It was left toTolstoy, the involuntary egoist, to wonder whathumans might be if only they could realise theiressential nature in the light of the Sermon on theMount; Chekhov remained an unworried child ofHume. It would be wrong to suggest that he was a man

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without faith: Russia without faith would beunendurable. Work was the answer.

His attitude to life can best be described as a distrust ofattitudes to life; it is surely scepticism that bestowsupon him his equanimity and wry amusement, andgeneral lack of resentment about the doings of time. Toput it another way: if Tolstoy saw the lie, Chekhov sawwhat seeing the lie occluded.

Chekhov returned from ‘hell’ on October 13, sailing onthe liner St Petersburg, which called in atVladivostock, Hong Kong (‘a glorious bay’), Ceylon(‘a heavenly place’) and the Suez Canal; he travelledwith two mongooses, a palm civet and a hairlessBuryat priest. All were to lodge with him in hisMoscow flat for varying lengths of time, and themongoose eventually became quite domesticated, ifsomething of an annoyance for the friends whostopped by to visit him in his flat in formal clothes—itliked to chew hats.

After recovering from a deterioration in his generalcondition over the winter, he began work towardspublication of his Sakhalin book in his ‘out-of-surgery’hours, on Mondays, Tuesdays and Wednesdays, aperiod in which he combined clinical work on his ownestate at Melikhovo with civic duties as an unpaidmedical inspector during an outbreak of cholera.Guests and family harried him for all sorts of favours,and often he had to stonewall them to secure time forwriting.

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The year after Sakhalin he went on a grand tour ofsome of the great European cities, including Viennaand Venice, and took in their opulence and architecturewith the same fascination he had shown, under ratherdifferent conditions, for the people of Siberia.Being a prison island inspector was just one ofChekhov’s many parallel lives; in those years he eventried to set up a scheme to rescue a financially ailingjournal of surgery.

Relatively few stories emerged from his Siberiantrip—Gusev, In Exile, The Murder (which, in its fourpages, does what he couldn’t achieve in his report’sthree hundred pages, according to Janet Malcolm) andPeasant Woman—as though insisting to his detractors,who had accused him of going in search of novelty,how serious he was about his objectives. His was to bea book outside the charmed codex of literature.

When Journey to Sakhalin appeared three years later,some of it having been serialised by the journalRussian Thought, the Russian delegate at the FifthWorld Prison Congress in Paris had to answer repeatedquestions about carceral conditions on the island. Thenotoriety of the American reporter George Kennan’sinvestigation Siberia and the Exile System, publishedin New York in 1891, had fanned the interest. Perhapshis own book didn’t achieve everything Chekhov hadhoped of it, but its publication certainly dispelled theutopian fantasy of transforming Sakhalin into anagricultural colony. The extended passage in his bookthat describes the lashing of the unfortunate Prokhorovcaused a public outcry. A government commission was

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sent to investigate prisoners’ conditions on the islandin 1896; and corporal punishment of women wasabolished the following year (and of men in 1904).Chekhov himself organised a dispatch of thousands ofbooks for use in the local schools. On 2 January 1894,finished with his corrections, he wrote to Suvorin:

‘Medicine can no longer reproach me with beingunfaithful: I’ve paid a proper tribute to erudition, andto what old writers call pedantry. And I’m happy that aconvict’s rough smock is hanging in my literarywardrobe too. Let it hang there!’

Journey to Sakhalin is a work of a quite different orderfrom the The Seagull or The Cherry Orchard or any ofthe marvellous stories, but it deserves a place alongsidethem, rather than being consigned to the mereparagraph it gets in some biographies (WilliamGerhardi’s, for instance): it is Chekhov’s mostmilitantly hopeful book. It is also by far his longestwork. He was protesting againstinjustice in his own way—a writer who happened to bea doctor, whose formative training had been in theempirical methods of the natural sciences.

Chekhov never doubted individuals could make adifference. Pages are blank like tundra, and freedom isour ability to surprise ourselves by leaving a mark onthem. The essayist Hubert Butler once observed ofChekhov’s individualism that ‘his faith is so soberlyexpressed as to be proof against all disillusionment.’ Itis a sound observation. In his desire to civilise Russiaby modest improvements—he once accused the

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Moscow intellectuals of being blinded by their grandutopian schemes and scientifically organised dreams ofsociety to the real achievements of the zemstva, thoselocal government bodies set up in the 1860s to buildhospitals and other civic amenities (and which in thelast days of tsardom employed that other brilliantdoctor-writer Mikhail Bulgakov)—his visit to Sakhalinlooks like an excursion to a century that will beremembered not just for its material improvements butfor revealing what utopia means: internment campsand total surveillance. When Humanity becomes aperfect transcendent unity, humans don’t just lose theircivic status and end up as poor Toms—they becomesuperfluous. The twentieth century showed beyonddoubt that philanthropy, as Edmund Burke suggestedin one of his pungent asides, has homicidal tendenciestoo.

Perhaps Chekhov’s visit to the prison colony at theback gates of Russia explains why his theatre sets seemso empty, abandoned to the implicating dimension oftime—recalled a dozen times at the opening of ThreeSisters—and the shelter of an enclosed gardenextending into the wings, out of our field of vision.Moonlight glints on the shards of bottle-glass strewnalong the crest of the wall. ‘If only we could know’,Olga’s cry concludes that play, ‘oh if only we couldknow’.

Sakhalin stands in the same haunting relationship toChekhov’s literary work as the darker meanings thathover over the garden wall.

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Uncle SiegfriedSCENES FROM A WORLD OF TRUST INFECTED BY

SUSPICION

Large print

After working for a year as a country doctor inScotland, I came across a slim pale-green hardback inHugendubel’s sixties-style bookshop overlooking theMarienplatz in Munich, and read it through my firstwinter away. It was a bibliophile edition of FranzKafka’s Ein Landarzt (A Country Doctor) published bythe small Berlin press run by Klaus Wagenbach,himself one of Kafka’s biographers, to celebrate thirtyyears in the book business.

The history of the book is a striking reminder thatKafka’s fame as a writer was not entirely posthumous.

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Written mostly in his sister Ottla’s apartment in thefamous medieval Alchemists’ Lane in Prague as ‘thewar to end all wars’ turned to disaster for the DualEmpire of Austro-Hungary, Ein Landarzt appeared inJanuary 1920, and received a single notice in thePrager Tagblatt newspapermonths after publication. Of the 1000 copies printed inoutsize Tertia Walbaum typeface, few—veryfew—were purchased in Kafka’s lifetime (the other sixbooks he published were also flops). The publishinghouse of Schocken Verlag, subsequently to relocate toNew York, took over the unsold remainder copies inthe 1930s.

Like the original, this new edition of the stories isprinted in the large typeface opted for by Kafka’soriginal publisher; it was so large in the WalbaumAntiqua typeface of the first edition that hyphens hadto be halved and punctuation marks omitted to fit theline. Kafka’s early writings—which often expand asingle seamless paragraph into an entire story—aresometimes so brief as to impose the large format andspacious margins, not least if his publisher needed abook that could be marketed. That his few thoughtshad acquired such lapidary scale was a source ofoccasional embarrassment: Kafka was reminded ofMoses and the Ten Commandments.

A final bibliographic connection: this new edition isprinted by the Offizin Haag-Drugulin in Leipzig, oneof the most famous printers in Germany and the samehouse that produced The Penal Colony for Kafka’soriginal publisher Kurt Wolff.

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Another genealogy

Kafka dedicated his book to his father. According tohis friend Max Brod, his father is supposed to havemuttered ‘put it on the table by my bed’; HermannKafka’s refusal to acknowledge his son’s literaryactivities is hardly one of the secrets of a well-documented fraught relationship. But the title figure ofthe collection—the country doctor—honours adifferent relative altogether, his uncle.

Siegfried Löwy was born in 1867, elder half-brother toKafka’s mother and, following his MD at theUniversity of Prague, possessor of the only doctoratein the family until his nephew’s, although many ofKafka’s mother’s family harboured scholastic, eventalmudic ambitions. Significantly, Franz often thoughtof himself as a Löwy rather than a Kafka: his diaryentry for 25 December 1911 contains a long list ofcolourful matrilineal begats, including a reference tohis maternal great-grandfather, who was amiracle rabbi. ‘In Hebrew my name is Amschel, likemy mother’s maternal grandfather, whom my mother,who was six years old when he died, can remember asa very pious and learned man with a long, white beard.She remembers how she had to take hold of the toes ofhis corpse and ask forgiveness for any offence shemight have committed against him. She alsoremembers his many books, which lined the walls. Hebathed in the river every day, even in winter, when hechopped a hole in the ice for his bath.’

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In his famous Letter to His Father he defined himselfas ‘a Löwy with a certain Kafka component which,however, is not pushed ahead by the Kafka will to life,business and conquest, but by a Löwyish spur thatworks more secretly, more diffidently and in anotherdirection, and which often fails to work entirely’. Oneof the Löwyish spurs was his TB, which he tended todescribe as if it were a conspiracy of organs:‘Sometimes, it seems to me that my brain and lungscame to an agreement behind my back. Things can’t goon this way, said the brain, and after five years thelungs said they were ready to help.’ Even theunpleasant transformation of the travelling salesmanGregor Samsa, in Kafka’s most famous storyMetamorphosis, into a hundred-footed insect coveredwith ‘sticky stuff’ seems morphologically related toKafka’s tuberculosis: the repulsive appearance of theinsect (which assures his victimisation) is in fact aninside: an eventrated respiratory tract replete with ciliaand mucus carpet.

A doctor of law he might have been in life, but Kafka’sreal doctorate was handed down by an imaginary guild,the Faculty of Concepts to Live and Die By. DespiteKoch’s demonstration of the bacillary nature oftuberculosis in 1882, Kafka always interpreted hisillness as a metaphor: what power could a bare facthave against a death sentence issued at birth?

An early speedster

While his nephew was in his last years at school, UncleSiegfried took up a post in Triesch, a small town of

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4800 inhabitants in a German-speaking enclave inMoravia called Iglau (known in Czech as Jihlava),about 130 kilometres south-east of Prague. Nearly halfthe local population was of German origin, and itboasted several small industries including wool andspinning factories, and a mine-works.He was to practise there for close on forty years.

Siegfried Löwy was a liberal (he almost had to be as auniversity-educated assimilated Jew) and man of histimes; open to change and innovation, he created asensation in the district when he became one of thefirst people in what was then an outpost of the Austro-Hungarian Empire to acquire a motorbike. Franz camevisiting many times in his summer holidays, the greatattractions of staying with Uncle Siegfried being hishorses, the billiard table and the library, whichcontained all the German classics. There were also themechanical appliances—a photograph in the bookshows his nieces, including Kafka’s sister Ottla, push-starting Uncle Siegfried on his brand-new bike across aforest path.

According to Hans Straße, Head Conservationist of theMotorcycle Department of the Deutsches Museum inMunich, the tin panniers behind the seat and thedistinctive rear shock absorbers identify it as a NSUCantilever, built in Ulm between 1909 and 1914: NSU(later amalgamated in the Audi concern) was one ofmore than fifty motorcycle manufacturers in theEurope of that time. Since the world speed record wasset on this machine in 1909, it may well be thatKafka’s uncle, a ‘munterer Vogel’ (an oddball) as he

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might have called himself, read about the exploit andordered a model for his practice rounds. Improvedtransportation was changing the nature of the medicalprofession, and speed would come to alter the veryshape of the consultation. Doctors were among the firstenthusiasts of vehicular transport, but most of thembought the rather stately sedans and berlins of theperiod. Dr Löwy’s speedster motorbike would nodoubt have amused the wags in Triesch.

Holisms

Unlike Kafka’s father, the self-made man, UncleSiegfried indulged Franz, and offered him advice andsupport at several junctures in his life. He was‘progressive’ in his medical thinking too. On hisrecommendation Franz became a vegetarian, and for atime practised the obscure double-chewing technique(‘each mouthful to be masticated thirty-two times’)recommended by the American physician HoraceFletcher (1849–1919) along with Johannes Müller’sfree air gymnastic techniques (developing the bodywasa cult, of course, long before the Nazis made it a keyelement of their cultural propaganda).

‘Fletschern’ and ‘müllern’, as they were rather rudelydescribed, were the alternative therapies of the earlytwentieth century, and the physically slight Kafkaseems to have hoped that such regular cud-chewingand callisthenics would deflect his conviction that hisillness was prefigured, not just historically, but in aprimordial sense—as if it were inscribed on his body.

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‘My body is too skinny for its weakness, it hasn’t theleast bit of fat to produce a blessed warmth, to preservean inner fire, no fat on which the spirit couldoccasionally nourish itself beyond its daily needwithout damage to the whole.’

Uncle and nephew both travelled together to theGerman North Sea islands of Heligoland and Nordeneyafter the completion of Franz’s school exams. Muchlater, in February 1924, in the last months of hisnephew’s life, when he was living a vie de bohème inBerlin with a young Jewish girl from the easternmarches called Dora Dymant (or Dora Diamant, as shecalled herself after she emigrated to Britain before thewar), his uncle visited him and persuaded him to entera sanatorium. This was the happiest period of Kafka’slife, according to Brod; it is known that Kafka wrote toDora’s Yiddish-speaking orthodox father asking forpermission to marry her: the rabbi prudently said no.Brod was a tireless friend: he even arranged the visitfrom Uncle Siegfried because doctors’ fees wereproving too expensive: Dora mentions having to pay160 crowns for a house visit at a time when all theyhad to pay the rent and buy provisions was Kafka’sinvalidity pension of one thousand crowns a month.

Siegfried Löwy continued to practise in his house inTriesch until his retirement in the mid-thirties, when hemoved to Prague and set up residence together with hisnieces—the Kafka sisters, Elli, Valli and Ottla—andtheir families, in the large house in the Bilkova left byHermann, Franz’s father. The night before theextended family was due to be deported to the death-

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camps in 1942, Siegfried Löwy drew up his will andinjected himself with a lethal dose of morphine.

Semi-colons

His nephew’s story A Country Doctor seems to begoaded on by its semicolons.

According to the literary critic Walter Benjamin, whorecorded their conversations in Sweden while bothwere on the run from the Nazis in 1934, the dramatistBertolt Brecht, famous in his lifetime for his agitproptheatre and Communist ideals, accused Kafka ofhaving the ‘precision of an imprecise man: a dreamer’;it is apparent from A Country Doctor how Brecht couldformulate such a dismissive statement, even if he doesresort to Kafkaesque method to do so. Kafka uses oneof the simplest grammatical markings to set up severallayers of apparently banal realism in which quitebizarre things happen without fuss, as matter of fact;his famous sliding paradoxes actually begin at the levelof parasyntactic notation, at what are usually termedthe accidentals.

The first sentence announces: ‘I was at my wits’ end:an urgent journey lay before me’. A colon buffers theadjoining phrases, in which five semicolons marshallthe subordinate clauses into separate stretches of timeand action and necessity. The American writerNicholson Baker has called the semi-colon ‘thatsupremely self-possessed valet of phraseology’; andthe literary critic Erich Heller once drew attention to a‘profound’ semicolon in a remark by the philosopher

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Wittgenstein: ‘The philosopher treats a question; like adisease’ where the profundity turns on whether thesemicolon ought to play the comma and makequestioning itself a kind of disease.

From his manuscripts, we know that Kafka had a fairlyidiosyncratic system of notation when entering earlyversions of his stories in his notebooks. He usedcommas and periods; semicolons were added onlywhen work was being prepared for publication. (In thecase of his novel The Trial, they were addedposthumously by his friend Max Brod, to whom he hadgiven the loose manuscript.) But perhaps we shouldregard the semicolon more conspiratorially thanBaker’s ‘valet status’ would suggest: commenting onhis friend Isaac Babel’s laconic stories, SergeiEisenstein, the great Russian film director,said—speaking of what literature could teach thecinema—‘no iron can enter the human heart with suchstupefying effect as a period placed at just the rightmoment’.

If periods are bullets, then Kafka’s semicolons arespurs. Theyedge one phrase recklessly on to the next, and barelyhold them all in check. They wink at the doctor’scognitive disarray—he is hardly through taking themeasure of one set of circumstances before anotherfalls upon him.

Only a doctor

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It all starts with the narrator, the country doctor, atwit’s end—‘in a dwam’, as some of my Scottishcountry patients would have said. A reportedly illpatient is awaiting his visit in a village ten miles off.He bemoans his lack of transport, his own horsehaving just died in the terrible winter weather. ‘Butyou just don’t know what you’re going to stumbleacross in your own house’, says the servant girl.

In the shortest possible grammatical time, the doctorhas come across a groom, two horses which squeezethrough the keyhole (from a pig-sty, a buried referenceto the treatment reserved for the string of horses in thenovella Michael Kohlhaas by the nineteenth-centuryGerman writer Heinrich von Kleist), abandoned hismaid to the groom’s cannibalistic designs on her (hebites her cheek), and arrived through a snowstorm in aflash at his patient’s bed. Demons have beenunleashed. These can only be Mephistopheles’ horses,on loan from Goethe’s Faust. The miraculous transportis itself described in a sentence with no less thaneleven semicolons. It is a breakneck, lightning-speedjourney that has a precedent in some of the Hasidicstories: Kafka would have known these from thefamous collection published by the philosopher MartinBuber, in which the Ba’al Shem-tov (the honorary titleof Rabbi Israel ben Eli’ezer, c. 1700–1760, the founderof Hasidism) is summoned to perform wonder cures atthe drop of a hat. The Yiddish writer Isaac BashevisSinger’s later stories are full of such dropped hats.

For Kafka’s doctor, however, any idea of a wondercure is sheer parody. Already the patient is whispering

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into his ear, ‘Let me die.’ At first glance there’snothing wrong with him; as the doctor gets ready toleave he notices a huge wound on the right side nearthe hip seething with what look like larval forms of thecommon house fly Musca domestica. Anothertradition—the Greek, in the story of Endymion andSelene—tells us the fly was once a beautiful, ifexcessively talkative girl; and since so many otherhalf-hiddenthings are happening in this story, we could beforgiven for assuming the patient laid low by the seedsof love. After all, in Shakespeare’s time love was stillconsidered an ‘illness’ (morbus amoris).

Some critics have thought the wound an act of self-castration or self-division, like the wound that won’theal in Parsifal, although it would seem moreobviously related to the place where Adam, before Godclosed it again, might have had his fatal rib extraction;in any case it is difficult to miss the equation of themaid Rose and the horribly pink gap in the skin—thewound recalls the supposedly ancient male fear of thefemale genitals. Kafka, with his keen instinct forambiguities, is confusing the absolute distinction thatmedical ethics tries to maintain between the roles ofdoctor and lover: this is a prerequisite to the art ofeffective diagnosis. Besides, remembering Rose duringthe consultation is a sure sign that the country doctor’smind isn’t entirely engaged with the nature of hispatient’s complaint.

‘Will you save me?’, pleads the patient, havingevidently changed his mind. Under his breath, the

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doctor berates the community for its loss of belief;people are always expecting the impossible from thedoctor’s healing hand. This is a community of ourtime, which ‘no longer believes in God’, as Nietzschewrote in one of his extended aphorisms, though ‘thereare still plenty of thinking people who believe in thesaint’. The country doctor is indeed a kind of‘saint’—an ascetic, self-denying figure in a materialage—of whom miracles are expected.

Then a posse of villager elders arrives at the housewith the school choir and teacher at its head, and singsa simple song denouncing doctors:

Strip him naked, then he’ll heal us

And should he fail to, kill him quick!

Only a mediciner, only a mediciner.

A saint is expected, but only a doctor turns up—amediciner, a saw-bones. The country doctor is human,all too human, the title Nietzsche gave to the book inwhich he examined what might make for saintliness inan age of unbelief. Stripped of his clothes, the villagerslift him head and feet onto the bed, ‘on the side ofthe wound’. His patient complains he’s always had togrin and put up with things, and doesn’t appreciatehaving to share his bed; the doctor consoles him withfalse reassurance: such wounds aren’t uncommon inthe wider world. And anyway, it seems to be a case ofMunchhausen’s syndrome, a couple of self-mutilatingblows with the blade of an axe. Self-knowledge was

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never easier; but there’s no cure for the wound thatcomes from the struggle between reality and reason.

Menaced, outmanoeuvred, and threatened by themassed ranks of the community, the hapless countrydoctor bears more than a passing resemblance to theepithet-title for the honest man in Henrik Ibsen’ssuggestively named drama An Enemy of the People.Effect and cause are disjoined in much the same wayas the doctor who fails his test of saintliness, revealingordinary human vulnerability: Gregor Samsa’s offence,in Metamorphosis, is even less an operation of thewill—he merely has to wake up to find he is what hedreamed he was. The country doctor’s fear that he maybe ‘misused for sacred purposes’ is not entirelygroundless: all persecutors attribute to their victims thecapacity to do harm as well as its reverse. Then hecatches himself: ‘But now it was time for me to thinkof saving myself.’

He runs from them, the children chanting a new songbehind him: ‘Now be cheerful, all you patients,Doctor’s laid in bed beside you!’ In contrast to hiscoming, his going is sluggish. Fleeing his patients,unsure whether he’ll get back home, his maid seizedby the groom, his shaman’s fur coat out of reach, castout into an Arctic desert whose contours are similar tothose glimpsed at the conclusion of one of Kafka’seeriest one-page stories ‘The Bucket Rider’ (the finalphrase of which reads: ‘And with that I ascend into theregions of the ice mountains and am lost never to beseen again’), the doctor’s closing words are no lessextraordinary than the entire story: ‘Betrayed!

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Betrayed! Respond to a false alarm on the nightbell—and it can’t be made good, ever again.’

Despite doing his duty, morally andprofessionally—indeed striving to fulfil it in sectarianconditions seemingly emptied of the usual ethical-legalcontent—he ends up stripped of authority, all hisclothes and in bed with the patient, and even thenmight not get home because he has dared upset thenatural order (despite trying to shirk off hisresponsibilities at one point by asserting thathe is ‘no world reformer’). In doing his duty he has putRosa, his own hidden wound, out of sight and mind.

One thing remains to be said about the country doctorand his sense of duty: Kafka allows the possibility thathis fatal error was to deny his other duty—to himself.The alarm on the night-bell is described as ‘false’, andin following its bidding he takes an ‘Irrweg’—thewrong path. Only near the end does he recollect the lifehe has been missing; but it is too late. Kafka’s storyholds up for inspection the Christian view of self-denial as a virtue, and then mocks it as a folly.

This is not Kafka’s last word on self-denial.

Medical euphemisms

As Erich Heller observed regarding that same quote byWittgenstein, a semicolon may sometimes mark thefrontier between a thought and a triviality.

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Kafka offers us a pathetic sight, a parody ofuprightness: a doctor stripped bare by his patients,even. ‘Certainly doctors are stupid, or rather, they’renot more stupid than other people but their pretensionsare ridiculous; nonetheless you have to reckon with thefact that they become more and more stupid themoment you come into their clutches...’, he informsMilena Jesenská early on in their correspondence.

His diary entry for 5 March 1912 contains anunflattering portrayal of the kind of bullishlyinsensitive doctor who, together with his Pooterishjudgement on the serving girl (presumably she couldn’tafford his full fee), has survived fairly intact into theera of can-do medicine, where he may be more of amenace: ‘These revolting doctors! Businesslike,determined and so ignorant of healing that, if thisbusinesslike determination were to leave them, theywould stand at sick-beds like schoolboys. I wish I hadthe strength to found a nature-cure society. Byscratching around in my sister’s ear Dr K. turns aninflammation of the eardrum into an inflammation ofthe inner ear; the servant collapses while getting thefire going; with the fleet diagnosis which is his wont inthe case of serving staff, the doctor declares it an upsetstomach and a resulting congestion of the blood. Thenext day she takes to her bed again, has a high fever;the doctor turns her from side to side,confirms it is a throat infection, and runs away so thatthe next moment won’t refute him. Even dares to speakof the “vulgarly violent reaction of the girl”, which istrue to this extent, that he is used to people whosephysical condition is worthy of his curative power and

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is produced by it, and he feels insulted, more than he isaware, by the strong nature of this country girl.’

Kafka mistakenly attributes his sister’s ear infection tothe ‘inner’ ear (it should be ‘middle’); his judgementon the Hausarzt—‘ignorant of healing’—strikes hard.Having consulted more than a few doctors in his time,Kafka was no doubt used to being treated by them as ifhis body were merely a fleshy appendage to hislungs—those ‘proud strong tormented imperturbablecreatures’. His diary is peppered with symptoms (‘anew headache of a kind unknown so far’, ‘I had aslight spell of faintness’, ‘this past week I sufferedsomething like a breakdown’) which are watched overwith the fastidiousness of a true hypochondriac.

In June 1914, well before he first coughed up blood(which he experienced, significantly, as a kind ofrelief: ‘actually, my headaches seem to have beenwashed away with the flow of blood’), he had writtento Grete Bauer: ‘undoubtedly an enormoushypochondria, which however has struck so many andsuch deep roots within me that I stand or fall with it’.Keenly observant of the theatrical aspects of hisuncle’s practice, and of the euphemous sounds ofdoctors in general (‘catarrh of the apex of the lungs’),Kafka sets the country doctor up for what doctorsroutinely subject their patients to but undergo rarelythemselves, and then only by peers, as humiliation andprimal fear: defrocking.

A plague of doctors

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Being familiar with doctors who suffer diseases fortheir patients in folk stories, how, we might wonder,forgetting that A Country Doctor was written in theearly days of psychoanalysis, could a doctor suffer awound for his patient? Is he being punished for hisimpatience by the spurs of those opening semicolons?Half a century before the French literary critic MichelFoucault deconstructed the power relations of themedical profession, Kafka identifies the surgeon’s ablehand as dispensing with the need for the confessional,the redundant cleric—in a telling image—sittingdown desolately to unravel his raiment. It is anabdication: the cleric embodies the collapse of areligiously-inspired idealism, but his renunciationprepares the way for the fall of the country doctor too.Kafka astutely sees that the Platonic idea of science asthe quest for truth is bound to the decline of thetranscendental affirmations of religion. Both are acts offaith, and the practical reason of science will also beundermined by the same empiricism that first displacedreligion.

Doctor-baiting has long been a clandestinely popularactivity in country regions. Despite the onslaught ofprogress and professionals with black bags it stillenjoys a vogue in some parts of the world; mygrandmother in Glasgow used to say, ‘that’s but aedoctor’s opinion’, meaning that one mere doctor stillhad a lot to learn about real wisdom. In country areas,where people have long memories, it is stillremembered that doctors themselves were once a sortof plague.

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As if to confirm her, the recently published writings ofDavid Rorie (1867–1946), an Aberdeenshire doctorand amateur anthropologist who collected folk medicalnostrums and maxims in rural Fife and Aberdeen in thefirst decades of the twentieth century, clearly show thatdoctors have only ever been one of several possiblesources of reassurance in parochial communities, andthat the transmission of learning and knowledge oftenwork against the grain of common sense. It is not just aScottish phenomenon. Indeed, Emanuel Strauss’extraordinary Dictionary of Proverbs tells us that everyEuropean language has its saws against the saw-bones.

These are some of the variations on Strauss’ entry1582. Latin: ‘errores medicorum terra tegit’: English:‘physicians’ faults are covered with earth’; German:‘junger Arzt, höckriger Kirchhof’; Dutch: ‘een nieuwmedicijnmeester een nieuw kerkhof’; Danish: ‘nylæge—ny kirkegaard’; French: ‘de jeune médecin,cimetière bossu’; Czech: ‘nedospelý lékar, hotovýzáhubce’. All of them are variations on an originalobservation by the ancient Greek poet Nicocles. Rorietells us the Scots rhyme on this is:

When the doctor cures,

The sun sees it.

But when he kills,

The earth hides it.

Writing recipes

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I don’t know if Uncle Siegfried had to go out on snowynights to answer a call (surely he did), but the dittiesquoted by Kafka in the story seem inspired by hisuncle, who was a wisecracker and self-deprecatingjoker—quite unlike Kafka’s father. Kafka describedhim to his friend Max Brod as the‘twitterer’—‘because such an inhumanly thin,bachelor’s, birdlike wit comes piping out of histightened throat, and never abandons him’. The famouslines in the middle of the story—‘Writing prescriptionsis easy, but otherwise coming to an understanding withpeople is hard’—have the ring of the horse’s mouth,indeed seem to propel the whole story which, on onelevel, is simply the enactment of a misunderstanding.Since prescription-writing in German is cognate withwhat cooks do in the kitchen—writing a recipe(Rezepte schreiben) being indisputably more art thanscience—the country doctor’s fate seems to depend onthe unpredictable nature of the second half of thesaying, on the burden he carries to make himselfunderstood. This is clearer in the original, where thereflexive German verb imposes just such a conditionon its grammatical subject (sich verständigen).

These days doctors ‘negotiate’ with their patients, justlike Kafka’s doctor; and contemporary patients can bejust as vague about what it was they wanted help within the first place. What has happened to the powerwhich the law itself confers on individuals to constitutea meaningful social life? Remove the plea for help, andthe doctor has no business being where he is. Kafkaunderdetermines meaning in his stories to such anextent that potential readings multiply alarmingly

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when the reader, anxious to reach firmer ground,attempts to place the narrative in a context he himselfhas supplied.

My interpretation would be this. Nothing is harder totouch than the reality of our lives, and Kafka’s ridermight be: hardest of all for doctors.

Hell for leather

Bizarrely enough (Kafka’s skill with syntax and smallwords has us driving the narrative on without stoppingto question its economy of explanation) this story doeshave anthropological parallels.

In his diaries, the writer Elias Canetti—a veryperceptive Kafkologist—records the followingobservation by the great German explorer Alexandervon Humboldt. ‘In thirteenth-century Egypt, a maniafor eating human flesh raged through all classes;doctors were the favourite prey. If a man was hungry,he feigned illness and sent for a doctor—not to consulthim, but to devour him.’ This is confirmed with a notefrom a Baghdad physician’s description of his travelsand travails in Egypt: ‘people used all possible dupesto waylay others or lure them into their homes on falsepretenses. Three doctors who visited me later met withthis fate...’

True or not, these observations replicate the internaldynamic of Kafka’s story very convincingly. Our heromight not be killed, but his nose gets rubbed in thepresumption of wanting to help. Kafka often portrayed

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fools and clownish figures in his writing; they werebeasts of meaningful burden for him as much as theywere for the philosopher Nietzsche, who once wrotethat fools were a disguise for ‘desperate, all too certainknowledge’. That would make Kafka’s uncle aShakespearean nuncle. Some of the most famousEnglish cartoons—Hogarth’s andRowlandson’s—lampoon doctors in just the termssuggested by Kafka, as buffoons whose veryministrations were a menace to the bodies of theirpatients. Perhaps folly and care charge hell for leatherout of the same stable; and little wonder if in hismoment of adversity the diagnostician, clumsy as he is,has no tradition to shelter in. In a letter to GershomScholem in 1938, Benjamin wrote, as part of a critiqueof Brod’s queasily sanctifying biography of Kafka:‘This much Kafka was absolutely sure of: first, thatsomeone must be a fool if he is to help; second, thatonly a fool’s help is real help. The only uncertain thingis whether such help can still do a human being anygood.’

Trust lost

As in so many of his stories of individuals thwarted bythe forms of life they lead in society at large, Kafkahimself seemed to weigh criteria for success in asuperdimension where language bears a differentcharge of trust. Famously dissatisfied with his gifts asa writer, he actually confided to his diary, shortly afterfinishing A Country Doctor in September 1917, that hecould still derive

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‘passing satisfaction’ from works like this, provided hecould continue to write such things at all; andhappiness only if he could raise the world into ‘thepure, the true and the immutable’. Those are attributesof the absolute, which is where literature cannot go.

The genius of A Country Doctor—and it is not abenign one—resides in the fact that Kafka describes,without naming it, one of the most pressing issues ofhis society, and all the more of our media-manipulated‘risk society’: the issue of trust. It is indeed odd that aman like Kafka, who worked in an insurance office,should have thought safeguards scarcely worth thepaper they were written on. His little village in thesnow is a world of faith abruptly and unaccountablyinfected by the language of suspicion. The onlystrongly individuated character in the story, the doctor,is exposed to a witch hunt. Should we be surprised atthe tribal, scapegoating logic that pursues him?Perhaps trust is a kind of non-renewable precapitalistresource that, once depleted, can never be replenished.This concern would account for the lurch into cosmicanguish at the end of the story—‘and it can’t be madegood, ever again’.

Every writer since the Enlightenment has been awareof being condemned to work in this atmosphere ofsuspicion, so mercilessly diagnosed by Nietzsche andMarx: without a craft tradition (loosely defined as theproduction and supply of articles needed by thecommunity) the artist’s search for meaning is painful,inward, and often absurd. Trust for a writer like Kafkais a primal state that can be regained only by an act of

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will: that is why he wrote, ‘nothing is granted to me,everything has to be earned, not only the present andthe future, but the past, too’. Or it can be seized byblind obedience; and Kafka’s family history showshow ruthlessly a world of will and illusion wasexploited by Hitler, whose inversion of the moral orderreceived shamefully wide support from the ‘caring’profession: forty-three percent of German doctorsjoined the Nazi party in 1933. Trust has lost its pristinequality. At the close of Kafka’s century it may be thatthis quality of trust has eroded further, not just in theartist’s despair about ‘doing art’, but in the citizen’ssense of the solidity of those ‘substantial categories ofstate, family and destiny’.

Concluding his recent literary study of trust, GabrielJosipovici provides a warning and a message of hope:‘But what the art andthought of the past two hundred years teaches us is notthe lesson the deconstructionists and post-modernistswould draw from it, a lesson of our freedom to live aswe want, to choose the stories and traditions we wantto live by, the lesson of the hopeless entanglement ofall culture and language in hidden struggles for power;it is, rather, that it is not possible to exist withouttrusting, that to walk and talk and, a fortiori, to writeand paint and compose is only possible because oftrust. When we grasp this we grasp too that denyingtrust is denying life itself as something that has to belived in time and in the world of others, the world intowhich we have been born and in which we will die.’

Pain relief

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In his last months, Kafka didn’t expect much of hisown doctors. ‘Verbally I don’t learn anything definite,since in discussing the tuberculosis [...] everybodydrops into a reticent, evasive, glassy-eyed manner ofspeech’, he wrote to a friend from the sanatorium atHauptstrasse 187, Kierling, near Vienna, in April 1924.

He’d been brought there by his medical student friendRobert Klopstock, appalled at how he had been treatedby Professor Hayek, the imperious Ear, Nose andThroat specialist who was also to operate that sameyear, with nearly disastrous results, on Freud’s oralcancer. That month Kafka weighed a mere 43 kilos(for a height of 180 cm). His TB was nowextrapulmonary: it had colonised his larynx, which wasacutely inflamed, and from there spread to hisepiglottis, effectively preventing him from nourishinghimself. Coughing and swallowing must have beensearingly painful. ‘To think that at one time I couldsimply dare to take a large gulp of water’, he wrote onone of the slips of paper he handed to his friends,under doctors’ orders to talk as little as possible.

Those same doctors injected phenol into the superiorlaryngeal nerve in an attempt to provide relief frompain, but the procedure was only partially successful.To his parents he wrote wonderful, affectionate,cheerful letters, published in their original Germanonly a few years ago after their chance discovery by aPrague bookseller. His letters belie any sense ofestrangement or grievance. In them he recalls theswimming lessons his father had given him,

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the beer and sausages after, and he makes no referenceto what he had formerly called ‘the disgrace ofshowing myself undressed in public’. This, a letterabout drinking beer, when he was literally dying tohave a drink of water but couldn’t because of the painin his throat! He wanted, at all costs, to avoid worryinghis parents into visiting him. Dora was there all hours,desperate for the slightest hint of an improvement. Hecorrected the galley proofs of A Hunger Artist, whichhad just arrived from the publishers. One of the severalnotes he wrote, perhaps a wry reflection on Hayek andhis retinue of medical assistants, was collected andpublished after his death by Klopstock. It read: ‘So thehelp goes away again without helping.’

To the end, Kafka retained his lucidity; and he left usone of the darkest and funniest Jewish doctor jokes:‘Kill me,’ he instructed Klopstock, with whom he hadarranged long in advance for a dose of morphine whennothing else availed, ‘or else you’re a murderer.’

Antinomies

Many of Kafka’s stories are explicitly concerned withthe individual’s relationship to the community (TheInvestigations of a Dog; The Chinese Wall; Josephine,the Singer); the enthusiasm he spasmodically feels forcommunal life, like his response to the troupe ofYiddish actors he saw in the 1910s, is fed by hiscriticism of what the writer does, feeding on themarrow of his race, doing ‘research’ as his sleuth-hound puts it. He turns suspicion on himself. Brechtmight have scorned the exactly dreamed precision of

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Kafka’s stories, but he also noted that Kafka had all theattributes of a great teacher: without a society toinspire, his apparently ingrained Confucianism endedup as ‘mere’ literature. Kafka noted this about himselftoo, as a postcard in 1916 to his fiancée Felice praisingthe landscape around the spa town of Marienbadattests: ‘I think that if I were Chinese and were goinghome (in fact I am Chinese and am going home), Iwould soon have to find a way to come back here.’The myth of the Way (the Chinese tao) was ofoverriding importance to Kafka, though once again heput a stumbling block in his way. There may be a goal,he told his notebook, but there is no way of reaching it.

Everything is weighed in terms of what we might callits socialutility value, and writing is found wanting. Doctoring,too. The Enlightenment philosopher Diderotspeculates, in one of his dialogues, about the secretkinship between criminals and artists (though it hasalways been easier, as the career of the Marquis deSade illustrates, to commit atrocities in the head thanwrite good novels); the villagers sketched out in ACountry Doctor also seem to regard the doctor, despitehis apparent bond to the life of the community, as akind of miscreant: he rides across the social order, heflaunts his individuality in the face of common values,his opinions are dissentient. He is a kind ofantinomian. Society punishes the doctor for thegratification he derives from his odd hours of serviceby making him an outlaw. Butcher, executioner, barberand surgeon used all to be trades which, dealing withblood and guts, carried a weight of social opprobrium.

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As dignified as he is ponderous, Kafka’s countrydoctor mimes solidarity with tradition even whileknowing his acts follow—and sometimes evenparade—the logic of enlightenment. His sense ofimpending persecution has the touchy tone heard sooften in the confessions and letters of Rousseau,assertive even while it looks defensively over itsshoulder: the citizen of Geneva may have contributedto the Encyclopédie, but he was also one of literature’smost thankless characters, and father to the veryKafkaesque conviction that the forms and conventionsof civilised life occasion our ills.

In relation to the criminal or miscreant, the doctor’smoral vanity makes him even more of a target. He is,we realise with a start, brother to the man on the rackin Kafka’s terrible dramatisation of the condemnedprisoner who learns his sentence on his person, ThePenal Colony, a story we know to have been inspiredin part by his reading of the infamous case of theFrench army officer Alfred Dreyfus, found guilty of atrumped-up charge of treason in 1894, and banished tothe prison colony of Devil’s Island. In his storyKafka’s chosen instrument of torture appears to be aGutenberg screw press.

It is hardly incidental, then, that the first bodiesauthorised by the Church for dissection in Renaissanceanatomy theatres were those of the condemned, stillwarm from the gallows. Ontologically, and certainly inthe mystical body of the Church, they would always bemen, no matter how violently extirpated from the

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social body. Nonetheless, the logic of the grudgingconsent from thepulpit amounts to an imprecation: cut up your ownthen, Men of Science! Let your knowledge bleed!

Hidden in full view

Lastly, it strikes me that the patient on the bed bearshis wound like Jacob who, after wrestling the nightthrough with the angel on the mountain, calls on theangel to bless him—even if it might seem like a curseto Kafka. There seems to be a buried reference to theBiblical scene in his first ‘real’ piece of writing, ‘TheJudgement’ (1912), in which the seemingly invalidfather hooks up his shirt, aping his son’s fiancée, anddisplays his ‘war wound’. His act of indecent exposureseems calculated to call into question his son’s verymanhood. Kafka mentions a similarly suggestiveepisode in his travel diaries. Planning to visit Paris inOctober 1910, he was forced to shelve his plans andstay in Prague due to a severe attack of furunculosis(boils on his backside) and writes, ‘a brief faintingspell deprived me of the pleasure of bawling the doctorout. I had to lie down on the sofa, and during thattime—it was very odd—I felt so much like a girl that Itried with my fingers to tug down my skirt.’

The ‘wound’, in fact, was Kafka’s word for theexperience of writing: his first story forced him torecognise his nature as a writer. He was one of thoseself-doubters, like his great predecessor, the Danishtheologian Søren Kierkegaard, who kept open ‘thewound of the negative’ so that trust might close it

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again in some kind of natural healing process. Kafka’s,however, was a mortal wound, since, as he wrote toMax Brod, a writer ‘dies (or doesn’t really live) and isperpetually sorry for himself’.

Most disconcertingly of all, for those of us who takepleasure in reading Kafka, in trusting him as a writer,is the extraliterary dimension his writing has acquired.Kafka is now a prophet. J.P. Stern, late Professor ofGerman at University College London, has pointed outthat there is a resemblance between Kafka’sdescription of the wound and the unappetising use ofnatural metaphors in anti-Semitic propaganda, the mostnotorious being a passage in Hitler’s Mein Kampfabout scandals in Vienna before the First World War inwhich he talks about ‘the leech on the Nation’s body’.The German word for insect or vermin (Ungeziefer)whichKafka uses to describe Gregor Samsa inMetamorphosis is one of the terms the Nazis later usedto stigmatise the Jews.

What is interpreted as Kafka’s clairvoyance is surelyhis ability to grasp the stock phrases and figures ofspeech conventionally reserved for conveying mentaland emotional states with the mental equivalent of thecountry doctor’s forceps: not as metaphor, but aswords of literal intent, however much they try tohide—like the hapless patient’s wound—in full view.That is what prophets do: they read the impersonallogic that stands behind the most commonplaceutterances. And they have to be right if they’re not tobe wrong.

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Kafka shows us, sometimes in amazing detail, theintellectual contortions and special inner pleading thatafflict people who try to make sense of the arbitrary.What is most striking perhaps about his victims is thatthey rarely take any steps to avoid the fate they seem tohave expected from the first. The unthinkable is acategory of monster: it is what we never care to thinkabout.

A prosthetic life

These days the country doctor’s model patient can befound in any old family: he’s probably looking forwardto being able to walk again in a few weeks now his hipis a vanadium and titanium sphere bonded to hisfemoral shaft, for a good fifteen years at least, withbiocompatible epoxy resin. Writing to Brod from thesanatorium in the Erzgebirge just after he hadcompleted A Country Doctor in 1917, Kafka dwells atlength on his uncle’s imperturbable cheeriness andaptitude for life in the country, and suggests that thiskind of life might have tempted him too—‘the way aslight rustling madness can make a person contented,thinking it the melody of life’. But at thirty-four, withquestionable lungs and even more questionablerelationships, he decides he has no right to such anexpectation. And besides, flight from the paternal lineis in that desire; the compelling nocturnal spectacle ofHope grappling with his Father.

Perhaps only the anorexic Kafka could have dignifiedhis beefy middle-aged dad in such a way, as if he werecalling the toss with the Wrestler of Genesis, ‘who

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touched the hollow of Jacob’s thigh in the sinew of thehip’.

The wound had done its work. It was a moribund manwho rehearsed a normal life with Dora in the last fewweeks of the only life he had. ‘Franz is cheery and ingood shape’, appends Dora to one of Franz’s lastletters; and a simple country doctor might wonder atthe affection with which he addresses his parents,especially the father he made stand in so often astormentor; at how he comes to accept his body and hismanhood, even as his illness, and not its metaphor,kills him.

As for his uncle, we have a story that sees throughhim: the photograph reproduced in the Wagenbachbook has him sitting on a metal skeleton with thepower of about twenty thoroughbreds, thighs urging itforward, knuckles clenched on the throttle, while fourfemale helpers, including Kafka’s favourite sisterOttla—the one who encouraged Franz so much to quitthe parental house in Prague, and sustained him withregular food-packets in his last months with Dora inBerlin—smile triumphantly through the long exposuretime in front of what may well have been UncleSiegfried’s camera too.

In the photo Uncle Siegfried’s NSU Cantilever isactually resting on its rear stand—poised for a momentin time, like the four human figures in the picture, onits own two legs.

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Is there Life on Earth?SOME OBSERVATIONS ON TECHNICAL LANGUAGE

Technology is on course to achieve such a degreeof perfection that humans will get by withoutthemselves.

– Stanisław Jerzy Lec

For an information technologist what you and I engagein on a daily, more or less unselfconscious basis is‘fuzzy discourse’. What is fuzzy discourse?—trytalking to someone with a microphone nearby or readsomething you’ve dictated in a hurry and you’ll see inan instant what’s fuzzy about it: lots of throat-clearingenunciations, phatic slab-words, trailing conjunctions,

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broken-backed metaphors. Linguists call these‘discourse markers’. Language doesn’t flow; it comesin stops and starts. Sometimes it looks like the angelwrestled by Jacob, and smashed to bits on hard ground.This idea was once expressed supremely well by KarlKraus, the one-man Viennese cabarettist and publisherwho never tired of telling German-speakers how nakedthe emperor was: ‘in no language is it so difficult tomake oneself understood as in language’.

For information technologists aiming to corner themarket in voice recognition systems and who probablywouldn’t give a hoot for Karl Kraus, what happens indaily life must be horrifying.

Like us, information technologists more or less speak alanguage. Inside the doors of their specialism, theycultivate what is properly called an ideolect, andthey’re presumably realistic enough to know that agalactic interlanguage in which everyone can talk shopand be understood is about as pertinent a prospect asfinding an Elsevier dictionary in the next world. Whatis language using us for if not to sowmisunderstanding, humankind’s rogue creativeprinciple? In the tongues of angels, however, whonever squabble (even if they disobey God), wordsexactly embrace their objects. Since we can’t pretendto speak High Angelic, what we have in our world is avehicular subvariety of English called Tech Talk.TT—acronym is as much a quick fix in TT aselsewhere, witness Chomsky’s LAD or ‘languageacquisition device’—is a way of giving structure andfunctional rigour to the fuzziness of everyday life.

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Language finds a way of saying what it needs to; thatis an axiom which introduces us to quite a different setof assumptions from those of the famous Sapir-Whorfhypothesis, suggesting that we can’t think what ourlanguages can’t say (Orwell’s Newspeak).

TT is a variety of discourse based on algorithms, analgorithm being an arborescent decision evaluationprocess template (ADEPT), a very distant and parodicoffshoot of the Tree of Knowledge. Doctors, forexample, use algorithms all the time (and they’republished in family-tree format in doctors’ journalsand in the backpages of books called Five Minutes forthe Patient to make it easier for them to be slid underthe little plastic protectors doctors keep on their desks)as a way of not having to think too hard (or even tothink at all). You turn up with symptom A: question:do you have contextually associated symptom B:question: Is it provoked by C; and so on, untildiagnosis emerges by a process of exclusion. Orperhaps exhaustion. This method derives fromSydenham in the seventeenth-century. In his attempt toidentify clinical phenomena as closely as possible inthe hope of establishing common signs and symptoms,he adopted the method used by the natural historian todescribe species. But reading through the hiererachy ofalmost legalistic specifications in the Diagnostic andStatistical Manual (DSM) of Mental Disorders, FourthEdition (theAmerican manual of psychiatric disorders) can leavean innocently inexplicit rule-deductionist quite dizzy atthe multiplication of species (no threat of extinctionhere); and WHO’s Manual of the International

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Statistical Classification of Diseases, Injuries, andCauses of Death contrives to be appalling andfascinating in equal parts. The philosopher Lichtenbergcould no longer claim, as he did in his scrapbook for1789, that ‘anxieties and gloomy thoughts [are not]among the register of diseases: this is very wrong’.Every distress has its technical idiom. This is section E980–989, ‘Injury undetermined whether accidentally orpurposely inflicted’:

E 980 Poisoning by solid or liquid substances,undetermined whether accidentally or purposelyinflicted

E981 Poisoning by gases in domestic use,undetermined whether accidentally or purposelyinflicted

E982 Poisoning by other gases, undeterminedwhether accidentally or purposely inflicted

E983 Hanging, strangulation or suffocation,undetermined whether accidentally or purposelyinflicted

E984 Submersion [drowning], undetermined whetheraccidentally or purposely inflicted

E985 Injury by firearms and explosives,undetermined whether accidentally or purposelyinflicted

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E986 Injury by cutting and piercing, undeterminedwhether accidentally or purposely inflicted

E987 Falling from high place, undetermined whetheraccidentally or purposely inflicted

E988 Injury by other and unspecified means,undetermined whether accidentally or purposelyinflicted

E989 Late effects of injury, undetermined whetheraccidentally or purposely inflicted

I like that Biblical ‘falling from high place’. You mightmake a mess on the ground, citizen, but there won’t beany ink stains on the death certificate.

Who uses Tech Talk? We all do, in fact, althoughsome professional groups are more likely to use it on asystematic basis than others. Its pedigree goes backfurther, and into stranger recesses, than you mightsuppose. The Church and its doctrinalists were afounding source. Shakespeare, in a proto-Tech Talkscene from the Scottish play, has Macbeth translatehimself down for the intellectually challenged in thefront rows of the Globe with his hand that ‘will rather /The multitudinous seas incarnadine, / Making thegreen one red’; and Dr Johnson fingers another culprit:Sir Thomas Browne, coiner of such otiose titles asPseudodoxia Epidemica, whom he chastens forpouring in ‘a multitude of exotick words’. Or DrJohnson himself, clearly not having heard the jokeabout lots of little holes joined up with string: ‘any

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thing reticulated or decussated, at equal distances, withinterstices between the intersections’ (a net).

The first book in English to be called a dictionary, byHenry Cockeram in 1623, was in fact subtitled anInterpreter of Hard English Words; although the first‘conceptual dictionary’, in which words are arrangedin groups by their meaning, was first promulgated byBishop John Wilkins in his Essay towards a RealCharacter and a Philosophical Language (1668).Wilkins wanted to give a more meaningful, structuringsense to functional variety, to represent the multiplicityof relationships, both potential and actual. Thenineteenth century—the century of the OED—was theformative age of TT, possibly because people stillknew their classics. Think of Bouvard and Pécuchet,and the sixteen hundred books Flaubert had to readbefore his two bonshommes knew they had to give uptrying to understand the world. If we look underBalzac’s valiant attempts to classify society much likea zoologist we find, not surprisingly, Linnaeus andBuffon, but also Goethe, with his unrealised ‘novelabout the universe’. In his Manifesto, Zola—whothought Balzacian classification outdated in relation tohis more modern notion of the novelist asexperimentalist—actually quotes pages and pages ofClaude Bernard, the physiologist. And surely Joyce’soverweening ambition to capture a day in all itsnuances—a day as a book, with nothing omitted—is aTT ambition? ‘The infinite lattiginous scintillatinguncondensed milky way’ turns up somewhere or otherin Ulysses. More recently James Fenton, a poet with avery large forebrain, bravely went on record about

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his wish to provide poetry with a language for thefuture: this he evidenced once in a very Victorianseries of ‘found’ poems called Exempla, one of whichreplicates the weird beauty of the following line fromMycologia (Vol. 60): ‘I deal in minutiae, / Not with thefungus growing on the low walls but its / Globosevesiculate hyaline conidia’. Taxonomies, as Fentonsuggests, are not entirely the arid, abstract exercisessome people might write them off as being; they aredensely clustered verbal theories about what theyrepresent. The outstanding natural history book FiveKingdoms: An Illustrated Guide to the Phyla of Life onEarth, by Margulis and Schwartz, is just such anexemplum. Or, as the Collins’ guide Birds of Britainand Europe explains:

Scientists classify all animals in a series of groupings,starting with 22 phyla and proceeding downwardsthrough classes, orders, families (ending in -idae),subfamilies (ending in -inae) and genera to the actualspecies, below which there are sometimes subspeciesor races based on geographical variation. Birds belongto the phylum Cordata, along with the mammals,reptiles and fishes, and are themselves distinguished asthe class Aves. With the Aves class, there are 27 ordersof living birds, much the largest of which is thePasseriformes, loosely known as song birds, perchingbirds, or Passerines. The passerines comprise morethan half the known bird species of the world, andmore than a third of the 154 bird families. They are allterrestrial and very diverse in shape and form, butgenerally adapted to perching in trees and often have avery well developed song.

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It was the achievement of a poet—the Russian poetOsip Mandelstam, who actually resembled a passerineaccording to his wife in her memoir about theirdifficult life in the Soviet Union—to find a formula forthe figure standing in the shadows behind them all,dangerous Mr Darwin, ‘who possessed the courage tobe prosaic precisely because he had so much to say anddid not feel obliged to express rapture or gratitude toanyone’.

That list is, of course, a very selective, partialidentification of only those names visible from mywriting desk. It overlooks most of the real actors andmovers, a list which should probably include theVietnam War, aerospace scientists, BuckminsterFuller, and theimpersonal militaristic restructuring of consciousnessrequired for the smooth running of batch processing,QA/QC, and alphanumeric systems. (The fêted non-gametic ‘photocopy’ sheep Dolly is much more aproduct of commercial interests than of disinterestedscientific curiosity, and as such should properly becalled Dolly™. I hardly have to force the invidiousparallel.)

At a deeper level, English’s schizoid nature is a tirelessgenerator of task-specific nomenclature, its primaryinput source being, of course, the Norman Conquest.There’s a whiff of clergyman and cleric in TT, aureateclassicisms being intoned in a draughty place abovethe din of Germanic monosyllables. This forking of thetongue is all the more obvious in historically moreinnocent forms of English: the effect of all those

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German immigrants settling in the mid-west onAmerican English usage has been far-reaching.Germans are as likely to say ‘Personenkraftwagen’(PKW in its quick fix form) as ‘Auto’. Even a simplebricks-and-mortar conjunction like ‘oder’ (or) is oftensupplanted with the toothy ‘beziehungweise’, whichcarries a more apparent charge of order and rank,although in written language it bristles as ‘bzw.’.Technical people have always marvelled at those ultra-concise German compound terms like‘Wärmeleitfähigkeitsdetektor’, which is a device formeasuring heat conductivity, or the nippy‘Kontrastmittellösung’ used by radiologists todesignate a radio-opaque solution for enhancing X-rays. In old Fiji, before the missionaries, ruggedwarriors used to eat the brains of their defeatedenemies in order to absorb their mana; those who wonthe last war did the same, but being too sophisticated toeat flesh, cannibalised mere mouthfuls of air.Twentieth-century Americans are no slouchers when itcomes to Chicago Dutch. Webster’s dictionary insistson plain speaking, but put American English in abureaucratic high-tech environment and listen to theway it goes into phase transition. Gadgeteer Optimism,forsooth.

Less is more. If TT has one governing principle, it isthis: communicate with parsimony, do not indulge incircumlocution. Be rigorous, the world is object-rich.Primo Levi once pointed out how many chemicalcompounds there are—over two million—and ifchemistry, as compared to alchemy, has been able tobuild its house on phlogisticon and antinomy and

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mercury, predicting the existence of elements fromtheir hypothetical place in thePeriodic Table long before they had been identified, itis because each compound is part of a vast interlockingstructure in which one thing conditions and isconditioned by its neighbours. Named insect speciesreach roughly the same total. No parole for this langue.

Texpressions are often misused in their guise as asublanguage of impersonal agency, most prominentlyand perniciously by four-star American generals tobaffle the immediate enemy called the press corps.Human Remains Pouch or the squeaky-sounding SmartWeapon are euphemisms of abysmal cuteness; thehelicopter machine guns that mowed down Vietnamesepeasants in the war were called Puff the MagicDragon. Euphemism and death always go together: theGreek Furies, older even than Zeus, were alwaysreferred to in conversation as the Eumenides, theKindly Ones, just as Hades was Pluto, Mr Rich. AlfredNobel, founder of the prize that bears his name andanother man who wasn’t short of a bob, was adistinguished euphemist: he called the nitratecompound discovered in his own laboratory in 1866‘safety powder’, the rest of the world preferring to callit dynamite. Tech Talk, it may be noted, offers littleresistance to being driven to that kind of extreme,exploding people in the same way a draughtsmanexplodes a technical drawing. In Dante’s Inferno, allthe damned distort language to their own ends, and theworst can only babble. Consider, in passing, thestrangeness of the world(s) we live in when one side inthe Gulf War issued flowery old-style parafundities

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like ‘Mother of All Battles’ while the other constipatedus with the verbal equivalent of fast food.

Like all mythic languages then, TT has two faces. Itshouldn’t adulterate or be adulterated by after-dinnerorotundities or political doublespeak, though it will be.It is capable of being both radical novelty and ancientrepressive instrument for upholding the firm. Perhaps Ican hazard a definition or two: it is a technocratic task-specific semiotic paradigm transfer system, with theuseful spin-off effect of ensuring primary user statusenhancement. Well, that’s just obscurantist jargon,you’re saying. Not entirely. Jargon is a prophylacticagainst understanding, a meta-language semanticallytoo broad for what it’s describing (go and listen toany university sociologist obfuscating if you want toknow what physics envy is); an honest TT word-stacker is desperate for you to hear the whisper, clank,glug and scrape of things. He wants you to show youhis collection of fast fluid-attenuated inversionrecovery (FLAIR) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) images of your head inthe MRI sequencer. He wants, in short, to saysomething non-fuzzy about the things which give TTits oomph. (Whether he wants, or even needs you tounderstand what he does at work is another matter.)Language is stripped back to the denotative. It’s aquestion of economics in a situation in which theadvantages of the kind of mental hygiene that TTconfers are never under question. Good TT enlargesthe bounds of comprehension even as it yields up thetrue intricacy of things. Indeed, TT is anti-entropic.

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Why call a spade a spade when it’s a spatulate pedally-applied dirt extractor?

Latin and Greek provide the core terms with which tostart the algorithmic compounding. ‘Organism’ is anold favourite (though Richard Dawkins, biologist-cum-fundamentalist of the selfish gene, isn’t happy usingthat—as it were—tried and tested Texpression: he optsinstead for the more patently declarative ‘vehicle’).‘Matrix’ is a more recent buzzword. These are theimportant root-terms, the substantive building-blocks.Word lego, if you like. They’re also usually the easiestto define. Take the following examples: ‘icon’, ‘cell’,‘node’, ‘paradigm’, ‘habitat’, ‘system’, ‘entity’,‘complex’. What they define is the nature of thesystem; general and non-specific, they often lack thetrue cutting edge of TT. Other more specific core termscan be used but depend on the degree of professionalspecificity required: ‘fractionator’, ‘donor’, ‘buffer’,‘assay’, for instance, the first two being active coreterms, the latter two passive. Cystic fibrosis, forexample, is due to a mutation of the cystic fibrosistransmembrane conductance regulator gene onchromosome 7, as it happens a mutation 1 in 20 of uscarry as heterozygotes. ‘Steady-state’, the term inpharmacokinetics (not cosmology) that designates theperiod during which continued intake maintains aconstant effective drug level in the plasma whilewobbling over the dash like a drunk man trying toregain his balance, is a personal favourite.

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The busy terms are the common specific epithets(CSE) and modifiers. These form an agglutinatearound the core terms,and the descriptive power of the Tech Talk locution isdirectly dependent on what is stacked in front of thesubstantive. Some are structural, some qualifying,some processive. One of the great advantages of TechTalk (and English generally) is that nouns can bepress-ganged to work as adjectives. They may be staticor dynamic, depending on the object. They can besubdivided in the best French schoolbook fashion(Penser/Classer, the title Georges Perec gave to one ofhis books) into as many classifications as you cancome up with: form, colour, state, origin, etc. Wordslike ‘quasi-static’, ‘pleomorphic’, ‘homogeneous’,‘randomised’ are a few instances of the terms thatseparate the expert Tech Talkers from the greenhorns.William Gibson’s latest cybernovel mentions a ‘Rodel-van Erp primary biomolecular programming moduleC-slash-7A’. Ben Marcus’ disinformativelymeaningful first book The Age of Wire and Stringdevotes itself entirely to recalibrating language,creating a world in which the seasons, for instance, aredefined legally, and words, intoned or revoked fromthe atmosphere, permanently alter its temperature. Thisis how he defines his title:

AGE OF WIRE AND STRING, THE: Period in whichEnglish science devised abstract parlance system basedon the flutter pattern of string and wire structuresplaced over the mouth during speech. Patriarchsystems and figures, including Michael Marcuses,

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were also constructed in this period—they are the onlyfathers to outlast their era.

Here the classics come into their own. Take medicine(again). A good Tech Talk word used by doctors todescribe the condition of neurotic patients who presentwith symptoms for which there is no objective cause issomatisation (also called Briquet’s syndrome, aneponym being almost as quick a fix as an acronym).Linguistically, doctors somaticise all the time. Whocan resist the semiotically enriched resonance of CSElike ‘visceral’, ‘glossal’, ‘talar’, ‘diaphoretic’,‘desquamating’ and ‘verruciform’ once, like themedieval doctor, he has licked them with his tongue?Only Californian patients, in my experience, have everbeen known to drop these words into a casualconversation with their physicians, though as aLimousin student explained to the startled Pantagruelin Rabelais’ great novel, ‘my genius is not aptly nate,as this flatigious nebulon asserts, to excoriate thecuticle of our vernacular Gallic, but vice-versally Ignave opere, and by sail and oar I enite to locuplete itfrom the latinicome redundance’ (Book 2, Chapter 6,Cohen’s translation). It is only when Gargantua grabshim by the throat that he stops trying to ‘talk Parisian’.

Since the agglutinating can become very starchy, it’squite common to add a few colourful but TT-specificqualifiers at the start of the locution. ‘Binary’ isexcellent TT, though ‘on-off’ is acceptable too, as aconcession to Anglo-Saxon monosyllabic directness.In fact, as whimsically Anglo-Saxon as you like,provided the ordinary connotation of the qualifier only

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has a weak force—‘keyhole limpet haemocyanin’(KLH), ‘zigzag DNA’ and other immunological andgenetic engineering terms provide good examples ofhow vernacular is conscripted to make functionobvious through description. Some of the signal termsare the smallest. ‘Pre-’ and ‘post-’ can be foundeverywhere. Other prefixes go out in pairs like theanimals from the Ark: ‘dys-/eu-’, ‘macro-/micro-’,‘inter-/intra-’, ‘ante-/retro-’, so on and so forth.

Try it yourself (Edward Tenner’s pioneering chapbookTech-Speak is an amusing guide for those who wish tolearn how to coin their own non-stochasticTexpressions using what he quaintly calls his ‘crystalseeding rules’). Everyone else is doing it, even if it hasto be pointed out to him. Look around your house andyou’ll probably find a few consumer-devotional TTicons. My wife’s face lotion advertises itself as a ‘highintensity moisture gel for thirsty skin’. It’s easy to beblinded by science on Planet Skincare, where the priceof what is essentially a mixture of oils and water isdirectly proportional to the number of Texpressions onthe package. You will almost certainly have used a‘serial interface’ or a ‘multiuser docking port’ on acomputer. Everyone knows what a cathode ray tube is.The raw materials for a leap into TT hyperprecision areall around us. Open the fridge and take out a carton ofmilk. Now say it in TT: a fixed-form bovine lactealrecipient. And probably UHT at that. As Barthes notedin one of his exquisite mythologies, the world ofadvertisement offers ‘a whole Molièresque vocabulary,updated perhaps by a touch of scientism’. Not least for

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fast moving consumer goods (FMCG), where languageseems to shift almost as fast as the goods.

What effect does TT have in a real-time anthropoidinterface profession like medicine—is it mystifyingand inhumane? That’s a chicken-and-egg question thatgoes back to the Whorf-Sapir hypothesis, in the lightof which a paper-pusher’s locution like ‘negativepatient care outcome’ represents metaphysical degreezero. Personally I don’t use much TT in medicine sincepatients would rightly regard it as a kind ofperiphrastic high talk, heaping of insult on injury, orjust noises off; though when I work as a TT translatorin the quiet bits between patients or deep into the night,I have no option. I simply observe the familiarsuddenly become exceedingly strange, professionalvices become oddly militant. I find it interestingthough that the compiler of the most famous‘conceptual dictionary’ of all, Peter Marc Roget’sThesaurus (1852), was a Manchester doctor; here isRoget’s (or rather the 5th edition’s updated) entry887.6 under the generic heading UNIMPORTANCE:

an insignificancy, an inessential, a marginal matter oraffair, a trivial or paltry affair, a small or trifling orminor matter, no great matter; a little thing, peu dechose <Fr>, hardly or scarcely anything, matter of noimportance or consequence, matter of indifference; anothing, a big nothing, a naught, a mere nothing,nothing in particular, nothing to signify, nothing tospeak or worth speaking of, nothing to think twiceabout, nothing to boast of, nothing to write home

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about, thing of naught, rien du tout <Fr>, nullity,nihility; technicality, mere technicality

Compare such an entry, to take one at random, with themain causes of dementia in adults:

Alzheimer’s disease; hypothyroidism, subacutecombined degeneration of the cord; pellagra;hypoparathyroidism; multiple cerebral infarction;alcohol/Wenicke-Korsakoff syndrome; intracranialmass, hydrocephalus (including subdural haematoma);chronic traumatic encephalopathy; Huntington’sdisease; multiple sclerosis; spongiformencephalopathy; progressive supranuclear palsy;general paralysis of the insane; drug or heavy metalpoisoning; post-anoxia or -hypoglycaemia; chronichepatic encephalopathy; AIDS encephalopathy;uraemia, rare metabolic disorders, e.g. Wilson’sdisease.

Notice too how easily the technical imagination—notan oxymoron, as this essay has tried toprove—obliterates itself. I would prefer to leave themoralising about language to Orwellians and otherprescriptivists for whom the technotalkative, asNicholson Baker has called it, is sheer torture. TTalways wraps itself in a nimbus of plausibility. It aimsfor precision, control and efficiency, and it shouldn’tbe surprising if that naively upbeat Enlightenmentimpulse to reveal the material nature of the worldbecomes more and more ramified as it broadens. Thatis its peculiar illusion: all language is equidistant fromreality. Only the words are different. Language speaks,

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and we have to be scrupulous in attending to it. That isessentially a religious attitude; it comes down to usfrom the pre-Socratics whose logos, the orderingprinciple of the universe, was not some realitysupposed to lie behind words, but the thing itself. It issurely some kind of phylogenetic guarantee thatlanguage can never be quite as supine as we fear itmight be, even if Karl Kraus was known to deplore thefact that half a man could write a whole sentence. Healso said: ‘The closer you look at a word, the further itlooks back at you from.’

Are platitudes all we have? Has a transcendenttechnology found us helpless, stricken without ourclichés? That proud American word ‘know-how’ longago—to my ear at least—started to acquire an ironicBritish feel. The materials of life have changed,language trails behind, and the old general-purposeterms get stretched and bent to the new circumstances.It’s a kind of cognitive dissonance we’re all fluentwith, since we accept it as a trade-off: the price ofadvancing knowledge is that we, too, become objectsof that knowledge. There’s nothing inherentlyscientific about TT’s lego principle of reality, anymore than biology is a field of study that looks at ‘life’.Chuck Jones, the American cartoonist who brought thetrickster sagas into the age of Looney Tunes, hadMarvin the Martian trying to vaporize our planet withhis ‘Iludium pew-36 Explosive Space Modulator’. TheMcDonald’s operators’ manual, nanotechnology andISO 9002 certificates must have been thereinforcements.

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Finding a language for life on Earth probably has a lottodo with a history of rising expectations, AT/GC ratioson the human genome and those shadowy double-agents called translators who spend a lot of timetransforming apparently value-free words from onestunned language into another. It’s the Steptoe & Sonapproach to things: cobbling them together and makingthem up while gleaming new technologies become ascapriciously disdainful of mere mortals as Zeus was inhis heyday. My latest reading of the pandemoniummodel tells me that computer logic now incorporates,of all things, non-linear logic: instead of a strictA+B=C approach, the silicon matrices are programmedto admit that A+B≈C. What that fuzzy little signmeans, I suppose, is that facts settle at their owncognitive level too, one that exposes how much we’reenmeshed in them, while those other facts of our worldcalled machines, once self-evident antonyms toanything human, now seem so unaccountably lively.

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Tell Me about TeethA DOCTOR LOOKS AT A DENTIST

It was Elias Canetti who threw down the challenge:‘To write about teeth. Just try!’

Canetti’s epigraph is the opener for an article on teethby the American essayist Eliot Weinberger, one of thewritings in his exquisite book Karmic Traces. In anenjoyably bizarre reflection on the problems of non-occlusion in his pet rabbit, he notices, as I have too,that while many writers seem to earn their keep bybeing qualified doctors, he couldn’t think of a singlewriter who puts in hours as a dentist. Teeth,Weinberger reasons, are too often identified withpower, or the lack of it: ‘the sickness of the tooth andits subsequent extraction have tended to be viewed

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allegorically rather than as revelatory of humannature’.

In fact, dentists perch too close to the cutting edge ofsarcasm to entertain immodest thoughts about havingbeen specially endowed—as physicians so often like toboast—with extrahuman humane concerns. How canyou believe the soul is a butterflywhen the human breath is so foetid? Dentists ought tomake good satirists, even if they all too often end up asthe butt of satire. The Russian poet Osip Mandelstam,who was banished to the Gulag after daring to write asatirical poem about Stalin, had a thing about thebuzzing of the dental burr (his teeth weren’t in suchgood shape either) and wrote sarcastically about loving‘dentists for their artistry, their wide horizons and theirtolerance of ideas’ (The Egyptian Stamp).

Perhaps the bigger problem with being a dentist is thatyou can’t have a conversation with your patients, atleast not much of a verbal exchange. Anything apatient says with a drainage pipe, cotton wool andgloved fingers in mouth is going to sound strangulated.It’s no way to learn about the roots of social problems.

It seems appropriate enough that Canetti, who spenttwenty years of his life in London writing hisunclassifiable book Crowds and Power, should seizeon a symbol which, if you watch a lot of television,seems to be what television is best at revealing. In theworld of show-biz TV, people smile, and they smilebecause they know that figuratively at least they’rehaving you for breakfast; and the more the showmaster

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flashes his credentials (and everybody knows it’s afaked smile) the more pitiless it all seems. Thisstopper-rod assembly, this fender-bar, this enamelxylophone of incisors, canines and premolars thatmakes a mouth: after years of orthodontic corrallingand straightening, it may be perfect to the millimetre,every tooth a regular tombstone—but which tombstoneever had this effulgence, this phosphorescent veneer,this whiteness?

There are mouths that fill screens. Some of them aremacrognathic too, gleaming Chrysler fenders,enormous lower jaws that can barely contain all theteeth. As the French sociologist Jean Baudrillard onceremarked, ‘Americans may have no identity, but theydo have wonderful teeth.’ The whiteness of Americanteeth is virtue itself; and the Italian writer CurzioMalaparte, in one of his novels about the end of theSecond World War, was haunted by the dental arcade‘that every American, as he steps smiling into hisgrave, projects like a final salute to the world of theliving’. It was of course an American marketeer,Claude C. Hopkins, who got people to brush their teethregularly with Pepsodent in the early years of thetwentieth century (and allegedlyinspired Willem de Kooning’s famous series Woman,in which each just-about-recognisable female formsports formidable teeth). Now Americans spend threebillion dollars every year on aesthetic dentistry alone.

It had all been prefigured by Edgar Allan Poe, whowrote an especially creepy story, ‘Berenice’, about aman obsessed with a beautiful consumptive girl who,

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like a ghoulish version of the Cheshire cat, shrinksback to her teeth: his nightmare was illustrated byOdilon Redon in a charcoal drawing of 1883, whichshows two rows of gleaming teeth suspended in frontof a shelf of books to which they impart the mostspectral light.

Franz Kafka, in one of his meditations on power andpowerlessness, sees teeth where nobody else does. ‘Itwas an ordinary day; it bared its teeth at me; I too washeld by the teeth and couldn’t squirm out of their grip;I didn’t know how they were holding me, for theyweren’t clenched; nor did I see them in the form of thetwo rows of a dental arcade, but merely some teethhere and some there. I wanted to hold on to them andvault over them, but I didn’t succeed in doing so.’

The steeplechase through the graveyard might not haveworked out for Kafka, but periodontal medicine hascome on leaps and bounds since his time. Nobody hasto lose all their teeth at the age of eighteen these days,as half the inhabitants of Glasgow did in 1900 (manystill lose their teeth even now, though perhaps not all atonce). The journalist Ian Jack, who comes from theother side of Scotland, wrote an off-putting piece forthe Guardian newspaper about his father arranging tohave all his teeth removed before he was fifty, andspitting them out one by one into a bucket, while thedentist stood by; his mother had long since beenedentulous. Being a practical man, his father thought itwould make life easier not having any more teeth toworry about.

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The German mystic Jakob Boehme would havesympathised with Jack’s father’s decision: in hiswritings he suggested that the prelapsarian Adamneeded no teeth for eating the ‘Paradisicall fruit’. It isquite a thought: Adam and Eve were masticating withtheir gums until the Fall. (Of course, they hardlyneeded to consume either, having nothing as revoltingas entrails.) But the deep metaphysical problem withteeth comes from a different direction: you need themnot just to eat but to speak.

The Jack family’s loss of dentition was nothingunusual in Scotland. In the early twentieth centuryconservative dentistry was almost unheard of except inScandinavia and the United States. Prostheses(‘falsers’ or ‘wally-dugs’ in Glasgow), bridges andimplants successively replaced teeth rotted by time’ssubtle sugars. Some scientists even began to think ofcaries as a slow-acting infectious disease. But who’sthinking caries? Now whitening techniques(‘customize your bright, white smile’) help to give theimpression that we are a generation not just of perfectteeth, but perfect tout court. The Smile Design Centerin Los Angeles makes a livelihood from exploiting thefact that the impeccable smile is a social marker, andnot just in Hollywood. No need to suffer the stain oftobacco: fingers might be yellow, but teeth can bebrushed and polished clean, and even veneered. All ofthe members of the immigrant families in ZadieSmith’s White Teeth have what the novel’s titleadvertises. They are poised, as it were, between thestrong natural teeth of people who have yet to meet the

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refinements of civilisation and civilisation’s ability toprovide extraordinarily refined dental aftercare.

Stomatology would seem to be a brazen business then.Yet, strangely enough, the suspicion remains that theseperfect teeth are hiding something. Perhaps they’re notreally morally perfect teeth? They smile at you butmean to tear you limb from limb. ‘Und der Haifisch,der hat Zähne, und die trägt er im Gesicht’, wroteBertolt Brecht in his famous song about Mack theKnife. The shark has teeth, and he sports them in hisface—sure, and they don’t always stay in the oralcavity. Giorgio Pressburger writes in his story ‘Teeth’that his obsession with teeth began the day when, as achild of six, he saw an old actor begging in the streetwho, at the end of his routine, whipped out his falseteeth in order to bag the sympathy coin. I can onlyimagine that his sense of pity was sharpened by astreak of that other moral sentiment, disgust. In one ofhis novels Philip Roth is pleased to inform us that themouth in its very origins is also a hiding place, beingderived from the same germinal tissue in the embryo asthe genitals.

Humans are nothing if not dialectical. How else couldbaring the teeth, the most unambiguously aggressiveand hostile of facial expressions, qualify with the helpof a few other changes in facial posture as theuniversal signal of friendliness and cooperation?Darwin notices, in his remarkable other book TheExpression of the Emotions in Man and Animals(1872), one of the first scientific books to be publishedwith photographic illustrations, that the teeth are

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generally exposed by the raising of the upper lip underthe action of the zygomatic major muscle. It was thepioneering French neurologist Duchenne who noticedthat the genuine smile of enjoyment rather than just thefrozen gesture of appeasement involved the action ofthe eye muscles in synchrony with the lip muscles. Togrin, though, has two meanings: not only to smile, butalso to draw back the lips in a grimace of leeringdispleasure or aggressive intent. In sneers of defiance,noted Darwin, the canine on one side only tends to beexposed (and it must be of interest to more thanphilosophers of the Cynical School that ‘sneer’ and‘snarl’ are cognates, too).

When I eventually located that Canetti epigraph, onpage 242 of his book of aphorisms The HumanProvince, I discovered what he had actually writtenwas: ‘To write without teeth. Just try!’ Had that great‘Menschenfresser’ (man-eater) Canetti left his falsersat home on one of his research raids on the old BritishLibrary? Was the haughtiest man in Hampstead downon his uppers? It was a Pressburger moment that castCanetti’s lifelong obsession with power relations in anentirely new light. Now it made sense to me whyCanetti thought false teeth had something to do withdialectics. Dialectics are falsers which, if you use themto bite into a stone instead of a freshly baked loaf, willbreak, just as surely as the real ones.

If one of the events that define the end of history is thatpeople no longer need to lose their teeth, it still needsto be said how many teeth have been lost in the courseof history.

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Hygiene of the SoulSMELL AND THE MORAL SENTIMENTS

The nose is the supremely Shandean organ. Protruding,comic, hubristic, shiny, a zoological bizarrery, as plainas any fact can be yet somehow related to that otherorgan hidden in men’s breeks (and the nostrils areallegedly in tantric relation to all sorts of hiddenpsychic zones in both sexes), it seems first to havebutted in on polite society in the novel Dr Johnson sogreatly disapproved of—‘Nothing odd will do long’,he growled of Laurence Sterne’s The Life andOpinions of Tristram Shandy, Gentleman.

Johnson’s antipathy to the nose carried over into hisconversation: Boswell reports in chapter 39 of hisbiography The Life of Dr Johnson an unsuccessfulattempt by a young controversialist to get the good

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Doctor to take on board the notion that the mind mightbody itself forth other than through the eye: ‘A younggentleman present took up the argument against him,and maintained that no man ever thinks of the nose ofthe mind, not adverting that though that figurativesense seems strange to us, as very unusual, it istruly not more forced than Hamlet’s “In my mind’seye, Horatio.” He persisted much too long, andappeared to Johnson as putting himself forward as hisantagonist with too much presumption; upon which hecalled to him in a loud tone, “What is it you arecontending for, if you BE contending?”’ At whichbelligerent retort the young man backs off, and theconversation switches, in spite of Boswell’s supportfor the figurative novelty of the nose as the organ ofsagacity, to a different subject. Johnson hadconversationally tweaked the young man’s nose, hispunishment for having tried to be too ‘nose-wise’.

But the young man was onto something. It wasfollowing their noses which, as recounted inSlawkenbergius’ Tale in Book IV of Tristram Shandy,ended the independence of the people of Strasbourg,previously a free city under the Holy Roman GermanEmpire until Louis XIV descended on Alsace withimperial ambitions in 1683. ‘’Twas not theFrench,—’twas CURIOSITY pushed open [the gatesof the city]—The French indeed, who are ever uponthe catch, when they saw the Strasburgers, men,women, and children, all marched out to follow thestranger’s nose—each man followed his own, andmarched in.’ In an era when people were to be seenwithout noses at all (destroyed in the later stages of

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syphilis), noses are replaced as casually as if they werespectacles. Dr Slop, the extraordinary accoucheur,fashions one for Tristram from ‘a piece of cotton and athin piece of whalebone out of Susannah’s stays’.

When it eventually got to St Petersburg in the earlynineteenth century, the nose went rampant. VladimirNabokov called the trend ‘olfactivism’. Gogol wrote afamous story called ‘The Nose’ (1834), in which asocially aware nose, sliced off by a barber, gains theautonomous life that normal noses sometimes thinkthey are entitled to. Its former owner, the minorbureaucrat Kovalyov, spots it dressed up in a gold-braided uniform and, in the kind of ingratiatinglanguage befitting its status, requests an audience. Thisnose is having a successful career without Kovalyov,so it thumbs its nose at him. In another of his famousshort-stories, ‘The Diary of a Madman’, we are toldthat noses have even managed to build a lunarcivilisation. ‘That’s why we can’t see our own noses:they are all on the moon.’

Perhaps Gogol wrote his story simply under theinspirationof the Russian expression ‘to get only nose’ (ostat’sia snosom). Its sense is not dissimilar to the English idiomthat leaves you with only the shirt on your back:you’ve been taken in, reader, and lost face. Except thatthis face still has a nose on it.

At any rate, there is more than a hint in Gogol that thesenses are becoming uncoupled, perhaps to theirgreater benefit. The German poet Rainer Maria Rilke,

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by way of contrast, was obsessed with exploring the‘gaps’ between what he called the five fingers of thesenses: in his poem ‘Orpheus. Eurydice. Hermes’ thegod’s sight runs ahead of him like a dog, but hishearing lags like a smell—the kind of smell that canlinger the best part of a lifetime. When Odysseusreturned from his twenty years’ meander around theAegean, the only member of his household torecognise him was his old dog Argos—Odysseus stillstank of master.

The nose has a bottom. When we want to evoke thepalpability of an experience (or, better said, its sheerimmediacy prior to any perceptive analysis or stirringsof the will) it is to the nose we turn. Tolstoy, in TheDeath of Ivan Ilyich, likens talk about death, whichpolite society must overlook or ignore, to somebodyblowing off in the drawing room.

Smell is the most reliable sentinel, the indisputablearbiter of the moral sentiments. It is the organ able toroot out the genuine article. Johann Fischart, one of theearliest masters of modern German prose, wrote apoem in 1571 with the motto ‘Sie haben Nasen undriechen’s nit’ (You have noses and smell it not) todefend Luther against accusations that he and otherProtestants supped with the Devil. The great Russianpoet Osip Mandelstam put it like this, in his essay ‘TheWord and Culture’: ‘I sense an almost physicallyunclean goat-breath emanating from the enemies of theword. Here the argument which emerges last in anyserious disagreement is fully appropriate: an adversarysmells bad.’ Smells flag up the corrupt, but smells are

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themselves potentially defiling. They can get beneathour guard and threaten total physical and moraldebasement, and bring with them besides theunwelcome attentions of dogs and flies. CommanderR. H. S. Bacon, who travelled in Benin, the site of oneof the most disgraceful episodes in British colonialhistory and backdrop for Conrad’s famous novella,Heartof Darkness, must have been holding his nose with onehand while holding his pen with the other:‘...everywhere death, barbarity and blood, and smellsthat it hardly seems right for human beings to smelland yet live!’

That he could smell, even figuratively, the death-dealing on their hands lends an eerily reckless bravadoto Isaac Babel’s explanation to the same Mandelstamof his penchant for spending time in Moscow with thenotoriously brutal members of the Cheka, Stalin’ssecret police. ‘M. asked him if he wanted to touch thedeath they dealt in with his fingers. “No,” he replied, “Idon’t want to touch it with my fingers—I just like tohave a sniff and find out what it smells like.”’ Babel’scuriosity, needless to say, brought him to a stickyend—he was shot by the same secret police after asummary trial in 1940. He became a victim of the newSoviet concept of death by quota.

So what kind of revelation is a smell?

In Ecce Homo, a whirlwind effort of three weeks’concentrated work in Turin even as he was losing hisgrip on his mind, Friedrich Nietzsche reviewed his life

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of philosophical vagabondage in some extraordinaryrhapsodic and apocalyptic pages. In the final chapter ofthat final book, which bears the immodest but notinaccurate heading ‘Why I am a Destiny’, he writes:‘Revaluation of all values: this is my formula for an actof supreme coming-to-oneself on the part of mankindwhich in me has become flesh and genius. It is my fateto have to be the first decent human being, to knowmyself in opposition to the mendaciousness ofmillennia... I was the first to discover the truth, in that Iwas the first to sense—smell—the lie as lie... Mygenius is in my nostrils... I contradict as has never beencontradicted and am none the less the opposite of anegative spirit.’

There’s a bitingly witty touch in that idea of himself asthe first decent man, and an even subtler wit in thesarcastic notion of sniffing truth—doggish,excremental and ground-level in one guise, mercilesslyrefined use of an underused faculty in another. In hisnotebooks, Ludwig Wittgenstein, discussing the lackof pretension and humility of the Gospels as comparedto the Pauline scriptures, flatly concludes his argumentwith the line, ‘That is, so to speak, what my nose tellsme.’ Richard Hoggart wrote thatOrwell, who had to overcome an extremely fastidious(middle-class) sense of propriety in order to gather(lower-class) material for The Road to Wigan Pier,‘could smell his way through complex experiences’.Decades before him, Flaubert had been unable to sleepafter having breathed the odour of the ‘proletarians’ inthe omnibus (he was however the nasal equivalent of avoyeur in respect of his mistress’ slippers and mittens).

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The novelist Adam Mars-Jones latches on to the oddityof smell in his memoir Blind Bitter Happiness—that itcan be an almost universally unminded sense-facultyyet the one which offers the most empirically reliablediscrimination—in the account of the car accident thatleft his mother Sheila without functioning olfactorynerves: ‘Whether because the sensing fibres had beenflattened by the van’s impact, or because the area ofthe brain that interpreted their signals had been closeddown while the blood pressure built up unnoticed,Sheila never smelt anything again, not fresh bread norburning hair. The technical term for this is anosmia.Strange: loss of sight or hearing are privileged with anAnglo-Saxon term, while loss of smell remains inGreek, as if this is a rather fancy description. Nevermind that smell is the most basic sense, the one thatcrouches lowest in the brain.’

Rachel Herz, a psychologist at Brown University, hasshown that the gustatory and olfactive are facultiesuniquely potent in evoking memory, having a directconnection with the hippocampus, a deep brainstructure that seems to be the store of our longer-termmemories. ‘When from a long distant past nothingsubsists,’ wrote Marcel Proust, ‘after the people aredead, after the things are broken and scattered, tasteand smell alone […] bear unflinchingly […] the vaststructure of recollection.’ Herz found that smellsproduce emotionally intense recollections but not veryintricate ones: they are association-poor. Lose yoursense of smell, however, and nothing will ever tastequite the same.

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Zoologically, smell is more prevalent amongprosimians. Among Old World monkeys, catarrhinessuch as ourselves and the great apes rely on the muchfaster transmission of information imparted by visualand vocal signals. Olfactory cues, of less variedcontent perhaps but lingering and moving in alldirections from the source, seem to be used for spacingand power relations, as well as to indicate sexualarousal. One great advantage of chemicalsigns is that they can signal in the absence of theindividual who left the odour. In monkeys, smell is justone of several sexual cues, so that its lack can becompensated for by other means. Odour associationsare learned by humans, and children exhibit noinherited reactions to smells. Despite this indifferenceto smell as a source of information, the smells we buycome in small but expensive bottles bearing the namesof very large opera singers. They are designed to coverup our natural body odours. The French sage Michelde Montaigne suggested in his essay on smells: ‘thosefine foreign perfumes are rightly regarded assuspicious in those who use them; it may be thoughtthat their purpose is to cover some natural defect inthat quarter’. We seek to cover up our smells out offear of eliciting disgust. And disgust, as thecontemporary American social thinker William IanMiller suggests in his pungent book The Anatomy ofDisgust, allows us to moralise about other people witha clear conscience, especially under the conditions ofmodern civilised society: it is the cardinal moralsentiment. We are prompt to make value-judgementsabout people who use too much perfume, and thosewho don’t use perfume at all. After all, scent ‘is a

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brother of breath’: it enters our very intimacy—deepthrough the limbic system—and there is little we cando to defend ourselves.

Things were different in the past. The Italian historianPiero Camporesi reminds us in his marvellous bookabout Italy in the middle ages, Bread of Dreams, acornucopia of evocative nostrums and popularmythologies, that ‘society of old was made up of aswarm of people, oiled, smeared, anointed and spiced,violently odorous and unbearably smelly, whereeveryone was in turn anointed and anointer, and wherethe sense of smell dominated heavily’. The Frenchhistorian Alain Corbin has also published a greatscholarly book about odours and the ‘socialimagination’, The Foul and the Fragrant; it appeared afew years before the German novelist PatrickSüskind’s remarkable debut novel, Perfume. Bothbooks evoke the Paris of the early eighteenth centurywhen the stench from the latrines and cesspools musthave been so potent, imaginatively at least, that it hungaround the streets until nineteenth-century couturiersand parfumiers, such as the House of Houbigant, founda way of making the grace-notes of plant-life—orangeblossom, jasmine and honeysuckle—the essentialadjunct to hedonism. Nosegays would slowly give wayto aerosols.

By contrast, the primordial human effluvium,according to these books, is a sweaty-cheesy-oily stink.Observing the bowler-hatted inhabitants of the modernasphalt city around him in the 1920s, Bertolt Brechtwas being anachronistic—but provocatively

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tolerant—when he wrote in his poem ‘Of poor B.B.’,‘They are quite particularly smelly animals. To which Isay: it doesn’t matter: so am I.’

V. S. Pritchett took the view that his fellow humanshad, in the course of the same century, becomemarkedly, and quite disappointingly, less odorous. Inan essay written in 1980, he recalled the lusty aromasof London before the Great War. ‘The smell of thatLondon of my boyhood and bowler-hatted youth is stillwith me. The streets smelled of beer; men and boysreeked of hair oil, Vaseline, strong tobacco [...] Thesmell of women was racy and scented.’ He had beencaptivated by what Jean-Jacques Rousseau would havecalled the search for the ‘memorative sign’, thecollapsing of past into present when an odour isrecognised which, far from leading into ‘reverie’,actually makes the self reveal its own affective history.

What is true is that humans are disgusted by strongsmells now to a degree that wasn’t the case a fewhundred years ago. Once the civilizing process gotgoing after Napoleon, and ours became a society of thespectacle, things changed for ever. And although weare all perfectly toilet-trained and no longer believemiasmas and vapours spell our doom, body odour stillhas a remarkable power to repulse and set apart, just inthe same way that the festering foot-wound of theGreek hero Philoctetes got him isolated on an island onthe campaign route to Troy. It wasn’t so very long agothat the Nazis redefined the Jews as other-smelling.Disgust is so much more direct as a moral sentimentthan hate, which needs reasons—all disgust needs is a

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whiff of body heat. What is as plain as the nose onanybody’s face has often been an olfactory convictionfirst. For nothing arouses fear—and cancels pity—likea bad smell. As Freud suspected, smell is where desireand shame are compelled, within the contradictions ofmodern life, to have intercourse.

Even the German language, according to the oncefamous culture critic Ivan Illich, has lost nearly all itsterms expressive of smell (although ‘nose-wise’—naseweis—is a perfectly current Germandescriptive for a cheeky or precocious person). TheItalian Bible scholar and essayist Guido Ceronetti islikewise adamant that the knowledge we have lostabout the nose is knowledge we have lost about ourselves: he insists—following Heraclitus—that soulssmell things in Hades. He writes in his fascinatingscrapbook on the history of medicine The Silence ofthe Body, ‘The smelliest parts of the body are thosewhere more soul is collected. The eye, which isodourless, is mirror not soul. Adding perfume to thebody adds soul or allows people with no soul topretend to have one. The strongest smells have come todisgust us, because the more civilisation represses andrestrains natural animality, the more intolerableexcessive soul becomes.’ He also alludes to what hecalls the sins of excessive cleanliness, Theresa ofAvila’s limpieza demasiada, and predicts that thesquandering of our most basic resource—water—willtake its revenge.

With his finely discriminatory nose, Nietzsche drewattention to himself as a geologist of concepts: he

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thought he was the only philosopher ever to get back totrue basics. His war with the academy had startedalmost as soon as he was appointed to the chair ofclassical philology in Basel in 1869, aged twenty-four,and reached a peak with The Genealogy of Morals, hismost decisive rejection of that unity of truth and reasonexpressed by the Encyclopedists. The genealogistrequires a breaking up of flat assumptions so thatradically new strata can emerge. Hence the importanceof the nose. In the hierarchy of the senses, it is thesense most despised by reason, the most animalistic.Yet only a truly desperate man would want to claimthat his genius was in his nostrils. In what wereeffectively his last sane words, Nietzsche wassimultaneously reaching out into his own benightmentand warning us, inadvertently perhaps, of reason’smost subtle enemy, the subversive point of view that iseverywhere. Nietzsche survived his own philosophy,and didn’t know it. In the last instance, it was thenose—his nose—that was the best receptor for what heonce called ‘moraline’, his scornful coining (it half-rhymes with nicotine) for the cloying perfumes ofdecomposition given off by those who thinkthemselves virtuous.

With his desire to break out of the consummative ideaof history that Christianity promulgated, andrediscover the endless cycles of India, Nietzsche wouldhave appreciated the word vasana. ‘It is the unknownthat you should remember’, the Jaiminiya Upanishadsays; since the same lives appear and reappear overvast expanses of time, there can be nothing whichcorresponds to our concept of memory or recollection.

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Learning is reminding ourselves of what we havealways known; and what triggers this reminding isvasana, or scent. This is the residue of a past life,which will be released only when a being isreincarnated in the same form. The nose allowseverything to be a re-enactment.

Stendal’s stories follow the logic of the epigram andanecdote, the remorselessness of logic itself: his art isone of codes and improvisations—‘my passionatecohabitation with mathematics’ he called it in The Lifeof Henry Brulard. In The Privileges, the short wish-listscribbled down as a kind of jocular testament in Rometwo years before he died, he commanded ‘The corpusand what comes out of it odourless.’ The reek of thereal wasn’t something to detain Stendhal; lucidity waswhat he was after. Although sociability figures greatlyin his work, it is a surface phenomenon. Not so Gogol.It was Nabokov who pointed out that the smells of thesame Rome are implicated in the origins of Gogol’swonderful story of the disembodied truant nose: whilehe was travelling through Tuscany, the Ukrainianwriter was almost preternaturally nose-conscious andwrote that the flowers of Italy gave him anoverwhelming desire to be transformed into a Nose‘with nostrils the size of two goodly pails so that Imight inhale all possible vernal perfumes’.

In must be a similar chemistry that excites the boredstationmaster on the Southern Austrian Railways inJoseph Roth’s marvellous short story ‘Fallmerayer theStationmaster’: he falls in love with a Russian countesswho needs to recuperate briefly in his house after a

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train accident nearby; she leaves ‘an inextinguishabletrace of cuir de Russie and some nameless scent’floating around his bedroom. For months he lives inher ‘sillage’—the train of scent left by a fragrantwoman. Sent to fight on the Russian front in the GreatWar, he tracks down the countess and ‘he smelt againthe scent which for countless years had pursued him,which had surrounded, enclosed, tortured and consoledhim’.

That is the special charisma of smell, and it has notescaped the notice of the modern perfume industry,which so generously tries to add zest to our lives ofolfactory deprivation in the cities of numbed noses. Dowe really need the perfume industry, though? Gooutdoors on a windy April morning and you’ll findyourself inhaling buckets of crisp vernal weatherspiced with anemones as if assuaging some profoundbut barely describable yearning: as the Italian poetGiacomo Leopardi noted, the smell of somethingbeautiful makes us want to merge with its source. Thatwas surely what drew Dante to describe paradiseitself—where God governs without intermediary andthe laws of nature no longer apply—as a sempiternalyellow rose whose petals are the souls of the blessed.The praises ascending sunwards are the emanations ofits perfume. And there is no windshadow, for all isradiance.

(Stendhal to Nikolai Vasilievich Gogol: if you want toget to heaven you’ll have to leave your nose behind.)

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The Importance of being an AgoraphobeTHE WRITINGS OF PETR SKRABANEK

Petr Skrabanek (1940–94) was one of the few reallydistinctive voices in post-war medicine: a polymath,world authority on substance P (a neurotransmitter)and Joyce scholar who ran yearly seminars onFinnegans Wake. He was on a visit to Yeats’ grave inSligo in 1968 when the Soviet army invadedCzechoslovakia. He and his future wife decided to stayin Ireland, and he completed his medical studies therein 1970. So began his mature career as ‘naturalscientist, forensic toxicologist, doctor of medicine andconnoisseur of the absurd’, and it culminated in anassociate professorship at Trinity College. Skrabanekwas a dissenter, fearless in his criticism of what hedubbed ‘cacademics’, ‘quackupuncturists’ and

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‘nonsensus-consensus’. The title of his best knownbook, Follies and Fallacies in Medicine, speaks foritself.

At last, someone has had the sense to bring out aselection of his several hundred published essays. Thisselection of sixteen of them gives a keen sense of thedistinctive, witty manner in whichhe applied an ‘attitude of mind rather than aphilosophy’: topics include electro-convulsive therapy,acupuncture, psychiatric nosology, anti-smokingcampaigns and a brilliant Socratic dialogue defending‘destructive’ criticism. (‘All criticism welcomeprovided it is constructive’, was the message I receivedfrom a journal editor the other day, in a perhaps onlypartly conscious attempt to defang criticism of its veryraison d’être.) Skrabanek was anything but arationalist by rote or bulk purchase. Overneatconceptual rationalisations are among his choicetargets: Freud’s and others’ bespoke therapies writethemselves off as science precisely because of theirsnap-shut snugness, the responsibility of the truescientist being to strive to find ways of proving himselfwrong. ‘By choosing unbelief’, Skrabanek wrote inFalse Premises, False Promises, ‘we do not rule out asubsequent change of opinion, based on new evidence,and thus nothing is lost; whereas, by being gullible, welose reason from the very beginning.’ Criticism isreally the quickest way to learn. Whetted by Hume andPopper, his native wit is jugulating: ‘Iconoclasm hasno place in science because science has nothing tovenerate.’ Nor, he might have added, can its results besettled by plebiscite, or even by experts.

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Medicine is a different matter, especially now that itsmethods of caring for the sick are overlaid with allsorts of socio-cultural agendas and quasi-religiousexpectations. It aspires to be a science though it isguided by notions of orthodoxy and heresy. As a socialutility, it is ruled by conceptions of the summumbonum that are outside the remit of science: scientificmethod disregards issues of good and evil, indeed issuccessful as a method insofar as it does so, andtherefore cannot be used as a moral guide.Unfortunately, doctors undergo a crammed, oftendogmatic training in thrall to clinical ‘bosses’, whichtends to hinder critical thinking. Then one fine daythey wake up to find themselves as soteriologicalsalesmen in the Valley of the Shadow of Death. Andthey hate to lose face by admitting they don’t know.Honest ignorance, as Skrabanek insists, is preferable todogma. Yet dogma is precisely what we have in massscreening and health checks—public health measuresblessed by the global clergy of the Church of Happyand Merited Health (Geneva, not Rome).

One of Skrabanek’s targets is epidemiology.Epidemiology—the branch of medicine that studiesepidemics—used to be a minordiscipline concerned with infectious diseases. Thoughsuch diseases have become markedly less prevalent,epidemiologists have not faded away; quite thereverse. The media of mass communication now serveas the best model for the spread of communicablediseases: sociogenic ones. ‘The knowledge of riskfactors rarely, if ever, contributes to the elucidation ofcausal mechanisms.’ Many crucial associations

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continue to be made by clinical observation althoughthe old-fashioned case report (a testimony about thenatural history of a disease in an individual patient) haslost nearly all the prestige it once enjoyed in medicaljournals: it is ranked lowest in the evidence hierarchyof current biomedical research. Skrabanek mentionsthe now-forgotten study in the 1980s that seemed toshow that AIDS was causally related to the use of‘poppers’ (amyl nitrite): such is the complexity ofassociation in the real world that the very method ofanalysing and reporting data may itself construct orconfound certain ‘findings’, and be quite unrelated tocause. This applies particularly to low-level risks.

Skrabanek called this kind of associationistepidemiology ‘black box thinking’. The ‘black box’ isan untested postulate which strives to link exposureand disease. In practice, it means looking at, say, acause of mortality and then sifting populations fordifferences in death rates so as to determine ex posthoc the principal causes of mortality. An association,by definition a fortuitous finding, is thus magickedretrospectively into a causal link. No smoke withoutfire, the public is invited to think, although Hume longago made cause and effect far more problematicnotions than they might seem. Kant summed up theScottish philosopher’s scepticism thus: ‘he inferredthat Reason completely deceives herself with thisconcept, in falsely taking it for her own child, whereasit is nothing but a bastard of the imagination fatheredby experience’. As a man of good sense, Hume merelyobserved that without access to the deeper causes ofthings we ought not to mistake our value judgements

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for absolute truths: an accumulation of facts is notsufficient to establish a universal law. But it seems tobe characteristic of our age that a loose association ofideas is commonly mistaken for a solid argument.These associational factors are then regarded as theintellectual equivalent of socially threateningDickensian imps and urchins: a regulating bureaucracyis called for; public information, enquiries andwatchdogs, outcome measurements, morebureaucracy, and so on. More than three hundred ‘risk-markers’ have been identified for coronary heartdisease, and the list keeps lengthening. If we have tohave lists, why not go back to the nine rigorous criteriadrawn up by Sir Austin Bradford Hill in 1965, whichought to be considered in any attempt to ascribe cause?They were strength, consistency, specificity,plausibility, coherence, biological gradient,experimental evidence, temporality and analogy—onlythe last two carry any weight with the media andpublic. Indeed, scare stories are topical analogies thathave run riot.

The practical effect of Skrabanek’s concern is bestseen in his 1990 essay ‘Why is Preventive MedicineExempted from Ethical Constraints?’ Early preventivemedicine grew out of hygiene and medical policing,which involved treating some people (on behalf of thestate) as if they were weeds in a flourishing marketgarden. Some preventive measures such as vaccinationhave a clear benefit but others do not, and their massdeployment results in labelling, anxiety andmedicalisation. While medical experiments onindividuals have been subject, since 1947, to the need

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to obtain fully informed consent, screening campaignsgot going among the populations of most developedcountries with almost no prior discussion of whatoutcomes might reasonably be expected. Prevention isalways better than cure, isn’t it? ‘The issues ofpreventive medicine have little to do with science,relative risks, and risk factors. They could be moreprofitably debated within the framework to which theybelong—ethics, politics, and vested interests.’ It mightbe more honest to call them population experiments orforms of early diagnosis. Certainly they fuel whatsociologists call the ‘ecological fallacy’—thepresumption that individual destiny can be modified onthe basis of evidence gathered from the study ofpopulations. Significantly, as medicine proceedstowards a disaster of good intention (a controversialreview in The Lancet at the start of 2000 suggestedscreening for breast cancer does not reduce mortality),it has come to rely increasingly on consensusconferences. Good science has no need for consensus,Skrabanek dryly remarks, since consensus is anessentially political notion, and a crying need for itarises only in its absence. Yet it was a politician (NyeBevan) who, at the outset of the National HealthService, quoted Galileo’s warning about mistaking themethods of science for what they are they not: ‘Theaim of science is not to open adoor on infinite wisdom, but to set a limit to infiniteerror.’

Those sharp-eyed nineteenth-century French socialobservers Tocqueville and Constant noted—especiallyin consideration of the budding United States—that the

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desire for well-being might push democracies tosurrender their liberty, perhaps without fully realisingit. Skrabanek grew up in a totalitarian society based onthe idea of the perfectibility of man; and it is surely histraditional Czech respect for a clear philosophical headthat makes him insist that life will always be elsewherefor those who believe happiness can be definedbureaucratically, as a health plan. A similar conceptualboldness and disdain for prescription-writers can beheard in the essays of his countryman, the lateMiroslav Holub, who was an immunologist and poet ofworld rank. One of Holub’s caustic remarks about thesupposed ‘wisdom’ of crowds (a trendy topic thesedays) reflects Skrabanek’s experience too: ‘stupiditymultiplies in a herd, whereas reason is divided by thenumber of heads, and reason thus diminishes withmultitude’. To be subversive is to think in the face offear, especially when the herd publicly gangs up onyou. Anyone who has anything to do with the healthsciences will profit greatly from Skrabanek’s book: itwill loosen them from the bonds of what W. H. Audenmemorably called ‘infernal science’, or what even theruthless Francis Bacon, in the first days of materialismas matter and mode of investigation, considered idolafori—idols of the market.

It is sobering to think that the practical effort requiredfor ‘the relief of man’s estate’, as Bacon called it,might just as comprehensively relieve man of hisestate.

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The Human PositionON FLYING AND FALLING

1

In the waiting room of my surgery in Strasbourg thereare a number of paintings and etchings. These havebeen loaned to me by my landlord, who is one of thecity’s elder artists (Philippe Stoll-Litschgy). I supposehaving his work on the walls lends a certain chicappeal to my surgery, but it sometimes makes me alittle nervous to think that I’m curator of an art galleryin addition to having to attend to the humdrum ofrunning a medical practice. But these paintings haveanother function: they allow me to stand in my waitingroom and daydream in broad daylight, surrounded bymythic themes: I extend invitations to all and sundry, Ioffer my card—here I am, dear townspeople of

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Strasbourg: come and watch how to fly away fromuncertainty.

One of the works on the wall is a woodcut showingIcarus with two improbable retaining bands tied to hisankles as he plummetsearthwards in a squawk of quill feathers. UnlikeBrueghel’s painting and W. H. Auden’s commentaryon it, Icarus’ fall rearranges the landscape; the objectsin the woodcut form a spatial choir around it. A nymphshields her eyes. An elephant does somethingelephantine. The leaves shiver. It is a cinematicmoment where agent, matter and observer are the threeseparate dimensions of a boy-angel’s body which hasentered time the wrong way. Sadly, nobody can nowexplain to Icarus the persistent flaw in the story of hispratfall since if he really had decided to fly high whenhis father said he shouldn’t, then the higher he flew thecooler and less resistant the ambient air would havebeen: wax or no wax, trailing edges at height becomemore efficient.

The etching made me go back to Auden’s famouspoem about Icarus, which he wrote in Brussels inDecember 1938, just a month before he made his ownflight from a Europe on the edge of war to the haven ofthe United States. It dilates laconically on one of thegreat myths of knowledge (in some ways a mirror-image of the Oedipus myth); Icarus flutters out of anupstairs Cretan window and shimmers peculiarly andincandescently across our technological age, the age ofbombing. Auden called his poem ‘Musée des Beaux

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Arts’ after the gallery where he saw the painting inBrussels:

About suffering they were never wrong,

The Old Masters: how well they understood

Its human position…

Suffering happens, and other things happen too:someone eats an apple or a pear, or opens the windowto air the house, or just strolls empty-headedly past.Dogs get on with their doggy lives, and ‘the torturer’shorse’ rubs its rump on a tree. With his fleetingreferences to Pieter Brueghel’s masterly studies ofterror, ‘The Numbering at Bethlehem’ and ‘TheSlaughter of the Innocents’, Auden then turns hisattention to ‘Landscape with the Fall of Icarus’ (1588),in which all that can be seen of Icarus is a pair offlailing legs about to disappear beneath the surface ofthe water.

how everything turns away

Quite leisurely from the disaster: the ploughman may

Have heard the splash, the forsaken cry,

But for him it was not an important failure…

Icarus looks like a flying trickster who hasn’t quiteperfected his water entry technique, one of thosemedieval airmen who regularly used to launch

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themselves from battlements and fortifications tosudden death or, if they survived coming a cropper,like Father Damian, the fifteenth-century Italian-bornScotsman who tried to fly with feathered wings fromStirling Castle to Paris, to the slower death of publicderision: Father Damian broke both his legs in thecastle moat. In the foreground of Brueghel’s painting aploughman cuts a furrow in a clay field whose furrowsrun to the edge of the field of vision: it is an imageredolent of inertia, custom and tradition. The ship is ofa kind Brueghel would have seen anywhere off thecoast of the Low Countries: it floats on the aquaticbeatitude of a world newly made by money. The Dutchwere rapidly expanding as the foremost maritimepower: 1588 was the year that a fierce gale in theEnglish Channel destroyed the redoubtable SpanishArmada. Not included in Auden’s poem is a fishermanon the bank who seems oblivious to what’s going onaround him, and a shepherd who, perhaps hearingsomething—a creak, a cry—, is leaning on his staffand looking skywards, though in the wrong directionaltogether. In a thicket close to the border of thepainting—even less apparent than the drowningIcarus—lies the bald head of an unburied corpse, faceup. Away in the distance a fabulous red-roofed cityshimmers in the early light.

The very moment Icarus comes into view he drops outof it altogether.

The painting tugs at custom and fable in a way thepoem does not: art historians tell us that although hissource was Book 8 of Ovid’s Metamorphoses,

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Brueghel’s intention was to actualise the harsh popularFlemish saying, ‘No plough comes to a standstill for adying man.’ Auden makes mundanity the bearer ofunderstanding, but permits only the Old Masters(something he was to become himself in his poet’sprogress) the cosmic amusement: to have theunderstanding. The morally critical incident, Icarus’slippage, is of passing relevance, and his fall happenspractically hors scène. Auden’s pronouns are evasivetoo: to what does the ‘it’ refer, for instance, in theopening lines? In this Arcadian costume drama humansare surrounded by a surfeit of gerunds: suffering,eating, opening, walking, waiting, skating,disappearing, falling—none of them is able to followthe action through to completion. His voicein this poem is seductively reasonable andcommonsensical: that is why we should distrust it,since common sense may also be an open trap.

So what is the ‘human position’ of suffering? Whymake this idea explicit when the painting instructs thedead to bury their own?

Icarus’ fall may be spectacular, but it’s not evidentwhy it should be thought of as giving access to thequality of suffering. Icarus, like the subject in one ofthe most vertiginous of all Futurist paintings, TullioCrali’s Incuneandosi nell’abitato (Nose-diving on aCity, 1939), which shows the cockpit view frombehind a pilot as he plummets vertically down on acircuit board of skyscrapers, is man on the move,rushing into his death. What happens next is forgottenin the vertigo of the image. Suffering, Auden’s poem

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suggests by contrast, is not something exceptional ordramatic: commonplace, uncharismatic, it may be asnear as the next life and yet utterly remote. There isnothing subtle about it. When the dying Mrs Gradgrindin Dickens’ Hard Times is asked: ‘Are you in pain,dear?’, and she replies, ‘There is a pain somewhere inthe room, but I cannot be positive that I’ve got it’, herreply makes no phenomenological sense at all, for painleaves no room at all for doubt. Pain is a state of beingthat impales us solipsists on the sensation of timeitself. It is one of the great stubborn facts of existence,a quality we can’t deny in ourselves but, equally, can’tconfirm in others. In terms of cognition, it reinforcesthe bounds of privacy, while undermining everythingsolid about others; in terms of recognition, it stakes itsclaims outside the field of knowledge altogether. Thedemand for acknowledgement is pain’s social life.

In another sense pain is the invisible, subterraneangeography that swallows up Icarus’ head.(Wittgenstein couldn’t understand how pain couldhave depth, although it’s only paint-deep in ourexample). For a person of Auden’s generation, it’seasy to see that geography as the trenches of the FirstWar. Nothing about the nature of war would ever bethe same again: people begin to be seen in terms ofmass, mud is the medium, and hard steel strips the tiny,vulnerable human frame of whatever patheticallyinadequate dignity it has left. Brute matter remainsitself, but the shell shock goes deep into language.

In 1909, just a few years before the war made theconnection between flight and alienation explicit, and

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decades before Europe was an afterglow of burningcities, Kafka wrote in his diary, having just attended anaviation meeting in Brescia, ‘What is happening? Hereabove us, there is a man twenty metres above the earth,imprisoned in a wooden frame, and defending himselfagainst an invisible danger which he has taken on ofhis own free will. But we are standing below, pushedaway, without existence, and looking at this man.’Aeroplanes? ‘Upchartered choristers of their ownspeeding’, was how the American poet Hart Cranedubbed them.

Or we can go back, but only through museum glass, tothe original state of innocence in which winged flightand bombing (the first aerial bombardment actuallytook place in 1849) were anticipated by Leonardo daVinci when he designed his ornithopter; man was toascend into the air ‘in order to look for snow on themountain tops, and then return to scatter it over the citystreets shimmering with the heat of summer’.

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But let me return instead to the semantic energies ofthe poem: notice how Auden concentrates our attentionon the peculiarly active sense of what ‘takes place’ inthe poem. The verb seems to engulf its sentence, to bea species of rhetorical hygiene.

No one would dispute that suffering is the unbearableindex of our uniqueness: part of the way it provokes aturning away in those who witness it is its resistance tolanguage. What materiality it has is mute. The distress

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and embarrassment we often feel in front of thesuffering of others comes about because we don’tknow what to say. Consolation may seem an upsurgetoo easily bought by words. Pain itself destroyslanguage, or at least reduces sustained utterance tocries and whimpers, animal beseechings. To put itanother way, sentient hurt has no object, and peopleare obliged to find parallels for it: ‘Doctor, it feels asif...’. This is what the doctor himself is supposed tospeak for, as the patient’s advocate or intermediary;and the doctor’s surgery should be the one place apatient can be sure the reality of his suffering isacknowledged and given terms of reference. Inpractice, expressing pain isa prelude to its alleviation, and nobody should everthink reality betrayed by that one welling moment ofimaginative empathy.

What irritates me about the poem, since I recognise itstemptations and deferments, and can feel even as Iwrite what it means to want to escape, is theresignation to the lamentational mode in the absolutismof the phrase ‘they were never wrong’. Nietzsche, apsychologist every bit as perspicuous as Auden, oncewrote, ‘I’ve given a name to my pain and call it“dog”’, which wins assent, since it evinces a kind ofcourage. It is theatrical. We know, as Nietzsche did,the ultimate hopelessness of the cause. Whipped,shouted at, or fetching metaphysical bones, pain-as-dog is company.

But as my adjective ‘theatrical’ hints, pain has enteredanother dimension: that of performance. Writers, as a

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genus, have little difficulty performing. The troublegenerally with suffering in the Musée is that artistsrepresent suffering so well and make it so convincinglyvisible that they come to be thought of as the mostauthentically suffering group of individuals. This ishow Kafka, with his unnervingly acute way offormulating a dilemma (it is one first voiced by Edgarin King Lear: ‘The worst is not / So long as we cansay, ‘This is the worst.’’) confides in his diary: ‘Havenever understood how it is possible for almosteveryone who writes to objectify his sufferings in thevery thick of them: I, for example, in the midst of myunhappiness, in all likelihood with my head stillsmarting from unhappiness, sit down and write tosomeone: I am unhappy. Yes, I can even go beyondthat and with as many embellishments as I have talentfor, all of which seem to have nothing to do with myunhappiness, ring simple, or contrapuntal, or a wholeorchestration of changes on my theme. And it is not alie, and it does not quiet my pain; it is simply amerciful surplus of strength at a moment whensuffering has raked me to the bottom of my being andplainly exhausted all my strength. But then what kindof surplus is it?’

Kafka rightly felt that there was something dubiousabout being a writer. This feeling bothered Auden inmid-life too; his cleverness in introducing a torturer’shorse and martyrdom to the scene show at least howthe failure to express pain can be co-opted, not somuch to extend culture, but to break it up. Thebystanders’ disinterest in Icarus’ thwarted but

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armourless flight seems to be a projection of theairman’s detachment from the mass observationsubjects obliterated on the ground below. Audenunderstands the situation like a neuro-psychiatrist:consciousness is a shield protecting us againstexperience. Self puts on its conscious life as if it werea steel helmet in order to block the impress of so muchsensory bombardment, from the subatomic to theIcarian. To survive, we have to cheat ourselves ofexperience. Or, to put it another way: if we intend to bejudges we dare not feel too acutely the reality of whatwe judge.

Many psychoanalytically minded critics have beentempted to read ‘Musée des Beaux Arts’ as if it wereautobiography—a kind of confession. It suggests amap of Auden’s own feelings after having urged hissocial imaginary to stand up and be counted in thefight against fascism, only to renounce politicalengagement by leaving for the United States. Icarus,after all, has just failed to fly away from thelabyrinth—from art. In ‘Voltaire at Ferney’, anotherpoem written at that time, Auden provides areassessment of the same crisis—‘all over Europestood the horrible nurses / Itching to boil theirchildren’—an image from an empire on its way down,and one which startles because a public schoolboy’snightmare seems so grotesquely inadequate to the hardrain that Auden all through the thirties had said wascoming. His conclusion to this poem harks back to thequite leisurely turning away of the Icarus poem: ‘Theuncomplaining stars composed their lucid song.’Evoking the stars—so far above us we can’t covet

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them, as Goethe said—advertises the triumph of pain;the song might be lucid, but its cadence isn’t human.Star-gazing isn’t something we should do alone.Indeed, for Walter Benjamin, the recently finished warhad been ‘an attempt at new and unprecedentedcommingling with the cosmic powers. Humanmultitudes, gases, electrical forces were hurled intoopen country, high-frequency currents coursed throughthe landscape, new constellations rose in the sky, aerialspace and ocean depths thundered with propellers, andeverywhere sacrificial shafts were dug into MotherEarth.’

With his fine instinct for personal existential choiceand disregard for the logic of his own position, it looksas if dear old Auden had decided to reach down for hisslippers in the famous chaotic life of books in MiddaghStreet, Brooklyn, and adopt the American avuncular ofUncle Whiz. His decision to quit Britain at its worstmoment still causes rancour (it has been said that he‘defected’like his friend Guy Burgess), usually followed by theinsinuation that in so doing he not only lost touch withhis natural constituency of readers but with the mother-tongue. One American writer, Guy Davenport,commented: ‘he wanted a place he could notromanticize. He came [to New York] to ensure that hewas among humanity at its worst in this century.’ Well,that’s saying it for America! It sounds like an act ofself-mortification. Auden was courageous in that herefused to be bullied by ancestral claims (‘because Iknew then that if I stayed, I would inevitably become amember of the British establishment’) or even to

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acknowledge the contingent impersonal claims ofhistory. His move to the States marks a crisis in hisown search for the good life: a genuine allegiance tothe political and moral community in which he hadgrown up would have made the nature of his politicalobligation obvious to him—there would have been nochoice to make. He renounced his past in order tosuffer the wrong life. Estrangement was the neurosishe chose to cultivate. It is not that he lost touch withhis language; it is rather than he was obliged, by hisact, to scrutinise what it meant to be a moral hero;more particularly, what it meant to want to be a moralhero in a democratic age.

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And Daedalus? Daedalus (‘the ingenious’) is alwaysabsent from these pictures. Either he’s picking up thefeathers of his archaic flying machine scattered on thesurface of the sea, or he’s back in the workshop on KillDevil Hill going over and over the drag coefficient ofhis flyer, correcting his notes on the mathematics ofbirdflight as a basis for aviation. He doesn’t know anyother way to be a father. His legs tremble, he canbarely hold himself erect for grief. Now he feels thefull force of not being able to take his son’s place, andfall in his stead. He clutches the sink, vomiting out hisson’s quip about ‘climbing up to oneself by climbingabove oneself’ (Nietzsche). Perhaps he blames himselffor passing on the technology before the boy was readyfor it: his time register was always horizontal,empirical, strenuous, never the plummet of now hisson flirted with. ‘Profundum, physical thunder,

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dimension in which / We believe without belief,beyond belief’, was how Wallace Stevens called it inhis little squib Flyer’sFall. Gottfried Benn’s Icarus poem of 1915 is the mostextreme expression of this regressive urge to ‘bloom todeath’, not so much a sublime attempt to fuse with thesolid world below—or to merge with the divine mind,like Goethe’s Ganymede—but a wild urge to plummetout of consciousness altogether and down through thephylogenetically old pathways of thebrainstem—spinoreticular, palaeospinothalamic andpropriospinal, as they were termed before Bennattended medical school—to a flinty, inorganic terraincognita where his left frontal lobe (Broca’s area)somehow still functions:

Still through the scree on the foothills, still throughland-carrion,

turning to dust, through beggarly jagged

cliff-edges—everywhere

deep mother-blood, this streaming

decerebrate

slack

wearing away.

Daedalus is a bit of a fogey: he represents knowledgeas baggage—it gives him ballast, keeps him ponderous

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and methodical, but gets him home. His is the awful I-saw-it-coming condescension of posterity. Hiswarnings to his son not to go off on his own course,not to swoop too low and wet his wings or soar toohigh and blaze out in one final moment of whiteheat—this warning is the clearest indication thatDaedalus has read his son’s mind, that he knows everyintricate dimension of his son’s secret wish tooverreach him long before he had even thought ofthose wings, as Miroslav Holub, the Czechimmunologist and poet noted in his poem OnDaedalus, which swarms with Icaruses:

In the airport lounge (automatic goodbyes);

at the space control centre (transistorisedmetempsychosis).

on the sports ground (enrolment of pupils born 1970),

in the museum (blond seepage of beards),

on the ceiling (a rainbow stain of imagination);

in the swamps (hooting of night, born 1640);

in the stone (Pleistocene finger pointing upwards).

For a man who was to invent the steam-bath, thereservoir, glue, the plumbline and the axe, Daedalusshould have been able to foresee almost anything.Father and son were fleeing from the labyrinthDaedalus had earlier devised for King Minos on Crete.

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The king had imprisoned them both in fury afterDaedalus had helped one of Poseidon’s white bulls tocopulate with King Minos’ wife Pasiphae, the unionresulting in the Minotaur, that hybrid of man, beast andjousting machine that was to become the maze’smonster attraction until the arrival of Theseus. Mutantsand labyrinths lurk where the lust for knowledge,libido sciendi, meets up with human ingenuity. Or asOvid reasons, in a famous couplet about the bull-man,man-bull: Daedalus ut clausit conceptum criminematris / Semibouemque uirum semiuirumque bouem...

4

Why was Daedalus exiled on Crete at all? Because hehad earlier pushed his own nephew and apprenticeTalos off the Acropolis; Talos’ ingenuity as acraftsman in his own right (inventor of the saw,compass and potter’s wheel) had been threatening toobscure Daedalus’ considerable fame. Talos waschanged into a partridge, a bird that lost its head forheights while saving its skin, as in Michael Longley’spoem Perdix:

a grim reminder to Daedalus

—Inventor, failure’s father—of his apprentice, a boy

Who had as a twelve-year-old the mental capacity

To look at the backbone of a fish and invent the saw

By cutting teeth in a metal blade […]

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And when his talented apprentice ‘slips’ off the edgeof a rockface at the Acropolis, Daedalus is economicalwith the truth,

but Pallas Athene

Who supports the ingenious, intercepted his fall,

Dressed him in feathers in mid-air and made him abird...

Not much scientific dispassion there. Clearly theirapprentice-master relationship was lacking in the kindof strictures and structures which are common to everyvocation in modern timesand which might have helped to avoid the laterretributive business with Icarus. For example, some ofthe tough inflexible professional strictures that medicalstudents put up with and eventually aspire to enter:strictly determined professional status, knowledgeacquisition as ordeal, solemn rites of passage, criticalappraisal by peers. The titles of some of Auden’sfavourite books in the thirties suggest just the interesthe took in some of those loyalty-binding shibboleths,as set out in John Layard’s Degree-Taking Rites in theSouth West Bay of Malekula. Those are the trappings,after all, that protect future doctors from indecentexposure to pity.

Knowledge decays. Daedalus was in a rut in Crete,despite all the ingenuity he had devoted to developingthe world’s first artificial insemination technique forcross-species hybridisation. Perhaps it’s a mistake to

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practise sex therapy on kings’ wives. Nevertheless hechose to take the baggage along with him, all thoserusty old ideas, their built-in obsolescence, the past’scolossal burden. That is perhaps why Socrates liked toclaim descent from Daedalus. His knowledge wasintellectual skill, artisanal and applied; it was rooted inthe real world. He might have been the kind of doctorwho invents and patents ergonomically efficientsurgical instruments: the father of Denis Diderotperhaps, who, in his master cutler’s workshop inLangres, produced surgical lancets of such high qualitythey were bought all over France and put to evengreater use, at least metaphorically, by his son. Hewould have marvelled at the great flying cathedrals ofour age: the 165 tons, six million parts, twenty-onethousand horse-power thrust of a Boeing 747. Theinsinuation that flight was an escape from one’s properbusiness would have baffled him.

Time is full of Icaruses: if a son symbolises anythingto his father, then Icarus was the sweep of progress, thehigh of pure theory, the flight from authority, the quickfix of the new—‘Zarathustra the dancer, Zarathustrathe light, he who beckons with his wings, poised to fly,beckoning to all the birds, poised and ready, blessed inthe ease of his levity.’ Icarus thought he could gull hisold man and came down with his engines on fire. Itwasn’t the sun that scorched his wings; in his father’slanguage, he was actually the first case of professionalburn-out: his waxy quill wings flared in the wind,torched from the inside, and down he fell, not on a bedof humbled assumptions but on the hard ground rising.

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This is why those few curious people who venture intomy surgery are compelled to think of Icarus, a lesscomplex and interesting figure than Daedalus (the Dentcompendium Who’s Who in Classical Mythology getsit right with its caption heading ‘Icarus: seeDAEDALUS’): the symbol of the age is something asinherently unstable as man trying to fly by travellinglight, incorrigible and alone. Icarus is a fictionalextreme—that is why he is so easy to represent. Thereal problem for the bystander, though, as he fills hishead with more and more about less and less, and asknowledge reduces its half-life, is to determinewhether he more closely resembles Daedalus theanaesthetist, or Icarus the air-head. Technicalcivilisation offers him a fantasy of total bodilycomfort—its underside is a shattered body politicwhere he can replay other people’s catastrophes all daylong. In our electronic ether, proximateelectromagnetic pain is a thought away and we all havesome quotient in what Ernst Jünger called the ‘SecondConsciousness’, the statistical probability in war andpeace (that is to say the moral irresponsibility) ofbecoming a technological casualty like Icarus. But itwas Jünger who, throughout the 1920s and mostspectacularly in his influential book Storm of Steel,aimed to repudiate Benjamin’s recognition of just howtiny and vulnerable the human body knew itself to be,opting instead for a kind of armoured perception, a fullmetal jacket for those who, like himself, werefascinated by the spectacle of mythic horror rearing upin the middle of a civilisation of gleaming steel. If

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Jünger cultivated an observational coldness, otherideologies of hardness would serve the functionalismof the Nazi state.

If Icarus’ fate is an allegory of self-delusion, thepunishable conduct of a son who had yet to hear aboutOedipus, his father by contrast seems both disciplinedagainst and vulnerable to the shock of history. Thehistoricist humbles himself by admitting his ownhistoricism. Or as Auden put it, poets have to be toughto maintain their fragility, which is to say that thequalities that allow them to be most productive are alsotheir Achilles’ heel.

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Now, as I wait for patients, I steal a glance out thewindow and suspect I resemble Icarus, who probablydidn’t have the perseverance and staying power tobecome a Daedalus. And now that Auden, (in myheretical opinion) a more convincing essayist than hewas a poet, has himself has become a whole climate ofopinion, I’d like to ask his gentle ghost one more thing:what would an Old Master ‘understand’ of those whocan’t turn away?

My position, for the time being, is firmly on mygluteals, which is just as well since, as Michel deMontaigne—who loved nothing more than to be seatedon his horse—observed, ‘even on the highest throne inthe world we only ever sit on our own rump’. Toomuch abstraction leads to a craving for the concrete,any old concrete.

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The sedentary station doesn’t stop me from feelingweightless though, especially now that I notice I don’thave any patients.

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Emergent propertiesJOSEPH NEEDHAM AND CHINA

One of the great synoptic works of developmentalbiology is a three-volume set published by CambridgeUniversity Press in 1931. I heard about this book whenI studied developmental biology myself, halfwaythrough my medical degree; and the professor ofanatomy under whom I studied had nothing but praisefor its author. Over two thousand pages long, ChemicalEmbryology provides not only an exhaustive accountof physiological changes in the embryo and placenta(osmotic pressure, pH, respiratory gradients, metabolicprocesses) but a descriptive history of the egg from itsearliest mythic beginnings. ‘Practically nothing was

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left out’, wrote its author—one Joseph Needham, born1900, only son of a Harley Street physicianspecialising in anaesthetics and an erratic, high-strungmother (who so seldom saw eye to eye with herhusband that she called her son by a different Christianname). Leading light of the Cambridge BiochemicalLaboratory, he was already being hailed as the newErasmus, so impressive were hisintellectual reach and vigour. He did have the benefitsof a photographic memory. His wifeDorothy—‘Dophi’—Moyle, herself a notedbiochemist, recalled him lying awake in bed, energisedby the work he had been doing in the hoursbefore—‘mentally visualising the book’s page proofs,and then correcting in a notebook any errors orinfelicities’.

Needham liked bringing things between covers, and itwasn’t always writings on biology. Wayward driver ofan Armstrong-Siddeley Tourer, brazen gymnosophist(nude bather), radical activist, forbearing Anglo-Catholic and keen morris dancer, he was also acquiringa considerable reputation as a skirt-chaser. To be aneccentric in Cambridge went with the turf; to beunsound was to invite social ostracism. But Needhamknew just how to toe the line, and people would makeallowances for him because of his brilliance. Then in1936, three Chinese research assistants came to workin his lab. He began a relationship with the femalemember of the team, Lu Gwei-djen, a physiologistfrom Nanjing, who stayed on in Cambridge: their affairwas to last, with the complaisance of Dophi, for thenext half-century. All three must have spent many a

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jolly evening together in the local pub discussing thebiomechanics of muscle tissue.

Theirs was to be a significant encounter in anotherway. Lighting a post-coital Player’s for her oneevening in 1938, Needham casually asked her how‘cigarette’ would be written in Mandarin. Lu Gwei-djen guided his hand, inscribing the ideogram thatseemed far more poetic in literal translation than theEnglish word: fragrant smoke. A cigarette had been thecatalyst: ‘I must learn this language—or bust!’ he toldher. Within a couple of years Needham had produced aseries of homemade notebooks detailing 6000characters indexed in terms of their radicals and cross-referenced to English words. The task of learningChinese made him, in his own words, ‘almost deliriouswith happiness’. (He was still spending his days as abiochemist.)

With the war in its third year, and large parts of Chinaunder Japanese control, a member of the Royal Society(of which Needham was now a fellow) suggested that asenior figure connected with British research should beairlifted into China, as head of a new body with quasi-diplomatic status to be called the Sino-BritishScientific Cooperation Office (SBSCO). Needhamwas the obvious choice. His duties were to includeorganising help for Chinese scholars fleeing theJapanese invaders, who were advancing into the innerprovinces. Equipped with a Webley service revolverand diplomatic papers, he was flown in February 1943into China over the notorious Hump, the airbridge thatled east of Calcutta and across Burma to occupied

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China. He had just seen his second major work throughthe press, Biology and Morphogenesis (1942). His basewas to be Chongqing, the capital of unoccupied China,at the humid confluence of the Yangzi and the Jialing:it is now said to be the world’s most rapidly expandingcity with a population of over thirty-five million.

It was a dangerous mission, full of hair-raisinglogistical difficulties, but Needham had a genius forimprovisation and an ‘imperturbable persistence’. Thescholarly Grand Panjandrum had derring-do, andSimon Winchester devotes nearly half of hiscompanionable biography to the three years in China.Needham was hardly ever in his office in Chongqing.He made no fewer than eleven sorties on behalf of theSBSCO, some of them fact-gathering missions butothers epic undertakings that were risky and, in onecase—which involved crossing the frontline southwestto Fuzhou—‘downright foolhardy’. The mostspectacular of them all—his own LongMarch—involved driving two Chevrolet trucksnorthwards to what was then known as ChineseTurkestan. This trip allowed him to inspect theirrigation project set up at Dujiangyan in 250 BC on theorders of Li Bing, governor of the province, whenwater engineering first proved to be crucial to thewelfare of the imperial system. His discovery that thewaterworks were still in working order brought him toa pitch of high excitement. Two months later theyreached the Mogao Caves at Dunhuang, a Silk Roadoasis on the edge of the western Gobi Desert and therepository of the world’s oldest printed book, theDiamond Sutra, and thousands of other rare scrolls.

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The man who had actually found the library in 1907and inspired Needham to make the trip, the famousexplorer Sir Aurel Stein, was, unbeknown to Needham,actually lying on his death-bed just a few hundredmiles away in Kabul.

When he left China in 1946, Needham had visited 296Chinese institutes and universities. He helped lay thefoundations for organisations to support Chinesescience. It was not the onlyorganisation he helped to establish: he was theadministrator in Paris who, as his admirers later said,‘put the “s” into Unesco’ as the founder and firstdirector of its Natural Sciences section. Two yearslater, glad to be back at his rooms in Gonville andCaius, he began opening the hundreds of boxes andcrates he had sent back to his college during the war.For daily work he now donned the traditional scholar’sgown of blue silk he had acquired on his travels. In1948 he addressed a proposal to the Syndics ofCambridge University Press: it was the outline of thework which would make him famous: Science andCivilisation in China.

In spite of a few querulous souls at the press who feltNeedham ought to be doing what he was ostensiblythere to do—teaching embryology and doingexperimental work into the chemistry of early life(specifically inisotol levels in the chickenembryo)—he was given leave of teaching duties. Fromthen on he was able, with the help of his assistant, theChinese historian Wang Ling, to ‘follow [his] starwithout distraction’. This is all the more remarkable

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when it is borne in mind that Needham had noacademic standing in the actual department of OrientalStudies. Soon, some of the discoveries he had made inChina—on the abacus, dam-making and plum-graftingtechniques—were being supplemented by the results ofmethodical reading and judicious probing of Chinesesources. Needham had already been awarded one ofthe Republic’s highest honours, but he had close tieswith the new rulers too. In fact, he was so close toZhou Enlai, Mao’s foreign minister, as to be blind tothe nature of the new regime: the Patriotic HygieneCampaign under the Communists would, he believed,be China’s saving. Loyalty to the Communists ledNeedham to put his entire career in jeopardy: in 1952he took part in a Chinese-led inquiry into alleged useof germ warfare by the Americans during the KoreanWar. Hoaxed (it would appear) by a Soviet-inspireddisinformation campaign, the inquiry’s findingsaccused the Americans of dropping cholera-infectedrats on northern villages. The entire Britishestablishment, including parliament, the Royal Societyand his own college, vented its fury on him—‘somepeople called him a dupe, others a traitor, a few simplya crank’. And most inconveniently for his career, theState Department in the US blacklisted him until wellinto the 1970s. Like a long list of British intellectualshe had been naïve enoughto think that politics worked on the same impartialprinciples as science. Where intentions were good actswould be good too.

Ending up persona non grata saved him for his work.Needham had read enough to start writing. Seven

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volumes were initially planned, of which the fifthwould be devoted to what has since become known,even in Mandarin, as the Needham question (Li Yuesenanti): if the Chinese had been so technologicallyinventive, why did they not come up with modernscience? ‘Sci[ience] in general in China—why [did it]not develop?’ was the original entry in his notebook.Wherever Needham looked the Chinese had been therefirst: fitting stirrups, steering with compasses, castingiron, inoculating against smallpox, recognising beri-beri, distilling mercury, making maps, ball-bearings,umbrellas and clockwork escapements… Yet just atthe time when the Renaissance was in full flow inEurope the creative passions of the Celestial Kingdomwere drying up. Needham was unsure. Perhaps hisquestion was back-to-front: perhaps it ought to be‘why Europe (of all places)?’ Was it related tomathematics, capitalism, or the peculiar ‘doubleness’of the European mind and its fondness for viewingthings as particles? It was a mind that was ‘oscillatingfor ever unhappily between the heavenly host on oneside and the “atoms and the void” on the other; whilethe Chinese, wise before their time, worked out anorganic theory of the universe that included Nature andman, church and the state, and all things past, presentand to come. It may well be that here, at this point oftension, lies some of the secret of the specificEuropean creativeness when the time was ripe.’ Thequestion is still open.

When the first volume, Introductory Orientations,appeared in 1954, it was an immediate critical success.Even Needham’s bitterest enemies praised it without

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stint: Laurence Picken, another Cambridge recruit tothe SBSCO who had fallen out badly with him inChongqing and was quite as brilliant a polymath(cytology, languages and ethnomusicology were hisprincipal interests), wrote in the Manchester Guardianthat its achievement was ‘prodigious… perhaps thegreatest single act of historical synthesis andintercultural communication ever attempted by oneman’. The initial print-run sold out, and it has beenreprinted several times since. When the second volumeHistory of Scientific Thought appeared two years later,it was apparent to everybodythat Needham’s magnum opus was going to besomething very remarkable indeed. Literary voicesjoined in the chorus of praise. George Steiner, noslouch himself, wrote that Science and Civilisation inChina was the modern work that came closest toMarcel Proust’s fictional attempt to recreate an entiresociety and past. He thought Needham wassympathetically reconstituting a prospect of theimagination forgotten by Chinese scholars themselves:‘Proust on the altering focus of the steeple atMartinville and Needham on man’s realisation, acrosscenturies and cultures, of the true shape of the snowcrystal are exactly comparable exercises in totalimaginative penetration. In each there is an intensepoetry of thought, readily felt but extremely difficult toparaphrase.’ It was in a little tractate, ‘Strena, seu deNive Sexangula’ (‘A New Year’s Gift of HexagonalSnow’), gifted to his patron Wackher von Wackenfelson New Year’s Day 1611, that Johann Kepler firstrecognised that ‘snow-flowers’ had an essential unityof pattern in their symmetrical hexagonal form. In one

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of his books Needham points out that the Chinesecontribution goes back to a tenth-centuryencyclopaedia entry, which preserves a passage in abook written by Han Ying from about 135 BC. Nothingmuch was made of this sound observation because sixwas the number associated with water: snow was ‘theextreme form of Yin’. In Europe, on the other hand,the natural six-pointedness of snowflakes was notobserved until the Renaissance, after which knowledgeabout it and many other phenomena rapidly increased.It is a wonderfully blown image upon which to tell thetangled history of a civilisation.

Needham’s personal life was on the up too. Lu Gwei-djen was living close by again, just a few yards awayfrom the house he shared with his wife, in anarrangement that suited all parties concerned. In 1959,he was elected to the presidency of the fellows atCaius, an almost unimaginable reversal of eventsearlier in the decade. Later to become master of thecollege, he proved to be a traditionalist whileremaining perfectly left-liberal in his support for theProgressive League, the New Left Review Club andthe Campaign for Nuclear Disarmament. But he wasslow to criticise the Great Helmsman Mao, eventhough his correspondents and scholars generally weresuffering greatly from the asperities of the CulturalRevolution.

Surrounded by a forest of documents, Needham wasbeginningto realise that he might not manage to recreate ancientChinese society in its entirety within his lifetime. Some

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of the seven volumes were calving fascicles. Hebrought in collaborators, and the work is still goingstrong: publication proceeds under the guidance of theNeedham Research Institute (NRI), which has justreleased part 11 of volume V, on ferrous metallurgy.The NRI had been set up at Cambridge by the ailingsinologist in 1987, after years on the fund-raisingcircuit. His library had to be housed somewhere, afterall. His ailing wife died that year too, fifteen yearsafter publishing her own magnum opus MachinaCarnis, an account of the biochemistry of muscularcontraction. In September 1989, in a small ceremony atthe college chapel, an ancient figure married thewoman whose love had inspired him so many yearsbefore. Lu Gwei-djen, aged eighty-seven, was to dienot long after, and Needham himself, now aCompanion of Honour, died, as old as the century, in1995.

Needham would hardly be surprised at the dynamicexplosion of wealth and creativity in China, even in thedecade or so since his death, since that creativity wasimplicit in his ‘discovery’ of China itself. He waschronicling a cultural self-confidence as well as atechnological past that had been completelyhidden—‘the unique degree of self-knowledge thathelps to make China China’. Winchester’s biographyfails to explain the shift in Needham’s interests: thereis less of a disruption than the reader might otherwisesuppose between his achievements in chemicalembryology and Chinese civilisation. The country towhich he devoted the later part of his life allowed himto examine how levels of complexity, process and

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relation had come together in the past in somethingthat resembled his projection of the future goodsociety. Not all sinologists or historians agree withNeedham’s categories, which have their sources inWestern thinking, nor with his diffusionist approach,which awards precedence to China on the basis ofhistoriographic record and then sets out to affirm howthe technology in question subsequently spread acrossthe world. Diffusionism, with its belief in the essentialunity of science, makes no allowance for thepossibility that innovations may be punctual orparallel, occurring independently of the social faith wecall progress, which Needham had in bags; they mayeven be lost, if only temporarily, to history. Besides,relying so heavily onhistoriography scants the achievements of otherancient civilisations, such as India’s, which left fewerrecords.

It remains to be seen whether China, which has gonethrough so many dynastic cycles and been bureaucraticsince its feudal beginnings, will absorb the twenty-firstcentury into its own history or whether, in undergoinga sped-up version of the industrial revolution’s war onNature (it took Britain three-quarters of a century toincrease its GDP fourfold, China has multiplied itsGDP tenfold in only twenty-five years), it hasabandoned its ancient cosmology and been engulfed bythat troubling western hunger for the ends of things. Acertain Captain Ahab heaves into view.

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A Mining Town in AustraliaTHE WORKING LIFE AS A MATTER OF CONSCIENCE AND

FAITH

Broken Hill is a nondescript town in the far west ofNew South Wales that lies over a thousand kilometresfrom Sydney, so distant from the state capital that itprefers to keep South Australian time. The typicalpostcard view of the city is an aerial one taken from aFlying Doctor plane, where it looks like a tiny circuitboard stranded in an almost flat straggly-brownexpanse of outback stretching to the horizon; onlywhen the plane begins to descend towards the smalllocal airport do you start to see furrows and ridges,skeletal trees, the bleach of salt lakes and claypans, theodd startled emu. In this vast dry bed west of theDarling River there are only one or two signs of humanhabitation, the corrugated iron roof of a farm or an out-

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station: Broken Hill lies out there in the big red, andhugs its isolation. The town lacks the conventionalmarkers of the picturesque but its history and characterare exemplary in a country that prides itself on theadaptability of its people.

I was a Medical Officer at Broken Hill Base Hospitalfor a year between 1990 and 1991, which meant beinga kind of dogsbody; but there were few areas ofmedicine I didn’t touch on in that year. I learned totreat problems of a variety and type I’d never met intextbooks. It was the kind of experience that left myheart in my mouth at times, other people’s hearts oftenbeing in my hands, but relief at getting things rightbuoyed me through fatigue and worry. For severalmonths I was duty officer in casualty by day, and up atnight to learn from the midwives, and sometimes therewere entire fortnights when I never got anuninterrupted night’s sleep. Lack of staff forced thoseof us who were there to work long hours, which wasirksome since I seldom had time to observe the countryaround me as much as I would have liked.

But I did notice a few things.

There were, all told, four directions to go from BrokenHill. Bush, which was anywhere in the four-wheeledzones that lay due north, west, and east; downriver,sheer poetic licence since the Darling river from whichthe town derived its drinking water ran at its closestpoint nearly a hundred kilometres to the east; andt’Adelaide, where the Flying Doctors would take youto the General Hospital for surgical repair if you sliced

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your tendons—those were the original three. Thenthere was the pervasive Broken Hill byname: You fromAway?

Away was indeed my provenance. Away started a fewhundred kilometres from Broken Hill, at Cobar on theSydney road, hovered around the affluent Murray andDarling rivers on the Victoria border, extended a littleinto neighbouring South Australia, and meandered onrugged, men-only holidays fishing for the freshwatercrustaceans called yabbies up along the dingo fence inCooper’s Creek, abutting Queensland. One of theworld’s most remote river systems, this collection oftransient waterholes with its shelter of coolibah treesand lush vegetation had rescued the explorer Sturtfrom the relentless heat in 1845, on one of his attemptsto find Australia’s inland sea.

There was, of course, another—unstated—way to go.That was underground. It came too as a permanentoption for some of the older miners, since gravity is aforce so strong it eventually drags all living thingsunder the earth’s cuticle. ‘In nations as in geology,’wrote the French historian Jules Michelet, ‘warmth isdown below. Descend, and you will find that itincreases; in the lower levels, it is burning hot.’

I went underground once, just for a day, in the SouthMines, down to level twenty-five. Level twenty-fivewas a kilometre under the surface of the earth. It wasblack, damp and very warm. ‘I was obliged to do it’,wrote the German writer Heinrich von Kleist in 1801about going down the mines at Freiberg in Saxony, in

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what had become a rite of passage for German writersin the Romantic era, ‘so that when I’m asked “haveyou been there?” I can answer: yes.’ Like Kleist, Iwanted to say ‘yes’, so I clad myself in gumboots toprotect my feet and a hard-hat to take any knocks. Afew weeks before, I’d read Fanny Kemble’s diary entryon her visit to the excavations for the Thames Tunnelin 1827: she was nearly overcome by an ‘indescribablefeeling of subterranean vastness’. She, however, wasabout to enter the age of the technological sublime;here in the mechanised gloom, it was decidedly post-heroic.

What I could see was a smooth functioning warren ofcables and sewers and service tunnels. Giantmastodons came up the ramp from below, their lightsflaring. Most of the miners’ work had been automatedand seemed to be entirely given over to running andmonitoring machines, rather than coming muscle tostone with the rockface. You would have to go backand read Orwell on the ‘fillers’, in 1937, to get animpression of the sheer physical dint involved incutting out a mountain from the inside. The miners hedescribes had to crouch down on their knees andshovel for seven and half hours, with one short breakfor bread and dripping and a flask of cold tea. He talksabout the oppressive heat too, and the fierce blasts ofair let out by opening the fire doors, and the distancesthe men had to trudge underground. That was miningat the end of the second technological revolution, whenhumans still manipulated matter with their bare hands.Mining, like farming and building, is one of thoseforms of work in which the worker is himself

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significantly altered by what he does; his posture, gaitand build are never the same again after he has‘worked’ on the world.

But the machines weren’t always predictable, nor wasthe seam. I’d had calls in the early morning at thehospital, when the emergency room waited for acrushed miner to be driven up from the several levelsbeneath ground; and there was the occasionwhen I’d had to wait at the mine-shaft for a thirty-yearold to be winched up from the passage where he’dcollapsed. He was blue where his skin could be seenthrough a film of dust, his eyes fixed and dilated andthere was nothing I could do. His heart, that fish on alead, had stopped jumping a good twenty minutesbefore.

The pensioners, the ones who stayed in the town whentheir money came through, and they weren’t many,would talk about how things had been in the old days.Life had been pretty awful.

In the mid-1880s a boundary rider called Charles Raspdiscovered the tip of a hangar of ore in the BarrierRange that would prove to be the world’s largest seamof silver, lead and zinc: a few years later over ninethousand men working in ten mines were supplying tenpercent of the world’s lead and eight percent of itssilver. The orebody was shaped like a coat-hanger, itsneck the outcrop of ‘broken hill’ from which the towngot its name. Rasp and the other outriders who becamehis partners lacked the expertise to make much of thediscovery and the rights were sold to a group of

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pastoralists who founded the Broken Hill ProprietaryCompany. Edward Stokes, the town’s gazetteer in hisphotographic record of the town in its hardest years,United We Stand, put the company’s wealth at aconservative eight million pounds by the end of thedecade. BHP’s dividends established heavy industry inthe country and were one of the major factors inmaking Australia the country with the highest livingstandard in the world in 1900: many Australians areunaware of this fact and those who are recall it withirony. And BHP is the country’s one truly internationalcompany, though the name of the town is a ghostinside the acronym. But clearly minerals and fossilfuels were instrumental in transforming what were toe-hold colonies into modern nation-continents, and inthis the opening of the Australian interior has much incommon with the settlement of the American West.

The whole history of Broken Hill was one-way: lots ofmoney out, and precious little in. Few of the mineproprietors had their residences built in the town. W.H. Patton, the BHP manager in 1899, refused to openthe new hospital; it was characteristic of his disdain forthis inhospitable place and the miners who worked theseam. After the 1909 lockout, BHP was regarded withsarcasm and bitter contempt in the town that had madeit wealthy.

And the region was inhospitable. In summer thetemperature was a constant 100 Fahrenheit and above.Rain was scanty; the nearest river a couple of daysaway. There was the torment of the bushfly, muscavetustissima: its passion for bodily orifices had been

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noted centuries before by William Dampier, one of thefirst Europeans to stumble across the continent.Everything had to be shipped up the road fromAdelaide, over three hundred miles. In winter andspring the prevailing westerlies blew unimpeded acrossthe scrub, which had been laid waste by almostcomplete deforestation and overgrazing, and whippedup huge billowing sandstorms that could be seen intheir ominous approach an hour before they hit thetown. The mobile rampart of sand blocked out the sunand choked the lungs, driving flocks of panicky birdsany which way in the preternatural stillness that ridesahead of pandemonium. A storm mighty as a deityheaved great eddies of dust from the slags of lead andzinc tailings next to the mineshafts, and made men andwomen tremble for their lives. The earth was in thesky. Movables were battened down, the animals takenin, the windows sealed. And still the dust crept into thehouses—through the ventilation slats, through minutecracks in the walls—and left a thick toxic rime on thetables and chairs.

I experienced a pipsqueak descendant of one of thesesandstorms myself one cold July morning shortly afterarriving: it was a nagging, tugging wind that barelylasted an hour and though it threatened at times to ripoff the roof it was certainly nothing like as fearsome asthe rolling dust storms that had entered collectivememory, most famously in 1907 when the town’s firstprofessional photographer, within weeks of arriving,caught his first scoop: a menacing black nimbus of dirtrising up behind the Trades Hall. Nonetheless, thishour-long storm was rude enough to expose our house

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as the flimsy tin-walled construction it was; it broughtto mind Lillian Gish struggling against the eightaeroplane propellers used to drum up the north wind inthe famous pre-talkie film The Wind, in which she andher lover are a hopelessly fragile pair in the lullingcore of the maelstrom. The visual power of the film, itwas apparent to me when I saw it once on television,would have been swamped by sound-effects.

A different dust killed miners. The old train station inSulphide Street had been converted into a museum andone room filled with old technology from the hospital.Iron lungs were displayed in every corner. These wererequired for the miners who developedpneumoconiosis and progressive fibrosis of the lungsbecause of the dry drilling. Safety measures were non-existent. Kerosene lamps lit the shaft landing areas butcandles were the main source of illumination untilabout 1911, when carbide lamps were introduced. It iseasy to imagine how intimately a miner would have toknow his orebody, replacing sight with a keen sense oftouch and vibration. ‘You’d tap her, try the ground’,confirms one old miner in Stokes’ book, categorisinganything in nature that was fickle or difficult to handleas female—I remember one of my patients, who’dtaken off his index finger while doing some repairwork on his fence, sexing the culprit chain-saw even ashe gingerly unwound the improvised bandage from hismangled hand—‘and the ground was groanin’ andtalkin’’. Other fatalities were due to the regular cave-ins (blasts and mine fires were less common since,unlike coal deposits, the lode did not produceexplosive gases); men ended up crushed beneath huge

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boulders and slabs of rock. Between 1906 and 1913one hundred and forty-five men died in the mines.Without running water or sewerage, the familiessuffered too: typhoid epidemics regularly claimedscores of infant lives.

The population then stood at thirty thousand. BrokenHill became, through want of an alternativearrangement, a self-governing municipality. On paperit was part of New South Wales, but the StateGovernment had little interest in such a remote outpostand the town made its own disdain of Sydneyostentatiously clear. The mayor Jabez Wright refusedto attend the celebration of the federation of states intothe Commonwealth of Australia in 1901. ‘I havesomething more important to do than attend theNational Drunk’, read the message he sent bytelegram. The resentment was long-standing: the stategovernment had refused to build a railway to connectBroken Hill with the South Australian narrow-gaugesystem that ran to the border, scarcely thirty milesaway; and it was only when a consortium called TheSilverton Tramway Company built a connecting line in1888 that the city was released from its isolation. Bythe turnof the century Broken Hill was a small town that hadorganised itself well beyond the cargo stage of humansettlement described in Gabriel Márquez’s Leaf Storm:‘Even the dregs of the cities’ sad love come to us in thewhirlwind and built small wooden houses where atfirst a corner and half-cot were a dismal home for thenight, and then a noisy clandestine street, and then awhole inner village of tolerance within the town.’

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Two newspapers were established, one of which—TheBarrier Daily Truth—is still publishing. Houses withtheir corrugated tin roofs and thin walls were builtalong parched green avenues and gum trees. The towntook on a grid form, and the streets were named afterthe chemicals associated with mining and extraction:Bromide (our street), Blende, Argent, Cobalt, Oxide,Chloride. The poet Auden, who prided himself on hisknowledge of mining lore and mentioned Broken Hillin one of his early dramatic pieces of the 1930s, wouldhave been delighted by the nomenclature. A brewerywas set up; there was a Theatre Royal, a score ofhotels, any number of watering holes, a brass band… itwas the beginning of a hundred years of going it alone.

The inner village of tolerance, as far as it went,stopped at the city limits where the desert started.Beyond was the Commonwealth of Australia: theMunicipality of the Hill stood with its crisscrossingstreets and patches of sunlight and refused to look anyfarther than the rows of quondong trees and municipalparks planted in the south to act as a windbreak againstthe duststorms.

The difference between the Australia littoral—one ofthe most densely populated areas on Earth—and theinterior, the bush, was so striking that I registered thedifference and some of the resentments that existbetween city and bush within a first few days ofarriving in the country. There were people I met inMelbourne who’d never heard of, or didn’t seem towant to hear about, Broken Hill: for many Australians,their continent still has a ‘dead heart’. Some people in

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the Hill wouldn’t give a Sydneysider the time of day.After a while, I started calling where we livedQuarantina; I speculated what a continental people likethe French or Russians might have made of theAustralian scrub if they had been its exploiters ratherthan the British. They might have called it Erytheia,land of red dirt. The inertia induced by a landscape thatstretches on and on into the remote distance is surely aspecies ofOblomovshchina—a word derived from the name ofthe lethargic main character in the famous novel byGoncharov. And the French dream of a glittering andbounteous Lake Chad in the middle of the Sahara thatwould feed the greedy boilers of the locomotives of theTrans-Saharan Railway bears ready comparison withthe desperate search for Australia’s inland sea. Butwould the Russians or French have reacted differentlyto the mining towns? I doubt it: it seems a safegeneralisation that ours is a civilisation that doesn’twant to know to whom it owes its graceful lifestyle.Who needs the red centre except for its minerals, atownie might shrug his shoulders; leave it to thereprobates, solitaries and misfits, so we can get on withthe business of being liberal. At any account, it seemedas if contemporary Australians were still a long wayfrom the feeling caught in its fright by C. E. W. Bean:‘The Australian comes in the end to the mysterioushalf-desert country […] And the life of this mysteriouscountry will affect the Australian imagination much asthe life of the sea has affected the English.’

In the year of 1908–9 wages were docked to below thesubsistence level. The company’s response to a court

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order requiring it to pay a minimum wage was to shutdown production for two years. The town became apolice state during the First World War, when theminers refused the draft. At the end of the war, theywent on strike for nineteen months. The concludingchapter of United We Stand tells the remarkable storyof that period of resistance and final triumph. Thehospital became a relief station. Women miscarried;children developed malnutrition and child mortalityincreased by fifty percent; rent ceased to be paid, andpeople lived on a diet of bread, margarine, onions andpotatoes. Every day the band went out and marcheddown Argent Street with most of the townsfolk behindthe Union’s banner. Troops lined the streets, and therewere running battles.

In the end the radical miners who had organised theBig Strike won, because no one else was prepared todo the work. The gum trees shed their bark along theAdelaide road and Bartley’s Barrier Band polishedtheir instruments and went out in the heat and bloodgot shed on the streets as well as underground; but themessage had reached home. It was just as Kafka, writerand insurance claims evaluator, formulated it in hisreport ‘Commune of Workers without PrivateProperty’ (1918)—‘the working life asa matter of conscience and a matter of faith in one’sfellow man’. No activity involving human lives is everentirely undeserving of attention, even if Kafka’sphrase represents the kind of seriousness that comeslate to human structures. In one of Chekhov’s storiesan idealistic young man decides not to work in agovernment office, but instead to seek honour in

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manual labour. He gets a job tiling roofs and paintinghouses: ‘I was living now among people to whomlabour was obligatory [...] and who worked likecarthorses, often with no idea of the moral significanceof labour, and indeed, never using the word “labour” inconversation at all.’ He has taken on in an almostfrivolous mood of acceptance what those who work alltheir lives shoulder involuntarily.

When the miners won, what they obtained were themost advanced working conditions anywhere in theindustrial world. The working week was restricted tothirty-five hours. Giant ducts and air filters were builtto extract the dust that killed so slowly and invidiously.The night shift was curtailed, since this was when mostof the accidents happened. Explosives were fired at theend of each shift, and the men would wait for an houruntil the debris had settled.

This created a closed shop well before the letter inBroken Hill. The Barrier Industrial Council—theUnion’s new name—became the de facto governmentof the town. It hired and blackballed men, set prices inthe shops, published a newspaper, regulated gamblinghours and determined when the bottle shops couldopen. Since none of the tycoons who had made abonanza out of the town ever built a mansion in it, the‘Second Empire’ building of the Trades Hall with itsmansards and metal roof and stately palm-trees becamethe one building in the town that suggested wealth orpermanence. The ‘living wage’ would be negotiatedhere every three years by the union delegates and thecompanies. That was the only item on the agenda

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subject to negotiation: the health and safety measuresof 1920 were to stay, almost as the town’s charter, andthe Miners’ Pneumoconiosis Society in Oxide Streetpreserves the statistics showing the dramatic fall inmortality among their members after the dust wasproperly evacuated.

All of which meant that Broken Hill was a relic incontemporary Australia: a shrine to mateship andrestrictive work practices. Jobs were scarce when I wasthere, a slide which had started inthe early eighties and showed no signs of slackeningoff. The hospital was the second biggest employer inthe town, and the month after I left they made fortynurses redundant. The Industrial Council used to payinducements to doctors to come to the Hill; all that hadgone well before my time. About five thousand peoplewere variously out of work or retrenched or on slacktime. There was a lot of illness in the town: lobarpneumonia, poorly controlled diabetes, alcoholic heartdisease, dysfunctional families. In 1986, the companiestried to reverse some of the working practices securedover half-a-century before; there were certainly mendoing the night shift when I was there, and blastingwent on while the men remained underground in thecanteens.

Global economics had made mining some of thepoorer seams of less financial interest for thecompanies; in other words, the yield wasn’t highenough to justify the expense of hauling it out of theground. So they started reworking the slagheaps, thebiggest of which stood like a small table mountain

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behind the railway line from Sydney to Adelaide: thetailings from the old days still contained twelve orthirteen percent silver and zinc. This stirred up cloudsof lead that settled on the town and created ageneration of dogs with poor control of their hind legs,which didn’t impress the RSPCA or the townspeople:Public health inspectors came and went, dismissing therisk of lead poisoning in the children unless they wentdown on all fours like the town dogs and startinglicking the ground. It was a folk memory. Onebiblically-minded indefatigable old miner I knewactually called his dog Neb, short forNebuchadnezzar—his father had made sure he wouldnever forget the time, a hundred years before, whensmelters in the town and dry-boring in the mines hadmade lead poisoning a real threat, and no cats or dogswere to be found at all in certain parts of town.

Isolation and fear of losing a job made tough menmalleable. Up the road, past the cemetery on RakowRoad with its bleak scrub and rows of miners’ graves,was the premonition that haunted Broken Hill:Silverton. Silverton had once been a mining town likeBroken Hill; it had had a population of three thousandin 1885 and solid stone-fronted buildings, and then themining companies had decided that the new town tothe south-east was more interesting and that was theend of Silverton. Silverton was a ghost town; it had apub with a few real locals and a spillover of touristswho came to see where they’d filmed Mad Max II andRazorback and the Castlemaine XXXX advert with thelager-drinking parrot, though word in the pub was thatit couldn’t stand the stuff. It was where the Broken Hill

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people would go if they felt a need to commune withthe bush but didn’t want the inconvenience of packingtheir four-wheel drives for the weekend. A littlepromontory looked out over the Mundi Mundi plains;people would park their cars there just before sunset,sit on the bonnets with a bottle of beer, and stare out asfar as they could across the flatness until the sun was adeep red afterglow and coolness came up off the rocks.Beyond the horizon, in the direction they were facing,was Mount Hopeless, so called by the explorer EdwardEyre in 1840 when a belt of salt lakes prevented himfrom venturing further towards the centre of thecontinent.

A hundred years later, it looked as if Broken Hill mightgo the same way as Silverton. After all, the capital ofthe ‘Indies’, one of the most famous cities in the worldafter the Spanish conquest of the Aztec and Incaempires, had disappeared into oblivion, along with itslode of silver, six miles across; it had been worked outby 1730. Situated high in the Andes in what wouldlater become Bolivia, Potosí, with its garish windfurnaces and freezing rock pits was, according to itshistorians, hell on earth.

In the belly of the beast, I was now being driven in ashuttle up a long ramp with a solid cylindrical sheathof concrete and bundles of cables pinned at intervals tothe wall. I looked at the shape they made with theirmachines, their bodies trembling as they drilled intoand prised loose the orebody; the machines products ofthe same hard material they had to cut and blast,inimical to the human shapes dragging it out of time.

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These ores were the planet’s memory. It seemed small-scale awesomeness, the height of the tunnel making thefigures of the miners look odd, macrocephalic, withtheir gumboots and overalls and steel cables coiledaround their shoulders. It wasn’t entirely dissimilar, Ithought for a moment, to what I did in the hospital onTuesdays and Fridays, when I assisted the surgeon,introducing an endoscope with its little fibreopticbougie down into someone’s intestine, a long snakingpush through the oesophagus and into the vault-likesumpof the stomach, a receptacle with its own groundwaterand slurry.

I had to walk the rest of the way up the gob road to thestope—a huge cavernous working area. It wasuncomfortably hot and the noise of machinery wasconstant. It seemed as if I was in the Paris catacombsrestyled by Le Corbusier as a huge inverted skyscraper,and I had a sudden vision of the town on the surfacepinned down to the surface like Gulliver. No one,looking at this unsteady town shimmering under thesky, would ever believe a kilometre-deep ballastprevented it from being traded to the desert like amirage. Its layers were so ancient they went back tobefore life on Earth: there was nothing organic trappedwithin them, not a single fossil; and the onlybiomorphic beast around was a giant mechanicalmollusc drilling into the seam in front, showering hugeslabs of dark ore to the side. Usually the blasters linedthe face with explosives and let them loosen the seam,before they prised it free; here they seemed to drillinga connecting passage between two levels. Had I

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wanted to ask I couldn’t have, since there was no wayof making myself heard.

The days when miners brought their sprawlers andpoppers down like exclamation marks on a hardintractable substance were long gone. Here, though,was where the sense of political cohesion haddeveloped that translated into solidarity above ground;in tunnels that collapsed, in bad air, in grime, inmassed assault, in the vertical time of the revolution,inside ‘Nature’s womb’.

It was still an activity that compelled imaginativeassent. But it needed an elastic imagination to see allthe strata where they worked, rested and played cardsand darts as the different layers of Salomon’s House inBacon’s New Atlantis, the underground chambers ofwhich were six hundred fathoms deep. ‘These caveswe call the lower region. And we use them for allcoagulations, indurations, refrigerations, andconservations of bodies. We use them likewise for theimitation of natural mines and the producing also ofnew artificial metals, by compositions and materialswhich we use and lay there for many years.’Underground was dark and archaic. At ground level,there was the mounting heap of rejected awareness.After Victor Hugo’s Les Misérables, the fictionaljourney into the depths of the earth also extended intosociety, with the vision of society perched on a vast,dispensable and poorly defined ‘underclass’ that wasvindicated in H. G. Wells’ subterranean anti-UtopiaThings to Come. Mining was where the intellectual metthe tough, since before digging became a respectable

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intellectual pursuit—one of our command metaphorsfor knowledge itself—only marginals and slaves had todig. There were no givens: in this job, reality was whatthe mind sought out and won for itself.

Giant life returned to size coming back up to thesurface in an old lift used to carrying far heavier loadsthat wobbled as it came up. As if language itself hadbeen under pressure underground, the small party ofvisitors all started speaking at once; it had been small-scale Jules Verne, but we had travelled down into theheart of the lode; one of the sources of Australia’swealth and a hidden city where the mind shucked offits own inertness.

On the surface the light was a shock, headachy andconfusing. The South Mines enclosure lookedbleached, our eyes recoiled. I felt a strange feeling ofrelief, as if I had doubted that I would return from theunderground levels, and made a mental note to look upmy Dante. ‘Here sighs and lamentations resoundedthrough the starless air, so that at first it made meweep. Strange tongues, horrible language, words ofpain, tones of anger, voices loud and hoarse, and withthese the sounds of hands, which made a tumultwhirling through the air forever.’

Dostoevsky’s man from a hole in the ground comes upto the light of the ‘most abstract and intentional city inthe world’ spoiling for a fight, enticed by what theNevsky Prospect holds out—freedom from the castestructure that keeps him at the bottom. He dares tothink himself on a footing with his social better, the

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officer who has yet to register his existence (whowalked through him, as Dostoevsky puts it). ‘And loand behold, the most astounding ideas dawned uponme! “What”, I thought, “if I meet him and—don’tmove aside? What if I don’t move aside on purpose,even if I were to bump into him? How would that be?”This audacious idea little by little took such a hold onme that it gave me no peace. I dreamt of itcontinually.’ It’s only when he risks his person, likethe Broken Hill miners, and confronts the ruling classin the person of the officer that he steps into hisdignity. Underground heroes are something likeProustian snobs, only stood on their heads.

I wondered how often the Broken Hill miners thoughtabout what their grandfathers and grandmothers hadrisked to throw off the dead weight of the past andcreate the kind of ebullient Australia Australians takefor granted. Broken Hill was the pivot of the country’smodernity. Thinking themselves marginal would havebeen to adopt someone else’s vantage point.

As for myself, I cherished that morning when I wentdown and came back up again. I was in search ofsomething approachable and met a mountain. Thereare few thoughts closer to the borders of terror thanimagining the effort of breathing with the weight of theearth’s crust on top of you. When fear goes there’sonly shame and the packed atomic darkness that evenDostoevsky’s underground man can’t budge with hisshoulder. I often think of those miners about to losetheir jobs. They didn’t think much of the work they didbut they didn’t know what they’d do without it. I liked

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their cragginess and I liked their wives. They couldn’tunderstand what would drag anyone from ‘away’—oftheir own free will—to this place on the edge of theworld.

There was no lack of light in Broken Hill. Next daywalking to work in blinding sunlight and flies, across aground marred by dry salt, I thought of goingunderground as the mirror-activity to that of the man inPlato’s cave who somehow wrenches free of the chainround his neck and goes out to contemplate the sun,only to go back in again to his comrades sittingobserving the shadow-play in an icy Tartarus or Hadesstuck like a tick on the rump of the earth. What he hadseen was real. A mole-man, he lives strengthened by it,turning the light over and over in his mind till itbecomes sheer flukish crystal. More than that. We setviolence and reason over against each other. Plato tellsus there is an affinity between them. Violence is theeffort of the man chained in the cave to escape the darkand see the real.

Another writer who knew about mines andunderground fires wrote that colours were light’ssufferings, material the gods concealed themselveswith. If so, minerals must be the earth’s calluses,where it hauls itself over on its side—crystalline, nervyoxides propagated by attraction.

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Lamplighters and LucifactorsON WRITING (ABOUT) SCIENCE

The world is a fluent place. Physicists borrow quarksfrom Finnegans Wake (itself an encyclopaedia ofcorrespondences) and lend allusions of strangeness andflavour to particle behaviour; there are crashingcomputers and left-handed neutrinos, the selfish geneand parasitic DNA, the slaving principle in critical-point physics, and an efflorescence of colourfullyviolent Marvel comic imagery in cosmology; while,curiouser and curiouser still, in the very next roomdeconstructionists and comparative linguists adoptalgebraic protocols, literary critics yield toindeterminacy and even social scientists acquireexpertise in confidence intervals.

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A mere thirty years ago this oddly engineered pangolinof spare-part imagery and transferred epithets wouldhave been shot dead on hearsay, and its carcasequarantined by scare quotes. Nowadaysanthropomorphic fiction-making has journalisticlicence. In fact, the further we get from the year ofWittgenstein’s death, 1951, the less inclined we seemto be to guard against it. ‘The truth is much moreserious than this fiction’, he once remarked about thesimplephrase ‘the cussedness of things’, needled (as it were)by the casual way human qualities get rubbed on tothings. The implication, post-Wittgenstein, seems to bethat fiction is as serious as truth, or that seriousnessitself is a faulty qualifier of either truth or fiction.

Then again our society may be more adept than itknows at living with conflicting epistemologies: thehistory of technology is also a history of language, forthe word technology itself, when first used in the timeof Leibniz’s De Arte Combinatoria and the universallanguage projects of Dalgarno and Wilkins, was a termapplied uniquely to grammar—to the science ofrhetoric. Three centuries later we are casually aware ofhow that formal syntactic manipulation of experienceundermines the very need it determines: for theconcrete. Walter Benjamin noticed this long beforeanyone else. In a letter to Gershom Scholem, he citedthis passage from Eddington’s The Nature of thePhysical World: ‘The plank has no solidity ofsubstance. To step on it is like stepping on a swarm offlies. Shall I not slip through? No, if I venture to do soone of the flies hits me and gives a boost up again; I

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fall again and am knocked upwards by another fly; andso on. I may hope that the net result will be that Iremain about steady; but if unfortunately I should slipthrough the floor or be boosted too violently up to theceiling, the occurrence would be, not a violation of thelaws of Nature, but a rare coincidence...’. He goes onto make the telling connection: in all of literature hecould find no passage quite so reminiscent of Kafka’sprose. The old symbolic understandings have gone, theexperimenter is a species of error in his ownexperiment.

This is the kind of unexpected correspondence thatProfessor Carey pounces on (although Eddington isrepresented here by an excerpt from his otherwritings), and one of the remote kinships that informsThe Faber Book of Science. Science writing, for that iswhat a fussier title might have suggested—The FaberBook of Popular Science or Story-Telling in Science orLiterate Science—has become a nearly fashionablegenre; more and more writers are adopting scientificideas, while more and more scientists find they canmaintain a good income as popularising writers. Thegenre even has its house rag in the Journal for thePublic Understanding of Science. While far from‘[plotting] the development of modern science fromLeonardo da Vinci to Chaos Theory’ as the dust-jacketclaims (what kind of book would that be?), ProfessorCarey’s anthology is both challenging and conciliatory.He isn’t afraid to stick his neck out: ‘[science writers]have created a new kind of twentieth-century literature,which demands to be recognised as a separate genre,distinct from the old literary forms’.

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What is this new genre? If it is separate then it hassomething to do with the specificity of what’s beingtold. Scientists do the telling, and have to tell storiesabout science to people who are not scientists. Whilethe goal of a general public understanding of sciencemight have been still possible in the time of theEdinburgh Review and de Quincey (even then therewere knockers), scientists least of all would presumesuch things possible now. Our ways of using words aretoo sectoral, too mutually exclusive. Scientists whowrite are guided by their readers’ appetite for sensationand ignorance of the subject-matter: anything thatemerges from such a process can only be second-rateart, and because the standards of scientificcommunication have ceased to bear any relation towhat passes for good literature, cannot be very goodscience either. Texts that require a firm grasp ofmathematics, like James Clerk Maxwell’s brilliantwork on the movement of gases and electromagnetism,resist glamorisation. Literature has no use for progress,and writers—who have no choice but to invent theirown problems—cringe at the user-defined statusenhancement packs scientists carry around on theirbacks like the academicians in Swift’s Lagado(jargon). How can the paradigms of what Wittgensteincalled ‘our disgusting, soapy-water science’ becomethe gorgeous bubbles of art? What can literature makeof the impersonal? Is facticity a fetish worth having?

Between the obvious selections—Galileo on histelescope, Priestley on dephlogisticated air,Leuweenhoek on his little ‘wolves’, Ronald Ross’discovery of the malaria protozoon in the gastric tract

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of the Anopheles mosquito, Pierre and Marie Curiescouring pitchblende for radium in their backyard, theinvention of electric light—the book contains well-edited extracts from Malthus and Erasmus Darwin,Huxley and Maxwell, a chillingly objective account ofparasitic wasps immolating a cricket by Fabre (whichProust, closer to the source, uses waspishly himself inSwann’s Way), Stephen Jay Gould’s sad account of thedoyen creationist Philip Gosse, Primo Levi’s story of acarbon atom from The Periodic Table, Armstrong andAldrin on their moon landing,Oliver Sacks’ classic case-history The Man WhoMistook His Wife for a Hat, and Richard Dawkins—‘Itis raining DNA outside.’ We find science asknowledge, and science as method, and sometimes it’shard to tell the difference. Some very obscure journalshave been ransacked for their booty. Kekulé’s dream-inventions of the nature of enantiomers—handednessin chemistry—and the aromatic structure of benzenecome from the Journal of Chemical Education 1958,35: 211. (Kekulé’s dream of the latter was to all intentsa mythic reappearance of the alchemist’s symbolOuroboros, the snake swallowing its tail, and clearlytoo disreputable a source of enlightenment for the 1985meeting of the American Chemical Association atwhich two participants flatly refused to accept hisstory, committed to print like the story of Newton’sapple, long years after the event.) Max Born’s articleon quantum mechanics with its proleptically accuratemachine-gun imagery is taken from his inaugurallecture at Edinburgh in 1936. Carey has discoverednaturalistic impulses in odd places: Maeterlinck,Berlioz at the anatomy table, Steinbeck on sea

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cucumbers and lice, Orwell on toads, Calvino on agecko’s belly (but no Proust or Kafka on the airplane,and no Bouvard or Pécuchet, or Zola—the problembeing, presumably, to know where to draw the line).Most satisfying of all, in many ways, are the editorialmontages where Carey boxes unlikely characters intothe framework of a common idea: Freud and Auden;Lamarck, Shaw and Richard Wilbur (it could havebeen Mandelstam); Lyell and Tennyson; andRoentgen’s X-rays hauled up to apotheosis in thesanatorium on The Magic Mountain. We get lost,pleasantly enough, in detail.

To venture a first definition of this new genre, wewould have to say that science writing bespeaks a kindof exceptionalism: it offers either exceptionalindividuals (Nobel-prize-winning sperm-donors)succumbing to the fairly standard temptation of thePromethean style (‘The solution came to me in aflash’, ‘arrived out of the blue’, ‘hit me like a bomb’),or alternatively, humdrum scientists of modest literarytalent in an exceptional situation (which hardly everhappens to be a laboratory). Above all, it has aproblem distinguishing ends and means, since the goalof science under controlled conditions can rarely ifever have been to turn a phrase: the discipline of ascience is quite a different order of experience fromimaginative needs and wants.

A passage of Scientific Sublime of the second typeentirely unknown to me comes from William Beebe’sHalf Mile Down (1934), an account of a record ocean-

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dive in a steel bathyscaphe, to depths previouslythought lifeless:

After a few minutes I sent up an order; and I knew thatwe were again sinking. The twilight (the word hadbecome absurd, but I could coin no other) deepened,but we still spoke of its brilliance. It seemed to me thatit must be like the last terrific upflare of a flame beforeit is quenched. I found we were both expecting at anymoment to have it blown out, and to enter a zone ofabsolute darkness. But only by shutting my eyes andopening them again could I realize the terribleslowness of the change from dark blue to blacker blue.On the earth at night in moonlight I can alwaysimagine the yellow of sunshine, the scarlet of invisibleblossoms, but here, when the searchlight was off,yellow and orange and red were unthinkable. The bluewhich filled all space admitted no thought of othercolors.

Beebe’s passage is eerie and calm, a reconstructionafter the event that has been worked on to render theshape of mythic time. Ideas become as heavy asobjects, and objects lose their solidity. The literarinessof the passage pulls the reader up short: what isstriking about scientists generally is their naïverealism, their unselfconsciousness about the non-scientific implications of what they do. Something ofthe same reconstructive intensity happens inNabokov’s imagination, which rarely if everfunctioned at normal atmospheric pressure. The strokeof a butterfly wing above the Oredezh river leadsacross the walls of time to the convolutes of the most

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pictorial of autobiographies, Speak, Memory, itself a‘diabolic’ reworking of another memoir calledConclusive Evidence: ‘by 1910, I had dreamed my waythrough the first volumes of Seitz’s prodigious picturebook Die Gross-Schmetterlinge der Erde…’

As a corollary to the boldness of predictive theory,overambition is almost the defining characteristic ofmodern literature. Much of twentieth-century literatureis a running commentary of misunderstanding in thewake of the sciences. In some cases, themisunderstanding itself became the creative principle:William Carlos Williams developed his new American‘objectivism’ onthe assumption that conventional prosody wasNewtonian and his freeing of the metrical fulcrum ashift not entirely dissimilar in its impact to Einsteinianrelativity. More fool Williams, one might think, butCarey reproduces part of his very curious poem ‘StFrancis Einstein of the Daffodils’ just to remind us thatafter Williams came an entire line of majormisunderstanders: Zukofsky, Olson, Duncan andCreeley. Even though we may mock Williams’immodest assumption of relativity theory for hispoetry, some of his poems did succeed in articulating anew appreciation of experience, with something likescience’s attitude to its material (take his wonderfullyexact description of the cyclamen); and it’s interestingto read Miroslav Holub’s declaration—Holub beingone of the very few who excel in both science andwriting, and a countryman of Kafka to boot—that hisfirst forays into poetry were made by applying theWilliams maxim ‘no ideas but in things’. As Holub

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might say, what poetry has come to be aware of is thatit lacks any equivalent for the velocity of light.

One problem is that as science has expanded so has theguilt of literate people about their ignorance. W. H.Auden, who was an avid reader of precisely the type ofScientific American prose included in this book (ifonly, as someone once wickedly suggested, to see howthings had moved on since Lucretius), practicallyadmits that the humanist cupboard is bare: ‘art is thespiritual life, made possible by science’. Nobody readsa novel nowadays to know how we live now, V. S.Naipaul once said (to Ronald Bryden): ‘today, everyman’s experience of dislocation is so private thatunless a writer absolutely matches that particularman’s experience the writer seems very private andobscure’. Indeed, Carey suggests that ignorance of thenatural world has become an aesthetic problem in thearts. He cites the blankness of his own honoursstudents, all intelligent and articulate, but unable to tellhim when discussing the speculative Donne line of1612 (written sixteen years before the publication ofHarvey’s De motu cordis) how blood gets from oneventricle to the other. Comparing Richard Dawkins’The Blind Watchmaker entirely to its advantage withMartin Amis’ Einstein’s Monsters he states: ‘from thepoint of view of late twentieth-century thought,Dawkins’ book represents the instructed and Amis’ theuninstructed imagination’. This is a moot point (andunfair on Amis; I would have rather he’drubbished Jeanette Winterson’s pretentious Written onthe Body), and Haldane was saying much the same

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thing in the last great era of scientific and literaryexchange, before war snuffed it out.

Presumably there is more than one form ofinstructedness. Wittgenstein once wrote: ‘the popularscience books written by our scientists aren’t theoutcome of hard work, but are written when they’reresting on their laurels’. This is the Wittgenstein, weshould remember, who studied mechanical engineeringat Manchester, co-designed the house for his sister at19 Kundmanngasse, and assassinated the old dream ofa universal language. He represents the view of scienceas an activity that stuns into summation, or as Goetheput it in his argument with Newton, ‘the empirico-mechanico-dogmatic torture chamber’.

There is little sense of the havoc this tradition oflinguistic scepticism once wreaked in the philosophyof science, perhaps because Carey’s scientists arepredominantly Anglo-American. A poet from the sameculture as Wittgenstein, Hugo von Hofmannstahl,provided the most succinct statement of a manparalysed by the failure of words to effect any kind oftransaction with reality, and it is no accident thatyoung Lord Chandos should address his fictional letterto Francis Bacon (who first invoked the authority ofnature against the tenets of scholasticism and isprominently placed in Carey’s foreword as an exampleof the instructed imagination).

Or take Robert Musil, one of two scientists to write adefining novel of the twentieth century (the other is theItalian Carlo Emilio Gadda). Two years after

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publishing his novel Young Törless Musil completedhis thesis on Ernst Mach’s theories of causality andscientific language. He never renounced hiscommitment to a philosophically rigorous andscientifically informed way of thinking. Realism was away to gain reality for the novel in competition withscience, an aim itself derived from a bowdlerisation ofthe scientific paradigm; and while he upholds theintense denominativeness typical of scientificdiscourse, his oeuvre deliberately abandons theunequivocality of a scientist’s language, the illusion itgives of always being in control. Even in Musil’s timethe notion of science as disinterested activity was oldhat. ‘The truth is’, he has his protagonist Ulrich say, inthat chapter in which it dawns upon him that he is aman without qualities, ‘that science had developed aconception of hard, sober intellectual strengththat makes mankind’s old metaphysical and moralnotions simply unendurable, although all it can put intheir place is the hope that a day, still distant, willcome when a race of intellectual conquerors willdescend into the valleys of spiritual fruitfulness.’

The problem science poses for modernity as Musilwrites it, is not one of meaninglessness, but ofvaluelessness. The unfinished The Man withoutQualities is an examination of the value of experience,and the metaphors by which its characters live. Evenwithin his large novel the essay was always Musil’sprivileged mode. This is a problematic choice, sincethe essay as a mode sets out unaware exactly where itmight end up, a reason for writing that is liable to havethe person ostensibly holding the lead dragged away

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for what may be a very long digression indeed. ‘Whatis truth; said jesting Pilate; and would not stay for ananswer.’ That was Francis Bacon, again, in the firstgreat collection of essays in English. The essay is adidactic tease.

In light of which Carey could perhaps have included inhis selection, as an example of humour in science, awonderfully funny short parody by the French writerGeorges Perec of the material-and-methods style offormal discourse scientists use when they talk to eachother (Sir Peter Medawar bluntly called it ‘calculatedhypocrisy’), anonymous first-persons-plural addressingtheir dictaphones after a round of ‘sacrifices’ in theanimal cages. ‘Experimental demonstration of thetomatotopic organization in the Soprano (Cantatrixsopranica L.)’ offers an analysis of throwing tomatoesat divas under controlled conditions, and can be foundin the slim volume of the same name. Perec even hadthe courtesy to write it in that international vehicularlanguage with the simple-Simon syntax known asEnglish.

Tomatoes (Tomato rungisia vulgaris) were thrown byan automatic tomatothrower (Wait & See, 1972)monitored by an all-purpose laboratory computer(DID/92/85/P/331) operated on-line. Repetitivethrowing allowed up to 9 projections per sec, thusmimicking the physiological conditions encounteredby Sopranoes and other Singers on stage (Tebaldi,1953). Care was taken to avoid missed projections onupper and/or lower limbs, trunk & buttocks. Only

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tomatoes affecting faces and necks were taken intoaccount.

Control experiments were made with other projectiles,[such] as apple cores, cabbage runts, hats, roses,pumpkins, bullets, and ketchup (Heinz, 1952).

A kind of unintended humour, if not parody, iscommonly found in science writing’s major modes: themind-stretching (‘gee-whizz mode’ corresponding tothe traditional literary idea of the Sublime) or theexplanatory (‘faction’), which might, if we want to befussy, be further subdivided into interpretative,resolutive or expository approaches. Since we have theMerton Professor of English acting as treasonous clerk,in Leavis’ eyes at least, it would have been good tohave known a little more about the formal structure ofrhetoric in science (though in all fairness perhapsbeyond the remit of the book), about the phoneyfeeling that creeps over many scientists when they areexpected to discuss their discipline in non-specialistlanguage. If the facts won’t speak for themselves, thenwho or what does? What kind of a narrative is it thatsets out to flatter the reader’s ignorance? Whathappens to the peculiarly exacting literalism ofscientists when they abandon the reality ofphenomena? Don’t we all live parallel to the age toscience anyway?—although I know how aspirin works,I still haven’t grasped what my neighbour up the roadtold me last week about cosmic microwavebackground radiation. It seems strangely appropriatethat when asked to explain what he had just lecturedon, the brilliant mathematician Paul Dirac repeated

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word for word the explanation he had given the firsttime.

Indeed, the sceptic might notice that any kind ofscience writing requiring more than a modicum ofmathematics has long since been given up as a lostcause. Language is, of course, used metalinguisticallyin many sciences—as Stanislaw Lem, a glaringomission and one of the few writers who knew his wayaround axiology, might have said. The sceptical readermight also wonder at the many kinds of scienceexplaining which sidestep language altogether. Hemight have tried explaining in words how the HIVvirus specifically attaches to a cluster designation 4(CD4) molecule on the surface of a T-lymphocte, orhow ‘chromosome walking’ is initiated using anidentified gene to pick out clones containing adjacentsequences; and having put the ‘same’ information ingraphic form seen what a difference ‘picture theory’makesto comprehension (Leonardo da Vinci had a relatedproblem: he was an uomo senza lettere who couldn’tcommunicate fully with the learned men of his timebecause he was unable to speak Latin). Our scepticmight be startled at the editor of this book cheerfullyand willingly exposing himself to charges of first-orderphilosophical naiveté. He might feel much of currentinterest in science and writing is simply confused ormisguided, and the conflation of genius and popculture to be another Californianism. Hard science hasto leave ambiguity and polysemy outside in thecloakroom; it requires semantically reliable words andsobriety, and any form of narrative which deliberately

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courts the metaphor, that tool of imitative magic, hadbetter watch its step. If I remain faithful to a metaphor,wrote Kafka in the guise of his investigating dogpondering the mystery of his dogdom, ‘then the goal ofmy aims, my questions, my enquiries, appearsmonstrous’. In another dimension: science writingeasily becomes to science what Walt Disney is to fairytales.

These kinds of arguments don’t dismay ProfessorCarey. He does his best to make good those old taboos,anthropomorphism and animism, showing how thebetter science explainers use them adroitly to engagethe reader’s understanding. Instead of beingembarrassed by animism, for example, he recruits it asan ally: we cannot help but invest our humanity in thethings around us. Perhaps a more subtle Darwinianjustification for the mixed genre approach to thelanguage of science writing is the increasingrecognition of how patterns emerge within non-equilibrium biological systems solely by virtue of thecooperative dynamics of the system itself; that theordering parameters of culture and science might at adeep level work like those of language. Here oursceptic might add: and all myths reflect the societiesthey come from, including myths about language, andin the way they rank their ontological priorities reflectwhat a society refuses as much as what it accepts.

Science writing—like any kind of writing—is alwaysrisking the metaphor: it cannot help but be partiallyaffected by the assumptions and imagery of its time,but then forgets that in a discussion about conflict in

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nature a metaphor—with its slippery, proximate, leap-frogging metapharand—is now being treated as aliteral in human affairs.

Think of Copernicus and Kepler, or the severelyrebukingeditor’s note that Peacock inserted into his edition ofThomas Young’s Reply to the Animadversion of theEdinburgh Reviewers of 1804 in which Young firstdeveloped the idea of the propagation of light as awaveform based on his experiments years earlier withsound in organ-pipes. The survival of the fittest in thestruggle for life is also, as the Encyclopedia britannicaentry reminds us, a metaphor: ‘fittest’ hardly everimplies a particulate genotype but an array ofgenotypes which enhance population survival;‘survival’ does not require catastrophe to make foreffective selection; and ‘struggle’ does not meanAchilles versus Hector. These are rhetorical terms; andin any case the entire expression chimes like atautology. (Darwin actually argued for thecomparative, the fitter, not the superlative: what maybe beneficial under one set of circumstances may be ahindrance under another.) It is surely extraordinary toothat ‘selfish’ has been used to characterise the gene,when what is intended is something like ‘optimising’.No wonder the Tree of Life looks wormy. Fit metaphoris image and idea, as Aristotle said in his Poetics. Atwhich level we might recognise Darwin’s insight, subspecie linguae, to be the flip-side of Ovid’s continuityof forms (and note in passing that metamorphosis wasKafka’s way of purifying his writing of metaphor). It isa characteristic of pseudo-science that it relies on the

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suggestive force of words rather than hard instances oractual models.

There are disappointingly few poems in this anthology.Professor Carey claims there are very few poems‘about’ science tout court: he should read more poetry.He includes a piece of dated bluster by Ted Hugheswhich illustrates all the worst anthropomorphic aspectsof being awed by science, but inexplicably fails toinclude anything by Marianne Moore, A. R. Ammons,Amy Clampitt, Edwin Morgan, Holub himself(‘Metaphors face extinction / in a situation which itselfis a metaphor. / And the whales are facing extinction /in a situation which itself is a killer whale’) or evenJames Fenton’s campily ironic Victorian revampingsof the Pitt-Rivers Museum and Lyell’s Principles ofGeology in his sequence Exempla. Francis Ponge’s Leparti pris de choses is the closest thing the twentiethcentury offers to Lucretius, but it isn’t here.Coleridge’s quip is advanced as an explanation forpoetry’s bias against science: ‘I believe the souls of500 Sir Isaac Newtons would go to the making up of aShakespeare or a Milton’, and thelack of science-mindedness among poets attributed toan unjustified assumption of superiority. Yeats put iteven more defiantly: ‘The discoveries of science cannever affect reality’; his reality, he meant. In fact, withthe notable exception of Hugh MacDiarmid, mostpoets have avoided the heroic mode in science notbecause they feel superior to it, but exactly for theopposite reason, as Auden’s humble-pie aphorismillustrates. There is a broad array of poems on sciencethat would quite flatly gainsay both Coleridge and

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Yeats, proving that Wordsworth’s famous prophecy inthe preface to the 1800 Lyrical Ballads of the daywhen Science ‘shall be ready to put on, as it were, aform of flesh and blood’ has substance after all.

According to Professor Carey, science and theologyare not mutually antagonistic since the latter ‘might,without any paradox, be regarded as a science,committed to persistently questioning andreinterpreting the available evidence about God’. Trueenough; but the Bible does not present hypotheses, itaffirms revealed truths. It was the church and scienceas institutions that were at loggerheads, for both werereligion’s claimants: what was the rationalistic essenceof Protestantism became, a generation later, theScientific Revolution. The most powerful impetus ofthe latter was the search for hidden divinity (as attestedby every page of Newton or even Locke, with his MostKnowing Being), and even in the Enlightenmentscience was still entangled in the search for authority:pantheism made something of a comeback in thenineteenth century. Yet Musil noted that the humanmind began to win its most tangible successes onlywhen it jettisoned the notion of God. Even so, ‘thenotion that haunted him [The Man without Qualities]was this: “Suppose precisely this ungodliness were theappropriate contemporary way to God! Every age hasits own way there, corresponding to its most potentspiritual resources: might it then not be our destiny, thedestiny of an age of ingenious and enterprisingexperience, to reject all dreams, legends andsophistries solely because on the heights of discoveryabout the natural world we shall turn towards him

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again and shall begin to achieve a relationship basedon experience?”’ A recent broad survey suggested thatabout forty percent of American scientists believe insome kind of Supreme Being, exactly the samepercentage as recorded in a similar survey at the startof the twentieth century.

On the other hand, Carey suggests science is anenterprise which, by its very mode of conviction, isfatally vulnerable to contamination by politics.Science’s lack of place for moralizing—the verysubstance of politics—is, he asserts, a condition of itsstrength and purity. Who could doubt it? Even so, heblithely skirts any (Frankfurt School) idea that modernpolitics may have hatched out of the samedisintegration of the social body as the technosciences,and ignores the troublesome complicity betweenviolence and technology. Take, for example, thecurious link between Pasteur’s development of thegerm theory and his hatred of mass society andsocialism, which is mentioned in a brief biographicalexcerpt in the book. The scientific credentials ofPasteur’s vindication of the germ theory were never atany point advanced or retarded by that hatred. But theywere deformed; and half a century later we find Louis-Ferdinand Céline, doctor and novelist, risking thePasteurian metaphor in one of his scabrous anti-semiticbooks where he talks about the Jews as abacteriological inoculum. The recurrence of Pasteur’sconcept in such a debased, excessive form shouldsuggest what is really at work. Myth in the modernscientific context tries to justify itself with facts, sincefacts always appears to mean something by themselves,

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thereby dispelling just those questions of value Musilwas so interested in.

The implicit moral thrust to Carey’s own argument is:we should be sparing with metaphor. Why add to theworld’s available reality when there’s already so muchthere? The overinvestment in metaphor and magicaltechnological energies characteristic of some sciencewriting (some people call it science fiction, but itmight just as profitably be called inverted archaeology)may simply be a way of hiding the essentiallypedestrian nature of the original activity. I wasgratified to find confirmation of this in MiroslavHolub’s wonderfully breezy book The Dimension ofthe Present Moment, where he maintains thatadministrative duties, cleaning up, telephoning,waiting in queues and being a citizen effectivelyaccount for ninety-five percent of his working time,leaving a less than significant amount of time forinterrogating the null hypothesis.

All things considered, there are some splendid texts inthis book, none of them so preoccupied with discoveryas to obliteratethe hum of the real. Carey enlarges the imaginativeboundaries of an issue that should be of pressingimportance to our culture; there may simply not beenough unprejudiced participants. There is no betterdescription of how we respond imaginatively toscientific explanations of our world than Lévi-Strauss’introduction to his book Histoire de Lynx: ‘everythingoccurs as the converse of oral societies in which hardfacts (connaissances positives) were very much

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inferior to the powers of the imagination. In oursociety, hard facts exceed the powers of theimagination to such an extent that the only resource ofthe imagination, incapable of apprehending the worldeven as it is being revealed to it, is to turn towardsmyth.’ That is exactly what Musil expressed withaphoristic lucidity in The Man Without Qualities: ‘wehave gained in terms of reality and lost in terms of thedream’.

As things are, I prefer to read Kafka to Eddington, notnecessarily because Eddington is a terrible old bore butbecause Kafka in his weightless way allows for whatwe might call the possibility of failure. That is the onequality in our long history of defamiliarisation withourselves that science, and science writing all the moreso, cannot risk. Science is a successfully unstableventure, successful because it is unstable. One crucialdistinction between writing and science is that failurein the latter is kin, not just etymologically, to falsity.Where imaginative writing is helpless in the face ofreality, it is only by trying and failing, and failingbetter, as Beckett tried to do again and again, that heencountered that sense of not-quite-arriving we callreality. The first writer to tell us that was anotherIrishman, Laurence Sterne, who, for all the literaryhigh jinks he got up to as he journeyed around Europein that age of lamplighters and lucifactors, keptinsisting all we have is a ‘terribly weak human voice’.

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Machine Made of WordsMEDICINE AND TRANSLATION

When I go through what I call euphemistically myarchives, I find mounds of dog-eared A4, heat-sensitive fax paper and computer disks on subjectssuch as the following: fermentation techniques formonoclonal antibodies, nitric oxide (NO) as Moleculeof the Year 1992, sterile loop ostomy bridges, Frenchmarketing chat about why pills that melt on the tongueare even more ‘seductive’ than pills that fizz in water,use of the Markov Model in cost-benefit analysis andheaps of CVs strewn with the historically-specificcultural insignia that really need an encyclopaedia toexplain them, for example the French academic order‘Palmes académiques’ or the German university title‘Privatdozent’.

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That is a very small sample list of some subjects I’vetranslated recently from my own source languages(SL), German and French, into English, the targetlanguage (TL) of about eighty-five percent of allbiomedical translations. (A poet-friend of mine whoalso works as a translator insists on calling it ‘hostlanguage’,translation being for him more an act of faith or even awager than a military directive.) The titles providesome idea of the multiple environments and disciplinesthat impinge on medicine and the biosciences:marketing, regulatory affairs, science journalism,production management, new productsanalysis—words that stare back in their strangeness.Often the human subject gets lost in this jungle ofcompeting outlooks and deadlines; on the other hand,the titles suggest why translation can be a possiblesource of income, or even a profession: it freights thefurniture of our time, technology.

Biomedical translation is a specialised form oftranslation, distinguishing itself from generaltranslation by its reliance on terminology. PeterNewmark has estimated that specialist terms accountfor five to ten percent of a technical translation. Thatpercentage will be much higher in a pharmacopoeiamonograph than in a psychologist’s report on theimportance of restoring erectile function for psychicwell-being in the average Frenchman. Out of necessity,since I often have to work in areas that skirt my basicfield of competence, I keep and continually updateglossaries of French and German words I encounteronly rarely. In my experience the various Euroglot

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dictionaries on offer are not much use, being full ofdodgy ‘equivalents’—it might be ‘physiopathologie’ inFrench but it has to be ‘pathophysiology’ in English.

Many areas of human endeavour and interest have arightful claim on technology, and even a grammar ofobjects supposedly stripped of emotive terms, sound-effects and metaphor still gets pulled every which way.George Orwell put it rather nicely: ‘above the level ofa railway guide, no text is ever quite free fromaesthetic considerations’. I remember once being putout at having to translate a brochure for a Germanpharmaceutical company which carried the motto‘Let’s join hands under these flowers against disease inthis world’: not only was the flower-image purple butit was also difficult to imagine a daisy chain of peoplebeing able to do much against that other chain: ofcause and effect. French sometimes yields to theponcif—a kind of linguistic affectation that compelseven technocrats, through fear of appearing ignorant ofthe real tradition, i.e. Ciceronian and humanist, to usearchaic terms where something functional ordeclarative would have done just as well. Since fewFrench scientists know Sanskrit,and since looking backwards is what distinguisheshumanists from scientists, Greek is the highest god (orat least a kind of Aunt Sally). Hence such wonders ofneologistic impulse as ‘nycthémère’ (twenty-four-hourperiod) or those intellectualising but mentally lazysuffixes (‘-ismes’).

A glance at my own files brings to light such curios as‘amyélé’ (pithed), ‘lésion achromatique’ (non-staining

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gap), ‘blutig bestimmen’ (measure by invasive method)and ‘Haltungsanormalitäten’ (lack of motorcoordination). Some of these terms are ordinary wordsco-opted to other denotative ends, others concept-termsor phrases that require formulaic repackaging. ‘Chez lafemme en période d’activité génitale’ ends up on apack leaflet as the less fearsome ‘in women of child-bearing age’, which isn’t quite the same thing, but ismore revealing in the context (teratogenic effects of adrug on the foetus). Translators should never be afraidto omit empty phrases when translating. Concision isnot the same thing as precision, but it can tighten asloppy expression. Many orotund phrases in French areredundant and can be rendered with simple Englishprepositions, for example ‘about’ (‘de l’ordre de’) or‘in’ (‘dans le cadre de’); true to its clerkish soul,German has convoluted adjectival constructions thatgo on for ages by the simple trick of turning aparticiple into an adjective (see Mark Twain’s essay‘The Awful German Language’).

A dualist approach is often adopted when thinkingabout translation. Poetry translation approachesuntranslatability; scientific translation hunts for theright Lego piece. One posits silence as the only thingmankind really holds in common; the other overridesphilosophical niceties, since the results seem to work.For the technical translator, the act of translation is anexercise in impersonality and secular reality (a job formoney)—rendering connotations, ‘transcoding’professional or technical terms and improving thesemantic clarity of the text, where necessary orpossible. He is as free as any other translator to recast

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syntax, house-style permitting. He may often be moreinterested in getting the job done than in following theoriginal, although in my experience it is impossible towork without first understanding both SL text andcontext. That would appear axiomatic, but I havesometimes been asked to salvage translations where ithas been clear that the original translator didn’t havethe faintest notion of the subject matter. Part ofthe translator’s ethics of competence includes knowingwhen not to translate.

Divergence and convergence are powerful forces thatmay be at work simultaneously within a language.English and French have been converging for the lastcentury or so, and while German is remarkablyhospitable to all kinds of specialist jargon fromEnglish, French often manages its own jargon: theacronym for Aids in French is Sida (‘syndromed’immuno-déficience acquise’). That a clinical termcan be more and less than it seems—morestigmatising, less innocent—is instanced by ‘sidaïque’(the adjective describing someone affected by Sida)which, rhyming with ‘judaïque’ (‘Jewish’), was oftenheard on the lips of Le Pen and other French extremeright-wingers in the 1980s. Rather than risk that kindof infection, German phagocytoses most Englishacronyms, although others win through: nuclearmagnetic resonance imaging (MRI) is‘Kernspintomographie’, where the notion of‘Kernspin’ is visually more dynamic and aurally morecatchy in German than nuclear resonance, i.e. it makesan irresistible appeal to the imagination. The Frenchfor ‘evidence-based medicine’ entered the language in

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1994 as ‘médecine factuelle’, which makes youwonder what was being practised beforehand.

What this suggests for the Euroglot translator is thatthe continent’s languages are cognitively too close,although this closeness may be one reason whyEsperanto survives as the only artificial language witha mass following, its substantives being almost but notquite familiar to anyone with a glancing philologicalinterest in the history of European languages. It is notentirely irrelevant that Zamenhof, its Polish founder,was an ophthalmologist. On original publication in1887 of his language project, Lingvo Internacia, heused the pseudonym Doktoro Esperanto (One WhoHopes); it was in fact this catchy pseudonym that tookover as name for the language, an eponymicdisplacement phenomenon well known to theprofessional translator. The linguist Benjamin LeeWhorf called this cognitive proximity of the Romanceand Germanic languages Standard Average European,and it is the ghost behind the very idea of translation inEurope: that it comes down to a process of lexicalswapping, with a few minor syntactic modifications.Meaning is something that can be uncoupled andreassembled over and over again in a new linguisticform—‘lesdécoupes du même reel’. Accepting that languages areisomorphs reinforces a semantic fallacy that goes backto Aristotle: words are vocal tags attached byconvention to things in a world supplied by Nature andidentically conceptualised by the human mind. Ameaning can then be lifted from its context and bodiedin a different form because these different incarnations

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are rationally connected. It’s as if we’re all reallythinking the same thoughts after all. But any personwho has stepped out of his own language knows thereare things he has to leave behind: if that weren’t thecase translators wouldn’t have to struggle with thestrictures of natural languages.

The Aristotelian view is omnipresent, however. Itunderpins machine translation (MT), or machine-assisted translation (MAT), the automated process oftranslating from one natural language to another. In theepisode of the Grand Academy at Lagado in Gulliver’sTravels Jonathan Swift was able to satirise the notionof a machine that could handle language. Threecenturies later, after Orwell and on the whole ratherless confident about the status of language as auniquely human attribute—or rather, condemned tofollow the logic of the metaphors about language wehave engendered—we still rely on Turing’s test as thebest way to ‘out’ a machine: by getting it to answer aseries of human questions. I once performed such a teston a MT programme and it spat out the term ‘forwardbedroom of the eye’ for the French ‘chambreantérieure de l’oeil’ (‘anterior chamber’ in Englishtoo). I know of companies which use MT software toproduce roughly usable versions of texts from Japaneseor other distant languages, but for little else. On theother hand, the fact that we ourselves makeincreasingly little distinction between vital processesand technological events (computer viruses andworms) might suggest to the uncritically conscious thatthe machines will soon be ‘outing’ the liveware.

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Other factors impinge on the translator’s autonomy.The power of transnational bodies like the EU has anincreasing effect on permissible terminology. Althoughthe term ‘product licence’ used to be a perfectlyacceptable term for the statutory paperwork requiredby a medicine before it came on the market, Eurospeakdictates use of the unwieldy ‘marketing authorisation’(by derivation from the French ‘autorisation de misesur la marché’); adrug itself is called a ‘medicinal product’. Nothing, toan English-speaker, is quite so presumptuous as theofficial publication of the French state, les JournéesOfficielles, which prints sanctioned versions of newscientific terms; it is interesting to consult thesepublications with ten or twenty years’ dust on themand note which words have had staying power.‘Endoprothèse’ might be the sanctioned term for a‘stent’ in French, a metal lattice device inserted via acatheter and expanded by the cardiac surgeon in orderto keep a narrowed blood vessel open, but you’ll belucky to find it outside this essay.

English is a handy language for objects to come tovoice in. Its furniture is more mobile than that of itsother European languages. It is almost desexed.Scientific English prefers simple or co-ordinate tocomplex sentences, and even here some claim to detectthe influence of the King James Bible (Hebrew part). Itdoesn’t frown on, indeed may actively favour termslike boil-off, shelf life, break-point, fit, doped andspiked where more conventional latinisms are alsoavailable. I recently discovered hot-melt forthermoplastic and step-down for decremental in an

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American text. Geologists speak of downbuckling forsubsiding and computer technicians use the termhandshake for confirmation of a connection: thegraphic quality of the term is a kind of non-verbalmnemonic—or trigger. Lakoff and Johnson point outthat no natural language is exempt from buriedintentionality: even in technical translations, you canfind yourself running up against—a sporting phrasalverb itself!—the weird prominence of cricket and golfas imagistic sources for metaphoric terms in English.

But to be fair (the idea of fair play has hitched its wayinto all the European languages), and since I love bothmy source languages, I would point out that Frenchand German have their own qualities. Frenchneologises effortlessly—‘morbimortalité’, ‘cathodique’(by analogy with ‘catholique’), and the homophonic‘cédérom’ are three recent examples—and German isadept at making sense with prepositions: take the basicroot-term ‘Blick’ and add aus-, ein-, durch- or über-,or other substantives such as Licht- and Augen-, andsix subtly related new words come into being. Here wehave a source of that system-building other literarycultures find pedantic: the literary critic WalterBenjamin once observed that ‘Mut’ (courage) was apolarised word, being divided into ‘Untermut’(stealth or cunning) and ‘Übermut’ (high spirits)—hewas writing about fairy tales. German has the ability toproject the brooding gestalt shape of its words soforcefully that their visceral meaning is ‘understood’preverbally before a commensurate term can be foundin the dictionary, or indeed in the mother-tongue.

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I’ve also come to the conclusion, after several years inEurope, that the prepositions are the truly tricky partsof a standard European sentence. ‘I’m interested in...’says the English speaker, while the French speaker‘s’interesse de...’ and the German ‘interessiert sichfür...’ Prepositions are angels and pimps, the bits oflanguage that get it going. J. S. Mill once observed that‘a large portion of all that perplexes and confusesmetaphysical thought comes from a vague use of thosesmall words’. Michel Serres, the maverick Frenchphilosopher of science, has written interestingly aboutour concentration on the heavy, substantive, materialnature of the world to the detriment of theprepositional ability to give direction, mobility andrelation. Prepositions trace relations rather than fixtheir position and contour. Serres’ concentration onmessages is, to say the least, intriguing given thatknowledge in the sciences seems to be such aformidable cluster of substantives. Someone else onceremarked that logical particles and, or and but—lessnoticed even than the prepositions—are the reallysubversive parts of language, an assertion that certainlybears thinking about. And Carlo Emilio Gadda, theItalian engineer-author, once complained that pronounsare the ‘lice of thought’ (pidocchi del pensiero), thefilthiest of them all being the first person singular.Technical documents, with their inveterate habit ofeffacing personhood and avoiding the active voice,would seem to back him up.

While translating keeps a translator, by proxy, on thecutting edge of what’s new—state of the art, so tospeak—there are times when I feel like the American

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poet John Ashbery, who wrote a poem called ‘TheInstruction Manual’ about a man translating a veryboring technical file. The translator looks up to find hisimagination running off to South America merely onthe exotic sound of a city’s name—‘Guadalajara! Cityof rose-colored flowers!’ But he conscientiouslyreturns from his reverie to his instruction manual; and Ican only suppose that doctors who end up in appliedlinguistics do a valuable job, since the practicalapplication and extension of the sciences intoTechnology and Big Businessrequire self-effacing types prepared to don thetranslator’s traditional mantle of invisibility. Butthere’s the rub: if a translator does his job properly,nobody notices; if not, then he has to put up with, atthe very least, accusations of sleeping with the enemy.

Medicine itself can never get away from symboliclanguage, or abandon its lay orientation, and it isperhaps as well that most doctors are instinctivelymore attuned to the curse of babble than to knowingjust where Broca’s area is. Should you have anotherlanguage and the time to apply it, working as a medicaltranslator makes you even more acutely aware of howopaque the medium is. On the other hand, manydoctors are unwittingly translators and interpretersanyway. Next time you have a quiet moment, readsomeone’s medical history: it’s nothing other than aformally explicit TL rendition of what for a patientmay well have been a barely recountable SL script ofthreateningly inchoate bodily sensations.

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The Poison TreeA JAVANESE BOTANICAL SHADOW-PLAY

The civic tree that would not grow

When I was studying medicine at the University ofGlasgow, I came across an arresting title in theuniversity bookshop that made me pick up the book fora second look. The Upas Tree: Glasgow, 1875–1975was a short history of the city written by theuniversity’s former professor of economic history andpublished by its press: indeed Sidney Checkland hadprobably taught my mother when she studiedeconomics there in the 1950s. In the spectacularnineteenth-century growth of the hundreds ofmalodorous, blackened and often squalid tenements(‘closes’) that would house the workers who put theirlabour and lives into the industrial achievements of

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heavy engineering and shipbuilding—with Glasgowserving as ‘a Liverpool and a Manchester together’long before the Clyde became a by-word for Britishengine power—and the ensuing slow painfultwentieth-century contraction of the ‘secondcity of the empire’ due to its overreliance on a veryspecific set of floating capital, skills and goods and acorresponding failure to diversify, Checkland saw aparadigm for the decline of the United Kingdom as awhole, a process that had become seeminglyunstoppable by 1981, the year of the book’s secondedition.

For all that his was a book centred on economichistory, Checkland had chosen a symbol of naturalgrowth to represent the city itself. The tree as ametaphor for human well-being—indeed as the fund oflife itself—is a reassuringly solid one. Though humansare ambiguous creatures suspended between nature andculture, trees and their root systems are entrenched inour metaphors for being at home in the world. Buddhareceived enlightenment under a sacred fig or Bodhitree, with its heart-shaped leaves. In Hinduism, thebanyan tree is the resting place of the godKrishna—‘and the Vedic hymns are its leaves’. Platoliked to discourse beneath the silver spears of an olivetree. Some Biblical commentators had Christ crucifiedon a tree, though they don’t say which. Norsemythology had its famous warden tree, Yggdrasil.Even Jeremy Bentham had his ‘tree of utility’.

But what was the upas tree?

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The Shorter OED describes the upas tree as ‘a fabulousJavanese tree so poisonous as to destroy life for manymiles around’. It is a symbol that stands for anythingexerting a baleful, destructive influence. Checklandwas using the upas tree as a figure for the doldrums ofthe once proud shipbuilding and marine engineeringcapital of the world: Glasgow’s determination tomaintain its reputation for heavy engineering had comeat the expense of everything else that ought to be‘growing’ in the city. It was a particularly rich irony,since the coat of arms of the city bore a famous miracletree that ‘never grew’, in the rhyme learned bygenerations of the city’s schoolchildren, includingmyself. ‘Now the Upas tree,’ wrote Checkland, ‘solong ailing, was itself decaying, its limbs falling awayone by one. Not only had its growth been inimical toother growths, it had, by an inversion of its conditionbefore 1914, brought about a limitation of its ownperformance.’ By the mid-twentieth century, the cityhad become a byword for militancy and defensiveness.Like a piece of machinery itself, Glasgow had, in thewords of Samuel Taylor Coleridge’s famousexpression, become a giant with one idea.

There was another sense in which the upas tree was apotent symbol of what industrial development had costa city which, a hundred years before its modernexpansion, had been declared by Daniel Defoe to be‘the cleanest and beautifullest’ in the kingdom: thechemical industries set up in the 1820s around theShawfield Works on Glasgow’s southern approacheswere to turn its water-meadows into the first industrialwastelands. The employees of this factory, which was

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established by John and James White on a twenty-acresite on the Rutherglen Road and was only one of thecity’s several huge chemical factories and ironfoundries, were known as ‘White’s canaries’ or‘White’s dead men’, depending on whether they hadbeen working with sulphur or soda ash. ‘There werethe chrome furnacemen, the pearl ashmen, the crystalhouse men, the workers at the vitriol tanks, and theacid towers, together with the general labourers’,writes Allan Massie in his short history of the city.‘The chemicals industry, indeed, in spite of beingscience-based, produced the nadir of workingconditions, a scene of terrible male degradation.’Contemporary critics wrote about the dismal light andpoor air, and the strange, bitter, blighting wind:Charles Dickens caught the atmosphere of all suchplaces with his description of Coketown in HardTimes—the foul-smelling black canals, the serpents ofsmoke from tall chimneys, the pistons of the steam-engines working monotonously ‘like the head of anelephant in a state of melancholy madness’.Industrialised or de-industrialised, there are devastatedparts of the country, and not just the suburbs ofGlasgow, that offer a ‘Scotland so real it defies theimagination’, in the words of the novelist JamesRobertson in And the Land Lay Still.

These were the strange fruits of that same scienceColeridge had told his friend Humphry Davy in a letterof 1800 was the supremely human activity—and‘being necessarily performed with the passion of Hope,it was poetical’.

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The exotic tree of permanent shadow

I hadn’t spared a thought for the upas tree in twentyyears when, in a dingy little second-hand bookshop atthe side of a garish shopping complex on the JalanRasuna Saïd in 2005, the year of my first visit as ahealth consultant to Java’s capital, Jakarta, acity so large that its current population is at least tentimes that of Glasgow at its peak of just over onemillion (but nobody is counting), I discovered a copyof a book called The Poison Tree. It was a translationof selected writings on the natural history of the DutchEast Indies (when Jakarta was known as Batavia)including a description of the upas tree, which hadgiven the book its title, by an obscure naturalist with acurious name: Rumphius.

Rumphius was the Latinised name of a Germannaturalist from Hanau, Georg Eberhard Rumpf(1628–1702), who settled in the capital of the volcanicBanda Islands in the Moluccas (present-day Maluku),then the heart of Dutch trading operations in thearchipelago. Rumphius worked for ‘The Company’,the metonym universally used to describe theformidable Dutch East Indies Company (VOC): heenlisted in its ranks as a gentleman soldier, leavingEurope in 1652. He would spend the rest of his life inAmbon (Amboyna), the main entrepot town in theSpice Islands from which the Dutch conducted andcontrolled their lucrative monopoly in cloves, pepperand nutmeg, which could sell in Europe for up to threehundred times the local purchase price. The firstEuropeans to moralise about materialism, the Dutch

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were ruthless in the defence of their economic interestson the Spice Islands, as the Portuguese and British andmany rebellious Bandanese were to discover.Rumphius rose through the ranks, becoming a civilservant and establishing a reputation for himself as aman of ability and probity. He had talents as anarchitect, geometrician and linguist, but by the 1660swas known as a botanist and naturalist—a man wholoved to devote himself to his ‘curious studies’. By acruel irony, even as he acquired a ‘small parcel ofland’ near Fort Victoria on Ambon and the leisure heneeded for his studies, he lost his sight, probably as acomplication of glaucoma. For the remaining thirtyyears of his life he had to rely on ‘borrowed eye andpen’. It didn’t stop him dictating to his son and varioussecretaries some astonishingly delicate descriptions ofthe world around him; and some of these entries hadbeen translated with brio, in the book I was holding, bythe scholar E.M. Beekman.

Understandably, in view of his geographic remotenessfrom anything like a printing house, only one ofRumphius’ writings was published in his lifetime, hisaccount of the earthquake thatkilled his native wife and daughter in 1674. He gavehis wife’s name to an orchid with white lanceolatefloral bracts they had found together: ‘I call it FlosSusannae in Latin […] in memory of her who whenalive, was my first Companion and Helpmate inlooking for herbs and plants’: the Susanna Flower isnow listed in the nomenclature as Pecteilis susannae.In all his work, Rumphius, like a twentieth-centuryethnographer, always sought out sources of practical

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knowledge at the local level: he quizzed the dukun (thelocal healers), most of whom were women, on howthey used plants, and ignored Galenic precepts entirely.And the women must have trusted him, because hewrites about plants that were used for intimate hygieneor as abortifacients—women’s secrets. Rumphius alsowrote a history of Ambon, as well as reports on theisland’s agriculture, a lexicon of the Malay language(up to the letter P) and the several folios that constitutehis d’Amboinsche Rariteit-kamer—his ‘AmboneseCuriosity Cabinet’.

These were mere by-works in relation to his magnumopus, The Ambonese Herbal, the seven hundredchapters of which he finished in 1687. It is one of thegreat works of pre-Linnean naturalism. Beekman, aDutchman who was a professor of Germanic languagesat the University of Massachusetts, spent the latter partof his life translating all the significant works ofRumphius’ considerable oeuvre. In his introduction toThe Poison Tree he writes that he set out to use onlywords that were current before 1700, and in order toverify usage had to turn to the Quaker historianWilliam Sewel’s A Large Dictionary of English-Dutch,a book first published in Amsterdam in 1691. What hasbeen lost to science has been reclaimed as literature,for Rumphius’ personality is stamped all over hiswriting: his is a richly embodied language thatpreserves the individuality of everything he comesacross. Osip Mandelstam’s description of theexperience of reading Linnaeus’ Systema Naturaconveys rather well the prose style of Rumphius’ work,which Linnaeus (who concealed his sources) had

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probably read during his time in the Netherlands: ‘It isAdam handing out certificates of merit to themammals, having invoked the aid of a wizard fromBaghdad and a Chinese monk.’

Rumphius’ fabulous botany (which already relies onthe economical use of binomials) is a reminder that oneof the most powerful forces behind what is now called‘enlightenment’ wasthe need to find an exact nomenclature and descriptivemethod for naming specimens from botany inparticular and the natural world in general. Botanyplayed a central role, as the substantial part of materiamedica and an item of cultural baggage which had tobe acquired by every educated person, in thedevelopment of modernity, bringing together medicineand science, commerce and expanding empire, andconnecting them all with the new cognitive scopeaccorded to the eye by magnification and microscopy.

Evocation is one thing, systematic description another;Rumphius had a talent for both. Beekman’s copiousnotes on what is a relatively obscure chapter of naturalhistory make it doubly a pleasure to linger overRumphius in translation: his translator is aknowledgeable guide not only to the naturalphenomena and obscure customs of the MalayArchipelago but also to changing usage in English,German, Dutch, Malay and Chinese. If George Steinercould spot a resemblance between Joseph Needham’sfamous synoptic work Science and Civilisation inChina and Marcel Proust’s A la Recherche du TempsPerdu as documents of a civilisation grasped in the

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round, then there is a case to be made for Beekman’srecreations of Rumphius’ primordial epiphanies.

After a brief description of the ‘spatter-poison’, thebloody sap of the tree collected using bamboo conduitsand smeared on arrow-tips for hunting game (andkilling Dutch mercenaries), Rumphius writes: ‘Underthis tree and for a stone’s throw around it, there growsneither grass nor leaves, nor any other trees, and thesoil stays barren there, russet, and as if scorched.’ Theupas tree casts a dense meteorological shadow: it has asinister climate all of its own. Birds unfortunateenough to alight on it can be found dead beneath it. Allanimals shun it except for a ‘cackle-snake’ thatsometimes terrorises nearby villages, a kind of basiliskable to immobilise victims by gazing at them beforedestroying them with its mephitic breath.

What Rumphius was describing was the cryptobotanyof the bark cloth tree, ‘ancar’ in Malay or Antiaristoxicaria in botanical nomenclature, around which hasgrown, as Beekman comments, a ‘tanglewood of loreand legend […] most of it preposterous thoughmarvellous as fiction’. A surgeon working for theDutch East Indies Company in Semarang, N.P.Foersch, published inthe London Magazine of December 1783 one of thefirst widely read accounts of the upas tree,embellishing his paper with several fantastic folk-talesabout the terrible ‘bohun upas’ but providing no detailsabout its botanical nature or even how the poison wasprepared. It now seems that Foersch was a fictitiousperson and the letter itself a hoax perpetrated by the

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Shakespeare specialist and friend of Dr JohnsonGeorge Steevens, who was pandering to theeighteenth-century fascination with exotic tales; at anyrate it was a literary mystification that gripped theRomantic imagination. The upas tree does indeedproduce a toxic latex containing a cardiac glycosidethat can cause a fatal arrhythmia, but its shade hasnever blasted the living in the manner either Rumphiusor Foersch suggest: indeed it is considerably lessmalign than the West Indian manchineel (Hippomanemancinella), commonly found as a windbreak nearcoastal plains and beaches: its fruit and sap are amongthe most toxic on the planet.

It is the upas tree, though, which has entered myth.

The sentinel tree of the Arctic Circle

The malefic upas tree bewitched the poets of the earlyRomantic period, where the fascination may have beenfed by references to it in Erasmus Darwin’s poem ‘TheBotanic Garden’, where it was called ‘the Hydra-treeof death’. Coleridge wrote, ‘It is a poison-tree, thatpierced to the inmost, / Weeps only tears of poison.’The Victoria and Albert Museum in south London hasa large, claustrophobic canvas titled The Upas, orPoison Tree in the Island of Java, based on Darwin’spoem by the Irish artist Francis Danby, which was thesensation of the British Institution exhibition of 1820,only a few years after Stamford Raffles had beenLieutenant Governor of the island during theNapoleonic Wars and penned a dismissive note aboutFoersch’s ‘extravagant forgery’ in his encyclopaedic

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The History of Java (1817). Byron in ‘Childe Harold’sPilgrimage’ associated the tree with the ‘uneradicabletaint of sin’; Balzac, Southey, Charlotte Brontë,Dickens, Melville and Ruskin all had upas trees intheir literary gardens. Even Blake imagined, in a pre-Freudian parable on the dangers of repression, anunspecified ‘poison tree’ growing in the garden of hismind: it had grown out of anger and its apples werelikely to be toxic. Nothing could growin its shade. The tree that brings death and not lifeleans out of the Romantic era and into the twentiethcentury as a self-poisoning of the mind: FriedrichNietzsche would have recognised it, having in spite ofhis better intentions contributed to its upkeep, as thetree of resentment.

In fact, it was the celebrated Russian poet AlexanderPushkin, who in his somnambulistic poem ‘Anchar’,wrote the finest lyric on the upas tree—‘The fearsomesentinel / Stands alone in all the world.’ Only a blackwhirlwind dares to disturb the poison tree and it, in itsturn, becomes pestilential. Where does the contagionstop? Even language itself, we suspect, might becomethe infectious vector of this primal curse. And sureenough, a man of power (Pushkin identifies him onlyas the Prince) sends another man (‘a poor slave’) by‘commanding glance’ to gather the glassy coagulatedresin that hardens in the night. The Prince has this gumspread on arrows and looses ‘perdition through the air’on neighbours without access to an antidote, and whoare in any case unacquainted with such ruthlessmethods of territorial acquisition.

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Pushkin neglected to submit this poem to the censorfor approval before its first publication in 1832 andconsequently had dealings with Count Alexander vonBenkendorff, director of Nicholas I’s Third Section(internal police), now remembered if at all for hisbizarre inability to remember his own name: he wasalert enough however to notice that Pushkin had beenbold enough to name outright the tyrant in the firstversion of the poem ‘Tsar’, the man to whom thehistory of the nation belongs. Not that anybody inRussia would have had any problems recognising whowas meant in subsequent versions by ‘the Prince’. In acritical study of Pushkin John Bayley wrote that,‘Anchar condenses its apprehension of power in a fewheavy drops’—indeed, both the Prince and the tree arethe grim guards of their redoubtable isolation.Pushkin’s subversive understanding of the nature oftyranny has been addressed by many subsequentRussian poets, including Joseph Brodsky. Instead ofthe Prince we have Stalin, the despot as paranoid,whose ‘passion for survival’ in a political landscapemade oppressive by his doings leads him to destroy allthose who might possibly pose a threat to his rule.

Pushkin’s upas tree poem is a parable about despotismand domination, and how Russia’s long history ofhard-nosed dealingswith its neighbours has poisoned regional politics, asituation that, as we are reminded from time to time,continues to this day. It is also in the RussianFederation that we find a contemporary upas tree withtap-roots descending deep into the history of theindustrial exploitation of nature as well as into the

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nature of political power. At the foot of the PutoranMountains, between the Yenisei River and TaymyrPeninsula is the ancient geological formation called theSiberian Traps, the flood basalt remnant of theparoxysmal eruptions (Permian-Triassic extinctionevent) that palaeontologists believe caused theextinction of nearly all species on Earth about 250million years ago: here is the city of Norilsk, the onlymajor city in eastern Siberia that lies inside the ArcticCircle. The polar night in Norilsk lasts for six weeks inwinter, blinding curtains of snow are commonplace,and the temperature can scrape around -50°C forweeks in January and February. Norilsk was foundedat the end of the 1920s as the one of the mainencampments of the boreal Gulag system: its nickeldeposits are the most extensive in the world, and it alsosits on vast seams of copper, platinum, cobalt,palladium and coal. Thousands of prisoners died thereunder the harsh conditions of forced labour, starvation,and intense cold in the years between 1935 and 1956,and detainees were being sent to the mines up to 1979:with a high accident rate and limited life expectancy itis still a dangerous place to work (and it appears in thetop-ten list of the Blacksmith Institute’s report on theWorst Polluted Places, 2007). Now the city is run by acompany called Norilsk Nickel, which raises capitaland trades in all the respectable places: it is a majorplayer in the global extraction business. Norilsk(population 175 000) is still a closed city, a usefulSoviet-era policy which has never been lifted in someplaces although you can apparently link up to theirinhabitants on the web.

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After sixty years of mining and smelting, it hasbecome economically cost-effective to work thepolluted soil around the mines in order to recuperatethe heavy metals dispersed in the initial tailings. Thatcan only be described as a death-star vision ofrecycling. Norilsk’s heavy metal smelter—where theores are melted in what Blake would have called ‘theFurnaces of Affliction’—is the largest in the world,with an annual atmospheric blow-off of many tons ofcadmium, copper, lead, nickel, arsenic, selenium andzinc as wellas several radio-isotopes. Within thirty miles of thenickel smelter, according to a CNN report in 2007,there is not a single living Siberian larch, the only treethat survives in the taiga. The name of the smelter isNadezhda (‘Hope’).

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Stendhal’s SyndromeOR, HOW ART CAN MAKE YOU LOSE YOUR WITS

Well before the nineteenth century, there weretravellers on the poorly maintained roads of Europe,most of them rich Englishmen doing the Grand Tourwith their tutors. Then, around the time of the FrenchRevolution (or a little before it), when the ‘true voiceof feeling’ was loosed on the world by Jean-JacquesRousseau, Laurence Sterne and a young German writercalled Wilhelm von Goethe, figures we wouldrecognise as modern travellers, might be spied movingon the roads. Hard on their heels came a certainNapoleon—arch romantic, poet and wit—who insistedon visiting the last-named author in Weimar duringone of his whirlwind campaigns in the east, a copy ofhis novella about a love-sick suicide in his pocket.

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And it was in Napoleon’s entourage that a young manfrom Grenoble, Marie-Henri Beyle, known through hiswritings as Stendhal, earned his spurs. He made hisfirst acquaintance with Italy in 1800, when he crossedas a dragoon in the army of liberationover the Grand Saint-Bernard pass to fight theAustrians, and it was to remain his country ofpredilection. And he ‘fell’, as he put it, whenNapoleon’s glorious career came to an end in 1814.After the Treaty of Fontainebleau he settled for a whilein Milan, and later in life was to be French consul atTrieste and Cività Vecchia. Many of his greatest booksare set in Italy, including his autobiography The Life ofHenry Brulard (Brulard was one of his many aliases),which opens with the writer looking out from theJaniculum Hill with ‘the whole of Rome […] from theancient Appian Way with the ruins of its tombs andaqueducts to the magnificent garden of the Pincio, builtby the French, spread out before me’. He travelledwidely, briefly visited Spain, spent two years as aquartermaster in northern Germany (whence the pen-name), and was in Russia with the Grande Armée, onthat infamous journey to Moscow and back that turnedinto a horrendous saga of frostbite and starvation andlost lives. He went to London three times, and evencontributed articles to English-language journals on thecultural life of Paris. Much of Stendhal’s authority as awriter derives from his assumed persona as a guidewho knows (and shows us) how to absorb what weexperience in and of the rapidly changing world. Thatwas the nineteenth century’s principal novelty.Accordingly, he liked to pepper his French withanglicisms; and was one of the first writers to

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popularise the use of the word ‘tourist’ in French. (Theone truly epic trip he never wrote about was theterrible, gruelling, inglorious retreat from Moscow.)

It was on one of his visits to Italy in 1811 that Stendhalbrought the swoon into literature. Visiting the Basilicaof Santa Croce in Florence, he found a monk to let himinto the chapel where he could sit on a genuflectionstool, tilt his head back and take in the prospect ofVolterrano’s fresco of the Sibyls without interruption.

The pleasure was keen. ‘I was already in a kind ofecstasy’, he writes, ‘by the idea of being in Florence,and the proximity of the great men whose tombs I hadjust seen. Absorbed in contemplating sublime beauty, Isaw it close-up—I touched it, so to speak. I hadreached that point of emotion where the heavenlysensations of the fine arts meet passionate feeling. As Iemerged from Santa Croce, I had palpitations (whatthey call an attack of the nerves in Berlin); the lifewent out of me, and I walked infear of falling.’ This vasovagal syncope prodrome (togive it its neurological name) was something he hadobserved many times of himself: ‘when a thought takestoo strong a hold of me in the middle of the street,’ hewrites in chapter 29 of his autobiography, ‘I falldown.’

While contemplating artistic beauty he had created anew perspective for himself: a sense of depth sointense he lost his footing, and fell into it. Otherswould call it vertigo; and sure enough Stendhal is oneof the cases written up in W. G. Sebald’s four-part

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book Schwindel. Gefühle (translated into English asVertigo although it divides what is one compoundnoun in German—Schwindelgefühle or ‘feelings ofdizziness’—into its punning component parts, one ofwhich suggests that a swindle or trick is being playedthrough a blatant display of feeling).

There were to be many cases resembling Stendhal’sexperience in the nineteenth century—thehypersensitive Marcel Proust had constant attacks ofthe vapours (and asthma) on his via dolorosa through Ala Recherche du Temps Perdu, and Dostoevsky isknown to have become terribly agitated when he sawthe famous painting of the dead Christ by HansHolbein the Younger in Basle (and made his pregnantwife fear he was going to have one of his epilepticfits). In his first Duino Elegy, the German poet RainerMaria Rilke wrote: ‘beauty is nothing but thebeginning of terror, which we are still just able toendure, and are so awed because it serenely disdains toannihilate us’. Roland Barthes’ term for it was ‘lapetite mort’. Great art is a threat. It can harbour ahidden violence so forceful that impressionable peopleforget who and where they are. Rilke’s definition ofbeauty is perhaps more exactly a definition of its moremasculine counterpart, ‘the sublime’—the sensationthat comes over us when we grasp the transcendentforce of the sacred looming into the cultural. And asRilke suggests, the sensation is followed by relief atbeing saved from annihilation by something greaterthan mere propositional language.

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Philosophers were getting in on the act, too. ImmanuelKant in his Critique of Judgement hypothesised thatthe contemplation of aesthetically stimulating objectsinduces ‘a rapidly alternating repulsion and attractionproduced by one and the same object. The point ofexcess for the imagination [...] is like an abyss inwhich it fears to lose itself.’ Nineteenth-centuryaesthetics abandonedthe classical idea of imitation and took on the notionthat contemplating an object was a self-activityexperienced as an attribute of the object. Thisinvoluntary emotional projection was calledEinfühlung: it is the German word that was broughtinto English as ‘empathy’.

Stendhal’s syndrome isn’t one of the disorders listed inthe latest edition of the Diagnostic and StatisticalManual of Mental Disorders (DSM V), but in view ofthe nosological inventiveness shown by the editors ofthat manual in recent years it may well be just a matterof time. In 1989, Graziella Magherini, an enterprisingpsychiatrist at the Santa Maria Nuova hospital inFlorence published a book of case studies La Sindromedi Stendhal on the 106 visitors who had been treated asemergencies and even hospitalised in her department inthe previous decade. Their symptoms included dizzyspells, palpitations, hallucinations, disorientation, lossof identity and physical exhaustion. Precipitatingfactors were ‘an impressionable personality, the stressof travel and the encounter with a city like Florencehaunted by ghosts of the great, death and theperspective of history’.

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The treatment was simple. It involved getting out ofItaly as fast as possible and back to mundane reality. Inhonour of Stendhal’s visit to the city she dubbed thisphenomenon ‘Stendhal’s syndrome’.

But is Stendhal’s syndrome anything new? In religioustimes, pilgrims often recorded a sense of exaltation onarriving in Rome, the caput mundi: the experience offeeling a little bit lighter (in all senses) once they get totheir destination is an experience common to pilgrimsacross the world, from Mecca to Santiago deCompostela. After all, a prolonged journey is anarchetypal experience: we enjoy reading travelliterature because it allows us a vicarious share in theauthor’s conviction of being on a quest. Goethe’sfamous Italian journey of 1786—away from his civilservant’s desk—is one such example; he thought hewould have been ‘a lost man’ if he hadn’t been able tosee Italy when he did. And there is nothing new eitherabout the urge to sightsee: the Greeks were doing it inantiquity, and Herodotus and Callimachus had alreadytried to meet the demand for tourist attractions(‘mirabilia’) by listing the Seven Wonders around theshores of the Mediterranean. Even in those daystravellers had a talent for coming back with uselesssouvenirs.

In view of its awestruck nature it could have beenpredictedthat Stendhal’s syndrome would find most florid andtoponymic expression among religious travellers. In anarticle in the British Journal of Psychiatry in 2000, ateam of psychiatrists at the Kfer Shaul Mental Health

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Centre in Jerusalem reported on an acute psychoticstate dubbed ‘Jerusalem syndrome’. Jerusalem, theywrite, is a city regarded in terms of ‘the holy, thehistorical and the heavenly’ by adherents of three ofthe world’s religions, who are often blind and deaf tothe politically divided, noisy and bustling modern cityaround them. They are after the transcendental, whichhas always been inimical to the pull of gravity.Jerusalem, after all, is the most potent metaphor in thehistory of the world. Tourists suffering from ‘psychoticdecompensation’—all of them—are referred to theirfacility at Kfer Shaul: that makes for an average ofabout 100 patients a year, forty of whom requireadmission. The psychiatrists distinguish three types ofpatients: those with pre-existing problems, usuallypathological identification with a character or idea,those with borderline personality disorders, andpreviously normal persons experiencing a short-livedacute psychotic episode, similar in many ways toStendhal’s syndrome but manifested by a desire to singpsalms out loud, wrap themselves in pristine hotel bed-linen or deliver loud sermons to passers-by in the city’sholy places. Such patients, the authors discovered,have ‘an idealistic subconscious image of Jerusalem’.Recovery was generally spontaneous on leaving thecity.

In his autobiography Memories, Dreams, ReflectionsCarl Gustav Jung describes how in 1949, by then anold man, he decided to go to Rome, something he hadwished to do all his life but had put off, fearing theemotional impact of encountering the heart of Europe’sancient imperial structure. Pompeii, which he had

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visited many years earlier, had exerted an effect which‘had very nearly exceeded [his] powers of receptivity’.The day he went to buy his ticket from the travel agentin Zurich he fainted. ‘After that, the plans for a trip toRome were once and for all laid aside.’ Jung was neverto see the Eternal City because of his idealisticsubconscious image of it. Sigmund Freud, who hadperhaps played a role in priming his former acolyte’simaginative receptivity to the idea of Rome, had asimilar lifelong thing about Athens. Which shows thatone way to avoid an experience is not to have it at all.On the other hand, not paying attention to yoursubconscious canget you into a lot of bother: embassies in India and theinsurance company Europ Assistance (a subsidiary ofthe Triestine insurance company AssicurazioniGenerali that Franz Kafka once worked for) areperfectly familiar with young Europeans who, inmystical transport, are found intoning unknownliturgies while climbing the stairs to their New Delhihotels on their knees, and have to be repatriated asemergency cases. Japanese tourists to Paris apparentlysuffer from a condition known (in Japan) as Parissyndrome—the terrible sense of failure at not beingable to visit all of the French capital’s listed museumsin the allotted time.

It occurred to me, thinking about these toponymicconditions (and realising I’d treated some of theseJapanese tourists myself when I worked at theAmerican Hospital of Paris in 1985), that theaforementioned Israeli doctors had clearly never readthe Talmud of Babylon, which states that Jerusalem is

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one of the ‘things which were created before theworld’. A city that existed before history—now that isa concept worth wrestling with. It ought to give anyonea flutter of Jerusalem syndrome.

Actually, it’s quite unsettling when people you assumeto be sensible turn out to be histrionic at heart. Thejournalist Louis Inturissi, in a hilarious piece for TheNew York Times in 1988, suggested that manyAmericans who come down with Stendhal’s Syndromehave simply OD’d on art. Like the Japanese tourists inParis, they have to ‘do’ Florence, Rome and Naples intwo days, and it almost kills them. Moreover, works ofthe imagination can sometimes pall dreadfully. DrJohnson, who was a most reluctant traveller (JamesBoswell dragged him all the way up to the WesternIsles of Scotland, in those days a monumental trek andnot a journey undertaken for pleasure), suggested that‘the use of travelling is to regulate imagination byreality’. But the reality encountered on travelling canoverwhelm even the best-regulated imagination. I’vepersonally experienced Jakarta Syndrome, which is akind of sinking feeling in the centre of a major Asiancity of at least ten million souls when you realise thereis almost nothing on offer for adoration except theatrium of a modern five-star hotel.

At the other end of the spectrum from the art attackdescribed by Stendhal is another kind of condition.Inturissi calls it Mark Twain Malaise, a cynical moodthat overcomes travellers and leaves them totallyunimpressed with anything Unesco has on its

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universal heritage list. In his account The InnocentsAbroad, one of the best-selling travel books everpublished, Twain, who takes some delight inlampooning the grandiose travel accounts of hiscontemporaries, was impudent enough to suggest thatwhen he saw Leonardo’s Last Supper in thedilapidated monastery of Santa Maria delle Grazie inMilan his first thought had been that the copies he hadseen back home were so much better than the original.(He was right of course; the painting was in a terriblestate until very recently, largely because Leonardoknowingly chose to used flawed materials in hisstucco.) ‘I am willing to believe’, he wrote, ‘that theeye of the practised artist can rest upon the Last Supperand renew a lustre where only a hint of it is left, supplya tint that has faded away, restore an expression that isgone [...] But I cannot work this miracle. Can thoseother uninspired visitors do it, or do they only happilyimagine they do?’ Years before Twain, John Ruskin,mistrustful of the new-fangled enterprise of tourism,had declared that he didn’t find romance in Venice,which is ‘simply a heap of ruins trodden underfoot’,but nevertheless might have wondered if thepublication of his book The Stones of Venice had hadsomething to do with the steep rise in romance-seekersto the watery city thereafter.

More recently, in what might be called his anticipatorymemoir Nothing to be Frightened Of, Julian Barnesremembered Stendhal’s account of his intenseexperience of the Florentine fresco. Intrigued, he didsome research on the original diary entries concerningthe writer’s trip to Italy and found no mention of the

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arty faint. That day—26 September 1811—Stendhalrecords that he had been dead tired, and his feet wereswollen and pinching because of his new boots—‘alittle sensation that would prevent God from beingadmired in the midst of His glory’; but as he gamelycontinued, ‘I overlooked it in front of the picture ofLimbo.’ It was his servant who had told him to take alook at the Sibyls anyway. He records being all aflutterat the experience, but there is nothing about swooningon the way out of Santa Croce.

So there we have it: there is no Stendhal syndrome.Stendhal appears never to have had the experience hewrote up in his travelogue. Or at least if he did have ithe had it as Beyle, and wrote it up as Stendhal. It was aself-performance that turned an apparently randomdate in the life of Henri Beyle into a spectacle in whichthe phenomenon Stendhal could be shared with others:in a word, a work of art.

We all react imaginatively to great art in the belief that,in a true fellowship of feeling, subject and objectmerge. That idea is as old as Plato, who still had somequalms about the ritualistic nature of aesthetic objectsand the obliterating violence of inspiration (which weacknowledge when we talk about being ‘struck’ by awork of art). Art can be so powerful we forget itsunpredictability or even the reality it is supposed torepresent, and faint like Mary at the Cross. All thosescenes were familiar too to that wizard Stendhal, whofostered a cult of spontaneity but whose novels insiston reminding us that in the world of desire a littlewater is always needed to prime a pump.

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The War of Eye and EarON THE SENSES CONSIDERED AS PERCEPTUAL SYSTEMS

‘…he who strains to listen doesn’t see.’

Walter Benjamin, letter to Gerhard Scholem

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Since the dawn of what Norbert Elias called ‘theprocess of civilisation’, sight has held an undisputedplace as the most estimable of the senses. Asked whathe had been born for, one of the earliest philosophers,Anaxagoras, replied: ‘For seeing.’ According toHeraclitus, the enigmatic philosopher who taught thathumanity was an organic extension of the Logos, ‘eyes

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are better informers than ears’. Plato was every bit asphiloscopic. That cornerstone of Western philosophy,Aristotle’s writings, opens with the assertion: ‘most ofall, we esteem the sense of sight’. Hippocrates, thefather of medicine, a bookish authority for latergenerations of physicians, also pleaded for theevidence of things seen. Although the ancientunderstanding of seeing—as a kind of effluence ofthe person, or what is called extramission—has little incommon with the mathematics of modern optics, bythe fifth century BC visual acuity and the attributes ofknowledge were already one: the Greek verb theoreinmeans ‘to contemplate’.

So when Greek ideas were rediscovered at thebeginning of what we call the Renaissance it wasn’tjust those troublesome antithetical terms from the pre-Socratic era, especially that conceptual pair light-dark,the former being ‘noble’ (like male, dry and right), thelatter ‘ignoble’ (like female, wet and left), that weregiven a new lease of life. The mind’s eye beheld theworld afresh: knowledge was once more analogous tovision. But less and less did things have a quality thatcorresponded to the eye. Leon Battista Alberti’swooden frame for establishing a perspectival constructof objects in space, of which Albrecht Dürer in afamous woodcut demonstrates the use, has tellinglybeen called an ‘optical scalpel’. The greatest figure ofthe Renaissance, Leonardo da Vinci, restricted hisstudies to the domain of what he called sperienza, bywhich he meant chiefly visual experience. He alreadyunderstood the new epistemology. The eye was apotentate, ordering the universe and rectifying jumble

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and clutter in accordance with the rules of perspective.Knowledge was predicated on things being madevisible, for darkness was where ignorance brooded.Want, famine and destitution throve in the dark, andonly the light of reason could bring salvation fromsuch primordial terrors. As Jean Starobinski tells us,‘Metaphors of light triumphing over darkness […]were to be found everywhere in the period leading upto 1789.’ The French Revolution hardly even had toannounce itself as the advent of light, a new dawn forhumankind. It was modernity’s solar myth, its ownbeatification.

By the early nineteenth century, imagination hadthrown its lot behind seeing—we can visualise evenwith our eyes closed (OED: ‘visualise: to construct avisual image in the mind’), but nobody has ever beenknown to audibilise, gustatise, olfactorise ortactualise. No sense except the visual has a geometry,which extends into space, while the other senses workintensively in time.

We enjoy the other senses for their adjectival qualities.For instance, there must have been a brief period at thebeginning of the modern era, to judge from Rabelais’wonderful lists of body parts restyled as foods inGargantua and Pantagruel, when the gustatorywas king, and the mouth, as in the Bible, still the routeto true understanding. ‘Open your mouth, and eat whatI give you’, the prophet Ezekiel is instructed. InFrench, knowledge (savoir) and taste (saveur) are stillrecognisably the same word. One famous chapter inRabelais’ second book even takes place inside

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Pantagruel’s oversized maw: Larynx and Pharynx aretwo large cities ‘like Rouen and Nantes’, and the causeof the plague turns out to be the foul vapours resultingfrom the giant eating too much garlic sauce. Theculture of early modern Europe revelled in itsfleshiness: starved of material goods, it generatedGoliardic fantasies of sated bodies. But the solidlyincarnate person didn’t survive the sixteenth century,and Gluttony, alone among the seven major vices, hasbecome an even more venial sin in our secular age.

Shakespeare suggests what happened, in his retellingof Menenius Agrippa’s ancient fable of the disputebetween the members and the stomach, in the openinglines of Coriolanus:

There was a time, when all the body’s members

Rebell’d against the belly; thus accus’d it:

That only like a gulf it did remain

I’th’midst o’th’ body, idle and unactive,

Still cupboarding the viand, never bearing

Like labour with the rest, where th’other instruments

Did see, and hear, devise, instruct, walk, feel,

And, mutually participate, did minister

Unto the appetite and affection common

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Of the whole body [...]

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Now eye motifs so imperiously govern our metaphorsfor understanding we scarcely notice our minds havegone the way our vision took them. Enlightenment hasbecome a bedazzlement, if not a blinding, and entireeras that went before ours are left to moulder in thatdungeon called the Dark Ages. The closer you look atit the more the life of Francis Bacon, that PR man formodern lighting fixtures, was a pretty dark thing, andthe early medieval period in Europe actually one ofgreat intellectualvitality, especially around the Mediterranean when thepower and brilliance of Islam were at their height: themedical school at Salerno, which provided the modelof medical education for all the great medievaluniversities of Europe, was founded just after the turnof the first millennium.

It doesn’t take a sociologist, or even a historian ofscience, to tell us that human relations are dominated,as never before, by sight. The empirical philosopherscontended that we cannot know why things are as theyare, and have to content ourselves describing what wecannot help believing any more than we can helpseeing: they put perception in a cave where everythingresembles events in the external world but there is nomeans of verifying the degree of resemblance. In theempiricist hall of mirrors you see what is meant, bringthings into focus, throw light on the matter. EvenShakespeare joins the chorus, with his famous line in

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Hamlet: ‘In the mind’s eye, Horatio.’ The broodinginner eye, cyclopean rather than binocular, can befound in St Paul and Plato too: the metaphor invites usto contemplate being spied out of our wits. In whatinfinitely regressive mental organ is the mind’s mind’seye? Soon we suspect that there’s something ratherchimerical about our perceptions, especially about thekind of seeing that confers bliss, as in Teilhard deChardin’s notion of the cosmos aiming at ‘theelaboration of ever more perfect eyes’. (So whathappened to that other property of eyes which brims sooften from Dante’s in the Purgatario?)

In spite of its genial anticlericalism, Rabelais’humanism was disregarded during the eighteenthcentury, the age of the lights: Voltaire thought hiswritings a mere impertinence. Victor Hugo, a centurylater in the age of l’homme moyen sensuel, couldn’tmake head nor tail of them. All their images of bodilylife, those fantastic catalogues of eating, drinking,copulation and defecation, had lost what MikhailBakhtin, in his famous study of Rabelais and his world,assures us was their regenerating power. For thephilosophes they were aspects of the crass superstitionof the agrarian age, mere grotesquery. Knowledge hadalready begun to explode in the age of Rabelais, whenEurope moved out to colonize the utopias its piousthinkers had prepared for it; the Enlightenment appliedtechniques of hygiene to the mind in order to disburdenit of the medieval era’s fantastic profusion of theoriesand interpretations.Memory was devalued in favour of lexicography.Knowledge had become a topology.

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Yet the stories that Rabelais took from folk culture,when penury and hunger belonged to the category ofnatural things, were fearless: terror was somethingcomic, to be repulsed by laughter. Rabelais’ exuberantbooks remove themselves from the fixed view ofmedieval thinking: he dares the reader to be taken bysurprise, to play with words, to venture into the wideworld though it be, as Erich Auerbach added, ‘at hisown peril’. Laughter is the mark of our humanity,wrote Rabelais. Nothing else we do is so richlyambivalent about standing out from the crowd: aliberal laughing with, an illiberal laughing at—or asNietzsche described it: ‘being schadenfroh but with agood conscience’. Laughter is involuntary andreciprocal: that’s why it’s infectious. And we end uplaughing so much we seem to be sobbing: ‘If you readas I wrote it, for mere amusement, we are both moredeserving of forgiveness than that great rabble ofquality statesmen, facilitators, agony aunts, souldissectors, dog heads, hypocrites, careerists, membersof the Church of Merited and Blessed Health, moralistsin white coats, and other such sects of people, whohave disguised themselves like maskers, to deceive theworld.’

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That world of cheekiness is pretty much alien to us:one distinguished contemporary historian, NormanDavies, even asked in his great history of Europewhether Rabelais wasn’t the last Euro-pean to be trulyhuman. Lucien Febvre suggests that the entire epoch islost to us: ‘the sixteenth century did not see first, it

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heard and smelled, it sniffed the air and caughtsounds’. And it’s not just the loss of the lower sensesthat horrify people; it’s the insight that in the future wemight lose what George Steiner called ‘realpresence’—being embodied, the dependability ofmaterial realities, face-to-face dealings with others,genuine community.

Sight is now our metonym for the raw feel ofperception in general, for no other sense offers suchmastery. It is the only one that never loses out frombeing at a distance: indeed knowledge at a sightedremove is often foreknowledge. It is the expandedsense of Marshall McLuhan’s famous Gutenberggalaxy where the margins,chapters, linearity and punctuation of the book supplythe structural model for a city divided into parks,districts, roads and bureaucracies. Yet sight’s nobilityand universality, as Descartes called them—and hiscogito that couldn’t reasonably doubt itself isessentially specular, a mirroring back to the self of theassertion that a self should be—are deficient: lookingand seeing (for the former has to be learned before youcan accomplish the latter) provide possibilities foraction, but require the support of more vulgarmediators, especially the hand, that Jeeves of an organ,to maintain a commerce with the world. It is the othersenses that do sight’s living.

Our world, just in case you hadn’t noticed, is organisedaround images. As Georg Simmel wrote in TheMetropolis, ‘interpersonal relationships in big cities aredistinguished by a marked preponderance of the eye

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over the activity of the ear’. This is particularly evidentin medicine, which is a parade of bodies, though theexhibits we get to examine, as more or less trainedinterpreters, seem to be part of an ever less embodiedreality. Sight is pervasive, overpowering,indiscriminate. ‘One can terrify with one’s eye, notwith one’s ear or nose’, noticed Ludwig Wittgenstein. Ican’t be alone in finding eerie parallels between theclosed circuit panopticons of our cities and the abilityof scopic technologies to render us transparent. Inorder to become an image a body must surrender itsmatter. Images are simulacra. They are a kind ofconsolation for never getting to grips with things at all,an invitation to the coldest kind of theatricality as wellas a desperate expression of the need for humanwarmth.

Perhaps that’s one reason why patients flock to the hotsprings and temples of alternative practitioners: theysimply can’t cope with the shame of seeing themselvesvivisected on celluloid or pixilated. They want to feelthemselves living, to participate in a notion of health asold as Pythagoras’ harmonies, though they knowweightlessness is the fate of a world where knowledgehas been drilled to see through every solid body,including their own. In the age of virtual reality,Narcissus is the essential classical model for psychicsurvival, though Narcissus knows, when the round ofself-adoration fails to function, that his ethereallyinfinite ego is but a purely formal unity ofrepresentations. Self-love is anything but sufficientunto itself: as Shakespeare’s plays show us, time and

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again, self-love is prisoner to its enslavement bysignificant others. Venturing out of his private oasis totread the jungle of the streets, Narcissus may evenrecall that street-corner cameras find theirphilosophical origin in Jeremy Bentham’s ideas for themodern penitentiary.

It may be a problem for the medical profession, too.Bulging with the amputated minds that make medicalmethod so powerful, but limit it too, doctors can hardlyescape another, perhaps more disturbing tension. Is theprofession pledged to the eye, or to the ear? After all,everything starts with listening. It is, one might say, anattitude prior even to care and concern. The descant ofthe ear is a reminder of medicine’s archaic past. Unlikethe imperialising eye, the ear is humble. It has to be; itis a servant. In Latin, ‘obedience’ (obedientia) isderived from the verb for ‘lending ear to’ (obaudire).The old-fashioned verbal command ‘hearken’ carriesthe same charge in English. ‘The ear is much slower incomprehension than the eye, far less avid of novelty,and far more appreciative of rhythmical repetition’,wrote W. H. Auden. The Austrian poet Rainer MariaRilke, who influenced Auden much in mid-life,defined his own life as a poet, in which inspirationcame to him like occasional rain to a desert plant, as‘days of enormous obedience’. Of course, demagoguesand dictators adore people who are all ears: they runtheir regimes on the principle that there should be nogap between command and action. In the doctor’soffice, however, it is precisely the person invested withthe power—the power to heal—who is obliged tolisten.

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Sound is bound: to duration, and other kinds oftrespass—it has to wait, it has to make room, it has tobe patient.

Appropriately enough, the ear is often considered thereligious organ, at least in iconographic representationsof the Annunciation: the Virgin Mary conceivesthrough hers. The infant Gargantua, in Rabelais’ book,gets dislodged from his mother’s womb after she takesa purgative for eating too much tripe, slips into a vein,and gets born through hers—and you might almost saythat the modern novel has been the afterbirth. In Psalm40, David thanks God for having so deeply ‘hollowedout his ear’. Why should he say that? Because youcan’t hear anything with your throat; or as the poet W.S. Graham wrote in a fine couplet: ‘the ear says more /than any tongue’. The ear is hope’s conduit. Peoplewho listenhard often close their eyes. In his commentary on theSefer Bahir, Gershom Scholem tells us that the ear isthe image of Aleph, ‘and Aleph is the first of allletters; more than that, Aleph is the precondition forthe existence of all the letters’.

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In fact, the ear is as close as medicine gets, or mightwant to get, to religion. The story in Acts of theApostles about what happened at the Pentecost isusually interpreted as authority for the gibberish of theUnknown Tongue. The more garbled the words thegreater the proof of divine inspiration. That’s thepractice (there’s no theory), though I must confess the

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original recording of James Joyce reading Anna LiviaPlurabelle is probably the only bit of pentecostalismI’ve ever listened to with enjoyment, and it surelydoesn’t qualify, since it was long premeditated,delivered chapter by chapter to a small magazine, andwritten up in a gloriously theatrical universal languageby an Irish philologist with a perfect English ear (and adeep love of Rabelais). But let me turn the rhetoricaltables. Since hearing is an existential possibility in theact of talking itself, why shouldn’t the incident atPentecost actually be a story about reception?—amiracle of listening with ears, not speaking in tongues.For ten minutes, or even a bit longer, the curse ofBabel is lifted by a readiness to listen.

I suspect most doctors have had a few Pentecostalexperiences in their careers. Nothing spectacular, noflash of light on the Damascus Road—just a slightchange of tone and register. Enough to prove thatsimultaneous translation really can happen, even whenpatient and doctor do speak the same language. For ifHume’s scepticism teaches us that we cannot evenknow the world exists, then knowledge is the wrongway to approach it. ‘The world is to be accepted; as thepresentness of other minds is not to be known, butacknowledged’, writes Stanley Cavell in his essay TheAvoidance of Love: A Reading of King Lear.

It seems to me, however, that ear and eye are fated notto be at peace. Not even now that the body has beenrehabilitated. Especially not now. Ours is supposedlyan age of body language, body image, body art, body

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consciousness even. The 1960s made a revolution outof liberating the body, as if its reality, despite thoselines in Genesis about its being the very first object ofknowledge to enter consciousness, had just becomeapparent. Another odd thing about the rehabilitatedbody: it only lets itself go under controlled conditions.The truth is that our carnival is nothing like Rabelais’.Ours is the cult of the machine for living, not thecarnival of the whole body. The price of the ticket forour ability to manipulate material things—and ourlives are inconceivably more comfortable than those ofShakespeare’s kings—has been surrender of our socialmutuality; everything that lives on trust. (Not that trustdisappears, for no human system can operate withoutit: it just becomes weaker and more etiolated.) Butwhat can social beings do for conviviality when theeye, that most enlightened of tyrants, politely butfirmly refuses to know anything at all about a placecalled Babel, where CCTV cameras have been fitted tothe top of the tower? These days, according to the eye,we have escaped the age of fear and faith. We areautonomous, and that’s no laughing matter.

The deep problem with the eye is this: it got to boastabout being noble only by blinding itself to the totalityof experience. Shakespeare’s King Lear turns on thatvery paradox. What we see is not the whole of whatthere is to see; what is seen is only a segment of whatmay potentially be known; and so the truth of ourexperience contrives to hide from us. As MarshallMcLuhan writes, ‘Probably any medieval personwould be puzzled at our idea of looking throughsomething. He would assume that the reality looked

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through at us, and that by contemplation we bathed inthe divine light, rather than looked at it.’ That’s whatthat lifelong troublemaker William Blake was gettingat in Milton when, in accordance with his convictionthat imagination is the ratio—‘the most precioussquare of sense’—holding the perceptive faculties inharmony, he described man prosthetically extended or‘outed’ to his sense organs. In his version of the wholeman every faculty is equally impoverished in itsextension:

The Eye of Man, a little narrow orb, clos’d up & dark,

Scarcely beholding the Great Light, conversing withthe ground:

The Ear, a little shell, in small volutions shutting out

True Harmonies, & comprehending great as very small[…]

Our civilisation is actually founded on an explicitrestriction of cognition, on aspect-blindness. As theveil of ignorance lifts, totality recedes ever further outof sight; indeed other aspects of experience maybecome inaccessible.

Some of us, however, are still smelling our way toDover. Far from having escaped the age of fear, theeye has stumbled on Shakespeare’s cupboard of viand.The more the eye insists on watchfulness, installsophthalmic surrogates and prostheses wherever it can,and generally believes like an American in the gospel

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of prevention, the more its vision of the world seemspartial, if not paranoid. For its gothic discovery is this:the body, that blackguard in the kitchens of a solidbourgeois mansion, that ruffian on the stairs, is somekind of Mr Hyde plotting to rob it of its integrity. Andsuddenly what seemed our biggest investment, our bitof plastic, our self-project, our adored machine forliving, turns out to have a mind of its own. Smoothskin on the outside, Old Adam in.

What name should we give to it, then—enemy?

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Under the Magic MountainFROM THE TB SANATORIUM TO MEDICAL TOURISM

An Alpine regime

In his influential commentary on Thomas Mann’snovel The Magic Mountain (1924), which appearedjust a few years after the novel itself, the scholarHermann Weigand called it ‘the epic of disease’.

We need to define terms. Mann’s novel is moreaccurately characterised as the epic of a disease,tuberculosis, a major disease that has accompaniedhumans throughout their history, at least since theystarted building and settling in cities. It is also, in thebroader sense, an epic of illness—an ambitious attemptto show how the condition of being ill (a more

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subjective category than disease) was experienced in aparticular culture at a particular time in its history.

In the nineteenth century, and not just in Germany,being tubercular was associated with being‘interesting’—and making yourself interesting is theprimordial Romantic impulse. Themain character in the novel adopts the sick role with asense of exaltation—and at times even election—thatgoes back to transcendental idealism and thesupposition, first expressed by the poet Novalis, thatillness might be ‘the means to a higher synthesis’. It isunsettling, then, that when seen from the ‘flatland’ (acode-word in the novel for ordinary existence) thesame character comes across as a malinger who hasjacked in his career in order to enjoy an institutionallycoddled life on the mountain top where he will becomea virtuoso in selfhood. In mere selfhood, one istempted to add.

As Thomas Mann himself suggested, his hero HansCastorp—a kind of dreamy Candide whose face, aswith Voltaire’s famous fictional character, is ‘the indexof his mind’—is on a somewhat paradoxical quest: hehas to pass through illness to rediscover the ethics ofnormal life itself. That is a search we are all familiarwith, one way or another: the magic mountain is nolonger a retreat or social height; it is the familiarlandscape, at least in the developed world, of atechnological Eden with no more onerous a task thanorganising our entire lives. On the bottom rung of allthis reorganising is a medical sociologist’s platitude:the healthier we become the more medicine we

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demand. In the words of Nikolas Rose: ‘like HansCastorp upon his Magic Mountain, our stay in thesanatorium is not limited to a brief and terminableepisode of illness. It is a sentence without limits andwithout walls, in which, apparently of our own freewill and with the best of intentions on all sides, ourexistence has become bound to the ministrations andadjudications of medical expertise.’

When Mann began his novel, tuberculosis was at asignificant juncture in its history: the discovery of thevisible effects associated with an unknown type ofelectromagnetic radiation, X-rays, on the cusp of thetwentieth century, had made it possible to detect withsome accuracy early active pulmonary forms of thedisease. Medicine’s therapeutic capacities, however,lagged decades behind its diagnostic accuracy: it wasonly after the Second World War that effectiveantibacterial treatments emerged for TB. But treatmentis lengthy and not always well tolerated, and patientstend to stop taking their treatment on the first signs ofremission. This abets the development of resistantforms. Even today, despite the newer drugs availableto treat it, containment campaigns in manydeveloping countries have only been partiallysuccessful and TB remains a major public healthproblem, not least in its multidrug-resistant forms: it isthought there are now more cases of TB worldwidethan at any time in history. It has been calculated thatfully about one-third of the global population has beenexposed to the bacillus (although only a percentage ofthose exposed go on to develop the disease).

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The Magic Mountain takes us to one of the fewtherapeutic options open to the better-heeled Europeanpatient of that time: a ‘change of air’ in the spa orsanatorium—what the Italians call villegiatura.

Going up into a mountain retreat was one of thegrowth sectors of Switzerland’s economy in thenineteenth century. From about 1860 to 1940, anAlpine regime of rest and rich food was thought toprovide the best chance for recovery from TB, and forthe body to work its healing ‘wisdom’. It was a policythat certainly isolated patients with active disease (whowere spreading the infection through coughing orsneezing) from the general population, but it made forlocal environments that had high circulating levels ofairborne bacilli. Indeed, the atmosphere of the HausBerghof, on the Davos plateau, to which Mann in theopening pages of his novel propels Hans Castorp, isnot quite as wholesome as it might seem. The thinmountain air, much as in the Bergfilme (mountainfilms) that were popular in the years of WeimarRepublic and later promoted by the Nazis as theGerman answer to the Western movie, proves to beanything but pure and clean; it turns out to be anarcotic, heady and disorientating.

Hans, who has just passed his engineering exams inHamburg, is travelling up from the ‘flatland’ into themountains to visit his cousin Joachim Ziemssen, anaspiring soldier with established TB. He plans to go fora three-week holiday and ends up staying seven years:the Berghof wins him over in the way people sent outto the European colonies used to be accused of ‘going

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native’. In this rarefied atmosphere snow falls all yearround and all days become ‘a continuous present, anidentity, and everlastingness’. It is where theconsumptives are confined, lying out in blankets onrattan deck-chairs to breathe the glacial air by day—thefamous Liegekur—and retiring to their rooms to coughout their lungs at night. They live ‘horizontally’, asJoachim remarks to Hans.

This society in exile is a circle of the living dead ormoribundi, yet to Hans its members seem frivolous andeven disobligingly superficial: the foppish Herr Albinlikes to upset his fellow diners by pressing a revolverto his temple and Hermine Kleefeld, a leading light ofthe Half-Lung Club—a select bunch of patients whohave undergone a surgical pneumothorax procedure tocollapse temporarily the affected lung—whistles atHans ‘from somewhere inside’. When not beingslothful and eating copious amounts of food—a typicalgourmet meal would comprise a chaud-froid ofchicken garnished with crayfish and stoned cherriesfollowed by ice-cream and pastries in spun-sugarbaskets—they indulge in an easy-going eroticism: thehigh-minded Hans at the outset of his stay is offendedby the amorous sounds of the Russian couple in thenext room ‘[whose] game had passed quite franklyover into the bestial’. In general, opting for the sick-role on the magic mountain seems to open the door ona life of constant good spirits and endless fun, notlucidity and depth about the human condition.

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Perhaps being afflicted with TB, as all thosenineteenth-century operas proclaim, was indeed anaphrodisiac.

How Hans becomes what he is

Improbable as it might seem to us, its present readers,The Magic Mountain started out as a short story, in factas a pendant to Mann’s famous tale of disease anderoticism, Death in Venice. Mann had just finishedwork on that novella when he visited his wife Katia atDr Jessen’s Waldsanatorium in Davos in May and June1912, and told one of his correspondents that he wasworking on a new project, a ‘kind of countertext’ to theAschenbach story. Both offer a journey out ofhumdrum life into a luxury setting, and explore anexistentially threatening situation subsequent to fallingin love. But while Aschenbach is degraded by decidingthat illness should be a reason for his not escaping thestricken city, Castorp, as Susan Sontag notes in Illnessas Metaphor, is ‘promoted’. ‘The atmosphere was tobe that strange mixture of death and lightheadedness Ihad found at Davos’, wrote Mann, in his afterword tothe novel. ‘There was to be an ordinary hero, inconflict between bourgeois decorum and macabreadventure […] Then the FirstWorld War broke out. It did two things: put animmediate stop to my work on the book, andincalculably enriched its content at the same time.’

Like the steam train that transports Hans Castorp fromHamburg to the mountain, Mann himself wastravelling from the comfortable patrician world of his

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upbringing to a more uncertain future: ‘It takes place[…] in the old days, the days of the world before theGreat War, in the beginning of which so much beganthat has scarcely yet left off beginning.’ Newpossibilities are in the air (including having an upstarttechnician-engineer as the hero of a Bildungsroman,since it was still the case in imperial Germany that theprofessions open to the classically educated carriedmore prestige than engineering), but there is a certainreluctance about abandoning the old world altogether:bits of the old scenery loom out of the mist, deepchasms and bare peaks damp with mythic associations.And behind the old scenery we sense the self-consciously ‘representative’ writer who, on theoutbreak of war, had been seduced by dreams ofglorious service to the Fatherland, including what hecalled ‘armed service with the pen’. After it, ruefullyaware of his romantic penchant for pessimism andapocalypse, Mann had tried to find a place in a worldrun by technically competent yet unexceptional menlike his Engineer. As late as 1918 he had published hisbulky collection of polemical essays Reflections of aNon-Political Man, a passionate defence of Germany’sparticipation in the war that goes so far as to identifyhis nation’s cause with Kant’s philosophy: as an arch-nationalist, he had argued against the liberal position ofhis own brother Heinrich, an enthusiastic Francophile.By 1922, Mann had completely changed his position,and gone public about his thinking on the matter—tothe consternation of supporters and opponents alike.He had seen where it had led, all the talk of war as arebirth of the spirit and an opportunity for Europe’smoral regeneration. He was now a supporter of

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democratic republicanism, even of accommodationwith what Bertolt Brecht called the ‘bad new’ things.The Magic Mountain is, over much of its length, anoblique account of his conversion.

An aspect of the ‘good old’ things that Mann insists ontaking with him is the classic humanism of Germanculture, of which Johann Wolfgang von Goethe is theemblem and figurehead. It isin Goethe’s early novella, The Sorrows of YoungWerther, his story of an ardent soul and teenagesuicide, that we find the origins of the descriptions ofnature that break into Hans’ stolid consciousness:‘Stupendous mountains encompassed me, abyssesyawned at my feet, and cataracts fell headlong downbefore me; impetuous rivers rolled through the plain,and rocks and mountains resounded from afar.’Goethe’s protagonists—notably the titular lead of hissecond novel, Wilhelm Meister’sApprenticeship—leave imprints all over Mann’s novel:Hans is still ingenuous, in the sense that his native witand intuition have not been educated out of him: earlyin the novel the narrator calls him ‘this still unwrittenpage’. From being a rather feckless young man whosebedside reading material when he arrives at theBerghof is a technical book called Ocean Steamships,by the end of his stay he has acquired the kind ofhermetic knowledge of ‘the innermost force that holdsthe world together’ that Goethe alludes to in the secondbook of Faust. In the spellbinding sphere of dreamsand magic (‘Traum-und Zaubersphäre’), anotherphrase from the same play, anything can happen:

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image can become reality and reality mere image, anda young man of promise can lose his soul.

Up on the mountain new cases arrive and old onesleave, some of them from the mortuary: the othersanatorium in the region, the Schatzalp, somewhatindelicately carts the bodies of its dead patients downin sledges during the winter. A death is neverannounced to other guests on the mountains: thatwould be considered an indecency. There are incomingmessages from the flatland; there are even occasionalvisitors, including, in an amusing interlude, Hans’great-uncle (and guardian) James Tienappel, who paysa visit to the young man, after a year has lapsed, inorder to persuade the lost sheep to return to Hamburg.Uncle James leaves in a hurry the next morning,apparently fearful of falling victim himself to themorbid charms of the Berghof. Uncle James ‘hadbecome inwardly aware’, muses Hans later. ‘After onlya week up here, he would find everything down belowwrong and out of place […] It would seem to himunnatural to go to his office, instead of taking aprescribed walk after breakfast, and thereafter lyingritually wrapped, horizontal on a balcony.’ The magicmountain is no prison, but its atmosphere has a terriblywarping effect on common sense.

In this grandiose natural setting, Mann compelsCastorp to tackle the opposing forces that sopreoccupied him in his own career as a novelist: reasonand irrationality, health and sickness, dynamism andpessimism, conscious will and unconscious impulse,West and East. Few novels of this length have a

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simpler narrative schema. And, of course, everythinghappens in sevens: the magical number is one ofMann’s little jokes, and a major structural principle. Itis evidence of Mann’s skill as a novelist that his hugesymbolic superstructure is able to nurture a society ofcharacters and offer a genuine portrait of the age. It isone in which a middling young man is compelled tobecome a genius, at least about himself; and he isobliged to discover it through being ill. He lives his lifeas an individual even while expressing the life of hisepoch.

Hans Castorp is a psychological man, sick to thedegree that he is unable to find any authority in hisupbringing that might give a sense of direction to hislife. Indeed, The Magic Mountain explores ways inwhich self-knowledge might be made social, a reversalof the old understanding that knowing one’s placecomes about through obedience to family andcommunity, to inherited tradition and the basic tenetsof civility. Hans is, let us not forget, an orphan.

A negative epiphany

One morning Hofrat Behrens, the jovially cynicalsuperintendent of the Berghof, tells Hans that he looksunwell—‘sine pecunia’, he adds twice, although heclearly has a vested interest in recruiting and retainingpatients. Patients are free to leave the sanatorium, evenagainst doctor’s orders; Behrens merely shrugs hisshoulders at the news of disloyal departure, and lets hisarms clap against his sides: he enjoys predicting thedate of their likely return ‘to spend yet more earthly

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time at this pleasure resort’. Hans, as fascinated as heis alarmed, buys a state-of-the-art thermometer (whichis ‘like a jewel’) and begins to record his temperaturefour times daily. In a rather innocent manner, Hans’adoption of routine fever-measuring foreshadows ourmore technically elaborate obsession with self-monitoring: the classic injunction ‘know thyself’ issomething we do with numbers these days, not words.Meanwhile, his cousin Joachim, the actual patient,chafes under his enforced leisure, and hankers to returnto his flatland life in the army; Behrens—tongue notentirely in cheek—tells Hans that he’ll make ‘a betterpatient’.

On the point of embracing the possibility that he toomight be ill, Hans meets the beguiling Russian,Clawdia Chauchat. With her blithe habit of slammingthe dining room door, this ‘Kirghiz-eyed’ womanirritates him, and then starts to intrigue him. She is afree spirit who cares nothing for the kind of orderedreason that governs social conventions such asmarriage, or even the proper running of thesanatorium. Her mysterious husband, who never turnsup to reclaim her from the sanatorium, is an oil-engineer working at the centre of the then world oilindustry in Daghestan, one of those ‘heavenly rose-gardens’ where Persia abuts on Russia in the easternCaucasus. He is too busy siphoning the geologicalsubconscious to appear in the novel: oil doesn’t justfuel the modern economy and provide strategicobjectives in time of war, it is the ‘crude’ stuff thatenergises the magic mountain and the life of itscharacters.

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It will take Hans months—seven in fact—before hecan work up the courage to address Clawdia. And sucha troubling influence cannot go unchallenged. Hansmeets the man who will play down her attractions:Ludovici Settembrini. Though Hans thinks he looksclownish on their first meeting, Settembrini proves tohave a sobering influence on him. He requests to be histutor, the humanistic pedagogue who will admonishHans regularly for his waywardness and urge him toreturn to his professional life. Settembrini, the greatdefender of Western liberalism, has no truck with thesupposition that illness might make a person moreinteresting. ‘Disease and despair are often only formsof depravity.’ Perfectly well people, he warns Hans,have even been known to insist on staying on themountain.

But Clawdia and the East prevail, and they overcomeHans at the moment that we see through him with thehelp of Behren’s X-ray machine—which Mann writesas a parody of the famous moment in 1896 whenWilhelm Röntgen first took an image of his wife’shand with his newly discovered invisibleelectromagnetic rays. The doctor concludes that Hanshas a ‘moist spot’ on his lung and scars from achildhood infection, the same pronouncementthat Mann heard from his wife’s physician, Dr Jessen,on his brief visit to the sanatorium in Davos. Suddenly,it seems as if the mountain atmosphere is just as likelyto bring out an incipient case of TB as it is to resolvean established one. Hans has a chance to show justhow good a patient he can be. In the room housing theradiology apparatus he catches a glimpse of ‘what he

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never thought it would be vouchsafed him to see: helooked into his own grave’. The none-too-solid fleshcan be penetrated—‘the flesh in which he walkeddisintegrated, annihilated, dissolved in vacantmist’—and its parts viewed as negative images quiteseparately from the living breathing body, and held upto the light for scrutiny. Hans has become exquisitelyimage-conscious, like the other patients of the Berghofwho pass the time observing their ‘interior portraits’.They are not disturbed by what might seem theultimate dehumanising experience: the ghostly asepticimages of their lung-fields—cavities full ofshadows—have become a kind of consolation prize fortheir inability to grasp the reality of their bodilyaffliction.

Momentous epistemological changes are just aroundthe corner. As Bettyann Holtzmann writes in herhistory of medical imaging Naked to the Bone, the X-ray undermined not only Victorian ideas of proprietyand private parts, it affected ‘the self-perception of anentire culture’. On the front in 1914, radiologistsworked in tandem with surgeons, using relativelyprimitive devices to localise bullets and shrapnel insoft tissue; and X-ray fluoroscopes entered civilian lifenot long afterwards, as a gimmick for fitting shoes.Since then, of course, imaging techniques have becomeever more sophisticated, revealing first soft tissues,then, with the advent of ultrasound, nuclear magneticresonance and positron emission tomography, thedetailed internal structure and even metabolic activityof living tissues.

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Yet which illness more visibly exposes the delusion ofmistaking an image of a disease process for the truereality of the logos incarnate in the human form thantuberculosis—the cavitating disease? Hofrat Behrensmight find the whole business of this new technology‘spooky’ but he doesn’t react to the X-ray films in thesame way as his patients. For him, the image is a signthat can be used to uphold his physical findings orconfirm advancement of the disease: it is ademonstration. It is metaphor-free; it lacks anyimaginative‘after-image’. In the very best of cases, it ought toserve as the prelude to rational action. What hispatients see in their X-rays is of a different order: forthem the image-symbol is an evocation. It gives the oldname for the disease an ironic twist: ‘consumption’was thought to spiritualise the person even as itconsumed the body, so that the inner glow of the soulcould shine forth. It is an odd business, this idolising ofX-rays…

Now that Hans can safely call the sanatorium hishome, he is free to pursue his love interest. MadameChauchat (her name is a double pun on the Frenchword for whispering and her sexually alluring felinity)proves to be a seductive and elusive personality. To hisvexation, she refuses to take his illness seriously.Settembrini, of course, detests her, seeing her as atelluric force that will disrupt the brotherhood ofenlightened men. Yet the ‘wicked, riotously sweethour’ Hans enjoys with her on Carnival night—sevenyears of hanging around a sanatorium for one hour ofbliss—probes his pedestrian soul. He declares his love

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for her in the most stilted French (which the firstEnglish translator of Mann’s novels sensibly left in theoriginal): ‘Let me take in the scent of your pores andbrush the down—O human image made of water andprotein, destined for the shape of the tomb: let meperish, my lips against yours!’ Hans verbally lays barehis soul, in the kind of purple prose only an engineerwould drum up; and then he takes possession of hersoul physically, in the form of his most ‘intimate’possession, the X-ray plate of her lung. Clawdia leavesthe sanatorium almost immediately after their night ofpassion, and Hans embarks on a long course of readingand studying.

The cure for heartbreak is a curriculum.

The battle for a soul

In Clawdia’s absence, Hans takes up the part of themedieval Everyman in a modern morality play.Settembrini and his new foil, Leo Naphta, a Polish Jewconverted to Catholicism who has taken up lodgings inthe village below the Berghof, become God and theDevil fighting it out for the young man’s soul—ormouthpieces for the antithetic arguments thatconvulsed twentieth-century history.

Many of their sermonettes do indeed offer ‘the greatdisputationon sickness and health’ that Mann hoped for his novel.According to Settembrini, the high-toned Italian liberaland Free-mason, the purpose of modern medicine is,through hygiene and social reform, to allow reason and

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enlightenment to triumph over all the contingencies ofdisease. To combat the sufferings of the flesh has amoral dimension to it, insofar as health will ultimatelybe identified with virtue. He reports, for instance, onthe work of the League for the Organisation ofProgress, the goal of which is nothing less than utopia:the total elimination of human suffering through totalknowledge. ‘Famous European specialists, physicians,psychologists, and economists will share in thecomposition of this encyclopaedia of suffering, and thegeneral editorial bureau at Lugano will act as thereservoir to collect all the articles which shall flow intoit.’

This is outright niaiserie to Naphta. Nothing could bemore detestable than a normalised ethics for living.True spirituality and freedom are bound not to ananodyne veneration of the healthy body, but to a stoicacceptation of bodily infirmity and suffering. Beinghuman is to be ill. ‘Man was essentially ailing, his stateof unhealthiness was what made him man. There werethose who wanted to make him “healthy”, to make him“go back to nature”, when, the truth was, he never hadbeen “natural”.’ Naphta, who sounds at timesuncannily like a member of the Frankfurt School oreven Michel Foucault, argues that the normal hasalways lived on ‘the achievements of the abnormal’.What counts is ‘iron allegiance, discipline, denial ofthe individual’ at the service of ‘the revolution ofantihumane backlash’.

Naphta seems to have all the persuasive arguments, yetnothing he says ever suggests a man who means well,

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certainly not by young Hans Castorp, for whom hisreasoning is often way above his head. Settembrini, onthe other hand, is quick to notice that Naptha’sthinking proceeds essentially through ‘malice’.

When Clawdia returns to the sanatorium, it is in thecompany of her lover, Mynheer Pieter Peeperkorn, aretired colonial coffee-planter from the Netherlands.He is a gift of sorts from Clawdia Chauchat to her‘little German Hänschen’, although he is hardly likelyto think so at first. Peeperkorn is the fatherly but vitalman whose role it is to teach Hans how to be a masterof antinomies. Although Thomas Mann admitted hehad modelled Peeperkornon the German writer Gerhart Hauptmann, he seems inhis embodiment of the sexual, the instinctualunconscious and the naturally religious to have steppedout of one of D. H. Lawrence’s more exotic novels: theeldest character in the book is a voluptuary ofstupendous personality—‘though blurred’. Thisinarticulacy is no disadvantage. Hans is forced to admitthat his soul-teachers are dwarfs beside Peeperkorn.His presence at their debates, which he mocks with aseries of tics and gestures, makes their verbal skillsseem trivial and unimportant. Peeperkorn’s mission atthe sanatorium appears to be to make Hans aware ofthe ‘sacraments of pleasure’. He has a duty to feel. Forbrief moments, Nietzsche had written in his early workThe Birth of Tragedy, we become ‘primordial Beingitself, and feel its indomitable desire for being, and joyin existence’. Even Clawdia is outshone by thebombastic enthusiasms of this primitivist, whoseshock-confession to Hans is his impotence—‘a cosmic

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catastrophe, an irreconcilable horror’. The vessel thatspouts the gospel of health is cracked. To be impotentand a sexual mystic can hardly be a happy condition.And sure enough, a short time later, Peeperkorn takeshis life on a picnic by a waterfall using a baroque littlegadget containing poison. Soon Clawdia leaves thesanatorium for good and Hans is cast again intodudgeon.

This irruption of vitalist philosophy into the becalmedatmosphere of the Berghof is still not enough to makeHans quit the mountain. His explorations of the occult,in which he is encouraged by Behrens’ assistant, theambiguous psychoanalyst Krokowski—who isdescribed as an ‘idealist of the pathological’—bringhim to another dark room and an apparition of his deadcousin Joachim dressed in a field uniform and wearingwhat appears to be a ‘steel pot’ on his head. It is adisconcerting vision which reverses the‘enlightenment’ of the earlier X-ray room experience.‘Hans Castorp liked the darkness, it mitigated thequeerness of the situation. And in its justification herecalled the darkness of the X-ray room, and how theyhad collected themselves, and “washed their eyes” init, before they “saw”.’ Called up by a medium, Hansmumbles his apologies to the wraith of Joachim—whoso resembled him that they had been called the‘Gemini twins’—and, in a Settembrini-like gesture,throws on the light.

Their frivolous desecration of the dead is over; and wesense

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that the magic of the mountain might just be starting towear off.

An abrupt end is also in sight for the debating circle.After a general deterioration in the atmosphere at theBerghof (mirroring the conflicts in Europe that led upto the war), Settembrini and Naphta’s intellectual cut-and-thrust loses its gentlemanly tone, and sinks intonasty bickering, with the former accusing the latter ofinfamy—of ‘misleading unsettled youth’. A duel isarranged; but Settembrini casually fires his revolverinto the air, refusing to shed blood, and offers his bodyto his rival. Naptha, enraged by Settembrini’s refusalto use his weapon, shouts ‘Coward!’ and shootshimself through the head. Death and the daemonic turnout to have been in cahoots. It is the novel’sclimax—an episode entirely in the manner of thatfamously drastic classic German author Heinrich vonKleist—though it is hardly its resolution. The gunshoton the mountain signals the more famous one soon toring out more than four hundred miles away in theflatlands: the Archduke Ferdinand’s assassinationprevents Hans from eking out his life indefinitely at thesanatorium. The first rumblings of the Great Warfinally enter the novel, like chairs being toppled in adrawing room. In the final, film-like epilogue to thenovel, we see Hans advancing over the mists of abattlefield, bayonet in his hand, humming to himselfthe Schubert song ‘Der Lindenbaum’ (The LindenTree) that once besotted him in the Berghof. He hadfirst heard it on the gramophone, another kind ofmachine brought in to lighten the lives of the Berghofguests.

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Looking down from heaven

Mann’s conclusion is the most unsettling part of thenovel, and not just because it falls in the shadow of themountain of text that precedes it. His epilogue is astilted delirium.

The first soldiers to go over the top in 1914 were thefirst victims of technological warfare, a horrifyinginferno to be run under the guidance of the coollyfunctional engineer types Hans had actually trained tobecome. (Given his training in naval architecture,perhaps Mann ought to have placed his noviceengineer in an office designing one of the advancedbattleships the Germans were busily rolling down theslipways in an attempt to outdo the Royal Navy’sdreadnoughts.) And there is another realisation. Forover seven hundred pages we have been preoccupiedwith Hans Castorp’s Bildung, his education—and whatis its likely outcome? He is about to fall in the mud ofa war that will not only nullify his existence but renderthe entire world of values that created him as archaicand irrecuperable as that of his Uncle James. The GreatWar certainly made it easier to die as an idealist thanlive like one: it was the turning point in the modernsurge of cynicism about authority and superiors andpeople in command generally. Any writer whopresumed to address warfare after 1918 would have towalk over dead bodies. Mann’s touchingly rhetoricalfarewell to ‘life’s delicate child’ is barely camouflageenough to prevent us from seeing that treading oncorpses is precisely what they, hero and author, areboth are doing in that final scene. It will also be noted

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that the young soldiers—those ‘feverish lads’—havethe same flushed face as Hans in his heightened stateon the magic mountain.

In the commentary he wrote in English in 1953 for theAmerican edition of The Magic Mountain, Mannobserved: ‘Such institutions as the Berghof were atypical pre-war phenomenon. They were only possiblein a capitalistic economy that was still functioning welland normally. Only under such a system was itpossible for patients to remain there year after year atthe family’s expense. The Magic Mountain became theswan song of that form of existence. Perhaps it is ageneral rule that epics descriptive of some particularphase of life tend to appear as it nears its end. Thetreatment of tuberculosis has entered upon a differentphase today; and most of the Swiss sanatoria havebecome sports hotels.’

While it is true that the discovery of streptomycin byAlbert Schatz in 1943, the first effectivepharmaceutical cure for TB, led to the closure on amassive scale of spas and sanatoriums, thephenomenon of leaving the ‘flatland’ for what mightbe called recreational medical treatments actually grewconsiderably. In some European countries thesetreatments are still funded by the national healthsystems. As the post-war French and Germangovernments were the first to grasp, medical tourismcould be seamlessly integrated into themacroeconomics of their respective nationaleconomies. These are the naturalistic ‘experiments inregeneration’ that Naphta ridicules in the novel. The

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word Mann used to describe the heightening of HansCastorp’spersonality—‘Steigerung’—now has its primarymeaning in the economic field, where it denotesincreased productivity. It was, in fact, one of Goethe’skey terms: intensification is what he saw as thepropensity of organic phenomena to manifestthemselves in ever more complex forms, to pushskywards in ‘a state of ever-striving ascent’. Mann hadperhaps not fully anticipated how grand bourgeoisfamilies would be replaced by mass consumers with asense of entitlement and enormous appetites, after thelibidinal revolution of the 1960s, for restorative leisure.This was a key element of Herbert Marcuse’s oncefamous notion of ‘repressive tolerance’, by means ofwhich citizens are kept too busy with the delights ofconsumerism and demands of fashion to pay anyattention to reforming society (itself a distraction fromwhat Blaise Pascal claimed was the need to attend tothe care of our immortal souls).

Under modern conditions, that delicious temporarysensation of being simultaneously above the fray,embedded in the elements (most pleasurably in theamniotic surround of a spa) or caught in a bubble ofluxurious rarefaction, can be had collectively. It is notjust German philosophers who get the chance to lookdown from heaven on the flatland far below. Now, asemployees who have paid their medical insurancepremiums, clients can ask their doctor to send them ona ‘cure’—to a place where they can partake in anatmosphere of the most gently enforced discipline,segregation and submission to orders from above,

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accompanied the while by a piped Haydn or Mozartquartet.

Visiting a spa or sanatorium is the equivalent inmedicine of adopting the pastoral mode in the arts.

Committed now to nothing more than our well-being,our principal guides in the art of living are doctors, notphilosophers. It is Settembrini’s ethics that prevail,even though the radical critique of medicine’s largelyhumane accomplishments is pure Naphta. Thecontemporary German philosopher PeterSloterdijk—who once wrote an epic novel about thebeginnings of psychoanalysis called Der Zauberbaum(The Magic Tree)—lists in the third volume of hismassive phenomenological account of modernitySpheres, a book with something of the grand synopticreach of Mann’s novel, the zones in our culture wherewe can find something of the magic mountainatmosphere: ‘Even where illness does not define thevery modus vivendi, it remains in the background asa constant possibility: fitness scenes, wellness and dietregimes, the smoothly organised and inward-lookingworlds of the spa towns, the balneological retreats andthe high-altitude castles for coughers would beinconceivable without it.’ These are the variousstations of the therapeutic good life. As an olderNaphta avatar, Carl Jung, once wrote: ‘the gods havebecome diseases’.

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The Life and Times of Ernst WeissEXPERIMENTAL WRITING AND THE MEDICAL ORDER

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A close literary friend of Franz Kafka, especially in thecrucial period leading up to the outbreak of the GreatWar when Kafka famously decided not to marry hislong-suffering fiancée Felice Bauer, Ernst Weiss is analmost entirely unknown figure outside Germanliterature. Although his collected works take up sixteenvolumes in the centenary German edition published in1982 by Suhrkamp, Georg Letham: Physician andMurderer—resourcefully translated by Joel Rotenbergand published by the enterprising New York houseArchipelago—is only the fourth of his novels to appearin English.

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Born in 1882 in the Moravian city of Brünn, then aHabsburg possession (now Brno in the CzechRepublic), Weiss studied medicine at the universitiesof Prague and Vienna where he became acquaintedwith many celebrated medical figures including JuliusSchnitzler and Sigmund Freud. It was a yet morefamous doctor of the day who was to become Weiss’mentor: Emil Theodor Kocher, professor of surgery inBern and winner of the Nobel Prize for Medicine in1909 for his work on the thyroid gland. (That wasn’this only contribution to medicine: every physician whohas ever worked in an emergency room has enactedKocher’s four-step manoeuvre for correcting ananterior dislocation of the humerus at the shoulderjoint.) Kocher was a father-figure for Weiss, and seemsto have supplied the model for the ‘good doctor’depicted in so many of his novels. He many even havehelped Weiss develop as a writer, since he required hisassistants to write full-scale medical reports, a genrewhose conventions are apparent in the writings of anyphysician in the early years of the last century, notablyFreud himself, who commented more than once on thestructural resemblances between the Novelle and hiscase histories. (Doing clinical work on the languagewas how many physician-writers got started in theircareer, but Kocher is perhaps a unique instance of thesurgeon as literary lion.)

Weiss’ most decisive experiences in medicinehappened during his period as a ship’s doctor, when hevisited the Far East and Japan (although Joseph Rothonce ribbed that he never went on land and ‘stayed inhis cabin to write’), and as a regimental doctor in the

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Austrian Army during the Great War. By 1921, he wasliving in Berlin and for all his personal prickliness,programmatically lurid Expressionism and partialityfor characters in extremis, was enjoying a bit ofsuccess as a novelist and playwright. Like so manyJewish-born writers of his generation, he quit Germanyafter the burning of the Reichstag and returned toPrague to look after his ailing mother; after her deathhe headed for Paris, where he was forced to eke out ameagre existence as a translator and had to turn tobetter-off friends like Thomas Mann and Stefan Zweigfor financial assistance.

Ernst Weiss died, of self-inflicted wounds, in theHôpital Lariboisière in June 1940 just hours after theWehrmacht marched into Paris.

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For a long time, Weiss was a name for a few rarespecialists in English solely on account of thedisturbing psychohistory of his last but oddly docilenovel The Eyewitness, whose publication in the USAin 1977 had more to do with the growing field of whatMel Brooks would probably call ‘Hitler studies’ thanany signal interest in Weiss as a literary figure.

While living in Paris, Weiss apparently met DrEdmund Forster, a renowned neurologist who hadspecialised during the 1914–18 war in the newphenomenon of battlefield trauma: it was he whotreated corporal Adolf Hitler in the closing months of1918 for an episode of ‘hysterical blindness’ after a gas

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attack at Ypres. A few weeks after his visit to theémigré circles in Paris, Forster was found dead in hishome at the University of Greifswald, an unlikelysuicide; and Hitler’s medical file disappeared fromhistory. Five years later Weiss wrote The Eyewitness: itsurvived the war and the spoliation of his papersincluding the diary Weiss regarded as his masterpieceby the Gestapo after his death only because it had beensubmitted for a literary competition in New York(which it failed to win). In a brief scene in the novel,its medical hero indulges the unsighted Corporal‘A.H.’ when the latter hysterically refuses tocontemplate Germany’s capitulation. The doctor putshis patient under hypnosis and suggests to him that hiseyes have indeed been scarred by the mustard gas. It isa white lie to flatter his patient’s vanity, and deny anypsychosomatic element in his inability to see.

He tells his patient that only a truly exceptional manwith ‘blind faith in himself’—a romantic artist in themould of one of the great religious leaders of thepast—will have the force of personality to restorehimself to sight. And his hypnotic suggestion works.Cure of his imaginary blindness opened the way for theultimate confidence man to begin his career ofspectacular ill will. Mein Kampf suggests a conversionexperience of some kind altered Hitler’s nature at theend of Germany’s lost war. The clinical art had spilledover, as W. H. Auden once warned, ‘from creating aworld of language into the dangerous and forbiddentask of trying to create a human being’.

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It is easy to see why such a story of deviance anddoctors appealed to Weiss. From his very first novel,Die Galeere (‘TheGalley’), he was taken with the figure of the doctor ashero: it is not unkind to see him as writing a highbrowvariety of the ever popular romantic Arztroman or‘doctor novel’. Although its equivalent in the English-speaking world (now largely superseded by TV series)has acquainted us with the idea that even priestly‘demigods in white’ can be fallible, Weiss’ figures aredeeply implicated in far more serious and morallydubious business than silly pranks and affairs withnurses. There is a largely unspoken assumption in hiswork that those who fake the virtues are especiallydangerous in a modern technological society. Hischaracter ‘A.H.’, for instance, is an incorrigiblefantasiser, but he is not exactly a liar: it would be moreaccurate to say that his whole life is one gigantic lie inwhich there is no absolute except the truth of hisimagination. Much in the same way, the not entirelyreliable first-person narrator in Georg Letham:Physician and Murderer—first published in 1931 byPaul Zsolnay Verlag in Vienna—declares in theforeword to the novel: ‘The profound, truly disastrousdisorder and futility of nature and the world—what inthe scientific realm we call the pathological, in themoral realm the criminal—these are constant’.

That is the preamble of a convicted murderer. Lethamis a reverse Hamlet: he is out to avenge not his father’sunlawful death but his father’s killing of his own soul.Weiss is an early explorer of the inward turn that hasmade ‘trauma’ a contemporary psychological concept

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in which perceived cause and manifest effect aredifficult to tell apart. The first third of the novel istaken up with events leading up to the murder of hisalmost twenty-year-older, wealthier wife, whosedevotion to him has been ‘doglike’. Self-important inhis devotion to science, Letham seems to moveeffortlessly from research to his lucrative privatepractice as surgeon and gynaecologist. (His personconjures up the glamorous society doctor depicted intrenchcoat, the one hand on his microscope and theother holding a test-tube, in Tamara de Lempicka’s1929 painting Portrait of Doctor Boucard.) ‘Illnessesinterested me, the ill did not’, Letham confesses,drawing attention to the dissevering of reason andemotion that marks his entire life. He is seeking an expost facto rationale for his crime, as if it had been adispassionate intellectual act, when what he sayssuggests he had often fantasised about it. Indeed, ithappens almost nonchalantly one evening when she‘asks for it’: mistaking a vial lying in his studyfor morphine, his wife begs him to administer somepain relief. What he injects is ‘Toxin Y’, a deadlyproduct of his own research.

Arrogant about his motives (‘Ultimately only I couldjudge this crime’) and seemingly indifferent to his fate,Letham is sentenced to hard labour at C., anunspecified penal colony in Central America. It is aDevil’s Island, where the locals live in terror ofcoming down with yellow fever (‘Y.F.’). As inThomas Mann’s TB-haunted mountain top, a microbialillness threatens an islanded society with dissolution.Little by little, Letham’s mortuary precision begins to

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buckle under the strain of real anguish. The youngman, March, with whom he is quartered falls in lovewith him; and although Letham is clearly fascinated byMarch he is unable to return his affection. It is onlywhen he himself develops feelings for a youngPortuguese girl entrusted to his care and whose life heis unable to save that he, for the first time, feelssomething like emotion. The veneer of objectivity isshowing cracks.

A penal colony has to rely on people with skills, evenwhen they are convicted murderers: Letham isdoctoring again. The subsequent saga of research anddiscovery is clearly based on the pioneering—andsuccessful—attempts to eradicate ‘Y.F.’ from Havanain the 1890s and William Reed’s proving of the‘mosquito hypothesis’ during the American building ofthe Panama canal in the 1900s (the French had had toabandon an earlier attempt at construction in the 1880sbecause of the exceptionally high mortality rate amongworkers and engineers as a result of malaria andyellow fever): Letham discovers a sense ofprofessional purpose in researching the epidemic’sorigins.

‘Scientific work is a joy’ he confesses; he has even‘become fond of life’. Like many pioneeringresearchers, he and his colleagues allow themselves tobe infected in order to determine whether theirspecially bred mosquitoes are indeed vectors for Y.F.But the experimenter in him—‘The experimenter islike God, but on a small scale’—gets the better of thismoment of self-sacrifice, when he fails to intervene on

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catching sight of an escaped mosquito, in all likelihoodinfected, poised on the nape of his colleague’spregnant wife. He wants to see whether the infectionwill be transmitted to the child in utero. It is thebeginning of the end of his relationship with March,who spots this act of dereliction.

Although Letham and his colleagues are successful ineradicatingthe blight—‘We gradually cleaned up an area largerthan Europe’—the sentence that concludes the book isemotionally telling: ‘I disappeared into the crowd, andthat is for the best.’ Dr Letham has the measure ofhimself at last.

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The New York publisher Archipelago is to becongratulated on commissioning and publishing thetranslation of this long novel. It is a pity nobody couldbe found to provide it with an introduction, though, oreven a few notes about its medical background. Weiss’own life is sufficiently if undeservingly obscure as torequire as much context as it can get, and the naturalhistory of the disease that punctuates the course of thenovel is not entirely as Weiss presents it: he appears tohave confused the mode of transmission of yellowfever, a haemorrhagic viral illness vectored by femalemosquitoes of the genus Aedes aegypti (in those days,and in the novel, called Stegomyia fasciata), withleptospirosis, a bacterial disease of the liver contractedthrough contact with infected mammalian urine. Itused to be known as ‘rat catcher’s yellows’, and was

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common in the trenches in the Great War. Its fulminantform is known as Weil’s disease.

Kafka’s reservations about Weiss’ editorial talentswere not ill-founded either: the entire first third of thenovel (leading up to the murder of Letham’s wife)ought to have been presented as a short flashback. Thewhole thing creaks under the weight of its symbolicsuperstructure: Thomas Mann might have imposed acomplex ‘rule of sevens’ on the realism of The MagicMountain, but the outcome there was rather moreconvincing and sustained by Mann’s understatedhumour. The very Kafkaesque obsession with all-conquering fathers—Georg Letham senior is a Polarexplorer as well as a rat-exterminator—raises morequestions than it answers, too. Hamlet’s actualcontribution to events is perhaps most felt in his advicein the original play to his mother, Queen Gertrude:‘Assume a virtue if you have it not.’ Assuming virtuesis plainly a perilous invitation in an inverted moralorder. If Kafka, in some of his short stories, providedthe imaginative backdrop to the geography of Nazihorror, Ernst Weiss seems to have had an ominoussense that monstrous programmes might descend onsociety through the workings of people able to assumea mask of goodness even as they pursue a radical evil.Hitler, certainly, was always very keen on medicalmetaphors; and his political method for resolvingcomplex social problems was all too often that ofbiological expediency.

In a novel that explores the ethics of experimentalscience, the more fitting character to adopt from

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Shakespeare would have been Iago, not Hamlet. He isthe true exponent of Francis Bacon’s contemporaneousidea of putting nature on the rack. Letham murders hiswife not because his father has bungled the job ofbringing him up but because she is the one person whoknows him—knows him in the intimate Biblical sense,since his disgust with her is closely linked to hiscompulsion to abuse her sexually: their relationship, ashe acknowledges, is sado-masochistic. The fact that herefuses other people this mutuality of knowledge issignificant. He is after scientific knowledge in Bacon’sclassic sense, to stand over what he is investigating,which is a stance nobody can adopt in an authenticallyhuman relationship.

In Shakespeare’s play, Iago utters his coldly dismissivefinal comment, ‘What you know, you know’, onlywhen he has reduced Othello to a thing. Hisunderstanding of other people’s desires (and how tomanipulate them) is Machiavellian in its subtlety buthe gives no sign of understanding his own reasons fordoing what he does, a phenomenon that is entirelyconsistent with a self that relates to others onlynegatively. Indeed, the recognition that he is parasiticon the creation he despises—‘I am nothing if notcritical’—shifts an otherwise empty soliloquy into thevertigo of infinite regress.

There are, however, a couple of expressionisticnightmare scenes in Georg Letham which attest toWeiss’ talent for what is recognisably a filmic style: alab dog with part of its cranium removed andelectrodes still implanted in its grey matter escapes its

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cage and scampers, barking with excitement, into themedical amphitheatre, only to have the remainingbrains knocked out of it in a coup de grâceadministered by the admired student who eventuallybecomes Letham’s colleague in C.; and a typhuscorpse buried at sea fails to sink, gradually unwindsfrom its grave-sheet, and is tossed ‘in mad high spirits’by the dolphins cavorting in the wake of the ship.

Both these scenes bring on animals: the entire novel ishaunted by creatures surviving—and eventhriving—on the boundaries of human society. Firstthe rats that dart in and out of Letham’s narrative, fromhis father’s ‘Rat Palace’ to the scenes of his ownnastiness; then the mosquitoes, which decimate thepopulation of C. and cut a strip off human ambition;and finally the viruses that are the hidden but effectivecause of Y.F. Outsiders all, but only Georg Lethampresumes to set himself up as a critic.

Ultimately the novel itself is a kind of experiment: justhow far can we trust such an unreliable narrator?Weiss knows we can’t entirely condemn his repulsiveexperimenter: our culture long ago endorsed the notionthat the right to know is absolute and overriding.Knowledge of what preys on us is one thing; the truthof the matter, eroded by those disruptive rats, is alwaysgoing to be something else.

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ParasitesOR, HOW TO FLYPE A METAPHOR

PARASITE: An organism that for some or all of itslives, lives on or in the body or cell of anotherorganisms (host), deriving its food from the host. Thehost does not benefit from the association and is oftenharmed by it. Human parasites include viruses,bacteria, protozoons and worms.

– Cambridge Encyclopedia of Evolution

PITY: A squandering of feeling, a parasite harmful tomoral health.

– Friedrich Nietzsche

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FLYPE: v.t. Chiefly Scottish. 1. Strip off (the skin,etc.), peel, flay. 2. Turn up or down, fold back; turninside out.

– Shorter Oxford English Dictionary

Lifted out of their hiding places parasites may lookstrange and monstrous, but only as strange andmonstrous as organisms which, to gain their ends, areresolved to one nervous or narrow form of themselves:dependency is organised in such a way as to seemalmost a virtue. The host is substance and nutriment;its inner dark is burrowed into and fed on; the parasitethrives and grows; and what results is a spectaculartriumph existing solely by meansof its attachment. A parasite is all in its feeding. Infact, it is in the nature of things that this veryattachment offers the host a means of protectionagainst the parasite. Soon the host is innocentlywhistling again, happy in the conviction that themicroworld of parasites he can’t see coincides in everydetail with the macroworld made squeaky clean bysuch essential gadgets as bars of soap, vacuum cleanersand wet-wipes.

Parasites exist, it would seem, despite waterpurification, sewage disposal, free school milk, andmedicine itself. Even, it would seem, despite Engel’sdescription of the Manchester slums in 1844, whereManchester now yields to cities like Lagos, Bombay,Nairobi or Lima. Adolf Hitler, another world-reformer,

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was fond of the word he correctly recognised as socialDarwinism’s gift to amour propre; unfortunatelynobody ever bothered to read his turgid ideas aboutwhat-to-do-with-those-who-sup-at-the-tables-of-others,written down in black and white; which is why weended up with the twentieth century. And the twentiethcentury, as we know, was just a coda to the marvellousnineteenth, which thought the future would work outjust the way humans wanted it to: the overwhelmingsuccess of Pasteur’s germ theory turned—and certainlynot just in the scientific imagination—all talk abouthealth and illness into a vision of armed camps andinvasions, with hygiene as a pre-emptive strike againstenemy forces. It’s not surprising, a hundred years later,that epidemiology (coined as a word in 1873, andmeaningful as a science only after the Second WorldWar) looks like catastrophe theory in slow motion.

We should examine some examples of what we’retalking about. Take malaria, for instance. It means ‘badair’ in Italian, is the paludal or marsh disease inFrench, and has proved to be a disease of greatresourcefulness notwithstanding the rather complicatednature of the sexual life of the organism Plasmodium,which was first written up by Sir Ronald Ross and hisless feted Indian assistant, Muhammad Bux. Thesexual life of Plasmodium, which in zoological termsis a protozoon (single-celled creature), takes place inthe salivary gland of the Anopheles mosquito; the otherpart of its life cycle requires colonisation of liver cellsin a specific mammalian species. Infection occurswhen the mosquito puts its

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mouthpart, which is a small but effective hypodermicsyringe, into your integument and sucks withoutobvious display of table manners at the puncture site.Mosquito saliva, of course, is where Plasmodium tendsto hang about. Once the host is inoculated, liver cellsare used for a while as incubators until they rupture,perhaps—as I used to imagine when I studied tropicalmedicine in London a decade ago—under the shock ofbeing defined by the bristly word ‘schizont’, sendingthousands of invading, and equally bristly merozoites(the first asexual stage) into the circulation. There theygo out like preachers and settle in naive young redcells, develop into female or male sexual cells, andwait for an obliging second mosquito to come andairlift them from the scene of their successful coup.This red cell stage causes the periodic fever that comeswith malaria, and each species (there are four inhumans) has its own pattern of febrile paroxysm. Theprime method of diagnosing malaria hasn’t changedsince the salad days of empire, and relies onmicroscopic identification of the Plasmodium parasitesin thick and thin blood films. Recent attempts todevelop simple dipstick serological assays have runinto problems of either cost or lack of specificity,although one method based on a soluble proteinantigen of P. falciparum was able to detect evidence ofinfection in a four-thousand-year-old Egyptianmummy. Moreover, hopes of a vaccine against P.falciparum, such as the SPf66 synthetic peptide whichincorporates various merozoite proteins and was testedrecently in children in Columbia, keep running upagainst evolutionary paradigms; namely, the capacityof the protozoon to modify its internal proteins through

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natural selection quicker than we can invent ways ofstopping those proteins from getting fresh with bloodcells. In tacit recognition of which, a sequence tag mapof the P. falciparum genome is now being constructedso that potential targets for drugs and vaccines can beidentified.

One version of the evolutionary paradigm runs likethis: once humans migrated from the savannah to moistplaces where they could do their laundry and drinkwater out of old tin cans, and Plasmodium reached anunderstanding with its host in terms of populationinfection rates, an amazing number of people turned upat the local Happy Africa Family clinic with itscorrugated tin facade and undressed concrete walls andwere found to have evidence of sickle cell disease andfoetal haemoglobin in theirveins. Sickle cell disease isn’t that common generally,but heterozygotes—people with one copy of a normalhaemoglobin gene and one copy of an abnormal sickle-cell gene—can be found in their thousands in WestAfrica. Selection in the human population retains theabnormal gene since it prevents the parasite gainingready admission to the red cells. On the other hand,natural selection, being entirely indiscriminate as far asgenetic base-pairs go, works on the parasitepopulations too: chloroquine resistance was firstreported in South America in 1961 and has since beenobserved in nearly all endemic areas. Vaccines aren’tlikely to be more successful, unless they can anticipatenew antigenic configurations before they happen. Anytalk of eradicating malaria is, in the long view of theevolutionist, a pipe-dream: such gorgeously coloured

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bubbles might have blown from Geneva not so manyyears ago, but enough to give the impression that anepoch has lapsed in terms of optimism. In 1995, 2.1million people died of malaria across the world.

Once, and not so long ago, parasitology itself seemedto exist only as a vector for the export of optimism tothe Third World. Nowadays, tropical medicine booksare more correctly called manuals to the diseases ofwarm climates, since it would be an error (and one Ihave fostered entirely to my own ends in this essay) tosuppose that the effects of disease are due solely toparasites: poverty is the most important risk factor formorbidity around the equatorial belt, and is likely tobecome even more so in this century. Parasitism itselfis a condition of the rural poor, not of city-dwellers,which is why people in the know (likeepidemiologists) refer on the one hand to the nowlargely defunct discipline of tropical medicine, whichwas an invention of British, French and Belgiancolonial policy at the end of the nineteenth century,notably the period of Joseph Chamberlain’sstewardship of the colonies, and to medicine in thetropics. In fact, the fastest growing diseases in thetropics these days are commonplace ‘western’conditions: hypertension, ischaemic heart disease andnon-insulin-dependent diabetes.

Whatever the claim these three diseases have on ourattention, and most doctors know them like the back oftheir hand, malaria is a good example of evolution inaction, and shows why the word ‘natural’ in natural

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selection sometimes seems a bit forced. This is the firstquality of parasites to be held against them: theirability to hitch rides and squeeze through loopholesand generally take credit for being hangers-on; inshort, their opportunism. The very dynamism ofevolution seems to depend on sameness at one removefrom itself.

Anopheline mosquitoes also transmit filiariasis, whichis an infection caused by long slender worms.Wuchereria bancrofti is one family of these filarialworms: they tend to be about 4–6 cm long, home in onthe tubes and ductules of the human lymphatic system,and can live there quite snugly for a decade or two. Ina mild infection, it’s possible for male and female tospend the rest of their life unsuccessfully trying to findeach other in the body’s sluice pipes and sumps andend up not producing any baby worms at all. Unliketheir parents, immature worms (microfilariae) preferthe small blood vessels of the lungs where they hole upduring the day and emerge into the general circulationat night, with rush hour between 10 at night and 2 inthe morning, in the hope that a visiting mosquito mightvacuum them in with the rest of its blood-meal. (Aswith malaria, the female anopheline mosquito may ofcourse deposit the infective larvae while feeding.) Thatthis tidal phenomenon should occur at all isremarkable, since it posits an ability on the part of thefilariae to read the human host’s circadian clock whilebanking on the regularity of female mosquitoes. Infact, there are two periodic forms of W. bancrofti: onewhich comes out at night, the nocturnally periodicform, and is transmitted by night-biting mosquitoes;

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the other a diurnally subperiodic form, which istransmitted by Aedes mosquitoes in the Pacific thatprefer to bite by day. Since infected people living inthe Nicobar Islands in the bay of Bengal have daytimetidal infections in a region where they should havenighttime (the nocturnal form is prevalent in most ofAsia), ethnologists have hypothesised that their great-grandparents originally migrated westwards across thesea from south-east Asia, not long enough ago thoughfor natural selection to have reset the worm clocks. Orfor the disease to have died out in the Nicobar Islandsfor that matter.

In filariasis, it’s usually the body’s urge to show off itsimmunological arsenal which causes symptoms ofdisease, rather than worms lurking about in therecesses of the lungs or lymphatics.Often the only index of parasitic infection (of anyparasitic infection) is a high count of some specialisedwhite blood cells called eosinophils. Eosinophils arepart of the cell-mediated response; they containgranules of toxic proteins and chemicals and regulateother defence cells. At a local level, cell-mediatedresponse is rapidly followed by antibody production inthe upstream lymphatic ducts. If this kind ofimmunological war gets under way, neither side reallywins: the lymphatic system clogs up with scar tissue,calcified worm parts and a jungle of obliteratingfibrosis—and the outside landscape changes.Lymphoedema may follow the initial attack on thelymphatics: deposition of collagen and secondaryinfection gives rise to the infamous swelling conditionknown as elephantiasis. This used to compel

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unfortunate older gentlemen in the South Seas totransport their varicose testicles down to market in awheelbarrow while hoping that nobody would mistakethem for a pawpaw.

This is the second quality of parasites: theirperiodicity; that is, their ability to rebound on us likeinherited and derivative modes of thinking.

Guinea worm (Dracunculus medinensis) is another,more spectacular parasitic worm, transmitted in larvalform by a fresh-water crustacean called Cyclops.Dracunculus is big enough to see. In fact, the adultfemale is as big as a knitting needle. It occurs mainlyin the rain forests and swamp areas of West Africa, andlives by vagabonding around the body’s connectivetissues. After mating, the male is absorbed by thefemale. Unlucky patients sometimes catch sight of onecrossing the tissues beneath the skin without so muchas a by-your-leave, but generally the adult femalesdraw attention to themselves only once their uterusgets bulky. At this point they become geotropic, that isthey make a break for Mother Earth by the shortestpossible route. That means if Dracunculus is in theabdominal tissues it heads for the genitals, if in thearms the fingers, and so on. Usually it pokes out justbehind the ankle. Since the host has just woken up witha bleb on his skin where he didn’t have one before, henot unnaturally tries to soothe his sore foot by bathingit in water. Whereupon the worm’s head emerges,sticks out a clear tube (its uterus, where nobody but anentomologist would expect it) and discharges a cloudy

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jism into the water. The guinea worm is packed withsome three million embryos,and even a sniff of water is enough to cause its graviduterus to contract peristaltically, thereby expelling thehuge genetic load in a few moments. Once in thewater, the larvae get siphoned in by Cyclops and moultin its body cavity. Man drinks water, and the cyclebegins anew. The Scottish poet Hugh MacDiarmidfound this parasitic simile so appealing he instancedthe guinea worm’s uterine prolapse in his late poem Toa Friend and Fellow-Poet as an odd naturalistic tropefor his own repeated acts of cultural kamikaze:

Is it not precisely thus we poets deliver our store,

Our whole being the instrument of our suicidal art,

And by the skin of our teeth ‘flype’ ourselves intofame?

Life goes on though, at least in West Africa, as ifunpleasant things like guinea worms were merely aminor irritation: the traditional method of removingone from the view of fascinated relatives is to wrap itshead around a matchstick and wind it a bit more everyday until the whole worm is out. It sounds a bit likeremoving a shoelace which has embedded itselfinadvertently in your foot, except that the people itaffects hardly ever wear shoes and if they did, mostlikely wouldn’t need to remove worms from their feet.I used to think the medical emblem of a snake coiledaround Asclepius’ staff (two snakes around Hermes’peace-restoring caduceus) was a tribute to the ability of

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snakes to regenerate their skin (and, by analogy, ofmedicine to heal the sick); it may simply be a verystylised guinea worm or two twisted around a splinterof balsa wood.

That is the third quality of parasites, and the one werecoil from with the most baroque shudder of all: theirlack of scruple in taking advantage of human nature.No matter how outlandish (and it seems the freakierthe better) they worm their way into our most hallowedinstitutions and freshly scrubbed ideas; and I haven’teven mentioned the figurative possibilities of linguisticcontagions like bilharzia, cestodes, jiggers and liverrot.

Clearly the systems relations of the parasitologist arefar from politically neutral. Parasites need people, butwhat do people gain from parasites, the one-sideddefinition of the Cambridge Encyclopedia of Evolutionnotwithstanding? A flyped metaphor, I suppose, is theanswer; a word safely anchored in literal truth thatspills out into the illimitable. Yet metaphors can vitiatewhat they sustain. It is surprising that a philosopher assensitive to language as Nietzsche would come up withthe suggestion that ‘no thinker hitherto has had thecourage to measure the health of a society or ofindividuals by the number of parasites they canwithstand’ (Daybreak), as if such a compromisingmetaphor could serve as any kind of measure of publicor individual ‘health’. But he did; and to those of ussensitised to biological metaphors, the twentiethcentury seems like a long catalogue of terriblelinguistic category errors, with one unscrupulous

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demagogue after another finding there is no limit towhat can done with a vocabulary that takes its ordersfrom Nature. Being at the bottom of the pile, ‘parasite’is the hierarchical order term par excellence. In thehunt for affinities in a world where solid things keepmelting into air, parasites reveal how irresistiblyreflexivity colonizes not just our bodies and theproduction chain, but even our language. ‘Onlyparasites tremble / On the edge of the future’, wrote theRussian poet Osip Mandelstam in his 1923 poem ‘MyEra’. And so it proved: ‘parasites’ was the termfavoured by the Soviet tribunals to stigmatise poets,especially when they sentenced them to hard labour.

Clearly parasites provide fantastically contrivedmechanisms for avoiding the obvious, methods ofburrowing deep into the architecture of humanreasoning and laying blisters of dissent inside the bodypolitic, there to trigger new ways of fear and loathing.Miroslav Holub, the Czech immunologist-poet, hasthis menacing close to his poem ‘Parasite’: ‘for yearsthe eruption will die away / and little spores ofimbecile agreement / will bore into granite and waitthere / like wet dynamite.’ In essence, the word‘parasite’ is itself metonymic for everything we don’tlike about everybody else. And, as a corollary, ofreinforcing just how sure we are about the inestimableadvantage of being ourselves. Of being proper. Justthink about it: within ten hours of being born anddeposited on the planet, pioneering streptococci havecolonised babies’ mouths, soon to be followed byenterococci, actinomycetes, candida, lactobacilli andother ecological golddiggers. That’s what happens

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when children can’t keep their mouths shut. Indeedthat’s what happens in general to human beings, whocan’t stop speaking in the same place where theyeat—not my words, not yours, buteverybody’s. Then again, as that now deeplyunfashionable poet Brecht once noticed in his poem‘On Thinking about Hell’, the fear of being thrown onthe street wears down the owners of villas no less thanthe denizens of shanty towns. Having guests, beinghospitable and convivial, showing concern for others’welfare: these were the first linguistic codes of thehuman community, a first recognition thatwe—creatures of the natural world—love and hate in asymbolic one.

In reality, we are extravagant hosts. While writing thispiece I was drawn up short to find out (as a response toNietzsche’s rhetorical challenge) just how laden weare: the average adult human is composed of about1014 cells, only ten percent of which are ‘human’. Allnucleated cells, which accounts for a good deal of oursubstantial being, are basically colonies of symbioticbacteria. And not only that, but we share most of ourDNA with almost everything in the universe, includingfungi and yeasts. That makes us nothing short oftravelling zoos. How much courage does it take to be azoo? We’ll never know. But let me seed a virtualparasite myself: thinking we can live closer to Natureby following the Victorian creed of applied Darwinismor even imaging we can get by without greeting theneighbours has a price: exclude the symbolic, and youget its dread extruded form, the diabolectic.

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Endnotes

A Taste of Bitter Almonds

[British Journal of General Practice, 2010]

Joseph Joubert’s remark that ‘those who have kepttheir personality are always enchanted by that of otherpeople, even if in opposition to their own’ mightalmost have been intended for Stendhal. Stendhalpreserved himself by being witty. But he didn’t acquirewit until he was middle-aged, at about the same time ashe—a provincial and Italophile—started to esteemParis. ‘That way of improvising with a tranquil mindonly came to me in 1827’, he confesses.

The Plastinator

[London Review of Books, 2000]

Given Professor Günther (von) Hagens’ partiality forpastiche, it is just as well he hasn’t come across theparallel scenes in Curzio Malaparte’s war novel TheSkin (1949), in which two men are rolled over bytanks, one a persecuted Jew in the Ukraine, the otheran Italian celebrating the arrival of American forces inRome. All that is left of them is ‘a skin in the shape ofa man’, which in the latter case is waved by colleaguesas a flag.

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I was gratified to see that my argument againstHagens’ spurious defence of his showmanship as a‘democratisation’ of anatomy received unrelatedsupport in Susan Mattern’s recent life of Galen ThePrince of Medicine (2013). ‘Anatomy is a cumulativescience’, she writes. ‘One cannot simply cut up acorpse and find meaning in its inner structures withoutknowing what to look for.’ Incidentally, AustinGresham, forensic histopathologist and author of theColour Atlas of Forensic Pathology (1975), was notimpressed that his manual ‘of every conceivable wayto get to the mortuary’, as the artist Mat Collishaw hasdescribed it, inspired some of the more controversialexhibits of the Britart pack, including Collishaw’s own‘Bullet Hole’ and Damien Hirst’s notorious shark informaldehyde. He believed the dead should be treatedwith that old-time concept, dignity.

It is curious that this year the first public dissections inthe United Kingdom resumed after a period of 170years (for the sum of £100 members of the public canattend a series of dissectionworkshops run by the University of Edinburgh to ‘seeunder the skin and gain an understanding of how[their] body works’), even as many medical studentsnow learn what they know about body structure fromcomputer simulations that spare them gross anatomy’srite of passage.

Knock! Knock!

[Medical Humanities, 2002]

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Jules Romains’ play Knock ou Le Triomphe de laMédecine (1924) is taught in French schools, andgenerally very well known in its country of origin. Ihad the crazy idea fifteen years ago of translating theplay and offering it to the BBC (or anyone else whomight take it) in the hope that the film, which stars theconsummate Louis Jouvet, might be broadcast in theoriginal French with my script doing service assubtitles; and if not nationwide, then as an ethicsprimer for medical students. Unfortunately I wasunable to interest anyone in the script, in spite of itsobvious relevance in an era of ‘more medicine canonly be better medicine’, and the manuscript is slowlyyellowing in a drawer somewhere.

In a rather overheated commentary on the play in hismemoir Témoignages sur le théâtre (1952), Jouvetuses the term ‘idée-force’, which I take to be a Frenchimport from German phenomenology (‘Zweckidee’): Ihave accordingly translated it as ‘guiding concept’.The Coué method namechecked in the essay was verypopular in the United States for a time, beingmentioned by Ferdinand, in Céline’s classic novelVoyage au bout de la nuit (1922) when the Americangirl Lola accuses him of ‘doing harm’ by telling herthat her mother’s liver cancer is incurable: ‘In herdespair I sniffed vestiges of the Coué method.’ Eventhen in the New World, all news had to be good news.

A Conspiracy of Good Intentions

[British Journal of General Practice, 2005]

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The alleged partiality of ethicists has been furtherexplored by Carl Elliott in his book White Coat, BlackHat: Adventures on the Dark Side of Medicine (2010)and David Healy in Pharmageddon (2013), whichdetail just how completely medicine has been absorbedinto the ‘health care’ priorities of large-scaleenterprise. Many bioethicists work now as paidconsultants to pharmaceutical companies,just as half of all anthropology graduates find jobs inindustry.

What is sinister about the extraordinary (empathic)explosion of ‘depression’ as a diagnostic category isthat it has become a basket diagnosis for thedemoralisation that consumer society brings,inevitably, in its wake. In the pharmaceutical paradigmwhich now prevails, patients are obliged to take,sometimes for years, the antidepressants whichdoctors, beholden to their employer (i.e. thegovernment), are compelled by their checklists andprotocols to prescribe. Only economists will ever beable to make productive sense of it.

Insomnia (in the Bed of Being)

[PN Review, 2013]

‘The greatest thing one man can do for another,’ wroteKierkegaard, ‘insofar as each individual has to dealonly with himself, is to leave him disquieted.’ To beinsomniac is to be haunted by thoughts that won’tsettle, and everything suggests that this has been thecommon fate of mortals since what the French call ‘la

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nuit des temps’—when Being was anything but tuckedup cosily in bed. To suffer insomnia is to experiencethe body as a complete stranger who refusesobstinately to do our bidding. Indeed, insomnia may beanother expression for the wound that doesn’t close, asin Kafka’s unsettling story about the country doctor(‘Uncle Siegfried’).

An American Book of the Dead

[PN Review, 1997, as ‘Man in Black, a review ofThomas Lynch’s memoir The Undertaking: LifeStudies from the Dismal Trade’]

I almost surprised myself at the amount of sympathy Iwas able to muster for Thomas Lynch, running hisfather’s funeral home in order to make ends meet. Butthen I was running a medical practice in Strasbourgstrictly as a business at the time, with none of thefinancial cushion provided by the NHS: the issue ofasking for payment directly from patients, whethersuffering or not, was a challenge for me in ways Ihadn’t expected. Some of the predicaments aired inLynch’s book received even more emphatic treatmentin the long-running HBO television drama Six FeetUnder, which follows events in an entire family ofundertakers in Los Angeles over five years. It is oftenrated as one of the best TVseries ever. Its creator Alan Ball attests: ‘the books Ifound most helpful were The Undertaking: Life Studiesfrom the Dismal Trade and Bodies in Motion and atRest: On Metaphor and Mortality, both by Thomas

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Lynch, a funeral director and poet, and a brilliant,soulful writer’.

Crise de Foie

[Süddeutsche Zeitung, 2000, as ‘Der majestätischeRang der Leber: die Franzosen und ihre Crise de Foie’]

The prominence of the liver in French medicine datesto the premodern period, and the battle waged by thedogmatic Galenist and ultraconservative member ofthe Paris faculty Jean Riolan the Younger (1580–1657)against William Harvey’s new doctrine of thecirculation, which he correctly saw as questioning notonly the pre-eminence of the liver as the blood-makingorgan but also fatally undermining the authority of hisfaculty and Galenic therapeutics in general. If the sameblood was circulating indifferently throughout thebody why should novice-doctors have to learn bleedingpoints? Why bleed patients at all? It was Descartes, anamateur dissector, who really saw the point ofHarvey’s new doctrine and enlisted it for hisgroundbreaking Discours sur la méthode (1637).

Some of the issues around ‘mal de foie’ are explainedin Colette Mechin, ‘Le foie, organe tropique dans lasociété traditionnelle française’, in the book Usageculturels du corps (1997). The (notorious) referenceabout what to do after the orgy is from JeanBaudrillard’s La Transparence du Mal (1990). EvenKarl Marx recognised the effects of liverishness on hiswriting style, explaining in a letter of 1858 to hispublisher Ferdinand Lassalle that his difficulty in

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delivering the final manuscript of his thesis on capitalwas due to efforts to ensure that ‘the thing shouldn’t bedisfigured by the kind of heavy, wooden style properto a disordered liver…’

The Moral Life of Happiness

[Quadrant, 2005, as ‘The Homeostatics of Happiness,a review of Ziyad Marar’s The Happiness Paradox andCarl Elliott’s Better than Well’]

Flaubert had a withering aside about the nineteenth-century search for happiness: ‘To be stupid, egoisticand in good health,those are the three conditions required in order to behappy. But if you lack the first everything is lost.’There have been scores of books since the turn of themillennium about the nature of happiness (and how toattain it); even governments haven’t shied away fromadopting it as an aspect of policy. Surely one of thewiser things written about the fabled state came fromJohn Stuart Mill in 1873: ‘those only are happy (Ithought) who have their minds fixed on some objectother than their own happiness. Aiming thus atsomething else they find happiness along the way.’ Itis adventitious. I can even remember people who usedto be happy helping others. And perhaps the truth issimpler and shier still: happiness abhors analysis.

An Empty Plot

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[London Review of Books, 2001, as ‘Then It’s YourWhole Life, an essay-review of Emmanuel Carrère’snovel The Adversary’]

In his various novels, Emmanuel Carrère has exploredthe condition of what he calls ‘Uchronie’—aneologism that clearly derives from the concept ofutopia. In English, this ‘time out of mind’ is betterknown in its different guises as the counterfactualnovel or the ‘what if’ retelling of alternative history.Carrère teeters on the edge of an abyss, playing theanalyst’s role of non-person to perfection, butsometimes forgetting that his subject is himself a non-person: a man who turns himself into a moral paragon,lies about himself exorbitantly for eighteen years, andthen murders his extended family when the truthemerges (as it was bound to do). This story gripped mewhen I read it, because I could see how the bordersituation in which I was living lent itself to this kind ofmoral duplicity, and raised troubling questions aboutthe self-determining modern individual, the egoismthat has no self behind it. Romand’s ‘integrity’ is thatof an empty husk.

Chekhov Goes to Sakhalin

[British Journal of General Practice, 2001, as ‘PagesBlank as Tundra, a contribution to a special issue ondeprivation in health care’]

The motives for Chekhov’s journey to Sakhalin arestill something of a mystery. Perhaps it was, as theFrench might say, an ‘antipsychanalyse’—James Joyce

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suggested in Ulysses that some people would ratherslog it to the ends of the earth than peerinwards. For a writer as insightful and articulate asChekhov his ‘fugue’ eastwards was surely propelledless by any scepticism about the introspected self thanhis interest in the variety of the world: conditions in apenal colony were as worthy of note as a cherryorchard on the outskirts of Moscow. The trip toSakhalin is an almost luridly dramatic insert in the lifeof a chronically unwell writer who introduced a note ofsophisticated inconclusiveness and indirection intoliterature that is present everywhere today.

My quotes are from the excellent translation ofChekhov’s report by Brian Reeve, which waspublished by a small press in Cambridge in 1993; analterative (American) version is also in existence. Ialso relied on Donald Rayfield’s classic biography(1997) and Janet Malcolm’s insightful ReadingChekhov: A Critical Journey (2001).

Uncle Siegfried

[Medical Humanities, 2000]

‘Where is the doctor? I’m searching the letter withoutreading it just to find the doctor. Where is he?’ Thatwas Kafka, writing in one of his insistent letters toMilena Jesenská during their brief if intenserelationship. If ‘cherchez la femme’ was the motiveintroduced into French fiction by Alexandre Dumas,suggesting that the reason for a man’s inexplicableactions was that he is either trying to cover up an affair

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or curry favour with a woman, then Kafka’s bright ideamight be said to be ‘den Arzt suchen’. Kafka had littlefaith in what the Germans call ‘school medicine’ andits obsession with ‘monocausal’ explanations (still aprominent feature of contemporary evidence-basedmedicine), and he was especially impatient withdoctors—and he consulted a lot of them in hisrelatively short life—who contradicted each other. Onthe other hand he showed great respect for one or twofigures, including his friend Robert Klopstock, whomhe called a ‘born doctor’ and who supported him in hisfinal illness.

Is There Life on Earth?

[Parnassus, 1998]

ICD-10 is the 10th revision of the InternationalStatistical Classification of Diseases and RelatedHealth Problems, a coding register set up by the WorldHealth Organization, which containsalmost 14,500 codes for signs, symptoms, findings,complaints, social circumstances, and external causesof injury or diseases. I have translated discharge letters(from the German) where doctors, rather than supplydiagnoses, simply list ICD codes, a procedure thatdisturbed me when I first encountered it.Standardisation is an important aspect of modernity,but in this case it seemed doctors were actuallyconniving to reorganise the profession under arationality that has little to do with the uncertaintiesthat dominate the doctor-patient encounter and morewith output, productivity and medicine-as-industry.

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The pressure to do this of course comes from thepaymaster, in this case Germany’s statutory healthinsurance funds.

This came home with even more force when my wife,who worked for a while as a district nurse in theOrtenau region of Baden told me about her rounds: inher car she carried a folder that held about a dozenlaminates with bar-codes at the bottom of each page.After every visit to a patient, she had to key in thepatient’s details and relay information to a centraldatabank about the nursing tasks she had justperformed by scanning the applicable bar-code with ahand-held scanner. On the last page was a standalonecode titled ‘Menschliches Handeln’—a roughtranslation of which might be ‘humane acts’. This wasmeant to cover time spent with the patient that couldn’tbe accounted for as a nursing procedure: askingpatients about the weather or their grandchildren, forinstance, or merely how they were feeling. It waslimited to ten minutes.

Tell Me about Teeth

[unpublished, 2015]

In the same week as writing this, I read about poorerBritish people performing ‘DIY dentistry’ with kitsavailable on the high street because of their inability toafford dental care, while cosmetic dentistry registered arecord turnover in 2014 of almost one billion poundssterling, suggesting that parts of the UK may bemoving towards neo-Victorian conditions of dental

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distress while other parts embrace the Americanfixation on perfect teeth.

I ought, besides, to admit a trifle guiltily that theacclaimed contemporary novel The YacoubianBuilding was written by the Egyptian dentist Alaa ElAswany, and had I tried harder wouldsurely have come across other writers who happen toearn their living as dentists. Indeed, dentist-writersmight be able to provide a few lessons in modesty fordoctor-writers all too ready to vaunt themselves asparagons of all the virtues.

Hygiene of the Soul

[Quadrant, 2012]

In view of what Brecht said about the smelliness ofhomo sapiens, it is noteworthy that when his reputationwas ‘assassinated’, thirty years after his death, in abook that detailed his covert homosexuality,exploitation of women (some of whom were supposedto have written his plays), love of money and politicalshiftiness, the killer stroke was delivered by those whoremember him as being a particularly smelly man, animpression no doubt intensified by those cheapkrumme Hunde cigars he liked to smoke.

Some curious recent research at the University ofChicago (McClintock and Pinto) has shown aninteresting correlation between anosmia (loss of smell)and mortality. It would seem that not being able tosmell is ‘the canary in the coal mine of human health’:

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it is not that loss of smell leads to death, it may be thatloss of turnover of olfactory cells indicates a loss ofregenerative potential elsewhere in the body.

The Importance of Being an Agoraphobe

[Times Literary Supplement, 2001]

It is perhaps slightly impertinent to end this ‘obit’ of adistinguished medical scientist on a note from FrancisBacon, who seems to have been utilitarian avant lalettre and might have disapproved of the virtuosocuriosity displayed by Petr Skrabanek, but modernsociety seems to be caught in the jaws of an onlyseemingly paradoxical question: how reasonable is it tobe rational? In other words, where do human curiosityand ingenuity tip over into science as mere mechanismand technique? ‘Natural science gives us an answer tothe question of what we must do if we wish to masterlife technically’, wrote Max Weber, the great Germansociologist. ‘It leaves quite aside, or assumes for itspurposes, whether we should and do wish to masterlife technically and whether it ultimately makes senseto do so.’

The Human Position

[PN Review, 1997, as ‘The Human Position: An Essayon Technology and Suffering’]

More recently I read Pascal Quignard’s Lesdesarçonnés, the seventh volume of his Last Kingdomseries, and yet another book in which he combines

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aphorism, philosophical excursus, observation andnovelistic fragment. His book is a meditation on whatit means to fall, specifically out of the saddle. For thatis the meaning of the verb desarçonner: to be unseatedfrom the arçon, an old French word for the saddle tree.Trees and forests have supplied humans withprimordial metaphors for notions of continuity andstructure: there is the Tree of Life, and also the familytree; and there is the saddle tree, which at one point inhuman history offered a man a seat as high as he couldget in the world. Now, in an age when everyone is apedestrian (or cocooned in his car), the posture of aman on his high horse seems slightly ridiculous.

Nevertheless, Montaigne wrote that if he were allowedto choose, he would ‘prefer to die in the saddle ratherthan in [his] bed, away from home and far from hisfolk’. (‘On vanity’.) He had several experiences duringhis life of falling from his horse, one of them almostfatal. Quignard—no doubt thinking of Saul on the roadto Damascus and his redressment after his episode ofpostural hypotension as Paul—is fascinated by thecentral role played by this experience of falling from ahorse: he offers the expression être desarçonné as ahumbler synonym for the experience of depression.

The philosopher Friedrich Nietzsche, who rode horsesin his writings and imagined he was a centaur, saw apainting of a horse by Van Dyck that made him happy,but lost his mind when he saw the actual misery of amaltreated drayhorse in a Turin street.

Emergent Properties

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[Quadrant, essay-review of Simon Winchester’sbiography Joseph Needham and the writing of Scienceand Civilisation in China, 2009] Many of the‘characters’ who emerged in British intellectual lifearound the Second World War—Ludwig Wittgensteinand Isaiah Berlin to name another two—wouldn’t getanywhere near a professorship today; and I suspectNeedham, with his dramatic switch from embryologyto sinology would be treated with disdain too. As theMaster said: ‘A man who can study for three yearswithout giving a thought to his career is hard to find.’(Confucius, Analect 8.12.) Much of this has to do withthe ‘professionalisation’ of the academy, in whichmodes of thought have been condensed into atechnique (or, worse, a mode of rhetoric), and littlecredence is given to originality or what used to becalled ‘amateurism’. Needham, for all his brilliance(and he is one of the few western scholars honoured bythe Chinese), had something of the perpetualadolescent about him. Yet it may well be that theopenness of adolescence is as close a quality as wehave in our society to universality.

A Mining Town in Australia

[PN Review, 1998 as ‘A Letter from Australia’]

The all-enveloping boredom of outbackAustralia—where the immensity is so enormous andthe horizon the same in every direction (a kind ofabyss laid out flat)—is such as to take on ametaphysical dimension. The traveller might think to

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find there the ennui that Blaise Pascal thought was thecondition proper to staying in one’s room.

In fact, outback Australia is full of enterprisingcharacters and a grittiness of truly surrealistic appeal,quite aside from the animal life. For fully five yearsafter returning to Europe from Broken Hill, I hadregular dreams of living in the town again; my wifeand I are still in touch with friends we made during ouryear there. That said, Broken Hill was thequintessential Australian ‘company town’, with asingle large employer able to hire and fire at will anddespoil large tracts of the town, especially in the lee ofthe lead tailings.

I ought to add that had I had sufficient resilience tobattle it out more directly with the forces changing theprofession I wouldn’t have written this book.

Lamplighters and Lucefactors

[PN Review, 1996, as a review of John Carey’santhology The Faber Book of Science]

The genial Paul Dirac (1902–1984), one of the keytheorists of quantum mechanics and creator of anentirely new physical field theory which predicted theexistence, in 1931, of antimatter, criticised RobertOppenheimer for his interest in poetry. ‘The aimof science is to make difficult things understandable ina simpler way; the aim of poetry is to state simplethings in an incomprehensible way. The two areincompatible.’ (Kragh, Dirac: A Scientific Biography,

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1990). Dirac’s quip aside, we seem to have a powerfulneed to describe and interpret human functions in theterms of our inventions which take their place, andthose tools in terms of the human functions that theyreplace. This used to be solely the domain ofimaginative writers, but now scientists commonlyindulge in acts of metaphoric transference, suggestingthat not just body parts have machine-like qualities butthe mind itself. This is not an innocent procedure, butone laden with consequences, as Raymond Tallis, forone, has shown in his many books.

Machine Made of Words

[British Medical Journal, 1998, as ‘BiomedicalTranslation; and The Linguist, 1998, as ‘TranscodingTechnical ‘Babble’’]

Michel Serres in Eclaircissements, his interview bookwith Bruno Latour, adds: ‘May I point out that each ofmy books describes a relationship, often expressed bya sole preposition? Inter-ference, for the spaces andtimes that are between; communication or contract forthe relation expressed by the preposition with;translation for across; the para-site for beside… andso on. Statues is my counterbook and asks thequestion: What happens in the absence of relations?’Serres sees it as his lifework to devise the ‘maritimemap’ of these ‘spaces and times that precede any thesis(meaning position)’.

In her book English: Meaning and Culture (2006)Anna Wierzbicka provides a fascinating account of

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how specifically English-bound ‘fairness’ is: far frombeing a universal it is a unique creation of the culturethat also associates coolheadedness withreasonableness, both of them questionable assumptionsfor many other cultures and languages.

And the famously gloomy French essayist andchronicler E. M. Cioran put in a good word fortranslators in Aveux: ‘I have known obtuse writers,even stupid ones. One the other hand, the translators Ihave managed to approach were more intelligent, andmore interesting that the authors they translated. Afterall, it takes more reflection to translate than “tocreate”.’

The Poison Tree

[Quadrant, 2014, as ‘The Upas Tree’]

This essay, which ventures from Glasgow to Norilskvia Ambon, offers a glimpse of my more recentactivity as a primary health care consultant in south-east Asia. There is almost no trace of Rumphius onAmbon, which I visited in 2014, other than his tomband the forbidding hulks of some of the Dutch fortsthat provided protection for the assets of his employer,the Dutch East India Company (VOC). Somehow, inspite of its lengthy gothic shadow, the upas tree, whichgave me my title, has vanished from the romanticherbarium. Three centuries after his death, most ofRumphius’ work has finally appeared in Englishthanks to the heroic endeavours of the late ProfessorBeekman following his retirement from the University

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of Massachusetts, and the sponsorship of YaleUniversity Press. There are some attentive referencesto Rumphius’ presence on Ambon in the distinguishedDutch novel by Maria Dermoût, published in Englishas The Ten Thousand Things (De Tienduizend Dingen,1958).

Stendhal’s Syndrome

[British Journal of General Practice, 2010]

According to one medical journal which tookStendhal’s syndrome more at face value than I do here,travelling is a ‘concentrate of stressors’: psychoticdisorders are apparently at cause in ten to twentypercent of tourists requiring medical evacuation. Forthose who prefer their voyaging in the armchairStendhal is a boon travelling companion, not least theaccount of the trip he made around the Midi in1837–38 and published as Mémoires d’un Touriste: heclaimed it was a book for the provincial ‘who still doesnot know that everything is life is a comedy’. Theanecdote in ‘A Taste of Bitter Almonds’ came from itspages.

Aqueous ammonium carbonate—sal volatile, orsmelling salts—was widely used in Victorian times,and is still used in some sports, to arouseconsciousness. I remember a rather stiff teacher at myprimary school who surreptitiously took out her littlebottle from a breast-pocket and sniffed on it wheneverher class of beastly eight-year-olds had become toomuch for her.

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The War of Eye and Ear

[The Lancet, 2002, as a filler; and PN Review 2008, asan expanded essay, ‘On the Senses as PerceptualSystems’]

It should be said that Aristotle, in contrast to Plato,doubted that our eyes emitted anything at all,surmising that they passively receive the radiation ofvisible objects: this is the intromission theory of vision.It took Emmanuel Kant to revive extramission, but inthe form of projected mental images of the empiricalworld.

It was only when I finished this article that I realised Ihad written a variant on the classic Athens versusJerusalem essay on the origins of Europeancivilisation. In the story of the burning bush, Mosesshields his eyes so as not to catch sight of God’s face:in refusing sight, he begins to hear the voice. And thisnotion of figural emptiness as a recipient for divineinstruction never leaves Western civilisation: Hegel’sphilosophy is essentially an instruction for us tobecome, ontologically, enemies or at least aliens toourselves.

The obsession with sight and sightedness is by nomeans limited to the sciences. The avant-garde artistand Bauhaus theorist László Moholy-Nagy talkedabout ‘the hygiene of the optical’, and suggested thatcreative use of the camera would, by cleansing visionand educating the subconscious, make amends for thedepredations of capitalism. By contrast, Emmanuel

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Levinas’ phenomenology gave primacy to the ear overthe eye; he also attributed expressivity to the face,which could ‘speak’ before the mouth opened. In a latepoem, Paul Celan expresses most concisely theattention to the other person that I was trying toadvocate. ‘…hör dich ein / mit dem Mund.’ (Listen in /with your mouth.)

If anything, these days, it’s not just that doctors don’thave the time to listen properly to their patients; theydon’t touch them much either. Machines do thediagnostic work so much more expeditiously.

Under the Magic Mountain

[Lapham’s Quarterly, 2009, as ‘Course of Illness: AReappraisal of Thomas Mann’s The Magic Mountain’]

In her book of recollections Meine ungeschriebenenMemoiren (1974) Thomas Mann’s wife Katia raisedthe possibility that the ill-defined health problem thathad afflicted her after the birth of her fourthchild (she had six children altogether) and led herMunich doctors to send her for months at a time tovarious fashionable retreats in the Swissvalleys—which included Dr Friedrich Jessen’sWaldsanatorium in Davos—might ‘have cleared up ofitself’.

Or perhaps she had never had ‘incipient’ TB in the firstplace? Four years before she published her memoir, alung specialist, Professor Christian Virchow, hadlooked at the well-preserved X-ray films from 1912

424

and told her that for all his ‘intensive study there wasno finding to suggest incipient tuberculosis’. In theirbiography Frau Thomas Mann (2003) Inge and WalterJens reveal that Katia Mann wouldn’t countenance anytalk of a diagnostic error—‘implying of course thatThe Magic Mountain novel would in significant partshave been based on a medical mistake’.

Whether a mistake or not, it doesn’t in the least detractfrom the novel, which at one level explores all thepossibilities of human wilfulness and perversity, andnot always those generated by ‘illnesses’. Germandoctors don’t contradict their rich patients who haveprivate insurance today, quite the reverse; and there isno reason to imagine they did in the 1910s either. Asarcastic letter-writer once termed this ‘opulence-based’ medicine.

Katia Mann died in 1980, aged ninety-seven.

The Life and Times of Ernst Weiss

[Times Literary Supplement, 2010, essay-review ofErnst Weiss’ novel Georg Letham: Arzt und Mörder,translated by Joel Rotenberg]

I have written about Ernst Weiss elsewhere, and therather sensationalist account of Hitler’s ‘conversionexperience’ under hypnosis in 1918 as described in hisnovel The Eyewitness (1963). It has to be said that forwant of reliable documentary testimony this episodereceives only glancing mention in the majorbiographies, although Hitler seems to refer to it himself

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in Mein Kampf. Whatever happened in Dr Forster’sBrandenburg clinic, the Führer’s behaviour was moreobviously influenced by another physician entirely: his‘Leibarzt’ or personal physician, the shadowy TheodorGilbert Morell, whom most of the Nazi leadershipdismissed (with good reason) as a quack. In addition tococaine eyedrops, the ‘tonic’ injections of the‘Reichsspritzenminister’ are known to have includedmethamphetamine, strychnine and other dubioussubstances.

The classic text on the dilemmas presented by yellowfever in the colonial development of central Americacan be found in François Delaporte’s The history ofyellow fever: an essay on the birth of tropicalmedicine, in its able translation by Arthur Goldhammer(1991).

Parasites

[Northern Review, 1996]

Years later after writing this essay, which reflects onmy experience of studying parasitology at the LondonSchool of Hygiene and Tropical Medicine, Idiscovered amongst the brilliant aphorisms andobservations of the Viennese physician and writerArthur Schnitzler (volume 5 of his Collected Works)the following entry: ‘Notions such as “parasitizing”,“corrupting”, “extorting” are generally understoodsolely in a material sense. But aren’t there parasitesattached to our being, ones much worse than thosewhich help themselves to earthly goods? Aren’t there

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forms of corruption more subtle and even moreunderhand than those which exploit money and values?And aren’t the worst forms of blackmail those whichattack our feelings or attempt to?’ It might even bethought, following on from Schnitzler, who waswriting well before the Second World War, that ourculture has become parasitic, feeding on its own past,and not always in an edifying way.

As for the hybrid nature of human beings, it wouldseem that at least part of our DNA has been picked upfrom seemingly utterly alien species: a study inGenome Biology suggests that the ABO antigen systemwhich codes for the basic blood groups is bacterial inorigin, the gene associated with fat mass derives frommarine algae and that the group of genes whichsynthesize hyaluronic acid, an intracellular bindingsubstance, was captured from fungi.

Twenty years ago, only a few specialists wereinterested in the gut: now the microbiome, the ecologyof symbiotic microorganisms that inhabits our innerbody space, is one of the trendiest topics around, andnot just because antibiotic resistance has becomemedicine’s ‘global warming’ equivalent. The unsungsymbionts of our gut provide us with a notinsignificant part of our calorific intake, manufacturevitamins and co-factors and protect us againstpathogens.

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Index of Names

d’Agoty, Jacques Gautier, 12

Alberti, Leon Battista, 227

Amis, Martin, 191

Anaxagoras, 226

Aristotle, 196, 204, 226

Ashbery, John, 206

Auden, Wystan Hugh, 43, 62, 65, 150, 152–58, 161–3,178, 189, 191, 197, 232, 254

Auerbach, Erich, 230

Austen, Jane, 68

Babel, Isaac Emmanuilovich, 102, 139

Bacon, Francis, 16, 150, 183, 192, 193, 228, 258

Bacon, Reginald Hugh Spencer, 138–39

Baker, Nicholson, 102, 139

Bakhtin, Mikhail Mikhailovich, 229

428

de Balzac, Honoré, 19, 121, 214

Barnes, Julian, 224

Barthes, Roland, 127, 220

Baudelaire, Charles, 9

Baudrillard, Jean, 60, 132, 273

Bauer, Grete, 107

Bayley, John, 215

Bean, Charles Edwin Woodrow, 179

Beebe, William, 190

Beekman, Eric Montague, 211–13, 281

Benjamin, Walter, 45, 102, 110, 157, 162, 187, 205–6,226

von Benkendorff, Alexander, 215

Bentham, Jeremy, 62, 67, 209, 232

Bernard, Claude, 19, 121

Beuys, Joseph, 12–15

Bevan, Aneurin, 149

Beyle, Marie-Henri (see Stendhal)

429

Blake, William, 214, 216, 234

Boccioni, Umberto, 12

Boehme, Jakob, 133

Bonaparte, Napoleon, 142, 218–19

Booth, Charles, 81

Borges, Jorge Luis, 7

Born, Max, 189

Boswell, James, 136–37, 223

Brecht, Bertolt, 102, 113, 134, 142, 240, 268, 277

Brod, Max, 98, 101, 102, 109, 110, 115, 116

Brooks, Mel, 254

Browne, Thomas, 7, 16, 121

Buber, Martin, 103

Buffon, Georges-Louis-Marie Leclerc, 121

Bulgakov, Mikhail Afanassievitch, 96

Burke, Edmund, 96

Burns, Robert, 63

430

Burton, Robert, 39

Butler, Hubert, 96

Callimachus of Cyrene, 221

Calvino, Italo, 189

Camporesi, Piero, 141

Canetti, Elias, 42, 44, 110, 131–32, 135

Carey, John, 187–88, 189, 191–93, 195, 197–99

Carrère, Emmanuel, 71–72, 73, 75–78, 274

Cavell, Stanley, 233

Céline, Louis-Ferdinand, x, 24, 198, 271

Ceronetti, Guido, 30, 143

Chamberlain, Joseph, 263

Charcot, Jean-Martin, 23

de Chardin, Teilhard, 229

Checkland, Sydney, 208–9

Chekhov, Anton Pavlovich, 79–96, 180

Chekhov, Nikolai Pavlovich, 81

431

Chesterton, Gilbert Keith, 38

Chomsky, Avram Noah, 119

Cobb, Richard, 18

Cockeram, Henry, 121

Coleridge, Samuel Taylor, 196–97, 209, 210, 214

Conrad, Joseph, 84, 93, 138

Constant, Benjamin, 150

Corbin, Alain, 141

Coué, Émile, 28, 271

Curie, Marie, 188

Curie, Pierre, 188

Dalgarno, George, 187

Dali, Salvador, 11

Dampier, William, 176

Danby, Francis, 214

Dante Alighieri, 88, 92, 124, 145, 184, 229

Darwin, Charles, 21, 122, 135

432

Darwin, Erasmus, 188, 214

Davies, Norman, 230

Davy, Humphry, 210

Dawkins, Richard, 125, 189, 191

Defoe, Daniel, 210

Descartes, René, 231, 273

Dick, Philip Kindred, 71

Dickens, Charles, 154, 210, 214

Disney, Walt, 195

Dostoevsky, Fyodor Mikhailovich, 65, 76, 184, 185,220

Douglas, Mary, 16

Duchenne de Boulogne, Guillaume-Benjamin, 135

Dürer, Albrecht, 12, 227

Durkheim, Émile, 8

Dymant, Dora, 101

Eddington, Arthur Stanley, 187, 199

Eisenstein, Sergei Mikhailovich, 102

433

Elias, Norbert, 226

ben Eli’ezer, Israel, 103

Elliott, Carl, 33, 65–67, 271, 273

Engels, Friedrich, 261

Fabre, Jean-Henri, 188

Fenton, James, 121–22, 196

Ferreri, Marco, 60

Fischart, Johann, 138

Flaubert, Gustave, 4, 121, 140, 273

Fletcher, Horace, 100

Fontana, Felice, 8

Fontane, Theodor, 66

Forster, Edmund, 254, 283

Foucault, Michel, 107, 246

Fragonard, Jean-Honoré, 12

Freud, Sigmund, 23, 27, 43, 50, 58, 61, 66, 112, 142,147, 189, 222, 253

Fuller, Richard Buckminster, 122

434

Gadda, Carlo Emilio, 192, 206

Galen of Pergamon, 57, 270

Galilei, Galileo, 149, 188

Galkin-Vraskoy, Mikhail Nikolayevich, 85, 89

Garin-Mikhailovsky, Nikolai Georgievich, 85

Gerhardi, William, 95

Gibson, William, 126

Gide, André, 18

Girard, René, 76

Gish, Lillian, 176

Gladstone, William, 52

von Goethe, Johann Wolfgang, 9, 103, 121, 157, 159,192, 218, 221, 240–41, 250

Goffman, Erving, 67

Gogol, Nikolai Vasilievich, 84, 92, 137–38, 144, 145

Gombrowicz, Witold, 76

Goncharov, Ivan Alexandrovich, 179

Gonzalez-Crussi, Frank, 7, 9

435

Gould, Stephen Jay, 188

Goupillières, Roger, 18

Graham, William Sydney, 232

Green, Henry, 53

Greene, Graham, 18

Hagens, Günther, 10–16, 270

Hauptmann, Gerhart, 247

Hauser, Kaspar, 73

Healy, David, 35–36, 271

Heller, Erich, 102, 106

Helman, Cecil, 55

Hemingway, Ernest, 50

Heraclitus, 143, 226

Herodotus, 221

Herz, Rachel, 140

Hesiod, 59

Hill, Austin Bradford, 149

436

Hippocrates of Kos, 26, 29, 226

Hirst, Damien, 50, 270

Hitler, Adolf, 29, 31, 111, 115, 256, 258, 261, 283

Hobbes, Thomas, 90

von Hofmannsthal, Hugo, 192

Hogarth, William, 7, 110

Hoggart, Richard, 139–40

d’Holbach, Paul-Henri Thiry, 63

Holbein, Hans, 220

Holtzmann, Bettyann, 244

Holub, Miroslav, 50, 150, 159, 191, 196, 198, 267

Hopkins, Claude C., 132

Horton, Richard, 36

Hughes, Robert, 91

Hughes, Ted, 196

Hugo, Victor, 183, 229

von Humboldt, Alexander, 110

437

Hume, David, 94, 147, 148, 233

Hunter, William, 8

Huxley, Thomas Henry, 188

Ibsen, Henrik Johan, 105

Inturissi, Louis, 223

Jack, Ian, 133–4

Jesenská, Milena, 106, 275

Johnson, Mark, 205

Johnson, Samuel, 63, 121, 136–37, 214, 223

Jones, Chuck, 129

Joseph II of Austria, 8

Josipovici, Gabriel, 111–12

Jouvet, Louis, 18, 22, 30, 271

Joyce, James, 43, 47, 121, 233, 274

Jung, Carl Gustav, 222, 251

Kafka, Franz, 42, 56, 59, 97–117 passim, 133, 155,156, 179–80, 187, 189, 191, 195, 196, 199, 223, 252,257

438

Kafka, Hermann, 98, 101

Kafka, Ottla, 97, 100, 101, 117

Kant, Immanuel, 148, 220, 240, 282

Karloff, Boris, 11

Kekulé, Friedrich August, 189

Kemble, Francis Anne, 174

Kennan, George, 95

Kepler, Johann, 169, 195

Kevorkian, Jack, 50

Kierkegaard, Søren, 115, 272

Kirmayer, Laurence, 35

von Kleist, Heinrich, 103, 174, 248

Klopstock, Robert, 112, 113, 275

Koch, Robert, 99

Kocher, Emil Theodor, 253

de Kooning, Willem, 133

Kouchner, Bernard, 70

439

Kramer, Peter, 35

Kraus, Karl, 38, 118–19, 129

Ladmiral, Luc, 69, 73

Laing, Ronald David, 78

Lakoff, George, 205

Lawrence, David Herbert, 247

Le Corbusier (Jeanneret-Gris, Charles-Édouard), 183

Lec, Stanisław Jerzy, 118

Leenhardt, Maurice, 8

Lefranc, Guy, 18

Lehmann, Heinz, 34

Leibniz, Gottfried Wilhelm, 38, 187

Leiris, Michel, 15

de Lempicka, Tamara, 255

Lenin (Ulianov, Vladimir Ilyich), 84

Leopardi, Giacomo, 145

Leopold II of Belgium, 84

440

Levi, Primo, 123, 188

Lévi-Strauss, Claude, 199

Levinas, Emmanuel, 41, 48

Levitan, Isaak Ilyich, 86

Li Bing, 166

Lichtenberg, Georg Christoph, 32, 67, 120

Linnaeus (von Linné), Carl, 121, 212

Löwy, Siegfried, 98–101

Lu Gwei-djen, 165, 169, 170

Luther, Martin, 13, 138

Lynch, Thomas, 49–53, 272–73

MacDiarmid, Hugh (Grieve, Christopher Murray), 197,266

McLuhan, Herbert Marshall, 230, 234

Magherini, Graziella, 221

Malaparte, Curzio (Suckert, Kurt Erich), 132, 270

Malcolm, Janet, 95, 275

Malthus, Robert, 188

441

Mandelstam, Osip Emilyevich, 122, 132, 138–39, 189,121, 167

Mann, Heinrich, 240

Mann, Thomas, 27, 84, 236–51 passim, 253, 256, 257,282–83

Mao Zedong, 167, 169

Marar, Ziyad, 62–64, 67, 273

Marcus, Ben, 126

Marcuse, Herbert, 250

Margulis, Lynn, 122

Márquez, Gabriel García, 178

Mars-Jones, Adam, 140

Marx, Karl, x, 31, 11, 273

Massie, Allan, 210

Maxwell, James Clerk, 188

Mechin, Colette, 56, 273

Medawar, Peter Brian, 193

Mérimée, Prosper, 3

442

Mesmer, Franz Anton, 27

de la Mettrie, Julien Offray, 62–64

Miller, William Ian, 141

Mitford, Jessica, 52

Molière (Poquelin, Jean-Baptiste), 20, 22, 32, 127

Monro, Alexander, 10

de Montaigne, Michel, 67, 141, 163, 278

Morgan, Edwin, 196

Müller, Johannes, 100

Munthe, Axel, 22–23

Musil, Robert, ix, 192–93, 197–99

Mussolini, Benito, 27

Nabokov, Vladimir Vladimirovich, 40, 89, 93, 137,144, 190

Naipaul, Vidiadhar Surajprasad, 191

Needham, Dorothy Moyle, 165

Needham, Joseph, 164–71, 213, 278

Newmark, Peter, 201

443

Newton, Isaac, 189, 192, 196, 197

Nicholson, Jack, 18

Nietzsche, Friedrich, 15, 28, 43, 59, 62, 67–68, 77,104, 110, 111, 139, 143–44, 156, 158, 215, 230, 247,260, 267, 268, 278

Nobel, Alfred, 124

Novalis (von Hardenberg, Georg Philipp Friedrich),237

Orwell, George (Blair, Eric), 38, 119, 140, 174, 189,201, 204

Osler, William, 56

Paré, Ambroise, 8

Parens, Erik, 34

Pasteur, Louis, 23, 82, 198, 261

Pavlov, Ivan Petrovich, 82

Peacock, Thomas Love, 196

Perec, Georges, 77, 126, 193

Peter the Great, 12

Picken, Laurence, 168

444

Pirandello, Luigi, 17

Plato, 26, 37, 57, 185, 209, 225, 226, 229, 282

Poe, Edgar Allan, 133

Poincaré, Henri, 93

Ponge, Francis, 196

Pope, Alexander, 68

Popper, Karl, 147

Pressburger, Giorgio, 134, 135

Priestley, John Boynton, 188

Pritchett, Victor Sawdon, 56, 142

Proctor, Robert, 29

Proust, Marcel, 4, 24, 44–45, 47, 140, 169, 188, 189,213, 220

Pushkin, Alexander Sergeyevich, 215

Pythagoras of Samos, 231

de Quincey, Thomas, 86, 188

Rabelais, François, 57, 127, 227–34 passim

Raffles, Stamford, 214

445

Rasp, Charles, 175

Ravachol (Kœnigstein, François Claudius), 21

Reed, William, 256

Reich, Robert, 67

Rilke, Rainer Maria, 44, 138, 220, 232

Robertson, James, 210

Robertson, Robin, 51

de la Rochefoucauld, François, 62

Roentgen, Wilhelm Conrad, 189

Roget, Peter Marc, ix, 128

Romains, Jules, 17–32 passim, 271

Romand, Jean-Claude, 69–78 passim, 274

Rorie, David, 108

Rose, Nikolas, 237

Ross, Ronald, 188, 261

Roth, Joseph, 144, 253

Roth, Philip, 134

446

Rousseau, Jean-Jacques, 63, 67, 77, 114, 142, 218

Rowlandson, Thomas, 56, 110

Rumphius, George Eberhard, 211–14, 281

Ruskin, John, 214, 224

Ruysch, Frederik, 12

Sacks, Oliver, 189

de Sade, Donatien Alphonse François, 66, 114

Schemm, Hans, 29

Schnitzler, Julius, 253, 284

Scholem, Gershom, 110, 187, 226, 233

Schopenhauer, Arthur, 59

Schwartz, Karlene V., 122

Schweitzer, Albert, 78

Sebald, Winfried Georg, 220

Sewel, William, 212

Shakespeare, William, 88, 104, 121, 196, 214, 228,229, 231, 234–35, 258

Shaw, George Bernard, 17, 22, 189

447

Simmel, Georg, 231

Skrabanek, Petr, 146–50, 277

Sloterdijk, Peter, 250

Smellie, William, 8

Smith, Zadie, 134

Snow, John, 29

Sontag, Susan, 239

Stalin, Joseph, 132, 139, 215

Stanley, Henry Morton, 84

Starobinski, Jean, 227

Steevens, George, 214

Stein, Marc Aurel, 166

Steiner, George, 169, 213, 230

Stendhal (Beyle, Marie-Henri), 3–5, 63, 66, 144, 145,218–25

Stern, Joseph Peter, 115

Sterne, Laurence, ix, x, 136, 199, 218

Stevenson, Robert Louis, 77

448

Straße, Hans, 100

Strauss, Emmanuel, 108

Süskind, Patrick, 141

Suvorin, Aleksey Sergeyevich, 79, 81, 82, 85, 86, 89,93–95

Sweeney, Matthew, 51

Swift, Jonathan, 38, 87, 88, 188, 204

Sydenham, Thomas, 119

Szasz, Thomas, 36

Tenner, Edward, 127

Theresa of Avila, 143

de Tocqueville, Alexis-Charles-Henri Clérel, 150

Tolstoy, Leo Nikolayevich, 21, 81–84, 94, 138

Turgenev, Ivan Sergeyevich, 93

Twain, Mark, 28, 202, 223–24

Valverde, Juan, 11

Veblen, Thorstein, 65

Verne, Jules, 60, 184

449

Vesalius, Andreas, 9

da Vinci, Leonardo, 12, 155, 187, 195, 224, 227

Voltaire (Arouet, François-Marie), 229, 237

von Wackenfels, Wackher, 169

Wagenbach, Klaus, 97, 117

Wang Ling, 167

Waugh, Evelyn, 52

Weigand, Hermann, 236

Weil, Simone, 25, 28

Weinberger, Eliot, 131

Weiss, Ernst, 252–59

Wells, Herbert George, 183

Wilkins, John, 121

William of Ockham, 8

Williams, William Carlos, 190–91

Winchester, Simon, 166, 170, 278

Wittgenstein, Ludwig, 65, 82, 102, 106, 139, 154,186–87, 188, 192, 231, 278

450

Wolfe, Tom, 64

Wolff, Kurt, 98

Wright, Jabez

Yeats, William Butler, 146, 197

Zamenhof, Ludwik Lejzer, 203

Zhou Enlai, 167

Zola, Émile, 24, 83, 86, 121, 189

Zummo, Gaetano, 8

Zweig, Stefan, 17, 30, 253

451

A Doctor’s Dictionary

Writings on Culture & Medicine

Iain Bamforth grew up in Glasgow and graduated fromits medical school. He has pursued a peripatetic careeras a hospital doctor, general practitioner, translator,lecturer in comparative literature, and latterly publichealth consultant in several developing countries,principally in Asia. His four books of poetry werejoined by a fifth, The Crossing Fee, in 2013. His proseincludes The Body in the Library (Verso, 2003), anaccount of modern medicine as told through literature;and The Good European (Carcanet, 2006), a collectionof writings on ideas and literature in European history.

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Also by Iain Bamforth from Carcanet Press

The Crossing Fee

The Good European

A Place in the World

Open Workings

Sons and Pioneers

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Every effort has been made by the publisher toreproduce the formatting of the original print edition inelectronic format. However, poem formatting maychange according to reading device and font size.

First published in Great Britain in 2015 by CarcanetPress Ltd, Alliance House, 30 Cross Street,Manchester M2 7AQ.

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