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BMJ. 2007 December 1; 335(7630): 1159.
PMCID: PMC2099531
Between the Lines

Grumpy old men

Theodore Dalrymple, writer and retired doctor

It is generally admitted, wrote R R Madden MD at the beginning of his book The Infirmities of Genius Illustrated by Referring the Anomalies in the Literary Character to the Constitutional Peculiarities of Men of Genius, published in 1833, that literary men are an irritable race, subject to many infirmities, both in mind and body. Worldly prosperity and domestic happiness are not often the result of their pursuits.

Fame and frailty, he says, are inseparable companions. This, he continues, is just as well; for it renders those of humbler capacities contented with their lot. Let us “thank God [we] are not like the . . . poor children of genius, frail in health, feeble in resolution, in small matters improvident, and unfortunate in most things.”

Madden was an Irish doctor who served in the tropics, wrote a book of his travels in Turkey and a history of the United Irishmen, and translated Poems by a Slave in the Island of Cuba, Recently Liberated, as well as The History of the Early Life of the Negro Poet, Written by Himself, published in 1840, when slavery had many years still to run in Cuba.

To what did Dr Madden attribute the irritability of literary men? Unfortunately, like many medical writers of the time, he was not clear or precise in his hypothesising. Most of his examples—Pope, Johnson, Burns, for example—had what he called “dyspepsia,” a protean disorder that accounted for palpitations of the heart, depression of the spirits, and nervous pains in the head. Sometimes this dyspepsia preceded, and sometimes followed, literary endeavours.

At any rate, the dyspepsia disturbed “the functions of the brain” and “ultimately debilitated that organ, and left it no longer able to resist the effects of the constant exercise of the mental faculties.” This led to “alteration in the structure, softening of its substance, or effusion serous or sanguineous.”

We believe something different now: that mental activity preserves the faculties. Where we say, “Use it or lose it,” they said, “Use it and lose it.”

Sixty-one years after Madden published his book about the infirmities of literary men, a scion of the famous Tuke family, J Batty Tuke, delivered the Morison Lectures in Edinburgh entitled “The Insanity of Over-Exertion of the Brain.” (Is it not strange how men with the names Madden and Batty should have been interested in insanity, while Henry Head and Russell Brain became neurologists?)

According to Tuke, over-exertion of the frontal lobes and exhaustion of the neurones by chronic emotion led to Wallerian degeneration. Thus, in treatment, “the first object to be obtained is REST for the brain.” The madman must be put to bed. This should present no difficulties, even in cases of mania, for “The influence of a stronger mind tells on a pathologically weaker one.”

Dr Tuke continues, “I need not tell you that the physician is most powerful in the sick-room or hospital, and that he strengthens his position when he orders the patient to bed. Even in cases which at first resent the order, as soon as it is obeyed no difficulty arises in maintaining it. A good nurse, or even two may be necessary.”

We may smile pityingly: but will not our descendents smile at us? Besides, many of my patients asked for help to stop thinking, not any thoughts in particular, but all thoughts whatsoever. They are tired of thought and its responsibilities. I suppose this is one of the reasons that meditation is so popular.

Most of Madden's examples had what he called “dyspepsia,” a protean disorder that accounted for palpitations of the heart, depression of the spirits, and nervous pains in the head


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