Book Review by Neil Vickers

Iain Bamforth is a physician-writer who tries to understand his life in terms of philosophy, literature, history and art. He is stupendously well-read in English, German, French, Italian and Spanish sources, which he deploys to beguiling effect in this strange and magnificent book. In a ‘Preface’ to Scattered Limbs, Bamforth calls it ‘a commonplace book, halfway between zibaldone and intellectual diary—a miscellany that explores the intermittencies of my relations with the medical profession.’ (A zibaldone, if you’re wondering, is an exceptionally miscellaneous commonplace book.) In truth, this description could be misleading if you expected to find in it a description of Bamforth’s dealings with fellow medical professionals, about which he says little. He is much more preoccupied by what medicine is: with what it asks of its practitioners, the purposes it serves, wittingly and unwittingly, and with what society seeks from it.

Scattered Limbs is a collection of aphorisms, similar in scale to the aphorisms in Nietzsche’s The Genealogy of Morals or Adorno’s Minima Moralia (but without Adorno’s corrosive pessimism). One advantage of the aphorism as a literary form is that it enables the writer to worry away piecemeal at truths without obliging him to reckon with any larger case he may be making in the process. Patterns are revealed adventitiously, over several pages. One of the many joys of this book is observing patterns take shape kaleidoscopically before disintegrating into the beginnings of some new design. The book begins by observing that the cult of physical fitness began in the late nineteenth century just as degenerationist, hereditarian discourses were at their height: ‘The cult of the body manifested itself only when it ceased to be universally human’. This in turn sponsors a reflection on what is involved in prognosis (‘Prognostication is where writers and doctors resemble each other most’). And from there it’s a short hop to Chekhov whose ‘subdued good nature shines through the gloom.’ There are long and rewarding accounts of the nature of human sympathy (‘a proper attitude to death is medicine’s only profundity’) alongside bracing descriptions of how people actually sicken and die.

Bamforth is fascinated by our reluctance to consider the ways other eras coped with their (very justifiable) dissatisfaction with medicine. ‘Dissatisfaction with medicine,’ he writes, ‘is an integral part of the larger discussion about civilisation and its discontents.’ The  twentieth-century promise that every social problem could be medicalised was one approach to the problem. These days, we place our trust in ‘AI, telemedicine, robot-assisted surgery, genomics, biometry, theranostics and as yet unthought-of interfaces between bodies and machines—but backwards is surely the direction to be facing if we wish to give a true account of how medicine arrived where it has, and indeed of its considerable accomplishments’. Bamforth occasionally traces irrationality around medicine, old and new, to a discomfort with the idea of flawed doctors treating flawed patients. ‘Modern hospital centres,’ he observes, ‘owe their existence to a way of thinking that admired mercy and pity more than care.’ That’s one way of cutting out the middle-man! He worries that medical humanists may be more nostalgic than they realise for a world based on ‘mercy and pity’. Not that mercy and pity don’t have their place. There’s a moving anecdote about an elderly woman from Strasbourg whose dying wish was to receive a fresh baguette in her hospital bed every morning. After she died, the woman’s family explained to her physician that as a young mother living in poverty in the harsh winters after the second world war she had been had felt obliged to eat the previous day’s remaining bread for breakfast. She could think of no greater luxury than freshly-baked bread. Bamforth suggests that this dying wish had something sacramental about it, ‘her very own Last Supper’. Mercy and pity possess some of the grandeur of religion; they are a part of medical practice doctors are occasionally privileged to witness but they generally proceed from the patient. As Bamforth puts it: ‘You have to trust a listener before you can burden him with the rich seams of your own embarrassment. And that will never be a person with an agenda. And listening properly means hearing whatever is being said (and not said).’

There is a riveting aphorism on the television doctor House. Here’s a sample: House’s ‘abrasive, odiously intelligent, often overbearing personality is generally accepted by the sick as a benefit. The crisis point then becomes a moment of revelation. The unity of opposites is seen from a new standpoint. And the viewer becomes the addict.’

I have not referred to Bamforth’s powerful critique of the market in medicine, his remarks on Julian Jaynes, Christopher Boorse, Chekhov’s plays or Proust’s A la recherche. These treasures await the reader. Bamforth is surely the most erudite, suavest and elegant physician writer in English at the present time. This book, the fruit of twenty years’ labour, is a distillation of his art. It’s a jewel that will enthral and astonish anyone seeking a broad view of medicine and culture.

Neil Vickers is Professor of English Literature and the Health Humanities at King’s College, London