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Hope and inspiration from a hero on the old front line of medicine

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UNDER lockdown I have derived a great deal of comfort and optimism from my reacquaintance with a now-forgotten author, James Harpole.

I recently bought the 1947 thirtieth edition of The Surgeon’s Log: Impressions of the Far East (1911), a hot seller for decades. It is a marvellous account of his short time as a young ship’s doctor on a cargo vessel bound for Egypt, Malaya and Japan.

Harpole in the course of his life was a civilian and Army surgeon, novelist, broadcaster and essayist who gathered along the way a DSO, CBE and Serbian knighthood. He was the most celebrated medical populariser of his day.

‘Harpole’, he explained in his engrossing autobiography, Surgeon’s Journey (1957), was a pen name, made necessary because medical etiquette back then forbade doctors engaging under their own names in anything that could be regarded as self-advertising. His practice was between Harley and Wimpole streets, hence Harpole.

Harpole was in fact J. Johnston Abraham (1876-1963) over whose name Surgeon’s Journey was published. His family came from Aughnacloy in County Antrim and his earliest memory was of watching the ritual burning of Robert Lundy’s effigy from the window of his Coleraine home. (Lundy was the Governor of Londonderry who, in sympathy with the enemy, failed to defend the city against the Catholic troops of James II during the Siege of Derry, 1688-89.)

Abraham’s father was a tea merchant, his grandfather a linen merchant.  His people were Primitive Methodists despite the Jewish-sounding name and he grew up fluent in braid Scots.

But his pride of ancestry was without rancour, as such pride usually is in those who travel the world. Besides, his medical reading of history lent him an even-handed humanity we in Ireland still need to learn.

He knows the besieged in Derry died in their thousands of typhus fever, diphtheria and dysentery, but knows too that King James’s army was likewise decimated by disease and melted away.   

At Trinity College, he studied both literature and science, as one could once do, but on the advice of the celebrated Shakespearean scholar Edward Dowden, opted for the security of a profession. That choice did not prevent him from soon writing a novel that became a succès de scandale

The Night Nurse (1913), recreating the avid private desires and ambitions of nurses and young doctors, was banned by hospital matrons in every English hospital save Guy’s in London and sold promiscuously. Abraham may have been the best-selling Northern Irish author of the 20th century. He was elected a member of the Athenaeum, became a friend of Rudyard Kipling and met D H Lawrence.

Abraham chose to be a surgeon over a physician, and he proved to be a skilled and venturesome one. He recalls for us some hairy moments, such as retrieving a service knife out of sight in the pericardium, the bag-like membrane that encloses the heart, plunged there by a suicidal Great War soldier in Egypt who had convicted himself of cowardice. He survived the operation, but died days later (of typhus), not an unfamiliar story in medical annals, it seems.

Though a surgeon, Abraham’s posts in hospitals in Dublin, London and overseas involved him in epidemics of bacterial and viral diseases of the kind we all now face. He admitted his fear of tetanus, and when he served with the British Red Cross Serbian Mission in the Great War, he saw it kill soldier after soldier horribly.

He was equally afraid of typhoid fever, which he watched ravage the Royal Irish Constabulary when he was with Dr Steevens’ Hospital in Dublin. In Serbia during the Great War, Austrian prisoners died in their thousands before the epidemic spread to the civilian population. He was in the midst of the London smallpox epidemic of 1902, having been familiar with the disease in Dublin, where it was not uncommon.

Engaged with the Royal Army Medical Corps in Egypt towards the end of the Great War, Abraham fought malaria as well as diphtheria and typhus. But even those menaces paled beside the great influenza pandemic of 1918-1919, when the base hospitals in Palestine were overwhelmed and casualty clearing stations had to hoard their patients.

Surgeon’s Journey reminds us of our human vulnerability to the ills that flesh is heir to.  All adults are presently being taught this fearsome lesson. Yet it is a story too of inspiring drama that we too are now being witness to: the drama of testing, diagnosis, containment, treatment and intervention, and, fingers crossed, cure.

But as time goes on, fingers need to be crossed less frequently. We are now aware of who the utterly necessary professionals are in our midst.  We should become aware of how this expertise – the diagnostic and healing powers – came into being.  

Abraham in the course of his autobiography tells us what extraordinary medical introductions, procedures and breakthroughs he witnessed during his career. Appendectomies; X-rays; surgical masks; dedicated operating tables; inoculation for diphtheria; serum for tetanus; penicillin; vaccination for typhoid; the discovery of hormones; the cure for rickets, and so on.

Above all, or so it seems to me (whose life as a lower middle-class child was saved by it), though not wholeheartedly to Mr Abraham, was the creation of the National Health Service in 1948. He writes of doctors being in the ‘throes of negotiating’ with a socialist government over the terms of the National Health Act of 1947 and of ‘the shadow’ of the coming NHS falling over the hospitals.

The voluntary system that had lasted for centuries and in which Abraham had served as a shilling doctor was inevitably coming to an end because the hospitals were bankrupt, costs in everything having rocketed. Essential government subsidies meant government control.

However, it was not just the nationalisation that was in the air after the war, but also the infrastructural provisions of the Act that made temperamentally conservative doctors in private practice apprehensive.  Abraham admits, but cautiously, that his fears had been exaggerated, though his suspicion of sweeping nationalisation survived the saving of the hospitals.

Surgeon’s Journey, like Abraham’s other fascinating books drawn from his extensive medical casebook, is a story of painstaking detective work, but also of resolve, action and energy. How timely it is to read of the scarcity of hospital beds under canvas on the eve of the third Battle of Gaza in the Great War in 1917. Between sunset and dawn, within earshot of the opening salvoes, the RAMC readied 3,000 beds up and under cover for the expected casualties.

No wonder Harpole-Abraham called one of his volumes of memoirs The White-Coated Army (1938). He saw doctors (and we can now add nurses) as ‘officers in a health army fighting the long fight against disease’. Under lockdown, I appreciate that thought infinitely more than when I first read it.

John Wilson Foster’s latest book is published this month: The Space-Blue Chalcedony: Earth’s Crises and the Tyler Bounty.

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John Wilson Foster
Professor John Wilson Foster was born in Belfast and is a literary critic and cultural historian.

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