The Pharmaceutical Journal
Vol 268 No 7194 p546
20 April 2002

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Pharmacien malgré lui [more]
Dismal outlook [more]
Diagnosing Dickens [more]

Pharmacien malgré lui

I recently had occasion to browse in some works of Alphonse Daudet (1840–97), an author for whom I have great admiration. His language is so simple and his plots so uncomplicated that it is relaxing to read his work after pursuing the maze of modern technical writings with their delight in complex constructions and strange neologisms. To learn of Corsican lighthouse keepers occupying their idle moments with Plutarch, and people lazing on Mediterranean rocks just enjoying the sunshine and the murmur of the sea takes me back to more leisured times, when time and money were less deified than in our days.

One of Daudet's prime creations is Tartarin de Tarascon, one of that intrepid band of individuals who made up the "chasseurs de casquettes" who took to holding shooting parties where the game was caps flung into the air, having scared away all the birds and other animals that should have populated their countryside. Among their number the pharmacien Bézuquet was a keen participant, and had a strong influence on his fellow Tarasconnais. We learn that in Tartarin's own home, "Toute y était rangé, soigné, brossé, étiqueté comme dans une pharmacie". What did take some of the aura from Bézuquet was the well-known fact that instead of replacing his perforated targets with new caps he made a habit of finding old ones riddled with bullets.

In the pharmacien's own home we learn that a piano was draped in green. We do not learn who played it — possibly Madame. Evening musical sessions were regular, when each of the participants had a song which others were denied. Bézuquet monopolised "Toi, blanche étoile que j'adore", while Tartarin joined Bézuquet mére in a boisterous duet from Meyerbeer's "Robert le Diable".

The pharmacien makes a second abject appearance when the circus is in Tarascon and Tartarin is discovered after dark with his gun, apparently guarding the lion. On encountering this apparition Bézuquet sneaks off home, muttering that he wants to collect his own gun, although he never does. But he comes into his own when Tartarin, obsessed with the idea of hunting lions, plans his visit to Algiers and starts to collect his assorted armoury and equipment. "Enfin le pharmacien Bézuquet lui confectionna une petite pharmacie portative bourrée de sparadrap, d'arnica, de camphre, de vinaigre des quatre-voleurs." In Africa, after the explorer has been robbed of his money and forced to sell off his equipment, we learn that the remaining sparadrap was purchased by a local pharmacien, after three porters had made themselves ill consuming some of the sparadrap and a tincture of camphor. Small wonder, perhaps, when we discover from Squire's 'Pocket companion to the British Pharmacopoeia' (1915 edition) that sparadrap is a vesicant based on cantharides. In the same work "vinaigre des quatres voleurs" is described as a compound infusion of wormwood, rosemary, sage, lavender, calamus, cinnamon, cloves, nutmeg and garlic, with camphor and strong vinegar. Evidently, the good pharmacien Bézuquet was determined to afford the intrepid Tartarin the most potent remedy he could devise to guard against the ills of Africa.

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Dismal outlook

An editorial in The Lancet for 23 March paints a pessimistic view of human health prospects in those regions of the world that are subject to political corruption and violence. In Africa, for example, we see little chance of a healthier lifestyle in an atmosphere of starvation, corruption and continuing violence. In the Middle East and Indo-China, too, conditions are not conducive to better health, let alone prosperity. An important conference on financing for development, recently held in Monterrey, resulted in much glib talk but sheer neglect so far as positive action is concerned.

At the Okinawa summit held in 2000 it was resolved that the incidence of human immunodeficiency virus infection and the related AIDS should be reduced by a quarter, deaths from tuberculosis by half, and malaria incidence by half by the year 2010. Such an expressed intention demanded action on the part of the world's financial institutions that has shown no sign of materialising. The World Bank calculates that some 1.2 billion people are forced to live on less than the equivalent of one dollar per day, but it has been shown that that the efficient deployment of one billion dollars of aid could raise at least half a million people above the poverty line. Yet any advance towards financing such a project has been vetoed by unilateralist interests in the United States in particular.

If it is to be accepted in the developed world that the fundamental interest in health improvement of both rich and poor nations must be shared, then, The Lancet article argues, health professionals as well as politicians must make their voices heard, and back talk with deeds. They will need to play a more prominent role in advocating and enabling change. To take one prominent example, poor countries will have to be helped to gain access to cheaper imported pharmaceutical products to which at present they are denied access by high prices and restricted availability. Unless they can have effective and reasonably safe medicines they have no chance of controlling chronic and epidemic ill-health.

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Diagnosing Dickens

In 1868 Charles Dickens, then aged 56, began to suffer from a serious recurrence of left-handed sensory symptoms that had previously afflicted him in 1865. The disorder took the form of temporary motor disturbances of the left side with giddiness. Nevertheless, the novelist denied any complaints and continued to work despite failing health. In 1870 he suffered a stroke which proved fatal. He had experienced a breakdown in health in April 1869, when his physician, Sir Thomas Watson, had concluded that he had been "on the brink of an attack of paralysis of his left side, and possibly of apoplexy", attributed to overwork, worry and excitement.

In The Lancet for 6 April, David Bateman of the Royal United Hospital, Bath, criticises the argument, offered by the psychologist I. C. McManus of University College London in The Lancet for 22/29 December 2001, that Dickens had a right parietal or parietal-temporal disorder. Dr Bateman concludes that Dickens's symptoms, including visual disturbances, which appeared in 1868 and again in March 1870, indicate a recurrent temporal left homonymous hemianopia, causing severe pain and lameness in the left foot which the writer attributed to frost-bite, first noticed in February 1865. The foot trouble was never properly diagnosed, although Dickens denied the possibility that gout might be responsible. However, he did show signs of heart disease, possibly precipitated by kidney disease. It is likely, Dr Bateman states, that Dickens was hypertensive, which conferred the high risk of early stroke.

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