Titanium Noir, by Nick Harkaway

The idea of mashing up detective fiction and sci-fi isn't new. Isaac Asimov did it in The Caves of Steel and The Naked Sun in the 1950s (the latter of which I reread last month). As a kid, I was a big fan of Robo-Hunter in 2000AD, in which hero Sam Slade is a space-travelling version of Dashiell Hammett's Sam Spade.

As I've argued before, I think science-fiction and the detective story share a lot in common anyway, not least in the way we read them. We follow a plot but we're also looking for clues - in the detective story to work out whodunnit, in sci-fi to understand how this world operates differently from our own. We also read (and write) such stories with a knowledge of what's gone before in the genre, so judge each new work on its ability to follow conventions while both avoiding cliche and adding something new.

Titanium Noir is much closer to a Dashiell Hammett style thriller, with narrator Cal Sounder a world weary, wise-cracking gumshoe acting as a buffer between the police and super-rich elite called "Titans" in a gritty near-future. When one of the Titans is found dead, apparently having shot himself, Cal can look into things on a softer, less formal basis than the police, but also without the protection that goes with carrying a badge.

What makes this world different from our own is that the super-rich can afford injections of Titanium 7. As we're told early on,

"It's a rejuvenation treatment given by infusion. It turns the body's clack back to pre-puberty, then runs you through it at speed. It's also used to stimulate regeneration of severely damaged organs and limbs. It really does make you young again, but since it starts with an adult body, it also makes you bigger, hence the name [Titans]. Oh, and it's so expensive almost no one has it. Strictly for the speciation rich." (pp. 10-11)

There's obviously something in this akin to IVF which also jump-starts the body like putting it through puberty again. As with IVF, the result is painful and takes months to recover from. But Titans then live extremely long lives.

There's a stark division between the Titans who've received T7 and the mass of ordinary, little people who haven't. We see the impact of this on one particular relationship where one party is a Titan. But there's more nuance here than a simple divide between haves and have-nots. Over decades, some Titans have had more than one infusion - each one making them bigger, stranger, something else. There are gradations of Titan, separate from one another, and also families and attachments and conflicts between different groups.

Newly created Titans are also strong and horny, so specialist establishments cater for titanic sex, while the media revels in gossip (and recordings of) the ins and outs of who is doing what to who. Many ordinary people are keen to get in on the action, and to modify themselves to look more like Titans while unable to afford T7. From this one medical intervention has developed a whole culture.

This all makes for a richly drawn environment in which the plot neatly twists and turns. The novel rattles along, zigging and zagging with everyone under suspicion - even the narrator, whose loyalties we're not always sure of. The final reveal of the killer hinges on something we've been told early on - a nicely played clue that seems obvious in retrospect but took this reader by surprise. And it's all wrapped up in 236 pages - a quick, exciting and satisfying read.

Dashiell Hammett used Sam Spade in several stories, and also created other heroes who featured in multiple adventures (ie the Continental Op, Nick and Nora Charles and secret agent X-9). It would be fun to see Cal Sounder in further adventures, exploring more of this world - and Sounder's changed position within it given what happens in this book. But that will have to wait, as first Nick Harkaway is writing a George Smiley novel.

See also:

• Me on Silverview by John le Carre (and completed by Nick Harkaway)
• Me on The Thin Man by Dashiell Hammett

Trouble with Lichen, by John Wyndham

There's a masterpiece in blurbage on the back of this Penguin edition:

"It was Diana Brackley who put the milk out for the cat; who dropped a speck of lichen in it by mistake; who noticed how the lichen stopped the milk turning.

But it was Francis Saxover, the famous biochemist, who carried on from there; who developed Antigerone, the cure for ageing; who then tried to suppress a discovery which was certainly in the megaton range.

And so it was Diana Brackley who went to town with Antigerone in one of John Wyndham's gayest and most satirical forays into the fantastic.

'If even a tenth of science fiction were as good, we should be in clover' - Kingsley Amis in the Observer"

It's a remarkable feat, a big science-fiction idea about the way science can affect social change, drawing, I think from the impact of penicillin and of the Suffragette movement, and all conveyed here as light romcom. Brian Aldiss famously criticised Wyndham for writing "cosy catastrophe", but this is all-out fun. 

Antigerone slows the biological process, so those who take it do not age. The trouble of the title is that there's only enough of the lichen to make this wonder drug for at most 4,000 people. The result is lots of debate on the ethics of announcing the discovery, let alone deciding who might share its benefits. 

Diana is a brilliant character, a young, determined woman with a habit of shocking people by saying the wrong thing - or rather what she thinks. At eighteen, she's asked by a schoolteacher whether her parents are proud of her academic success. Diana responds immediately that her "Daddy's very pleased", but can't say the same for her mother.

"'She tries. She's really been awfully sweet about it,' said Diana. She fixed Miss Benbow with those eyes again. 'Why is that mothers still think it so much more respectable to be bedworthy than brainy?' she inquired. 'I mean, you'd expect it to be the other way round.'

Miss Benbow replies, carefully, that "comprehensible" might be a better word that "respectable", and suggests the possibility that, "when the daughter of a domestic-minded woman chooses to have a career she is criticising her mother by implication".

"'I hadn't looked at it that way before,' Diana admitted thoughtfully. 'You mean that, underneath, they are always hoping that their daughters will fail in their careers, and so prove that they, the mothers, I mean, were right all the time?'" (pp. 12-13)

Diana soon has a career as a brilliant scientist who also likes to look good, and sees no contradiction in using the cutting-edge science she's developed as a beauty treatment for other women. In fact, she sees how the cosmetic aspects of the new discovery can advance the feminist cause. It's not exactly what you expect from a male sci-fi writer of this vintage.

Several of the traits Diana exhibits align with what we'd now think of as autistic and it's refreshing to read a decades-old book that celebrates such diversity. They make her a better character and better person. Sadly, Saxover is less engaging and there's little to explain Diana's long-lasting attraction. His attitude to other women doesn't exactly do him any favours - over pages 25 and 26, he lists the young women who have caused chaos at his laboratory by falling for the men, the women the ones at fault.

Other things are discomforting from a modern perspective. There's a racist joke on page 196 and a general ease with the idea that resources in China should be for the exclusive use of people in the UK. This may be part of the satire. As the situation gets ever more serious, with moral quandaries leading to kidnap and murder, the lightly comic love story gets a little tangled.

"There could have been bloodshed even something like a civil war,"

says one character on page 200, justifying a rash course of action. But there has been bloodshed: this speech comes just 18 pages after an old watchman, Mr Timpson, is killed by the blow from a cosh, a man called Austin is hospitalised and Saxover barely survives a planned arson attack on his home.

I think that mismatch is down to the effort to bridge different forms: science-fiction with the satirical, fantasy on the cusp of what's credible. It's a balancing act, and one that doesn't wholly work in this instance, but it's fascinating to see tried in this way. In fact, that balance is what Wyndham talked about in a 1960 interview for the BBC magazine programme Tonight at the time of publication. How boggling to see him justify this approach and discuss the mechanics of genre on the equivalent of The One Show. 

James Bond in the Lancet

The new issue of medical journal Lancet Psychiatry includes my essay, "Was it obvious to everyone else that I'd fallen for a lie?" on James Bond, and also Len Deighton and John le Carre. I wrote it before I'd seen No Time To Die.

You need to be signed up to read the whole thing, but the teaser first paragraph goes like this:

"When actor Sean Connery died in October, 2020, media coverage focused on his success as the secret agent James Bond. The franchise is still going strong, with Bond now played by Daniel Craig and No Time To Die, the latest film, now in cinemas. That enduring appeal is partly due to the movies consciously keeping up with the times and reflecting contemporary trends. Yet Connery's Bond films are still screened on prime-time TV in the UK; remarkable, given that the first of them, Dr No, is nearly 60 years old and invidiously features White actors made up to look Asian. The best of Connery's Bond films, Goldfinger (1964), was even back in cinemas at the end of 2020. They are exciting movies, and sexy and fun, but their persistence is down to something more profound. The world of espionage portrayed by mid-20th century writers was deeply concerned with scientific and political issues concerning individuality, identity, and the human mind..."

Simon Guerrier, "Was it obvious to everyone else that I'd fallen for a lie?", Lancet Psychiatry vol 8, issue 12, pp 1040-1 (1 December 2021)

Sherlock Holmes - The Great War

I'm currently in the midst of writing Sherlock Holmes - The Great War, an original novel for Titan Books. More details soon but here's the exciting cover...

Sherlock Holmes -
The Great War

• My listing on the Titan Books website
• Me on Conan Doyle and London

Caligari in the Lancet Psychiatry

I've written about the 100 year-old movie Das Cabinet des Dr Caligari in the August 2020 issue of the Lancet Psychiatry. You need to pay to read the whole thing, but here's a preview:

Das Cabinet des Dr Caligari (The Cabinet of Dr Caligari) is now a century old. Even if you've never seen it, much will be hauntingly familiar. The plot is simple enough: wild-eyed showman Dr Caligari (Werner Krauss) has an unsettling stage act involving willowy Cesare (Conrad Veidt), who we're told has been asleep for almost all of his 23 years. Krauss has complete power over this somnambulist, waking him for brief intervals to foretell the future. One eager member of the audience is horrified to be told he'll die that very night—and then does. We soon learn that Caligari sends Cesare out at night to commit murder but, in a shock twist, “Caligari” is revealed to be the director of the nearby asylum. Then, in another shock twist, all of this turns out to be the gothic fantasy of another of the patients (Friedrich Fehér). The staff and other patients at the asylum have all been given roles in his delusion, and the exaggerated, Expressionist production design of the film is the world as seen by, in the language of the time, “a madman”.

Turned out nice again in the Lancet Psychiatry

The June issue of medical journal the Lancet Psychiatry includes my essay on David Storey's play Home. You need to pay to read the whole thing, but the first paragraph goes like this:

"50 years ago, on June 17, 1970, the Royal Court theatre in London (UK) debuted Home by David Storey. This “sad Wordsworthian elegy about the solitude and dislocation of madness and possibly about the decline of Britain itself” (according to the Guardian) won the Evening Standard Drama Award and, after transferring to Broadway, the New York Drama Critics' Circle Award for Best Play. In January, 1972, BBC One broadcast a version featuring the original cast, and there were soon productions in the Netherlands, Germany, and South Africa and it is still often revived—a huge success for a small-scale and understated drama..."

Here's the BBC version with the original stage cast: Ralph Richardson, John Gielgud, Dandy Nichols, Mona Washbourne and Warren Clarke:

Once bitten in the Lancet

The February issue of the Lancet Psychiatry includes my "Once bitten", my review of the book Dracula for Doctors by Fiona Subotsky.

“According to Pliny in the first century AD, 'epileptic patients are in the habit of drinking the blood even of gladiators,' considering it 'a most effectual cure for their disease.' Medical science took longer to accept the restorative powers of someone else's blood. During the summer of 1492, in an event sometimes claimed as the first transfusion, the comatose Pope Innocent VIII was reportedly given blood from three ten-year-old boys. The boys died, as did the Pope, and the doctor fled...”

I posted a little more about Dracula for Doctors last month. 

I'm Just Having Fun in the Lancet

The new issue of Lancet Psychiatry (January 2020) features my review of the Wellcome Collection's current exhibition, "Play Well".

In a 2013 interview with the Daily Mail, the then Education Minister, Liz Truss, said she wanted nurseries in England to be more like those in France, with structured activities for preschool children led by graduate-level staff. “I have seen too many chaotic settings,” she said, “where children are running around. There's no sense of purpose.” Some people criticised—and mocked—this idea of imposing objectives on toddlers, but, as the Wellcome's new exhibition demonstrates, play has long been a serious business...

You have to pay to read the full review. The exhibition is free and runs until 8 March 2020. Details here:

• "Pay Well" at the Wellcome Collection

"The Man With Two Brains" in the Lancet Psychiatry

"Me and my brain" is a piece I've written about 1983 comedy The Man with Two Brains, and the history of brain transplants in fiction more generally, for the new issue of the Lancet Psychiatry (vol. 4, no. 12, December 2017). You need to be a subscriber to read the whole thing, but the Lancet website boasts the opening paragraph:

"The Man with Two Brains (1983), the classic comedy starring Steve Martin, is about a love triangle. Beautiful but wicked Dolores Benedict (Kathleen Turner) is hit by a car driven by neurosurgeon Michael Hfuhruhurr (Martin). He saves her life and falls for her but, once married, Dolores delights in tormenting him. Then Michael meets someone else. He has a lot in common with nice Anne Uumellmahaye (voiced by Sissy Spacek)—not least an unpronounceable surname. The only snag is that she's a brain in a jar."

And the Lancet Psychiatry tweeted the following tantalising excerpt:

"Despite the jokes, fun, and adventure, there's something deeply unsettling about the idea of brain and mind transplants. It plays on anxieties about the distinction between our physical body and our identity, and the linked fear of our bodies failing us through accident, illness, or decrepitude, redefining who we are. It speaks to anxieties about our own uniqueness and autonomy, and the threat of personal annihilation. And then there's the ongoing concern of how scientific and economic change threatens our personal control. It's ripe for further exploration, not just in research but in comedy and horror, because it's a subject best met with nervous laughter."

1927 review of William Hartnell

According to the Oxford Dictionary of National Biography, William Hartnell – later, the first Doctor Who – trained as an actor at the Italia Conti Stage School. In 1924, aged 16, he joined the repertory company of actor-manager Frank Benson.

The ODNB says Hartnell “often” appeared in eight plays in a single week. I've found little supporting evidence for this in the contemporary press – but then the press wouldn't necessarily name every member of a cast, especially if they played only a small role.

Benson's company was well known for its productions of Shakespeare and Wikipedia lists appearances by Hartnell in The Merchant of Venice, Julius Caesar, As You Like It, Hamlet, The Tempest and Macbeth all in 1926. The same year he also appeared in She Stoops to Conquer and School for Scandal, and the following year in Good Morning, Bill. I've seen his name in cast lists but no reviews that comment on his performance - until now.

The following review was published on page 8 of The Devon and Exeter Gazette on Tuesday, 15 November 1927.

A THRILLER
“The Man Responsible” at Exeter Theatre.
SENSATIONAL PLAY
The Theatre Royal, Exeter, during the past season or so has staged a number of “thrillers”, but they have been, with the possible exception of “Dracula”, thrillers of a wholesome character. We recall such dramatic sensations as “The Ghost Train”, “The Bat”, “No. 17” and “The Cat and the Canary.” This week a thriller of a totally different character is being presented in “The Man Responsible.” The play, it is true, is full of thrills, but thrills of a nature which hardly appeal to the ordinary theatre-goer we should imagine. It opens upon an unpleasant note, and as the play develops situations arise which are unpleasant in the extreme. The drugging and hypnotising of a promising young doctor by a specialist driven mad by revenge for the death of a daughter by an illegal operation, and the forcing of the young medico to perform a critical operation on his mother, who dies while under the influence of the anaesthetic, form sensational thrills, but whether they are of a wholesome description is another matter. The reference to the “Justice of the Almighty being too slow” in the “trial scene” is not pleasant, to put it mildly, even though it be the ravings of a madman. To our mind “The Man Responsible” strikes the note of “melodrama gone mad.” Probably we shall be hauled over the coals for our opinion, but the duty of a critic seems to us to be to express his opinion, and this is the opinion of our critic. By the way, what has Exeter done to be mentioned as near the scene of the play?
    The company who present the play have a difficult task, and the most difficult of all is that which falls to the lot of Mr. William Hartnell, to whom is entrusted the all-important role of Dr. Ronald Warden, the tortured young medico. It was a realistic playing of the part for which Mr. Hartnell was responsible. First there was the brilliant young medical man, eager and enthusiastic, standing at the threshold of what promises to be a useful and splendid career. Then there comes the transformation into the drugged, nervous wreck, the tool of the medical maniac. A wonderful realistic presentation Mr. Hartnell gave, and his audience accorded him the whole-hearted applause he deserved. Miss Mabel Heath gave a sympathetic rendering of Annie Ritter – another part calling for careful handling. Mr. A Fellows Bassett gave a “Svengalistic” touch to the role of the hypnotising maniac, Dr. Morris Morton, while Mr. Harold Greaves was convincing as Dr. Felex Gordon. Miss Hazel Morne did well as Marion, and the minor roles of Vernie (Miss Dulcie French), Mrs. Warden (Miss Eugenie Vernie), and Jensen (Miss Sylvia Rimmer) were well presented. There will be the usual Friday matinee.

The following year, Hartnell had a role in Miss Elizabeth's Prisoner, alongside the actress Heather McIntyre. They married in 1929. In 1932, Hartnell made his first appearance on film in Say It With Music.

Mr Holmes

The new issue of medical journal the Lancet Psychiatry boasts my review of the film Mr Holmes starring Ian McKellen as an aged and decaying Sherlock. It's a follow-up to my piece on the Museum of London's recent Sherlock Holmes exhibition.

Also of interest in the new issue is a review by Deborah L Cabaniss, Clinical Professor of Psychiatry at Columbia University, of the Pixar movie Inside Out:

"This stunning and popular movie should be required viewing for anyone in the mental health field."

Four non-fiction books

"The people interested in the history of comic books are not the same as the people interested in the history of the polygraph. (And very few people in either group are also interested in the history of feminism.)"

Jill Lepore, The Secret History of Wonder Woman (2014), pp. 295-6.

The Secret History of Wonder Woman is extraordinary: a compelling, strange secret history of alternative sexuality and modern times. William Moulton Marston - under the pseudonym Charles Moulton - based the superhero he created on his wife and their girlfriend - the latter the niece of Margaret Sanger, the campaigner who popularised the term "birth control". There are reasons why Wonder Woman proclaims "Suffering Sapho!" and that she's so often tied up in chains...

Marston, who invented a "lie detector" based on a test of systolic blood pressure, which later led to the polygraph, was shrouded in falsehoods - about his private life, about who in his household wrote what, about his qualifications as a psychologist. There's lots on how his threesome contrived to build a myth around him, and how for all he extolled the versions of men submitting to dominant women, he rather had it the other way round.

The epilogue is especially interesting, placing the feminist reclamation of Wonder Woman in the early 1970s amid what else what happening in the feminist movement at the time. The examples Lepore cites of "trashing" seem like a modern phenomena.

I also remain haunted weeks after finishing Do No Harm, a memoir by brain surgeon Henry Marsh. Marsh recounts a number of different cases where he has got it right or wrong - the latter always with horrific consequences. Really this is a catalogue of the terrible awfulness that life brings to us, and of human efforts to get through it. Marsh is painfully honest about his own fears and weakness, but what haunts me are his perfect turns of phrase: that all surgeons are carry with them cemeteries of the patients they have wronged; that, when facing the angry parents of a young patient, love is selfish; that doctors forget patients and patients forget doctors if everything goes well, and it's only the tragedies that linger...

Marsh's anger at the management and cut-backs, and the effect he can see them having on people's lives, echoed Nick Davies' Hack Attack, his account of the hacking scandal that he originally broke in the Guardian. At the end, he rants against a system that has removed accountability from our political systems, where even the most terrible personal tragedy has become a commodity. Like Marsh, Davies is forthcoming about his own failings - how he missed connections or said the wrong things or jeopardised his whole case. He's also good in making his account of Leveson so much about human character.

And now I am 35 pages into H is for Hawk, which is currently collecting literary prizes all over town. It turns out to echo much of these other books - how we handle tragedy and injustice and anger, how we're losing the old world in exchange for something as yet unknown. I'm not quite sure what it's about yet - so far a memoir of loss, some personal history and falconry, and the works of TH White (I am also rereading The Once and Future King) - but there's this striking moment on the process of grief, gleaned from too many books.

"I read that after denial comes grief. Or anger. Or guilt. I remember worrying about which stage I was at. I wanted to taxonomise the process, order it, make it sensible. But there was no sense, and I didn't recognise any of these emotions at all."

Helen Macdonald, H is for Hawk (2014), p. 17.

The Couch on which John Hunter Died

The Hunterian Museum at the Royal College of Surgeons in London is a fascinating place full of dead things in jars. The surgeon John Hunter (1728-93) collected specimens of lizards and other animals, using them to teach the next generation of doctors.

"While most of his contemporaries taught only human anatomy, Hunter's lectures stressed the relationship between structure and function in all kinds of living creatures. Hunter believed that surgeons should understand how the body adapted to and compensated for damage due to injury, disease or environmental changes. He encouraged students such as Edward Jenner and Astley Cooper to carry out experimental research and to apply the knowledge gained to the treatment of patients."
- Hunterian Museum website

It wasn't just medicine that benefited from Hunter's collection. In 1824, Gideon Mantell tried to match a fossilised fragment of jawbone he'd discovered to a comparable modern-day creature. He visited the Hunterian Museum, where assistant-curator Samuel Stutchbury saw a resemblance - in shape if not size - to a specimen of iguana. The following year, Mantell announced to the Royal Geological Society the discovery of Iguanadon - "iguana-tooth". Along with the fossilised remains of two other creatures, Iguanadon would later be used to define a new kind of animal: the dinosaur.

I visit the Hunterian Museum a fair bit, most recently to look up what it has to say on regeneration - the way some animals are able to regrow lost limbs. (I should also declare an interest: my dad volunteers there and gives a good talk every other Friday on the history of syphilis.)

The collection, though, is not just of animals: there are also plenty of human bodies - whole ones as well as partial bits of interest. If this can leave visitors feeling a bit squeamish, the ethos is very clear: by better understanding the body and how it can go wrong, we can better mend injury and cure disease. That said, deciding what specimens count as "better understanding the body" can be open to debate, such as the museum continuing to display the body of Charles Byrne, the "Irish Giant", against his clearly stated views.

I don't have a problem with Byrne's skeleton being displayed, but I was struck by something else I saw this week. By the reception of the Hunter Wing of St George's Hospital in Tooting there's a display devoted to Hunter. The hospital has just done very well in the results of the Research Excellence Framework for 2014 and links its current research to the precedent set by Hunter - who worked at St George's, but back when it was based at Hyde Park Corner (the hospital moved in stages between 1976 and 1980).

I can see why it might not be appropriate to show medical specimens as people go to their medical appointments in the hospital - it would be too blunt a reminder of our inevitable fate. But is the couch on which Hunter died a more tasteful relic for display? It doesn't seem to do much for the better understanding the body. I find myself more bothered by that the bones of Charles Byrne.

Sci-Fi London winners

The nice people at Sci-Fi London have announced the winners of this year's 48 hour challenges to make films and tell stories.

For each competition, entrants had 48 hours to entirely create an original work based on stuff we gave them on the morning of Saturday 12 April: the title, a line of dialogue, a prop or action, and an optional science theme or idea (created by readers of New Scientist).

As you may remember, two years ago, Brother Tom, I and a gang of handsome desperadoes threw our all into the 48-hour film challenge. Read of our adventures making Revealing Diary.

This year, I was one of the three judges on the "flash fiction" short story competition, helping Charles Christian and Robert Grant whittle the entries down to one winner and two runners up:

1. "Silent Storm" by Erin Johnson (PDF)
2. "The Journey" by Bisha K Ali 
3. "Tomorrow At Noon" by Glen Mehn

Congratulations to Erin, Bisha and Glen, and well done to everyone who took part. You can also watch the winning storytelling film and short films here:

"Shift" by Gareth Topping:



The March by Mission Media / Black Ant



The two runners-up in the film-making contest were Back Issue by the Creepy Guys:



And Life External by Bokeh:

Some items of interest pertaining to Sherlock Holmes

First a review of The House of Silk, and then some other items of Sherlockian interest...

The House of Silk by Anthony Horowitz is a thrilling, richly drawn new Sherlock Holmes adventure, that gets Holmes, Watson and their world pretty much perfectly right. It's a gripping read, and even though I was ahead of Holmes with several of the clues, it kept me guessing till the end. Yet, it left me disappointed. Why?

The edition I read included a bonus feature: "Anthony Horowitz on Writing The House of Silk: Conception, Inspiration and The Ten Rules". It's fascinating to read the rules Horowitz set himself when writing the book - such as "no over-the-top action", "no women", and "no gay references either overt or implied in the relationship between Holmes and Watson". But including those rules is also surely a challenge to the reader: how would you write Holmes?

Horowitz's rules seem largely to do with not repeating the mistakes or attempting to emulate over iterations of Holmes, and to stick closely to the canon of stories written by Conan Doyle. But they didn't explain my misgivings with the book.

Horowitz is keen to slot his book seamlessly into the canon. I found the constant references to other, canonical cases a bit wearing. One rule - "include all the best known characters - but try and do so in a way that will surprise" - struck me as odd. Yes, he's got Mrs Hudson, Lestrade, Mycroft, Wiggins, and even an appearance by someone Holmes hasn't yet heard of - a fact that, to fit with the canonical stories, requires some awkward contriving:

"You must swear on everything that is scared to you that you will never tell Holmes, or anyone else, of this meeting. You must never write about it. You must never mention it. Should you ever learn my name, you must pretend that you are hearing it for the first time and that it means nothing to you."

Anthony Horowitz, The House of Silk (2011), p. 260.

But are these characters' roles surprising? As Horowitz admits,

"In each case, I added very little to what was known about them simply because it seemed to be taking liberties."

Ibid., p. 404.

Where he does develop the world of Sherlock Holmes. As Horowitz says, in Doyle's stories,

"Victorian London is economically sketched in".

Ibid., p. 397.

Horowitz digs a little deeper: there's an insight into the kind of awful existence lived by the Baker Street irregulars when not engaged in cases for Holmes; there's a visit to one of the prisons to which villains are dispatched when Holmes has caught them. In both cases, Watson seems surprised by the oppressive conditions, as if a practising doctor in London would not already know. But I liked the attempt to explore the world Holmes lives in and furnish extra depth.

That depth is partly the result of the length of the book.

"My publishers, Orion Books, had requested a novel of between 90,000 and 100,000 words (the final length was around 94,000) - big enough to seem like value for money on an airport stand. But actually, this goes quite against the spirit of Doyle's originals which barely run to half that length".

Ibid.

Horowitz's solution is to have Watson recount two cases, not one - a trick also used in the later episodes of the TV series starring Jeremy Brett, where they blended Doyle's stories.

All of which, again, I cannot fault. And yet, these two aims - to fit The House of Silk perfectly within the canon, and to explore the world of Holmes - also also what left me dissatisfied. In the latter, the world we explore is murky and cruel, with corruption reaching so high into the establishment that even Myrcroft is powerless to act.

One of the mysteries that Holmes exposes is particularly vicious - and of a kind Doyle himself could not have published in his own time. It's not the crime but the way it fits Horowitz's general character of Victorian London that makes it so affecting: Holmes might stop what's happening, but only in this one instance.

On top of this, in fitting this adventure into the canon, Horowitz also seeks to reconcile a continuity error in Doyle about when exactly Watson married. Some Sherlockians have conjectured that Watson was married twice; Mary Morstan - who Watson married at the end of The Sign of Four - must have died at some point and Watson remarried. Horowitz confirms this hypothesis, with Mary mortally ill.

That the whole book is narrated from after Holmes has died only adds to the bleak feeling. For all his rules, Horowitz has missed a key ingredient of the canon: the element of joy. Holmes might walk through the mire of crime, but the stories celebrate his brilliance. The Final Problem, in which Holmes meets his match, is affecting and extraordinary precisely because it's so unlike the norm - and, in The Empty House, even the great detective's death turns out to have a solution.

That's what The House of Silk sadly misses: Sherlock Holmes is not about awful problems but the ingenious answer.

I think the current run of Sherlock on BBC One has got the mad, thrilling flavour of Doyle just right. I adored The Sign of Three last week, but my chum Niall Boyce was bothered by the central wheeze: that a victim would not know they'd been stabbed because of the tightness of their clothing. Niall's an editor of the medical journal, the Lancet, so tends to spot these things.

In fact, just such a killing has a precedent - and from Doyle's own time. Elisabeth, Empress of Austria, was murdered in September 1898:

The assassination of Empress Elisabeth of Austria,
via Wikipedia.

"After Lucheni struck her, the empress collapsed ... Three men carried Elisabeth to the top deck and laid her on a bench. Sztaray opened her gown, cut Elisabeth's corset laces so she could breathe. Elisabeth revived somewhat and Sztaray asked her if she was in pain, and she replied, "No". She then asked, "What has happened?" and lost consciousness again...

The autopsy was performed the next day by Golay, who discovered that the weapon, which had not yet been found, had penetrated 3.33 inches (85 mm) into Elisabeth's thorax, fractured the fourth rib, pierced the lung and pericardium, and penetrated the heart from the top before coming out the base of the left ventricle. Because of the sharpness and thinness of the file the wound was very narrow and, due to pressure from Elisabeth's extremely tight corseting, the hemorrhage of blood into the pericardial sac around the heart was slowed to mere drops. Until this sac filled, the beating of her heart was not impeded, which is why Elisabeth had been able to walk from the site of the assault and up the boat’s boarding ramp. Had the weapon not been removed, she would have lived a while longer, as it would have acted like a plug to stop the bleeding."

Wikipedia: Empress Elisabeth of Austria - 10. Assassination

Niall also provided me with two snippets of Sherlockian interest from the Lancet archives, which he's kindly allowed me to share. First, here's Conan Doyle weighing in on the case of George Edalji - the case that's the subject of the novel Arthur and George by Julian Barnes, which I blogged about in 2007.

Niall also tweeted this later contribution from Doyle's son, "Was Sherlock Holmes a Drug Addict?", in 1937:

You may also care to note that I passed Doyle's house in South Norwood a couple of months ago. And, if you've not already discovered it, John Watson's blog - written with some assistance by m'colleague Joseph Lidster - has been especially good this series.

"Lunacy" and the Bride of Frankenstein's Mum

The Dr has been much absorbed by the second most festive of her Christmas presents, Inconvenient People - Lunacy, Liberty and Mad-Doctors in Victorian England by Sarah Wise (2012), a history of mental health institutions with lots of horror stories worse than what happened to the first Mrs Rochester.

The book, says the Dr, debunks a lot of myths: men were much more likely to be incarcerated, and people were often locked up because they were an embarrassment to their families or because of disputes over money and inheritance. She was particularly pleased to show me this account following the introduction of the Lunacy Act 1890, by turns amazing and chilling:

"The first major case for the new law came in 1895. Edith Lanchester was the epitome of the New Woman of the Nineties: educated to degree level, she was a white-collar worker, a Socialist, a feminist, and determined to spend the rest of her life with her lover, James Sullivan, a railway clerk, in their Clapham Junction lodgings, without marrying. Her father, a wealthy architect, was having none of this, and on the evening of Friday 25 October 1895, he and two of Edith's brothers dragged her to a carriage, tied her with rope, and deposited her at The Priory, Roehampton. It was all very old-fashioned. 

An 'urgency order' had been written by Dr George Fielding Blandford [...] Blandford's rationale for authorising Lanchester's detention sounded decidedly quaint in 1895, and indeed there was some sniggering when his diagnosis became public: 'She says she is going to live with a man below her in station because marriage is immoral. This she argued in a wholly irrational manner.' Blandford stated that certification would have been unquestioned if Miss Lanchester had threatened suicide; as it was, she was threatening 'social suicide', which had justified his saving her from 'utter ruin... She had a monomania on the subject of marriage, and I believed that her brain had been turned by Socialist meetings and writings, and that she was quite unfit to take care of herself.' 

Coincidentally - and fortunately - just two days later the Commissioners in Lunacy turned up at The Priory for a statutory visit; and as her father had not yet had time to obtain a magistrate's order and a second lunacy certificate, they immediately freed Edith. She was brought back to Clapham in triumph by her comrades from the Social Democratic Foundation, who helped to keep the tale of 'The Socialist Romance' in the newspapers for weeks. Fresh from his destruction of Oscar Wilde, the Marquess of Queensbury - atheist, divorcé - wrote James Sullivan a supportive letter offering to pay any legal costs: 'I should like to shake you and your wife [sic] by the hand... You have a chance now of making a public protest, as everyone's attention is attracted. What is their idiotic [marriage] ceremony?' (Lanchester and Sullican never married and lived together until James's death in 1945; their daughter, Elsa, went on to be the Hollywood star of Bride of Frankenstein - a different kind of horror story.) 

The Lanchester case had shown that the new lunacy system seemed to be working, as the victim had been speedily freed. However, some things clearly hadn't changed. The Commissioners refused to take any action against Blandford or the Lanchester family. Her counsel also warned Edith not to go ahead with a private prosecution, as it would be an expensive failure to try to prove in court that malice - rather than a genuine mistake - lay behind the attempt to have her certified."

Sarah Wise, Inconvenient People - Lunacy, Liberty and Mad-Doctors in Victorian England (2012), pp. 377-8.

(The Dr's most festive present was of course Paul Preston's The Spanish Holocaust).

IVF

Something different for my 900th post. I don't normally blog personal stuff, but the Dr and I want it out in the open that we're doing IVF. There's a weird taboo around the subject, and even people who know that we're doing it don't always know what it entails or quite how to respond. We're just starting our second attempt, and a lot of people seemed surprised that the first go didn't work. IVF is not some miracle pill that lets “career women” have babies later. It's a last resort, with the odds stacked up against it.

This goes on a bit, is probably a bit mawkish and we know that everyone has their own shit to deal with. But anyway, here goes...

The usual method of making a baby is via the ancient combination of alcohol, fumbling and interlocking body parts. There are all sorts of reasons why this might not work – apparently some one in seven couples have fertility problems. All sorts of tests and treatments can help spot the problem and, with luck, sort it out.

This all takes time. You might hear helpful comments about IVF being for women in their mid-thirties who have “left it too late”. The Dr and I have been “trying” (i.e. with alcohol and interlocking parts) since before we got married in 2004, when we were both in our late twenties. The doctors won't consider you've got a problem until you've been trying for about two years, so we started tests in late 2005.

There are a lot of tests: taking supplements, giving samples, prodding around in the plumbing. We collect matching punctures from the blood tests. None of it is particularly fun, and we made regular trips to the GP and two separate hospitals. I'll write about the joyous practicalities of sperm tests – and the instruction sheets they give you – another time. Medical stuff works on the basis of “Have a go and see what happens.” We tried a lot of different things.

For most of 2008, the Dr was on nasty stuff called clomid which made her paranoid, weepy and claustrophobic. About 11 pm every night she'd want to be home in bed, and away from other people. We didn't know this at first, of course, but worked it out by degrees. By the last month of the treatment I'd realised that when the Dr said “I want to go now”, whatever the time, wherever we were, we had to get up and go – usually without saying goodbye to anyone.

Gradually, I also worked out that I should let people know at the start of a night out or meal or wedding that this was what we might do. “Don't,” I'd say, “worry, or hold us up as we go. We'll just disappear.” And it helped to have enough money on me for taxis so as to avoid crowded trains. Generally, it made even the most simple tasks much more complicated. And after all those months, the clomid didn't have any positive effect.

If none of these tests and experiments work you get put on to in vitro fertilisation (IVF), where instead of using alcohol and interlocking parts the sperm and egg are mixed up in a petri dish. We were recommended for our first go at IVF in late 2008, and went through it last summer – more than five years after we began “trying”, and in our mid-thirties.

There are all sorts of percentages for how successful it will be depending on the exact problem. For example, you seem to have a better chance if the chap's sperm is okay and the issue is with the lady. The statistics are also less good for women after they turn 35 – we're luckily just inside that bracket before we try this second go. One doctor said this was because we had “got through the tests relatively quickly”, so some poor women must find this all especially cruel.

Once you're doing IVF, the process takes about two months. The wheeze is to jump-start your system to get it going, then extract the bits, put them together manually and re-insert them into the womb. There are distinct stages, and – a bit like end-of-level baddies in a computer game – you can only progress to the next stage when you've passed the last one.

First you go on what's basically the pill. Then, on the 21st day of your cycle you start injecting yourself with drugs that effectively put you through the menopause, shutting down your system. Symptoms of that can include hot flushes, night sweats, hormones all over the place (so lots of crying for no reason) and hair growth (sadly, the Dr didn't grow a beard). You have to inject the drugs at the same time every day, you can't drink and you're not scintillating company anyway. So it kills your social life.

After two weeks you go for a scan to see that your insides are shut down. If they have you're on to the next stage, injecting the menopause drugs and the drugs that put you through puberty. That's why you feel like you're being pulled in two directions. The Dr felt giddy, found it difficult to concentrate and kept forgetting things (she lost her mobile phone three times last year while on the various drugs). She only wanted to eat sweets and her body changed shape completely.

All the stuff with the clomid the previous year had prepared us a bit for these side effects. Knowing to leave early and to apologise in advance made things a little easier, but you're constantly on edge, madly hoping that you'll get to the next stage. It's also not easy to see someone you love going through something like this – and being completely unable to help.

Then there's another scan to see that your ovaries are producing follicles – the things that house the eggs. You'll have some idea already if it's working because you're swollen and sore, and even walking a step is painful. If it is working, they call you in for what's called a "harvesting", where they remove the follicles. This process hurts, so they put you on opiates and you still feel pretty wiped out and bruised. You're not allowed to leave on your own; you need someone else there to ensure you get home. The Dr was bruised for weeks afterwards.

They're hoping for about 10-12 good eggs from this harvesting, so there's some to fertilise and some to freeze so you can skip to this stage if you need to go through the process again. If you're with a chap, he donates his sperm at this stage and the boffins put it all together.

If that putting together works, two days later you're in again for the implantation, which is pretty straight-forward and easy. Then you wait two weeks to see if it's worked. “Try not to worry,” they say, as one might advise, “Try to walk to the Moon”. You get used to the matter-of-fact language as you go through the process. “If you've not bled after a fortnight,” they tell you, “do a pregnancy test”. Depending what statistics you read, at implantation your chances of pregnancy are about 40%.

Once there, you face all the normal risks of pregnancy, though IVF increases your chances of having twins which can mean a whole number more complications. Most people I've talked to who've done this thing see twins as just catching up on all the time spent getting this far.

But if it doesn't work – and last time ours didn't on the 14th day – you can try again.

It's all a numbers game, with the waiting “room” (a corridor) at the Assisted Conception Unit filled with the same despair and desperation, the plaintive longing for miracles, as in any Ladbrokes. According to the British Medical Journal,

“One cycle of IVF offers a 25% chance of pregnancy; three cycles offer a 50% chance”.

On that basis, the National Institute for Clinical Excellence in 2004 published guidelines,

“aimed at raising infertility service provision in England and Wales to the standards enjoyed elsewhere in Europe”,

which included the key recommendation of,

“up to three free cycles of in vitro fertilisation (IVF) for couples who have been unable to conceive for three years because of an identifiable reason—provided that the woman is under 40 years old.”

Caroline White, "Infertile couples to be given three shots at IVF", BMJ. 2004 February 28; 328(7438): 482

That recommendation is still not happening: it all depends where you live and which health authority you're under. We're caught between two health authorities, so went with the one that said it would pay for two goes. Until, that is, we actually needed to have a second attempt, when it admitted it would only pay for one.

It's about £4,000 to go through the whole thing (roughly what I get paid for a novel), and about £1,000 if you've got eggs already frozen, plus the £400 per year for freezing them. There's a brilliant bit of internal market cleverness when it comes to buying the drugs – the hospital gives you a list of the drugs you need and numbers for three suppliers. You take a morning off and ring round these people, getting the best price. There was about £70 difference between them, depending on postage arrangements. We couldn't, though, then order the drugs ourselves. We had to schlep back to the hospital who did it for us. Any savings made had been lost in the time faffing about. But this is apparently a key part of “Patient Choice” and is somehow empowering for us.

We've also had delays because of ongoing building works at the hospital, and our second go looks like it will be split between two different sites, so there'll be added excitements about where we're meant to be for any given part of the cycle. Ordinarily, stuff like that would just be annoying, but on something so complex, emotional and intrusive, it leaves you howling at the sky.

It also doesn't help that we already know what to expect – the side effects and pain, the desperate hope and even more desperate disappointment. It took several months for the Dr to get the drugs out of her system last time; she still felt clutzy and forgetful, and kept finding herself lost or double-booked.

There are difficult decisions to be made about how long you try for: how much the drugs affect the lady, how much you can afford, how close you get at each stage, how much you're wasting your time. It is, all told, weird and knackering. It's like we've both been carrying this weight around with us for years.

You start noticing how much female identity is built up on having kids – especially when women get to their late twenties. It's still surprising how often strangers will ask if you have children and then ask why not – are we “focusing” on our careers? You notice how many people see their kids as an achievement, not the result of alcohol, fumbling and interlocking parts and being lucky in the draw. We've been envious, yes, and sometimes upset, as our friends and relations get pregnant with such relative ease. It's not quite the same as watching my colleagues get thrilling writing gigs – where I'm torn between thinking both, “Good for them,” and also “Bastardsbastardsbastards!”

Sometimes we've hidden away from celebrations rather than be spectres at the feast. Not that that's how other people treat us, it's how we feel ourselves. I struggled for a long time to explain how this feels, but a good friend, K., described what we're going through as a kind of grief. That's exactly what it feels like – as if part of our future has died.

And yet through all of this the Dr and I are closer than we've ever been. Oh, we've had some spectacular rows, but mostly its being howling at the sky rather than each other. I don't think we'd have made it this far otherwise. And we've learned who our friends really are. The weirdest thing about all of this is what it does to other people as they try to help. There's the cheery teasing about us not turning up to things, or about leaving early. Or the ones who interrogate us about how we're feeling and want details of all the worst bits. Or – a favourite – those who tell us how difficult being pregnant and having kids is, as if in many ways we're blessed.

I know it's all well meant but these things don't really help. All that happens is that we want to withdraw, to hide away and lick our wounds. One kind person even told us – for our benefit, I'm sure – that we were being over-sensitive. But it's difficult to feel anything but broken, and constantly pelted with stones. There's news of abuse or neglect of children, or you see people shouting at their kids in the street, or yet another “authority” speaks out about IVF or even that marriage is all about having kids, or that some medical condition is a moral judgement on the person who has it, and it's like twisting the knife.

We're not expecting the second go at IVF to work. We're already prepared for the result of that: the blunt statement that we can't have children. We just have to grit our teeth and get on with it; whatever happens, then we can move on.

So the best thing is not to crowd us, or worry if we disappear. But it is good to know that our friends are thinking of us. The best thing to ask is, “How are things going?” and after that, “Would you like a drink?”

Who. Am. Iiiiii?

Had an appointment at that hot-bed of terrorism University College London this afternoon. Got taken for lunch in the Senior Common Room - by someone both senior and common - and admired the paintings.

As we left, I noticed this plaque in honour of a local celebrity, but can only assume it was researched on Wikipedia. Where is the mention of "The Rapture", or those four episodes of Sarah Jane's Adventures?

Thence with Nimbos to the Wellcome Collection for a nose round their free Identity show, which runs until 6 April. In eight rooms - with doors which are hiding - we learn of nine lives that illuminate what makes us who we are.

There were plenty of top facts and things to ruminate on. One caption explained that the publishers of the first version of Pepys' diary (Latham and Matthews, 1983),

"took advice on whether they were likely to be prosecuted under the 1959 Obscene Publications Act by printing for the first time Pepy's reference to his wife's menstruation."

Pepys' contemporary Robert Hooke, meanwhile, kept a diary from 1672-80 that was limited to "terse observations of fact" - though he did helpfully use a "Pisces" symbol to mark days on which he ejaculated. On the wall behind these extracts played diary extracts from Big Brother.

The exhibition deftly mixes up the lives as lived by people, and the pioneers and theorists transforming how we (think we) live our lives. There's the impact of IVF has on a family of twins, and people who've campaigned and had surgery to change the gender-labels affixed at birth.

I was also impressed by the room shared by Sirs Francis Galton (inventor of eugenics and the fingerprint) and Alec Jeffreys (pioneer of DNA profiling), and the wealth of detail about phrenologist Franz Joseph Gall - including how much he was mocked in his own time.

A set of stairs also leads up to the permanent exhibition on Wellcome himself, packed with the odd things he collected. I loved the caption on Hiram-Maxim's Pipe of Peace:

"Hiram Maxim (1840-1916) invented the machine gun and also a patent inhaler (his Pipe of Peace), which he devised to treat his bouts of bronchitis. His friends worried that this invention could damage his reputation. As he said: "It is a very creditable thing to invent a killing machine, and nothing less than a disgrace to invent an apparatus to prevent human suffering."

Pipe of Peace and Maxim Inhaler by Sir Hiram Maxim
English, acquired before 1936
Medicine Man exhibition, Wellcome Collection, London.

Holes in our heads and other stories

"People are too often terrible advertisements for their own beliefs."

Derren Brown, Tricks of the Mind, p. 357.

The Dr took me to see Derren Brown's magic show, Enigma, for my birthday back in June. Even before I'd read his book I suspected how some of the tricks might be done. Perhaps he wasn't reading people's minds, he just remembered which cards they'd taken; perhaps he used a loaded die...

I'd thought the book, Tricks of the Mind, would be a magic primer, detailing his card-sharpery and the mechanics of illusion. Indeed, Brown begins with a simple coin trick and a simple card trick. He explains misdirection and showmanship – at least as important as the simple “trick” of palming a coin or remembering a sequence of cards.

But he then goes on to explore all kinds of gaps in our cognition that can mean we’ll believe very odd things. In doing so, we learn how to use our memories better, how to hypnotise ourselves, and see how neuro-linguistic programming, psychics and other belief systems are able to ensnare us...

Brown tells us he uses a mixture of these techniques himself. He also tells us something much more important: that what he does is a trick.

The joy of magic, I think, is in knowing it’s a trick – a way of fooling our perception a given event. The performer doesn't really have psychic abilities or a way to sidestep physics. We just have to puzzle out how it was done. Brown talks about laying false clues to muddle the audience when they try to review what they've just seen. But even if we can't figure out how trick is done, we know there is an answer.

On that basis, it's easy to see where Brown's thinking overlaps with scientific enquiry. He's intrigued by NLP but cynical about its cult of personality and resistance to meet its great claims with evidence. Brown is a doubter, though he also talks earnestly about having previously been an evangelical Christian. There's a sense - one I sort of share - that he hates the thought of being fooled again.

He might labour the point, but Brown’s good at explaining why, if you have a proposition – that a certain chemical has healing properties, that the world works in a certain way, that there’s some kind of God – the onus is on you to prove the proposition is true, not for others to prove that it isn't. That's especially important if your proposition encourages some kind of action.

With the zeal of the convert Brown hopes to convince us to doubt. In many ways, Brown's book reminded me of Dawkins' The God Delusion – it's smart, it's lively, it covers a great deal of ground and it explains complex ideas simply. Yet the petulant tone makes it read as if written by a clever 17 year-old. It’s hectoring, ranty and the jokes are often forced. That can give the impression – in both books – that the author has all the answers, whereas the whole point is that we don't settle on easy answers.

Rather, Brown explains the strangeness of reality. In the section on lying, he explains how people telling the truth include all kinds of odd, incongruous details. (I'm reminded of Orwell on Charles Dickens and the genius of his “unnecessary detail”.)

On which point, though I've still not got to Ben Goldacre, I'm hesitant about m'colleague Jonny's review of it:

"Yes! That’s exactly what I already thought, but put slightly more clearly!"

As Brown and Dawkins both spell out themselves, a lot of science is counter-intuitive. In fact, one good test of a scientific theory is whether it confirms what the proponent already "knows". Brown has a whole section on "confirmation bias".

That in turn reminded me of Flat-Earth News by Nick Davies – and especially the bit on heroin use and the war on drugs, where policy seems based on comforting, fundamental beliefs and not on physical evidence.

In fact, Brown’s book has make me connect dots between all sorts of disparate stuff. I shall blog at some point on Father Christmas and on birthdays – two subjects much scrawled in my notebook.

Tricks of the Mind is then a primer not in magic trickery but in strange and wondrous reality. Despite the painful jokes and adolescent tone, it’s an extraordinary book.

Other recent reads:

Austerity Britain by David Kynaston
Loved this; intend to blog my notes. But then I said that about Flat-Earth News, too. Oops. So here’s the Telegraph’s glowing review.

A Man Without a Country by Kurt Vonnegut
A funny, provocative collection of leftie newspaper columns full of sharp one-liners. Not as heavyweight as the other stuff of his I’ve read, but more hits than misses.

The Ghosts of India by Mark Morris
Doctor Who in an exciting adventure with Ghandi. Mark explores the last complex and controversial days of the Raj, for ages eight and up. Plus there’s spooky monsters. I wish I’d thought of this.

Johannes Cabal – The Necromancer by Jonathan L Howard
Reviewed for Vector, but didn’t think that much of it.

Me, Cheeta by Cheeta and James Lever
Another birthday present, the autobiography of the chimpanzee who played Tarzan’s mate. I thought the joke might wear thin quite quickly, but it’s an often very funny read. Sometimes it’s funny because we read between the lines, sometimes because of Cheeta’s animal perspective. Cheeta’s last meeting with the aged Johnny Weissmuller is beautifully moving. What’s more, it’ll be hard to hear salacious showbiz tales without thinking of that ape.

Now reading Spies by Michael Frayn.

“Have a go to see what happens”

Blood and Guts – A History of Surgery is a fascinating, gruesome, layman-friendly book, packed with anecdotes and horror stories. Author Richard Hollingham, following Michael Mosley's TV series, takes us from Galen's treatment of gladiators in the Second Century AD, through Vesalius and Paré in the Sixteenth Century to 2006, where Stuart Carter was freed from paralysis by Parkinson's disease through the use of electrical brain implants.

Hollingham argues there were four obstacles to successful surgery: surgeons needed to understand the workings of the body (usually through dissection of dead bodies); they had to learn from the experience methodically; they had to bypass the pain of an operation (by inventing anaesthetic); and they had to prevent infection.

So we follow the haltering steps towards achieving these goals, such as the discovery of chloroform and carbolic soap. We also see some of the cul-de-sacs we've since backed out of – usually the result of surgeons insisting they know best rather than looking at the evidence.

Hollingham is also hot on the statistics – no two patients are the same, so operations are judged not on a single win or lose, but the percentage of success when trying the same procedures time and again. Before the discovering of carbolic soap, infection was fought by operating quickly; Liston could remove a leg in 30 seconds.

“The morality rate from Robert Liston's operations was remarkably good. Between 1835 and 1840 he conducted sixty-six amputations. Ten of his patients died – a death rate of around one in six. About a mile away at St Bartholomew's Hoispitals, surgeons were sending one ion four patients tot he mortuary, or 'dead house', where the all too frequent post-mortems took place.”

Richard Hollingham, Blood and Guts, p. 38.

Yet Hollingham is also quick to show that the medical heroes are also all-too human.

“Jealous rivals would whisper that Liston was so quick that he once accidentally amputated the penis of an amputee ... The most worrying incident for his students occurred during an amputation when Liston accidentally amputated an assistant's fingers. The outcome of this operation was horrific: the patient died of infection, as did the assistant, and an observer died of shock. It was the only operation in surgical history with a 300 per cent mortality rate.”

Ibid., pp. 41-2.

All to often the effort is, “Well, we don't know, but we'll try this...”, and slowly, over the centuries, that philosophy has benefited us all.

The two world wars meant the raw material with which to make extraordinary advance in grafts and the treatment of burns. There are harrowing stories of the multitude of operations suffered by men without faces – and there are also harrowing photos. This is really not a book for the squeamish. But I'm less squeamish of blood and guts per se as unnecessary pain and procedures...

There's some terrifying stuff about lobotomies. The 1941 operation on Rosemary Kennedy (sister of future President John F.) left her,

“a very different person. Slow and emotionless, she was hardly able to move or speak. Although she eventually learnt to walk again, she was left permanently disabled and ended up in a residential institution in Wisconsin ... Freeman never said a word about the case. It was in his best interests not to publish the details of any high-profile failures.”

Ibid., pp. 279-80.

Walter Freeman refined and developed the lobotomy, after it had first been performed in 1935 by Portuguese surgeon Egas Moniz. By 1946 Freeman was now offering a new refinement, the “transorbital” lobotomy. The “transorbital” bit is where they shoved an ice-pick up through your eye socket to detach bits of your brain. It was a shockingly quick procedure, and doctors were quick to recommend it, too.

“Freeman ... personally performed about three and a half thousand lobotomies, and trained doctors across the world. In total, it is thought that around one hundred thousand people were lobotomized.”

Ibid., p. 283.

The case of Howard Dully, an eleven-year-old boy who wasn't getting on with his step-mum, is like something out of a fairy tale. Her evidence for why the wayward child should receive the treatment included that “he daydreamed and scowled if the TV was tuned to some programme other than the one he liked,” (p. 285). Using “orbitoclasts” - a step up from ice picks – Freeman operated on the boy on 16 December 1960.

“Howard has spent most of his life coming to terms with what happened to him. He suffered problems with work, relationships and money. He drifted in and out of jobs and in and out of jail. Gradually, he was able to piece his life back together. Today he holds down a job as a bus driver. There is absolutely nothing about him to suggest that he has two black holes in his brain. What saved him from going completely off the rails was probably his youth. Howard's young brain was able to rebuild neural pathways and compensate for the damage Freeman inflicted.”

p. 287.

Yet Freeman is not portrayed as monster, for all he “operated on a total on nineteen children, including a four-year-old,” and he ignored criticism and the new drugs that “did much the same thing only without the danger or permanence of surgery,” (p. 287). Hollingham lays as much blame on the authorities who let Freeman continue working “when the procedure was discredited and opposed by almost the entire medical establishment,” (p. 288).

“But it is difficult to reconcile the image of a monster with the kind and gentle doctor his patients encountered. When the lobotomy was conceived it seemed to provide the only treatment for chronic mental illness. It certainly transformed some people's lives for the better.”

p. 288.

In fact, Freeman spent the last five years of his live travelling “some fifty thousand miles” tracking down former patients to see how they had fared.

“To the end of his life he believed in what he had done, and he believed he was right.”

p. 289.

Hollingham says “Freeman's greatest failure of judgement was not knowing when to stop,” (p. 288), but that sits uncomfortably with what follows. In the 1950s, the US intelligence agency were “toying” with “brainwashing individuals, invariably communists”. In 1967, psychiatrist Frank Ervin and neurosurgeon Vernon Mark's proposal in “the prestigious Journal of the American Medical Association” to prevent urban riots by subduing black rioters with brain implants (one of Ervin's medical students, Michael Chricton, later wrote The Terminal Man). In 1972, psychiatrist Robert Heath proposed using “brain implants to 'cure' homosexuality,” (all p. 293).

And yet Hollingham doesn't talk about one of the biggest areas of surgery today – and one of the most morally problematic. Cosmetic surgery is booming, yet its only mention in the book is the cautionary tale of Gladys Deacon, a beautiful lady in 1903 who wanted a more beautiful nose. The hot paraffin wax surgeons injected her face turned her into a “freakish waxworks dummy” (p. 222).

Nor is there much on the philosophy of surgery – the Hippocratic oath, the impact of the National Health Service on surgeons (who insisted, when it began, that they kept their private work) and the role of the private sector today. Perhaps the NHS bits would be too parochial for a book that tries to cover the global history of surgery (and its covered anyway in NHS plc), but who pays for surgery – and for surgeon's mistakes – would have lifted this fascinating pop-history into something more profound.

(No, I've not yet read Bad Science.)