Apomorphine Versus Addiction

Chapter 1

“The only source of Knowledge is Experience”
— Albert Einstein

John Yerbury Dent (1888 – 1962) came from a Northern English Quaker family that had lapsed by the time it settled in London. Nevertheless, the core Quaker testimonies; simplicity, pacifism, integrity, community and equality, (S.P.I.C.E.)  would remain constant guiding principles. Dent himself became a non-theist when, as a teenager, he read the bible and Paley’s  “Evidences” but could find no faith in any doctrine. However, his Quaker spirit remained intact and provided an animating force in his emerging interest in the “human herd” and its reaction to an increasingly secular environment. He wrote in his second book, “The Human Machine”, 1936; 

The search for the possible seat of the soul is drawing to an end in the same way as did the search for an earthly paradise. With every new discovery we find places where it is not.”

William Dent - "I am NOT a MISERABLE sinner!"

William Dent – “I am NOT a MISERABLE sinner!”

 

From that moment Dent emerged into adulthood as an optimistic Humanist strengthened by a rich Quaker sensibility. Quakers are renowned as reformers, for their immovability, their fiercely contested positions concerning individual rights. The Dents, therefore, were typically ‘Quakerish’ as illustrated by this anecdote of Dent’s grandfather; William Yerbury Dent.

This strikingly tall gentleman and friend to Joseph Lister, the surgeon, regularly accompanied his devout family to the local Sunday service. Everything would go smoothly until the Litany when the congregation parroted; “I am a miserable sinner”. Probably remembering the third core testimony, integrity, this was intolerable to Dent’s grandfather. He rounded on the congregation, stood as tall as his enormous frame would allow and bellowed; “I am NOT a MISERABLE sinner”! A flurry of consternation and embarrassment spread throughout the worshippers but none at all on the part of this erstwhile Quaker. All that mattered to him was that a significant remnant of his unassailable heritage had been threatened with compromise and this was simply too much to bear, even in the respectful atmosphere of a Victorian church. A “lie” had been soberly put in its place and that was that.

When his grandson, John Yerbury Dent, became a doctor he too found that his principles in respect of health care were frequently threatened by morality, policy makers and other doctors with agendas unrelated to his views on efficacy. To that end he had a pathological disgust for dishonesty, he could almost smell it and would expose it with a zeal that rendered him entirely unsuited to the wiles of politics. In truth Dr. Dent may have been more influential if he’d been able to temper his principles but, by the same token, should health care ever be about compromise and practices that lead to greater harm? In that sense the values of Dent. and what motivated him, may be seen as the missing ingredient in what defines many of our questionable drugs policies today and it is this element as much as any other which gives the Apo’ story a particular and peculiar significance.

Dent’s father was also a doctor but did not encourage his son to follow suit. Various career paths were considered until Dent junior eventually settled on medicine. When he finally broke the news his father responded;

Very well, but understand this; when you pass an exam you’ll be happy, when you fail one I’ll be happy.”

The reason was simply that Dent’s father felt that more study would encourage more learning and you could never learn too much. He was also a man of few words but on the few occasions he did speak he didn’t beat about the bush. He gave his son just one piece of medical advice;

If you do not prescribe your patient anything you wont have done him any harm…….and if you make him laugh, you may have done him some good!

 

Harry LR Dent. "If you do not prescribe your patient anything you wont have done him any harm.....and if you make him laugh, you may have done him some good!"

Harry LR Dent. “If you do not prescribe your patient anything you wont have done him any harm…..and if you make him laugh, you may have done him some good!” – photo: courtesy of A. Buchanan

This was highly significant in the career and philosophy of Dent junior for it was something, whenever practicable, he would apply and it was something he never forgot. Apo’ was prescription but Dent only used it when he thought it necessary and would not have contemplated its use if it was unsafe or led to another addiction. He also would have been quite happy to use any other medicine if there had been a better alternative.

Dent enrolled as a student at the old site of King’s College Hospital near Lincoln’s Inn, London. Its surroundings were crumbling slums riddled with disease. He describes in his book Medici Libris, – a vivid and varied compilation of medical stories, – that his training was really a “weeding out process” where, from the start, any residual idealism was brutally crushed by the horror and stench of the dissecting room. If you survived this, the post mortem room awaited, a picnic compared to the ultimate test, the operating theatre. This forbidding place felt like an antechamber to the tomb where lives were “casually” lost with a resignation that appalled Dent. As arteries spurted blood against wall and ceiling the surgeon would bark “Next!” even before the victim was dead. Somehow Dent stuck it out but many did not. Three of his colleagues took their own lives.

Dent was not a good student but perhaps that wasn’t surprising given his father’s advice and one tutor’s attitude;

I’m here to teach waffle. Waffle will get you through your exams. And how to be a doctor? Well, you’ll have to learn that from your patients.”

Dent passed his “midwifery” which meant he could deliver babies in the slums. This made Dent extremely anxious but he wasn’t advised to read the obstetric textbooks; “they’ll only confuse you” though the practical; just stand on a newspaper and pour chloroform into your turn upswas useful against lice and cockroaches.

Dent took much of this in his stride but what he found harder to accept were the wretched conditions his patients lived in. Feeling that something should be done he was prompted to report to the Town Hall. Some years later Dent met the councillor, a retired colonel. Ah yes,” he said, we didn’t reply to your letter.  You see, the more you do for such people the more you may do.”

His second slum delivery, a woman expecting her second child, had been dissatisfied with the midwife first time round and called King’s for a doctor. “Yes,” she said, “a proper doctor, one that’ll give me chloriform”. Poor Dent! He was not yet even a doctor, knew but a fraction as much as even the most incompetent midwife and had just poured all his chloroform into his trousers!

But what could he do before such faith:

She was asking me to start the chloroform now. I asked her had she ever had it before. She said no, but she knew, ‘them as ‘ad ‘ad it. It’s wonderful — yer don’t feel nuffin’.

Dent rummaged in his bag, found smelling salts (sal volatile) poured some on a tissue and applied this to her face. To his astonishment she immediately became unconscious. Dent had never before encountered a “hypnotic trance”. This was probably engendered in the woman’s mind due to her own expectations and complete confidence in a “proper doctor”. Close to panic Dent assessed his options:

 “I thought it was a faint but to bring her round everything that could be done had already been done. So I left the tissue where it was…..the baby was born the afterbirth was born and I cleaned up as best I could. Remembering the tissue I took it off and she immediately awoke and asked me if it was all over. I said that it was and she swore that she’d never have another baby without ‘chloriform’ “It was wonderful.”

Strictly speaking this was not “placebo” because smelling salts do have a physiological effect but it did provide the young Dent with a lesson in the power of psychology. Later in life Dent firmly believed that psychology should not attempt to take the place of medicine or surgery but that neither of these disciplines can afford to scorn its help. Throughout his career he grew convinced as to the power of the word, its worth as an aid to recovery from so many ailments particularly the imagined ones, the anxieties. Dent split patients into two categories;

those that are worse than they believe, and those who believe they are worse than they are. The latter suffer more.”

Dent realised that words were key to identifying and stimulating change writing:
when people take a dose of medicine, the medicine, if any good, will help, but if the patient reads the label he gets two treatments: one from the medicine and one from the label. What he gets from the label is psychological help”.
Later, when Dent started to treat people for addiction with or without Apo’, he was the psychological help for there was no label, no pharmaceutical company and no marketing for his work. This was an entirely self-funded initiative; it was never endorsed or actively encouraged by any medical or scientific body either as a treatment or even considered an area worthy of research and development. (If it had would the scientific community have realised much earlier that Apo’ provides symptomatic relief for Parkinson’s Disease?)  Dent also had to withstand resistance from other doctors who were critical of his interpretation that those battling the later forms of addiction had to be treated bio-chemically while variously, depending on their interest, other doctors were sure Dent relied on his psychotherapist’s skills for his success rather than any neural change enacted by Apo’. Germane to this it therefore seems only fair to point out that Dent, even as a student, realised just how suggestible the human mind can be and how much importance he placed on various forms of talk therapy, psycho-social support and positive reinforcement. Dent, of all people, knew that defeating addiction meant breaking a vicious cycle and his method, demonstrably successful, was always, in its broadest sense, holistic.

After his stint in midwifery Dent returned to King’s and immediately felt unwell. He had his sputum analysed, was diagnosed with acute tuberculosis and told that he should expect to die! He would have to go to a sanatorium immediately, as there was no treatment but rest. Upon arrival the gloomy prognosis was repeated. “Yes, you must prepare yourself, you’re dying, there’s nothing to be done I’m afraid, and you mustn’t work, no reading, no, just try to rest and sleep.” Dent was not a good patient and confessed to smuggling in books, as many as he could. He was, however, a good sleeper and needed to be. The rats gnawed his pyjamas and left footprints on his face. His strength was ebbing away, it was 1913, his twenty fifth year.CARTOON 10

During the weeks and months that followed he was allowed to walk to the sanatorium gate and back. It was two hundred yards all told.  This walk, simple at first, gradually became more difficult. The gate symbolised survival and at the point when he finally accepted that it would always be out of reach it simultaneously dawned on him that his weakness had plateaued and his immunity was returning. His complete recovery was still a long way off and several tedious months followed until the all clear and discharge. He had been forced to confront his mortality and into the bargain gained a patient’s perspective of illness and doctors, but there was no time to dwell, his disrupted studies had to be resumed and Britain was at war.

The First World War was good for Dent. His diseased lungs spared him military service and as most qualified doctors were required in Flanders he often found himself expected to perform duties beyond his station. His private correspondence gives a flavour of the difficulties faced;

Dear Edward, To think that I have not seen you since the War. Everything has changed at the Hospital. All those that were qualified have gone, six of them have been killed, two in the last action. It is so dark in the streets we think of carrying little electric hand torches for crossing the roads. Up to now a large sheet of newspaper has been enough to let you be seen….”

The morning surgeries with hundreds of patients were hectic but a fascinated Dent sucked it up like a dry sponge. Confusingly the morning consultations often resulted in a referral by Dent to a specialist that by afternoon also turned out to be Dent! He’d apologise and do the best he could. The new King’s at Denmark Hill was turning out to be a “wonderful hospital” with its facilities and design conceived by doctors and surgeons. Dent realised that he had found his vocation and at King’s an environment that he revelled in. It came as a shock therefore, to discover on his locums, that very few other hospitals shared this ideal.

A friend in the Midlands suggested a weekend visit to help out that led to an eighteen months posting. In the first few days he was introduced to a senior surgeon who sounds similar to the bizarre “Doc Benway” from  William Burroughs’s “Naked Lunch” (more on this later). “Benway” often led a surgical team that soon found itself discussing what had just gone horribly wrong. During one of these interludes they dejectedly discussed at which point the previously healthy limb should be amputated. Detecting a mutinous gloom the surgeon tried to cheer his charges.

 “Oh do come on, after all, I’ve accidentally cut every main artery in the body….every single one.”

Dent suggested that he knew of one that he missed.

Rising to the challenge the surgeon urged; Go on then, tell me.”

The aorta?”,  Dent ventured.

Ahaha, got you, no I did that when a man came in with a chest swelling. I assumed abscess but it was in fact an aneurism. I stuck in a scalpel and got it straight in the face!”

On another occasion the same team hovered over a serious skull fracture.   A panting “Benway” levered up chunks of grinding bone with brain still attached. This was too much for one of the nurses who recoiled in disgust. The ‘old boy’noticed this but refused to temper his enthusiasm;

 “Oh you fellows don’t know us Midland folk, I’m one of them, you know? I know what they’ll stand!”

These experiences confirmed in Dent what he had always suspected; that experience or rank is no proof of worth. Towards the end of the war he was regularly starting to test the mettle of authority and it is a feature of Dent’s character that it did not matter where the “fault” lay he would expose it. This extended to his military wards where “his” beds would under no circumstances be allowed to carry the chevrons denoting rank. The visiting chief of staff enquired why this important tradition was being “overlooked”.  Dent pointed out that health had bugger all to do with any absurd notion of elitism; military, social or otherwise. Dent, no doubt recalling the Quaker testimony Equality, remained true to this all his life. On many occasions during the research of this piece people have regretted that Dent did not keep and bequeath detailed medical notes of patients who were or became, famous. What this view reveals is a fundamental difference between the consistency of Dent the doctor who promised confidentiality and the current obsession with celebrity and cult. If Dent had been interested in this he would never have been the man or doctor he became; a pioneering champion of the causes and treatment of addiction. Medicine had to be delivered at the point of need. The disease of addiction doesn’t discriminate, and neither, even in a society riven with class, prejudice and stupidity, did Dent.
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At another locum, a military hospital in Norfolk, he noticed that while filling in admissions it upset the soldiers to be asked what religion they were.

Soldier: “Am I as bad as that?”

Dent: “No, you’ll be fine, it’s just a question on the form.”

Soldier: “You want to know where to bury me.”

Dent: “No, really. Tell you what, I’ll leave that line blank.”

A week letter Dent received an angry letter from Whitehall. ‘Why aren’t you filling in the forms correctly?’ Dent ignored it. A fortnight letter a flustered civil servant arrived to have it out with Dent.

“Why are you STILL not doing what is required?”

Dent explained, quietly at first; “These men have been fighting a war, they’ve been injured, some of them grievously and have endured a long and tortuous journey from France. When they arrived they were assembled on the station platform with no choice but to participate in a solemn church service, blessed by the vicar and introduced to several local dignitaries and their wives….and this before they could receive any, and in some cases, life saving medical care. In light of all of this,” informed Dent, his voice filling with frustration, “the only honest way of filling in your bloody form would be ‘militant atheist’!” 

The issue was not raised again and a beneficent anarchist was born.

 

Click to view Chapter two – “Experience is a name we give our mistakes”

One Response

  1. t--t.info says:

    Historum – History Forums

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