by Desmond Curran
I have probably known Eliot Slater longer than any other contributor to this Festschrft. We did not know each other at Cambridge. We first met just over 50 years ago. This was at St George's Hospital in 1925. I had gone there in 1924, so he came a year later. But we only really got to know each other well when we met again at the Maudsley in 1931. We have kept in touch ever since. I greatly treasure his friendship.
I was struck in re‑reading the fascinating 'autobiographical sketch' and moving 'retrospect' that he has contributed to the impressive volume of his selected papers, by certain similarities in our early training and experiences, completely different though the outcome has been; for Eliot is surely the most original and productive British psychiatrist of his generation, with an international reputation based not only on the famous more general textbooks he has written with others, but also upon his other contributions with special reference to genetic research; and, of course, I can make no such claim.
I must first apologize in advance if, in what follows, I bring myself in too much; I am under orders to indulge in reminiscences; so I do not see how that can be avoided. It will also become clear that I have found myself at variance with Eliot on certain points. But I know him well enough to be sure that he will not mind in the least. I have also little doubt that any future argument will end by my finding 'I have no loophole left to stand a leg on' (a metaphor in which I proudly claim a proprietary interest, since it once sprang unbidden from my lips; so far as I know it is original).
St. George’s Hospital
I know I am prejudiced, since I spent so much of my working life associated with the hospital. But when I took Eliot to task because in his 'autobiographical sketch' I thought he was describing the students in our day as well‑dressed youths who were excellently taught in the sort of medicine and manners required in their subsequent careers as successful, if at times sycophantic, fashionable West End general practitioners (a well‑known breed in those‑for some‑more prosperous times, when the world of 'Upstairs Downstairs' still persisted) he replied: 'I am sorry if what I wrote sounded hard. If I am convicted of exaggerating the facts, I did not exaggerate the impression made on me at the time ... Actually, I dearly loved St George's, and was most reluctant to leave. I was always delighted that I went to what was then a small medical school, with medical students who behaved like gents and not ruffians ('beefy and boisterous') and a tradition for tolerating individualities, even eccentrics'.
I remember Eliot well as a student. He stood out as quite different. He has forgotten. Whereas all the other students did wear short white jackets, Eliot wore a much longer confection of a café au lait colour. I recall him with his then red hair (which he wore rather long, in those days uncommon), falling over his forehead, absorbed in reading Proust, quite oblivious of his surroundings, his absorption punctuated by an occasional quite loud yelp of laughter. He was tall, pale and lanky, perhaps rather aloof, but it was obvious to all of us fellow students that he had a first rate brain and was very well read. He was perhaps thought a bit unusual, but none the worse for that. We all liked him very much.
I know that I am now going to invite the editorial blue pencil, but I am pretty sure that St George's between the wars was unique in Great Britain as a medical school in its combination of small size, pleasant atmosphere, and excellent clinical teaching for undergraduates. What follows may also possess some interest as illustrating the changes that have occurred in the medical and psychiatric scene, with special reference to a budding psychiatrist.
There had been no preclinical department at St George's since 1905, when it was closed for what seems now strange reasons. The annual intake was only 20‑25, many from 'Oxbridge' and the rest from King's in the Strand. With few exceptions, the students, housemen and consultants were not only civilized and friendly, but intelligent and conscientious. We would all mix together with delightful informality in the primitive students' club luncheon room, with marble‑topped tables, apparently the first in any London teaching hospital. It certainly looked it. Little store was set by set lectures. And, indeed, when I first came for interview, I was accepted by the then Dean with the words 'Personally, I think nearly all lectures are a bloody waste of time. But do come and see for yourself'. All the 'firms' were small, seldom more than 3‑4. This was admirable for instruction in the personal examination of patients (I am speaking of physical examination). Much emphasis was laid on small group tutorials. The housemen got bed and board but no pay, and the visiting consultants were of course 'honorary'. There were no professors. The only full‑time members of the staff that I can remember were the pathologist (a dim, dull, droning Scot, later a professor elsewhere), and a biochemist (a fat man whose speciality was lipid metabolism). On the wall of the pathology laboratory hung a real sacred cow in a glass case, with the inscription 'The skin of the Cow from which the first vaccine matter was taken by Dr. Jenner. Presented by his family'. Jenner had been one of the first students of the New Medical School attached to St George's in the eighteenth century where he was a pupil of John Hunter 1770‑1772.
I am sure that patients in our day received kindly attention and excellent nursing in the often rather beautifully proportioned wards with good window spacing, but with deplorable sanitary annexes. I recall with pleasure the pleasing custom of giving champagne‑or any other drink they preferred‑to the dying. We had by a long way the largest alcoholic cost per patient of any London hospital, the table of figures being published bitterly by some temperance society, and republished with glee in the Hospital Gazette in 1936.
The administrative staff consisted of the Hospital Secretary, dressed in a morning coat, and assisted by, I think, two clerks, who tapped away at, I think, the only two typewriters in the place. How different from nowadays, when admistrators are, like committees and subcommittees, 'spawned with the fertility of a herring'.
Our system of teaching, essentially by apprenticeship, did work very, very well at that time. I was told by a later Dean, who went into it, that we had the best examination results of any London medical school. And to confute Eliot, far from becoming fashionable West End general practitioners, quite recently (1963) a photograph was found and published in the Hospital Gazette of the 16 members in my time in the 'Cottage', the name for the residents' quarters. All but one, and he was a part‑time anaesthetist, subsequently became consultants, and two of them, Leslie Hilliard (later a leader in the field of mental subnormality) and myself subsequently became psychiatrists. Others of our near contemporaries, like Eliot, and the attractive fey bohemian, Bill Hubert (the joint author of the well known East‑Hubert Report on the psychological treatment of crime), did the same; and several others I remember as well.
So that later when we met at the Maudsley, in 1931, three of the nine Assistant Medical Officers came from St George's.
The only instruction in psychiatry that we had were a few lecture demonstrations of a Grand Guignol type in a mental hospital by our 'Lecturer on Insanity'. He was not a member of the hospital consultant staff. The hospital did not have any consultant psychiatrist. I do not know what deductions, if any, can be drawn.
Eliot clearly enjoyed his time at St George's and from his own account blossomed in that urbane and friendly atmosphere after feeling rather the odd man out at Cambridge. This was in spite of the fact he had the misfortune to be House Surgeon to the one real boor on the staff. Nor was the consultant to whom he was House Physician of much help; he was apparently stupidly discouraging.
I, on the other hand, had the great good fortune to be House Physician to Anthony Felling, charming and cultured, always immaculate, and with the courtesy, manners and appearance of what, even then, seemed a bygone age. He was a good general physician, but primarily a neurologist. He played the major part in the initiation and later expansion of psychiatry at St George's. Personally, I am deeply grateful to him for many things. He died in 1975 aged 89.
Before we met again at the Maudsley in 1931, both Eliot and I had postgraduate experience as residents in neurological hospitals and in unsatisfactory mental hospitals, but in the reverse order. In addition, I had the chance of working at the Phipps Clinic at Baltimore with Adolf Meyer.
My experience of neurologists is different from Eliot's. I have not come across much anti‑psychiatric feeling, or have not been aware of it. At the Maida Vale Hospital for Nervous Diseases, Edward Mapother, whom later I was to succeed there, was, amongst his many other activities, the visiting psychiatric consultant. There were also a number of psychotherapists, one of them the most gifted I have known, if the criterion for that is doing good to his patients, rather than in contributions to psychopathological theory. Mapother offered me a job at the Maudsley on my return from the Phipps, having first, with Tony Feiling, wangled a travelling fellowship to go there.
Again, I disagree with Eliot over Adolf Meyer and his 'psychobiology', which I think has been much maligned by him. I fully realize that to read many of Adolf Meyer's papers produces the uneasy feeling that one's mind is slipping. But he did not disregard the importance of making a diagnosis (to be replaced by 'dynamic understanding') or of constitutional and genetic factors. Fundamentally, I do not see much difference between what Meyer taught and the 'multidimensional diagnosis' to which 'clinical psychiatry' so warmly subscribes, except in the clarity of exposition in the latter, and the Swiss‑Germanic fog that renders impenetrable so much of what Adolf Meyer has written. I think perhaps you had to fall under the spell of the magician by sitting at his feet. All my contemporaries at the Phipps - the seniors including Horsley Gantt and Curt Richter in their labs, and the outstanding 'intern' with me, Harold Wolff - greatly admired Adolf for his compassion, tolerance, great learning, breadth of outlook and deep respect for each patient's unique individuality. The 'Meyerian miasma' did not adversely affect these distinguished men in their productivity.
I hope this digression on 'psychobiology' will be forgiven. Anyway, owing to this experience, I did not find the Maudsley quite such a startling revelation as Eliot did, according to his autobiographical sketch. At Maida Vale, I had known both Mapother and the donlike, disdainful Golla, the one the Medical Superintendent of the clinical side and the other Director of the Laboratories. Golla once said to me, 'Dickens? He writes about such crude people.' Golla had stayed on the staff at Maida Vale to keep his hand in clinically. He was, with Grey Walter, a pioneer in the introduction of the electroencephalograph for clinical use. But sometimes his own clinical judgement faltered. I am credibly informed he once diagnosed an almost purely Welsh‑speaking Welshman with multiple sclerosis as an interesting case of jargon aphasia'.
We, the juniors on the clinical side, as already mentioned, were then a small group of about nine, only to increase gradually. There were no registrars. So the total medical staff were greatly outnumbered by the inpatients, which I am told is no longer true. We also had to carry a heavy load of outpatients both at the Maudsley and at outlying clinics, which I am told is no longer true either. Instead of perhaps two or three new outpatients per session, we had to see up to eight or more, as well as old patients.
As Eliot has rightly pointed out in his autobiographic sketch, we were all devoted to Edward Mapother and I would also entirely agree that Aubrey Lewis was the leading spirit amongst us juniors. He was even then very learned; nor did he hide this under a bushel. I remember many years later saying to a distinguished Scandinavian psychiatrist that 'existentialism' quite baffled me. What were the tenets of the faithful? He replied: 'It is really quite easy. If you put up any proposition you will get the reply "No, that is wrong".' If this is correct, Aubrey was an early leading exponent.
I recently re‑read a book, given by the author to my parents in 1893, because I remembered it contained an essay on euthanasia, one of Eliot's later interests. This book also contains recollections of conversations held in 1882 with the well‑known oxford don and Rector of Lincoln College, Mark Pattison, which, if slightly modified, and with some drops from Adolf Meyer's 1933 Maudsley Lecture added, may give a picture of the sort of discussion battles that went on so often between our two leading disputants at the Maudsley in those very happy far‑off days of long ago. Looking back, we were all pretty vocal.
The subject was whether Englishmen were, on the whole, better off in the reign of George II than either before or since:
Aubrey Lewis: I shall not be committed. But I might predict that England will go on declining.
Eliot Slater: I insist that, in discussing the question, we must start with the assumption that there is more good than evil in life.
Aubrey: I don't see why I should assume anything of the sort. I think I shall take up the view of Schopenhauer.
Eliot: May I recall to you some of the conclusions that may be drawn from that wildly antisocial theory? For example, might not those persons who say they would not, if they could, live their lives over again‑in other words that, so far as their experience goes, the good of life is a minus quantity‑ought not these Schopenhauerites to rejoice instead of sorrowing at the sight or news of a fatal car smash?
Aubrey: Well, suppose that I do grant that life is good on the whole, what relevance has that to human progress?
Eliot: For convenience of figures, let us compare the present time with the time when the population of England was one‑third of what it now is, and let us suppose that the average Englishman was twice as happy as now. Even on this extreme supposition, the aggregate of happiness in England would be half as great again now as then: Englishmen in tripling their numbers, would have gained more collectively than they have lost individually.
Aubrey: (impatiently) But that is not what is generally meant by progress. You must define your terms. But first you should read Froschhammer's tactful reservation on your naive and uncritical apparent espousal of Neo‑Darwinism, and Roux's Entwicklungsmechanik‑that means roughly mechanics of evolution you know and ‑and‑
Eliot: You suggest I am wrong. What did your authorities conclude and what do you mean by progress?
Aubrey: (huffily) I really cannot be expected to give a succinct answer to a problem that is inherently complex and difficult.
Eliot: And pray what problem would you not put in that category?
Aubrey: I should advise you to make a start with the aggressive vitalism you may find in Driesch‑Do be careful with those keys and stop swinging them about like that. They might hit me.
When he came to Maudsley Eliot himself had changed a great deal outwardly. Instead of his former café au lait coloured jacket, he now constantly wore a somewhat shapeless and very hairy tweed suit of a most unusual 'love in the mist' colour. We all at once recognized his first rate mind with an unusual twist to it. Many of us were then rather sceptical of intelligence tests, but when all the junior staff were guinea pigs for a new one ('Black is to white as Purple is to . . . ' sort of thing) I for one began to waver. Eliot came easily top, Aubrey second after a big interval, at which he was sore displeased, and then the rest of us all bunched together after another big interval. I was one from the bottom.
Eliot did not get really going productively until after he went to study under Rüdin in Munich in 1934, but, looking back, it was striking how not only we British juniors, but the very distinguished and mature German emigrants, who arrived in 1933 escaping from the Hitler regime, at once recognized his intellectual quality and originality. Willi Mayer‑Gross, Erich Guttmann and Eddie (Eduardo) Krapf whom I saw much of both then and subsequently had no doubts from the start about the quality of Eliot's intellect.
I think patients in those days may have found Eliot rather aloof and preoccupied. I think that probably, both then and later, this arose partly from the need for self‑protection, surely quite commonly shown by those who are highly imaginative and sensitive and are all‑too‑readily upset by the sadness and injustice of this world.
Mapother was another who had no doubts. When I last saw him, in 1939, he was a sick man, breathless and in bed, but brave as always and his mind clear and incisive. I had prepared a memo with my opposite number, Macdonald Critchley, the neurologist, on our proposed plans for the development of a neuropsychiatric service in the Navy. I thought that if fit enough, to be consulted might please him, and also I knew nobody whose opinion I would value more highly. His devoted wife said 'Do come'. After some trenchant, astringent and valuable comments he began to reminisce over the staff at the Maudsley. He was sure that Eliot was the man to make the most important contributions. He also told me how he so much admired his complete and utter integrity, adding 'so unlike some of the others I could mention', which, to my great surprise, he then proceeded to do.
Ever since Maudsley days, I have always been delighted to see Eliot, but we have never worked together as colleagues. I think I have read much of what he has written; and I have often heard him speak, which he can do admirably.
I cannot judge of his contributions on the mathematical level, since I am innumerate. It would be wholly presumptuous of me to express any opinion on the battle between the importance of a major dominant single gene as opposed to the polygenetic theory in the origin of schizophrenia. I would be quite incapable of starting. Yet I have found some of his papers left me wondering. For example, in 'Birth order and the maternal age of homosexuals' I was as sure as may be that homosexuality is not a specific propensity which you either possess or you do not; or in Kinsey's terms there is a continuum varying between his 0 and 6. Where on this continuum did the Maudsley cases diagnosed as 320.6: pathological personality: sexual deviation: homosexuality' lie? And might this not crucially affect the value of the study?
Again in the address 'Hysteria 331', it never had occurred to me since Phipps days that anybody had regarded 'hysteria' as a discrete more or less clearly defined condition, comparable to schizophrenia. When I might describe a case as 'posturing hysteria' or as showing 'hysterical amnesia' I would have just regarded this as a convenient 'shorthand' initial description, that did convey some meaning but needing further study for evaluation. This address rather struck me as an elegant sledgehammer to crack a non‑existent nut. But I was quite wrong. Many did, and perhaps still do, regard hysteria as a 'clinical syndrome' of purely psychogenic origin.
To take some more general subjects in which Eliot has shown a keen interest. He kindly sent me a reprint of a symposium on euthanasia, in which he took part, held in 1973 by the Royal Society of Health. I was fascinated to find that the arguments for and against were almost identical with those that appeared in the Fortnightly Review a hundred years before in 1873 and reprinted in the volume already mentioned, except for a striking passage from Sir Thomas More's Utopia, in which euthanasia was gladly accepted and recognized by all. The author of the 1873 article, entitled 'The cure for incurables' also suggests the possible value of testamentary capacity as a test. If someone was capable of making a will, why. should he not also be capable of deciding how soon that will should take effect? In a sense, what could be more neatly logical? And does it really differ in essentials from the 'proforma' proposed for nonresuscitation in special care units by the euthanasiasts?
But Eliot goes on to say 'From the standpoint of Society, it is the duty of the dying man to die' and backs up this proposition with cogent reasons. Later he suggests that there is no biological reason why man should not be able to look forward to dying, 'not in suffering, but in a state of bliss. The pleasure centres of the brain are there only waiting to be mobilized'.
Let us sincerely hope they will be.
Now, both for personal reasons, and as the result during recent years of seeing a considerable number of seniles, mindless and incontinent, often nobly cared for by their relations (for many such cases come under the Court of Protection to which, as Lord Chancellor's Visitor, I rendered reports), I am personally in favour of legislation on euthanasia, much on the same lines as was recently proposed, and heavily rejected in Baroness Wootton's Bill. The 'medicated survival', that I have seen all-too-often, seemed to me fantastic. But, of course, the dividing line between not prolonging life 'officiously' and actively hastening death is one difficult to draw.
Yet I had an uneasy feeling that Eliot's logical and compassionate plea might provoke antagonism. And doubtless the alleged origin of the sardonic smile might do the same. Apparently, the natives in Sardinia in days gone by were wont to eat such of their countrymen as were worn out by age. By his own consent, the stringy old gentleman would himself issue the invitations to the guests at this final feast, greeting them with the original prototype of the sardonic rather than blissful smile.
I certainly do not wish to seem foolishly facetious. I am quite serious, in advocating 'euthanasia', with suitable safeguards, that would ensure it was not comparable to the Nazi gas chamber. There are so many for whom death 'would be a merciful release' from any humane or reasonable standpoint.
To take another interest, penology. It is obvious that the gladiatorial system of trial in this country in courts of law is far more unpleasant for doctors (and their reputation) than the inquisitorial system in other countries, for reasons that need not be recapitulated. But is the latter system, on the whole, better for 'justice' than ours That is something I just do not know.
Many of the readers of this volume will, I am sure, have greatly enjoyed 'What happened at Elsinore'. For those who were enchanted by it, as I was, may I recommend 'Horatio's Version' on the same Hamlet theme by Alethea Hayter? It is a splendid parody of the official inquiry before which witnesses are called. There had naturally been a lot of ugly rumours going about in Denmark about what had happened at Elsinore. 'King Fortinbras was most anxious that the whole truth about this very distressing affair should be fully established', as Voltimand, who had been appointed chairman, said in opening the proceedings. It has the further recommendation of giving Eliot much pleasure. I am indeed sorry that two other essays of Eliot's, both written by him for Festchrtfts, one for Fernandez of Lisbon, and the other for Manfred Bleuler of Zurich, have appeared in journals improbably read by many. Happily, Eliot gave me reprints written in English.
In the first he argues most plausibly that Shakespeare (of Stratford) did not write Shakespeare; and whilst not claiming whodid, he suggests he must have been the sort of person revealed by a study of the Sonnets. Eliot is inclined to think that the Sonnets' author did not go further than 'eyes', or at most a 'romp' with the 'lovely boy'. Personally, I find this hard to believe. But on Eliot's side is the 'mythohistorical truth' of a prize-winning sonnet in a competition for one written by Mr W. H. to Shakespeare.
Whenas-methinks that is a pretty way
To start-my father spoke to you anent
The precious po'm I got the other day,
The perfum'd posy and the pot of scent,
My drowned eyes are constantly bedewed;
The cruel rod of wrath I have not 'scaped,
My mother has been cool, my brother rude,
Honest, you'd think I was already raped
- You really think I'm like a summer's day?
Really and truly? Thank you ever so‑
Behind the Globe, if I can get away,
I'll show my weals and tell thee all my woe,
In your next po'm, an thou wouldst give me joy,
Will you make clear I'm not that sort of boy?
The other essay is on the 'Colour imagery of poets' and is based more on adding up sums. I had never realized before how 'brown' was so seldom used by poets, nor quite how exotic was the colour imagery used by Gerard Manley Hopkins in his non‑religious poems.
Eliot has always shown an intense and wide‑ranging curiosity that happily still continues. Some men have a capacity for intense concentration; but I cannot recall anyone else who can apply this enviable endowment with such skilful imagination and ingenuity to such a wide range of interests. These include general textbooks, internationally recognized; genetic studies in various types of mental disorder and disease; clinical investigations into neurosis, psychopathy and the psychoses associated with epilepsy; statistical methodology; twin studies; more general issues affecting society and the individual, such as eugenics, penology and euthanasia; music, chess, 'pathography', and various aspects of literature, more recently Shakespeare in particular. But the list is not complete for he has written an all‑too‑short book of poems and made his name as an abstract painter. His selected papers, edited by others, is followed by a bibliography that, up to 1970, included 148 references to his work.
Further, although it is certainly possible to disagree, it is always quite clear what he means. If the essence of a good style, in addition to this, is 'honesty, clear thought, good manners, clear‑sightedness' and 'the power to think with the heart as well as the head' Eliot has it.
I think his influence on psychiatry in Great Britain has been almost wholly beneficial. It may be difficult for a younger generation to realize, to use the late Pip Blackers  somewhat florid language, how the inter-war years 'covered a period when yeasty growths of theory and steamy screens of narcotizing jargon were obfuscating the minds of many young men and women who beheld themselves as pioneers of new systems, creeds and revelations'. Both by his own serious works and, indirectly, as an editor he has done much to correct such dangers. Also, as the editors of the selected papers have pointed out, Eliot has rightly stressed 'the value of numerical analysis in reaching a rational judgement. All‑embracing explanations and concepts are of dubious value for Slater, as for Karl Popper, since they do not permit testing and refutation'. I have read that 'as some saw it' Eliot, Willi Mayer-Gross and Martin Roth were guilty in the 1954 edition of Clinical Psychiatry of a 'savage and ill‑informed attack on psychoanalysis'. These three would, I think, be amongst the last of the psychiatrists I have known to whom the terms 'savage and ill‑informed' would be applicable. And one can only note that in the 1960 edition their former critique of psychoanalysis was curtailed, because no reply to correct and enlighten the heathen had been forthcoming.
Eliot certainly delights in controversy, but nobody I know is more genuinely pleased to be shown that he is wrong, or indeed is more naively surprised that this attitude should not be shared by others. It certainly is not. Without hesitation, I can correct Eliot on that point.
Eliot has every reason to look back with pride on his achievements. And all his old friends are proud to have known him.
 The late Dr C. P. Blacker (MC, GM, DM, FRCP), was a great character. He left the Maudsley not long before I came. I think he must hold a record in group therapy. He ran one for his male patients, using the technique of boxing gloves rather than verbalization. He laid one of them out for he had been a boxing blue at Oxford, and had to carry him to bed unconscious.