A Fortunate Man: the story of a country doctor

John Berger: 5 November 1926 to 2 January 2017

I took John Berger’s book A Fortunate Man: the story of a country doctor to read over the New Year holiday. Berger’s account of a General Practitioner working in the Forest of Dean in the 1960s, illustrated with Jean Mohr’s photographs, was first published in 1967 and reissued by Canongate in 2015.

The extended essay opens with vignettes of patients attended by an old-fashioned community physician in a rural area: a woodman trapped under a felled tree; a young woman’s asthma brought on by the stress of a failed affair; the hopeless grief of a widowed farmer; and the severe piles of a man who has long lived as a woman.

The patient cases are set in lyrical descriptions of the Forest of Dean countryside where the central character is Dr John Sassal whose qualifications are displayed outside his surgery: M.B., Ch. B., D. Obst.R.C.O.G. Sassal was the pseudonym Berger employed for Dr John Eskell whose British Medical Journal obituary lists his merits as MD DPH DOBSTRCOG.

Although the opening vignettes sketch a few dimensions of their lives, it is the doctor rather than his patients that are the centre of interest. Berger portrays Sassal/Eskell as an exceptional individual; an invaluable and respected member of an isolated and sparse population. Berger looks to explain why Sassal/Eskell’s patients accept and value him. Notwithstanding Sassal/Eskell’s skills as a diagnostician, minor surgeon and psychotherapist, Berger seeks to explain how his patients acknowledge him as a good doctor. He describes the doctor as the clerk of the records who recognises and documents his patients’ suffering. By having their symptoms named and defined the diagnostician alleviates some suffering, offering relief through recognition of and familiarity with disease and, ultimately, death.

The heroic doctor tending his patients in their moments of need, echoes a 1948 publication in Life magazine: Country Doctor by W. Eugene Smith. Smith spent a few weeks in Colorado with an ‘indefatigable general practitioner’ as he tended his fellow tough, uncompromising Coloradans. The ‘modest, tireless rural physician’ who turned down a big-city medical career to enjoy an unrelenting, tough but ultimately ‘uniquely rewarding life’ in a sparsely populated rural area applies to Berger’s version of the Forest of Dean, as to Smith’s vision of Colorado.

The class gap between Sassal/Eskell, the ‘gentleman’ doctor and his patients in the Forest of Dean – described as a backward and economically depressed – is touched upon. Sassal/Eskell’s auto didactic drive to practise the range of physician skills, and to do so well, is set out in words and pictures. Berger uses the metaphor of a master mariner who charts human experience and the globe as the self-sufficient master of his ship. Berger suggests that Sassal/Eskell can fulfil his role as clerk of the records because and not despite of his privileged education and unorthodox thinking, which sets him apart from his patients.

Gavin Francis, who wrote an introduction for its reissue, describes A Fortunate Man as a masterpiece of witness, exemplifying exceptional medical practice and illustrating the difference between healing and medicating. But there are crucial circumstances missing from Berger’s account, rendering its interpretation incomplete and perhaps untrustworthy. Phillip Toynbee, the writer and prominent journalist, reviewing the book in the Observer (30 April 1967) castigates Berger for omitting the doctor’s wife from the story. As a patient and friend of Dr Eskell of some years standing, Toynbee felt qualified to point out that without his wife’s support, ‘this racked and pain-haunted man’ would have collapsed long ago. Philip Toynbee’s daughter, Polly Toynbee, notes that while Eskell was a remarkable and sensitive doctor, he was also a serious depressive who failed to diagnose her father’s ultimately fatal intestinal cancer for many years, being more interested in discussing psychological symptoms. She speculates wistfully as to whether her father’s depression, that confined him to bed over a number of years, might have been caused by the undiagnosed cancer.

Elsewhere Roger Jones who grew up in the Forest of Dean, and went on to become Professor of General Practice and Editor of the British Journal of General Practice, objects to Berger’s patronising characterisation of ‘Foresters’ as uncultured half-wits. Berger gives the impression that the local population consists only of ‘villagers and foresters’ with Sassal/Eskell the only educated man in the Forest. Where intellectual figures such as Phillip Toynbee, and future physicians such as Roger Jones fitted in was occluded.

When his wife died in 1981, Eskell gave up the General Practice and a year later shot himself. Berger notes Sassal/Eskell’s low moments, but does not discuss how the highs of his manic depression affected his troubled professional life, a life that was conducted in social and professional isolation according to Roger Jones. The omission of the negative aspects of Eskell’s depressive illness, his wife’s role in the medical practice and the absence of the middle-class patients all simplify the picture of the Forest community. Berger idealised Eskell’s work in the persona of Sassal and drawing an ideal requires such occlusion.

Notice of Berger’s death both interrupted and informed my reading of A Fortunate Man – a book not even mentioned in the Telegraph obituary (pay-wall). Berger was well known in his own lifetime for 1972’s Ways of Seeing – a successful book and accompanying television series (this book was touched upon in last week’s post)– and for sharing his Booker Prize money with the London chapter of the Black Panthers.

In 1962, Berger left England, where he was born and educated, for a remote peasant community at Quincy in the Haute-Savoie of France, where he remained resident until 2013 when his wife died. A Fortunate Man offers a lyrical picture of how the privileged and educated Sassal played a crucial role in his patients’ lives. Was the conundrum of living in harmony with the noble peasants of the locality what really interested Berger?

A Fortunate Man does not work as an ethnography of a rural community, nor a balanced picture of doctor-patient relations. However, if you’re interested in how an articulate middle-aged man, as Phillip Toynbee described both Berger and Eskell, integrates himself into a well-established rural community with which he had had little previous contact, then this might be the book for you. In the Haute Savoie Berger wrote his 1975 book on European migrant workers and the peasant fiction trilogy of the 1980s. And, as it turns out, the eponymous figure of A Fortunate Man turns out not to have been Sassal/Eskell at all, but rather Berger who spent fifty years in the Haute-Savoie, his chosen rural setting.