The Doctor’s Surgery

On a little heap of barley Died my aged Uncle Arly, And they buried him one night, Close beside the leafy thicket. (But his shoes were far too tight.) Edward Lear, Incidents in the Life of My

Uncle Arly These days, case histories are not much in fashion in medical journals because they aren’t truly scientific. Nevertheless, they are sometimes most instructive, as was that of a friend of mine who, like me, has reached the age of those arthritic aches and pains that are the first topic of conversation when people of our age speak or meet.

For a few months, however, the pain in his hip had become so severe that he could scarcely walk and climbing the stairs was – as patients are inclined to put it – sheer agony. Sometimes the pain would shift from his right to his left and then back again. It prevented his sleeping soundly and frequently woke him up. He could no longer walk his dogs, fine lurchers who needed several miles’ walk each day.

Himself a doctor, he was reluctant to visit his own medical adviser (illness is for the laity), but eventually he did so. The doctor sent him off to be put into what a physician of my acquaintance calls the answering machine, that is to say an MRI scanner. Since by our age no hip scans are normal, the orthopaedic surgeon suggested that he might soon need an operation, rather like the one tennis player Andy Murray had recently.

Then my friend, who is sometimes called to court as an expert witness, was called in for a few days to give evidence. Instead of his usual trousers, he wore a suit with braces. At the end of his court appearances in his suit, the pain in his hips was gone.

He slept well, he no longer had to crawl up the stairs on hands and knees, and he could accompany the dogs on their long walks. He came to the conclusion that his months of agony had been caused by trousers that were too tight (like Uncle Arly’s shoes) at the waist.

The physiological mechanism of his illness, if that is the proper term for it, was almost certainly pressure on the nerves, combined with an adverse effect on his posture. There is a recognised syndrome or pattern in which those who wear their trousers too tight suffer problems. But I have never heard of anyone suffering anything quite as bad as that which he suffered; far worse than mere meralgia paraethetica, a condition that may be caused by pressure on the lateral, cutaneous nerve of the thigh and which gives rise to a burning sensation, numbness and tingling on the lateral aspect of the thigh.

A moralist might see in this story a just reward for two vices, namely meanness and vanity. Although my friend is by no means a poor man, he will in no circumstances buy himself new clothes. He prefers to accept the cast-offs of his neighbours, whether they fit him fully or not. More importantly, perhaps, he is reluctant to admit that his waistline may have expanded in recent years. In his case, pride went not before a fall, but before months of severe pain. He has since had the offending trousers let out.

There is another moral to the story: how easy it is to have an unnecessary operation performed upon one. My friend might easily have had a serious operation on his hip when all he needed was, in the cant phrase of the counterculture, to loosen up a bit.

‘His agony had been caused by trousers that were too tight’