Thursday, January 11, 2024

Professor Keith Simpson and Textbook Strangulation

In the mid-1970s, I went to a meeting at Guy's Hospital in London to hear the eminent Home Office pathologist Professor Keith Simpson (1907-1985) talk about his work. It was an excellent and memorable evening. Simpson described things to which very few have access.

At one point, he described how, during strangulation, the body of the thyroid cartilage in the neck fractures diagonally. That, I remember thinking, was contrary to something I had read - albeit in an elementary textbook. (I may even have heard it mentioned in a classroom lecture).


At the end of the talk, the floor was open for questions. The first to speak was a woman with a 'snooty' voice and an overbearing manner to match. She did not so much ask a question as seek to impugn the speaker's integrity. She stated that in "book after book after book" that she had read, the cornu at the back of the thyroid cartilage were said to fracture during strangulation, not its body. "Which are we to believe," she concluded, "you or the books?"


A buzz went around the auditorium. The tone of the question was quite improper. That evening's meeting was the type of academic meeting at which the speaker and his work were each on display. The two become inseparable. It was not the type of meeting where research findings get presented, differences of opinion aired and heated arguments follow. (Even on those occasions, a speaker's integrity is unquestioned.)


Simpson was unphased. He was, in response, a perfect gentleman and, as a result, utterly devastating. "Madam", he replied, in an almost apologetic tone, "I can only tell you what I have seen during many years of experience." That would have been enough to answer his inquisitor, but he went on to expand - and this is the point of this anecdote. He pointed out (quoting his questioner) that "book after book after book" on the body is written, not from making dissections but from reading other books. In short, books of anatomy are the product of books of anatomy. Once an error creeps in, it gets perpetuated.


That is especially so when one reads uncritically. What Simpson had unintentionally highlighted was such an error. The inquisitor was somebody who had accepted the authority of textbooks uncritically. That is something quite common. I once had a student express surprise that anyone could doubt a textbook. She even described the contents as being 'set in stone'. Fortunately, one can take a chisel to stone.


Interestingly, the standard British textbook on forensic medicine - 'Simpson's Forensic Medicine' - now bears the name of that evening's speaker. It was first published as 'Forensic Medicine' in 1947 and must, ironically, have been the one not read by his inquisitor.