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Pharmacology for Anaesthesia
and Intensive Care
THIRD EDITION
www.cambridge.org
Information on this title: www.cambridge.org/9780521704632
C Tom Peck Sue Hill and Mark Williams 2008
A catalogue record for this publication is available from the British Library.
Peck, T. E.
Pharmacology for anaesthesia and intensive care / Tom Peck, S. Hill, Mark Williams. – 3rd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-521-70463-2 (pbk.)
1. Pharmacology. 2. Anesthetics. 3. Anesthesia. 4. Critical care medicine.
I. Hill, S. A. (Sue A.) II. Williams, Mark (Mark Andrew) 1965- III. Title.
[DNLM: 1. Anesthetics–pharmacology. 2. Cardiovascular Agents–pharmacology.
3. Intensive Care. QV 81 P367p 2007]
RM300.P396 2007
615 .1–dc22 2007029048
Cambridge University Press has no responsibility for the persistence or accuracy of URLs for
external or third-party internet websites referred to in this publication, and does not guarantee
that any content on such websites is, or will remain, accurate or appropriate.
CO N T E N TS
Preface page ix
Foreword xi
v
vi Contents
Index 360
CO N T R I B U TO R
vii
P R E FAC E
The third edition has seen further changes. The mathematics section has been over-
hauled and expanded to give a better base for the kinetics. An additional chapter
has been added on intravenous fluids, and the chapters on intravenous and volatile
anaesthetics have been combined with an expanded section on the molecular mech-
anism of anaesthesia.
We have tried to maintain the style of the previous two editions with an emphasis
on clarity both in terms of presentation and content. In addition we have tried very
hard to eliminate those small errors that are disproportionately irritating. We hope
that this book will continue to be a helpful aid to the wide range of readers it appears
to have attracted.
Tom Peck
Sue Hill
Mark Williams
ix
FO R E WO R D
I can remember my first day as an anaesthetic senior house officer, back in August
1985, and the advice that I received on that first day is still relevant for the twenty
first century anaesthetist. “Anaesthesia is based on three basic sciences, physiology,
physics and pharmacology,” said my first college tutor. The following weekend I took
a trip to Lewis’s book shop in Gower Street to buy the recommended texts of the day.
None of those I bought are still in print, but the pharmacology text has certainly been
replaced by “Pharmacology for Anaesthesia and Intensive Care.”
The first two editions established themselves as the core pharmacology text for
aspiring anaesthetists. It has evolved with each edition and the third edition has
continued this trend, with some interesting new features. The mathematics and
pharmacokinetics chapter is particularly well presented, and explains the concepts
concisely and clearly. This is core knowledge that appears in the examinations of the
Royal College of Anaesthetists but should be retained for all clinical anaesthetists
and intensive care specialists.
Perhaps the title of the book should be changed for future editions as there has
been a large change in medical education in the UK since the second edition, namely
Modernising Medical Careers. This book is relevant to all foundation trainees who
rotate through anaesthesia, intensive care and acute medical specialties. The new
chapter on fluids is especially relevant to those at the start of their careers. The
core knowledge presented should help to encourage good prescribing practice on
all acute medical and surgical wards and avoid fluid management errors.
In summary the new edition is essential reading for those embarking on an anaes-
thetic career and is a core text for the FRCA. The authors come from district gen-
eral and teaching hospital backgrounds but this book offers concise common sense
pharmacology knowledge to all grades, even those who started anaesthesia before
propofol was introduced!!
xi
SECTION I Basic principles
1
Drug passage across the cell membrane
Many drugs need to pass through one or more cell membranes to reach their site
of action. A common feature of all cell membranes is a phospholipid bilayer, about
10 nm thick, arranged with the hydrophilic heads on the outside and the lipophilic
chains facing inwards. This gives a sandwich effect, with two hydrophilic layers sur-
rounding the central hydrophobic one. Spanning this bilayer or attached to the outer
or inner leaflets are glycoproteins, which may act as ion channels, receptors, interme-
diate messengers (G-proteins) or enzymes. The cell membrane has been described as
a ‘fluid mosaic’ as the positions of individual phosphoglycerides and glycoproteins
are by no means fixed (Figure 1.1). An exception to this is a specialized membrane
area such as the neuromuscular junction, where the array of post-synaptic receptors
is found opposite a motor nerve ending.
The general cell membrane structure is modified in certain tissues to allow
more specialized functions. Capillary endothelial cells have fenestrae, which are
regions of the endothelial cell where the outer and inner membranes are fused
together, with no intervening cytosol. These make the endothelium of the capil-
lary relatively permeable; fluid in particular can pass rapidly through the cell by
this route. In the case of the renal glomerular endothelium, gaps or clefts exist
between cells to allow the passage of larger molecules as part of filtration. Tight
junctions exist between endothelial cells of brain blood vessels, forming the blood–
brain barrier (BBB), intestinal mucosa and renal tubules. These limit the passage
of polar molecules and also prevent the lateral movement of glycoproteins within
the cell membrane, which may help to keep specialized glycoproteins at their site
of action (e.g. transport glycoproteins on the luminal surface of intestinal mucosa)
(Figure 1.2).
1
Section I Basic principles
Extracellular
K+
β
γ α
Na+
Na+
ATP ADP
Intracellular
Figure 1.1. Representation of the cell membrane structure. The integral proteins embedded in
this phospholipid bilayer are G-protein, G-protein-coupled receptors, transport proteins and
ligand-gated ion channels. Additionally, enzymes or voltage-gated ion channels may also be
present.
the pKa of the drug in question. Factors influencing the rate of diffusion are discussed
below.
In addition, there are specialized ion channels in the membrane that allow inter-
mittent passive movement of selected ions down a concentration gradient. When
opened, ion channels allow rapid ion flux for a short time (a few milliseconds) down
relatively large concentration and electrical gradients, which makes them suitable
to propagate either ligand- or voltage-gated action potentials in nerve and muscle
membranes.
The acetylcholine (ACh) receptor has five subunits (pentameric) arranged to form
a central ion channel that spans the membrane (Figure 1.3). Of the five subunits,
two (the α subunits) are identical. The receptor requires the binding of two ACh
molecules to open the ion channel, allowing ions to pass at about 107 s−1 . If a thresh-
old flux is achieved, depolarization occurs, which is responsible for impulse trans-
mission. The ACh receptor demonstrates selectivity for small cations, but it is by
no means specific for Na+ . The GABAA receptor is also a pentameric, ligand-gated
2
1 Drug passage across the cell membrane
Acetylcholine
β γ or ε
α δ
Acetylcholine
Figure 1.3. The acetylcholine (ACh) receptor has five subunits and spans the cell membrane.
ACh binds to the α subunits, causing a conformational change and allowing the passage of
small cations through its central ion channel. The subunit replaces the fetal-type γ subunit
after birth once the neuromuscular junction reaches maturity.
channel, but selective for anions, especially the chloride anion. The NMDA
(N-methyl D-aspartate) receptor belongs to a different family of ion channels and is
a dimer; it favours calcium as the cation mediating membrane depolariztion.
Ion channels may have their permeability altered by endogenous compounds or by
drugs. Local anaesthetics bind to the internal surface of the fast Na+ ion channel and
prevent the conformational change required for activation, while non-depolarizing
muscle relaxants prevent receptor activation by competitively inhibiting the binding
of ACh to its receptor site.
Facilitated diffusion
Facilitated diffusion refers to the process where molecules combine with membrane-
bound carrier proteins to cross the membrane. The rate of diffusion of the molecule–
protein complex is still down a concentration gradient but is faster than would be
expected by diffusion alone. Examples of this process include the absorption of
steroids and amino acids from the gut lumen. The absorption of glucose, a very
polar molecule, would be relatively slow if it occurred by diffusion alone and requires
facilitated diffusion to cross membranes (including the BBB) rapidly.
Active transport
Active transport is an energy-requiring process. The molecule is transported against
its concentration gradient by a molecular pump, which requires energy to function.
Energy can be supplied either directly to the ion pump, or indirectly by coupling
pump-action to an ionic gradient that is actively maintained. Active transport is
encountered commonly in gut mucosa, the liver, renal tubules and the BBB.
3
Section I Basic principles
ATP ADP
Na 1° active transport
K
Pinocytosis
Pinocytosis is the process by which an area of the cell membrane invaginates around
the (usually large) target molecule and moves it into the cell. The molecule may then
be released into the cell or may remain in the vacuole so created, until the reverse
process occurs on the opposite side of the cell.
The process is usually used for molecules that are too large to traverse the mem-
brane easily via another mechanism (Figure 1.5).
4
1 Drug passage across the cell membrane
Concentration gradient
Fick’s law states that the rate of transfer across a membrane is proportional to the
concentration gradient across the membrane. Thus increasing the plasma concen-
tration of the unbound fraction of drug will increase its rate of transfer across the
membrane and will accelerate the onset of its pharmacological effect. This is the
basis of Bowman’s principle, applied to the onset of action of non-depolarizing mus-
cle relaxants. The less potent the drug, the more required to exert an effect – but this
increases the concentration gradient between plasma and active site, so the onset of
action is faster.
Ionization
The lipophilic nature of the cell membrane only permits the passage of the uncharged
fraction of any drug. The degree to which a drug is ionized in a solution depends on
the molecular structure of the drug and the pH of the solution in which it is dissolved
and is given by the Henderson–Hasselbalch equation.
The pKa is the pH at which 50% of the drug molecules are ionized – thus the con-
centrations of ionized and unionized portions are equal. The value for pKa depends
on the molecular structure of the drug and is independent of whether it is acidic or
basic.
The Henderson–Hasselbalch equation is most simply expressed as:
[proton acceptor]
pH = pKa + log .
[proton donor]
5
Section I Basic principles
Hence, for an acid (XH), the relationship between the ionized and unionized forms
is given by:
[X− ]
pH = pKa + log ,
[XH]
Lipid solubility
The lipid solubility of a drug reflects its ability to pass through the cell membrane; this
property is independent of the pKa of the drug. However, high lipid solubility alone
does not necessarily result in a rapid onset of action. Alfentanil is nearly seven times
less lipid-soluble than fentanyl, yet it has a more rapid onset of action. This is a result
of several factors. First, alfentanil is less potent and has a smaller distribution volume
and therefore initially a greater concentration gradient exists between effect site and
plasma. Second, both fentanyl and alfentanil are weak bases and alfentanil has a
lower pKa than fentanyl (alfentanil = 6.5; fentanyl = 8.4), so that at physiological pH
a much greater fraction of alfentanil is unionized and available to cross membranes.
Lipid solubility affects the rate of absorption from the site of administration. Thus,
fentanyl is suitable for transdermal application as its high lipid solubility results in
effective transfer across the skin. Intrathecal diamorphine readily dissolves into, and
fixes to, the local lipid tissues, whereas the less lipid-soluble morphine remains in
the cerebrospinal fluid longer, and is therefore liable to spread cranially, with an
increased risk of respiratory depression.
6
1 Drug passage across the cell membrane
Protein binding
Only the unbound fraction of drug in plasma is free to cross the cell membrane; drugs
vary greatly in the degree of plasma protein binding. In practice, the extent of this
binding is of importance only if the drug is highly protein-bound (more than 90%).
In these cases, small changes in the bound fraction produce large changes in the
amount of unbound drug. In general, this increases the rate at which drug is metab-
olized, so a new equilibrium is re-established with little change in free drug con-
centration. For a very small number of highly protein-bound drugs where metabolic
pathways are close to saturation (such as phenytoin) this cannot happen and plasma
concentration of unbound drug will increase and possibly reach toxic levels.
Both albumin and globulins bind drugs, each has many binding sites, the number
and characteristics of which are determined by the pH of plasma. In general, albumin
binds neutral or acidic drugs (e.g. barbiturates), and globulins (in particular, α−1
acid glycoprotein) bind basic drugs (e.g. morphine).
Albumin has two important binding sites: the warfarin and diazepam. Binding
is usually readily reversible, and competition for binding at any one site between
different drugs can alter the active unbound fraction of each. Binding is also possi-
ble at other sites on the molecule, which may cause a conformational change and
indirectly influence binding at the diazepam and warfarin sites.
Although α−1 acid glycoprotein binds basic drugs, other globulins are important
in binding individual ions and molecules, particularly the metals. Thus, iron is bound
to β−1 globulin and copper to α−2 globulin.
Protein binding is altered in a range of pathological conditions. Inflammation
changes the relative proportions of the different proteins and albumin concentration
falls in any acute infective or inflammatory process. This effect is independent of
any reduction in synthetic capacity resulting from liver impairment and is not due
to protein loss. In conditions of severe hypoalbuminaemia (e.g. in end-stage liver
cirrhosis or burns), the proportion of unbound drug increases markedly such that
the same dose will have a greatly exaggerated pharmacological effect. The magnitude
of these effects may be hard to estimate and drug dose should be titrated against
clinical effect.
7
2
Absorption, distribution, metabolism
and excretion
Absorption
Drugs may be given by a variety of routes; the route chosen depends on the desired
site of action and the type of drug preparations available. Routes used commonly by
the anaesthetist include inhalation, intravenous, oral, intramuscular, rectal, epidural
and intrathecal. Other routes, such as transdermal, subcutaneous and sublingual,
also can be used. The rate and extent of absorption after a particular route of admin-
istration depends on both drug and patient factors.
Drugs may be given orally for local as well as systemic effects, for example, oral
vancomycin used to treat pseudomembranous colitis is acting locally; antacids also
act locally in the stomach. In such cases, systemic absorption may result in unwanted
side effects.
Intravenous administration provides a direct, and therefore more reliable, route
of systemic drug delivery. No absorption is required, so plasma levels are indepen-
dent of such factors as gastrointestinal (GI) absorption and adequate skin or muscle
perfusion. However, there are disadvantages in using this route. Pharmacological
preparations for intravenous therapy are generally more expensive than the corre-
sponding oral medications, and the initially high plasma level achieved with some
drugs may cause undesirable side effects. In addition, if central venous access is
used, this carries its own risks. Nevertheless, most drugs used in intensive care are
given by intravenous infusion this way.
Oral
After oral administration, absorption must take place through the gut mucosa. For
drugs without specific transport mechanisms, only unionized drugs pass readily
through the lipid membranes of the gut. Because the pH of the GI tract varies along
its length, the physicochemical properties of the drug will determine from which
part of the GI tract the drug is absorbed.
Acidic drugs (e.g. aspirin) are unionized in the highly acidic medium of the stomach
and therefore are absorbed more rapidly than basic drugs. Although weak bases
(e.g. propranolol) are ionized in the stomach, they are relatively unionized in the
duodenum, so are absorbed from this site. The salts of permanently charged drugs
(e.g. vecuronium, glycopyrrolate) remain ionized at all times and are therefore not
absorbed from the GI tract.
8
2 Absorption, distribution, metabolism and excretion
AUCoral
Plasma Bioavailability =
concentration AUCi.v.
i.v.
oral
Time
Figure 2.1. Bioavailability may be estimated by comparing the areas under the curves.
In practice, even acidic drugs are predominantly absorbed from the small bowel,
as the surface area for absorption is so much greater due to the presence of mucosal
villi. However, acidic drugs, such as aspirin, have some advantages over basic drugs
in that absorption is initially rapid, giving a shorter time of onset from ingestion, and
will continue even in the presence of GI tract stasis.
Bioavailability
Bioavailability is generally defined as the fraction of a drug dose reaching the systemic
circulation, compared with the same dose given intravenously (i.v.). In general, the
oral route has the lowest bioavailability of any route of administration. Bioavailability
can be found from the ratio of the areas under the concentration–time curves for an
identical bolus dose given both orally and intravenously (Figure 2.1).
9
Other documents randomly have
different content
useful, but on the whole a mean trade; often the fruit, and always
the parent of meanness in every mind that permanently follows it.”
And indeed in all critics there must be a marrow of conceit
stiffening the backbone. Else how could they—who fell out of the
ranks footsore on the march to battle—come along so complacently
when the fight is over, to talk to the soldiers covered with the grime
and sweat of their work, and tell them how easily it might all have
been done without soiling the pipeclay.
All critics however do not write merely from this motive. There are
many of course writing from the far higher motive of greed. Then
there are some few who do it for the rare fun of the thing—to enjoy
the intense annoyance it gives to foolish, sensitive artists—these are
the mud flingers and corner boys of the trade, and of course a few
critics have lived who played the game and knew it and brought a
message of heaven-sent sympathy to the artist. Maybe such a one
exists to-day, in some corner behind the clouds, struggling to let his
rays shine encouragement on honest endeavour.
But apart from the writings of critics vanity and conceit have
always been strong motives of authors. They are found especially in
schools of literature, where the form is preferred to the substance.
Take our eighteenth century writers and read the story of their lives.
Can it be denied that they were a vain crowd? Even Swift, Pope and
Addison—the greatest of them—were not without it. As for the
smaller fry, with their degrading squabbles and jealousies—their very
faces seem to me pitted with the small-pox of conceit. And
throughout this period you have one symptom;—the writer exalting
the letter above the spirit,—and when you find that, it is invariably
the indication of disease, and the disease is vanity.
This is not only the case in writing. It is so in nearly all pursuits.
When you begin to believe in technical excellence of form as an end
in itself, it is necessary to become to some extent narrow, vain and
conceited or you will not achieve your end. In those arts in which
form is more essential to the art than substance, vanity and conceit
are more commonly found. Thus actors, singers, dancers, and
schoolmasters are often not without vanity. You may notice, too, that
the minor technical pursuits of life produce a certain conceit. It is
occasionally observable in the semi-professional lawn-tennis
amateur. In a lesser degree too by many golfers the same vice is
sometimes displayed, but more often in the club-house and on the
first tee than during the progress of the game. When a man is
deeply bunkered style becomes a secondary consideration.
But generally speaking all writers who think literature an affair of
quantities, metres, syntax and grammatical gymnastics, all men who
reverence literary form rather than practical substance, are bound to
write in a spirit of vanity and conceit, which is the only petrol that
can push them along the weary road they have chosen. It oppresses
you to-day to find this spirit in nearly all the great writers of the
eighteenth century. How Oliver Goldsmith stands out amongst them
as the one great writer with a human heart; how we readers of to-
day love him and reverence him with an enthusiasm we cannot offer
to Addison himself.
But enough of conceit and vanity, let us turn to our second motive
—a far pleasanter and more everyday affair—greed. I should put
Shakespeare among the first and greatest whose motive was greed.
I cannot imagine anyone taking the trouble to write a play from any
other motive, certainly not from a lower motive. Shakespeare’s main
desire in life, if we may trust his biographers, was to become a
landowner in Warwickshire—possibly a county magistrate. What an
ideal chairman he would have made of a licensing bench. Would
Mistress Quickly’s license have been renewed? I doubt it.
Shakespeare wrote plays for the contemporary box office to make
money out of them and thrive. As Mr. Sidney Lee tells us he “stood
rigorously by his rights in all business relations.” There being in
those days no law of copyright he borrowed all he could from
common stock, added to it the wonderful flavouring of his own
personality and served up the immortal dramatic soup which
nourishes us to-day. After this fashion of borrowing, if Emerson be
right, the Lord’s Prayer was made. The single phrases of which it is
composed were, he says, all in use at the time of our Lord in the
rabbinical forms. “He picked out the grains of gold.” It is the same if
you think of it with Æsop’s fables, the Iliad and the Arabian Nights,
which no single author produced. And so must all great work be
done, for we are nothing of ourselves and if we do not take freely of
those who are gone before we can do naught. But only those have
the right to borrow who can embroider some new and glorious
pattern on the homely stuff they appropriate. Shakespeare had no
vanity and conceit; no doubt he wrote for the fun of the thing, as all
writers who are worth their salt must do, possibly—though I for one
doubt it—he knew of the message he was delivering to the world;
but that he wrote his plays primarily for greed, the few records of his
life that we possess seem to me to prove beyond reasonable doubt.
Unless, of course, you are mad enough to believe Bacon wrote the
plays. Then indeed the motive power of the author was greed—
greed of a baser sort than Shakespeare’s—for the great Lord
Chancellor never did anything that I know of, except a few trivial
scientific experiments, from any other motive.
But when I speak of Shakespeare and greed, I speak as a modern
and not as an Elizabethan. Greed in Shakespeare’s day meant the
greed of filthy lucre, the insatiate greediness of evil desires. It was
an insanitary word in those days. But greed to-day means something
quite otherwise. When I speak of greed as the main motive of
authorship I use the word, not with any old-fashioned dictionary
meaning, but in an up-to-date, clear-sighted, clarion, socialist sense.
You speak to-day—those of you who are in the movement—of the
greed of the capitalist, the greed of the employer. In this way I
speak of the greed of the author. The greed of anyone to-day is the
greed which urges him to endeavour to enrich himself and provide
for himself and his family by using his brains in producing things.
Incidentally he may employ a vast number of people with less brains
or no brains, incidentally he may ruin himself after he has used his
brains, and paid a large number of people in publishing the result of
his brain-work; but do not let us in an age of socialism gainsay that
it is pure greed to use your brains for the purpose of putting money
into your own pocket. It is true this kind of greed led to Columbus
discovering America—but if he had not done so how many fewer
capitalists there would have been. Sir Walter Raleigh, too, was a bad
instance of a man moved by greed; we cannot acquit Drake, or the
great Lord Burghley or even my own historical heroine the Maiden
Queen herself. The greed of Elizabethan England is a thing to
shudder at, if you are a real socialist, and Shakespeare, I fear, must
be found guilty from a modern standpoint of having written his plays
from the simple motive power of greed.
I am the more certain of this for the only Shakespearean play of
modern times “What the Butler Saw,” was written, I am ashamed to
say, from similar motives. I happen to know that this is a play after
Shakespeare’s own heart. I learned it in a vision. I am not a believer
in dreams myself, but there must be something in some of them,
and mine is worthy of the consideration of the Psychical Research
Society. It was after the first night of the Butler in London, and after
a somewhat prolonged and interesting supper with some of those
responsible for the production,—in psychical research supper should
always be confessed to,—that I had a curious dream of the people
who were present at the theatre. Many who appeared had actually
been present, others had not. Milton and Oliver Cromwell, both
came up to me and hoped it would not have a long run—
Wordsworth, I remember, wanted to know what the Butler really did
see, and Charles Lamb, winking at me, took him away to tell him. It
was then that Shakespeare came and patted me lightly on the
shoulder, saying “It’s all right, my young friend”—young of course
from Shakespeare’s point of view—“I couldn’t have done it better
myself.”
Many will wonder why this story has not long before this gone the
round of the press. The answer is that I am not a business man. I
once mentioned the dream to a spiritualist, who said that there was
no evidence that it was the shade of Shakespeare—it might have
been the astral body of one of the inhabitants of the Isle of Man. I
replied that then we should have heard of it long ago.
As an instance of dramatic justice it is interesting to know that the
production of this play costs its authors money. Incidentally it made
money for others, actors, actresses, scene-shifters, proprietors of
theatres, dramatic critics and the like, to the tune of tens of
thousands of pounds. Some day when I publish the play, as I hope
to do, I will set out in detail its financial side, which is quite as
amusing as the play itself. But the main point, which from a socialist
point of view is so entirely satisfactory, is that the brain-workers who
wrote it, and the capitalist who produced it lost over it; but that it
provided work and bread and cheese for a large number of people
who might otherwise have filled the ranks of the unemployed. It is a
fitting termination to the work of an author whose motive power is
greed. The only fear is that if this were always to happen, there
might come a time when there would be a shortage of authors ready
to supply food and wages for others at a cost to themselves.
Personally, I do not think this is all likely to occur, for authors seem
to me a class of persons who will always be actuated by vanity, and
a greed of so unintelligent and unbusinesslike a character that they
will go on writing for others, rather than themselves to the end of
time. I in no way regret the results of “What the Butler Saw.” I fear
my greed is of a very poor commercial standard. I had plenty of fun
for my money. It is something to have written a masterpiece, and it
is something better to have seen it beautifully acted. I am very poor
at taking the amusements of life seriously, and even when playing
golf I often find myself looking at the scenery instead of at the ball.
Indeed, I am not sure that I did write “What the Butler Saw,” from
any really high sense of greed, and that may account for its having
turned on me and bitten me financially. I have more than a half
belief that I wrote it for the fun of the thing.
And this brings me to my third motive of authorship, writing for
the fun of the things. All the best writing in the world—short of the
very highest and most sacred work—is done for the fun of the thing.
Some people prefer the phrase the love of the thing, and say it is
the love of the beautiful, or the love of mischief, or the love of
romance that moves them to writing. But I prefer to call it writing for
the fun of the thing, because that describes to me exactly what I
mean. All games should be played in this spirit, and writing is a far
less serious game with most of us than games like bridge or chess or
golf or cricket.
Charles Marriott—not the national novelist of our high seas, but
Marriott the modern—who has a gracious gift of hinting great ideas
in simple phrases and never shouts them at you, so that if you are a
deaf reader you do not always get the best out of him—Marriott says
in “The Remnant”: “Quite in the beginning, when men went out to
kill their enemies or their dinner, there was always one man who
wanted to stay, at home and talk to the women, and make rhymes
and scratch pictures on bones.” There are two great truths in this.
One is that the first author was an artist. He scratched pictures on
bones long before he made rhymes. Of course he did it for the fun
of the thing. There could be no other reason, the motives of vanity
and greed were not open to him. There was no publisher in the
cave-dwellers’ days to seize his bones, and pay him a royalty on
them, and build a big cave for himself out of the proceeds of the
speculation, whilst the bone-scratcher slept in the open. I think a
cave-artist had a good time. He enjoyed his life in his own way, and
I believe got better food for his work than many an artist of to-day.
But modern artists have forgotten the great truth that to paint well
you must paint for the fun of the thing, as the cave-man scratched
his bones, and as children draw to-day if you give them paper and
pencil, and don’t look on and worry them. Few artists now paint for
the fun of the thing without vanity or greed, but when they do they
sometimes find an echo in the shape of a patron as mad as
themselves, who buys pictures for the fun of the thing, and not
because the critics tell him that this or that is good. The recent
McCullough collection at Burlington House was worth showing
despite the sneers of the superior persons, because it was an honest
collection of what one man had really liked. What annoyed the critics
was that a man had bought the pictures because he loved them, and
not because he had been told he ought to love them.
And then there is another great truth in what Marriott says. The
cave-artist stayed at home to make rhymes and pictures for the
women whilst the men went out to get the dinner. How few writers
remember that the real judges of literature are and must be the
women of the country. Women necessarily fill the churches and
lecture halls, and the lending libraries, and the theatres, and the
picture galleries—only in music halls do men predominate. It is for
women primarily that all literature and art are made to-day, just as
they were in the cave-dweller’s time. To follow out this interesting
theme and account scientifically for the phenomenon would take a
longer essay than this. Moreover, one would run up against the
problem of the women who want to vote and many other dangerous
questions. The cave-dwellers really knew all about it. The men went
out to get the dinner in those days merely because there were no
shops in Cave Street—but the researches of all professors show that
even in those days the women ordered the dinner. And the voice
that orders the dinner, and the hand that rocks the cradle will always
rule the world.
If you want to test the value of writing for the fun of the thing in
relation to the work produced take the case of Southey. Southey
was, among the many mansions of literature of his day, the most
eligible mansion of all. He was a most erudite and superior literary
man. But though what he wrote was important and well paid for
when he wrote it, to-day the world has no use for it. But once in a
way Southey wrote a story for the fun of the thing and it will live for
ever. I refer of course to “The Three Bears.” Southey, strange to say,
wrote that wonderful story. He invented the immortal three, the
Great Huge Bear with his great rough gruff voice, and the Middle
Bear with his middle voice, and the Little Small Wee Bear with his
little small wee voice. And such a work of genius is it that already it
is stolen and altered and the name of the author is almost unknown.
And just because he wrote it for the fun of the thing it will go on
living as long as there are children in the world to tell it to. Porthos,
Athos, and Aramis, Dumas’ three musketeers, may vanish into
oblivion, but the three bears will be a folk-lore story when the affairs
of this century are a prehistoric myth.
Remember too, Southey’s companion, Wordsworth, the
“respectable poet” as De Quincey unkindly called him. Did he ever
write anything for the fun of the thing? Had he any fun in him to
write with? Wordsworth serves his purpose to-day, no doubt. He is
there for professors of English literature to profess. He is there for
serious-minded uncles to present as a birthday gift, in one volume
bound in whole morocco, floral back and sides, gilt roll, gilt edges,
price sixteen shillings and sixpence, to sedate nieces. But do the
sedate nieces read his poetry? As Sam Weller says: “I don’t think.”
Coleridge again, when you set aside the few poems that he did write
for the fun of the thing, presents the somewhat mournful spectacle
of a literary man spending a literary life doing literary work. You read
of him starting this periodical and that periodical, roaming about
England in search of subscribers under the impression that he had a
message to deliver; when, sad to say, all the while he was ringing
his bell and shouting “Pies to sell” the tray on his head was empty of
any useful food for mankind.
Compare these great names with that of their humble companion,
Charles Lamb. He never wrote an essay or a letter except for the fun
of the thing. He had to go down to an office day by day and do his
task. He might have kept pigeons or done a little gardening or
played billiards, but he preferred to read books and to go to plays
and write about things he loved. Not that his hobby was in its nature
a higher thing to him than another man’s, but it was his naturally,
and he simply wrote because he enjoyed writing, in the same way
that he drank because he enjoyed drinking. And what is the result?
Southey has departed into the shadows, when you take Wordsworth
off the young lady’s shelves you have to blow the dust off the top of
the volume, and Coleridge is only to be found in school poetry books
which are carefully compiled by economic editors of poems which
are non-copyright. But Charles Lamb has more friends and lovers to-
day than he had in his own lifetime. He wrote for the fun of the
thing and the fun remains with us to-day, bounteous and joyful,
bubbling over with humour and delight, and overflowing with
affection and respect for everything that is best in human nature.
And perhaps part of what I mean by writing for the fun of the
thing is to be found in a phrase that used to be uttered about
writings that they “touch your heart.” It is a curious old-fashioned
phrase. It would be interesting to enquire what it is that keeps a
book alive through after-generations. I think that this capacity of
“touching the heart” has much to do with it. Shakespeare, Dickens
and Goldsmith had this quality; so in a different way had Izaak
Walton and Samuel Pepys. It may be that this magic power is the
salt that keeps a man’s writings sweet among the varied
temperatures of thought through which they survive. Qualities of
brain and intellect vary century by century, but what we call the
heart of man is the same to-day as it was when King David wrote his
psalms. Therefore, unless our writings appeal to the heart it is
impossible for them to attain everlasting life. Much of the literature
of to-day is, I fear, as Touchstone says—“damned like an ill-roasted
egg all on one side.” For the fashion of the hour is to despise the
heart and to sneer at the simple folk whose hearts still beat in
harmony with the silly domestic notions of love and honour and
charity and family life. To-day who would be a writer must write for
the brains and intellects of the learned—meaning by the learned
those who have passed sufficient examinations to render it
unnecessary they should ever think for themselves again. And even
this is outdone by the new school who pride themselves that the
brain is as old-fashioned an audience for the author as the heart,
that the proper portion in the twentieth century is the liver. If a book
stirs the bile of all decent people it is to-day a popular success. So
unintelligent a view do some take of the movement that they try to
throw opprobrium upon it by the use of the epithet “yellow” as in
the phrase “Yellow Press”: whereas, yellow among the inner
brotherhood is the holy colour as typical of the movement as it is of
jaundice itself. Personally, I should like to send many of our great
novelists and playwrights of to-day to Harrogate for the season. I
believe that a course of ten ounce doses of the “strong sulphur,” at
that charming watering place would diminish the risk for them of a
far longer course of far stronger sulphur in the hereafter. Their
writings may have a vogue for a time and after all their position in
literature will not be decided by anything I say, or anything their
friendly and scholarly critics say, except in so far as we are atoms of
the general mob of mankind whose taste is final. For as Newman
said: “Scholars are the tribunal of Erudition, but of Taste the
educated but unlearned public is the only right judge.”
But before I deal with the last motive of authorship which I
suggest, let me say a few words about an entirely different answer
to the question I am putting “Why be an Author?” There are wise
men who declare that a man is an author from pre-destination;
because he cannot help himself, because he is built that way. In
other words that to be an author is a habit like drink or gambling. I
can see that if this theory gains ground, libraries are going to have a
rough time of it in the future. No doubt there are people—like myself
—who waste a great deal of time in reading and writing which might
be better used by digging in the garden, or cleaning the boots. As
education proceeds upon the lines of to-day this bad habit will grow
more popular. Young folk will take to spending their evenings, and
even their Sundays, in libraries and meeting together over books as
they do over football. Older folks will imbibe books much as they
imbibe beer. Respectable employers of labour will see the danger of
it—indeed, many of them to-day are clamouring against plays and
fiction and other literary products as evil in themselves. They will, I
think, rightly begin by persuasion. They will form Blue Ribbon
Societies and a United Kingdom Alliance for the total suppression of
the Book Trade. Then will come, in the natural order of things, a
Licensing Bench to license libraries. On this no magistrate will sit
who has ever written a book, or been connected with the publishing
trade, but magistrates who are total abstainers from reading and
writing will properly form a majority of the tribunal. And in the city of
Manchester, which is a city of Libraries, which library will they close
first? I should say the Ryland’s Library. For there is a seductive
beauty about its surroundings, and the books it gives you to drink
are of such wondrous flavour and served in such rare goblets, that
to the poor erring man, who like myself is not a teetotaler among
books, the temptation to leave his worldly duties and forget his tasks
among its luxurious pleasures, is one that wise magistrates will not
permit. Then, too, the landlord—I mean the librarian—is such a kind-
hearted fellow. Always ready to give you another—and nothing to
pay. Charles Lamb would never have got to the East India Office if
the Ryland’s Library had been in his path. For my part I always used
to approach my County Court in Quay Street from the other side,
saying to myself as I crossed Deansgate, “Lead us not into
temptation.”
Do not think that this idea of a future licensing authority for
literature is by any means a fanciful one. We have seen a Yorkshire
town council turning Fielding’s works out of a free library to their
own eternal disgrace, and a Library Committee in Manchester
boycotting Mr. Wells. Already Town Councils decide what sort of
plays we may go and see, and what sort of dances are good for us,
and absolutely settle for us what we are to drink in between the
acts, putting all the whisky on one side of the street and all the soda
on the other. When, therefore, the town council mind wakes up to
the fact that from a respectable employer of labour point of view the
author habit is as dangerous a habit as the drink habit, the licensing
system will most certainly extend. And I feel sure when things
progress and authors themselves are made to take out licenses I
shall run a serious risk—unless I mend my ways—of having my
license endorsed.
But for my own part, I do not believe in an author habit any more
than I greatly believe in a drink habit. Given sanity I believe a man
can keep off authorship if he tries. I never seriously tried, but I think
I could stop, if I wished to, even now. And there would be a danger
in any system of state or municipal control of authors that you might
hinder or prevent the author who has a message to deliver. Surely
there are enough amateur censors to bully and destroy the man with
a message without setting the Town Council at him. And the man
with a message after all is the only man who can plead justification
to the indictment “Why be an Author?”
Of course there are messages and messages; purely business and
temporary messages, and heaven-sent messages of eternal import
to mankind. Of temporary messages, sermons, and scientific
treatises should be published by telegraph, lest the message become
stale news before it reaches its destination. All books written by
craftsmen and schoolmen to impart knowledge are instances of
books written by people who have messages to deliver. Lamb calls
some of them biblia a biblia—books that are no books. In a sense he
is right, the more so because this class of book is generally written
by an author, wholly unable to explain the very limited message he
sets out to deliver. Reading a text-book is too often like listening to a
stutterer over the telephone. You know that he knows what he has
to say, but he can’t get it over the wires to your receiver. Some
literary gift is required even to write a school book. One must have
knowledge, power of arrangement, and the gift of imparting
knowledge to the ignorant. This last quality depends, I believe, in a
great measure on the capacity in the writer to conceive the depth of
ignorance in his probable readers.
He must have the rare faculty of putting himself in the students’
place. I do not myself remember a single good school book—but
that may be due to my youthful inattention, rather than any critical
insight in early life. On the other hand, I can name three books
which I regard as models of the kind of message-literature I am
speaking about; books that told me clearly and admirably everything
I wanted to know about the subjects they dealt with. These books
are, Dr. Abbott’s “How to write clearly,” Sir James Fitzjames
Stephen’s “Law of Evidence,” and Mr. H. Paton’s “Etching Drypoint
and Mezzotint.” The last book I regard as a model of what a practical
treatise on a craft should be. Although himself an etcher of
experience and great ability, he is able to follow the mind of the
ignorant and its possible questions, so accurately, that he provides
answers to the questions that arise from time to time in the mind of
the duffer bent on making an etching on a copper plate. I have
never seen the process done, but with the aid of this book I have
made many etchings—and what I have done other duffers can do. I
do not say these etchings of mine are masterpieces, but I do say
that the book so delivers its message that the most ignorant may
hear and understand. Mr. Justice Stephen’s book on Evidence is a
most wonderful piece of codification. The English Law of Evidence
has about as near relation to the real facts of life as the rules of the
game of Poker. It is one of those things that must be learned more
or less by heart, there is no sense or principle in it. Until Mr Justice
Stephen published his book the law was a chaos of undigested
decisions; since the publication it has been as orderly a science as a
game of chess. It has still no reality about it, but the moves and
gambits and openings are analysed and can be learned. As to Dr.
Abbott’s “How to write clearly,” let no one think evil of the work on
account of anything I have written, any more than Mr. Paton’s
volume should be judged by the artistic quality of my etchings.
As to the greater messages of life which we have had delivered to
us by the hands of the great authors, these are as I have suggested,
the real answer to the question, “Why be an Author?” The writings
of men like S. Paul and the author of the Book of Job and S.
Augustine, and in our own day, of Thomas Carlyle and Charles
Dickens, all seem to me to have been written in reply to some such
command as was given to S. Paul himself to whom it was said:
“Arise and go into the City and it shall be told thee what thou must
do.” The writer who has a message to deliver is generally told what
it is and he never, I think, fails to deliver it. He does not need
motives of vanity or greed—nor is there any question of writing for
the fun of the thing—he is told by some force beyond and outside
him what he must do, and he does. He is a happy messenger boy
sent on his errand by the Great Postmaster, whose messages he
delivers.
There are many names we all instinctively remember of writers
who seem to have had messages to deliver to ourselves, and whose
messages we have received with thankfulness, and I trust, humility.
It is wonderful sometimes to remember how these messengers have
been upheld in their service through dangers and difficulty, and
protected against the hatred, malice and uncharitableness of the
official ecclesiastical post-boys who claim a monopoly of all moral
letter carrying. Take as an instance the author of the Book of Job. It
has always been a marvel to me how he ran his message through
the cordon of the infidelity and ignorance by which the holy places of
his time were surrounded, and landed his book safely and soundly
into the centre of the literature of the world. I suppose the creed of
the author of the Book of Job was, as Froude puts it, “that the sun
shines alike on good and evil, and that the victims of a fallen tower
are not greater offenders than their neighbours.” That was a new
message then, and very few believe it in their hearts now. Most of
us have a secret notion that riches are the right reward of goodness,
and poverty the appropriate punishment of evil. It must have
required a stout heart to pen that message when the Book of Job
was written, and a fearless heart to face the publication of it among
the orthodox literature of the time.
I do not know if attention has ever been drawn to the point, but
the author of the Book of Job has always settled for me the literary
righteousness of the happy ending. Job, you know—as every hero of
every story-book ought to—lives happily ever afterwards. The Lord
gave him twice as much as he had before, his friends each gave him
a piece of money and a ring of gold, and he finished up with
fourteen thousand sheep and six thousand camels, and a thousand
yoke of oxen and a thousand she-asses, not to mention seven sons
and three daughters—“So Job died, being old and full of days.”
Now-a-days, when every story we read or play we see is
deliberately formed to leave us more unhappy than it found us, is it
not pleasant to those, who like myself do not believe in the dismal
Jemmy school of writers, to remember that the author of the Book
of Job “went solid” for the happy ending? I have no doubt the
dramatic critic of the Babylon Guardian “went solid” for him, and
called him a low down, despicable person—but the critics, if any,
have disappeared—the author, too, has disappeared—only his
message remains, and will always remain until it is no longer
necessary to us. And one reason that it remains is, because he was
a big enough author to know that if you write for mankind you must
not despise mankind, you must not sneer in your hearts at the very
people you are writing for, but you must write for them in a spirit of
love and affection, and respect, even to the respecting of their little
weaknesses, and you must remember that one of the weaknesses of
mankind—if it be a weakness—is the child-like love of a story which
begins with “Once upon a time,” and ends with everyone living
happily ever afterwards.
I have not answered the question, “Why be an author?” because
as I said in the beginning I do not know the answer. In so far as
there is an answer, it is given, I think, in the words of the prophet,
Thomas Carlyle. He is reassuring himself that the work of a writer is
after all as real and sensible and practical a work as that of any
smith or carpenter. “Hast thou not a Brain?” he says to himself,
“furnished with some glimmerings of light; and three fingers to hold
a pen withal? Never since Aaron’s Rod went out of practice, or even
before it, was there such a wonder-working Tool: greater than all
recorded miracles have been performed by Pens. For strangely in
this so solid-seeming World, which nevertheless is in continual
restless flux, it is appointed that Sound to appearance the most
fleeting, should be the most continuing of all things. The word is well
said to be omnipotent in this world; man, thereby divine, can create
as by a Fiat. Awake, arise! Speak forth what is in thee; what God
has given thee, what the Devil shall not take away. Higher task than
that of Priesthood was allotted to no man: wert thou but the
meanest in that sacred Hierarchy, is it not honour enough therein to
spend and be spent?”
That, if any, is the answer to the question, “Why be an Author?”
WHICH WAY IS THE TIDE?
“Will you take the oath of allegiance, George Fox?” asks the
Judge in the Court of Lancaster Castle.
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