In response to:

The Powers of Alexander Pope from the December 20, 1979 issue

To the Editors:

While Dr. Ehrenpreis’s comments about Alexander Pope do seem to arise from a creative imagination, he is somewhat less than accurate in his treatment of the data of morbid anatomy [NYR, December 20]. While rickets was defined in early times as softening of the spine without etiologic attribution, it is now universally applied to the disease of bone caused during infancy and childhood by lack of vitamin D. Tuberculosis of the spine does not give people rickets although it may cause deformity. Neither spinal tuberculosis nor rickets need render its victims incapable of normal sexual relations or impotent. Normal sexual relations might not have been out of the question even for a Pope; it depends on how normal sexual relations are defined and whether a normal spine is a prerequisite.

It is of course not uncommon to blame physical ills for psychic symptoms and it is often justifiable. But we should be more cautious and precise in the use of the terms of pathological anatomy and seek more secure medical foundations in dealing with etiology. After all, John Wesley advised us to wash children every morning in cold water if we wished to prevent or cure rickets. Attribution of rickets to tuberculosis in Wesley’s day was acceptable in the absence of sufficient knowledge of pathogenesis. It isn’t today.

John H. Felts, M.D.


North Carolina Medical Journal

Winston-Salem, North Carolina

Irvin Ehrenpreis replies:

I used “rickets” to refer to symptoms and not to the etiology of rachitis, just as I might say that Johnson’s asthma was produced by kidney trouble. At school, I was taught that rachitis results from an inadequate absorption of calcium or phosphate, although a lack of vitamin D is generally what leads to that deficiency. I agree that sexual intercourse was possible for Pope, because a compliant female might have found ways of compensating for the poet’s stunted body, weak back, curved spine, and poor muscle tone. But I think Pope would not have described the exercise as normal sexual relations. I also think his incapacity for ordinary, physical approaches to women left him with a sense of sexual impotence. I return due acknowledgments to Dr. Felts for endowing me with creative imagination and for drawing a witty parallel between Wesley and myself.

This Issue

March 6, 1980