PsychoGeography #85: The Harley Street operation

I've known Dr X for years - although not, thankfully, very well.

I've known Dr X for years - although not, thankfully, very well. He acquired notoriety in his field after treating Haile Selassie for a severe marijuana psychosis that the late Emperor picked up off the "secondary smoke" of a Rastafarian delegation. X was able to convince Selassie that he was an ordinary man, with the same thoughts, feelings, dreams and fears as the rest of us; and not - as the Emperor maintained in his delusion - the absolute ruler of a bizarrely anachronistic kingdom who was being conspired against by a sinister cabal. Sadly the breakthrough in Selassie's therapy came only hours before Mengistu seized power in a blaze of gunfire, and X was forced to flee Addis Ababa. "It was," X explained to me over a mozzarella and sun-dried tomato ciabatta in a café off Welbeck Street, "distinctly touch and go."

I like to think that Dr X was being metaphoric, rather than referring to his own bedside manner; certainly he was scathing about the way in which the seamier denizens of London's preeminent medical quartier drain pelf from their wealthy patients: "Did you clock the numbering on the doors near my building?" he asked me. And I had. Between X's establishment on Lower Wimpole Street - The London Hospital for the Medievally Ill - and the corner of Harley Street itself, I passed Numbers 117, 117a, b, c, d, e, f ... through z. So intense is the desire of quacks to obtain premises in the grid of streets between Portland Place and Marylebone High Street that some unscrupulous cosmetic surgeons have been known to tunnel in from as far afield as Hounslow. Obese dowagers are then strapped to motorised trolleys and powered through the underbelly of London to where they can have the fat sucked out of them for vastly inflated prices, purely on the basis that they're "in" Harley Street.

"I tell you there are basements directly beneath us which are awash with yellow blubber," Dr X declaimed, waving skinny latte about so vigorously that hot foam dappled the cheeks of secretaries lunching nearby. "Not, you appreciate, that we're all like that." No indeed, ever since this neighbourhood began to be colonised by the medics (c. 1845), snake oil and science have resided in unsavoury propinquity. Looking at a map of central London it becomes clear that Harley Street is all about location, location, location. To the east is the University of London, with its own hospital and research schools, while in every other direction lie terrace upon terrace of the idle moneyed, crying out to have their assetocephalus relieved by the timely insertion of a Mont Blanc pen.

Now, no fewer than seven private hospitals dominate this medical Monaco, together with countless other clinics and consulting rooms. "The truth is," X continued as we strolled arm-in-arm along Wigmore Street, "that Harley Street has the finest medical science has to offer ... at a price." "But how," I asked, disentangling myself from his embrace, "how has it happened, and why does it continue?"

"Well you have to appreciate that to be truly posh, British doctors have traditionally had to maintain a foot in the NHS - because that's where the cutting-edge research and teaching facilities are. But front and frontage are equally important. The De Walden estate, which owns most of the properties around here, has always been concerned to maintain the Regency ambience ..." - X waved his snowy cuffs at the blank façades - "while the consultants themselves wouldn't be seen dead in anything less than full fig: shirts from Pinks, shoes from Lobb, suits from Turnbull & Asser, underwear from Smythson's ..."

"Smythson's?" I was incredulous. "I thought they did stationery?"

"Stationery and these custom-designed, 120gsm, bonded-weave medical pants," before I could stop him, X had pulled his trousers to half mast, "perfect for scribbling down prognoses while at stool."

There was no stopping the doctor once he had the bit between his teeth. "I tell you," he expostulated, "while perhaps half of the GPs down in Chelsea who refer their patients here are perfectly kosher, the others are social-climbing charlatans who're hanging on to Lord Snooks until his own grim death, desperate purely for their own advancement. If there were a bourse here, titled patients would be openly traded on it!"

I left Dr X at his hospital and wandered away feeling sick and bemused. Some workmen were excavating a section of the roadway, and was it my imagination, or did they seem to be performing gargantuan surgery; peeling back the epidermis of the city so that they could replace its atrophied tubes and valves? True, they wore hard hats and smoked roll ups, and they were hard at it in the public roadway, but undoubtedly, like all the denizens of Harley Street, they were firmly within the private sector.