Members of other academic faculties – such as lawyers, who reduce humans to paragraphs of print – have no conception of medicine, even when they write books attacking it. The incomparable Stephen Butler Leacock (1869-1944), who was Professor of Economics at McGill University in Montreal, clearly understood medicine and doctors only too damn well.
CERTAINLY THE PROGRESS of science is a wonderful thing. One can’t help feeling proud of it. I must admit that I do. Whenever I get talking to anyone – that is, to anyone who knows even less about it than I do – about the marvellous development of electricity, for instance, I feel as if I had been personally responsible for it. As for the linotype and the aeroplane and the vacuum house-cleaner, well, I am not sure that I didn’t invent them myself. I believe that all generous-hearted men feel just the same way about it.
However, that is not the point I am intending to discuss. What I want to speak about is the progress of medicine. There, if you like, is something wonderful. Any lover of humanity (or of either sex of it) who looks back on the achievements of medical science must feel his heart glow and his right ventricle expand with the pericardiac stimulus of a permissible pride.
Just think of it. A hundred years ago there were no bacilli, no ptomaine poisoning, no diphtheria, and no appendicitis. Rabies was but little known, and only imperfectly developed. All of these we owe to medical science. Even such things as psoriasis and parotitis and trypanosomiasis, which are now household names, were known only to the few, and were quite beyond the reach of the great mass of the people.
Or consider the advance of the science on its practical side. A hundred years ago it used to be supposed that fever could be cured by the letting of blood; now we know positively that it cannot. Even seventy years ago it was thought that fever was curable by the administration of sedative drugs; now we know that it isn’t. For the matter of that, as recently as thirty years ago, doctors thought that they could heal a fever by means of low diet and the application of ice; now they are absolutely certain that they cannot. This instance shows the steady progress made in the treatment of fever. But there has been the same cheering advance along the line. Take rheumatism. A few generations ago people with rheumatism used to have to carry round potatoes in their pockets as a means of cure. Now the doctors allow them to carry absolutely anything they like. They may go round with their pockets full of water-melons if they wish to. It makes no difference. Or take the treatment of epilepsy. It used to be supposed that the first thing to do in sudden attacks of this kind was to unfasten the patient’s collar and let him breathe; at present, on the contrary, many doctors consider it better to button up the patient’s collar and let him choke.
In only one respect has there been a decided lack of progress in the domain of medicine, that is in the time it takes to become a qualified practitioner. In the good old days a man was turned out thoroughly equipped after putting in two winter sessions at a college and spending his summers in running logs for a sawmill. Some of the students were turned out even sooner. Nowadays it takes anywhere from five to eight years to become a doctor. Of course, one is willing to grant that our young men are growing stupider and lazier every year. This fact will be corroborated at once by any man over fifty years of age. But even when this is said it seems odd that a man should study eight years now to learn what he used to acquire in eight months.
However, let that go. The point I want to develop is that the modern doctor’s business is an extremely simple one, which could be acquired about two weeks. This is the way it is done.
The patient enters the consulting-room. ‘Doctor,’ he says, ‘I have a bad pain.’ ‘Where is it?’ ‘Here.’ ‘Stand up,’ says the doctor, ‘and put your arms up above your head.’ Then the doctor goes behind the patient and strikes him a powerful blow in the back. ‘Do you feel that,’ he says. ‘I do,’ says the patient. Then the doctor turns suddenly and lets him have a left hook under the heart. ‘Can you feel that,’ he says viciously, as the patient falls over on the sofa in a heap. ‘Get up,’ says the doctor, and counts ten. The patient rises. The doctor looks him very carefully without speaking, and then suddenly fetches him a blow in the stomach that doubles him up speechless. The doctor walks over to the window and reads the morning paper for a while. Presently he turns and begins to mutter more to himself than the patient. ‘Hum!’ he says, ‘there’s a slight anaesthesia of the tympanum.’ ‘Is that so?’ says the patient, in an agony of fear. ‘What can I do about it, doctor?’ ‘Well,’ says the doctor, ‘I want you to keep very quiet; you’ll have to go to bed and stay there and keep quiet.’ In reality, of course, the doctor hasn’t the least idea what is wrong with the man; but he does know that if he will go to bed and keep quiet, awfully quiet, he’ll either get quietly well again or else die a quiet death. Meantime, if the doctor calls every morning and thumps and beats him, he can keep the patient submissive and perhaps force him to confess what is wrong with him.
‘What about diet, doctor?’ says the patient, completely cowed.
The answer to this question varies very much. It depends on how the doctor is feeling and whether it is long since he had a meal himself. If it is late in the morning and the doctor is ravenously hungry, he says: ‘Oh, eat plenty, don’t be afraid of it; eat meat, vegetables, starch, glue, cement, anything you like.’ But if the doctor has just had lunch and if his breathing is short-circuited with huckleberry pie, he says very firmly: ‘No, I don’t want you to eat anything at all: absolutely not a bite; it won’t hurt you, a little self-denial in the matter of eating is the best thing in the world.’
‘And what about drinking?’ Again the doctor’s answer varies. He may say: ‘Oh, yes, you might drink a glass of lager now and then, or, if you prefer it, a gin and soda or a whisky and Apollinaris, and I think before going to bed I’d take a hot Scotch with a couple of lumps of white sugar and a bit of lemon-peel in it and a good grating of nutmeg on the top.’ The doctor says this with real feeling, and his eye glistens with the pure love of his profession. But if, on the other hand, the doctor has spent the night before at a little gathering of medical friends, he is very apt to forbid the patient to touch alcohol in any shape, and to dismiss the subject with great severity.
Of course, this treatment in and of itself would appear too transparent, and would fail to inspire the patient with a proper confidence. But nowadays this element is supplied by the work of the analytical laboratory. Whatever is wrong with the patient, the doctor insists snipping off parts and pieces and extracts of him and sending them mysteriously away to be analysed. He cuts off a lock of the patient’s hair, marks it, ‘Mr Smith’s Hair, October, 1910.’ Then he clips off the lower part of the ear, and wraps it in paper, and labels it, ‘Part of Mr. Smith’s Ear, October, 1910.’ Then he looks the patient up and down, with the scissors in his hand, and if he sees any likely part of him he clips it off and wraps it up. Now this, oddly enough, is the very thing that fills the patient up with that sense of personal importance which is worth paying for. ‘Yes,’ says the bandaged patient, later in the day to a group of friends much impressed, ‘the doctor thinks there may be a slight anaesthesia of the prognosis, but he’s sent my ear to New York and my appendix to Baltimore and a lock of my hair to the editors of all the medical journals, and meantime I am to keep very quiet and not exert myself beyond drinking a hot Scotch with lemon and nutmeg every half-hour.’ With that he sinks back faintly on his cushions, luxuriously happy.
And yet, isn’t it funny?
You and I and the rest of us – even if we know all this – as soon as we have a pain within us, rush for a doctor as fast as a hack can take us. Yes, personally, I even prefer an ambulance with a bell on it. It’s more soothing.
1. As someone studying “how to be a doctor,” how do you feel towards the tone of this article, and towards how scientific progress and medical education are presented?
2. Have you had any experiences (e.g. as a patient, a family member, a medical student shadowing a clinician) that reflect Stephen Leacock’s rendering of the therapeutic encounter?