FOR AND AGAINST DOCTORS
1
1191 specific. On the other hand, it opens up a biological problem as to the nature of the encephalitogenic agent existing in health and also in organs from cases of disease of the hsemopoietic system. Furthermore there seems no reason to doubt that the syndrome is of real practical utility for identifying glands from cases of lymphadenoma. In the hands of Gordon himself, who retains the rabbits for only a week after inoculation, glands tested at St. Bartholomew’s Hospital from suspected cases of lymphadenoma over a period of three years gave the following results 1 : glands from lymphadenoma cases, 35 tested, 30 positive; glands from conditions other than lymph- adenoma, 67 tested, 67 negative. FOR AND AGAINST DOCTORS "If a hundred or a thousand people, all of the same age, of the same constitution and habits, were suddenly seized by the same illness, and one-half of them were to place themselves under the care of doctors, such as they are in our time, whilst the other half intrusted themselves to Nature and to their own discretion...." " THIS outline of a neatly controlled experiment, though of modern pattern and indicating a critical attitude to therapeutics which is generally regarded as peculiar to our own times, is actually taken from Thoughts from the Letters in J. Lohse’s translation of Petrarch. The forecast of the result of such an experi- ment hazarded’ by Petrarch’s medical friend is not flattering to our profession ; but the compilers of the anthology " For and Against Doctors"2 where it is to be found, with many other biting comments on our art, deem it not surprising that mediaeval doctors were held in low esteem by the public ; the qualified"leech" of the Middle Ages derived his knowledge almost entirely from Arabian commentaries on the books of Hippocrates and Galen and had little or no practical training. A large part of actual practice, however, was in the hands of unlearned men, generally in religious orders, who were probably like hospital orderlies or the village nurse, and acted independently. It is in the mediaeval section of this anthology that we find most of its gems, though ancient Chinese records have yielded comments still apposite-for example : " The skilful doctor knows by observation, the mediocre doctor by interrogation, the ordinary doctor by palpation." The " modem " section is said to include only a few extracts from English literature of the nineteenth and twentieth centuries, culled almost at random, but, we may add, with fine discrimination. Here, as Dr. Hutchison and Dr. Wauchope point out, the praise is more generously bestowed than in earlier periods, but alas, even in an age of advancing technique and scientific discovery, it is mainly for kindness and moral support rather than for professional skill. If therefore we have dwelt here on the bitter rather than the sweet in this collection it is because much of the latter has an emotional flavour, being addressed to heart rather than to head. And also perhaps, because there is a malicious pleasure in letting others say what we are debarred from saying ourselves. For in the words of Miss Joyce Dennys quoted at the end of this delightful anthology : "Of course everybody knows that Doctors never say anything unkind about each other, it is part of their Unwritten Law and a sore trial to nearly all of them." 1 Gordon, M. H., and Gow, A. E. : Proc. Roy. Soc. Med., 1934, xxvii. (Sect. Med., p. 49). 2 For and Against Doctors. An anthology compiled by Robert Hutchison and G. M. Wauchope, and illustrated by Miss Barclay-Smith. London: Edward Arnold and Co. 1935. Pp. 168. 7s. 6d. ANATOMY AT ST. THOMAS’S THE extensions and alterations of the anatomical rooms, which have been in progress in the medical school at St. Thomas’s Hospital, are now complete, and a compact and well-equipped department was visited last week by fellow anatomists and others on Prof. A. B. Appleton’s invitation. The new two- floored buildings occupy an area lying behind the old dissecting-room. The upper floor is given over to laboratories, including the professor’s rooms and technicians’ work-room ; this position gives excellent lighting. The flooring here, and in the X ray room, is of Granwood, a composition in blocks looking very like wood, which seems to promise a long and service- able life. Other rooms, on the lower level, comprise museums, filing offices and work-rooms, radiological and photographic rooms, and, of course, the dissecting- room. All these, with two lecture theatres, make a well-ordered and contained section of which the medical school may justifiably be proud. Medical men whose first education in their profession dates back some forty years or so have memories of a dissecting-room and a cloak-room, and little beside this, in which they carried through their anatomical studies. It would probably cause them some astonishment to come within the circuit of a modern department of anatomy, especially if they have had occasion to read some recent remarks on the futility of anatomical knowledge, with the suggestion of the moribund senescence of the subject. There is no sign of such decay. On the contrary, there is enthusiastic research by numerous workers in ever-widening fields, and the dissecting-room is only one of the many laboratories which are necessities in every modern department. A visit to one such as this at St. Thomas’s, with its modern methods both in work and teaching, should convince any honest mind that anatomy has advanced and widened more rapidly than some other subjects which come under the segis of medicine. A YEAR’S WORK ON ASTHMA OSLER pointed out that the student of syphilis gets to know the whole of medicine. The Asthma Research Council is coming to much the same con- clusion about the study of asthma. The latest report of progress 1 admits that the asthma problem has so many sides that rapid progress cannot be expected. The problem in fact still remains unsolved in its essentials, but at five centres work on a particular line of inquiry is going on with a view to laying bare one root of the baffling problem. At Guy’s E. T. Cony- beare and L. J. Witts have been estimating the degree of improvement which may be expected in asthmatics as the result of general medical care and advice without the use of any specific treatment. At the same time R. S. Bruce Pearson is attempting by physical methods to reproduce the conditions which the patient believes to have precipitated attacks. At Guy’s all patients go through a proba- tionary period of two months in which they perform the exercises recommended by the Council. Among asthmatic children C. H. Rogerson continues his study of the psychological factors lowering the threshold for stimuli which ordinarily produce an attack. The intelligence of these children is above the average, but many of them have to contend with a difficult environment, often indeed parental 1 Asthma Research Council. Report of Progress for the Year ended Oct. 31st, 1935. Copies free from the secretary of the Council, c/o King’s College, Strand, London, W.C.2.
Transcript of FOR AND AGAINST DOCTORS
1191
specific. On the other hand, it opens up a biologicalproblem as to the nature of the encephalitogenicagent existing in health and also in organs from casesof disease of the hsemopoietic system. Furthermorethere seems no reason to doubt that the syndromeis of real practical utility for identifying glands fromcases of lymphadenoma. In the hands of Gordonhimself, who retains the rabbits for only a week afterinoculation, glands tested at St. Bartholomew’s
Hospital from suspected cases of lymphadenomaover a period of three years gave the following results 1 :glands from lymphadenoma cases, 35 tested, 30
positive; glands from conditions other than lymph-adenoma, 67 tested, 67 negative.
FOR AND AGAINST DOCTORS
"If a hundred or a thousand people, all of the sameage, of the same constitution and habits, were suddenlyseized by the same illness, and one-half of them were toplace themselves under the care of doctors, such as theyare in our time, whilst the other half intrusted themselvesto Nature and to their own discretion...." "
THIS outline of a neatly controlled experiment,though of modern pattern and indicating a criticalattitude to therapeutics which is generally regardedas peculiar to our own times, is actually taken fromThoughts from the Letters in J. Lohse’s translation ofPetrarch. The forecast of the result of such an experi-ment hazarded’ by Petrarch’s medical friend is not
flattering to our profession ; but the compilers of theanthology " For and Against Doctors"2 where it is to befound, with many other biting comments on our art,deem it not surprising that mediaeval doctors were heldin low esteem by the public ; the qualified"leech" of theMiddle Ages derived his knowledge almost entirely fromArabian commentaries on the books of Hippocrates andGalen and had little or no practical training. A largepart of actual practice, however, was in the handsof unlearned men, generally in religious orders,who were probably like hospital orderlies or the
village nurse, and acted independently. It is inthe mediaeval section of this anthology that we findmost of its gems, though ancient Chinese recordshave yielded comments still apposite-for example :" The skilful doctor knows by observation, themediocre doctor by interrogation, the ordinary doctorby palpation." The " modem " section is said toinclude only a few extracts from English literatureof the nineteenth and twentieth centuries, culledalmost at random, but, we may add, with finediscrimination. Here, as Dr. Hutchison and Dr.
Wauchope point out, the praise is more generouslybestowed than in earlier periods, but alas, even inan age of advancing technique and scientific discovery,it is mainly for kindness and moral support ratherthan for professional skill. If therefore we havedwelt here on the bitter rather than the sweet in thiscollection it is because much of the latter has anemotional flavour, being addressed to heart ratherthan to head. And also perhaps, because there isa malicious pleasure in letting others say what weare debarred from saying ourselves. For in the wordsof Miss Joyce Dennys quoted at the end of this
delightful anthology : "Of course everybody knowsthat Doctors never say anything unkind about eachother, it is part of their Unwritten Law and a soretrial to nearly all of them."
1 Gordon, M. H., and Gow, A. E. : Proc. Roy. Soc. Med.,1934, xxvii. (Sect. Med., p. 49).
2 For and Against Doctors. An anthology compiled byRobert Hutchison and G. M. Wauchope, and illustrated byMiss Barclay-Smith. London: Edward Arnold and Co. 1935.Pp. 168. 7s. 6d.
ANATOMY AT ST. THOMAS’S
THE extensions and alterations of the anatomicalrooms, which have been in progress in the medicalschool at St. Thomas’s Hospital, are now complete,and a compact and well-equipped department wasvisited last week by fellow anatomists and others onProf. A. B. Appleton’s invitation. The new two-floored buildings occupy an area lying behind theold dissecting-room. The upper floor is given overto laboratories, including the professor’s rooms andtechnicians’ work-room ; this position gives excellentlighting. The flooring here, and in the X ray room,is of Granwood, a composition in blocks looking verylike wood, which seems to promise a long and service-able life. Other rooms, on the lower level, comprisemuseums, filing offices and work-rooms, radiologicaland photographic rooms, and, of course, the dissecting-room. All these, with two lecture theatres, make awell-ordered and contained section of which themedical school may justifiably be proud.
Medical men whose first education in their professiondates back some forty years or so have memoriesof a dissecting-room and a cloak-room, and littlebeside this, in which they carried through theiranatomical studies. It would probably cause themsome astonishment to come within the circuit of amodern department of anatomy, especially if theyhave had occasion to read some recent remarks onthe futility of anatomical knowledge, with the
suggestion of the moribund senescence of the subject.There is no sign of such decay. On the contrary,there is enthusiastic research by numerous workersin ever-widening fields, and the dissecting-room is
only one of the many laboratories which are necessitiesin every modern department. A visit to one such asthis at St. Thomas’s, with its modern methods bothin work and teaching, should convince any honestmind that anatomy has advanced and widenedmore rapidly than some other subjects which comeunder the segis of medicine.
A YEAR’S WORK ON ASTHMA
OSLER pointed out that the student of syphilisgets to know the whole of medicine. The AsthmaResearch Council is coming to much the same con-clusion about the study of asthma. The latest reportof progress 1 admits that the asthma problem has somany sides that rapid progress cannot be expected.The problem in fact still remains unsolved in itsessentials, but at five centres work on a particularline of inquiry is going on with a view to laying bareone root of the baffling problem. At Guy’s E. T. Cony-beare and L. J. Witts have been estimating thedegree of improvement which may be expected inasthmatics as the result of general medical care andadvice without the use of any specific treatment.At the same time R. S. Bruce Pearson is attemptingby physical methods to reproduce the conditionswhich the patient believes to have precipitatedattacks. At Guy’s all patients go through a proba-tionary period of two months in which they performthe exercises recommended by the Council. Amongasthmatic children C. H. Rogerson continues his
study of the psychological factors lowering thethreshold for stimuli which ordinarily produce anattack. The intelligence of these children is abovethe average, but many of them have to contendwith a difficult environment, often indeed parental
1 Asthma Research Council. Report of Progress for theYear ended Oct. 31st, 1935. Copies free from the secretary ofthe Council, c/o King’s College, Strand, London, W.C.2.
