Abstract:
My attention, rather belatedly, has been called to a rather startling evidence of confusion oven the terms social and in the tribute paid to our beloved and highly esteemed friend, Dr. Joseph Wall. I refer to the In Memoriam at the bottom of page 232 of the August 1953 issue of Pediatrics. Here one notes the following: It would be impossible to evaluate his service to the Academy, and the medical profession generally. To him `social medicine9 was as the setting sun to medical freedom. He fought `socialized medicine9 in no unmistakable terms. The encroachment of Government in medicine, and pediatrics in particular, found a worthy opponent. He was never dismayed by the might of social interests, nor faltered in aggressive attacks on their activities. Certainly no one could question Dr. Wall9s vigorous attacks upon the encroachment of socialized At the same time he would be the last one to wish to have socialized medicine confused with social medicine. He was, in fact, a leader among us in broadening the Academy9s izonhorizon in the social implications of health services for children and the whole structure of community organization in behalf of improving child health.Keywords:
Tribute
Confusion
Wish
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"To See for Oneself: Sir William Osler on Autopsies, Medical Education, and Economics." Baylor University Medical Center Proceedings, 28(1), pp. 120–121
Center (category theory)
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Sir William Osler (1849-1919), a dedicated and caring physician, was the prolific author of more than 1600 works in his lifetime, including The Principles and Practice of Medicine, one of the first comprehensive medical textbooks. Such was his output, his great personal following and the large number of eponymous signs and diseases he gave rise to, it is unsurprising that his sayings have endured. Many a lecturer has embellished his talk with an Oslerian quote or two. A Canadian by birth, he worked in his native country, the United States and finally in Oxford as the Regius Professor of Medicine, so his influence spanned two continents.
The Quotable Osler is a collection of quotations compiled from his various publications by three American editors. The book is divided into themes such as personal qualities, the art and practice of medicine, diagnosis and science and truth. The selected quotes portray Osler as a deeply moral, committed and enthusiastic doctor whose capacity for hard work was immense. He believed ‘that the practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head’. His bedside skills and manner were widely admired by students and colleagues. He was a passionate educator of medical students and advocate of lifetime learning, believing in the value of careful examination of the patient and the study of medical texts. ‘To study the phenomena of disease without the books is to sail an uncharted sea, while to study books without patients is not to go to sea at all’.
The chapter on Men, Women, Aging and History provides some of the most surprising and colourful quotes. Osler's ambivalent views on women in medicine are aired. On the one hand he applauded the decision to allow women entry to medical school but, on the other hand, he considered women more suited to science than to medicine: ‘a larger proportion of women than men are unfit for practice... and what they [women] lack in initiative and independence is counterbalanced by a more delicate technique’. It is easy to criticize 100 years on but Osler's reservations reflected the views of his generation. He had some advice on marriage—‘Choose a freckle-faced girl for a wife: they are invariably more amiable’—and considered it important for a physician to ‘marry well’. Osler possessed some amusing ageist views on ‘the comparative uselessness of men above forty’ and considered that ‘a very large proportion of the evils [of the world] may be traced to sexagenarians’, who account for the greatest political and social mistakes, the worst poems and the worst sermons. Not surprisingly, he felt ‘men above 60 should retire’.
The Quotable Osler is a fascinating insight into the life and beliefs of one of the greatest physicians. It is mainly of value as a historical account rather than of direct relevance to today's practice. Osler enthusiasts will doubtless disagree. This book will enthral retired physicians, and doctors with even the slightest interest in medical history.
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Anton Chekhov (1860-1904) was not only a writer, but also a doctor. One might think that he was primarily concerned with writing, but he also dedicated himself fully to being a doctor. When he had to give up his practice in 1897 upon urgent medical advice, he experienced it as a great loss. As a medic he often felt unsure and believed that he failed in his duties. This did not change the fact that many patients called upon him for assistance. They were probably also fond of him because of his genuine interest in their living conditions and because of his compassion. In terms of his scientific activities, his attempt to have his visit in 1890 to the Russian penal colony Sakhalin recognised as a dissertation failed. In many ways, Chekhov was a hard-working idealist, but one without illusions. Doctors appear as the main character or one of the main characters in 25 of Chekhov's hundreds of stories as well as in various plays. Although Chekhov undoubtedly will have incorporated his own experiences into his works, he did not give a picture of his own medical activities in the doctors he portrayed. A large number of the doctors he describes are depressed, nervous or irritable. Others are naïve and clumsy, while others still are skeptic, cynical or disillusioned. In some of the descriptions the image of Chekhov as a doctor may be observed.
Compassion
Skepticism
Neurasthenia
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It may seem superfluous to write about Lewis Thomas in a journal for biology teachers. There are very few of us who have not read at least some of his work, and many of us have been inspired both by his ideas and by the way he presented them. But that's really why I feel the need to write about him here. His death last December just cannot go unnoted by a community that drew so much inspiration from his words, and for whom he cared so deeply. I felt that I really had gotten to know Thomas when I read his autobiography, The Youngest Science (1983). I discovered that he was born in Flushing, a New York City neighborhood about two miles from my childhood home. His father was a physician; and Thomas followed in his footsteps, entering Harvard Medical School in 1933. In 1937, he interned at Boston City Hospital and learned of the medical problems facing the indigent. He notes that the two major chronic diseases he had to deal with on the wards were tertiary syphilis and alcoholism, and that syphilis and tuberculosis were the two diseases people feared most, much as we fear cancer today. He describes the amazement physicians like him experienced when they first saw sulfa drugs, and then antibiotics, bring dreaded diseases like pneumonia under control. His career spanned a time of tremendous change in medicine, but as the title of his book implies, he sees the science of medicine as still in its infant stages since so much of human disease remains very much of a mystery to us.
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D R J. C. VAN ES in his inaugural address on taking up his duties in March 1967 as Professor in the Medical Art of the Family Doctor at Utrecht University said that family doctors, in particular, have become so beset with doubt as to the professionalism of their calling that they are quite at sea about their own identity. This is largely due to the fact that the unity of knowledge shared by all doctors has long been disrupted by the unavoidable and very necessary process of specialization. But there are now many signs that there is a great renaissance taking place in general practice. With the advent of the National Health Service and the tremendous growth of the specialities, the family doctor has been passing through a bewildering time wondering what his future role, if any, is to be; and in trying to define his future role he has been called many things by all men. He has been called the family doctor, the community doctor, and the generalist, but with the advent of the Royal College of General Practitioners and its spread to Canada, South Africa, and Australia, it can be taken as settled that he is to be called the general practitioner. What is his r6le? The Gillie report (1963) describes him as a physician who does not limit his practice to certain disease entities, and who offers his patients of all ages direct and continuing access to his services; as opposed to a specialist who limits his practice to particular disease entities or specific age groups.
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N CINCINNATI 140 years ago, at the opening of what was then our westernmost medical school, Dr. Daniel Drake, president of the New Medical College of Ohio, in his Inaugural Discourse on Medical Education, said, Clinical medicine is an unceasing employment of means for the accomplishment of specific or definite objects. Considered in relation to our knowledge of these means, the profession is a science-in relation to the application of them, it is an art. He who acquires the former only is learned; he who relies on the latter alone is ignorant, empirical, and criminal; he who encompasses both reaches the highest attainable perfection. Perhaps this is where a quondam psychologist can speak up without feeling too de-fensive. There are many ways of dividing and subdividing the rapidly expanding world of science. We have the earth sciences versus the life scienceis. We have the physical sciences versus the behavioral sciences. But Elton Mayo, of Harvard, has divided the sciences into the successful and the unsuccessful. Into the former category he put chemistry and physics; into the latter he put psychology and economics. That was some time ago, and this state of affairs is not going to last forever. The behavioral sciences, so far, justify inclusion in the unsuccessful sciences, in the sense that they have more unknowns in them than they have equations with which to solve them. But foir the very reasions which Dr. Drake called forth, the medical sciences, so-called, also belong among the unsuccessful sciences because, despite medicine's enormous content of science, it is also an art. is interesting to a layman to take a ba,ckward glance at the history of medical education in this country. In modern times, I suppose, the opening of the Johns Hopkins Medical School and Hospital in 1893 was a ma,jor landmark, with the, emergence of those four great men of medicine-Welch, Osler, Halsted, and Kelly. So high had the standards of admission been set that one of Welch's principal worries was whether anyone would arrive to be taught, and Osler said to Halsted, so the story goes, It is very fortunate we are here as professors, for I greatly doubt if we could qualify as students. And there is that other landmark: the Flexner Report. is not very long ago in the scale of history that the Flexner Report on medical education turned things upside down, and this nat.ion assumed concern for the kind and quali.ty of medical education which was to place American physicians and surgeons at the very top of the world's best in their technical skill and qualifications. is not for me to say why another problem sometime thereafter began to beset medical eidncation and medical practice, nor could I even say with accuracy when the Age of the Specialist dawned in this country. But certainly there was a time which has not yet drawn to, a close when the general practitioner who ha.d once been the mainstay of American medicine declined almost to the role oif the preliminary classifier, whose principal function became th.at of referring the patient to the man who knew all the neek or the knee joint and almost prided This paper is based on a talk given at the dedication of the Stanford Medical Center, Palo Alto, Calif. Dr. Stanton is president of Columbia Broadcasting System, Inc., and former chairman, Center for Advanced Study in the Behavioral Sciences.
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John Morgan, founder of the University of Pennsylvania School of Medicine in 1765, had probably one of the wisest concepts of medical education that any man has ever had in this country. Certainly his ideas were many, many years in advance of his contemporaries and those educators who followed after him. In his dissertation on the institution of medical schools in America he pointed out the necessity of the medical neophyte having a thorough preliminary education both in literature and in the sciences. Unfortunately the mental perturbation that resulted from his dismissal from the Continental Army as the medical director turned aside his thoughts on medical education and the principles of the training of physicians to other things which he considered more important, certainly more important to him but not of great importance to the future of medical education. Morgan never engaged in teaching after he entered the army and,
Aside
Institution
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In his presidential address before the 23rd scientific meeting of the International Cardiovascular Society in Boston last June, Allan D. Callow, MD, was mindful of the Quaker adage that one should not speak unless he can improve on silence. In his discourse, to be published inArchives of Surgery,1he first paid tribute to the foreign scientists who have contributed substantially to advancement in his field of interest. Second, he gave a brief history of the Society he represents, enumerated its weaknesses, and offered suggestions for its improvement and for that of the North American Chapter. For the latter, he announced the objectives and responsibilities to be concerned "with the improvement of training programs in cardiovascular surgery and the pursuit of excellence in patient care." He implied that the training programs may be found wanting. He took into account the fact that, after long experience in the area of
Tribute
Excellence
Presidential address
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HE physician has long been looked on as a special sort of person in our society. The best of the profession have always been leaders in their communities. The repute in which the physician has been held was eloquently stated in Robert Louis Stevenson's tribute to him: "He is the flower of our civilization, and when that stage of man is done with, only to be marveled at in history, he will be thought to have shared but little in the defects of the period and to have most notably exhibited the virtues of the race." For generations the best of our physicians have been educated not only in the science of their times but also in the humanities. However, there was a time when some of our medical schools were "proprietary schools," which did not require even a grammar school education as a prerequisite to study medicine. About 50
Tribute
Grammar school
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In one way or another the theory and practice of modern medicine is confronting us with many dilemmas, chiefly, though not exclusively, of a moral character; the transplantation of organs, abortion, and euthanasia are examples, and closely associated with these are more obviously conceptual problems such as the definition of death and, for that matter, of life itself. Contemporary moral philosophers have been strangely silent on these matters, and have been content to leave the field to lawyers and churchmen and those few medical men both able and willing to reflect upon their practices. (I think it is fair to say that the attitude of the profession as a whole is exemplified by the physician who recently dismissed a journalist's question about how he decided which patients were to receive kidney dialysis and which not, with the remark ‘I'm not a moralist, I'm a doctor’.)
Moral character
Content (measure theory)
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