What Good Are Doctors?

‘WHAT good are doctors?’ you ask.

I cannot tell you in the proper terms, because I am not one of them. But because I am a human being, and because human beings have profited more from medical science than from any other one branch of man’s learning, I regard it highly. Medicine is a science in the strictest sense of the word, which implies not only knowing, but also learning. As it is not the same kind of science as the multiplication tables, rigid and fixed for years, it must continue to discover, and must, in order to develop, experiment as it goes. While the results of these experiments have sometimes been bitter mistakes, on the whole mankind has profited so much from the doctors’ knowledge that we have come to consider good health our natural right and to resent illness as a personal insult. We expect our doctors to be more than the limited human beings that we know ourselves to be. We expect them to ensure to us a life happy and void of pain, and if circumstances which neither we nor they can control produce ailments that irk and hurt us, we blame the medical profession first of all.

This attitude is very modern, and very narrow.

In proof of this statement, I beg you to turn your attention to another age, when doctors were not expected to make a heaven of earth and when people were not so pampered by the mechanical conveniences of our generation, and therefore bore within themselves the ability to ease the more difficult moment by means of fortitude and philosophy. I mean the age of Samuel Johnson, about one hundred and sixty years ago.

I call it the age of Samuel Johnson, — though it would, of course, be more appropriate to mention the American Revolution, — for I wish to designate it by the name of the man who dominated the intelligentsia of England, and who, with his circle of wealthy and clever admirers, got as much out of life as anyone could. Yet none of them expected perfect health, and none of them blamed the doctors when he did not get it.

And what kind of doctors were theirs?

They were men so ignorant, compared with our physicians, that, tracing the history of medicine from its beginning in the mummification art of Egypt to the latter half of the eighteenth century, one wonders why they were allow ed to practise at all! Disease was the ordinary condition, not the extraordinary, as it is with us. Once it laid hold on a man, it rarely let go. These doctors could dope him, bleed him, and embalm him. They seldom cured sickness, and never prevented it.

Consider Samuel Johnson, who had scrofula. As a very young child he was taken, with dozens of others similarly afflicted, to be touched by the royal hand. Though he remained scrofulous until he died, it is not unworthy of note that the disease has since become most uncommon, and we can only assume that the kingly power, which unfortunately failed in Johnson’s case (perhaps because it was a queen who exercised it), has reduced this hideous malady to a minimum. Much as the Great Lexicographer had to say on almost every subject under the sun, I can find no record of his bearing a grudge against Queen Anne for betraying his faith in her healing powers. Instead, he lived all his life without hope of recovery, at times partially blind, periodically practising his ‘strange discipline — starving, mercury, opium.’ Yet he helped to write one of the most authoritative books on medicine of his day and was considered to have a wide knowledge of that subject. He died of dropsy at seventy-five, and few men have accomplished more in an equal number of years.

Had his own poverty been the cause of Johnson’s ailments, Hester Thrale, who finally inveigled him into gracing her literary group at Streatham Park, would have seen to their curing. But money could not buy health then any more than it can now; and in those years a patient got even less return for the investment of his fee. You may say that Mrs. Thrale took charge of Dr. Johnson too late to do him any good. I ask you to consider the life of Hester herself, who from the time of her marriage had everything wealth could command. It could command a good deal, but not health, nor the love of her husband, nor the lives of all her thirteen children. Thirteen! And no ether to lighten the labor, and no serums to combat the childhood diseases of eight of them, who were not strong enough to combat the infections alone.

So the children died, and Henry Thrale grew more bitter and self-indulgent, and solaced himself with the tremendous meals that made his beautiful home renowned throughout England, and which ultimately caused his death. He had a fortune, as money went in those days, and he wanted a son to leave it to. Finally there came a boy, who lived to be ten years old. One day, when racing with his sisters, he dropped dead at his mother’s feet. There were no stethoscopes to indicate if a child had a weak heart, and so long as he had n’t a fever, no one thought he might be ill.

Henry Thrale grew more bitter, but his wife was a clever and an interesting woman, with, as she said, ‘too many strong points in her face for beauty,’ and she had Dr. Johnson to talk to when her husband went to see the Sly Sophie Streetfield, who lived and died in the same house. Mrs. Thrale also had a Diary, for there were no sanitariums or psychoanalysis clinics in those days, and she relieved her feelings, as most other ladies of her time were wont to do, by keeping secret journals of her more dramatic moments, and inventing witty rhymes against her rivals. Her husband laughed at her endless scribblings, and twitted her on their seriousness, but gave her a thick book to keep them in, nicknamed the ‘Thraliana.’

From it comes the account of her trip to Wales with Dr. Johnson, in an age when, if you wanted to go somewhere, you hired a carriage and drove there. They took Queeny, the eldest of the girls, with them. She was about thirteen.

August 12. — Queeny’s cough is not now worth thinking on. She has a slight touch of the worms, but I don’t much mind that.

August 16. — Queeny rose in such spirits that I fretted myself for fretting about her, but she is always in spirits in the morning and at night, and seems to flag in the middle of the day. So I think did poor Lucy! Oh! what a horrid thought! And she is feverish too, and hot in the hand. I wish I knew what ailed her. — I gave her some salts today to cool her. The aloes, I think, was too hot a physick.

September 2. — Queeny’s worms bite again. I gave her a quarter of a Scott’s pill, but it was not enough. Her head does not ache, however.

Stalwart Queeny, to survive the discomforts of such a journey! For, fever or no fever, the trip was never halted, and the ill child was jolted over rough Welsh roads and then given a Scott’s pill. She deserves vast credit for withstanding that remedy. It is more than Oliver Goldsmith could accomplish, for ’t is said that it was of a Scott’s pill that he died. But Queeny was a model for our Better Baby Shows, from all accounts. Once her father, to test her ten-year-old ability to count, offered her a penny for every goat she could see in the pasture. Dr. Johnson kept the score, and was witness to the fact that whereas Mr. Thrale saw a dozen goats, Queeny saw one hundred and forty-nine, and cleaned her father out of pocket money. That was a surprise for Henry, but so was the discovery that he was nearsighted.

Dr. William Fellowes was the Thrale physician. He gave Hester much advice about the ‘flatulance and spasms’ to which she was, all her life, subject, but his advice apparently never helped her, for she continued to have them. He did, however, give her husband a lecture about his diet, of which Henry took as much as he chose and ignored the warning as to what would happen if he did not curb his appetite for food and yet more food. And he died as the doctor had predicted, from apoplexy, after a prodigious meal. It was only by bleeding till he fainted that his life had been saved once before, as Dr. Johnson had remarked. One could hardly expect the rigorous bleeding to work every time!

Hester was not long in contracting a marriage with an Italian musician. Indeed, she lived to celebrate her eightieth birthday, when she entertained with a concert, a ball, and a supper to six hundred people at the Kingston Assembly Rooms in Bath. Her health was drunk, and she led the dancing. Two years later, the still vigorous old lady fell and broke her leg. She died in ten days.

Mr. Pennington wrote of the accident: ‘Probably you will suppose that the accident to the leg was the cause of this sudden catastrophe? Not at all — it was perfectly cured, and the manner in which it headed, contrary to all expectations, was considered a Proof, a fallacious one as it turned out — of the purity and strength of her constitution. Inflammation of the Intestines, over which Medicine had no power, was the cause of her death.’

Such is the fate of a fracture without an X-ray!

4I have now lost, just lost,’ wrote Fanny Burney d’Arblay, ‘ my once most dear, intimate, and admired friend, Mrs. Thrale-Piozzi.’

Shortsightedness in friendship was not the only kind of shortsightedness that Madame d’Arblay suffered from. While it was only during her illness at Court that she reached the point of being unable to see unless her eyes were within a few inches of her book, — a condition which took Sir Joshua Reynolds from his painting, — still her limited vision was a constant source of discomfort and embarrassment. While a lady in waiting to Queen Caroline, she would often march upon the astonished George IV before she was aware of his royal presence. Then came the blushes, apologies for not seeing him, and the awkward, backward exit, with tangled skirts and a thumping heart; for she was a very shy person, and frightfully sensitive about her defective sight. That spectacles might, have helped her was beyond her comprehension. On the contrary, the Court physician regarded her case as one needing diet, and of it she writes her sister: ‘The weakness of my eyes, which will not bear the light, prevents me from tasting animal food all this time.’

But though her vision was not as broad as one could wish, either in fact or in friendship, Madame d’Arblay was capable of seeing scientifically far ahead of many people of her age. The scourge of smallpox was the horror of her generation, as indeed it had been for many generations before her and many after, some of them not so far removed from our own century. All too many of her friends had succumbed to it or, what was sometimes worse, had survived it, to live out their lives blind, unlovely, and too frequently unloved. It was a menace that hung over the thrones of kings and startled thinking people into a realization of the need for adequate protection. Hester Thrale had, she said, ‘small pox and measles’ to interrupt the studies of her girlhood. Apparently the two of them went hand in hand in the list of expected children’s diseases.

Indeed, the sense of general alarm is felt in the Queen’s discussion of Camilla, the third of Madame d’Arblay’s novels, when Her Majesty says to Fanny: 4I have read but fifty pages as yet; but I am in great uneasiness for that little girl, for I am afraid she will get the small pox! — But I won’t peep. I read quite fair.’ The Queen was herself an ardent advocate of inoculation, and had her own children safeguarded against the disease, and the Court held its breath until each one was pronounced out of danger. But she was Queen, and had not to argue what she chose to do as lesser mortals must, as Fanny d’Arblay did with her sister concerning her own son.

‘But consider, my dear Esther, the small pox — ’

And the more timorous one replied: ‘I have considered it at least six times, in all its stages, Heaven help me!’

Yet it was an intelligent fear that led the d’Arblays to subject their ‘so sweet a bantling’ to inoculation, and it was no slight ordeal, as you see from the letter describing it to Dr. Burney: —

MY DEAREST PADRE,
Relieved at length from a terror that almost from the birth of my little darling hung upon my mind, and with what confidence in your utmost kindness do I call for your participation in my joy that all alarm is over, and Mr. Ansel taken his leave!
When Mr. Ansel came to perform the dreaded operation, he desired me to leave the child to him and the maid; but my agitation was not of that sort. I wished for the experiment upon the most mature deliberation; but while I trembled with the suspence of its effect, I could not endure to lose a moment from the beloved little object for and with whom I was running such a risk.
He sat upon my lap, and Mr. Ansel gave him a bit of barley sugar to obtain his leave for pulling off one sleeve of his frock.
[The four-year-old boy here held out his arm, and the doctor made a deep incision.]
Mr. Ansel pressed out the blood with his lancet again and again, and wiped the instrument on the wound for two or three minutes, fearing from the excessive strictness of his whole life’s regimen he might still escape the venom. When it was over, Mr. Ansel owned himself still apprehensive it might not take, and asked if I should object to his innoculating the other arm. I told him I committed the whole to his judgement as Mr. d’Arblay was away from home.

The letter continues: ‘—so the other day, Mr. Ansel begged leave to take some matter from his arm for future experiments,’ whereat the small Alexander ‘suffered him to make four successive cuts to take matter for four lancets.’

Hardly a pretty picture, but none the less, I believe, a very accurate one, for Dr. Johnson is our guarantor of Fanny’s veracity, and we may be quite sure that whatever he said on earth he will adhere to in Heaven, Dr. Johnson being Dr. Johnson.

It was one hundred and thirty years ago that this scene occurred. Technique and human thought have changed greatly since then. Vaccination is now a simple little pricking of the skin, thanks to the mothers who helped the doctors in their ‘future experiments.’ We wear spectacles at the slightest provocation, and instead of being bled until we faint, we are given blood transfusions. We have anaesthetics and twilight sleep. We have antiseptics and plastic surgery and X-rays and serums. We have comfort undreamed of one hundred and sixty years ago!

The result is that our point of view has changed. If we wish to threaten a heroine, we depict a failure on Wall Street, not an attack of smallpox. After all the doctors have done with smallpox, the vaccinated public does not think it worth reading about. With the lessening of danger from it and similar diseases, our sense of security, vastly exalted, has in turn depreciated the doctors’ achievements. We like the feeling that we are immune, and we expect the men who have made us immune to keep us so. And then we blame them when they can’t. We neglect to look into the reasons for our immunity. We forget that it was not built by the medical profession working alone, but by the coöperation of our forbears with the doctors in the making of their ‘future experiments’ — the fruits of which we are enjoying to-day.

What good are doctors, without the coöperation of the patient?