FROM A SUBURBAN BALCONY

Evening Star, Issue 19197, 13 March 1926, Page 2

FROM A SUBURBAN BALCONY

ANY LAYMAN TO ANY DOCTOR-ALMOST The doctors have been a good deal in the limelight of late. I myself have recently emerged from their hands. I want to set down one or two things that have suggested themselves to mo as the result. * * » * When I was a small hoy two sorts of people were the terror of my life — the doctor and the policeman. I was brought up in a secluded part of an Irish county. In those far-off days we know little of the great world beyond our parish. News of it drifted fitfully to us from a weekly newspaper, which was passed round among perhaps half a dozen subscribers, or from the casual visits of beggars and pedlars. The arrival of a doctor or a policeman into the quietude ,of the community was always an ominous event. The doctor’s advent was made ominous for mo by the fact that in those times they bled everybody that was sick, no matter almost what the sickness might ho. That scared the unsophisticated child of threescore years ago. I watched the process once or twice. The hared arm, the tight bandage, and then the shining steel shoved into the vein, and the spurt of the red blood —all this was a bit terrifying. And when the doctor proposed to operate on mo after that fashion I swiftly dilcovcred I had business elsewhere, and was off like a shot. There was another reason also for my dread of the profession. 'The doctor and death seemed nearly always a natural combination. For in those early days doctors were not as numerous as they are now-; nor did people send for them until their case seemed desperate. “Is Fat dead yet?” one man was heard calling tO ( another. “No; but 1 don’t fancy it will bo long now, 1 saw the doctor going there yesterday.’’ The normal child shudders at death—does not know- what to make ol it, and the doctor’s close association with it led mo to regard him ns a fearsome being, to bo .shunned as a wild beast. * * * * But we have altered all that. Neither doctor nor policeman is regarded with awe by the modern boy. We go to visit the former ns blithely almost as wo go to a picnic. From being a terror to youth he is nowwelcomed into our homes by both old and young. He is a kind of uncrowned king. Jn some respects'he is tho most influential man in the whole nation. Hii* power is absolute; his presence a charm. The doctors are, as Major Beith (fan Hay) happily called them, " the standing army and navy of humanity,” Ho recently- told the students of Guy’s Hospital: “You bring us into the world; you attend us upon om voyage through life; at any moment we may call upon you to dry-dock us, or more frequently assist ns to carry out tho most ticklish of undertakings—the execution of repairs while under steam. And when the time conies for us to pass beyond the horizon of human life wc call upon you again for the Inst time to assuage our sufferings and soften tho pangs of death.” There is, perhaps, no class of men in tho community who make more sacrifices for the common good. Here, c.g., are three of them inoculating themselves with tho cholera poison, and then with serum in order to test its effectiveness. Here are two more living for mouths on the edge of a plague-stricken swamp outside Rome, and one allowing himself to bo bitten by forty inosquitoes in order to try to discover , the cause of the deadly malaria. Two American doctors act similarly elsewhere, and pay the penalty with their lives; and so on. The muster roll of doctor martyrs in the interests of science and humanity is long and brilliant. Even the ordinary doctor’s profession is not without its quiet heroism. It takes more courage, perhaps, to perform the humdrum round of daily duties adequately and in the right spirit than to do two or three daring experiments which might cost the life. There is no class of people in the community so constantly on tho job. Others have definite hours for work and play. The doctor has none. His bell and ’phone go night as well as day; Sunday as w-ell as Saturday, lb is a winter night. He has been hard at it all day among the sick and painstricken. He feels weary, and welcomes bed. Ho is just getting warm and going off into a comfortable sleep, when whirr goes the ’phone. It a mighty temptation to bo deaf or indifferent. It is not everyone that could thus face out into the inhospitable night under the compulsion of duty and need. I’m glad I’m not a doctor. I’m afraid I. should not be equal to such a moral strain.

Tint I am* uot*writiug a general disquisition on doctors. 1 am only inferring to one or two things that have suggested themselves to mo ns a result of my experience of them in earlier years. I. think it would bo oil if doctors took their patients more into their confidence, explained the natuieot their disease to them, and told them frankly what it was"and what it implied. Some do this; many do not. The patient may seek for information himself, but the replies to his queries don’t enlighten him much. A prescription is written in an unintelligible language, but ho is is not informed what the medicine is meant to aceoraplish. He is treated something like a dummy, passively

manipulated from without by methods and medicines whoso purport he does not understand. It is all something of the nature of a ponny-in-thc-slot machine. Only once or twice have I had experience of that kind of doctor. But I am told he is common enough. An obvious reply is that the doctor docs not always know just what the trouble is. His diagnosis may bo at la.ult, and a close mouth makes a wise head. Moreover, the patient might not ho able to understand or bear the information if it were given. M e know now how the sciences are all interrelated. Hence exact information on any particular case would probably bo misunderstood without a knowdedgo of its context. The average layman docs not possess this, and to impart fragmentary medical truths 'without a comprehension of their relation to others might probably, alarm him unnecessarily.

That raises the old casuistical question: Is a lie ever justifiableP Me can all appreciate tho Canterbury schoolboy’s definition of it as blasphemy against God, but a very present help in time of need. The problem is to determine the time of need. It is a very common practice among doctors and tho friends of patients to conceal from them the precise possibilities of their trouble. Hope, it is argued, must bo kept up at all costs. For there is no medicine to equal it. When a patient loses hope his recovery becomes exceedingly doubtful. So what is called the lie of kindness is usually resorted to. A distinguished member of the profession, an American, Dr Richard C. Cabot, contributes a suggestive discussion of the question. Ho says ho was brought up as most physicians are, to be truthful as far as possible, but to lie when the patient’s interests absolutely demanded it. But after seven years acting on the principle he gave it up, for no man was skilful enough to make a success of lying unless he kept in constant practice. In his later years ho tried truth. By telling the truth he does' not mean emptying his mind of all its contents before everyone. It is no one’s duty to do that. But it is their duty to be fair and square, to deceive no one, never to be double-faced. To act otherwise is a short-sighted policy, and in the end is self-destruc-tive. A family conspire wuu tneir friends and tho doctor to deceive tiro sick man as to his real condition, and buoy him up with what they know is a deceptive hope. They may succeed for a time. Cut how about tho conspirators themselves? Some day they will be ill. MTiom then can they trust? They have learned each ol them that the trusted medical adviser, the faithtul nurse, the devoted friends, will “ lie for the patient’s good, and each one s judgment differs as to the extent of that good.” A girl of twenty said to Dr Cabot: “Oh, of course, I never believe what doctors say. I’ve helped them lie and fix up the letters to mother too often myself.” A lie works only so long as confidence is firm, but it always tends to undermine confidence :nd make neither truth nor falsehood effective. All of which is confirmatory of my plea for greater openness and frankness between doctors and patients.

And if the worst comes to the worst there is always for the patient the possibility that the doctor’s diagnosis may not be right. Or, even if it be, there are more things in heaven and earth than are dreamt of in any doctor’s case hook. Half a generation ago the average doctor would probably have doubted that. Their confidence was iit drugs. But the modern practitioner places less and less dependence upon these. He does this because ho has come to understand that the greater part of diseases have their origin in the psychical sphere, and must be dealt with there. Hence the successful doctor must be something of a psychologist. He ought, in fact, to be m the main one who keeps in close contact with the spiritual sido of things. The day of drugs is passing. Much of that practice was about as sensible as to apply a porridge plaster to the heart to euro it of love. A process of differentiation is going on. in the medical profession. Already the surgeon and the physician are being specialised. With the rapid growth of dietetic knowledge, the ignorance of which among the masses accounts for four-fifths of the diseases, the need of the physician will grow loss and less. The surgeon will always bo necessary, though the demands even for him will diminish as life is made more immune from accidents and the laws of health observed. For after all wo must realise that we live in a world where law rides and” rules, from atoms to planets, from bodies to souls. And law implies a Lawgiver. Hence it would seem to follow that the doctor who mostly deeply cultivates communion with the Make/ of the laws of the universe should, other things being equal, be the most, accomplished practitioner. Centuries ago, when the student entered the school of the father of medicine, Hippocrates, the oath which ho took ran: “ With purity and with holiness I will pass my life and practise my art.” And a modern philosopher, Amiel. writes in his ‘ Journal ’: “The ideal doctor should bo a man endowed with profound knowledge of the life and the soul, intuitively divining any suffering or disorder, ami restoring peace by his mere presence The model doctor should be at once a genius, a saint,

and a man of God.” I have referred to the greatness of tho doctor’s work. It is interesting to recall what Christianity owes to a member of the profession. Of the twenty-seven documents that comprise the New Testament all save two were written by Jews. But of these two one gives us the most human picture we have of tho Founder of Christianity, and the other the most vivid and accurate history of its spread from Jerusalem to Rome, tho then centre of the world And both these were written by Luke, “ the beloved physician.” And we may let one of the most distinguished members of the craft, Professor Sir Alexander Simpson, point the moral of this: “ Many a system of medicine lias been written since then, and has followed tho- Hippocratic writings to oblivion. But the Lukan treatises are instinct with life. Renan says of Luke’s evangel that ‘ it combines the emotion of the drama with the serenity of an idyll,’ No physician has done justice, to his own culture who has not studied a treatise of. which this French critic could speak as the most beautiful pioc. of literature in existence, and which comes from the pen of a member ol the profession which it ennobles.” Bon.