John Tyndall, Science and Man
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| tardation and frank psychosis. Gradually the name was changed to antisocial personality, and latelv to sociopath. Dr. Henry Davidson, a psychiatrist, recently questioned whether either name was a diagnosis or a term of derision. "Sometimes," he wrote, "these people are unhappy or neurotic, occasionally they are truly psychopathic, and in some cases you get the feeling that they are just evil." The patient may be sad, mad or bad, but the name serves its purpose-to hide the doc
tor's ignorance of the true state of affairs. (Or sometimes to show his political preferences. Antisocial indicates violent dissatisfaction with the best of all possible worlds, our present society, thus putting Black Panthers, Communists, anarchists and hippie revolutionaries in the same bag. A little extension could also include other dissenters and nonconformists like Jeremiah, Jesus and John Adams.) Today we still have what is called schizophrenia. give the real name of the sickness. (I note that I have used the word layman. Laynian stresses the snobbish separation of the medical profession from the common herd. Doctors think they are like the clergy, anointed and blessed, with the power to dispense life and death. You're the layman, the poor slob who accepts the distinction. Other professions also have their noses in the air-teacbers, lawyers and iindertakers. ) Words clothe the doctor in more than a little brief authority; they decorate him better than the plumes of the African wizard or the ocher of the Australasian. Osteonmlacia is more melodious than softening of the bones, and alopecia more euphonious than plain baldness. If the doctor puts on such verbal trappings merely to mystify you, he does you no harm. The danger comes when he himself pays credence to the mantras he sings. 12
gave a name to it, a name from the Greek meaning split thinking. So if it's thinking that's at fault, why look to the body for the cause? Keep investigating the psyche. Only after decades and decades of no results from those investigations did research turn to the physical processes going on in schizophrenics. Naming may have held up progress. (I say "may have." So far there hasn't been much progress. Doctors still "treat" the condition by a variety of methods, even by reading poetry to the patients. ) 2 Do you remember rheumatism? It was probably a diagnosis when you were younger, but now not even TV commercials for pain relievers mention it. Rheumatism was a convenient catchall name for rheumatoid arthritis, rheumatic fever, osteoarthritis, gout and a dozen more painful disorders of the joints and muscles. Rheumatism had a standard treatment: heat, rest, and salicylates. Only when rheumatism disintegrated into its component verities (gout, rheumatoid arthritis, osti,oarthritis, etc.) did treatment become more rational. Naming saves the busy doctor's time. He doesn't have to think too hard about what causes the troubleunless he's a researcher, and then the name may become an ignis fatuus to lead him astray. Example: There was in my time a disease called Hebrews' Disease. (It is a canard that the name comes from 11 Chronicles 16: 12-13, which reads, "And in the thirty and ninth year of his reign Asa was diseased in his feet, until his disease was exceeding great; yet in his disease he sought not unto the Lord, but went unto physicians. And Asa slept with his fathers, and died in the one and fortieth year of his reign.") The name, Hebrews' Disease, obviously indicates that the disease occurs in Jews and hence must have a genetically determined background. And if the fathers have eaten sour grapes, what's the use of taking care of the children's teeth? More than fifty years ago a brilliant New York surgeon wrote a paper on its etiology (a good word, meaning causation; you'll hear it used again, so don't forget it) in which he pointed out the curious fact, discovered by himself, that only Russian Jews (he was a German Jew) were afflicted by the disease. A gifted writer and an iconoclast, he said the cause must be found in geography, not in genetics. "In a narrow band from the Baltic to the Balkans" lies the origin of the disease, he said. He investigated many cases of the disease in New York City; he found it only in immigrant Russian Jews, except for one man of Irish descent born right in the city. The Medicine Af Being a persistent cuss, he finally drew from the man*s mother the admission that the father may have been an itinerant Jewish peddler. Before he could proceed with further research into the dietary and sexual habits of his series of patients, someone else discovered that another ethnic group could have the same disease and the next edition of a surgical textbook alliteratively described its incidence in Jews and Japanese. By this time other researchers got suspicious and when Finns. Frenchmen, Norwegians and native New Englandersall uncircumcised-were discovered with Hebrews' Disease, the name was changed to thrombo-angitis ob literans, descriptive of its appearance under the microscope, and its etiology was more carefully looked into. (But not yet discovered. Some doctors have given up in disgust and say the disease doesn't even exist. Others have attributed it to causes as varied as fungus infections of the feet and the eating of ergot-infested rye bread. On the basis of the latter, a textbook of therapeutics advised that sufferers from the disease could drink all forms of alcohol except rye whiskey.) On occasion doctors put names to what isn't there. Some diseases, like the emperor's new clothes, just don't exist. Remember how superfluous characters in Victorian novels were removed by brain fever? That was not encephalitis. Brain fever was a literary disease. It came soon after prolonged study, extreme worry or overwhelming emotion, as when a girl was jilted. it usually ran a short, fatal course-two or three paragraphs. Other characters died of a decline; that was good for a chapter or two. Brain fever is no longer prevalent, nor is teething fever, but idiopathic colic, chronic cystic mastitis, and visceroptosis are still around. (Idiopathic is a great word for doctors. It means the disease started by itself. That means that the disease needed no cause, no creator; it just sprang up. There's idiopathic thrombocytoper.ic purpura, idiopathic scoliosis, idiopathic atrophy of the skin, and lots more. Idiopathic is the medical version of the Big Bang theory in astronomy. Who needs God, allergies, bacteria, viruses or chromosomal aberrations in such diseases?) I'm not nit-picking. Naming has perils. Dr. Frank Cole, editor of the Nebraska State Medical Journal, describes cardiac arrest. "It means that the heart has stopped, and whose heart does not stop when he dies? It suggests that the heart stopped without a cause, and ' You don't believe that? See a book called Poetry Therapy, edited by Dr. J. J. L-dy, published by Lippincott, 1970. The Name of the Rose this is pure nonsense. The idea that people die during anesthesia from mysterious causes is as old as anesthesia.... But while the false idea will not die, the name is changed every twenty years, so that the theory appears fresh and new and therefore modern and valid. And we have called this non-existent disease by such names as status lymphaticus, status thymolymphaticus, status periculosus, primary syncope, cardiac standstill, asystole, and now cardiac arrest. These are lovely names, they are sesquipedalian. Their elegance and their very length almost convince us. But people die on the operating table because they are not watched or because they bleed. Mysterious agents do not ... kill patients 'between two heart beats.' Death in surgery is due to respiratory obstruction, cardiovascular accident, hypotension, and to other members of a list, all of which are known and have proper names." Naming, you see, is different from diagnosis. It can be as hazardous as calling on the devil, pacts with Satan being notorious for being weighted in his favor. Plato, in The Republic, said, "Of a surety, they give strange and newfangled names to diseases." Perhaps you ought to be as wary of the glib doctor as that old Greek implies he was. When a doctor pronounces that the disorder he is treating is thus-and-so in Latin, ask him what it is in English and don't be satisfied unless he can make you understand. Refuse to be mystified. It is better for you to know that he doesn't know. Then vou won't take the medication (which may have potential for harm) be orders, and you can always go to another doctor. You'll save money and possibly your health. Naming can be harmful to your health. When a doctor orders a regimen of drugs or diet on the basis of a named but undiagnosed condition, you are the one who's taking a chance, not he. My niece was recently treated for what the doctor called Winter Vomiti-ig Disease. (That sounds like the opposite of Summer Diarrhea, which has disappeared in name and in fact. It was shown to be caused by bacteria, not solstices or equinoxes, and disappeared after the introduction of pasteurized milk.) Whatever Winter Vomiting Disease was, it was not helped by a starvation diet and opium in the form of paregoric. 2. Naming is also a short-cut for the doctor-to tell his 13 colleagues something unfit for untutored ears to hear. I don't refer to fellatio, which has already appeared on the drama pages of the New York Times. I mean the private language of the profession. Every predatory trade has its argot, vividly expressive of its contempt for its victims. The secret language of doctors is used only in intimate discussions in the privacy of hospital staff rooms or the golf course. There, where there is no need for magic, the practitioners thereof talk about patients and their illnesses with their hair down. A very short glossary follows: Acute Lunipuk-acceiited on the second syllable-aii acute illness of no importance, not Nvorth the I)other of having an accurate diagnosis, self-liniited, responding well to reassurance and any prescription xvhether taken or not. Chronic ,Iloldavian Crit(I-itp obscure skiii disorder that the doctor can treat for at ]~ast three times before sending the sufferer therefrom to another doctor, and (la capo. Cinque Test-a useless laboratoi~~,, test done at the patient's insisence and accomplished by pouring the specimen down the draiii. Crock-an uncooperative patient NN,Iio stubbornly persists in I)aviiig the sanie complaints time and again despite the expert ministrations of his plin,siciaii. Disease Entity-an actual disorder from which a patient stiffers, recognized by the doctor as uiidiagiioseid but which he will nevertheless treat until a diagnosis is established. Fecalemia of the Circle of IVillis-the circle of Willis being the arterial supply of the brain, this condition indicates that the patient's head is full of feces. Gork-a vegetable; i.e., a patient whose mental faculties are clouded to the point of total apathy. Neuremia-a form a hypochondria, the implication being that the patient's blood hurts. Sliopper-a patient whose dissatisfaction with diagnosis or treatment is expressed by his going to ar.otlier (not necessarily more skilled) doctor. More definitions could be given, but this is not, after all, a dictionary. The. Medicine M IV The Sacred Precincts "Examine me, 0 Lord, and test me; try out mv reins and my heart." -Psalms, 26:2 -\Ia~,be you're not sick enough to have the doctor see you at home. You go to his office. Civilized people need no skulls hanging outside the cave, no totems, no jujus to awe them and fill them with appropriate respect when they enter the doctor's office. You're beyond that. You don't expect alembics, skeletons, or fetuses in bottles, as your fathers did. In keeping with your sophistication and your recognition that the practice of medicine is a business-although unlike other businesses-you look for a crisp, efficient place where your ills can be attended to quickly and you can be on your way. That expectation is part of the modern ritual of the healing art. You have been indoctrinated by magazine articles, by television interviews and by club lectures. You know that a doctor who is so behind the times that he has no appointment system must be a scientific laggard. You're aware that the doctor has many demands on his time (like golf or bridge) and you don't want to waste it. You3re in Ms office to do your business and get it over with. The waiting room is shiny clean, with uncomfortable chairs and a magazine rack filled with the latest issues of Fortune, Vogue, Golf, Travel, Outdoor Sports, Playboy, and National Review. The chairs are uncomfortable because tradition can't be broken with entirely. Hard chairs keep you painfully alert. The magazines are those the doctor has read and discarded; they give you an idea of the kind of man he is. On the walls are hung reproductions of Picassos, Braques and Mir'os for the wealthy suburban crowd; there are also bland autumn landscapes and "The Stag at Bay" for the runof-the-mill bunch. At the far end of the room, sometimes behind a glass partition, is the receptionist dressed like a priestess in a see-through white uniform and a permanent smile, She is the dragon who guards the filing cabinets, the telephone, the intercommunication system, the billing ledgers and the appointment book. She has another function-to politely and firmly ward off presumptuous visitors to the doctor. You have an appointment, so you're welcome. if this is your first visit, you give the receptionist such vital statistics as she may ask for, including your Blue Shield and Social Security numbers. If your doctor is really with it, you'll receive from her a history sheet which you'll be asked to fill out. You understand that the selfhistory is a great timesaver for the doctor. At a glance he'll be able to see what your medical background is and what you're complaining of now. You want to be accurate (after all, it's your health), so you carefully fill in what Papa and N,Iama died of and what Aunt Nliiinie had and you check whether you had measles, nialai-i.t or tsutstigqmuslii fever. (That last one's a litinidiiiger, isn't it? Some other good ones ar( verrug,t perti\-iana, ainhum, Q fever, Rocky NIountaiii spotted fever and kala-azar.) Then comes the list of present symptoms starting with backache, belching and blurred N,isioii. Half the time you're not sure whether the term fits your case. For example, "sensation of fullness after meals." Does that mean that you have -. good appetite and get pleasantly replete or that you have such a bad appetite that a little food fills you up quickl~,? You don't want to appear ignorant, so you leave that space unchecked. The selfhistory sheet is fascinating. It's a better time-consumer than a crossword puzzle or a coloring I)ook. You suddenly realize that your appointn-tent was for two-thirty and it's now past threefifteei-t. You mtistn't keep the doctor waiting. You hurriedly rush tlirou,,b the remaining questions 1 Z7~ and turn the paper in to the receptionist. That makes you feel as though you're back in grammar schoolrather a pleasant feeling, to shake off all those years. Then you settle back and wait for your summons. Now you have time to see who else is waiting. Your confidence in the doctor rises. It's a good thing, you congratulate yourself, that you chose him. Look at the patients: well-dressed, clean, obviously upper upper class. Even later on, after you've become a regular visitor to the doctor and you've discovered that the stylish lady is actually the wife of the storekeeper down the The Sacred Precincts street and the distinguished-looking man is an electrician, N-our confidence is not diminished but rather heightened. You're impressed by the doctor's demoer-atic spirit and his love for humanity. He's willing to treat anyone, of any race, color or creed, providing he will pay. Or his insurance company will. Or Medicare. At last your name is called. You enter the sanctum s;anctorum, the consulting room. Here you find a thick carpet, two or three comfortable chairs (but you sit on the straight-backed one by the desk) and a general sense of luxury. On the walls are displayed framed diplomas and various certificates. The desk, very imposing, has on it a large picture of the doctor's family, an ornate Florentine inkstand, eight or ten medical journals, in-add-out correspondence boxes piled high with letters and insurance forms. The doctor leans back in his swivel chair and, peering over the Ossa and Pelion on his desk, asks, "What's %,our chief complaint?" See, no nonsense. He gets right to the point. The selfhistory yo,-i've so painfully struggled over lies open on the desk before him, but he ignores it. You tell him why you came. He makes a few notes and while you're in the middle of describing the terrible heartburn you get after eating your mother-inlaw's stuffed cabbage, he gets up and ushers you into a small cubicle where you undress and put on an examining gown. You're supposed to know whether it goes on frontwards like a kimono or backwards to expose your behind. That skimpy costume, the stock in trade of medical humorists, is not comic. It is a real put-down. Nakedness puts you in a properly humble frame of mind. It is also used for a similar psychological reason in concentration camps, prisons and draft board examinations. Unclothed, as Erving Goffman points out in Asylum, you are immediately inferior to the civilized man who stands before you. You become painfully conscious of the roll of fat, of the pimples on your legs and of your ridiculous lack of muscle or curve. The doctor then proceeds to the examination, even though he's already made up his mind about what ~-ou've got and what he's going to do about it. Medical schools teach that 80~'c of diagnoses can be made on the history alone. But without an examination you wouldn't believe him no matter bow graphically you've detailed the spells of vertigo, deafnese and buzzing in your ears you've come about. (That's known as M6nie're's syndrome. Don't get hypochondriacal.) You're inspected with and without instruments in various orifices, palpated, percussed, and auscultated (to auscultate-to 15 listen to, medically). Inspection is comprehensible. If the doctor doesn't look, he can't see. Although sometimes you may wonder, because of his abstracted expression, whether he does see. I can assure you he doesmost of the time. A medical joke (a favorite with doctors) tells of the proctologist who fails to remember the faces of his patients but who never forgets a posterior. Palpation is also understandable, particularly when the doctor's hands are cold, making you wince when he places them on your abdomen. (I use abdomen because it is correct. Stomach is not; it is an internal organ of digestion. Belly is okay, but to the layman-no offense meai-it-it carries connotations of infantilism and vulgarity, if not downright obscenity. The layman is wrong, but this is not the place to correct either his anatomical confusion or his niceiiellyisms; let him read The Song of Solomon or Venus and Adonis.) Palpation is a form of laying on of bands, a highly regarded tliaumaturgic practice. Many doctors neglect palpation when it does not seem necessary to them for diagnosis. The abandonment of that method is one of the causes of public discontent with the profession. "He didn't even put a finger on me!" The patient, particularly the neurotic searcher after magic, feels he has been shortchanged if the doctor hasn't touched him. He becomes a devotee of chiropractic, which means literally the laying on of hands. Percussion, the tapping of the chest, sometimes of the abdomen, rarely of the skull, is a technique by which the doctor presumably gathers information about the contents of the cavity he is percussing. From variations in tonal quality he can deduce what's wrong or what's missing despite the loud piped-in music overhead. The variations are slight; the doctor must have a keen ear. Fortunately, most doctors have that; it is constantly being trained by hi-fi stereo recordings of jazz concerts and Tchaikovsky symphonies. At last comes auscultation, the most arcane and yet the most routine part of the examination. The stethoscope is the badge of the profession. It is an insigne that belongs exclusively to medical men. When you see a garage mechanic using a stethoscope, you get suspicious that he's reaching above his station and for your pocketbook. When a nurse takes your blood pressure and uses the stethoscope, you're skeptical. She doesn't seem to have the same careless finesse with which the doctor brandishes the instrument. The stethoscope protrudes from the doctor's pocket or lies atop all the other tools in his bag. (Dr. Watson carried his in his bat, as you recall. It must have reeked of pomade.) The mysteriotis instrument is applied to your chest and moved from spot to spot, while the doctor has a faraway look in his eyes as though he were listening to the music of the spheres. He tells you to breathe in and out, to stop breathing (temporarily, of course) and to say ninetynine, and all the time he listens as though to distant harmonies. There's no question that he's finding out something about you. Alas! That's not true. I must ad~,aiice your knowledge by dispelling that illusion. A recent survey of physicians' stethoscopes showed that about 20% didn't transmit sounds bilaterally and that more than half distorted the sounds. Blood pressure determinations which depend on the use of the stetboscope, it follows, are often fallacious, as Dr. Irvine Page pointed out in an editorial in Modern Medicine. He ended his statement there with, "Far better no measurement at all than an inaccurate one. I mean it!" But auscultation cannot be omitted, as palpation often is. It is an essential part of the ritual. For you have gone through a ritual. The doctor sincerely believes be is doing something to aid him in diagnosing your ailment. He may rush through the procedure, be may rely on defective instruments, be may not know the rationale for what be is doidg, but be would never, never, never skip the examination, no more than he would expect to examine N,oti gratis. lie needs the ritual as much as you do. Aiid most often he does discover what's wrong with you. (Sometimes he discovers what isn't, too. Two true stories: A doctor discovered a lttiiip in the (yroiii, suspected malignancy and adx-ised a biopsy, he i,,iiored all the infected pimples on the patient's le,, which had caused secondary enlargement of the lynipli iiodes of the groin. Another doctor of my acquaiiitaiice found unexplainable very low blood pressures in his patients until be realized that his sphygmomanometer [blood pressure machine] was poorly calibrated.) The examination being over, you I re ready for the next phase: the necessary laboratory tests (discussed in another chapter). And then you're back in the consulting room. Like a prisorier awaiting verdict and sentence you wait for the fateful words. You don't have long to wait. The doctor tells you what you have and what must be done to restore you to health. No sweat-for him. He has the diagnosis at his fingertips. He's not a lawyer who tells you he'll have to look up the law before be can solve your problem. He's not a minister who must seek divine guidance. He knows. His knowledge is encyclopedic. It The Medicine M ranges through the alphabet from Addison's disease to zoster. And be gives you the benefit of his knowledge, almost with a snap of his fingers (This is known in the trade as a snap diagnosis). You leave the office relieved and happy you chose such a -,ood and smart doctor. I quote now, deadpan, a statement by a Georgia doc tor from a book entitled Liste-i to Leaders in Medicine, a book for the guidance of fledgling doctors: "A suc cessftil doctor is one who inspires confidence ... with out any ti-ace of dishonesty, he can appear competent to manage the patient's problems, even though he admits that he cannot give an exact diagnosis or treatment at that moment. Most patients are confused and frightened; they need the reassurance and comfort that a trained person can give them." A trained person, indeed! Trained in what? Science or magic? Reassurance and comfort are what a mother gives when she kisses her child's scraped knee. If that's what you want, okay, but then don't blame the doctors when more than that is not forthcoming. To have good doctors there must be good patients, and good patients are not those who seek father figtires and mother substitutes when they need fungicides or mercuhydrin. SympatliN~ is no surro ate 9 Directory: 2013 2013 -> Annual InStructional unit plan 2013 -> The Ministry of Education and Science of Ukraine 2013 -> #1 a lifesafer of virginia inc 2013 -> Name(s): your name here team or Group #(if applicable): Professor’s name 2013 -> Alcott Local School Council (lcs) Meeting Minutes 2013 -> Table Of Contents introduction 2 2013 -> Supplemental demographic information 2013 -> 【Education&Working Experience】 Download 468.23 Kb. Share with your friends:
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