John Tyndall, Science and Man
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| He then opens his medicine bag, which contains stones, beads, shells, 1:)ones, paints, herbs and other assorted esoteric miscellany at which the family's eyes pop open. He makes a diagnosis by divination, by the casting of bones or the inspection of entrails or the response to the pricking of the skiii by thorns. He sits and thinks, shakes his bead and informs the family, "This is a hard case."
They plead with him to use his knowledge. They offer him a larger reward than is customary. He sighs and says, "I'll try." Therapy starts. He chants, he sings, he dances, shaking a rattle. If he is a very renowned practitioner of the art, he has one or two assistants help him by handing him the fetishes or the sacred sticks. He burns herbs for fumigation to drive away evil spirits. He lets blood to eliminate poisons. He makes mystic symbols with rootink on a piece of bark which the patient then chews and swallows. In some cases he actually sucks out from the patient's body the stone an enemy has caused to be there implanted. Exhausted by his labors, be sinks back and condescends to drink some banana wine or fermented coconut juice handed to him by the grateful family. He gathers up his medical impedimenta, collects his fee, and departs after giving long and complicated instructions for further treatment. I've made no analogy but I'm sure you already have, and just as quickly you've suppressed that iconoclastic thought. How can you compare, you ask yourself, the enlightened American populace to ignorant, benighted, superstitious barbarians? Or those devoted men who minister to our health needs to leaping grotesques in masks and feathers? It's silly, you say, to equate a Doctor of Medicine with a Doctor of Magic. Is it so silly? Think about it, weighing the pros and cons. In the first place, we're smart. We know that physical ailments are not caused by nonexistent ghosts and spirits but by equally invisible bacteria. Mental illness is of a different nature. The Melanesian can attribute it to a broken taboo or to divine retribution for having a wicked soul; we know it's due to an unresolved Oedipus complex or to the surfacing of hidden psychological conflicts. Furthermore, we place no faith in diagnosis by conjuration or sand paintings. Our doctors use rubber tubes with earpieces and shining instruments with lights. The poor African has to driuk nauseating mixtures to get well; we have multicolored capsules and pills that work in mysterious ways their wonders to perform, Let primitive peoples rely on rites and rituals when illness strikes. More sophisticated, we apply scientific methods. But let's not be too snotty. Remember the mirror. There is a superstition of faith. Certainly, a scientific education can lead some people to find it easy to believe a number of impossible things before breakfast, such as that men are distinguished from animals only by the size and convolutions of the cerebral cortex or that calories don't count or that every boy has a deep urge to rape his mother. Let's apply some of the teachings of the cultural anthropologists to medical practice today. Let's do as the anthropologist does when be goes below the surface of the antics of the Bushman or the Papuan. He tries to find out their rationale, because even primitive Stone Age people are men endowed with reason. Their rituals are part of their attempt to control natural processes like rain or childbirth. They dance to bring the rain; they sacrifice a goat to ensure an easy labor. Underneath the weirdness lies sense. What about us? Look carefully at the mirror. How much of what we do in the cure of disease is ritual? How much is effective? How different are we from our brothers in Australasia? Their medical arts are traditional. They have not varied for centuries. Ours are constantly changing to keep up with the advances of knowledge in the sciences. But plus ~a change, plus c'est la meme chose. Which brings me to a description of present-day practice in America. 11 The Visitation "The threat of a neglected cold is for doctors what You get sick. Not terribly sick. just sick. You ache all over, your throat feels scratchy, you have a stuffy nose, you've lost your appetite. The ubiquitous thermometer shows you have a fevernot much, but fever's fever, isn't it? Otherwise why do the manufacturers go to the bother of marking those lines in red? You reach for the aspirin, but on the label, by order of the Federal Food and Drug Administration (which will look after your health whether or not you want it to), you read, "In case of persistent fever, call your doctor." Not only are you patriotic and willing to do what Washington says, you are also clever. You don't believe in patent medicines. You're also lucky. You have a doctor and it isn't Wednesday, Friday, Saturday or Sunday. So you can call him. (I like that phrase believe in. It shows that Americans are not credulous like other folk beyond the Law. This is a free country. You can believe in or not believe in psychoanalysis, penicillin or poultices. You can believe in blood counts and not believe in birth control pills or the other way around. It's the American way of life. That's why orgone boxes got sold in such quantity and why Lydia Pinkham survives only in bawdy ballads.) The doctor comes in his big black car with the M.D. license plate and the Aesculapian emblem. Sometimes the latter is replaced by the caduceus because he doesn't know the difference. Snakes are snakes, aren't they? Maybe the ' caduceus is the more accurate symbol, anyway. It's the sign of Hermes, the god of travel, thieves and commerce. The doctor is almost always dapper, whether he wears a sports jacket or a black suit like an undertaker's. His costume varies according to where he lives: the suburbs or the city. His Countess Mara tie is neatly knotted. His shirt is gleaming white. He carries a little black bag. The size of the bag depends on his fees: if it's big, he charges less than if it's only a little larger than a lady's handbag. just by looking at him you know he's competent. Why shouldn't he be? He spent four years in college, another four in medical school, a year or two in internship, maybe three more as a resident. After all that training he has to be good, hasn't he? Even an airplane pilot (on whom life often depends) doesn't have that long an apprenticeship. The doctor stands by your bedside, disregarding the proffered chair. How can a busy physician take time the threat of purgatory is for priests-a gold mine." -Nicholas de Chamfort, Pens~es out to sit down? It's enough that he deigned to come to your house. He listens to the recital of your symptoms until he gets bored, which doesn't take too long. After all, what new are you telling him? He puts a thermometer in your mouth. He takes your pulse, looks at your eyes, reads the thermometer, shakes his head and goes on to apply the stethoscope to your chest. Maybe he thumps here and there. Then he says sympathetically, "It's A Virus. It's been going around." He really is sympathetic. Doctors are very good at sympathy. It's part of the bedside manner. Sympathy is a cheap commodity--costs absolutely nothing, as a matter of fact-so why not be generous with it? Phase One of the ritual has been accomplished. Now you have a rational diagnosis, which is better than being told someone put a curse on you. By the use of inspection, palpation, percussion and auscultation, the doctor has brought to bear on you the full weight of the marvelous advances of Western medicine. And be comes up with ... A Virus. No doubt that's more dignified than a common cold. You'd feel like a fool if you paid out your good money for just a cold. It's also far superior to what was once fashionable-U.R.I., or upper respiratory infection. U.R.I., because of cultural lag, can still be found on hospital charts where the intern's history records "Patient had U.R.I. treated by L.M.D. and followed by S.O.B." That last abbreviation got you, didn't it? You're wrong. It's not a pejorative characterization of the L.M.D., who is the local medical doctor and very, very, very far down on the totem pole. It means shortness of breath. A Virus is guaranteed to get you more attention than U.R.I. because everyone knows that A Virus can have many complications. And what could be more serious than A Complication? Now Phase Two starts. The doctor says, being of the new.school and perfectly honest with his patients, "Of course, The Virus is a self-limited disease. You'll be better in three or four days, but just to make sure I'll give you a prescription." The logic of his remark escapes me-not you, because you're the patient and at the moment in your clouded state what he says seems to make sense. But if you'll be better in three or four days, why take any medication? And if he's not sure, what's 8
he prescribing? And for what? Don't ask. Yours not to reason why in this day of specialized technology. The pen comes out and the little white pad is scribbed on and the prescription is dutifully carried to the drug store and the bottle of red-and-white, blue-and-green, or orangeand-yellow capsules brought home. You take them. Later on I'll discuss what's in the capsules. Don't cheat. Don't look ahead. You'll spoil the mystery. Phase Three is important. As the doctor pockets his fee or makes a note in his charge book, be says, "Call me if be's not better in a few days." This is known in the lingo of the trade as covering up. It is highly recommended in books on medical management and in journals of medical economics. It is a talisman against potential malpractice claims. But by that soothing remark a little anxiety is added to the family's cares. The doctor knows more than he is telling. This Virus is nothing to be fooled around with. Even the doctor is worried. Not too much. When the telephone call is made, "Doctor, he still feels weak. He has no fever but lie complains that be's tired," the doctor calmly answers, "Now, don't worry. He'll be better tomorrow. just see that he gets plenty of fluids, especially juices, and give him a full diet. It was only The Virus." Did you get that only? A trivial illness, so why are you concerned? Reassurance is so pleasant, isn't it? And Doctor's so patient, he's an absolute angel! And you do get better, becoming a living proof of the wonders of scientific niedicine. Before The Virus, a cold lasted four days or ninetysix hours, depending on the treatment. That's a real doctor joke, straight from the in-group. You took capsules. And what was in the capsules? An antibiotic? Maybe-but antibiotics have been shown to have no value in the curing of The Virus. An analgesic? (Good word. Thanks to television commercials, future generations will have no trouble distinguishing between anesthesia and analgesia.) Aspirin's cheaper-and safer. An antihistamine? Interferes with normal body response to infection and is potentially dangerous to children, pregnant women and the aged. Time out for education. Dr. Joseph Garland, in the New England Journal of Medicine, reported on a study of 781 patients with acute infei~tiotis illness assumed (that's exactly the word used in a reputable publication highly regarded by physicians) to be viral in origin. The study showed that antimicrobial agents affected neither the duration of the illness nor the development of complications. Another study reported in the Lancet (a British publication) that penicillin and the tetracyclines had no advantage over aspirin in the treatment of minor respiratory infections. In actuality, even aspirin had no effect on the course of the illness. In an interview reported in Patient Care (August 15, 1970) Dr. Martin McHenry, a Cleveland infectious disease specialist, recommended chicken soup and time, not antibiotics or aspirin. Maybe the doctor's prescription was for your comfort only and he knew well it wouldn't cure you. Maybe he was merely trying to keep our nose from running and your bones from acbing. Grandma did just as well, remember, with hot tea and rum and a featherbed. But look what you'd have niissed if you hadn't called the doctor. All that glamour, all that ceremony, all that sympathy. You could have saved money, but what's money compared to your health? (While we're on the subject of the treatment of colds, here are a few therapeutic measures I have come across in addition to the standard time-filling ones. My father used to mix a teaspoon of ca-,,enne pepper with a double shot of whiskey. \4rs. N'erni icelli- [obviously not her right name. You wouldn't believe the real one. It was Lemoiijello ]-varied that b%- squeezing a clove of garlic into a glass of homemade red wine. Mrs. Mocz dosed her children with Epsom salts in soured milk; the result kept their minds off their colds. Mr. Schwantz swore by red flannel dipped in vinegar and wrapped around the Deck. Mrs. Skatottlos liked horse-radish stirred into yogurt and followed by a raw egg. I'm just telling you about these. I never ran a double-blind control series on any of them, so I can't say whether they were any more effectiNTe than what I used to prescribe -aspirin, vodka and hot tea. If yoi-i want to try any one of them, go ahead. Don't bother to let me know bow they worked. Tell your neighbors. The~"re gettii-ig tired of that old chicken soup deal.) Ah! you say, but a neglected cold may lead to pneumonia or something worse. Nonsense! If you stopped to think, yot-i'd realize you know better. Pneumonia is an infection caused by a specific germ; it has nothing to do with the common cold. And what's neglect? It must mean not calling the doctor, obviously, even though his treatments have no value and are purely ritualistic. When you have the doctor "treat" a cold, you are going through the motions of propitiating the gods. That wouldn't be so terrible were it not for the doctor's naive belief that he's doing you good. Read on. You'll find a chapter on what he does to you in good faith and bad judgment. 9 The Name of the Rose "Nor bring, to see me cease to live, Some doctor full of phrase and fame To shake his sapient bead and give The ill he cannot cure a name." All right. You can't blame a man for trying. After aU, who knows anything about a common cold? But that ignorance doesn't extend to many other areas, you're sure. Besides, what's the difference if the ailment is called a cold or a virus? It makes a difference. Giving a disease or any phenomenon a name is the first step in most magic. It implies power over the unknown. It signifies knowledge of what it is and how it is caused. Necromancers go through elaborate rituals and end by invoking the name of the devil, who then will be forced to give them gold, glory or Marguerites. The knowledge of the unutterable names of God gave Solomon wisdom to understand the language of birds and beasts. There is also a branch of medicine called nosology, the systematic classifica -Matthew Arnold, The Wish tion of diseases. Nosology has an ancient but not honorable history. The Greeks believed that a disease was caused by an imbalance of any of the four humors: blood, phlegm, yellow bile, black bile. (These humors described personahty as well as pathology. From their names we get sanguine, phlegmatic, choleric and melancholic.) By that nomination they proceeded to treatment aimed at restoring the proper balance of the humors, mainly by diet, exercise and exorcism, none of which helped much in cases of malaria or typhoid fever. Later, Erasistratus taught that plethora, an excess of blood, caused disease. He, too, used diet and exercise to reduce the volume of blood, but his followers felt they were more logical 10
when they actually let blood. This practice returned, reinforced by improved knowledge of the circulation of the blood, and gallons of blood were removed in the era of bloodletting that followed. Macaulay gleefully describes the macabre details by which King Charles 11 was medically exsanguinated in his last illness. Most Americans are unaware of how George Washington died--of a sore tbroat treated by emetics, purges and the removal of four pints of blood. Still later came the development of pathology and then the germ theory Vaccines, sera, antisepsis and asepsis were each believed to be the definitive medical answer to disease. They weren't, but some doctors still cling to the teaching that Corynebacterium acnes causes adolescent acne, and others still treat that condition with vaccines. Now we are -in the stage where a whole class of disorders is called degenerative, thereby implying there's not much we can do about them. For if man is born to trouble as the sparks fly upward and death is inevitable and hardening of the arteries an inexorable concomitant of aging, then why beat our beads against a stone wall? Sigh and say, "It's one of those things" when eyes grow dim and hearing fails and skin gets slack. It's discouraging. It also gives the doctor an out. You can't expect him to hold back time. Naming of diseases is an important function of the doctor's ritual. Example: You have a miserable itch at the anal area. You scratch, which is about all you can do, considering how invisible that part of your anatomy is to you unless you're a Japanese acrobat. You worry that you have cancer or something equally horrendous. You shed your false modesty and in desperation go to the doctor (who may be a dermatologist or a proctologist, depending on your psychological background). He examines that very private place and tells you, "You have a condition called priiritus ani," and he outlines a course of treatment. One thing I can guarantee youhe's 100~'c right in his diagnosis and no gambler would take odds that he isn't. Pruritus ani means itching at the anus. Check it in the dictionary if you don't believe me. Another example: Your child had a sore throat and now has swollen glands in the neck. Being a good parent, you hasten with him to the pediatrician, who says, "Don't worry. It's only cervical adenitis." You could hug him for that reassuring bit of information! And to think he made the diagnosis without even a blood count! Only if you're a suspicious, subversive character would you wonder what that is, and you would- look that up, too, when you get home. Provided you can spell it, that is. If you did that little bit of research you would find that cervical means of the neck and ad,-nitis means inflammation of the glands. It's a good thing for the doctor that you're an honest, loyal American. Still another example: Ever~, now and then, after you've smoked too much or been too excited, you've felt your heart give a sudden ]:)timp and you swear you've felt an extra beat. You're frightened. Time's swift chariot seems a bit closer than it should be. You make an emergency appointment with the doctor. He listens to your heart, hems and haws, nia-,-be takes an electrocardiographic tracing. He ponders on-er the squiggles on the paper and then tells N'Otl, "YOLI liak-e an occasional extrasystole." You exhale in relief that you don't have a myocardial infarction, the same as Senator Soand-so had, who died last week. Yoti console yourself that it's a good thing you went to the doctor,. for now that the diagnosis has been made, xoti'll get treatment appropriate to that fearful sounding disorder. How fortunate for the doctor that you don't know that extrasystole means extra beat! It seems as though words are just as good as casting the dice, and names can be substituted for messy inquiries at a sacrificial altar. Some doctors deny that they are being intellectually dishonest by giving a Greek or Latin synonym for the English name of a disease and thereby cloiining the patient. They say that they are merely using euphemisms (like passed away for died) for the patient's comfort. Maybe so. Palsy sounds better than paralysis, edema than dropsy, and nervoiis breakdown than depressive psychosis. But other euphemisms make the patient's flesh crawl just by their sound: nosocomial disease for hospital infection and pediculosis for lousiness. And where's the psychological value of writing or saying Hansen's disease when the explanatory leprosy is added parenthetically? (When I was an intern I heard a patient tell her doctor that she fell asleep promptly and as promptly woke t-ip an hour later and then stayed awake all night. Instead of saying, "You have insomnia," which would have satisfied her need to have her complaint given a name, the doctor said, "The trouble with you is that you sleep too fast. Sleep more slowly." As we left the bedside I saw her pondering over that very reasonable answer.) The doctor's jargon has a double purpose: to astound and confound his patients (as in the above anecdote) and to cover up his ignorance. Too often, alas, the sec ond overshadows the first. By naming the disease the The Name of the Rose doctor deludes himself into thinking he has made a rational d;agnosis; he can then go on with confidence to therapy-and he does. Astounding and confounding are part of the ritual, They have therapeutic value if you're stupid enough or trusting enough to believe that part of a cure is obfuscation by conglomerate Greek or Latin words. Some words have no value, however. Halitosis has lost its terrors; everyone knows what that is. Some itises, like burs-, arthr-, and neur-, are becoming worn out from common use. That accounts for the present popularity amongst doctors of fibrositis and myositis. Neuralgia, too, is on the way out except in the lower classes, but cephalalgia (made up of Greek words, meaning an ordinary headache) is taking its place. I said "lower classes" above. I meant it. Class distinctions exist in the doctors' naming of diseases, just as class distinctions exist in other life styles. ( iN,Iarxists, please note). Army officers get iii,ethritis but enlisted men get gonorrhea. Poor patients have the wax blotcii out of their ears but rich ones have impacted cerunieti removed. Dr. Thomas Szasz, a maverick psychiatrist, has written extensively on the iioiidifference between the insanity of the ordinary citizen and the abnormal behavior of the V.I.P. Once upon a time there was a condition called general paralysis of the insane, or paresis; instructions for its treatment appeared in textbooks of psychiatry. Naturally, because the name implied that the paralysis followed the insanity, it followed that the cause lay in the insanity. Dr. Richard von Kraff t-Ebing (you're right!-the same fellow!) said in 1877 that paresis was the result of emotional stresses and psychic factors such as excessive intercourse (when you're on to a good thing, why give it up?), weak nerves (known as nervozis asthenia in those days, another example of naming), and too much striving after wealth. Other psychiatrists, noting the frequency of the disease in actors, soldiers and sailors, had another explanation: actors played so many roles and impersonated so many characters that thev fiiialln, lost their own identities and became completely confused; soldiers and sailors were exposed to such harsh climates, foreign miseries and general hardship that they just went crazy. In 1898 Virchow (I quoted him before, but maybe I shouldn't have, considering what follows) vehemently attacked the idea that paresis could be caused by syphilis. Then in 1913 Hidevo Nogucbi demonstrated the presence of spirochetes in the brain tissue of paretics, thus proving that paresis was a late form of syphilis and should be A new twist on medical nomenclature for the laymen treated as such. The misnomer, general paralysis of the is the homely touch: athlete's foot for epidermophyto-insane, was quietly dropped. sis, for example, and housemaid's knee for I)rel)atellar Also in the field of psychiatry there once was a coiidi bursitis. Of course, the patient knows that the doctor is tioii called constitutional psychopathic personality. comforting him by using the vulgar tongue. He also is Now there was a diagnosis. It was obviously incurable, not fooled-good old Doc is trying to keep the ])ad I)eiiig inborn, as the first part betokeiied, and the rest news from him. When pressed, not too hard, Doc will indicated it was on the borderline between mental re 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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