Ordinarily, the mob tyranny which has become such an alarming feature of our public life would be checked by the aristocratic element in society. It is part of the aristocratic function to foster cultural tolerance and to resist herd suggestion: the aristocratic or dominant type, in enjoying the most privileges, is normally least subject to compulsions and taboos. With us that is not the case. The Southerner, for instance, our most traditional aristocrat, finds himself paralyzed by the consciousness of a black shadow behind him who constantly threatens both his political and his sexual superiority. He moves in an atmosphere of taboos from which he himself cannot escape, for it is an established fact that interdiction in one line of thought has a crippling effect upon a man’s intellectual activity as a whole. Elsewhere our native aristocrat frequently finds himself in the position of a lonely outpost of a thin Anglo-Saxon tradition which he must defend against the constant onslaughts of alien civilizations, in the desperate attempt to uphold the fiction that spiritually, at least, we are still an English colony. He is in a state of tension where he himself cannot move with any of the freedom which he vaunts as one of the outstanding characteristics of the country of his fathers. In his hands his own latest hope, our war-born Americanization programme, which should really be an initiation into freedom, has quickly become little more than a forced observance of sterile rites with which to impress the alien. He already sees its failure, and, like a general who is afraid of his own army, he does not sleep very well.
Alfred B. Kuttner
MEDICINE
From time immemorial the doctor has been the object of respect and awe by the generality of mankind. It is true that he has occasionally been made the butt of the satirical humour of such dramatists as Molière and Shaw, but the majority of people have regarded these jests as amiable buffooneries, and not as penetrating criticisms. In ancient days the veneration of the medico was based upon his supposed association with gods and devils, and upon the belief that he could cure disease by wheedling propitiation of deus, or by the exorcism of diabolus. In modern times he holds sway by his supposed possession of the secrets of science.
In spite of his pretension to scientific attainment, many vestiges of his former priesthood remain, and this mélange of scientist and priest has produced curious contradictions and absurdities. But these absurdities must by an inexorable law remain concealed from all save a few, and the general failure to recognize them has led to a great increase in the importance and prosperity of the medical cult. In America, of all civilized nations, medical magnificence has reached its most formidable proportions. This exaggeration, characteristic of all social phenomena in the new world, makes the real importance of the doctor to society easy to inspect and to analyze.
A friend not long ago asked me to explain the co-existence, in the same city, of the elaborate installation of the Harvard Medical School and the magnificent temple of the religion of Mrs. Eddy. “What is it in our culture,” said he, “that permits the symbol of such obvious quackery as that of Mrs. Eddy to flourish within a stone’s throw of such an embodiment of scientific enlightenment as the medical college?”
I replied that the reason for this must be sought in the gullibility of our citizens, who are capable of entertaining most incompatible and contradictory credos. Thus, the average American can believe firmly and simultaneously in the therapeutic excellence of yeast, the salubrious cathartic effects of a famous mineral oil, the healing powers of chiropractors, and in the merits of the regimen of the Corrective Eating Society. His catholicity of belief permits him to consider such palpable frauds seriously, and at the same time to admire and respect authentic medical education and even the scientific study of disease. But the teachers, students, and alumni of medical colleges are drawn from our excessively credulous populace. So it is dangerous to consider the votaries of the profession of medicine as sceptical and open-minded savants, in contrast to the promulgators of the afore-mentioned imbecilities and to Homo sapiens americanus, who is the unconscious victim of such charlatanry. In reality the great majority of the medical profession is credulous and must always remain so, even in matters of health and disease.
The tendency to consider physicians in general as men of science is fostered by the doctors themselves. Even the most eminent among them are guilty in this respect. Thus the Director of the Hospital of the Rockefeller Institute maintains that medicine must be considered not as an applied science but as an independent science (R. Cole, Science, N. S., Vol. LI, p. 329). And an eminent ex-President of the American Medical Association holds a similar view, at the same time preposterously asserting that “medicine has done more for the growth of science than any other profession, and that its best representatives have been among the leaders in the advancement of knowledge....” (V. C. Vaughan, Journal, A. M. A., 1914, Vol. LXII, p. 2003.)
Such pronunciamentoes rest upon the almost universal confusion of the art of the practice of medicine with the science of the study of disease. Science, in its modern definition, is concerned with the quantitative relationship of the factors governing natural phenomena. No favourites are to be played among these factors. They are to be weighed and measured meticulously and coldly, without enthusiasm for one, or disdain and enmity toward another. Now, in the case of relationship of doctor to patient, it is clear that such emotions must enter. The physician must entertain enthusiasm for the defensive powers of his patient, John Smith, and at the same time hate virulently the pneumococcus that attacks him. This emotional state of the soldier of health prevents the employment of what is known in the language of the laboratory as the “control.” For example, a doctor wishes to test the efficacy of a serum against pneumonia. In America it is practically unknown for him to divide his cases of pneumonia into two groups of equal size, to administer his serum to group A and to leave group B untreated. He almost invariably has a parti-pris that the serum will work, and he reflects with horror that if he holds his remedy from group B, some members of this group will die, who might otherwise have been saved. So he injects his serum into all of his patients (A and B), and if the mortality in the entire group appears to him to be lower by statistics than that observed in previous series of cases, he concludes that the value of his nostrum is proved. This is an illustration of the fallacy of the notion that medicine is a science in the modern sense.
Modern study of disease, conducted in the laboratory upon experimental animals, has furnished medical practitioners with a few therapeutic and prophylactic weapons. In the use of these the American medico has not lagged behind his European colleague. But the great majority of the malaises that plague us are not amenable to cure, and it is with these that the doctor has since the beginning of time played his most important rôle, i.e., that of a “professional sympathizer.” The encouraging conversation with the family of the sufferer; the mumbling of recondite Latin phrases; the reassuring hopeful hand on the patient’s shoulder; the grave use of complicated gimcracks; the prescription of ineffective but also innocuous drugs or of water tinted to pleasing hues; all these are of incalculable value to the ménage stricken by disease. It is my lamentable duty to point out the danger of the decline of this essential rôle among the doctors of America. The general practitioner of the ancien régime was sincere in his performance of his quasi-religious function. He was unsparing of his energies, stern in his devotion to duty, deeply altruistic in sentiment, and charmingly negligent in economic matters.