The Medical Session: St. Mary's Hospital
The Medical Session: St. Mary's Hospital is an article published in The Times on 4 october 1910.
Report of speech by Arthur Conan Doyle to the students of St. Mary's Hospital on "The Romance of Medicine".
The Medical Session
The Medical Session opened yesterday at most of the medical schools. We give below reports of the most interesting addresses to the students :—
St. Mary's Hospital
At St. Mary's Hospital Medical School the prizes were distributed by Sir Arthur Conan Doyle, who gave an address to the students on "The Romance of Medicine."
Sir A. Conan Doyle said that he had no possible claim to be regarded as a successful medical man. An unkind chairman in America once remarked that the most sinister feature of his career was that no living patient of his had over yet been seen. But, though his actual practice of the profession was never either very profitable or very glorious, he might claim that at least it was very varied. His experiences went back to the days of the unqualified assistant — a person who had now been legislated out of existence, with, he had no doubt, an excellent result upon the death-rate. He served in that legion of the lost before he ever attained to the regulars. He had been an assistant in country practices of rural England ; he had served in the slums of Sheffield and of Birmingham ; he had been the unqualified surgeon of an Arctic whaler, and the qualified one of a West African mail-boat. He had taken temporary military duty at Portsmouth, and had been for eight years in general practice in Southsea. He had migrated to the exalted neighbourhood of Cavendish-square, where he started a waiting-room — which was a room where a doctor waited for something to come along. The only thing which came along to him was the rent collector, so he left the profession, only to return to it for six months of South African service. There was his humble record, and it would serve to show them what poor credentials he had for standing there. But he could testify how great a privilege and how valuable a possession it was to be a medical man, and to have had a medical training, even though one did not use it.
Drawbacks of Medical Training.
There were, Perhaps, some dangers which cams from a medical training, but there was a great post-graduate course called life, and in that course one learnt to correct, these weaknesses. One was an undue materialism. Ho was educated in a materialistic age, before psychical research, scientific hypnotism, telepathy, and other such agencies tie the possibilities which lie outside the things that we can see, handle, and explain. They looked upon mind and spirit as secretions from the brain in the same way an bile was a secretion of the liver. Brain centres explained everything, and it you could find and stimulate the centre of holiness von would produce a saint — but if your electrode slipped and yen got on to the centre of brutality, on would evolve a Bill Sikes. That was, roughly, the point of view of the more advanced spirits among them. They talked about tans, and how all things were done by immutable law, and thought that was profound and final. Only more mellow experience and riper thought mods a man realise that there must be a law-maker at the back of a law, and that if every dogma wee banished from earth, there still re-moaned the ordered universe without and the conscious soul within to testify to forces, call them by what name we Would, which must break down the barriers of any purely materialistic philosophy. And besides an undue materialism, there was another danger upon which he would warn them. it was intellectual priggishness. Each generation had thought it knew all About it, each generation had in turn discovered its limitations, and yet with invincible optimism each fresh lot still thought that they really bad got to the bottom of the matter. Not only had they never got to the end of any medical matter, but it was only the truth that they bad never got to the beginning of it, What they had done was to come in in the middle of it, with more or less accurate empirical knowledge.
There was another fact which life would teach them, which was the Talkie of kindliness and humanity es well ea of knowledge. That was exactly the point which the intellectual prig had missed. A strong and kindly personality was us valuable an asset as actual learning in a medical man. He had known teen in the profusion who were stuffed with accurate knowledge, and yet were to cold in their bearing, and no unsympathetic in their attitude, assuming the role rather of a judge than a friend, that they left their half-frozen patients all the worse for their correct.
Medicine and History.
With a knowledge of medicine they would find that they continually, in their general reading, bore with them a little private lantern which threw a light of its own. It illuminated many an incident which woo clerk to the layman. There was a wide field for he writer who would explore the. Influences of medical facts upon social customs and upon historical incidents. To take an obvious example, for centuries mankind beautified themselves by means of wig. Whence came such a custom, unknown to antiquity sod absurd in its nature? Medical, of course. A skin disease on the top of the head of Francis the First of France, which induced alopecia, or bald patches, compelled him to cover himself with artificial hair, and his courtiers all followed suit. The association of certain diseases with certain characters was an extraordinary problem. To take an example, there were few men who had influenced history more deeply than Julius Caesar and Mahomed. They were both epileptic. Was not that a most remarkable fact? Many other great men, including Napoleon, Saint Paul, and Alexander the Great, might be said to be under suspicion, but thine two were undoubted. He would further adduce Napoleon as an example of the sidelights and fresh interests which a medical man could read into history. One could trace for many years, certainly from 1802 the inception of that disease which killed him at St. Helena in 1821.
Napoleon's whole career eves profoundly modified by his complaint. History abounded with examples of what he had called the romance of medicine — a grim romance, but a realistic and an absorbing one. Look at the men, for example, who were tire prime movers in the French Revolution. How far were their inhuman actions dependent upon their own complaints? They were a diseased company — a pathological museum. How many times did the most important historical developments appear to depend upon small physical causes? There was, for example, the case of the Revocation of the Edict of Nantes. How came Louis XIV who had always held out upon this point, to give way at last to the pressure of Madame de Maintenon and his clerical advisers? The answer lay in one of his molar teeth. It was historical that he had for some months bad toothache, caries, abscess of the jaw, and finally a sinus which required operation; and it was at this time, when he was pathologically abnormal and irritable, that he took the step which had modified history.
It was nearly 30 years since ho graduated, and it was a wonderful thing to him to note the progress which those 30 years had effected. Their weakness 30 years ago was due to the vagueness of their knowledge. They never knew why. But this generation had, as it seemed to him, brought about a greater change in medical science than any century had done before. At last there was some attempt to make it exact instead of empirical. Great results had been obtained and even greater ones had been promised for the future. In every literary or dramatic romance they world observe that from the time that the villain was unmasked he was innocuous. It was the undiscovered villain who was formidable. So it had been in this wonderful romance of medicine. All the work of late years had been in the direction of exposing the villain. When once this was done, were he micro-coccus or microbe, and were his accomplice a mosquito or a rat-flea, the forces of law and order, could be turned upon him and he could be broken in to that human system which he had so long defied.
The story of how these forces of evil were exposed, how one by one their machinations were traced, was one of the most wonderful, and certainly one of the most eventful, in science. It was one also which they, as Britons, could regard with a peculiar satisfaction, for their fellow-countrymen had been protagonists in the battle. That great line which honoured British medicine since the days of Harvey had never had a more brilliant group than that which contained the names of Manson, Ross, Bruce, and Wright.
After describing the researches of Manson into filiariasis and of Ross into malaria and the Anopheles mosquito, he said that in 1800 we sent a force of 40.000 men to Flanders. No finer force ever left these shores. They returned beaten, decimated, and disorganized, and yet they had never seen the enemy. Who had beaten them? They did not know themselves. And now we knew. Just a little grey gnat, a tiny insect buzzing up from the marshes of Walcheren. All the brigades and all the guns were powerless before its little proboscis. We knew it, now, and could meet it now, but then it was our conqueror. And so through all the ages, in the history of Africa, in the history of Central America, even in the history of such European districts as Greece and the Campagna of Italy they would find the whole course of history altered by this fantastic and absurd little insect, whose chief physical characteristic was that he preferred to stand on his head with his tail almost perpendicular in the air above him.
He could nob pass from these stories of modern medicine without referring to that most remarkable of all, the opsonic researches of Professor Wright. This transcended romance and seemed rather to approach the fairyland of science. It tens a familiar thought, even in his student days, that the leucocyte, or white corpuscle, was the guardian of the body, and that he devoured and digested every microbe which penetrated into the blood stream. Now, the starting point of the opsonin investigation was when It was shown that a white corpuscle taken out of the blood plasma would not digest microbes, and would only renew its activities when it was moistened with that fluid. This experiment showed that in that fluid there was suspended some invisible stuff which increased the activity of the white corpuscle, and made it devour microbes — some sort of sauce, in fact, which made the microbes more attractive to it. This substance was named opsonin. The next stage was to prove that the normal man had a fixed quantity of opsonin, and therefore a fixed power of resisting any disease. What that fixed point was could be actually chosen by counting how many microbes one of his white corpuscles could destroy. This normal resisting power was called the opsonic index. If certain complaints — localized tubercle for one — had established, themselves in a man, it meant that his white corpuscles had been conquered. Yon would expect, therefore, to find that the opsonic index had fallen, that his power of destroying microbes was lessened, and this was found to be so. But now came the question of cure. In order to effect this, you wanted to raise the opsonic index — in other words, to stimulate the activity of the white corpuscles to a point above the normal, as that they might make unusual exertions and destroy the microbes. It had been found that an injection of dead microbes of the sort which caused the disease was the most effective means to this end. With every injection the leucocytes worked harder, the living intruders were more rapidly destroyed, and the cure came nearer.