Behind The Times: Conan Doyle's Message for Today's Physicians
Behind The Times: Conan Doyle's Message for Today's Physicians is an article written by Alvin E. Rodin & Jack D. Key published in the A.C.D. - The Journal of The Arthur Conan Doyle Society (Vol. 1, No. 1) in september 1989.
The article uses Conan Doyle's short story "Behind the Times" to argue that medical practice must balance scientific technique with human sympathy and personal care. It presents Conan Doyle as an early advocate of medical humanism, warning that technology without compassion risks alienating patients and undermining true healing.
Behind The Times
Conan Doyle's Message for Today's Physicians
Arthur Conan Doyle's 'Behind the Times' was published in 1894 as the first item in his collection of fifteen medically oriented short stories — Round the Red Lamp (1). These tales from the last century do not indulge in scientific descriptions of diseases or of treatment. Instead, they are based upon the effects of illness on the lives and sentiments of the afflicted, of their families, and of their physicians.
Conan Doyle wrote Round the Red Lamp with the general public in mind. He stated in the preface that 'A tale which may startle the reader out of his usual grooves of thought, and shake him into seriousness, plays the past of the alternative and tonic in medicine, bitter to the taste, but bracing in its results'
Some book reviews of the time reacted quite negatively. The Nation (2) considered the stories to be disgusting. The Catholic World (3) suggested that 'if we are not easily nauseated we may wade through professional horrors so ghastly in their way as anything that the feverish imagination of Edgar Allen Poe conjured up in a less sickening school,' The Spectator (4) complained of too much levity in tales of fancy which are 'worse than nightmares which overwhelm human misery and sin.' Less drastic. hut still not favourable, were reviews in The Critic (5) and in Harper's Monthly. (6)
'Behind the Times' was considered by The New York Times (7) to be a delightful story; and indeed it is the least offensive of the fifteen stories in respect to overt Victorian sensibilities. It has none of the intimate medical details found in some of the others — such as the ever increasing erosion by cancer of the skin of a beautiful woman, the revengeful excision of part of the lower lip of an unfaithful wife, and the transmission of syphilis through three generations. Instead. 'Behind the Times' portrays and contrasts the manner of medical practice of three physicians in a small, unnamed English town. At one extreme is old Doctor Winter and, at the other, two young physicians, one of whom is the narrator and the other, Doctor Patterson.
Synopsis of 'Behind the Times'
Old Doctor Winter had been the narrator's physician from the latter's birth until his medical training. When the narrator and Doctor Patterson began their own practices in Doctor Winter's town, they decried his outmoded ways. Doctor Winter looked on modern medical science as 'a huge and ludicrous experiment,' called the stethoscope a 'newfangled French toy,' regarded chloroform as a dangerous innovation, and laughed at the germ theory. He used common sense and sympathy rather than the latest instruments and drugs. The two younger doctors were appalled because 'It is the judicial frame of mind, not the sympathetic which is the essential one.'
In spite of Doctor Winter's atavistic approach to medical practice, 'his patients do quite well' according to the narrator. He succeeded in removing a bladder stone with his finger after the instruments of his younger colleagues failed. However, they loved the old fellow, even while deploring his lack of up-to-date judgement, and in spite of their own failure to build up large practices.
'Behind the Times' concludes with the two young physicians becoming quite ill during an influenza epidemic. The narrator was about to call Doctor Patterson when 'the idea of him suddenly became repugnant to me. I thought of his cold critical attitude, of his endless questions, of his tests and his tappings. I wanted something more soothing — something more genial.' When the narrator's house-keeper was sent to fetch the old doctor, she was told that ‘he has just been called to attend Doctor Patterson.'
Significance for Our Tame
'Behind the Times' establishes one of the major themes of Round the Red — humanism in the practice of medicine. Medical humanism can be defined as any delivery of health care which emphasises human interest, values and dignity, and which is compatible with medical scientism and technology. The physician needs more than technology, symbolized in 'Behind the Times' as the stethoscope, in order to heal and minister to the ailing. This is even truer now, almost a century after the story was written, when the emotional, psychological, and caring needs of patients are often submerged beneath a fantasia of diagnostic paraphernalia.
For example, the Magnetic Resonance Imager (MRI) of today is more than the modern equivalent of the stethoscope of Conan Doyle's narrator. It swallows up not only sounds from the patient's chest but also the entire patient! The end result is not the magnetic 'healing touch' of old Doctor Winter, but a very precise sanitized representation of inner organs and tissues — to the neglect, however, of the more ethereal soul and humanity of the patient. Thus, technology 'can be a separating wall between clinician and patient. Some invalids have a special need of personal contact with the doctor; and if he relies entirely on instruments, or hides his own inadequate techniques behind them, the apparatus may cause failure of communication.
Conan Doyle's highlighting of humanism in Round the Red Lamp is not new. It has been propounded since the time of Hippocrates. Nor was Conan Doyle the first to publish a collection of medical short stories. An example is Samuel Warren's Passages from the Diary of a Late Physician (9) of 1838. Humanistic emphasis on the travails of patients and physicians is more evident in the medical short stories of Anton Chekov (10) and the more recent ones of William Carlos Williams (11) — but not with as sharp a contrast with technology as those of Conan Doyle.
The literary writings of Conan Doyle, Chekov and Williams are of considerable significance for today's health care delivery because 'they explain to us (physicians) what it means to be sick, tell us something about the inner life of the patient and how he communicates to others what he feels.' (12) Some physicians, who have grown up with miracle drugs and the diagnostic armamentarium of the 20th century, appear to be unaware (or unconcerned) that human emotions influence even physical disease, both as to extent and cure. The result can be the manipulation of human beings 'as so much raw material upon which to exercise our scientific ingenuity in the name of scientific progress.' (13)
The two up-to-date physicians in Behind the Times recognise that old Doctor Winter, although 'very much behind the day,' benefits his patients to a considerable degree. His two medical confreres seek him out for their own illnesses, in spite of their disparagement of his rejection of instrumentation. Such cognitive dissidence is all the more marked today, when the need for 'something more soothing — something more genial' is becoming quite evident. And yet medical technology appears to have overwhelmed medical humanism, even though the one does not necessarily exclude the other.
Conan Doyle not only wrote about the fallacy of ignoring the human being who harbours the disease, but also practiced what he preached. For example a woman described to Conan Doyle's daughter how considerate and warm her father had been while looking after her pregnancy. (14) In his M.D. Thesis on Tabes Dorsalis (15), Conan Doyle's description of the effect of the syphilitic process on a patient is an excellent example of the fusion and tempering of medical knowledge with medical humanism.
As the disease progresses the sufferer gets some relief from pain, the sudden shocks dying away and being replaced by analgesia and anaesthesia. Motor paralysis and acute muscular atrophy may supervene. Slowly the unfortunate victim sinks from one gradation of misery to another and can only look forward to the death which may reach him from pure exhaustion or may come from the involvement of the vital centres in the medulla.
'Behind the Times' exemplifies the benefits of the humane application of medical knowledge in more colloquial terms.
He has the healing touch — that magnetic thing which defies analysis... His mere presence leaves the patient with more hopefulness and vitality... He would shoo death out of the room as though he were an intrusive hen. But when the intruder refuses to be dislodged, when the blood moves more slowly and the eyes grow dimmer, then it is that Dr. Winter is of more avail than all the drugs in his surgery. Dying folk cling to his hand as if the presence of his bulk and vigour gives them more courage to face the change; and that kindly, wind-beaten face has been the last earthly impression which many a sufferer has carried into the unknown.
There is an urgent need today for the humanistic behaviour of old Doctor Winter and of Doctor Conan Doyle. This is the century old lesson of 'Behind the Times' for modern day medicine.
REFERENCES
1. Doyle, A. C.: Round the Red Lamp being Facts and Fancies of Medical Life: London, Metheun, 1894.
2. The Nation, 60:33, Jan.10, 1895.
3. Tale About New Books: Catholic World, 60:419-420. Dec., 1894.
4. Round the Red Lamp: The Spectator, 74:238-239, Feb. 16, 1895.
5. 'Round the Red Lamp' By A. Conan Doyle: The Critic, 25(ns):326, Nov.17, 1894
6. Hutton, L.: Literary Notes: Harper's Monthly, 90(supp 2). 1-2 Ar., 1895.
7. A Physician's Yarns. Round the Red Lamp: New York Times, p.23. C1.6, Nov.11, 1894.
8. Entralgo, P. L.: Doctor and Patient: trans. from Spanish by F. Partridge, NY, McGraw-Hill, 1969, pp. 190-191.
9. Warren, S.: Passages from the Diary of a Late Physician: 3 vols., Sth ed., N.Y., Harper, 1857.
10. Chekov, A.: Anton Chekov’s Short Stories: compiled by R. E. Matlaw, N.Y., W. W. Norton, 1979.
11. Williams, W.C.: The Doctor Stories: Ed. by R. Coles, N.Y., New Directions, 1984.
12. Spiro, H. M.: Doctors, Patients and Placebos: New Haven, Conn., Yale U. Press, 1986, p.62.
13. Bruer, H-P.: The Roots of Guilt and Responsibility in Shusaka Endo's 'The Sea and Poison': Lit & Med, 7:80-106, 1988.
14. Rodin A. E. & Key J. D.: Doctor Arthur Conan Doyle's Patients in Fact and Fiction: Med. Heritage, 1:80-98, 1985.
15. Doyle, A. C.: An Essay Upon the Vasomotor Changes in Tabes Dorsalis: unpublished Thesis, U. of Edinburgh, April, 1885.
- Article courtesy Christopher Roden, founder of The Arthur Conan Doyle Society (1989-2003).
