Doctors / An Address delivered to the Students of the Medical School of the Middlesex Hospital, 1st October, 1908
Date: 2022-03-25T00:00:00+00:00
Keywords: Physicians

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Title: Doctors

Author: Rudyard Kipling

Author of introduction, etc.: Reginald Lucas

Contributor: Oliver Wendell Holmes

Release date: March 25, 2022 [eBook #67704]
Most recently updated: October 18, 2024

Language: English

Original publication: United Kingdom: Macmillan and Co., Limited

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DOCTORS

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DOCTORS

An Address delivered to the Students of the
Medical School of the Middlesex Hospital,
1st October, 1908

BY
RUDYARD KIPLING

WITH A PREFACE

Sold for the benefit of the Middlesex Hospital

MACMILLAN AND CO., LIMITED
ST. MARTIN’S STREET, LONDON
1908

Richard Clay and Sons, Limited,
BREAD STREET HILL, E.C., AND
BUNGAY, SUFFOLK.

THE MIDDLESEX HOSPITAL

MORTIMER STREET, W.

Patrons:
H.M. THE KING
H.M. QUEEN ALEXANDRA

President:
H.G. the Duke of Northumberland, K.G.

Chairman of the Board of Management:
Major-General Lord Cheylesmore, C.V.O.

Deputy-Chairman:
H.S.H. Prince Francis of Teck, G.C.V.O., D.S.O.

Treasurers:
G. J. Marjoribanks, Esq.
Hon. Walter Rothschild, M.P.
C. H. Burnand, Esq.

Secretary-Superintendent:
F. Clare Melhado, Esq.

A Ward in the Middlesex Hospital, Cancer Wing.

Photograph by Elliott & Fry, 55, Baker Street, W.

PREFACE

On October 1st, 1908, Mr. Rudyard Kipling was kind enough to distribute the prizes at the opening of the new session of the Medical School of the Middlesex Hospital. The address which he then delivered was deemed by those who heard it so admirable, both in form and substance, that there arose a desire to preserve it.

The object of this little book is to satisfy that wish. It has been suggested that its publication might be appreciated by others, who were neither concerned with the particular occasion, nor are personally connected with the medical profession. This being so, there is no need for an elaborate preface. Readers would derive no added pleasure from a detailed history of the hospital: Mr. Kipling’s speech requires no elucidation.

Nevertheless it will do no harm to explain, for the benefit of some, why and where Mr. Kipling spoke. The Middlesex Hospital, in Mortimer Street, near Oxford Street, was founded in 1745. It then contained 24 beds. In 1907 the average daily number of occupied beds was 269: the total number of patients relieved in the out-patient department was 47,597. These figures will suggest the magnitude and scope of the work accomplished.

The hospital is open to anybody who chooses to seek help and refuge there, free of all charge and cost. Amongst the honorary staff—those who give their services for nothing—are some of the first physicians and surgeons in London.

In this connection attention may be called to what Mr. Kipling says of people who “cadge round the hospitals.” There must be some abuse by people who can well afford to pay their own doctors, and for whom the benefits of free hospitals were never intended. Such abuse is demoralising to themselves and adds obvious difficulties to the career of the private practitioner. This is one of those cases where it is not easy to reconcile the letter with the spirit: on the one hand, there is risk of withholding what is avowedly offered; on the other, of countenancing an admitted evil. It need only be said that the Board of Management do not ignore the problem which confronts them.

The Medical School, the object of Mr. Kipling’s attention, manifestly requires no explanation. It was founded in 1835 and stands upon its own merits. Some of the scholarships and prizes in question represent the gifts and endowments of generous individuals interested in the progress of medical science. Others are provided by the School.

A distinct, and most important, branch of the Hospital is the Cancer Charity with its Research Laboratory. The history of this department is certainly worth a little notice. It was established in 1792, mainly through the munificence of an anonymous donor, who turned out to be Mr. Whitbread, father of the famous Whig member of Parliament. It began with the allocation of one ward in the hospital to the care of patients who were to be kept in “until relieved by art or released by death”—a phrase retained to the present day. The disease was described by Mr. John Howard, surgeon, in his letter to the hospital of October 12, 1791, as one which “is, both with regard to its natural history and cure, but imperfectly known”—a statement which, unhappily, is not yet entirely out of date.

Further endowments came from Mrs. Stafford about 1815, and from Sir Joseph de Courcy Laffan in 1848. In 1900 a separate wing for the treatment of cancer cases, and for laboratory research was opened. It contains forty-nine beds. These poor sufferers are allowed certain privileges and indulgences outside the usual routine of a hospital ward.

At intervals the cancer department has been more or less the victim of quacks.[1]

[1] The conditions upon which new remedies or alleged cures for cancer are permitted in connection with the treatment of patients in the Cancer Wing are:—

(1) The treatment must be carried out by a member of the Hospital Staff.

(2) The composition of all remedies must be disclosed to the Cancer Investigation Committee.

(3) The consent of the patient must be obtained before the treatment is commenced.

In 1817 one Ashby was allowed to try his hand, and was immediately exposed as a fraud. Presently Mr. Whitbread, the younger, introduced a friend of his own, whose treatment by compression he averred to have resulted in “joyful declarations” on the part of patients that they were “greatly relieved.” It sounds an ungracious return for the Whitbread benevolence to hear that the Governors remained “uncontaminated by that love of quackery which is so common among the gentry of England.” But we are told that the treatment “often gave much pain, and often appeared to hasten the end; and in the latter it did not retard the progress of the disease.”

“Guy’s caustic” was another popular remedy, and it is of historical interest to read that “it was Guy’s caustic, or rather Plunket’s paste, that killed Lord Bolingbroke.”

“Lord Arundel’s cancer cure” was a compound invented by the illiterate wife of a blacksmith. She professed to be a “cancer-curer,” but an unkind commentator observes that “no doubt she killed a great number of poor women.” Dr. Fell, an American, was permitted to make a series of experiments in 1857, but he got nothing from the hospital beyond a rather frigid letter of thanks. Dr. Arnott’s freezing system, about the same time, seems to have met with a larger measure of approval.

Not long before this, Lord Metcalfe, the Governor of Canada, had developed the dreaded symptoms, and amongst the remedies recommended for his relief were mesmerism, a powder in which some part of a young frog was the principal ingredient, an application of pure ox-gall, and so on.

Amongst provocative causes of the disease, the habit of “smoking tobacco” and the profession of sweeping chimneys were noted as most frequent. Confidence had long been placed in the healing virtues of Wiltshire Holt Water, which came from a spring near Bradford-on-Avon; but discredit was thrown upon this in the following manner: “A young gentleman who acted as House Surgeon to The Middlesex Hospital, had omitted to procure a supply of the Wiltshire Holt Water, which was in much request. To conceal the circumstance he filled one of the accustomed bottles with water from a pump in the apothecary’s shop there, and having inserted a sealed cork to complete the resemblance, he used that water as a substitute. The effects were so similar to those of the genuine mineral water that he continued to employ it, and to gain instruction in his profession.”

Carrot poultices found favour with many people; but those made with “red onions” (mashed and cold) were rejected as “mostly too irritating.”

In such a preface as this, it would be impertinent to use technical words, or to touch so much as the fringe of medical controversy; but it is no more than a truism to say that the cause and character of cancerous disease have not yet been revealed beyond dispute to the eye of science. Nevertheless the pathologist of to-day has passed far beyond the stage of mesmerism, onions, carrots, and Lord Arundel’s cure. How far and how fast that progress is to continue depends to a large extent upon the opportunities available; of able and devoted workers there will be no dearth. The Middlesex Hospital is doing its best, and will earnestly endeavour to facilitate scientific research for the good of the public, so long as public assistance and support are forthcoming.

Mr. Kipling naturally refrained from expounding such opinions on general medical questions as he may happen to entertain; but beyond giving passing pleasure to a restricted audience, he will have done enduring good if his speech may become the means of calling the attention of an unreflecting generation to certain aspects of a doctor’s life which are persistently ignored.

To emphasise these points would only be to say again, and say less well, what will be found in the address which follows; but even the man who beats the drum outside the tent may contribute something to the popularity of the show within. The students of the Medical School are the physicians and surgeons of to-morrow, and it should be no small encouragement to them to hear their profession described in such honourable terms. Many men and women, probably a great majority, regard all doctors as necessary evils. For surgeons they entertain rather a fearful admiration; the physician they dismiss with the complacent summary that it is curious that medicine should have made no progress whilst surgery has advanced by leaps and bounds; which is not true in fact, and not fair to a class of men pre-eminently earnest, self-sacrificing, and single-minded.

The Presidential Address delivered at the opening of the Session of the Medical Society of London, in 1907, had this fallacy for its text, and it is much to be regretted that such papers seldom reach beyond the confines of the profession. The author here sweeps away a mass of illusions born of ignorance; and not only claims for medicine some share of the credit given to surgery for accuracy of diagnosis and efficiency of treatment, but boldly lays it down that “having regard to the wide field which it covers, the advance of medicine has been during the last thirty years infinitely greater in the mass than that of surgery, although not perhaps so readily appreciable by the public.”

So much one may say without offence to surgeons, whose labours and services are amply acknowledged by the public, and who run no risk of disparagement. These ought we to praise, and not to leave the others unpraised.

Sir Thomas Browne, in his Religio Medici, observes: “he forgets that he can dye who complains of misery; we are in the power of no calamity while death is in our own”; which is not a helpful saying, and one against which the entire medical profession would rise in protest.

“That a man should strive and agonise
And taste a veriest hell on earth”

may result in suicide. It is hardly necessary to point out that the cases of which we read have their origin, almost always, in some trouble of mind, real or imaginary, and are not to be ascribed to a desire to escape from physical pain or misery. Human beings, with rare exceptions, are tenacious of life, and are most unwilling to die. Doctors, on their side, live with the single purpose of postponing death: not one of them will compromise the matter for a moment. It can never be a question with him whether a life is worth preserving, or whether there is reluctance to let it go. So long as there remains one animating spark, the doctor will fight and struggle to preserve it, accepting cheerfully the sacrifices of comfort and convenience which Mr. Kipling describes. He may not even claim the exciting rewards, such as they are, of the politician or the artist, nor the more showy compensations due to the soldier’s peril. He cannot boast of diplomatic victories and forensic triumphs: he does not hear the thunders of a crowded audience: he may not display a row of decorations to an admiring world. It is enough for him to probe deeper and deeper into the problems that confront him every day, and be prepared for that meagre recognition which was indicated as the destined lot of the students of the Medical School.

Lord Salisbury once wrote: “a war minister must find his reward in his conscience or his salary: he must not look for fame.” Every doctor is entitled to dream of fame; some may eventually have a “salary” to rejoice in; meanwhile, it is the badge of all their tribe to find reward in conscience; and Mr. Kipling’s handsome tribute need not be ascribed either to formal compliment or mere literary elegance.

By request of the Board of Management of the Middlesex Hospital, so much has been written to introduce Mr. Kipling’s address at large. The writer cannot doubt that it is a form of grace before meat which will be impatiently endured or abruptly discarded. It will probably be condemned as a superfluous dotting of i’s and crossing of t’s. It will not even be given the merit of originality.

In order that all these disadvantages may be frankly admitted, yet stubbornly defended, the transition shall be covered by a third version of the same, or an allied, theme: Oliver Wendell Holmes with his “Two Armies” shall be called in to blunt the edge of so much criticism and mitigate the shock of contrast.

Reginald Lucas,
Member of the Board of Management.

THE TWO ARMIES

As life’s unending column pours,
Two marshalled hosts are seen,—
Two armies on the trampled shores
That Death flows black between.

One marches to the drum-beat’s roll,
The wide-mouthed clarion’s bray,
And bears upon a crimson scroll,
“Our glory is to slay.”

One moves in silence by the stream,
With sad, yet watchful eyes,
Calm as the patient planet’s gleam
That walks the clouded skies.

Along its front no sabres shine,
No blood-red pennons wave;
Its banners bear the single line
“Our duty is to save.”

For those no death-bed’s lingering shade;
At Honour’s trumpet call,
With knitted brow and lifted blade
In Glory’s arms they fall.

For these no clashing falchions bright,
No stirring battle-cry;
The bloodless stabber calls by night—
Each answers, “Here am I!”

For those the sculptor’s laurelled bust,
The builder’s marble pile,
The anthems pealing o’er their dust
Through long cathedral aisle.

For these the blossom-sprinkled turf
That floods the lonely graves,
When Spring rolls in her sea-green surf
In flowery-foaming waves.

Two paths lead upwards from below,
And angels wait above,
Who count each burning life-drop’s flow,
Each falling tear of Love.

Though from the Hero’s bleeding breast
Her pulses Freedom drew,
Though the white lilies in her crest
Sprang from that scarlet dew,—

While Valour’s haughty champions wait
Till all their scars are shown,
Love walks unchallenged through the gate,
To sit beside the Throne!

Oliver Wendell Holmes.

THE ADDRESS

Gentlemen,

It may not have escaped your professional observation that there are only two classes of mankind in the world—doctors and patients. I have some delicacy in confessing that I belong to the patient class—ever since a doctor told me that all patients were phenomenal liars where their own symptoms were concerned. If I dared to take advantage of this magnificent opportunity which now lies before me, I should like to talk to you all about my symptoms. However, I have been ordered—on medical advice—not to talk about patients, but doctors. Speaking then, as a patient, I should say that the average patient looks upon the average doctor very much as the non-combatant looks upon the troops fighting on his behalf. The more trained men there are between his dearly beloved body and the enemy, he thinks, the better.

I have had the good fortune this afternoon of meeting a number of trained men who, in due time, will be drafted into your permanently mobilised army which is always in action, always under fire against Death. Of course it is a little unfortunate that Death, as the senior practitioner, is always bound to win in the long run, but we non-combatants, we patients, console ourselves with the idea that it will be your business to make the best terms you can with Death on our behalf; to see how his attacks can best be delayed or diverted, and when he insists on driving the attack home, to take care that he does it according to the rules of civilised warfare. Every sane human being is agreed that this long-drawn fight for time which we call Life is one of the most important things in the world. It follows therefore that you, who control and oversee this fight and you who will reinforce it, must be amongst the most important people in the world. Certainly the world will treat you on that basis. It has long ago decided that you have no working hours that anybody is bound to respect, and nothing except extreme bodily illness will excuse you in its eyes from refusing to help a man who thinks he may need your help at any hour of the day or night. Nobody will care whether you are in your bed or in your bath, on your holiday or at the theatre. If any one of the children of men has a pain or a hurt in him you will be summoned. And, as you know, what little vitality you may have accumulated in your leisure will be dragged out of you again.

In all times of flood, fire, famine, plague, pestilence, battle, murder, or sudden death, it will be required of you that you report for duty at once, go on duty at once, and remain on duty until your strength fails you or your conscience relieves you, whichever may be the longer period. This is your position. These are some of your obligations. I do not think they will grow any lighter. Have you heard of any legislation to limit your output? Have you heard of any Bill for an eight hours’ day for doctors? Do you know of any change in public opinion which will allow you not to attend a patient even when you know that the man never means to pay you? Have you heard any outcry against those people who are perfectly able to pay for medical attention and surgical appliances, and yet cadge round the hospitals for free advice, a cork leg, or a glass eye? I am afraid you have not.

It seems to be required of you that you must save others. It is nowhere laid down that you need save yourselves. That is to say you belong to the privileged classes. May I remind you of some of your privileges? You and kings are about the only people whose explanations the police will accept if you exceed the legal limit in your car. On presentation of your visiting card you can pass through the most turbulent crowd unmolested; even with applause. If you fly a yellow flag over a centre of population you can turn it into a desert. If you choose to fly a Red Cross flag over a desert you can turn it into a centre of population towards which, as I have seen, men will crawl on hands and knees. You can forbid any ship to enter any port in the world. If you think it necessary to the success of any operation in which you are interested, you can stop a 20,000 ton liner with her mails in mid-ocean till that operation is completed. You can tie up the traffic of any port without notice given. You can order houses, streets, whole quarters of a city to be pulled down or burnt up, and you can count on the co-operation of the nearest armed troops, to see that your prescriptions are properly carried out.

To do us poor patients justice, we do not often dispute doctors’ orders unless we are frightened or upset by a long continuance of epidemic diseases. In that case, if we are uncivilised, we say that you have poisoned the drinking water for your own purpose, and we turn out and throw stones at you in the street. If we are civilised, we do something else. But a civilised people can throw stones too. You have been, and always will be exposed to the contempt of the gifted amateur—the gentleman who knows by intuition everything that it has taken you years to learn. You have been exposed—you always will be exposed—to the attacks of those persons who consider their own undisciplined emotions more important than the world’s most bitter agonies—the people who would limit and cripple and hamper research because they fear research may be accompanied by a little pain and suffering. But you have heard this afternoon a little of the history of your profession. You will find that such people have been with you—or rather against you—from the very beginning, ever since, I should say, the earliest Egyptians erected images in honour of cats and dogs on the banks of the Nile. Yet your work goes on, and will go on.

You remain now perhaps the only class that dares to tell the world that we can get no more out of a machine than we put into it; that if the fathers have eaten forbidden fruit the children’s teeth are very liable to be affected. Your training shows you daily and directly that things are what they are, and that their consequences will be what they will be and that we deceive no one but ourselves when we pretend otherwise. Better still you can prove what you have learned. If a patient chooses to disregard your warnings, you have not to wait for a generation to convince him. You know you will be called in in a few days or weeks, and you will find your careless friend with a pain in his inside, or a sore place on his body, precisely as you warned him would be the case. Have you ever considered what a tremendous privilege that is? At a time when few things are called by their right names, when it is against the spirit of the times even to hint that an act may entail consequences—you are going to join a profession in which you will be paid for telling men the truth, and every departure you may make from the truth you will make as a concession to man’s bodily weakness, and not his mental weakness.

Realising these things, as I have had good reason to realise them, I do not think I need stretch your patience by talking to you about the high ideals and the lofty ethics of a profession which exacts from its followers the largest responsibility and the highest death-rate—for its practitioners—of any profession in the world. If you will let me, I will wish you in your future what all men desire—enough work to do, and strength enough to do your work.

R. CLAY AND SONS, LTD., BREAD STREET HILL, E.C., AND BUNGAY, SUFFOLK.

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