Medicine - Chauvinism in Medicine
( Originally Published 1905 )
A RARE and precious gift is the Art of Detachment, by which a man may so separate himself from a life-long environment as to take a panoramic view of the conditions under which he has lived and moved: it frees him from Plato's den long enough to see the realities as they are, the shadows as they appear. Could a physician attain to such an art he would find in the state of his profession a theme calling as well for the exercise of the highest faculties of description and imagination as for the deepest philosophic insight. With wisdom of the den only and of my fellow-prisoners, such a task is beyond my ambition and my powers, but to emphasize duly the subject that I wish to bring home to your hearts I must first refer to certain distinctive features of our profession:
1. FOUR GREAT FEATURES OF THE GUILD
Its noble ancestry.—Like everything else that is good and durable in this world, modern medicine is a product of the Greek intellect, and had its origin when that wonderful people created positive or rational science, and no small credit is due to the physicians who, as Professor Gomperz remarks (in his brilliant chapter "On the Age of Enlightenment," Greek Thinkers, Vol. 1), very early brought to bear the spirit of criticism on the arbitrary and superstitious views of the phenomena of life. If science was ever to acquire "steady and accurate habits instead of losing itself in a maze of phantasies, it must be by quiet methodical research." "It is the undying glory of the school of Cos that it introduced this innovation into the domain of its Art, and thus exercised the most beneficial influence on the whole intellectual life of mankind. Fiction to the right! Reality to the left! was the battle cry of this school in the war it was the first to wage against the excesses and defects of the nature philosophy"(Gomperz). The critical sense and sceptical attitude of the Hippocratic school laid the foundations of modern medicine on broad lines, and we owe to it: first, the emancipation of medicine from the shackles of priestcraft and of caste; secondly, the conception of medicine as an art based on accurate observation, and as a science, an integral part of the science of man and of nature; thirdly, the high moral ideals, expressed in that most "memorable of human documents" (Gomperz), the Hippocratic oath; and fourthly, the conception and realization of medicine as the profession of a cultivated gentleman. No other profession can boast of the same unbroken continuity of methods and of ideals. We may indeed be justly proud of our apostolic succession. Schools and systems have flourished and gone, schools which have swayed for generations the thought of our guild, and systems that have died before their founders; the philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of to-morrow; through long ages which were slowly learning what we are hurrying to forget—amid all the changes and chances of twenty-five centuries, the profession has never lacked men who have lived up to these Greek ideals. They were those of Galen and of Aretaeus, of the men of the Alexandrian and Byzantine schools, of the best of the Arabians, of the men of the Renaissance, and they are ours today.
A second distinctive feature is the remarkable solidarity. Of no other profession is the word universal applicable in the same sense. The celebrated phrase used of the Catholic Church is in truth much more appropriate when applied to medicine. It is not the prevalence of disease or the existence everywhere of special groups of men to treat it that betokens this solidarity, but it is the identity throughout the civilized world of our ambitions, our methods and our work. To wrest from nature the secrets which have perplexed philosophers in all ages, to track to their sources the causes of disease, to correlate the vast stores of knowledge, that they may be quickly available for the prevention and cure of disease these are our ambitions. To carefully observe the phenomena of life in all its phases, normal and perverted, to make perfect that most difficult of all arts, the art of observation, to call to aid the science of experimentation, to cultivate the reasoning faculty, so as to be able to know the true from the false—these are our methods. To prevent disease, to relieve suffering and to heal the sick—this is our work. The profession in truth is a sort of guild or brotherhood, any member of which can take up his calling in any part of the world and find brethren whose language and methods and whose aims and ways are identical with his own.
Thirdly, its progressive character.—Based on science, medicine has followed and partaken of its fortunes, so that in the great awakening which has made the nineteenth memorable among centuries, the profession received a quickening impulse more powerful than at any period in its history. With the sole exception of the mechanical sciences, no other department of human knowledge has undergone so profound a change--a change so profound that we who have grown up in it have but slight appreciation of its momentous character. And not only in what has been actually accomplished in unravelling the causes of disease, in perfecting methods of prevention, and in wholesale relief of suffering, but also in the unloading of old formulae and in the substitution of the scientific spirit of free inquiry for east-iron dogmas we see a promise of still greater achievement and of a more glorious future.
And lastly, the profession of medicine is distinguished from all others by its singular beneficence. It alone does the work of charity in a Jovian and God-like way, dispensing with free hand truly Promethean gifts. There are those who listen to me who have seen three of the most benign endowments granted to the race since the great Titan stole fire from the heavens. Search the scriptures of human achievement and you cannot find any to equal in beneficence the introduction of Anaesthesia, Sanitation, with all that it includes, and Asepsis—a short half-century's contribution towards the practical solution of the problems of human suffering, regarded as eternal and insoluble. We form almost a monopoly or trust in this business. Nobody else comes into active competition with us, certainly not the other learned professions which continue along the old lines. Every few years sees some new conquest, so that we have ceased to wonder. The work of half a dozen men, headed by Laveran, has made waste places of the earth habitable and the wilderness to blossom as the rose. The work of Walter Reed and his associates will probably make yellow fever as scarce in the Spanish Main as is typhus fever with us. There seems to be no limit to the possibilities of scientific medicine, and while philanthropists are turning to it as to the hope of humanity, philosophers see, as in some far-off vision, a science from which may come in the prophetic words of the Son of Sirach, " Peace over all the earth."
Never has the outlook for the profession been brighter. Everywhere the physician is better trained and better equipped than he was twenty-five years ago. Disease is understood more thoroughly, studied more carefully and treated more skilfully. The average sum of human suffering has been reduced in a way to make the angels rejoice. Diseases familiar to our fathers and grandfathers have disappeared, the death rate from others is falling to the vanishing point, and public health measures have lessened the sorrows and brightened the lives of millions. The vagaries and whims, lay and medical, may neither have diminished in number nor lessened in their capacity to distress the faint-hearted who do not appreciate that to the end of time people must imagine vain things, but they are dwarfed by comparison with the colossal advance of the past fifty years.
So vast, however, and composite has the profession become, that the physiological separation, in which dependent parts are fitly joined together, tends to become pathological, and while some parts suffer necrosis and degeneration, others, passing the normal limits, become disfiguring and dangerous outgrowths on the body medical. The dangers and evils which threaten harmony among the units, are internal, not external. And yet, in it more than in any other profession, owing to the circumstances of which I have spoken, is complete organic unity possible. Of the many hindrances in the way time would fail me to speak, but there is one aspect of the question to which I would direct your attention in the hope that I may speak a word in season.
Perhaps no sin so easily besets us as a sense of self-satisfied superiority to others. It cannot always be called pride, that master sin, but more often it is an attitude of mind which either leads to bigotry and prejudice or to such a vaunting conceit in the truth of one's own beliefs and positions, that there is no room for tolerance of ways and thoughts which are not as ours are. To avoid some smirch of this vice is beyond human power; we are all dipped in it, some lightly, others deeply grained. Partaking of the nature of uncharitableness, it has not the intensity of envy, hatred and malice, but it shades off in fine degrees from them. It may be a perfectly harmless, even an amusing trait in both nations and individuals, and so well was it depicted by Charelt, Horace Vernet, and others, under the character of an enthusiastic recruit named Chauvin, that the name Chauvinism has become a by-word, expressing a bigoted, intolerant spirit. The significance of the word has been widened, and it may be used as a synonym for a certain type of nationalism, for a narrow provincialism, or for a petty parochialism. It does not express the blatant loudness of Jingoism,, which is of the tongue, while Chauvinism is a condition of the mind, an aspect of character much more subtle and dangerous. The one is more apt to be found in the educated classes, while the other is pandemic in the fool multitude—" that numerous piece of monstrosity which, taken asunder, seem men and reasonable creatures of God, but confused together, make but one great beast, and a monstrosity more prodigious than Hydra" (Religio Medici). Wherever found, and in whatever form, Chauvinism is a great enemy of progress and of peace and concord among the units. I have not the time, nor if I had, have I the ability to portray this failing in all its varieties; I can but touch upon some of its aspects, national, provincial and parochial.