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2000-09, 327, Ben Haneman, Literature

Medicine and Literature

Whoever has made a search on the Internet and has not sufficiently focussed the points of interest, often has been over-whelmed by the enormous number of resulting references. The reader may well be shaking the ungendered head on reading the title of this essay.

We could start with the literature to be found in a doctor’s waiting room. The cartoonist and humorist Emile Mercier once drew a scene in a doctor’s waiting room with cobwebs growing onto the patient (one may assume that Mercier himself had been kept waiting) and the newspaper he was reading bore the headlines “The Relief of Mafeking”. Mercier often had a tendency to overdo his commentary. There may be some truth in his criticism, however, and anyhow, doctors rarely sit in their own waiting rooms. In my salad days, I found that the publications certain to be stolen from my waiting room were the Ginger Meggs’s books. (Don’t ask me why I had them there in the first place.) Recipes were regularly torn out of magazines. Today the more sophisticated patient asks for a photocopy of any item which particularly interests them. I remember that when I was very young and indeed had not been reading for long, I was visiting my mother in a maternity hospital because my younger sister had just been born, and I recall studying Bairnsdale’s brilliant cartoons of World War I., black and white of course, but brilliant.

After that warm-up start I should become more serious. There are books written by doctors, about doctors, about patients, about hospitals and books primarily on other themes which have considerable medical content. By the way, I shall talk of doctors and medical practitioners confusingly perhaps but must confess here and now that most medical practitioners, courteously called doctors by their patients (clients, customers, consumers, G.S.T. payers, depending on how far you have travelled to the Sodom and Gomorrah of economic rationalism), do not in fact hold university doctorates.

Some doctors collect books written by doctors. Here it may be inserted, that I have decided not to include medical textbooks in my ramble. Some doctors are pleasantly surprised if not amazed that one of their kind would be capable of doing anything as literary and cultured as to write a book. Some medical men and women have escaped the heavy yoke of medical practice and have exercised their undoubted talent in other fields. The particular field which interests us for the purpose of this essay is the writing of a book which might end up on our library shelves. Medical literary production takes in fiction (for convenience let us add poetry and essays) and non-medical non-fiction. Dr Arthur Andrews of Albury is little known in medical circles but wrote Australian Tokens & Coins, a classic text for numismatists. Max Lake, a successful Sydney surgeon, will be better known for his books on wine, notably Vine and Scalpel as well as others, and to this day his name can be joyously remembered drinking his wine, Lake’s Folly. Considered from the point of view of history, when the doctors’ pharmaceutical armamentarium was minimally effective (it is intriguing how the medical profession was more respected then, when it could do far less), doctors of sheer professional necessity had to know about wines. This is the reason that so many of the pioneer wine growers in Australia were doctors and there is a bur-geoning literature on this sub-topic alone. R.J.H.L. Cumpston, once Commonwealth Director of Health, had written not only on disease in Australia but also a significant number of biographies relevant to Australian history, and valiant contributions they prove to be. Dr. John Cobley, a Sydney physician and endocrinologist, has to his eternal credit a considerable oeuvre concerning Sydney Cove and the early days of settlement in Sydney. Dr. E. Graeme Robertson of Melbourne wrote the definitive text on our iron lace verandahs, while from Tasmania there is good material on whaling and Aborigines, notably from W.E.H.L. Crowther. Some whaling ships carried doctors on board and hence the connection. Doctors can pop up in the most unexpected places. One who, when a young man, was involved in blackbirding off the Queensland coast was later to become foundation professor of anatomy in the University of Adelaide. The reference is to Professor Archibald Watson. Still thinking nautically, a small book appeared in 1931, inter-estingly published by the Australasian Medical Publishing Com-pany. It was called Wire Splicing for Yachtsmen. It was written by Dr Robert Scot Skirving who trod prominently on the stage of Sydney medicine as we entered the twentieth century. His memoirs, edited by Ann McIntosh, his grand-daughter, is one of the most delightful books in Australian medical literature, replete with old world charm and venom. (The book had to wait some years before it appeared in print because of fear of legal repercussions.) By the way, Ann McIntosh has a remarkable pedigree. Two of her grandfathers were Scot Skirving himself and Edmund Barton, the latter as the first Prime Minister of Australia much to be remem-bered in the months ahead as we celebrate the Centenary of Federation.

It was the same Scot Skirving who wrote a novel in 1901 called Love and Longitude: A Story of the Pacific in the Year 1900, which is somewhat tedious and does little to advance the repute of Australian literature, but of course that in no way, diminishes its collectability. The best known doctor/author is Peter Goldsworthy, who has written memorable novels, amongst them Honk if You Are Jesus and he is a most readable poet too. Professor Miles Lit-tle, whose first discipline was surgery, has written some sensitive poetry in his Round Journey, but is now more concerned with medical ethics. Perhaps it is a pity that more of his academic friends are not similarly involved. Grace Perry wrote poetry divinely as well as furthering poetry in Australia in general. In this regard she exhibited a missionary-like zeal. Berrima in the Southern Highlands, where she lived, is well celebrated in her writings.

Insular and parochial are two reproachful epithets to which I lay myself open. Today I have concentrated mostly on Australia without any disregard or disrespect for English and European literature that is situated in this same borderland between medical practitioners and life and literature as it exists.

If there are reasons why medical practitioners should be better novelists or poets, I cannot adduce any. It has been said that some doctors find in literature an escape from their daily clinical cares and responsibilities. Another belief is that they have been trained to observe carefully and this ingrained discipline helps them in recording details and giving a greater verisimilitude to their descriptions. Be that as it may, the reader usually does not sense any detail which distinguishes a medical from as non-medical writer, unless, of course, the writing is strewn with medical jargon. But in practice, the question of medical authorship might be of interest only to the curious medical man or woman.

In a different category fall novels about doctors and medical students and novels which give extensive description of disease. Two non-Australian examples would by Tolstoi‟s The Death of Ivan Ilyich (he probably had cancer of the pancreas but that is my diagnosis and by no means beyond argument) and Paul Bellow‟s latest novel Ravelstein, where he records the case of a man suffering from cigatuerra fish poisoning, a rare condition but occasionally seen off the Queensland coast. Bellow’s case is an atypical one at that, but it is the first time I have seen this disease in a novel. The patient reader of my essay will immediately be able to volunteer other titles in which disease, death and destruction have been novelised. We should be wondering about what purpose the reading of these novels could have, particularly in medical education.

The answer comes from a new sub-division in the medical school curriculum, that of medical humanities. You may well protest: But isn’t medicine of itself the most humanist or, you might say, humane of all professions? Well, it should be. Unhappily, in producing the most competent state-of-the-art medical scientists and technicians we are also producing some inter-personal cripples. In response to such a questioned perception, the subject of Medical Humanities is being inserted into many medical curricula, particularly in the United States. The proposition is that somehow tomorrow’s doctor must be taught also to be a caring sensitive person. Not only is this a problem for the overall course planners but it is also a problem for the patient. Do you (presuming that one day or another, with great reluctance of course, you too will be a patient) want your doctor to be brilliant at his medicine but near mute when it comes to interacting with you, or do you want an affable cultured gentleman who will have read the latest novels but maybe not the latest medical journals? Perhaps I have caricatured the two extremes and you as a patient, if sufficiently exigent, could ask to have a practitioner who is both, i.e. well read and well read.

Medicine and literature is now a popular elective in medical courses. The idea is that the class read a previously selected novel or a handout of selections from the novel under consideration. Heavens above, no medical student has time to read a whole novel. But please be fair, because does the leisured reader always read the whole of a novel? Then, in class, there is open discussion; students can talk freely about their reactions, to the illness, to the patient, to his relatives, to being the doctor. Some stories reflect less than great credit on the venerable paramount profession. The class must take that in its stride. These classes are being taken by senior doctors, perhaps less likely to do any harm in the class room than in the clinic or in the operating suite. Increasingly, the course is being colonised by teachers from the arts faculties. With shrinking humanities departments, the junior teachers are no doubt exhorted to go west and establish themselves in these new intellectual territories.

Medical students and doctors rarely have an opportunity of mulling over how they feel as students, as doctors, as mortals, as fallible human beings, and of course they rarely speak about how it must be to be a patient, still less are they comfortable talking about ageing, dementing and dying. These courses have given medical students “permission” to talk about these things. When you think of it, the reading of novels plays a very similar role in our own lives in general. We can become involved in themes which would otherwise be too threatening. Although some texts are evidently more suited than others, an inspired teacher, in my opinion, could take almost any text and find aspects of great rele-vance to being a medical practitioner. The Old and New Testaments could easily serve a trimester. Doctors’ Dilemma comes as suitably as a glove to a hand in this matter. I should add that a professor of pathology of my acquaintance in bemoaning the igno-rance of many medical students of their basic anatomy, regretted that they had not been taught the Negro spiritual about the leg bone being connected to the knee bone and so on. He thought that at least, might have been a start. (It was the late Professor Ritchie Nairn.)

The event which sparked this essay was the arrival on my desk of Teaching Literature and Medicine, edited by Anne Hunsaker Hawkins and Marilyn Chandler McEntyre, and published by The Modern Language Association, New York, this year. The book is a collection of reports from different North American academic departments describing in each particular case how they go about teaching Literature and Medicine. One could equally well entitle their book We Did it Our Way. What captures your imagination is that there are so many different ways, so many different processes, so many different texts chosen. The results are amazingly congruent. Medical students respond positively to the opportunity to discuss medicine and medical life in general in an open, supportive and non-threatening forum. Some courses have more on medical history, others lean more to literature study per se, but in general the result is the same: medicine as a profession is exalted and lit-erature recognised for its humanising role.

Soon you will be hearing more about medical humanism. There may be a request from a medical student for a loan of a book in your personal library. One of the next books you read may well have a part which could be ideal for a Literature and Medicine class and which you would recognise instantly as suitable for such teaching.

Finally, doctors, like their patients, eventually die. What is nown about their terminal reading? Sir William Osler was buried with his favourite copy of Religio Medici by Sir Thomas Browne. When the distinguished London physician Lord Horder died, his acquaintances (because he had few close friends) were anxious to learn what reading he had on his bedside table that explained his clinical brilliance and acumen. They found a well-read copy of Jeavons’ ok on logic. But we must not end on a sad note. A most reliable sign of when a patient has started to improve again is him or her asking to read the daily paper. For it is widely recog-nised you need to be fit and have a strong stomach to do that nowadays and, anyhow, our patient has announced a returned in-terest in the life around us. Moreover, you may safely issue a certificate of expectation of longevity to any convalescent who starts reading Tolstoi’s ar and Peace.

Ben Haneman



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