DOCTORS

                            [Illustration]

                      MACMILLAN AND CO., LIMITED

                      LONDON . BOMBAY . CALCUTTA
                               MELBOURNE

                         THE MACMILLAN COMPANY

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                   THE MACMILLAN CO. OF CANADA, LTD.

                                TORONTO

                    [Illustration: Rudyard Kipling

      _Photograph by Reginald Haines, 4, Southampton Row, W.C._]




                                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.

     [Illustration: 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.