Confidence in Family Physician


By WILLIAM ELLIOTT, President and Publisher of The State

Delivered at the Commencement Exercises of the Medical College of South Carolina, Charleston, S. C., June 4, 1942

Vital Speeches of the Day, Vol. VIII, pp. 635-638.

IT IS a pleasure to be invited to speak here today— since it is in Charleston, the city to which my pioneer forbears came, the city which honored my father by sending him as its representative in congress. Out in the harbor is Fort Sumter in which my uncle was commander for more than a year during which it endured fierce bombardment, and this is the medical college which trained my mother's only brother.

I would indeed be a human icicle if I were not warmed by the invitation.

For four years now you graduates have been privileged to be in constant contact with the culture of Charleston— in broader terms I might say the culture of the coast country. Someone may recall the fact that my residence for three decades or more away from the coast country would debar me from speaking as a coast country man. My response would be; it is a poor rule that does not work both ways. When J. C. Hemphill, who occupied the editorial chair now held by the gifted and distinguished Dr. William W.

Ball, said to a cultivated and literary lady of Charleston that he could not understand certain attitudes of Charleston people, she replied: "But we do not expect a newcomer to know about such things," and Hemphill remarked, "And I have been a resident of Charleston for 30 years." Turning the formula the other way, if a heritage cannot be gained in 30 years, ergo a man cannot lose one in that time.

You are to be envied because of the great adventure upon which you are about to embark. All the scientific discoveries and learning of the past are charted for you, and all yet to come will be spread before your eyes. In 1913 in the great medical conference held in London, one of the leading physicians intimated that he had much sympathy for the young men entering the medical profession because there was so little that could be added to medical science to thrill them.

This reminds one of the director of the United States patent office who some hundred or so years ago advised that the patent office be closed because there could be no newinventions to be patented. Think for a moment of the splendid progress made in your profession since 1913. Manifestly the great men, like Homer, could nod. Having no gift of prophecy, especially in scientific matters, I can only give you a pleasing parallel.

When a young man complained against his dullness Sir Arthur Helps said: "What! dull when you do not know what gives its loveliness of form to the lily, its depth of color to the violet, its fragrance to the rose; when you do not know in what consist the venom of the adder, any more than you can imitate the glad movements of the dove. What! dull when earth, air, and water are all alike mysteries to you, and when as you stretch out your hand, you do not touch anything the properties of which you have mastered; while all the time nature is inviting you to talk earnestly with her, to understand her, to subdue her, and be blest by her! Go away, man; learn something, do something, understand something, and let me hear no more of your dullness."

It may be of interest to you to get a layman's side lights on some medical problems. As a small boy in Beaufort during the last yellow fever epidemic I recall that they burned sulphur in the streets of Beaufort believing that the air was polluted. But the stegomyia, the yellow fever mosquito, liked the fumes of burning sulphur as little as did human beings. The rice planters followed a regular routine in case a storm should compel them to spend the night in the plantation house during the summer. The object was to avoid miasma. First, before sunset they went in the house, shut all the doors, built a fire in the fireplace, put on an overcoat, sat up all night and drank quarts of water and did not go out until next morning when the sun was high in the heavens. The scientific doctor of today may laugh at these precautions, but tell me wherein was the inadequacy? We know now that the malaria mosquito flies from sunset to sunrise. The delicate female of the species does not like strong sunlight and goes out on a raid only when the shades of night are falling fast and the morning glow is soothing to her delicate nature. The closed doors prevent the she devil from flying in and the fire in the fire place drives her out of the chimney and keeps her from coming down. The chimney undoubtedly smoked and the lady does not like smoke. The overcoat protects most portions of the human anatomy, and I have no doubt that the routine would make a person die of thirst were it not for the bountiful pitcher of water—mind you I said water. Also, perhaps, the Mrs. Quadrimaculatus does not like to stick her proboscis through perspiration. All in all, tell me a better way to keep from being bitten by a malaria mosquito during the summer in the rice fields. Needless to say few nights were spent in the rice fields.

Those who endured this ordeal can sympathize with the Spanish settlers on near-by Parris Island, who in 1564 complained to the great navigator Menendez that they preferred to have chills and fever rather than drink the liberal drafts of sassafras tea required of them.

Then, too, in the middle country the first settlers built their houses on the rich bottom lands. But soon they found that chills and fever prevailed there and they moved to the high lands. Again the theory was that they avoided miasma on the high hills. A sound illustration of doing the right thing for the wrong reason.

This brings up the persistency of folk ways. I was trying a case once in a county in this state, involving what was known as a "mosquito case"; the allegation being that the power company's back water caused mosquitoes and malaria to the long-time residents. Both the plaintiffs' and the defendants' attorneys were highly scientific. We differentiated between the culex and the anopheles quadrimaculatus andthe anopheles punctipenis, and we had specimens of different kinds and explained how one specimen breathed in a horizontal position and another kind breathed parallel to the water; how one kind stood on his head when it bit and the culex just hit you and was done. We even had the deposition of General Gorgas, besides the government expert, Doctor Carter, who had worked on the Panama Canal. To my great gratification the jury brought in a verdict for me, and as always when that happened I thanked members of the jury as they came out. One juror said, "You are a pretty smart lawyer." My ego broadly expanded and my vanity soared to unexpected heights. I agreed with him, but like many a lawyer has done, I asked one too many questions— what persuaded them to decide for my side? "Well, you see, it was this way," he said. "The plaintiffs never said anything about miasma and you followed their lead and you were smart enough not to help them out by referring to miasma, and as the whole jury knew that chills and fever were caused by miasma and not by mosquitoes we found a verdict for you because the plaintiffs had failed to prove their case."

But do not overlook that where there is miasma there is the gentle anopheles and malaria. The female anopheles is a delicate little lady, and reminds me of a client of mine of foreign birth who had a quarrel with a Chinaman, and testified about the combat in court by saying: "Just like a lady I says, Charlie, you are a damn rascal, and I slapped his face 'bim,' just like a lady, Judge,"

In 1913 I went on one of the first trips made through the Panama Canal, on the boat with General Goethals, and we were all amazed at the great engineering works. But along the side of the canal were great mounds jutting up with tropical trees and lianas covering the huge machinery left by the French after their attempt to dig the canal. Their workmen died by thousands from yellow fever and malaria, and the French had to abandon the work. Then soon after the redoubtable Teddy put us on the job there was no yellow fever and little malaria. I pondered whether General Goethals built the great canal, or Doctor Gorgas who abated the mosquitoes, and with them the two dread diseases.

And now in this great state of ours doctors are performing a service not so dramatic, but in the aggregate equally valuable in freeing the territory surrounding our great water power lakes of the deadly anopheles. And all through the country surrounding these lakes which are turning our ocean-seeking rivers into horses—of course I mean horse power— these doctors travel constantly teaching the people how to avoid malaria.

And this is as it should be, for one of the important duties of a doctor is to teach us lay folk how to be healthy and therefore happy. The word "doctor" means "teacher" in its original connotation, for the word "doctor" comes from a Latin word meaning teacher.

The layman has a right to expect the doctor to have common sense—or what in reality is uncommon sense. All good doctors have it. The great Southern orator Henry Grady said that a farmer must sow brains with his fertilizer, so the doctor must mix common sense with his science. I recall reading of the great doctor who was thought to have some kind of occult power, because with some other doctors he visited a sick woman at the request of the family, although the attending physician said there was nothing serious the matter with her, and when he looked at the patient he said, "There is nothing I can do for her, she will be dead in 24 hours," and by morning she was dead.

Another woman was said to be desperately and dangerously ill. The consultant looked at her carefully and when she asked, "Doctor, am I not dying?" He replied, "Certainly not, and you will live to have a dozen babies yet." Which she did.

He explained that the first woman was dull and apathetic, her countenance was grey and sallow, and she was dying of puerperal fever. The face of the second was bright and expectant.

Once Sir James Mackenzie was addressing a gathering of doctors and spoke of the extra-systole. Said Doctor Mackenzie: "I have never known harm to befall anyone in whom this irregularity was the only sign of departure from normal." He sat down. One of the leaders of the profession rose and in round and emphatic tones said: "I had four patients whose pulses were irregular in the way described by Doctor Mackenzie. They all died." Quick as a flash came Doctor Mackenzie's retort: "I had 400 patients with bald heads. They all died. But it was not the baldness of their heads that killed them."

Once when Sir James Mackenzie was relating an experience with a patient, a doctor exclaimed that of course he had been called in consultation as a heart specialist. Mackenzie, with surprise and rather reprovingly said, "I was the family physician."

He constantly warned his young students to study human beings as well as the instruments of precision. When an enthusiast differed with him, he pointed to a vase of roses and asked: "Can your instruments of precision smell those roses over there?"

Down through all the centuries the patient has appealed to the doctor, "Oh, Doctor, what do these symptoms mean for me, and what can you do to make me well?" We value your instruments of precision because you value them, but we value the doctor more.

It has been said, "blessings be upon the head of Cadmus, the Phoenician," or whoever it was that invented books—so I say blessings be upon the head of Hippocrates, the Greek, or whoever it was that invented the family physician.

Into your faithful care we entrust our lives, our happiness; our families. I know of no such abiding trust elsewhere in our human relations. You have our faith; we may die, but if you are the right kind of doctor we die in the faith. The wish for a trustworthy doctor is "graven upon the human heart."

A great contemporary and associate was asked when Osier left Johns Hopkins hospital to go to Oxford, what made Osier great.

The reply was: "An infinite compassion towards his human kind."

Said Osier: "The extraordinary development of modern science may be her undoing. Specialism, now a necessity, has fragmented the specialties themselves in a way that makes the outlook hazardous. The workers lose all sense of proportion in a maze of minutiae applying themselves early to research, young men get into back waters from the main stream."

It was said of the great doctor Sir William Osier, that when he walked into the room of a sick patient, the patient was instantly better, and no matter how many were in the room the patient saw only Doctor Osier. As one doctor expressed it, when Sir William walked into a sick room there were only three persons in the room, the patient, Sir William and power—all others had become invisible.

Although Mackenzie throughout his career emphasized the advantage of making a study of the patient, he saw that garrulous folk did not waste his time. In London he was called to see a great leader of the social world, famous for her powers of speech. For four minutes she babbled on to Sir James' increasing annoyance.

Then in tones like Jove "to threaten and command," he

declared: "My good woman, would you kindly hold your tongue?"

Throughout a subsequent long friendship she boasted that he was the only man who had ever silenced her.

Epictetus, the great Roman slave philosopher, makes Jupiter say: "If it had been possible to make your body and your property free from liability to injury, I would have done so. As this could not be, I have given you a small portion of my divinity." He must have been speaking of doctors.

The layman is often mystified by the doctor's constant habit of using technical terms—that is to say terms too technical, to the patient and in court. I recall a case that was made confused by the fact that the doctors and the learned judge, always referred to the injury of the plaintiff as double inguinal hernia, when if they had defined it to the jury and witnesses as double rupture, everyone would have understood what the injury was that the plaintiff had suffered.

And now a special word to you nurses who have today completed your training:

After arduous years of training the eyes of your souls have been opened, prudery has been erased from your minds, you have seen human suffering, and have helped your patients to cross the dark river, and now go out alone, at times, and in groups perhaps, and often without the parental supervision of hospitals. As Napoleon said once that each of his soldiers carried in his knapsack the baton of a field marshal, so you may have in your hand bag the shoulder straps of a lieutenant, a captain, a major, or even a colonel. And so in. anticipation, I salute you.

And because our hearts were pure we thought no evil while the barbarians of central Europe, and the islands bordering Asia prepared against us. In their days of disaster we sent them food, money and materials in mercy, and the barbarians actually saved our mercy-sent resources with which to fight against us.

But now the brazen voice of war has bellowed through all the lands and seas of the world and we must fight to save ourselves from the barbarian Jap and the sickening cruelties of the Nazis with their steel whips.

The cruelty of the Prussian is no new thing. In the autobiography of that good man and great surgeon of Johns Hopkins, Dr. J. M. T. Finney, he tells of a visit to Germany in his youth to gain from them what he could of their science, and visited the operation room where a leading German surgeon was to operate on a young woman.

"On that one occasion the patient was a young woman about twenty. She was wheeled into the operating room on a stretcher, then stripped of all of her clothing, lifted to the operating table and tied there by the orderlies with bandages binding her legs together and her arms to her sides, with her head pulled back over the end of the table and tied fast there in a most uncomfortable position. Thus she could not move her head, arms or legs, but could only cry. The whole procedure was brutal. There was no nurse present, only a maid, and the surgical amphitheater was full of doctors and medical students. When she cried from fright and from the rough handling, one of the orderlies would smack her on the side of the face and roughly tell her to shut up. When the surgeon himself came in, she was crying loudly and begging for mercy. He walked over and gave her a resounding smack on the cheek and in turn told her to be quiet. He then proceeded to do the operation, a most painful one, without a drop of anesthetic of any kind, believe it or not. The poor girl screamed and cried until she stopped from sheer exhaustion. The details of the operation are too horrible to relate. I waited until after it was over, just lone enough to go up and ask the operator—I won't call him asurgeon—why he hadn't given the poor girl an anesthetic. With a shrug of the shoulders he replied, 'It wasn't necessary. We could hold her.' Fortunately, that experience was unique, but I must say that it made me thankful to get out of Germany without having to have a surgical operation done on myself or any of my family."

You doctors and nurses and pharmacists have parts to play in this cruel drama. It may be in frigid Iceland, or wind swept New Foundland; it may be in the tropics of South America or of northern Australia, and that is where your training here in tropical diseases will be of great benefit; it may even be in Flanders Field where the poppies grow. You will have camps to keep healthy, wounds to bind up, pain to ease, death to watch, courage and heroism to admire.

You will apply your skill to our own soldiers, sailors and nurses. You may be called upon to treat Japanese, Italians and Germans, our enemies; and Russians, our allies. In a way you will be the only representatives of internationalism. Your skill will have an international foundation.

Says the last report of the Rockefeller Foundation:

"There is not an area of activity in which this cannot be illustrated. An American soldier wounded on a battlefield in the Far East owes his life to the Japanese scientist, Kitasato, who isolated the bacillus of tetanus. A Russian soldier saved by blood transfusions is indebted to Landsteiner, an Austrian. A German soldier is shielded from typhoid fever with the help of a Russian, Metchnikoff. A Dutch marine in the East Indies is protected from malaria because of the experiments of an Italian, Grassi; while a British aviator in North Africa escapes death from surgical infection because a Frenchman, Pasteur, and a German, Koch, elaborated a new technique."

When in December, 1917, General Pershing was shocked by the health conditions at the port of debarkation of Saint Nazaire, he sent Hugh H. Young, the eminent urological surgeon of Johns Hopkins to investigate—not an army officer but this Johns Hopkins surgeon—and his report resulted in the complete reformation of this menace to the health of our newly arrived expeditionary force, and converted that port almost into a health resort, just as General Goethals converted the Canal Zone. Hugh Young's report and recommendation were incorporated into General Pershing's General Order Number 77, which should be studied by every doctor in the army. Naturally I read Young's book, as we lived in adjoining rooms at the University of Virginia. If you will read his book you will find much medical lore which went over my layman's head—but many spicy anecdotes which are on the level of a layman's mentality.

I have spoken of the Russians, and about them but let me purge my conscience. Few have fulminated against the Communist more than I—those who protect themselves under our Bill of Rights while they seek to destroy our government by violence. But Russia has changed. At any rate I have read the dispatches of our ambassador, Davies, to our secretary of state. Because Stalin trusted him and our President he let Davies go everywhere, see everything, investigate what he pleased and report what he found.

His reports are profoundly convincing because they are factual, detailed and forthright.

He said and proved:

1. That Stalin is not a Communist and does not seek world revolution. Trotsky did, and that is why Stalin ran him out.

2. That the Russian people are solidly behind the Stalin government, through patriotism and not through fear. Hence the amazing resistance they have made against the Nazi.

3. That in the great traitor trials Stalin only executed those conspiring with Germany or Japan. Davies attended the trials with an interpreter, and says the charges were proved. So there was no fifth column in Russia. They were all dead.

4. That the Stalin regime is sincerely friendly to us.

5. He predicted Russia would amaze the world by the extent of her preparation in planes, tanks and trained soldiers against the inevitable war with the lying Hitler. Instead of Hitler surprising Stalin, Stalin surprised Hitler.

These facts are of the most profound concern to us, for Russia led by Stalin may be the cause of our being able to preserve our national existence.

And this should be your motto: Our fair union of states shall not sink into barbarism. The little Japanese shall not dictate the terms of peace from the White House; Prussians shall not tell us when and where we shall work, and eat and pray.

When we have bound up our wounds, and cleansed our garments from the dreadful soil of war, and have tamed the barbarians, we will return to the paths of peace and of righteousness, untainted by the Prussian master-race or the Eastern sun gods.

But there is something else that I can hold out to you besides this great sacrifice for race and nation.

A great Greek tragedian gives the answer: a great truth that has burned a course down the centuries.

Said he:

"God, whose law is that he who learns must suffer. And even in our sleep pain, that cannot forget, falls drop by drop upon the heart and in our own despites, against our will comes wisdom to us by the awful grace of God."

To skip 2,500 years and quote Rudyard Kipling, when you have learned wisdom through suffering, "you will be a man, my son."

We need unity—unity of heart, faith, nerve, money and loyalty among ourselves, and with our allies. As the old sage Benjamin Franklin said, "we must hang together or we will all hang separately."

To quote Ralph Waldo Emerson:

"Life is too short to waste
In critic peep or cynic bark,
Quarrel or reprimand;
T'will soon be dark;
Up! mind thine own aim,
And God speed the mark."

Winston Churchill voiced the grim determination of the British when he said: "We shall go on to the end; we shall fight in France, we shall fight on the seas and oceans, . . . we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender."

Churchill did not speak alone for the British.

To this Hitler replied: "We will wring the neck of Britain like a chicken."

Winston's only reply was, "Some neck; some chicken." Doubtless this infuriated the psychopathic Adolf. Like all self-created supermen, the salt of humor is not in him.

The Nazis teach their youth to sing: "Tomorrow we own the world."

We must teach them different words to that tune.

We must give the battle cry the bard "sublime, whose distant footsteps echo through the corridors of time," the battle cry that should ring throughout all this great nation of ours and throughout all the continent of America:

"Awake, arise, or be forever fall'n."