On the Shoulders of Medicine's Giants: What Today's Clinicians Can Learn from Yesterday's Wisdom

264 Pages·2015·10.2 MB·English

by  Robert B. Taylor (auth.)

ON THE
SHOULDERS
OF MEDICINE’S
GIANTS
What Today’s Clinicians
Can Learn from
Yesterday’s Wisdom
RO B E RT B .TAY L O R
On the Shoulders of Medicine’s Giants

Robert B. Taylor
On the Shoulders
of Medicine’s Giants
What Today’s Clinicians Can Learn
from Yesterday’s Wisdom
Robert B. Taylor
Department of Family Medicine
Oregon Health and Sciences University
School of Medicine
Portland , OR , USA
Department of Family and Community Medicine
Eastern Virginia Medical School
Norfolk , VA , USA
ISBN 978-1-4939-1334-3 ISBN 978-1-4939-1335-0 (eBook)
DOI 10.1007/978-1-4939-1335-0
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2014954588
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I n the continual remembrance of a glorious past individuals and nations fi nd their noblest
inspiration.
—Sir William Osler (1849–1919)
The leaven of science. Philadelphia: Wister Institute of Anatomy and Biology of the
University of Pennsylvania; 1894, page 79.
Medicine is the oldest learned profession in the world and it is rooted in the past. Each suc-
cessive generation of doctors stands, as it were, upon the shoulders of its predecessors, and
the fair perspectives that are now opening before you are largely the creation of those who
have gone before you. It is therefore reasonable to think that anyone who has spent a long
professional life in medicine must have something to pass on—however small or modest.
—British neurologist Sir F.M.R. Walshe (1888–1973).
In: Canadian Medical Association Journal. 1952;385:67.
You have chosen the most fascinating and dynamic profession there is, a profession with the
highest potential for greatness, since the physician’s daily work is wrapped up in the subtle
web of history. Your labors are linked with those of your colleagues who preceded you in
history, and those who are now working all over the world. It is this spiritual unity with our
colleagues of all periods and all countries that has made medicine so universal and eternal.
—Spanish-born American physician and educator Felix Martí-Ibáñez (1911–1972).
Epilogue: To be a doctor.
In: A prelude to medical history. New York: MD Publications; 1961, page 197.
v

Pref ace
This book, intended to make you a more knowledgeable clinician, presents selected
insights of some of the history’s leading physicians, scientists, and scholars—the
admonitions of Hippocrates, what Edward Jenner had to say about the end of small-
pox, Sir William Osler’s thoughts about uncertainty and probability in medicine,
and Florence Rena Sabin’s vocal commitment to believing in her work—and
describes how their words are pertinent to the current practice of medicine. This
book will show how much the thoughts of medicine’s giants were prescient, and are
manifested in what we believe and do today.
The book’s title is inspired by the words of the English physicist and mathemati-
cian Isaac Newton in 1676: “If I have seen further it is by standing on the shoulders
of giants” [1]. There is, of course, evidence that the metaphor describing s tanding
on shoulders of predecessors predated Newton in various iterations [2]. Attribution
squabbles notwithstanding, as we ponder this image, an example that comes to mind
is the 1854 prophetic comment attributed to John Snow that the key to elimination
of the great plagues, such as cholera, would lie in understanding how they are prop-
agated. Today’s knowledge of disease prevention is built upon the fi ndings of Snow
and others like him.
In this world of electronic medical records, virtual physicians, and nocturnalists
(physicians who choose to work the “graveyard” shift in hospitals), why do we need
a book based on the wisdom of our forebears? Perhaps the answer lies in the prem-
ise of the query: We have become deeply enchanted with the twenty-fi rst century’s
dazzling technology, expansive communication options, and lifestyle-oriented prac-
tice choices. And in doing so, we risk losing touch with the passion for clinical
excellence and commitment to service that made medicine what it is today.
T here is another reason this book is important. Today’s healers enjoy a level of
societal confi dence and trust that is the envy of our colleagues in other professions.
In the 1940s, American author and newspaper columnist Damon Runyon quipped:
“My old man used to say that he guessed the percentage of scoundrels was less
among doctors than any other class of men, professional or otherwise, in the
vii
viii Preface
world” [3]. This lofty status exists only partly because of the good works of we, the
living, but is much more a legacy of the dedication, perseverance, and stature of
those who created today’s house of medicine—the medical giants upon whose
shoulders we stand. If only for this reason, we should all spend some time learning
about our heritage.
The topics discussed are diverse. They range from basic science to philosophy,
from doctors to patients and their families, and from classic descriptions of disease
to how clinical caregivers view their world. Some quotations, such as Lewis
Thomas’ observation that “most things get better by themselves” are presented with
a hint of irony as we consider the heroic therapy often employed in modern clinical
practice. Other discussions, such as Albert Schweitzer’s commitment to service, are
unashamedly inspirational, and some have a touch of pragmatism, as in William
Heberden’s advice to cease doctoring at the right time, before one can no longer do
justice to patients. Some are refl ective, as the thoughts of Elizabeth Blackwell,
America’s fi rst female medical school graduate, about being a pioneer. And I include
a few notions that time has proved to be quite erroneous.
I s this just another book of medical quotations? Not really. The thoughts pre-
sented are, in most cases, whole paragraphs, allowing greater elucidation of the
authors’ ideas than is possible with a single adage. One example is the paragraph
taken from the 1927 article The Care of the Patient, by Francis W. Peabody,
although, as you will see in Chap. 3 , I might have quoted only the memorable last
sentence. In the case of Elizabeth Kübler-Ross M.D., the selection is both extended
and metaphorically vivid. Robert Lewis Stevenson’s representation of physicians
as standing “above the common herd” cannot be summarized in a few words. On
the other hand, pithy quotes such as the observation by Sir Dominic Corrigan that
“The trouble with doctors is not that they don’t know enough, but that they don’t
see enough” might reasonably be termed aphorisms. There are even a few poems
included in the book.
A re all quotations from the past? Not by any means. In searching for sayings that
resonated with my idea of what medicine should be, the characteristics of the ideal
physician, and the broad panorama of medical practice in history and today, I came
across a number of thoughtful insights penned by “modern” physicians, scientists,
and other writers. And while some may hold that these persons have not yet been
accorded the status of “giant,” I felt that their words merited inclusion in the book.
Thus, in addition to Celsus, Hunter, and Pasteur, I have included the writings of
some individuals, such as Edmund Pellegrino and Barbara Starfi eld, who have
shared our time on this earth, and others, including Abraham Verghese and David
Hilfi ker, who are still contributing to medicine.
I n assembling my sources, I was forced to make some decisions. First of all,
should I return to the same source more than once? In fact, I could easily have pre-
sented an Oslerism on every third page. I decided that, for the sake of variety,
I would cite major extracts from the works of Galen, Freud, Sydenham, and other
familiar names only once in a chapter, and that I would lean toward including a
Preface ix
broad range of “giants.” Hippocrates, Virchow, Osler, and a few others do, however,
show up more than once in the book.
I also faced the question: Who is medical giant? It is someone, and not necessar-
ily a physician, whose thoughts, words, and deeds have helped make medicine what
it is today. I concluded that some writings by nonmedical authors such as Aristotle,
Rudyard Kipling, and Michael de Montaigne have infl uenced how we view medi-
cine and physicians, and hence their words are included.
A few giants have given us a treasury of medical quotes, sometimes including a
notable “signature” adage. In these instances, I have given preference to the well-
known saying, even though some writings that are less well known are also percep-
tive. For example, the words “Chance only favors the prepared mind” will always be
linked to Louis Pasteur.
A more vexing issue was this: What about publications with multiple authors? I
have found some astute thoughts in committee-authored articles, some with as many
as fi ve or six contributors. I decided that these words had been polished by many
hands and also, I suspect, were subsequently buffed by unnamed editorial assistants.
Thus I could not describe the entire team of authors as “giants,” although some
multiauthor publications are cited in my annotated comments.
For the most part, this book is grounded in literature, not simply the product of
my personal refl ections (although there are more than a few of the latter), and
source-based annotations are supported by reference citations. Most are from the
mainstream medical literature—published books, historical documents, peer-
reviewed journals such as T he New England Journal of Medicine, and so forth. And,
in an effort to make the content timely and relevant, I have also used some less tra-
ditional resources such as the W all Street Journal, the New York Times, and the
World Wide Web .
T his book may never lead you to a “eureka” diagnosis or guide a brilliant thera-
peutic drug choice. I hope that it will, however, infl uence how you think about your
profession, your patients, and your career, and help you avoid the fate of becoming
an “automated medical kiosk” [4]. I will be delighted if this book helps rekindle
your idealism regarding what medicine is at its core, and that it reminds you how
being a physician can be what Osler termed “a daily joy” [5].
On the Shoulders of Medicine’s Giants is intended not as a text or reference
source, but as an e nrichment book. It is, fundamentally, a collection of perceptive
quotations, with comments. Perhaps you will experience an “Aha” moment of rec-
ognizing the historical origins of why we think this or do that. I hope that you will
fi nd it fun to read—perhaps on a quiet evening or while passing the time on a long
plane ride—and that your life will be a little richer for it.
1 . T urnbull HW, Ed. The correspondence of Isaac Newton, vol 1. London:
Cambridge University Press; 1959; page 416.
2. Dorizzi RM. Standing on the shoulders of giants—Isaac Newton? Bernard of
Chartres? Priscian! (letter). Pharos. Alpha Omega Alpha Honor Med Soc.
2012;75:1.