Superbrain; Curing and Teaching Around the Round Table
By
Most of this mail-out today is devoted to selections scanned in from the biography of William Osler that I read lately, spiced up with some selections from Mahmud's Diary of the Master's trip across
"It is written in the Hadith [Islamic traditions] that cities shall draw nearer to each other. Besides spiritual nearness and communications between the cities of the hearts and friendships between diverse people in the promised Day, how physically close have the cities and countries also become. Truly, if not for railroads and the power of steam, how could these long distances be traversed with such ease? This is one of the miracles of this promised century of our current age." (Mahmud, 283)
Now it is communication and cybernetics rather than transport that are making leaps forward, changing the ground rules for everything. All that means that what my children Tommy and Silvie learn in school today, or what their doctor does when they fall ill, must be decided primarily by - what do we call this new mix of human experts and cybernetic intelligence? How about the name my father gave his personal computer: Superbrain? Superbrain is the new scientific method, Superbrain is the collective intelligence of the entire human race mediated, expanded, made reliable and virtually blunder-free by the Internet. But that is not to say that Superbrain will put teach or doc or farmer Joe, or any other skilled worker out of a job. There will in fact be an expanded role for individual experts, though of course it will be radically changed. A teacher whose curriculum is fed in and out of Superbrain or a doctor whose diagnosis is fed in and checked by Superbrain will be able to concentrate on the patient or student standing before him or her. In such conditions charisma, personal magnetism, the ability to inspire, provoke independent thought and motivate others to put forth an effort will become the first requirement of the job description. Mere ability to manipulate facts and data, the old mark of a good expert, will sink into the background. That is why I think an expert like Osler, who had these rare qualities, is of primary interest to everybody, not just to a few student doctors.
Bliss: To have understood the self-limiting nature of disease was a great step forward by the medical profession. If only the laity would follow that!
Osler: A desire to take medicine is, perhaps, the great feature which distinguishes man from other animals. Why this appetite should have developed, how it could have grown to its present dimensions, what it will ultimately reach, are interesting problems in psychology. Of one thing I must complain, that when we of the profession have gradually emancipated ourselves from a routine administration of nauseous mixtures on every possible occasion, and when we are able to say, without fear of dismissal, that a little more exercise, a little less food, and a little less tobacco and alcohol, may possibly meet the indications of the case - I say it is a just cause of complaint that when we, the priests, have left off the worship of Baal, and have deserted the groves and high places, and have sworn allegiance to the true god of science, that you, the people, should wander off after all manner of idols, and delight more and more in patent medicines and delight more than ever at the hands of advertising quacks. But for a time it must be so. This is yet the childhood of the world, and a supine credulity is still the most charming characteristic of man. (Michael Bliss, William Osler, A Life in Medicine, 189)
JET: As for drug desire or longing for medicine distinguishing us from animals, `Abdul-Baha was of a varying, if not opposite opinion.
"The most important of all intentions is to spread the love of God, to establish harmony and oneness among the people. This is what distinguishes man from animals." (Mahmud, 16)
"A little later a group of philosophers, doctors and journalists met with 'Abdu'l-Baha. He spoke to them in detail about composition and decomposition and the diagnosis of disease:
"If one is fully cognizant of the reason for the incursion of disease and can determine the balance of elements, he can cure diseases by administering the food that can restore the normal level of the deficient element. In this way there will be no need for medicines and other difficulties will not arise."
After a detailed discussion of this subject, He asked them, 'Although animals do not know the science of medicine, why, when they are sick, do they abstain instinctively from what is injurious to them and eat foods that are beneficial, while man, when ailing, inclines more to that which is injurious to him?' They had no answer to this question and stated that the Master knew the answer better than they.
'Abdu'l-Baha then gave a description of the extraordinary power of the world of humanity and the freedom of man from the limitations of nature:
"Since man's attention is not confined to one interest, his negligence is greater; while his comprehension is greater than that of all other creatures when it is focused and fixed on one subject."
Thus did the Master speak to the group of journalists, philosophers and doctors, who thanked Him for His discourse." (Mahmud, 84)
Edith Gittings Reid, a writer, observed Osler closely when Harry was sick with typhoid, when their children were ill, and during her own sicknesses:
To have been a patient of Sir William Osler’s was to have obtained an almost impossible idea of what a physician could be ... It was not necessary for him to be sensitive to a social atmosphere, because he always made his own atmosphere. In a room full of discordant elements he entered and saw only his patient and only his patient's greatest need, and instantly the atmosphere was charged with kindly vitality, everyone felt that the situation was under control, and all were attention. No circumlocution, no meandering. The moment Sir William gave you was yours. It was hardly ever more than a moment but there was curiously no abrupt beginning or end to it. With the easy sweep of a great artist's line, beginning in your necessity and ending in your necessity, the precious moment was yours, becoming wholly and entirely a part of the fabric of your life ...
With his patients he recognized at once the thing or characteristic that concerned him and them; and for the rest, whatever was uncongenial or unattractive he put from his mind and prevented any expression of it. A pose or an attempt at serious chatter about unessentials was intolerable to him. But he was as merciful as he was masterful, and from the very poor and the genuinely afflicted he would even have borne being bored.
Such telling love, such perfect confidence were given him that he could do what he liked without causing offense. Three times in my life I have seen him, when in consultation, smash the attending physician's diagnosis and turn the entire sick-room the other way about; but he left the room with his arm about the -corrected physician's neck, and they seemed to be having a delightful time. The reason for this was perfectly evident: every physician felt himself safe in Sir William's hands; he knew that he could by no possibility have a better friend in the profession; that if, with the tip of his finger, Sir William gaily knocked down his house of cards, he would see to it that the foundation was left solid. (Michael Bliss, William Osler, A Life in Medicine, 263-264)
And Clarence B. Farrer, a former student who became one of
He usually tried to cushion a grim outlook, a habit some thought he took to a fault in later years. 'The careful physician has but one end in view not to depress his patient in any way whatever,' he wrote while reflecting on the humor of Rabelais. He cautioned students against saying anything in the hearing of a patient that would increase anxiety. If a man's terror at knowing his chest pains were angina would itself worsen them, Osler told him he had 'a neuralgia of the pneumo-gastric nerve.' On the other hand, he advised telling tuberculous patients the truth about their condition right away. It was 'really not often necessary, since Nature usually does it quietly in good time, to tell a patient he was past all hope, Osler maintained, he added, 'and yet, put in the right way to an intelligent man it is not always cruel.' (Michael Bliss, William Osler, A Life in Medicine, 265)
Michael Bliss, William Osler, A Life in Medicine,
In a 1910 secular sermon called Mans Redemption of Man to 2,500 listeners at
The outlook for the world as represented by Mary and John and Jennie and Tom has never been so hopeful. There is no place for despondency or despair. As for the dour dyspeptics in mind and morals who sit croaking like ravens let them come into the arena, let them wrestle for their flesh and blood against the principalities and powers represented by bad air and worse houses, by drink and disease, by needless pain, and by the loss annually to the state of thousands of valuable lives let them fight for the day when a mans life shall be more precious than gold. Now, alas! The cheapness of life is every days tragedy. (Michael Bliss, William Osler, A Life in Medicine, 393-394)
Osler was witty, expansive, and medically humble: `Fullness of knowledge does not always bring confidence; the more one knows the more timidity may grow. He had seen too many men live for years with severe angina, too many apparently mild cases die suddenly, and, now that postmortem data was coming in, too many confusing and contradictory pathological findings to be confident in a prognosis. Angina kept reminding him of the Hippocratic dictum: Experience is fallacious and judgment difficult. (Michael Bliss, William Osler, A Life in Medicine, 372)
Not surprisingly, given the nature of his practice, Osler thought angina pectoris occurred almost entirely in men, usually in high-achieving men, and disproportionately in doctors. He was particularly impressed by the extreme anxiety many sufferers experienced - a 'mental anguish' so overwhelming that it could take on a life of its own, leading to varieties of the syndrome based on and accentuated by worry and stress. Arteriosclerosis was often enough discovered in angina sufferers, but the total picture seemed to involve a more general pattern of chronic misuse of the body - too much eating, drinking, work, and worry - leading to its deterioration.
If public health measures could stave off infectious disease, good personal habits were called for to avoid or minimize bouts of heart pain. In his metaphoric way, Osler had always advised young men against worship at the
shrines of Venus, Bacchus, and Vulcan. Now he varied false-gods image with advice not to overstrain the human mechanism. In the early twentieth century his favorite image of the body was as a machine. Like transatlantic steamers Osler and his well-to-do patients so often took, doubt using the crossing to rest and reflect on their health, the body would give out if the engines were overstoked, driven too long under high pressure, negligently maintained. During actual malfunction, you worked desperately to get things going again. Otherwise, for signs of overexertion, ranging from chest pains to nervous exhaustion, the prescription was often to reduce speed. Osler found himself telling patient after patient (for his angina consultations continued to increase) to eat less, drink less, smoke less, work less, worry less. Look after the machine. Cut back from twenty-five to fifteen knots: 'Go slowly and attend to your work, live a life, and avoid mining shares ... I doubt if quinine could have very much influence.'
Such advice shaded into general maxims for healthy living. These fitted with and reinforced Osler's dislike of unnecessary drugging as well as his personal temperance. To the Johns Hopkins graduating class of 1900 and at the Historical Club in 1901 he preached lay sermons about how the progress of the past century had culminated in 'a new school of medicine,' based on a return to natural methods for both the treatment and the prevention of disease. Hydrotherapy and massage were important in treating disease. Diet and exercise, he argued with a touch of hyperbolic fever, were crucial in preventing it:
Some one said he cared not who made the laws, so that he could write the songs of a nation, which I would paraphrase by saying, I care not who physics the people, provided that I could train their cooks. From the kitchen must come one of the great needed reforms in medicine. The besetting malady of this country is dyspepsia ... From it about one half of the income of doctors is derived, and at least two thirds of that of the patent medicine vendors ... If the women of the country whose energies are at present engaged in the problems of temperance, the suffrage, missions and millinery, would take a year off and spend it in the kitchen something might be done ... (Michael Bliss, William Osler, A Life in Medicine, 272-273)
"With the introduction of light beer there is not only less intemperance, but we see much less of the serious organic disease of heart, liver and stomach caused by alcohol, and less of the early general degeneration ... How few cases, comparatively, of alcoholic cirrhosis of the liver one sees. I I wish that I could say the same of intemperance in eating ... We physicians are beginning to recognize that the early degenerations, particularly of the arteries and of the kidneys, which we formerly attributed in great part to alcohol, is due to too much food. The clinkers kill, and we all, I fear, habitually have clinkers and ashes in our machines which clog the workings, rust the bearings, and lead to premature break-down ...
"The remarkable increase in the means of taking wholesome out of door exercise goes far to counteract the universal malignity of the American kitchen. Golf and the bicycle have in the past few years materially lowered the average incomes of the doctors of this country as derived from persons under forty. From the senile contingent - those above this age - the average income has for a time been raised by these exercises, as a large number of persons have been injured by taking up sports which may be vigorously pursued with safety only by those with young arteries.
"In other talks Osler sometimes warned against the excessive use of tobacco but it was not in the foreground of his neopuritanism. In 1896 he remarked on the rarity of tobacco's toxic effects despite its widespread use. He believed there was a form of angina, 'tobacco heart,' brought on or aggravated by tobacco, and a tongue condition, 'tobacco tongue.' Otherwise he sided with lovers of the precious weed and attacked a writer in the British Medical Journal who condemned cigarette smoking: 'As a cigarette smoker of some twenty-four years standing, I would like to make the counterstatement, that to smoke a cigarette (a good one, of course!) is to use tobacco in its very best form, and that in moderation it soothes physical irritability and corrects mental and moral strabismus.'
Osler proscribed all forms of tobacco for youth. Tom Cullen told the story of Osler one day persuading a young man to give the vile habit up and throw away his box of cigarettes. 'Dr. Osler walked down the step to the lawn, picked up the box of cigarettes, took one out, lighted it and put the box in his pocket.
(Michael Bliss, William Osler, A Life in Medicine, 274)
Jet: later on in England Osler gave a lecture against smoking and as a grand finale lit up a cigarette, to the great amusement of the audience. His death was caused by emphysema and pleurisy, which the MD author of this biography does not attribute to smoking. I have no expertise here but my brother, a smoker, has emphysema and I, a non-smoker, do not.
"A moderate health reformer in those years, Osler today would have eschewed the extremes of modern food and exercise faddism, though he surely would have stopped smoking. He would certainly have endorsed devotion to good health as an almost religious pursuit. The very origin of his profession had been in the cult of Aesculapius, the worship of health. `In the old Greek there was deeply ingrained the idea of the moral and spiritual profit of bodily health. It was too bad, Osler wrote at the beginning of the twentieth century, that the `beauty and majesty of this old therapeutic worship had degenerated into the sordid superstitions of
Let us give the last word to the Master. He firmly believed that the real cure is doing the Will of God, which, as Ostler himself often said of preventive cures, puts no money into the hands of doctors or Big Pharma.
"In the early stages of our long journey to
No comments:
Post a Comment