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]
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.