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Truants from Medicine

Medicine, perhaps because it is the most human as well as - one hopes - the most humane science, has always numbered in its ranks men and women who have made significant contributions to the arts. This is attributed in part to the fact that because of its many career pathways, medicine attracts people with a broad spectrum of interests. The interlocking influences between health and society foster interests in physicians that extend beyond medicine. And, in the past, the opportunity to explore the classics and the humanities during preparation for a medical career was a factor that led creative minds to become "truants from medicine."

In fact, men who have studied medicine have scattered their talents and interests in a far-flung network. Nicholas Copernicus (1473–1543), the Polish priest who was the first to advance the heliocentric theory of the universe, studied medicine at the renowned University of Padua, Shakespeare’s “mother of the arts.” John Locke (1632–1704), the distinguished English philosopher, studied medicine. Jean Paul Marat (1743–1793), one of the four leaders of the French Revolution, studied medicine in France and Britain. Georges Clemenceau (1841–1929), French premier during World War I, “Tiger of France,” and the chief architect of the Treaty of Versailles, was a medical graduate.

But rather than indulging in name-dropping, I would like to look at a few physicians whose contributions have earned them lasting renown in the areas of music, drama, and literature—so much so that many people today are unaware of their medical training.

Alexander Porfirevich BorodinFrom music I have selected two men whose relations with the medical profession were diametrically opposite. The renowned Russian composer, Aleksandr Porfirevich Borodin (1834–1887), was one of Russia’s most distinguished physicians and chemists. As a consultant to the Czar’s Imperial Academy, Borodin was a founder of the Military Academy of Medicine and Surgery at St. Petersburg. As a composer, he ranks among Russia’s top five; his music has a unique rhythmic energy and melodic beauty. Many of his themes have been “popularized,” for example, in the musical Kismet. Because of his many professional activities, Borodin left only a small number of compositions of which his greatest was the opera Prince Igor. Unfinished at his death, it was completed by three composer-friends and first performed in St. Petersburg on November 4, 1890.

While Borodin loved medicine, his French contemporary, Louis Hector Berlioz (1803–1869), composer of La Damnation de Faust, Symphonie Fantastique, and the leading French opera of the nineteenth century, Les Troyens, detested it. Berlioz was driven to study medicine by a relentless physician-father. At first Berlioz refused to enroll at Paris, but aware of his love of music, the father bribed him to study osteology by the gift of an expensive flute. The lad, however, fled from the dissecting room at his first visit. “How horrible,” lamented Berlioz, “to be a student of medicine, to study anatomy, to dissect and assist at terrible operations instead of giving one’s body and soul to music.” Berlioz’s departure from medicine was as determined as his flight from the dissecting room.

Louis Hector BerliozAlthough not a physician himself, Johannes Brahms (1833–1897)—composer, pianist, and outstanding figure of German romanticism—had close ties with the medical profession not only through his past as conductor of the unique Doctors’ Orchestra of Vienna but also through his close friendship with Theodor Billroth (1829–1894)—the father of abdominal surgery. Billroth wanted to pursue a career as a pianist. When he was a student in the Gymnasium his mother persuaded him to enter medicine, and as a medical student in Gottingen, he became equally devoted to medical science.

When Billroth was elected professor of surgery at Vienna in 1862, the school was the center of clinical medicine in Europe. His two leading colleagues were Josef Skoda (1805–1881), professor of medicine and the father of therapeutic nihilism, and Carl Rokitansky (1804–1878), professor of pathology, who by 1866 had performed some 30,000 autopsies. Their fame was of such proportions that the adage of the day was “How fortunate the man who has been diagnosed by Skoda and autopsied by Rokitansky.”

Billroth’s fame was to equal that of his colleagues, but his involvement in music never flagged. He mastered the viola so that he would be able to play in string quartets. It was music that forged the bond of enduring friendship between Brahms and Billroth. Brahms tested his compositions in Billroth’s salon before they were made public, and together the physician and the composer wrote a work on the physiology of music: Wer ist musikalisch.

The German physician who gained the greatest distinction in music, Albert Schweitzer (1875–1965), was deeply tied to religious music, Bach, the pipe organ, and the study of divinity before he enrolled in the medical faculty at Strasbourg in 1905. Six months earlier he had read an article in which Alfred Boegner, the president of the Paris Missionary Society, complained that the mission had not enough workers to carry on its work in Gabon, the northern province of the Congo colony. This convinced Schweitzer that he should be a “Jungle doctor.” When he entered the office of the dean at Strasbourg, he feared that because he was 30 “he would have liked best to hand me over to his colleague in the psychiatric department.” At his mission in Lambarene in Gabon, the organ continued as Schweitzer’s avocation, and he supported the mission in large measure by organ-recital tours in Europe.

Oliver Wendell Holmes (1809–1894) of Boston illuminated the nineteenth century in both his vocation and avocation. His essay On the Contagiousness of Puerperal Fever published in 1842, stressed the communicable nature of childbed fever and was a major medical contribution.

When Holmes graduated from Harvard Medical School in 1836, the Paris Medical School with its great teaching hospitals, Hotel Dieu and Le Charite, was the world center of medical education. Holmes was one of a group of the brightest American medical graduates who were drawn to Paris to sit at the feet of the masters of percussion and ausculation. From his Paris days, he derived one of his cleverest poems, The Stethoscope Song. He writes about a young Boston physician fresh from Paris with a fancy new stethoscope, which made him a popular consultant. But all went awry when a spider crawled into the bell of the stethoscope and spun a web that trapped two wildly buzzing flies. When he was called to the bedside of his first patient:

Oliver Wendell Holmes

Then out his stethoscope he took,
And on it placed his curious ear;
"Mon Dieu!"said he, with a knowing look,
"Why here is a sound that’s mighty queer!"
Five doctors took their turn to hear;
"Amphoric buzzing," said all five.
"There’s empyema beyond a doubt;
We’ll plunge a trocar in his side."
The diagnosis was made out,
They tapped the patient so he died.

The young man then examined a chronically ill female.
So there the nice old lady sat,
With phials and boxes all in a row,
She asked the young doctor what he was at,
To thump and tumble her ruffles so.
Now, when the stethoscope came out,
The flies began to buzz and whiz.
Oho! the matter is clear, no doubt;
An aneurism there plainly is.
Now, when the neighboring doctors found
A case so rare had been described,
They every day her ribs did pound
In squads of twenty; so she died.

The young doctor’s last patients in Boston were six lovelorn damsels whose hearts pounded so rapidly that the flies buzzed louder than ever.
He shook his head:
"There’s Graves
I greatly fear you all
   must die;
A slight post-mortem
   if you please,
Surviving friends
   would gratify."
The six young
   damsels wept
Which so prevailed on six young men
That each his honest love avowed,
Whereat they all got well again.

This was the final blow; the young man’s budding practice collapsed and he ended in a country town. And, Holmes’s final admonition:
Now use your ears all you that can,
But don’t forget to mind your eyes,
Or you may be cheated like this young man
By a couple of silly, abnormal flies.
For the 20th century’s truant to poetry, I have chosen William Carlos Williams (1883-1963), who practiced medicine, primarily pediatrics, in Rutherford, New Jersey, for 40 years. He was, at the same time, a prolific writer of drama, short stories, and other forms of fiction. But his poems, with their vivid and lucid style in the idiom of everyday American speech, are in the first rank of American poetry. Much of his work is drawn from his association with the poor families he treated in his practice. Medicine not only enabled him to support his family. It gave him emotional ballast and was itself the source of some of his most impressive writing. Toward the end of his career as a practitioner, Williams was frequently asked how he managed to maintain an equal interest in medicine and poetry for so many decades. He responded that for him they were nearly the same thing. “And my medicine was the thing that gained me entrance to these secret gardens of self. It lay there, another world, in the self. I was permitted by my medical badge to follow the poor, defeated body into those gulfs and grottos.” Without the insights that Williams gained as a physician, he probably would not have gained the accolade that, at his death, he had no peer as the total American writer. Perhaps more than any other poet of the 20th century, he shaped the present American approach to the writing of verse.

Anton Chekhov’s (1860–1904) greatness as a playwright and short story writer stems from his ability to evoke poignancy from deceptively simple situations where nuance serves as “action.” While the lineage of the other leading Russian writers—Pushkin, Tolstoy, Turgenev—was patrician, Chekhov was the son of a serf. His interest in medicine evolved from the attachment he developed for his physician when he was 15 years old and ill with an abdominal infection. He had already shown a singular ability as a writer of dramatic scenes and as an actor, and when he enrolled at the medical school of Moscow University in 1879, Chekhov was able to support himself and his parents by his writing. In medical school, his two interests often met. After he attended an autopsy, for example, instead of recording his objective observations, Chekhov wrote a short story based on the deceased man’s lifestyle and the circumstances of his death. And from the beginning of his career he was more interested in the dawning science of medicine than in the art of practice: “I’m steeped in medicine although I do not have faith in myself as a physician,” Chekhov wrote to his brother in 1883.

In 1884, when he was only 24 years old, Chekhov was diagnosed as having pulmonary tuberculosis. His fame as a writer was growing and by 1888 friends were urging him to forsake medicine and concentrate on the less arduous career of writing. But as he confided to a friend, A. S. Suvorin, in a letter dated August 29, 1888: “I feel more contented when I remember that I have two professions and not one. Medicine is my lawful wife and literature my mistress. When I am bored with one, I spend the night with the other. Though this is irregular it is not monotonous, and besides neither really loses anything through my infidelity.” In the same year, he was awarded the Pushkin prize for the best literary production demonstrated by high artistic worth. Both his failing health and his literary success convinced Chekhov to lessen his commitment to medicine, but it was a reluctant decision. As a playwright, though, his greatest successes were awaiting him with The Sea Gull in 1896, Uncle Vanya in 1899; and The Cherry Orchard in 1904.

A.J. CroninNovels
Illness and rising literary success were also the factors in A. J. Cronin’s (1896–1981) decision to forsake a medical practice in London. After graduating in medicine from Glasgow University, Cronin practiced in a colliery town in South Wales—an experience that became the basis for one of his greatest novels, The Citadel (1937). He earned membership in the Royal College of Physicians and moved to Bayswater in London where he soon developed a lucrative practice in internal medicine. Since his student days in Glasgow, Cronin had been plagued with indigestion and in 1930 his discomfort became acute. He was found to have a chronic duodenal ulcer, and a period of rest away from medicine was prescribed. He welcomed it: “I am going to write, I had always wanted to write.” With his wife and two young sons, Cronin spent six months in the western Highlands of Scotland and in three months wrote Hatter’s Castle (1931). The novel recounts the tragic consequences of a man’s egotism and bitter pride. Cronin, however, thought it a waste of time and tossed the manuscript away several times. Fortunately, it was rescued by a friend, Victor Gollancz, and as we know, it became his first and one of his most successful novels with translations into 22 languages. By 1932, Hatter’s Castle had sold over three million copies, and Cronin tells us: “I hung up my stethoscope, and put away that little black bag—my medical days were over.”

With medical practice behind him, Cronin entered two decades of remarkable productivity: The Stars Look Down (1935), The Keys of the Kingdom (1942), The Green Years (1944), Shannon’s Way (1948), and The Spanish Gardener (1950). In The Keys of the Kingdomand The Citadel, which many consider his greatest books, A. J. Cronin’s medical background is quite evident. Surely, people in many lands can be grateful for the duodenal ulcer that led him to six months’ rest and Hatter’s Castle.

“I do not know a better training for a writer than to spend some years in the medical profession.” These were the words of William Somerset Maugham (1874–1965), who more than any other “refugee” lauded the important role that medicine played in his resounding success as a writer. An expert craftsman and storyteller, Maugham was a cynic who wrote with great sentimentality, a trait that made critics cool to him but endeared him to millions of readers.

Maugham had little motivation to study medicine. “I did not want to become a doctor . . . the medical profession did not interest me, but it gave me the chance of living in London and so gaining the experience of life that I hankered after.” After he enrolled at St. Thomas’s Hospital Medical School in London, Maugham found the basic sciences dull but liked the clinical work because of its human contacts. The emergency room and out-patient department were especially attractive. “In those three years I must have witnessed pretty well every emotion of which man is capable. It appealed to my dramatic sense. It excited the novelist in me.” It was from these experiences that Maugham derived Liza of Lambeth (1897), his first novel which he wrote while still a medical student. In discussing it he emphasizes again the value of the human side of medicine for a writer. “Any merit it may have is due to the luck I had in being, by my work as a medical student, thrown into contact with a side of life that at that time had been little exploited by novelists.” He was referring to the lower classes who frequented the clinic at St. Thomas’s and to whose wretched homes he was sent as a student and intern. Maugham described the people and the incidents so vividly that Liza of Lambeth was an unexpected success; Maugham decided that his fortune was made and abandoned medicine to become a writer.

Of Human Bondage (1915), which is generally considered Maugham’s finest book, tells the story of a London medical student, Philip Carey. The first draft of the manuscript was written while Maugham himself was a 23-year-old medical student. Many years later he described the book as an autobiographical novel, written partly to purge the teeming memories of his past life.

Maugham’s travels to the South Seas produced such short stories as Rain and the novel The Moon and Sixpence (1919)—a fictional account of the life of the French painter, Paul Gauguin (1848–1903). Some of Maugham’s finest short stories are based on his visits to Malaya; one of the most memorable, Up at the Villa, became a movie, The Letter, in 1929.

We have commented on two physicians who left medicine because of illness—Chekhov and Cronin; one who left because he preferred another career—Maugham; and one who left simply because he detested medicine—Berlioz. Sir Arthur Conan Doyle (1859–1930), creator of the greatest detective of them all, Sherlock Holmes, dropped out of medicine because he was unsuccessful as a practitioner. Doyle grew up in Edinburgh, and his mother decided that he should be a doctor because of the renown of the medical school. As a student, Doyle was intrigued by the professor of surgery, Joseph Bell (1837–1911), scion of a surgical dynasty at Edinburgh that spanned the eighteenth and nineteenth centuries. A thin, wiry, dark man with penetrating grey eyes, Bell selected Conan Doyle to be his outpatient clerk. This relationship afforded Doyle an opportunity to appreciate Bell’s incisive perceptive sense: “He often learned more of the patient by a few quick glances than I had done by my questions.” Doyle graduated as a bachelor of medicine in 1881, and after sea voyages to the Arctic and West Africa, in 1882 he opened a general practice in Southsea, the residential quarter of Portsmouth. He had been trying his hand at short stories for nearly ten years, and after several failures, decided to write a mystery, using Bell as the model for Sherlock Holmes. “I thought of my old teacher, Joe Bell, of his eagle face, of his curious ways, of his eerie trick of spotting details. If he were a detective he would surely reduce this fascinating but unorganized business to something nearer to an exact science.”

Sir Arthur Conan DoyleDoyle’s recollection of specific examples of Bell’s intuition was important: “It is all very well to say that man is clever, but the reader wants to see examples of it—such examples as Bell gave us every day in the wards.”
Since Holmes was too modest to recount his dazzling exploits, he needed a quiet, retiring companion as his narrator. Dr. John H. Watson, a retired Army medical officer was contrived—perhaps Doyle pictured himself as Watson. The first Holmes mystery, “A Study in Scarlet,” was published in Beeton’s Xmas Annual in December 1887 and as a book the following year. It started Doyle and Holmes on the road to fame.

Although Doyle’s practice grew slowly, it was sufficient to keep him occupied, but in 1890, he decided to move to London. Doyle had tired of general practice and spent six months learning ophthalmology at Vienna before opening his office on Wimpole Street, London. It included a consulting room and the use of a waiting room; Doyle soon discovered that it was he who was waiting. “Each morning I walked from the lodgings at Montague Place, reached my consulting room at ten and sat there until three or four with never a ring to disturb my serenity.” He capitalized on that serenity by turning out short stories on Holmes; thus he was able to convert his failure in practice into a brilliant literary career.
After a severe bout of influenza in 1891, Doyle finally gave up any ideas of life as a physician in order to concentrate on writing. At this juncture, he tired of Holmes and turned to historic novels, the first of which, The Refugees(1891), was about the French Huguenots. He found this genre more gratifying than Sherlock and although the public clamored for more adventures of the master detective, Doyle decided to end the life of his hero in The Final Problem (1893) which culminates in a contest with the wicked Professor Moriarty and both falling into Reichenbach Falls in Switzerland. There was not such widespread mourning in London until the death of Queen Victoria seven years later. Young men wore black silk bands on their sleeves or around their hats and women appeared in black veils. Queen Victoria was quoted as saying, “We are not amused!” Fortunately, as we know, Holmes managed to drop to a narrow ledge instead of into the cataract. Doyle left him on this ledge for a decade before Sherlock reappeared in 1903 at the flat of Dr. John Watson. Doyle’s well-known interest in the paranormal was acquired while a medical student at Edinburgh and lectures on psychic experiences became a major preoccupation after his son’s death in World War I.

Can we anticipate a new wave of medical truants such as Doyle, Cronin, Maugham, and Holmes? It would be more difficult in America today because of the intense concentration on quantitative science in premedical education, to the detriment of the humanities and the consequent development of the broadly cultivated mind. But doctors continue to write more than research papers and prescriptions: Michael Crichton; a Harvard graduate who has never practiced medicine, is the author of The Andromeda Strain (1969), The Terminal Man (1972), and The Great Train Robbery (1975); and Robin Cook, a graduate of Columbia University’s College of Physicians and Surgeons and a practicing ophthalmologist and clinical instructor at Harvard, is the author of Coma (1977).

The worlds of medicine and literature have never really been far apart; their concern is humanity in all its varied conditions, both emotional and corporeal. Great writers, like great physicians, do not come along every day. But then, who knows? Somewhere, after the last patient has been seen and the last insurance form has been filled out in quintuplicate, a physician is reaching into his or her desk drawer to commence “moonlight” work on a novel or book of poetry that will find its way to publication and send the critics scurrying for new superlatives. Medicine and the humanities need such truants.

John Z. Bowers '38
As my husband’s literary executor, I am very pleased that the
Bulletin editorial board has selected “Truants from Medicine” for publication.

This lecture was delivered in 1978 at the fourth Biennial International Film Festival at the University of Texas Health Science Center in San Antonio. The invitation to participate was extended by Walter Matthau.

The author had the unique ability, with his consumate skill and scholarship, to bring a subject to life. His style of writing provided for an entertaining evening of worthwhile reading for both medical professionals and nonprofessionals.

A 1938 graduate from Maryland, my husband was an internationally recognized leader in medicine, particularly on medical history and education. While he was trotting the grove to promote international public health, he always found time to devote himself to producing numerous books and journals. The author himself was a truant from medicine.

—Akiko Kobayashi Bowers, LHD

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