English Surgeon and Pioneer in Neurosurgery
Wilfred Trotter, fully Wilfred Batten Lewis Trotter
English Surgeon and Pioneer in Neurosurgery
The first [quality] to be named must always be the power of attention, of giving one's whole mind to the patient without the interposition of anything of oneself. It sounds simple but only the very greatest doctors ever fully attain it. ... The second thing to be striven for is intuition. This sounds an impossibility, for who can control that small quiet monitor? But intuition is only interference from experience stored and not actively recalled. ... The last aptitude I shall mention that must be attained by the good physician is that of handling the sick man's mind.
The fundamental activity of medical science is to determine the ultimate causation of disease.
The mind likes a strange idea as little as the body likes a strange protein, and resists it with a similar energy. It would not perhaps be too fanciful to say that a new idea is the most quickly acting antigen known to science. It we watch ourselves honestly, we shall often find that we have begun to argue against a new idea even before it has been completely stated. I have no doubt that that last sentence has already met with repudiation—and shown how quickly the defense mechanism gets to work.
The ordinary patient goes to his doctor because he is in pain or some other discomfort and wants to be comfortable again; he is not in pursuit of the ideal of health in any direct sense. The doctor on the other hand wants to discover the pathological condition and control it if he can. The two are thus to some degree at cross purposes from the first, and unless the affair is brought to an early and happy conclusion this diversion of aims is likely to become more and more serious as the case goes on.
The truly scientific mind is altogether unafraid of the new, and while having no mercy for ideas which have served their turn or shown their uselessness, it will not grudge to any unfamiliar conception its moment of full and friendly attention, hoping to expand rather than to minimize what small core of usefulness it may happen to contain.
An event experienced is an event perceived, digested, and assimilated into the substance of our being, and the ratio between the number of cases seen and the number of cases assimilated is the measure of experience.
The various systems of doctrine that have held dominion over man have been demonstrated to be true beyond all question by rationalists of such power—to name only a few—as Aquinas and Calvin and Hegel and Marx. Guided by these master hands the intellect has shown itself more deadly than cholera or bubonic plague and far more cruel. The incompatibility with one another of all the great systems of doctrine might surely be have expected to provoke some curiosity about their nature.
Disease often tells its secrets in a casual parenthesis.
If mankind is to profit freely from the small and sporadic crop of the heroically gifted it produces, it will have to cultivate the delicate art of handling ideas. Psychology is now able to tell us with reasonable assurance that the most influential obstacle to freedom of thought and to new ideas is fear; and fear which can with inimitable art disguise itself as caution, or sanity, or reasoned skepticism, or on occasion even as courage.
If we watch ourselves honestly we shall often find that we have begun to argue against a new idea even before it has been completely stated.
It has already been pointed out how dangerous it would be to breed man for reason - that is, against suggestibility. The idea is a fit companion for the device of breeding against “degeneracy”. The degenerate – that is, the mentally unstable – have demonstrated by the mere fact of instability that they possess the quality of sensitiveness to feeling and to experience, for it is this which has prevented them from applying the remedy of rationalization or exclusion when they have met with experience conflicting with the herd suggestion.
It is interesting to notice that in discussing the mechanism of psychoanalysis in liberating the ‘abnormal’ patient from his symptoms, Freud repeatedly lays stress on the fact that the efficient factor in the process is not the actual introduction of the suppressed experiences into the conscious field, but the overcoming of the resistances to such an endeavor. I have attempted to show that these resistances or counter-impulses are of environmental origin, and owe their strength to the specific sensitiveness of the gregarious mind. Resistances of similar type and identical origin are responsible for the formation of the so-called normal type of mind. It is a principal thesis of an earlier essay in this book that this normal type is far from being psychologically healthy, is far from rendering available the full capacity of the mind for foresight and progress, and being in exclusive command of directing power in the world, is a danger to civilization.
It is sometimes asserted that a surgical operation is or should be a work of art ... fit to rank with those of the painter or sculptor. ... That proposition does not admit of discussion. It is a product of the intellectual innocence which I think we surgeons may fairly claim to possess, and which is happily not inconsistent with a quite adequate worldly wisdom.
It was not noisy prejudice that caused the work of Mendel to lie dead for thirty years, but the sheer inability of contemporary opinion to distinguish between a new idea and nonsense.
Mr Anaesthetist, if the patient can stay awake, surely you can.
Nothing is more flatly contradicted by experience than the belief that a man, distinguished in one of the departments of science is more likely to think sensibly about ordinary affairs than anyone else.
The air of caricature never fails to show itself in the products of reason applied relentlessly and without correction. The observation of clinical facts would seem to be a pursuit of the physician as harmless as it is indispensable. [But] it seemed irresistibly rational to certain minds that diseases should be as fully classifiable as are beetles and butterflies. This doctrine ... bore perhaps its richest fruit in the hands of Boissier de Sauvauges. In his Nosologia Methodica published in 1768 ... this Linnaeus of the bedside grouped diseases into ten classes, 295 genera, and 2400 species.
The mind likes a strange idea as little as the body likes a strange protein and resists it with similar energy. It would not perhaps be too fanciful to say that a new idea is the most quickly acting antigen known to science. If we watch ourselves honestly we shall often find that we have begun to argue against a new idea even before it has been completely stated.