Lessons from a Pandemic

 

We are not the first to live through a pandemic and there is much to learn from the successes and the failures of those who have gone Before

 

A world awakens to a global pandemic, as cases of a new and poorly understood virus grow almost exponentially. There is confusion, mixed public health messages and a lack of international co-ordination and collaboration. Conspiracy theories about its origins start to circulate, and the headlines report that even the rich and famous are affected, from Royalty to those in Hollywood. Newspapers are full of complaints about the Government’s slowness to take the disease and its impact seriously. Medical students are mobilised to assist in frontline hospital care. Social distancing measures are put in place and face masks become a normal sight on the streets. And the British Prime Minister contracts the virus.

However, this is not Boris Johnson, but David Lloyd-George and not 2020, but 1918. Evidence, if any were needed, that history does repeat itself and can offer lessons for those who chose to learn them.

Today, in the midst of a new pandemic, we are inundated with graphs showing infection rates and death rates. On the nightly news there are coloured lines that soar and flatten, that compare and contrast, that dispute and justify. But, almost the same graphs, albeit hand-drawn and now looking yellowed and somewhat quaint, were produced in 1918–19. They tell the story of that other pandemic, of its spread and of its toll. They chart the weaknesses in their defences and they record the successes and failures of different ploys used to “flatten the curve” a century ago.

The figures are stark. In 1918, as a world at war was at last seeing the possibility of an end to hostilities, a new enemy emerged—influenza. We still do not know where the new virus came from despite its common name of Spanish Flu, nor, despite decades of research, do we fully understand what made it so deadly. Over a two-year period one-third of the 1.5 billion global population were infected and somewhere between 50–100 million died—several times the number that had been killed in the Great War. The death toll in the UK alone was almost a quarter of a million. One of the most striking things about that pandemic was the impact it had on apparently healthy young adults aged 20–30. Young men and women were often reported to be healthy at breakfast and dead by the evening.

Of course, the world in 1918 was very different to that of today. Despite a wealth of everyday experience, there was a much poorer understanding of infectious diseases. There were no antivirals, and penicillin would not be discovered for another decade. Intensive care in hospitals was unknown and the mainstay of management was general supportive therapy. Today, we certainly have much more in our acute medicine arsenal, but from a public health perspective the responses to the 1918–19 pandemic were not so different to those we have put in place a century later.

Schools, shops and theatres were closed. Social gatherings were limited, quarantines were put in place and face masks became a common sight. However, the unevenness of how these containment policies were applied and how erratically they were followed provides a useful lesson. For example, in the United States, different cities adopted very different approaches to the pandemic, and, even those that put in place strenuous measures to limit the spread of the disease, did so on different timescales. Those cities, such as Seattle, that reacted quickly and held firm to their policies, were the ones to fare best, with the lowest numbers of influenza deaths. Those that responded well initially but chose to relax their lockdowns as soon as they saw a downturn in the disease, such as Denver, would see subsequent new waves of infection. And those, such as Philadelphia, that delayed in putting any meaningful measures in place, and thus allowed the infection to take hold in their populations, saw the worst death rates of all.

The politicians in 1918–19 also faced the same dilemmas that our policy makers do today. They had to balance public health concerns with the economic impact of a shutdown, and they had to deal with incomplete and often conflicting scientific advice along with growing public outcry over the consequences of their policies. A century ago, just as there are today, there were some very vocal groups hostile to the strategies. Many flouted the preventive measures, with some calling them unnecessary and draconian and others expressing their outrage at the infringement of their personal liberties. Different administrations around the world followed different public health strategies with little, if any, co-ordinated effort and the global infection and death rates were equally variable.

Today, in a society with wall-to-wall news coverage, we are acutely aware of how the complex story of a pandemic unfolds. New data informs as well as distorts the picture. Policies based on the latest information quickly become obsolete, and all the time we are expecting the best decisions to be made about our lives and our livelihoods.

In 1918–19, those having to deal with a disease they barely understood were eager to try any treatment that might work, irrespective of evidence. Interestingly, one of the main contenders was the anti-malarial drug quinine. In 2020, in another startling parallel, one of the main treatments that has been advocated, with equally little evidence, is the anti-malarial drug, hydroxychloroquine. The notion of evidence-based practice was not strong in 1918 and perhaps the headlong dash to use untested treatments might be understandable. However, in 2020 it is nothing short of unforgivable. In a matter of weeks, the collective global research project has turned all its energies and resources towards discovering an effective treatment, a viable test and a safe vaccine for Coronavirus, but already concerns are being raised about the speed, quality and ethics of some of these studies. We must ensure that the immediacy of the challenge will not be used to justify a descent into poor research practices.

There are clearly lessons to be learned from history, but as the philosopher George Santayana famously said, “Those who cannot remember the past, are condemned to repeat it.” Our collective memories may be dimmed by the passing years, but every line on those old graphs, despite their fading figures, represent men and women who lived and died during a pandemic a century ago. And their ghosts speak loudly and eloquently. Let us not give credence to the words of that other philosopher, Georg Wilhelm Friedrich Hegel who noted pessimistically that, “The only thing we learn from history is that we learn nothing from history.” Given the gravity of the situation we find ourselves in, perhaps it might do us well to try. History is an open book; the lessons are there if we choose to heed them.

© Allan Gaw 2020

A version of this article appeared in MDDUS Insight, June 2020.

 

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

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“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

Also available on kindle:

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Conference Season Goes Virtual

 

As more academic conferences go online, how can attendees make the best of them?

The conference is one of the cornerstones of academic life. Assembling with our peers to learn, share, network and sometimes even to carouse, usually in a pleasant location away from the distractions of home and our everyday work, has become something that most academics look forward to with relish.

We write abstracts and craft short presentations of our work, design posters and slides and pore over the agenda of the meeting working out what can’t be missed, and when there might be a space to meet with old friends or the time and opportunity to make some new ones. We attend conferences not just because it is expected of us, but because they can be a rich source of professional exposure, opportunity and feedback. They might even be inspiring and we all need that. And, of course, they provide a change of scene and of pace, adding colour and interest to the oftentimes drudge of solitary scholarship.

However, all of this depends on often hundreds of people travelling to a venue, maybe in a foreign city, rubbing shoulders and shaking hands and doing everything possible not only to encourage the spread of ideas but also of Coronavirus. As such, the current pandemic has forced a speedy rethink on how and whether the academic conference can continue. In truth, even before the world awoke to the need for social distancing, many were already sounding the death knell of the traditional conference. Can we really justify flying half-way around the world to deliver a ten minute presentation of our research work, either economically or environmentally? And even if we think we can, there are a growing number of researchers who can no longer find the financial support to make it a reality.

Already, many academic conferences were reinventing themselves as hybrid events — a traditional face-to-face extravaganza, but with online options for those who could not attend in person to share the experience. This undoubtedly democratises the academic conference ensuring that anyone with an internet connection can take part, not just those who can afford the plane ticket.

Now, however, conference organisers are being compelled to overhaul their whole approach and deliver entirely virtual events. Of course, this presents a number of challenges, especially when we think of all the things that conferences do. But, might it also offer some opportunities — could the entirely virtual conference be an even better experience for attendees?

 

Learning

We go to conferences, probably first and foremost, to learn. All conferences, whether traditional or online, will be judged by the quality of the programme and the speakers. In every field there are top-tier events that everyone would like to attend largely because they know that’s where the real action will be —the leading lights in the subject presenting their latest findings. But there are also a host of smaller, second-rate, maybe even third-rate, events that you might think twice about putting the effort in to attend.

This aspect of the academic conference is probably the one most easily translated into an online format. After all, how different is it to sit at the back of a very large auditorium listening to a recent Nobel Laureate explain her latest discovery while looking at her slides but barely being able to see her face, than to watch the same presentation from the comfort of your own desk? Alright, you can’t put your hand up and ask a question, or corner her afterwards to strike up a discussion — or can you? Most virtual learning environments will not only allow you to listen and view a presentation, they will also allow you to ask questions and interact with speakers in a variety of ways. And as for cornering the speaker afterwards, you will have her contact details and if your question or comment is compelling enough, you might even get an answer. Of course, one big advantage the online conference has here is that all the presentations can be recorded and made available asynchronously to attendees. No more worries about falling asleep in the middle of that keynote lecture because of jet lag.

 

Presenting

What about presenting? We go to conferences not just to listen to others but also to talk about or display our own work. We do this partly in the hope of getting valuable feedback, but also to raise our academic profile — to become a player in our field. Many virtual conference organisers are trying a variety of formats to offer online substitutes for this aspect of the conference experience. At the low-tech end of the spectrum, you will still be invited to submit a written abstract of your work, which will be curated and made available for all attendees to read. A little further up the scale, you might be invited to submit a virtual poster or a short stand-alone slide show. And at the top-end you might be asked to record a short presentation or even deliver one live. Again, if the conference has your presentation recorded, it can be made available to a much larger audience than you might ever expect to address at a traditional conference. If you do have to deliver an online presentation, do take the time to learn how to do it (have a look here).  Remember, as with all academic presentations, the quality of your work will often be judged by the quality of your talk.

 

Networking

Probably the next most important reason for going to all the bother and expense of attending a conference is to network. Meeting your peers and mixing with the great and the good in your field is an essential first step to building those lasting professional relationships that will form the scaffolding of your career.

But, if you can’t meet anyone, look into their eyes, offer them your hand and your smile, how can it work? Well, networking at its most basic is about making contact and then nurturing that contact. Many virtual conferences are currently making use of all sorts of different apps to allow for networking. Some of these are undoubtedly better and easier to use than others, and I suspect we will see a few becoming the dominant tools of the trade as we gain more experience with virtual conferences. You may, for example, be put randomly in a virtual meeting room with several other online attendees and asked to introduce yourselves and discuss a specific issue. This forces you to meet and interact with new people. Another app acts rather like a speed dating service where you are serially assigned to other attendees, one by one. You both have a few minutes to discuss who you are and what you do and in each case at the end you can agree to exchange contact details for further follow up, or not. Not quite Tinder, but almost. Some conferences encourage virtual community groups to form before and during the conference with a view to extending those new-found contacts after the event is over. If the conference makes available lists of attendees and their contact details before the conference, you can also identify those of interest and contact them ahead of the event.

In every case, you are being given an opportunity to make first contact and forge new professional friendships, but the ongoing nurturing that is so important to effective networking will be up to you, and that requires being pro active, just as it does at the traditional conference.

Closely related to this networking are the social aspects of conferences. At meetings, we eat and drink together, we chat about matters other than work, we sometimes enjoy entertainments, especially if the organisers wish to showcase some of their local culture, and we may even get a chance to see the sights. Some conferences are working hard to replicate these aspects of conference attendance in the virtual environment. Why not have coffee breaks with forums dedicated to non-conference chat? What about an inspirational speaker, such as an Olympian or an Astronaut to close the day? What about a virtual walking tour of the local art gallery? What about some national singing, dancing or even a cookery class teaching you how to make a local delicacy? All of these and more are being explored in an attempt to flesh out the programme and to provide virtual conference attendees with an experience far richer than just a series of poorly delivered webinars.

And of course, let’s not forget the freebies that you might spend your conference time hunting down. If there are conference sponsors, they may have trade stands where you might delight in picking up that free pen, post-it pad or even key ring. Can’t fill a swag bag online, can you? Of course you can, it just has to be with digital freebies. Useful downloads, free apps, discount vouchers, zoom backgrounds, clip art libraries for your slides — the list is almost endless, and I am sure virtual conferences in the coming months will surprise you with digital delights that you never even knew you needed.

 

Conclusion

Ultimately, attitude is everything for the attendees at a virtual conference. All the opportunities are there but you do have to engage with the conference, and you do have to work at ensuring you get what you need out of it. If we approach the virtual conference with a preset notion that it will be a pale imitation of the last face-to-face meeting we attended, then it will be. But, if we sign in and really take part, making full use of all that is on offer, we can get as much, maybe even more, out of the virtual conference than its traditional alternative. It will certainly cost us less money to attend, it is likely to be a more efficient use of our time, we will be able to revisit presentations we found particularly useful as often as we like and there will be a host of networking opportunities there for the taking.

Going forward, we can expect huge variability in the style and quality of online conferences — as disciplines vary the emphasis they place on different aspects of the conference to suit their own specialist needs and as different virtual platforms are tried and tested. The organisers of such events are, of course, also still learning how to do it, and mistakes and missteps will inevitably be made. But, while the pandemic will come and go, the virtual conference is certainly here to stay. No, it won’t be quite like getting on a plane for a three-day conference in Edinburgh or Florence or San Diego or Kyoto, but it will be cheaper, greener, smarter and quite possibly better for your academic career in the long run.

© Allan Gaw 2020

 

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

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“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

Also available on kindle:

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A Better Normal

Physically, most of us are relatively unscathed by the circumstances we find ourselves in, but the same cannot be said for our psychological well-being.  We are all suffering some form of loss—the loss of independence, mobility, interaction, touch, intimacy.  But there are also deeper psychological issues at stake.  Many of us are frightened.  We are worried about our health and that of our loved ones, and about our livelihoods. We are scared to go out, to meet people and, as the lockdown lifts, even to re-enter the world. But, perhaps the most significant impact has been on our internal lives.

We have all been forced to spend time with ourselves and our thoughts, and we have been compelled to reflect on what might be most important to us.  There are those who crave a shopping trip, but there are also many who ache just to be held.  There is a hole in many people’s lives that busy restaurants and bars occupied, but there is also a vacancy in others that might only be filled by a shared moment of silence between friends, or even strangers.  Some are trapped by lockdown; others feel liberated.  Some are angry and frustrated and desperate to get back to normal. And others are questioning what that normal might be.  They are examining their lives in the space that this hiatus has afforded, and they are redefining what that life should look like.

We look at those things we are unable to do and question whether we really miss them, especially as we balance them against those things we can still do.  We bemoan the fact that we cannot pop to the shops when we want, either because those shops are closed or because we are being strongly encouraged to limit our travel and exposure to other people. But, are we really missing those little ad hoc spending sprees or is it merely symptomatic of our curtailed freedom? Are we really just railing against the straitjacket of lockdown? When we are free to do as we please again, what exactly will please us?

On the other side of the balance sheet are all the things we have spent more time on—the walks, the spring flowers, the butterflies, the cleaner air, the silence, the skies unwrinkled by jet trails. There have also been moments of remarkable humanity as the vulnerable and the elderly are finding support from those whom they thought of before as strangers.  There are helping hands and moments of grateful acknowledgment, smiles, nods and words of kindness that were not there before. And there is a growing realisation that this is how we could be all the time.

There are golden opportunities in every situation, irrespective of how difficult the circumstances are.  Humans rise and respond to challenge.  Indeed, that might be our defining feature as a species and now is no different.  We will invent, create, and think our way into a new way of living.  There will, of course, be a natural desire for a simple return to a stable, familiar normal—everything just as it was.  But, if this period of enforced reflection has taught us anything, it might be that our lives before the virus were not all they could be.  We are asking not for a return to the old normal, or even a new normal, but a better normal.  This pandemic has brought enormous human tragedy, but it is also the kind of opportunity that will unlikely be afforded us again in our lifetimes. It has been responsible for the kind of social and psychological upheaval that usually occurs only in war and natural disaster, and, on a more personal level, life-threatening illness and deep personal loss. Let’s seize the opportunity to find any silver lining.

So, what does your better normal look like?  What changes have you had to make during lockdown that have allowed you to learn a little more about yourself? How will your life be better from now on?  I do not say “after this” because despite what the politicians and the media might have you believe there is no “after”, no “when it’s over”. We will have to learn to co-exist with this virus and with the others that will likely come after it.  We have had a century of respite between this and the last major pandemic, but there is no assurance that we will have that kind of time again.  In the space of a few months, humanity has been reminded of its fragility and we have seen just how quickly a society, its institutions and its economy unravel. And we have all been given an opportunity to think again.  The important thing is not to squander this chance.

 

© Allan Gaw 2020

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

Screen Shot 2015-10-14 at 21.22.11

“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

Also available on kindle:

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So, you have to give an online lecture…

In these days of physical distancing, academics are having to adapt to delivering their lectures online. Many university teachers have little or no experience of this format of education, and when called upon to do it for the first time, it can be a daunting and less than enjoyable experience. However, just as no one is a born teacher — we all learn how to do it — no one is a natural at online presenting. Like everything else, though, by following a few simple rules, we can modify our approach and learn to deliver effective online lectures.

Different systems are used for online delivery. Blackboard Collaborate is the standard at many institutions, while some academics will make use of Google Classroom, Skype or Zoom. As with most educational tools, however, the platform used is less important than the teacher. Unfortunately, no software, however sophisticated, is going to turn you into an effective online presenter. That all depends on how you use the technology and how effectively you can communicate with your audience — an audience that you usually cannot see or hear. To that end there are a number of simple strategies that I think you should consider to make the best of any online teaching session, and I have put these together as my top tips.

1. Stand up when you’re talking

If you were giving a face-to-face lecture, you would be standing, so do the same when you present online. First, it will feel more like you are used to, and, second, your voice will sound better. All you have to do is elevate the computer you are using so that you can comfortably look at the webcam while standing. And while you’re adjusting the camera position, make sure you are not looking up, or more likely down, at the camera —look straight on and then your image will not be distorted by an odd and amateurish angle.

Not the best camera angle, looking down at a webcam on a laptop while seated at your desk

2. Think about what’s behind you

As well as seeing you, the students can see what’s on that shelf behind you. So, take a moment to preview your video image and check that there is nothing distracting or even embarrassing for the world to see, especially if you are delivering the session from home. Watch the news just now and you’ll see lots of people, such as Reporters, Public Health experts and even Cabinet Ministers delivering a piece to their webcam without a thought to all the domestic clutter we can see behind them.

All that media training, and that’s the messy, distracting background we get from a Cabinet Minister

3. Look at the camera

When giving your presentation, look at the camera or you won’t be looking at the students. Eye contact is just as important in online sessions as it is with face-to-face teaching. It’s very easy to fix your gaze on some part of your screen, such as a slide, and forget that your audience is on the other side of that little lens at the top of the screen.

 

4. Sort out the technical stuff at the start

Just as presenters are having to learn to give online talks, students are also having to learn to listen to and watch them. Because of this, it’s always a good idea to check right at the start whether they can hear you, see you and see anything you are sharing with them, such as slides. I usually do an emoji poll — ‘give me a thumbs up or a happy face if you can see me, hear me and see my slides.’ It’s also a good strategy to pre-empt any common technical questions because having to help an individual student with an audio or visual problem during the session can use up valuable online time. One way to do this is to open the session at least 15 minutes before the start time. During this pre-session, have a slide on view that details how to set up the audio and video functions of the system you’re using, and open your mic and play some music. That way when a student logs on to join the session, even though it is still to start, they will immediately hear something and see something and be prompted to check that all is well with their settings.

5. Keep it simple

All the good advice given for effective lecturing applies just as much in the online environment as to the face-to-face setting. But, I think when we are delivering online, it is even more important to be as simple and clear as possible. It is essential to signpost the presentation —make it clear from the outset what the format is, what level of interaction is expected and how and when students can ask questions. Take the students through the topic in a logical way, preferably broken down into short manageable segments. Anything you plan to share with students during the session, such as slides, whiteboard writing and documents, should also be as clear, simple and as uncluttered as possible. The various technologies you might use will all allow you to do fancy things, but the simpler and more straightforward you make the session, the more likely it is to work without a hitch.

6. Limit your content

When planning your presentation, you need to be aware that the online format means you will be able to cover less ground than you would in a face-to-face lecture. In my experience, this is usually of the order of 20% less. The reasons for this are multiple: for example, you will inevitably use up some of your time at the start explaining how the session will run and maybe even dealing with technical issues, and if you are taking questions during or at the end of the sessions, these will usually take longer to ask and to answer than you are used to.

7. Be interactive

If the session is live, as many are, make an effort to involve the students. If you don’t, they might as well be watching a video and a rather poorly produced one at that. But, by interacting and showing them that you are listening to them and reacting to them elevates the whole experience and any less than perfect production will be forgiven. You can interact in many ways and of course some will lend themselves more readily to some topics than others. You might ask simple polling or ‘with a show of hands’ questions to elicit a response. You could include simple activities in your presentation and ask them to comment. All these interactive options will take time and that has to be factored in to your plan. I also like to pause every 10 minutes or so and ask the students to reflect on what’s been said and invite them to ask any questions they might have. Depending on the system you are using this may involve opening a student’s mic and allowing them to speak or more simply and often technically easier, especially with large groups, to invite them to type their questions.

8. Keep up the commentary

Because your online audience doesn’t have all the usual visual clues, they can sometimes become confused if you don’t tell them what’s happening at your end of the lecture. For example, if you decide to pause to check if any written questions have been asked, or you stop speaking while you upload a slide or a document you wish to share, your students are suddenly hit with silence and a visual of you looking away. They might think they have lost audio or that something else technical has gone wrong, so keep them in the loop and keep up the flow of your commentary: ‘Let me just check the question boards…I see we have question from…’ or ‘Now, I just want to show you this page. Let me just upload it, so you can see it…there you go…’

9. Use music

If you have to pause for anything longer than say 30 seconds, it’s a good idea to fill the audio void with something, and I generally use some music when, for example, I am asking students to do a short activity or to review some text I have made available. This allows the students to know you are still there and the session is still running and they are still connected to it. As mentioned above, it is also useful to use music before the session proper starts, to allow any students to confirm that their audio connections are working properly. In addition, music can be useful not just as an ‘intro’ but also as an ‘outro’, clearly signalling that the session has ended.

10. Use handouts

To support online sessions, consider using more handouts than you would normally use. These electronic documents may provide simple access to the slides or documents you have used, perhaps questions you want to address or activities you want to do during the session, or lists of references and further reading/viewing for follow-up. All this allows you to extend the reach of your session and to balance the online lecture with guided offline resources.

11. Keep at it

Nobody gets it right first time and just as you had to work at becoming a proficient lecturer, you will have to put the hours in to become an effective online presenter. The more you do it, the more comfortable you will become and what at first seemed a very odd, self-conscious act, can develop into a much more relaxed form of teaching.

© Allan Gaw 2020

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

Screen Shot 2015-10-14 at 21.22.11

“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

Also available on kindle:

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The Guardian of My Solitude

Sometimes all we need is for the noise to stop and the air to still. Sometimes we need to sink into ourselves and find the comfort, the warmth, the solace of what beats within. Sometimes we need to be alone, to feel alone and to listen to nothing more than our breath.

Life is a merry-go-round, spinning as it flashes and rises and falls. We need to hold tight to enjoy the ride, but at times we might also be afraid of the fall. And although breathless with excitement, we can just as easily find ourselves dizzied, unable to focus on what has flashed by: the mirrors, the music, the clowns and the face in the crowd. On that carousel there is no silence, certainly no stillness, but sometimes that’s what we need. Life is a balance and the dazzle of the carnival, for all its thrill, has to be countered by the emptiness of thought and the simple peace that we find in solitude.

The German language poet Rainer Maria Rilke knew this and saw it as the role of those to whom we are bound, writing:

“I hold this to be the highest task of a bond between two people: that each should stand guard over the solitude of the other.”

To help another to find peace in solitude is ultimately a selfless act of friendship. To stand guard over that solitude, enabling it without sharing it, is a simple act of love. We are enabled in so many ways by those who care for us, and in return we need to do our best to enable them. But for those who are closest to us, we need to do more. We need to offer our defence.

But just as a lifelong ride in the clamour of the carnival would be unbearable, so would a life of unendurable isolation. Solitude only acquires its restorative power by being interrupted. Again Rilke recognised this when he wrote:

“…love and friendship are there for the purpose of continually providing the opportunity for solitude. And only those are the true sharings which rhythmically interrupt periods of deep isolation.”

Those who love us help us on to the merry-go-round of life, but they also help us off. They are with us and at the same time without us while they “stand guard”. They offer rhythm, change and interruption. They make our lives better by offering us the possibility of balance.

We may ask, “How can I be the guardian of another’s solitude?” In the same way as they will be the guardian of yours. By allowing you to be still. By understanding your silence. By not questioning, by not judging, by not needing anything more of you than the sound of your breathing. And most importantly, by leaving you alone for as long as you need and at the same time knowing when it is time to interrupt and re-enter your mind. Love is always about what we do for one another, but it is often about making sure we are actively doing nothing. Nothing to distract, nothing to demand, nothing to say and nothing to interfere with a time of solitude. We can keep others out, but we also need to stand back ourselves. We are the gatekeepers of that solitude and the guardians of the moment and we embrace those roles because we do them for those that we love.

Life can be hard. We often feel ill-equipped to cope. The demands made of us outstrip our time and resources. And at the end of the day, the week, the project, we are left empty. Our resilience spent, we need a time and a space for recovery and we need others to help us find them. Who will be the guardian of your solitude today? The same person whose solitude you will stand guard over tomorrow; the person who loves you and who you love in return.

© Allan Gaw 2020

 

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

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“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

Also available on kindle:

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The Art of Medicine – Part III of III

In this, the third and final part of the series, I want to continue the study of fine art, asking how paintings might be used effectively in a medical education, and how they might serve as the starting point for conversations about health, healthcare and what it means to be a doctor or a patient. This time, I wish to look at images created by artists who’s own ill-health has affected their work and finally at what I have called “conversation pieces”.

 

 

Self Portrait, Vincent van Gogh (1890)

In part II, I ended with van Gogh’s portrait of his doctor, Paul Gachet.  Let us look another of van Gogh’s works.  Painted in 1890, as was the portrait of Dr Gachet, this is one of almost forty self-portraits that Vincent completed in his brief artistic career.  It was described by those who knew him as the best likeness of them all.

Intense and brooding – the artist portrays himself against a background of swirling turmoil.  This painting almost shakes with rage,  with frustration, if you stand before it in the Musée d’Orsay in Paris.

Van Gogh’s  genius as an artist is often inextricably linked to his mental illness.    “My pictures are almost a cry of anguish,” he wrote, but despite many contemporary reports of his clinical state, the exact nature of his illness remains elusive.  Was he suffering from manic-depressive psychosis, as his family history might support? Was he suffering from petit-mal epilepsy, as some of his doctors thought?  Was it turpentine poisoning, as Gachet suggested? Was he simply an alcoholic or was it the more hallucinogenic and mind-numbing effects of absinthe – a favoured drink in 19th century France?

We are unlikely ever to know. But, our legacy from van Gogh’s, albeit disturbed, genius not only comprises his immense portfolio of masterpieces, but also his words:

“I should like to paint portraits,” he wrote, “which would appear after a century to the people living then as apparitions.”

A wish surely fulfilled.

Despite the lyrics of the song – van Gogh did not take his life on a starry, starry night, but in the heat of a July afternoon in Auvers-sur-Oise.  He shot himself, aiming at his heart, but the bullet was deflected by the fifth rib.  It took him almost two days to die of his septicaemia.  It was a shabby end.

Dr Gachet eased his last hours and when Vincent finally escaped the world he found so difficult, he did not escape art. Even on his deathbed this artist, who had been obsessed with confronting his own image, was the subject of yet another portrait, not this time by his own hand but by that of his doctor.

 

Portrait of Vincent van Gogh, Paul Gachet (1890)

Dr Gachet drew several portraits of the dying Vincent and one charcoal drawing can be seen in the Musée d’Orsay .

Van Gogh’s words as well as his paintings and his thoughts about the very nature of art resonate with anyone who studies medicine. He wrote:

I know no better definition of the word Art than this, ‘Art is man added to nature’, nature, reality, truth, but with a meaning, with an interpretation, with a character that the artist brings out and to which he gives expression, which he sets free, which he unravels, releases, elucidates.”

Some years later he added:

I feel like a fool going and asking doctors permission to paint”

Van Gogh was an artist in whose paintings, in whose words, and I believe even in whose eyes we are afforded one of the best examples of how art and medicine may come together and find greater meaning in each other.

 

Les Cocquelicots, Claude Monet (1874)

The second of my Artist-as-Patient case histories is that of Claude Monet.  The title of one of Monet’s early works (Impression, Sunrise) gave the Impressionist movement its name, and this painting – Les Cocquelicots – was exhibited along with it at the first impressionist exhibition in 1874 and can now be enjoyed at the Musée d’Orsay in Paris.

Painted when the artist was 33, Les Cocquelicots, or the Poppyfield is a masterpiece, yet perhaps a masterpiece somewhat cheapened by over-reproduction.

Much has rightly been made of Monet’s talent and his genius. Much has also been made of his theories and perception of light and colour, but less is written on what may have been an important reason for the changes that took place in his palette and on his canvasses over the years.

Let’s go forward some 20 years to examine these changes.

Rouen Cathedral, Claude Monet (1892)

Painted in the artist’s middle years this is one snapshot from the great Rouen Cathedral series and can be seen in the National Museum of Serbia in Belgrade.  It is indicative of the changing style and colouration, which Monet was adopting in this period.

The blue end of the spectrum begins to dominate and his canvasses drift slowly from impressionism to abstraction. Only two years after this painting was completed, the neo-impressionist Paul Signac was moved to write:

But, no M. Monet, you are not a naturalist…Trees in nature are not blue, people are not violet, and your great merit is precisely that you painted them like this, as you feel them and not just as they are.”

 

Waterlilies, Claude Monet (1910)

By the time the artist was in his 70s he had moved almost exclusively to the study of his garden at Giverny and particularly his waterlily pools. He painted around 250 versions of his beloved water lilies and they can now be seen in galleries the world over, but perhaps the most striking versions hang in the specially build oval rooms of the Musée de l’Orangerie in Paris.

In this example from around 1910, there is intense violet-blue and almost abstract brushwork. What could account for this?  A maturing artistic talent?  A developing colour theory?  Yes, but also consider what was taking place in Monet’s eyes.

His vision had been failing for years, and in the summer of 1912 bilateral cataracts were diagnosed which continued to grow over the decade until in February 1923, at the age of 83 he had surgery on one eye, which was considered at least partly successful.

Cataracts, or opacities of the lens of the eye are well known to slowly deteriorate vision, but they can also cause alterations in the way we see colour.

Such changes both in acuity and colour vision could go a long way towards explaining the apparent changes in style we can now, retrospectively, observe in Monet’s work.

The physician-cum-amateur art historian can meet with many difficulties trying to venture into the ivory towered city of fine art, but I think this particular story demonstrates clearly that the professional art historian may sometimes learn from the physician.

Conversation Pieces

Lastly, I would like to discuss three more complex images.  These are images that do not fall easily into a category, and images that from the point of view of medical education may be called conversation pieces.

 

Roses in a Champagne Glass, Edouard Manet (c1882)

What could be complex about a small vase of flowers hanging in the Burrell Collection in Glasgow?  And, what could the medical significance of such a painting be?

Nothing, at face value – for some paintings to achieve their significance, medical, historical or otherwise, you have to understand their background, perhaps the conditions in which they were painted – why, when and for whom they were painted.

When Edouard Manet, who painted these flowers, was a young man, he dazzled and scandalised the art world with his huge studio compositions  such as Déjeuner sur l’herbe or Olympia.  But, this small canvas – and that’s the key, its size – this small canvas only about 20 by 30 cm was painted in the year before the painter’s death at the age of 51.

The reason he had to revert to such small scale work, being no longer able to stand at his easel, was not because of his frailty – remember he was only 50 – no, the reason was syphilis.  Loss of proprioception and therefore loss of balance is a late feature of syphilis and this painting would not only be a useful conversation piece for the interaction of art and medicine but also an attractive mnemonic for the neurological effects of tertiary syphilis.

 

Experiment with an Air-Pump, Joseph Wright of Derby (1768)

The second of my conversation pieces is an earlier work and this time from England and hangs in the National Gallery in London. When Joseph Wright of Derby painted his Experiment with an air-pump in the 18th century, scientific research was clearly a collaborative effort, and more than 200 years later little has changed.  Little has also changed regarding our diverse views on medical research from profession and public alike, and in particular on the use of animals in research.

Here the cockatoo is being used to demonstrate that air is required for life – a demonstration that, of course, will cost the bird its life.  The faces of those present show a range of attitudes from eager anticipation, through disinterest, to revulsion.

This painting, while being a masterpiece of technique (Wright specialised in unusual lighting effects in his work) is also a masterpiece of observation and as such would be an excellent resource for the discussion of modern medical research.

This brings us to my third and final conversation piece.

 

Bathsheba holding King David’s letter, Rembrandt van Rijn (1654)

In 1654 Rembrandt painted this portrait of his mistress Hendrickje Stoffels as “Bathsheba holding King David’s letter” which now hangs in the Musée du Louvre in Paris.

After the death of his wife, Hendrickje was Rembrandt’s maid and nanny to his son Titus, but soon she became his lover and later bore him a daughter, Cornelia.  She died a young woman of 37, probably from breast cancer, but the reason I highlight this painting is only partly because it shows the swelling in Hendrickje’s left armpit and the discolouration of the underside of her breast that some have characterised as features of such a malignancy.  No, the main reason – the poignancy of this painting – is that Rembrandt took such care to record the details of her tumour.  Whatever the cause of Hendrickje’s premature death, she died defenceless against her disease.  Medical science could offer her no real help, nor any hope of recovery.  Today, however, a woman in her place should expect both.

The acceptance by patients and their relatives of a serious diagnosis, and indeed its discussion with them is an area fraught with difficulty.  Should all patients be told their diagnosis, however painful this may be?  Should their relatives be involved in this decision, or should they be entirely secondary? Like all ethical problems there are no easy answers.  Suffice to say, however, the problem is illuminated, if not solved, by discussion and I can think of worse and less interesting ways of starting that discussion with students than by looking at this masterpiece by Rembrandt.

Conclusion

I began the first of this series of essays with a quotation from Marie Therese Southgate, who served as the cover editor for the Journal of the American Medical Association for over 30 years. Each week she would choose a work of art to reproduce on the cover of that medical journal and write a short but enlightened piece on its meaning and significance.  It is to Dr Southgate that I return to give the last words.

Medicine is itself an art. It is an art of doing, and if that is so, it must employ the finest tools available — not just the finest in science and technology, but the finest in the knowledge, skills, and character of the physician. Truly, medicine, like art, is a calling. And so I return to the question I asked at the beginning. What has medicine to do with art?

I answer: Everything.”

© Allan Gaw 2020

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

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“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

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The Art of Medicine — Part II of III

 

In this the second part of our series looking at the Art of Medicine, I want to continue by studying some remarkable images of the physician and surgeon at work. And again I want to think about how such paintings may be used in medical education and how they might serve as a starting point for a conversation with students.

 

The Gross Clinic, Thomas Eakins (1875)

Many people’s image of the great physician is that of the elderly expert; the clinical sage; the master. I think this stereotype is captured here in the leonine head of Professor Gross painted in 1875 by the American realist Thomas Eakins.

This large painting, now hanging in the Philadelphia Museum of Art, which became known as “The Gross Clinic” caused a scandal in its day, and only long after the artist’s death was it described, “as the most powerful painting ever painted in America”.

As an image of the physician it works admirably showing Gross, then aged 70 standing in his milieu, the surgical amphitheatre performing and lecturing on an orthopaedic procedure on the femur of a young man.

It also works as an historical document showing the surgical conditions of the day. These can be contrasted with modern surgery, but perhaps even more interestingly with a similar scene painted by the same artist just 14 years later.

The Agnew Clinic, Thomas Eakins (1889)

“A quick but precise operator and his use of instruments was light and graceful.” So, was described Professor Hayes Agnew on whose retirement in 1889 after more than a quarter of a century teaching anatomy and surgery at the University of Pennsylvania, Eakins was commissioned to paint his portrait. This portrait became the second of his great medical works and acquired the title “The Agnew Clinic” and it also hangs in the Philadelphia Museum of Art.

Here again the physician is portrayed at work – this time at the closing of a mastectomy on a young woman. But, note the differences, which have occurred in only 14 years. Most obviously neither the patient nor the physician wears ordinary clothes – each is now appropriately gowned or draped. The theatre is now artificially lit giving control and flexibility of operating schedules. A female nurse is now present assisting with an instrument tray. Still, however, no masks, no gloves, and only anaesthesia by open drop ether.

Clearly, both these paintings by Thomas Eakins – “The Gross Clinic” and “The Agnew Clinic” – would find a place in the teaching of the history of medicine, but they are also impressive images of the physician that go further to explore the drama of the doctor at work.

This drama is yet further examined in our next painting – “The Doctor”, by Sir Luke Fildes, which can be found in the Tate Britain collection in London.

The Doctor, Luke Fildes (1891)

This has been described as “undoubtedly the best-known medical painting ever done”, and it is thought to have been inspired by the death of one of his own children on Christmas day 1877, and the medical care they received. On a superficial level it is simply a sentimental scene of country life, which appealed to the rural nostalgia intrinsic to late Victorian Britain – so much so that an engraving of the paining published at the time was a best seller.

Except for prevention, the physician of a century and a half ago had few of the tools of modern medicine – yet the central drama of medicine even in a staged scene such as this remains the same. It is played out, not in the expressions of the parents in the shadowy background, where the father stands helpless, trying to comfort his distraught wife who weeps into her arms at the table, but rather in the interaction between the two centre-staged figures – the physician and his patient. The relationship of the doctor to the child can best be summarised in a single word – attention.

In spite of its great advances, what medicine is still all about is the patient, the physician and the quality of the relationship that exists between them. I think this painting has a great deal to say on that subject, and what it says it says more eloquently that words.

Portrait of Dr Gachet, Vincent van Gogh (1890)

The last of our portraits of physicians is that of Paul Gachet – a doctor who loved art. He lived in Auvers-sur-Oise where he was an enthusiastic patron of several of the impressionist artists including Pierre-Auguste Renoir, Paul Cézanne and Claude Monet.

He was regarded as more than a little odd by the townsfolk and as well as having a professional specialist interest in psychiatry is thought to have suffered from a form of depression himself. Certainly, for many, there is an overwhelming sense of sadness, perhaps even despair, in Gachet’s disposition as depicted here. This portrait was painted by his most celebrated patients who was, of course, Vincent van Gogh. As an aside, there are two versions of this Gachet portrait, one believed to be in a private Japanese collection, the other hanging in the Musée d’Orsay in Paris, and one of the paintings is believed by some to be a forgery.

Unlike the previous examples, this is not a painting of a physician at work, but are we given any clues to Gachet’s profession? Van Gogh has provided us with a frond of foxglove or digitalis on the table in front of his model, perhaps as a visual reminder that his subject is a prescriber of medication derived from this plant. But for those standing before this painting, the most striking features are Gachet’s eyes.

On June 12, 1890, six weeks before he would shoot himself, the artist wrote to his sister,

I painted a portrait of M. Gachet with an expression of melancholy, which would seem to look like a grimace to many who saw the canvas. And yet it is necessary to paint it like this, for otherwise one could not get an idea of the extent to which, in comparison with the calmness of the old portraits, there is expression in our modern heads, and passion and like a waiting for things as well as a scream. Sad and yet gentle, but clear and intelligent – this is how one ought to paint many portraits.”

Despite his own illness, van Gogh could see the suffering in the eyes of his doctor, describing him as “sicker than I am, I think, or shall we say just as much.” That foxglove, those eyes, the whole demeanour of the painting are the beginnings of a conversation about what it means to be doctor and at the same time a human being, as much at the mercies of ill-health as everyone else.

Mention of Dr Gachet’s patient and painter, Vincent van Gogh brings us to our fourth category, that of the artist as patient, which we will explore in our next and final part of this series.

© Allan Gaw 2020

 

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

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“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

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The Art of Medicine — Part I of III

Medicine and Art have a common goal: to complete what nature cannot bring to a finish, to reach the ideal, to heal creation. This is done by paying attention. The physician attends to the patient; the artist attends nature. If we are attentive in looking, in listening and in waiting, then sooner or later something in the depths of ourselves will respond. Art, like medicine, is not an arrival; it’s a search. This is why, perhaps, we call medicine itself an art.”

These are the words of Marie Therese Southgate, a physician and former Deputy Editor of the Journal of the American Medical Association. This was an enlightened journal in many ways, not least of all because, amongst the clinical and scientific reports it published, it placed fine art high enough to have reproduced images of paintings and sculpture on its covers for almost 50 years.

 

M. Therese Southgate, MD, Physician-Editor  (1928-2013)

This essay is designed to explore this quotation – the common ground between art and medicine. In particular, I want to explore the role of fine art in medical education, and I want to show through a series of examples how works of art can be used to effect and enrich a formalised and all too often conservative medical curriculum.

My credentials for this task are admittedly poor. I am not an Art Historian, nor an expert in any of the humanities. But I am a doctor, a teacher, a writer and perhaps above all I am a lover of art. What I have to say about Medicine and Art will not be profound – it will be personal, as is my choice of the paintings I want to show you.

To assist us in this discussion I have chosen to divide the paintings we shall look at into several rather arbitrary categories. The first of these is Medical History.

Medical History

 

The Anatomy Lesson of Dr Nicolaes Tulp, Rembrandt van Rijn (1632)

I have chosen to begin with this painting because it was the only one ever to feature in my own medical education, and I have never forgotten it. Almost 40 years ago, one of my lecturers at the University of Glasgow went off-piste one afternoon and surprised us by starting his lecture on orthopaedics with a slide of a painting, a great painting. He talked us through it and drew us in, and of course that was his plan.

The painting in question hangs today in the Mauritshuis Museum in The Hague, and in 1633 it was Rembrandt’s first important commission for a group portrait. On the canvas, he portrays the eminent anatomist Dr Nicolaes Tulp demonstrating the dissection of the muscles of the forearm. Propped up at the foot of the dissection table, perhaps to show his credentials, he has the famous anatomy textbook by Vesalius. Huddled around the cadaver, there are a group of rather ageing medical students ….or were they. Despite the familiar group demeanour – the over-eager ones at the front, the one trying to crib from his notes, and the one staring off into space at the back – despite all this, these seven were in fact not medical students, but Masters of the Surgeons Guild of Amsterdam – indeed the top Dutch surgeons of the day.

The dissection itself is also not all that it seems. Before the practice of preservation of cadavers – those organs that would deteriorate first, had to be dissected first, viz. the contents of the abdomen and the head. A dissection would never begin with the muscles of the forearm, and as such this scene is staged and unrealistic.

If, then, we are viewing this painting as an historical document it falls short on several counts, but it is an excellent backdrop on which to hang a discussion of the pros and cons of small group teaching in medicine, and that’s certainly how I still use it in my own workshops.

 

The Anatomy Lesson of Dr Deijman, Rembrandt van Rijn (1656)

A more historically accurate portrayal of the 17th century dissection room is seen in the only surviving fragment of Rembrandt’s other great medical work. This is “The Anatomy Lesson of Dr Deijman” from 1656, now hanging in the Amsterdam Museum in the Netherlands. Here, the abdominal cavity lies empty and the dissection of the brain is underway.

Both these paintings have obvious appeal to the pre-clinical anatomist, but they also raise more important issues on the use of fine art as a documentation of historical fact. In many instances, what is portrayed is what it appears. But not always. We often, wrongly, ascribe an almost photographic quality to fine art representations of people, events and places connected with medicine. We should leave these two examples on a note of caution, but remembering that even a misrepresented image may be of educational use.

 

Visiting the Sick, Master of Alkmaar (1504)

 Another image of medical history is provided by one of the Master of Alkmaar’s Seven Works of Charity: “Visiting the Sick”, which hangs today in the Rijksmuseum in Amsterdam. Here we are afforded a glimpse into an early 16th century hospital. Has so much changed?

This painting documents a number of key similarities between the hospital ward of today and that of more than 500 years ago. Patients are in beds; patients are being washed; and patients are being comforted and spoken to. In short, patients are being cared for – but even then the administrators are at the very door of the ward with outstretched hands.

The depiction of patients in this painting leads us to our second category that of Images of Illness.

Images of Illness

 

The Sick Child, Gabriël Metsu (c1660)

You don’t have to be a physician to know that this child is ill – you only need to have eyes. While there is nothing to direct the diagnostician to any specific disease, this child is unmistakably sick. Painted in around 1660 by the Dutch master Gabriël Metsu, this painting also hangs in the Rijksmuseum in Amsterdam, and it is an image with immediate educational appeal. When we teach our students clinical medicine we hope, that even if they do not retain all that they learn they will acquire the basic clinical skill of recognising and separating the sick from the well. I vividly remember one senior Paediatrician taking us, his group of awkward 5th year medical students, on a ward round at the Children’s Hospital. He said that we could talk all day long about the details of the diseases and their treatments, but that first and foremost he wanted us to leave his tutelage with one skill, that of being able to tell if a child is sick or well. Everything else can follow from that, but if we could not distinguish, we would be very poor clinicians.

I believe a discussion of this painting could find a useful place at the start of any course in paediatrics or clinical examination.

 

Monna Vanna, Dante Gabriel Rossetti (1866)

While Metsu clearly intended to represent illness, the same cannot be said for Dante Gabriel Rossetti. This sumptuous portrait of his model, Alexa Wilding was painted in 1866, and Rossetti himself thought it one of his best. It now hangs in the Tate Britain in London.

Alexa was a dazzling redhead, who like some of his other models was found by Rossetti on the streets of London. She figures in several of Rossetti’s major works and her features and colouring have become almost synonymous with the Pre-Raphaelite ideal of beauty. Beautiful though she was, she also had thyroid disease as evidenced from the swelling of the thyroid gland, or goitre, in her neck.

There are countless instances throughout the galleries of the world of clinical signs inadvertently captured by the artist, and it makes an amusing game finding them.

Here’s another…

Elderly Woman, Frans Hals (1633)

Returning to Holland again….some 350 years ago the artistic skill of Frans Hals inadvertently captures in oils another interesting clinical sign with his “Portrait of an Elderly Lady” which hangs in the National Gallery of Art in Washington, DC. This lady has tendon xanthomata or fatty lumps in the tendons on the back of of her hands as a result of a genetic disorder of her cholesterol metabolism. If you look at a close up of her left hand, you can see without too much trouble the abnormality in question.

It would probably be true to say that whatever clinical sign you choose, there will be a painting of it somewhere in the world.

 

The Sick Lady, Jan Steen (c1663-66)

While depiction of clinical signs may be common in Art, so are examples of clinical techniques. This mid 17th century painting by Jan Steen entitled, “The Sick Lady” can be found in the Rijksmuseum in Amsterdam, and it shows us that palpation of the pulse is hardly a recent part of clinical examination.

The presence of the doctor and his prominent portrayal in this painting leads us to our third category – that of images of the physician and we will look at these as well as images of the Artist as Patient in the next part of this series.

© Allan Gaw 2020

SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.

What can we learn from the past that may be relevant to modern drug research?

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“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.”  Madhu Davis review in Pharmaceutical Physician

Also available on kindle:

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The Shape of Time

 

Time is a slippery concept.  Simultaneously achingly slow and heart-stoppingly fast;  crawling by when we are bored and racing past in moments of joy; grinding and at the same time galloping.  We are all familiar with this play of perception, and as we get older we become more aware of it, especially the apparent and disconcerting acceleration of time.  The theories of relativity notwithstanding, in everyday reality, time for us is a constant.  There are still 24 hours in every day and 60 minutes in every one of those hours, no matter what we do with them.  That observation, of course, means next to nothing when we think about how it feels to be carried along in its flow.

But, therein lies the problem; words like ‘slow’, ‘fast’ and especially ‘flow’ are awkward descriptors.  Not only are they inadequate, they also, by their implications, anchor us into a way of thinking about time that may not be helpful.  We see ourselves in a river of time, carried forward by the current, at times stagnating and at others rushing through the rapids.  We are thrown into the river at birth and we only get out of the water on our death.   Although, of course, most of us acknowledge that the river was there and flowing long before we joined it, and it will continue long after we are gone.  We might even think of it as eternal, with neither beginning nor meaningful end.

But are there other ways to think about time?  In her novel Flights, Polish Nobel Laureate in Literature Olga Tokarczuk recollected a conversation she had on one of her travels.  Her fellow traveller shared her theory that time came in two distinct shapes.  Sedentary people, she hypothesised, such as those tied to the land through agriculture, viewed time as a circle.  Perhaps dependent on the cycle of the seasons, they found understanding in time as a recurring phenomenon.  Things go around, repeat themselves and find their way back to their beginnings.  On the other hand, those who by necessity are on the move, such as nomads and merchants, see time as a line measuring their progress towards a goal or a destination.  In this linear way of thinking about time, no moment is repeated, forcing us to make the most of any opportunity that presents itself. Perhaps, because it will never happen again, we are even prompted to take risks.  If time is a circle, we only have to wait for the merry-go-round to take us back; another spring, another summer, another beginning, another chance. But if time is linear, we need to make the most of it for you pass this point only once.

Again, this way of thinking simply ties us down and forces us to contemplate time in a different but equally inadequate way.

Albert Einstein said the only reason for time was so that everything didn’t happen at once.  That’s the kind of statement that starts off amusing and then begins to hurt as you try to digest it, and certainly for me it is ultimately unhelpful.  That time exists at all, beyond our human perception of it, starts to become debatable.  But again that doesn’t help either, for the simple reality is that we all feel time whether it exists or not.  We grow and flourish and age and decline, and we watch others around us do the same.  And, I suppose, for me that’s maybe the essence of it all.

Left to our own devices, we undoubtedly age, but the passing of time is less perceptible.  We feel the same inside whether we are twenty or sixty.  What does change though, and what does present us with the stark evidence of time passing, is the child.  The speed of their growth and development marks the passage of time more acutely that we can ever perceive in our own lives. As a parent, you experience the birth of your child, their first smile, first steps, first words, first day of school, first exam, their successes, failures, disappointments, loves and heartbreaks. You watch them grow out of shoes and friendships and grow into a personality distinct from your own.  You watch them fledge and soar and then fly away, and all the time nothing for you has changed, or so it seems.  Their time and yours co-exist, the same but different, in parallel and occasionally intersecting.

Whether time is a river or a circle or a line, whether it runs as a series of intertwined threads or whether it doesn’t really exist at all, perhaps makes no difference. There is no single metaphor that completely describes time and how each of us at different points in our lives perceive it.  The concept of time is, at the same time, inexplicably complex and glaringly obvious, but as with any equally indescribable concept, any attempt to frame it in mere words does it an injustice.  I think there is a lot of life that falls into this category.  I don’t know what love is, or happiness, or hope, but then again, like you, I know exactly what they are — but, like time, I just can’t describe them adequately in words. And I don’t think anyone can, despite the best efforts of philosophers and poets across the years.  That, however, is not a human failing.  The indescribable is and remains exactly that, and our acknowledgment of the ineffable is all that there is and perhaps all that there needs to be.

© Allan Gaw 2019

 

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“The learned physician-scholar of the abolition movement” How a black American found an education in Scotland

In the summer of 1832, a young man disembarked from the transatlantic ship Caledonia and as he stood on the Liverpool dockside, he declared, “I am free!”  The 19 year-old was James McCune Smith, a student who had travelled alone across the world to receive an education denied him in his native America.  He was articulate and gifted, but he was also black and no medical school in the US would grant him entry.

After spending time in Liverpool, Smith continued his travels by steamer to Glasgow where he matriculated at the University.  Arriving in Glasgow,  he would have found a city of paradox.  Glasgow had been at the centre of the New World slave trade, building its wealth on the cargoes of sugar, cotton and tobacco loaded onto the returning slave ships. While the UK may have offered him the liberty to study, he had arrived in a country that would not abolish slavery for another year.  But, Glasgow was also an intellectual centre of the Scottish Enlightenment, which saw slavery as philosophically abhorrent.   Indeed, this enlightened approach had prompted the French intellectual Voltaire, a generation before Smith arrived, to say, “We look to Scotland for all our ideas of civilisation.”

Glasgow at the time was a city already enjoying the benefits, and suffering from the woes, of the industrial revolution.  In 1832 it had approximately the same population as Smith’s native New York City, but there would have been considerably fewer black inhabitants and he would undoubtedly have been isolated.  However, he was supported locally by the activists in the Glasgow Emancipation Society to whom his benefactors in New York had reached out, in order to facilitate his higher education.

At the University he studied in a class with 78 other young men and tackled a variety of subjects including Latin, Greek, Logic, Philosophy and Astronomy, as well as the more traditional medicine, midwifery and surgery. He graduated with a BA in 1835, an MA the following year and, finally, he obtained his MD in 1837, graduating top of his year.

After qualifying, he furthered his clinical experience in Paris before returning home to New York City, where it is said he was received by an enthusiastic crowd of some 16,000.  He set up practice in Lower Manhattan and became resident physician at the “Colored Orphan Asylum”, but despite his obvious qualifications and experience, he was never accepted as a member of any New York medical associations or the American Medical Association.

As well as being a practising physician, Smith was also a prolific writer in both the medical and political spheres.  In 1844 he became the first African-American to author a paper in a US medical  journal and he would contribute important works to further the abolitionist movement.  In the latter, he used his knowledge of statistics, acquired at university in Scotland, to systematically refute, argument by argument, the claims made by those who fought against emancipation. In medicine, he targeted homeopathy and phrenology aiming to debunk the claims of their exponents by careful analyses of the facts.

His position, as the first African-American with a university degree, gave him considerable kudos, but it was his intellect and industry that allowed him to rise to a position of community leader and to move in the highest circles of the abolitionist movement.  Indeed, the most prominent figure in the movement, Frederick Douglass, cited Smith as the single most important influence on his life.  Furthermore, one commentator has noted that, “As the learned physician-scholar of the abolition movement, Smith was instrumental in making the overthrow of slavery credible and successful.”

Smith lived to hear of Lincoln’s assassination, but died in November 1865 one month before the ratification of the 13th Amendment that would formally end slavery in the US.  He was buried quietly in an unmarked grave in Brooklyn by his family who did not wish to publicly acknowledge their African-American heritage.  It would not be until 2010 that his descendants would rectify this.

Until recently, the only memorial in Glasgow to one of its most famous students was a café that bears his name near the original entrance to Old College in Duke Street.  But what of the University of Glasgow itself? Glasgow has been at the forefront of academic institutions acknowledging their  historical links with the slave trade and, as part of its programme of reparative justice, it announced in October 2018 that it would name its new £90m learning hub building in Smith’s honour.  An appropriate move, no doubt, but perhaps the fact that almost 200 years ago it saw fit to admit Smith when other universities turned him away because of the colour of his skin says even more.

Sources

  • Morgan TM.  J Natl Med Assoc 603-14; 95: 2003.
  • Matthews K. Washington Post, September 24, 2010.
  • BBC News,  October 7, 2018.

© Allan Gaw 2019

This article was originally published in the MDDUS Insight Magazine

 

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