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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 1; 335(7617): 453.
PMCID: PMC1962888
Between the Lines

Arms and the man

Theodore Dalrymple, writer and retired doctor

Many writers were also doctors, of course, and some were medical students who never qualified. Yet others were the children of doctors, as if the literary advantages of a medical career were heritable. Among them was John O'Hara, an American writer often dismissed because of his irascibility, self promotion, and reactionary political ideas as just a pulp writer.

His long story “The Doctor's Son” was written for a short story competition in 1931 whose prize money disappeared in the great depression. It is set in the middle of the Spanish influenza epidemic of 1918-9, in which many more people died than in the first world war. The story is narrated by the 15 year old doctor's son of the title, who acts as a chauffeur for the medical student “Doc” Myers. The student has come from Philadelphia to a coal mining town in Pennsylvania to replace the boy's father, who has fallen ill of the flu. The town, Collierville, is eerie during the epidemic: the streets so deserted that it seemed as if the epidemic had brought about “a new kind of holiday.”

The most interesting thing about the story is the unquestioned faith the patients show in doctors and their ministrations. Evidence based medicine, if it had then been in existence, would surely have demonstrated the impotence of medicine to affect the clinical course of the disease. Yet patients queued to see the doctor as if for salvation. So many were ill in their families that they described the symptoms of each member, and Doc Myers prescribed en masse for them.

At one point the manager of the mine, one of the three notables of the town, asks Doc Myers to attend his wife at home and asks whether the hour's delay that Doc Myers proposes because he has other patients to attend will not be fatal. What does the mine manager imagine that Doc Myers could do to save his wife's life?

The one time when speed might have saved a life, however, is when Doc Myers and the doctor's son visit a Polish miner's home and find a child there dying from diphtheria. Doc Myers sends the doctor's son to the car for instruments to perform a tracheotomy, but they arrive too late: the child has died. The doctor's son is then given 20 000 units of antitoxin as prophylaxis. “I was stiff the next morning,” he writes, “but it had not been so bad as the other times I had taken it.” I suppose he was fortunate not to have suffered from serum sickness.

I discovered from the story that, contrary to my belief, violence against doctors is not an entirely new phenomenon. The narrator tells us how his father, when practising, went to sleep with a revolver within reach. “He had to have the revolver, because here and there among the people who would come to his office, there would be a wild man or woman, threatening him, shouting that he would not leave until he left with them, and that if their baby died they would come back and kill him. The revolver . . . kept the more violent patients from becoming too violent.”

There is a lesson here, surely, for British casualty departments and GPs.

His father, when practising, went to sleep with a revolver within reach. The revolver kept the more violent patients from becoming too violent

Articles from The BMJ are provided here courtesy of BMJ Publishing Group