Egotism and the Doctor

First and foremost Paul de Kruif is a journalist. He has the gift of vivid portrayal, the nose for a good story, and a love for verified facts. His early scientific training may have contributed to this last characteristic, as it certainly has to his sense of discrimination and his analytical faculties. It is, therefore, doubly unfortunate that he should have departed from his course as he has in “Health Is Wealth.” With those who are acquainted with the subject his reputation will suffer; those who are emotionally interested, but uninformed, are likely to be misled. De Kruif has made the fatal error of writing about himself, blatantly in the first person, and about such an exciting subject even the coldest man cannot retain his critical powers. Worse than this, he believes that he has given birth to a new idea, the beginning of all true messianic complexes. The idea is blazoned in the title of the book: if the public, and especially the great industrialists, appreciated the costs of ill health and physical disability, the money to abolish these evils would be immediately provided. That the results of medical neglect may be more costly than an adequate preventative program has been repeatedly suggested, often with facts to support it. It was even frequently mentioned before the National Health Conference which de Kruif treats with scorn. If he had been content to use his strength to sell this idea, original or not, through The Country Gentleman, he would have done the cause of health great service. If he had followed his usual technique of investigation, he might have adduced new evidence to support his thesis. But this was not for Paul de Kruif, the savior. What were investigations, studies, experiments here or elsewhere, or the men who had labored over them? De Kruif had seen in Michigan an experiment in the categorical approach to medical care. Out of this, with the help of local disciples, he devised the formula of salvation. The first 218 pages of his book are devoted to a description of his mad drive to secure the adoption of this formula. Devotion to or knowledge of the health needs of the country mean nothing. Statesmen, economists, public health experts, physicians, all are damned if they failed to declare their faith on the dotted line. Meanwhile the reader, if he is unversed in the subject, waits with bated breath for a five page rabbit in italics. Two chief motives run through this declaration. The first is decentralization: the function of the Federal government is only to place funds at the disposal of the states to be used by the latter for the promotion of health programs. The second is an injunction against any alteration of the prevailing method of providing medical care by competitive private practice. To try to freeze by fiat the existing system, to put a stop to experiment marks the extinction of scientist by the messianic complex. As usual the old states’ rights issue leads to utter confusion. Although the administration of programs is ostensibly to be left to the states, grants for these programs are so conditioned that to secure them the states would be forced to sacrifice cherished prerogatives, among them the right to regulate medical practice within their borders. It is a nice question in law whether the Federal government could, without violating the Constitution, penalize a state for promoting non-profit group practice or adopting compulsory health insurance. After assailing the program of the Interdepartmental Committee and the Wagner Health Bill for their extravagant appropriations, the sacred formula discreetly neglects to mention such worldly matters at all. It stands as a blank check, an unlimited invitation for feet and snouts to get into the trough. There is the usual touch of humor for the initiate in the author’s citation of data and statistics derived from investigations and reports of agencies he roundly condemns. Those who have known and enjoyed de Kruif will hope that this is merely a brief phase of exaltation in the career of a volatile character.

“As I Remember Him,” which appeared first in The Atlantic Monthly, is ostensibly written about a fictitious physician called “R. S.” Behind this thin disguise Hans Zinsser has rather skilfully escaped the semblance of egotism while retaining the personal touch that characterizes the best autobiographies. It is not a record of his life. Episodes and experiences, drawn from a career that led through war, plague, and revolution, though vividly recounted, serve chiefly as vehicles for reactions and reflections about people and issues. The personality that emerges is a gallant cavalier, one who rides in park as well as desert.

There is an absence of self-consciousness that goes with the assurance of aristocratic antecedents, in this case that freedom-loving, intellectual aristocracy of Germany of which it is well to be reminded in these days when all things Teuton are branded as hateful. He deplores the existence of suffering and misery and much of his life was devoted to its alleviation; but these evils seem to violate his sense of aesthetics rather than ideals of social justice. This aestheticism extends beneath superficial polish to real cultural values. He is uncompromising in his denunciation of the trivial trends of modern education. Of his own broad culture there can be no doubt. The frequent quotations from all languages may seem to many casual readers ostentatious. In his judgment of persons, though not unmindful of character and accomplishment, he does not escape the influence of those amenities and traditions that mark his class of privileged equestrians. College presidents rank high in his estimation; the sight of the magnificent seat of one exposed moves him to horsemanly eulogy. The sturdy pedestrian, Jacques Loeb, who scoffed at this broad posterior, is dubbed “a wretched judge of character.” In fairness it must be admitted that the virtues of the good yeoman are not lost on the author because of his unfortunate tendency to lese-majeste. The report of Loch’s remarks on the president’s predilection for fishes is price-lessly realistic and could have been written only by one who had for Loeb the sincere affection which Zinsser expresses.

The book is peculiarly free from personal animus, full of tributes to associates and colleagues, kindly but not mawkish portraits. Led from Westchester County across the continent and back, through Europe’s wars and pestilences, and into Africa, the reader is not left unaware of the educational and epidemiological activities of the author nor of the settings in which they were pursued, but it is the personalities encountered that dominate the stage. Only in Russia is everything swallowed in a storm of invective at the violation of individualism, the supreme god of this liberty-loving horseman. It is a distinguished company of medical scientists who march across these pages and Zinsser has the art to lend them individuality and life. Whimsical humor and felicity of expression make this a charming picture of one of the most significant and provocative figures of modern medicine, the tale of the full life of one who knows how to enjoy and contribute to its fulness.

“In Search of Complications,” by Eugene de Savitsch, is another book by a physician about himself. It is the tale of a Russian aristocrat, displaced from his heritage by war and revolution. His triumphs over the handicaps of birth and training, tuberculosis, and the American educational system are told in an entertaining manner. The author has humor and an easy style; the book is full of action and shifting scenery. The reader, lay or medical, may, therefore, expect diversion; but he should look for nothing deeper in these adventures of an egocentric, versatile young man.