Humour me.

The time will come when diligent research over long periods will bring to light things that now lie hidden. There will come a time when our descendants will be amazed that we did not know things that are so plain to them. Many discoveries are reserved for ages still to come, when memory of us will have been effaced. Our universe is a sorry little affair unless it has in it something for every age to investigate. Nature does not reveal her mysteries once and for all.

Lucius Annaeus Seneca

Natural Questions

Book 7,

First century AD.

In this edition there are two papers from the department of hepatobiliary surgery in the Mater hospital. The first considers biliary complications following cholecystectomy1 and the second, hepatic portal venous gas2. It is fascinating to consider how far we have travelled in our understanding of matters hepatobiliary. Since Hippocrates in the 4th century BC, ‘The Four Humours’ were felt necessary for a proper balance of what Claude Bernard would later call ‘Le Milieu Intérieur’. These four were ‘Blood’, ‘Yellow Bile’, ‘Black Bile’, and ‘Phlegm’. Each was linked not only with the four Seasons; the four elements Earth, Fire, Water and Air (by Empedocles) but with the ancient names ‘Sanguine’,‘Cholic’, ‘Melancholic’ and ‘Phlegmatic’, that represented courageous, angry, despondent, and unemotional behaviour respectively and of course, these vestigal descriptive characteristics still persist in the English language. Expelling an excess of one humour e.g. blood-letting or purging was the logical consequence of any perceived imbalance but with our sophisticated retrospectoscope, we look back, eyebrow raised, shoulders shrugged, in a ‘what were they thinking?’ kind of way. Those ancients: what fools.

What will future generations make of our medical interventions and therapies? Evidence-based, to be sure, but isn’t there the vague sense of unease that decades from now, our Foundation doctors, well stricken in years, will explain to an impatient youth of tomorrow how things were done? Peter Kavanagh’s paper on final year work-shadowing3 and Alexandra Murphy’s view from the standpoint of the Foundation doctor4present impressive descriptions of what our theological colleagues might call, ‘The Now.’ The tour d’horizon however, shifts continuously, and the Foundation doctor now faces a bewildering series of deanery, hospital and specialty decisions, unknown to this middle aged practitioner. Some years ago, at lunchtime (remember lunchtimes?), I was listening to several eminent colleagues, discussing their training years. What struck me forcibly at the time, was that not one of them ended up where they thought they would. One wonders if the same latitude is available to our Foundation doctor colleagues.

In his paper, ‘ Three Ulster Gentlemen5’ a fourth Ulster gentleman, David Macafee considers the professional lives of three of his relatives, covering a working span of 90 years, from 1905 until 1995. That first decade of the 20th century saw the original installation of the stained glass window that graces our new Ulster Medical Society rooms, and this edition’s cover, unveiled on 27th November, 1902, by the Earl of Dudley, having been commissioned for the library of the Ulster Medical Institute by Sir William Whitla. Two central characters are evident: William Smyth and Brendan McCarthy. Dr William Smyth was born on March 30, 1859. He clearly had a most robust constitution having contracted, and survived, both typhoid fever and smallpox at school and university respectively. His general medical practices were at Ardara and later Burtonport, in the Rosses, Co. Donegal.

In 1901, an outbreak of typhus occurred on the island of Arranmore, off Burtonport. Dr Smyth and Dr McCarthy, Medical Officer of Health for Co. Donegal were instrumental in the evacuation of sick patients from the island, but unfortunately Smyth contracted the disease. His typhus proved fatal and he died at the age of 42. He is buried in the parish graveyard in Dungloe beside six of his fourteen children. All six had died before the age of five. A man perhaps for all Seasons, and with a medical orthodoxy closer to ‘The Four Humours’ than he might have cared to admit. The circumstances of his work, life, death and that of his young children stand mute witness from the past. It is salutary to consider that all he accomplished he did without a job plan. Sanguine, indeed.

Have a wonderful summer. Do keep sending me your good papers.