The Country DoctorBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c313 (Published 20 January 2010) Cite this as: BMJ 2010;340:c313
- Jerry O’Sullivan, retired consultant histopathologist, Chichester, West Sussex
Doctors are now expected to see their role in a broader context than just their interaction with individual patients. They are encouraged to take an interest in the health consequences of global problems and to perform opportunistic testing on their patients to try to reduce the future burden of disease in the population. There is a point of view that society would benefit if the ministry of health were the most important department of state; and Balzac portrays this situation, in miniature, in The Country Doctor.
Benassis has been a successful Paris doctor but has decided to set up practice in a remote Alpine village near Grenoble. The village has a number of “cretins,” and Benassis believes that, through interbreeding and heredity, the prevalence of the condition may increase in the local population. (The word cretin is thought to come from a dialect of the area, where cretinism, or stunted mental and physical growth resulting from hyphothyroidism, was common.) He contrives to become mayor so that he can have the cretins relocated to another district. He has to overcome considerable resistance from the villagers, because of their religious beliefs and superstitions, but he eventually convinces them of the benefits of his plan when they see how they will gain financially from the deportation. This is the first of a long list of changes that Benassis institutes in the commune. He introduces agricultural improvements, has a road built to connect with the Grenoble highway, and starts up new trades and businesses. In brief, in 12 years, Benassis, as mayor and doctor, transforms a backward Alpine village of 700 people into a prosperous small town of several thousand.
The villagers were, to start with, happy with their traditional ways, and Benassis had great and continuing difficulty getting them to accept his proposed changes. But as he became popular and trusted through his medical practice he found it easier to overcome their resistance to his efforts to wean them from their old way of life. Just as his medical efforts helped to facilitate his improvements to the commune, so the new prosperity improved the health of the community, for their medical complaints “were mostly due to ill nourishment.”
His altruism and selflessness are evident throughout his account of the improvements he has achieved, but he is conscious that he is paternalistic and autocratic. He refers several times to the people as being under his rule, and he says that he rules “both mildly and firmly.”
However, he makes no mention of anyone in this utopian commune who prefers to keep to the old ways, in spite of the obvious merits of his improvements, and the reader suspects that considerable pressure or even moral coercion has been applied on everyone to conform. And this is possibly the disadvantage of the idea that it would be better for society if doctors were in charge. In their well meant desire that everyone should practise what is best for their health, personal freedom could be eroded—the freedom to do what may not be good for you as long as it is within the law. So politicians may after all be the best people to run a country, with the benefit of advice from the medical profession at a high level.
Cite this as: BMJ 2010;340:c313
The Country Doctor
By Honoré de Balzac
First published 1833
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