Instant wisdom

This is the first paragraph of a lecture I gave to the Cardiff Medical Society on “Decision making in the glare of publicity.” An abridged version was published in The Scientific Proceedings of the Cardiff Medical Society on 8 January 1974.

“When I was a student at University College Hospital, London, I was deeply impressed by a story which Thomas Lewis recounted of his early years in London before the first world war. As a young man he was invited to dinner one evening by Sir James Mackenzie, the then doyen of London cardiologists. The company, all medical men and their wives, was a distinguished one and Lewis far the most junior person present It was Edwardian England and before the port circulated the ladies retired. At this stage one of the elderly physicians enquired of Mackenzie how his two daughters were. Mackenzie replied that one of them was poorly and he thanked the questioner because it reminded him that he had intended to seek the opinion of his guests on a peculiar patch of oedema which had appeared on the girl's forehead. A message was sent to the nursery and the young lady, about twelve years old, was brought down. The rash was examined. Eventually one of the patriarchs pronounced. It was clearly angioneurotic oedema, Quincke's circumscribed oedema. All were satisfied: a diagnosis had been made—the young lady was taken upstairs. The next day she died. She had an abscess of the frontal lobe of the brain. Lewis told the story to show us students that giving a name to lesions may satisfy professional dignity but does not necessarily help the patient. He used to add, however, that medicine was a difficult subject and diagnosis was not made easier if the patient was the daughter of a distinguished physician, the consultation took place while the port circulated and was in the presence of a number of respected colleagues. It was Lewis's opinion that if any of the gentlemen present had seen that girl earlier in the day in an ordinary outpatient clinic they would have done better than merely describe the lesion in Latin.”

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