Thursday, March 18, 2010

Tolstoy on Doctors

I'm reading War and Peace now and will probably post a review here when I finish. I don't remember how, but in childhood I managed to only read 1.5 of the novel's 4 volumes, all of which must have been required at school. If I missed the rest of the book because I was out sick, then this post would be pretty fitting.

Tolstoy didn't care the least bit about elegant prose or humor, but he wrote about a very interesting, no longer existing group of people (the Russian aristocracy) from an insider's perspective and he had a lot of wisdom. He applied this wisdom to dozens of very diverse topics in this enormous book. I made this post about Tolstoy's take on the medical profession because it completely agrees with mine.

In the third volume Natasha Rostova, one of the novel's major characters, is suffering from teenage heartbreak, but her family mistakenly believes that her condition is more serious than that.

"She could not eat or sleep, grew visibly thinner, coughed, and, as the doctors made them feel, was in danger. They could not think of anything but how to help her. Doctors came to see her singly and in consultation, talked much in French, German, and Latin, blamed one another, and prescribed a great variety of medicines for all the diseases known to them, but the simple idea never occurred to any of them that they could not know the disease Natasha was suffering from, as no disease suffered by a live man can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine--not a disease of the lungs, liver, skin, heart, nerves, and so on mentioned in medical books, but a disease consisting of one of the innumerable combinations of the maladies of those organs. This simple thought could not occur to the doctors (as it cannot occur to a wizard that he is unable to work his charms) because the business of their lives was to cure, and they received money for it and had spent the best years of their lives on that business. But, above all, that thought was kept out of their minds by the fact that they saw they were really useful, as in fact they were to the whole Rostov family. Their usefulness did not depend on making the patient swallow substances for the most part harmful (the harm was scarcely perceptible, as they were given in small doses), but they were useful, necessary, and indispensable because they satisfied a mental need of the invalid and of those who loved her--and that is why there are, and always will be, pseudo-healers, wise women, homeopaths, and allopaths. They satisfied that eternal human need for hope of relief, for sympathy, and that something should be done, which is felt by those who are suffering. They satisfied the need seen in its most elementary form in a child, when it wants to have a place rubbed that has been hurt. A child knocks itself and runs at once to the arms of its mother or nurse to have the aching spot rubbed or kissed, and it feels better when this is done. The child cannot believe that the strongest and wisest of its people have no remedy for its pain, and the hope of relief and the expression of its mother's sympathy while she rubs the bump comforts it. The doctors were of use to Natasha because they kissed and rubbed her bump, assuring her that it would soon pass if only the coachman went to the chemist's in the Arbat and got a powder and some pills in a pretty box of a ruble and seventy kopeks, and if she took those powders in boiled water at intervals of precisely two hours, neither more nor less.

What would Sonya and the count and countess have done, how would they have looked, if nothing had been done, if there had not been those pills to give by the clock, the warm drinks, the chicken cutlets, and all the other details of life ordered by the doctors, the carrying out of which supplied an occupation and consolation to the family circle? How would the count have borne his dearly loved daughter's illness had he not known that it was costing him a thousand rubles, and that he would not grudge thousands more to benefit her, or had he not known that if her illness continued he would not grudge yet other thousands and would take her abroad for consultations there, and had he not been able to explain the details of how Metivier and Feller had not understood the symptoms, but Frise had, and Mudrov had diagnosed them even better? What would the countess have done had she not been able sometimes to scold the invalid for not strictly obeying the doctor's orders?

"You'll never get well like that," she would say, forgetting her grief in her vexation, "if you won't obey the doctor and take your medicine at the right time! You mustn't trifle with it, you know, or it may turn to pneumonia," she would go on, deriving much comfort from the utterance of that foreign word, incomprehensible to others as well as to herself.

What would Sonya have done without the glad consciousness that she had not undressed during the first three nights, in order to be ready to carry out all the doctor's injunctions with precision, and that she still kept awake at night so as not to miss the proper time when the slightly harmful pills in the little gilt box had to be administered? Even to Natasha herself it was pleasant to see that so many sacrifices were being made for her sake, and to know that she had to take medicine at certain hours, though she declared that no medicine would cure her and that it was all nonsense. And it was even pleasant to be able to show, by disregarding the orders, that she did not believe in medical treatment and did not value her life.


The symptoms of Natasha's illness were that she ate little, slept little, coughed, and was always low-spirited. The doctors said that she could not get on without medical treatment, so they kept her in the stifling atmosphere of the town, and the Rostovs did not move to the country that summer of 1812.

In spite of the many pills she swallowed and the drops and powders out of the little bottles and boxes of which Madame Schoss who was fond of such things made a large collection, and in spite of being deprived of the country life to which she was accustomed, youth prevailed. Natasha's grief began to be overlaid by the impressions of daily life, it ceased to press so painfully on her heart, it gradually faded into the past, and she began to recover physically."

The average person reading this now probably thinks that that's only how medicine was like then, that progress and technology have blah blah blah...

If Tolstoy's description fit 95% of the medical practice of his day, then it would probably fit 70% of what's going on in 2010. Medicine is still and probably will always be mostly like that.

From what I've read, Tolstoy practiced what he preached, never asking or following doctors' advice and lived to the age of 82.

Being a glossophiliac, I can't resist mentioning that the native Russian word for doctor (vrach) is etymologically related to the Russian word for lying (vrat'). Faith healers were habitually called liars by their customers. When Western medicine arrived in Russia, its typical practitioner seemed like just another type of faith healer, so the word vrach was applied to him as well. It is now roughly as popular as "doctor" in Russia, but with overuse has unfortunately lost its sting.


  1. You're very right about doctors. I made dozens of trips to many doctors for elevated blood pressure. I was prescribed every type of medication. They made no difference. I discovered by myself that the problem was caused by the interaction of two other medications I was taking. I stopped them and my systolic bp dropped by 20 pts.

    In the US where grades are a means of selection much more than test scores doctors tend to be pushy stupid people rather than smart people.

    Medicine is a business with a great brand. When they have nothing to sell they sell hope, all the time killing you with their pills.

  2. Most of my experiences with medicine have also been negative. It always amazes me how sure they sound when giving out advice. You ask 3 MDs the same question, all 3 give different answers, and each one sounds absolutely sure.

    I wonder if anybody's ever studied how much treatment they themselves seek out when they're sick. I'm thinking of statistics like the number of prescriptions per person per given diagnosis, same with the number of surgeries and of chemo sessions if they get cancer. I'd bet real money that the numbers would be lower for MDs than for the population as a whole.

  3. One of the first duties of the physician is to educate the masses not to take medicine. — Dr. William Osler

  4. Don't bore the doctor with your inane talk. Find the answer to life's riddles elsewhere. I suggest PTL Club for Anonymous 1 and a nice dose of heroin for Glossy.