If symptoms

persist.. .

I AM unsure where patients get their medical misinformation from, but it must in part be from each other. One can scarcely travel half a mile on a bus or a train without overhearing a medical conversation. 'So the doctor said to me, he said . . .' And there follows a state- ment which no doctor could possibly have made, and which causes one to realise that even now Galenic or pre- Vesalian anatomy lives on in the minds of many, and the germ theory of disease is not entirely assimilated. I once knew a man, well educated in the humanities, who thought that the interior of the human abdomen was made of a homoge- neous substance, rather like the interior of a chocolate truffle.

I like to ask my patients for their opin- ion as to the cause of their disease, and their answers, if not very illuminating as far as pathology is concerned, sometimes illustrate their general state of mind. Last week, I asked a lady with pains in the calves of her legs what she thought had caused them.

`I've tried to blame it on cycling, doc- tor, but the trouble is I haven't got a bicycle.' Why she should have tried to blame her discomfort on this innocent, indeed healthful, pastime, one in which, moreover, she did not participate, was a mystery which pressure of work and shortage of time, alas, did not permit me to unravel.

Sometimes the patients offer their aetiological theories spontaneously, without being asked to do so. Last week also, I was consulted by a widow who described the last, terrible years of her husband's life, whose behaviour had played a large part in her own ill-health. `He caught syphilis when his ship was torpedoed during the war, and then it went dormant. The doctor said it woke up again when he was made redundant, and it left him with half a brain.'

The magic bullet is an established metaphor in medical history, but the syphilitic torpedo is something entirely new.

There is poetry in the patients' utter- ances for those with an ear to hear it. An arthritic old lady appeared in my office recently with a form she had filled in to claim the disability living allowance, which required my signature. Against the question 'Can you undress by yourself?' she had written the following answer:

When my clothes fall to the ground, my husband stands behind me and does what's required.

But to return to the matter of aetiolo- gy. Sometimes even doctors get it wrong. I remember a general practitioner who was notorious for the brevity of his refer- ral letters to eminent consultants. In his haste to reach the golf course, he would scribble a single line about the patient he was referring for specialist care and attention. More than usually in a hurry, he once wrote the following letter of sur- passing brevity to a cardiologist of repute about a patient who was short of breath.

Dear Dr L., Re Mr John Smith

Heart.

Yours sincerely ...

The cardiologist's reply was equally brief and to the point.

Dear Dr F., Re Mr John Smith Not heart, lungs.

Yours sincerely .. .

Theodore Dalrymple