SECOND OPINION:MOST PEOPLE are aware of Santayana's famous dictum that those who cannot remember the past are condemned to repeat it.
Fewer recognise the preceding clause which states that progress, far from consisting in change, depends on retentiveness. That careful attention to our mistakes of the past can best inform our future is as important in medicine as in the rest of life.
I was reminded of this when visiting the small but intriguing exhibition in the Long Room at Trinity College Dublin on France in the time of Louis XIV, the Sun King. Based on the university’s extensive collection of early books, pamphlets and maps, the layout is well designed and enticing. We get insights into the richness and turbulence of the period, from the fortifications of Vauban, through the flight of the Huguenots, to the heights of French literature and culture, particularly Molière and Lully.
An early edition of Molière's School for Wiveswas typical of the wealth of material in the library, and points to an interesting gap in the exhibition, that of material relating to medicine. This is not actually surprising as the Faculty of Medicine in 17th-century Paris was rigidly conservative, denying advances such as Harvey's description in 1628 of the circulation of blood.
Instead, they relied on the theories of humours dating back to Hippocrates, and their response to illnesses all related to the elimination of bad humours through enemas, laxatives, emetics and blood-letting. To survive these “cures” as well as the illness was a true sign of a strong constitution, and Louis XIV attributed his survival of typhoid to frequent doses of emetic wine.
Medicine's inadequacy was literature's gain, as Molière found fantastic material for satire in these doctors, who feature in a major way in seven of his 36 plays. The material is wonderfully droll, the highest point in a lineage of medical satire that stretches from the Roman playwright Plautus, through Shaw's Doctor's Dilemmato the ever-entertaining Dr Hibbert in The Simpsonsand Dr Kelso in Scrubs.
On the one hand, knockabout comedy – such as the vision of Lully in l'Amour Médecin, with an enema syringe in his hand, chasing a Molière who was hiding his backside with a hat around the stage – but on the other hand, his plays also give deep consideration of the fallibility of medicine, our retreat to rituals, and our habit to seek too much certainty in the future.
There is a particular poignancy to Molière's death during the fourth performance of the Malade Imaginaire(The Hypochondriac). The chair used on stage was the one used for several hundreds of years for performances of the play in the Comédie Française in Paris, and is now preserved in the lobby of the theatre. A traditional joke is that the doctors take the pulse from the arm of the chair rather than from Argan, the protagonist.
It is a pity that Molière has receded from our cultural consciousness in Ireland: his plays were popular in the Abbey, Gate and Taibhdhearc in the era of Lady Gregory and Lord Longford, and were hugely influential for GB Shaw.
Still genuinely funny, they are a celebration of human fallibility while never losing sympathy for ourselves at our most pretentious and naive, whether through snobbery ( Le Bourgeois Gentilhomme), religious hypocrisy ( Tartuffe), greed ( The Miser) or cynicism ( Don Juan).
Despite much progress in the science of medicine, its practice remains imbued with habit, ritual and customs (both good and bad), and Molière provides us with a lens to explore our fallibility in this regard, from eugenic sterilisation across much of Europe in the 1930s to lobotomies (such as notoriously occurred with Frances Farmer) in the 1950s, to ongoing widely held beliefs such as the use of counsellors in schools after traumatic deaths or routine medical screening of drivers over the age of 70 (the scientific literature is very dubious in regard of both).
But the broader scope of Molière’s plays is to remind us that this is two-way traffic, and all of us may harbour unrealistic expectations of life and medicine, or seek inappropriately high levels of security about the future. For example, who would not be anxious about the prospect of rigidly binding healthcare proxies after the Terry Schiavo case, yet the general tenor of public debate is to support them? Our need for more Molière was never greater.
Troubled Magnificence: France under Louis XIV, Long Room, TCD, until April 1st, 2012
Des O’Neill is a consultant in geriatric and stroke medicine