Medicine: Plain English Diction

“Every morning a long file of black soldiers in white pajamas used to approach the laboratory down the avenue of palm-trees. Each bore before him a bedpan decently shrouded in a ‘cloth, distinctive.’ They were the inmates of the dysentery ward bearing their daily offerings.”

This gutty description, which introduces a technical discussion of tropical amoebae, comes from the distinguished pages of the oldest medical journal in the English language. It is a fair sample of the unvarnished style and the deadpan humor that mark the weekly Lancet as the sprightliest and most outspoken voice in medical journalism.

In a field traditionally befogged by jargon and a monolithic solemnity, the Lancet’s witty, lucid approach has long been a refreshing anomaly. “We shall exclude from our pages,” said Founder Thomas Wakley, “the semibarbarous phraseology of the schools, and adopt as its substitute plain English diction.”

Wakley was a disenchanted physician who launched the Lancet in 1823 as a vehicle to attack the abuses rampant in 19th century medicine. His magazine tilted at the high-collared sacred cows of Harley Street, crusaded for better sewage disposal, better operative technique, more humane treatment of the insane. At a time when doctors jealously guarded their hospital lectures to prevent loss of fees, the Lancet insisted that all lectures should be public property, began sending reporters into the lecture halls. When Surgeon John Abernethy complained that he was misquoted, the Lancet offered a devastating verbatim sample of his tutorial style: “I’ll be hanged if erysipelas is not always a result of a disordered state of the digestive organs . . . Egad, it is a traveling disease . . If it be seated in an unimportant part, in the name of God let it go there!” Abernethy promptly slapped an injunction on the Lancet, and the magazine won a court decision that henceforth medical lectures were to be regarded as public property.

Lithotomy, Lithotrity. Through its youth and middle age, the Lancet built its reputation on solid reporting and its circulation on a succession of widely publicized hassles with medical authorities. It offered the first report (1847) of the use of anesthetics, the first discussion (1867) of Joseph Lister’s treatment of wounds with antiseptics. It boldly reported on a bungled lithotomy by Bransby Cooper, nephew of famed Surgeon Sir Astley Cooper. Young Cooper had made an incision in the wrong place, tried to force an opening into the bladder with forceps, finally turned to his unanesthetized patient a few minutes before he died and complained petulantly that he could not imagine how he had failed. The Lancet was fined a token £100 for printing that story, but had the satisfaction of seeing Parliament appoint a commission to study monopolistic practices in medicine.

In 1873 the Lancet touched off another major debate by charging that London Surgeon Sir Henry Thompson had caused the death of exiled Emperor Napoleon III by operating on him for a bladder stone by lithotrity (penetration into the urethra by a pair of forceps) instead of lithotomy (incision into the bladder).

If the modern Lancet is less angry−principally because most of the reforms it advocated have been put into effect− it is nonetheless outspoken and alert. In 1952, a few days after King George VI of Great Britain died, the Lancet frankly discussed the King’s ailments (Buerger’s disease, lung cancer and arteriosclerosis) and the immediate cause of his death (coronary thrombosis). It has also reported candidly about the low standards of general practice under the British National Health Service, about bad conditions in mental hospitals, about the problems of the aged.

Zippers & Telephones. The wider interests of the Lancet’s current editor, Dr. T. F. Fox−a medical-school graduate but never a practicing physician−are reflected in such salty recent discussions as the effects of contraception on the national IQ, the dangers of infection from public telephones and the obsoleteness of bedpans (the Lancet favors mobile bedside commodes). In essays from subscribers (“Peripatetic Correspondents”), the Lancet is likely to wander into even more esoteric fields. Recent correspondents discussed jammed zippers on men’s trousers, the moral rights of physicians to evade traffic rules, the hazards of being attacked by family pets. One correspondent started an animated debate by advising his fellow practitioners to use a hypodermic syringe to deflate air bubbles when helping their wives to paper walls.

On a fare of solid fact and far-ranging fancy, with only a five-man staff to help, Editor Fox and the Lancet have achieved an influence far greater than the magazine’s estimated 30,000-reader circulation would indicate. The Lancet occupies a place all its own in the affections of the medical profession. Says one G.P., paying it the ultimate tribute: “It’s the only medical journal I’ve ever heard of that one’s wife can actually read.”