On Medicine and Dr. Knock

Image for article On Medicine and Dr. KnockHowever it might be varnished by imagination or sophistry, the Covid pandemic is one of the most extraordinary phenomena of our times – but it is also the culmination of a mode of thought gradually developed through a long historical gestation. For what originally was (and still is), the natural and necessary need for assistance by him who is sick or in pain, has evolved into assigning to the ‘other’ the responsibility (and the knowledge) of what constitutes our personal physical well-being and health.

Even in antiquity there were voices saying for example that “a man after thirty must be the physician of himself.” Others (few) expressed similar skeptical ideas throughout the centuries, especially when the purported benefits of the then current medicine clashed with frequent contrary evidence.

Typical is the advice given by Timon of Athens to two robbers who visited him in the forest, believing that Timon was still rich, though he lost his fortune through mismanagement. After converting them to leading a better life than robbing, Timon warns them, “Trust not the physician, for his antidotes are poison, and he slays more than you rob.” (1)

Before continuing I should make it clear that I have the greatest respect for medicine – especially for those latter-day Michelangelos who literally save the lives of humans by reconstructing their bodies after being involved, for example, in traumas and accidents.

Here I will touch but the surface of the history of medicine and of language. Both being subject, at times, to curious, amusing and unexpected mutual influences and derivations.

For example, the word ‘charlatan’ is a compound word of medieval Florentine-language origin, and its original association with medicine may surprise a few.

One part of the etymology is ‘ciarla’ or ‘ciarlare’. A 16th century linguistic historian states, “The word ‘ciarla’ and the verb ‘ciarlare’ are applied to those who speak only because they have a tongue, while having nothing else to do but talking. And because they cannot do anything else, what they say is nonsense, as they don’t know what they are talking about.”

The other etymological contributor is ‘Cerreto’, the name of a medieval fortified town close to Spoleto, in the Italian region of Umbria. ‘Ciarlatano’ then derives from the lexical admixture of ‘ciarla’=nonsense and ‘Cerretano’, that is an inhabitant of Cerreto.

For it came to pass that in the 14th century some Cerreto citizens were granted fund-raising right for the benefit of certain hospitals of the “Order of St. Antony.” This is documented in the Statutes of Cerreto for the year 1380.

For very urgent was the need to re-build and re-organize the hospitals and the “system of charity” (read ‘free health-care for the poor’), which had been disrupted and almost destroyed by the plague epidemic of 1348-49, and by subsequent recurrences. A plague that, allegedly, killed about one third of all Europeans.

Some Cerretans were granted the concession of collecting offers for the hospitals. It was a meritorious and lucrative activity, for contributing to the funds were not only the offerings by the poor but the elargitions of the rich.

Writer Masuccio Guardati, called the “Salernitan,” in chapter 18 of his ‘Novellino’ reports as follows: “… the Cerretans, as pseudo-friars of St. Antony, roam around Italy, asking for money in exchange for promises (made by St. Antony). Under this disguise, they pretend to be the mediators of miracles that cure the infirm.”

But it took about a century for the word ‘cerretano’ to migrate into multiple European languages as the word ‘charlatan.’ The meaning remained though the history is forgotten.

Through time, new discoveries have inspired different ages to create new models for defining physiological analysis, medical practice and, in the end, medical truths.

The alembic is one example. Its use was known since the High Middle Ages, but it had remained for long a mysterious and cabalistic device, used by alchemists and sorcerers. However, it acquired widespread use and notoriety in the XVI century, as the engine of distillation.

From the alembic medicine drew the model for the direction of fluids in the body and their purification. According to this theory, subtle gaseous humors ascend from the lower to the upper body, cleansing the body’s components of pollutants, in a process of filtering and decanting.

Gerard Dorn, a French doctor and alchemist (1530-1584), represents man actually inside an alembic while alongside, at different ascending levels, are represented a burner, a boiler, a condenser and a spout. That is, in this model, as the fluids ascend, various parts of the body burn, boil, distil and finally exhale the fluids, leaving the body purified through a kind of gentle effervescence.

To obtain a positive medical outcome, a satisfactory distillation occurs only when the direction of the gaseous humors is facilitated by the position of the body. Michel de Montaigne (1533-1592), in his famous ‘Essays,’ subscribes to this model describing the type of heat that is generated in the feet and then transformed into purifying vapors “that grow and exhale.”

Francois de Bassompierre, a 16th century scientist, in his memoirs, proves the alembic-model theory by the way he could recognize the cadavers of Turkish soldiers, killed during the siege of Vienna in 1529. Their key characteristic – he wrote – was their rotten teeth, caused by wearing a turban, a “headwear that impairs the distillation and therefore the ascension of the cleansing vapors and the complete purification of the body.”

But none can halt the inaudible and noiseless foot of time. (2) The theory of the distillation of humors gradually gave way to the theory of ‘invisible emanations.’ Writes Pierre Bailly, in his “Questions nouvelles et curieuses” – (New and curious questions, 1628), “If fresh laundry has the power of cleansing and attract impurities, then as much, as long and as often we wear fresh laundry, the more quickly we will be purified.”

Yet, as we know, the web of life is of a mingled yarn, good and ill go together, (3) as it was the case for the noble lady Mademoiselle de Montpensier. She found herself in Paris during the famous “Frondes” (a rebellion by the French nobility against the King) in 1649. She had to escape quickly and take refuge in the Castle of Saint Germain. Another carriage, adventurously carrying her accouterments and general wardrobe, only reached her 10 days later. In her Memoirs she writes that, during those 10 days and being short of clothes, “I was compelled to wash my nightgown by day and my day-gown by night.”

In a subsequent further evolution, the ‘invisible emanations’ turned into ‘impalpable humidities.’ Which increased the intermediate stages between health and illness, as most of the symptoms remained hidden (today we would call this patient an asymptomatic carrier). This state of affairs frequently created medical management problems. In her memoirs, Madame de Maintenon (1683-1715, mistress of King Louis XIV, the “roi-soleil”), writes, “According to the doctor I am very well, but according to me I feel horrible.”

Jules Romains (1885-1972), in his play titled ‘Dr. Knock,’ written in the 1920s, gives us perhaps the best representation of two contrasting approaches to medicine. The play exposes a dilemma that today is magnified (in the West notably), by the blending of medicine with technology, politics and turbo-capitalism.

Dr. Knock accepted the offer of a practice in the little country town of St. Maurice, not far from Lyon, in that wonderful land that prepares the traveller for the Alps in the East and for the wonders of Provence in the South.

The current resident physician, Dr. Parpalaid, is moving to Lyon to take up another practice. While driving together to St. Maurice from the railway station, the incoming doctor makes some general inquiries and the subject casually drifts to rheumatism.

Are there many cases of rheumatism in St, Maurice?” – asks Dr. Knock. Dr. Parpalaid states that rheumatism is one of the most frequent complaints among the St. Mauricians. This seems of great interest to Dr. Knock. “Is it because you wish to study rheumatism?” asks Dr. Parpalaid?. Dr. Knock answers that his interest is really in the patients. At which the resident doctor damps Knock’s expectations by stating that, “The people here would not think of going to the doctor for a rheumatism more than you would go to the church curate in order to end the drought.

Dr. Knock then inquires about pneumonias and cardiac attacks. Dr. Parpalaid replies that, “They never suspect to have either pneumonia or a heart attack, and die as if struck by lighting when they are about 50.”

Somewhat puzzled, Dr. Knock tries to know what brings the patients of St. Maurice to a doctor. After some reflection Parpalaid thinks that influenza could be an opportunity to apply medical skills to the inhabitants of St. Maurice. “Not the banal flu, though – that does not worry them at all, actually they even welcome it, because they think that it brings out the bad fluids. No, I’m thinking of the major global influenza epidemics.”

Knock disagrees. Waiting for a large-scale epidemic is like waiting for the appearance of a comet.

In this first meeting there are already evident two opposite interpretations of medical practice. From the chat it transpires that Dr. Knock received his degree only the year before, though he had worked as a ship doctor for some time. His college thesis was titled, “On the pretense of being healthy” to which he appended an epigraph attributed to the famous French physiologist Claude Bernard (1813-1878), “People who believe themselves to be healthy are but patients who are sick without knowing it.” A concept, idea or philosophy – incidentally – well described and confirmed by Ivan Illich, a few decades ago.

From an early age Knock had developed a keen interest in medical matters, pharmaceutical announcements and promotions, including the instructions glued to pill-boxes. When 9-year old, he says, he already could recite by heart entire tracts about the imperfect evacuations of the constipated. Above all, he adds, “I understood what is the real spirit and aim of medicine, something that university training does not teach, being swamped by all that scientific clutter. I can say that I already had a “correct medical sentiment.”

The hosting doctor is curious, but Knock suggests that Parpalaid visit St. Maurice after one year, to verify the correctness of Knock’s medical approach.

To implement his strategy, Knock initially consults and enlists three resources, the town crier, the school-teacher and the pharmacist. The town crier is first. The idea is to penetrate the psyche and (skeptics would say) weaken the critical defenses of the audience. Today that task is the media’s. Knock’s objective is to instill the notion that man’s new sin is not curing oneself adequately.

By the way, to avoid making unnecessary enemies among my 25 readers, I am not taking sides. It may well be that truth lies with corporate medicine and big pharma. I have no qualifications to say otherwise. I can only state without fear of contradiction that all that lives must die, passing through nature to eternity.(4)

Knock selects the town crier’s most expensive promotional option. Perceiving the beginning of a new opportunity, the crier volunteers to give his impression on Parpalaid’s approach to health-care.

“Nine times out of ten he would send off the patient saying, “It’s nothing, my friend. You will be up and running tomorrow.” He would just listen to you saying ‘yes, yes’ and then start talking about something else. Not only. But he would prescribe very cheap remedies, sometimes just a tisane. You understand that people who paid eight francs per hour for a consultation didn’t appreciate being prescribed remedies only worth pennies. For even the most naïve does not need a doctor to drink a chamomile.”

Knock’s ‘commercial’, shouted out by the crier, went as follows, “Dr. Knock, successor of Dr. Parpalaid, offers his compliments to the population of the town and district of St. Maurice. In a philanthropic spirit he will be pleased to inform you about the worrying progress of recent ailments and diseases that have affected our regions… Effective immediately, every Monday morning, from 9.30 to 11.30 he will give a consultation completely free of charge to the residents of the district. The consultation charge for non residents will be the customary eight francs.”

The crier is already convinced. “You put the finger on the sore. We do not take care of ourselves enough. When we feel sick, we keep going on with little care. We may as well be animals.”

The next key contact and future ally of the doctor is the schoolteacher, Mr. Bernard. For the new medical knowledge to become established – Dr. Knock holds – education is critical. It must spread the terror of germs and promote social distancing. Education must be assimilated into bio-power – including the necessity to educate future patients to fear diseases and potential disease carriers.

Doctor, “Do people here know how many bacteria are in the water?”

Educator, “Here the water is good, we live on the mountains.”

Doctor, “Do people know what is a microbe?”

Educator, “I doubt it, a few know the term, but they figure it must be some kind of fly.”

By now the doctor knows how to secure the cooperation of the educator. It should be stressed that Dr. Knock is not acting in bad faith – he simply subscribes to a different ideology.

Perceiving the innate modesty of the educator, he adds, “You are the only one ignoring that you possess moral authority and personal influence. Allow me to say this. Nothing here can happen without your cooperation. For who, other than yourself, will instruct these people about the dangers their organism is subjected to, every second in time? Who will instruct them not to wait until they’re dead to call the doctor?”

The educator is then persuaded to promote what today we call a seminar, to inform the St. Mauricians about typhoid fever, the insidious forms it takes and the innumerable ways it assaults people with: water, bread, milk, shellfish, legumes, salads, dust, breath etc., – the weeks and months typhoid fevers remains hidden without disclosing its presence, the mortal attacks it often carries out, the complications it leaves behind… and “all explanations accompanied by nice illustrations, bacilli greatly magnified, details of excrements showing the effect of typhoid fever, infected ganglia, perforated intestines, using (in the illustrations) as much color as possible..”

Educator, “But if I think about all this, I will no longer be able to sleep”

Doctor, “Exactly, This is the shocking message we must deliver to the audience. For their fault is to sleep with a deceptive sense of security, from which a painful awakening is like a lighting strike.”

To strengthen the effect of the first seminar, there will be a second, titled, “The germ carriers. It has been proven beyond doubt that it is possible to be healthy, have a pink tongue and an excellent appetite while holding and hiding inside the body trillions of bacilli whose virulence can in fact kill an army.”

But the aircraft carrier of Dr. Knock’s medical weaponry will be the pharmacist of the town, Mr. Mosquet. Understandably, the ‘naturistic’ approach to medicine of Dr. Parpalaid did not greatly contribute to the fortunes of the local pharmacy. But this will quickly change.

“My dear Mr. Mosquet – says the doctor – we have two of the finest professions one can imagine. Is it not a shame that we have gradually deprived the practitioners of our professions of the high degree of prosperity and power, which our predecessors were able to confer to them? The word sabotage comes to my lips.”

As an aside, in this thoroughly incomplete perspective on historical mores and their changes in time, my recent experience with the medical milieu reminded me of Ivan, one of the brothers in Dostoyevsky’s “The Brothers Karamazov.”

To explain, curious as I am (was) to know more about the American Health Care System, I took the exam to become a medical interpreter for Spanish. Consequently I have been exposed, and had the opportunity to learn how the ‘system’ works. As I said, I have no criticism whatsoever, but I have been repeatedly struck by the remarkable subdivision of specializations among the specialists.

Eventually, what triggered the memory of Dostoyevsky was a recent case of a patient who suffered from a sinus conditions, to which he also attributed occasional sore throats, head and neck aches. The specialist diagnosed the sinus problem to be an occlusion of some sort in the upper nasal system, as confirmed by radiography and CAT/SCAN. A surgical intervention to clear the occlusion would be the most expedient means to cure the problem. The patient insisted saying that he had suffered from the headaches even before the sinus issues, they had only grown worse. What could that be due to? The physician replied that headaches were not his specialty and referred him to a suitable neurologist and headache specialist.

It was the joint recollection of the above interpreting session and of the philosophy of Dr. Knock that made me remember Dostoyevsky. Who, in the narrative, describes an approach to medicine that, allowing for the changes in times and technologies, is perhaps even more modern than Dr. Knock’s.

Says Ivan: “… all my right side is numb and I am moaning and groaning. I’ve tried the entire medical faculty: they can diagnose beautifully, they have the whole of your disease at their finger-tips, but they’ve no idea how to cure you. There was an enthusiastic little student here, ‘You may die,’ said he, ‘but you’ll know perfectly what disease you are dying of!’ And then what a way they have of sending people to specialists! ‘We only diagnose,’ they say, ‘but go to such-and-such a specialist, he’ll cure you.’

The old doctor who used to cure all sorts of diseases has completely disappeared, I assure you, now there are only specialists and they all advertise in the newspapers. If anything is wrong with your nose, they send you to Paris: there, they say, is a European specialist who cures noses.

If you go to Paris, he’ll look at your nose; I can only cure your right nostril, he’ll tell you, for I don’t cure the left nostril, that’s not my specialty, but go to Vienna, there there’s a specialist who will cure your left nostril.

What are you to do? I fell back on popular remedies, a German doctor advised me to rub myself with honey and salt in the bath-house. Solely to get an extra bath I went, smeared myself all over and it did me no good at all.

In despair I wrote to Count Mattei in Milan. He sent me a book and some drops, bless him, and, only fancy, Hoff’s malt extract cured me! I bought it by accident, drank a bottle and a half of it, and I was ready to dance, it took it away completely. I made up my mind to write to the papers to thank him…”

Back to our protagonists. Mr. Mosquet confides to Dr. Knock that he earns less than the town’s tinsmith and the baker. “Shocking – replies Knock – it is equivalent to the wife of the President of the Chamber to wash the bake’s laundry in order to have bread.” And he follows up with declaring that, “as a matter of principle,” henceforth all the inhabitants are target customers.

Mosquet agrees that a citizen, as the occasion arises, can become their mutual client. “Occasion? – says Knock – Not al all, a constant client is a faithful client.”

“But isn’t it still necessary that he falls sick? – asks Mosquet

“Fall sick? – rebuts Knock – it is an obsolete notion that no longer holds, given the current scientific knowledge. Health is but a word, that nobody would find it inconvenient if it were erased from the vocabulary.”

Almost an echo of more historically famous lines, this time applied to conscience. “Conscience is but a word that cowards use, devised at first to keep the strong in awe.” (5)

“Do you know what Pasteur said – Knocks continues – ‘Those who think they are healthy are sick without knowing it.’ For my part I only know people more or less affected by diseases more or less numerous with more or less rapid evolution. Of course, if you go and tell them they’re okay…they ask no better than to believe you, but you would deceive them. Your only excuse would be that you already have too many patients and cannot take new ones. In the veins of every man there is the germ of the disease. We must organize the inhabitants of this district as an army…an army of the sick and each with his own rank… mildly, severe, very serious, deadly…just as in an army there are soldiers, corporals, officers, generals.”

Mosquet never heard more pleasing words. “Dear doctor, I would be an ungrateful human being of I did not thank you with great effusion, and a miserable human being if I did not help you with all that’s in my power.”

Taking advantage of Dr. Knock’s first free consultation is the most influential lady of St. Maurice, a wealthy widow and owner of a prosperous farm. “If the citizens see me doing this, they will follow – she says to Dr. Knock – otherwise they would be suspicious, even my light actions are observed and commented upon.”

Knock commends the lady for her noble sentiments, and in the following conversation Madame admits that she has for ages been affected by (almost) chronic insomnia.

“What did Dr. Parpalaid prescribe for the problem?”

“To read, every evening, three pages from the Civil Code. It was a kind of pleasantry. He never did take my condition seriously.”

More accurately, Dr. Knock diagnoses the problem as due to inter-cerebral circulation, an alteration of the inner vessels. Cure is possible – he says – thanks to the newly discovered properties of radio-activity. However, the doctor must maintain an almost incessant observation and gradation of the radioactive applications, meaning daily visits, except the three days per week when Knock is unavailable.

One year goes by and Dr. Parpalaid returns to St. Maurice, with the intention to re-acquire his clinic. The Lyon clinic has prospered but he misses St. Maurice. But here he finds that not only Mr. Mosquet is very happy, but even Madame Remy, the manageress of the hotel, where many patients come to stay for the night for the next day’s medical visit. “They receive all needed care here – she adds – and all rules of modern hygiene are minutely followed.”

On hearing that Parpalaid plans to return, Madame Remy is literally terrified and even refuses at first to give him a room for one night. On learning from her of so many sick people, Parpalaid is perplexed and modestly vents the opinion that with time the town folks’ health must have deteriorated.

“Do not say this – answers Madame Remy – people had no idea of curing themselves – now all is different. You Dr. Parpalaid, are a man of another era… who rather prefers to lose an eye and a leg rather than buying three francs worth of medicine. Things are changed now.”

Now Mr. Mosquet returns on the scene, dressed in elegant attire. “How is Mrs. Mosquet,” asks Parpalaid.

Mr. Mosquet: “Do you remember those migraines that sometimes she suffered? Dr. Knock has diagnosed the condition as an insufficiency of ovarian secretions, and has prescribed an ‘opotherapic’ treatment that does marvels.”

Parpalaid. “The migraines, have they gone?”

Mosquet. “The old migraines have completely disappeared. The ones that now she suffers from are exclusively caused by over-work, which is quite natural.”

Eventually Knock arrives as well and, after the customary mutual greetings, Parpalaid raises a question, “Is it not that, with your method, the interest of the patient is somewhat subordinated to the interest of the physician?”

Knock, “Dr. Parpalaid, you forget that there is a superior interest at play. That of medicine, the only one I am concerned about…. Give me a district of people who, from the medical point of view, are neutral, uncommitted, undetermined. My role is to guide them, to lead them to the acknowledgement of a ‘medical existence’.”

Observing how the tone of public opinion is so much in favor of Dr. Knock, Parpalaid desists from the idea of returning to St. Maurice.

Eventually Knock convinces Madame Remy to give Parpalaid a room for the night, because “I can see by the way he looks that one day journey from Lyon is too much for him, to go back tonight.”

Parpalaid is grateful and yet puzzled. “Did you really see from my looks that it was better for me to remain here for the night? If so what is your diagnosis? I’d be curious to know, because I have felt for some time some changes within myself, from a purely theoretical point of view. But I would be curious to know more about your diagnosis….”

“Let’s not talk about it now – replies Dr. Knock – let’s have dinner together. As for your state of health we may talk about it later, in my clinic, tomorrow.” Thus the play ends.

But how in heaven did I think of Jules Romain’s play, considering, from a note I made in the book, that I read it over 20 years ago?

Here is why. Last week I went to a store for some shopping, only to discover at the door that I had left the mask in the car and went back to get it. The store is adjacent to a pharmacy. At that moment I see a young girl from the pharmacy literally running towards me.

“Would you like to have a vaccination today? We have a special offer.” – she asked.

“Thank you, young lady – I replied – but I am past hope, past help, past cure. (6) And by the way, another young lady originally said so, in a play whose author’s name you may recognize… if I told you.”


** 1. Timon of Athens
** 2. 3. All’s Well that Ends Well
** 4. Hamlet
** 5. King Richard III
** 6. Romeo and Juliet





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