Dr. Frankenstein was a monster, because he created one.
Dr. Krankheit, a hilarious vaudeville figure, was a buffoon. "Krankheit" is German for "ill health."
The long-enduring Dr. Kildare, of books, films and TV of the '30s, '40s and '50s, was a saint.
Dr. Marcus Welby, the Robert Young character of the next TV generation, was the pluperfect family doctor, warm, unhurried, correct.
The doctors of "M.A.S.H." were troubled human beings, burying their anguish in pranks and alcohol.
The doctors of "St. Elsewhere" are more human still. They miss diagnoses. They have disordered lives. Still, they help or save most of their patients, preserving our image of the doctors we would all like to have.
These healers and more -- physicians, psychiatrists, dentists, nurses -- were the subject of a symposium at the National Library of Medicine last week on public perceptions of medical practitioners as reflected in the arts: literature, drawing, theater, film, radio, television.
"Our fascination with images of healers goes back thousands of years," said Anne Hudson Jones, lecturer on literature and medicine at the University of Texas Medical Branch in Galveston.
And the negative images have far outnumbered the positive ones. "Our feelings about these people are ambivalent," Jones explained. "They have power over us, because they deal with life and death. But we don't always like them."
One of the procession in Chaucer's 14th-century "Canterbury Tales" was (as rendered in modern prose) "a physician . . . He was trained in astrology . . . He knew the cause of every disease . . . Indeed, he was the perfect practitioner . . . He especially loved gold."
A 16th-century engraving showed the physician in four stages: God to the ill patient, angel to the improving patient, man to the cured one and devil when the patient gets his bill.
Mary Shelley's 1816 novel, "Frankenstein," set the pattern for stories of doctors as horror mongers. "When a doctor goes wrong, he is the worst of criminals. He has nerve and he has knowledge," said Sherlock Holmes, the creation of Arthur Conan Doyle, M.D. Yet Holmes' sidekick, Dr. Watson, while no genius, was a solid and assured family practitioner, always ready with a dash of medicine -- usually brandy -- when needed.
It was not until Conan Doyle's era, the late 19th century, that literature began to view doctors with sympathy, for it was not until then, said Jones, "that advances in scientific knowledge began to make it possible for the physician to do something actually helpful." Even brandy sometimes helped.
But in cartoons and sketches of the early 20th century, said William Helfand, collector and scholar, physicians were again most often ridiculed as ignorant and ineffective healers and even killers. They were de- The Marcus Welby image is no longer credible.
picted as peacocks in manner and speakers of incomprehensible gobbledegook.
Ridicule dominated the stage, as in the celebrated Smith and Dale's Dr. Krankheit vaudeville sketches.
"How do you do, I'm Dr. Krankheit."
"How do you do, Mr. Dubious."
Then there was Dr. Krankheit as dentist, when his nurse told him his patient has died and she objects to signing the death certificate. "All I do all day is sign death certificates!"
"We laugh at that we fear the most," said Brooks McNamara, professor of performance studies at New York University, quoting philosopher Henri Bergson. ::
Dentists have consistently been portrayed as heartless sadists. Examples: An old cartoon's "I must have made some mistake -- there's nothing wrong with this tooth. No matter, try again." Dr. Krankheit with his grotesque tools. W.C. Fields wrestling patients into his chair. A Charles Addams waiting room filled with instruments of torture. Sadist-dentist Steve Martin in the movie "Little Shop of Horrors."
Physicians of the same ilk occupied the films of the '30s and '40s, with Abbott and Costello and Laurel and Hardy either playing or confronting men in white, the Three Stooges as crazy surgeons and Groucho Marx as Dr. Hugo Quackenbush, horse doctor mistreating humans.
In 1925, however -- and in a 1931 film starring Ronald Colman -- Americans saw a new kind of 20th-century doctor, "Arrowsmith," the dedicated physician and self-sacrificing scientist, fighting plague and selfishness.
Dr. Martin Arrowsmith was nonetheless a physician of his time. As a young doctor, he chastened a brash young nurse (whom he of course later marries): "I've been informed that the first duty of a nurse is to stand when speaking to a doctor."
Nurses have typically been portrayed in only three degrading guises. As docile handmaidens to male doctors, like Arrowsmith's nurse and wife. Or as severe taskmistresses, and sometimes cruel ones, like the infamous Nurse Ratched, who dispensed mind-numbing medicines in "One Flew Over the Cuckoo's Nest." Or as sexpots. "Nurse Legs" titillated the World War II disabled in film's "Captain Newman, M.D.," and Hotlips Houlihan was the sex symbol of the 4077th in "M.A.S.H."
"Nurses are especially popular in pornography, largely out of convenience," since they typically attend unclothed patients, observed Barbara Melosh of the Smithsonian Institution.
What we do not see in the visual arts is today's nurse -- at least today's ideal nurse -- as "empathetic communicator," said Jennifer Tebbe of the Massachusetts College of Pharmacy and Allied Health Sciences.
So Laraine Day, nurse to film's young Dr. Kildare, and her nursing sisters slavishly served the new hero-doctors of film, radio and TV. Arrowsmith. Kildare. "Ben Casey," the angry young neurosurgeon. "Marcus Welby, M.D." Radio's "Dr. Christian" and "Young Dr. Malone," forebears to the hordes of young heroes in white in today's soaps.
And television's "Quincy," pathologist-detective, heir not so much to Dr. Watson as to Sherlock Holmes, whom Dr. Conan Doyle patterned after his teacher, Dr. Joseph Bell, brilliant Edinburgh professor who could often detect a patient's occupation at a glance.
Heroes all. And heroes now outdated in our new time of skepticism toward physicians and physick. Prof. David Tanner of the Massachusetts College called this an "an era of debunking" and "the medical establishment as enemy."
In 1971 came "The Hospital" with George C. Scott as a chief of medicine nearly driven to suicide at a hospital where a patient is turned into a vegetable by a series of mistakes and mishaps. In 1972 came "M.A.S.H.," and in 1975, "Cuckoo's Nest," Ken Kesey's story of discipline by tranquilizer and electroshock.
1978, "Coma." Doctors as manipulators in a science-fiction shop of medical horrors. 1982, "The Verdict," in which weatherbeaten attorney Paul Newman fights a cover-up of medical negligence and malpractice.
1982, "St. Elsewhere." Said Dr. Rita Charon of Columbia University of this sometimes faltering hospital's sometimes infamous doctors, "They make mistakes. They commit crimes. They rape, they pillage, they murder. They complain about their work. They don't have god-like power. This seems real."
Both patients and doctors now wrestle with ethical dilemmas. In "Whose Life Is It Anyway?," a play and then a movie, the helpless, paraplegic accident victim shouts, "I've decided I don't want to stay alive!" as the doctor persists in making another life-extending injection.
Films -- and other portrayals of healers in art forms -- reflect our desires, our fantasies and our fears, said the National Library of Medicine's speakers. What we are asking in a show like "Whose Life," said Tanner, is: "Can doctors be trusted to respect our will?" ::
In previous years, said Prof. McNamara, the barbs that the arts aimed at healers mainly alleged ineffective therapy. Today, he reported, that is only an occasional image, replaced by new ones: "modern medical technology causes harm, potent medications cause serious side effects, physicians are unsympathetic, pompous, evil, malicious, overly amorous and mercenary, charging exorbitant fees, failing to provide services and inspiring fear."
Why the changed view? Why "St. Elsewhere's" Dr. Westphal missing a crucial diagnosis instead of young Dr. Kildare purveying endless cures?
"A Kildare wouldn't work on prime time today," Charon said. "People won't accept the image of the perfect doctor. 'Doctor knows best' doesn't work any more. Patients -- some -- want to make decisions for themselves.
"The doctor still stands for some of our wishes in terms of healing. But with the demystifying of medicine, the myth has had to be updated."
The way the arts portray doctors affects doctors, and sometimes affects them disturbingly, she reported.
"I think the changes might give us some trouble," she said. "But ultimately they might be very good for us. We might miss our image as perfect human beings, but we may be able to achieve a better understanding of what our calling really is.
"Doctors know that sometimes we're powerful, but most of the time we're not. We know how helpless we are in most situations. We know the helplessness, the sadness, the loss, the incompetence, the fear of incompetence. The ambiguity and responsibility of accompanying people to their deaths."
When TV begins to reveal these feelings, she said, "I think it makes the medical trainee and the medical practitioner acknowledge them. It makes us acknowledge the inner conflict that boils away, most of the time repressed."
Prof. Tebbe added this thought. The change from "Kildare" to "St. Elsewhere," the change from blind deference to realistic suspicion, is a hard one but probably a good one for doctors and patients alike.
Next Week: A doctor reflects on his illness.