Humour Me

The time will come when diligent research over long periods will bring to light things that now lie hidden. There will come a time when our descendants will be amazed that we did not know things that are so plain to them. Many discoveries are reserved for ages still to come, when memory of us will have been effaced. Our universe is a sorry little affair unless it has in it something for every age to investigate. Nature does not reveal her mysteries once and for all. In this edition there are two papers from the department of hepatobiliary surgery in the Mater hospital. The first considers biliary complications following cholecystectomy 1 and the second, hepatic portal venous gas 2. It is fascinating to consider how far we have travelled in our understanding of matters hepatobiliary. Since Hippocrates in the 4th century BC, 'The Four Humours' were felt necessary for a proper balance of what Claude Bernard would later call 'Le Milieu Intérieur'. These four were 'Blood', 'Yellow Bile', 'Black Bile', and 'Phlegm'. Each was linked not only with the four Seasons; the four elements Earth, Fire, Water and Air (by Empedocles) but with the ancient names 'Sanguine','Cholic', 'Melancholic' and 'Phlegmatic', that represented courageous, angry, despondent, and unemotional behaviour respectively and of course, these vestigal descriptive characteristics still persist in the English language. Expelling an excess of one humour e.g. blood-letting or purging was the logical consequence of any perceived imbalance but with our sophisticated retrospectoscope, we look back, eyebrow raised, shoulders shrugged, in a 'what were they thinking?' kind of way. Those ancients: what fools. What will future generations make of our medical interventions and therapies? Evidence-based, to be sure, but isn't there the vague sense of unease that decades from now, our Foundation doctors, well stricken in years, will explain to an impatient youth of tomorrow how things were done? Peter Kavanagh's paper on final year work-shadowing 3 and Alexandra Murphy's view from the standpoint of the Foundation doctor 4 present impressive descriptions of what our theological colleagues might call, 'The Now.' The tour d'horizon however, shifts continuously, and the Foundation doctor now faces a bewildering series of deanery, hospital and specialty decisions, unknown to this middle aged practitioner. Some years ago, at lunchtime (remember lunchtimes?), I was listening to several eminent colleagues, discussing their training years. What struck me forcibly at the time, was that not one …