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Oncology Times:
doi: 10.1097/01.COT.0000311439.13505.48
Scriptdoctor: Medicine in the Media

Medicine in a Musical

Holtz, Andrew MPH

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The story of a physician who is nearly consumed by temptation made headlines in the New York Times—show biz headlines, that is. On the heels of Oklahoma! and Carousel, Richard Rodgers and Oscar Hammerstein II had $500,000 worth of ticket sales already in the till on the day Allegro opened on Broadway at the Majestic Theatre.

It was October 10, 1947. Sam Zolotow, theater reporter for the Times, wrote that despite unprecedented advance sales ($500,000 in 1947 is the equivalent of $5 million today), the thirst for tickets could not be slaked: “Prospective customers have raised a hue and cry because they haven't been able to get tickets. From personal observation, we can assure them that strenuous efforts are being made to please all. They'll have to be patient, though, as the demand has assumed flood-like proportions,” he wrote.

And yet the next morning, reviews were mixed. Some were sharply negative. Today, Allegro is largely unknown and rarely staged.

Figure. Howard Marke...
Figure. Howard Marke...
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But back to the reason for writing about this six-decade-old show: It's all about the life of a physician, Joseph Taylor Jr., the son of a small-town doctor. I discovered this episode of medicine in the musicals through an article by historian of medicine Howard Markel, MD, PhD, writing in the Journal of the American Medical Association (“Gotta' Sing! Gotta' Diagnose!” A Postmortem Examination of Rodgers and Hammerstein's Medical Musical Allegro. JAMA 2007;298:1575–1577).

A fan of musicals, Dr. Markel says he had picked up a copy of the Allegro script when he was a teenager, but just tucked it away. Then during a visit to New York, he listened to a rare cast recording from the production.

“It just jumped out as, ‘Yes, this needs to be written about!’ so I did,” he said.

In the show, young Dr. Taylor aspired to help his father realize a dream of expanding the three-bed hospital attached to their home. But his new wife has grander ambitions. She maneuvers her husband into accepting a prominent position at a big-city practice. Instead of caring for farmers and their families, the doctor finds himself catering to the foibles of the worried wealthy. Bedside manner is supplanted by cocktail party prattle.

Dr. Markel sees eternal themes in this medical storyline: “What were your original goals? Why did you go into medicine? Or, why did you choose a particular branch of medicine? Or, why did you choose practice over academia? And more broadly, as we talk to our patients, what choices are they making?”

In the preface to a published version of the script, Oscar Hammerstein wrote that an equivalent story could be told about other professions. Yet he noted the ways he saw the practice of medicine warped by money and celebrity. I think it's telling that Hammerstein felt that a physician so neatly fit the bill of a character diverted from his intended path by nudges and lures.

“It is difficult for a man to recognize the gentle transitions of his own deterioration…,” Hammerstein wrote in that preface. What a delicious construction of words! Say it aloud and the phrase echoes with a feeling of stealthy, inexorable corruption.

He continues: “…the millions of small steps whereby he becomes less and less a doctor, more and more a politician, a promoter, a rumba dancer, a cocktail-party raconteur, a wet-nurse for spoiled adults—everything but what he started out to be, studied to be, struggled to be.”

All it would take is the insertion of “well-paid consultant to pharmaceutical or device companies” for this comment, penned more than a half-century ago, to seem to be an op-ed on medical conflicts of interest cut from today's newspaper.

Dr. Markel notes that in the decades since Allegro premiered, medicine has changed more than it had in preceding centuries. A multitude of effective treatments are common now that were beyond the science fiction of the mid-20th century. The transformation in medical devices and methods is illustrated by a bit of period technology featured in a turning point in the drama.

Dr. Taylor is entertaining guests (described as “high-bracket patients, and hospital trustees”) when he is interrupted by his nurse. She's brought along x-ray films of a less-prominent patient's stomach. The doctor had hastily reviewed the films before dashing off to the party.

“But I've already looked at them. You were there, Emily. Don't you remember? I told you to phone him and tell him there was nothing to worry about,” Dr. Taylor chides.

But the nurse persists, pointing to a spot on the film. “Couldn't that be an ulcer crater?”

Dr. Taylor's wife, Jenny, enters and urges him back to the party. One of his benefactors is calling for him. Jenny Taylor tells the nurse, “She wants to talk to my husband about donating three hundred thousand dollars toward our new private pavilion.” That'd be about $3 million today.

Dr. Taylor hustles back into the party, but he realizes his quick first reading of the film was wrong.

Dr. Markel says that on one hand, the scene illustrates how much has changed in medicine.

“This guy was using a flat plate belly film to diagnose a peptic ulcer. In 1947 that was kind of cutting edge. We use very different methods today.”

The treatments are different, too: “In 1947 you basically did a Billroth II, you surgically remove half the stomach, and that created a dumping syndrome—as opposed to now, with all the wonderful acid reflux reducers that we have.”

And yet on the other hand, it reveals how much the song remains the same.

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“So on every level medicine has changed markedly, but that's the great thing about a classic, and that's an overused word, but to me any great work of art or literature continues to speak to generations long after the day-to-day details it describes have become antiquated,” Dr. Markel said.

When you open the Allegro time capsule to see how popular media of the mid-20th century portrayed physicians and the practice of medicine, the essential message about tension between professional ideals and common reality remains solidly familiar.

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Medical School Enrollment Increases; More Black & Hispanic Males Apply

Association of American Medical Colleges data show that the 2007 class is the largest in history. The number of first-year enrollees is almost 17,800, a 2.3% increase over 2006. More than 42,300 people applied in 2007, an 8.2% increase over last year.

The 2007 applicants included more people from racial and ethnic minorities. Black and Hispanic male applicants increased by 9.2%, and black males accepted and enrolled this fall increased by 5.3%. The number of Hispanic male first-year entrants was the same as in 2006.

“With our nation expected to face a serious shortage of physicians in the future, we are pleased to see interest in medicine continuing to increase,” AAMC President Darrell G. Kirch, MD, said. “We are especially encouraged by the growing interest among students from groups historically underrepresented in medicine.”

Overall, the academic credentials of applicants to medical schools this year were stronger than ever, with the highest MCAT scores and cumulative grade point averages on record. In addition, over the past five years there has been an increase in applicants' average amount of experience in premedical activities, including time spent in medical research and community service in clinical and nonclinical settings.

© 2008 Lippincott Williams & Wilkins, Inc.

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