Dear Marion,

Most of the day, I've spent reading Hawthorne's Scarlet Letter,
my acquaintance with which is long overdue. I started to read it
today because it's an assignment for my grandson Benjamin, now
in 11th grade. If he wants to talk about the book, I'd like to
be able to discuss it with him. Maybe my thoughts will be of no
interest, and he'll listen only, if at all, because he is by
nature very polite. I found a passage which I thought was relevant
to our discussion about medical diagnosis and treatment:

"Thus Roger Chillingworth scrutinised his patient carefully, both
as he saw him in his ordinary life, keeping an accustomed
pathway in the range of thoughts familiar to him, and as he
appeared when thrown amidst other moral scenery, the novelty of
which might call out something new to the surface of his
character.  He deemed it essential, it would seem, to know the
man, before attempting to do him good.  Wherever there is a heart
and an intellect, the diseases of the physical frame are tinged
with the peculiarities of these.  In Arthur Dimmesdale, thought
and imagination were so active, and sensibility so intense, that
the bodily infirmity would be likely to have its groundwork
there.  So Roger Chillingworth--the man of skill, the kind and
friendly physician--strove to go deep into his patient's bosom,
delving among his principles, prying into his recollections, and
probing everything with a cautious touch, like a treasure-seeker
in a dark cavern.  Few secrets can escape an investigator, who
has opportunity and licence to undertake such a quest, and skill
to follow it up.  A man burdened with a secret should especially
avoid the intimacy of his physician.  If the latter possess
native sagacity, and a nameless something more,--let us call it
intuition; if he show no intrusive egotism, nor disagreeable
prominent characteristics of his own; if he have the power,
which must be born with him, to bring his mind into such
affinity with his patient's, that this last shall unawares have
spoken what he imagines himself only to have thought; if such
revelations be received without tumult, and acknowledged not so
often by an uttered sympathy as by silence, an inarticulate
breath, and here and there a word to indicate that all is
understood; if to these qualifications of a confidant be joined
the advantages afforded by his recognised character as a
physician;--then, at some inevitable moment, will the soul of
the sufferer be dissolved, and flow forth in a dark but
transparent stream, bringing all its mysteries into the
daylight."

The passage obviously speaks for itself. As for the role of
a personal physician-patient relationship in medical therapy,
superfluous or essential, consider the issue of immunization,
the simplest and most direct of therapeutic efforts, often
mandated by statute or regulation, and readily administered
by technicians or nurses. Yet the decision whether any specific
immunization should be obtained is often a critical one in
the mind of the anxious patient, as for example Merck's latest
miracle "Zostavax" to ward off herpes zoster, a vaccine constituted
of live inactivated, and sometime not so inactivated virus which
costs $200 for a single .65 ml. injection, recommended for _all_
older patients by some government agency, but not covered by
Medicare. Who is to decide? Even more compelling, the occasional
allergic reactions, anaphylactic or delayed, which can occur in
consequence of many injections. Most patients would be less distressed
at the biological and financial costs of immunization if they had
incurred them on the advice of a physician who had their unique,
individual interests at heart. - Just a passing thought.

Thank you again, and very much, for your concerns about Margrit.
I wish I could see a possibility for Margrit to resume her adventurous
independent existence in Detroit; but I don't. I haven't said anything
to her and I won't. I'll let future developments speak for themselves.
I don't know what the future holds for any of us. At this juncture
Margrit is still too weak and too sick, - her diarrhea comes and goes -
to make it practical for her to go back.  I've mentioned often enough my
concerns about her inability to cope with the problems of independent
existence isolated as she is in that economically forlorn and
disorganized city. The circumstance that I see no solution doesn't
mean that a solution might not turn up. If it did, I would welcome it.

As for the Caribbean Cruise sponsored by the Nation, it seems
inordinately generous of you to offer to accompany Margrit,
especially since you yourself have no great enthusiasm for the
project. From the perspective of public health, neither Klemens
nor I can advise her to make the trip. The presumptive cause of
her recurrent diarrhea, clostridium difficile, is recognized as
a communicable pathogen responsible for a disease with 25% mortality
in susceptible populations. While quarantine is not mandated, and
there are no official restrictions on travel, if an epidemic broke out
on board ship, a physician who had acquiesced to such gratutitous
exposure, would be hard put to defend himself,

Notwithstanding such concerns,  you should know that Margaret and I
are always pleased to have you stay with us to visit Margrit and
ourselves in Belmont - when we're in Belmont, - or in Konnarock,
when we're in Konnarock, at any time that the spirit so moves you.
If you're not taking antibiotics, the risk of clostridium infection
is probably low.

I apologize for a letter almost entirely lacking in inspiration. I
don't believe Hawthorne is at all good for my mind. I'll try to get
back to my own writing soon, and then, I hope I'll have more meaningful
things to write to you.

Jochen