the importance of being ignorant

Z. W. Colson, M. D., Lawrence, Mass.

reprinted from The Laryngoscope, Vol. 17, No. 11, pp. 683-689, November, 1947

This summer I had the opportunity of reading the remarks of Dr. Mosher when he was made an Honorary Fellow of the American Laryngological Association. Among other pithy statements, he had this to say, "Remember that research, which is the idol of all universities, next to money, calls for imagination on the part of the worker, and especially for the correlating mind."

When I next saw Dr. Mosher I told him that medical education of our day is so crowded and intense for the average student that it tends to standardize and crowd out any imagination which he may ever have possessed, and that I believed an ignorant man would make a better researcher than a learned one. "In other words," Dr. Mosher came back at me, "if we turn our research work over to the Ditch Diggers' Union we might get somewhere."

My lame attempts to make him understand what I meant were not made easy by his comments on my crazy notion, and I soon wondered whether I had been wise in bringing it up at all. Before I left him, however, he instructed me to commit my thoughts to paper on the subject of "Ignorance as an Asset in Medical Research." He seemed to delight in choosing this topic for me, and implied that I had an intimate and personal knowledge of the subject. .

I realize in all seriousness that those who would read a paper on this subject are not ignorant or uninformed. If you were such, this paper could serve no useful purpose.

Dr. Mosher has stated that there are two vital requirements for research—imagination and correlation. In an effort to find a third leg for Dr. Mosher's two-legged stool, I shall have to apply various descriptive names to it, and I shall try to bolster it up so that none will be afraid to risk his weight upon it. The third leg we shall name, — for lack of a better title, "Ignorance."

I am too ignorant to define the term "ignorance" in the sense I mean it. Since I am unable to define it, I shall discuss it.

There are many kinds of ignorance, but for the purpose of this discussion we shall consider only two, first, objective ignorance, which is demonstrated by written and oral examinations. This is unimportant as an indication of what a man may or may not accomplish in research. The other—the kind which also contributed to the title of this paper—is subjective ignorance. This is the ignorance which is known only to the worker himself and is his stimulus to the acquisition of knowledge. Subjective ignorance has a strong connotation of humility and some men find in it the Fountain of Eternal Youth. They never grow up to become scholars and continue through their lives to be students.

One saving grace of our present day system of medical education lies with the comparatively few good teachers who refuse to be entirely orthodox themselves and who develop a wholesome agnosticism in their students. They teach what is required to be taught in their classes, sometimes with tongue in cheek. They give their students the impression that they must learn this modicum to pass the course, but that the subject they are teaching has more interesting and important value than the course itself. When the student parts from such a teacher he feels that he has been brought to the gate- way of intriguing territory, and that he has just enough knowledge of the terrain to begin to explore it with interest and appreciation.

During my medical school days I entered the lecture room early one morning, and two young men were sitting in the front row, quizzing each other on the previous lecture in Proctology. One asked, "What are the seven causes of hemorrhoids?" The other answered glibly one, two, three and four, and all were correct. Then he gave the fifth cause. "No," said the questioner, "you are wrong—that is the seventh cause." Both of these boys graduated from medical school with honors. You are not surprised, and neither am I, that they did not develop into research men, nor have they contributed to the advancement of their profession. You may say that such an example is ridiculous and has no place in a discussion of education as conducted in your departments. You must admit that something of this type of memory is necessary, even in postgraduate circles. If you are sitting as a board examiner and ask some poor candidate to describe to you the origin, course and distribution of the Vidian nerve, and all he can do is place it vaguely in the vicinity of the sphenoid sinus, it is not going to help him much that he knew the thing once and carried it around in his head for weeks. Of course, while as a young doctor, he is spending two years or so of his life trying to cram for his board examination, you should not expect productive thinking from him—he is too busy getting into the groove. Once he is in the groove, he has about as much chance of getting out as a phonograph needle. And, as the needle does, he stays in the groove and repeats every subsequent advance in medical science as it reaches him in his groove. Then, if he is sufficiently alert and reads all the periodicals and retains them, he is a learned man in his specialty, who keeps abreast of his time. You can expect no research from him—he is still in the groove.

At this stage the young man is not entirely hopeless as a researcher, for, after all, his mind is not completely filled with worthless facts, and his training has given him insight into the methods of experimental research. Perhaps he has a problem of his own which interests him, and some day when he has time he will work on it—but the medical literature is so full that any time he has for study must be spent in trying to keep abreast of new work by others. He has not time to think overmuch for himself, so he adopts the thought of leaders in the field, becomes orthodox and content with the knowledge he has. When this point is reached, you may write off our promising young student as a researcher, for he is headed into a dead end.

The deadening effect of the constant rise in educational standards involves not only students but teachers themselves. The teacher is loaded with an ever increasing load which he must unload in a limited time. This responsibility robs him of any considerable freedom of mental play and transforms him into a stern taskmaster—even against his will.

I recall no better illustration of this than an incident in my early medical school days which involved an outstanding professor of physiology. He was one of the first lecturers I ever heard who had written textbooks on his own subject, and I read them with an interest akin to worship. We were encouraged to discuss with him any individual problem we might have in the field, of physiology. When my turn came I said, "So far as I know, the only nerve endings we have in the skin are those of touch, temperature, pain and pressure. If this is true, how do you explain the sensation of itching?" At first there seemed to be the light of interest in his eyes, but he dismissed me with a stern rebuke and told me to spend my time studying what was being taught. It was days before I recovered from this disappointment. I was not troubled with the itch—my heart was hurt—my idol in research had feet of clay.

I would not go so far as to say that a researcher should be entirely ignorant of his problem, but he must be ignorant enough to see in it a problem. Many inventions and many advances in science have come from men who were so ignorant that they didn't know it couldn't be done. To paraphrase Edgar Guest: "The poor man didn't know that it couldn't be done, so he rolled up his sleeves and he did it."

In speaking to Mr. Howard Kichline, of the North American Cement Co., who has engineered research in ceramics, I asked him what criteria he used in the selection of his research personnel. I posed this question: "Which of these two young men will you select to head a research project? Both are young engineers of equal promise. One is a brilliant student who displays a broad knowledge of the problem, and who readily knows the answers to any phase of the project which is yet to be undertaken. The other man is keenly interested but does not readily know the answers, and is uncertain as to where the investigation will lead." Without hesitation, he replied that he would take the man who knew less but was interested in finding out. He believes that the man who knows or thinks he knows the answers cannot have the same interest as the man who is not so sure.

Few men can possess, individually, the proper balance of ignorance, imagination and correlation to become top-notch researchers, but in this day of teamwork such is not absolutely necessary. The burden of my message to you is to leaven your laboratories with ignorant men who can contribute more than their share of interest and imagination. Then it will be your problem to keep them intellectually honest, correlate their work, and direct their energies so that no discredit will come to you or your institutions.

I do not advocate filling your laboratories with dullards, for ignorance is not dullness—nor does ignorance guarantee imagination. I do maintain that our system of examinations is the poorest possible yardstick for the measurement of these qualities. It does not measure the all too uncommon commodity of common sense. It gives us no line on intellectual honesty. It tells us nothing about versatility. It is no measure of creative ability. It is not an indication of interest, imagination or initiative. All that the examination purports to measure is the amount of knowledge a man can reproduce at the tip of his tongue or the point of his pen at a given hour on a given date. It tells you nothing about how the candidate could answer those same questions even three months later, or how he could answer a slightly different set of questions on that date or any other date. If what I have just said is true or even partially true, it must follow that there are men classed as ignorant lost to our specialty and turned away from the whole field of medicine, who well might be more of a credit to medical practice and research than some of us who are in it.

One educator has estimated that in a class of 100 medical students, there are perhaps 10 men who possess outstanding imagination. Another believes that even this estimate is probably too high. There can be no question that the men of passing grade who possess this quality to a high degree can contribute more to medical research than a "95 average" man who lacks it. Thus, it would appear that when the annual pruning time comes to the medical school class, it would be wise to hold on to the man who has imagination. It might even be necessary that you accord him the same consideration and coaching which you would give a star athlete to keep him in his class.

Since I have no magic tape measure to replace the examination, I can only urge you to grade down its importance, and you may find that the relative value of the examination is nearer 10 per cent than a 100. Perhaps there might even be a place in medical research for men who, measured by our present educational standards, are "ignorant." I am willing . to concede considerable value to the examination. Though it is a poor measure as a yardstick, it is useful as a prod for lagging students and this, perhaps, is its greatest value.

On the same occasion which I mentioned in the first part of this paper, Dr. Mosher referred to tradition as "the most tangible of things intangible." This is particularly true in the field of medical education. The new head of a department in medical school feels that it is his duty to teach all that had been taught by his predecessors, and also to teach the cumulated advances of his time. Tradition seems to teach that nothing shall be subtracted, that everything be added. If this process is continued much longer, we shall be obliged to have two teaching heads for each department—one to teach what was taught to a certain date, and the other to start from there. When this comes to pass, the student will at least reach a professorial age before he will be qualified to practice.

I should be pleased to see one first-class university which has the courage, in the face of tradition, to remove deadwood from its curriculum and, at the same time, keep available in its libraries what has been taught previously.

There will always be a place in medical research for the grade A scholar, even though he is totally lacking in imagination. The presence of a walking encyclopedia is an asset in any laboratory, and such a man is necessary in keeping the record straight; but the real dynamo in research in the future, as in the past, will be the man who possesses a restless, imaginative and searching mind. He must have a mind which is fettered neither by tradition nor by smugness of self-content. His previous school marks are relatively unimportant.

The director of a research laboratory should not be a specialist in any narrow meaning of the term. He should have a broad and universal interest in subjects outside his field. I shall not commit the heresy of suggesting that our medical research should be directed by lay Edisons or Ketterings, but it should be directed by medical men who possess an equal diversity of interest. The elusive key to a problem in medical research may be common knowledge to men who are working in a different and apparently unrelated field. One must have restless imagination and broad interest if he is to correlate the knowledge gained by diverse patterns of thought.

We must bear in mind that in research truth is not the possession of the worker, but his goal. We should not forget that accepted knowledge has been known to raise itself as a barrier to hide the truth—and this unconsciously and certainly without intent.

Ignorance is not antagonistic to knowledge but is a stimulus to its acquisition. Newton expressed this personally when he wrote: "I do not know what I may appear to the world, but to myself I seem to have been only like a boy playing on the seashore and diverting myself now and then finding a smoother pebble or a prettier shell than ordinary, while the great ocean of truth lay all undiscovered before me."