• optic neuritis
• multiple sclerosis
• treatment

Based on the 2nd Meadows Memorial Lecture, given at the Royal College of Physicians, London, on the occasion of the meeting of the European Neuro-ophthalmological Society, in May 1997

The title of my lecture derives from a statement by the great lexicographer Dr Samuel Johnson in the course of a review of theEssay on Waters, by Dr Charles Lucas.1 Lucas extolled the healing powers of the waters at Bath (where he was physician) and elsewhere during an enforced hiatus in his political life in Dublin. Dr Johnson was evidently not persuaded: “It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.”2

Like most Johnsonian aphorisms this one is at once arresting and amusing. One has an immediate sense that he is right — and as a physician, rightly, one is uncomfortable. But again typically, as one reflects on it, there are depths and complexities. Its force derives from the tension created between the perception that there is an important truth here, and the perception that it is not universal. In this lecture in which we celebrate the memory and contribution of a truly great physician, I want to explore some of these complexities, using Swithin Meadows as the exemplar — firstly, because he did not fall into the Johnsonian trap as Dr Lucas did; and secondly because these issues are deeply relevant to us and our patients today.

I first met Dr. Meadows in 1962 in Dunedin when he and Mr Douglas Northfield (the neurosurgeon) toured the main medical centres in New Zealand, and finally led a 2 day course on neurology in Auckland. His physical presence, his wisdom, his warmth and geniality, and his integrity made a profound impression, which was consolidated when, the following year, I came …