gravely. "It's increasing by leaps and bounds, and it has the
distinction of being absolutely incurable. General paralysis is its full
title, and I tell you it promises to be a perfect scourge. Here's a
fairly typical case now which I saw last Monday week. A young farmer, a
splendid fellow, surprised his friends by taking a very rosy view of
things at a time when the whole country-side was grumbling. He was going
to give up wheat, give up arable land, too, if it didn't pay, plant two
thousand acres of rhododendrons and get a monopoly of the supply for
Covent Garden--there was no end to his schemes, all sane enough but just
a bit inflated. I called at the farm, not to see him, but on an
altogether different matter. Something about the man's way of talking
struck me and I watched him narrowly. His lip had a trick of quivering,
his words slurred themselves together, and so did his handwriting when
he had occasion to draw up a small agreement. A closer inspection showed
me that one of his pupils was ever so little larger than the other. As I
left the house his wife came after me. 'Isn't it splendid to see Job
looking so well, doctor?' said she; 'he's that full of energy he can
hardly keep himself quiet.' I did not say anything, for I had not the
heart, but I knew that the fellow was as much condemned to death as
though he were lying in the cell at Newgate. It was a characteristic
case of incipient G.P."
"Good heavens!" cries the outsider. "My own lips tremble. I often slur
my words. I believe I've got it myself."
Three little chuckles come from the front of the fire.
"There's the danger of a little medical knowledge to the layman."
"A great authority has said that every first year's student is suffering
in silent agony from four diseases," remarks the surgeon. "One is heart
disease, of course; another is cancer of the parotid. I forget the two
other."
"Where does the parotid come in?"
"Oh, it's the last wisdom tooth coming through!"
"And what would be the end of that young farmer?" asks the outsider.
"Paresis of all the muscles, ending in fits, coma and death. It may be a
few months, it may be a year or two. He was a very strong young man and
would take some killing."
"By the way," says the alienist, "did I ever tell you about the first
certificate I ever signed? I stood as near ruin then as a man could go."
"What was it, then?"
"I was in practice at the time. One morning a Mrs. Cooper called upon me
and informed me that her husband had shown signs of delusions lately.
They took the form of imagining that he had been in the army and had
distinguished himself very much. As a matter of fact he was a lawyer and
had never been out of England. Mrs. Cooper was of opinion that if I were
to call it might alarm him, so it was agreed between us that she should
send him up in the evening on some pretext to my consulting-room, which
would give me the opportunity of having a chat with him and, if I were
convinced of his insanity, of signing his certificate. Another doctor
had already signed, so that it only needed my concurrence to have him
placed under treatment. Well, Mr. Cooper arrived in the evening about
half an hour before I had expected him, and consulted me as to some
malarious symptoms from which he said that he suffered. According to his
account he had just returned from the Abyssinian Campaign, and had been
one of the first of the British forces to enter Magdala. No delusion
could possibly be more marked, for he would talk of little else, so I
filled in the papers without the slightest hesitation. When his wife
arrived, after he had left, I put some questions to her to complete the
forms. 'What is his age?' I asked. 'Fifty,' said she. 'Fifty!' I cried.
'Why, the man I examined could not have been more than thirty!' And so
it came out that the real Mr. Cooper had never called upon me at all,
but that by one of those coincidences which takes a man's breath away
another Cooper, who really was a very distinguished young officer of
artillery, had come in to consult me. My pen was wet to sign the paper
when I discovered it," says Dr. Manson, mopping his forehead.
"We were talking about nerve just now," observes the surgeon. "Just,
after my qualifying I served in the Navy for a time, as I think you
know. I was on the flag-ship on the West African Station, and I remember
a singular example of nerve which came to my notice at that time. One of
our small gunboats had gone up the Calabar river, and when there the
surgeon died of coast fever. On the same day a man's leg was broken by a
spar falling upon it, and it became quite obvious that it must be taken
off above the knee if his life was to be saved. The young lieutenant who
was in charge of the craft searched among the dead doctor's effects and
laid his hands upon some chloroform, a hip-joint knife, and a volume of
Grey's _Anatomy_. He had the man laid by the steward upon the cabin
table, and with a picture of the cross section of the thigh in front of
him he began to take off the limb. Every now and then, referring to the
diagram, he would say: 'Stand by with the lashings, steward. There's
blood on the chart about here.' Then he would jab with his knife until
he cut the artery, and he and his assistant would tie it up before they
went any further. In this way they gradually whittled the leg off, and
upon my word they made a very excellent job of it. The man is hopping
about the Portsmouth Yard at this day.
"It's no joke when the doctor of one of these isolated gunboats himself
falls ill," continues the surgeon after a pause. "You might think it
easy for him to prescribe for himself, but this fever knocks you down
like a club, and you haven't strength left to brush a mosquito off your
face. I had a touch of it at Lagos, and I know what I am telling you.
But there was a chum of mine who really had a curious experience. The
whole crew gave him up, and, as they had never had a funeral aboard the
ship, they began rehearsing the forms so as to be ready. They thought
that he was unconscious, but he swears he could hear every word that
passed. 'Corpse comin' up the 'atchway!' cried the cockney sergeant of
Marines. 'Present harms!' He was so amused, and so indignant too, that
he just made up his mind that he wouldn't be carried through that
hatchway, and he wasn't, either."
"There's no need for fiction in medicine," remarks Foster, "for the
facts will always beat anything you can fancy. But it has seemed to me
sometimes that a curious paper might be read at some of these meetings
about the uses of medicine in popular fiction."
"How?"
"Well, of what the folk die of, and what diseases are made most use of
in novels. Some are worn to pieces, and others, which are equally common
in real life, are never mentioned. Typhoid is fairly frequent, but
scarlet fever is unknown. Heart disease is common, but then heart
disease, as we know it, is usually the sequel of some foregoing disease,
of which we never hear anything in the romance. Then there is the
mysterious malady called brain fever, which always attacks the heroine
after a crisis, but which is unknown under that name to the text books.
People when they are over-excited in novels fall down in a fit. In a
fairly large experience I have never known any one to do so in real
life. The small complaints simply don't exist. Nobody ever gets shingles
or quinsy, or mumps in a novel. All the diseases, too, belongs to the
upper part of the body. The novelist never strikes below the belt."
"I'll tell you what, Foster," says the alienist, "there is a side of
life which is too medical for the general public and too romantic for
the professional journals, but which contains some of the richest human
materials that a man could study. It's not a pleasant side, I am afraid,
but if it is good enough for Providence to create, it is good enough for
us to try and understand. It would deal with strange outbursts of
savagery and vice in the lives of the best men, curious momentary
weaknesses in the record of the sweetest women, known but to one or two,
and inconceivable to the world around. It would deal, too, with the
singular phenomena of waxing and of waning manhood, and would throw a
light upon those actions which have cut short many an honoured career
and sent a man to a prison when he should have been hurried to a
consulting-room. Of all evils that may come upon the sons of men, God
shield us principally from that one!"
"I had a case some little time ago which was out of the ordinary," says
the surgeon. "There was a famous beauty in London Society--I mention no
names--who used to be remarkable a few seasons ago for the very low
dresses which she would wear. She had the whitest of skins, and most
beautiful of shoulders, so it was no wonder. Then gradually the frilling
at her neck lapped upwards and upwards, until last year she astonished
every one by wearing quite a high collar at a time when it was
completely out of fashion. Well, one day this very woman was shown into
my consulting-room. When the footman was gone she suddenly tore off the
upper part of her dress. 'For God's sake do something for me!' she
cried. Then I saw what the trouble was. A rodent ulcer was eating its
way upwards, coiling on in its serpiginous fashion until the end of it
was flush with her collar. The red streak of its trail was lost below
the line of her bust. Year by year it had ascended and she had
heightened her dress to hide it, until now it was about to invade her
face. She had been too proud to confess her trouble, even to a medical
man."
"And did you stop it?"
"Well, with zinc chloride I did what I could. But it may break out
again. She was one of those beautiful white-and-pink creatures who are
rotten with struma. You may patch but you can't mend."
"Dear! dear! dear!" cries the general practitioner, with that kindly
softening of the eyes which has endeared him to so many thousands. "I
suppose we mustn't think ourselves wiser than Providence, but there are
times when one feels that something is wrong in the scheme of things.
I've seen some sad things in my life. Did I ever tell you that case
where Nature divorced a most loving couple? He was a fine young fellow,
an athlete and a gentleman, but he overdid athletics. You know how the
force that controls us gives us a little tweak to remind us when we get
off the beaten track. It may be a pinch on the great toe if we drink too
much and work too little. Or it may be a tug on our nerves if we
dissipate energy too much. With the athlete, of course, it's the heart
or the lungs. He had bad phthisis and was sent to Davos. Well, as luck
would have it, she developed rheumatic fever, which left her heart very
much affected. Now, do you see the dreadful dilemma in which those poor
people found themselves? When he came below 4,000 feet or so, his
symptoms became terrible. She could come up about 2,500, and then her
heart reached its limit. They had several interviews half-way down the
valley, which left them nearly dead, and at last, the doctors had to
absolutely forbid it. And so for four years they lived within three
miles of each other and never met. Every morning he would go to a place
which overlooked the chalet in which she lived and would wave a great
white cloth and she answer from below. They could see each other quite
plainly with their field glasses, and they might have been in different
planets for all their chance of meeting."
"And one at last died," says the outsider.
"No, sir. I'm sorry not to be able to clinch the story, but the man
recovered and is now a successful stockbroker in Drapers Gardens. The
woman, too, is the mother of a considerable family. But what are you
doing there?"
"Only taking a note or two of your talk."
The three medical men laugh as they walk towards their overcoats.
"Why, we've done nothing but talk shop," says the general practitioner.
"What possible interest can the public take in that?"
XIII
THE SURGEON TALKS
"Men die of the diseases which they have studied most," remarked the
surgeon, snipping off the end of a cigar with all his professional
neatness and finish. "It's as if the morbid condition was an evil
creature which, when it found itself closely hunted, flew at the throat
of its pursuer. If you worry the microbes too much they may worry you.
I've seen cases of it, and not necessarily in microbic diseases either.
There was, of course, the well-known instance of Liston and the
aneurism; and a dozen others that I could mention. You couldn't have a
clearer case than that of poor old Walker of St. Christopher's. Not
heard of it? Well, of course, it was a little before your time, but I
wonder that it should have been forgotten. You youngsters are so busy in
keeping up to the day that you lose a good deal that is interesting of
yesterday.
"Walker was one of the best men in Europe on nervous disease. You must
have read his little book on sclerosis of the posterior columns. It's as
interesting as a novel, and epoch-making in its way. He worked like a
horse, did Walker--huge consulting practice--hours a day in the clinical
wards--constant original investigations. And then he enjoyed himself
also. '_De mortuis_,' of course, but still it's an open secret among all
who knew him. If he died at forty-five, he crammed eighty years into it.
The marvel was that he could have held on so long at the pace at which
he was going. But he took it beautifully when it came.
"I was his clinical assistant at the time. Walker was lecturing on
locomotor ataxia to a wardful of youngsters. He was explaining that one
of the early signs of the complaint was that the patient could not put
his heels together with his eyes shut without staggering. As he spoke,
he suited the action to the word. I don't suppose the boys noticed
anything. I did, and so did he, though he finished his lecture without a
sign.
"When it was over he came into my room and lit a cigarette.
"'Just run over my reflexes, Smith,' said he.
"There was hardly a trace of them left, I tapped away at his knee-tendon
and might as well have tried to get a jerk out of that sofa-cushion. He
stood, with his eyes shut again, and he swayed like a bush in the wind.
"'So,' said he, 'it was not intercostal neuralgia after all.'
"Then I knew that he had had the lightning pains, and that the case was
complete. There was nothing to say, so I sat looking at him while he
puffed and puffed at the cigarette. Here he was, a man in the prime of
life, one of the handsomest men in London, with money, fame, social
success, everything at his feet, and now, without a moment's warning, he
was told that inevitable death lay before him, a death accompanied by
more refined and lingering tortures than if he were bound upon a Red
Indian stake. He sat in the middle of the blue cigarette cloud with his
eyes cast down, and the slightest little tightening of his lips. Then he
rose with a motion of his arms, as one who throws off old thoughts and
enters upon a new course.
"'Better put this thing straight at once,' said he. 'I must make some
fresh arrangements. May I use your paper and envelopes?'
"He settled himself at my desk and he wrote half a dozen letters. It is
not a breach of confidence to say that they were not addressed to his
professional brothers. Walker was a single man, which means that he was
not restricted to a single woman. When he had finished, he walked out of
that little room of mine, leaving every hope and ambition of his life
behind him. And he might have had another year of ignorance and peace if
it had not been for the chance illustration in his lecture.
"It took five years to kill him, and he stood it well. If he had ever
been a little irregular he atoned for it in that long martyrdom. He kept
an admirable record of his own symptoms, and worked out the eye changes
more fully than has ever been done. When the ptosis got very bad he
would hold his eyelid up with one hand while he wrote. Then, when he
could not co-ordinate his muscles to write, he dictated to his nurse. So
died, in the odour of science, James Walker, aet. 45.
"Poor old Walker was very fond of experimental surgery, and he broke
ground in several directions. Between ourselves, there may have been
some more ground-breaking afterwards, but he did his best for his cases.
You know M'Namara, don't you? He always wears his hair long. He lets it
be understood that it comes from his artistic strain, but it is really
to conceal the loss of one of his ears. Walker cut the other one off,
but you must not tell Mac I said so.
"It was like this. Walker had a fad about the portio dura--the motor to
the face, you know--and he thought paralysis of it came from a
disturbance of the blood supply. Something else which counterbalanced
that disturbance might, he thought, set it right again. We had a very
obstinate case of Bell's paralysis in the wards, and had tried it with
every conceivable thing, blistering, tonics, nerve-stretching,
galvanism, needles, but all without result. Walker got it into his head
that removal of the ear would increase the blood supply to the part, and
he very soon gained the consent of the patient to the operation.
"Well, we did it at night. Walker, of course, felt that it was something
of an experiment, and did not wish too much talk about it unless it
proved successful. There were half a dozen of us there, M'Namara and I
among the rest. The room was a small one, and in the centre was the
narrow table, with a mackintosh over the pillow, and a blanket which
extended almost to the floor on either side. Two candles, on a
side-table near the pillow, supplied all the light. In came the patient,
with one side of his face as smooth as a baby's, and the other all in a
quiver with fright. He lay down, and the chloroform towel was placed
over his face, while Walker threaded his needles in the candle light.
The chloroformist stood at the head of the table, and M'Namara was
stationed at the side to control the patient. The rest of us stood by to
assist.
"Well, the man was about half over when he fell into one of those
convulsive flurries which come with the semi-unconscious stage. He
kicked and plunged and struck out with both hands. Over with a crash
went the little table which held the candles, and in an instant we were
left in total darkness. You can think what a rush and a scurry there
was, one to pick up the table, one to find the matches, and some to
restrain the patient, who was still dashing himself about. He was held
down by two dressers, the chloroform was pushed, and by the time the
candles were relit, his incoherent, half-smothered shoutings had changed
to a stertorous snore. His head was turned on the pillow and the towel
was still kept over his face while the operation was carried through.
Then the towel was withdrawn, and you can conceive our amazement when we
looked upon the face of M'Namara.
"How did it happen? Why, simply enough. As the candles went over, the
chloroformist had stopped for an instant and had tried to catch them.
The patient, just as the light went out, had rolled off and under the
table. Poor M'Namara, clinging frantically to him, had been dragged
across it, and the chloroformist, feeling him there, had naturally
clapped the towel across his mouth and nose. The others had secured him,
and the more he roared and kicked the more they drenched him with
chloroform. Walker was very nice about it, and made the most handsome
apologies. He offered to do a plastic on the spot, and make as good an
ear as he could, but M'Namara had had enough of it. As to the patient,
we found him sleeping placidly under the table, with the ends of the
blanket screening him on both sides. Walker sent M'Namara round his ear
next day in a jar of methylated spirit, but Mac's wife was very angry
about it, and it led to a good deal of ill-feeling. Some people say
that the more one has to do with human nature, and the closer one is
brought in contact with it, the less one thinks of it. I don't believe
that those who know most would uphold that view. My own experience is
dead against it. I was brought up in the miserable-mortal-clay school of
theology, and yet here I am, after thirty years of intimate acquaintance
with humanity, filled with respect for it. The evil lies commonly upon
the surface. The deeper strata are good. A hundred times I have seen
folk condemned to death as suddenly as poor Walker was. Sometimes it was
to blindness or to mutilations which are worse than death. Men and
women, they almost all took it beautifully, and some with such lovely
unselfishness, and with such complete absorption in the thought of how
their fate would affect others, that the man about town, or the
frivolously-dressed woman had seemed to change into an angel before my
eyes. I have seen death-beds, too, of all ages and of all creeds and
want of creeds. I never saw any of them shrink, save only one poor,
imaginative young fellow, who had spent his blameless life in the
strictest of sects. Of course, an exhausted frame is incapable of fear,
as any one can vouch who is told, in the midst of his seasickness, that
the ship is going to the bottom. That is why I rate courage in the face
of mutilation to be higher than courage when a wasting illness is fining
away into death.
"Now, I'll take a case which I had in my own practice last Wednesday. A
lady came in to consult me--the wife of a well-known sporting baronet.
The husband had come with her, but remained, at her request, in the
waiting-room. I need not go into details, but it proved to be a
peculiarly malignant case of cancer. 'I knew it,' said she. 'How long
have I to live?' 'I fear that it may exhaust your strength in a few
months,' I answered. 'Poor old Jack!' said she. 'I'll tell him that it
is not dangerous.' 'Why should you deceive him?' I asked. 'Well, he's
very uneasy about it, and he is quaking now in the waiting-room. He has
two old friends to dinner to-night, and I haven't the heart to spoil his
evening. To-morrow will be time enough for him to learn the truth.' Out
she walked, the brave little woman, and a moment later her husband, with
his big, red face shining with joy came plunging into my room to shake
me by the hand. No, I respected her wish and I did not undeceive him. I
dare bet that evening was one of the brightest, and the next morning the
darkest, of his life.
"It's wonderful how bravely and cheerily a woman can face a crushing
blow. It is different with men. A man can stand it without, but it
knocks him dazed and silly all the same. But the woman does not lose her
wits any more than she does her courage. Now, I had a case only a few
weeks ago which would show you what I mean. A gentleman consulted me
about his wife, a very beautiful woman. She had a small tubercular
nodule upon her upper arm, according to him. He was sure that it was of
no importance, but he wanted to know whether Devonshire or the Riviera
would be the better for her. I examined her and found a frightful
sarcoma of the bone, hardly showing upon the surface, but involving the
shoulder-blade and clavicle as well as the humerus. A more malignant
case I have never seen. I sent her out of the room and I told him the
truth. What did he do? Why, he walked slowly round that room with his
hands behind his back, looking with the greatest interest at the
pictures. I can see him now, putting up his gold _pince-nez_ and staring
at them with perfectly vacant eyes, which told me that he saw neither
them nor the wall behind them. 'Amputation of the arm?' he asked at
last. 'And of the collar-bone and shoulder-blade,' said I. 'Quite so.
The collar-bone and shoulder-blade,' he repeated, still staring about
him with those lifeless eyes. It settled him. I don't believe he'll ever
be the same man again. But the woman took it as bravely and brightly as
could be, and she has done very well since. The mischief was so great
that the arm snapped as we drew it from the night-dress. No, I don't
think that there will be any return, and I have every hope of her
recovery.