WHEN Doctor Hillhouse arrived at his office, it lacked only a
quarter of an hour to twelve, the time fixed for the operation on
Mrs. Carlton. He found Doctor Kline and Doctor Angier, who were to
assist him, both awaiting his return.
"I thought twelve o'clock the hour?" said Doctor Kline as he came in
hurriedly.
"So it is. But everything has seemed to work adversely this morning.
Mr. Ridley's wife is extremely ill--dying, in fact--and I have had
to see her too or three times. Other calls have been imperative, and
here I am within a quarter of an hour of the time fixed for a most
delicate operation, and my preparations not half completed."
Doctor Kline regarded him for a few moments, and then said:
"This is unfortunate, doctor, and I would advise a postponement
until to-morrow. You should have had a morning free from anything
but unimportant calls."
"Oh no. I cannot think of a postponement," Doctor Hillhouse replied.
"All the arrangements have been made at Mr. Carlton's, and my
patient is ready. To put it off for a single day might cause a
reaction in her feelings and produce an unfavorable condition. It
will have to be done to-day."
"You must not think of keeping your appointment to the hour," said
Doctor Kline, glancing at his watch. "Indeed, that would now be
impossible. Doctor Angier had better go and say that we will be
there within half an hour. Don't hurry yourself in the slightest
degree. Take all the time you need to make yourself ready. I will
remain and assist you as best I can."
A clear-seeing and controlling mind was just what Doctor Hillhouse
needed at that moment. He saw the value of Doctor Kline's
suggestion, and promptly accepted it. Doctor Angier was despatched
to the residence of Mr. Carlton to advise that gentleman of the
brief delay and to make needed preparations for the work that was to
be done.
The very necessity felt by Doctor Hillhouse for a speedy repression
of the excitement from which he was suffering helped to increase the
disturbance, and it was only after he had used a stimulant stronger
than he wished to take that he found his nerves becoming quiet and
the hand on whose steadiness so much depended growing firm.
At half-past twelve Doctor Hillhouse, in company with Doctor Kline,
arrived at Mr. Carlton's. The white face and scared look of the
female servant who admitted them showed how strongly fear and
sympathy were at work in the house. She directed them to the room
which had been set apart for their use. In the hall above Mr.
Carlton met them, and returned with a trembling hand and silent
pressure the salutation of the two physicians, who passed into a
chamber next to the one occupied by their patient and quickly began
the work of making everything ready. Acting from previous concert,
they drew the table which had been provided into the best light
afforded by the room, and then arranged instruments, bandages and
all things needed for the work to be done.
When all these preparations were completed, notice was given to Mrs.
Carlton, who immediately entered from the adjoining room. She was a
beautiful woman, in the very prime of life, and never had she
appeared more beautiful than now. Her strong will had mastered fear,
strength, courage and resignation looked out from her clear eyes and
rested on her firm lips. She smiled, but did not speak. Doctor
Hillhouse took her by the hand and led her to the table on which she
was to lie during the operation, saying, as he did so, "It will be
over in a few minutes, and you will not feel it as much as the
scratch of a pin."
She laid herself down without a moment's hesitation, and as she did
so Doctor Angier, according to previous arrangement, presented a
sponge saturated with ether to her nostrils, and in two minutes
complete anaesthesis was produced. On the instant this took place
Doctor Hillhouse made an incision and cut down quickly to the tumor.
His hand was steady, and he seemed to be in perfect command of
himself. The stimulants he had taken as a last resort were still
active on brain and nerves. On reaching the tumor he found it, as he
had feared, much larger than its surface presentation indicated. It
was a hard, fibrous substance, and deeply seated among the veins,
arteries and muscles of the neck. The surgeon's hand retained its
firmness; there was a concentration of thought and purpose that gave
science and skill their best results. It took over twenty minutes to
dissect the tumor away from all the delicate organs upon which it
had laid its grasp, and nearly half as long a time to stanch the
flow of blood from the many small arteries which had been severed
during the operation. One of these, larger than the rest, eluded for
a time the efforts of Doctor Hillhouse at ligation, and he felt
uncertain about it even after he had stopped the effusion of blood.
In fact, his hand had become unsteady and his brain slightly
confused. The active stimulant taken half an hour before was losing
its effect and his nerves beginning to give way. He was no longer
master of the situation, and the last and, as it proved, the most
vital thing in the whole operation was done imperfectly.
At the end of thirty-five minutes the patient, still under the
influence of ether was carried back to her chamber and laid back
upon her bed, quiet as a sleeping infant.
"It is all over," said Doctor Hillhouse as the eyes of Mrs. Carlton
unclosed a little while afterward and she looked up into his face.
He was no longer the impassive surgeon, but the tender and
sympathizing friend. His voice was flooded with feeling and moisture
dimmed his eyes.
What a look of sweet thankfulness came into the face of Mrs. Carlton
as she whispered, "And I knew nothing of it!" Then, shutting her
eyes and speaking to herself, she said, "It is wonderful. Thank God,
thank God!"
It was almost impossible to, restrain Mr. Carlton, so excessive was
his delight when the long agony of suspense was over. Doctor
Hillhouse had to grasp his arm tightly and hold him back as he
stooped down over his wife. In the blindness of his great joy he
would have lifted her in his arms.
"Perfect quiet," said the doctor. "There must be nothing to give her
heart a quicker pulsation. Doctor Angier will remain for half an
hour to see that all goes well."
The two surgeons then retired, Doctor Kline accompanying Doctor
Hillhouse to his office. The latter was silent all the way. The
strain over and the alcoholic stimulation gone, mind and body had
alike lost their abnormal tension.
"I must congratulate you, doctor," said the friendly surgeon who had
assisted in the operation. "It was even more difficult than I had
imagined. I never saw a case in which the sheathings of the internal
jugular vein and carotid artery were so completely involved. The
tumor had made its ugly adhesion all around them. I almost held my
breath when the blood from a severed artery spurted over your
scalpel and hid from sight the keen edge that was cutting around the
internal jugular. A false movement of the hand at that instant might
have been fatal."
"Yes; and but for the clearness of that inner sight which, in great
exigencies, so often supplements the failing natural vision, all
might have been lost," replied Doctor Hillhouse, betraying in his
unsteady voice the great reaction from which he was suffering. "If I
had known," he added, "that the tumor was so large and its adhesion
so extensive, I would not have operated to-day. In fact, I was in no
condition for the performance of any operation. I committed a great
indiscretion in going to Mr. Birtwell's last night. Late suppers and
wine do not leave one's nerves in the best condition, as you and I
know very well, doctor; and as a preparation for work such as we
have had on hand to-day nothing could be worse."
"Didn't I hear something about the disappearance of a young man who
left Mr. Birtwell's at a late hour?" asked Doctor Kline.
"Nothing has been heard of the son of Wilmer Voss since he went away
from Mr. Birtwell's about one o'clock," replied Doctor Hillhouse,
"and his family are in great distress about him. Mrs. Voss, who is
one of my patients, is in very delicate health and when I saw her at
eleven o'clock to-day was lying in a critical condition."
"There is something singular about that party at Mr. and Mrs.
Birtwell's, added Doctor Hillhouse, after a pause. I hardly know
what to make of it."
"Singular in what respect?" asked the other.
The face of Doctor Hillhouse grew more serious:
"You know Mr. Ridley, the lawyer? He was in Congress a few years
ago."
"Yes."
"He was very intemperate at one time, and fell so low that even his
party rejected him. He then reformed and came to this city, where he
entered upon the practice of his profession, and has been for a year
or two advancing rapidly. I attended his wife a few days ago, and
saw her yesterday afternoon, when she was continuing to do well.
There were some indications of excitement about her, though whether
from mental or physical causes I could not tell, but nothing to
awaken concern. This morning I found her in a most critical
condition. Puerperal fever had set in, with evident extensive
peritoneal involvement. The case was malignant, all the abdominal
viscera being more or less affected. I learned from the nurse that
Mr. Ridley was away all night, and that Mrs. Ridley, who was
restless and feverish through the evening, became agitated and
slightly delirious after twelve o'clock, talking about and calling
for her husband, whom she imagined dying in the storm, that now
raged with dreadful violence. No help could be had all night; and
when we saw her this morning, it was too late for medicine to
control the fatal disease which was running its course with almost
unprecedented rapidity. She was dying when I saw her at half-past
eleven this morning. This case and that of Mrs. Voss were the ones
that drew so largely on my time this morning, and helped to disturb
me so much, and both were in consequence of Mr. Birtwell's party."
"They might have an indirect connection with the party," returned
Doctor Kline, "but can hardly be called legitimate consequences."
"They are legitimate consequences of the free wine and brandy
dispensed at Mr. Birtwell's," said Doctor Hillhouse. "Tempted by its
sparkle and flavor, Archie Voss, as pure and promising a young man
as you will find in the city, was lured on until he had taken more
than his brain would bear. In this state he went out at midnight
alone in a blinding storm and lost his way--how or where is not yet
known. He may have been set upon and robbed and murdered in his
helpless condition, or he may have fallen into a pit where he lies
buried beneath the snow, or he may have wandered in his blind
bewilderment to the river and gone down under its chilling waters.
"Mr. Ridley, with his old appetite not dead, but only half asleep
and lying in wait for an opportunity, goes also to Mr. Birtwell's,
and the sparkle and flavor of wine and the invitations that are
pressed upon him from all sides prove too much for his good
resolutions. He tastes and falls. He goes in his right mind, and
comes away so much intoxicated that he cannot find his way home. How
he reached there at last I do not know--he must have been in some
station-house until daylight; but when I saw him, his pitiable
suffering and alarmed face made my heart ache. He had killed his
wife! He, or the wine he found at Mr. Birtwell's? Which?"
Doctor Hillhouse was nervous and excited, using stronger language
than was his wont.
"And I," he added, before Doctor Kline could respond--"I went to the
party also, and the sparkle and flavor of wine and spirit of
conviviality that pervaded the company lured me also--not weak like
Archie, nor with a shattered self-control like Mr. Ridley--to drink
far beyond the bounds of prudence, as my nervous condition to-day
too surely indicates. A kind of fatality seems to have attended this
party."
The doctor gave a little shiver, which was observed by Doctor Kline.
"Not a nervous chill?" said the latter, manifesting concern.
"No; a moral chill, if I may use such a term," replied Doctor
Hillhouse--"a shudder at the thought of what might have been as one
of the consequences of Mr. Birtwell's liberal dispensation of wine."
"The strain of the morning's work has been too much for you, doctor,
and given your mind an unhealthy activity," said his companion. "You
want rest and time for recuperation."
"It would have been nothing except for the baleful effects of that
party," answered the doctor, whose thought could not dissever itself
from the unhappy consequences which had followed the carousal (is
the word too strong?) at Mr. Birtwell's. "If I had not been betrayed
into drinking wine enough to disturb seriously my nervous system and
leave it weak and uncertain to-day, if Mr. Ridley had not been
tempted to his fall, if poor Archie Voss had been at home last night
instead of in the private drinking-saloon of one of our most
respected citizens, do you think that hand," holding up his right
hand as he spoke, "would have lost for a moment its cunning to-day
and put in jeopardy a precious life?"
The doctor rose from his chair in much excitement and walked
nervously about the room.
"It did not lose its cunning," said Doctor Kline, in a calm but
emphatic voice. "I watched you from the moment of the first incision
until the last artery was tied, and a truer hand I never saw."
"Thank God that the stimulus which I had to substitute for nervous
power held out as long as it did. If it had failed a few moments
sooner, I might have--"
Doctor Hillhouse checked himself and gave another little shudder.
"Do you know, doctor," he said, after a pause speaking in a low,
half-confidential tone and with great seriousness of manner, "when I
severed that small artery as I was cutting close to the internal
jugular vein and the jet of blood hid both the knife-points and the
surrounding tissues, that for an instant I was in mental darkness
and that I did not know whether I should cut to the right or to the
left? If in that moment of darkness I had cut to the right, my
instrument would have penetrated the jugular vein."
It was several moments before either of the surgeons spoke again.
There was a look something like fear in both their faces.
"It is the last time," said Doctor Hillhouse, breaking at length the
silence and speaking with unwonted emphasis, "that a drop of wine or
brandy shall pass my lips within forty-eight hours of any
operation."
"I am not so sure that you will help as much as hurt by this
abstinence," replied Doctor Kline. "If you are in the habit of using
wine daily, I should say keep to your regular quantity. Any change
will be a disturbance and break the fine nervous tension that is
required. It is easy to account for your condition to-day. If you
had taken only your one or two or three glasses yesterday as the
case may be, and kept away from the excitement and--pardon me
excesses of last night--anything beyond the ordinary rule in these
things is an excess, you know--there would have been no failure of
the nerves at a critical juncture."
"Is not the mind clearer and the nerves steadier when sustained by
healthy nutrition than when toned up by stimulants?" asked Doctor
Hillhouse.
"If stimulants have never been taken, yes. But you know that we all
use stimulants in one form or another, and to suddenly remove them
is to leave the nerves partially unstrung."
"Which brings us face to face with the question whether or not
alcoholic stimulants are hurtful to the delicate and wonderfully
complicated machinery of the human body. I say alcoholic, for we
know that all the stimulation we get from wine or beer comes from
the presence of alcohol."
While Doctor Hillhouse was speaking, the office bell rang violently.
As soon as the door was opened a man came in hurriedly and handed
him, a slip of paper on which were written these few words:
"An artery has commenced bleeding. Come quickly! ANGIER"
Doctor Hillhouse started to his feet and gave a quick order for his
carriage. As it drove up to the office-door soon after, he sprang
in, accompanied by Doctor Kline. He had left his case of instruments
at the house with Doctor Angier.
Not a word was spoken by either of the two men as they were whirled
along over the snow, the wheels of the carriage giving back only a
sharp crisping sound, but their faces were very sober.
Mr. Carlton met them, looking greatly alarmed.
"Oh, doctor," he exclaimed as he caught the hand of Doctor
Hillhouse, almost crushing it in his grasp, "I am so glad you are
here. I was afraid she might bleed to death."
"No danger of that," replied Doctor Hillhouse, trying to look
assured and to speak with confidence. "It is only the giving way of
some small artery which will have to be tied again."
On reaching his patient, Doctor Hillhouse found that one of the
small arteries he had been compelled to sever in his work of cutting
the tumor away from the surrounding parts was bleeding freely. Half
a dozen handkerchiefs and napkins had already been saturated with
blood; and as it still came freely, nothing was left but to reopen
the wound and religate the artery.
Ether was promptly given, and as soon as the patient was fairly
under its influence the bandages were removed and the sutures by
which the wound had been drawn together cut. The cavity left by the
tumor was, of course, full of blood. This was taken out with
sponges, when at the lower part of the orifice a thin jet of blood
was visible. The surrounding parts had swollen, thus embedding the
mouth of the artery so deeply that it could not be recovered without
again using the knife. What followed will be best understood if
given in the doctor's own words in a relation of the circumstances
made by him a few years afterward.
"As you will see," he said, "I was in the worst possible condition
for an emergency like this. I had used no stimulus since returning
from Mr. Carlton's though just going to order wine when the summons
from Doctor Angier came. If I had taken a glass or two, it would
have been better, but the imperative nature of the summons
disconcerted me. I was just in the condition to be disturbed and
confused. I remembered when too late the grave omission, and had
partly resolved to ask Mr. Carlton for a glass of wine before
proceeding to reopen the wound and search for the bleeding artery.
But a too vivid recollection of my recent conversation with him
about Doctor Kline prevented my doing so.
"I felt my hand tremble as I removed the bandages and opened the
deep cavity left by the displaced tumor. After the blood with which
it was filled had been removed, I saw at the deepest part of the
cavity the point from which the blood was flowing, and made an
effort to recover the artery, which, owing to the uncertainty of
hand which had followed the loss of stimulation, I had tied
imperfectly. But it was soon apparent that the parts had swollen,
and that I should have to cut deeper in order to get possession of
the artery, which lay in close contact with the internal jugular
vein. Doctor Kline was holding the head and shoulders of the patient
in such a way as to give tension to all the vessels of the neck,
while my assistant held open the lips of the wound, so that I could
see well into the cavity.
"My hand did not recover its steadiness. As I began cutting down to
find the artery I seemed suddenly to be smitten with blindness and
to lose a clear perception of what I was doing. It seemed as if some
malignant spirit had for the moment got possession of me, coming in
through the disorder wrought in my nervous system by over
stimulation, and used the hand I could no longer see to guide the
instrument I was holding, for death instead of life. I remember now
that a sudden impulse seemed given to my arm as if some one had
struck it a blow. Then a sound which it had never before been my
misfortune to hear--and I pray God I may never hear it
again--startled me to an agonized sense of the disaster I had
wrought. Too well I knew the meaning of the lapping, hissing,
sucking noise that instantly smote our ears. I had made a deep cut
across the jugular vein, the wound gaping widely in consequence of
the tension given to the vein by the position of the patient's head.
A large quantity of air rushed in instantly.
"An exclamation of alarm from Doctor Kline, as he changed the
position of the patient's neck in order to force the lips of the
wound together and stop the fatal influx of air, roused me from a
momentary stupor, and I came back into complete self-possession. The
fearful exigency of the moment gave to nerve and brain all the
stimulus they required. Already there was a struggle for breath, and
the face of Mrs. Carlton, which had been slightly suffused with
color, became pale and distressed. Sufficient air had entered to
change the condition of the blood in the right cavities of the
heart, and prevent its free transmission to the lungs. We could hear
a churning sound occasioned by the blood and air being whipped
together in the heart, and on applying the hand to the chest could
feel a strange thrilling or rasping sensation.
"The most eminent surgeons differ in regard to the best treatment in
cases like this, which are of very rare occurrence; to save life the
promptest action is required. So large an opening as I had unhappily
made in this vein could not be quickly closed, and with each
inspiration of the patient more, air was sucked in, so that the
blood in the right cavities of the heart soon became beaten into a
spumous froth that could not be forced except in small quantities
through the pulmonary vessels into the lungs.
"The effect of a diminished supply of blood to the brain and nervous
centres quickly became apparent in threatened syncope. Our only hope
lay in closing the wound so completely that no more air could enter,
and then removing from the heart and capillaries of the lungs the
air already received, and now hindering the flow of blood to the
brain. One mode of treatment recommended by French surgeons consists
in introducing the pipe of a catheter through the wound, if in the
right jugular vein--or if not, through an opening made for the
purpose in that vein--and the withdrawal of the air from the right
auricle of the heart by suction.
"Doctor Kline favored this treatment, but I knew that it would be
fatal. Any reopening of the wound now partially closed in order to
introduce a tube, even if my instrument case had contained one of
suitable size and length, must necessarily have admitted a large
additional quantity of air, and so made death certain.
"Indecision in a case like this is fatal. Nothing but the right
thing done with an instant promptness can save the imperiled life.
But what was the right thing? No more air must be permitted to
enter, and the blood must be unloaded as quickly as possible of the
air now obstructing its way to the lungs, so, that the brain might
get a fresh supply before it was too late. We succeeded in the
first, but not in the last. Too much air had entered, and my patient
was beyond the reach of professional aid. She sank rapidly, and in
less than an hour from the time my hand, robbed of its skill by
wine, failed in its wonted cunning, she lay white and still before
me."