is covered with very thick leather which is suspiciously shiny and
black. It suggests no more comfort than a rack. Its associations are
unpleasant. It has been smothered with blood and with every kind of
imaginable filth, and has been cleaned up so often that it is no
wonder that the deeply stained leather is shiny. It is on this grim
black couch that “the case” just carried into the hospital is placed.
It may be a man ridden over in the street, with the red bone-ends of
his broken legs sticking through his trousers. It may be a machine
accident, where strips of cotton shirt have become tangled up with
torn flesh and a trail of black grease. It may be a man picked up in
a lane with his throat cut, or a woman, dripping foul mud, who has
been dragged out of a river. Sometimes the occupant of the sofa is a
snoring lump of humanity so drunk as to be nearly dead, or it may be
a panting woman who has taken poison and regretted it. In both cases
the stomach pump is used with nauseating incidents. Now and then the
sofa is occupied by a purple-faced maniac, who is pinned down by sturdy
dressers while a strait-jacket is being applied to him. This is not the
whole of its history nor of its services, for the Receiving Room nurse,
who is rather proud of it, likes to record that many a man and many a
woman have breathed their last on this horrible divan.
The so-called dressing room is at its best a “messy” place, as two mops
kept in the corner seem to suggest. It is also at times a noisy place,
since the yells and screams that escape from it may be heard in the
street and may cause passers-by to stop and look up at the window.
Among the sick and the maimed who are “received” in this unsympathetic
hall, the most pathetic are the wondering babies and the children.
Many are brought in burnt and wrapped up in blankets, with only their
singed hair showing out of the bundle. Others have been scalded, so
that tissue-paper-like sheets of skin come off when their dressings
are applied. Not a few, in old days, were scalded in the throat
from drinking out of kettles. Then there are the children who have
swallowed things, and who have added to the astounding collection of
articles—from buttons to prayer-book clasps—which have found their
way, at one time or another, into the infant interior, as well as
children who have needles embedded in parts of their bodies or have
been bitten by dogs or cats or even by rats.
I remember one bloated, half-dressed woman who ran screaming into
the Receiving Room with a dead baby in her arms. She had gone to
bed drunk, and had awakened in the morning in a tremulous state to
find a dead infant by her side. This particular experience was not
unusual in Whitechapel. Then there was another woman who rushed in
drawing attention to a thing like a tiny bead of glass sticking to her
baby’s cheek. The child had acute inflammation of the eyeball, which
the mother had treated with cold tea. The eye had long been closed,
but when the mother made a clumsy attempt to open the swollen lids
something had popped out, some fluid and this thing like glass. She
was afraid to touch it. She viewed it with horror as a strange thing
that had come out of the eye. Hugging the child, she had run a mile or
so with the dread object still adhering to the skin of the cheek. This
glistening thing was the crystalline lens. The globe had been burst,
and the child was, of course, blind. Happily, such a case could hardly
be met with at the present day.
On the subject of children and domestic surgery as revealed in the
Receiving Room, I recall the case of a boy aged about four who had
pushed a dry pea into his ear. The mother attempted to remove it with
that common surgical implement of the home, a hairpin. She not only
failed, but succeeded in pushing the pea farther down into the bony
part of the canal. Being a determined woman, she borrowed a squirt, and
proceeded to syringe out the foreign body with hot water. The result
was that the pea swelled, and, being encased in bone, caused so intense
and terrible a pain that the boy became unconscious from shock.
Possibly the most dramatic spectacle in connexion with Receiving Room
life in pre-ambulance days was the approach to the hospital gate of a
party carrying a wounded woman or man. Looking out of the Receiving
Room window on such occasion a silent crowd would be seen coming down
the street. It is a closely packed crowd which moves like a clot,
which occupies the whole pavement and oozes over into the road. In the
centre of the mass is an obscure object towards which all eyes are
directed. In the procession are many women, mostly with tousled heads,
men, mostly without caps, a butcher, a barber’s assistant, a trim
postman, a whitewasher, a man in a tall hat, and a pattering fringe of
ragged boys. The boys, being small, cannot see much, so they race ahead
in relays to glimpse the fascinating object from the front or climb
up railings or mount upon steps to get a view of it as it passes by.
Possibly towering above the throng would be two policemen, presenting
an air of assumed calm; but policemen were not so common in those days
as they are now.
The object carried would be indistinct, being hidden from view as
is the queen bee by a clump of fussing bees. Very often the injured
person is merely carried along by hand, like a parcel that is coming to
pieces. There would be a man to each leg and to each arm, while men on
either side would hang on to the coat. Possibly some Samaritan, walking
backwards, would hold up the dangling head. It was a much prized
distinction to clutch even a fragment of the sufferer or to carry his
hat or the tools he had dropped.
At this period the present-day stretcher was unknown in civil life. A
stretcher provided by the docks was a huge structure with high sides.
It was painted green, and was solid enough to carry a horse. A common
means of conveyance for the helpless was a shutter, but with the
appearance of the modern ambulance the shutter has become as out of
date as the sedan chair. Still, at this time, when anyone was knocked
down in the street some bright, resourceful bystander would be sure to
call out “Send for a shutter!”
The conveying of a drunken man with a cut head to the hospital by the
police (in the ancient fashion) was a more hilarious ceremonial. The
“patient” would be hooked up on either side by an official arm. His
body would sag between these two supports so that his shoulders would
be above his ears. His clothes would be worked up in folds about his
neck, and he would appear to be in danger of slipping earthwards out
of them. As it was, there would be a display of shirt and braces very
evident below his coat. His legs would dangle below him like roots,
while his feet, as they dragged along the pavement, would be twisted
now in one direction and now in another like the feet of a badly
stuffed lay figure. He would probably be singing as he passed along, to
the delight of the people.
Of the many Receiving Room processions that I have witnessed the most
moving, the most savage and the most rich in colour, noise and language
was on an occasion when two “ladies” who had been badly lacerated in a
fight were being dragged, carried or pushed towards the hospital for
treatment. They were large, copious women who were both in an advanced
stage of intoxication. They had been fighting with gin bottles in some
stagnant court which had become, for the moment, an uproarious cockpit.
The technique of such a duel is punctilious. The round, smooth bottoms
of the bottles are knocked off, and the combatants, grasping the
weapons by the neck, proceed to jab one another in the face with the
jagged circles of broken glass.
The wounds in this instance were terrific. The faces of the two,
hideously distorted, were streaming with blood, while their ample
bodies seemed to have been drenched with the same. Their hair, soaked
in blood, was plastered to their heads like claret-coloured seaweed on
a rock. The two heroines were borne along by their women friends. The
police kept wisely in the background, for their time was not yet. The
crowd around the two bleeding figures was so compressed that the whole
mass moved as one. It was a wild crowd, a writhing knot of viragoes
who roared and screamed and rent the air with curses and yells of
vengeance, for they were partisans in the fight, the Montagues and
Capulets of a ferocious feud.
The crowd as it came along rocked to and fro, heaved and lurched as if
propelled by some uneasy sea. The very pavement seemed unsteady. Borne
on the crest of this ill-smelling wave were the two horrible women.
One still shrieked threats and defiance in a voice as husky as that of
a beast, while now and then she lifted aloft a blood-streaked arm in
the hand of which was clutched a tuft of hair torn from her opponent’s
head. Every display of this trophy called forth a shout of pride from
her admirers.
The other woman was in a state of drunken hysteria. Throwing back her
head until the sun illumined her awful features, she gave vent to
bursts of maniacal laughter which were made peculiarly hideous by the
fact that her nose was nearly severed from her face, while her grinning
lips were hacked in two. At another moment, burying her head against
the back of the woman in front of her, she would break out into sobs
and groans which were even more unearthly than her laughter.
The whole affair suggested some fearful Bacchanalian orgy, associated
with bloodshed, in which all concerned were the subjects of demoniacal
possession. There is, happily, much less drunkenness nowadays and less
savagery, while the police control of these “street scenes” is so
efficient and the public ambulance so secretive that such a spectacle
as I now recall belongs for ever to the past.
When a crowd, bearing a “casualty,” reaches the hospital gates its
progress is stayed. It rolls up against the iron barrier. It stops and
recoils like a muddy wave against a bank. The porter is strict. Only
the principals, their supporters and the police are allowed to filter
through. The members of the crowd remain in the street, where they look
through the railings, to which they cling, and indulge in fragments
of narrative, in comments on the affair, and on the prospects of the
parties injured. If a scream should escape from the Receiving Room the
watchers feel that they are well rewarded for long waiting, while any
member of the privileged party who may leave the building is subjected
to very earnest questioning.
It is needless to say that the Receiving Room is not always tragical,
not always the scene of alarms and disorders, not always filled with
wild-eyed folk nor echoing the scuffle of heavy feet and the moans of
the suffering. It may be as quiet as a room in a convent. I have seen
it so many a time, and particularly on a Sunday morning in the heyday
of summer. Then the sun, streaming through the windows, may illumine
the figure of the nurse as she sits on the awful sofa. She has her
spectacles on, and is busy with some white needlework. Her attitude
is so placid that she might be sitting at a cottage door listening to
a blackbird in a wicker cage. Yet this quiet-looking woman, although
she has not fought with wild beasts at Ephesus, has fought with raving
drunkards and men delirious from their hurts, and has heard more foul
language and more blasphemy in a week than would have enlivened a
pirate ship in a year.
The Receiving Room nurse was, in old days, without exception the
most remarkable woman in the hospital. She appeared as a short, fat,
comfortable person of middle age, with a ruddy face and a decided look
of assurance. She was without education, and yet her experience of
casualties of all kinds—from a bee-sting to sudden death—was vast and
indeed unique. She was entirely self-taught, for there were no trained
nurses in those days. She was of the school of Mrs. Gamp, was a woman
of courage and of infinite resource, an expert in the treatment of the
violent and in the crushing of anyone who gave her what she called
“lip.” She was possessed of much humour, was coarse in her language,
abrupt, yet not unkindly in her manner, very indulgent towards the
drunkard and very skilled in handling him. She was apt to boast that
there was no man living she would not “stand up to.” She called every
male over fifty “Daddy” and every one under that age “My Son.” She
would tackle a shrieking woman as a terrier tackles a rat, while the
woman who “sauced” her she soon reduced to a condition of palsy. She
objected to the display of emotion or of feeling in any form, and was
apt to speak of members of her sex as a “watery-headed lot.”
She had, like most nurses of her time, a leaning towards gin, but was
efficient even in her cups. She had wide powers, for she undertook—on
her own responsibility—the treatment of petty casualties. The dressers
regarded her with respect. Her knowledge and skill amazed them, while
from her they acquired the elements of minor surgery and first aid.
The house-surgeons were a little frightened of her, yet they admired
her ready craft and were duly grateful for her unswerving loyalty and
her eagerness to save them trouble. Her diagnosis of an injury was
probably correct, so sound was her observation and wide her experience.
She was a brilliant bandager, and was accepted by the students as the
standard of style and finish in the applying of a dressing. She was on
duty from early in the morning until late at night, and knew little of
“hours off” and “half-days.” In the personnel of the hospital of half a
century ago she was an outstanding figure, yet now she is as extinct as
the dodo.
The hospital in the days of which I speak was anathema. The poor people
hated it. They dreaded it. They looked upon it primarily as a place
where people died. It was a matter of difficulty to induce a patient to
enter the wards. They feared an operation, and with good cause, for an
operation then was a very dubious matter. There were stories afloat of
things that happened in the hospital, and it could not be gainsaid that
certain of those stories were true.
Treatment was very rough. The surgeon was rough. He had inherited that
attitude from the days when operations were carried through without
anæsthetics, and when he had need to be rough, strong and quick, as
well as very indifferent to pain. Pain was with him a thing that had
to be. It was a regrettable feature of disease. It had to be submitted
to. At the present day pain is a thing that has not to be. It has to be
relieved and not to be merely endured.
Many common measures of treatment involved great suffering. Bleeding
was still a frequent procedure, and to the timid the sight of the red
stream trickling into the bowl was a spectacle of terror. There were
two still more common measures in use—the seton and the issue. The
modern student knows nothing of these ancient and uncleanly practices.
He must inform himself by consulting a dictionary. Without touching
upon details, I may say that in my early days, as a junior dresser, one
special duty was to run round the ward before the surgeon arrived in
order to draw a fresh strand of thread through each seton and to see
that a fresh pea was forced into the slough of every issue.
Quite mediæval methods were still observed. The first time in my life
that I saw the interior of an operating theatre I, in my ignorance,
entered by the door which opened directly into the area where the
operating table stood. (I should have entered by the students’
gallery.) When I found myself in this amazing place there was a man on
the table who was shrieking vehemently. The surgeon, taking me by the
arm, said, “You seem to have a strong back; lay hold of that rope and
pull.” I laid hold of the rope. There were already two men in front
of me and we all three pulled our best. I had no idea what we were
pulling for. I was afterwards informed that the operation in progress
was the reduction of a dislocated hip by compound pulleys. The hip,
however, was not reduced and the man remained lame for life. At the
present day a well-instructed schoolgirl could reduce a recent hip
dislocation unaided.
In this theatre was a stove which was always kept alight, winter and
summer, night and day. The object was to have a fire at all times ready
whereat to heat the irons used for the arrest of bleeding as had been
the practice since the days of Elizabeth. Antiseptics were not yet in
use. Sepsis was the prevailing condition in the wards. Practically all
major wounds suppurated. Pus was the most common subject of converse,
because it was the most prominent feature in the surgeon’s work. It
was classified according to degrees or vileness. “Laudable” pus was
considered rather a fine thing, something to be proud of. “Sanious” pus
was not only nasty in appearance but regrettable, while “ichorous” pus
represented the most malignant depths to which matter could attain.
There was no object in being clean. Indeed, cleanliness was out of
place. It was considered to be finicking and affected. An executioner
might as well manicure his nails before chopping off a head. The
surgeon operated in a slaughter-house-suggesting frock coat of black
cloth. It was stiff with the blood and the filth of years. The more
sodden it was the more forcibly did it bear evidence to the surgeon’s
prowess. I, of course, commenced my surgical career in such a coat, of
which I was quite proud. Wounds were dressed with “charpie” soaked in
oil. Both oil and dressing were frankly and exultingly septic. Charpie
was a species of cotton waste obtained from cast linen. It would
probably now be discarded by a motor mechanic as being too dirty for
use on a car.
Owing to the suppurating wounds the stench in the wards was of a kind
not easily forgotten. I can recall it to this day with unappreciated
ease. There was one sponge to a ward. With this putrid article and
a basin of once-clear water all the wounds in the ward were washed
in turn twice a day. By this ritual any chance that a patient had of
recovery was eliminated. I remember a whole ward being decimated by
hospital gangrene. The modern student has no knowledge of this disease.
He has never seen it and, thank heaven, he never will. People often
say how wonderful it was that surgical patients lived in these days.
As a matter of fact they did not live, or at least only a few of them.
Lord Roberts assured me that on the Ridge at Delhi during the Indian
Mutiny no case of amputation recovered. This is an extreme instance,
for the conditions under which the surgeons on the Ridge operated were
exceptional and hopelessly unfavourable.
The attitude that the public assumed towards hospitals and their works
at the time of which I write may be illustrated by the following
incident. I was instructed by my surgeon to obtain a woman’s permission
for an operation on her daughter. The operation was one of no great
magnitude. I interviewed the mother in the Receiving Room. I discussed
the procedure with her in great detail and, I trust, in a sympathetic
and hopeful manner. After I had finished my discourse I asked her if
she would consent to the performance of the operation. She replied:
“Oh! it is all very well to talk about consenting, but who is to pay
for the funeral?”
III
THE TWENTY-KRONE PIECE
More than once in speaking at public meetings on behalf of hospitals I
have alluded to my much valued possession—a twenty-krone piece—and have
employed it as an illustration of the gratitude of the hospital patient.
The subject of this incident was a Norwegian sailor about fifty years
of age, a tall, good-featured man with the blue eyes of his country
and a face tanned by sun and by salt winds to the colour of weathered
oak. His hair and his beard were grey, which made him look older than
he was. He had been serving for three years as an ordinary seaman on
an English sailing ship and spoke English perfectly. During his last
voyage he had developed a trouble which prevented him from following
his employment. Accordingly he had left his ship and made his way to
London in the hope of being cured. Inquiring for the hospital of London
he was directed to the London Hospital and, by chance, came into my
wards. He had an idea—as I was told later—that the operation he must
needs undergo might be fatal, and so had transferred his savings to his
wife in Norway.
He was a quiet and reserved man, but so pleasant in his manner that
he became a favourite with the nurses. He told them quaintly-worded
tales of his adventures and showed them how to make strange knots with
bandages. The operation—which was a very ordinary one—was successful,
and in four or five weeks he was discharged as capable of resuming his
work as a seaman. His ship had, however, long since started on another
voyage.
One morning, three weeks after he had left the hospital, he appeared
at my house in Wimpole Street. My name he would have acquired from the
board above his bed, but I wondered how he had obtained my address. I
assumed that he had called to ask for money or for help of some kind.
As he came into my room I was sorry to see how thin and ill he looked,
for when he left the wards he was well and hearty.
He proceeded to thank me for what I had done, little as it was. He had
an exaggerated idea of the magnitude of the operation, which idea he
would not allow me to correct. I have listened to many votes of thanks,
to the effulgent language, the gush and the pompous flattery which
have marked them; but the little speech of this sailor man was not of
that kind. It was eloquent by reason of its boyish simplicity, its
warmth and its rugged earnestness.
As he was speaking he drew from his pocket a gold coin, a twenty-krone
piece, and placed it on the table at which I sat. “I beg you, sir,”
he said, “to accept this coin. I know it is of no value to you. It is
only worth, I think, fifteen shillings. It would be an insult to offer
it as a return for what you have done for me. That service can never
be repaid. But I hope you will accept it as a token of what I feel,
of something that I cannot say in words but that this coin can tell
of. When I left my home in Norway three years ago my wife sewed this
twenty-krone piece in the band of my trousers and made me promise never
to touch it until I was starving. A seaman’s life is uncertain; he
may be ill, he may be long out of a job; and so for three years this
coin has been between me and the risk of starvation. When I was in the
hospital I had a wish to give it to you if it so happened that I got
well. Here I am, and I do hope, sir, you will accept it.”
I thanked him as warmly as I could for his kindness, for his thought in
coming to see me and for his touching offer, but added that I could
not possibly take the gold piece and begged him to put it back into his
pocket again and present it to his wife when he reached home. At this
he was very much upset. Pushing the coin along the table towards me
with his forefinger, he said: “Please, sir, do take the money, not for
what it is worth but for what it has been to me. I am proud to say that
since I left the hospital I _have_ been starving. I have been looking
for a ship. I have not slept in a bed since you saw me in the wards.
Now, at last, I have got a ship and, thank God, I have kept the coin
unbroken so that you might have it. I implore you to accept it.”
I took it; but what could I say that would be adequate for such a gift
as this? My attempt at thanks was as stumbling and as feeble as his had
been outright; for I am not ashamed to confess that I was much upset.
I have received many presents from kindly patients—silver bowls,
diamond scarf-pins, gold cigarette cases and the like, but how little
is their value compared with this one small coin? As I picked it up
from the table I thought of what it had cost. I thought of the tired
man haunting the docks in search of a ship, often aching with hunger
and at night sleeping in a shed, and yet all the time with a piece of
gold in his pocket which he would not change in order that I might have
it.
A coin is an emblem of wealth, but this gold piece is an emblem of a
rarer currency, of that wealth which is—in a peculiar sense—“beyond the
dream of avarice,” a something that no money could buy, for what sum
could express the bounty or the sentiment of this generous heart?
It would be described, by those ignorant of its history, as a gold
coin from Norway; but I prefer to think that it belongs to that “land
of Havilah where there is gold” and of which it is truly said “and the
gold of that land is good.”
IV
A CURE FOR NERVES
In the account of the case which follows it is better that I allow the
patient to speak for herself.
I am a neurotic woman. In that capacity I have been the subject of much
criticism and much counsel. I have been both talked to and talked at.
On the other hand I have detailed my unhappy symptoms to many in the
hope of securing consolation, but with indefinite success. I am afraid
I have often been a bore; for a bore, I am told, is a person who will
talk of herself when you want to talk of yourself.