THE “MEDIC”--_Continued_
Our Caddie’s greeting was a pleasant surprise when we went back
to College that second year. Stopping me and beaming on me, she
congratulated me warmly on my anatomy paper:
“Frankly, Miss Arnold, I was astonished when I learned it was your
paper. You seldom did yourself justice in quizzes, it seems.” Even to
this graciousness I was so constrained I could only blush and look
pleased; but some years later when she visited in the city where I was
practising, and I was driving out with her and another woman physician,
I confessed my former fear. How she laughed and melted! Then, turning
suddenly, she asked in her old manner,
“Did you think I would eat you?” For an instant I almost trembled, as
in the old days, but her merry smile soon followed. Since then the
utmost cordiality has existed between us.
The second year in College was the busiest. We had more studies, more
instructors, and a more varied life in every way. They lectured us on
disease-conditions and on the remedies to be applied. There were the
various clinics in the dispensary department--throat clinics, chest
clinics, women’s clinics, surgical clinics, children’s clinics, and so
on, where, under the various instructors, we were required to examine
and diagnose cases and to watch the result of treatment. Patients too
ill to come to the clinics were visited in their homes by the senior
students, and by the “middlers” after the first half of their second
year. Before taking cases, however, we went with the seniors on their
visits to get a little familiar with the work. Once on going with a
senior to an obstetric case, we found the baby already born, and the
cord tied and cut! A half-witted sister of the patient met us at the
door; the woman lay on the bed with no sheets on it; the new baby,
naked and cold, was crying vigorously; and, playing on the bed beside
the mother, was a little five-year-old who had been there through the
labour. It seems when the baby came and the patient had told her sister
to cut the cord, the sister refusing, the woman had sat up in bed and
cut it herself!
What a mass of instruction was thrust upon us that second year! I
enjoyed most the lectures of our professor in _materia medica_. A
charming man, enthusiastic, fluent, apt at illustration--a more
ready and engaging speaker I have never heard. Taking all he said as
gospel-truth, I was not a little disturbed toward the close of that
year to hear the seniors insinuate that he never spoiled a story for
the truth’s sake; that he would tell of some wonderful case one year,
ascribing the favourable termination to a certain remedy, and the next
year would forget and tell of it under quite another remedy! Each
disclosure of this kind came as a shock; it was so difficult--it is,
even now--to believe that people are not what they seem.
One man, our professor in pathology, never swerved one jot or tittle
from the truth. This trait was so strong that he seemed always to be
telling us what _not_ to believe; he was for ever exposing shams and
false theories, dubbing them “all fol-de-rol.” He gave us clear,
concise pictures of diseases; told what measures to adopt to relieve
them; what remedies to rely on, so far as remedies could be of
service; but never failed to impress upon us that “the books lie, and
doctors lie,” if they claim that cases follow the typical courses so
beautifully pictured; or that remedies, however well selected, will
invariably relieve. There was a touch of peevishness in his attempts
to make us chary about believing the stock statements in the books.
I had a great liking for him; his earnestness appealed to me. Abrupt
and brusque as he was, on the rare occasions when he smiled, his smile
had that distinctive charm that an infrequent smile always lends to a
stern, serious face. He was an excellent offset to the optimism and
enthusiasm of our professor in _materia medica_.
(A few years ago he came on as guest of honour and read a paper at our
State Medical Society meeting in Brooklyn. He looked much older, his
hair was thinned and white, but his voice had the old scornful ring,
and carried me back to those student days in Boston; every familiar
inflection was a fresh delight; and to make it more realistic, there
was dear Dr. Wilkins who had come on, too--the Miss Wilkins who had
so mothered me in college--past and present were strangely blended
that day: on the platform Dr. “Conrad,” whose tones made me a student
again; by my side the class-mate who had sat with me in the old days
and listened to those same tones; while all around me were also friends
and associates of to-day, else I surely should have felt myself a girl
again and back in the old lecture room.)
Our professor in throat diseases was no favourite with the students.
He had a smooth face, china-blue eyes, and wore a brown wig. We
thought him vain, and knew he was irritable; and we failed to get
much out of his lectures or clinics. Once I asked him to go with me in
consultation to a home where I suspected my case was diphtheria; he
went and, confirming my diagnosis with alacrity, hurried out of the
house, showing such personal apprehension that it made me feel a bit
contemptuous. He asked me if I were not afraid of it, and advised me,
wisely, to send the case at once to the city hospital, which I did.
The same professor whom we had had the first year in the History
of Medicine, instructed us in diseases of the chest; friendly and
approachable, he gave us good lectures and valuable clinics.
The Dean, bless his heart! lectured to us on surgery. He always seemed
in a hurry; he was an easy talker. Some of the students were inclined
to belittle his skill as an operator, though admitting that he had been
an excellent surgeon in his palmier days. Anyhow, he had force and
charm, and was an indefatigable worker, and a warm-hearted, tactful man.
In obstetrics we had an able man, friendly, alert, conscientious, and a
good instructor.
The professor in diseases of women was a pretty, fascinating woman,
a general favourite; she had a big practice over on the Back Bay. We
students thought her charmingly inefficient as a lecturer; it was a
pleasure to look at her, and to listen to her, but her lectures were
thin, and her clinics disappointing. I could so seldom find what she
would tell us we ought to find in the cases, and when I would say I
couldn’t, she would smile in her bewitching way and say, “Oh, but you
_must_, it is there”; and then I would try again, often unsuccessfully,
while she seemed to have little aptitude to make me find the thing in
question. Somehow, we got in the way of not taking her very seriously;
but, come to think of it, it is hardly fair to single her out as the
cause of my stupidity, for there were clinics of the other professors
as well, where I failed to find conditions we were told existed. I
suppose it was the untrained student’s incapacity for seeing, hearing,
and feeling what the trained clinician sees, hears, and feels so easily.
The man who lectured to us on gunshot wounds always came in the
amphitheatre as though he had been shot out of a gun himself. His
lectures were clear and to the point.
The lecturer on electro-therapeutics was a pleasing, gentle person; the
one on diseases of children a trig, dapper little man; and there were
other branches--medical chemistry, skin diseases, diseases of eye and
ear, and so on--assuredly a busy year.
When, the latter half of the year, we were allowed to take cases, they
were assigned us in alphabetical order. Each student before receiving
his degree must have himself managed at least thirty medical, five
surgical, and three obstetrical cases; although he was at liberty when
necessary to ask a senior to accompany him, and, in grave cases, to
call on the Faculty.
All that we knew of our cases till visiting them in their homes was the
name and address furnished by the house-physician at the Dispensary.
How exciting those first calls--wondering what we should find! I well
remember the first visit I started out alone to make with my new little
medicine-case under my arm: “Lynch, 846 Albany Street” was the legend
supplied at the Dispensary.
The place was in a somewhat better locality than many I had visited
in company with seniors. Mounting the stairs, I knocked in some
trepidation as I realized I was about to undertake alone my first
patient. What would it be? Should I be able, after examining her, to
know what ailed her? and what to do for her? A strapping big Irish
woman came to the door.
“Does Mrs. Lynch live here?” I asked in as professional a tone as I
could summon, to which she grudgingly admitted that she did.
“I am the doctor from the Dispensary, I would like to see her.”
“_I_ am Mrs. Lynch,” she said, without opening the door further, “but
I’ll have you understand my son is pretty sick--it is no time to fool
around; I sent for a doctor, _not for a little girl_.”
I can see myself as I stood there; can feel just how taken aback and
indignant I was; how helpless I felt; but it was only momentary.
Pocketing my anger, I said quietly but firmly, “_I_ am the doctor who
has been sent to you; if your son is very ill, you must let me see him
at once.” She hesitated, but I added that if, after I prescribed for
him, she preferred to have a _man_ doctor, in the morning, I would send
one instead. I chose to relinquish the case, if need be, on the ground
of sex rather than youth, thus seeming to preserve my dignity.
She wavered as though not intending to let me in, but I looked at her
compellingly, and, with an ungracious snort, she led the way to the
sick-room.
There lay a young coal-driver of twenty-five, with high fever, pains
in head and limbs and around his heart, and the fear that he was going
to die--a case of rheumatic fever. He looked disappointed as I came
in, but was civil; he was too apprehensive to reject even my feeble
help. After listening to the history of the onset, I took his pulse and
temperature, asked my questions, which at first the mother refused to
answer, but her son answered them; and, as the examination progressed,
she herself vouchsafed bits of information, showing some lessening
of hostility. Prescribing, and giving strict and explicit directions
about medicine and diet, on leaving, I said, “I will come early in the
morning to see how he is; if you then wish a male physician, I will
have one sent for the next visit.” She was less uncivil as she showed
me out.
I prescribed _rhus toxicodendron_. That very afternoon the lecturer
had discussed the remedy. My case seemed made to order for it. Though
prescribing without a moment’s hesitation, still I rushed home and
looked up my notes, and studied the subject in the books, finding to my
satisfaction that the remedy was well prescribed. In those days one had
abundant faith that the remedies, if correctly applied, that is, if the
true _similimum_ be found, would do all they promised. My class-mates
laughed at my rebuff, but congratulated me on effecting an entrance,
and on the selection of the remedy.
Early in the morning I hastened to my patient. At the door the big
woman met me with the warmth and cordiality that only an Irish woman
can Show when so disposed:
“Come in, Doctor, come right in; my son do be feelin’ better, God bless
you!”
Of course he was better; had I not given him _rhus tox_ when all his
symptoms called for it? I have since wondered what I should have
thought, or done, had my patient failed to respond to the remedy; but
there he was, surprisingly better, it was plain to see.
It was my time for revenge: Treating the woman’s warmth with the same
apparent indifference that I had her insolence, I allowed myself an
outlet for my satisfaction in cordiality to my patient. Going carefully
over his symptoms I found him indeed better, though still far from
well, and this I told him. Mixing fresh medicine, and giving fresh
directions as to his care, I told him he ought to get on nicely now;
and then, turning to the woman, said, “To-morrow I will have one of the
male physicians make the visit.”
The patient began to protest, and the woman herself to show
disappointment:
“Oh, no, Doctor, I guess you’ll do as well as anybody.” But I wickedly
replied that I thought she would be better pleased to have another
doctor, and I could easily arrange it. Then she pleaded with me not to
throw up the case--no one could do so well--her son would get worse
if he had a change of doctors, and so on. So, not wishing to excite
my patient, and thinking I had punished her enough, I condescended to
keep the case. He made a good recovery, and Mrs. Lynch was one of my
staunchest advocates after that, recommending me to her neighbours
in glowing praise. She also recommended her son to me: “Mike do be
thinkin’ a lot of you, Doctor, for savin’ his life. He’s a good boy, is
Mike, and will make someone a good man; he gets twinty dollars a month,
and has no bad habits, Doctor. Sure an’ a woman might do worse. But
Mike says, he says to me, ‘Now, Mother, you do be talkin’ nonsense--the
Doctor ain’t for the loikes of me.’”
I can laugh now at the rebuffs I met on account of my youth, not only
when in College, but even when practising in U----, but it was hard
to laugh at them then. Hence, I suppose, the dignity I instinctively
assumed to make up for my short stature and lack of years. I learned,
toward the close of my medical course, that it had been customary among
the students to speak of me as “the dignified little Miss Arnold.”
This dignity was no pose. I was dreadfully in earnest, and felt keenly
this drawback to success. There was Miss Wilkins in the same class,
no older than I _as a doctor_, but her years and her spectacles were
passports to immediate acceptance, and she got credit for being wise
where I was scarcely tolerated. Exasperation was no name for it! I
lost one obstetrical case in my third year just because of this: After
I had made my first visit, the patient sent me a polite note saying
her husband was unwilling to go so far as my boarding-place for a
doctor; that she would have liked to have me, and hoped I wouldn’t
be offended--all a pretense--she was afraid to trust herself in my
hands. Under this suddenly terminated record in my note-book I wrote
with a sigh, “Oh, for the bonnet and spectacles of Miss Wilkins!” Even
within a few months of graduation, while shopping for a cloak, I was
chagrined to have the saleswoman tell the taller, but younger, girl
who, accompanying me, acted as spokesman, “Oh, you will have to take
_her_ into the misses’ department.” The “misses’ department,” indeed!
and I almost ready to take my degree! and I would have to be taken
in--I could not even go there myself! It amuses me now to recall what a
sore point this was with me.
During my second year, Sister came on to Boston to take up nursing.
What delight when she landed there! She looked so pretty, and I was
so overjoyed to have her there, so proud of her, so eager to show
her about and introduce her to my friends! She had been over to the
hospital only a week when one day, between lectures, one of the young
men came to me and said, “Miss Arnold, there’s an awful nice little
thing out in the hall wants to see you.” Just then another rushed up
and said, “Miss Arnold, if you’re not in here, you’re out in the hall,
and you want to see yourself.” I ran out and found Kate in her nurse’s
garb, smiling, blushing, and enjoying having these young men dance
attendance on her. I was flattered that they had seen so marked a
resemblance when she was so much more attractive than I.
Not wishing to pledge herself to the two-year course, Kate stayed
at the hospital only during the probationer’s term, deciding that
she would go home and say Yes to the wooer to whom distance was
lending enchantment. But she occupied herself with private nursing
in and around Boston till I went home in June. Once she just missed
an opportunity to go as companion to the invalid wife of Dr. Oliver
Wendell Holmes, but an unkind Providence prevented--she having accepted
a case in that city. How I bewailed her untimely absence--actually
to have been in the same house with the dear Autocrat! I was almost
tempted to go myself--medicine or no medicine.
During that second year, Dr. “Conrad” asked for volunteers for
drug-provings among the students: A drug was prepared for each prover
with directions for taking, and whatever symptoms were experienced
while taking it were to be recorded in a little book, whether we
thought them due to the drug or not. The provers were enjoined not to
compare notes, but to turn in their reports at a stated time. I was one
of six to volunteer.
For a few days I had only the slightest symptoms to record, but after
that there developed an intestinal disturbance which gradually became
pronounced. I began to get interested, wondering if it was really
the drug that was responsible--those tiny tasteless powders--so,
doubting it, kept on with the medicine. I suppose I was a little
skeptical because of a rumour that they always gave some of the provers
_saccharum lactis_, and that not infrequently records were turned in
with a long string of symptoms, when the provers had only been given
_sac. lac._ Naturally I did not want to attribute symptoms to drug
action if I were not taking a real drug; so, though growing worse and
worse, I kept on with the proving. The day came for our examination in
pathology by the very professor who had solicited the provings--our
skeptical pessimist. Uncomfortably ill by that time, I could hardly
hold out to take the examination. Miss Wilkins had insisted that if I
did not go to see Dr. “Conrad” immediately afterwards, she would go
herself, so as I handed in my paper, I told him I was ill, and would
like to call at his office in the afternoon. I added that I was one of
the drug-provers, but was not sure whether this illness had anything
to do with what I had been taking. He bent upon me those scrutinizing
eyes, his face stern but kindly, and said, “Poor child, why didn’t you
tell me before? How have you sat through the examination? Go home at
once, and come to me at two o’clock.”
That afternoon I went to his office on Commonwealth Avenue--a luxurious
place, a side of life that, as students, we saw only from the outside,
our entrée in Boston houses being chiefly in those of the Lynches,
the Sullivans, and O’Gradys. The kind, fatherly look he bent upon me
as he drew me in his office and listened to my confused, embarrassed
tale, was worth it all. Weak and in pain, I was unable to tell a clear
story. He snatched my note-book, read the symptoms, looking up every
few minutes, then read on, after which he gave me a soothing talk, and
I have loved him ever since. Though commending my zeal, he deplored the
fact that I had carried it to the extent of suffering so much.
“No one else did it--no one else did it,” he scolded, half to
himself. “They turned in their worthless notes before the time was
up, pretending they had taken the drugs faithfully when I knew they
hadn’t; some of them got symptoms on taking _sac. lac._--a good list of
them! but you wanted to be sure yourself--that is the only way to get
at the truth.”
Who would not have been willing to suffer to get this from the stern
Dr. “Conrad?” Rigidly prescribing my diet and rest, he gave me some
medicine and sent me home in his carriage, calling on me that evening
to my delight. In two days I was as well as ever. I learned later that
it was _mercury_ that I had proved, but in so weak a potency that he
had been surprised at the results.
That same year I experimented with _atropine_ in my eyes (a silly,
risky thing to do), applying it just to see how I would look with the
pupils widely dilated, little knowing how it would incapacitate me for
my work. Putting in a tiny bit just before starting for College one
morning, by the time I got there I could not see to take notes or to
read, and it was only a day or two before “exams”!
For one of the meetings of our College Society, I was given the
subject _materia medica_ to treat in any way I chose. Having just been
reading the “medicated novels” of Dr. Holmes--“Elsie Venner” and “The
Guardian Angel”--I thought it would be fun to take a case described
in one of them, as given in the nurse’s report, ask the students to
diagnose it and prescribe, leading them at the start to think it a
_bona fide_ case. The one I chose, I myself diagnosed as one of _globus
hystericus_, and decided what remedy I would give, were she a real
patient. Then it occurred to me that it would be interesting to know
what our professor in _materia medica_ would prescribe for such a case
in real life; and that it would add to the interest if I could tell the
students that I would give them Prof. S----’s prescription after they
had submitted theirs.
I had no intention of deceiving the professor when I first thought of
going to him, but growing bold on arrival, as I handed him the paper
with the symptoms copied off verbatim, told him I was especially
anxious to prescribe carefully for this case, as it had come into my
hands from _a prominent old school physician_.
As he read, his eyes twinkled at the nurse’s phraseology; he looked up
at me once or twice, curiously, as I sat there scared, then, at what
I had done. Seeing my pencilled diagnosis with a question mark at the
bottom, he said:
“Yes, you have diagnosed the case correctly beyond a doubt, and now for
the remedy--I see you have three suggested, but first, let me know more
about the case.” Then he plied me with questions. By this time I was
greatly embarrassed; a suspicious twinkle in his eye, as he remarked
that the nurse herself must be a unique person, made me uncomfortable.
Finally he queried, “Who _is_ this ‘old school physician’ who had the
case?”
“Dr. Oliver Wendell Holmes,” I confessed timorously.
How he laughed! Hastening to explain and apologize, I told him how I
had come to present the case to him, and that only on the spur of the
moment had I conceived the idea of offering it as a real case. He had
seen from the start that there was something queer, but was at a loss
to unravel the mystery. After a jolly chat about it, he discussed the
symptoms as seriously with me as though it had been a case in real
life; so I went to the Society meeting in great glee, hoodwinking them
until their answers were turned in, then telling them the whole story.
The experiences of that second-year vacation kept pace with the advance
in our studies. Uncles, aunts, and cousins, school-mates, neighbours,
and chance acquaintances came rehearsing their aches and pains,
expecting me in my inexperience to help them promptly. I took them
all seriously. I was a good listener, but was often of little further
help. So many of them had complaints about which we had as yet had no
lectures. Still I had the hope and confidence that go with youth, and
the temerity to “rush in” where the more experienced might fear to
tread.
The coloured woman who did our washing asked me to attend her in
confinement--her confidence in me was touching; for, although we had
had our lectures in obstetrics, and I had been to a few cases with
seniors, I had then managed none myself. But Josie had had several
children so would be likely, I thought, to have an easy time; and, if I
should need help, I could call on Dr. Campbell--the physician for whom
I had had the girlish infatuation.
It was a hot Fourth of July when they called me. Josie’s poor little
home was a paradise in neatness and order compared to those I had
frequented in dispensary practice. I felt quite elated at the prospect
of managing a case alone. But from my first examination I felt
uneasy, seeing that I had a different condition to deal with than any
encountered in my limited experience. As labour progressed, to my
consternation I found the cord, instead of the head, presenting, so
knew that I had a case of transverse presentation--one which would
require turning and speedy delivery to save the child. Of course I was
incompetent to do this, nor would it have been lawful to attempt it,
being an undergraduate.
Dr. Campbell responded promptly to my summons, performed version, and
delivered the child and the adherent placenta. I managed the after-care
without difficulty. Josie was glad of her enforced rest in bed. In the
days preceding her confinement I had gone past her house and seen
her, big with child, standing at the ironing-board, late at night,
thus supporting her family while her great lazy husband, John Wesley
Freeman, would loll about all day, then sit by her at night and read
the Bible and exhort as she stood ironing. True to his name, he felt
called to preach, and, failing a larger audience, preached to poor
Josie, in and out of season. While I kept her in bed, the lazy fellow
had to shift for himself or starve, as his swarming offspring were too
small to be of service in the household.
One morning, on finding Josie worse, and learning that John Wesley
had been preaching to her the night before, and scolding her because
she had fallen asleep, I berated him soundly. It was a good time to
chastise him generally; to warn him against deeds of omission and
commission. So I set forth how near Josie had come to losing her life,
and said she probably would not live through another pregnancy. When
I had done, in his drawling, falsetto voice, and with a sanctimonious
air, he said:
“Yes, Miss ’Genia, I reckon she was mighty sick, but she’s gettin’
on now, and you know, Miss ’Genia, the Bible says we chillun must be
fruitful and multiply and ’plenish the earth; and, Miss ’Genia, we
sholy must do as the good Book says.”
More exasperated than amused, I snapped out:
“Well, John Wesley, I think you have done your share toward being
fruitful and multiplying and replenishing the earth--I guess the Lord
will excuse you if you turn around now and help Josie to support the
ones you have on hand.”
But he didn’t; he continued compliant to his favourite text; and after
one or two more evidences of his cheerful obedience came, Josie left
her wash-tub and ironing-board forever and replenished the earth with
her worn-out body, able no longer to be fruitful and multiply at
the rate John Wesley thought necessary in order to fulfil the Holy
Scriptures.
All that summer I attended an old man dying of Bright’s disease,
prescribing for him and helping his over-burdened wife in nursing
him. It was hard work--those bed-sores, his extreme emaciation and
helplessness; but I then learned the luxury of feeling myself really
useful. I knew I was helping to lighten burdens growing well-nigh
unendurable. Yet how critical I was in my heart of the poor wife when,
the morning I went there early and found her carrying out blankets and
pillows to air, I heard her announce, with a relief in which there
was no attempt at concealment, “Well, he’s gone at last!” She let me
do the autopsy. I invited Belle and Dr. Campbell. I can remember the
appearance of those worn-out kidneys far better than the details of
many a later autopsy.