“WALKING THE HOSPITAL.”
We easily forget our faults when they are known only to ourselves.
—_La Rochefoucauld._
DOCTOR. Is it not natural to die? Then if a dozen or two of my
patients have died under my hands, is not that natural?
LISETTE. Very natural, indeed.—_Mrs. Inchbald._
And if you die,
Why then you lie
Stretched on the bed of honour.—_Dibdin._
Early the following morning, Elsworth presented himself to young Dr.
Wilson, the house surgeon in charge of the wards under the chief care
of the surgeons, to whom he was appointed dresser.
Hitherto he had done no practical work in the wards at all. It was
against the regulations for any student to be a dresser in the surgical
wards till he had passed his primary or first professional examination,
at the end of his second winter session.
He had opportunities of learning the countless little details of minor
surgery in the out-patient departments day by day, but now he was to be
introduced to a very different kind of work. He would have some forty
or fifty patients to study and report upon, to watch the progress of
their maladies, or the processes of their cure, to dress the wounds,
bandage, apply the remedies ordered by the house surgeon, or the
surgeon-in-chief, and himself perform such operations as in their
discretion he might be entrusted with. Everybody must have a beginning,
and upon whom can one begin surgery so well as an hospital patient?
Your dentist began upon somebody; he did not acquire without practice
that nice skill, that rapidity, almost amounting to sleight of hand, by
which he jerks out your offending molar, before you are half aware he
has begun. To be sure, he had a long course on sheeps’ heads from the
butchers, and then at the hospital or dispensary, he tugged away at the
mouths of poor children, or men and women of low degree, who could not
afford the chemist’s shilling, or the still cheaper barber’s fee, and
who, getting the job done for nothing, could not reasonably complain of
the several bungling attempts with the wrong instruments applied in the
wrong way, and often to the wrong tooth.
“I say, young man,” said a poor carpenter to an hospital novice, after
the fifth attempt to lug out his grinder had been fruitlessly made. “Do
they pay you here by time or by the job?”
Even your hair-dresser must have cut somebody’s hair for the first
time. You may be sure it was not a duke’s. “We allus begins on
children’s at the Workhus schools,” was the answer of a master barber
to an inquiry as to the method of learning the art. Here, then, were
fifty live subjects, all human, at the mercy of our new dresser. That
young blacksmith with the broken rib thinks he is here simply to get it
mended. He will think so in a fortnight’s time, but the officials know
better; the mended rib is a mere contingency. The butcher lad in the
corner bed has compression of the brain. He shall be cured, if
possible. Meanwhile, he shall make himself useful to those who want to
investigate the latest theory of “localisation of brain functions.”
He shall be trephined—that is to say, a round hole shall be neatly cut
in his cranium, and the brain exposed at the injured part; and while
the organ of the mind is open to the view, are there not many pretty
ideas to be discoursed of, and various experiments awaiting trial? Are
there not galvanic batteries at hand? Is not the man at their mercy? He
has ether or chloroform, and able men of science about him; and, if
they don’t cure him, they will doubtless get information that will
enable them to cure some much more important personage! It is not
enough to have done all this on a monkey; it needs a man before you can
be quite sure. Ultimately they will do it with safety to a gentleman, a
duke, a royal prince, and the successful operation will make somebody’s
fortune. So as every rising surgeon carries a royal surgeon’s baton in
his instrument bag, have at the butcher!
The house surgeon “went round” with our new dresser, and explained the
nature of each case in very brief terms, and in a perfunctory manner.
It was his duty to instruct his dressers, and he did it after a
fashion; but he was not paid to do anything of the sort, and, with the
young and partially-educated, there is often a sort of contempt for
those who know just a little less than they do. The scorn felt and
expressed by the Board School child who knows decimals, for his
companion just beginning vulgar fractions, is nothing to the sense of
superiority assumed by a house surgeon appointed a few weeks since, and
aged twenty-three, towards his unqualified dressers, who cannot go up
for examination for another six months. And the dresser, in his turn,
looks down from his exalted post on those late companions of his who
failed at the primary, and have not yet achieved the right to handle
cases in the wards.
Elsworth was shown a number of beds, of the occupants of which he was
required to write complete family histories, going into the minutest
details, as practice in note-taking. He was called on to carry out,
with the assistance of the nurses, daily, all the directions as to the
dressings and bandaging required by the nature of the case; and was
encouraged to avail himself, while doing so, of any and every means
that would assist him in the acquisition of his art, so far as it was
consistent with the regular treatment of the patient, and was not
calculated to alarm him or make him think it was not actually connected
with his cure. Our house surgeon was going in for ophthalmology, and he
never missed an opportunity of dropping belladonna into every patient’s
eyes, and taking stock of his retina with the ophthalmoscope. Whether
you had cracked your skull or broken your leg, fractured a rib or
sprained your ankle, your eyes must be examined minutely, on the chance
of something pretty turning up to show the professor of ophthalmology.
Dr. Wilson was such an enthusiast on eyes that one day, happening to
pass through one of the out-patient wards, he caught sight of a working
man in whose visual organs he instantly detected something of interest.
Immediately he had him under a lamp, and set to work making sketches of
the morbid appearances in the retina, explaining to the other students
the beautiful things to be seen therein. Now the patient had not come
about his eyes, but being troubled with indigestion, wanted a bottle of
medicine to cure it; and he was naturally surprised that for three
mortal hours eighteen young gentlemen should be examining his eyes,
which wanted no treatment but the sight of a little more weekly pay;
and marvelled that no questions should be asked him about the ailment
which caused him discomfort. He was still more amazed when, as evening
drew on, one after another went away, and nobody prescribed anything
for him at all! However, one of the resident staff saw him before the
place was closed, and he had a bottle of “house mixture,” and went away
more satisfied; but still wondering at the singular ways of doctors.
Let us go round the wards with Dr. Wilson and our hero, his new
assistant.
Here is a middle-aged woman, evidently having but a short time to live,
yet this afternoon Dr. Wilson says his chief proposes to perform upon
her a capital operation. He has not the least hope it can save her
life, but the chance of performing such an operation arises but seldom;
and it is but just and kind to the house surgeon, who wants all the
practical work he can get, to let him assist. So the woman and her
friends are duly pressed to consent that this—“the only means of
saving her life”—shall forthwith be done. To this end all the nurses
are instructed to urge her. At last she submits. She will be carried to
the operating theatre, and this chance of instruction will fall to Dr.
Wilson’s hands; for, as soon as the chloroform has effected its work,
_he_ will take the place of the chief, and “do his first strangulated
hernia.” Dr. Wilson is jubilant—slightly nervous, for it is very grave
work. It is utterly unjustifiable work, Elsworth thinks, but dare
hardly express his thoughts except by a timid question or two. He knows
he must steel himself to plenty of such matters, that his turn will
come and that he would not like to leave St. Bernard’s without doing
just as much himself. But his heart, for all that, misgives him.
“Might he warn the patient of her imminent danger?”
“On no account! It might cause her to revoke her consent; might, at any
rate, depress her, and hasten the catastrophe.”
In the next bed is an elderly woman with a contused side. That is a
slight matter. It was not for that she was taken in, but in her
examination in the out-patients’ department it was discovered that she
had a peculiarly interesting bony growth on her leg that would make a
very neat and pretty operation. So a bed was found for her, and daily
and increasing pressure put upon her to have this queer growth removed.
It was no inconvenience or annoyance to her at all. She was past middle
life, and she had been told by her family doctor there was not the
slightest occasion for operative interference; but everybody at St.
Bernard’s wanted just such a case to try a new method of treatment
recently invented in Vienna, and the chief surgeon was eager to do the
operation, and all concerned were charged, as they loved him, not to
let it slip. That also was to come off this afternoon.
The next bed is occupied by a girl, the subject of a rare and very
interesting skin affection. No active treatment has yet been suggested,
as it is much too pretty to spoil by any attempt at cure just yet.
Several surgeons are expected from other hospitals to see it, so she
has an ounce of peppermint water three times a day and full diet, and
the cure is postponed till a sufficient number of interested people
have seen it. Drawings must be made; the artist to the hospital could
not attend for a week to come; then there were photographs to be taken,
and it would never do to spoil anything so effective by commencing a
cure. So “repeat the mixture,” till science has done with the first
part of the case, and therapeutics can step in.
“That woman, you will perceive,” said the surgeon, “has a squint. She
came in with a fracture of the arm, but with a little more pressure she
will let us operate on the ocular deformity. I like doing squints. By
the way, there is a woman dying in the next ward who has a perfectly
charming optic neuritis. You ought to see that. Don’t examine it very
often, as it hurts her dreadfully, and she can’t live much longer; but
the case is perfectly typical. I am going to sketch it this evening.
One don’t like to hurt folks if it can be avoided, but this is much too
good to miss. She grumbles a bit at being disturbed, and I fear
suspects all this is no part of her treatment; but I order her a glass
of wine before I begin, and she likes that.”
They next enter one of the male wards, and Dr. Wilson draws Elsworth’s
attention to a man _in articulo mortis_. “He can scarcely live till the
next morning,” says he; “but if you are interested in phthisis, take
your stethoscope and have a quarter of an hour overhauling his
posterior thorax. There are some sounds to be heard that with careful
auscultation are quite typical, and one very rarely gets them so
distinct. Don’t be too long at him, as turning him over on his face
exhausts him so much, and we have examined him a good deal lately, poor
devil!” Elsworth was obliged to assume a look of eager interest in the
proposed investigation, for the sake of pleasing his instructor, but he
resolved that the auscultation, as far as he was concerned, should at
least not distress the poor sufferer. How any human being could find it
in his heart to disturb the last moments of his patient with
investigations of “cavernous breathing,” “râles,” and “pectoriloquy”
puzzled our hero;—but then, this was his first day in his new office;
he had much to learn yet.
“Come into this room, Elsworth. See here is a case on which I am trying
a rather singular experiment. I have kept this man for the past seventy
hours sitting up to his waist in a bath of cold water, as you see. He
has all his meals in this position, and sleeps and reads without
removal from his tub.”
“Does he like it?”
“Well, I can’t say he does; but the experiment is a very interesting
one, and I am getting up a good paper on it. I shall not keep him in
much longer, for I have nearly completed my investigations. This is the
best case on which I have tried the treatment. I have lost three
others, but I think this one will do well.”
And thus the days went by. To a man who loved his work as our hero
loved it, there was hourly something fresh to interest and excite
speculation. But the atmosphere of the place was beginning to tell upon
him. The utterly reckless, matter-of-course way in which experiments
were tried upon the occupants of the beds; tried by everybody
concerned, from the chief to the dresser; tried by the performance of
operations of terrible gravity on those who, at longest, had but a few
weeks to live; down to the snipping off little mites of skin from the
arms of one person to “graft” on the wounds of another, had tended to
blunt Elsworth’s fine sense of humanity and lower his ideal. Not that
anybody about the place ever suggested that all this was wrong; nobody,
except now and then a patient or his friends, expressed any objection
to a course so fraught with information and dexterity of hand. It all
seemed the most natural thing possible, and the hospital system as
perfect as could be imagined. Outside “some sentimentalists,
weak-brained lords and hysterical women,” as they were termed by the
men of science, were making a noise over these very things—were
threatening to withdraw their subscriptions, indeed; but nothing ever
came of their agitation, and the greater public was too well convinced
of the perfection of the system to interfere with it.
“How is a medical man to learn his business if he does not pick it up
at the hospital?” asked a noble lord of a friend the other day. The
reply was a sensible one. “I don’t know, but I fancy these confounded
Socialist fellows will put a stop to all this sort of thing before the
world is much older.”
Quite so. The mob did not like Marie Antoinette’s carriages to run over
them in the streets of Paris just because they were only _canaille_.
Our Radical friends have not found out just yet how we run over them
scientifically. When they do, be sure they will find their remedy.