Medical men are, as a class, very much too busy to take stock of
singular situations or dramatic events. Thus it happens that the
ablest chronicler of their experiences in our literature was a lawyer.
A life spent in watching over death-beds--or over birth-beds which are
infinitely more trying--takes something from a man's sense of
proportion, as constant strong waters might corrupt his palate. The
overstimulated nerve ceases to respond. Ask the surgeon for his best
experiences and he may reply that he has seen little that is
remarkable, or break away into the technical. But catch him some night
when the fire has spurted up and his pipe is reeking, with a few of his
brother practitioners for company and an artful question or allusion to
set him going. Then you will get some raw, green facts new plucked
from the tree of life.
It is after one of the quarterly dinners of the Midland Branch of the
British Medical Association. Twenty coffee cups, a dozer liqueur
glasses, and a solid bank of blue smoke which swirls slowly along the
high, gilded ceiling gives a hint of a successful gathering. But the
members have shredded off to their homes. The line of heavy,
bulge-pocketed overcoats and of stethoscope-bearing top hats is gone
from the hotel corridor. Round the fire in the sitting-room three
medicos are still lingering, however, all smoking and arguing, while a
fourth, who is a mere layman and young at that, sits back at the table.
Under cover of an open journal he is writing furiously with a
stylographic pen, asking a question in an innocent voice from time to
time and so flickering up the conversation whenever it shows a tendency
to wane.
The three men are all of that staid middle age which begins early and
lasts late in the profession. They are none of them famous, yet each
is of good repute, and a fair type of his particular branch. The
portly man with the authoritative manner and the white, vitriol splash
upon his cheek is Charley Manson, chief of the Wormley Asylum, and
author of the brilliant monograph--Obscure Nervous Lesions in the
Unmarried. He always wears his collar high like that, since the
half-successful attempt of a student of Revelations to cut his throat
with a splinter of glass. The second, with the ruddy face and the
merry brown eyes, is a general practitioner, a man of vast experience,
who, with his three assistants and his five horses, takes twenty-five
hundred a year in half-crown visits and shilling consultations out of
the poorest quarter of a great city. That cheery face of Theodore
Foster is seen at the side of a hundred sick-beds a day, and if he has
one-third more names on his visiting list than in his cash book he
always promises himself that he will get level some day when a
millionaire with a chronic complaint--the ideal combination--shall seek
his services. The third, sitting on the right with his dress shoes
shining on the top of the fender, is Hargrave, the rising surgeon. His
face has none of the broad humanity of Theodore Foster's, the eye is
stern and critical, the mouth straight and severe, but there is
strength and decision in every line of it, and it is nerve rather than
sympathy which the patient demands when he is bad enough to come to
Hargrave's door. He calls himself a jawman "a mere jawman" as he
modestly puts it, but in point of fact he is too young and too poor to
confine himself to a specialty, and there is nothing surgical which
Hargrave has not the skill and the audacity to do.
"Before, after, and during," murmurs the general practitioner in answer
to some interpolation of the outsider's. "I assure you, Manson, one
sees all sorts of evanescent forms of madness."
"Ah, puerperal!" throws in the other, knocking the curved grey ash from
his cigar. "But you had some case in your mind, Foster."
"Well, there was only one last week which was new to me. I had been
engaged by some people of the name of Silcoe. When the trouble came
round I went myself, for they would not hear of an assistant. The
husband who was a policeman, was sitting at the head of the bed on the
further side. 'This won't do,' said I. 'Oh yes, doctor, it must do,'
said she. 'It's quite irregular and he must go,' said I. 'It's that
or nothing,' said she. 'I won't open my mouth or stir a finger the
whole night,' said he. So it ended by my allowing him to remain, and
there he sat for eight hours on end. She was very good over the
matter, but every now and again <i>he</i> would fetch a hollow groan, and I
noticed that he held his right hand just under the sheet all the time,
where I had no doubt that it was clasped by her left. When it was all
happily over, I looked at him and his face was the colour of this cigar
ash, and his head had dropped on to the edge of the pillow. Of course
I thought he had fainted with emotion, and I was just telling myself
what I thought of myself for having been such a fool as to let him stay
there, when suddenly I saw that the sheet over his hand was all soaked
with blood; I whisked it down, and there was the fellow's wrist half
cut through. The woman had one bracelet of a policeman's handcuff over
her left wrist and the other round his right one. When she had been in
pain she had twisted with all her strength and the iron had fairly
eaten into the bone of the man's arm. 'Aye, doctor,' said she, when
she saw I had noticed it. 'He's got to take his share as well as me.
Turn and turn,' said she."
"Don't you find it a very wearing branch of the profession?" asks
Foster after a pause.
"My dear fellow, it was the fear of it that drove me into lunacy work."
"Aye, and it has driven men into asylums who never found their way on
to the medical staff. I was a very shy fellow myself as a student, and
I know what it means."
"No joke that in general practice," says the alienist.
"Well, you hear men talk about it as though it were, but I tell you
it's much nearer tragedy. Take some poor, raw, young fellow who has
just put up his plate in a strange town. He has found it a trial all
his life, perhaps, to talk to a woman about lawn tennis and church
services. When a young man <i>is</i> shy he is shyer than any girl. Then
down comes an anxious mother and consults him upon the most intimate
family matters. 'I shall never go to that doctor again,' says she
afterwards. 'His manner is so stiff and unsympathetic.' Unsympathetic!
Why, the poor lad was struck dumb and paralysed. I have known general
practitioners who were so shy that they could not bring themselves to
ask the way in the street. Fancy what sensitive men like that must
endure before they get broken in to medical practice. And then they
know that nothing is so catching as shyness, and that if they do not
keep a face of stone, their patient will be covered with confusion.
And so they keep their face of stone, and earn the reputation perhaps
of having a heart to correspond. I suppose nothing would shake <i>your</i>
nerve, Manson."
"Well, when a man lives year in year out among a thousand lunatics,
with a fair sprinkling of homicidals among them, one's nerves either
get set or shattered. Mine are all right so far."
"I was frightened once," says the surgeon. "It was when I was doing
dispensary work. One night I had a call from some very poor people,
and gathered from the few words they said that their child was ill.
When I entered the room I saw a small cradle in the corner. Raising
the lamp I walked over and putting back the curtains I looked down at
the baby. I tell you it was sheer Providence that I didn't drop that
lamp and set the whole place alight. The head on the pillow turned and
I saw a face looking up at me which seemed to me to have more
malignancy and wickedness than ever I had dreamed of in a nightmare.
It was the flush of red over the cheekbones, and the brooding eyes full
of loathing of me, and of everything else, that impressed me. I'll
never forget my start as, instead of the chubby face of an infant, my
eyes fell upon this creature. I took the mother into the next room.
'What is it?' I asked. 'A girl of sixteen,' said she, and then
throwing up her arms, 'Oh, pray God she may be taken!' The poor thing,
though she spent her life in this little cradle, had great, long, thin
limbs which she curled up under her. I lost sight of the case and
don't know what became of it, but I'll never forget the look in her
eyes."
"That's creepy," says Dr. Foster. "But I think one of my experiences
would run it close. Shortly after I put up my plate I had a visit from
a little hunch-backed woman who wished me to come and attend to her
sister in her trouble. When I reached the house, which was a very poor
one, I found two other little hunched-backed women, exactly like the
first, waiting for me in the sitting-room. Not one of them said a
word, but my companion took the lamp and walked upstairs with her two
sisters behind her, and me bringing up the rear. I can see those three
queer shadows cast by the lamp upon the wall as clearly as I can see
that tobacco pouch. In the room above was the fourth sister, a
remarkably beautiful girl in evident need of my assistance. There was
no wedding ring upon her finger. The three deformed sisters seated
themselves round the room, like so many graven images, and all night
not one of them opened her mouth. I'm not romancing, Hargrave; this is
absolute fact. In the early morning a fearful thunderstorm broke out,
one of the most violent I have ever known. The little garret burned
blue with the lightning, and thunder roared and rattled as if it were
on the very roof of the house. It wasn't much of a lamp I had, and it
was a queer thing when a spurt of lightning came to see those three
twisted figures sitting round the walls, or to have the voice of my
patient drowned by the booming of the thunder. By Jove! I don't mind
telling you that there was a time when I nearly bolted from the room.
All came right in the end, but I never heard the true story of the
unfortunate beauty and her three crippled sisters."
"That's the worst of these medical stories," sighs the outsider. "They
never seem to have an end."
"When a man is up to his neck in practice, my boy, he has no time to
gratify his private curiosity. Things shoot across him and he gets a
glimpse of them, only to recall them, perhaps, at some quiet moment
like this. But I've always felt, Manson, that your line had as much of
the terrible in it as any other."
"More," groans the alienist. "A disease of the body is bad enough, but
this seems to be a disease of the soul. Is it not a shocking thing--a
thing to drive a reasoning man into absolute Materialism--to think that
you may have a fine, noble fellow with every divine instinct and that
some little vascular change, the dropping, we will say, of a minute
spicule of bone from the inner table of his skull on to the surface of
his brain may have the effect of changing him to a filthy and pitiable
creature with every low and debasing tendency? What a satire an asylum
is upon the majesty of man, and no less upon the ethereal nature of the
soul."
"Faith and hope," murmurs the general practitioner.
"I have no faith, not much hope, and all the charity I can afford,"
says the surgeon. "When theology squares itself with the facts of life
I'll read it up."
"You were talking about cases," says the outsider, jerking the ink down
into his stylographic pen.
"Well, take a common complaint which kills many thousands every year,
like G. P. for instance."
"What's G. P.?"
"General practitioner," suggests the surgeon with a grin.
"The British public will have to know what G. P. is," says the
alienist 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 fellows 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 signed? I came 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 form. '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 take 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
while 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 a 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 Hard
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 latchway!' 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 anyone 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, belong
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's 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 everyone 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 Gods 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 had 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 four thousand feet or so, his symptoms became terrible. She
could come up about twenty-five hundred 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?"