"Men die of the diseases which they have studied most," remarked the
surgeon, snipping off the end of a cigar with all his professional
neatness and finish. "It's as if the morbid condition was an evil
creature which, when it found itself closely hunted, flew at the throat
of its pursuer. If you worry the microbes too much they may worry you.
I've seen cases of it, and not necessarily in microbic diseases either.
There was, of course, the well-known instance of Liston and the
aneurism; and a dozen others that I could mention. You couldn't have a
clearer case than that of poor old Walker of St. Christopher's. Not
heard of it? Well, of course, it was a little before your time, but I
wonder that it should have been forgotten. You youngsters are so busy
in keeping up to the day that you lose a good deal that is interesting
of yesterday.
"Walker was one of the best men in Europe on nervous disease. You must
have read his little book on sclerosis of the posterior columns. It's
as interesting as a novel, and epoch-making in its way. He worked like
a horse, did Walker--huge consulting practice--hours a day in the
clinical wards--constant original investigations. And then he enjoyed
himself also. 'De mortuis,' of course, but still it's an open secret
among all who knew him. If he died at forty-five, he crammed eighty
years into it. The marvel was that he could have held on so long at
the pace at which he was going. But he took it beautifully when it
came.
"I was his clinical assistant at the time. Walker was lecturing on
locomotor ataxia to a wardful of youngsters. He was explaining that
one of the early signs of the complaint was that the patient could not
put his heels together with his eyes shut without staggering. As he
spoke, he suited the action to the word. I don't suppose the boys
noticed anything. I did, and so did he, though he finished his lecture
without a sign.
"When it was over he came into my room and lit a cigarette.
"'Just run over my reflexes, Smith,' said he.
"There was hardly a trace of them left. I tapped away at his
knee-tendon and might as well have tried to get a jerk out of that
sofa-cushion. He stood with his eyes shut again, and he swayed like a
bush in the wind.
"'So,' said he, 'it was not intercostal neuralgia after all.'
"Then I knew that he had had the lightning pains, and that the case was
complete. There was nothing to say, so I sat looking at him while he
puffed and puffed at his cigarette. Here he was, a man in the prime of
life, one of the handsomest men in London, with money, fame, social
success, everything at his feet, and now, without a moment's warning,
he was told that inevitable death lay before him, a death accompanied
by more refined and lingering tortures than if he were bound upon a Red
Indian stake. He sat in the middle of the blue cigarette cloud with
his eyes cast down, and the slightest little tightening of his lips.
Then he rose with a motion of his arms, as one who throws off old
thoughts and enters upon a new course.
"'Better put this thing straight at once,' said he. 'I must make some
fresh arrangements. May I use your paper and envelopes?'
"He settled himself at my desk and he wrote half a dozen letters. It
is not a breach of confidence to say that they were not addressed to
his professional brothers. Walker was a single man, which means that
he was not restricted to a single woman. When he had finished, he
walked out of that little room of mine, leaving every hope and ambition
of his life behind him. And he might have had another year of
ignorance and peace if it had not been for the chance illustration in
his lecture.
"It took five years to kill him, and he stood it well. If he had ever
been a little irregular he atoned for it in that long martyrdom. He
kept an admirable record of his own symptoms, and worked out the eye
changes more fully than has ever been done. When the ptosis got very
bad he would hold his eyelid up with one hand while he wrote. Then,
when he could not co-ordinate his muscles to write, he dictated to his
nurse. So died, in the odour of science, James Walker, aet. 45.
"Poor old Walker was very fond of experimental surgery, and he broke
ground in several directions. Between ourselves, there may have been
some more ground-breaking afterwards, but he did his best for his
cases. You know M'Namara, don't you? He always wears his hair long.
He lets it be understood that it comes from his artistic strain, but it
is really to conceal the loss of one of his ears. Walker cut the other
one off, but you must not tell Mac I said so.
"It was like this. Walker had a fad about the portio dura--the motor
to the face, you know--and he thought paralysis of it came from a
disturbance of the blood supply. Something else which counterbalanced
that disturbance might, he thought, set it right again. We had a very
obstinate case of Bell's paralysis in the wards, and had tried it with
every conceivable thing, blistering, tonics, nerve-stretching,
galvanism, needles, but all without result. Walker got it into his
head that removal of the ear would increase the blood supply to the
part, and he very soon gained the consent of the patient to the
operation.
"Well, we did it at night. Walker, of course, felt that it was
something of an experiment, and did not wish too much talk about it
unless it proved successful. There were half-a-dozen of us there,
M'Namara and I among the rest. The room was a small one, and in the
centre was in the narrow table, with a macintosh over the pillow, and a
blanket which extended almost to the floor on either side. Two
candles, on a side-table near the pillow, supplied all the light. In
came the patient, with one side of his face as smooth as a baby's, and
the other all in a quiver with fright. He lay down, and the chloroform
towel was placed over his face, while Walker threaded his needles in
the candle light. The chloroformist stood at the head of the table,
and M'Namara was stationed at the side to control the patient. The
rest of us stood by to assist.
"Well, the man was about half over when he fell into one of those
convulsive flurries which come with the semi-unconscious stage. He
kicked and plunged and struck out with both hands. Over with a crash
went the little table which held the candles, and in an instant we were
left in total darkness. You can think what a rush and a scurry there
was, one to pick up the table, one to find the matches, and some to
restrain the patient who was still dashing himself about. He was held
down by two dressers, the chloroform was pushed, and by the time the
candles were relit, his incoherent, half-smothered shoutings had
changed to a stertorous snore. His head was turned on the pillow and
the towel was still kept over his face while the operation was carried
through. Then the towel was withdrawn, and you can conceive our
amazement when we looked upon the face of M'Namara.
"How did it happen? Why, simply enough. As the candles went over, the
chloroformist had stopped for an instant and had tried to catch them.
The patient, just as the light went out, had rolled off and under the
table. Poor M'Namara, clinging frantically to him, had been dragged
across it, and the chloroformist, feeling him there, had naturally
claped the towel across his mouth and nose. The others had secured
him, and the more he roared and kicked the more they drenched him with
chloroform. Walker was very nice about it, and made the most handsome
apologies. He offered to do a plastic on the spot, and make as good an
ear as he could, but M'Namara had had enough of it. As to the patient,
we found him sleeping placidly under the table, with the ends of the
blanket screening him on both sides. Walker sent M'Namara round his
ear next day in a jar of methylated spirit, but Mac's wife was very
angry about it, and it led to a good deal of ill-feeling.
"Some people say that the more one has to do with human nature, and the
closer one is brought in contact with it, the less one thinks of it. I
don't believe that those who know most would uphold that view. My own
experience is dead against it. I was brought up in the
miserable-mortal-clay school of theology, and yet here I am, after
thirty years of intimate acquaintance with humanity, filled with
respect for it. The evil lies commonly upon the surface. The deeper
strata are good. A hundred times I have seen folk condemned to death
as suddenly as poor Walker was. Sometimes it was to blindness or to
mutilations which are worse than death. Men and women, they almost all
took it beautifully, and some with such lovely unselfishness, and with
such complete absorption in the thought of how their fate would affect
others, that the man about town, or the frivolously-dressed woman has
seemed to change into an angel before my eyes. I have seen death-beds,
too, of all ages and of all creeds and want of creeds. I never saw any
of them shrink, save only one poor, imaginative young fellow, who had
spent his blameless life in the strictest of sects. Of course, an
exhausted frame is incapable of fear, as anyone can vouch who is told,
in the midst of his sea-sickness, that the ship is going to the bottom.
That is why I rate courage in the face of mutilation to be higher than
courage when a wasting illness is fining away into death.
"Now, I'll take a case which I had in my own practice last Wednesday.
A lady came in to consult me--the wife of a well-known sporting
baronet. The husband had come with her, but remained, at her request,
in the waiting-room. I need not go into details, but it proved to be a
peculiarly malignant case of cancer. 'I knew it,' said she. 'How long
have I to live?' 'I fear that it may exhaust your strength in a few
months,' I answered. 'Poor old Jack!' said she. 'I'll tell him that
it is not dangerous.' 'Why should you deceive him?' I asked. 'Well,
he's very uneasy about it, and he is quaking now in the waiting-room.
He has two old friends to dinner to-night, and I haven't the heart to
spoil his evening. To-morrow will be time enough for him to learn the
truth.' Out she walked, the brave little woman, and a moment later her
husband, with his big, red face shining with joy came plunging into my
room to shake me by the hand. No, I respected her wish and I did not
undeceive him. I dare bet that evening was one of the brightest, and
the next morning the darkest, of his life.
"It's wonderful how bravely and cheerily a woman can face a crushing
blow. It is different with men. A man can stand it without
complaining, but it knocks him dazed and silly all the same. But the
woman does not lose her wits any more than she does her courage. Now,
I had a case only a few weeks ago which would show you what I mean. A
gentleman consulted me about his wife, a very beautiful woman. She had
a small tubercular nodule upon her upper arm, according to him. He was
sure that it was of no importance, but he wanted to know whether
Devonshire or the Riviera would be the better for her. I examined her
and found a frightful sarcoma of the bone, hardly showing upon the
surface, but involving the shoulder-blade and clavicle as well as the
humerus. A more malignant case I have never seen. I sent her out of
the room and I told him the truth. What did he do? Why, he walked
slowly round that room with his hands behind his back, looking with the
greatest interest at the pictures. I can see him now, putting up his
gold pince-nez and staring at them with perfectly vacant eyes, which
told me that he saw neither them nor the wall behind them. 'Amputation
of the arm?' he asked at last. 'And of the collar-bone and
shoulder-blade,' said I. 'Quite so. The collar-bone and
shoulder-blade,' he repeated, still staring about him with those
lifeless eyes. It settled him. I don't believe he'll ever be the same
man again. But the woman took it as bravely and brightly as could be,
and she has done very well since. The mischief was so great that the
arm snapped as we drew it from the night-dress. No, I don't think that
there will be any return, and I have every hope of her recovery.
"The first patient is a thing which one remembers all one's life. Mine
was commonplace, and the details are of no interest. I had a curious
visitor, however, during the first few months after my plate went up.
It was an elderly woman, richly dressed, with a wickerwork picnic
basket in her hand. This she opened with the tears streaming down her
face, and out there waddled the fattest, ugliest, and mangiest little
pug dog that I have ever seen. 'I wish you to put him painlessly out
of the world, doctor,' she cried. 'Quick, quick, or my resolution may
give way.' She flung herself down, with hysterical sobs, upon the
sofa. The less experienced a doctor is, the higher are his notions of
professional dignity, as I need not remind you, my young friend, so I
was about to refuse the commission with indignation, when I bethought
me that, quite apart from medicine, we were gentleman and lady, and
that she had asked me to do something for her which was evidently of
the greatest possible importance in her eyes. I led off the poor
little doggie, therefore, and with the help of a saucerful of milk and
a few drops of prussic acid his exit was as speedy and painless as
could be desired. 'Is it over?' she cried as I entered. It was really
tragic to see how all the love which should have gone to husband and
children had, in default of them, been centred upon this uncouth little
animal. She left, quite broken down, in her carriage, and it was only
after her departure that I saw an envelope sealed with a large red
seal, and lying upon the blotting pad of my desk. Outside, in pencil,
was written: 'I have no doubt that you would willingly have done this
without a fee, but I insist upon your acceptance of the enclosed.' I
opened it with some vague notions of an eccentric millionaire and a
fifty-pound note, but all I found was a postal order for four and
sixpence. The whole incident struck me as so whimsical that I laughed
until I was tired. You'll find there's so much tragedy in a doctor's
life, my boy, that he would not be able to stand it if it were not for
the strain of comedy which comes every now and then to leaven it.
"And a doctor has very much to be thankful for also. Don't you ever
forget it. It is such a pleasure to do a little good that a man should
pay for the privilege instead of being paid for it. Still, of course,
he has his home to keep up and his wife and children to support. But
his patients are his friends--or they should be so. He goes from house
to house, and his step and his voice are loved and welcomed in each.
What could a man ask for more than that? And besides, he is forced to
be a good man. It is impossible for him to be anything else. How can
a man spend his whole life in seeing suffering bravely borne and yet
remain a hard or a vicious man? It is a noble, generous, kindly
profession, and you youngsters have got to see that it remains so."