St. Bernard's: The Romance of a Medical Student

CHAPTER XX.

THE PROFESSOR AT HIS WORK

Doctrines and maxims, good or bad, flow abroad from a public teacher as from a fountain, and his faulty lessons may become the indirect source of incalculable mischief and suffering to hundreds who have never even heard his name.

    – Sir Thomas Watson.

Physicians vary their prescriptions to give the disorder an opportunity of choosing for itself.

    – Lacon.

As Mr. Crowe was surgeon to the hospital, every new experiment and each fresh result was religiously tried upon a human subject. Being a man grateful for any little services his assistant rendered him, he repaid him in various ways, one of the most valued rewards being the privilege of trying “any new drug you may take a fancy to upon any of my patients, Mr. Mole.” None of Mr. Mole’s services went unrecognised, and the acknowledgment was not costly to the professor. The sufferers in the wards where his beds were located would not have seen the matter in precisely the same light had it been explained to them, but Mr. Crowe was really generous – with other people’s pain!

“I wish to investigate,” said one of his dressers, “the presence of lithic acid in the blood of rheumatic patients. May I blister one or two of your patients, Mr. Crowe?”

“Oh, certainly,” said the obliging physiologist; “only you must take precautions to let the patient imagine you are doing it for his benefit, and be careful the nurses don’t see what you are about – nurses are getting so ’cute now-a-days. With these provisos, you are free to roam at large, my friend, over the bodies of any of my clinics.”

Several poor men and women broke out in great blisters the following morning, the serum from which was carefully collected and evaporated in the laboratory for pretty crystals of lithic acid. “They look very nice if carefully mounted; but mind you place a black circle round the covering glass, it shows ’em up better. Grumbled a bit, did she? She must have the battery again if she is intractable.”

Jack Murphy, a merry, reckless little dog as we know, used to tell a droll story of his first bit of skin-grafting in the wards.

“Graft him,” said Mr. Mole. “Don’t know how? Oh, you just snip bits of skin off his arm and pop ’em on the raw surface of the burnt leg, and in a few days you’ll find ’em growing like watercress all over the shop. Perfectly simple. One of the grandest discoveries of modern surgery.”

Now these directions, although satisfactory to the adept, were wanting in lucidity to the pupil; and Mr. Murphy, who never liked to admit even to himself that there was anything in his profession too hard for him, went down into the erysipelas ward and set to work upon his wretched victim with a light heart.

“Going to heal up your leg, old chap, in a brace of shakes. Splendid invention for putting a new skin on your leg. Sha’n’t hurt you a bit. Don’t squeal. I’m just going to snip off a tiny bit or two from your arm, and transplant ’em on to your leg.” And having cheered up the patient with a stiff glass of grog which the nurse had at command, the vigorous young dresser took off a dozen or more pieces of skin the size of a threepenny-piece, from the arms, and scattered them in likely places on the badly healing burn.

When Mr. Murphy entered the dining-room that night, he was received with a perfect roar of laughter from the house surgeons, who had become aware of the ignorant barbarity the burnt man had suffered; and Mr. Murphy was made to know that his idea of a snip of skin for grafting was at least a hundred times in excess of what it ought to be, and that for the future he must be less generous with his pound of flesh. Even the patient found out the error, and Murphy, who was a good-hearted fellow, wished he had known more about skin-grafting before he had punished him so. It was some weeks ere the victims arms healed, and the scars remain now, and even the operator is still sore when the subject is referred to.

It was wonderful how they managed to get the patients to take all the new remedies that were tested upon them. Folks are usually very careful as to the physic they swallow. Your poor folk do not mind it being nasty, they rather like it thick, with a good rich, nourishing sediment and an awakening odour; but they are very suspicious of anything that gives them queer sensations. They often return to their doctor with a bottle of stuff which he has prescribed them, and declare that they “cannot take any more of it, because the first dose made them feel as if all their senses was a-running away from them down their right arm, making them feel that strange in their toes as they seemed as if they wore going to die.” And this when the poor practitioner has merely given them perhaps a little quinine, or some simple diffusible stimulant! Their confidence seems to come with the increase in the number of their medical attendants; and when the chief surgeon, with his dozen of satellites, supported by several capable-looking nurses, has ordered them to take a decoction that works in their systems as if scorpions and tarantella spiders were careering through their veins, they submit with meekest resignation, and admire the regularity with which their doses are timed. You can do things in hospital it would be as much as your life were worth to attempt outside. A hospital doctor may steal the horse where a general practitioner dare not look over the hedge. “It’s the confidence as does it,” Mrs. Podger used to say. But not always. Some do resent. The spread of Socialism, the tracts of the various societies which dare to question some of the cherished privileges of the profession, and the general uprising against all authority that characterizes the present age, have produced a class of patients who provokingly assert their right “to know what you are about with them.” Such are awkward people of whom to make use.

These persons are not liked in the wards, and are frequently cured right away and sent about their business with indecent haste. A sort of ungrateful folk that want to get all they can out of the hospitals, and then be off. A most unappreciative class, which seems a growing one too. “Like to know what they thinks ’ospitals is for?” said Podger. “Seems to me they think ’em ’otels!”

Latimer complained in his day, that “physick was a remedy prepared only for rich folks, and not for poor, for the poor man is not able to wage the physician.” He could not fairly say that now. It is possible, if good Master Latimer were preaching one of his plain sermons at Paul’s Cross, he would complain for quite an opposite reason.

CHAPTER XXI.

TAKEN IN

Although hospitals have been intended as a blessing and benefit to the poor, they have too often proved the reverse, on account of the ignorance on the part of their administrators of the true principles of health.

    – Encyclopædia Britannica.

There are diviner, truer laws,
That teach a nobler lesson still.

    Procter.

One of the greatest blots upon hospital management of the present day is the abuse of alcoholic drinks. The immense amount of spirits needlessly, and often not harmlessly, given to the patients is a serious tax on the resources of the charities, and a fertile cause of dram-drinking in the people at large. As you pass along the wards and read the cards over the beds, indicating the diet and amount of drink ordered by the medical officers, it is startling to see how many sick or convalescent patients are ordered six ounces of whisky or brandy a day. Now six ounces represent three wineglassfuls of good average size, or say nearly two bottles a week. This is expensive, to say the least – of very questionable service in most cases to say nothing more. That the custom has its advantages in an hospital like the one we were describing is indisputable – to the medical staff. Where a system obtains by constant worrying and painful, or at least unpleasant physical examinations, it is of great assistance to doctors and nurses to have at hand an unfailing means of putting and keeping the patient in good humour and benevolent docility. Does he object to be “mauled about,” as he sometimes inelegantly calls his dose of “palpation and stethoscopy,” his equanimity is at once restored by the comfortable words of the doctor, “An ounce of brandy, sister!” Should he object to his treatment, and rebel against the hallowed customs of the place, considering he has a right to the orderly arrangement and general integrity of his own limbs, he is a lucky fellow if upon an early date his spirit card is not reduced, or even taken away altogether. You could not manage St. Bernard’s on its present lines without alcohol. The medical school would not have a chance with it. Let us follow, say, Thomas Smith from St. Giles to the hospital. He has inflammation of the lungs, is very weak and ill, has been badly fed and cannot in his own home obtain proper care and nursing. His clergyman kindly gives him a letter for the hospital. He is advised to be at the out-patient department at one o’clock. To make sure, the poor fellow’s cab is there by half-past twelve; the great waiting-hall is already filling. The physician of the day arrives a little after two. About three, if he is lucky, Smith’s turn will come. He is not sorry. It was weary waiting, sitting upright on a hard bench in a great noisy, draughty room, with many distressing and painful sights around him; and when the kind, gently speaking physician tells his wife to strip him to the waist, he begins to think he is going to be cured straight off by some of the superabundant medical force surrounding him.

There are many interesting clinical features in Tom Smith’s case, and the doctor lectures long and learnedly to the score of good-natured, athletic young gentlemen whom he has just been informed are “sucking doctors.” They have all come provided with stethoscopes, and after the examining physician has thoroughly thumped, pummelled, and “auscultated” poor Smith’s chest, back and front, as many of the aforesaid young men who are invited, or who can be induced to interest themselves, “have their go” at the patient, and are very kindly and patiently shown precisely where the mischief is, and what is the exact stage of its progress; but all this could not be got through without an ounce or two of brandy in a drop of water, in a measure glass that stands handy. And everybody having quite done, with many remarks, such as, “You see the point I was driving at, Mr. Dobbs?” or, “You are quite convinced my theory of pneumonia is correct, Mr. Murphy?” poor, shivering, sick and faint Tom Smith is sent up to the wards to bed, under the care of an entirely fresh physician, physician’s assistant, clinical clerks, and students of the in patient department.

None of those men who have spent so much time over the case, will probably ever see it again. Smith’s cards, papers, and books having all been duly made out, signed and registered, he is conducted, say, to Magdalen ward, where he is put to bed and made comfortable. If he has brought any tea and sugar with him, he can have a cup; but these things are luxuries not provided by the charity.

When the staff has dined, the house physicians and surgeons, accompanied by their clinical clerks, dressers, and nurses, go their rounds. All the fresh cases that have come in during the day have to be examined. All that Tom Smith has undergone in the out-patient department goes for nothing, and the process is now still more carefully repeated. A minutely exact record of the “physical signs” is made; all that drumming of the fingers on the poor tender chest, that long stethoscoping at the panting lungs, whose every movement causes acute distress, has to be undergone; the heart sounds are scrupulously noted; its size and the line of demarcation of the liver and other organs recorded, not by the qualified doctor temporarily in charge of the case alone, but, by his kind permission, his assistant clerks also, for their education, verify all the recorded facts for themselves. “An ounce of brandy, sister!” and the man suppresses his growing discontent. His night temperature is recorded on the card above his bed, and now, if so disposed, he may say his prayers and compose himself to sleep. At six in the morning he will have to get his breakfast, for work in a hospital must begin early, or the wards will not be scrubbed and tidied up by ten o’clock, when the doctors go their morning rounds.

If the gentlemen who examined him overnight have been duly interested in their cases, they will have read them up from the approved text-books; and it will be strange if that reading has not raised questions and points that will necessitate a fresh examination. So the man gets another ounce of brandy, and another knocking about. At three in the afternoon the head physician – a fashionable West-End speciality man for diseases of the chest – goes his rounds, followed by a crowd of students. He makes himself responsible for each of the cases in the beds allotted to him, and naturally wants to know all about them, especially if any of them are likely to make good subjects for elaborate clinical demonstration. So with tenderest grace and the most honied phrases, with every courtly apology to the patient for disturbing him, the great man proceeds secundem artem to teach the young idea how to shoot. The junior in charge of the case, reads his report of the physical signs, family history, diagnosis and prognosis of the case, with the treatment proposed, while the lecturer verifies or objects to the statements of the record. He is so thoughtful, so kind and sympathising with the poor fellow on whom he is going to discourse for the next half-hour, that having noticed he is distressed by the process before it is fairly begun, he, in his most mellifluous tones, asks, “Would you like a little wine or brandy, my friend?” And the poor man thinks he would. Then have at him, lads! for here is a pretty case, a typical text-book case, and all you who are going up for examination had better get all you can out of Tom Smith, for here are “minute crepitations,” “vesicular murmurs,” “obscured resonance,” and if you watch the progress of the disease you may get “tubular breathing,” “bronchophony” “increased vocal vibration,” and no end of good things. Tom Smith remains in the hospital six weeks before he is “discharged cured.” He has suffered many things at the hands of his physicians; he has cost St. Bernard’s say about a pound a week, besides his medical attendance. Who says he has gone out without paying his bill? It has occurred to no one concerned, least of all to the patient, that there is anything wrong in all this treatment. In their passionate eagerness to acquire information that can only be obtained at the bedside, the assiduous students are of course delighted to have Mr. Smith amongst them. The house physician is soon going into private practice, and he wants to consolidate and confirm all his knowledge of the various forms of disease; the lecturer loves nothing better than to exhibit his really admirable powers of clinical observation to a body of rising men, who can send him many patients and more guineas. The patient is usually delighted that so much interest is taken in his case, and contrasts the hurried “Put out your tongue; give me your hand; take this medicine, and I will see you again in two or three days;” all in a hop, skip, and jump style, of the club doctor, with this elaborate marshalling of great medical forces for the purposes of his cure, sadly to the discredit of the club doctor’s hasty method.

Nobody sees through it all; – yes, the sisters and the nurses do. The former do their very utmost to soften by their kind assiduity evils which they think are inseparable from the work of a public hospital. The nurses do what they have to do; it is their business to execute orders, and they usually say little, whatever they may think. Then says the reader, “Who is aggrieved? What is there wrong in the system?” What is wrong? Everything! From the long waiting in the out-patients’ ward; the exposure of such a case while the preliminary examination is made; to the long and dangerous examinations of the stripped sufferer in the ward upstairs: with their constant repetition by so many persons; so that it is probable he would have made a better and speedier recovery under the care of the club doctor, who seemed hasty because full of business, but who thoroughly knew what he was about, and only did not waste time over matters his quick eye took in at a glance, and whose large experience was an additional sense. All that auscultation had nothing to do with the man’s cure, but a great deal to do with the education of those concerned in it; and as the treatment consisted in salines, tonics, poultices and rest, with suitable food at suitable times combined with good ventilation and cleanliness, the elaborate exhibition of therapeutic force was very much like cracking a nut with a Nasmyth hammer, only the cracking of the nut was but a detail!

It is possible that if all this could be knocked into Tom Smith’s uneducated head, he might not again lend himself so readily to the business; still less is it probable that all those cheques would be drawn in favour of St. Bernard’s, if the subscribers knew just how the case stood. They might ask with much cogency, “Cannot we get our nuts cracked without the use of those costly steam hammers?” And, after all, that is a very important factor in the case. For consider! It is only by much begging and by resorting to many stratagems that the governors can keep these charities going. Now if the charitable Christian public chooses to crack its nuts with steam hammers, we cannot offer any objection. It seems costly, but that is their business; but if they think their nuts can be cracked by no other and less costly method, they are very much in the dark. Let alone the fact of so much unconscious cruelty, wrought in the name of charity and mercy. Of that we have said enough. The fees for a complete hospital curriculum average a hundred guineas for the four years’ course, an absurdly small sum for such an education. In what other learned profession could such advantages be obtained for twenty-five guineas a year? But then the charitable public does not assist other professions so liberally as that of medicine.

CHAPTER XXII.

HOW ELSWORTH CAME TO HIMSELF

Oh, then, if Reason waver at thy side,
Let humbler Memory be thy gentle guide;
Go to thy birthplace, and, if Faith was there,
Repeat thy father’s creed, thy mother’s prayer.

    – Oliver Wendell Holmes.

A dream is o’er,
And the suspended life begins anew;
Quiet those throbbing temples, then, subdue
That cheek’s distortion!

His forehead pressed the moonlit shelf
Beside the youngest marble maid awhile;
Then, raising it, he thought, with a long smile,
“I shall be king again!” as he withdrew
The envied scarf; into the font he threw
His crown.

    – Browning (“Sordello”).

When the scrimmage and riot was at the highest point, Elsworth suddenly found himself separated from his companions, and involved in a rush of people who were making for the street. These persons were anxious to escape from the violence that had suddenly come upon them, and taking rapid stock of affairs, thought it best to be outside. So, in a very few moments, Elsworth was in Oxford Street, with no chance of getting back to the scenes which he had just so unwillingly left. He turned down the Seven Dials, and as he walked towards the Strand had time to feel heartily ashamed of himself and that night’s work. Had he not had nearly enough of this sort of thing? Was it for this he had read and worked, earned honours, learned many and great things, profited by the labours of the past, which surely could not have come to him through such channels as he was likely to prove? For several days past he had been immersed in the study of Browning’s “Paracelsus.” He had seen how that hero of medicine had torn himself away from home and friends, and all his loved surroundings, to go far into the distant world to gather, with enormous difficulty, hints and scraps of medical learning which were but the veriest crumbs compared to the loaded tables now set before the student of the healing art; how, with poor means, great hardships, and the scantiest help, in opposition to the teaching of its appointed professors, doing violence to the received notions of his time, he had struck out a path for himself, through the trackless forest to the unexplored country where lay, he felt and knew by the inner light that guided him, the key to the true treatment of the hurts and troubles of men’s bodies – all this against tears and entreaties such as often hold a man back from attempting new and great things. And how, after many wanderings and contentions, much violence, and opposition, he had seized, Prometheus like, Divine gifts for men, all by his own great soul, fortified by faith in God and love to man: and had dowered the human race with gifts greater than kings and captains ever won for it, and blessings for which the art of medicine yet sings his praises. While he, Elsworth, standing as it were high on the shoulders of the discoverers of the past, had been using his time at best to acquire a mere means of livelihood, his predecessors, who had helped him to all this knowledge, had been glad to win from nature, by years of work, one by one those secrets he was using so lightly. He was overcome by shame and the sense of his unfitness for such a work as he had dared to undertake.

Paracelsus, – the Paracelsus made known to this age, not by the false portraits limned by his contemporaries and enemies but as drawn by the master hand of Browning, – seemed to step out from the dark past and forbid his progress on a path he had traversed. A horrible sense of degradation took possession of him. He had once held a lofty ideal. When at Oxford, when his faith in God was a real working faith, he had often vowed himself to the service of humanity. That the saints of the Church, the fathers of the faith, the apostles, the prophets, the teachers of the past should have all worked to hand down to him – Elsworth – this noble, Divine light of Christian faith, which alike impelled his adhesion and claimed his co-operation; and for him to receive all, and then hesitate to give in his turn his best years and his whole heart to the world’s needs, was surely but to be repelled on its suggestion. But faith was gone, intellect had usurped the place of will, the will was unsanctified, and the man in brain and heart a chariot whose steeds rushed uncontrolled along the beaten track of habit, and were carrying him – whither? If there were no hereafter – nothing beyond this life – was it worth while to go on with this devilry, this riot, this attempt to drag the better part, the reason, into the mire, with the swine? Why not forsake it all, and now while there was time for repentance? The man was pulled up short: thrown back like a horse on his haunches. A great gulf in these few minutes was opened between him and the past; and not Paul when smitten down on Damascus road was blinder as to the future than Elsworth on this night in Seven Dials, amongst the suspicious men and bedraggled women, who passed him as he moved listlessly along, arrested by the scream of a conscience that would be heard at least once more, and whose voice had unspeakable terrors for him. For he was made for better things – that he always had felt; he was not vile, debauched, debased, as some of his companions were. He had fought against light; he had struggled not to believe, not that he might give the reins to his passions, but that he might deify intellect. He thought it was cowardly to leave those poor lads in the fight, but it was useless to go back; and even if he could have saved them from arrest, he dare not engage in any more of that work – away with that at least; it was too horrible to think of any more. So on he went, scolding himself, calling himself by every opprobrious epithet, and berating himself back into manhood again. He had reached Chelsea; it was almost too late to get a lodging, but he would try; for the conviction began to dawn upon him that he should not go back one single step into the past, but there and then break with it all, and be a man, and live a man’s life. He prayed – once more repeated, “Our Father, which art in heaven;” it seemed very unphilosophical, very unscientific. He had often sent out aspirations to “the Power not ourselves which makes for righteousness,” to “the one Consensus of the whole,” to “the Eternal Verity,” but it was long since Elsworth had said “Our Father;” he felt that in doing so he had reopened that long closed “window towards the Infinite,” and had once more let in the light of the Divine and supernatural wisdom without which he had been groping along. He found a clean, but mean lodging in a little eating-house down by the river, and went to bed. Surely a voice out of heaven had called him that night. Not clearer was Paul’s arrest – not plainer Loyola’s, “Hitherto, but no farther” – than this to him to-night. So, ever, when there is a work for a man that he must do, that he is sealed and set apart for, when the full time comes he shall hear the call; if not in the still small voice and the whispering wind, then in the fire and thunders of Sinai.

Elsworth felt that night, as he lay restlessly tossing on the rough bed, that he had gone about his whole work at the hospital the wrong way. Thus had not Paracelsus done! How he cried at the outset of his career:

“I can abjure so well the idle arts
These pedants strive to learn and teach; black arts,
Great works, the secret and sublime, forsooth —
Let others prize; too intimate a tie
Connects me with our God! A sullen fiend