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

“There was the body of a newly imported subject, that had just been got ready for use upstairs, lying in ghastly whiteness on a coffin lid in the middle of the place. I noticed that its right arm was attached to a rope and pulley in the ceiling, and had been left in that position when the beadle had injected his preservative fluid into the arteries. The weight which acted as counterpoise was lying on a heap of old rags on the edge of the table. I did not like the look of the raised arm; it seemed pointing at me in a nasty ghostly sort of way, and I pulled it down. Then exploring further, I came upon a great store of tow and old sacking, and with these I made up a tidy sort of bed on a wide shelf, and determined when bedtime came to try and get some sleep. I was downright mad when I thought of my jolly little fire at my diggings, and the kidneys and stout I had ordered for supper. I wasn’t in much of a humour for reading, and had nothing to read with me except my Gray’s Anatomy. I hadn’t light enough to dissect, or would have kept at it all night. I could hear the clock of St. Andrew’s tolling out the lazy hours – how long they seemed! At nine I couldn’t stand it any more, and lay down on my shelf, and covering myself with the sacks tried to go to sleep. It was past ten before I dropped off; my bed was most uncomfortable, and my pillow too low – a low pillow always makes me dream so. I rested badly, and soon awoke. As I lay thinking and praying for morning, I became aware of a peculiar low moaning noise, as of some creature in great pain in a distant corner, as it seemed. Listening with the intensified sense that such circumstances arouse, I heard, in addition to the moans, a regular clank of some machine working like a bellows, and then I remembered that on the day before I had been trying some experiments on two dogs in the next vault. To one I had given curare, and had to keep his respiration going by Paul Bert’s beautiful little machine, invented for the purpose; the other dog had been horribly mangled by Crowe, and ought to have been killed, but there was a question of the bile duct on which I hadn’t completely satisfied myself, and he told me to take the animal below, and I am ashamed to say I had forgotten the poor little beggar.”

“Was that the rough little terrier which followed Dr. Arnold in the Laboratory when he was starving? I have heard him laugh at the misplaced confidence of the brute,” said Elsworth.

“The very animal,” replied the story-teller.

“But, I say, you had no licence, you know!” said Wilks, a shy, curate-looking freshman, who belonged to several humanitarian societies, and thought all this very dreadful.

The roar of laughter with which the delicious joke was received made poor Wilks blush to the roots of his hair, as one of the audience cried:

“Licence be hanged! Do you think we care for the fanatics who impede our work? Let them show themselves at St. Bernard’s! Crowe has one, because it looks well to the public; but don’t you preach, Wilks, or you’ll do for yourself. Go on.”

“Now when I was at work on the physiology part of the business, I never thought of the cruelty, but now it all came upon me horribly. My position was bad enough, but these poor dogs – animals, like ourselves – they were in cruel agony without food or water. I was only not on a feather bed, that was all; they were dying in awful torment. I thought my imprisonment was all arranged by a higher Power, to let me know what I was doing; and God knows I suffered shame and mental distress that night. I fell asleep at last, though the moans and the clockwork worked themselves into my dreams. All at once a loud noise aroused me. I started up, and to my unutterable horror, saw the arm of the corpse on the coffin lid slowly rising, and pointing its rigid hand at me in the dim light. I am no coward, as you know; but my heart was in my mouth as I stared with starting eyeballs at the ghastly object, and then I saw what had happened. The counterpoise of the pulley had slipped down, and dragged up the right arm of the corpse. It was the falling of the weight on the floor of the vault that awoke me. Just then the clock struck three, and I left the arm pointing its stiff fingers at me and went to sleep again – ‘to sleep, to dream.’ I dreamt that two awful-looking burkers had brought a subject in, had taken their gold from the place where it lay ready for them, and had caught sight of me. ‘Why, Bill,’ said one, ‘here’s a chance; let us smother this bloke, and he’ll be worth another five-pun-note to us!’ ‘Right you are, Tom!’ said the other. And they proceeded to carry out their diabolical plans, when I awoke. Horrible night-mare! I shudder now when I think of it.”

“Rather creepy, I must say,” said little Murphy.

“Well, I could not sleep any more after that, and lay a-meditating. After all, I thought, why shouldn’t I have been murdered and given up to science, as I had done with those wretched dogs in the next room? Did not the same Power frame their bodies as mine? Were not the processes Nature so lovingly and carefully carried on in their sensitive little frames just as beautiful and well adapted as those which went on in me? I repented, my lads, that night, and I have never spoken to Crowe since, and have done with that sort of work.”

“Ah! you are a sentimentalist,” they cried; “but tell us how you got out.”

“Oh, I got through the night somehow – an end comes to everything sooner or later; but the scoundrelly porters were later than usual that morning before they opened the place. Jim, the sweeper, was in a beastly funk, and implored me not to tell anybody, because it was his place to look round the vaults before closing; but he says the fog had got into him, and the other porter had asked him to go and have some hot spiced ale with him, and he was anxious he should not change his mind.”

It was getting late, and Mrs. Harper knocked at the door with “Time! gentlemen; time!” Of course she was asked in and invited to have a toothful.

“As my spasms was just a-comin’ on, strange to say, gentlemen, as up the stairs I came, I don’t mind if I do. Just a thimbleful; no, Mr. Murphy! not a drop beyond the pretty part, and cold I’ll have it to-night. It does me most good when the liquor is strong. Here’s your very good ’ealth, gentlemen, and may you all have lots of practice when you’ve done with the ’orspital; and what’s more, lots of fees, and good ’uns.”

“Well done, missus,” said all the men; “you could not have wished us anything better.”

“And now, gentlemen, I thank you for your kindness, but shut up my house I must; so I hope you will pardon me if I ask you to clear out. Oh! lawks, Mr. Murphy; I ’opes to goodness the perlice won’t see this blessed board, nor these knockers and things. I chops up that there ‘Similar – attached Willa Residence’ to-morrow for the fires. I said you should have it for your party, but no more of it – not if I knows it. Now, gents! Good-night! good-night!” And she got rid of them, and they went rollicking home.

CHAPTER VII.

NURSE PODGER

A gentleman who in a duel was rather scratched than wounded, sent for a chirurgeon, who, having opened the wound, charged his man with all speed to fetch such a salve from such a place in his study.

“Why?” said the gentleman, “is the hurt so dangerous?”

“Oh, yes,” answered the chirurgeon; “if he returns not in poste haste, the wound will cure itself.”

    – Thos. Fuller.

Now being from Paris but recently,
This fine young man would show his skill;
And so they gave him, his hand to try,
A hospital patient extremely ill.

    – Oliver Wendell Holmes.

Mrs. Sarah Podger was receiving-room nurse at St. Bernard’s, and one of the most important officials of the charity. The receiving-room is immediately within the main door of the hospital, and when an accident or other case of emergency is brought in, the patient is taken straight to this waiting hall. He first encounters Mrs. Podger, who is on the alert, having been summoned by the bell the gate porter rings when the case passes his lodge.

Mrs. Podger is at least fifty years old, is short, stout, and good-tempered. Her face is florid; she is not a convert to Blue Ribbonism; to use her own expression, she “leaves all that there rot to the sisters and fine ladies who play at nussin’.” She is of the good old school, “before all these fads and fooleries was got up;” she “don’t hold with none of ’em” “and don’t you go for to tell me,” she used to say, when questioned, “as nussin’ can be properly done on milk and water. Milk-and-water nussin’ is all very well for them as ain’t got nothin’ the matter with ’em, but folks as has to be treated at St. Bernard’s is too serious bad to get on with teetotal notions. Teetotal is all very well for the mumps; but lor’ bless yer, my dear, how are yer goin’ to nuss a capital hoperation on tea, leastways not without a drop of somethin’ in it?”

Mrs. Podger is first of all the obsequious and humble servant of the house governor, the resident staff, and the doctors attached to the charity. To these she is a very dragon of virtue and propriety. To them she protests against all larks on the part of the young students, and is never seen to smile at them in their presence. The hospital and the good of the patients is her sole love and desire. Not Jerusalem was holier to the Jew than St. Bernard’s to Mrs. Podger, when any of these were in her presence. But her heart was with the boys, and her pockets in that lavender print gown found its account in keeping well in with them. “The boys,” as she used to call the students, who were always lounging about the receiving-room, waiting for somebody to fall off a scaffold, or get run over, boasted that Podger could teach them more than all the staff put together. Where was the man who had not learned his practical surgery at Podger’s hands? Did he shine in his bandaging, it was Podger who had taught him to make those neat, smooth turns. How would that “foreign body in the eye,” as was designated the bit of coke dust in the governor’s organ of vision, have been extracted just now by the house surgeon of the day, if Podger had not given him that gentle nudge and that knowing look and told him exactly what to do, and let him have all the credit of doing it? If Podger liked the students, they on their part found Podger indispensable to them. Without her the receiving-room was the house without the mistress – the whole business went wrong. Now Podger was capital for the students, and well deserved all her tips and all her drops of gin and whisky; but you would not have appreciated Podger at her proper value had you tumbled off an omnibus, and been carried to her place of business, say at five o’clock, when the staff was dining, or at ten, when the house surgeon of the week had his little card party in his rooms. Well, yes, it would have been all right if the friend who went with you had “exhibited,” say, half an ounce of silver coinage for application to the palm of Podger’s hand, right or left; otherwise you would have been placed on that black leather couch in the corner there under the shelf of lint and tow, and you would have been weary waiting in that receiving-room, counting the various form of splints hanging round it, and listening to the groans of other sufferers waiting till dinner was over, or the game of cribbage finished, for your wounds and bruises to be attended to.

At a card-party, say, in the house surgeon’s room, her manner was much appreciated. A knock. “Come in!” “Accident sir!” “Oh, bother, Podger, what a fidget you are!” “Well, sir, it wasn’t me as caused it; there’s three of ’em, for the matter of that, and they have been here about half-an-hour, and I thought as you’d like to know.” “Fifteen two, and a pair’s four, and his nob! Now, Podger, wet your whistle, old girl; here, have a toothful, and tell them you have called the doctors, and they are all in the wards over a bad case, but are coming to see them directly.” “Bless you, sir,” says Podger, having bobbed a curtsey, “I told ’em that when they came in. Here’s your very good ’ealth, gentlemen, and long life and plenty of practice for you all.” And she returns to the receiving-room refreshed in spirit and better able to contend with the grumbling of the unhappy victims it contained. She would have dressed their wounds, and sent them all off packing about their business, but it was against the rules, grave scandals having arisen from this “unqualified treatment.” Not but that the work would have been often done quite as well as if the students, to the number of say eight or nine, had all had “a go” at it, and with infinitely less discomfort and even agony to the patient; but it was “agin’ the rules,” as she declared “’cos why? it didn’t seem proper for ‘a nuss’ to set broken limbs; besides, it pervented the boys from gettin’ ‘the experience’ they paid for.” She was very anxious they should avail themselves of every opportunity that arose to improve themselves. No member of the staff was more interested than she in the pass list of the College of Surgeons; she felt it as a reproach against her teaching when any of them failed, and on the eve of a “Pass Exam.” or a “Final College,” she spared the patients in the receiving-room no agony as long as any one of the men “going up,” could extract useful information about fracture, dislocation, or the adjustment of a splint.

“Now, stop that there row, young man; it’s all for your good! The doctors is a-settin’ of your leg, and if you ’oller like that, you’ll make ’em nervous. You may thank yer stars there’s ’orspitals for poor sufferers like yourself to come to, and have so many kind gents to make yer all right agen.” And the old girl would wink at the boys, give them all a good chance with the case, and when everybody had quite done, and had got all their points, the poor suffering wretch was sent into the wards, there to undergo as many further examinations as the pursuit of knowledge demanded. Did he scream, she bade him desist; did he struggle, she called another and a stronger nurse to her assistance; did he rebel yet, a porter or two came in to reduce him to order. Chloroform was not often resorted to, it had an element of risk; and ether was too troublesome to be given unnecessarily. The house surgeons always prided themselves on an air of nonchalance and dignity; they were never in a hurry; it was undignified and unprofessional to be anything but perfectly calm under any circumstances. To speak loftily, in measured tones, and with studied stand-offishness, was no less necessary than the binaural stethoscope they never appeared without, the gold spectacles or eye-glass they usually affected, and the patronising manner they adopted towards the men with whom they had been fellow-students, whose larks and escapades they had shared in with equal relish, but who, not having yet attained the dignity of membership of the College of Surgeons, and the still greater honour of house surgeon to St. Bernard’s, were no longer their companions, nor participants in their enjoyments.

They all comported themselves as became members of the staff of a great hospital; they would not have been of much use in any of the ordinary sicknesses that require the aid of the experienced general practitioner or family doctor, who is so serviceable in our every-day troubles and infirmities: they paid no attention to colds, measles, and the mumps; they aspired to greater things, and occupied themselves with eye diseases, maladies of the brain, or the higher surgery. Attend you in your attack of the gout? Oh, dear no! any fool of a G.P. (slang for general practitioner) could do that, or your nurse might manage the case. But trephine you, resect your knee-joint, or do a gastrotomy upon you, – they were burning with enthusiasm for nothing less. So they all told each other they meant to be operating surgeons, speciality men, consulting physicians; they would all go to live and practise in Saville Row, or the neighbourhood of Cavendish Square. “Work for half-crowns like the miserable family doctors in the high-road outside? Not if they knew it!” They were born to send cases to the Lancet, to read papers at Congresses, to edit the Journal of Psychopathy, or arouse the medical world by their work on “Diseases of the Upper Eyelid.” Poor beggars; in ten years’ time seven-tenths of them would be toiling up rotten staircases, or groping in coal mines, visiting patients at an average of nine-pence-halfpenny a head, or holding parish appointments, and doing Friendly Societies’ work at half that rate; while of the other three-tenths, one would be starving in two gloomy rooms in a West End square, the second might make his fortune by marrying a rich wife, and the other work his way to distinction late in life by an ultimate succession to the permanent staff of his own hospital. Now and then he might be luckier still; he might start a special Hospital for Diseases of the Upper Eyelid, and so work his way to eminence and emolument. Of course all these men were supremely scientific. What was pain (in other people), if science could be advanced? What was suffering (in patients), if anything could be added to the sum of our knowledge as to the causes of their suffering? To cure the disease, to cut short the malady – ah, no, too often that was to extinguish alike the discomfort and the interesting course of phenomena that accompanied it. The true patient, the typical client, was he who – devoured by fever or disfigured by disease – asked for nothing better than to be well watched by observant medical eyes, while the “expectant treatment” (i. e., the letting the disease severely alone) did its work. To the objection that a man may die while the expected cure does not arrive, what more obvious than the answer, “But see what a brilliant paper for the Journal is the outcome of it all?” Somehow, Podger vaguely saw all this. Podger recognised that all the “cases” were but “cases.” She knew that Mr. Graves was getting up statistics on broken legs, and was well aware that Mr. Brand was hard at work on a treatise on “Burns and the Cayenne Pepper Treatment.” Now this was in no way objectionable to Podger; she, indeed, could cure burns beautifully with her lint and cotton wool, and soothing unguents; “But, lor bless you! my dear sir,” she would say, “if you likes to pepper ’em on the chance of making a discovery, I ain’t the nuss as ’ud stand in your way of your doing something singular to get yerself a name. So pepper ’em, I say. Thank the Lord it ain’t me nor mine as you are a-operatin’ on. What makes ’em come to the ’orspital at all, I says, if they are a-goin’ to find fault with the treatment?” So Podger co-operated bravely with all the science of the day; she would have flayed the broken-backed bricklayer alive if the staff had ordered it, and said it was scientific treatment. She knew very well the chief object of St. Bernard’s existence, and above all, she knew her place. Oh, but she was an artful and motherly old woman! the true daughter of the receiving-room; the inheritor of all its traditions, and the heiress of a large legacy of hospital tricks. She had such wheedling ways. “You! only an ignorant carpenter, good enough, perhaps, at joists, and flooring, and staircases, what was your opinion against the learned, clever, charitable young surgeon, who wanted to take your leg off, and all for nothing? Shame on you, sir, to suggest ‘practice, practice, all for practice, like making me plane up deals when I was a ’prentice.’ Have it off like a brave Englishman, and don’t make a fuss about a paltry broken leg.” What could a man say under the circumstances? What Podger said to the house surgeon of the day, who had bribed her to get him the operation, was: “It’s all right, Mr. Esmarch; he’s a-goin’ to have it done, so take him while he is in the humour;” and Mr. Esmarch did; and the theatre bell rang to assemble the men for the operation, and Mr. Esmarch rushed off to his books to read up “legs,” and take notes for his first “flap operation.” Oh, Podger could manage it when she gave her mind to it. Was it not truly an invaluable Podger?

CHAPTER VIII.

AMONGST THE OUT-PATIENTS

Some persons will tell you, with an air of the miraculous, that they recovered although they were given over; whereas they might with more reason have said, they recovered because they were given over.

    – Lacon.

Mosca. And then, they do it by experiment,
For which the law not only doth absolve them,
But gives them great reward, and he is loath
To hire his death so.
Corbaccio. It is true, they kill
With as much license as a judge.

    – Ben Jonson.

While engaged during their first year at the medical school dissecting, learning their bones, and listening to lectures on physiology, the students were encouraged to attend the out-patient department of the hospital. Hundreds of poor suffering folk attend at noon daily to consult the physicians and surgeons on the staff. Very arduous is the work these gentlemen perform. Many hours a week are given by them gratuitously for this purpose, and half their lives may be said to be passed here or in the wards. Such of them as in addition are lecturers at the school receive fair but not very liberal fees, but the purely hospital work is without monetary reward. Yet the appointments are eagerly sought for by medical men, because of the publicity and private practice which are sure to follow a successful hospital practitioner; and above all, on account of the great number of rare and interesting cases which occur in hospitals, giving great scope for the trying of new remedies, new apparatus and modes of treatment, new operations and new methods of dealing with obscure forms of disease. Every inducement is held out for sick folk to attend the out-patient department of a large hospital. The great majority of the cases may present no new feature, but there will certainly be a fair proportion of strange and curious maladies, inviting the attention of the penetrative skill of some member of the staff. You see, you are sick of some grievous disorder which your family doctor fails to cure. You demand to see some specialist who has had larger experience of your class of case. He sends for such a one who has passed half his life hunting up this malady in its every phase; it is reasonable he should know more about it than the man who has to attend to everything that comes in his way. It is, therefore, very well worth the while of the aspirant to “consulting practice” to spend every spare moment where he can see most cases. This is the way the hospital pays him for his services. He attends a hundred cases which cannot interest him, because of their frequency; the hundred and first is a variant of the peculiar complaint on which he is writing his great monograph. And there are ways by which every one of the hundred others may be made to contribute their quota of information. If you have not suffered from the complaint forming the subject of the monograph, you will be lucky if you escape exhibiting the genesis of the disease or one of its stages for clinical purposes.

The out-patient departments of the great general hospitals stand more in need of reform than perhaps any of the charitable institutions of our time. To the contributors and subscribers they appear, doubtless, to be the one great means of affording poor persons the highest medical and surgical advice, and the best medicines and appliances free of charge. The poor believe this, the well-to-do middle classes, and even the rich believe it. The out-patient department day after day is thronged by several hundreds of men, women, and children, who go there at noon and wait hour after hour, often till five o’clock in the evening, for an interview with the physician or surgeon who, between the hours of two and four, will probably see one hundred cases. Well-dressed women and men, whose aspect proves them to be at least above the necessity of obtaining medical assistance gratuitously, occupy the time of the staff, and deplete the resources of the hospital in respect of valuable drugs to the extent of many thousands of pounds’ worth annually in London alone. Vast numbers of patients attend who are suffering from trifling ailments which need but the simplest home remedies for their cure. On the other hand, children and adults of both sexes go week after week to the out-patient department, when every time they leave their room for the purpose, the exposure, the necessary fatigue, the long waiting in draughty and over ventilated rooms, does them more harm than any medical treatment they can receive, under such circumstance, can do good. All this happens within the perfect knowledge of the staff, who, so far from discountenancing the system, encourage the patients to attend regularly, and seldom dissuade them till the last days of the poor creatures’ existence. The reasons for such policy, held to be paramount are these:

First; the greater the number of patients who seek the aid of the charity, the greater claim the committee can make on the purses of the charitable.

Again; the greater the number of the cases in hand day after day, the more chance there is of getting hold of rare and interesting complaints for their own notes and statistics; and for clinical teaching for their students, who attend the out-patient department with great assiduity. But even the simplest and least complicated case has its uses for demonstration to the students. Here is a case of commencing phthisis; there is one still more advanced; another is in the last stage; and all afford good opportunities for demonstrating a multitude of points useful for the tyros in medicine to know. A half-dead woman, with lungs far advanced in the destructive changes of pulmonary consumption, applies for treatment. She is examined with care and kindness by the physician, who, having satisfied himself as to the nature and progress of the disease, makes the requisite notes of her case, and hands her over to his class for perhaps a dozen more fatiguing examinations. She has been waiting probably two or three hours for the interview, for another hour or more she must be stethoscoped, percussed, pounded and pummelled, while the students are picking up from her emaciated and wasting frame the elements of their profession. Nobody at the hospital supposes for a moment they can do her any good, but she offers herself in her ignorance, day after day, a sacrifice on the altar of science, that her abnormal breathing sounds, and other phenomena of disease may teach young men how to earn a respectable living. Then, again, there are a vast number of minor operations, for the performance of which, by novices, the out-patient departments afford peculiar facilities. How much it adds to the terror, nervous apprehension, shame and mental distress of the patients, who cannot but feel often how greatly their trouble and risks are increased by their performances as school experiments, can be readily imagined. No doubt medical men do as much work for nothing as other professional men, but certainly not more – not nearly so much as clergymen, for instance. Yet, the hospitals do not pay their staff for all the time and labour devoted to its work. How, then, are they paid? In the first place, their students are constantly going into practice on their own account; they will require well-known and trusted consultants and operators to assist them in difficult cases occurring in well-to-do and affluent families; they will introduce them in this way to lucrative practice, ever increasing if they are skilful men. Every one of their students, therefore, becomes an agent for their success. Even the patients who have received benefit will often be able to recommend to richer relatives or friends, masters or mistresses – as in the case of workpeople or servants – the doctor who has helped them to a cure. It is in this way the great practices of the greatest men attached to the hospitals have all been founded and maintained. That they should devote themselves to the interests of their pupils is, then, of the first importance, as, in a few years, the kindnesses shown to them will be coming back in a steady flow of guineas.

At the close of the second winter session, the men are expected to be ready for the first professional examination at the College of Surgeons, in anatomy and physiology. It is the desire of both teachers and the hospital itself, that as large a proportion as possible of the students shall present themselves for examination at the regular time, as the credit of the school depends on the proportion of passes. Every effort is made to urge the men on, and the teaching staff take the utmost pains to perfect the knowledge of their pupils, and thoroughly instruct them in the subjects they will be required to know. They hold test examinations, and send the men up in batches; those of most promise go up first, while the backward ones are detained till the last efforts have been put forth to fit them for the day of trial. Elsworth was sent up in the first batch, and passed creditably. Having thus proved that he had a sufficient knowledge of the rudiments of his work, he was at once permitted to act as a dresser or surgeon’s assistant in the wards of the hospital proper. This is the first bit of promotion which the successful student obtains. The nurses could do pretty well all the work he has to do, as far as the dressing goes; but this is purposely left to him, that he may pick up instruction and experience.

CHAPTER IX.

“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.