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

And if you die,
Why then you lie
Stretched on the bed of honour.

    – Dibdin.

Early the following morning, Elsworth presented himself to young Dr. Wilson, the house surgeon in charge of the wards under the chief care of the surgeons, to whom he was appointed dresser.

Hitherto he had done no practical work in the wards at all. It was against the regulations for any student to be a dresser in the surgical wards till he had passed his primary or first professional examination, at the end of his second winter session.

He had opportunities of learning the countless little details of minor surgery in the out-patient departments day by day, but now he was to be introduced to a very different kind of work. He would have some forty or fifty patients to study and report upon, to watch the progress of their maladies, or the processes of their cure, to dress the wounds, bandage, apply the remedies ordered by the house surgeon, or the surgeon-in-chief, and himself perform such operations as in their discretion he might be entrusted with. Everybody must have a beginning, and upon whom can one begin surgery so well as an hospital patient? Your dentist began upon somebody; he did not acquire without practice that nice skill, that rapidity, almost amounting to sleight of hand, by which he jerks out your offending molar, before you are half aware he has begun. To be sure, he had a long course on sheeps’ heads from the butchers, and then at the hospital or dispensary, he tugged away at the mouths of poor children, or men and women of low degree, who could not afford the chemist’s shilling, or the still cheaper barber’s fee, and who, getting the job done for nothing, could not reasonably complain of the several bungling attempts with the wrong instruments applied in the wrong way, and often to the wrong tooth.

“I say, young man,” said a poor carpenter to an hospital novice, after the fifth attempt to lug out his grinder had been fruitlessly made. “Do they pay you here by time or by the job?”

Even your hair-dresser must have cut somebody’s hair for the first time. You may be sure it was not a duke’s. “We allus begins on children’s at the Workhus schools,” was the answer of a master barber to an inquiry as to the method of learning the art. Here, then, were fifty live subjects, all human, at the mercy of our new dresser. That young blacksmith with the broken rib thinks he is here simply to get it mended. He will think so in a fortnight’s time, but the officials know better; the mended rib is a mere contingency. The butcher lad in the corner bed has compression of the brain. He shall be cured, if possible. Meanwhile, he shall make himself useful to those who want to investigate the latest theory of “localisation of brain functions.”

He shall be trephined – that is to say, a round hole shall be neatly cut in his cranium, and the brain exposed at the injured part; and while the organ of the mind is open to the view, are there not many pretty ideas to be discoursed of, and various experiments awaiting trial? Are there not galvanic batteries at hand? Is not the man at their mercy? He has ether or chloroform, and able men of science about him; and, if they don’t cure him, they will doubtless get information that will enable them to cure some much more important personage! It is not enough to have done all this on a monkey; it needs a man before you can be quite sure. Ultimately they will do it with safety to a gentleman, a duke, a royal prince, and the successful operation will make somebody’s fortune. So as every rising surgeon carries a royal surgeon’s baton in his instrument bag, have at the butcher!

The house surgeon “went round” with our new dresser, and explained the nature of each case in very brief terms, and in a perfunctory manner. It was his duty to instruct his dressers, and he did it after a fashion; but he was not paid to do anything of the sort, and, with the young and partially-educated, there is often a sort of contempt for those who know just a little less than they do. The scorn felt and expressed by the Board School child who knows decimals, for his companion just beginning vulgar fractions, is nothing to the sense of superiority assumed by a house surgeon appointed a few weeks since, and aged twenty-three, towards his unqualified dressers, who cannot go up for examination for another six months. And the dresser, in his turn, looks down from his exalted post on those late companions of his who failed at the primary, and have not yet achieved the right to handle cases in the wards.

Elsworth was shown a number of beds, of the occupants of which he was required to write complete family histories, going into the minutest details, as practice in note-taking. He was called on to carry out, with the assistance of the nurses, daily, all the directions as to the dressings and bandaging required by the nature of the case; and was encouraged to avail himself, while doing so, of any and every means that would assist him in the acquisition of his art, so far as it was consistent with the regular treatment of the patient, and was not calculated to alarm him or make him think it was not actually connected with his cure. Our house surgeon was going in for ophthalmology, and he never missed an opportunity of dropping belladonna into every patient’s eyes, and taking stock of his retina with the ophthalmoscope. Whether you had cracked your skull or broken your leg, fractured a rib or sprained your ankle, your eyes must be examined minutely, on the chance of something pretty turning up to show the professor of ophthalmology. Dr. Wilson was such an enthusiast on eyes that one day, happening to pass through one of the out-patient wards, he caught sight of a working man in whose visual organs he instantly detected something of interest. Immediately he had him under a lamp, and set to work making sketches of the morbid appearances in the retina, explaining to the other students the beautiful things to be seen therein. Now the patient had not come about his eyes, but being troubled with indigestion, wanted a bottle of medicine to cure it; and he was naturally surprised that for three mortal hours eighteen young gentlemen should be examining his eyes, which wanted no treatment but the sight of a little more weekly pay; and marvelled that no questions should be asked him about the ailment which caused him discomfort. He was still more amazed when, as evening drew on, one after another went away, and nobody prescribed anything for him at all! However, one of the resident staff saw him before the place was closed, and he had a bottle of “house mixture,” and went away more satisfied; but still wondering at the singular ways of doctors.

Let us go round the wards with Dr. Wilson and our hero, his new assistant.

Here is a middle-aged woman, evidently having but a short time to live, yet this afternoon Dr. Wilson says his chief proposes to perform upon her a capital operation. He has not the least hope it can save her life, but the chance of performing such an operation arises but seldom; and it is but just and kind to the house surgeon, who wants all the practical work he can get, to let him assist. So the woman and her friends are duly pressed to consent that this – “the only means of saving her life” – shall forthwith be done. To this end all the nurses are instructed to urge her. At last she submits. She will be carried to the operating theatre, and this chance of instruction will fall to Dr. Wilson’s hands; for, as soon as the chloroform has effected its work, he will take the place of the chief, and “do his first strangulated hernia.” Dr. Wilson is jubilant – slightly nervous, for it is very grave work. It is utterly unjustifiable work, Elsworth thinks, but dare hardly express his thoughts except by a timid question or two. He knows he must steel himself to plenty of such matters, that his turn will come and that he would not like to leave St. Bernard’s without doing just as much himself. But his heart, for all that, misgives him.

“Might he warn the patient of her imminent danger?”

“On no account! It might cause her to revoke her consent; might, at any rate, depress her, and hasten the catastrophe.”

In the next bed is an elderly woman with a contused side. That is a slight matter. It was not for that she was taken in, but in her examination in the out-patients’ department it was discovered that she had a peculiarly interesting bony growth on her leg that would make a very neat and pretty operation. So a bed was found for her, and daily and increasing pressure put upon her to have this queer growth removed. It was no inconvenience or annoyance to her at all. She was past middle life, and she had been told by her family doctor there was not the slightest occasion for operative interference; but everybody at St. Bernard’s wanted just such a case to try a new method of treatment recently invented in Vienna, and the chief surgeon was eager to do the operation, and all concerned were charged, as they loved him, not to let it slip. That also was to come off this afternoon.

The next bed is occupied by a girl, the subject of a rare and very interesting skin affection. No active treatment has yet been suggested, as it is much too pretty to spoil by any attempt at cure just yet. Several surgeons are expected from other hospitals to see it, so she has an ounce of peppermint water three times a day and full diet, and the cure is postponed till a sufficient number of interested people have seen it. Drawings must be made; the artist to the hospital could not attend for a week to come; then there were photographs to be taken, and it would never do to spoil anything so effective by commencing a cure. So “repeat the mixture,” till science has done with the first part of the case, and therapeutics can step in.

“That woman, you will perceive,” said the surgeon, “has a squint. She came in with a fracture of the arm, but with a little more pressure she will let us operate on the ocular deformity. I like doing squints. By the way, there is a woman dying in the next ward who has a perfectly charming optic neuritis. You ought to see that. Don’t examine it very often, as it hurts her dreadfully, and she can’t live much longer; but the case is perfectly typical. I am going to sketch it this evening. One don’t like to hurt folks if it can be avoided, but this is much too good to miss. She grumbles a bit at being disturbed, and I fear suspects all this is no part of her treatment; but I order her a glass of wine before I begin, and she likes that.”

They next enter one of the male wards, and Dr. Wilson draws Elsworth’s attention to a man in articulo mortis. “He can scarcely live till the next morning,” says he; “but if you are interested in phthisis, take your stethoscope and have a quarter of an hour overhauling his posterior thorax. There are some sounds to be heard that with careful auscultation are quite typical, and one very rarely gets them so distinct. Don’t be too long at him, as turning him over on his face exhausts him so much, and we have examined him a good deal lately, poor devil!” Elsworth was obliged to assume a look of eager interest in the proposed investigation, for the sake of pleasing his instructor, but he resolved that the auscultation, as far as he was concerned, should at least not distress the poor sufferer. How any human being could find it in his heart to disturb the last moments of his patient with investigations of “cavernous breathing,” “râles,” and “pectoriloquy” puzzled our hero; – but then, this was his first day in his new office; he had much to learn yet.

“Come into this room, Elsworth. See here is a case on which I am trying a rather singular experiment. I have kept this man for the past seventy hours sitting up to his waist in a bath of cold water, as you see. He has all his meals in this position, and sleeps and reads without removal from his tub.”

“Does he like it?”

“Well, I can’t say he does; but the experiment is a very interesting one, and I am getting up a good paper on it. I shall not keep him in much longer, for I have nearly completed my investigations. This is the best case on which I have tried the treatment. I have lost three others, but I think this one will do well.”

And thus the days went by. To a man who loved his work as our hero loved it, there was hourly something fresh to interest and excite speculation. But the atmosphere of the place was beginning to tell upon him. The utterly reckless, matter-of-course way in which experiments were tried upon the occupants of the beds; tried by everybody concerned, from the chief to the dresser; tried by the performance of operations of terrible gravity on those who, at longest, had but a few weeks to live; down to the snipping off little mites of skin from the arms of one person to “graft” on the wounds of another, had tended to blunt Elsworth’s fine sense of humanity and lower his ideal. Not that anybody about the place ever suggested that all this was wrong; nobody, except now and then a patient or his friends, expressed any objection to a course so fraught with information and dexterity of hand. It all seemed the most natural thing possible, and the hospital system as perfect as could be imagined. Outside “some sentimentalists, weak-brained lords and hysterical women,” as they were termed by the men of science, were making a noise over these very things – were threatening to withdraw their subscriptions, indeed; but nothing ever came of their agitation, and the greater public was too well convinced of the perfection of the system to interfere with it.

“How is a medical man to learn his business if he does not pick it up at the hospital?” asked a noble lord of a friend the other day. The reply was a sensible one. “I don’t know, but I fancy these confounded Socialist fellows will put a stop to all this sort of thing before the world is much older.”

Quite so. The mob did not like Marie Antoinette’s carriages to run over them in the streets of Paris just because they were only canaille. Our Radical friends have not found out just yet how we run over them scientifically. When they do, be sure they will find their remedy.

CHAPTER X.

THE NEW MORALITY

Our mistress is a little given to philosophy: what disputations shall we have here by-and-by!

    – Gil Blas.

They add up nature to a nought of God
And cross the quotient.

    – Elizabeth Barrett Browning.

Voilà de l’erudition.

    Les Femmes Savantes.

Dr. Day had introduced Elsworth to a rather singular society, founded by himself and daughter, in the West End of town, and much frequented by medical, literary, musical, and artistic young folk of “advanced” views. One of its members, Arthur Devaux, was a rising physician at the hospital, and his sister Linda soon became impressed with the attentions of young Elsworth, and they met frequently and studied many things together. Both were addicted to philological research; Linda worked at Anglo-Saxon in the library of the British Museum, and, as Elsworth had pronounced tastes in that direction, they were much thrown together. Her father was an artist of French extraction, and, sharing his daughter’s tastes for comparative languages and dialects, they found the young doctor a welcome addition to their family circle. Basque, and Caló, the dialect of the gipsies of Spain, were just now occupying some of their attention, and the whole history and customs of the latter interesting people had taken hold of young Elsworth to the extent of making him desirous to visit them as soon as his hospital work would permit. Such studies had by no means interfered with his professional duties, but had assisted them by relaxing the mind when wearied with the strain of long-continued effort in one direction. Philology was one of his modes of unbending the bow, and a latent Bohemianism gave him a strange sympathy with a gipsy’s life. Have not a large proportion of the solemn and respectable folk dwellers in our great cities a taint of this same disorder? Would not that calm, awe-inspiring judge upon the bench, when the fit is on him, like to pitch off his wig and crimson robe, and betake him to a Bedouin’s life, if it were possible? Is it too much to imagine there may possibly be a bishop or two who now and again have to smother a temptation, just the least spice of a desire, say, to doff apron and shovel hat, and have a season or two in a quiet, well-ordered sort of way, where Mrs. Grundy could not find them? Certes, we have known more than a dozen doctors who have neat broughams, and whose manner of entering them is dignified and becoming; who wear well-cut clothes, spotless linen, and the shiniest of hats; who speak in measured tones, and look the very impersonations of propriety; who yet are so heartily sick of your tongues and pulses, your livers and your hearts, your pills and potions, and your horrible stair-climbing, that were it not for the overpowering sense of duty to Mrs. Leech and the little Leeches, they would long ere now have been off out of walled cities, and away from the galling proprieties of civilisation, and betaken themselves to the forest, the moor, and the mountain.

Our Society met every Sunday evening for social intercourse and amusement; combined with the propagation of their advanced ideas. They were all free men and women, that is to say, they had got rid of old-world superstitions, and had dethroned God, setting up Science and the Nineteenth Century in His place. They were a perfectly proper and well-conducted set of people, who, though very revolutionary over tea and biscuits, defending Nihilism, dynamite mission work, and the loosening of mental fetters and actual bricks and mortar generally, would not have rashly upset even a box of crackers, or exploded a match in an unguarded manner. They were well dressed, spoke in subdued society tones, and conducted themselves exactly as other people, only they persisted in letting everybody know how extremely they disapproved of God.

The young ladies were for the most part accompanied by their highly respectable mammas or papas, who did not seem in the least alarmed at their daughters’ sympathy with the violent doings of “men struggling for freedom;” or at the indifference to continued existence on this ill-conducted planet manifested by the young creatures in bewitching evening toilettes who were under their tutelage. The mammas and papas had heard it all before, and knew just what it meant; it made them rather proud, perhaps, when they saw a blushing young curate confronted for the first time with such advanced sentiments, but even the curate got over his alarm when he found how very harmless it all was, and how when the girls married they became just as reactionary as such people usually are when they realize that they have any responsibilities. For the most part the mammas seemed to act on the suggestion of one of the lights of their school of thought, who maintained that it was “the duty of parents to obey their children in all things;” reversing the Mosaic command, as being suitable for the governance of a nomadic tribe of Eastern people who had little or no science, but not a fit code of behaviour for the highly educated and well-convoluted brains of nineteenth-century children. Their mammas looked up to their offspring with a touching pride and awe – they had, from their superior height, been able to overlook and despise the lower ground on which their parents stood. The parents, indeed, still felt in their nerves – however much they might affect to disregard – the potent influence of the old creeds – they could not relegate to the limbo of discarded stage properties all the articles of the Christian faith in which they had been nurtured, but this their sons and daughters could and did; and they admired their superior attainments and often wished they had at their tongues’ ends those caustic and supercilious answers to the objections of the orthodox which came so readily from the lips of their children. It was they who would set the world right on all those points; it was they who would be able to forego prayer without that constantly recurring sense of desolation and orphanhood. It was they who would let the world see how Christ was to be estimated at perhaps a lower standard than Confucius, and certainly as the inferior of Buddha. It was they who would one day explode the Sermon on the Mount, and substitute for it the New Morality, summed up in the motto, “Every one for himself, and the devil take the hindmost.” It had not been quite decided what word to substitute for devil, but it would be something like “reversion to original type,” “degradation of species,” “retrogression,” or some such scientific term. Meanwhile the word devil was used not as implying any theological assent to the personality of unpleasantness, but as a mere phrase like “Good-bye,” which originally, of course, was “God be with ye,” now cut short, or topped and tailed, as cooks prepare radishes. The inner schools of this society were at the time we write of engaged in preparing a list of phrases which advanced people should not be permitted to use, – an index expurgatorius, in which were already placed “Good-bye!” “Adieu!” “Good gracious!” “Bless me!” “Mercy on us!” “Faith!” “Oh law!” (though some were for retaining this), “Heaven send us,” “Providential escape!” and all ejaculations and expressions having their rise in “fables and lying deceits.”

The use of the “big, big D.” and similar exclamations, was inhibited for gentlemen, not merely on account of vulgarity, but because such words implied some latent belief in superstitious dogmas, as Dr. Newman argues that the terrible language used by the Tuscans and Neapolitans is an evidence of the complete orthodoxy of their faith, – just as “By our Ladye,” subjected to an abbreviating process, is in the modern vernacular of the vulgar, a relic of Mariolatry, of which even our enfranchised and much voting mechanics have not yet divested themselves.

CHAPTER XI.

TEA AND ANARCHY

Opinions, like showers, are generated in high places, but they invariably descend into low ones.

    – Lacon.

Those heads, as stomachs, are not sure the best,
Which nauseate all, and nothing can digest.

    – Pope.

You share not with us, and exceed us so,
Perhaps, by what you’re mulcted in, your hearts
Being starved to make your heads.

    – Elizabeth B. Browning.

It was Elsworth’s third year at the hospital. He had taken several gold medals and scholarships; and so, to outward appearance, had done well. But he was not as he was when he entered. He was sowing what he called his “wild oats,” forgetting the reaping of the crop that one day would have to be considered. He had not abandoned his faith, but it had ceased to influence his life. The thing he came for he had not won. He defended Christianity still when he heard it attacked; but this was because he thought it honourable to take the side of the weakest in every argument, and partly because the set who were so severe upon it were a perky, superficial, insincere lot of folk, that, above all things, wanted taking down. Christianity might be false, he argued, but it could not be such a tissue of absurdities as these people maintained.

One summer’s night, about this time, the society was assembled to hear an address by a well known atheist propagandist, on marriage. Mr. Edgar Adams he was called. He was a singular-looking man; he was tall, lean, and hungry-looking, with long, dank, black hair, and a complexion such as poor people get who work in lead factories, and let it impregnate their systems. His dress was untidy, not to say greasy; his vast display of shirt front looked as if it had done duty in gas-light more than once before. Altogether, he was an unwholesome looking object, and, as a seafaring youth present declared, “it seemed as if a good holystoning down was what he wanted.” It did not surprise you the least when he advocated the destruction of Czars and despots generally, and talked with enthusiasm of the great French Revolution, with his starting eye-balls, and his thin, claw-like hands nervously twitching, expressing his eagerness to assist in the work of another Robespierre. He declared he would “abolish all property, especially that in a wife. The origin of the marriage superstition was pagan and suicidal, for marriage is the suicide of love. When the law no longer supplies husband or wife with a cage, each will take care of holding what has been won. Chastity and modesty are merely conventional ideas, having their origin in utility.” He declared that till Christianity was finally abolished, the real progress of the world could not be continued. “What is called the virtue of humility was never known – not even the word for it – by the Greeks and Romans; that is the great barrier in the path of modern man. Humility was invented by priests to hold man in slavery.” He ended by reciting a poem of Shelley’s denouncing tyrants and despots, and was much applauded.

The rooms of the society are well-filled to-night, and all the chief attractions in force. The people who could lead conversation, and who had strong opinions, and were able to put them cleverly, had assembled. The habitués had all some distinguishing trait, some particular socialistic or anti-religious fad; no two exactly agreed on anything, except that it was of the first importance to smash up existing beliefs. Hinduism, Confucianism, Judaism, Buddhism, were all held to be much better than Christianity as systems of religious thought, but that was because they were all impossible for our age; the one thing that was possible, that had established itself by renovating society and redeeming the world, must be crushed and cast out, because it was not the outcome of the age of steam and the electric light. There was scarcely anybody in the room who did not owe his or her character and virtuous environment entirely to a Christian training, which had made them decent members of society, and which they were anxious to requite by proving its incapacity to be any longer a suitable moral system for our age. A curious and a priggish set of imperfectly educated and vain people; mostly young, impracticable, and unversed in the wants and remedies of a work-a-day world. It is worth while to be introduced to these typical folk, who are bent on substituting some of their nostrums to take the place of the old religion when it dies of age.