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

CHAPTER XIII.

“THE SOOTHING IDEA OF GOD.”

How dear, how soothing to man, arises the idea of God, peopling the lonely place, effacing the scars of our mistakes and disappointments.

    – Emerson.

That grand sin of atheism or impiety, Melancthon calls it monstrosam melancholiam, monstrous melancholy; or venenatam melancholiam, poisoned melancholy.

    – Burton.

It would be very far from the truth to say that when people cast off their orthodox creeds they turn their morals out of doors. Some of the noblest and most beautiful souls maintain their pure and lovely lives in spite of their having long ceased to be Christians – that is, as far as they can tell – for sure it is that many such follow Christ and know it not, perhaps follow Him very much closer than more orthodox believers. Still, it must be confessed from an impartial view of the question, that these cases are quite exceptional, that they cannot be claimed as the fruits of atheism. For one such opponent of Christian teaching who lives an exemplary life in spite of his want of faith, a thousand quiet, self-sacrificing men and women could be found. Of course, philosophy and high culture will do something for mankind. It did something for the pagan world, it does much for the Buddhist and Confucian peoples. But the note of all these philosophers is Melancholy, and the note of all true Christian folk is Cheerfulness. “Christianity alone stands between the human intellect and madness.”

Elsworth could not but notice the despair which at times and in moments of confidence was so manifest in Dr. Day and his daughter, and Linda and her brother; they were “without hope and without God in the world.” They often lamented that they could not believe, and enjoy the peace of God that passes all understanding. How often in the wards of the hospital or at the bedsides of out-door patients had he been moved by the contrast offered by the simple, sublime faith of some poor suffering Christian man or woman, whose sick-room was illumined by a light that never sprang from the human intellect, but rayed forth from the face of God Himself. Peace that yet was not indifference, cheerfulness that was not stoicism, made the chambers and the couches of these men and women unspeakably different from those of their unbelieving neighbours. Prayer, “the window that opens towards the infinite,” as a great writer has beautifully expressed it, brought light and warmth and joy to these poor souls; and his atheist friends would not have made proselytes of them on any account. They said that for these folk their religion was philosophy made easy, and thought this accounted for the matter satisfactorily.

The chaplain of a general hospital should be a man of liberal ideas and wide sympathies; he should be capable of taking an interest in the daily life of his charges, and try to see the things that interest them as much as possible from their own points of view. Here he will meet with people who have perhaps had no instruction in religion whatever, and whose sole knowledge of its working has been gathered from the misrepresentations of a street infidel orator or the ignorant distortions of an atheist journal. To such he cannot be too human and unecclesiastical. He must not talk “Church” to them, but the simplest, most loving human words. One of the St. Bernard chaplains made a great mistake when he asked everybody “if they had said their prayers.” He never got to their hearts, and no wonder. The new chaplain, Mr. Anderson, was a man of very different stamp; he was of Charles Kingsley’s school, and seemed familiar with every calling and phase of the life of his people. He was a devoted son of the Church, but you did not find it out by any symbols or tone. The fact that no patient, whether heathen, Christian, or “unattached,” left the hospital without being the better for knowing him, proved his fitness for his work.

He taught many an indifferent one the true spirit and method of prayer, and many thanked God for the accident or malady which had brought them under his happy influence. In him they had secured at least one friend for life, for discharge from the wards was not the usual termination of the friendship of Mr. Anderson. Before he came the chapel was seldom attended by the resident students; their pews were conspicuous by their emptiness, but he won even them, and helped many out of difficulties with the authorities. Mr. Horsley, the late chaplain of Clerkenwell prison, tells us he learned thieves’ slang, the better to acquaint himself with his flock. Mr. Anderson had some very curious specimens of humanity to deal with who required almost as much skill on his part, for many men injured in unlawful proceedings are taken to hospitals and watched by the police till their recovery permits their removal. He neglected not even these.

CHAPTER XIV.

THE SACRED WHOLE OF MAN

So ignorant of man’s whole,
Of bodily organs plain to see —
So sage and certain, frank and free,
About what’s under lock and key —
Man’s soul!

    – Browning.

He alone is an acute observer who can observe minutely without being observed.

    – Lavater.

When the students enter the wards of the hospitals for regular work with the staff, they have to devote a considerable portion of their time to the business of minutely recording the family history, physical signs and symptoms, and the treatment of each patient allotted to them. These records are valuable for reference, and still more so for the education of the pupils. They accustom the student to habits of careful observation; and as clinical work is by far the most important factor in his training, the man who does most of this stands the best chance of thoroughly learning his business. Elsworth found his account in sticking to the bedside, and often learned from conversing with his patients many things which helped him to understand how they came to be patients at all. Indeed, he found so much imprudence and ignorance in the habits of the people, that he wondered how it was they were ever free from disease. All the industrious men were great note-takers in the wards; they found that to understand the disease one must understand the subject of it. The practice introduced them to the habits of the working classes as nothing else could have done so perfectly. The expert note-taker learned more of human nature in thus recording these histories than he could have acquired from reading any number of books. Some startling revelations as to the amount of drink the British workman can absorb were often made in this way. There were several great breweries in the neighbourhood, and the men employed assured the doctors they usually drank about two gallons of beer a day. These men were always awkward persons to treat; their flesh healed badly, and they were liable to many complications which abstemious persons would escape. Many artisans, whose weekly wages would average twenty-eight to thirty shillings, owned to spending ten shillings on their own liquor – a sum which, given to their wives, would have often made all the difference between poverty and decent comfort. Many of the accidents that were brought in could be traced to unsteadiness of brain caused by alcohol. When men are working in dangerous situations, it is perilous in the extreme for them to indulge in stimulants. It was not surprising that men who drank two gallons of strong beer a day should fall into the vats or down trap-doors; the wonder was they could walk at all.

One man confessed to having taken on an average forty two-pennyworths of rum a day. He was a Jew dealer in metals, and made a good deal of money at times; but his liver could not stand the alcohol, and he was the subject of a good pathological address on cirrhosis when he died.

This drink-madness was often found to be hereditary, as were many other maladies. Very often the taking of the family history involved the collection of very curious facts from the patients’ relatives when they came to visit their sick friends. Idiosyncrasies were often traced several generations back, odd deformities and bodily peculiarities persisted in families as explained by Darwin, and illustrated the fact that a man thinks and reasons in certain grooves wherein have run the wheels of thought of hosts of his ancestors. A descendant of a Huguenot refugee remarked lately that his nerves had not yet got rid of the terror infused into them by the hair-breadth escapes his progenitors endured hundreds of years ago. It is said the whole world feels the effect of the stamp of one’s foot on the ground; not less is it true that our habits and work will influence the minds of untold generations of our successors.

True psychological medicine is less understood in the present age of science by our doctors than it was in the East thousands of years since. It will scarcely be credited that the great, the overwhelming majority of medical men can and do obtain their diplomas to practise, and attain to all the honours of their profession, without ever having heard a lecture on mental diseases, seen the inside of a lunatic asylum, or examined a person of unsound mind, except in connection with some physical signs indicating bodily disease, as in the delirium of fevers. In connection with some medical schools facilities are offered to the students to visit a neighbouring asylum for clinical observation, but it is extremely rare for them to avail themselves of the privilege. One may pass half a score of examinations at the various boards which have the power of licensing the practitioner who is to be charged with the duty of aiding by his counsel the families amongst which he will practise in a hundred forms of mental affliction, without having ever been asked a single question bearing upon psychological medicine. The student will be required to state with the minutest accuracy the stages of great operations which there are ten thousand chances to one he will never have the chance of performing, and a still remoter probability that he would have either the knowledge or the nerve to perform if he had the opportunity. He will be minutely cross-examined over obscure and rare complaints which it is extremely likely he will never see in his own practice if he live to Methuselah’s age; yet he will not be required to diagnose the difference between melancholia and hysteria. At the same time it is quite true, if he be an industrious man, he may learn a good deal about these mental maladies if he attend the lectures of the physicians who make them their speciality, but this is optional; he does not get any credit for it in his schedules; he will not be advancing his chances of a “pass” by so doing, and there is much temptation if, amongst so many things which a student of medicine must know, he holds in light esteem some things about which he may or may not trouble himself at his discretion. The study of mental phenomena occupies the attention, then, of but few, and those only the most cultivated and thoughtful of the students. To the Sawbones it is like cuneiform inscriptions or the domestic economy of the Hittites. Is not this a scandalous blot on our system of medical education? Yet every half-educated, idle, and beer-boozing young man who can get one foot on the medical register, and write L.S.A. after his name (implying that he has the licence of the Apothecaries’ Society, Blackfriars), has the legal power to sign a lunacy certificate which may consign anyone of us to the walls of a mad-house! Would this be tolerated were it understood? It is recorded of Garibaldi that in the war against the Austrians in Lombardy, he was seized with the marsh fever in the midst of one of his campaigns. The malady soon turned to typhus, and he was given over by his physicians. Lying at Lerino at the point of death, he heard the wild shout – “The Austrians!” The enemy had suddenly come down upon the little town, and the slaughter of his followers had begun. Springing from his bed with an infusion of new life in his veins, he buckled on his sword, and led his troops, inspired by his own wonderful personality, to conflict and victory. What was the influence of the mind in effecting this cure? Ah! that is no part of a medical curriculum. Mesmerists, spiritualists, theologians may deal with that as best they may – it is beneath the notice of the colleges.

A fact like this is surprising only to those medical men who have never studied psychological medicine.

The miracles of Lourdes and of hundreds of other Catholic shrines need not be denied altogether as unworthy of credence. There is abundant evidence that some cases of cure do really occur in connection with faith healing. Those who have made a study of mesmerism have adduced instances of healing by its means which it would be foolish to deny. So much charlatanism and fraud have always been mixed up with these things that it is not perhaps matter of much surprise that they are held in low esteem by men of science. Still, as there are undoubted phenomena in connection with them worthy of patient examination, it is surprising that so prominent a field of inquiry should be so completely neglected by our doctors, while it is considered necessary to know precisely how long a dog covered with varnish would live, and how many degrees of heat a rabbit can tolerate before succumbing to its agony. A young lady of hysterical temperament, who had been humoured to the top of her bent by her medical man, had, after a few months of gynæcological treatment, become so enfeebled in mind that she imagined she had lost the use of her lower extremities, and even succeeded in inducing her doctor to believe that she really was unable to walk. She was advised to consult a well-known hospital physician, who was chiefly celebrated as a true mind doctor. When he took his seat by the couch of the invalid he soon diagnosed her malady, and, finding she was of high intellectual culture, asked permission to read to her. The doctor was an admirable reader, and his rendering of a long and soul-stirring passage from one of the great poets made the girl forget her ailment so completely that she sprang from her couch with energy as he paced the room declaiming the poem, and exclaimed, “Is not that magnificent?” At that moment the deluded woman found the complete use of her limbs, and a few more readings cured her without other medicine. They don’t teach this sort of things in hospitals, – not the curative part, at least. Examiners at the colleges would “plough” the man who ventured to propose readings from Shakespeare three times a week with dramatic action as a remedy for hysteria. What they want is —

R. Tinct. Valer. Am. dr. j; Potass. Brom. gr. x.

Aq. Dest. oz. j; ter die sumend.

You see, it has been discovered by physiologists that if a solution of the bromide of potassium is applied locally to a rabbit’s heart, it produces instantly marked lessening of its action,[3 - Virchow’s Archiv., xli. 101.] and if applied to the muscle of the frog it throws it into tetanic spasm.[4 - Dublin Journal, xlvii. 325.] On the nerve trunks it acts as a paralyzing poison;[5 - Bull. Therap., lxxiii. 253. 290.] in fact, if you inject it in the vicinity of a living dog’s heart, “cardiac arrest always occurs.” So that you see how easily the physiologist can demonstrate how bromide of potassium quiets the excited nervous system of the hysterical ladies. You do not quite follow the reasoning? Well, do not tell the examiners that, because they declare it is quite plain to them, and helps to prove the value of experiment. Now, as there are no instances given in any books of physiology known to us, detailing any effects produced on the hearts or brains of any mammals by the dramatic reading of poetry, it would be manifestly unscientific to treat lady patients by any such method. Moreover, as it is of no use to cure anybody if you cannot demonstrate precisely how you cure him, it is better to let him alone.

The mind specialist who effected these remarkable results was answered by his colleagues who went in for the rabbit and dog theories that in the first place the patient wasn’t ill at all; secondly, that consequently she was not cured; and thirdly, that she was still as ill as ever. But the good physician still holds on his course, speaks with growing disrespect of the Pharmacopœia, studies Nature, but does not “put her to the question,” and takes hints from old women, birds, trees and flowers; and like another Paracelsus, is ridiculed by his professional brethren in proportion to his success in unorthodox methods.

CHAPTER XV.

SCIENCE AND FASHION

Full ready had he his apothecaries,
To send him drugs and his electuaries;
For each of them made other for to win!
Their friendship was not newè to begin.

    – Chaucer.

He was a very perfect practisoùr,

*       *       *       *       *

His study was but little in the Bible.

    – Chaucer.

Nothing in his curriculum puzzled our embryo physician so much as the different methods of treatment advocated by his teachers. With many of them, it is only fair to say, the only treatment they advocated was the extension of the palmaris muscle in the hand, known to anatomists as the guinea muscle, for the purpose of receiving the fee. Men of the new school declared the only treatment necessary for any medical, as distinct from surgical disease, was a good warm bed, and discarded all drugs. As, however, these gentlemen lived by the practice of their profession, it was a question if they were not liable to be charged with obtaining money by false pretences, as they did nothing whatever to assist their client’s recovery.

Some, on the other hand, wrote great books on therapeutics, and gave you a list of some score or so of drugs, more or less deadly, for the cure of every complaint, real or imaginary, leaving the selection to the practitioner, as he, when he combined them, left Nature to take what she thought would best answer her purpose.

King James the First declared that the perusal of Hooker’s “Ecclesiastical Polity” (written as an apology for the Church of England) made him a Roman Catholic. How many students having heard at the hospitals the defence its professors have to make for it, and seen its practice in the wards, have retained any faith at all in the science of medicine? King James found that the arguments of Hooker did not go far enough. The student of medicine finds his teachers go a great deal too far; and becoming a medical sceptic when he has obtained his diploma, he generally adopts “the expectant treatment,” and leaves everything to the vis medicatrix naturæ– in other words, he leaves his case exactly where he found it, and takes much scientific credit to himself for his non-interference.

You could always, if you liked, have the expectant treatment exhibited at St. Bernard’s; it was rather a favourite experiment. You got two cases as nearly as possible of the same type of the same disease, say typhoid fever, in exactly the same stage of development. You put the cases side by side in the same ward. With the one you adopted all the therapeutic routine which might just then be the fashion – for fashion in medicine is as variable as in ladies’ dress – and in the neighbouring case you gave no drugs at all, but water simply coloured with burnt sugar as a placebo, lest the patient should think himself neglected. You watched the progress of the malady, you adopted in each case the same diet, and at the end of three weeks or a month, both cases terminated by recovery as nearly as possible at the same time. Dr. Oliver Wendell Holmes said,“if all drugs were cast into the sea, it would be so much the better for men, and so much the worse for the fish.” They quite went in for this idea at St. Bernard’s, with an exception in favour of newly discovered drugs whose physiological actions were yet to be investigated, and till all was known of them which could be learned, they compelled their patients to swallow them. This was part of the expectant treatment. Mr. Micawber, it will be remembered, was somewhat of a disciple of this school. It is most unfair to argue that nobody got any good from this method, because many papers were produced for the medical journals on these new preparations; though, as an inquisitive lady reader once remarked, the cases all seemed to end with an autopsy.

But then, you see, a “P.M.” is like a lady’s P.S., quite the most important part of the whole concern. The drug bill at our hospital was a very heavy one, because all these new remedies at their first introduction are necessarily costly from their limited demand. Then all sorts of worthless articles of diet, much belauded by the journals which received large sums from the proprietors who advertised their wares in their columns, had to be tried. Poor wines, with high-sounding titles, at prices to match, were for mysterious reasons certified by the physicians of the place to be particularly “rich in phosphorus, and peculiarly suitable to invalids suffering from dyspepsia and want of nervous tone;” and were used in the hospital generally, in proof of the favour in which they were held, by Dr. Octavius Puffemup, M.R.C.P. (Lond.), Lecturer on Diseases of the Supra-Orbital Nerve at St. Bernard’s Hospital, London, Fellow of the Royal Society of Diana Lucina, and Member of the Royal Institution of Cynegetics, etc., etc., etc. All these much-belauded nostrums, like our little systems, “had their day and ceased to be;” they cost the charity a great deal of money, and served merely to advertise the members of the staff who demeaned themselves by praising them.

Did a member of the staff invent a new bed, a new inhaler, a new instrument, or a new kind of invalid’s clothing, it must be purchased, no matter what the cost, as often as he chose to order it for his patients. It served to keep his name before the public; it was one of the many ways in which the charity could recompense him for the time he devoted to its work.

A bookseller once declared, if his customers only purchased the books they were likely to read, he would not get bread and cheese. If only the pharmaceutical preparations were purchased which the patients really required, the makers of them would be in the same predicament. It is so easy to be liberal when you don’t have to pay. With proper conscientious management, directed for the patient’s benefit alone, the expenses of our great hospitals might easily be reduced one-half. But then there must be a good deal of self-sacrifice.

CHAPTER XVI.

SOWING WILD OATS

The acquirements of science may be termed the armour of the mind; but that armour would be worse than useless that cost us all we had, and left us nothing to defend.

    – Lacon.

We go our ways
With something you o’erlooked, forgot, or chose to sweep
Clean out of door; our pearl picked from your rubbish-heap.