The Atlantic Monthly, Volume 08, No. 50, December, 1861

The old man's face warmed.

"Stephen, then," holding out his hand, "sence old times dawn't shame yoh, Stephen. That's hearty, now. It's only a wured I want, but it's immediate. Concernin' Joe Yare,—Lois's father, yoh know? He's back."

"Back? I saw him to-day, following me in the mill. His hair is gray? I think it was he."

"No doubt. Yes, he's aged fast, down in the lock-up; goin' fast to the end. Feeble, pore-like. It's a bad life, Joe Yare's; I wish 'n' 't would be better to the end"–

He stopped with a wistful look at Holmes, who stood outwardly attentive, but with little thought to waste on Joe Yare. The old coal-digger drummed on the fire-plug uneasily.

"Myself, 't was for Lois's sake I thowt on it. To speak plain,—yoh'll mind that Stokes affair, th' note Yare brought? Yes? Ther's none knows o' that but yoh an' me. He's safe, Yare is, only fur yoh an' me. Yoh speak the wured an' back he goes to the lock-up. Fur life. D' yoh see?"

"I see."

"He's tryin' to do right, Yare is."

The old man went on, trying not to be eager, and watching Holmes's face.

"He's tryin'. Sendin' him back—yoh know how that 'll end. Seems like as we'd his soul in our hands. S'pose,—what d' yoh think, if we give him a chance? It's yoh he fears. I see him a-watchin' yoh; what d' yoh think, if we give him a chance?" catching Holmes's sleeve. "He's old, an' he's tryin'. Heh?"

Holmes smiled.

"We didn't make the law he broke. Justice before mercy. Haven't I heard you talk to Sam in that way, long ago?"

The old man loosened his hold of Holmes's arm, looked up and down the street, uncertain, disappointed.

"The law. Yes. That's right! Yoh're a just man, Stephen Holmes."

"And yet?"–

"Yes. I dun'no'. Law's right, but Yare's had a bad chance, an' he's tryin'. An' we're sendin' him to hell. Somethin's wrong. But I think yoh're a just man," looking keenly in Holmes's face.

"A hard one, people say," said Holmes, after a pause, as they walked on.

He had spoken half to himself, and received no answer. Some blacker shadow troubled him than old Yare's fate.

"My mother was a hard woman,—you knew her?" he said, abruptly.

"She was just, like yoh. She was one o' th' elect, she said. Mercy's fur them,—an' outside, justice. It's a narrer showin', I'm thinkin'."

"My father was outside," said Holmes, some old bitterness rising up in his tone, his gray eye lighting with some unrevenged wrong.

Polston did not speak for a moment.

"Dunnot bear malice agin her. They're dead, now. It wasn't left fur her to judge him out yonder. Yoh've yer father's eyes, Stephen, 'times. Hungry, pitiful, like women's. His got desper't' 't th' last. Drunk hard,—died of't, yoh know. But she killed him,—th' sin was writ down fur her. Never was a boy I loved like him, when we was boys."

There was a short silence.

"Yoh're like yer mother," said Polston, striving for a lighter tone. "Here,"—motioning to the heavy iron jaws. "She never—let go. Somehow, too, she'd the law on her side in outward showin', an' th' right. But I hated religion, knowin' her. Well, ther's a day of makin' things clear, comin'."

They had reached the corner now, and Polston turned down the lane.

"Yoh'll think o' Yare's case?" he said.

"Yes. But how can I help it," Holmes said, lightly, "if I am like my mother here?"—putting his hand to his mouth.

"God help us, how can yoh? It's harrd to think father and mother leave their souls fightin' in their childern, cos th' love was wantin' to make them one here."

Something glittered along the street as he spoke: the silver mountings of a low-hung phaëton drawn by a pair of Mexican ponies. One or two gentlemen on horseback were alongside, attendant on a lady within. She turned her fair face, and pale, greedy eyes, as she passed, and lifted her hand languidly in recognition of Holmes. Polston's face colored.

"I've heered," he said, holding out his grimy hand. "I wish yoh well, Stephen, boy. So'll the old 'oman. Yoh'll come an' see us, soon? Ye 'r' lookin' fagged, an' yer eyes is gettin' more like yer father's. I'm glad things is takin' a good turn with yoh; an' yoh'll never be like him, starvin' fur th' kind wured, an' havin' to die without it. I'm glad yoh've got true love. She'd a fair face, I think. I wish yoh well, Stephen."

Holmes shook the grimy hand, and then stood a moment looking back to the mill, from which the hands were just coming, and then down at the phaëton moving idly down the road. How cold it was growing! People passing by had a sickly look, as if they were struck by the plague. He pushed the damp hair back, wiping his forehead, with another glance at the mill-women coming out of the gate, and then followed the phaëton down the hill.

* * * * *

HEALTH IN THE HOSPITAL

In preparing to do the duty of society towards the wounded or sick soldier, the first consideration is, What is a Military Hospital? No two nations seem to have answered this question in the same way; yet it is a point of the first importance to them all.

When England went to war last time, after a peace of forty years, the only idea in the minds of her military surgeons was of Regimental Hospitals. There was to be a place provided as an infirmary for a certain number of soldiers; a certain number of orderlies were to be appointed as nurses; and the regimental doctor and hospital-sergeant were to have the charge of the inmates. In each of these Regimental Hospitals there might be patients ill of a great variety of disorders, from the gravest to the lightest, all to be treated by the same doctor or doctors. These doctors had to make out statements of all the diets, as well as all the medicines required by their patients, and send in their requisitions; and it might be said that arrangements had to be separately made for every individual patient in the whole army. The doctors went to work each in his own way, even in the case of epidemics. There was no knowing, except by guess, what diseases were the most to be apprehended in particular places or circumstances; nor what remarkable phenomena of disease were showing themselves on any extended scale; nor what improvements could be suggested in the treatment. There was no possibility of such systematic cleanliness and such absolute regularity of management as can be secured by organization on a large scale. Yet the medical officers preferred the plan to any other. One plea was, that the medical officers and the patients were acquainted with and attached to each other: and this was very true. Another consideration was, that each surgeon liked to have his field of duty to himself, and found it an advantage to have a large variety of ailments to treat, to the constant improvement of his experience. They said that doctors and patients and nurses all liked the Regimental Hospital best, and this was clear proof that it was the best. They could at that time say also, that every soldier and every doctor had a horror of General Hospitals, where the mortality was so excessive during the Peninsular War that being carried to the General Hospital was considered the same thing as being sentenced to death.

Such being the state of opinion and feeling in the profession, it naturally happened that British army-surgeons stuck to their Regimental Hospitals as long as they could, and, when compelled to cooperate in a General Hospital, made the institution as like as possible to a group of Regimental Hospitals,—resisting all effective organization, and baffling all the aims of the larger institution.

In busy times, no two Regimental Hospitals were alike in their management, because the scheme was not capable of expansion. The surgeon and his hospital-sergeant managed everything. The surgeon saw and treated the cases, and made out his lists of articles wanted. It was his proper business to keep the books,—to record the admissions, and make the returns, and keep the accounts, and post up all the documents: but professional men do not like this sort of work, when they want to be treating disease; and the books were too often turned over to the hospital-sergeant. His indispensable business was to superintend the wards, and the attendance on the patients, the giving them their medicines, etc., which most of us would think enough for one man: but he had besides to keep up the military discipline in the establishment,—to prepare the materials for the surgeon's duty at the desk,—to take charge of all the orders for the diet of all the patients, and see them fulfilled,—to keep the record of all the provisions ordered and used in every department,—and to take charge of the washing, the hospital stores, the furniture, the surgery, and the dispensary. In short, the hospital-sergeant had to be at once ward-master, steward, dispenser, sergeant, clerk, and purveyor; and, as no man can be a six-sided official, more or fewer of his duties were deputed to the orderly, or to anybody within call.

Nobody could dispute the superior economy and comfort of having a concentration of patients arranged in the wards according to their ailments, with a general kitchen, a general laundry, a dispensary and surgery, and a staff of officials, each with his own distinct business, instead of as many jacks-of-all-trades, each doing a little of everything. Yet the obstinacy of the fight made by the surgeons for the system of Regimental Hospitals was almost insuperable. There was no desire on any hand to abolish their hospitals, which must always be needed for slight, and also for immediately pressing cases. What was asked of them was to give way when epidemics, or a sudden influx of wounded, or protracted cases put a greater strain upon the system than it would bear.

The French, meantime, had three sorts of hospitals,—the Divisional ones coming between the Regimental and the General. Only the very slightest cases ever enter their Regimental Hospital; those which may last weeks are referred to the Divisional; and those which may last months, with prospect of recovery, to the General Hospital. The Sardinian plan was nearly the same. The Russians had Divisional Hospitals at various stations; and all cases were carried to them.

The Regimental Hospitals are wherever the regiments are. The advantage is, that aid can be immediately rendered,—not only in case of wounds, but of cholera, in which it is desirable to lay a patient down in the nearest bed to which he can be conveyed. The disadvantages are the hap-hazard quality of the site, the absence of quiet and seclusion, and the liability of being near the scene of conflict. These things cause the French to prefer the Divisional Hospital, which, while still within reach, is set farther back from the force, in a picked situation, and managed on a large scale and with nicer exactitude.

The General Hospital is understood to be at the base of operations: and this supposes, as a part of its organization, a system of transport, not only good of its kind, but adequate to any demands consequent on a great battle, or the spread of an epidemic in the camp. The nearer the hospital is to the active force, the better, of course; but there are conditions to be fulfilled first. It must be safe from the enemy. It must be placed in a permanent station. It must be on a good road, and within immediate reach of markets. It ought also to be on the way home, for the sake of the incurable or the incapacitated who must be sent home.

In the Regimental Hospital, the surgeon may be seen going from the man who has lost a finger to a fever patient,—and then to one who has ophthalmia,—passing on to a fellow raving in delirium tremens,—next to whom is a sufferer under bronchitis, who will not be allowed to go out of doors for weeks to come; and if half a dozen are brought in with cholera in the course of the day, the officials do not know which way to turn. It is possible that the surgeon may be found making starch over the kitchen fire, because there is nobody at hand who understands how to make starched bandages; or he may be at the desk, casting up columns of figures, or writing returns, when he is urgently wanted at the bedside. Such things can hardly happen now; but they have happened within ten years. The Russians, meantime, would be carrying all manner of patients to one of their hospital-stations,—each sufferer to the hospital of his own division. The French would leave the men with scratches and slight diarrhea and delirium tremens in the Regimental Hospital,—would send the fever and bronchitis and scorbutic patients to the Divisional,—and any gravely wounded, or rheumatic, or other very long cases to the General Hospital at the base of operations.

Such arrangements, however, are of no use, if the last be not so organized as to render it fit to supply what the others cannot give, and to answer purposes which the others cannot even propose.

When doctors and soldiers alike shuddered at the mention of the General Hospital as a necessary institution at or near the seat of war, they were thinking of what they had seen or heard of during the Peninsular Campaigns. There were such infirmaries wherever there was a line of march in Spain; and they seemed to be all alike. Hospital gangrene set in among the wounded, and fever among the sick, so that the soldiers said, "To send a poor fellow to the hospital is to send him to death." Yet there was nothing else to be done; for it was impossible to treat the seriously sick and wounded at the spot where they fell. During that war, nearly twice the number which composed the army passed through the hospitals every year; and of these there were known deaths to the amount of thirteen thousand five hundred; and thousands more were never the same men again. When the case was better understood,—as during the last year in the Crimea,—the mortality in the hospitals barely exceeded that of the Guards in their barracks at home! Recovery had become the rule, and death a remarkable event. General Hospitals had come to surpass all other means of curing patients, while fulfilling their own peculiar service to society through new generations.

What are the functions of General Hospitals, besides curing the sick and wounded? some readers may ask, who have never particularly attended to the subject.

The first business of such institutions is undoubtedly to restore as many as possible of the sufferers brought into them: and this includes the duty of bringing in the patients in the most favorable way, receiving them in an orderly and quiet manner, doctoring, nursing, feeding, clothing, and cleaning them, keeping their minds composed and cheerful, and their manners creditable, promoting their convalescence, and dismissing them in a state of comfort as to equipment. This is the first duty, in its many subdivisions. The next is to obviate, as far as possible, future disease in any army. The third grows out of this. It is to improve the science of the existing generation by a full use of the peculiar opportunities of observation afforded by the crop of sickness and wounds yielded by an army in action. To take these in their reverse order.

There must be much to learn from any great assemblage of sickness, under circumstances which can be fully ascertained, even at home,—and much more in a foreign climate. The medical body of every nation has very imperfect knowledge of classes and modifications of diseases; so that one of the strongest desires of the most learned physicians is for an improved classification and constantly improving nomenclature of diseases; and hospital-records afford the most direct way to this knowledge. Thus, while the phenomena are frittered away among Regimental or unorganized General Hospitals, a well-kept record in each well-organized hospital will do more than all other means to promote the scientific understanding of disease.

The statistics of disease in armies, the ascertainment of the numbers who sicken and who die of particular diseases, would save more lives in future generations than can be now appreciated; but what can the regimental surgeon do towards furnishing any trustworthy materials to such an inquiry? A dozen doctors, with each his smattering of patients, can learn and teach but little while they work apart: whereas a regular system of inquiry and record, in action where the sick are brought in in battalions, is the best possible agency. Not only are these objects lost when surgeons are allowed to make the great hospital a mere receptacle for a cluster of small and desultory hospitals, but the advantages of a broad study of diseases and their treatment are lost. Inestimable facts of treatment are learned by watching, at the same time and in the same place, a ward full of patients ill of the same disease. People of all countries know this by the special learning which their physicians obtain in large civil hospitals: and the same thing happens in military hospitals, with the additional advantage that the information and improved art tend to the special safety of the future soldiery, in whatever climate they may be called on to serve.

There has long been some general notion of the duty of army-surgeons to record what they saw in foreign campaigns; but no benefit has been reaped till of late. The works of French field-surgeons have long been justly celebrated; but I do not know that in the statistics and the nomenclature of disease they have done much more than others. The English surgeons carried or sent home in 1810 a mass of papers about the Walcheren fever, and afterwards of the diseases of the Peninsular force: but the Director General of the Medical Department considered such a bulk of records troublesome, and ordered them to be burnt! Such an act will never be perpetrated again; but directors will have a more manageable mass of documents to deal with henceforth. With a regular system of record, at a central station of observation, much more may be done with much less fatigue to all parties.