XII
A MEDICAL DOCUMENT
Medical men are, as a class, very much too busy to take stock ofsingular situations or dramatic events. Thus it happens that the ablestchronicler of their experiences in our literature was a lawyer. A lifespent in watching over death-beds--or over birth-beds which areinfinitely more trying--takes something from a man's sense ofproportion, as constant strong waters might corrupt his palate. Theoverstimulated nerve ceases to respond. Ask the surgeon for his bestexperiences and he may reply that he has seen little that is remarkable,or break away into the technical. But catch him some night when the firehas spurted up and his pipe is reeking, with a few of his brotherpractitioners for company and an artful question or allusion to set himgoing. Then you will get some raw, green facts new plucked from the treeof life.
It is after one of the quarterly dinners of the Midland Branch of theBritish Medical Association. Twenty coffee cups, a dozen liqueurglasses, and a solid bank of blue smoke which swirls slowly along thehigh, gilded ceiling gives a hint of a successful gathering. But themembers have shredded off to their homes. The line of heavy,bulge-pocketed overcoats and of stethoscope-bearing top hats is gonefrom the hotel corridor. Round the fire in the sitting-room threemedicos are still lingering, however, all smoking and arguing, while afourth, who is a mere layman and young at that, sits back at the table.Under cover of an open journal he is writing furiously with astylographic pen, asking a question in an innocent voice from time totime and so flickering up the conversation whenever it shows a tendencyto wane.
The three men are all of that staid middle age which begins early andlasts late in the profession. They are none of them famous, yet each isof good repute, and a fair type of his particular branch. The portly manwith the authoritative manner and the white, vitriol splash upon hischeek is Charley Manson, chief of the Wormley Asylum, and author of thebrilliant monograph--"Obscure Nervous Lesions in the Unmarried." Healways wears his collar high like that, since the half-successfulattempt of a student of Revelations to cut his throat with a splinter ofglass. The second, with the ruddy face and the merry brown eyes, is ageneral practitioner, a man of vast experience, who, with his threeassistants and his five horses, takes twenty-five hundred a year inhalf-crown visits and shilling consultations out of the poorest quarterof a great city. That cheery face of Theodore Foster is seen at the sideof a hundred sick-beds a day, and if he has one-third more names on hisvisiting list than in his cash-book he always promises himself that hewill get level some day when a millionaire with a chronic complaint--theideal combination--shall seek his services. The third, sitting on theright with his dress-shoes shining on the top of the fender, isHargrave, the rising surgeon. His face has none of the broad humanity ofTheodore Foster's, the eye is stern and critical, the mouth straight andsevere, but there is strength and decision in every line of it, and itis nerve rather than sympathy which the patient demands when he is badenough to come to Hargrave's door. He calls himself a jawman, "a merejawman," as he modestly puts it, but in point of fact he is too youngand too poor to confine himself to a specialty, and there is nothingsurgical which Hargrave has not the skill and the audacity to do.
"Before, after, and during," murmurs the general practitioner in answerto some interpolation of the outsider's. "I assure you, Manson, one seesall sorts of evanescent forms of madness."
"Ah, puerperal!" throws in the other, knocking the curved grey ash fromhis cigar. "But you had some case in your mind, Foster."
"Well, there was one only last week which was new to me. I had beenengaged by some people of the name of Silcoe. When the trouble cameround I went myself, for they would not hear of an assistant. Thehusband, who was a policeman, was sitting at the head of the bed on thefurther side. 'This won't do,' said I. 'Oh yes, doctor, it must do,'said she. 'It's quite irregular, and he must go,' said I. 'It's that ornothing,' said she. 'I won't open my mouth or stir a finger the wholenight,' said he. So it ended by my allowing him to remain, and there hesat for eight hours on end. She was very good over the matter, but everynow and again _he_ would fetch a hollow groan, and I noticed that heheld his right hand just under the sheet all the time, where I had nodoubt that it was clasped by her left. When it was all happily over, Ilooked at him and his face was the colour of this cigar ash, and hishead had dropped on to the edge of the pillow. Of course I thought hehad fainted with emotion, and I was just telling myself what I thoughtof myself for having been such a fool as to let him stay there, whensuddenly I saw that the sheet over his hand was all soaked with blood; Iwhisked it down, and there was the fellow's wrist half cut through. Thewoman had one bracelet of a policeman's handcuff over her left wrist andthe other round his right one. When she had been in pain she had twistedwith all her strength and the iron had fairly eaten into the bone of theman's arm. 'Aye, doctor,' said she, when she saw I had noticed it. 'He'sgot to take his share as well as me. Turn and turn,' said she."
"Don't you find it a very wearing branch of the profession?" asks Fosterafter a pause.
"My dear fellow, it was the fear of it that drove me into lunacy work."
"Aye, and it has driven men into asylums who never found their way on tothe medical staff. I was a very shy fellow myself as a student, and Iknow what it means."
"No joke that in general practice," says the alienist.
"Well, you hear men talk about it as though it were, but I tell you it'smuch nearer tragedy. Take some poor, raw, young fellow who has just putup his plate in a strange town. He has found it a trial all his life,perhaps, to talk to a woman about lawn tennis and church services. Whena young man _is_ shy he is shyer than any girl. Then down comes ananxious mother and consults him upon the most intimate family matters.'I shall never go to that doctor again,' says she afterwards. 'Hismanner is so stiff and unsympathetic.' Unsympathetic! Why, the poor ladwas struck dumb and paralysed. I have known general practitioners whowere so shy that they could not bring themselves to ask the way in thestreet. Fancy what sensitive men like that must endure before they getbroken in to medical practice. And then they know that nothing is socatching as shyness, and that if they do not keep a face of stone, theirpatient will be covered with confusion. And so they keep their face ofstone, and earn the reputation perhaps of having a heart to correspond.I suppose nothing would shake _your_ nerve, Manson."
"Well, when a man lives year in year out among a thousand lunatics, witha fair sprinkling of homicidals among them, one's nerves either get setor shattered. Mine are all right so far."
"I was frightened once," says the surgeon. "It was when I was doingdispensary work. One night I had a call from some very poor people, andgathered from the few words they said that their child was ill. When Ientered the room I saw a small cradle in the corner. Raising the lamp Iwalked over and putting back the curtains I looked down at the baby. Itell you it was sheer Providence that I didn't drop that lamp and setthe whole place alight. The head on the pillow turned, and I saw a facelooking up at me which seemed to me to have more malignancy andwickedness than ever I had dreamed of in a nightmare. It was the flushof red over the cheek-bones, and the brooding eyes full of loathing ofme, and of everything else, that impressed me. I'll never forget mystart as, instead of the chubby face of an infant, my eyes fell uponthis creature. I took the mother into the next room. 'What is it?' Iasked. 'A girl of sixteen,' said she, and then throwing up her arms,'Oh, pray God she may be taken!' The poor thing, though she spent herlife in this little cradle, had great, long, thin limbs which she curledup under her. I lost sight of the case and don't know what became of it,but I'll never forget the look in her eyes."
"That's creepy," says Doctor Foster. "But I think one of my experienceswould run it close. Shortly after I put up my plate I had a visit from alittle hunch-backed woman, who wished me to come and attend to hersister in her trouble. When I reached the house, which was a very poorone, I found two other little hunched-backed women, exactly like thefirst, waiting for me in the sitting-room. Not one of them said a word,but my companion too
k the lamp and walked upstairs with her two sistersbehind her, and me bringing up the rear. I can see those three queershadows cast by the lamp upon the wall as clearly as I can see thattobacco pouch. In the room above was the fourth sister, a remarkablybeautiful girl in evident need of my assistance. There was no weddingring upon her finger. The three deformed sisters seated themselves roundthe room, like so many graven images, and all night not one of themopened her mouth. I'm not romancing, Hargrave; this is absolute fact. Inthe early morning a fearful thunderstorm broke out, one of the mostviolent I have ever known. The little garret burned blue with thelightning, and the thunder roared and rattled as if it were on the veryroof of the house. It wasn't much of a lamp I had, and it was a queerthing when a spurt of lightning came to see those three twisted figuressitting round the walls, or to have the voice of my patient drowned bythe booming of the thunder. By Jove, I don't mind telling you that therewas a time when I nearly bolted from the room. All came right in theend, but I never heard the true story of the unfortunate beauty and herthree crippled sisters."
"That's the worst of these medical stories," sighs the outsider. "Theynever seem to have an end."
"When a man is up to his neck in practice, my boy, he has no time togratify his private curiosity. Things shoot across him and he gets aglimpse of them, only to recall them, perhaps, at some quiet moment likethis. But I've always felt, Manson, that your line had as much of theterrible in it as any other."
"More," groans the alienist. "A disease of the body is bad enough, butthis seems to be a disease of the soul. Is it not a shocking thing--athing to drive a reasoning man into absolute Materialism--to think thatyou may have a fine, noble fellow with every divine instinct and thatsome little vascular change, the dropping, we will say, of a minutespicule of bone from the inner table of his skull on to the surface ofhis brain may have the effect of changing him to a filthy and pitiablecreature with every low and debasing tendency? What a satire an asylumis upon the majesty of man, and no less upon the ethereal nature of thesoul."
"Faith and hope," murmurs the general practitioner.
"I have no faith, not much hope, and all the charity I can afford," saysthe surgeon. "When theology squares itself with the facts of life I'llread it up."
"You were talking about cases," says the outsider, jerking the ink downinto his stylographic pen.
"Well, take a common complaint which kills many thousands every year,like G.P. for instance."
"What's G.P.?"
"General practitioner," suggests the surgeon with a grin.
"The British public will have to know what G.P. is," says the alienistgravely. "It's increasing by leaps and bounds, and it has thedistinction of being absolutely incurable. General paralysis is its fulltitle, and I tell you it promises to be a perfect scourge. Here's afairly typical case now which I saw last Monday week. A young farmer, asplendid fellow, surprised his friends by taking a very rosy view ofthings at a time when the whole country-side was grumbling. He was goingto give up wheat, give up arable land, too, if it didn't pay, plant twothousand acres of rhododendrons and get a monopoly of the supply forCovent Garden--there was no end to his schemes, all sane enough but justa bit inflated. I called at the farm, not to see him, but on analtogether different matter. Something about the man's way of talkingstruck me and I watched him narrowly. His lip had a trick of quivering,his words slurred themselves together, and so did his handwriting whenhe had occasion to draw up a small agreement. A closer inspection showedme that one of his pupils was ever so little larger than the other. As Ileft the house his wife came after me. 'Isn't it splendid to see Joblooking so well, doctor?' said she; 'he's that full of energy he canhardly keep himself quiet.' I did not say anything, for I had not theheart, but I knew that the fellow was as much condemned to death asthough he were lying in the cell at Newgate. It was a characteristiccase of incipient G.P."
"Good heavens!" cries the outsider. "My own lips tremble. I often slurmy words. I believe I've got it myself."
Three little chuckles come from the front of the fire.
"There's the danger of a little medical knowledge to the layman."
"A great authority has said that every first year's student is sufferingin silent agony from four diseases," remarks the surgeon. "One is heartdisease, of course; another is cancer of the parotid. I forget the twoother."
"Where does the parotid come in?"
"Oh, it's the last wisdom tooth coming through!"
"And what would be the end of that young farmer?" asks the outsider.
"Paresis of all the muscles, ending in fits, coma and death. It may be afew months, it may be a year or two. He was a very strong young man andwould take some killing."
"By the way," says the alienist, "did I ever tell you about the firstcertificate I ever signed? I stood as near ruin then as a man could go."
"What was it, then?"
"I was in practice at the time. One morning a Mrs. Cooper called upon meand informed me that her husband had shown signs of delusions lately.They took the form of imagining that he had been in the army and haddistinguished himself very much. As a matter of fact he was a lawyer andhad never been out of England. Mrs. Cooper was of opinion that if I wereto call it might alarm him, so it was agreed between us that she shouldsend him up in the evening on some pretext to my consulting-room, whichwould give me the opportunity of having a chat with him and, if I wereconvinced of his insanity, of signing his certificate. Another doctorhad already signed, so that it only needed my concurrence to have himplaced under treatment. Well, Mr. Cooper arrived in the evening abouthalf an hour before I had expected him, and consulted me as to somemalarious symptoms from which he said that he suffered. According to hisaccount he had just returned from the Abyssinian Campaign, and had beenone of the first of the British forces to enter Magdala. No delusioncould possibly be more marked, for he would talk of little else, so Ifilled in the papers without the slightest hesitation. When his wifearrived, after he had left, I put some questions to her to complete theforms. 'What is his age?' I asked. 'Fifty,' said she. 'Fifty!' I cried.'Why, the man I examined could not have been more than thirty!' And soit came out that the real Mr. Cooper had never called upon me at all,but that by one of those coincidences which takes a man's breath awayanother Cooper, who really was a very distinguished young officer ofartillery, had come in to consult me. My pen was wet to sign the paperwhen I discovered it," says Dr. Manson, mopping his forehead.
"We were talking about nerve just now," observes the surgeon. "Just,after my qualifying I served in the Navy for a time, as I think youknow. I was on the flag-ship on the West African Station, and I remembera singular example of nerve which came to my notice at that time. One ofour small gunboats had gone up the Calabar river, and when there thesurgeon died of coast fever. On the same day a man's leg was broken by aspar falling upon it, and it became quite obvious that it must be takenoff above the knee if his life was to be saved. The young lieutenant whowas in charge of the craft searched among the dead doctor's effects andlaid his hands upon some chloroform, a hip-joint knife, and a volume ofGrey's _Anatomy_. He had the man laid by the steward upon the cabintable, and with a picture of the cross section of the thigh in front ofhim he began to take off the limb. Every now and then, referring to thediagram, he would say: 'Stand by with the lashings, steward. There'sblood on the chart about here.' Then he would jab with his knife untilhe cut the artery, and he and his assistant would tie it up before theywent any further. In this way they gradually whittled the leg off, andupon my word they made a very excellent job of it. The man is hoppingabout the Portsmouth Yard at this day.
"It's no joke when the doctor of one of these isolated gunboats himselffalls ill," continues the surgeon after a pause. "You might think iteasy for him to prescribe for himself, but this fever knocks you downlike a club, and you haven't strength left to brush a mosquito off yourface. I had a touch of it at Lagos, and I know what I am telling you.But there was a chum of mine who really had a curious experience. Thewhole
crew gave him up, and, as they had never had a funeral aboard theship, they began rehearsing the forms so as to be ready. They thoughtthat he was unconscious, but he swears he could hear every word thatpassed. 'Corpse comin' up the 'atchway!' cried the cockney sergeant ofMarines. 'Present harms!' He was so amused, and so indignant too, thathe just made up his mind that he wouldn't be carried through thathatchway, and he wasn't, either."
"There's no need for fiction in medicine," remarks Foster, "for thefacts will always beat anything you can fancy. But it has seemed to mesometimes that a curious paper might be read at some of these meetingsabout the uses of medicine in popular fiction."
"How?"
"Well, of what the folk die of, and what diseases are made most use ofin novels. Some are worn to pieces, and others, which are equally commonin real life, are never mentioned. Typhoid is fairly frequent, butscarlet fever is unknown. Heart disease is common, but then heartdisease, as we know it, is usually the sequel of some foregoing disease,of which we never hear anything in the romance. Then there is themysterious malady called brain fever, which always attacks the heroineafter a crisis, but which is unknown under that name to the text books.People when they are over-excited in novels fall down in a fit. In afairly large experience I have never known any one to do so in reallife. The small complaints simply don't exist. Nobody ever gets shinglesor quinsy, or mumps in a novel. All the diseases, too, belongs to theupper part of the body. The novelist never strikes below the belt."
"I'll tell you what, Foster," says the alienist, "there is a side oflife which is too medical for the general public and too romantic forthe professional journals, but which contains some of the richest humanmaterials that a man could study. It's not a pleasant side, I am afraid,but if it is good enough for Providence to create, it is good enough forus to try and understand. It would deal with strange outbursts ofsavagery and vice in the lives of the best men, curious momentaryweaknesses in the record of the sweetest women, known but to one or two,and inconceivable to the world around. It would deal, too, with thesingular phenomena of waxing and of waning manhood, and would throw alight upon those actions which have cut short many an honoured careerand sent a man to a prison when he should have been hurried to aconsulting-room. Of all evils that may come upon the sons of men, Godshield us principally from that one!"
"I had a case some little time ago which was out of the ordinary," saysthe surgeon. "There was a famous beauty in London Society--I mention nonames--who used to be remarkable a few seasons ago for the very lowdresses which she would wear. She had the whitest of skins, and mostbeautiful of shoulders, so it was no wonder. Then gradually the frillingat her neck lapped upwards and upwards, until last year she astonishedevery one by wearing quite a high collar at a time when it wascompletely out of fashion. Well, one day this very woman was shown intomy consulting-room. When the footman was gone she suddenly tore off theupper part of her dress. 'For God's sake do something for me!' shecried. Then I saw what the trouble was. A rodent ulcer was eating itsway upwards, coiling on in its serpiginous fashion until the end of itwas flush with her collar. The red streak of its trail was lost belowthe line of her bust. Year by year it had ascended and she hadheightened her dress to hide it, until now it was about to invade herface. She had been too proud to confess her trouble, even to a medicalman."
"And did you stop it?"
"Well, with zinc chloride I did what I could. But it may break outagain. She was one of those beautiful white-and-pink creatures who arerotten with struma. You may patch but you can't mend."
"Dear! dear! dear!" cries the general practitioner, with that kindlysoftening of the eyes which has endeared him to so many thousands. "Isuppose we mustn't think ourselves wiser than Providence, but there aretimes when one feels that something is wrong in the scheme of things.I've seen some sad things in my life. Did I ever tell you that casewhere Nature divorced a most loving couple? He was a fine young fellow,an athlete and a gentleman, but he overdid athletics. You know how theforce that controls us gives us a little tweak to remind us when we getoff the beaten track. It may be a pinch on the great toe if we drink toomuch and work too little. Or it may be a tug on our nerves if wedissipate energy too much. With the athlete, of course, it's the heartor the lungs. He had bad phthisis and was sent to Davos. Well, as luckwould have it, she developed rheumatic fever, which left her heart verymuch affected. Now, do you see the dreadful dilemma in which those poorpeople found themselves? When he came below 4,000 feet or so, hissymptoms became terrible. She could come up about 2,500, and then herheart reached its limit. They had several interviews half-way down thevalley, which left them nearly dead, and at last, the doctors had toabsolutely forbid it. And so for four years they lived within threemiles of each other and never met. Every morning he would go to a placewhich overlooked the chalet in which she lived and would wave a greatwhite cloth and she answer from below. They could see each other quiteplainly with their field glasses, and they might have been in differentplanets for all their chance of meeting."
"And one at last died," says the outsider.
"No, sir. I'm sorry not to be able to clinch the story, but the manrecovered and is now a successful stockbroker in Drapers Gardens. Thewoman, too, is the mother of a considerable family. But what are youdoing there?"
"Only taking a note or two of your talk."
The three medical men laugh as they walk towards their overcoats.
"Why, we've done nothing but talk shop," says the general practitioner."What possible interest can the public take in that?"