Edward Berdoe
St. Bernard's: The Romance of a Medical Student
CHAPTER XXVI.
SISTER AGNES REVOLTS
The world’s male chivalry has perished out,
But women are knights-errant to the last;
And if Cervantes had been Shakespeare too,
He had made his Don a Donna.
– Elizabeth B. Browning.
When it was found that Elsworth had quite disappeared, and nothing more was heard of him, many of the good sisters and kind-hearted nurses were really sorry to have lost him. None more so than Sister Agnes. Sister Agnes was the brightest, cleverest, and most devoted nurse that could be imagined. She never wearied of her work, never grew snappy and huffy, as the best of women will when worn and weary with hard work and watching. She never seemed to need rest; that is to say, she never exhibited in her perfect temper the strain upon her system which her heavy duties entailed. She was not only the intimate personal friend of all the nurses under her, but she made it her business to aid in a thousand ways all her patients and smooth their pillows by the many sweet attentions such a loving woman could bestow. She was the widow of a clergyman who had died two years after his marriage, and having no family she was free to follow a long cherished desire, and so devoted herself and her admirable talents to the sacred office of nursing. She was tall and dark, with charming wavy hair and a healthy, not to say ruddy, complexion, which bespoke more than the usual health of a London woman. Deeply religious, of High Church principles, she was yet entirely free from those prejudices against other forms of belief which often detract from the usefulness of a hospital sister. It was enough for her to know that a patient loved her Master, in whatever outward form that love was expressed, to make Sister Agnes at once a friend. In many a way she contrived to instil even into the hearts of the most indifferent some thought of better things, some hope of a life beyond. Most of her patients left her wards the better for having come into contact with her. Sister Agnes often said she had observed in Elsworth traits that promised a great and useful man, and she was always unwilling to believe that he had gone wrong in any way. For many months past she had found difficulties in her work at St. Bernard’s in consequence of the growing dissatisfaction she felt at the conduct of most of the doctors who attended her patients. It pained her and roused her indignation that needless and dangerous things were constantly done to patients who had no idea of their import, and who would have protested with all their might if the opportunity had been given them. Valuable lives of patients who had become her friends had been sacrificed to the growing taste for novelty in methods and instruments, daily introduced from all parts of the world. What one man had done in Berlin must be imitated here, and what had proved fatal in New York was tried at St. Bernard’s in the hope of better success and the increased reputation of the operator. One man extirpated one organ and one another; one resected this and another that, till poor Sister Agnes began to wonder what, and if any, part of the frame would ultimately claim exemption from the rage for taking it away. And she was expected to do her part in paving the road for all these mutilations. The wiser she grew, and the more she learned of her business, the more she saw that much, if not most, of all this was not for the patient’s good; and no wonder she began to rebel. She was brought principally in contact with Dr. Stanforth, who was the chief physician of the women’s wards. Not alone did she object to his professional methods, but the manner he used in the wards. It was neither useful nor expedient for Dr. Stanforth to regale his class, in the presence of herself and nurses, with his most salacious anecdotes, his coarse allusions and indecent jokes. Some patients no doubt enjoyed them, but these were a minority which should have been made better instead of worse by living in the hospital. To most, however, these things were painful in the extreme. It required better health and stronger nerves than the women generally possessed to cope with Dr. Stanforth and his rollicking lads. The valley of the shadow of death is an ill place for satyric abominations. The sympathetic nerves of the poor sister’s face were too habituated to Dr. Stanforth’s little ways to cause her cheeks to flush at all of their manifestations, but there were times when her indignation would make her turn away with her note-book and inkstand, and remove out of earshot. At such times the funny man would apologise in a way which only made matters worse, and she would often wonder in her own mind how much longer she could or ought to be a party to these improprieties.
CHAPTER XXVII.
“ANOTHER PATIENT, SISTER!”
He was happier using the knife than in trying to save the limb.
– Tennyson.
And whom have ye knowen die honestly
Without help of the Poticary?
– Heywood.
Dr. Stanforth was considered a model hospital physician – for the students. They were ever the first in his thoughts; to touch one of them was to touch the apple of his eye. He lived for them (and by them), yet he never allowed any of his patients to suspect anything of the kind. There was nothing he grudged his pupils, and they consequently worshipped him. To serve any of his boys he would sacrifice the feelings of any interesting bit of “clinical material” that came in his way, and he boasted that he turned out more proficient practitioners than any one of his colleagues. His methods were startling even to them, and many were the wrinkles he put them up to. His fame in his speciality – gynæcology, was so great, and his really remarkable abilities so well recognised, that nothing he did, startling though it was to the outside world, diminished the crowds of patients who flocked to his consulting rooms. Of course he had the bonhomie and social tact that are needful in attaching young men to a teacher; he was, in addition, able to prove to them that by attending his practice they were acquiring a practical knowledge of their work which they could obtain in no other way.
Dr. Stanforth held all his patients at the disposal of any pupil of his who desired to do or see something new. “Do what you like, my lad,” he used to say to a favourite assistant. “You are in these wards to learn all you can, and all my beds are at your service. Would you like to do a gastrotomy? You ought to do one or two before you leave; it’s a very pretty operation. I never knew a case survive more than a week; but there’s nothing like trying, and if you pick out a case that must die any way, you are welcome to use any of my cases that we can get to consent: and with Sister Agnes’ help – Sister is capital at getting consent to anything, aren’t you Sister? – it can generally be managed. Yes, you had better do one or two; it will be a fashionable operation before long. Rabbits do very well with it, better than dogs in my hands; but humans don’t take nicely to it at all. Now, don’t scruple to let me know anything you’d like to do. I owe you something good for keeping that pretty Pemphigus going so nicely while I was on my holiday – very good of you, very good indeed – I sha’n’t forget you; bye-bye.”
At what awful cost all this was to the “material” he never troubled to estimate. The scandal at last got too strong for St. Bernard’s, and he was soon promoted “out of the opportunities of his art” – as he complained.
“Sister, let us have another patient!” said Dr. Stanforth, on one occasion, just as one might say, “Hand me another chair,” or “Bring me another book.” It was in the private operating room at St. Bernard’s, screened off from the ward specially set apart for women. The assistant physician of this important department had invented a new apparatus for administering anæsthetics, and it was tried that day for the first time – tried on hospital patients first, of course. It promised materially to assist in bringing the patient under the influence of the anæsthetic with rapidity and comfort. Being a complicated machine, with various ingeniously constructed valves, it was not by any means an easy thing to manage, and the least error might have fatal consequences; it would never do, therefore, to use such a thing out of doors till all its bearings had been taken at the hospital, where any mishap could be adroitly attributed to some other cause. Long before one dare use such a thing on Lady Millefleurs, its capabilities and little eccentricities must be exhibited on the unimportant carcass of Eliza Smith; and so it fell out that day that a little knot of students, interested in giving chloroform or ether, with due address, were assembled to see the working of this pretty bit of mechanism.
Dr. Stanforth was an amiable creature, who lived and worked for, and devoted all his energies to his “boys,” as he called his students; for them he spared his patients neither shame nor pang; for them his beds were occupied by so much “teaching stuff.” He was skilful to cure, but at St. Bernard’s he often forebore to cure too rapidly, lest the “pretty case” might get well before all his boys had had their fill of it. It was far better, he used to say, that a patient should “bide a wee,” if any interest attached to her case, than that any budding obstetrician should leave the hospital imperfectly equipped with all the weapons he required. “Have as many patients as you want, my lad,” he said; “let us get the thing right while we are about it.” “The thing” was the new apparatus, and on its first trial on patient number one, had narrowly escaped sending her to kingdom come by suffocation. She appeared to be “going off lovely,” as funny Mr. Philips said, till Dr. Stanforth, suddenly turning round in the middle of a droll story about his friend “Wales and the actress,” seized the patient’s hand, and declared she was “going” in quite another sense. Artificial respiration was performed, and the woman restored to life and consciousness. It was generous not to subject her to any further experiment that day, and she was sent back to her bed, which she had not left for any benefit likely, under any circumstances, to accrue to herself, while the instrument which had so terribly failed was carefully examined for the cause of the mishap. On taking it to pieces, a mechanical genius amongst the students found that a valve had got fixed, and as it was speedily put to rights, the operator was encouraged by Dr. Stanforth with “Better luck next time my boy. Sister, let us have another patient!” How the sister managed to induce a second woman to undergo a mysterious ordeal, the purport of which she was not permitted to question, and after the experiences of the first victim, which did not appear to the curious ward as having been altogether pleasant, we do not pretend to understand; but hospital sisters who know their business have clever little ways whereby they aid and abet the doctors in their search for wisdom. Sister Agnes had long felt that her conscience was being overstrained at St. Bernard’s. Her work was developing itself as quite other than she had expected when she gave herself up to the life of a nurse. These good women, at any rate, had a lofty ideal, and followed it with no hope of other than its own reward. They were not seeking fame, or money, or any worldly reward; it was no wonder therefore that a noble-minded woman like Sister Agnes should see that unless the great work of her life, for which she had given up all else, were undeviatingly followed, she at any rate had failed in attaining her mission. It was not to help doctors to get knowledge; it was not by trickery and “white lies,” used to induce defenceless sufferers to submit to horrible ordeals, and indescribably painful examinations for no benefit to themselves, but simply to teach their business to young men, that she had devoted herself to work in the wards of a general hospital. And daily the conduct of Dr. Stanforth and his assistants clearly showed that the patient’s benefit was quite a secondary object, and the chief end of his or her residence in the wards of St. Bernard’s was precisely that of an artist’s model visiting a studio. Very good, doubtless, in its way, but not what the main body of hospital subscribers intend; still less what the patients come for, and only partially, surely, what such as she had left the world to aid. In a word, she saw plainly that the whole system of the modern hospital in great cities was a gigantic sham, a cruel fraud on the subscribers, and an atrocious delusion and a snare to the patients themselves.
How difficult a task it would be to convince the world of all this! What an Augean stable for a weak woman to cleanse! Then again nothing annoys the public more than to open the doors of its whited sepulchres. Of course, it was no use to condemn the present system without putting something better in its place. The workhouse infirmary was far better in one sense; there, the object was to help the patient to get well as speedily as possible, and take himself off the books; but there attaches a stigma to the infirmary from which the hospital is free, yet the hospital must be reformed on the model, in some respects, of the infirmaries.
The sister was a clever woman, a woman of ample means, and with great influence; why should not this be her life-work to found a new order of charity? It had been the work of many a noble woman to do greater things than this, and with apparently less foothold; and that night, before she went to rest, she prayed that strength and wisdom might be given to her to carry out the scheme which was taking hold upon her heart. “I shall want half a million of money to make a beginning. What is that? A man dies, and leaves a quarter of a million to a college of anatomy and surgery, to be spent in skeletons and pickled specimens of curious fish and odd deformities. Many a man’s picture gallery has had that spent upon it; it might buy a moderately good ironclad; would make a mile or two of suburban railway, and execute a few hundred yards of submarine tunnel. Somebody will come along who will see with me that humanity and cruelty, whom God hath disjoined eternally, shall not be forced into unholy union. Let me be the Joan of Arc to fight this out.”
But not yet. She must arrange her plan of campaign, collect her forces. So enormous a task must demand an adequate inception, and though she shrank from nothing, she ventured nothing rashly.
CHAPTER XXVIII.
DR. STANFORTH WITH HIS PUPILS
His story would not have been worth one farthing if He had made the hat of him whom he represented one inch narrower.
– Steele.
Natural ferocity makes fewer cruel people than self love.
– La Rochefoucauld.
Dr. Stanforth knew everybody, from “a very exalted personage,” with whom he led the students to believe he was on terms of close intimacy, down to the most insignificant disciple of Galen who had ever been connected with the hospital. He never permitted a patient to baffle him; he always pretended that he knew all about him or her, and had his or her medical history at his fingers’ ends. His days in the out-patients’ rooms were looked forward to by the students with delight. He was so droll; he teased the pert and knowing patients worse than any Old Bailey barrister. “There was no getting over Stanforth,” they declared; “he was too much for the artfullest of ’em.” His bete noir was the over-dressed, robust, viragoish lady patient, who could well afford to pay for medical advice, but wanted it for nothing.
“Put out your tongue, madam.”
The lady complied. Carefully adjusting his gold eye-glasses, he would minutely inspect it.
“Did I understand you to say you were a strict teetotaler?”
“No, sir, I am not exactly that: but it’s little I ever touch except a glass of beer with my dinner.”
“No spirits, madam?”
“Very seldom, sir.”
Dr. Stanforth would take off his glasses, carefully wipe them with his handkerchief, and readjust them.
“Permit me to see your tongue again, madam. Um – ah – h – h.” Then, after looking at the organ closely for some moments, he would ask, incredulously —
“You never take spirits, madam?”
“I said very seldom, doctor – never more than a teaspoonful of brandy in a little water the last thing at night. You know you told I might do that last time I was here.”
“One teaspoonful, madam?” with another scrutiny of the tongue; “only one teaspoonful of brandy?”
“That is all, sir,” said the patient, bridling up and getting restive.
Dr. Stanforth took off his glasses, folded them, and leaning back in his chair, asked in his blandest tones, “Pray, where do you procure your brandy? It must be very strong. I can get none so good!”
The woman would bear no more roasting that day, and having taken her prescription, left the room, the assembled students heartily enjoying her discomfiture.
The way to annoy him and put him on his mettle was for a lady patient to object to an examination in the presence of his very large class of students.
“Can’t I see you privately, doctor?”
“Why?”
“Well, sir, I do not like to undergo all this before these young gentlemen.”
“You are married, I believe?”
“Yes, sir.”
“Have you any boys?”
“Two, doctor.”
“Would you like your eldest to be a great physician when he grows up?”
“Oh, yes, indeed I should, if he were clever enough!”
“I thought so. Now all these young gentlemen’s mammas have the same desire, and have sent them to me for that purpose. If you don’t help them, they can’t learn to be doctors. Now, nurse, assist this lady to undress.” And, without sparing the poor creature a pang of shame, he would submit her to a degrading ordeal, so that every one of his boys might have the chance of learning that for which, as he said, “they have paid large sums of money.”
To amuse them and impress them with the idea of his wit, he would, in the presence of patient and nurses, often tell shady stories as broad as they were long. Such droll scenes, such lively contests between one weak, suffering woman (for he would never permit a patient to bring mother or friend into his room), and this brilliant physician and his admiring, tittering pupils, made the gynæcological out-patients’ days the great fun of the place. “Beats Punch into fits!” said Murphy. “Never half as much spree at the play!” vowed Robins. But it was poor spree and very mitigated fun to the hundreds of afflicted creatures who sought this great doctor’s aid; for great he was and very skilful, and had saved many thousands of sufferers from pain and discomfort. He was a generous, patient, useful man, and in his private practice was everything that could be desired in a doctor; but he thought, and that thoroughly, that he was at St. Bernard’s first to interest and teach in the completest manner all the men who attended his classes. If in this doctor-factory any sick woman could avail herself of the by-product or waste for her cure or relief, she was heartily welcome. In any case, her attendance served his purpose very well indeed – unless she became troublesome, and refused to comply with some of his too outrageous demands, and then her letter would be taken from her, and marked by the doctor “Refuses treatment,” and she would be escorted out of the hospital by one of the nurses.
Sometimes “a very pretty case,” as they called good clinical subjects, would be taken into the wards, with the assurance that it could only be effectually treated there, but really that it might be daily examined and watched by the students, although it would have done as well or even better at home. Thus he used a bed – at say a cost of a pound a week for two months, – a bed which in another case, far worse but not so interesting, would have been much better engaged. Of course the pupils were not unmindful of all these efforts for their advancement when they got into practice; and as they were daily qualifying, Dr. Stanforth was daily making a number of valuable friends.
CHAPTER XXIX.
AN IDEAL PHYSICIAN
The Christ Himself had been no Lawgiver,
Unless He had given the life, too, with the law.
– Elizabeth B. Browning.
He hansels not his new experiments on the bodies of his patients, letting loose mad receipts into the sick man’s body, to try how well nature in him will fight against them, whilst himself stands by and sees the battle.
– Thomas Fuller.
Darwin spending whole nights watching pots of earth-worms, and studying minutely the habits of these creatures – Thoreau exiling himself from civilization that he might learn how to live cheerfully and healthily, in company with the animals of the forest, are examples of the true method of learning from Nature. There can be no real sympathy with those with whom we have to deal apart from an intense desire to know them intimately. Can we expect to reach the heart of Nature except by the royal road of love?
Elsworth learned this in his voluntary exile, – learned that he could interrogate Nature, get at her secrets and apply them to the healing of mankind, when he had reverently put off the shoes from his feet and entered her temple as a worshipper, rather than as the devastator placing the abomination of desolation in the holy place. The secret of Nature, as of the Lord, is with them that fear her.
To analyse a rose is a poor way of learning the sweetness of its perfume; to master the language of a country is of the first necessity to knowing anything about its people.
The Monte Sagrado is reached by a road made through the hill of the Albayzin, which overhangs it on one side. Everywhere we see masses of enormous Indian figs, or prickly pear, the fruit which for months together forms the chief diet of the gipsy population. They live in a quarter by themselves, outside the city, as did the Jews in their ghettos in Italy. In Granada they are more settled in their habits than in other places, with the exception of Seville. Their dwellings are caves dug out of the hill-side, and it is very curious to see the smoke from their fires issuing from holes in the ground amongst the Indian fig plants. Very dirty and smoky are these grottoes; the only daylight which can enter them comes through the doorway. As a rule, the furniture is of the most wretched description, though some of the burrows are better off in this respect than the rest. These poor folk are much looked down upon by their Spanish rulers, to conciliate whom they pretend to be good Catholics – in the old days of the Inquisition a not unnecessary affectation. They excel in many ingenious trades, best of all in horse dealing and thieving, professions nearly allied in most countries. Social pariahs as they have ever been, it need not excite any surprise that they are depraved and ignorant, though, as they have some noble qualities, they must be capable of great improvement when an age of wider sympathy and diminished race prejudice shall enable their neighbours to do justice to them.
They are at war with mankind because they have always been cruelly oppressed and ill-treated; but as in our own country a George Smith of Coalville and a George Borrow in Spain have found the gipsy character well repay the efforts made to improve it, we may fairly hope Christianity will ultimately conquer even this stubborn race. They are light-hearted, clever, courteous, and forgiving, generous, and kind even, to strangers in distress; great lovers of Nature, and full of affection for dumb creatures; surely in such a race there must be the material for improvement!
Rico, the gipsy king, soon became warmly attached to Elsworth, who spent many a pleasant hour in his sooty hut; pigs, fowls, and children wallowed and grovelled together in the mud-floored cabin, which was more suggestive of the Green Isle than of lordly Spain.
It was worth a journey to Granada to hear and see Rico play the guitar. The instrument only really lives in Spain, elsewhere it is but a feeble, voiceless toy; here it speaks, declaims, rouses and fires the brain, but then that is because the performer and the instrument become one. Rico’s guitar was part of himself, not only the strings but the body of the thing.
Often he would gather round him some of the young men and women of the colony, who would accompany his playing with plantive, weird singing and hand-clapping, in perfect tune, strange Eastern dances, with wild gesticulation and choruses which seemed reminiscences of ancient Greece. In return Elsworth, with hearty, manly sympathy, would recite some sweet narrative from the Gospels, and win his way to the hearts of these poor people by stories of the Saviour’s love.
Amulets, charms, fetishes, all these they knew. How the King of Heaven loved the despised Romany people, this was a strange thing to them which the Englishmen had come to teach. But it touched their hearts, poor outcasts!
When he had completed the translation of the Gospel of St. Luke into their language, they would listen with apparent interest to his reading by hours together. This was not the sort of Christianity that had before been presented to them. In its grand simplicity and manifest adaptation to the wants of these wandering children of Nature, surely here if anywhere, was the ideal religion for them; and as for their teacher, who lived their life and proved in a hundred ways his devotion to their interests, who showed that he loved these people, outcast and despised as they were, because of his honour to them as children of the same Father whom he loved, surely they were bound to treat his mission with respect.
And so four years had gone by. He had journeyed with the gipsies into many parts of Spain, but had always returned to Granada as his home, as the centre for his work and life interest.
How real and earnest a life he was living now! On this lofty height overlooking the historic scenes which had occupied so large a space in the annals of the past, what wonder if to an ardent poetic mind, romantic yet intensely practical, there often came, in moments of deep sympathy with mankind born of the love of God, high aspirations after noble deeds, and the determination, when his hour came, to go down into the arena and bear his part manfully in the fight! No, Elsworth was not skulking in idle retirement; not shirking his share of work; but because of a deep conviction that there was work for him to do which required his retirement to fit him for it he stayed, and did what lay to his hand, and waited for the summons.
The life of the hermits of the Theban Desert was a violation of common sense and true religion, inasmuch as it was all preface and no book; all preparation and girding on of armour, and no work; all tuning of instruments, and no music. The great wonder is, how the fanatics could have stood it so long.
Elsworth found that doctors were not held in nearly such high esteem in Spain as in England. They pursued the barbaric methods of treatment which were in vogue here at the beginning of this century, and which, if followed now, would subject the practitioner to a trial for manslaughter. Spain is so far behind the rest of Europe in everything, that it can easily be imagined how perilous it is for an invalid to fall into the hands of the sangrados even of the present day. The Spaniards are celebrated for their proverbs, not a few of which are aimed at the doctors. A popular rhyme goes like this: —
“And, doctor, do you really think
That asses’ milk I ought to drink?
It cured yourself, I grant it true;
But then ’twas mother’s milk to you!”
His fourth autumn had been passed in Spain, when another terrible epidemic of cholera broke out in Granada and other cities of Andalusia. Now he seemed to learn why he had been sent, hither. Now he could test the reality of his conversion. Now he would realise the dignity of his calling and the strength of his humanity. And he did not flinch.
His skill in sanitary matters and his surgical knowledge stood him in good stead. A good head for mechanics, much common sense, and a readiness of resource had already enabled him to save many of his Gitano friends from the hospitals they so much dreaded. He could mend their broken limbs with extemporised splints, reduce dislocations, and dress wounds antiseptically; and by cheering them by the infusion of his own light-heartedness, shorten their period of convalescence. To be sure, they had their own well-tried methods of cure, which were not so contemptible, though unrecognised in the schools. Having small faith in drugs, and smaller still in their wholesale administration by ignorant and unthinking practitioners, his medicine chest seldom needed replenishing. He valued his opium (Mash Allah, the gift of God, the Turks call it), but administered it with scrupulous care. Quinine was indispensable, and a dozen other well-tried remedies enabled him to work many a cure. But cold water and fresh air, wholesome food and temperance, want few aids from medicine for the ills of man. The wiser the physician the fewer the drugs, and by the length of your doctor’s prescription you may estimate the shallowness of his pretence to wisdom.
Sanitary engineers have done so much for the improvement of the health of towns, that the low death-rate in London and other English cities is more to be attributed to their agency than to improved methods of medical treatment. The wonder is that Spain and Italy are not continually decimated by pestilence. We may see what was the state of England in the time of the Black Death and the Great Plague by the condition of Naples and Granada under recent cholera visitations; the most elementary sanitary precautions being not only neglected but apparently impossible of comprehension by the people generally, so that the soil is always ready for the seeds of disease.
Elsworth was in robust health and vigour while he lived at Granada. Every morning he took two hours’ exercise on his bicycle into the open country of the Vega. His daily bath, the simplicity of his diet, his entire abstention from alcohol, and his scrupulous care to drink no water which he had not himself carefully boiled and filtered, with his cheerful, well-occupied mind, prevented him from taking any complaint during his work amongst the sick. He was well received by the poor folk he visited; and though the local doctors and priests looked coldly on his work, he had no difficulty in finding cases neglected by both, where his services were eagerly welcomed. Ho found amongst the very poor a strange prejudice against the doctors, who were ignorantly accused of giving the disease to the people to lessen the population. This seems to have had its origin in the inoculations practised by a disciple of Pasteur, and which undoubtedly did cause many deaths. There is such a widespread dislike of the priests among Spanish men, not altogether to be marvelled at by those who know the country, that the religious ministrations of this young English surgeon were often acceptable where the public functionary would have had scant courtesy. The authorities of the town recognised his work, and gave him permission to act as a medical man when they had satisfied themselves as to his qualifications. He attempted no concealment. Why should he? The British vice-consul of the city, a wealthy old Scotchman, the head of a firm of mining engineers, soon became a good friend to him. He was a Presbyterian of the good old school, with convictions about the Man of Sin and the Scarlet Lady, and loved Spain chiefly for the lead his firm extracted from the bowels of her mountains. Being a man of considerable standing in the city, and withal highly respected for his probity and charity, he had no difficulty in making easy the sort of work Elsworth aspired to do in the public service.
