Edward Berdoe
St. Bernard's: The Romance of a Medical Student
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.
You care not for your loss; we calculate our gain.
– Browning.
Our doctor was now given wholly to the material side of his work. Young men are an imitative order of beings, loving smartness, and desiring to be in the foremost rank, whether in sports or study. The men of the hospital found there was no road to distinction at St. Bernard’s except that of novelty. There was nothing to be done on the old lines; to stay there was to be content with the dead level of mediocrity. This section of the school scoffed at religion, held faith to be a mark of imperfect development; and in proportion as they grew more in the sort of knowledge they thought it the proper thing to acquire, learned to despise everything which of old had served to make the world wise and good. Elsworth, for some time, kept himself aloof from this set, but his abilities and his rising ambition made him a man to be competed for and flattered. Gradually he became puffed up with a sense of the importance of the things he had acquired. So far from thinking himself, with Newton, a child on the sea-shore picking up shells of truth, he fancied he was doing business in the deep waters, though he was only stumbling amongst rocks. When this state of mind is reached, the man becomes selfish and indifferent to the condition of his fellow-men, and as God becomes a vanishing point Self looms large. All the virtues were to these men mere conventionalities, and it was as absurd not to live for one’s own advancement as for a giraffe to contravene the law of his nature pressing him to crop the highest branches he could reach with an increasing length of neck. So they craved after the best within their reach, regardless of the poor wretches below them who had not learned how to put forth their powers.
A purely scientific education has a tendency in the minds of the young to produce this selfishness, and the wisdom of our forefathers is shown in their having made the masterpieces of ancient literature the great pièces de résistance of the mental provender which they provided for their alumni, because Literature ennobles and subdues Self, and inspires with great and generous thoughts as does no other human learning.
The hospital education of the present day is mere craftsmanship, and should only be permitted in conjunction with a liberal university training. The man who knows medicine and surgery only, however well he may know both, has only half learned the business of a doctor.
The old custom of serving an apprenticeship to a general practitioner had many advantages. Hospital work is so different from that in the outer world in which the student will have to practise, that he is only half educated when his curriculum is finished, and his diploma obtained. One acquires a certain wholesale business air in dealing with patients while attending the hospitals which is particularly objectionable to patients in general; and till a man has had considerable contact with private patients, he is far too rough and ready in the sick-room to be very welcome there. Our every-day complaints, it is evident, do not particularly interest him. He has been dealing with “cases as is cases; none of your trumpery family doctor business,” as Podger said. He has no respect for the miserable creature who has only bruised himself, not fractured anything; or whose mind is disturbed by family troubles and so misses his sleep, instead of being the subject of the vastly more interesting cerebral disease. In the latter case there is something pretty for his ophthalmoscope; in the former your eyes are not worth looking at. He has got hold of the notion that there can be nothing at all the matter with you if you have no “physical signs.” For your true scientist rejects the imagination. He wants facts he can handle and see. At heart he is a mere mechanic; he must open the frog’s thorax, and actually see the heart beating; must see with his own eyes the way carbonic acid acts on the living blood corpuscle. When completely imbued with this spirit, as the human mind can only entertain one great idea at a time, he acquires a sovereign contempt for the men who imagine merely, and do not see, taste, handle, and feel.
Linda had given herself up to the Socialist propaganda, and had quite resolved to waste no part of her life in love affairs. “It was quite time,” she declared, “that women should begin the work of setting to rights a world that men had so grievously muddled up.” She had often said more unwise things than this. She was, moreover, quite sincere, and had refused several very eligible offers for her hand. A bright-eyed, graceful woman like Linda, with her undoubted intellectual powers and her nice little fortune, would naturally have had offers before she reached her twenty-eighth year; but she loved the new gospel, and honestly thought it her duty “to war against the Jahveh worship introduced by a tribe of wandering Semites, and to substitute the evangel of Humanity for the code of Sinai.” There are plenty of such people about. It is not only the followers of Christ who sacrifice their lives and substance for their faith; His enemies do that, and do it honestly enough in their way. Were these people enemies of Christ? They did not think so. They maintained that the greatest Socialist who ever lived was Jesus of Nazareth, that He would have really conquered the world had not the Church conquered Him.
Elsworth was not in love with Linda in any true sense. He was attracted towards her by her brilliancy, wit, and mental powers. She was not beautiful if you analysed her form and features, – not one of the latter would have passed muster with an artist; yet, taken altogether, with intellect and grace beaming from her eyes, and influencing every movement, she was just the woman a clever man would fall in love with while in her presence. But this love would not last long. Clever men are usually held in bondage by coarser fetters than those of intellect. Girton or Newham are not at all the places one would go to for the purpose of seeking a wife: they can want no very high walls at either to keep Romeo out. As this is not a love story, we do not propose to analyse very minutely the sentiments that drew these young people towards each other. Perhaps it is quite enough to say that Elsworth was attracted by the very efforts she used to demolish the principles he had brought to his hospital career. He felt that Christianity was not intellectual enough for Western notions, however, it might include the highest modern ideas of philanthropy. In face of that young girl and her brother, he lacked the courage to take upon him the offence of the Cross. Peter denied his master at a maid-servant’s question. Linda had vanquished our young surgeon’s faith.
The athlete glories in his strength, the boisterous health of a well-knit frame requires an outlet; hence the periodical rowdyism which attacks students everywhere, especially those in training for callings that will repress their ardents spirits all too soon. With Tom Lennard and little Murphy, Elsworth was now almost nightly engaged in some wild frolic or other. A curious mixture was in him – half hero, half imp; at times he was given to periods of deep meditation on the highest matters that can interest mankind, to speculation on questions which have agitated the minds of philosophers, with a deep under-current of poetry running through his soul. Yet with all this there was a surface hot-headed foolishness which he neglected to restrain, leading him, at the suggestion of the moment, into outrageous acts of purposeless folly, if fun could be extracted from it. He wanted one thing —
“Discrimination – nicer power man needs
To rule him than is bred of bone and thew.”
Ever some new madness was attempted, some scandal enacted. The favourite amusement just then was disturbing music-halls and theatres, bar-rooms, and supper places in the West. The public seemed rather to like the students’ riots, and the proprietors condoned for money compensation what the police were only too anxious to punish.
One proprietor of a large and popular place of amusement did not see these disturbances in just this amiable light, and had recently caught and punished several young medicos who had made themselves obnoxious to him. It was determined very secretly to combine the fighting men of several hospitals into one grand attack on this man’s property.
CHAPTER XVII.
THE LOST LEADER
Well, he is gone, and with him go these thoughts.
– Shakespeare.
Meantime, how much I loved him,
I find out now I’ve lost him.
– Browning.
It was the 9th of November, and Lord Mayor’s Show day – a festival of the first class at all the medical schools of the metropolis. On great occasions like this, the spirits of all medicos run high. They drink deeply, sally forth with knobby sticks, and prepare for multiform scrimmages. On this particular day word had been sent round to all the medical schools that a raid was to be made on the “Frivolity” Music Hall, Oxford Street, and Medicine expected every hospital man to do his duty. The rendezvous was at Piccadilly Circus, the time ten o’clock. At the appointed hour the locality was crowded with active, healthy young fellows, armed with their characteristic bludgeons; and the word was quickly passed to link arms and rush up Regent Street, driving everybody before them. No sooner suggested than done; right across the street they formed, from house-front to house-front, in triple rows. Of course everybody got out of their way, and gave a wide berth to them, and the young clerks and shopmen, who were delighted to join in the spree, and willing to undergo the indignity of being arrested for the pleasure of being suspected and perhaps described in the papers as medical students. As it is not the cowl that makes the monk, these vain persons do not always deceive either the public or the magistrates before whom they appear. The music hall was quickly reached, with little interference on the part of the police who had not previously got notice of the raid. The turnstiles were upset or broken down, the money-takers roughly handled, and the spacious “hall of splendour and realm of dazzling light,” as one of the fellows called it, was taken by storm; the glasses and crockery at the refreshment bars were smashed, the looking-glass on the walls demolished, the marble tables overthrown, and the unfortunate portion of the audience, which did not succeed in escaping, soon had cause to regret the excessive demonstrativeness of the followers of medicine. Of course, when the place was half wrecked, the police came in force, and restored order. Some half-dozen of the rioters were arrested, and duly appeared before the magistrate, received their lecture on the manner they disgraced their noble calling, and were let off with fines. But the event of the night was the disappearance of Elsworth. No one knew what had become of him; he was not among the arrested, nor had he turned up at the hospital or his lodgings. No one had seen him after the row at the “Frivolity,” and all sorts of alarming rumours began to circulate as to his absence. He was last remembered in the heat of battle in the music hall, rallying his forces, crying, “St. Bernard’s to the rescue!” when the police had captured one of his heroes. After that no one saw him more. Had he met with an accident? Had he been attacked and robbed, and then killed by some of the bad characters in Seven Dials close by? No one could say. A week passed, and though inquiries had been made at every possible place, and all his friends communicated with, nothing whatever could be heard of him. The fellows began to rake up every bit of his conversation they could recollect. As we have already narrated, at Oxford he was deeply religious, but his medical studies had imbued him with serious doubts on all the distinctive dogmas of Christianity, till at last the atmosphere of the dissecting-room and the physiological laboratory seemed to have weakened his faith in God, the soul, and the future life. It was the fact that this state of things often obtained at St Bernard’s. All its professors but one or two were agnostics, or even atheists. Some were serious, thoughtful men, who grieved they could not believe; while others, as far as they dared, made a jest of the most sacred themes. Young men – and especially young medical men – are prone to copy very closely the speech and the modes of thought of those who are in authority over them, and the school took its tone from the many brilliant men of science on its teaching staff. The microscope, the test-tube, and the scalpel had dissipated much of young Elsworth’s faith, and he had not cared to conceal it. Had he committed suicide? Why should he? He was not embarrassed; he had ample means and wealthy friends. Nor was he involved in any intrigues, as far as could be known; and as he was of the liveliest and most optimistic turn of mind, the idea was scouted by those who knew him best.
CHAPTER XVIII.
AN EPICURE OF PAIN
I pity the unfortunate who, in their necessities, find only the succour of the civil authorities, without the intervention of Christian charity. In reports presented to the public, philanthropy may and will exaggerate the care which it lavishes on the unfortunate, but things will not be so in reality.
– Balmez.
He loves not to be prodigal of men’s lives, but thriftily improves the objects of his cruelty, spending them by degrees, and epicurizing on their pain.
– Thos. Fuller.
The institution and maintenance of such public charities as hospitals for the gratuitous relief of sickness all over Europe are directly due to Christianity; no other religion or policy, except Buddhism in its prime, ever blessed the world with such a form of charity. It has become a recognised idea in our day that a poor sick man has a right to be restored to health at the hands of a Christian people. That there are misuses of it is well known, many persons seeking to participate in this benevolence who could afford to obtain medical aid at their own expense; yet the public is so convinced that at any cost it is bound to remove the burden of illness from the shoulders of the poor, that it is ready to wink at the abuse of its kindness in this way. The physicians and surgeons attached to the greater hospitals are much sought after by very well-to-do, not to say opulent, persons, who use every mean device to obtain consultations gratuitously. Many such persons have been known to attire themselves in the clothes of their servants, and to send their children in charge of their cooks, to obtain advice and medicine which would have entailed expense if obtained privately. This is one of the ways in which such institutions are robbed.
It is possible that the treatment of the ills to which humanity is subject may in course of time be considerably improved, in consequence of the patient investigation that has long been carried out on every form of disease at our hospitals. At present physiology and pathology so entirely occupy the attention of the doctors, that treatment is relegated to the distant future. A French physician spoke the truth when he said, “The object of the scientific practitioner is to make a good diagnosis in life, and then verify it on the post-mortem table.” It is not to be denied that the art of making a good diagnosis has been brought to considerable perfection of late; but whether we are more successful than the doctors of former times in curing these well-diagnosed diseases is very doubtful. Now a general hospital, frequented by thousands of “cases,” is to the inquiring physician what an Alpine valley is to the botanist, or a Brazilian forest to an entomologist. It is there that orders, genera, and species are to be found. Diseases for classification in all their variations are met with amongst the crowds applying for treatment. The great object is to get the crowds; they come for one thing, the doctors for another. Very good and kind and clever at curing folk, no doubt they often are, but primarily the object of calling the crowd together is precisely that which the herbarium supplies to the botanist, and the nest of drawers to the entomologist.
The hospital professor is like Linnæus, who so curiously expressed himself when he had achieved success: —
“God hath so led me, that what I desired and could not attain has been my greatest blessing;
“God hath given me interesting and honourable service, yea! that which in all the world I most desired;
“He hath lifted me up among the mæcenates scientiarum, yea! among the princes of the kingdom, and into the King’s house;
“He hath lent me the largest herbarium in the world, my best delight.
“He hath honoured me with the honorary title of arkiater, with the star of a knight, with the shield of a nobleman, and with a name in the world of letters, etc.”
The only difference being that the great botanist thanked God for his herbarium, while our hospital man of science has generally little thought of God when making up his case book, unless it be to think, with Helmholtz, how much more perfect organs he could have devised had he been consulted at creation.
Elsworth often thought that all their diagnosis and classification did little for the cure of disease; and that, as the labourer said of his landlord’s claret, “You didn’t get any forrarder with it all!”
“Some day we shall arrive at the treatment stage,” they said; “at present all is chaos in that direction. We have not diagnosed enough,” they urge. “We must diagnose a good deal more in every part of the world; then meet in congress, then keep up discussion in a hundred societies, and, in the course of a century or so, we may begin to try to cure people; but it is too early yet. Meanwhile, we can diagnose. And take our fees? Why, certainly!”
Mr. Crowe was lecturer on physiology and pathology; that is to say, he taught the students what the human body is in its normal state, and what happened to it when subject to disease. He claimed that the only gate to the true knowledge of a doctor’s work was the branch of science which formed his speciality; and, as the examiners seemed to take the same view, Mr. Crowe occupied a considerable share of the students’ time and attention. St. Bernard’s made a great fuss with Mr. Crowe, and grudged no expenditure on his department. He could have all sorts of costly and curious apparatus on application, because, in the present rage for experiment, it was found to pay. He had a beautiful laboratory for his work in the medical school, and in the hospital, fine new chambers attached to the post-mortem room, where he kept his microscopes, and made sections with the utmost patience and skill. Here he often spent whole nights alone; here it was more than rumoured the most gruesome things went on in secret, for, in the vaults below, there was a small menagerie. No one was supposed to have access to this inquisition-chamber, except he was either in Mr. Crowe’s employ, or in his completest confidence, for of late unpleasant discussions had taken place, and the subscribing public had made it pretty well known that they did not support St. Bernard’s for this sort of work. Thus, great care had to be exercised, and all Mr. Crowe’s familiars were cautioned to mind what they were about. The tabbies and the lap-dogs of the neighbourhood could venture abroad with less danger of being pressed for service at St. Bernard’s, and the porters had to go to Seven Dials for their purchases. These porters were characters in their way. Long service in this line of business had left its marks upon them. They were scarred and furrowed about the hands and arms with bites, cuts, and scratches, which had healed badly, and, to the skilled observer, sufficiently stamped them with the trade mark of the hospital. They were brutalized by their ghoul-like work, and, if given the opportunity of doing a stroke of business, would stick at nothing in the way of subjects, which did not actually jeopardize their necks.
Mr. Crowe was forty-two years old, of middle height, dark, and inclined to leanness. He had a decidedly malevolent aspect. His face was not that of the libertine, the schemer, or the man of pleasure; but a perfect pitilessness, an utter dissociation from any genial or loving characteristics, was boldly recorded on the lines of his face, and the very carriage of his body. Hard was not the word for it, cruel was not wide enough to comprehend his character. Disregard of all pain in others, contempt for those who professed to care for what troubled others; these were the distinguishing traits of Mr. Malthus Crowe’s moral character, and his face advertised it. Mr Crowe was rapidly becoming an authority in his branches of science, and accordingly brought much kudos to St. Bernard’s. Had not physiology been invented in these latter days, it is difficult to imagine what the world could have done for Mr. Crowe. He loved pain; he reverenced and esteemed it (in others, of course). He had inflicted it in every form, and watched its effects learnedly without flinching, both in animals and man. He always described it as a tonic – Nature’s great nerve bracer – but he never took it himself if he could help it. He declared the world could not get on without it.
He had married in early life the daughter of an Italian engineer, who lived at Cernobbio, on Lake Como. Having been in the habit of taking his long vacation tour in Switzerland and Italy, he had formed the acquaintance of several hospital surgeons of kindred tastes to his own, and had frequently visited them at Milan and Genoa, and compared notes on matters of mutual interest. One of these confrères had introduced him to his family, and so he met Olympia Casatelli, and, having some reason to think her prospects good, had married her, notwithstanding she was a Catholic, though her pronounced Garibaldian sentiments had left her without any very ardent attachment to the religion of her baptism.
Olympia was deeply imbued with the new Italian patriotism, and cordially detested the “rule of the monk.” Passionate in her love for her country, she eagerly caught at Mr. Crowe’s atheistic and revolutionary notions, and, repellent as he appeared to most women, he succeeded in winning her love, more by his professed sympathy with the cause of Italian independence, and his hatred of the Bourbon and Austrian, than by his own personal attractions. Downright ugliness in a clever man is often an additional attraction, even to a handsome woman; and Mr. Crowe’s science and revolutionary sympathies found their way to Olympia’s heart, during an autumn holiday he passed at the lakes. She must have loved him very much, or thought she did, or she could never have torn herself away from the beloved mountains and the blissful lake to bury herself in a wilderness of brick in the heart of London. However, she had not been married a year ere she began to pine for her picturesque home by the waterfall in the midst of the vineyard at Cernobbio.
She soon found that her husband’s interest in Italy was merely that of a destroyer – he cared only to upset the old order of things everywhere, loved anarchy for the sake of pulling down something venerated by Christian folk, and was insusceptible of sympathy with patriotism. Soon poor Olympia was disillusioned; her husband was absorbed so completely in his unpleasant branch of science, that she had little of his company, and gradually was entirely neglected. She had few friends in London, and none of the resources that would have helped an Englishwoman similarly situated. It was not long before Mr. Crowe threw off his mask. He cared for her less even than he cared for her country: it was plain that he had married for money, and had not realized his expectations. Working as he was doing for European fame, engaged in researches which could only indirectly bring him reward, it was irksome in the extreme for him to have to devote valuable time to patients and pupils, for the sake of earning a living. He had trusted to a good marriage to liberate him from these necessities. Never a very ardent lover, he showed disgust when his neglected wife sought a miserable refuge from her grief in narcotics. She gradually neglected her personal appearance, and declined her food, occupying herself with painting and music, but not sufficiently to absorb herself in these pursuits; she slowly wasted, and ultimately lost her health completely. Then her sleep forsook her, and she took chloral by her husband’s suggestion. Its fascination held her in a bondage, from which she had no sufficient energy to escape, and in mind and body the beautiful Olympia, so recently the flower of her mountain home, became a wreck, Her very presence soon became an annoyance to her husband, and for days together he would absent himself from the house. She was so irksome to him, that had he any deity in his pantheon who could have assisted him, he would have prayed for her death. The sole deity he acknowledged was the one who only helps those who help themselves; and at times a dark thought occurred to him that some day he should be compelled to come to his own assistance – the methods of carrying out such an idea were all too easy and too safe for a man with his knowledge and in his position.
