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

CHAPTER XIX.
AN APT PUPIL

 
Gentle friends,
Let’s kill him boldly, but not wrathfully;
Let’s carve him as a dish fit for the gods,
Now hew him as a carcass fit for hounds.
 

– Shakespeare.

I hold that we should only affect compassion, and carefully avoid having any; it is a passion that is perfectly useless in a well-constituted mind, serving but to weaken the heart, and being only fit for common people, who, never acting by the rules of reason, are in want of passions to stimulate them to action.

– La Rochefoucauld.

Walter Mole was assistant to Mr. Crowe in his laboratory. He was twenty two years of age when he entered St. Bernard’s. He was the youngest son of a speculative builder in the West of England, who having made a fortune by erecting many streets of stucco-fronted villa residences (built on ground the gravel of which he had dug out and sold and replaced with the contents of the dust-bins of the town), was ambitious to settle his sons in life in the learned professions. He tried hard to make his eldest a clergyman, but as he lacked the ability even to conceal his evil habits, he sank back to the gutter from which it was impossible to raise him, and followed the entirely congenial calling of a billiard marker. The aspiring parent still determining to make capital out of evil and unpleasant things, sent his smart, pushing little cad of a son Walter to St. Bernard’s, to bring honour to the family name as a surgeon. Mr. Walter Mole was a very diminutive specimen of humanity, making up however in conceit, as is often the case, what he lacked in inches. Mr. Mole was a young man of aspirations. Sharp at his books, he had done so well at the cheap boarding school where he had got his education, that he had no difficulty in passing the examination in arts required by the very moderate ideas of the Apothecaries’ Society of London. By industry and a plodding perseverance, combined with an intense desire to elevate himself in the social ladder, he ingratiated himself in the favour of the Professor of Anatomy, who made him a “demonstrator,” a kind of anatomical pupil teacher. He won the scholarship in anatomy and physiology; by constant practice he acquired a nice dexterity with his fingers, and his dissections were so accurate and careful that many of them were honoured with places in the college museum. Now Mr. Mole, although popular with the lecturers, was detested by the men. He was, in the first place, not a gentleman; everything he said or did proclaimed him “Cad.” His oily hair, and still more oily tongue; his dirty finger-nails and dirtier ideas; his paper collars and imitation jewellery; his low money-grubbing propensities; his scheming cunning to win the favour of those who could help him, and his insolent contempt of those whom he considered to be beneath him in position, made him detested by the men of the school who were unfortunate enough to have to associate with him. To thrash him was of no use. Who could fight such a contemptible object? So all sorts of tricks were played upon him, which he resented in his own way; and as he had much influence with the authorities, his resentment was not always to be despised. As he did a good deal of money-lending at exorbitant interest, he was always able to secure the favour of the very considerable section of the men who were in his debt. Such a man can always hold his own, and Mr. Mole held his at St. Bernard’s, and was not to be put down. If popular dislike could exterminate – say – toads, how few would be left! And as toads must have some use in the economy of nature, there is no knowing what disarrangements of her plans their disappearance might effect. There was possibly some use for Mr. Mole, or “Molly Cular,” as he was usually called. He acquired this epithet from a mispronunciation in his early days at the hospital of the term “molecular,” and the nickname stuck to him even when he became house surgeon. His eye was as quick as his hands were dexterous, and as Jack Murphy used to say, “Mole was cut out for a pick-pocket, but spoiled in the making.” When assisting the lecturers he never failed to detect the larking student who was causing all the uproar, and many were the men who lost marks and favour by the watchful supervision of Demonstrator Mole. His sensitiveness to ridicule served to improve his taste, and he gradually acquired correctness of pronunciation and much general knowledge from sheer dread of the suffering he would have to undergo if caught in the slightest mistake. He had endured so much for dropping his h’s that he fell into the opposite error of a too liberal use of the aspirate. He so economized the truth that he never used it unnecessarily, and was as sparing of it as of his money, though probably not for the same reasons. Of course he scoffed at religion as something beneath the notice of an advanced scientist, and was never more in his element than when shocking some pious pupil by a coarse joke twisted out of Biblical language, or a metaphor which was perverted from a sacred subject. His familiarity with Holy Writ enabled him to shock a great many good people, and amuse some evil ones; but even they were few, as it is rightly considered the mark of a vulgar mind to make fun of any man’s faith. This habit ultimately caused complaints to be made of him to the college board, and he was cautioned that he must abandon it if he expected advancement. Hating religion, which was a constant rebuke to all he loved best, he threw himself with renewed zest into the pursuit of science, which was too cold to reproach him with anything, and he determined to win respect for services rendered to physiology which he could scarcely hope could be conceded for anything else within his reach. He was not loved; he determined to be respected. Soon he found his opportunity. A skilful and patient worker at the microscope, he earned much favour and profit from Mr. Crowe by his admirable pathological work. Many thousands of beautiful sections and other objects in the microscope room were the result of Mr. Mole’s deft labours in this direction. He became indispensable in the physiological room, and the constant attendant on the researches of his master. There was a common sentiment which drew these men together. Both feeling that the world did not love them for themselves sought to compel admiration for their achievements. Both were essentially cruel at heart; both would not only have gladly botanized on their mother’s graves to discover anything to win them credit, but would have learned with pleasure anything they could from the sufferings of their dearest relations. Mr. Mole took care that his chief never ran short of dogs, rabbits, guinea pigs, mice, or frogs, for use at the tables and troughs. To show his devotion to this work he even gave up a worn-out retriever which had saved his life a few years before by arousing him from sleep when his chamber was on fire. What greater proof of devotion to one’s work could be demanded than this? But he would have done even more to win favour with Mr. Crowe. Had he not been introduced by him with high encomiums to several learned medical societies, and had not his early attempts at writing for the scientific journals been aided by his counsel? Such a friend was worth a dog or two. He laboured at first, above all things, to win Mr. Crowe’s favour; then, as the work began to be familiar, he embraced it with an ever-increasing love. It did not give Mr. Mole much difficulty to rid himself of the outside prejudice against causing needless suffering to sentient beings, though when he first began, it was not with the “true spirit of the artist” that he approached his work. But this came in time, and now not alone on Mr. Crowe’s account, but for its own sake, this laboratory business took hold of every fibre of his being. He revelled in it; he spent in it his nights as well as his days. His Sundays were specially devoted to the more private, revolting, and awful exercises which Mr. Crowe would only share with priests of the inner temple of science. Here one vied with another who could do the most startling things, who could invent newer forms of torture.

CHAPTER XX.
THE PROFESSOR AT HIS WORK

Doctrines and maxims, good or bad, flow abroad from a public teacher as from a fountain, and his faulty lessons may become the indirect source of incalculable mischief and suffering to hundreds who have never even heard his name.

– Sir Thomas Watson.

Physicians vary their prescriptions to give the disorder an opportunity of choosing for itself.

– Lacon.

As Mr. Crowe was surgeon to the hospital, every new experiment and each fresh result was religiously tried upon a human subject. Being a man grateful for any little services his assistant rendered him, he repaid him in various ways, one of the most valued rewards being the privilege of trying “any new drug you may take a fancy to upon any of my patients, Mr. Mole.” None of Mr. Mole’s services went unrecognised, and the acknowledgment was not costly to the professor. The sufferers in the wards where his beds were located would not have seen the matter in precisely the same light had it been explained to them, but Mr. Crowe was really generous – with other people’s pain!

“I wish to investigate,” said one of his dressers, “the presence of lithic acid in the blood of rheumatic patients. May I blister one or two of your patients, Mr. Crowe?”

“Oh, certainly,” said the obliging physiologist; “only you must take precautions to let the patient imagine you are doing it for his benefit, and be careful the nurses don’t see what you are about – nurses are getting so ’cute now-a-days. With these provisos, you are free to roam at large, my friend, over the bodies of any of my clinics.”

Several poor men and women broke out in great blisters the following morning, the serum from which was carefully collected and evaporated in the laboratory for pretty crystals of lithic acid. “They look very nice if carefully mounted; but mind you place a black circle round the covering glass, it shows ’em up better. Grumbled a bit, did she? She must have the battery again if she is intractable.”

Jack Murphy, a merry, reckless little dog as we know, used to tell a droll story of his first bit of skin-grafting in the wards.

“Graft him,” said Mr. Mole. “Don’t know how? Oh, you just snip bits of skin off his arm and pop ’em on the raw surface of the burnt leg, and in a few days you’ll find ’em growing like watercress all over the shop. Perfectly simple. One of the grandest discoveries of modern surgery.”

Now these directions, although satisfactory to the adept, were wanting in lucidity to the pupil; and Mr. Murphy, who never liked to admit even to himself that there was anything in his profession too hard for him, went down into the erysipelas ward and set to work upon his wretched victim with a light heart.

“Going to heal up your leg, old chap, in a brace of shakes. Splendid invention for putting a new skin on your leg. Sha’n’t hurt you a bit. Don’t squeal. I’m just going to snip off a tiny bit or two from your arm, and transplant ’em on to your leg.” And having cheered up the patient with a stiff glass of grog which the nurse had at command, the vigorous young dresser took off a dozen or more pieces of skin the size of a threepenny-piece, from the arms, and scattered them in likely places on the badly healing burn.

When Mr. Murphy entered the dining-room that night, he was received with a perfect roar of laughter from the house surgeons, who had become aware of the ignorant barbarity the burnt man had suffered; and Mr. Murphy was made to know that his idea of a snip of skin for grafting was at least a hundred times in excess of what it ought to be, and that for the future he must be less generous with his pound of flesh. Even the patient found out the error, and Murphy, who was a good-hearted fellow, wished he had known more about skin-grafting before he had punished him so. It was some weeks ere the victims arms healed, and the scars remain now, and even the operator is still sore when the subject is referred to.

It was wonderful how they managed to get the patients to take all the new remedies that were tested upon them. Folks are usually very careful as to the physic they swallow. Your poor folk do not mind it being nasty, they rather like it thick, with a good rich, nourishing sediment and an awakening odour; but they are very suspicious of anything that gives them queer sensations. They often return to their doctor with a bottle of stuff which he has prescribed them, and declare that they “cannot take any more of it, because the first dose made them feel as if all their senses was a-running away from them down their right arm, making them feel that strange in their toes as they seemed as if they wore going to die.” And this when the poor practitioner has merely given them perhaps a little quinine, or some simple diffusible stimulant! Their confidence seems to come with the increase in the number of their medical attendants; and when the chief surgeon, with his dozen of satellites, supported by several capable-looking nurses, has ordered them to take a decoction that works in their systems as if scorpions and tarantella spiders were careering through their veins, they submit with meekest resignation, and admire the regularity with which their doses are timed. You can do things in hospital it would be as much as your life were worth to attempt outside. A hospital doctor may steal the horse where a general practitioner dare not look over the hedge. “It’s the confidence as does it,” Mrs. Podger used to say. But not always. Some do resent. The spread of Socialism, the tracts of the various societies which dare to question some of the cherished privileges of the profession, and the general uprising against all authority that characterizes the present age, have produced a class of patients who provokingly assert their right “to know what you are about with them.” Such are awkward people of whom to make use.

These persons are not liked in the wards, and are frequently cured right away and sent about their business with indecent haste. A sort of ungrateful folk that want to get all they can out of the hospitals, and then be off. A most unappreciative class, which seems a growing one too. “Like to know what they thinks ’ospitals is for?” said Podger. “Seems to me they think ’em ’otels!”

Latimer complained in his day, that “physick was a remedy prepared only for rich folks, and not for poor, for the poor man is not able to wage the physician.” He could not fairly say that now. It is possible, if good Master Latimer were preaching one of his plain sermons at Paul’s Cross, he would complain for quite an opposite reason.

CHAPTER XXI.
TAKEN IN

Although hospitals have been intended as a blessing and benefit to the poor, they have too often proved the reverse, on account of the ignorance on the part of their administrators of the true principles of health.

– Encyclopædia Britannica.

 
There are diviner, truer laws,
That teach a nobler lesson still.
 

Procter.

One of the greatest blots upon hospital management of the present day is the abuse of alcoholic drinks. The immense amount of spirits needlessly, and often not harmlessly, given to the patients is a serious tax on the resources of the charities, and a fertile cause of dram-drinking in the people at large. As you pass along the wards and read the cards over the beds, indicating the diet and amount of drink ordered by the medical officers, it is startling to see how many sick or convalescent patients are ordered six ounces of whisky or brandy a day. Now six ounces represent three wineglassfuls of good average size, or say nearly two bottles a week. This is expensive, to say the least – of very questionable service in most cases to say nothing more. That the custom has its advantages in an hospital like the one we were describing is indisputable – to the medical staff. Where a system obtains by constant worrying and painful, or at least unpleasant physical examinations, it is of great assistance to doctors and nurses to have at hand an unfailing means of putting and keeping the patient in good humour and benevolent docility. Does he object to be “mauled about,” as he sometimes inelegantly calls his dose of “palpation and stethoscopy,” his equanimity is at once restored by the comfortable words of the doctor, “An ounce of brandy, sister!” Should he object to his treatment, and rebel against the hallowed customs of the place, considering he has a right to the orderly arrangement and general integrity of his own limbs, he is a lucky fellow if upon an early date his spirit card is not reduced, or even taken away altogether. You could not manage St. Bernard’s on its present lines without alcohol. The medical school would not have a chance with it. Let us follow, say, Thomas Smith from St. Giles to the hospital. He has inflammation of the lungs, is very weak and ill, has been badly fed and cannot in his own home obtain proper care and nursing. His clergyman kindly gives him a letter for the hospital. He is advised to be at the out-patient department at one o’clock. To make sure, the poor fellow’s cab is there by half-past twelve; the great waiting-hall is already filling. The physician of the day arrives a little after two. About three, if he is lucky, Smith’s turn will come. He is not sorry. It was weary waiting, sitting upright on a hard bench in a great noisy, draughty room, with many distressing and painful sights around him; and when the kind, gently speaking physician tells his wife to strip him to the waist, he begins to think he is going to be cured straight off by some of the superabundant medical force surrounding him.

There are many interesting clinical features in Tom Smith’s case, and the doctor lectures long and learnedly to the score of good-natured, athletic young gentlemen whom he has just been informed are “sucking doctors.” They have all come provided with stethoscopes, and after the examining physician has thoroughly thumped, pummelled, and “auscultated” poor Smith’s chest, back and front, as many of the aforesaid young men who are invited, or who can be induced to interest themselves, “have their go” at the patient, and are very kindly and patiently shown precisely where the mischief is, and what is the exact stage of its progress; but all this could not be got through without an ounce or two of brandy in a drop of water, in a measure glass that stands handy. And everybody having quite done, with many remarks, such as, “You see the point I was driving at, Mr. Dobbs?” or, “You are quite convinced my theory of pneumonia is correct, Mr. Murphy?” poor, shivering, sick and faint Tom Smith is sent up to the wards to bed, under the care of an entirely fresh physician, physician’s assistant, clinical clerks, and students of the in patient department.

None of those men who have spent so much time over the case, will probably ever see it again. Smith’s cards, papers, and books having all been duly made out, signed and registered, he is conducted, say, to Magdalen ward, where he is put to bed and made comfortable. If he has brought any tea and sugar with him, he can have a cup; but these things are luxuries not provided by the charity.

When the staff has dined, the house physicians and surgeons, accompanied by their clinical clerks, dressers, and nurses, go their rounds. All the fresh cases that have come in during the day have to be examined. All that Tom Smith has undergone in the out-patient department goes for nothing, and the process is now still more carefully repeated. A minutely exact record of the “physical signs” is made; all that drumming of the fingers on the poor tender chest, that long stethoscoping at the panting lungs, whose every movement causes acute distress, has to be undergone; the heart sounds are scrupulously noted; its size and the line of demarcation of the liver and other organs recorded, not by the qualified doctor temporarily in charge of the case alone, but, by his kind permission, his assistant clerks also, for their education, verify all the recorded facts for themselves. “An ounce of brandy, sister!” and the man suppresses his growing discontent. His night temperature is recorded on the card above his bed, and now, if so disposed, he may say his prayers and compose himself to sleep. At six in the morning he will have to get his breakfast, for work in a hospital must begin early, or the wards will not be scrubbed and tidied up by ten o’clock, when the doctors go their morning rounds.

If the gentlemen who examined him overnight have been duly interested in their cases, they will have read them up from the approved text-books; and it will be strange if that reading has not raised questions and points that will necessitate a fresh examination. So the man gets another ounce of brandy, and another knocking about. At three in the afternoon the head physician – a fashionable West-End speciality man for diseases of the chest – goes his rounds, followed by a crowd of students. He makes himself responsible for each of the cases in the beds allotted to him, and naturally wants to know all about them, especially if any of them are likely to make good subjects for elaborate clinical demonstration. So with tenderest grace and the most honied phrases, with every courtly apology to the patient for disturbing him, the great man proceeds secundem artem to teach the young idea how to shoot. The junior in charge of the case, reads his report of the physical signs, family history, diagnosis and prognosis of the case, with the treatment proposed, while the lecturer verifies or objects to the statements of the record. He is so thoughtful, so kind and sympathising with the poor fellow on whom he is going to discourse for the next half-hour, that having noticed he is distressed by the process before it is fairly begun, he, in his most mellifluous tones, asks, “Would you like a little wine or brandy, my friend?” And the poor man thinks he would. Then have at him, lads! for here is a pretty case, a typical text-book case, and all you who are going up for examination had better get all you can out of Tom Smith, for here are “minute crepitations,” “vesicular murmurs,” “obscured resonance,” and if you watch the progress of the disease you may get “tubular breathing,” “bronchophony” “increased vocal vibration,” and no end of good things. Tom Smith remains in the hospital six weeks before he is “discharged cured.” He has suffered many things at the hands of his physicians; he has cost St. Bernard’s say about a pound a week, besides his medical attendance. Who says he has gone out without paying his bill? It has occurred to no one concerned, least of all to the patient, that there is anything wrong in all this treatment. In their passionate eagerness to acquire information that can only be obtained at the bedside, the assiduous students are of course delighted to have Mr. Smith amongst them. The house physician is soon going into private practice, and he wants to consolidate and confirm all his knowledge of the various forms of disease; the lecturer loves nothing better than to exhibit his really admirable powers of clinical observation to a body of rising men, who can send him many patients and more guineas. The patient is usually delighted that so much interest is taken in his case, and contrasts the hurried “Put out your tongue; give me your hand; take this medicine, and I will see you again in two or three days;” all in a hop, skip, and jump style, of the club doctor, with this elaborate marshalling of great medical forces for the purposes of his cure, sadly to the discredit of the club doctor’s hasty method.

Nobody sees through it all; – yes, the sisters and the nurses do. The former do their very utmost to soften by their kind assiduity evils which they think are inseparable from the work of a public hospital. The nurses do what they have to do; it is their business to execute orders, and they usually say little, whatever they may think. Then says the reader, “Who is aggrieved? What is there wrong in the system?” What is wrong? Everything! From the long waiting in the out-patients’ ward; the exposure of such a case while the preliminary examination is made; to the long and dangerous examinations of the stripped sufferer in the ward upstairs: with their constant repetition by so many persons; so that it is probable he would have made a better and speedier recovery under the care of the club doctor, who seemed hasty because full of business, but who thoroughly knew what he was about, and only did not waste time over matters his quick eye took in at a glance, and whose large experience was an additional sense. All that auscultation had nothing to do with the man’s cure, but a great deal to do with the education of those concerned in it; and as the treatment consisted in salines, tonics, poultices and rest, with suitable food at suitable times combined with good ventilation and cleanliness, the elaborate exhibition of therapeutic force was very much like cracking a nut with a Nasmyth hammer, only the cracking of the nut was but a detail!

It is possible that if all this could be knocked into Tom Smith’s uneducated head, he might not again lend himself so readily to the business; still less is it probable that all those cheques would be drawn in favour of St. Bernard’s, if the subscribers knew just how the case stood. They might ask with much cogency, “Cannot we get our nuts cracked without the use of those costly steam hammers?” And, after all, that is a very important factor in the case. For consider! It is only by much begging and by resorting to many stratagems that the governors can keep these charities going. Now if the charitable Christian public chooses to crack its nuts with steam hammers, we cannot offer any objection. It seems costly, but that is their business; but if they think their nuts can be cracked by no other and less costly method, they are very much in the dark. Let alone the fact of so much unconscious cruelty, wrought in the name of charity and mercy. Of that we have said enough. The fees for a complete hospital curriculum average a hundred guineas for the four years’ course, an absurdly small sum for such an education. In what other learned profession could such advantages be obtained for twenty-five guineas a year? But then the charitable public does not assist other professions so liberally as that of medicine.