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

Æsculapius Scalpel

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

CHAPTER I.

THE FIRST OF OCTOBER

“Homines ad deos nullâ re proprius accedunt quàm salutem hominibus dando.”

Having selected medicine as a profession, the usual day for a man to enter on a course of study at one of our great medical schools is the first of October. The almanack tells us this is the feast of St. Remigius, the day on which Cambridge term begins and pheasant shooting commences. Neither of these interesting facts, however, explains the opening of the medical schools on the day in question; nor is it explained by the circumstance that this period is the anniversary of the institution of the order of merit for Folly, created at Cleves in the year of our Lord 1381; nor by what good old Thomas Fuller tells us of the holding of Lawless Courts, or Curia de Domino Rege Dicta sine Lege on Kingshill at Rochford in Essex; though some non-medical antiquaries, holding the learned profession of medicine in low esteem, have pretended that a day sacred to folly and lawlessness is peculiarly appropriate for the commencement of the curriculum of a medical student. We will not, like the ancient philosopher of whom Montaigne speaks, seek for learned and obscure explanations when our serving maid can offer us a simple one, but will state at once that the medical schools open at this season of the year because the weather being now cool, corpses set apart for dissection keep well! Thus did scholastic speculation vanish before the timely discovery of the legend, Bill Stumps, his X mark. This day of high festival at all the hospitals to which medical schools are attached is celebrated in various ways. An inaugural address, given by one of the staff, has long been the custom at the most famous of these; and on such occasions the freshman is usually staggered by the picture of the awful responsibilities he has undertaken, and made aware that he has devoted his life and energies to the loftiest, noblest, and worst paid calling he could have possibly selected. He is assured that he will be a benefactor to humanity of the highest type, but must expect neither gratitude, wealth, nor elevation to the peerage; that although he will, if he join the Army Medical Service, be looked down upon as only a superior kind of camp follower; that, as Dr. Abernethy used to say, if he does not claim his fees “while the tears are about,” he stands a good chance of losing them – so prone is an ungrateful country and a forgetful client to ignore the doctor when the danger is over. Notwithstanding all these drawbacks, however, he is assured he will find in the commendation of his own conscience an ever-sufficient reward for his devotion to suffering humanity. All successful professional men talk more or less of this pessimistic cant, like the Chancery judge who addressed a batch of newly admitted barristers-at-law in these terms: “Gentlemen, I cannot congratulate you on the profession which you have chosen. It is one in which very few succeed, and most of those who succeed wish they had failed.” The fact is, with professions and business, as with wives, men get just as much success as they deserve. These sentiments produce on the newly entered pupils their profoundest effect, but they are totally lost on the older ones, who declare them all humbug, and only intended to gull the public who will read them in the daily papers. Many of the seats are always filled by medical men who were educated in the hospital and school attached, who like to hear these time-honoured sentiments, reminding them of the happy period when they entered their Alma Mater with an enthusiasm long since damped by contact with the harsh world without. After the address, the prizes won by the successful students are usually distributed, and the teaching staff dine together, and the students go off to make a night of it, and show their new companions a little life about town.

“The learn’d physician, skilled our wounds to heal,Is more than armies to the public weal,”

On this particular first of October with which the present history is concerned, Harrowby Elsworth affiliated himself to the old and honoured medical school attached to St. Bernard’s Hospital, London – an hospital of high reputation, with a great and renowned school of medicine. He had distinguished himself at Oxford, and had selected his profession with the determination to do well in it, as he had done with all he had hitherto put his hand to.

He was a tall, slim fellow, standing six feet one in his stockings, so dark in the complexion that he might have passed for a native of Southern Europe. Although rather an Apollo amongst men, his graceful bearing and manly carriage were not the characteristics that gave him a passport at first hand to every one he met. It was the full, deep, earnest, clear, and honest eye, by which you could look into his soul. At a glance you took this in; there was no mistaking that, in the handsome young fellow who confronted you, there dwelt a spirit as brave, strong, and well braced as the frame that held it.

He had long since lost his mother – so long ago that he could but just recall her image as that of a tall, fair, delicate, blue-eyed woman, who had left her heart on his lips on the day she died.

His father was a retired Indian officer, who had seen much service, and had greatly distinguished himself in the Indian Mutiny. He had been severely wounded, and returned to England. Having recruited his health after several years’ stay in Cheltenham, he went back to the scenes of his former victories to occupy himself with investigations concerning the ancient literature of the Hindoos. He soon became so completely engrossed in this work, in which he hoped to cover himself with no less glory than in his campaigns, that he determined not to trouble himself with his native country or its affairs till he was able to announce to the learned societies of Europe the full fruition of his labours. He was a good man, and had been a kind and generous father, but became so enwrapped in his musty literature as to be practically dead to his duties to his only son, who, with all his kinsmen and friends of his fatherland, had become of very much less importance to him than the Sanskrit poem he had just discovered hidden in an image of a cross-legged Buddha serenely contemplating his epigastrium. So it having been finally settled that Harrowby was to be made a doctor, Major Elsworth arranged with his agents in England to pay the necessary fees, and settled on his son a sum of £300 a year for life, so that he might be free to pursue his own calling untroubled by the smaller anxieties of life till his profession should afford him a more ample subsistence. All these matters having been finally concluded, at the expense of much distraction from the Mahâbhârata research, the old gentleman felt disburdened of a long-standing load which had often impeded the even tenor of his work, and once more settled down to the classic heroes of Indian song and the legends of his mythic age. He felt that Harrowby was off his hands, and gave him very plainly to understand that, pending the completion of his great work on the Origin of the Mahâbhârata Poems, he must have no disturbing communications requiring any reply from him. Acting upon these hints, Harrowby very rarely troubled his father with any letters, and still more rarely had any replies to them. He made up his mind that when he had done all the work at the hospital he wanted to do, he would go out to his father, and spend a year or two with him before finally settling down to practice.

CHAPTER II.

THE SCHOOL OF ANATOMY

Foremost in the regal classNature has broadly severed from her massOf men…– Browning.

Elsworth entered the profession of medicine with a large stock of a commodity just now rather out of fashion with our young men. This limp and degenerate age seems unable to supply our youth with backbone enough to make them enthusiasts about anything beyond dress, the Opera Comique, and the quality of their tobacco. They adopt a profession without at all intending it shall absorb them; they consider it a sign of weakness to show a consuming interest in great subjects, and their energies are frittered away on the most trivial concerns. How many men enter the Church, not as though Heaven-sent messengers, but as affording them a pleasant way of getting on in life! As for a message to mankind or a call from God, it would be too much in the way of the Methodists and Salvation Army people to be consistent with their notions of propriety. What they have to offer the world may be taken or left without interfering in the least with their peace of mind. Hence so many empty churches, while our courts and alleys are full of folk perishing for lack of knowledge which nobody is sufficiently interested to impart, except in a perfunctory manner. It may be all very well for good Mr. Spurgeon to be consumed with desire to save souls; that sort of thing may be consistent with life in the “region of the three D’s” (Dirt, Dissent, and Dulness), over the water. But fancy anybody in Pall Mall or the Row being “so dreadfully in earnest, don’t you know!”

Such being too commonly the case with the Church, what can be expected of medicine? Inaugural addresses and the classic poets notwithstanding, it is rather too much, they say, to expect fellows in the nineteenth century to live up to an ideal guild of St. Luke. Now, by a beautiful instance of the law of compensation ever active in Nature, just as men are voting enthusiasm bad form, women are taking up the work men are too limp and too selfish to perform, and the spectacle is presented to the eye of hundreds of noble, clever, earnest, indefatigable women coming forward to fill the places which men decline, and leaving work more congenial to their habits and tastes, because men lack the energy and sympathy required to effect the necessary reforms. The salt of the earth is now fast becoming a feminine compound.

But the man of our story was a true man, not a nineteenth century sham; he had his enthusiasms and was not ashamed of them, was a sentimentalist if you will, and was proud of the title. He had an idea that no good had ever been wrought in this world except by enthusiasts and sentimentalists. He felt that sentiment was thought sublimed, and enthusiasm the holy fire that exalted it; his prayer was to be classed with the band of workers who had helped their world; and when he decided to enter the portals of a great hospital, it was not to make his account with fame, to exploit the poor and suffering for his own advancement, but just simply to have the satisfaction day by day of having, by even ever so little, diminished the awful sum of human misery. It was a perfectly contemptible ideal, an absurdly insufficient goal to nineteen-twentieths of the men who that day had enrolled their names in the books of the hospitals of the kingdom; but it was just simply his ideal and his goal, and he thought no other profession would help him to attain these like medicine. “The parson,” he used to say, “sees men at their best, the lawyer at their worst, but the doctor as they are. I will be a doctor.” Now of all things which Elsworth was not, least was he a prig; so that he had no idea of the very unusual nature of the impetus that was driving him on a medical career. He thought, in his ingenuous way, that such impulses moved his fellow-aspirants. This sentiment was to be modified.

In what a world he found himself! He had several friends on the staff, and some half-dozen of his fellow-students were more or less known to him; but to what others was he introduced! In a couple of hundred young men one looks for variety, one expects that some will be heedless, vain, indolent, or vicious, while others are earnest, industrious, and true. But who were these men he saw to-day, and how came they to adopt the sacred ministry of healing, the work of the great Physician Himself?

Rough, rowdy, vulgar, and decidedly unintellectual as many of them appeared, with all the characteristics of the fast man about town, the profession they had chosen to follow seemed likely to suffer at their hands, if these men were fair samples. It has long been the habit of society to view with great leniency the peculiarly Bohemian manners and customs of medical students. The very term has become the symbol for rollicking rowdyism that would be tolerated in no other class. Their boisterous mirth, rude violence, and disregard of the ordinary proprieties of civilized existence have become recognised as their appropriate conduct, partly no doubt because their lugubrious occupation at the schools needs relaxation of a pronounced kind, and especially perhaps that as they must when in actual practice become the gravest and most “respectable” of men, it must be permitted to them to compress into their student life the follies, the riotousness, and the highly flavoured pleasures that must suffice for the rest of their mundane existence.

Be this as it may, it is certain that from the patient in the hospital ward to the magistrate on the bench, conduct that would be considered in other men as intolerable and worthy of the severest punishment is in their case lightly passed over. On the part of the public at large, and on behalf of the men themselves, this is a great error, and has its foundation in a wrong conception, both of the work the students have to do and the sort of relaxation it requires. On behalf of the suffering humanity soon to become dependant upon such men for their help in sickness, a revolution in such a false system of education is no less urgently demanded. Unpleasant as the work of the dissecting, post-mortem rooms, and hospital wards, may seem to the outside world, its daily recurrence makes it so familiar to all engaged in it that it very soon ceases to be any more unpleasant than many other occupations. The men who take real interest in their work very speedily forget or do not recognise any of its disagreeables, while those who do not acquire this real interest in their occupation become mere hangers-on at the schools, and grow rowdy for want of better employment. The real students, with their hearts in business, do not seek or take such methods of unbending the bow; for the rest it should not be permitted them to insult their noble calling by behaviour that would disgrace savages in unexplored tracts of equatorial Africa.

The sooner a more common-sense theory of medical student life is adopted by the public, the better for the world and the men themselves.

Young Elsworth, then, was not altogether pleased with what he saw of his future companions, and it took him but a short time after his entry at the schools to see that not more than half of the men by whom he was surrounded would be for him even tolerable class mates.

The opening festival was over, and early in the following week he began the work of dissecting. He had previously bespoke of the College beadle what is known as “a part,” for be it known to the outside world that a well conditioned corpse having no friends to claim it after death in the hospital or workhouse which saw its owner’s last moments, is by the Anatomy Act permitted, under certain legal restrictions, to be used for dissection. To preserve it for the length of time it will require for some six or eight men daily working at it to unravel all its mysteries of muscle, nerve, artery, and vital organs, its blood vessels are injected by an ingenious process by the dissecting room porters with a preservative fluid which, permeating every part of the body, keeps it fairly fresh and arrests decay till the scalpel of the young anatomist has revealed all it has to teach.

Let us enter into the dissecting room of St. Bernard’s, and see how our future doctors learn to deal with the ailments our flesh is heir to. It is a spacious chamber, some fifty feet long by thirty feet wide; its floor is slate, cold, and non-absorbent; its walls half-way up of the same impervious material; it has no windows, but is lighted by a glass roof and many gas jets for dark days. On either side are eight strong tables, on each of which lies a corpse. Round each table are several heavy, well-made stools; they need be heavy. They are often subject to rough usage at the hands of their occupants when not engaged in more scientific work.

On this first of October, all the “subjects,” as they are technically called, are untouched by the knife; in a few days they will scarcely be recognisable as having ever been our brothers and sisters of the mortal life. The busy scalpel of the anatomy student will be engaged on every limb and feature in “getting out,” as it is termed, his “part.” Then the observant eye of a man of science would see how fearfully and wonderfully we are made. The Psalmist could have had but a faint idea how much his beautiful phrase conveyed. Here are displayed for us the exquisite sets of muscles and tendons that enable us to move our hands and arms. This part shows the nerve and blood supply of the leg, and that one the machinery by which we smile, laugh, or express our wonder and surprise. Here is a man at work seeking to unfold the marvellous convolutions of the brain, while at another table one has got down to the articulations of the foot, and is showing the pulleys and joints that enable us to walk. The art of anatomical dissection consists in freeing the muscles, tendons, arteries, veins, and nerves from the surrounding fat and connective tissue which in the living body preserves and covers them.

It is absolutely necessary that the student should not only know from books, but actually see with his own eyes, and for a long period attentively observe the origin and course of every nerve, artery, and vein which in the whole body is capable of being dissected out. He must know the exact position of all the muscles, how they move the bones, how they extend or flex the limbs, what nerves supply them with motive power, and how that nerve takes its course from the brain or spinal cord. The number of complications is so great that nothing but patient tracing out with forceps and scalpel for himself will ever teach a man anatomy.

As an accurate knowledge of this science is the foundation of all medical learning, it is not to be wondered at that the medical schools and examining bodies insist on a very long and careful training in the practical part of this study. So indispensable is it that the schools have never scrupled to obtain subjects for dissection when popular prejudice stinted the supply, by foul means when fair did not avail. No questions were asked in the old days, before the passing of the Anatomy Act, how the “subject” was procured; enough that it was on the table for the uses of science. Whether murder had brought it there, or the visitation of the graveyard by the body-snatcher, nobody concerned in teaching or learning anatomy cared a jot.

In one famous school there was a private trap through which the corpse was pushed into the porter’s room, he passing the money out to the persons who delivered the body, and holding no communication with the body-snatcher, or even seeing his face. Things, however, are different now, and the workhouses are permitted to send the bodies of friendless and unclaimed paupers, whom nobody owns or cares to bury, for the purposes of dissection.

Dissection and the making of a post-mortem examination, though often confounded in the public mind, differ materially. Dissection consists in minutely tracing out all the important structures of the limbs, body, and vital organs, and thus it takes several weeks’ hard work to get through a whole subject; while a post-mortem examination is the labour of an hour or two, and consists in examining and noting the pathological conditions of the internal organs, with a view merely to discovering the cause of death. An adult subject is worth about £5 when properly prepared for research. Each arm and leg, the half of the head, the chest, and the rest of the trunk, was charged to the student requiring it at St. Bernard’s, 12s. 6d., and he was expected to make good use of his opportunity. Every portion removed by his scalpel was carefully gathered up by a porter, and every night and morning placed in a coffin in the vaults below. When a coffin is filled with this minutely divided humanity, it is sent to a cemetery and buried as “our brethren and sisters departed.” The provisions of the Anatomy Act forbid the taking of any portion of the subjects out of the schools; nevertheless more than one ardent student whom we see in the room will finish his work on the hand or the foot at his own lodgings, to the horror and disgust of his landlady if she catches him at it.

Some men never make good dissectors; they can cram up what they want for their examinations without the infinite pains required for a beautiful “preparation” such as is being made at this table on our right for the college museum. It is an arm, and every muscle stands out clean and clear, every artery is seen with its vermilion wax injection running its sharply defined course, and anastomosing with its neighbouring vessels. Here are the nerves like silver threads, becoming, like the blood supply, smaller as they reach the fingers, till they are lost in their terminations at the tips. It requires a man with a special genius, and the gift of an infinite capacity for taking pains, to do work like this, and many take a pride in doing it.

Round this table on the left is a group of junior students, listening to the demonstrator, who is lecturing on the muscles of the chest, or thorax as it is called, and asking each of his auditors in turn some question to test his knowledge, and explain his difficulties if he have any.

The coloured diagrams round the walls, and the illustrations in the text-books used, serve to complete our acquaintance with the matter in hand, and its daily repetition fixes it in the memory. The men do their work in great linen blouses or aprons with sleeves. Most of them smoke, and the dissecting-room certainly is one place from which the most violent anti-tobacco agitator would hardly wish to banish it, if he knew how it mitigates its awful odours. When the morning is over, and the men have taken their lunch (they eat sandwiches at their work without the least fastidiousness), few of them return for any more work in that place unless they chance to be very industrious. There are some few men who, in their first and second year, dissect on every available opportunity; for anatomy cannot be crammed, and can only be mastered by this persistent business of the scalpel. Occasionally a visitor will drop in to look round at the work going on; some general practitioner who has been at the school in his early days, to refresh his memory on some point, or to rekindle for a few moments the lost enthusiasm in such studies. Often they tell good stories of the difficulties they had in the olden time of procuring bodies. One old fellow who had been a demonstrator in that room, told one day how, on one occasion some fifty years before, he had been urging the beadle to provide more subjects.

“Can’t get you a fresh ’un before this day week, sir,” replied the man. “You see, sir, it is my mother-in-law. She only died last night. She will be buried on Thursday. We’ll have her up the same night, and she’ll be ready next morning for you.”

And then he related how the body-snatchers went to Bow Cemetery, then almost out in the country, and “resurrected” the poor woman, stripped her of her shroud (to take which was felony), put her in a light cart, and drove off with her. On either side of the Bow road at that time were fields; it was very dark and lonely. When half-way towards their destination they feared they were closely pursued, and to avoid a capture they cast the body out into the ditch, and made off with all haste. Next morning there was a report of a horrible murder. An inquest followed, and an open verdict was returned, name and cause of death unknown.

Close by the hospital there dwelt an aged man with his daughter in genteel poverty, a learned and serious person, who seemed to have known better days. His conversation was charming, and his society was much sought after, but seldom accorded. He kept himself apart from his neighbours, and held no more intercourse with them than was necessary for the amenities of life. But he was on good terms with the St. Bernard’s staff, often strolled through the dissecting-room and the museum, and was generally present in the operating theatre when anything of special interest was “on the table.”