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

This drink-madness was often found to be hereditary, as were many other maladies. Very often the taking of the family history involved the collection of very curious facts from the patients’ relatives when they came to visit their sick friends. Idiosyncrasies were often traced several generations back, odd deformities and bodily peculiarities persisted in families as explained by Darwin, and illustrated the fact that a man thinks and reasons in certain grooves wherein have run the wheels of thought of hosts of his ancestors. A descendant of a Huguenot refugee remarked lately that his nerves had not yet got rid of the terror infused into them by the hair-breadth escapes his progenitors endured hundreds of years ago. It is said the whole world feels the effect of the stamp of one’s foot on the ground; not less is it true that our habits and work will influence the minds of untold generations of our successors.

True psychological medicine is less understood in the present age of science by our doctors than it was in the East thousands of years since. It will scarcely be credited that the great, the overwhelming majority of medical men can and do obtain their diplomas to practise, and attain to all the honours of their profession, without ever having heard a lecture on mental diseases, seen the inside of a lunatic asylum, or examined a person of unsound mind, except in connection with some physical signs indicating bodily disease, as in the delirium of fevers. In connection with some medical schools facilities are offered to the students to visit a neighbouring asylum for clinical observation, but it is extremely rare for them to avail themselves of the privilege. One may pass half a score of examinations at the various boards which have the power of licensing the practitioner who is to be charged with the duty of aiding by his counsel the families amongst which he will practise in a hundred forms of mental affliction, without having ever been asked a single question bearing upon psychological medicine. The student will be required to state with the minutest accuracy the stages of great operations which there are ten thousand chances to one he will never have the chance of performing, and a still remoter probability that he would have either the knowledge or the nerve to perform if he had the opportunity. He will be minutely cross-examined over obscure and rare complaints which it is extremely likely he will never see in his own practice if he live to Methuselah’s age; yet he will not be required to diagnose the difference between melancholia and hysteria. At the same time it is quite true, if he be an industrious man, he may learn a good deal about these mental maladies if he attend the lectures of the physicians who make them their speciality, but this is optional; he does not get any credit for it in his schedules; he will not be advancing his chances of a “pass” by so doing, and there is much temptation if, amongst so many things which a student of medicine must know, he holds in light esteem some things about which he may or may not trouble himself at his discretion. The study of mental phenomena occupies the attention, then, of but few, and those only the most cultivated and thoughtful of the students. To the Sawbones it is like cuneiform inscriptions or the domestic economy of the Hittites. Is not this a scandalous blot on our system of medical education? Yet every half-educated, idle, and beer-boozing young man who can get one foot on the medical register, and write L.S.A. after his name (implying that he has the licence of the Apothecaries’ Society, Blackfriars), has the legal power to sign a lunacy certificate which may consign anyone of us to the walls of a mad-house! Would this be tolerated were it understood? It is recorded of Garibaldi that in the war against the Austrians in Lombardy, he was seized with the marsh fever in the midst of one of his campaigns. The malady soon turned to typhus, and he was given over by his physicians. Lying at Lerino at the point of death, he heard the wild shout – “The Austrians!” The enemy had suddenly come down upon the little town, and the slaughter of his followers had begun. Springing from his bed with an infusion of new life in his veins, he buckled on his sword, and led his troops, inspired by his own wonderful personality, to conflict and victory. What was the influence of the mind in effecting this cure? Ah! that is no part of a medical curriculum. Mesmerists, spiritualists, theologians may deal with that as best they may – it is beneath the notice of the colleges.

A fact like this is surprising only to those medical men who have never studied psychological medicine.

The miracles of Lourdes and of hundreds of other Catholic shrines need not be denied altogether as unworthy of credence. There is abundant evidence that some cases of cure do really occur in connection with faith healing. Those who have made a study of mesmerism have adduced instances of healing by its means which it would be foolish to deny. So much charlatanism and fraud have always been mixed up with these things that it is not perhaps matter of much surprise that they are held in low esteem by men of science. Still, as there are undoubted phenomena in connection with them worthy of patient examination, it is surprising that so prominent a field of inquiry should be so completely neglected by our doctors, while it is considered necessary to know precisely how long a dog covered with varnish would live, and how many degrees of heat a rabbit can tolerate before succumbing to its agony. A young lady of hysterical temperament, who had been humoured to the top of her bent by her medical man, had, after a few months of gynæcological treatment, become so enfeebled in mind that she imagined she had lost the use of her lower extremities, and even succeeded in inducing her doctor to believe that she really was unable to walk. She was advised to consult a well-known hospital physician, who was chiefly celebrated as a true mind doctor. When he took his seat by the couch of the invalid he soon diagnosed her malady, and, finding she was of high intellectual culture, asked permission to read to her. The doctor was an admirable reader, and his rendering of a long and soul-stirring passage from one of the great poets made the girl forget her ailment so completely that she sprang from her couch with energy as he paced the room declaiming the poem, and exclaimed, “Is not that magnificent?” At that moment the deluded woman found the complete use of her limbs, and a few more readings cured her without other medicine. They don’t teach this sort of things in hospitals, – not the curative part, at least. Examiners at the colleges would “plough” the man who ventured to propose readings from Shakespeare three times a week with dramatic action as a remedy for hysteria. What they want is —

R. Tinct. Valer. Am. dr. j; Potass. Brom. gr. x.

Aq. Dest. oz. j; ter die sumend.

You see, it has been discovered by physiologists that if a solution of the bromide of potassium is applied locally to a rabbit’s heart, it produces instantly marked lessening of its action,3 and if applied to the muscle of the frog it throws it into tetanic spasm.4 On the nerve trunks it acts as a paralyzing poison;5 in fact, if you inject it in the vicinity of a living dog’s heart, “cardiac arrest always occurs.” So that you see how easily the physiologist can demonstrate how bromide of potassium quiets the excited nervous system of the hysterical ladies. You do not quite follow the reasoning? Well, do not tell the examiners that, because they declare it is quite plain to them, and helps to prove the value of experiment. Now, as there are no instances given in any books of physiology known to us, detailing any effects produced on the hearts or brains of any mammals by the dramatic reading of poetry, it would be manifestly unscientific to treat lady patients by any such method. Moreover, as it is of no use to cure anybody if you cannot demonstrate precisely how you cure him, it is better to let him alone.

The mind specialist who effected these remarkable results was answered by his colleagues who went in for the rabbit and dog theories that in the first place the patient wasn’t ill at all; secondly, that consequently she was not cured; and thirdly, that she was still as ill as ever. But the good physician still holds on his course, speaks with growing disrespect of the Pharmacopœia, studies Nature, but does not “put her to the question,” and takes hints from old women, birds, trees and flowers; and like another Paracelsus, is ridiculed by his professional brethren in proportion to his success in unorthodox methods.

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 waysWith something you o’erlooked, forgot, or chose to sweepClean 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 needsTo 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.