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

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.

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.