The Necessary Evil

by André Couvreur

  What distinguished that dwelling from other similar ones situated on the same landing was a vast copper plaque fixed to the door, on which the following inscription was engraved in black letters:

  Institut Homeopathique de Passy

  founded in 1863

  for the cure of all diseases

  by Dr. Caresco’s system.

  Some time ago, the doctor’s name had been scratched out, and was almost no longer legible.

  Once through the door, one penetrated into a somber little room, scarcely illuminated by a window looking out into a gloomy courtyard. The furniture was of the utmost simplicity; it consisted of a few vulgar benches, dirty and greasy, disposed in parallel lines. Along the walls, frames enclosed attestations of cures.

  Pale-faced wretches sat limply on the benches, arranged in order of their arrival, clutching a piece of cardboard bearing the order number given to them on entry by a grave domestic in a formal jacket. They waited meekly for their turn to come to penetrate into Dr. Caresco’s consulting-room. To pass the time, some of them read the pinned-up letters, commenting on the signatures, comparing the lists of symptoms with their own; other chatted about the method—thirty years of success!—employed by the physician they were going to see, a method whose result had been cures so miraculous that the newspapers had reported them.

  In one corner, apart, having not found anywhere to sit down, stood a poor old grandmother preciously cradling in her arms the burden of a child who was dying of tubercular meningitis. She had summoned a physician to her home; alas, he had immediately diagnosed the malady and offered an estimate of the days of life remaining. There was nothing to be done in such a case, the doctor had said. However, as she had read in the newspapers about the cures obtained by Dr. Caresco’s new method, maddened by the fear of that crushing inevitability, determined to make the ultimate sacrifices, she had made the resolution to bring her child to the Savior.

  It was her whole life, that little parcel of flesh on its way to extinction, the daughter of her daughter, who had died at twenty-three of tuberculosis, the hereditary disease of the family, which she had escaped herself by a fluke of chance. She surrounded the infant with a thousand attentive cares, rocking her amorously, feeling a stab in her heart every time that a faint, plaintive, distant cry emerged from the baby’s dry throat, or a convulsion, revealing the whites of the eyes, passed like an escape of death from the body in which life was no longer reflected.

  Wearied by that cherished burden, which she could not put down, leaning against the wall, humble and pitiful, how anxious the wait was for her! How desperate were the glances she darted toward the door of that consulting-room, too slow to open again, behind which an imbecile faith told her that she would recover health for the creature dearest to her in all the world!

  Armand Caresco went through that room rapidly. The domestic bowed to the authority of his attire; a few of the wretches stood up as he passed by. He paid no attention to them and went into his father’s consulting-room without knocking.

  The latter was in the process of writing a long prescription for an old man who had just submitted to him the horror of a paralysis immobilizing half the body. He looked up and, without interrupting his task, said: “It’s you.” Then, turning to the old man, he said: “Here, my friend, this is what it’s necessary to do. Friction every morning; two granules at midday, two in the evenings, before meals. All that is written down. Go to get these medicaments from the pharmacist along the street, to the right as you go out. He’s the only one who can supply them. You can go.”

  The man made a vague gesture with the arm that he could still move, and, his heavy tongue making it difficult to get the words out of his lop-sided mouth, asked: “Will it cost much? I’m not rich...”

  “Does it cost much?” the old practitioner replied, irritably. “I don’t know”

  He knew perfectly well that the prescription would cost the poor devil eight francs, of which the pharmacist would give him fifty per cent—which is to say, four francs. The consultations were free, and that loudly-trumpeted gratuity brought people flocking to his clinic, but the payment of the account at the pharmacy—the only one who could supply the remedies he prescribed—was colossal. That was the arrangement the two scoundrels had made to rob the unfortunates, safe from any criminal sanction, their system being based on the most wretched thing in the world: the exploitation of the maladies of the poor.

  To be sure, a law exists that forbids these infamous and fortunately infrequent associations, but how can the abomination be proven? How can anyone be present in the wings to catch the bandits at the moment when they are sharing out the fruits of their theft?

  The man left, dragging his hemiplegia painfully. The father and son remained alone, looking at one another. The old physician had a benevolent, happy smile for the young surgeon, the pride of his old age. As Armand’s physiognomy remained grave, however, he became anxious.

  “What’s the matter, son,” he asked.

  The son did not reply, but, taking a newspaper out of his overcoat, he placed it before his father’s eyes. The homeopath immediately understood that it was a matter of an advertisement that had appeared that morning in a sensational form in the rag that Armand was holding out to him.

  “Well,” he said, “do you think there’s something wrong with it?”

  “Not that it’s badly-written; evidently, the audience for this sort of newspaper will be interested in the story of this little child condemned by everyone else and saved by you”—he had a slightly ironic smile—“but truly, Papa, you’re abusing publicity. You know that it harms me—why continue?”

  “But I haven’t put my name on it!”

  “That makes no difference; the sign of your clinic is sufficiently well-known and everyone can put the signature at the end of the article that isn’t to be found there. Thus, this morning, at the Hôpital de la Charité, I went into Professor Maral’s department and found a group of students in the process of reading the very article that I’ve brought. Oh, I promise you that they were paying, in venom, while listening to your prose being read out, and if you’d heard the reflections that those imbeciles were making...as unflattering for me as for you!

  “You must understand that it causes me a great deal of prejudice. I’m already very badly judged by the Faculté, whose qualified surgeons, the mandarins, are jealous of my skill and my success; if you get mixed up in it too, and cause trouble for me by providing fodder for their calumnies...”

  He did not finish what he had set out to say. Fundamentally, he was scornful of his father, not because of the commerce to which his homeopathy obliged him, but because the old man industrialized his art so miserably, on such restricted lines. However, a kind of restraint persisted in his relationship with the old physician, which did not derive from respect, but depended on the submission to elders and the family spirit appropriate to Jews—the sacred traditions and authority of the legendary high priests of the Talmud. Then again, did he not owe to the aid of that stunted mercantilism the first steps in his career, the lessons so well-learned, not in matters of science—the old man being incapable of giving any, having only made the vaguest studies with a view of obtaining the conversion of his own nation’s diploma into the diploma of a officer of health—but practical lessons concerning the commercial side of the profession: an apprenticeship in business, as the atavistic soul understands it.

  Now, the head leaning on the back of his armchair, while Caresco senior reflected on his own account, Armand thought with a certain pleasure about his initial difficulties. He recalled, as he darted a glance around that somber room, now dilapidated, how he had begun the edification of his surgical reputation after four years of internship in the hospitals of Paris.

  Yes, it was in this obscure hovel that he had carried out his first operations, before possessing the sumptuous town house that he had made into his clinic, before even having a little house of his own on the Boulevard Péreire. What memories were
revived within his brain by those narrow walls and dirty parquet—veritable breeding-grounds of microbes—and, most of all, the narrow, badly-ventilated room behind his father’s consulting room, in which he had abandoned to the care of a part-time nurse the creatures—always poor disinherited pauperesses who offered no more interest for him once the operation was terminated—whose flesh his scalpel had just violated, in which he had trained his hand in anima vili.

  It was his father, the old homeopath, who had chosen from his clientele the victims of those scientific sacrifices, the price being not very high and paid in advance. The operations always succeeded, but death often followed. There had once been a sequence of seven deaths…but how well, in the wake of that massacre, the young surgeon had known how to carry out further resections of the ileocecal appendix! After the complaint of a husband, however, on whose wife he had operated without authorization, the people at the Prefecture of Police had become strangely excited by such a hecatomb; a discreet investigation had been ordered by a judge.

  That was also one of the rare occasions when Armand had experienced an emotion; he generally floated with a monstrous indifference above all human sentiment, and had rarely felt such an anguish stirring in his heart as on the day when he had seen a grave black-glad man go into his father’s study: the Commissaire of Police, come to inspect the registers in which every clinic had to record operations and their nature.

  Very courteously, the man in black had explained that it was a simple formality, and that he was convinced that the affair would have no further consequences. The registers were there, in the desk drawer; the surgeon could have handed them over—but they were incomplete; their surrender would have provoked further investigations, perhaps leading to his conviction.

  By virtue of a stroke of fortunate audacity, Armand had told the Commissaire that the books were at his private house, and that he would send them as soon as he got home—and with what fervor, as soon as the magistrate had gone, the key having been turned in the lock, the father and son, gripped by an atrocious fear, had set about correcting the register! They destroyed the pages that bore the observations of fatal operations, and added others in which they created wholesale accounts of magnificent results in the cases of people since vanished.

  And in that haste, in that panic, of what presence of mind they had nevertheless given proof—he smiled at the memory—when they had nixed a certain quantity of cigar-ash with the ink, to give the writing an appearance of age! The law had been deceived, and the file had been closed.

  Armand also remembered the profound joy he had experienced on the day when, his initial savings having been liquidated, he had finally been able to get his fortunate career off the ground, rent a small house on the Boulevard Péreire, install an operating theater there, still modest, in reality, but already permitting him to invite Parisian, provincial and foreign colleagues to the manifestations of his talent. Thus, he had exalted his mastery, satisfied his pride and allowed himself to be led to celebrity by the accomplishment of the work of life and death.

  Thus, with the contentment of the peril effaced, he thought about those old tribulations. Now, things were marching triumphantly, the past eclipsed by the joy of present success.

  To be sure, he still did operations that, for the great majority of other surgeons, would have been veritable crimes; certainly, the thousand-franc bills that he needed to appease the gluttony of his aging mistress led him to apply himself, knife in hand, even when the result of his interventions was almost certain to be death; certainly, he acted in such a way that the desperate rich came to him to finish their calvary in the tomb, and that one of the most honest surgeons in Paris said in speaking of some inoperable case: “Only a madman like Caresco would operate here”—but he had a sturdy back with which to support such unsuccessful endeavors and such appreciations. How well-known to everyone the near-genius of his skill was! He had the most beautiful and cleanest of surgical installation in Paris!

  What is more, he operated in broad daylight, surrounded by a host of colleagues, who marveled at his manual skill and rapidity. Foreign scientists in Paris never failed to pay him a visit; his books were discussed; his ideas had taken on weight; and he had published so many cases thought incurable by others and cured by him that he did not care at all about the quantity of cadavers that still disappeared through the back door of his house of operations.

  He abandoned his incursion into the past and turned to his father, who was meekly respecting his silence.

  “So, Papa, it’s understood, isn’t it? No more advertising.”

  The old Semite adopted a lachrymose tone that strangely exaggerated the accent particular to exotic Israelites—a stigma that he corrected in ordinary circumstances, but reappeared, an indelible trace, when he was excited.

  “But I won’t be able to earn a living!”

  “A living! Get away!” Armand growled. “A living! As if you didn’t have enough to live on—don’t tell me that. Anyway, I’ll compensate you. From now on, I’ll let you keep all the money for the operations on the patients that you send me. Is that agreed?”

  The father acquiesced. To tell the truth, those sums were mostly derisory, but there is no profit small enough to neglect. Then again, he would make it up in the quantity. The agreement straightened his face.

  “Let’s see,” said Armand. “What do you have to offer me today?” He was talking about patients on which to operate. “You know that the surgical conference opened yesterday. I’m making two reports on my operations on the liver; they’ll generate a lot of talk! I have a dozen cases of resection of the gall bladder. You can see the faces of our dear colleagues now, can’t you? Can you imagine that in one case I unblocked the bile duct…?”

  Having started to describe an extraordinary case, however, his enthusiasm was cut short by the indifferent physiognomy of his father. What had prompted him to take science to that old businessman? Gall bladder…bile duct…did he even know where they were? Why try to scrape the rust from that superb ignorance?

  “It would take too long to explain,” he continued. “I’ll tell you about it another time. So, the congress has opened and the foreigners are coming to watch me operate tomorrow morning. The members of the Faculté aren’t budging, of course. Oh, they’ll be able to make a comparison, the foreigners! I have at their service in the same morning two livers, a kidney, one abdominal hysterectomy, another vaginal, a tubercular tumor on the foot, and a resection of the shoulder. A lot of surgery, eh!”

  He laughed loudly, allowing he ardent gleam of his teeth to pass through his lips. “I’m only lacking a skull,” he continued. “Do you have a skull to offer me? What’s wrong with the child in the arms of an old woman waiting out there? It reeked of meningitis at fifteen paces when I went past. If it’s meningitis, I’ll operate. Have the old woman come in.”

  Before his father could reply, he pressed the button of an electric bell, which was on the table between the papers.

  The domestic appeared.

  “Send in the old woman with the child,” said Armand.

  The old woman was introduced. Timid and anxious, she took her place on the seat indicated to her by the domestic. The grave faces of the two physicians, the manservant’s uniforms and the imminent moment of the verdict weighed down upon her. She had prepared words that she could not pronounce, and contented herself with rocking the inert parcel of flesh.

  Solemnly, the father began to question her. How long was it since the illness began? What were the antecedents? Armand shrugged his shoulders at the futility of the information. Rapidly, he had the child undressed, and when the old woman’s anxious hands could not find the pins he finished the task himself, without repulsion at the dirtiness of the linen.

  The little invalid, drawn out of her torpor, opened her eyes momentarily, deflected by a squint, but closed them again to plunge back into unconsciousness. The body was slightly folded upon itself, the fact red and pale by turns, the hollow belly emphasizing the
projecting ribs and hips. Two thin arms, in which the blue furrows of the veins were visible, formed a cross over the breast; she seemed to have adopted the pose of immolation. The amplified respiration sometimes became precipitate, only to stop suddenly, as if death had already accomplished its work—but it began again, at a precipitate rhythm: an anxious breath that had difficulty getting out through contractions of the jaw which made the teeth grate.

  The tableau was typical of tubercular meningitis in its second phase. Armand, studying the symptoms scientifically, took note of the irregularity of the pulse, felt the dry heat of the skin and, by means of repeated pinches along the limbs, established anesthesia. Absorbed by his study, oblivious to the grandmother’s suffering, he nodded his head in satisfaction; he had found a skull to open. The spectators of the following day’s operations would be astonished. It was now only a matter of persuading the old woman of the necessity of an operation—but that was child’s play, for him.

  As his father tacitly interrogated him, he said: “Tubercular meningitis, second phase, of course. There’s no doubt about it. The child is doomed, unless an operation...”

  He looked at the grandmother. Tears were swelling her eyelids; dolorous wrinkles were plowing her shriveled features.

  “An operation?” she said. “There’s an operation for meningitis, then? My God! An operation!”

  “Understand, Madame,” the surgeon went on, “that the operation is to release the water that is in the head. She has water in her head, your child, and that fluid is compressing the brain. The operation consists of making a little hole, as one empties a cask of wine. You’ve taken wine from a cask, haven’t you? Well, it’s the same thing.”