by A. J. Cronin
While the husband stood by in the cramped, ill-lit stone floored room he examined the patient with scrupulous care. There was no doubt about it, she was ill. She complained that her head ached intolerably. Temperature, pulse, tongue, they all spoke of trouble, serious trouble. What was it? Andrew asked himself that question with a strained intensity as he went over her again. His first case. Oh, he knew that he was over-anxious! But suppose he made an error, a frightful blunder? And worse – suppose he found himself unable to make a diagnosis? He had missed nothing. Nothing. Yet he still found himself struggling towards some solution of the problem, striving to group the symptoms under the heading of some recognised disease. At last, aware that he could protract his investigation no longer, he straightened himself slowly, folding his stethoscope, fumbling for words.
‘Did she have a chill?’ he asked, his eyes upon the floor.
‘Yes, indeed,’ Williams answered eagerly. He had looked scared during the prolonged examination. ‘Three, four days ago. I made sure it was a chill, doctor.’
Andrew nodded, attempting painfully to generate a confidence he did not feel. He muttered, ‘We’ll soon have her right. Come to the surgery in half an hour. I’ll give you a bottle of medicine.’
He took his leave of them and with his head down, thinking desperately, he trudged back to the surgery, a ramshackle wooden erection standing at the entrance to Page’s drive. Inside, he lit the gas and began to pace backwards and forwards beside the blue and green bottles on the dusty shelves, racking his brains, groping in the darkness. There was nothing symptomatic. It must, yes, it must be a chill. But, in his heart he knew that it was not a chill. He groaned in exasperation, dismayed and angry at his own inadequacy. He was forced, unwillingly, to temporise. Professor Lamplough, when confronted by obscurity in his wards, had a neat little ticket, which he tactfully applied: PUO – pyrexia of unknown origin – it was noncommittal and exact, and it had such an admirable scientific sound!
Unhappily, Andrew took a six ounce bottle from the recess beneath the dispensary counter and began with a frown of concentration to compound an anti-pyretic mixture. Spirits of nitre, salicylate of sodium – where the dickens was the soda sal. Oh, there it was! He tried to cheer himself by reflecting that they were all splendid, all excellent drugs, bound to get the temperature down, certain to do good. Professor Lamplough had often declared there was no drug so generally valuable as salicylate of sodium.
He had just finished his compounding and with a mild sense of achievement was writing the label when the surgery bell went ‘ping’, the outer door swung open, and a short, powerfully thick-set red-faced man of thirty strolled in, followed by a dog. There was a silence while the black and tan mongrel squatted on its muddy haunches and the man, who wore an old velveteen suit, pit stockings and hobnail boots with a sodden oilskin cape over his shoulders, looked Andrew up and down. His voice, when it came, was politely ironic and annoyingly well-bred.
‘I saw a light in your window as I was passing. Thought I’d look in to welcome you. I’m Denny, assistant to the esteemed Doctor Nicholls, LSA. That, in case you haven’t met it, is the Licentiate of the Society of Apothecaries, the highest qualification known to God and man.’
Andrew stared back doubtfully. Philip Denny lit a cigarette from a crumpled paper packet, threw the match on the floor, and strolled forward insolently. He picked up the bottle of medicine, read the address, the directions, uncorked it, sniffed it, recorked it and put it down, his morose red face turning blandly complimentary.
‘Splendid! You’ve begun the good work already! One tablespoonful every three hours. God Almighty! It’s reassuring to meet the dear old mumbo-jummery. But, doctor, why not three times a day? Don’t you realise, doctor, that in strict orthodoxy the tablespoonfuls should pass down the oesophagus three times a day.’ He paused, becoming, with his assumed air of confidence, more blandly offensive than ever. ‘Now tell me, doctor, what’s in it? Spirit of nitre by the smell. Wonderful stuff, sweet spirit of nitre. Wonderful, wonderful, my dear doctor! Carminative, stimulant, diuretic, and you can swill it by the tubful. Don’t you remember what it says in the little red book? When in doubt give spirit of nitre, or is it pot. lod. Tut! Tut! I seem to have forgotten some of my essentials.’
Again there was a silence in the wooden shed broken only by the drumming of the rain upon the tin roof. Suddenly Denny laughed, a mocking appreciation of the blank expression on Andrew’s face. He said derisively:
‘Science apart, doctor, you might satisfy my curiosity. Why have you come here?’
By this time Andrew’s temper was rising rapidly. He answered grimly.
‘My idea was to turn Drineffy into a health resort – a sort of spa, you know.’
Again Denny laughed. His laugh was an insult, which made Andrew long to hit him. ‘Witty, witty, my dear doctor. The true Scots steamroller humour. Unfortunately I can’t recommend the water here as being ideally suited for a spa. As to the medical gentlemen – my dear doctor, in this valley they’re the rag-tag and bobtail of a glorious, a truly noble profession.’
‘Including yourself?’
‘Precisely!’ Denny nodded. He was silent a moment, contemplating Andrew from beneath his sandy eyebrows. Then he dropped his mocking irony, his ugly features turned morose again. His tone, though bitter, was serious. ‘ Look here, Manson! I realise you’re just passing through on your way to Harley Street, but in the meantime there are one or two things about this place you ought to know. You won’t find it conform to the best traditions of romantic practice. There’s no hospital, no ambulance, no X-rays, no anything. If you want to operate you use the kitchen table. You wash up afterwards at the scullery bosh. The sanitation won’t bear looking at. In a dry summer the kids die like flies with infantile cholera. Page, your boss, was a damn good old doctor, but he’s finished now, finished by overwork, and’ll never do a hand’s turn again. Nicholls, my owner, is a tight little money-chasing midwife. Bramwell, the Lung Buster, knows nothing but a few sentimental recitations and the Songs of Solomon. As for myself, I better anticipate the gay tidings – I drink like a fish. Oh! and Jenkins, your tame druggist, does a thriving trade, on the side, in little lead pills for female ills. I think that’s about all. Come, Hawkins, we’ll go.’ He called the mongrel and moved heavily towards the door. There he paused, his eyes ranging again from the bottle on the counter to Manson. His tone was flat, quite uninterested. ‘ By the way, I should look out for enteric in Glydar Place if I were you. Some of these cases aren’t exactly typical.’
‘Ping’ went the door again. Before Andrew could answer Doctor Philip Denny and Hawkins disappeared into the wet darkness.
Chapter Three
It was not his lumpy flock mattress which caused Andrew to sleep badly that night, but the growing anxiety of the case in Glydar Place. Was it enteric? Denny’s parting remark had started a fresh train of doubt and misgiving in his already uncertain mind. Dreading that he had overlooked some vital symptom he restrained himself with difficulty from rising and revisiting the case at an unearthly hour of the morning. Indeed, as he tossed and turned through the long restless night he came to ask himself if he knew anything of medicine at all.
Manson’s nature was extraordinarily intense. Probably he derived this from his mother, a Highland woman who, in her childhood, had watched the Northern lights leap through the frosted sky from her home in Ullapool. His father, John Manson, a small Fifeshire farmer, had been solid, painstaking and steady. He had never made a success of the land and when he was killed in the Yeomanry in the last year of the War, he had left the affairs of the little steading in a sad muddle. For twelve months Jessie Manson had struggled to run the farm as a dairy, even driving the float upon the milk-round herself when she felt Andrew was too busy with his books to do so. Then the cough which she had unsuspectedly endured for a period of years turned worse and suddenly she surrendered to the lung complaint which ravages that soft skinned, dark haired type.
At eight
een Andrew found himself alone, a first year student at St Andrews University, carrying a scholarship worth £40 a year, but otherwise penniless. His salvation had been the Glen Endowment, that typically Scottish foundation which in the naïve terminology of the late Sir Andrew Olen ‘invites deserving and necessitous students of the baptismal name of Andrew to apply for loans not exceeding £50 a year for five years provided they are conscientiously prepared to reimburse such loans whenever they have qualified.’
The Glen Endowment, coupled with some gay starvation, had sent Andrew through the remainder of his course at St Andrews, then on to the Medical Schools in the city of Dundee. And gratitude to the Endowment, allied to an inconvenient honesty, had sent him hurrying down to South Wales – where newly qualified assistants could command the highest remuneration – to a salary of £250 a year, when in his heart he would have preferred a clinical appointment at the Edinburgh Royal and an honorarium of one tenth that sum.
And now he was in Drineffy, rising, shaving, dressing, all in a haze of worry over his first patient. He ate his breakfast quickly, then ran up to his room again. There he opened his bag and took out a small blue leather case. He opened the case and gazed earnestly at the medal inside, the Hunter Gold Medal, awarded annually at St Andrews to the best student in clinical medicine. He, Andrew Manson, had won it. He prized it beyond everything, had come to regard it as his talisman, his inspiration for the future. But this morning he viewed it less with pride than with a queer, secret entreaty, as though trying to restore his confidence in himself. Then he hurried out for the morning surgery.
Dai Jenkins was already in the wooden shanty when Andrew reached it, running water from the tap into a large earthenware pipkin. He was a quick little whippet of a man with purple veined, hollow cheeks, eyes that went everywhere at once and the tightest pair of trousers on his thin legs that Andrew had ever seen. He greeted Manson ingratiatingly:
‘You don’t have to be so early, doctor. I can do the repeat mixtures and the certificates before you come in. Miss Page had a rubber stamp made with doctor’s signature when he was taken bad.’
‘Thanks,’ Andrew answered. ‘I’d rather see the cases myself.’ He paused, shaken momentarily from his anxiety by the dispenser’s procedure. ‘What’s the idea?’
Jenkins winked. ‘ Tastes better out of here. We know what good old aqua means, eh, doctor, bach. But the patients don’t. I’d look a proper fool too, wouldn’t I, them standin’ there watchin’ me fillin’ up their bottles out the tap.’
Plainly the little dispenser wished to be communicative, but here a voice rang out from the back door of the house forty yards away.
‘Jenkins! Jenkins! I want you – right away.’
Jenkins jumped, his nerves were apparently in a very poor state. He muttered: ‘Excuse me, doctor. There’s Miss Page callin’ me. I’ll… I’ll have to run.’
Fortunately there were few people at the morning surgery, which was over at half past ten and Andrew, presented with a list of visits by Jenkins, set out at once with Thomas in the gig. With an almost painful expectancy he told the old groom to drive direct to 7 Glydar Place.
Twenty minutes later he came out of No 7, pale, with his lips tightly compressed and an odd expression on his face. He went two doors down, into No 11, which was also on his list. From No 11 he crossed the street to No 18. From No 18 he went round the corner to Radnor Place where two further visits were marked by Jenkins as having been seen the day before. Altogether, within the space of an hour, he made seven such calls in the immediate vicinity. Five of them, including No 7 Glydar Place, which was now showing a typical rash, were clear cases of enteric. For the last ten days Jenkins had been treating them with chalk and opium. Now, whatever his own bungling efforts of the previous night had been, Andrew realised with a shiver of apprehension that he had an outbreak of typhoid fever on his hands.
The remainder of his round he accomplished as quickly as possible in a state dithering towards panic. At lunch, during which Miss Page dealt out a dish of boiled fish, which she explained frowningly, ‘I ordered it for Doctor Page but he don’t seem to fancy it somehow,’ he brooded upon the problem in frozen silence. He saw that he could get little information and no help from Miss Page. He decided he must speak to Doctor Page himself.
But when he went up to the doctor’s room the curtains were drawn and Edward lay prostrate with a pressure headache, his forehead deeply flushed and furrowed by pain. Though he motioned his visitor to sit with him a little, Andrew felt it would be cruelty to thrust this trouble upon him at present. As he rose to go, after remaining seated by the bedside for a few minutes, he had to confine himself to asking:
‘Doctor Page, if we get an infectious case, what’s the best thing to do?’
There was a pause. Page replied with closed eyes, not moving, as though the mere act of speech were enough to aggravate his migraine. ‘ It’s always been difficult. We’ve no hospital, let alone an isolation ward. If you should run into anything very nasty ring up Griffiths at Toniglan. That’s fifteen miles down the valley. He’s the district medical officer.’ Another pause, longer than before. ‘But I’m afraid he’s not very helpful.’
Reinforced by this information, Andrew hastened down to the hall and rang up Toniglan. While he stood with the receiver to his ear he saw Annie, the servant, looking at him through the kitchen door.
‘Hello! Hello! Is that Doctor Griffiths of Toniglan.’ He got through at last.
A man’s voice answered very guardedly. ‘Who wants him?’
‘This is Manson of Drineffy. Doctor Page’s assistant.’ Andrew’s tone was overpitched. ‘I’ve got five cases of typhoid up here. I want Doctor Griffiths to come up immediately.’
There was the barest pause, then with a rush the reply came back in a sing-song intonation, very Welsh and apologetic. ‘ I’m powerful sorry, doctor, indeed I am, but Doctor Griffiths has gone to Swansea. Important official business.’
‘When will he be back?’ shouted Manson. This line was bad.
‘Indeed, doctor, I couldn’t say for certain.’
‘But listen …’
There was a click at the far end. Very quietly the other had rung off. Manson swore out loud with nervous violence. ‘Damn it, I believe that was Griffiths himself.’
He rang the number again, failed to get a connection. Yet, persisting doggedly, he was about to ring again when turning, he found that Annie had advanced into the hall, her hands folded upon her apron, her eyes contemplating him soberly. She was a woman of perhaps forty-five, very clean and tidy, with a grave, enduring placidity of expression.
‘I couldn’t help but hear, doctor,’ she said. ‘You’ll never find Doctor Griffiths in Toniglan this hour of day. He do go to the golf at Swansea afternoons mostly.’
He answered angrily, swallowing a lump that hung in his throat.
‘But I think that was him I spoke to.’
‘Maybe.’ She smiled faintly. ‘When he don’t go to Swansea I’ve’eard tell he do say ’e ’ave gone.’ She considered him with tranquil friendliness before turning away. ‘I wouldn’t waste my time on him if I was you.’
Andrew replaced the receiver with a deepening sense of indignation and distress. Cursing, he went out and visited his cases once more. When he got back it was time for evening surgery. For an hour and a half he sat in the little back-shop cubicle which was the consulting-room, wrestling with a packed surgery until the walls sweated and the place was choked with the steam of damp bodies. Miners with beat knee, cut fingers, nystagmus, chronic arthritis. Their wives, too, and their children with coughs, colds, sprains – all the minor ailments of humanity. Normally he would have enjoyed it, welcomed the quiet appraising scrutiny of these dark, sallow-skinned people with whom he felt he was on probation. But now, obsessed by the major issue, his head reeled with the impact of these trifling complaints. Yet all the time he was reaching his decision, thinking, as he wrote prescriptions, sounded chests and offered words of advice, �
�It was he who put me on to the thing. I hate him. Yes, I loathe him – superior devil – like hell. But I can’t help that, I’ll have to go to him.’
At half past nine when the last patient had left the surgery he came out of his den with resolution in his eyes.
‘Jenkins, where does Doctor Denny live?’
The little dispenser, hastily bolting the outer door for fear another straggler might come in, turned with a look of horror on his face that was almost comic.
‘You aren’t goin’ to have anything to do with that fellow, doctor? Miss Page – she don’t like him.’
Andrew asked grimly:
‘Why doesn’t Miss Page like him?’
‘For the same reason everybody don’t. ’E’s been so damn rude to her.’ Jenkins paused, then, reading Manson’s look, he added, reluctantly, ‘ Oh, well, if you ’ave to know, it’s with Mrs Seager he stops, Number Forty-nine Chapel Street.’
Out again. He had been going the whole day long yet any tiredness he might have felt was lost in a sense of responsibility, the burden of those cases, pressing, pressing, urgently upon his shoulders. His main feeling was one of relief when, on reaching Chapel Street, he found that Denny was at his lodgings. The landlady showed him in.
If Denny was surprised to see him he concealed it. He merely asked, after a prolonged and aggravating stare, ‘Well! Killed anybody yet?’
Still standing in the doorway of the warm untidy sitting-room Andrew reddened. But, making a great effort, he conquered his temper and his pride. He said abruptly:
