“Don’t you find it a very wearing branch of the profession?” asks Foster after a pause.
“My dear fellow, it was the fear of it that drove me into lunacy work.”
“Aye, and it has driven men into asylums who never found their way on to the medical staff. I was a very shy fellow myself as a student, and I know what it means.”
“No joke that in general practice,” says the alienist.
“Well, you hear men talk about it as though it were, but I tell you it’s much nearer tragedy. Take some poor, raw, young fellow who has just put up his plate in a strange town. He has found it a trial all his life, perhaps, to talk to a woman about lawn tennis and church services. When a young man is shy he is shyer than any girl. Then down comes an anxious mother and consults him upon the most intimate family matters. ‘I shall never go to that doctor again,’ says she afterwards. ‘His manner is so stiff and unsympathetic.’ Unsympathetic! Why, the poor lad was struck dumb and paralysed. I have known general practitioners who were so shy that they could not bring themselves to ask the way in the street. Fancy what sensitive men like that must endure before they get broken in to medical practice. And then they know that nothing is so catching as shyness, and that if they do not keep a face of stone, their patient will be covered with confusion. And so they keep their face of stone, and earn the reputation perhaps of having a heart to correspond. I suppose nothing would shake your nerve, Manson.”
“Well, when a man lives year in year out among a thousand lunatics, with a fair sprinkling of homicidals among them, one’s nerves either get set or shattered. Mine are all right so far.”
“I was frightened once,” says the surgeon. “It was when I was doing dispensary work. One night I had a call from some very poor people, and gathered from the few words they said that their child was ill. When I entered the room I saw a small cradle in the corner. Raising the lamp I walked over and putting back the curtains I looked down at the baby. I tell you it was sheer Providence that I didn’t drop that lamp and set the whole place alight. The head on the pillow turned, and I saw a face looking up at me which seemed to me to have more malignancy and wickedness than ever I had dreamed of in a nightmare. It was the flush of red over the cheek-bones, and the brooding eyes full of loathing of me, and of everything else, that impressed me. I’ll never forget my start as, instead of the chubby face of an infant, my eyes fell upon this creature. I took the mother into the next room. ‘What is it?’ I asked. ‘A girl of sixteen,’ said she, and then throwing up her arms, ‘Oh, pray God she may be taken!’ The poor thing, though she spent her life in this little cradle, had great, long, thin limbs which she curled up under her. I lost sight of the case and don’t know what became of it, but I’ll never forget the look in her eyes.”
“That’s creepy,” says Doctor Foster. “But I think one of my experiences would run it close. Shortly after I put up my plate I had a visit from a little hunch-backed woman, who wished me to come and attend to her sister in her trouble. When I reached the house, which was a very poor one, I found two other little hunched-backed women, exactly like the first, waiting for me in the sitting-room. Not one of them said a word, but my companion took the lamp and walked upstairs with her two sisters behind her, and me bringing up the rear. I can see those three queer shadows cast by the lamp upon the wall as clearly as I can see that tobacco pouch. In the room above was the fourth sister, a remarkably beautiful girl in evident need of my assistance. There was no wedding ring upon her finger. The three deformed sisters seated themselves round the room, like so many graven images, and all night not one of them opened her mouth. I’m not romancing, Hargrave; this is absolute fact. In the early morning a fearful thunderstorm broke out, one of the most violent I have ever known. The little garret burned blue with the lightning, and the thunder roared and rattled as if it were on the very roof of the house. It wasn’t much of a lamp I had, and it was a queer thing when a spurt of lightning came to see those three twisted figures sitting round the walls, or to have the voice of my patient drowned by the booming of the thunder. By Jove, I don’t mind telling you that there was a time when I nearly bolted from the room. All came right in the end, but I never heard the true story of the unfortunate beauty and her three crippled sisters.”
“That’s the worst of these medical stories,” sighs the outsider. “They never seem to have an end.”
“When a man is up to his neck in practice, my boy, he has no time to gratify his private curiosity. Things shoot across him and he gets a glimpse of them, only to recall them, perhaps, at some quiet moment like this. But I’ve always felt, Manson, that your line had as much of the terrible in it as any other.”
“More,” groans the alienist. “A disease of the body is bad enough, but this seems to be a disease of the soul. Is it not a shocking thing — a thing to drive a reasoning man into absolute Materialism — to think that you may have a fine, noble fellow with every divine instinct and that some little vascular change, the dropping, we will say, of a minute spicule of bone from the inner table of his skull on to the surface of his brain may have the effect of changing him to a filthy and pitiable creature with every low and debasing tendency? What a satire an asylum is upon the majesty of man, and no less upon the ethereal nature of the soul.”
“Faith and hope,” murmurs the general practitioner.
“I have no faith, not much hope, and all the charity I can afford,” says the surgeon. “When theology squares itself with the facts of life I’ll read it up.”
“You were talking about cases,” says the outsider, jerking the ink down into his stylographic pen.
“Well, take a common complaint which kills many thousands every year, like G.P. for instance.”
“What’s G.P.?”
“General practitioner,” suggests the surgeon with a grin.
“The British public will have to know what G.P. is,” says the alienist gravely. “It’s increasing by leaps and bounds, and it has the distinction of being absolutely incurable. General paralysis is its full title, and I tell you it promises to be a perfect scourge. Here’s a fairly typical case now which I saw last Monday week. A young farmer, a splendid fellow, surprised his friends by taking a very rosy view of things at a time when the whole country-side was grumbling. He was going to give up wheat, give up arable land, too, if it didn’t pay, plant two thousand acres of rhododendrons and get a monopoly of the supply for Covent Garden — there was no end to his schemes, all sane enough but just a bit inflated. I called at the farm, not to see him, but on an altogether different matter. Something about the man’s way of talking struck me and I watched him narrowly. His lip had a trick of quivering, his words slurred themselves together, and so did his handwriting when he had occasion to draw up a small agreement. A closer inspection showed me that one of his pupils was ever so little larger than the other. As I left the house his wife came after me. ‘Isn’t it splendid to see Job looking so well, doctor?’ said she; ‘he’s that full of energy he can hardly keep himself quiet.’ I did not say anything, for I had not the heart, but I knew that the fellow was as much condemned to death as though he were lying in the cell at Newgate. It was a characteristic case of incipient G.P.”
“Good heavens!” cries the outsider. “My own lips tremble. I often slur my words. I believe I’ve got it myself.”
Three little chuckles come from the front of the fire.
“There’s the danger of a little medical knowledge to the layman.”
“A great authority has said that every first year’s student is suffering in silent agony from four diseases,” remarks the surgeon. “One is heart disease, of course; another is cancer of the parotid. I forget the two other.”
“Where does the parotid come in?”
“Oh, it’s the last wisdom tooth coming through!”
“And what would be the end of that young farmer?” asks the outsider.
“Paresis of all the muscles, ending in fits, coma and death. It may be a few months, it may be a y
ear or two. He was a very strong young man and would take some killing.”
“By the way,” says the alienist, “did I ever tell you about the first certificate I ever signed? I stood as near ruin then as a man could go.”
“What was it, then?”
“I was in practice at the time. One morning a Mrs. Cooper called upon me and informed me that her husband had shown signs of delusions lately. They took the form of imagining that he had been in the army and had distinguished himself very much. As a matter of fact he was a lawyer and had never been out of England. Mrs. Cooper was of opinion that if I were to call it might alarm him, so it was agreed between us that she should send him up in the evening on some pretext to my consulting-room, which would give me the opportunity of having a chat with him and, if I were convinced of his insanity, of signing his certificate. Another doctor had already signed, so that it only needed my concurrence to have him placed under treatment. Well, Mr. Cooper arrived in the evening about half an hour before I had expected him, and consulted me as to some malarious symptoms from which he said that he suffered. According to his account he had just returned from the Abyssinian Campaign, and had been one of the first of the British forces to enter Magdala. No delusion could possibly be more marked, for he would talk of little else, so I filled in the papers without the slightest hesitation. When his wife arrived, after he had left, I put some questions to her to complete the forms. ‘What is his age?’ I asked. ‘Fifty,’ said she. ‘Fifty!’ I cried. ‘Why, the man I examined could not have been more than thirty!’ And so it came out that the real Mr. Cooper had never called upon me at all, but that by one of those coincidences which takes a man’s breath away another Cooper, who really was a very distinguished young officer of artillery, had come in to consult me. My pen was wet to sign the paper when I discovered it,” says Dr. Manson, mopping his forehead.
“We were talking about nerve just now,” observes the surgeon. “Just, after my qualifying I served in the Navy for a time, as I think you know. I was on the flag-ship on the West African Station, and I remember a singular example of nerve which came to my notice at that time. One of our small gunboats had gone up the Calabar river, and when there the surgeon died of coast fever. On the same day a man’s leg was broken by a spar falling upon it, and it became quite obvious that it must be taken off above the knee if his life was to be saved. The young lieutenant who was in charge of the craft searched among the dead doctor’s effects and laid his hands upon some chloroform, a hip-joint knife, and a volume of Grey’s Anatomy. He had the man laid by the steward upon the cabin table, and with a picture of the cross section of the thigh in front of him he began to take off the limb. Every now and then, referring to the diagram, he would say: ‘Stand by with the lashings, steward. There’s blood on the chart about here.’ Then he would jab with his knife until he cut the artery, and he and his assistant would tie it up before they went any further. In this way they gradually whittled the leg off, and upon my word they made a very excellent job of it. The man is hopping about the Portsmouth Yard at this day.
“It’s no joke when the doctor of one of these isolated gunboats himself falls ill,” continues the surgeon after a pause. “You might think it easy for him to prescribe for himself, but this fever knocks you down like a club, and you haven’t strength left to brush a mosquito off your face. I had a touch of it at Lagos, and I know what I am telling you. But there was a chum of mine who really had a curious experience. The whole crew gave him up, and, as they had never had a funeral aboard the ship, they began rehearsing the forms so as to be ready. They thought that he was unconscious, but he swears he could hear every word that passed. ‘Corpse comin’ up the ‘atchway!’ cried the cockney sergeant of Marines. ‘Present harms!’ He was so amused, and so indignant too, that he just made up his mind that he wouldn’t be carried through that hatchway, and he wasn’t, either.”
“There’s no need for fiction in medicine,” remarks Foster, “for the facts will always beat anything you can fancy. But it has seemed to me sometimes that a curious paper might be read at some of these meetings about the uses of medicine in popular fiction.”
“How?”
“Well, of what the folk die of, and what diseases are made most use of in novels. Some are worn to pieces, and others, which are equally common in real life, are never mentioned. Typhoid is fairly frequent, but scarlet fever is unknown. Heart disease is common, but then heart disease, as we know it, is usually the sequel of some foregoing disease, of which we never hear anything in the romance. Then there is the mysterious malady called brain fever, which always attacks the heroine after a crisis, but which is unknown under that name to the text books. People when they are over-excited in novels fall down in a fit. In a fairly large experience I have never known any one to do so in real life. The small complaints simply don’t exist. Nobody ever gets shingles or quinsy, or mumps in a novel. All the diseases, too, belongs to the upper part of the body. The novelist never strikes below the belt.”
“I’ll tell you what, Foster,” says the alienist, “there is a side of life which is too medical for the general public and too romantic for the professional journals, but which contains some of the richest human materials that a man could study. It’s not a pleasant side, I am afraid, but if it is good enough for Providence to create, it is good enough for us to try and understand. It would deal with strange outbursts of savagery and vice in the lives of the best men, curious momentary weaknesses in the record of the sweetest women, known but to one or two, and inconceivable to the world around. It would deal, too, with the singular phenomena of waxing and of waning manhood, and would throw a light upon those actions which have cut short many an honoured career and sent a man to a prison when he should have been hurried to a consulting-room. Of all evils that may come upon the sons of men, God shield us principally from that one!”
“I had a case some little time ago which was out of the ordinary,” says the surgeon. “There was a famous beauty in London Society — I mention no names — who used to be remarkable a few seasons ago for the very low dresses which she would wear. She had the whitest of skins, and most beautiful of shoulders, so it was no wonder. Then gradually the frilling at her neck lapped upwards and upwards, until last year she astonished every one by wearing quite a high collar at a time when it was completely out of fashion. Well, one day this very woman was shown into my consulting-room. When the footman was gone she suddenly tore off the upper part of her dress. ‘For God’s sake do something for me!’ she cried. Then I saw what the trouble was. A rodent ulcer was eating its way upwards, coiling on in its serpiginous fashion until the end of it was flush with her collar. The red streak of its trail was lost below the line of her bust. Year by year it had ascended and she had heightened her dress to hide it, until now it was about to invade her face. She had been too proud to confess her trouble, even to a medical man.”
“And did you stop it?”
“Well, with zinc chloride I did what I could. But it may break out again. She was one of those beautiful white-and-pink creatures who are rotten with struma. You may patch but you can’t mend.”
“Dear! dear! dear!” cries the general practitioner, with that kindly softening of the eyes which has endeared him to so many thousands. “I suppose we mustn’t think ourselves wiser than Providence, but there are times when one feels that something is wrong in the scheme of things. I’ve seen some sad things in my life. Did I ever tell you that case where Nature divorced a most loving couple? He was a fine young fellow, an athlete and a gentleman, but he overdid athletics. You know how the force that controls us gives us a little tweak to remind us when we get off the beaten track. It may be a pinch on the great toe if we drink too much and work too little. Or it may be a tug on our nerves if we dissipate energy too much. With the athlete, of course, it’s the heart or the lungs. He had bad phthisis and was sent to Davos. Well, as luck would have it, she developed rheumatic fever, which left her heart very much affected. Now, do you see the dread
ful dilemma in which those poor people found themselves? When he came below 4,000 feet or so, his symptoms became terrible. She could come up about 2,500, and then her heart reached its limit. They had several interviews half-way down the valley, which left them nearly dead, and at last, the doctors had to absolutely forbid it. And so for four years they lived within three miles of each other and never met. Every morning he would go to a place which overlooked the chalet in which she lived and would wave a great white cloth and she answer from below. They could see each other quite plainly with their field glasses, and they might have been in different planets for all their chance of meeting.”
Delphi Complete Works of Sir Arthur Conan Doyle (Illustrated) Page 913
