If the gentlemen who examined him overnight have been duly interested in their cases, they will have read them up from the approved text-books; and it will be strange if that reading has not raised questions and points that will necessitate a fresh examination. So the man gets another ounce of brandy, and another knocking about. At three in the afternoon the head physician—a fashionable West-End speciality man for diseases of the chest—goes his rounds, followed by a crowd of students. He makes himself responsible for each of the cases in the beds allotted to him, and naturally wants to know all about them, especially if any of them are likely to make good subjects for elaborate clinical demonstration. So with tenderest grace and the most honied phrases, with every courtly apology to the patient for disturbing him, the great man proceeds secundem artem to teach the young idea how to shoot. The junior in charge of the case, reads his report of the physical signs, family history, diagnosis and prognosis of the case, with the treatment proposed, while the lecturer verifies or objects to the statements of the record. He is so thoughtful, so kind and sympathising with the poor fellow on whom he is going to discourse for the next half-hour, that having noticed he is distressed by the process before it is fairly begun, he, in his most mellifluous tones, asks, “Would you like a little wine or brandy, my friend?” And the poor man thinks he would. Then have at him, lads! for here is a pretty case, a typical text-book case, and all you who are going up for examination had better get all you can out of Tom Smith, for here are “minute crepitations,” “vesicular murmurs,” “obscured resonance,” and if you watch the progress of the disease you may get “tubular breathing,” “bronchophony” “increased vocal vibration,” and no end of good things. Tom Smith remains in the hospital six weeks before he is “discharged cured.” He has suffered many things at the hands of his physicians; he has cost St. Bernard’s say about a pound a week, besides his medical attendance. Who says he has gone out without paying his bill? It has occurred to no one concerned, least of all to the patient, that there is anything wrong in all this treatment. In their passionate eagerness to acquire information that can only be obtained at the bedside, the assiduous students are of course delighted to have Mr. Smith amongst them. The house physician is soon going into private practice, and he wants to consolidate and confirm all his knowledge of the various forms of disease; the lecturer loves nothing better than to exhibit his really admirable powers of clinical observation to a body of rising men, who can send him many patients and more guineas. The patient is usually delighted that so much interest is taken in his case, and contrasts the hurried “Put out your tongue; give me your hand; take this medicine, and I will see you again in two or three days;” all in a hop, skip, and jump style, of the club doctor, with this elaborate marshalling of great medical forces for the purposes of his cure, sadly to the discredit of the club doctor’s hasty method.
Nobody sees through it all;—yes, the sisters and the nurses do. The former do their very utmost to soften by their kind assiduity evils which they think are inseparable from the work of a public hospital. The nurses do what they have to do; it is their business to execute orders, and they usually say little, whatever they may think. Then says the reader, “Who is aggrieved? What is there wrong in the system?” What is wrong? Everything! From the long waiting in the out-patients’ ward; the exposure of such a case while the preliminary examination is made; to the long and dangerous examinations of the stripped sufferer in the ward upstairs: with their constant repetition by so many persons; so that it is probable he would have made a better and speedier recovery under the care of the club doctor, who seemed hasty because full of business, but who thoroughly knew what he was about, and only did not waste time over matters his quick eye took in at a glance, and whose large experience was an additional sense. All that auscultation had nothing to do with the man’s cure, but a great deal to do with the education of those concerned in it; and as the treatment consisted in salines, tonics, poultices and rest, with suitable food at suitable times combined with good ventilation and cleanliness, the elaborate exhibition of therapeutic force was very much like cracking a nut with a Nasmyth hammer, only the cracking of the nut was but a detail!
It is possible that if all this could be knocked into Tom Smith’s uneducated head, he might not again lend himself so readily to the business; still less is it probable that all those cheques would be drawn in favour of St. Bernard’s, if the subscribers knew just how the case stood. They might ask with much cogency, “Cannot we get our nuts cracked without the use of those costly steam hammers?” And, after all, that is a very important factor in the case. For consider! It is only by much begging and by resorting to many stratagems that the governors can keep these charities going. Now if the charitable Christian public chooses to crack its nuts with steam hammers, we cannot offer any objection. It seems costly, but that is their business; but if they think their nuts can be cracked by no other and less costly method, they are very much in the dark. Let alone the fact of so much unconscious cruelty, wrought in the name of charity and mercy. Of that we have said enough. The fees for a complete hospital curriculum average a hundred guineas for the four years’ course, an absurdly small sum for such an education. In what other learned profession could such advantages be obtained for twenty-five guineas a year? But then the charitable public does not assist other professions so liberally as that of medicine.
CHAPTER XXII.
HOW ELSWORTH CAME TO HIMSELF.
Oh, then, if Reason waver at thy side,
Let humbler Memory be thy gentle guide;
Go to thy birthplace, and, if Faith was there,
Repeat thy father’s creed, thy mother’s prayer.
—Oliver Wendell Holmes.