Chapter IX: THE “MEDIC”--Continued

Our Caddie’s greeting was a pleasant surprise when we went back to College that second year. Stopping me and beaming on me, she congratulated me warmly on my anatomy paper:

“Frankly, Miss Arnold, I was astonished when I learned it was your paper. You seldom did yourself justice in quizzes, it seems.” Even to this graciousness I was so constrained I could only blush and look pleased; but some years later when she visited in the city where I was practising, and I was driving out with her and another woman physician, I confessed my former fear. How she laughed and melted! Then, turning suddenly, she asked in her old manner,

“Did you think I would eat you?” For an instant I almost trembled, as in the old days, but her merry smile soon followed. Since then the utmost cordiality has existed between us.

The second year in College was the busiest. We had more studies, more instructors, and a more varied life in every way. They lectured us on disease-conditions and on the remedies to be applied. There were the various clinics in the dispensary department--throat clinics, chest clinics, women’s clinics, surgical clinics, children’s clinics, and so on, where, under the various instructors, we were required to examine and diagnose cases and to watch the result of treatment. Patients too ill to come to the clinics were visited in their homes by the senior students, and by the “middlers” after the first half of their second year. Before taking cases, however, we went with the seniors on their visits to get a little familiar with the work. Once on going with a senior to an obstetric case, we found the baby already born, and the cord tied and cut! A half-witted sister of the patient met us at the door; the woman lay on the bed with no sheets on it; the new baby, naked and cold, was crying vigorously; and, playing on the bed beside the mother, was a little five-year-old who had been there through the labour. It seems when the baby came and the patient had told her sister to cut the cord, the sister refusing, the woman had sat up in bed and cut it herself!

What a mass of instruction was thrust upon us that second year! I enjoyed most the lectures of our professor in _materia medica_. A charming man, enthusiastic, fluent, apt at illustration--a more ready and engaging speaker I have never heard. Taking all he said as gospel-truth, I was not a little disturbed toward the close of that year to hear the seniors insinuate that he never spoiled a story for the truth’s sake; that he would tell of some wonderful case one year, ascribing the favourable termination to a certain remedy, and the next year would forget and tell of it under quite another remedy! Each disclosure of this kind came as a shock; it was so difficult--it is, even now--to believe that people are not what they seem.

One man, our professor in pathology, never swerved one jot or tittle from the truth. This trait was so strong that he seemed always to be telling us what _not_ to believe; he was for ever exposing shams and false theories, dubbing them “all fol-de-rol.” He gave us clear, concise pictures of diseases; told what measures to adopt to relieve them; what remedies to rely on, so far as remedies could be of service; but never failed to impress upon us that “the books lie, and doctors lie,” if they claim that cases follow the typical courses so beautifully pictured; or that remedies, however well selected, will invariably relieve. There was a touch of peevishness in his attempts to make us chary about believing the stock statements in the books. I had a great liking for him; his earnestness appealed to me. Abrupt and brusque as he was, on the rare occasions when he smiled, his smile had that distinctive charm that an infrequent smile always lends to a stern, serious face. He was an excellent offset to the optimism and enthusiasm of our professor in _materia medica_.

(A few years ago he came on as guest of honour and read a paper at our State Medical Society meeting in Brooklyn. He looked much older, his hair was thinned and white, but his voice had the old scornful ring, and carried me back to those student days in Boston; every familiar inflection was a fresh delight; and to make it more realistic, there was dear Dr. Wilkins who had come on, too--the Miss Wilkins who had so mothered me in college--past and present were strangely blended that day: on the platform Dr. “Conrad,” whose tones made me a student again; by my side the class-mate who had sat with me in the old days and listened to those same tones; while all around me were also friends and associates of to-day, else I surely should have felt myself a girl again and back in the old lecture room.)

Our professor in throat diseases was no favourite with the students. He had a smooth face, china-blue eyes, and wore a brown wig. We thought him vain, and knew he was irritable; and we failed to get much out of his lectures or clinics. Once I asked him to go with me in consultation to a home where I suspected my case was diphtheria; he went and, confirming my diagnosis with alacrity, hurried out of the house, showing such personal apprehension that it made me feel a bit contemptuous. He asked me if I were not afraid of it, and advised me, wisely, to send the case at once to the city hospital, which I did.

The same professor whom we had had the first year in the History of Medicine, instructed us in diseases of the chest; friendly and approachable, he gave us good lectures and valuable clinics.

The Dean, bless his heart! lectured to us on surgery. He always seemed in a hurry; he was an easy talker. Some of the students were inclined to belittle his skill as an operator, though admitting that he had been an excellent surgeon in his palmier days. Anyhow, he had force and charm, and was an indefatigable worker, and a warm-hearted, tactful man.

In obstetrics we had an able man, friendly, alert, conscientious, and a good instructor.

The professor in diseases of women was a pretty, fascinating woman, a general favourite; she had a big practice over on the Back Bay. We students thought her charmingly inefficient as a lecturer; it was a pleasure to look at her, and to listen to her, but her lectures were thin, and her clinics disappointing. I could so seldom find what she would tell us we ought to find in the cases, and when I would say I couldn’t, she would smile in her bewitching way and say, “Oh, but you _must_, it is there”; and then I would try again, often unsuccessfully, while she seemed to have little aptitude to make me find the thing in question. Somehow, we got in the way of not taking her very seriously; but, come to think of it, it is hardly fair to single her out as the cause of my stupidity, for there were clinics of the other professors as well, where I failed to find conditions we were told existed. I suppose it was the untrained student’s incapacity for seeing, hearing, and feeling what the trained clinician sees, hears, and feels so easily.

The man who lectured to us on gunshot wounds always came in the amphitheatre as though he had been shot out of a gun himself. His lectures were clear and to the point.

The lecturer on electro-therapeutics was a pleasing, gentle person; the one on diseases of children a trig, dapper little man; and there were other branches--medical chemistry, skin diseases, diseases of eye and ear, and so on--assuredly a busy year.

When, the latter half of the year, we were allowed to take cases, they were assigned us in alphabetical order. Each student before receiving his degree must have himself managed at least thirty medical, five surgical, and three obstetrical cases; although he was at liberty when necessary to ask a senior to accompany him, and, in grave cases, to call on the Faculty.

All that we knew of our cases till visiting them in their homes was the name and address furnished by the house-physician at the Dispensary. How exciting those first calls--wondering what we should find! I well remember the first visit I started out alone to make with my new little medicine-case under my arm: “Lynch, 846 Albany Street” was the legend supplied at the Dispensary.

The place was in a somewhat better locality than many I had visited in company with seniors. Mounting the stairs, I knocked in some trepidation as I realized I was about to undertake alone my first patient. What would it be? Should I be able, after examining her, to know what ailed her? and what to do for her? A strapping big Irish woman came to the door.

“Does Mrs. Lynch live here?” I asked in as professional a tone as I could summon, to which she grudgingly admitted that she did.

“I am the doctor from the Dispensary, I would like to see her.”

“_I_ am Mrs. Lynch,” she said, without opening the door further, “but I’ll have you understand my son is pretty sick--it is no time to fool around; I sent for a doctor, _not for a little girl_.”

I can see myself as I stood there; can feel just how taken aback and indignant I was; how helpless I felt; but it was only momentary. Pocketing my anger, I said quietly but firmly, “_I_ am the doctor who has been sent to you; if your son is very ill, you must let me see him at once.” She hesitated, but I added that if, after I prescribed for him, she preferred to have a _man_ doctor, in the morning, I would send one instead. I chose to relinquish the case, if need be, on the ground of sex rather than youth, thus seeming to preserve my dignity.

She wavered as though not intending to let me in, but I looked at her compellingly, and, with an ungracious snort, she led the way to the sick-room.

There lay a young coal-driver of twenty-five, with high fever, pains in head and limbs and around his heart, and the fear that he was going to die--a case of rheumatic fever. He looked disappointed as I came in, but was civil; he was too apprehensive to reject even my feeble help. After listening to the history of the onset, I took his pulse and temperature, asked my questions, which at first the mother refused to answer, but her son answered them; and, as the examination progressed, she herself vouchsafed bits of information, showing some lessening of hostility. Prescribing, and giving strict and explicit directions about medicine and diet, on leaving, I said, “I will come early in the morning to see how he is; if you then wish a male physician, I will have one sent for the next visit.” She was less uncivil as she showed me out.

I prescribed _rhus toxicodendron_. That very afternoon the lecturer had discussed the remedy. My case seemed made to order for it. Though prescribing without a moment’s hesitation, still I rushed home and looked up my notes, and studied the subject in the books, finding to my satisfaction that the remedy was well prescribed. In those days one had abundant faith that the remedies, if correctly applied, that is, if the true _similimum_ be found, would do all they promised. My class-mates laughed at my rebuff, but congratulated me on effecting an entrance, and on the selection of the remedy.

Early in the morning I hastened to my patient. At the door the big woman met me with the warmth and cordiality that only an Irish woman can Show when so disposed:

“Come in, Doctor, come right in; my son do be feelin’ better, God bless you!”

Of course he was better; had I not given him _rhus tox_ when all his symptoms called for it? I have since wondered what I should have thought, or done, had my patient failed to respond to the remedy; but there he was, surprisingly better, it was plain to see.

It was my time for revenge: Treating the woman’s warmth with the same apparent indifference that I had her insolence, I allowed myself an outlet for my satisfaction in cordiality to my patient. Going carefully over his symptoms I found him indeed better, though still far from well, and this I told him. Mixing fresh medicine, and giving fresh directions as to his care, I told him he ought to get on nicely now; and then, turning to the woman, said, “To-morrow I will have one of the male physicians make the visit.”

The patient began to protest, and the woman herself to show disappointment:

“Oh, no, Doctor, I guess you’ll do as well as anybody.” But I wickedly replied that I thought she would be better pleased to have another doctor, and I could easily arrange it. Then she pleaded with me not to throw up the case--no one could do so well--her son would get worse if he had a change of doctors, and so on. So, not wishing to excite my patient, and thinking I had punished her enough, I condescended to keep the case. He made a good recovery, and Mrs. Lynch was one of my staunchest advocates after that, recommending me to her neighbours in glowing praise. She also recommended her son to me: “Mike do be thinkin’ a lot of you, Doctor, for savin’ his life. He’s a good boy, is Mike, and will make someone a good man; he gets twinty dollars a month, and has no bad habits, Doctor. Sure an’ a woman might do worse. But Mike says, he says to me, ‘Now, Mother, you do be talkin’ nonsense--the Doctor ain’t for the loikes of me.’”

I can laugh now at the rebuffs I met on account of my youth, not only when in College, but even when practising in U----, but it was hard to laugh at them then. Hence, I suppose, the dignity I instinctively assumed to make up for my short stature and lack of years. I learned, toward the close of my medical course, that it had been customary among the students to speak of me as “the dignified little Miss Arnold.” This dignity was no pose. I was dreadfully in earnest, and felt keenly this drawback to success. There was Miss Wilkins in the same class, no older than I _as a doctor_, but her years and her spectacles were passports to immediate acceptance, and she got credit for being wise where I was scarcely tolerated. Exasperation was no name for it! I lost one obstetrical case in my third year just because of this: After I had made my first visit, the patient sent me a polite note saying her husband was unwilling to go so far as my boarding-place for a doctor; that she would have liked to have me, and hoped I wouldn’t be offended--all a pretense--she was afraid to trust herself in my hands. Under this suddenly terminated record in my note-book I wrote with a sigh, “Oh, for the bonnet and spectacles of Miss Wilkins!” Even within a few months of graduation, while shopping for a cloak, I was chagrined to have the saleswoman tell the taller, but younger, girl who, accompanying me, acted as spokesman, “Oh, you will have to take _her_ into the misses’ department.” The “misses’ department,” indeed! and I almost ready to take my degree! and I would have to be taken in--I could not even go there myself! It amuses me now to recall what a sore point this was with me.

During my second year, Sister came on to Boston to take up nursing. What delight when she landed there! She looked so pretty, and I was so overjoyed to have her there, so proud of her, so eager to show her about and introduce her to my friends! She had been over to the hospital only a week when one day, between lectures, one of the young men came to me and said, “Miss Arnold, there’s an awful nice little thing out in the hall wants to see you.” Just then another rushed up and said, “Miss Arnold, if you’re not in here, you’re out in the hall, and you want to see yourself.” I ran out and found Kate in her nurse’s garb, smiling, blushing, and enjoying having these young men dance attendance on her. I was flattered that they had seen so marked a resemblance when she was so much more attractive than I.

Not wishing to pledge herself to the two-year course, Kate stayed at the hospital only during the probationer’s term, deciding that she would go home and say Yes to the wooer to whom distance was lending enchantment. But she occupied herself with private nursing in and around Boston till I went home in June. Once she just missed an opportunity to go as companion to the invalid wife of Dr. Oliver Wendell Holmes, but an unkind Providence prevented--she having accepted a case in that city. How I bewailed her untimely absence--actually to have been in the same house with the dear Autocrat! I was almost tempted to go myself--medicine or no medicine.

During that second year, Dr. “Conrad” asked for volunteers for drug-provings among the students: A drug was prepared for each prover with directions for taking, and whatever symptoms were experienced while taking it were to be recorded in a little book, whether we thought them due to the drug or not. The provers were enjoined not to compare notes, but to turn in their reports at a stated time. I was one of six to volunteer.

For a few days I had only the slightest symptoms to record, but after that there developed an intestinal disturbance which gradually became pronounced. I began to get interested, wondering if it was really the drug that was responsible--those tiny tasteless powders--so, doubting it, kept on with the medicine. I suppose I was a little skeptical because of a rumour that they always gave some of the provers _saccharum lactis_, and that not infrequently records were turned in with a long string of symptoms, when the provers had only been given _sac. lac._ Naturally I did not want to attribute symptoms to drug action if I were not taking a real drug; so, though growing worse and worse, I kept on with the proving. The day came for our examination in pathology by the very professor who had solicited the provings--our skeptical pessimist. Uncomfortably ill by that time, I could hardly hold out to take the examination. Miss Wilkins had insisted that if I did not go to see Dr. “Conrad” immediately afterwards, she would go herself, so as I handed in my paper, I told him I was ill, and would like to call at his office in the afternoon. I added that I was one of the drug-provers, but was not sure whether this illness had anything to do with what I had been taking. He bent upon me those scrutinizing eyes, his face stern but kindly, and said, “Poor child, why didn’t you tell me before? How have you sat through the examination? Go home at once, and come to me at two o’clock.”

That afternoon I went to his office on Commonwealth Avenue--a luxurious place, a side of life that, as students, we saw only from the outside, our entrée in Boston houses being chiefly in those of the Lynches, the Sullivans, and O’Gradys. The kind, fatherly look he bent upon me as he drew me in his office and listened to my confused, embarrassed tale, was worth it all. Weak and in pain, I was unable to tell a clear story. He snatched my note-book, read the symptoms, looking up every few minutes, then read on, after which he gave me a soothing talk, and I have loved him ever since. Though commending my zeal, he deplored the fact that I had carried it to the extent of suffering so much.

“No one else did it--no one else did it,” he scolded, half to himself. “They turned in their worthless notes before the time was up, pretending they had taken the drugs faithfully when I knew they hadn’t; some of them got symptoms on taking _sac. lac._--a good list of them! but you wanted to be sure yourself--that is the only way to get at the truth.”

Who would not have been willing to suffer to get this from the stern Dr. “Conrad?” Rigidly prescribing my diet and rest, he gave me some medicine and sent me home in his carriage, calling on me that evening to my delight. In two days I was as well as ever. I learned later that it was _mercury_ that I had proved, but in so weak a potency that he had been surprised at the results.

That same year I experimented with _atropine_ in my eyes (a silly, risky thing to do), applying it just to see how I would look with the pupils widely dilated, little knowing how it would incapacitate me for my work. Putting in a tiny bit just before starting for College one morning, by the time I got there I could not see to take notes or to read, and it was only a day or two before “exams”!

For one of the meetings of our College Society, I was given the subject _materia medica_ to treat in any way I chose. Having just been reading the “medicated novels” of Dr. Holmes--“Elsie Venner” and “The Guardian Angel”--I thought it would be fun to take a case described in one of them, as given in the nurse’s report, ask the students to diagnose it and prescribe, leading them at the start to think it a _bona fide_ case. The one I chose, I myself diagnosed as one of _globus hystericus_, and decided what remedy I would give, were she a real patient. Then it occurred to me that it would be interesting to know what our professor in _materia medica_ would prescribe for such a case in real life; and that it would add to the interest if I could tell the students that I would give them Prof. S----’s prescription after they had submitted theirs.

I had no intention of deceiving the professor when I first thought of going to him, but growing bold on arrival, as I handed him the paper with the symptoms copied off verbatim, told him I was especially anxious to prescribe carefully for this case, as it had come into my hands from _a prominent old school physician_.

As he read, his eyes twinkled at the nurse’s phraseology; he looked up at me once or twice, curiously, as I sat there scared, then, at what I had done. Seeing my pencilled diagnosis with a question mark at the bottom, he said:

“Yes, you have diagnosed the case correctly beyond a doubt, and now for the remedy--I see you have three suggested, but first, let me know more about the case.” Then he plied me with questions. By this time I was greatly embarrassed; a suspicious twinkle in his eye, as he remarked that the nurse herself must be a unique person, made me uncomfortable. Finally he queried, “Who _is_ this ‘old school physician’ who had the case?”

“Dr. Oliver Wendell Holmes,” I confessed timorously.

How he laughed! Hastening to explain and apologize, I told him how I had come to present the case to him, and that only on the spur of the moment had I conceived the idea of offering it as a real case. He had seen from the start that there was something queer, but was at a loss to unravel the mystery. After a jolly chat about it, he discussed the symptoms as seriously with me as though it had been a case in real life; so I went to the Society meeting in great glee, hoodwinking them until their answers were turned in, then telling them the whole story.

The experiences of that second-year vacation kept pace with the advance in our studies. Uncles, aunts, and cousins, school-mates, neighbours, and chance acquaintances came rehearsing their aches and pains, expecting me in my inexperience to help them promptly. I took them all seriously. I was a good listener, but was often of little further help. So many of them had complaints about which we had as yet had no lectures. Still I had the hope and confidence that go with youth, and the temerity to “rush in” where the more experienced might fear to tread.

The coloured woman who did our washing asked me to attend her in confinement--her confidence in me was touching; for, although we had had our lectures in obstetrics, and I had been to a few cases with seniors, I had then managed none myself. But Josie had had several children so would be likely, I thought, to have an easy time; and, if I should need help, I could call on Dr. Campbell--the physician for whom I had had the girlish infatuation.

It was a hot Fourth of July when they called me. Josie’s poor little home was a paradise in neatness and order compared to those I had frequented in dispensary practice. I felt quite elated at the prospect of managing a case alone. But from my first examination I felt uneasy, seeing that I had a different condition to deal with than any encountered in my limited experience. As labour progressed, to my consternation I found the cord, instead of the head, presenting, so knew that I had a case of transverse presentation--one which would require turning and speedy delivery to save the child. Of course I was incompetent to do this, nor would it have been lawful to attempt it, being an undergraduate.

Dr. Campbell responded promptly to my summons, performed version, and delivered the child and the adherent placenta. I managed the after-care without difficulty. Josie was glad of her enforced rest in bed. In the days preceding her confinement I had gone past her house and seen her, big with child, standing at the ironing-board, late at night, thus supporting her family while her great lazy husband, John Wesley Freeman, would loll about all day, then sit by her at night and read the Bible and exhort as she stood ironing. True to his name, he felt called to preach, and, failing a larger audience, preached to poor Josie, in and out of season. While I kept her in bed, the lazy fellow had to shift for himself or starve, as his swarming offspring were too small to be of service in the household.

One morning, on finding Josie worse, and learning that John Wesley had been preaching to her the night before, and scolding her because she had fallen asleep, I berated him soundly. It was a good time to chastise him generally; to warn him against deeds of omission and commission. So I set forth how near Josie had come to losing her life, and said she probably would not live through another pregnancy. When I had done, in his drawling, falsetto voice, and with a sanctimonious air, he said:

“Yes, Miss ’Genia, I reckon she was mighty sick, but she’s gettin’ on now, and you know, Miss ’Genia, the Bible says we chillun must be fruitful and multiply and ’plenish the earth; and, Miss ’Genia, we sholy must do as the good Book says.”

More exasperated than amused, I snapped out:

“Well, John Wesley, I think you have done your share toward being fruitful and multiplying and replenishing the earth--I guess the Lord will excuse you if you turn around now and help Josie to support the ones you have on hand.”

But he didn’t; he continued compliant to his favourite text; and after one or two more evidences of his cheerful obedience came, Josie left her wash-tub and ironing-board forever and replenished the earth with her worn-out body, able no longer to be fruitful and multiply at the rate John Wesley thought necessary in order to fulfil the Holy Scriptures.

All that summer I attended an old man dying of Bright’s disease, prescribing for him and helping his over-burdened wife in nursing him. It was hard work--those bed-sores, his extreme emaciation and helplessness; but I then learned the luxury of feeling myself really useful. I knew I was helping to lighten burdens growing well-nigh unendurable. Yet how critical I was in my heart of the poor wife when, the morning I went there early and found her carrying out blankets and pillows to air, I heard her announce, with a relief in which there was no attempt at concealment, “Well, he’s gone at last!” She let me do the autopsy. I invited Belle and Dr. Campbell. I can remember the appearance of those worn-out kidneys far better than the details of many a later autopsy.