Chapter V: Part 5

These reflections were the outcome of an incident which had set me thinking of the equipment of a surgeon and of what is needed to fit him for his work. The episode concerned a young medical man who had started practice in a humble country town. His student career had been meritorious and indeed distinguished. He had obtained an entrance scholarship at his medical school, had collected many laudatory certificates, had been awarded a gold medal and had become a Fellow of the Royal College of Surgeons. His inclination was towards surgery. He considered surgery to be his _métier_. Although circumstances had condemned him to the drab life of a family doctor in a little town, he persisted that he was, first and foremost, a surgeon, and, indeed, on his door-plate had inverted the usual wording and had described himself as “surgeon and physician.” In his hospital days he had assisted at many operations, but his opportunities of acting as a principal had been few and insignificant. In a small practice in a small town surgical opportunities are rare. There was in the place a cottage hospital with six beds, but it was mostly occupied by medical cases, by patients with rheumatism or pneumonia, by patients who had to submit to the surgical indignity of being poulticed and of being treated by mere physic. Cases worthy of a Fellow of the Royal College of Surgeons were very few, and even these seldom soared in interest above an abscess or a broken leg.

Just before the young doctor settled down to practise he married. It was a very happy union. The bride was the daughter of a neighbouring farmer. She had spent her life in the country, was more familiar with the ways of fowls and ducks than with the ways of the world, while a sunbonnet became her better than a Paris toque. She was as pretty as the milkmaid of a pastoral picture with her pink-and-white complexion, her laughing eyes and her rippled hair.

Her chief charm was her radiant delight in the mere joy of living. The small world in which she moved was to her always in the sun, and the sun was that of summer. There was no town so pretty as her little town, and no house so perfect as “the doctor’s” in the High Street. “The doctor’s” was a Georgian house with windows of many panes, with a fanlight like a surprised eyebrow over the entry and a self-conscious brass knocker on the door. The house was close to the pavement, from which it was separated by a line of white posts connected by loops of chain. Passers-by could look over the low green wooden blinds into the dining-room and see the table covered with worn magazines, for the room was intended to imitate a Harley Street waiting-room. They could see also the bright things on the sideboard, the wedding-present biscuit box, the gong hanging from two cow horns and the cup won at some hospital sports. To the young wife there never was such a house, nor such furniture, nor such ornaments, nor, as she went about with a duster from room to room, could there be a greater joy than that of keeping everything polished and bright.

Her most supreme adoration, however, was for her husband. He was so handsome, so devoted, and so amazingly clever. His learning was beyond the common grasp, and the depths of his knowledge unfathomable. When a friend came in at night to smoke a pipe she would sit silent and open-mouthed, lost in admiration of her husband’s dazzling intellect. How glibly he would talk of metabolism and blood-pressure; how marvellously he endowed common things with mystic significance when he discoursed upon the value in calories of a pound of steak, or upon the vitamines that enrich the common bean, or even the more common cabbage. It seemed to her that behind the tiny world she knew there was a mysterious universe with which her well-beloved was as familiar as was she with the contents of her larder.

She was supremely happy and content, while her husband bestowed upon her all the affection of which he was capable. He was naturally vain, but her idolatry made him vainer. She considered him wonderful, and he was beginning to think her estimate had some truth in it. She was so proud of him that she rather wearied her friends by the tale of his achievements. She pressed him to allow her to have his diploma and his more florid certificates framed and hung up in the consulting room, but he had said with chilling superiority that such things “were not done,” so that she could only console herself by adoring the modesty of men of genius.

One day this happy, ever-busy lady was seized with appendicitis. She had had attacks in her youth, but they had passed away. This attack, although not severe, was graver, and her husband determined, quite wisely, that an operation was necessary. He proposed to ask a well-known surgeon in a neighbouring city to undertake this measure. He told his wife, of course, of his intention, but she would have none of it. “No,” she said, “she would not be operated on by stuffy old Mr. Heron.[3] He was no good. She could not bear him even to touch her. If an operation was necessary no one should do it but her husband. He was so clever, such a surgeon, and so up-to-date. Old Heron was a fossil and behind the times. No! Her clever Jimmy should do it and no one else. She could trust no one else. In his wonderful hands she would be safe, and would be running about again in the garden in no time. What was the use of a fine surgeon if his own wife was denied his precious help!”

The husband made no attempt to resist her wish. He contemplated the ordeal with dread, but was so influenced by her fervid flattery that he concealed from her the fact that the prospect made him faint of heart and that he had even asked himself: “Can I go through with it?”

He told me afterwards that his miserable vanity decided him. He could not admit that he lacked either courage or competence. He saw, moreover, the prospect of making an impression. The town people would say: “Here is a surgeon so sure of himself that he carries out a grave operation on his own wife without a tremor.” Then, again, his assistant would be his fellow-practitioner in the town. How impressed he would be by the operator’s skill, by his coolness, by the display of the latest type of instrument, and generally by his very advanced methods. It was true that it was the first major operation he had ever undertaken, but he no longer hesitated. He must not imperil his wife’s faith in him nor fail to realize her conception of his powers. As he said to me more than once, it was his vanity that decided him.

He read up the details of the operation in every available manual he possessed. It seemed to be a simple procedure. Undoubtedly in nine cases out of ten it is a simple measure. His small experience, as an onlooker, had been limited to the nine cases. He had never met with the tenth. He hardly believed in it. The operation as he had watched it at the hospital seemed so simple, but he forgot that the work of expert hands does generally appear simple.

The elaborate preparations for the operation—made with anxious fussiness and much clinking of steel—were duly completed. The lady was brought into the room appointed for the operation and placed on the table. She looked very young. Her hair, parted at the back, was arranged in two long plaits, one on either side of her face, as if she were a schoolgirl. She had insisted on a pink bow at the end of each plait, pleading that they were cheerful. She smiled as she saw her husband standing in the room looking very gaunt and solemn in his operating dress—a garb of linen that made him appear half-monk, half-mechanic. She held her hand towards him, but he said he could not take it as his own hand was sterilized. Her smile vanished for a moment at the rebuke, but came back again as she said: “Now don’t look so serious, Jimmy; I am not the least afraid. I know that with you I am safe and that you will make me well, but be sure you are by my side when I awake, for I want to see you as I open my eyes. Wonderful boy!”

The operation was commenced. The young doctor told me that as he cut with his knife into that beautiful white skin and saw the blood well up behind it a lump rose in his throat and he felt that he must give up the venture. His vanity, however, urged him on. His doctor friend was watching him. He must impress him with his coolness and his mastery of the position. He talked of casual things to show that he was quite at ease, but his utterances were artificial and forced.

For a time all went well. He was showing off, he felt, with some effect. But when the depths of the wound were reached a condition of things was found which puzzled him. Structures were confused and matted together, and so obscured as to be unrecognizable. He had read of nothing like this in his books. It was the tenth case. He became uneasy and, indeed, alarmed, as one who had lost his way. He ceased to chatter. He tried to retain his attitude of coolness and command. He must be bold, he kept saying to himself. He made blind efforts to find his course, became wild and finally reckless. Then a terrible thing happened. There was a tear—something gave way—something gushed forth. His heart seemed to stop. He thought he should faint. A cold sweat broke out upon his brow. He ceased to speak. His trembling fingers groped aimlessly in the depths of the wound. His friend asked: “What has happened?” He replied with a sickly fury: “Shut up!”

He then tried to repair the damage he had done; took up instrument after instrument and dropped them again until the patient’s body was covered with soiled and discarded forceps, knives and clamps. He wiped the sweat from his brow with his hand and left a wide streak of blood across his forehead. His knees shook and he stamped to try to stop them. He cursed the doctor who was helping him, crying out: “For God’s sake do this,” or “For God’s sake don’t do that”; sighed like a suffocating man; looked vacantly round the room as if for help; looked appealingly to his wife’s masked face for some sign of her tender comfort, but she was more than dumb. Frenzied with despair, he told the nurse to send for Mr. Heron. It was a hopeless mission, since that surgeon—even if at home—could not arrive for hours.

He tried again and again to close the awful rent, but he was now nearly dropping with terror and exhaustion. Then the anæsthetist said in a whisper: “How much longer will you be? Her pulse is failing. She cannot stand much more.” He felt that he must finish or die. He finished in a way. He closed the wound, and then sank on a stool with his face buried in his blood-stained hands, while the nurse and the doctor applied the necessary dressing.

The patient was carried back to her bedroom, but he dared not follow. The doctor who had helped him crept away without speaking a word. He was left alone in this dreadful room with its hideous reminders of what he had done. He wandered about, looked aimlessly out of the window, but saw nothing, picked up his wife’s handkerchief which was lying on the table, crunched it in his hand, and then dropped it on the floor as the red horror of it all flooded his brain. What had he done to her? She! She of all women in the world!

He caught a sight of himself in the glass. His face was smeared with blood. He looked inhuman and unrecognizable. It was not himself he saw: it was a murderer with the brand of Cain upon his brow. He looked again at her handkerchief on the ground. It was the last thing her hand had closed upon. It was a piece of her lying amid this scene of unspeakable horror. It was like some ghastly item of evidence in a murder story. He could not touch it. He could not look at it. He covered it with a towel.

In a while he washed his hands and face, put on his coat and walked into the bedroom. The blind was down; the place was almost dark; the atmosphere was laden with the smell of ether. He could see the form of his wife on the bed, but she was so still and seemed so thin. The coverlet appeared so flat, except where the points of her feet raised a little ridge. Her face was as white as marble. Although the room was very silent, he could not hear her breathe. On one side of the bed stood the nurse, and on the other side the anæsthetist. Both were motionless. They said nothing. Indeed, there was nothing to say. They did not even look up when he came in. He touched his wife’s hand, but it was cold and he could feel no pulse.

In about two hours Heron, the surgeon, arrived. The young doctor saw him in an adjacent bedroom, gave him an incoherent, spasmodic account of the operation, laid emphasis on unsurmountable difficulties, gabbled something about an accident, tried to excuse himself, maintained that the fault was not his, but that circumstances were against him.

The surgeon’s examination of the patient was very brief. He went into the room alone. As he came out he closed the door after him. The husband, numb with terror, was awaiting him in the lobby. The surgeon put his hand on the wretched man’s shoulder, shook his head and, without uttering a single word, made his way down the stairs. He nearly stumbled over a couple of shrinking, white-faced maids who had crept up the stairs in the hope of hearing something of their young mistress.

As he passed one said: “Is she better, doctor?” but he merely shook his head, and without a word walked out into the sunny street where some children were dancing to a barrel-organ.

The husband told me that he could not remember what he did during these portentous hours after the operation. He could not stay in the bedroom. He wandered about the house. He went into his consulting room and pulled out some half-dozen works on surgery with the idea of gaining some comfort or guidance; but he never saw a word on the printed page. He went into the dispensary and looked over the rows of bottles on the shelves to see if he could find anything, any drug, any elixir that would help. He crammed all sorts of medicines into his pocket and took them upstairs, but, as he entered the room, he forgot all about them, and when he found them in his coat a week later he wondered how they had got there. He remembered a pallid maid coming up to him and saying: “Lunch is ready, sir.” He thought her mad.

He told me that among the horrors that haunted him during these hours of waiting not the least were the flippant and callous thoughts that would force themselves into his mind with fiendish brutality. There was, for example, a scent bottle on his wife’s table—a present from her aunt. He found himself wondering why her aunt had given it to her and when, what she had paid for it, and what the aunt would say when she heard her niece was dead. Worse than that, he began composing in his mind an obituary notice for the newspapers. How should he word it? Should he say “beloved wife,” or “dearly loved wife,” and should he add all his medical qualifications? It was terrible. Terrible, too, was his constant longing to tell his wife of the trouble he was in and to be comforted by her.

Shortly after the surgeon left the anæsthetist noticed some momentary gleam of consciousness in the patient. The husband hurried in. The end had come. His wife’s face was turned towards the window. The nurse lifted the blind a little so that the light fell full upon her. She opened her eyes and at once recognized her husband. She tried to move her hand towards him, but it fell listless on the sheet. A smile—radiant, grateful, adoring—illumined her face, and as he bent over her he heard her whisper: “Wonderful boy.”

XI

BREAKING THE NEWS

Among the more painful experiences which haunt a doctor’s memory are the occasions on which it has been necessary to tell a patient that his malady is fatal and that no measure of cure lies in the hands of man. Rarely indeed has such an announcement to be bluntly made. In the face of misfortune it is merciless to blot out hope. That meagre hope, although it may be but a will-o’-the-wisp, is still a glimmer of light in the gathering gloom. Very often the evil tidings can be conveyed by the lips of a sympathetic friend. Very often the message can be worded in so illusive a manner as to plant merely a germ of doubt in the mind; which germ may slowly and almost painlessly grow into a realization of the truth. I remember being present when Sir William Jenner was enumerating to a friend the qualities he considered to be essential in a medical man. “He needs,” said the shrewd physician, “three things. He must be honest, he must be dogmatic and he must be kind.” In imparting his dread message the doctor needs all these qualities, but more especially the last—he must be kind. His kindness will be the more convincing if he can, for the moment, imagine himself in the patient’s place and the patient in his.

The mind associates the pronouncing of a verdict and a sentence of death with a court of justice, a solemn judge in his robes, the ministers of the law, the dock, a pallid and almost breathless audience. Such a spectacle, with its elaborate dignity, is impressive enough, but it is hardly less moving when the scene is changed to a plain room, hushed almost to silence and occupied by two persons only, the one who speaks and the one who listens—the latter with bowed head and with knotted hands clenched between his knees.

The manner in which ill-news is received depends upon its gravity, upon the degree to which the announcement is unexpected and upon the emotional bearing of the recipient. There may be an intense outburst of feeling. There may be none. The most pitiable cases are those in which the sentence is received in silence, or when from the trembling lips there merely escapes the words, “It has come.”

The most vivid displays of feeling that occur to my mind have been exhibited by mothers when the fate of a child is concerned. If her child be threatened a mother may become a tigress. I remember one such instance. I was quietly interviewing a patient in my consulting room when the door suddenly flew open and there burst in—as if blown in by a gust of wind—a gasping, wild-eyed woman with a little girl tucked up under her arm like a puppy. Without a word of introduction she exclaimed in a hoarse whisper, “He wants to take her foot off.” This sudden, unexplained lady was a total stranger to me. She had no appointment. I knew nothing of her. She might have dropped from the clouds. However, the elements of violence, confusion and terror that she introduced into my placid room were so explosive and disturbing that I begged my patient to excuse me and conducted, or rather impelled, the distraught lady into another room. Incidentally I may remark that she was young and very pretty; but she was evidently quite oblivious of her looks, her complexion, her dress or her many attractions. I had before noticed that when a good-looking woman is unconscious of being good-looking there is a crisis in progress.

The story, which was told me in gasps and at white heat, was as follow. The child was a little girl of about three, almost as pretty as her mother. She was the only child and had developed tuberculous disease in one foot. The mother had taken the little thing to a young surgeon who appears to have let fall some rash remark as to taking the foot off. This was enough for the mother. She would not listen to another syllable. She, whom I came to know later as one of the sweetest and gentlest of women, changed at the moment to a wild animal—a tigress.

Without a word she snatched up the baby and bolted from the house, leaving the child’s sock and shoe on the consulting-room floor. She had been given my name as a possible person to consult and had dashed off to my house, carrying the child through the streets with its bare foot and leg dangling in the air. On being admitted she asked which was my room. It was pointed out to her, and without more ado she flung herself in as I have described. The child, I may say, was beaming with delight. This dashing in and out of other people’s houses and being carried through the streets without a sock or a shoe on her foot struck her as a delicious and exciting game.

The mother’s fury against my surgical colleague was almost inexpressible. If the poor man had suggested cutting off the child’s head he could not have done worse. “How dare he!” she gasped. “How dare he talk of cutting off her foot! If he had proposed to cut off my foot I should not have minded. It would be nothing. But to cut off her little foot, this beautiful little foot, is a horror beyond words, and then look at the child, how sweet and wonderful she is! What wickedness!” It was a marvellous display of one of the primitive emotions of mankind, a picture, in human guise, of a tigress defending her cub. By a happy good fortune, after many months and after not a few minor operations, the foot got well so that the glare in the eyes of the tigress died away and she remembered again that she was a pretty woman.

It is well known that the abrupt reception of ill-tidings may have a disastrous effect upon the hearer. The medical man is aware that, if he would avoid shock, the announcement of unpleasant facts or of unhappy news must be made slowly and with a tactful caution. In this method of procedure I learnt my lesson very early and in a way that impressed my memory.

I was a house-surgeon and it was Christmas time. In my day each house-surgeon was on what was called “full duty” for one entire week in the month. During these seven days all accident cases came into his surgeon’s wards. He was said to be “taking in.” On this particular Christmas week I was “taking in.” Two of my brother house-surgeons had obtained short leave for Christmas and I had undertaken their duties. It was a busy time; so busy indeed that I had not been to bed for two nights. On the eve of the third night I was waiting for my dressers in the main corridor at the foot of the stair. I was leaning against the wall and, for the first and the last time in my life, I fell asleep standing up. The nap was short, for I was soon awakened, “rudely awakened” as novelists would put it.

I found myself clutched by a heated and panting woman who, as she clung to me, said in a hollow voice, “Where have they took him?” The question needed some amplification. I inquired who “he” was. She replied, “The bad accident case just took in.” Now the term “accident” implies, in hospital language, a man ridden over in the street, or fallen from a scaffold, or broken up by a railway collision. I told her I had admitted no such case of accident. In fact the docks and the great works were closed, and men and women were celebrating the birth of Christ by eating too much, by getting drunk and by street rioting, which acts involved only minor casualties. She was, however, convinced he was “took in.” He was her husband. She gave me his name, but that conveyed nothing, as it was the dresser’s business to take names. With a happy inspiration I asked, “What is he?” “A butler,” she replied. Now a butler is one of the rarest varieties of mankind ever to be seen in Whitechapel, and it did so happen that I had, a few hours before, admitted an undoubted butler. I told her so, with the effusion of one eager to give useful information. She said, “What is the matter with him?” I replied cheerily, “He has cut his throat.”

The effect of this unwise readiness on my part was astonishing. The poor woman, letting go of my coat, collapsed vertically to the floor. She seemed to shut up within herself like a telescope. She just went down like a dress dropping from a peg. When she was as small a heap as was possible in a human being she rolled over on to her head on the ground. A more sudden collapse I have never seen. Had I been fully awake it would never have happened. We placed her on a couch and soon restored her to consciousness.

Her story was simple. She and her husband had met. The two being “full of supper and distempering draughts” (as Brabantio would say) had had a savage quarrel. At the end he banged out of the house, exclaiming, “I will put an end to this.” She had bawled after him, “I hope to God you will.” He had wandered to Whitechapel and, creeping into a stable, had cut his throat there and then. The friend who hastened to inform the wife told her, with a tactfulness I so grievously lacked, that her husband had met with an accident and had been taken to the hospital. This lesson I never forgot and in the future based my method of announcing disaster upon that adopted by the butler’s discreet friend.

Although a digression from the present subject I am reminded of the confusion that occasionally took place in the identity of cases. All patients in the hospital who are seriously ill, whether they have been long in the wards or have been only just admitted, are placed on “the dangerous list” and have their names posted at the gate so that their relatives might be admitted at any time of the day or night.

A man very gravely injured had been taken into the accident ward. He was insensible and his condition such that he was at once put on the dangerous list, or, in the language of the time, was “gated.” During the course of the evening a youngish woman, dressed obviously in her best, bustled into the ward with an air of importance and with a handkerchief to her lips. She demanded to see the man who had been brought in seriously injured. She was directed by the sister to a bed behind a screen where lay the man, still insensible and with his head and much of his face enveloped in bandages. The woman at once dropped on her knees by the bedside and, throwing her arms about the neck of the unconscious man, wept with extreme profusion and with such demonstrations of grief as are observed at an Oriental funeral. When she had exhausted herself she rose to her feet and, staring at the man on the bed, exclaimed suddenly, “This is not Jim. This is not my husband. Where is he?”

Now, in the next bed to the one with the screen, and in full view of it, was a staring man sitting bolt upright. He had been admitted with an injury to the knee. This was Jim. He was almost overcome by amazement. He had seen his wife, dressed in her best, enter the ward, clap her hand to her forehead, fall on her knees and throw her arms round the neck of a total stranger and proceed to smother him with kisses. Jim’s name had been “gated” by mistake.

When she came to the bedside of her real husband she was annoyed and hurt, so hurt, indeed, that she dealt with him rudely. She had worked herself up for a really moving theatrical display in the wards, had rehearsed what she should say as she rode along in the omnibus and considered herself rather a heroine or, at least, a lady of intense and beautiful feeling which she had now a chance of showing off. All this was wasted and thrown away. An injured knee, caused by falling over a bucket, was not a subject for fine emotional treatment. She was disgusted with Jim. He had taken her in. “Bah!” she exclaimed. “Come in with water on the knee! You might as well have come in with water on the brain! You are a fraud, you are! What do you mean by dragging me all the way here for nothing? You ought to be ashamed of yourself.” With this reproof she sailed out of the room with great dignity—a deeply injured woman.

To return to the original topic. In all my experience the most curious manner in which a painful announcement was received was manifested under the following circumstances. A gentleman brought his daughter to see me—a charming girl of eighteen. He was a widower and she was his only child. A swelling had appeared in the upper part of her arm and was increasing ominously. It became evident on examination that the growth was of the kind known as a sarcoma and that the only measure to save life was an amputation of the limb at the shoulder joint, after, of course, the needful confirmatory exploration had been made.

A more distressing position could hardly be imagined. The girl appeared to be in good health and was certainly in the best of spirits. Her father was absolutely devoted to her. She was his ever-delightful companion and the joy and comfort of his life. Terrible as the situation was it was essential not only that the truth should be told but told at once. Everything depended upon an immediate operation and, therefore, there was not a day to be lost. To break the news seemed for a moment almost impossible. The poor father had no suspicion of the gravity of the case. He imagined that the trouble would probably be dealt with by a course of medicine and a potent liniment. I approached the revelation of the dreadful truth in an obscure manner. I discussed generalities, things that were possible, difficulties that might be, threw out hints, mentioned vague cases, and finally made known to him the bare and ghastly truth with as much gentleness as I could command.

The wretched man listened to my discourse with apparent apathy, as if wondering what all this talk could mean and what it had to do with him. When I had finished he said nothing, but, rising quietly from his chair, walked over to one side of the room and looked at a picture hanging on the wall. He looked at it closely and then, stepping back and with his head on one side, viewed it at a few feet distant. Finally he examined it through his hand screwed up like a tube. While so doing he said, “That is a nice picture. I rather like it. Who is the artist? Ah! I see his name in the corner. I like the way in which he has treated the clouds, don’t you? The foreground too, with those sheep, is very cleverly managed.” Then turning suddenly to me he burst out, “What were you talking about just now? You said something. What was it? For God’s sake say that it is not true! It is not true! It cannot be true!”

XII

A QUESTION OF HATS

I had had a very busy afternoon and had still two appointments to keep. The first of these was in the suburbs, a consultation with a doctor who was a stranger to me. It was a familiar type of house where we met—classic Doric pillars to the portico, a congested hall with hat-pegs made of cow horns, a pea-green vase with a fern in it perched on a bamboo tripod, and a red and perspiring maid-servant. Further, I became acquainted with a dining-room containing bomb-proof, mahogany furniture, and great prints in pairs on the walls, “War” and “Peace” on one side, “Summer” and “Winter” on the other. Then there was the best bedroom, rich in lace and wool mats, containing a bedstead as glaring in brass as a fire-engine, a mirror draped with muslin and pink bows, and enough silver articles on the dressing-table to start a shop. After a discussion of the case with the doctor in a drawing-room which smelt like an empty church, I rushed off, leaving the doctor to detail the treatment we had advised, for I found—to my dismay—that I was twenty minutes late.

The second case was that of an exacting duke whom I had to visit at regular periods and, according to the ducal pleasure, I should be at the door at least one minute before the appointed hour struck. I was now hopelessly late and consequently flurried. On reaching the ducal abode I flew upstairs prepared to meet the storm. His Grace ignored my apologies and suggested, with uncouth irony, that I had been at a cricket match. He added that it was evident that I took no interest in him, that his sufferings were nothing to me, and concluded by asserting that if he had been dying I should not have hurried. I always regard remarks of this type as a symptom of disease rather than as a considered criticism of conduct, and therefore had little difficulty in bringing the duke to a less contentious frame of mind by reverting to that topic of the day—his engrossing disorder.

The duke never allowed his comfort to be in any way disturbed. He considered his disease as a personal affront to himself, and I therefore discussed it from the point of view of an unprovoked and indecent outrage. This he found very pleasing, although I failed to answer his repeated inquiry as to why His Grace the Duke of X should be afflicted in this rude and offensive manner. It was evident that his position should have exempted him from what was quite a vulgar disorder, and it was incomprehensible that he, of all people, should have been selected for this insult.

The interview over, I made my report to the duchess, who was in a little room adjacent to the hall. She followed me out to ask a final question just as I was on the point of taking my hat. The hat handed to me by the butler was, however, a new hat I had never seen before. It was of a shape I disliked. The butler, with due submission, said it was the hat I came in. I replied it was impossible, and, putting it on my head, showed that it was so small as to be absurd. The duchess, who was a lady of prompt convictions, exclaimed, “Ridiculous; that was never your hat!” The butler could say no more: he was convicted of error. The duchess then seized upon the only other hat on the table and held it at arm’s length. “Whose is this?” she cried. “Heavens, it is the shabbiest hat I ever saw! It cannot be yours.” (It was not.) Looking inside, she added, “What a filthy hat! It is enough to poison the house.” Handing it to the butler as if it had been an infected rag, she exclaimed, “Take it away and burn it!”

The butler did not at once convey this garbage to the flames, but remarked—as if talking in his sleep—“There is a pianoforte tuner in the drawing-room.” The duchess stared with amazement at this inconsequent remark. Whereupon the butler added that the new hat I had rejected might possibly be his. He was at once sent up to confront the artist, whose aimless tinkling could be heard in the hall, with the further message that if the dirty hat should happen to be his he was never to enter the house again. The butler returned to say that the musician did not “use” a hat. He wore a cap, which same he had produced from his pocket.

While the butler was away a great light had illumined the mind of the duchess. It appeared that Lord Andrew, her son-in-law, had called that afternoon with his wife. He had just left, his wife remaining behind. It was soon evident that the duchess had a grievance against her son-in-law. When the light fell upon her she exclaimed to me, “I see it all now. This horrible hat is Andrew’s. He has taken yours by mistake and has left this disgusting thing behind. It is just like him. He is the worst-dressed man in London, and this hat is just the kind he would wear.”

At this moment the daughter appeared. She had overheard her mother’s decided views, and was proportionately indignant. She disdained to even look at the hat, preferring to deal with the indictment of Andrew on general grounds. She defended her husband from the charge of being unclean with no little show of temper. Without referring to the specific hat, she said she was positive, on a priori grounds, that Andrew would never wear a dirty hat. Her mother had no right to say such things. It was unjust and unkind.

The duchess was now fully roused. She was still more positive. This, she affirmed, was just the sort of thing Andrew would do—leave an old hat behind and take a good one. She would send him at once a note by a footman demanding the immediate return of my hat and the removal of his own offensive headgear.

The daughter, deeply hurt, had withdrawn from the discussion. I suggested that as Lady Andrew was about to go home she might inquire if a mistake had been made. Her Grace, however, was far too moved to listen to such moderation. She wanted to tell Andrew what she thought of him, and it was evident she had long been seeking the opportunity. So she at once stamped off to write the note. In the meanwhile I waited, gazing in great melancholy of mind at the two hats. The silent butler also kept his eyes fixed upon them with a gloom even deeper than mine. I had hinted that the new hat might belong to Lord Andrew, but the duchess had already disposed of that suggestion by remarking with assurance that Andrew never wore a new hat. The note was produced and at once dispatched by a footman.

I have no idea of the wording of the note, but I was satisfied that the duchess had not been ambiguous, and that she had told her son-in-law precisely what were her present views of him in a wider sense than could be expressed in terms of hats. The writing of the letter had relieved her. She was almost calm.

She now told the silent butler to fetch one of the duke’s hats, so that I might have at least some decent covering to my bare head thus unscrupulously stripped by the unclean Andrew. The butler returned with a very smart hat of the duke’s. It had apparently never been worn. It fitted me to perfection. In this vicarious coronet I regained my carriage. I felt almost kindly towards the duke now that I was wearing his best hat.

Next day I placed the ducal hat in a befitting hat-box and, having put on another hat of my own, was starting for the scene of the downfall of Lord Andrew. At my door a note was handed me. It was from the suburban doctor. He very courteously pointed out that I had taken his hat by mistake, and said he would be glad if I would return it at my convenience, as he had no other, and my hat came down over his eyes. It was a dreadful picture, that of a respected practitioner going his rounds with a hat resting on the bridge of his nose; but at least it cleared up the mystery of the new hat. The butler was right. In my anxiety at being late on the previous afternoon I was evidently not conscious that I was wearing a hat which must have looked like a thimble on the top of an egg.

On reaching the ducal residence I was received by the butler. He said nothing; but it seemed to me that he smiled immoderately for a butler. The two hats, the new and the dirty, were still on the table, but the duchess made no appearance. I returned the duke’s hat with appropriate thanks and expressed regret for the stupid mistake I had made on the occasion of my last visit. I then placed the doctor’s new hat I had repudiated in the hat-box ready for removal.

The full mystery was still unsolved, while the butler stood in the hall like a hypnotized sphinx. I said, in a light and casual way, “And what about Lord Andrew? Did his lordship answer the note?” The butler replied, with extreme emphasis, “He did indeed!” Poor duchess, I thought, what a pity she had been so violent and so hasty.

Still the dirty hat remained shrouded in mystery, so, pointing to it, I said to the butler, “By the way, whose hat _is_ that?” “That hat, sir,” he replied, adopting the manner of a showman in a museum, “that hat is the duke’s. It is the hat His Grace always wears when he goes out in the morning.” “But then,” I asked, “why did you not tell the duchess so yesterday?” He replied, “What, sir! After Her Grace had said that the hat was enough to poison the house! Not me!”

PRINTED BY CASSELL & COMPANY, LIMITED, LA BELLE SAUVAGE, LONDON, E.C.4.
F.35.1222

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| FOOTNOTES: |
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| [1] _British Medical Journal_, Dec., 1886, and April, 1890. |
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| [2] Fisher Unwin, London, 1922. |
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| [3] The name is fictitious. |
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Transcriber’s Notes:

- Text enclosed by underscores is in italics (_italics_). - Blank pages have been removed. - Redundant title page has been removed. - Redundant chapter heading pages have been removed. - Silently corrected typographical errors. - Hyphenation variations made consistent.