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Round The Red Lamp - The Surgeon Talks

1. Behind the Times

2. His First Operation

3. A Straggler of '15

4. The Third Generation

5. A False Start

6. The Curse of Eve

7. Sweethearts

8. A Physiologist's Wife

9. The Case of Lady Sannox

10. A Question of Diplomacy

11. A Medical Document

12. Lot No. 249

13. The Los Amigos Fiasco

14. The Doctors of Hoyland

15. The Surgeon Talks

"Men die of the diseases which they have studied
most," remarked the surgeon, snipping off the end of
a cigar with all his professional neatness and
finish. "It's as if the morbid condition was an evil
creature which, when it found itself closely hunted,
flew at the throat of its pursuer. If you worry the
microbes too much they may worry you. I've seen
cases of it, and not necessarily in microbic diseases
either. There was, of course, the well-known
instance of Liston and the aneurism; and a dozen
others that I could mention. You couldn't have a
clearer case than that of poor old Walker of St.
Christopher's. Not heard of it? Well, of course, it
was a little before your time, but I wonder that it
should have been forgotten. You youngsters are so
busy in keeping up to the day that you lose a good
deal that is interesting of yesterday.

"Walker was one of the best men in Europe on
nervous disease. You must have read his little book
on sclerosis of the posterior columns.
It's as interesting as a novel, and epoch-making
in its way. He worked like a horse, did Walker--huge
consulting practice--hours a day in the clinical
wards--constant original investigations. And then he
enjoyed himself also. `De mortuis,' of course,
but still it's an open secret among all who knew him.
If he died at forty-five, he crammed eighty years
into it. The marvel was that he could have held on
so long at the pace at which he was going. But he
took it beautifully when it came.

"I was his clinical assistant at the time.
Walker was lecturing on locomotor ataxia to a wardful
of youngsters. He was explaining that one of the
early signs of the complaint was that the patient
could not put his heels together with his eyes shut
without staggering. As he spoke, he suited the
action to the word. I don't suppose the boys noticed
anything. I did, and so did he, though he finished
his lecture without a sign.

"When it was over he came into my room and lit a

"`Just run over my reflexes, Smith,' said he.

"There was hardly a trace of them left. I tapped
away at his knee-tendon and might as well have tried
to get a jerk out of that sofa-cushion. He stood
with his eyes shut again, and he swayed like a bush
in the wind.

"`So,' said he, `it was not intercostal neuralgia
after all.'

"Then I knew that he had had the lightning pains,
and that the case was complete. There was nothing to
say, so I sat looking at him while he puffed and
puffed at his cigarette. Here he was, a man in the
prime of life, one of the handsomest men in London,
with money, fame, social success, everything at his
feet, and now, without a moment's warning, he was
told that inevitable death lay before him, a death
accompanied by more refined and lingering tortures
than if he were bound upon a Red Indian stake. He
sat in the middle of the blue cigarette cloud with
his eyes cast down, and the slightest little
tightening of his lips. Then he rose with a motion
of his arms, as one who throws off old thoughts and
enters upon a new course.

"`Better put this thing straight at once,' said
he. `I must make some fresh arrangements. May I use
your paper and envelopes?'

"He settled himself at my desk and he wrote half
a dozen letters. It is not a breach of confidence to
say that they were not addressed to his professional
brothers. Walker was a single man, which means that
he was not restricted to a single woman. When he had
finished, he walked out of that little room of mine,
leaving every hope and ambition of his life behind
him. And he might have had another year of
ignorance and peace if it had not been for the chance
illustration in his lecture.

"It took five years to kill him, and he stood it
well. If he had ever been a little irregular he
atoned for it in that long martyrdom. He kept an
admirable record of his own symptoms, and worked out
the eye changes more fully than has ever been done.
When the ptosis got very bad he would hold his eyelid
up with one hand while he wrote. Then, when he could
not co-ordinate his muscles to write, he dictated to
his nurse. So died, in the odour of science, James
Walker, aet. 45.

"Poor old Walker was very fond of experimental
surgery, and he broke ground in several directions.
Between ourselves, there may have been some more
ground-breaking afterwards, but he did his best for
his cases. You know M`Namara, don't you? He always
wears his hair long. He lets it be understood that
it comes from his artistic strain, but it is really
to conceal the loss of one of his ears. Walker cut
the other one off, but you must not tell Mac I said

"It was like this. Walker had a fad about the
portio dura--the motor to the face, you know--and he
thought paralysis of it came from a disturbance of
the blood supply. Something else which
counterbalanced that disturbance might, he
thought, set it right again. We had a very obstinate
case of Bell's paralysis in the wards, and had tried
it with every conceivable thing, blistering, tonics,
nerve-stretching, galvanism, needles, but all without
result. Walker got it into his head that removal of
the ear would increase the blood supply to the part,
and he very soon gained the consent of the patient to
the operation.

"Well, we did it at night. Walker, of course,
felt that it was something of an experiment, and did
not wish too much talk about it unless it proved
successful. There were half-a-dozen of us there,
M`Namara and I among the rest. The room was a small
one, and in the centre was in the narrow table, with
a macintosh over the pillow, and a blanket which
extended almost to the floor on either side. Two
candles, on a side-table near the pillow, supplied
all the light. In came the patient, with one side of
his face as smooth as a baby's, and the other all in
a quiver with fright. He lay down, and the
chloroform towel was placed over his face, while
Walker threaded his needles in the candle light. The
chloroformist stood at the head of the table, and
M`Namara was stationed at the side to control the
patient. The rest of us stood by to assist.

"Well, the man was about half over when he fell
into one of those convulsive flurries which come
with the semi-unconscious stage. He kicked and
plunged and struck out with both hands. Over with a
crash went the little table which held the candles,
and in an instant we were left in total darkness.
You can think what a rush and a scurry there was, one
to pick up the table, one to find the matches, and
some to restrain the patient who was still dashing
himself about. He was held down by two dressers, the
chloroform was pushed, and by the time the candles
were relit, his incoherent, half-smothered shoutings
had changed to a stertorous snore. His head was
turned on the pillow and the towel was still kept
over his face while the operation was carried
through. Then the towel was withdrawn, and you can
conceive our amazement when we looked upon the face
of M`Namara.

"How did it happen? Why, simply enough. As the
candles went over, the chloroformist had stopped for
an instant and had tried to catch them. The patient,
just as the light went out, had rolled off and under
the table. Poor M`Namara, clinging frantically to
him, had been dragged across it, and the
chloroformist, feeling him there, had naturally
claped the towel across his mouth and nose. The
others had secured him, and the more he roared and
kicked the more they drenched him with chloroform.
Walker was very nice about it, and made the most
handsome apologies. He offered to do a plastic
on the spot, and make as good an ear as he could, but
M`Namara had had enough of it. As to the patient, we
found him sleeping placidly under the table, with the
ends of the blanket screening him on both sides.
Walker sent M`Namara round his ear next day in a jar
of methylated spirit, but Mac's wife was very angry
about it, and it led to a good deal of ill-feeling.

"Some people say that the more one has to do with
human nature, and the closer one is brought in
contact with it, the less one thinks of it. I don't
believe that those who know most would uphold that
view. My own experience is dead against it. I was
brought up in the miserable-mortal-clay school of
theology, and yet here I am, after thirty years of
intimate acquaintance with humanity, filled with
respect for it. The, evil lies commonly upon the
surface. The deeper strata are good. A hundred
times I have seen folk condemned to death as suddenly
as poor Walker was. Sometimes it was to blindness or
to mutilations which are worse than death. Men and
women, they almost all took it beautifully, and some
with such lovely unselfishness, and with such
complete absorption in the thought of how their fate
would affect others, that the man about town, or the
frivolously-dressed woman has seemed to change into
an angel before my eyes. I have seen death-
beds, too, of all ages and of all creeds and want of
creeds. I never saw any of them shrink, save only
one poor, imaginative young fellow, who had spent his
blameless life in the strictest of sects. Of course,
an exhausted frame is incapable of fear, as anyone
can vouch who is told, in the midst of his sea-
sickness, that the ship is going to the bottom. That
is why I rate courage in the face of mutilation to be
higher than courage when a wasting illness is fining
away into death.

"Now, I'll take a case which I had in my own
practice last Wednesday. A lady came in to consult
me--the wife of a well-known sporting baronet. The
husband had come with her, but remained, at her
request, in the waiting-room. I need not go into
details, but it proved to be a peculiarly malignant
case of cancer. `I knew it,' said she. `How long
have I to live?' `I fear that it may exhaust your
strength in a few months,' I answered. `Poor old
Jack!' said she. `I'll tell him that it is not
dangerous.' `Why should you deceive him?' I asked.
`Well, he's very uneasy about it, and he is quaking
now in the waiting-room. He has two old friends to
dinner to-night, and I haven't the heart to spoil his
evening. To-morrow will be time enough for him to
learn the truth.' Out she walked, the brave little
woman, and a moment later her husband, with his
big, red face shining with joy came plunging into my
room to shake me by the hand. No, I respected her
wish and I did not undeceive him. I dare bet that
evening was one of the brightest, and the next
morning the darkest, of his life.

"It's wonderful how bravely and cheerily a woman
can face a crushing blow. It is different with men.
A man can stand it without complaining, but it knocks
him dazed and silly all the same. But the woman does
not lose her wits any more than she does her courage.
Now, I had a case only a few weeks ago which would
show you what I mean. A gentleman consulted me about
his wife, a very beautiful woman. She had a small
tubercular nodule upon her upper arm, according to
him. He was sure that it was of no importance, but
he wanted to know whether Devonshire or the Riviera
would be the better for her. I examined her and found
a frightful sarcoma of the bone, hardly showing upon
the surface, but involving the shoulder-blade and
clavicle as well as the humerus. A more malignant
case I have never seen. I sent her out of the room
and I told him the truth. What did he do? Why, he
walked slowly round that room with his hands behind
his back, looking with the greatest interest at the
pictures. I can see him now, putting up his gold
pince-nez and staring at them with perfectly
vacant eyes, which told me that he saw neither them
nor the wall behind them. `Amputation of the arm?'
he asked at last. `And of the collar-bone and
shoulder-blade,' said I. `Quite so. The collar-bone
and shoulder-blade,' he repeated, still staring about
him with those lifeless eyes. It settled him. I
don't believe he'll ever be the same man again. But
the woman took it as bravely and brightly as could
be, and she has done very well since. The mischief
was so great that the arm snapped as we drew it from
the night-dress. No, I don't think that there will
be any return, and I have every hope of her recovery.

"The first patient is a thing which one remembers
all one's life. Mine was commonplace, and the
details are of no interest. I had a curious visitor,
however, during the first few months after my plate
went up. It was an elderly woman, richly dressed,
with a wickerwork picnic basket in her hand. This
she opened with the tears streaming down her face,
and out there waddled the fattest, ugliest, and
mangiest little pug dog that I have ever seen. `I
wish you to put him painlessly out of the world,
doctor,' she cried. `Quick, quick, or my resolution
may give way.' She flung herself down, with
hysterical sobs, upon the sofa. The less experienced
a doctor is, the higher are his notions of
professional dignity, as I need not remind you, my
young friend, so I was about to refuse the
commission with indignation, when I bethought me
that, quite apart from medicine, we were gentleman
and lady, and that she had asked me to do something
for her which was evidently of the greatest possible
importance in her eyes. I led off the poor little
doggie, therefore, and with the help of a saucerful
of milk and a few drops of prussic acid his exit was
as speedy and painless as could be desired. `Is it
over?' she cried as I entered. It was really tragic
to see how all the love which should have gone to
husband and children had, in default of them, been
centred upon this uncouth little animal. She left,
quite broken down, in her carriage, and it was only
after her departure that I saw an envelope sealed
with a large red seal, and lying upon the blotting
pad of my desk. Outside, in pencil, was written: `I
have no doubt that you would willingly have done this
without a fee, but I insist upon your acceptance of
the enclosed.' I opened it with some vague notions
of an eccentric millionaire and a fifty-pound note,
but all I found was a postal order for four and
sixpence. The whole incident struck me as so
whimsical that I laughed until I was tired. You'll
find there's so much tragedy in a doctor's life, my
boy, that he would not be able to stand it if it were
not for the strain of comedy which comes every now
and then to leaven it.

"And a doctor has very much to be thankful for
also. Don't you ever forget it. It is such a
pleasure to do a little good that a man should pay
for the privilege instead of being paid for it.
Still, of course, he has his home to keep up and his
wife and children to support. But his patients are
his friends--or they should be so. He goes from
house to house, and his step and his voice are loved
and welcomed in each. What could a man ask for more
than that? And besides, he is forced to be a good
man. It is impossible for him to be anything else.
How can a man spend his whole life in seeing
suffering bravely borne and yet remain a hard or a
vicious man? It is a noble, generous, kindly
profession, and you youngsters have got to see that
it remains so."

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