St. Bernard's: The Romance of a Medical Student. Edward Berdoe

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СКАЧАТЬ Friendly Societies’ work at half that rate; while of the other three-tenths, one would be starving in two gloomy rooms in a West End square, the second might make his fortune by marrying a rich wife, and the other work his way to distinction late in life by an ultimate succession to the permanent staff of his own hospital. Now and then he might be luckier still; he might start a special Hospital for Diseases of the Upper Eyelid, and so work his way to eminence and emolument. Of course all these men were supremely scientific. What was pain (in other people), if science could be advanced? What was suffering (in patients), if anything could be added to the sum of our knowledge as to the causes of their suffering? To cure the disease, to cut short the malady – ah, no, too often that was to extinguish alike the discomfort and the interesting course of phenomena that accompanied it. The true patient, the typical client, was he who – devoured by fever or disfigured by disease – asked for nothing better than to be well watched by observant medical eyes, while the “expectant treatment” (i. e., the letting the disease severely alone) did its work. To the objection that a man may die while the expected cure does not arrive, what more obvious than the answer, “But see what a brilliant paper for the Journal is the outcome of it all?” Somehow, Podger vaguely saw all this. Podger recognised that all the “cases” were but “cases.” She knew that Mr. Graves was getting up statistics on broken legs, and was well aware that Mr. Brand was hard at work on a treatise on “Burns and the Cayenne Pepper Treatment.” Now this was in no way objectionable to Podger; she, indeed, could cure burns beautifully with her lint and cotton wool, and soothing unguents; “But, lor bless you! my dear sir,” she would say, “if you likes to pepper ’em on the chance of making a discovery, I ain’t the nuss as ’ud stand in your way of your doing something singular to get yerself a name. So pepper ’em, I say. Thank the Lord it ain’t me nor mine as you are a-operatin’ on. What makes ’em come to the ’orspital at all, I says, if they are a-goin’ to find fault with the treatment?” So Podger co-operated bravely with all the science of the day; she would have flayed the broken-backed bricklayer alive if the staff had ordered it, and said it was scientific treatment. She knew very well the chief object of St. Bernard’s existence, and above all, she knew her place. Oh, but she was an artful and motherly old woman! the true daughter of the receiving-room; the inheritor of all its traditions, and the heiress of a large legacy of hospital tricks. She had such wheedling ways. “You! only an ignorant carpenter, good enough, perhaps, at joists, and flooring, and staircases, what was your opinion against the learned, clever, charitable young surgeon, who wanted to take your leg off, and all for nothing? Shame on you, sir, to suggest ‘practice, practice, all for practice, like making me plane up deals when I was a ’prentice.’ Have it off like a brave Englishman, and don’t make a fuss about a paltry broken leg.” What could a man say under the circumstances? What Podger said to the house surgeon of the day, who had bribed her to get him the operation, was: “It’s all right, Mr. Esmarch; he’s a-goin’ to have it done, so take him while he is in the humour;” and Mr. Esmarch did; and the theatre bell rang to assemble the men for the operation, and Mr. Esmarch rushed off to his books to read up “legs,” and take notes for his first “flap operation.” Oh, Podger could manage it when she gave her mind to it. Was it not truly an invaluable Podger?

      CHAPTER VIII.

      AMONGST THE OUT-PATIENTS

      Some persons will tell you, with an air of the miraculous, that they recovered although they were given over; whereas they might with more reason have said, they recovered because they were given over.

– Lacon.

      Mosca. And then, they do it by experiment,

      For which the law not only doth absolve them,

      But gives them great reward, and he is loath

      To hire his death so.

      Corbaccio. It is true, they kill

      With as much license as a judge.

– Ben Jonson.

      While engaged during their first year at the medical school dissecting, learning their bones, and listening to lectures on physiology, the students were encouraged to attend the out-patient department of the hospital. Hundreds of poor suffering folk attend at noon daily to consult the physicians and surgeons on the staff. Very arduous is the work these gentlemen perform. Many hours a week are given by them gratuitously for this purpose, and half their lives may be said to be passed here or in the wards. Such of them as in addition are lecturers at the school receive fair but not very liberal fees, but the purely hospital work is without monetary reward. Yet the appointments are eagerly sought for by medical men, because of the publicity and private practice which are sure to follow a successful hospital practitioner; and above all, on account of the great number of rare and interesting cases which occur in hospitals, giving great scope for the trying of new remedies, new apparatus and modes of treatment, new operations and new methods of dealing with obscure forms of disease. Every inducement is held out for sick folk to attend the out-patient department of a large hospital. The great majority of the cases may present no new feature, but there will certainly be a fair proportion of strange and curious maladies, inviting the attention of the penetrative skill of some member of the staff. You see, you are sick of some grievous disorder which your family doctor fails to cure. You demand to see some specialist who has had larger experience of your class of case. He sends for such a one who has passed half his life hunting up this malady in its every phase; it is reasonable he should know more about it than the man who has to attend to everything that comes in his way. It is, therefore, very well worth the while of the aspirant to “consulting practice” to spend every spare moment where he can see most cases. This is the way the hospital pays him for his services. He attends a hundred cases which cannot interest him, because of their frequency; the hundred and first is a variant of the peculiar complaint on which he is writing his great monograph. And there are ways by which every one of the hundred others may be made to contribute their quota of information. If you have not suffered from the complaint forming the subject of the monograph, you will be lucky if you escape exhibiting the genesis of the disease or one of its stages for clinical purposes.

      The out-patient departments of the great general hospitals stand more in need of reform than perhaps any of the charitable institutions of our time. To the contributors and subscribers they appear, doubtless, to be the one great means of affording poor persons the highest medical and surgical advice, and the best medicines and appliances free of charge. The poor believe this, the well-to-do middle classes, and even the rich believe it. The out-patient department day after day is thronged by several hundreds of men, women, and children, who go there at noon and wait hour after hour, often till five o’clock in the evening, for an interview with the physician or surgeon who, between the hours of two and four, will probably see one hundred cases. Well-dressed women and men, whose aspect proves them to be at least above the necessity of obtaining medical assistance gratuitously, occupy the time of the staff, and deplete the resources of the hospital in respect of valuable drugs to the extent of many thousands of pounds’ worth annually in London alone. Vast numbers of patients attend who are suffering from trifling ailments which need but the simplest home remedies for their cure. On the other hand, children and adults of both sexes go week after week to the out-patient department, when every time they leave their room for the purpose, the exposure, the necessary fatigue, the long waiting in draughty and over ventilated rooms, does them more harm than any medical treatment they can receive, under such circumstance, can do good. All this happens within the perfect knowledge of the staff, who, so far from discountenancing the system, encourage the patients to attend regularly, and seldom dissuade them till the last days of the poor creatures’ existence. The reasons for such policy, held to be paramount are these:

      First; the greater the number of patients who seek the aid of the charity, the greater claim the committee can make on the purses of the charitable.

      Again; the greater the number of the cases in hand day after day, the more chance there is of getting hold of rare and interesting complaints for their own notes and statistics; and for clinical teaching for their students, who attend the out-patient department with great assiduity. СКАЧАТЬ