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

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СКАЧАТЬ demonstration to the students. Here is a case of commencing phthisis; there is one still more advanced; another is in the last stage; and all afford good opportunities for demonstrating a multitude of points useful for the tyros in medicine to know. A half-dead woman, with lungs far advanced in the destructive changes of pulmonary consumption, applies for treatment. She is examined with care and kindness by the physician, who, having satisfied himself as to the nature and progress of the disease, makes the requisite notes of her case, and hands her over to his class for perhaps a dozen more fatiguing examinations. She has been waiting probably two or three hours for the interview, for another hour or more she must be stethoscoped, percussed, pounded and pummelled, while the students are picking up from her emaciated and wasting frame the elements of their profession. Nobody at the hospital supposes for a moment they can do her any good, but she offers herself in her ignorance, day after day, a sacrifice on the altar of science, that her abnormal breathing sounds, and other phenomena of disease may teach young men how to earn a respectable living. Then, again, there are a vast number of minor operations, for the performance of which, by novices, the out-patient departments afford peculiar facilities. How much it adds to the terror, nervous apprehension, shame and mental distress of the patients, who cannot but feel often how greatly their trouble and risks are increased by their performances as school experiments, can be readily imagined. No doubt medical men do as much work for nothing as other professional men, but certainly not more – not nearly so much as clergymen, for instance. Yet, the hospitals do not pay their staff for all the time and labour devoted to its work. How, then, are they paid? In the first place, their students are constantly going into practice on their own account; they will require well-known and trusted consultants and operators to assist them in difficult cases occurring in well-to-do and affluent families; they will introduce them in this way to lucrative practice, ever increasing if they are skilful men. Every one of their students, therefore, becomes an agent for their success. Even the patients who have received benefit will often be able to recommend to richer relatives or friends, masters or mistresses – as in the case of workpeople or servants – the doctor who has helped them to a cure. It is in this way the great practices of the greatest men attached to the hospitals have all been founded and maintained. That they should devote themselves to the interests of their pupils is, then, of the first importance, as, in a few years, the kindnesses shown to them will be coming back in a steady flow of guineas.

      At the close of the second winter session, the men are expected to be ready for the first professional examination at the College of Surgeons, in anatomy and physiology. It is the desire of both teachers and the hospital itself, that as large a proportion as possible of the students shall present themselves for examination at the regular time, as the credit of the school depends on the proportion of passes. Every effort is made to urge the men on, and the teaching staff take the utmost pains to perfect the knowledge of their pupils, and thoroughly instruct them in the subjects they will be required to know. They hold test examinations, and send the men up in batches; those of most promise go up first, while the backward ones are detained till the last efforts have been put forth to fit them for the day of trial. Elsworth was sent up in the first batch, and passed creditably. Having thus proved that he had a sufficient knowledge of the rudiments of his work, he was at once permitted to act as a dresser or surgeon’s assistant in the wards of the hospital proper. This is the first bit of promotion which the successful student obtains. The nurses could do pretty well all the work he has to do, as far as the dressing goes; but this is purposely left to him, that he may pick up instruction and experience.

      CHAPTER IX.

      “WALKING THE HOSPITAL.”

      We easily forget our faults when they are known only to ourselves. —La Rochefoucauld.

      Doctor. Is it not natural to die? Then if a dozen or two of my patients have died under my hands, is not that natural?

      Lisette. Very natural, indeed.

– Mrs. Inchbald.

      And if you die,

      Why then you lie

      Stretched on the bed of honour.

– Dibdin.

      Early the following morning, Elsworth presented himself to young Dr. Wilson, the house surgeon in charge of the wards under the chief care of the surgeons, to whom he was appointed dresser.

      Hitherto he had done no practical work in the wards at all. It was against the regulations for any student to be a dresser in the surgical wards till he had passed his primary or first professional examination, at the end of his second winter session.

      He had opportunities of learning the countless little details of minor surgery in the out-patient departments day by day, but now he was to be introduced to a very different kind of work. He would have some forty or fifty patients to study and report upon, to watch the progress of their maladies, or the processes of their cure, to dress the wounds, bandage, apply the remedies ordered by the house surgeon, or the surgeon-in-chief, and himself perform such operations as in their discretion he might be entrusted with. Everybody must have a beginning, and upon whom can one begin surgery so well as an hospital patient? Your dentist began upon somebody; he did not acquire without practice that nice skill, that rapidity, almost amounting to sleight of hand, by which he jerks out your offending molar, before you are half aware he has begun. To be sure, he had a long course on sheeps’ heads from the butchers, and then at the hospital or dispensary, he tugged away at the mouths of poor children, or men and women of low degree, who could not afford the chemist’s shilling, or the still cheaper barber’s fee, and who, getting the job done for nothing, could not reasonably complain of the several bungling attempts with the wrong instruments applied in the wrong way, and often to the wrong tooth.

      “I say, young man,” said a poor carpenter to an hospital novice, after the fifth attempt to lug out his grinder had been fruitlessly made. “Do they pay you here by time or by the job?”

      Even your hair-dresser must have cut somebody’s hair for the first time. You may be sure it was not a duke’s. “We allus begins on children’s at the Workhus schools,” was the answer of a master barber to an inquiry as to the method of learning the art. Here, then, were fifty live subjects, all human, at the mercy of our new dresser. That young blacksmith with the broken rib thinks he is here simply to get it mended. He will think so in a fortnight’s time, but the officials know better; the mended rib is a mere contingency. The butcher lad in the corner bed has compression of the brain. He shall be cured, if possible. Meanwhile, he shall make himself useful to those who want to investigate the latest theory of “localisation of brain functions.”

      He shall be trephined – that is to say, a round hole shall be neatly cut in his cranium, and the brain exposed at the injured part; and while the organ of the mind is open to the view, are there not many pretty ideas to be discoursed of, and various experiments awaiting trial? Are there not galvanic batteries at hand? Is not the man at their mercy? He has ether or chloroform, and able men of science about him; and, if they don’t cure him, they will doubtless get information that will enable them to cure some much more important personage! It is not enough to have done all this on a monkey; it needs a man before you can be quite sure. Ultimately they will do it with safety to a gentleman, a duke, a royal prince, and the successful operation will make somebody’s fortune. So as every rising surgeon carries a royal surgeon’s baton in his instrument bag, have at the butcher!

      The house surgeon “went round” with our new dresser, and explained the nature of each case in very brief terms, and in a perfunctory manner. It was his duty to instruct his dressers, and he did it after a fashion; but he was not paid to do anything of the sort, and, with the young and partially-educated, there is often a sort of contempt for those who know just a little less than they do. The scorn felt and expressed by the Board School child who knows decimals, for his companion just beginning vulgar fractions, is nothing to the sense of superiority assumed by a house surgeon appointed a few weeks since, and aged twenty-three, towards his unqualified dressers, СКАЧАТЬ