The Surgeon Talks
From The Arthur Conan Doyle Encyclopedia
- in Round the Red Lamp (1894-1930)
- in Mémoires d'un médecin (1906, Félix Juven [FR]) as Réflexions d'un chirurgien
- in Une momie qui ressuscite (ca. 1920-1923, L'Édition Française Illustrée [FR]) as Les Propos du Chirurgien
- in Tales of Adventure and Medical Life (27 july 1922, John Murray's Fiction Library [UK])
- in The Man from Archangel and Other Tales of Adventure (autumn 1925, George H. Doran Co. [US])
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 cigarette.
"'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 so.
"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."