Читать книгу St. Bernard's: The Romance of a Medical Student - Edward Berdoe, Edward Berdoe - Страница 9

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, who cannot go up for examination for another six months. And the dresser, in his turn, looks down from his exalted post on those late companions of his who failed at the primary, and have not yet achieved the right to handle cases in the wards.

Elsworth was shown a number of beds, of the occupants of which he was required to write complete family histories, going into the minutest details, as practice in note-taking. He was called on to carry out, with the assistance of the nurses, daily, all the directions as to the dressings and bandaging required by the nature of the case; and was encouraged to avail himself, while doing so, of any and every means that would assist him in the acquisition of his art, so far as it was consistent with the regular treatment of the patient, and was not calculated to alarm him or make him think it was not actually connected with his cure. Our house surgeon was going in for ophthalmology, and he never missed an opportunity of dropping belladonna into every patient’s eyes, and taking stock of his retina with the ophthalmoscope. Whether you had cracked your skull or broken your leg, fractured a rib or sprained your ankle, your eyes must be examined minutely, on the chance of something pretty turning up to show the professor of ophthalmology. Dr. Wilson was such an enthusiast on eyes that one day, happening to pass through one of the out-patient wards, he caught sight of a working man in whose visual organs he instantly detected something of interest. Immediately he had him under a lamp, and set to work making sketches of the morbid appearances in the retina, explaining to the other students the beautiful things to be seen therein. Now the patient had not come about his eyes, but being troubled with indigestion, wanted a bottle of medicine to cure it; and he was naturally surprised that for three mortal hours eighteen young gentlemen should be examining his eyes, which wanted no treatment but the sight of a little more weekly pay; and marvelled that no questions should be asked him about the ailment which caused him discomfort. He was still more amazed when, as evening drew on, one after another went away, and nobody prescribed anything for him at all! However, one of the resident staff saw him before the place was closed, and he had a bottle of “house mixture,” and went away more satisfied; but still wondering at the singular ways of doctors.

Let us go round the wards with Dr. Wilson and our hero, his new assistant.

Here is a middle-aged woman, evidently having but a short time to live, yet this afternoon Dr. Wilson says his chief proposes to perform upon her a capital operation. He has not the least hope it can save her life, but the chance of performing such an operation arises but seldom; and it is but just and kind to the house surgeon, who wants all the practical work he can get, to let him assist. So the woman and her friends are duly pressed to consent that this – “the only means of saving her life” – shall forthwith be done. To this end all the nurses are instructed to urge her. At last she submits. She will be carried to the operating theatre, and this chance of instruction will fall to Dr. Wilson’s hands; for, as soon as the chloroform has effected its work, he will take the place of the chief, and “do his first strangulated hernia.” Dr. Wilson is jubilant – slightly nervous, for it is very grave work. It is utterly unjustifiable work, Elsworth thinks, but dare hardly express his thoughts except by a timid question or two. He knows he must steel himself to plenty of such matters, that his turn will come and that he would not like to leave St. Bernard’s without doing just as much himself. But his heart, for all that, misgives him.

“Might he warn the patient of her imminent danger?”

“On no account! It might cause her to revoke her consent; might, at any rate, depress her, and hasten the catastrophe.”

In the next bed is an elderly woman with a contused side. That is a slight matter. It was not for that she was taken in, but in her examination in the out-patients’ department it was discovered that she had a peculiarly interesting bony growth on her leg that would make a very neat and pretty operation. So a bed was found for her, and daily and increasing pressure put upon her to have this queer growth removed. It was no inconvenience or annoyance to her at all. She was past middle life, and she had been told by her family doctor there was not the slightest occasion for operative interference; but everybody at St. Bernard’s wanted just such a case to try a new method of treatment recently invented in Vienna, and the chief surgeon was eager to do the operation, and all concerned were charged, as they loved him, not to let it slip. That also was to come off this afternoon.

The next bed is occupied by a girl, the subject of a rare and very interesting skin affection. No active treatment has yet been suggested, as it is much too pretty to spoil by any attempt at cure just yet. Several surgeons are expected from other hospitals to see it, so she has an ounce of peppermint water three times a day and full diet, and the cure is postponed till a sufficient number of interested people have seen it. Drawings must be made; the artist to the hospital could not attend for a week to come; then there were photographs to be taken, and it would never do to spoil anything so effective by commencing a cure. So “repeat the mixture,” till science has done with the first part of the case, and therapeutics can step in.

“That woman, you will perceive,” said the surgeon, “has a squint. She came in with a fracture of the arm, but with a little more pressure she will let us operate on the ocular deformity. I like doing squints. By the way, there is a woman dying in the next ward who has a perfectly charming optic neuritis. You ought to see that. Don’t examine it very often, as it hurts her dreadfully, and she can’t live much longer; but the case is perfectly typical. I am going to sketch it this evening. One don’t like to hurt folks if it can be avoided, but this is much too good to miss. She grumbles a bit at being disturbed, and I fear suspects all this is no part of her treatment; but I order her a glass of wine before I begin, and she likes that.”

They next enter one of the male wards, and Dr. Wilson draws Elsworth’s attention to a man in articulo mortis. “He can scarcely live till the next morning,” says he; “but if you are interested in phthisis, take your stethoscope and have a quarter of an hour overhauling his posterior thorax. There are some sounds to be heard that with careful auscultation are quite typical, and one very rarely gets them so distinct. Don’t be too long at him, as turning him over on his face exhausts him so much, and we have examined him a good deal lately, poor devil!” Elsworth was obliged to assume a look of eager interest in the proposed investigation, for the sake of pleasing his instructor, but he resolved that the auscultation, as far as he was concerned, should at least not distress the poor sufferer. How any human being could find it in his heart to disturb the last moments of his patient with investigations of “cavernous breathing,” “râles,” and “pectoriloquy” puzzled our hero; – but then, this was his first day in his new office; he had much to learn yet.