Doctor and Patient Part 2

That medical poet who has the joyous art of sending a ripple of mirth across the faces of the Anglo-Saxon world recognizes this fact in a cheerful poem, called "The Morning Visit," and to which I gladly refer any of my readers who would like to know from the lips of Oliver Wendell Holmes what manner of delightful patient he must have been. I can fancy that he lost for his doctor many a pleasant hour.

It has seemed to me as if this wonderful remaking and regrowing of the tissues might be likened to a swift change from the weak childhood of disease to a sudden manhood of mind and body, in which is something of mysterious development elsewhere unmatched in life. Death has been minutely busy with your tissues, and millions of dead molecules are being restored in such better condition that not only are you become new in the best sense,--renewed, as we say,--but have gotten power to grow again, and, after your terrible typhoid or yellow fever, may win a half-inch or so in the next six months,--a doubtful advantage for some of us, but a curious and sure sign of great integral change.

The Greeks had a notion that once in seven years we are totally changed, the man of seven years back having in this time undergone an entire reconstruction. We know now that life is a constant death and a renewing,--that our every-day nutrition involves millions of molecular deaths and as many millions of births,--although to liken that which is so exquisitely managed, so undisturbingly done, to the coa.r.s.er phenomena of death and birth is in a measure misleading.

Diseases such as typhoid fever, or a sharp local lung-trouble like pneumonia, really do make these minute changes approximate in abruptness to death. You weigh, let us say, one hundred and eighty pounds, and you drop in three weeks of a fever to one hundred and thirty pounds. The rest of you is dead. You have lost, as men say, fifty pounds, but your debt to disease, or to the blunders of civilization, for it is a case of creditor behind creditor, is paid. Your capital is much diminished, but you have come out of the trial with an amazing renovation of energy.

This is the happy convalescence of the wholesome man. The other, the unlucky, fellow, does not get as safely through the cleansing bankruptcy of disease. The vicious, unlucky, or gouty grandfather appears on the books of that court in mysterious ways; his sins are pathologically visited on his child's child in this time of testing strain.

In the happy rush towards useful health, of a convalescence undisturbed by drawbacks, it is pleasant to think, as one lies mending, of the good day to come when my friend, recovering from typhoid or smallpox, shall send for his legal adviser and desire him as usual to bring suit against the city for damages and loss of time.

A little girl coughed in my face a hideous breath of membraneous decay.

I felt at once a conviction of having been hit. Two days later I was down with her malady. She herself and two more of her family owed their disease to the overflow of a neighbor's cesspool, and to them--poor, careless folk--Death dealt out a yet sterner retribution. There was a semi-civilized community beyond both. Should one go to law about it and test the matter of ultimate responsibility?

The amiability of convalescence is against it. One feels at peace with all the world, and so lies still, and reflects, "like souls that balance joy and pain," as to whether, on the whole, the matter has not had its valuable side. Certainly it has brought experiences not otherwise attainable.

Of the deeper and more serious insights a man gathers in the close approach of death and the swift, delicious return to safety and enlarging powers I hardly care to speak. To a physician, it is simply invaluable to have known in his own person pain, and to have been at close quarters with his constant enemy, and come off only wounded from the contest. In the anxiety about you is read anew what you look upon in other households every day, and perhaps with a too accustomed eye. And as to pain, I am almost ready to say that the physician who has not felt it is imperfectly educated. It were easy to dwell on this aspect of convalescence, but the mental state of one on the way to health is not favorable to connected thought. It is more grateful to lie in the sun, at the window, and watch the snow-birds on the ice-clad maples across the way, and now and then, day after day, to jot down the thoughts that hop about one's brain like the friendly birds on the mail-clad twigs.

I make no apology for the disconnectedness of my reflections, but turn gladly to my records of the joyous and less grave observations which the pa.s.sing hours brought me. Much as I have seen of disease and recoveries in all manner of men and women, the chance to observe them in my own person presented me with many little novel facts of interest. I find in my brief notes of this well-remembered time many records of the extraordinary acuteness won for a while by the senses.

Not dubious, but, alas! brief, is the gain which the sensorium acquires in this delightfully instructive pa.s.sage out of death's shadow into certain suns.h.i.+ne. In my own case there was a rapid exfoliation, as we call it, of the skin, a loss and renewal of the outer layer of the cuticle. As a result of this, the sense of touch became for a while more acute, and was at times unpleasantly delicate. This seemed to me, as I first thought of its cause, a mere mechanical result, but I incline to suspect now that it was in a measure due to a true increase in capacity to feel, because I found also that the sister sense of pain was heightened. Slight things hurt me, and a rather gentle pinch gave undue discomfort. No doubt a part of this was owing to my having taken a good deal of opium, and then abruptly laid it aside. As I have elsewhere stated, this is apt to leave the nerves oversensitive for a season. The sense of hearing seemed to me to be less wide awake. I did not hear better, but high notes were for a while most unpleasant. The sense of taste grew singularly appreciative for a time, and made every meal a joyful occasion. The simplest food had distinct flavors. As for a gla.s.s of old Madeira,--a demijohned veteran of many ripening summers,--I recall to this day with astonishment the wonderful thing it was, and how it went over the tongue in a sort of procession of tastes, and what changeful bouquets it left in my mouth,--a strange variety of varying impressions, like the play of colors. In these days of more unspiritual health and coa.r.s.er sense I am almost ashamed to say what pleasure I found in a dish of terrapin.

The function of smell became for me a source both of annoyance and, later on, of pleasure. I smelt things no one else could, and more things than I now can. The spring came early, and once out of doors the swiftly-flitting hours of sensory acuteness brought to me on every breeze nameless odors which have no being to the common sense,--a sweet, faint confusion of scents, some slight, some too intense,--a gamut of odors. Usually I have an imperfect capacity to apprehend smells, unless they are very positive, and it was a curious lesson to learn how intense for the time a not perfect function may become. Recent researches have shown that a drug like mercaptan may be used to test the limit of olfactory appreciation. We have thus come to know that the capacity to perceive an odor is more delicate than our ability to recognize light.

Probably it is an inconceivable delicacy of the sense of smell more than anything else which enables animals to find their way in the manner which seems to us so utterly mysterious. Yet, even in human beings, and not alone in a fortunate convalescence, do we see startling ill.u.s.trations of the possibilities of this form of sensorial acuteness.

I know of a woman who can by the smell at once tell the worn gloves of the several people with whom she is most familiar, and I also recall a clever ch.o.r.eic lad of fourteen who could distinguish when blindfold the handkerchiefs of his mother, his father, or himself, just after they have been washed and ironed. This test has been made over and over, to my satisfaction and surprise.

If a man could possess in the highest degree and in combination all of the possible extremes of sensory appreciativeness seen in disease, in hysteria, and in the hypnotic state, we should have a being of extraordinary capacities for observation. Taylor, in his "Physical Theory of Another World," a singular and half-forgotten book, has set this forth as conceivable of the beings of a world to come, and dwelt upon it in an ingenious and interesting way. For a long time even the inhalation of tobacco-smoke from a friend's cigar disturbed my heart, but one day, and it was, I fear, long before my physician, and he was wise, thought it prudent, I suddenly fell a prey to our lady Nicotia. I had been reading listlessly a cruel essay in the _Atlantic_ on the wickedness of smoking, and was presently seized with a desire to look at King James's famous "counterblast" against the weed. One is like a spoiled child at these times, and I sent off at once for the royal fulmination, which I found dull enough. It led to results the monarch could not have dreamed of. I got a full-flavored cigar, and had a half-hour of wors.h.i.+pful incense-product at the shrine of the brown-cheeked lady,--a thing to remember,--and which I had leisure enough to repent of in the sleepless night it cost me.

This new keenness of perception, of taste and touch, of smell and sound, belongs also, in the splendid rally which the body makes toward health, to the intellectual and imaginative sphere of activities. Something of the lost gifts of the fairy-land of childhood returns to us in fresh apt.i.tude for strange, sweet castle-building, as we lie open-eyed, or in power to see, as the child sees, what we will when the eyes are closed,--

Pictures of love and hate, Grim battles where no death is. Tournaments, Tall castles fair and garden terraces, Where the stiff peac.o.c.k mocks the sunset light, And man and maiden whisper tenderly A shadowy love where no heart ever breaks,-- Love whose to-morrow shall be as to-day.

With the increase of intellectual clearness, within a certain range, come, as with the brightened senses, certain drawbacks, arising out of the fastidiousness which belongs to the changing man just at this time.

Let him, therefore, be careful what novels he chooses, for of all times this is the one for fiction, when we are away from the contradictions of the fierce outer world, and are in an atmosphere all sun and flowers, and pleasant with generous service and thankful joy. Be careful what Scheherezade you invite to your couch. By an awful rule of this world's life, in all its phases, the sharper the zest of enjoyment, the keener the possible disgusts may be. I recommend Dumas's books at this crisis, but they should be read with acceptance; as stories, their value lying largely in this, that no matter who is murdered or what horror occurs, you somehow feel no more particular call upon your compa.s.sion than is made when you read afresh the terrible catastrophes of Jack the Giant-Killer.

A delightful master of style, Robert Louis Stevenson, in a recent enumeration of the books which have influenced him in life, mentions, as among the most charming of characterizations, the older Artagnan of the Vicomte de Bragelonne. I feel sure that on the sick-bed, of which he does not hesitate to speak, he must have learned, as I did, to appreciate this charming book. I made acquaintance then, also, with what seems to me, however, the most artistic of Dumas's works, and one so little known that to name it is a benefit, or may be, the Chevalier d'Harmenthal.

In the long road towards working health, I must have found, as my note-books show, immense leisure, and equal capacity to absorb a quant.i.ty of fiction, good and bad, and to find in some of it things about my own art which excited amused comment, and but for that would long ago have been forgotten. Among the stuff which I more or less listlessly read was an astonis.h.i.+ng book called "Norwood." It set me to thinking, because in this book are recounted many things concerning sick or wounded folk, and those astonis.h.i.+ng surgeons and nurses who are supposed to have helped them on to their feet again.

The ghastly amus.e.m.e.nt which came to me out of the young lady in this volume, who amputates a man's leg, made me reflect a little about the mode in which writers of fiction have dealt with sick people and doctors. I lay half awake, and thought over this in no unkindly critical mood,

"With now and then a merry thought, And now and then a sad one,"

until I built myself a great literary hospital, such as would delight Miss Nightingale. For in it I had a Scott ward, and a d.i.c.kens ward, and a Bulwer ward, and a Thackeray ward, with a very jolly lot of doctors, such as Drs. Goodenough and Firmin, with the Little Sister (out of Philip) and Miss Evangeline to take care of the patients, besides cells for Charles Reade's heroes and heroines, and the apothecary (out of Romeo and Juliet) to mix more honest doses than he gave to luckless Romeo.

Should you wander with a critical doctor through those ghostly wards, you would see some queerer results of battle and fray than ever the doctors observe nowadays,--cases I should like to report, it might be: poisonings that would have bewildered Orfila, heart-diseases that would have astounded Corvisart, and those wonderful instances of consumption which render that most painful of diseases so delightful to die of--in novels. I have no present intention to weary my readers with a clinic in those crowded wards, but it will ease my soul a little if I may say my say in a general fas.h.i.+on about the utter absurdities of most of these pictures of disease and death-beds. In older times the sickness of a novel was merely a feint to gain time in the story or account for a non-appearance, and the doctor made very brief show upon the stage.

Since, however, the growth of realism in literary art, the temptation to delineate exactly the absolute facts of disease has led authors to dwell too freely on the details of sickness. So long as they dealt in generalities their way was clear enough. Of old a man was poisoned and done for. Today we deal in symptoms, and follow science closely in our use of poisons. Mr. Trollope's "Gemma" is an instance in point, where every one will feel that the spectacle of the heroine going seasick to death, owing to the administration of tartar emetic, is as disgusting and inartistic a method as fiction presents. Why not have made it croton oil? More and worse of this hideous realism is to be found in About's books, such, for instance, as "Germaine"; but from which censure I like to exclude the rollicking fun of "Le Nez d'un Notaire." As to the recent realistic atrocities of Zola, and even of Tolstoi, a more rare sinner, if we exclude his disgusting drama of peasant life, I prefer to say little.

As to blunders in the science of poisons I say little. The novelist is a free lance, and chooses his own weapons; but I cannot help remarking that, if recent investigators are to be trusted, one unlucky female, at least, must be still alive, for a novelist relates that she was done to death by the internal taking of a dose of rattlesnake venom. I hope when I am to be poisoned this mode may be employed. She might as well have drunk a gla.s.s of milk. That book was a queer one to me after this catastrophe: the woman ought to be dead and could not be.

The difficulty of the modern novelist in giving symptoms and preserving the entire decorum of his pages has amused me a little. Depend upon it, he had best fight shy of these chronic illnesses: they make queer reading to a doctor who knows what sick people are; and above all does this advice apply to death-beds. As a rule, folks get very horrible at such times, and are a long while in dying, with few of their wits about them at the last. But in novels people die marvellously possessed of their faculties; or, if they are shot, always jump into the air exactly as men never do in fact.

Just here, concerning wounds, a question occurs to me: The heroes who have to lose a limb--a common thing in novels since the war--always come back with one arm, and never with a lost leg. Is it more romantic to get rid of one than of the other?--considering also that a one-armed embrace of the weeping waiting lady-love must be so utterly unsatisfactory.

But enough of the patients. Among them I think I like Pendennis the best, and consider little Dombey and Nell the most delightfully absurd.

And as to the doctors. Some of them have absolutely had the high promotion to be the heroes of a whole book. Had not one, nay, two, a novel to themselves? There is delightful Dr. Antonio, not enough of a doctor to call down on him my professional wrath. As to Dr. Goodenough, he has been in our family a long while,--on the shelf (G.o.d bless him!),--and attended, we remember, our friend Colonel Newcome in that death-bed matchless in art since Falstaff babbled life away. Yet, after all, he is not a doctor so much as a man charmingly drawn.

There are in novels many good portraits of lawyers, from Pleydell to Tulkinghorn. Whether fair or unjust as pictures, I am scarce able to judge, although I believe that some of them have been recognized by our legal brethren as sufficiently exact. While, however, we have plenty of characters which for his purpose the novelist labels M.D., there seems to have been some insuperable difficulty in evolving for artistic use a doctor who shall seem at home, as such, among the other characters of the novel,--one, at least, who shall appear to any reasonable degree like a doctor to those who really know the genus doctor thoroughly. Save Lydgate, no doctor in fiction answers this critical demand, or seems anything to me but a very stiff lay figure from the moment he is called upon to bring his art into the story, or to figure, except as an unprofessional personage.

Nor does this arise from poverty of types in the tribe of physicians.

The training of a doctor's life produces the most varied effects for good or evil, as may chance, upon the human natures submitted to its discipline, so that I think any thoughtful medical man will tell you that there is a more notable individuality among his brethren in middle life than among most of the people he encounters. As for the novelist's effort--an inartistic one, it seems to me--to bring on his stage representations of some especial kind of doctor, I have only a grim smile to give, remembering Mr. Reade's grewsome medico in "Hard Cash,"--a personation meant, I suppose, to present to the public a certain irregular London doctor, but which, to the minds of most physicians, reads like an elaborate advertis.e.m.e.nt of the man in question.

Sir Bulwer Lytton's renderings of a h.o.m.oeopath and a water-cure specialist are open to the same charge, and could only have been successful in the hands of a master.

There are at least two doctors in Balzac's novels. Rastignac, man of fas.h.i.+on and science, is drawn with the master's usual skill, but he is not a doctor. His art has no prominence. It is not shown how his peculiarities influenced his work, nor how his art, and its use, altered or modified the man. "The Country Doctor," by the same strong hand, is far more near my ideal of what this portraiture should be than any other known to me in French literature. The humorous aspects of a medical life in the provinces of France are nicely handled in Jules Sandeau's "Doctor Herbeau," but the study, however neat and pleasing, is slight.

Wander where you may, in the drama or the novel, you will still find, I think, that the character of the physician awaits in its interesting varieties competent portrayal.

Shakespeare has left us no finished portrait of a doctor. Moliere caricatured him. Thackeray failed to draw him, and generally in novels he is merely a man who is labelled "Doctor." The sole exception known to me is the marvellous delineation of Lydgate in "Middlemarch." He is all over the physician, his manner, his sentiments, his modes of thought, but he stands alone in fiction. How did that great mistress of her art learn all of physicians which enabled her to leave us this amazingly truthful picture? Her life gives us no clue, and when I asked her husband, George Lewes, to explain the matter, he said that he did not know, and that she knew no more of this than of how she had acquired her strangely complete knowledge of the low turf people she has drawn in the same book, and with an almost equal skill and truth to nature.

It were easy, I fancy, to point out how the doctor's life and training differ from those of all the other professions, and how this must act on peculiar individualities for the deepening of some lines and the erasure of others; but this were too elaborate a study for my present gossiping essay, and may await another day and a less lazy mood.

If any one should be curious to see what are the modifying circ.u.mstances in a physician's life which strongly tend to weaken or to reinforce character, I recommend a delightful little address, quite too brief, by Dr. Emerson, the son of the great essayist. It is unluckily out of print and difficult to obtain. If you would see in real lives what st.u.r.dy forms of personal distinctness the doctor may a.s.sume, there is no better way than to glance over some half-dozen medical biographies. Read, for instance, delightful John Brown's sketch of Sydenham and of his own father, or George Wilson's life of John Reid, the physiologist, whom community of suffering must have made dear to that gentle intelligence, and whose days ended in tragic horror such as sensational fiction may scarcely match; or, for an individuality as well defined and more pleasing, read Pichot's life of Sir Charles Bell, or one of the most remarkable of biographies, Mr. Morley's life of Jerome Cardan.

I am reminded as I write how rare are the really good medical biographies. The autobiographies are better. Ambrose Pare's sketches of his own life, which was both eventful and varied, are scattered through his treatise on surgery, and he does not gain added interest in the hands of Malgaigne. Our own Sims's book about himself is worth reading, but is too realistic for the library table, yet what a strangely valuable story it is of the struggle of genius up to eminent success.

But these are the heroes of a not unheroic profession, and I had almost forgotten to set among them, as a study of character, the life of the tranquil, high-minded Jenner, the country doctor who swept the scars of smallpox from the faces of the world of men, and beside him John Hunter, his friend, impulsive, quick of temper, enthusiastic, an intensely practical man of science. These are ill.u.s.trations of men of the most varied types, whose works show their characteristics, and who would, in the end, I fancy, have been very different had fate set them other tasks in life, for if the sculptor makes the statue, we may rest quite sure that the statue he makes influences the man who made it.

These, I have said, are our heroes, but I still think there remains to be written the simple, honest, dutiful story of an intelligent, thoughtful, every-day doctor, such as will pleasantly and fitly open to laymen some true conception of the life he leads, its cares, its trials, its influences on himself and others and its varied rewards. John Brown got closest to it in that sketch of his father, and in her delicately-drawn "Country Doctor" Miss Jewett has done us gentle service. But my doctor would differ somewhat in all lands, because nationality and social conventions have their influence on us as on other men, as any one may observe who compares the clergymen of the Episcopal Church in America with those of England.

The man who deals with the physician in fiction would have to consider this cla.s.s of facts, for social conventions have a.s.signed to the physician in England, at least, a very different position from that which he holds with us, where he has no social superior, and is usually in all small communities, and in some larger ones, the most eminent personage and the man of largest influence.

In the rage for novel characters the lady doctor has of late a.s.sumed her place in fiction. Lots of wives have been picked up among hospital nurses, especially since the Crimean war, and since other women than Sisters of Charity got into the business, and so made to seem probable this pleasing termination of an illness. There was a case well known to me where a young officer simulated delirium tremens in order to get near to a Sister of Charity. If ever you had seen the lady, you would not have wondered at his madness; and should any author desire to utilize this incident, let him comprehend that the order of Sisters of Charity admits of its members leaving the ranks by marriage, theirs being a secular order; so that here are the chances for a story of the freshest kind. As for the lady doctor in fiction, her advantages would be awful to contemplate in sickness, when we are weak and fevered, and absurdly grateful for a newly-beaten pillow or a morsel of ice. But imagine the awful temptation of having your heart auscultated. Let us dismiss the subject while the vision of Beranger's Ange Gardienne flits before us as De Grandville drew her.

I have not now beside me Howells's "Doctor Breen's Practice." It is a remarkable attempt to do justice to a very difficult subject, for there are two physicians to handle, male and female, not, I think, after their kind. "Doctor Zay," by Miss Phelps, makes absurd a book which is otherwise very attractive. This young woman doctor, a h.o.m.oeopath, sets a young man's leg, and falls in love with him after a therapeutic courts.h.i.+p, in which he wooes and she prescribes.

The woman doctor is, I suspect, still available as material for the ambitious novelist, but let him beware how he deals with her.

PAIN AND ITS CONSEQUENCES.

As I look from my window, on the lawn below are girls at play,--gay, vigorous, wholesome; they laugh, they run, and are never weary. How far from them and their abounding health seem the possibilities of such torment as nature somewhere in life reserves for most of us. As women, their lives are likely, nay, certain, to bring them a variety of physical discomforts, and perhaps pain in its gravest forms. For man, pain is accidental, and depends much on the chances of life. Certainly, many men go through existence here with but little pain. With women it is incidental, and a far more probable possibility. The most healthy will have least of it. Vigor of body is its foe. Thin blood is its ally.

Speaking now, not of the physiological pain, which few escape, but of the torments of neuralgia and the like, Romberg says, "Pain is the prayer of the nerves for healthy blood." As the woman is normally less full-blooded than the man, she is relatively in more danger of becoming thin-blooded than he.

Moreover, the disturbances which come from the nature of her physiological processes subject her to larger risks of lessened blood than man, and hence, for all reasons, she is more likely than he to become anaemic, and out of this to evolve pain in some shape.

If we see that our girls are not overtasked at the age of s.e.xual evolution, that the brain is not overtrained at bitter cost of other developments as essential, we escape a part of this peril. To discuss the question here is not my intention. To secure in our artificial life what is desirable is difficult. It involves matters of dress, exercise, proportion of lessons, diet, and other matters, of which I shall yet say something, and as to which I have elsewhere said a good deal.

But no matter how careful we may be, how thoughtful as to the true needs of these young lives, we may be sure that our daughters will be more likely to have to face at some time the grim question of pain than the lads who grow up beside them.