Dr. Maxworth took his firm round the ward every Wednesday morning. He was a thin, desiccated little man who had never been known to appear in public dressed in anything but black coat and striped trousers. He was not really interested in students at all. For most of the round he forgot we were crowding in his footsteps, and would suddenly recall our presence by throwing a few half-audible scraps of instruction over his shoulder, He was a specialist in neurology, the diseases of the nervous system. This is the purest and most academic branch of medicine and requires for its practice a mind capable of playing three games of chess simultaneously while filling in a couple of stiff crossword puzzles between the moves. As almost all the nervous diseases we saw in the ward appeared to be fatal, it seemed to me a pretty barren speciality. But Maxworth drew exquisite pleasure from it. He was not primarily concerned with treating his patients and making them better, but if he scored a diagnosis before the proof of the post-mortem he was delighted. He was, his houseman said, a fairly typical physician.
I began to see how the ward was managed by Sister, whom I avoided like a pile of radium. Every bodily occurrence that could be measured-the pulse, the amount of urine, the quantity of vomit, the number of baths-was carefully entered against the patient's name in the treatment book, which reduced the twenty or so humans in the ward to a daily row of figures in her aggressive handwriting.
There were two functions of the physiology which Sister thought proceeded wholly in her interest. One was temperature. The temperature charts shone neatly from the foot of the beds, and each showed a precise horizontal zigzag of different amplitude.' Sister wrote the dots and dashes on them herself every morning and evening. The temperatures were taken by the junior nurses, who used four or five thermometers. In spite of inaccuracies due to a different instrument being used daily on each patient and the varying impatience of the nurse to whip the glass spicule away, the figures were looked upon as indispensable. Any errors occurring through mercurial or human failings were not of great importance, however, because Sister always substituted figures of her own if the ones returned by the patient did not fit with her notion of what the temperature in the case ought to be.
The other particular concern of the Sister was the patient's bowels. A nurse was sent round the ward every evening with a special book to ask how many times each inmate had performed during the past twenty-four hours. 'How many for the book?' she would enquire with charming coyness. The patients caught the spirit of the thing, and those returning fair scores to the nurse did so with a proud ring in their voices but anyone making a duck confessed with shame and cowered under the bedclothes.
The number of occasions was written in a separate square at the foot of the temperature chart. A nought was regarded by Sister as unpleasant, and more than two blank days she took as a personal insult. Treatment was simple. One nought was allowed to pass without punishment, but two automatically meant cascara, three castor oil, and four the supreme penalty of an enema.
We rapidly became accustomed to our position of inferiority to everyone on the ward staff. Like all apprentices, the students were used as cheap labour by their superiors. We did all the medical chores-urine-testing, gruel meals in patients with duodenal ulcers, blood samples, and a few simple investigations. For the first few weeks everything seemed easy. It was only at the end of the three-month appointment that there crept up on me an uneasy certainty that I did not yet even know enough to realize how ignorant I was.
6
The impact of surgery on the student is likely to be more dramatic than the first gentle touch of medicine. Although surgeons have now abandoned such playful habits as hurling a freshly amputated leg at a newcomer in the theatre, the warm, humid atmosphere, the sight of blood spilt with apparent carelessness, and the first view of human intestines laid out like a string of new sausages sometimes induces in a student a fit of the vapours-a misfortune which draws from his unaffected companions the meagre sympathy afforded a seasick midshipman.
Nevertheless, I started the surgical course with a feeling of superiority over my predecessors of ten or fifteen years ago. As I went to the pictures fairly regularly I was already as familiar with the inside of an operating theatre as with my father's consulting room.
From a seat in the local cinema not only myself but most other people in the country had achieved a thorough and painless knowledge of what went on behind the doors marked 'Sterile.' I was ready for it alclass="underline" the crisp white gowns; the cool, unhurried efficiency; the tense concentrated silence broken only by the click of instruments, a curt word of command from the surgeon, or a snapped-out demand for a fresh ligature by the theatre sister. I prepared myself to face the solemnity of an operation, with the attention of everyone in the room focused on the unconscious patient like the strong beam of the operating spotlight.
I was attached to Sir Lancelot Spratt for my surgical teaching. My official title was Sir Lancelot's dresser, which meant not that I had to help him into his white operating trousers in the surgeons' changing-room, but that I was supposed to be responsible for the daily dressings of three or four patients in the ward. The name had a pleasing dignity about it and suggested the student really did something useful in the hospital instead, as it was always impressed on him by the nurses and houseman, of getting in everyone's way like a playful kitten.
The appointment of Sir Lancelot's firm was something of an honour, as he was the Senior Surgeon of the hospital and one of its best-known figures. He was a tall, bony, red-faced man with a bald head round which a ring of white fluffy hair hung like clouds at a mountain top. He was always perfectly shaved and manicured and wore suits cut with considerably more skill than many of his own incisions. He was on the point of retiring from the surgical battlefield on which he had won and lost (with equal profit) so many spectacular actions, and he was always referred to by his colleagues in after-dinner speeches and the like as 'a surgeon of the grand old school.' In private they gave him the less charming but equivalent epithet of 'that bloody old butcher.' His students were fortunate in witnessing operations in his theatre of an extent and originality never seen elsewhere. Nothing was too big for him to cut out, and no viscus, once he had formed an impression it was exercising some indefinite malign influence on the patient, would remain for longer than a week _in situ._
Sir Lancelot represented a generation of colourful, energetic surgeons that, like fulminating cases of scarlet fever, are rarely seen in hospital wards to-day. He inherited the professional aggression of Liston, Paget, Percival Pott, and Moynihan, for he was trained in the days when the surgeon's slickness was the only hope of the patient's recovery, the days before complicated anaesthetics, penicillin, blood-transfusion, and the other paraphernalia of modern surgery had watered down the operator's skill and threatened to submerge him completely.
Sir Lancelot had made a fortune, chiefly from the distressing complaints of old gentlemen, and was charging two hundred guineas for an appendicectomy while Aneurin Bevan was still thumping a local tub in Ebbw Vale. His real success started in the 'twenties, when he earned his knighthood by performing a small but essential operation on a cabinet minister that allowed him to take his seat in the House with greater ease. The minister was delighted, and recommended him in every drawing-room of importance in London. Just at that time Sir Lancelot got it into his head that rheumatism could be cured by the removal from the body of all organs not strictly necessary for the continuance of life. As most people over the age of fifty have rheumatism and it is impossible to make it much better or much worse with any form of treatment his practice increased tenfold overnight.