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SOME OPINIONS OF THE PRESS.
" A wild romance of the preternatural kind . . •
told in a direct, business-like fashion."—Spectator.
" Originality of design, artistic neatness of con¬
struction, and pferfect style, with shrewd insight into
the humours of individual character, go far to
recommend a story.''—Illustrated London News.
" A fairy tale for grown-up people, in which a good
and an evil genius contend for the destiny of a young
lady fresh from a boarding school. . . The idea is
worked out with considerable power."—Literary
World.
" He is fond of tracing the rose-strewn career of
some young person of either sex, who devotes him¬
self or herself to self-enjoyment, unfettered by social
restraints, and owing no duty to any one but first
person singular.''—Times.
"Will be pronounced exceedingly clever, and
should win many readers."—Scotsman.
" The idea of mysticism is cleverly treated, and
the unnatural power exercised over the girl's mind by
the old magician, even when separated by some con¬
siderable distance, recalls the days of spiritualism."—
Court Journal.
"The style is fluent, the characterization clever,
and the atmosphere of mystery well maintained."—
Globe.
LONDON:
SWAN SONNENSCHEIN & CO.,
Paternoster Square.
DYING SCIENTIFICALLY.
ST. BERNARD'S:
THE ROMANCE OF A MEDICAL STUDENT.
Cheap Edition, 2s.
The following are a few extracts from PRESS OPINIONS
which appeared on the publication of "St. Bernard's," in
September, 1887.
"A story with a purpose, written very much in earnest. .
There is much that is good and useful in this."—Athenceinn.
" A powerfully written work. . . . There is a ring of sincerity
in the author's manner which will have weight with a large circle
of readers."—Morning Post.
" The main theme of the book is an attack on the management of
the great Hospitals, by one who has had means of knowing their
procedure intimately."—Pall Mall Gazette.
" A terrible indictment of the medical profession. . . . The
book is written with great ability, and it cannot be ignored. It
must be answered if possible."—British Weekly.
" Even if it can be shown that St. Bernard's is in some respects
unjust, the book is one which should certainly be read by every one
entering on the study of medicine."—Chemist and Druggist.
" If this book represents, even approximately, what goes on in
our great teaching hospitals, we have amongst us a monster iniquity
that closely rivals the Vivisecting Institutions of unenviable noto¬
riety. That St. Bernard's is a deliberate libel, we cannot believe."
—Spectator.
"The book is likely to make some stir not only in the medical
world, but among all who subscribe to the funds of the great London
Hospitals."—The Lady.
" If half that he says is true, then the Hospital system is a crying
disgrace to our civilization."—Whitehall Review.
DYING SCIENTIFICALLY:
A KEY TO ST. BERNARD'S.
BY
^SCULAPIUS SCALPEL,
Author of "St. Bernard's, the Romance 0/ a Medical Student."
SECOND
EDITION.
LONDON:
SWAN SONNENSCHEIN, LOWREY & CO.,
PATERNOSTER SQUARE.
1SS8.
Butler & Tanner,
The Selwood Printing Works,
frome. and london.
NOTICE TO THE READER.
The References to the pages of St. Bernard's correspond to
the 1st Edition of that work. For those who have the
Stereotyped Edition, the following table will be necessary to
find the quotations.
In 1st Edition. In Stereotyped Edition.
Page B corresponds to ... ... Page -2
„ 22 „ „ IB
,, 47 ,, ... ... ,, 27
,, 71 ,, ... ... ,, 42
„ 88 ... ... ,, ,, 51
„ 106 „ „ 61
„ 109 „ ... ... „ 63
„ 111 „ ,, 64 & 65
„ 112 „ „ 65
,, 114 ... ... t, ... ... ,, 66
„ 150 „ ,, 88
„ 155 ,, „ 92
„ 167 „ 99
,, 168 ,, „ 100
,, 169 ... ... m ••• ••• )> 100
„ 170 „ „ 101
„ 175 ... ... „ „ 104
„ 176 „ „ 105
„ 178 „ „ 106
„ 179 „ 107
„ 197 ,, „ 118
„ 213 ... ... „ „ 129
„ 216 ,, „ 130
„ 220 „ „ 133
„ 223 ,, „ 135
„ 279 „ „ 168
„ 287 „ „ 173
„ 302 „ „ 181
„ 326 „ „ 195
„ 32« „ „ 196
„ 333 ... ... „ „ 200
„ 426 „ „ 256
„ 427 „ „ 257
„ 434 „ „ 262
FOREWORDS.
"St. Bernard's: the Romance of a Medical
Student," was published on September 15th,
1887. Since that date and the time of writing
this, some fifty reviews and press notices con¬
cerning it have appeared. The edition has
been sold out, and a second is now in the press.
It was to be expected that such a book, con¬
taining such serious charges against some of
our most cherished and admired charities, should
create much controversy and excite much indig¬
nation. This anticipation has been fully borne
out by the results. It was not possible to draw
public attention to these abuses by any other
method than that of writing a story, as interest¬
ing as might be, embracing all the facts. A
treatise on hospital management would have
fallen still-born from the press. The abuses
complained of in St. Bernard's have been
6
DYING SCIENTIFICALLY.
ventilated over and over again in the medical
and lay papers, and nothing has been done to
rectify them. I could only expect the most
violent denunciation from medical critics and
others whose sympathies were enlisted on
their side. I expected to be called moonlight
assassin, dynamiter, slanderer, liar, calumniator,
libeller, and such like, because I have read the
history of many reforms, and I well knew the
sweet ways of my professional brethren and
their methods of dealing with their opponents.
I knew that if a medical man did not subscribe
to the British Pharmacopoeia, and make his
patients swallow it in gross or detail, in the
prescribed doses too, and that without any
mental reservations, he was henceforth to be
considered as an heathen man and a publi¬
can, or even as these homoeopathists. I knew
that if he objected to vivisection, he was
held to be an ignorant faddist; if he did not
fall down and worship the vaccine lymph
which the Local Government Board hath set
up, he was to be cast into the fiery furnace
heated specially for him by the Royal Col¬
leges ; if he objected to abominable outrages
on the persons of unhappy women for the bene-
A KEY TO ST. BERNARD'S.
7
lit of a licentious soldiery, he was held to be
an unscientific, philanthropic idiot. I knew all
these things when I wrote St. Bernard's.
I knew that "a fuss in the papers," as a Lon¬
don house surgeon recently phrased it, was just
what the hospitals did not like (unless as
appeals for funds), and yet I wrote St. Ber¬
nard's ; and notwithstanding some severe stric¬
tures in the medical press, I stand by every
word I have written in my novel, and I justify
every charge by the publication of this key.
Now to the facts.
I have said that in our great general hospitals
to which medical schools are attached, the
healing of the patients is made subordinate
to the professional advantage of the medical
staff and the students ; and I justify the charge
by the extracts from the medical journals on
pages 30 to 34 of this work.
I have said that the healing of patients
is deliberately retarded for the purpose of
clinical study; and I justify that charge on
Pages 39, 40, 70, 71, 72, etc.
I have declared that new drugs are tried
O
8
D YING SCIENTIFIC ALL Y.
upon hospital patients, and that in a manner
which dare not be attempted on private patients;
and I substantiate the charge on pages 73 to
80, and 81 to 87.
I have told how patients are needlessly
examined by doctors and students ; and I con¬
firm this by extracts from medical journals on
pages 41 to 45.
I have said that patients are often made
to undergo unnecessary operations, and even
amputations, that surgeons may have practice;
and I illustrate this on pages 52 to 56.
I have told how students are sent out to
poor midwifery cases, and their blunders kindly
covered by their teachers for the credit of the
hospital; and the extracts from the British
Medical Journal on pages 24 and 25 confirm
the statement.
I have protested against the horrible cruelty
of the iced-bath craze for fever patients; and
the cases from the great medical journals sup¬
port the protest. See pages 98 to 102.
I have said that in a hospital }rou cannot
A KEY TO ST. BERNARD'S.
9
even die in peace, but are ever in danger of
some ghastly medical freak being tried upon
you ; and I explain what I mean on pages
I02 tO 112.
I have declared that the dying are tortured
by useless operations ; and I make the charge
good on pages 45 to 51.
I have said a great many other startling
things in St. Bernard's, and in this book I
give a great many equally startling proofs in
support thereof.
Mr. Spurgeon asks in the Sword and Trowel,
" How much is romance and how much reality
in this remarkable book?" I reply, about 25
per cent, romance and 75 per cent, stern reality,
so much romance being a concession to the
weakness of our nature.
The Literary World says that " the tone of
the times is much higher than it was fifty years
aofo, and the medical student has conformed to
o j
it"; to which I reply, "No doubt it is so," to
the first part of the sentence, and " I doubt
that it is so," to the second.
IO DYING SCIENTIFICALLY.
The Lancet says my book " will serve no
useful purpose." Then, I reply, daylight, fresh
air, and truth have lost their ancient properties.
The Illustrated London News says there is
" a disgusting parade of religious sentiment"
in St. Bernard's. If this be so, I must have
imbibed it from the many introductory addresses
I have heard and read on the ist of October
for some years past.
John Bull says : " The book will raise the
deepest indignation in those interested in hos¬
pitals;" to which I reply, I sincerely hope it may.
The Spectator asks : " What possible motive
can its author have for vilifying his professional
brethren, and incurring their lasting enmity,
except the hope of putting wrong right ?"
What, indeed ?
The British Weekly says : "To write it was
either a great duty or a great crime ;" and I am
perfectly willing to accept the position.
The reader will see that I have only pro-
A KEY TO ST. BERNARD'S. n
claimed on the housetop what has long been
whispered in the closet. It is necessary some¬
times to speak from the housetop.
As I have no wish to make this controversy
a personal one, I have omitted the names of
the physicians and surgeons, and those of the
hospitals to which they are attached, in the
extracts which I give from their communica¬
tions to the medical journals. These can easily
be verified, if desired, by reference to page and
date of the published accounts. Of course in
many cases I have had to leave out passages
which would not be suitable for general read¬
ing, and I have omitted details and minutiee
not material to the illustration. I think in
most instances the facts recorded in their naked
simplicity are sufficient to acquit me of exaggera¬
tion in my book, but the details are usually
given in such technical language that the reader
requires a medical education fully to realise their
meaning, and the notes which I have added
on the various cases are only what I consider
necessary to make them intelligible to the non¬
professional reader.
In all cases the italics are to be taken as my
own.
12
DYING SCIENTIFICALLY.
In conclusion, I wish it to be understood that
I have not quarrelled with my profession or my
Alma Mater. I love my daily work as a
medical man in large practice, and have no
desire to earn my bread by any better busi¬
ness. I love my old hospital, in which I
passed some of the happiest years of my life.
I never met with anything but the utmost kind¬
ness from everybody connected with it. I am
grateful for all the advantages the institution
gave me, and the reason I do not give my
name as the author of St. Bernard's, is that I
desire not to identify any hospital in particular,
believing them all to be " tarred with the same
brush," and all implicated in the same condem¬
nation, and in need of the same reform. If I
gave my real name, as some of my critics have
demanded, I could not avoid injuring the insti¬
tution where I learned my profession, because
people would naturally believe my scenes were
taken from that field of observation. I mean
to implicate no persons in particular in my
charges. As I am entirely orthodox in my
practice, and daily send my patients their usual
six ounces of regulation physic, I hope I shall not
be claimed as a brother by any homoeopathic,
A KEY TO ST. BERNARD'S.
13
anti-vaccinationist, or hydropathic heretic, or
even as a disciple of the great physician who
declares that sick folks want " nothing but a
good warm bed" to cure them. My medical
creed is not nearly so advanced, and I say
with Mrs. Podger that my patients " is much
too serious bad to get on with them notions."
Let the following utterances of one of the
medical papers be my text for this book.
"Too much prominence cannot be given to the
fact that, as Mr. Cartwright pointed out in his speech
on Mr. Reid's Vivisection Abolition Bill, if experi¬
ments on animals are prohibited, then human beings
must necessarily become the subjects of the roughest
treatment. Refinements of research under these cir¬
cumstances, moreover, would be simply impossible, and
every medical man would perforce become, whether
he willed it or not, a vivisector of his patients ; for it
cannot be gainsaid that the attendant's duties to his
profession have a higher claim than any advanced by
the men and women who come to him for cure and
relief. These truths are great and important, and
they deserve to receive the utmost public attention
at the present time."—Medical Press and Circular,
April 18, 1883.
*5
DYING SCIENTIFICALLY.
I will take the principal points of St. Bernard's
seriatim, and illustrate them by published ex¬
tracts from the most authoritative sources.
" He is assured that he will be a benefactor to
humanity of the highest typed—St. Bernard's,
P- 3-
This is how we speak at Inaugural Addresses
on the first of October
" While religion raises the heart of man from the
finite to the infinite; while education makes him cul¬
tured and refined, it is left for Medicine, when rightly
employed, to humanise man. In the present day, we
see it in the work of the medical missionary. By such
men, Medicine is taken to all of every creed and every
tongue ; giving relief to suffering man and woman \
asking for nothing in return but this, the basis of all
social religion, that they should go and do likewise—
gratitude thus becoming, instead of a mere sentiment
of the heart, an energising principle of the life. In
i8
DYING SCIENTIFICALLY.
this fact I recognise the one great element that will
lead up to the unification of mankind; the one in¬
fluence that will develop and maintain a common
brotherhood, emulous to advance the honour, the
interests, and the glory of the race " (Inaugural Address
at University of Durham College of Medicine, by
Dr. F. Oliver).—Brit. Med. Journ., Oct. 7, 1882.
And this is how we talk amongst our-
o
selves :—
" F.R.C.S. writes : ' I have read, in your December
10th number, "A Ballad of the Services," and I am
not inclined to find fault with the verses; they are
good; but I confess I have my doubts about the
sentiments expressed therein, and especially in the
extract given above them—a portion, I presume, of
some lecture or address by Sir James Paget: " Con¬
tent because they are in the path of duty; blest if
only they see or think that they minister to the welfare
of their fellow-men," etc. " Content! " Are we con¬
tent ? " Blest! " Are we blest ? Except, peradven-
ture, we are " blest" as soldiers sometimes use the
term. Why, the entire space of pages 1306 and 1307,
in one of which the verses in question occur, is taken
up with letters expressive of discontent.
" ' I have often thought this aping of humility, this
pretence that we as a profession are quite " contented
with the sweet reward of exercising it, despising the
filthy lucre, honours, and advancement all other pro¬
fessions and callings aspire to, is one reason of the very
curious treatment we receive at the hands of the
authorities. Successful lawyers are rewarded not only
with enormous fees, but with peerages and seats of
A KEY TO ST. BEE KATE'S.
19
honour. The clergy, professors of humility and hum¬
ble aspirations, are nevertheless content to accept
high places, to go clad in purple and fine linen, and
fare sumptuously every day; but we, and we only, are
to be "content and blest if we see or think we minister
to the welfare of our fellow-men !" I am afraid a
shrewd public see through all this, but are " content "
to take us at our word.
"' I should like to hear some man, as eloquent as
Paget, if such a one is to be found, take up the parable
with a different text.'"—Brit. Med. Journ., Dec. 31,
1887.
" And then he related how the body-snatchers
went to Bow Cemetery," etc.—St. Bernard's,
p. 22.
Seethe article in the British Medical Jour¬
nal, January 11, 1879, entitled "Reminiscences
of a Medical Student prior to the Passing of the
Anatomy Act," where the author, after relating
experiences similar to those in the novel, says,
"if the present Anatomy Act, which gives the un¬
claimed bodies of paupers to the medical schools,
should be successfully interfered with, it would
not only materially imperil medical education,
but would probably lead to a renewal of those
horrible crimes, culminating in the atrocities of
which Burke and Hare were guilty ; and that
20
DYING SCIENTIFICALLY.
they, in their anxiety to give Christian burial
to unclaimed paupers and lunatics, would be¬
come accessories to the murder of their fel¬
low-creatures."
For the whole story of the Burke and Hare
murders, see " The Life of Robert Knox, the
Anatomist," by Lonsdale (Macmillan & Co.,
1870).
I have described medical student life as I
knew it in my own hospital days. Some of
my lay critics and all my medical ones declare
that things are quite otherwise now, and that
I am drawing more from Dickens than per¬
sonal observation in my pictures of student life.
Yet I read in the Daily Chronicle of November
15, 1887, the following :—
" Extraordinary Demonstration of Medical Students.
—Yesterday the Leeds townspeople were startled by
the spectacle of about a hundred medical students
walking in procession through the principal streets
and indulging in sundry strange antics, greatly to the
amazement as well as the amusement of the by¬
standers. The affair appears to have arisen through
a proposal made by certain of their number that the
students—or, at any rate, the majority of them—
should become members of the local Young Men's
Christian Association. A notice having been posted
up in the medical school asking the students to as¬
semble at the Young Men's Christian Association
A KEY TO ST. BERNARD'S.
21
rooms to hear the matter discussed, nearly a hun¬
dred young men came together, most of whom ex¬
pressed disapprobation of the movement. A lively
scene ensued, the dissentients smoking, shouting,
letting off crackers, and generally behaving in a riotous
manner. Ultimately they left the hall, and marched
in procession to Victoria Square, in front of the Town
Hall, where one of them in the midst of a large crowd
delivered a mock oration beginning, ' Fellow-brethren
and unemployed.' The party then moved to the
nearest public-house, and after drinking resumed the
procession throughout the streets, vigorously singing
the well-known comic song ' Ballyhooley,' and cheer¬
ing every prominent townsman they met. In the
course of the march round several sandwich-men
were thrown into the gutter, and for two hours the
scene altogether was one of an almost unprecedented
character, the only breaks in the demonstration being
the intervals in which the public-houses were visited."
And in the Liverpool Courier of November 10,
1886, I read of what it calls—
" A scene of rowdyism which reflected the greatest
discredit on those who were its originators. The vast
crowds who paid their last visit on Monday were most
orderly both during their stay in the buildings and at
their departure, but there was a small gang of well-
dressed young men to whom the police were compelled
to give some very firm attention. From what some
members of this band have stated, it appears that the
majority were medical students, who had arranged to
hold one of those riotous demonstrations which young
men in their position i ?i various towns in this cou?itry
think they have a prescriptive right to make, despite
22
DYING SCIENTIFICALLY.
public protests and police interference. When the hour
for closing the Exhibition arrived, and the great majo¬
rity of visitors were hurriedly making their way to the
exits, a company of about thirty young men who had
taken up a position at the bar of Mr. Wood's first-
class refreshment-rooms, which are on the terrace of
the grounds, refused to leave, although repeatedly
invited in a most courteous manner to do so by Mr.
Wood's representatives. The doors were then closed,
and the police sent for, and in a few minutes Inspector
Higginbotham, with about a dozen members of the
county constabulary, entered the bar. The inspector
again gave the gang an opportunity of beating a re¬
treat in a peaceful manner, but his courtesies were
rudely refused by the youths, whose language and de¬
meanour were of the rowdiest description, and might
have been more naturally expected to proceed from a
' High-rip gang' than a number of educated people
of respectable appearance. Finding mild persuasion
useless, the inspector very properly gave the order to
clear the place, and the officers proceeded to carry out
the command. The disagreeable task was not well
begun before the rowdies delivered at the police an
irregular fire of bottles seized from the bar, and as they
were gradually expelled from the bar and deprived of
these missiles, they picked up the small Vauxhall lan¬
terns which have served for the illumination of the
grounds, and threw them at the officers, several of
whom were struck on the face. The rioters who had
been ejected smashed the door of the refreshment-
rooms, and breaking the ornamental wooden railings
which surrounded the building, used them as weapons
against the police, who by this time had drawn their
staves and were effectually using them on their
assailants."
A.' KEY TO ST. BEEN J ED'S.
23
When I read these things, I say, I am led
naturally to think that matters are pretty much
with these young gentlemen as they were in
my time, and as I have described them in St.
Bernard's. My descriptions must be taken with
this explanation, that I do not think medical
students are any worse than the general average
of other students; and that if they are more
rowdy, it is due to the lenience of the public,
who allow them to act in a way which would
not be tolerated in other young men.
" The lecturers poured forth their ivisdom to a
scant attendance at such timesP etc.—St. Ber¬
nard's, p. 47.
Dr. Waters, of Chester, gave evidence before
the Select Committee on the Medical Acts
Amendment Bill, as reported in the British
Medical Journal, July 12, 1879; and in reply
to Mr. Wheelhouse, said :—
" It would be just possible under the present regu¬
lations for a person to get upon the Register without
having attended a single lecture; but I do not say
that it is a common thing. A student might omit a
very considerable number of lectures, and yet by a
process of cramming pass his examination. There
24
DYING SCIENTIFICALLY.
are no satisfactory means that I know of for testing
the attendance of students at any of the lectures,
except, perhaps, by class examinations ; but these are
not compulsory. It was a recommendation of the
Council that there should be compulsory class exami¬
nations ; but, as I have said, its recommendations
have not been carried out."
" Sometimes very terrible acccidents arose in
this way—St. Bernard's, p. 71.
See "A Curious Mistake," British Medical
Journal., November 7, 1885, p. 879.
And this :—
"We expressed our opinion that when the student
had reached his fourth year it is questionable whether
a twelvemonth with a practitioner would not be highly
advantageous to him. It would afford the best way
for learning practical midwifery, far better than ob¬
stetric work in slums, with or without the aid of
an overworked and inexperienced hospital midwifery-
assistant. The pupil would learn those social require¬
ments which are so important to all who live to cure
the sick."—From article on "Medical Education and
Apprenticeship," in British Medical Journal, June 18,
1887, p. 1343.
And this :—
'' Hospital Death-Certificates.— Hospital has
again incurred the censure of a coroner's jury. Mr.
W. J. Payne concluded an adjourned inquest on the
A KEY TO ST. BERNARD'S.
25
bodies of three newly born children, who died shortly
after birth. The feature of each case was that a
student from Hospital attended at the confine¬
ment, and owing to the peculiarity of the death-certi¬
ficates given from the hospital, the local registrars
refused to accept them. However, Mr. , house-
physician at Hospital, deposed to making the
post-mortem examination on two of the bodies, and
said that the students in each case had done all that
was necessary in a proper manner. The cause of
death was a want of vitality—both children being
exceedingly puny. Had properly qualified men been
sent, the result would doubtless have been the same;
but he was bound to admit that, in the last instance,
the student was to blame in not informing the staff
that the case was serious, and that the child could not
possibly live, as a fully qualified man would then have
been sent. The custom of the hospital was to allow
the students to attend and not call for any superior
skill while, they were satisfied they could do without
it. With regard to the method of signing the certifi¬
cates, it was the common practice to sign them on the
report of the students and without seeing the child at
all. In reply to the coroner and jury, the witness said
they were quite aware that by the Act of Parliament
they rendered themselves liable to a fine and two years'
imprisonment by pursuing this course. Witness could
see also that for the staff to sign certificates on mere
information might sometimes lead to serious results.
In the third case, the certificate stated that the child
had died of convulsions. The coroner said the inquiry
had revealed a blot on the hospital system, and he would
take care to lay all the facts before the Registrar-
General. The jury returned a verdict of death from
natural causes in each case, and added a rider cen-
26
DYING SCIENTIFICALLY.
suring the hospital authorities for not sending properly
qualified persons to see the dead bodies before grant¬
ing certificates for the registrars.—Brit. Med. Journ.,
July 15, 1882.
" The house-surgeons always prided themselves
on an air of nonchalance and dignity."—St.
Bernard's, p. 88.
An instructive illustration of this chapter
is taken from the British Medical Journal,
August 27, 1881 :—■
'■'■Hospital Arrangements.—The newspapers report at
some length an inquest which was held this week on
a cabman, who died from injuries received by being
thrown from his cab. He was taken to St. Thomas's
Hospital, where a surgeon examined him, ordered a
dresser to strap his side, and directed him to come
next day. The following morning he became worse,
and was taken to St. Mary's Hospital, where it was
found he had five broken ribs ; and he shortly after¬
wards died. The jury expressed regret that a more
efficient examination was not made at the first-named
institution, as this would probably have resulted in the
discovery of the fractured ribs, and the man's admis¬
sion as an in-patient. Before commenting on this
event, which has given rise to severely critical com¬
ments in the daily papers, we should be glad to know
what explanation, if any, the hospital authorities have
to offer. There has been lately a notable increase of
cases in which surgical injuries of a severe but suffi¬
ciently obvious character have been overlooked by
dressers and house-surgeons, and the patients reck-
A KEY TO ST. BERNARD'S.
27
lessly sent adrift. St. Bartholomew's, the Middlesex,
and now St. Thomas's Hospital, have furnished their
quota. Is the race of house-surgeons deteriorating ?
Or must more stringent regulations be instituted for
ascertaining the competence of those who are ap¬
pointed to these important offices, and more efficient
means of making them realize their great and twofold
responsibility? Their duty to the public and their
duty to the hospital, whose fair fame and character
are in their hands, should make house-surgeons and
dressers realize ,the fact that the examination and
treatment of ' casualties' app lying for relief at a public
hospital is one of the gravest charges which can be
assumed by any man at any period of his career—
almost too serious, possibly, for the very young men
to whom it is now often entrusted."
My chapter entitled, " Amongst the Out-
Patients," is, I consider, amply justified by the
following extracts from the medical journals :—
"Sir William Gull's motion, at the recent meeting
of the Charity Organization Society, in favour of the
establishment and extension of Provident Dispensaries,
together with the lucid and convincing arguments he
advanced in support of his proposition, once more
draws attention to the urgent necessity of hospital
reform.
" The experience of thirty years' close attention to
the diseases of the poorer classes, fifteen of which
were passed at Guy's Hospital, has taught Sir William
Gull that the present system of out-patient relief pur¬
sued at the hospitals is highly unsatisfactory, or, as he
28
D YIXG SCIEN TIFICALL Y.
himself expressed it, ' a disgrace to any civilized com¬
munityThis is strong language ; yet the speaker is
no sciolist.
" It is a notorious fact that a fractional part only of
the out-patients who crowd the London hospital doors
can obtain more than a few hurried words of advice
from the medical staff, let alone careful diagnosis or
treatment; yet so rooted is the conviction among the
poorer and uneducated classes that skilled medical
treatment is to be found at the hospitals only, that
thither they flock, often after a weary and painful
journey, necessitating the loss of a day's work or the
neglect of household duties, only to receive instruc¬
tions to return for treatment some other day. To
make matters worse, the greater part of those pre¬
senting themselves for gratuitous medical relief stand
far more in need of the friendly services of the
butcher and baker than of the physician or surgeon;
many others are not in such straitened circumstances
as to warrant their application for either gratuitous
advice or treatment, and the scant time at the disposal
of the medical staff is sorely wasted and trespassed upon,
at the expense of bond fide and more serious cases
requiring immediate and close attention. To obviate,
then, these abuses—the necessity of the painful tramp
to the hospital, the weary and anxious time wasted in
the densely packed waiting-rooms (undoubtedly tend¬
ing to aggravate the patients' disorders)—no less than
to afford some relief to the overtaxed and totally
inadequate medical staff, Sir William Gull once more
urges the immediate establishment and extension of
Provident Dispensaries throughout the metropolis.
With this aid, in place of the present loose and
slipshod method, or rather wTant of method, in admin¬
istering out-patient relief, a proper and carefully
A KEY TO ST. BERNARD'S.
29
organized system might be at hand to meet the
exigencies of every case, the more grave of which
could be treated clinically at home. The same tale
has been told over and over again by the late Sir
William Fergusson, by Dr. A. P. Stewart, by Mr.
Timothy Holmes, and by other leading members of
the consulting branch of the profession, as well as
by Dr. Joseph Rogers, Mr. Nelson Hardy, Mr.
Stephen Alford, and other representatives of the
class of general practitioners in the metropolis, not
to speak of their provincial confreres. In an interesting
and extremely able paper read before the Metropolitan
Counties Branch of the British Medical Association
(see British Medical Journal, March 16th, 1878), Mr.
Timothy Holmes pointed out that at the hospitals
admission is too indiscriminate, so that a number of
persons are admitted beyond the powers of the institu¬
tions properly to deal with; and that it is impossible
in those hospitals attached to medical schools, to
give that instruction which the students ought to
derive from the out-patient practice. As a conse¬
quence of this excess of numbers, the poor are made
to wait an inordinate time for the advice given ; and
such advice, when obtained\ is often hurried and worth¬
less."—Brit. Med. Joum., May 4, 1878.
In the above-quoted journal of January 5,
1878, Mr. T. Holmes, the great surgeon, writes
as follows :—
" The absurdity and cruelty of keeping a poor patient
waiting for four or six hours, and then scratching a
1 B' on his paper and serving him out a bottle of use
less physic, would be at an end."
3°
DYING SCIENTIFICALLY.
This, too, is as strong a condemnation of the
out-patient system as anything I have written,
where the same authority says :—
" I think no one would seriously deny that (speak¬
ing still of London only) a great deal of our out¬
patient relief is superfluous, and a great deal is not
efficient. I do not speak so much of the cases of
well-to-do persons who are believed to attend out¬
patient departments. There is no doubt that there is
a certain proportion of such persons at special institu¬
tions ; but such special institutions are often hardly
public hospitals in any genuine sense, and we need
not here inquire whether all the patients are really
gratuitous. There is obviously no public reason why
they should be so. But I refer more to the crowd of
utterly trivial and routine cases which load our out¬
patient rooms. We are told that the reason why hun¬
dreds of patients are admitted every day at some of these
institutions is in order that, out of this mass of chaff, a
few grains of wheat may be winnowed; that a feiu in¬
teresting or important cases may be selected for treatment
as in-patients. But is this necessary, and is it really
done ? Mr. Jordan has well pointed out its admitted
evil effect in completely destroying the ample field of
clinical instruction which the out-patient room ought
to afford, but which it now cannot possibly afford,
unless the physician or surgeon neglects his primary
duty, that of attending to his patients, for what is,
after all, as far as the hospital is concerned, only a
secondary object : the instruction of the students. I
know that some out-patient officers have imparted
most admirable clinical instruction to their classes ;
but it has always, I believe, been done by transferring
the great bulk of the routine work to assistants.''
A KEY TO ST. BERNARD'S.
3i
At a meeting on the medical treatment of
the working classes held at the Society of Arts,
the committee recommended that " those cases
which are vouched for by the physicians or sur¬
geons as of special interest should be retained
for hospital treatment
At a meeting of the Hospitals Association
held on the 23rd April, 1884, Mr. Timothy
Holmes, as reported by the British Medical
Journal, urged,—
" That the chief use of hospitals was that they
should teach practitioners of medicine and surgery.
. . . Firstly, a hospital should be a place for medi¬
cal education; secondly, for the relief of suffering;
and, thirdly, for the training of nurses ; all of which
objects should be considered in due proportion by
those exercising the management."
"The greatest use of hospitals is to promote the
advancement of medical science, and to afford an
improved method of recognising and of treating
disease" (Oration at the Mansion House by the
President of the Medical Society of London).—Lancet,
June 26, 1886, p. 1250.
" He would repeat that perhaps the very greatest
advantage that the hospitals conferred was not upon
the sick, but upon those who stood aside and who
only sometimes grudgingly gave to their support"
(Address by Sir Bart., M.D., at Lambeth Palace.)
—Lancet, June 26, 1886, p. 1252.
In an article in the British Medical Jour nal,
32
DYING SCIENTIFICALLY.
on " The Abuse of Hospitals," the opinions of
an eminent authority are thus expressed :—
" As to the cause of this gigantic and growing evil,
which threatened to pauperize the profession in its
lower branches, and to denude it of its dignity in all,
Dr. Hickman believed it lay entirely with the medical
profession itself. The public did not require nor de¬
mand gratuitous medical services. The philanthropic
founders and,, supporters of the old hospitals made
liberal provision for the remuneration of the medical
staffs, whom they attracted by a liberal pay and digni¬
fied position. It never entered their heads that the
doctors, more than the butcher or baker, should give
services for nothing. The medical profession itself,
which thrust its gratuitous services on an almost un¬
willing public, was really responsible for the present
state of things. The large and increasing number of
hospitals and dispensaries was not an evidence of the
intense interest taken by the profession in the poor, nor
was the large amount of time and labour gratuitously
devoted to their service simply an index to the dis¬
interested philanthropy of medical men. The object of
this interest and these services was not the benefit of the
poor, nor of the profession, but the particular benefit of
the individual\ who looked forward to be amply repaid
in the future, by increased experience, enhanced reputa¬
tion, and the legitimate advertisement of himself which
was almost the only opening to high-class practice and
high-class fees.
* * -55- *
"At present there was an enormous waste of mate¬
rial and power going on at all hospitals. Rare diseases
were daily demonstrated to students who knew nothing
of ordinary diseases; the ripest professional minds
A KEY TO ST. BERNARD'S.
33
were employed in drumming the same elementary
knowledge into series after series of apathetic youths,
many of whom would never even present themselves
for a diploma. Would not the physicians and sur¬
geons be more usefully and honourably employed in
unfolding their rich stores of experience, and the
mature results of their study and thought before an
appreciative audience of earnest fellow-workers, brother
practitioners ?
-x- -* * * *
"The hospital should be the centre of medical
knowledge for its district, where the practitioner could
daily see, and practise, the use of the latest instru¬
mental or other aids, see the last introduced drugs or
chemicals ; where he could always find some rare or
important case, and witness the details and effects of
new or revised methods of treatment; assist at care
fully conducted post-mortem examinations, and in¬
crease his acquaintance with pathology and patholo¬
gical processes."
The British Medical Journal, July i, 1882,
says :—
"We are informed that, henceforth, the abundant
clinical and pathological material at the Brompton
Hospital will be utilised for the purposes of mere
systematic teaching."
Dr. C. D. Williams, in his oration to the
Medical Society of London, May 5, 1884,
said :—
" But there is one aspect of our profession which is
unrivalled, and that is its scientific aspect. It is this
c
34
D Y1NG SCIENTIFIC ALL Y.
which fascinates us all, that makes us give our services
gratuitously," etc., etc.—Lancet, June, 1884, p. 1019.
The Management of Hospitals.—On Friday, June
1 oth, 1881, at 8 p.m., an adjourned general meeting
of the Metropolitan Counties Branch was held at the
rooms of the Medical Society of London, n, Chandos
Street, Cavendish Square, to receive the report of the
committee appointed at the meeting on February 23rd
to collect information on the subject of the Manage¬
ment of Hospitals. Dr. Habershon, President of the
Branch, occupied the chair.
One eminent surgeon said :—■
" It was not proposed to ask the Government to
make improvements in medical teaching—that must
come from the physicians and surgeons. But in the
hospitals a large amount of material was allowed to
go to waste; there was a great deficiency of material
for clinical teaching. One thing that was desired was
that the Royal Commission should inquire whether
the Poor-law hospitals and similar institutions might
not be used for medical education."
Another doctor said :—
"As to medical schools, he had observed that the
lay governors required education as to the advantages
of medical teaching in hospitals. Many thought that
a clinical hospital was a great institution for experi¬
ments on the sick."
[Not Far out either!]
Dr. J. H. said :—
" As to the workhouse hospitals, the profession had
A KEY TO ST. BERNARD'S.
35
a right to ask for admission to them for the purpose
of clinical teaching. A vast amount of good teaching
and valuable cases of an acute kind were lost in
them."
[No ; the ratepayers want their sick paupers
cured as quickly as possible, that they may take
themselves off the rates and get to work.
The "good teaching" and the "valuable cases"
are all very well for the great charities, but the
over-burdened ratepayer would never stand this
sort of thing, Mr. J. H. !]
The next speaker hit the mark when he
declared that—
" Experience showed that no House of Commons
would allow the workhouse infirmaries to be used for
clinical instruction. The passage of paupers to the
infirmaries was not voluntary, and the attempt to use
them for clinical study would be opposed by all the
Radicals. There had been a difficulty of obtaining
subjects for dissection. Teachers of anatomy had
been trying to get the bodies of paupers, but were
told that no one dare make such a proposal. Govern¬
ment investigation would lead first to Government
control, and then to Government management."
Bravo, Radicals! Of course they would
oppose it, because, poor creatures, they are so
liable to be the next victims of clinical study!
36
D YING SC1ENTIF1CALL Y.
" Are there not galvanic batteries at hand ?"
—St. Bernard's, p. 106.
" On October 6th, in order, if possible, to determine
the nature of the cerebral protrusion, as to whether it
was cerebral matter or only granulation tissue, reduced
shocks from a Du Bois coil were passed through it,
but no visible result followed. The child felt nothing
of it; there was no movement, nor did the pupils alter
in size." (Case of compound fracture of the skull.
Death. 's Hospital.)—Brit. Med. Joum., Oct. i,
1887, p. 720.
" lie has not the least hope it can save her
life."—St. Bernard's, p. 109.
"We all know that the statistics in favour of
tracheotomy below the age of three are not very favour¬
able, some practitioners in Germany even refusing to
perform the operation in croup or diphtheria, while
some of the hospitals deny admission to the patients, as it
increases the mortality percentage of their operative
treatment to a very great extent. Out of 504 patients
on whom the operation of tracheotomy was performed
in diphtheria at Professor von Langenbeck's clinic
during the last six years, 357, or 70-8 per cent., died."
(Memorandum on a bloodless method of performing
tracheotomy, by Louis Henry, M.D., L.R.C.P.)—Brit.
Med. Joum., May 25, 1878, p. 752.
Dr. , Physician to the Samaritan Free
Hospital, in a paper in the British Medical
Journal for April 30, 1887, says :—
A KEY TO ST. BERNARD'S.
37
" M. S., aged 24 (married), came under my care on
July 10th, 1886, for a tumour. It was determined to
treat this tumour by electrolysis. Dr. , electrician
to St. Bartholomew's Hospital, kindly gave me his
valuable advice and assistance with the battery. I
passed three curved needles into the tumour. The
ends of the needles were connected with the positive
pole of a 30-cell (Stohrer) constant current battery, all
the cells being in use. Dr. S then applied a flat
sponge electrode connected with the negative pole on
the left thigh of the patient. The patient was put
back to bed." This was on August 2nd. The patient
died on August 22nd. "The husband objected to a
post-mortem examination, but leave was obtained to
remove the tumour, and this was done, but the
specimen was accidentally destroyed by a nurse before
it was examined. Altogether, a more disappointing
termination to an interesting case could not be
imagined." " The case has taught me that galvano-
puncture is by no means free from danger, while it is
not suited for cases ... In a future case I should
prefer to use the Faradic current daily for several days,
as first applied by Dr. . Personally I should not
again employ galvano-puncture until we know more
about the exact dose that is advisable."
[Does it not seem wonderful this has never
been ascertained after the millions of animals
experimented on for the benefit of the human
race ? Poor " M. S. (married), aged 24" ; it
was a pity she could not have waited till we
had learned to measure our doses of electricity.
There seems a great future before electricity,
38
D YING SCIENTIFIC ALL K
but it is a nasty thing to dabble in till we know
all about it!]
Several medical critics have taken me to
task for stating that house surgeons do capital
operations. It is impossible in a novel to be
as technically correct as if we were writing a
medical treatise, and I have not always made
it sufficiently plain whether I meant house or
assistant surgeon. But I have known a house
surgeon do a capital operation, and very proud
he was of the honour; and there is a case
reported in the British Medical Journal of
December 4, 1886, page 1098, where a senior
obstetric resident performed perhaps the
gravest operation in the whole region of
abdominal surgery—in a maternity case of the
charity department of one of our great hospitals.
Unhappily the patient died soon after the opera¬
tion was completed. __ There is no doubt that
the operation (if it was at all likely to have
been of any use to the poor woman) was
properly performed. I only mention the fact
as recorded to prove that operations of the
greatest gravity are sometimes done by other
than the visiting surgeons.
A KEY TO ST. BERNARD'S.
39
" Then there were photographs to be taken"—
St. Bernard's, p. hi.
A man broke both his arms and went to
a hospital—
" The surgeon for the week saw the patient, and,
thinking the case rather rare and curious, suggested
that a photograph should be taken, which was accord¬
ingly done. The young fellow did not care much about
this ordeal, as he could not keep his arms very quiet,
on account of the great pain he was suffering. The
fractures were treated with straight anterior and pos¬
terior splints, not reaching much beyond the wrists,
each hand being drawn to the ulnar side."—Brit.
Med. Journ., Dec. 8, 1883, p. 1129.
A fatal result of operation for genu valgum
was reported in the British Medical Journal,
June 21, 1879, in which it was stated that—
" Bearing on the fatal issue was a circumstance
which Dr. only discovered after the patient
died ; viz., that on the evening of the day of operation
the house surgeon had made efforts to straighten the
thigh, which was flexed slightly on the abdomen
owing to a seeming lumbar curvature, using two
extra splints and an elastic bandage, which he kept on
for several hours. Dr. traced the cellulitis of
the upper part of the thigh to this treatment."
" A rare and very interesting skin affection.
No active treatment has yet been suggested, as it is
4°
DYING SCIENTIFICALLY.
much too pretty to spoil by any attempt at aire
just yet."—St. Bernard's, p. hi.
At a clinical lecture delivered at the
Hospital by , F.R.C.S., Senior Sur¬
geon to the Hospital, etc., etc., etc., the lecturer
said :—
"The patient whom we are about to discharge from
ward, cured of severe pemphigus, was admitted
for a special purpose. He was sent in by my friend
and former pupil Dr. , in order that he might
be cured. You will say that the hope of cure is the
motive which brings most of our patients to us. True;
but in this instance there was something more than
this. Dr. could easily have cured him himself,
but he sent him here in order that I might do the
miracle of cure under your eyes, and thus claim your
belief in the efficacy of drugs. You will remember
his state when admitted; he was covered from head
to foot with bullae; the trunk was less severely
affected than his limbs and head; on these, there was
nowhere a space as large as the palm free from bullae,
and on the trunk also there were a considerable
number. He was in a miserable condition from fain
and irritation. The eruption had been out about ten
days, and it affected the mucous membrane of his
mouth as well as the skin. You may remember that
we kept him in bed for a few days before we used the
magician's wand, in order that all might see that there
was no natural tendency to amelioration. More bullae
came out; then, without making the slightest change in
diet, we ordered a few drops of a tasteless solution of
arsenic to be swallowed three times a day. The result
A KEY TO ST. BERNARD'S.
41
was that, at our next visit, most of the bullae had
dried, and there were no fresh ones."—Brit. Med.
Jouru., Jan. 7, 1882, p. 5.
" By the way, there is a woman dying in the
next ward who has a perfectly charming optic
neuritis. You ought to see that. Dont ex¬
amine it very often, as it hurts her dreadfully,"
etc.—St. Bernard's, p. 112.
The following case is perfectly typical of the
method of teaching students in hospitals at the
expense of pain and often permanent injury to
those who attend for the purpose of recovering
their health with all possible speed. Note that
this man's " intolerance of light was very
marked"—so much so, that a long time must
elapse ere an ophthalmic examination could be
made. As soon as this was possible, the clinical
teacher was so delighted with what he sfcw, that
he " advised those shtdents who were studying
ophthalmology to miss no single opportunity of
making themselves thoroughly masters of the
cased
This, if carried out, must have been anything
but pleasant to the patient, who, as we see
by the last sentence, was not yet cured.
42
DYING SCIENTIFICALLY.
" General Infirmary.— Case of Inflamed
Of lie Discs (Under the care of Mr. ——).
"J. , aged 32, a watchmaker, applied for advice.
Six months ago he began to suffer from intolerance
of light, and slight orbital neuralgia. These symptoms
remained unaltered for some months. The following
was his condition when first seen. Intolerance of
light was very marked. There was redness (sclerotic)
of degree No. 3. Tension = x yz. Pain was of the
degree No. 2. A rough test of vision showed that he
could read large letters.
" His general health was below par.
" He was wearing glasses of a dark green colour,
which he said were a great comfort to him. Intoler¬
ance of light was so great that only the most cursory
examination could be made. Mr. , in remark¬
ing on the external symptoms, said he had but little
doubt the ophthalmoscope would disclose a neuro-
retinitis, but that a length of time must elapse ere
such an examination could be made.
"The treatment consisted in absence of light, leeches,
iodide of potassium, and atropine.
" The progress from the first was very marked. The
dilatation of the pupil by atropine and the local bleed¬
ings afforded great relief. This treatment was
continued for six weeks; and on May 17th, for the
time, Mr. was enabled to make a satisfactory
examination with the ophthalmoscope. A very un¬
usual appearance of disc was at once observable. Mr.
drew attention to the fact that the condition
of the discs was unlike anything he had previously
seen. Each disc stood out prominently from the
retina as a round well-defined mass, in shape like a
large shot heated to redness (ball of fire). No vessels
could be seen on the face of the discs. The media
A KEY TO ST. BERNARD'S.
43
were slightly cloudy, and the retina was inflamed. A
condition so unusual goes far to prove that the optic
disc may undergo various phases of inflammation, and
yet vision remain. The history of the case points to
no cause other than the excessive strain of the eyes
when using a glass of high power under a brilliant
light. Mr. , in his clinical remarks, observed that
it was the first case of the kind he had seen which ex¬
hibited this strange peculiarity of disc \ a condition so
striking that he advised those students who were studying
ophthalmology to miss no single opportunity of making
themselves thoroughly masters of the case.
" The ultimate result of the case, Mr. believes,
will be a gradual return of healthy circulation in the
disc, and useful vision."—Brit. Med. Journ., June 7,
1879, p. 853.
" He can scarcely live till next morning, but if
you are interested in phthisisetc.—St. Ber¬
nard's, p. 112.
In the British Medical Journal, September
24, 1887, p. 675, we read of the very minute
examination of one A. L., aged 50, who was
admitted to Hospital, on May 26, 1887.
" On admission, patient was unable to speak, but
appeared to comprehend when spoken to. The eyes
were turned to the right; the pupils were very con¬
tracted, and did not react to light. There was paraly¬
sis of the left arm and leg, and lower part of left face.
There was not any marked turning of the head or
tongue. Patient did not appear to feel the prick of a
44
DYING SCIENTIFICALLY.
pin at all down the left half of the body, and sensation
was somewhat impaired on the right; the left conjunc¬
tiva was much more insensible than the right. There
was free sweating confined to the left side, and noticed
chiefly on the face. Knee-jerk was absent on both
sides ; plantar reflex present on the right, absent on
the left. There was no conjugate deviation of head
or eyes. There was a presystolic and a systolic mur¬
mur at the apex, and abundance of rales in the chest p
abundant albuminuria. Pulse 100, irregular, hard;
respiration 34, Cheyne Stokes; temperature 99*4°
Temperature during
May 27th.
4.0 A.M.
4.3O P.M.
5.3O P.M.
6.3O P.M.
8.0 P.M.
Right Axilla.
IOO'2
99-6
ioo'6
100'6
1008
Left Axilla.
ioi'6
100 -6
ioro
101 -o
ioi'6
Rectum.
103
103
103
" Patient gradually got worse, and died shortly
after eight."
I give this case not as involving any horrors,
but merely to prove the truth of my statements
that in the hospital the last moments of the
dying patient are not exempt from the obser¬
vations necessary to make " a case for the"
journals."
Here again, in the British Medical Journal,
May 14, 1887, we have the same sort of thing.
11A unusual Cause of Emphysema. (Under the care
of M.R.C.S.E., Assistant Medical Officer.)—
1 These signs must have been ascertained by the stethoscope, and
the whole of the observations were evidently made with the minute care¬
fulness with which such things are done in hospitals.
A KEY TO ST. BERNARD'S.
45
Wm. P., aged 44, was admitted in a dying state into
the on Monday, October 25th, 1886, at 5 p.m.
He had urgent dyspnoea,1 his skin and mucous mem¬
branes being very blue, and his pulse quick and feeble.
His face and neck were much swollen, and on palpa¬
tion this was found to be due to emphysema of the
subcutaneous connective tissue, which on further
examination could be traced all over the trunk as low
down as the hips, and for some distance down the
arms. He denied having sustained any injury. After
a careful examination by my colleague, Mr. , and
myself, no injury to the ribs or respiratory tract could
be made out. The chest-wall moved very little on
respiration, the breathing being for the most part
diaphragmatic.
" Percussion elicited a resonant note all over the chest,
though at the bases and in the axillae the note was flatter
than that obtained at the anterior and tipper part of the
lungs ; in the former situations there was almost an en¬
tire absence of breath-sounds on both sides in the lower
half of the chest, but in the former air entered freely.
The heart's apex could not be made out, his breathing
gradually became worse, and he died, somewhat sud¬
denly, three hours and a half after admission."
" Tried by the performance of operations of
terrible gravity on those who, at longest, had but
a few weeks to live."—St. Bernard's, p. 114.
The following published cases will illustrate
the meaning of this passage :—
1 Difficulty of breathing,
46
D YIMG S CI EN TIFICA L L V.
" The patient, who was in a most critical state during
the operation, rallied well; but, on the following day,
he began to breathe with difficulty, secretion accumula¬
ting in the trachea, and he died within thirty-six hours.
On post-mortem examination, it was found that the
cancer had ulcerated completely through from the
oesophagus to the trachea, and that the latter was full
of secretion from the growth, which, in his exhausted
state, the patient had been unable to expectorate.
* * * * *
"So far as it went, the object aimed at in this, the first
and most important stage of gastrostomy, had been
attained, and the case may be regarded as telling in
favour of the operation in simple insuperable stricture
of the oesophagus ; but, in cases of malignant disease,
I would never urge, indeed, hardly recommend, an
operation, the object of which is merely to prolong
life, while leaving the disease itself untouched. Cases
of gastrostomy, ending as did this case, are, I doubt
not, far more common than public records would lead
us to suppose. That a man should die as did my
patient is nothing extraordinary; that he should re¬
cover is so, and it is the extraordinary, not the ordi¬
nary case, which is usually published."—Brit. Med.
Journ., Feb. 9, 1884, p. 263.
Here is a similar case at—
" Hospital, London. Gastrostomy for epithe¬
lioma of oesophagus ; death after six hours."—Brit.
Med. Journ., May 21, 1887, p. 1097.
We are informed that—
" The operation was undertaken solely as a last
A KEY TO ST. BERNARD'S.
4 7
resource. The state of the patient was such as to
preclude any sanguine hope."
At Hospital the operation of gastro¬
stomy was performed on F. R., for cancer of
the oesophagus. The operator, in his report
of the case to the British Medical Journal,
says :—
" In none of these three cases does life appear to
have been lengthened by gastrostomy; nay, it must pro¬
bably be admitted that the lives of two of these patients
were slightly shortened by it. . . . To ensure, as far
as possible, a better result in future, I shall adopt the
vertical incision through the semilunar line, and shall
examine the stomach with greater care to test its
mobility, and to discover exactly the part of it with
which I am dealing."
In the discussion on his paper at the meeting
in question, another surgeon says :—■
" Of course the operation is only palliative, and
cannot add more than a few weeks or months to the
patient's life. Yet I hope and think Mr. has
taken too- gloomy a view of the advantages to be
derived from it."
The sequel to a case of gastroenterostomy,
by Arthur E. Barker, F.R.C.S., Surgeon to
University College Hospital, etc.
" It is too soon to pronounce upon the position
which this operation is to take among regular proce-
48
DYING SCIENTIFICALLY.
dures ; but in this case, at all events, there was speedy
convalescence, considerable improvement in the gene¬
ral condition for at least nine months, and probably
some prolongation of life.
" In conclusion, I cannot think that this operation
ought to be done in extreme cases, where the patient
is quite worn out by disease and suffering."—Brit.
Med. Jouru., April 9, 1887, p. 776.
I do not quote the details of " a terrible
operation," as the Lancet (January 30, 1886, p.
220) describes it, because it took place in the
chief hospital of one of the principal cities of the
Continent, and not in our own country ; but the
Lancet thinks that such a terrible mutilation can
have " no other result than the patient's speedy
death; " and I only refer to the record of the
case because I think that opinion could be
equally well applied to much of our English
surgical work at the hospitals.
In an article in the Lancet for January 9th,
1886, p. 72, the editors say, with reference to
the operation of gastrostomy :—
" It is doubtful whether some of these operations
have resulted in adding to the sum total of human
life; the prolongation of a life here and there does
not compensate for the netting short of that of many
others."
A KEY TO ST. BERNARD'S.
49
See also Lancet, February 20, 1886, p. 340,
where six deaths after gastrostomy are re¬
corded.
Mr. Surgeon to the Hospital, in
a lecture—
"After recapitulating his well-known views, speaks
of hysterectomy as an operation attended with
a fearful mortality. In his own experience it has
amounted to 357 per cent., owing chiefly, he be¬
lieves, to deaths from haemorrhage. . . . He
believes that, in some of these incomplete cases, he
might have finished the operation, but he always had
a horror of a patient dying on the operating table ;
and from that distressing incident he has hitherto been
entirely free. He now believes, however, that it
would have been better to have had such a disaster,
and to have finished a larger number of these opera¬
tions."—Brit. Med. Journ., January 31, 1885, p. 219.
In an article in The British Medical Journal
for January 31, 1885, by Dr. , Surgeon
for Ovarian Diseases, Edinburgh, on Hys¬
terectomy, this eminent specialist says :—
" The fatal case in this series is a typical one of
the way in which, with one or two exceptions, my
fatal cases after abdominal operations have died
for some years past. Death seems to begin from the
hour of the operation, or rather during it, before even
the patients are placed in bed. There is a cold sur¬
face, a rapid feeble pulse—150 to 180 ; and this never
comes down till they die.
-* * * * -:<•
D
DYING SCIENTIFICALLY.
" I often ask myself the question, Does a mortality
of 8 per cent, justify an operation for a disease that,
as a rule, has only a limited active life, that torments
simply, and that only for a time, though of itself it
rarely kills ? The mortality of an ordinary uterine
fibroid, if left alone, is nothing approaching a death-
rate of 8 per cent. Most of the cases on which I
have operated were known to me for years before;
only the extreme cases were done; in nearly all, the
lives were useless, and the risk of operation was clearly
understood. Considering the nature of the cases, it
seems to me that these operations were, perhaps,
justifiable; and, if these were barely justifiable, what
can be said of those ghastly lists of hysterectomy
where the mortality is one death in every two, one
death in every three, or even one death in four or five.
Dr. Bigelow, of Washington, has lately collected all
the cases placed on record up to March, 1884. At
best this must be an imperfect list, and can only
show the least bad side of the operation. Of 359
operations, done by sixteen of the most successful
operators, there were only 227 recoveries and 132
deaths, or a greater mortality than one of every three
operated on.
■if *vr
" Be this as it may, the fact is that we must look
for greater success in hysterectomy in the develop¬
ing of the technical methods of operating, just as
Mr. Baker Brown did twenty years ago, when, by a
simple change in his way of treating the pedicle of an
ovarian tumour, he at once lowered the mortality of
ovariotomy by two-thirds ; only in this case the Lon¬
don surgeons would have none of it, but worked
away on the old lines, losing one patient out of every
three or four, while this great improvement really
A KEY TO ST. BERNARD'S.
5i
seemed to be wilfully neglected; and now, when the
real discoverer of a perfect intraperitoneal method is
long lying in his grave, they begin to wonder what
Mr. Baker Brown really had to do with the advance¬
ment of abdominal surgery."
" I say it deliberately, hysterectomy is an operation
that has done more harm than good, and its mortality
is out of all proportion to the benefits received by the
few. What is the mortality of this operation, now so
often and so unnecessarily performed ? We shall
never know. I put it at 25 per cent., though it
is probably much higher. I may be wrong; others
can correct me by giving their total results. In other
words, one out of every four women operated on by
hysterectomy has till now died after an operation for
the removal of a tumour that has, as a rule, a limited
active existence, and that of itself rarely shortens life.
We have no right to rush our patie?its into such a
fearful risk, yet this is done every day. In abdominal
surgery responsibility seems to have become old-
fashioned and gone out of date "—(Dr. , Surgeon
to the , Edinburgh).—Brit. Med. Journ., Dec. 10,
1887, p. 1257.
"A study of recorded cases in which nephrectomy
had been performed seemed to show that life was not
prolonged even in the successful cases, and the statis¬
tics proved the danger that attended the operation."—
See Brit. Med. Journ., April 18th, 1887, p. 881.
" Dr. Wilson had what has been aptly termed
the 'furor operations '—the operative madness
—St. Bernard's, p. 150.
52
D YING S CIE NTIFICA L L Y.
Hear the British Medical Journal on this,
May 28, 1887, p. 1178:—■
"Readers of German medical journals must be
astonished at the large series of total extirpations of the
uterus which different operators have recently recorded.
This perilous operation is of a nature totally different
to the numerous varieties of abdominal section which
have developed since the establishment of ovariotomy.
In the Ceniralblatt fur Gynakologie for April 23rd,
Dr. C. H. Stratz writes some severe strictures on
' Furor Operativus,' in reference to an article published
by a Cologne surgeon in a recent number of the
Archiv fur Gynakologie. This surgeon claims to have
performed sixteen cases of his 'extra-peritoneal method
of extirpation of the uterus.' The indications for
operating were in five cases cancer, in one fibroma
(operation incomplete), in four endometritis, in three
' retroflexio or versio fixata,' in two prolapsus, one of
these being complicated with endometritis, in one
' pruritus uterinus,' and in one neuralgia and retention
of urine, making up the sixteen cases, the incomplete
operation being excluded. The fact that out of sixteen
cases only five were cancerous is sufficient to character¬
ize the questionable boldness of the operator. ' It is
astounding,' Dr. Stratz observes, ' to read on what
slight excuse a difficult and dangerous operation was
performed"
On Sept. 15, 1883, p. 522, the same journal
reported an eminent London specialist as
saying that such operations had been in this
country " simply disastrous. Look at the num-
A KEY TO ST. BEE NATE'S.
53
ber dying miserably with recurrence shortly
after " the operation in question.
In the same journal, Jan. 5, 1878, p. 15, we
have a report of a discussion on a very terrible
operation which seems to have caused the death
of several patients. A great physician present
asked :—" Why was it done ? The course of
fibroids was not usually fatal, and abdominal
section should not be undertaken for their
removal unless life was endangered." And
another great authority said :—" Unless there
were danger, the operation was not justifiable."
Dr. , of Guy's Hospital, reports on
twelve cases of exophthalmic goitre who have
been in the hospital recently; he says, in the
course of his paper, that—
" Seven of the twelve are dead. With regard to the
treatment (of the five who are still alive), Jane A.,
who did best of all the cases, had no treatment." —
Brit. Med. Journ., July 24, 1886, p. 151.
[Just so !]
" 11 could have saved that leg if it had been my
easel said Senior Surgeon Bishop."—St. Ber¬
nard's, p. 155.
54
DYING SCIENTIFICALLY.
In an article in the Lancet of March 20, 1887,
by , F.R.S.E., the writer says :—
" In a large proportion of cases in hospital and
private practice in which I have been called upon to
amputate, I have not touched the knife, and have
spared the limb."
And he proceeds to say how condemned
limbs may be saved.
Again, in the British Medical Journal,
Feb. 21, 1880, p. 274, a great hospital surgeon
says:—
" And now, having taken leave of the subject of
osteotomy, I cannot help remarking, in the most
general terms, and with no arrierepensee whatever, how
often it happens that, when we are reading the account
of a cutting operation, which perchance might be con¬
sidered unjustifiable, or for the performance of which
there might seem at any rate to have been no urgent
demand, we find it noted that ' the operation was con¬
ducted throughout upon the strictest antiseptic princi¬
ples.' The recorder of the event would throw the
fine dust of carbolic acid even into the eyes of critics
who might otherwise, perhaps, have regarded the
surgical interference unfavourably ; and thus Lister's
grand precautions for insuring cleanliness are made
a stalking-horse for speculative surgery. Oh, anti-
septicity, how many crimes have been committed in
thy name !"
But I have something more startling even
than these strong statements. Let us hear
A KEY TO ST. BERNARD'S.
55
what the British Medical Journal (Dec. 6, 1879*
p. 892) says of a work entitled—
"The Surgical Treatment of Wounds ; and Extracts
from the Clinique for Military Surgeons." By I.
Neudorfer, Principal of that Clinique. Vienna.
" Dr. Neudorfer is well known as one of the most
scientific of the surgeons who are opposed to the
theory on which Mr. Lister's treatment of wounds is
based, while admitting the practical success of Lister's
treatment, and affirming the goodness of his method
of dressing in its most essential features. ... In
his more recent treatise, our author commences by
a repetition of his attack upon Lister's method; and,
whatever may be thought of his theoretical or experi¬
mental objections to it, the following observations are
at any rate worthy of careful consideration by anti-
septicists.
" Still worse is the fact that many surgeons are led
on by the method of Lister to perform operations which
had better have been omitted. Now it is the almost
disused operation of trephining, which is represented
as a mere trifle in surgical treatment under Lister's
dressing; now, again, it is the opening of the great
cavities of the body, or of the great joints, or the
stoppage of the great arterial trunks, to which the
surgeon is encouraged as being safe under Lister's
treatment. . . . But worst of all is the circumstance,
that by Lister's treatment one of the greatest acquisi¬
tions of the surgery of this century is put in danger.
It is my opinion that that great branch of surgery,
only about twenty-five years old, and only slowly
making its way, and which in the two short words
' conservative surgery,' embraces a multitude of happy
surgical novelties and improvements, is threatened by
56
DYING SCIENTIFICALLY.
Lister's method. I possess proof that even now, in
the short period during which Lister's method of treat¬
ing wounds has prevailed, a noticeable retrogression
has taken place in conservative surgery ; and / am in
ji posit ion to assert that, out of the hundreds of amputa¬
tions of limbs and resections of large joints performed in
the last few years, a considerable percentage have been
undertaken only to glorify Lister's method, or in conse¬
quence of its influence, and might have been omitted
without any detriment to the patient " (pp. 16, 17).
" We must admit that there is at any rate some
truth in the charge, and that both Mr. Lister himself
and his followers have been led by their confidence
in antiseptics to perform operations which it is a com¬
pliment to designate as ' dubious.' "
Have I said anything worse than this in St.
Bernard's, O wrathful critics and reviewers ?
A great authority on lunacy has lately told
us that, in addition to the risk to our lives which
we run in these operations, we have also to face
the risk of insanity from the anaesthetics given
to us therein.
At the Annual Meeting of the British Medical
Association, held in Dublin, August, 1887, Dr.
Savage, Medical Superintendent and Resident
Physician, Bethlehem Royal Hospital, and
Lecturer on Mental Diseases, Guy's Hospital,
read a paper on " Insanity following the Use of
A ICEY TO ST. BERNARD'S.
57
Anaesthetics in Operations."—Reported in Brit.
Med. JournDec. 3, 1887.
Soon after the Medical Congress had held
its great session in London in 1881, the follow¬
ing very remarkable letter appeared in the
British Medical Journal, and is far stronger
than anything in the pages of St. Ber¬
nard's :—
" 'Dr. Rumbold has made quite a little collection of
things which ought not to be, and of tales out of school,
with which he regales his countrymen. At the Liver¬
pool Infirmary, he was scandalised with the " young
ward doctors"; "the most of them," he observes
parenthetically, " part their hair in the middle." He
spoke to the young gentleman who thus incurred his
wrath, of the nasal cavities and Eustachian tube, and
reports his answer : " Oh, that is a nasty part of the
head ; we can learn enough of this in the books."
" His contempt, his conceit, and his ignorance," says
the amiable visitor, " were equal." Dr. Rumbold was
then taken through the whole hospital. His comment
is : "As I have said, I saw nothing that was striking,
except the universal clumsiness of their splints for
fractures of all kinds." Coming on to London, he
has much to say of the bungling mistakes of brilliant
operators. Thus he describes an operation in which
the mastoid process was needlessly trephined and the
lateral sinuses opened. He adds : " I am very certain
that it will pay American physicians to come over here
and see mistakes made ; but to see them too often
makes one too reckless, which is closely allied to bar-
DYING SCIENTIFICALLY.
barism." He adds : "As an instance of heroic sur¬
gery at one of the old hospitals, I may direct the
reader's attention to an operation of ovariotomy per¬
formed there. The abdomen was ripped from pubis
to sternum, and what appeared to me to be ovarian
or ovario-uterine or uterhie fibroid\ by a persistent
and persevering series of separating, tearing, ligating,
and dividing, was taken out of the then apparently (at
a casual look) eviscerated subject, and the extensive
wound stitched up, just before the patient breathed
her last." Further : " A gynaecologist of considerable
experience a few days ago proposed to do ovario¬
tomy ; but, after opening the abdomen, he found the
tumour to be uterme, when he declined to proceed
further, and closed up the opening at o?ice."'"
As an illustration of the truth of my charge
on p. 167, of the gross defects of medical edu¬
cation at our hospitals, I give the following
remarks to students by one of their exami¬
ners :—■
"Your presence hereto-day shows that the better
class of students can still find time for some work of
supererogation, when such work brings with it the
opportunity for studying diseases which, though
common in practice, are rare in hospitals.
" I say, then, that some means ought to be found
for utilising the great institutions under the poor-law
system, and more particularly for giving students
practical tuition in the unspeakably important subject
of fevers, a subject more neglected than any other in
A KEY TO ST. BERNARD'S.
59
our present system of medical education, if we con¬
sider it in proportion to its vast importance to public
hygiene. When this has been done, and when our
students are freely taught the many lessons they could
learn in the parish infirmaries, I think the chief func¬
tion of special hospitals in medical education would
have been discharged" (From an address on Chil¬
dren's Hospitals as Medical Schools by Timothy
Holmes, F.R.C.S., etc., Surgeon to St. George's
Hospital).—Brit. Med. Joum., Oct. 30, 1886, p. 807.
And again :—
" He thought it was true, and was one of the im¬
perfections of the present system of medical education,
that they did not teach the student to recognise cases
of scarlet fever, measles, and small-pox."—Dr. Glover,
at the Session of the General Council of Medical
Education and Registration, 1887. Reported in Brit.
Med. Joum., Nov. 26, 1887, p. 1161.
At the same session—
" Dr. Wilks said there were undoubtedly certain
points on which qualified assistants might be found
wanting. He had examined for years with Dr. Pea¬
cock, and he had never failed to ask the candidates
how many cases of scarlet fever they had seen. Most
of them answered that they had never seen a case.
He remembered a young man, who had taken prizes
at his school, and had taken the diploma of the Royal
College of Physicians, and he had obtained the most
excellent testimonials from his teachers, himself
among the number. This young man obtained the
appointment of medical officer to a school at the
place in Essex where he was going to practise. Some
6o
D i 7 NG S CIE NTIFICA LL Y.
time after a boy had an eruption, then another, then
twenty, and at last he was obliged to ask an old coun¬
try friend to come and tell him what it was. He was
told it was measles ! That gentleman had never seen
a case of measles before.
" Professor Haughton said it was a fact that he had
been urging on the Council for ten years past in the
matter of midwifery cases. It was only quite recently
that every young man going into the profession had
seen a case of midwifery. He would be very sorry to
be treated by a young medical man in any case of
fever. He knew as a matter of fact that many stu¬
dents attending hospital practice never went near a
fever hospital. He asked Dr. Banks whether it was
not a very common practice for medical men in Dub¬
lin to give a cynical testimonial that Mr. So-and-So
had ' had ample opportunities for studying every kind
of fever,' but not a word was said as to whether he
had availed himself of his opportunities. On several
occasions he had had to tell parents that their chil¬
dren were suffering from scarlet fever when the medical
attendant had overlooked the fact. He cordially
supported the final paragraph of the report.
" Dr. Aquila Smith said that men had been known
actually to refuse to examine a case of fever."
Dr. Urban Pritchard, Aural Surgeon to
King's College Hospital,'delivered an address
at the meeting of the British Medical Associa-
tion, in Ryde, Isle of Wight, August, 1881, on
one of the great shortcomings in medical educa¬
tion—the absence of practically any study of
ear-disease. This contempt, he said, leads to
A KEY TO ST. BERNARD'S.
61
injurious treatment, which is a very positive
evil, concluding his address with asking :—
" Can we not do something to induce our examining
bodies to include aural surgery in their examina¬
tions?"—See Brit. Med. Journ., August 27, 1881,
PP- 356, 357-
Now, I venture to say, all this reveals a ter¬
rible state of things. A student is expected to
know how long it takes to bake a rabbit to
death in a properly constructed oven, what the
effect upon us would be if we were varnished
all over, and no end of other such nonsense;
but of fever, measles, and lunacy, he is sup¬
posed to want no other teaching than his books
will odve him. .
O
" May consign any of us to the walls of a
madhouse."—St. Bernard's, p. 168.
And when we get there, how about getting
out again ? Let us see what Dr. Bucknill, late
Lord Chancellor's Visitor in Lunacy, has to say
in the matter, as reported in the British Medical
Journal, Feb. 7, 1880, p. 199 :—
" Are we sure that our recovered patients will not
be indefinitely detained, under the supposition that
they only appear to have recovered, and may possibly
62
DYING SCIENTIFICALLY.
have a relapse ? Perhaps I may be wrong in the
opinion that, under the best treatment and the most
auspicious circumstances, patients do not often attain
to perfect recovery in asylums, any more than they
do so in fever-hospitals; the last touch of treatment
wanted being the cordial restorative of home or
the tonic of liberty. But do not the proprietors of
asylums often recognise the persistence of symptoms
of insanity in patients who appear to us to have re¬
covered, which no one else can observe ? If the
matter were not too sad and serious, I could amuse
you by descriptions of the manner in which I have
myself been kept at bay in my diagnosis of recovery ;
for although, upon sufficient evidence, you may make
up your mind with certitude as to the existence of
mental disease, it requires great pains and patience and
knowledge of your people to avoid being misled as
to the possible existence of symptoms which you
may not be capable of observing or of denying. Sup¬
pose, for instance, that the proprietor tells you that
your patient, who appears to have recovered, has had
a slight stroke, with a little facial palsy and some
slight mental obfuscation, which passed off the day
before yesterday; or that he has had two or three
slight epileptic seizures, and has been a little fierce
and angry just after them; or that he hears voices at
night and denies them in the morning,—upon what
principles of diagnosis are you to determine that the
gentleman is drawing upon his invention for his state¬
ments, and that he will not be inconsolable should
the relapse occur which he assures you that he is anti¬
cipating ? "
Not at all pleasant reading that!
A KE\ TO ST. BERNARD'S.
63
Anecdote of Garibaldi's sudden cure.—St.
Bernard's, p. 169.
In the " Life of Sister Dora" there is a
similar instance of sudden cure. She was
suffering from a disease of the knee, and her
cure was as sudden as the attack. A serious
operation seemed to demand her presence.
She jumped out of bed, and resumed her duties
as if nothing had been the matter.
" Gynecological treatment" [that is to say, for
diseases peculiar to women].—St. Bernard's,
p. 170.
" But we know that there are others of whom this
cannot be said. Physicians have coined names for
trifling maladies—if they have not invented them—and
have ' set fashions ' of disease. They have treated,
or maltreated, their patients by endless examinations,
speculations, applications, and the like; and this
sometimes for months, sometimes for years; and
then, when by some so-called accident the patient has
been removed from their care, she has become quite
well."—From an Address on " Specialism in Medi¬
cine," delivered before the Medical Society of
College, London, by , M.D., F.R.S., Consulting
Physician to Hospital, etc.
A^ain :—
"It will thus be seen that I consider the cases
64
DYING SCIENTIFICALLY.
requiring tracheloraphy to be rare, and that I do not
think it justifiable for the repair of a slight cervical
fissure of recent occurrence or of old standing. When
tracheloraphy has been advised by one practitioner, it
will be wise to take the opinion of another, for I have
already heard of a lady who was told by a distinguished
gynaecologist that her case was serious, and required
an operation, for performing which his fee would be
sixty guineas. On going the next day to another
distinguished practitioner, she was told that there was
only a small fissure, and that she could be easily cured
by simpler treatment" (Paper by Dr. E. J. Tilt, Past
President of the Obstetrical Society of London).—
Brit. Med. Joum., Nov. 25, 1882.
But there is something stronger still in the
British Medical Journal of September 26,
1885, p. 591 :—■
" But the general practitioners of England who
tell me I have spoken out what they have been
muttering under their breath for twenty years, will
smile an incredulous and bitter smile if Dr.
attempt to represent the practice of other gynsecologists
as he may justly represent his own. Provincial medi¬
cal men know well what, up to the present, they have
had to expect when one of their lady-patients migrated
to the ' London gynecologist.' It meant too often
the very reverse of Dr. 's description. It meant
lodgings in town, the doctor's brougham at the door
three or four times a week, sixty or seventy guineas to
pay at the end of the season, and a deluded and
neurotic patient at the end of it all.
" If, as Dr. says, ' to suppose such things of
A KEY TO ST. BERNARD'S.
65
gynaecologists is a mere survival of old prejudices,'
I am most thankful to hear it. But a couple of years,
then, must have sufficed to make the change, for it is
no longer than that since two eminent gynaecologists
supplied the material for my reference to the curious
cessation of treatment during the long vacation, in
both cases to be assiduously renewed in October.
Both ladies were connections of my own, and their
husbands began to compare notes upon this odd
feature of disease, intermittent with the sessions of
the schools of medicine and of the London season.
Again, I would ask Dr. in what works on
gynaecology these anxious warnings of his are to be
found, and in which of them these strictures on the
excesses of topical medication are laid down in his
definite language of to-day. I have not his own work
just now at hand, but I will assume that these warn¬
ings and limitations are to be found there, as well as
in the works of the new or laissez aller school of
gynaecology; but that such warnings and limitations
are to be found in the writings of gynaecologists
generally I venture to deny. Fortunately, there have
always been men at the head of this branch of medi¬
cine to whom we could, in all fashions, trust abso¬
lutely in their wisdom and in their honour, and I wish
it were proper gratefully to name some of them.
"Let me tell the following story in place of an
argument, and with it I will conclude these somewhat
irregular remarks. A lady was under the care of a
Yorkshire medical man for pelvic pain, utter inability
to walk or to bear the jolting of a carriage, for some
general nervous symptoms also, and in particular for
a strangely intermittent melancholy. I saw her with
my friend, and I, at least, shall not be accused of
error in that direction when I verified the diagnosis,
E
65
D YING SCIENT1FICAI.L V
and helped to perfect the same line of treatment.
At last, the husband, being weary of the relapses,
took his wife to an eminent gynaecologist, to whose
house she was unable to walk. The latter gentleman
declared to her that she ailed nothing but the vapours,
and, in fine, gained so strong an ascendency over her,
that she walked from his house, travelled home, and set
about the duties and pleasures of an active life. This
is now quite two years ago, and she has enjoyed
perfect health ever since."
In the Gulstonian Lectures on " Neuroses of
the Viscera," delivered at the Royal College of
Physicians, March 14, 1884, by Dr. , M.A.,
M.D., F.R.C.P., Lecturer on Practice of Physic
at the School of Medicine, and Consult¬
ing Physician to the Hospital for Women
and Children, the lecturer says :—
" We physicians have been a feeble folk in this, we
have shrugged our shoulders and submitted to gynaeco¬
logical taunts in a way that may be very modest, but
in a wTay that betrays our trust and our art. If the
gynaecologists pelt us with stories of long pain and
sickness uncured by medical futilities, but rapidly
cured under uterine medication, we can mate their
stories, and check them by double the number of cases
received by the physician from the sofa, the manipu¬
lations and mental abasements of narrow uterine
specialism.
■St "St *St
"Now if we turn our eyes upon the flock of women
who lie under the wand of the gynaecologist, we shall
A KEY TO ST. BERNARD'S.
67
find it so largely composed of. the neurotic and
hysteric.
* * * * *
" Now, gentlemen, is not this case one which in their
degrees could be multiplied a hundred-fold from our
case-books or our memories, and yet these are they
which form a great part of the women who are caged
up in London back drawing-rooms and visited almost
daily for uterine disease, their brave and active spirits
broken wider a false belief in the presence of a secret
and overmastering local malady, and the best years of
their lives honoured only by a distressful victory over
pain."—Brit. Med. Journ., March 15, 1884, p. 495.
Could a more astounding charge against any
system be imagined than is conveyed in these
brave and outspoken words ? Let it be noted
that they are the words of one of the most
eminent members of the medical profession, not
made in the pages of a novel, nor in an obscure
print, but uttered at the Royal College of
Physicians, London, by a man who is himself,
not only a great specialist in the particular
diseases of which he is speaking, but a lec¬
turer on medicine at one of the great schools.
Think of the effects of all these " mental abase¬
mentsand this "false belief" fostered by
ereed of fees, and then blame the author of
St. Bernard's as a libeller of his honourable
profession if you can.
68
DYING SCIENTIFICALLY.
"For the cure of every complaint, real or
imaginary."—St. Bernard's, p. 175.
" In more severe cases, we have until recently had
to rely upon some form of ' spinal support;' and I
show you here one or two specimens, only to warn
you against employing them. J have tried them, both
in hospital and private, and I must say I have never
seen any good result. . . . Not only do these
machines fail to do good, but they do positive harm
by preventing the proper exercise of muscles; and
yet they are extensively applied, and applied, too, to
my certain knowledge, to cases where no apparatus
at all could be required, the patient's hack having
nothing the matter with it!"—(From a Clinical
Lecture on " Lateral Curvature of the Spine," de¬
livered at University College Hospital, by Christopher
Heath, F.R.C.S. Eng., Holme Professor of Clinical
Surgery in University College, London).—Brit. Med.
Joam., May 25, 1878, p. 745.
" It [the expectant treatment] was rather a
favourite experiment."—St. Bernard's, p. 176.
" Dr. Collie said that, of every hundred cases of
enteric fever, seventy-five would recover without any
medical treatment, fifteen would die in spite of any
treatment, while the recovery of a small percentage
would depend a good deal on the nursing."—Brit.
Med.Journ., Nov. 27, 1880, p. 839.
" They ' had their day, and ceased to bed "—
St. Bernard's, p. 178.
KEY TO ST. BERNARD'S.
69
"Judging from the immense number of medicines
in use, and these daily increasing, one would think
that the sole object of the physician was to discover
new remedies. In looking over a list lately sent me
by a druggist, I counted no less than fifty drugs whose
names I had never heard of, and the multiplication
is still going on."—Dr. Samuel Wilks.—Brit. Med.
/burn., Nov. 21, 1885, p. 949.
" It is so easy to be liberal when yon doiit
have to pay I—St. Bernard's, p. 179.
" (The conduct of the great London hospitals is at
once a scandal to the country and a reflection on the
fair fame of the London population. If the system
had been expressly designed to facilitate malfeasance,
to conceal wrong, and to reduce the benefaction of
founders to a minimum, it could not have been more
successful.' These words are quoted from a paper on
the Management of Hospitals, read at the beginning
of this year by Dr. Belgrave, of Sydney, New South
Wales. Dr. Belgrave's views and criticisms are founded
on the belief that London hospitals are the ' prey of
cliques more intent on indirect business advantages
than on the recovery of patients and the promotion of
medical science.'"—Brit. Med. Journ., Oct. 7, 1882,
p. 693.
" We have not diagnosed enough, they urge I—■
St. Bernard's, p. 197.
" In Dr. Haddcn's paper, nothing is said as to the
70
DYING SCIENTIFICALLY.
diet or treatment; this is, however, in accordance
with the fashion of the day, which, taking for its
motto, ' the first point in medicine is diagnosis; the
second is diagnosis, and the whole is diagnosis,
calmly ignores the fact that some patients would like
to be treated, and cured"-—(Surg.-Major Shirley
Deakin, F.R.C.S.)—Brit. Med. fourn., Oct. 23, 1886,
p. 761.
" Gruesome things went on—St. Bernard's,
p. 671.
" We may compare the effects of varnishing the
skin in animals. Valentin and Edenhuizen have
shown that the coating of the skin of rabbits with
impermeable varnish is followed by rapid loss of
temperature, by remarkable slowness of respiration
and by speedy death, the fatal effect following when
no more than one-sixth of the entire surface is thus
treated. And, though Senator has treated men
similarly without producing the same effects, the anal¬
ogy holds good for our purpose."-—(Clinical Lecture on
Myxoedema, by , M.D., F.R.C.P., Physician to
and Lecturer on Medicine at Hospital).—Brit.
. Med. Journ., May 11, 1878, p. 671.
And here is a horrible thinsf from the same
o
journal, March 25, 1882 :—
"St. Hospital.—Case of Hysterical Catalepsy,
under the care (!) of Dr. . From the notes of Mr.
, late House Physician.—Mrs. A., widow. . . .
Occasionally, and especially after the limbs had been
put in any particular position, a slapping movement of
A KEY TO ST. BERNARD'S.
7i
the hands over each other began; the movements
grew quicker and quicker, and there was added some
kicking of the legs ; finally she rose into a sitting
posture and uttered a cry. . . . During the fit the
patient foamed at the mouth. ... In the evening
the soles of her feet were tickled and pricked with a pin;
this was followed by the convulsive movements above
described; she shrieked and fell back with eyes open
and was conscious. . . . Next morning she was
in much the same condition. . . . Pricking the
soles of the feet, etc., produced a fit. On the follow¬
ing morning the convulsions conld not be so easily in¬
duced."
Why were these convulsions produced at
all ? Could they have done anything but harm
to the dying creature ? Was it not done merely
to satisfy the curiosity of the doctors ?
" ' You are free to roam at large, my friend\
over the bodies of any of my clinics"—St. Ber¬
nard's, p. 213.
In the Lettsomian Lectures delivered before
the Medical Society of London, 1886, by ,
F.R.S., Emeritus Professor of Surgery to the
Hospital College, the lecturer says : —
" Since Basserau's time, numberless experiments,
especially . . . have abundantly proved his point.
. . . consisted in inoculating the secretion of [a
7 2
D YIXG SCIENTIFIC ALL V.
hideous disease] in the skin. The result was that
. . formed. . . . Danielsen, however, in Ber¬
gen, tried the practice on a number of lepers.
* * * ■* * .
" Very important evidence as the origin of . . .
is afforded by at least two experimenters. Mr. ,
of Dublin, whose paper I have just quoted, inoculated
with purulent . . . fluid from . . . , and found
that he could produce the typical . . . From the
sores thus produced, he could inoculate repeatedly,
and with sameness of results," etc.—Brit. Med.Journ.,
Jan. 9, x886, p. 57.
Here is another skin case :—>
"A typical case (of dysidrosis) was admitted into the
hospital a fortnight ago, under my care, and exhibited
the disease in both its earlier and later stages.
# * * * *
"I promised to try to obtain the patient's consent to
the removal of a piece of skin for careful examination ;
and you will be glad to hear that I have succeeded.
Some of you saw me mark between two ink lines a
portion of skin containing a few ridges of papillae,
where I stated that characteristic vesicles existed in an
early stage, i.e., about the fourth day of the disease.
The portion of skin was removed, and Dr.
kindly took charge of it for the purpose of preparing
some microscopical sections, which he has accordingly
done with much success. Dr. and I have care¬
fully examined these preparations, and I will now
acquaint you briefly with the main results obtained.
You shall examine, however, some of the preparations
for yourselves."
A KEY TO ST. BERNARD'S.
73
Here follows a long account of the morbid
anatomy of the preparations, and the lecturer
continues :—
"To my mind, the views I have taught in this
school about dysidrosis are fully vindicated by these
preparations. In my Atlas," etc., etc.
" I thought it well, whilst the clinical features of our
recent case were fresh in your minds, to show you
these specimens, and thus vindicate the correctness of
my teaching on the subject during the last few years."
[The above-noted points were then fully demonstrated
by the specimens.]—From " Clinical Comments on
Dysidrosis and its Morbid Anatomy," delivered at
Hospital, by , M.D., F.R.C.P., Physician
to the Department for Skin Diseases.—Brit. Med.
Jonrn., May 25, 1878, pp. 748, 749.
" You can do things in a hospital it would be
as much as your life were worth to attempt out¬
side"—St. Bernard's, p. 216
" Obstetrical Society of London, Wednesday,
December 1st, 1886, , M.D., President, in the
chair.—Mercurialism in Lying-in Women.—'On Mer-
curialism in Lying-in Women undergoing Sublimate
Irrigation,' by , M.D., B.S. The author gave a
list of deaths recorded from mercurialism in lying-in
patients, with an epitome in each case of the post-mor¬
tem appearances. He mentioned Keller's recognition
of mercury in patients douched with sublimate solu-
74
DYING SCIENTIFICALLY.
tion; this had been confirmed by his own experiments.
Having noticed the contra-indications to its use, he
detailed the method employed at the Hospital,
and examined the conditions affecting susceptibility to
the poison, including Von Herff's experiments. The
symptoms of poisoning -were given in detail in the
cases observed."—Brit. Med. Joiim., Dec., 1886.
[Corrosive Sublimate is now the fashionable
hospital antiseptic, and this is how it is keeping
down the population in the hospitals.]
Surely none of my medical friends can have
forgotten the two London doctors who, on their
own confession, in the Lancet of November 3,
1883, tried a number of experiments with
poisonous drugs on hospital out-patients. These
experiments were described in the Medical
Times and Gazette of November 10, 1883, as
" useless and cruel."
" Drs. and proceed to make the following
avowal. The italics are our own :—
" ' In addition to these experiments, we have made
some observations clinically. To eighteen adults—
fourteen men and four women—we ordered ten grains
of the pure nitrite of sodium in an ounce of water,
and of these seventeen declared that they were unable
to take it. They came back, protesting loudly, and
required no questioning as to the symptoms produced.
They seemed to be pretty unanimous on one point—
A KEY TO ST. BERNARD'S.
75
that it was about the worst medicine (!) they had ever
taken. They said if they ever took another dose they
would expect to drop down dead, and it would serve
them right. One man, a burly, strong fellow, suffer¬
ing from a little rheumatism only, said that after
taking the first dose he "felt giddy," as if he would "go
off insensible." His lips, face, and hands turned blue,
and he had to lie down for an hour and a half before
he dared move. His heart fluttered, and he suffered
from throbbing pains in the head. He was urged to
take another dose, but declined, on the ground that he
had a wife and family. Another patient had to sit
down for an hour after the dose, and said that it "took
all his strength away." He, too, seemed to think that
the medicine did not agree with him. . . . The
women appear to have suffered more than the men •
at all events they expressed their opinions more
forcibly. One woman said that ten minutes after
taking the first dose—she did not try a second—she
felt a trembling sensation all over her, and suddenly
fell on the floor. Whilst lying there, she perspired
profusely, her face and head seemed swollen and
throbbed violently, until she thought they would
burst. . . . Another woman said she thought she
would have died after taking a dose ; it threw her
into a violent perspiration, and in less than five minutes
her lips turned quite black and throbbed for hours ;
it upset her so much that she was afraid she would never
get over it. The only one of the fourteen patients
who made no complaint after taking ten grains was
powerfully affected by fifteen. . . . The effect on
these patients was so unpleasant that it was deemed
unadvisable to increase the dose."
Are my critics ignorant of the outcry in the
76 DYING SCIENTIFICALLY.
press caused by these cruelties ? If so, let me
draw their attention to the following from the
Standard of November 19, 1883 :—
" Corpora Vilia.
" To the Editor of the Standard.
" Sir,—Those of your readers who have attentively
followed the interesting experiments with nitrite of
sodium on the persons of patients of the humbler
class, so obligingly communicated by Drs. and
, will be much gratified by reading pp. 340-1 of
Dr. Ringer's ' Handbook of Therapeutics,' Eighth
Edition, 1830.
"We there read, 'Dr. Rickards and I gave to an
habitual drunkard, making him " dead drunk," twelve
ounces of good brandy in a single dose, without the
smallest reduction of temperature.'
" ' Drs. and gave to a healthy young
man, in divided quantities, for six days, a daily amount
of absolute alcohol, varying from one to eight ounces
and, on a subsequent occasion, twelve ounces of brandy
daily for three days, observing meanwhile the tempera¬
ture of the body every two hours.'
" Tn a boy aged ten who had never in his life before
taken alcohol in any form, I found, through a large
number of observations, a constant and decided reduc¬
tion of temperature.'
"We have all heard of the convivial gentleman in
reduced circumstances, who earned an honest living
by acting as the ' frightful warning who went round
with the temperance lecturer.' Is there, at present,
a select band of anti-Blue Ribbonites, from the age
of ' ten years' upwards, who combine self-support with
A KEY TO ST. BERNARD'S.
77
the advancement of science and the promotion of the
cheerful glass by means of frequenting the apartments
(hospital or private) of scientific physicians ? A
further question suggests itself. Dr. guarantees
that the quality of the brandy with which he and Dr.
made their victim 'dead drunk' was 'good.'
We may, therefore, fairly infer that they had not
merely sent for it to the ' public over the way.' Had
one of these gentlemen, then, generously brought it
in his pocket from his own cellar ? Or did it come
from the Hospital stores, which are intended
for the benefit of the patients, and not for the behoof
of physicians with a taste for experiments on inebria¬
tion ? If it comes to be generally known that this is
the way in which the contributions of the benevolent
are expended, 'Hospital Sunday'is likely to become
year by year less productive. .
" I am, Sir, your obedient servant,
" November 19." " M.D."
On which the Zoopholist had the following
remarks in its issue of December, 1883 :—-
" Finally, a marvellous result of the controversy, a
London doctor of considerable repute and standing
was prompted by the excitement of the moment, to
make the Standard, and through it the British public,
the confidante of the genuine sentiments of a ' scien¬
tific ' medical man, regarding the ' Vile Bodies' of the
unfortunate patients who seek relief in the public
hospitals. No words of ours could add force to Dr.
's own contemptuous treatment of the rights of
these men and women, whose crime it is to be un¬
able to pay their doctors out of their own pockets.
73
DYING SCIENTIFIC ALL I.
We therefore print his letter in extenso ; merely call¬
ing attention by italics to some of the passages which
reveal with amazing simplicity a medical man's ideas
of the relative rights of Science and of human
beings :—
"'The Use of Hospital Patients.
" ' To the Editor of " The Standard
4' Sir,—-A few days ago an anonymous letter ap¬
peared in your columns which, emanating (as the
signature, " M.D.," appeared to show) from a medical
practitioner, ought not to be allowed to pass without
an energetic protest.
" ' As far as I can see, the writer intends to bring a
charge against a distinguished member of his own
profession—a physician who, by his labours in the
field of therapeutics, has done eminent service to
medicine, and has been instrumental to the relief of
much human suffering—a serious charge, I say; viz.,
that of having used patients in a hospital for other
purposes than those tending to their own direct
benefit.
"'Now, I should like to ask "M.D." whether his
whole career as a medical student, from the day he
handled his first bone to that on which he passed
his last clinical examination, did not involve abuses
very similar to those for which he now Joins the un¬
fortunately ever-growing pseudo-h n ma n it a rian outcry
against the methods of rational medicine 1
" 'What right had he to trample upon the feelings of
others in dissecting the bodies of people whose sole
crime was to have been poor, and, still more, to acquire
his clinical experience at the expense of, perhaps, much
human shame and stiffening I
" 11 think we, as medical men, should not attempt
A KEY TO ST. BERNARD'S.
79
to conceal from the public the debt of gratitude they
owe to the " corpora villa "—-for such there are, and will
be, as long as the healing art exists and progresses. So
far from there being a reason why moral and pecuniary
support should be refused to hospitals on the ground
that their inmates are made use of otherwise than
for treatment, there is even ground why more and
more should be given to them, in order to compen¬
sate by every possible comfort for the discomforts neces¬
sarily entailed by the education of succeeding generations
of medical men, and the improvements in our methods of
coping with disease.
"'No amount of hysterical agitation and so-called
humanitarian agitation will alter the laws of Nature,
one of the plainest of which is that the few must
suffer for the many. Sentimentalists who think they
know better, who uphold the abstract " Rights of
Man," and want to push them to their logical conse¬
quences, have no other alternative in the question
now before us than to condemn the modern course of
medical studies, and trust themselves into the hands
of bookmen, whose iactus erudiius will have then to
be formed at their expense. The fundamental ques¬
tion at issue is not whether in this or that instance
improper use was made of a hospital patient, but
whether the manipulations and observations indis¬
pensable for the acquisition and extension of medical
knowledge are to be made in a connected and en¬
lightened manner, in public institutions, and under
the eyes of experienced men, or to be left to the
isolated, haphazard, and groping efforts of necessarily
ignorant men upon the persons of any who may be
found to pay them in the hope of benefitting by their
medical skill.
" < Whilst defending the moral grounds upon which
So
D YING SCIENTIFIC ALL Y.
experimental medicine rests, I allow that there are
limits, narrow limits, beyond which it would be im¬
prudent or criminal to go. But I must emphatically
protest against the tendency of men nowadays—and
i am ashamed to observe that a few are to be found
within the medical profession itself—who act upon the
supposition that the public at large form a proper tri¬
bunal to decide upon what constitutes a transgression of
those limits. Those alone are competent judges who
are able to form a correct opinion on the one hand
of the ultimate utility, on the other of the proximate
consequences, of any investigation in corpore vili.—I
am, Sir, your obedient servant, M.A., M.D.,
B.Sc., November 22."—Standard, November 24th."
Surely the unprejudiced reader will say, on
reading this amazing letter, that here alone is
justification for the charges made in St. Ber¬
nard's ? This man is at least honest and candid
in the expression of his opinions. But what
can be said of those reviewers who, knowing
well that the pages of the medical press teem
with proof of far more terrible things than any¬
thing I have laid at the doors of St. Bernard's
Hospital, yet call me "slanderer," "libeller,"
"dynamiter," " literary moonlighter," "assassin,"
and the like ? The fact is, I might have said
with impunity ten times as much as I have said
in St. Bernard's, if, instead of making a story
to be read by all the world, I had confined
A KEY TO ST. BERNARD'S.
my strictures within the pages of the medical
journals, where the laity would never have
noticed them.
A paper on "The Action of Drugs in Albu¬
minuria," was read at the 54th annual meeting
of the British Medical Association, at Brighton,
by Dr. , Physician to the General Hospi¬
tal, . The writer says :—
" We must always allow an element of uncertainty
in our most carefully devised experiments with drugs
in disease, and our conclusions must be based rather
on wide experience than upon the minute observations
of particular cases.
•* * * * *
" I have experimented with a very large number of
drugs, a list of which I append to this paper; but the
inconstancy of my results, and the absence of any
striking effect from the use of any one of them, compels
me to confess that I am unable to answer the ques¬
tion of Sir William Roberts with a distinct affirmative.
" Appendix.—The following is a list of drugs wrhose
action on albuminuria has been tested in these and
former experiments. Bitartrate of potash, bicarbonate
of potash, citrate of lithia, carbonate of lithia, bicar¬
bonate of soda, benzoate of soda, tannate of soda,
tannic acid, digitalis, scoparium, sulphate of sparteine,
strophanthus, pilocarpine, Trousseau's diuretic wine,
caffeine, apocynum cannabinon, ergot, turpentine,
tcrpine, copaiba, oil of sandal-wood, fuchsin, anti-
hydropin (pulvis blattae orientalis), cantharides, iodide
of potassium, chloral, spirits of nitrous ether, perchlo-
ride of iron, sulphate of iron, acetate of iron, acetate
82
DYING SCIENTIFICALLY.
of lead, tartrate of antimony, sulphate of alum, bichlo¬
ride of mercury, elaterium, jalap, scammony, guaia-
cum, and sulphur."—Brit. Med. Journ., Nov. 27, 1886,
pp. ion, 1012.
At the 53rd annual meeting of the British
Medical Association, a paper on the " Duration
of the Action of Medicines " was read by Dr.
, Professor of Materia Medica and Thera¬
peutics in College, and Physician to the
Infirmary, .
An account was given of the action of nitrite
of amyl, nitro-glycerine, ethyl nitrite, sodium
nitrite, potassium nitrite, cobalt yellow, and
other potent and deadly drugs. Fifteen sets of
figures of pulse tracings, taken from persons
who had been the subjects of the experiments,
are given, and the following are a few of the
remarks of the lecturer :—
" The phenomena produced by the nitrites and
nitro-glycerine vary not a little in different individuals.
Some people, for example, are powerfully affected by
half a drop of a one per cent, solution of nitro-glycerine,
but many can take five drops, and some even a larger
quantity, without feeling any sense of discomfort. In
endeavouring, therefore, to determine the period during
which nitro-glycerine and the nitrites depress tension,
I have administered these drugs to individuals differing
considerably in susceptibility to their effects; and
though the number of experiments is not sufficient to
A KEY TO ST. BERNARD'S.
83
fix absolutely the limits of the duration of their action,
I think that the results show that an approximately
correct estimate of these limits may be obtained.
" The subjects of my experiments were all free from
cardiac disease.
" The administration of this nitrite caused, in half
an hour, such faintness as to compel him to assume the
recumbent position; slight traces of the influence of
the drug on the pulse could be detected two hours
after administration.
* -fr -Jfr -X-
" But nitro-glycerine acts on some individuals more
powerfully and for a longer time. Fig. 7 shows the
effect of a single drop of a one per cent, solution.on
the pulse of W. H., one of the most susceptible of all
the subjects on whom I have experimented.
-X- -X- -k -X- -fr
" I never ventured to give W. H. a larger dose ; but
to another susceptible man (V. C.) I gave three minims
and a half; and the results are set forth in Fig. 6.
" In the discussion which followed, Dr. , Presi¬
dent of the Section, asked whether Dr. 's observa¬
tions were made in a state of health or otherwise ?
[Otherwise is a good word !] Dr. said in reply :
'. . . None of the observations had any bearing on
disease, though the subjects of his experiments were
not always in perfect health.' "—See, for the whole
paper, British Medical Journal, Nov. 28, 1885, pp.
1005-1011.
Let it be noted that these observations and
experiments had no bearing on disease! Who
were the patients, and where did he find them
if not in Infirmary ?
84
D Y1NG SCIENTIFIC ALL Y.
The new drugs tried at the hospitals some¬
times produce more diseases than they cure.
The following extract from the British Medical
Journal of Nov. 21, 1885, on the " Dangers of
Cucaine," is instructive :—
"Dangers of Cucaine.—Mr. said he wished to
hear the experience of members of the Society. Was
there any general suspicion that the gelatine-discs of
cucaine were not satisfactory ? His suspicions had
been raised by the occurrence of a serious run of cases
of panophthalmitis at St. 's Hospital, while, at the
same time, the cases at did well. At St. 's
Hospital he had been using gelatine-discs of cucaine
before iridectomy and cataract. Messrs. Savory and
Moore had informed him that, since cucaine was
hygroscopic, the gelatine-discs were always moist, and
that it was impossible to keep them thoroughly dry;
he suggested that the discs might afford a breeding-
ground for pathogenic organisms. Solutions of cucaine
also apparently had a tendency to cause panophthal¬
mitis. Grafe had found chronic interstitial keratitis
much more common since he had used cucaine.—Mr.
■ had also, at one time, had a run of panophthal¬
mitis after using solutions of cucaine. Fifteen days
appeared to be the longest time which it was safe to
keep a solution of cucaine; since using quite fresh
solutions (eight per cent.) he had had no bad cases.—
Mr. had also recently had an unfortunate series of
cases, and was inclined to suspect that cucaine was
responsible for that misfortune.—Mr. said that
solutions of cucaine might be made up with boracic
acid. He observed that he found it difficult to under¬
stand why solutions of cucaine should be so dangerous,
A KEY TO ST. BERNARD'S.
85
while atropine-solutions had been used for many years
without mischance. He observed that epidemics of
panophthalmitis had always occurred from time to
time before the introduction of cucaine.—Mr.
suggested that these epidemics might have been due
to the atropine-solutions, which had also afforded a
breeding-ground for germs.—Mr. mentioned a
case of panophthalmitis which he had recently en¬
countered, where the only cause that could be sug¬
gested was that the solution of cucaine was not fresh.
—Mr. said that, at , the solutions of cucaine
were made up with saturated solution of boracic acid.
He had never before had so severe a run of cases in
his own practice."
Sometimes patients object to this sort of
thing.
" Some do resent."—St. Bernard's, p. 216.
See action for libel against the British Medical
Journal at Cork. Crawford v. the British
Medical Journal. Reported in British Medical
Journal, April 16, 1881. Mr. Murphy, Q.C.,
for the plaintiff:—
" The learned counsel then read the article from
the Medical Press, which, generally speaking, was
laudatory of Dr. Jones, and condemned the persecu¬
tion to which he had been subjected. Continuing,
he said that experiments should, no doubt, be carried
on, but they should be always accompanied by the
greatest precautions. Many young men in the medical
86 DYING SCIENTIFICALLY.
profession were much given to this kind of practice.
He had heard of two Dublin physicians who belonged
to the new school of their time—Dr. Sheridan and
Dr. Charley—and who looked down very much on a
physician of the old school. The latter, however,
brought back a good deal of his practice by some
couplets he made with regard to the two other doctors.
With regard to the first, he wrote :
' Look out for the grave you would wish to be buried in,
Before you take physic from sweet Doctor Sheridan.'
And, with regard to the second, he wrote :
' The sexton's glory, the undertaker's pride—
The coffin market fell when Charley died.'
Now, when this child was admitted into the hospital,
the remedy which one doctor prescribed, the other
did not perform; and, between them both, Mr. Craw¬
ford might well say, ' My child is dead, and that is
the result of my experience of the introduction of this
novel drug into the city of Cork.' It seemed, from
the article copied from the Medical Press, that Mr.
Crawford should have been very thankful for the treat
ment his child had received. It reminded counsel of
a conversation that occurred between a doctor and
the person who was nursing his patient: ' How is the
patient this morning ?' said the doctor. ' Dead,' was
the reply. ' Did you give him the medicine I ordered
last night ? ' 'I did.' ' Well, dead or alive, he is the
better for that.'"
Even infants a few days old are not spared
these experiments in the action of drugs. It is
recorded in the British Medical Journal that
Fehling recently by experiments studied the
A KEY TO ST. BERNARD'S.
§7
effects on nurslings of certain drugs given to the
women who suckled them. The drugs experi¬
mented with on these poor babes were salicy¬
late of soda, iodide of potassium, ferrocyanide of
potassium, iodoform, mercury, morphia, chloral,
atropine, etc.
It is right to say that these abominable experi¬
ments were carried out in Paris, but they are
reported in the British Medical Journal " from
our own Correspondentwithout a word of
protest against their cruelty.
" There are many interesting clinical features
in the case."—St. Bernard's, p. 220.
"After our examination of the case" at Hospital,
" the physician asks what is the best treatment to
pursue, and if there be any medicine which may be of
service to the patient. If it be thought so, a medicine
is ordered in its simplicity. The students have then
an opportunity of watching its effects unalloyed with
other drugs, and in this way they acquire a positive
knowledge of the effects of iodide of potassium, digi¬
talis, belladonna, or arsenic."—Brit. Med. Journ.,
Nov. 21, 1885, p. 949.
" The patient's danger may be increased from the
interest of those around. As the operation proceeds,
in a natural anxiety to see everything, those looking
on, or even assisting, are apt to crowd closely around
the table, and thus largely to deprive the patient of
what just then he very much wants—fresh air."—
88
DYING SCIENTIFICALLY,
(Clinical Lecture by , Esq., F.R.S., Surgeon to
Hospital).—Brit. Med. Journ,, Jan. 5, 1878.
" For work in a hospital must begin early—
St. Bernard's, p. 223.
" Another rule is being enforced, which is as un¬
necessary as it is thoughtless and cruel. The matron
has decided that those patients who are not confined
to their beds throughout the day shall rise and dress
themselves at five o'clock in the morning. Such treat¬
ment must in most cases retard, and in not a few
absolutely prevent, the recovery of the patient."—Brit.
Med. Journ.) Dec. 27, 1879, P- 1028.
A London daily comments on this extra¬
ordinary custom, in the following terms :—
" The London hospitals are such splendid institu¬
tions, and confer such real benefits upon the poor,
that criticism upon details of their management should
never be hastily made. But the best-managed insti¬
tutions are sometimes all the better for a wholesome
breath of publicity, and the bracing influence of public
opinion may sometimes do good when the air becomes
heavy with officialism. In one of the principal hospi¬
tals of central London, if we are correctly informed,
an extraordinary custom prevails of making those
among the patients who are well enough to leave their
beds at all, get up at five o'clock in the morning. The
consequence is what might be expected — they are
utterly exhausted and sick with fatigue by the time
when the doctors make their rounds. What happens
may be best described by following a particular case,
which has been narrated to us. A patient comes up
A KEY TO ST. BERNARD'S.
89
from the country afflicted with a painful and probably
incurable internal disorder. The doctors' examination
leaves it doubtful whether it is a case for an operation.
After a few days he is told he may get up the next
day. This means that the night nurse rouses him at
five in the morning and bids him get breakfast ready
for those patients in the same ward who are too ill to
leave their beds at all."
Let those of my readers who have suffered
from any serious malady themselves, or who
have nursed a sick relative or friend in illness,
reflect for a moment on the horrible barbarity
of stirring up a whole hospital full of pain-
racked, debilitated or dying creatures at 5 o'clock
in the morning. I know how bitterly the poor
sufferers complained of this practice. Just when
they feel most inclined, perhaps, to sleep, after
a night of restlessness or agony, they are
aroused, not even that they may advance
science or teach young doctors, but simply for
the convenience of the hospital authorities.
"But theres nothing like trying."—St. Ber¬
nard's, p. 279.
In the British Medical Journal, Oct. 14, 1882,
p. 722, is a paper on "Ligature of the Innominate
go
DYING SCIENTIFICALLY.
Artery," by an eminent Irish surgeon, in which
he says :—
" Many writers on surgery have left us in no doubt
as to their opinion upon this operation. At best its
execution is surrounded by the greatest danger.
Erichsen says, 'The difficulties of the operation are
in themselves of serious magnitude;' and he declares
that 'it should, without doubt, be banished from
surgical practice.' While Gross has words of admira¬
tion for the ' intrepid skill' of Mott, ' which could
execute so daring and brilliant a feat,' he observes
that obstacles meet the surgeon 'in every direction,
even if he should be so fortunate as to get his ligature
around the vessel, which, however, is by no means
always the case.'
" Velpeau says : 'Six trials of six different surgeons,
of different countries, have ended in six fatal results.
Is it not enough to enable us to pronounce an in¬
exorable verdict upon such an operation? At the
present day, therefore, I do not hesitate formally to
proscribe it.' Heath, in his operative surgery, does
not even tell how the operation is to be performed."
* * * * *
" Death occurring through a series of cases is no
reason why we should desist from repeating an opera¬
tion which, although attended by enormous difficulties,
is, under the present conditions of surgery, by no
means hopeless."
Exactly! but the " daring and brilliant feat"
can only be performed on hospital patients. Till
it has been perfected upon these, it is not within
the range of practicable surgery.
A KEY TO ST. BERNARD'S.
91
" Gastrostomy.—Notwithstanding the fact that the
immediate dangers of gastrostomy have of late been
very much reduced, many surgeons are evidently be¬
ginning to doubt whether this operation can ever be
considered justifiable in cases of cancer of the oeso¬
phagus. In the Revue de Chirurgie, M. Lagrange
argues against the operation in such cases, and says
that it is not needed in early stages of the disease, and
is useless when the cancer has advanced so far as to
cause complete obstruction, for then the patient, under
any circumstances, must soon die."—Brit. Med.
Journ., Dec. 26, 1885, p. 1212.
"For my own part, I like those free lances who
break away from old tradition and explore new paths.
Let each mount his hobby—be it cautery, intra-uterine
stem, or cleverly devised needle—and let us see who
will ride furthest and best. Should any one, in his
eagerness, deviate on to the forbidden ground of vivi¬
section, his good intentions, and the warning afforded
to others, shall serve to absolve him."—Brit. Med.
Journ., July 14, 1883, p. 60.
"Dr. Stanforth with his pupils."—St. Ber¬
nard's, p. 287.
In the address on "Obstetric Medicine,"
by Dr. Sinclair Coghill, Lecturer on Midwifery
in the University of Edinburgh, recorded in the
British Medical Journal for Aug. 20, 1881, he
says:—
" The use of instruments for diagnosis and treat¬
ment and direct personal medication have been
92
DYING SCIENTIFICALLY.
greatly overdone. The nimici diligentia has been too
rampant," and speaks of " over-active perturbative
treatment and mischievous polypharmacy." " I am not
sure that many of us are capable of realizing the
effort that is necessary to enable a virtuous or in¬
deed any woman to submit to the painful ordeal of
local examination and manipulation, or the gradual
deterioration of delicacy which in too many its fre¬
quent repetition tends to accomplish." " The diagnosis
in all cases should be inductive—under no circum¬
stances either speculative or experimental."
" The cholera in Spain."—St. Bernard's,
P- 3°2-
" Ferran and his 'caldos' are now viewed with
dread and terror by all the towns where the Govern¬
ment ordered him to follow up his ' preventive
cholera-inoculations ;' so much so that, as soon as it
became known he was to visit certain towns, the
people rose with the alcade and municipality, and
prevented him from entering the towns. So it hap¬
pened at Denia, which was to be his ' centre '; also in
San Matero, Oliva, etc."—Brit. Med. Journ., Aug.
22, 1885, p. 359.
" Count your sponges, sister."—St. Ber¬
nard's, p. 328.
Let those who say I have been guilty of
" gross exaggeration " read the following extract
from a communication to the British Medical
A KEY TO ST. BERNARD'S.
93
Journal for Dec. 25, 1880, page 1036, by an
eminent hospital ovariotomist:—
" In the second case, E. R., aged 39, a tedious and
difficult operation, I placed a drainage-tube, as the
tumour had been so adherent as to require partial
enucleation. Six hours after the operation, the 'sister'
at the hospital telephoned to me that they missed a
torsion-forceps. On seeing the patient at once, I
found her fairly well, though in pain; and I recom¬
mended a further search. Next morning, exactly
twenty-four hours after operation, she was in intense
pain, anxious, quick pulse, though the temperature
was not much raised; but, as the forceps could not be
found, I concluded that it was in the patient's abdo¬
men ; and, under the spray, I cut the uppermost stitch,
and made from it a fresh opening into the abdomen,
above the umbilicus. After a short search, I found the
forceps, with lymph upon it, lying down against the
left side of the spine. I made the fresh opening so as
not to interfere with the drainage-tube, or to allow its
contents to enter the abdomen. The patient made a
perfect recovery."
Suppose I had used this case in my novel,
and touched it up a little secundem artem.
Suppose I had said something like this : " The
telephone bell rang, Dr. Stanforth rose from
the dinner table, put the instrument to his ear,
and asked who wanted him. ' Sister Agnes,
doctor! I have lost a pair of dressing forceps ;
have you taken them away by mistake?'
94
DYING SCIENTIFICALLY.
Doctor Stanforth feels in his pockets, looks in
his little black bag which was lying on the side¬
board, and fails to find them. He rings the
telephone bell, and informs the Sister he has
not taken them, and has not the least idea where
they are. Wishes her good evening, and re¬
turns to his dinner. Next morning he goes his
rounds, and pays an early visit to the woman
who twenty-four hours ago underwent at his
hands the terrible operation of ovariotomy.
Sister Agnes reproachfully remarks that she had
not found her forceps. The poor patient had
complained to him of a terrible pain in the
back. ' Happy thought!' cries Stanforth, slap¬
ping his knee ; ' shouldn't wonder if I haven't
sewn 'em up in her abdomen! Let's have
a search !' The sufferer is anaesthetized, im¬
ploring the doctor 'not to cut her about any
more.' The stitches are undone, another in¬
cision is made to facilitate the search, and lo!
the missing instrument is found lying snugly
under the left kidney " ; and so on.
What a storm of abuse I should have had
from the reviewer who wrote the criticisms
in the Illustrated London News, that mild-
mannered delight of the nurseries of England!
A KEY TO ST. BERNARD'S.
95
What frantic denunciations from the innocent
little Literary World, comporting itself like
a moiiton enragd. And yet I should but have
given the precise facts which occurred a few
years back in one of our great English
hospitals.
" And they was a-going to take her pretty
nigh all to bits."—St. Bernard's, p. 326.
See the leading article in the Lancet of
Aug. 14, 1886, on the case tried before Mr.
Justice Cave, at Liverpool, to recover damages
for the improper performance of an operation
at the Hospital for Women, without giving the
patient any intimation of the nature or result
of the operation. The article argues that the
operation in question is justly condemned by
the highest authorities in this country.
On the Liverpool Hospital for Women, and the
reports of the Committee of Inquiry upon the
operations performed therein, see the articles
in British Medical Journal, Dec. 18, 1886, p.
1225, and Jan. 15, 1887, p. 117.
" With reference to one very serious operation, the
Committee said that the patients examined upon this
point ' very generally denied that sufficient informa-
gS
DYING SCIENTIFICALLY.
tion—or, indeed, any information at all—was given
to them as to what was proposed to be done to them."
"As to the expediency of abdominal incision for 'pelvic
hematocele,' the Committee expressed the opinion
that ' in ordinary cases it is not to be recommended.'
" The Committee state ' that sufficient care and
discrimination have not been exercised in the selection
of cases for operation,' ' a sufficient trial of rest in
hospital had not been given.'
" ' If it be objected that in some cases the abdomen
has been opened without finding the disease which
was expected, the same may also be said of ovario-
tomists. Is there any one of extensive experience who
has not at some time opened the abdomen with the
view of removing an ovarian or a uterine tumour,
and found himself mistaken ?
* * •* * *
" 'And what is the penalty of error? In the vast
majority of cases, an exploratory incision brings out a
clear diagnosis, which directs treatment in the right
way, and, in fact, does no harm !' "
Here is a little blunder from the British
Medical Journal, July 14, 1883, by a surgeon
to a Hospital for Women :—
"Not very long ago I was unlucky enough to tear
open the colon to the extent of more than two inches,
in attempting to detach a firmly adherent tumour.
The rent was sewn up, a cyst or two tapped, and then,
with her operation abandoned, the patient was carried
off to her bed to die. Nothing of the sort. She
recovered from her mauling rapidly, full of that
pathetic, ignorant gratitude which now and then re-
A KEY TO ST. BERNARD'S.
97
wards very blundering work. A few months later,
post-mortem examination revealed a mere faint line at
the point where the bowel had been torn."
[The inevitablemortem /]
"Founded on conjectitre and improved by
murder—St. Bernard's, p. 333.
At the meeting of the Clinical Society of
London, on May 8, 1885, Dr. read notes
of a case of haemoptysis, treated by the induc¬
tion of pneumothorax, so as to collapse the
lung, at Hospital. The patient died. The
reader of the paper said :—
" In this case, notwithstanding careful antiseptic
precautions, pleurisy was set up."
In the discussion which followed, Dr.
said :—
" There were three points in this case. The first
was, its great interest; the second, Dr. 's courage
in resorting to the operation; and the third, its utility.
It must be borne in mind that these haemorrhages
sometimes stopped of their own accord, even when
enormous quantities of blood had been brought up.
.... He thought one ought to try everything
before resorting to such a proceeding as that adopted
by Dr. .
*****
"As regarded the utility of the operation, what would
become of the patient ? Was it desirable to go about
G
D YING SCIENTIFIC ALL Y.
with a pneumothorax? He could not feel inclined
to adopt Dr. 's operation, unless he had more
satisfactory data to go upon. He should exhaust every
method before taking to it."—Brit. Med. Journ., May
x6, 1885, p. 992.
" The iced-water bath treatment—St. Ber¬
nard's, p. 426.
At the meeting of the Clinical Society of
London, February 5, 1887,—
" The President said that he had not seen convul¬
sions occur during the rise of temperature. He had
seen them come on during the cold bath in a case
which ultimately proved fatal, and he had seen hyper¬
pyrexia supervene during the use of salicylate of
sodium.—Dr. wished to know the exact nature
of the convulsions, and particularly whether they were
tonic or clonic, or both.—Dr. said he had had
three or four cases of hyperpyrexia in private practice,
and could endorse the remarks as to the difficulty of
the cold-water treatment in private practice. He had
succeeded in reducing the temperature to normal, but
they had all terminated fatally. Those cases required
the most careful supervision.—The convulsions were
invariably tonic.—The President said the convulsions
took the form of opisthotonos, without clonic convul¬
sions.—Dr. said, in reply, that the convulsions
came on after the patient had been removed from the
bath. The first bath lasted a good hour, as a greal
difficulty was experienced in reducing the temperature
of the bath. He thought the antipyrin did more harm
than good by favouring collapse. The salicylate did not
A KEY TO ST. BERNARD'S.
99
appear to have had much effect either. He thought
antipyrin was a dangerous drug."—See Brit. Med.
fount.) March 5, 1887, p. 510, and March 1, 1884, p.
423.
Dr. , Senior Physician to Hos¬
pital, in British Medical Journal, Nov. 27,
1880, p. 839, says :—
"But two cases occurred in rapid succession in
which I thought, perhaps erroneously, that the baths
were instrumental in causing death."
Of one of these cases, Dr. remarks :—
" Believing that the patient had not had baths, I
observed half jokingly to the resident assistant, who
was present, that if only baths had been employed, I
should certainly have attributed his death to them.
His answer was that they had been employed."
Here is another cold-bath story from the
British Medical Journal of Aug. 22, 1885,
P- 335
"At two o'clock on the afternoon of the 26th it
was noted that she had passed a fairly good night;
that she was quite sensible, and that she expressed
herself as feeling well, and wanted to get up. But
her joints were still somewhat tender and swollen;
her tongue was dry and brown ; her skin dryish ; h^r
pulse 100; and her temperature had risen from 102*2°,
on admission, to 104°. There was no change in the
condition of the heart. Having regard to the state of
the skin and tongue, and to the rising temperature, I
IOO
DYING SCIENTIFICALLY.
feared the coming on of hyperpyrexia, and lefi direc¬
tions that the cold bath should be applied if the
temperature reached 105°.
"At 3.30 the temperature had risen to ios'a0.
She was quite sensible, and did not appear to be
worse. Tepid sponging was employed, and the
surface-temperature was reduced by it to 104 "4°. At
4.30 the patient was fidgety, and wanted to throw the
bedclothes off. At 6 her temperature had reached
106-4°. She was placed in a cold bath, but at the
end of five minutes had to be removed in consequence
of faintness. The surface-temperature, however, was
reduced to 102'6°. After this she became delirious,
muttered a good deal, and tried to get out of bed.
There were also subsultus, and picking at the bed¬
clothes. At 8 the temperature was io6*6°; the pulse
150, and very feeble; the respirations 51; the teeth
were covered with sordes ; and the skin was very
dry. At 9 a cold bath was again attempted, but she
became so violent that the attempt was abandoned;
and half an hour later tepid sponging was again re¬
sorted to, and ten grains of quinine were administered.
The sponging was repeated, but the pulse and tem¬
perature continued to rise; she became insensible, or
nearly so; the convulsive movements, which had
spread from her limbs to her muscles of expression,
became more marked; and at times there was much
groaning. At 12 p.m. the pulse was 174. She died
at 1.30 a.m. on the 27th. Her temperature, which
had risen then to in°, was still in° half an hour
later."
The following observations are from the notes
of the case of a patient who died of "acute rheu-
A KEY 70 ST. BERNARD'S.
lot
matism with hyperpyrexia," in the Royal
Infirmary, on July 12th, 1885 :—
From the "Lancet."
At 1.30 a.m. he was put into a bath, cooled down
by ice to 50° F. ; his pulse at the wrist was impercept¬
ible, and complete coma supervened; five minutes
later an enema of brandy was given, in ten minutes
this was repeated. At 2.16 he was taken out of the
bath, carried to bed, and rapidly dried and transferred
to another bed ; at 2.38 had an enema of hot coffee;
at 3.0 had another; at 3.30 had a hypodermic in¬
jection of ether; at 7.0 this was repeated ; at 7.30
had an enema of 30 grains of quinine, and ice-bags to
the spine and head ; at 8.30 had another hypodermic
injection of ether; at 9.30.severe vomiting came on;
he was then stethoscoped, mustard plaisters were ap¬
plied to his chest, and turpentine stupes over the bases
of his lungs. At 10 had another hypodermic injection
of ether; at 10.30 had another iced bath; at n.10
had another hypodermic injection of ether; at 11.25
had an enema of brandy; at 11.35 was taken out
of the bath; at 11.40 had brandy and beef tea by
the stomach pump; at 1.30 p.m. another injection
of ether; at 2.0 this was repeated; at 3.10 he was
stethoscoped again, and percussed over bases of lungs;
at 3.20 p.m. apomorphia was injected subcutaneously,
when he vomited immediately. [At 3.50 p.m. death
released him from his sufferings and his doctors !]
An easy-going and amiable lady who had
just finished reading St. Bernard's, said to a
friend who asked her what she thought of it:
102
D YhYG SCIENT1FICALL Y.
" Oh, I think it is a most consoling book. It's
so nice, you know, dear, to be assured that the
poor sufferers are not neglected ; it is so much
better, don't you think, to have too much done
for you when you are ill than not enough ?"
And the friend replied, having just read the
details of the above case, " If I am ever taken
ill with ' acute rheumatism with hyperpyrexia,'
as the Lancet calls it, I shall say as David
said unto Gad, ' Let me fall now into the hand
of the Lord ; for His mercies are great: and
let me not fall into the hand of man.' "
" Yen cannot even die in peace."—St. Ber¬
nard's, p. 427.
" College Hospital, Tumour of medulla oblon¬
gata : Remarks. (Under the care of Dr. and Dr.
. (For the following notes we are indebted to
Mr. , House-Physician.)—Mary S., aged 52, was
admitted on January 29, 1883, suffering from difficulty
of speech and paralysis. Three months previously
her speech began gradually to become thick, she saw
double, and had numbness and loss of power on the
left side of the body. For five weeks she had been
unable to stand. She was a thin, pale, but fairly
healthy-looking woman. There was no headache or
tenderness of the skull. There was slight blankness
of the right side of the face, and the tongue was pro¬
truded to the right. There was visible ptosis of the
A KEY TO ST. BERNARD'S.
right upper eyelid, with convergent strabismus of the
right eye from paralysis of the right external rectus;
there was also paralysis of the left internal rectus,
though less marked. She had homonymous diplopia,
the images being side by side. The pupils were equal,
and contracted both to light and accommodation. A
watch was heard one inch and a half from the right,
and eight inches from the left ear, and the tuning-
fork was heard best on the left side. The voice was
somewhat nasal in tone, the speech thick and indis¬
tinct. There was no dribbling of saliva, but the
mouth and fauces were full of thick mucus, causing
frequent coughing and hawking. Some drooping of
the right arch of the palate and considerable dys¬
phagia were present. The right arm and leg were
normal as regards sensation and motion. The grasp
of the left hand was feeble. Voluntary movements
were present in the left leg, but were very feeble;
there was no apparent wasting. Sensation in the left
arm and leg was much impaired, but on being
obtained, was referred correctly and without delay.
The patellar reflex was equal and normal on both
sides ; the plantar reflex was normal on the right, but
absent on the left. The heart and lung-sounds were
normal. The symptoms noted subsequently were
increasing dysphagia and rapid shallow respiration
without dyspnoea. More complete notes could not
be taken, as she was only under observation for twenty-
four hours, when she died from asthenia."—Brit.
Med. Journ., Oct. 27, 1883.
It is satisfactory to note that though poor
Mary S. afforded her doctors so few oppor¬
tunities of observation, they had a post-mortem
104
D Y1NG SCI EN TIFICA LL Y.
examination and a microscopical report, with a
good pathological and physiological account of
her case from an expert in brain disease. The
enumeration of the physical signs recorded in
the woman's last moments reads simple enough,
but they could not have been obtained without
the very complete medical overhauling de¬
scribed in the chapter entitled, " Walking the
Hospital," in St. Bernard's. As she died from
asthenia (general debility), the minute examina¬
tion must have greatly distressed the woman.
Here is another case from the British Medical
Journal of June 14, 1879, p. 893 :—
"The patient was a boy aged eleven, who was
struck on the forehead with a stone on October 21st.
This caused a small wound, exposing the bone, for
which he attended as an out-patient at the Queen's
Hospital till November 28th, when a small scale of
bone exfoliated ; pulsation was detected at the bottom
of the wound, and the probe passed into a cleft in
the bone. No fracture had been detected at the
time of the injury. On December 6th it was noted
that pus was ejected from the wound when he coughed,
and that it came evidently from the cavity of the
skull. There were no definite symptoms, except that
his hands and feet were cold, and his pulse very feeble.
He was kept in hospital till January 1st, 1879,
and then discharged as cured. The wound was
then covered with a small firm scab, and seemed to
A KEY TO ST. BERNARD'S.
be healed. In a fortnight (January 15th) he was
again admitted on account of headache and vomiting,
with rapid emaciation. The wound was described as
being ' a little moist,' but no action was going on
about it. He was rapidly losing flesh. The temper¬
ature was generally normal, but an evening fall of
about one degree was noted. There was optic neu¬
ritis in both eyes. He continued to get worse,
shrieking and wandering at night; but there was no
paralysis. He was trephined by Mr. Gamgee at the
seat of the wound on January 31st, but no pus was
found. The inner surface of the bone was slightly
eroded, but the dura mater seemed healthy, and did
not bulge into the trephine-hole. The symptoms
were unaffected by the operation. On the following
day he quite suddenly ceased to breathe. Mr. Lloyd,
the house-surgeon, found him apparently dead; but,
having revived him somewhat by artificial respiration,
divided the dura mater in the trephine-hole, causing
an escape of about half an ounce of serum, but no
pus, and then plunged a knife into the substance of
the brain for about an inch, when pus welled up. A
director was passed into this puncture, and felt the
base of the skull. Along this, a thin drainage-tube
was gently passed, and curled itself up in the cavity
of the abscess. The child was nearly dead, but
revived with artificial respiration, and survived for a
week, dying quite suddenly on February 8th."
Here we note that the house-surgeon "plunged
a knife into the substance of the brain," and
passed an instrument into the wound, ''and felt
the base of the skull." Yet we are told by
our critics that house-surgeons do nothing but
o &
loS DYING SCIENTIFICALLY.
trifling operations. We shall be told, of course
that the poor lad's doctors fought bravely
against death, and kept him alive after he had
"quite suddenly ceased to breathe;" but it is
difficult to see what the poor boy gained by
being revived.
Yet more illustrations. The British Medical
Journal of Feb. 7, 1880, p. 197, has some remarks
on "Tumours of the Cerebellum," by Dr. ,
Physician to the Hospital, London.
" He was later on transferred to my care. On
October 6th I saw him. His head was then drawn
back, but, at my examination, he was not in a par¬
oxysm. When taken out of bed, he could walk, but
reeled, although very slightly. When sitting, his legs
acted strongly whilst endeavouring to overcome our
resistance to flexion, extension, and to raising his
knees. His arms were not affected. Patellar tendon-
reflex was normal.
" He continued subject to the paroxysms. On
October nth he had paroxysms nearly all daylong.
A diagrammatic sketch of the patient in one of them
was taken by Dr. , whilst the patient was standing.
It was of necessity taken rapidly. I noticed spasm
of no other parts than of the muscles of the spine, and
in particular that the masseters were not engaged.
Possibly part of the incurvation of the back was com¬
pensatory. To my astonishment the patient died the
same day."
I sincerely trust none of my readers' dying
A KEY TO ST. BET NARKS.
107
moments may be disturbed by their having to
pose as an artist's model to any doctor with a
taste for drawing !
Again :—
" Mr. , in a case of gunshot injury of the sig¬
moid flexure, recently opened the abdominal cavity,
but found it impracticable to apply Lembert's suture
to the intestinal perforations caused by the bullet.
The patient was in a state of impending collapse at
the time of the operation, and died twelve hours after¬
wards."—Brit. Med. Joitm., May 7, 1887, p. 976.
In an article on " Intubation of the Larynx,"
by Dr. , Surgeon at 's Hospital, in the
British Medical Journal of Nov. 19, 1887,
some curious facts are given about laryngeal
operations. One doctor condemned the method
in question, believing " he had lost many of his
cases from the traumatic pneumonia set up by
the entrance of food, thirty-one out of thirty-
two cases having died ! "
Another doctor recorded ten cases all fatal.
Tracheotomy under four is admitted to be on
the whole unsuccessful. Dr. Inorols estimates
O
the recoveries at 15 to 20 per cent.
Another says, " I remember a series of nine¬
teen tracheotomies at 's with one death, fol¬
lowed by another series in which nearly all died."
ic8
DYING SCIENTIFICALLY.
Here are a few of the "ghastly medical
freaks " referred to.
Mr. , Surgeon to the , and
Hospitals, in a paper communicated to the
British Medical Journal for June 6, 1885, on
the " Intravenous Injection of Milk," says : —
" Hare recently injected milk into the veins of a
patient about to die, who survived for some hours
after the operation," . . . finds " that sometimes
no good has accrued from the injection (when impro¬
perly performed, or when performed in unsuitable
cases); and the operation appears to have proved fatal
in a few instances."
He records a number of cases in which this experi¬
ment was tried with varying results. Of one case it is
reported that " the intravenous injection of milk did
no good. After the first operation, there was tem¬
porary improvement, but after the last grave symptoms
ensued ; and it cannot be doubted that the result was
hastened by the operation
At the Royal Medical and Chirurgical Society,
on April 12, 1887, three papers were read by
as many hospital surgeons on cases of aneurism
of the aorta, treated by the new method adopted
by Loreta, of Bologna, which consists in intro¬
ducing a quantity of steel wire into the " sac."
One patient, aged 46, was in the Hos¬
pital. They had some trouble to get the wire
A KEY TO ST. BERNARD'S.
109
nicely into him ; it was stopped by a kink, when
the first foot or so was introduced. All went
well, however, for two days, then the patient
became "almost maniacal, and died." They
thought the result of this pretty experiment
"presented many encouraging features," and
proceeded to discuss case number two.
The patient was a powerful man, aged 48,
and he had an aortic aneurism, so it was " de¬
cided to employ Moore's treatment, and on
January nth Mr. passed thirty-two feet
of steel wire" into his chest. [it seems odd,
but we are so mechanical now-a-days.] " A
good deal of blood was lost during the opera¬
tion, and on the 19th January the skin was
found to be gangrenous, and in a few hours
the patient died.
It is noteworthy that this "stout, florid" man,
said, on admission to the hospital, that he was
free from pain, and felt " quite well."
The authors suggested several reasons for the
fatal result, and think the treatment was worthy
of further careful trial in properly chosen cases ;
but they think only a small quantity of wire
should be introduced at any one time.
[Thirty-two feet was a good deal!]
I 10
DYING SCIENTIFICALLY.
Then another gentleman gave his experiences
of steel wire. "He thought it was only right,
whilst Moore's method of treatment was as yet
only in what might be called an eai'ly experi¬
mental stage, that all the evidence that was
available upon the subject should be brought
forward. He admitted that an error of diag¬
nosis was involved, but thought that that made
no difference as to the value of the evidence."
The patient was a sailor, they passed thirty-
three feet of steel wire into his chest, and—he
died!
The operator said, " he certainly in a second
case should not use so much wire again, but he
thought they had not yet found precisely the
right material."
[What! not after all the dogs, guinea pigs,
and rabbits that were to set all these matters
right ?]
At the date of publication of this paper (April
12, 1887), this interesting operation had been
tried sixteen times, with the result that fourteen
of the patients died !
Now I make bold to assert that an operation
accompanied by such a terrible death - rate
A KEY 70 ST. BERNARD'S.
hi
would never have been performed on any but
a hospital patient. No doctor's carriage would
evermore be seen stopping at any patient's door
where thirty-three feet of steel wire had been
poked into a man's chest with such a result!
The discussion on this paper can be seen in
the " Proceedings of the Royal Medical and
Chirurgical Society," new series, vol. ii., p. 241.
There is a very instructive article in the
Medical Press for July 9, 1884, p. 22, by Dr.
Jackson, Lecturer on Surgery to the Sheffield
School of Medicine, wherein the writer says :—
" Instead of the careful examination of patients be¬
fore the day of operation as well as at the time, the
latter is made often in a very hasty manner, with con¬
siderable bustle and noise going on in the theatre. To
this fact, I think, may be ascribed the more frequent
deaths from chloroform which have occurred in recent
years."
" What a terrible tale would abdominal sections
tell, were they all recorded accurately !"
"As Mr. Erichsenputs it, 'Will the surgery of our
time record surgical triumphs or operative audaci¬
ties ? ' May I substitute the word ' atrocities ' ? "
[I do hope my critics will observe that it is
not Dr. Scalpel, but the professor of surgery
who says this.]
"The St. Bartholomew's Hospital reports (1884)
112
DYING SCIENTIFICALLY.
record twenty-one abdominal sections, with nineteen
deaths."
" A boy on whom I performed Ogston's operation,
with the strictest Listerian precautions, is still under my
care, having had pyaemia and an empyasmia. Would
not both these children (he had another bad case,
which he says caused him ' the greatest misery,')
have had happier lives and better prospects of success
of life with their crooked legs, and without the opera¬
tion ? "
" Unnecessary operations are still performed."
" It does seem to me that we are going too fast."
[E xactly so ! that is the whole contention of
St. Bernard's.]
Your brilliant operator must at any cost
" keep his hand in." Prof. Rolleston, in his
evidence before the Royal Commission on Vivi¬
section (1287), says that in Skey's work on
Surgery, he remarks that "a man who has the
reputation of a splendid operator is ever a just
object of suspicion ; " and Prof. Rolleston adds
that there is a good deal more in Skey's intro¬
duction to the same effect.
Here is a cutting from the Kentish Express
and As/iford News of Dec. 24, 1887 :—
" A little black boy, aged 13, is now being attended
at St. James's Hospital. He is in the Scottish division
of the Royal Artillery, stationed at Woolwich, he
A KEY TO ST. BERNARD'S.
"3
having been rescued from slavery in Egypt by the men
of the division two years ago. He is now undergoing
an operation for his legs, which are fearfully bent,
and it is feared that both limbs will have to be broken
for the purpose of straightening them."
Poor little black boy, he would have stood a
better chance as a slave !
In the Daily News of Friday, Dec. 2, 1887,
is the following pretty experiment:—
" A death from woolsorters' disease has occurred in
Bradford after a severe combat between the malady
and the medical men. The patient was removed to
the infirmary at a late stage in his illness, a course
which it was frankly owned might have hastened death
in this instance, but which was taken for the best.
It was desired to increase the temperature of the
patient's body to 107 degrees in order to kill the
bacilli. The bacilli were killed\ but so was the patient.
The condition of his brain was not favourable to the
experiment, which was followed by exhaustion and
collapse."
" Inoculating with the sputa of a phthisical
patient."—St. Bernard's, p. 434.—See " The
Zoopholist," June, 1884.
" When once the passion for experiment is aroused,
it is difficult to stop at animals. These humanitarian
experimenters, whose genial doctrines would shut up
the large section of the human race who have the
misfortune to be consumptive in pest-houses, away
H
H4
D YING SCIENT1F1CALL Y.
from their friends, with none but consumptives in
earlier stages to wait on them—these humane persons
did once succeed in ' inducing phthisis experimentally'
in man. Dr. Andrew shall tell the story :—
" ' Experiments conducted by Demet, Paraskeva,
and Zablonis, in Syra, Greece, were not only success¬
ful in transmitting the disease to rabbits by inoculation
with the sputum and blood from a man affected with
phthisis, but they ve?itured upon the unprecedented
experiment of inoculating a human patient whose history
gave no indication of tuberculous taint, and whose lungs
were perfectly healthy so far as physical examination
could discover, but who was suffering from gangrene
of the big toe of the left foot, due to obliteration of the
femoral artery. Amputation of the limb was proposed
by the surgeon, but would not be submitted to, and as
a fatal termination was inevitable, a quantity of sputum
from a man who had abscess in his lungs was inocu¬
lated into the upper part of the left thigh.'
" In three weeks there were signs of tubercle in the
lung, and in thirty-eight days the man was dead !
After death the tubercles were found. And so the
man was done to death. Gangrene is not necessarily
fatal, and to say that he must have died of that is a
pure assumption. To ignore the effect of the inocula¬
tion with diseased matter from another man on the
general health of the patient and on his chance of
recovery is quite unjustifiable. The fact that the man
lived for over a month with the two diseases proves that
he had a very good chance of recovering from the one."
Bargigli inoculated two children (all he could obtain)
of six and eight years old with " la matibre sanieuse
d'un ulcere de lepreux," to try if leprosy could be so
communicated :—See Hirch Handbuch der Pathologie,
2 abt., 1883, p. 32.
A KEY TO ST. BERNARD'S.
115
Dr. Lund, of the Isle of Samso, " fed his child on
the milk of diseased cows for two years and half, to
communicate tuberculosis."—Scandinavian Medical
Archives, vol. xi. (for 1879).
And lest the source of the extracts should be
objected to by my medical readers, I append
the observations of Dr. in a lecture de¬
livered in the King's College Hospital, and
recorded in the British Medical Journal June
17, 1882, p. 895 :—
"Two physicians* mentioned in the Nouveau Dic-
tionnaire de Medecine et de Chirurgie (Art. ' Phthisis
went so far as to inoculate themselves with the serum
of a blister applied to a phthisical patient, and, we are
not surprised to hear, without effect: for, if the pecu¬
liar micro-organism which we have recently seen be the
active agent in the production uf tubercle, we should
scarcely expect to find it in the serum extracted from
the blood by the action of a blister. Another remark¬
able case of human inoculation is mentioned in the
work I have just cited. Three medical men of Syra
(in Greece), in 1874, inoculated a man, fifty-five years
of age, with tubercle. He was suffering from gangrene
of the left great toe, due to obliteration of the femoral
artery, and was in a moribund state. They inoculated
some of the sputa of a phthisical patient into the
upper part of the right leg. The lungs were pre¬
viously examined with great care, and found to be
perfectly sound. Three weeks later, there were signs
of commencing induration at the right apex. On the
thirty-eighth day after the inoculation the patient died
116
DYING SCIENTIFICALLY.
of gangrene. At the necropsy there were found, at
the apex of the right lung, seventeen small tubercles,
varying in size from that of a mustard-seed to that of
a lentil. Two similar tubercles were found at the left
apex—two others on the convex surface of the liver.
The authors of the experiment considered the em¬
bryonic state of the tubercles, and their limited num¬
ber, to correspond with the short space of time that
had elapsed from the inoculation.
" It is not likely that an experiment of this kind will
be often repeated; but though it stands alone, it is,
none the less, an important observation."
Not a word of disapproval do we find! " Oh,
but all these things were done abroad," I hear
an opponent angrily remonstrate. I know it,
and I am only mentioning them to illustrate
page 434 of St. Bernard's, where my charac¬
ters are talking of their foreign experiences.
And while we are on the subject, let me quote
from an address by Dr. J. H. Clarke in the
Altrincham Chronicle of Nov. 4, 1887 :—
" According to the Vienna correspondent of the
Chicago Medical Era, Professor Braun recently caused
immense merriment in his class by experimenting be¬
fore them on the unborn child of a woman in her
pangs."
The poor babies even are useful as clinical
material, as well as their mothers. Read this
A KEY TO ST. BERNARD'S.
117
from the Paris correspondent of the British
Medical Journal, it all bearing on page 434 of
St. Bernard's :—
" Fehling has recently, by experiment, studied the
effects on nurslings of certain drugs given to the
women who suckled them. When doses varying from
two to three grammes of salicylate of soda were
administered to the nurse, every time that a child was
suckled within an hour after the administration of the
dose the salicylate appeared. . . . After an interval
of twenty-four hours there remained no trace of the
drug. When the child was suckled too soon after
the medicine had been taken, the salicylate could not
be found . . . Elimination was completed at the
same time in the mother and the child. With iodide
of potassium the results were the same. The milk,
when analysed, gave the characteristic reaction. In
the infant, elimination lasted seventy-two hours, in
the mother forty-four. After twenty-four hours, the
milk still contained iodide of potassium. With ferro-
cyanide of potassium, reaction was very pronounced
in the maternal . . . , but absent in the child's. Pro¬
longed applications of iodoform upon . . . women
in parturition, after prolonged use, generally resulted
in iodine being found in the milk ... of the mother,
but not always in . . . the infant. The child was
never indisposed, even when iodoform was used to dry
up the umbilical cord. There was only a small quantity
of mercury transmitted through the milk of a nursing
mother, and its presence was not constant."
Remark that these experiments are not con¬
demned by this English journal.
Ii8
DYING SCIENTIFICALLY.
" This is the heroic work we need so much in
Englandsaid Dr. Stanforth, in St. Bernard's.
We will give a few examples of what he
meant :—
" M. Laborde has studied the action of aceto-
phenone on patients when administered in relatively
small doses. M. Dujardin-Beaumetz, in a recent
communication to the Biological Society, stated that
this substance produces sleep accompanied by vertigo
and headache."—Brit. Med. Journ., Jan. 9, 1886.
" Professor Ehrlich, who has had very good results
from thallin in typhoid fever, has had the candour to
report a case {Munchener Med. Wochenschr., No. viii.)
which ended fatally under repeated progressive doses—
namely, o'o8 up to 0^58 grammes (one and a quarter
grains to nine grains nearly)—of thallin tartarate."
" Experiments made at the Philadelphia Hospital
and confirmed by Dolbeau (Annales dHygiene, Jan.
1874) have proven that persons sound asleep may be
chloroformed without their being awakened."— Wood's
Therapeutics, p. 293.
" In epilepsy, some trials have been made of the
drug {Calabar Bean), but its value is very doubtful.
Drs. Harnack and Witkowski have found that in
epileptic guinea-pigs physostigmia causes a succession
of fits lasting for hours and days. They have further
noted a similar influence upon man."—Wood's Thera¬
peutics, p. 319.
" Professor Or£, of Bordeaux, has proposed intra¬
venous injections of chloral as a substitute for ether and
chloroform in surgery, and as a means of combating
tetanus. His suggestion has been carried out by
himself and others in a number of cases with asserted
good results. But in other instances it has apparently
A KEY TO ST. BERNARD'S.
119
caused death, and is, in my opinion, absolutely unjusti¬
fiable."— Wood's Therapeutics, p. 341.
" Dr. E. Rose has reported a case in which death
resulted from a large injection (of iodine) into an
ovarian cyst. ... In the experiments of Jorg
and his pupils, doses of iodine of a grain and a grain
and a half gave rise to colicky pains," etc., etc.—
Wood's Therapeutics, p. 399.
" In feeble persons, however, caution must always
be exercised in using it (apomorphia), as one-fifteenth
of a grain has caused death in seven minutes in an
adult."—Med. Rec., 1887, p. 664.
Conclusion.—My task is done. It was not
lightly undertaken, nor have the charges against
the hospital system been recklessly made. I
think the reader, if he has followed me thus
far, will acquit me of writing against scientific
cruelties without justification. These pages
give the gravamen of my charge. I have, as
far as it was possible, illustrated every chief
point in my attack. Of course it will be readily
understood that many things, such as the in¬
decent joking of Dr. Stanforth, could not be
proved from the pages of scientific journals
like those from which I have quoted ; neither do
I pretend that I have met men like Mr. Crowe
in actual life. But that such men have existed
the various trials of medical men for murder of
120
DYING SCIENTIFICALLY.
their relatives, and their condemnation to death
(one of them occurring while these sheets were
passing through the press), sufficiently prove.
I honestly believe that the constant practice
of torturing animals for scientific purposes tends
to harden the hearts of those who adopt it,
and leads them to experiment on, and torture
for scientific purposes, their fellow-men. When
the heart of man has arrived at this stage of
degradation, I think the line which divides its
imaginings from those of Mr. Crowe a very
fine one indeed. That, however, I leave the
public to judge. " What I have written I have
written." If there be any points other than
those I have indicated which I have omitted to
prove by published extracts, I beg the reader
not to think I am unable to confirm them also,
but that I cannot draw from my own experience
without implicating institutions and individuals
against whom I have no personal differences
whatever. I have proved by chapter and verse
so much of the truth of my book that I ask the
public, as I think I may fairly do, to give me
credit for the rest.
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