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Round The Red Lamp

A >> Arthur Conan Doyle >> Round The Red Lamp



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ROUND THE RED LAMP

BEING FACTS AND FANCIES OF MEDICAL LIFE

By SIR ARTHUR CONAN DOYLE




THE PREFACE.

[Being an extract from a long and animated
correspondence with a friend in America.]

I quite recognise the force of your objection
that an invalid or a woman in weak health would get
no good from stories which attempt to treat some
features of medical life with a certain amount of
realism. If you deal with this life at all, however,
and if you are anxious to make your doctors something
more than marionettes, it is quite essential that you
should paint the darker side, since it is that which
is principally presented to the surgeon or physician.
He sees many beautiful things, it is true, fortitude
and heroism, love and self-sacrifice; but they are
all called forth (as our nobler qualities are always
called forth) by bitter sorrow and trial. One cannot
write of medical life and be merry over it.

Then why write of it, you may ask? If a subject
is painful why treat it at all? I answer that it is
the province of fiction to treat painful things
as well as cheerful ones. The story which wiles
away a weary hour fulfils an obviously good
purpose, but not more so, I hold, than that which
helps to emphasise the graver side of life. A
tale which may startle the reader out of his usual
grooves of thought, and shocks him into seriousness,
plays the part of the alterative and tonic in
medicine, bitter to the taste but bracing in the
result. There are a few stories in this little
collection which might have such an effect, and I
have so far shared in your feeling that I have
reserved them from serial publication. In book-form
the reader can see that they are medical stories, and
can, if he or she be so minded, avoid them.

Yours very truly,

A. CONAN DOYLE.


P. S.--You ask about the Red Lamp. It is the
usual sign of the general practitioner in England.



CONTENTS.

BEHIND THE TIMES
HIS FIRST OPERATION
A STRAGGLER OF '15
THE THIRD GENERATION
A FALSE START
THE CURSE OF EVE
SWEETHEARTS
A PHYSIOLOGIST'S WIFE
THE CASE OF LADY SANNOX
A QUESTION OF DIPLOMACY
A MEDICAL DOCUMENT
LOT NO. 249
THE Los AMIGOS FIASCO
THE DOCTORS OF HOYLAND
THE SURGEON TALKS




ROUND THE RED LAMP.




BEHIND THE TIMES.




My first interview with Dr. James Winter was
under dramatic circumstances. It occurred at two in
the morning in the bedroom of an old country house.
I kicked him twice on the white waistcoat and knocked
off his gold spectacles, while he with the aid of a
female accomplice stifled my angry cries in a flannel
petticoat and thrust me into a warm bath. I am told
that one of my parents, who happened to be present,
remarked in a whisper that there was nothing the
matter with my lungs. I cannot recall how Dr. Winter
looked at the time, for I had other things to think
of, but his description of my own appearance is far
from flattering. A fluffy head, a body like a
trussed goose, very bandy legs, and feet with the
soles turned inwards--those are the main items which
he can remember.

From this time onwards the epochs of my life were
the periodical assaults which Dr. Winter made upon
me. He vaccinated me; he cut me for an abscess; he
blistered me for mumps. It was a world of peace and
he the one dark cloud that threatened. But at last
there came a time of real illness--a time when I lay
for months together inside my wickerwork-basket bed,
and then it was that I learned that that hard face
could relax, that those country-made creaking boots
could steal very gently to a bedside, and that that
rough voice could thin into a whisper when it spoke
to a sick child.

And now the child is himself a medical man, and
yet Dr. Winter is the same as ever. I can see no
change since first I can remember him, save that
perhaps the brindled hair is a trifle whiter, and the
huge shoulders a little more bowed. He is a very
tall man, though he loses a couple of inches from his
stoop. That big back of his has curved itself over
sick beds until it has set in that shape. His face
is of a walnut brown, and tells of long winter drives
over bleak country roads, with the wind and the rain
in his teeth. It looks smooth at a little distance,
but as you approach him you see that it is shot with
innumerable fine wrinkles like a last year's apple.
They are hardly to be seen when he is in repose; but
when he laughs his face breaks like a starred glass,
and you realise then that though he looks old, he
must be older than he looks.


How old that is I could never discover. I have
often tried to find out, and have struck his stream
as high up as George IV and even the Regency, but
without ever getting quite to the source. His mind
must have been open to impressions very early, but it
must also have closed early, for the politics of the
day have little interest for him, while he is
fiercely excited about questions which are entirely
prehistoric. He shakes his head when he speaks of
the first Reform Bill and expresses grave doubts as
to its wisdom, and I have heard him, when he was
warmed by a glass of wine, say bitter things about
Robert Peel and his abandoning of the Corn Laws. The
death of that statesman brought the history of
England to a definite close, and Dr. Winter refers to
everything which had happened since then as to an
insignificant anticlimax.

But it was only when I had myself become a
medical man that I was able to appreciate how
entirely he is a survival of a past generation. He
had learned his medicine under that obsolete and
forgotten system by which a youth was apprenticed to
a surgeon, in the days when the study of anatomy was
often approached through a violated grave. His views
upon his own profession are even more reactionary
than in politics. Fifty years have brought him
little and deprived him of less. Vaccination was
well within the teaching of his youth, though I
think he has a secret preference for inoculation.
Bleeding he would practise freely but for public
opinion. Chloroform he regards as a dangerous
innovation, and he always clicks with his tongue when
it is mentioned. He has even been known to say vain
things about Laennec, and to refer to the stethoscope
as "a new-fangled French toy." He carries one in his
hat out of deference to the expectations of his
patients, but he is very hard of hearing, so that it
makes little difference whether he uses it or not.

He reads, as a duty, his weekly medical paper, so
that he has a general idea as to the advance of
modern science. He always persists in looking upon
it as a huge and rather ludicrous experiment. The
germ theory of disease set him chuckling for a long
time, and his favourite joke in the sick room was to
say, "Shut the door or the germs will be getting in."
As to the Darwinian theory, it struck him as being
the crowning joke of the century. "The children in
the nursery and the ancestors in the stable," he
would cry, and laugh the tears out of his eyes.

He is so very much behind the day that
occasionally, as things move round in their usual
circle, he finds himself, to his bewilderment, in the
front of the fashion. Dietetic treatment, for
example, had been much in vogue in his youth, and
he has more practical knowledge of it than any one
whom I have met. Massage, too, was familiar to him
when it was new to our generation. He had been
trained also at a time when instruments were in a
rudimentary state, and when men learned to trust more
to their own fingers. He has a model surgical hand,
muscular in the palm, tapering in the fingers, "with
an eye at the end of each." I shall not easily
forget how Dr. Patterson and I cut Sir John Sirwell,
the County Member, and were unable to find the stone.
It was a horrible moment. Both our careers were at
stake. And then it was that Dr. Winter, whom we had
asked out of courtesy to be present, introduced into
the wound a finger which seemed to our excited senses
to be about nine inches long, and hooked out the
stone at the end of it. "It's always well to bring
one in your waistcoat-pocket," said he with a
chuckle, "but I suppose you youngsters are above all
that."

We made him president of our branch of the
British Medical Association, but he resigned after
the first meeting. "The young men are too much for
me," he said. "I don't understand what they are
talking about." Yet his patients do very well. He
has the healing touch--that magnetic thing which
defies explanation or analysis, but which is a very
evident fact none the less. His mere presence
leaves the patient with more hopefulness and
vitality. The sight of disease affects him as dust
does a careful housewife. It makes him angry and
impatient. "Tut, tut, this will never do!" he cries,
as he takes over a new case. He would shoo Death out
of the room as though he were an intrusive hen. But
when the intruder refuses to be dislodged, when the
blood moves more slowly and the eyes grow dimmer,
then it is that Dr. Winter is of more avail than all
the drugs in his surgery. Dying folk cling to his
hand as if the presence of his bulk and vigour gives
them more courage to face the change; and that
kindly, windbeaten face has been the last earthly
impression which many a sufferer has carried into the
unknown.

When Dr. Patterson and I--both of us young,
energetic, and up-to-date--settled in the district,
we were most cordially received by the old doctor,
who would have been only too happy to be relieved of
some of his patients. The patients themselves,
however, followed their own inclinations--which is a
reprehensible way that patients have--so that we
remained neglected, with our modern instruments and
our latest alkaloids, while he was serving out senna
and calomel to all the countryside. We both of us
loved the old fellow, but at the same time, in the
privacy of our own intimate conversations, we could
not help commenting upon this deplorable lack of
judgment. "It's all very well for the poorer
people," said Patterson. "But after all the educated
classes have a right to expect that their medical man
will know the difference between a mitral murmur and
a bronchitic rale. It's the judicial frame of mind,
not the sympathetic, which is the essential one."

I thoroughly agreed with Patterson in what he
said. It happened, however, that very shortly
afterwards the epidemic of influenza broke out, and
we were all worked to death. One morning I met
Patterson on my round, and found him looking rather
pale and fagged out. He made the same remark about
me. I was, in fact, feeling far from well, and I lay
upon the sofa all the afternoon with a splitting
headache and pains in every joint. As evening closed
in, I could no longer disguise the fact that the
scourge was upon me, and I felt that I should have
medical advice without delay. It was of Patterson,
naturally, that I thought, but somehow the idea of
him had suddenly become repugnant to me. I thought
of his cold, critical attitude, of his endless
questions, of his tests and his tappings. I wanted
something more soothing--something more genial.

"Mrs. Hudson," said I to my housekeeper, would
you kindly run along to old Dr. Winter and tell
him that I should be obliged to him if he would step
round?"

She was back with an answer presently. "Dr.
Winter will come round in an hour or so, sir; but he
has just been called in to attend Dr. Patterson."




HIS FIRST OPERATION.


It was the first day of the winter session, and
the third year's man was walking with the first
year's man. Twelve o'clock was just booming out from
the Tron Church.

"Let me see," said the third year's man. "You
have never seen an operation?"

"Never."

"Then this way, please. This is Rutherford's
historic bar. A glass of sherry, please, for this
gentleman. You are rather sensitive, are you not?"

"My nerves are not very strong, I am afraid."

"Hum! Another glass of sherry for this gentleman.
We are going to an operation now, you know."

The novice squared his shoulders and made a
gallant attempt to look unconcerned.

"Nothing very bad--eh?"

"Well, yes--pretty bad."

"An--an amputation?"

"No; it's a bigger affair than that."

"I think--I think they must be expecting me at home."

"There's no sense in funking. If you don't go
to-day, you must to-morrow. Better get it over at
once. Feel pretty fit?"

"Oh, yes; all right!" The smile was not a success.

"One more glass of sherry, then. Now come on or
we shall be late. I want you to be well in front."

"Surely that is not necessary."

"Oh, it is far better! What a drove of students!
There are plenty of new men among them. You can tell
them easily enough, can't you? If they were going
down to be operated upon themselves, they could not
look whiter."

"I don't think I should look as white."

"Well, I was just the same myself. But the
feeling soon wears off. You see a fellow with a face
like plaster, and before the week is out he is eating
his lunch in the dissecting rooms. I'll tell you all
about the case when we get to the theatre."

The students were pouring down the sloping street
which led to the infirmary--each with his little
sheaf of note-books in his hand. There were pale,
frightened lads, fresh from the high schools, and
callous old chronics, whose generation had passed on
and left them. They swept in an unbroken,
tumultuous stream from the university gate to the
hospital. The figures and gait of the men were
young, but there was little youth in most of their
faces. Some looked as if they ate too little--a few
as if they drank too much. Tall and short, tweed-
coated and black, round-shouldered, bespectacled, and
slim, they crowded with clatter of feet and rattle of
sticks through the hospital gate. Now and again they
thickened into two lines, as the carriage of a
surgeon of the staff rolled over the cobblestones
between.

"There's going to be a crowd at Archer's,"
whispered the senior man with suppressed excitement.
"It is grand to see him at work. I've seen him jab
all round the aorta until it made me jumpy to watch
him. This way, and mind the whitewash."

They passed under an archway and down a long,
stone-flagged corridor, with drab-coloured doors on
either side, each marked with a number. Some of them
were ajar, and the novice glanced into them with
tingling nerves. He was reassured to catch a glimpse
of cheery fires, lines of white-counterpaned beds,
and a profusion of coloured texts upon the wall. The
corridor opened upon a small hall, with a fringe of
poorly clad people seated all round upon benches. A
young man, with a pair of scissors stuck like a
flower in his buttonhole and a note-book in his hand,
was passing from one to the other, whispering and
writing.

"Anything good?" asked the third year's man.

"You should have been here yesterday," said the
out-patient clerk, glancing up. "We had a regular
field day. A popliteal aneurism, a Colles' fracture,
a spina bifida, a tropical abscess, and an
elephantiasis. How's that for a single haul?"

"I'm sorry I missed it. But they'll come again,
I suppose. What's up with the old gentleman?"

A broken workman was sitting in the shadow,
rocking himself slowly to and fro, and groaning. A
woman beside him was trying to console him, patting
his shoulder with a hand which was spotted over with
curious little white blisters.

"It's a fine carbuncle," said the clerk, with the
air of a connoisseur who describes his orchids to one
who can appreciate them. "It's on his back and the
passage is draughty, so we must not look at it, must
we, daddy? Pemphigus," he added carelessly, pointing
to the woman's disfigured hands. "Would you care to
stop and take out a metacarpal?"

"No, thank you. We are due at Archer's. Come
on!" and they rejoined the throng which was hurrying
to the theatre of the famous surgeon.

The tiers of horseshoe benches rising from the
floor to the ceiling were already packed, and the
novice as he entered saw vague curving lines of
faces in front of him, and heard the deep buzz of a
hundred voices, and sounds of laughter from somewhere
up above him. His companion spied an opening on the
second bench, and they both squeezed into it.

"This is grand!" the senior man whispered.
"You'll have a rare view of it all."

Only a single row of heads intervened between
them and the operating table. It was of unpainted
deal, plain, strong, and scrupulously clean. A sheet
of brown water-proofing covered half of it, and
beneath stood a large tin tray full of sawdust. On
the further side, in front of the window, there was a
board which was strewed with glittering instruments--
forceps, tenacula, saws, canulas, and trocars. A
line of knives, with long, thin, delicate blades, lay
at one side. Two young men lounged in front of this,
one threading needles, the other doing something to a
brass coffee-pot-like thing which hissed out puffs of
steam.

"That's Peterson," whispered the senior, "the
big, bald man in the front row. He's the skin-
grafting man, you know. And that's Anthony Browne,
who took a larynx out successfully last winter. And
there's Murphy, the pathologist, and Stoddart, the
eye-man. You'll come to know them all soon."

"Who are the two men at the table?"

"Nobody--dressers. One has charge of the
instruments and the other of the puffing Billy. It's
Lister's antiseptic spray, you know, and Archer's one
of the carbolic-acid men. Hayes is the leader of the
cleanliness-and-cold-water school, and they all hate
each other like poison."

A flutter of interest passed through the closely
packed benches as a woman in petticoat and bodice was
led in by two nurses. A red woolen shawl was draped
over her head and round her neck. The face which
looked out from it was that of a woman in the prime
of her years, but drawn with suffering, and of a
peculiar beeswax tint. Her head drooped as she
walked, and one of the nurses, with her arm round her
waist, was whispering consolation in her ear. She
gave a quick side-glance at the instrument table as
she passed, but the nurses turned her away from it.

"What ails her?" asked the novice.

"Cancer of the parotid. It's the devil of a
case; extends right away back behind the carotids.
There's hardly a man but Archer would dare to follow
it. Ah, here he is himself!"

As he spoke, a small, brisk, iron-grey man came
striding into the room, rubbing his hands together as
he walked. He had a clean-shaven face, of the naval
officer type, with large, bright eyes, and a firm,
straight mouth. Behind him came his big house-
surgeon, with his gleaming pince-nez, and a
trail of dressers, who grouped themselves into
the corners of the room.

"Gentlemen," cried the surgeon in a voice as hard
and brisk as his manner, "we have here an interesting
case of tumour of the parotid, originally
cartilaginous but now assuming malignant
characteristics, and therefore requiring excision.
On to the table, nurse! Thank you! Chloroform,
clerk! Thank you! You can take the shawl off,
nurse."

The woman lay back upon the water-proofed pillow,
and her murderous tumour lay revealed. In itself it
was a pretty thing--ivory white, with a mesh of blue
veins, and curving gently from jaw to chest. But the
lean, yellow face and the stringy throat were in
horrible contrast with the plumpness and sleekness of
this monstrous growth. The surgeon placed a hand on
each side of it and pressed it slowly backwards and
forwards.

"Adherent at one place, gentlemen," he cried.
"The growth involves the carotids and jugulars, and
passes behind the ramus of the jaw, whither we must
be prepared to follow it. It is impossible to say
how deep our dissection may carry us. Carbolic tray.
Thank you! Dressings of carbolic gauze, if you
please! Push the chloroform, Mr. Johnson. Have the
small saw ready in case it is necessary to remove the
jaw."

The patient was moaning gently under the towel
which had been placed over her face. She tried
to raise her arms and to draw up her knees, but two
dressers restrained her. The heavy air was full of
the penetrating smells of carbolic acid and of
chloroform. A muffled cry came from under the towel,
and then a snatch of a song, sung in a high,
quavering, monotonous voice:


"He says, says he,

If you fly with me

You'll be mistress of the ice-cream van.

You'll be mistress of the----"

It mumbled off into a drone and stopped. The surgeon
came across, still rubbing his hands, and spoke to an
elderly man in front of the novice.

"Narrow squeak for the Government," he said.

"Oh, ten is enough."

"They won't have ten long. They'd do better to
resign before they are driven to it."

"Oh, I should fight it out."

"What's the use. They can't get past the
committee even if they got a vote in the House. I
was talking to----"

"Patient's ready, sir," said the dresser.

"Talking to McDonald--but I'll tell you about it
presently." He walked back to the patient, who was
breathing in long, heavy gasps. "I propose," said
he, passing his hand over the tumour in an almost
caressing fashion, "to make a free incision over the
posterior border, and to take another forward at
right angles to the lower end of it. Might I
trouble you for a medium knife, Mr. Johnson?"

The novice, with eyes which were dilating with
horror, saw the surgeon pick up the long, gleaming
knife, dip it into a tin basin, and balance it in his
fingers as an artist might his brush. Then he saw
him pinch up the skin above the tumour with his left
hand. At the sight his nerves, which had already
been tried once or twice that day, gave way utterly.
His head swain round, and he felt that in another
instant he might faint. He dared not look at the
patient. He dug his thumbs into his ears lest some
scream should come to haunt him, and he fixed his
eyes rigidly upon the wooden ledge in front of him.
One glance, one cry, would, he knew, break down the
shred of self-possession which he still retained. He
tried to think of cricket, of green fields and
rippling water, of his sisters at home--of anything
rather than of what was going on so near him.

And yet somehow, even with his ears stopped up,
sounds seemed to penetrate to him and to carry their
own tale. He heard, or thought that he heard, the
long hissing of the carbolic engine. Then he was
conscious of some movement among the dressers. Were
there groans, too, breaking in upon him, and some
other sound, some fluid sound, which was more
dreadfully suggestive still? His mind would keep
building up every step of the operation, and
fancy made it more ghastly than fact could have been.
His nerves tingled and quivered. Minute by minute
the giddiness grew more marked, the numb, sickly
feeling at his heart more distressing. And then
suddenly, with a groan, his head pitching forward,
and his brow cracking sharply upon the narrow wooden
shelf in front of him, he lay in a dead faint.


When he came to himself, he was lying in the
empty theatre, with his collar and shirt undone. The
third year's man was dabbing a wet sponge over his
face, and a couple of grinning dressers were looking
on.

"All right," cried the novice, sitting up and
rubbing his eyes. "I'm sorry to have made an ass of
myself."

"Well, so I should think," said his companion.

"What on earth did you faint about?"

"I couldn't help it. It was that operation."

"What operation?"

"Why, that cancer."

There was a pause, and then the three students
burst out laughing. "Why, you juggins!" cried the
senior man, "there never was an operation at all!
They found the patient didn't stand the chloroform
well, and so the whole thing was off. Archer has
been giving us one of his racy lectures, and you
fainted just in the middle of his favourite story."




A STRAGGLER OF '15.


It was a dull October morning, and heavy, rolling
fog-wreaths lay low over the wet grey roofs of the
Woolwich houses. Down in the long, brick-lined
streets all was sodden and greasy and cheerless.
From the high dark buildings of the arsenal came the
whirr of many wheels, the thudding of weights, and
the buzz and babel of human toil. Beyond, the
dwellings of the workingmen, smoke-stained and
unlovely, radiated away in a lessening perspective of
narrowing road and dwindling wall.

There were few folk in the streets, for the
toilers had all been absorbed since break of day by
the huge smoke-spouting monster, which sucked in the
manhood of the town, to belch it forth weary and
work-stained every night. Little groups of children
straggled to school, or loitered to peep through the
single, front windows at the big, gilt-edged Bibles,
balanced upon small, three-legged tables, which were
their usual adornment. Stout women, with thick, red
arms and dirty aprons, stood upon the whitened
doorsteps, leaning upon their brooms, and shrieking
their morning greetings across the road. One
stouter, redder, and dirtier than the rest, had
gathered a small knot of cronies around her and was
talking energetically, with little shrill titters
from her audience to punctuate her remarks.

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