X Tales of the Moral and Pathological — X — Tales of the Moral and Pathological
I — The Rewards of Science
Once upon a time there was a surgeon who spent seven years perfecting an extraordinarily delicate and laborious operation for the cure of a rare and deadly disease. In the process he wore out $400 worth of knives and saws and used up $6,000 worth of ether, splints, guinea pigs, homeless dogs and bichloride of mercury. His board and lodging during the seven years came to $2,875. Finally he got a patient and performed the operation. It took eight hours and cost him $17 more than his fee of $20....
One day, two months after the patient was discharged as cured, the surgeon stopped in his rambles to observe a street parade. It was the annual turnout of Good Hope Lodge, No. 72, of the Patriotic Order of American Rosicrucians. The cured patient, marching as Supreme Worthy Archon, wore a lavender baldric, a pea-green sash, an aluminum helmet and scarlet gauntlets, and carried an ormolu sword and the blue polka-dot flag of a rear-admiral....
With a low cry the surgeon jumped down a sewer and was seen no more.
II — The Incomparable Physician
The eminent physician, Yen Li-Shen, being called in the middle of the night to the bedside of the rich tax-gatherer, Chu Yi-Foy, found his distinguished patient suffering from a spasm of the liver. An examination of the pulse, tongue, toe-nails, and hair-roots revealing the fact that the malady was caused by the presence of a multitude of small worms in the blood, the learned doctor forthwith dispatched his servant to his surgery for a vial of gnats’ eyes dissolved in the saliva of men executed by strangling, that being the remedy advised by Li Tan-Kien and other high authorities for the relief of this painful and dangerous condition.
When the servant returned the patient was so far gone that Cheyne-Stokes breathing had already set in, and so the doctor decided to administer the whole contents of the vial—an heroic dose, truly, for it has been immemorially held that even so little as the amount that will cling to the end of a horse hair is sufficient to cure. Alas, in his professional zeal and excitement, the celebrated pathologist permitted his hand to shake like a myrtle leaf in a Spring gale, and so he dropped not only the contents of the vial, but also the vial itself down the œsophagus of his moribund patient.
The accident, however, did not impede the powerful effects of this famous remedy. In ten minutes Chu Yi-Foy was so far recovered that he asked for a plate of rice stewed with plums, and by morning he was able to leave his bed and receive the reports of his spies, informers and extortioners. That day he sent for Dr. Yen and in token of his gratitude, for he was a just and righteous man, settled upon him in due form of law, and upon his heirs and assigns in perpetuity, the whole rents, rates, imposts and taxes, amounting to no less than ten thousand Hangkow taels a year, of two of the streets occupied by money-changers, bird-cage makers and public women in the town of Szu-Loon, and of the related alleys, courts and lanes. And Dr. Yen, with his old age and the old age of his seven sons and thirty-one grandsons now safely provided for, retired from the practise of his art, and devoted himself to a tedious scientific inquiry (long the object of his passionate aspiration) into the precise physiological relation between gravel in the lower lobe of the heart and the bursting of arteries in the arms and legs.
So passed many years, while Dr. Yen pursued his researches and sent his annual reports of progress to the Academy of Medicine at Chan-Si, and Chu Yi-Foy increased his riches and his influence, so that his arm reached out from the mountains to the sea. One day, in his eightieth year, Chu Yi-Foy fell ill again, and, having no confidence in any other physician, sent once more for the learned and now venerable Dr. Yen.
“I have a pain,” he said, “in my left hip, where the stomach dips down over the spleen. A large knob has formed there. A lizard, perhaps, has got into me. Or perhaps a small hedge-hog.”
Dr. Yen thereupon made use of the test for lizards and hedge-hogs—to wit, the application of madder dye to the Adam’s apple, turning it lemon yellow if any sort of reptile is within, and violet if there is a mammal—but it failed to operate as the books describe. Being thus led to suspect a misplaced and wild-growing bone, perhaps from the vertebral column, the doctor decided to have recourse to surgery, and so, after the proper propitiation of the gods, he administered to his eminent patient a draught of opium water, and having excluded the wailing women of the household from the sick chamber, he cut into the protuberance with a small, sharp knife, and soon had the mysterious object in his hand.... It was the vial of dissolved gnats’ eyes—still full and tightly corked! Worse, it was not the vial of dissolved gnats’ eyes, but a vial of common burdock juice—the remedy for infants griped by their mothers’ milk....
But when the eminent Chu Yi-Foy, emerging from his benign stupor, made a sign that he would gaze upon the cause of his distress, it was a bone that Dr. Yen Li-Shen showed him—an authentic bone, ovoid and evil-looking—and lately the knee cap of one Ho Kwang, brass maker in the street of Szchen-Kiang. Dr. Yen carried this bone in his girdle to keep off the black, blue and yellow plagues. Chu Yi-Foy, looking upon it, wept the soft, grateful tears of an old man.
“This is twice,” he said, “that you, my learned friend, have saved my life. I have hitherto given you, in token of my gratitude, the rents, rates, imposts and taxes, of two streets, and of the related alleys, courts and lanes. I now give you the weight of that bone in diamonds, in rubies, in pearls or in emeralds, as you will. And whichever of the four you choose, I give you the other three also. For is it not said by K’ung Fu-tsze, ‘The good physician bestows what the gods merely promise’?”
And Dr. Yen Li-Shen lowered his eyes and bowed. But he was too old in the healing art to blush.
III — Neighbours
Once I lay in hospital a fortnight while an old man died by inches across the hall. Apparently a very painful, as it was plainly a very tedious business. I would hear him breathing heavily for fifteen or twenty minutes, and then he would begin shrieking in agony and yelling for his orderly: “Charlie! Charlie! Charlie!” Now and then a nurse would come into my room and report progress: “The old fellow’s kidneys have given up; he can’t last the night,” or, “I suppose the next choking spell will fetch him.” Thus he fought his titanic fight with the gnawing rats of death, and thus I lay listening, myself quickly recovering from a sanguinary and indecent operation.... Did the shrieks of that old man startle me, worry me, torture me, set my nerves on edge? Not at all. I had my meals to the accompaniment of piteous yells to God, but day by day I ate them more heartily. I lay still in bed and read a book or smoked a cigar. I damned my own twinges and fading malaises. I argued ignorantly with the surgeons. I made polite love to the nurses who happened in. At night I slept soundly, the noise retreating benevolently as I dropped off. And when the old fellow died at last, snarling and begging for mercy with his last breath, the unaccustomed stillness made me feel lonesome and sad, like a child robbed of a tin whistle.... But when a young surgeon came in half an hour later, and, having dined to his content, testified to it by sucking his teeth, cold shudders ran through me from stem to stern.
IV — From the Chart
Temperature: 99.7. Respiration: rising to 65 and then suddenly suspended. The face is flushed, and the eyes are glazed and half-closed. There is obviously a sub-normal reaction to external stimuli. A fly upon the ear is unnoticed. The auditory nerve is anesthetic. There is a swaying of the whole body and an apparent failure of co-ordination, probably the effect of some disturbance in the semi-circular canals of the ear. The hands tremble and then clutch wildly. The head is inclined forward as if to approach some object on a level with the shoulder. The mouth stands partly open, and the lips are puckered and damp. Of a sudden there is a sound as of a deep and labored inspiration, suggesting the upward curve of Cheyne-Stokes breathing. Then comes silence for 40 seconds, followed by a quick relaxation of the whole body and a sharp gasp....
One of the internes has kissed a nurse.
V — The Interior Hierarchy
The world awaits that pundit who will study at length the relative respectability of the inward parts of man—his pipes and bellows, his liver and lights. The inquiry will take him far into the twilight zones of psychology. Why is the vermiform appendix so much more virtuous and dignified than its next-door neighbor, the cæcum? Considered physiologically, anatomically, pathologically, surgically, the cæcum is the decenter of the two. It has more cleanly habits; it is more beautiful; it serves a more useful purpose; it brings its owner less often to the doors of death. And yet what would one think of a lady who mentioned her cæcum? But the appendix—ah, the appendix! The appendix is pure, polite, ladylike, even noble. It confers an unmistakable stateliness, a stamp of position, a social consequence upon its possessor. And, by one of the mysteries of viscerology, it confers even more stateliness upon its ex-possessor!
Alas, what would you! Why is the stomach such a libertine and outlaw in England, and so highly respectable in the United States? No Englishman of good breeding, save he be far gone in liquor, ever mentions his stomach in the presence of women, clergymen, or the Royal Family. To avoid the necessity—for Englishmen, too, are subject to the colic—he employs various far-fetched euphemisms, among them, the poetical Little Mary. No such squeamishness is known in America. The American discusses his stomach as freely as he discusses his business. More, he regards its name with a degree of respect verging upon reverence—and so he uses it as a euphemism for the whole region from the diaphragm to the pelvic arch. Below his heart he has only a stomach and a vermiform appendix.
In the Englishman that large region is filled entirely by his liver, at least in polite conversation. He never mentions his kidneys save to his medical adviser, but he will tell even a parlor maid that he is feeling liverish. “Sorry, old chap; I’m not up to it. Been seedy for a fortnight. Touch of liver, I dessay. Never felt quite fit since I came Home. Bones full of fever. Damned old liver always kicking up. Awfully sorry, old fellow. Awsk me again. Glad to, pon my word.” But never the American! Nay, the American keeps his liver for his secret thoughts. Hobnailed it may be, and the most interesting thing within his frontiers, but he would blush to mention it to a lady.
Myself intensely ignorant of anatomy, and even more so of the punctilio, I yet attempted, one rainy day, a roster of the bodily parts in the order of their respectability. Class I was small and exclusive; when I had put in the heart, the brain, the hair, the eyes and the vermiform appendix, I had exhausted all the candidates. Here were the five aristocrats, of dignity even in their diseases—appendicitis, angina pectoris, aphasia, acute alcoholism, astigmatism: what a row of a’s! Here were the dukes, the cardinals, nay, the princes of the blood. Here were the supermembers; the beyond-parts.
In Class II I found a more motley throng, led by the collar-bone on the one hand and the tonsils on the other. And in Class III—but let me present my classification and have done:
Class II
Collar-bone
Stomach (American)
Liver (English)
Bronchial tubes
Arms (excluding elbows)
Tonsils
Vocal chords
Ears
Cheeks
Chin
Class III
Elbows
Ankles
Aorta
Teeth (if natural)
Shoulders
Windpipe
Lungs
Neck
Jugular vein
Class IV
Stomach (English)
Liver (American)
Solar plexus
Hips
Calves
Pleura
Nose
Feet (bare)
Shins
Class V
Teeth (if false)
Heels
Toes
Kidneys
Knees
Diaphragm
Thyroid gland
Legs (female)
Scalp
Class VI
Thighs
Paunch
Œsophagus
Spleen
Pancreas
Gall-bladder
Cæcum
I made two more classes, VII and VIII, but they entered into anatomical details impossible of discussion in a book designed to be read aloud at the domestic hearth. Perhaps I shall print them in the Medical Times at some future time. As my classes stand, they present mysteries enough. Why should the bronchial tubes (Class II) be so much lordlier than the lungs (Class III) to which they lead? And why should the œsophagus (Class VI) be so much less lordly than the stomach (Class II in the United States, Class IV in England) to which it leads? And yet the fact in each case is known to us all. To have a touch of bronchitis is almost fashionable; to have pneumonia is merely bad luck. The stomach, at least in America, is so respectable that it dignifies even seasickness, but I have never heard of any decent man who ever had any trouble with his œsophagus.
If you wish a short cut to a strange organ’s standing, study its diseases. Generally speaking, they are sure indices. Let us imagine a problem: What is the relative respectability of the hair and the scalp, close neighbors, offspring of the same osseous tissue? Turn to baldness and dandruff, and you have your answer. To be bald is no more than a genial jocosity, a harmless foible—but to have dandruff is almost as bad as to have beri-beri. Hence the fact that the hair is in Class I, while the scalp is at the bottom of Class V. So again and again. To break one’s collar-bone (Class II) is to be in harmony with the nobility and gentry; to crack one’s shin (Class IV) is merely vulgar. And what a difference between having one’s tonsils cut out (Class II) and getting a new set of false teeth (Class V)!
Wherefore? Why? To what end? Why is the stomach so much more respectable (even in England) than the spleen; the liver (even in America) than the pancreas; the windpipe than the œsophagus; the pleura than the diaphragm? Why is the collar-bone the undisputed king of the osseous frame? One can understand the supremacy of the heart: it plainly bosses the whole vascular system. But why do the bronchial tubes wag the lungs? Why is the chin superior to the nose? The ankles to the shins? The solar plexus to the gall-bladder?
I am unequal to the penetration of this great ethical, æsthetical and sociological mystery. But in leaving it, let me point to another and antagonistic one: to wit, that which concerns those viscera of the lower animals that we use for food. The kidneys in man are far down the scale—far down in Class V, along with false teeth, the scalp and the female leg. But the kidneys of the beef steer, the calf, the sheep, or whatever animal it is whose kidneys we eat—the kidneys of this creature are close to the borders of Class I. What is it that young Capt. Lionel Basingstoke, M.P., always orders when he drops in at Gatti’s on his way from his chambers in the Albany to that flat in Tyburnia where Mrs. Vaughn-Grimsby is waiting for him to rescue her from her cochon of a husband? What else but deviled kidneys? Who ever heard of a gallant young English seducer who did’t eat deviled kidneys—not now and then, not only on Sundays and legal holidays, but every day, every evening?
Again, and by way of postscript No. 2, concentrate your mind upon sweetbreads. Sweetbreads are made in Chicago of the pancreases of horned cattle. From Portland to Portland they belong to the first class of refined delicatessen. And yet, on the human plane, the pancreas is in Class VI, along with the cæcum and the paunch. And, contrariwise, there is tripe—“the stomach of the ox or of some other ruminant.” The stomach of an American citizen belongs to Class II, and even the stomach of an Englishman is in Class IV, but tripe is far down in Class VIII. And chitterlings—the excised vermiform appendix of the cow. Of all the towns in Christendom, Richmond, Va., is the only one wherein a self-respecting white man would dare to be caught wolfing a chitterling in public.