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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


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