THE CHIMNEY CORNER.
A REALLY GOOD CASE. [a legend of st. Michael’s hospital.] Everyone knows that St. Michael’s, as we shall take the liberty of calling it, is the largest and most celebrated of the London hospitals. It is situated quite in the heart of the city, and is • about equidistant from London bridge, Westminister, Gower street, Smithfield and Whitechapel. I was a student there, and there the happiest days of my life were passed.. And now to my story. A large number of the students had gone down for the short Christmas vacation, and I should have gone also, but was just then “ dresser” to Carver Smith, and could not leave , town ; moreover, it was my week of residence. I must beg you to remember, what is perhaps but little understood by thp general public, that a large part of the watching and care, and a certain proportion also of the treatment of hospital patients, devolve upon assistants selected from the senior students. Some of the less important appointments, such as the “ dresserships,” are held by every student in turn ; but the more responsible offices, some of which require twelve months’ residence in the hospital, can only be gained by a few men each year. And for these appointments, which are esteemed positions of great trust and honor, and which are
exceedingly valuable as stepping-stones to professional success, there is very keen competition. On the surgical side of the hospital each of the foui visiting surgeons had a resident housesurgeon, and to be Sir Carver Smith’s “ H.S.” was one of the highest ambitions of a “ St. Mike,” for Sir Carver was at that time one of the leading English surgeons. A man named George Adams held the post at this time, and as he is the hero of my story, so far as I have a , hero, I will just say a word about him. He was one of those men that we occasionially meet with, who seem to stand head and shoulders among their fellows —very quiet and reserved, and when he chose quite inscrutable. No one knew where he came from. But his very great ability, his calmness in all emergencies—l never saw him discomposed except once—his mature judgment, and his great kindness, won him the respect alike of the students, the nursing staff, and the surgeons. Under him were four dressers, juniormen, who assisted in the hospital under his direction. I was one of them. Each week, one of us in turn resided in the hospital, and, as I said, Christmas week fell to my turn, and that is how I came to spend Christmas in St. Michael’s. I ought to add that there were four assistant surgeons to the hospital, but their care was over the out-patient department, and it was only in the absence of the visiting surgeons that they had any duty in the wards. Well, it was Christmas night, and our work for. the day was done, except some late visits to the wards by-and-bye, and of course any casualities that might turn up. But Christmas day is usually pretty slack in that respect. It is medical rather than surgical casualities that Christmas day produces. We had got up in honor of the day a little entertainment in an empty ward, for any of the hospital inmates who cared to attend and were able to do so. We had a famous little programme. One or two of our residents could play and sing well; another had a curious facility in whistling to the piano; another was an amateur ventriloquist and presdigitateur; and I fancy there were also some recitations and tableaux to come off. Also, there was one of the patients, an old sailor, who could sing in a grand, rich, stentorian baritone and bring down the house. Our chairman—Adams, of course—had just begun, and was delivering himself in a semi-serious way of some very eloquent remarks, amidst great applause—for nothing pleases the lower classes better than a few oratorical flourishes—-when, “ tinkle, tinkle, tinkle, tinkle,” went a small, high-pitched, imperious bell. It was the accident bell !
Oh, ye lay mortals, ye little know how the social and domestic joys of a medical' man are at the mercy of a bell! We invite our friends to tea, we welcome them, we anticipate a pleasant evening, and—there goes the bell 1 We come home tired and wet, change boots for slippers, and get comfortably by the fireside, and —there goes the bell ! We turn into bed on a cold night, and just get warm and snug, when —there goes the bell 1 My bell experiences began that night at St. Michael’s, and I shall not soon forget it. It was Sir Carver’s “ taking-in week,” and his assistants had to attend to the accidents. Adams nodded to me, and off I went to investigate, knowing that it might be anything from a cut finger to a railway smash. I found a scene of considerable excitement in the acci-dent-room. Two policemen, aided by a crossing-sweeper and a cabman, had just brought in a patient, and some other spectators had pushed their way in out of curiosity. “ Just happened outside,sir; knocked down by a runaway cab, sir.” “ Lost a lot of blood ; ’fraid it’s a bad case, sir.” Thus the policemen.
“ Ask Mr. Adams to come down at once, and clear the room/’ I said. It was a young, fair-haired girl of eighteen or nineteen, perfectly pale, unconscious and almost pulseless —a strange contrast to her rough, swarthy, weather-beaten bearers. A deep wound in the neck was bleeding profusely ; but, on tearing open the dress, I found I could stop the hemorrhage almost entirely with my finger. Adams was there immediately: in a minute he knew all about it, and had settled his course of action. Quietly he said : “ Send for Sir Carver. Take her to the theatre [the operating room] at once. Ask the other men to come, and get everything ready for operation.” And then to me : “ Keep up steady pressure, and don’t take your finger away for an instant.” Nothing could be found out concerning her. No one was with her when she was struck down. She was very tastefully, though not expensively dressed. Her features were exceedingly regular and pretty, and when the color was in her face she must have possessed a very considerable share of good looks. Nothing but a purse and a handkerchief were found in her pocket. The former was well filled, and the latter was marked “ E, Stead.” Adams said at once that she was a lady.
I do not know whether it ever happened before at St. Michael’s that, on the occurrence of a sudden emergency, no one of the surgical staff was at hand. Strange to say, it happened so to-night. Sir Carver Smith and three of the medical assistant surgeons lived close to the hospital; but in five minutes the messenger returned with the news that Sir Carver had been called to some aristocratic celebrity at the West End, who had met with an accident, and had taken one of the assistant surgeons with him. The second was out of town; and the third, who had been left to act in emergencies, had been taken suddenly ill. We had been discussing the case,, and offering advice upon it with all* that calm assurance that characterises embryo surgeons. But matters now. became serious. Half an hour would' suffice to summon one of the other' surgeons ; but it was plain that something must be done at once. We all looked at Adams, who had said very little hitherto, but had gone on making everything ready. He simply said : “ Begin to give chloroform ; I am going to operate.” • “ What are you- going to do ?” we asked.
He told us; but I will not inflict any details upon my readers, but will simply say that the sharp end of a broken
shaft, had made a narrow, deep gash in the roof of the neck, and had wounded a large artery. The operation contemplated afforded almost the only chance of life; and to delay it any longer, Adams said, would be throwing that chance away. It was an operation of the highest difficulty and danger under the present condition of the parts; and could the performance have been anticipated, the theatre would have been crowded with spectators from all the hospitals in London. And there was a young surgeon of twenty-five, called upon at a few minutes’ notice to undertake what many a long-experienced surgeon might hesitate to attempt, for it was impossible to perform it without additional loss of blood; and it was not at all improbable that a patient might not survive the operation, to say nothing of after dangers. Adams carefully explained to the other house surgeons what assistance they would have to give him ; and when the patient was ready, commenced at once. Perfect silence reigned, broken only at intervals by a word from the operator, but, indeed, he had little need to speak, for we were well drilled at St. Michael’s, and everything he needed was put into his hand almost before he asked for it. I think I can still see that quiet eager group of young men under the brilliant gaslight, standing around the palid, slumbering, girl; and in the centre the young surgeon, cool, collected, without hurry, without hesitation, doing his work. I have witnessed many of the most brilliant operators in England, and of course have seen Adams himself in that theatre in later years ; but I think I never_ saw that night’s operation surpassed either by himself or anyone else. A special demand sometimes calls forth special powers, and acts almost like an inspiration ; and so it seemed now.
In a short time it was done, and successfully done, and the patient was carried away to a quiet ward, where she was duly cared for by the nurse in charge, Adams, and Sir Carver Smith, who came on later. Our miscellaneous entertainment did not come off; but we scarcely regretted the change of programme. In a place where accidents are hourly, and operations daily occurrences, one more or less seldom creates much excitement; and when I go on to say that this case excited more interest among residents and nonresidents than almost any other case I ever saw in the hospital, I wish you to clearly understand that this fact was due entirely to the extreme professional interest in the case and the great enthusiasm of St. Michael’s men for the study of surgery. At the same time, I may state, although not particularly bearing on the question, that the patient was an uncommonly pretty, girl; and day after day passed by without any light being shed on the question as to who she was and whence she came —circumstances quite sufficient to excite in a mind not pre-occupied with such matters as burden the intellect of the average medical student, the liveliest interest and curiosity. After the operation she was at first too ill to be interrogated, when she got a little better she declined to give any information ; at any rate, none could be obtained from her. Perhaps she was a little “queer” with feverish or hysterical excitement.
At the expiration of two days I went in to help with the dressings. She was very grateful for everything done for her, and bore her pain very well. For a long time she was in a very critical state. As the euphonious phrase of the young profession went, “She had a very close shave for it.” At the end of three weeks, however, she was in fairly smooth water, and for the first time some of the clinical class went in with Sir Carver Smith to see the case. Hd had hitherto said nothing on the subject of the operation. He was a man of few words; but one word of praise or blame from him was never forgotten by any of us. Turning to us from the patient, he said. “ This, gentlemen, is a case of so-and-so,” and he briefly explained it. Then he added : “ Nothing but the most exceptional circumstances could justify a house surgeon in this hospital in undertaking an operation of such importance. In this case those exceptional circum-’ stances existed. The operation is one of great difficulty and rarity. I have once, many years ago, performed it myself, and the patient died. Had my patient recovered, such a recovery would then, I believe, have been without precedent. But the gratification to myselTof having performed the first successful operation would not have been greater than is my gratification now at having under my care a case which will, I believe, recover, and whose recovery will be due, without doubt, to the prompt and skilful action of a St. Michael’s Student, my own house surgeon, Mr. Adams.” “ Strong for Carvy, and good for Adams ” was the general comment. Adams pretended to be writing notes; but there was not one of us who would not readily have suffered “ plowing ” in our “ final college ” to gain such a word from Carver Smith.
And now my fair readers, if you will turn to the clinical report of the celebrated case in the pages of the Lancet, somewhere about March, 18—, you will find it stated that “after this point the case presents no features of special interest ; convalescence was rapid, and the patient was discharged cured on the forty-seventh day after admission.” I therefore give you fair, notice that you may lay down this record here and not read any further unless you like. , Yes ; she recovered rapidly; and prettier and prettier she grew as she got better. She talked very little, and said nothing at all to help her identification. Inquiry was fruitless, even though the case got into the newspapers. The interest among the students increased daily. It was reported that she was an heiress Who had quarrelled with her guardian ; that Adams was madly in love with , herthat she was waiting for- him to propose, and then would marry off-hand ; that Adams knew all about her, but kept it snug. And then men got to chaffing.him ; in a mild sort of. a way, wanting to know the “state of the heart,” and the chances of “ union by first intention.” But Adams was impenetrable. Personally? I am inclined to think that, whatever the condition of his patient’s heart might be, he was a little affected in that region.. : She was evidently very, fdnd'of him, and liked no one but him
to dress the wound. Still the mystery increased.
(To be continued.)
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Ashburton Guardian, Ashburton Guardian, Volume 2, Issue 225, 24 December 1880
THE CHIMNEY CORNER. Ashburton Guardian, Volume 2, Issue 225, 24 December 1880
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