CH.-L' 
 ;'TAI/ 
 
 JAMES G MUMFOKD 
 
 m 
 
 m s 
 
 m
 
 A DOCTOR'S TABLE TALK
 
 [A DOCTOR'S 
 
 TABLE TALK^ 
 
 t 
 
 BY JAMES GREGORY MUMFORD, M.D. 
 
 LECTURER ON SURGERY IN HARVARD UNIVERSITY, ETC. 
 
 BOSTON AND NEW YORK 
 
 HOUGHTON MIFFLIN COMPANY 
 
 <$be ttttutjtitie pte&i Cambridge 
 
 1912
 
 COPYRIGHT, IQI2, BY JAMES GREGORY MUMFORD 
 ALL RIGHTS RESERVED 
 
 Published October iqig
 
 TO 
 S. WEIR MITCHELL 
 
 GREAT PHYSICIAN AND BELOVED MAN OF LETTERS 
 
 THIS BOOK WITH SINCERE AFFECTION 
 
 IS INSCRIBED BY 
 
 THE WRITER
 
 NOTE 
 
 IN consigning this little book to a kind and 
 ingenuous public, I make one emphatic protest: 
 the fictitious persons here described do not repre- 
 sent actual individuals. Dr. Primrose, Dr. Ely, 
 Dr. James, Dr. Flaxman, Dr. Consequence, Scho- 
 lasticus, Scriba, and the rest have no true proto- 
 types. They are composite studies. There is one 
 exception : Dr. Optimus (chapter vi) is that remark- 
 able man, Dr. Edward Fitch Gushing, of Cleve- 
 land, and my very dear friend, now dead. 
 
 Actual public and historical characters are not 
 disguised, but are truly named in the text. 
 
 J. G. M.
 
 CONTENTS 
 
 I. THE DOCTOR'S HABITAT i 
 
 II. DOCTOR AND PATIENT I .... 20 
 
 III. DOCTOR AND PATIENT II . . . 41 
 
 IV. SOME DOCTORS AND THEIR TROUBLES . .67 
 V. DR. PRIMROSE ON WOMEN .... 95 
 
 VI. THE DOCTOR is A PATIENT . . . .115 
 
 
 
 VII. DR. PRIMROSE ON SOCIALISM .... 140 
 
 VIII. REFLECTIONS AMBROSE PARE . . .160 
 
 IX. HOSPITAL TALK . . . . . . 200 
 
 X. REMINISCENCES . 222 
 
 XI. A LETTER FROM SCRIBA TO HIS SON . . 245
 
 A Doctor's "Table Talk 
 
 CHAPTER I 
 The Doctor's Habitat 
 
 MY friend Dr. Myers does not live in the town of 
 which I approved, for he is happily indifferent to 
 his surroundings, as well as to the canons of good 
 taste. Should you drive from Concord, Massa- 
 chusetts, to Milton, you may, if you choose, travel 
 for half a mile or more on a vast road which the 
 admiring natives call a "boulevard." It is very 
 wide; it bounds nothing; it leads nowhere; stretches 
 of unimproved land surround it with sand-pits, 
 forlorn spaces, goat-ranges and tin-can depositories. 
 In the midst of the boulevard runs a double trolley 
 line the gibbet-like posts stretching off in a 
 straight, meaningless perspective. Parallel drives 
 on either side of the rails bear countless motor-cars, 
 with sad occupants, speeding voiceless; while 
 rarely a gloomy horse drags forth a Sunday van.
 
 A Doctor'' s Table Talk 
 
 The region is inhabited. For miles on either side 
 stand rows of wooden houses, "villa apart- 
 ments," they are called, garish, ornate, tall, 
 shapeless, with countless piazzas and balconies, 
 cupolas, bow-windows, and unnamed bizarre pro- 
 jections; of many colors : pink houses, green houses, 
 purple houses, yellow houses; houses of strange 
 design, striped and starred and squared. People 
 live therein. Late on a summer's afternoon, as 
 you drive past, you will see weary fat men, in 
 shirt-sleeves, rocking on the balconies, smoking 
 cigars, and gazing solemnly at the tin cans below. 
 Stout, black-haired women rock with them, and 
 pursue a ceaseless knitting. Listless, unhealthy 
 children throng the gutters, or whine unnoticed 
 from open windows. 
 
 It is a dreary company; but it swarms with in- 
 crease, and doctors are in demand. Into the midst 
 of these people young Myers made his way, and 
 among them he settled to the practice of his art. 
 
 He was right, and I was wrong. That settling 
 of his took place ten years ago, and now he rules 
 the region with a kindly sway. He lives in a great 
 pink house, which he owns. He is happily married 
 and a busy father. He has learned to sit inarticu-
 
 The Doctor's Habitat 
 
 late, with others of his kind, on a summer evening, 
 mysteriously exchanging views of neighborhood 
 interest. Rarely, I, too, have been admitted to 
 these solemnities. Dr. Myers has called me in 
 consultation ; I have sat in the midst of his patients ; 
 I have dropped feeble words of advice, and have 
 gained their mild good will. My friend tells me 
 that, for himself, he is satisfied; that he has found 
 his place. Happy man; thrice blessed of the gods; 
 Deo favente, indeed. 
 
 To most of us that question of where to settle is 
 a mighty problem. For many years my student 
 friends, about to leave the hospital, and seek an 
 establishment, have consulted me regarding their 
 plans, and each man's problem contains new and 
 difficult features. The bald question, "Where shall 
 I locate?" which the young doctor confidently 
 asks, regardless of the English language, admits of 
 no simple answer. In his problem there are several 
 items of which I want to know. Nowadays these 
 young men are not products of a single mill. Some 
 of them are trained as surgeons; others as intern- 
 ists. Some wish to specialize more narrowly; some 
 few would fain be general practitioners. Some 
 long for a country life; others for city practice;
 
 A Doctor's Table Talk 
 
 some turn to the army or navy; while others, again, 
 care not what they do so long as they get promptly 
 to work and make a living, for there is a girl in 
 port, and they would marry and be happy, 
 good human souls. And yet, mostly, the talk and 
 the planning and the beating of heads is as naught. 
 It's the man that counts, and not the place. Every 
 large city among us abounds in sons of successful 
 physicians. The father's fame is not transferred 
 The son rises or falls like the rest of his kind. For 
 years Robert Koch was an unknown country doc- 
 tor in Wollstein. One of the best-known surgeons 
 in New York City to-day was an "upstate" lad 
 without influence or acquaintance; and the most 
 popular surgeon in Boston was a country boy who 
 hewed his own way. In a small Northwestern vil- 
 lage, far from the haunts of men, there flourishes a 
 little company of surgeons and physicians whose 
 work has made them famous the world over. How- 
 ever, for the average man of moderate attainments 
 and commonplace ambition, doubtless the location 
 counts. Oliver Wendell Holmes advised such to 
 open an office in the most conspicuous house on 
 Beacon Street, and trust to luck. 
 
 If a man who has not had the advantage of a
 
 The Doctor's Habitat 
 
 residentship in a great hospital wishes to devote 
 himself to surgery, he may choose one of two 
 courses: assuming that he has a little money to 
 carry him on for a few years, let him settle down 
 quietly in the city of his choice, among congenial 
 surroundings ; seek opportunities for research work 
 in laboratories, clinics, and libraries; bide his time, 
 take what comes his way, and learn something, of 
 his kind as stray samples of humanity drift past 
 him. Or, secondly, if he have true ambition and 
 a wish to strike early and deep into the surgical 
 field, knowing himself, perhaps, and his limitations, 
 let him cut loose from timid hoverings about old 
 haunts; let him, while still young, go out boldly 
 into some of those new regions in which our coun- 
 try abounds. There let him grow up with the 
 place, stimulated by his new opportunities, and 
 expanding broadly and generously with the vigor- 
 ous life about him. In five years he will smile 
 with pity at his mild colleagues, clinging to that 
 conventional community, the dust of which he 
 himself has shaken from his feet. If I were again 
 and now beginning the surgeon's life, such adven- 
 turing would be my course. 
 
 Perhaps a majority of the physicians in our land
 
 A Doctor's Table Talk 
 
 live in small cities and towns of established size 
 and considerable age. Such communities should 
 be sought out far more commonly by our best- 
 trained young men. At present jealousy and pro- 
 fessional backbiting are unhappily prevalent in 
 many of these places; but if a man in such a town 
 can command his soul, his temper, and his tongue, 
 he will live down envy, hatred, and malice before 
 long, and will find his lines to be laid in very 
 pleasant places. If he is trained properly in a 
 specialty, let him cling to that specialty and so 
 increase the number of his friends in the profession. 
 A common cause of professional bad blood in small 
 cities is the custom among some of their general 
 practitioners of holding themselves out as experts 
 in a specialty. That is a bad combination. Other 
 general practitioners protest, and refuse to send 
 them special cases. The genuine specialists protest, 
 and regard them as hybrid humbugs. In these 
 places of moderate size, however, is to be found a 
 good living, a pleasant and satisfying life, and fame 
 if our hero is worthy. 
 
 Then there is the bona-fide country doctor. 
 Truly, if he be a man of education, culture, appre- 
 ciation, and devotion, his life may well be the
 
 The Doctor's Habitat 
 
 happiest of all. The other day, my friend Dr. 
 Primrose, a physician in a mountain village of New 
 Hampshire, said to me: "I never could understand 
 why you men settle down in the cities. The best 
 years of your lives you spend on the rack, working 
 yourselves to death to get practice; and later, 
 when you're established in heavy practice, you 
 find you've forgotten everything else; and you 
 grind away at the dreary routine until you drop. 
 For me, I live. Life is very pleasant. I pass 
 my time in a beautiful country and in healthful 
 surroundings. I am always with nature. I have 
 time to know and enjoy my wife and children; I 
 have enough work to keep me busy, contented, 
 and reasonably prosperous, but not so much as- to 
 wear me out. I can read and think and travel. You 
 men struggle and succeed, and then half of you 
 collapse." In some measure he is correct ; and cheer- 
 ful are the days I pass with this kindly philosopher. 
 Sometimes, of a summer midnight we've driven 
 out together, a silent and happy time for a man 
 of feeling. The shadows fall from the hillside; the 
 sounds of country night mingle in drowsy harmony; 
 in the distance a dog barks; the moonlight sifts 
 flickering through the leaves, and the dusky road
 
 8 A Doctor's Table Talk 
 
 lies dimly undefined. At our feet, as we jog round 
 a curve, the waters of the lake lap gently the con- 
 stant shore; a tree toad, unceasing, sings his song; 
 the wind sighs among pastured elms, obscure, 
 remote; mist settles on the face of the waters. 
 Overhead the stars sing together in their courses, 
 the moon presides with gentle radiance over all. 
 The dawn begins to break. Far away a cock crows 
 on a hilltop ; and now, at our feet, from the valley 
 a voice replies. A mist rises about us; the air is 
 chill. Infrequent lights appear on distant slopes; 
 the chirp of birds is heard, scattered, at first; un- 
 certain, faint; then, gathering strength, constant, 
 sustained, soaring in mingled choir. Rocks, trees, 
 and shrubs take form; the way grows clear; a 
 mountain-top glows in the rising sun. We climb 
 an upper road, circling the hill. The morning wind 
 blows fresh upon our eyes. A battered house 
 stands close against the trail; the old horse stops. 
 Such are some of the errands of Primrose, the 
 country doctor; it is the life he loves; the poet often 
 illustrates the man. Doubtless he is in some sense 
 right about those of us who toil ceaselessly among 
 men. Against us he quotes Stevenson's delightful 
 words: "Extreme busyness, whether at school or
 
 The Doctor's Habitat 
 
 college, kirk or market, is a symptom of deficient 
 vitality; and a faculty for idleness implies a catho- 
 lic appetite and a strong sense of personal identity. 
 There is a sort of dead-alive, hackneyed people 
 about, who are scarcely conscious of living except 
 in the exercise of some conventional occupation. 
 Bring these fellows into the country, or set them 
 aboard ship, and you will see how they pine for 
 their desk or their study. They have no curiosity; 
 they cannot give themselves over to random provo- 
 cations; they do not take pleasure in the exercise 
 of their faculties for its own sake; and unless 
 Necessity lays about them with a stick, they will 
 even stand still. It is no good speaking to such 
 folk; they cannot be idle; their nature is not gener- 
 ous enough; and they pass their hours in a sort of 
 coma which are not dedicated to furious moiling 
 in the gold-mill." 
 
 As regards physicians, such reflections are not 
 altogether fair. Wherever they live, or whatever 
 their ambitions, doctors rarely become rich; but 
 Dr. Primrose is a man of uncompromising views. 
 Almost the only one among us whom he truly 
 respects is the city general practitioner, a rare man 
 in these latter days. That is a man, he will exclaim,
 
 10 A Doctor's Table Talk 
 
 who attends to his proper business the healing of 
 the sick; and he twirls his cigar and pulls at his 
 hair as he strides up and down my study. Then he 
 becomes personal: "I mean Ely, Bill ,Ely. He 
 promised well when we were all at the hospital 
 twenty years ago. He liked folks, and he knew 
 how to take care of 'em. He was always on his job, 
 as you say; and they tell me he's on it still." 
 
 This is all true enough; Ely has made good; but 
 then Ely is a rare soul. He set up an office near me 
 when he began practice, and I have seen his daily 
 work ever since. He looked towards general medi- 
 cine (they call such men "internists" nowadays), 
 while I looked towards surgery. To a wide experi- 
 ence he united learning and courage. He has suc- 
 ceeded beyond his earliest dreams; but then he 
 hungers for work, and depends on no location. 
 The sick and unfortunate seek him. He belongs 
 to that old school of practitioners who believe in 
 the doctor's personal influence and contact. He 
 loathes the modern notion of a mechanical practice 
 which depends solely on steam, serum, and test- 
 tubes, but disregards personality, wisdom, sanity, 
 and friendliness in the family physician. Once a 
 year he and Primrose come together at my table
 
 The Doctor's Habitat 1 1 
 
 to exchange and refresh their views, Ely all 
 sympathy and encouragement; Primrose flashing 
 philippics and thirsting for reform. 
 
 As Primrose says, Ely has certainly made good. 
 To be sure, Ely went about his business from the 
 first in the old-fashioned way; but in considerable 
 measure that is what people still want; and later 
 you shall hear the two men arguing the relative 
 advantages of the old and the new. Beyond per- 
 adventure, Ely has succeeded by his untiring 
 devotion to clinical medicine. He consults detail. 
 When he opened his first office and installed one 
 of the early telephones, he saw to it that that tele- 
 phone was always intelligently answered. Think 
 how the ordinary telephone is answered, he would 
 lament. Some fool takes down the receiver and 
 says, "Well; what do you want? No; I can't tell 
 you when he'll come in. Call up whom? what 
 name? Murdock? Murphy? Mumpy? Well, spell 
 it. Oh, Carter. Yes, I'll tell him"; and then she 
 goes upon her gadding way, diligently forgetful of 
 the message. 
 
 "Fancy the indignation of poor Mrs. Carter," 
 groans our friend. " When you call a doctor, you 're 
 in pain or trouble. You want him. You don't want
 
 12 A Doctor's Table Talk 
 
 to gossip. You mean business; and that's what the 
 average servant does n-'t seem to understand." 
 
 So Ely imposed an invariable standard reply to 
 telephone calls, in case he was not at home: "No; 
 Dr. Ely is not in; but I can get him for you in a 
 few minutes. What is your number? He will call 
 you." Only last week I had occasion to telephone 
 him, when I received that same familiar reply 
 which his office attendant has been sending out 
 these twenty years. It must have secured to him 
 countless friends and thousands of dollars in all 
 this time. 
 
 Such methods are sometimes called "tricks of 
 practice" by the fools and the faithless among his 
 contemporaries and rivals, but Ely has something 
 better than tricks of practice to offer his patients. 
 I have said that he has knowledge and ability. He 
 began by studying the habits of his community. 
 He observed that great numbers of prospective 
 patients deserted the city every year during the 
 summer and autumn months, migrating to such 
 seaside places as Atlantic City, Beverly, and New- 
 port. So he followed them. One prosperous sum- 
 mer he spent in Saunderstown, near Newport; then, 
 the next year, encouraged by success, he descended
 
 The Doctor's Habitat 13 
 
 boldly upon Newport itself, where he was soon 
 appreciated and properly valued. Now for eighteen 
 years he has spent his time between Newport and 
 his home city. He has made those two communi- 
 ties call for him and respect him because he has 
 cherished his patients in the old-time manner, and 
 has made their troubles his own. 
 
 This means a generous and sincere love of his 
 kind. Such love is a quality that grows with a 
 man's growth. It cannot be aped and cultivated. 
 It cannot be imitated successfully for eighteen 
 years. Ely follows his patients. He coordinates 
 the generations. From the cradle to the grave 
 whole families hang upon him. He cares for the 
 babies in their growings-up until they have babies 
 of their own. He is a storehouse of strange family 
 histories and appropriate wisdom. 
 
 One day, perplexed and indignant, Dr. Ely came 
 to me to talk over one of his problems, which he 
 called "The Folly of the Vanderpoels." He had 
 known the Vanderpoels for some ten years only. 
 He called them one of his new families. They fol- 
 lowed him from Newport. At the time of their 
 first coming there was a cheerful, sparkling father, 
 a joyous man of middle age, immersed in carnival
 
 14 . A Doctor's Table Talk 
 
 habits. There was a high-hearted mother, giving 
 herself wholly to her many children. There were 
 two sons and four daughters, of whom Ellen was 
 the youngest. They took a big house, spent more 
 money than they should, and then, shortly, the 
 joyous father fell a victim to typhoid fever and 
 died. Ellen, our heroine, was fourteen, a shy, seri- 
 ous child always buried in her book, or by the. 
 hour long practicing her violin. For the winter 
 after Mr. Vanderpoel's death, the mother, with her 
 girls, went to Europe, where they spent most of 
 their time during some years, returning home for a 
 month or two only every summer. 
 
 "Now," said Ely, "you must suppose that sun- 
 dry cheerful American girls, turned loose in sundry 
 German watering-places, will attract a certain 
 amount of attention. And of course our Vander- 
 poel girls have had their heads turned by those 
 insufferable German and Austrian officers. What 
 should happen but that our little friend Ellen, now 
 a twenty-year-old beauty, must fall in love with 
 some brass buttons, a sword and a mustache. 
 The cub seems to be a decent enough cub, for he 
 reciprocates, and the two have been planning 
 matrimony; she's been at home the past two
 
 The Doctor's Habitat 15 
 
 months buying stockings and other wedding gar- 
 ments. 
 
 "In the mean time her officer, a captain in a 
 royal guard regiment, or something that sounds 
 like it, has been having the deuce of a time getting 
 permission to marry. It seems that the officers in 
 certain Austrian regiments must not marry for- 
 eigners. So this poor fellow has been having a 
 bad time of it; but finally, through family and 
 court influence he has secured a special permit and 
 absolution from the Emperor himself to marry our 
 friend Ellen. So he's temporarily shed his brass 
 buttons, concealed his sword in his trunk, clothed 
 himself in the unbecoming garments of a Viennese 
 civilian, and will arrive here to-night at eight 
 o'clock to claim his bride; and what do you 
 suppose she is doing? She's locked the door of her 
 room taking care to leave open the communi- 
 cating door of her sister's room; she's gone to bed 
 in hysterics; she sobs that she 'hates the shape of 
 her captain's nose, that she will not see him, and 
 that she'll never, never, never marry him." 3 
 
 So they sent for poor Ely, and begged him to 
 persuade the girl to decency and her duty. But 
 his interference was of no use; of course it was of
 
 1 6 A Doctor's Table Talk 
 
 no use, as Ely told them before he began his task. 
 His heart was not in it. For all he knew, Ellen 
 was right. He handed her the usual platitudes, 
 describing the humiliation of her family and the 
 shock and misery of the insulted Austrian. It was 
 hopeless; she turned her face to the wall, refused 
 to argue, and sobbed out at intervals, "I can't 
 help it; I hate him, I hate him, and I'll never 
 marry him." And she kept her word. A brother 
 and a sister met the poor, unsuspecting, smiling 
 wretch at the train, and told him his fate. He 
 refused to believe them, of course. He stayed in 
 town for a week, trying to get speech of his be- 
 loved, but in vain. He haunted her house for days, 
 taxing the patience and vocabulary of mother, 
 brothers, and sisters; he even discovered poor Ely, 
 and drove with him for hours, exhausting his sym- 
 pathy and his most cherished German idioms. He 
 refused food and comfort, he lived on beer and 
 cigarettes, he began to cultivate a wild disorder 
 of whisker about his foolish countenance; and at 
 last, amid a deluge of tears, and sighs of Vander- 
 poel relief, he was led away to Vienna by poor 
 Ellen's distracted eldest brother. That good soul 
 never left him until he had delivered him safely at
 
 The Doctor's Habitat 17 
 
 his barracks, when he himself escaped to Paris for 
 a two weeks' convalescence. What became of the 
 broken-hearted lover Ely never heard; but one 
 imagines the Gargantuan applause of his comrades 
 when they heard his tale; the anger and mortifica- 
 tion of his superiors; and the avidity with which 
 poor Fritz sought the consolation and sympathy 
 of some kindly neighborhood Gretchen. 
 
 "And the worst of it all was," said my indignant 
 friend, as he told me the completed story, long 
 afterward, "that, in spite of my silence and utmost 
 effort to keep the affair quiet, some confounded 
 reporter nosed it out, and, two days after the cap- 
 tain had left for home, told the whole yarn, ex- 
 actly as it occurred, names and all, in one of the 
 Sunday papers." The exposure was too much for 
 human endurance. The family left town, and have 
 never returned. 
 
 Perhaps I have gone out of my way and have 
 wandered from our subject in telling this episode of 
 the Vanderpoels. It illustrates, however, the variety 
 of a physician's problems. Ely sometimes refers to 
 it in our discussions, and I think he still regards it 
 as one of the most difficult of the social and psy- 
 chical phenomena with which he has had to deal.
 
 18 A Doctor's Table Talk 
 
 Of all my friends among physicians, however, I 
 turn most often to Dr. Primrose, when I look for 
 detached views and a wide perspective. "To go 
 back to your original question," he says, "let me 
 observe that in the main I agree with you about 
 localities, though what you state is true of all men 
 in all vocations. I know many doctors, from Port- 
 land, Maine, to Portland, Oregon; and from Mon- 
 treal to San Antonio. I attend their annual meet- 
 ings; I like them. The able and efficient always 
 make themselves felt. Their location has little to do 
 with their success. I've come to the conclusion 
 that the second-raters and the lame ducks are the 
 fellows most particular about their place of abode. 
 Yet, after all, did it ever occur to you that the 
 second-raters are doing most of the work of the 
 world? Few of us can be leaders. Most of us must 
 get down into the pit, and grind faithfully at the 
 mill, without hope of distinguished reward. To 
 most of us, then, the question of location matters, 
 but only in so far as it concerns competition. With- 
 out rivals we get along more comfortably com- 
 petition stimulates the elect, the leaders; it dis- 
 courages the rest of us. After all, given a good 
 education and some experience, faithful service is
 
 The Doctor's Habitat 19 
 
 what brings success to the average doctor; and I 
 don't care where he serves. I'm old-fashioned 
 enough," he adds, "to believe in the golden rule, 
 good ethics, and a square deal. It does us no harm, 
 too, to reflect sometimes on those fine old words of 
 the Psalmist: 'Blessed is the man that walketh not 
 in the counsel of the ungodly, nor standeth in the 
 way of sinners, nor sitteth in the seat of the scorn- 
 ful. But his delight is in the law of the Lord; and 
 in his law doth he meditate day and night.' "
 
 CHAPTER II 
 Doctor and Patient / 
 
 DR. PRIMROSE, from the New Hampshire hills, 
 and Dr. Ely, from Madison Street, met at my house 
 the other night for one of our annual dinner talks 
 on medical topics and life in general. Both my 
 friends were at their best, and kept the ladies long 
 at the table. Primrose held forth for a time on 
 present-day teaching in the universities; and the 
 educators , as the newspapers call them, came in for 
 their usual drubbing. 
 
 "But so many of our harsh criticisms are true," 
 he said. "The college corporations are lavishing 
 money on buildings and flower-beds, while the 
 real teachers are starving; and untrained boys are 
 set over the students in the classrooms. Here's a 
 yarn a freshman friend of mine told me last night. 
 It appears that the ambitious fellow has elected a 
 Greek course. His class of twenty are reading the 
 Odyssey. Now, you will admit, Ely, that that gives 
 an unusual chance for the real teacher in these 
 hard-headed days ; that is a very great poem, little
 
 Doctor and Patient 21 
 
 read of late, about which old custom and tradition 
 have grouped a vast library of some of the most 
 interesting criticism in the world's literature. 
 Think what the Odyssey has stood for these three 
 thousand years, to the peoples and the poets of the 
 world. 
 
 "So I said to my freshman friend, 'Good; that's 
 splendid. It's the literature of the gods. Isn't 
 your instructor delighted to have so large a class 
 this year? Does he give you some of his own 
 enthusiasm?' 
 
 "'Well; no, sir,' says my friend, with a grin; 'his 
 principal interest is to find out how much we use 
 trots.'" 
 
 " I know, I know," said Ely, with a sad shake 
 of the head. He himself is an overseer of his uni- 
 versity. "There's no doubt that the fundamental 
 trouble is with our governing boards; but consider 
 how difficult, or almost impossible, it is to find 
 university governors or trustees who are trained 
 for their job. They are business and professional 
 men, who are important in their communities. 
 They are chosen governors because they are im- 
 portant; but they are immersed mostly in their 
 own affairs. They know nothing, at first, about
 
 22 A Doctor's Table Talk 
 
 the conduct of great or small university matters; 
 and, even later, they rarely succeed in handling 
 those affairs to the best advantage, except, in the 
 case of the investment and expenditure of money." 
 
 "Yes, yes," quoth Primrose; "and I know that 
 the true teacher is a rare man, a gift of God, indeed. 
 How many real teachers had you? I knew two. 
 One was the great head master of our old school; 
 the other was a college professor. In the medical 
 school we had no great, informing, and stimulating 
 teachers, as we should have had." 
 
 My companions sat silent for a time, wagging 
 their heads over the lamentable situation. 
 
 Said Ely; "Our best medical schools are run too 
 exclusively for the race-horses. The average man 
 does n't get enough mental stimulation, or practical 
 advice about how to make his living. I see the 
 results constantly among my younger consultants 
 who come to me for help and direction. And then 
 there is that protest which the doctors are raising 
 throughout the land: 'What's the matter with 
 practice ? Have the people lost confidence in medi- 
 cine?'" 
 
 "About that last question the attitude of the 
 public," remarked Primrose, "I have a word to
 
 Doctor and Patient 23 
 
 say, though I cannot pretend, in a sentence, to 
 clear up a most complex situation. The puzzled 
 uncertainty of the public and their rather irritating 
 skepticism should not surprise us. The academic 
 explanations of our sundry theorists that we 
 are inefficient, that our standards of education are 
 uncertain, etc., etc. are mostly rubbish. A hun- 
 dred years ago, when we were far less efficient and 
 well trained, the public trusted us with little ques- 
 tion. 
 
 "The fact is, our professional fathers and grand- 
 fathers, back to the five hundredth generation and 
 earlier, persistently fooled the public. Our genera- 
 tion has, quite properly, attempted to reverse the 
 practice and tradition of the ages, by taking the 
 public into its confidence, and attempting to discuss 
 with the public our scientific problems. You can- 
 not blame the fathers for their methods. Humbug 
 and tomfoolery were much of the stock in trade of 
 the priests, wizards, and medicine-men from whom 
 we are descended. The same was true of all pre- 
 tenders to knowledge. Throughout history, you 
 will find the man who knows some one thing a little 
 better than his neighbors making a mystery of ft, 
 and trading on his possession. The history of
 
 24 A Doctor's Table Talk 
 
 religion shows the same tendency among bigots. A 
 few great souls only have withstood the temptation. 
 Our doctors, even fifty years ago, were walking in a 
 maze of uncertainty and puzzlement. Only after 
 Virchow, Pasteur, Koch, and a few others showed 
 us the nature of disease, did we begin confidently 
 to plant our feet on firm ground. But the public 
 don't understand all that. They are looking al- 
 ways for immediate results. They persist in think- 
 ing that medicine is an exact science, as much as 
 algebra; and we cannot make them see that it must 
 be compared rather with farming or gardening. 
 
 "Now we have come out in the open, and are 
 trying to tell the public what we are doing and 
 attempting. They cannot or will not understand 
 us. They're always looking for some underhand 
 dealing or concealed meaning. Through their own 
 ignorance, or lack of careful training, they fail 
 utterly to comprehend our accurate, critical, scien- 
 tific attitude of mind. Thank God ; there are a few 
 great exceptions, the Hannas, the Rockefellers, 
 the Carnegies and the Morgans. As Ewing 1 said the 
 
 1 Professor James Ewing, " The Public and the Medical Pro- 
 fession." Address before the New York Academy of Medicine, 
 November 16, 1911.
 
 Doctor and Patient 2$ 
 
 other day in his talk at the Academy of Medicine, 
 and I read it from this journal lack of public 
 sympathy with the medical profession 'is seen in 
 the crude and halting manner in which medical 
 topics are handled by distinguished writers, clergy- 
 men, lawyers, statesmen, and public officials. The 
 efforts of the daily press to furnish information on. 
 medical topics consist of sensationalism, person- 
 alities, wonder tales, absurdities. The National 
 Government, however, has at last awakened to the 
 necessity of a National Bureau of Health, such as 
 has long existed in other countries. Yet, instead of 
 going ahead with it, we have the astonishing spec- 
 tacle of the President of the United States holding 
 a public hearing to debate the question.' Let so 
 much stand for my present contribution to this 
 very difficult subject, which has troubled me 
 much." 
 
 "Fundamentals and panaceas are, of course, the 
 most interesting subjects for discussion," Ely re- 
 marked; "but my younger friends ask me for some 
 practical means of improving their incomes. I tell 
 them, first of all, to get and read carefully James 
 Jackson's 'Letters to a Young Physician,' and then 
 I talk over with them the dozen or more important
 
 26 A Doctor's Table Talk 
 
 details of practice, which we learn by a hard 
 experience only. 
 
 "So long as we have started on this rather 
 technical subject, let's explore it further. It's 
 interesting, and you can help me. Just to show 
 you what inane things a recent graduate may do: 
 I met this morning my very good friend John 
 Strong. Now, Strong is an important man, whose 
 name goes a long way in this community. His 
 family are not regular patients of mine. It seems 
 that last night one of his children developed what 
 their trained nurse took to be diphtheria. Strong 
 went in great haste, about one in the morning, for 
 young Hamblen in his neighborhood, whom, as a 
 competent general practitioner, I had recom- 
 mended to him; and what do you suppose Hamblen 
 did ? He informed Strong that he could not see the 
 patient, as he does not take cases of diphtheria. 
 Of course Strong was furious. He went home and 
 telephoned to me; I went over there, took cultures, 
 and turned the case over to my assistant. I don't 
 think it is diphtheria. 
 
 "This morning I had a pleasant talk with that 
 young donkey, Hamblen. It seems he had a notion 
 that he might have some sort of a surgical case this
 
 Doctor and Patient 27 
 
 week. 'Did you tell Mr. Strong?' I asked. No, he 
 had not told Strong. At the least, he might have 
 gone to his patient's house, interviewed the nurse, 
 found another doctor for the child, and taken the 
 responsibility off from the parents' shoulders. But 
 no, he could think of nothing better to do than 
 shout, 'No! No!' and slam the door. That young 
 man was a good undergraduate student." 
 
 "Your friend Strong has a deficient sense of 
 humor," said Primrose; "the other day a doctor 
 I know told a patient to close his eyes, put his 
 thumb to his nose, and stand on one leg. As the 
 man was leaving the office, he said to the doctor, 
 'Why did you make me stand on one leg and all 
 that business?' 'Oh,' said the other, grinning, 'I 
 wanted to give my small boy practice with his new 
 camera.' The patient was a Hebrew. He brought 
 suit against the doctor for malpractice, and recov- 
 ered one hundred dollars. He had no sense of 
 humor either." 
 
 "We must not be too hard on the beginners," 
 Ely replied. "Entirely aside from his technical 
 training, the business of being a doctor is difficult, 
 intricate, personal, and calls for a very superior 
 form of tact and sense. It is for want of these quali-
 
 28 A Doctor's Table Talk 
 
 ties that so many physicians, both men and women, 
 fail; and I am not sure but what the women make 
 worse failures than the men. I suppose because 
 women, more than men, are tenacious of their own 
 opinions. That sex element is a curious thing, by 
 the way. Did you ever notice how most women 
 nurses resent being under the orders of women 
 doctors?" 
 
 Primrose seemed to agree, although he commonly 
 holds women and women's achievements in the 
 highest regard. 
 
 The discussion of practice by these two men 
 leads me to formulate some of the views which I 
 have often expressed to my younger friends in 
 their early years of business. I find that Ely in- 
 dorses me in the main. This discussion takes no 
 account of technical training. A good, scientific 
 training is assumed. We are talking about the 
 more superficial aids to practice, with a glance, 
 perhaps, at some questions of ethics and etiquette. 
 
 As the young doctor thinks of superficial, but 
 important aids, let him make three divisions of his 
 problem: first, his own personal setting, house, 
 office, and location; second, his attitude towards 
 patients, his method, his manner, the human
 
 Doctor and Patient 29 
 
 relation, and his regard for the individual; third, 
 his professional relations, his associates, the 
 medical societies to which he belongs, his medico- 
 social activities, and his contributions to the pleas- 
 ure and information of his fellows. 
 
 In spite of what may be said about superior men, 
 and their success no matter where they live, the 
 question of location is important to most of us 
 average men. I am not referring to the broad 
 question of city, town, or country; but in what 
 part of the city or the village shall the young 
 doctor open his office, and hang out his "shingle"? 
 The general practitioner, or the surgeon, in most of 
 our eastern American cities and towns, will do well, 
 still, to appear to occupy his own house and to have 
 his office there; and the more conspicuous the house 
 the better. In our old communities the prejudice 
 lingers that such a combination of house and busi- 
 ness office marks a doctor as serious, conservative, 
 and of good morals. As for specialists, the old com- 
 munities regard them, like dentists, as pariahs, 
 as outside of the rules. Let them go where they 
 choose, to hotels or apartment houses for their 
 offices; and, indeed, they do often abide in such 
 convenient places. In most American cities, how-
 
 30 A Doctor's Table Talk 
 
 ever, cities and towns beyond the Atlantic sea- 
 board, a much more convenient and reasonable 
 custom now prevails. In those places, the doctors 
 have learned, like lawyers and other professional 
 men, to keep separate their homes and their busi- 
 ness. Quite commonly, special buildings are erected 
 for doctors, or doctors group themselves in con- 
 verted private houses, in apartment houses, in 
 hotels, or even in ordinary business blocks. It 
 makes little difference where they go so long as 
 they command easily those neighborhoods in 
 which they wish to find their patients. And 
 observe this, that a doctor must be able to live on 
 the same financial scale as his neighbors. If he is 
 in a tenement district, he may live from hand to 
 moutH, as a poor man. If he is in a middle-class 
 district, he may live on a small scale spending 
 from a thousand to fifteen hundred a year; but if 
 he is surrounded by well-to-do or rich people, he 
 must plan to spend money freely. His patients 
 among his neighbors will expect to find in his estab- 
 lishment an air of circumstance, . comfort, and 
 proper distinction, not necessarily luxury and 
 extravagance, but the sort of thing they are accus- 
 tomed tp see in their own homes. Local conventions
 
 Doctor and Patient 3 1 
 
 have their significance in special localities. The 
 city practitioner who makes his calls on foot or by 
 trolley car may enjoy the confidence of his com- 
 munity, and be regarded as a prosperous and suc- 
 cessful personage, whereas his country brother, in 
 a neighboring village, must drive his horses or his 
 motor, if he is not to be thought a hopeless failure. 
 
 Wherever he lives, however, and whatever his 
 special practice, there are certain features and 
 attributes of his setting which no physician can 
 afford to neglect. A certain atmosphere, a certain 
 air of serious work and solid accomplishment, a 
 tone of smartness combined with a sense of 
 assured propriety in his house, his rooms, and their 
 furnishing, not only go a long way towards giving 
 him an unconscious sense of security, but tend, 
 through a sort of subconscious impression, to steady 
 himself, to smooth his day's work, and to endow 
 him with assurance and a feeling of professional 
 dignity and power. 
 
 The reverse of all this is sombre and depressing. 
 Not long ago I visited the house of a friend who 
 complained bitterly of his lack of patients. Flax- 
 man is a young man of rather sad address, but well 
 educated for his work, who lives in an attractive
 
 32 A Doctor's Table Talk 
 
 city suburb, among people of moderate means, 
 small shopkeepers, sober clerks, and the like a 
 distinctly non-stimulating, bourgeois atmosphere; 
 a community to be suffered, gladly or not, 
 but from which no sweetness or light can be 
 expected to emanate. They cannot yet appreciate 
 Dr. Flaxman, sensitive, reserved, unheroic of 
 aspect, a man who would cut his tongue out 
 rather than gossip of professional secrets. But his 
 neighbors and clients complained of him for other 
 reasons, and with some justice, as I could see. I 
 drove to his house in a motor, but was unable to 
 dismount at his door, owing to a dreary phalanx of 
 disreputable ash-cans which lined and obstructed 
 the curb. After floundering in the slush and ice 
 of the street, and breaking through a dingy snow- 
 bank, I encountered Flaxman on his knees, dis- 
 mally breaking up the sidewalk ice with an incon- 
 sequential hatchet. At the sight of an old friend 
 his expression changed instantly. He has a smile 
 of rare sweetness and sympathy. As he jumped 
 up from his dripping knees, I received his smile 
 full in the eyes, and we shook hands warmly. I 
 must go into the house at once and get dry, he 
 ordered. He himself would be in, in five minutes,
 
 Doctor and Patient 33 
 
 and there were cigarettes and matches on his 
 desk. 
 
 Flaxman, who is a bachelor, lived in a small, 
 detached, commonplace wooden house, with a 
 patch of lawn bearing in the midst an iron funeral 
 urn painted blue. The house has a wing with a side 
 entrance for patients, and in the wing were the 
 waiting-room and office, with a bedroom on the 
 floor above. 
 
 Making my way along the unkempt path to the 
 side door, I found it obstructed by an old pair of 
 rubber boots, a snow-shovel, and a down-at-heel 
 broom. Two pulls at the bell failed at first to dis- 
 turb the peace of the house, but finally the door was 
 cautiously opened by a collarless drab, with bare 
 arms and a water-soaked blue checked apron, who 
 seemed inclined to dispute my entrance. The sight 
 of Flaxman on the front walk was needed to con- 
 vince her that I told the truth. I sank into an 
 office chair, as she shuffled off down the passage. 
 A strident and uncompromising female voice 
 sounded from remote upper regions, demanding of 
 "Maggie" information concerning my name, sex, 
 and purposes, and animadverting in no uncertain 
 tones on the character of any person who would
 
 34 A Doctor's Table Talk 
 
 call at such an hour in the morning. Later I was 
 informed that the cross lady abovestairs was Flax- 
 man's landlady, and the mother of the collarless 
 drab. 
 
 The interior of my poor friend's establishment 
 was forlorn enough, though I knew him to be by 
 nature a man of somewhat exacting requirements, 
 interesting tastes, a reader of good books, and a 
 lover of order. The struggle of life, with disap- 
 pointment and chagrin, seemed to have changed all 
 that. Everything about his office suggested neglect 
 if not actual poverty. The passage was uncarpeted 
 and unkempt; the office door stood partly open, its 
 wider swing obstructed by a rickety table, on which 
 were piled high dozens of unopened medical jour- 
 nals, running back probably for two or three years. 
 The heavy odor of venerable cigar smoke clogged 
 the atmosphere. The room was small and over- 
 lumbered, and the two windows were inaccessible. 
 Before one window stood the office desk, littered 
 and uninteresting; before the other a makeshift 
 examining-table, constructed of two old dry-goods 
 boxes, roughly knocked together, and partially 
 covered by a disorderly rag of carpet. On the desk 
 stood an unpleasant-looking glass vase full of some
 
 Doctor and Patient 35 
 
 material for examination, while the dump of patent 
 medicine venders bottles, boxes, and ointment 
 jars added to the confusion. And yet, somehow, 
 you knew that this uncomely lair was the abode 
 of a cultured man and a student. The walls, every- 
 where, were lined with books to the ceiling, in 
 tumbled disarray, to be sure, but books, books, 
 books; German, French, and English books and 
 monographs on physiology, chemistry, bacteri- 
 ology, and practice; mingled with volumes of Hume, 
 Gibbon, Ferrero, Rhodes, Keats, Oscar Wilde, 
 Walter Pater, Ruskin, Matthew Arnold, Izaak 
 Walton, and even Bernard Shaw and Chesterton; 
 the "Atlantic Monthly," the "Outlook," "Spec- 
 tator," and "Harper's Weekly" sprawled on desk 
 and chair. Some loose sheets of unfinished manu- 
 script showed me that Flaxman continued his 
 researches on the function and diseases of the thy- 
 roid gland, while the ready microscope and micro- 
 tome in a neighboring closet again suggested the 
 serious investigator. 
 
 In spite of the hopeless confusion of the place, I 
 said to myself, How can it be possible that the 
 people hereabout do not see that this is a true 
 physician come among them, a man of attain-
 
 36 A Doctor's Table Talk 
 
 ments and ability, a man in whom there is no guile ? 
 And from his hospital record we know that he is 
 abundantly able to treat disease; or is it that the 
 people are hopeless philistines? That striking 
 passage of Arthur Benson's came into my mind, 
 naming Flaubert, of whom he writes: "It is re- 
 corded that he was pained at contact with the 
 bourgeois mind, not because such people thought 
 and felt differently from himself, but because they 
 did not really think and feel at all. They were 
 interested only in events. Their trivial volubility, 
 using the language of emotion without either think- 
 ing or feeling, was what horrified him." 
 
 Before long Flaxman joined me. He came in 
 with a deprecating smile, a shake of the head, and 
 a what-do-you-think-of-it-all ? attitude which was 
 hard to answer. I sat back in the patient's chair, 
 took a cigarette, and cogitated. Slowly light 
 dawned on me, though I knew from the first that 
 the case was far from hopeless. 
 
 "The great trouble with you, Flaxman, is that 
 you are still an amateur. You have not got to work 
 to fend off starvation. You have a small independ- 
 ent income." 
 
 "Yes, but what then?"
 
 Doctor and Patient 37 
 
 "This," I replied. "As you know, we are given 
 to dividing mankind into classes according to our 
 notions, into those who do, or do not, answer 
 letters; into those who do, or do not, close the door; 
 into those who are always on time and those who 
 are always late; and so on. For myself, I divide 
 men into professionals and amateurs; into those 
 who must work seriously in order to live, and those 
 who work, in part or in whole, for the interest or 
 pleasure they get out of it. I have been both an 
 amateur and a professional, and I know the distinc- 
 tion as many men do not. Until I was twenty-eight 
 years old, I had behind me the potential of a com- 
 fortable income all I needed. I worked moder- 
 ately, as I chose, and gained some sort of profes- 
 sional position not much. I think I was a very 
 decent amateur, but I had not grown up. Then, 
 through a series of calamities, I found myself 
 bankrupt; the little fortune swept away beyond 
 recall, and myself involved in debts and obliga- 
 tions for which I was not to blame. Fortunately 
 for my character and happiness I was recently 
 married. 
 
 "Most men in active life find their Rubicon, 
 first or last. That loss of fortune was my Rubicon.
 
 38 A Doctor's Table Talk 
 
 I seemed suddenly to have advanced from child- 
 hood to maturity, but the passage of the river was 
 involuntary and rough. For months, and perhaps 
 for years, the new life seemed to belong to another 
 person. As I walked the familiar streets in my 
 anxious and morbid state, the very buildings were 
 strange, and the old friends appeared to avoid 
 me. My only resources indeed, my salvation 
 were incessant work and the satisfaction of home. 
 Everything else went widely by me. But I trust, 
 and humbly believe, that the experience made a 
 man of me. So I became a professional. Thanks 
 to the confidence of a few generous friends I was 
 able to keep my feet for the moment, and I went 
 on. The great lesson I learned was not self-reliance, 
 thank God, most American men are born with 
 that, but a knowledge of the common lot. That 
 is what levels us and brings us into sympathy with 
 our kind. Do you know what it is to be unable to 
 meet your rent on the first of the month, or to get 
 money for the market bill, or to buy shoes for your 
 wife, or to find car fare for yourself? 
 
 "All these wants, my friend, make a valuable 
 experience, which you have never been privileged 
 to acquire. But take courage; your little bank
 
 Doctor and Patient 39 
 
 account will not hurt you much. You have never 
 had to say, I must succeed, to live; but you are 
 man enough to say, I will succeed, to make myself 
 respected. 
 
 "As I understand it, you want to be a practi- 
 tioner, not a mere student. Just cast your eye over 
 this outfit of yours. How can you expect self- 
 respecting patients to come to you in such sur- 
 roundings? Your tawdry house; your dirty side- 
 walk; your office unkempt, chaotic, down-at-heel; 
 your carpet torn; your desk littered, your examin- 
 ing-table disreputable; your closed windows unap- 
 proachable, and your whole establishment pre- 
 sided over by a strident vixen and a collarless drab. 
 Failure, in capital letters, is written large on every- 
 thing you own. 
 
 "What must you do? Get out of this office. 
 You like the neighborhood; stay in it. Live in a 
 decent, properly kept-up house; there are plenty 
 such. Find a landlady who will make your inter- 
 ests hers. Live in one room if you must, but live in 
 peace and dignity. If you can afford it, get an 
 office attendant who will devote herself to you and 
 to nothing else. Give your patients a sense of 
 privacy, comfort, and confidence when they come
 
 40 A Doctor's Table Talk 
 
 to you. Let them feel that they are dealing with a 
 successful man, who understands himself and them, 
 and will help them. Such trifles go far towards 
 making a family doctor popular. 
 
 "Of course the best thing of all for you would be 
 a proper marriage. You are the sort of man who 
 needs a domestic keeper, and none can keep you so 
 well as a wife; only don't marry a fool or a spend- 
 thrift. Whatever you do, come to me and report 
 when six months have passed."
 
 CHAPTER III 
 
 Doctor and Patient // 
 
 EARLY in June, Ely and I were on our way to the 
 New Hampshire hills for a week's fishing with 
 Primrose. By agreement he met us at Concord, 
 where we stopped off a couple of days for the an- 
 nual "Anniversary" and boat-race of St. Paul's 
 School. All three of us are old St. Paul's boys, and 
 were following a frequent plan. It was my more 
 than thirtieth "Anniversary," for I entered the 
 school as a small Fourth Former in 1878, and the 
 place is dear to me. No old school-boy forgets his 
 introduction to that new, mysterious, and some- 
 what terrifying school life. As we drive out from 
 the Concord station, two miles to the School, 
 every house, tree, and wall is familiar. There, on 
 the right, is the Phoenix, and there the Eagle 
 Hotel; why so named no man knoweth, but 
 famous in fact and fiction as the headquarters of 
 questionable party politics. On the left of the 
 broad Main Street, lined with farm wagons, and 
 punctuated with "Democrat" buggies stopping for
 
 42 A Doctor's Table Talk 
 
 neighborly salutes, and obstructing traffic, on 
 the left stands the old State House, dignified and 
 remote in its grove of elms. Now our "hack," with 
 its high-boned horses, swings off to the left, mounts 
 the hill, and bears us past the "corner store" and 
 out into the country. The broad-stretching valley 
 of the Merrimac, its fields of waving green, its 
 prosperous-looking farms, and in the middle dis- 
 tance its state fair-grounds, stretches far on our 
 front. One smells the old familiar smells of the 
 region, and begins to "sense" the School, still a 
 long mile beyond. 
 
 The day was ideal for a boat-race, and as 
 we approached the School we encountered joyous 
 groups of boys, sauntering on the road, and burn- 
 ing time. "Pleasant View," Mecca of Christian 
 Science, with its pink walls and gingerbread con- 
 struction, lies to the left; to the right is the bat- 
 tered and picturesque old Indian monument, com- 
 memorating early settlers murdered by redskins. 
 Farther down the road is the cheerful Alumni 
 House, the School inn, and beyond, in the 
 dip of the valley, and bordering road and ponds, 
 the scattered school buildings themselves, with the 
 beautiful chapel tower arising gently above the
 
 Doctor and Patient 43 
 
 trees, and presiding over all. The famous playing- 
 fields of Eton are no more precious to old Etonians 
 than are these friendly walls and gracious elms 
 and meadows to those of us who love St. Paul's. 
 
 We drove to the rooms of my old friend Scholas- 
 ticus to deposit our modest luggage, and then 
 scattered to various houses for the midday School 
 dinner, to meet later for the race at Long Pond, 
 two miles distant across the hills. 
 
 At the Pond, that afternoon, I found Scholas- 
 ticus, after some search, and, seated together on 
 the hillside, we enjoyed the races. It is a beautiful 
 sight on a clear summer's day. Long Pond lies in 
 an oval basin about two miles long and half a mile 
 wide. Farms and pine woods surround it, while the 
 slopes rise sharply from its sparkling waters. To- 
 wards the head of the Pond, which we overlook, 
 clusters of boys with their elders throng the shores. 
 The whole School divides itself into two clubs, 
 Shattuck and Halcyon, rivals now for many 
 school-boy generations. Fathers, sons, and even 
 grandsons cheer their club colors. Single shells and 
 eight-oared crews frisk upon the lake. Some ninety 
 boys in all are in the boats, "First" crews, 
 "Second" crews, "Third" crews, down to single
 
 44 A Doctor's Table Talk 
 
 scullers, they float before us. I recall to Scho- 
 lasticus the day when he was a young master, and 
 I a Sixth Form boy in one of the boats ; how with 
 no thought but of an easy victory my crew paddled 
 out to the start; and how from the word "Go" until 
 our gasping finish, we were steadily and continu- 
 ously led by our despised and pitying rivals. Poor, 
 forlorn company of lads, with broken hearts, as we 
 thought, I see us now paddling across the line, 
 and rallying to a feeble and raucous cheer for the 
 exulting enemy. 
 
 To-day, however, the tables are turned, and all 
 goes as we would have it, even to the last. A 
 "blue" sculler wins, then a "blue" Fifth crew, a 
 Fourth, a Third, a Second, a First. It is a blue day, 
 indeed, never to be forgotten, but not flip- 
 pantly to be rehearsed. The catastrophe for the 
 red is too awful and overwhelming, and the next 
 year may plunge us all in grief. The cheers become 
 few and broken; unfeeling parents only, who see 
 their boys struggling in the boats of blue, whole- 
 heartedly rejoice until the end. 
 
 A friendly motor returns us to the School; we 
 watch the flag-raising and hear the generous cheers ; 
 we sup, and as evening falls we three old friends
 
 Doctor and Patient 45 
 
 gather ourselves again with Scholasticus to gossip 
 of the School, the world, and the year that's nearly 
 gone. 
 
 Scholasticus is a charming person; of middle 
 height, erect, alert, he carries his handsome white 
 head well back on broad shoulders, while his clean- 
 shaven face and winning smile attract attention 
 and response. Though living in a somewhat eccle- 
 siastical atmosphere, he has never thought of tak- 
 ing orders, and he wears his rough gray suit and 
 dark blue tie with a certain air of distinction 
 among the black coats of some of his colleagues. 
 
 He is no hermit, no pessimist. He loves men and 
 affairs, and to talk and read of them. While Latin 
 is his specialty, his fine mind is a storehouse of 
 varied information. His zeal for facts and his curi- 
 osity about all things under the sun are never sated. 
 Perhaps his greatest attraction for others is the 
 pleasure he seems to receive from the prattle of his 
 friends, on whom he draws patiently; whose pride 
 in their powers of speech expands under his smile 
 and kindly words. 
 
 Encouraged by Scholasticus, Primrose usurped 
 the floor. "Of course Scholasticus is interested in 
 our problems," he vociferated; "he knows the
 
 46 A Doctor's Table Talk 
 
 feebleness of our minds, none better; and he 
 knows as well as we do what a mess the whole edu- 
 cational world is in to-day. And by * educational 
 world ' I don't mean the world of school and college 
 merely; I group under the word * education' all 
 that concerns intellectual progress: the education 
 of professional men and the making them efficient; 
 the education of the politicians, of the labor unions, 
 of the farmers, of the financial, manufacturing, 
 and commercial classes, of all those people 
 whose properly coordinated efforts and coopera- 
 tion should go to make the world so much easier 
 and pleasanter a place in which to live. One sees 
 clearly what ought to be done, and at the same time 
 one is impotent to accomplish results." 
 
 "Yet improvement is going on, if only you had 
 the grace to admit it," said Ely; "the world 
 is better than it was when we were boys, and 
 vastly better than it was two hundred years ago. 
 But what a banal remark! Of course to us, as 
 physicians, nothing is more obvious than the in- 
 crease in the world's population, owing to the 
 infrequency of war, the prolonging of human 
 life, the elimination of much epidemic disease, 
 and the great diminution of infant mortality. In
 
 Doctor and Patient 47 
 
 view of such facts, the common talk of race-suicide 
 sounds rubbishy. I suppose, though, you are 
 coming around to the problems of the medical 
 profession. They are what Scholasticus wants to 
 hear about." 
 
 "Nay, nay," remarks our friend the scholar; 
 "but indeed you are already on the subject. What 
 chiefly puzzles me in these days of specializing is 
 how to find a doctor in the city to take care of me 
 when I am ill. Primrose suggested that problem 
 when he spoke of progressive men and groups of 
 men failing to cooperate for the greatest efficiency. 
 Men of varied affairs don't cooperate because they 
 know too little of each other, and of how to coop- 
 erate for the greatest benefit to the public. Broad- 
 minded men of wide .general information are hard 
 to find; yet such are the men who must be found, 
 or possibly trained, to coordinate the various cogs 
 in our modern . social structure. We are making 
 progress, but very slowly, considering the intelli- 
 gence we boast. The great machine still runs 
 rumbling and rusty in spite of the more or less 
 groping efforts of chambers of commerce, worlds' 
 fairs and houses of governors. Each man and 
 group of men labor unions, employers of labor,
 
 48 A Doctor's Table Talk 
 
 political parties, farmers and merchants, lawyers, 
 doctors, and artisans is looking out for his or its 
 own interest, and playing his own hand alone, 
 regardless of all the rest. These men can't define 
 the word 'cooperation.' They are far, indeed, from 
 it, as their inane lawsuits, tariff bills, and labor 
 wars show us every day. Since we can't have an 
 all-wise God, or dictator, or czar to straighten out 
 the tangle, we must go ahead in our old stupid, 
 blundering, evolutionary fashion. But that does 
 not half answer my first question: when I am in 
 the city, how am I to find an out-and-out, old- 
 fashioned doctor for my needs? Your specialists 
 don't help, and there is no one but a hotel clerk 
 to tell me what to do." 
 
 Scholasticus had hit upon one of our most press- 
 ing and difficult problems. When my friends and 
 I were medical students, one of our far-sighted 
 teachers advised us all to become general practi- 
 tioners. They are needed more and more, he said; 
 and the men who stick to general practice will do 
 the most good, and make the best incomes. 
 
 "The other day," I remarked, "a well-known in- 
 ternist told me that there are but two first-class 
 family doctors left in the city. Only yesterday I
 
 Doctor and Patient 49 
 
 met with another example of the situation about 
 which Scholasticus complains: A young woman, 
 reader and companion to an elderly invalid, broke 
 down through anxiety and loss of sleep, and be- 
 came the victim of what is still called 'neurasthe- 
 nia.' She was advised to put herself under the care 
 of a certain Dr. Blackwell. After seeing her several 
 times Dr. Blackwell concluded that she was 'no- 
 thing but a nervous wreck,' and sent her to a sana- 
 torium, with the advice that she be given a long 
 rest. The sanatorium physicians thought differ- 
 ently, and put her through a course of 'feeding up' 
 and active exercises. By the end of two weeks she 
 was completely undone, and her friends, in great 
 distress, came to me asking what course to follow. 
 They said she was in despair about the sanatorium, 
 and knew not what to do. I pointed out to them 
 that Dr. Blackwell had been acting as her family 
 physician, and that they had best consult him as to 
 her proper course. Further, I reminded them that I 
 knew nothing at first-hand about her case. Accord- 
 ingly they went to Dr. Blackwell, who informed 
 them that he was a specialist in digestive disorders, 
 that he had sent the patient to a sanatorium for the 
 treatment of her nervous troubles, that he had no
 
 $o A Doctor's Table Talk 
 
 further advice to give, and that he must now wash 
 his hands of the whole affair. The much buffeted 
 people, in sore distress, then came back to me; and 
 realizing at last that Dr. Blackwell is a donkey, I 
 sent them to a safe general practitioner who has 
 saved the day for his happy patient. 
 
 "Such stories are common enough, but they 
 don't argue, as many shallow persons think and 
 say, that doctors are 'no good,' and that the pro- 
 fession of medicine is a failure. Entirely aside from 
 any question of scientific progress, the dividing 
 of physicians into specialists is the most momen- 
 tous feature of modern practice. Neither the pro- 
 fession nor the public has yet adapted itself to 
 the change, or learned how best to utilize the new 
 forces. In other words, the many cogs in the 
 machine are not yet coordinated; and the family 
 doctor must survive, if only to attend to that 
 coordinating. 
 
 "The question of providing competent and 
 humane physicians to take care of the sick is be- 
 coming increasingly more urgent, as Scholasticus 
 intimates ; and the trouble lies with the high-grade 
 medical schools and hospitals. These institutions 
 are becoming dominated by men largely unfamiliar
 
 Doctor and Patient 51 
 
 with the problems of practice; their leading idea 
 being to train both students and physicians to an 
 expert knowledge of preventive medicine, and the 
 theory rather than the practice of physic. Teach- 
 ers of undergraduate students realize their own 
 shortcomings more or less, but justify their course 
 by saying that the young men will get all the bed- 
 side practice they want when they become hospital 
 internes. In a measure that is true, and the young 
 men, in the course of one or two years, do become 
 familiar with disease as seen in hospitals ; but how 
 are they to acquire a knowledge of disease as seen 
 in private practice? The rank and file are content 
 to work out their own salvation through the stress 
 of daily experience, and the theoretical knowl- 
 edge already theirs. Laboratories and hospitals no 
 longer concern them. The more ambitious men, 
 however, those who think they may become 
 qualified to lead in medical progress, find per- 
 manent hospital positions, and struggle to keep 
 to the front in hospital, teaching, and laboratory 
 work as well as in practice. They fail, of course. 
 You can't be a great laboratory investigator and a 
 good practitioner at the same time. 
 
 "Then there is that pernicious advice, which is
 
 52 A Doctors Table Talk 
 
 constantly given to beginners : ' If you have a little 
 money of your own, stay in the city and wait for 
 practice. If you must support yourself at once, 
 go to a small town or to the country'; the re- 
 sult of which advice, when it is taken, is to send 
 away our most promising men. Per contra, the 
 more or less idle amateur, waiting for practice, 
 is a sight for gods and men. You will find him 
 loafing at his club any afternoon after four o'clock. 
 From the best of these men who elect to wait, the 
 hospital staffs are recruited. Happily, every year 
 one or two genuine professionals remain in the city 
 struggle. They are our chosen ones. 
 
 "Picture to yourself then, the young internist, 
 five or ten years established, immersed in hospital 
 and academic work: his best energies so occupied; 
 supported, perhaps, by his modest patrimony, or 
 having taken to himself a wife with money. From 
 such material, general practitioners able, expe- 
 rienced, resourceful are not made. These hos- 
 pital men do not stand ready, day and night, for 
 small fees or for no fees, to rush to the aid of the 
 afflicted. Soon they learn to call themselves 'con- 
 sultants,' and to keep hours and appointments so 
 irregularly that practice cannot find them. Then 
 

 
 Doctor and Patient 53 
 
 patients float off to the virtuous and patient 
 rank and file, to irregular practitioners, to osteo- 
 pathists, to Christian Scientists, and the like. 
 When the chief shepherds have, for a generation, 
 so neglected and maltreated their flocks, what can 
 you expect? Many of these self-satisfied seekers 
 after causes have become so contemptuous and so 
 inexpert in the treatment of disease that the words 
 * social service ' are to them a stench, and the suc- 
 cesses of psychotherapy a cause for bitterness and 
 intolerant outcries, Vinfame of Voltaire, which 
 even among 'scientists' will never die." 
 
 "What then? where is your remedy?" says 
 Scholasticus with a weary smile, when I reach the 
 end of my holding forth. 
 
 Ely took up the tale. " There are two courses to 
 follow, we may choose one or both : let the hos- 
 pital trustees see to it that more men of their 
 staffs are encouraged to practice general medicine, 
 and not to give the best part of their days to the 
 hospital; or, let little groups of specialists, includ- 
 ing general practitioners, form associations for 
 practice. To such a group, as to an ordinary doc- 
 tor, or to a small hospital, a patient should be able 
 to go, or to send, at any time, and get there any
 
 54 A Doctor's Table Talk 
 
 sort of service he wants, and at a sliding-scale-fee, 
 as is the fact now with individual practitioners. 
 There are many other reasons for forming such 
 groups in practice, chief among which is this, 
 that thus we may best reach the great mass of the 
 public, the people of moderate means; those who 
 cannot now afford freely to consult specialists, but 
 who do not wish to be classed with the very poor, 
 by attending the free clinics of the municipal hos- 
 pitals. That great middle class, estimated at eighty 
 per cent of our people, fail now to get the full bene- 
 fit of modern scientific medicine." 
 
 "Of course," Primrose remarked, "you city men 
 have problems to meet which don't especially con- 
 cern us country doctors. I have to take care of 
 every variety of disease from felons and broken 
 arms to consumption and brain abscess. When I 
 have a case I can't handle, I send for one of you 
 good-natured men to help me out, or I persuade 
 my patient to go to the city. 
 
 "There are certain features of practice, however, 
 which we must all consider, in dealing with 
 which we meet on common ground; I mean our 
 personal contact with patients, what one might 
 call the human, or inhuman, side of practice. In
 
 Doctor and Patient 55 
 
 that relation the real physician or the humbug is 
 displayed, I don't care what his training or what 
 his ability for writing scientific papers. It's the 
 old argumentum ad hominem. Where the personal 
 relation is concerned, you can't make a silk purse 
 out of a sow's ear. You may think you can make 
 a fair substitute for a physician out of a machine 
 with a test-tube in his hand. That's the reason 
 why so many of you people imagine you prefer 
 impersonal consulting work to the hard soul- 
 exhausting grind of a true physician. But you can't 
 eliminate the personal element. The community 
 find you out, and hate you, or laugh at you, or 
 love you, just as you may deserve." 
 
 Scholasticus smiled a sympathetic smile. 
 
 "My friends, my friends," I said, "such talk is 
 near treason. Is it for me, unworthy, to defend 
 Scientific medicine'? The other day I said some- 
 thing of Primrose's heresy to our friend Bluff, the 
 pathologist. It was a plea for the old-time human- 
 ist doctor as compared with the modern product. 
 
 "'Nonsense, nonsense!' he snorted; 'those old 
 ladies may have been good-natured, but they did 
 awful harm, awful harm, awful harm!' Can't you 
 hear him?
 
 56 A Doctor's Table Talk 
 
 "What's the use, however, of continually re- 
 hearsing the triumphs of medicine in the past hun- 
 dred years? They are certainly interesting, but 
 not marvelous. The teachings of such as Voltaire, 
 and then the French Revolution, set men free to 
 think, without fear of what king or church might 
 say or do. Of course, as soon as men began to think 
 again, and to express themselves, after the lapse of 
 fifteen hundred years, then they began to discover 
 things. But this was no more true of medicine than 
 of other activities. The re-discovery of the capacity 
 for thought is the great triumph of modern times. 
 In medicine, of course, there are many things to 
 record of the past century from Jenner's vacci- 
 nation, let us say, through the development of 
 pathology, physiology, chemistry, and the rest of 
 it, down to the most recent discoveries in immunity, 
 in serum therapy, and the superb jugglery of mod- 
 ern surgery. But these are heavy subjects for mid- 
 night gossip. 
 
 "We were talking not long ago about the 
 troubles of us commonplace doctors, and of how 
 men are saying that practice is leaving the regular 
 profession. Surely the fault is mainly ours. As I 
 said, when young doctors come to me for advice,
 
 Doctor and Patient 57 
 
 I talk to them, among other things, of their per- 
 sonal relations with their patients and their 
 patients' friends. We can't all be as brutal as my 
 old acquaintance Roland. When an anxious, in- 
 quiring busy-body came to his office to ask, 'How 
 is dear Mary? and what did you find her trouble to 
 be ? ' he used to send the busy-body a bill for ten 
 dollars. The remedy was effective." 
 
 "Roland was n't a real doctor," said Ely. "He 
 was a business man, which, thank God, few doc- 
 tors are. If we were, practice would be leaving us 
 faster than it is said to leave us now. 
 
 "There's an inevitable fineness about a physi- 
 cian's life, and his wide grasp of human experi- 
 ence as compared with that of other men, which 
 even the meanest of us in some fashion perceives. It 
 usually subdues the more vulgar business instinct." 
 
 Such were the reflections of Ely, and I believe 
 them to be sound; but there are certain worldly- 
 wise aids to practice which the beginner should 
 consider. For example, he should. make his rounds 
 promptly, and should make his new calls first and 
 at once. There is a common sort of medical goose 
 who seems to think that calls made tardily, or put 
 off for a day, impress patients with the doctor's
 
 58 A Doctor's Table Talk 
 
 importance and rush of business. Alas; late calls 
 do no such thing. They usually create the impres- 
 sion that the fellow is inefficient and lazy. My old 
 friend Dr. Circumstance is an exception to the 
 rule; and being popular and amazingly effective, 
 his example has done much harm to admiring 
 juniors. He is an abnormally busy surgeon and is 
 generally from an hour to two hours late for ap- 
 pointments. He bites off too much. But then he 
 makes up for it. He comes in, breathless and 
 troubled, to the patient and his friends ; and ingen- 
 uously takes them into his confidence. They are 
 made partners in his trials. He explains that he 
 has driven furiously from a terrible operation, 
 where he overcame difficulties never before re- 
 corded; and that, at last, he removed an appendix, 
 which in another thirteen minutes would have 
 killed the luckless patient. However, modern 
 surgical science prevailed. We name no names, 
 but you are given to understand that the patient 
 came on last night from Washington in desperate 
 haste and by special train. How is the stock 
 market acting now, Job? 
 
 Let not youthful genius be misled. Fine old 
 Circumstance can carry it off, but you can't.
 
 Doctor and Patient 59 
 
 Again, and above all things, don't arrive late 
 for a consultation. You are allowed five minutes' 
 grace, but err on the wrong side. You can't hum- 
 bug your colleagues. 
 
 In the sick-room always try to be self-controlled, 
 kind, firm, and sustaining; and never tell needless 
 fibs to a very ill patient. To some one responsible 
 member of his family, at least, always tell the 
 exact truth. In talking to your patient, don't be 
 guided by his wife or daughter, or some other, as 
 to what you may tell him. Under the stress of 
 severe illness in the house, the advice of wife and 
 daughter is often silly. They cannot get the pa- 
 tient's point of view. If you are sick unto death, 
 you regard death with a composure of which well 
 people have small conception. But don't worry 
 over-much. The man or woman in acute illness 
 who asks the blunt question, Am I going to die? 
 is very rare indeed. 
 
 On the other hand, the chronic invalid the 
 woman with cancer, or Bright's disease often 
 wants to know the truth, and she has a right to 
 know. Tell her the truth, and as cheerfully as 
 possible, for you need not carry gloom. Here is a 
 chance for some helpful psychotherapy. Admit
 
 60 A Doctor's Table Talk 
 
 that the patient's ailment is desperate or incurable, 
 but point out that she still has many months or 
 years of life. The difference between her and her 
 attendant sister is that she knows in advance the 
 disease which is to cause her death, while her sister 
 is still ignorant of the nature of her own fatal ill- 
 ness: "You will surprise them all yet; you will out- 
 live half your family. None of us is immortal, and 
 the going is not hard. We've all got to go before 
 long. The only question is, who will go first?" 
 
 With such talk and encouragement, fortified by 
 his other palliative treatment, the physician will 
 find that most intelligent patients regain their 
 composure and leave his office in a reasonably 
 cheerful and philosophical state of mind. 
 
 The physician at a patient's house, on the one 
 hand, or in his own office on the other, occupies 
 somewhat different roles; not that in the one case 
 he is guest and in the other case host, though in 
 some slight measure that is the fact, but because 
 the doctor has far better control of his patient and 
 of his own time at her house than in his office. 
 Observe the "her." The majority of calls are from 
 women. When at her house, you ask your questions, 
 make your examination, give your directions, and
 
 Doctor and Patient 6 1 
 
 go. Prompt, kindly expedition gives a sense of 
 your efficiency and dignity. Rarely is it necessary 
 to stop for gossip. 
 
 In your office, on the other hand, you may be 
 at the mercy of a heedless or selfish patient. A very 
 busy consultant, with a trained office attendant, 
 can have patients shown in and out rapidly at the 
 touch of a bell; but the average practitioner, with 
 his small and irregular office practice, must suffer 
 the whims of the heathen. Don't hurt their feelings, 
 unless they be mere humbugs and bores. Bear with 
 them as long as you think proper, then rise and get 
 rid of them by the plain statement that you are 
 busy, or that patients by appointment are awaiting 
 you as the case may be, and that you will see 
 them again that day week. Some day I must write 
 a book on the miseries of a doctor's consulting- 
 room, from the doctor's point of view. 
 
 In these days of trained nurses and social service 
 workers it is comparatively easy to get your direc- 
 tions for treatment carried out in the case of bed 
 patients and of serious illness; but in the case of 
 office patients you are never sure. Don't be mys- 
 terious, except, perhaps, with some children. Don't 
 tell your patient to rise at 7.13, to go to bed at
 
 62 A Doctor's Table Talk 
 
 9.48, and to take an unknown pill on the stroke of 
 each half-hour unless, indeed, such directions 
 are useful to jog his memory. If you are trying to 
 impress him by humbug, he will find you out and 
 dislike you. But take him into your confidence, 
 explain to him the nature of his own case, and 
 what you intend to do for him, and so secure his 
 interest and effective cooperation, except he 
 be a fool, in which case you must use the axe. 
 Write out full and explicit directions for every pa- 
 tient, whether he has a nurse or not. Thus will 
 you be sure of obedience. The spoken word is as 
 snow in the desert. 
 
 Another detail of practice which modern methods 
 have made important is the pathologist's examina- 
 i tion and report on bits of tissue, and the like, re- 
 moved from diseased organs, as well as the results 
 of X-ray and other special and difficult examina- 
 tions. Intelligent and inquisitive patients await 
 these reports with the greatest interest, and often 
 with anxiety. Don't disappoint them. Don't tell 
 them you will send the report on Monday, when 
 you know you cannot send it until Saturday. 
 There's a deal of cruelty in the world. We must 
 not add to it. Send the report at the earliest possi-
 
 Doctor and Patient 63 
 
 ble moment, but make no foolish promises. Explain 
 to your patient that the special expert examiners are 
 not your assistants (as some jobbing practitioners 
 represent them), but are proper and dignified con- 
 sultants. Then the patient will not be surprised when 
 he receives a consultant's bill for special services. 
 In regard to that matter of bills and fees, a deal 
 of misinformation and twaddle is published in the 
 daily papers, and there is a quite constant pressure 
 to make it appear that doctors are extortioners. 
 Not long ago an influential Boston newspaper 
 published an editorial which suggested that physi- 
 cians are in the habit of charging fees according to 
 the location of their offices: "Do not some physi- 
 cians even now charge according to the locality in 
 which they live, without reference to the nature 
 of the case, and the amount of time and skill ex- 
 pended? There are few doctors who would admit 
 the reasonableness of a sliding scale. The majority 
 charge the servant girl and her mistress alike. 
 There are glorious exceptions, men of marked 
 ability who take the trouble to inquire into the 
 pecuniary condition of a patient, and then charge 
 accordingly, after asking only a nominal sum, 
 that the patient's pride may not be wounded."
 
 64 A Doctor's Table Talk 
 
 As one of our distinguished fellow citizens would 
 say, the main contention in that editorial charge is 
 an unqualified and unmitigated falsehood. With 
 the rarest exceptions physicians make their fees 
 without regard to locality, and they all employ 
 the sliding scale. What humane physician would 
 carry his patient through a severe illness, only to 
 cast him down into the depths of wretchedness at 
 the end, by insisting upon charges which the 
 patient could not pay? Common sense and the 
 claims of his own bank account impel the doctor 
 to a sliding scale. If his charges were fixed and 
 immutable, they would inevitably be low to accom- 
 modate his poorest patients. I find that physicians 
 and most surgeons have what they call their stan- 
 dard fee, which they raise or lower, according to the 
 circumstances of the patient and the demands of 
 the case. In spite of sneers, " Charge all that the 
 traffic will bear " cannot be applied to doctors. 
 
 There is another side, a familiar side, to this 
 question of fees. Some months ago a cheerful and 
 breezy woman, dressed in handsome furs, brought 
 to see me her little girl, also well dressed. The 
 wardrobes of the two represented a thousand dol- 
 lars, at least. The child stood in need of a serious
 
 Doctor and Patient 65 
 
 operation, for which, in the case of wealthy parents, 
 the figures four hundred, or five hundred, dollars 
 would be reasonable, considering the responsibility 
 assumed by the surgeon and the immense comfort 
 and relief to be secured by the child. From the 
 first, however, the mother was insistently voluble 
 on the subject of the fee, and vowed that her hus- 
 band could pay but fifty dollars. I agreed and 
 operated. During the operation the family physi- 
 cian said to me, "What is Mr. Jacobs to pay you?" 
 I told him. "The scamp!" he exclaimed with an 
 angry laugh; "why the fellow's worth a million. 
 He is Jacobs, the great clothier." 
 
 By the time my rambling talk was finished, I 
 observed Scholasticus glancing often and furtively 
 at the clock. It was after one, but Primrose's turn 
 had come and he was not to be moved from a final 
 word. 
 
 "There is one more situation about which I want 
 to relieve my mind," he said; "but it's a hopeless 
 situation, I suppose. I refer to the blackmailing, 
 especially by women, which is sure to come near 
 every one of us first and last. You don't often hear 
 it mentioned because its details don't always bear 
 public discussion. We all know of the cases, how-
 
 66 A Doctor's Table Talk 
 
 ever; and we know that from trials for breach of 
 promise the results run all the way down the scale 
 of horrors. Honest husbands and devoted wives 
 have been made miserable for life, and families 
 have been broken up by such devil's doings; and 
 there is no redress. You remember how one of our 
 old teachers used to tell us never to submit to a 
 call from a strange female without having one's 
 wife, or some other reliable woman, within hearing. 
 But that's not always practicable for country 
 doctors. It's a hard problem, and perhaps the most 
 maddening part of it is that one's friends smile 
 wisely and think there must be 'fire where there 
 is so much smoke.' ' 
 
 "Tut, tut," said Ely, yawning; "we'll hear your 
 story to-morrow, Primrose. It's after one, and 
 Scholasticus is asleep."
 
 CHAPTER IV 
 
 Some Doctors, and their Troubles 
 
 "COMMON Sense, Tact, the Sense of Humor; 
 those are excellent words," said Primrose, as he 
 reeled in a final bass, "but the qualities are as rare 
 as trout in January. Here's Phillpotts's definition 
 of humor, I'm never tired of it, though it's been 
 quoted in many books: 'For this humor is an ad- 
 junct divine, and as far beyond the trivial word for 
 it as " Love " is or " Charity." No definition or 
 happy phrase sums it correctly or rates it high 
 enough; it is a balm of life; it makes for greater 
 things than clean laughter from the lungs. It is the 
 root of tolerance; the prop of patience; it suffers 
 long and is kind ; serves to tune each little life-har- 
 mony with the world-harmony about it; keeps the 
 heart of man sweet, his soul modest. And at the 
 end, when the light thickens, and the mesh grows 
 tight, humor can share the suffering vigils of the 
 sleepless, can soften pain, -can brighten the ashy 
 road to Death"'; with which apparently irrelevant 
 words he ceased for the time being. ^
 
 68 A Doctor's Table Talk 
 
 It was nearing mid-June and we were fishing in 
 Squam waters. Our anchored boat rocked gently 
 on Bear Cove. Evening was falling. Venus glowed 
 in the western sky; the golden glories of the 
 sunset failed. Shadows stretched far across the 
 ripples; and the darkening slopes of the Rattle- 
 snakes lowered in mystic gloom. To the east, Red 
 Hill still held a gleam of day, while the old red 
 farmhouse at its foot glimmered with welcome 
 light. 
 
 Primrose's bass was landed, the boat made snug, 
 the anchor raised ; Ely took the oars and sculled us 
 slowly back to camp. Our quarters consisted of a 
 cozy bungalow near the head of the cove, in a 
 charming grove of pines, some twenty feet above 
 the water. We kept an accommodating New Hamp- 
 shire boy about the place, who good-naturedly 
 allowed us to do our own work, while he himself 
 threw in a critical remark as he chewed the occa- 
 sional straw. 
 
 As we sat about our camp-fire that evening, 
 Primrose began : " Some of us doctors have a strange 
 sense of humor and a very odd notion of science 
 and scientific men. The best of us are unfettered 
 and are doing good things, but some of the con-
 
 Some Doctors, and their Troubles 69 
 
 servative ones, who preside in high places and are 
 called 'professors,' are certainly remarkable beings. 
 You have observed how they sit smug and snug, 
 and teach the old platitudes and quote the old 
 text-books until progress has gone by, when with a 
 groan they catch on as the last car whirls past; 
 not that most of them are wedded to tradition 
 and the doings of former generations ; they are not. 
 They know nothing of the history of medicine, but 
 they think they learned something day before yes- 
 terday, and they don't want to be bothered with 
 unlearning it." 
 
 "What are you driving at? "queried Ely. "Some 
 one in office has been abusing you. Teachers of 
 medicine are n't so bad. I was once one myself." 
 
 "Yes, and they pushed you out. Listen to this 
 yarn: A friend of mine has a jolly little ten-year- 
 old boy, whom I have known since his birth. He 
 has always been strong and active, but excitable. 
 Three years ago he had two or three convulsions in 
 the night, but nothing characteristic. The family 
 doctor was away on his summer vacation; so the 
 child's parents began the usual dreary round of 
 calls on specialists. They consulted three or four 
 neurologists and pediatrists; they were told that
 
 7O A Doctor's Table Talk 
 
 the case was clearly epilepsy, and the outlook bad; 
 that there was nothing to do but to diet the boy, 
 keep him quiet, and dose him with bromides. No 
 one gave any real sympathy or help. No one said, 
 'Put your burden on me; I '11 try to carry it for you; 
 and if I can't help, I'll find some one who can/ 
 Nothing of the sort. There was plenty of service 
 in it all, but no humanity. The parents were pa- 
 tient, confiding, and sincere, but that did not count. 
 Finally they fell into the hands of a good fellow, 
 Dr. James (and mind you, all these men were good 
 fellows in the ordinary sense), who personally and 
 solicitously looked after the child for two years. 
 He furnished a competent nurse, regulated the 
 boy's diet and exercises, gave the necessary medi- 
 cines, and kept him in the country. There was 
 great improvement, and we began to think that the 
 trouble was superficial, after all. Then, a month 
 ago, there were two more slight convulsions. When 
 he heard of them the good fellow of a doctor lost 
 heart and gave his final verdict of hopeless 'ideo- 
 pathic' epilepsy, whatever that means. The boy's 
 father, who had been doing some thinking on his 
 own account for more than two years, suggested 
 that there are many obscure epilepsies with cause
 
 Some Doctors, and their Troubles 71 
 
 unknown; that a case of epilepsy due to congenital 
 misplacement and obstruction of the bowel re- 
 cently had come to his knowledge, after apparent 
 cure had followed appropriate treatment of the 
 bowel; and he suggested X-ray examinations to 
 determine the anatomy of his own boy's vitals. 
 
 "What do you suppose our confrere answered? 
 That such examinations are of absolutely no use; 
 that they show nothing; that they lead to no- 
 thing; and that they merely encourage false hopes. 
 Does n't it make you want to hide your diminished 
 head, after all the enlightening work that has been 
 done on poisoning from misplaced vitals? Poor 
 James! Osier is right. We pass by early the enthu- 
 siasm for new knowledge. At forty-five, James is 
 already an old fogy. He knows literally nothing 
 about this new work; so he says it's 'no good.' 
 What's worse, he does n't want to know. He's 
 simply a competent old-time routinist and he'll 
 never be anything more. You can't blame him. 
 He has reached the limit of his little tether; but 
 you can blame the system. It's the same old 
 situation at which Scholasticus growls, and it will 
 never be better until we have that cooperation of 
 which prophets tell. As for the proposition made
 
 72 A Doctor's Table Talk 
 
 to James, there may be something in it or there 
 may be nothing. The maddening thing is that he is 
 unwilling to consider it at all. Why? Because it is 
 new." 
 
 "Of course, James is a fair sample of a common 
 enough type," replied Ely; "but of late you have 
 seemed to me altogether too pessimistic in your 
 talk about the profession. You know quite well 
 that as a group of men our ethics are sound and our 
 standards high. And I believe that our best stan- 
 dards are maintained by you country doctors. 
 Buncombe and pretension irritate you, and at such 
 things we city men are the worst offenders. Look at 
 our friend Scriba here. He writes a very decent sort 
 of a book on surgery, and gives it to a bustling 
 firm of commercial publishers, who string the 
 country with a series of flapdoodle advertisements, 
 setting forth the virtues of Scriba's very common- 
 place book. Listen to this, I have the journal 
 here: 'A Surgery that is different. It is in every 
 particular up to date, and shows that rare quality 
 of accentuating the essential and omitting the 
 unnecessary,' etc., etc., etc. Of course that's rub- 
 bish. No self-respecting scientific man wants to be 
 shown up in such a light. Imagine the wrath of a
 
 Some Doctors, and their Troubles 73 
 
 Warren or a Huxley at finding himself so adver- 
 tised. Here is a worse one still, booming the per- 
 sonal clinical work of a well-known surgeon. 
 
 "'A skilled operator, a natural diagnostician, 
 and a forceful teacher the qualifications pos- 
 sessed by Dr. Smilax in the highest degree make 
 his Surgical Clinics the greatest piece of publishing 
 ever undertaken. They deal almost exclusively 
 with diagnosis and treatment. These Clinics are 
 published just as delivered by Dr. Smilax. In this 
 way they retain all that individual force and charm 
 so characteristic of the clinical teaching of this 
 distinguished surgeon. But the most vital point 
 about these Clinics is that they are absolutely fresh. 
 They are surgery right down to the minute, 
 published practically as soon as delivered. There 
 is no stale matter; everything is new, never having 
 appeared in print before, and never will appear in 
 print except in this form. Further, you can rest 
 assured that here are facts facts only: definite 
 points in diagnosis; concise, crisp directions in 
 operative technique. . . . Subscribe to-day? 
 
 "You may say that all this is merely the work of 
 a vulgar-minded publisher, who knows something 
 of human nature and exploits the medical profes-
 
 74 A Doctor's Table Talk 
 
 sion for his own pocket. And yet we are not alto- 
 gether blameless. We try to be consistent, but we 
 sometimes wind up by being silly. Our most re- 
 presentative medical journal abolishes advertise- 
 ments of many proprietary medicines because they 
 are humbugs, while it gives its most conspicuous 
 page to such personal advertising gabble as I have 
 just read to you. 
 
 "These are extraneous things, though, as is much 
 of which Primrose complains. At bottom doctors 
 are a remarkably clean, honest, straightforward lot. 
 We live too near the facts of life to mistake garbage 
 for gold. Every generation furnishes its Walter 
 Reeds; and the life of one such man steadies every 
 private in our ranks. 
 
 "Here's a little story that came to me only last 
 week. We all recognize the sort of thing. Young 
 Coit was a student of mine some four years ago. 
 He hailed from one of those small midland cities, 
 where plain living and high thinking don't count 
 for much. Coit's father was a prosperous busi- 
 ness man, who wanted his son to have the best 
 possible education in medicine. There was, be- 
 sides, a mother and four younger sisters. The son 
 was always a serious, hard-working fellow, but no
 
 Some Doctors, and their Troubles 75 
 
 prig. He was an oarsman, was well read in general 
 literature, and had been graduated with distinc- 
 tion from Yale. From the beginning of his medical 
 course he showed unusual powers; his anatomi- 
 cal dissections were of the best; his grasp of the 
 meaning of physiological problems was surprising; 
 and equally so was his sympathetic interest in 
 allied subjects. While a student he traveled, visit- 
 ing other laboratories. He was no blind, contracted, 
 satisfied routinist, but showed a breadth and a 
 comprehension which delighted his teachers, when 
 it did not stagger them. At the same time he kept 
 up his French and German reading, nor did he neg- 
 lect current English literature. When he chose he 
 wrote charming verses; yet he was no paragon, and 
 the other students made him their class president, 
 He took no interest in marks : he mastered subjects. 
 Of course he was a conspicuous man through his 
 student years, but he was graduated in medicine 
 third only in a class of sixty-three. By that time he 
 had made up his mind to devote himself to research, 
 for especially interesting to him were the problems 
 of surgical physiology. To make sure of himself, 
 however, he pushed on with clinical work for a 
 time. He went through the interne courses of two
 
 76 A Doctor's Table Talk 
 
 general hospitals, with credit, and then for a year 
 he held a position in the Rockefeller Hospital in 
 New York. That satisfied him, and so he went to 
 Europe where he spent three profitable years grind- 
 ing at his physiology in Berlin and London. Is it 
 not a satisfying story? Who could ask for him- 
 self or for his son a more stimulating career so 
 far? Wherever he went, Coit made himself felt, 
 and already he had published two significant 
 papers. 
 
 "Three months ago the crash came. His father 
 died insolvent, and Coit was called home to take 
 care of his mother and sisters, who are as penniless 
 as himself. He has settled down in his native town 
 to practice general medicine, and to help support 
 those five unhappy women. Perhaps he finds 
 humor in the situation. Certainly his neighbors 
 see nothing hard in it, nor do they understand the 
 kind of man who has come among them. Last 
 week I went out to see him. The tale of personal 
 hardship which had reached me seemed too bad to 
 be accepted to say nothing of the loss to science. 
 I found him as you would expect to find such a 
 man doing his duty, and doing it superbly. His 
 mother is a peevish invalid, who has no confidence
 
 Some Doctors, and their Troubles 77 
 
 in her son or his 'notions.' She keeps a futile 
 osteopathist hanging about. However, Coit has 
 one sister who is a fine girl. I spent a half-hour in 
 his waiting-room, and heard the usual talk of his 
 few patients, excusing themselves to each other 
 for employing such a youthful doctor. I talked 
 with one of his father's old friends, who informed 
 me that he thinks young Coit will get along; that 
 already he has a few patients, and that his business 
 will look up when old Dr. Bloodgood retires. 
 Fancy it! Coit, a favorite pupil of Senn and the 
 friend of half the physiologists of Europe! Yes; 
 he'll get along, and you will hear of him yet, if he 
 lives, and his cortex keeps on working." 
 
 "Of course," said Primrose, delightedly walking 
 up and down and furiously rumpling his hair, 
 "there are heroes in every profession, in none more 
 than in medicine. I must meet that young Coit, 
 and know more about him. But is it not surprising 
 how the English-speaking world even yet ignores 
 or underestimates scientists as well as literary men? 
 Lister is the only English doctor ever given a peer- 
 age. Macaulay got his barony as a politician, not 
 as a historian. Thank God, though; the fools are 
 not all dead. They help to keep us guessing. But
 
 78 A Doctor's Table Talk 
 
 such a story as Colt's renews one's confidence in 
 human nature." 
 
 It is a mistake to suppose that doctors have no 
 hobbies. They have as many interests as most 
 men, in these days of narrow interests; and their 
 hobbies are generally of a wholesome kind. To 
 shooting and fishing, commonly, are they addicted, 
 especially in middle life; while tennis and baseball 
 are the joys of many in their earlier years. Nor are 
 the fishing doctors of the contemplative Izaak 
 Walton type, given to fishing because thus they 
 may find time to dream and philosophize; indeed, 
 I find that few doctors have heard of the immortal 
 linen draper, or know whether or not he spelled 
 "The Compleat Angler" with or without the a. 
 The doctors fish zealously for the sport of the thing, 
 with all the lusty joy of their ancestors, happy 
 in the number of their catch, and mendacious as 
 other mortals, when they describe their exploits. 
 
 I have often observed that doctors are gregarious. 
 They have no love of solitude or midnight oil. 
 They are given much to marriage feasts, to eating 
 and drinking, and to relaxing themselves in season. 
 This fishing business especially fits them. They
 
 Some Doctors, and their Troubles 79 
 
 remove themselves to remote places, with others of 
 their kind. They fish, they lead the simple life, 
 and they gossip. The implied oath of secrecy and 
 silence in their relations with mankind in general 
 is omitted in the case of trusted fellow craftsmen ; 
 the problems and experiences and trials of the 
 daily round are poured flooding over the patient 
 comrade, who listens or not as he awaits his turn. 
 
 On one particular evening of our week at Squam, 
 Primrose was especially loquacious. He had just 
 returned from a meeting of the American Medical 
 Association in Atlantic City, and was full of his 
 experiences. There was little conversation that 
 night. It was all monologue. 
 
 Primrose loquitur, with feeble gasps of assent or 
 dissent from his audience: 
 
 "Of course every properly qualified doctor in 
 America should belong to the Association. These 
 meetings are wonderful. They're a liberal educa- 
 tion. Outside of national politics, and Washing- 
 ton, there's nothing like them. I've been to your 
 Chautauquas and Church Triennials. They're 
 froth and nursery tales in comparison. The gener- 
 ation just ahead of us did us a great wrong when 
 they belittled the meetings of the A.M.A. I re-
 
 80 A Doctor's Table Talk 
 
 member old Dr. Grimm's once saying to me, * Don't 
 be fooled by all this talk; and don't mix yourself 
 up with that crowd. They're nothing but a parcel 
 of advertisers.' Whatever they may have been 
 once, they're primarily nothing of the sort now; 
 and remember that the Association was started, 
 and was run for years, as it is now, by our most 
 representative men. The whole thing is certainly 
 very well done to-day, and I'm always preaching 
 to the younger men that they should never miss 
 these meetings. Of course I'm an old country 
 duffer, but I confess that I 'm full of excitement and 
 interest from the moment I reach the station plat- 
 form. It's stimulating to see hundreds of men all 
 bent on the same errand as one's self; it's delight- 
 ful to meet dozens of old friends, and I confess that 
 I often rejoice to shake the hand of some much- 
 talked-of man from Europe who has come here to 
 tell us what he knows. I always try to reach the. 
 convention twenty-four hours early, and I spend 
 that free day going about among the men, watch- 
 ing the arrivals, and visiting the House of Dele- 
 gates. That first evening fills me with delight as I 
 sit in the corridor or smoking-room. What a chance 
 to study types and character! I am growing rather
 
 Some Doctors, and their Troubles 81 
 
 skillful as an interpreter, and claim that I can tell 
 roughly the region from which a man hails, unless 
 he is a very recent importation there. There's one 
 type that especially interests me, and I'm coming 
 to think it may some day become the common 
 American type, just as Brother Jonathan and the 
 Yankee farmer were once the type. These newer 
 characteristic men come from the Middle West 
 the Mississippi Valley mostly. Among politicians, 
 look at W. J. Bryan, Champ Clark, Chairman 
 Mack, Urey Woodson, and perhaps Underwood 
 and Folk. They are mostly large, heavy, stooping 
 men, somewhat paunchy, who have not learned 
 properly to walk or to carry themselves, their 
 immensely productive and laborious lives being 
 given up to other activities. See their clean-shaven 
 faces, their compressed, down-drooping mouths, 
 and their keen, earnest, tired eyes. 
 
 "I saw hundreds of such among the doctors at 
 Atlantic City last week; and I heard many of their 
 stories. Sometimes it seems as though they be- 
 longed to a different race from us pampered East- 
 ern men. They come mainly from the farm and the 
 village store. I know one fine fellow who started 
 in life as a veterinary surgeon; and another splen-
 
 82 A Doctor's Table Talk 
 
 did useful chap with an enormous surgical practice, 
 who traveled Michigan in his buggy, peddling 
 patent medicines until he was thirty years old. 
 Then some one persuaded him to study real medi- 
 cine. A friend of mine, one of the most conspicu- 
 ous surgeons north of the Ohio River, started out 
 to be a doctor thirty years ago. His father was a 
 small farmer up north. He himself knew nothing 
 of the game he was undertaking; so he consulted 
 their old family doctor. Now it happened that 
 their old family doctor was a homceopathist and a 
 graduate of a third-rate homoeopathic medical 
 school in St. Louis. Thirty years ago that school 
 was on the verge of collapse, but my friend knew 
 nothing of all that. He did not know that there 
 was any difference between a homceopathist and 
 any other doctor. He looked on his old friend as 
 the source of all wisdom in matters medical, and 
 so by his advice he went to the homoeopathic 
 school. Of course, his preliminary education was 
 practically nothing. At the end of two years he 
 was graduated, and began a country practice near 
 Chicago. He is a man of great ambition and bound- 
 less curiosity in scientific matters. He reads. Very 
 soon he discovered, as he put it to me, that he was
 
 Some Doctors, and their Troubles 83 
 
 in the wrong crowd; and certainly that was the 
 wrong crowd thirty years ago. He found that he 
 was not in proper touch with wide medical pro- 
 gress; that his associates did not interest him; that 
 he was not eligible for the American Medical 
 Association; and that his special school was un- 
 known or unrecognized outside of a small radius. 
 More than all, he perceived that he himself was 
 an ignoramus. So after five years he collected his 
 assets, he was then but twenty-five, went to 
 Germany, spent seven years at grinding work, and 
 then returned triumphantly, with an education 
 and a proper degree in medicine; while besides his 
 conventional education, he was a trained man who 
 knew how to use his knowledge. Quickly he went to 
 the front, became an important citizen, and has long 
 been one of our most astute surgeons, as you know. 
 "You see how I enjoy looking up such men as 
 that year after year. You two seem to lose the 
 human side of our annual meetings. You run on 
 for an appointed day or hour, read the paper 
 assigned to you, and then take a night train for 
 home. You should go as I go, and see the thing 
 through. So you get the spirit of the affair. You 
 should visit the different sections and see what men
 
 84 A Doctor's Table Talk 
 
 are doing and thinking. Physiology and medicine 
 are as important as chemistry and surgery. 
 
 " It gives one a thrill sometimes to hear a really 
 big man read a truly great paper. I've had the 
 experience twice. Last year, when Browning made 
 his announcement of finding and destroying the 
 cancer parasite, the house rose to him three thou- 
 sand strong, and that, too, though it was the 
 Surgical Section which knew that the discovery 
 meant a serious loss of business for them. 
 
 "Then there's the machinery at work all the 
 time, to keep going these meetings and the Associ- 
 ation itself. If you stop, look, and listen you can 
 sometimes hear the wheels creaking and groaning. 
 The mere preparation for, and conduct of, such a 
 congress is a tremendous job, and keeps the local 
 committee busy for six months or more. But be- 
 yond that, there's always the burning question of 
 electing officers, especially the president of the 
 Association. There's sometimes as much election- 
 eering, wire-pulling, and marshaling of delegates 
 as though the poor man were going for four years 
 to the White House. He must be of the proper age 
 and the proper distinction, and from the proper 
 geographical region. He must not be too able or too
 
 Some Doctors, and their Troubles 85 
 
 distinguished; though able men, to their own sur- 
 prise, do sometimes slip in; and above all, it must 
 be shown that he has trodden on no one's corns. 
 Then there are the followers to be reckoned with, 
 and the rivals to be placated with the promises of 
 future office. Oh, it's a grand game. But after all, 
 it's harmless. It is one method of honoring a popu- 
 lar man, while all the time the real power rests in 
 the trustees, as we call the executive committee. 
 
 "Those trustees are very important people, yet 
 I suppose that scarcely one member in five hun- 
 dred of the Association knows anything about 
 them. They seem to combine both legislative and 
 executive functions ; they originate all sorts of new 
 activities, keep a rein on what is going on, and 
 appropriate the necessary moneys. We forget that 
 the Annual Meeting stands for a part only of the 
 work of the Association. The trustees and the 
 various standing committees like committees 
 of Congress are busy throughout the year con- 
 sidering all sorts of most important questions, 
 of legislation and expediency, of public health and 
 instruction, of medical education, of pharmacy 
 and chemistry, and a dozen other similar topics. 
 But I've bored you enough."
 
 86 A Doctor's Table Talk 
 
 "No," said the always polite Ely, rubbing his 
 eyes, "but I think we were to climb Red Hill at 
 four to-morrow morning. 
 
 ' ' Sweet Phosphor, ,bring the day; 
 Light will repay 
 The wrongs of night; 
 Sweet Phosphor, bring the day.' " 
 
 As we sat on the top of the mountain the next 
 morning, munching our simple breakfast and 
 watching the sun climb up from among the hills, 
 Ely turned suddenly to Primrose and asked what 
 he thought of Bernard Shaw. 
 
 "Almost a genius," was the answer; "but, 
 please Heaven, his works will perish with him. At 
 the worst, a piping jigster of narrow vision, his 
 experiences are really few. He has no true know- 
 ledge of men or of the world we live in. Can you 
 imagine Shaw rejoicing in this glorious sunrise? 
 He's a yellow journalist in literature. He's a mere 
 critic, and of a cheap type, in spite of his clever- 
 ness. You can't think of him as creating anything. 
 Near-sighted people will speak of him as dangerous 
 until the end of his little day, for he's a splendid 
 liar and vastly amusing, and then we'll forget 
 him, as fast as we can. Let's not talk of Shaw.'*
 
 Some Doctors, and their Troubles 87 
 
 "It's a letter I got yesterday that suggested 
 Shaw. The writer quoted one of Shaw's unkind 
 remarks about doctors, and then went on to tell 
 of Bumstead's lawsuit. He's been sued for mal- 
 practice by a charity patient. I heard a lot about 
 it before leaving home; indeed I was one of his 
 witnesses." 
 
 Primrose absently signified his willingness to 
 listen; so Ely continued. 
 
 "There are one or two points in the case that 
 are fundamental or vital. The matter at issue 
 hangs largely on the question of an employer's or 
 surgeon's liability, in these days of intricate oper- 
 ating or elaborate 'team play,' as they call it. 
 
 "Here's the clinical story of the case as told to 
 the jury: Some three years ago a poor devil of an 
 Italian cobbler had an attack of gall-stone colic 
 in the middle of the night. (Query; who ever heard 
 of an Italian cobbler before?) He described his 
 sufferings in harrowing detail. No doubt they were 
 severe, for he certainly became a very sick man. 
 The great pain subsided, somewhat, after a day, 
 but he was left with a fever and much soreness. He 
 was then sent by his doctor to a hospital where 
 Bumstead was the surgeon on duty. Two days
 
 88 A Doctor's Table Talk 
 
 later, Bumstead operated; removing gall-stones 
 and draining a badly infected gall-bladder. It was 
 a nasty case, and the patient had a close call. 
 
 "The wound did not heal well; a small draining- 
 sinus remained open for months. The man said 
 that during those months he was never free from 
 pain, which is unlikely, of course. During much of 
 this time the patient was Bumstead's private char- 
 ity patient at his office. Meanwhile the man had 
 become a qualified chauffeur. Finally the corpus 
 delicti, the cause of the lawsuit, appeared; the 
 patient got rid of a gauze sponge left in at the oper- 
 ation. In spite of this, his condition did not im- 
 prove materially. The wound continued open, and 
 finally he went to another hospital, where after 
 some secondary operation the wound eventually 
 healed. Now he sues Bumstead for leaving the 
 sponge in his abdomen, and causing him a year of 
 great suffering; and he sets his damages at ten 
 thousand dollars. 
 
 "Of course, on the first hearing, any unpreju- 
 diced person would say that the surgeon was at 
 fault and should be made to suffer in his turn; but 
 truly I think that such judgment would be wrong. 
 Evidently this plaintiff and his attorney believed
 
 Some Doctors, and their Troubles 89 
 
 they had an easy case, for they called no experts, 
 and relied entirely on the unvarnished statement 
 of facts; nor would they compromise, but pushed 
 on for their maximum ten thousand. 
 
 "Unfortunately, the situation of 'sponge left in* 
 is no new one. During the past thirty years a large 
 number of these cases have come to light. Nearly 
 every considerable operating surgeon has had one 
 or two; and in regard to the cases, the public, and 
 especially the courts, should ask themselves two 
 questions: how serious a matter is this for the 
 patient, and what is the responsibility of the sur- 
 geon for this accident or negligence. In the past, 
 juries have divided, or have found for the plaintiff. 
 
 "As to that first question, of damage to the 
 patient, most of the evidence goes to show that the 
 damage is usually not great. The sponge is clean 
 when inserted; through the action of the body's 
 tissues it is soon rolled up into a small ball. If the 
 sponge is connected with a drained wound, it 
 usually keeps that wound open until itself is dis- 
 charged; or if left in a tightly closed cavity, the 
 sponge seeks some nook where it lies for years 
 without doing harm; or else it penetrates one of 
 the hollow organs, as in t;his case, and so is
 
 90 A Doctor's Table Talk 
 
 discharged. It may occasionally cause a little pain 
 or discomfort, but the cases in which its presence 
 leads to serious damage, or to death, must be rare. 
 "Now, think for a moment about our second 
 question, the responsibility of the surgeon. 
 Is he, or is he not, to be held responsible for such a 
 calamity as * sponge left in'? and if not he, then, 
 who is responsible? It seems as though the best 
 way to get at our answer would be to consider the 
 conditions under which modern operations are 
 done. The conditions are mostly quite new, and 
 little understood by the public, though the methods 
 employed are now in a general way much the same 
 the world over. These conditions are greatly dif- 
 ferent from what they were a few years ago; and 
 that is a fact which juries, and even judges, find 
 it hard to understand. A few years ago, the surgeon 
 himself, alone, practically unsupported, was every- 
 thing in an operation. Tradition and fiction are full 
 of familiar situations. Even Ian Maclaren, in 'The 
 Bonnie Briar Bush,' brings to the Highlands a great 
 London surgeon bearing in his hand a trifling bag 
 of instruments, and without an assistant. He brings 
 him, too, to perform a singularly difficult, life- 
 saving operation. Indeed, old-time surgeons, in
 
 Some Doctors, and their Troubles 91 
 
 the ancient bad days when wound-fever and death 
 were the common results of operating, old-time 
 surgeons, with their slender equipments, were solely 
 responsible. Themselves surgically unclean, they 
 operated with unclean instruments, in unclean sur- 
 roundings, on unclean patients. Mostly the oper- 
 ations were simple; body cavities seldom were 
 opened; all operations were rare, and all were 
 momentous : the surgeon did everything himself 
 cutting, sponging, tying, sewing. He was respon- 
 sible for every step, and he alone. If anything 
 went wrong, it went wrong under his own eye and 
 hand. So the courts properly held; no employers' 
 liability applied to the surgeon in those days, for 
 the operating surgeon was not an employer in our 
 present sense. 
 
 " Look now at the conditions of a modern oper- 
 ation. The surgeon is still the central figure, for the 
 surgeon initiates all the moves, and gets whatever 
 glory or cursing 'is coming.' But a well-conducted 
 modern operation is as much a piece of team work 
 as is a well-played football game. Consider: the 
 progress of the operation has begun twenty-four 
 hours or more before the patient goes to the oper- 
 ating-table. Nurses put him through a process of
 
 92 A Doctor's Table Talk 
 
 dieting, scrubbing, and cleansing. An anaesthetist 
 studies him and advises about the anaesthetic and 
 the subordinate drugs. If all is done well, the 
 patient is brought to the operating-room with mind 
 and body in the best condition for the job. The 
 anaesthetist continues, and produces in him uncon- 
 sciousness with the most suitable drugs. The pa- 
 tient is then taken in hand by the house surgeon 
 and his assistants, who again scour and cleanse 
 him, and pack him in sterile wrappings. So much 
 for the patient himself. All other persons concerned 
 with the operation must be prepared with equal 
 care, the surgeon, the first assistant, the second 
 assistant, the one or two operating nurses, and in a 
 large, well-equipped hospital, other subordinate 
 assistants, if such there be. Beyond this care of the 
 individuals concerned, there is the care of the in- 
 struments, dressings, sponges, ties, stitches, and 
 other apparatus. In a trial like that of Bumstead's, 
 all this must be made clear to the jury. We must 
 consider especially in his case the question of the 
 use and care of sponges. They are confided to a 
 nurse, whose chief and important business is to 
 keep in touch with them. A definite, known num- 
 ber of sponges are used. They are divided into
 
 Some Doctors, and their Troubles 93 
 
 groups or bundles, usually of six sponges each. 
 A counted number are handed out by the nurse to 
 the surgeon, for use in the wound; and then, after 
 the operation is over, she collects them, scores up 
 every one, and to the surgeon's regular routine 
 inquiry announces that the 'sponge count is cor- 
 rect,' or some such phrase. Of course this announce- 
 ment relieves the surgeon of any anxiety or further 
 responsibility, regarding the fate of the sponges. 
 No one is infallible, however, and mistakes, or mis- 
 counts by the nurse sometimes happen, as in this 
 case. 
 
 "The question, then, is, Who is responsible 
 in the present case ? Obviously and primarily, the 
 nurse. But she is an employee. She is the servant 
 of the hospital. There's the rub. In most of our 
 public hospitals, as at present conducted, the sur- 
 geon has no voice whatever in the selection of his 
 nurse assistants. He may have something or every- 
 thing to say about the subordinate doctors and 
 student assistants, but not a word about the 
 nurses. These operating nurses, good or bad, are 
 thrust upon him. He must suffer for their errors, 
 if errors there be. I dare say this is all unavoid- 
 able; I don't know, not being a surgeon; but I can
 
 94 A Doctor's Table Talk 
 
 see how it must put every surgeon in a difficult 
 position. 
 
 "On the other hand, in his private practice, a 
 surgeon can make up his own team completely, 
 selecting and training his own operating nurses. 
 When fully developed, such private teams are im- 
 mensely superior to the public hospital teams. If I 
 make my point, you see, then, that in my judgment 
 the public hospital should be held responsible for 
 the errors of its nurses in public hospital operating; 
 while in private operating, the surgeon should 
 be held responsible. This question is fundamental, 
 and it's a great shame that the courts don't set- 
 tle it. In Bumstead's case the jury disagreed, 
 eleven to one in his favor. The gossip was, later, 
 that the one juror against Bumstead was a crank 
 who wanted to get even with the hospital because 
 his wife died there fifteen years ago. Juries are 
 wonderful things." 
 
 "Good, Ely, good," said Primrose, after a pause. 
 "You've told your story very well. But I can't 
 help feeling sorry for that poor devil with a sponge 
 in his stomach."
 
 CHAPTER V 
 
 Dr. Primrose on Women 
 
 I CAN'T escape from Primrose and his enthusi- 
 asms. He has an enthusiasm just now for putting 
 down the Woman Suffrage movement. He's a 
 devoted squire of dames and an admirer of the sex; 
 but the suffrage for women, with all it implies, is a 
 burden which he thinks they should not be com- 
 pelled to bear. "Let 'em vote," he clamors, "I 
 dare say they'd vote no more stupidly than most 
 men. If the vote were all, let 'em have it. But after 
 the vote will come the duties of public office. We 
 shall have ill-conditioned women shrieking to be 
 aldermen and mayors, legislators and governors, 
 judges and senators." 
 
 For myself, I am inclined to think that Mr. Roose- 
 velt may be correct when he writes : " I do not re- 
 gard the movement as anything like as important 
 as either its extreme friends or its extreme oppon- 
 ents think. It is so much less important than many 
 other reforms that I have never been able to take a 
 very heated interest in it." I believe that is coming
 
 96 A Doctor's Table Talk 
 
 to be the attitude of thousands of thoughtful men. 
 They don't altogether like to see women taking 
 part in public life, but they are thinking that the 
 experiment may be worth trying, that women will 
 tire of the obligation, and that probably no great 
 harm will be done. Such men agree with Miss 
 Tarbell when she writes ("Book of Woman's 
 Power"), in substance: "Men and women have 
 always crawled or soared together. The lot of 
 woman is hard, but the human lot is hard. The 
 assumption that the improvement of woman's 
 condition depends upon the vote is quite as un- 
 sound as the charge of her inferiority. The woman 
 in industry is, after all, but a transient. A training 
 that will lead her to apply her power with apprecia- 
 tion and enthusiasm to domestic and not political 
 life is what she needs. It is harmful and unsound to 
 believe that woman's position in society would im- 
 prove in proportion as her activities and interests 
 become the same as man's. This implies that man's 
 work in society is more important and developing 
 than woman's." Again, Mr. Roosevelt writes this re- 
 freshing paragraph: "Other fools, advising women 
 to forsake their primary duties and 'go into indus- 
 try,' prattle about the 'economic dependence' of
 
 Dr. Primrose on Women 97 
 
 the wife. Economic dependence, forsooth! Any 
 husband who regards his wife as * economically 
 dependent,' or who fails to recognize her as a full 
 partner, needs severe handling by society or the 
 state." 
 
 With such thoughts as these in mind, I was 
 somewhat startled by Primrose, who was full of his 
 subject when he rushed in upon me one winter 
 afternoon, some six months after our talk on Red 
 Hill. "My friends the New Hampshire Progress- 
 ives," he informed me, "are going in for a try at 
 Woman Suffrage. At any rate, they have persuaded 
 the legislature to refer the question to the voters. 
 I tell you, Scriba, the majority of women aren't 
 up to it. It'll be too much for 'em, and they'll 
 leave the voting to the cranks and the unfit." 
 
 I told him that I doubted all that;. but in order 
 to silence his clamor I asked him to come in later 
 to dine and talk it out. 
 
 "That is just what I meant to propose," he said. 
 "Get Ely. I've written down some of my ideas, 
 and I want to read the paper to you. We hear 
 nothing but the positive side of the argument in the 
 public press, to-day. Nothing much is being said 
 about woman's psychology, physiology, and evolu-
 
 98 A Doctor's Table Talk 
 
 tion. The editors are all scared. They think that 
 it is liberal and progressive to shout for women's 
 rights." 
 
 And so that evening Ely joined us at dinner; and 
 the ladies, mildly approving, sat with us while 
 Primrose read his piece. 
 
 SOME REFLECTIONS CONCERNING WOMAN'S 
 SUFFRAGE 
 
 By Jonathan Primrose, M.D. 
 
 "Arguments flimsy and sound on both sides of 
 the interesting question of granting the suffrage 
 to women have been piled high; fists have been 
 shaken now for two generations; households have 
 been made miserable, and sex-antagonism has been 
 created for the first time in the history of the human 
 race. Most of the good arguments for suffrage are 
 too familiar to need recalling, for they are founded 
 on the much-quoted authority of John Stuart Mill, 
 to the effect that every rational adult human being 
 should have a voice in the conduct of democratic 
 government. 
 
 " In this connection it is interesting, betimes, to 
 seek some perspective; to view from a distance the 
 great question of human development and to esti-
 
 Dr. Primrose on Women 99 
 
 mate the position at which we are now arrived, 
 our relation to the past, to the future, and to the 
 world in which we live. To the mass of persons in 
 our world that relationship is without meaning: 
 the thought is as though it were not. Everyday 
 people run in an everyday circle ; their feeble notions 
 are bounded by their native town. The concentra- 
 tion of modern life, and the specializing of modern 
 effort curiously contract their horizon. 
 
 "The other day a clever collegian said to me: 
 'What shall I read? I know nothing; I am like a 
 rat in a barrel.' The man in the street is in even 
 worse case. He is like a stranger in a strange city. 
 You cannot make the New Yorker lose himself in 
 New York. Hide him overnight in a back room of a 
 hotel; and for a moment, when looking about in the 
 morning, he may be confused, but quickly he finds 
 himself. From his window he recognizes familiar 
 landmarks. He is on Fifty-fourth Street, or on 
 Washington Square, as the case may be. He goes 
 out on the street ; he makes his way uptown or down- 
 town without hesitation. The people about him 
 have the accustomed air; they suit him; he knows 
 what is going on in his little world; he reads his 
 morning paper; he rejoices in its local tone: the
 
 ioo A Doctor's Table Talk 
 
 name and doings of the mayor, of the police com- 
 missioner, of the latest city enterprise, of the sub- 
 way stations, of the theatre, all these things are 
 pleasant to him. He orientates. 
 
 "But take this same honest fellow and conceal 
 him overnight in a back room of a hotel on Michigan 
 Avenue, Chicago, a city unknown to him. What 
 now are his morning sensations? He looks out in 
 confusion upon unknown roofs. The strange street 
 carries with it no meaning; he knows not north from 
 south. Within five minutes of the door, he is lost. 
 The faces he passes signify nothing; he pronounces 
 the morning paper a narrow and provincial sheet; 
 he knows and cares not for the concerns of this 
 dreary town; the shops, the elevated road, the 
 buildings, the theatres are all to him as something 
 vague and unfamiliar; he delivers himself into the 
 hands of the nearest police officer or cabman, and 
 cries aloud for the railway station and a ticket to 
 New York. 
 
 "Equally vague are the notions of the average 
 citizen regarding the land in which he lives. The 
 United States of America has a fine sound for him. 
 It is God's own country, he babbles ; but he knows 
 little about it, and nothing of the lands beyond its
 
 Dr. Primrose on Women 101 
 
 borders. He has a few shadowy ideas about Ameri- 
 can geography. With the aid of a time-table, a 
 map, and a Pullman car he can make his way from 
 Boston to Washington; but Washington, when 
 reached, has no special meaning for him. He 
 knows it is the capital of his country, the great 
 headquarters of democratic government; but these 
 are mere words. He knows nothing of how the city 
 came into existence, of its architecture and its 
 vicissitudes. He may know that in Washington are 
 to be found the President, Congress, and the Su- 
 preme Court; but talk about the nature of a gov- 
 ernment expressed in terms of an executive, a 
 legislative body, and a court to interpret the laws 
 and the constitution, is gibberish in his ears. He 
 has a school-boy's knowledge of his country's his- 
 tory; of a Columbus; of a George Washington, of a 
 cherry-tree and a hatchet, of Puritans, Indians, a 
 Boston Tea-Party, a Fourth of July, an American 
 Revolution, bloody-minded Tories, and a wicked 
 King George; but for the life of him he cannot tell 
 you what it was all about. From the adoption of 
 the Federal Constitution to the bombardment of 
 Fort Sumter, all is black chaos to the average 
 American citizen. He knows that the Civil War
 
 IO2 A Doctor's Table Talk 
 
 was about freeing the negro slaves ; and he believes 
 that Lincoln, Grant, Sherman, Jefferson Davis, 
 Grover Cleveland, Lee, John Brown, Daniel Web- 
 ster, and sundry other worthies had a hand in it. 
 He brings his flabby mind down to modern times, 
 and sees about him a seething mass of ideas, activi- 
 ties, and emotions to him uncorrelated, which 
 leave him unimpressed, or dumb and gasping. 
 What shall he say of labor unions, of the 'trusts,' 
 of political parties, of national leaders, of modern 
 altruism, of the great democratic and socialistic 
 movements towards human betterment; of a revo- 
 lutionized Church, of modern conceptions of human 
 development, human life and human destiny, of 
 all that modern enterprise in the arts, in science, in 
 invention and literature is bringing to twentieth 
 century men and women ? The average citizen has 
 nothing to say to all these things. They flood over 
 him. He hears a name now and again, like a 
 great bell rung beneath the waves ; now and again 
 he rises for air; he sees a glimmer of truth; he hears 
 a word spoken in his own interest; he nods wisely 
 his head; he casts his foolish vote; he shouts his 
 shout. But the meaning of it all never reaches him. 
 He is confused and puzzled by what he hears and
 
 Dr. Primrose on Women 103 
 
 reads. He retires smugly to his hearth and his daily 
 bread, and he tells his wondering children how big 
 and foolish and naughty is this world and the things 
 thereof. 
 
 " Such is the average citizen and voter, the 
 member of the great gray mass, swayed back 
 and forth by impulse, by hysteria, by fancied 
 interest, by demagogues, anon by an honest man 
 of genius. Such are the masses, the millions, whose 
 votes are equally divided, who impress by their 
 quantity, whose quality is as naught. 
 
 " They are not the true rulers and governors set 
 over us, but out of their ranks the rulers come. From 
 the midst of the chaos there is tossed to the surface 
 now and again a superior person, a man, a leader, 
 a governor. Just as the great gray mass is made up 
 of all sorts and conditions of men, the rich and 
 the poor, the idle and the toilers, the educated 
 and the uneducated, the virtuous and the vicious, 
 so the chosen ones, the superior persons who rise 
 by force of intellect, come from no special class, and 
 represent no special interest. The superior ones 
 gather themselves together for mutual support or 
 offense; they control and direct the multitudes 
 from whom they sprang. They rule.
 
 IO4 A Doctor's Table Talk 
 
 "And now into this seething mass, into this stage 
 of human development, we see injected the ques- 
 tion of Woman Suffrage. This question is becom- 
 ing an important question. There may or may not 
 be truth in the oft-repeated assertion that the 
 woman's vote is coming. So long as woman's vote 
 is immersed in the vote of the great mass, it will 
 be divided and have little influence, for, as David 
 Harum said, there is a deal of human nature in all 
 of us. But woman would not, and doubtless should 
 not, be content with such a situation. The more 
 ambitious women will strive to rise to, and mingle 
 with, the class of superior men, and to take an 
 active part in affairs. 
 
 "As the judicious critic hearkens to the debate 
 and views the activities of Woman Suffragists, he 
 is often impressed by the feeling that most of these 
 women have thrown little light on the problem of 
 progress. They carry a feeble candle which sheds a 
 narrow, encircling glimmer on the road, but they 
 fail utterly to illuminate the broad path down 
 which civilization has marched, and they fail utterly 
 to show us the highroad on which we are advancing. 
 
 " What is it, then, that women so boldly and con- 
 fidently demand ? Nothing less than an equal share
 
 Dr. Primrose on Women 105 
 
 in the conduct of government. You may grant 
 them the ballot if you choose, and a voice in the 
 direction of local personal interests which touch 
 them nearly ; in the direction of schools, of 
 municipal hygiene, of factories, and the like. 
 Those are practical, everyday questions which 
 concern the immediate comfort and well-being 
 of the women themselves, and women have long 
 proved the value of their services in these fields. 
 But when we consider admitting the women to an 
 equal share with men in great affairs and in the 
 conduct of government, shall we not properly 
 pause and ask what has been accomplished by 
 those men whom women would rival or supplant, 
 and what meantime has been woman's contribution 
 to human progress ? Be it said, at the same time, 
 that woman's excuse of lack of opportunity in the 
 past is a fatuous and misleading begging of the ques- 
 tion. The Roman slave Epictetus wrote a book of 
 philosophical reflections which have rejoiced the 
 ages equally with the philosophy of the Roman Em- 
 peror, Marcus Aurelius. A poor Syrian carpenter 
 founded a system of ethics, preached a philosophy 
 of life, and established a great religious system 
 which has controlled the Western world for nearly
 
 106 A Doctor's Table Talk 
 
 two thousand years. An obscure Dutch mechanic 
 invented and developed a system of multiplying 
 books which has revolutionized civilization and has 
 made possible the march of human progress. But 
 one need not multiply examples. Most of the great 
 achievements of the human mind have been accom- 
 plished by men obscure, down-trodden, little re- 
 garded. The prophet and genius does not wait for 
 occasion and privilege. He makes and seizes his 
 own opportunity. He rises above circumstance, 
 and the world hears him from the depths. 
 
 "What, then, have the men accomplished through 
 ten thousand years of progress ? They have invented 
 and established civilization; they have developed 
 agriculture and commerce. They have perfected 
 navigation and transportation; they have devel- 
 oped a world-wide system of finance; they have 
 invented, if they have not perfected, the arts of 
 architecture, sculpture, painting, and music. They 
 have conquered and colonized the world ; they have 
 devised and perfected a glorious literature, they 
 have created splendid philosophies; they have 
 adopted and formulated great religious systems; 
 they have conceived of honor and human brother- 
 hood, and they have established that greatest work
 
 Dr. Primrose on Women 107 
 
 of man, the court of justice. Through the spirit 
 of modern altruism they have sought out the 
 down-trodden; on a great scale they strive to re- 
 lieve the afflicted; they have established popular 
 education; they have developed scientific medicine; 
 they have immensely mitigated the sufferings of 
 the human race; they have developed science and 
 invention; they have explained the secrets of the 
 earth, and the history of the past, the facts of na- 
 ture, and the mystery of the stars ; they have con- 
 ceived of a true democracy, and they have estab- 
 lished and conducted happily great systems of 
 beneficent government. 
 
 "These are no small matters; the record is far 
 from complete; but such as it is, the work is the 
 work of men, and of men only. The great, prophetic, 
 creative master-minds are the minds of men. Wo- 
 men's names do not appear. These things must 
 needs be said. It is in the face of such overwhelm- 
 ing facts that one reflects on the mingled pathos 
 and audacity of some of the Suffragists' demands. 
 
 " It will be protested that women have shone in 
 some of the fields of great human endeavor. They 
 have so shone, but never has their light dazzled 
 the world. The other day in Cambridge a distin-
 
 io8 A Doctor's Table Talk 
 
 guished woman astronomer died. She was famous 
 for minute and painstaking studies of statistics, 
 for interpreting stellar photographs, for compiling 
 data. No woman has founded a great scientific 
 system; the women have produced no Confucius, 
 no Galileo, no Newton. The strong, sane, penetrat- 
 ing minds among them range another field. They 
 are close, exact, microscopic, while the minds of the 
 great men among us are generous, wide-ranging, 
 telescopic, if one may phrase it so. 
 
 "The progress of mankind and their happiness 
 are dependent on other things, however, than the 
 great achievements I have named; and towards that 
 progress women's contributions have been great, if 
 not priceless. The bearing and rearing of the human 
 race alone would place woman on a plane higher 
 than that occupied by mere physical man, but she 
 has done more; she has concentrated, coordinated, 
 and made permanent and coherent the civilization 
 carved out by man. Without this work of woman, 
 civilization could not persist. Wherever and when- 
 ever woman has been debased or abolished, civil- 
 ization has withered and failed. Such is the teach- 
 ing of history. Among those peoples and races 
 where woman has been down-trodden, progress has
 
 Dr. Primrose on Women 109 
 
 languished; and chaos, ignorance, cruelty, and vice 
 have usurped the place of generous enlightenment. 
 The story of Oriental civilization shows this; for 
 with those Eastern peoples the debasing of woman 
 and the development of a semi-barbarism went 
 hand in hand. Among the ancients, the Greeks 
 and the Romans, the fall of woman and the 
 degeneration of empires coincided. The brutal wars 
 of mediaeval and modern times, while they destroyed 
 the influence of woman, coincidently halted and 
 put back progress. In our own country no per- 
 manent establishments were made by explorers, 
 colonists, or pioneers until woman came to join in 
 the work. 
 
 "This surprising and convincing influence of 
 woman has been subtle but effective. About women 
 have gathered the fundamental elements which 
 make for permanence and advance, the concep- 
 tion and establishment of the roof-tree and the 
 home; of the family, the tribe, the village settle- 
 ment, the state, and the nation. For her and for 
 the children men have fought and died that she and 
 her ideals might endure. Her influence has con- 
 firmed and cemented every forward step. For her 
 have been wrought the arts of peace, through the
 
 no A Doctor's Table Talk 
 
 establishment of which the great accomplishments 
 of mankind have been made possible. In all these 
 matters woman has been no idle observer, no pas- 
 senger, as we say. She has taken an active, strenu- 
 ous, and unceasing part. She has advised, admon- 
 ished, and approved. She has bestowed rewards; 
 she has stood for comfort, sanity, and happiness. 
 Without her cooperation, man in his forward strug- 
 gle would have come to naught and have ceased. 
 With her cooperation, we see supplemented and 
 made effective the toil of man. Through the ages 
 men and women have stood together, shoulder to 
 shoulder, and have created the good world in 
 which we live. 
 
 " So it comes about that if a sound development 
 of the historic sense and a broad outlook upon the 
 world teach us anything of the relations of men and 
 women, and of the capacities and achievements of 
 both, it is that the sexes supplement and support 
 each other. Neither can successfully break into or 
 take over the other's work. Physiology teaches 
 this ; psychology confirms it. Man at his best, in his 
 greatest expression, is prophetic, judicial, compel- 
 ling, creative. Woman is faithful, patient, enduring, 
 supporting, generous, conservative. Through jus-
 
 Dr. Primrose on Women ill 
 
 tice and sanity man has constructed democracy. 
 You cannot democratize woman. Man builds; 
 woman conserves; and an unhalting progress in 
 social uplift results." 
 
 We all applauded. 
 
 "That's a good piece, Primrose," said Ely; "you 
 ought to publish it." 
 
 "I've tried to publish it, but the editors won't 
 take it." 
 
 "Why?" 
 
 "They're afraid of it, I think. I sent it to 'The 
 Antarctic Monthly.' The editor flattered me, but 
 said the public were tired of the subject. Then I 
 sent it to the weekly ' Forecast' in New York. The 
 editor returned it with thanks. Two weeks later 
 our most distinguished fellow citizen published in 
 that journal an article on the same subject; but 
 it was a mild utterance. I observed, too, that he 
 did not altogether agree with the veteran editor-in- 
 chief." 
 
 "You know, of course, that that article is not 
 going to add to your popularity." 
 
 "I don't know; for I don't yet know which is the 
 popular side."
 
 112 A Doctor's Table Talk 
 
 "You will find, I think, that the women divide 
 themselves broadly into three social groups or 
 classes, just as civilized mankind has always 
 and inevitably divided itself into three classes, - 
 the 'upper/ the 'middle/ and the 'lower/ It's 
 an artificial thing, a question of money-getting 
 capacity on some one's part, and the ability to 
 keep it. The upper class among women have come 
 to see that the suffrage has little in it for them, so 
 long as it is not limited to property-holders; the 
 lower class are too serious and too busy with the 
 personal problems of daily life to think or care any- 
 thing about the suffrage. The result is that the 
 question is left mainly in the hands of the great 
 seething middle class, with women especially more 
 or less unattached or unemployed. These vigorous 
 and kindly souls are bestirring themselves, not only 
 for themselves, but for their less fortunate sisters. 
 That great middle class will not like your saying 
 that the women have done none of the big construc- 
 tive things. They'll point to Joan of Arc, Queen 
 Elizabeth, George Eliot, and Queen Victoria. I'm 
 glad I have not to settle the question you've at- 
 tacked. My patients and consultants give me plenty 
 to do."
 
 Dr. Primrose on Women 113 
 
 "But that's absurd. Those four women con- 
 structed nothing." 
 
 "Of course not." 
 
 "Then why ?" 
 
 "Exactly; why? That's the one trouble with the 
 whole situation. I advise you to let it alone. It's 
 probably not the great issue that some people think 
 it. It's a means, not an end. The end we should 
 have in view is good government. Vox populi, vox 
 Dei, may be true, I don't know. It 's the best 
 thing we have found yet; generally, but not al- 
 ways." 
 
 Primrose sat silent for a few minutes. Then he 
 said: "If this is a great movement it is the first 
 great movement, right or wrong, which has had no 
 great leaders. Think of some of the great reform 
 movements of modern times: the Reformation 
 with its Luther, its Wycliffe, and its William of 
 Orange; the great Civil War of England, with 
 Hampden, Pym, Cromwell; the American Revolu- 
 tion and Constitution building, with their Wash- 
 ington and Hamilton; the French Revolution, with 
 its Voltaire, Rousseau, Mirabeau, and the rest; the 
 Reform of the Suffrage in England eighty years 
 ago, and the strong men who debated it; to say
 
 1 14 A Doctor's Table Talk 
 
 nothing of our Slavery problem and the Civil War, 
 with the great men, and women, too, on both sides. 
 Those were truly mighty questions that produced 
 their giants, but I don't see any one above five 
 feet two in the present scramble." 
 
 "I dare say. But keep cool. And first let us see 
 the result of your New Hampshire referendum. 
 
 "'For forms of government let fools contest; 
 Whate'er is best administered is best: 
 For modes of faith let graceless zealots fight; 
 His can't be wrong whose life is in the right.' "
 
 CHAPTER VI 
 
 The Doctor is a Patient 
 
 MY friend Primrose has been ill. The busy doc- 
 tor has for months been turned in upon himself. 
 He has forgotten the Woman Suffrage trouble 
 as a trouble; and he has taken to analyzing life 
 through his own glasses. He looks back in these 
 days to his long neglected "Religio Medici"; and 
 he talks about the mysteries of the unknowable as 
 though, indeed, they were very present with him. 
 He quotes with gusto Sir Thomas Browne: "The 
 Devil, that did but buffet St. Paul, plays, methinks, 
 at sharps with me. Let me be nothing, if within the 
 compass of myself I do not find the battail of Le- 
 panto, Passion against Reason, Reason against 
 Faith, Faith against the Devil, and my Conscience 
 against all. ... As Reason is a Rebel unto Faith, 
 so Passion unto Reason: as the propositions of 
 Faith seem absurd unto Reason, so the Theorems of 
 Reason unto Passion, and both unto Reason. Yet 
 a moderate and peaceable discretion may so state 
 and order the matter, that they may be all Kings,
 
 Ii6 A Doctor's Table Talk 
 
 and yet make but one Monarchy. . . ." And so he 
 concludes serenely in cheerful optimism. 
 
 He has taken to much letter-writing and he 
 copies from voluminous journals: 
 
 MY DEAR SCRIBA, You will wonder that I have 
 been so long silent, but indeed my Pride hath had 
 its fall; though I trust that 
 
 "my way of life 
 Is (not yet) fallen into the sear, the yellow leaf." 
 
 My doctor friends, with cruel kindness, have turned 
 upon me; three months ago they put me to bed, and 
 in bed I remain. Of them all, Ely is the only one of 
 humanity and intelligence. It seems that I played 
 the mischief with that clock inside my chest, and 
 so I have at last fallen upon evil days. When I 'm 
 ill, though, I think of our dear old chum Optimus 
 in Ohio. I know you loved him. For me he was the 
 greatest physician in the land. Read this : it is the 
 letter he sent me when he heard that I was laid low 
 three years since. Perhaps it may help you or your 
 patients some day. It gives me a strange thrill to 
 think that he himself has gone before, leaving us to 
 keep up the fight: "Dear Jack, George has just 
 been down to see me, very unhappy over your
 
 The Doctor is a Patient 117 
 
 letter. I have been showing him what James Mac- 
 kenzie says about prognosis in his wonderful new 
 book on Diseases of the Heart, and have sent him 
 off in a much more cheerful frame of mind; and I 
 want to send on to you some of Mackenzie's optim- 
 ism. To begin with, get somebody to read to you, 
 on page 257 of his book, his history of the mechani- 
 cal engineer who twenty-six years ago, at thirty- 
 two, had rheumatism, and was left with a mitral 
 lesion; fourteen years later he lay for weeks uncon- 
 scious with dropsy; from this he recovered with all 
 kinds of heart murmurs and irregularities; but none 
 the less, since, and up to date, he has been doing 
 the laborious work of his profession as well as any- 
 body. We doctor-folk, with our stethoscopes, are 
 apt to take too grave a view of the extent of restora- 
 tion possible in recent heart lesions. The general 
 practitioner who follows his people through their 
 illnesses and long afterwards, or who, like myself, 
 has inherited patients from father and grandfather, 
 knows how long a life and how active a one a man 
 may lead who has seemed hopelessly invalided when 
 his rheumatic heart lesion was new. The long stay 
 in bed at the first, with massage and resistive move- 
 ments by and by, to strengthen the skeletal and
 
 1 1 8 A Doctor's Table Talk 
 
 heart muscles, are therapeutic tricks our fathers, 
 too, did not know; and unquestionably the rest less- 
 ens the puckering and shrinking of a valve scar. 
 I should like to talk to you about patients. Two 
 years ago a man of about your age had a rheumatic 
 fever, and developed both mitral and aortic lesions. 
 I shook my head over him, and told his friends 
 what your doctors are saying to you. He stayed in 
 bed three months, and went slow for a year; but 
 now he is in the hurly-burly again, and likely to 
 live a life of activity for years so far as I can see. . . . 
 I hope Dr. Samson has been well enough to see you. 
 He is the chap I should like to have talk to me, if I 
 lay on my back with a heart lesion, and wanted to 
 know what the future held. But inevitably the 
 doctor's stethoscope scares him, and misleads him 
 in estimating the significance of recent lesions. . . . 
 And then, if you are left like a cup with a crack in 
 it, that is the one that outlasts the rest of the set, 
 if it is kept out of boiling water. Did you ever read 
 Weir Mitchell's charming essay on convalescence? 
 You have resources enough to make a * pleasant 
 land of counterpane* for yourself, I know. Now 
 I'm off for Bermuda with the boy. Good-bye. As 
 ever, yours, E. F. O."
 
 The Doctor is a Patient 119 
 
 "Omnem crede diem tibi diluxisse supremum " was 
 truly part of Optimus's creed; but I cannot help 
 feeling that that brave fellow's death was an 
 offense to medicine. And does it not give one a 
 catch in the throat to read those fine, ringing, in- 
 spiring words, posthumous, as it were, from a man 
 who led the life for all there is in it. That was 
 a physician of the sort for which the world will 
 always cry, of a species almost extinct. Useful 
 and self-sacrificing as are many of our laboratory 
 men, I am growing a little tired of hearing them 
 proclaimed the heroes of medicine. What in civil 
 life could be more heroic than the career of Opti- 
 mus ? With a mind of the finest, and the whitest of 
 souls; generous as a woman, gentle-spirited as a 
 child; worldly-wise from long training, but great- 
 hearted, charitable, and infinitely kind, his was 
 a character of which it is an inspiration to think. 
 He was splendidly equipped for his work. His 
 broad interests and wide-ranging thought inter- 
 preted the needs of the time. He was brilliantly 
 qualified to practice either as surgeon or physician, 
 for such was his training. Finding to hand, how- 
 ever, a surgical colleague of sympathetic mind and 
 progressive views, Optimus abandoned surgery,
 
 120 A Doctor's Table Talk 
 
 and for twenty years devoted himself constantly, 
 untiringly, generously, superbly to that humble 
 calling the practice of general medicine. Mod- 
 est, retiring, silent, he did his own work and no 
 other. In a measure he had his reward. In all 
 things medical, and in much else, the great com- 
 munity in which he lived became his devoted sub- 
 jects. In any field of service he would have shone. 
 He might even have emulated yon capering Smilax, 
 of whom you tell. He might well have been a 
 national figure; but he was content with a career 
 which the absurd fiction of to-day regards as hum- 
 ble and commonplace. He was simply useful. His 
 was a life of service to thousands of his fellow men. 
 There is a saying that every life, however com- 
 monplace and humble, may be of supreme interest, 
 and carry its great lesson, if that lesson be but 
 properly told. Here was a life abundantly worth 
 the telling. 
 
 "He had kept 
 The whiteness of his soul, and thus men o'er him wept." 
 
 This letter is degenerating into an epistle, but 
 I find there is a lot I want to say. Perhaps it is the 
 familiar sick man's garrulity; and yet, like the 
 patient "coming out of ether," I want to tell all
 
 The Doctor is a Patient 121 
 
 about it, for I am sure that no one else has had such 
 a unique experience. In the first place, I am at last 
 convinced in my own person that one may drift into 
 alarming and serious illness without special dis- 
 comfort. We doctors all know how there is rarely 
 any such thing as the traditional "death-agony," 
 because most people become unconscious long be- 
 fore they die; but we sometimes forget that other 
 fact about serious illness. Of course sickness is as 
 natural a process as are birth, death, and decay; 
 and I suppose some day, when Almoth Wright and 
 the others have worked out their problem beyond 
 peradventure, showing the organism that causes the 
 given patient's disease, and by the opsonic index, 
 his exact powers of resistance, that then we can 
 increase his resisting powers at will, and play up 
 and down the scale with every feeling of assur- 
 ance. 
 
 My friend, I was sick; not merely "ill," as our 
 English friends would say for they do corrupt and 
 turn to contemptible uses the good old Anglo-Saxon 
 speech; I lay on a "sick-bed," in a "sick-room"; 
 I was truly on " sick-leave," and the "sick-list," and 
 I experienced many new things. Was it not our old 
 James Jackson who wrote that no physician could
 
 122 A Doctor's Table Talk 
 
 regard himself as thoroughly competent to practice 
 medicine until he had experienced a serious sickness 
 in his own person ? We are wont to say that a period 
 of severe sickness seems a nebulous period after- 
 wards. Perhaps so. But this time I declared to my- 
 self that no detail should escape me or be forgotten, 
 and I think I succeeded in my resolve. After six 
 months of unwonted feebleness, with increasing 
 shortness of breath, rapidity of pulse, and failing 
 mental vigor, I finally consulted Ely, who told me 
 that I had tachycardia, which I knew; with a 
 dilated heart, which I had suspected; and sent me 
 to bed under the immediate care of one of my kind 
 neighbors here. Since that time three months 
 ago I Ve lain in bed with reasonable cheerful- 
 ness, and have observed life. IVe made some 
 study of sick-room attendants, especially of doc- 
 tors and their ways. I've been under the care of, 
 or been visited by, eight or ten of the faculty, and 
 on the whole I Ve concluded that they are a fine set 
 of fellows. There is a tradition that doctors make 
 bad patients. I think I Ve disabused my friends of 
 that notion. I am sure I have been a fairly good 
 patient, and I am not sure but what that is true 
 of most men. You remember that when we were
 
 The Doctor is a Patient 123 
 
 hospital house-officers the experienced nurses used 
 to say they would rather take care of a ward full 
 of men than a ward full of women; because, in the 
 case of acute illness, men are so much more docile 
 less critical, less peevish, less fault-finding. Men 
 don't know much about illness. Nowadays they 
 have little experience in the nursery. That does 
 not seem to be a part of their job. The atmosphere 
 of the sick-room is woman's own. Why is it, then, 
 that women are not the great doctors, the great 
 clinicians? I sometimes ask myself. Perhaps because 
 they have been at the business too short a time to 
 have gained the proper assurance. But it seems as 
 though there must be some inherent reason ; other- 
 wise, during the seventy years or more that women 
 have been going into medicine, they would have 
 produced at least one great physician. They will 
 do it yet, I feel sure they will do it yet. I doubt if 
 they have had half a chance until now. Johns 
 Hopkins is educating them alongside of the men. 
 Let us await developments there. 
 
 For myself, I presume I have been peevish 
 enough, and a grief to my friends. Though I seem 
 to have the whole experience in memory, still there 
 are one or two knock-out features; especially a
 
 124 A Doctor's Table Talk 
 
 sense of overwhelming unreality, as though one 
 were another person. I suppose the simple expla- 
 nation of that is the variation in the intracranial 
 blood pressure an entirely natural phenomenon, 
 accentuated at times by hyperactivity of the heat 
 centre; for, mark you, rheumatism and fever have 
 added variety to my lot. The other most pro- 
 nounced and interesting feature of illness, I find 
 to be the astonishing feebleness. I fancy that 
 explains the unaccountable alarm which many 
 men, as contrasted with women, display in sick- 
 ness. With men in sickness the variation from nor- 
 mal health is much the greater. A majority of 
 women are accustomed to a certain amount of ill- 
 health, or at least to recurring periods of depression, 
 lassitude, and feebleness. Prostrating disease for 
 them is no such stunning surprise as for men. So 
 the men for a time protest and complain in most 
 unhandsome fashion. I don't think that I showed 
 any improper alarm, but I admit that for a time 
 I was undone mentally as well as physically; and 
 that, to my shame and disgust, I found myself 
 taking a jabbering interest in my own symptoms, 
 and hanging on to my doctor like a sailor to an 
 upset dory.
 
 The Doctor is a Patient 125 
 
 Perhaps the most distressing, even humiliating 
 part of the whole experience for me was the sick- 
 bed toilet. That, I suppose, is a matter of individual 
 temperament; but for me, to have a young woman 
 eternally hanging about, bossing me, entering 
 without knocking, violating my privacy, brushing 
 my teeth, washing my face, and rubbing my legs 
 was intolerable. And then, her reading aloud! 
 She never tried it but once. I am sure that the 
 modern trained nurse is a great comfort to the 
 doctor ; and I know that my specimen is a good 
 and superior girl, for she's a neighbor's daughter, 
 and used to play in my back garden ; but upon my 
 word, it seems at times as though the Devil was in 
 her. She hangs around during the doctor's visit, 
 and " makes remarks." She bustles from the room 
 with him, and holds him in long whispered consul- 
 tation outside my half-open door. She returns 
 with an air of superior knowledge; and she actually 
 has the effrontery to tell me not to be nervous. 
 Worst of all, she munches apples in my presence, 
 and she sleeps in my room and snores. Yes; I sup- 
 pose I am nervous, as she tells me to my face. 
 
 Is it not a dreary and sordid tale? And yet 
 there are compensations. When I was at my
 
 126 A Doctor's Table Talk 
 
 worst, they thought it would be a good thing to 
 have a doctor in the house for a few days; so Ely 
 sent up young Flaxman. You remember, the 
 clever chap in the disreputable suburban office, 
 whom you advised to find proper quarters, become 
 a professional, and marry a wife. He's not yet 
 found the wife, as you know, but in other respects 
 he has found his feet and is trig, smiling, and hu- 
 man. He did me a power of good, and I am not sure 
 but what he "pulled me through," as they say. 
 
 I told him that I had heard of him, and asked 
 if he had moved his quarters. Yes: it seems he 
 moved into the next block a week after your visit. 
 His cross landlady would hardly let him go without 
 searching his trunk, while the " collarless drab " put 
 on some forlorn neck-gear, and burst into tears as 
 she packed his shirts. He now lives in a smart 
 little apartment of his own, drives a motor, and 
 tells me that his practice trebled last year. Mrs. 
 Primrose and the children felt that they could not 
 let him go, and I fancy he took all their hearts with 
 him. Apropos, what father knows his own daugh- 
 ter? 
 
 Now, my friend, I am convalescent; that is the 
 wonderful fact I have to tell; and you must come
 
 The Doctor is a Patient 127 
 
 to see me. The winter is over; spring is at hand; 
 by six of the clock the sun now crowns the peak; 
 the sap runs eager in the trees; buds sprout from 
 willow boughs along the brook; a soft and tender 
 green enshrouds the hill, the streams rush full, and 
 crowd the jealous bank. 
 
 "And this reviving Herb, whose tender Green 
 Fledges the River-Lip on which we lean 
 Ah, lean upon it lightly! for who knows 
 From what once lovely Lip it springs unseen!" 
 
 There's no one like dear old Fitzgerald to 
 translate some of our thoughts. And how wonder- 
 ful is this spring-time of returning health! Your 
 heart beats full and strong; you feel no anxious 
 flutter in the chest; your breathing's like a child's 
 regular, deep. You sleep as boyhood sleeps 
 hour after hour. Haply you eat the gods pro- 
 vide the food ; Ceres attends ; you shake off vulgar 
 cares; the merry, merry days of youth seem for the 
 moment gently to return. You hold a cherished 
 hand; some soft emotion thrills your moistened 
 eyes; old friends, old books, old thoughts engross 
 your heart; you sigh and smile; again the world is 
 yours. Such is the measure of my great content, 
 and you must share it. We've much to say. I've
 
 128 A Doctor's Table Talk 
 
 read some books while you've been reading 
 men. Bring Ely, if you can; the time for talk has 
 come. 
 
 That very next Saturday afternoon Ely and I 
 reached Poquonnock Village for a week-end with 
 our old friend and his family. We left the stage 
 ten miles from the railway at the foot of his ram- 
 bling street, and strolled to his house. The joy of 
 the land was all that Primrose said. The clear 
 upland air, the soft wind with a suggestion of sum- 
 mer in its caress, the smell of new-turned soil, the 
 delicious warmth of the kind embracing sun 
 seemed indeed to restore our youth. Ely, emanci- 
 pated, frisked like a puppy. He took off his hat, 
 and stretched and shouted. He cast from him his 
 coat to my devoted back. He capered in the middle 
 of the road, to the dismay of a patient ox team 
 approaching; and his happiness was complete 
 when he discovered a stately and solemn proces- 
 sion of geese debouching in single file upon our 
 path. Immediately he named them, Obadiah, 
 Amos, Barnum, Savonarola, Mr. Carnegie, and 
 Mary Baker Eddy. He assured me that Mr. Car- 
 negie was the only one in the flock with a sense
 
 The Doctor is a Patient 129 
 
 of humor, and he proceeded to prove his point 
 by bombarding them gently with a shower of 
 pebbles. 
 
 The gabble of the geese and the shouts of Ely 
 were at their height when a peal of laughter and a 
 call upon our names came to us from a buggy 
 which trotted past. A girl waved her whip at us 
 and a young man raised his hat. 
 
 "Upon my word," said Ely, flushed and sedate, 
 "that's my friend Marion Primrose; and the man 
 is Flaxman, the rogue. Observe me, Scriba, for 
 I claim to be as knowing as a woman in these mat- 
 ters, there 1 s a match. From Flaxman now let me 
 depart in peace. His destiny and your prescription 
 are met. His future's safe." The buggy was dis- 
 appearing around the curve. The girl's big hat, 
 well-poised whip, and upright figure seemed set at 
 "attention"; while beside her the young man's 
 head was bent, and his right arm thrown over the 
 back of the seat in privileged lover fashion. "And 
 a good thing, too; a good thing," said the astute 
 Ely, as he wagged his foolish bachelor head. 
 
 Almost in silence we strolled on up the hill after 
 this, though an occasional muttering at my side 
 assured me that Flaxman was a young villain, that
 
 130 A Doctor's Table Talk 
 
 Marion Primrose was a sweet thing, and that that 
 arch plotter Ely was content. 
 
 As we turned in at the Primrose gate, a little 
 whirlwind came down behind us, and a manly 
 voice chanted the sturdy lines of a great American 
 epic: 
 
 "There was ease in Casey's manner as he stepped into his 
 
 place, 
 There was pride in Casey's bearing, and a smile lit Casey's 
 
 face; 
 
 And when, responding to the cheers, he lightly doffed his hat, 
 No stranger in the crowd could doubt 'twas Casey at the 
 
 bat." 
 
 But even an engagement in the family could not 
 long keep our old friend Primrose from his favorite 
 topics. Of course he was glad to see us, and his 
 eyes glistened with kindly emotion and a loyal wel- 
 come as he held our hands. We learned that Flax- 
 man had been regarded for some weeks as one of 
 themselves; that the wedding would take place in 
 June; and that the young couple would live in the 
 Poquonnock neighborhood. An important endowed 
 hospital had been opened in the near-by town of 
 Asphodel, with Primrose and Flaxman respect- 
 ively as physician and surgeon-in-chief.
 
 The Doctor is a Patient 131 
 
 Primrose is a person of unappeasable curiosity. 
 It seems that there has been recently a serious 
 strike among the mill operatives in one of our 
 New England towns. Primrose thinks that he is 
 half a Socialist, as is Flaxman altogether; so the 
 younger man was straightway packed off to the 
 mills to study the situation. We all sat round the 
 great open fire in the library that evening discuss- 
 ing the affair. Flaxman, with a good deal of earnest 
 excitement, told his story, and Primrose expressed 
 general views. It was all trite enough, I dare say, 
 and of small value to experts ; but for the audi- 
 ence of uninformed city doctors it was novel and 
 thrilling. 
 
 Flaxman, while investigating, had met Weyl, 
 the well-known correspondent, to whose superior 
 knowledge he owed much. As the correspondent 
 wrote later: "The strike came suddenly. The 
 Legislature had passed a law reducing the hours 
 of labor from fifty-six to fifty-four, and the mill- 
 owners, without warning to their employees, re- 
 duced wages in a like proportion. It was a ruthless, 
 immoral, ill-advised proceeding. It was ruthless, 
 because wages already were indecently low. . . . 
 They are far lower, here as elsewhere, than the
 
 132 A Doctor's Table Talk 
 
 cost of living and the demands of our American 
 civilization imperatively require. It was immoral, 
 because the method of reduction was that of a de- 
 spotic master deciding, according to his sole will, 
 the fate of his subjects. It was ill-advised, because 
 it revealed to an already irritated American public 
 the other side of Schedule K. It showed that the 
 woolen manufacturers were obtaining a high pro- 
 tective tariff under the false pretense of benefiting 
 American labor. I have rarely seen in any Ameri- 
 can city so many shivering men, without overcoats, 
 as I have seen in this cloth-producing town." 
 
 With such views Flaxman was in sympathy. 
 He had found a community of many nationalities, 
 and little English spoken; but with the exception 
 of a few hot-heads the people German, French, 
 Flemish, Italian, Syrian, and the like were 
 peaceable and kindly, debating the situation with- 
 anxiety, but with entire good temper. A large 
 body of militia had been called out to keep order, 
 but they found little to do. Yet here is an eco- 
 nomic situation, as Flaxman declares, which has 
 advanced almost beyond the limits of human 
 endurance; and again he quotes Weyl: "To-day, 
 to-morrow, and year after year in America the
 
 The Doctor is a Patient 133 
 
 question raised at the conference between legisla- 
 tors and strikers will rise up against us, 'What can 
 the State do? What can we do to make the wrong 
 right for the people of our mills and factories ? ' ' 
 
 This sort of discussion could not have been a 
 good thing for Dr. Primrose in his feeble state. 
 He restrained himself, as best he could, however; 
 but at last with a flash, and his old-time quiver he 
 broke in : 
 
 "Public men and newspapers, from Mr. Roose- 
 velt down to the editor of 'Barker's Weekly,' have 
 been doing a powerful lot of talking of late years 
 about Socialism and its dreadful dangers. What do 
 they mean? I'd like to know. Or what do they 
 think they mean? They don't define Socialism. 
 No one does. Socialism is not Anarchy, as most of 
 them seem to think. Our most respectable people, 
 whenever they get a little frightened, or dislike 
 some political movement of their opponents, go 
 into hysterics, and tell us to look out for Socialism. 
 Our ordinary politicians are the most irritating. 
 The average Representative in Congress is a gaby, 
 with facility for stringing words together in pom- 
 pous and regular cadence. Socialism is his word 
 of words. He's uneducated, of course. He has no
 
 134 d Doctor's Table Talk 
 
 vision. He has no expression of patriotism in the 
 wider sense; though the pathetic fellow in his soul 
 really thinks he has patriotism itself. Fortunately, 
 from time to time he has wit enough to choose 
 superior leaders, otherwise would representative 
 government go to wreck, in spite of harking back 
 to such panaceas as referendums, initiatives, and 
 the like. 
 
 "I'd like to know something more about that 
 Socialism bogy. Many of us would. I observe that 
 several millions of our fellow creatures call them- 
 selves Socialists, and that a great many of them 
 are keenly intelligent persons. I suppose that the 
 Germans of to-day are, as a people, the most 
 widely educated, the most philosophical, and per- 
 haps the most wise in practice. It's fair to say 
 that more than half of them are Socialists. Our 
 own present industrial, economical, and social 
 condition is not so fine that we should wish to 
 perpetuate it. Through trade and class prejudices 
 the groups of our people are drifting further and 
 further apart. Compared with what the fathers 
 of the Republic knew, the present industrial situa- 
 tion is horrible. 
 
 "I've just been reading some stuff in a Boston
 
 The Doctor is a Patient 135 
 
 newspaper. The writer assures us that the 'Pro- 
 gressive movement is responsible for the strike/ 
 Then he goes on to say: 'All agree that the strike 
 is a symptom of advancing Socialism. . . . The 
 appeal to the passions of the mob is bred by the 
 demagogic propaganda of the La Follettes, the 
 Hearsts, the Fosses, and others of their ilk, who 
 would destroy the basic principles of Government.* 
 What do you suppose the simple lunatic thinks he 
 means by basic principles of government? The 
 framers of our Federal Constitution had no inten- 
 tion of establishing an industrial order that puts 
 millions of women and children practically at the 
 mercy of a few gigantically rich capitalists. Then 
 our friend the newspaper man goes on to write these 
 glowing words : 'The present progressive movement 
 is a movement in the direction of Socialism. The 
 strike was not needed to prove that. . . . Those 
 who believe in Socialism will help the movement 
 along. Those who believe in the established order 
 will halt while there is time.' Words, words, 
 words, you see." 
 
 At this Ely began to grumble a little: "I think 
 you're too hard on our Congressmen. They're not 
 such a bad lot of fellows. And as for the newspaper
 
 136 A Doctor's Table Talk 
 
 writer, I'm much inclined to agree with him. 
 All this talk about tearing up the Constitution is 
 terrifying to us old fellows." 
 
 "I don't want to tear up the Constitution," 
 Primrose almost shouted. "I want to see some- 
 thing done to wipe out some of the terrible dis- 
 parity of living. Our history books tell a dreadful 
 story about the conditions in France before the 
 Revolution. I declare, except for the presence of 
 the ballot, the conditions in some of our mill towns 
 to-day are not so very different. When you see 
 employed operatives shivering and starving in 
 'good times,' and their daughters by the thousands 
 driven to the life of the street, you know that some- 
 thing is wrong. You have no right to draw the 
 shutters, comfortably to fold your hands, and settle 
 down before the fire, in the face of these things. I 
 sometimes think that the man who does so is 
 either a fool or a traitor; and yet I don't think that 
 I am a ranter or a demagogue. 
 
 "But let us get away from this alarming side 
 of the subject. I don't yet feel equal to it. There 
 are mild questions involved, rather academic of 
 their kind. In the Presidency of Washington, who 
 seems, by the way, to have been one of the richest
 
 The Doctor is a Patient 137 
 
 men in the country, the distinction between his 
 rate of living and that of the poorest New Hamp- 
 shire farm laborer was measurable. Each had 
 enough to eat and enough to wear; perhaps the 
 luxuries of the one were the necessities of the other. 
 But the brain, the abilities, and the services of the 
 one were immeasurably greater than those of the 
 other. The same was, as a rule, true of all prosper- 
 ous men in those days. There resulted none of 
 that class bitterness which we know. The wealthy 
 merchant, the squire, the parson, the farmer, and 
 the laborer met on equal terms at the store or the 
 tavern, and a kindly harmony prevailed. The poor 
 man recognized facts and limitations. 
 
 "The present disparity between the lots of the 
 highest and the lowest is so great that it seems as 
 though it could not long endure: Your mill-opera- 
 tive, the father of a family, 'unskilled/ he is 
 called, earns four hundred dollars a year; your 
 skilled operative earns nine hundred dollars. Mind 
 you, I'm talking averages; not about the fancy 
 pay of such specialists as locomotive engineers, 
 high-class chauffeurs, and a few others. At the 
 other end of the intellectual scale come your col- 
 lege presidents; men who lead anxious, responsible,
 
 138 A Doctor's Table Talk 
 
 laborious lives, your Garfields, Hydes, Wilsons, 
 and Eliots; they are paid from five thousand to ten 
 thousand a year. Please take a great jump now 
 not at all in the intellectual but in the pecuniary 
 scale, and you come to your pork-packers, your 
 beef-barons, your captains of industry in steel, oil, 
 tobacco, sugar, and the like. The top pay among 
 these men, and they are truly able and far- 
 seeing, the best of them shouldering immense 
 responsibilities, and toiling always, their top 
 pay, including of course the return on investments, 
 ranges between one hundred thousand and a million 
 dollars a year. 
 
 "So let me ask you again the old question not 
 yet truly answered, what is there in the nature, 
 the intellect, the work, or the services of one of 
 these last which should entitle him to one hundred 
 times the pay of an Eliot, or to one thousand times 
 the pay of a skilled operative? Is our system 
 rational ? 
 
 "But, you will say, the work and the services 
 of an Eliot, and of thousands of other devoted 
 brain-workers in this world, cannot be measured 
 by dollars. Exactly; and that brings me at last to 
 the two questions in this Socialism debate, which
 
 The Doctor is a Patient 139 
 
 I have never heard properly discussed: first, is 
 individual effort to be measured inevitably by 
 dollars? and second, in a Socialistic State, would 
 not the educational opportunities and training of 
 all the citizens be fair and equal?" 1 
 
 Upon this Ely rose up in very wrath: "Jonathan 
 Primrose, this will never do. Off with you to bed. 
 It is ten o'clock. If this madness continues, we may 
 hear you again to-morrow." 
 
 1 It appears that the conceptions of present day advanced So- 
 cialists are unfamiliar to Dr. Primrose. He seems to talk of abol- 
 ishing money, and cherishes old-fashioned popular notions and 
 Utopian dreams. The view of Socialism as an enterprise for a col- 
 lective owning of the tools of industry and a collective distribut- 
 ing of its products is strange to him. SCRIBA.
 
 CHAPTER VII 
 
 Dr. Primrose on Socialism 
 
 SUNDAY is still a day seriously to be observed in 
 Poquonnock Village. The traditional quiet settles 
 upon the lovely valley. You may hear remote 
 tinklings from the distant herd upon the hills, or 
 down the rocky road the lazy shuffle of old Joe 
 and Frank, the farm-horses released from plow, 
 bringing the family to the meeting-house. By ten 
 o'clock the place is all astir, and scattered groups 
 collect about the church, the postmaster and 
 his wife, the keeper of the country store with his 
 ten children, the blacksmith, the carpenter, the 
 farmer-deacons with their women-folk; and last, 
 the doctor's family friends of all. Here were 
 Dr. Primrose's beloved people, of whom he chose 
 to tell. Of all the world their fate concerns him 
 most. Two generations seem to have gone back; 
 these are the folk of sixty years ago. One thought 
 almost that they should be discussing the doings of 
 their famous neighbors, Daniel Webster, Horace
 
 Dr. Primrose on Socialism 141 
 
 Greeley, and President Franklin Pierce. Surely, 
 says the doctor, with our traditions and our great 
 names on the state roll, the glory of New Hamp- 
 shire must return. To-day, of course, our friend 
 does not appear. His health forbids. His anxious 
 patients ask for him, and smile in satisfaction at 
 the news. 
 
 True to his patriarchal character, Dr. Primrose 
 is an old-fashioned believer in revealed religion, 
 though he looks for increasing tolerance, and prays 
 sincerely on bended knee for a united Christendom. 
 Of all our authors, perhaps he loves best Sir 
 Thomas Browne, whose wise lines he recites: 
 "Holy water and Crucifix deceive not my judge- 
 ment, nor abuse my devotion at all. I am, I con- 
 fess, naturally inclined to that which misguided 
 Zeal terms Superstition. My common conversa- 
 tion I do acknowledge austere. . . . Yet at my 
 Devotion I love to use the civility of my knee, my 
 hat, and hand, with all those outward and sensible 
 motions which may express or promote my invisi- 
 ble Devotion." Our kind friend has a joyous faith; 
 he believes his fellow men to be loyal and sound, 
 and he worships his God always in such words as 
 he read to us this morning at family prayers: "The
 
 142 A Doctor's Table Talk 
 
 heavens declare the glory of God; and the firma- 
 ment showeth his handiwork." 
 
 Just now, however, his mind is sorely tried, and 
 his faith in man put to the test. To him fair play 
 and honest sportsmanship are a second religion, and 
 he fears that the group of money-making, potent, 
 forceful men, who control the industries and the 
 markets of the world, are drifting far from fair 
 play and honest sportsmanship. He even whispers 
 sadly that he believes some of them to be not only 
 unpatriotic but dishonest. He thanks Heaven for 
 the hundreds of fine exceptions. He quotes the 
 good deeds of well-intentioned, pathetic restitu- 
 tion as he calls them of the Goulds, Car- 
 negies, Rockefellers, and the like. He glories in 
 the fine career and noble democratic frankness and 
 fairness of such a man as Richard F. Crane; not 
 because he built up a mighty business and devised 
 by will millions to his employees, but because he 
 did not make his money at the expense of his fellow 
 creatures. I remember Primrose quoting from 
 "Collier's Weekly" a paragraph about Crane: 
 "Once he noticed that some of his men were doing 
 sand-blasting with helmets on their heads. It 
 seemed to him an unhealthy occupation, and he
 
 Dr. Primrose on Socialism 143 
 
 ordered a change to a method much less profitable 
 to himself. Frequently he told his branch managers 
 not to push business too hard in competition with 
 weaker opponents. ... It was his principle and 
 his practice never to be hard towards employees, 
 competitors, or public. Although he lived to see 
 his business become enormous, he never regularly 
 retained a firm of lawyers. He did not fight his 
 fellow creatures, but helped them. . . . He never 
 asked or needed tariff favors. He was an honor to 
 the business world and to the country in which he 
 lived." 
 
 A fine act need not be conspicuous in order to 
 stir Primrose to the depths; indeed, one of his 
 favorite occupations is the collecting from obscure 
 newspaper columns accounts of self-sacrifice and 
 devotion among the humble and unknown. His 
 is a whole-souled patriotism. He cannot endure 
 long to be absent from his native land and his 
 home state; and with Van Dyke, 
 
 "His Heart is turning back again to God's countrie." 
 
 He is no captious critic, no agitator, no dissatis- 
 fied and jaundiced growler. He envies no man his 
 success, for he has a proud and wholesome con-
 
 144 A Doctor's Table Talk 
 
 sciousness that his own life has not been lived in 
 vain. He knows his country's story. He glories in 
 her achievements; he sorrows over her errors; and 
 he holds her great men in almost idolatrous vener- 
 ation. For him the names of Washington, Hamil- 
 ton, Lincoln, and anon of Lee and "Stonewall" 
 Jackson, bring a flush of the cheek and a fine lift 
 of the head. He never tires in hearing and reading 
 about them. He prefers the society of the immor- 
 tals. 
 
 What, then, shall he say of the sorrows which 
 latterly have come upon the land? His optimism 
 tells him that perhaps the worst is over, and that 
 we are passing out from the shadows ; but he sees 
 continually about him, and in the midst of smiling 
 peace, fresh evidences of man's inhumanity to man. 
 So he looks always for new light; he shocks conserv- 
 ative ears, and mingles wisdom with hypotheses. 
 
 That Sunday afternoon he joined us on the broad 
 piazza in the warm spring sunshine. We looked 
 down across the prosperous valley, and at the 
 rolling line of the Sandwich range lifted in middle 
 distance. Dr. Primrose was feeling unusually well, 
 vigorous, and cheerful, and soon the conversation 
 was where he wanted it, in his own hands.
 
 Dr. Primrose on Socialism 145 
 
 "William Ely, you maltreated me last night; 
 and now you must listen to more Socialism talk. 
 I'm looking for light as I told you; and so the first 
 thing that surprises me, when I hear men denounc- 
 ing Socialism, is their confident assertion that it 
 would destroy individualism and personal effort. 
 I suppose they have some sort of nebulous idea 
 that in a Socialistic society all men who so choose 
 could sit idly about in armchairs and smoke 
 Havana cigars at the expense of the State. That is 
 to say, the ordinary money rewards of labor being 
 removed or minimized, there would be no incentive 
 to labor. Or, to put it more grossly, they believe 
 that money is the only incentive to labor. Let me 
 say parenthetically that I don't propose to discuss 
 the detailed constitution of a Socialistic State. No 
 one is doing that yet, understandingly, I fancy. 
 But I do question and protest against the assump- 
 tion that money is the one reward of effort. The 
 history of the race bears out no such assumption. 
 Money is a recent invention in human evolution; 
 it is merely our present conventional medium of 
 exchange in the markets of the world. 
 
 "Even among our most commonplace moderns, 
 however, money is not the only reward of effort.
 
 146 A Doctor's Table Talk 
 
 It is not the one thing which we most seek in order 
 to fend off individual degeneration. I like to think 
 of those prizes which stimulate the young before 
 they begin to take their part in the sordid dollar- 
 scramble. The * generous delusions of youth/ by 
 the way, don't coincide with dollar-grabbing. The 
 child in the nursery looks for prizes and rewards 
 in return for effort. He finds them in the approba- 
 tion of his parents and the smiles of his nurse. 
 The school-boy is rewarded for good work by the 
 joy of competition; by advancement in his classes; 
 by the respect of his mates; and perhaps by medals, 
 books, and the like; or in the athletic field, by dis- 
 tinction in games, by selection for important teams, 
 by the generous applause of friends and rivals. 
 As the boy becomes a man, he continues for a long 
 time to look for similar distinctions. He does not 
 shout at once for money. If he is in college, or 
 learning a trade, or merely leading a social life, he 
 strains for and finds many sorts of prizes, not least, 
 perhaps, the wife whom he wins through struggle. 
 "You will say, perhaps, that these are all per- 
 sonal and selfish rewards. That saying is largely 
 true of the rewards of the young, with their limited 
 vision; but you will admit that the rewards of
 
 Dr. Primrose on Socialism 147 
 
 broadening maturity take on a different bearing. 
 Of course there are always the prizes of personal 
 satisfaction; in medicine, for example, satisfaction 
 in the confidence and goodwill of one's commu- 
 nity, in the securing of distinguished and cov- 
 eted appointments in schools and hospitals, and 
 in the country-wide professional recognition, per- 
 haps, which comes with years of increasing effort 
 and solid accomplishment and contribution; but 
 far more than these, though intimately concerned 
 with such personal good things, are those imper- 
 sonal, undefinable rewards, in satisfaction with 
 a life-work effectively, proudly, and generously 
 done; perhaps for the benefit of the many, and for 
 the well-being of the State. 
 
 "Of course, in every walk of life and in every 
 vocation there are great rewards. If you are a 
 blacksmith, is it not well to be the best blacksmith; 
 or if a plumber, the best plumber? On the other 
 hand, in the countless industrial occupations of 
 the modern world, through a narrow specializing, 
 much is being done to stifle individualism; as a 
 result thousands of workers hate their jobs. To 
 meet this sad fact, it should be the effort of em- 
 ployers and of labor organizations to see to it that
 
 148 A Doctor's Table Talk 
 
 cramping, narrowing, stultifying work is varied 
 in every possible fashion, for the sake of the 
 physical and intellectual development of the in- 
 dividual. 
 
 " In discussing the rewards of life, however, and 
 the non-monetary prizes towards which men and 
 women may strive, we need not conceive of imag- 
 inary or merely possible situations. We have 
 already in our midst two great bodies of men, who 
 are incessantly and actively concerned for their 
 own 'Services' and for their country; I mean the 
 officers of the army and navy. To me there is 
 something peculiarly fine in the unselfish devotion 
 and the unrewarded service of the thousands of 
 those men. When a young lieutenant with his 
 little company follows a gang of Indian murderers 
 for weeks through the desert, brings them to bay, 
 destroys them, and relieves the frontier of an 
 ancient terror, he is not looking for dollars. When 
 a naval commander, in a converted yacht, attacks 
 a squadron of three times his power, or sinks his 
 vessel at the mouth of a hostile harbor beneath the 
 guns of the enemy; or when a general officer 
 pacifies a turbulent island, restores order, com- 
 poses the abuses of generations, brings stability
 
 Dr. Primrose on Socialism 149 
 
 and prosperity, and wipes out a ghastly endemic 
 scourge, he does it all because it is his duty and in 
 spite of the criticism, or grudging recognition, of 
 his ungracious fellow citizens. Look at Goethals 
 and Gorgas in Panama, one accomplishing, 
 successfully, superbly, and in briefest time, the 
 greatest piece of engineering in history; the other 
 making that work possible by turning a notorious 
 pest-hole of the tropics into a salubrious winter 
 resort, and keeping in the field with unimpaired 
 health the thousands of laborers needed for the 
 mighty work. 
 
 "Are Goethals and Gorgas looking for dollars? 
 Surely not they; and yet, I tell you, they shall have 
 their reward. 
 
 "It was Emerson who wrote the homely but 
 delightful words : ' If a man can write a better book, 
 preach a better sermon, or make a better mouse- 
 trap than his neighbor, the world will make a 
 beaten path to his door.' 
 
 "Of course you will say that all this is very true 
 of selected and heroic groups, but what is to keep 
 the average man up to his work? I take it that 
 community interest, public sentiment, and, above 
 all, education, must be relied upon. Of course I
 
 150 A Doctor's Table Talk 
 
 have no Utopian dreams of a perfected human 
 nature. There will always be weak, pathetic, and 
 degenerate souls, I suppose. But when you con- 
 ceive of the State as a great family, you will see 
 that, in the course of a very few years, three 
 or four generations, our individual types will be 
 of a greatly higher average, and the unfortunates 
 much fewer. It is not difficult to conceive of a 
 people among whom there shall be no acute epi- 
 demic disease; no tuberculosis; no cancer, no alco- 
 hol; no foul, unmentionable contagions; and as a 
 result few or no congenital deformities, nervous 
 diseases, insanities, criminal tendencies, and other 
 handicaps to individual and community progress. 
 This is not a pipe-dream or a vision ; it is the fore- 
 cast of a situation which we are surely to bring 
 about with or without Socialism. And when that 
 time comes, when we have to deal with a thor- 
 oughly sane, alert, educated, physically sound 
 community, then will we, indeed, be the greatest 
 of nations, and be in a position to abolish the wars 
 which still reveal our barbarism, and terrify and 
 disgrace our civilization. 
 
 "Such an outcome of concerted altruistic en- 
 deavor should be no farther from us than we are
 
 Dr. Primrose on Socialism 151 
 
 from the French Revolution. Perhaps, though, I 
 have not yet answered your question, Ely: in a 
 Socialistic State what is to keep the individual 
 citizen in line? I have shown that the naughty 
 fellows who need to be kept in line will be few in 
 number, if all goes well with us; and I have hinted 
 at a system of rewards and punishments. Some- 
 thing of that kind there must be. A State whose 
 public business is so all-embracing as the one we 
 are considering must take official notice of the good 
 or bad lives of its citizens. There exists to-day an 
 interesting institution, popularly known as the 
 'Carnegie Hero Fund.' It is administered by a 
 committee. One conceives easily that such a com- 
 mittee might be multiplied so as to concern itself 
 with many and diverse interests. 
 
 " You will remind me how it is a matter of com- 
 mon observation that public enterprises, public 
 interests, and public utilities are to-day far more 
 economically and efficiently administered by pri- 
 vate corporations than by public officials. I admit 
 it, but from that you cannot augur eventual failure 
 of community-directed interests. We anticipate 
 vast improvements, first, in public health, in public 
 education, in public morals, and in public coopera-
 
 152 A Doctor's Table Talk 
 
 tion. Then we can look safely for increased public 
 efficiency. 
 
 "All that, again, is parenthetical. We were speak- 
 ing of rewards and punishments. In an important 
 sense, of course, punishments must always exist. 
 The undesirable citizen must be taught his unde- 
 sirability, and be reformed or isolated. The fool, 
 the knave, the traitor, the ingrate, the indolent, 
 cannot receive the recognition and compensation 
 of the honest citizen; but that is a matter of obvious 
 detail. 
 
 "Letmesay a fewmore words. There is one funda- 
 mental matter to which I have already alluded, 
 universal education. I do not mean the present 
 popular and obligatory education, which stops with 
 the grammar school or the high school; which 
 teaches little more than the rudiments of English, 
 and of popular science, and produces no trained 
 minds whatever. I mean a higher training, which 
 equips the student with intellectual or mechanical 
 tools and an accurate knowledge of their use. Com- 
 monly, in the Socialism discussion, disputants lose 
 sight of the fact that every single member of the 
 ideal State would receive a high intellectual train- 
 ing, so far as he is capable of receiving it, some-
 
 Dr. Primrose on Socialism 153 
 
 thing approximating to the college or the technical 
 school education of to-day. This conception throws 
 an entirely new light on the social and civic prob- 
 lem, for we should then be dealing with a group of 
 citizens such as the world has never known, and this 
 group would comprise all the people. 
 
 " In view of this new conception of an educated 
 people, countless new and unexpected questions 
 industrial and economical arise. I will hint only 
 at these, for the line of debate is obvious. An edu- 
 cated critic says, What's going to become of the 
 rough, unskilled, manual work of the State, if all 
 your citizens are accomplished technicians? My 
 friend, the thought should make you gasp for joy. 
 Did you ever go on a camping, surveying, fishing, 
 or shooting expedition with a group of men of your 
 own kind? I have. One man may have charge of 
 the wagon, another of the horses, another of the 
 tents, another of the dish-washing, and so on. 
 Whose is the rough, unskilled work there ? and who 
 cares ? Work is worthy or unworthy, skilled or un- 
 skilled, onerous or joyous, according to community 
 conventions, and the zeal, training, and ability of 
 the worker. If a trained man be set to run a fur- 
 row, dig a trench, or sweep a crossing, he will
 
 154 A Doctor's Table Talk 
 
 quickly develop methods of accomplishing his task, 
 such as the age-long, grudging inefficiency of the 
 untrained would never accomplish. The highly 
 trained men of our ideal State, with their tradi- 
 tions of culture and mutual support, should develop 
 an intelligence and a reasonableness such as would 
 move mountains. Cooperative efficiency also would 
 be developed to a high level, hours of work and of 
 needless effort would be minimized ; time would be 
 allowed all men for recreation and cultivation, and 
 new joys of life and new powers of human happiness 
 would come into being, as I do believe." 
 
 He stopped, tired with much talking. 
 
 "Well, my dear Jonathan," said Ely at last, 
 "you have certainly been reading and thinking to 
 some purpose. You are as much of a dreamer as 
 ever, and I admit that your dreams are sometimes 
 beautiful. Of course, the one obvious reply, for 
 hard-headed persons like Scriba and myself, who 
 are constantly encountering the facts of life, is that 
 men like you ignore the actual weakness, the in- 
 herent wickedness, and the brutality of humanity. 
 You're talking of Utopia, of course, but the sad 
 thing is that you seem truly to look for it. Scriba 
 here was right, too, long ago, when he told Flaxman
 
 Dr. Primrose on Socialism 155 
 
 that only by becoming a professional, by learning 
 to depend on himself alone for a living and advance- 
 ment, only so could he put off childish things, at- 
 tain maturity, and 'arrive.' Your ideal Socialistic 
 community seems to me especially designed to 
 undermine and sap individualism, and to cut out 
 that tough fibre which is needed for character- 
 building; and you misrepresent present Socialistic 
 tendencies. You Ve gone back to Bellamy's * Look- 
 ing Backward.' 
 
 "As for that strike which gives you a text for 
 your sermon, you should hear some of the people 
 in the city talk about it. They may not be well 
 informed, but they are far better informed than the 
 frantic strike leaders, and the pathetic, ignorant 
 mobs who follow them. The city people of whom I 
 speak are kindly and generous, as their deeds do 
 testify. Many of them are stockholders in those 
 very mills. Many of them have sons in the troop of 
 mounted militia, which has been sent down to as- 
 sist in keeping order, and in protecting property. 
 They tell me, from practically first-hand knowledge, 
 that the state of things in that mill-town is truly 
 shocking, a grave menace to individual property 
 rights, and a most serious danger to civil govern-
 
 156 A Doctor's Table Talk 
 
 ment. They say that the strike leaders are ferocious 
 and unreasoning, while the maddened strikers 
 half-starved, and lashed by anarchistic talk 
 are like packs of wild creatures, ready for any bru- 
 tality, mischief, or violence." 
 
 " Well, well," returned our host, with a smile, " we 
 are far enough from Utopia as yet. I fancy we all 
 need educating on new lines. I believe, too, that 
 you are correct, that human nature is still much 
 what it was two thousand years ago, though Black 
 Care may not sit behind those joyous young horse- 
 men, whose anxious mothers have sent them off 
 to put down the strike." 
 
 The Sunday afternoon was waning. Dusk was 
 falling. Scattered fires sprang into light on distant 
 hillsides across the valley. The farmer was again 
 abroad; tidying his fields and roads, and burning 
 the gathered "brush." 
 
 As Primrose watched the familiar and pensive 
 scene, a twinkle of mirth shone in his kindly eyes 
 and lighted his earnest face. "I love a fire," he 
 said. "Who does not? What a marvelous thing 
 it must have been to our far-away ancestors, when 
 they discovered it. No wonder they worshiped it.
 
 Dr. Primrose on Socialism 157 
 
 From those idolaters down to Charles Lamb, every 
 lover of his kind has loved a fire; and every man 
 has loved best the fire of his own making. Often I 
 have speculated idly as to how those prehistoric 
 fires first were lighted. Did some freak of nature, 
 some volcanic outburst, or the dregs thereof, sug- 
 gest the uses of fire to the shivering cave men ? Or 
 did primitive man create fire by the friction of 
 wood, or by the blow of flint on metal? Certainly 
 it seems to be that the domestic fire, the purposeful 
 fire, is the work of man. No most superior animal 
 ever truly understood it, or adopted it of himself; 
 while no tribe of men, even the most ignorant, 
 savage, and debased, now lacks the fire. 
 
 "Of all fires the fire of the personal hearthstone 
 is the most precious; and each one of us builds, 
 cherishes, and tends his own fire with the care that 
 he bestows upon a child. He is jealous for its repu- 
 tation; he delights in its peculiar symmetry or 
 eccentric activities; and his soul resents for it the 
 unsympathetic mending and the rude and bump- 
 tious touch of the unfamiliar hand. There are 
 fundamental principles common to the building 
 of all fires, but each one of us gives his own fire a 
 peculiar and personal flavor. As there are princi-
 
 158 A Doctor's Table Talk 
 
 pies which underlie the building and starting of a 
 fire, so, too, are there principles which underlie 
 the keeping of it up. Did it ever occur to you that 
 four creatures or elements enter into the construc- 
 tion of every fire? The tools of ignition, for which 
 we employ the homely match; the tinder, for which 
 discarded newspaper may best suffice; the 'kind- 
 lings,' with us finely split strips of driest wood ; and 
 finally the permanent coals, or 'cordwood,' which- 
 ever we may choose. For me the open fire of wood 
 alone possesses charm, and coals bituminous con- 
 cern me not. A wide and deep chimney and 
 hearth, with perfect draft, are first essentials, too; 
 andirons not high, and, banked upon the hearth, 
 a clean and copious bed of ashes, of many weeks' 
 burning, piled nearly to the level of the 'dogs.' 
 Two different constructions I do affect, though 
 similar in principle: a large round back-log behind 
 the 'dogs'; in front of it, much crumpled tinder 
 lightly strewn; down from the log, a sloping thatch 
 of kindlings; and then above, two large split logs to 
 catch the early blaze. Or else, two split logs laid 
 upon the irons, a six-inch space between; below and 
 then between, abundant paper laid; from log to log 
 a copious roof of sticks, supporting well a third,
 
 Dr. Primrose on Socialism 159 
 
 split, trusty log. So placed, a roar of flame lights 
 up the hearth, and if the wood be dry, a glorious 
 fire springs. You see that at the start we deal with 
 elements all cold ; for these, wide space and generous 
 drafts play an important part. 
 
 " For me, however, tending and mending of the 
 fire when burning full, or flagging, is of the greatest 
 joy: the keeping narrowed spaces, gentle drafts; 
 approaching glowing face to glowing face, without 
 too rudely and by jealous chinks excluding air; 
 dropping the fore-log now upon the hearth; raising 
 an end or raking embers down; inserting curious 
 charred and gleaming bits beneath their mighty 
 fellows freshly piled; watching the smoke outpour; 
 the streak of flame updart, then vanish, then en- 
 dure with steady, buoyant, life-returning zeal; 
 this is serene contentment. Build me no fires; let 
 me tend mine own."
 
 CHAPTER VIII 
 
 Reflections Ambrose Pare 
 
 "'THE atrocious crime of being a young man, 
 which the honorable gentleman has, with such 
 spirit and decency, charged upon me, I shall neither 
 attempt to palliate nor deny; but content myself 
 with wishing that I may be one of those whose fol- 
 lies may cease with their youth, and not of that 
 number who are ignorant in spite of experience/ 
 What public man to-day," added Dr. Primrose, 
 "has the wit or the ability to write such English as 
 that. No wonder old Robert Walpole slunk away 
 from the fierce assaults of the terrible young Cornet 
 of Horse." 
 
 It was the Monday of our week-end visit, but 
 Ely and I still tarried. Our host's returning cheer- 
 fulness and vigor, his inspiring vitality, and his 
 almost pathetic hunger for the audience of a life- 
 time, induced us to stay with him in his sunny bed- 
 room. He was speaking of current literature, es- 
 pecially of the newer writers of fiction. 
 
 "In spite of that famous saying of Pitt's, which
 
 Reflections Ambrose Pare 161 
 
 old Samuel Johnson is said to have prepared for 
 him, the fact remains that the season of youth is 
 not always one of wisdom, even among novel 
 writers. There's a young Englishman, Arnold 
 Bennett, whose writings are said to be having an 
 enormous sale. He is clever and industrious, but 
 utterly without humor or a sense of perspective. 
 I read through two of his books last winter, though 
 I don't know why. He is that difficult thing to 
 define, a realist, whatever he himself means by the 
 word. He is said to boast of the amount of work he 
 is able to turn off. He seems to produce 'literature' 
 by the foot. Lately he spent two or three weeks in 
 America to study us. He was extremely well 
 advertised, and even to the end he submitted kindly 
 to interviews. 
 
 "Of course his remarks about America are of no 
 value, and are not even interesting; but his notions 
 about literature have a certain value, because they 
 are the notions of many modern readers, who are 
 partly educated without being trained. This young 
 man's conceit is colossal, though that is merely by 
 the way. He appears to think well of some of our 
 own short story writers; but it is when he gets to 
 rattling about among the immortals that he takes
 
 162 A Doctor's Table Talk 
 
 away your breath. He is said to acknowledge the 
 genius of Henry Fielding; he is willing even to 
 speak a kind word for good old Richardson; but for 
 the past hundred and fifty years, he finds no writer 
 of any particular distinction until he comes to 
 Hardy. Scott, Charlotte Bronte, Dickens, Thack- 
 eray, George Eliot he groups as second-rate artists, 
 as mere sentimentalists. 
 
 "That is the word we are waiting for, my friends. 
 That expresses the idea which shocks and con- 
 founds the muddy-minded realist. Sentiment to 
 him is as naught. It finds no place apparently in 
 his vocabulary or in his life. What a distorted half 
 vision of history and of our little world must be 
 his, for it is Sentiment that distinguishes us from 
 men of the Stone Age, and from the lower animals. 
 What has not Sentiment accomplished in the world 
 'of men? It was Sentiment, true or false, that 
 prompted the Psalms of David; that inspired Bud- 
 dha and the Hebrew seers to the construction of 
 great religions; that provoked the awful crime of 
 Calvary; that led the footsteps of St. Paul; that 
 established and extended the Christian Church; 
 that inspired the Crusades, that confirmed the 
 Reformation; that led thousands to martyrdom;
 
 Reflections Ambrose Pare 163 
 
 that made real civil liberty and political freedom 
 in England, America, and France; that put an end 
 to slavery; that liberated Cuba, and is now eman- 
 cipating industrial mankind; these are a few of 
 the results of Sentiment. The thoughts come to one 
 offhand. Something of the story is hinted by Ben- 
 nett's second-rate artists, the Sentimentalists. I 
 fancy their works will live, and that future genera- 
 tions will thrill at the tale they have to tell. Is the 
 world no better or happier for 'Ivanhoe,' for 'Jane 
 Eyre,' for 'David Copperfield,' for Colonel New- 
 come and for Maggie Tulliver, or must we seek in- 
 spiration and literary satisfaction in 'Clayhanger' 
 and in 'Tess'? 
 
 "To return to our own work, did it ever 
 occur to you that running through all technical 
 talk, especially doctor talk, there is a sense of aloof- 
 ness, as though our training and our interests kept 
 us in a world apart from all the others. The very 
 word 'doctor,' in English speech, means a doctor 
 of medicine; and physician is implied, unless one 
 specially indicates a doctor of laws, of divinity, of 
 science, or of letters. We physicians are expected 
 to perform curious wizard-like feats, and if we 
 don't, we shatter even the most intelligent conn-
 
 164 A Doctor's Table Talk 
 
 dence. Not long ago a well-known Boston surgeon 
 told me of a painful experience. It seems that for 
 some fifteen years he had done most of the surgery 
 in the town of Barchester ten miles from the city. 
 The leading family physician of Barchester had 
 sent for him to see scores of surgical cases, and for 
 years his work in the town was almost brilliantly 
 successful. He looked upon that physician and 
 those townspeople as his friends, while at the same 
 time he drew from the place a considerable share 
 of his professional income. 
 
 "Then in one year there came a series of unavoid- 
 able calamities : he operated for internal abscess on 
 the wife of a well-known broker, taking every rea- 
 sonable precaution. That very night an old, latent 
 heart trouble recurred, and within thirty-six hours 
 she died of malignant heart disease. Again he 
 operated for a small growth on another well-known 
 woman in Barchester. The anaesthetic, as always 
 in his cases, was given by an expert. The patient 
 developed pneumonia, and died in forty-eight 
 hours. Six months later, he operated for relapsing 
 appendicitis on a fourteen-year-old schoolgirl, the 
 charming daughter of his consultant's next-door 
 neighbor. The child never rallied; a serious kidney
 
 Reflections Ambrose Pare 165 
 
 involvement developed, and she died at the end of 
 a week. During her anxious illness her physician 
 told my friend that he must pull the child through; 
 that she must not die; for if she did, not only would 
 his own practice be seriously damaged, but it 
 would be impossible for him ever again to call my 
 friend in consultation. That forecast has been veri- 
 fied at least so far as my friend the surgeon is 
 concerned. From that day, now two years ago, he 
 has made no professional visits in Barchester. 
 
 "To those of us who are familiar with the prob- 
 lems of disease, and with the chances of life and 
 death, it is obvious, of course, that this surgeon was 
 essentially blameless. Those patients would have 
 died no matter who operated, and they would prob- 
 ably have died shortly had no operation been done. 
 Moreover, this same man had to his credit scores of 
 successful operations without a death; but these 
 facts weighed not at all with the terrified family 
 physician and his demoralized flock." 
 
 "You can't blame them, though," said Ely; 
 "naturally they look only to results. The ability, 
 native sense, and sagacity of a surgeon, his years of 
 preparation, his anxious days and nights, his heart- 
 breaking experiences, if he be an honest, humble
 
 166 A Doctor's Table Talk 
 
 man, and his earnest, unceasing struggles to save 
 the particular case, all go for nothing. In these 
 respects, I admit that the physician has an im- 
 mense advantage over the surgeon. If the physi- 
 cian loses a patient, the fact is commonly recog- 
 nized as an act of God, and in spite of endeavor. 
 If a surgeon's patient dies, the unthinking say that 
 the surgeon operated and killed him. Pleasant for 
 the surgeon, is n't it? and yet it's a reproach he 
 must continually meet." 
 
 "The only way out," replied Primrose, taking up 
 the thought, "lies in the better education of our 
 public. Harvard is doing something through those 
 weekly 'Popular Lectures,' but a great deal is still 
 to do. For one thing the story of medicine and 
 of medical men remains to be written. Technical 
 historical volumes for the profession have been com- 
 piled by the dozen, but there's no story of medicine 
 for the average reader. That is true of few other 
 professions. Law, theology, politics, natural science, 
 engineering, astronomy, and dozens of other serious 
 interests have been brought to popular libraries; 
 but the story of medicine and physicians is un- 
 known, even to physicians themselves. 
 
 "Last winter, while dreaming on these things,
 
 Reflections Ambrose Pare 167 
 
 as I lay for months in bed, I thought I would make 
 a little beginning of such popular preaching, by 
 writing down briefly and simply the story of 
 Ambrose Pare. You know that Pare was the first 
 conspicuous clinical surgeon among us moderns. 
 He himself tells of his struggles and trials in a very 
 human and enlightening fashion. It seemed to me 
 that the story of his life might well introduce the 
 average man to the doctor's manner of thought. 
 
 "Here is my little manuscript. Shall I read it 
 out? Yes? Let us call it 
 
 By Jonathan Primrose, M.D. 
 
 " ' Now let there be the merry sound of music and the dance 
 Through thy corn-fields green, and sunny vines, O pleasant 
 land of France.' 
 
 "No man loves his country more than does the 
 Frenchman, and never did Frenchman love France 
 more than did Ambrose Pare. He was a lover of 
 his kind as well. He was the great and simple 
 democrat of sixteenth-century Europe. When 
 Pare first saw the light, the modern world also had
 
 i68 A Doctor's Table Talk 
 
 just been born, and he lived through the glorious, 
 heroic, and terrible years of its struggling child- 
 hood. The record of his days covers almost the 
 whole of the sixteenth century from 1510 to 
 1590. It was a memorable century for France, 
 whose great writers still tell the story with wonder. 
 The Valois kings were nearing the end of their 
 erratic course. In 1510 Louis XII was still upon 
 the throne, unquestionably to us moderns the 
 best king of his line, and France was still en- 
 joying something of the calm and consequent pros- 
 perity which the two preceding reigns had brought. 
 Those were times of curious groping change in 
 politics and in life. The flowers of new knowledge, 
 sown by the great Italian humanists, were begin- 
 ning to bloom in sheltered gardens. Old knowledge 
 was being brought back; and neglected science 
 again was lifting her head. Men of vision were look- 
 ing abroad. Printing and Luther; the magnetic 
 compass and Columbus; the revival of the English 
 language and Latimer; the vast student migrations, 
 Padua, and Vesalius the anatomist, are not words 
 of mere coincidence. 
 
 "Again, after years of coma, mankind was be- 
 ginning to think. The feudal system was dying;
 
 Reflections Ambrose Pare 169 
 
 old things were passing away; intellect was begin- 
 ning to supplant force; the common people were 
 looking about; and the train was being laid which 
 was to lead through years of blood and groans to 
 the French Revolution and the claims of modern 
 thought, not yet perfected. 
 
 "Conventional historians use kings and queens 
 as milestones with which to measure the course 
 of history, kings and queens turned pawns in 
 our unkind, modern days. For us still kings and 
 queens serve well enough to mark eras and to line 
 off the centuries, though their story tells us little 
 enough of the true makers of history the people 
 of the land. In the France of Ambrose Pare the 
 people of the land were abundantly worth knowing. 
 Their sixteenth-century kings we remember be- 
 cause Dumas talks about them pathetic, degen- 
 erate, mischievous young fellows mostly, and 
 Francis I leads them, with his foolish beard, his 
 wild-Indian boastings, his harem, his Field of the 
 Cloth of Gold, his squabbles with English Henry 
 VIII and with Charles V of Spain, Francis, a 
 man now notable to us chiefly because he began to 
 make trouble for his parliaments and to restrict 
 them in those political rights which his two im-
 
 170 A Doctors Table Talk 
 
 mediate predecessors had conferred. In Francis's 
 time Pare found an education and service as a field 
 surgeon. After Francis came his son, Henry II, 
 who brought that very naughty Catherine de' 
 Medici to France as his queen and made the 
 famous Diane de Poitiers his mistress. That 
 Catherine, most wicked of modern women, was the 
 mother of the feeble dandy kings who made a foot- 
 ball of France and brought to an end the Valois 
 line thanks to their feeble queens, to the Hugue- 
 nots, to St. Bartholomew, and to Henry of Navarre. 
 
 "Pare was surgeon to Henry II, the gay lover of 
 Diane; he saw him pierced by the lance of Mont- 
 gomery in a friendly joust; and he foretold his 
 death when he perceived that the lance-head had 
 deeply penetrated the brain through the orbit. 
 The king died in his early forties, and was suc- 
 ceeded by his pathetic son, Francis II, whom we 
 remember as the first husband of our Scotch Mary 
 Stuart, and the victim of a middle-ear disease, 
 which produced a meningitis and carried him off 
 in the second year of his reign, Pare again 
 attending and protesting against the follies of his 
 medical colleagues. 
 
 "Then came Charles IX, he of St. Bartholo-
 
 Reflections Ambrose Pare 171 
 
 mew, a mock heroic sportsman, clinging to his 
 old nurse, and to Pare, the friendly surgeon, albeit 
 they were Huguenots. Pare was with the king 
 to the last of his fatuous twenty-four years the 
 surgeon now advanced well beyond threescore. 
 The old hero was aging strongly. Men and women 
 loved and trusted him. He stands as a tower of 
 vigor, honor, and charity in the midst of that fool- 
 ish throng of wild courtiers and jealous physicians. 
 
 "Henry III, the last Valois king, followed his 
 brother Charles. With Henry also Pare had many 
 scenes. One fancies the great surgeon humoring 
 and chiding the effeminate, debauched, cruel, 
 superstitious wretch who now sat on the throne of 
 St. Louis, his one sane and able companion the 
 court jester, Chicot, as Dumas would have us 
 believe. 
 
 "Those were active days, terrible days in 
 which to live, gasping, hectic, vicious, blood- 
 spilling days; men looking about wildly for relief 
 and direction; women turning to a nebulous 
 heaven, whither they would fain be led, with choice 
 for guides of libertine priests or hard-fisted, blood- 
 stained Puritan divines. 
 
 "Pare was busy among them all. He seems to
 
 172 A Doctor's Table Talk 
 
 have been present as surgeon with the royal gar- 
 rison of Cahors when Henry of Navarre made his 
 successful attack on that devoted town. It was 
 Navarre's first taste of war. Chicot, the court 
 jester, unwillingly was in his suite. The great 
 novelist tells his story: 
 
 "'At this moment, as if in response to the imag- 
 ination of Chicot, the cannon of the fortifications 
 thundered, and opened a lane through the infantry 
 within ten paces of the king [of Navarre]. " Venire 
 Saint Gris!" he said, "did you see, Chicot? It is 
 all for the best, I think," and his teeth chattered. 
 "He is going to be ill," said Chicot. "Ah," mur- 
 mured Henry, "ah, you are afraid, cursed carcass; 
 you tremble; wait, wait a moment; I will make you 
 shake for something"; and burying his spurs in the 
 flanks of the white horse that carried him, he rushed 
 onward before the troops.' 
 
 "Cahors fell. Pare and Chicot returned with 
 the news to the imbecile king in Paris. 
 
 "The French people and the land which Pare 
 loved suffered the extreme of misery through all 
 these times. The broad valleys, the rich plains, 
 and the vine-clad hills, such as we know them to- 
 day, were harried and devastated.
 
 Reflections Ambrose Pare 173 
 
 "Foreign wars with Spain, Italy, and Germany 
 followed close one on another. The new religion 
 and the old were in continual conflict. In 1574, on 
 the accession of Henry III, it is estimated that 
 * already by reason of the civil wars more than a 
 million persons had been put to death, all under 
 the pretext of religion and public utility, with 
 which both parties shielded themselves.' Public 
 executions took place daily in all parts of France. 
 Private murders were still more frequent. The 
 nobility were becoming debased or extinguished; 
 the peasantry were starved or driven from the plow 
 to the battle-field; the middle class sat quaking 
 and making spasmodic efforts to assert itself 
 through the States-General; towns were razed, 
 chateaux were burned, and the worst scenes of 
 ancient Rome were reenacted. The most gracious 
 and romantic country of Europe was staggering 
 in a slough of misery and contempt, while across 
 the Channel England was living the splendid days 
 of Elizabeth, and continental Europe was falling 
 under the powerful sway of Charles V and of his 
 dark and vicious son Philip. 
 
 "In the midst of these cruel years science and 
 the arts of medicine and surgery were beginning
 
 174 A Doctor's Table Talk 
 
 again to take on life. Suffice it now to mention a 
 few conspicuous names of Fare's period: Andreas 
 Vesalius, of Padua, his contemporary, restored 
 anatomy, Vesalius, one of those remarkable 
 youths whom history betimes records, wise, pro- 
 phetic, daring; Paracelsus, charlatan or seer, bom- 
 bastic and brilliant, taught his disciples to look 
 beyond tradition and the authority of a dead lan- 
 guage; Malpighi showed that the organs of the 
 body are not homogeneous, but are composed of 
 cells, themselves distinct entities; Servetus per- 
 ceived something of the circulation of the blood, 
 and was burned by the Protestants; Eustachius 
 contributed to human anatomy; Linacre founded 
 the Royal College of Physicians in London; while 
 Sylvius, in Paris, gathered up, compiled, and sys- 
 tematized the fragments of former knowledge. 
 
 "One observes such scattered facts, not because 
 they matter much now to us, or greatly concerned 
 Pare, but because they recall for us the best types 
 of scientific men who were then beginning to think. 
 For the mass of physicians and surgeons in the 
 sixteenth century we can say little of good. They 
 lived according to their dreary lights, and practiced 
 monstrously. Ignorant of anatomy, of physiology,
 
 Reflections Ambrose Pare 175 
 
 and of the causes and nature of disease, they sub- 
 stituted a pathetic traditional empiricism for com- 
 mon sense, and did what harm they could. The 
 Indian savage, with his incantations, and the Tar- 
 tar nomad, with his primitive massage, were in 
 better case than our sixteenth-century ancestors 
 of semi-civilized Europe. 
 
 "In Fare's time medical practice had been in 
 some sort systematized, with its rules and its pro- 
 fessors. There were three orders of practitioners, 
 physicians, surgeons, and barber-surgeons, of 
 whom the writers tell, each with their peculiar 
 traditions, rights, and methods; each with their 
 shortcomings and characteristic absurdities. The 
 physicians stood at the top. They must talk Latin, 
 must have studied in recognized schools, and have 
 passed rigid tests in the pedantry of the times. 
 They inherited many of the traditions of the priests, 
 their predecessors, and were looked to as the guard- 
 ians of their art. They determined the disease of 
 afflicted patients and prescribed the treatment. 
 On no pretext must they soil themselves, or debase 
 their calling, by the shedding of blood. Next to 
 the physicians came the surgeons proper, of the 
 confraternity of Saint Cosmo, surgeons of the long
 
 176 A Doctor's Table Talk 
 
 robe, as they were called. They, too, were to an 
 extent educated men, speaking Latin, passing 
 examinations in Latin; acting as humble colleagues 
 to the physicians, performing serious surgical 
 operations in civil practice, but not permitted to 
 prescribe medicine for general disease. Finally, 
 there were the barber-surgeons, humble fellows 
 enough, speaking the vernacular only, rudely 
 trained as apprentices in the shop, the hospital, 
 and on the battle-field, themselves, too, follow- 
 ing an old-time tradition and calling. In ancient 
 days they were servants of the monasteries, 
 lay brothers, gardeners, footmen, butlers, and bar- 
 bers; busy barbers, for they shaved the crowns of 
 their masters. Their further duties were manifold; 
 to shaving they added the simple household surg- 
 ical arts of bleeding and poulticing. On such lines 
 and in later times the barber-surgeon practiced 
 his own independent business. It came about that 
 the victim of a bleeding was taught to grasp in his 
 hand a stout pole, to stimulate the flow of blood 
 from the arm; the blood as it ran would often stain 
 the pole. About the blood-stained pole the barber 
 twisted a white ribbon and hung this emblem of his 
 trade above the outer door. To-day he hangs it there.
 
 Reflections Ambrose Pare 177 
 
 "Pare began his active life a humble barber- 
 surgeon. In his time, physicians, surgeons, and 
 barber-surgeons were continually in strife, sur- 
 geons poaching upon the preserves of physicians, 
 barber-surgeons upon those of surgeons, and all 
 three calling upon the courts and the king to 
 support them in their struggles and pretensions. 
 Those were bitter days; union labor was strongly 
 organized, and the struggle for existence was never 
 more fierce. Such were the men, the wrangles, and 
 the times into which Ambrose Pare was born, in 
 the year of Our Lord 1510, Louis XII reigning over 
 France. 
 
 " France was then at war in Italy a war mem- 
 orable to us because it saw the death of Bayard. 
 These matters did not immediately concern the 
 family of the child Pare. His native place was a 
 hamlet close to Laval in Maine. His father was a 
 servant, probably valet and barber, to the Seigneur 
 de Laval. There were other children of whom the 
 writers tell; a sister Catherine, who married Gas- 
 pard Martin, a master barber-surgeon of Paris, 
 and two brothers of no special moment. The boy 
 grew up in humble village surroundings, but had 
 the unusual privilege for that day of learning to
 
 178 A Doctor's Table Talk 
 
 read and write, and perhaps some slight tincture 
 of the Latin though he seems to have lost that 
 later. We find him next in Paris, a young man of 
 twenty-three, attending lectures on anatomy at 
 the University, having served an apprenticeship 
 to a barber-surgeon, name unknown. The training 
 was hard and crude enough, long hours, con- 
 stant work, little leisure, and blows for recompense. 
 The lectures, too, must have been a sorry farce, for 
 besides anatomy, the teacher expounded the writ- 
 ings of De Chauliac on wounds, tumors, and ulcers, 
 with a few remarks on fractures and dislocations. 
 'The honor of the University forbade a professor 
 to speak French, and the apprentices did not 
 understand Latin' (Paget). 
 
 "By this time the old King Louis XII was eight- 
 een years dead, and his cousin, Francis I, married 
 to Louis's daughter Claudia, was on the throne. 
 It was a reign of many wars, furnishing abundant 
 practice for the budding surgeon. 
 
 "This early portion of Fare's life was constantly 
 busy and constantly progressive. He was a keen, 
 ambitious, highly intelligent man; kindly, affec- 
 tionate, generous; undismayed by great names 
 and pomposities; familiar early with human weak-
 
 Reflections 'Ambrose Pare 179 
 
 ness and sorrow; sympathetic alike with the suffer- 
 ings of peasant and priest, fierce men and frail 
 women, merchant, magistrate, and monarch. 
 While still unlicensed to practice, he won an 
 interneship at the famous Hotel Dieu, a hospital 
 already nine hundred years old; the refuge of 
 penniless affliction, the abode of misery, filth, 
 nameless abominations, and some good surgery. 
 One might fill pages with the description of this 
 marvelous asylum, where men and women, boys 
 and girls, the dead and the living, thieves and their 
 victims, lepers and infants with their young mothers, 
 the wounded, the insane, and the plague-stricken 
 were herded promiscuously together, often three 
 or four in a bed; in great wards, where privacy 
 was impossible and decency was unknown, where 
 fierce and brutal operations, without anaesthesia, 
 were done at the bedside, and the gigantic washing 
 of foul linen was accomplished in the near-by Seine 
 but twice in a twelvemonth. Such was Fare's 
 home for nigh three years, and there he learned to 
 know and serve his kind. 
 
 "The year in which Pare left the Hotel Dieu was 
 1537, and he was twenty-seven years old, suffi- 
 ciently skilled in his profession and ready to begin
 
 i8o A Doctor's Table Talk 
 
 the business of life. He had good health, common 
 sense, and a broad outlook on the future. He was 
 content with no paltry corner practice and the 
 humdrum good will of simple neighbors. Immedi- 
 ately he established a snug surgery in Paris, and 
 then he went off to follow his profession with the 
 army. This double and hazardous course he took 
 that he might extend his activities, increase his 
 acquaintance, and never lack occupation, whether 
 in time of peace or war. 
 
 "The second of the three chapters of Fare's life 
 begins with this year 1537 the chapter of war 
 and adventure. Not until 1569, after more than 
 thirty years, did he settle down finally to a civilian 
 practice in Paris, and to the duties and employ- 
 ments incident to his dignity and advancing years. 
 
 "Fare's military life furnishes the material for 
 one of the most picturesque and stimulating sur- 
 gical memoirs in literature. It was written after 
 many years, and in the author's old age. In it he 
 tells us much of the story of his life. When Pare 
 was seventy years old there ruminated in Paris one 
 Etienne Gourmelen, dean of the faculty of medi- 
 cine, a devotee of the easy-chair, a dyspep- 
 tic, unpractical, controversial person. This dean
 
 Reflections Ambrose Pare 1 8 1 
 
 attacked the great surgeon in an inane book, 
 which opposed ancient authority to certain of the 
 new, brilliant, and effective surgical measures 
 introduced by Pare. Pare answered, told much of 
 the story of his life and achievements, in a series 
 of short, trenchant essays, and incidentally crushed 
 Gourmelen, whom he contemptuously addresses 
 throughout as Mon petit Maistre. Pare was a 
 master of clinical surgeons. Listen to his opening 
 paragraphs. He begins without preamble: 'I will 
 here show my readers the towns and places where 
 I found a way to learn the art of surgery. ... In 
 the year 1536 the great King Francis sent a large 
 army to Turin. . . . M. de Montejan was Colonel- 
 General of the infantry, whose surgeon I was at 
 this time.' Observe that officers took with them 
 their own personal surgeons. There was then no 
 regular, organized army medical corps. 
 
 "A great part of the army being come to the 
 pass of Suze, we found the enemy occupying it, 
 and they had made forts and trenches, so that we 
 had to fight to dislodge them and drive them out. 
 And there were many killed and wounded on both 
 sides. . . . Now I was at this time a fresh-water 
 soldier; I had not yet seen wounds made by gun-
 
 1 82 A Doctor's Table Talk 
 
 shot, at the first dressing. It is true I had read in 
 John de Vigo that wounds made by fire-arms par- 
 take of venenosity; and for their cure he bids you 
 cauterize them with oil of elders scalding hot, 
 mixed with a little treacle. And to make no mis- 
 take, before I would use the said oil, knowing this 
 was to bring great pain to the patient, I asked first, 
 before I applied it, what the other surgeons did for 
 the first dressing, which was to put the said oil, 
 boiling well, into the wounds, wherefore I took 
 courage to do as they did. At last my oil ran 
 short, and I was forced, instead thereof, to apply 
 the yolks of eggs, oil of roses, and turpentine. In 
 the night I could not sleep in quiet, fearing some 
 default in not cauterizing, that I should find the 
 wounded to whom I had not used the said oil dead 
 from the poison of their wounds, which made me 
 rise very early to visit them; when beyond my 
 expectation I found that those to whom I had 
 applied my digestive medicament had but little 
 pain, and their wounds without inflammation or 
 swelling, having rested fairly well that night; the 
 others, to whom the boiling oil was used, I found 
 feverish, with great pain and swelling about the 
 edges of their wounds. Then I resolved never more
 
 Reflections Ambrose Pare 1 83 
 
 thus cruelly to burn poor men with gunshot 
 wounds.' 
 
 "That anecdote the trying experience and 
 the sane conclusion are characteristic of Pare. 
 He drew his own conclusions, and acted on convic- 
 tion, and in that he differed from all practitioners 
 of his time. He dared greatly, for he lived in an age 
 of conservative authority. Those fine, humane, and 
 rational qualities made him one of the foremost 
 clinical surgeons in our annals. And regarding this 
 particular story of the boiling oil, so modestly told, 
 let us observe this : that the simplified wound treat- 
 ment for gunshot injuries, then introduced, was 
 one of Fare's great contributions to surgery 
 perhaps his greatest. After Pare, torturing of the 
 wounded put men in ill repute. So let us note, as 
 his first important contribution to surgery, the 
 simplified treatment of gunshot wounds. 
 
 " Fare's memoirs are full of strange tales, one of 
 which suggests the famous Harvard crowbar case 
 in which a quarryman recovered after a tamping- 
 iron had passed completely through his head from 
 beneath the chin upwards, emerging at the vertex. 
 Pare tells us how Francis of Lorraine, Duke of 
 Guise, was wounded before Boulogne with a
 
 184 A Doctor's Table Talk 
 
 thrust of a lance, 'which entered above the right 
 eye, towards the nose, and passed out on the other 
 side between the ear and the back of the neck, with 
 so great violence that the head of the lance, with a 
 piece of wood, was broken and remained fast; so 
 that it could not be drawn out save with extreme 
 force with smith's pincers. Yet, notwithstanding 
 the violence of the blow, which was not without 
 fracture of bones, nerves, veins, and arteries, and 
 other parts torn and broken, my lord, by the grace 
 of God, was healed.' 
 
 "Casual students of surgical literature think of 
 Pare as the man who invented the ligature of arter- 
 ies, and doubtless we recall the celebrated paint- 
 ing, many times reproduced, of the great surgeon 
 on the battle-field, surrounded by prancing horses, 
 stately pavilions, and pompous-looking officers, 
 as he amputates the leg of ah anxious soldier, who 
 sits stroking his long beard and gazing at the stump, 
 while Pare waves aside the hissing cautery and 
 applies a linen ligature to the bleeding artery. It is 
 a striking scene. Here is Pare's modest account of 
 the great achievement: 'On his return from the 
 expedition King Henry [II] besieged Danvilliers, 
 and those within would not surrender. They got
 
 Reflections Ambrose Pare 185 
 
 the worst of it, but our powder failed us; so they 
 had a good shot at our men. There was a culverin- 
 shot passed through the tent of M. de Rohan, which 
 hit a gentleman's leg, who was of his household. 
 I had to finish the cutting-off of it, which I did 
 without applying the hot irons.' He tied the bleed- 
 ing vessels with linen threads, and so, without 
 needless pain, he saved the life of the man, who 
 exclaimed that he had got clear of his leg on very 
 good terms. 
 
 "In truth, however, Pare never dreamed of 
 claiming that he had invented the ligature. The 
 ligature was used by Roman Galen and many oth- 
 ers in ancient times to control hemorrhage from 
 wounds; but strangely enough, the thought of 
 controlling hemorrhage from amputation wounds 
 seems to have occurred to none until Pare in the 
 middle of the sixteenth century. 
 
 "That was a notable feat. It marked an era in 
 surgical history. Taken with the simplified method 
 of wound treatment, it inaugurated a new concep- 
 tion of surgery, of an art hitherto barbarous and 
 cruel, now become beneficent and humane. In a 
 hundred other ways Pare showed his kindness of 
 heart and an understanding of how human suffer-
 
 186 A Doctor's Table Talk 
 
 ing might be lessened, until his sensibilities bore 
 the stamp of genius. He learned to go about his 
 work deftly, silently, effectively. He quieted terror; 
 he soothed pain; he encouraged sleep; he appreci- 
 ated the value and limitations of food and stimu- 
 lants, of clean air and fresh linen. His splints and 
 dressings were a revelation in comfort and support. 
 His bandaging was a marvel of smoothness, beauty, 
 and efficiency. Henry II felt that he could die 
 under his care in dignity and ease. Francis II, in 
 his last hours, held the kind hand of his benefactor. 
 Antoine, King of Navarre, resigned himself to 
 death when Pare whispered that his torn shoulder- 
 joint would prove fatal; and Charles IX clung to 
 him through his final, shrieking, ghost-haunted 
 days. Ambrose Pare was a great soul, truly with- 
 out fear and without reproach. 
 
 "Let us look again at some of the facts and de- 
 tails of his career. We saw him off for the wars in 
 Italy, when Francis I was fighting, when the cen- 
 tury was still young, and himself in his twenty- 
 eighth year. So well did he conduct himself that he 
 rose shortly above the crowd, for he qualified as a 
 master barber-surgeon at thirty-one. Later, after 
 sixteen years of military life, he had so won the
 
 Reflections Ambrose Pare 187 
 
 confidence of kings and their officers, and had so 
 endeared himself to the common soldiers, that his 
 presence alone was looked on as better than a rein- 
 forcement. When Metz was besieged by the Span- 
 iards in 1552, Pare, sent by King Henry, penetrated 
 to the city. Guise commanded the defense. He 
 embraced the great surgeon, presented him to his 
 delighted officers, and revived the spirits of his 
 broken troops, who cheered him wildly, shouting 
 that now they should not die, since Ambrose Pare 
 was come. The city was saved. 
 
 "We remember the surgeons of the long-robe, 
 that proud little brotherhood of Saint Cosmo, 
 who patronized and scorned the barber-surgeons. 
 They saw the rise of Pare, appreciated his distinc- 
 tion, and resolved to make him their own. So, with- 
 out formality, with scarcely the pretense of an 
 examination, their precious Latin forgotten, they 
 admitted him to their ranks and made him their 
 most honored member. 
 
 "In the intervals of these skirmishings, rewards, 
 and military honors, Pare was employing himself 
 as a civil surgeon of distinction. His casting-forth 
 of the boiling oil had early attracted the interest 
 of the great Sylvius, now an old man, and his former
 
 188 A Doctor's Table Talk 
 
 master; and the friendship of Sylvius helped his 
 struggling youth. He returned often to Paris; his 
 military fame introduced him to powerful patrons, 
 and kings honored him, as we have seen. He mar- 
 ried Jehanne Mazelin whose father was a 
 servant of the great Du Prat, Chancellor of France. 
 Pare took her with one hundred and twenty dol- 
 lars for dot; she was twenty and he was thirty-one. 
 They had a daughter, but no son lived to maturity. 
 Years later, when past middle-age and after the 
 death of Jehanne, Pare married again; this time 
 with many marriage settlements and much stately 
 display. But though he became the father of nine 
 children in all, he had the fate of most great men ; 
 no children lived to carry down his name. 
 
 "Of Pare we recall another fact, too, a fact in- 
 evitable in the life of a distinguished surgeon, he 
 was a great writer and teacher. He was a keen and 
 unsparing controversialist; he was a born leader of 
 men. Much of his writing was final for centuries. 
 He had been publishing essays and treatises through 
 all his professional life mostly on matters deal- 
 ing with military surgery; but in 1575, when sixty- 
 five years old, he issued an edition of his collected 
 works, dedicated to that absurd king, Henry III:
 
 Reflections Ambrose Pare 189 
 
 'God is my witness,' he writes, 'and men are not 
 ignorant of it, that I have labored more than forty 
 years to throw light on the art of Surgery and bring 
 it to perfection. And in this labor I have striven so 
 hard to attain my end that the ancients have naught 
 wherein to excel us, save in the discovery of first 
 principles; and posterity will not be able to surpass 
 us (be it said without malice or offense) save by 
 some additions, such as are easily made to things 
 already discovered.' 
 
 "It would be profitless here to discuss in detail 
 those surgical accomplishments which brought him 
 pride. Of his methods and his attitude towards 
 suffering I have already spoken. He was an en- 
 cyclopaedic writer. As Paget remarks: 'Save Art 
 and Politics, the works of Pare contain every possi- 
 ble subject: Anatomy and Physiology, Medicine, 
 Surgery, Obstetrics, State Medicine, Pathology, 
 Pharmacy, Natural History, Demonology, and 
 much else/ He dealt, as an authority, with all 
 these matters : he had the short-comings of his time, 
 to be sure, something of credulity, no little of 
 superstition, dread of unseen and malign influences; 
 but when all is said, he recognized in the main the 
 healing forces of nature and the preponderance of
 
 190 A Doctors Table Talk 
 
 good, even in that blood-stained age; the value of 
 solid accomplishment, the saving grace of work, 
 and all with the simplicity and enthusiasm of a 
 truly great soul. His enormous experience lends 
 force to his descriptions, conclusions, and advice; 
 we rise from the reading convinced that here indeed 
 was a man. 
 
 " Such writings, activities, and labors kept Pare 
 continually in the public eye. While he won and 
 held the regard of kings and peasants, he was 
 not always in favor with conventional physicians. 
 While he labored for the dignity and advancement 
 of his own order, he met the jealousy, dislike, and 
 opposition of university authorities. In the end he 
 prevailed largely. That is a long story, signifi- 
 cant to Dryasdust, valueless to us. 
 
 "Tradition has reckoned Ambrose Pare a Hugue- 
 not, but that is a matter on which he himself mainly 
 is silent. The friend of Coligny, the correspond- 
 ent of Calvin, the surgeon and friend of Guise, 
 the confidant of Charles IX and Henry III, it is 
 impossible to class Pare among the partisans of a 
 creed. He went to mass; he read the Bible; he 
 respected the Church of Rome; he lived in charity 
 with Protestant divines : not that he was all things
 
 Reflections Ambrose Pare 191 
 
 to all men, but he looked for the best in all, and 
 endured sadly the shouting of sectaries, the pre- 
 tension of dogma, and the exalting of fugacious 
 gabble. Whatever he believed, peace to his 
 ashes, I doubt if he had a creed. But he lived 
 through the St. Bartholomew a bitter day, never 
 to be forgotten, August 24, 1 572. Two days before 
 the massacre the Huguenot hero, Coligny, Admiral 
 of France, was shot at, while leaving the king's 
 palace. His hand only was injured, and he sent for 
 his friend Pare to repair the damage. Pare ampu- 
 tated two ringers, but he had come in haste, im- 
 properly equipped. The work was roughly done, 
 but Coligny never flinched. Rumors were in the air; 
 anxiety was abroad; the king in his palace was 
 reserved and morose; the villainous queen mother, 
 Catherine de' Medici, was conspiring; young 
 Henry of Navarre half prisoner, half guest 
 was being married to the king's sister, Marguerite 
 d.e Valois; unwonted crowds, with strange tokens 
 and passwords, roamed the streets. Pare went 
 unharmed among them all. We hear of him in the 
 king's chamber; we watch him accosted by Guise; 
 we see him at the sick-bed of Coligny. Early in 
 the morning of the twenty-fourth, Sunday, one of
 
 192 A Doctor's Table Talk 
 
 Coligny's gentlemen, Cornaton, hurries in. 'Mon- 
 seigneur,' he cries, 'it is God who calls us to Him.' 
 Coligny replies, * I have been ready to die this long 
 time, but you, my friends, save yourselves if you 
 still can/ They escaped over the roof, Ambrose 
 Pare carried with them; and later, by the king's 
 order, he was secreted in the royal chamber from 
 the assassins. We read of the old Admiral stabbed 
 in his bed, cast out into the courtyard, and there 
 dispatched by order of Guise, director of the day's 
 work. 
 
 "The last chapter of Fare's life runs with the 
 reign of the last Valois king, Henry III, from 
 1574 to 1589. Pare himself died in 1590, in his 
 eighty-first year. While those last sixteen troubled 
 years were given largely to his country, Pare never 
 for a day forgot the advancement of his own pro- 
 fession. He worked. The sum total of his labors is 
 astounding. He wrote; he spoke; he traveled. He 
 was seventy-five years old when he published the 
 famous 'Journeys,' in reply to Gourmelen. A 
 few years before this we find him putting out two 
 great surgical volumes of five hundred pages each. 
 One groans over his daily routine. He rose at four 
 in the morning, and went at once to his surgery,
 
 Reflections Ambrose Pare 193 
 
 where he read and wrote until six; then he break- 
 fasted on milk and dry bread. At six-thirty he 
 began the reception of patients, who thronged to 
 him until eleven o'clock, when he dined. After 
 dinner he slept for a half-hour, when he started 
 forth on his rounds, on foot or horseback, sur- 
 geons had no carriages in those days. Often he 
 visited the Hotel Dieu, where he operated and 
 taught, and where he wrote over the door: 'I dress 
 the wound; God heals it.' He supped wherever 
 chance found him, in some humble shop, at the 
 hospital, the Louvre, or rarely with his wife at 
 home; then to his studies again, or to see more 
 patients, and at last to bed, at midnight or long 
 after. 
 
 " He was always well. Born in the country, and 
 of a vigorous stock, he grew up a vigorous lad, and 
 rarely himself knew what sickness was. Simple and 
 abstemious, his forces never failed, and he met his 
 work as it came. Once he broke his leg; once he was 
 bitten by a poisonous reptile; once he had a hemor- 
 rhage; and again a sharp sciatica from exposure 
 and overwork; but he rallied with vigor unimpaired. 
 Once he fainted, standing over a plague-stricken 
 patient; he had the plague himself later, but it
 
 194 d. Doctor's Table Talk 
 
 mattered not. He was abstemious, though he 
 loved good wine, and it is surmised (Paget) that 
 he never smoked, for he was fifty when Jean Nicot 
 brought the first tobacco to Paris. Once he believed 
 that his enemies tried to poison him. It was at 
 Rouen in 1562, and he writes: *I found myself at 
 dinner with a company, wherein were some who 
 hated me to death for the Religion. They handed 
 me some cabbages, which contained either corro- 
 sive sublimate or arsenic. With the first mouthful 
 I felt nothing; with the second, I had a great heat 
 and burning, and great astringency in the mouth, 
 and especially at the back of it, and the foul taste 
 of the good drug.' . . . Loyal man; at any rate, he 
 took the proper remedy and it worked. 
 
 "The writers, and especially his voluminous 
 biographer, Malgaigne, tell many stories character- 
 istic of Pare. In spite of his goodness of heart, he 
 hated beggars, for the beggars of old Paris were a 
 mighty army of rogues, thieves, and impostors, 
 such as Victor Hugo scores: 'There was the woman 
 whom Jehanne Pare found begging at the door of 
 the Huguenot Chapel at Vitry, on a Sunday, with 
 a counterfeit ulcer, and so she was whipped and 
 banished.' There was another beggar, with banner
 
 Reflections Ambrose Pare 195 
 
 and tub and castinets; his face was covered with 
 leprosy made of glue, and was kept of a livid tint 
 by a scarf pulled round his neck, half throttling 
 him. He, too, was unmasked, and was whipped 
 thrice through the town, and the third whipping 
 killed him, while the gossips told how it was no 
 great loss to the country. 
 
 "In those last years of his life, when the royal 
 house was tottering, when the Guises and a few 
 great nobles endeavored to control the king, when 
 the country was rent by religious wars, and Hugue- 
 not Henry of Navarre, opposing the Catholic 
 League, was advancing across the land, Pare con- 
 tinued in Paris, busy with his peaceful art. That 
 was a distraught and unhappy Paris, set in the midst 
 of an unhappy France. Two hundred years later 
 we read of the Reign of Terror, and the downfall 
 of an aristocracy, the great ones of the earth. Un- 
 happy France; she has seen many reigns of terror, 
 but the cruelty of Robespierre and of Danton was 
 as nothing compared to the cruelty of Catholic and 
 Huguenot, Henry of Valois, Henry of Navarre, 
 and Henry of Guise. 
 
 "In his own last years Pare's Paris was a place 
 of some two hundred thousand souls, constantly
 
 196 A Doctor's Table Talk 
 
 increased by the wretched country people whom 
 war, devastation, and famine drove to the city. 
 They came in, haggard, emaciated, starving, 
 diseased, to swell the increasing swarms of beg- 
 gars and the destitute. The sufferings of Paris were 
 indescribable, and Pare was a familiar figure to all 
 these people. He is one of the historic figures of 
 the Paris of those awful times, as it is written 
 of him, ' Known to everybody, keeper of the lives 
 and secrets of innumerable important people, head 
 of his profession, chief surgeon to the king.' The 
 plague came in 1580, and remained for years, as if 
 that alone were wanting. The price of food was 
 prohibitive except for the rich. Taxes rose mean- 
 time, and the luxury of the court and its followers 
 increased. One might quote scores of instances. 
 Observe one from L'Estoile's Journal: 'August 
 23, 1587, Jean Louis de Mougaret, due d'Espernon, 
 chief favorite of the king, whom he used to call his 
 eldest son, was married quietly at the chateau of 
 Vincennes. The story was told everywhere that 
 the king gave him on his marriage the sum of four 
 hundred thousand crowns.' 
 
 "And again: 'Truly the face of Paris was miser- 
 able at this time; and he who has ever heard or
 
 Reflections Ambrose Pare 197 
 
 read in Josephus the factions of John, Simon, and 
 other villains, who under the veil of hypocritical 
 religious zeal plundered and sacked the city of 
 Jerusalem, if he had now come to Paris, he would 
 have seen a like thing.' 
 
 "The diary of the years goes on with increasing 
 gloom and despair. The king becomes more craven, 
 superstitious, and imbecile; the power of the 
 Catholic Guises and their League increases; rioting 
 and anarchy spread. Pare remains at his post, but 
 his fees have dwindled away. 
 
 "Great national and international events are re- 
 corded: News of the execution of Mary Queen of 
 Scots in 1587; Navarre's victory of Coudras in the 
 same year; the outbreak of fighting between the 
 Guises and the king in 1588, and their pretended 
 reconciliation; news of the Spanish Armada de- 
 stroyed; and finally, at the end of the year, the 
 murder of Guise and of his brother the cardi- 
 nal. With the incoming of another year, 1589, old 
 Queen Catherine, the King's mother, died, and 
 then, six months later, the King himself was assas- 
 sinated. 
 
 "All this availed nothing to our old hero Pare and 
 his forlorn people. The political heirs of the Guises
 
 198 A Doctor's Table Talk 
 
 kept up the civil war, and Henry of Navarre, now 
 Henry IV, laid siege to distracted Paris, after win- 
 ning the battle of Ivry in March, 1590. 
 
 ' Through thy cornfields green, and sunny vines, pleasant 
 land of France.' 
 
 "We come to the last scenes of Ambrose Pare. 
 Henry IV, the Huguenot champion, invested Cath- 
 olic Paris. The people began to die in the streets, 
 
 one hundred to two hundred daily. The food 
 came to an end, and they ate the dead. The Arch- 
 bishop of Lyons led the defense, while the priests 
 put on armor and raged through the city. Here 
 again we find Pare. Eighty years old, heart-sick, 
 exhausted, and indignant, he meets the great pre- 
 late in the streets. Before hundreds, he shows him 
 the hopeless situation and the misery of his flock, 
 
 dead and dying about them, and implores 
 him to put an end to the useless struggle. A few 
 days later the siege was raised. 
 
 "This last awful year saw the end of Pare. He 
 died in December, but of his last days we know no 
 more. It is a notable and important life. Perhaps 
 it was a great life. One speculates on what this man 
 might have done had he lived in better days and 
 saner times. But such speculation is profitless.
 
 Reflections Ambrose Pare 199 
 
 The times helped make the man. We see him a 
 mighty soul when men's hearts were failing them; a 
 brave reformer, a good citizen, and a great surgeon, 
 when chaos reigned. Some men are great for having 
 lived unspotted in this naughty world. It was so 
 with Pare. The people of France loved him for 
 what he was. The spirit of his young manhood 
 never left him; and he died as he had lived a 
 high-hearted and gallant gentleman. 
 
 " ' So nigh is grandeur to our dust, 
 So near is God to man, 
 When Duty whispers low "Thou must," 
 The Youth replies "I can." '"
 
 CHAPTER IX 
 
 Hospital Talk 
 
 As we journeyed southward a day or two later, I 
 found Ely unusually silent. The beautiful drive 
 through the hills passed him by almost unnoticed ; 
 and it was not until we had been a half-hour in the 
 train that he came to himself. In the morning's 
 paper I read undigested fragments of thought, and 
 other slip-slop. The newspaper world seemed triv- 
 ial enough after the little world of earnest fact we 
 had left. 
 
 Ely took up the tale: "There is no doubt that 
 Primrose has an interesting life; perhaps his 
 method is better than ours. In his writing and talk- 
 ing about illness, too, I could not but contrast his 
 thoughts, and his point of view with those of aver- 
 age patients. He suggested that contrast himself 
 when he wrote about their frequent puzzlement 
 and terror. How true it is that with most of us the 
 final scenes are undignified and commonplace even 
 among the highest and most aloof persons. We 
 doctors seem to get under the skins of all mankind.
 
 Hospital Talk 201 
 
 I remember Arthur Benson puts it somewhat dif- 
 ferently. In describing the last hours of Charles 
 Kingsley, who died of pneumonia, Benson writes 
 something of this sort, 'He lay unconscious, in 
 the sad and solemn occupation known as dying 
 when the most commonplace person in the world, 
 who lies dozing and fevered in the darkened room, 
 is invested for all who move silently about the house 
 with a strange majesty and awe.' Yet that descrip- 
 tion does not necessarily conflict with my statement. 
 For the doctor, and more especially for the nurse, 
 for those of us who are occupied with the humble 
 personal offices about the sick man, it is all 
 commonplace enough; while for the anxious 
 friends and children, for those who loiter sadly 
 near the accustomed room, in unaccustomed idle- 
 ness, waiting through the hours, there is that 
 strangeness and that awe of which Benson tells. 
 Sometimes it seems as though the waiting were 
 without beginning and would never end. Then 
 unexpectedly, gently, a whispered voice tells us it 
 is over; and we look about surprised, almost 
 offended, as it were, by something past belief. 
 
 "Those are the days in which one lives at 
 close grips with the unknown, and yet that un-
 
 202 A Doctor's Table Talk 
 
 known should some day be knowable, one almost 
 thinks. 
 
 "Primrose's little description of the ancient 
 Hotel Dieu was interesting. The fact is, in that 
 nasty, unwashed old France, the great hospital 
 grew worse and worse until after the French Revo- 
 lution. I remember reading how surprised were the 
 French medical officers, who came to America dur- 
 ing our own Revolution, when they saw the decency 
 of our well-swept wards in the new Philadelphia 
 and New York hospitals. Of course all hospitals, 
 the world over, shine to-day with resplendent pol- 
 ish, but I fancy the sensations of modern patients, 
 when they enter one of our hospitals, are not very 
 different from the sensations of their great-grand- 
 mothers. I mean our large municipal hospitals for 
 the poor. 
 
 "Did you ever try to put yourself in the place of 
 a sensitive sick man going to a large general hos- 
 pital ? I have, and I Ve come to see that the expe- 
 rience may be very hard. It was far worse be- 
 fore we had the help of Social Service workers. 
 Of course all these trials against which sensitive 
 persons protest are perhaps inevitable; but cer- 
 tainly a sick man on going to a hospital has a right
 
 Hospital Talk 203 
 
 to demand better treatment than he gets from the 
 ticket-agents and gate-men in a railway station. 
 Of course, too, all officials who deal personally 
 with the great public must have a hard time of it. 
 Every policeman knows that. That great public 
 is rude, boisterous, and uncivil mostly, on the 
 street, on its travels, and at baseball games. In 
 such places it needs firm, and even rough handling. 
 But when the great public is ill and goes to a hos- 
 pital, it must be kindly treated. Then it is fright- 
 ened; it is in pain; it has fever; it is mystified; 
 it is not bossing its own job; it is confiding itself to 
 the care of strangers, whom it is told to trust, and 
 it feels that it is entering blindly upon a great, 
 strange, and terrible experience. We doctors, in 
 talking to a poor patient in our offices, and when 
 advising his going to a general hospital, are often 
 unreasonably impatient and irritable because the 
 patient shrinks from the prospect. I 'm afraid we 're 
 sometimes bumptious and patronizing. Our point 
 of view seems often to be that we alone are bestow- 
 ing the benefit, a mediaeval and absurd notion. 
 It is said that Mr. Rockefeller gave a great sum to 
 help medical teaching at one of our universities 
 because he was convinced that that university,
 
 204 A Doctor's Table Talk 
 
 through its hospital affiliations, controlled the * rich- 
 est clinical material' to be found. The staff posi- 
 tions of our great hospitals even those that pay 
 nothing whatever in dollars are sought and 
 held through active life by our most ambitious 
 men. Every patient in a hospital, every sick man, 
 furnishes material for laboratory study. Without 
 the sick in our general hospitals, medical progress 
 would be almost impossible, or would stop; and 
 without the complacent patient for his demo'nstra- 
 tions the bedside teacher would soon resign his 
 chair. These are facts which our own profession, 
 as well as the general public, should have more 
 constantly in mind. I wish you would write them 
 down and put them in a book some time. 
 
 "Another thing, as long as I am lecturing you, 
 and Primrose has turned us towards medical his- 
 tory, we must remember that the purpose of a hos- 
 pital is quite different is immensely broader, than 
 it was a hundred years ago. Take the old Penn- 
 sylvania Hospital in Philadelphia, for example; 
 as Benjamin Franklin's inscription runs, it 'was 
 piously founded for the relief of the sick and miser- 
 able.' That purpose is still true of modern hospi- 
 tals, we trust; but there are now two other pur-
 
 Hospital Talk 205 
 
 poses of a hospital, the study of disease and the 
 teaching of medicine. Many well-to-do and well- 
 informed people forget those last two purposes; 
 and sometimes in talking to poor patients we forget 
 them, too; but the poor patients don't forget them. 
 They exaggerate the evil, as they think it. They 
 don't know, or they ignore the fact, that competent 
 and experienced chiefs are responsible for every 
 hospital ward, and that the chiefs have junior 
 assistants. Many of the patients see the assistants 
 only and eventually leave the hospital proclaiming 
 that they have been in the hands of students. In 
 frequent instances, when examining old hospital 
 patients, of fair intelligence even, I find that they 
 know nothing of any surgeon-in-chief, and can't 
 name the man who operated on them. These are 
 old tales, of course; and of no special consequence 
 except as showing how little trust you can put in 
 the story of the average hospital patient. 
 
 "Not only is the purpose of the hospital greatly 
 broader than it was, but the obligations of the staff 
 are vastly more burdensome. In the old days, the 
 surgeon or physician * went on duty' at the hospital 
 for three or four months of the year. His object 
 was to do his share towards caring for the city's
 
 206 A Doctor's Table Talk 
 
 sick poor. His action was regarded as simple 
 charity. He thought of it as nothing else. Inci- 
 dentally, perhaps, he might give a few clinical lec- 
 tures to medical students. 
 
 " In the course of time all that has been changed ; 
 gradually the hospital, with its associated medical 
 school, has become the centre of medical life in the 
 community. Members of the staff are now on duty 
 for six, nine, and even twelve months of the year. 
 The labors of these public servants have come to be 
 excessive, out of all proportion to the recognition, 
 or any other reward, which the men get. In many 
 cases, happily, the problem of proper values is 
 working itself out. In most progressive communi- 
 ties, nowadays, special hospital wings or * private 
 wards' are reserved, in which the staff lodge and 
 tend their private patients, charging regular fees. 
 So they relieve immensely the strain of their work; 
 and save time and strength by concentrating their 
 'public' and their private patients under one roof. 
 In a very few old-fashioned hospitals the inhuman 
 practice still prevails of taking the best of a physi- 
 cian's strength for public charity work, and then 
 driving him forth to make his bread and see his 
 private patients at their homes or in a number of
 
 Hospital Talk 207 
 
 necessarily inferior private hospitals. I 'm told that 
 in Boston the eccentric people, not content with 
 two splendid public or semi-public hospitals, 
 pricelessly equipped, and capable of indefinite 
 expansion for the benefit of private patients, - 
 I'm told that the people there are planning to 
 build an extravagant, independent, and distinct 
 private hospital, duplicating the present equip- 
 ments, and calling upon the already over-rushed 
 profession to man these extra works." 
 
 "It's all true, in a measure," I said, "though you 
 do somewhat exaggerate the situation. The fact is 
 that many surgeons especially welcome this make- 
 shift scheme, as a relief from conditions which were 
 becoming intolerable." 
 
 Our train, by this time, was far down the state, 
 racing through* the Merrimac Valley, and by the 
 side of those beautiful stretches of river which the 
 rails follow as far as the Massachusetts city of 
 Lowell. We had gone to the dining-car, and were 
 dawdling over the conventional railway luncheon. 
 
 "After all," I continued, "the good which our 
 hospitals are doing seems to be greater every year; 
 and the dread of hospitals is certainly less than when 
 you and I first knew them. In spite of the modern,
 
 208 A Doctor's Table Talk 
 
 impersonal, organized charities, and the more or 
 less communistic sentiment which is coming to 
 prevail, I find that an interest and a care for in- 
 dividual patients is more frequent than it was 
 twenty or thirty years ago. Then we were satur- 
 ated with the bad German tradition, which a for- 
 mer generation of students had brought home with 
 them. Hospital patients, especially 'out-patients,' 
 were driven like sheep, and their personal feelings 
 were ignored. I remember some of my old teachers, 
 men still living, whose public insulting questions 
 and callous maulings of decent men and innocent 
 young women made me groan and shudder in 
 spirit. The good done by such doctors outside 
 of mere inevitable mechanical treatment must 
 have been less than nothing. Now, we are on better 
 ground, as it seems. We are developing an Ameri- 
 can hospital method, so to say; thanks in part to 
 publicity, but especially to Cabot and his Social 
 Service preachments. Concentrate on the indi- 
 vidual; don't bind up your patients in inflexible 
 groups; learn their stories; follow them to their 
 homes; succor and assist them; stimulate and in- 
 spire them. That is the present teaching, and for 
 such teaching we should have been hooted into
 
 Hospital Talk 209 
 
 bedlam a few years ago. It's a method as old as 
 Christianity; but it was unorganized and almost 
 obsolete, until Cabot again saw its possibilities; 
 revived it, organized it, dressed it up, told the world 
 about it, and replanted it for our present delecta- 
 tion. 
 
 "On the other hand, of course there is the serious 
 and growing danger of ' hospital abuse.' Thousands 
 of unscrupulous persons have learned that they can 
 be treated for little or nothing at public hospitals, 
 and by highly trained men. Being without self- 
 respect, they abuse that privilege. Such abuse is 
 another problem, which our much-talked-of hospi- 
 tal-for-the-middle-class would help to solve. The 
 other day, one of our friends in a New England 
 hospital, with much spirit informed me that in the 
 'West 'they do better; that out there hospital abuse 
 is almost unknown; that practically every patient 
 who enters a Western hospital must pay something, 
 according to his means. I don't understand it. 
 I'm sure I trust it may be so; but how it is accom- 
 plished, and why there should be such a change in 
 human nature between New York and Chicago 
 passes comprehension." 
 
 "From many aspects large modern hospitals are
 
 2io A Doctor's Table Talk 
 
 extremely interesting, and growing more interest- 
 ing," said Ely reflectively. "I'm inclined to think 
 that for the working staff, physicians and nurses, 
 the hospital life is more absorbing than is univer- 
 sity life for its professionals, if we except the 
 Fellows of Cambridge and Oxford. In the past 
 generation there has been the development of a 
 unique hospital community. What would the old 
 quidnuncs of thirty years ago have said to a young 
 graduate in medicine who proposed to spend five 
 or ten more years, and his best years, in hospital 
 life? They would probably have thought him an 
 amiable lunatic. We should invent some word 
 more dignified than * Resident' for the man who 
 chooses that life. You notice that the number of 
 Residents in our best hospitals is increasing. The 
 presence of such men in hospitals is surely add- 
 ing to the importance and stability of a hospital 
 career. A Resident is becoming as important a part 
 of a hospital service as is the Chief-of-StafF himself. 
 The junior men, internes and externes, should never 
 have been given such uncontrolled powers as they 
 had a few years ago. That was an accident in hos- 
 pital development. Old-time surgeons, when they 
 established interneships, never intended that their
 
 Hospital Talk 211 
 
 assistants should have important independent pow- 
 ers; and for years they had no such powers. They 
 were minutely supervised by their chiefs. With 
 the enormous expansion of modern hospitals, how- 
 ever, the work and responsibilities of internes piled 
 up in proportion, the tasks were beyond the lim- 
 ited experiences and capacities of the young men; 
 and yet they met them and assumed them with 
 the splendid assurance of youth. Now we have the 
 Resident, who shall temper the wind to the shorn 
 novice. Even as it is, a two years' interne service 
 in a busy hospital gives a man an experience in the 
 use of his tools which an ordinary lifetime of private 
 practice could not supply. Of men and women he 
 comes out ignorant. Them he has still to learn." 
 
 "Another difficult problem in this community 
 life of yours, Ely, is the trained nurse problem," I 
 ventured. "Human nature is human nature; and 
 when you have thirty or forty young men, and one 
 or two hundred young women under one roof, and 
 in the most intimate of all relationships short of 
 marriage, it's often a question how the situation is 
 to develop itself. Happily all these folks are very 
 hard-worked; otherwise I suspect that Hymen and 
 other less reputable gods and goddesses would
 
 212 A Doctor's Table Talk 
 
 find themselves under a heavy strain. The wonder 
 is that marriage is hot far more common among 
 these very marriageable people. That's one aspect 
 of the trained nurse problem; and I think we'd 
 best leave it, with other aspects, to the experts. 
 One point, though, a reply to all the severe criti- 
 cism of trained nurses, and the poor things are 
 criticized more unfairly than any other people in 
 the world except servants and doctors; the pro- 
 per standard reply is this, that they are quite as 
 human and liable to error as the rest of us. I often 
 think that on account of the almost incredible inti- 
 macy which must exist between nurse and patient, 
 the position of a nurse in private practice is one 
 of the most difficult positions conceivable. Two 
 young sisters, or husband and wife, are more inti- 
 mate, but, with those exceptions, comparisons 
 cease. 
 
 "Now the nurse-patient intimacy is a forced one: 
 a normal family is going on in its usual fashion, 
 when suddenly the son of the house becomes 
 acutely ill. A doctor is called, and to aid him in his 
 labors, he promptly installs a strange young woman 
 in the young man's bedroom. She is to minister 
 unto him day and night, and to perform all the
 
 Hospital Talk 213 
 
 necessary offices of the toilet. To a certain extent 
 mother and sisters are excluded, and the strange 
 young woman assumes an attitude of proprietor- 
 ship and responsibility, which, under any other 
 circumstances, would seem monstrous and incred- 
 ible. To become a gracious presence in that house- 
 hold, such a young woman must be endowed with 
 the tact, the virtues, and the ability of an arch- 
 angel. While the illness is grave and acute, all other 
 considerations are smothered, but as soon as the 
 patient begins to mend, his family begin to won- 
 der; and unless they are old hands, familiar with 
 illness and with trained nurses, they quickly begin 
 to chafe without understanding clearly the cause 
 of their discomfort. One morning the mother of 
 the family mysteriously summons the doctor to a 
 conference in her own room before he visits the 
 patient. She has no doubt that Miss Minns, 'the 
 nurse you sent us, is an excellent person and is well 
 trained; yes, you've employed her for five years? 
 Yes, but should she not wear a cap while on duty; 
 not the rule? Oh, well; she understood; and 
 should not Miss Minns sweep under the bed every 
 day; supposed she did? no, not every day. 
 And, is it necessary for her to go out for two hours
 
 214 -A Doctors Table Talk 
 
 every afternoon ? had supposed that nurses 
 always stood by, in case of accidents ; yes ; 
 probably she is mortal, and must preserve her 
 health; but she is so quiet, and never tells any- 
 thing; leaves that for the doctor? Oh, didn't 
 understand. But surely, a nurse should not object 
 to eating in the kitchen and carrying dear Jack's 
 trays up to him six times a day; it's only four 
 flights. No longer customary? Oh; then I suppose 
 . . . well; all right; thank you. I won't detain 
 you any longer now.' 
 
 "The weary doctor escapes, but on the next 
 floor he is waylaid by his patient's elder sister, 
 supported by her maiden aunt 'a most experi- 
 enced woman, and accustomed to illness.' 'So 
 sorry to trouble you, but don't you think that 
 mother is looking dreadfully ? No more than you 'd 
 expect? Perhaps not, but why should not Miss 
 Minns give her a good massage treatment every 
 night after mother goes to bed? She's not trained 
 or engaged for that sort of work ? must get a 
 regular masseuse? Oh; Miss Minns seems so kind 
 and interested, had supposed she'd be only too 
 glad to help mother; and with her high wages, too.' 
 And so on day after day. In my experience a nurse
 
 Hospital Talk 215 
 
 captures the family at once, or else she is a target 
 for criticism throughout her stay. Of course the 
 nurse is not perfect; very likely she is of a type 
 peculiarly strange or distasteful to that especial 
 family. Often she is their superior in breeding and 
 education, even though the family appear well-to- 
 do and well placed. This the family recognize 
 and resent. All other things being equal, however, 
 and the superficial relationship being in no way 
 strained, the position is a difficult one for all con- 
 cerned. The nurse often feels suspicious and on 
 guard; in her distress or through native dullness, 
 she accentuates her own faults; while the afflicted 
 family, invaded, dispossessed, managed, and oc- 
 casionally ignored, accumulate a sense of outrage, 
 which, though intangible, is none the less real. 
 Whenever a nurse tells me that she fears her em- 
 ployers are dissatisfied, and that perhaps she had 
 better go, I always say: 'Go; at once; you can't go 
 too quickly, both for your own reputation and for 
 this family's peace of mind. Later they will under- 
 stand your action, and will have nothing but a kind 
 report of you to make.' 
 
 "We seem to have gone far outside of our hos- 
 pital talk, Ely; but we agreed to leave hospital
 
 216 A Doctor's Table Talk 
 
 nurses to experts. I have been relieving my mind 
 about nurses in private practice; and those are the 
 nurses about whom you and I know most." 
 
 "Let me say one more word on the subject," he 
 replied. "There is a period, a mere moment, per- 
 haps, when the hospital nurse is breaking the shell 
 and emerging as a private nurse. Then is the time 
 when all the good friendly folks gather about her, 
 celebrate her 'graduation/ and get some amiable 
 man, who often knows nothing of his subject, to 
 make a pleasant little speech telling the class what 
 nice young women they are, and how they are ' ded- 
 icating themselves to a noble career.' Or else, the 
 fatuous man has been primed by some knowing 
 woman, and so takes the other tack, telling the 
 happy and well-meaning neophytes that they must 
 n't be too smart; that they are put here to serve! 
 that the human lot is hard at the best; and that 
 they must n't think they know all there is to 
 know. 
 
 "Of course they don't know anything. They're 
 nothing but youngsters. You can't expect a parcel 
 of girls, from twenty-one to twenty-three years old, 
 to take a very serious philosophical view of life. 
 They resent the 'noble career' talk as gammon,
 
 Hospital Talk 217 
 
 and the harsh instruction as preaching. Mostly 
 they have taken up nursing for a living, as they 
 might take up teaching or dressmaking. They are 
 glad of honest advice straight from the shoulder, 
 and no nonsense. Don't think that I fail to under- 
 stand and value the fine ethical side of the nurse's 
 career; but in my knowledge that fine side of the 
 life is developed out of experience, sorrow, struggle, 
 and time. With women as well as with men, the 
 * noble career' is a thing of painful and laborious 
 growth. As a fact a majority of nurses fail to de- 
 velop that career at all, because most of them 
 marry while still in the joyous age." 
 
 The solemn converse of young professional 
 people always interests me. It is not babble; and 
 sometimes it is informing, because it shows how 
 the wind sets. Students of law and medicine and 
 young practitioners seem to be most given to this 
 sort of talk. The awful person who chatters of 
 stocks develops his awfulness late in life; and the 
 politician is nearly always acceptable, because the 
 politician, whether wise or foolish, deals with sub- 
 jects of widest interest. Moreover, his talk is 
 rarely technical. Medical talk in public " doctor
 
 218 A Doctor's Table Talk 
 
 rot" as one of my tired friends calls it is some- 
 times heard even from venerable lips which should 
 have been better trained. I have agonized memo- 
 ries of hanging on to trolley-car straps with certain 
 merciless consultants, while they poured out upon 
 me and upon our long-eared neighbors the details 
 of the case we were about to visit. I've tried to 
 escape from my misery, by sitting down even while 
 my companion remained standing, but that ma- 
 noeuvre stimulates one's tormentor to worse aggres- 
 siveness and louder shoutings. The best plan is to 
 murmur appreciation and to approach a listening 
 ear as near to his lips as decency will permit. Even 
 so, painful moments arise, as when he nips off his 
 discourse suddenly, and demands in truculent 
 tones what you would do under the conditions he 
 has described. I have learned to say that I can't 
 tell until I have seen the patient. 
 
 We were speaking, however, about the shop-talk 
 of young doctors, and of nurses, too, if you 
 choose. I like to hear them talk their talk and air 
 their views, if only their speech be in season. Let 
 them be modestly reticent, though, in the presence 
 of older persons whose training is not medical. A 
 young doctor by his talk may impress the village
 
 Hospital Talk 219 
 
 clown or drunkard, but not the lawyer or the par- 
 son. The admiring father and mother of the para- 
 gon may well bear in mind the same advice. I 
 recollect one beautiful afternoon of my vacation. 
 Our little company were canoeing, and stopped at 
 a charming camp by the lakeside to pass a word 
 with friends. The ladies of that camping party 
 were given to pleasant reading, and one of them to 
 much sprightly writing also. I spent that long sum- 
 mer afternoon listening as she read out the letters 
 to herself of a young medical colt a woman 
 who was assisting a famous missionary in his distant 
 field. The letters were precisely what a specialist's 
 letters addressed to a layman should not be, 
 prolix, technical, gushing; but my friend thought 
 them delightful, and the writer an entertaining 
 and beautiful character. To the professional it was 
 all crude, sophomoric, and unspeakably tiresome. 
 After some few words about the place and her sur- 
 roundings, with a needlessly smart criticism of the 
 overworked surgeon, her immediate superior, the 
 writer went on to discuss "her cases," the numerous 
 operations at which she assisted, and her successful 
 method of giving chloroform. The partial friend to 
 whom this stuff was addressed was entirely pleased,
 
 220 A Doctor's Table Talk 
 
 but I doubt if the writer had anticipated the larger 
 audience. 
 
 Shop-talk and enthusiasm among the young pro- 
 fessionals themselves is another matter, and to be 
 encouraged; though, indeed, they care little for 
 our encouragement. By directing the flow of talk, 
 however, the older and more experienced man may 
 often be of some service. Eager beginners are 
 prone to concentrate their interest and their discus- 
 sion on trivial matters of routine and narrow tech- 
 nique, while they invariably see the case and not 
 the patient. Their talk will foam among the shal- 
 lows of bandaging, apparatus, salt infusions, pulses, 
 points in diagnosis, and details of the operation, 
 instead of seeking the deeper and more profitable 
 currents which are concerned with the significance 
 and nature of " surgical support," the comparative 
 value of methods of raising the blood pressure 
 their dangers and advantages when applied to the 
 case in hand ; the importance of a diagnosis of local 
 disease, when the general and psychical conditions 
 are considered ; and finally the value of any oper- 
 ation in the patient's present state. 
 
 Medical science is full of problems waiting to be 
 solved. Well-educated students know this; but
 
 Hospital Talk 221 
 
 mostly, when undirected, they leave the solutions 
 to others. In spite of scientific training few of us 
 carry on into the battle of life a true scientific 
 curiosity. We labor to live merely, and it suffices 
 us at last to earn our daily bread. Rare and precious 
 is the man who takes into middle life his enthusi- 
 asms and his zeal for investigating. If we could all 
 so take them the rate of progress in science would 
 soon be doubled; for we should have the accom- 
 plishments of men at once vigorous and ripe. 
 Thank God, there are among us a few such; and 
 they are those whom the world calls "great men." 
 Their enterprise not only carries themselves far 
 beyond the van, but opens other eyes still young 
 enough to see the possibilities of a career. Two or 
 three creative minds arise in every generation. 
 These men may live without obvious reward; in- 
 deed, their lives may pass away without recogni- 
 tion, but happily and always they are optimists; 
 they are men of vision, and they have learned that 
 truly their works do follow them.
 
 CHAPTER X 
 
 Reminiscences 
 
 WITH the return of summer Dr. Primrose is back 
 at his work; he has visited the city, and has fore- 
 gathered with his friends there. But he is not yet 
 the old Primrose. He walks slowly, he minds his 
 steps, he chooses to ride in elevators, and he goes 
 early to bed. Moreover, he is reminiscent, nodding 
 his head as he recounts some ancient tale. He is 
 given to general talk rather than to professional 
 discussion. 
 
 " Scriba," he said, as he sank into my easy-chair, 
 "I've just encountered a donkey at the club, and 
 I 'm too old to be bothered with donkeys. He is our 
 excellent classmate Brattle, and he has cultivated 
 the unspeakable habit of 'cutting' folks. I sup- 
 posed that that inanity went out of fashion with 
 dueling, cutting off your eldest son with a shilling, 
 and other barbarisms. You remember Brattle in 
 college. He was blatant and could be a dreadful 
 ass when in liquor. He used to talk about his ances-
 
 Reminiscences 223 
 
 tors; and divide all the world of his acquaintance 
 into 'gentlemen' and 'cads.' He boasted of being 
 a Southern 'gentleman'; and enlivened our dinner- 
 table by informing us dumb-stricken Yankees that 
 ' You Northern cowards would never have licked 
 the South if you had n't filled up your ranks with 
 imported Irishmen, who did all your fighting for 
 you.' He had no sense of humor, but he had little 
 fat legs, was boisterous and impressive, and sang a 
 good song in a charming tenor. We thought that 
 with time he would grow out of his follies, but I fear 
 we were mistaken. He's done nothing worth re- 
 cording since leaving college. I had n't seen him 
 for ten years, when this morning I met him, held 
 out my hand, and was annoyed and disgusted by 
 being cut dead. One feels like asking why we 
 admit such canaille to our clubs, anyway. Fortu- 
 nately I remembered that delicious anecdote of 
 Lincoln and the traveling Englishman. It's one of 
 the best of Lincoln stories. 
 
 "This Englishman, you must know, possessed 
 happily an old name, a faultless tailor, and excel- 
 lent introductions. He came over here during our 
 Civil War, traveled up and down, and was much 
 entertained by our good-natured fellow country-
 
 224 A Doctor's Table Talk 
 
 men. Finally he turned up in Washington, and was 
 taken to see President Lincoln. 
 
 "Mr. Lincoln, tired but good-hearted, spoke a 
 few words to the fellow: 'So you have been travel- 
 ing through our country, Mr. Howard; and I sup- 
 pose you've seen many unusual sights and cus- 
 toms.' 
 
 "'Yes, Mr. President; and, do you know, they 
 tell me it's the habit of gentlemen in this country 
 to polish their own boots.' 
 
 " ' Indeed,' said Lincoln, looking at him sadly, 
 'that is a frequent habit. And pray, sir, whose 
 boots do you polish?' 
 
 "Almost good enough to be true, is it not? I 
 wanted to tell it to Brattle, as he turned away to 
 talk with Croesus; but that would have been too 
 awkward, I suppose. 
 
 "Let me get away from Brattle. As I drove 
 down the street I recalled Ely's story of Wendell 
 Holmes and the ladies' luncheon. Please let me 
 tell it: The old gentleman was asked to meet a 
 number of people at luncheon. As he entered the 
 drawing-room, his hostess, in some distress, met 
 him at the door, and said: 'Dr. Holmes, we're so 
 sorry to disappoint you, but the three men we ex-
 
 Reminiscences 225 
 
 pected cannot come. Here we are, four women. 
 You will have to take us all out to luncheon.' 
 * Madam,' said the ready Autocrat, 'it shall be my 
 pleasure. Forewarned is four-armed!" 
 
 I looked at my visitor in some doubt. "Jona- 
 than Primrose," I said, "this does not sound like 
 you. Lie down there, please, until dinner-time. 
 We will have a short and quiet evening." 
 
 Ely joined us, of course. It was many weeks 
 since we three had come together. The talk drifted 
 until we fell upon the time-honored subject, 
 what leads a man to choose his profession. 
 
 "Indeed," said Ely, "it is hard to see what else 
 than family tradition could induce a young fellow 
 to study medicine. Such ones as Warren and 
 Shattuck, Mitchell and Gross must turn to medi- 
 cine, for their fathers have been doctors for gener- 
 ations. My own people have been doctors for five 
 generations; and I'm sure it was an advantage 
 to me to grow up in a medical atmosphere; to know 
 the difficulties of a doctor's life, and to understand 
 dimly the nature of scientific thought. But what 
 turned you towards medicine, Primrose? Your 
 people were not doctors." 
 
 " No, they were always lawyers. The first thought
 
 226 A Doctor's Table Talk 
 
 of being a doctor came to me in childhood. I had 
 an unusual experience. When I was eight years 
 old, my father sent me with one of my brothers to 
 spend three summer months on a farm in the 
 Genesee Valley, near Rochester, where we had 
 many friends. That summer is marked with a 
 white stone for me. The farm is a beautiful place 
 in the township of Chili ' Chy-ly,' they call it. 
 Black Creek the * crick* meanders through 
 its charming fields ; bits of primeval forest wood- 
 lots are scattered along the bottom lands ; and 
 withal, the whole region has about it an air of 
 ancient solidity and longtime cultivation and pro- 
 sperity, as rare as it is captivating in this new land 
 of ours. The vast grain-fields of the Western 
 prairies had not then destroyed through competi- 
 tion our modest Eastern farming; and the Genesee 
 country was famous as a garden of the Lord and a 
 bountiful granary. The five- and ten-acre lots 
 yielded abundant harvests of wheat, corn, oats, 
 hay, and buckwheat, while the groaning orchards 
 of apples, peaches, pears, and plums supplied the 
 markets of the state. 
 
 "The old wooden farmhouse in which we lived 
 with our kind hostess, a farmer's widow, Mrs.
 
 Reminiscences 227 
 
 Blake, and her grown daughter, Nora, stood at a 
 crossroads and was surrounded by its barns and 
 outhouses, its corn-cribs, home orchard, stacks, and 
 gardens; while across the wide 'square' of country 
 road, here almost a 'common,' were the brick house 
 and belongings of our one neighbor, Mr. Joe Gruen- 
 dike. 
 
 "We urchins were turned loose upon the farms. 
 Provided we reported for our meals, there were no 
 restrictions. Often we spent our days afield with 
 the men, busy with haying, reaping, stacking, 
 ploughing, and harrowing. Again we wandered 
 all day by the stream. We learned the simple arts 
 of farmer-fishing. We learned to dive and swim; 
 and other games, less bland and innocent, I fear we 
 learned. A small boy, Dennis Fox, skilled in field- 
 sports, came forth from the neighboring village. 
 Instructed in some measure by a prudent mother, 
 he made as though to welcome us, but we knew 
 that his heart was estranged. His years were ten. 
 To him, city boys, as he regarded us, for his 
 vision knew nothing beyond Rochester, to him, 
 city boys were things to be despised. Did they not 
 wear shoes and stockings, and foppish Rollo hats, 
 and collars, and other fooleries? Above all, were
 
 228 A Doctor's Table Talk 
 
 they not given under compulsion to that abomin- 
 ation of brushing the teeth. And then, they knew 
 not how to fight. 
 
 " In the eyes of Dennis Fox we were fair game, 
 but he reserved us for himself, and kindly under- 
 took our education. First, he induced us, when 
 abroad, to forego shoes and stockings; and to our 
 untold agony, he forthwith led us through a stubble- 
 field of wheat, then freshly cut. Our hats were 
 greatly improved by removing their ribbons and. 
 immersing the hats themselves for a half-hour in 
 the stream. We were taught to dispense at once 
 with collars. Our most objectionable custom, by 
 far, however, was an absurd use of the English lan- 
 guage. It was finicking, unpicturesque, and, for 
 the want of expletives, entirely lacking in force. 
 We must learn at once to swear; and remember 
 those were the days of gross and reckless swearing. 
 I recollect retiring to a remote corner of the rail 
 fence in a distant field and practicing timidly some 
 of the strange new words which this young rascal 
 taught us. 
 
 "Happily for our peace of mind, Dennis's next 
 move proved less successful. He had not yet licked 
 us, and as we were unskilled in rough-and-tumble
 
 Reminiscences 229 
 
 lighting, he stated that we might pick up a little 
 learning while he practiced himself upon us. Un- 
 happy boy! He forgot that, though unskilled, we 
 were not without ambition. His first assault was 
 delivered by means of the needless and ugly kick 
 upon my childish person. Now the kick classical, 
 as all the world knows, is addressed from the rear 
 and upon that portion of the body which is best pro- 
 tected from violence. Moreover, though the first 
 attack may be unexpected, and the assailed person 
 be, by so much, taken at a disadvantage, it is im- 
 probable that he will again be caught unawares. I 
 dissembled my indignation and planned a reprisal 
 then new to me. A minute later Dennis pre- 
 pared to resume the assault. I saw him fall back 
 into position. In an instant he drew off, and drove 
 at me viciously, but I was too quick for him. As his 
 bare foot reached me I stepped aside, and leaning 
 backwards, I seized his upraised ankle in my hand. 
 Instantly I realized my advantage. I had him 
 'cast'; he was hors-de-combat. I sprang forward, 
 still grasping his leg. Behind me he rolled on the 
 ground, helpless, blinding the summer air with 
 shrieking oaths. Then he yelled empty promises 
 of reform. Treacherous viper, we knew their
 
 230 A Doctor's Table Talk 
 
 worth, and we were through with Dennis. My 
 brother and I threw ourselves upon him, held his 
 hands, and extracted from him a promise that he 
 would depart from us instantly. Then we let him 
 up; he glared furiously and oppressed us with his 
 words; but as we had armed ourselves with sticks, 
 and stood our ground, he left us suddenly, and 
 ran off along the road in a cloud of insinuations. 
 He returned no more. 
 
 "We spent two glorious summers at the farm; 
 the happiest of childhood, as I think; but who shall 
 say, when all was glad? I ponder now on health 
 such as we had, and wonder where it's gone. Why 
 do we squander that rich blessing, our capital in 
 life, if we but knew? And looking back through 
 forty years I see two eager boys scampering down 
 the lane, scouring the wood, following the teams, 
 hunting the barn for eggs, fishing the creek, digging 
 the garden, eating like young Indians, sleeping 
 deeply the night of twelve hours through, and al- 
 ways under the gentle care and humorous, kindly 
 eyes of Nora, the daughter, and of Mother Blake. 
 
 "Into the midst of this Arcadia tragedy came. 
 It was mid-August; the wheat and oats were reaped 
 and stacked and stored. The barns were bursting
 
 Reminiscences 23 1 
 
 with grain. The time to ' thrash' had come. We 
 knew something of this glorious climax to the sum- 
 mer harvest. The great lumbering threshing- 
 machine, horse-drawn, would make its rounds 
 among. the neighboring farms. I may not guess its 
 ownership or the plan of its assignment; but all the 
 farmers seemed to share it, though it was stored 
 and operated by two of our neighbors down on the 
 Scottsville road, 'old' Mr. Desmond, as we 
 called him, and his nephew, our special chum, 
 Frank Hale. That gay and kindly heart, Frank 
 Hale, I recollect him well, the friend of 
 children, dogs, and birds, and other harmless 
 things. He is my ideal of a fine upstanding yeoman ; 
 some twenty-five years old, six feet, perhaps, 
 broad-chested, blond and ruddy; bearded, as the 
 mode then was; expert in country life; a farmer, 
 carpenter, blacksmith, woodsman wise. During 
 those weeks in which threshing was done, he drove 
 and kept the horses, cleaned the gear, fed the ma- 
 chine's great maw, and at night returned home 
 with Mr. Desmond, whom he loved and cherished 
 as a father. The tie between the two was rarely 
 deep and strong. I know not their private history, 
 but they seemed much alone in the world; both
 
 232 A Doctor's Table Talk 
 
 bachelors, with no other kindred in my time. The 
 uncle, serious, silent, effective, respected; the 
 nephew, alert, joyous, active, popular they held 
 their place, an institution of the countryside. 
 
 "That threshing week with us I well recall. It 
 seemed a free and gala time. Work in the fields was 
 stopped. The women-folk were deep in plans of 
 feeding many men. Eating and drinking were to 
 the fore. The great barnyard was cleared; a stout 
 railed pen, or circuit fence, was built in which to 
 raise the stack. The mighty doors, front and rear, 
 were opened wide; all lumber was removed; the 
 heavy machine was rolled upon the floor, its horses 
 taken out, its jaws uncoupled, and the long flume 
 or chute, whatever be its name, for bearing straw, 
 led out across the railed-in pen beyond. 
 
 "On Monday morning early we began. There 
 was a grand commotion. Two horses tramping 
 out a circle in the fore yard furnished the power. 
 The mighty engine clattered and groaned and 
 trembled, devouring sheaves of wheat; its great 
 steel teeth seizing the grain, rending it from its 
 straw, pouring it into bins; while the discarded 
 straw, whirling in clouds of dust, was tossed aloft 
 along the chute, and piled upon the stack. Old
 
 Reminiscences 233 
 
 Desmond drove the team, around and around; 
 while Frank, our friend, stood on the feeding- 
 board above the pole, and all day long, deft and 
 unceasing, fed sheaves and sheaves of grain into 
 the jaws. Our many men about the place stood to 
 them both, but mostly they were busied on the 
 stack, receiving, sorting, piling up the straw. It's 
 hard to say why such days should be joyous and 
 clearly marked, perhaps the novelty; perhaps 
 because the men all work in gangs, near to the 
 house, and have no evening tramp for home. 
 
 " For five days long our threshing lasted. Slowly 
 the wheat is sifted from the straw; the bins are 
 filled and the great stack piled like a classic dome 
 above the barn. Now, Desmond and Frank Hale, 
 with their machine, have traveled on to other 
 farms. Our barn is swept; the doors are closed; 
 and all made snug against the coming fall. 
 
 "Late on a sultry afternoon, a week, perhaps, 
 after the work was done, I sat upon the horse-block 
 in front of Gruendike's house, awaiting the call to 
 supper from Nora Blake's great bell. The day's 
 work was over save for the milking and other 
 evening * chores.' In shirt-sleeves, noisy, crowding, 
 and cheerful, Gruendike's men had filed into his
 
 234 A Doctor's Table Talk 
 
 great kitchen to eat the evening meal. Kind young 
 Mrs. Gruendike presided at the stove, and served 
 with generous profusion. Outside I sat, and watched 
 the sun, still a good hour high. On the great barn 
 floor, opposite, a rooster flapped and strutted. A 
 clucking hen beneath a barrow gathered her chick- 
 ens close. The horses snorted and stamped and 
 shook their racks. Thin clouds, updrifting in the 
 western sky, foretold to-morrow's rain. The wal- 
 nut tree above me stirred to a passing breath. 
 
 " From far along the road a dog's quick bark 
 sharp as in fright struck on my ear. The distant 
 rattle of a team driven at speed grew loud and 
 louder. Turning, I saw a line of dust come up the 
 slope. Snorting and straining, two horses dragged 
 a heavy wagon, crested the hill, trotted across the 
 grass, and stopped before the house. Three men 
 sat on the driving-seat. On straw behind, a blanket 
 at his head, I saw a figure laid; blood smeared 
 the face. Beside him poor old Desmond held a 
 hand. 
 
 "As the wagon stopped, Desmond sprang up, 
 his kind face drawn and anxious. 'Joe!' he cried, 
 'Joe Gruendike!' There was no mistaking the call 
 of deep distress. In a moment, the farmer came
 
 Reminiscences 235 
 
 running from the kitchen door, his napkin in his 
 hand, his red beard flying, his eye alert. 
 
 "'Joe,' said Desmond, leaning out from the 
 wagon and speaking low and quick, ' my boy Frank 
 is awful hurt; his arm tore off in the machine; hitch 
 up, and drive like hell for Dr. Hicks: up there 
 next to the church. Send him to the house as 
 soon as he can git there; and have him fetch his 
 tools.' 
 
 "That scene is not to be forgotten: the steaming 
 horses ; the earnest men in front, their faces turned 
 towards us; the big green country wagon, splashed 
 and stained; the great bed of straw, in which 
 Frank lay groaning and unconscious; Desmond, 
 hatless, horrified, but cool, leaning out over the 
 wheel, his old hands gripping the rim, his old blue 
 shirt thrown open at the neck; Gruendike stand- 
 ing, tense, shocked and sympathetic, taking 
 his orders; and in the background, at the open door, 
 the farmer's faithful wife, puzzled and uncertain; 
 two children at her skirts, while behind her in the 
 dim passage, the men stood craning, fearful and 
 curious. 
 
 "By the farmer's side, unnoticed, shrank the 
 little ' city boy,' his eyes swimming with fright and
 
 236 A Doctor's Table Talk 
 
 sympathy; his hand gropingly outstretched to take 
 that of his wounded friend. It was a doctor that 
 they wanted, and at once. A doctor should make 
 all right, if only he were here. The year before, 
 when a young friend was struck and mangled on the 
 railway, this boy had heard that very cry for help. 
 Then up from the background of his baby life there 
 came that other cry, which the old minister at 
 home used to read out, as the people knelt in church; 
 'And we beseech Thee, O Lord, to comfort and 
 succour all those who are in trouble, sorrow, need, 
 sickness, or any other adversity.' Here, indeed, 
 were need and sickness. In some dim fashion the 
 child felt that the Lord and Dr. Hicks must both 
 come quickly. Ah, if only he were Dr. Hicks. 
 
 "As Gruendike strode towards the big barn, I 
 ran by his side, and held his hand : 'Mr. Gruendike, 
 may I go with you; perhaps I can help.' He looked 
 down at me and smiled, for big Joe Gruendike was 
 my friend. 'Yes,' he said; 'jump in and hang on.' 
 The men pulled the muddy old buggy out upon the 
 grass. Bess, the freshest horse in the stalls, was 
 put between the shafts; all buckles were drawn 
 tight; I sat huddled in the seat; whip in hand Joe 
 jumped in by my side, and within five minutes of
 
 Reminiscences 237 
 
 leaving his house we cantered down the hill, 
 while Nora Blake rang the great supper bell. 
 
 "The sun was at our backs, the long hot road 
 stretched straight before us. The regular thud, 
 thud of the old mare's hoofs seemed to fill up the 
 day, while Gruendike with his flicking whip saw 
 that she kept her pace. Above the thistles and 
 goldenrod by the roadside, the heated air shim- 
 mered and burned; now and again the cry of a 
 nesting bird was heard; the fields were desolate; 
 far behind us the dust still rose, and settled where 
 we passed. In the half-mile before us a few cows 
 loitered, blocking the road. We came up and I saw 
 that Dennis drove them. Switch in hand, he 
 laughed and jeered, that for a moment we were 
 halted. 
 
 "The drive was five miles long. At sunset we 
 reached the cross-roads and the church, and found 
 the doctor's house, next door. Dr. Hicks, with coat 
 off, was in his garden, gathering fruit. We called 
 across the high, green picket fence, and he came 
 out a tall, dark, rugged man, with faithful eye 
 and serious face; a man who knew his work; a man 
 to trust. We told our tale. 
 
 "Then we drove slowly back again, making for
 
 238 A Doctor's Table Talk 
 
 Desmond's place. The doctor passed us on the road, 
 his famous Morgan speeding. We must have been 
 a half-hour after him in reaching the house. Dr. 
 Hicks was there, but all was over. Poor Frank had 
 died in the wagon going home. It was still dusk; 
 the windows not alight. The place was sad enough, 
 the house one of those dreary two-story carpenter- 
 modeled structures most common in city suburbs. 
 The paths leading to the doors were almost smoth- 
 ered in tall Timothy grass awaiting the scythe. 
 The forlorn little front door, up five steps, looked as 
 though never opened, and bore upon its middle 
 panel the twisting handle of an unused bell. From 
 the back door issued an old woman, 'the help,* 
 bearing a great basket in both hands, the tears 
 unheeded streaming on her cheeks. 
 
 "Dr. Hicks came out leading poor Desmond, 
 speechless. Other neighbors gathered with us and 
 heard the tale. The accident had happened towards 
 the hot day's close. Frank Hale was tired; he had 
 been 'feeding* the machine for many hours. He 
 grew careless and rushed his work. On a sudden he 
 shouted, 'Stop.' They saw him leaning forward, 
 and they knew his arm was in the teeth. An instant 
 halt they could not make. The horses stopped, but
 
 Reminiscences 239 
 
 for an awful spell, the works went on. The men ran 
 up; they saw him rise; his life was pouring from the 
 mangled stump; he looked, smiled, threw up his 
 other hand, and fell unconscious backward, head- 
 foremost, smashing on the wagon-pole. They took 
 him up, bound straw with sheets tightly across his 
 arms and chest, and tried to rush him home. He 
 died upon the road. Perhaps, had they not moved 
 him from the barn he might .have lived. I believe 
 not, not with his broken head. 
 
 "Even to-day, with a veteran's experience, I 
 think of that old accident as very bad. Imagine 
 the dreadful mental agony, as he saw his arm drawn 
 in. He could not stop it. Then the teeth reached 
 his shoulder and he knew his chance was gone. The 
 bone was wrenched from the socket, and dragged 
 away. That was the end of thought. He fell. For 
 him, as we all know, the time had come; but brave 
 old Uncle Desmond must go on. 
 
 "After two days had passed they buried him, 
 with all the world of Chili at the grave. Good Mrs. 
 Blake and Nora, with us two boys, drove her old 
 buggy to the house and hitched beneath a tree. 
 The day was steaming hot; the sun beat fiercely 
 down. The doors were all thrown open. As we
 
 240 A Doctor's Table Talk 
 
 walked up the path to the front steps we passed a 
 group of men headed by Uncle Desmond. Joe was 
 there, and all my well-known friends; standing in 
 awkward clothes, and unfamilar, a solemn row; 
 their heads were bare; their faces sad and set. They 
 were both choir and bearers of the dead. Within 
 the house, in the forlorn front room, garnished with 
 hair-cloth and a mighty volume of the scriptures, a 
 plain oak coffin stood. The room was given over 
 to the women; to me they all seemed old or middle- 
 aged, all in black silk and shawls, and heavy 
 lonesome bonnets. They wiped their eyes and sat, 
 or stood, and whispered, murmuring sounds about 
 poor Frank. My own dear Mrs. Blake became as 
 one of them, and looked severe, and muttered now 
 and then a word in some adjacent ear. Nora alone 
 was fresh and calm and sweet a breath of youth 
 in that sad company. I sat against the wall, low on 
 a stool, hidden by Mrs. Blake. 
 
 "Awkward young Mr. Stiles came in, the 
 student-minister; arrayed in heavy black, and white 
 disjointed tie. He held a service, of just what 
 form one cannot say; it seemed unending. He told 
 about our Frank his fine and useful life. I could 
 have told it better. I almost cried to hear the
 
 Reminiscences 241 
 
 feeble words. He wandered on and on, and then he 
 prayed. Dear Lord, how he did pray! He spoke 
 with God about us all, and all our doings. I thought 
 within myself that God must ever weep if such 
 despairing words ascended to the throne this day, 
 and every day throughout the world. But then 
 they say God is all-wise; and dwelling there in 
 bliss with saints and other joyous ones, where sor- 
 row is unknown. I could not grasp it all. I'd never 
 seen a funeral before. The women took some com- 
 fort, shaking their heads and wiping furtive tears. 
 Anon, he read the Bible, not happily, but long 
 sonorous verses, naming strange names, dealing 
 with death and pain and sin, beyond my puny 
 knowledge, for I slept. 
 
 "A strain of music sounded as I woke. The sad- 
 voiced man was gone. Outside, the tender words 
 of a familiar hymn rose on the summer air. My 
 Mr. Desmond and his farmer choir in touching 
 fervor quavered through the lines : 
 
 "'Nothing in my hand I bring, 
 Simply to Thy cross I cling.' 
 
 " I wept; I broke out in an agony of childish sobs. 
 Kind Dr. Hicks, who stood near at the door,
 
 242 A Doctor's Table Talk 
 
 stooped down and led me out. The men and wo- 
 men about, in their stern faith, now dry-eyed, 
 looked on unmoved; all but our Nora. I clung to 
 the good human hand, and again the words of our 
 clergyman at home returned, ' in trouble, sor- 
 row, need, sickness.' Ah, if only Dr. Hicks had 
 been there in time. Then came the thought, 
 when I'm a man, that shall be my work. 
 
 "In the shade of the house, beyond the line of 
 men, we stood and waited. The others joined us. 
 For us little boys there was excitement and curiosity 
 as well as sadness. But my brother reproved me 
 for my outburst; he was concerned for family 
 dignity. 
 
 "When you went to a country funeral, in those 
 days, you saw it through. There was no unseemly 
 scattering of the people, such as occurs after a city 
 service. We were all mourners. So now we mounted 
 into our buggies and wagons, and waited. Our men, 
 going inside the house, returned with shambling 
 steps, bearing the coffin. They were new to the 
 work; their hands and feet disturbed them; as for 
 their hats they knew not what to do, and so they 
 hung them on the picket fence. Laughter is near 
 to tears. Now and again a woman, or the little
 
 Reminiscences 243 
 
 boys, coming to the gate, broke out in hysteric 
 giggles at so grotesque a sight, beaver hats, slouch 
 hats, straw hats, each with its handkerchief, in 
 solemn disarray. 
 
 " Led by the simple hearse, whose driver kept the 
 village tavern, we passed in slow and sad proces- 
 sion to the now distant graveyard, close by the 
 church. It seemed an eternity, but so best could we 
 show respect to Mr. Desmond and the dead. 
 
 "Who does not know the shabby dreariness of 
 such a graveyard scene? the walled-in square of 
 land; the treeless waste; the tumbled stones; the 
 garish, broken shafts; the unkempt gravel; the 
 weeds; the tangled grass; the rusty chains. In a 
 remote corner we gathered at the open grave. The 
 farmers brought the coffin, lowered it down, and 
 shoveled in the soil. Haltingly, 'Earth to earth, 
 and dust to dust' was said by Mr. Stiles; and then 
 again the men and women lifted a scattered voice 
 in last salute: 
 
 "'When I rise to worlds unknown, 
 See Thee on thy judgment throne,' 
 
 faithfully, earnestly, every word from the heart. 
 "I tell you, my friends," Primrose concluded, as
 
 244 ^ Doctor's Table Talk 
 
 he turned towards us with his smile, "those are the 
 people who made us what we are; those are the 
 ones with whom I choose to live. The world is 
 better for their being here."
 
 CHAPTER XI 
 
 A Letter from Scriba to his Son Thomas at 
 St. Paul's School 
 
 SOUAM LAKE, N. H., 
 
 25th Sept., 1911. 
 MY DEAR TOM: 
 
 At the Twenty-fifth Reunion of his college class, 
 my old friend Jack Starling made a famous talk on 
 Asses. Jack has the misfortune to be of the class 
 one year ahead of your father's, so that I missed 
 that talk, but fragments of it reached me. In his 
 speech, Jack's method was to select from the class- 
 list sundry men well known in college days; by a 
 few vigorous strokes to recall their leading qualities; 
 then, with charming humor, to assert that, after 
 all, they belonged to the genus Ass, assigning each 
 to his particular variety; for you must know that 
 Asses, like Thackeray's Snobs, fall into certain 
 groups. There is the Solemn Ass, the Blatant Ass, 
 the Fresh Ass, the Ass who would be a Man of the 
 World, the Ass for whom Women sigh, the Sly Ass, 
 the Pompous Ass, and a dozen others. It was a
 
 246 A Doctor's Table Talk 
 
 delicious study; and then Starling left to his hearers 
 the joy of it all, the comparing these youths at 
 twenty with the same men at forty-five. The 
 words were so kindly and mirthful that no feelings 
 were hurt. Insignificant men were proud to be 
 rescued from oblivion; and distinguished men 
 could afford to laugh. 
 
 Much in the same way, I have often thought, 
 could groups of men other than Asses be studied, 
 men of my own profession, for example, might tell 
 by their lives an important lesson; if their lives 
 were presented in a "before" and "after" fashion; 
 and so, by a series of object lessons, one might an- 
 swer the anxious question in your letter, Shall 
 I follow my father and study medicine? 
 
 Apropos, I recollect our old friend Dr. Farring- 
 ton saying to me long ago, that after all, medicine 
 is a very good business. The average doctor is 
 earning a fair income and supporting himself years 
 before his contemporaries in law and business are 
 doing as well. No right-minded man, however, 
 turns to medicine as a business, that you know; 
 and Dr. Farrington's own fine career is far 
 removed from vulgar thoughts of money-getting. 
 
 Then, again, one may look at the vocation ques-
 
 Scriba to his Son Thomas 247 
 
 tion from the negative point of view, What call- 
 ing shall I avoid? The other day a lady told me 
 of an interesting experience. She had been lunching 
 with a company of eleven other women, the hus- 
 bands of no two of whom followed the same pro- 
 fession. In an attitude of protest towards the work 
 of those twelve husbands, the women made their 
 several complaints. The one would advise her 
 daughter not to marry a clergyman, his life is 
 too much absorbed in parish work, and he is con- 
 stantly run after by other women; the next would 
 never marry a lawyer, he brings his work home 
 with him, and sits up until two o'clock; another 
 would advise against a coal operator, he is al- 
 ways worried to death about the strikes and prices, 
 and if he happens to have a clear week, he runs off 
 to visit the mines in West Virginia. The doctor's 
 wife protests that her life is insupportable; her 
 husband's hours are monstrous; she's never sure of 
 him; he never takes her to the opera, and he has not 
 been to a church for two years, except for a funeral. 
 He's killing himself for other people, who are en- 
 tirely selfish and ungrateful. And so the talk went 
 round the table, not a woman there but would 
 have her husband change his work.
 
 248 A Doctor's Table Talk 
 
 I don't believe in the moral of that story, my boy. 
 Those women were not telling the truth. Each was 
 trying to out-talk the last. At heart, each probably 
 believed in her husband and his doings. They did 
 show, though, how no profession, no calling, can be 
 altogether comfortable for all concerned. And fur- 
 ther, no profession can be anything but ashes, 
 gall, and bitterness if your heart be not in it. 
 
 For myself, I love my profession, as you know, 
 but I rarely encourage young seekers to follow it. 
 It is too fine a calling lightly to be entered upon. 
 When some flabby-minded patient says to me: 
 "Surgery always did interest me; I came near being 
 a doctor myself," my only possible reflection must 
 be that medicine and surgery have had a fortunate 
 escape. Those things are trifles; but the anxious 
 father of a weathercock son is not to be lightly 
 regarded when he comes to me with the question, 
 "Shall I put my boy into medicine? He seems to 
 have a fancy for it." My inclination is to groan, 
 to beat my head, and to shout No ! No ! Then I 
 remember a little chapter of my own youth : I had 
 always promised my dear father, your grandfather, 
 that I would 'go into medicine.' He himself and 
 my elder brother were lawyers. One day in my sen-
 
 Scriba to his Son Thomas 249 
 
 ior year I walked with my foolish friend Brattle 
 through the college grounds. He pointed to the 
 law school, and said, "I go there next year. How 
 about you?" 
 
 "I'm in for medicine," I said. 
 
 "Pshaw," he retorted. "Come with us to the 
 law school," and he named half a dozen of our 
 friends, who would go with him. "Law is the pro- 
 fession for you. No gentleman studies medicine." 
 And, do you know, so feeble was my resolution, 
 and so impudent his urging, that almost he per- 
 suaded me. I know now that he, too, was an Ass, a 
 sorry, Pompous Ass. Later, my wise father's look 
 of scorn, a look without words, upset the silly 
 Brattle argument, and swung me back into my 
 place. 
 
 All the same, medicine, like most scientific call- 
 ings, is an exacting mistress. Men follow other 
 pursuits, with more or less satisfaction, as means 
 to an end, to provide a living and to support 
 their families. You may not so treat medicine. 
 You must follow it as the end itself, else will your 
 life be wretched. That is the fundamental fact 
 about medicine, which escapes the superficial critic. 
 Like the doctor's wife at the lunch party, he finds
 
 250 A Doctor's Table Talk 
 
 fault because of surface discomforts. It's as though 
 the astronomer's wife were to scold because the 
 astronomer must be up o' nights if he would learn 
 the stars. These things must needs be. 
 
 You are to know that there are two broad motives 
 for a man's following medicine: either he loves his 
 kind, and wishes to serve them; or he loves science, 
 and would fain pursue it. There are no other mo- 
 tives which can lead one to distinction among us. 
 You see that in a fashion a doctor must be some- 
 thing of a missionary, something of an idealist, and 
 very much of an enthusiast. He must have breadth 
 of vision, sanity; a mind capable of work without 
 flagging; readiness to accept the new, courage to 
 reject the old; optimism, and a scorn of that 
 crabbed skepticism which glories in intrenched 
 dogma. Dogma has no place in the vocabulary of 
 science; nor has heresy. Remember that Voltaire 
 defined a heretic as a man who does not believe as 
 I do. Above all, a doctor must have sound health 
 during his early years, at least. 
 
 You may say that I am hard on you; that I have 
 set an ideal standard which no physician attains. 
 Of course I have. None but the gods attain their 
 ideals ; but you must have ideals, none the less. And
 
 Scriba to his Son Thomas 251 
 
 I am talking of the qualities we see in leaders. No 
 proper man embarks on an enterprise among men 
 except with the determination to succeed and to 
 lead. If you go into medicine you must expect to 
 encounter the best minds of our time. Gradually 
 it has come home to me that the leaders in medicine 
 are remarkable men. Among such you should 
 strive some day to mingle as an equal. I believe 
 you to have a good mind, a white soul and capacity 
 for work. Those are useful assets. You are eigh- 
 teen years old, with one more year at school. 
 Whether you become a practitioner or a research 
 man, student and teacher, you have ten or 
 twelve years of study ahead, before you can sup- 
 port yourself or marry a wife. This is a fact not to 
 be forgotten. 
 
 You are a boy still. Take three more years be- 
 fore determining. Look about you. See something 
 of older men. Three years from now you will under- 
 stand me better. In this letter I do not try to per- 
 suade. I have put down facts for your contempla- 
 tion. Keep the letter and read it again in the middle 
 of your college course. 
 
 My dear Tom, you must know that I shall be 
 very happy, should you decide some day to join
 
 252 A Doctors Table Talk 
 
 me. You will, indeed, be a staff for my old age. So 
 much I think it fair to say. 
 
 The comparing of experiences, and the balancing 
 of promise against accomplishment, is one of the 
 pleasures of maturity, and sometimes one of its 
 pains. Out of the twenty-four men from my college 
 class, who "went into" medicine, eighteen still 
 write themselves "Doctor." That does not mean 
 that a quarter of our number have forsaken medi- 
 cine for other callings. Those six men, no longer in 
 our ranks, are either dead or they never matricu- 
 lated at a medical school. Here is an interesting 
 fact about physicians, a fact unique, they rarely 
 change their job. You don't hear it said of a man 
 active in the world that he used to be a doctor. 
 Physicians sometimes retire, but not for change of 
 business. This is true of no other class of men. 
 Medicine gets a grip which is seldom loosened. It 
 has a fascination all its own. There is a peculiar 
 freemasonry, as there is a peculiar code of ethics, 
 among doctors. 
 
 You must remember that in my time the classes 
 graduated from our great universities were small 
 as compared with the classes of to-day. Of my own 
 class there were but one hundred and seventy-two,
 
 Scriba to his Son Thomas 253 
 
 all told. All our eighteen doctors have done well. 
 In trying to classify them I have marked them as 
 distinguished, i; superior, 9; modest, 8. By "dis- 
 tinguished" I mean a man of international reputa- 
 tion, who has made solid contributions to medicine. 
 By "superior," a man widely known at home, who 
 holds responsible positions as a teacher and clini- 
 cian. A "modest" physician is one who devotes 
 himself to taking care of the sick and attending to 
 his own proper business. Though I have thus arbi- 
 trarily grouped these men, I am by no means sure 
 that each is properly placed. For instance, I sup- 
 pose your kind godfather, Dr. Primrose, must be 
 put in the "modest" group, though his services 
 have been very great. Again, Dr. Ely might well 
 be called "distinguished." He is known widely in 
 this country and in Europe as a brilliant practitioner 
 and an able writer, but he cannot be called an 
 original investigator. He is "superior." On the 
 whole, I think I am justified in calling my old 
 friend Blair, of Liverpool, the one truly "distin- 
 guished" doctor of us all. His career is interesting, 
 and it teaches, among other lessons, that the boy 
 is not always father of the man. Blair was "easy" 
 in college. For the first two years he did nothing,
 
 254 A Doctor's Table Talk 
 
 except play amiably. Then he disappeared for a 
 year, either removed by his father or rusticated. 
 That year of absence seems to have matured him, 
 for he returned to us a student. He was gi aduated 
 in good standing, and went with me to the medical 
 school. Even there he was not oppressive, merely 
 a good average man. We had adjoining desks in 
 the chemical laboratory, and I remember him as 
 painstaking, slow, and thorough. Then we drifted 
 apart. He became a house-physician, I a house- 
 surgeon. He immersed himself in internal medi- 
 cine, especially in diseases of the chest. He has the 
 rare faculty of perceiving in what a subject is weak; 
 and has the capacity and insight to hurl himself 
 at the problem and produce a remedy. He studied 
 in Europe when modern work on the blood was 
 new. He came home, was called by Superbus to 
 Liverpool, when the great new university hospital 
 was founded, and there he is to-day. He has been 
 through all the teaching and clinical grades, from 
 Resident up; and now, since the resignation of 
 Superbus, Blair is a full professor and head of his 
 department. He is some twenty-two years in 
 practice; he is known the world over for his contri- 
 butions to our knowledge of certain fevers, and of
 
 Scriba to his Son Thomas 255 
 
 diseases of the blood and of the heart. He is a tire- 
 less worker; a careful and informing teacher, a pro- 
 found and convincing writer, and a brilliant speaker. 
 To these pleasant qualities he adds a capacity for 
 practice. Through a large section of our country 
 he is in demand; he flourishes as a prosperous con- 
 sultant; and with it all he is the same good friend 
 and agreeable companion that we knew twenty- 
 five years ago. I believe him to be a happy man. 
 Well, now; does all that sound attractive to you? 
 I dare say it does not, and yet I have given you in 
 outline the story of the most successful doctor 
 of my own group. You are old enough to regard 
 somewhat the philosophy of life, and you recall the 
 old saying that what is one man's meat is another 
 man's poison. How can you, a school-boy, appre- 
 ciate the accomplishments of a mature man, and 
 sympathize in his life-work? The other day I asked 
 the son of a distinguished novelist if he remembered 
 a certain recent writing of his father. "Oh, no," 
 said the boy, "that's in one of father's books. He's 
 writing 'em all the time, but I never read 'em." 
 In my simplicity I had supposed that he knew and 
 rejoiced in every word of his father's writings. So, 
 no doubt, you are untouched by the dry details of
 
 256 A Doctor's Table Talk 
 
 Blair's life. The personal human experiences, the 
 adventures, the hardships of a doctor's life are 
 what would appeal to you, and Dr. Blair has 
 had them in plenty. There are a few delightful 
 books telling about such things. When you are a 
 little older, read the "Lives" of Pare and Pasteur 
 in France; of Harvey, Hunter, Huxley, and Lister 
 in England; of Rush, Warren, Howe, and Bigelow 
 in America. All these were high-hearted, able men, 
 men of action, men whose works still live. Such 
 are a few, but there are hundreds of others you 
 should know. As for the fiction writers, they 
 do not understand us. They draw us as inane sen- 
 timentalists, as simpering toadies, or as vulgar 
 brutes. Oliver Wendell Holmes knew us, of course; 
 but almost alone among the novelists George 
 Eliot in "Middlemarch," and Robert Grant in 
 "Unleavened Bread," catch the true scientific 
 spirit and the point of view of the cultivated and 
 sincere physician. 
 
 Medicine should appeal to the imagination of 
 adventurous youth. Of all the highly developed 
 pursuits in civil life, it is perhaps the most perilous 
 and the most varied. The contagion of the casual 
 patient, the epidemic of the slums, the scourge of
 
 Scriba to his Son Thomas 257 
 
 the tropics, the problems of country practice, the 
 fascination of laboratory study, the trials of the 
 exploring party, and the hazards of the battle-field 
 are incidents of medicine. The doctor is always 
 present. From the cradle to the grave, on land and 
 on sea, he is in demand. For him who has eyes to 
 see, and an understanding heart, the physician's 
 calling is one of endless diversion, of constant 
 interest, of broadening content. 
 Think of these things, betimes; and remember 
 
 that I am, 
 
 With entire sympathy, 
 
 Your affectionate 
 
 FATHER. 
 
 THE END
 
 <f be iMicrjSiDe 
 
 CAMBRIDGE . MASSACHUSETTS 
 U . S . A
 
 Date Due 
 
 PRINTED IN U.S.A. 
 
 CAT. NO. 24 161
 
 000509982 
 
 \ 
 
 W 9 
 M962d 
 
 1912 
 
 Mumford, James Grepory 
 A doctor's table talk 
 
 W 9 
 M962d 
 1912 
 
 Mumford, James Gregory 
 A doctor's table talk 
 
 MEDICAL SCIENCES LIBRARY 
 
 UNIVERSITY OF CALIFORNIA, IRVINE 
 
 IRVINE, CALIFORNIA 92664