Daydreams of a Doctor

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Preface

AS a title for this work I have chosen " Daydreams j^'y^ of a Doctor." While it may not seem, on first thought, to be the most appropriate, yet the subjects treated of are those which have occupied my mind during idle hours when there was little to do but to think over the many important questions connected with my peculiar profession. Much of the material presented I trust will be found of interest to the well-informed layman. Many lessons of value in the management of the sick, and especially of the contagious and infectious diseases have been presented in such a manner as was thought would be most instructive to the lay reader.

It has seemed to the writer that the medical profession as a useful and even an indispensable factor to mankind has never been fully appreciated. It has, therefore, been one of the objects in presenting this work to the public to show in a comprehensive way the responsibilities of the physician, not only as a specialist but as a general practitioner. The half has not been told of the peculiar life and work of the physician, his responsibilities, the invaluable services he renders to society, and the dangers to which he is often exposed. These are all features of his everyday life, which the writer has tried to illustrate.

vii viii Preface

Doctor S. Weir Mitchell, in his " Doctor and Patient/' says, " I still think there remains to be written the simple, honest, dutiful story of an intelligent, thoughtful, everyday doctor, such as will pleasantly and fitly open to laymen some true conception of the life he leads — its cares, its trials, its influences on himself and others, and its varied rewards." This, in part, has been attempted in these pages. The story is not complete — it never will be, perhaps, — but enough has been presented to give a fair conception of the real life of the plain, hardworking, everyday doctor.

Woman has been recognized in these pages as the equal of man, not only in the practice of medicine, but in other walks of life as well. Incidents from actual practice are interspersed. The vein of romance running through the work, the writer ventures to hope, may not be uninteresting.

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Chapter I

MY day's work is done — so &r as it is possible for a physician to know, — and I find myself in my library with a Webster's Dictionary on one side, a medical dictionary on the other, a Johnson's Cyclopaedia near at hand, and books and papers and journals all about me. But I do not busy myself with these, for my mind has been carried, by some trivial incident, back to my early career as a physician, and I think of many things — of my college days, of my first experiences in a professional way, of the long years of hard work, and of the amount of good I have done in the world — or tried to do, — of the manner in which my services have been appreciated, and the various phases of my past life. I think of my many medical fiiends, and especially of those who have been burdened with a large practice, whose heads are prematurely gray, whose feces are becoming wrinkled before their time, whose eyes and features give indisputable evidences of the student life they are leading, of the great burden of responsibility they are carrying, and of the many dangers they are compelled to fcice in their peculiar calling. I think of storms, of dark nights, of high waters, and especially of a time when my own horses became frightened at a flash of lightning and jumped from a bridge into the overflowing stream, and of what a narrow escape I had that night I think of the contagious diseases to which these physician friends of mine must have been exposed, and of the various other dangers and hardships they are continually undergoing for the sake of humanity in general and of their £unilies in particular. I think of their hard contests with disease, and of what heroic fights they so frequendy make for the lives of their patients, and how they hold the grim monster at bay and protect the entire populace against the ravages of contagious and infectious diseases ; and I think of one in particular — one of my early friends — who made an unusually good record, and whom I will introduce to you as Doctor Samuel Jones, who, something less than twenty years ago, was a young manful! of life, hope, and energy, and who had recently become the possessor of a piece of parchment familiarly known as a '^sheepskin."

He had been looking forward with great expectations to the time when he should possess this coveted document, and now that he had secured it, the great question presented to his mind was — what was he to do with it? His daydreams of the past three or four years were now actually fulfilled ; the time had at last — though slow in coming — arrived when he was the proud possessor of the very important scroll which entided him to pursue the practice of medicine in any part of the United States. What part of it must he select as most likely to furnish

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o IE

1 I immediate returns, in a financial way, for the ability which he believed himself to possess, and for which he felt sure some particular locality was at that very moment anxiously and impatiendy waiting?

In his dreams of the future he had pictured a clientele of prosperous farmers, or business men, or both, who would, of course, appreciate him at once, and would amply remunerate him in solid cash for the many professional services he could already see himself — in his imagination — cheerfully but anxiously rendering them. Some, he imagined, would almost take the risk of a slight indisposition just to give him a chance to display his extraordinary abilities, which, of course, would be meekly and modesdy brought into service upon his magnanimous patients. He (this young medicus) even dreamed of pleasant drives in a magnificent turnout of his own, and a beautiful home, backed by sufficient funds to amply meet the demands of such a home and of such a life. He dreamed of wealth and reputation within a few years to come, and he even had the assurance to dream of retiring at the early age of fifty. His practice, of course, would be amongst a class of people who would always pay their bills, and almost go into ecstasies over their appreciation of his services, and back their words by the immediate deposit of cash, with an occasional bonus for what they considered extraordinary skill.

In his dreams his patients nearly always recovered ; and if one happened to die it was generally the result of unforeseen circumstances, or was beyond the power of human aid from the beginning, and, of course, would be so regarded by all interested parties. In hb dreamings dark nights and stormy da3rs were ignored ; the hard batdes at the bedside, and the great anxiety and mental worry, were lost sight oC and for him smooth sailing, with now and then a sprinkle of hard work and a litde solicitude, would be the price of the wealth and affluence which surely must be his.

We see him now after a few years of practice. He found what he believed to be a suitable location in a little village in a good farming community. He has ceased his daydreams, and is now struggling hard for an existence and doing his dreaming at night when all but he are sleeping soundly. He dreams, not of wealth and ease, but of hard work and aching head and limbs — and funerals. He has visited a number of very sick people during the day, and has had many very perplexing questions to decide; in fiict, he has made decisions upon which he believed the very lives of his patients depended ; and now in his dreams he can see the coffin of his patient, and the minister and the undertaker performing the last sad rites ; and he hears the friends, in a sorrowful but cruel way, giving vent in an uncompromising manner to their belief that if the doctor had treated the case differently the patient would not have died. He has dreams of a different character in r^ard to another patient to whom he has given heroic treatment for a desperate malady ; and now in his sleep he sees him in the throes of death as a result of a desperate blow aimed at the disease, but which, unfortunately, hit the patient. He dreams of his little patients looking silendy into his tace as though calling for that help which he knows he cannot give ; he sees them struggle, and at last cease to breathe, in their mothers' arms ; he sees death holding high carnival : and he feds that he will be blamed for that which no mortal could prevent.

In his dreams he sees himself trying to collect a few dollars with which to supply the immediate needs of his littie family, and, to his horror, learns that many are unable to pay. Some tell him his services were not worth paying for ; others intimate that, if he insists, a suit for malpractice will be the result. The few honest customers, knowing his circumstances, had paid their bills when the services were rendered; and he is compelled to go home penniless to see the wolf staring in at the kitchen door. He dreams of unpaid rents and of the immediate needs of his family. He witnesses many such scenes, sees hideous visions, has the nightmare, almost gets out of bed and walks in his sleep ; and finally awakes, more dead than alive, to resume the arduous and responsible duties of the day.

He experiences all this and more. He learns that his night dreams are more real than his daydream^ — that the physician's life is full of trials and privations. He now realizes that the pleasures of home — not that home he dreamed of in the daytime, but that little obscure home, poor as it is, the dearest place on earth to him — must be sacrificed, together with many other pleasures, to the unrelenting demands of his profession. He now realizes that his life work, his chosen profession, has enchained him as completely as any black man was bound in the days of slavery. It is an honored servitude and a voluntary one ; but, going as it does under the guise of a learned and noble profession, it is perhaps not germane to mention its victims as slaves, but physicians — guardians of the health of the people, archenemies of disease, or men of science, devotees at the shrine of i£sculapius — and of the microbe.

We next see our friend in his fiiU manhood after several years of arduous and responsible work, still in' the vigor of life, but nearer the top of the hill. He knows all about the struggles and hardships and disappointments of the early career of the general practitioner; he also has by this time some realization of the success, financially and otherwise — but mostly otherwise — of the average physician. He has, however, by dint of hard work and economy, driven the wolf from his door, and the human parasites — I mean those who deserve the name, but not the worthy poor — from his clientele ; and he can now afford three square meals a day, and a real covered buggy to ride in. He is still dreaming moderately in regard to the future in the daytime ; and his night dreams are not, so hideous, for he is now learning to sleep more like other mortals, and to disregard, when asleep, the impressions made upon his mind when awake.

But he still dreams — not altogether of himself, for he now has others to dream about, and it is their future welfere that he is considering ; for who can estimate the possibilities of that boy or of that girl who has been liberally endowed by nature, and for whose development and moral training he feels himself responsible? Who can

Coogle tell the result of a misstep or a miscalculation on his part? The slightest circtunstance sometimes changes the entire environment, or even the life itself, of an individual. Then how important are his obligations to the ones who by the ties of nature are so much to him and about whom he finds himself much more anxious than ever he was about his own wel&re. There is no use to disguise the feict that their infemtile days are over, and that the time has arrived, or is fast approaching, when they must be educated — sent off, perhaps, amongst strangers, or if not sent off, must be taken to another locality, where they can be given the advantages of a liberal education.

This he finds to be a very important epoch in his life. A mistake here means a great deal : it involves his financial success, and more ; it involves the future — not only in this world, but in the world to come, perhaps — of his children, and of himself as well. But his dreams upon this subject are too numerous and complicated and indecisive to put upon record. They are the results of his environment ; and perhaps it is better as it is than if* he had lived where all these advantages had been near his door, and, because of their very nearness, not appreciated by himself or taken advantage of by his children.

He has now arrived at that period when he has been able to evolve some ideas of his own in a professional way, and we find him dreaming about the scientific progress of his profession since his advent into it Has there been any real progress in all these years? Very few of the old remedies have been discarded, and not many of them have been put to new uses ; and he knows but little more of their physiological properties than he did He has learned on this point that his predecessors had accurately learned what to ex|>ect from certain drugs, and from certain lines of treatment, but they could not tell how or why. The how and why he has learned in some instances ; and in others Uke them he only knows he gets certain results, or believes he does, and is just as much in the dark as were his medical ancestors of a hundred years ago. He has become acquainted with many new remedies, but he is not sure that they are any better than the old ones ; and some of them — many of them, in fiict — have been tried and found wanting, and have been discarded as worse than useless. A few additions of real worth have been made to the pharmacopoeia, and are here to stay ; and this is the most he can say for therapeutic advancement so far, unless it be in regard to the physiological effects of alcohol and the specific treatment of contagious and infectious diseases. But he has had the pleasure . of watching and admiring almost from its infancy the unparalleled growth of the science of bacteriology, and he feels proud of this legitimate offspring of modem research, and he is sure that in the strength of its manhood mighty things are to be expected of it. He already sees the spread of contagious and infectious diseases stayed by the mighty hand of this young giant; and he looks with admiration into the possibilities of its future growth and development.

In his dreams he can see, only a short distance in the future, the unveiling of some scientific facts that will astonish the world. Histology is being studied as never before ; biological experiments are being made by master minds ; pathological processes are better understood ; and the eve of a great discovery is near at hand. In his musings he can see the results of the investigations of the great leaders of his profession in the early dawn. He believes that in the physiological properties of the white blood corpuscles and their nuclei, and in the blood serum, lies hidden — but no longer deeply hidden — the key to the treatment of the infectious and contagious diseases.

In his reveries he sees the immense domain of medicine spread out before him, and he is astonished at its magnitude. This great expanse which spreads around him in all directions, farther than human eye can see, is divided into numerous fields known as specialties. Some of them he observes already in a high state of cultivation, while others are hardly rid of their rubbish. As he looks, he is astonished at their grandeur, and he wonders how so much work as is even now done could have been accomplished by human hand and brain. He is greatly impressed with the importance of the medical profession to mankind. He is still more impressed with the great weight of responsibility he sees resting upon the shoulders of the workers in many of these fields. And he decides to take a stroll over this domain and through these fields, and he invites you to go with him and there see for yourself something of the greatness of this profession, of its usefulness to mankind, and of the trials and hardships and responsibilities of its individual members — these magnanimous people who, in their efforts to prolong the lives of others, give up their own lives years before the allotted time.

Chapter II

THE doctor, in looking over the great domain of medicine, is attracted by, and at once passes into, the field of surgery, a field which challenges the admiration of the civilized world, and might jusdy be mentioned as the eighth wonder of the world, beside which the seven wonders sink into insignificance. Our dreamer in his mental wandering has seen this field when it was the densest forest of giant trees and a mere mesh of tangled undergrowth — in the da)rs of Agenor, a Phoenician king, who dressed the wounded arm of a son of Priam; of Chiron the Thessalian, who is generally accredited as the father of surgery in the fabulous pages of Grecian history ; of iCsculapius and his two sons, who were also surgeons ; and the theological stage through which surgery, in common with other branches of knowledge, had to pass. He sees the Asclepiadae, descendants of i^^ulapius, who supplemented their ignorance by appeals to the gods, as did nearly all nations. He views the priests of India, the Magi of Egypt, the jugglers of China and Japan and the savage tribes of the two hemispheres (who depended chiefly upon their mysterious practices for their cures), and the surgical schools at Rhodes, Cnidus, and Cos, and in Egypt as well. He recognizes Pythagoras, and Heropholis (who was the first to direct attention to the radial pulse), and Erasistratus, and Aristotle, and Celsus, and Galen, and Oribesius (who, at the request of the empercH* Julian, compiled an encyclopedia of surgery of seventy-two volumes). He sees Actius, and the many surgeons of the followmg centunes, and the chirurgical tonsorial artists of the last century, his vision extending even unto the twentieth century, when the last vestige of forestry shall have been removed, and nothing left but the rich, productive soil of modem surgery. In this field he sees the ideality of cleanliness, — not cleanliness in the ordinary sense of the term, but that cleanliness which removes even the minutest forms of microorganisms, — and he is astonished at modem surgical technique, which is rapidly nearing perfection, — not, perhaps, absolute perfection, as that is scarcely attainable in this world, but that perfection which is sufficient for all practical purposes, but stops far enough short of the ideal to still give some original work for the future surgeon to do.

What has the surgeon of the nineteenth century accomplished? He has done so much that it is hard to tell it all or even to form a conception of an appropriate answer ; but the one word which comes nearest expressing it is — everything. In his- reveries our doctor sees surgery elevated from the most meager art to the ideality of art and of science ; from the untrained hand of the barber, and of the but little better trained hand of the twelfth century doctor, to the most skillful hand of the liberally educated and scientific modem surgeon; and from the most barbarous — yet unavoidable — siugery as practiced before the discovery of anaesthetics, to the peaceful and quiet and deliberate and painless surgery of the present time, with the patient sleeping calmly under the influence of an anaesthetic.

What can he say of anaesthesia, or, rather, of the men who discovered the anaesthetic effects of ether, of chloroform, of bromide of ethyl, and of cocaine? He is not sure but it is about enough to say that they were ph3rsicians, and being such it became possible for them to do more for the world and for mankind than all the heroes whose praises have been sounded by admiring historians or sung by poets since the time of Homer. Military men have been admired and lauded for their deeds of bravery in all ages ; but what are the deeds of a warrior, whose business it is to take life, to destroy property, to spread carnage far and wide, and to bereave hosts of wives, mothers, daughters, and sisters, whose loss is a thousand times more to them than all the glory of all the generals of the world, as compared with the benefits to be derived from the discovery of anaesthetics? What should be the honors of the military chieftains as compared with the honors of those physicians whose life's work culminated in the discovery of a means by which surgical operations could be performed without pain and with much less danger to the life of the patient? Modem surgery was made possible only by the discovery of anaesthetics, and the millions of lives saved by the surgeon should be accredited in a measure to those brave men who even risked their own lives by inhaling the vapor of chloroform and of ether until they became unconscious, that they might give to suffering humanity the greatest possible boon — painless surgery.

Then surely these medical heroes should be placed high up among the immortals of the world as the greatest bene- £LCtors of them all.

Anaesthetics having been discovered, and painless surgical operations having become a possibility, our dreamer now looks with wonder and admiration at the work of the modem surgeon. In place of the horrified features, the unearthly cries, the tormenting agonies, and the sickening writhings of the suffering patient, — a scene, once witnessed, never to be forgotten, — he now sees the patient calmly sleeping while the surgeon is deliberately performing the operation. But there is yet much to be learned before surgery can be called a science in* any sense of the term. The surgeon operates ; nature does the rest ; and the surgeon may believe himself exceedingly fortunate to have such a £iithful fiiend.

It was not until the discoveries of the bacteriologists and the development of bacteriology as a science, that modem surgery began to assume something of its present features.

In his reveries our dreamer looks again upon the realm of surgery, and the dazzling and brilliant picture he now sees is indeed startling. He sees the principles of asepsis and antisepsis intelligently applied ; he sees extensive wounds heal without any inflammation, almost without pain, and without the formation of a single drop of pus ; he sees limbs amputated, joints resected, and diseased bone removed, and the patient recover in a few days without any alarming S3rmptoms, much acceleration of the pulse, or the slightest rise of temperature. He sees operations upon the gall bladder, the stomach, and, in fact, upon all the viscera, and the appendix vermiformis, that unaccountable and persistendy inflammable little organ, which has become so habituated to pathological processes that its removal has become &shionable — and that, too, with the most astonishing uniformity of results. The pleural cavity, the lungs, and even the brain itself he sees explored and operated upon by the modem surgeon. He witnesses all these things and more; he sees the patients, with few exceptions, restored to health — if not health, generally much improved, — and life made tolerable.

Then what can he say for modem surgery? It saves more lives, perhaps, than any one fector known to man ; it deprives malignant growths of much of their terror, and removes and renders harmless many forms of disease that would otherwise most certainly destroy the life of the patient within a short period of time. The lives saved by this branch of medicine are innumerable.

And the men who have brought this all about — what can he say of them ? He is at a loss to find words adequate for such a eulogy as should be spoken for the brave deeds of these daring and self-sacrificing men. Daring, did I say ? Daring hardly expresses it. The reckless bravery of the great warrior, who is bent on taking life, fells into insignificance when compared with the zealous and determined efforts of the surgeon who is bent on saving life.

We invite the reader to look with our dreamer into the operating room of the modem surgeon and there see for himself a demonstration of the heroism of the average surgeon. The room itself is not impressive ; in feet, there is not much to be seen — the uncarpeted floors, the naked walls, a shelf or two, and a smaU stand beside the operating table is about all he will see, except a glass douche with a long rubber tube hanging above the table ; an abundant supply of sterilized water and bichloride solution, a stand with a pan containmg about a dozen sterilized sponges, another pan with sterilized water or antiseptic solution, a basin containing instruments which have also been sterilized and are lying in an antiseptic solution, and another large basin to catch the water which has been used for cleaning purposes — this, and two or three assistants in snow-white gowns and a nurse or two in white aprons and caps.

The patient is a young lady with suppurative disease of one kidney. There is a fistulous track from which oozes a constant discharge. The patient is anaemic and poorly nourished. Life is a burden to her, and she must have relief or drag out a miserable existence until death puts an end to her trouble ; or she may undergo a very hazardous operation, which, if successful, will restore her to health, with a prospect of a feirly comfortable existence for a number of years. The kidney in this case is probably disorganized and lies buried in a mass of pathological tissues which are adherent to the peritoneum, which is liable to be punctured in the operation ; and if punctured to be infected with pus microbes, meaning almost sure death to the patient

Here you see the surgeon enter, also in a white gown with sleeves rolled above his elbows, — the patient having been previously anaesthetized by the assistants, — and he at once begins his work, after first bathing hands and arms in a sterilizing solution. He may say a word or two in regard to the difficulties to be encountered, but almost simultaneously he makes a deep incision. He goes boldJy down ; and as the woimd is opened wide by retractors in the hands of his assistants, he finds that he has encountered a mass of diseased tissues. It is with great difficulty that he is able to keep his bearings, — to keep from wounding the peritoneum on the one hand, and from opening into a pus cavity upon the other. You now see him carefully working, carefully dissecting, but not so much with the sharp cutting edge of the scalpel as with the handle ; and with his fingers you see him gently pushing the tissues aside, and separating them from the adherent peritoneum and from the surrounding healthy tissue. The kidney he finds almost completely disorganized, and the remnant that is left lies buried in a mass of morbid tissues from which it cannot be separated. You see him very anxiously working his way around the diseased mass, mosdy using the handle of his scalpel and his fingers. Every now and then he calls for a sponge, which is applied by the nurse or an assistant to take up the excess of blood — for he has opened a blood vessel ; — and you see him, or one of his assistants, apply the catch artery forceps to the bleeding vessel. Hemorrhage is at once controlled, and he proceeds again deliberately, but anxiously, with the operation.