CHAPTER II In the later eighties, I had about determined to make my (Part 6)

subject of nervous derangement, I learned that suggestion was a powerful influence in treatment and asked the family to let me take charge of the case for a day. It was generally agreed that the boy had only a short time to live, and my proposition was accepted. In less than two hours the boy was sitting up, talking naturally, and asking for something to eat. His "hydrophobia" was cured, and he suffered only from the effects of the drugging which he had received. Since thai time many newspaper accounts of similar cases have been reported, and it seems probable that death in these cases was due to drugs that were employed, — the disease being a peculiar form of hystero-epilepsy. This does not indicate any lack of belief on my part in the terrible diseases of rabies and of hydrophobia, for we know them only too well, but this particular form of nervous derangement which simulates hydrophobia is often mistaken for that disease. My first "good" patient was a man who was suffering from larial fever. One of his friends called me in an emergency TO-MORROW'S TOPICS 99 because no other doctor was quickly available. The patient informed me that he could not use quinine or arsenic in any form, or in fact any of the resources with which I happened to be familiar. It was very confusing. After investing good money and years in preparation for medical work, and feeling that I was ready with principles to take charge of almost any sort of case, or at least to take charge until special informa- tion could be collected, here at the very outset of practice were conditions which were completely out of order. Up to my last day on earth I can never forget the sickening feeling of discouragement at having to tell the patient (a distinguished architect, Mr. T.) frankly that I did not know what to do. His friend sent for a Homoeopathic practitioner and it was learned subsequently that the patient was getting on very comfortably and satisfactorily. After that nothing but dispensary patients came to the office for some weeks, but all at once notice was received that a second "good" patient was to arrive in New York on the following day. An old college friend in the West, who had confidence in me in some general way, had recommended this very influential business man to come East for treatment for his dyspepsia. It seemed really grand next day to be actually going into a fine hotel to see a patient who wore good clothes and a necktie. My feeling was one of great responsibility and importance. The patient stated that he had suffered for many years from dyspepsia, but without receiving any satisfactory treatment. It was high time to get at the case scientifically. It seemed the part of wisdom to begin safely, to study every detail, and to make as perfect a brief of the case as was ever made for any man. In order to be certain not to do anything wrongly I started in with his diet question, and told the patient that for dinner that night he would be allowed nothing but kumyss and toast. He remarked that he had never tried kumyss, but it lOO TO-MORROW'S TOPICS seemed probable that this delightful beverage food would please him, and at the same time keep his stomach contented until morning. There would be time for thinking over all of the points which had been obtained when getting notes of the case. There would be opportunity also for talking with some of my older colleagues. Next day the morning greeting was not very cordial. My heart fell with remem- brance of the first "good" patient. I timidly asked how kumyss and toast had agreed. He growled that "it did not go." When he had stepped to the wash bowl to pull the cork out of the kumyss bottle, it came out too suddenly, and he jammed the bottle against the wash bowl forcibly. The hotel proprietor had informed him that it would cost twenty- five dollars to replace the broken bowl. About half of the explosive fluid flew over his wife's silk dress which it would cost about one hundred dollars to replace. The rest of the beverage which he drank made him so sick at the stomach that he had not fully recovered from the effects. He chose to go to another physician during the day. After another series of dispensary patients the third "good" patient turned up. It was in an emergency. The people probably would have obtained somebody else if they could have found him quickly. A young woman of the rapid set had held up a bottle of champagne at the dinner table while a guest from the West endeavored to shoot out the cork. This he undoubtedly did well, and no one knows where the cork went in the dining room, but a piece of glass had flown into the young woman's eye, causing a dangerous injury. This sort of case could not be managed on general principles, and it did not seem right to take charge of such a special case myself, as it required very expert work. Consequently we decided i to call a famous ophthalmologist Dr. A. in consultation at The consultant was sitting with his wife about the TO-MORROW'S TOPICS loi library table at his home. He asked me the nature of the case. I asked if he would kindly step into an adjoining room, in order to avoid shocking his cultured wife with the statement of a case in which a woman's eye had been injured in an attempt to shoot the cork out of a champagne bottle. It was a proud moment when he complimented me upon my nicety of sensibility, and the wisdom of choosing an experienced consultant. He suggested that a cab be called, a luxury to which I was not accustomed. After we had seen the case and returned to his house, a very awkward position developed, because there was no money in my pocket with which to pay the cabman. It would not do to ask the consultant to loan me money, and the cabman could not be asked to give credit to one whom he did not know. The only way was to drive about until someone was found from whom the money could be borrowed. The hour being late at night, it was a long while before help could be obtained from a dear old friend. Dr. C. L. B., who was just returning late from a call and had not retired. The cab fee had risen meanwhile to such pro- portions that it cut a ragged hole in the fee which was collected from the patient, as it had seemed best to turn her over to the expert, leaving me without remuneration excepting for the first steps. These were the first three "good cases" of a young doctor. I ran over in mind a list of acquaintances who were finely equipped, yet who had failed in practice. Was I to join this particular group? The signs were unquestionably point- ing that way, and assured success appeared to belong only to patent medicine men and to fakers. One remark of Frank's gave me a strong handle. Said he, "If there is room in the profession for one more man I'm going to be that man." Among my early cases was one of an old fracture of the spine. The patient was paralyzed below the point of fracture. 102 TO-MORROW'S TOPICS The idea occurred of trying to get together the ends of the divided spinal cord after removing a sufficient number of vertebrae. I talked the matter over with Dr. L. A, Sayre as an orthopedist and with Dr. E. C. Sequin as a neurologist. Both of them said that while such work had never been done, there was a possibility of making some observations of con- siderable value in the case. It was my wish to have for assist- ants some of the physicians of the town in which the young man lived, but they all refused to take part in any such pro- ceeding. Further than that, the coroner was notified of the proposed operation and warning was given that if anything serious happened, I would be held responsible. The young man belonged to a church near at hand, and some of the members of the church had been instructed to use their influ- ence and interfere with performance of the operation. Two volunteer assistants were taken from New York. At the moment of beginning the operation, somebody who was watch- ing gave a signal to someone else at the church, who began to toll the bell. The operation was done with the church bell tolling and the sheriff waiting. The patient did not die as a resuh of the operation. We found on entering the spinal canal that the distal part of the cord had degenerated into a fibrous j string to such a distance that the work could not be carried ' out as planned. Since that time many similar operations have I been done for recent injuries and once in a while cases in [ which the cord has not been entirely severed have made good I recovery. "Pay cases" eventually began to come to the ofllice, but there I was some aggravation associated with almost every one of I them. An old bachelor came in one day and asked to have I his appendix removed, as he was just starting for a trip around »th« world and was worried with the new popular fear. On examination it was apparent that he had never had trouble of TO-MORROW'S TOPICS 103 any sort with his appendix, and decision was made against operation. He was quite indignant, and said he was prepared to pay whatever my fee would be, and did not see what the surgeon had to say about it under the circumstances. He was advised to keep his appendix until he really had appendicitis, and I would then charge him twenty-five himdred dollars and be fifteen hundred dollars in, — sort of saving him up. People have different views about the severity of this particular operation. A young woman for whom an interval appendix operation through a short incision had been done, and who was up in a week, said, "Now, Doctor, I want to have you tell my husband that the shock of the operation makes it necessary for me to take a good deal of time for convales- cence. Please, dear Doctor, tell him that I should go to Palm Beach until Spring and then over to Southern France, and gradually travel northward to the colder countries of Europe." The very next case might have been one really calling for such a period of recuperation. On one occasion an old friend, a physician in a small village in the western part of the state, telegraphed me to come and help him with a man who had a strangulated hernia. It was a blizzard time in midwinter. The train arrived at about six o'clock in the .afternoon. The case was one in which the patient like all people in that village, could not pay a fee of any account, but the doctor was a personal friend of mine who gave time and effort so generously that one really had to join him in spirit. When we started from the house in a sleigh after dark, driving across fields where fences were covered by snow drifts, we could not keep our lantern lighted on account of the whis- tling gale. About midnight the horse finally became entirely stalled in a drift, so we packed the snow down around him and then burrowed through snow for some two miles more on foot, arriving at the house about four o'clock in the morning, — four hours for making two miles. The operation was done, and we had breakfast at the house, and then started to return. It was near midday when we finally got back to the doctor's I house, and two and a half days of time were expended on I the case, in which the fee was fifty dollars and expenses. A man telegraphed me from the western part of the state to come and care for his wife, stating that Dr. B. wished it. An ovarian tumor with twisted pedicle was to be removed. When I arrived there was no Dr. B. to meet me, but a man in a loose-jointed farm wagon instead. He took me to a small house and then went for Dr. B.. who seemed considerably surprised at my appearance. We quickly made arrangements and finished the operation. Dr. B. took me to the train and asked how it happened that I had come up. He was told about the telegram. "Well," said Dr. B.. "if Van were as smart as that all the time he would do better in the world. I know that he has not a dollar to pay you with, not even your railroad fare, to say nothing of charges for time and operation." This proved to be the case. It was a twenty-four-hour trip, and paying my own expenses beside losing New York work for the day. Dr. B. wrote later that he asked the man about his send- ing for me. His reply was: "Why, you said the trouble was terrible bad and you wished Dr. Morris was here, so I went over to the Jacksons and got his address and telegraphed him to come, 'cause I wanted my wife to have the best there was." It is worth while doing something for a man with that spirit. One question which comes up in this connection may be fairly asked — why should I not go to a distance for nothing and pay my own expenses in order to care for a poor patient if we are living for the purpose of helping people who need us? There is jwrhaps only one answer that ts not sophistical. People living in New York belonging to my clientele might have needed me still more during the time of absence; in k. TO-MORROW'S TOPICS 105 fact, some of the patients under my care no doubt did suffer something from neglect on that day. In addition to expenses of the trip I lost the fees for office consultations on account of being away. It is a question if any one man in the profession should be called upon to suffer personal loss, even though he ostensibly and theoretically stands ready to render service to the ones who need him most, without regard for compensa- tion. One point in the argument would include the fact that surgeons at Buffalo would have been very much nearer, for this particular case.