More Truth Than Poetry

CHAPTERS VII — XIII

MORE TRUTH THAN POETRY

THE BIOGRAPHY OF R. S.

BY Hans Zinsser

‘More Truth Than Poetry’ is the story of an American who all his life followed two careers — the scientific career of a doctor, fighting to avert plagues, and the career of a scholar and poet.

In Serbia in 1914-1915, in the American Army in France, in Russia, Mexico, and China, he has fought as a scientist . At Columbia, Leland Stanford, Harvard, the Sorbonne, and universities in China and Japan, he has passed on his knowledge and skill to students and colleagues. To larger audiences he has, through philosophy and poetry, expressed his knowledge of men and languages, of science and the humanities.

In the first installment of his biography of his alter ego, R. S., he describes with tenderness and admiration his German parents, his early religious experiences, his school and college life, his love affairs. At Columbia he fell under the spell of poetry and philosophy, as illuminated by George Edward Woodberry, and of biology as it was defined by Edmund B. Wilson and Bashford Dean. Graduating from the laboratory, he went out to the Western plains, where he had his initial experience of anthropology, and so took the first tentative step in that career which was to lead him to the plague spots of the world.

MORE TRUTH THAN POETRY

BY HANS ZINSSER

VII

THIS biography of R. S. would be far from complete without some account of his student life in Paris. Let him in his own words describe those golden days:—

Flowers blooming in the Luxembourg gardens and little bare-kneed children throwing colored balls to and fro. Under the trees on the terrace, old men playing very scientific croquet to an admiring gallery. Across the allée, a guignol, with Lilliputian chairs and benches for audiences that never tired of seeing the venerable but thrilling story of the ‘Brigands de Fontainebleau.’ The paths full of comfortable strollers, some of them with moth-eaten beards, velvet trousers, and wide black hats; and, on the benches, happy couples that cared not at all whether they were seen kissing each other.

Spring in the Luxembourg gardens; twenty-one, and the head full of Villon, Ronsard and Verlaine, Dumas and Victor Hugo! These were the gardens through which the little Anatole France had skipped to school ‘like a sparrow’ — hands in his pockets, a pack of books on his back. And here, as a young man, he sat on a bench to marvel at the extremes of genius which the French spirit can produce, as he saw walk by, first, the austere mathematician, Raymond Poincaré, stiff and formal in his black coat; and, a little later, Verlaine and his disreputable companions, after a night in a neighboring wine cellar. Here walked the shades of Henri Quatre, of Diderot, of Voltaire, of Danton, of Murger, and of countless others.

Now that I have come to know French thought and the French people through many years of close association, and am irritated by their faults as I am charmed by their virtues, Paris is to me only the most civilized city in the world. In those enchanted days, it was for me the city of romantic history, of revolutionary fervor, of political exiles, and of poets and painters. I walked the same pavements on which d’Artagnan and Cyrano had strutted, in a wide feathered hat, and with a rapier at my side; in every pretty shopgirl I saw a Louise or a Mimi, in every dilapidated, bewhiskered art student an Alfred de Musset or a young Rimbaud. Heine and George Sand and Chopin were my neighbors, and Balzac and Alfred de Vigny lived around the corner. On every street I saw the pageant of great events parade before my imagination, without taking sides, in that happy irresponsibility one feels for the past; and the aristocrats who jested in the conciergerie cellar were not less heroes to me than Desmoulins and Danton.

I had a room giving on a garden in a house behind the Trocadéro. Roses were in bloom, and a cherry tree; and there was a warm fragrance of box and gooseberry bushes. Every morning I had a French lesson from my landlady, a cultivated spinster of the terrifying age of forty. She had a pointed nose, a little moustache, and a mole with hair on the end of her chin. We had our lesson, with coffee and croissants, in the garden; and we read Fénelon’s Télémaque, and odds and ends of Pascal’s Pensées, for she was very pious. But she was an old romantic, too, for I shall never forget the emotion with which she read the opening lines of Télémaque, in which Calypso bewails her immortality because Ulysses is gone, never to return. And we read Cyrano with fervor and compassion. I suspected a personal sorrow, but it was probably my own state of mind.

After the daily lesson, I would walk, across the bridge, over to the PetitLuxembourg, where the École Coloniale was giving courses in nineteenth-century French literature, in political history (here I heard the learned Thalamas), and in phonetics — a course in which we repeated for criticism such ingenious phrases as ‘ Paul et Pierre, appuyant le parapluie contre le parapet du pont, ne parlent presque pas,’and so on.

In the afternoons I would saunter into the garden, or take a mouche up the river, or walk for exercise in the Bois until the mellow afternoon dusk faded into darkness and the cafés became brilliant with light.

The world is always as young and as happy, or as old and as unhappy, as we are. I was in a state of being constantly in love, not only with every pretty girl I saw, but with the city and the people and with the sensation of being in love. Indeed, like Heine, I even fell in love with the beautiful Milo and regretted her lack of arms. Much later, during the years after the war, when I saw hordes of underbred Americans drinking and chattering till all hours of the night in the cafés along Montparnasse, finding in Paris only the opportunities for playing at Bohème and pretending to see genius in any artistic eccentricity that could be exploited without hard work, utterly untouched by the strong heartheat of this country rising from its knees with wounds still bleeding, I was glad that I had been there as a youth. And I was glad, as I associated with French students, scientists, and teachers, that the real life of Paris, the life of the people and their intellectual leaders, was going on essentially uninfluenced by the barbarian invasion. Parts of the Left Bank were merely set aside as a sort of ghetto for American Pernodians, where they could disport themselves temporarily until the franc should rise and the visitors be reclaimed by Greenwich Village, Kansas City, and other points west.

A few of these Americans, of course, worked hard, were stimulated to productive labors by their European experiences, and eventually came through. Very few, however, either wished or had the opportunity to enter into the intellectual or artistic life of France, but spent their precious months utterly unconscious of the treasures that the centuries had here accumulated for their taking. Most of my compatriots reminded me of two engineer officers I had known during the war, who for two months after the Armistice lived in the basement of a ruined house in Thiaucourt drinking bad whiskey, without knowing until too late that under their feet, accessible by a trap door, there was a cave filled with bottles of Chablis, Nuits-St.Georges, and old, old cognac.

That summer I saw the parade at Auteuil to celebrate the return of Marchand from Fashoda. He marched with his company of Senegalese, escorted by the garrison of Paris, and was acclaimed the young Napoleon. There were riots in the crowd about the Dreyfus business; blows and shouts of ‘ Conspuez les juifs!’ and calm cleaning up by the unhurried and silently effective ‘agents.’ That night the streets were lighted; cabs — each with a garlanded, coal-black Colonial soldier and two or three white girls — rambled through the streets; and bands played on the corners. I danced on the Place Voltaire with my good friend the fat wife of the patron of a restaurant-bar opposite the Odéon. She was still alive last year, and greeted me with a hug.

Although these were not the days of the artistic Bohème made famous by Murger, Paris was then — as always — full of students of all nationalities, most of them hard-up, who lived in little furnished rooms in the narrow streets near the Sorbonne, the Faculté de Médecine, and the Beaux-Arts. They were not tourists, and they had to be reasonably sober to do the hard work that was required to keep them in good standing. But they were gay and free and different from students anywhere else in the world. There was, and is even today, a residue of the spirit of the mediæval student life in Paris. That things have not essentially changed I learned when, teaching a few years ago at the Faculté de Médecine, I renewed my youth many a merry evening, in the cafés and the salles de garde of the hospitals, with the postwar generation of medical students and their friends.

At the time of which I was speaking, there was an architectural student who lived with another American on a little street running into the Rue de l’Université. His rooms were on the third floor, and under him the proprietress of the first-floor shop had on her window sill a goldfish tank in which she kept several fish and a very small turtle. These were the delights of her leisure moments, sharing her affections with her old husband and her cat. My friend, leaning out of his window on mellow evenings, smoking his pipe, could look down directly into the tank, and he often watched her as she broke bread crumbs for her pets, muttering terms of endearment. On such an evening he suddenly conceived a brilliant idea. The next day he went to the fish market and bought a series of six turtles, ranging in size from one like a five-franc silver piece to one about six inches across. At the same time he bought wire, a bit of cheesecloth, and a bamboo fishing pole, which he smuggled into his rooms after dark and from which he fashioned himself a very small scoop net.

Each day after that, very early in the morning, he would lean out of his window, fish out the old lady’s turtle, and put in a bigger one. The first exchange she didn’t notice. When the second one went in, this time about three inches across, she looked surprised, but only said: 'Tiens! Tiens!’ When the third one appeared, she began to show signs of excitement. First she called her husband; then the neighbor’s wife; gradually the other neighbors. There were animated discussions. The facteur offered advice; said she was feeding too heavily. The fourth turtle changed the place into a public sensation. The old lady began to tell people her system. The fifth one, about five inches across the top, started a riot — not without some tragedy, for this turtle began to chew the fish. The old man bought a separate small tank for the sole surviving goldfish. A reporter from the Paris-Midi came in and wrote a story. It was a headliner. Madame Perrier became famous. She was interviewed, and it was said that her husband would be decorated.

The architect never put in the sixth turtle — the tank wasn’t quite large enough. But he had a still more brilliant idea. He now began to make the turtles small again. He skipped the fourth one — took it out and let it loose in the Seine. He put in the third, which diminished the animal to half-size in a single night. Now the excitement really began. An official from the Jardin des Plantes paid a visit. He pulled at his beard, wagged his head, and, being from Rouen, said: ‘C’est vraiment cocasse.’ The shop did an enormous business. All the children of the neighborhood came in for sucres d’orge and had a look without extra charge. My friend skipped to the original beast and destroyed the evidence in his washbasin, putting the remaining turtles into his pocket and carrying them out to the Bois, When he came home that night, he stopped in to see the turtle. Madame Perrier had become a national heroine. She had given her magic turtle to the man from the Jardin des Plantes for observation.

VIII

After graduation from college, R. S. had considerable difficulty in choosing a career. Although his early ambitions had been in the direction of literature, he lost some of his self-confidence in this regard. As a consequence of his own recognition of the very low quality of a booklet of poems which, together with his friend W. A. Bradley, he had privately published, he questioned his talent for a writer’s career, not without a permanently wistful desire in this direction, and turned to his second love, biology, in which he discovered — to his surprise — a romantic appeal hardly less potent than that which had at first attracted him to the arts. With Professor Bashford Dean, R. S. had his first introduction into research, and learned the incomparable satisfaction that lies in the exploration of the unknown, even when the problem is a small one — the application of reasoning, controlled imagination, and precision of technique to the study of natural phenomena. On his trip to Texas, he had had a look-in on geology and palæontology, and the broad vision of Edmund B. Wilson, who was at that time engaged in those classical studies of chromosomes and cell division by which he paved the way to scientific genetics, aroused an enthusiasm in R. S. hardly second to that stimulated toward literature by Woodberry.

His teachers advised him to study medicine. He was twenty years old, and they believed that four years of rigid discipline in a medical school would mature him and lead him naturally into fields of medical biology for which they thought he was fitted.

As a matter of fact, R. S. always held that medical training has for certain types of people a ripening influence that no other field of education possesses. Aside from the habits of hard work that it demands, it embraces a broad survey of the biological field, enforces a considered correlation of the fundamental sciences, and, on the human side, brings the thoughtful student face to face with the emotional struggles, the misery, the courage and cowardice, of his fellow creatures — to say nothing of the familiarity it gives him with sociological conditions, vice, crime, and poverty. There is in it a balanced education of the mind and the spirit which, in those strong enough to take it, hardens the intellect and deepens the sympathy for human suffering and misfortune.

His medical-school days were like those of thousands of others. He did well, enjoyed himself, and managed to pass a competitive hospital examination which, in those days, was the climax of the medical student’s career. Once in a good hospital, he was a doctor, and in full cry.

It is perhaps one of our most praiseworthy traits as a nation — which I pray may persist — that we have never been reluctant to admire and emulate the intellectual achievements of other nations. At the time that R. S. began his medical studies, there were few eminent American teachers of the fundamental sciences who had not spent a few graduate years in Europe, chiefly in German seats of learning, and could proudly call themselves pupils of Virchow, Koch, Cohnheim, Dohrn, Weismann, Helmholtz, Ludwig, and countless others of the masters, to say nothing of the great clinicians and surgeons whose wards were intimately related to and influenced by adjacent institutes of pathology, physiology, bacteriology, and chemistry. Gradually, Americans returning from these training grounds began to shape the course of American medicine. Preëminent — the most potent individual force — was William Welch. But there were also Abel and Howell, Christian Herter, Victor Vaughan, Prudden, Huntington, Mall — to name only a few. The leaders were assembling, but the opportunities for leadership of the right sort had yet to be organized.

America had before this time many medical schools. But, with few exceptions, they were ‘proprietary’ ones — that is, privately founded corporations of groups of physicians and surgeons who organized courses without a well-conceived educational plan, often without hospital facilities. In a few places, this was being corrected by intelligent groups who voluntarily placed themselves under university control, or allied themselves with well-run hospitals. But taken as a whole the situation was a deplorable one, lacking any uniformity in educational standards, care in the choice of faculty, laboratory or clinical facilities.

In a few places, owing largely to financial support, university influence was gaining power, and in Philadelphia, Boston, Ann Arbor, and New York, schools of increasing strength developed. An especially strong pressure for improvement was exerted by President Eliot, at the Harvard school. The situation was distinctly improving before 1880 and probably was on its way to better things, largely under the influence of the young men returning from Europe. But, at best, this would have been slow and might have taken many wrong turnings had it not been for the opening, in 1876, of the Johns Hopkins Medical School. Thomas Huxley came over to make the dedicatory address, and the promises he made for the importance of the new school to American medicine were more than fulfilled. Whether we attribute it to good fortune or to extraordinary wisdom, the group eventually assembled at Hopkins — Osler, Welch, Halsted, Mall, Howell, and Abel — became the model for American schools, and it was not long before men trained by them became the leaven that raised the general level of all other progressive institutions.

But Johns Hopkins had an endowment and a hospital of its own. It was equipped with laboratories and backed by a university. Few other places could, even with the best will, meet the new requirements. By 1900, great improvement had taken place. But the country was still full of second-rate proprietary schools and university schools that were limping along in penury. Then came Abraham Flexner’s report to the Carnegie Foundation.

Oh, Abraham Flexner! We have fought with you on minor points, have alternately admired and disliked you, have applauded you for wisdom and detested you for opinionatedness. But in just retrospect, layman as you are, we hail you as the father — or, better, the uncle — of modern medical education in America. You did, on occasion, hit below the belt, yet in the spirit in which the Christian knights slashed off the infidels’ heads while shouting ‘Kyrie Eleison! ‘ It was your report — uncompromising, cruelly objective, courageous and incisive — which opened the eyes of the medical profession to the state of their training schools, aroused public opinion to the need of better education of the guardians of health, and set the floodgates of the golden streams of philanthropy in medical directions.

For a decade, Abraham Flexner — backed by the huge resources of the Rockefeller Foundation and, indirectly, by similar funds, and advised by such wise men as Welch, Mall, Edsall, Pierce, and less wise ones who, like R. S., gave unsolicited advice which he did not follow — dominated the educational situation in medicine. Meanwhile, laboratories were founded in the schools; young men of spirit, training, and ambition were enlisted; professorships were bestowed for promise and accomplishments; and research institutes began to step up the pace of creative production.

One reads the increasing mass of literature on the origins of the great American fortunes of the nineteenth century, and one takes bicarbonate of soda. But however one feels about that, one must acknowledge that the preëminent position of American medicine today would have been impossible without a certain amount of rich malefaction in the eighties and nineties.

Thus, modern American medicine is, in a way, a phœnix arising from the ill-smelling ashes of a big business that is forever gone.

IX

Riding an ambulance is, for a boy in his early twenties, an experience that teaches him little medicine but introduces him to phases of human life which he can see in no other way. It is both shocking and maturing, but if the heart is right it does him no harm and gives him an unforgettable insight into the manner of life of the poor and the miserable.

There is probably not anywhere in America today such abject poverty as there was in the worst tenement quarters of New York in the first decade of the 1900’s. We found people frozen on the street; we saw families dispossessed in winter, with their furniture on the sidewalk, and utterly destitute. Private and public charities, as far as they could help, were miserably inadequate. I accumulated a considerable respect for the activities of the Catholic Church at this time. The Paulist Fathers, who had their headquarters beside the hospital on 59th Street, were constantly circulating through these districts and were intimately acquainted with the Irish families in most of the tenement houses. Father Cafferty, a redheaded priest with whom I formed a firm friendship, was often present at the place of need before the police or the ambulance arrived. Often, too, I found him, when I came to pick up a mother with pneumonia or a laborer with some serious disease, at all hours of the night, standing by, heating milk on the stove, doing all kinds of little services, and — most important — taking the responsibility for the family when one or the other parent was taken to the hospital. Furthermore, when drunkenness or physical brutality threatened completely to ruin one of these small groups, a word to Father Cafferty or one of his colleagues was followed by visits and conferences during which he put the fear of Hell into the guilty, so that the situation was often relieved. I gained, then, a lasting impression of the pragmatic usefulness of Hell. The trouble with the modern world, I am convinced, is not so much the weakening of faith in salvation as the loss of the fear of Hell.

Emergency childbirth was one of the chief problems. I have spoken of some of these cases in another place, but hardly a week went by without some odd obstetrical occurrence.

Some of the suicides were extremely ingenious; others were unbelievably maladroit. There seemed to be a sort of fashion in the technique of suicide. For a time, it was almost all illuminating gas. Then, in succession, it was carbolic acid or lysol, bichloride of mercury, hanging, shooting, and throat-cutting with amazingly inefficient utensils — jackknives, or even slivers of glass. The most sensible ones, I thought, were the illuminating-gas people. Many of them, however, made too little allowance for the fact that the odor of the gas would attract rescue. Only one man I found had taken precautions against this. He had done so by sticking an ordinary tin kitchen funnel into the gas hose and tying it over his face with a string above the ears. These people became unconscious rapidly, and if they were rescued before they died, some of them continued to live for five or six days in coma.

The carbolic-acid cases could often be rescued if the ambulance got there soon enough. All that was necessary was to get a stomach tube into them and wash them out with dilute alcohol or, if that was not available, with whiskey. Sometimes, however, it was difficult to get the stomach tube into them, since they had spasms of the diaphragm where the œsophagus enters the stomach. Then, occasionally, the stomach tube slipped into the larynx. In a case of this kind in which I had eventually reached the stomach in time to wash it out and save the patient, I had first slipped my tube into the larynx, and had pumped whiskey into the lung. This unfortunate, though he got over the carbolic acid, developed a pneumonia from which I am glad to say he recovered. While demonstrating the case to a class in my presence, Dr. James humiliated me deeply by saying that it was the only true alcoholic pneumonia he had ever encountered.

Another carbolic candidate, ignorant of course of the fact that alcohol is the antidote, walked into a saloon near the hospital one night, asked the barkeeper for a double whiskey, then pulled out a little bottle from his pocket and, saying to the bartender, ‘Well, Bill, this is the last drink I will ever take,’ swallowed the contents of the bottle and followed it with a large dose of bad whiskey. He then sank to the floor — purely because that seemed to be the proper thing to do. When I got there a few minutes later, it wasn’t even necessary to wash him out, and I think he was considerably annoyed because I didn’t take the trouble to treat him.

It has always seemed ridiculous to me that the poor people who try to commit suicide should be regarded as criminals before the law and placed under arrest. Since the tenets of Christianity — either Catholic or Protestant — do not seriously influence our politics or our business practices, it is strange that ecclesiastical tradition should so rigidly determine our official attitude toward suicide and birth control. It is still a punishable offense to make an unsuccessful attempt on one’s own life. Yet philosophers through history have justified the lawfulness of ‘self-violence’ under special circumstances. Robert Burton has half a chapter on it and cites Socrates, Plotinus, Epictetus, and Seneca in its favor. ‘I pity thee not,’said Diogenes to the sick Speusippus, who moaned complaints, 'qui cum talis vivere sustines’— since, being thus, you continue to live. Diogenes himself is said to have acted on this sentiment, though it is hard to credit the report that he committed the act by voluntarily stopping to breathe. I have seen too many sincere and enthusiastic suicides repent after the deed, and try to save themselves, to believe that anyone could voluntarily refrain from breathing at the moment when the medullary centre is beginning to react to lack of oxygen.

Schopenhauer thought suicide the only logical result of an intelligent assessment of human life, and Nietzsche said: ‘The thought of suicide is a great comfort and helps one over many a bad night.’ He did not, however, try it. Few people are ever sufficiently miserable and hopeless to do more than think of suicide and comfort themselves with the ‘back door’ from time to time. Usually, they are deterred by the consideration which Stendhal expressed, when he said: ‘Souvent je m’aurais tué, si je n’avais pas eu peur de me faire mal.' I have seen a number of attempted suicides where the execution became pitifully inadequate as soon as the knife or the sliver of glass began to burn into the neck, or the rope began to shut off the windpipe. Yet whenever misery was so great that the attempt was made in all seriousness, and rescue resented, I have felt sorry that it was an automatic medical obligation to defeat the poor devil’s purpose by all possible efforts. To rescue him against his wish was bad enough; but, in addition, to place him under arrest appeared excessively stupid.

Related to this problem is that of the physician’s duty of keeping patients alive for short periods of uncontrollable suffering, when all hope of even temporary improvement is gone. This question of ‘euthanasia’ is one that is arousing a good deal of discussion among intelligent people. To put hopeless sufferers deliberately out of their agonies with lethal drugs may often be desirable, but to admit even a consideration of this implies the exercise of judgment that will inevitably be fallible in a small percentage of cases. It might be worked out under reliable boards in a limited number of conditions. But it would open the doors for dreadful possibilities. One can easily imagine these, if one considers the manner in which psychiatric experts — even in groups — can be induced to testify on both sides of cases where insanity is an issue, or the ease with which lawyers can find doctors to testify in accident insurance cases and in matters of veterans’ compensation. The average integrity of the medical profession is perhaps a little higher than that of the population as a whole, but not high enough for euthanasia.

It is quite another question, however, whether a doctor should continue to keep a hopeless case alive for a few weeks or months, when judicious inactivity would bring rest to the patient and peaceful resignation to his family and friends. This is a problem which has troubled me on a number of occasions. And always I have come to the conclusion that the safest principle — except in a few special instances, such as the last stages of cancer or of leukémia or of Hodgkin’s disease — is to continue to work with all means at one’s disposal as long as the pulse keeps going and the breathing continues. I remember the experiences of two of my young colleagues who purposely gave up — one, the case of his own father — with the compassionate thought of not prolonging a tragic situation. In both instances, I am sure their judgments were right. In both cases, however, they never entirely got over reproaching themselves.

On the other hand, I have graven in my memory a typhus patient in a Serbian hospital, whom we had given up for dead. It was my job to do autopsies on such cases as soon after death as possible, in order to take material for culture before secondary postmortem infections of the tissues could take place and before the responsible — then uncertain — virus could begin to die out. For in some infections — such, for instance, as syphilis — the infecting organisms die quite promptly when the body dies and the cells cease to respire. This patient was hardly breathing, and his pulse could be detected only with a stethoscope. He was in that state of final exhaustion which I have seen to a similar degree only in this disease and in typhoid fever. I postponed a short walk into the hills because I thought that this boy would be carried into my autopsy barrack at any minute. But my friend George Shattuck, who was the physician on the ward, kept working at him. His persistence fascinated me. He gave saline infusions; he stimulated him with camphor and strychnin; he covered him with hot blankets. Shattuck omitted nothing that might feed the little flame that still flickered. He was hopeless, as I was, but he kept on. We expected death by noon. At two o’clock the patient was unchanged, but still going. By four, we could begin to feel the pulse. By six, there was distinct hope. Six weeks later, the young warrior was lying in the sun near my autopsy barracks, drinking a glass of thin milk, and beginning to feel bloodthirsty again — hoping soon to kill an Austrian.

A girl with typhoid fever at the Roosevelt Hospital came back from the inner gates in just the same way. I was young enough then to ask her later whether she had had any sense of death, or any visions. She said she had no memories whatever. A year later, I went to her wedding, when she married a policeman. Were we wise in saving her, after all? At any rate, he was not a traffic officer.

One of the questions that troubled me a great deal in those early hospital days — as, indeed, it still does today — is that concerning the extent to which the physician should tell his patients the truth in regard to their own illnesses. Usually, in acute conditions in which the patient is too sick to care, and in the less dangerous ailments, the problem does not arise. But there are so many prolonged, inevitably fatal diseases in which the patient’s state of mind is an important factor in his own comfort and that of his family, that the doctor’s judgment in this matter may determine whether the last months or years are to be reasonably tranquil or a supplice. And a physician’s duty extends beyond the more direct care of the body, as we are increasingly learning. The power of the mind over physical welfare is not a discovery of Mrs. Eddy. Changes of the pulse, as Struthius, the Polonian, knew, may betray the passions of the mind: ‘Si noscere vis an homines suspecti tales sint, tangite eorum arterias.' Avicenna knew it, as did Galen, and the Church has acted upon this knowledge for centuries.

So often, in the history of medicine, scientific discovery has merely served to clarify and subject to purposeful control facts that had long been empirically observed and practically utilized. The principles of contagion were clearly outlined and invisible microörganisms postulated by Fracastorius over a hundred years before the most primitive microscopes were invented, and the pre-Pasteurian century is rich with clinical observations that now seem a sort of gestation period leading to the birth of a new science. Thus modern psychiatry is striving to organize, on a basis of scientific precision, the vague but observationally significant gropings of centuries of half-charlatanry, faithhealing, Christian Science movements, Carrelism, and miraculism — endeavoring to segregate the truth from the fantastic, determining limitations, and directing therapeutic possibilities.

In their crude ways, practising physicians have long appreciated the importance of the mental approach in physical illness. And great physicians of all times have combined with medical erudition that intelligence of the heart which is the essence of a distinguished personality.

To return to the matter of frankness with a patient about his own illness, no rules can be set down. Those who have tried to do this have dismally failed. A well-known American physician who was at the same time — to my mind — a canting moralist held on occasion that absolute, uncompromising truthfulness is the only justifiable position, however cruel. That principle may lead to the sort of situation that once occurred in the practice of one of his colleagues who adopted his views. An old lady had what is known as an ‘epithelioma’ of the lip, a growth occurring in the aged which has all the pathological earmarks of a cancer, but represents a variety that never extends to other organs and usually yields to appropriate treatment. To tell this poor soul, for the sake of one’s distorted conscience, that she was suffering from ‘cancer,’ planting this spectre in her sensitive old mind, was — however well meant — inhumanly stupid.

This and other examples of uncompromising truth-telling remind me of a story told me by the great Norwegian oceanographer, Hjört. Hjört was on a fishing smack off the Norway coast, engaged in studies of fish migration. Somewhat of an experienced sailor himself, he was disturbed by noticing that the old captain of the smack was inexcusably careless about writing the daily log. On some days he neglected making any notations at all, composing a partially fictitious two or three days’ entry when it suited him. Hjört reproached him for this; appealed to him on the basis of tradition, professional ethics, the honor of the seaman’s calling. It made no impression. The old captain remained obdurate; said it was unimportant; insisted he didn’t care a damn — nobody ever read a fisherman’s log anyway, and so forth. Hjört kept on. Finally, the ancient became irritated. ‘You are a professor,’ he said. ’I am a captain. I have lived a long time, and I have seen many things. And I tell you, Professor, — and you can remember it, — the truth can be exaggerated, Professor.’

The old mariner was quite right. The truth can be exaggerated when the doctor talks to a hopeless patient. There are no two cases alike. Judgment, tact, and compassion can be the only guides; and external circumstances must be taken into account. In some cases, the cold truth may bring panic and serve no useful end whatever. In other cases—those in which the patient accepts tranquilly the philosophy of Seneca, ‘ Stultum est timere quod vitari non potest,’ the certainty of impending death may clear the mind for the resigned tendernesses of the precious remaining days which lend dignity and gentleness to death itself.

I learned something of this as a young interne in long midnight conversations in a hospital ward with a poor old Irish woman, who knew she was dying and taught me much of the nobility of quiet resignation. And a gallant young officer in the Argonne, struggling in agony with a machine-gun bullet in his spine, became calm and serene when told he had only four hours to live; dictated a letter to his wife; asked to have the Lord’s Prayer read to him; and saying, ‘That’s great stuff, doctor,’ composed himself to die.

One must pick one’s situations and one’s cases, and adjust the truth with the judgment of wise kindness. But one must not ‘exaggerate’ the truth without purpose.

X

An interne who doesn’t sooner or later fall in love with a nurse is usually a depraved fellow. And if he doesn’t marry one of them before he’s House Surgeon, it does him no particular harm. But at first they are only terrifying. ‘Doctors,’ my Onkel Fritz used to say, ‘may be roughly divided into physicians who know a lot but can’t do anything, and surgeons who can do a great deal but don’t know very much.’ Of course, this has changed a good deal. But the poor interne, when he first enters on his service, feels as though he didn’t know a great deal and could do nothing whatever. He approaches patients with fear that they may see through his lack of confidence, and as for the nurses — he knows that they do.

Later, he finds out that they are quite as ignorant as they should be to be good nurses. But, at first, how he marvels at the way they roll a patient over from one side to the other, while making a bed; how they sling a baby across their laps by its legs; put on binders and dressings; and bustle around among the bottles and hypodermics with placid efficiency. If he’s a wise interne, he approaches them modestly, and learns from them. They soon find out whether he knows his business or not. And the coöperation of able young doctors and competent nurses in the care of the sick in hospital wards is possibly one of the most satisfying associations between men and women that exist. It brings out the best in both of them, and a wholesome mutual respect. One soon gets over the ‘ministering angel, thou!’ attitude toward them. The element of grimness in the nature of their occupations diminishes the proclivities toward sentimentality. And they help you out of many a hole.

One of my first jobs in the hospital was to be left alone on a Sunday afternoon in charge of a patient dying of tetanus. Except for hydrophobia, there is no form of death more frightful to witness. I did all I could, but when it was all over I broke down. The nurse, no older than I was, closed the door of the little private room, wiped my face, patted my back, and stood guard until I had myself in hand. I was able to return the favor some time later, when — by an accident that was not her fault, but for which she would have been made miserable by the supervisor (incidentally, most supervisors of nurses get to be little female Caligulas; they must have been nice girls once)—she broke off a glass catheter in the bladder of a fat lady. I spent the night picking it out, and nothing was said.

There was another — a very pretty and well-educated girl of French extraction. She married one of my colleagues, a terrible duffer, and they moved to San Francisco. To her I owe my first introduction to ‘Mireille.’ We had a sick Eskimo in the wards. They all get tuberculosis when they come down here. He was telling us, when we made evening rounds together, that up in Greenland he had eight children. Miss Dubois smiled at me and quoted:

I mention it because it led me to read Provençal, which became the source of much enjoyment.

So you see, I owe nurses a great deal — and not only medical education. To one, I actually owe my life. She nursed me when I had typhus, and kept me from jumping out of a fourth-story window. I had, and retain, a soft spot in my heart for the whole profession, and I do hope they stay as they are —instead of trying to become half-baked doctors.

At midnight rounds, I always got to know the nurses best, for— in the half-lighted wards, with most of the patients asleep and no bustle and disturbance — we could concentrate on the really sick ones. At night, one’s graver and humane qualities seem to expand.

Romance, of course, was not wholly lacking in these relationships, and a number of my friends married into the training school — the courtships carried on under considerable difficulties, since the supervisors, like the wasps they were, had eyes that could look backward. In one case, the entire love story took place on a fire escape in the winter evenings, and the actual engagement, my friend told me, occurred over a sawed-off leg that had been laid there to freeze until a dissection could be made. All through the declaration her eyes were fixed on the leg. In another case, the binding words were spoken in a hot delivery room, while the doctor was holding back the baby’s head and the nurse was wiping his face with a towel. Poor things, they’ve had no baby of their own. On the other hand, I really don’t know whether they wanted one after that.

Far be it from me to make fun of the Law. I am too much afraid of it. Lawyers, except when met at dinner, give me the same feeling I have had on an operating table, just before I ‘went under,’ while I could still see the distorted image of the hooded nurse carrying a clinking basket of knives to the little table next to my ear. When I go to court after driving through a traffic light or having hit someone in the leg or running into another man’s car from behind, — for I am apt to be a little absent-minded when driving, — I go with more terror than I have ever felt on truly perilous occasions. Quite recently I was ‘up’ on one of these charges, with the opposing lawyer a little old man who wore a Prince Albert and a high hat, in which he kept papers, like Lincoln. Fortunately, the case was settled in the corridor outside the courtroom. For just looking at him and into his steely, accusing eyes took any capacity for logical thinking clean out of me.

Felix Frankfurter and other philosophers of the law don’t scare me. It is the practising ones, the ones who get me on what is called ‘the stand,’ ask impossible, unanswerable questions, and then turn to the jury — while one is stuttering either in confusion or in indignation — with a sort of ‘Well, gentlemen, look at this criminal imbecile’ kind of expression. My only consolation on such occasions — a sterile one, I confess — is to think: ‘Would that he could get smallpox or pneumonia and I could see him in consultation.’ As soon as I am out of the courtroom, with my tail between my legs, I usually think of some clever rejoinders that would have made the jury laugh at him. But I have rarely been able to think of the right thing until a little too late under any circumstances.

I never get away with this sort of thing with lawyers because I am always too much rattled. And it is not sordid cowardice. I have been in too many tight places to believe that. It is owing to the early experiences I had with law courts while I was a young doctor, was summoned as witness and made a fool of for no fault of my own but for naïvely thinking that all I had to do was to tell the truth. But I soon gave up the expert business. I was not built for it. I either simply told the truth and was made to look like a well-meaning imbecile, or I lost my temper and was made to appear a malicious liar.

In the ordinary ambulance case, the procedure was always more or less as follows: I had had a two-in-the-morning call to a tenement house on the second floor of which I found a man who had been shot in the chest. He was lying diagonally across a small room lighted by a single gas burner. He was bleeding heavily into his clothes. He also had a scalp wound which bled profusely. My business was to get him to the hospital as fast as possible, after a hasty dressing and stimulation. I got him there alive, and he was immediately taken care of — but he died. The question of murder arose. My cross-examination by the defense followed these lines: —

‘How long have you been a doctor? Do you feel competent to handle cases of this kind? How many windows were there in the room? How many people were there? Do you recognize the two persons sitting on the bench as present in the room that night ? How far was the deceased’s head away from the corner of the bureau? Could his head have hit the bureau and caused the wound in the scalp?’ Etc., etc.

Of course, having concentrated on the job in hand, I had no idea of any of these things. The jury thought I was a poor stick. The lawyer said so.

In the long run, I suppose the methods of the law make for the highest average of justice. At least, I am generous enough to believe so. But queer things will happen.

There was a man by the name of König who ran away with a butcher’s wife. One couldn’t be very severe on her for running away from a butcher. But her choice of a substitute was unwise. König, a blond and stocky ruffian, didn’t love the butcher’s wife very long, and when he got tired of her— perhaps she wasn’t a very nice woman anyway: she looked as though she might not have been — he strangled her to death with a piece of wash line. He must have done it more absent-mindedly than in anger, because he immediately regretted it and stabbed himself in the abdomen in two places with a big bread knife, which I found on the floor beside him.

It didn’t take long to make sure that the butcher’s wife was beyond resurrection. I declared her dead and turned her over to the police. König, however, a tough individual, though bleeding internally, was conscious and still had a strong pulse. There was nothing I could do but stop superficial hemorrhage, put a tight binder on him to discourage abdominal hemorrhage, and rush him to the hospital. It was about six o’clock in the morning and, fortunately, one of the greatest surgeons in New York — Dr. Joseph Blake — happened to be in, looking after a private patient. We got König into the operating room and Blake, with his entire team of expert assistants, aroused for this extraordinary case, did the kind of job for half of which, in private practice, he would have received from five thousand dollars up. König had cut off a slice from one of his kidneys; he had severed his small intestine in two places; and he had penetrated the peritoneum just under the pancreas. Dr. Blake took out a piece of intestine and joined the ends. He stopped the bleeding in the kidney, and sewed up the peritoneum. He cleaned up thoroughly, left in drains, gave the patient a large saline infusion; and König was established in one of the small private rooms off the male ward.

We didn’t any of us expect him to live, but he did, and convalesced in the hospital for about three months, during which he was constantly guarded by bored policemen, who sat in the hall

— costing the City of New York at the rate of twelve hundred dollars a year. After three months, König was fit as a fiddle, and from the quality of his mind I judged ready to murder another butcher’s wife. But he was taken to prison, where—for another long period

— he was fed and tended by the government. About six months after his discharge from the hospital, he was tried, — also at some expense, — declared guilty, and some months later was electrocuted. I had no sympathy for König, but I remember thinking how dreadful to have wasted all that extraordinary surgery. It was an education in criminal sociology that made a deep impression.

Our ambulance district extended from 14th to 86th Street , along the North River, and as far east as Seventh Avenue. It included the old Hell’s Kitchen quarter, perhaps one of the most sordid tenement-house districts in the city and, in addition, two separate Negro districts, one known as’ Buck-Cat Alley,’ the blocks where the Pennsylvania Station and railroad terminals are now situated; the other, ‘San Juan Hill,’ north of 58th Street on the slopes leading down to the Hudson River. In both places, Negroes lived piled up on each other — sometimes six or eight in a single small flat. There were holes through the back fences and between the cellar walls of the houses, so that a Negro wishing to escape from the police could go into one house and come out of another a block away.

It is not a fairy tale that the Negroes are fond of using razors. These were transformed into weapons by folding them over backwards and holding them blade outward in the palm of the hand. With this, they stroked each other’s heads, and the wounds we sewed up sometimes started at the back of the neck and went clean over the top of the head, through the forehead.

They also shot. I once brought a huge buck Negro out of a poolroom, where he had been shot across the table with a .45 army revolver. He was lying on the floor when I found him, but was in perfectly good condition. He had apparently fallen down either from the shock or because, when one is shot, it is a conventional thing to do. The bullet, by one of those fantastic accidents that happen to bullets, had entered the front of his throat, next to the larynx, and had skidded around under the fascia of the neck. I took it out easily from just under the skin of the back of his head.

The defenses of the neck in this respect are extraordinary, if things don’t hit it squarely or with sufficient force. I once had the broken tip of a fencing épöe enter my own neck in the same way, skid around on the fascia, bounce off the sternomastoid muscle, and come out again, without doing any damage to the large vessels.

Sometimes shooting was done with the old-fashioned pocket pistols of small calibre in such a way that the consequences were more amusing than tragic. A little man in one of the Irish tenement houses one evening shot his excessively fat and belligerent wife with a small .22 pistol. He managed to get in five shots before she fetched him a clap with something — I’ve forgotten whether it was a skillet or some other household weapon. By the time I got there, the little Irishman was completely laid out with a scalp wound. His wife said she had been shot twice, in both breasts. There were little holes in her enormous bosom, from which fat-globules oozed. I easily located the bullets, quite close under the skin, but when I had managed to remove these and clean out the wounds in the hospital emergency ward, she said she also had a pain in the place where she sat. Apparently she had stooped over to pick up the weapon with which she laid out her peevish husband, and during that time he had taken another shot. She thought he had kicked her, but here, too, she was well defended and had almost forgotten the episode. She could hardly believe it when I managed to get another bullet out of the padding. It took a lot more trouble to bring her husband back to life.

It was during this time that I also learned that criminals do not like to turn over their personal grudges to the police. There was a saloon on the corner of 45th Street and Broadway which, at that time, was a well-known resort of sporting people — gamblers, race-track followers, and such. Kelly, a policeman whom I knew well, was walking his beat near the saloon one morning at about 4 A.M. when he heard a shot, apparently from the inside of the supposedly closed saloon. He battered at the door of the barroom, was let in by a frightened-looking barkeeper who emerged from the little restaurant next to the barroom, and there found two men and two women, sitting at a table. He thought that he smelled revolver smoke, and as he entered the room he asked:—

’Did anyone shoot a pistol here?’

They all looked at him innocently. Then, just as he was about to leave, one of the men collapsed, and Kelly telephoned for the ambulance. I brought the man to the hospital. He had been shot, apparently, from under the table into the lower part of his abdomen, and although promptly operated on he developed peritonitis. There was very little that could be done for him. His name was Comstock, and he was a wrestler by profession. He had an extraordinary amount of nerve, and, since he was under my care, I got to know him well. The other people at the table with him had been arrested, and a revolver was found under the table. There was no question whatever that the man opposite him had shot him, but when the police and a man from the District Attorney’s office brought his assailant to the hospital and asked Comstock to identify this person, Comstock looked at him earnestly and said that he had never seen him before. He insisted on this, and never weakened. He told me afterwards that if he got well he wanted to get this man himself, and if he didn’t, his friends would do so for him.

XI

R. S., finding that there was no competitive demand for his talents in any of the medical laboratories, established himself, for a time, as a practitioner in New York. He was not a success, though the experience did a great deal to develop his judgment. Yet his heart was never in practice. From the very beginning, he retained a place for work in the laboratories of the College of Physicians and Surgeons, where he was usually to be found when some patient asked for him. When he was telephoned for and conscientiously rushed to his office, he was so obviously annoyed by the interruption that few tried him more than once. That sort of thing doesn’t help. He tells of his brief career as a practitioner: —

For the young physician, there is no more painful experience than the sudden transition from the proud dignity of House Physician or House Surgeon to the desolate situation of young doctor without a practice. Yesterday, he was absolute ruler over two hundred patients. Assistants reported to him, laboratory workers carried out his orders, nurses rose when he entered a ward. There were, in my time, no residents between the Senior Interne and the Consulting Staff, and when the latter had made their daily rounds, the House Physician was the responsible head of an active service. The two happy years over, his last midnight rounds made on the last day of June or December, he woke up the next morning a man without a job.

In my case, I had entered medicine only with the eventual hope of becoming an investigator of infectious disease. But the fascinalion of practical medicine is a powerful one. Once in a hospital, the feeling of power, the contact with patients, the opportunities to console, to comfort, and — not infrequently — actually to help, make a deep appeal to all that is best in youngsters of that age. Moreover, in those days, laboratory opportunities were rare. The scientific departments of medical schools and hospitals were small, and budgets at a minimum. There was room for a very few only; and even if one obtained entrée to a well-equipped laboratory, the wages for a beginner ranged somewhat lower than those of a scullery maid —from two hundred and fifty to four hundred dollars a year.

True to my early determination, I applied for one of these positions in the Bacteriological Department of my old Medical School, which was presided over by two dignified but stern gentlemen known to the students — because of their superior aloofness — as ‘The Jesi.’ The Jesi received me kindly, and after much questioning and careful scrutiny of my record gave me a job representing a good deal of work but no pay. It included, however, a working place, the use of apparatus, and a free hand to do as I pleased in my spare time. Together with this, I picked up another job, which yielded $400 a year in real money, as Bacteriologist to a hospital where I obtained, in addition, the title of Assistant Pathologist, unlimited pathological material, and the instruction of a man who was unusually erudite and a born teacher. These two jobs might easily have filled my time, but I was ambitious— I think quite properly — of contributing more adequately to my own support. For this reason, as well as because of a growing reluctance to lose all contact with practical medicine, I opened an office in West Eightieth Street, together with a classmate, K.

K. was a born doctor. He was somewhat older than I was, and appeared much older. He had the not unimportant asset of a blond moustache that looked as though it belonged to his face naturally, and not like the red and downy stage whiskers that were the best my face could bring forth on one or two vacations during which I had abjured the razor, hoping that I might look more like a doctor. K. was the kind of man to whom patients were drawn in admiring and confiding awe. He has amply proved all this since then, in his large practice in a New England city. Thanks to him, our office started with considerable éclat. Older physicians, knowing K.’s qualities, began to send him patients. What little I had to do, at first, was in the form of laboratory examinations. But every now and then even I picked up a neighborhood emergency or some case that no one else wanted — chronic leg ulcers, delirium tremens, old people without money, and such.

It was dull, keeping office hours. When the doorbell did interrupt my one-handed chess game (I didn’t dare to play the piano), it was more often than not a book agent, or someone visiting my wife, or the grocer delivering vegetables. At first, this was exciting. On the sound of the bell, I would put on my coat, straighten my necktie, and seat myself behind my desk with a serious expression. When it really was a patient, I didn’t believe it until I had him safely sitting in my office, with the door closed and myself between him and the door.

My great fault, apart from my youthful appearance, was my excessive thoroughness. Most patients in those days wanted immediate directions and a prescription, after a bit of conversation. A physical examination they didn’t mind if they felt very sick. But I never let it go at that.

The great Dr. J. had once said to me, after rounds on the private corridor: ‘My boy, you seem to know your stuff; but you’ll never make a good doctor unless you pay a little more attention to the psychology of your patients. Now, that last woman is a damn fool. There’s nothing much the matter with her, but she wants to be taken seriously. All patients, especially women, expect the doctor to act as though they were really sick — but bearing up bravely. Never act as though you took them lightly, and never seem in a hurry. Whatever else you may not do, never fail to sit down in the sickroom as though all your time were for this particular case. Pat the hand, and say “Brave little woman,” or something like that. Act thoughtful; and if you don’t know what to say, say nothing; but say nothing deliberately and slowly, with an air of withholding a great deal. Then give them a good overhauling, with a lot of laboratory examinations.’

This might have worked with the Fifth Avenue practice that crowded Dr. J.’s office. It is also possible that I overdid it. Anyway, I lost the few good patients that were referred to me, by just this technique.

First, I sat them down and looked at them penetratingly. Then, pad in hand, I began to ask them questions. The patient might be bursting to tell me about a pain in his foot. ‘Just a minute, just a minute! We’ll get to that presently,’ I’d say. Then, still fixing him with an accusing eye, I’d begin to ask questions. ‘Taking the history,’ we called it.

‘How old are you? What is your occupation? Were your parents healthy? Is there any tuberculosis in your family? What did your father die of? And your mother? How old were they when they died? Have you any brothers or sisters? Are they healthy? Have you had any children? Are they healthy? Have you ever had any venereal disease? What! Are you sure? Do you drink? How much? Do you sleep well? How is your appetite? Do you sweat at night?’

By this time, many of them showed signs of fatigue or indignation. Some of them asked for a drink of water. But I gazed at them with disapproving severity, and began on their childhood.

‘What diseases did you have as a child? Were you precocious? Did you ever notice any swollen glands in the neck? Were you premature? Did you ever have a rash on your skin? Do your bowels move regularly? Do you have to take medicine for it? What do you take? Do you suffer from colds? Do you cough in the morning? Do you bring up anything when you cough? Do you have to get up at night?’

All the time, I was taking notes. If any of the answers were unfavorable, I would appear to prick up my ears— the patient could see it in my face. Some began to look anxious. One got up and left at this point, the best prospect I had — she had driven up in a victoria. Old Dr. ‘Monkey’ Jackson had told her I was a very thorough youngster. She believed it, but didn’t like it in practice.

Those tha 1 lasted thus long I would then proceed to examine. First, down the throat with a light and a hand mirror. The tongue was pushed down. ‘Say Eeech!’¹ They gagged. Then into the ears with a speculum. Then up the nose, ditto. And the ophthalmoscope!

I was proud of that. It had cost twentyfive dollars, and I could see the eye grounds with it. It might disclose bad kidneys, or diabetes. Then, ‘Will you undress, please?’ The heart —thump, thump! I outlined it with a blue pencil. The stethoscope. No murmurs. The lungs. ‘Say one, two, three. Again! Whisper ninety-nine, ninety-nine. Well, fine! That’s all right.’

‘ But, doctor —’

‘Lie on this couch, please. Pull up your knees.’ I percussed the liver. I pushed for the spleen. I palpated the gall bladder, and McBurney’s point, and the ovaries.

‘ Does that hurt ? ‘

‘You push so hard, doctor.’

‘You can dress now. But first, step behind that screen and let me have a specimen of the urine.’

Meanwhile, I’d be getting my things ready to take blood. A drop from the ear, for cell counts and a differential. A syringe, for the vein. I had just learned to do the Wassermann reaction. It was great fun, and I was proud of it. Every case must have a Wassermann done. No one tells the truth about such things.

Few lasted through. Those few got their money’s worth —largely, perhaps, because they never paid my modest bills. Most of them walked out at one stage or another, because we didn’t, get down to the sore foot. Some even slammed the door as they walked out.

This was unquestionably the wrong technique, certainly for a young practitioner. K. was wiser. He allowed the patient to unburden himself, asked a few pertinent questions, examined as far as necessary, and prescribed.

Some years later, in a very busy office in a provincial town, a colleague showed me a large bottle into which all the left-over remains of dispensed mixtures were spilled together. In that town, twenty years ago, the doctors still dispensed their own medicines. The big bottle was marked ’Bill Kelly,’ after a patient who was an insatiable medicine tippler. When anyone who had nothing obvious the matter with him, but had a lot of symptoms to show for it, came in, he was given a four-ounce bottle filled from Bill Kelly,’ to take a teaspoonful three times a day, after meals. It tasted atrociously and, of course, was different every day. But it cured a lot of cases.

Apropos of medicine tippling, the elevator boy in my apartment house, who also cleaned out the wastepaper baskets, used to take all the medicines that came to me from drug houses as samples. I found on one occasion that he had swallowed a quart of a preparation that was recommended for irregular menstrual periods. He said it made him feel fine.

We ‘fired’ a Negro cook at this time who left behind such a dirty kitchen that, being still young and helpful, I decided to clean it out myself. In a closet I found a whole case of empty bottles labeled: ‘Stimulates the reproductive organs and prevents tumors.’ It smelled like bad whiskey. Thus have some of our largest American fortunes been acquired.

The old practitioner adapts his method to the situation, with psychological insight. Dr. J., who gave me all that advice about making a big fuss over every patient, did not follow this out with all of them by any means. His assistant, who occasionally sent me a case, told me of an old lady who had come to Dr. J. faithfully, twice a year, for twenty years or more. When admitted to the inner sanctum, she never gave the doctor a chance to say even ‘How do you do?’ She burst into the room with a ‘Now, doctor —don’t move. I don’t want you to examine me. Don’t ask me any questions, Just write me a prescription for that brown tonic you gave me last year.’ She always got it, paid her money, and went out satisfied. Another, a younger woman who adored Dr. J., — as most of them did, — he dismissed one day, after a short conversation and a look at her tongue, saying: ‘Don’t worry, my dear. You’ll be all right. Just keep your bowels open and always wear mauve.’

I might, of course, have learned this sort of thing if I had stuck at it long enough. But in the two years that I was a private practitioner I never got over the fear that if I didn’t go into every possibility I might be overlooking some hidden danger that hung over my patient’s unsuspecting head. And often the patient, who may have come in for the simplest kind of advice, sensed my own nervousness and rushed off to another physician for just the kind of overhauling I was about to give him.

Nevertheless, my method was professionally correct— if I had only been more adroit about it. It certainly saved me from the kind of thing that happened to a friend of mine who leaned rather too much toward ‘snap diagnosis.’ A middle-aged man, a coachman, came to see him one day, complaining of a stiffness and soreness in the throat. My friend looked into his mouth, saw a little redness, and prescribed a gargle. The next day the man was back. His throat was still sore, and much more stiff on swallowing. Again the look in, a painting of the throat with iodine in glycerine, and a reassuring pat on the back. Two days went by, and back came the coachman. This time he said he had difficulty in opening his mouth for examination. ‘You know, doctor.’ he said, ‘if you didn’t say I was all right. I’d think I might have lockjaw.’ ‘Good God, man!’ cried my friend in consternation. ‘Why didn’t you tell me that in the first place?’

I had had, as I have elsewhere recorded, a not inconsiderable experience in acting as master of ceremonies at the ‘coming-out parties,’ one may call them, of unfortunate infants into a world that had little to offer them except squalor, hardship, and defeat. Of course I thought occasionally of Benjamin Franklin’s often quoted remark when he answered, ‘What good is a newborn baby?’ to a Philistine who questioned the value of an apparently useless scientific observation. But I thought progressively less of the wisdom of this rejoinder as I learned to forecast the futures of these babies by increasing familiarity with their elders, born under the same handicaps of heredity and environment. It started me on my way to becoming a confirmed advocate of birth control. And I never hear of the birth of a child among my acquaintances that I don’t wonder, in each case, whether the parents have performed a useful service or committed an act of criminal negligence.

When one reads Malthus — whom far too few read — one learns that unobstructed nature attempts automatically to regulate the numbers of its living creatures in various ways. And when man takes charge of the breeding of domestic animals he proceeds, if not always scientifically, at least with the planned wisdom of the husbandman, adjusting numbers and improving breeds for specified purposes. Only for his own species he leaves the most important biological responsibility, over which he might have control, to blind instinct and accident.

I have often been struck by this contrast between man’s wisdom with animals and lack of it with his own species at hunt meets, where one sees underbred people sitting on the noblest horses. Sensible attention to these matters in families is rare. One of the few cases I can recall is that cited by Malthus, who says that ‘the ancient family of Bickerstaff . . . are said to have been very successful in whitening the skins and increasing the height of their race by prudent marriages, particularly by that very judicious cross with Maud, the milk-maid. . . .’ It would be interesting to suggest to sociologists and anthropologists, who are always looking about for some fulcrum on which to brace their statistical crowbars, that they investigate this matter. It is fair betting that they would find the highest physical and possibly intellectual averages among families that could show a relatively recent bastard or two in the family tree.

There is really no valid argument against birth control. The encouragement of mass propagation in dictator countries is too admittedly based on the most barbaric and militaristic motives. The objections of the Church, though often laid to abhorrence of ‘unnaturalness,’are really on a much higher moral plane, but so illogical for the modern world that even the Catholic Church is beginning to weaken by acceptance of adjustments of intercourse to the œstrogenic cycle and the ‘safe’ period between menstruations. Some of the best work on this problem is, as a consequence, being done by Catholic physicians. As to the purely ‘moral’ arguments, no intelligent person, nowadays, advances them without his tongue in his cheek. There is no historical evidence that, after two thousand years of Christianity, the fornication index of populations has materially declined under that of ancient Greece. And when Martin Luther laid down the rule,

‘ Zweimal die Woche macht Hundert und vier,’ he was encouraging human frailty in a manner that surely defeats in principle the only completely moral form of birth control which the Church is said to sanction.

As far as comparative morality is concerned, what can be more immoral than to put children into the world that are unwanted, that cannot be properly nourished, cared for, educated, and otherwise inducted into life with a reasonable expectation of happiness and usefulness? What can be more immoral than to give a woman the grim choice of being physically destroyed and deprived of strength and leisure for anything but the animal functions she shares with the cow and the cat, or living an asexual life that either produces the bitter, frustrated spinster or sends her well-to-do sisters to Austen Riggs in Stockbridge?

Not even the argument that the free dissemination of birth-control information would tend to lower the selective propagation of the better genetic material in favor of the worst has any scientific justification. The human race is so ‘crossbred’ that eugenic experiment is bound to fail. In animal breeding, we can ruthlessly eliminate all but the perfect sires and dams and can breed for particular characteristics — such as long ears in dogs, speed in horses, or milk production in cattle. In man, with his forty-eight chromosomes, each with its mosaic of genes, the problem is far too complex for practical application, unless we could keep a selected group of couples in corrals and inbreed them, during a century or so, for some special characteristic like tallness, long-nosiness, cupidity, or bad temper. Those who advocate eugenics have limited themselves, quite wisely, to the negative idea of elimination by breeding away objectionable or abnormal characteristics.

Mohr, who is very learned in these matters, refutes even this prospect (the hope of the sterilizers, one of whom — Lenz — he quotes as making even ausgesprochene Hässlichkeit a cause for gelding) by quoting an example based on the calculations of Hogben. Albinism, lack of pigmentation of the skin, is a recessive anomaly that has an incidence of less than 0.01 per cent. In this case, the heterozygous offspring carry the characteristics. By this is meant that even those who appear normal may contain the latent albinic ‘recessive gene’ and transmit it. Thus, as Hogben figures, if all the obvious albinos were sterilized ‘in every generation, it would require a period about equivalent to the Christian era to reduce its incidence to one half the present dimensions.’ And that holds good for all recessive characteristics. The best we can do is to continue the study of human genetics, and discourage the marriage of individuals with recognized dominant defects as these are revealed as ‘dominant’ by statistical study of observed cases.

The dominant nature of defects in man can be determined only by the observed results of accidental matings. Among these, Mohr has studied cases in which the woolly, crinkly hair type was dominant over the soft, straight hair. In one Nordic strain, he observed this through five generations. In one of these a heterozygous woolly and short-haired woman, mated with a soft-haired husband, gave birth to three woolly and three soft-haired children. Another instance of a dominant human characteristic, cited by him, is a family afflicted with hereditary short-fingeredness, traced back six generations to a Norwegian woman whose ‘every second child had — like herself—a shortened or curved forefinger, with one joint only.’ Genetics may eventually give a rational basis for mating. But even then it will meet the ancient obstacle, — long encountered by the proponents of reason in mating,—the heavenly madness, love.

The natural checks of population, to the study of which Malthus devotes his first two books, ‘result principally,’ he concludes, ‘from an insufficiency of subsistence.’ The age of chemical and physical discovery which developed industry and agriculture to a degree unpredictable in the eighteenth century has neutralized these natural ‘checks’ so that for a century they have given a negligible slope to the rapidly rising curve of reproduction. In consequence, as Professor East — among others — has shown, the population of the world has increased, during these hundred years, by an increment never before attained. Now again a point has been reached at which the two forces are more equal and the curve flattens. And such flattening, if maintained, seems our only hope for the eventual subsidence of international rivalry, nationalism, and war.

It is interesting to contemplate whether we may now hope to pass into an era in which biological discovery may take a hand in the situation and correctively modify the purely material and industrial civilization of the last generations. Let us consider the stupendous consequences which might result for world economy if we could precisely establish a non-fertile period in the monthly cycles of women, a principle of birth control now accepted as permissible by the Catholic Church and at the disposal, without expense or appliances, of all women. My experience of women, even the poor things in the slums, is such that I do not question for a moment that such knowledge would automatically limit a large percentage of families to the number of children that could be properly taken care of — even if dictators ranted and the men in general knew nothing about it. The spirit of Lysistrata is more alive today than most men suspect.

XII

However, all this has led us far afield from my own practice. I had, as I said, done my reluctant duty as an accoucheur for a considerable number of ambulance and hospital babies, and felt that I had mastered at least the first principle, the Fabian strategy of ‘watch and wait,’ with reasonable skill in the rudiments of manipulation. There is quite a difference, psychologically at any rate, — which the institutionalized doctor will never understand, — between that sort of thing and handling one’s first private case.

Obstetrics is not the pleasantest of medical occupations, although it pays well and is one of the things that the young physician with any kind of practice can count on as a financial backlog. Yet it takes a great deal of time and means a lot of night work. While the statement may not be statistically correct, it does seem to the medical man as though the large majority of all babies were born at night.

An observant medical student in my class once asked one of our instructors about this. ‘Dr. V., why is it that most children are born at night?’

Dr. V., who was something of a wag, replied: ‘Well, my boy, that’s simple. It takes just nine months.’

Helping babies into the world was becoming more and more of a specialty at the time that I started to practise, and most physicians, after they had attained the financial security in which they could begin to pick and choose, referred their obstetrical cases either to a specialist or, if among the poorer classes, to a young colleague who needed the money. Some of them gave up obstetrics purely for reasons of convenience. Old Dr. T., famous as one of the last physicians in New York, who made his reputation largely by giving his patients the most extraordinary doses of assorted drugs, once told me why he gave up obstetrics as a young practitioner.

‘When I was a young man,’ he said, ‘I took everything that came along, just as you will, and I got quite a reputation, among other things, for my skill as an accoucheur; but I gave it up because it didn’t pay. Let me tell you about my last case. I was up all night with a primipara, and things went very slowly. The baby finally came along about nine o’clock the next morning, and when I got things tidied up I went home. I had just had my place redecorated, because I was going to get married: new plaster, wallpaper, and a complete set of furniture downstairs. All this had cost me my savings. I went upstairs to run a bath, and when I had turned on the water I stretched out on the sofa until the tub should fill up. The next thing I knew was a crash. The bath water had run over. The water leaked through the ceiling, the ceiling came down, water splashed the walls — and the place was a mess. It cost me ten times as much as I collected. From that moment, I never took another obstetric case, and if I ever get any referred to me — which is now unlikely—I will send them to you.’

At about this time I was making periodical visits to a well-known hospital for the mentally diseased in order to pick up what I might about advances in psychiatric practice. It seemed to me that were I destined, by lack of opportunity in my chosen field, to continue for some years in private practice, it was essential that I learn more about the manifestations of mental derangement in my fellow beings. For though I had not yet met Dr. Thomas Salmon, who later called attention to the importance of the study of the so-called ’borderline’ cases, I was already impressed by the large number of people in my personal and professional acquaintance who appeared to me — at least—quite unable either to think clearly or to hold their emotional impulses within the pendulum swings of average excursions.

At the hospital, under the guidance of my friend the director, I saw a great many instructive cases, but was particularly interested in those who differed only in degree — and then only moderately — from a number of people whom I prized as friends, possibly because of the momentary deviations from the norm which they represented. Most especially was I impressed by a few whose insanities took the forms of ambitions and desires which in our society are regarded highly praiseworthy if based on factual circumstances instead of imagined ones. There was one group of patients who have stuck in my mind, since between them they enacted a satire on the civilization of our times which could not have been more effectively staged by a Swift or a Voltaire.

There happened to be in the hospital, admitted within a few months of each other, three patients of well-to-do families who, before admission, had been engaged respectively in the law, in the wholesale fruit business, and in shipping. The lawyer had delusions of persecution, which, however, had not affected his professional memory or technical knowledge. The merchant had the delusion that he owned all the dried apples in the world. The shipper thought, quite without justification in fact, that he had cornered all the world’s steamship lines and was in practical control of the globe’s entire merchant marine.

A clever young interne had considered these cases and, since there seemed no hope of permanent cure for any of the three, concluded that the poor fellows should be at least made as happy as possible. Accordingly, since all three of the patients were well off and their families quite willing to spare no expense, he brought the three together, furnished an office for them, and encouraged them to do business. A highly satisfactory arrangement resulted.

The fruit man kept books on enormous stocks, shipments, and sales of dried apples. The shipper agreed to carry these apples to all corners of the earth on his fleets; and the lawyer was kept busy drawing up contracts between them and attending to disputes that naturally arose in the course of this gigantic commerce. I found them, on numerous visits, exceedingly busy with accumulating files of transactions and records of great profits which made them all happy and complacent. They always received me with the ill-concealed impatience of men too busy with important affairs to have much time for idle conversation, but were never unwilling to explain the world-wide expansion of the dried-apple business, especially when I consulted them about the possibility of opening some new market for this commodity in territories like Abyssinia or French IndoChina.

Soon after one of these visits to the hospital I attended a dinner at which there were present several bankers, a very wealthy manufacturer of buttons, and a corporation lawyer. They made the usual kind of speeches and when the button manufacturer, who came last, was almost at the end of his discourse, I had the misfortune to think of my three crazy men and was taken with such an uncontrollable impulse to explode into laughter that — to save my dignity — I had to make a quick exit. These men were spending this one short life vouchsafed them by Providence in exactly the same way as my three friends in the asylum. The only difference between them and my patients was that the latter seemed to enjoy their occupations, while these princes of finance were worried and anxious.

One of the most beloved and distinguished figures in the New York medical profession at this time was Abraham Jacobi. He was one of the first great children’s specialists in this country, but was honored by the German-American community of the city not only for this but because of his record as a courageous revolutionist who was said to have had a hand in the escape of Carl Schurz from a Prussian prison. He was a very small man with an enormous bearded head and was sometimes spoken of as ‘The Jewish Jupiter.’ Even in the later days of his practice, when all the medical honors at the disposal of his colleagues had been heaped upon him, he maintained free office hours for the poor. In our family he was regarded as a sort of benign deity who took care of the children and remained their friend as they grew up. I owed him not only early physical care but many acts of kindness, especially during the time when he was visiting physician to the children’s service in a large hospital in which I was the interne in charge of his ward. One of his most engaging qualities was a quaint sense of humor.

He was so kind that people often imposed on him, stopped him on the street and asked him for advice. Naturally he got tired of this, and the following story is told of him in this connection: —

On one occasion a man whom he knew only slightly accosted him on the street and said: ‘Dr. Jacobi, I know you are busy, but I, too, am a very busy man. I have got a little sore throat this morning, and wonder whether you would take a quick look at it to see if there is anything I ought to do about it. Maybe you will look at me right here on the street.’

Dr. Jacobi smiled at him and said: ‘All right. Come over and lean against this lamppost. Now open your mouth, close your eyes, and stick out your tongue.’

Then he walked away, and when he reached home said: ‘I guess the damn fool is standing there yet.’

Early in my medical career I developed a deep and lasting admiration for the old-fashioned, self-reliant country practitioner, the ‘horse and buggy doctor’ so sympathetically described in the recent book by Dr. Hertzler. While a medical student in New York, I was accustomed to recuperate from strenuous days and nights under a lamp by spending occasional week-ends on my father’s farm in Westchester County. I slept in a cold house, with a wood stove in my bedroom, stoked till the lid glowed red, with my collie dog keeping my feet warm. All day and into the night I would ride the horses — each one in turn — across country over the snow-covered hills.

Those were unforgettably lovely vacations. The utter loneliness of the big house (the farmer lived at the other end of a beech wood), the nights silent except for the cracking of the frozen branches of the big trees in the wind, the brittleness of the air and the incandescent brilliance of the stars! And the rides! Physical fitness that could spend itself on three successive unexercised horses, and the spiritual peace that only a good horse or a small boat at sea can give — the white landscape, woods and fields crisp, cold, and lifeless except for the silent testimony of tracks in the snow, an occasional squirrel and, once in a while, a flock of crows angrily clamoring away from a leafless perch. I knew all the paths and openings and the hidden spots in the birch woods where, in the summers, I hunted birds; where the foxes went to earth; and where, among the big rocks on Piano Mountain, one could get a glimpse of the Hudson.

I still remember those rides as among the happiest gifts of a Providence that has been munificent. Often, galloping through the fields and across the hills between snowbound villages, I would see far off on the valley roads the familiar ‘cutter’ sleighs of our local doctors — Jenkins and Hart — answering calls that often meant hours of driving and small fees, irrespective of roads or weather, with an unfailing and expected fidelity not demanded of the rural delivery. Sometimes I would meet one of them, whiskers frosted, nose red and dripping, with not much more showing than these between the fur cap and the muffler.

Always they stopped for a chat, to tell me about the case and exchange medical gossip — they treated me as a professional equal who was getting things they wished they had time to catch up with. For their difficulties made them modest; whereas I, with the arrogance of a young and silly student (arrogance, being a state of mind, I have noticed is always intensified by sitting a horse), was just a trace patronizing. I lost all that as a matter of course when I tried to practise by myself. But a good deal of it was jarred out of me by the episode of Dr. Kerr.

Dr. Kerr is now dead. He is probably forgotten by all but a few old farmers’ wives. He had neither fame nor more than a frugal living. He was probably unhappy, while he lived, not for the reasons mentioned, but because he never could do for his people as much as he wanted to do. He practised in St. Lawrence County, near Chippewa Bay. His office was a little surgery extension of a small village house. He was tall, thin, and very dark, with hairy wrists, a big nose, a bushy moustache, and kind, sloppy brown eyes.

I was camping on my island in the bay and was known to the grocer in the village as a young doctor from New York. One day at about 4 a.m. a motorboat approaching my island aroused me and the grocer’s son shouted through the fog and drizzle that Dr. Kerr needed my help in a difficult case. He landed while I dressed, and we were off four miles to the village. There Dr. Kerr was waiting for me with his buggy.

I had never seen him before and he impressed me, in my young self-confidence, as probably a poor country bonesetter whom I should have to show how a case should be handled. This, however, lasted only until we were bumping along a muddy country lane and he had begun to tell me about the patient.

It was a woman, a farm hand’s wife, who was having her first baby. She had developed eclampsia seven months along, and the child had died. She was having convulsions. The problem was to deliver the dead baby from a uterus with an undistended cervix, and the mother dangerously toxic. At this point, I was thoroughly scared. I had had training at the Sloane Maternity, but this was a ‘high forceps’ under difficulties, a case for Professor Cragin in a well-equipped operating room, with an assistant and two or three nurses.

We drove about four miles into the river flats. I could see the little unpainted cottage next to a haystack a mile away. I offered no suggestion while I was trying to recover my old ambulance courage. He didn’t ask me any questions.

The place was a picture of abject poverty. The husband, a pathetic little bandy-legged, redheaded fellow in torn overalls, was waiting at the door, anxious and silent. The kitchen was a mess from his efforts at housekeeping. In the next room the woman, halfconscious, her bloated face twitching, lay on a dirty double bed, on a mattress without sheets under an old quilt half kicked off, leaving her almost naked.

While I stood looking at her with frightened sympathy, Dr. Kerr unpacked his bag. Without asking me to do anything, he filled a wash boiler with hot water from a kettle, added a little lysol, and put on his forceps to boil. Then he took off his coat, rolled up his sleeves, filled a basin, and began to soap and lysol his hands. Not until he was doing this did he speak.

Then he began to give me directions. In a few minutes I was cleaning up the patient, spreading clean towels under her, preparing a chloroform cone and jumping at his words as though in Dr. Cragin’s clinic. With no essential help from me, he performed as neat a cervix dilation and forceps delivery as I had ever seen. When, after the long and arduous task, with everything complete as possible, he began to clean up, he didn’t even thank me. He took it for granted that, being a doctor and being in the neighborhood, I was on call. It was his only compliment, except for a friendly smile.

He asked me to stay there the rest of the day while he made his rounds, gave me a few directions, and left a sedative. Then he went out, patted the husband on the back, and drove away. The woman recovered. Dr. Kerr, I heard later, spent the first two nights after this on a rocking chair, drinking cider with the husband, and napping when he could. His fee, I also heard, accepted to please the husband, was a peck of potatoes.

Some time later, I had occasion to ask him to open a boil on my neck. He sat me down in a chair, wiped my neck with alcohol, took a knife out of a little leather case, wiped that with alcohol, and let me have it. I made no suggestion whatever. I saw him often after that, and I sincerely hope — even now — that he liked me.

One of Dr. Kerr’s colleagues from up near Ogdensburg, whom I had met at this time, did a most extraordinary thing. I met him on the river one day when we were both fishing off the head of Watch Island. Just as I came in sight of him as I rounded the point, he pulled out a magnificent pickerel.

‘Good for you, doctor!’ I shouted to him.

‘What d’ye think, young feller?’ he called back. ‘I caught that fish with a nice fat appendix I took out this mornin’.’

Speaking of Dr. T. reminds me of a case in which I was credited with saving a life under peculiar circumstances. While I was House Physician at the hospital, during Dr. T.’s visiting period, we had a poor fellow on the male ward who appeared to suffer from advanced nephritis. Dr. T., as I have remarked, was a virtuoso at compounding drugs. During his short annual reign of three months, the order sheets of every patient were covered with the red ink in which medication orders were entered. They got something or other ‘t. i.d.’ (three times a day), other things with meals, something else on waking up, another before the lights went out, and a few odd pills or injections ’p. r. n.’ (pro re nata). Many of them had to be waked out of sound sleep to get one of his ‘black draughts’ or ‘blue pills’ or ‘brown decoctions’ — all of them proudly originated by the Chief himself, and most of them quite complicated with strong medicaments.

The particular old boy of whom I write was getting a formidable sequence of daily doses and was slipping out of our hands — taking it patiently, with good humor and courage. We all liked him, and during his month on the ward he became a favorite. One night, when he was pretty low, I was making my midnight rounds with the ward nurse. We stopped at his bed and held a whispered conversation. He was in bad condition, the nurse said, and she didn’t think he’d last long. She hated to force all that medicine down his throat. It bothered him and didn’t seem to be doing him any good.

‘All right,’ I said. ‘He’s going to die soon anyway, and we’ll stop all medication. Just leave the orders on the chart, and we’ll steer the old boy around him as well as we can. Give him anything he wants to eat, within reason, and a shot of my Scotch when you come on at night. I’ll bring you a bottle. He might as well die happy.'

From that moment, our friend began to improve. Pretty soon, by respectful and adroit suggestion, I arranged to have official sanction for the omission of one pill and ‘draught’ after another. In two weeks our patient began to sit up in bed for extraordinarily hearty meals. In three weeks he was up — his old self, he said. In four, he was out and I forgot about him.

The sequel came one Sunday afternoon during the following winter, when I was sitting in my office. The doorbell rang, and in walked a short, fat, ruddy man of about sixty, behind him a shorter, fatter, and ruddier boy of twenty or so. Neither of them did I recognize. Yet the older man stuck out his ham of a hand and said: ‘God bless you, doctor, how are you?’ Then I suddenly remembered him. ‘I hope you’re not sick again,’ I said.

‘Oh, no, doctor! I’m fine. I just brought in my son’ (who, apparently in the horse business, was embarrassedly rolling a flat-topped derby in one hand while he kept adjusting a white piqué tie with a horseshoe pin) ‘to show him the man who saved my life. You remember, doctor, that night in the hospital when I was nigh dead? You came around about midnight with the nurse. I was feelin’ awful low, an’ everybody thought I was goin’ to die. I was thinkin’ so my own self. You thought I was sleepin’, but I wasn’t. I was just pertendin’. You had a long talk with the nurse in front of my bed an’ then you give her some orders. From that minute, I begun to mend.

‘This is the man, my boy, as pulled your Pa out of the claws of the Reaper,’ he said poetically.

XIII

I was at that time beginning to become deeply interested in that disease which is called by a venerable French writer ‘une punition divinement envoyée aux hommes et aux femmes pour leur paillardises et incontinences désordonnées’; by Sytz of Pforzheim, on the other hand, ‘die bösen Franzosen’; and by Goethe, with his prophetic vision,— considering the wormlike appearance of the Treponema pallidum, — ‘der Wurm in der Liebe.' I was to spend a number of subsequent years on this malady, in an effort to gain insight into the properties of the strange microörganism which the great Schandinn had discovered. For the time being, I was engaged in introducing the so-called ‘Wassermann reaction’ into the laboratory practice of St. Luke’s Hospital. This reaction, in its original form, was based on a principle too technical for these pages, established by the Belgian bacteriologist, Bordet, and taught to me, out of the kindness of his heart, by my friend Noguchi, in whose room at the Rockefeller Institute I sat for hours to pick up what I could. According to the old technique, one of the reagents required for this reaction was tissue from heavily infected syphilitic organs. And the most heavily infected organs known to medicine are those of stillborn, syphilitic babies.

Accordingly, I had a standing order at the Sloane Maternity Hospital that syphilitic babies were to be kept for me. And whenever one of these coveted treasures appeared it was put into a large paper bag on which my name was written, and I was notified by telephone. I would then stop at the hospital on my afternoon journey to St. Luke’s, tuck my prize under my arm, and proceed.

On the occasion of which I write, I received the happy news that ‘one of your babies,’ as the facetious head nurse called them, was ready for me. I was just about to leave my laboratory for a luncheon meeting of the newly formed Society for Cancer Research, which was to take place at a downtown hotel. It was only natural, therefore, since I was due at the hospital after this meeting, that I should stop to pick up my baby and take it to the meeting with me.

The society was not a large one. At the hotel, therefore, a convenient bedroom had been assigned for hats and coats. Arriving late, I shoved my paper bag under the bed, laid hat and coat on top of the bed, and went to my place at the table. It was not a very thrilling meeting. There were hardly any ideas, and those there were were neither new nor very intelligent. But I was very young, and proud of being present; and I listened to every word spoken by my elders with hopeful attention. One or two of the speeches were needlessly long, and when the meeting broke up I found that I was at least an hour behind my usual schedule. I rushed to the improvised cloakroom, picked up my hat and coat, and ran out to the subway. I had an incubatorful of work waiting for me, an autopsy to perform, and cultures to examine. Toward the end of the afternoon, an interesting case turned up on one of the wards, and I was asked to make several examinations, including a blood culture. It was not until 8 P.M. that I got home to a late supper, and not until 8.15 that suddenly, gazing into my soup, I exclaimed, ‘Good God — the baby!’

When I remembered that my name was plainly written on the bag, I began to sweat. My appetite left me. It was not easy to decide what to do. I still remember to this day the number of the room. It was 217. I couldn’t very well call up the clerk and say: ‘Look here — I forgot a dead baby under the bed of 217. Take care of it for me.’ If I went down there, what could I say? On the other hand, I couldn’t very well leave the baby where it was, if only for æsthetic reasons. Yet if my name — good God! — had not been on the bag, this is what — in the state I was in — I might have done. It would have made a first-rate police mystery, and in the end, with sufficient publicity, might even have proved amusing. However, my name was on the bag. By this time it was 8.30.

I got into a cab and went down to the hotel. It needed all the little courage I had left to address the room clerk. I tried to be what is called nonchalant.

‘I wonder whether you could let me go up to room 217,’ I said to the young man at the desk. ‘I was at the cancer meeting today, and I left something behind when I took my hat and coat out of that room.’

The clerk, I thought, didn’t seem to like my looks. Perhaps it was just my nervousness. He said that if anything had been left behind it would have been reported by the chambermaid who had cleaned up. What was it I’d forgotten, anyway? ‘A package, ‘ I called it.

‘Hey, Miss White,’ he called over his shoulder. ‘Was a package reported left in 217 this afternoon?’

Miss White, who sat behind a glass partition, fumbled about in a pigeonhole, read three or four paper slips, and said: ‘No. Nothing reported to me.’

Could I see the chambermaid? It was a very important package.

‘She went off duty at seven. Back in the morning.’

Could I go up and have a look around the room?

‘The room’s been taken.’

Could I ask the people now in it to let me look around?

He guessed ‘they went out to the theatre. Young couple from Milwaukee.'

I had not stopped sweating, but now I sweated harder. The clerk looked at me suspiciously, I thought. ‘May I ask who you are?’

I told him. I looked pretty young for a doctor. Obviously, he didn’t believe me.

‘Do you mind if I call up the room and see if they’re in?’

Reluctantly, he consented. The name was Richards.

‘Hello, is this Mr. Richards?’ I asked.

‘What do you want?’ answered an excited voice.

Here I made another mistake. I should have explained what I wanted; but all I could think of was to get into that room.

‘May I come up to see you a minute?’

I heard a whispered conversation, ‘Ask him who it is,’ then: —

‘Who are you?’

‘You don’t know me.’ I said the wrong thing again. ‘I just want to see you a minute.’ The man hung up abruptly.

‘He told me to come up,’ I reported to the clerk, and went right up. I didn’t bother about the elevator, and I went three steps at a time. I knocked at the door of 217.

‘Who’s there?’

‘It’s the man who called you on the telephone.’

‘What do you want ?'

The door was opened a crack and I saw the pale face of a frightened man with a chin beard. I shoved my foot against the crack. He pushed, but couldn’t close the door.

‘Better let him in, Frank. We can prove we’re innocent,’ I heard in a woman’s voice.

We stared at each other through the crack. ‘Stop pushing,’ said the man. ‘Don’t resist him, Frank’—the woman’s voice. Frank weakened. The door opened, and I slipped in.

On the bed sat a stout woman in a kimono. She was quite handsome, I noticed later, but now there were signs of recent tears and her hair was in disorder. She stared at me. At her feet on the floor was my bag. She looked at it and shuddered.

I turned and closed the door. The bellboy had followed me up. I could hear him in the hall. As I turned around, the husband confronted me. He was in his shirt sleeves, suspenders hanging. His chin whiskers stood out like the hair on the back of a frightened cat.

‘Look here,’ he said, ‘we can explain all this, though you may not believe it.’

‘Good Lord, man, there’s nothing for you to explain.’

They hadn’t seen the name on the bag.

‘Do you mind if I sit down?’—my knees were shaky. I told them my story. As I told it, I could see them gradually relax. Then, as I finished, Mrs. Richards began to laugh. First she laughed silently, with her face only. Then she began to make a noise, and the laughter spread down to her shoulders and chest. Then her whole body began to laugh, and she shrieked. She fell backward on the bed, writhing and shaking as though in a convulsion, stuffing the pillow into her mouth. Then her husband began to laugh. He leaned against the door, and his big shoulders made it rattle. At first, I didn’t know whether to laugh or to cry. Then I laughed. We tried to speak, but we couldn’t. There were tears in our eyes, and every time one of us stopped laughing, the sight of the others started it over again. Finally, we recovered, and Mr. Richards ordered a round of highballs. When I left, we were old friends; but every time they looked at me, they started to chuckle.

As I walked out of the hotel with my ‘package’ under my arm, I felt the clerk’s eyes boring into my back. But now I didn’t care. I took the subway to the hospital, clutching my baby, and — once there —I put it into the ice box.

I heard from the Richardses a year later. They had a real baby of their own. I still hear from them from time to time. They are among my most grateful patients.

My private practice did not grow. At the end of the first year my collections had amounted to about eleven hundred dollars, my uncollected bills to almost the same sum. My expenses had been about six thousand. Probably I should never have made a successful practitioner. My heart was in the laboratory. And when I was offered a full-time position in the Bacteriological Department of the University, I jumped at the chance, and felt that my true career had begun.

(To be continued)

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