a house-surgeon at a great accident hospital in the east of london happens upon strange scenes, some pathetic, some merely sordid, together with fragments of tragedy in which the most elemental passions and emotions of humanity are displayed. the chief place in which this experience is gained is the receiving room. i speak of a hospital not as it is now, but as it was some fifty years ago. the receiving room is a bare hall, painted stone colour. it contains as furniture rows of deal benches and as wall decoration a printed notice, framed and glazed, detailing vivid measures for restoring the apparently drowned. below this helpful document is fixed an iron-bound money-box. there is, moreover, a long desk in the hall where entries are made and certificates and other papers issued. as a room for the reception of the sick and suffering it is a cold, harsh place, with about it an air of cynical indifference.

this hall serves as a waiting-room, and there42 are nearly always some people waiting in it. it may be a sniffing woman who has called for her dead husband’s clothes. it may be a still breathless messenger with a “midwifery card” in her hand, or a girl waiting for a dose of emergency medicine. there may be some minor accident cases also, such as a torn finger, a black eye like a bursting plum, a child who has swallowed a halfpenny, and a woman who has been “knocked about cruel,” but has little to show for it except a noisy desire to have her husband “locked up.” in certain days of stress, as on saturday nights, when the air is heavy with alcohol, or on the occasion of a “big” dock accident, the waiting-room is crowded with excited folk, with patients waiting their turn to be dressed, with policemen, busybodies, reporters and friends of the injured.

on each side of the waiting-hall is a dressing room—one for women, one for men. into these rooms the accident cases are taken one after the other. here the house-surgeon and his dressers are engaged, and here the many-sided drama of the receiving room reaches its culminating point. it is an uninviting room, very plain, and, like the outer hall, bears an aspect of callous unconcern. by the window is a suspiciously large sink, and on the ledge above it a number of pewter porringers.43 one side of the room is occupied by a mysterious cupboard containing dressings, gags, manacles, emetics and other unattractive things. in the centre are a common table and two hard chairs.

the most repellent thing in the room is a low sofa. it is wide and is covered with very thick leather which is suspiciously shiny and black. it suggests no more comfort than a rack. its associations are unpleasant. it has been smothered with blood and with every kind of imaginable filth, and has been cleaned up so often that it is no wonder that the deeply stained leather is shiny. it is on this grim black couch that “the case” just carried into the hospital is placed. it may be a man ridden over in the street, with the red bone-ends of his broken legs sticking through his trousers. it may be a machine accident, where strips of cotton shirt have become tangled up with torn flesh and a trail of black grease. it may be a man picked up in a lane with his throat cut, or a woman, dripping foul mud, who has been dragged out of a river. sometimes the occupant of the sofa is a snoring lump of humanity so drunk as to be nearly dead, or it may be a panting woman who has taken poison and regretted it. in both cases the stomach pump is used with nauseating incidents. now and then44 the sofa is occupied by a purple-faced maniac, who is pinned down by sturdy dressers while a strait-jacket is being applied to him. this is not the whole of its history nor of its services, for the receiving room nurse, who is rather proud of it, likes to record that many a man and many a woman have breathed their last on this horrible divan.

the so-called dressing room is at its best a “messy” place, as two mops kept in the corner seem to suggest. it is also at times a noisy place, since the yells and screams that escape from it may be heard in the street and may cause passers-by to stop and look up at the window.

among the sick and the maimed who are “received” in this unsympathetic hall, the most pathetic are the wondering babies and the children. many are brought in burnt and wrapped up in blankets, with only their singed hair showing out of the bundle. others have been scalded, so that tissue-paper-like sheets of skin come off when their dressings are applied. not a few, in old days, were scalded in the throat from drinking out of kettles. then there are the children who have swallowed things, and who have added to the astounding collection of articles—from buttons to prayer-book clasps—which have found their way,45 at one time or another, into the infant interior, as well as children who have needles embedded in parts of their bodies or have been bitten by dogs or cats or even by rats.

i remember one bloated, half-dressed woman who ran screaming into the receiving room with a dead baby in her arms. she had gone to bed drunk, and had awakened in the morning in a tremulous state to find a dead infant by her side. this particular experience was not unusual in whitechapel. then there was another woman who rushed in drawing attention to a thing like a tiny bead of glass sticking to her baby’s cheek. the child had acute inflammation of the eyeball, which the mother had treated with cold tea. the eye had long been closed, but when the mother made a clumsy attempt to open the swollen lids something had popped out, some fluid and this thing like glass. she was afraid to touch it. she viewed it with horror as a strange thing that had come out of the eye. hugging the child, she had run a mile or so with the dread object still adhering to the skin of the cheek. this glistening thing was the crystalline lens. the globe had been burst, and the child was, of course, blind. happily, such a case could hardly be met with at the present day.

46

on the subject of children and domestic surgery as revealed in the receiving room, i recall the case of a boy aged about four who had pushed a dry pea into his ear. the mother attempted to remove it with that common surgical implement of the home, a hairpin. she not only failed, but succeeded in pushing the pea farther down into the bony part of the canal. being a determined woman, she borrowed a squirt, and proceeded to syringe out the foreign body with hot water. the result was that the pea swelled, and, being encased in bone, caused so intense and terrible a pain that the boy became unconscious from shock.

possibly the most dramatic spectacle in connexion with receiving room life in pre-ambulance days was the approach to the hospital gate of a party carrying a wounded woman or man. looking out of the receiving room window on such occasion a silent crowd would be seen coming down the street. it is a closely packed crowd which moves like a clot, which occupies the whole pavement and oozes over into the road. in the centre of the mass is an obscure object towards which all eyes are directed. in the procession are many women, mostly with tousled heads, men, mostly without caps, a butcher, a barber’s47 assistant, a trim postman, a whitewasher, a man in a tall hat, and a pattering fringe of ragged boys. the boys, being small, cannot see much, so they race ahead in relays to glimpse the fascinating object from the front or climb up railings or mount upon steps to get a view of it as it passes by. possibly towering above the throng would be two policemen, presenting an air of assumed calm; but policemen were not so common in those days as they are now.

the object carried would be indistinct, being hidden from view as is the queen bee by a clump of fussing bees. very often the injured person is merely carried along by hand, like a parcel that is coming to pieces. there would be a man to each leg and to each arm, while men on either side would hang on to the coat. possibly some samaritan, walking backwards, would hold up the dangling head. it was a much prized distinction to clutch even a fragment of the sufferer or to carry his hat or the tools he had dropped.

at this period the present-day stretcher was unknown in civil life. a stretcher provided by the docks was a huge structure with high sides. it was painted green, and was solid enough to carry a horse. a common means of conveyance for the helpless was a shutter, but with the48 appearance of the modern ambulance the shutter has become as out of date as the sedan chair. still, at this time, when anyone was knocked down in the street some bright, resourceful bystander would be sure to call out “send for a shutter!”

the conveying of a drunken man with a cut head to the hospital by the police (in the ancient fashion) was a more hilarious ceremonial. the “patient” would be hooked up on either side by an official arm. his body would sag between these two supports so that his shoulders would be above his ears. his clothes would be worked up in folds about his neck, and he would appear to be in danger of slipping earthwards out of them. as it was, there would be a display of shirt and braces very evident below his coat. his legs would dangle below him like roots, while his feet, as they dragged along the pavement, would be twisted now in one direction and now in another like the feet of a badly stuffed lay figure. he would probably be singing as he passed along, to the delight of the people.

of the many receiving room processions that i have witnessed the most moving, the most savage and the most rich in colour, noise and language was on an occasion when two “ladies” who had been badly lacerated in a fight were being49 dragged, carried or pushed towards the hospital for treatment. they were large, copious women who were both in an advanced stage of intoxication. they had been fighting with gin bottles in some stagnant court which had become, for the moment, an uproarious cockpit. the technique of such a duel is punctilious. the round, smooth bottoms of the bottles are knocked off, and the combatants, grasping the weapons by the neck, proceed to jab one another in the face with the jagged circles of broken glass.

the wounds in this instance were terrific. the faces of the two, hideously distorted, were streaming with blood, while their ample bodies seemed to have been drenched with the same. their hair, soaked in blood, was plastered to their heads like claret-coloured seaweed on a rock. the two heroines were borne along by their women friends. the police kept wisely in the background, for their time was not yet. the crowd around the two bleeding figures was so compressed that the whole mass moved as one. it was a wild crowd, a writhing knot of viragoes who roared and screamed and rent the air with curses and yells of vengeance, for they were partisans in the fight, the montagues and capulets of a ferocious feud.

50

the crowd as it came along rocked to and fro, heaved and lurched as if propelled by some uneasy sea. the very pavement seemed unsteady. borne on the crest of this ill-smelling wave were the two horrible women. one still shrieked threats and defiance in a voice as husky as that of a beast, while now and then she lifted aloft a blood-streaked arm in the hand of which was clutched a tuft of hair torn from her opponent’s head. every display of this trophy called forth a shout of pride from her admirers.

the other woman was in a state of drunken hysteria. throwing back her head until the sun illumined her awful features, she gave vent to bursts of maniacal laughter which were made peculiarly hideous by the fact that her nose was nearly severed from her face, while her grinning lips were hacked in two. at another moment, burying her head against the back of the woman in front of her, she would break out into sobs and groans which were even more unearthly than her laughter.

the whole affair suggested some fearful bacchanalian orgy, associated with bloodshed, in which all concerned were the subjects of demoniacal possession. there is, happily, much less drunkenness nowadays and less savagery, while the police51 control of these “street scenes” is so efficient and the public ambulance so secretive that such a spectacle as i now recall belongs for ever to the past.

when a crowd, bearing a “casualty,” reaches the hospital gates its progress is stayed. it rolls up against the iron barrier. it stops and recoils like a muddy wave against a bank. the porter is strict. only the principals, their supporters and the police are allowed to filter through. the members of the crowd remain in the street, where they look through the railings, to which they cling, and indulge in fragments of narrative, in comments on the affair, and on the prospects of the parties injured. if a scream should escape from the receiving room the watchers feel that they are well rewarded for long waiting, while any member of the privileged party who may leave the building is subjected to very earnest questioning.

it is needless to say that the receiving room is not always tragical, not always the scene of alarms and disorders, not always filled with wild-eyed folk nor echoing the scuffle of heavy feet and the moans of the suffering. it may be as quiet as a room in a convent. i have seen it so many a time, and particularly on a sunday morning in52 the heyday of summer. then the sun, streaming through the windows, may illumine the figure of the nurse as she sits on the awful sofa. she has her spectacles on, and is busy with some white needlework. her attitude is so placid that she might be sitting at a cottage door listening to a blackbird in a wicker cage. yet this quiet-looking woman, although she has not fought with wild beasts at ephesus, has fought with raving drunkards and men delirious from their hurts, and has heard more foul language and more blasphemy in a week than would have enlivened a pirate ship in a year.

the receiving room nurse was, in old days, without exception the most remarkable woman in the hospital. she appeared as a short, fat, comfortable person of middle age, with a ruddy face and a decided look of assurance. she was without education, and yet her experience of casualties of all kinds—from a bee-sting to sudden death—was vast and indeed unique. she was entirely self-taught, for there were no trained nurses in those days. she was of the school of mrs. gamp, was a woman of courage and of infinite resource, an expert in the treatment of the violent and in the crushing of anyone who gave her what she called “lip.” she was possessed of much humour,53 was coarse in her language, abrupt, yet not unkindly in her manner, very indulgent towards the drunkard and very skilled in handling him. she was apt to boast that there was no man living she would not “stand up to.” she called every male over fifty “daddy” and every one under that age “my son.” she would tackle a shrieking woman as a terrier tackles a rat, while the woman who “sauced” her she soon reduced to a condition of palsy. she objected to the display of emotion or of feeling in any form, and was apt to speak of members of her sex as a “watery-headed lot.”

she had, like most nurses of her time, a leaning towards gin, but was efficient even in her cups. she had wide powers, for she undertook—on her own responsibility—the treatment of petty casualties. the dressers regarded her with respect. her knowledge and skill amazed them, while from her they acquired the elements of minor surgery and first aid. the house-surgeons were a little frightened of her, yet they admired her ready craft and were duly grateful for her unswerving loyalty and her eagerness to save them trouble. her diagnosis of an injury was probably correct, so sound was her observation and wide her experience. she was a brilliant bandager, and was accepted by the students as the standard of style54 and finish in the applying of a dressing. she was on duty from early in the morning until late at night, and knew little of “hours off” and “half-days.” in the personnel of the hospital of half a century ago she was an outstanding figure, yet now she is as extinct as the dodo.

the hospital in the days of which i speak was anathema. the poor people hated it. they dreaded it. they looked upon it primarily as a place where people died. it was a matter of difficulty to induce a patient to enter the wards. they feared an operation, and with good cause, for an operation then was a very dubious matter. there were stories afloat of things that happened in the hospital, and it could not be gainsaid that certain of those stories were true.

treatment was very rough. the surgeon was rough. he had inherited that attitude from the days when operations were carried through without an?sthetics, and when he had need to be rough, strong and quick, as well as very indifferent to pain. pain was with him a thing that had to be. it was a regrettable feature of disease. it had to be submitted to. at the present day pain is a thing that has not to be. it has to be relieved and not to be merely endured.

many common measures of treatment involved55 great suffering. bleeding was still a frequent procedure, and to the timid the sight of the red stream trickling into the bowl was a spectacle of terror. there were two still more common measures in use—the seton and the issue. the modern student knows nothing of these ancient and uncleanly practices. he must inform himself by consulting a dictionary. without touching upon details, i may say that in my early days, as a junior dresser, one special duty was to run round the ward before the surgeon arrived in order to draw a fresh strand of thread through each seton and to see that a fresh pea was forced into the slough of every issue.

quite medi?val methods were still observed. the first time in my life that i saw the interior of an operating theatre i, in my ignorance, entered by the door which opened directly into the area where the operating table stood. (i should have entered by the students’ gallery.) when i found myself in this amazing place there was a man on the table who was shrieking vehemently. the surgeon, taking me by the arm, said, “you seem to have a strong back; lay hold of that rope and pull.” i laid hold of the rope. there were already two men in front of me and we all three pulled our best. i had no idea what56 we were pulling for. i was afterwards informed that the operation in progress was the reduction of a dislocated hip by compound pulleys. the hip, however, was not reduced and the man remained lame for life. at the present day a well-instructed schoolgirl could reduce a recent hip dislocation unaided.

in this theatre was a stove which was always kept alight, winter and summer, night and day. the object was to have a fire at all times ready whereat to heat the irons used for the arrest of bleeding as had been the practice since the days of elizabeth. antiseptics were not yet in use. sepsis was the prevailing condition in the wards. practically all major wounds suppurated. pus was the most common subject of converse, because it was the most prominent feature in the surgeon’s work. it was classified according to degrees or vileness. “laudable” pus was considered rather a fine thing, something to be proud of. “sanious” pus was not only nasty in appearance but regrettable, while “ichorous” pus represented the most malignant depths to which matter could attain.

there was no object in being clean. indeed, cleanliness was out of place. it was considered to be finicking and affected. an executioner57 might as well manicure his nails before chopping off a head. the surgeon operated in a slaughter-house-suggesting frock coat of black cloth. it was stiff with the blood and the filth of years. the more sodden it was the more forcibly did it bear evidence to the surgeon’s prowess. i, of course, commenced my surgical career in such a coat, of which i was quite proud. wounds were dressed with “charpie” soaked in oil. both oil and dressing were frankly and exultingly septic. charpie was a species of cotton waste obtained from cast linen. it would probably now be discarded by a motor mechanic as being too dirty for use on a car.

owing to the suppurating wounds the stench in the wards was of a kind not easily forgotten. i can recall it to this day with unappreciated ease. there was one sponge to a ward. with this putrid article and a basin of once-clear water all the wounds in the ward were washed in turn twice a day. by this ritual any chance that a patient had of recovery was eliminated. i remember a whole ward being decimated by hospital gangrene. the modern student has no knowledge of this disease. he has never seen it and, thank heaven, he never will. people often say how wonderful it was that surgical patients lived in these days.58 as a matter of fact they did not live, or at least only a few of them. lord roberts assured me that on the ridge at delhi during the indian mutiny no case of amputation recovered. this is an extreme instance, for the conditions under which the surgeons on the ridge operated were exceptional and hopelessly unfavourable.

the attitude that the public assumed towards hospitals and their works at the time of which i write may be illustrated by the following incident. i was instructed by my surgeon to obtain a woman’s permission for an operation on her daughter. the operation was one of no great magnitude. i interviewed the mother in the receiving room. i discussed the procedure with her in great detail and, i trust, in a sympathetic and hopeful manner. after i had finished my discourse i asked her if she would consent to the performance of the operation. she replied: “oh! it is all very well to talk about consenting, but who is to pay for the funeral?”