Dreadful screams were said to issue from this room. I saw nothing to confirm these stories and no doubt they were all nonense, though I did see two students kill a sixteen-year-old boy, or nearly kill him (he appeared to be dying when I left the hospital, but he may have recovered later) by mischievous experiment which they probably could not have tried on a paying patient. Well within living memory it used to be believed in London that in some of the big hospitals patients were killed off to get dissection subjects. I didn’t hear this tale repeated at the Hôpital X, but I should think some of the men there would have found it credible. For it was a hospital in which not the methods, perhaps, but something of the atmosphere of the nineteenth century had managed to survive, and therein lay its peculiar interest.
During the past fifty years or so there has been a great change in the relationship between doctor and patient. If you look at almost any literature before the later part of the nineteenth century, you find that a hospital is popularly regarded as much the same thing as a prison, and an old-fashioned, dungeon-like prison at that. A hospital is a place of filth, torture and death, a sort of antechamber to the tomb. No one who was not more or less destitute would have thought of going into such a place for treatment. And especially in the early part of the last century, when medical science had grown bolder than before without being any more successful, the whole business of doctoring was looked on with horror and dread by ordinary people. Surgery, in particular, was believed to be no more than a peculiarly gruesome form of sadism, and dissection, possible only with the aid of body-snatchers, was even confused with necromancy. From the nineteenth century you could collect a large horror-literature connected with doctors and hospitals.
Think of poor old George III, in his dotage, shrieking for mercy as he sees his surgeons approaching to ‘bleed him till he faints’! Think of the conversations of Bob Sawyer and Benjamin Allen, which no doubt are hardly parodies, or the field hospitals in La Débaĉle and War and Peace, or that shocking description of an amputation in Melville’s Whitejacket! Even the names given to doctors in nineteenth-century English fiction, Slasher, Carver, Sawyer, Fillgrave and so on, and the generic nickname ‘sawbones’, are about as grim as they are comic. The anti-surgery tradition is perhaps best expressed in Tennyson’s poem, ‘The Children’s Hospital’, which is essentially a pre-chloroform document though it seems to have been written as late as 1880. Moreover, the outlook which Tennyson records in this poem had a lot to be said for it. When you consider what an operation without anaesthetics must have been like, what it notoriously was like, it is difficult not to suspect the motives of people who would undertake such things. For these bloody horrors which the students so eagerly looked forward to (‘A magnificent sight if Slasher does it!’) were admittedly more or less useless: the patient who did not die of shock usually died of gangrene, a result which was taken for granted. Even now doctors can be found whose motives are questionable. Anyone who has had much illness, or who has listened to medical students talking, will know what I mean.
But anaesthetics were a turning-point, and disinfectants were another. Nowhere in the world, probably, would you now see the kind of scene described by Axel Munthe in The Story of San Michele, when the sinister surgeon in top-hat and frock-coat, his starched shirtfront spattered with blood and pus, carves up patient after patient with the same knife and flings the severed limbs into a pile beside the table. Moreover, national health insurance has partly done away with the idea that a working-class patient is a pauper who deserves little consideration. Well into this century it was usual for ‘free’ patients at the big hospitals to have their teeth extracted with no anaesthetic. They don’t pay, so why should they have anaesthetic – that was the attitude. That too has changed.
And yet every institution will always bear upon it some lingering memory of its past. A barrack-room is still haunted by the ghost of Kipling, and it is difficult to enter a workhouse without being reminded of Oliver Twist. Hospitals began as a kind of casual ward for lepers and the like to die in, and they continued as places where medical students learned their art on the bodies of the poor. You can still catch a faint suggestion of their history in their characteristically gloomy architecture. I would be far from complaining about the treatment I have received in any English hospital, but I do know that it is a sound instinct that warns people to keep out of hospitals if possible, and especially out of the public wards. Whatever the legal position may be, it is unquestionable that you have far less control over your own treatment, far less certainty that frivolous experiments will not be tried on you, when it is a case of ‘accept the discipline or get out’. And it is a great thing to die in your own bed, though it is better still to die in your boots. However great the kindness and the efficiency, in every hospital death there will be some cruel, squalid detail, something perhaps too small to be told but leaving terribly painful memories behind, arising out of the haste, the crowding, the impersonality of a place where every day people are dying among strangers.
The dread of hospitals probably still survives among the very poor and in all of us it has only recently disappeared. It is a dark patch not far beneath the surface of our minds. I have said earlier that, when I entered the ward at the Hôpital X, I was conscious of a strange feeling of familiarity. What the scene reminded me of, of course, was the reeking, pain-filled hospitals of the nineteenth century, which I had never seen but of which I had a traditional knowledge. And something, perhaps the black-clad doctor with his frowsy black bag, or perhaps only the sickly smell, played the queer trick of unearthing from my memory that poem of Tennyson’s, ‘The Children’s Hospital’, which I had not thought of for twenty years. It happened that as a child I had had it read aloud to me by a sick-nurse whose own working life might have stretched back to the time when Tennyson wrote the poem. The horrors and sufferings of the old-style hospitals were a vivid memory to her. We had shuddered over the poem together, and then seemingly I had forgotten it. Even its name would probably have recalled nothing to me. But the first glimpse of the ill-lit, murmurous room, with the beds so close together, suddenly roused the train of thought to which it belonged, and in the night that followed I found myself remembering the whole story and atmosphere of the poem, with many of its lines complete.
1946
