A Treasury of Doctor Stories
Page 12
He has come to a school where the professors will teach him the answers to death, rather than legal answers to greed and vengeance.
Skoda is a renowned man. He is strong, audacious, experimental. He laughs at controversy—and medicine is a controversy almost as vicious as politics. A corpse runs for election, and always wins. The doctors conduct the campaign.
Philip venerates Skoda. He will learn everything from him but his laughter.
Our Philip works like a steam engine. It is not grief that makes him work. It is the avidity that is always the first disordered sign of genius. He pries everywhere. He travels through miles of viscera. And a bell is always tolling faintly over his books and his cadavers.
A new character appears—Professor Rokitansky. He occupies the first chair of Pathological Anatomy in the school. He is not as famous as Skoda, but he has a deft hand with the scalpel. He is a beer drinker and a man who roars poetry at the night.
Skoda and Rokitansky are the ordained Godfathers of Semmelweis. Says Celine: “They will follow with anxious eyes the labors and efforts of their unforgettable disciple. With anguish they will watch him staggering along the road of his Calvary—and they will be able neither to help nor yet always understand.”
CHARACTERIZATION
Philip Semmelweis is not an easy character, even now. There is a hole in his heart. He has looked into a grave and never quite looked out of it. This is the beginning of his new love story—his hunt among the cadavers.
Philip’s eyes are not on the world. He is insolent to his superiors. He explodes easily—like all concentrated matter. He is oversensitive to the ancient jokes of medical students. He toils, broods, snarls, and behaves like a man full of slivers. Yet there is only love in his heart.
The trouble with Philip is that he has the genius for smelling out stupidity in others—which is unpardonable in a man who has as yet no other gift to offer to the world. (It will be even more unpardonable When he brings the unwanted gift.)
Harassed by his own nature, by his own ignorance, by the strutting ignorance around him, Philip abandons the clinics and cadavers for happier surroundings. He becomes a beachcomber in the Royal Botanical Gardens. Here he meets Herr Bazatov—a shy man and a great expert on plant life. He talks with Bazatov week after week about the wonders and secrets of blossoms.
Philip is delighted by the flowers. He is never to know any other sweetness for the rest of his life than these garden months. No faces will ever smile on him as do the petunias, the roses, the calla lilies.
It is of flowers he writes (in Latin) when he submits his doctorate thesis to the medical school. Skoda and Rokitansky smile. It is bad Latin and worse botany and has no bearing on the medical arts. But they are in a beer stube. The music is playing. The brew is good. And Semmelweis is a stormy one who touches their hearts. They give their way-ward Godson an official diploma. In May, 1844, Semmelweis is pronounced a doctor.
SCENES IN SHADOW FOR THE CAMERA
Philip’s personality continues to stand in his way like a hippopotamus. But with the aid of his Godfathers, he manages to vault over it. He becomes an assistant to Rokitansky.
He becomes one of the death dealing surgeons of that era. It is the time before Pasteur and asepsis. Nine major operations out of ten terminate with immediate death, or infection—which is death walking.
Young Semmelweis watches the other death-dealers at work over the tables with their little guillotine knives. They are neither disturbed nor ashamed. They are full of strut and wisdom. Young Semmelweis sees that this is the way of the world—to be smug in error, content with stupidity and hateful of all that challenges it.
He listens to learned discourses in which the death-dealers explain the mystery of the tolling bell. They speak of “thickened pus,” of “benign pus” and “laudable pus.” Celine calls these phrases “the sonorities of impotence.”
Semmelweis has also something to say. Vague words, but not smug ones. Remember that he is a man of his time, that he sits among the satraps of ignorance, that he has not seen tomorrow. Yet he writes (out of tomorrow): “Everything they are doing here seems to me quite futile, deaths follow one another with regularity. They go on operating, however, without seeking to find out why one patient succumbs in exactly the same circumstances in which another survives.”
Rokitansky sighs over his beer mug as he reads this heresy. Skoda frowns and is thoughtful. Their godson is a question-asker. Dangerous calling. They have flirted with questions themselves. But they know how to laugh and drink beer.
ENTER, THE VILLAIN
Master Surgeon Philip Semmelweis, with a hundred dead patients already in the bag, moves to a new department. It is new only to his science. His tears were there before. It is the department where women die in childbirth. The professor at its head is the gallant Dr. Klein.
Dr. Klein is now known in medical history as one of its super villains. This is unfair. Medical history, like world history, likes to condemn the great error-makers of the past. This gives the present always the illusion that it has progressed beyond admiring and defending error. Vain boast! With error constantly disproved and exposed, what remains triumphant in the world? Only this—the genius for admiring and defending further error. The trouble lies in our education. It doesn’t begin till we are almost ready to die. Except for a few precocious people like Semmelweis.
Dr. Klein was no villain at all, for he was the friend of his time, the associate of current error. This made him an authority. Patients adored him—on the few occasions when they survived his ministrations. The medical press fawned on him. He was not the kind of presumptuous booby who knew more than the Editors. Nobody defends ignorance as savagely as an Editor. His job depends on holding off tomorrow—like the little boy with his finger in the dyke. Editors always stand behind authorities. Authorities are the dykes.
To boot, Professor Klein wore a frock coat and his beard pointed the way to righteousness. He was all-knowing. Nobody could win an argument from him. His was a firm mind. But there was nothing in it. Nothing but yesterday in a coat of armor.
NOTE TO THE CASTING DIRECTOR
To cast this man right in our movie, we must have him played by the most dignified actor in all of Hollywood and the most heroic. Gary Cooper would do if he could sigh like Charles Boyer and beam with indulgent humor like Clark Gable. He must win the hearts of the audience at once. For in our movie, he, and not Semmelweis, is their man. He is the robust, clever, chuckling, fascinating Know-It-All. The fatuous Weisenheimer World masquerading as Hero. He is a man the audience believes automatically—the moment he says anything about Medicine, God, Politics, or the stupidity of all opposition. Just as Semmelweis is a man the audience wants to turn over to the police the moment he starts gabbing.
This is the great casting difficulty in our movie—but a most vital issue. Right is not on the side of the audience and the audience is not on the side of right. This oddity must be underscored.
THE BELL GROWS LOUDER
Semmelweis comes to work on his first day as scientist in the Lying-in Pavilion through February snows. There are two separate pavilions in the hospital for lying-in cases. The Second Pavilion is presided over by Dr. Bartsch—a professor who likes his job a little more than anything else. Dr. Klein commands the First Pavilion.
Semmelweis remembers the day he paced the waiting room full of hope and heard the bell tolling. His wife died here and his child. He has come to avenge them.
He sits down at a desk. His duty is to register the admission of pregnant women. They are from the poor districts of Vienna, from the slums, from the cafe street corners. They have no money for private obstetrics. We see Semmelweis surrounded by women come for delivery. They weep. They cry out as if before a firing squad. It is Tuesday and Bartsch’s Pavilion Number i is closed. They plead to be entered in Bartsch’s. But the Hospital has rules. On alternate days pregnant women seeking free medical service must be entered in Klein’s pavilion. This is the Klein day.
Semmelweis sends for the records. It is true. The percentage of women dying in childbirth from puerperal fever is three times higher in the Klein pavilion than in the Bartsch pavilion.
What can this mean? Semmelweis frowns at this curious fact. But he can do nothing. Twenty penniless women, wailing their farewells to life, are admitted on this Tuesday into Klein’s childbirth inferno. Others scream and run out and refuse to be coaxed back again by the relatives who brought them in. They prefer to give birth in the streets. Their chances of survival are better.
For this group of twenty, the little bell that goes before the priests tolls nineteen times. Semmelweis hears the priests chanting as they walk slowly, and the bell tolling. He knows the hope and love that die at this sound. He sits at his desk and hurls his mind at the dark.
SCENES OF TERROR AND SMUGNESS
Day after day Semmelweis sits at his registrar’s desk in the Klein Pavilion—not a doctor, but a Charon embarking terrified women for the shores of death.
Around him are many doctors. They are a little nervous from their toil in the charnel house. But the mighty Klein commands them. There is no nervousness in the face of this hero. It beams. It knows that a best of all possible worlds lies around it. If you are worried, look at Klein—and peace comes back into your heart. Thus do Prime Ministers and Foreign Secretaries and all High Authorities look when the smells of disaster touch their noses. They look proud and All-Knowing, and the world cheers them.
The mortality rate in the Klein Pavilion has risen to 96%. A hundred mothers come in to have babies. Ninety-six go out as corpses. It is a very bad situation.
But Klein has an answer. He points to London, Paris, Berlin, Rome. It is not much better in those great cities. The pregnant women of the poor die off in all the free hospitals of the world. The percentages vary from thirty percent to fifty, to ninety. It is obvious to Professor Klein and to the world that venerates him and all his colleagues in Edinburgh, London, Paris, Rome, and Berlin, that puerperal fever is a curse of nature. It is a sort of pox that belongs among the divine mysteries. God is restive with his sinful children. Did He not once send a flood? Now he sends puerperal fever. Perhaps because it is easier to transport than water.
Nevertheless, there is a scandal in Vienna. The poor have clung only to one basic right—the right of producing more poor. This has been always the single joy that no monarchs or taxes or hellish laws could rob them of. And this right is now in jeopardy.
Investigations are started. The professors meet, listen to each other speak (using many Latin phrases), and finally figure out the professorial cure for puerperal fever. Close all the lying-in hospitals. Then there will be no hospital statistics to frighten and depress anybody.
Semmelweis does not attend these learned conferences. He sits in the gloomy reception room. His heart is burdened and he hurls his mind into the darkness.
A RAY OF LIGHT
A student stops to talk to the brooding, snarling Charon at his desk. The student says humorously, “I bet you the reason there are fewer deaths in Bartsch’s pavilion than in Klein’s is because the work over there is done by midwives—and not by doctors.”
The student has a hangover and a grudge. He walks on chuckling at his mot.
But Semmelweis is on his feet, staring at something he cannot see. But it is there. And it is not a joke. It is a Fact, a ray of light from God, or from His only child—Genius.
Semmelweis rushes to Pavilion No. 2. He drags out all the record books. It is true. It has been true for fifty years. Always a half, a third as many dead mothers at Bartsch’s as at Klein’s.
Semmelweis makes his first move. It is more the move of a checker player than a scientist. Skoda and Rokitansky support him. He moves all the midwives from Bartsch’s to Klein’s. He moves all the doctors from Klein’s to Bartsch’s. Bartsch and Klein are amused at this childish game.
The move is an overwhelming success. Semmelweis has moved Death from one space to another. The doctors are Death. Two weeks after the doctors have taken over Bartsch’s Pavilion, its mortality rate has doubled. The mortality rate in the Klein Pavilion, where the midwives now deliver babies, has been cut in half.
LIGHT BEATS ON DISASTER
Why do doctors carry death—and not midwives? Why are men, nobly trained in medicine and surgery, villains of the darkest hue—and ignorant midwives medical heroines?
Semmelweis puts these questions to Klein. The Professor with the beard is outraged. Says Klein, these are not questions. They are insults. They impugn. They defy authority.
Semmelweis, Master Surgeon and question-asker, is fired.
LIGHT DIMS AND THE WORLD TRIUMPHS
Semmelweis has lost his badge. He is no longer the official Charon. He has no other standing in the Klein Pavilion now but busybody.
And he is a daily busybody at the Pavilion of the 96%. He sits at the bedsides of the dying women. This is now his love affair. He loves these agonized ones who try to bring life into the world—and die trying. His heart bursts with a hope for them. He would take their fever away. He would open their eyes and let them see the new face of a child of which they had been dreaming so long. He would place life at their breasts to feed.
Such is his desire. Not his own dead but all the dead torment him. Not his own lost hope, but all lost hope aches in his heart.
All day the priests in their vestments march with the viaticum. The attendant in front of them tolls his bell. Semmelweis, lover of life, hears only the tongue of death. He sits and weeps beside the dying ones, snarls over them when they are dead, not at them, but at Death. He is the poet who has found a Cross from which to look on the world. It is not yet a big Cross, but it will enlarge.
THE CROSS GROWS BIGGER
How does it happen that Semmelweis suddenly looks into tomorrow, suddenly looks on the truth—a flash, a tittle, a finger of it? The Camera will have to explain this. The Camera will come close to his face as he sits at a bedside and holds the hand of a dying mother. It will see his eyes widen, see a stare come into them and register a grimace as of terror that fills his face.
Sitting at the bedside of the poor dead one, Semmelweis knows suddenly why women die of puerperal fever. Women in Rome, London, Berlin, Paris, Edinburgh, Boston, New York. With what he knows in this moment of light, Semmelweis can save a million lives a year in Europe alone.
Skoda and Rokitansky hear the news. It is so simple and Semmelweis speaks so violently that the thing is hard to understand. But they manage to figure out what he is saying. He wants wash bowls placed beside all the lying-in beds. He wants all the doctors to wash their hands—before delivering babies. This is the great Semmelweis discovery—that there is dirt on the hands of authority that needs washing off.
Skoda and Rokitansky abet this mad plot. The washstands are installed, the orders given to the doctors. The results are astonishing. In one week the Klein mortality rate drops to 70%—a twenty per cent fall.
But Professor Klein is outraged once more. The Devil is loose again. He summons this laundryman of a scientist, this washerwoman savant Semmelweis, into his office. He demands to know—why does he want doctors to wash their hands? What in God’s name does Semmelweis think is on their hands? Are doctors evil people? Does he think scientists are witches?
Semmelweis replies a little wildly. He has not the facts of tomorrow’s Pasteur. He cannot name the thing. But it is there—on the hands of doctors. He has seen it kill.
“Why do you want theories now?” he cries at Klein. “Look at the facts. Facts are enough for the time being. Fewer women are being killed by doctors with washed hands.”
The thing drives Professor Klein out of his head. How does a priest feel if he hears God called dirty? How does a patrio
t feel if he hears his land slandered? How does a citizen feel if he listens to criticism of his reason? Klein is all these things. He rises up like a trinity. No priest, no patriot, no citizen was ever more righteous. He calls for the dismissal of Semmelweis from the hospital.
Hospital directors, physicians, surgeons, journalists and believers in authority, make an army around Professor Klein. They sustain him. They chant his praises. He is defending his Time. He is saving authority from an enemy.
Semmelweis, who had almost saved a million women a year, is thrown out of the hospital. His Godfathers Skoda and Rokitansky can do nothing. Scandal shakes the pillars of medicine. Not the scandal of a numbskull slayer of poor women, named Professor Klein—and named all the obstetricians of Europe and America, great and small. But the scandal of a man who dares question Professor Klein, dares challenge today—who dares ask a few men to wash their hands and save a million lives.
HIDEAWAY IN LAUGHTER
Disgraced, derided, Semmelweis leaves medicine, leaves Vienna—city of science. He is a little mad. The worried Godfathers send a friend to look after him.
Semmelweis goes gasping to Venice. Here he drinks, paddles around in gondolas, laughs in bagnios and sings at the top of his voice. He plays pagan in Venice. He is never still, rarely sober. He falls in love with Art. Art is noble and serene and has triumphed over the Kleins. He rhapsodizes over paintings and sunsets, over women and barcarolles.
He is trying to put out of his mind the memory of a light that was in it, and out of his ears the tolling of a bell. But this bell rings through all his revelries. It wakens him in the bagnios. Drunk, he hears it. It comes through kisses and sounds out of emptied wine bottles. And it pulls him back to Vienna—and the death beds.
MELODRAMA OF A FACT
Semmelweis arrives in Vienna to find that his best friend, Dr. Kolletschka, is dead. Kolletschka was Professor of Anatomy and dear to him. He had died in the night as a result of infection through a finger wound. He had been dissecting a corpse.
Semmelweis weeps. He weeps—but he investigates. No one else is investigating the death of the estimable Kolletschka. But Semmelweis has genius. Genius is a quality that knows nothing but works as if it knows. This is the way answers are found—by not knowing them. And Semmelweis finds an answer. He investigates not Kolletschka, but the cadaver on which he operated. He finds the same death in the cadaver as in his friend. He finds that pericarditis, peritonitis, and meningitis can come from the exudations of a corpse. It is all theory, for he has no microscope to identify the villains. Nor has he enough chemical learning to make a scientific case of it. But he has light without words, logic and the gift for truth. And he proclaims his discovery.