by A. J. Cronin
Like an artist defining the outline of a great picture, he took a lancet and made the first incision. Swiftly he reflected the scalp, exposed the shining table of the skull. Then the whir of the trephine filled the room as he began to cut away a circle of bone as large as a good-sized saucer. The work was hard, for he did not use an electric drill. If MacEwen had a foible, it was to disdain modern appliances and to employ only the simplest equipment, relying entirely upon his own superb skill. Once, when called as an expert witness in a high court of law, he was asked by the presiding judge if he boiled his instruments. ‘My Lord,’ Billee replied, holding out his hands, small and delicate as a woman’s, ‘how could I boil these?’
Now he had laid aside the trephine and with a reactor lifted out the disk of bone. Beneath, the pink membranes of the brain were revealed, frail and delicately veined as a butterfly’s wing. Skilfully he turned them back. But apparently the aperture did not satisfy him, and boldly, calmly, he proceeded to enlarge it. I held my breath as the metal forceps crunched through the skull bone, wrenching at the very roots of the cervical vertebrae. When it was done, and the meninges parted, a low murmur, almost a sigh, broke from the class. There, dark and angry red in the white substance of the brain, was the tumour. Under the bright beam of the professor’s frontal mirror, ringed by forceps, within that frightening, pulsing cavity, it blossomed like a malignant jungle flower, or like some strange marine organism, swaying in a subaqueous light, a sea anemone, whose scarlet fronds brought death by their embrace.
And now MacEwen, slowly and deliberately, began to dissect out the growth from the complex tracts and convolutions with which it was entwined and which, if severed, would cause the patient’s instant dissolution. What miracles of skill and knowledge, what judgement and intuition, what imperturbable courage were displayed in this technique! Watching, fascinated, as he touched and made to tremble the chords of life, I longed with all my heart to achieve something of the mastery which had brought him to such pre-eminence. Ah yes, that was the battle cry … get on, get on, get on.
At last it was done – the gliomatous growth, oozing red, large as a pomegranate, enucleated in its entirety, and whisked away by a nurse in a tissue of gauze. And swiftly, with unbelievable dexterity, the professor cauterised the vessels, removed the clamps, and replaced the aponeurosis. The scalp was stitched up, and although there seemed little sign of shock, a saline administered. Then MacEwen tied the final suture.
‘Thank you, gentlemen. That is all for this morning. In three days’ time it may be necessary to drain accumulated fluid. Otherwise we look for an uneventful recovery.’
The patient, her head swathed in a great turban of bandages, was wheeled out by the house surgeon and two nurses. The class began to leave the theatre, not with the usual shuffling of boots and babble of tongues, but silently, as though overwhelmed. Later there would be talk in plenty. And in the afternoon when MacEwen appeared in the lecture room they would give him an ovation. Now, however, this stillness held a greater tribute.
I let the others get away, remaining seated, in the pretence of making notes, in reality gathering my forces for the effort I meant to make. The anaesthetist had risen, stretched himself, and, taking a cigarette from his case, quitted the theatre. MacEwen, attended only by the sister, showing no signs of fatigue or strain, was quietly washing up, as though the superb exhibition he had given were nothing more than ordinary routine. Presently the sister left him – he was alone.
I took a deep quiet breath and went forward.
‘Excuse me, sir. May I speak to you a moment?’
He turned, wiping his hands on the stiffly laundered towel.
‘Certainly … We are always prepared to listen to the young.’
His tone, the indulgence in his gaze, gave me confidence. After all, I had done brilliantly in the examinations. In the wards my answers to his questions had seemed to interest him, and more than once my more daring flights of fancy had made him smile. All that I sought was the lowest position on his staff. Taking courage, I asked him for it.
For a moment he observed me.
‘Why do you wish to be my dresser?’
In all sincerity I answered:
‘I want to specialise in surgery.’
Again there was a silence, a long silence. Then, gently, yet firmly, he shook his head.
‘No. I have already made the appointment.’
His sharp eye remained bent upon me kindly, yet with that unerring judgement that never failed him.
‘In medicine, or some other field, I believe that you may make your mark. But of one thing I am sure. You will never be a surgeon.’
Chapter Two
Lochlea Asylum: wanted: a clinical clerk. Full board and lodging provided at the institution. Honorarium 100 guineas. The candidate appointed will be permitted to attend classes at the University.
Two anxious and depressing weeks had passed since my rejection by MacEwen when this notice, pinned on the board in the Students’ Union among dozens of dog-eared intimations of surgery lectures, midwifery courses, post-mortem demonstrations, and final-year dances, caught and held my desperate eye. It seemed so miraculously the chance of my salvation I scarcely dared to hope, and lest any of my needy friends should forestall me, I turned quickly, tore down Gilmore Hill, and boarded a green tramcar – one of the sedate and splendid vehicles which, in those days, bore the citizens of Glasgow immense distances for a single penny.
The asylum, situated in nicely wooded country, four miles west of the city, was dismayingly imposing – a great castellated mansion, set in well-tended gardens, surrounded by meadows and orchards, the whole domain encircled by a high stone wall. At the gate lodge, when I had stated my business, I was admitted and conducted up the long beech avenue by an attendant who brought me, finally, through an arched doorway and a vestibule, adorned by marble statuary, to the office of the superintendent.
Dr Gavinton, acknowledged as one of the leading alienists of his time, was a tall, spare, iron-grey man, gaunt and sallow-featured, with a quiet, rather baffling aloofness in his manner. As he gazed at me in silence from behind his desk, his penetrating, strangely hypnotic yellow eyes increased my nervousness. Conscious of my deficiencies, sadly shaken in my self-esteem, I steeled myself for a searching and painful interrogation. To my surprise, he repeated my name, mildly, then remarked:
‘Are you related to the youngster who captained the eleven in the Scottish Shield three years ago?’
‘Well, sir,’ I stammered, ‘ as a matter of fact I …’
He nodded, his severity broken by a human and friendly smile.
‘I saw the game. You played well. If the ground had been less muddy you might easily have won. Sit down. You’ll find that chair reasonably comfortable.’
I took a long, breath, scarcely daring to believe in my good fortune – that this should be my reward for that grim and gruelling match, lost in a rainstorm by a single penalty goal a defeat which had reduced me, in the dressing-room, to bitter tears. Yet it was so. Frank Gavinton was a football enthusiast, an old International, who had played regularly for Queen’s Park, the premier Scottish amateur club, and twice represented his country at Hampden Park. For half an hour we discussed football, with the intimacy of those who know and love the game. Then, abruptly, he stood up, held out his hand.
‘Report here tomorrow at nine o’clock. I know that you’ll be punctual. Oh, by the way.’ He called me back. ‘ We pay in advance here. You’d better have this … your first quarter’s stipend.’
He took his pen, wrote for a moment, and, not looking at me, handed me a cheque for twenty-eight guineas. My heart was too full for speech. I hoped he had not guessed how hard up I was – yet I rather suspected he had. But at least I could now settle my indebtedness to Mrs Grant, get my watch out of pawn, and retrieve my impounded valise. I was saved.
Nothing could have been more supremely opportune than this appointment, which was, of course, far superior to anything I could have
obtained at the Infirmary. I was free, in the forenoon, to continue my medical education; I had my splendid honorarium. My new quarters, a comfortable sitting-room, with easy chairs and a fireplace, communicating with a snug, red-carpeted bedroom and a well-fitted bathroom, were, by contrast with the wretched ‘digs’ I had quitted, palatial. My diet, no longer limited by the state of my purse, was equally improved, for at Lochlea everything was done in admirable style. Breakfast now consisted of cereal and cream – thick and fresh from the home farm – an inexhaustible platter of crisp bacon and eggs, fragrant coffee, fresh roll, and fruit. For lunch, which was served to the staff with some formality, we had soup, a joint of meat or roast chicken with several vegetables, an excellent dessert, and cheese. Tea, brought to my sittingroom at four o’clock, displayed always the housekeeper’s skill in baking, since the tray bore, every day, a tempting plate of milk-and-soda scones and those delicious iced pastries which, for some reason, are known in Scotland as ‘French’ cakes. Supper, a movable feast, usually brought several cold dishes to the sideboard, with kedgeree, macaroni, or curry kept hot for us on an electric plate. Add to this the privilege of dropping in at any hour to the great basement kitchen for a snack, and it becomes possible to imagine the change in circumstances and outlook for a famished youth who for weeks had been keeping body and soul together on an odd stale bun and an occasional mug of tea.
In addition to the superintendent, two other physicians made up the medical staff of the asylum: Dr Peters, a rotund elderly little man with a jolly face and a passion for grand opera which caused him to hum Verdi and Offenbach on his rounds; and Dr Jane Carmichael, a charming and brilliant woman who, scarred and disfigured in her youth by a laboratory accident, had refused to let her life become a tragedy but thereafter had devoted her career magnificently to the care of the insane. Nor must I forget to mention the matron. Miss Montgomery, a frail, slender, silver-haired lady, demurely quiet in speech, patrician in manner, in whose delicate hands rested much of the complex management of the establishment and who, by one soothing word, a single tranquil glance, could calm the most refractory patient. All these good people displayed towards me a kindness and indulgence which I tried to repay by pulling my weight in my new team, in short, by a conscientious attention to my work.
Certainly, the duties of the ‘ clinic’ at Lochlea lacked neither interest nor variety. All the dispensing was under my charge, the preparation of the huge Winchesters of stock solutions of potassium, sodium, and ammonium bromide, of chloral hydrate, paraldehyde, and many other drugs which were widely used as sedatives. I undertook the bacteriological work and microscopical examinations of pathological specimens. I also had the rather odd duty of feeding those patients who refused to eat, an operation which demanded the passing of a stomach tube, a recondite art in which I soon became extremely proficient. In addition, I kept the case records, made the evening round of the galleries when one or other of the doctors had the day off, and in general made myself useful and agreeable to my betters. Most of all, at Dr Gavinton’s request, since he set a high therapeutic value on this line of treatment, I was expected to mingle with our patients in a social way, to organise their games, play tennis, cricket, and handball with them, take part in the concerts and dances that were regularly held for their benefit and entertainment.
Much has been written of the inmates of mental institutions that is not only in extremely bad taste, but also arrant nonsense. It is customary, for example, to portray such afflicted persons as highly amusing individuals who frequently believe themselves to be important historical characters, such as Napoleon, Julius Caesar, or Lady Godiva, and whose consequent aberrations in these roles are made a subject for exquisite mirth. Nothing could be further from the fact. Not once in my stay at Lochlea did I come across a patient with such obligingly diverting tendencies. The sober truth is that mental disorders are always pitiful. Yet they are fascinating to those who study them, who essay the stupendous task of probing the mysteries of the human mind.
Lochlea was an advanced institution, one of the best in Scotland, and although it supported the usual quota of incurables, it received many ‘ breakdown’ cases, people thrown out of gear by the stress and strain of life – a businessman brought to attempted suicide by bankruptcy, a poor young mother pathetically deranged through the loss of her first baby, a wife broken by family trouble and an unfaithful husband …
To heal and rehabilitate these patients, to see them go forth, clear-eyed again, from this walled citadel, fit to resume their daily avocations and take their part in the battle of life, this was the main objective and the real reward of Gavinton and his co-workers at Lochlea. It was in many ways a thrilling work. But there was danger in it too.
Of all the inmates of Lochlea, the one to whom I had become most attached was George Blair. Known to everyone as Geordie, this young man had a history which, made more moving by his open and engaging disposition, particularly aroused my sympathy. Five years before he had killed his cousin – had, indeed, strangled him to death. Yet the circumstances of the crime seemed, to a certain extent, to exonerate the culprit. When we talked the matter over together – this process of self-revelation was always encouraged – Geordie confessed to me that the murdered youth had insulted his sister; had, indeed – to put the matter in its least offensive form – tried physically to force his attentions upon her. It was this outrage that had temporarily unbalanced Blair: a fact which, with such an upright young fellow, was quite understandable. Certainly the verdict of the court had been ‘Guilty, while of unsound mind’. Thus Geordie, sentenced to detention ‘during His Majesty’s pleasure’, found himself removed, mainly through family influence, to Lochlea, where he must spend the rest of his days.
This burden of lifelong punishment, heavy and unjust though it seemed to me, had been accepted manfully by Blair, a fact which prejudiced me more strongly in his favour. No one in the place was more cheerful or energetic. He sang at the concerts, in a fine baritone voice, led the church choir every Sunday. At the monthly assemblies he appeared in a dress kilt, was up for every dance, led the grand chain, was tremendous in the eightsome reels. Although somewhat short and thickset in his figure, he was endowed with a remarkable physique and took enthusiastic part in all the games organised at Lochlea. It was this, in the first place, which brought us together. I have always loved all kinds of sport and at this period made a fetish of physical culture, rising every morning at six for an ice-clod bath, which was follwed by half an hour of Müller calisthenics, by a sprint round the grounds or a game of some sort, before I set out for the University to attend my classes. Thus Geordie and I had many rattling exchanges at tennis and squash racquets. Often on Saturday forenoon when I was free we took out a ball and punted it to each other in the recreation ground. He was such a likeable fellow, so gay and virile – so obliging, too, going out of his way, without being asked, to perform many thoughtful personal services for me – that I became extremely fond of him. Indeed, I went so far as to bring his case before the superintendent.
After the day’s work, Gavinton was fond of a game of billiards, and since Dr Peters didn’t play, he often asked me to his house, where he had an excellent table and would give me twenty in a hundred up. One evening when we were so engaged, I said to him:
‘It’s very hard, sir, that Blair should be condemned to spend the rest of his life at Lochlea.’
‘Indeed.’ He chalked his cue. ‘Do you think so badly, then, of our little place here?’
‘Oh, no, sir. It’s … it’s extremely pleasant in many ways. But after all … it’s shut off from the world by a high stone wall.’
‘That wall serves a fairly useful purpose.’
‘Of course, sir. But surely not for Blair. He’s such a decent chap. And he’s had a rotten deal. Don’t you think some sort of appear could be made to the authorities … or a petition got up?’
There was a silence during which Dr Gavinton, stroking his upper lip with a characteristic gesture, gave
me an odd look. Then he smiled faintly and, bending to take his shot, remarked:
‘My dear clinic, I think our friend Blair will do very well at Lochlea.’
Of course, that closed the discussion. But I was not satisfied. I went out of my way to make things as pleasant as possible for my friend Geordie.
One evening, a few weeks after this conversation, I was on duty in Dr Peters’s absence – he had gone, in high glee, to a performance of La Bohème by the visiting Carl Rosa Company – and I went to make the round of the men’s galleries. I had been studying in my room, and it was later than usual, almost eleven o’clock, when I entered the ward kitchen where old Currie, the night attendant, was busy making a brew of hot Ovaltine, which, according to custom, he took to a number of the less robust patients. Currie was over seventy, a steady-going, grey-bearded Highlander, bowed by age but still hearty, who for nearly fifty years had kept night watch in the gallenes of Lochlea, who used to tell me with a chuckle, in his soft Inverness accent, that for half a century he had rarely seen the sun. I had enjoyed many chats with Currie over a measure of his nourishing beverage, but tonight as he poured and handed me a cup he glanced at me sideways.
‘Geordie had a nasty turn this evening. They’ve put him in Number 7.’
I gazed at the attendant in amazement.
‘Blair … in Number 7?’
‘Ay.’ Currie nodded. ‘He was real bad.’
I could not understand. Number 7, in this gallery, was the padded cell. I thought for an instant that the old man was joking, but the expression on his face dismissed that thought. Puzzled and distressed, I started out of the kitchen, still holding the cup of Ovaltme. If Blair were really ill, he might be glad to have it. As I went down the gallery I heard Currie call after me, but I paid no heed, and using my key, without which one could not pass anywhere in Lochlea, I let myself into Number 7.