The Elephant Man and other reminiscences/Two Women

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IN the course of his experience the medical man acquires probably a more intimate knowledge of human nature than is attained by most. He gains an undistorted insight into character. He witnesses the display of elemental passions and emotions. He sees his subject, as it were, unclothed and in the state of a primitive being. There is no camouflage of feeling, no assumption of a part, no finesse. There is merely a man or a woman faced by simple, rudimentary conditions. He notes how they act under strain and stress, under the threat of danger or when menaced by death. He observes their behaviour both during suffering and after relief from pain, the manner in which they bear losses and alarms and how they express the consciousness of joy. These are the common emotional experiences of life, common alike to the caveman and the man of the twentieth century. Among the matters of interest in this purview is the comparative bearing of men and of women when subject to the hand of the surgeon. As to which of the two makes the better patient is a question that cannot be answered in a word. Speaking generally women bear pain better than men. They endure a long illness better, both physically and morally. They are more patient and submissive, less defiant of fate and, I think I may add, more logical. There are exceptions, of course, but then there are exceptions in all things.

Perhaps what the critic of gold calls the "acid test" is provided by the test of an operation. Here is something very definite to be faced. A man is usually credited with more courage than a woman. This is no doubt a just estimate in situations of panic and violence where less is expected of a woman; but in the cold, deliberate presence of an operation she stands out well.

A display of courage in a man is instinctive, a feature of his upbringing, a matter of tradition. With women is associated a rather attractive element of timidity. It is considered to be a not indecorous attribute of her sex. It is apt to be exaggerated and to become often somewhat of a pose. A woman may be terrified at a mouse in her bedroom and yet will view the entrance into that room of two white-clad inquisitors—the anæsthetist and the surgeon—with composure. A woman will frankly allow, under certain conditions, that she is "frightened to death"; the man will not permit himself that expression, although he is none the less alarmed. A woman seldom displays bravado; a man often does. To sum up the matter—a woman before the tribunal of the operating theatre is, in my experience, as courageous as a man, although she may show less resolve in concealing her emotions.

In the determination to live, which plays no little part in the success of a grave operation, a woman is, I think, the more resolute. Her powers of endurance are often amazing. Life may hang by a thread, but to that thread she will cling as if it were a straining rope. I recall the case of a lady who had undergone an operation of unusual duration and severity. She was a small, fragile woman, pale and delicate-looking. The blow she had received would have felled a giant. I stood by her bedside some hours after the operation. She was a mere grey shadow of a woman in whom the signs of life seemed to be growing fainter and fainter. The heat of the body was maintained by artificial means. She was still pulseless and her breathing but a succession of low sighs. She evidently read anxiety and alarm in the faces of those around her, for, by a movement of her lips, she indicated that she wished to speak to me. I bent down and heard in the faintest whisper the words, "I am not going to die." She did not die; yet her recovery was a thing incredible. Although twenty-eight years have elapsed since that memorable occasion, I am happy to say that she is still alive and well.

There are other traits in women that the surgeon comes upon which, if not actually peculiar to their sex, are at least displayed by them in the highest degree of perfection. Two of these characteristics—or it may be that the two are one—are illustrated by the incidents which follow. The first episode may appear to be trivial, although an eminent novelist to whom I told the story thought otherwise and included it, much modified, in one of his books.

The subject was a woman nearing forty. She was plain to look at, commonplace and totally uninteresting. Her husband was of the same pattern and type, a type that embraces the majority of the people in these islands. He was engaged in some humdrum business in the city of London. His means were small and his life as monotonous as a downpour of rain. The couple lived in a small red-brick house in the suburbs. The house was one of twenty in a row. The twenty were all exactly alike. Each was marked by a pathetic pretence to be "a place in the country"; each was occupied by a family of a uniform and wearying respectability. These houses were like a row of chubby inmates from an institution, all wearing white cotton gloves and all dressed alike in their best.

The street in which the houses stood was called "The Avenue," and the house occupied by the couple in question was named "The Limes." It was difficult to imagine that anything of real interest could ever occur in "The Avenue." It was impossible to associate that decorous road with a murder or even a burglary, much less with an elopement. The only event that had disturbed its peace for long was an occasion when the husband of one of the respected residents had returned home at night in a state of noisy intoxication. For months afterwards the dwellers in "The Avenue," as they passed that house, looked at it askance. It may be said, in brief, that all the villas were "genteel" and that all those who lived in them were "worthy."

The plain lady of whom I am speaking had no children. She had been happy in a stagnant, unambitious way. Everything went well with her and her household, until one horrifying day when it was discovered that she had developed a malignant tumour of the breast. The growth was operated upon by a competent surgeon, and for a while the spectre was banished. The event, of course, greatly troubled her; but it caused even more anxiety to her husband. The two were very deeply attached. Having few outside interests or diversions, their pleasure in life was bound up with themselves and their small home.

The husband was a nervous and imaginative man. He brooded over the calamity that had befallen his cherished mate. He was haunted by the dread that the horrid thing would come back again. When he was busy at his office he forgot it, and when he was at home and with a wife who seemed in such beaming health it left his mind. In his leisure moments, however, in his journeyings to London and back and in sleepless hours of the night, the terror would come upon him again. It followed him like a shadow.

Time passed; the overhanging cloud became less black and a hope arose that it would fade away altogether. This, however, was not to be. The patient began to be aware of changes at the site of the operation. Unpleasant nodules appeared. They grew and grew and every day looked angrier and more vicious. She had little doubt that "it"—the awful unmentionable thing— had come back. She dared not tell her husband. He was happy again; the look of anxiety had left his face and everything was as it had been. To save him from distress she kept the dread secret and, although the loathsome thing was gnawing at her vitals, she smiled and maintained her wonted cheerfulness when he and she were together.

She kept the secret too long. In time she began to look ill, to become pallid and feeble and very thin. She struggled on and laughed and joked as in the old days. Her husband was soon aware that something was amiss. Although he dared not express the thought, a presentiment arose in his mind that the thing of terror was coming back. He suggested that she should see her surgeon again, but she pooh-poohed the idea. "Why should a healthy woman see a surgeon?" At last her husband, gravely alarmed, insisted, and she did as he wished.

The surgeon, of course, saw the position at a glance. The disease had returned, and during the long weeks of concealment had made such progress that any operation or indeed any curative measure was entirely out of the question. Should he tell her? If he told her what would be gained thereby? Nothing could be done to hinder the progress of the malady. To tell her would be to plunge her and her husband into the direst distress. The worry that would be occasioned could only do her harm. Her days were numbered; why not make what remained of her life as free from unhappiness as possible? It was sheer cruelty to tell her. Influenced by these humane arguments he assured her it was all right, patted her on the back and told her to run away home.

For a while both she and her husband were content. She was ready to believe that she had deceived herself and regretted the anxiety she had occasioned; but the unfortunate man did not remain long at ease. His wife was getting weaker and weaker. He wondered why. The surgeon said she was all right; she herself maintained that she was well, but why was she changing so quickly? The doubt and the uncertainty troubled both of them; so it was resolved that a second opinion should be obtained, with the result that she came to see me in London.

A mere glimpse was enough to reveal the condition of affairs. The case was absolutely hopeless as her surgeon, in a letter, had already told me. I was wondering how I should put the matter to her but she made the decision herself. She begged me to tell her the absolute truth. She was not afraid to hear it. She had plans to make. She had already more than a suspicion in her mind and for every reason she must know, honestly and openly, the real state of affairs. I felt that matters were too far gone to justify any further concealment. I told her. She asked if any treatment was possible. I was obliged to answer "No." She asked if she would live six months and again I was compelled to answer "No."

What happened when she left my house I learned later. It was on a Saturday morning in June that she came to see me. For her husband Saturday was a half-holiday and a day that he looked forward to with eager anticipation. So anxious was he as to my verdict that he had not gone to his business on this particular day. He had not the courage to accompany his wife to London and, indeed, she had begged him not to be present at the consultation. He had seen his wife into the train and spent the rest of the morning wandering listlessly about, traversing every street, road and lane in the neighbourhood in a condition of misery and apprehension.

He knew by what train she would return, but he had not the courage to meet it. He would know the verdict as she stepped out of the carriage and as he caught a glimpse of her face. The platform would be crowded with City friends of his, and whatever the news—good or bad—he felt that he would be unable to control himself.

He resolved to wait for her at the top of "The Avenue," a quiet and secluded road. He could not, however, stand still. He continued to roam about aimlessly. He tried to distract his thoughts. He counted the railings on one side of a street, assuring himself that if the last railing proved to be an even number his wife would be all right. It proved to be uneven. He jingled the coins in his pocket and decided that if the first coin he drew out came up "Heads," it would be a sign that his wife was well. It came up "Heads." Once he found that he had wandered some way from "The Avenue" and was seized by the panic that he would not get back there in time. He ran back all the way to find, when he drew up, breathless, that he had still twenty-five minutes to wait.

He thought the train would never arrive. It seemed hours and hours late. He looked at his watch a dozen times. At last he heard the train rumble in and pull up at the station. The moment had come. He paced the road to and fro like a caged beast. He opened his coat the better to breathe. He took off his hat to wipe his streaming forehead. He watched the corner at which she would appear. She came suddenly in sight. He saw that she was skipping along, that she was waving her hand and that her face was beaming with smiles. As she approached she called out, "It is all right!"

He rushed to her, she told me, with a yell, threw his arms round her and hugged her until she thought she would have fainted. On the way to the house he almost danced round her. He waved his hat to everybody he saw and, on entering the house, shook the astonished maid-servant so violently by the hand that she thought he was mad.

That afternoon he enjoyed himself as he had never done before. The cloud was removed, his world was a blaze of sunshine again, his wife was saved. She took him to the golf links and went round with him as he played, although she was so weak she could hardly crawl along. His game was a series of ridiculous antics. He used the handle of his club on the tee, did his putting with a driver and finished up by giving the caddie half a sovereign. In the evening his wife hurriedly invited a few of his choicest friends to supper. It was such a supper as never was known in "The Avenue" either before or since. He laughed and joked, was generally uproarious, and finished by proposing the health of his wife in a rapturous speech. It was the day of his life.

Next morning she told him the truth.

I asked her why she had not told him at once. She replied, "It was his half-holiday and I wished to give him just one more happy day."

The second episode belongs to the days of my youth when I was a house-surgeon. The affair was known in the hospital as "The Lamp Murder Case." It concerned a family of three—husband, wife and grown-up daughter. They lived in an ill-smelling slum in the most abject quarter of Whitechapel. The conditions under which this family existed were very evil, although not exceptional in the dark places of any town.

The husband was just a drunken loafer, vicious and brutal, and in his most fitting place when he was lying in the filth of the gutter. He had probably never done a day's work in his life. He lived on the earnings of his wife and daughter. They were seamstresses and those were the doleful days of "The Song of the Shirt." As the girl was delicate most of the work fell upon the mother. This wretched woman toiled day by day, from year's end to year's end, to keep this unholy family together. She had neither rest nor relaxation, never a gleam of joy nor a respite from unhappiness. The money gained by fifteen hours' continuous work with her needle might vanish in one uproarious drinking bout. Her husband beat her and kicked her as the fancy pleased him. He did not disable her, since he must have money for drink and she alone could provide it. She could work just as well with a black eye and a bruised body as without those marks of her lord's pleasure.

As she had to work late at night she kept a lamp for her table. One evening the sodden brute, as he staggered into the room, said that he also must have a lamp, must have a lamp of his own. What he wanted it for did not matter. He would have it. He was, as a rule, too muddled to read even if he had ever learnt to read. Possibly he wanted the lamp to curse by. Anyhow, if she did not get him a lamp to-morrow he would "give her hell," and the poor woman had already seen enough of hell. Next day she bought a lamp, lit it and placed it on the table with some hope no doubt in her heart that it would please him and bring a ray of peace.

He came home at night not only drunk but quarrelsome. The two lamps were shining together on the table. The room was quite bright and, indeed, almost cheerful; but the spectacle drove him to fury. He cursed the shrinking, tired woman. He cursed the room. He cursed the lamp. It was not the kind of lamp he wanted. It was not so good as her lamp and it was like her meanness to get it. As she stood up to show him how nice a lamp it really was he hit her in the face with such violence that he knocked her into a corner of the room. She was wedged in and unable to rise. He then took up his lamp and, with a yell of profanity, threw it at her as she lay on the ground. At once her apron and cotton dress were ablaze and, as she lay there burning and screaming for mercy, he hurled the other lamp at her.

The place was now lit only by the horrible, dancing flames that rose from the burning woman. The daughter was hiding in terror in the adjoining room. The partition which separated it from her mother's was so thin that she had heard everything that passed. She rushed in and endeavoured to quench the flames; but streams of burning oil were trickling all over the floor, while the saturated clothes on her mother's body flared like a wick. Her father was rolling about, laughing. He might have been a demon out of the Pit. Neighbours poured in and, by means of snatched-up fragments of carpet, bits of sacking and odd clothes, the fire was smothered; but it was too late.

There followed a period of commotion. A crowd gathered in the dingy lane with faces upturned to the window from the broken panes of which smoke was escaping. People pressed up the stair, now thick with the smell of paraffin and of burning flesh. The room, utterly wrecked, was in darkness, but by the light of an unsteady candle stuck in a bottle the body of the woman, moaning with pain, was dragged out. An improvised stretcher was obtained and on it the poor seamstress, wrapped up in a dirty quilt, was marched off to the hospital, followed by a mob. The police had appeared early on the scene and, acting on the evidence of the daughter, had arrested the now terrified drunkard.

When the woman reached the hospital she was still alive but in acute suffering. She was taken into the female accident ward and placed on a bed in a corner by the door. The hour was very late and the ward had been long closed down for the night. It was almost in darkness. The gas jets were lowered and the little light they shed fell upon the white figures of alarmed patients sitting up in bed to watch this sudden company with something dreadful on a stretcher.

A screen was drawn round the burnt woman's bed, and in this little enclosure, full of shadow, a strange and moving spectacle came to pass. The miserable patient was burned to death. Her clothes were reduced to a dark, adhesive crust. In the layers of cinder that marked the front of her dress I noticed two needles that had evidently been stuck there when she ceased her work. Her face was hideously disfigured, the eyes closed, the lips swollen and bladder-like and the cheeks charred in patches to a shiny brown. All her hair was burnt off and was represented by a little greasy ash on the pillow, her eyebrows were streaks of black, while her eyelashes were marked by a line of charcoal at the edge of the lids. She might have been burnt at the stake at Smithfield.

As she was sinking it was necessary that her dying depositions should be taken. For this purpose a magistrate was summoned. With him came two policemen, supporting between them the shaking form of the now partly-sobered husband. The scene was one of the most memorable I have witnessed. I can still see the darkened ward, the whispering patients sitting bolt upright in their nightdresses, the darker corner behind the screen, lit only by the light of a hand lamp, the motionless figure, the tray of dressings no longer needed, the half-emptied feeding-cup. I can recall too the ward cat, rudely disturbed, stalking away with a leisurely air of cynical unconcern.

The patient's face was in shadow, the nurse and I stood on one side of the bed, the magistrate was seated on the other. At the foot of the bed were the two policemen and the prisoner. The man—who was in the full light of the lamp—was a disgustful object. He could barely stand; his knees shook under him; his hair was wild; his eyes blood-shot; his face bloated and bestial. From time to time he blubbered hysterically, rocking to and fro. Whenever he looked at his wife he blubbered and seemed in a daze until a tug at his arm by the policeman woke him up.

The magistrate called upon me to inform the woman that she was dying. I did so. She nodded. The magistrate then said to her—having warned her of the import of her evidence—"Tell me how this happened." She replied, as clearly as her swollen lips would allow, "It was a pure accident."

These were the last words she uttered, for she soon became unconscious and in a little while was dead. She died with a lie on her lips to save the life of the brute who had murdered her, who had burned her alive. She had lied and yet her words expressed a dominating truth. They expressed her faithfulness to the man who had called her wife, her forgiveness for his deeds of fiendish cruelty and a mercy so magnificent as to be almost divine.