The Doctor's Christmas Eve

On a near peak of especial moral grandeur, his Nevermore stood in her supernal resentment of his wife's wrong. For whatever Nevermore was not, at least, she was woman. And what woman fails to espouse any wife's dignity except the woman who supplants the wife? (Not even she; for if ever in turn her hour comes, her first outcry is, 'I might have known.')

Dr. Birney did not have three hours for this morning's business, then, but two hours and a half; and forthwith beginning, he took from his breast-pocket a small book and transferred from it to a large diary his notes of visits to patients on the day preceding. This soon done, he was ready for the main work.

It was now the closing week of the year when according to custom he posted the year's books; for he was his own secretary. By New Year's Day his accounts were about ready and new books were opened.

He always took up with repugnance this valuation of his services. It was to him one of life's ironies that in order to live he must take toll of death. He must harvest his bread from the fields of tears. He must catch his annual treasure from those rainbows of hope that spanned weary pillows. He must fill his wine-jar by dipping his cup into the waves of Lethe. He must equip his very stable with the ferriage he had collected on the banks of the Styx.

His heart was never in his bookkeeping; this morning he could barely fix upon it his thoughts; so that before commencing he allowed himself to turn the leaves, getting a distasteful bird's-eye view of this panorama of neighborhood suffering and mortality there outspread on the table.

Two infants in January had had scarlet fever; so much for the infants and the fever. A boy had had measles; an assessment for measles. A girl had had mumps; the price of mumps. An old lady, going one bitter February afternoon to her hen-house to see whether the hens had begun to lay, had slipped on the ice-covered step and had fractured her hip-bone; damages for the friable hip-bone of the senile. A negro man, stationed in an ice-house to knock to pieces with an axe the blocks of ice as they were hauled from the pond, had had his feet frost-bitten. In April a stable-boy had been kicked in the groin and bitten in the shoulder by a stallion. This stallion, in whom survived the fighting traits of the wild horse and defiance of man as an enemy who had no use for him but to enslave him and work him to death, had already killed two stablemen. Too valuable for the stud to be himself killed, and too dangerous to be approached or handled, it was decided to destroy his eyesight; and the doctor had been called in to treat both stable-boy and stallion. There was a bill for his services to the boy; none for the stallion; he was not a veterinary. But it was his hand that had jabbed the long needle into those virile unconquerable eyes – leaving that Samson Agonistes of the herd whose only crime had been to reject civilization, as was his right. There was no one to put out the doctor's eyes, who also had rejected civilization: which was not his right.

In June a lad, climbing a cherry tree with the ambition to capture the earliest cherries dangling scarlet, had fallen flat upon his back when the limb had split from the half-rotten trunk, thus jarring his spine. It was a bad case; he must now make out a good bill for it, otherwise the father would feel resentful.

In harvest time one of his friends, a young farmer, overheated, went bathing too soon in a fresh-water pond – made cooler by a recent hail-storm; between the leaves lay a note from his widow, with its deep black border and its mourning perfume; she had asked for the account – had asked punctiliously to pay for a beloved young husband's fatal chill. In autumn two barefoot half-grown brothers were cutting ironweeds in a pasture with hemphooks; the elder by too heavy a stroke had sent his blade clean through a clump of weeds into the ankle of the younger, slashing it to the bone.

Thus the record ran on as the doctor turned the pages in a preliminary survey of his chart of suffering. And then there were the cases of those coming into the world and the cases of those going out: birth-rates, death-rates. He must exact of Nature his fee for continuing the existence of the human race; and he must go about among his friends and neighbors and wring money out of them because those they loved best had merely paid their own decent debt to mortality.

He dipped his pen into the ink, drew before him some blanks, and began to make out the bills. The rooms were very quiet and comfortable; winter sunshine entered through the windows; the Christmas wind frolicked outside the walls.

To be forced to sit there and say to the world: My feelings have nothing to do with it: you must pay what you owe! Because all life is payment; everything is a settlement. There is but one that is exempt – Nature. It is only she who never fails to collect a debt but who never pays one. Who that has ever lived our common human life, borne its burdens, felt its cares, fought against its wrongs, who but knows that Nature is in debt to him? But what son of hers has ever been able to tear his due from her!

More may be learned about the doctor by an inspection of his rooms. Of these there were three, with a small fourth chamber as an ell in the house: in this ell there was a single bed, and here he sometimes slept – as nearly outside the house as it was possible to lie and still to be within it.

The room in which he now worked was his library; communicating through an open door was his office; beyond the office through another open door was a third room in which were stored many personal articles of indoor and outdoor use.

Beginning with his office, you derived the knowledge which any physician's and surgeon's office, if modern and complete, should afford. On one wall hung his diploma from a New York Medical College; on another a diploma from Vienna for post-graduate study and hospital work.

The rooms taken together bore testimony in their entire equipment to a general outside truth: that the physician who lived in them was not a country doctor because he had been crowded by abler members of the profession out of the cities where there are many into the country where there are none: and this fact in turn had its larger historic significance.

Almost within a generation a radical change has taken place in the relation of town and country as regards the profession of medicine. The old barriers which half a century ago separated the sick in the streets from the sick in fields and forests have been swept away. The city physician now twenty-five miles away can often arrive more quickly than a country doctor who lives five; and a surgeon can come in an hour who formerly needed half a day. But many now living with long memories can well remember the time when the country doctor ruled in his neighborhood as the priest in mediæval Europe swayed his parish. However remote, he was always sent for. His form was the very image of rescue, his face was the light of healing. As a consequence, the country often developed leaders in the profession. Instead of its being dependent upon the cities, these looked to the rural districts for many of the most skilful practitioners.

This was strikingly true from the earliest settlement of the West on that immense plateau of forest and grass land which has long since drawn to itself the notice of the world as the loveliness of Kentucky. It was on the southern boundary of this plateau, living in a pioneer hamlet and practising far and wide through a wilderness, that a country doctor became the father of ovarian surgery in the United States and won the reverence of the world of science and the gratitude of humanity. In another pioneer settlement one of the greatest of American lithotomists spread the lustre of his name and the goodness of his deeds over the whole country west of the Alleghany Mountains; and these were but two of those many country doctors who there for well-nigh a century were the reliance of their people: physicians, surgeons, diagnosticians, nurses, pharmacists, friends – all in one.

This powerful and brilliant tradition had descended to Dr. Birney, and he had worthily upheld it. In some respects he had solidly advanced it, notably in his treatment of children's diseases.

A second room, in which the articles of his personal life were kept, gave further knowledge of him as a man. Outside the windows there was a tennis court; he played tennis with his children and with young people of the neighborhood. You saw his racquet on the wall; and if you had opened a closet, you would have found the flannels and the shoes. Elsewhere on the wall you saw his reel. In season he liked to fish, when his patients also could go fishing, or at least were well enough to feel like going; and in the same closet you might have noted the residue of a fisherman's outfit. He fished not only for black bass, but for that mild pond and creek fish prized as a delicacy on Kentucky tables – a variety of the calico bass known in the local vocabulary as "newlight."

Still elsewhere you saw his game bag and bird gun – he liked to call it by the older word, fowling-piece. He hunted: quail, doves, wild duck. In another closet you would have been interested to discover his regalia as a member of the Order of Masons; and well placed beside it his uniform as a member of the State Guard – the two well placed there. When years before his neighbors had enrolled him in the Guard, they had saluted him as one more Kentucky Colonel. "I will submit to no official degradation," he had said; "I am already the Commander of the whole army of you on the field of your human Waterloo: salute your General!"

His library added its testimony as to other humanities. Scattered about on tables and mantel-piece were fine old pipes and boxes of cigars and playing-cards. There were poker chips, showing that the doctor had poker neighbors (where else if not there?), though whist was his game. You realized that he was a man at home among a people who loved play – must have play. On his sideboard were temperate decanters: he had sideboard neighbors. Altogether a human-looking room for much that is human; easy to enter, comfortable to stay in, hard to quit.

But our closest friends can come so close to us and no closer; they surround us but none of them enters us. Nature forbids that any but our own feet should cross the bridge spanning the distance between other people and the fortress of the individual. Across that bridge we can take with us no companions except those that keep silent amid its silences; that can speak to us but that cannot see us: those great voices without eyes; those great listeners without ears; great counsellors without criticism; great hands that guide and refuse to smite; great judges that embody law and refuse to sit in judgment on us – Books.

Some of the doctor's books held for him life's indispensable laughter; and no one of us ever tells all the things in this world that we laugh at. Some held for him life's tears; and no one of us ever tells the things that secretly start our own. Some held neither laughter nor tears but what is above both – life's calm; and what one of us but at times feels the need to ascend to some inner mountain-top of our own spirits – far above the whole darkened or radiant cloud-rack of emotion – and look futureward into the promised peace, the end of our wandering. Joys – sorrows – and calm: these three for him, too.

Such books stayed with the doctor year after year. He could wake in the night and find them through the darkness; in the darkness they knew how to find him. They were not part of his medical library, of course, which was another matter. But they filled three sides of a large low revolving bookcase in the middle of the room beside his easy chair and his lamp and table.

The fourth side of his bookcase held the books that came and went as a stream, entering and passing on: he drank from them as they flowed by. Always they were books of fiction or biography which held in solution the truth of the human matter about some life that had fought or was fighting its path through to victory. Always he would have books of victory. By preference it must be a story real or imagined of some boy, youth, young man, middle-aged man, who was in the struggle for existence and who was on the side of survival. He kept in mind the words of a great Frenchman that the way to make an impression upon the world is to plough through humanity like a cannon-ball or to creep through it like a pestilence. But he knew that in this world there are very few human cannonballs, though of such pestilence there is always more than enough. Rather every common man's life, and every uncommon man's life, is a drawn sword that has to cut its way through all other drawn swords. Here were the books which disclosed the mettle of a character: the last magnificent refusal to be ruined by evil which is the very breath of a man and the slow measure of the world's advance. So that, while much is always failing in everybody, all is never failing. Out of the blackest abyss there arises in the wounded and prostrate some white peak of unmelting innocence – at the base of which Life's battle rages.

Many a time long after midnight he would read to a finish some such triumphant story; and with a murmur of "Well done!" he would close the book, turn out his lamp, and go to sleep in his chair with his clothes on – with that scene of victory emptying its echoes into his ear and his dreams.

Here, then, was some discrete knowledge of the doctor as a doctor and as a man. But there was one thing in his library that blended these two separate aspects, showing how the man felt as a physician and how the physician felt as a man. This was a series of pictures running around the walls and connecting great epochs in the progress of Medicine.

He had a liking, as the world has, for some brief series of climaxes that will depict a subject at a glance. Very memorable to him was Shakespeare's Seven Ages – because they were seven and were thus easily grasped by poetry and reason. But he knew that Shakespeare might as truly have substituted another seven – with as good poetry and reason; or he might have made the ages fourteen or forty-nine or forty-nine hundred; for actually the ages of a man's life are infinite; but being reduced to seven, we all recognize them.

And memorable to him likewise had been Hogarth's Progress of the Rake with its few pictures; and his Progress of the Harlot with its few; and his Progress of Marriage à la Mode with its few; and the Progress of Cruelty with its fewest of all – only four, but more than enough! And yet the stages in the progress of the rake and of the harlot and of marriage à la mode and of cruelty are infinite; and at no single stage in the progress of any one of them could you actually find either Rake or Harlot or Infidelity or Cruelty. Being portrayed as few, the world understands and finds its own account in them.

So around the walls of his library there hung a series of pictures showing the progress of Medicine across the ages.

The first picture represented a scene in the life of primitive man, during the period when he had long enough been man to form into hostile tribes, but not long enough to have advanced far from the boundaries of the brute. It is a battle picture: the battle is over: the survivors are gone: the dead and wounded lie about. Medicine as a human science has not yet been born; surgery has not yet separated itself from the movements of instinct. Yet there was activity among the wounded. In some of the warriors you saw such attempts in the care of their wounds as one may witness to-day in wounded birds and animals – if one is fortunate enough to be so placed as to be able to watch: there were the instinctive devices to cleanse, to protect, to alleviate: those low beginnings of the great science which you may observe to-day in your dog when he has come home after a fight with lacerated ears and slashed thighs – when he crawls under the porch to the darkest corner to keep away other dogs and light and flies; whose sole instrument of cleansing is his tongue and whose only bathing fluid is saliva. On that battle-field you saw such beginnings of surgery as to-day is practised by a bird treating its broken wing or broken leg. Thus the wounded warriors concerned themselves with their hurts – all mother-naked. Along one edge of the battle-field was a stream of running water; some had started to draw themselves toward this and had died on the way. One was stretched full alongside – a young chief of magnificent proportions and a face of higher intelligence. And out of that intelligence, as a marvellous advance in the development of man, you saw one action: he was dipping up water in the palm of his hand and pouring it upon his wound. At some moment in the history of the race there must somewhere have been that first movement of the developing animal to substitute water for saliva. That great historic moment was depicted there. It was still the Azoic Age of Medicine.

Near by hung a second picture. Ages have passed, no one knows how many. The brute has become Prometheus; he has learned the use of fire; and he has learned the most heroic application of flame – to touch it to himself where he is in greatest agony: that is, he has learned to cauterize his wounds. More than fire can he now handle; he has learned to bring together fat and flame; and he has discovered how from flame to produce oil; and he has learned to pour boiling oil into the holes in his body made by the implements of war. It is the long Ages of Medicine for the cautery and burning oil.

A third picture hung next. More ages have passed, no one knows how many; and the scene is another battle-field far down toward modern times. It is France; it is the second half of the sixteenth century; it is warfare in Piedmont. Troops are sweeping up the hill, and in the background is a walled city with turrets and towers; and in the foreground wounded soldiers are arriving or are lying about on the ground. There is a rude mass of masonry used as an operating-table; and on the operating-table is a soldier, one of whose legs has just been amputated above the knee; an attendant holds the saw with which the leg has just been sawed off, and the stump of it has dropped below. Beside the wounded man stand two figures: one the figure of the past; and the other a figure of the future – a poor barber's apprentice, father of modern surgery, named to be massacred on St. Bartholomew's eve, but spared because none but a despised Huguenot could be found in all France skilful enough to safeguard the royal orthodox blood. There beside the soldier they stand, these two, and in them ages meet; for the figure of the past holds in his hand one of the cauteries that are kept redhot in a brazier near his feet; and the other holds in his a new thing in the world – a simple ligature. A great scene, a great epoch: the beginning of new surgery when the flowing of blood from amputations of the great arteries could be stopped by a mere bandage: that man – Ambroise Paré!

More centuries have passed – we know exactly how many now from year to year. It is the nineteenth, and it is the New World; the next picture on the library wall portrayed a scene on the Western frontier of a new civilization. It is the backwoods of Kentucky, it is a pioneer settlement of three or four hundred souls, nearly a thousand miles from any hospital or dissecting-room. In the front door of his rude pioneer house stands a Kentucky country doctor, Ephraim MacDowell. His patient is before him, a woman on horseback in a side-saddle. She has just arrived, having ridden some seventy miles through the wilderness. He is assisting her to alight; and he is soon to perform, without consultation, without precedent in the ages of surgery (but not without a prayer for himself and her), by strength of his own will and nerve and by the light of the solitary candle of his own genius, an operation which made Kentucky the mother of ovarian surgery for all coming time, a new epoch of life and mercy: he going his own way to immortality as Shakespeare went his, as the greatest always go theirs – by a new path untrumpeted and alone.

Another picture represented a scene in Boston in 1846, less than half a century later; for the lonely mountain peaks of progress stretching across the ages are beginning to crowd each other now; they are beginning to run together into a range of continuous discovery. That picture also shows an operating-room; and there stood the American Morton, making for the world the first merciful use of anæsthetics: with which the silence of painlessness fell upon humanity's old outcry of torture under treatment.

There the doctor's pictures ended. In our own time he might have added one more for the epoch of the Roentgen Ray and another for the Finsen Light; and another for transfusion of blood; and still others crowning other mountain-tops in the new Surgery and new Medicine.

Thus he had before his eyes in his library some few Ages of his Science – as it went forward and slipped back and missed the road and forgot the road, yet somehow steadily advanced across the centuries like an erring unconquerable man across his years. Not progressing however as a man grows, from infancy to decrepitude; but moving from its old age toward its youth, always toward its youth, as Swedenborg's Angels fly forever toward their Spring. It ran around his walls like a great roadway, connecting the last discoveries of his Science with the surgery of the wolf who gnaws off his imprisoned leg and with the medicine of the sick dog that eats grass.

He called it his World's Path of Lessening Pain.

It was the last refuge and solace of his often tired and often wounded mind. Even after friends were gone at night and the poker chips were stacked or the whist counters folded; after the sideboard had been visited and temperately forsaken; after the abiding books had done for him what they could; in the still house far into the night, he would sometimes lie back in his chair and survey those battle-pictures of a science on which he was spending his loyalty and his strength.

Once, in younger days, outside the Eternal City, he had gone to study those fragments of the Old Roman Aqueduct that to-day are slowly crumbling on the Campagna; and standing alone before it he had in imagination searched for the figure of some young workman who had helped to mould those brick or to finish those columns: the figure of some obscure vanished peasant. So the great wall of his science, being built onward across the centuries into the future, would be revisited by men of the future in places where it stood in ruins. He would be as one whose life with its mistakes was yet linked to indestructible good. He would vanish from beside the wall himself, but his work upon it would have helped to uphold humanity. And many a night he went asleep in his chair, committing himself to his Science, as the forgotten Roman laborer of old may have fallen asleep under his own arch.

But, in that same Italy, northward are the Apennines; and sometimes in travelling through these or through the Swiss glaciers where Nature measures all things on the scale of the sublime – sometimes as your eye is passing from snow peak to snow peak, suddenly away up on some mountain-side you will see a human hut; and standing in the door of that hut a single human being; and the thought may come to you that there, in the heart of that pygmy, may dwell sorrow that dwarfs the Alps.

The doctor's library had such a picture: it completed the story of the room, and it effaced everything else in it. In a somewhat darkened corner hung a framed photograph of his wife in her bridal dress made not long after their wedding. Once his photograph had hung beside it. The plaster where the nail had been driven in had either fallen out or it had been torn out. He never knew – he knew enough not to ask.

As for the photograph, there stood a young bride, looking into her future and trying to conceal from herself what she saw soon awaiting her: the life of a woman wedded but not loved. And there was recollection in the eyes too: that the man who had married her perhaps in the very breath of his wooing had wished she were another; that at the altar he had perhaps wished he were putting his ring upon another's hand; and that if there were to be children, he would always be wishing for them another mother.

The doctor sat there that morning trying to work at the books of the year. The rooms were comfortable; the children were away at the fireside of another man's wife; the servants did not dare disturb him; his horses waited in their stalls; it was the day on which he could begin to reap his golden harvest – a pleasant day for most men; but he could not see the blanks before him nor remember the names he filled in nor the figures that were for value received.