The Citadel (39 page)

The out-patients department where Andrew found himself was, in part, a relic of the eighteenth century. Indeed, a pestle and mortar used by Doctor Lintel Hodges, honorary physician to the same section of the hospital from 1761 to 1793, was proudly exhibited in a glass case in the entrance hall. The untiled walls were painted a peculiar shade of dark chocolate, the uneven passages, though scrupulously clean, were so ill-ventilated that they sweated, and throughout all the rooms there hung the musty odour of sheer old age.

On his first day, he went round with Doctor Eustace Thoroughgood, the senior honorary, an elderly, pleasantly precise man of fifty, well under the middle height, with a small grey imperial and kindly manner, rather like an agreeable churchwarden. Doctor Thoroughgood had his own wards in the hospital and under the existing system, a survival of old tradition – in which he was interestingly erudite – he was ‘ responsible’ for Andrew and for Doctor Milligan, the other junior honorary.

After their tour of the hospital he took Andrew to the long basement common-room where, although it was barely four o’clock, the lights were already on. A fine fire blazed in the steel grate and on the linenfold walls there hung portraits of distinguished physicians to the hospital – Doctor Lintel Hodges, very pursy in his wig, in the place of honour above the mantelpiece. It was a perfect survival of a venerable and spacious past and from the delicate dilation of his nostrils Doctor Thoroughgood – bachelor and churchwarden though he was – loved it as his own child.

They had a pleasant tea and much hot buttered toast with the other members of the staff. Andrew thought the house physicians very likable youngsters. Yet as he noted their deference to Doctor Thoroughgood and himself he could not refrain from smiling at the recollection of his clashes with other ‘insolent pups’, not so many months ago, in the frequent struggles to get his patients into hospital.

Seated next to him was a young man, Doctor Vallance, who had spent twelve months studying under the Mayo Brothers in the United States. Andrew and he began to talk about the famous Clinic and its system, then Andrew, with sudden interest, asked him if he had heard of Stillman while he was in America.

‘Yes, of course,’ said Vallance. ‘They think a lot of him out there. He had no diploma of course, but unofficially they more or less recognise him now. He gets the most amazing results.’

‘Have you seen his clinic?’

‘No,’ Vallance shook his head. ‘I didn’t get as far as Oregon.’

Andrew paused for a moment, wondering if he should speak. ‘ I believe it’s a most remarkable place,’ he said at length. ‘I happen to have been in touch with Stillman over a period of years – he first wrote me about a paper which I published in the
American Journal of Hygiene.
I’ve seen photographs and details of his clinic. One couldn’t wish for a more ideal place to treat one’s cases. High up, in the centre of a pine wood, isolated, glassed balconies, a special air-conditioning system to ensure perfect purity and constant temperature in winter.’ Andrew broke off, deprecating his own enthusiasm, for a break in the general conversation made everything he said audible to the entire table. ‘When one thinks of our conditions in London, it seems an unattainable idea.’

Doctor Thoroughgood smiled with dry asperity.

‘Our London physicians have always managed to get along very well in these same London conditions, Doctor Manson. We may not have the exotic devices of which you speak. But I venture to suggest that our solid, well-tried methods – though less spectacular – bring equally satisfactory and probably more lasting results.’

Andrew, keeping his eyes lowered, did not answer. He felt that as a new member of the staff he had been indiscreet in voicing his opinion so openly. And Doctor Thoroughgood, to show that he had intended no snub, went on very pleasantly to turn the conversation. He talked about the art of cupping. The history of medicine had long been his special hobby and he had a mass of information on the subject of the surgeon-barbers of ancient London.

As they rose he declared agreeably to Andrew:

‘I actually have an authentic set of cups. I must show you them one day. It really is a shame cupping has gone out. It was – still is – an admirable way of inducing counter-irritation.’

Beyond that first slight breeze, Doctor Thoroughgood set himself out to be a sympathetic and helpful colleague. He was a sound physician, an almost unerring diagnostician, and he was always glad to have Andrew round his wards. But in treatment, his tidy mind resented the intrusion of the new. He would have nothing to do with tuberculin, holding that its therapeutic value was still completely unproved. He was chary of using pneumothorax and his percentage of inductions was the lowest in the hospital. He was, however, extremely liberal in the matter of cod-liver oil and malt. He prescribed it for all his patients.

Andrew forgot about Thoroughgood in beginning his own work. It was wonderful, he told himself, after months of waiting, to find himself starting again. He gave, at the outset, quite a good imitation of his old ardour and enthusiasm.

Inevitably his past work on the tubercular lesions induced by dust inhalation had brought him forward to the consideration of pulmonary tuberculosis as a whole. He planned vaguely, in conjunction with the Von Pirquet test, to investigate the earliest physical signs of the primary lesion. He had a wealth of material available in the undernourished children brought by their mothers in the hope of benefiting in Doctor Thoroughgood’s well-known liberality with extract of malt.

And yet, though he tried very hard to convince himself, his heart was not in the work. He could not recapture the spontaneous enthusiasm of his inhalation investigations. He had far too much upon his mind, too many important cases in his practice, to be able to concentrate upon obscure signs which might not even exist. No one knew better than he how long it took to examine a case properly. And he was always in a hurry. This argument was unanswerable. Soon he fell into an attitude of admirable logic – humanly speaking, he simply could not do it.

The poor people who came to the dispensary did not demand much of him. His predecessor had, it appeared, been something of a bully and so long as he prescribed generously and made an occasional joke his popularity was never in doubt. He got on well, too, with Doctor Milligan, his opposite number, and it was not long before he found himself adopting Milligan’s method of dealing with the regular patients. He would have them up, in a bunch, to his desk at the beginning of dispensary and rapidly initial their cards. As he scribbled Rep.Mist. – the mixture as before – he had no time to recollect how he had once derided this classic phrase. He was well on the way to being an admirable honorary physician.

Six weeks after he had taken over at the Victoria, as he sat at breakfast with Christine, he opened a letter which bore the Marseilles postmark. Gazing at it unbelievingly for a moment, he gave a sudden exclamation:

‘It’s from Denny! He’s sick of Mexico at last! Coming to settle down, he says – I’ll believe that when I see it! But, Lord! It’ll be good to see him again. How long has he been away? It seems ages. He’s coming home via China. Have you got the paper there, Chris? Look up when the
Oreta
gets in.’

She was as pleased as he at the unexpected news, but for a rather different reason. There was a strong maternal strain in Christine, a queer Calvinistic protectiveness towards her husband. She had always recognised that Denny, and indeed, in a lesser degree, Hope, exerted a beneficial effect upon him. Now, especially, when he seemed changing, she was more anxiously alert. No sooner had this letter arrived than her mind was at work planning a meeting which would bring these three together.

The day before the
Oreta
was due at Tilbury she broached the matter.

‘I wonder if you’d mind, Andrew – I thought I might give a little dinner next week – just for you and Denny and Hope.’

He gazed at her in some surprise. In view of the vague undercurrent of constraint between them it was strange to hear her talk of entertaining. He answered:

‘Hope’s probably at Cambridge. And Denny and I might as well go out somewhere.’ Then, seeing her face, he relented quickly. ‘Oh!

All right. Make it Sunday though; that’s the best night for all of us.’

On the following Sunday Denny arrived, stockier and more brick-red of face and neck than ever. He looked older, seemed less morose, more contented in his manner. Yet he was the same Denny, his greeting to them being:

‘This is a very grand house. Sure I haven’t made a mistake.’ Half turning gravely to Christine. ‘This well-dressed gentleman
is
Doctor Manson, isn’t he? If I’d known I’d have brought him a canary.’

Seated, a moment later, he refused a drink.

‘No! I’m a regular lime juicer now. Strange as it may seem I’m going to set to and get a real pull on the collar. I’ve had about enough of the wide and starry sky. Best way to get to like this blamed country is to go abroad.’

Andrew considered him with affectionate reproof.

‘You really ought to settle down, you know, Philip,’ he said. ‘After all you’re on the right side of forty. And with your talents –’

Denny shot him an odd glance from beneath his brows.

‘Don’t be so smug, Professor. I may still show you a few tricks one of these days.’

He told them he had been lucky enough to be appointed Surgical Registrar of the South Hertfordshire Infirmary, three hundred a year and all found. He did not consider it a permanency, of course, but there was a considerable amount of operative work to be done there and he would be able to refresh his surgical technique. After that he would see what could be done.

‘Don’t know how they gave me the job,’ he argued. ‘It must be another case of mistaken identity.’

‘No,’ said Andrew rather stolidly, ‘it’s your MS, Philip. A first class degree like that will get you anywhere.’

‘What have you been doing to him?’ Denny groaned. ‘He don’t sound like the bloke what blew up that sewer with me.’

At this point Hope arrived. He had not met Denny before. But five minutes was enough for them to understand one another. At the end of that time, as they went in to dinner, they were agreeably united in being rude to Manson.

‘Of course, Hope,’ Philip sadly remarked as he unfolded his napkin. ‘You needn’t expect much food here. Oh, no! I’ve known these people a long time. Knew the Professor before he turned into a woolly West-ender. They were thrown out their last home for starving their guinea-pigs.’

‘I usually carry a rasher in my pocket,’ said Hope. ‘It’s a habit I acquired from Billy Buttons on the last Kitchen-gunga expedition. But unfortunately I’m out of eggs, Mother’s hens are not laying at the moment.’

There was more of this as the meal went on – Hope’s facetiousness seemed especially provoked by Denny’s presence – but gradually they settled down to talk. Denny related some of his experiences in the Southern States – he had one or two negro stories which made Christine laugh – and Hope detailed for them the latest activities of the Board. Whinney had at last succeeded in steering his long contemplated muscular fatigue experiments into action.

‘That’s what I’m doing now,’ Hope gloomed. ‘But thank heaven my scholarship has only another nine months to run. Then I’m going to
do
something. I’m tired of working out other people’s ideas, having old men stand over me’ – his tone dropped into ribald mimicry – ‘“How much sarco-lactic acid did you find for me this time, Mr Hope?” I want to do something for myself. I wish to God I had a little lab of my own!’

Then, as Christine had hoped, the talk became violently medical. After dinner – despite Denny’s melancholy prognostication, they had stripped a brace of ducks – when coffee was brought in, she pleaded to remain. And though Hope assured her that the language would not be ladylike she sat, her elbows on the table, chin upon her hands, listening silently, forgotten, her eyes fixed earnestly on Andrew’s face.

At first he had appeared stiff and reserved. Though it was a joy to see Philip again he had the feeling that his old friend was a little casual towards his success, unappreciative, even mildly derisive. After all, he had done pretty well for himself, hadn’t he? And what had Denny – yes, what had Denny done? When Hope chipped in with his attempts of humour he had almost told them, pretty sharply, to stop being funny at his expense.

Yet now that they were talking shop he was drawn into it unconsciously. Momentarily, whether he wished it or not, he caught the infection from the other two and with not a bad copy of his old rapture, he made himself heard.

They were discussing hospitals which caused him suddenly to express himself upon the whole hospital system.

‘The way I look at it is this.’ He took a long breath of smoke – it was not now a cheap Virginian cigarette but a cigar, from the box which he had, braving the devil in Denny’s eye, self-consciously produced – ‘The whole layout is obsolete. Mind you, I wouldn’t for anything have you think I’m knocking my own hospital. I love it down there at the Victoria and I can tell you we do great work. But it’s the system. Nobody but the good old apathetic BP would put up with it – like our roads, for instance, a hopeless out-of-date chaos. The Victoria is falling down. So is St John’s – half the hospitals in London are shrieking that they’re falling down! And what are we doing about it? Collecting pennies. Getting a few quid out of the advertisement hoardings we stick up on our frontage.
Brown’s Beer is Best.
Isn’t that sweet! At the Victoria, if we’re lucky, in ten years’ time, we’ll start to build a new wing, or a nurses’ home – incidentally you should see where the nurses
sleep
! But what’s the use of patching up the old carcase. What is the use of a lung hospital in the centre of a noisy foggy city like London? – damn it all, it’s like taking a pneumonia down a coal-mine. And it’s the same with most of the other hospitals,
and
the nursing-homes, too. They’re bang in the middle of roaring traffic, foundations shaken by the Underground, even the patients’ beds rattle when the buses go past. If I went in there,
healthy
, I’d want ten grains of barbitone every night to get to sleep. Think of patients lying in that racket after a serious abdominal, or running a temperature of a hundred and four with meningitis.’