Victorian London - Publications - Social Investigation/Journalism - The Little World of London, by Charles Manby Smith, 1857 - The Physician's Levee

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THE bills of mortality, and the reports of the registrar, published weekly in the newspapers, inform us that above a thousand of our fellow-creatures pass away by death during the intervals between each recurring Sabbath. At the moment we write, the general weekly average of a thousand has risen to above sixteen hundred, and that without the prevalence of any extraordinary epidemic or infectious disorder. The two and a half millions of people congregated within the circle which contains London and its suburbs are by means of the tables of the registrar-general, converted into a vast barometer of health and disease, of life and death - a barometer so susceptible of the numberless influences which affect human health and existence, that the operation of each one of them, however trifling compared with others it may be, is marked and recorded with invariable precision for the benefit and admonition of the survivors. In a city where above a thousand die weekly, how great must be the amount of the sickness and suffering which are the forerunners of decease How many must lie groaning in anguish from day to day, awaiting, amidst the strife and turmoil of the surrounding multitudes, their dismission to that silent land where no voice is heard, nor sound of human joy or grief can penetrate How many men are there in whom the seeds of decay and dissolution, latent in all men, have begun to germinate, and who, bound by a thousand ties to the sympathies and obligations of life, are alarmed by the indications of approaching disease, or, wrestling with it in [-341-] the midst of duties which may not be neglected, seek counsel of the physician to ward off, if possible, or to defer to an indefinite period, the execution of the sentence they know and feel to be pronounced. Among this latter class we are most of us - may we not say all of us? - occasionally numbered - the exceptions being those favoured few who have never been compelled by inward warnings to seek medical advice.
    The love of life is rarely manifested in a stronger light than by those who for the first time feel its sacred outworks assailed by the advance of some insidious or unsuspected disorder. "All that a man hath will he give for his life." Let him but feel that that is endangered, and away fly the maxims of economy and miserly prudence ; they are but feathers in the balance against the life that God has given him, to preserve which no sacrifice is too great. He seeks for the best advice - the best, at least, that he is in circumstances to procure - and he acts upon it, postponing every other consideration to the means of restoring his lost health. This state of feeling, with which no reasonable man will quarrel, affords the key to the spectacle to which we are about to introduce the reader.
    The scene is in one of the genteel squares lying north of the Holborn line of route, and verging towards the west end; the time eight o'clock, or a minute after, on a cold and misty November morning. If the sun has risen, no Londoner has yet seen his face. The surrounding streets are still as a church-yard ; the footfall of a plodding policeman may be heard at intervals, but no further echoes break the silence. The inhabitants of this fashionable quarter are fast bound in sleep ; even the servants are not yet astir, as is evidenced by the absence of smoke from the chimneys. The milkman will not come round for this hour, and no morning cry will disturb the sleepers repose. But see yonder comes a cab gently round the corner ; it pulls up at a private house in [-342-] the square, sets down an elderly gentleman, and draws off a little to wait for him. At the same moment a middle-aged woman, leading a young girl, ascends the steps, and all three disappear into the house together. Another cab, and then several others follow, discharging their fares at the same door some of the visitors have to be lifted from the vehicle, and assisted up the steps ; others spring out and in lightly enough ; some are accompanied by friends, some are alone.  Now the foot passengers increase in number ; we have hardly been watching half an hour ere between thirty and forty people of various ages, and some of them bowed with infirmity or pain, have vanished silently within that ever-opening door. What has brought all these pilgrims out on such a morning as this ? The love of life. That house is the residence of Dr. Quinine, one of the most learned and successful practitioners of the day, whose time is worth many thousands a year to him. He visits the aristocracy during the day, travelling hither and thither in his coach, and he devotes an hour and a half every morning of the year to those who choose to consult him personally at his own house. He will see perhaps forty patients this morning, and if he chose he might receive a guinea from each but, from what we know of him, he is as likely to give a guinea to some poor creature in need of it, and his advice into the bargain, as to take her hard-earned or perhaps borrowed fee.
    Let us enter the waiting-room and look around us. It is a handsome and lofty chamber nearly thirty feet square. Upon the walls are a few fine old portraits - one, apparently of a court beauty, by Sir Peter Lely; there is a large landscape of the Flemish school; and over the sideboard, on which stands a decanter of water and a few glasses, there us a fruit and flower piece still larger. A cheerful fire is blazing in the grate, warming the whole room, in which there are substantial padded chairs and settees enough to accommodate fifty sitters. On the table in the centre are a few [-343-] books and yesterday's newspapers. The majority of the waiting seats are occupied by the morning's arrivals, each his turn for admission to the physician in the inner room. There sits by the fire a young fellow about town, who is paying the penalty of dissipation by the endurance of its retributive consequences, and whose hard, noisy breathing tells us, without the aid of the stethoscope, that the orgies of his nights have borne their natural fruit of miserable days. Beside him is an elderly tradesman, with a face of dogged endurance deeply lined with the habit of silent suffering, who has probably borne the martyrdom of an unhealthy occupation for the best years of his life, and, hopeless of cure, seeks only a temporary relief. Opposite to him is a widow with her only daughter, whose pallid face and leaden eye bespeak the presence of some functional derangement which has, perhaps, baffled the skill of former advisers, and may elude the investigation even of Dr. Quinine himself. Behind the widow there sits a girl whose vacant expression tells you as plainly as possible that she has long been growing deaf, and more deaf, and who is come, if it may be done, to have her hearing restored. Then there is a mother with two white-faced children, blighted buds of promise, apparently withering away ; and whom she has brought up yesterday all the way from Maidstone, to show to the famous London physician, and to have his advice. But what needs it to catalogue the individual woes and maladies of this various assembly. They all come with one purpose, with one settled thought in their hearts, like the hapless Israelites of old, who swarmed round the pool of Bethesda to await the descent of the heavenly messenger of health.
    Standing at a green-baize door, which has another door close behind it, is an elderly footman with the stolid face of a martinet, overshadowed by powdered hair. He is the janitor of the inner shrine, and his movements are directed [-344-] by the tinkling of a little bell, at the sound of which he opens the door, and the patient comes forth after a consultation of a minute or two, generally carrying a prescription in the hand. When the man-about-town comes forth, we observe that he looks particularly serious, and takes extraordinary care in buttoning and bandaging himself up, while the young man in waiting in the lobby is gone to summon his cab to the door - and we guess that he has received a reprimand for venturing out of doors on such a day as this. When the mother with her two children comes out, we are glad to see she brings a cheerful, quite a merry face with her : there is evidently nothing seriously the matter with her little ones, and the prescription she holds in her hand will set them all to rights ; and the golden fee too, which we saw her slip under her glove when she entered, she now puts back in her purse, because Dr. Quinine wouldn't take it. The poor widow and her daughter are closeted a long time, though it is plain they have not a fee to give ; but there is a gleam of hope on the face of each as they come out, and we may indulge the expectation that the recovery of the poor girl is not far distant.
    We must leave the elderly tradesman, and the rest of the rather motley company to the physician's management, and proceed on our way, not, however, without a parting trait of the celebrated Dr. Quinine himself. It happened some years ago that an acquaintance of ours, a farmer of good property, requested us to accompany him, on the ground of his feeling rather nervous, on the occasion of his consulting our physician on account of what he called queer symptoms, such as seeing double, &e., &c. The doctor received bins politely, and whilst the patient was giving a description of the symptoms, examined him minutely. While he was yet speaking the medicus seized his pen and wrote a prescription. " You need say no more," he said "take this, and act upon it. There are twenty years of life in you [-345-] yet if you are wise. I don't know what your powers of self-denial may be, but upon them depends your existence. Take plenty of exercise - drink wine but rarely, ale and spirits never. In that case you may look to be an old man : pursue your present course, and I would not buy your life at a year's purchase.'' The patient, who was what is called a generous liver, had the sense to take the advice thus sternly given, and profited by it.
    It is an old maxim that advice which costs nothing is rarely followed. In spite of this maxim, however, "ADVICE GRATIS" is a commodity as common as any other in London, judging from the frequency with which these two words confront us in our rambles. It is well for the poorer classes that this practice is so general. Excellent advice in common cases, that is, in the majority of the disorders to which we are liable, is to be had for nothing but it must be remarked, charity is not the only element in this proffer of gratuitous advice. The practitioner who gives you his advice expects, reasonably enough, to sell you the medicines he prescribes - and thus the commercial element steps in. It would be worse than churlish, it would be ungrateful, to complain of this mode of practice, where it is carried out in honesty and good faith, as we know well enough that it is in a multiplicity of instances. Such an arrangement is deserving of the highest countenance, because it meets the wants of a large and most praiseworthy class of the community, who, being too poor to consult a first-rate physician, and at the same time too honourable and independent to receive from charitable institutions the relief which they can afford to pay something for, are anxious to get good advice at a cheap market. The misfortune is that this practice, from its adaptation to the popular necessity and its recognised usefulness, has, like most other good things, led to many and infamous abuses. It has opened a door, which would otherwise have been closed to them, to numerous quacks and [-346-] pretenders, who, under the specious mask of giving "advice gratis,'' are enabled to thrust down the public throat all manner of abominable nostrums, prepared with no other view than the unprincipled one of their own emolument. Hence we have, on the one hand, the self-dubbed Doctor Crossbones, inviting all London to come for his gratuitous advice, and prescribing to the multitude for every imaginable disease that flesh is heir to, his one infallible specific, contained in a square green bottle, "price four and sixpence;" and on the other hand we have the self-dubbed Doctor Sarcophagus Pillcloud,
     "Who, with one little wonderful pill,
     Can every disorder keep under,"
at least according to his own account - who makes his hogsheads of wonderful pills by steam machinery, and rains them in a deluge of boxes at one and three-halfpence - "treble boxes two and nine," - upon all who apply to him or to his ubiquitous agents for "advice gratis."
     Such unprincipled abuses arc among the crying scandals of our day. They are abounding in every quarter - the followers, rivals, and imitators of the Messrs. Crossbones and Pillcloud infesting every populous district, and being always most successful, which means most mischievous and most murderous, where the population is most dense and least educated. Let us warn our readers to act with judgment in matters affecting their health, and remind them that, inasmuch as no man in his senses would think of intrusting a watch needing repairs into the hands of a scavenger, he ought not to think of intrusting his bodily frame - which is a machine infinitely more complex than a watch - to the mercies of an ignoramus who knows nothing of its mechanism.