"You confounded old fool!" said I, losing my temper. "Are you in earnest? I supposed you were joking from the first but if you're talking as good sense as you've got just leave this office. I--"

He left.

He reported to his company that I was in a more advanced stage of the disorder than he had at first feared. I had arrived at the unnecessarily irritable condition. Of course my case was settled with that company.

Professional etiquette again stepped in, and the doctor for the M. B.

of C. took another whack at my liver. He said that the organ was badly enlarged and he'd hold me off for one year to see if it would return to its normal proportions. According to his diagnosis fully nine-tenths of the population of New York were carrying around livers that were enough to tire out an ox. He could tell a big livered man as far as he could see him, and he pointed out five who pa.s.sed while he was talking.

He said that enlargment of the liver was getting to be a very real danger to the population of all of the chief cities, and if the cause was not soon discovered by the medical profession and a reducing process, so to speak, clapped on to the metropolitan liver, life insurance companies would have to keep a mighty sharp eye on all applicants, or the death rates would wreck the most prosperous of them in pretty short order.

I was led to infer from the way he poked and prodded around me and measured and sounded that my liver was rather badly sagged at one side and that the other lobe was swelled up like a bladder. It seems as if a person would notice a thing like that himself, but the doctor said that as like as not I'd never have discovered it at all if he had not--fortunately for me--been called in to examine me.

He said that he never prescribed for men, he is required to examine for insurance, but he told me to take a certain remedy for the next three months and then report to him. Meantime his company would "hold me off."

"We won't reject you outright," he explained "because this thing may be only temporary--may not be organic--and it wouldn't be a fair thing to your heirs to decline you outright, because that would most likely prevent you from ever getting life insurance anywhere in the future."

That was a new idea to me and gave me a good deal of a scare.

It occurred to me that the future of a man's family--where it depended on the insurance money of its head--was subject to considerable uncertainty from the various fads of the doctors.

Here I was in danger of being rejected--p.r.o.nounced an unsound risk--by four separate and distinct companies for four separate and distinct ailments of which my own doctor could find not the least trace and I could feel not the faintest twinge.

If any one of them decided positively against me the future of my family was nil--so far as insurance went, for the examining physician of no other company would be bold enough or sufficiently lacking in "professional courtesy" to p.r.o.nounce in my favor, whether he could find anything wrong with me himself or not. I began to realize that what I had so far looked upon as rather a good joke might be serious after all.

It occurred to me, too, that it would be a good deal more far reaching than I had supposed.

If Old Pulmonary--as the agent called him--stuck to his theory of my lungs, not only I, but my children, would be unable to get insurance. It would establish a family history--a "heredity"--hard to get rid of. My little joke in speaking of the fact that my aunt had been said to cough before she died, together with Dr. Pulmonary's ability to scent lung trouble in the breathing apparatus of a porous plaster, might lead to a serious complication not only for me but for my children. I concluded to make a clean breast of it. I did not quite dare tell Dr. Pulmonary that I had been deliberately guying the profession--and in fact that was not my first intention--but I asked if he did not think it a little odd that no two of them had held me off for the same reason and that each one had found indications of the particular disorder for which he had a special leaning. He p.r.i.c.ked up his ears at once and asked all about the others.

I told him that one had found alb.u.men, another enlarged liver, and the third was afraid of heart failure or softening of the brain, and one was still waiting, because he could find no trouble--on account of professional etiquette--before reporting at all.

"Meantime my own doctor--the one who has known me from childhood--p.r.o.nounces me fit for a scull race," said I a little drily.

"Does your physician know of these examinations?*' he inquired.

"No, he doesn't," I responded rather hotly this time, "or no doubt he'd have discovered that I had inflammatory rheumatism and gangrene. He is a good deal of a professional ethic man, himself."

The doctor turned and walked into his private room, promising to overhaul the papers again and talk with his subordinate.

I hunted up the agent who had first called upon me and complained that this sort of nonsense had gone about as far as I wanted it to go. "That old donkey at the head of your medical department upholds the idiotic report of the young gosling that first examined me here, notwithstanding the fact that he says himself that he can't find the first trace of the trouble. Now, if insurance companies employ impecunious young physicians with little experience, because they can get them cheap, and then insist upon it that professional etiquette forbids any other examiner from correcting their blunders, it seems to me--"

The agent had been looking about carefully to be sure that no one overheard.

At this point he said:

"Sh! Don't talk so loud. You see young Cardiac, who had you first, pa.s.sed a man a short while ago who died in about six months and it was discovered that he had only a part of one lung and had been that way for years. The referee--Old Pulmonary is our referee, you know--gave him a pretty bad scare, and he's afraid to pa.s.s anybody at all since. 'Fraid he'll lose his place. All the agents are mad about it. Manage to hold their men over for examination until he leaves the office and then take 'em to another one of the examiners. He'll refuse every body now for a while--or hold him off. Fully one-half the men he examined last month were rejected outright or held over. I didn't know it when I took you to him or I'd have taken you to some one else to be examined."

"That would be all very well," said I, "if it wasn't for the absurdity of what the doctors are pleased to call professional etiquette, which prevents any other examiner for any other company from finding a man so held or rejected, sound. In the first place nearly all the big companies refuse to allow any but an 'old school' or 'regular' allopathic physician to examine a man. Then if that examiner has a fad, or makes a mistake, they are all banded together to sustain him in it and not to correct it, even if they can't find the first symptom of a disease about him. I tell you it is not only outrageous to the man and his family, but the result will be that men who know it will refuse to place themselves in any such danger. They won't want a family record of hereditary diseases made and put on file to stare them and their descendants in the face just for the sake of professional etiquette toward some young M.

D., who just as like as not got his place from the fact that he married a daughter of a director of the company and had to be supported some way and hadn't the skill to do it in an open field in his profession. Men are not going to stand it. It will injure them, and it is bound to react on the company too. I'd never have applied at all if I'd known of it in time. What business has a company to ask whether an applicant has or has not been rejected by another company? If their own examiner can't find anything wrong with him, isn't that enough? This thing of the doctors of all the companies combining to keep a record against a man is outrageous. Why can't a company depend on the capacity of its own medical staff? If it wants any other information of a medical nature, why isn't the applicant's own family physician quite enough? I consider the thing a good deal of an outrage, and the company that omits from its papers the sort of questions that result in this absurd and oppressive professional etiquette folderol, is going to be the company of the future. Intelligent men know too well the chaotic state of medical science to be willing to risk it. Why, good Lord, man, that softening of the brain--paresis--idiot over at the . of Y. can, and no doubt will, give me a record that may cling to me and my family in a way that might, in many a business or other contingency, cause the very greatest hardship." I looked up and saw that the medical referee who had really indicated that he meant to reconsider my case was standing where he had heard me.

His face was a study* He was angry clear through. He would have (in a medical journal or debate) taken issue with, and proved the utter incapacity of nine-tenths of the profession, but to have a layman criticise their action when it might mean even life or death to him and his was more than the doctor's adherence to professional etiquette could bear.

* My friend, the agent, saw his face.

"I'll bet you four dollars, John, that you not only won't get a policy here now but that no other company will pa.s.s you," said he under his breath. "The old man is on the war path."

That was eight months ago and I'm "held off" in eleven companies now. I was never sick in my life. I'm as sound in person and in heredity as any man who ever lived, but I am at the mercy of that absurdest of all covers for personal incapacity--professional etiquette--combined with the unreasonable fact that insurance companies require an applicant to tell their examiners just what piece of idiotic prejudice has been launched at him by the doctor of every other company, so that they can all hold together and fit his case to the reports, and not the reports to the facts in his case as they find them.

Meantime, Jack Howard, who died last week, poor fellow, was accepted by five of them because the first examiner who got hold of him, not being a kidney fiend but having his whole mind on lung trouble--and Jack had splendid lungs--didn't discover that he was in the last stages of Bright's disease. His family made $27,000 out of professional etiquette, and mine--when I die--will most likely lose that much, together with a reputation for a sound heredity which may affect the insurers to the third and fourth generation of them that love truth and tell that their father was rejected by all the leading life insurance companies for pulmonary trouble, heart disease, kidney affection, paresis, and enlargement of the liver. Meantime the first good company that shows enough sense and sufficient confidence in its own medical men to omit that sort of questions from its form of examination is going to get me--and a good many others like me.

COMMON SENSE IN SURGERY

There are certain forms of expression which once heard fit themselves into the mind so firmly, and re-appear in one connection or another so frequently, that one scarcely recognizes the fact even when one changes a word or two in order to make the original idea fit the case in point.

So when I stood watching the ingenious method by which the trainers of the English fox-hounds induced each dog to perform his own surgical operations after a hunt, I remarked, with no recognition of the plagiarism from Dr. Holmes, "Every dog his own doctor."

"No," replied the trainer, with a fine sense of distinction which I had not before observed--"no; I am the doctor; the dogs are the surgeons. I prescribe; they perform the operation. They do that part far better than I could; but they wouldn't do it in time to save the pain and trouble of a much more serious operation that they could not perform, if I did not set them at it in time, and keep them at work until all danger of inflammation is past."

It was after a hunt. The dogs--splendid blooded fellows, a great pack of over sixty of them--had gotten many thorns and briers in their feet.

They came back limping, foot-sore, and with troubled eyes that looked up piteously for relief from their pain. They were very hungry too, after the long chase; but "No doctor will allow a patient to eat just before a surgical operation," remarked the trainer, dryly. "Now watch."

He threw open a door leading into an outer room of the splendid Hunt Club Kennel, and gave the word of command.

There was a rush, and the entire pack burst through the wide entrance.

Then every dog lay suddenly down, and began with great vigor to lick his feet.

Why? Simply because in rushing through that door they had waded through a wide, shallow trough or sink of pretty warm soup. This basin was sunk in the stone floor, and reached entirely across the door, and was too wide to jump over, even had it been visible from the outside, which it was not.

The dogs had plunged into it before they knew it was there, and were instantly out of its rather uncomfortable heat.

Each dog worked at his feet with vigor. He was hungry. The soup was good; but dogs object to soup on their feet. This process was continued and repeated until it was thought that all thorns and briers and pebbles had been licked and picked from the crippled feet. Then the dogs were fed and put to bed--or allowed to lie down and sleep--in their fresh straw-filled bunks.

"A doctor and a surgeon may be the same person," remarked the philosophical trainer, oracularly, "but they seldom are. If you whine--as the dogs do when their feet hurt after a hunt--or if you limp or complain, a doctor guesses what is the matter with you. Then he guesses what will cure you. If both guesses are right, you are in luck, and he is a skilful diagnostician. In nine cases out of ten he is giving you something harmless, while he is taking a second and a third look at you (at your expense, of course) to guess over after himself."

His medical pessimism and his surgical optimism amused and entertained me, and I encouraged him to go on.

"Now with a surgeon it is different. Surgery is an exact science. Before I took this position I was a surgeon's a.s.sistant in a hospital. In some places we are called trained nurses. In our place we were called surgeons' a.s.sistants. That's why I make such a distinction between doctors and surgeons. I've seen the two work side by side so long. I've seen some of the funniest mistakes made, and I've seen mistakes that were not funny. I've seen post-mortem examinations that would have made a surgeon ashamed that he had ever been born, looked upon by the doctor who treated the case as not at all strange; didn't stagger him a bit in his own opinion of himself and his scientific knowledge next time.

I remember one case. It was a j.a.panese boy. He was as solid as a little ox, but he told Dr. G------ that he'd been taking a h.o.m.oeopathic prescription for a cold. That was enough for Dr. G------. A red rag in the van of a bovine animal is nothing to the word 'h.o.m.oeopathy' to Dr.

G------. Hydropathy gives him fits, and eclecticism almost, lays him out. Not long ago he sat on a jury which sent to prison a man who had failed in a case of 'mind cure.' That gave deep delight to his 'regular'

soul. Well, Dr. G------ questioned the little j.a.p, who could not speak good English, and had the national inclination to agree with whatever you say. Ever been in j.a.pan? No? Well, they are a droll lot. Always strive to agree with all you say or suggest.

"'Did you ever spit blood?' asked Dr. G------, by-and-by, after he could find nothing else wrong except the little cold for which the h.o.m.oeopathic physician was treating the boy.

"'Once,' replied that youthful victim.

"'Aha! we are getting at the root of this matter now,' said Dr. G------.

'Now tell me truly. Be careful! Did you spit much blood?'

"'Yes, sir; a good deal.'