Doctor in the House by Richard Gordon Page B

were drummed into us like drill to recruits. Whatever part of the patient you examine, whatever disease you suspect, the four motions must be gone through in that order. You look first, then feel; when you have felt, you may tap, but not before; and last of all comes the stethoscope.
    I began to learn how to look at a patient so that even the fingernails might shine with a dozen diagnoses. They taught us to feel lumps, livers, and spleens; how to percuss correctly and to understand the evasive murmurs transmitted through a stethoscope. Diagnosis is simple observation and applied logic – detection, in fact. A matter of searching for clues, igniting a suspicion and knowing where to look for proof. Conan Doyle modelled Sherlock Holmes on a physician, and the reverse holds perfectly well.
    Dr Maxworth took his firm round the ward every Wednesday morning. He was a thin, desiccated little man who had never been known to appear in public dressed in anything but black coat and striped trousers. He was not really interested in students at all. For most of the round he forgot we were crowding in his footsteps, and would suddenly recall our presence by throwing a few half-audible scraps of instruction over his shoulder. He was a specialist in neurology, the diseases of the nervous system. This is the purest and most academic branch of medicine and requires for its practice a mind capable of playing three games of chess simultaneously while filling in a couple of stiff crossword puzzles between the moves. As almost all the nervous diseases we saw in the ward appeared to be fatal, it seemed to me a pretty barren speciality. But Maxworth drew exquisite pleasure from it. He was not primarily concerned with treating his patients and making them better, but if he scored a diagnosis before the proof of the post-mortem he was delighted. He was, his houseman said, a fairly typical physician.
    I began to see how the ward was managed by Sister, whom I avoided like a pile of radium. Every bodily occurrence that could be measured – the pulse, the amount of urine, the quantity of vomit, the number of baths – was carefully entered against the patient’s name in the treatment book, which reduced the twenty or so humans in the ward to a daily row of figures in her aggressive handwriting.
    There were two functions of the physiology which Sister thought proceeded wholly in her interest. One was temperature. The temperature charts shone neatly from the foot of the beds, and each showed a precise horizontal zigzag of different amplitude. Sister wrote the dots and dashes on them herself every morning and evening. The temperatures were taken by the junior nurses, who used four or five thermometers. In spite of inaccuracies due to a different instrument being used daily on each patient and the varying impatience of the nurse to whip the glass spicule away, the figures were looked upon as indispensable. Any errors occurring through mercurial or human failings were not of great importance, however, because Sister always substituted figures of her own if the ones returned by the patient did not fit with her notion of what the temperature in the case ought to be.
    The other particular concern of the Sister was the patients’ bowels. A nurse was sent round the ward every evening with a special book to ask how many times each inmate had performed during the past twenty-four hours. ‘How many for the book?’ she would enquire with charming coyness. The patients caught the spirit of the thing, and those returning fair scores to the nurse did so with a proud ring in their voices but anyone making a duck confessed with shame and cowered under the bedclothes.
    The number of occasions was written in a separate square at the foot of the temperature chart. A nought was regarded by Sister as unpleasant, and more than two blank days she took as a personal insult. Treatment was simple. One nought was allowed to pass without punishment, but two automatically meant