The Citadel (8 page)

She smiled. ‘What do you want to talk about?’

He reddened, with a sense that she had cornered him. ‘Oh, my work, I suppose.’ He halted, then felt obliged to explain himself. ‘I seem just to be blundering about, running into one problem after another.’

‘Do you mean you have difficult cases.’

‘It isn’t that.’ He hesitated, went on. ‘I came down here full of formulae, the things that everybody believes, or pretends to believe. That swollen joints means rheumatism. That rheumatism means salicylate. You know, the orthodox things! Well I’m finding out that some of them are all wrong. Take medicine, too. It seems to me that some of it does more harm than good. It’s the system. A patient comes into the surgery. He expects his “ bottle of medicine”. And he gets it, even if it’s only burnt sugar, soda carb. and good old aqua. That’s why the prescription is written in Latin – so he won’t understand it. It isn’t right. It isn’t scientific. And another thing. It seems to me that too many doctors treat diseases empirically, that’s to say, they treat the symptoms individually. They don’t bother to combine the symptoms in their own mind and puzzle out the diagnosis. They say very quick, because they’re usually in a rush, “Ah! headache – try this powder,” or “ you’re anaemic, you must have some iron.” Instead of asking themselves what is
causing
the headache or the anaemia –’ He broke off sharply, ‘Oh! I’m sorry! I’m boring you!’

‘No, no,’ she said quickly. ‘ It’s awfully interesting.’

‘I’m just beginning, just feeling my way,’ he went on tempestuously, thrilled by her interest. ‘But I do honestly think even from what I’ve seen that the text-books I was brought up on have too many old-fashioned conservative ideas in them. Remedies that are no use, symptoms that were shoved in by somebody in the Middle Ages. You might say it doesn’t matter to the average GP. But why should the general practitioner be no more than a poultice mixer or a medicine slinger? It’s time science was brought into the front line. A lot of people think that science lies in the bottom of a test-tube. I believe that the outlying GP’s have all the opportunities to
see
things, and a better chance to observe the first symptoms of new disease than they have at any of the hospitals. By the time a case gets to hospital it’s usually past the early stages.’

She was about to answer quickly when the door bell rang. She rose, suppressing her remark, saying instead, with her faint smile:

‘I hope you won’t forget your promise to talk of this another time.’

Watkins and his wife came in, apologising for being late. And almost at once they sat down to supper.

It was a very different meal from that cold collation which had last brought them together. They had veal cooked in a casserole and potatoes mashed with butter, followed by new rhubarb tart with cream, then cheese and coffee. Though plain, every dish was good and there was plenty of it. After the skimpy meals served to him by Blodwen it was a treat to Andrew to find hot appetising food before him. He sighed:

‘You’re lucky in your landlady, Miss Barlow. She’s a marvellous cook!’

Watkins, who had been observing Andrew’s trencher work with a quizzical eye, suddenly laughed out loud.

‘That’s a good one.’ He turned to his wife. ‘Did you hear him, mother? He says old Mrs Herbert’s a marvellous cook.’

Christine coloured slightly.

‘Don’t pay any attention to him,’ she said to Andrew. ‘It’s the nicest compliment I’ve ever had – because you didn’t mean it. As it happens, I cooked the supper. I have the run of Mrs Herbert’s kitchen. I like doing for myself. And I’m used to it.’

Her remark served to make the mine manager more jovially boisterous. He was quite changed from the taciturn individual who had stoically endured the entertainment at Mrs Bramwell’s. Blunt and likeably common, he enjoyed his supper, smacked his lips over the tart, put his elbows on the table, told stories which made them laugh.

The evening passed quickly. When Andrew looked at his watch he saw to his amazement that it was nearly eleven o’clock. And he had promised to pay a late visit to see a case in Blaina Place before half past ten.

As he rose, regretfully, to take his leave, Christine accompanied him to the door. In the narrow passage his arm touched her side. A pang of sweetness went over him. She was so different from anyone he had ever known, with her quietness, her fragility, her dark intelligent eyes. Heaven forgive him for daring to have thought her skimpy!

Breathing quickly, he mumbled:

‘I can’t thank you enough for asking me tonight. Please can I see you again? I don’t always talk shop. Would you – Christine, would you come to the Toniglan cinema with me, sometime?’

Her eyes smiled up at him, for the first time faintly provocative.

‘You try asking me.’

A long silent minute on the doorstep under the high stars. The dew scented air was cool on his hot cheek. Her breath came sweetly towards him. He longed to kiss her. Fumblingly he pressed her hand, turned, clattered down the path and was on his way home with dancing thoughts, walking on air along that dizzy path which millions have tritely followed and still believed themselves unique, rapturously predestined, eternally blessed. Oh! She was a wonderful girl! How well she had understood his meaning when he spoke of his difficulties in practice! She was clever, far cleverer than he. What a marvellous cook too! And he had called her Christine!

Though Christine now occupied his mind more than ever the whole complexion of his thoughts was altered. He no longer felt despondent but happy, elated, hopeful. And this change of outlook was immediately reflected in his work. He was young enough to create in fancy a constant situation wherein she observed him at his cases, watched his careful methods, his scrupulous examinations, commended him for the searching accuracy of his diagnosis. Any temptation to scamp a visit, to reach a conclusion without first sounding the patient’s chest, was met by the instant thought: ‘Lord,
no!
What would she think of me if I did that!’

More than once he found Denny’s eye upon him, satirical, comprehensive. But he did not care. In his intense, idealistic way he linked Christine with his ambitions, made her unconsciously an extra incentive, in the great assault upon the unknown.

He admitted to himself that he still knew practically nothing. Yet he was teaching himself to think for himself, to look behind the obvious in an effort to find the proximate cause. Never before had he felt himself so powerfully attracted to the scientific ideal. He prayed that he might never become slovenly or mercenary, never jump to conclusions, never come to write ‘the mixture as before’. He wanted to find out, to be scientific, to be worthy of Christine.

In the face of his ingenuous eagerness it seemed a pity that his work in the practice should suddenly and uniformly turn dull. He wanted to scale mountains. Yet for the next few weeks he was presented by a series of insignificant mole-hills. His cases were trivial, supremely uninteresting, a banal run of sprains, cut fingers, colds in the head. The climax came when he was called two miles down the valley by an old woman who asked him, peering yellow faced from beneath her flannel mutch, to cut her corns.

He felt foolish, chafed at his lack of opportunity, longed for whirlwind and tempest.

He began to question his own faith, to wonder if it were really possible for a doctor in this out-of-the-way place to be anything more than a petty, common hack. And then, at the lowest ebb of all, came an incident which sent the mercury of his belief soaring once again towards the skies.

Towards the end of the last week in June, as he came over the station bridge he encountered Doctor Bramwell. The Lung Buster was slipping out of the side door of the Railway Inn, stealthily wiping his upper lip with the back of his hand. He had the habit, when Gladys departed, gay and dressed in her best, upon her enigmatic ‘shopping’ expeditions to Toniglan, of soothing himself unobtrusively with a pint or two of beer.

A trifle discomfited at being seen by Andrew he nevertheless carried off the situation with a flourish.

‘Ah, Manson! Glad to see you. I just had a call to Pritchard.’

Pritchard was the proprietor of the Railway Inn and Andrew had seen him five minutes ago, taking his bull terrier for a walk. But he allowed the opportunity to pass. He had an affection for the Lung Buster whose highflown language and mock heroics were offset in a very human way by his timidity and the holes in his socks which the gay Gladys forgot to darn.

As they walked up the street together they began to talk shop. Bramwell was always ready to discuss his cases and now, with an air of gravity, he told Andrew that Emlyn Hughes, Annie’s brother-in-law, was on his hands. Emlyn, he said, had been acting strangely lately, getting into trouble at the mine, losing his memory. He had turned quarrelsome and violent.

‘I don’t like it, Manson.’ Bramwell nodded sagely. ‘I’ve seen mental trouble before. And this looks uncommonly like it.’

Andrew expressed his concern. He had always thought Hughes a stolid and agreeable fellow. He recollected that Annie had looked worried lately and when questioned had inferred vaguely, for despite her proclivity for gossip she was reticent upon family affairs, that she was anxious about her brother-in-law. When he parted from Bramwell he ventured the hope that the case might quickly take a turn for the better.

But on the following Friday at six o’clock in the morning he was awakened by a knocking on his bedroom door. It was Annie, fully dressed and very red about the eyes, offering him a note. Andrew tore open the envelope. It was a message from Doctor Bramwell.

Come round at once. I want you to help certify a dangerous lunatic.

Annie struggled with her tears.

‘It’s Emlyn, doctor,
bach.
A dreadful thing has happened. I do hope you’ll come down quick, like.’

Andrew threw on his things in three minutes. Accompanying him down the road, Annie told him as best she could about Emlyn. He had been ill and unlike himself for three weeks, but during the night he had turned violent, and gone clean out of his mind. He had set upon his wife with a bread knife. Olwen had just managed to escape by running into the street in her nightgown. The sensational story was sufficiently distressing as Annie brokenly related it, hurrying beside him in the grey light of morning, and there seemed little he could add, by way of consolation, to alter it. They reached the Hugheses’ house. In the front room Andrew found Doctor Bramwell, unshaven, without his collar and tie, wearing a serious air, seated at the table, pen in hand. Before him was a bluish paper form, half filled in.

‘Ah, Manson! Good of you to come so quickly. A bad business this. But it won’t keep you long.’

‘What’s up?’

‘Hughes has gone mad. I think I mentioned to you a week ago I was afraid of it. Well! I was right. Acute mania.’ Bramwell rolled the words over his tongue with tragic grandeur. ‘Acute homicidal mania. We’ll have to get him into Pontynewdd straight away. That means two signatures on the certificate, mine and yours – the relatives wanted me to call you in. You know the procedure, don’t you?’

‘Yes.’ Andrew nodded. ‘What’s your evidence?’ Bramwell began, clearing his throat, to read what he had written upon the form. It was a full, flowing account of certain of Hughes’s actions during the previous week, all of them conclusive of mental derangement. At the end of it Bramwell raised his head. ‘Clear evidence, I think!’

‘It sounds pretty bad,’ Andrew answered slowly. ‘Well! I’ll take a look at him.’

‘Thanks, Manson. You’ll find me here when you’ve finished.’ And he began to add further particulars to the form.

Emlyn Hughes was in bed and seated beside him – in case restraint should be necessary – were two of his mates from the mine. Standing by the foot of the bed was Olwen, her pale face, ordinarily so pert and lively, now ravaged by weeping. Her attitude was so overwrought, the atmosphere of the room so dim and tense, that Andrew had a momentary thrill of coldness, almost of fear.

He went over to Emlyn and at first he hardly recognised him. The change was not gross, it was Emlyn true enough, but a blurred and altered Emlyn, his features coarsened in some subtle way. His face seemed swollen, the nostrils thickened, the skin waxy, except for a faint reddish patch that spread across the nose. His whole appearance was heavy, apathetic. Andrew spoke to him. He muttered an unintelligible reply. Then, clenching his hands, he came out with a tirade of aggressive nonsense, which, added to Bramwell’s account, made the case for his removal only too conclusive.

A silence followed. Andrew felt that he ought to be convinced. Yet inexplicably, he was not satisfied. Why, why, he kept asking himself,
why
should Hughes talk like this? Supposing the man had gone out of his mind, what was the cause of it all. He had always been a happy contented man – no worries, easy going, amicable. Why, without apparent reason, had he changed to
this
!

There must be a reason, Manson thought doggedly, symptoms don’t just happen of themselves. Staring at the swollen features before him, puzzling, puzzling for some solution of the conundrum, he instinctively reached out and touched the swollen face, noting subconsciously, as he did so, that the pressure of his finger left no dent in the oedematous cheek.

All at once, electrically, a terminal vibrated in his brain.
Why
didn’t the swelling pit on pressure? Because – now it was his heart which jumped! – because it was not true oedema but myxoedema. He had it, by God, he
had
it! No, no, he must not rush. Firmly, he caught hold of himself. He must not be a plunger, wildly leaping to conclusions. He must go cautiously, slowly, be sure!

Curbing himself, he lifted Emlyn’s hand. Yes, the skin was dry and rough, the fingers slightly thickened at the ends. Temperature – it was subnormal. Methodically he finished the examination, fighting back each successive wave of elation. Every sign of every symptom, they fitted as superbly as a complex jig-saw puzzle. The clumsy speech, dry skin, spatulate fingers, the swollen inelastic face, the defective memory, slow mentation, the attacks of irritability culminating in an outburst of homicidal violence. Oh! the triumph of the completed picture was sublime.