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Br J Gen Pract. 2008 February 1; 58(547): 134–135.
PMCID: PMC2233972

A patient's diary: episode 14 — Dr Teacher's dream

Evening surgery is over. In his consulting room, Dr Teacher relaxes for a few minutes with a favourite Jane Austen novel. But his eyelids are heavy. He sleeps. He dreams …

Sally Greengage, good-looking, clever and ambitious, with a comfortable flat in a fashionable part of town and a happy disposition seemed to unite some of the best blessings of existence; and had lived nearly 28 years in the world with very little to distress or vex her. Wishing to qualify herself in the medical profession, she had recently engaged herself as apprentice to Mr Gerald Teacher, a reputable local apothecary. She soon proved herself an apt pupil, rapidly acquiring a skillful consultation manner and a good knowledge of medicinal herbs; much admired and respected by her many grateful patients, she seemed to have a brilliant professional future ahead of her.

If she had any fault at all it was perhaps the power of having rather too much her own way and a disposition to think too well of herself. She would sometimes alight on an interesting diagnosis without sufficient resort to the evidence base, or indeed the counsel of her master. She would also delight in giving injudicious advice to the apothecary's female servants concerning their personal lives and matrimonial aspirations. However, these disadvantages of her character, if they can be so described, were at present unperceived by Sally and so did not by any means rank as misfortunes with her.

Now there lived in the pleasant little village of Glanders Magna in the County of Surry, a very civil and respectable gentleman of middle years called Norman Gland. He and his wife, Hilda, had a very pleasant house enclosed before and behind by small, yet well-tended gardens. Although an amiable man, with an enquiring mind and a friendly disposition, it was universally acknowledged that Mr Gland's thoughts were excessively occupied by the state of his health. For many years he had fretted over the condition of his liver and other internal organs; and his conversation revolved almost entirely round the remedies he had sought for them. All manner of herbs were sent for from London; leeches had many times been applied in vain and even the drawing of three of his teeth wherein lay, he was convinced, the source of the disorder, appeased his suffering for only a few days. And now, being once again sorely distressed, he had sent for his favourite apothecary, Mr Teacher, who practised but a few miles away.

So it was that Mr Teacher and Miss Greengage were proceeding in the doctor's new carriage along the country lane which led to Glanders Magna. As the carriage moved along they talked of an affair which had of late been exciting the interest of both of them. There was a young health care assistant in the practice, not above 17 years, who was very taken with Mr Martin, the local podiatrist and had hopes of an offer of marriage from him. ‘Pray, Dr Teacher,’ said Sally, ‘do not you think that Harriet should aim higher than Mr Martin who is a man of limited education. In truth he is a very agreeable young man but in no way is he Harriet's equal. You may as well know that she shewed me his letter, and I am glad to say that I was able to guide her to pen to refuse his offer. For I have it in mind to make a match for Harriet with Dr Elton!’

‘Oh, Sally’ returned her mentor, ‘I have always thought your intimacy with Harriet a foolish one, though I have kept my thoughts to myself. But now I perceive that it has been very unfortunate for Harriet. You will puff her up with such ideas about herself that she will lose all chances of matrimony with a man of her station in life. Do not forget the mystery of her parentage which in our society is bound to count against her.’

It was not long before the carriage drew up under the pleasant chestnut trees that sheltered the home of Mr and Mrs Gland. Mrs Gland welcomed them courteously for indeed she was relieved to see them. ‘Oh, Miss Greengage, it is so obliging of you to come and bring Mr Teacher because Norman has been so ill lately, I do not know what to do with him. He lies on the couch in his dressing room, groaning constantly and refusing all food except for a thin gruel which is the only nourishment his poor liver can tolerate. Do tell me, Miss Greengage, have you brought the leeches? Or will you do scarification and cupping today. Please do not draw any more of his teeth or he will never chuse to eat the apple dumplings that I made him, when a week ago I was in high hope of his recovery. Do not you think that the air here might be too full of impurity? We were considering a visit to the sea at South End, but Mr Gland says he is now much too weak. Oh dear, am I talking too much, dear Miss Greengage?’

Sally was tempted to make a tart remark to the effect that Mrs Gland's volubility was entirely within her expectations. Sometimes her youthful high spirits made her tongue run ahead of her kinder sensibilities; and Mr Teacher had had occasion to remonstrate with her about it, to her considerable shame. This time she restrained herself and merely said, ‘not at all, Mrs Gland, you are understandably upset. Now shall you conduct us to your patient?’

So they climbed the stairs and entered the dressing room, where Mr Gland lay groaning. A bowl of gruel lay untouched on the small table by his couch.

‘It is good to see you, Teacher,’ said the invalid, on perceiving his old friend. ‘And your fair apprentice too. But I fear your visit is too late. I fear that the consumption has destroyed my liver entirely and spread to my other vital organs. If only you had a magic glass with which to see inside me you would be amazed at the terrible destruction.’ ‘Now, now, my dear Gland,’ replied the good doctor. ‘Pray do not distress yourself in this way. Let me examine this specimen of your urine that I see Mrs Gland has thoughtfully placed on the sideboard for us. Now, I declare, it is perfectly clear and the colour is most satisfactory. If I may say so, your melancholy temperament has again led you to experience a lowering of the spirits as a physical suffering. This is not uncommon in country gentlemen; we see many such cases and some have even been described in the learned journals. You may recollect, Sally,’ he said, turning to his young apprentice, ‘that I placed the volume on your desk only yesterday in the hope that you would read it. But alas,’ he went on shaking his head solemnly, ‘you did not.’ ‘I meant to read it’ said Sally. To which her master replied, ‘I have seen a great many lists of books and journal articles that Sally has meant to read. And very good lists they were too, But somehow she cannot find the time, but must be always exchanging the latest intelligence with her young friends, or buying new clothes. I have given up expecting any course of serious reading from Sally.’

On receiving this rather affectionate admonition, Sally pouted a little but made no reply other than a toss of her fair head. Changing the subject, she reminded her master that they had brought some fresh herbs from the physic garden especially for Mr Gland and that a good result might be anticipated by applying them in a poultice to his liver. She then proceeded to do this with utmost skill and competence … Mr Gland thanked them in a low voice for their trouble and said that he would make sure that Mr Teacher's fee was sent to him by his widow, even if, as he feared, he did not live to see the sun rise on another day. Mr Teacher, patted him fondly on the shoulder and said that he looked forward to attending on him for many a year. And with a word of thanks to Mrs Gland for the apple dumplings that she had stuffed into his bag, he turned and descended the stair, followed by the resourceful Miss Greengage.

From the diary of Dr Teacher.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners