THE REMARKABLE BEN HECHT (1894–1964) was a child prodigy on the violin, giving a concert in Chicago at the age of ten. As a young teenager, he spent his summer vacations in Wisconsin touring as an acrobat with a small circus. He ran away to Chicago at sixteen, owning and managing an “art theater” before becoming a successful journalist, first as a crime reporter and then as a foreign correspondent.
He was an integral part of the Chicago literary renaissance in the 1920s, writing newspaper columns, short stories, novels, and dramas. Cowriting The Front Page with Charles MacArthur made him famous and wealthy; it has been produced on the stage frequently since it opened in New York in 1928 and has served as the basis for numerous motion pictures under its original title and others, including His Girl Friday.
It is fair to say that Hecht was the most successful screenwriter in Hollywood history, both critically and in terms of the popularity of his films. Among his nearly one hundred screen credits are Underworld (1927), winner of the first Academy Award for Original Screenplay, The Front Page (1931), Scarface (1932), Gunga Din (1939), Wuthering Heights (1939), It’s a Wonderful World (1939), Spellbound (1945), Notorious (1946), and Kiss of Death (1947). Films on which he worked extensively but did not receive screen credit include Stagecoach (1939), Gone With the Wind (1939), Foreign Correspondent (1940), The Thing from Another World (1951), The Hunchback of Notre Dame (1956), and Mutiny on the Bounty (1962).
“The Fifteen Murderers” was first published in the January 16, 1943, issue of Collier’s Magazine. It was first collected in The Collected Stories of Ben Hecht as “The Miracle of the Fifteen Murderers” (New York, Crown, 1945).
THERE IS ALWAYS an aura of mystery to the conclaves of medical men. One may wonder whether the secrecy with which the fraternity surrounds its gatherings is designed to keep the layman from discovering how much it knows or how much it doesn’t know. Either knowledge would be unnerving to that immemorial guinea pig who submits himself to the abracadabras of chemicals, scalpels, and incantations under the delusion he is being cured rather than explored.
Among the most mysterious of medical get-togethers in this generation have been those held in New York City by a group of eminent doctors calling themselves the X Club. Every three months this little band of healers have hied them to the Walton Hotel overlooking the East River and, behind locked doors and beyond the eye of even medical journalism, engaged themselves in unknown emprise lasting till dawn.
What the devil had been going on in these conclaves for twenty years no one knew, not even the ubiquitous head of the American Medical Association, nor yet any of the colleagues, wives, friends, or dependents of the X Club’s members. The talent for secrecy is highly developed among doctors who, even with nothing to conceal, are often as close-mouthed as old-fashioned bomb throwers on their way to a rendezvous.
How then do I know the story of these long-guarded sessions? The answer is—the war. The war has put an end to them, as it has to nearly all mysteries other than its own. The world, engaged in re-examining its manners and its soul, has closed the door on minor adventure. Nine of the fifteen medical sages who comprised the X Club are in uniform and preside over combat-zone hospitals. Deficiencies of age and health have kept the others at home—with increased labors. There is a part of science which retains a reluctant interest in the misfortunes of civilians and has not yet removed its eye entirely from the banal battlefields on which they ignominiously keep perishing.
“Considering that we have disbanded,” Dr. Alex Hume said to me at dinner one evening, “and that it is unlikely we shall ever assemble again, I see no reason for preserving our secret. Yours is a childish and romantic mind, and may be revolted by the story I tell you. You will undoubtedly translate the whole thing into some sort of diabolical tale and miss the deep human and scientific import of the X Club. But I am not the one to reform the art of fiction, which must substitute sentimentality for truth, and Cinderella for Galileo.”
And so on. I will skip the rest of my friend’s all-knowing prelude. You may have read Dr. Hume’s various books, dealing with the horseplay of the subconscious. If you have, you know this baldheaded mastermind well enough. If not, take my word for it that he is a genius. There is nobody I know more adept at prancing around in the solar-plexus swamps out of which most of the world’s incompetence and confusion appear to rise. He has, too, if there is any doubt about his great talent, the sneer and chuckle which are the war whoop of the superpsychologist. His face is round and his mouth is pursed in a chronic grimace of disbelief and contradiction. You can’t help such an expression once you have discovered what a scurvy and detestable morass is the soul of man. Like most subterranean workers, my friend is almost as blind as a bat behind his heavy glasses. And like many leading psychiatrists, he favors the short and balloonlike physique of Napoleon.
The last dramatic meeting of the X Club was held on a rainy March night. Despite the hostile weather, all fifteen of its members attended, for there was an added lure to this gathering. A new member was to be inducted into the society.
Dr. Hume was assigned to prepare the neophyte for his debut. And it was in the wake of the round-faced soul fixer that Dr. Samuel Warner entered the sanctum of the X Club.
Dr. Warner was unusually young for a medical genius—that is, a recognized one. And he had never received a fuller recognition of his wizardry with saw, ax, and punch hole than his election as a member of the X Club. For the fourteen older men who had invited him to be one of them were leaders in their various fields. They were the medical peerage. This does not mean necessarily that any layman had ever heard of them. Eminence in the medical profession is as showy at best as a sprig of edelweiss on a mountaintop. The war, which offers its magic billboards for the vanities of small souls and transmutes the hunger for publicity into sacrificial and patriotic ardors, has not yet disturbed the anonymity of the great medicos. They have moved their bushels to the front lines and are busy under them, spreading their learning among the wounded.
The new member was a tense and good-looking man with the fever of hard work glowing in his steady dark eyes. His wide mouth smiled quickly and abstractedly, as is often the case with surgeons who train their reactions not to interfere with their concentration.
Having exchanged greetings with the eminent club members, who included half of his living medical heroes, Dr. Warner seated himself in a corner and quietly refused a highball, a cocktail, and a slug of brandy. His face remained tense, his athletic body straight in its chair as if it were poised for a sprint rather than a meeting.
At nine o’clock Dr. William Tick ordered an end to all the guzzling and declared the fifty-third meeting of the X Club in session. The venerable diagnostician placed himself behind a table at the end of the ornate hotel room and glared at the group ranged in front of him.
Dr. Tick had divided his seventy-five years equally between practising the art of medicine and doing his best to stamp it out—such, at least, was the impression of the thousands of students who had been submitted to his irascible guidance. As Professor of Internal Medicine at a great Eastern medical school, Dr. Tick had favored the Education by Insult theory of pedagogy. There were eminent doctors who still winced when they recalled some of old bilious-eyed, arthritic, stooped Tick’s appraisals of their budding talents, and who still shuddered at the memory of his medical philosophy.
“Medicine,” Dr. Tick had confided to flock after flock of students, “is a noble dream and at the same time the most ancient expression of error and idiocy known to man. Solving the mysteries of heaven has not given birth to as many abortive findings as has the quest into the mysteries of the human body. When you think of yourselves as scientists, I want you always to remember everything you learn from me will probably be regarded tomorrow as the naïve confusions of a pack of medical aborigines. Despite all our toil and progress, the art of medicine still falls somewhere between trout casting and spook writing.
“There are two handicaps to the practice of medicine,” Tick had repeated tenaciously through forty years of teaching. “The first is the eternal charlatanism of the patient who is full of fake diseases and phantom agonies. The second is the basic incompetence of the human mind, medical or otherwise, to observe without prejudice, acquire information without becoming too smug to use it intelligently, and most of all, to apply its wisdom without vanity.”
From behind his table old Tick’s eyes glared at the present group of “incompetents” until a full classroom silence had arrived, and then turned to the tense, good-looking face of Dr. Warner.
“We have a new medical genius with us tonight,” he began, “one I well remember in his prewizard days. A hyperthyroid with kidney disfunction indicated. But not without a trace of talent. For your benefit, Sam, I will state the meaning and purpose of our organization.”
“I have already done that,” said Dr. Hume, “rather thoroughly.”
“Dr. Hume’s explanations to you,” Tick continued coldly, “if they are of a kind with his printed works, have most certainly left you dazed if not dazzled.”
“I understood him quite well,” Warner said.
“Nonsense,” old Tick said. “You always had a soft spot for psychiatry and I always warned you against it. Psychiatry is a plot against medicine. And who knows but it may someday overthrow us? In the meantime it behooves us not to consort too freely with the enemy.”
You may be sure that Dr. Hume smiled archly at this.
“You will allow me,” Tick went on, “to clarify whatever the learned Hume has been trying to tell you.”
“Well, if you want to waste time.” The new member smiled nervously and mopped his neck with a handkerchief.
Dr. Frank Rosson, the portly and distinguished gynecologist, chuckled. “Tick’s going good tonight,” he whispered to Hume.
“Senility inflamed by sadism,” said Hume.
“Dr. Warner,” the pedagogue continued, “the members of the X Club have a single and interesting purpose in their meeting. They come together every three months to confess to some murder any of them may have committed since our last assembly. I am referring, of course, to medical murder. Although it would be a relief to hear any one of us confess to a murder performed out of passion rather than stupidity. Indeed, Dr. Warner, if you have killed a wife or polished off an uncle recently, and would care to unbosom yourself, we will listen respectfully. It is understood that nothing you say will be brought to the attention of the police or the A.M.A.”
Old Tick’s eyes paused to study the growing tension in the new member’s face.
“I am sure you have not slain any of your relatives,” he sighed, “or that you will ever do so except in the line of duty.
“The learned Hume,” he went on, “has undoubtedly explained these forums to you on the psychiatric basis that confession is good for the soul. This is nonsense. We are not here to ease our souls but to improve them. Our real purpose is scientific. Since we dare not admit our mistakes to the public and since we are too great and learned to be criticized by the untutored laity and since such inhuman perfection as that to which we pretend is not good for our weak and human natures, we have formed this society. It is the only medical organization in the world where the members boast only of their mistakes.
“And now,” Tick beamed on the neophyte, “allow me to define what we consider a real, fine professional murder. It is the killing of a human being who has trustingly placed himself in a doctor’s hands. Mind you, the death of a patient does not in itself spell murder. We are concerned only with those cases in which the doctor, by a wrong diagnosis or by demonstrably wrong medication or operative procedure, has killed off a patient who, without the aforesaid doctor’s attention, would have continued to live and prosper.”
“Hume explained all this to me,” the new member muttered impatiently, and then raised his voice: “I appreciate that this is my first meeting and that I might learn more from my distinguished colleagues by listening than by talking. But I have something rather important to say.”
“A murder?” Tick asked.
“Yes,” said the new member.
The old Professor nodded. “Very good,” he said. “And we shall be glad to listen to you. But we have several murderers on the docket ahead of you.”
The new member was silent and remained sitting bolt upright in his chair. It was at this point that several, including Hume, noticed there was something more than stage fright in the young surgeon’s tension. The certainty filled the room that Sam Warner had come to his first meeting of the X Club with something violent and mysterious boiling in him.
Dr. Philip Kurtiff, the eminent neurologist, put his hand on Warner’s arm and said quietly, “There’s no reason to feel bad about anything you’re going to tell us. We’re all pretty good medical men and we’ve all done worse—whatever it is.”
“If you please,” old Tick demanded, “we will have silence. This is not a sanatorium for doctors with guilt complexes. It is a clinic for error. And we will continue to conduct it in an orderly, scientific fashion. If you want to hold Sam Warner’s hand, Kurtiff, that’s your privilege. But do it in silence.”
He beamed suddenly at the new member.
“I confess,” he went on, “that I’m as curious as anybody to hear how so great a know-it-all as our young friend Dr. Warner could have killed off one of his customers. But our curiosity will have to wait. Since five of you were absent from our last gathering I think that the confession of Dr. James Sweeney should be repeated for your benefit.”
Dr. Sweeney stood up and turned his lugubrious face and shining eyes to the five absentees. Of all present, Sweeney was considered next to old Tick the ablest diagnostician in the East.
“Well,” he said in his preoccupied monotone, “I told it once, but I’ll tell it again. I sent a patient to my X-ray room to have a fluoroscopy done. My assistant gave him a barium meal to drink and put him under the fluoroscope. I walked in a half hour later to observe progress and when I saw the patient under the fluoroscopic screen I observed to my assistant, Dr. Kroch, that it was amazing and that I had never seen anything like it. Kroch was too overcome to bear me out.
“What I saw was that the patient’s entire stomach and lower esophagus were motionless and dilated, apparently made out of stone. And as I studied this phenomenon, I noticed it was becoming clearer and sharper. The most disturbing factor in the situation was that we both knew there was nothing to be done. Dr. Kroch, in fact, showed definite signs of hysteria. Shortly afterward the patient became moribund and fell to the floor.”
“Well, I’ll be damned!” several of those who had been absent cried in unison, Dr. Kurtiff adding, “What was it?”
“It was simple,” said Sweeney. “The bottom of the glass out of which the patient had drunk his barium meal was caked solid. We had filled him up with plaster of Paris. I fancy the pressure caused a fatal coronary attack.”
“Good Lord,” the new member said. “How did it get into the glass?”
“Through some pharmaceutical error,” said Sweeney mildly.
“What, if anything, was the matter with the patient before he adventured into your office?” Dr. Kurtiff inquired.
“The autopsy revealed chiefly a solidified stomach and esophagus,” said Sweeney. “But I think from several indications that there may have been a little tendency to pyloric spasm, which caused the belching for which he was referred to me.”
“A rather literary murder,” said old Tick. “A sort of Pygmalion in reverse.”
The old Professor paused and fastened his red-rimmed eyes on Warner. “By the way, before we proceed,” he said, “I think it is time to tell you the full name of our club. Our full name is the X Marks the Spot Club. We prefer, of course, to use the abbreviated title as being a bit more social sounding.”
“Of course,” said the new member, whose face now appeared to be getting redder.
“And now,” announced old Tick, consulting a scribbled piece of paper, “our first case on tonight’s docket will be Dr. Wendell Davis.”
There was silence as the elegant stomach specialist stood up. Davis was a doctor who took his manner as seriously as his medicine. Tall, solidly built, gray-haired and beautifully barbered, his face was without expression—a large, pink mask that no patient, however ill and agonized, had ever seen disturbed.
“I was called late last summer to the home of a workingman,” he began. “Senator Bell had given a picnic for some of his poorer constituency. As a result of this event, the three children of a steamfitter named Horowitz were brought down with food poisoning. They had overeaten at the picnic. The Senator, as host, felt responsible, and I went to the Horowitz home at his earnest solicitation. I found two of the children very sick and vomiting considerably. They were nine and eleven. The mother gave me a list of the various foods all three of them had eaten. It was staggering. I gave them a good dose of castor oil.
“The third child, aged seven, was not as ill as the other two. He looked pale, had a slight fever, felt some nausea—but was not vomiting. It seemed obvious that he too was poisoned to a lesser degree. Accordingly I prescribed an equal dose of castor oil for the youngest child—just to be on the safe side.
“I was called by the father in the middle of the night. He was alarmed over the condition of the seven-year-old. He reported that the other two children were much improved. I told him not to worry, that the youngest had been a little late in developing food poisoning but would unquestionably be better in the morning, and that his cure was as certain as his sister’s and brother’s.
“When I hung up I felt quite pleased with myself for having anticipated the youngest one’s condition and prescribed the castor oil prophylactically. I arrived at the Horowitz home at noon the next day and found the two older children practically recovered. The seven-year-old, however, appeared to be very sick indeed. They had been trying to reach me since breakfast. The child had 105 degrees’ temperature. It was dehydrated, the eyes sunken and circled, the expression pinched, the nostrils dilated, the lips cyanotic and the skin cold and clammy.”
Dr. Davis paused. Dr. Milton Morris, the renowned lung specialist, spoke. “It died within a few hours?” he asked.
Dr. Davis nodded.
“Well,” Dr. Morris said quietly, “it seems pretty obvious. The child was suffering from acute appendicitis when you first saw it. The castor oil ruptured its appendix. By the time you got around to looking at it again, peritonitis had set in.”
“Yes,” said Dr. Davis slowly. “That’s exactly what happened.”
“Murder by castor oil,” old Tick cackled, “plus an indifference to the poor.”
“Not at all,” Dr. Davis said. “All three children had been at the picnic, overeaten alike and revealed the same symptoms.”
“Not quite the same,” Dr. Hume said.
“Oh, you would have psychoanalyzed the third child?” Dr. Davis smiled.
“No,” said Hume. “I would have examined its abdomen like any penny doctor, considering that it had some pain and nausea, and found it rigid with both direct and rebound tenderness.”
“Yes, it would have been an easy diagnosis for a medical student,” Dr. Kurtiff agreed. “But unfortunately, we have outgrown the humility of medical students.”
“Dr. Davis’s murder is morally instructive,” old Tick announced, “but I find it extremely dull. I have a memo from Dr. Kenneth Wood. Dr. Wood has the floor.”
The noted Scotch surgeon, famed in his college days as an Olympic Games athlete, stood up. He was still a man of prowess, large-handed, heavy-shouldered and with the purr of masculine strength in his soft voice.
“I don’t know what kind of murder you can call this.” Dr. Wood smiled at his colleagues.
“Murder by butchery is the usual title,” Tick said.
“No, I doubt that,” Dr. Morris protested. “Ken’s too skillful to cut off anybody’s leg by mistake.”
“I guess you’ll have to call it just plain murder by stupidity,” Dr. Wood said softly.
Old Tick cackled. “If you’d paid a little more attention to diagnosis than to shot-putting you wouldn’t be killing off such hordes of patients,” he said.
“This is my first report in three years,” Wood answered modestly. “And I’ve been operating at the rate of four or five daily, including holidays.”
“My dear Kenneth,” Dr. Hume said, “every surgeon is entitled to one murder in three years. A phenomenal record, in fact—when you consider the temptations.”
“Proceed with the crime,” Tick said.
“Well”—the strong-looking surgeon turned to his hospital colleague, the new member—“you know how it is with these acute gall bladders, Sam.”
Warner nodded abstractedly.
Dr. Wood went on: “Brought in late at night. In extreme pain. I examined her. Found the pain in the right upper quadrant of the abdomen. It radiated to the back and right shoulder. Completely characteristic of gall bladder. I gave her opiates. They had no effect on her, which, as you know, backs up any gall-bladder diagnosis. Opiates never touch the gall bladder.”
“We know that,” said the new member nervously.
“Excuse me,” Dr. Wood smiled. “I want to get all the points down carefully. Well, I gave her some nitroglycerin to lessen the pain then. Her temperature was 101. By morning the pain was so severe that it seemed certain the gall bladder had perforated. I operated. There was nothing wrong with her gall bladder. She died an hour later.”
“What did the autopsy show?” Dr. Sweeney asked.
“Wait a minute,” Wood answered. “You’re supposed to figure it out, aren’t you? Come on—you tell me what was the matter with her.”
“Did you take her history?” Dr. Kurtiff asked after a pause.
“No,” Wood answered.
“Aha!” Tick snorted. “There you have it! Blind man’s buff again.”
“It was an emergency.” Wood looked flushed. “And it seemed an obvious case. I’ve had hundreds of them.”
“The facts seem to be as follows,” Tick spoke up. “Dr. Wood murdered a woman because he misunderstood the source of a pain. We have, then, a very simple problem. What besides the gall bladder can produce the sort of pain that that eminent surgeon has described?”
“Heart,” Dr. Morris answered quickly.
“You’re getting warm,” said Wood.
“Before operating on anyone with so acute a pain, and in the absence of any medical history,” Tick went on, “I would most certainly have looked at the heart.”
“Well, you’d have done right,” said Wood quietly. “The autopsy showed an infraction of the descending branch of the right coronary artery.”
“Which a cardiogram would have told you,” said old Tick. “But you didn’t have to go near a cardiograph. All you had to do is ask one question. If you had even called up a neighbor of the patient she would have told you that previous attacks of pain came on exertion—which would have spelled heart, and not gall bladder.
“Murder by a sophomore,” old Tick pronounced wrathfully.
“The first and last,” said Wood quietly. “There won’t be any more heart-case mistakes in my hospital.”
“Good, good,” old Tick said. “And now, gentlemen, the crimes reported thus far have been too infantile for discussion. We have learned nothing from them other than that science and stupidity go hand in hand, a fact already too well known to us. However, we have with us tonight a young but extremely talented wielder of the medical saws. He has been sitting here for the last hour, fidgeting like a true criminal, sweating with guilt and a desire to tell all. Gentlemen, I give you our new and youngest culprit, Dr. Samuel Warner.”
Dr. Warner faced his fourteen eminent colleagues with a sudden excitement in his manner. His eyes glittered and the dusty look of hard work and near exhaustion already beginning to mark his youth lifted from his face.
The older men regarded him quietly and with various degrees of irritation. They knew, without further corroboration than his manner, that this medico was full of untenable theories and half-baked medical discoveries. They had been full of such things themselves once. And they settled back to enjoy themselves. There is nothing as pleasing to a graying medical man as the opportunity of slapping a dunce cap on the young of science. Old Tick, surveying his colleagues, grinned. They had all acquired the look of pedagogues holding a switch behind their backs.
Dr. Warner mopped his neck with his wet handkerchief and smiled knowingly at the medical peerage.
“I’ll give you this case in some detail,” he said, “because I think it contains as interesting a problem as you can find in practice.”
Dr. Rosson, the gynecologist, grunted, but said nothing.
“The patient was a young man, or rather a boy,” Warner went on eagerly. “He was seventeen, and amazingly talented. He wrote poetry. That’s how I happened to meet him. I read one of his poems in a magazine, and it was so impressive I wrote him a letter.”
“Rhymed poetry?” Dr. Wood asked, with a wink at old Tick.
“Yes,” said Warner. “I read all his manuscripts. They were sort of revolutionary. His poetry was a cry against injustice. Every kind of injustice. Bitter and burning.”
“Wait a minute,” Dr. Rosson said. “The new member seems to have some misconception of our function. We are not a literary society, Warner.”
“And before you get started,” Dr. Hume grinned, “no bragging. You can do your bragging at the annual surgeons’ convention.”
“Gentlemen,” Warner said, “I have no intention of bragging. I’ll stick to murder, I assure you. And as bad a one as you’ve ever heard.”
“Good,” Dr. Kurtiff said. “Go on. And take it easy and don’t break down.”
“Yes.” Dr. Wood grinned. “I remember when Morris here made his first confession. We had to pour a quart of whisky into him before he quit blubbering.”
“I won’t break down,” Warner said. “Don’t worry. Well, the patient was sick for two weeks before I was called.”
“I thought you were his friend,” Dr. Davis said.
“I was,” Warner answered. “But he didn’t believe in doctors.”
“No faith in them, eh?” old Tick cackled. “Brilliant boy.”
“He was,” said Warner eagerly. “I felt upset when I came and saw how sick he was. I had him moved to a hospital at once.”
“Oh, a rich poet,” Dr. Sweeney said.
“No,” said Warner. “I paid his expenses. And I spent all the time I could with him. The sickness had started with a severe pain on the left side of the abdomen. He was going to call me, but the pain subsided after three days, so the patient thought he was well. But it came back in two days and he began running a temperature. He developed diarrhea. There was pus and blood, but no amoeba or pathogenic bacteria when he finally sent for me.
“After the pathology reports I made a diagnosis of ulcerative colitis. The pain being on the left side ruled out the appendix. I put the patient on sulfaguanidin and unconcentrated liver extract, and gave him a high protein diet—chiefly milk. Despite this treatment and constant observation the patient got worse. He developed generalized abdominal tenderness, both direct and rebound, and rigidity of the entire left rectus muscle. After two weeks of careful treatment the patient died.”
“And the autopsy showed you’d been wrong?” Dr. Wood asked.
“I didn’t make an autopsy,” said Warner. “The boy’s parents had perfect faith in me. As did the boy. They both believed I was doing everything possible to save his life.”
“Then how do you know you were wrong in your diagnosis?” Dr. Hume asked.
“By the simple fact,” said Warner irritably, “that the patient died instead of being cured. When he died I knew I had killed him by a faulty diagnosis.”
“A logical conclusion,” said Dr. Sweeney. “Pointless medication is no alibi.”
“Well, gentlemen,” old Tick cackled from behind his table, “our talented new member has obviously polished off a great poet and close personal friend. Indictments of his diagnosis are now in order.”
But no one spoke. Doctors have a sense for things unseen and complications unstated. And nearly all the fourteen looking at Warner felt there was something hidden. The surgeon’s tension, his elation and its overtone of mockery, convinced them there was something untold in the story of the dead poet. They approached the problem cautiously.
“How long ago did the patient die?” Dr. Rosson asked.
“Last Wednesday,” said Warner. “Why?”
“What hospital?” asked Davis.
“St. Michael’s,” said Warner.
“You say the parents had faith in you,” said Kurtiff, “and still have. Yet you seem curiously worried about something. Has there been any inquiry by the police?”
“No,” said Warner. “I committed the perfect crime. The police haven’t even heard of it. And even my victim died full of gratitude.” He beamed at the room. “Listen,” he went on, “even you people may not be able to disprove my diagnosis.”
This brash challenge irritated a number of the members.
“I don’t think it will be very difficult to knock out your diagnosis,” said Dr. Morris.
“There’s a catch to it,” said Wood slowly, his eyes boring at Warner.
“The only catch there is,” said Warner quickly, “is the complexity of the case. You gentlemen evidently prefer the simpler malpractice type of crime, such as I’ve listened to tonight.”
There was a pause, and then Dr. Davis inquired in a soothing voice, “You described an acute onset of pain before the diarrhea, didn’t you?”
“That’s right,” said Warner.
“Well,” Davis continued coolly, “the temporary relief of symptoms and their recurrence within a few days sounds superficially like ulcers—except for one point.”
“I disagree,” Dr. Sweeney said softly. “Dr. Warner’s diagnosis is a piece of blundering stupidity. The symptoms he has presented have nothing to do with ulcerative colitis.”
Warner flushed and his jaw muscles moved angrily. “Would you mind backing up your insults with a bit of science?” he said.
“Very easily done,” Sweeney answered calmly. “The late onset of diarrhea and fever you describe rule out ulcerative colitis in ninety-nine cases out of a hundred. What do you think, Dr. Tick?”
“No ulcers,” said Tick, his eyes studying Warner.
“You mentioned a general tenderness of the abdomen as one of the last symptoms,” said Dr. Davis smoothly.
“That’s right,” said Warner.
“Well, if you have described the case accurately,” Davis continued, “there is one obvious fact revealed. The general tenderness points to a peritonitis. I’m certain an autopsy would show that this perforation had walled off and spilled over and that a piece of intestine was telescoped into another.”
“I don’t think so,” Dr. William Zinner, the cancer-research man, said. He was short, bird-faced and barely audible. Silence fell on the room, and the others waited attentively for his soft voice.
“It couldn’t be an intussusception such as Dr. Davis describes,” he went on. “The patient was only seventeen. Intussusception is unusual at that age unless the patient has a tumor of the intestines. In which case he would not have stayed alive that long.”
“Excellent,” old Tick spoke.
“I thought of intussusception,” said Warner, “and discarded it for that very reason.”
“How about a twisted gut?” Dr. Wood asked. “That could produce the symptoms described.”
“No,” said Dr. Rosson. “A volvulus means gangrene and death in three days. Warner says he attended his patient for two weeks and that the boy was sick for two weeks before Warner was called. The length of the illness rules out intussusception, volvulus, and intestinal tumor.”
“There’s one other thing,” Dr. Morris said. “A left-sided appendix.”
“That’s out, too,” Dr. Wood said quickly. “The first symptom of a left-sided appendix would not be the acute pain described by Warner.”
“The only thing we have determined,” said Dr. Sweeney, “is a perforation other than ulcer. Why not go on with that?”
“Yes,” said Dr. Morris. “Ulcerative colitis is out of the question considering the course taken by the disease. I’m sure we’re dealing with another type of perforation.”
“The next question,” announced old Tick, “is what made the perforation?”
Dr. Warner mopped his face with his wet handkerchief and said softly, “I never thought of an object perforation.”
“You should have,” Dr. Kurtiff stated.
“Come, come,” old Tick interrupted. “Let’s not wander. What caused the perforation?”
“He was seventeen,” Kurtiff answered, “and too old to be swallowing pins.”
“Unless,” said Dr. Hume, “he had a taste for pins. Did the patient want to live, Warner?”
“He wanted to live,” said Warner grimly, “more than anybody I ever knew.”
“I think we can ignore the suicide theory,” said Dr. Kurtiff. “I am certain we are dealing with a perforation of the intestines and not of the subconscious.”
“Well,” Dr. Wood spoke, “it couldn’t have been a chicken bone. A chicken bone would have stuck in the esophagus and never got through to the stomach.”
“There you are, Warner,” old Tick said. “We’ve narrowed it down. The spreading tenderness you described means a spreading infection. The course taken by the disease means a perforation other than ulcerous. And a perforation of that type means an object swallowed. We have ruled out pins and chicken bones. Which leaves us with only one other normal guess.”
“A fishbone,” said Dr. Sweeney.
“Exactly,” said Tick.
Warner stood listening tensely to the voices affirming the diagnosis. Tick delivered the verdict.
“I think we are all agreed,” he said, “that Sam Warner killed his patient by treating him for ulcerative colitis when an operation removing an abscessed fishbone would have saved his life.”
Warner moved quickly across the room to the closet where he had hung his hat and coat.
“Where are you going?” Dr. Wood called after him. “We’ve just started the meeting.”
Warner was putting on his coat and grinning.
“I haven’t got much time,” he said, “but I want to thank all of you for your diagnosis. You were right about there being a catch to the case. The catch is that my patient is still alive. I’ve been treating him for ulcerative colitis for two weeks and I realized this afternoon that I had wrongly diagnosed the case—and that he would be dead in twenty-four hours unless I could find out what really was the matter with him.”
Warner was in the doorway, his eyes glittering.
“Thanks again, gentlemen, for the consultation and your diagnosis,” he said. “It will enable me to save my patient’s life.”
A half hour later, the members of the X Club stood grouped in one of the operating rooms of St. Michael’s Hospital. They looked different from the men who had been playing a medical Halloween in the Walton Hotel. There is a change that comes over doctors when they face disease. The oldest and the weariest of them draw vigor from a crisis. The shamble leaves them and it is the straight back of the champion that enters the operating room. Confronting the problem of life and death, the tired, red-rimmed eyes become full of greatness and even beauty.
On the operating table lay the unconscious body of a Negro boy. Dr. Warner in his surgical whites stood over him.
The fourteen other X Club members watched Warner operate. Wood nodded approvingly at his speed. Rosson cleared his throat to say something, but the swift-moving hands of the surgeon held him silent. No one spoke. The minutes passed. The nurses quietly handed instruments to the surgeon. Blood spattered their hands.
Fourteen great medical men stared hopefully at the pinched and unconscious face of a colored boy who had swallowed a fishbone. No king or pope ever lay ill with more medical genius holding its breath around him.
Suddenly the perspiring surgeon raised something aloft in his forceps.
“Wash this off,” he muttered to the nurse, “and show it to these gentlemen.”
He busied himself placing drains in the abscessed cavity and then powdered some sulfanilamide into the opened abdomen to kill the infection.
Old Tick stepped forward and took the object from the nurse’s hand.
“A fishbone,” he said.
The X Club gathered around it as if it were a treasure indescribable.
“The removal of this small object,” old Tick cackled softly, “will enable the patient to continue writing poetry denouncing the greeds and horrors of our world.”
That, in effect, was the story Hume told me, plus the epilogue of the Negro poet’s recovery three weeks later. We had long finished dinner and it was late night when we stepped into the war-dimmed streets of New York. The headlines on the newsstands had changed in size only. They were larger in honor of the larger slaughters they heralded.
Looking at them you could see the death-strewn wastes of battles. But another picture came to my mind—a picture that had in it the hope of a better world. It was the hospital room in which fifteen famed and learned heroes stood battling for the life of a Negro boy who had swallowed a fishbone.