I acknowledged the apology somewhat stiffly and asked: "You are Mr. Weiss, I presume?"
"Yes, I am Mr. Weiss. It is very good of you to come so far and so late at night and to make no objection to the absurd conditions that my poor friend has imposed."
"Not at all," I replied. "It is my business to go when and where I am wanted, and it is not my business to inquire into the private affairs of my patients."
"That is very true, sir," he agreed cordially, "and I am much obliged to you for taking that very proper view of the case. I pointed that out to my friend, but he is not a very reasonable man. He is very secretive and rather suspicious by nature."
"So I inferred. And as to his condition; is he seriously ill?"
"Ah," said Mr. Weiss, "that is what I want you to tell me. I am very much puzzled about him."
"But what is the nature of his illness? What does he complain of?"
"He makes very few complaints of any kind although he is obviously ill. But the fact is that he is hardly ever more than half awake. He lies in a kind of dreamy stupor from morning to night."
This struck me as excessively strange and by no means in agreement with the patient's energetic refusal to see a doctor.
"But," I asked, "does he never rouse completely?"
"Oh, yes," Mr. Weiss answered quickly; "he rouses from time to time and is then quite rational, and, as you may have gathered, rather obstinate. That is the peculiar and puzzling feature in the case; this alternation between a state of stupor and an almost normal and healthy condition. But perhaps you had better see him and judge for yourself. He had a rather severe attack just now. Follow me, please. The stairs are rather dark."
The stairs were very dark, and I noticed that they were without any covering of carpet, or even oil-cloth, so that our footsteps resounded dismally as if we were in an empty house. I stumbled up after my guide, feeling my way by the hand-rail, and on the first floor followed him into a room similar in size to the one below and very barely furnished, though less squalid than the other. A single candle at the farther end threw its feeble light on a figure in the bed, leaving the rest of the room in a dim twilight.
As Mr. Weiss tiptoed into the chamber, a woman—the one who had spoken to me below—rose from a chair by the bedside and quietly left the room by a second door. My conductor halted, and looking fixedly at the figure in the bed, called out:
"Philip! Philip! Here is the doctor come to see you."
He paused for a moment or two, and, receiving no answer, said: "He seems to be dozing as usual. Will you go and see what you can make of him?"
I stepped forward to the bedside, leaving Mr. Weiss at the end of the room near the door by which we had entered, where he remained, slowly and noiselessly pacing backwards and forwards in the semi-obscurity. By the light of the candle I saw an elderly man with good features and a refined, intelligent and even attractive face, but dreadfully emaciated, bloodless and sallow. He lay quite motionless except for the scarcely perceptible rise and fall of his chest; his eyes were nearly closed, his features relaxed, and, though he was not actually asleep, he seemed to be in a dreamy, somnolent, lethargic state, as if under the influence of some narcotic.
I watched him for a minute or so, timing his slow breathing by my watch, and then suddenly and sharply addressed him by name; but the only response was a slight lifting of the eyelids, which, after a brief, drowsy glance at me, slowly subsided to their former position.
I now proceeded to make a physical examination. First, I felt his pulse, grasping his wrist with intentional brusqueness in the hope of rousing him from his stupor. The beats were slow, feeble and slightly irregular, giving clear evidence, if any were needed, of his generally lowered vitality. I listened carefully to his heart, the sounds of which were very distinct through the thin walls of his emaciated chest, but found nothing abnormal beyond the feebleness and uncertainty of its action. Then I turned my attention to his eyes, which I examined closely with the aid of the candle and my ophthalmoscope lens, raising the lids somewhat roughly so as to expose the whole of the irises. He submitted without resistance to my rather ungentle handling of these sensitive structures, and showed no signs of discomfort even when I brought the candle-flame to within a couple of inches of his eyes.
But this extraordinary tolerance of light was easily explained by closer examination; for the pupils were contracted to such an extreme degree that only the very minutest point of black was visible at the centre of the grey iris. Nor was this the only abnormal peculiarity of the sick man's eyes. As he lay on his back, the right iris sagged down slightly towards its centre, showing a distinctly concave surface; and, when I contrived to produce a slight but quick movement of the eyeball, a perceptible undulatory movement could be detected. The patient had, in fact, what is known as a tremulous iris, a condition that is seen in cases where the crystalline lens has been extracted for the cure of cataract, or where it has become accidentally displaced, leaving the iris unsupported. In the present case, the complete condition of the iris made it clear that the ordinary extraction operation had not been performed, nor was I able, on the closest inspection with the aid of my lens, to find any trace of the less common "needle operation." The inference was that the patient had suffered from the accident known as "dislocation of the lens"; and this led to the further inference that he was almost or completely blind in the right eye.
This conclusion was, indeed, to some extent negatived by a deep indentation on the bridge of the nose, evidently produced by spectacles, and by marks which I looked for and found behind the ears, corresponding to the hooks or "curl sides" of the glasses. For those spectacles which are fitted with curl sides to hook over the ears are usually intended to be worn habitually, and this agreed with the indentation on the nose; which was deeper than would have been accounted for by the merely occasional use of spectacles for reading. But if only one eye was useful, a single eye-glass would have answered the purpose; not that there was any weight in this objection, for a single eye-glass worn constantly would be much less convenient than a pair of hook-sided spectacles.
As to the nature of the patient's illness, only one opinion seemed possible. It was a clear and typical case of opium or morphine poisoning. To this conclusion all his symptoms seemed to point with absolute certainty. The coated tongue, which he protruded slowly and tremulously in response to a command bawled in his ear; his yellow skin and ghastly expression; his contracted pupils and the stupor from which he could hardly be roused by the roughest handling and which yet did not amount to actual insensibility; all these formed a distinct and coherent group of symptoms, not only pointing plainly to the nature of the drug, but also suggesting a very formidable dose.
But this conclusion in its turn raised a very awkward and difficult question. If a large—a poisonous—dose of the drug had been taken, how, and by whom had that dose been administered? The closest scrutiny of the patient's arms and legs failed to reveal a single mark such as would be made by a hypodermic needle. This man was clearly no common morphinomaniac; and in the absence of the usual sprinkling of needlemarks, there was nothing to show or suggest whether the drug had been taken voluntarily by the patient himself or administered by someone else.
And then there remained the possibility that I might, after all, be mistaken in my diagnosis. I felt pretty confident. But the wise man always holds a doubt in reserve. And, in the present case, having regard to the obviously serious condition of the patient, such a doubt was eminently disturbing. Indeed, as I pocketed my stethoscope and took a last look at the motionless, silent figure, I realized that my position was one of extraordinary difficulty and perplexity. On the one hand my suspicions—aroused, naturally enough, by the very unusual circumstances that surrounded my visit—inclined me to extreme reticence; while, on the other, it was evidently my duty to give any information that might prove serviceable to the patient.
As I turned away from the bed Mr. Weiss stopped his slow pacing to and fro and faced me. The feeble light of the candle now fell on him, and I saw him distinctly for the first time. He did not impress me favourably. He was a thick-set, round-shouldered man, a typical fair German with tow-coloured hair, greased and brushed down smoothly, a large, ragged, sandy beard and coarse, sketchy features. His nose was large and thick with a bulbous end, and inclined to a reddish purple,