ISSUE 48

In man the chief organ is the heart. But second in rank comes the liver, which performs ancillary functions in the human machine’s internal economy.

At times of emotional upheaval, in distressing situations, it’s the heart which takes the strain and begins to go pit-a-pat, speeding up circulation and heating the blood.

Dr Pancrácio, however, was a curious exception to this rule: it was his liver, not his heart, which bore the brunt. His ticker remained steady, not one beat more or less, not the slightest tremor. His liver, however, pumped away, producing bile in an abundance ignored by classic works on physiology and pathology before expelling this gall violently through his intestines. At these moments Dr Pancrácio’s unruly gut seemed to jack-knife like a desperately fleeing snake, causing him so much pain, such violent cramps, that he feared emotional upheaval more for its effects than its causes.

Dr Pancrácio referred vaguely to this peculiar affliction as his ‘idiosyncrasy’, a term much used by medics to refer to phenomena they are unable to explain.

The Hospital was unusually busy that day. The medical students brimmed with enthusiasm: they had a cadaver to autopsy, a rare event indeed. The dead were normally borne away by their relatives, who considered it profane to slice open a dead body. The students had therefore to learn anatomy from a mannequin, surgery from illustrated books, and obstetrics from a rubber doll. Physiology, pathology, therapeutics and other subjects were taught by oral disquisitions of fine literary quality and admirable philosophical depth.

The lecturer arrived.

The doors of the autopsy room swung open. Upon the table lay the filthy body of an old man, his mouth ajar in a sinister rictus. With his desiccated limbs, sharply pointed shoulders and prominent ribs poking through his skin, he was the grim image of Death itself!

The students recoiled in horror, Pancrácio, then in the fifth year of his studies, cringed away even further than the others. The lecturer noticed this, and with his usual gravity, an ironic smile playing upon his lips, invited Pancrácio to remove his outer garments and don a white coat. He handed him a scalpel and said in a friendly voice:

‘Mr Pancrácio, my future colleague, perform a laparotomy on this cadaver.’

Pancrácio, in a paroxysm of anguish and anxiety, took hold of the scalpel as he would a knife, with the edge facing down. Gripping tight, so his hand wouldn’t shake, he stabbed the abdomen in a swift, deep, decisive thrust. The man’s intestines, startled by such a brutal, unexpected attack, spurted out and spread over the table. In protest at their treatment at the hands of this tyro laparotomist, they sprayed him with such a fetid, asphyxiating gas that Pancrácio almost passed out.

But then the dead man’s liver began to slip slowly down into the abdominal cavity vacated by the guts. Pancrácio spied it and – being a fifth-year student – recognised the organ instantly: it was indeed the liver, with its dark-blue bilious vesicle. He steeled his nerves and prepared to cup the lobe with tender solicitude, but his own liver, in a fit of jealousy, began to pump out a violent stream of bile through his own guts. A fearful colic gripped him. His intestines writhed desperately like a crushed serpent. Unable to stand the pain, Pancrácio dropped the scalpel on the table and staggered back, leaving the corpse with its belly sliced open. Clutching his own with both hands, without asking the lecturer for permission or taking leave of his classmates, he turned tail and fled to the backrooms of the hospital…

At the end of the year, having been a first-class student with a magnificent talent for oratory, he was passed with distinction and received several prizes. A few months later, he did his acto grande, or final exam, in which viva voce he presented his inaugural thesis on ‘idiosyncrasies’.

Now fully qualified, Dr Pancrácio opened a practice in his native village. One morning, rising early, he made himself a nice cup of tea, lit a cigarette and went to stretch out on the stone bench of his balcão. As he waited for patients to arrive, he savoured the cigarette and wriggled into a more comfortable position, stretching one leg out over the cool rendered concrete and dangling the other over the backrest.

It was a tepid morning. Like a tiresome drizzle, a vague and unending melancholy drifted down from the grey skies. Here and there in the front garden, chickens pecked at worms in the sluggish, lukewarm air.

Dr Pancrácio tried various simple tricks to cement a reputation as a distinguished clinician. When he had a days-old remittent fever on his hands, he diagnosed the patient as a serious case of typhoid to frighten the relatives. He then consoled and encouraged all concerned before taking credit for the recovery. When, contrariwise, a peer had a serious case to deal with, Dr Pancrácio went around telling everyone it was just a minor fever, and that the complications were down to the physician in question sticking pigheadedly to the wrong treatment.

But these ruses failed and Dr Pancrácio’s clinic bumped along with only half a dozen patients a month.

Finally, an old woman arrived. She had a bedridden husband eighty years of age and, on the advice of a neighbour, wanted to try out the new doctor.

Dr Pancrácio, who was getting tired of waiting for patients, got hurriedly to his feet and took detailed information about the old man, who hadn’t left his bed for twelve years. He told the little old woman that her spouse’s condition would improve after a few months of the medicine he was about to prescribe and withdrew to his dispensary.

This dispensary had been installed in a room once used for storing firewood, this now having been relegated to a palm-leaf shelter in the back garden. Though the lime plaster on the walls of this unlit room had flaked off, the floor was swept and had been spread with fresh cow dung. On one wall, new pine shelves had been put up, and now held a few large jars of magnesium sulphate and other cheap preparations as well as some smaller containers of more expensive salts like quinine. Upon an old table covered in spots of grease and bicarbonate of soda stood a little set of scales and a marble mortar that was chipped and dirty looking. Dr Pancrácio opened a small bottle of quinine and, without even bothering to measure it, shook some out into the mortar. He then dumped in a bit of sodium sulphate and ground the resulting mixture with his pestle. Since there was no more dissolving agent in the flask under the table, he brought over his teapot and glugged its dregs into a bottle with the sulphate and quinine. After giving the mixture a good shake, he went out and handed it to the woman, giving her strict instructions as to its use.

Dr Pancrácio received, in exchange, four tangas, which was what the medicine cost per bottle. Since consultations were free, this was his only source of income. He advised the woman to come back in the following days to pick up a fresh dose.

As there was fat chance of any other patients turning up, Dr Pancrácio donned his cap, and though still wearing slippers and indoor clothes, decided to pop by the church and pretend he was returning from a house call. But on his way there he ran into the village barber, who was hurrying breathlessly in the opposite direction in search of a doctor. The man asked Dr Pancrácio to accompany him: it was urgent, an emergency!

Off they set without further ado. On the way, the barber explained the situation: his wife had been up all night with labour pains that seemed endless. Dr Pancrácio, who had never assisted or even seen a birth, and only knew the procedure in theory, took fright at the responsibility he was about to assume. As they drew nearer the barber’s house, a tremor seized his knees. Cold sweat pearled his brow.

But he took courage and strode resolutely into the woman’s bedroom. There she was, held down by two neighbours as she convulsed in agony, thrashing with pain amid a sea of blood… Dr Pancrácio felt an emotional upheaval. His liver – that damnable organ – flipped its switch and, throbbing like mad, expelled its inevitable bile.

Dr Pancrácio, racked with spasms as though he himself were in labour, clutched his belly with both hands and fled from the barber’s house. He sought refuge under the benevolent shade of a coconut palm and cursed the terrible idiosyncrasy that made him look so fearful, so cowardly.

Applications were invited for a vacant position as district medical officer. Since Dr Pancrácio had no clientele whatsoever, having fallen victim to a tireless campaign of defamation by the barber, he applied. And since he had magnificent qualifications he was placed first and awarded the job.

Everything ran smoothly in his new post: all he had to do was write reports, which Dr Pancrácio did magnificently, filling them with much erudition, untold references and, in accordance with the old habits of his School, churning them out in brilliant literary style.

But suddenly, towards the end of August, scattered cases of choleroid diarrhoea began to appear. Dr Pancrácio took a serious attitude. His official role admitted of nothing less: he requested a nurse, a stretcher, a corporal backed up by six privates, and an intestinal shower unit. He set up headquarters in his residence, from which he refused to budge. From this fastness he barked orders to his soldiers and the nurse, wrote report after report and gave himself a twice daily enema with a four per cent solution of boric acid.

However, the nurse was struck down with cholerine, the soldiers quailed, and the outbreak flared up again. Countless families were laid low.

The administration, taken aback by the passive attitude of the district medical officer, pressed him to adopt a more active approach, to get out into the field and visit the afflicted population, or else face arrest and imprisonment.

Terrified, Dr Pancrácio found himself between Scylla and Charybdis. Either he visited the homes of those afflicted or he’d wind up in jail, where he suspected the bacteria had already reached. Plumping for the first option, he took a shower, donned a cashmere suit and stuffed his stethoscope in his pocket. He then steeled his nerves before entering the house of the first cholera sufferers he could find.

It was a paupers’ hovel, unlit and poorly kept. Just inside the entrance, on a bamboo mat, two dead bodies lay abandoned in macabre poses. A little further ahead a dying woman was stretched out on her side. Between bouts of vomiting, she begged piteously for water, just a drop of water, to quench her thirst. Littering the floor were filthy sick-soaked rags abuzz with flies. From the bodies a trickle of reddish liquid made its disgusting, pestilential way to the door.

White with terror, Dr Pancrácio felt everything around him spin. The foul-smelling effusions made him nauseous and he turned round to spew out the contents of his stomach. Next his liver, its abundant bile combining with the remnants of his intestinal shower, did its work. The poor doctor was almost caught short but just managed to uphold the minimum of decency. In two successive, regular, rhythmic blasts he expelled the whole kit and caboodle.

This fatal rout left Dr Pancrácio more dead than alive. He saw he had all the symptoms of cholerine: the vomiting and vertigo, cold sweats and the squits. He staggered along like a drunk, supposing to have suffered a severe bout of the affliction. Abandoning his home, his official post, his books and his reports, he clambered up onto a passing ox cart and returned to his native village.

But three days later, seeing the condition hadn’t developed, Dr Pancrácio twigged it had all been down to his ‘idiosyncrasy’. Now it was too late. He had already been dismissed, his place taken by another doctor whose liver wasn’t prone to such failings.

And so, resigned to his fate, to the dismal star over his birth that had made him ‘idiosyncratic’, Dr Pancrácio gave up life as a clinician. He considered dedicating himself to medical writing and a book on idiosyncrasies. He pulled out his dissertation to re-read: it was the story of his defective liver and its ‘idiosyncrasy’. It was his own story. There was nothing else to say.

Translator’s Note

‘Dr Pancrácio’s Liver’ typifies Silva Coelho’s ‘Contos Regioniais’ (or ‘Regional Tales’), his best known, most successful, and perhaps only ‘truly’ literary series. In ‘Regional Stories’ Silva Coelho satirised a whole panorama of First Republic Goa. His scope was perhaps wider than any other Goan writer in Portuguese. As well as the lawyers, doctors, civil servants, councillors, primary school teachers, bhatcars and clergymen that formed what we might term the backbone of Indo-Portuguese society, he turned his sights on figures drawn from the English-speaking lower middle class, both in Goa and Bombay, as well as characters of yet humbler station: ayahs, fishwives, coachmen and temple dancers among others. In this story, Silva Coelho takes aim at the inadequacies of medical training and practice in early twentieth-century Goa, the misplaced privileging of form over practicality and the inadequacies of the colonial state. If Pancrácio’s liver shows the concentration on lower bodily functions that characterises satire – a fundamental aim of which is to pull low that which is considered (or which considers itself) too highly – in his description of the victims of cholera he sketches in brief strokes a scene that is truly horrible yet rendered with consummate skill.

In man the chief organ is the heart. But second in rank comes the liver, which performs ancillary functions in the human machine’s internal economy.

At times of emotional upheaval, in distressing situations, it’s the heart which takes the strain and begins to go pit-a-pat, speeding up circulation and heating the blood.

Dr Pancrácio, however, was a curious exception to this rule: it was his liver, not his heart, which bore the brunt. His ticker remained steady, not one beat more or less, not the slightest tremor. His liver, however, pumped away, producing bile in an abundance ignored by classic works on physiology and pathology before expelling this gall violently through his intestines. At these moments Dr Pancrácio’s unruly gut seemed to jack-knife like a desperately fleeing snake, causing him so much pain, such violent cramps, that he feared emotional upheaval more for its effects than its causes.

Dr Pancrácio referred vaguely to this peculiar affliction as his ‘idiosyncrasy’, a term much used by medics to refer to phenomena they are unable to explain.

The Hospital was unusually busy that day. The medical students brimmed with enthusiasm: they had a cadaver to autopsy, a rare event indeed. The dead were normally borne away by their relatives, who considered it profane to slice open a dead body. The students had therefore to learn anatomy from a mannequin, surgery from illustrated books, and obstetrics from a rubber doll. Physiology, pathology, therapeutics and other subjects were taught by oral disquisitions of fine literary quality and admirable philosophical depth.

The lecturer arrived.

The doors of the autopsy room swung open. Upon the table lay the filthy body of an old man, his mouth ajar in a sinister rictus. With his desiccated limbs, sharply pointed shoulders and prominent ribs poking through his skin, he was the grim image of Death itself!

The students recoiled in horror, Pancrácio, then in the fifth year of his studies, cringed away even further than the others. The lecturer noticed this, and with his usual gravity, an ironic smile playing upon his lips, invited Pancrácio to remove his outer garments and don a white coat. He handed him a scalpel and said in a friendly voice:

‘Mr Pancrácio, my future colleague, perform a laparotomy on this cadaver.’

Pancrácio, in a paroxysm of anguish and anxiety, took hold of the scalpel as he would a knife, with the edge facing down. Gripping tight, so his hand wouldn’t shake, he stabbed the abdomen in a swift, deep, decisive thrust. The man’s intestines, startled by such a brutal, unexpected attack, spurted out and spread over the table. In protest at their treatment at the hands of this tyro laparotomist, they sprayed him with such a fetid, asphyxiating gas that Pancrácio almost passed out.

But then the dead man’s liver began to slip slowly down into the abdominal cavity vacated by the guts. Pancrácio spied it and – being a fifth-year student – recognised the organ instantly: it was indeed the liver, with its dark-blue bilious vesicle. He steeled his nerves and prepared to cup the lobe with tender solicitude, but his own liver, in a fit of jealousy, began to pump out a violent stream of bile through his own guts. A fearful colic gripped him. His intestines writhed desperately like a crushed serpent. Unable to stand the pain, Pancrácio dropped the scalpel on the table and staggered back, leaving the corpse with its belly sliced open. Clutching his own with both hands, without asking the lecturer for permission or taking leave of his classmates, he turned tail and fled to the backrooms of the hospital…

At the end of the year, having been a first-class student with a magnificent talent for oratory, he was passed with distinction and received several prizes. A few months later, he did his acto grande, or final exam, in which viva voce he presented his inaugural thesis on ‘idiosyncrasies’.

Now fully qualified, Dr Pancrácio opened a practice in his native village. One morning, rising early, he made himself a nice cup of tea, lit a cigarette and went to stretch out on the stone bench of his balcão. As he waited for patients to arrive, he savoured the cigarette and wriggled into a more comfortable position, stretching one leg out over the cool rendered concrete and dangling the other over the backrest.

It was a tepid morning. Like a tiresome drizzle, a vague and unending melancholy drifted down from the grey skies. Here and there in the front garden, chickens pecked at worms in the sluggish, lukewarm air.

Dr Pancrácio tried various simple tricks to cement a reputation as a distinguished clinician. When he had a days-old remittent fever on his hands, he diagnosed the patient as a serious case of typhoid to frighten the relatives. He then consoled and encouraged all concerned before taking credit for the recovery. When, contrariwise, a peer had a serious case to deal with, Dr Pancrácio went around telling everyone it was just a minor fever, and that the complications were down to the physician in question sticking pigheadedly to the wrong treatment.

But these ruses failed and Dr Pancrácio’s clinic bumped along with only half a dozen patients a month.

Finally, an old woman arrived. She had a bedridden husband eighty years of age and, on the advice of a neighbour, wanted to try out the new doctor.

Dr Pancrácio, who was getting tired of waiting for patients, got hurriedly to his feet and took detailed information about the old man, who hadn’t left his bed for twelve years. He told the little old woman that her spouse’s condition would improve after a few months of the medicine he was about to prescribe and withdrew to his dispensary.

This dispensary had been installed in a room once used for storing firewood, this now having been relegated to a palm-leaf shelter in the back garden. Though the lime plaster on the walls of this unlit room had flaked off, the floor was swept and had been spread with fresh cow dung. On one wall, new pine shelves had been put up, and now held a few large jars of magnesium sulphate and other cheap preparations as well as some smaller containers of more expensive salts like quinine. Upon an old table covered in spots of grease and bicarbonate of soda stood a little set of scales and a marble mortar that was chipped and dirty looking. Dr Pancrácio opened a small bottle of quinine and, without even bothering to measure it, shook some out into the mortar. He then dumped in a bit of sodium sulphate and ground the resulting mixture with his pestle. Since there was no more dissolving agent in the flask under the table, he brought over his teapot and glugged its dregs into a bottle with the sulphate and quinine. After giving the mixture a good shake, he went out and handed it to the woman, giving her strict instructions as to its use.

Dr Pancrácio received, in exchange, four tangas, which was what the medicine cost per bottle. Since consultations were free, this was his only source of income. He advised the woman to come back in the following days to pick up a fresh dose.

As there was fat chance of any other patients turning up, Dr Pancrácio donned his cap, and though still wearing slippers and indoor clothes, decided to pop by the church and pretend he was returning from a house call. But on his way there he ran into the village barber, who was hurrying breathlessly in the opposite direction in search of a doctor. The man asked Dr Pancrácio to accompany him: it was urgent, an emergency!

Off they set without further ado. On the way, the barber explained the situation: his wife had been up all night with labour pains that seemed endless. Dr Pancrácio, who had never assisted or even seen a birth, and only knew the procedure in theory, took fright at the responsibility he was about to assume. As they drew nearer the barber’s house, a tremor seized his knees. Cold sweat pearled his brow.

But he took courage and strode resolutely into the woman’s bedroom. There she was, held down by two neighbours as she convulsed in agony, thrashing with pain amid a sea of blood… Dr Pancrácio felt an emotional upheaval. His liver – that damnable organ – flipped its switch and, throbbing like mad, expelled its inevitable bile.

Dr Pancrácio, racked with spasms as though he himself were in labour, clutched his belly with both hands and fled from the barber’s house. He sought refuge under the benevolent shade of a coconut palm and cursed the terrible idiosyncrasy that made him look so fearful, so cowardly.

Applications were invited for a vacant position as district medical officer. Since Dr Pancrácio had no clientele whatsoever, having fallen victim to a tireless campaign of defamation by the barber, he applied. And since he had magnificent qualifications he was placed first and awarded the job.

Everything ran smoothly in his new post: all he had to do was write reports, which Dr Pancrácio did magnificently, filling them with much erudition, untold references and, in accordance with the old habits of his School, churning them out in brilliant literary style.

But suddenly, towards the end of August, scattered cases of choleroid diarrhoea began to appear. Dr Pancrácio took a serious attitude. His official role admitted of nothing less: he requested a nurse, a stretcher, a corporal backed up by six privates, and an intestinal shower unit. He set up headquarters in his residence, from which he refused to budge. From this fastness he barked orders to his soldiers and the nurse, wrote report after report and gave himself a twice daily enema with a four per cent solution of boric acid.

However, the nurse was struck down with cholerine, the soldiers quailed, and the outbreak flared up again. Countless families were laid low.

The administration, taken aback by the passive attitude of the district medical officer, pressed him to adopt a more active approach, to get out into the field and visit the afflicted population, or else face arrest and imprisonment.

Terrified, Dr Pancrácio found himself between Scylla and Charybdis. Either he visited the homes of those afflicted or he’d wind up in jail, where he suspected the bacteria had already reached. Plumping for the first option, he took a shower, donned a cashmere suit and stuffed his stethoscope in his pocket. He then steeled his nerves before entering the house of the first cholera sufferers he could find.

It was a paupers’ hovel, unlit and poorly kept. Just inside the entrance, on a bamboo mat, two dead bodies lay abandoned in macabre poses. A little further ahead a dying woman was stretched out on her side. Between bouts of vomiting, she begged piteously for water, just a drop of water, to quench her thirst. Littering the floor were filthy sick-soaked rags abuzz with flies. From the bodies a trickle of reddish liquid made its disgusting, pestilential way to the door.

White with terror, Dr Pancrácio felt everything around him spin. The foul-smelling effusions made him nauseous and he turned round to spew out the contents of his stomach. Next his liver, its abundant bile combining with the remnants of his intestinal shower, did its work. The poor doctor was almost caught short but just managed to uphold the minimum of decency. In two successive, regular, rhythmic blasts he expelled the whole kit and caboodle.

This fatal rout left Dr Pancrácio more dead than alive. He saw he had all the symptoms of cholerine: the vomiting and vertigo, cold sweats and the squits. He staggered along like a drunk, supposing to have suffered a severe bout of the affliction. Abandoning his home, his official post, his books and his reports, he clambered up onto a passing ox cart and returned to his native village.

But three days later, seeing the condition hadn’t developed, Dr Pancrácio twigged it had all been down to his ‘idiosyncrasy’. Now it was too late. He had already been dismissed, his place taken by another doctor whose liver wasn’t prone to such failings.

And so, resigned to his fate, to the dismal star over his birth that had made him ‘idiosyncratic’, Dr Pancrácio gave up life as a clinician. He considered dedicating himself to medical writing and a book on idiosyncrasies. He pulled out his dissertation to re-read: it was the story of his defective liver and its ‘idiosyncrasy’. It was his own story. There was nothing else to say.