James L. Franklin
Chicago, Illinois, United States

The January 16, 1943 issue of Collier’s Weekly featured a short story by the famous and multifaceted author Ben Hecht titled “Miracle of the Fifteen Murderers,” with the subtitle “The X Club hosts a post-mortem.” The publisher framed the text with a black-and-white illustration of a group of masked and gowned surgeons peering down at an operating field. Hecht is less mentioned today than he was almost six decades ago, when he collapsed on April 18, 1964, at the age of seventy while reading on the fourteenth floor of his New York apartment. At the time, his death garnered a full-page obituary in The New York Times. Lack of currency did not discourage the appearance in 2019 of two notable biographies, Ben Hecht: Fighting Words, Moving Pictures by Adina Hoffman and The Notorious Ben Hecht: Iconoclastic Writer and Militant Zionist by Julien Gorbach.¹ Hecht distinguished himself as an American screenwriter, playwright, journalist, and author. He was above all a storyteller, as is evident in his prodigious output of film scripts, plays, novels, and short stories. Biographer William MacAdams credits Hecht with sixty-five screenplays, ten novels, and about 250 short stories.²

“Miracle of the Fifteen Murderers” is not necessarily the best known of his writings. More attention is given to collections such as 1001 Afternoons in Chicago or Stories from a Thousand and One Afternoons in New York. But others have called attention to “Miracle of the Fifteen Murderers.” In 1965, Groff Conklin and Dr. Noah D. Fabricant included the story in their anthology Great Detective Stories About Doctors, and Rosamund Morris included the story in a collection Masterpieces of Suspense in 1983.

What inspired Hecht to write this story does not seem to be known. Biographies give the story only passing mention. He did not have any special attachment to the medical profession and doctors are seldom mentioned in his works. Hecht’s is a layman’s view of doctors and their profession in mid-twentieth-century America. He employs satire, humor, and a surprise ending. It is certainly not a detective story.

Hecht introduces the story by reflecting on the aura of mystery members of the medical profession drape around themselves to keep the layman from “discovering how much it knows or how much of it doesn’t know.”³ One of the most mysterious “conclaves” is that group of doctors calling themselves the “X Club.” Its members met every three months behind closed doors at the Walton Hotel overlooking the East River in Manhattan. The club no longer meets, as “nine of the fifteen medical sages . . . are in uniform.” The story, set just before World War II, is the telling of the last “dramatic meeting” of the X Club held on a rainy March night and featuring the induction of a new member. In a framed narrative, the narrator, a journalist, learns about the club over dinner with his friend Dr. Alex Hume, a psychiatrist and member of the club, who was assigned at the final meeting to “prepare the neophyte for his debut.” The initiate, Dr. Samuel Warner, is a surgeon. Unusually young for a “medical genius,” he is described “as tense and good-looking with the fever of hard work glowing in his steady eyes.”

At nine o’clock, Dr. William Tick orders the fifty-third meeting of the X Club in session (doing the math, this makes it the first meeting of the club’s fourteenth year). Dr. Tick, seventy-five years of age, is a “Professor of Internal Medicine at a great Eastern medical school [who] has favored the education-by-insult theory of pedagogy.” Tick informs the new member that their purpose is to “come together every three months to confess to some murder any of them have committed since our last assembly.” By this he means “medical murder” and “nothing will be brought to the attention of the police or the A. M. A.” Tick defines a professional murder as “the killing of a human being who has trustingly placed himself in a doctor’s hands. . . 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.”

Dr. Warner receives this explanation and is very anxious to speak. Dr. Tick insists that they follow their agenda and calls on Dr. James Sweeny, a radiologist, to repeat his confession for the benefit of five members who missed the previous meeting. It is murder through a pharmaceutical error. Instead of a barium meal, the patient was given plaster of Paris. The two cases of the evening include the “elegant stomach specialist Dr. Wendell Davis,” who has misdiagnosed appendicitis and administered castor oil, and Dr. Kenneth Wood, a “noted Scotch surgeon famed in college days as an Olympic Games athlete” who has operated on a patient for an acute gallbladder attack who dies of an “acute infarction of the branch of the right coronary artery.” Dr. Wood admits he failed to take a history before operating on the patient. “Murder by a sophomore,” Old Tick pronounced “wrathfully.”

A very nervous Dr. Warner is finally given the floor and relates, while fielding numerous interruptions, his case in some detail. The members want to know when and at what hospital the patient died. Dr. Warner tells them it was three days ago at St. Michael’s. The patient “was seventeen” and a talented poet. He had been sick for two weeks. The illness began with pain on the left side of the abdomen, which subsided and then returned three days later with fever and diarrhea. “There was no pus and blood” and amoebiasis was ruled out. Dr. Warner made a diagnosis of ulcerative colitis and treated the patient with sulfaguanidine and a “high protein diet – chiefly milk.” Despite treatment the patient worsened, developed findings of peritonitis, and died. The members are informed that there was no autopsy and they debate the possible causes. They arrive at a perforation caused by the ingestion of a foreign body, a fish bone to be exact.

With that, Dr. Samuel Warner abruptly starts to leave the meeting, admitting that the patient is still alive. Thanking them for their help, he now has the correct diagnosis and will be able to save the patient’s life. Thirty minutes later, the members of the X Club are in the operating rooms of St. Michael’s standing over the “naked body of a Negro boy.” The operation proceeds and the fish bone is retrieved. Dr. Hume closes the story, informing the narrator that the boy made a complete recovery over the next three weeks.

Late at night, having finished their dinner, the narrator and Dr. Hume return to the streets of New York where headlines speak of war. The narrator conjures up the picture of a better world in a hospital room where “fifteen famed and learned heroes battled for the life of a Negro boy who had swallowed a fish bone.”

Commenting on his short stories, Hecht tells us that “the people I have written about are actually people I have known, and that the anecdotes in which I wrap them up are truly adventures which have befallen me or those around me at some time.” The doctors in this story seem to conform to commonly held stereotypes: Dr. Samuel Warner, the intense young surgeon; Professor William Tick, the cynical sadistic chairman; Dr. Kenneth Wood, the overworked Scottish surgeon; and Dr. Wendell Davis, the stomach specialist (gastroenterologist, a polysyllabic word Hecht would avoid), “who took his manner as seriously as his medicine.” He also seems to have picked up on the enmity between psychiatry and the medical profession of the day. Dr. Tick levels several pointed digs at the psychiatrist, Dr. Alex Hume, and an eminent neurologist, Dr. Phillip Kurtiff (this at a time when psychiatry and neurology were united under one specialty board). When they attempt to offer solace to the impatient surgeon Dr. Warner, Tick silences them: “this is not a sanitorium for doctors with guilt complexes. It is a clinic for error.” He also remarks: “Psychiatry is a plot against medicine.”

The clinical scenarios in this story warrant further comment. The radiology department that substituted plaster of Paris for a barium meal causing the sudden death of the patient is fanciful and one suspects it formed in Hecht’s fertile imagination. The fatal acute right coronary artery thrombosis mistaken for acute cholecystitis is interesting. Such clinical errors occur in both directions; an acute gallbladder attack, cholecystitis, associated with changes in the electrocardiogram may also be confused with a cardiac event. In an era before coronary angiography, his choice of “an infarction of the descending branch of the right coronary artery” is surprising. Perhaps Hecht reasoned that the right coronary artery might result in pain radiating to the right side of the abdomen, imitating an acute gallbladder attack.

Dr. Warner’s debut case bears little resemblance to ulcerative colitis and further, what surgeon needs consultation in the face of evolving signs of peritonitis? The diagnosis of intestinal perforation and abscess resulting from swallowing a fish bone is a fact. An article in The New York Times in January 30, 2019 called public attention to a challenging case that appeared as a Clinical Pathologic Conference (CPC) in the New England Journal of Medicine.⁴ The patient, an eighteen-year-old athlete, had unknowingly swallowed a toothpick in a sandwich. It traveled through his intestinal tract, ultimately perforating his sigmoid colon and resulting in an abscess that eroded into an artery, causing acute lower intestinal bleeding. As is traditional in a CPC, the differential diagnosis was discussed by Dr. Helen M. Shields, who included the possibility that the patient unknowingly swallowed either a chicken or fish bone. The patient, who almost died, eventually recovered and was able to resume athletics.

For those in the medical profession, Hecht’s story calls to mind an unusual version of the time-honored morbidity and mortality conference (the M&M conference). The M&M conference was meant to be an objective review of adverse outcomes arising during the course of medical treatment that are analyzed with the goal of learning from mistakes in an effort to improve the outcome of medical care. The M&M conference was first suggested by Ernest Codman (1869–1940) in 1904 as a means of evaluating surgical competence at the Massachusetts General Hospital in Boston. Codman was rewarded for his suggestion by having his staff privileges revoked. His ideas formed the basis of the American College of Physicians case reporting system for adverse patient outcomes in 1916.⁵ These conferences reached their “zenith in 1983 when the Accreditation Council for Graduate Medical Education mandated the presence of weekly M&M conferences to achieve and maintain accreditation for all surgical residency programs.”⁶ In 2019 Chad G. Ball, a coeditor of the Canadian Journal of Surgery, decried the loss of interest in these conferences that were becoming a lost art.⁷

As a preface to The Collected Stories of Ben Hecht, the author included “Some Introductory Thoughts” about his story writing. He tells us that he “was weaned on The Arabian Nights and Dickens.” He saw himself as a storyteller: “I have seen myself like those sunny and cackling fellows who once upon stood on the street corners of Baghdad and unfolded tales to the harassed citizens who paused to listen – and fling grateful kopecks at their feet.”⁸

References

1. Adina Hoffman, Ben Hecht: Fighting Words, Moving Pictures, Yale University Press, 2019; Julien Gorbach, Notorious Ben Hecht: Iconoclastic Writer and Militant Zionist, Purdue University Press, 2019.
2. William MacAdams, Ben Hecht: The Man Behind the Legend, Charles Scribner’s and Sons, New York, 1990.
3. Quotations from “Miracle of the Fifteen Murderers” are from The Collected Stories of Ben Hecht, Grosset & Dunlap, New York, N.Y. 1943.
4. Denise Grady, “He Swallowed a Toothpick. It Could Have Killed Him,” The New York Times, Jan. 30, 2019; Case Records of the Massachusetts General Hospital. “Case 4 – 2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia,” New England Journal of Medicine 380(5), 473-485, 2019.
5. Alexander Gregor and David Taylor, “Morbidity and Mortality Conference: Its Purpose Reclaimed and Grounded in Theory,” Teaching and Learning in Medicine 28(4); 439-437, 2016; Avedis Donabedian, “The End Results of Health Care: Ernest Codman’s Contribution to Quality Assessment and Beyond,” The Milbank Quarterly 67(2); 233-256, 1990.
6. Alexander Gregor and David Taylor, “Morbidity and Mortality Conference.”
7. Chad G. Ball, “Are morbidity and mortality conferences becoming a lost art?” Canadian Journal of Surgery 62(2):76, 2019
8. Ben Hecht, The Collected Short Stories of Ben Hecht.