Mary Keeper 39;s Aching Head Answers

[Irma Tchakian]

Inthis problem-based learning case, students read about a 41-year-old woman who is suffering from recurring headaches. Working in small groups, the students analyze a variety of information and then formulate a diagnosis. This case study was developed for a two-semester anatomy and physiology course that is aimed at sophomore and junior level undergraduate students. These students are typically biology or health science majors who are pre-med, pre-nursing, or pre-physical therapy.

Teaching notes are intended to help teachers select and adopt a case. They typically include a summary of the case, teaching objectives, information about the intended audience, details about how the case may be taught, and a list of references and resources.

"'How knowest thou,' may the distressed Novel-wright exclaim, 'thatI, here where I sit, am the Foolishest of existing mortals; that thismy Long-ear of a fictitious Biography shall not find one and theother, into whose still longer ears it may be the means, underProvidence, of instilling somewhat?' We answer, 'None knows, none cancertainly know: therefore, write on, worthy Brother, even as thoucanst, even as it is given thee.'"

The more I reflected on this unhappy state of things between those sobound to each other by common interests, as the employers and theemployed must ever be, the more anxious I became to give someutterance to the agony which, from time to time, convulses this dumbpeople; the agony of suffering without the sympathy of the happy, orof erroneously believing that such is the case. If it be an error,that the woes, which come with ever-returning tide-like flood tooverwhelm the workmen in our manufacturing towns, pass unregarded byall but the sufferers, it is at any rate an error so bitter in itsconsequences to all parties, that whatever public effort can do inthe way of legislation, or private effort in the way of mercifuldeeds, or helpless love in the way of "widow's mites," should bedone, and that speedily, to disabuse the work-people of so miserablea misapprehension. At present they seem to me to be left in a state,wherein lamentations and tears are thrown aside as useless, but inwhich the lips are compressed for curses, and the hands clenched andready to smite.

To myself the idea which I have formed of the state of feeling amongtoo many of the factory-people in Manchester, and which I endeavouredto represent in this tale (completed above a year ago), has receivedsome confirmation from the events which have so recently occurredamong a similar class on the Continent.

Groups of merry and somewhat loud-talking girls, whose ages mightrange from twelve to twenty, came by with a buoyant step. They weremost of them factory girls, and wore the usual out-of-doors dress ofthat particular class of maidens; namely, a shawl, which at mid-dayor in fine weather was allowed to be merely a shawl, but towardsevening, or if the day were chilly, became a sort of Spanish mantillaor Scotch plaid, and was brought over the head and hung loosely down,or was pinned under the chin in no unpicturesque fashion.

Their faces were not remarkable for beauty; indeed, they were belowthe average, with one or two exceptions; they had dark hair, neatlyand classically arranged, dark eyes, but sallow complexions andirregular features. The only thing to strike a passer-by was anacuteness and intelligence of countenance, which has often beennoticed in a manufacturing population.

There were also numbers of boys, or rather young men, rambling amongthese fields, ready to bandy jokes with any one, and particularlyready to enter into conversation with the girls, who, however, heldthemselves aloof, not in a shy, but rather in an independent way,assuming an indifferent manner to the noisy wit or obstreperouscompliments of the lads. Here and there came a sober quiet couple,either whispering lovers, or husband and wife, as the case might be;and if the latter, they were seldom unencumbered by an infant,carried for the most part by the father, while occasionally eventhree or four little toddlers had been carried or dragged thus far,in order that the whole family might enjoy the delicious Mayafternoon together.

Sometime in the course of that afternoon, two working men met withfriendly greeting at the stile so often named. One was a thoroughspecimen of a Manchester man; born of factory workers, and himselfbred up in youth, and living in manhood, among the mills. He wasbelow the middle size and slightly made; there was almost a stuntedlook about him; and his wan, colourless face gave you the idea, thatin his childhood he had suffered from the scanty living consequentupon bad times and improvident habits. His features were stronglymarked, though not irregular, and their expression was extremeearnestness; resolute either for good or evil; a sort of latent,stern enthusiasm. At the time of which I write, the good predominatedover the bad in the countenance, and he was one from whom a strangerwould have asked a favour with tolerable faith that it would begranted. He was accompanied by his wife, who might, withoutexaggeration, have been called a lovely woman, although now her facewas swollen with crying, and often hidden behind her apron. She hadthe fresh beauty of the agricultural districts; and somewhat of thedeficiency of sense in her countenance, which is likewisecharacteristic of the rural inhabitants in comparison with thenatives of the manufacturing towns. She was far advanced inpregnancy, which perhaps occasioned the overpowering and hystericalnature of her grief. The friend whom they met was more handsome andless sensible-looking than the man I have just described; he seemedhearty and hopeful, and although his age was greater, yet there wasfar more of youth's buoyancy in his appearance. He was tenderlycarrying a baby in arms, while his wife, a delicate, fragile-lookingwoman, limping in her gait, bore another of the same age; little,feeble twins, inheriting the frail appearance of their mother.

The last-mentioned man was the first to speak, while a sudden look ofsympathy dimmed his gladsome face. "Well, John, how goes it withyou?" and, in a lower voice, he added, "Any news of Esther, yet?"Meanwhile the wives greeted each other like old friends, the soft andplaintive voice of the mother of the twins seeming to call forth onlyfresh sobs from Mrs. Barton.

"Come, women," said John Barton, "you've both walked far enough. MyMary expects to have her bed in three weeks; and as for you, Mrs.Wilson, you know you're but a cranky sort of a body at the best oftimes." This was said so kindly, that no offence could be taken. "Sityou down here; the grass is well nigh dry by this time; and you'reneither of you nesh [1]folk about taking cold. Stay," he added, withsome tenderness, "here's my pocket-handkerchief to spread under you,to save the gowns women always think so much of; and now, Mrs.Wilson, give me the baby, I may as well carry him, while you talk andcomfort my wife; poor thing, she takes on sadly about Esther."

These arrangements were soon completed: the two women sat down on theblue cotton handkerchiefs of their husbands, and the latter, eachcarrying a baby, set off for a further walk; but as soon as Bartonhad turned his back upon his wife, his countenance fell back into anexpression of gloom.

"No, nor shan't, as I take it. My mind is, she's gone off withsomebody. My wife frets, and thinks she's drowned herself, but I tellher, folks don't care to put on their best clothes to drownthemselves; and Mrs. Bradshaw (where she lodged, you know) says thelast time she set eyes on her was last Tuesday, when she came downstairs, dressed in her Sunday gown, and with a new ribbon in herbonnet, and gloves on her hands, like the lady she was so fond ofthinking herself."

"Ay, she was a farrantly[2]lass; more's the pity now," added Barton,with a sigh. "You see them Buckinghamshire people as comes to work inManchester, has quite a different look with them to us Manchesterfolk. You'll not see among the Manchester wenches such fresh rosycheeks, or such black lashes to gray eyes (making them look likeblack), as my wife and Esther had. I never seed two such pretty womenfor sisters; never. Not but what beauty is a sad snare. Here wasEsther so puffed up, that there was no holding her in. Her spirit wasalways up, if I spoke ever so little in the way of advice to her; mywife spoiled her, it is true, for you see she was so much older thanEsther she was more like a mother to her, doing every thing for her."

"That's the worst of factory work, for girls. They can earn so muchwhen work is plenty, that they can maintain themselves any how. MyMary shall never work in a factory, that I'm determined on. You seeEsther spent her money in dress, thinking to set off her pretty face;and got to come home so late at night, that at last I told her mymind: my missis thinks I spoke crossly, but I meant right, for Iloved Esther, if it was only for Mary's sake. Says I, 'Esther, I seewhat you'll end at with your artificials, and your fly-away veils,and stopping out when honest women are in their beds; you'll be astreet-walker, Esther, and then, don't you go to think I'll have youdarken my door, though my wife is your sister.' So says she, 'Don'ttrouble yourself, John. I'll pack up and be off now, for I'll neverstay to hear myself called as you call me.' She flushed up like aturkey-cock, and I thought fire would come out of her eyes; but whenshe saw Mary cry (for Mary can't abide words in a house), she wentand kissed her, and said she was not so bad as I thought her. So wetalked more friendly, for, as I said, I liked the lass well enough,and her pretty looks, and her cheery ways. But she said (and at thetime I thought there was sense in what she said) we should be muchbetter friends if she went into lodgings, and only came to see us nowand then."

"Well, well, I call her 'little,' because her mother's name is Mary.But, as I was saying, she takes Mary in a coaxing sort of way, and,'Mary,' says she, 'what should you think if I sent for you some dayand made a lady of you?' So I could not stand such talk as that to mygirl, and I said, 'Thou'd best not put that nonsense i' the girl'shead I can tell thee; I'd rather see her earning her bread by thesweat of her brow, as the Bible tells her she should do, ay, thoughshe never got butter to her bread, than be like a do-nothing lady,worrying shopmen all morning, and screeching at her pianny allafternoon, and going to bed without having done a good turn to anyone of God's creatures but herself.'"

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