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Look here, I said to the child, we’re going to look at your throat. You’re old enough to understand what I’m saying. Will you open it now by yourself or shall we have to open it for you?
Not a move. Even her expression hadn’t changed. Her breaths however were coming faster and faster. Then the battle began. I had to do it. I had to have a throat culture for her own protection. But first I told the parents that it was entirely up to them. I explained the danger but said that I would not insist on a throat examination so long as they would take the responsibility.
Mathilda is “old enough to understand” what the doctor wants but not old enough to understand her peril; diphtheria is “nothing to her.” In these lines, which occur after she tries to scratch the doctor’s eyes, he seems to be giving her a choice. But he isn’t really respecting her agency, because he follows his request with the threat that “we” will open her mouth if she doesn’t. In her terror, Mathilda has retreated into a defensive position, but she has no power over what will happen to her own body. Only once does the mother object that her daughter may not be able to endure the examination. Nor do the parents have real agency to decide what they think best, since the doctor subtly threatens to blame them for their daughter’s possible death if they don’t cooperate. For a child to lack autonomy was not unusual at the time of the story, and even today children often have little say about how they are treated. However, had the adults taken time to approach Mathilda not as authorities over her life and death (“You’re killing me!” she screams at one point), the outcome might have been less traumatic for all.
In a final unreasoning assault I overpowered the child’s neck and jaws. I forced the heavy silver spoon back of her teeth and down her throat till she gagged. And there it was—both tonsils covered with membrane. She had fought valiantly to keep me from knowing her secret. She had been hiding that sore throat for three days at least and lying to her parents in order to escape just such an outcome as this.
Now truly she was furious. She had been on the defensive before but now she attacked. Tried to get off her father’s lap and fly at me while tears of defeat blinded her eyes.
The force that finally produces the diagnosis of diphtheria is violent. The doctor “overpowered” Mathilda by forcing her head back, apparently, since her neck is involved. Readers can imagine the father holding the struggling girl while the doctor holds her head back with one hand while pushing the smooth, slippery spoon between her teeth with the other. The spoon presses so far back that Mathilda gags. While the doctor has his victory—the diagnosis he suspected and a conviction that the child has been “hiding” this “secret” intentionally, even though he has already said that she can’t understand what having diphtheria means—Mathilda is devastated. What little agency and ability to defend her person she had exercised has failed. The trauma of the loss makes her “furious,” and she switches tactics, from defense to attack. Yet even here, in the story’s final sentences, she can only “try” to escape her father’s restraining arms to strike at the man who has terrified and harmed her. She cries at her “defeat” and loss of the last shred of self-determination. The people with agency—primarily the doctor and to a lesser extent the father—have made all the terrifying decisions without her consent.
