Matilda and her family through the doctor’s eyes, the reader notes the cramped, damp kitchen of the poor family. The doctor separates himself from them through his disgust for the parents and their speech. The father tells the doctor,

My wife has given her things, you know, like people do, but it don't do no good. And there's been a lot of sickness around. So we tho't you'd better look her over and tell us what is the matter.

The father’s vernacular and deference to the doctor as an authority figure highlight the class difference between them. It also contrasts the doctor's more educated speech and elevated word choice like “magnificent,” “profusion,” “photogravure,” “desist,” and more.

Second, the first-person point of view—combined with a lack of punctuation—blends the story’s action with the doctor’s thoughts. This absence of quotation marks fails to delineate the characters' dialogue and external actions from the doctor's internal thoughts. As a result, these elements run into each other, producing a vertiginous and off-putting effect on the reader who wonders what is really true and accurate. The mixing of dialogue with thoughts and actions emphasizes the doctor’s subjective point of view. Initially, he and his mother try to reason with Matilda:

Aw, come on, I coaxed, just open your mouth wide and let me take a look. Look, I said opening both hands wide, I haven't anything in my hands. Just open up and let me see.

Such a nice man, put in the mother. Look how kind he is to you. Come on, do what he tells you to. He won't hurt you.

At that I ground my teeth in disgust. If only they wouldn't use the word "hurt" I might be able to get somewhere.

The placement of the word "hurt" in quotation marks also illustrates how offensive it is to the condescending doctor. When he does become frustrated, his thoughts lead to actions: "Then the battle began. I had to do it.”

Third, as the doctor’s actions become shockingly angry and violent through the course of the story, he tries to justify his emotions and actions as a public health necessity. When he first approaches Matilda, he smiles “in my best professional manner and asking for the child's first name I said, come on, Mathilda, open your mouth and let's take a look at your throat." He falls “in love with the savage brat.” But when she refuses, he admits that he has “grown furious” and justifies his use of force by noting "I had to have a throat culture for her own protection” and

I have seen at least two children Iying dead in bed of neglect in such cases, and feeling that I must get a diagnosis now or never I went at it again. ... The damned little brat must be protected against her own idiocy, one says to one's self at such times. Others must be protected against her. It is social necessity.

Disturbingly, though, as he proceeds he confesses that ,

I could have torn the child apart in my own fury and enjoyed it. It was a pleasure to attack her. My face was burning with it. ... But a blind fury, a feeling of adult shame, bred of a longing for muscular release are the operatives One goes on to the end. In a final unreasoning assault I overpowered the child's neck and jaws.

The entire examination becomes an extended metaphor for a rape, with the doctor as the aggressor and the girl as the victim who resists unsuccessfully. To him, she appears as “an unusually attractive little thing, and as strong as a heifer in appearance.” He knows that he employs violence to examine her throat but was his violation of her personal space and body justified for the good of public health? The initially gentle, professional doctor becomes angry and shocks himself (and readers) by actually feeling pleasure in wielding power.