At the beginning of the winter session Philip became an out-patients’
clerk. There were three assistant-physicians who took out-patients, two
days a week each, and Philip put his name down for Dr. Tyrell. He was
popular with the students, and there was some competition to be his
clerk. Dr. Tyrell was a tall, thin man of thirty-five, with a very
small head, red hair cut short, and prominent blue eyes: his face was
bright scarlet. He talked well in a pleasant voice, was fond of a
little joke, and treated the world lightly. He was a successful man,
with a large consulting practice and a knighthood in prospect. From
commerce with students and poor people he had the patronising air, and
from dealing always with the sick he had the healthy man’s jovial
condescension, which some consultants achieve as the professional
manner. He made the patient feel like a boy confronted by a jolly
schoolmaster; his illness was an absurd piece of naughtiness which
amused rather than irritated.
The student was supposed to attend in the out-patients’ room every day,
see cases, and pick up what information he could; but on the days on
which he clerked his duties were a little more definite. At that time
the out-patients’ department at St. Luke’s consisted of three rooms,
leading into one another, and a large, dark waiting-room with massive
pillars of masonry and long benches. Here the patients waited after
having been given their ‘letters’ at mid-day; and the long rows of
them, bottles and gallipots in hand, some tattered and dirty, others
decent enough, sitting in the dimness, men and women of all ages,
children, gave one an impression which was weird and horrible. They
suggested the grim drawings of Daumier. All the rooms were painted
alike, in salmon-colour with a high dado of maroon; and there was in
them an odour of disinfectants, mingling as the afternoon wore on with
the crude stench of humanity. The first room was the largest and in the
middle of it were a table and an office chair for the physician; on
each side of this were two smaller tables, a little lower: at one of
these sat the house-physician and at the other the clerk who took the
‘book’ for the day. This was a large volume in which were written down
the name, age, sex, profession, of the patient and the diagnosis of his
disease.
At half past one the house-physician came in, rang the bell, and told
the porter to send in the old patients. There were always a good many
of these, and it was necessary to get through as many of them as
possible before Dr. Tyrell came at two. The H.P. with whom Philip came
in contact was a dapper little man, excessively conscious of his
importance: he treated the clerks with condescension and patently
resented the familiarity of older students who had been his
contemporaries and did not use him with the respect he felt his present
position demanded. He set about the cases. A clerk helped him. The
patients streamed in. The men came first. Chronic bronchitis, “a nasty
’acking cough,” was what they chiefly suffered from; one went to the
H.P. and the other to the clerk, handing in their letters: if they were
going on well the words Rep 14 were written on them, and they went to
the dispensary with their bottles or gallipots in order to have
medicine given them for fourteen days more. Some old stagers held back
so that they might be seen by the physician himself, but they seldom
succeeded in this; and only three or four, whose condition seemed to
demand his attention, were kept.
Dr. Tyrell came in with quick movements and a breezy manner. He
reminded one slightly of a clown leaping into the arena of a circus
with the cry: Here we are again. His air seemed to indicate: What’s all
this nonsense about being ill? I’ll soon put that right. He took his
seat, asked if there were any old patients for him to see, rapidly
passed them in review, looking at them with shrewd eyes as he discussed
their symptoms, cracked a joke (at which all the clerks laughed
heartily) with the H.P., who laughed heartily too but with an air as if
he thought it was rather impudent for the clerks to laugh, remarked
that it was a fine day or a hot one, and rang the bell for the porter
to show in the new patients.
They came in one by one and walked up to the table at which sat Dr.
Tyrell. They were old men and young men and middle-aged men, mostly of
the labouring class, dock labourers, draymen, factory hands, barmen;
but some, neatly dressed, were of a station which was obviously
superior, shop-assistants, clerks, and the like. Dr. Tyrell looked at
these with suspicion. Sometimes they put on shabby clothes in order to
pretend they were poor; but he had a keen eye to prevent what he
regarded as fraud and sometimes refused to see people who, he thought,
could well pay for medical attendance. Women were the worst offenders
and they managed the thing more clumsily. They would wear a cloak and a
skirt which were almost in rags, and neglect to take the rings off
their fingers.
“If you can afford to wear jewellery you can afford a doctor. A
hospital is a charitable institution,” said Dr. Tyrell.
He handed back the letter and called for the next case.
“But I’ve got my letter.”
“I don’t care a hang about your letter; you get out. You’ve got no
business to come and steal the time which is wanted by the really
poor.”
The patient retired sulkily, with an angry scowl.
“She’ll probably write a letter to the papers on the gross
mismanagement of the London hospitals,” said Dr. Tyrell, with a smile,
as he took the next paper and gave the patient one of his shrewd
glances.
Most of them were under the impression that the hospital was an
institution of the state, for which they paid out of the rates, and
took the attendance they received as a right they could claim. They
imagined the physician who gave them his time was heavily paid.
Dr. Tyrell gave each of his clerks a case to examine. The clerk took
the patient into one of the inner rooms; they were smaller, and each
had a couch in it covered with black horse-hair: he asked his patient a
variety of questions, examined his lungs, his heart, and his liver,
made notes of fact on the hospital letter, formed in his own mind some
idea of the diagnosis, and then waited for Dr. Tyrell to come in. This
he did, followed by a small crowd of students, when he had finished the
men, and the clerk read out what he had learned. The physician asked
him one or two questions, and examined the patient himself. If there
was anything interesting to hear students applied their stethoscope:
you would see a man with two or three to the chest, and two perhaps to
his back, while others waited impatiently to listen. The patient stood
among them a little embarrassed, but not altogether displeased to find
himself the centre of attention: he listened confusedly while Dr.
Tyrell discoursed glibly on the case. Two or three students listened
again to recognise the murmur or the crepitation which the physician
described, and then the man was told to put on his clothes.
When the various cases had been examined Dr. Tyrell went back into the
large room and sat down again at his desk. He asked any student who
happened to be standing near him what he would prescribe for a patient
he had just seen. The student mentioned one or two drugs.
“Would you?” said Dr. Tyrell. “Well, that’s original at all events. I
don’t think we’ll be rash.”
This always made the students laugh, and with a twinkle of amusement at
his own bright humour the physician prescribed some other drug than
that which the student had suggested. When there were two cases of
exactly the same sort and the student proposed the treatment which the
physician had ordered for the first, Dr. Tyrell exercised considerable
ingenuity in thinking of something else. Sometimes, knowing that in the
dispensary they were worked off their legs and preferred to give the
medicines which they had all ready, the good hospital mixtures which
had been found by the experience of years to answer their purpose so
well, he amused himself by writing an elaborate prescription.
“We’ll give the dispenser something to do. If we go on prescribing
mist: alb: he’ll lose his cunning.”
The students laughed, and the doctor gave them a circular glance of
enjoyment in his joke. Then he touched the bell and, when the porter
poked his head in, said:
“Old women, please.”
He leaned back in his chair, chatting with the H.P. while the porter
herded along the old patients. They came in, strings of anaemic girls,
with large fringes and pallid lips, who could not digest their bad,
insufficient food; old ladies, fat and thin, aged prematurely by
frequent confinements, with winter coughs; women with this, that, and
the other, the matter with them. Dr. Tyrell and his house-physician got
through them quickly. Time was getting on, and the air in the small
room was growing more sickly. The physician looked at his watch.
“Are there many new women today?” he asked.
“A good few, I think,” said the H.P.
“We’d better have them in. You can go on with the old ones.”
They entered. With the men the most common ailments were due to the
excessive use of alcohol, but with the women they were due to defective
nourishment. By about six o’clock they were finished. Philip, exhausted
by standing all the time, by the bad air, and by the attention he had
given, strolled over with his fellow-clerks to the Medical School to
have tea. He found the work of absorbing interest. There was humanity
there in the rough, the materials the artist worked on; and Philip felt
a curious thrill when it occurred to him that he was in the position of
the artist and the patients were like clay in his hands. He remembered
with an amused shrug of the shoulders his life in Paris, absorbed in
colour, tone, values, Heaven knows what, with the aim of producing
beautiful things: the directness of contact with men and women gave a
thrill of power which he had never known. He found an endless
excitement in looking at their faces and hearing them speak; they came
in each with his peculiarity, some shuffling uncouthly, some with a
little trip, others with heavy, slow tread, some shyly. Often you could
guess their trades by the look of them. You learnt in what way to put
your questions so that they should be understood, you discovered on
what subjects nearly all lied, and by what inquiries you could extort
the truth notwithstanding. You saw the different way people took the
same things. The diagnosis of dangerous illness would be accepted by
one with a laugh and a joke, by another with dumb despair. Philip found
that he was less shy with these people than he had ever been with
others; he felt not exactly sympathy, for sympathy suggests
condescension; but he felt at home with them. He found that he was able
to put them at their ease, and, when he had been given a case to find
out what he could about it, it seemed to him that the patient delivered
himself into his hands with a peculiar confidence.
“Perhaps,” he thought to himself, with a smile, “perhaps I’m cut out to
be a doctor. It would be rather a lark if I’d hit upon the one thing
I’m fit for.”
It seemed to Philip that he alone of the clerks saw the dramatic
interest of those afternoons. To the others men and women were only
cases, good if they were complicated, tiresome if obvious; they heard
murmurs and were astonished at abnormal livers; an unexpected sound in
the lungs gave them something to talk about. But to Philip there was
much more. He found an interest in just looking at them, in the shape
of their heads and their hands, in the look of their eyes and the
length of their noses. You saw in that room human nature taken by
surprise, and often the mask of custom was torn off rudely, showing you
the soul all raw. Sometimes you saw an untaught stoicism which was
profoundly moving. Once Philip saw a man, rough and illiterate, told
his case was hopeless; and, self-controlled himself, he wondered at the
splendid instinct which forced the fellow to keep a stiff upper-lip
before strangers. But was it possible for him to be brave when he was
by himself, face to face with his soul, or would he then surrender to
despair? Sometimes there was tragedy. Once a young woman brought her
sister to be examined, a girl of eighteen, with delicate features and
large blue eyes, fair hair that sparkled with gold when a ray of autumn
sunshine touched it for a moment, and a skin of amazing beauty. The
students’ eyes went to her with little smiles. They did not often see a
pretty girl in these dingy rooms. The elder woman gave the family
history, father and mother had died of phthisis, a brother and a
sister, these two were the only ones left. The girl had been coughing
lately and losing weight. She took off her blouse and the skin of her
neck was like milk. Dr. Tyrell examined her quietly, with his usual
rapid method; he told two or three of his clerks to apply their
stethoscopes to a place he indicated with his finger; and then she was
allowed to dress. The sister was standing a little apart and she spoke
to him in a low voice, so that the girl should not hear. Her voice
trembled with fear.
“She hasn’t got it, doctor, has she?”
“I’m afraid there’s no doubt about it.”
“She was the last one. When she goes I shan’t have anybody.”
She began to cry, while the doctor looked at her gravely; he thought
she too had the type; she would not make old bones either. The girl
turned round and saw her sister’s tears. She understood what they
meant. The colour fled from her lovely face and tears fell down her
cheeks. The two stood for a minute or two, crying silently, and then
the older, forgetting the indifferent crowd that watched them, went up
to her, took her in her arms, and rocked her gently to and fro as if
she were a baby.
When they were gone a student asked:
“How long d’you think she’ll last, sir?”
Dr. Tyrell shrugged his shoulders.
“Her brother and sister died within three months of the first symptoms.
She’ll do the same. If they were rich one might do something. You can’t
tell these people to go to St. Moritz. Nothing can be done for them.”
Once a man who was strong and in all the power of his manhood came
because a persistent aching troubled him and his club-doctor did not
seem to do him any good; and the verdict for him too was death, not the
inevitable death that horrified and yet was tolerable because science
was helpless before it, but the death which was inevitable because the
man was a little wheel in the great machine of a complex civilisation,
and had as little power of changing the circumstances as an automaton.
Complete rest was his only chance. The physician did not ask
impossibilities.
“You ought to get some very much lighter job.”
“There ain’t no light jobs in my business.”
“Well, if you go on like this you’ll kill yourself. You’re very ill.”
“D’you mean to say I’m going to die?”
“I shouldn’t like to say that, but you’re certainly unfit for hard
work.”
“If I don’t work who’s to keep the wife and the kids?”
Dr. Tyrell shrugged his shoulders. The dilemma had been presented to
him a hundred times. Time was pressing and there were many patients to
be seen.
“Well, I’ll give you some medicine and you can come back in a week and
tell me how you’re getting on.”
The man took his letter with the useless prescription written upon it
and walked out. The doctor might say what he liked. He did not feel so
bad that he could not go on working. He had a good job and he could not
afford to throw it away.
“I give him a year,” said Dr. Tyrell.
Sometimes there was comedy. Now and then came a flash of cockney
humour, now and then some old lady, a character such as Charles Dickens
might have drawn, would amuse them by her garrulous oddities. Once a
woman came who was a member of the ballet at a famous music-hall. She
looked fifty, but gave her age as twenty-eight. She was outrageously
painted and ogled the students impudently with large black eyes; her
smiles were grossly alluring. She had abundant self-confidence and
treated Dr. Tyrell, vastly amused, with the easy familiarity with which
she might have used an intoxicated admirer. She had chronic bronchitis,
and told him it hindered her in the exercise of her profession.
“I don’t know why I should ’ave such a thing, upon my word I don’t.
I’ve never ’ad a day’s illness in my life. You’ve only got to look at
me to know that.”
She rolled her eyes round the young men, with a long sweep of her
painted eyelashes, and flashed her yellow teeth at them. She spoke with
a cockney accent, but with an affectation of refinement which made
every word a feast of fun.
“It’s what they call a winter cough,” answered Dr. Tyrell gravely. “A
great many middle-aged women have it.”
“Well, I never! That is a nice thing to say to a lady. No one ever
called me middle-aged before.”
She opened her eyes very wide and cocked her head on one side, looking
at him with indescribable archness.
“That is the disadvantage of our profession,” said he. “It forces us
sometimes to be ungallant.”
She took the prescription and gave him one last, luscious smile.
“You will come and see me dance, dearie, won’t you?”
“I will indeed.”
He rang the bell for the next case.
“I am glad you gentlemen were here to protect me.”
But on the whole the impression was neither of tragedy nor of comedy.
There was no describing it. It was manifold and various; there were
tears and laughter, happiness and woe; it was tedious and interesting
and indifferent; it was as you saw it: it was tumultuous and
passionate; it was grave; it was sad and comic; it was trivial; it was
simple and complex; joy was there and despair; the love of mothers for
their children, and of men for women; lust trailed itself through the
rooms with leaden feet, punishing the guilty and the innocent, helpless
wives and wretched children; drink seized men and women and cost its
inevitable price; death sighed in these rooms; and the beginning of
life, filling some poor girl with terror and shame, was diagnosed
there. There was neither good nor bad there. There were just facts. It
was life.