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Having finished my second year at hospital and taken my preliminary examinations, including the scientific preliminary, and my first Bachelor of Medicine for the University of London degree, I had advanced to the dignity of 'walking the hospitals,' carried a large shining stethoscope, and spent much time following the famous physicians and surgeons around the wards.

Our first appointment was clerking in the medical wards. We had each so many beds allotted to us, and it was our business to know everything about the patients who occupied them, to keep accurate 'histories,' and to be ready to be quizzed or queried by our resident house physician or our visiting consultant on the afternoon when he made his rounds, followed by larger or smaller crowds of students according to the value which was placed upon his teaching. I was lucky enough to work under the famous Sir Andrew Clark, Mr. Gladstone's physician. He was a Scotchman greatly beloved, and always with a huge following, to whom he imparted far more valuable truths than even the medical science of those days afforded. His constant message, repeated and repeated at the risk of wearying, was: 'Gentlemen, you must observe for yourselves. It is your observation and not your memory which counts.'

Compared with the methods of diagnosis to-day, those of that day were very limited, but Sir Andrew's message was the more important, showing the greatness of the man, who, though at the very top of the tree, never for a moment tried to convey to his followers that his knowledge was final, but that any moment he stood ready to abandon his position for a better one. On one occasion, while he was in one of the largest of our wards (one with four divisions and twenty beds each), he was examining a lung case, while a huge class of fifty young doctors stood around.

'What about the sputum, Mr. Jones?' he asked. 'What have you observed coming from these lungs?'

'There is not much quantity, sir. It is greenish in colour.'

'But what about the microscope, Mr. Jones? What does that show?'

'No examination has been made, sir.'

'Gentlemen,' he said, 'I will now go to the other ward, and you shall choose a specimen of the sputum of some of these cases. When I return, we will examine it and see what we can learn.'

When he returned, four specimens awaited him, the history and diagnosis of the cases being known only to the class. The class never forgot how, by dissolving and boiling, and with the microscope, he told us more from his examination of each case than we knew from all our other information. His was real teaching, and reminds one of the Glasgow professor who, in order to emphasize the same point of the value of observation, prepared a little cupful of kerosene, mustard, and castor oil, and, calling the attention of his class to it, dipped a finger into the atrocious compound and then sucked his finger. He next passed the mixture around to the students who all did the same with most dire results. When the cup returned and he observed the faces of his students, he remarked: 'Gentlemen, I am afraid you did not use your powers of obsairvation. The finger that I put into the cup was no' the same one that I stuck in my mouth.'

On changing over to the surgical side in the hospital, we were employed in a very similar manner, only we were called 'dressers,' and under the house surgeon had all the care of a number of surgical patients. My good fortune now brought me under the chieftaincy of Sir Frederick Treves, the doyen of teachers. His great message was self-reliance. He taught dogmatically as one having authority, and always insisted that we should make up our minds, have a clear idea of what we were doing, and then do it. His ritual was always thought out, no detail being omitted, and each person had exactly his share of work and his share of responsibility. It used greatly to impress patients, and he never underestimated the psychical value of having their complete confidence. Thus, on one occasion asking a dresser for his diagnosis, the student replied:

'It might be a fracture, sir, or it might be only sprained.'

'The patient is not interested to know that it might be measles, or it might be toothache. The patient wants to know what is the matter, and it is your business to tell it to him or he will go to a quack who will inform him at once.'

All his teachings were, like Mark Twain's, enhanced by such over-emphasis or, like Christ's own, by hyperbole. He could make an article in the British Medical Journal on Cholecystenterostomy amusing to a general reader, and make an ordinary remark as cutting as an amputation knife. He never permitted laxity of any kind in personal appearance or dress, or any imposing on the patients. His habit of saying openly exactly what he meant made many people fear as much as they respected him.

One incident recurs to my mind which I must recount as an example when psychology failed. A Whitechapel 'lady,' suffering with a violent form of delirium tremens, was lying screeching in a strait-jacket on the cushioned floor of the padded room. With the usual huge queue of students following, he had gone in to see her, as I had been unable to get the results desired with a reasonable quantity of sedatives and soporifics. It was a very rare occasion, for cases which did not involve active surgery he left strictly alone. After giving a talk on psychical influence, he had the jacket removed as 'a relic of barbarism,' and in a very impressive manner, looking into her glaring eyes and shaking his forefinger at her, he said: 'Now you are comfortable, my good woman, and you will sleep. You will make no more disturbance whatever.' There was an unusual silence. The woman remained absolutely passive, and we all turned to follow the chief out. Suddenly the 'lady' called out, 'Hi, hi'—and some perverse spirit induced Sir Frederick to return. Looking back with defiant eyes she screamed out, 'You! You with a faice! You do think yerself ———— clever, don't yer?' The situation was promptly relieved by his bursting into a genuine fit of laughter.

Among other celebrated men who were admired and revered was Mr. Hurry Fenwick on the surgical side, for whom I had the honour of illustrating in colours his prize Jacksonian essay. Any talent for sketching, especially in colours, is of great value to the student of medicine. Once you have sketched a case from Nature, with the object of showing the peculiarity of the abnormality, it remains permanently in your mind. Besides this, it forces you to note small differences; in other words, it teaches you to 'obsairve.' Thus, in the skin department I was sent to reproduce a case of anthrax of the neck, a rare disease in England, though all men handling raw hides are liable to contract it. The area had to be immediately excised; yet one never could forget the picture on one's mind. On another occasion a case of genuine leprosy was brought in, with all the dreadful signs of the disease. The macula rash was entirely unique so far as I knew, but a sketch greatly helped to fix it on one's memory. The poor patient proved to be one of the men who was handling the meat in London's greatest market at Smithfield. A tremendous hue and cry spread over London when somehow the news got into the paper, and vegetarianism received a temporary boost which in my opinion it still badly needs for the benefit of the popular welfare.

Truly one has lived through wonderful days in the history of the healing art. The first operations which I saw performed at our hospitals were before Lord Lister's teaching was practised; though even in my boyhood I remember getting leave to run up from Marlborough to London to see my brother, on whom Sir Joseph Lister had operated for osteomyelitis of the leg. Our most famous surgeon in 1880 was Sir Walter Rivington; and to-day there arises to memory the picture of him, clad in a blood-stained, black velvet coat, and, without any attempt at or idea of asepsis, removing a leg at the thigh. The main thing was speed, although the patient was under ether, and in quickly turning round the tip of the sword-like amputation knife, he made a gash in the patient's other leg. The whole thing seemed horrible enough to us students, but the surgeon smiled, saying, 'Fortunately it is of no importance, gentlemen. The man will not live.' Amputations practically always went septic then.

Then came the day when everyone worked under clouds of carbolic steam, which fizzed and spouted from large brass boilers over everything; and then the time when everyone was criticizing the new young surgeon, Treves, who was daring to discard it, and getting as good results by scrupulous cleanliness. His aphorism was, 'Gentlemen, the secret of surgery is the nailbrush.' To-day, with blood examinations, germ cultures, sera tests, X-rays, and a hundred added improvements, one can say to a fisherman in far-off Labrador arriving on a mail steamer, and to whom every hour lost in the fishing season spells calamity, 'Yes, you can be operated on, and the wound will be healed, and you will be ready to go back by the next steamer, unless some utterly unforeseen circumstance arises.'

A LONELY SETTLER

A LABRADOR FISHERMAN'S HOME

A little later my father's health began to fail in London, the worries and troubles of a sensitive clergyman's work among the poor creatures who were constantly passing under his care utterly overwhelming him. We agreed that a complete change of thought was necessary, and he and I started for a fishing and sight-seeing tour in Norway. Our steamer was to sail from the Tyne, and we went up to Newcastle to catch it. There some evil fiend persuaded my father to go and consult a doctor about his illness. Thus, while I waited at the hotel, my father became persuaded that he had some occult disease of the liver and must remain in Newcastle for treatment. However, I happened to be treasurer of the voyage, and for the first time asserting my professional powers, insisted that I was family physician for the time, and turned up in the evening with all our round-trip tickets and reservations taken and paid for. In the morning I had the trunks packed and conveyed aboard, and we sailed together for one of the most enjoyable holidays I ever spent. We travelled much afoot and in the little native carriages called stolkjaerre, just jogging along, staying anywhere, fishing in streams, and living an open-air life, which the increasing flood of tourists in after years has made much less possible.

My father's death a year later made a great difference to me, my mother removing to live with my grandmother at Hampstead, as it was too lonely and not safe for her to live alone in East London. Twice our house had been broken into by burglars. The second occasion was in open daylight during the hour of evening service on a Sunday. Only the maids would have been in the house had I not been suffering from two black eyes contracted during the Saturday's football game. Though I had accompanied the others out, I had decided that my appearance might have led to misinterpretations in church, and returned unnoticed. The men escaped by some method which they had discovered of scaling a high fence, but I was close behind following them through the window by which they had entered. Shortly afterward I happened to be giving evidence at the Old Bailey on one of the many cases of assault and even murder where the victims had been brought into hospital as patients. London was ringing with the tale of a barefaced murder at Murray Hill in North London, where an exceedingly clever piece of detective work, an old lantern discovered in a pawnbroker's shop in Whitechapel—miles away from the scene of the crime—was the means of bringing to trial four of the most rascally-looking villains I ever saw. The trial preceded ours, and we had to witness it. One of the gang had turned Queen's evidence to save his own neck. So great was the hatred of the others for him and the desire for revenge that even in the court they were handcuffed and in separate stands. Fresh from my own little fracas, I learned what a fool I had been, for in this case also the deed was done in open daylight and the lawn had tight wires stretched across it. The young son, giving chase as I did, had been tripped up and shot through the abdomen for his pains. He had, however, crawled back, made his will, and was subsequently only saved by a big operation.

The giving of expert evidence on such occasions was the only opportunity which the young sawbones had of earning money. True, we got only a guinea a day and expenses while thus in court, but we learned a lot about medical jurisprudence, a subject which always greatly interested me. It was no uncommon sight either at 'The London,' or 'Poplar,' at both of which I did interne work, to see a policeman always sitting behind the screen at the foot of the patient's bed. One man, quite a nice fellow when not occupied in crime, when furiously drunk had killed his wife and cut his own throat. By the curious custom of civilization all the skill and money which the hospital could offer to save a most valuable life was as usual devoted to restoring this man to health. He was weaned slowly back from the grave by special nurses and treatment, till it began to dawn upon him that he might have to stand his trial. He would ask me if I thought he would have to undergo a long term, for he had not been conscious of what he was doing. As he grew better, and the policeman arrived to watch him, he decided that it would probably be quite a long time. He had a little place of his own somewhere, and he used to have chickens and other presents sent up to fellow-patients, and would have done so to the nurses, only they could not receive them. I was not personally present at his trial, but I felt really sorry to hear that they hanged him.

Many of these poor fellows were only prevented from ending their own lives by our using extreme care. The case of one wretched man, driven to desperation, I still remember. 'Patient male; age forty-five; domestic trouble—fired revolver into his mouth. Finding no phenomena of interest develop, fired a second chamber into his right ear. Still no symptoms worthy of notice. Patient threw away pistol and walked to hospital.' Both bullets had lodged in the thick parts of his skull, and, doing no damage, were left there. A subsequent note read: 'Patient to-day tried to cut his throat with a dinner-knife which he had hidden in his bed. Patient met with no success.'

Another of my cases which interested me considerably was that of a professional burglar who had been operated upon in almost every part of the kingdom, and was inclined to be communicative, as the job which had brought him to hospital had cost him a broken spine. Very little hope was held out to him that he would ever walk again. He was clear of murder, for he said it was never his practice to carry firearms, being a nervous man and apt to use them if he had them and got alarmed when busy burglaring. He relied chiefly on his extraordinary agility and steady head to escape. He and a friend had been detailed by the gang to the job of plundering one of a row of houses. The plans of the house and of the enterprise were all in order, but some unexpected alarm was given and he fled upstairs, climbed through a skylight on to the roof, and ran along the gables of the tiles, not far ahead of the police, who were armed and firing at him. He could easily have escaped, as he could run along the coping of the brick parapet without turning a hair, but he was brought up by a narrow side street on which he had not counted, not having anticipated, like cats, a battle on the tiles. It was only some twelve to fifteen feet across the gap, and the landing on the other side was a flat roof. Taking it all at a rush he cleared the street successfully, but the flat roof, black with ages of soot, proved to be a glass skylight, and he entered a house in a way new even to him. His falling on a stone floor many feet below accounted for what he characterized 'his unfortunate accident'! After many months in bed, the man took an unexpected turn, his back mended, and with only a slight leg paralysis he was able to return to the outside world. His long suffering and incarceration in hospital were accepted by the law as his punishment, and he assured me by all that he held sacred that he intended to retire into private life. Oddly enough, however, while on another case, I saw him again in the prisoner's dock and at once went over and spoke to him.

'Drink this time, Doctor,' he said. 'I was down on my luck and the bar-keeper went out and left his till open. I climbed over and got the cash, but there was so little space between the bar and the wall that with my stiff back I couldn't for the life of me get back. I was jammed like a stopper in a bottle.'

Among many interesting experiences, one especially I shall never forget. Like the others, it occurred during my service for Sir Frederick Treves as house surgeon, and I believe he told the story. A very badly burned woman had been brought into hospital. Her dress had somehow got soaked in paraffin and had then taken fire. Her terribly extensive burns left no hope whatever of her recovery, and only the conventions of society kept us from giving the poor creature the relief of euthanasia, by some cup of laudanum negus. But the law was interested. A magistrate was brought to the bedside and the husband sent for. The nature of the evidence, the meaning of an oath, the importance of the poor creature acknowledging that her words were spoken 'in hopeless fear of immediate death,' were all duly impressed upon what remained of her mind. The police then brought in the savage, degraded-looking husband, and made him stand between two policemen at the foot of the bed, facing his mangled wife. The magistrate, after preliminary questions, asked her to make her dying statement as to how she came by her death. There was a terrible moment of silence. It seemed as if her spirit were no longer able to respond to the stimuli of life on earth. Then a sudden rebound appeared to take place, her eyes lit up with a flash of light, and even endeavouring to raise her piteous body, she said, 'It was an accident, Judge. I upset the lamp myself, so help me God': and just for one moment her eyes met those of her miserable husband. It was the last time she spoke.

Tragedy and comedy ran hand in hand even in this work. Saint Patrick's Day always made the hospital busy, just as Christmas was the season for burned children. Beer in an East London 'pub' was generally served in pewter pots, as they were not easily broken. A common head injury was a circular scalp cut made by the heavy bottom rim, a wound which bled horribly. A woman was brought in on one Saint Patrick's Day, her scalp turned forward over her face and her long hair a mass of clotted blood from such a stroke, made while she was on the ground. When the necessary readjustments had been made and she was leaving hospital cured, we asked her what had been the cause of the trouble. ''Twas just an accidint, yer know. Sure, me an' another loidy was just havin' a few words.'

On another occasion late at night, we were called out of bed by a cantankerous, half-drunken fellow whom the night porter could not pacify. 'I'm a regular subscriber to this hospital, and I have never had my dues yet,' he kept protesting. A new drug to produce immediate vomiting had just been put on the market, and, as it was exactly the treatment required, we gave him an injection. To our dismay, though the medicine is in common use to-day, either the poison which he had been drinking or the drug itself caused a collapse followed by head symptoms. He was admitted, his head shaved and ice-bags applied, with the result that next day he was quite well again. But when he left, he had, instead of a superabundance of curly auburn hair, a polished white knob oiled and shining like a State House at night. We debated whether his subscription would be as regular in future, though he professed to be profoundly grateful.

The intimacy which grew up between some of my patients and myself showed me (which I never could otherwise have understood) the seamy side of life in great cities, its terrible tragedies and pathos, and how much good there is in the worst, how much need of courage, and what vast opportunities lie before those who accept the service of man as their service to God. It proved to me how infinitely more needed are unselfish deeds than orthodox words.

My parents having gone, it became necessary for me to find lodgings—which I did, 'unfurnished,' in the house of a Portuguese widow. Her husband, who had a good family name, had gone down in the world and had disappeared with another 'lady.' The eldest son, a mathematical genius, had been able to pay his way through Cambridge University by the scholarships and prizes which he had won. One beautiful little dark-eyed daughter of seven was playing in a West End theatre as the dormouse in Alice in Wonderland. She was second fiddle to Alice herself, also, and could sing all her songs. Her pay was five pounds a week, poor enough for the attraction she proved, but more than all that of the rest of the family put together. The 'dormouse' used to come up and say her parts for my benefit and that of occasional friends, and was so modest and winsome, and her earnings so invaluable to the family, that then and there I came to the conclusion that the drama was an essential part of art, and that those who were trying to elevate and cleanse it, like Sir Henry Irving, whose son I had met at Marlborough, must have the support of a public who demanded clean plays and good conditions both in front and behind the curtain.

My new lodgings being close to Victoria Park afforded the opportunity for training if one were unconventional. To practise throwing the sixteen-pound hammer requires rough ground and plenty of space, and, as I was scheduled for that at the inter-hospital sports, it was necessary to work when not too many disinterested parties were around. Even an East-Ender's skull is not hammer-proof, as I had seen when a poor woman was brought into hospital with five circular holes in her head, the result of blows inflicted by her husband with a hammer. The only excuse which the ruffian offered for the murder was that she had forgotten to wake him, he had been late, and lost his job.

A number of the boys in my class were learning to swim. There was only one bathing-lake and once the 'waters were troubled' we drew the line at going in to give lessons. So we used to meet at the gate at the hour of opening in the morning, and thus be going back before most people were moving. Nor did we always wait for the park keeper, but often scaled the gates and so obtained an even more exclusive dip. Many an evening we would also 'flannel,' and train round and round the park, to improve one's wind before some big event. For diet at that time I used oatmeal, milk, and eggs, and very little or no meat. It was cheaper and seemed to give me more endurance. Moreover, the real value of money was dawning on me.

Victoria Park is one of those open forums where every man with a sore spot goes out to air his grievance. On Sundays there were little groups around the trees where orators debated on everything from a patent medicine to the nature of God. Charles Bradlaugh and Mrs. Annie Besant were associated together in iconoclastic efforts against orthodox religion, and there was so much truth in some of their contentions that they were making no little disturbance. Hanging on their skirts were a whole crowd of ignorant, dogmatic atheists, who published a paper called The Freethinker, which, while it was a villainous and contemptible rag, appealed to the passions and prejudices of the partially educated. To answer the specious arguments of their propaganda an association known as the Christian Evidence Society used to send out lecturers. One of them became quite famous for his clever arguments and answers, his ready wit, and really extensive reading. He was an Antiguan, a black man named Edwards, and had been a sailor before the mast. I met him at the parish house of an Episcopal clergyman of a near-by church, who, under the caption of Christian Socialism, ran all kinds of social agencies that found their way to the hearts of the people. His messages were so much more in deeds than in words that he greatly appealed to me, and I transferred my allegiance to his church, which was always well filled. I particularly remember among his efforts the weekly parish dance. My religious acquaintances were apt to class all such simple amusements in a sort of general category as 'works of the Devil,' and turn deaf ears to every invitation to point out any evil results, being satisfied with their own statement that it was the 'thin edge of the wedge.' This good man, however, was very obviously driving a wedge into the hearts of many of his poor neighbours who in those days found no opportunity for relief in innocent pleasures from the sordid round of life in the drab purlieus of Bethnal Green.

Exactly opposite the hospital was Oxford House, only two minutes distant, which combined definite doctrinal religion with social work. Being an Oxford effort it had great attractions for me. Moreover, right alongside it in the middle of a disused sugar refinery I had hired the yard, converted in into a couple of lawn-tennis courts, and had run a small club. There I first met the famous Dr. Hensley Henson, now Bishop of Durham, and also the present Bishop of London, Dr. Winnington Ingram—a good all-round athlete. He used to visit in our wards; and as we had a couple of fives courts, a game which takes little time and gives much exercise, we used to have an afternoon off together, once a week, when he came over to hospital. Neither of these splendid men was a dignitary in those days, or I am afraid they would have found us medicals much more stand-offish. We liked both of these men because they were unconventional and good sports, and especially in that they were not afraid to tackle the atheist's propaganda in the open. I have seen Dr. Henson in Whitechapel debating alone against a hall full of opponents and with fairness and infinite restraint. Moreover, I have seen Dr. Ingram doing just the same thing standing on a stone in the open park. It may all sound very silly when one knows that by human minds, or to the human mind, the Infinite can never be demonstrated as a mathematical proposition. But the point was that these clergy were proving that they were real men—men who had courage as well as faith, who believed in their message. Christ Himself showed His superb manhood by just such speaking out.

Far and away the most popular of the Park speakers was the Antiguan. His arguments were so clever it was obvious that he was well and widely read. His absolute understanding of the crowd and his witty repartee used frequently to cause his opponents to lose their tempers, and that was always their undoing. The crowd as a rule was very fair and could easily distinguish arguments from abuse. Thus, on one Sunday the debate was as to whether Nature was God. The atheist representative was a loud-voiced demagogue, who when angry betrayed his Hibernian origin very markedly. Having been completely worsted and the laugh turned against him, he used the few minutes given him to reply, in violent abuse, ending up that 'ladies and gentlemen did not come out on holidays to spend their time being taught English by a damned nigger.'

'Sir,' Edwards answered from the crowd, 'I am a British subject, born on the island of Antigua, and as much an Englishman as any Irishman in the country.'

Edwards possessed an inexhaustible stock of good-humour, and his laugh could be heard half-way across the Park. As soon as his turn came to mount the stone, he got the crowd so good-natured that they became angry at the interruptions of the enemy, and when someone suggested that if Nature were that man's God, the near-by duckpond was the natural place for him, there was a rush for him, and for several subsequent Sundays he was not in evidence. Edwards was a poor man, his small salary and incessant generosity left him nothing for holidays, and he was killing himself with overwork. So we asked him to join us in the new house which we were fitting up in Palestine Place. He most gladly did so and added enormously to our fun. Unfortunately, tuberculosis long ago got its grip upon him, and removed a valuable life from East London.

It was a queer little beehive in which we lived in those days, and a more cosmopolitan crowd could hardly have been found: one young doctor who has since made his name and fortune in Australia; another in whose rooms were nearly a hundred cups for prowess in almost every form of athletics, and who has also 'made good' in professional life; besides several others who for shorter or longer periods were allotted rooms in our house. Among the more unusual was C. M., a Brahmin from India, a priest in his youth, who had been brought back to England by some society to be educated in medical missionary work, but whom for some reason they had dropped. For a short time a clever young Russian of Hebrew extraction who was studying for the Church helped to render our common-room social engagements almost international affairs.

It so happened that there was at that time in hospital under my care a patient known as 'the Elephant Man.' He had been starring under that title in a cheap vaudeville, had been seen by some of the students, and invited over to be shown to and studied by our best physicians, and to be cared for kindly for the rest of his life. The poor fellow was really exceedingly sensitive about his most extraordinary appearance. The disease was called 'leontiasis,' and consisted of an enormous over-development of bone and skin on one side. His head and face were so deformed as really to resemble a big animal's head with a trunk. My arms would not reach around his hat. A special room in a yard was allotted to him, and several famous people came to see him, among them Queen Alexandra, then the Princess of Wales, who afterward sent him an autographed photograph of herself. He kept it in his room, which was known as the 'Elephant House,' and it always suggested Beauty and the Beast. Only at night could the man venture out of doors, and it was no unusual thing in the dusk of nightfall to meet him walking up and down in the little courtyard. He used to talk freely of how he would look in a huge bottle of alcohol—an end to which in his imagination he was fated to come. He was of a very cheerful disposition and pathetically proud of his left side, which was normal. Very suddenly one day he died—the reason assigned being that his head fell forward and choked him, being too heavy for him to lift up.

In 1886 I passed my final examinations and duly became a member of the College of Physicians and of the Royal College of Surgeons of England; and sought new fields for change and rest, where also I could use my newly acquired licence to my own, if to no one else's benefit.