第八十一章

冬季学期一开学，菲利普就上医院门诊部实习。门诊部有三名助理医师轮流为门诊病人看病，每人每周值班两天。菲利普投在蒂勒尔大夫手下当助手。蒂勒尔大夫在医科学生中颇有点声望，大家都争先恐后地要当他的助手。这位大夫年方三十五，身材颀长，面容清癯，小小的脑瓜上覆着剪得短短的红发，一双蓝眼睛鼓鼓的，红红的脸膛油光发亮。他能说会道，嗓音悦耳动听。说话时，还喜欢插句把笑话。他还有点儿玩世不恭。蒂勒尔大夫是个有所成就的人，行医多年，预期不日即将被授予爵士衔。由于常同医科学生和穷人们打交道，他一面孔的恩人气派；又因为常与病人周旋，他身上流露出一个壮汉的乐善好施的神态。所有这些均是某些顾问医师通常具有的职业风度。蒂勒尔大夫的言谈举止使得病人感到自己好比是站在一位和蔼可亲的教师面前的小学生，而他的疾病不过是一个可笑的恶作剧，与其说使人感到痛苦，毋宁说给人带来了乐趣。

前来实习的医科学生，每天都得到门诊部去观察病例，尽量学得一些医疗知识。不过，当轮到某个学生给自己的指导医师当助手时，他的职责就要略为具体些了。那个时候，圣路加医院门诊部共有三个相互沟通的就诊室，还有一个宽敞的、光线昏暗的候诊室。候诊室里竖着粗实的大理石柱，摆着一张张长条椅。病人们正午挂上号后就在此等候。他们手里拿着药瓶或药罐，排着长队，有的衣衫褴褛、蓬头垢面，有的穿着还颇为体面。男女老少各色人等，坐在这半明不暗的候诊室里，给人以一种怪异、可怕的印象。此情此景使人想起了多米尔所作的令人森然可怖的画画。这几个房间四周墙壁都漆成橙红色，高高的墙裙一抹栗色。里面弥漫着消毒药水的气味儿，随着下午时光的流逝，还充斥着从人身上散发出来的汗臭味。第一个房间最大，中央摆着供大夫看病用的桌子和椅于。这张桌子的两旁各放一张略微矮小的桌于，一边坐着住院医生，一边坐着当大负责记录的助手。记录用的簿子很大，里面分别登录着病人的姓名、可龄、性别、职业以及病情的诊断情况。

下午一点半，住院医生首先来到这儿，按了按铃，通知传达把老病号挨个儿叫进来。老病号总是不少的。他们得赶在蒂勒尔大夫两点上班之前尽快处理完这批复诊病人。跟菲利普在一起的这位住院医生，生得短小精悍，颇有些自尊自大的神气。他在助手面前总是摆出一副纡尊降贵的姿态。那些同他年龄相仿的医科学生对他的态度比较随便，并不用跟他目下地位相称的礼貌待他，对此，他很不以为然。他立即着手给复诊病人看病。这时，有个助手协助他。病人们川流不息地走进就诊室，走在前面的都是男病人。他们主要是来看慢性支气管炎和"令人头痛的咳嗽"。其中一人走到住院医生面前，另一人走到助手跟前，分别交上挂号证。事情进行得顺利的话，住院医生或助手就在挂号证上写明"连服十四天"的字样，于是病人就拿着药瓶或药罐上药房取足够服用十四天的药品。有些滑头病人缩在后面，希望让住院医生给他们看病，但很少有人得逞的。通常只有那么三四个人，因为病情特殊非得让住院医生亲自过问不可，才有幸被留下。

不一会儿，蒂勒尔大夫飘然而至。他脚步生风，动作敏捷，使人不禁想起嘴里一边嚷着"我们又来到贵方宝地"一边跃上马戏团舞台的丑角来了。他那股神气似乎在告诉人们：你们都生些什么样的荒唐病呀？鄙人驾到，手到病除！他刚坐稳身子，就问有没有要他看的复诊病人，接着便动作迅速地检查着病人，那对精明的眼睛审视着他们，在这同时，还同住院医生讨论病人的症状，不时地插句把笑话（逗得在场的助手们开怀畅笑）。那位住院医生格格地欢笑着，不过从他的神气来看，他似乎认为助手们竟咧嘴傻笑太不知趣了。接着他便哼哼哈哈地不是说天气很美就是抱怨天气太热，然后按响电铃，吩咐传达招呼初诊病人进来。

病人一个挨一个地走向蒂勒尔大夫的桌子跟前。他们中有老头，有小伙子，也有中年人。多数属于劳力者，其中有码头苦力、马车夫、工厂工人和酒店侍者。不过他们中也有些衣冠端正的人，显然是些社会地位比一较优越的店员、职员之类的人物。蒂勒尔大夫用怀疑的目光打量着他们。有时候，有些人故意披件蹩脚衣服，装出一副穷酸相。但是蒂勒尔大夫的目光犀利，对凡是他认为是伪装的一律加以制止，有时干脆拒绝给那些他认为出得起医疗费的人看病。女人可是最叫人头痛的捣乱者。不过她们伪装的手法实在不高明，往往身上穿件破烂不堪的斗篷或者裙于，可忘了抹去套在手指上的戒指。

"你戴得起珠宝饰物，也一定有钱请医生。医院是个慈善机构。"蒂勒尔大夫冷冷地说。

他说罢便把挂号证扔还给病人，叫下一位病人上来。

"但是我持有挂号证呀！"

"我才不在乎呢。你快给我出去！你没权利上这儿来揩油，占穷人看病的时间。"

那个病人恶狠狠地瞪了蒂勒尔大夫一眼，气呼呼地退了出去。

"她很可能会写信给报社，去告伦敦的医院管理不善，"蒂勒尔大夫一边笑吟吟地说，一边信手拿起下一个病人的挂号证，并用狡黠的目光朝那病人扫一眼。

大多数病人都以为这家医院是国立医疗机构，并认为他们交纳的赋税中就有一部分是用来办这家医院的。因此，他们把来看病当作自己的应有权利。他们还认为医生费时给他们看病一定得到很高报酬。

蒂勒尔大夫让他的助手们每人检查一名病人。助手们把病人带进里面房间。这些房间都很小，每个房间都摆着一张睡椅，上面铺着一块马毛呢。助手首先向病人提出各种各样的问题，然后检查他的肺部、心脏、肝脏，并把检查情况一一记在病历卡上，同时根据自己的判断开出处方。这一切完毕后，他便等候蒂勒尔大夫进来。蒂勒尔大夫一看完外头的男病人，就来小房间，身后还尾随着一小批实习的学生。此时，助手便高声读出自己检查的结果。蒂勒尔大夫听完后，便向助手提出一两个问题，然后亲自动手检查病人。要是碰到值得一听的情况的话，刚才跟他一道进来的那批医科学生便纷纷掏出听诊器。此时，你就会看到这样的场面：两三个学生站在病人的面前，默默地诊听着他的胸腔，可能还有两名学生在诊听他的背部，而在旁边还有几位学生，一个个急不可耐，急于想一饱耳福。那位病人处在这批学生的包围之中，脸上虽说有几分尴尬的神色，但看到自己成为人们注意的中心，倒也不见得不高兴。在蒂勒尔大夫口齿伶俐地剖析病例的当儿，那位病人扑朔迷离地在一旁聆听着。有两三个学生再次操起听诊器专心听着，力图听出蒂勒尔大夫刚才提到的杂音和噼啪声。他们听完后，才叫那病人穿上衣服。

病情诊断完毕后，蒂勒尔人大便回到大房间里，重新在他的办公桌旁就座。这时候，无论是哪位学生在他身边，他都要征求该学生对刚才他看过的病人开什么处方。被问的那位学生随即报出一两种药名。

"你开这种药？"蒂勒尔大夫接着说。"嗯，无论从哪一点来看，你那个处方颇有独到之处。不过，我认为我们不能轻率从事啊。"

他的话总是逗得学生哄堂大笑，而他对自己的连珠妙语似乎也颇为欣赏，眸子里总是闪烁着扬扬得意的神色。这时候，他开出完全不同于那位学生提出的处方来。一巳碰上两个一模一样的病例，学生就建议采用蒂勒尔大夫给第一个病人开的处方，可他却充分发挥其聪明才智，煞费苦心地开出一味完全不同的药来。有时候，配药房的药剂师成天疲于奔命，双腿累得够呛，他们喜欢医师开列已备药品，以及多年临床证明疗效灵验的该院的传统混合药剂。对此，蒂勒尔大夫心里知道得一清二楚，可他还是乐于开出一种配方复杂的药方来。

"我们得给药剂师找些事儿干干。要是我们老是在处方上写'药方：白肮'，那他的脑于就不好使了。"

学生们听后又爆发出一阵热烈的笑声。蒂勒尔大夫闪烁着兴奋的目光，朝他们扫视了一下。然后，他接了按铃，吩咐探头进来的传达说：

"请叫复诊女病人进来。"

在传达把复诊女病人领进就诊室时，他身子后仰靠在椅背上，同住院医生聊起天来。女病人徐徐进入房间，中间有一队队身患贫血症，额前留着蓬松的刘海，嘴唇惨白的姑娘。她们吃的食物很粗糙，而且常常吃了上顿没下顿的，但她们还是患有消化不良症。那些上了年纪的妇人，有胖墩墩的，也有瘦骨嶙峋的，因生育过多，天一凉就咳个不停，过早地衰老了。这些女人身上，这病那病的，应有尽有。蒂勒尔大大和住院医生很快就把她们打发走了。随着时间的流逝，那小小的就诊室里的空气变得越来越浑浊。住院医生看了看手上的表。

"今天初诊的女病人多不多？"蒂勒尔大大问了一声。

"我想不会少的，"住院医生回答说。

"我们还是让她们都进来吧。你继续替老病号看。"

初诊的女病人被唤进了就诊室。男人生病，大都是由饮酒过度而引起的，可对女人来说，她们的疾病则大半是由营养不良引起的。到了六点钟光景，病人全都看完了。由于全神贯注地站了整整一个下午，再加上房间里空气浑浊，菲利普觉得筋疲力尽。此时，他同其他几位助手一起踱向医学院去用茶。他感到工作富有情趣，令人向往，表面看来虽然粗陋，但其间却富有人情味，倒是艺术家们用来创作的好素材。菲利普突然想到自己本人就处在艺术家的地位上，而那些病人不过是捏在自己手中的泥团，心头不觉掠过一阵狂喜。当回忆起自己当年在巴黎度过的时光时，菲利普饶有兴味地耸了耸肩。那会儿，他抱着创造出美好事物的目的，成天热中于色彩、声调、价值，天晓得是些什么玩意儿。同男男女女的病人直接打交道，使他体会到一种从未有过的力量感。他发觉在端详他们的面孔和倾听他们的谈吐中间自有无穷的乐趣。他们走起路来，各有各的姿势，有的粗鲁地拖曳着脚步，有的踏着轻快的碎步，有的迈着缓慢、沉重的步子，还有的则羞羞答答，忸怩不前。往往只要瞧一眼他们的外表就知道他们从事何种职业。你学会该怎么发问才能使他们懂得你的意思，你会发现在哪些问题上他们通常是要撒谎的，这时你晓得该问哪些问题才能从他们嘴里掏出真情来。你发觉人们用各自不同的方式提着相同的问题。在接受对危急病症开的处方时，有的人不是启齿一笑就是开个玩笑，可有的却一脸丧气，绝望至极。菲利普发觉自己同这些人介一起时，就不像以往同别人在一起时那样害羞胆怯。他并不感到他有什么怜悯，因为怜悯意味着自己在摆架子。同他们在一起时，他大有如鱼得水之感。他还发觉自己有能耐叫他们安下心来，而每天大夫叫他检；查病人时，他仿佛觉得那病人怀着一种特殊的信任感把自己托付给他似的。"

"也许，"菲利普暗自思忖着，这当儿，脸上还挂着一丝微笑呢，"也许我生来就是当医生的料子。如果我无意中选择了正适合我干的事儿，那简直太有趣了。"

在菲利普看来，助手们中间只有他才能领悟到那些下午值班中的富有戏剧性的意趣。对其他也助手来说，那些男女仅仅是一个个病人而已。要是病情错综复杂，他们就欢迎；要是病情一目了然，他们就会觉得厌烦。他们为听到了杂音或为检查出肝病而不胜惊讶；听到肺部发出的一种异乎寻常的响声，他们就会喋喋不休地议论起来。但是，对菲利普来说，事情远不止于此。他只是看看他们的长相，头部的形状，手，眼神以及鼻子的高低，就觉得兴趣盎然。在那门诊室里，他看到的是被不测之故侵袭的人的本性，此时世俗的面具被粗暴地撕下了，呈现在眼前的是赤裸裸的心灵。有时还会看到一种无师自通的禁欲主义的表现，那情景简直动人心魄。有一次，菲利普遇上一位粗鲁、目不识丁的男病人。他告诉菲利普说他的病已无可救药，但说话时极力控制自己的情感。面对使得这位老兄在陌生人面前还是那么坚毅的奇妙的本能，菲利普不由得惊讶不已。要是他本人面对着自己的心灵时，是否也能这样勇敢呢？是否会向绝望的情感低头屈服呢？有时候也会发生令人悲伤的事情。一次，有位少妇带了她妹妹来作体检。那位姑娘年方十八，容颜娇嫩，生着一对大大的蓝眼睛。有那么一会儿，浅色的头发在一缕秋天阳光的照耀下，反射出缕缕金光。她的肤色美得惊人。在场的几位助手微笑地盯视着她。在这几间邋里邋遢的门诊室里，他们很少看到这样的窈窕女郎。那位少妇开始介绍亲属病史，说她的父母双亲均死于肺结核。一位弟弟和一位妹妹也由于同样的原因而夭亡了。她们姐妹俩是这家的幸存者。那位姑娘近来老是咳嗽，还日见消瘦。她解开罩衫，露出那白如牛奶的脖子。蒂勒尔大夫默默地检查着。同往常一样，他的动作敏捷利索。他吩咐两三个助手用听诊器诊听他手指示的部位。接着，他叫那位姑娘扣好衣服。那位少妇站得稍远一点。为了不让那姑娘听见，她压低了嗓门说话。她的声音因害怕而发颤了。

"大夫，她没得肺病，是不？"

"恐怕她毫无疑问是得了。"

"她是最后一个了。她再一走，我可没一个亲人了。"

那个少妇嘤嘤抽泣起来。蒂勒尔大夫脸色阴郁地望着她。他私下里想她自己又何尝不是如此，同样活不长。那姑娘转过身来，发觉她姐姐在流泪。她明白这意味着什么。血色渐渐从她那张妩媚的脸蛋上褪去，两行泪珠顺着双颊扑籁而下。她们俩站了分把钟，无声地抽泣着。接着，那少妇把在一旁冷眼旁观的几个人都忘了，走到她妹妹跟前，一把把她搂在怀里，一前一后地摇晃着，仿佛是在哄婴儿似的。

她们走后，一位学生问道：

"你认为她还能活多久了"

蒂勒尔大夫耸了耸双肩。

"她的兄弟和姐妹一发现症状以后三个月就死了。她也会是这样的。假如她们有钱，那还可以想想办法。你可不能叫她们上圣马利兹医院去呀。对她们这种人来说，无法可想。"

一天，来了位身体强壮、正当盛年的中年汉子。他身上有块地方终日疼痛不止，使他备受折磨。可给他看病的这位跛脚医生看来并没有使他的疼痛有丝毫的减轻，最后诊断为不治之症，只有等死。这不是那种令人胆寒然而还是情有可原的不可避免的死亡，因为科学在这病症面前也束手无策嘛。这种死亡之所以不可避免，是因为这个人不过是错综复杂的社会文明这部庞大机器上的一个小小齿轮，就像一部自动机那样，压根儿无力改变自己周围的环境。要病痊愈，他就得彻底休息。然而，蒂勒尔大夫并没有要求他做不可能做到的事情。

"你该换个轻微的工种干干。"

"在我那个行业里，可没一件轻活。"

"嗯，你再这样干下去，是要送命的。你的病可不轻呢。"

"你的意思是说我快要死了？"

"我可不想这么说，不过你肯定不宜干重活。"

"我不干，谁来替我养活妻子儿女呢？"

蒂勒尔大夫耸了耸肩膀。这种困境在他面前出现已不下上百次了。眼下，时间紧迫，还有许多病人在等着他呢。

"那好吧，我给你开些药，一个星期之后再来，告诉我你的感觉怎样。"

那个汉子拿起上面开着毫无疗效的药方转身走了出去。医生爱说什么随他说去。他对自己不能继续干活这一点倒并不觉得难过懊丧。他有个好工作，岂能轻易撒手。

"我说他还有一年可活，"蒂勒尔大夫说。

有时候，门诊室里会出些富有戏剧性的事件。耳边不时传来有人操着浓重的伦敦口音说些不无幽默的隐语。时而走进来个老妇人，就像狄更斯笔下出现的这一类人物一样，她说起话来特别罗唆，絮絮叨叨的说个没完没了，把他们逗得呵呵直乐。有一次，来了位女人，是一家颇有名气的杂耍剧场的芭蕾舞演员。她看上去有五十岁了，可自报才二十八岁，脸上涂抹着厚厚的脂粉，一对乌黑的大眸子滴溜溜地转动着，厚颜无耻地对那些学生们频递媚眼。她那笑容既下流又颇具诱惑力。她非常自信。特别令人感兴趣的是，她对蒂勒尔大夫那股随便亲热劲儿，正好比她在对待一位信誓旦旦的追求者一般。她患有慢性支气管炎，在蒂勒尔大夫面前抱怨这病给她眼下从事的行当带来不便。

"我真并不懂为什么我偏偏要生这种病。说句老实话，我真的弄不懂。我这辈子没生过一天病。你只要瞧我一眼就会知道这是不假的。"

她的眼睛对着周围的年轻人骨碌碌转，那假装的长睫毛对他们意味深长地眨了一下。她还朝着他们露了露那口黄牙。她操着一口伦敦士音，不过说话时却带着一种幽雅的情感，每吐一个字，都使听者觉得趣味隽永。

"这就是人们常说的咳嗽病，"蒂勒尔大夫神情严肃地答道，"许多中年妇女都得这种毛病。"

"哦，天哪！你的话跟一位女士去说倒蛮动听的。还从来没有人说我是个中年妇女呢。"

她圆睁着双眼，头朝一边歪着，带着一种难以形容的诡诈相凝视着蒂勒尔大夫。

"这就是我们这一行业的不利之处了，"蒂勒尔大夫说，"它有时逼着我们说话不能那么高雅了。"

她在接过处方的当儿，再一次朝蒂勒尔大夫嫣然一笑，那笑容颇有点勾魂摄魄的魅力。

"你一定会来看我跳舞的，亲爱的，是不？"

"我一定去。"

蒂勒尔大夫说罢按响电铃，吩咐带下一个病人。

"有你们这几位先生在这儿保护我，我感到非常高兴。"

不过，总的印象既非悲剧也非喜剧。这种印象无法用言语来表达。真是五花八门，色彩斑斓；充斥着眼泪和笑声、幸福和悲哀。一切是那么冗长乏味，既饶有兴趣而又平淡无奇。情况正如你见到的那样：它是那么的喧嚣、热烈，又那么的严肃；它是那么的可悲、可笑，又那么的微不足道；它既简单又复杂；有欢乐，但又包含着绝望；还有母亲对子女的母爱；男人对女人的情爱；欲望拖曳着沉重的步伐穿过房间，惩罚着罪人和无辜者以及一筹莫展的妻子们和可怜的孩子们；男男女女都酗酒，但不可避免地要付出那笔惨重的代价；一个个房间都回荡着死神的叹息声；新生命在那里得到了诊断，却使得一些可怜的姑娘心里充满恐惧和羞愧。这儿既不好又不坏，有的只是赤裸裸的事实。这就是生活。

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.