make for failure, partly in order that they shall see the necessity for better organisation and union in the profession, and thus be induced to move in their own as well as the public's interest, and partly in order that the general public shall have a better understanding as to the relationship which should subsist between the members of the profession and the laity.

As regards drinking I would advise a practitioner never to take alcoholic drink in any house whatever in which he is paying a professional visit—not even when the visit is a long one, such as in the case of a confinement occurring in the night. He might take anything else non-alcoholic, but he would do well to wait until he reaches home, or until he gets on neutral ground, before imbibing anything else, even if he wants it badly. On a purely friendly visit he may of course take anything he pleases in reasonable amounts. I will give two reasons for the advice given. In the first place refusals pay, in every case, unless perchance some alcoholic drink should be required urgently and medicinally. If the house is an unusually hospitable and convival one, and the people might be offended, then they should be informed by the doctor that he never takes a drop of anything while on a professional visit, but that he would have no objection on any other occasion. He will be respected the more for this explanation, and will win further confidence. Secondly, it is a very easy matter for some of the best and strongest-minded men to be drawn into taking refreshment too often. The average doctor is a very harrassed and hardworked man and might well be excused for wanting stimulants pretty often. One of the best provincial doctors I ever knewhe was even distinguished-ultimately gave way in his later years to intemperance, simply through beginning to take drink. at various houses he attended in the country. I was also acquainted with another practitioner-whom now I consider a rather remarkable instance--who was drawn into drink in the same manner, but who realised the mistake before it was

too late not being able to get out of his perilous predicament in any other way he sold his practice and left the neighbourhood. At one time he could have been frequently seen the worse of drink as he drove about; but in a new practice he bought he altered his ways entirely and became a sober and sensible man again. He had been gradually drawn into a habit of taking drink at various houses he visited, a habit which only change of district and friends could alter.

Drink is a very great curse in the medical professional. Arduous duties, worrying cases, long hours of weary waiting, all tend to make a medical practitioner turn to stimulants ; and therefore no man deserves pity more than he does. I can forgive a drinking doctor when I could no one else, knowing what hardships he has so often to endure. But the habit can be avoided, notwithstanding, and if this should seem impossible then I advise any who have tried ordinary means, and failed, to try extraordinary means-let them leave the work of their profession and turn to manual labour, rather than sink further into sloughs of soddened despair and hopeless degradation as some do.

I would also advise a practitioner never to smoke either pipe, cigar, or cigarette in the streets of the district he works in; nor should he smoke in public anywhere when he is on professional duty, unless he be walking or driving where no one would recognise him, as in a remote country district, or in the East End of a large town where the public scarcely recognises and rarely cares. Some will doubtless argue "How ridiculous, to think that a doctor should not be seen with a cigar in his mouth!" But, my reader, again I say you are the public's child if you are a medical practitioner: I insist upon it that you are; and you must do as you are told by the public or you will run the risk of falling behind. The public likes to observe a man so busy and absorbed in his work that he has no time to smoke, and the public values him for this mental

absorption and enforced abstinence from creature comforts. Cigarettes, pipes or cigars spell leisure, idleness or dalliance, according to many of our critics. The young doctor mouthing cigarettes at all times of the day on his rounds will be adjudged, by some, to be an easy-going and worldly individual, not to be thoroughly trusted as a medical adviser.

One may well ask, after reading this and other chapters, why should doctors be obliged to study appearances more than lawyers or architects? Why do they calmly submit to this ignominious grinding down before the public, which competition has brought, without taking steps to ameliorate their condition? Why do fourpenny and sixpenny dispensaries exist, and why is a class of work allowed which is paid for at a rate that is only equalled in trade by the worst cases of "sweating?" Why should union take place on the part of the patients as against doctors, while no similar defence union exists amongst doctors as against even the most unscrupulous class of patients? Lastly, above all, why should so many enter a profession which has so many disadvantages?

The answer to the last of these questions constitutes an answer to most of the others: it is an answer that the careful reader has already read between the lines of this and other previous chapters. The profession is not what it seems. The youth enlisting into the army is chiefly attracted by the prospect of wearing a uniform and winning the hearts of the nursemaids in the parks, and he is only kept from deserting, once he has taken the King's shilling, by being taught to appreciate the force of discipline and the penalties of disobedience. Youths who imagine they would like to be doctors only think of nice horses, carriages, and shining tall hats; they dream the sensation of having great powers over humanity and of being paid splendid fees for doing quite easily so much good. No doctor will disillusionise them; no doctor can afford to give himself away.

CHAPTER VIII

SOME INTERESTING BUT TROUBLESOME CASES

His

MANY individuals of the laity imagine that the life of a doctor is a very easy one, that he need only apply all he has learnt as a student to the cases he is called to, and he will get well paid for very little trouble indeed. But the real truth is that his life is a hard and harassing one, full of wories and anxieties. cases are not by any means all easy ones to deal with; many require deep consideration and shrewd judgment if the issue is to be satisfactory and creditable. Let twenty average general practitioners be assembled together and be examined: more than half will appear worn and worried, often pale and thin also. This is because they work hard and get very little real diversion. Their working hours are generally from nine o'clock in the morning to nine in the evening. After this they may receive a call at any moment, perhaps to a case that takes three or four hours out of their sleeping time. I know I am not exaggerating, when I assert that a hale and hearty unworried medical practitioner, if he have an average practice, can very rarely be found.

To be an average doctor you must not only know all about diseases as they occur in the ordinary way, but you must be quite alive to everything extraordinary. You must be even an expert detective in some instances. When I explain to the reader that not uncommonly doctors have to sift false evidence, false statements made by patients regarding their condition, it

will be better understood that doctors' work is not quite as easy and pleasant as many imagine; it does not invariably constitute listening comfortably and calmly to the genuine and plainly expressed symptoms of patients.

So that some idea may be gained as to the difficulties which some cases present, I will refer to a class of patient which the reader would, at first, hardly believe ever existed, namely malingerers, those who are not really ill, but who pretend they are. When an individual either pretends he has a disease, or wilfully protracts a disease already contracted, or exaggerates a slight ailment into one worse, for the purpose of avoiding duty or gaining certain pleasanter or more profitable conditions, he or she malingers.

Malingerers are to be found amongst all classes of society, from the patient of position, whose pretences are cultivated with a view to obtaining an advantage of some sort, or in order to make themselves in some way and in the eyes of certain people, interesting, to those who have duties to perform that are unpleasant or irksome, such as officials, employees of all kinds, prisoners, workhouse inmates, and soldiers. Business people who want holidays, or an easier time of it, will sometimes malinger.

Ill-health is often an excuse for idleness and incompetency; it is also pleaded by the luxurious and pleasure-loving, who will go the round of health resorts, persuading themselves as well as others that their state of health requires it, when really gambling and other delights of life, away from home, are the attraction.

People of the highest classes will sometimes malinger in order to gain some kind of advantage, even if only sympathy from friends; or they may want an excuse for what might be taken to be an inclination for vicious and luxurious pursuits. Ne'er-do-weel sons will account for their failure in life, sometimes, by telling the story that they were very delicate when