became boring, so he read the morning paper. When he had exhausted the paper, he passed the remainder of the time in clinical discussion with his neighbours. This was the most attractive part of the visit, and a pleasure he had been storing up for himself.
Discussion of one's illness with neighbours on the bench was done with pride: the patients wore their symptoms like a row of campaign medals.
'Wot you in for, cock?' he began to the man next to him.
''Art trouble,' was the reply, delivered with gloomy zest.
'Anyfink else?'
'That's enough, ain't it?' replied the neighbour sharply. 'Ow about you?'
'The doctor says I am a walking pathological museum.' The patient rolled the syllables off his tongue deliberately.
'Go on!'
'I've got diabetes mellitus, 'emeroids, normocytic anaemia, chronic bronchitis and emphysema, 'ammer toe, cholecystitis, and an over-active thyroid.'
'That's a packet, all right,' his neighbour admitted grudgingly.
'And I 'eard 'im say I've got a positive Wasserman, too!' he added in triumph.
''Ave you 'ad any operations?' inquired a thin woman on the other side of him in a voice rich with misery.
'Not to date, touch wood, I 'aven't.'
The woman gave a loud sigh.
'I wish as I could say the same,' she remarked, shaking her head sadly.
''Ow many 'ave you 'ad, missus?' asked the patient, anxious over his own record.
'Fifteen,' she told him, in tones of exquisite martyrdom.
'Coo! I'm glad I 'aven't got your complaint.'
'That's the trouble. They don't know wot's wrong with me. The last time they took out my colon. The doctor said it was the worst they'd ever 'ad in the 'ospital. Took them four and a 'arf hours, it did. Then they 'ad to leave some of it behind. I'm lucky to be 'ere now, if you ask me.'
'Must have been a bad do,' the patient said, respectful of such exuberant pathology.
'Bad do! I was left to die four times!'
'Oo's your doctor, missus?'
'Mr. Cambridge. Wot a lovely man! 'E's got such soft 'ands.'
I soon discovered another peculiarity of out-patient work. In the wards the patients are all ill: in outpatients' they are nearly all healthy. Men and women with organic disease formed a small fraction of the hundreds who came past the fat porter at the door every day. Most of them complained of vague aches and pains that they had been trotting up to the surgeries of their own doctors for several months, and they, poor men, had got rid of them temporarily by handing them a note to St. Swithin's. This was an example of an established medical practice known as snag-shifting, which went on just as actively in St. Swithin's itself.
The most usual condition in out-patients' was headache, which was slightly more common than troubles of the poor feet, giddy spells, the rheumatics, and insomnia ('Not a wink for forty years, doctor'). Most of the symptoms were manifestly incompatible with life if they had existed, but every patient had to be investigated in case something sinister lay beneath. This provided an excellent opportunity for snag-shifting. A persistent patient with headaches could, with a few strokes of the pen, be transferred to the eye department. It simply needed the houseman to scribble 'Headaches. Any eye signs?' on the notes and the patient moved to another queue outside another doctor's door. After the eye department had found nothing and were tired of the fellow appearing in front of them week after week they sent him to the throat clinic. The throat surgeons usually operated on all their patients and would probably remove his tonsils or the inside of his sinuses; when he continued to attend with his headaches afterwards, they would pack him off to the general surgeons with the suggestion his complaint was the result of sepsis lurking in his gall-bladder, kidney, or some other organ comfortably outside their province. The surgeons might operate or not, according to the length of their waiting-list at the time; whatever happened, after a few more visits to out-patients' he would find himself having all his teeth out in the dental section, who packed him off afterwards to the physiotherapy department in case the headaches-which continued-were due to disfunction of the neck muscles. From the physiotherapy department the patient went as a last resort to the psychiatrists, and as they were then unable to transfer him to anyone he probably continued to visit them and talk about his headaches once a week for the remainder of his life.
While I was working in out-patients' the hospital authorities installed a bar for tea and buns in the hall to break the tedium of the long wait. The regular patients were delighted, and showed their appreciation by spending as many of their afternoons as they could enjoying a medical tea-party with their fellow sufferers.
'Times have changed,' one of the old porters said gloomily, looking at the girl distributing cups of tea from the new counter. 'None of this 'ere nonsense in the old days. Mollycoddling, I call it.'
He wistfully described the routine of forty years ago. The patients had to be inside the building and seated at the benches by eight o'clock every morning. Then the doors were locked and anyone coming late had no alternative than to wait until the next day. The consultant arrived at nine, and strode to his room accompanied by a senior porter. When the doctor had settled himself in his chair the porter went to the door and shouted: 'Nah then! All them with coughs, stand up!' A handful of patients came to their feet and shuffled into the room. When they had been seen the porter returned and commanded: 'Stomach pains, diarrhoea, and flatulence!' The possessors of these alimentary disorders filed before the doctor while the porter marshalled the chronic cases who had come simply for a new bottle of medicine. The patients found the system convenient, and it was abolished only when the senior physician left for Harley Street after a remarkably heavy morning treating chest symptoms and found a stall outside the hospital from which was being sold 'Genuine St. Swithin's Cough Mixture.' This was bought off the patients for twopence and retailed to the public by the stallkeeper at sixpence a bottle.
We each spent two days a week in the accident room, where I began to feel I was at last learning a little medicine by discovering how to put a bandage on without dropping it on the floor, to sew up cuts, to remove foreign bodies from eyes, and to apply a kaolin poultice. A pair of us were obliged to sleep once a week in a couple of bunks in a small room by the accident entrance, to attend the minor injuries that trickled in unendingly during the night. This system was nearly the end of Tony Benskin. In his wanderings round the sleeping hospital he had met, and taken a fancy to, one of the night nurses, and turned himself into a red-eyed wreck all day by sitting most of the night in her company.
The conditions in a ward at night are admittedly lightly aphrodisiac. The nurse sits alone at one end of the long room, which melts away on each side into shadows and is illuminated only by a single red-shaded lamp on the desk in front of her. The soft warm light makes her as desirable as a ripe peach. There is not much room at the desk, so the student and nurse sit close together., To avoid disturbing the patients they must whisper, which turns every remark into an intimacy. They are the only two awake in a sleeping world and they draw together with a tingling sense of isolation.
The nurse mixes the student a milk drink from the patients' night rations. It is surprising what can occur in such conditions over a couple of cups of Horlicks. Their knees touch under the desk; their hands brush together in a determined accident; their fingers entwine and they sweat into one another's palms until the night sister is due on her round. The student pours soft endearments over the girl like treacle on a pudding, though his technique is sometimes ruined by his being interrupted in a delicate submission to her charms by a rough voice from the nearest bed demanding 'Can I 'ave the bedpan please, nurse?'
Benskin's romance might have ended harmlessly if it had not been for a lapse on the last night of our appointment. We were on duty together, and to celebrate 'the end,of the session we persuaded the casualty nurse to do our work and spent the evening in the King George. At closing time Benskin rushed to see his night nurse, while I flopped into bed.
Just after three I was shaken awake. Automatically I reached for my trousers, thinking it was the porter demanding my attendance in the accident room: but it was Benskin. He was in a pitiful state.
'Old man!' he said urgently. 'You've got to help me! Something terrible's happened!'
I tried to concentrate on the disaster.
'What's up?' I asked sleepily.
'You know that girl up in the ward-Molly. Remember, the one I've been popping up to see?'
'Umm.'
