Ht^aca, Situ Qotb 
 
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Cornell University Library 
 R 707.P13 
 
 Confessio medici, 
 
 3 1924 012 493 270 
 
Cornell University 
 Library 
 
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 tlie Cornell University Library. 
 
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CONFESSIO MEDICI 
 
•Tl 
 
 ^^^^ 
 
 THE MACMILLAN COMPANY 
 
 NEW YORK ■ BOSTON • CHICAGO 
 ATLANTA - SAN FRANCISCO 
 
 MACMILLAN & CO., Limited 
 
 LONDON • BOMBAY ■ CALCUTTA 
 MELBOURNE 
 
 THE MACMILLAN CO. OF CANADA, Ltd. 
 
 TORONTO 
 
CONFESSIO MEDICI 
 
 BY THE WRITER OF 
 
 "THE YOUNG PEOPLE" 
 
 " The physician is the flower (such as it is) of our 
 civilisation ; and when that stage of man is done with, 
 and only remembered to be marvelled at in history, 
 he will be thought to have shared as little as any in 
 the defects of the period, and most notably exhibited 
 
 the virtues of the race." 
 
 Stevensoh. 
 
 Nein gorfe 
 
 THE MACMILLAN COMPANY 
 
 a .1. 
 1908 
 
 ^11 rights reserved 
 
Copyright, igo8. 
 By the MACMILLAN COMPANY. 
 
 Set up and electrotyped. Published February, igo8. 
 
 I^otinootr ^tats 
 
 J. B. Gushing Co. — Berwick & Smith Co. 
 
 Norwood, Mass., U.S.A. 
 
PREFACE 
 
 A POOR writer is always tempted by the titles of 
 old books. It is hard on him, that he may not 
 write again ' The Anatomy of Melancholy,' or 
 ' Pride and Prejudice,' or ' A Midsummer Night's 
 Dream,' But I, not daring to steal from one 
 of my betters, have stolen from two ; from Sir 
 Thomas Browne and from Gower. Consider what 
 temptation is exposed on the top of Gower's 
 monument. There he lies, as near as he can get 
 to Shakspeare's brother : and his effigy has for 
 a pillow his three books, whose titles, 'Vox 
 Clamantis,' ' Speculum Meditantis,' ' Confessio 
 Amantis,' make me say to myself, as Bliicher said 
 of London, Was fiir Plunder. If only I might 
 have them, which would be no loss to Gower, I 
 could write a most noble trilogy. ' Vox Clamantis ' 
 would be easy work : it would write itself, in a 
 fortnight, in a red-hot rage, all drums and trum- 
 pets, thunder and lightning. Then, 'Speculum 
 Meditantis,' in two big volumes, every sentence 
 polished and exact: a book not to read, but to 
 
vi PREFACE 
 
 give to public libraries. Last, ' Confessio Amantis.' 
 A less careful thief would put them in a different 
 order, would begin with ' The Lover's Confession,' 
 young A murmuring to Miss B, Dearest, I confess 
 to you that I have been in love before, with C, D, 
 E, and many, many other letters of the alphabet ; but 
 never with Ampazand. I swear to you, my darling, 
 that you need not be jealous of poor Ampazand. Of 
 that sort of Lover's Confession, I only say that 
 young A is happy and thrice blessed, if he has 
 nothing to confess to his God but what he can 
 tell to his sweetheart. But I have arranged my 
 trilogy the right way ; for ' Confessio Amantis ' 
 signifies not the confessions of a lover, but con- 
 fession of love. 
 
 Not all confession is of sins : and a man may 
 confess his faith, his ignorance, or his love. Use 
 the word as we will, it means no more than this, 
 that he goes outside himself for answer, assurance, 
 audience. Faith joins the company of the faithful, 
 ignorance asks for enlightenment, and love asks 
 for love. We do not talk of confessing Euclid, 
 or cookery, or sport: for they are complete in 
 themselves. To confess, is to appeal to our fellow- 
 creatures, it may be to one, it may be to all, for 
 sympathy and a fair hearing. 
 
 But is it necessary, or wise, or quite like a 
 gentleman, thus to run to confession, and, as it 
 were, to seed ? Has everybody got something to 
 
PREFACE 
 
 vu 
 
 say worth saying ? Are not they the nicest people, 
 who say nothing ? Indeed, that may be true ; and 
 if ever, like Prospero, I recover my dukedom, I 
 will drown my book : but there comes a time, 
 even to people who might otherwise be nice, when 
 they find pleasure in writing. They are tired of 
 their own company ; they have lived inside their 
 hearts till they know every stick of the furniture: 
 they desire now, before it is too late, to leave that 
 narrow lodging, to say what they think, and to 
 proclaim what they have learned. Silence is golden ; 
 but gold is for circulation. They are sick of silence : 
 it is not vanity, but human nature, that makes them 
 want to address themselves to anybody who will 
 listen to them. In brief, they feel the need of 
 confession. 
 
 Rome gives this meaning to the word. At Rome, 
 the Confessio, in this or that church, is the wide 
 sunken space, in front of the altar, surrounded by 
 a balustrade. The saint, whose body lies under 
 the altar, is by this device kept above ground, and 
 there is no right of way over his bones. After 
 his death, he found that he had not finished what 
 he was saying when he died. For that reason, he 
 stays among the living. Between them and him, 
 nothing interferes, neither Mother Church nor 
 Mother Earth : he is still in the world, level with 
 present affairs, unburied, attentive. Confiteor, says 
 he ; and waits for the word to come back to him. 
 
viii PREFACE 
 
 That is why this part of the church is called 
 Confessio. Here is no place for the confession of 
 sins : all such business must be transacted else- 
 where, not with a saint but with a fellow-sinner, in 
 a box ; not here, across this open treasury, walled 
 with marbles, and lit with silver lamps. This 
 atrium, this court-yard in front of the saint's little 
 house under the altar, was designed for more 
 cheerful exercises : here, he gives audience, and 
 has requested the pleasure of my company. I am 
 to stand at the balustrade, and he will speak to 
 me, confessing his faith, in the hope that I shall 
 repeat it after him : but he has not the faintest 
 wish to hear about my sins. 
 
 People are so careless, what they say to him. 
 Shock-headed children tell him how naughty they 
 have been, and pray him to save them from a 
 whipping. Old women, short of breath, set down 
 their market-baskets, and confide to him the gossip 
 of the neighbourhood and the state of their health. 
 Tourists, which is the most unkindest cut of all, 
 read guide-books to him, and he hears, a dozen 
 times a day, who he is, when he died, and how 
 many lamps are burning in front of him. But of 
 course, say the tourists, you mustn't believe all that ; 
 and I don't suppose for a moment that he is really 
 there: which is our way, when we visit the Eternal 
 City. The porter cheated us on Monday, and the 
 flower-girl was so impudent on Tuesday, and it 
 
1 PREFACE ix 
 
 rained all Wednesday, and to-day is only Thursday, 
 and is it likely, that a saint would be genuine ? 
 Thus we see Rome, and make ourselves beloved 
 there. Anyhow, here I stand at the approach to 
 his house, and might be in a worse place : for he 
 is a most eloquent handful of dust, and of great 
 age. He loves courtesy, he hates controversy : he 
 knows nothing, happy saint, of the way I pro- 
 nounce Latin. He asks me, not to confess my 
 sins to him, but to say his Confiteor with him. 
 What can I do, as one gentleman to another, but 
 hide the guide-book, and endeavour to say some- 
 thing suitable to the occasion ? 
 
 It is in this sense, and no other, that the word 
 Confessio is used here. For here is no confession 
 of sins and errors, no disclosure of secrets, no 
 mention of names, no memory of offence, no airs 
 of penitence. I neither ravel-out my weaved-up 
 follies, nor complain that I wasted Time, and now 
 doth Time waste me. Even if it were true, I am 
 not minded to talk in that silly way. I only want 
 to confess what I have learned, so far as I have 
 come, from my life, so far as it has gone. 
 
CONTENTS 
 
 
 
 
 FAGB 
 
 Preface 
 
 
 
 V 
 
 Vocation ..... 
 
 
 
 I 
 
 Hospital Life .... 
 
 
 
 II 
 
 An Essay for Students . 
 
 
 
 26 
 
 A Good Example 
 
 
 
 55 
 
 Practice 
 
 
 
 69 
 
 The Discipline of Practice 
 
 
 
 83 
 
 The Spirit of Practice . 
 
 
 
 95 
 
 Wreaths and Crosses of Practice 
 
 
 
 114 
 
 
 
 
 126 
 
 The Very End 
 
 
 
 145 
 
 Epilogue ..... 
 
 
 
 156 
 
VOCATION 
 
 It is said that there is a difference between pro- 
 fession and vocation ; that the doctor has a 
 profession, and the priest has a vocation. But I 
 find, from Johnson's Dictionary, that Swift uses 
 the latter word of the vilest of all trades, and that 
 Shakspeare makes Joan of Arc use it of her con- 
 temptible estate as a farm-hand : 
 
 Lo, whilst I waited on my tender lambs. 
 
 And to sun's parching heat displayed my cheeks, 
 
 God's Mother deigned to appear to me : 
 
 And, in a vision fiill of majesty. 
 
 Willed me to leave my base vocation. 
 
 And free my country from calamity. 
 
 He misses the point, that her voices were her 
 vocation. That is the worst of Latin words : they 
 are good servants, but bad masters. When I meet 
 a long Latin word, in a line of quiet English, 
 elbowing its neighbours right and left, like a 
 motor-omnibus raging down a country lane, I stop 
 it, and ask to see its root. That is the way to 
 
2 CONFESSIO MEDICI 
 
 take the conceit out of all such words. Here is 
 one, which so impressed Shakspeare that he made 
 four syllables of it : but its root, vo or voc, is a 
 mere animal noise, the cry of an ape courting 
 an ape. Away with Latinity. If it could thus 
 impress Shakspeare, what may it not do with us? 
 Let us be agreed, that a vocation is a call, or a 
 calling. But here is a new difficulty. For it is 
 one thing, to have a call, and another, to have a 
 calling ; and a man may have either, or both. 
 Joan of Arc had a call to leave her calling : 
 Burns followed the calling of an exciseman, and 
 the call of poetry. There is no call for anybody 
 to run another music-hall in London, or to make 
 a huge profit, in time of war, out of his country's 
 army : still, a man thus engaged might say that 
 he had a calling. Again, a man is called to the 
 Bar : but they are mortal voices which call him, 
 and most unlike those heard by Joan of Arc. 
 Again, in Medicine, many of us are glad that we 
 have a calling, but doubtful whether we had a call. 
 It is certain, that some men are indeed called 
 to be doctors : and so are some women. They 
 are, as we say, born doctors : they were shapen in 
 Medicine. So apt are they to their work, and it 
 to them, that they almost persuade me to hold 
 opinion with Pythagoras, and to believe that in 
 some previous existence they were in general 
 practice. Or their ability may be the result of 
 
VOCATION 3 
 
 inheritance : but we know next to nothing about 
 inheritance, neither is it imaginable by what 
 physical processes the babe unborn is predisposed 
 for one profession. Still, there are men and 
 women, but not a great number, created for the 
 service of Medicine : who were called to be 
 doctors when they were not yet called to be babies. 
 To this word call, Johnson assigns no less than 
 nine meanings : but I am concerned only with 
 those which he numbers 3 and 4, quoting in 
 support of them the honoured names of Milton, 
 Dryden, and Locke. Call 3 is divine vocation, 
 summons to true religion : call 4 is a summons 
 from heaven, an impulse. I cannot see any 
 difference between divine vocation and a summons 
 from heaven, or between a summons from heaven 
 and a summons to true religion. To say that a 
 man is called to be a doctor, is no more than 
 to say that he is designed for that life, as coals 
 are designed for fuel, and candles for light. And, 
 of course, a call is not bound to be ante-natal : 
 it can come when it likes. For example, take, in 
 Middlemarchy Lydgate's call : 
 
 One vacation, a wet day sent him to the small home- 
 library, to hunt once more for a book which might have 
 some freshness for him : in vain ! unless, indeed, he took 
 down a dusty row of volumes with grey-paper backs and dingy 
 labels — the volumes of an old Cyclopaedia which he had never 
 disturbed. . . . The page he opened on was under the head of 
 Anatomy, and the first passage that drew his eyes was on the 
 
4 CONFESSIO MEDICI 
 
 valves of the heart. He was not much acquainted with valves 
 of any sort, but he knew that valvae were folding doors, and 
 through this crevice came a sudden light startling him with 
 his first vivid notion of finely-adapted mechanism in the 
 human frame. . . . The moment of vocation had come, and, 
 before he got down from his chair, the world was made new 
 to him by a presentment of endless processes filling the vast spaces 
 planked out of his sight by that wordy ignorance which he 
 had supposed to be knowledge. From that hour, Lydgate felt 
 the growth of an intellectual passion. 
 
 But, if the call had been addressed to his intellect 
 alone, he would have turned toward science rather 
 than practice. Therefore we read again of him : 
 
 His scientific interest soon took the form of a professional 
 enthusiasm. . . . He carried to his studies in London, Edin- 
 burgh, and Paris, the conviction that the medical profession as 
 it might be was the finest in the world ; presenting the most 
 perfect interchange between science and art ; offering the most 
 direct alliance between intellectual conquest and the social 
 good. Lydgate' s nature demanded this combination : he was 
 an emotional creature, with a flesh-and-blood sense of fellow- 
 ship which withstood all the abstractions of special study. He 
 cared not only for 'cases,' but for John and Elizabeth, 
 especially Elizabeth. 
 
 Again, he was called not only to science and to 
 practice, but to the advancement of his profession : 
 
 He went to study in Paris with the determination that when 
 he came home again he would settle in some provincial town 
 as a general practitioner, and resist the irrational severance 
 between medical and surgical knowledge in the interest of his 
 own scientific pursuits, as well as of the general advance : he 
 would keep away fi-om the range of London intrigues. 
 
VOCATION 5 
 
 jealousies, and social trucklings, and win celebrity, however 
 slowly, as Jenner had done, by the independent value of his 
 work. 
 
 Read Middlemarch, I say to all students. Lydgate 
 died long ago : for it is near eighty years since he 
 started in practice, at a time when most medical 
 practice was still strutting or shambling along the old 
 paths. But the whole story of his life — believe me. 
 Gentlemen, it will help you more than all the novels 
 of the last quarter of a century. Besides, it will 
 save you from falling in love with young ladies like 
 Rosamond. Read Middlemarch, I tell you : and, if 
 Lydgate's life does not touch you, ask yourselves 
 whether you have any call to be doctors. 
 
 But Lydgates are rare : and fathers and mothers, 
 bent on making a doctor of one of the children, 
 must not take the boy's mere vagaries as a sign that 
 he is intended for that profession. / mean to be a 
 doctor like Father, says he, and they rejoice over 
 him ; and a month later he wants to be a fireman, 
 or a member of Parliament. Or he is neat with his 
 fingers, rides well, understands the ways of animals, 
 and loves to attend the minor ailments of the family : 
 and then all that side of him goes, and he gives 
 himself to poetry, or, which is worse, to music. 
 Or he is ambitious, and will make a great name, a 
 great discovery : and again the wind catches the 
 weather-cock, and he praises a leisurely life and the 
 happiness of insignificance. His parents look in vain 
 
6 CONFESS lO MEDICI 
 
 for such assurance as may justify action. I'ime will 
 show, they say, and wait; but nothing happens, 
 nothing decisive. Something must be done ; Time, 
 still silent, is up : they determine, amid hopes and 
 fears which he hardly notices, that he shall study 
 Medicine. For all fathers and mothers thus per- 
 plexed, there is consolation in Bacon's essay, ' Of 
 Parents and Children ' : 
 
 Let Parents choose betimes the Vocations and Courses they 
 mean their Children should take, for then are they most flexible : 
 and let them not too much apply themselves to the disposition 
 of their Children, as thinking they will take best to that which 
 they have most mind to. It is true, that if the Affection or 
 Aptness of the Children be extraordinary, then it is good not 
 to cross it : but generally the precept is good. Optimum elige ; suave 
 et facile faciei illud Consuetudo. 
 
 And what better profession than Medicine, what 
 more liberal and loveable, for a young man at a 
 loose end ? As Matthew Arnold said of religion, 
 that it is morality touched with emotion, so practice 
 is science touched with emotion : which is a fine 
 occupation for any young man of no affection or 
 aptness so extraordinary that it may not safely be 
 crossed. If we all had to sit and wait for such a 
 call as came to Lydgate, many of us would be 
 sitting there still, wearying our kind elders, and 
 sick of waiting. Give me something to do, cry 
 the young men, put me into a decent profession, and 
 let me take my chance. Jack is in the Navy, and Joe 
 
VOCATION 7 
 
 is in the City, and bless me also, O my father, and find 
 me some work, I don't much care what. Here, in 
 this wholesome impatience, are opportunity and 
 guidance : so it comes to pass, that all other plans 
 of the family council are put aside, and one more 
 young man sets out to be a doctor. 
 
 To want to be wanted, to fight and shove, 
 single-handed, for a place in the world, are evidence 
 of strength. To count on the help and influence 
 of other men, to wonder what A and B will do 
 for us, are evidence of weakness. Especially, a 
 young man must be careful to reckon a successful 
 father not among his assets, but among his liabilities. 
 For he who enters his father's profession counting 
 on his father's name, enters it at his peril : and his 
 venture is the more perilous, if he takes, in the 
 same profession, the same line. There was Icarus, 
 son of Daedalus : he fashioned for himself wings, 
 to follow his father aloft ; and they bore him off 
 the earth, but the wax of them was melted by 
 the sun, and he fell into the sea. Practice is the 
 solvent of all such wings : for it is the man himself, 
 the skill of his hands, the judgment of his reason 
 on the expert evidence of his senses, the quick 
 selection and watchful use of the right set of facts. 
 It cannot be taken over like a theatre-ticket or a 
 share in a railway. Name, influence, privilege, suc- 
 cession, are what we make them. He who has them 
 must use them, for they are part of his life, and 
 
8 CONFESSIO MEDICI 
 
 are there to be used : but they may fail him. 
 Like Icarus, he is too much in the sun. Expec- 
 tation waits upon him, and the word goes round 
 that he ought to do well, with such advantages. 
 It is pleasant for him, to rise into that soft air, 
 and try his wings in the sunshine : but the heat of 
 the sun may be too fierce for them. There is 
 nothing disgraceful in that. They were an accurate 
 copy of the wings of Daedalus : and every young 
 man would like to have wings. And, after all, 
 though Icarus was drowned, yet it was a splendid 
 adventure, to fly, even a little way : and wax was 
 made to be melted. 
 
 Precept and example, from father to son, are gifts 
 of more lasting stuff; but they are not imperish- 
 able. The place of each life in the other is always 
 changing. If they could for a moment stand still, 
 they would be like mirrors, face to face, each reflect- 
 ing the other, and itself in the other, and the 
 reflection of itself in the reflection of the other, in 
 and in, to an immeasurable depth : but they are 
 incessantly on the move. Outside forces, uncalcu- 
 lated events, interfere between them, till those early 
 influences, which were so strong, fail. And then, 
 at the last, there may be in store for the two lives 
 a wonderful phase, when precept and example are 
 permitted, gently, and by common consent, to take 
 a rest. They have done their work ; they belonged, 
 it appears, to the Old Dispensation, the time when 
 
VOCATION 9 
 
 home, now and again, had a feeling about it as of 
 Mount Sinai, and there was thunder in the air. 
 They are ended, and put away. The father's im- 
 patience, the son's disaffection, cease to be remem- 
 bered : and the two Hves, what is left of them 
 together, touch, and stay close, without apology or 
 excuse or explanation or self-pity, and are united. 
 But this phase comes late, or may never come : 
 for it often happens that just as the two lives almost 
 touch, one of them stops. 
 
 Since name and influence, precept and example, 
 and all else that our elders can give us, are thus 
 fortuitous, we must look inside the man himself, 
 to discover what is the good of a call. The moment 
 we do that, we light on the obvious fact, that 
 the good in men is only inside them because' it is 
 outside them. Thus we are brought back to John- 
 son's definition, number 4«, that a call is a summons 
 from heaven. By what physical process it enters 
 into the fabric of a man's life, we need not ask, 
 or wait for an answer. It has an endless series of 
 methods, and is not bound to any one of them : 
 therefore, its presence is apt to be overlooked, and 
 its very existence denied by minute philosophers. 
 Every year, young men enter the medical profession 
 who neither are born doctors, nor have any great 
 love of science, nor are helped by name or influence. 
 Without a welcome, without money, without pros- 
 pects, they fight their way into practice, and in 
 
lo CONFESSIO MEDICI 
 
 practice ; they find it hard work, ill-thanked, 
 ill-paid : there are times when they say, What call 
 had I to be a doctor ? I should have done better for 
 myself and my wife and the children in some other 
 calling. But they stick to it, and that not only 
 from necessity, but from pride, honour, conviction : 
 and Heaven, sooner or later, lets them know what 
 it thinks of them. The information comes quite 
 as a surprise to them, being the first received, from 
 any source, that they were indeed called to be 
 doctors ; and they hesitate to give the name of 
 divine vocation to work paid by the job, and 
 shamefully underpaid at that. Calls, they imagine, 
 should master men, beating down on them : surely, 
 a diploma, obtained by hard examination and hard 
 cash, and signed and sealed by earthly examiners, 
 cannot be a summons from heaven. But it may 
 be. For, if a doctor's life may not be a divine 
 vocation, then no life is a vocation, and nothing is 
 divine. 
 
HOSPITAL LIFE 
 
 Great Hospitals, with their Schools, are something 
 more than blocks of buildings where patients are 
 doctored, and students and nurses are taught. I 
 do believe in the spirit of a place. To me, the 
 genius loci is really there : and the Religio Discipuli, 
 the student's obedience to the spirit of Hospital 
 life, is a very important part of his education. 
 
 It is strange, in modern London, that the genius 
 loci still survives as an object of worship : that 
 here, at the heart of the Empire, a religion lingers 
 which may fairly be called primitive. It bears traces 
 of tribal origin : each Hospital has its local deity, 
 whose votaries deride the gods of other Hospitals 
 as idols, but offer at their own shrine gifts and 
 sacrifices, especially on the first of October. The 
 ritual, on such occasions, is frankly pagan. Let us 
 look at these curious customs, and observe what 
 gifts, at the October festival, are presented and 
 accepted. For there are sacrifices which are not 
 wanted, gifts which might as well be left outside 
 
12 CONFESSIO MEDICI 
 
 the precincts, and worthless promises. And even 
 the meekest priest of the shrine may be able to 
 assist the little crowd of worshippers, praising one, 
 rebuking another, advising a third, and always on 
 the look-out for such as are likely, by the excellence 
 of their gifts and the importunity of their devotion, 
 to become priests like himself. 
 
 In plain words. What gifts of heart and mind 
 ought a student to bring to the service of his 
 Hospital ? 
 
 He ought to bring those gifts which come of a 
 good disposition, a good home, and a good public 
 school. He should have reverence, and a fair 
 liking for work, and a certain simplicity or direct- 
 ness of thought; and should know Latin, and a 
 manageable quantity of general facts ; and should 
 be resolute, in company, and even against company, 
 to say the right thing and take the right side. One 
 more gift he should have, which Time alone can 
 give, a sufficient age. He is very young for life 
 in London : and it is well for him if his father 
 can send him to the University, there to learn his 
 preliminary sciences, and thence to obtain, in due 
 course, his degree. And here I touch the question. 
 What is the value, to a medical student in London, 
 of a previous existence at Cambridge or Oxford ? 
 
 But I am not thinking of examinations, or of 
 the study of those sciences which our students 
 lightly call preliminary. I am thinking of the general 
 
HOSPITAL LIFE 13 
 
 belief, that a medical student, who has been at 
 Cambridge or Oxford, has thereby gained not only 
 knowledge, but other accomplishments, which evade 
 the coarse test of examination, but are of great 
 help to him in Hospital life, and afterward in prac- 
 tice. An old University, it is believed, is a system 
 of impressions, tones, and influences. It exercises 
 on all faithful undergraduates the magic of beautiful 
 buildings, immemorial traditions, immortal names ; 
 it sets them living and moving in a wonderful city 
 where philosophers, poets, statesmen, scholars, and 
 critics have lived and moved ; it shows them, for 
 the asking, the true ways of religion, friendship, 
 logic, athletics, courtesy, and self-judgment. Hence- 
 forth, they are of the world's elect : for they have 
 been where they have been, and there have learned 
 to think and to feel. They give evidence of good 
 style, good form, good taste ; something in the 
 clothes, the handwriting, the voice. If they praise 
 a picture, a book, or a piece of music, we had 
 better do the same ; and, if they reconcile autho- 
 rities who seem to us to be opposed, we may be 
 sure that they are right : for they have visions which 
 never come to us, and they wear on their foreheads, 
 like a phylactery, the University arms. This belief 
 is doubtless founded on fact, and assuredly is sup- 
 ported by fiction ; and is dear to the foolish people 
 who take every University man to be a gentleman, 
 and treat their family doctor as a tradesman. 
 
14 CONFESSIO MEDICI 
 
 But the preliminary sciences, as their name implies, 
 are on the very threshold of the undergraduate's 
 life. Even in his first year, he dissects the earth- 
 worm. So much the better for his future patients : 
 he cannot too soon begin to learn his proper 
 business. But I dare to ask him. What, after all, 
 is the difference between the University earth-worm and 
 any other ? You, at your time of life, what have you 
 to do with forms of thought and points of view ? Is 
 there more than the one way for you, the same for all 
 of us, to learn how to use your eyes and your hands ? 
 And are not your special studies opposed, on principle, 
 to the old magic of your University ? He may answer, 
 that he has no great respect for the last enchant- 
 ments of the Middle Ages, and that all Universities 
 ought to be Centres of Modern Thought : which 
 is a dreadful phrase, on such young lips. Thirty 
 years ago it was the preliminary sciences that were 
 despised, and the nickname for the whole majestical 
 circle of them was Stinks, more shame to Cambridge 
 and Oxford. Thirty years hence, at the present 
 rate — but I only say that not even undergraduates 
 can have everything. If they love their sciences 
 as they ought, they may fail to receive the non- 
 scientific influences of the place. 
 
 And these influences, I think, are of very little 
 use, either in Hospital life or in practice. There 
 was a time, within the memory of men, when a 
 student from Cambridge or Oxford was taken, not 
 
HOSPITAL LIFE 15 
 
 without reason, to be vastly superior to other 
 students ; was observed, envied, privileged, marked 
 for distinction. If the Hospital was honoured by 
 a sufficient number of these rare young men, there 
 would be an University set. Now, with the great 
 and happy increase of the supply of them, and with 
 the University of London crowned and enthroned, 
 and with the rise of many new Universities, the 
 times are changed, and there is no more talk. 
 Heaven be praised, of University sets. But this 
 change is not all due to the increased representation 
 of the old Universities in Hospital life. The young 
 men from Cambridge or Oxford would still tend 
 to form sets, if they found any great difference 
 between other students and themselves. They do 
 not find it, and that for two reasons : first, because 
 they do not look for it, and next, because it is not 
 there. 
 
 They do not look for it ; they are content to 
 be freshmen again. One Alma Mater at a time is 
 enough for them : and, as it were by instinct, they 
 give to their Hospital the allegiance which they gave 
 to their University. They are quick to see that 
 the new Alma Mater does not care for any traditions 
 but her own, and is averse from all academic or 
 aesthetic modes. She prefers physiology to philo- 
 sophy, museums to the Muses. She lets them 
 know, at once, that she is too busy to be Interested 
 in their accomplishments, and that she does not 
 
i6 CONFESS lO MEDICI 
 
 want to think about thinking and feel about feeling. 
 It is as much as she has time for, to read the 
 paper of a weekday, and get a walk in the park 
 of a Sunday, and not often that : and as for stopping 
 to hear about poetry, she really couldn't dream of 
 such a thing, with so many cases waiting to be 
 dressed, and the telephones going, though of course 
 it is all very clever, and quite wonderful, what they 
 have learned by heart, and how they can remember 
 so much. Dear, wise, old Alma Mater, most 
 practical, most loveable : they would be very stupid 
 young men, if they were not glad to enter your 
 service. Besides, they enjoy the sense of masquerade. 
 To hide his pride is even more delightful, to a 
 young man, than to air his pride: then, at the 
 appropriate moment, like the Duke in the opera, 
 he can fling open his mantle, and show on his breast 
 the glittering star of the Order of the University. 
 They say goodbye, without regret, to that leisurely 
 University life, which was so exactly the right thing 
 and the real article, and was enclosed in such a 
 beautiful place. The sudden change shakes them 
 out of themselves, and everything has something 
 to say to them : they give to the new life their 
 undivided loyalty, and do not look for a line 
 between themselves and their fellow-students. 
 
 Nor would they find it, if they looked. He who 
 brings to his Hospital the gifts of a good disposition, 
 a good home, and a good public school, is a fair 
 
HOSPITAL LIFE 17 
 
 match for him who comes from an University. 
 The Hospital takes us for what we are, not for 
 where we were. Inside its walls, we are all equal, 
 and there is no opportunity for the Cambridge mind 
 and the Oxford mind. It is doubtful, whether these 
 minds are in general use even at the seats of learning 
 assigned to them : it is certain, that they are not 
 necessary for Hospital life. To every deserving 
 community. Heaven gives a mind : and provides, 
 for its life, a proper setting. 
 
 The setting of the life of a Hospital, the build- 
 ings, and such works of art as the Hospital may 
 possess, are shown to every visitor. But, to observe 
 its mind, the visitor need not go further than the 
 Hospital garden ; that quiet place, which is no 
 more like the outside world than home is like a 
 music-hall. For the genius loci loves the open air ; 
 and the Hospital garden is his sacred grove. And 
 it shall be summer-time, with patients lying under 
 the shade of the plane-trees, and nurses bringing tea 
 to them, and students, bare-headed, playing tennis, 
 or talking over the day's affairs, or just doing 
 nothing. Of itself, it may be not much of a 
 garden : but we admire it as an open space, a great 
 well of light and air, a shaft of health sunk into 
 diseased and injured London. This pleasant old- 
 fashioned quadrangle, blessed with sunshine and 
 silence and an excellent view of the sky, is the 
 centre of the Hospital life : and a visitor, loitering 
 
i8 CONFESSIO MEDICI 
 
 here, will see that we are a brotherhood, and that 
 the patients are our guests. Every Hospital is a 
 charity : but there is a difference between charity 
 and hospitality. They who give money to Hospitals 
 are charitable ; we, who have the spending of it, 
 are hospitable : and, of course, it is we who get the 
 fun out of the money. And we spend it well, 
 entertaining in good style our innumerable guests. 
 
 All of us, staff and students, sisters and nurses, 
 residents, lecturers, and officials, work together, 
 keeping open house. Our students, a brotherhood 
 within a brotherhood, live under communal rules, 
 mostly of their own making. In some Hospitals, 
 there are Colleges, where students reside, with 
 admirable opportunities for reading, and, more's 
 the pity, for bridge ; and enjoy the intimate life, 
 a time so pleasant that every student ought to have 
 it for a part, at least, of his course. There is the 
 more need, now, to maintain the unity of Hospital 
 life, because the University of London is beginning 
 to relieve some Hospitals of the heavy honour of 
 teaching the preliminary sciences. The advantages 
 of this change are crossed by the fear lest the new 
 student should feel unattached. Fm not much wanted 
 here, he might say, at the Hospital; and, I shall not 
 he wanted here, once Fm through, at his work outside 
 the Hospital. Every student, from the beginning, 
 reckons on the right of immediate access to the local 
 deity. But, now that the new Universities attract 
 
HOSPITAL LIFE 19 
 
 so many students who but for them would be in 
 London, we must submit to change, knowing that 
 we are in good hands. I have a dream of the future. 
 Within the estate of each great Hospital, there is 
 a great College of the University of London, with 
 rooms for all, or nearly all, its students. I cannot 
 see, in my dream, whether the Hospital is still in 
 London, or has fled into the country : but I think 
 that it has fled, and has left on its old site a httle 
 Hospital for accidents and emergencies. Anyhow, 
 where the great Hospital is, there is the College, a 
 splendid range of buildings, worthy of an Univer- 
 sity of London, with Chapel, Hall, Common-rooms, 
 Library, swimming-bath, gymnasium, all perfect. 
 The residential life, the sense of attachment, are 
 part of the secret of the old Universities : and we, 
 no less, desire that our life should have that setting 
 which it deserves. 
 
 Or will anybody say that the genius loci is all 
 nonsense, and that a great Hospital is only a big 
 machine ? My answer is, that I know what I am 
 talking about. Sickness, as Lucretius says of im- 
 pending death, shows us things as they are : the 
 mask is torn offj the facts remain. That is the 
 spiritual method of the Hospital : -it makes use of 
 sickness, to show us things as they are. This 
 delicate word, sickness, includes drink, the con- 
 tagious diseases, infant mortality, starvation, the 
 sweating system, the immigrant alien, dangerous 
 
20 CONFESS lO MEDICI 
 
 trades, insanity, childbirth, heredity, attempted 
 suicide, accidents, assaults, and all the innumerable 
 adventures, tragical or comical, which end in the 
 Casualty Department. To a young man of good 
 disposition, tired of the preliminary sciences, and of 
 humanity stated in terms of anatomy and physiology 
 to the satisfaction of the examiners, this plunge into 
 the actual flood of lives is a fine experience. 
 Hitherto, he has learned organisms ; now, he begins 
 to learn lives. He need not go, like other young 
 men, for that lesson, to the slums ; for they come 
 to him, and that thrilling drama. How the Poor 
 Live, is played to him, daily, by the entire company, 
 hero and heroine, villain and victim, comic relief, 
 scenic effects, and a great crowd of supers at the 
 back of the stage — undesired babies, weedy little 
 boys and girls. Hooligans, consumptive workpeople, 
 unintelligible foreigners, voluble ladies, old folk of 
 diverse temperaments, and many, too many, more 
 comfortable but not more interesting people. It all 
 happens so naturally, with such a quick and sure 
 touch : the reality of the day's work, the primal 
 meaning of the crowd, the clash of hand-to-hand 
 encounter with diseases and injuries, urge him to 
 unexpected uses of himself. Here are the very 
 people of the streets, whom he passes every day, 
 here they are coming to him for help, to him of all 
 men, telling him all about it, how it happened, what 
 it feels like, why they did it : looking to him, right 
 
HOSPITAL LIFE 21 
 
 away, for advice and physic. They are no two of 
 them quite alike : and their records, laid before 
 him, range through every intermediate shade from 
 purest white to a nauseating black. He begins to 
 see that he has more to learn than the use of a 
 stethoscope : he must learn lives. The problem of 
 lives exalted, or sunk, or messed away, knocks at 
 his heart. Let other young men write lurid little 
 books, and tear the veil from the obvious, and be 
 proud of that achievement : what are they to him, 
 who entertains daily, as a matter of course, both 
 Hell and Heaven ? 
 
 I say that he sees things as they are ; but I do 
 not say that he puts a right interpretation to all 
 that he sees. At first, I think, he is apt to look 
 too hard at the dark side. There are times when 
 all London seems to him rotten with the contagious 
 diseases and sodden with drink, a city as gross and 
 vulgar as Rome under Nero ; and down with a crash 
 come Faith, Hope, and Charity, and he reads the 
 universe as a bad job, and half wonders what is the 
 good, in such a world, of being good. That is the 
 shock of collision with things as they are : and you 
 may hear him quoting. Hell was a city very much like 
 London. But the bright side, the courage and pa- 
 tience of the majority of his guests, their courtesy, 
 their honour, their humour, are always before him : 
 which may help him to set up again, on stronger 
 pedestals, these three. 
 
22 CONFESSIO MEDICI 
 
 He works under the guidance of his seniors, and 
 refers some of his perplexities, but not all, to them, 
 and is but a point in a system. He cannot feed the 
 hungry, but he can give them cod-liver oil, and, if 
 the Hospital can afford it for out-patients, maltine; 
 and he knows how to get at the Samaritan Fund. 
 He cannot clothe the naked; but he can tell the 
 drunkards not to drink the shirts off their backs. 
 Poor himself, he enjoys the exercise of hospitality, 
 and his alms and kind acts are of singular felicity. 
 His acquaintance with his guests is ofF-hand, but 
 fairly accurate so far as it goes : he has wide generic 
 names for them, Polly, Tommy, Granny, Daddy, 
 and for the immigrant alien the vague title of 
 Abraham. Not all deserve his compassion, and it 
 is his duty to tell some what he thinks of them, for 
 he sees parents dead-drunk, girls beaten by the men 
 who live on their shame, and children dying of 
 neglect : he is bound to rage, not grin, over such 
 cases. But, if he rages, it is to good purpose ; if he 
 chaffs, it is taken in good part : and the voluble 
 lady, sipping his well-meant pint of mild tonic on 
 the Hospital steps, calls him a nice young chap, and 
 advises the neighbourhood to be sure they have him, 
 next time they go there. 
 
 In the wards, where quiet and order reign, he 
 has further opportunities for insight, and for more 
 deliberate observation. He learns, with higher 
 exactness, to trust and to distrust himself, to be 
 
HOSPITAL LIFE 23 
 
 slow to find fault with other men and quick to 
 help them : he becomes acquainted with heavy 
 responsibility, with the full bitterness of a bad 
 mistake, the full delight of pulling people out of 
 death's way. He begins to be able to read characters, 
 and to see, by the scars on the lives allotted to his 
 care, what havoc we make of our chances. 
 
 Finally, if he obtains, when he is qualified, the 
 office of a House-physician or a House-surgeon, he 
 has a time so happy, so rich in friendship, advance- 
 ment, and experience, that he hates the day when 
 he must say goodbye to the Hospital. Deus in 
 medio ejus, says he ; non commovebitur. Years ago, 
 he brought his gifts to the shrine, and they were 
 accepted : and the spirit of the place has approved 
 his long and faithful service. 
 
 Contrast, with these crowded years, the narrow 
 outlook and bookish studies of young men reading 
 for the Bar, or for the Civil Service : who have no 
 Hospital, and entertain nobody. Or look away, 
 from the sleepless energy of a great Hospital, to 
 the emptiness of the City after office-hours, and 
 the wastes of South Kensington from Saturday to 
 Monday. There is not one profession that we 
 need envy : for there is none that gives to its 
 students such a good introduction to things as 
 they are. 
 
 I have attributed to my imaginary student a 
 more emotional temperament than the public 
 
24 CONFESSIO MEDICI 
 
 admires in its doctors ; for I wanted to say, as clearly 
 as I could, that a great Hospital is something 
 more than a big machine. All the same, the public 
 is right : emotional students do not make successful 
 practitioners. A man of sentiment: well, there is 
 nothing in the world so noble as a man of sentiment, 
 says Sir Peter Teazle. Then, down comes the 
 screen, and he changes his mind: If you have any 
 regard for me, never let me hear you utter anything 
 like a sentiment. So says the public, when it is ill, 
 really ill, to the practitioner. 
 
 Now that I have mentioned the practitioner, I 
 must end and sum up this discourse de Religione 
 Discipuli. Every student ought to bring to the 
 service of his Hospital the gifts of a good dis- 
 position, a good home, and a good public school. 
 He need not bring gifts which will hardly be 
 wanted : the spirit of the place is a rustic deity, 
 caring little for elaborate offerings. He should 
 love the Hospital life ; remembering, that it is 
 likely to be changed. Tribal worship, rival shrines, 
 and all such paganism, must reckon with the 
 University of London, whose faith hath centre 
 everywhere. Already, in the teaching of the 
 threshold sciences, this change is beginning : and 
 the time may come when it shall be said, on :behalf 
 of medical education, that even for clinical teaching 
 the Hospitals of London ought to work together, 
 abandon competition, break their distinctive idols. 
 
HOSPITAL LIFE 25 
 
 throw open their sacred groves, and pool their 
 patients. That would be a new version of the 
 story of Bethesda : and the waters of that pool 
 would indeed be troubled. A Hospital patient has 
 no desire to be associated with any body but his 
 own. He likes the off-hand, homely, old-fashioned 
 kindliness of a good Hospital : he makes a friend 
 or two, and keeps them. Of us, who entertain 
 him, it may be for a day, it may be for months, 
 he is of opinion that we are a very decent lot, 
 especially Sister. He does not always admire us 
 all : but he would not care to be run by the 
 London County Council, or by the Labour Party ; 
 and I agree with him. In medical education, let 
 us welcome loyally any change that will help us 
 to do more for our patients : but let us hold fast to 
 the unity of Hospital life, and to our bounden 
 duty to the spirit of the place. 
 
AN ESSAY FOR STUDENTS 
 
 I DARE to preach to students, for this reason, that 
 they preach, so many of my juniors, to me. One 
 by his love of practice, another by his love of 
 science ; one by his confidence, another by his 
 diffidence ; one by what he can do, another by 
 what he can do without. Now it is my turn. 
 I want to say what I think about Psychology. I 
 believe that many students, by a loose and ofF-hand 
 notion of Psychology, do themselves more harm 
 than good, and go into practice believing what is 
 not true. Illogical talk drifts, like a mist, through 
 Hospital life, all tending to deny that the word 
 Psyche means anything. I hate that sort of talk. 
 If this Confessio Medici is to be of any use to 
 students, it will be, I hope, here, in this essay on 
 Psychology. 
 
 I sit at my writing-table, and see, through the 
 
 window, a beggarly strip of grey sky, and the 
 
 backs of some houses, and the flickering leaves of 
 
 26 
 
AN ESSAY FOR STUDENTS 27 
 
 a tree round the corner. I hear the sound of 
 bricklayers at work on my neighbour's premises : 
 and now and again a motor hoots. The furniture 
 of the room, so famiUar that it seems thought-worn, 
 is of such and such colours and shapes. A moment 
 ago, I hardly noticed my surroundings : now, they 
 are asserting themselves. Light and outline and 
 contrast and contact are appealing to me, bidding 
 for recognition, elbowing their way to me, throwing 
 themselves at my head : and in at the window 
 comes a new legion of auxiliary sounds, of rain, 
 and a piano somewhere, and far-ofF traffic. I feel 
 like a theatre when the doors open, and the queues 
 are admitted to pit and gallery. I am filling-up 
 quick : and it only needs the smell and the taste 
 of a cigarette, or a mouthful of food, to occupy the 
 reserved seats. There, I have lighted a cigarette : 
 and now my senses can say, with proper pride, 
 House Full: Standing Room Only. The use of such 
 a notice is many centuries old : for there is in the 
 British Museum a stone slab, with holes bored in 
 it for immediate hoisting — Circus Plenus, Clamor 
 Ingens. That is the present state of my mind, 
 Circus Plenus. The doors opened, and the external 
 world came in : and that, not disorderly but orderly, 
 with all pomp and circumstance of reality, wealth 
 of incident, and majesty of association. 
 
 External, I call the world: it is a strange ad- 
 jective. My hand, as I sit here writing, holds a 
 
28 CONFESSIO MEDICI 
 
 wooden penholder, and rests on a table which is 
 covered with a green cloth. The penholder, of 
 course, is a part of the external world : but how 
 about my hand ? Looking at the two implements, 
 and observing how they work together, I do not 
 see that the one is more external than the other. 
 I separate them, and lay them on the table, side 
 by side, a few inches apart; I join them again, 
 and use them as one implement, part made of 
 wood, part made of hand. I find no evidence that 
 the external world stops at my enveloping skin, at 
 the exact plane where my pen and my hand are 
 in contact. Likewise, when I have my hair cut, 
 the hair which stays, on the near side of the scissors, 
 is just as external as the hair which falls, on the far 
 side of the scissors. Or take these three cases. 
 A had his leg amputated : the surgeon removed, 
 but did not externalize, the leg. They buried it 
 in the garden ; and A, when he got on crutches, 
 went, for his first walk, to its graveside : it was still, 
 he said, his leg. B swallowed a sixpence : he made 
 a good recovery, so good that it included the 
 recovery of the sixpence, which, of course, had 
 been external to him all the time. C died of drink : 
 it wrought the usual changes in his tissues : it could 
 not have got at them, unless they had been just 
 as external as itself. Once we begin to talk as if 
 the external world were outside our skins, there is 
 no end to casuistry. 
 
AN ESSAY FOR STUDENTS 29 
 
 , But let us take some object which is wholly 
 extra-corporeal. To me, at this moment, the ex- 
 ternal world offers, as a sample of its wares, this 
 green tablecloth here under my hand. Here is a 
 miracle indeed, and a whole legion of them : for 
 there is no other or greater in the universe than 
 I may find in this bit of serge. It was the fashion, 
 when I was a child, for our teachers to show us 
 familiar objects under the microscope. A needle- 
 end looking like a pokeir, a flea looking like a 
 night-mare, enlarged our minds by their own 
 enlargement; and wonder, like beauty, drew us 
 by a single hair. We examined the dust off a 
 butterfly's wing, and behold, it was a myriad of 
 scales delicately shaped and ribbed like palm-leaf 
 fans ; or we saw in a drop of blood the rouleaux 
 of red corpuscles : and were amazed, but there we 
 stopped, not wondering how these facts of the 
 external world found their way to us. And, I 
 think, we were tempted to believe that we had 
 somehow accounted for Nature by magnifying her 
 belongings ; and that nothing remained to be said, 
 when we had seen what the microscope had to say. 
 The real excitement, of course, begins where the 
 microscope leaves off. Imagination divides a speck 
 of dust into its component parts, and each of these 
 into its component parts, and so on, till we go over 
 the edge of thought, still thinking of that which is 
 divisible : the microscope cares only for the evidence 
 
30 CONFESSIO MEDICI 
 
 of its own eyes, and takes no interest in the mere 
 fact that objects are visible. 
 
 This tablecloth, what is it ? How does it con- 
 trive to enter into my life and stay there ? What 
 has happened, that here is a tablecloth ? I cannot 
 hope to find the right answer, or any answer, to 
 these questions, unless I approach them in the proper 
 spirit. Here, between my finger and thumb, is all 
 that anything material has been, or is, or ever will 
 be. If I can understand this fold of stuff, I can 
 understand the stars. We need not look at large 
 objects a long way off, when we want to philoso- 
 phize : the universe should be studied not in bulk 
 but in sample. It follows, that I must reverence in 
 this cloth, or in a single thread of its fabric, all 
 those immensities and eternities which I reverence 
 in the universe, or, as the fashion is to call it, the 
 cosmos, which is a very inferior word. If the 
 heavens declare the glory of God, so does the table- 
 cloth : if it does not, neither do they. I will go 
 down on my knees before it, and stay there. 
 
 Kneeling to these unconsecrated elements of warp 
 and woof, I begin to think that I see where 
 Psychology has gone wrong. She is so anxious to 
 be a complete science, that she refuses to be sur- 
 prised at the universe : she affects the cold matter- 
 of-fact demeanour of the sciences which are complete. 
 They cut me, they cut me dead, these sciences, they 
 fix a vacant stare, and slay me with their noble 
 
AN ESSAY FOR STUDENTS 31 
 
 birth : and Psychology, that she may get into their 
 set, imitates them. It is not their way, to wonder 
 that the universe is here : they are sure that nothing 
 in Nature is unnatural, and that the infinite is only 
 the rest of the finite. Chemistry is not surprised 
 when salt dissolves in water, nor Botany when a bulb 
 turns into a hyacinth, nor Biology when an egg, 
 discarding its original design for a pair of gills, turns 
 into a chicken. They would be ashamed, these 
 quiet gentlewomen, of gasping and exclaiming over 
 normal phenomena : they never forget themselves 
 in Ohs and Ahs, like the crowd at the Crystal Palace 
 when the rockets explode. Therefore Psychology, 
 that she may be admitted to their circle, apes their 
 tone. 
 
 She insists on it, that she is a science. In vain 
 the wisest of her servants. Professor James, tells her 
 that she is not : and that, of all places, in his Text- 
 book of Psychology. His first words to her, on 
 page I, are to the effect that she is not a science: 
 and his last words, on page 468, are to the same 
 effect. He begins by shaking the dust of her house 
 off his feet : and he ends by shaking them again, to 
 make sure. On page i, he calls her a provisional 
 beginning of learning, and says that she must stick 
 to her own arbitrarily selected problems, and ignore 
 all others. " Psychology," he says on page 2, " as a 
 natural science, deals with things in a partial and 
 provisional way. In addition to the 'material 
 
32 CONFESSIO MEDICI 
 
 world,' which the other sciences of nature assume, 
 she assumes additional data peculiarly her own, and 
 leaves it to more developed parts of Philosophy to 
 test their ulterior significance and truth." On 
 page 468, the last page of all, he fairly lets himself 
 go. " This is no science, it is only the hope of a science. 
 The matter of a science is with us. Something 
 definite happens when to a certain brain-state a 
 certain ' sciousness ' corresponds. A genuine glimpse 
 into what it is would be the scientific achievement, 
 before which all past achievements would pale. 
 But, at present, psychology is in the condition of physics 
 before Galileo and the laws of motion, of chemistry 
 before Lavoisier and the notion that mass is pre- 
 served in all reactions. The Galileo and the 
 Lavoisier of psychology will be famous men indeed 
 when they come, as come they one day surely will, 
 or past successes are no index to the future. When 
 they do come, however, the necessities of the case will 
 make them ' metaphysical.' " 
 
 The italics, I am proud to say, are mine. And 
 there the book ends, with a final warning to 
 Psychology that her assumptions are provisional 
 and revisable, and that she is groping in great 
 darkness : and nothing is left to be read but the 
 index, and the slip from the Times Book Club, 
 with the good news that I can buy all this wisdom 
 in Class B for less than It is worth. For I love 
 a text-book of Psychology which begins and ends 
 
AN ESSAY FOR STUDENTS 33 
 
 with the assurance that I need not be frightened, 
 though the experimental psychologists furiously 
 rage together, and imagine a vain thing. Professor 
 James is like Jehu. Psychology paints her face, 
 and tires her head, and looks out of the window : 
 and Throw her down, says he, and treads her under 
 foot. Then, when he has gone in, and has eaten 
 and drunk in the house of Philosophy, Go, says 
 he. See now this cursed woman, and bury her : for 
 she is a King's daught-er: and they go, and find 
 no more of her than the skull, and the feet, and 
 the palms of the hands. 
 
 She assumes the material world. It has an 
 inverted comma on either side of it, and she 
 assumes it in spite of those warning signals. She 
 assumes, also, certain additional data peculiarly her 
 own, which have not had their ulterior significance 
 tested, nor their truth. Who told her that she 
 might do that ? Who gave her those data ? If 
 nobody gave them to her, if she simply took them, 
 in what sense are they her own? I might assume, 
 provisionally, the name of John Sebastian Bach : 
 but would it be my name ? And what is the 
 difference, if any, between the ulterior significance 
 of a datum, and its truth ? Or between ulterior 
 significance and any other sort of significance ? And 
 what measure of faith do we owe to the hope of 
 a science ? 
 
 At present. Psychology is in the condition of physics 
 
34 CONFESSIO MEDICI 
 
 before Galileo. That is a blessed sentence ; and I 
 will have it framed and glazed, and hung where 
 I can lie in bed and look at it, next time I am 
 ill. It is a great help, it leaves the mind so free, 
 to have such a text before the eyes. Even more 
 soothing is the promise that future psychologists, 
 who will really know what Psyche is — alas, I shall 
 not live to see that day — will be, by the necessities 
 of the case, philosophers. There they are, that 
 angelic host, the necessities of the case. Far above 
 the additional data which have not yet been tested, 
 and the great darkness in which this unscientific 
 science gropes, the necessities of the case stand 
 and wait. What will they do, what will they not 
 do, in that day of Armageddon when they shall 
 take Psychology seriously in hand ? 
 
 Suppose that I ordered a coat, a bicycle, and a 
 watch, and that each of them arrived piecemeal, a 
 loose lot of parts ; the coat cut-out but not sewn 
 together, the bicycle in three packing-cases, the 
 watch a disconnected handful of bits of machinery. 
 With the coat, this letter — Please to kindly regard 
 this consignment as provisional and revisable. We are 
 forwarding to you the data of your coat, as per 
 esteemed order. Their ulterior significance must be 
 tested by some more developed firm. This is not a 
 coat, it is only the hope of a coat. We send you the 
 matter of a coat, something definite, which has happened: 
 but we regret that we have not been able to obtain 
 
AN ESSAY FOR STUDENTS 35 
 
 a genuine glimpse into what it is. When we do, you 
 will be pleased to find that the coat, by the necessities 
 of the case, will put itself together. Hoping for the 
 continuance of your valuable patronage. — Such a letter 
 would make me think that tailoring is not an 
 art, any more than Psychology is a science, for all 
 her assumptions. 
 
 Not that her assumptions, of themselves, matter 
 twopence, one way or the other. It is the use 
 that she makes of them, which matters. Assump- 
 tions are honourable, or dishonourable, according 
 to their intention. If I had to attend a fancy- 
 dress ball, which Heaven forbid, I should go as a 
 Gentleman of the time of Charles the Second. 
 That would be all right. I should assume the 
 appropriate clothes, and a long peruke. Nobody 
 would be deluded, or unduly impressed : nobody 
 would think that I was really of that period. I 
 must go as something, or I cannot go at all. But 
 suppose that I assume, in the corner of a cheque, 
 the signature of a rich friend. How will it fare 
 with me and my honour, when the ulterior signifi- 
 cance of that assumption is tested by the cashier 
 at the Bank ? And I make bold to say that 
 Psychology, or, at any rate, a certain talkative lady 
 who calls herself by that name, is not very scrupu- 
 lous what she assumes, nor very careful of her 
 honour. She longs to be a science, to move in the 
 best circles, in a set not her own, in the drawing- 
 
36 CONFESSIO MEDICI 
 
 rooms of those old peeresses, the Complete Sciences. 
 To get there, she must push and pose, and be 
 hard, pretentious, in a word, unprincipled. Watch 
 her, hinting, cajoling, fighting her way into their 
 society, and you will be reminded of Mrs. Rawdon 
 Crawley, who was, you remember, Becky Sharp, 
 in the company of Lady Steyne, Lady Jane Crawley, 
 and the Dowager Countess of Southdown. And 
 we all know what happened to Becky, when her 
 husband was compelled, by the necessities of the 
 case, to test her ulterior significance. 
 
 II 
 
 Still, we hear so much of the Principles of 
 Psychology, that we are bound to try to find 
 them. But what do we mean, by this word 
 Principles ? 
 
 When a man sets to work to study one of the 
 natural sciences, he provides himself with forms of 
 thought, mental images, which may be called the 
 principles of that science. The chemist has mental 
 images of atoms combining or separating, under 
 definite laws, with definite results : the geologist 
 has mental images of an earth cooled through 
 millions of years from a red-hot haze of gases 
 to a hard globe, and cracked in the cooling. Other 
 men of science, the botanist, the bacteriologist, the 
 physiologist, have mental images of living matter. 
 
AN ESSAY FOR STUDENTS 37 
 
 Is there any difFerence, in kind, between the mental 
 images of chemistry and those of physiology ? 
 Surely, there is no such difference. Matter is none 
 the less matter, though it be living : and motion 
 is none the less motion, though it be voluntary. 
 
 Dr. Johnson's advice is apt here, that we should 
 clear our minds of cant. A great deal of cant is 
 talked about the mystery of life, as if life were 
 somehow more mysterious than the rest of Nature. 
 When a man says that one fact of Nature is more 
 wonderful than another, he is at fault. The striking 
 of a match is every bit as wonderful as the working 
 of a brain : the union of two atoms of hydrogen 
 and one of oxygen in a molecule of water is every 
 bit as wonderful as the growth of a child. Nature 
 does not class her works in order of merit ; every- 
 thing is just as easy to her as everything else : 
 she puts her whole mind into all that she does — 
 
 Lives through all life, extends through all extent. 
 Spreads undivided, operates unspent — 
 
 perfect at every moment, omnipresent, and, like 
 His Majesty the King, within her dominions 
 supreme. Life is neither more nor less mysterious 
 than the attraction of the magnet, the density of 
 a paving-stone, or the colour of a tie : our presence 
 in the midst of Nature's achievements does not 
 affect her estimate of them. She prices her wonder- 
 ful goods all at the same value, like the stock of 
 a sixpence-halfpenny bazaar, nothing under and 
 
38 CONFESSIO MEDICI 
 
 nothing over : she makes them all out of the one 
 stuff, constructing with it a grain of sand, a drop 
 of water, a micro-organism, or a nerve-cell, all with 
 equal ease. In brief, all Nature is of the same 
 nature, all her processes are one process, all her 
 facts are one fact, all her acts are one act, and 
 everything material is ultimately identical with 
 everything else. These platitudes, of course, are of 
 a respectable age : they are no more than the doctrine 
 of Thales of Miletus, who lived, if I remember 
 right, six hundred years before our Lord. Arm- 
 in-arm with Thales, I wonder at the mystery of 
 the fabric of my own brain as I wonder at the 
 mystery of the fabric of a pound of butter ; and 
 I take it for granted, that the forces which animate 
 my tissues are just as natural, that is to say, are 
 just the same, as the forces which animate the 
 tissues of an ape, a frog, an oyster, or a dandelion, 
 and thrill in every grain of sand, and compel two 
 atoms of hydrogen and one of oxygen to clutch 
 each other so close that they are neither hydrogen 
 nor oxygen, nor hydrogen plus oxygen, but water. 
 
 Hitherto, I have said what I believe to be true. 
 Now, I am going to say what I believe to be false. 
 I pray you, therefore, to give me your most careful 
 attention. 
 
 When we strike a match, there is a splutter and 
 a flare, which are the atoms of the match and of 
 the atmosphere performing a new sort of dance. 
 
AN ESSAY FOR STUDENTS 39 
 
 Nothing is added to what was already there; no 
 fresh elements or forces arrive on the gay scene. 
 The atoms are the explosion, and the explosion is 
 the atoms. They hurry up, they change step, they 
 exchange partners : that is all. Before we struck 
 the match, they were dancing, as it were, the second 
 figure of the Lancers ; now, they are dancing the 
 third figure, pulHng and pushing in that hilarious 
 fashion which is called Kitchen-Lancers : that is all. 
 Even so it is, with consciousness. When something 
 strikes us, there is a splutter and a flare, which are 
 the atoms of our cerebral cells performing, in the 
 crowded ball-room of the brain, a new sort of dance ; 
 and that is all. That dance is consciousness, and 
 consciousness is that dance. Consciousness is neither 
 the music which accompanies the dance, nor the 
 reaction which follows the dance : it is the dance, 
 it is atoms in motion. Of course, to dance this 
 particular figure, the atoms must be accustomed to 
 dancing, and there must be enough of them to make 
 up a set, so many ladies and so many gentlemen : 
 and then they can dance till they are tired, and that 
 dance is consciousness. But, we know, it is possible 
 to dance less than sixteen : indeed, a child will dance 
 all alone, without so much as a barrel-organ. Even 
 so it is, with consciousness. In its simplest form, 
 consciousness may be observed even in very humble 
 structures. As, by putting a penny in the slot, we 
 obtain, if the automatic machine be going, a measured 
 
40 CONFESSIO MEDICI 
 
 projection of chocolate or of scent, or of two foreign 
 bodies called cigarettes, or an electric current, or the 
 exhibition of a moving picture, or the liberation of 
 a balance, so, from the amoeba, if it be going, we 
 get something out, some faint consciousness, a mere 
 glimmer ; still, it is the real article, what there is of 
 it. When we stand in the presence of nobler 
 creatures, such as the oyster, we see movements 
 more definitely purposive ; and begin to feel fairly 
 sure that the sun of consciousness has risen. We 
 are for a time puzzled, because the oyster has several 
 centres set apart, and far apart, for consciousness; 
 and it is hard to see how an oyster can be conscious 
 in three or four places at once : and this difficulty 
 is not diminished, but rather is increased, when we 
 contemplate the earth-worm, which is a sort of 
 common lodging-house of consciousness, with a 
 double row of cubicles right and left all the way 
 up. But, when we come to the frog, we know 
 where we are : for we can see at a glance that the 
 cerebral hemispheres must be conscious of the rest 
 of the frog, and that the rest of the frog cannot be 
 conscious of the cerebral hemispheres. Here, at or 
 about this level of life, we find special organs, brains, 
 so complex that they must of necessity be conscious. 
 But of what are they conscious ? Is it of themselves, 
 of their own atomic motion, their own chemical 
 changes ? Not a bit of it : they are conscious of 
 sensations, dim pleasures and pains, heat and cold. 
 
AN ESSAY FOR STUDENTS 41 
 
 light and darkness, taste and smell. They feel, they 
 perceive. From this point onward, it is easy to 
 observe the development of consciousness; the brain, 
 as we ascend the scale of life, beginning to divide its 
 experiences into self and not-self. At first, it was 
 conscious : at last, it is self-conscious. Henceforth, 
 it remembers, imagines, thinks, and wills, or thinks 
 that it wills. It reads and writes, pursues the fine 
 arts, invents God, takes an active interest in politics, 
 and, if it be lodged in a male skull, has a vote. 
 Behold, Gentlemen, yourselves : you who are so 
 highly differentiated brains that you can understand 
 anything, even the false doctrine which I have here 
 declared to you. For I no more believe that my 
 brain is self-conscious than I believe that two and 
 two make five. All the same, it was a fair caricature 
 of the random talk which calls itself Psychology. 
 
 Ill 
 
 Let us start again, at the right end of creation, 
 at ourselves. If we desire to find the Principles of 
 Psychology, it seems not amiss that we should first 
 look for them there, where Psyche and Logos are 
 most in evidence. Besides, we know more of our- 
 selves than of the lower animals. 
 
 Let us bring Science to bear on our environment. 
 There cannot be any harm in doing that. Here, at 
 this moment, I still reading this essay to you, and 
 
42 CONFESS lO MEDICI 
 
 you, it may be, still listening to me, where are we ? 
 This Common-room, its colour, light, and resonance, 
 its temperature, and the smell of tobacco, and the 
 vision of your presence — What, in the name of 
 Science, are all these facts ? A mild shock passes 
 through me, as I remind myself that they are diverse 
 lengths and velocities of waves of air or of ether. 
 The tint of the walls, the pattern of the carpet, the 
 warmth of the fire, the sound of my voice, the 
 fragrance of your smoking, the sight of your faces, 
 all are waves, of which I know nothing, agitating 
 an invisible something, of which I know less than 
 nothing. Colour is so many waves a second, heat 
 so many more, sound so many more. Neither do 
 I find in the furniture and upholstery, or in the 
 hardness of this desk in front of me, or in the resist- 
 ance of the ground under my feet, or in the mus- 
 cular sense of my limbs, or in the pressure of the 
 glasses across my nose, any other sort of environ- 
 ment than that which I find in colour, warmth, and 
 sound. In brief, this room is the sum of our 
 sensations ; and our sensations are waves from the 
 material world impinging on our sensory nerve- 
 endings : and the material world is a permanent 
 possibility of consciousness. That is the teaching 
 of Science. When we take our sensory nerve- 
 endings home with us, what is left of this room ? 
 The answer seems to be, that nothing is left but 
 a permanent possibility of consciousness, impinging 
 
AN ESSAY FOR STUDENTS 43 
 
 on nothing. This, I feel sure, is the only kind of 
 room in which Science permits us to hold our 
 meetings. 
 
 But consider what happens to these waves. They 
 strain through our sensory nerve-endings like water 
 through a sieve, rush up our nerves, attain their 
 appointed places in our cerebral hemispheres, and 
 there they set our atoms dancing. But, whatever 
 they do, they are still waves : and, when they stop 
 moving, are still a sort of bottled motion. Once 
 a wave, always a wave ; that is the law of the con- 
 servation of energy : and a wave can no more be 
 a sensation than a fiddle can be a tune. They can- 
 not translate themselves : it is we who do that for 
 them. What are they, apart from us ? A tree is 
 not green, unless we see it ; a man playing a 
 trombone makes no noise, unless we are there ; 
 there is neither taste nor smell in our food, unless 
 it comes our way ; and a brick wall is not hard, 
 unless we hit our heads against it. If I prick my 
 finger with a needle, the pain is in me, not in the 
 needle : if I wear a grey coat, the grey is in me, not 
 in the coat : and if I hear a motor hooting, the hoot 
 is in me, not in the motor. 
 
 From these elementary facts, which are the 
 commonplaces of Science, we come at last toward 
 the Principles of Psychology. No, we do not : we 
 only come within ear-shot of a stand-up fight between 
 two irreconcileable modes of thought. 
 
44 CONFESSIO MEDICI 
 
 Over chemistry, geology, botany, physiology, a 
 man cannot go wrong. In these Complete Sciences 
 there is no choice of principles. There cannot be 
 two mental images of the earth : there cannot be two 
 mental images of living matter. But there are two 
 mental images of Psyche, two conflicting modes of 
 thought, each in arms against the other : and we 
 must choose between them, for we cannot have it 
 both ways. Psyche is, or Psyche is not : we must 
 choose, and our choice is a serious business for us, 
 and for those who take their cue from us. It is 
 said that in Paris, all through the Reign of Terror, 
 there were stupid people, in the quiet parts of the 
 city, who never heard the tumbrils on their way to 
 the guillotine, never knew that anything more was 
 happening than the usual discontent, the usual mob- 
 oratory. If that be so, they have their parallel 
 to-day in the stupid people who never hear the 
 tumbrils of Experimental Psychology, escorting 
 Psyche on her way to be explained away. 
 
 IV 
 
 That school of Psychology which bears, 'mid snow 
 and ice, a banner with this strange device. Psyche is 
 not, offers to provide us with a ready-made mental 
 image of self-conscious matter. The opposite school 
 offers us, to my thinking, a pleasanter image ; which 
 is indeed that original Psyche in which we all 
 
AN ESSAY FOR STUDENTS 45 
 
 believed when we were children. Give me leave 
 to commend this pleasanter image to you, not in 
 the name of tradition or sentiment, but in the name 
 of logic and common-sense. 
 
 Take for granted the primary miracle, the trans- 
 lation of waves into sensations. So easy, to say 
 that. Still, assume it : assume that we have got 
 past that miracle, and remain competent judges of 
 what comes next. What have we gained, and where 
 do we stand ? We have got no further, we have 
 gained nothing. A chaos of sensations has replaced 
 a chaos of waves ; but that does not help us toward 
 the construction of the world in which we live. 
 We have substituted chaos for chaos, and there we 
 stop. If this world be a world of sensations, it is 
 all up with Psyche, and we must swear allegiance 
 to them who deny her existence. 
 
 But we live, not by sensations, but by experiences : 
 not in chaos, but in space and time. I dare not 
 philosophize about space and time. I am inclined 
 to the transcendental doctrine, that they are in some 
 sense antecedent to experience and independent of 
 sensation. Psychology says that the baby begins 
 without them, and makes them up as it goes along ; 
 but I cannot see how, without them, it can begin 
 to go along, or out of what it can make them up. 
 Our experiences cannot report themselves as in 
 space and time ; for they cannot report themselves 
 at all, till space and time are there for them. One 
 
46 CONFESSIO MEDICI 
 
 might, perhaps, have a simple sensation of all red, 
 or all blue ; but one cannot have a sensation of 
 blue and red side by side, because neither can report 
 itself as side by side with the other. Blue and red 
 side by side are not a sensation, but an experience ; 
 and the more you try to imagine a baby apart 
 from its universe, or a universe apart from its baby, 
 the less you can. Really, we know very little about 
 the baby. Professor James, for instance, who is 
 like Socrates for simphcity of style, says : 
 
 The Object which the numerous inpouring currents of the 
 baby bring to his consciousness is one big blooming buzzing 
 Confusion. That confusion is the baby's universe. . . . 
 
 If that was indeed my universe once, then glory 
 be to Psyche, for making it what it is now. I 
 cannot believe, as I look at my present orderly 
 and beautiful universe, that I am a succession of 
 states of consciousness, or a stream, or anything 
 of the kind. How a stream of states of conscious- 
 ness can be conscious of itself, conscious that it is 
 neither a stream nor a state, when all the time it 
 is a state of a stream, and therefore is not a stream 
 of states, yet is a stream, and therefore is nothing 
 at all, yet is conscious of streaming, and therefore 
 must be something — how all this can mean any- 
 thing, let them decide, to whom Psyche means 
 nothing. Here is that which is neither matter in 
 motion, nor sensations in chaos, nor states in succes- 
 sion. It lives on experiences, which it judges. 
 
AN ESSAY FOR STUDENTS 47 
 
 places, times, connects, compares, and remembers. 
 It abides in a flux of objects, all of which it has, 
 none of which it is. Out of waves, it creates sensa- 
 tions ; out of sensations, experiences ; out of experi- 
 ences, its proper life. Yet these achievements are 
 trivial, compared to its more active work. For 
 it has a will of its own. In a world which is all 
 made of results, it still manages, somehow, to be 
 a cause. It is permanent, real, non-material : I 
 never could see why everything should have to 
 be made of matter to be real. 
 
 But the animals, the lower animals ? Are we not 
 bound to widen our conception of Psyche till it 
 includes all sentient life ? In the presence of the 
 lower animals, what becomes of all that I have been 
 saying ? 
 
 I will try to be perfectly honest here. Ourselves, 
 we can, in some measure, understand. The moment 
 we leave ourselves, all understanding begins to fail ; 
 and inch by inch, as we go back down the scale 
 of life, the darkness gets more impenetrable. The 
 inner lives of animals are one of Nature's ultimate 
 secrets. We can hardly guess at them, even at 
 those which are likest to us : we cannot imagine 
 the final reason why they and we are herded together 
 on this planet. Well, we must be guided by what 
 we can see. I must choose, it seems, between two 
 schools of thought. One, which explains me in 
 terms of the lower animals, explains me away. 
 
48 CONFESSIO MEDICI 
 
 leaving nothing but my cerebral hemispheres. The 
 other, explaining me as I think that I deserve to 
 be explained, evades the mystery of the lower 
 animals. I shall certainly die before these two 
 schools are reconciled. Meanwhile, I choose that 
 school which gives the best explanation of me : 
 because I am able to square its teaching with my 
 knowledge of myself. 
 
 In defence of my choice, I say that Science is 
 just as ignorant as I am of the inner lives of the 
 lower animals. You, who are young men of science, 
 I pray you to imagine that our meeting is over 
 and we have gone home, we and our sensory nerve- 
 endings. It is midnight : this room has relapsed 
 to a permanent possibility of consciousness, a fact 
 which is hardly more definite than a dream. 
 Suddenly, into this abstract environment, enter, by 
 chance, a mouse and a blackbeetle. What do they 
 make of it all ? How does it strike them ? What 
 is it, to be a blackbeetle ? When a blackbeetle 
 enters into a room, in what sense, if in any, does 
 the room enter into the blackbeetle ? Go to Science, 
 and ask her these questions ; and she will confess 
 that she has not the ghost of a notion how to answer 
 them. Ask yourselves what you mean by the con- 
 sciousness of a mouse : and you will find that you do 
 not know what you mean. Nor will men a thousand 
 years hence be any nearer to that knowledge. 
 
 I am sorry : I began with an essay, and here 
 
AN ESSAY FOR STUDENTS 49 
 
 I am with a creed. I believe in the reahty of 
 myself, and in the freedom of my will : and I 
 believe that we, addressing ourselves to the universe, 
 are as real as the universe, addressing itself to 
 us. But I cannot even begin to try to guess 
 which of the lower animals are run, as we are, on 
 spiritual lines. If I look down a list of the Verte- 
 brata, beginning with Man and ending with the 
 Amphioxus, I only see, long before I get near the 
 Amphioxus, the gradual blotting-out and final 
 extinction of all that is most sure and most familiar 
 to me in Man : and then come the Invertebrata. 
 I believe that there is a final cause of the lower 
 animals, wholly independent of the fact that they 
 are useful, nourishing, instructive, or amusing to 
 us : but that is a matter of faith, whereas my belief 
 in myself is a matter of knowledge. Well, I must 
 go by what I know. Here, not in blind guesses 
 and vague talk about the lower animals, but in the 
 clear sense that I am I, here, in myself, and in 
 myself at my best, I hope to find the Principles 
 of Psychology. We cannot understand, we cannot 
 explain, the anthropoid apes. Still, that is no reason 
 why the anthropoid apes should explain us. I find 
 no logic in the fashionable phrases about streams 
 of states of consciousness : I stick to the old belief, 
 I am that I am, which is a comfortable doctrine, 
 and more than comfortable, for it does not outrage 
 the rules of logic. 
 
50 CONFESSIO MEDICI 
 
 The faults of Psychology, her want of principles, 
 her neglect of logic, make her useless in practical 
 life. She thinks that she is very useful, or will be 
 some day ; she pretends to understand us, our 
 motives, habits, passions, acts, and imaginings ; she 
 will interpret us to ourselves. Let us consider her 
 oiFer to superintend our conduct and our work. 
 
 What has she to do with our conduct? The 
 influences which determine conduct are not in text- 
 books, but in the home, the school, religion, com- 
 petition, and the policeman : and the application of 
 Psychology to individual conduct is like the applica- 
 tion of an aseptic dressing to Central Africa. From 
 the nursery to the grave, I look backward and 
 forward : my father and mother, brothers and sisters, 
 friends and acquaintances, masters and teachers — 
 how did Psychology help them to help me ? Which 
 of us owes thanks to her for the good in him ? 
 Of all her talk about conduct, not a word is original, 
 not one : it is all cribbed, and was old already, ages 
 before her birth, and was enforced and accepted in 
 every country of the civilized world. If we could 
 strip her of her borrowed plumage, she would be 
 left without ethics enough to make her decent. 
 
 But, like all of us in time of present failure, she 
 promises to do great things in the future, when 
 she is really grown up. There is to be a millennium. 
 
AN ESSAY FOR STUDENTS 51 
 
 The days will come, when laws shall be made on 
 psychological principles, and men and women shall 
 be mated, and children mothered by the State, and 
 evils abolished, and everybody shall be just like 
 everybody else, all on psychological principles. But 
 these days will not come till the principles are ready 
 for them, which now are conspicuous by their 
 absence. Meanwhile, Edwin and Angelina will fall 
 in love in the old style, without awaiting instructions 
 from Psychology ; and the world in general will no 
 more ask the advice of Psychology in matters of 
 conduct than it would ask the gentlemen at Green- 
 wich Observatory to stop the next earthquake. 
 Her promises are magnificent : but what is the use 
 of them ? 
 
 Her proper line is the abnormal. She has care- 
 fully studied exceptions to rules, has dissected the 
 twilight, has made some discoveries, and will make 
 more. Psychical Research is full of discoveries. 
 I believe in hypnotism, I believe in telepathy, I 
 believe that Psyche may call to Psyche, and be 
 heard. Only, from the point of view of this 
 essay, I have three remarks to make on Psychical 
 Research. 
 
 (i) We mean by it, mostly, a patient, critical, 
 dispassionate enquiry into stories of ghosts, haunted 
 houses, premonitions, thought-transference, and so 
 forth. But I would rather, here, be passionate 
 than dispassionate. The enquiry touches me too 
 
52 CONFESSIO MEDICI 
 
 nearly ; Psyche is on her trial ; it is a matter of 
 her life or death. I do not see the good of 
 researching into Psyche without believing in her. 
 If a man believes that she is a succession of states 
 of consciousness, without anybody there to be con- 
 scious that these states are successive, his researches 
 will be as vague — it is an old simile — as a blind 
 man looking in a dark room for a black hat that 
 is not in the room. I believe that Psyche may 
 call to Psyche : but I do not believe that a suc- 
 cession, which is a word, not a thing, can call to 
 another succession, or do anything, or be any- 
 thing. I could as well imagine two calling to two, 
 begging it to come and make four. 
 
 (2) Psychical Research, in the wider sense of 
 its name, includes Experimental Psychology. So 
 far as I can understand these experiments, they 
 are Physiology : they use the whole body as a 
 gigantic nerve-muscle preparation. That is not 
 Psychology, but Physiology : it is the method 
 which you follow in a case of paralysis. Say 
 that you suspect some loss of power in one arm ; 
 Squeeze my finger, you say to the patient ; you 
 test his muscles, reflexes, appreciations of touch 
 and of warmth, and so forth. But that is not 
 Psychology. Neither is it Psychology, to study 
 how long it takes a man to spot a word flashed 
 before his eyes, or to respond to a signal : it is 
 merely a parlour-game of Physiology. 
 
AN ESSAY FOR STUDENTS 53 
 
 (3) Abnormal people, spiritual freaks, are what 
 Psychology loves. It does not appear that she 
 does much for them, but she demonstrates them, 
 plays tunes on them. One is clairvoyante, another 
 has fits, another has two personalities, and I have 
 read of a distressed lady who had five ; another 
 is a daemoniac Frenchwoman, Madame A or Mile. 
 X, a most untrustworthy person. Psychology plays 
 with these unhappy people, as a bad child pulls the 
 wings off a fly, to see what it will do without them. 
 Of course, these cases are, more or less, real : but 
 they are so rare, that we learn from them next to 
 nothing. 
 
 But what use is she to us in practice ? Take, 
 for example, cases of drink, and cases of insanity. 
 We class them as organic diseases of the brain, and 
 so they are : and we look for help, in their treat- 
 ment, to the medical sciences. But we never look 
 to Psychology : except that hypnotism is a method 
 of treatment. And hypnotism, surely, is what we 
 must call a spiritual treatment ; it falls in with the 
 commonplace influences of one will over another, 
 which are spiritual influences. Therein the patient 
 must minister to himself. Sixpennorth of drugs to 
 get at his brain, and six months of spiritual treat- 
 ment to get at him : that is the way of practice. 
 I do not say that the spiritual treatment is our 
 business: it is the business of the patient's friends. 
 But I do say that the record of the dealings of 
 
54 CONFESSIO MEDICI 
 
 Psychology with Psyche in trouble is a record of 
 words, not of deeds. To hear her talking of these 
 diseases, is to be reminded of Nero fiddling while 
 Rome was burning. 
 
 I seem to have come to this lame conclusion, 
 that our chief use of Psychology is to satisfy the 
 examiners in Psychology. Also, she makes us think. 
 But, when she says that we are streams of states 
 of consciousness, then she is talking nonsense, 
 not Science. 
 
A GOOD EXAMPLE 
 
 It seems a pity, that the good example of Ambr oise 
 Pare is almost forgotten. He was born in 1510, 
 of working people, in a village : he went early into 
 apprenticeship, and thus escaped the deadening 
 influences of the University of Paris — / make no 
 claim to have read Galen either in Greek or in Latin : 
 for it did not please God to be so gracious to my youth 
 that it should be instructed either in the one tongue 
 or in the other. For three years, or it may be four, 
 he held a resident appointment at the Hotel Dieu. 
 For more than twenty years, off and on, he was 
 an Army-surgeon, with a foothold in Paris. He 
 had a great practice, wrote, lectured, upheld the 
 rights of the surgeons against the physicians, held 
 many Court appointments, and was twice married. 
 He attended Henri II., Fran9ois II., Charles IX., 
 Henri III., Fran9ois due de Guise, and Coligny ; 
 knew Vesalius, Catherine de Medicis, Mary Stuart, 
 and all Paris ; was on the side of the Huguenots : 
 and outlived, at eighty, the siege of Paris by 
 Henri IV. 
 
 55 
 
56 CONFESSIO MEDICI 
 
 From Malgaigne and le Paulmier, we may learn 
 all about his life. In his books, we possess him, 
 his affairs, habits, and opinions ; and may almost 
 recognize his very air, and the sound of his voice. 
 The record of his adventures with the Army, his 
 Voyages faicts en divers Lieulx, is fine reading. 
 Here is one who can praise without offence his 
 own performances, and chronicle with proper pride 
 his own words, and score off a fool, and relish his 
 meat and drink : a shrewd, happy, confident, 
 business-like gentleman, not wholly free, in a vain 
 and cruel age, from vanity, nor incapable of cruelty, 
 but steadily compassionate, humble, wise, and 
 honourable : and a true lover of his country, his 
 home, and his profession. Everybody reads Boswell 
 and Pepys, but who reads Pare? All his gossip 
 about his patients, and all his good stories of the 
 campaigns, the months of endurance, the moments 
 of terror, the dreadful jobs to be done after an 
 engagement, the brutality of the Spanish soldiers, 
 the rough-and-tumble ways of the French camp, 
 all the tragedy and all the comedy, are shelved in 
 this or that library, and the dust is thick on 
 Opera Omnia. We have no time to read of the 
 life of an Army that is three centuries dead ; we 
 know only this of Pare, that he used to say, / 
 dressed him, and God cured him : and he deserves 
 more recognition than the memory of that one 
 phrase. 
 
A GOOD EXAMPLE 57 
 
 Je lepansay et Dieu le guarit: and he rings changes 
 on it, thus : 
 
 I dressed him, and God cured him. 
 
 My lord, by the grace of God, was cured. 
 
 I did him the services of physician, surgeon, apothecary, 
 and cook. I dressed him, to the end of the case, and God 
 cured him. 
 
 I returned to Paris, with my gentleman whose leg I had 
 cut off: I dressed him, and God cured him. I sent him 
 home happy with a wooden leg, and he was well satisfied, 
 saying that he had got off cheap. 
 
 I reduced and dressed his leg so skilfully that he was free 
 from pain, and slept all night : and in time, thank God, he was 
 cured, and is now in the King's service. 
 
 God blessed my work so well, that I sent my patients 
 back to Paris ; where I still had to make some incisions in 
 M. de Mansfeld's arm. He was cured, by the grace of God, 
 and made me a handsome present ; so I was well content 
 with him, and he with me : as he has shown me since. 
 
 Always, this piety was in him : not only in 
 practice, but in daily life. It is true that every- 
 body, in his time, talked religion ; but the sincerity 
 of Fare's talk is as clear as crystal. And it is true 
 that he was superstitious ; but he was less supersti- 
 tious than many of his grand patients, and mocked 
 at the fashionable craze for amulets and horoscopes. 
 What nickname, I wonder, had he at the Court? 
 What did the Queen Mother, and the mad Valois 
 line, make of him ? Observe him, this uneducated 
 self-made man, standing up, at that Court, for 
 plain living and Huguenot thinking : and the King 
 
58 CONFESSIO MEDICI 
 
 himself, on the night of the Massacre, locking him 
 in a room of the Louvre, swearing that it was not 
 reasonable that a man, who was worth a whole world 
 of men, should be murdered. 
 
 But consider his works. Sitting here, transcribing 
 Opera Omnia, I could fill a book with his good 
 stories and his good cases : but one must sufRce, 
 and he who wants more can find them for himself. 
 
 M. le Marquis d'Auret, brother of M. le Due 
 d' Ascot, was a very magnificent young gentleman, 
 twenty years old. He was suffering from a gun- 
 shot wound of the thigh, which had fractured the 
 bone. For seven months he had been lying in 
 misery, at Mons in Hainault, slowly nearing death, 
 and attended by many doctors. The King, at the 
 Duke's request, sent Pare, who was at this time 
 sixty years old, and premier surgeon at the Court. 
 Pare found the young man in a frightful state ; as 
 if he had been, for seven months, with a compound 
 fracture of the femur, and diffuse suppuration, under 
 the Christian Science treatment : 
 
 Seeing and considering all these great complications, and 
 the vital powers thus broken down, truly I was very sorry I 
 had come to him, because it seemed to me that there was 
 little hope that he would escape death. All the same, to 
 give him courage and good hope, I told him I would soon 
 set him on his legs, by the grace of God, and the help of 
 his physicians and surgeons. 
 
 Having seen him, I went a walk in a garden, and prayed 
 God to show me this grace, that he should recover, and to 
 
A GOOD EXAMPLE 59 
 
 bless our hands and our medicaments to cure such a complica- 
 tion of diseases. I turned in my mind what measures I must 
 take to this end. They called me to dinner. I came into 
 the kitchen, and there I saw, taken out of a great pot, half 
 a sheep, a quarter of veal, three great pieces of beef, two 
 fowls, and a very large piece of bacon, with abundance of 
 good herbs. Then I said to myself that the broth of the 
 pot would be fiiU of juices, and very nourishing. 
 
 After ditmer, we began our consultation, all the physicians 
 and surgeons together, in the presence of M. le Due d' Ascot 
 and some gentlemen who were with him. I began to say 
 to the surgeons that I was astonished that they had not made 
 incisions in the patient's thigh, seeing that it was all suppu- 
 rating, and the thick matter in it very fetid and offensive, 
 showing that it had long been pent-up there ; and I had 
 found with the probe caries of the bone, and scales of bone 
 already loose. They answered me. Never would he consent 
 to it : indeed, that it was near two months, since they had 
 been able to get leave to put clean sheets on the bed, and 
 that one scarce dared touch the coverlet, so great was his 
 pain. Then I said. To cure him, we must touch something 
 else than the coverlet of his bed. Each said what he thought 
 of the malady of the patient, and, in conclusion, they all held 
 it hopeless. I told them that there was still some hope, 
 because he was young, and God and Nature sometimes do 
 what seems to physicians and surgeons impossible. 
 
 Then follows a discourse, of prodigious length. 
 The treatment, he tells the doctors, must include 
 free incisions, fomentations, a clean bed, hot bricks 
 and a hot bottle duly medicated, massage, a dusting 
 powder, a plaster and a pillow for a bed-sore, a 
 refrigerant over the heart, a head-cloth and a fore- 
 head cloth and a pomander, an opiate at night, a 
 
6o CONFESSIO MEDICI 
 
 generous diet, a moderate allowance of wine : " and, 
 (he adds) we must make artificial rain, pouring water 
 from some high place into a cauldron, that he may 
 hear the sound of it, whereby sleep shall be induced 
 on him." For the fomentations, a decoction of 
 sage, rosemary, thyme, lavender, chamomile, melilot, 
 and red roses boiled in white wine : for a generous 
 diet, raw eggs, plums stewed in wine and sugar, 
 the broth of the great pot, white meat of fowls, 
 partridge-wings, and other roast meats easy to 
 digest, with orange, verjuice, sorrel, and bitter 
 pomegranates : or boiled with good herbs, such 
 as lettuce, parsley, chicory, bugloss, marigold, 
 and the like. This excellent food, and the well- 
 flavoured opiate, and the fragrant blend of roses, 
 lilies, poppies, and camphor on the forehead-cloth, 
 and the good bread, which must be farm-house 
 bread neither too stale nor too new, are all noted 
 with the utmost minuteness. Yet the discourse 
 is mainly on pathology. If he spoke it as he 
 published it, the greater part of the afternoon must 
 have been occupied. 
 
 This my discourse was well approved by the physicians 
 and surgeons. The consultation ended, we went back to the 
 patient, and I made three openings in his thigh. . . . Two 
 or three hours later, I got a bed made near his old one, 
 with clean white sheets on it ; then a strong man put him 
 into it, and he was thankful to be taken out of his foul, 
 stinking bed. Soon afterward, he asked to sleep ; which he 
 did for nearly four hours ; and everybody in the house 
 began to feel happy, and especially his brother. 
 
A GOOD EXAMPLE 6i 
 
 Slowly, the young man recovered ; and we have 
 a pleasant picture of his convalescence : 
 
 I stopped there about two months, not without seeing 
 many patients, rich and poor, who came to me from three 
 or four leagues round. He gave food and drink to the 
 needy, and commended them all to me, asking me to help 
 them for his sake. I protest that I re&sed not one, and 
 did for them all that I could, to his great pleasure. Then, 
 when I saw him beginning to get well, I told him that he 
 must have viols and violins, and a buffoon to make him laugh : 
 which he did. In a month, we got him into a chair; and 
 he had himself carried about his garden, and to the door of 
 his chateau, to watch people passing. The villagers, for two 
 or three leagues round, now that they could see him, came 
 on holidays to sing and dance, a regular crowd of light- 
 hearted country folk, rejoicing in his convalescence, all glad 
 to see him, not without plenty of laughter and plenty of 
 drink. He always gave them a hogshead of beer : and they 
 all drank his health with a will. He was dearly loved, both 
 by the nobihty and by the common people, as for his generosity, 
 so for his handsome face and his courtesy, with a kind look 
 and a gracious word for everybody. In six weeks he began 
 to stand a little on crutches, and to put on flesh and get a 
 good natural colour. He wanted to go to Beaumont, his 
 brother's place : and was taken thither in a carrying-chair, 
 by eight men at a time. And the peasants, in the villages 
 through which we passed, when they knew it was M. le Marquis, 
 fought who should carry him, and insisted that we should drink 
 with them : and it was only beer, but they would have given 
 us hippocras, if there had been any. And all were glad to 
 see him, and prayed God for him. 
 
 There is no room here to describe the life at 
 Beaumont, the feasting, the fencing-matches, the 
 
62 CONFESSIO MEDICI 
 
 fifty guests met to amuse the patient ; and how 
 they tried, more shame to them, by all drinking 
 to Pare, to make him drunk, and failed, for he 
 would drink no more than his usual allowance ; 
 and how, at last, well-thanked, well-paid, he got 
 away home. We do not now record cases in 
 this lively style : 
 
 I took my leave of the Duchess, who drew a diamond from 
 her finger, and gave it to me, in her gratitude for my good 
 care of her brother-in-law : and the diamond was worth 
 fifty crowns. I was two days and a half, on my way home, 
 seeing the city of Antwerp ; where certain merchants begged 
 that they might have the honour of giving us a dinner or 
 a supper : it was. Who should have us ? And they were all 
 truly glad to hear how M. d'Auret was doing, and made 
 more of me than I asked. I forgot to say that the Spaniards 
 have since ruined and demolished his Chateau d'Auret, and 
 have sacked, plundered, and burned all the houses and villages 
 belonging to him, because he would not be of their wicked 
 party in their assassination and ruin of the Netherlands. 
 
 Observe, all you who are students, that the 
 patient had six doctors, but no nurse, and that 
 Pare understood the whole art of nursing ; and so 
 ought you. Even Charles IX., dying of phthisis, 
 and haunted by the ghosts of the Massacre, had no 
 nurse, save the old lady who had looked after him 
 when he was a child : and she, as we happen to 
 know, composed herself to sleep while he was dying. 
 Observe, also, the sequence of Pare's thoughts : 
 the shock of the first sight of the case, the bold 
 
A GOOD EXAMPLE 63 
 
 encouragement of the patient, the meditation in the 
 open air, the shrewd glance at the great pot, the 
 authority in consultation, the readiness to operate. 
 Observe, especially, his glorious common-sense and 
 his scrupulous attention to every detail of the 
 treatment. 
 
 For his home-life, see le Paulmier. The start in 
 practice in Paris, with two little rooms on a ground- 
 floor, handy to the fashionable duelling-field : the 
 poverty of his first marriage, the coming of pro- 
 sperity, the move into a good house, the purchase 
 of adjoining houses, and of a cottage at Meudon : 
 the affluent air of his second marriage, and what 
 important personages were sponsors for the grand- 
 children, and how the recurrent names of old friends, 
 as witnesses, enliven marriage-settlements and leases : 
 and what family affection was in the home, and how 
 the little church round the corner, Saint Andre des 
 Arcs, baptized, married, and buried them all — you 
 find it all made out and put in order. The evidence 
 is complete, that Pare was happy in his family and 
 in his friends, a good business man, charitable, 
 kindly, a bit vain, a bit old-fashioned, fond of life, 
 glad to be a loyal, hard-working, and well-beloved 
 citizen. If now, at the corner of the Rue de 
 I'Hirondelle, close to the Quai des Augustins, you 
 could come across the jocund ghost of the Maison 
 des Trois Maures, its windows would be radiant 
 with light, and you would hear laughter and friendly 
 
64 CONFESSIO MEDICI 
 
 voices, and would smell a good dinner, if dinners 
 have ghosts : but you would hear no solemn or 
 pedantic talk, no Greek and Latin. This ghostly 
 house, when it was alive, was the home of a man 
 self-made and self-taught, who won his everlasting 
 name, without help of birth, education, privilege, 
 or money, by hard work, by wholesome self- 
 assurance, by spiritual goodness, and by strict 
 attention to business. 
 
 "We have difficulties which did not come to 
 him. Incessant examinations, books, and schedules 
 weigh on our Hospital life : then comes practice, 
 and the stress of competition, so severe that many 
 of us fail, or partly fail, do what we will. To 
 him, we think, success was easier. He just was 
 apprentice, House-surgeon, barber-surgeon. Army- 
 surgeon, and eminent surgeon, each in due time : 
 he had elbow-room, he was free, he was lucky. 
 
 It is true that Pare, at the very beginning 
 of his time in the Army, even before he was 
 qualified, had a grand bit of luck. His famous 
 discovery, that boiling oil is not good for gunshot 
 wounds, was ascribed, even by him, to chance. It 
 happened at Suse, a little place near Mont Cenis, 
 in 1537: 
 
 The enemy within the castle, seeing our men come on 
 them with great fiiry, did all that they could to defend 
 themselves, and killed and wounded many of our soldiers with 
 pikes, arquebuses, and stones : whereby the surgeons had all 
 
A GOOD EXAMPLE 65 
 
 their work cut out for them. Now I was at this time a 
 ftesh-water soldier ; I had not yet seen gunshot wounds at 
 the first dressing. I had read in John de Vigo, book one. Of 
 Wounds in General, chapter eight, that wounds made by fire- 
 arms partake of venenosity, by reason of the gunpowder ; and 
 for their cure he bids you cauterize them with oil of elders, 
 scalding hot, mixed with a Uttle treacle. And to make no 
 mistake, before I would use the said oil, knowing that it was 
 to bring great pain to the patient, I asked first, before I 
 applied it, what the other surgeons used for a first dressing ; 
 which was, to put the said oil, boiling well, into the wounds, 
 with tents and setons : wherefore I took courage to do as 
 they did. At last, my oil ran short ; and I was compelled, 
 instead of it, to apply a digestive made of yolks of eggs, oil 
 of roses, and turpentine. In the night, I could not sleep in 
 quiet, fearing some default in the not cauterizing, lest I should 
 find those, to whom I had not applied the said oil, dead from 
 the poison of their wounds ; which made me rise very early 
 to visit them : where, beyond my expectation, I found that 
 they to whom I had applied my digestive had suffered but 
 little pain, and their wounds without inflammation or swelling, 
 having rested fairly well that night. The others, to whom the 
 boiling oil was applied, I found feverish, with great pain, and 
 swelling round the edges of their wounds. Then I resolved 
 nevermore to burn thus cruelly poor men with gunshot wounds. 
 When I was at Turin, I found a surgeon famed above all 
 the rest for his treatment of gunshot wounds ; into whose 
 favour I found a way to insinuate myself, that I might have 
 the recipe of his balm, as he called it, wherewith he dressed 
 these wounds. And he made me pay my court to him for 
 two years, before I could possibly get the recipe out of him. 
 In the end, thanks to my gifts and presents, he gave it to 
 me, which was this, to boil down, in oil of lilies, young 
 whelps just bom, and earthworms prepared with Venice tur- 
 
66 CONFESSIO, MEDICI 
 
 pentine. Then was I joyful, and my heart made glad, that 
 I had learned his remedy, which was like that which I had 
 obtained by chance. 
 
 See how I learned to treat gunshot wounds : not out of books. 
 
 His Other great discovery, the use of the ligature, 
 instead of the red-hot irons, to stop the bleeding 
 of an amputation, was made about 1552 : which 
 it pleased God to teach me, without T had ever seen 
 it done in any case, no, nor read of it. Prometheus, 
 who brought fire to suffering mortals, is not to be 
 compared with this good surgeon, who took it away 
 from them. 
 
 Once we begin to count his gifts, it is a long 
 list. He had a keen, orderly, business-like mind, 
 intensely practical ; a pleasant cleanness of talk on 
 sexual subjects ; perfect contentment with his place 
 in society ; love of home, pride in his work, be- 
 lief in himself, and unaffected sympathy with his 
 patients. These gifts, and more, were in him, and 
 kept him young. 
 
 But all praise of him is poor stuff, beside that 
 one picture of him which is in the Memoirs of 
 Pierre de I'Estoile. In 1590, after the battle of 
 Ivry, came the siege of Paris. It began in May; 
 by the end of August, the poor were dying like 
 flies, and the dead were lying in the streets : the 
 agony of that siege, and the fury of the League, 
 under the iron rule of the Archbishop of Lyon, 
 belong to history. Pare, eighty years old, and 
 
A GOOD EXAMPLE 67 
 
 with only four months to live, was still afoot in 
 the hot streets, among the starving crowd. His 
 practice, we may be sure, had left him, and gone 
 to Antoine Portail and other surgeons. His 
 grand patients, Catherine de Medicis, the King, 
 the Guises, were dead. Suddenly, close to his 
 own house, he came face to face with the Arch- 
 bishop of Lyon : either by chance, or of set 
 purpose to speak his mind to him. " I remem- 
 ber," says Pierre de I'Estoile, "about eight or ten 
 days, at most, before the siege was raised, Mon- 
 seigneur the Archbishop, crossing over the end of 
 the Pont Saint Michel, when he found his way 
 blocked by a crowd of those who were dying of 
 hunger, they cried out to him, begging for bread 
 or for death : he not knowing what to say to 
 them. Master Ambroise Pare meets him, and says 
 to him in a loud voice, ' Monseigneur, this poor 
 people, whom you see here round you, are dying 
 of the cruel pains of famine, and they ask pity of 
 you. For God's sake. Monsieur, have pity on 
 them, if you want God to have pity on you : 
 think a little of the high place to which God has 
 called you, and how the cry of these poor men 
 and women goes up to Heaven, and is a warning 
 sent you by God, to remind you of the duties of 
 your office, for which you have to answer to Him. . 
 Therefore, by that office, and by the power which 
 we all know that you have, bring about peace for 
 
68 CONFESSIO MEDICI 
 
 us, and give us a way of living: for the poor can 
 no longer help themselves. Do you not see that 
 all Paris is dying, thanks to the wicked men who 
 wish to prevent peace, which is the special work 
 of God ? Set all your strength against them, 
 Monsieur : take in hand the cause of this poor 
 afflicted people, and God will bless you and repay 
 you.' Monseigneur the Archbishop said nothing, 
 or next to nothing : only, he was patient to hear 
 him to the end and not interrupt him, which 
 was not his usual way. And, afterward, he said 
 that the good man had fairly astonished him ; 
 and again, that this was not the sort of politics 
 he was used to hear talked ; and that Master 
 Ambroise Pare had waked him up, and made 
 him think of many things." Four months later, 
 Pierre de I'Estoile writes : " On Thursday, De- 
 cember the twentieth, the Eve of Saint Thomas, 
 at Paris, in his own house, died Master Ambroise 
 Pare, the King's surgeon, eighty years old ; a 
 learned man, and the chief of all surgeons ; who, 
 even against the times, all his life talked and 
 spoke openly for peace and for the people : which 
 made him as much beloved by the good as he 
 was opposed and hated by the wicked." 
 
PRACTICE 
 
 The casket scenes in the Merchant of Venice are 
 exquisite poetry wasted on an episode so foolish 
 that I wonder nobody has taken it for a musical 
 comedy : and in my imagination I see the posters 
 of that new piece, and read, on the mind's 
 hoardings, its ugly name. 
 
 The challenge of the caskets was devised by 
 Portia's father, on his death-bed, under divine 
 inspiration. She knows, but must not say, which 
 of them contains her portrait. I wish that she 
 did not know : I should like to watch the 
 perplexity of her suitors mirrored in her face. 
 Each suitor was challenged on the very threshold 
 of courtship ; and a strange and most unreasonable 
 oath was exacted from him : 
 
 Arragon. I am enjoined by oath to observe three things. 
 First, never to unfold to any one. 
 Which casket 'twas I chose : next, if I fail 
 Of the right casket, never in my life 
 To woo a maid in way of marriage : lastly. 
 If I do fail in fortune of my choice. 
 Immediately to leave you and be gone. 
 69 
 
70 CONFESSIO MEDICI 
 
 So it is, with us doctors, as with Portia's suitors. 
 Practice, when we come courting her, challenges 
 us. She could tell us, if she would, which casket 
 to choose ; but she will not. Even when Bassanio 
 comes, she will not tell him : is it likely that she 
 would tell us, who thrust ourselves, unasked and 
 unwelcome, into her house ? Belmont is full of 
 us, and she is tired of us all. 
 
 It is true that we, if we fail, are free to tell other 
 suitors how we chose, and so we do: but they will 
 not believe us. It is true, also, that we are free to 
 follow another love, if we fail to find Practice : but 
 every profession, nowadays, challenges its suitors. 
 
 Consider, Gentlemen — thus I shall begin my 
 next Address to Students at the Opening of the 
 Winter Session — how it was that the Prince of 
 Morocco and the Prince of Arragon failed, and 
 Bassanio succeeded, in the localization of fair 
 Portia's counterfeit : and let me recall to you the 
 inscriptions on the caskets : 
 
 Gold. 
 Who chooseth me, shall gain what many men desire. 
 
 Silver. 
 Who chooseth me, shall get as much as he deserves. 
 
 Lead. 
 Who chooseth me, must give and hazard all he hath. 
 
 ■ Morocco, one of the greatest of Shakspeare's 
 lesser characters, is, of course, Othello's understudy. 
 He has Othello's dignity, authority, and faith. He 
 
PRACTICE 71 
 
 brings the air of the desert along with him : it 
 hardly crosses his mind that he is in Italy, among 
 a people fond of thimble-rigging tricks. In all 
 the world, this exalted spirit sees only Portia and 
 himself. But he cannot keep himself out of the line 
 of his own vision. That is why he, alone of the 
 three suitors, takes the trouble to read the caskets 
 twice : not only from fear of losing Portia, but 
 from fear of committing himself. That, also, is 
 why he rejects the leaden casket : not only because 
 it is unworthy of her, but because it is unworthy 
 of him, whose golden mind stoops not to shows of 
 dross. Over the silver casket, he stays long, still 
 contemplating himself, weighing his value with an 
 even hand, and allowing it full weight : 
 
 As much as I deserve ? Why, that's the lady: 
 I do in birth deserve her, and in fortunes. 
 In graces, and in qualities of breeding; 
 But, more than these, in love I do deserve. 
 What if I strayed no further, but chose here ? 
 
 But he reads again the saying graved in gold ; 
 and then and there he forgets at last himself, and 
 out of him with a rush comes a love-song of such 
 fire as would never do for a musical comedy, and 
 he calls in a fury of impatience for the key, and 
 open flies the casket, and Oh Hell, What have we 
 here ? a skull, with a scroll poked into one of its 
 orbits. The moral, for us doctors, is twofold. 
 First, that birth and fortune, graces, and qualities 
 
72 CONFESSIO MEDICI 
 
 of breeding, do not ensure Practice. Next, that 
 the imaginative man is apt to idealize Practice, and 
 to be in love with his own vision of her descending 
 out of Heaven. His golden mind sets up a 
 golden image, and worships it, and will not stoop 
 to shows of dross. But Practice, though she is 
 of heavenly origin, is a human business, competitive, 
 and overcrowded ; which Heaven is not. 
 
 Arragon, compared with Morocco, is a poor 
 creature, with no care for anybody but himself 
 He hardly notices the leaden casket, simply fails 
 to see why it is there ; and he refuses the gold 
 for this foolish reason, that most people, being 
 commonplace, would choose it, and he is sure 
 that he is not commonplace. No, what he deserves 
 is good enough for him, for whom nothing is too 
 good. Therewith he opens the silver casket, and 
 loses alike Portia and his temper : for he finds 
 in it a sort of comic valentine, the portrait of a 
 blinking idiot, with a rude set of verses. I have 
 profound sympathy with Arragon. First, because 
 Portia despises and mocks him. Next, because, at 
 this or that theatre, he is not acted at all, but 
 simply omitted : that is what they call the acting 
 version of the play. Finally, and especially, because 
 I approve his choice. I deplore its motive ; none 
 the less, I admire its principle. 
 
 Bassanio, after a beautiful soliloquy on the 
 deceitfulness of appearances, goes straight for the 
 
PRACTICE 73 
 
 right casket. Oh, I have no patience with him. 
 Shakspeare made him, therefore let him pass 
 for a man : but look at him. Bassanio, to be 
 moralizing over the deceitfulness of appearances, 
 who has just borrowed three thousand ducats for 
 clothes and finery, to outshine Morocco and 
 Arragon. It is for Portia's money — how to get 
 clear of all the debts I owe — that he goes to Bel- 
 mont. He is so vain, that he tells of her evident 
 admiration of him ; so careful of appearances, that 
 he warns Gratiano not to disgrace him by being 
 vulgar when they get there : and it was a most 
 necessary warning. Let us be glad, that Bassanio 
 never really happened. All the same, he is the 
 successful suitor : and the moral is, that Practice 
 admires him who wants her money. Begin poor, 
 be in urgent need of capital, borrow of a friend, 
 hold up your head, take courage, make opportunity, 
 face rivalry: so shall you find Practice, who 
 already is in love with you, and win her, and 
 make her pay your debts. 
 
 But here my simile, like Portia's father, is on 
 its death-bed. For there is this difference between 
 her and Practice, that she set the caskets side by 
 side, but Practice sets them one inside another. 
 Lead, gold, silver ; that is the order, from without 
 inwards, as the anatomists say : and we must open, 
 for her sake, not one but all. First, the leaden 
 casket, the venture of faith : Who chooseth me, must 
 
74 CONFESSIO MEDICI 
 
 give and hazard all he hath. Before you go 
 further, count the cost of this first commandment. 
 You make the venture, raise the leaden lid, read 
 the gold : Who chooseth me, shall gain what many 
 men desire. Why, that is Practice ; all the world 
 desires her : from the four corners of the earth 
 they come, to kiss this shrine. Very well, young 
 man : if you insist on quoting Morocco's lines, 
 you must imitate his action. Come, open this 
 second casket. What is inside it ? Oh, you know 
 that, as well as any of us ; quick, the key, and 
 up with the golden lid. What have we here ? 
 A third casket: WIio chooseth me, shall get as much 
 as he deserves. This is the last of them : and 
 here, truly, is divine inspiration, and you must 
 say Amen to it. You, when the time comes for 
 you to look back at the work of your life, will 
 you care to think of it more than this, that you 
 got what you deserved ? Take the last of the 
 keys, and turn it. There is the lady, an excellent 
 likeness. Pray, what do you think of her? 
 
 The portrait of Practice, as you bring it, in 
 hands that shake a little, to the light, will I fear, 
 disappoint you, at first. A middle-aged, strong- 
 featured woman, with a lined forehead and pale 
 checks ; for she is up at all hours, and seldom 
 allows herself a holiday. Her hands are rough; 
 for she works hard, and is glad of employment. 
 Her hair, touched with grey, is packed away 
 
PRACTICE 75 
 
 under a nurse's cap ; her dress is of some dark, 
 serviceable stuff, and of no emphatic fashion : and 
 she wears no ornaments. Tired, quiet eyes : a nose 
 and a chin more mascuUne than feminine : a mouth 
 rather large, but well shaped, and well under 
 control : and, alas, a scar, from an old hurt that 
 she got at her work. You poor young man, you 
 expected to find her looking like Lady Hamilton 
 by Romney. But what more can you see, now 
 that you have studied, not without a sinking of 
 your heart, this portrait of your life's partner ? 
 Why, nothing : portraits are not prophets. That 
 is love's most urgent need, a portrait of twenty 
 years hence. For the present, be thankful, you 
 who are a gentleman, that Practice is a lady, a 
 born lady, you can see that at a glance : with 
 a good, sensitive, kind, clever face, absolutely free 
 from the very least hint of vulgarity. Her eyes 
 look straight into yours, and seem to be reading 
 you more profoundly than you can yet read her : 
 and her lips, too severe for immediate kissing, 
 give promise of steady, gentle sympathy, and of 
 the very best sort of laughter. Oh, a lady, a 
 perfect lady : and I, for my part, prefer her to 
 Portia, whose jests are of the stage, and her 
 charms require very careful acting. 
 
 Now that you have seen the face of Practice, 
 you will be wanting to know what is her fortune. 
 Let us consider, what reward we have of her. 
 
76 CONFESSIO MEDICI 
 
 To make a beginning, let it be granted, that our 
 reward is paid to us part in money and part in kind. 
 We cannot keep separate, as it were in two ledgers, 
 these two incomes : nor can we say exactly, at any 
 time, how much we are worth. Our lives are 
 invested in the goodwill of friends, in the confi- 
 dence of patients, in the approval of the brethren ; 
 and in our Hospital record, and in our intention 
 of sticking to work. All these and the like se- 
 curities are but other names for ourselves. What 
 we are, that we make : some of it, but not much, 
 in money, and the rest of it in kind. 
 
 Not all of us get as much as we deserve : there 
 are exceptions to the rule. Among them, are the 
 many who die young, or in middle-age ; and they 
 who have taken, and cannot leave, a line of practice 
 not in accordance with Nature's plan for them ; and 
 the ill-starred Lydgates whom a discordant home- 
 life crosses and keeps back ; and they who lose 
 health, or savings, or good appointments, through 
 no fault of theirs, and are unable to repair that 
 loss. The list of exceptions is of great length : 
 still, it is not long enough, and in a world run 
 by Providence no possible list could be long 
 enough, to annul the rule, that we get what we 
 deserve. 
 
 But, if money were all that we made by practice, 
 we are far from our deserts. Many of us, gentle- 
 men by birth, experts by education, earn little, even 
 
PRACTICE -j^ 
 
 with hard work ; and might covet the takings of the 
 pubUc-house, which provides such a multitude of 
 patients for the Hospital, without subscribing to 
 its funds. I wish the present Government would 
 arrange for lo per cent, of the profits of the public- 
 house to go direct to the Hospital, as a slight return 
 for repairs executed on customers.* 
 
 * To write, in one sentence, of doctors and of Hospitals 
 is to be reminded of a certain opposition of their interests. 
 It is no wonder, that we find fault, now and again, with our 
 Hospitals, even with our Hospitals, that they admit, or treat 
 as out-patients, so many people who could afford to pay a 
 practitioner. But this grievance is light, in comparison with 
 the advantages which we obtain from their teaching, and from 
 the use of their services. Besides, they do try to check abuse : 
 but all detective methods are somewhat uncongenial to their 
 kind old hearts. Of all such methods of scrutiny, the worst, 
 I think, is the enforcement of Hospital letters. That a dis- 
 abled labourer should have to apply to the tradesmen in the 
 neighbourhood for a printed form, telling the Hospital what 
 it can see at a glance, here is indeed an abuse of Hospital 
 charity : that a tradesman will not subscribe to his local 
 Hospital unless he gets a sheaf of letters for his guinea, here 
 is indeed an uncharitable opinion. The authorities of the 
 King's Fund ought to make a bonfire, on His Majesty's birth- 
 day, of Hospital letters. They assume the vanity of the small 
 subscriber, and play up to it ; they worry and alienate the 
 poor ; and the best thing to do with them is to light your 
 pipe with them. They are a survival of the bad Georgian 
 way of patronizing the unfortunate. Nothing can justify them, 
 unless it were the existence of people who would not subscribe 
 even to the maintenance of Heaven, without an Annual Report 
 and the right to recommend four souls for immediate admission if 
 found suitable cases. 
 
78 CONFESSIO MEDICI 
 
 Of our professional earnings, what we make in 
 money, I have nothing to say; partly because they 
 vary so widely, and partly because I do not know 
 on what principles they are determined. If Medi- 
 cine is a trade, why should the doctor so often work 
 for nothing? If it is an art, what works of art 
 does he produce? None, says Claude Bernard, 
 Le medecin artiste ne cr'ee rien : but surely he is 
 wrong. The doctor, so far from creating nothing, 
 creates life : for he who saves or prolongs life, 
 creates more life. If Miss X is seventy, and the 
 doctor, by an operation, enables her to live till she 
 is seventy-five, he has not prolonged the seventy 
 years, for they were ended before he came ; but he 
 has created five brand-new years. If he had not 
 been there, they would not be here : that is creation. 
 He has not lengthened her past, nobody could ; he 
 has called into existence her present and her future : 
 and they are she, therefore he has called into 
 existence her. Not that he thinks much of that 
 tremendous act. For he knows that the butcher, 
 the grocer, the milkman, the people who sell 
 blankets and flannel garments, and most of us, in 
 the case of such an old lady, would add the wine- 
 merchant, all take part in the work of creation : and 
 I must not forget the coal-merchant, the baker, 
 the cook, and the housemaid. Miss X, from 
 seventy to seventy-five, is the achievement of a 
 syndicate, and owes her life to all of them. Her 
 
PRACTICE 79 
 
 recognition, thus widely diffused, must be spread 
 thin. She cannot take a joint-stock company to her 
 heart, crying My gallant preservers : she cannot 
 endow them all. Suppose that she gives the doctor 
 what Pare would call an honourable present and of 
 great value : To my kind doctor, who under Providence 
 was the means of prolonging my life. Why should she 
 stop there ? The servants, the tradespeople, the 
 very horses which take her for an airing, are they 
 not all, under Providence, creators, per quos ilia facta 
 est ? I begin to see the meaning of that plural in 
 the first chapter of Genesis : it is such a business, 
 tantae molis, to create people. 
 
 To estimate what may thus be done, take the 
 instance of a Hospital surgeon in charge of forty 
 beds. Allow him six weeks' holiday : and put the 
 average stay of his patients in Hospital at three 
 weeks. That gives him 600 patients a year. Take 
 any ten of them. Of these ten, let us guess that 
 one dies, one is none the better for treatment, and 
 three, being cured of maladies which could not 
 shorten life, gain nothing in length of days. That 
 leaves five patients. Of these five, let us guess that 
 two gain five years, two gain ten years, and one 
 gains thirty years. That gives a gain of sixty years 
 on ten cases, or 3600 years on 600 cases. In twenty 
 years, at that rate, he will have saved 72,000 years 
 of other people's lives. Of course, he cannot alone 
 claim them ; many minds and hands are at work 
 
8o CONFESSIO MEDICI 
 
 with him. Still, the years are saved ; and that, 
 free of charge. 
 
 Many and great are the rewards in kind which 
 we have of practice : the world never seems tired 
 of telling us how thankful we ought to be for 
 our blessings. And, truly, we are. The depth and 
 the width of our work, its bewildering diversity, 
 its vivid discoveries, its science, all these make us 
 happy. So does its humanity, so rich in the friend- 
 ship and the goodwill of our patients. I hesitate to 
 allude to their gratitude, because Modern Thought 
 is inclined to explain away gratitude : still, there it 
 is, and we, not being the least bit like Wordsworth, 
 and seeing many sights that oftener leave us mourn- 
 ing, are very fond of gratitude. 
 
 Further, we have this reward of practice, that we 
 are, within ample limits, independent of all forms 
 and ceremonies. So long as we do our work well, 
 nobody cares what we believe, what we look like, 
 or how we vote. Wherever we go, we are taken 
 for granted, and the world neither asks for our 
 passporis nor suspects our motives nor doubts our 
 word. We have nothing up our sleeves. Nowhere 
 need the doctor feel, if the phrase may be pardoned, 
 out of it : save that he may be embarrassed by 
 sudden admission inside a sacred circle of hopes 
 and fears all spinning round a case that he has 
 never seen before. We come natural to people ; 
 which is more than can be said of every profession. 
 
PRACTICE 8 1 
 
 It is not an honour, to come natural to people ; 
 he who does that, travels in very queer company : 
 still, it is a pleasure. Everywhere, from the Smart 
 Set, whatever that may be, to the slums, and we 
 know better than most folk what the slums are, 
 we are understood and welcome. I'm so glad you 
 are here, says the grand house, all huddled under 
 the blow which has fallen on it ; the house hardly 
 knows itself, the invitation-cards over the mantel- 
 piece have an air of mockery, the sounds of the 
 street are insufferable, the very window-blinds are 
 tugging at their cords to be let down. I'm so 
 glad you are here, says the little house in the slums. 
 Come along quick, doctor, she's awful bad. Of course, 
 we must not be proud that we are wanted. The 
 cat's-meat man, for instance, is not proud that the 
 cats want him, and come twisting out of every 
 area. Still, if I were he, I should try to be glad 
 of such a welcome. But to be wanted by men 
 and women, to come natural to them in time of 
 trouble, is a very different matter, and may fairly 
 be called a career. 
 
 It is said that any doctor who holds a Court 
 appointment enjoys thereby a certain privilege. If 
 he is on his way to the Palace, and his carriage 
 is stopped by the passing of the Household Cavalry, 
 he may in his turn stop them, and drive straight 
 through the little procession. I should love to 
 see that. Imagine the scene, those resplendent 
 
82 CONFESSIO MEDICI 
 
 horsemen all held-up by one doctor, like the sun 
 and the moon in the Book of Joshua : see the 
 honest pride of the doctor's coachman, as the glitter- 
 ing line of helmets and cuirasses halts, with a back- 
 ward shock, like so many coal-trucks. Cedant arma 
 togae. The onlookers laugh, and stare : and one or 
 two, as the carriage trundles past them, lift their 
 hats. Here is a true figure of the doctor's life. 
 He goes straight to his work, and is let through 
 to it without delay or hindrance : his business is 
 privileged, his authority admitted, his presence 
 explains itself. The forms and conventions which 
 impede society do not interfere with him, and he 
 can drive right through the middle of them on 
 his way to an urgent case. At once, he comes 
 natural into lives all scared and shaken by some 
 disaster so unexpected that he seems the one natural 
 event in the house. Oh, we have our faults, and 
 may be made to look very funny on the stage 
 or in a novel : but life is not measured that way. 
 
THE DISCIPLINE OF PRACTICE 
 
 All of us, while we are students, wonder what 
 we shall make of practice : but some of us forget 
 to wonder what practice will make of us, and how 
 we shall stand its discipline. That the discipline 
 is there, we know ; for no work worth doing is 
 without discipline : but we seldom trouble ourselves 
 to anticipate in thought its methods and its purposes. 
 Of course, we say, Things will be slow and uphill at 
 first, but I don^t mind that: and we reckon with 
 confidence on the usual sequence, first the lean 
 years, then success, and at the last a comfortable 
 and honoured old age, with a garden,- in a pleasant 
 neighbourhood not too far from London. This 
 forecast does not compel us to see, as we ought, 
 that when we take our work in hand it takes us 
 in hand, and chastises us. Nothing, in practice, 
 is more certain than its use of the scourge; and 
 we need not go outside the day's work to learn 
 obedience. Talk of the patience of Job, said a 
 Hospital-nurse, Job was never on night-duty. She 
 
 83 
 
S4 CONFESSIO MEDICI 
 
 had found the discipline of practice ; and it had 
 found her. 
 
 Consider, first, this instrument of the discipline ; 
 that we live under responsibility, and go in fear 
 of making a mistake. In every science and every 
 art, in every business and every trade, mistakes 
 are made: they are a part of all men. But doctors 
 practise their science and their art on life. With 
 that material, a mistake may be irreparable. You, 
 who are now a student, keen over your work, and 
 one of the best men of your year at the Hospital, 
 what will you do when that disaster happens .'' 
 How long will it wait, before it happens ? Indeed, 
 it may happen before you leave the Hospital. Say 
 that you are a House-physician or a House-surgeon, 
 hard-worked, sometimes over-worked, careful, gentle, 
 diligent — oh, let us say, and have done with it, that 
 you have every virtue under Heaven — yet the blow 
 may fall, before the end of your term of office, 
 on some man, woman, or child under your care : 
 fall, before your death, on one or more than one 
 of your patients. Look this fact in the face, now, 
 before it comes into your life. People talk of 
 the Fine Arts : but what art is so fine as Medicine, 
 which works in hves, and cannot correct its proofs, 
 or begin with a sketch, or waste its fabrics, or 
 rehearse its effects, or use a model ; and, by a 
 mistake, injures not an image of life, but life ? 
 Why, that is just why Medicine is not fine. It 
 
THE DISCIPLINE OF PRACTICE 85 
 
 is not the art, but the stuff, which is so fine : 
 we must interfere with that one substance which 
 is above all else in Nature, the one texture, man, 
 infinitely complex, infinitely precious. We touch 
 Heaven, it is said, when we lay our hands on the 
 human body: and the doctor is bound to dose it, 
 to operate on it. This fear of doing harm, which 
 is called the strain of practice, does not pass with 
 the passing of youth : it is acknowledged by a 
 famous surgeon, in a letter written when he was 
 fifty-six. What happy hours they were, he says, of 
 a holiday just over, in their contrast of carelessness 
 with the care of mind with which, here, one goes 
 from one responsibility to another, and always with 
 the thought that, while meaning to do good, one may, 
 from carelessness or inadvertence, do harm. 
 
 Consider, next, that discipline which we receive 
 from cases which fail, through no fault of ours, 
 yet they fail. The treatment was correct: there 
 was no offence either of omission or of com- 
 mission. Yet, over such cases, temperament is 
 apt to get the upper hand of reason. Our suc- 
 cessful cases, we feel, might belong to anybody : 
 but our unsuccessful cases belong to us. It is 
 true that our leaders achieve successes which belong 
 to them alone : but, to us of the rank and file, 
 the argument seems not merely sentimental, but 
 logical, that, where I succeed, the rest of us would 
 have succeeded ; but, where I fail, it is I who 
 
86 CONFESS lO MEDICI 
 
 fail, and not the rest of us. I have no doubt, 
 that A would still have recovered, if B, and not 
 I, had been in attendance : but, if A had died, 
 he was not B's patient, but mine. It was very 
 delightful, when A began to get well : but that 
 does not alter the fact that I was not the only 
 letter of the alphabet who could have cured him. 
 Indeed, if it had not been for B's book on the 
 subject, which taught me C's modification of D's 
 method, it is possible that A would not have 
 made such a quick recovery. Besides, his recovery 
 was not all due to me : for he had a good con- 
 stitution, and the will to get well, and a wonderful 
 power of sleeping, and two nurses : and it was 
 Mrs. A, now I come to think of it, who sug- 
 gested the champagne. In brief, the success was 
 mine as my thermometer and my stethoscope are 
 mine : everybody has the like of them. And 
 now, when I meet old A, and he says, as he 
 always does, like a clock striking. My dear fellow, 
 by GocTs mercy, you saved my life, I think of God's 
 mercy as a thousand incalculable forces all meeting 
 at A ; and am sure, that any doctor could have 
 done that. 
 
 Later, I attended A's son, who died. Nothing 
 could have saved him, I was not at fault, I got 
 another man to see him with me, the treatment 
 was all right, it was a hopeless case from the 
 beginning. All the same, the failure, the dismal 
 
THE DISCIPLINE OF PRACTICE 87 
 
 going-out of young A, the disappointment, were 
 mine : it was I who had to watch him, and to 
 worry myself imagining that I might be doing 
 something better for him. He was my patient, 
 he suffered under me, passus et sepultus est: and 
 I heard afterwards that old A said. The doctor 
 saved me: I wish to God he had saved my boy 
 instead of me. 
 
 I have put these two cases as in my own 
 practice ; but I am thinking of another man, who 
 carried about with him, always, the sense that his 
 unsuccessful cases were nearer to him than his 
 successes. It did him no good, nor his patients 
 either; the last thing that he wanted was a poor 
 opinion of himself, and he was only tempting peo- 
 ple to take him at his own valuation : but he could 
 not break himself of this habit of mind. There 
 is no name for it, and it neither deserves praise 
 nor helps practice : still, as a part of the discipline, 
 as a purge for pride, I commend it to students. 
 Gentlemen, you attend a patient, who recovers ; 
 and you know that he would have recovered 
 under any doctor as good as you are. You attend 
 a patient, who dies ; and you know that he would 
 have died under any doctor : but he died under 
 you. The two events do not balance : the re- 
 covery of the one does not sweeten the death of 
 the other. A successful case is like sunshine, or 
 music, or food, which a man enjoys as they come. 
 
88 CONFESSIO MEDICI 
 
 but they come to everybody : an unsuccessful case 
 is a more intimate experience. 
 
 These methods of discipline are of our own 
 invention, and we chastise ourselves. But we also 
 suffer chastisement at the hands of our patients, 
 and at the hands of the brethren. Consider, first, 
 in what measure we are subject to public opinion, 
 and for what good purposes. 
 
 We have to bear, now and again, gossip, ill- 
 will, distrust, the proud man's contumely, the 
 insolence of office. There really are people, 
 happily they are rare, who dislike all doctors, and 
 are fiill of stories against us, and sure that the 
 chemist is not only cheaper, but safer, and quite as 
 gentlemanly, and much nearer. In the silly season, 
 but they never seem to go out of season, they 
 write in this or that paper, under the head-line. 
 Are Doctors Avaricious? or, it may be. Ought we 
 to fay for Health P To them, we are Shylock ; 
 they even go back to the old idea, which to my 
 thinking was the true idea, of a comic Shylock. 
 And, in every place, there is gossip, and one or 
 more idiots who wound characters to kill time. 
 
 As for gossip, we are none of us perfect, and 
 some of it is true ; and the rest we can alleviate. 
 Like the pilgrim, condemned to walk to Rome 
 with peas in his shoes, who accepted the penance, 
 but boiled the peas, so is the solvent action on 
 gossip of a good temper and a clear conscience. 
 
THE DISCIPLINE OF PRACTICE 89 
 
 But the young doctor, the new doctor, in a 
 gossipy house, must never be off his guard. He 
 has seen and prescribed for his patient, and has 
 said all that need be said to the friends ; and there 
 is tea, and what seems a favourable opportunity 
 for extending the practice. Trust them not, young 
 man : put your fingers in your ears, and flee from 
 the City of Destruction of Reputations. If you 
 must stay, do not stay long, and keep the door 
 of your lips. Talk of the patient, of the weather, 
 or of the proposition, which will as surely as the 
 bread-and-butter be handed to you, that There is a 
 good deal of illness about. Avoid all topics of 
 Church and State, quote neither poetry nor prose, 
 give neither censure nor approval to music and 
 the drama, hide your liking for any art but your 
 own. Leave behind you, for gossip to lap, a 
 saucerful of the milk of human kindness. Never 
 mind about producing a favourable impression ; 
 produce this one impression, that you know your 
 work, and that it will not be your fault if the 
 mixture fails to relieve the patient upstairs : and 
 then flee. 
 
 Beside gossip, which is the discipline of our 
 tempers, we have to bear opposition, which is the 
 discipline of our convictions. The anti-vaccina- 
 tionist, the anti-vivisectionist, and the Christian 
 Scientist, are against us. So much the better for 
 our faith in our calling. And, of course, we have 
 
90 CONFESSIO MEDICI 
 
 no quarrel with anybody who honestly wants to 
 know why we believe in the protective efficacy of 
 vaccination, the necessity for experiments on animals, 
 and the reality of disease. Our quarrel is, and 
 should be fiercely maintained, against the chief 
 offenders, the Societies, the paid officials, the 
 itinerant lecturers with their platform facts. Yet I 
 advise the young doctor not to rush unarmed, not 
 even to the defence of science and ethics. Our 
 opponents fight us with platform facts ; we must 
 beat them with true facts. I advise all students, 
 when they have time, to get a fair knowledge of 
 these three subjects ; which cannot be done without 
 steady reading. Not only their duty to their pro- 
 fession, but their own interests, urge them to be 
 thus definite : neither the profession, nor the public, 
 admires Mr. Facing-both-ways. And it is well, 
 also, to keep close at hand, for reference, a store 
 of instances and figures ; for we ought to be as 
 firm on the right side as our opponents are fluent 
 on the wrong side. 
 
 But, if we are to fight Christian Science, we 
 must make haste : for it will not long survive its 
 founder. It will die before it gets to the poor. 
 Not that it shows any great anxiety to get to 
 the poor, so long as it can get at the rich. It 
 will go downhill quick, for it is not strong : how 
 could it be, with such a family history, with Fear 
 for its father, and with such a Mother ? See how 
 
THE DISCIPLINE OF PRACTICE 91 
 
 delicate it is. It says nothing, or next to nothing, 
 about our sins ; does just mention them, but tends 
 to explain them away as illusions. It appeals to 
 our belief in our own cleverness ; hints at a 
 philosophical superiority, a purer vision, a rarer 
 atmosphere ; suggests to me, that Plato and I 
 would find a lot to talk about, and that most 
 people are in darkness but I am in light. Its 
 one vital doctrine is this, that God is real. What 
 then is the God of Christian Science ? He is, if 
 you unwrap him, the Infinite, the One, the All, 
 merum Ens, pure Being : above superstition, above 
 anthropomorphism, above the comprehension of 
 bishops, priests, and deacons, especially deacons. 
 This comfortless word Being, whether in Greek, 
 Latin, or English, always leaves me where it finds 
 me. Still, in this high creed, we must recognize 
 an air of Aristotle, a sense of freedom, and an 
 exercise of the reason, which must all of them, 
 especially the last, be very refreshing to fashionable 
 society. Here, in this cult of Being, we have, if 
 the phrase may be forgiven, a very large order. 
 For you cannot worship merum Ens without paying 
 for that intellectual treat. If nothing is real but 
 pure Being, and we must lift up our thoughts all 
 that tremendous way, or nowhere, then it is plain 
 that health, comfort, and life are no more real 
 than sickness, pain, and death. If the black 
 squares on the chess-board are not real, neither 
 
92 CONFESSIO MEDICI 
 
 are the white : and a strong spine is just as 
 illusory as a weak one. Christian Science, on its 
 own showing, has only substituted one set of 
 illusions for another. Look at this advertisement, 
 say the proprietors of a soap or a pill, and you 
 see green on a red ground. Shut your eyes, and you 
 see red on a green ground. That is how the pro- 
 prietors of Christian Science capture men. There 
 must be much virtue in a soap, if you can see 
 its name with your eyes shut : and red on green 
 must, of course, be more real than green on red, 
 because green on red is what you see with your 
 eyes open, just like ordinary people. It comes 
 to this, that the Christian Scientist, though she 
 sounds very subtle, is not; for she has two Gods, 
 one to explain her pleasures, and the other to 
 explain away her pains ; one popular and in touch 
 with the world, the other metaphysical and not in 
 touch with the world. 
 
 The testimonials, at the end of the official book, 
 are sad reading. Here are the obsessed, they who 
 cannot help thinking of their insides, and watch 
 for symptoms, and talk of diseases, and read medical 
 books, and are very sensitive, and never know what 
 it is to feel well. The neurotic man who lost all 
 liking for tobacco, thanks to Christian Science ; and 
 the diphtheritic child who coughed up some mem- 
 brane, thanks to Christian Science, and sang a hymn ; 
 and the lady who had such a bad time with her 
 
THE DISCIPLINE OF PRACTICE 93 
 
 first baby, and such an easy time, thanks to Christian 
 Science, with her second — they all are witnesses. 
 You note, especially, that if a man is in such pain 
 that he cannot fix his mind on Mrs. Eddy's 
 methods, he may have morphia till he can ; and 
 that surgical cases, for the present, had better be 
 left to the surgeon, till the world has more faith : 
 but you are not told which cases are surgical and 
 which are medical. I should like to collect and 
 pubUsh what our chief physicians and surgeons know 
 of the works of Christian Science. But apart from 
 its works, and the ill-gotten gains of its proprietors, 
 I hate its faith ; and, if it were going to stay in 
 this world, I should thank my God that I am 
 not. 
 
 Beside that discipline of practice which we impose 
 on ourselves, and that which our patients and the 
 public impose on us, there is the inner discipline 
 of the brotherhood, the scourge of competition. 
 Always, year in year out, we work under the crack 
 of that whip. It is no wonder, that some students 
 dread starting in practice, and cling too long to 
 resident or travelling appointments. For, say what 
 we will of the excellence of competition, the fact 
 remains, that practice is the breaking of dreams. 
 Inside the precincts of the Hospital, we were safe 
 and at home ; she mothered us, sheltered us, made 
 room for us all, and there was no fighting, more 
 than a friendly contest for a prize or a House 
 
94 CONFESSIO MEDICI 
 
 appointment. Nowhere, in the imagery of Heaven, 
 is it presented as a competitive system : and the 
 candidati are not candidates. It is true, that practice 
 has its golden times, when the discipHne is remitted. 
 But the gold is rare : and is mixed, in life's till, 
 not only with silver but with coppers, and here and 
 there a bad coin. 
 
THE SPIRIT OF PRACTICE 
 
 Our admission to practice might be made a more 
 imposing ceremony : but we have no spare imagina- 
 tion, in our profession, for any such uses. We 
 keep it all for scientific purposes ; or we should 
 see, in that row of examiners right and left of the 
 President, the curve of a presbytery : and there 
 would be appropriate rites, and then a little pro- 
 cession of happy young men, from the Examination 
 Hall on the Embankment to the Royal College 
 of Physicians, which would be indeed a procession 
 of the unemployed. Or the authorities might prefer 
 to revive the method of Greece, and to administer 
 to us the Oath of Hippocrates : 
 
 I swear by Apollo the Healer, and Aesculapius, and Hygieia, 
 and Panacea. 
 
 And I call all Gods and Goddesses to witness, that I will, 
 according to my power and judgment, make good this oath, and 
 this covenant which here I sign. 
 
 To think of him who taught me this art as I think of my 
 parents. To hold my life as his life, and to give him, in the time 
 of his need, a share of my belongings. To consider his sons as 
 my brothers, and to teach this art, to such of them as wish to 
 learn it, wdthout payment or agreement. 
 
 95 
 
96 CONFESSIO MEDICI 
 
 To impart the doctrine, and the interpretation, and the whole 
 learning, to my sons, and to my master's sons, and to students 
 enrolled and sworn under medical law, and to nobody else. 
 
 And I will use all ways of medical treatment that shall be 
 for the advantage of the sufferers, according to my power and judg- 
 ment, and will protect them from injury and injustice. Nor will 
 I give to any man, though I be asked to give it, any deadly drug, 
 nor will I consent that it should be given. Likewise, I will not 
 procure abortion. But purely and holily I will keep guard over 
 my life and my art. 
 
 Nor will I cut them that have the stone, but will send them to 
 men whose work it is to perform that operation. 
 
 And, into whatever houses I enter, I will enter into them 
 for the benefit of the sufferers, departing from all wiliul injustice 
 and destructiveness, and all lustful works, on bodies male and 
 female, free and slaves. And whatever, in practice, I see or hear, 
 or even outside practice, which it is not right should be told 
 abroad, I will be silent, counting as unsaid what was said. 
 
 Therefore, to me accomplishing this oath and not confounding 
 it, may there be enjoyment of life and of art, being in good 
 repute among all men for ever and ever : but, to me transgress- 
 ing and perjured, the contrary. 
 
 It seems a pity that we should tumble into our 
 profession in a way that would have shocked 
 Hippocrates. Ages hence, it may be, our admis- 
 sion to practice will be solemnized with ceremonial 
 observances proper to each of our orders. But 
 nothing shall be said here about our orders : for, 
 in the advance of the whole profession, the lines 
 between them get crossed and shifted. Besides, I 
 am thinking not of the body but of the spirit 
 of practice. 
 
THE SPIRIT OF PRACTICE 97 
 
 Pare, looking over my shoulder as I write, says 
 that in his time there were three chief orders : 
 the barber-surgeons, the surgeons of the Confra- 
 ternity of Saint Cosmo, and the physicians. " But 
 as for me," says he, " I protest that I did the 
 offices of all three of them, and was moreover 
 nurse, apothecary, and cook to my patients : neither 
 was there anything in all medicine and surgery left 
 without my hand put to the work. Now I will 
 tell you, for the better instruction of the young 
 surgeon, how I learned my business, by the grace 
 of God. My father was a carpenter, which is a 
 good trade : he used to make the big linen-chests, 
 such as they give to the bride when she leaves her 
 home. I had but little schooling, no more than 
 what Monsieur le Cure taught me. Then, one 
 day, when I was but a boy, Laurence Colot came 
 to Laval, to cut a man for the stone : and when 
 I saw the stone, I said to myself that I would 
 be a surgeon. So my father apprenticed me to 
 a barber-surgeon, I have forgotten his name. I 
 shaved, cut hair, dressed wigs, and sold pomades ; 
 I bled and I cupped the customers, and opened many 
 abscesses, and minded the shop : it was a dog's 
 life. My only chance of a lecture or a book was 
 at daybreak, or after nightfall, and then it was in 
 Latin, and I leave you to judge what fine lectures 
 they were. Truly, I was thankful and glad, when I 
 got work at the great Hospital in Paris. I prepared 
 
98 CONFESSIO MEDICI 
 
 the dissections for Sylvius his lectures, and examined 
 the bodies of them who died in the Hospital ; and I 
 helped at many operations of surgery, not without 
 much lopping-ofF of limbs, and saw many cases of 
 the plague ; I was never in want of a job. Some 
 recovered, the rest died, according to the nature of 
 their wounds and maladies. In one winter, I had 
 the charge of four frost-bitten noses : and one of 
 the Sisters of the Hospital taught me how to make 
 a very excellent ointment. I must not forget to 
 say that there was a Commission, of eight citizens 
 of Paris, to reform the Hospital. I protest before 
 God that we had no need to be reformed : and 
 that I loved the Hospital, and never refused to 
 help any sick, person, no, not even in the middle 
 of the night. Then, though I was not yet admitted 
 to the Company of the Barber-surgeons, I took 
 service under Monsieur de Montejan, and went off 
 to the wars. But I kept a foothold in Paris, just 
 two little rooms ; and my wife and I were very 
 happy there, when I could be at home. And, by 
 my faith, people came to me, not because I had a 
 degree in Surgery, but because they knew that I 
 could set them on their legs again, if anybody 
 could. Which I did, by the grace of God : and 
 they were well pleased, and gave me many honour- 
 able presents, of great value." 
 
 He seems to have forgotten the feuds of his 
 time, between the barber-surgeons, the surgeons. 
 
THE SPIRIT OF PRACTICE 99 
 
 and the physicians. Nobody would think, hearing 
 him now, that he took a great part in them, and 
 led one order of his profession against another. 
 As, in Florence or Perugia, long ago, feuds tore 
 the city, and departed, leaving it half dead, so 
 Medicine was torn by the spirits of Aristotle, 
 Galen, and Saint Thomas Aquinas, possessing and 
 tormenting its members, till Science, at last, cast 
 out of Medicine all authority but her own. Pare 
 has forgotten the grievances and the medical politics 
 which were so exciting then, and sound so strange 
 now. We still have, order against order, one or 
 two grievances, but none serious ; we are come as 
 near as any profession to Liberty, Equality, and 
 Fraternity : or, it may be, they have come across 
 the Channel, exiles from Fare's country, to us. 
 
 Of the spirit of practice, this much may safely be 
 said, that it does not readily enter into a life which 
 is full of furniture. It must have opportunity for 
 its influences ; it cannot write on walls which are 
 covered with pictures, or make its voice heard above 
 music and much talking : the life must be clear, 
 affording space, and observing silence. I have had 
 the honour of knowing many great physicians and 
 surgeons ; and I see this in all, or nearly all, of 
 them, that, when they were young, they made ready, 
 for the coming of the spirit of practice, apartments 
 of the utmost simplicity : quiet, bare, whitewashed, 
 empty little rooms. Some of us block the room 
 
100 CONFESSIO MEDICI 
 
 with all that we put in it. I know a man who 
 did that. He crammed his brains with books, and 
 learned whole sciences by heart, and read till he 
 could read no more : that was how he furnished 
 the room, and it looked like the inside of a second- 
 hand furniture shop, and he could hardly move 
 without knocking down something, or hurting him- 
 self. He was a young man with a great deal of 
 taste ; so he decorated the room, very prettily, with 
 soft-coloured upholstery, and old engravings, and 
 casts of the Parthenon frieze, and a piano, and 
 complete editions of the poets. Now, said he, the 
 place is ready, at last, for the spirit of practice. But 
 it went elsewhere. The use of culture is not to 
 help us in practice, but to console us for want of 
 practice, and then it is above rubies. We serve 
 three masters, our profession, our patients, and our 
 own people : where, in this threefold service, is 
 culture required of us ? 
 
 Our profession would have us obedient to its 
 rules and loyal to the members of its body, con- 
 tributing according to our means to the common 
 store of knowledge, and working well : and it no 
 more cares for culture than if we were so many 
 District Nurses, and one could hardly be anything 
 better than that. But our patients, what do they 
 demand ? Set aside those demands which may fairly 
 be called not reasonable, for infallibility, for extra- 
 vagant sympathy, for perfect alacrity to be out all 
 
THE SPIRIT OF PRACTICE loi 
 
 night for nothing ; what, in reason, do they demand ? 
 Health, recovery, relief, or at the worst some pro- 
 longation of life. What else ? When people are 
 very ill, their demands are not many. They send 
 for the doctor to make them well, not for the 
 pleasure of seeing him. There are times when his 
 patients are interested, more or less, in his private 
 affairs, likes and dislikes, tastes, politics, family, 
 previous education, and personal appearance : it is 
 when they are not very ill, or nearly well. The 
 worse they are, the less they note these aspects of 
 him : and, when they are very ill indeed, he might 
 stand on his head, and they would hardly notice it, 
 but would ascribe his strange demeanour to the dis- 
 tempered condition of their senses. 
 
 The patient, in his time of peril, wants not us 
 but himself; he wants to be himself again. So far 
 as he wants us, he wants not what we call us, but 
 what we have with us. That is what he means by 
 us. At the last, we are of no use at all, neither 
 we nor what we have with us : 
 
 Nor bring, to see me cease to live. 
 Some doctor fiill of phrase and fame. 
 To shake his sapient head, and give 
 The ill he cannot cure a name. 
 
 So sings Matthew Arnold, if you can call it sing- 
 ing. That, now and again, is our hard lot, to be 
 told. We sent for you, because we thought we ought, 
 but of course we know that you can't do anything. 
 
102 CONFESSIO MEDICI 
 
 Here, at the start of the downward grade from 
 health to death, is a patient with very Httle the 
 matter with him or her, well enough to enjoy a 
 talk with the doctor, and hardly needing what he 
 has with him. Here, halfway down the grade, is a 
 patient far too ill to take much interest in the 
 doctor, and caring only for what he has with him. 
 Here, at the last step of the grade, is a patient 
 dying, who wants neither him nor anything. The 
 doctor, as he descends this dolorous way, sheds, 
 bit by bit, his non-medical self, takes it off, as a 
 man in for a fight takes off his coat. Over a very 
 urgent case, he may even divest himself of his 
 manners, and nobody will notice whether he has 
 them on or not : only, he must have with him 
 what is necessary. Last, he comes where he might 
 as well not be there, for all the use that he 
 can be. 
 
 Thus, the proper field for culture seems to be 
 among them who, not having much the matter with 
 them, enjoy talking. But not all, even of them, 
 enjoy listening. I know of one, who said to a 
 friend, / don't want my doctor to talk to me about the 
 National Gallery; which is a shrewd saying, and 
 has taught me to avoid all such dangerous topics. 
 Anyhow, people who are seriously ill care no more 
 for preciosity in us than for gold-dust in beef-tea. 
 What they want is a man who has just had and 
 cured a case exactly like theirs; and he need not 
 
THE SPIRIT OF PRACTICE 103 
 
 be a judge of anything outside their insides. It 
 is poor comfort to them, to know that he is very 
 fond of really good poetry. 
 
 Young men, whose pride bruises at a touch, are 
 apt to be offended, when they are thus classed as 
 plumbers and glaziers of the body. Perhaps they 
 have never been seriously ill, never come to that 
 point of sharp thought where the physician, the 
 surgeon, the anaesthetist, are your best friends, 
 your Godsends, not because they talk to you about 
 the National Gallery, but just because they do not 
 talk, but dose, anaesthetize, and incise you. Every 
 doctor, early in his course, ought to stand at that 
 point. You cannot be a perfect doctor, till you 
 have been a patient : you cannot be a perfect 
 surgeon, till you have enjoyed in your own person 
 some surgical experience. Enjoyed, I say, and stick 
 to the word. Count the ways of enjoyment. To~ 
 be the dear object of so much care and friendship, 
 to be compassed about with hopes and prayers, is 
 there no pleasure in that ? To behave nicely, and 
 nothing common do or mean, upon that memorable 
 scene, but lie on the operating-table like Patience 
 on a monument, is there no pleasure in that act 
 of self-control ? On you, on you, rests the love 
 of many hearts, and every pulse in the house is 
 quick with thinking of you. Somebody, these last 
 few days, for I take it that you are married, or at 
 the least engaged, has been at her wits' end of 
 
104 CONFESSIO MEDICI 
 
 miserable anxiety for your sake : and behold, this 
 morning early, she brings you roses and lilies, and 
 wears a wonderful mechanical smile, a most curious 
 grimace, which makes her more beautifial than ever. 
 It is time for the operation. You are, what is so 
 rare in this world, at rest. The very elements of 
 thought and of will, the disposition of the least 
 bodily act, are now to be taken out of your hands. 
 Put them by your side, and shut your eyes. Go 
 to sleep : do nothing, think of nothing, be nothing. 
 Shut your eyes; go to sleep. Before you wake, 
 back in bed, the good news of your safety will be 
 rapped out, like a spiritualist message, at remote 
 post-offices ; and kind people, ever so far off, will 
 be saying, all in a breath. Oh my dear it says doing 
 favourably operation perfectly successful no immediate 
 anxiety thank God best love Tomkins ; and your lady 
 of the roses and lilies, with her pretty face all 
 smudged with crying, and one ear red with listen- 
 ing at the key-hole, will give you such a kiss as 
 no man deserves to have twice. And you, though 
 you feel horribly sick, being so full of ether that 
 you reek like a peppermint-drop, are proud, yes, 
 and happy, and through the fumes of the clinging 
 anaesthetic are the captain of your soul. 
 
 Besides, see what you have gained in practice. 
 To be ill, or to undergo an operation, is to be 
 initiated into the mystery of nursing, and to learn 
 the comforts and discomforts of an invalid's life ; 
 
THE SPIRIT OF PRACTICE 105 
 
 the unearthly fragrance of tea at daybreak, the dis- 
 appointment of rice-pudding when you thought it 
 was going to be orange-jelly, and the behaviour of 
 each constituent part of the bedclothes. You know, 
 henceforth, how many hours are in a sleepless night ; 
 and what unclean fancies will not let us alone when 
 we are ill ; and how illness may blunt anxiety and 
 fear, so that the patient is dull, but not unhappy 
 or worried ; and how we cling to life, not from 
 terror of death, nor with any clear desire for the 
 remainder of life, but by nature, not by logic. In 
 brief, you learn from your own case many facts 
 which are not in text-books and lectures : and your 
 patients, in the years to come, will say that they 
 prefer you to the other doctor, because you seem 
 to understand exactly how they feel. I wish you 
 therefore, young man, early in your career, a serious 
 illness, or an operation, or both. For thus, and 
 thus alone, may you complete your medical educa- 
 tion, and crown your learning with the pure gold 
 of experience. The crown of experience is like the 
 crown of Lombardy, a band of iron set in a band of 
 gold : and it is believed, even now, by some people, 
 that the iron of that crown is more valuable than 
 the gold. 
 
 Besides, see what you have gained in thought. 
 I hesitate here, for I am on disputed territory. Of 
 course, no problem is solved, no doctrines are 
 shifted, by illness. Only, as you lie a-thinking. 
 
io6 CONFESSIO MEDICI 
 
 this cleared space of a few weeks does present to 
 you an aspect of life which your work hides from 
 you. If the mind be clouded or swamped, all 
 aspects of life are blurred or lost: but, in most 
 illnesses, there are fine days, when thought can 
 go out and get a good view. The feel of life, 
 at such a time, may be compared to the feel of 
 London, at four o'clock in the morning, to a 
 man walking home after a ball. The streets and 
 squares and houses are the same as ever ; and so 
 is he. The taste of his pipe in his mouth, the echo 
 of the music in his head, the chill of the pavement 
 under his feet, are familiar to him ; everything is 
 what it always was and will be, nothing is happening ; 
 and he makes his way past the shouting linkmen and 
 the line of cabs and carriages, glad to be out in 
 the open air, and as sure as Cleopatra that there 
 is nothing remarkable beneath the visiting moon. 
 Only, as he goes, the silence, the closed shops, the 
 odd sense of solitary wakeful self, the brooding sky, 
 the empty roads, begin to talk to him, asking him 
 to see for himself how, even in London, Nature is 
 omnipresent, and, in the act of labouring like a 
 machine, sleeps as a picture. Then they remind 
 him that all London is but a point in the world's 
 purpose ; yes, and all the world but a point in the 
 universal purpose, or what is the good of the stars ? 
 He begins to feel small ; and is surprised that he 
 was proud, half-an-hour ago, of his excellent dancing. 
 
THE SPIRIT OF PRACTICE 107 
 
 A breeze of dawn comes, and raises a little whirl of 
 dust : and he says to himself, being a thoughtful 
 young man for his age, that the Anima Mundi is 
 just like that, and every speck of dust is a planet. 
 If planets are specks of dust. Lord, what is man ? 
 There is a touch of light in the East : and it sets 
 him wondering at his own existence, continuous from 
 day to day. He never thought of that in the ball- 
 room. There, he had thought it romantic to dance 
 five times with one partner : here, under the stars, 
 he finds more romance than he had expected. 
 Nothing has happened, he is what he was, he has 
 not changed a hair's-breadth, nor has London : 
 bricks and mortar, trees and sparrows, have no 
 arguments in them, no logical force. All the same, 
 the vision did come to him. 
 
 So it may be with a man when he is ill. The 
 silent, empty hours, the lull in the traffic of his 
 life, the shutters up in the shop-front of his work, 
 have something to say to him : they explain nothing, 
 but they give him a point of view. They emphasize 
 his individuality. It is all very well, in the vanity 
 of health, to call ourselves a succession of states 
 of consciousness : that nonsense is knocked out of 
 us by a month in bed, where we have time and 
 opportunity to feel sure that we are not. An 
 illness, I hardly know how, does tend to make us 
 understand that matter and reality are not inter- 
 changeable terms. Here, in this sense of the 
 
io8 CONFESSIO MEDICI 
 
 non-material reality of self, is a thread worth 
 holding. Especially, it is to be found, and held, 
 in the very act of surrender to an anaesthetic. 
 For he, who offers himself to be reduced to un- 
 consciousness, is most conscious ; and the freedom 
 of his will was never more plain to him than now, 
 when he lays it down. With the first breath of 
 ether, he flings a last defiance to all that we call 
 Haeckel, and swears that it is false. Which is a 
 fine experience, and cheap at the price. 
 
 Therefore, since happiness, and insight into other 
 people's feelings, and even a thread of philosophy, 
 may be got out of illness, I advise every young 
 doctor to take his chance of being a patient. But, 
 when he is well again, and back at work, he must 
 keep his philosophy to himself, not let it come 
 near his cases. I do not mean that he will infect 
 them, but that he may be tempted to philosophize 
 over them. The spirit of practice refuses point- 
 blank to have anything to do with philosophy : and 
 quite right too. All practice, to the great advantage 
 of our patients, is founded and built on materialism. 
 No other foundation could bear for a moment the 
 weight of the present building. In practice, we take 
 it for granted, that our fellow-creatures are what 
 Haeckel says that they are. That is the law of our 
 work, and we are under it from the beginning of our 
 preliminary studies to the end of our working lives. 
 
 So long as we are in the dissecting-rooms and the 
 
THE SPIRIT OF PRACTICE 109 
 
 physiological laboratory, materialism is content to 
 enslave us, and scarcely troubles to convert us. 
 But, when we advance from anatomy and physiology 
 to medicine and surgery, it assumes a more in- 
 quisitorial air, and loves, in the wards, to send us 
 down on our bended knees. Look here, it says, 
 and here, and here : and don't you dare to bandy 
 words with Me. That is Haeckel's clinical teaching, 
 his way of demonstrating the facts of pathology. 
 These cases of injury or disease of the brain, what 
 are they, but brains injured or diseased ? If you 
 believe that they are more than that, put your belief 
 to the test. Here is a case of cerebral haemorrhage : 
 Cry aloud, for he is a god, peradventure he sleepeth, 
 and must be waked. And there is no voice, nor 
 any to answer. From ward to ward, forcing on us 
 the one simple explanation of everything, dominating 
 the whole Hospital, bullying everybody, absolutely 
 self-satisfied, rages Haeckel, never in doubt, never 
 at a loss : and carries us along at his heels. This 
 is the way we go to school, we go to school, we 
 go to school ; the only way for us to learn our 
 art. A patient is a case, Latin casus, an occurrence ; 
 that is Haeckel's rule : and we must practise what 
 he preaches, and take hold of his hand tight, and 
 not let go, or we shall get lost, or run over at the 
 next crossing. 
 
 We cannot do better than obey him. FooHsh 
 people talk as if it were somehow the doctor's 
 
no CONFESSIO MEDICI 
 
 fault, and a rebuke against him, that every scrap 
 of his work is saturated with materialism. Why, 
 that is just how he makes it tell. There is no place, 
 in practice, for any other form of thought. Here, 
 for instance, is a patient in immediate danger of 
 death, but not quite past all hope of recovery. 
 To the philosopher, the poet, he is animula, hospes 
 comesque corporis. To the doctor, who must deal 
 with him at once, and that by methods most 
 unpoetical, he is neither hospes nor comes corporis^ 
 but just corpus. We learned him as corpus, and it 
 took us five years, and some of us more, to learn 
 him that way : and we treat him as corpus, because 
 it takes us all our learning to treat him that way. 
 For the sake of our patients, the spirit of practice 
 compels us to work always within the ring-fence of 
 materialism. 
 
 But this wise compulsion, this honourable law 
 of our work, is a purely business arrangement 
 between the spirit of practice, on the one hand, 
 and the practitioner, on the other hand. It is a 
 convention, a serviceable fiction, a good understand- 
 ing between them. In every art, there is convention. 
 Observe this admirable subscription-portrait of His 
 Worship the Mayor, in his robes of office. It is 
 dumb, though he is voluble ; it is flat, though he is 
 not ; it cannot stir, though he is a very active man. 
 This painted cloth, this idol, which everybody 
 admires as a work of art, is the only way in 
 
THE SPIRIT OF PRACTICE iii 
 
 which the artist could treat the Mayor. So we, 
 when we treat our patients, obey the conventions 
 of our art. Like the postulates of EucUd, which 
 enable him to solve his problems and construct 
 his figures, they enable us to solve our problems 
 and employ our methods. Euclid takes it for 
 granted, that he is dealing with lines perfectly 
 straight; we take it for granted, that we are 
 dealing with automatic machines out of order. Both 
 assumptions, alike, are but the forgeries of science. 
 
 Look back to the time when you were not the 
 doctor but the patient, lying there and wondering 
 at the mystery of yourself; or to the day of your 
 operation, when that mystery accompanied you as 
 you went under the anaesthetic, and met you as you 
 came out of it. You were you, that day, and your 
 brain was yours, not you. Pick up this thread, and 
 follow its guidance. How far does it go ? Never 
 mind ; follow it, and see. It has nothing to do 
 with practice ? But practice, by and by, will have 
 nothing to do with you. In that day, you may 
 be glad of a thread of philosophy. For the present, 
 submit yourself, in all your work, to the spirit of 
 practice ; accept the current jargon about thought- 
 cells and successions of states of consciousness : and 
 hide your thread of philosophy from the derision 
 of Haeckel. 
 
 Here are many pages, all to say that the spirit 
 of practice regards neither culture nor philosophy. 
 
112 CONFESSIO MEDICI 
 
 This negative conclusion is but a poor result, in 
 comparison with the kind things said of us in 
 books about good doctors, and in Hospital-Sunday 
 sermons. But is it not true, and positive, that the 
 spirit of practice loves to enter such lives as offer 
 to it neither adornments, nor a view out of the 
 windows, but a bare room, and expectant silence, 
 and passionate longing for it, and for it alone ? 
 
 Nil ergo optabunt homines? Have we, then, 
 nothing to pray for ? Indeed, Juvenal's prayer, 
 being one of the world's masterpieces, will bear 
 translation here. {TKe know not, he says, how to 
 pray. We pray for wealth, glory, eloquence, beauty, 
 strength, long life : and the easy-going Gods grant our 
 prayers, and thereby we bring on ourselves misery and 
 ruin.) " Well, then, shall men stop praying ? If 
 you want my advice, you will let the Gods them- 
 selves decide what is good for us and useful for 
 our stations in life. For they will give us, not the 
 pleasures of the moment, but all that is most fit 
 for us. Man is dearer to them than to himself. 
 Still, that you may have something to say, some 
 prayer to go with your foolish sacrifices, pray for 
 a sound mind in a sound body. Ask for a brave 
 heart, wholly free from the fear of death ; a heart 
 which reckons mere length of days among the least 
 of Nature's kindnesses, and can bear all hardship, 
 and cannot lose its temper over trifles, and covets 
 nothing, and is persuaded that the bitter labours 
 
THE SPIRIT OF PRACTICE 113 
 
 of Hercules have more salvation in them than the 
 lust and luxury of Sardanapalus. Behold, I am 
 telling you of those gifts which you can give to 
 yourself, Gods or no Gods." 
 
 But these gifts will not suffice. Pray to the 
 Gods, also, for a fair measure of the love of science, 
 a good memory, a quiet manner, the accurate use 
 of your hands and your senses, and the necessity of 
 making money. Pray even for opposites ; for 
 humility and pride, for plodding business-ways and 
 for the wings of ambition, for a will both stubborn 
 and flexible : and, above all, for that one gift 
 which has been the making of the best men in our 
 profession, the grace of simplicity of purpose. 
 
WREATHS AND CROSSES OF PRACTICE 
 
 A florist's shop, at the height of the fashion, is a 
 
 strange sight. Roses out of season, and carnations 
 
 grown so large that they wear paper stays to 
 
 preserve their figures ; other less fortunate flowers 
 
 dyed, wired, or twisted in devices, or imprisoned 
 
 in wooden shoes and china wheelbarrows ; violets 
 
 without earth, forget-me-nots without water, crocuses 
 
 growing out of terracotta pigs, and green grass 
 
 sprouting over comic little bald heads. Across the 
 
 fragrance of the flowers, you seem to catch the 
 
 smell of a restaurant : and the messenger-boy, going 
 
 off with an elaborate centre-piece of poppies, is the 
 
 counterpart of the confectioner's boy coming round 
 
 with the ices. Fashion, you would say, has ousted 
 
 Nature. Yet, as you stand there, you become aware 
 
 that Nature, lurking about the shop, is watching 
 
 you with a spiteful smile, and will still have the 
 
 last word : and she has it, on a label, slung in the 
 
 window. Wreaths and Crosses. That is Nature's 
 
 way. She is not in any hurry, nihil per saltum facit ; 
 
 everything comes to her who waits. We, who 
 
 114 
 
WREATHS AND CROSSES 115 
 
 now order table-decorations, and bouquets to match 
 frocks, shall one day have wreaths and crosses 
 ordered to match us. You catch your breath, for 
 a moment, at that; and the shop seems haunted. 
 The white flowers are whispering one to another : 
 Are you engaged to-morrow afternoon? Tes, Kensal 
 Green, worse luck. They nod their wicked heads at 
 you. The big white lilies, especially, have seen you 
 looking at the label, and guess your thoughts, and 
 share your misgivings, and are going your way : 
 Ave Caesar, they say with a little laugh, morituri 
 te sahtant. None of them, for my money, this 
 Saturday evening : give me unconcerned, unfashion- 
 able, jolly flowers, that are never in mourning, and 
 such as go neither to funerals, no, nor to dinner- 
 parties : homely flowers, of all the colours of the 
 rainbow, and with none of the associations of the 
 cemetery. 
 
 A wreath does not commit the kind donor to 
 any expression of opinion ; a cross might seem 
 to commit him. Perhaps, therefore, a wreath is 
 safer : one does not want to appear to be putting 
 oneself forward, or pretending more than one really 
 feels. Yes, a wreath, please, a nice wreath. Tie 
 your card to it: you have paid your last call on 
 your friend, and he was out. Or shall it be a 
 cross ? For he was ill such a long time, and did 
 so want to get well. Shall we drive back to the 
 shop, and tell them to make it a cross, not a 
 
ii6 CONFESSIO MEDICI 
 
 wreath ? Perhaps, after all, we had better not. 
 People are so silly, they do notice such little things, 
 and they always read the cards. Besides, there are 
 sure to be lots of crosses ; there always are. And 
 somehow a wreath seems more appropriate. Per- 
 haps he wouldn't quite have liked a cross, himself 
 Indeed, now you come to think of it, they were 
 married at a registry-office : of course, that was a 
 long time ago, still, they were. So you send your 
 wreath ; and somebody else, because your friend, 
 whether he liked crosses or not, certainly bore one, 
 sends a cross ; and then somebody, as scrupulous 
 as you, sends a wreath ; and then somebody sends 
 a cross for this reason, that if people do not like 
 them, they ought. Thus, at the last, the whole 
 house is fragrant with these opposed emblems. 
 
 Practice, also, has her wreaths and crosses : but 
 she is never in doubt which to send, for she does 
 not wait till we are dead. Nor does she play fast 
 and loose with the difference between them. To 
 her mind, a wreath is a wreath, and a cross is a 
 cross, patibulum, as it was in the days of Tiberius. 
 A wreath for the victor, and a triumph, along 
 the Sacred Way, up to the Capitol : a cross for 
 the unsatisfactory slave, and off with him to the 
 Esquiline. 
 
 The wreaths of Practice are those highest rewards 
 which she gives to our leaders, our victorious 
 generals, and to them alone. The cross of Practice 
 
WREATHS AND CROSSES 117 
 
 is failure in practice. Its weight, in each case, is 
 determined by the rights and the wrongs of that 
 particular case. 
 
 Over failure, a man may laugh, or preserve a 
 dignified silence, or worry himself to bits : do what 
 he will, he cannot get clear away from the idea that 
 he has himself, in some measure, to blame. Practice 
 does not desire that he should thus get clear away. 
 What he was, she says, is where he is : and 
 where he is, she says, is just about where he ought 
 to be. 
 
 But why should a man be surprised at some 
 admixture, in his life, of failure ? Is it to be won- 
 dered at, that now and again we take the wrong 
 turning in the maze, play the wrong move in the 
 game ? It would be a miracle, if we did not. 
 Why then should we be tragic over the sense of 
 failure, or, what is worse than tragic, theatrical ? 
 To be sorry for our faults is trouble enough, without 
 making a scene over them, and them so common. 
 Let us avoid the antick disposition of the penitent 
 hero on the stage. Behind him prostrate on a 
 wooden rock, a paper moon rides in a muslin sky. 
 In front of him, the footlights, glassed in green, shed 
 a pale gloom, as from the paper moon. Beneath 
 him, in the bowels of the stage, the fiddles wail, 
 the double-basses grunt, in sympathy with such a 
 weight of woe. He stirs, he speaks ; and lo, from 
 highest Heaven, a ray of limelight falls on his sad 
 
ii8 CONFESSIO MEDICI 
 
 face. He is in real distress, his plans have failed, 
 and he tells us that it was his fault. He put the 
 will, in a moment of light-hearted carelessness, 
 where the villain found it. He forgot to tell the 
 heroine that the wine was drugged, the plank sawn 
 half-through, the letters forged. No wonder that 
 the fiddles are crying and shivering, and the larger 
 instruments are breathing heavily : for here is 
 genuine tragedy, which is a series of unavoidable 
 disasters, arising directly out of human character, 
 and happening to somebody very important. 
 
 We are all of us that ; and all of us, in point 
 of character, are more or less at fault : and then, 
 direct from our fault, comes failure. We were 
 ardently in love with Success ; we were going to 
 marry her, and live happy ever after. The very 
 day was fixed for the wedding : indeed, we were 
 on our way to the church, when we remembered 
 that we had forgotten to tell her about the villain. 
 Even as we came up the lane, in our best clothes, 
 she, poor dear, all smiles and song, and thinking 
 only of us, was walking that plank, and went splash 
 into the deserted lock. Oh, it is too dreadful. 
 Tragedy, tragedy, let us play up to you, and fall 
 upon the ground. Taking the measure of an unmade 
 grave. 
 
 Yet, if a man, disappointed of the fullness of his 
 hopes, is hard hit by that loss, it is no laughing 
 matter ; and, as we admire him who hides a hurt, 
 
WREATHS AND CROSSES 119 
 
 so we distrust him who does not feel one. When 
 we ask a man. Does it hurt ? and it does, we like 
 him to say Tes. If he says. No, I feel nothing, 
 either he is not speaking the truth, or there is 
 something wrong with his nervous system. 
 
 Consider, what is the hurt of failure in practice. 
 I do not mean complete failure, the point at which 
 a man must either do nothing, or take some new 
 occupation : I mean partial failure, some disappoint- 
 ment, that line along which a man must continue 
 at his work, the same as before, what there is of it. 
 
 He casts about in his mind, to find what has 
 happened. Was it self, or chance, or Providence, 
 or circumstances, or an enemy, or what was it, that 
 was against him ? First, he takes himself, holds 
 his own character to the light, as you may see a 
 housewife, in autumn, examining a blanket. He 
 finds, of course, one or two moth-holes. Perhaps 
 he was not really practical in practice, but had 
 bookish views as to the proper behaviour of diseases ; 
 or he was a bit slow, unbusiness-like, a lover of 
 leisure, a bad hand at making work ; or he was a 
 bit quarrelsome, or hard, or difficult, or fantastical ; 
 or he was of the number of those who are proud 
 of being humble, who assert their freedom from 
 self-assertion, and advertise their dislike of advertise- 
 ment; or he was fond of talking about himself to 
 people who were aching to talk about themselves. 
 One or more of these faults he finds in himself: 
 
I20 CONFESSIO MEDICI 
 
 yet, honestly, he cannot see that they explain his 
 disappointment. They had, he says, something to 
 do with it. But the fault and the failure do not 
 balance, are not proportionate. Over the doors of 
 old cathedrals, amid a labyrinth of sculpture, angels 
 weigh in balances the souls of men ; over the doors 
 of law-courts, Justices hold empty balances, waiting 
 blindfold for a job. All the same, fault and failure 
 are not commensurate. Fault is dynamic : a few 
 grains of fault can blow up a whole edifice of 
 ambition, and spoil the finest castle that ever was 
 built in the air. Our imaginary man has suflFered 
 that reverse. His castle still stands, but with sad 
 cracks in its walls, and broken windows, and a 
 leaking roof. The dynamite went off: and we need 
 not trouble to ask what made it go off. Perhaps 
 it went off by chance. Anyhow, he had it there : 
 he is himself, in a measure, the cause of his dis- 
 appointment. 
 
 Then comes the thought, how many lives are 
 affected. Here, just here, is the hurt of his dis- 
 appointment, in its centrifugal results on circles 
 beyond circles of other people. The shaking of 
 his castle is like the seismic waves of Mont Pelee, 
 which were felt, again and again, by every observa- 
 tory in the world, and are still embodied, somehow, 
 in the universe. First, his home-circle. I assume, 
 of course, that he is middle-aged, and has given 
 hostages to fortune. Solitary men, as they miss 
 
WREATHS AND CROSSES 121 
 
 the sweetness of making money, so they avoid the 
 bitterness of wanting it : young men, likewise, avoid 
 that bitterness, for they are sure that the sweets 
 are to come. Therefore, our imaginary man is 
 middle-aged, and has a wife and family : and, as 
 his life tastes now, so it will taste henceforth. 
 
 Husband and wife, while they are young, and 
 the baby is still the baby, play at economy as at a 
 game. They remind me of that pleasant minstrel, 
 at the swing-doors of the public-house, who gets 
 melody out of a coffee-pot with holes cut in the 
 spout, or from hard little strips of glass or metal. 
 They shall have music wherever they go. To him 
 and her, who can find pleasure in saving a cab-fare, 
 and spend that shilling, arm in arm, quite seriously, 
 on something else, that she really did want, this 
 discourse is not addressed. I envy and honour 
 them. Out of books, out of good examples, out 
 of their own hearts, they encourage one another, 
 and quote the whole anthology of the praise of 
 thrift : My father was just as poor, at my age, as 
 I am. My mother had to do without lots of things: 
 besides, she had such had health. They invent 
 challenges and pass-words of love : Why didnt you 
 marry somebody with money ? That is the challenge ; 
 and the pass-word takes all four lips. They surprise 
 each other with sixpennorths of luxury, and have 
 a thousand plans for the immediate future, and 
 Aunt Maria's fifty pounds is spent in fancy many 
 
122 CONFESSIO MEDICI 
 
 times before it comes to them. In the profound 
 Greek sense of the word, they have enthusiasm. 
 Look which way they will, back or here or ahead, 
 they see sunshine : and people ask them to evening- 
 parties because their happiness lights up that dim 
 pleasure. They find a sacrament in their daily 
 bread, and a miracle in the coming of the baby. 
 To save, to wait, to scrape along, — why, that is 
 what they enjoy ; that is the way to begin, the 
 classic, heroic, historic, romantic, practical way : 
 besides, how stupid it would be to be rich now, 
 how vulgar. See them, this man and this woman, 
 setting-out, hand in hand, heart in heart, into an 
 expectant world. I could rhapsodize for pages over 
 them : indeed, if it comes to that, they can do it 
 for themselves. In all life, there is nothing more 
 delightful, more inspiriting, than the sight of their 
 bow in the clouds ; and I hope that it will be lost 
 not in a sky of grey, but in a sky all sapphire. 
 
 But suppose the sky keeps grey. Not black, 
 but grey ; no storm clears the dull air and washes 
 the streets of life : only, the sky is grey, and the 
 bow gone. Oh, not a regular wet day, no excuse 
 for stopping indoors, or giving up any engagement : 
 still, a dull heavy sort of day, and rather cold, 
 considering that it ought to be summer. Slowly, 
 the sense of effort and of make-believe comes 
 into their game of economy. They begin to long 
 to play at something else. Once, they were proud 
 
WREATHS AND CROSSES 123 
 
 of not being rich : now, the most that they can 
 compass is to be proud of not being ashamed of 
 being poor ; and sometimes even that humble pride 
 breaks, and lies in the dust. Once, they could chaff 
 one another over his earnings, and had a sort of 
 slang, for home-use, a love's lingo, weird names 
 for the tradesmen's bills, and for his pocket-money, 
 and her sewing-machine : but that is all left off 
 now, because it hurts them both ; and he gives 
 her with a sigh the week's takings, which he used 
 to give with a laugh ; and each of them is longing 
 to see the other looking happy. Hospitality, so 
 far as they still exercise that grace, begins to lose 
 touch with the rest of home-life. Into their rare 
 festivities, there enters a hint of Macbeth's feast ; 
 no actual ghost, nothing so gross as that : only, 
 on your way back, you cannot help doubting 
 whether he and she, left alone, are very cheerful. 
 That is the most dreadful passage in all Shakspeare, 
 when everybody has gone, the ghost and all of 
 them, and Macbeth is talking to himself, and his 
 wife is looking at him. 
 
 Circle beyond circle, the wave of their disappoint- 
 ment spreads. They cannot afford to be generous, 
 they cannot afford to be charitable. This embarrass- 
 ment might be called a negative trouble : but I 
 always have a difficulty in seeing any difference 
 between negative and positive. Not to give, is 
 to withhold. Say that a well-timed gift would save 
 
124 CONFESSIO MEDICI 
 
 a man or a woman from going to the bad. Is it 
 not to say that he, who withholds that gift, sends 
 them there ? 
 
 He and she did so want to be hospitable and 
 charitable : it seems such a reasonable desire. What 
 shall they do ? I do not see that they can do any- 
 thing. He has not altogether failed ; he is only 
 a bit disappointed, a bit disillusioned. Oh, they 
 have much to be thankful for, says their little world : 
 they have good health, and I do like her so much. 
 That is quite true, they have a great deal to be 
 thankful for : but, for all that, he and she, still 
 hand in hand, and heart in heart, are bearing the 
 cross of practice between them. 
 
 Practice, thank Heaven, sends also wreaths; olive, 
 laurel, gold, she has them of all sorts, I have seen 
 them : and never, in all the history of Medicine? 
 were they more plentiful and more beautifiil than 
 they are now. Ah, did you once see Shelley plain. And 
 did he stop and speak to you ? Shelley, indeed. Why, 
 I have seen and shaken hands with doctors worth 
 a wilderness of Shelleys. Into their keeping, God 
 entrusted lives precious to the Empire, to be saved. 
 Out of their work, out of their discoveries, came, 
 and come, and will come, health and safety and 
 length of days and delivery from pain. 
 
 Yet, if we look close at Medicine, we may doubt 
 whether any wreath, that Practice has to give, is 
 equal in value to the wreaths of Science. The 
 
WREATHS AND CROSSES 125 
 
 doctor, more and more, turns, for the advancement 
 of his art, toward the physiologist, the pathologist, 
 and the bacteriologist. From them, who are not 
 in practice, whose work is in the laboratory, whose 
 language is mostly unintelligible to us practitioners, 
 have come new methods, new facts : to them we 
 look, and shall not look in vain, for help and 
 guidance. 
 
RETIREMENT 
 
 He who would write a book, but cannot think of 
 a subject, should plan a series of short essays, each 
 on a word. To that end, he should open, at 
 random, a dictionary ; and there he will find, always, 
 a word in want of an essay. This method of divin- 
 ation, the sortes, was once in frequent use ; and 
 may be less foolish than it sounds. You open, at 
 random, a Bible or a Virgil, and take, as advisers, 
 the first words that come. Why should you not ? 
 Say that you cannot decide between two courses, 
 cannot look far ahead : shall not one of the 
 Hundred Best Books, at random, be as wise as you 
 at sea ? You are ready enough to use a friend 
 that way, opening his heart at random, and letting 
 yourself be guided by what you find there. A 
 friend and a book are not so very different : in- 
 deed, the book may be the truer prophet, as with 
 King Charles the First, who opened a Bible, and 
 found. Let his children be fatherless, and his wife a 
 widow. None of his friends had warned him of 
 
 that. And, even on me, the sortes have just dis- 
 
 126 
 
RETIREMENT 127 
 
 played their power. For I had headed this chapter, 
 and begun to write it, and then I fell to playing 
 sortes with a volume of Johnson's Dictionary. I 
 opened it, at random, six times : and behold, the 
 third time, this very word Retirement, which I had 
 just written, met my eyes. The other five words 
 were Pardon, Sorrow, Morality, Vitality, and 
 Thief: all thoroughly essayable words, especially 
 Pardon. 
 
 Retirement, said the Dictionary, is derived from 
 the French. To understand the meaning of a word, 
 one must observe and consider what pictures it 
 raises in the mind's eye. This Retirement gave me 
 three such pictures. First, I had a vision of French 
 and English thumping each other up and down 
 Southampton Water, or under the walls of Calais, 
 or round and round some old castle in Normandy : 
 and the French were swearing, I could hear them 
 all this way off, and across the centuries, that these 
 devils of English were retiring, se retiraient. Then, 
 came a curious vision of an amoeba under the 
 microscope : I could see it contracting, till all its 
 processes were indrawn, and it ceased to move. 
 Then, I saw what I took to be the wilderness, and 
 a man, alone in the wilderness, gone there for that 
 one purpose, to be alone. 
 
 Of course, to play this game of word-pictures 
 as it ought to be played, you must have words 
 of the right size. As a rule, the size of a word 
 
128 CONFESSIO MEDICI 
 
 is inversely as its length. For example, all such 
 words as heterogenesis, undenominationalism, and 
 diazoamidonaphthalene, though two of them really 
 mean something, and the third is in daily use, yet 
 you cannot play with them, because they are too 
 small : they raise feeble, ridiculous pictures. On the 
 other hand, such words as love and life and death 
 are too large : they raise no pictures, only frames. 
 Your words must be of the right size, and, as it 
 were, of the right shape : then, with a little care, 
 you can obtain a delightful succession of pictures. 
 I only got three out of Retirement : but some words 
 will give you half-a-dozen, or more. 
 
 Of my three, the first and the last were common- 
 place. But the vision of the amoeba was of great 
 value : it more than illustrates, it illuminates, the 
 meaning of the word. To retire, se retirer, is to 
 draw back self; the verb is, or was, active, govern- 
 ing self, like conscience, in the accusative : and the 
 dictionary gives an instance of this old use. He 
 retired himself into the castle. No wonder I saw 
 soldiers. For a soldier, there is always the castle ; 
 for a hermit, there is always the wilderness : but let 
 us, in accordance with the principles of physiology, 
 begin with a very humble organism. The amoeba 
 is its own castle, its own wilderness ; it cannot 
 retreat but into itself. When it feels the need of 
 retirement, it merely contracts. Its occupation, so 
 far as we can see, is gone : it neither thrusts-out 
 
RETIREMENT 129 
 
 adventurous feelers, nor hunts after food, nor adapts 
 itself to its surroundings, nor deludes medical students 
 into talking about voluntary movements, nor takes 
 any interest in its neighbours. It may be digesting, 
 or it may be dead : a dreadful sort of retirement, to 
 be so inert as to leave doubt on that point. 
 
 The amoeba is a warning to all of us, against 
 the day when we also shall retire. Having no 
 refuge, it simply leaves off. Its very name signifies 
 change ; and now it has ceased to change. We 
 dare not do that ; we must have a refuge. Let 
 us prepare for ourselves, now, castles to withstand the 
 siege of Monotony, and let us fit ourselves to find 
 opportunity in the wilderness of Superannuation. If 
 we do not betake ourselves to some resort outside 
 ourselves, we shall not retire ; we shall only contract. 
 
 But the amoeba, when it is weary of retirement, 
 can start again. We retire once and for all, and 
 cannot a second time come forth, suffer ourselves 
 to be desired, nor blush to be admired. Over the 
 door through which we pass, and shut it behind 
 us, the red lamp is extinguished ; we resign our 
 appointments, cut-off our night-bells, and remove 
 our brass-plates : I shall keep mine for the last of 
 my abodes, when I shall retire a itvi feet deeper 
 from my profession. 
 
 It is strange that men should talk so lightly of 
 retirement, seeing that it can no more be undone 
 than the rest of our deeds. The explanation of 
 
130 CONFESSIO MEDICI 
 
 this levity may be, that retirement takes time, out- 
 stays emotion, and does not lend itself to dramatic 
 treatment, or to the sending of telegrams and 
 flowers. Surely, in these days of pageants, we 
 ought to devise a ceremony of retirement, a service 
 of surrender. The Universities might arrange some 
 cheerful yet sympathetic office, that should gather 
 into one passionate, formal act, the doctor's 
 thoughts, as his work drops from his hands: and 
 I think, also, that the Church might suggest some- 
 thing. And, for those of us to whom University 
 and Church sound excessive, there should be at 
 least a vellum address from the Mayor and Cor- 
 poration, and a silver inkstand, and a band playing 
 Auld Lang Syne, and tea and coffee downstairs. 
 But the fact is, that retirement is a lengthy and 
 deliberate process, so sicklied o'er with the pale 
 cast of thought that it loses the name of action. 
 To be born, or to be married, or to die, is the 
 work of a moment : and the clock records the 
 baby's first cry, the sudden cadence of the knotting- 
 words of the marriage service, and the last sigh of 
 the breath. But we cannot thus time retirement. 
 Kings and Queens and Cabinet Ministers can, but 
 not we : 
 
 Now mark me, how I will undo myself. 
 I give this heavy weight from ofFmy head. 
 And this unwieldy sceptre from my hand; 
 The pride of kingly sway from out my heart: 
 
RETIREMENT 131 
 
 With mine own tears I wash away my balm. 
 With mine own hands I give away my crown. 
 With mine own tongue deny my sacred state. 
 With mine own breath release all duteous rites. 
 
 That is how kings retire, and the whole sky 
 is red with that sunset : but we, less majestical, 
 whose only language is prose, and home our only 
 audience, we go slowly, feeling our way ; and so 
 gradual is the action that we hardly note the 
 finality of the act. There have been so many 
 plans and calculations, that the event seems merely 
 the last of many plans, and is no surprise to our 
 friends. Why, they say, he s been retiring for ever 
 so long : he was talking of it last February, after 
 that' attack of influenza. The change from autumn 
 to winter, If you go by the thermometer, does 
 not feel like an event. If you want to make an 
 event of it, you must go by the calendar. So we, 
 changing from the harvest of practice to the frosts 
 of retirement, go by the thermometer of our hopes 
 and fears, which have a wide range, and are slow 
 to settle down. If we want to make an event of 
 it, we must go by the calendar of our fates, in 
 which book our retirements are precisely marked, 
 just like our births, marriages, and deaths, one 
 day for each event. 
 
 The act, or event, of retirement is the same 
 for all of us : but the attendant circumstances are 
 particular to each of us. Some men are born to 
 
132 CONFESSIO MEDICI 
 
 retirement, some achieve it, and some have it 
 thrust upon them. 
 
 He who is born to retirement is of that 
 temperament which is called retiring. Other names 
 for it, in order of merit, are these — unassuming, 
 mild, soft, and feeble. The born retirer does not 
 understand, he never did, he never will, how to 
 fight, force his way, hold his own, and increase 
 his holding, advance, bring up reinforcements, 
 advance again, and beat thundering at the gates of 
 Success : Open, open to me. Open, I say. It is I. 
 The passion of his profession flickers in him, 
 just keeps him warm, but will never blaze. He 
 was always like that. In the nursery, he was fond 
 of his toys, but let all the other children play 
 with them ; and, in the service of that charity 
 which begins at home, many were broken, and 
 he did not mind. At school, he was a good 
 boy ; pleased, out of all proportion, with every 
 gradual inch of advancement, a remove, a word of 
 praise, full marks for a set of verses, bookish 
 little triumphs, all of them : but the point is, 
 that competition made them none the sweeter, 
 and full marks all round would have pleased him 
 just as well, if not better. Compelled to take 
 part in athletic exercises, he behaved, rather than 
 played ; and half was vexed at his incapacity, and 
 half was vain of it. Physically, he was Inclined 
 toward cowardice, and contrived to go all his time 
 
RETIREMENT 133 
 
 at school without one thrashing either official or 
 otherwise. Diligent, polite, tidy, punctilious in 
 religion and fastidious over food, and glad to 
 share both his prayers and his hampers with other 
 boys ; found on the side of the authorities in times 
 of feud, and bearing his own authority, when it 
 came to him, with provoking meekness ; fond of 
 loneliness, yet desirous of popularity : self-observant, 
 elaborate — oh, who can describe a boy's inner 
 world ? — but his hold on the real world was all 
 wrong. To fight and sweat and put himself in 
 the way of pain, to stick to his rights with brute 
 force and bad language against attack and strategy, 
 to find fault with heaven and earth, to mock and 
 rage and rebel — these accomplishments were not 
 in his plan, if he had one, of his life. He was 
 content with his conscience, his books, his fair 
 record, his tepid sense that some of us thought 
 well of him. When he left, we were neither 
 sorry nor glad ; nor was he. School cut no deep 
 mark on him, nor he on it. He had wanted to 
 be good, had tried to be good, had been good: 
 and we had no objection to that, or next to none. 
 But he had failed to fight, had worked, but had 
 not fought. At the hospital, he was much the 
 same. There, of course, they diagnosed his case; 
 no actual disease, no real degeneration : simple 
 weakness, or deficiency of strength. This brilliant 
 diagnosis had not occurred to the authorities at his 
 
134 CONFESSIO MEDICI 
 
 school, because they did not know, there, what 
 he was going to be, and what sort of strength 
 he would want. In practice, he did begin to try 
 to fight, but without much result. Always, he 
 was inclined to take the day's work not as competi- 
 tion but as performance ; not as a good-natured 
 scrimmage for a front place .in the crowd, but as 
 a walk through interesting streets. Later, he 
 began to persuade himself, or half persuade himself, 
 that a solitary walk is the best form of exercise. 
 Later still, he began to be neglectful of honourable 
 and approved ways of self-advancement, and to 
 feel a bit out of heart, slack, envious. So, at 
 last, the quiet verdict went round, that he might 
 have done better. And some of the jury, for 
 they liked him — Heaven, not thinking it wise to 
 give him much money, had given him many 
 friends — said that it was infernal hard lines on 
 him. But was it? 
 
 For still the Lord is Lord of might : 
 In deeds, in deeds. He takes delight. 
 
 But we need not waste pity on them who are 
 born to retirement. They find pleasure by the 
 way ; it is a kindly nature, a not ignoble birthright : 
 there is much to be said in favour of it, and 
 would be more, if there were no such place as 
 the world. Let us keep our pity for them who 
 have retirement thrust upon them. Ill-health, 
 
RETIREMENT 135 
 
 disablement, bereavement, misadventure, offence, 
 I dare not write of these ways of grief and 
 tragedy. And I console myself with the thought 
 that a man may have retirement thrust upon him, 
 not by adversity, but by prosperity. A legacy, 
 too big to be hid, from a kind uncle, the sort of 
 legacy that gets into the papers, is apt to make 
 our patients say that we do not want practice, 
 and have raised our fees to a giddy height, and 
 are thinking of buying a palace on the Grand 
 Canal ; and as for his wife, my dear Louisa, why, 
 she won't look at you and me now, T suppose. In 
 the long run, the uses of such prosperity may be 
 no sweeter than the uses of adversity. 
 
 Of them who achieve retirement, it is true that 
 we may all do that, by achieving old age : we have 
 but to stay here till practice retires from us. But 
 I would narrow the phrase and keep it sacred. 
 Achievement is a word for Caesar. He achieves 
 retirement, whose absence is felt far and wide 
 through his profession ; whose work stands long 
 after he has gone. He led and taught so many of 
 us : he set so many of us on lines just suited to 
 our abilities, he knew what was in us. To watch 
 him operate, was a pleasure : to meet him in con- 
 sultation, was an honour. We recall his very words 
 and looks, we tell old stories about him to young 
 men who will never see or hear him. 
 
 One way and another, we retire. What next? 
 
136 CONFESSIO MEDICI 
 
 Fanciful pictures are common, too common, of 
 Sabine farms, and long walks and long talks, and 
 the beauty of the country. These pictures are not 
 to be trusted. Neither in the country, nor in the 
 town, is it easy for us doctors to be happy in 
 retirement. For consider this, which I reckon 
 among the seeming cruelties of Providence, that he 
 who has done most suffers most from the want of 
 something to do; he who has worked hardest is 
 hardest hit by the sudden silence of the loss of 
 work. He gave up everything for his work, and 
 now he must give up his work. Take the case of 
 Velox, who had, as we all know, a huge practice 
 in the Midlands. By day and night, by road and 
 rail, he drove his influence to every point of the 
 compass, into half-a-dozen towns and fifty villages ; 
 a masterful man, dominant and positive, a born 
 fighter, loving to besiege, in all honour and by 
 declared war, the strongholds of other men. For 
 thirty years he did without a holiday, never afraid 
 of the rush of the day's work, the night-calls, the 
 meals got anyhow, the nearness of a breakdown ; 
 then, victory, and a stately practice, unassailable, for- 
 tified in authority : at last, his name a household 
 word, his face known everywhere, his presence felt, 
 his anger dreaded, his verdict final, and no wonder, 
 for there was no sounder judge of an obscure 
 case, not in all England. For thirty miles round, 
 he was the man to have. In every country-house, 
 
RETIREMENT 137 
 
 in time of peril, the cry was. Send for Velox : and 
 he knew all their secrets, and very unsavoury some 
 of them were. See him, on the go from breakfast 
 to supper, and then, after supper, over his pipe, 
 writing letters and making up his books to any 
 hour. He did the work of two men ; and slept, 
 like Napoleon, in his carriage. 
 
 Then, at the zenith of his practice, Velox fell 
 ill : and, with a certain fitness, his malady was no 
 less tempestuous than himself. They fought it out 
 between them : Death would not budge an inch for 
 Velox, nor he for Death. Each had a long score 
 against the other, run-up at a thousand bedsides. 
 The struggle was of unprecedented length and 
 severity, till exhausted Nature finally separated 
 them, and declared that honour was satisfied. The 
 matter was compromised. Velox was permitted to 
 survive, to Death's disgust, but was compelled to 
 retire, to Death's relief. They exchanged the usual 
 courtesies, but feebly, for both of them were badly 
 shaken. Death, the brute, went oflF round the 
 corner, and avenged himself on a small child, one 
 of his adversary's patients. Velox, with that sen- 
 tence ringing in his ears, stumbled away, somehow 
 or other, out of the crowd, and sat down to think, 
 like Marius among the ruins of Carthage. The 
 bitterness of retirement, the full and sudden bitter- 
 ness, had come to him, whose life's work had filled 
 with sweetness so many lives. He was not thinking 
 
138 CONFESSIO MEDICI 
 
 of the loss of money. At seven shillings a visit, 
 and even at less, if you only save enough lives, 
 you can save plenty to live on. He was thinking 
 of the loss of work : he felt as if he were bound 
 hand and foot, his eyes bandaged, his ears stopped, 
 his mouth gagged. So this was the end of it all, 
 to be idle, idle : to come to a standstill, he, Velox, 
 to be superfluous, to have nothing to do. 
 
 We told him that he would enjoy travelling, 
 Italy, Egypt, a voyage round the world: but he 
 did not want to see the world, he wanted to see 
 patients. Somebody suggested golf, somebody 
 bridge ; and he turned and rent them, not without 
 bad language. Between a death and a funeral, you 
 do not invite the chief mourner, by way of con- 
 solation, to a dinner-party ; and Velox had just lost 
 the love of a life-time, and said that it was damned 
 unkind of us to talk rot like that about him and 
 bridge. Books, gardening, politics, were all urged, 
 and all fell flat: or, to speak with exactness, did 
 not fall, having nowhere to fall, but remained in 
 mid-air, mere possibilities, waiting till Velox should 
 be less impossible. Always, he had been proud of 
 having no time for these pursuits, proud of giving 
 to his children the advantages which had not been 
 given to him when he was their age. Two sons 
 at the University, which was hard indeed to man- 
 age, and four daughters as well educated as the 
 county families, which was less difficult, he had 
 
RETIREMENT 139 
 
 spent on them the earnings of his tearing life. 
 Touve got your work cut out for you, he used to say 
 to them, and your Mother has got hers, and Tve got 
 mine. Now, it is cut away from him. What shall 
 take its place ? Shall he begin, right off, at sixty, 
 to enjoy new pursuits ? Cras amet, qui nunquam 
 amavit ? The year after next, perhaps, he may be 
 elected Mayor: a fine consolation, when a man is 
 feeling like Prometheus bound, that he may live to 
 be a Mayor. 
 
 If he could have written a full record of his 
 experiences, a System of General Practice, it would 
 have been a very valuable book. But the greater 
 part of his wisdom was hardly communicable ; and 
 he had mere scraps of notes of cases, and not one 
 case in twenty had been noted at sufficient length to 
 be of any use for a book : and, of course, it had not 
 been possible for him to keep up with physiology 
 and bacteriology. Besides, the whole business of 
 writing was unfamiliar to him, and almost ridiculous : 
 and he was appalled at the present flood of medical 
 literature, especially in America and Germany. No, 
 catch him trying to write a book ; men must find 
 things out for themselves, by experience, the way 
 he had gone : and, as he said that, it sounded like 
 Pare's voice. See how I learned to treat gunshot wounds; 
 not out of hooks. 
 
 Prometheus bound, Samson shorn and blinded, 
 Velox out of work, are tragic figures : but most of 
 
140 CONFESSIO MEDICI 
 
 us, at heart, would rather be cast for tragedy than 
 for comedy. It is better to be dull in old age, than 
 to be distracted, in middle age, by outside interests 
 and elaborate devices against dullness, such as men 
 call hobbies. A hobby is that wooden horse through 
 which the clown in the circus puts his legs, and 
 capers round the ring of sawdust, and belabours an 
 opposite clown with a bladder at the end of a stick. 
 It is true, that home, friendship, religion, and food, 
 might all be called, in relation to our work, outside 
 interests : but they are not hobbies. They get 
 inside us, and urge us forward. With a hobby, 
 the situation is reversed ; we get inside it, and urge 
 it forward. That is a hobby, an artificial outside 
 interest, which looks as if it were sustaining and 
 impelhng us, when we are sustaining and impell- 
 ing it. 
 
 I imagine a man who, at forty-five, having before 
 his eyes the fear of an aimless retirement, took, for 
 a hobby, the modern drama. He went to all the 
 new plays in London, talked of them, wrote of them, 
 and signed his articles ; he even ran over to Paris to 
 see plays there : at last he wrote a play, paid for its 
 production, and it was fairly successful. By the time 
 he was fifty, he was full of theatrical criticism ; and 
 people who were well said, JVhat a delightful man to 
 sit next ; such wide interests ; I don't know when Fve 
 enjoyed a dinnerparty more : but people who were ill 
 said, Oh, the doctor who is so fond of Ibsen. I cannot 
 
RETIREMENT 141 
 
 help thinkings as my case is such a peculiar one, I would 
 rather have somebody else. At fifty-five, he had written 
 two more plays, which failed, and a book, profusely 
 illustrated, on the Modern Drama in Germany ; 
 having unearthed the Beautiful even there. He 
 made less than two hundred pounds, that year, in 
 practice. At sixty, he retired, and set to work on 
 a Royal Institution lecture on the Meaning of 
 Maeterlinck ; which he gave ultimately to a sub- 
 urban literary society. In retirement, he lost heart, 
 left off caring about plays, came to himself. Medicine 
 does not trouble to recover her prodigal sons : once 
 we take our portion and go into a far country, there 
 we stop till there we drop. He began to be in want, 
 he and his wife and the children; and he lived, poor 
 gentleman, till he was seventy-five. 
 
 Velox, also, lived longer than was quite agreeable 
 to him : but was comforted, always, by the thought 
 that he had done everything for the best, had worked 
 hard and close, lost no opportunity, never swerved 
 from his purpose. He mourned the death of his 
 work ; but rejoiced, that his work and he had never, 
 all those many years, been apart, never at variance. 
 He had loved, cherished, and honoured his work ; 
 sentences of the marriage-service, he often used to 
 say, ran in his head — With my body I thee worship ; 
 I take thee only unto me — Never a cross word, for 
 near forty years, between him and his work : he con- 
 soled himself with that precious memory. Every 
 
142 CONFESSIO MEDICI 
 
 doctor, sooner or later, must lay his practice in her 
 grave. He who has not loved her, will soon see her 
 buried, and will hardly be sorry : and the general air 
 of her obsequies will be that of Gounod's Funeral 
 March of a Marionette. But Velox, at the burial 
 of his love, was crying, yet a grand figure ; and 
 the whole place was black with mourning, and a 
 hundred kind hearts put up the shutters of respect 
 and pity. 
 
 By and by, he began to find contentment in odd 
 nooks and corners of life, which from want of time 
 he had left unexplored : found what a host of friends 
 he had, and what wonderful grandchildren, and how 
 casual and off-hand had been his estimates of other 
 men's words and deeds. Of course, he had his bad 
 times of dullness and loneliness. Especially, at those 
 hours of the day which were most unkind, he must 
 sit and hear the devil saying. Nobody wants you now. 
 That was horrible, the sense that he was inventing 
 engagements, protracting occupations, playing at 
 work ; that his colleagues had put him on the 
 Board of the Hospital to give him something to 
 do and keep him from moping ; that an old patient, 
 now and again, would consult him as it were out of 
 charity. Or he would be cut by the sense of the 
 finality of his loss, or by its cruelty, its waste of all 
 his experience ; or would be worrying himself that 
 another man was attending Mrs. So-and-so, and did 
 not know the ins and the outs of her case. Oh, he 
 
RETIREMENT 143 
 
 had his bad times, he suffered. He took up no new 
 pursuit of any importance ; there was none that he 
 cared to take. He found no rapture in the con- 
 templation of the country, or in the destruction of 
 lower forms of life : no bliss in organized philan- 
 thropy, and no allurement in poetry. To the end 
 of his days, he remained shy of Nature, bored by 
 solitude, and averse from the artistic temperament. 
 Long ago, like the rulers of Plato's Republic, he 
 had turned the poets and the musicians out of the 
 kingdom of his life, and was not minded now to 
 recall them : besides, if he had, they would not have 
 come. 
 
 But Heaven gave him, thus disabled in its service, 
 a handsome pension. Great respect is paid, by 
 Heaven, to the Employers' Liability Act ; and it 
 accepts the extension of that Act even to those 
 whom it employs only for odd jobs at infrequent 
 intervals : but Velox, of course, had been in regular 
 employment. It is not in a hurry to pay all claims : 
 indeed, some people are of opinion that application 
 must be made in person. Anyhow, Velox got his 
 pension, paid in every coin of that realm : but I am 
 not speaking from experience of such transactions. 
 I only know that he was paid, in peace of mind, in 
 a clear conscience, in home-love, in a name honoured 
 far and wide, in faith and hope, and in shrewd and 
 mellow wisdom. For the sake of his work, he had 
 lived in a groove, in a narrow sort of way ; and 
 
144 CONFESSIO MEDICI 
 
 behold, now that he was permanently out of work, 
 he had the reward of that way. 
 
 Back we come to the meaning of the word 
 Retirement, and to my threefold vision of the 
 soldier, the amoeba, and the hermit. He who dares 
 not be narrow when he is young, from fear he 
 shall be dull in old age, is the amoeba : when he 
 retires, he stops. Velox, in his retirement, attained 
 something of the courage of a soldier, the patience 
 of a saint. And he had need of these graces. 
 Here, at last, thinking of him, I find one more 
 figure of retirement. It is our school. It pre- 
 pares us, none too pleasantly, to go up to the 
 University of Old Age, that grim seat of desperate 
 learning, where we finish our education, and take 
 our degree. 
 
THE VERY END 
 
 By the time that they come to the sea, all great 
 rivers are much alike. Their surroundings are 
 blank and flat, no longer the hills and the woods, 
 and not yet the cliffs. Their waters, no longer 
 sweet, and not yet salt, have lost force, and are 
 swayed by the tides. All depth of colour, sharp- 
 ness of outline, and strength of purpose, are gone 
 from rivers thus dying ; neither the sea, nor the 
 land, seems to want them, and they are neither at 
 work nor at rest. No more adventures for a river 
 so near its end, no surprises in store for it, no 
 hope of further increase. It has taken its last 
 tribute from the hills, and has said goodbye to 
 them ; has given its blessing to its towns, and 
 forgiven them their sins, their poisonous factories : 
 has closed its account with earth. One or two 
 ships, by way of trade, still find some hope of 
 profit in this desolate stretch of the river's course, 
 and come, and hang about, like distant relatives 
 waiting on the mere chance of a legacy : but the 
 
 river hardly recognizes them. Besides, it has 
 L I4S 
 
146 CONFESS 10 MEDICI 
 
 nothing now that it can call its own. Long ago, 
 it made its will, disposed of its property, gave 
 everything to the children. It cannot even re- 
 member now what it did with its wealth ; or it 
 would have a thousand pleasant memories of gifts 
 to every city and every field, right and left, all the 
 way : but its mind is clouded and confused, for 
 it is within a mile or two of its dissolution. 
 Silent, lonely, passive, moving not of itself but of 
 the tides, it becomes, hour by hour, less river and 
 more sea ; and dies, by inches, in its sleep. 
 
 Not all rivers end like that. Some run full tilt, 
 laughing and shouting Here goes, and are gone ; 
 some leap from a height, and put an end to them- 
 selves, as if they had lost their senses ; some just 
 shuffle into the sea, in a slipshod fashion, as if 
 they did not know that it was there ; and some, 
 fighting to the last moment, retain for a while, 
 even among the waves, their colour and their 
 outline. But these are the lesser rivers, that die 
 young. There is something, but not much, to be 
 said in praise of dying young. Is there not something 
 brave and spirited, says Stevenson, in such a termina- 
 tion ? and does not life go down with a better grace, 
 foaming in full body over a precipice, than miserably 
 straggling to an end in sandy deltas ? And that Greek 
 poet, who says that they whom the Gods love, 
 die young, does not mean that they whom the 
 Gods love, may live to be old, yet will always be 
 
THE VERY END 147 
 
 young : he means what he says. But what is 
 the good of all this talk about the Gods, and 
 bravery, and grace ? Length of days is not a 
 matter of choice. A river cannot end, with a 
 plunge and a flourish, just when and where it 
 likes : and a great, laborious river, many hundreds 
 of miles old, is bound to have a lingering, mono- 
 tonous time, on its way out. 
 
 Matthew Arnold, in Sohrab and Rustum, attributes 
 a happier disposition to the Oxus. It moved re- 
 joicing, he says, toward the sea, as toward home, 
 longing to hear the dash of the waves. His 
 narrative poems are none too light-hearted ; and I 
 cannot say how it may be with the Oxus, for I do 
 not know that river, not even on the map. But 
 the more common destiny of great rivers, at the 
 very departure of life, is to be kept waiting, without 
 rejoicing. 
 
 The reason why the river miserably straggles to 
 an end in sandy deltas, is in the river itself. All 
 the way, it has been bringing down tons of alluvial 
 soil. By its own doing, it has prepared for itself 
 a slow and difficult exit : the very length and 
 breadth of its course have created these impeding 
 deltas. Ever since it was born, it has been deciding 
 how it will die ; and cannot now go back on that 
 decision. 
 
 Its dreams, as it falls asleep, are haunted by 
 signals of coming change. Nothing happens ; but 
 
148 CONFESSIO MEDICI 
 
 something, it is sure, is going to happen. The 
 tides, it says, must mean something ; so must the 
 brackish taste of its waters, and the unfamihar flakes 
 of weed in them, and the appearance and disappear- 
 ance of little islands, where strange birds wheel 
 and light, and stay a minute, and are off again. 
 Oh, there cannot be a doubt of it, with all these 
 signallings and premonitions, something is certainly 
 going to happen. Meanwhile, how slow it all is, 
 this featureless, drifting, last bit of existence, neither 
 one thing nor the other, neither here nor there. 
 
 So unkind may be the extremity of our old age. 
 Take the case of that famous old servant of God, 
 let us call him Prudens, the eminent surgeon. 
 Consider what influence he had on the men and 
 women of his time, and how his work enriched 
 the fields of science and practice. All his life, he 
 was learning and teaching : he [gave back to man- 
 kind what he got from mankind, he turned the 
 waste-products of disease to the uses of health. 
 But, do what he would, he could not give away 
 all that he amassed ; and he brought down, to the 
 coast-line of his life, great stores of alluvial know- 
 ledge. Now, he was told, S(ay where you are. 
 Nature showed him, at the last, no gratitude, no 
 reverence, and, I would add, no mercy. She kept 
 him waiting. He could neither enjoy, nor impart, 
 his accumulated experiences : they lay in his mind, 
 at last, as the deltas lie at the last of old Nile, 
 
THE VERY END 149 
 
 and he seemed to be trying to find his way out, 
 among so many results, without strength to get 
 past them. Science was become impossible, practice 
 had long ago vanished ; and even friendship was 
 mostly a memory, for he could not see more than 
 one or two friends. Work was at an end, and so 
 were holidays. The sixteen-hours' day, the pride 
 of overwork, had been his life. Visits and con- 
 sultations and country journeys. Hospital practice 
 and lectures, solemn committees. Royal Commissions, 
 learned Societies, Councils and Congresses, and four 
 or five hours of reading and writing after dinner, 
 had been the material out of which he had still 
 made time for religion, home, and society. He 
 had, really, made Time : which is a most divine 
 achievement. Now, it was all Time, and none of 
 it of his making. He must be helpless, unable 
 to walk, or to speak above a whisper, or to perform ' 
 without distress the meanest functions of his body, 
 or to put himself to bed. Prudens, oh yes, he is alive, 
 but very infirm : but he must be alive, or we should 
 have heard of it. That was now become his life, 
 to go on being very infirm. 
 
 But Prudens, at the heart of his infirmities, was 
 still Prudens ; and faced the situation with that 
 gravity, reticence, and authority which had always 
 distinguished him in practice. Here was the last 
 case that he would ever have, himself, a typical case 
 of natural decay. Not a very interesting case, but. 
 
150 CONFESSIO MEDICI 
 
 take it or leave it, he would never have another: 
 and some of its aspects appealed to him. For he 
 had always been skilled in advising how lives which 
 were past cure might yet be rendered valuable, and 
 how they who would never be themselves again 
 must adjust themselves to that loss. This last 
 patient, himself, this foregone conclusion, this forlorn 
 hope, would anyhow give him an opportunity to 
 exercise judgment, and to make deliberate choice 
 of a method of treatment. 
 
 Of course, he began the treatment in the first 
 stage of the malady. There are two ways, and 
 no more, of treating natural decay. You begin 
 with active resistance : in the final stage, you have 
 recourse to passive resistance. So long as he was 
 capable of action, he clung to the remnant of his 
 work ; cherished every engagement that was still 
 within his power, refused help, fasted from ease, and 
 urged his tired limbs to be always at some employ- 
 ment. In brief, he went on doing all that he could 
 do. Then, when active resistance was overborne 
 and impossible, came the time of passive resistance. 
 He made no protest; he was silent: you cannot 
 imagine him playing to the gallery. He simply 
 went on being all that he could be. In politics, 
 the passive resister's goods are seized once a year : 
 but Prudens suffered distraint daily, and that not 
 on his goods but on himself Impending Death 
 had, as it were, put the bailiflFs into the house of 
 
THE VERY END 151 
 
 his soul ; Very welly said he, they can take what 
 they like: and they did. They took his strength, 
 his memory of names and faces, the sharpness of 
 his senses, the use of his hands. Always, he 
 managed somehow, by sleep, by force of will, by 
 sheer grace, to repair, or almost to repair, the levy 
 of the day before. There was always something 
 still to be taken. He went without ceasing, and 
 nobody bought him back ; yet there he was, daily, 
 much the same, to the very end, when there came 
 a touch of pneumonia, which doctors call the old 
 man's friend, and Death was left in possession. 
 
 The spirit of practice is positive that there 
 was nothing to be seen but the multiplication of 
 infirmities, the closing of the avenues of sense, the 
 decay of the whole fabric. Neither in the last few 
 months, nor in the last few days, was there any 
 sudden light or heat from the embers of his life : 
 they steadily cooled, and fell into ashes. Nothing 
 happened; only, everything went. When every- 
 thing had gone, he went. Somewhere in the brain, 
 like one lamp not turned-out in an empty theatre, 
 a little group of cells, for a few hours, did just 
 complete the circuit ; and then, not even that. But 
 suppose that Prudens had been conscious up to the 
 last moment, like that other eminent surgeon, who 
 put his finger to his pulse, and waited till the instant 
 came, and said Stopped, and died; yet here is 
 nothing beyond ordinary facts. 
 
152 CONFESSIO MEDICI 
 
 Doctors, of course, have no special information 
 here. We are as much in the dark, here, as 
 everybody else. The spirit of practice bids us think 
 of faith and hope as open questions, and confine 
 our attention to charity : and, so far as the latter 
 part of this injunction go.es, we do not need much 
 bidding. 
 
 Still, we have our private opinions. I am re- 
 minded, here, of one of my friends, who is of 
 opinion that we should no more 'look to Nature 
 for hope than to miracles for faith. He does not 
 believe in miracles : and he finds no evidence in 
 Nature of any order but that of Nature. Indeed, 
 his professional familiarity with her senseless failures 
 and useless cruelties, if that were all, would make 
 him deny the possibility of any other order. But, 
 well away from his work, he is just able, he tells 
 me, with some trouble — and most things worth 
 doing are troublesome — to find and hold, now and 
 again, the belief that he, and not his brain, is 
 conscious. He had the toothache lately, and de- 
 clared to me that, according to his philosophy, he 
 had the toothache, but, according to Haeckel, he 
 was the toothache, or would be the toothache, if 
 he were he, which, according to Haeckel, he could 
 never hope to be, or be to hope. He added, that 
 it was he who experienced the tooth in space, and 
 the ache in time, and united these two dissimilar 
 experiences, in his permanent identity, as the 
 
THE VERY END 153 
 
 toothache. I will not pretend, for it was a very 
 bad tooth, that all his language was so philosophical. 
 Anyhow, he was sure that we cannot be what we 
 have, or have what we are. 
 
 But the toothache, after all, is not the sort of 
 malady to shake a man's belief. What does that, 
 is the dismal acquaintance of us doctors with brains 
 injured, diseased, ill-developed, ill-nourished, wasted 
 by drink, poisoned slowly by toxins, or suddenly 
 held-up by an anaesthetic. These and the like facts 
 are apt to haunt us, when we get home after the 
 day's work. The doctor, let us say, has just been 
 seeing a case of concussion. Back at home, he 
 cannot doubt that his wife and the children, in 
 the same circumstances, would present the same 
 aspect as the patient ; and the sudden thought 
 runs into him like a pin, that he, and she, and all 
 of them, especially the baby, are but organisms ; to 
 say nothing of the dog on the hearth-rug. For a 
 moment, things look black : the home-talk flags, 
 he is silent, addressing himself to that plateful of 
 food which is on its way from being his to being 
 he. The general impression, round about the 
 table, is that Father is very tired ; give him his 
 pipe, and his slippers, and the evening paper: 
 perhaps something has disagreed with him. In- 
 deed, something has. That ugly log of a body, miles 
 away, has disagreed with his faith. 
 
 Consider, again, the case of Prudens. The spirit 
 
154 CONFESSIO MEDICI 
 
 of practice was quite certain that he came to an 
 absolute end. He had been he, and was become it. 
 Like Michael and Satan in the legend, fighting 
 over the body of Moses, so these two words. 
 He and It, fought over the body of Prudens. 
 
 The river, to which I compared the course of 
 Prudens' life, died, like him, by inches ; without 
 assurance of revisiting or remembering the land, or 
 of retaining, in the sea, its limiting banks. Only, it 
 felt sure that something was going to happen, and 
 that the tides were not there for nothing. It was 
 to suffer a sea-change, it felt sure of that, but 
 was unable to think further. So, with Prudens, 
 as we watched him, we felt sure that something 
 was going to happen : but what it would be, and 
 how he could still be he through it, we could not 
 say. But rivers go out as candles go out. Their 
 dissolution is a purely chemical process : they have 
 no identity but in us. The death of Prudens, his 
 dissolution, was also chemical, to all appearances: 
 but we knew that his life had not been a matter 
 of chemistry. So it seemed reasonable, to trust 
 our memory of him, and to believe that he died as 
 he had lived, at another level than that of the natural 
 sciences. It was hard to see how he should still 
 be individual and distinct : but we were sure that 
 the individuality, which had distinguished him 
 here, had been real. Once, he had been : some- 
 how, therefore, he is : that was the argument. He 
 
THE VERY END 155 
 
 had been he : and, though words are useless here, 
 the fact remains, that nobody has any right to 
 play conjuring-tricks with the two most difficult 
 words in our language, which are He and It. 
 Prudens, not it but he, still he, went to what had 
 been, always, the spiritual element of his life. 
 The reality of that element, and the reality of 
 him, part of it yet apart from it, are facts which 
 he had so proved by the manner of his life that 
 they were not challenged by the manner of his 
 death. 
 
EPILOGUE 
 
 It is the plain duty of us doctors, who are Life's 
 paying guests, to be thankful for what we have 
 received. A man is not likely to find it hard to 
 be thankful, if only he will begin low enough down ; 
 he should approve the order of Life, as Lord Mel- 
 bourne approved the order of the Garter : and, if 
 he would be profoundly thankful, he must begin 
 de profundis. Instances are recorded of people 
 giving thanks before taking physic; not from any 
 fear of the consequences, but with gladness antici- 
 pating them. It is not all of us who could be so 
 good as that : but we might be more thankful for 
 not having either to take physic or to submit to 
 surgery, seeing how many thousands of invalids are 
 passionately longing to be able to do without pain 
 what we do without pleasure. Once a man were 
 to particularize all the bodily acts which are health, 
 he would be long over that list, and would include 
 many advantages which the poHte world does not 
 name in general conversation. For our food, it 
 
 should be easy to be thankful ; and so we are, when 
 
 156 
 
EPILOGUE 157 
 
 we are hungry : but the doctor is not fond of the 
 use of grace before a big dinner. He knows too 
 much, he foresees in the mind's eye the course of 
 each course, he cannot pray over proteids and carbo- 
 hydrates, and them in excess. 
 
 Advancing outside our bodies, we come to the 
 question whether we need be thankful that we are 
 so useful. It is not easy, because all of us are 
 useful, and the supply of us exceeds the demand. 
 But what of that ? A man's use is what it is, 
 though his work, if he should leave it, would in a 
 few days be in hands no less able. The work is 
 the man : it is not the work that counts, but the 
 man at work. Here, at this level of thought, 
 reasons for thankfulness extend all round us like a 
 landscape : the help that we give, the lives that we 
 save or prolong, the friendships that we make and 
 keep to the end. 
 
 I have had losses : and my heart goes out to 
 Dogberry, for he reckons his losses among his 
 accomplishments. " I am a wise fellow ; and, which 
 is more, an officer ; and, which is more, a house- 
 holder; and, which is more, as pretty a piece of 
 flesh as any in Messina; and one that knows the 
 law, go to : and a rich fellow enough, go to ; and 
 a fellow that hath had losses ; and one that hath 
 two gowns, and everything handsome about him." 
 They who have had losses are good company, and 
 I am glad to be of their fellowship. A man would 
 
158 CONFESSIO MEDICI 
 
 like to possess this, that, and the other ; but they 
 who do without these luxuries may be as happy as 
 they who have them. He would like to save the 
 lives of Dukes ; but the tissues of humbler folk 
 are just as interesting. He would like to be 
 immensely proud of his own performances, all of 
 them ; but who is, except a thrice-distilled fool ? 
 He would like to leave more money behind him — 
 ah, that regret is sacred, and must not be profaned ; 
 but things may mend. He has not fulfilled his 
 ambition to be at the top of the tree ; but he can 
 still congratulate himself that he is on a branch. 
 The natural dignity of our work, its unembarrassed 
 kindness, its insight into life, its hold on science — 
 for these privileges, and for all that they bring with 
 them, up and up, high over the top of the tree, the 
 very heavens open, preaching thankfulness. Circle 
 above circle, the reasons for it are established, out 
 of the reach of words. 
 
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