Chapter XXVI

_To John Summers, M.B., c/o the Rev. W. B. La Touche, High Barn, Winchester._

91B HARLEY STREET, W.,
_October_ 18, 1910.

MY DEAR JACK,

I have just received your letter, and also the accountant's statement as regards Dr. Singleton's books; and I have instructed the solicitors to sell out enough of your stock to buy the quarter-share of his practice upon which you and he have agreed. If you can manage to obtain with it an equal proportion of his skill, kindliness, and cheerful adequacy you may be quite sure that the advantage of the bargain will not be altogether upon his side. For though books are important of course, if the man who keeps them is sound you needn't trouble your head so very much about them. And Singleton is sound through and through--not exactly one of those brilliant men, perhaps, of whom, as operating surgeons, Sir Frederick Treves has declared himself to be so justly timid, but what is far better, one of those level-headed, big-hearted general practitioners, tender of hand and essentially careful, in whose professional history mistakes have been, and will continue to be, practically unknown.

Moreover he was never, even as a student, one of those people who have set out to purchase skill in their own profession by the sacrifice of very nearly every other human interest. _Nihil humani a me alienum puto_ has been his own as well as his hospital's motto. And you must some day get him to tell you the story of how an odd little insight into esoteric Buddhism that he was once curious enough to obtain became the means of saving the life, to say nothing of the sanity, of one of the most valuable men of our time. That late cut of his, too, is still well worth seeing; and there are not many of my friends who can go straighter to the heart of a book or a picture--that is, if the book or the picture has a heart to be got to.

He may not be able to excise a Gasserian ganglion, or know very much about the researches of Calmette or von Pircquet. But he knows precisely when to call in the men who do. And he's just the sort of assistant with whom they feel safe in setting out to work. While, on the other hand, upon a hundred points--little everyday problems of medical practice, unclassified ailments that have never got into the text-books or been dignified with a Latin name, doubtful beginnings of more definite illnesses, their home-treatment, and the adequate settlement of the domestic problems that they involve--there isn't a man in Harley Street who could give a more valuable opinion. And he has performed a tracheotomy with his pocket-knife and a hair-pin, five miles from anywhere, in the heart of the Hampshire downs.

Such men are not only the pillars of our profession, but its topmost pinnacles, even if the wreaths and the knighthoods but seldom come their way. I am saying all this because I think that I can detect in your letter, and certainly in the newer generation of qualifying students, a kind of reluctance about going into general practice, as if this were in a way an admission of failure, a sort of _dernier ressort_. Whereas of course there is no point of view from which such a way of looking at it is at all justifiable. General practice is at least as difficult, if it is to be carried on well and successfully, as any special practice can be, and probably more so; for the G.P. has to live continually, as it were, with the results of his handiwork. He is always liable to meet his failures round the next corner; and his mistakes may quite easily rent the pew behind him in the parish church. The consultant, on the other hand, comes into the family life from afar, and returns again, an hour or two later, to the seclusion of his private fastness. He has brought down his little bit of extra technical skill or knowledge. He has used it for good or ill. And the results do not follow him, save indirectly, and at a very comfortable distance. But the G.P. who has taken upon himself the responsibility of calling him in must needs still bear upon his shoulders not only the anxiety that heralds ultimate success, but a large share of the possible obloquy that may follow failure.

Moreover, in all the hundred extraneous interests that are involved, his advice becomes of paramount importance. This would be the best room for the patient from the point of view of quietness and aspect. But that, on the other hand, is the room that he has been used to. His favourite books and pictures surround him there in the old accustomed order. Does the doctor think it better for him to be moved? His wife, his mother, or his sister are anxious to nurse him. Are they strong enough or skilful enough? What is the doctor's opinion on this point? Here is a telephone message from the office. A disturbing point has arisen in the conduct of a great business, and should be dealt with promptly. Are we to worry the patient with it now, or postpone the settlement, with the possibilities of greater anxieties later on? Let us wait, at any rate, until the doctor comes.

And from this household he has to drive home by a private school where lies some boy with a cheerful countenance and a suspicious red rash on his chest. It would never do to create a false alarm. But, on the other hand, it would be more than disastrous to let the origin of some sweeping epidemic go free for convenience' sake. And here is a servant-maid in the surgery with a throat that looks as diphtheritic as a throat can well be; and she comes from a dairy farm that supplies half the town with milk, under the eyes of a government inspector; while the rector's wife, nervous, and uncomfortably near forty, is expecting her first, long-looked-for baby some time this afternoon.

It may take a good man to remove successfully an adherent appendix or an obscure tumour of the brain, or to diagnose some out-of-the-way lesion of a heart valve. But such a man, after all, has spent the greater portion of his professional life in dealing with no other subjects but these. And it must surely require at least an equal equipment, after its own kind, to deal wisely and rapidly with such variously conflicting problems as I have just been describing.

You are probably becoming a little bored by these commonplace remarks of mine. But they are the sort of truism that will generally bear an occasional reconsideration. And if I have a very private opinion, to which you cannot subscribe, that the really able general practitioner is perhaps the very best man in our ranks bar none, I am quite willing to concede this extra superiority if you will grant him at least an equal eminence to that of Sir Grosvenor le Draughte, as Mr. Russell has called him in one of his recent books.

So go into your practice with a good heart. Your experience as a locum in Bristol and Shropshire will have prepared you for any little mortifications that may be in waiting during your first few months. You will be used to the disheartening fall of the countenance that greets the junior partner when his senior was expected. And you will accept with a grave countenance and an inward chuckle your knowledge of the extremely frank criticism that is likely to herald and succeed your first few visits. Even now there's a letter upon my desk from a disrespectful young lady who shall be nameless. A new curate has made his initial appearance in an Eastbourne drawing-room. "He shook hands just like a baby," she writes, "and he stopped to tea, and he sprawled all over the table, and he has quite nice eyes, but his mouth is just like cook's when she's having one of her windy spasums." And if sixteen can rise to heights like this, what about eighteen and twenty and twenty-two? Nor are curates, alas, the only legitimate prey. I wonder if there's a girls' school in your practice?

You may lament too, for a little while perhaps, the slow dawning of confidence in your new patients. But before very long you may even be rather overwhelmed (quite privately of course) by the freedom and completeness with which it is accorded you. And above all things, be just your natural self in dealing with them, forgetting, if you can, that you have ever even heard of such an attribute as a good bedside manner.

This reminds me that only last week, in a railway carriage, I overheard two young ladies discussing a very sympathetic physician well known to us both. One of them was wondering why he had always been so successful. "Oh, that," said the other cheerfully, "is because he's so frightfully good at comforting the relatives--_afterwards_, you know."

If your news must be bad, tell it soberly and promptly. It's seldom--very seldom--wise to conceal it for some dubious temporary benefit. And if you are in doubt about any of their maladies let them know it quite frankly, explaining to them in language suited to their degree of education and intelligence exactly why this should be the case.

There's been a good deal written lately about the personal factor in treatment, the Psychology of the Physician, and the mental therapeutics at his command. And I even saw a letter in the "Lancet," a few weeks ago, urging that the practical application of Personality in the sick-room should form one of the recognised subjects of the medical curriculum. But in the first place, I'm exceedingly doubtful if the modesty of our profession is so excessively marked as to demand for its correction a course of instruction in the conscious prescribing of its own personality. And in the second, I fail to see how this latter could ever be done without, by the very act, considerably altering that uncertain quantity, at any rate so far as its victim was concerned. And what would one's _ego_ be like, I wonder, after ten years' conscientious labour? So I shouldn't worry too much about your personality if I were you. It will be a good thing, no doubt, to get all you can into it by encouraging such tentacles as it may put forth to the sun and the breeze. But what other people are to get out of it is a matter with which you may quite properly, I think, be too busy to concern yourself.

While I'm still in the pulpit, let me recommend you to husband your energies. Don't play tennis all the afternoon (even with Amaryllis) if you have been up all night. Go to sleep in the hammock, instead, over a book or a paper or a letter from Uncle Peter. And don't forget sometimes to say your prayers. For whatever may be one's private notions as to their ultimate Destination; whether one affects a belief in some beneficent Overlord, once incarnate; or regards God as the ever-growing sum of all higher human volitions; or, remembering this infinitesimal particle of earth in the greatness of the universe, considers such a conception to be inadequate; or admits only some possible Starting-point, a kind of Divine Convenience upon which to found theories; or has never thought about the matter at all--it's always a gracious and comforting act to remove one's moral hat, as it were (even if reverence goes no further) to Something at any rate bigger than most of us. While even on the very chilliest of auto-suggestion grounds there is still a word to be said for it as a vehicle wherein to despatch one's extra troubles to some handy mental cemetery. For prayer, whether we look upon it as sacred or superstitious, must still, as the hymn says, be the soul's sincere desire, uttered or unexpressed. And occasional expression is about as valuable a prelude to the acquiring of knowledge as any that are going.

So I may as well tell you at once that I know nothing whatever about motor-cars, and therefore find the last half of your letter entirely unintelligible. But I gather that the one you mean to purchase combines speed, silence, and freedom from odour in a quite unusual degree. Some day, no doubt, I shall be sponging upon you for a lesson in driving it--or him--or do you call the thing her?

Yr. affect. uncle,
PETER HARDING.