The student was supposed to attend in the out-patients’ room every day, see cases, and pick up what information he could; but on the days on which he clerked his duties were a little more definite.  At that time the out-patients’ department at St. Luke’s consisted of three rooms, leading into one another, and a large, dark waiting-room with massive pillars of masonry and long benches.  Here the patients waited after having been given their `letters’ at mid-day; and the long rows of them, bottles and gallipots in hand, some tattered and dirty, others decent enough, sitting in the dimness, men and women of all ages, children, gave one an impression which was weird and horrible.  They suggested the grim drawings of Daumier.  All the rooms were painted alike, in salmon-colour with a high dado of maroon; and there was in them an odour of disinfectants, mingling as the afternoon wore on with the crude stench of humanity.  The first room was the largest and in the middle of it were a table and an office chair for the physician; on each side of this were two smaller tables, a little lower:  at one of these sat the house-physician and at the other the clerk who took the `book’ for the day.  This was a large volume in which were written down the name, age, sex, profession, of the patient and the diagnosis of his disease.

At half past one the house-physician came in, rang the bell, and told the porter to send in the old patients.  There were always a good many of these, and it was necessary to get through as many of them as possible before Dr. Tyrell came at two.  The H.P. with whom Philip came in contact was a dapper little man, excessively conscious of his importance:  he treated the clerks with condescension and patently resented the familiarity of older students who had been his contemporaries and did not use him with the respect he felt his present position demanded.  He set about the cases.  A clerk helped him.  The patients streamed in.  The men came first.  Chronic bronchitis, “a nasty ’acking cough,” was what they chiefly suffered from; one went to the H.P. and the other to the clerk, handing in their letters:  if they were going on well the words Rep 14 were written on them, and they went to the dispensary with their bottles or gallipots in order to have medicine given them for fourteen days more.  Some old stagers held back so that they might be seen by the physician himself, but they seldom succeeded in this; and only three or four, whose condition seemed to demand his attention, were kept.

Dr. Tyrell came in with quick movements and a breezy manner.  He reminded one slightly of a clown leaping into the arena of a circus with the cry:  Here we are again.  His air seemed to indicate:  What’s all this nonsense about being ill?  I’ll soon put that right.  He took his seat, asked if there were any old patients for him to see, rapidly passed them in review, looking at them with shrewd eyes as he discussed their symptoms, cracked a joke (at which all the clerks laughed heartily) with the H.P., who laughed heartily too but with an air as if he thought it was rather impudent for the clerks to laugh, remarked that it was a fine day or a hot one, and rang the bell for the porter to show in the new patients.