They came in one by one and walked up to the table at which sat Dr. Tyrell.  They were old men and young men and middle-aged men, mostly of the labouring class, dock labourers, draymen, factory hands, barmen; but some, neatly dressed, were of a station which was obviously superior, shop-assistants, clerks, and the like.  Dr. Tyrell looked at these with suspicion.  Sometimes they put on shabby clothes in order to pretend they were poor; but he had a keen eye to prevent what he regarded as fraud and sometimes refused to see people who, he thought, could well pay for medical attendance.  Women were the worst offenders and they managed the thing more clumsily.  They would wear a cloak and a skirt which were almost in rags, and neglect to take the rings off their fingers.

“If you can afford to wear jewellery you can afford a doctor.  A hospital is a charitable institution,” said Dr. Tyrell.

He handed back the letter and called for the next case.

“But I’ve got my letter.”

“I don’t care a hang about your letter; you get out.  You’ve got no business to come and steal the time which is wanted by the really poor.”

The patient retired sulkily, with an angry scowl.

“She’ll probably write a letter to the papers on the gross mismanagement of the London hospitals,” said Dr. Tyrell, with a smile, as he took the next paper and gave the patient one of his shrewd glances.

Most of them were under the impression that the hospital was an institution of the state, for which they paid out of the rates, and took the attendance they received as a right they could claim.  They imagined the physician who gave them his time was heavily paid.

Dr. Tyrell gave each of his clerks a case to examine.  The clerk took the patient into one of the inner rooms; they were smaller, and each had a couch in it covered with black horse-hair:  he asked his patient a variety of questions, examined his lungs, his heart, and his liver, made notes of fact on the hospital letter, formed in his own mind some idea of the diagnosis, and then waited for Dr. Tyrell to come in.  This he did, followed by a small crowd of students, when he had finished the men, and the clerk read out what he had learned.  The physician asked him one or two questions, and examined the patient himself.  If there was anything interesting to hear students applied their stethoscope:  you would see a man with two or three to the chest, and two perhaps to his back, while others waited impatiently to listen.  The patient stood among them a little embarrassed, but not altogether displeased to find himself the centre of attention:  he listened confusedly while Dr. Tyrell discoursed glibly on the case.  Two or three students listened again to recognise the murmur or the crepitation which the physician described, and then the man was told to put on his clothes.

When the various cases had been examined Dr. Tyrell went back into the large room and sat down again at his desk.  He asked any student who happened to be standing near him what he would prescribe for a patient he had just seen.  The student mentioned one or two drugs.