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In October 1896 Maugham arrived at the final stage of his training at St Thoma's, the study of Obstetrics and Gynaecology.
The first morning's lecture was memorable.
Gentlemen, woman is an animal that micturates once a day, defecates once a week, menstruates once a month, parturates once a year and copulates whenever she has the opportunity.
Recently a new equipment had been introduced, a course in practical midwifery, for which students were expected to be on call for a period of three weeks, and within a mile's radius of the hospital to attend a minimum of twenty confinements.
During his tour of duty Maugham was called out on sixty-three occasions. Temporarily lodged in a room opposite the main gates where he could be quickly summoned by the porter, he was rarely able to snatch more than a couple of hours' sleep, and yet he was almost unaware of his exhaustion so absorbed was he in what he witnessed of his patients' lives.
It was the first time he had worked outside the hospital precints, and it was only now that he saw for himself the frightening reality of the poverty in which large numbers struggled to exist, experienced at close quarters the noise, the stench, the overcrowding, the filthy, verminous conditions from which for many there was no chance of escape.
If the head of the family were in work, the life was tolerable; if not, then the situation was desperate, and in such cases the arrival of another baby was regarded with despair.
The Secret Lives of Somerset Maugham - Selina Hastings