Among the latter Dr.Letsom was not popular.

He had an unpleasant fashion of calling everything by its right name.

If a lady would take a little more stimulant than was good for her he could not be persuaded to call her complaint "nervousness;" when idleness and ennui preyed upon a languid frame, he had a startling habit of rousing the patient by a mental cautery.

The poor idolized him, but the ladies pronounced him coarse, abrupt; and when ladies decide against a doctor, fate frowns upon him.
How was he to get on in the world?
Twenty years before he had thought less of getting on than of the interests of science or of doing good; now those ideas were gradually leaving him--life had become a stern hand-to-hand fight with hard necessity.

The poor seemed to be growing poorer--the difficulty of getting a fee became greater--the ladies seemed more and more determined to show their dislike and aversion.
Matters were growing desperate, thought Dr.Letsom on this autumn night, as he stood watching the chrysanthemums and the fading light in the western sky.