This wound was not accidental but self-inflicted. It was a perverted result of a Siamese custom. In those days slavery prevailed in the country. Besides the war-captives who were cast into slavery, custom made it possible for any of the common people to be sold into servitude. If a man failed to pay a debt there were two alternatives before him, to be confined in one of the horrible jails until he discharged his obligation, or to sell himself or his wife or children into slavery to remain in that state until the accumulated value of the services should cancel the debt. Only too often these debts were the result of gambling, a vice that was universally prevalent under license of the government. If the debtor was fortunate enough, he might sell the chosen victim to some lord who was willing to accept the services in pledge for a loan with which to pay the actual creditor. Such an arrangement was not altogether without its advantages, for many an improvident spendthrift had a comfortable living for himself and family assured by the better management of his lord. But once in servitude the victim was likely to be held in peonage indefinitely, because usury on the loan was liable to mount up faster than the value of services rendered. It will readily be imagined that a man so improvident as to permit himself to fall into slavery would not be the most willing worker, and many would be the tricks of the lazy man to labour as little as possible. A rather common scheme to avoid an unpleasant duty or merely to spite the over-lord was to go to the extreme of inflicting upon self a wound that would incapacitate from work. Such was the nature of this first surgical case to which Dr. House was called. The readiness with which this great man summoned a strange foreign doctor will be easily understood when it is known that for twelve years previous there had been an American physician in Bangkok. Since 1835 Rev. Daniel B. Bradley, M.D., representing the American Board of Commissioners for Foreign Missions (A B C F M), had been practising medicine and he had established a high reputation among all classes for western medicine and surgery. On account of the recent death of his wife, Dr. Bradley, with his young children, had sailed for home only a few weeks before the arrival of the new missionary. When Dr. House set out for Siam he knew that Dr. Bradley was there and, having had no practical experience in his profession before leaving home, he looked forward to beginning his labours in association with one who not only was a skilled practitioner but who also knew the pathological conditions of the Siamese. When, upon arrival, Dr. House discovered that Dr. Bradley had withdrawn he felt some alarm at the absence of professional counsel, for he had a constitutional lack of self-confidence that caused him to feel a painful burden of responsibility in prescribing for patients. At the end of the first six months he wrote: