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 Complete Revision Guide
for MRCOG Part 2
SBAs and EMQs
Third Edition

Justin C. Konje FWACS, FMCOG (Nig), FRCOG, MD, MBA, LLB, PgCert Med Ed
Emeritus Professor of Obstetrics and Gynaecology University of Leicester, UK
Professor of Obstetrics and Gynaecology
Weill Cornell Medicine-Qatar, Qatar
Senior Attending Physician
Sidra Medical College, Qatar
CRC Press
Taylor & Francis Group
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 Contents

Preface iv
Abbreviations vi
Author ix

Introduction 1

SBA Questions 9

SBA Answers 91

EMQ Questions 157

EMQ Answers 301

Index 369
 Preface

The Membership of the Royal College of Obstetricians and Gynaecologist (MRCOG) examination
remains one of the most internationally recognized postgraduate examinations in the specialty.
For those training in the UK, it is an essential requirement to progress from intermediate to
advanced training. While it is not an exit examination in the UK, it assesses quality of training
and clinical standards hence highly regarded and popular not only in the UK but in most parts of
the world.
Over the years, the examination has evolved in keeping with changes in medical education. In the
previous edition of this book, Part 2 – then the ultimate examination for the award of MRCOG –
consisted of true and false multiple-choice questions, extended matching questions (EMQs), short
answer questions and an oral examination popularly referred to as the OSCE. In the intervening
years, the MRCOG Part 2 has rightly been uncoupled into Parts 2 and 3. The Part 2 examination
has also itself changed and now consists of two papers made up of Single Best Answer (SBA)
questions and EMQs; the new Part 3 consists of 14 tasks, each assessing one of the 14 core modules
in the curriculum.
An important part of training and preparing for the ultimate role of a senior physician in the
specialty is that of sifting the plethora of material that is readily available to identify the best
evidence that would underlie any good clinical practice. This is the basis for the MRCOG
examination being driven by evidence – all the questions in the exams have to be supported by
robust and defendable evidence. This means examiners and trainers must use the best evidence for
setting questions and preparing for exams. This is a welcome and very positive direction of travel
and one that must be applauded.
In revising this book, I recognize that one of the unmet needs of trainees is a book that provides
enough material to guide their preparations and provide some reality check to the standards of the
examination. This book provides precisely that. It is a combination of two books in one – the first
part consists of 400 SBA questions (200 in Obstetrics and 200 in Gynaecology) and the second part
consists of 400 EMQs (200 in Obstetrics and 200 in Gynaecology). I have grouped these into papers,
so that by the time you have finished working through this book, you will have had the ‘experience’
of at least four diets of the examination.
In this edition, I have kept the concepts of the last edition, once again giving general advice on
how to prepare for the exams and also discussing the reasons why trainees fail the examination.
I must state here that the contents of the book, including the statements and interpretation of
evidence, are personal and I accept responsibility for inaccuracies and mistakes. It is important that
you verify whatever information is given in this book and also accept that there will be errors –
some of which will be glaring omissions and others the result of misinterpretation on my part.
I hope that this book is useful not only to trainees but also to trainers and examiners who
will find the content useful in guiding trainees and in helping them generate good questions for
examinations.

iv
 PrEfAcE

This has been one of the most difficult tasks to undertake, probably because I am getting older
or because I set myself very high standards and struggled to meet them. All of this would not have
been possible without the amazing support I have had from my family. They have endured hours
and hours on end of me sitting in front of the computer at home and tapping on keys. I am sure
that finally closing this chapter will be a welcome to them. Thank you, Mrs. Joan Kila Konje, for
not only being an adorable and best wife but also for being very understanding, encouraging and
not losing your cool too often. Thanks to my wonderful kids – Dr. Swiri Konje, Monique Konje
and Justin Jr. Konje – for bearing with your dad and not complaining too much about ignoring you
and not being in touch too often. I could not have wished for better children. I am truly blessed.
I am most grateful to God, my creator and our Almighty Father in Heaven for giving me belief and
patience. This would not have been possible without His blessings. Finally, I would like to thank the
publisher for being so patient with me.
Visit emedicalcourses.com for additional supporting material.

Justin C. Konje

v
 Abbreviations

AC abdominal circumference CT/PA computerized tomography

ACE angiotensin-converting enzyme pulmonary angiography
AEDs antiepileptic drug CTG cardiotocograph(y)
AFP alpha-fetoprotein CVA cerebrovascular accident
AID artificial insemination by donor CVP central venous pressure
AIH artificial insemination by CVS chorionic villus sampling
husband CXR chest X-ray
AIS adenocarcinoma in situ DOCA deoxycorticosterone acetate
AR autosomal recessive DNA deoxyribonucleic acid
ARM artificial rupture of fetal DHEA dehydroepiandrosterone
membranes DHEAS dehydroepiandrostendione
AST alanine aminotransferase sulphate
β-hCG beta-human chorionic DIC disseminated intravascular
gonadotrophin coagulation
BBI blood-borne infection DVT deep vein thrombosis
BCG bacille Calmette–Guérin ECG electrocardiograph(y) or
BMI body mass index electrocardiogram
BP blood pressure ECV external cephalic version
BPP biophysical profilometry EMQ extended matching question
BPS bladder pain syndrome EUA examination under anaesthesia
BSO bilateral FAS fetal alcohol syndrome
salpingo-oophorectomy FBC full blood count
CAH congenital adrenal hyperplasia FBS fetal blood sampling
cART combined antiretroviral therapy FDP fibrinogen degradation product
CDH congenital diaphragmatic FGR fetal growth restricted/fetal
hernia growth restriction
CIN cervical intraepithelial FISH fluorescent in situ hybridization
neoplasia FSE fetal scalp electrode
CMV cytomegalovirus FSH follicle-stimulating hormone
CNS central nervous system FT4 free thyroxine
COCP combined oral contraceptive FVS fetal varicella syndrome
pill GA general anaesthesia
CHC combined hormonal GnRH gonadotropin-releasing
contraception hormone
CPA cyproterone acetate GnRHa gonadotropin-releasing
CPP chronic pelvic pain hormone agonist
CT computerized tomography GP general practitioner

vi
 ABBrEvIAtIonS

GUM genitourinary medicine MCA middle cerebral artery

Hb haemoglobin M/C/S microscopy, culture and
HbAlc glycosylated haemoglobin sensitivity
HBIG hepatitis B immunoglobulin MDT multidisciplinary team
hCG human chorionic gonadotropin MRI magnetic resonance imaging
HDU high dependency unit MSU midstream specimen of urine
HIV human immunodeficiency virus NHS National Health Service
hMG human menopausal NICE National Institute for Health
gonadotropin and Clinical Excellence
HRT hormone replacement therapy NICU neonatal intensive care unit
HPV human papillomavirus NSAID non-steroidal anti-inflammatory
HRT hormone replacement therapy drug
HSG hysterosalpingography NT nuchal translucency
HSV herpes simplex virus NTD neural tube defect
HVS high vaginal swab OC obstetric cholestasis
HyCoSy hystero-contrast-sonography ODP operating department
ICSI intracytoplasmic sperm practitioner
injection OHSS ovarian hyperstimulation
ICU intensive care unit syndrome
i.m. intramuscular PAPP1 pregnancy-associated plasma
INH isoniazid protein-1
IUD intrauterine contraceptive PCOS polycystic ovary syndrome
device PCR polymerase chain reaction
IUFD intrauterine fetal death PE pulmonary embolism
IUGR intrauterine growth restriction PET pre-eclampsia
i.v. intravenous PFE pelvic floor exercise
IVF in vitro fertilisation PID pelvic inflammatory disease
IVF-ET in vitro fertilization with PMS premenstrual syndrome
embryo transfer POP progestogen-only pill
IVU intravenous urogram POPQ pelvic organ prolapse
LA local anaesthesia quantification
LARC long-acting reversible PUO pyrexia of unknown origin
contraceptive RCOG Royal College of Obstetricians
LAVH laparoscopically assisted and Gynaecologists
vaginal hysterectomy RDS respiratory distress syndrome
LH laparoscopic hysterectomy SANDS Stillbirth and Neonatal Death
LFT liver function test Society
LH luteinizing hormone SBA single best answer
LLETZ large loop excision of the SERM selective oestrogen receptor
transformation zones modulator
LMP last menstrual period SCJ squamocolumnar junction
LMWH low-molecular-weight heparin SHO senior house officer
LNG-IUS levonorgestrel intrauterine system SSRI selective serotonin reuptake
LUNA laparoscopic uterosacral nerve inhibitor
ablation STI sexually transmitted infection
LVS low vaginal swab TAH total abdominal hysterectomy
MAP mean arterial pressure TB tuberculosis

vii
ABBrEvIAtIonS

TED thromboembolic deterrent U&Es urea and electrolytes

TENS transcutaneous electrical nerve USI urodynamic stress
stimulator incontinence
TOT trans-obturator tape USS ultrasound scan
TPR temperature, pulse and UTI urinary tract infection
respiratory rate VAIN vaginal intraepithelial
TSH thyroid-stimulating hormone neoplasia
TST tuberculin skin test VE vaginal examination
TTN transient tachypnoea of the VQ ventilation-perfusion
newborn VTE venous thromboembolism
TVS transvaginal ultrasound scan/ VZV varicella-zoster virus
transvaginal ultrasound scanning WCC white cell count
TVT tension-free transvaginal tape WHO World Health Organization

viii
 Author

Justin C. Konje (FWACS, FMCOG (Nig), FRCOG, MD, MBA, LLB, PgCert Med Ed) is senior
attending physician at Sidra Medicine and professor of obstetrics and gynaecology at Weill Cornell
Medical College, Doha, Qatar. Prior to joining Sidra, Dr. Konje was a professor of obstetrics and
gynaecology and honorary consultant at the University of Leicester and University Hospitals of
Leicester NHS Trust, UK. He is trained in maternal-fetal medicine, and developed and directed the
training program and services at the University Hospitals of Leicester, UK, for 10 years. He also
has an interest in minimal access surgery, having led the service at his previous unit with particular
interest in the management of complex endometriosis. Dr. Konje has published over 180 peer-
reviewed papers, several textbooks and chapters in reference textbooks. His research interests are in
fetal physiology and growth, endocannabinoids in human reproduction, endometriosis and recurrent
miscarriages and implantation failure. He has supervised over 10 PhDs and collaborated in various
research programs both in the United Kingdom and internationally. He is passionate about teaching
both at undergraduate and postgraduate levels having served as a tutor at the Royal College of
Obstetricians and Gynaecologists (RCOG), London, UK. He was the head of the Postgraduate
School of Obstetrics and Gynecology for 5 years – a post he left to join Sidra. He has developed and
runs the most popular and successful MRCOG Part II Revision Course which attracts candidates
from all over the world. Dr. Konje has served as an external examiner to several universities all over
the world, delivered several invited lectures and also served on the Examination Committee of the
RCOG both as member and chair of one of the committees. He was an International Representative
on the Royal College of Obstetricians and Gynaecologists Council for 4 years where he also sits
on the Global Health Board. He is on the editorial board of several journals, the CPD editor for
The Obstetrician and Gynaecologist and the section editor for the European Journal of Obstetrics
and Gynaecology and Reproductive Biology.

ix
 Introduction

Preparing for the Part 2 examination

The MRCOG Part 2 examination is sat by trainees not only in the UK but all over the world.
The standards of the examination are, however, based on UK practice. Ideally, this examination
should not be attempted unless the examinee has completed at least four years in the specialty.
There will be exceptional circumstances where candidates may be allowed to sit for the examina-
tion earlier. An ideal preparation for the examination should include:
1. Completion of the minimum clinical requirements as defined in the RCOG structured training
programme.
2. Being signed off by the trainer and also having approval from the RCOG to sit the examination.
3. Completing all the mandatory modules in the curriculum, including family planning.
Additionally, it is highly recommended that the following reading material is covered:
1. All the RCOG ‘Green-top’ Guidelines, including those that the RCOG have written with other
societies such as the Royal College of Radiologists, the Faculty of Sexual and Reproductive
Health, and the British Association of Sexual Health and HIV (BASH) (https://www.rcog.org.
uk/guidelines).
2. Relevant guidelines from NICE, SIGN, BSCCP, International Society for the Study of Vulvar
Disorders, International Urogynaecological Association/International Continence Society,
ESHRE, BFS, BMFM, RCCH, FIGO classification/staging of gynaecological cancers and
abnormal vaginal bleeding, etc.
3. The Obstetrician and Gynaecologist – including their freely available Single Best
Answer (SBA) questions online (https://elearning.rcog.org.uk/tutorials/exam-preparation/
sba-questions-obstetrician-gynaecologist/tog-online-sba-resource).
4. STRATOG (https://elearning.rcog.org.uk/).
5. MBRRACE (Mothers and Babies, Reducing Risk through Audit and Confidential Enquiries):
these are published yearly and cumulatively (i.e. every three years) (https://www.npeu.ox.ac.
uk/mbrrace-uk).
6. Journals – BJOG, BMJ, Lancet, NEJM, JAMA, AJOG, and ‘The Green Journal’ (Obstetrics &
Gynaecology) – from these journals, systematic reviews and standard review articles would be
the preferred articles to read.
In the past, textbooks in obstetrics and gynaecology have been considered the gold standard for
those preparing for the exams, but now, in the era of evidence-based practice and up-to-date ques-
tions, many textbooks have often become outdated by the time they are published. However, most
of these books contain valid evidence that has stood the test of time, including clinical anatomy
and physiology, biochemistry, pathogenesis of diseases, surgical techniques, and complications of

1
IntroductIon

surgery. I would therefore recommend that you identify a standard textbook as a reference and one
that will complement your reading of the RCOG education material.
Finally, I strongly recommend that you consider identifying a revision course to attend. It is
most likely that a good course will focus your preparation and also provide insights of your weak-
nesses. It is best to do this 2–3 months before the exams. Some candidates prefer to attend a course
6–9 months before the exams, but, in that case, there is the danger of burning out as you prepare for
the exam over a very long period of time.
In this day of technology, there are several electronic sources for candidates. A word of caution –
be careful about where you base your preparations on. The only reliable and perhaps well-vetted
site is that of the RCOG. Other sites are based on individual opinions and do not necessarily reflect
those of the RCOG.
Finally, the patient is the best teacher for your exams. A busy clinical job exposes you to many
teaching opportunities, and you must take advantage of them. Every patient you encounter/see in
the clinic, on the wards, delivery suite (labour ward), or in the theatres is a potential Extended
Matching Question (EMQ) or an SBA. Examiners – including myself – commonly use our clinics
or patient encounters to set these questions. To make the best of these learning opportunities, work
with your clinical/education leads and senior trainees, especially those who have recently been suc-
cessful at the exams. Every unit also has mandatory training sessions – ensure that you see each of
them as an opportunity to cover an area of the curriculum for the exams.

Why do candidates fail the examination?

It is a fact that most candidates sitting for the MRCOG Part 2 examination are most widely read.
However, there is a difference between reading and understanding and applying the knowledge to
questions. Most failures are due to:
1. Failure to understand the question. It is not uncommon for candidates to misread questions,
skip a word, or make an assumption about the context of the question. For example, you may
read ‘the least likely’ as ‘the likely’ or ‘the most unlikely‘ as the ‘the most likely’.
2. The phenomenon of ‘déjà vû’ – the questions look familiar and therefore the answers have to
be the ones I have worked on before. Unfortunately, the only reliable source of questions is the
RCOG and the examination paper. All those who profess to have access to the questions or
market themselves as having an examination question bank are preying on the vulnerability of
candidates.
3. Poor preparation – lack of knowledge. Any candidate who undertakes the examination and yet
fails to read the material identified as essential for the exams does not deserve sympathy from
anyone. Much of the material is available on various websites and is free! You therefore do
not have an excuse for sitting for the exams without knowing the necessary guidelines.
4. Poor understanding and misinterpretation of questions: unfortunately, the exams are in English
and you need to have a good grasp of English to be able to pass. This should not be a problem
for UK graduates and those working in the UK, but those sitting the exams from overseas,
especially where English is not a commonly spoken language, may struggle with some of the
expressions used. For such candidates, the key to passing is working with colleagues who have
a better grasp of the language and also working through sample questions.
5. Poor time management – over the years, I have seen candidates fail to complete the exami-
nation papers. They spend so much time on the EMQ paper that they have little time for the

2
 IntroductIon

SBA paper. The EMQ component of the exams makes up 60% of the total marks, and there-
fore, you should also spend 60% of the total time on the EMQs and 40% on the SBAs.
6. Failure to follow instructions: although this is uncommon, from time to time, candidates fail
because they have not followed simple examination instructions, e.g. on completing the answer
sheets. Be very vigilant and ensure that you mark the answer on the sheet that corresponds to
the question.

How to fail the examination

I do not expect that any examinee will work through this section with the desire to operationalize
it, but rather, I hope that it will summarize the preceding section in order to help candidates avoid
the most common errors that are made in the exams. (If, however, an examinee is determined to fail
the exams, then this would be very useful.)
1. Avoid reading the educational material provided by the RCOG – Green-top and NICE
Guidelines, TOG, STRATOG, etc. and do not make an attempt to look at the sample questions
provided by the RCOG.
2. Delay reading the guidelines until the last few days before the examination and instead focus
on textbooks.
3. Avoid busy clinical postings and spend more time working on materials available online.
4. Look for sources that provide crash courses on the MRCOG and work through their material.
5. Make no attempt to work through past questions or questions from a course or a reasonable
source/author.

How to answer Extended Matching Questions

The EMQs component of the examination is made up of 100 questions (50 in obstetrics and 50 in
gynaecology). Extended Matching Questions should not be considered as simple true-and-false
answer questions. It is important for candidates to recognize that several of the options given in the
list could be correct answers to the particular question; the issue is which of them is the best or most
suitable or most appropriate.
In answering EMQs, you should avoid looking at the option list unless you have absolutely no
clue as to what the question is all about. A logical approach to answering an EMQ is as follows:
1. First, read the instructions (sometimes referred to as the introduction statement) for the ques-
tions. This will enable you to precisely focus on the task that you are given. In some cases,
these instructions may give you a clue about the theme under which the questions will fall.
2. Read the clinical scenarios or vignettes and decide what you feel is the correct answer, before
looking at the option list. It may be wise to consider more than one option but make sure that
you have an order (i.e. first, second, and third if possible). However, this is only applicable in
cases where the first option is not in the list of options. In the exams, I would recommend that
you write this/these options against the vignette and later refer to this when you must look at the
option list. The option list should be arranged alphabetically to make it easier for the candidates
to know where to look for their chosen option.
3. You should repeat (1) and (2) above for each of the vignettes/scenarios.
4. Finally, you should look at the list of options and match your chosen option with those on
the list.

3
IntroductIon

5. If your options are not on the list, you should look for the one closest to your option.
Narrowing your answer is an art that you must learn to master. Some clues to this are pro-
vided in (7).
6. If none of the options in the list is close to yours, you should start the process of elimination.
It is likely that, of the 10–25 options you may have for each question, not more than 5–6 will be
applicable to the particular scenario or vignette. The only problem with this approach is time
constraints.
7. For the questions where you are struggling, you will need to guess. The first step in this process
is to narrow down the options. You should initially look at all the information on offer. Use
the pointers offered in the vignettes to narrow down the potential answers and return to the
modified list for further, more refined thinking. Similarly, do not be caught by the distracters
slipped into statements and/or options. The difficulty with this approach is time – you only
have limited time per question. You should therefore not do this until you have finished all the
questions whose answers are quite obvious to you.

How to answer Single Best Answer questions

The ‘Single Best Answer’ (SBA) paper consists of 100 questions (50 questions on obstetrics and
50 on gynaecology). It is ‘Single Best Answer’ because it is not unusual for more than one answer
to be correct. However, the candidate must decide which of the correct answers is the best. Each
question has a stem (or lead-in statement or instructions) followed by five options numbered A, B,
C, D, and E. Ideally, the options should appear in alphabetical order for two main reasons: to mini-
mize guessing (the person setting the question is most likely to have provided the correct answer
first, so rearranging these into alphabetical order will prevent test-wise candidates making useful
guesses based on that alone) and to help guide the knowledgeable candidate in looking for the cor-
rect answer.
The SBA part of the exam, by and large, assesses factual knowledge, recall of facts, and time
management. Although guessing is discouraged, all examinees should attempt all questions, as
there is no negative marking. The best preparation for this part of the examination is for the candi-
date to read as widely as possible, ensuring that most of the sections in the curriculum that could
be assessed by SBAs are covered. Furthermore, it is advisable that greater emphasis is placed on
understanding basic principles and concepts than on memorizing. Finally, it is always beneficial
to have a partner with whom to discuss questions and work through examples from a good source
such as textbooks.
At the examination itself, you should answer the question using your first impression or instinct.
Candidates who change answers often do so at their own peril. Overthinking about a question is
fraught with the danger of getting it wrong. In the examination, you should first deal with the ques-
tions that you can answer confidently. Only after this is completed, should you go through the ones
you are unsure of. Leave the ones you have absolutely no clue on last; this is where your ability to
guess comes in.
In answering the questions, particular attention has to be paid to certain words in the questions.
Understanding these would help with your guesses. The table below shows some of the keywords
used in SBAs and their meanings.

4
 IntroductIon

Keyword Meaning
Never/exclusively/always There are no exceptions
Could/possibly/may May apply under certain circumstances
Essential feature Required to confirm diagnosis
Occurs/recognized feature/recognized A reported occurrence irrespective of frequency
association
Characteristic/frequently/likely Implies a frequency greater than 50%
Pathognomonic Specific to a particular disease/condition

It should now be possible to apply your understanding of these words to the various questions espe-
cially those where you have to guess. Below is some guidance on how to use these words in arriving
at possible correct answers where you are unsure or have no clues.

• Questions which include ‘never, always, exclusively’ are generally false (but be careful as
there are exceptions).
• Questions which include the keywords ‘could, possible, may’ are often true (again beware of
the exceptions).
• Statistics – When questions have exact statistic, they are more likely to be wrong (different
studies produce different figures). This does not apply to statistics given as >…% or <…%,
approximately, estimates, or as a range.
Both candidates and some clinical leads/education leads often confuse SBA questions with
True-and-False answer questions. In this type of question, it is not about being correct or wrong;
it is about which of the answers is the best. A good SBA question should have at least two pos-
sible correct answers, although this is often not easy to generate. The candidate’s task is there-
fore to select what is not only a good answer but also the best answer from the given options.
One answer is always better than the others. Therefore, it is critical that you read through all
the options before making your choice. Remember, you do not get any points for selecting the
second-best answer. If the choice you want to select seems (only) partially correct, then it is
entirely wrong. On many occasions, the correct answer usually occurs to the reader after read-
ing the stem.
In setting questions, most experts would have been schooled on what to avoid and what to include
to increase in-depth thinking by examinees before selecting the correct option. While this is the case
most of the time, it is inevitable that some of the questions will still enable the test-wise candidates
to second-guess the correct answers. In the next paragraphs, some clues are provided to examinees
on how to improve the chances of getting questions right when you are either clueless or unsure.
Examiners tend to include statements/phrases in questions/answers in an attempt to divert the
examinees’ attention from the correct answer or from the main thrust of the question. These are
commonly referred to as distractors. Their purpose is to ‘distract’ – i.e. to get you to pick them
rather than the best answer. Each distractor is most likely to be selected by one or more candidates;
otherwise, they would not be included as an option. It is likely that every option may fool someone
and you must make sure that you are not that person. Why should these be included in questions?

5
IntroductIon

Remember that this is a clinical examination often reflecting clinical scenarios. For example, it is
not uncommon to see a patient in the clinic or as an emergency and be ‘distracted’ by a symptom or
sign that on occasions leads to the wrong diagnosis.
In general, most distractors in the options would seem plausible and few will stand out as obvi-
ously incorrect. Some may indeed be partially correct answers but not necessarily the best answer.
Some of the reasons why candidates easily select distractors include misconceptions, incomplete
knowledge, and faulty reasoning.
Where you are clueless or uncertain, apply the following tips to your choice of answers.

1. Grammatical cues: Where one or more distractors do not follow grammatically from the stem
(i.e. the stem and some distractors are not congruous). For example, a stem ends in ‘an’ and
only some options begin with a vowel or the stem points to the answer.
2. Word repeats: Where the same word or phrase is included in both the stem and the correct
answer. This gives away the answer.
3. Absolute terms: When terms such as ‘always’ and ‘never’ are used, they are rarely correct.
Vaguer terms such as ‘may’ or ‘could’ are much more likely to be correct.
4. Logical cues: Where a group of options is logically exhaustive, indicating that the answer is
one of the groups, for example, including three options: ‘greater than’, ‘same as’, and ‘less than’
in a five-option question. You will also not find logically exhaustive options when one of the
options is nonsensical.
5. Convergence strategy: The correct answer can be ‘worked out’ as it has most in common with
other options (i.e. the correct answer includes most of the elements in common with the other
options). This is much more subtle but common.
6. Long correct answers: One option is obviously longer than the others. Efforts are made to
ensure that the correct answer is longer, more specific, or more complex than the other options.
7. Word association links: Here, the correct answer can be arrived at by simple word associa-
tion without a deeper understanding of the topic. For example, ‘female genital mutilation’ and
‘post-traumatic stress’ can be associated. However, in a diagnostic stem about a female genital
mutilation, the correct answer may well be some other condition.

A simple approach to answering SBA questions will consist of the following:

1. Read the stem and ensure that you have a thorough understanding of the ask (i.e. what is being
asked by the question?).
2. Three scenarios are likely after you have read the stem/question:
a. The answer is obvious and you do not have to look at the options to decide.
b. You have an idea of what the answer ought to be but are unsure (in this case, care must be
taken of the distractors).
c. You are completely lost (i.e. do not know the answer and have no clue).
3. If you know the answer and it is in the options, select that and DO NOT change your mind.
The more you rationalize the answer, the more likely you are going to change your mind and
get it wrong. This is more likely when you start extrapolating the information given to every
possible scenario.
4. When you are unsure of the answer but have two options, it may be worthwhile identifying
these options and coming back after you have attempted other questions. It is not uncommon
for one or more questions to trigger your memory and help refine the answer to a previous
question.

6
SBA QuEStIonS – SBA oBStEtrIcS: PAPEr I

46. What advice should a woman who had breast cancer and wishes to conceive after com-
pleting her course of tamoxifen but has been found on imaging to have suspicious metas-
tases in the lungs be given?
A. Can conceive provided she has been off tamoxifen for 3 months
B. That pregnancy is contraindicated until after treatment
C. To avoid pregnancy as life expectancy is limited and treatment of metastasis will be
compromised
D. To delay pregnancy for 12 months to allow for treatment of the metastasis
E. Will be able to have chemotherapy and continue with pregnancy provided she is not given
chemotherapy for the first 3 months
47. A 24-year-old woman is admitted at 30 weeks of gestation with regular uterine contrac-
tions. This is her first pregnancy and until now the pregnancy has been uncomplicated.
She is examined, and the cervix is found to be soft with a closed os. A decision is taken
to give her a course of corticosteroids and to commence her on the tocolytic nifedipine.
What is the benefit of giving her nifedipine?
A. Associated with a reduction in the incidence of preterm delivery/birth
B. Associated with improved mortality
C. Associated with improved neonatal morbidity
D. Associated with improved perinatal morbidity
E. Prolongs the pregnancy by 2–7 days
48. A woman books for antenatal care at 8 weeks of gestation in her first pregnancy. What is
the recommendation with regard to testing for blood group and antibodies?
A. Test blood group and antibody at booking and then at 28 weeks of gestation
B. Test blood group and antibody at booking and then antibody at 28 weeks
C. Test blood group and antibody at booking, 28 and 36 weeks
D. Test blood group and antibody at booking and then blood group at 28 weeks
E. Test blood group and antibody at booking and 28 weeks and then antibody at 36 weeks
49. What is severe postpartum haemorrhage?
A. Blood loss of more than 1000 mL
B. Blood loss of more than 1500 mL
C. Blood loss of more than 2000 mL
D. Blood loss of more than 2500 mL
E. Blood loss of more than 3000 mL
50. What is the most common cause of primary postpartum haemorrhage?
A. Disorders of thrombin
B. Disorders of tissues
C. Disorders of tone
D. Disorders of trauma
E. Disorders of trauma and thrombin

18
Another random document with
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—one of the best known in Paris as well as St. Petersburg and
Vienna. Immediately I wanted to know everything about him. He on
his side wished me to tell him all sorts of things of which I had never
even dreamed. We were at once on terms of delightful intimacy.
A short time after I was obliged to leave Nice. Just as my train
was about to go, my good friend jumped into my carriage and
accompanied me as far as Marseilles. There he bade me adieu and
returned to Nice.
Letter writing followed, in the course of which he told me how
highly he regarded my friendship—more highly in fact than anything
else in the world. For my part I thought of him more often than I
should care to confess, but I had my wits about me sufficiently to
announce to him, at the cost of a great effort of will, that he was too
young for our feelings of regard for each other to continue without
danger to both, and that he ought to forget me.
Just at this time there was presented to me a viscount, who laid
claim to my heart and hand. Need I confess that, with my eyes still
filled with pictures of the other man, I could not endure his assiduous
importunity. No one is deafer, says a French proverb, than who he is
unwilling to hear. And the viscount would not listen to my
discouraging remarks.
He seemed to have imposed upon himself, in spite of my rebuffs,
which were often severe and always discourteous, the task of
bringing me to terms. Undoubtedly, in spite of my reserve and
coldness, he might eventually have succeeded if one fine evening he
had not dropped out altogether under threat of legal proceedings. He
had a well-established reputation as a swindler.
During the time when the viscount was playing his game to win
my affections, my good friend’s communications stopped coming. I
wrote him several letters. They were never answered.
Some years later, in 1900, I had installed my theatre, as is
perhaps still remembered, at the Universal Exposition in Paris.
One day as I was on my way to the theatre I saw at a distance
my lover of the days at Nice. My heart began to beat violently.
 My friend approached. We were going to pass each other. He
had not yet seen me; for he was walking with his eyes on the
ground. Standing still, with my left hand restraining the beating of my
heart, I waited, feasting my eyes upon him. He turned his head and
passed me.
I was destined not to see him again for a long time.
Meantime, indeed, I learned through a third person that he had
told his father of his desire to marry me. A violent scene took place
between the two men. The father threatened to disinherit him. The
poor boy was sent away, almost by main force, on a voyage round
the world.
I have frequently reflected since then on the part the “viscount”
played in all this affair, and I should not be astonished to learn that
he led some artful embassy against His Majesty King Love.
 XVII
SOME PHILOSOPHERS

I HAVE frequently seen monarchs whose profession consisted in

ruling the crowd. I have sometimes seen crowds that appeared to
me mightier than the greatest of monarchs.
More rarely I have encountered philosophers, out of touch with
everything, who yet were able to create kingdoms within themselves.
These last have seemed to me more affecting than the proudest of
monarchs or the most impressive of crowds. Characteristic traits of
some of these are worthy of being described here. I should like to try
to do so, because of the emotions they have aroused in me.
We were living at Passy, my mother and I, in a house situated in
the centre of a garden. One day I heard some animated music
coming from the street. I ran to the gate to look at the makers of this
joyful harmony. A man and a woman were passing. The man played
an accordion as he walked with short steps. He was blind, and his
wife led him. The music was so sprightly, so different from the folk
who were making it, that I hailed the pair. I wanted the man to play in
the garden, behind the house, so that my mother, who was
paralysed, might hear him. They consented very willingly. I made
them sit down under a tree, near my mother’s chair, and the man
played on the accordion until a servant came to say that lunch was
served. I asked the man and his wife if they had eaten. When I
discovered they had had nothing since the day before, I told the
maid they were going to share our meal.
LOIE FULLER IN HER GARDEN AT PASSY
 At table we had a long conversation. The man had always been
blind. I asked him if he could perceive difference among colours. No.
But he was able, at least, to tell without fear of making a mistake,
whether the weather was clear or cloudy, dull or pleasant. He was
extremely sensitive to differences of texture.
I placed a rose in his hand and asked him what it was. Without
hesitation and without raising the flower to his nostrils he replied:
“It is a rose.”
Almost immediately, grasping it gently in his fingers, he added:
“It is a beautiful one, too, this rose, very beautiful.”
A little more and he would have told me whether it was a La
France, a Maréchal Niel, or some other species of rose.
As he had used the word “beautiful” I asked him what seemed to
him the most beautiful thing in the world.
“The most beautiful thing alive is woman.”
I then asked him who the person was in whose company I had
found him. His voice took on a tender tone as he said:
“It is my wife, my dear wife.”
After that I looked with more attention at the self-effacing and
almost dumb soul who accompanied the blind musician. Confused,
embarrassed, she had lowered her eyes, which she kept obstinately
fixed upon an apron, of a faded blue, on which the patches appeared
to be more extensive than the original material.
She was unattractive, poor thing, and at least twenty years older
than her companion.
Quietly, without concerning myself with the beseeching looks the
poor woman cast at me from under wrinkled and reddened
eyebrows, I asked the blind musician:
“She satisfies you, does she?”
“Certainly.”
 “You find her beautiful?”
“Very beautiful.”
“More beautiful than other women?”
As he had peopled his darkness with beauty my optimist replied:
“I do not say that, for all women are beautiful. But she is better,
yes, better than most of them, and it is that which, in my sight,
constitutes the purest beauty.”
“What makes you think she is better than the others?”
“Oh, everything. Her whole life, her whole manner of existence as
regards me.”
And in words so convincing that for a moment I felt that he could
see, he added:
“Just look at her, my good lady. Isn’t it a fact that goodness is
written on her face?”
The woman, with her eyes lowered, kept looking at her blue
apron. I then asked the blind man how he had made his living up to
this time, and how they had become acquainted, he and his
companion.
“I used to be, owing to infirmity, a real burden upon my family. I
did whatever I could but I could not do much. I washed the dishes,
lighted the fire, picked the vegetables, swept the floor, washed the
windows, made the beds—perhaps badly, but at any rate I did all
that, and although we were very poor at home they kept me. The day
came, however, when my mother died. Then it was my father’s turn. I
had to leave the empty house. I went on the road armed with my
accordion, asking for alms. My accordion became my best friend.
But I blundered along the roads. Then I met my dear companion who
is with me, and I married her.”
She was a cook, the woman told me this herself in an undertone,
who had become too old to keep her place, and who consented to
join her fate with that of the wandering blind man, serving as his
guide along the roads. The blind man found this arrangement a
blessing from Heaven, a kindness bestowed upon him by
Providence. They were married without delay.
“But how do you manage to live?” I asked.
“Well, it is not always easy to make both ends meet, for alas! now
and then, one of us falls ill. We are getting old, you understand.
When it is not fatigue that gets the better of us, then there is always
the cold. There are times when we cannot go out. Then it is
necessary to take a notch in one’s girdle.”
Each day they visited one district of Paris. They had divided the
city into blocks, and they sometimes walked miles before arriving at
their destination, for they lived far from the centre, in one of the
poorest suburbs.
“What day do you go by here?”
“Every Sunday, before mass. Many people of this quarter go to
church, and we encounter them going and coming.”
“Do they give you something?”
“It is a rich neighbourhood. We have several very good clients.”
“Good what?” I asked. “Good clients?”
“Yes, good clients,” he repeated simply.
“And who are these clients?”
“They are servants of the rich.”
“Servants?”
“Yes, some of them are very good. They give us old clothes; food
and money when they can.”
“And the rich people themselves?”
“We do not see them often. This is the first time a client has ever
invited us to lunch, and we have been going through this street for
seven years. No one ever asked us to come in before.”
“What do you do when you are tired?”
 “We sit down on a bench or on one of the steps, and we eat
whatever we have in our pockets. Here we eat while they are at
church.”
“Very well. You will have no need to bring anything to eat the day
you come by here. I invite you for every Sunday.”
I expected impassioned thanks. The man said simply:
“We thank you very much, good lady.”
Shortly after, I left for a long tour in America, and during my
absence my domestics received them every Sunday. From their
point of view I was merely a sure client.
One day I gave them tickets for a great concert. I was in the hall
and observed them.
The woman was overcome at seeing so many fashionable
people. As for the man, his features aglow with an unearthly light, his
head thrown a little back after the way of the blind, he was in
ecstasy, intoxicated with the music.
After four years they disappeared. I never saw them again.
The man, whom I had seen to be failing, probably died, and the
woman, the poor old thing, so unattractive in her blue apron,
undoubtedly did not dare to return alone.
At Marseilles I saw another blind man, a very old man, seated on
a folding stool against a wall.
Beside him stood a basket, guarded by a very young dog, who
sniffed at all the passers-by and barked after each one. I stopped to
talk to the old man.
“Do you live all alone?” I asked him.
“Oh, no,” he replied. “I have two dogs. But I cannot bring the
other one with me. He makes a continual disturbance, leaps and
fidgets so much that he never gets fat and any one would think to
see him that I don’t give him anything to eat. As a matter of fact, you
see, I cannot show him without being ashamed of him. People would
suppose that I was allowing him to die of hunger. Anyway I need only
one dog here. As for the other I leave him at the house, where he
serves as watch dog.”
“Oh, you have a house,” I said.
“That is to say, I have a room, I call it my house.”
“Who does your cooking for you? Who makes the fire at your
house?”
“I do,” he replied. “I light a match and then by the crackling of the
wood I know whether it has caught.”
“How do you clean your vegetables?”
“Oh, that is easy. I can tell by the feeling when the potatoes are
well peeled.”
“And the fruits and the salad?”
“Oh, that is something we do not have very often.”
“I suppose you eat meat.”
“Not very often, either. We have bread and vegetables, and when
we are rich we buy some cheese.”
“Why does your dog sniff so at every one passing by? Why does
he bark so spitefully?”
“Ah, madam, you see each time that any one hands me a sou,
thanks to his grimaces, I give him a little piece of bread. There, look
at him now.”
At this moment somebody had just thrown a coin into the blind
man’s bowl. The old man drew from his pocket a little piece of dry
bread.
The animal fell upon it with such a cry of joy that one might have
supposed he had just received the daintiest titbit in the world. He
nearly devoured his master with caresses.
“At what time do you eat? Do you go home to your lunch?”
“No. I carry my lunch in a basket.”
I looked. It contained some crusts of bread and nothing else.
 “Is that all that you have to eat?”
“Why, yes. Like the dog, I don’t ruin my digestion.”
“Where do you drink when you are thirsty?”
He pointed to a corner of the alley, where there was a little
fountain, alongside of which hung a goblet attached to a chain.
“And the dog?”
“He leads me to the fountain when he is thirsty and I give him his
share.”
“Do you come here every day?”
“Yes. This is the entrance to the baths. We do a good business
here.”
“How much do you make a day?”
“Twenty sous, sometimes thirty. That depends on the day. There
have been times when we have made more than two francs. But that
is rare. I have my rent to pay and three mouths to feed, my two dogs
and myself.”
“Where do you get your clothes?”
“They are given me by one and another. The butcher, the grocer,
the cabinetmaker, these are very kind to me.”
“Are you happy all alone so?”
“I am not all alone. I have my dogs. The only thing I lack is my
eyesight. But I thank Providence every day for keeping me in good
health.”
It was in consequence of a malignant fever that he had lost his
eyesight, for unlike my blind man at Passy, this man was not born
blind. Formerly he had been able to admire nature, to see pretty girls
in a country flooded with sunlight, to enjoy with his own eyes the
smile in other eyes, in eyes tender and well loved. In short he had
seen. What sadness his must be, to be unable to see again!
With much diplomacy I asked him about this.
 He had far less difficulty in answering me.
“I used to admire many pretty things,” he said. “I still have them
carefully enclosed under my eyelids. I see them again whenever I
wish, just as if they were there before me once again. And so, you
see, as these are things of my youth it seems to me that, in spite of
everything, in spite of being such an old hulk as I am, I have
remained young. And I thank the dear Lord for having been kind
enough not to have made me blind from birth.”
“And how old are you?”
“Eighty years, madam.”
This old man had a long walk before him to get back to his
residence. As I commiserated him regarding this, he replied:
“There is no reason for complaining, madam, I have such a good
guide, such a brave little comrade!”
He made an almost theatrical gesture, and said, in a voice filled
with emotion:
“My dog!”
“Does he guide you through the streets of Marseilles?”
“He does!”
“And no accident happens to you?”
“Never. One day I was crossing a street. My dog pulled at me so
hard from behind that I fell backward. I was just in time. A step more
and I should have been crushed by a tramcar, which grazed me. I
am mighty lucky, come now, to have a dog like that.”
In all circumstances this old man was willing to see only the
favourable side of things. That side, at least with the eyes of
imagination, the blind man could see.
One day the charwoman who came to our house at Passy to help
the servants arrived very late.
As she was ordinarily exceedingly punctual, I reproached her in a
way I should not have done if she had been habitually unpunctual.
Here is what I found out about this brave woman.
Three years before one of her neighbours, a working woman, had
had an attack of paralysis. This neighbour was poor, old, without
relatives and no one would bother with her. The poor little
charwoman, encumbered with a drunken husband and six children,
agreed to take care of the paralytic and her home if the other
neighbours would be willing to provide the bare necessities of life.
She succeeded in overcoming the selfishness of each and every one
in the warmth of her kindness. From that time on she never ceased
in the rare hours when she was free to look after the paralytic. She
attended to the housework, the cooking, the washing. The
neighbour’s condition grew worse. The case was one of complete
paralysis. The assistance which she had to give to this half-dead
woman was often of the most repulsive kind. Always smiling, always
tidy, always cheerful, she gave to the human hulk she had taken
under her protection the most thorough and intelligent care.
My little charwoman had always, at all times, been cheerful. I
wondered what kind of gaiety she would exhibit when at last the
paralytic’s death should free her from the load with which she had
benevolently burdened her life. This morning, the morning on which
she came late, she was crying. She wept warm tears.
I supposed that my reproach had caused this tearful outpouring.
But not at all. She said to me between sobs:
“I am crying—crying—because—she’s dead—the poor woman.”
It was her neighbour the paralytic for whom she wept.
In the north of Ireland I once saw some children barefooted in the
snow, during an intensely cold February. With some friends I visited
the poor quarter of a provincial city, where, I was told, people
working in the mills lived twelve or even more in cabins containing
but two rooms.
We placed no especial credence in these stories and we decided
to look into the matter for ourselves. It was all true, nevertheless. In
some cases the conditions were even worse.
 On reaching the district in question we noticed that a little boy
had followed our carriage. At a trot sharp enough to run his little legs
off he continued for about a mile and a half, all in the hope of getting
twopence.
The small boy came forward to open the door of our carriage.
The coachman rebuked him brutally. The child had so odd an
expression that I began to talk to him. He had five brothers and
sisters. He did the best he could to pick up something in the streets,
and he made from sixpence to eightpence a day. Just at present he
was trying to get a little money to buy some coal for his mother.
I, doubting the truth of these statements, made him take me to
his hut, which he had pointed out to us.
“That is where I live, madam.”
Certainly there was no coal in the house, but there were three
sick people. The father swept snow in the streets to make a few
pennies, for in this cold weather the mill where he worked was not
running.
There was complete wretchedness, frightful wretchedness,
irreparable wretchedness. And yet our little lad sang while he trotted
behind our carriage, just as his father whistled as he swept the snow.
Is not misery the school, the sadly sovereign school, of
philosophy?
 XVIII
HOW I DISCOVERED HANAKO

E VERYTHING that comes from Japan has always interested me

intensely. Consequently it is easy to understand with what
pleasure I came into relationship with Sada Yacco, and why I
did not hesitate to assume financial responsibility for her
performances when she decided to come to Europe with her whole
company.
Sada Yacco had brought with her a troupe of thirty people. These
thirty cost me more than ninety of another nationality would have
done; for apart from everything that I was obliged to do to entertain
them, I had constantly to go down on my knees to secure permission
to attach to each train that carried them an enormous car laden with
Japanese delicacies, rice, salted fish, mushrooms and preserved
turnips—delicacies were necessary to support the existence of my
thirty Japanese, including Sada Yacco herself. During one whole
season I paid the railway companies 375,000 francs for
transportation, but that cost me much less than to pay all the debts I
should have been obliged to assume from Lisbon to St. Petersburg if
I had decided to send my Japanese home.
I tried for a long time to get my money back by transporting my
Nipponese and their viands up and down the earth, but, weary of the
struggle, I finally assembled another troupe, which was as good as
the first one and which was willing to travel without a cargo of rice
and salted fish.
“Business is business” I am well aware. I decided, therefore, to
endure bravely the losses I had incurred, and I was thinking of quite
another subject when fortune appeared to smile on me again.
In London there was a Japanese troupe looking for an
engagement. The actors came to see me. They made some
ridiculous claims and I sent them away. But as they did not find an
engagement, we came to an understanding, and I found an
impresario for them, who took them to Copenhagen.
I went to Denmark, too, and I expected to look after the affairs of
these Japanese and attend to my own business as well.
When they arrived at Copenhagen I saw the whole troupe for the
first time. They all came to greet me at my hotel and played some
piece or other of their own invention.
I noticed at that time, among the comedians, a charming little
Japanese woman, whom I should have been glad to make the star of
the company. Among these Japanese, however, women did not
count for much, all the important roles being taken by men. She was,
nevertheless, the only one who had attracted my attention. She
played a minor part, it is true, but very intelligently, and with the
oddest mimicry. She was pretty withal, refined, graceful, queer, and
so individual as to stand out, even among those of her own race.
When the rehearsal was over I gathered the actors together and
said to them:
“If you are going to remain with me you will have to obey me. And
if you do not take this little woman as your star you will have no
success.”
And as she had a name that could not be translated, and which
was longer than the moral law, I christened her on the spot Hanako.
To make a long story short they assented to my request, and
lengthened out my protégée’s role. In reality the play had no climax. I
therefore made one for it then and there. Hanako had to die on the
stage. After everybody had laughed wildly at my notion, and Hanako
more than all the others; she finally consented to die. With little
movements like those of a frightened child, with sighs, with cries as
of a wounded bird, she rolled herself into a ball, seeming to reduce
her thin body to a mere nothing so that it was lost in the folds of her
heavy embroidered Japanese robe. Her face became immovable, as
if petrified, but her eyes continued to reveal intense animation. Then
some little hiccoughs convulsed her, she made a little outcry and
then another one, so faint that it was hardly more than a sigh. Finally
with great wide-open eyes she surveyed death, which had just
overtaken her.
It was thrilling.
The evening of the first appearance came. The first act was
successful. The actors acquired confidence and entered into the
spirit of their parts, a fact which caused them to play wonderfully
well. I was obliged to leave after the first act, for I was dancing at
another theatre, but some one came to tell me at the close of the
performance that Hanako had scored more than a success; it was a
veritable triumph. To her it came as a genuine surprise, but one that
was not more extraordinary than the anger provoked by her success
among the actors of the company. The box office receipts, however,
somewhat assuaged their sensitiveness, and I was able to give to
the feminine member of the troupe a longer part in the new play,
rehearsals of which were just beginning.
From this time on Hanako was in high favour. Everywhere she
was obliged to double the number of her performances. After
Copenhagen she made a nine months’ tour of Europe. Her success
in Finland bordered upon popular delirium. Finland, it is interesting to
note, has always evinced the greatest sympathy for Japan. This was
during the time of the Russian-Japanese War.
She played in all the royal theatres of Europe. Then after a tour in
Holland she came finally to Paris.
 LOIE FULLER’S ROOM AT THE FOLIES-BERGÈRE
The Japanese and Hanako stayed with me for nearly a year. At
the close of their contract they gave some performances at
Marseilles and then dispersed. Some of them went home, others
proceeded to Paris or elsewhere. Time passed, and I heard nothing
more about my Japanese, when one day I received a letter from
Hanako, who told me that she was at a cheap concert hall at
Antwerp, where she had to sing and dance for the amusement of
sailors, patrons of the place. She was all alone among strangers,
and the man who had brought her to this degrading pursuit inspired
her with mortal terror. She wrote me that she wanted at all costs to
be saved from her fate, but that, without assistance, the thing was
utterly impossible. She had gone from Marseilles to Antwerp with
other actors of the troupe to take a steamer for Japan. At Antwerp
she and her travelling companion had fallen into the hands of a low-
lived compatriot, and she called me to her rescue.
One of the actors of the company happened to be in Paris, and I
sent him to Antwerp with two of my friends. After numerous
difficulties and thanks to the police, they were able to enter into
communication with Hanako and tell her that they had come to take
her away.
One evening she succeeded in escaping with her companion,
and, with no baggage except the little Japanese robes which they
wore, they took the train for Paris.
Hanako had been obliged to leave behind her little pet Japanese
dog, lest by taking it away from the house she should arouse the
proprietor’s suspicion. They reached Paris shrouded in the European
cloaks I had sent them, which were far too long, and hid them
completely.
Presently I found myself in Paris, manager of one of the most
gifted Japanese artists, but, alas! with no company to support her. I
was puzzled to know what to do with and what to do for a kind,
gentle, sweet little Japanese doll.
I first tried to find out if some one would not engage Hanako, then
an entire stranger to Paris, and a small, a very small company for
one of the minor theatres.
I received from one of the managers a remarkable answer. If I
could guarantee that the play which Hanako would present was a
good one he would engage her.
The play? Why there was no play. But I was not bothered by a
little detail like that, and I explained that Hanako would offer a
wonderful play, one that was easy to understand whether you knew
Japanese or not.
Then I signed a contract for ten performances on trial. A
contract? Yes, it was a contract. And I had not secured my actors
yet. And I had no play yet. I had, altogether, Hanako, her maid and a
young Japanese actor. I was not discouraged, however. I undertook
to find another actor. I secured one in London, thanks to an agent.
Then I went to work to construct a play for four characters. There
were two major roles and two supernumeraries. The result of my
efforts was “The Martyr.”
 A great difficulty now arose. The question came up of procuring
wigs, shoes, costumes and various accessories. But here again luck
helped me out. They made a very successful first appearance at the
Théâtre Moderne in the Boulevard des Italiens. The play was given
thirty presentations instead of ten and twice a day, at a matinee and
in the evening. Presently the manager said to me:
“If your actors have another play as good as that one I would
keep them a month longer.”
Naturally I declared they had another play, a better one than the
first, and I signed a new contract.
New stage settings, new costumes and new accessories were
necessitated. The result was a new tragedy called “A Drama at
Yoshiwara.”
While the new play was running the manager of the Palais des
Beaux-Arts at Monte Carlo made a very important offer for my
Japanese, for three performances. I accepted. The troupe left for
Monaco, where they gave twelve performances instead of three. In
the meantime a small theatre, that of the Musée Grevin, proposed to
engage my Nipponese for a month in a new play which was to be a
comedy. To suit the purposes of this theatre we wrote “The Japanese
Doll.” Next the Little Palace offered a month’s engagement for a play
that was to be a tragi-comedy. There my Japanese played the “Little
Japanese Girl.” Finally they went to the Treteau Royal, where Mr.
Daly engaged them for their six plays, a circumstance that compelled
me to increase their repertoire by three new pieces, “The Political
Spy,” “The Japanese Ophelia,” and “A Japanese Tea House.”
Hanako finally began a tour of Switzerland with the company. Mr.
Daly suddenly wanted Hanako to appear in New York, and to break
off this trip I needed more imagination and took more trouble than in
writing a dozen plays. Then I was obliged, still on Mr. Daly’s account,
to break an agreement for a tour in France.
Such is the history of my relations with Hanako, the great little
actress from Japan. As it is always fitting that a story of this kind
shall end with a wedding, I may say that, conforming to the tradition,