1960 2

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Journal of the Gdlenicak' SacieD. Unite$ity af Btistol

vol. 16

SPRING TERM,

1960

No.

"Therc is only one tule aJ ptactice: put )autself in the patie t's tlace-"-LtstEr.

CONTtrNTS

Edilorial B.M.A. Presidenrial Book Review A MilLion Years

9

l0 22 23

24

The Missin! lJnrhiiicus Archaeology for the Corone.

21 29 32

3l

Exanination Resulis The Maternity Flylng Squad Thc Hc) Day ol sL-pery ColTce

T

e

...

34 37 59

..

( lin'cal <r,ake. and Ladde\

Published

b]

THE CALENTCALS' SocIETy, UNrvERsrry oF BRIsroL

Ptnlkd bli Lo sdo\,ns. Printets, Tto\rbridge ANNUAL

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1TJ!Y & BA(IR ) ATD R

Editofial Committee F. J. W. Lrwis, M.B., cH.B. J. A. MoR?HEw

Edirot Assista

t Editot

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Disbibution Manager

C. E. PoLKEY G. R. BuRsroN Mrss J. LEwrs SISTER

M. A.

PRIEST

rhe Soring weJrher flood,1g ur wirh.unchine and WITH '' $arnrh. rhi\ edrr on \e-y ncarl) appearcd devoid of an editorial. Philosophy wilhdraws discretely at such times.

Nevertheless, perhaps this short editorial could make a plea

events going on in thâ&#x201A;Ź world around us, where we are exhorted to join boycotts, sign petitions, donate half-pcnnies or absorb Ulel.ature on Moral Re-armament; where the cinena rerninds us of the possible consequences of a nuclear war. Cynically, and with our minds bent on reading for

for us to have a regard for the

the Summer cxaminations, we are tempted to consider thesâ&#x201A;Ź evcnls as being no concern of ours. It is not easy to take ar active interest or indeed exhibit any positive feelings. The last two decades have impregnated our generation with a strong dose of pessimism, apathy, and sense of futility.

Perhaps we should exchange " existing " for " living " and remind ourselves that the aim of medicine does not reside solely in the test-tube or opcratjng theatre.

" We cary with us the wonders we see without us: therc is Africa and her prodigies in us "; as Sir Thornas Browne said in his Religio Medici. The palient is more important than his pain. aLl

BATH, BRISTOL AND SOMERSET BRANCH, BRITISH MEDICAL ASSOCIATION PRESIDENTIAL ADDRESS, December

l7th.

1959

qa. arloJrcc,l a ih n on t apo rhar rr :rqJirJ $a. l-cins tT r he.d inro rhe Un ver'ir1 .areerotiruderr,andrl'ej.ub.equeri

" why do people fail?" A writer in Zr? Zm?.r (August 5th, 1959) rem.rkcd; " Ifthe answer can be found to that, it may be possible to do soncthing to hclp thcm when they do." A rnonth ago I came across some Kiplinglike hints as to how failure in careers. One of the quesrions which is being exanined is:

examinarions might be avoided; slighily modilied rhey

run:-

" IF you can kccp your hcad whcn all about you Are losing theirs Gnall wonder if thcy do); If you can trust yoxrself when reachers doubt you, And make allowance for their doubting, tooi If facts you know, but make no facts your masteri Tf 1o: czr gr'. bJI ra n:.1" gJ, )oL- uim.

If yox

can quote a dose without dhastcr, And treai siatistics as a pleasant game; l')oL can wri.e and nor be tired o) wfl.ing.

And $,rilc. nroreover. words rvhich can be readj If you forgct thc truth you should be citing.

But defrly put anorher in irs slcad; lf you can lil1 each unforgiving minute With sixty seconds' worth of wriiing donei Th( pztrr', \or ... :,nd .\cr)tfing lfal , i" ir.

Ard. ,\lar i, rrorc. )oJ fr,, Ihr r\r',. rr) \o

Alrhough T anr not going to try this evenitrg

to

r.'

answer

comprehensively lhe qucstioD about wby pcoplc fail, it galc rne the idea ihat I might weale n1y talk round the subject of exanrinalions- I hope this will not cause you to think thai l]ly intention is to borc you to tears; but if you will be patient I beLieve you will see that it is noi qtrile such a t€dious subject as jt sounds-

I havc noticed in recent years that not all Presjdents of rhis Branch have lakcn cntirely serious subjecis for their addresses and that personal hobbies or non-mcdical interesis have sonetincs featured. Conduciing exaninations and assessing ihe results have bccn part of my duties for many years, and I must confess to a weakncss alll1osr anouniing to a hobby-for extracting and l0

storjng such hunour as has come my way in the process. I am therefore going to ask you to bear with me while r make sone general remarks abour examination candidates and to share with ne sone of ny examination experiences. I must remind you that I am a mere pre-clinicjan and my experiâ&#x201A;Źnce as an examiner has been confined to Physiology aDd relaied subjects, and my candi dates to siudents of Medicine, Denristly, Veterinary Sciencâ&#x201A;Ź, Pharnracy and pure Science; but it is, I suppose, nor unlikely thar those of you who are engaged in general practice, even

assuning that you never had any difiiculties with your own examinatjons, will occasionally have had young palients whose lives have becn tcmporaily disturbed by problens ln thai fie1d.

Not so many years ago, when there was no difficulty in obiaining a student place in a medical school, failures in examinations wcre nol regardcd with quite the seriousness that is now atlached 1o them. In the case of weak students a nunber of siitings at each stage quite often led to ultimate success at the expense of a considerable number of years and rhe parent's pocket; but in these days, when ihere is great competiiion for University places and when the vast majority of students are suppo ed by tax- and ratc'paycrs through various auihorilies, examination failures are looked on with considerable disfavour, a very brief succession speliing the rermination of a University career. To the average student this knowledge, if it nakes any appreciable impression on him, acts as a stimulus; but to the occasional one who lacks self-confidence and thinks rhar he knows loo little 10 be successful it may increase his feeling of unreliability and quite often leads him 10 the fale which he is so anxious to avoid-the abandonnent of the career which he had hoped to follow.

Broadly, eraninalions arc neant io Iind out what a candjdate knows and ot ro expose his jgnorance. They cao a1 best be only represenlative tests, and many people regard them as far frorn an ideal way of determining whether a person should be graDtcd a

dcgree or other qualification. The phrasc " delcaling the exaninen." so comnoDl) rlsed. is pcrlraps an unfortunatc one; examiners are not the candidale's enenles and lhev are anxious 10 give full credit where ir is due.

Tcn years ago I cane across this paragraph in a rredical B"ll , Ho,p. J.. la:la. s1. l)6) " l donl suppose a nan caD rend Medicine longer than 18 moDths bcfore losing the naive idca that passing exaniF aiions has anythi.g to do wilh skill. knowledge or ability.

Exans can only be ovcrcome by a mixtue of showmanship,

ioun al /SI.

tl

71'I

E RLACK

BAG

quick-wittedncss and downright low cunning; thus they remain pefectly lair tcsls of lhe qualities denandcd ol thc successful

This raihcr cynical remark has somc truth in it: but there cin bc very few students who are unwisc enough deliberately io set out to deceive their erarnjncrs in the way described, rhough occasional signs of attributcs of this sort do occur. A Bristol medical student in the course of an answer in his Physiology

paper staged a dive$ion from the information he uas giving by a description oftle Haldane gas analysis apparatus iD thcse tcrms:" Hourc of entertailllnent can be had with this apparatus by getting thc liqxids mixed if great care is not trkeD to see what will happcn cl'ery iime a tap is turncd bcforc you turn it."

I was glad 10 know lhat one student at least could refer to his exercises wirh a Haldane as entertainrnent.

Another candidate, showing how interestcd he was in the subject, wrole picruresquely: " Physiologv enables ihose who arc intcresied to reduce thc h maD body to terms ofa cask of watcr, sornc few candles aDd a quantity of nails."

I once read at the end of an account of tlre funciions of fat

in the body: " Fat also produces

refined sculptural eFccts." lvas left a1 thal; the candidate refrajncd from describing obesily in these ierms.

An clement of self-plty sometimes shows itself-no doubt in an allempt to invite leniency on thc Parl of the examiner. In an account of human dietary needs appeared this little paragraph: "A heavy nanual worker uscs up and requires mo.e energy-giving and protein malerial than a sedentrry pcrson who sperds half his lile sitling at a desk taking examiDatioDs;

It

such as is my casc."

Clearly one of the

" old chronics."

Some people would, no doubt correclly, describe thcse quolations as examplcs of nippaDcy; yet il is not uncornmon to read answers which are coloured by tactics ol that sort. The writcr of the last qxotatior might have felt sonc hope if he had hec| abe ro rcad $i.l ne some )ea^ larcr: " People lend to get depressed at cxam times; this is a type of refiex. Bur if exam iine was accompanied by feelings of joy the depressed attiiude would disappear."

Any average class of exanrination candidates can easily bc divided inro a number of groups, of which the following arc thc l2

(l) At ihe lower end of the scale there is the man wlrose knowledge is cleady deficient and who appears lo stand little chance of passirg an examiration. One who is really ignorant aDd js incapable of assimilating a scientific subject is nowadays rightly rare in Univcrsity mcdical faculties and should never have been admitted. But in this group one nnds an apprecinble nxmber who are capable of learning bui who for one reasoD or another usually the newly-found attracrions of undergraduate life have failed to work or take advantage of the facilities onered tlrem.

They are morc conmon in the early stages of a course; rhey do not appear later for, unless they have been rcquired by financial or other sanctions fron abandoning their objectives, they will have learnt their lesson through the pain of failures.

(2) Then there is rhe pure oprimist. He seems to be unaware ol how little tre kDows and enters an examinalion \lith irresponsible conlidencc. The bunp which follows his failure to reach the pass standard is the first and nost impo.tant step in brirging him to a sense of reality. Subsequent conversation with the optimist almost invariably helps to complete his conversion to a healtlier state of mind. The cure is usually easy.

(3) The largest group consisis of students who have worked quite well aDd who know thar they do not know everything.

They usually pass their exaninatioDs wilhout difficulty, and they deserve

to

pass. Most

of then are sensible and well

balanced,

and aLe able to enier an examinaliorl with a reasonable amount

(4) An intercsting rype is the candidate who has a remarkable memory for the printed page. Hc is able to quot€ with a high degree of accxracy whole paragraphs from the text books he ias read. This sometimes appean 1() bc an automalic p.ocedure, for

the qrotation may be continued afier the needs of the qlestion have been met, and some of these candidates are quile easily exposed in the subscquent oral examination by a question which is designed io make then think. A few, however, put llp a good performance throughout.

(5) Then there is the brilliant caDdidate io whon the absorption of knowledge is as child\ play and whose iDtclligcnce is of a high order. He obtains distinctions, and if he writes well the examiner\ heart warns to read his answers. He does not form a large fraction of the whol€.

An exaninarion failure lnay be the Jirst eFective occasion for an unwise sludent lo be brought to face facts. After leaving school he has perhaps lound the sudden relative freedom of Univenity life loo beguiling, and he samples the various distractions which are allowed to take up too nuch of his tim€.

Mosr of such students, if they fail in an exanination, innediately become honest wiih themselves and are ready to confess the t3

failure; with litllc or no help they learn to use their time more appropriaiely.

OccasioDally this set-back is laken so hardly by a student that he becomes over-conscieniious and hermit-like, and decides ro \pend dll his .rrure rinre at hr' $or\. esclesrng pamc' d,d e\en an approprirrc d i) 'pe.l ol oJldoor e\erci.e Thi'c\lreme of course may easjly lead lo failure from staleness lf tlrat phase mishr he described as a chronic form of the diseasc. lhe acute for-rn is very comnonly encountered during the few {tays preceding an examinatioD: then even sone hilherto scnsible students go into a khd of purdah, in which intense rcading is indulged in for hours on end righl up lo the comnencement of their 1es1.

It is not dimcult to uDderstard why some of then answersometimes tolcrably well-questions which have Do1 been sei; a kev word rcnrinds them of sonethiig ihey have rccenily read, and without taking the linre aDd trouble to understand what the que.rion acrurl.l r.[' Il'c) g" l) .. oT qr ting $h l i. upDer'rt mer r follos\ qhen Ilrey rhe:r Srd di'illr.ior in mind.. ;o'r .ub.equenrl\ di*u" r\e paper iiLl- rh. orher errninee' and Ile e\ari ,er.Jfler. ul lJJs rr equ l dcgree ol regrct tIe r \e finds thal he can award few marks. or none at all, to the candidates' cause of their

I havc foxDd no easier way of provoking hoots of mirthless laughtâ&#x201A;Źr rhan by urging a class to close ihe books at least three or four days before an exaniDatio and spend the intervnl in the country or in some heallhy diversion which will rake their rninds righr away irom rhe subjects ihey lave been studying. ODly those who lave reallv lried this can testifv 1() ihe freshness uilh which thev come to iheir examination and thei' consequent success; for'most it seens too great n trial of faiih.

Examiners lrave lo put up wilh a number ofirritaling features when readnrg scripts. To my mind, undoubtedly the most exaspcratiig of these is illegible haDdwritirg, which nay rnask a

nunber of other blemishes and prevents the examiner from seeiDg the good points. I do not suggest that candidaies deliberately write poorlt in order to creare a kind of fog which prevents the examin;r frorn seeirg how liuLe they really know, but this is ceriainlv the resuli in a nunber of cases. It seens inconceivable that aDyone who wants someone else to read, and give him credit for, what he has writien can really expect to gei any benent from illegibility: some candidates adopt a " take it or lcave it " attilude which is of no help to thenselves and a discourtesy to the rcader. This irouble is fotunarely confined to a smal1 minority ofcandidales, but it seems well-nlgh impossible to get a Universitv student io alier a bad habit inio which he has been allowed to drift during his earlier years. Some of them, when asked after the

€xamination to interprct what they have wdtten, have to confess that they cannot read their own writing.

Anyone who is by nature or upbdngug sensitive about spelling frequently has his feelings outmged by misspeling, which is all too common. The English lansuage is notodously dimcult in this respect and some people, I admit, appear to have a cotrgenital defect which prevents them from developing satisfactoiy spelling habits. I shall never forget a fellow-student with whom I spent three months in a Clinical Pathology clerkship; his reports had to be seen to be believed. Pus, of course, was always spelt " puss. and words wbich panrcularly srick in m) memory $ere " lucosite " and " limfosite." H€ would send in his reports to

the chief apparently quite urconscious of his orthoglaphical shortcomings,

The fact that some candidates do not even copy words correcdy from the qu€stion paper makes one think that they have their own prcconceived id€as as to how certain words should be spelt and prefer not to use the orthodox forms. More than one of my candidates have headed a Physiology script " Phisiology," and the word Medicine is often mis-spelt, to their shame, by medical students, I have quite

a collection of stmnge spellings culled lrom

examination pape$, of which the following arc examples;" Vitamins are found in serials," " Fluxidity of muscles."

Addison's anaemia has been descibed as " the pemicious

" Insulin is

secreted

by the

eyelets

of

Langerhans

in

the

" The diabetogenic hormone is agnostic to insulin."

A decapitate prepamtion used in a cross-circulation experi ment I have seen descdbed as " a decapitulated dog." " Fats are disgusted by lipases in th€ elementary tract."

Some kidney tubule cels were onc€ described as being " tall

colummr with Bgged boarders," which looked as though the writer had in mind cells of quite another sort containing tmmps or unkempt prisonen, A candidate in a practical Histology test, being showl a section of pituitary, wrote: " This is a s€ction of Hypothesis cerebri." Another, in refering to the bifurcation of the common carotid artery, suitably anglicized the word " bifurcatiotr " to " biforkation."

Association by sound was no doubt responsibie for the phrase, in an answer on the pituitaryr " a state of matuitary," meaning maturity; and for this sentence in a description of a tra$verse sectioD of the spinal cord, which made m€ smile when t5

I

read it: " There can be seen the grey matter and ihe white matter, and round them the pia matter and the dura matter."

Sheer carelessness was no doubt the cause of a candidate, when rcferring to experiments on the giant axons of squids, which have given us a lot of information about the physiology of ne e fibres, writing: " The changes taking place in a nerve fibre were irvestigated using the nerves of a giant squib." This might almost refer to a tl?e of r€flex common on November 5th.

It

sometimes seems dimcult to believe that a studeni has ever read any respectable literature or, for thal matter, the pages

of a text-book, when he spells in his owl} phonetic way words whose visible appearance jn print cannot have made any useful impressioD on his visual centrcs. No doubt the more plausible explanation is that the imprcssion which the printed word makes is by some psychological process pushed down so far into the subconscious that it canrot readily be recalled, and the individual relies entirely on his sound memories for writing as well as for speaking. One even wonden wheth€r the sound film, the radio and television. from which the written word is excluded, and which have rcplaced the silent film with its frequent captions and the reading of literature for its own sake, may Dot be partly r€sponsible for tlis.

I often also silently deplore the almosi complete absence of Creek frorn the earb education of present-day young scientists and doctors; a knowledge of the etymology of the very many scientific words derived ftom that language would greatly improve the standard of spelling.

Next to bad spelling, poor English is a common enough trial to the examiner. I have in mind poor expression, faulty construction of sentences, plural subjects witb singular verbs and vice vena, sometimes the omission ofa verb or even ofthe subject of a sentenc€, slang phrases and Americanisms, lack of paragraphing, hopeless punctuation or more often a complete lack of it. In my schooldays I was often required to spend part of the holidays in reading standard English works. As this was not part ofthe school-prescribed holiday task I submitted to the imposition with considerable reluctanc€; but although I caDnot honestly say that I enjoyed this additional encroachment on my holiday time, I am quite prcparcd to believe that, even if it did not give me p€rfect style, it at least taught me what I ought to look for itr the triting of others. More recently I discovered that Fowler's " The King's English " is an exc€llent guide to the proper use of our langrage, as well as being quite entertaining in places. Would that all who intend to tak€ University courses were requir€d to read it while stif at school; but it is a meaty book, and I have a strong suspicion that the tendency to early specialisation at school 16

after the passing of the Ordinary level G.C.E. examination may make such reading impossible except for the boys and girls who

to take Advanced level English.

Proper names are, I suppose, fair garne for misspelling.

The plexus of Auerbach in the intestire has been written as " the plexus of Aard-Vark "; and Hayem's solution of ha€mocytometry as " Hymen's solution." The motor speech area has are

been described as " Broker's arca." The Donnan equilibrium has been assigned to " Donovan." A histrionic elernent is introduced

by the phrase " Th€ Fo.bes-Robertson reflex." One of the most striking misspellings I have seen was a description of the preparation $irh which E. H. Srarlir)g did ,o much \aluable work on rhe beart a. " Srdlin, heafl-lung preparalion. fhe primiri\e distinctior between ihe retinal rods and cones, commonly called the Duplex theory, I once saw personified in the statementr " Duplex put for\'r'ard his theory of vision."

An uncomfotable habit which has been growing in the last few yeals is the wriring ofproper names with sma ininal l€ttersby studenis who comnence their owr names with capital l€tters.

I wonder whether the common modern practice of spelling the names of firns in advertisenents and on shoD fronts with small rnilial lelleF i( re.pon.ible lor rhr,.

Speaking ofproper names rcminds me ofa wonderful assortment of variations on the classical investigation into human gastric functioo carried out in North America between 1825 and 1833. Perhaps you will remember that Alexis St. Martin, a young French-Canadian, was accidentally shot in the left side, the resulring $ound leavrng a permanen' gasric fi.rula. william Bcaumonr. d Unrted Stares Army ,urgeon, who allended him, took advantage of this opening to study gastdc secretion and digestion. Here are some of the accounts which I have seen jn examination papers over the years: " Quite an amount of evidence is du€ to the accidental fistula in a French soldier called St. Thomas and its employment by Bellemont." " The lirst direct experiments with human gastric fistulae were upon a French Canadian, Alex, who was wounded in the American War of Independence " (which actually took place about 50 years earlier). " Pavlow in 1882 was wounded by a cannon-shot in the stomach and was able to make interesiing discoveries as to the seffetions of his own stomach " is a related piece of imasin-

A

candidate once rcferred

Harvey."

to Alexis St. Martin as " Martin

Two further gaucheries about alimentary secretions which t1

TTTE

BLACK

B'4G

othff occu ed in eniirâ&#x201A;Źly seDarate examinations: --'-'' ii is a well-knovn lacl lhal menlal tbougbt of a paF t;"u1215 elsasanr aa'lronomic delighl or lislenrng to a coni,'." oiit *n Dromore s;livarioD Thjs phenomenon "..."ii,i" i" maiked -:iri?-aon "in thâ&#x201A;Ź dos. ' $irb a dirb. nor being allowed ro '" 'erv ii or.s.ntia eat it. sastric secr;tion is induced." *i. i: %i ,n.orn'noo ro frnd wbar mishr be described ar For instance:near truths." " -'--' the remedy for to be closely

seem

related

to

each

'dadn[ti"tlo" of lime water used to be ' r"'.vv on iaitine ships when no fruir was avajlable *:'rt'.-Gh mitral rhe is called val!e iuriculo.entricular '

shaped tike a Milre s hat "'--:Ji.its cusos arerespir'arion unnatural obsracle' musL be ."-"";;. -riniiut F;; i;trt*J, rhe \ubjecr 'mav bave s$allowed his

hecause

out or ferhap' eren

tonpueand this ffust be pulled '-M"aii"ii,ni"Ll"e,

aD abseoce

of

thoughr'

i''''-"': reioonsible lor some srrange iratements For instance: beswalrowed iii;;i;;;a;uifooi'orotber matenalcan ensues ' il Deatb of cource *i,h.'i ''''-;t*nih; ";^." knowins ;iai";ourt bas a"n oxvgen debr qhicb i' slored until rt wanLed." The idea of $aDting a debl seems strange '' is"::l""; rio ii u oro,.,n foun-d in egg,l ir is poi,onous."

ol '' Ethyl alcohol acrs as a diureric due to lhe amount ' such s5 waler u|"o 3q15 Tfierefore warer it;;Dtains or takiog

r";;i;;i;";.. Ts this aD argument in ravour t..,;;i;;-;th ii?Jhat sentiment-mishL also applv ro ihe followins:'-"" ::i"-" neoDle arc subiecr ro rhe desire lo iogesr large i:h"

quanri;;s of $aier' In Ibis case a feeting of deprcssion elc ' '"li'"la!",. the menlion of alcohol reminds me tbal the ,fro"nni oi".i, -uv.olour absent-minded caodidates'answers "*" i;;";;il;; more acdurarelv, their ninds are verv mucb presenr sphete ol acrjril)). For instance:i"' u- aifi.i.nr -;i. Cr""r.

Disease lh; tughba . prorrude.' lnteresling examples. $hen lhe candldate mosl ol lhe and in one was dealins $jlb lbe futrctjoo' of tbe longue he descrrLred lbe four raste'-as 'ah. s\ eel, mild and birrer"' '-- a;;1";.."' js often re"pon'rble ror some (rarrlins state' rnents. A candidare answering a question on respiralion wrote: ''Tbe Drocess of teproduclion occurs ln man al tbe rale of about 2d times a miDute ' -oth;';6i;t of exiraordinarv sentences which I have

"''"

_'':

Vita-io o

"u"ses

rickets in young animals and degenert8

ation ofbones and teeth in adults; it is therefore called the antirachitic vitamin " '' Bv lumbar Dunclure and lbe re\ulling collap(e ol luDgs we Drov"e lhat lh; pleural pres'ure is negatire '

A lons sDinal needle (eerrs lo be called for here. ''T[e frllins ol lhe blddder i' broughr abour b] peristaltic movement in uterus."

One wonders what the poor male does about it. How€ver, he _ sers hi! o$n back in anorher etaminarion:_ The rilli ol rhe ovum embed lhenrselre\ inro tbe qall of the uterus and thus set up a connection with ihe patemal Here is another stranqe example:-

conlenr of lbe ''A-lter rearo.al olihe paDirea' the 'ugar blood uould rise ro dangerou( heigbr.: aD e{aminarion of rhe urine lor prolein would 'oon confirm rhir"' A would-be pharmacist in an answer on biological assay

'

'' th. lerh.l .to'e shich is lhe dose admini'rered ro

make

death extinct."

Indifference to the distinction between life and death, h€alth and disease, also appears in these two quotations:" The suprarenal medulla is not consistent with life." " Note that th€ propotion ofalbumin to globulin in blood

i" abour 2 : L This is imporrant in rhe maiorenance 6f health and is indicative ol disease."

In most cases, of cours€, it is fairly clear what the candidate is drivins ar. But hoq does he manage ro par' tbe eadier scbool eraminailon' rl he \rrires such rubbi"b: and qill rhis unforluoare habit persist into his subsequenl career? _the obvrouq rreaLment is lo rnculcare rhe pracrice ofcarelully readins Ltuoueh wbat one ha' $ritten before pafiing silh il i in time s-uch a icacrice. olt repealed. should lead Io prevenrjon. lbouqh ir $oirld al.o deprrre an addre"s of rhis .ort of much Dlasma

iDteresting material.

rert lew

Mv 5crrobook conrarns ,"*, j conituae thal incorrrcr recording as malleA

eiamples

rLatements

ol

ignor'

'heer are rarelv \ orlh

ol inlererr' ln an early e\aminalion

experi-

ence of mine one of lhe eiaminers a.ked a queslion about prturtary

function: lhe candidate. ob\iouJv ar sea, de'cribed a case ol hrnoniruirar;'ln as 'a crealine. The e\aminer, an\ious Io be ki;.t lelr bound ro sdv: You arusr be rhinkiDs ol'credn': uhaL is rhat: The riplr qa': Ilhink rt is some kind of nationality." I suppose tie'" Cretinisation of the red blood cells " desoribed-by ano^t-her candidate elsewhere would therefore be a form of naturalisation. l9

TEE BLACK BAG

An original description of the hea -beat, with admittedly in it, commenc€d in this way:" The heart-beat arises in the cer€bellum atrd passes to th€ sino-auricular node-where tte impulse is propagated in all directions and meets the auricular veDtricular node and

some truth incorporated

at an extremely mpid rate by the Bundles of His down the ventricle and up their sides back to ihe bmin again."

passes

The wfiter did not say what happened to it tlen; possibly he had run short of brcath owing to the " extremely rapid rate," as indicated by a complete abseDce of punctuation.

This quotation may be an example of what some studeDts descnbe as a " viscous circle."

Malapropisms are always amusing. The vis a tergo of the left ventricular pump I once saw described as " the vertigo." " Th€ pars nervosa of the pituitary is composed ofneuralgia ceS.', Is this why thai candidate's pap was such a headache to because

read

?

" In adulis th€ amoutrt of milk to

be taken

io obtain the

necessary amount of nitrogen rcquired would be so voluptuous

to be unpleasant." " In hyperthyroidism the body g€ts thin and emancipated." was the candidate thinking of the liberation of the soul

as

after a fatal termination ?

Oth€r faulty uses of wods appear in the following examples.

An enuretic is a common enough word nowadays; but I was recently totd that " a diurctic is a person who is continua y passing urine."

Scuny, of which a description was sought, was simply " bad temper." " Fertilising female rabbits with sterilised bucks " mak€s

described as

otre wond€r how this feat was accomplished.

" Morohia taletr in e-i.cess will cause the iris ro cotrtract until the p'upil is no more lban a pin-prick.'

A candidate wri!ing abour Ihe medullary centre. itrjury of wbrcb produced blperglycaemia in experimeoLs by Claude Bernard on rbe rabbil and whicb is commonly relerred io in English as diabetic puncture, said " If this centre is injurcd the condition of diabetes mellitus quickle appears in tle body; this condition is referr€d to as a diabetic Dunch."

An eqirally rigorous oullook ir rndtcaLed ;n tbis descriplion of the apex b€at:" When we put our hand opposiie the fifth intercostal space one feels a kick from behind."

Another inieresting way of describing a pa icular type ol sensatioD appearcd in a candidate's account of p€ristaltic move2A

TTTE

BLACK BAG

ments. whicb. as be wrote. " are enrircly iovoluDtariiy conrrolled; we can t feel rhese movemenLs allhough al lifies ir cerrainly feels

like it."

Desoiptions of endocrine activity have been fruitful sources of additions to my coll€ction. I have already quoted some of rhese. Here are (so more. relaring lo lbe lhyroid:" The general appearance of hyperrhlroidism is a bishlysirung agitatiotr, as opposed to the appearance of'mouldy'looking indifference of hypothFoidism." " People who suffer from aD over-activity of the thyroid gland are very ne ous and use a large amount of neivous energy; they are mrely seen to be still, for they must always be doing things in order ro uqe up the ercess energy whicb ihey

to have."

A conrriburion lrom rbe suprarenal:" Seqetion of adrenalin o€cu$ during moments of crisis.

For example, when one is going to fight or run away it would be inconvenient for the sphincters of the bladder and rcctum appea c

The writer evidently regarded ihis as the chief function of

A candidate, after mentioning that androgens are responsible for the secondary sex characteristics, stated that these characterirtics were repre\enred in the bull b) Lbe growth of horos and a ferocious state of mind."

A novel action of these hormones was announced in another examination where I rcad that they " send messages of sw€et seosation to tbe different parrs ol Lhe bodv at rhe srage of orgasm during sex relatjons.'

Hypogonadism is apparently illustlated in this rather cryptic

"A

calcitrated sh€ep grows bigger and fatty; may be

hornl€ss."

I must repeat a sentence which I recently in a medical student\ paper:" The pigment of the iris probably has some soft of

While on this topic came across

secondaily sexual function," which, after some initial hesitation, I interprcted as a delicate referenc€ to the glad eye.

Anaromical peculiarilies are sometimes found. For iosLance, it was once described that in inspiration " the stetnum ris€s and goes away from the body." Nothing was said about its rctum.

A sid€light on avian anatomy appeared in an answer to a questiotr on vitamin B: " Pigeons fed a vitamin B-free diet develop after 10-15 days Lime errreme muscular weakness, with inebiUty ro fly, walk or even in pafiicular lo keep Lheir cb;ns up.'

2t

of Ibe ob\ious 'omelime" appear: Climore\ - r:ih;';;;,; i. a larqe racemosd gland -in mrcroscopic ' pancrea' ro Lhe verv simildr aDDearance ""-:lii6 acdvitv is destroled. wbile dr I00 deg a."'..n^*e js aboli(hed ' complerel) aciivrrv the enzrme '-wh.'"i"; mav have been iDrendins Io il'. ruir...unriiaut. his laurologrcal urlerha\e avoided easilv rav. LU. lo.ti.i."ta ance b\ readiDe his paper before rbowing rl up- I liar e noriied a sradual increa'e in lhe u'e ol "lang rn eramrnrhe la'r war nvle $as i'irl.ii'i"ii'i *cent )ears Berore -i"" tigour ol lbrs descnp(ron rhe Ihal I leel bul nerhaos more eenreel: oi dentat caries made ir worrh puLtins in 5i

iiii.i.r"i.;;i

"'' "'i'iln tt"". anil ridses appear on the tâ&#x201A;Źeth and these "u"t there's a he[ of a mess " increase until '''-il;';.i;;.i;it" comes from rhe end or a paper ob!ioulrv

snrcb incomplete o;iDg ro tbe candidate s lack of knowledge ol he '---":;io?was awarei"- himself *rtut iirn about to receive mav I be truly thankful -ShakesDeare." ii ii. i'i"pp.'", possible that I bare unwiLrinsl) siven vou Lt'" i-"riss;." ittar uit rt'... :rrange quolauoosqoba\e been per-

herer if rhir 'bould i" ""i.^'.i i. "..i""iir ""..i"a."rs and io asrure vou thar rhe majorirv ol rhe srrange"t irem. $ere culled lrom eraminations out'ide Bri'Lol l ba!e taken *itt' any of them, but have rcported them to vou 'J--iiu"ttii' aDpeared exactlv as thev '*'ii il -i.;';;; be i'clined Io assume rbaL eramining *irh a perperual rior ol humour' I should irii.*rr.1;.i -""ia.' before iii ir'"' i.. r'li. G read siueial thourands of $ord' Nev-errheless' recording worrb ri tbar ,,'r.ui"g iii'"* lt"i"* Io $hal mav orren De a be

lmust

hasren

the ociasional dr'co\erv add' a:pice

'

Prof. R.

BOOK REVIEW

J

BRocKLlHURsr'

40s SURGICAL TECHNIQUE.2nd Ed. STEPHEN PowER. M S F-RCS London Ltd,.

Heinemann ' 'ho'e b"{c ir.i" r'""r i' a-or.O ro rhe m'nor re-\nnal l e, or 'urc"tJ or' sroo m{um iiehiii.o'm'' .'i-.,;i;' *.ol 'horr "a' t{cellenrlr pre'e-red 'o ta\e ro 't'e cranred li.ir''r.. i."al," surqc.l e\rb;ok' i;i:'' i";eoi';; ,;;'""'* -any re\ r.ons or rre o, cinar ILe\r' t'e.ho'rl \olum< i;sD,Eof rhe.iTehapprcdch ro,he(uoj4L,r icqrnqd' ol r\e momenr' rhe !ud'nr'r tev"no i. mai'tr li.l'"r' ii ir'*"t ""a is $err qo n read rg l "- ** -t.1s iiil"ii., 'ii'. i"iiliii,'." i, c;n,a,n. ;;.,h. oi the norice orthe 'ruden wrrh or uitho-L cur8rcdraip 'arronr" r'n A larse section on book reviews will appear in the summer edilion

'ili'i:ii.

22

TEE BLACK BAC

A MILLION

YEARS FROM NOW

rWorlina on the assumprioD tlar humouc js a kjDdly dispensalion of Proiidence lo endble us lo smootb over lile s litlle problems. tle authd has come to the conclusion that witl the disaipearance of the latter there will be nothing left to laugh at.) tM slad that I shall not be bere A'mitlion learg from now, wl]en Shaw;nd weu" and olher suells Have really shown us how; when the w6r1d is workins smoottrly, And the worker is content In the supor-dispensatlons Of a supeFgove.nment; When the nature of the seather Is determined bY the State; Wlen the tools are all colected By the Plumber and his mate;

when the haggis and the kipper Have by science been replaced; When the Scots retum to Scotland;

When the women fix the waist; When the world resumes its chapeau wh€n it plumps for " wet " or " alry When no longer 'tis directed B! rbe wriling io the slq I

whan lhey\e settled the relalionship Of mislr€sses and maids, And the Problem of disposal Of old safety r^zor blades.

Wh€n the nations at Geneva Have for ever done with " force," When there isn't any mariage Nor, in consequence, divorce.

Then Utopia ri.ill have no Place

For humour or for mirth lite the Dodo, Re aholished from the earth.

It's a simple proposition, Ith a tuth that's not a half lf there's nothing You can laugh at Then You simplY cannot laugh; It's a dismal sort of Prospect And I solemnly avow T am thankful I shall not be here A million Years from now.

ADd Prrcr? will,

";

I

TEE BLACK BAE

Pf,RSONAL TUTORS

ju.r EOR I

over a year, e\ ery clinical s(udenr and all studenrs from

over,ea, have been the po,,es.ors ol per(ooal lulors. This tutodal scheme is sti in an early stage ofdevelopment and no one would vet claim that it has had much influence on life in the Medicai School. As with all novel ideas there ar€ still a few misapprehensions and anxieties about its origins, objectives and functioN and it is possibly an opportune moment to rcview some of the features.

It may be surprising to consider a tutorial system new or in any way original. Tutors are probably as old as universities themselves, but the system starting in Bristol is not a copy of the Oxbddge pattern. It is an attempt to provide a panial solutionto some modern and urgent problems which have appeared as a consequ€nce of the social and educatioml changes which have taken place during the past decade. Only by considedng some of these problems will the purpose of our ' personal tutors ' become more clear or make any sense at all.

English nedical educatio& especially in the clinical years, is rooted in an apprenticeship system. This follows the master-pupil relationship Iaid down by Hippocrates for ihe puryose ofensuring the transmissjon from generation to generation of a way of life as well as the technological mysteri€s of the doctor's cmft. More recently, the master and his pupils becam€ replaced by the ' firm,' which stil holds a prominent positior in clinical teaching. Firms, however, are not what they used to be. They have been taken over by the administrators until now they are litde more thatr devices to allocatemore or lessequal numbersof students to each consultant, at the corect inte als of time. The true appreDticeship has

almost gone in these days of expanded medical schools, multiplicity of teachers and specialists, and the demands of the crowded curriculum on the student. If Medicine, however, is to remain an honoured professio& it is necessary perhaps, as never before, for its philosophy and ideals to be propagated along with its scientific knowledge.

The doctor has " carefully to observe the phenomena of life in all its phases." As life becomes rnorc and more complicated it becomes mor€ dimcult to obse e and understand those elements outside our particular phase. Gone are the leisurely days of the ' whole rnan ' who undersiood most of the world's store of knowledge and mixed frequendy and freely with all sorts of men and women. Today more of us are isolated satellites bound for ever in our narrow orbits to the great detriment of our personalities, and skill as doctors. Inter-action between the young and old is peculiarly djficutt in a fast-moving world, yet the cross-fertilisation of 24

TEE RLACK BAG concepts and ideas is no less important. Doctors are at odds over such problems as publicity, contraception and artificial insemination, all problems relating as much to the changing face of socieiy

as any pafiicular dogma. Teacher and students have much to learn frorn one another, but the day to day business of formal teaching does not lend its€lf to either free speech or free thought and something extra is needed.

The third and potentially the most serious problem is related to all phases ofuniversity life and is not one peculiar to the faculty of medicine. In the past, the majority of university students were recruited from a socially and financially privilesed caste. The few ' poor ' scholars lived isolat€d lives and were not €xpect€d to join in other than academic paths. Although undesirable in mary ways, this social and financial selection had certain advantages. The students largely came from homes where education and culture were valued. Opportunities for leisure activities were considerable and, as the financial background was morc orless secure, there was little or no pressure on pure scholastic succ€ss. The univ€$ities were uncrowded and the majority of students were in R€sidence.

Domestic help was cheaply and freely available, so that university life was free ofchorcs, relaxed and yet intensely stimulating.

Those days are gone, completely and utterly, yei many of

those whose rcsponsibility it is to plan university education stifl cling to th€m. The student of today is drawn from a vadety of backgrounds, social, economic and seosraphical. There is no homogenous university caste and no sense of'belonging' by almost heredity right. Many students have fought and worked hard to get to the university against opposition at home. They have surmounted, driven by themselves or thei{ parents, one academic hurdle after another to the exclusion ofalmost every other activity.

Apalt from their schoolteachers they may have had little contact with cultivated minds, nor learned the manners which are Dot snobbery but are the means by rvhich intelligent, responsible adults live and vork harrnoniouslv. The univ€rsitv should be the means of broadening rhe ourlooli of rhere 'rude;rs and can no longer rake it for granted thal \ ide inleresrs are part of Lhe studenl s make-upon admi-ion. Al'houeh Lhe learning and practice of rnedicin€ leaves little time for leisure the record of the medical profession in regard to its breadth of irterests has been a worthy one. In sport, in literature, in social and political affairs, in local history and as naturalists, doctors have done well and coniributed a great deal to human culture. Such interests are often bom and facilitated durins the student yeals, provided that the environm€nt is suitable.

These, then, ar€ three problems and the personal tutor scheme has been introduced to help minimise them. From the nature of

ihe problems

it

becomes immediately obvious

that the penonal

tutor system is designed not to do c€rtain things. It is not a system ofcoaching or clarnming. It may well be thai problems concerning work will arise in individual cases and the tutor may be able to advise, but he will not hold tutorial classes. The system is not a camouflaged investigation in social anthropology. No doubt there is much ofinterest in the primitive cultures of Clifton or the initiation rites of Manor Hall, but it is not the function of the tutors to compile a dossier for ihe Dean.

The tutor is not a ' moral ' tutor in the sense of a Censor of behaviour, he may, as a friend, otrer suidance or even reproof, but must not become a 'bjg brother.' He is not an amateur psychiatdst and it is not his job to seek out penonal difficulties and problems, although at all tlmes he must be rvilling to listen and to help.

What, then, exactly is the tutor's function, and as the relationship is mutually beneficial, the student's? This is personal and still experimental without set rules or rcgulations. It is the responsibiljty ofthe tutor to make sure that none of his students is lonely, adrift or unsettled. Beyond this it is a matter of mutual inclinations. The aim is that each tutor and his students become a club, very exclusive, very informal and, we hope, interested in the better things of life. If you are not clubbable types then individual friendships will provide an altermtive.

The student is not bound to his particular tutor. If he is troubled it is hoped that he will naturally tum to his tutor but there may well be others with whom he will prefer to talk. He has com-

plete freedom to choose whomso€ver he wishes. The student ne€d have no fear tlat his tutor wi[ us€ anything he leams in evidence against him. There are no reports and no files. It would be surprising if there were tro incompatibilities between tutor and students. WheD this happens it is hoped that a mutual transfer will

take place, the student going to anoth€r tutor and the tutor accepting another student. This will be arranged without enquiry or fuss by the Dean. The iniative for such a chanse may come ftom either side, but in any cas€ there would be no cause for recrininatiotrs,

Many clinical students have commented: " I don't need a tutor now, but when I first came to Bdstol it would have been a $eat help to have had someone to go to when life goi difrcult or I hadn'i a shilling for the gas ffre." This is an apt obse ation and the tutorial scheme has been extend€d to cover the pre-clinical years. This iD its€lf may help a little to bidge the gap between the pre-clinical and clinical years for both students and staff.

There are few people who would deny the need for strong personal inter-relatioDships bet\rr'eetr staff and students jn universities. The strength of an institution does not lie in its buildings or 26

TEE BLACK BAG

in its traditions, but in the people who work within it. The strongest institutroDs are those where atl are bound by a common aim. This we have and by inqeasing our unity we will strengthen immeasurT.F.H. ably the succâ&#x201A;Źss of Bistol Medical School.

w.H.

T.F..O.

THE MISSING UMBILICUS WIrFN Sherlock Holmes to leaven flew Si. Peter to him said: " Hil Wait a minure! Who wâ&#x201A;Źre you

Beforc you joined

$e dead?"

" crcat Scottl" said sherlock " don't you know?

I was a man of fame. when

T

lived on the earth below

why! Millions knew my

name.

I

was Sherlock Holmes, the famous sleuth."

St. Peter gasped: " Good Lordl But how do I know that's the truth?

You might be Henry Ford!

But half a tick! You see tlose men Just over there?" he c.ied. " Now tell me which is Adam, tlen I'11 let you come inside."

" You don't,"

said Holmes, " by any chance Consider me a dunce ?"

He gave the men a cursory glance Aird spotted Adam at once.

Up fluttered Doctor Watson, through the blue, Amazement on his face, " How did you te[? Of any clue

I fail to find

a tmce."

" Your ignorance," said Holmes with " Would make a common fly cuss.

Really, Watson, didn't you He had no umhili. s."

see

glee,

dotting the â&#x201A;Ź>

o's

of

vigilance T|e

lests lo w|ich cvery Claxo product is n,bjecred rhrouehout its formalivc lile are lhc most searching drar nodern technique and lhc vigjlance olour An.lyticrl Depa.lnent can dcvisc. Bcelnnins wnh lhe .iw

maLcrirls,.nd.r every strse of m^nufactuo. srDrplcs are scrupulously .mlysed both aunlitatively and q!anlitatjvely.

As rvnh dre prodncr, so wnh its cont.iner.

P.ck.sing materirls ol all kinds equally

,4r

.tc,trk

at Gh\a aDabliot

ertrx vi'a''in Ajquaf ld ,t ,h|@t

ortadt

'o

d..1qrct1Jadda. h

obb"d .h?.k ttnt ttx

i ro'ua,reeiri)

undcrso ccaselcss scienrifi c sc.utiny.

Finally. cven altd thc linhhed producr gets ils P6s'label ihe analytical stafdoes nor let go. Srmples f.om evcry bntch are kepl b.ck for stor.ge dt both ordjnary and clcvatcd lcnrDcolures a.d ffe periodically examined. Tbus, right 10 thc nroment ofns use each

Claxo product is

\ndq orr

eye'.

Glnxo do inded dot rhe i s olvieil..ce.

"GLAXO

LId's Dda,, ote ibiatis, @r d(ait',Ioat',

28

TEE BLIICK BAC

ARCHAf,OLOGY FOR TI{E CORONER jnfrequenlly il bappens lhaL bumao rcmains are dug up.

NTOT r! when rrenches are being made lor Ia)ing dmins or lor lhe foundations of buildings. When this happens the proper course is to report the matter to the Coroner, who will then wish to know whether the remains are recent enough to be of interest to him from tbe professional point of view. He is not likely to be int€rested in anything more than fifty yeals old. After a f€w years, however, all traces of the soft pa s may disappear, and then the dating of bones may be quite difficult, in the absence of collateral

My firsr problem of this sort was brought to me by my Dr. A. C. Hunt, in April, 1958. FouDdations for a

coleague,

building were being dug beside the wall of rhe sou[h-eas[ corner of the boil€r house of St. Martin's Hospital at Bath. There the workmen found the remains oftwo skel€tons, on€ above the other, Iying supine in an extended position. One skeleton was that of an elderly lemale and around one of the fingers were found two thin copper dngs, each split across. This excavation was near to a known 19th century cemetery, but around Batl there are a great many unchafi€d cemeteries from Roman times onwards. Unforlunately we were not able to get any very clear dating evidence from these ngs. They are thinner than most Roman rings and are without a bezel. They are composed mainly of copper alloyed with silver and a little tin. They do not rcsemble any dngs that I have heard of being in use in rclatively modern times. when looking for related ariefacts it is, of course, of importance to know their relative position to that of the bones. There were in this case some bits of petrified wood and nails, which might have been parts of the cofrns for the bodies, but which might have come from a slisbtly difierent level. So I asked Dr. Hunt to let me know next time anything of the sort turned up, so that I could go with him and see what mig:ht be found.

The next opportunity occurred towards the end of May, 1958, when some human bones turned up at the bottom of a four foot deep trench, which was being dug near Sion Road, Lansdown, Bath, for the purpose of drainage. Dr. Hunt and I went 10 Bath and called first on the Chief Constable with whom we had coffee.

He had to leave us at €leven and put on his uniform, in order to attend the opening ceremony of tle Batl Festival. The omcial opener was 1() be none oth€r tlan Sir Mortimer Wh€eler. So Dr. Hunt and I went up Lansdown in company with the Coroner's Offic€r and visited the site. There, while Dr. Hunt was tuming over the bones, and comirg to the conclusion that they had belonged to a strongly built male person, probably of late middle

THE BLACK BAG

L

Digital phalanx with twa cappet tings fron the St. Mafiin's Hospital site d/ aarr. (Scalc X 1-1.)

-l Romalo-Btitish potshetd and square-headed ircn ail La sdovn buial at aarr. (Scale x 1.1)

fron

the

TEE BLACK BAG

age,l had borro$ed a trowel and was getting muddy in lhe boltom of lhe rrercb. I found many pieces of charcoal and one square sectioned iron nail ,r? sitr, but nothing really us€ful.

So I asked th€ workman who had un€arthed the bones wheth€r h€ had found any bits of pottery with them. " Oh yes," said h€, " there was this bit." AJld he produced a piece of the rim of a bowl which, even to my untutored eye, was obviously Romano-British. We began, now, to feel in the clear. Th€ Coroner himself had come to the site, and we told him that th€ associated finds show€d that the burial was probably in Roman times.

On our return to his ofrce the Coroner asked us if we would like to show our finds to Sir Mo imer Wheeler. The ceremony was over, the bells ofthe Abbey were pealing, and it was said that Si Mo im€r was only killing time before lunch. We readily assented, and in a few minutes time the famous archaeologist himself sxrode into tle Coroner's ofrce, accompanied by the (fuef Consrable. Dres.ed in a morning coal, wearing a carnalion of dazzling pink, Sir Mortimu was in a chee ul mood. Therc had evidently been something more interesting than time to kill.

I show€d him the potsherd. " Is this a[ you could find?" said he. " It is all th€ workmen turned up," I rcplied. " But it is a v€ry nice piece of pot, it has a {im." " Oh y€s," said he, " obviously Romano-British. You get heaps of it around here."

I th€n produced the nail. " That," said he, " could be anything." " Could it be as old as Roman?" " Yes, easily. But," he added, turning to the Chief Constable, " he might have been murdered by another Roman, you know."

The Chief Constable opined thal he was unlikely to let that possibility worry him.

On leaving the offic€, Sir Mortimer tumed round and oromised 1o send in his bill $hen he sot home. I ba!e not liked lo ;nquire wh€ther he ever did so.

OLTVER C. LLoYD.

SOCIAL NEWS Engagem€nts

Mr. Mr. Mr. Mr.

J. E. Barber J. A. Morphew R. Whatley

D.

Ferguson

Miss M. O'Halloran, B.A. Miss A. Harris, s.R.N. Miss S. critchley Miss J. Stock

ll

,THE BLACK B.4G

THE PANTOMIME The Sleeping Beauly. OR An Aeslheric Nurse'

B.R.L, Dâ&#x201A;Źcember 30th' 1959 r\ rR. DAVID CARR ha" pulled it offl Hehasgiten usawitlv' M '."i"uf. ionuio,ionul Dantomime. ll is so refreshing lo ha\e a a stiry. instead or a series of skerche' and *"1 ;;;i;;i;;;i,h songs, ioosely thrown together' Ar oroducer or author. once one iaq decided to hale a 10 " reiL iantorn;me one har lo nrerch one's inventive Po\ ers1be on Io ruper-rmpose maLerial ropical sumcienl Lhe full io find fairv-srorv framework. Me*rs Mike Ctrck. Menln Reed ioDv Ben;er and Da.e Carr did a good job. but they found 1-bemsel\es sliohtlv ar a loss rn Acr ll $hen the comic siruation ol a den ol iou"*t'.titrs could nol sustain ilself. This however' \ as "iEr."i the only seriously weak point in ihe show. ln Act l- \c. l. $e are present ar lhe biah of the heroine Morgan' e t"iu oJ it'*-;ne midwire" tCern Brown. Cqvn sweetlv, supernt"i i.""t and Jo"hn McGatv) serinaded us Mr' carr has a i.i";1a"J w o"";a Carr ar the lieroinet Nannv natural aoiitude for comedy He made a spleDdid dame--Hrs mannerisi". make-uo and liming (mosl imporlant) were excellent In sc- 2 t\ enlv-one iears have elapsed. aDd our heroine (AnDete inuitsr i trairns nic comins-ol-aie parlv sbe has grown up 10 from 1be i" i'Lri".^i""G*q 'Ludeni nuni All iie coosulranrs moments Ihe best are These e-[.f. are in'itia ro-rne celebrations ;i th" ;i;;. wJ lua on" brilliant characterisation after another (as the consultanis sang!)

Laureate were Mr' Alley Jones as Prof Cherry The Mimics 'Ciiiii'u"ii.r a' Dr' Barble. rirev uere 'uperb- A.llev ,"a voice. Tbe) were closely fo]lowed by Mr' lones has a Dled.inq Jim Barber 'and Mr. Gerrl Bronn as Messrs Morlon and lii.""*. ii,a vi. i."v Bennet as Mr' Crooke poor tvlr' crooke' -':';;"; h; neelecled The make-up of lim Barber and Peter gu,. on. u'' wbi.h r"in has lhe roni ? " ii,'ii. " enae'Lbet isr wa( not invrted ro this littr;n ilii es in a cloud ol smoke ro casl his curse' ii'"'.." ll,tt*;"". *o "tri\the most of a \erv dimcult pan W. bi* C""iay made ln lhe nexi scene lbe Villain manages to implemenl hrs curse' .na ihe Beaurv rleep'. From tbis point on it is a pitched baltle (Annetle-s beloved' belween the foices of good and evil. Johnny tbe Cood tarry on one Vorphew).and played John b) Mt ably the other' side. and the Anaesthetists on lL $as verv nice lo see a rc^l live lenate Fairy I s ilh aPologies ro T.D.). Miss'Mariorie Creighton made a charmiDg wrlelul iarry' i2

vi

i!'"iii-"l, ilil i'iii*li"'il

1

I

THE RLACK BAC We hr!e atreadv menlioned lhe Anae'lhetisr''.ceoe This was

lr $a' reliered bv a **.'i " sii u^tii,a and rarher tedrou'. (and Barber bv Jim suirarr disguised as-a [ri.'iur r.nai,ion p"ii."i i" rU. l itt";'it clutche\ ol The Ballad of lhe B R T " Fmalh. of cou$e, alt come. well. The villaio anaeclheti<t inro rbe arm" or trannv' -and *.ou"i.l'riii *li "iv', and fall' .ucce*lulll out lhe bnal

.lohnnv and Annelle ate 'ery 'orted .t'orui _ Ctutirv, Cbatit) lJnivercal." seems to bate become an iostitution. Perbaps !t will remajn so

Mr. Willian Ormerod accompanied very skilfullv on

the

piano, and pleasant scenery was painted by Mr. Ken Day

ALAN BLANDFORD.

EXAMINATION RESULTS r\r. rdnu"rJ la6o FtAM,NArtoN roP rHr DLur' I or Do loP oP VrDr' j.

Dn.e alionq dppro\ed: f. J B"rler rq,l' dhr "crio (

_

lq5a f-NAr F\qvr\^rro! roR ar qDruPrr'or MB (HB.De'e-ber' p"li, u Be$on, c ( DuR. H \ ' HrsliN' ii r'ir.i!.,i'". e.,A...\ru*. i L Lo'ren. v D n c Hoas.. c $ \4 ii. e. u't,i siuu"ta. ii ii i"r "H. -C;;.-. r swun/e..R J o-L \rdvre b. v. ,i;"]'b. i. i iiijii,*ei. r'; Ji."p i.i"mprerins the e\"mrn,rio- : K R Davie' G Keii I -i;'ili'i.

IxAMrNAttoNroc rHr Dr.R jsoPV B.(ts B r\!c ao\ lr' Decembtr rsi,j'NAr J. iri*.;. i. i. cL,rt<., p. H co nll K R Dd\res w o it. r' ;;^-;, p. in. n c;'";i. B ! Hac\ma.. w. I vorr''.

L ;;; i rilil i'ii"..r. c. D. Ra{,'"s, w J c c Rich H Ruhomaullv J N Sebi.e, D. M- D. Wbire, B. E O Willians.

BRnroL RoYAL HosPIrAL.-The follo{ins nurses were sucssful in rhe A \ Arren' i." Par' I onrr' o."iiil iriii. i.i:,'ii"i,' iure F''.'n, (crmpbcr'. r M ii.h"'liil'hira"i". ir. blli,{";;:h. H. \ ! Burnerr' Dlo\.

Irt Hrmpon' A L.Da\s.c. D Deer, I A Engln".\' villi l Vorl"' K J lavlor' P" tl o t ia*ter. n. L Va on, c Dr.l'ttiam.. r. \ o,is, ;;-i;.;'( t \,\-iti,- u. r. l l\1n5 ( I'ourdi onlv:S.J.B'e.et.v D,v,A P Dre\.M L F\an . Mr'trre A A .venerr' tr"", P A Ledch D r \uhe. ;;;,;;:i.-i.6:".", vt-.ns. v T Pcir\.

M.v. Nerm;,.H o i:'ii"i,;,";,. n'i;;,. D. P. sL'nbutJ n: i. ii;.;'. t I. R"drord. A h sracc r' aMcrr$o'h\' i;t ; ;1i":i;:1, i r,'.. ltishr. ll.M.4lro,d,P l chdople. u i.t u iiriri,-i'.. p.'. r "id tr ,oge.l'er: R. ir. Posell. v. P s-,rh

RRrsror RovAr HorP

rqr

The fo' owrng nu^er were (ucce'5rul rn lhe

M.H Baldrd' rr,-rnar:o : L? B"rk'.v o--ii: ie'e: r ';;. s.;'. a P R ( oeger' r Lvans F s D B;pec. B. Brs/e. H. Br\e,D Bulron H Harris.B A Ha'' i',";;;"i. i a:.d.c P. M c6\,e,.J GreenP;c\er'r.L sha-d L D v.\,1il'n,r'M i l' i,i 'iir."'. Ij".-e ti.i.-\.r -M-M R w,rri"m". R i;,r";, p. q. v r'.o, \i,,;;"1"il' ii;";;;: Dde. P \4r'd,'. I r' NrcLor'on. iirl'Ji.:,,..r."ti';lij, d. v. Ham',on Addm, \' c Free\rone M 4 srapre" il'il'i.;r-;;; i!ii"i. r. r'4. BJron rnâ&#x201A;Ź i . i. i. q. i,*-nooi^, I I Ponirotd. w P Robetrl J. L Reed.

33

THE MATERNITY " FLYING SQUAD '' N overca.t dark cold winrer) nighr. A midwife in an old l-ord rArAnglia ir $indine ber wa) rhrough a maze of uncl'arred srreelc,

crescents and avenues in a new housins estate on rhe ourskirts of Bristol, in answer to an urgent call by a highly agitated expectant father. The clock on the mantlepiece stnkes one as the nidwife walks into th€ bedroom of a young labouring woman. At a glance she appreciates that the baby is well on the way aDd proceeds with an air ofordered efhcienc! ro prepare for rhe new arrival. Her firsr wise move is to despatch the overanxious husband for a kettle of

boiling water.

Two o'clock in the morning and through a cloud of tobacco smoke the now almost prostrate husband hears the first lusty cry of his son but he has to wait for half an hour before he is summoned to his wifet bedside and then only to hear the midwife mumbling something about the " after birth " being stuck and the urgent need for a doctor. B€neath what should have been a radiance of happiness there is clearly a strained exp€ctant atmosphere.

The old General Practitioner climbs wearily into bed for the second time that night having just returned from one of those inevitable after midDight calls, blissfully unaware of the drama that is unfolding some few miles away. Sleep has just overtaken him when he is rudely awakened once more by the sharp dnging of the telephone. A few moments latet he is by the bedside of a now rather shocked young mother. A quick examination and a prompt assessment of the situation convinces him of the need for the Maternity " Flying Squad." His subsequent telephone message to Southmead Hospital sets in motion the wel-oiled and elaborat€ machinery of the " Emergency Maternity Service." Within a few minutes the nurse on duty, a residenl student. the house ofrcer and the anbulance driver are all ready and waiting when the obstetrician arrives to join the team (or the obsetrisian goes in his own car and meets the anbulance at the house). Speed and smooth organisation is a vital feature of this mission of mercy.

The clock strikes four as the almost demented and panic stricken father welcomes the team and leads them to the bedroom upstairs. Wilhin an hour or tvr'o of their arrival and following on their ministrations, the patientcan beseensleeping peacefuliy. She has a healthier colour and is obviously out ofdanger. Another pint ofblood hasjust been put up and the oFending placenla is burning in the grate. Apart from the baby, who is whimpering but snugly auck€d in his cot in a corn€r, all the personnel under that rooflook tired, sleepy, but happy and content in the knowledee of a job l,l

This no$ commonplace drama. or somerhing rimilar,

is

enacled once or r$ice a \ eek in Brisrol alone. lhere are hundreds of other comparable incidents throughout the country when many preciou' lives are saved. Whar proponion ol rhese poor motben $ould la\e died $ilhour lhe rimely acrion of a mid$ile and rhe General Practitioner and the prompi attention ofthe service is impossible 10 say; but therc is no doubt that quite a number of the $avely ill cases would not ha\re survived rransportation to hospital. The need of Maternity " Flying Squad " is there so long as domiciliary midwif€ry continues. Its aim will always be to cope with certain emergencies and to bring skiUed aid to the woman in her own home where she can be treated or rcndered fit fortransport to hospital.

The potentialities of an " Emergency Domiciliary Obstetric Service " now commonly designated as the Maternity " Flying Squad " was first conceived and advocared in the United Kingdom

by E. Farquhar Murray in a communication ro rhe B.M.J. of Apdl 13th, 1929. However, there followed a " gestation " period of six years beforc the " birth " of the fiIst Maternity " Flying

" in Newcastle-on-Tyne. Thisr appropriately enough, was under lhe guidance ol Professor Farquhar \4urra) 1o whose iniriari!e and enlhusid.m we ose much ror lhe subsequenr grow1h and development of th€ service. Since that lime many similar Emergency Obstetdc Services have been esrabtished throughout the country and the increasing demands of this servic€ coupled with the excell€nt results obtained t€stilies to the unquestionable need and value of this branch of obstetrics in this country,where about 40 per cent. of the deliveries are conducted at home.

A draft memorandum for the establishment of a Bristol Matemity " Flying Squad " was first submitted from the Department of Obsteldcs and Cynaecology, Bristol University, early in 1951. but it was nine months before the service was brought into operation. Since its inception in Bristol over 460 patients have been Squad

treated, and during the past year the number of calls have averaged seven per month. The total mileage already covered by the servic€ is estimated at 12,000 miles. The total number of pinrs of blood given since its inception exceeds the 600 mark (the cost per pint is 35 -). The,er\ic€. operaring lrom Sourhmedd Ho(piral. ir e\pecially loflunalejn haring rhe Sourh wesrern negiorai I randu'ion Cenrre in rhe same ho,pilal for. apan from \uppllng all the necesrary bloodar ver) shorr norice. ir aLo pro!ide, rhe required transpod for the team.

A rcview of the calls made on the " Flying Squad " in tle past seven years revealed that, as expected, post partum haemorrhage in one form or another was responsible for the majority of calls r80 per cenr. ). O\er 40 per cenr. of lhese case, uere severely shocked and e\ransuinaLed requiring urgenl. energe'ic and imme35

rEE BLACK

BAG

diate treatment. It is worth noting that " such atr acute crisis can occur even in th€ most ca{efully supervised cases " and it is equally important to remembd that nowadays post partum haemorrhage mnks second to toxaemia as a cause of maternal mortalitv and is

ole!er) l2 sucb dearhs.

In aboul 50 per cenl. ol rbe cases wirb posr partum haemorrhage the placenra was found lo be rerdined in urero. ln lbese responsible for one out

patients as well as in a few other cases (10 per cent.), with retained placenta but no post partum haemorrhag€, manual removal of the " after birih " was carried out under general anaesthesia in

tlepatient's own bome. Resuscitaiive measures were giv€nin each case prior to any operative intervention and very few patients in this group required transfer to hospital, thus lessedng the strain on the alrcady overburdened .hospital maternity beds.

Abortlon, antepanum ha€morhage, the fortunately now rare cases of eclampsia, failed forceps, complicat€d breech and twin deliveries are other examples of indications where the s€rvices of the " Flying Squad " have occasionally been called for.

A review of the activity of the Emergency Obstetic Service would not be complete without rcference to the very few occasions on urhich the team turns out only to discover on arrival that the patient has fully recovered and does not require their s€rvices. Such an incidence has never been considered a source of embarrassment since it is much better to attend several " false alarms " than to be called in too late!

One can faily conclude that until such time as a[ de]iveries can be conducted in hospital, whether by a midwife, general practitioner or sp€cialist, an obstetric Emergency Service will remain a necessary adjunct to maternal safety. It is indeed a mission of m€rcy and undoubtedly one of the most outstanding contdbutions to British Obstetrics.

T. M. AIBAS, M.D., M.R.C.O.G., F.R.C.S.(E). of " Flying Squad " CaIs-1959

R€sults

..

37 13 18

2

I

3 fsecondary post parium

I

5

haemorrbage (2) I Ante-panum

i

I

baemoffbage

Brcech-difrculty witl head

Nusins Homes (N.H,S. G.P. Units) Total ... ... 32 St. Brenda's ., 13

t ... ....4 Ashcombe House wendover... ...

Mouni Hop€ ...

We s Cottage Hospital ... ...

Kno1l

...

6

Almondsbury

1 1

5

2

THE HEY-DAY OF SURGERY A

SXETCH in two pa s, pe ormed as part of the Residents' Concert at th€ B.R.I., Clristnas, 1935 CASTE SCENE

Surgeorl

House-surgeon .,.

Dresser Smith Cleall Nurse ...

Dresser Jones ...

Amedcan surgeon Patient Second

nurse .,.

Entr'acte

..-

... ... ... ... ... .., ... ... ...

...A. L. Eyre-Brooke

SclNr

...

Dresser Dark

Two other

I

... Rowan Mitchell ... Kat een G. Brimelow ... Russel Mcwllirter ? ... Alan W. Woolley ... Antony Gathom-Hardy ... Samuel Douglas Loxton ... D. Russell cray ... J. L Fmnklin-Adams II

...

Antony Gathom-Hardy 2

dressers

Surgeon

Dresser Jones Physician Patient

....-

2

Rowan Mitchell Alan W. Woolley Samuel Douglas Loxton

D. Russel cmy ?

First Child Second

child

Appleyard

Kathieen G. Brimelow ...

Russe[ Mcwhirter Freddie Maysten

TTTE

BLACK BAG

THE HEY-DAY OF SURGERY SCENE I The cufiain nses on a mo.lem opelating thearrc. The sw1eon, H. S.,sutsical dr?ss?FSmi!h a"d nuEing tQf arc onthe staie. A blood-cutdti"8 ycll is hea of ease SuRGroN: Ahl The anaesthetist has arrived.

H.S.: He arrived some time ago, sir.

SURGEoN: Oh, did he!-Then the patient should be in some time today. (Laughtet.) And yet-without anaesthetics, \r'here would surgery be !

(E t€l DRESSER JoNBs in a soiled gown, Jones! Go and put a clean gown on at once ! and, for H€aven's sake. put youi mask sLraighrl Strolling in like an infecled dustbi; l-Don\ you realise lhat this is lhe Aee ol Asepsisthat is enabting us to rescue so much of sufering humanity from the clutches of the Physician! The Em of Hope, Jonesthe Hey-day of surgery I JoNrs: Yes, sir. jn SuRGtoN: Then never lel me see )ou shambling in here again. germ hair slicking gown your laden and frlrhy a blood stained oul of )our cap: Do You undersrand me?

JoNrs: Yes, sir.

Sr,RcEoN: Very well, then.

.rxt

JoNEs

Smith!

SMrrn: Sir !

SuRcEoN : Tell me Smith, what is surgerv ?

Surrr: Surgery, sir? Som€body told me Surgery sir, is an art' Yes, sir, an art that combines two gifts suRcEoN: Yes, smith?

SM H: lirslly sir, lhe gih ol being able lo persuade lhe pauent thal he $ould be betler off vilhoul cerlain ponions ol brs anatomYSuRcEoN: Go on, Smith.

SMITH: Aod secondl\, sir, thal ol removing the maximum ol lhose ponions whh the minimum ol subsequenl djsablemenl.

SuRcEoN: Would you call surgery a philanthropy?

SMrrlI: Oh, very definitely, sir.

SuRcEoN: Really!! Why? SMIrH: Now why ? Oh yes. B€cause it t€aches the patient not only to give willingly of his organs, sir, but lavishlv of his pocket 38

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44 TRIANGLE WEST, CLIFTON' BRISTOL 8

TEE BLACK RAG

R?-err?/ Jo\rs in a spotlcss gown St.Rcto\: Now Jones. Ah. thal s mucb ber"rer: Whar would you consider ro be lhe disco!ery. mosr valuabte ro surger)

?

JoNrEs: The appendjx, sir.

SuRcEoNr The appendix!! Why? JoNEs: Because it can be reach€d the body, sir.

from almost ev€rv incision in

SURGEoN: Go oD, Jones.

loNrs: And. therefore. sir. no surgeon -

need erercome our

ofany

abdomen emply handed.

StRGEo\: No surgeoD comes oul ol aDvlfung emply banded, "be Jones I Smirh l-wha( would you consid;r ro ltri ia'anragei of surgery to mankind at large ?

SMIrs: I am afraid I can't remember- sir-

SLxcroN: Come, come. Smirb: lhink. man. rhinkt Don\ vou know thar nolhing can be done in medicine wilhout Thoulht, that nothing can aris€ without the most careful of reasoning ?

JoNEs

I

Please, sir ?

SuRGroN: Yes, Joles ?

Jol{ES: Then why are most discoveries stumbled on by accident?

SLRcpoN: Quhe. Jone"l Bur rhere musl ha\e been Thoughl, there musL bave been Reasoningl Palieot medicat rhinking, unhampered by fact or directionSMITE: Please, sir.

SURGEoN: Yes, Smiih?

SltrrE: Why do some people not bury the stump in appendicectomy ?r

SURGEoNT_As

I

said, Smith; painstaking rcsearch and

thought !

SMITB: Then whv do others hurv it?

SLxcEoN: \trhy:obviously lor'Lbe very same reason.

I

deep

am sur-

prised at your asking me!

SwrH: lsn'r medical rea\oning rarher elasric, the'r, sirl StRcto\: Deligblfuuy so, Smirhl Hence iLs uoique charm. ir can b€ sh€tched xo fit anything.

JoNrs: Please, sir.

SuRGroN: Yes, Jones?

JoNEs: Then sureb, sir, one need never work out a step until one has taketr it, nor ihink out a statemeni until one h;s made it?

SURGEoN: Have you ever known the contrary in our profession ?

JoNEs: No, sir.

Exactly! That is why \{e surgeons never withold our hand; a reasonable and dignified explanation of our conduct wil always follow. Have either ofyou ever known anything in medicine to be condemned by unanimous medical opinioD?

SURGEoN:

BorH: No,

sfu.

SURGEoN: Or seen two physicians agree?

q

Bortr: No, sir.

SuRcEoN: Neither have I. That is why the Law has such little difficulty, Jones, in finding expert opinion for both sides. sMrrn: Hence the pyramids.

SuRcEoN (r6pirto D): You both see what I am driving at?

BorE: Yes, sir.

SURGEoN: Really !!

BorE: Oh yes, sir.

SURGBoN I

Well, what am I driving

(site

at ? ce)

(Sig/ir) I was hopins you would be enlightenins me!

Entet ykiting AMERI0^N SuRcEoN lrili a/o /,rr)

An,

Mr.-

B, Googanmeyer.

SURG!oN: So glad you were able to come.

AMERTCANi Nyeson

all right

You found tle way

?

AMERTCAN: Obviously.

SuRcEoN: Hmmm. These are my house surgeon and my dressers.

How do, folk.

ArL: How do you do, sir.

AMERTCAN: Wouldn't Iike to have left ihis little old lsland without seeing if Bristol surgery was up to standard. But I intenupted you in your lectureSURGEoN: Oh, I was only teaching them to use their heads, you AMERTCANT

know,-to think.

AMERTCAN: Sure, sure. The big possess in a large way. Yes,

Idea! Just what we Americans siree, that is why the little old States is God's own country. Do you r€alise, sir, that it was an American who thought of boiling the Atlartic to desttoy the submarine menac€ of the Great War?

SURGEoN: No, r€ally! And why didn't he carry it out?

AMERTCaN: Just couldnt be bothered with the details; the handi-

All the great pioneers of r€cent years have Americans: Robert Jones, ListerSURGEoN: But surely, Mr. Goo-Goo cap of brains, sir. been

AMERTCAN: Nyeson B. Googanmeyer. Just call me N.B.G.

SuRGroN: Very well, N.B.G. But I always laboured under the d€lusion that Jones and Lister were Englishmen.

N.B.G.: You're away behind the times, sir. Congless in January voted them American citizens and in March deprived them of their British nationaliiy. Y€s, sir, all the $eat pionee$ SURGEoN: How can I doubt it under the clrcumstances. Jon€s, kindly pres€nt my compliments to the anaesthetist, and ask him ro finish lhe induclion in the rheatr(.

Er,

loNFs

We don't always have to wait so long, er-N.B.G. Sometimes the patient is on the table in as little as twenty-five minutes.

4l

N.B.G.: Sure, surc-Now in the States, five minutes is alt we ever require for inducing. Aoaesrhetics are real cla\s over SuRcEoN: Really!! The anaesthetic taking some

instrument,

N.B.c.:

I

presume?

No,_jusr experience.

form of blunt

The patient

is wheeled il1 and put on the table br the a aesthetist. Ee cones rcwd and :ils up. He is innediatel) s?ized and pushed bo.A. fatting on the foor i rh? pro.er. The fall is brcIen b), the dr&rers.-The a aesthetist foo* the ma\k, while he is on the foot. drcssets, the natse and the

: Fwightfully sowwy, old man. No excuse. 3 Fwed I ! {Wheellarl! Where are th€y? Never here when I want th€m.

SURGEoN: This is our able anaesthetist, N.B.G. N.B.G.: Obviously!

SuRcEoN (to a aesthetist)t This is Mr. coo, coo-, never can get you name right.

N.B.G.: Nyeson B. Googanmeyer.

SoRGroN: N)eson B. Cooganmeler. Mr. Cooganme)er has come all the wa) lrom Ameflca ro see Fnglish surgery.

ANArs.: How do )ou do. Vr. Cooganmeler. and ho$ hare )ou found English surgery?

N.B.G.: With difrculty.

SuRcEoN: Ar€ you using tle cough mixture or the emetic, Mr. ANAEsrHErFre

Anaesthetist?

ANA!S.: Neither; my patients neither vomit nor cough. (violent parcxrsm of coushins fion the patienr) At least, not what you would cal coughing or vomiting.

SURGEoN: Aren't you rather splitting hairs ?

AN^Es.t(Pu s his cap back, sctatches his bald pate and rcplaces it\l I nevah split hain.

SuRGroN: No I can see you are handicapped.

N.B.G.: Brains, sir! crass never grows in a busy street.

ANAES. : Give me a hand, you people. (Patr?r/ IJ put on the table\.

Now where's my stool ? Fwed ! ! Wheellah ! !

N.B.G.: Your stool is behind you, sir.

ANAES.: So it it. Thank you.

(SUlGE1N pumps the table up. This carthet the E.s. b, het

niddle and tifts hel

of

het

feet.)

SURGEoN: Smith, kindly unhook my 6house surgeon and give her a stool to stand on. (Snith does so.)

N,B.G.: Do you prefer small assistants?

SLRcroN: Yes, I do rather. They cannot hang over the wound and bang my head. Do you know, there is one surgeon here who has 6suffered so continually from such bangings, that most of 42

his hair has been driven f(om the top of his head

to

his eye-

N.B.G.: You don't sayl And does he have to shave them?

SuRcEoN: No. They jusl stand out as dread sentinels, warning all future assistants.

N.B.G.: Remarkable!

SURGEoN (to

drdesl.i€tirt): R;adi?

ANAES.: Go ahead.

If

you saw sursery in the States, sir, you would be flat.-Yes sir, knocked flat.

SuRcEoN: I have very li1tle doubt of it, N.B.G. N.B.G.: Yes, sirree, surgery is real class over ther€ May I ask N.B.G.:

knocked

what you propose doiDg? I hope to remove the appendix.

N.B.G.: I orce removed an appendix so large, that a surgeon of European reputation thought I had removed the €olon ANArs.: And had you?

N.B.G.: No, I reckon it was the appendix.

SuRcEoN:

SuRcEoN: Bung full of glands. Bung full of glands;-glands €verywhere. Appendix? Looks normal. However, we had bettir remove it. Hmmm. GaI bladder? doubtful Ah well, we'll drain it. Now let us see about these glands Yes, glands everywh€re, simply bung full of them.

N.B.G.

(t,

d/effeff): waal you boys, what do you think of

surgery ?

SMrrH: lt's wonderful, sir.

N.B.G.: The noble art. eh?

Bors:

Yes, sir.

N.B.G.: Suryrising sense of humour, the Englishl SuRcEoN: Hullo! Carcinoma of the uterus. \.8.C.: Mishr I remrnd ]ou, "ir, lhat Ihe patienl has a beard.

Sr RGroN: Did l.ay ureru":No, I medn bladder. Yec.carcinoma

of the bladder.-No bladder normal. Bung full of glands; slands erery\rbere. \ow ler me see \b,i"g., out a lool ol irle'tin? and exdnine\ r, no,-Dear nel Consripalionll ANAES.: Nurse!! Nursel! Oh, there you are I Get mea B.P. apparatus please; there's a dear. why do you wish to lake hi' blood-pressurel A\aFs.: I ULe to feel I ba!e done everyrhing. m) dear the patient pewish.

N B G : Yor fear for his life- then?

ANArs.: oh, dear me, no. H;'s delighrfully pink N.B.G. : Perhaps you'rc researching?

ANAES.: No, not at th€ momenl.

N.B.G.: Remarkablel

\.8.C.:

4l

'ir. 'hould

TEE BLACK

BAC

(T4e nuse

rctuni with an

obyious tookins bed-pan -

cot'ercd with a cloth, and stanh behind the anaes.\

ANArs.: Have you got it, nune?

NURSE: Yes, sir.

ANArs.: Is it in good working order?

I

I lhinl so. sir.

ANAES.: Well, you ought NuRsEr

to final out before you bwing it to

Haven't you twi€d it out?

Nr,RsE

: No, sir.

I hope, at

ANAES.:

NURSE: Oh, no, sir,

least,

it is not

me.

leaking?

ANAES.: Thank heaven for tlat. The last one you bwought me was and I had the gweatest dificulty contwoling ir.

(Tuns ahd lifts the cloth, rcwaling an inge ious blood-

ptessure appantus.)

N.B.C.: A very natly appam(us.

if I may say so, sir.

ANArs.: Now rben, Mr. Coosanme\er. vou are rurelv nor soino lo rell us lbar )ou have rbim mrich llreer in Ame;ica? - -

N.B.C.: No. I reclon they

re Lhe same size. Perhaps neater.

Jo{ts. who ha,Ja ch a eep on a drun

Loud snot? fton rn lhe .ornPt 'l SuRcEoN: Jones !'Jones ! Dmt the boy, he's asleep (

!

BLACK OUT CIJRTAIN

ENTR'ACTE An explanrtory spe€ch by tbe announcer That, Ladies and centlemen, is modem surgery; as the surgeon so empbalically rells us. lhe He)-day of suigery. Somebody laughed. I agree. lq it lor rhiq rhar ,urgeons-hire been striving for so long, or has the star that has gui:ded them for so many years proved nothing but a wi[-o,-the-wisp?

We are apl to consider the fouDdations ofmodern surgery so soutrd as ro daunt tJle braves( of Us sho Dresume (o o;esiion them. Aid so. wben misgi!ings possess ui. do oe. aj honesr searchers afier Trulb. in lac(. e\amine them? \o Cendemeol

Ralher do w." hasleo ro put on patchwork wbich.arjrfi-es Do one, or bury our heads in lhe sand lest ue see perpetraLed some greai sac_rilegel Yes. Lbe founda(ions otmodern suigery are so sa;red, and to question them so unthinkable. as to iun' anv who dare iolo rbe gravest datrger ol being srruck off lhe Medic;l Resislerl _ To-nigbt we are raling our courage iD both bands -a;d, in the supreme co06deDce thar nolhing -r\onb doing caD erer be rree_lrom danger. are proposing lo dojusr that. lu y alive lo our peril at th€ hands of the c.M.C.

What arc these foundations? Modern anaesthetics and the Germ Theory; that is a , Gentlemen; no amouni of rcsearch will rcveal any more. On these two rocks stands modern surgery.

You notice we stress modelr, anaesthetics: we do so purposely, for throughout our medical careers we have b€en led to believe that, before,-there was no anaesthetic at all. Why else has Sir James SimpsoD as the pioneer of chloroform in this country become one of the two pahon saints of surgery! Gentlemen, we have been glossly deceivedl I will show you.

Fetches a bottle of three star brardy Here is an anaesthetio that, in our humble opinion, stards supreme-alcoholl Who, after all, is the most important person in the operating theatre? The patientl And were you to give him his choice between tl s and ether, can any of you doubt the answer? Here js an ana€sthetic with an induction stage so smooth, so pleasant, that many of us and, even a few of you have been known to indulge in it merely as a pastime. Can this be said of ether, of chloroform, of ethyl chlorjde? Need we say more! But, parting shot!-We arc taught that if there are many ways of -a doiog one rhjng. none of 1io'e way\ can be wbolly satisladory.

Tbe nunber of anaesthetics js legion.

Now for the Germ Theory. Ifwe take a culture fiom normal

skin, we may find an organism known as the Staphylococcus. this with an abscess we may also find the Staphylococcus; although, nind you,-and I am not joking-we may find no orgaDism at all, whereupon we call it a sterile absc€ss-and yet, we are asked to believe that Staphylococci caus€d it!

Again, if we swab lhe lhroal of a person sutreriDg lrom lonsilliris, we somelime. fiDd an organism knolt n a. Lhe Diphlberia BaciltN; we then call the condition diphth€ria and the bacillus tle casual organism. But if we swab the throats of healthy people we mdy also find what is, to our unenlightened intelligence, the iden cal organism. WbaL doe. lhe palhologist reporl? He calls iL a pseudo or diplheroid bacillus; uniess he qees us laugbing. and fearing that he is not quite putting it across, is himself forced lo aeree tbat rr i" iodeed Ihe Diphlheria Bacillus. lhe patienl js rhen said to be a carrier irnmune Lo Dipbtherial We may. of coune, swab the throat ofa pe$on sufiedng from, apparcntly, ihe identical attack of tonsillitis and find no such organism at alll! Gentlemen, how prcposterous! Further exampl€s are innumerable; but does it not make one believe in mass hypnotism: to think that this has beer slipped across us for y€ars and we have swallowed it!

There is one point in favour ofmodern surgery that is apparently unanswemble: the Death-Rate. Allowing for a[ the lies,

If wedo

45

TEE BLACK BAC misrepresentations ard inaccuracies of medical statistics, no one can deny that the death-rate is lower roday_ But, Ladies and Gendemen, let us look closer. Because two rlings exist together, one is not neces\arily rbe cau.e of rhe orher. Aftar the crea-( wa; rhere was an epidemic of lnflueo,,d of such !iruletrce thal peopte rirere dropping in the srreers. Influenza exists today and ieoile are nol dropping itr lhe .rreers \Lb]? Is il because ;ediial lrealmetrl had advanced so ldr I I lhink lou all lnow the anstrer ro tbal onelAod so come Scdrlet Ferer. and Diphtheria- iD waves of variable severiry.even as rhe Sea,on;, hol atrd cotder "u;nmers winlers are follosed b) ner summen and mild wioters. And 50 we 6Dd in Narure. !tbere erer we Lurn! $aves of one extreme alternatitrg wjlh waves ol another.

Is it notjust possible that the older surgery rested on a wave _ of- tugh morLatity aFd a, rhir rubsided gjving way ro aoorber of low mortality. so did modern surger) begin, neir her as a cause nor as an effecr. bul merely a( a concurreol erenrl Those of you wbo

are feeling doubtful must. in common fairness- admit ihat tlis e\piaDalion. in no $dy. latl. ot man) of rbe exptanarion" "ho of rDedical_ mynerie. roda). And .houtd yori attow rhii explanatjon and lhereby lift the responribiliry of a high mortaLiri fron lbe sboulders ol Lbe older .uigery. ,ee ubaL yoi trave aonit r ou bave lurned lhis same morlalit) rnro yer anorber advantage over modertr surgeryi for hou berrer can i,ne tearn than at rb; po,rmorlem-!.Arâ&#x201A;Ź lhere nor ali\e roda) people. whose diagooses. in rprle ol rnoumerable ob,cure as ever thev we.el I will remitrd you of a $elt known (lory:-A doclor waslo bamed byâ&#x201A;Ź lady's condilion rbar be dd\ised a consuttalion. Tbe mysrery called for more con\ul(anb and do$o rbe\ came in their ilotls-Royces. When (bey had deparled rhe hu"6and timidty eDquired *hal diagnosis so many distingur,hed docrors had madi, ani rtu, was the reply: "Although rhe case still remains a mysrery, they are all agreed upon one pornr: rhe) are con\jnced tbai eveiyrhini; will be revealed post morrem. ln the words of one of our most illustrious surgeons?-..We live and learn, the patient dies and teaches us." What better

opportunity fo. leaming than in rhe older sulgeryJones has fallen asleep and hi5 dream rranspons us to these grand old days ol a buodred lear\ aso. DerhaDs ihe reat Hev-dav of surgery. His krowledge ii .kercit ind Lirercfore you -mu,'r forgive him the innumeraOte anachroiri,ms and rnaccuricies rhar you wil discoveri and rf you hnd hi, mind ctogged with modern ideas which clash and are mr,undehlood on rhastage. and some ol tbe charactels and name\ remind you of oeoote aliie Lodav. vou must forgive him rha( al,o. remenibering rhdr this is, aft;r-a , onlv a dre.m 46

THE DLACK BAG SCENE

TIIE

II

DREAM

o

The cuttein tises an old fashioned theatrc. In it arc:The assistant, the drcsser Da*, two athet dtesseft. AI arc tn The swseon entets btiskly. He is d'essed i a ftock-coat, top hat, ek. He \|ea$ side whiskeft and vetf furce $raxed

SuRcEoN: Good afternoon, gentlemen,

ALL: Good afiemoon, sir. {Stseon takes olf his hat a d coat, giving rhem to his assisrant, who goes a* Nith them. Dark gives him a di.ty tubbet apron, wllich he puts on.)

SuRcmN: Nose still the same delightful colour, Mr. DarkDARK: Touch of the wind. sir.

SURG€oN: Wind in a bottle, Mr. Dark. Now what have we for today? Ah, yes, just the one, I think:-cutting for stones.

Mr. Dark, how do we know that th€ patient has stones?

DARK: Because he rattl€s, sir.

SURGmN: Quite dght, because he raLtles. (Ptoduces two stones fton his pocket.) These are bladder stones, Gentlemen.

Always keep stones by you in case of emergency. No patient cares to go through the pain of an operation for nothing.

Enter loNqs in a spoiess vhite coat

Now gendemen, w€ are to b€ honoured today by a visit from orll distinguished colleague, the physician. (Catching sighr of Jone.s' coat). Odd's Bloodll Just look at Mr. Jotres' coat! Stap me if he hasn't had it washed! Have you Mr. Jorcs ?

JoNrs: Yes, sir.

SURGmN:

What!! You mean to tell m€ that you have washed a

coat that has taken you two or three years to decorate l Jor,$s: Yes, sir.

SnRGEoN: I take it almost'as a personal affront to me, Mr. Jotres.

Jor\Es:

I'm sorry,

sir.

Sorry! Sorry indeedl Don't you realise that that was your diary, sir; that each stain was a record of youl work; each blot, each tear a milestone jn your march towards a wider kno!,yledge, a greater grasp of this, the noblest plofessiotr in the world! And you tell me you've washed it!!

JoNEs: Yes, sir.

(Assisrant entets ith sutgeon's Nhite coat on his atm.)

SuRcEoN: (rlrpr ,trr ,ro,r). This is terible, gentlemen! Hand me my old coat, Mr. Assistant. (Holds it up. It i: fhhy md ton;) SURGEoN:

Look at this old coat of mine. Look at its frayed borders, its larrered sleeve,. Lool al Lhese: (lrdi(drrr th?-stains.l I mishr almosl call them noble scars lbar pa) Juch homage to ihe service of a lifelime. A norable coar. Centlemm: I v;nrtrre r. say, a_n eloquenr coar. Do you lbink rhar I could see tbis coar, my close companion lor thin) )ears: do you thjnk thaL T could see (hjs coat $ashed I CenllemeD. the tboughr appalls me! Behold this great stain here: My fint operation. end lhis litlle hole be,rde il: I witt ter you into a secrer; rlar is where a tjled lady now dead. Heaven re* her soul, bi( me.

D^RK: Please, sir.

SURGEoN: Yes, Mr. Dark ?

DaRK: Whai is this stain here with rhe blue chatk roDnd ir?

SuRcEoN: My firsL pat'enr lo live, \4r. Dark. A red le er da\.

Yes.l har,e walcbed rhir coar grow me ow in my care, and whetr I die I shall be bu";ed in ir. Mr. Jones.\;bar ea(bty reasoD could )ou hate had lor baving )ours washed?

JoNrs: To get ir clean. sir, SURGEoN: I don't think I understand.

Jor.I8s: To get it clean, sir.

SuRGsoN: Merely to get it clean, Mr. Jones? No ot_her reason ?

JoNFs:

No, sir.

wlat on ea h has cleanljness to do with surgery?

JoNEs: don't know, sir.

SURGmN: I should think not, indeedt I sincerely hope you would trever allempr Lo operale in such a coai?

SURGEoN:

I

JoNFi: No. sir,

I

am relieved ro hear il. Why. rbe patieot would hav€ a be saw you approacbrng *irboJL any experience, I migbt almost add. wiihour degrees. *iLboui qualificarions upon your coat.

JoMs: I would scrub uo. sir SuRGmN: You wouLd d; whatllt JoNEs: I would scrub up. (ir-make m),elf aseptic.

SURGEoN: A septic! You mean a sceDric.

JoNFs: No. sir, not a sceotic:-aseDtic.

SURGEoN: Zouod,. man:Are you pri,uming to teach me my own language? Explain youseLt JoNEs: lf you boil yollr clorber. )ou make )oursef aseptic.

SuRcEox: Am I supposed ro be ii rhem ar t-he (ime, tlr'- Jooes?

SuRcEoN:

61.

JoNEs:

if

l-I-no,

SURGEoN: By the

sir.

blood ofall rhe Sainrs!AmI having

or is this boy mad? Listen to him:

IfI

a

dghtmare,

boil mi clothei l-become a sceplicl A sceDtic of $bar. mjgbt I ast ? A sepric, rl it pleas€s you; a sep c of wbaL. \4r. Jotres?

JoNEs:

I

don't quite understand, sir.

TEE BLACK

B,4G

It's a[ very simple; you have rnade a statement that boiling my clothes would make me a sceptic. Well, a sceptic

SuRcEoNr

of what ?

JoNEs: Aseptic means sterile.

Oh,-it means sterile, does it?

IoNFs (with obrious rcli?n: Yes, sir.

SURGEoN:

SuRoEoN:

Let me get this straight: then if is lhat it?

become stedle, JoNEs

I Yes,

SURGEoNT

JoNEs,

I

boil my clothes I

sir.

Are you seriously recornmending me this step, by any

Yes, gii,

I suppose your coat wasn't boiled?

It's possible, sir.

SuRcEoN: But you don't know?

JoNEsr No, sir.

SURGEoN: Aren't you feeling mther nervous, Mr. Jones?

JoNBs: Why, sir ?

SURGEoN: Tchah! 0o tie olhers)i Do any of you know what he suRcEoN: JoNEs:

is

talking about ?

ALL: No, sir.

SuRcEoN: Thank Heaven lor that! (Orrdrver ,atk picking up the anaesthetic bo le): Put that bottle down, Mr. Dark.

DARK: It's a quarter empty, sir.

SURGBoN: Oh is it? Now I begin to see day light. You have been at that bottle, Mr. Jones. Well kindly resirain yourself in future, appearunce, larye vihite muton chop side-r.hiskels and gold spectscles suspended on black silk ribbon.\ PFysrcrAN: Good afternoon, gentlemen.

ALL: cood afternoon, sir.

PHys.:

I

hope

SURG!oN:

I

haven't missed the excitment?

No, ind€ed no. The patient hasn't come up

yet.

PIIys.: So glad; so glad. You plumbing gentlemen are so quick these days. Ye-es. (Srrveys Jones fot a mome t hoftot sbuck).

God bless my soull What an offensively clean €oat, Mr. Jones.

SuRGloN: Please, Please! We have just closed the subject with the very greatest of dimculty.

PEys.: Have you now? Dear me.-Oh, by the way, I have taken the libe y of inviting some young friends of nune,-children of very old acquaintanc€s.

SuRGloNr

What

again?

Pl{ys.: Ye-es. You'll like them, dear little boys. Cut out for surgeryt too, SL'RGEoN: Indeedl 19

TEE BLACK BAG PHys.: Ye-es. PUU lhe wings otr blue-bottles. srjck pin. in burrerflies. rie catrs to dogs' tails. Dear Lillle boys. ]e-e,t-Born

to be surgeo$!

SURGEoN:

Are they here now?

No-not

yet.

SuRcEoN: You rclieve me.

PHYS.:

PI]ys.: Oh, you'Il like them, {ear litde boys,-ye-es.

(Grcat tummotion is heard of nae?.)

Sr RG6or, V, rhe rwo o w drcss?tsl: Co a;d see whaL ir i,?

EXEUNT TEE (Shoutins is head ol sidc.

'XESS'N"S Th" patienr. iA a tong white night shi and barc Ieet. app"an in thi e runft. a probarioner is holding him tightly by the am. me tvo dressers and tvo potters are rgi s hin fotwa ftom behind. He stands i the woD't 'ave iL-I woD't 'ave it, I tetls verl wbal won'l you'ave?

PAIrE\r: Tbis 'ere blukitr' performaoce oo meSLRGEo\: Why has he be€tr allowed to walk, \urse?

PATENT:

I

SuRcEoN:

NuRsr: He insisted, sirPArIrNr:'Course I walked! They vrasn't gwitre ter bring me on no strctcher. Probably the Iarc'time I shall walk acine roo.

I $on't'a!e il, I rell; y€r; I won'r'ave irl SURGEoN: He is very iively, Nurce. Has he had his laudanuml NURSE: Yes, sir.

PArrENr: 'Course, I'm lively. 'Aven't I drunk pitrrs of rhat there $utr iD m) Lime? I ain'r been a Pill pilor fer norhin'.8 SuRGto\: Come now. Mr. Cently, oo need for all Lhis fuss.

PAflE\r: Ho. ain'r rhere!! (Cat.hing siCh of the long kniJe in the sngeon's hqnA cawd love mell! You ain't never gwine ter use that ther€ knife on me?

SuRcroN: Oh no, Mr- Cently,-a much better one.

PArrt\r: You ain't oever goiD'ter use no knile otr met I ave cbanged my miod, I 'ave.

SURGEoN: But you can't do that.

PA nt\r: Ob can'l I ? This is a fre€ counlry. ain\ n: \Brcaks (rwa) and dashcs lot the e"trunce. is stoppei, bur teaps iieh tishtn;is onto a.upboa.d k"otbv.1'hey a .roid rcund htn. He apTeats to the pb,sician.) Yonlooks as if you 'ad a kind fice, guv'ner, won.l yer speak up fer me? Don't yer rhitrk rbe) did oughr ro let I be? Don't yer think tbey did?

Pt+\s.t (Srarcs at hin Ior a non"ntl: l'm afraid you misrake me, my man. I don't thinl at all; I am a physician, -ye-es.

PATIENT: Gawd, ifs alive!!

SURGIoN: Come down Mr. cently. Ifs all for you. own good, 50

THE BLACK BAG

'oo says so,t-Jest look at yer! Yer tongues 'angin' out like a pack of 'utrgry \r'o1ves.-Yes, thafs wot you are:A blinkin' pack o'ungy wolves! And I'm ter be yer bleedin'

PATIENT:

victim. Gawd 'elp me!!

SuRGroN: You mustn't speak like that,

Mr. Gentlyl These are th€ of enlightened suigery. Come sir, come. Have you no pide?

PArrrNr: Wot'as pride to do with it? I arsks yer. Wot'as pide ter do with it? 'Aven t I a wife an' kids? 'Aven't I a comfortdays

able'ome? Atrd aitr't

agine; ain't

I?

I

got a rightful wish fer ter see them

You talk as if we were butchers, Mr. Gently. no!! You ain't no butchersl A butcher would brcak 'is blinkin' 'ea{ rathd than see th likes of me in th€ likes of this 'ere plight. No, I won't 'ave it, I tell yer SuRGroN: But you promised, you know.

ParrENr: I must 'ave been drunk! Blime, that's ],ot I must 'av€ been,-drunk!

SuRcEoN: That is very easily remedied, Mr. GeDtly. Fetch the anaesthetic botde, somebody.

SURGEoN:

PATENT: Lawks a'mercy,

(The anaesthetic bottle is handed to the patient, who takes

a lons pul an.l wipes his moudt with the back of his hdnd.\ SURGEoN: Isn't that better ?

ParBNr: I 'aven'i said I will, mind. (rrnfr). But I will say, (r/rxLr) this is a bit of orl right.

SURGEoN: There, now! Just you drink as much as you can. But I should come off youl perch, if I were you.

PArIrNr: l'll bide where I be. (Dtinks). Pack of nurderous 'oundsll SuRcEoN: You'll only fall ofi PATIENT: You let I be! Look at yer; All hitchin'ter get at me, that's wot you are. We[, I won't 'ave itl SvkcBoNt (The patient drinks lrlmost co tinuously vhile the surqeon is speaking)- We wouldn't dream of touching you, Mr. Cently. All we are asking you to do is to go into that room with nulse and drink.

PATENT: (Glrer Nutse a long look, wipes his tips again with the back of his hand and slo*ly clinbs do*n\ P'raps I will! (raking the nurte by one hand akd clutching the bottle in the othet he nakes slob,ly for the Exit.)

SuRcEoN (ro the t$o porterc)i You [ad better go in with them.

PArrENr: I knawed ihere'd be a catch in it somewhere!!

E)GUNT

PlrysrcrAN: Dear me! I am forgetting those childrcn. (Goer /o the e trcnce). Oh, there you are! Come along then to Uncle. e(A sha boy with bis eaE, appetry in a sailor suit an.l

fEE BLACK

BAC

whitc Ane can sqilot hal s;.Jlcing rcun(l thc entranrc hta!.

A la4e $e i\ iA it, nouth and it is suc*ing it's fnSeLi There's a dear lirtle boy.-ye-e:. t L"ads it fu the hand ro fip skeeon). -thts;s rlttle Angie.

SURGmN: Really!

ANctt (takes itr fnsct out of irs nouth and points to the sury?o ): Is be a rcw Uncle?

PIIi.s.: Ahem! Ye-es. hâ&#x201A;Ź\ a new Uncle. \NoLE (tou(hing lhe sutgeon's rubbt gaant: Why is he wearing this? Is ht a Nurq& nrr.

PHYS.: You musn't ask questions, ANGLE: Ournusey always wears one when she barphs the baby.

Is he going to barph a baby ?

PEYS.: f.: cod Cod bless my Soul: Where i. )our lillle lnetrd2 (Anstc points to the entrunce\ We11, run along and fetch him. aExlr ANcLE' SURGEoN: How manv more a.e there? ' PEYS- Only the one.

SmGmN: Couldnl you raise any more?

PuYs.: O[, you 11 ]ike them CHoRUs oF DREssERs: Dear little bovs PFrys. (rra.pr at then): Ye-e.. 6e-inter anele topclhct with a boy ih Mldiet's unrlotn and shonst. Tbar's right. Now borh of you run aloog in tbere and pla1.

SuRGEo\: Hmmn. Sirrb Clouce,rers. I seelo. \Thc childrcn wande. to the instrument table. Angle picks up d la.ge knife, Hey! Put ttrat down. (Angle doet so. It is imme.liatelt ptcked trp

bt

the

BoY: Shan't!

bo : Aid yo'll

SuRcEoN: Oh, yes you will, young man.

Bw (Stutmps his foot)t Shan'r.

(Tre SuRcEoN walks up to them, fe.ely twi in. his nou"rla(hes. Th? boy. t?t.ifcd, drcps knilc on th" floor. [*cte

bu.sts into tears.)

SurrctuN (Pornts to daol): You go into that room and do as you are rold!

Exeunt ANGLE and the Bo) Plrrs.: Bit rough, what!

SItRGEoN: You mean this'l (Picking up the knife). If only I could have been sure tbaL rbey $ould ,rrck ir jDto anybody bur themselves !

Pnys.: Come Dow. siri You ll like rhem. de-(C/"a.s 16 /&roar Md look: atuund\ ]/e-P\ (Reantet th; patie t, hetcl up by the poltels. me NuRsE cafties the bottle;)

52

Whoal-Whoa! me 'earties! (Stops and poinrs b the 'e be,-Mister blooming Shawbores and Mishter blinkin' Butcher all jn one. But I be ready for 'ur.

(I:akes the bo le fron NuRsE s /ran4 drtuks and giyes it back 1o het. He gesticulates vik f.)

Coliasb Shenrly be read) lor all ol e n.

PAr]ENT:

SURGEoN). There

(He is led fot\9ad.) please. I'm a meek man, a kindly man PATBNT (.4gdin rlolr): Whoall Hicli I'm sozschled, ge'men, SURGEoN:

Mr. Gently,

soushed.

(Dtoops and ir picked u? and put on the table. He rcu.ses hinself slishtly.) \trboa, rberel-\Lomen an chil'ur) rr:ht.

(He is held dovn on the table bf the pottets ahd hessen.\ NURSE: I think he has passed out, sir.

SuRcEoN: Right, we'll begin.

P^'ttBN\ (Leapi,t& up as the knife tauches hin\ Whoa! He's shot mel He's bleedin' well gorn an' been an' shot me.

SuRcBoN (Sigr,rg, r/o/r): cive him another drink, nurse. (Sre does so a d puts the bottle dow .\ Ah mel I bear with the grealest of fortitude the sutredngs of my patients. Ready?

NuRsa: Yes, sir.

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SuRctiN lTo th" ph)sh iarj: PHYS-:

I will,-ye-es.

\

rtl you do a pbtebotomy for me, sir

?

(Fishe!,hi, insuun"nt' ou at his porkct and b?eins .

AsslsrANrj Why do you remo\e more blood. wheo rh; parienr is already losina it from the oDerarion?

SuRcmN:.Mr._ Assi(ranr pted;e do not presume ro question established medical procedure. Remember the rnediiat nroverb:-Ask no queriion.t A que.rioning mind in our brof€ssion. my dear sir, leadr ine\llabty lo ihe mad-house. bur noble art is burlr on enrpirici.m dnd iradilion: may iL Dever be su[ied by (be un$elcome inrru.ion ofr(aoo-

if rhe Datient dres. sir?

And $baL ol illlt L our glorious handiwork lo be Lmpalred by such a rri\ial mafer a. rhe toss ofour pa(ienL?

AssrsTANr: But

SuRchoN:

No sir. we rise above rLch paJrry con5iderations. Wteie. pray. would surgery be. if ,ucce,, $ere ro be measured by Lbd priservation of lif€

|

PFys.: We concur. To follow rcason is to follow the proverbial red berrins. Civins free rein ro reason is like letd;e toose a lreacberous arimar; il lurn. round and biles us iehind._ Ye-es.

PATTEN

r:

" Tbere $a( a )oung soman catled Fost€r, Who mer a )ouog surseon of Ctoucester.

Thev- " ,lrr. hq lTh" n,

-SwcmN:

hand

opt

hi'

north.)

Now wby""did 1bu do rhar, Nur,e? t hado.i heard rhal one. Let him alone. (fre N\tRsE takes het h6ut a*-ay. Sitence.)

There, you see, I never will now.

NttRsB: Now at cuvs-l1 SURGEoN:

I

hospital.

don't iare what you did at cuys; ihis is a better

PHys.: Peculiar dream last night. Dreamt I was seeing into the future. Dreamt I wasn't taking blood out of a m-an's arm; dreamt I was pu.hjng in a rbin traler) \olulion otsugar: aqd I heD, borror of borrors, il lurned ro ;ll I SuRcmN: Something you ite, no doubt.

PI]ys.: No doubt. Then I dreamt it rurned from satt into blood.

Dreamt I v/as vjsjting your ward.

SURGEoN:

You surDrise ne

pHys,: ye-es

Thii sar a nighLmare. parlicutarty missed Lbar heallby smell ol.uppurari;g soundr and gaogiene. I remember noriDg all alongbne .idi ot Lbe ward.ireiid tookirg contraptions pumping this fluid into most of rhe patients. _ SLRcEoN: And the condilioD ol rhese Dadenr,?

PEYS.: Moribund.

SuRcEoN:

I

should thitrk they werc!

54

JoNEs (Exctredl./): Those were continuous jntravenous

ddps,

glucose and saline.

sir-

SuRaFo\: S 'Dearh and Corruprion:: Are you off again. Vr. Jon€s?

No. sir.

Sr RGFoN: Kjndl] examine rbe borrle, Vr. Dark.

DARK: It has sunk a bit, sir.

SL'RcEoNr Mr, JonesIoNEs (Indignantly): haven't touched the bottle, sir. Mr. Dark knows more about it than I do. (,tracty'oh DARK.) SuRGroN; I am not quite as green as I'm cabbage looking, Mr, Jones. am very well aware that Mr. Cljcky Dark is in the habit oftaking surreptilious puls, but it is asking m€ too much to believe thai he is entirely r€sponsible for all that disappears.

JoNrs: Well he &t in the back fion D^R.'l., Hicll SuRcEoN: That is a sufrciently good answer, Mr. Jones.

(The children appeat on the edge af the stage; the boy takes aim vith his gu and hits /re SuRGroN o,, the side of the lace vith the cork. Thet dash of.Therc is a spaut of blood upva s .

The P'JystcrAN whips up his umbrcIa and catches it.\ A ligatwe, please, nu$e.

(Ire NuRs! hsnh him a piece of stfins, which he gives

JoNEs:

I

I

(l

t

Tie that vessel, Mr. Assistant.

AssIsrANr : Shall I tie it four or fiv€ millimetrcs from the end. sir ? t , The StrrcloN ignorcs him a d marches of stage after the childrcn. He rctw s in a fev moments with the gun. Thk he brcaks and then ttamples upon

t.

Tre PFysIcIAN,

io it

stan.ling \)ith the umbrc a still raised, rriggelr. flre SURGEoN holds out his hand, the PE\stcraN slowb) closes lhe umbrc a a d gircs it to rin. fre SuRGroN bftaks this also acrcss his knee a d thtows it aeay. The apetation co tinues. A tunblitlg noise prcceeds the teappearunce oJ the childrcn, pushitg a large heary ball acrcss the foot. This makes fot a delicste stand supponing an old urn, b nging it down \)ith a cmsh.)

SURGBoN ("Ll,r1J ,?.) | Caramba | | The coNtipation ball ! (a no"/ of pain fiot the Assts't^Nr). Take those brats outside, nurse, and nevel let me see them again I (NuRsE lea6 them out.\ A\cLr fBr^r( into tcatt)t l'm goiDg lo America.

Exeunt PFYS.: You don't like them?

SuRGloN: Nol PAYS.:

Pity. Pity.

55

TITE ELACK BAG

SnRcEoN: My foot | !

PHys.: Mmn. Perhap" ]ou're rigbl. Who knows? t{ay- yet live , to b€Jliilals of tbi. greal insliau(ion. Sucb spiritCEoRUS: Dear little bovsPHYS.: Damn!l SuRcmN (,Vorric€.r that the ass:dtant is hunti g fot something): Now, what's the matter?

AssrsrANr:-I afi looking for rny finger. sir. shich youjust cul on SURGEoN: Don\ be so particularl Srop rhe bteedine and hetp me.

As,stsraNr: l've fdxn.l it (ir SL.RcEo\: WeU, graft ir on wrrh pta(ler and dont be so fu1\\.

(Nutie. who ha: retarnci. \traps it up Iot hin.l Mr. Dark. go and lelch Apple)ardrts I have jusr abouL tinished-

DanK: Yes, sir.

Exit DARK rjr rrr ttuments dawn): And thar's T[erc, Mr. Gently! A[ over.

PATTENT: Wasch 'at, nurse?

NURSE: It's all over, PATTENT: Gor'blesch the Dook of Welington!

SLrRcmN (?rrliaS

rhe etrd

ofthat.

(tnr?r AppLryARD \tith the strctcher. He goes up to

ossistant)

the

Appt-EyAxD: l've been lookjnp all orer lor vou, sirl youie wanted

in Casu.ltv AssNr Nr: W;fl, I've beer here.

.

(Patient is pdt on th?

rrcrther

thp suryeon puts sonething

into hlt hand.)

SuRcroN: Your stones. Mr. Genrlv.

PAnENT: Thank ee. Cu\'nor.-do'shame ler'ee one day.

SuRGtoN: Cod fotbid'. tWheetell our singing).

(The swgeon casuall), puts hk hand into his v'aistuat pockets and is innedtat?lv galwnis?d inb a.tiorl-) l{jyl Appleyardl Bring him back: Dash it all he's gor my dice! Here are rhe srones!

(Folloh's the ,ttetchc, o,f the sngp. He rctums in a n'onent ei h his dice.)

Dear old Applelard: He nerer change,. Looks exac y tjke he did when I came l-ere 6r"r. rhjnv -vears agoPHys.: Younger! They sa) he va, rbe-fi'rsr piJe of moveable equipment rhe Infirmary ever bougbr.

SuRcroN: I suppose he mu,L be: I beard lhey found him in fie sub-soil when the foundations were being dug.

PEl.s.: Realy!

SURGEoN: Yes, he was bought off the foreman as a keepsake or J6

De me! Why, if you are right, he must be our ground landlord- Ye-es.

SLTRGToN: What a ttought!! (opens a ftesh bouk of anaesrheti.c.)

PEys.: Henessey's Pale Amber, I see. Satisfactory?

SURGEoN: Veryl Don't you agree, Mr- Dark?

DARK: Yes, sir.

Pnrs. (produces a botrle of ein out of his pocket): Have you tried this? New firm:-Booth's Crystal Clear.

SuRcEoN (tr&r iir 1r7s drd twns to the others)i Tlat will be all, gendemen. My colleague and myself have important matters PHys.:

(Exeunt ALL ExcEpr JoNEs, who sits n oticed fu rhe cornet. The ttro men bring t\9o lov stools and sit down togethet, Bottles excharge hands. The SuI.cEoN p,od ces his dice and the PHystctAN btws oltt of hk pocket a BreasJ pack of ca s.)

Now vhere /ere we last time?

PI]YS.: You wer€ in my debt, I believe.

(Grcat commo,ion.Ther lookup to see Appkta rctuning 1+ith the s/rctcher. The patient k fat ott.)

SuRGroN: What on €arth's the matrer?

AppLEyARD: k's the patient, sir, he be moltal bad.

(The suryeo looks into the patimt's eyes; the phrsician SURGEAN:

fshes an enomo s fat stethoscope ot of his pocket and Iistens to the heai.)

SL'RcroN: Very bad!

PHYS.: He's almost gon€.

SuRGroN: Try him with your Crystal clear.

(The phJskian inserts thc boole of gin be^r'een the patient's lips anll then holds it waiting. There is no .espoNe.) PHYsrcraN: Dear mq too late.

(The patie

t

slo$,ly plrts out

a hanl and gentlr lifts the

eh oat oJ the phy:ician's hand).

Lookll 1Ve have saved him! How wonderful is surgery

bottle of SuRcEoN:

that it should enable us to bdng people to the very edge of the grave and then 10 snatcft them away.-And sometimes w€

do,

sometimes we do.

BLACK OUT (loud

snorc't

VoIcE: Jores! Jones! Drat the boy, he's asleep.

CURTAIN 57

7I]E BLACK BAG

EXPLANATORY NOTES (1) Hubert Chittyt practice, (2) Stuat Stock senior anaesthetist at the B.R.I. );{ }Theatre porters at the B.R.L (5) A very petite lady House sirrgeon-Lc.B. (6) Hubert Chittyt €yebrows were a feature of the B.R.I. (7) Prof. Redle Short.

(8) Tbese piioLs !\ere sajd Io obrain opium from saiiors on rhe Chioa roure and bence de\eloped greal toleranc€.

(9) Mr. Angell-James had paid or was abod to pay a visit to the States.

(10) Mr. W. A. Jackman was Hon. Colonel of 6th clouceston at the time.

(11) The then Matron at the B.R.L, a Guys Hospital trainee, was always using this phrase.

(12) I-egendary rcmark, attributed to Rendle Short vhen a casualty dresser at the B.G.H. (13) Hospitat porter of legendary great age.

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Prof. L-nn-n to Mrs. P-y-e: "lt is the little things in life that count."

A I Contraceptions'!

Mr. I-o-u: " Excus€ me, sir, is it a good thrng to go on having babies?

ThP rnri\.owred cou u! ian h,hose boun no traw et leturfut"" Mr. D-s-Ii " I met a girl who comes from Euthanasia at the International Club to-night."

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Mr. P. F-ud: " Queen Victoria died."

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59

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Announcing :

MODERN NURSING: Theory and Practice

by Winifred

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This is a completely new textbook on every 6D=t o{ lursing. It colers rhe SylLlbus of the CeDenl Nursins Comil, and is profus:ly illuslrated, many of rhe d.awiles having bcn sp*ialy commissioned for

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RURDERRY

AEENTS

CHESTER BARRIE AGENTS

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