1965 1

BLACK BAG

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sw

corticosteroids Thc

t1t6t

Ctaxo topic.t

.ofi

:d-

The

vas

6st @oulcerei ol tbe ctiai@l rahe ot corftone uile in 1949. This sta ed a! ilteGive soltil-qirle

ior yeseiable stercids tlat cotrld te used as siartins the ecdomic syl|resis ol tle bolmode.In tle tniteil Kineilom. clrxo Diddril a Briituh uo@sB utilisias be, oepDin dsreerl bon Esst Alrl@n s,sal $trtp. ItrhN've ilevelopnent ol this basic !:etbod bf,s €ubted Claio noi oDjy io lroitu@ a raDge ol corlicostdoiits ior ail trT* ot lrsfmeni but rtso DrosrNiyely to reiiu@ th€ir prices, search

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,n the ktbaratat! asnrsl

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nto^it! at

xs

,to,ir3is and atht stdaii re:jrn lat:n ir

D' i.e

it uchle""6

t

tho ,rtn ol ,ittet an.t

"1ak

1.

n&

d

dpciite

uterial lor

tire rcent inbodlclion oI b€tlD€thasoae was a @jot til@ce in this $e*, Eecruse jt is srler and mor€ ef€ctive tlrn dther cqtisone llrnadves. tet3nett*one c6as a tuesh start in corticcsteloid ineraly.

FirtlerEoe. it sa the 6Et trev coriiccteroiil- eiih

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1t6d.

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6

BLACK BAG

Spring

CONTENTS

Ng.

I

Edlto.lal Th€ Whlt€ Coatcd

1965

lm{c

.

Profe.eor R. Mlln$ Wslk.r, C.B.E., M.s., F.R.CS., F.A.C.S.(Hoi,)

t1

How to wln your v€ry own HoqlFJob

l6

Th.

t8

Feud?l KlnSdomr

20 Blochamlatry .nd M€dlcal Stodcnts

22

Bonlgn..nd Malltnant Fru.tratlon

21

Th€ 8lbll..l God

?3

NlSht Nurr€

3o

N€wr from G.lenlol3 Pantomanla

32

Book Revl€w!

31

The man-size cigar for the price of a pint...

*,"",CASTELLACIGAR,S

EDITORIAL Well here we are, bright and new, allSa/ and Gill Sans. We hope you like it. The gen€ral response has been heartening. . . pl€a5€ l€t it continue. Let the Medic ofr his belly ris€!

Seriourl), though, a lot of work has 8on€ into makinS this a presentabl€ magazin€, Th€ old stolid, reactionary image peopl€ had of BLACK DRAG has now, we cross ears, gone for good. You have something worth writing

At a m€etin8 of the Medical Board held a few weeks ago, it was agreed to stop the showing of films in the lunch hour to pr€.linical stud€nts. Films of a Seneral m€dlcal nature, and selected by a m€mb€r of the Anatomy Staff had previously be€n shown once a w€ek in the medical school, and an arransement had be€n made with the University Catering Dept. to provide a lunch seryice on thes€ da),s. The filmshows were entirely voluntary, well supported and tho.oushly enjoyed by many preclinical students- Th€n one of the Preclini.al Depts. insisted that th€ filmshows were encroa€hing on students freetime, that this was a bad thidg and that as th€ s.heme was being sponsored by th€ Professor of Anatomy, this indicat€d that it was an integral part of th€ Anatoml course and therefore ought to fit into Anatomyteachingtime. Thus the M€dlcal

Oh dear what ha! happened on the surgerl side BRll The colour-mindedness which found satisfactor), expression upon th€ walls and doors of Outpatients hat run amok. Lots of

squdgey pinks and yellows and blu€s in horrible combinations. lfa bit mor€ restraint

.nd subtletl had

been exercised,

the result

would have been iust as 'jolly' aid fa. more equible. You don't have to be sa.kh in order to

be 8ay.

Board deemed

it

necessarl for the filmshows

lfthis policy is to be widely adopted by the Univ€rsity, the days of lunchtlme concerts and public lectures takinS place in €xtrac'rrricular hours, appear to be numbered. An emin€nt member of Galenicals commlttee has even been hea.d to query if 12.0 p.m. post mortems <oont as lunch time entertainment, but it was suSSested that they were merely an aperitit Some wonder how

There is a change. Somewher€, somehow there has been a subtle alteration of attitud€ amonSst the sixth /ear. This is the short gribble to finals. The student cloak is cast off for now they are 'Nearly Doctors'. No time must be lost in the task of impressions to be

5.0_6-0 p.m. lectur€s manage

to

escape the

cateSorl of usinS up th€ stud€nts' free time.

Th€ lunch hour is a good time to show fllms, for it enables lst M.8., Hons. Physiology and

to it. Of course thk hn't true for €v€ryone,

Biochemistry, and clinical stud€nts aho to s€€ them, and provides i pleasant relaxation in the middle ofthe day. As the student body as a whole is thoroughly in favour ofthese filmshows, which originally wer€ provided for their ben€fit and at no stage has any protest been rais€d ontheirpart, it has been suggested that Galenicals takes ov€r the running of the

not all Medical Students are depersomlis€d by

shows. This would reli€ve the

made'. A BRI house-iob becomes a monum€nt

of priceless count to which the self must

be

offer€d up. Senior rounds becom€ rituals in an efforr to get your face, that sad thing, recoSnlsed and perhaps even a nam€ attach€d

the time finals close in. But it a sad reflection on mentalities that so many's a.e.

Universityofits weighty responsibilit/ in "depriving the stud€nt of hk free time."

provided. She does not f€el at all bitter that she is the only female m€dical student with size 8 fe€t, but ls considering changing to the

of course, thls was the point. lf th€ views had been changed in any way it would have been valueless-reality throuSh one pair of eyes is the same Glenside alwa),s distorted.

Hospital is one of the most forward looking, and is run by an extremely enliShtened grouP of doctors under Dr. Early. Enormous efforts are belng made to briShten up and redecorate, and byfar th€ majority ofpatients do notwant

white, kinky boot! that abound on the

to

elephantine feet of her male colleagues, b€in8 confident that this would not endan8er the

students doing

state of the national economy as might the provision of a few n€w pairs o{ shoes.

will

The co-editor k sufferlng from a condition known as National Health feet, the pres€nting complaint ofthh disease being pain and cramp in the toes. She is not sur€ ofthe aetiology of this state, but attributes it to w€arin8 one of

the f€w pairs of white operating

sho€s

ln th€ last edition an article appeared presencing rh€ patient's attitude to hef treat-

ment at Glenside Hospital. That it was a patl€nt's point of view was stressed at the end ofthe article, but all the same it has come in for som€ strenuous criticism. For som€ the writ€. gave a dktorted view ofthe place, but

'UnderAlcohol Immersion'

All

leave. Arrangem€nts are now such that

their

Psychiatry

firm will

spend a w€ek at Glenside and, like the editor,

see

for

thems€lves what

From April the 6th

a

progr€ssive

to the loth, Bristol

Facultyof Medicine will be welcoming students from medical schools throuShout the United Kingdom for this year's National Clinical

Conference. A programme of lectures and demonstrations and 8ay, gay social €vents G being arranSed. P€rhaps we'll see you th€re?

The world of medicine appears

to

hav€ fa5-

cinated and intriSued the imagination of many wrlters of note, the product of their f€.tile minds, bringing to fruition several ePic works, and at least three Nob€l Prizes in re€oSnition of their genius.

The position of Doctors, with the P€culiar aura of mlstiqle, mysterl, if not doubtful magic, preyalent since Grecian Galen, and certainly malntain€d by the Gra€co-Roman nomen€lat!re of thk century's Pactitioners. ls fulll exploit€d and heiShtened by these

llterary masterpi€ces. lnterest is seeminSl/ unlv€rsal, a whole Samut of French, Russian, German, Amerlcan nov€lists, namely Camus, Pa3ternak, Thomas Mann, F. Scott FlizS€rald,

and even the home-8rown

Englishman

Lawr€nre Durr€ll, despite his voluntary exil€. have all been arous€d by thk toPlc.

Whether the interesl iarSon, slmpl/

as

h

due

to

words aPPealing to

a

e

Perlon

out re€elvinS r€liSious Platltudes or moralisln8 censure.

"Doctots togethet with lavycrs ond parcons arc pttvtlegcd to enqrire into the p.ivote liv€t of theit patients. Ihis is whol mdtes ,,fe nteresti ng ond sqiceY

Coated lmage

medical

can divulte hk personallt/ or lack of lt, wlih-

i

White

writ€rt

mind (ln a similar wa/ lo the ilick, often facile use of'bons mots"; wltne$ l4ann, who aisumes hls reader to be billntual, with at tlmes whole pates of French to trouble the unwlttlng, or to be hurried over uncomPreheidlnSl), b/ the cat0al fllPPer of leaves), Or ls lt the layman's bllnd falth in an esoterlc professlon. PerhaPs it h the Position of the Doctor ln socl€ty, a confident and friend ot the recular world, someone to whom

The

"

Thes€ three professions have all enioyed a vogue, and undergone Periods of debunkinS; thouSh from the juetified jibes of Moliere at the quacks of the lTth c€ntury has emerged

the shiny incorruptibl€ image of th€ 2fth century honest to goodness G.P., onlt within very recent y€ars showing siSns of tarnish€d €xterior, if not a corrod€d core Less can be

said for the cleri.al lmage, the downgraded do8-collar ls dellnitely out this decade.

Dr. Rieux Thi! rivalr), berw€€n do.ior and Prlest h rellected by Dr. Rieux, mouthPlece of camus in 'La Peste'. who is enSaged ln a PerPetual dot-fi8ht for the lives of his Patlents wlth the Jesuit prie* F:ther Pan€loux, who ls seeklnt their souh. The latter in his dramatic sermon to the plague-strl.ken citizens of Oran. . .

"Cdlonitt

hds cone on you

m), ,retrrren ),ou deserv€d

ny

brcthen, ond

it"

to whlch Rieux retorts

"whot's true of oll the evilt ,n the world is plogue os weil- l. he/ps me, to r/se

tue of

obove .hemselves. Al, the sdne, wh€n you see

th. nisery it

btings, you'd need to be a mod' stone blind, to give in

nan, or a coword, ot tonely to Plogue."

Rieux believed himself to b€ on the 'rlght road' in fiShtin8 against creation a5 he found it, suggesting there's no profit in PhilosoPhlsing about evil or its origin, until it is eradi-

cated; and ironjcally, Paneloux contracts th€

uprisings of 1905 in Moscow, as a backsround).

H€ takes a 4 year course, sp€nding one term on ly ofhis firsr year studying anatomy-a most

disease, loses his faith, and submits to hospital

proper lengtfi of time one feels, for such a mund:ne subiecr. The author\ description of the scene is reminiscent of the days spent in the litde-laked and even less lamented otd dissection rooms in our own Univ€rsity. . . "k wot deep underyrcund in o botenen| of the univercity. You cdme down the vtindint stdr.cdse. Ihe.e werc atvays o ctowd of disheyeired stud€nrs, sone ho ot wotk over their tatteted kxtbooks and swunded by bon€s, or guiet/), disse.ti,g, eoch in his.omet, otlers &oli"g about, ctq.king jokes, and chosingrois..."

Yura Zhiva8o is no humdrum student, to the contrarl he is observed worktnS on an essay on rhe nervous sysrem of rhe e/e, fothe Univ€rsity Gold Medal. He is intensely concern€d with the relarion between imagery in art and the logical srructure of ideas; and, he is no mean poet-his poems to be found

Dr, Dick Diver ln a different vein, Scotr-Firzserald's Dr. Dick Diver, the all-American hero of hrs epic nov€|, "Tender is the Night", is portrayed as

the idealistic, Ivy leagu€ and Oxford Rhodes Scholar, doctor. He devotes himself to rhe car€ of one patient, a girl relapsing into perlods of acute schjzophr€nia, whom he marrles, eventually to su€cumb; defeated b), the uneven struggle of being Dr., husband, Iover, hrher', and ever/thin8 else rhar's going. Scott-F., whos€ own wife enrered an 'asylum' and became himself reduc€d ro increasing bouts of alcoholic debauch, reverls his interest in, and even his own atrirude to psychiatr),, culled from his involv€ment with a psychotic in real llfe. He rarely dwells on details of medicine, the whole remaining

clouded in obscunry, alrhough Diver

in l9l6

reaches Vienna in rearch of Freud and wrires

as a

umpreen languages. and spends rhe rest ofhis marrled life, before his dissiparion, preparinS a

and soon reveals hjs clinical acumenl he diagnoses an echinococcus of the liver, in opposition to his superiors ind k proved right at the autopsy. He is cauSht up in the

''An ottenpt aL o unifom and ptagr.i,otic .tasifi.ation of rhe ,eu'oses dnd psychoses

throes of war, revolurion, counrer-revolu on. and reSular purSing, but sreadfasrly prac set his medicine almosr oblivious of rh€ Bames o.

his pamphlet entlrled, "A PsycholoSy for Psychlatrists" later to b€ translated into

bosed on an

post€ript ro the main stor),. Yury quatifies,

politics around him-retains hrs poer'! eye

exominatnn of 1500 Pre-Kroep€lrr

and Post-kaepelin Cd\er. 05 the/ wou]d be diagnoted in the teminolo\y of dtffercnL

and quietly follows his own philosophy.

contemporcty schools-together with a chrcnof ot su.h subdivisions of opiniont os have o tisen independently ".

Magic Mountain

I

From Pasternak to Thomas Mann may se€m an impossible leap in both style dnd g€ogrrphy, from Russia to Swtrzerland, from revolutjon to a complacent principaliry; the two novels are however s€t in approximately the same decad€, the pre-first world war years of this century. l.,lann's epic tome, the 'l'1a8i€ f,lountain', des€ribing the relin€d .nd rarefied atmosph€re of a T.B. sanatorium for the not so poor victims of the tlbercle, po.trays the hero, a younS engineer by name of Hans Castorp, who on a visit to his cousin, a

This grandiose tltle, to be written in €ven mor€ grandios€ Gothi€ cerman, ferments as a pile of pap€rs on his desk, and nor surprjsinSly, this proposed accumulator of dust is nev€r published.

7zhivago Pasternak's Dr. Zhivago is given a more formal medical education than most (wjth the unsettled pre-revolution and abortive

t2

second book ofthis monum€ntal qlartet. The

patient in this same institution, is fourd to be tuberculous hims€lt His proposed three week visit stretches into a sev€n y€ar sentenc€.

Mann describes the life of l€isure, the reSime

complexit/ and interwoven counterpoint of

the theme p.esents dificulty in deriving a clear imaSe of any .haracr€r, not the least this being true for Balthazar. A jew, and rrther a shadowy fi8ur€, but whose very pres€nce €manates strenSth-as lustine

of

superlative food, strictly observed r€st hours, and the all embracint boredom. T€mporal matters hinge on the thermometer ritual, not the arbitrary hour or day; as Hans remarks, becoming aware of his illness.

-,

"Balthozat is the onlf nan to whom I .an tell eve{|i'hing. He only loughs. But somehow he nelps ,ne to dispe/ the hollowness I feel in

"99.6, in broad daylight, hetween ten and halfpost in the thaa wos too mu.rr, it wds 'l,orning,

A man with uSly hands (in his temporary lapse from g.ace, he even attempts to cut them off, so deep is his despair, before being restored and revertinS to his former s€lf). He em€rtes as a more than competent doctor who appears to moye in an aura of wisdom aod benevolen.€; h€ is mentloned as spending much of his working time in th€ Sovernment .linic for venereal disease. . . " l live ot the .entrc ofthe .ity's life-its genito-

The sanatorium is no primitiye placethough, all patient! are X-rayed, tapped and percussed,

and auscukated at regular intervak. . . and recorded as faint, diminished or vesicular; rough, very rough and rhonchi- th€ latter being ominous. Dr. or Hofrat Behrens th€ proprietor, practices the'Pneumothorax', and is r.egular dab at it. An incision is made somewhere on the 5id€, then the), fill you up with nitrogen, which has to be ren€w€d ev€ry

utinoty j'stelx: it is a sobeting sott of pla.e".

BalthMr is at times cajoled into philosophising. revealing a subtle humour...

"We get too .ertoin of outselves lJavelltng bockwads ond fotwotds olong the trcnlines

two vreeks; one girlacquir€5 the biza.re party

trick of being able to whistle with

her

she has been walking rcthet fast, she it whistle, she uses up het nitrogen when she do€s it, for she ,l os to be tefrlled once

"When

can noke

of el',piti.'al fad.

Occosionolly one gets hit softly on the head by a strcy btick whi.h has

been loun hed

Mann is no laSgard, and has Hofrat Behrens speculating on med ical advan ces; he is cr€dited wirh such a sag€ observation as. . .

"Everybody hos cocci and ony oss can have

fron sone othet rcCion."

Perhaps rhen the strikang thing about the doctors, porrrayed by these Sifted writ€rs, is the vividness oftheir personalities. For them, the 'rakon d'etre' is not simpl), medicine;

there is no hidinS behind the doctor's mask or the white coat image, they exkt as individuals wirh their medical pseudon),ms, almost s an incidental. lf these fictitious characters are painted unrealistically, then what a misfortune for the doctors of Maudlin Street.

and slightly off the tra.k. . . "we orcn t more tion three stePs from tfe conception thot tuberculosis is d dtsedse oftbe

Again, mention of u stepto-vacclne treatment, of which Behrens Promises himself 'unheard of resolts', is made, and our hero submits to bloodletting for culture justforth€ inreresc of seeing his buSs grow.

Balthazar Finally a mention of Lawrence Durrell s, Doctor Bakhazar, who gives his name to th€

JOHN ROUTH l3

this Sroup and his pioneerworkin pulmonary and €ard iac su rgery is widely r€coSnised. He is,

however, best known for his contributions to the surgery ofthe liver, becoming a world authority on the treatment of portal hyp€rtension, so that patients and visitors came from far and wide to l€arn from and work in hl! department. ln addirion co these surgical achievemenrs. he still found time for a lvide range of extra mural aciivities and following el€ction to the Councll of th€ Royal Colleg€ of Surt€ons ln 1953, he has served on man/ nailonal and international commlltees ruch as the Medical Res€arch Council, the N!fiield Foundation and the M€dical S€ction of the University Grants Committ€e, all of whlch have contributed Sready to the organhatlon and development of surgery in many parts of the world. He w"s elect€d a Fr€eman of the City of London in l95l and in 1962 was made

Profe.ror R. Hilncs Walker, C.S.E., M.S., F.R.c.s., F.A.c.s.(Hon.) Many students io this country and abroad will rememberwlth esteem and affection Professor

R. l,lilnes Walker who reilred as the first full-tlme Prof€ssor of Surg€ry ln th€ Unlverslry

of grlstol io

August last year. Comlng to Brlstol ln 1946, lmmedlately after the last World War, he had to create a Universlt/ Departmentof Suryeryata tlme when SurSery itselfwas rapidly expanding, scle n illic research was €xtending into clincial surS€.y and many of the cla$ical conc€pts of teaching were Educat€d

it

Oundle School, where

he

gymnrst, he trilned subsequenrly at University College Hospitaland griduated M.8.,8.S., with Distincrion in 1925. He passed his M.S. in 1927 and wa5 awarded Gold l,ledals with both degrees. He obtained rhe diplomaof Fellowship of the Royal College of Surgeons exc€ll€d

an Honorary Fellow of the American Coll€ge of SurSeons. His advice and time were more and more sought after and in 1964 at rhe age

as a

of England in

lt8,

of 5l years he retired from the Chair of Surgery, being mad€ a Commander of the British Empire in th€ same year. H€ has reason to b€ proud of the Deparrment he created and the services h€ has and still

his postSraduate training

in surgery beint at the Coventr/ and WaF wickshire Hospital and the SurSi<al Unit at Unlversity ColleSe Hospital. He was elected to the Consultant Staffofthe Royal Hospital, Wolverhampton,

in l9ll

continu€s

the p.ivilege of working with him and

and rapidly estab-

personal qualities

abilitl.

These qualities w€re recognised as early as 194,t, when he was elected to the Court of Examlners of the Royal ColleSe of

of

En8land, whilst

siill ar a

his

of

kindness, unassuming modesty and enthusiasm have resuked in hi,s acquirinS friends throuShout the world. His wife, Grace, and his famil/ have cont.ibuted much to University life and rhe hospltalir), they extended to a larSe nomber of srudents

lished himselfas an outstandinS surgeon with wide experience and tremendols technical

SurSeons

to render to British SurSery. He is

reSarded with admiration by all who have had

and vhltors from abroad, irrespecrlve of

non-

teachlnt hospltal-a rare dlstlnctlon, ln Brhtolhe <ollected round hlrh men whom he lmbued wlrh hls own enrhusiasm and moulded them into a surSlcal unit whrch over the yeaff nor onl), fulfill€d lhe Unlversiry

status, colouror cr€ed ls wellknown.

Both the students and stsffofthe Univer!iry over th€ last elthteen years have reason to be

trat€ful for the work done by the trsr fulltime Professor of Slrgeq/ co the Universary of Bristol and to wish him and his wlfe every happlness in the new €.a of their lives that has just begun.

ln

requirem€nts medlcal educarion, bur acquired for its€lfa National and lnternanon.l reputation for surSery and rese.rch of rhe highest.alibre. He remained outslinding in

t. t4

PEACOCK, F.R:C.S.

aarr.swrtif||'atq

HOW

TO WIN YOUR VERY owN

A

HOUSE-JOB

^.t-

.lt ts €s..nii.l to gei, a eood r6pui.tio! on t,he Firn.EveryihinA tou do i. Doti..d and rill he reDebb€.ed by.6!eone.You c.nDot be Loo .nreful nbout r.trr 6cti.na oD the Firornld Jou cirno( 6t.rl, too s'ooD on you. nit.rel to .onv.X . good i.pre8.io! of tourself.

2.

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Ih. ;nttent6 take t lot ol Dotic. of totr .ad it ir c.rL.itrlt re*.ber.d bJ e.ber. o! tn. !i.fl rh.ih.r i gttd.trt looked civitt.ed or lot.

4l.

if nt nll Doesible.Tiir ey loi teach you very Du.n .bout i,he d!bl..t .orc.rn".l,btrt t{ rill tedch tou t. b. ! g.od ldDint.lEior(,hi.n is rhat .o.t houre.@n r.!llr ire ).

D6 dhe Loctrr

dA

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d good cbnc. ot g.iting,!!d kior rho

t,h.rk you for

tt.

t. .rort :gg tsrd - rou ne.d Lh€ referercc lor your future job3,

a.se sr.teful

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nF tou r.nllr rure

You

t.!i

ADVICE BY TONY DROPPINGS t7

the Arts and Sciences at Pre-University l€vel,

The Feudal Kingdoms

and secondly a greater co'ordination berw€€n the diffe.ent parts ofthe curri.ulum, so as to pres€nt a united course, combinirg a scientiJlc

assimilation and its application.

"/vled,col Scrroois ore not designed fot chonqe.

They ate feudat kingdons ||herc evety bo.on is all-powetful in his ovh castle."

Sir Charles lllingworth-

Television The problem of how to improve the presentation of preclinical material was heatedly attacked. D€monstrations of living anatomy and tutoriak on prepared specimens were d€manded rath€r than the traditional hours

ln th€ New Year, delegat€s from medical schools met in BirminSham under th€ auspices of BMSA for a national conf€rence on

Medical Edu.ation, to equip themselves with battering rams needed to invade the mighty

spent on dissection. More us€ ofteaching aids, such as closed circuit television, was consid€red. Us€ of television has already been tried in some lvledical Schools. Jor clinical demonstEtions as well as preclinical, and was widely acclaimed. At the Royal Free Hospital, pathological specimens at post mortem are

fort.esses of medlcil tradition. The result of two days hard dlscussion, was a document of47 recommendations drawn up from a report by BMSA, and forwarded to the n€wly formed

Committee

on Mediql

Education

of

the

G€neral Medical Council-

t€levised (and consequently magnifed) with commentary. thus enablinS a large number of stud€nts to view in comfort, instead of th€ perpetual n€ck-craning in hardly agre€abl€ surroundings, At Newcastleand the l.4iddlesex

ln the training of a doctor, th€re a.e at present two €ntir€ly separate concepts of the basic principles on which a Medical cLJrricul'im should b€ constructed. This st€ms

Hospital, tel€vision lsed for anatomical demonstration-other'shospitals have us€d it to show pharmacological experiments, and in the Psych'atry and E.N.T. departments; a television camera can apparently peer down a throat much more efiicienrly than

from the unanswerable question as to whether Medicine is an art or science. Ther€ a.e thos€ who consider that a three y€ar Honours Degree course in Human BioloSy without any

clinical bias whatsoever, should prec€de practical work in hospital and from a purely scientific ground on which to base the clini€al training. Thls ls oppos€d by an equally strong opinion thatthe p r€-clinical yea.s should be as short as possible, and that th€ majo.ity of medical knowledge can be t?ught from the bedside, using the patient as a t€xtbookThe ideal rurriculum would encompds

both these views, but at pres€nt

it

th€ averag€ student.

Concentration of teachinS There was great concern about the concen'teaching hospitals' only. This was particularl),stressed by delegates from some of the London

tration of medical education to

Hospitals where th€ patient student ratio is v€ry low and where ther€ is a lack ofsome of the more common diseases. A period spent in a'non-teaching' hospital would not only

deals

satisfactorily with neither. as the Preclinical Years are us€d to push in the cannonloads ofscientific fact, instead of fostering an ability to assimilate scientjfic knowledSe, which can then be appli€d to the animate being, the pat'€nt, whose welfare rnd cure, is aft€r all, the purpose of the exercke. f4any delegates, time after tim€, str€ssed this need for a greater link, firstl/ berween

enable

the student to witness:lternative

approaches to medicine, but aho to experience a different clin ical climate. This wid€ning ofthe m€dical horizon mightalso h€lp to remov€ the

.egrettable socialstigma, that house jobs done

outside a teachinS hospital ar€ only t8

to

be

THE FORGOTTEN ONES_

appli€d for ifall else fails. and are certainly not a stepping stone to a successful career. Thus r€commendation 43 states: "At least one of the Pre-Resistration House lobs must be done outside the teaching hospital".

ln the articl€ on lYedical Students publlshed in Nonesuch News on Nov 6th, the authors forgot to includ€ some tw€nty-five first ll.B. students who, having studied to'A'level, subiects not sp€cifi€ally required by the medical fa.ulty, are forced to sPend an extra year at the beginninS ofthe coufse.

At its hard€st, this year means studying

General Practice The establishment of Depts. of General Practice and agreatercontact between Medical

Stldents and G.P's is also an essential factor

Physi.s, Chemistr), dnd BioloSy to about'A' level standard. This must be extremely difi-

in aiding the d€€entralisation of t€achin8. and widenin8 itr application. A most impor tanr resolution. seized on b), the Press, was that General Practice Atrachment schemes of at least 2 weeks should be €ompulsory for all Students. This s.heme is already well und€r

cult for the broad-minded arts student who

to medicine.

At its easiert, this year means studyinS only one subject to complete the normal facultl requirements for direct €ntry lnto the se€ond has turn€d

way at Bristol, but on a voluntary basis. and exceedingly well subscribed to. An excellent P!blic Health firm here also €nables the Bristol student to see an application of medicine outside the Facuky. lt was emPhasned that Elective Periods abroad are invaluable in forminS an integral partofgeneral experience, which it is ess€ntial for all students to acquire, and th:t th€re should be greater encouragement and oPPortunities

year, the student in this aPParently fortunate position finds himselfwith Plenty of free time much in factl DesPite the two subsidlary -too subjects that he must Pursle, he can easily become academicall), lazy, havinS a working

week of only twelve comPulsorl hours. As a result, he may well be unable to adjust himselfto the exacting work required right from the b€ginning of the second year. Surely it would b€ ben€ficial for this student to attend

Throughout the conferenc€, it was int€resting and pl€asing to note that this faculty has b€en one of ihe foremost to attemPt experiments in chanSin8 the curriculum.

some ofthe 2nd f'1.8. lectur€s in Anatomy and

PhysioloSy and First Ald if onll to make the second year easier and to PreYent him from becoming mentalll dull Those pursuing this lst ll.B course are entirely divorced from the m€dical school as regards lectures and, aPart from the few who (ake med'cal statistrcs. Gal€nicak Provides the onl/ contacl with actual medical subjeccs

l'{any suggestions made by oth€r faculti€s, on

th€ incorporation of additional courses, or modernisation of €xisting ones, have already been tried or a.e in operation here- However, the emotions roused ,nd spent at th€ Conference, and the scrength wi(h which views were

The material of the course is s0<h that a student may complete it wlth littleor no more

expressed by delegates. only emPhasrsed the

knowledge of medicine than he had when he

current demand, recognised in all fields, for a complete review of

m€dical m€dical education. lt is hoped that the document and recommendations forward€d by B.M S.A. to

arrived at the University. Surely lt is hiSh time that this course should be re'examined in order to make it a real Part of the medical

expressing the opinion of students, will at least be read.

the G.M.C., and 12,000

ANNE MABBITT ANd PETER HARDWCK

ELAINE FLOWER

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NOVEMBER

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JILL GR,EENATWAY 2t

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rchody.

Those headlines were made Possibly by the long. patient acqunition of information over the years when biochemistry matur€d into a scientific subject in its olYn ri8ht, and it is this story, which has interest and signifi€ance that

BIOCHEMISIRY AND MEDICAT STUDENTS It is no great wonder that both students and staffshould be dissatisfied with the traininS of medical students in the preclinical subjects, and lfon€ side ofthis view is to be recorded, I would like to pr€face my r€marks by: state-

of

There are

At

pres€nt Ph/siology, intent. ment Anatomy and Biochemistry form the structure

of a hard-worked five term

course. These subiects must be unshakeably rooted in Purely scientific ground. They serve as a d€scriPtion ol the nomal condition of man. Afrer 2nd

number of probl€ms over which

Pals (h€ rrial our and directed short siShted is l€ss outlook

textbook will enable him to

M.B. a scudent translates to the territory of applled scienc€-m€dicine. This should clearly perluade thos€ who make PUerlle complaints aboui the fact ihat fundam€ntal Blochemistry does not sufiiclently reveal lts importance and slSnlficanc€ to m€dlcine, to make the mental efforr ro adlust thelr vlslons and Intellects to

nore io und€rstording !he subiect than lea'nln8 it, slnce only ln rhis way will che beneflt or rhe subject accrue co the one-time s(udent over that subsequ€nt dauntlng forty years To rhk end a new course mounted chis year for the nrst tim€, will Provlde the necessitiet and Po,nt to slSnificant tr€nds

receive th€ benefits of lJnivertlty teachinS We have been comp€lled for too long, to quote Slr Llndor Brown, "to extrude from our care half-baked, lll-tralned men who are nelther sclentlsts to pracllse the sclence of

which the future docior mayfind relnforc€able'

lo his Patients at a fl]!ure tlme. Bui on the int€rpretation ofthese and ultlmately helPful

we remain formally sllent Our duty is to present

medlclne, nor educated tentlemen to Practlse

a coherent Plcture of

Present-day

Blochemistry. not to forecart (he clinrcal dlvidend of a sclentlfic facr. This demands of the

lrs art." Thh scientlfic troundwork ln the precllnlcal sublects ls . matter then of the Sreatert lmportanc€. We all feel the welghl of rhe responslbility to equlp Potential doctors wlrh lnformatlon now v.hlch is to serve th€m dependably for the next forty years. Thh task

sludent

a

need

to droP hk

self imPortant

pseudo-professlonal attltude to medlclne in hlr first five terms, a wllllngness to accePt a cerrain amount of doSmatlc statements in the lectur€s, whlle still retaining a ldrg€ measure of independ€nce of mind, in rhe knowledS€ that though much ls known a very great deal more ls still unknown, and that only by weighlng scienrlfic evid€nce ln his own mind against his experlence of Proved theories can

A Glamorous Baby and my colleagu€s leach the newest of these subjects-Bioch€mirtry. lt has the

I

advantaSe and disadvantage

a

we are conc€rned. The major of these is communication. We teach to a great vari€ty of classes and to a disparity of intellects within any class. Whereas the ltudent k chrefly con.erned in Passing an eiamination, and his interest ls that the lectur€s should Provide sufil€ient fodder offacts which together wi(h a

of beinS a Slam-

orous bab/. Press coverage of th€ recent Nobel Prlze winners. and the wonders of mole€ular biology tilt the mind of the new students into the nrm belief that th€ subject should b€ pr€sented in lectures and Practical class€s as a giddy, 8llltering cascade of breathtaking scoops. And it isn't like that at all.

he attempt

to adjlst the balance.

Staff-student .elationshiP Though there may be a frrlure o'commun cation on our slde over thk matter, one Point is of cardinal importance: that €ri.ichm by students of the €ontenl or Presentation of 22

their courres should under no circumsrances fulmanate around other deparrments, but quickly come back to th€ memb€rs of rhe dep:rtment direcrl), concerned. This.riticism must be well info.med and corre.tly per, spectived-the student who complains of the unintelligibilit/ of a certain lecture and then is found never to have artended it, is asking for trouble. That most difiicult ol things-the staff-student relationship will improve and allow easi€r ex€hang€ of ideas and a mutual corre.ting of standpoint. Tutorials in this respe€t are vital links in the improvement of

fundamental approach to pure sciencei theirs a vital application of this to the unwell.

And ro to my final point. Though we reach

lor a shor( period offive rerms in the Loral of six lo seven years of a doctors training, the Sroundwork laid here, k so importanr thar it must be laid well. We exercise our ingenuit/ and talents at this end. We ma), sometimes fail, and if we do we should like direcr knowledge ol this. New vhtas open: for lnstance it is the d€partmentt inrention ro make it possibl€fora med ical stud€nr to read Honours Biochemistrl after s€cond 1.1.B. provided h€ has subsequentll taken rhe examination in Subsidiary Blochemistry. To those srudents

this d€licat€ relationship, and ofl€r an environment in which confid€nce on both sides can

grow with understanding of th€ people involved. The nomber of tuioriak, ar present marginally adequate musr be considerabty expanded in the next lears.

One attitude which h communicated to us, infrequently, by studenrs entering their clini-

who find Biochemistry the exciting and stimu-

latinS subject

it

is, the opportunity always

exists and is our hlghest object in reachinS and our only r€turn in 'profits', to produce ProPerlI trained research workerr who can

utilise this posr-graduate exp€rien€e to their chosen field of specialisation.

cal t€ars, is th€ air ofdisparagement cast over

advance

terms'ntelle.tual bI their new tea€hers. I hope this is fictitious, for it hints ai an arrogance and toral

(in five terms) of inculcatinS th€ spirit of €nqoiryr th€ true scienrific attitude of mind

the

content of the preclinicat

Sir Lindor Brown asks "what hope hav€ we

jncomprehension of what all rhe pr€clinicat d€partments strive ro do. Weteach, acrossth€

thatis needed ifmedicine

in this country k nor lamentably behind its rivals." I hope this can be :nswered "yes there is hope".

to fall

divid€ of the second 11.8. examination, different disciplines. Ours is, to repear, a

PICIGD

IT

c.F.P.

!::!{

UP

A SONC IN TEE sPtEH{, CAVE 1T A

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RECONIITIONM XIJC],EIJS -ANN

IT

SOES

LIKX

A

BOB BUSH 23

BENIGN

AND MALIGNANT FRUSTRATION Frustrarion is a ghastly awful disease, which can strike at any level or a8e in p.esen! day so€iecy. lc is virtually impossible to d€fine a normal l€vel of frustration, some inv€stiSators saying you can and others saying /ou can\, while rhe remaind€r say that in certain cat€s yo! can, but of course in other cases you .an't, depending on che dew-poinr and lors of orher things which miSht well be going on ar rhe

time. We ourselv€s have sifred rhrolgh rheaves of evid€nce and have come (nore or less) to the .onclusion that on the whole you

can, bur always b€aring

in mind that

quire

History Now that wc have 8or a clear picrure of

Frustration in our heads we can proce€d. The <ondicion was flrst described by thar randy old l4an of f,1€di.ine Harry Wolph, who w:s once

heard ro say in the Eored Room... "The afilicrion o[ Frusrers is ye mosre unkinde of all ye afilicrions, and doth corse men to acre in all mann€rr ofdavergencies, and corses them to whistle at l',1aiden s ankles and comely shinns". The involuntary act of whastling at

the opposite SEX srill

remains, a prim:rI f€ature of benign frusration, and is known as Wolph s whistle !o rhis day.

Chemotherapy The druS employed for trearmenc k 35Hydroxyphenyldood!m'meLhyurare whi.h is the thirty-fifth derivative of Hydroxlpheny74

ldood!m-methyuric acid (lmperial Emâ&#x201A;Źti.s lndustries). The subsrance has been shewn ro be of very little use, although it has caused rats to'throw-up'and eases miSraine in toads.

22.000 rats were saoificed in the .ourse ofthe experiments and all were shewn to rhrow-up

at the mere mention of the word hydroxyphenyldoodum-merhyurare. Toads were administered v/ith the compo!nd and then hurled with ample force at shollder height upon lhe last remaining rat, rendering the latter unconcious. All the toads complained bitterll of severe headache on completion of this procedure. The effects of rhe drug upon rhe hormone excretion of parient5 v/ich Erg\ syndrome hevâ&#x201A;Ź not yet been investig3red.

Case Histories Itlr. P. came to our clinic complaining of sporadic attacks. Every morninS whilst traveling on rhe Tube he woold deveiop a Playrex advertisement fixation. When the fixation oc.urred he would either be decending opon the down-escalxtor or ascending upon the up-escalator and would have to furiously mark rime by runninS up the down-es.alator or down the up-es.alator, as rhe .ase may be.

"The porte.s are beginning ro norice ' he s:id, "and anyway I keep missing my trains-" lr wa5 obvious rhat the man had an :dvanced form of l,liss O. came to our Rooms in a severely aSitated frame of mind. I keep getrang these frightful Urges doctor", when questioned a5 to rhe precise nature of these urges her nose

quivered and she wa5 unable to speak. On giving her a glass of Ovuletine she regained

Typical facies in Frustration.

l.

Sir,;'qle Frustrotion

Z. Mani. Frustration

3. Cel i bati c F r ustrotion 4. Extremely molignant Ftustt.tion 5. Bizafte Frustrotion

6.

I

her dem€anour and the entire truth came out. . . Whilst she had been on holiday in Minorca sh€ had allow€d her best friends'

The BiblicalGod

poodle to ravlsh her, she was concerned about the possible sequelae. We were able to reassure her on this point, but the general

depleted state was one of f'lalignant

,;{, . , _.,.,-..t .l-- .tr,:,l: :a'-,--.' t...

Recently theologians and philosophers have lpeculated and conclud€d that the Biblical God k out ofdate and that His lmage most go.

The Bible also has.ome in for severe critisism in the term'nology employs

E--r'

't concerning God. The criti<s concluding lhat while God and His Book are inter€sring, they should not be tak€n too seriously and perhaps delegat€d to som€ Museum along with other relics of antiquity. Those still believing being 'not quite with it' are advised

LIkt O.

by these MODERN theoloSians to take places in the l'4useum and for ever hold

Both patients improved markedly on initial administration ofthe aforementioned drug, in each case the libido was evidently depressed. l'4r. P. was shewn innum€rable copies of Everywoman and Boy's Own, non€ of which induced an), rerponse. f4iss O. wis able to visit Crufts and remained completely stable throughout the proceedings. Even in the presence of Bull Mustafrs she was onmoved!

It must be mentioned however. that at this juncture I'lr. P. contracted a severe bout of mumps which confused rhe Gsue somewhat.

The great drawback of Hydroxyphenyldoodum-methyurat€ is of co!rse .he throwin8-up'. The inv€stigators w€re continually dodginS and avoiding the !nexpected frontal assault, this made the €xperimeni exceedinSly

their their

May I, as on€ disagreeing with them and 'not quite with it'offer an apoloSy for my faith in God and Holy Scriprure. I ofer it hoping ),ou won't squirm too mu.h if I quote from the source of the controversy; a thing whi.h theologians do not indulge in too often.

The Scripture makes it plain from the start that asking questions abour God is 'Can a nan by wisdon frnd out God' asks one oI lsrael's ancient sages. Zophar the Naamathite asks the patriarcfi lob the same 'Con thou hy seotching fnd out the alnighty' Both Solomon ind .lob's tormentor receive

an answer to their question in the Apostle

hazardous and many fell by the way-side.

Mr. P. and fliss O. became socially unacceptable and ev€ntuall), f€ll passionat€l), in love with each other. We went to their wedding it was all very gratifyinS. D.R,G,

Paulk letter

to the Corinthian

Assembly,

'God will btirg to nothinE the undetstonding of the prudent \lhere is the wisel Whe.e is the sctibel Wherc is the disputet of the vlorld1 Hos not God node foolish the wisdo of the wotldl for "The wotld by wisdon knew not

H.G.S.

God" ' 26

have to

Th€ usage of ngurative language of this nature is absolutely necessary, when a God

facethefactthatthescripturesdo not setoutto prov€, discuss, orexplain the exisrence ofGod.

who cannot be found by wisdom reveals Himself to lYan. Because God is beyond

No Explanation

At th€ threshold of our study we

This fact is assumed from Genesis onward.

The idea of God is left as an Axiom. Human logic and th€ Hum:n mind are quite inad€quate to deal with the problem and if we attempt to ask questions about the nature ofGod wewill

reason and loSi€ then he.an only b€ revealed

cond€scending into the human realm.

How .an Human reason that cannot even

by

hold the elusive atom or find the distanr galaxyor di8 into th€ un€onscious be expected to understand the nature of the Deity wh€n faced with it in scripture. lt is not Divine limitation that forces figurative languaSe on the inspjred writers, but rather an acknowledgement of the limits ol the Human understanding. This point cannot be str€ssed too much, ir is cenrral to all correct thought on

end up as confused as th€ modern theologian.

Their confusion would be tolerable were it restricted to themselves, bur they procl:im their insiSht abroad to the confounding of

One ofthe greatest difiiculties th€ modern theologians find in Soipture is when God is pictured

as a man

(especially

who G very bad tempered!

in the

lf

Hebrew) and liv€s in

Heaven on a throne. This the), find an almost

insurmountable problem.

When scripture speaks of God in this manner it is usanS the ngure called AnthroPomorPhism or condescension. ln fact scripture must refer to God in rhis wiy because if He is to be known, he must

This figurative languaSe is used

in

To the invisible God are ascribed

s€ripture only expressed God

in

the

concrete t€rms listed above then the theologians might have an ex<use for their bewalderment. But this is not so.

Scriptore mak€s it clear that the God it deals with is far removed from the ngures in

which He condescends.

'No mon hos seen God at ony tine' 'The invisible God'

'lmnottol invisible' 'Dwelling in the light whi.h no man .an

many

hands,

arms, €yes, nostrils mouth and feet (and toes?)

'Grcot is the mystety of Godliness'

To God. who'is not a man that he should repent', is ascribed a whole r:nge of human feelinss repentan.e, sorrow, jealousy, joy,

lf the

'God |9os the Log6'

above quotes do not latisfy the critics taunt that God is still an old man in h€aven, then perhaps the apostle John will

pitl and anger.

We read of God instituting enquaries:s

zeal,

silence them. He merely said: "God is Spirit" and there the matter must rest, let the

though he would learn, of forSetting, of beang reminded, of laughing and even hissinSl We see Him sitting on a throne and dwell-

in8 in a sanctuary-hence the old man

of th€ S€riptural God first

critic

describ€ spirit

before he proceeds further.

in

The fact that God is unapproachable by or any othe. means makes it imperative that God condescends to the human estate, if we are ever to know anything of

God is associated with time, with battle, with buildanSs, wirh inheriranc€, with wfirinS

reason

and €lothin8.

Not onl), are we asked to pictur€ God as a man with Human f€elin8s, but also as a lion, a lamb, and a dove, and at the same time roaring and bellowing.

him.

We are shut up to revelation and know nothing, absolutel), nothing, apart from that one source. Scripture reveak all that we can 27

The Hebrew word for God is ELOHIM thls h a pluralform, the endinS 'lM' occurring ln other words such as CHERUB,TV. Although the word is plural and should naturall), take a plural verb, we nevertheless find in a number of occurrences that the verb is Lrsed in the singular. ln Genesls l.l we read 'ln the beginning God ueoted heoven ond eotth' .

the infinite and eternal God. that is sufiicienti Even if it is in human

apprehend of Surely

language, metaph),slcs may well be left alone.

So far as the nature and ittribltes of God

are concerned we muit remember that the

whole of lanSuage ls symbollc and that ln every utterance concernlng God the revelatlon ls llmlred by the necesslty of uslng human forms of thoughc.

ln thls verse the Hebrew verb for created, is BARA; lc h the 3rd person masculine dng. perf€ct of the verb.

Later down the chapcer v/e come across

The Mediator An llhrttration of thk may be drawn from the well known propertles of'radlo waver', Throuth every room and house radlo waves are passlng contlnually, sllent, lnvhlble, lncomprehenslble. The occupantr are entlrely obllvlous of thelr pr€sence, and unmoved by their messaSe. The human ear responds to the sound waves in the alr. but needs the mediation of

"And 6od satd (3rd p€r, masc, sJnS) 'Let ur ,noke-(,trst per, piu.ol)mon tnou lnoge"' The ldea that God took counsel wlth anSels or rec€ived assirtance from any creature js repudiated by many scrlptures.

So henc€ we have the paradox ln one chaprer concerninS such a fundam€ntal matter as the nature of God, a problem anvolving the use of !ingular and pluralverbs.

We should not expect that Moses would use any words that wer€ misleading on such a vital subject. He evidendy seeks to demon-

the wlreless r€celverto translate the ethereal. waves of which it is quite unconscious into sound which it can det€ct. ln everyday lanSuage we may say that we heard a lecturer speaking over the radio but

in

reality we have only heard the waves interpreted by the rec€iver into sound.

strate the fact that God cannot be properl)/ expressed wirh human lnnSuage. At the very start ofs<ripture we are warned that there is no polsible way of understandinS the nature

ln the same wa), Scripture speaks of Godk face, yoice and hands, but this is only the inte.p.etatlon of unseen splrltual equival€nts that have no counterpart in Human exp€rienc€.

of God in terms of human losic.

It seems that the theologlans have n€ver even started readlng rh€ divine r€cord.

Had they only read Genesis I th€n they would

Apart from this condescension the spiritual realities behlnd would remain for ever

Scrlprure is llk€ th€ receiver and lusr

as

never have produced the pitiful tripe that flows so eloquently from their pens.

Ruler of Grammar arise out of the Nature of thlngs. gecalre man ls male and female we ne€d the pronouns He and She, Because we sometlmes speak of man ln the dngular and plural we haye he and the),. But God dld not arlse our of the nature of thlngs; lhat ls why even the name of God In lhe Hebrew is

the human ear cannot tune to €lectronlc radlatlon so human logic cannot approach the infinlte God wichout a recelver.

That human logic ls lnadeqoate to deal wlth the problem of God was made clear lont before the theolotlans 8ot mlxed 0p ln ri!

The Hebrew Dilemma The way Moses uses the Hebrew word for God in the first chapt€r of Genesis dlsposes of an), theory that scrlpture reveals a God limlted to human reason-

fraughr wi!h grammatlcal difrlcultles,

lAm The 28

hopelesrness

of the

human mind

approaching rhe divine is i utcrared again,n God s reply ro Moses ar rhe burninS bush.

Moses speaking ot rhe mlssron ro Israet

"When

I

say the God of you fathers has s€nt ne to you: and they shotl say to me what tt. Hit nonet what shal t soy Lo Lhem? ' And cod soid to Moses.

"lAf|

THAT

lAl'4-sal-tAt1

years a da), but a day a thousand /ears.

tt

is

impossible for th€ human mind to operare in a realm when rhere i, neirher rime nor space.

Theologians who wish ro enrer rhis r€atm most use a language which is removed from the realm of human exp€rience and togicperhaps that is 'ahat th€/ are doing-and why th€lr writinS ls so obscure.

has seht me',

The idea ofa perp€tuat pr€senr, a condition in y/hich rh€re is neither pasr nor future, mal

Scripture must be accepted or reject€d.

No hilf mdsure here. One must open the Book and accept it:! revelation, or leave jt for€ver closed. lf on€ does open it one can be sur€ that the God depicted is far r€moved from the Old Man in the sky of poputar

not be the meaninS that should be attached these words. But whatever the true

to

translation, the words convey ideas that are as much beyond the grasp of the great€st philosoph€r as the/ wer€ b€),ond the towest Egyptian bondmen.

Christ echoed Jehovah's nam€ when

imaginatlon.

The Bible will not allow man to me€t tt half wa/, he must take tt or leave jt. There can be no room for compromise.

he

r€plied to the Phartsee.

"Beforc Abrahom wos I on."

This statement is not grammatical, ir has no

MICHAEL DENTON

parallej in human experience and no lustrfication in human lo8ic. ir is a ltimpr€ of. truth berond our knowledge. tc i! onty when rhe I Atl 'sreps in condescension, r'hau we may comprehend the messaSe. This is why Jehovah adds in hts r€pty ro

The M€di@l Protectior Socicty

SY,!EPIOilUIT

Mo'es.

LEGAL IJAZARDS OF MEDICAL AND DENTAL PRACTICE

"You shall soy to the .hildren of tsrcet. The Lold God ofYour fothets, the Go,t of Abrahom. the cod of tsoo. ond he God of la.ob has sent ne to you. fhis is my non€ fo. rie ofe"

Crd,ftd,i Pllor. MrLNls W^r@ .Sma!,r: R. c. Tiylor, M^, ;.cx. M!, FRcs. rRc' E.ro6 i! drc Csuaky Dcp.rthdlt F. I. V. M.ilicld, LDs Mishrys in rhc DNtJ Surgcry Fhtrkis T. Evatrs, MR, r,Rcs, FFrncs

Here the absolure I AM-€ondescends ro human limilations and reveats Hrmsetf associited wirh a people-,your farhers'and wirh a time 'for the a8e'.

When the absolute stoops to the relative

Anasfictic Accidcnts

we immediately und€rstand.

While we do not know the I A!1 we know the God of Abraham be€ause of His mantfestation in History. We are never asked to speculat€ over the lAt'1, thar rs bevond us But we are asked to beti€ve in rhe L;rd cod

H. A. Constablc, urcs, rrcp

xvcq'd.y Problcms of Mcdical protecrior R. I. Milne, M., M!, Mno, sanisr€.-At-raw DArE.

.-

].l]c Coroner md thc Docror TsuisD y, AnrL rsr

TrM!,..2,3o PL^CE . . .

It must n€ver b€ forgotren that the God of Scripture is entirell removed from th€ realm of tine. To him nor only is a thousand

AI

LEcru$

TrurE,

?.M,

MlDrc^L ScEooL

Mcdic.l dd Denral Studdrs in their cliniel y€m are welcome.

79

*NIGHT

NURSE'O

9.45 p.m.-Scene-r4ale l'4edical Wa.d-Statr Nurse in ofic€.

Chief Chotoctets : l4r.'f .-zsed gG-lesless-in oxygen tent.

Mr. W.-Bronchial pneumonia-unconscioos, not exPect€d to survivethe niSht Mr. L.-Coronary thrombosis.

Mr. E.-Diabetic-tenile-

Mr. P.-Coronary thrombosis-on cardio-rater machine which bleePs wh€n pulse rate drops.

Other patients, more or

less routine

fi€atm€nts,

Plus

two extra beds in middle

of ward.

loudly because they cannot sleep! Time

Enter: I Junior, I second-year Nurse.

Whisk briskly round giving sleepinS d.u8s-

12.30

check l2o'clock drugs-machine bleeps again

has dropped-quick, where's the the last time! Diab€ti! complains he is hot and sweity-not the onll one! An E.C.G. is being

-pulse Doctor-Mr. W's feed given, perhapr

frantically, "Nurse, come and listen to Mr. W. that Cheyn€y-Stokes ?" Agre€ that it is, -isnt but attention drawn to agitated signal from flr. T., who decides h€ must have a <ommod€ immediately. Whilst fet€hin8 commode, h€ar more bleeps from cardio-ater machine in other ward: abandon commode and dash to Mr. P.---another false alarm-he moved his arm! Back with <ommode to Mr. T. Enter Sister-whilst telling her about Mr.

W. and

his Cheyney-Stok€s, Mr. L.

sev€re pain

done on Mr. P.. and the machine is reset. Take a deep br€ath, interrlpted by yell from a far bed "Nurse,I'vetipped my bottle in th€ bed! ' Can help for the moment, must sit out in chair-machine bl€€ping madly- "Sorry, only scrat.hinS my l€gl" 1.30 a.m. send lunior to lunch-must change that wet bed-Doctors

t

still hopef'rlly looking for

shrieks-

bleeps once more-dash to rescue, but am Sreeted by cheerful "O.K. Nurse, iust wanted a drink!" l'!r. T. d€cides he is no longer interested in th€ commode, but Doctorarrives to s€e coronary,

spining, feet of lead-can't stop, more oxygen n€ed€d, and ice too. Everyone wants teamusr put kettle on as a gesture-must change thar bed, patient still wrapped up, in chair.

Ma.hine bl€eps, call lights ar€ on-rush to

orders Pethadin+machine bleeps-Doctor and Nurserushtot4r. P. again-pu lse dropp€d

deak with

him-

throned. l''lr. P's puls€ now

Mr. P.-puke has dropped again-another E.C.G- m'rst be done-whar about the 2

the coronary

shrieks again-and still poor Mr.

20-at

T. is €n-

last able

coffee-another

bottl€ want€d-don't you dare upset it, either-Mr. W. worse, must tell Sister. Head

in chest-machine

to lo-Doctor

a.m--Junior should go to lunch, cannot

be spar€d yet. S/N. comes again, hoping to

take report from S/N who then depans. lmmediate bleeps from machin€- false alarm, patient merely moved ! lunior calls

to

p.m. t-p.r

?

4 a.m. The machlne

ble€ps-"Only

getrin8 a drink, Nurse . Another E.C.G. it

dethrone I'lr- T.-tfiank goodness for thatl

tank-S/N arrivesand ma<hin€ Soes crazy-instead of movinS from sideto side the pattern is going from top don€, porterfi lk the i€e

th€

Ring for S/N. to check druS-machine bleePs againlBreathe once more, only another drink of water! l'1r- \/!r'. g€ts worse, still hasn't had his l0 o'clock feed, time now 12 midniSht! Doctors want cotree-impossible must make ir themselves-hal ha! Mr. T. gets out of his

(o bottom! Doctors rushinS ever/wherecan't they sleep either? More druts to Sive-

and rr's time !o put the lr8hts on againpatients don't need any awak€nin8, and the b.ight and breezy day statrcom€ bouncin8 on duty, rsking if we've had a nice quiet niSht!

oxygen tent, and protests loudly when put firmly back again. Other pitient3 ako protest 30

to the efons of Chris

News frorn Galenicals

Summart of

s€curit),. However we w€.e not entirelt successful due to lack of assistance, as books totaling {16 were missing. Most of these we are sor.)" to suSgest, were probabl/ removed

Total tu/in8 Price

{410

1963 Debr

t48 7 f 6t3 {4t t3 f 39 t6

Balan<e

{ tt7

16

4

7 0

6

5

2 6 8 I

7

It has been suggested that this need woutd be satisfied by incorporation with the Union Eooktall, W€ feel such a merger would be dtastrous: th€ Bookstall should be run by

during sale.

Th€ accounts

of the 1964 Sookstalt w€re complicated by gross debts and unfinished business inherited from th€ pr€vious bookstall. The debts amounted to f55. I I . I for missinS books and I40 loan rrom Btack Ba8 for purchase of instruments; ters ext€nded credit amounting to ft6. t8. 0, a batan<e of

peopl€ who hav€ experienced preclanical

study and are in a position to alsist the new Medics, in th€ choi.€ of books; it is .un at the most convenient rime and place and it makes proyision for the sale of tab 'nstruments, coats aod skeletons. These facilities the Union gookrall would not be able to offer.

ar C24. t5 . 9

(ahhough we revalued rhem ar considerabtl

les) We allo.evalued lhe missiog books ro

Galenic control has been sugSested though so

f42.17.6. Thus the actuat debr befor€ commencing sale was {19. 16. L This y€ar despit€ a loss ofbooks amountingtoft6 -4.0 we Jinished up with a n€tt profit off4t . t3 . L which leaves us with : balance oI {1.17.7

far no adion has been taken. Since rhe affairs ofthe Bookstall occupy most of the s€ssion, a member of Galenicals Coftmittee could be made responsible p.eferably a cGopted 3rd. y€ar student. We would be wilting to assist and advise an/one who feels they woutd tik€ to continue the venture

Because of the incurr€d debt w€ increased the profit margin. Nevertheless we assum€

that both buyers and sellers were satisfi€d as we have so far receiv€d no comphints. The future of the bookstall, which has become an accepted amenity

17

{

f478 t3 7

so many books had been 'unaccounted for' last year we attempted to enforce maximum

. l0 and instruments valued

Account

L€ss Books Missins

For the srorag€ and sale we acquired rhe us€ of a locked room at rhe Medicat S(hoot. Sin(e

.7

l95d

TotalSellins Pric€ f494

Th€ Booksta t964 Books were priced usin8 the fo owin8 criteria; original price, edition, condition and academi< value. A similar Sradins was made for other arti.les. Thus we t.ied ro enrure a fair deal to borh buyer and se €r.

fl

Davis and colleagues

3 years ago, is now uncerratn. We feel that the facilities it has to ofre. would be greatty missed if it were discontinued. However, in the past the Bookstall has enjoyed only vague con nection with eith€r Black Ba8 or Galenicals.

Now that it is in a position to starr afresh ofrcial recoSnition is d€sirable.

H. M. MURPHY M. H. ORNSTEIN R. W. MORZARIA

to medical students thanks 3t

PANTOMANIA I964 For the connoisseur of

hospital pantomim€s

this year provided a bumpercrop.There were three to choose from, "L€t's Take the Roof Off" :t the Royal lnfirmary, "The Two Way

Mlrror" at the Dental Hospital, and "One Fine KniSht" at th€ G€nerJ Hospital. Of course, bumper crop doesn't always mean the R@f off"

vintage year, but "Let's Tak€ did provide a most €njo),able eveninS's entertainm€nt during it's four niSht run. The stor), ofAladdin was suitabl/ €mbellished with local and topical references which were sufiiciently feYY

to r€main funn/.

The script its€lf was lma8lnatlv€ and often veryfunny but it was not altoSether d ramatically successfu I since the characcers were rather sk€tchy and the dlalotue a littl€ forced. The only character who was funnyfor what he w5s and noi for what he sald was How.rd Smith's "loseph Greentage". Here there was a Sood

opportunlty for fun between the Pantomime characrers and the B.R.l. pofter. lt was a Pity thei so manl comlc sltuatlons withio the story proper should have been lost because they lacked definition. Thls could hav€ been dlsSulsed most efectivel), had the production of scenei been more lmaSinatjve and en€r-

tetic, but too often no (lse was mad€ of movement or exprestlon which even the most solld scrlpt needs. The more cr€dlt then to those characters who livened up the proceedings, notably Andrew Walker ar Wdow Twankey, Anrhony Clarke as the Wick€d Uncle, and Ml(ha€l Richards as the Genie of the Lamp. Graham Purnell as Aladdln gave a solid performanc€ and the best moment ol the eveninS war undoubtedly bis

'rnconvincing

the superb lighting of Robin Garnett. lt is too

edy to take this sort of thing for

granted beeuse, lik€good mak€-up, it's not noticeable.

Both 8ener3l lighting and the etrects (David

Ge.ring)w€relirstclass. Peter Curtis deserves praise for his overall direction of a yery

ln "TheTwo Way Mirror" David Lewls was with considerable difiiculty in the shap€ of the Common Room. Although he was able faced

toconstructamore or less conventional sta8e, it was a plt/ he did not simplify. The sets for example, thou8h imatinative proved awkward to manipulat€ in the confined working space.

The story was a Sood one. The characters vrere boldly drawn and enerSeticall/ played. Thls

show had the admirable intention of not rel/lnt on d€ntal lok€s for lt's laught but unfortunately fell into the eq!ally dangerous sltoation of playlnS relentlessly to the audl enc€. Thk came ofr well wlth the natural .lown of Marrln Betts' "Soldier" but was too often the excuse for a general go slow when €mplo)/ed by the less able.

The P.incess and "Prince". Anne Evans and Martin Ell/att were well cast ar was Llndsay Owen as Nlnette. Richard Joy as P.l. was su. premely Brltlsh, while Davld Phllllpr' "l'l/re" was a tood characterlz.tlon, John Lucla

provlded some excellent laughs as Griswold but it was a pity that he overplayed th€ audi€nce. His orlginal music how€v€r, was the surprise and delltht of the evening, Sood r/thmic numbers, well sung by a vigorous chorus and a hauntinS love them€.

Photogtophs,

fton left to ttght

renderlng of "through all et€.nlty too" in the wedding song.

The guita. trio of lan Mackenzi€, DouSlas Sims and Howard Smith provided a lively interlud€ and it was a pity that greater use waln't made ofthis verl efrective team in the

2. The Genies with loseph Gteengoge.

3. /vlembers oftl'e Chorus.

4. (Left to tight) EnPetor Phlooh,

chorus songs. Miss Jean Wyn-Jones'colourful sers and costumes were much enhanc€d bI

5. Tfte 6rupe.

Wishey-Woshey, Ptin.ess, Aladdin, Emqrcss, Widow fwonkey, Uncle

6.

High and Low Ptiests

(Pantononio,

6t.

ftud p. t2J

lcot.nkots, .@r. ftun p. 3t )

The costumes were pleaiing and

The B.ll

Jane

HlSSlnr' mllllnery wa! splendid. Technically the lnfluence of Rodne/ Staines was heard and felt to great efrect. This was a good start to a rradition which hai Sreat potentialfor the

The Annual Ball was h€ld once more at the G..nd Spa Ballroom, on Nov€mber llth. A

Denral School and David Lewis is

iiafrand d€leSates from other medical schook.

Th€re wis a cabaret whose scrlpt wds punctu-

greater numb€r of stud€nts w€re present than ev€r before as well as members of our

to be cooBrarulared for hk eherty ln breaklnt new ground agalnst conslderable odd5.

The General Hospltal's offerlnS

ared by the more inebrlated (t!e!r who) membeB ofthe audlence. For some tlme now, It har be€n felt that the Grahd Spa k far too small for a Ball of thls slze and h k proposed thar as an exp€rlment lt should be held at the Top Rank Ballroom. Thk wlll be more expensive, but there wlll be room for more people and the faclllties are much b€tter.

Ev€rybody wlll be seated and ltudent! as well as staff, wlll be able to book table!. The slccesr of this move will depend on support.

It should be possible to make at one of the

of "One

Flne Knlghr" thouth not pretendint to be on io complex e rcale as the other two shows was much more of a fourth form rat. lt had one superb momentt when a rtudent nurse. wlth Sreat sklll, pushed a custard pie into the face of a very tallant Dr. Hale, but as thir came at the end, on€ felt it had been earned. Dr. Hale sald that it was a Sood thing that the General Hospital was again trying to provlde some Christmas entertalnm€nt and I fully agree, but preparatlons here wer€ mlnimal and a weak script sagged between the time worn crutches of crudity and shop humour. I lost count of how many times the "magic" word chastity belt was invok€d in the hope of a laugh. The sound €ffects vrere the brltht spark of a rather drear eveflin8. lt was the sort of show that the cast thoroughlt

maior social events of the year.

Meanwhlle prepar€ yolrlelf for the n€xt source of good food and entertainment, the Dinner and Dance on March 23rd at the Grand Hotel.

FRED STAMP

A. E. B. GIDDINGS.

RECENT ADVANCES

lN I'lEDlclNE (Bcrumont rnd

Dodds) larh Edition. Editcd bI

E

on Comprton ind

50s, Dano . tublkh.d ht Chut.hill.

A hi8hly inforn.tlk r6vi., otmrnt r.ceit.dv.nc€! in rhc th.ort .nd pr..d.. ol M.dlcal 3.lenc.. T.xt materi.l nng.i from th..rotlc to th. m!nd.n. and, oft.. b.idSint th. t.p b.tw..n th. b.ddd. and th. l.bo..ro.y, wlll b. found ndt r.rd.bl., Th. .dlroB h.r. !o....d.d lnrhel..lm rotrodu.e r rorL fo. !h. rener.l m.dial r.ad... akhoueh I im vert .rd to note that they h.v. omhEd a .hipt.r on

Book Reviews

ro

It ir to be hoped that thl. v.luable .t.pplnt s!on6 rhit now ovevh.lmi.s r..lh ol .h. 'louriolosl3f

will

sn

6e drabllrhed ln

th.

medl.al llbrary.

c.

34

T_ a.

oavts

AN

MEDICAL EMBRYOLOGY. b),1:n trngman.

Bailliare, Tinddll & aot. Pti.e t0t.

Thk b@k is divided into two j€dionl the tiBr derling with Sener embrtolosy and the .e@nd de.li.g with special €mbryoloy, The seaion on geneEl embryoloSt cov€B 7l pa8$ of rhe lt2 page b@k. The text ir extremely well laid out and very re.dible and there are r grea. numbe. ot ve.y ctea. well rnnorited diasrams. The embryonicd€vetopnent

is dividcd up into

tametog€nisk, fedlizrtion b implintntion, billmi.ar and rilahiner serm dis6, €mbryonic p€riod and fGtal period; th6e dive6ionr althoush naturilly rrtifi.ial are made in sensible p€riods oI development rnd aid in the undedandinS olthe srowth oI the emb.yo a.d roerur, Thc second se.don deils with the dev€lopment ol the bodt systens ind i. €ach secrion rhe no.mat dcvelopment k descdbed followe.l by a .lear illusindon ol the .ommoner congenital rbnormaliris.

Alihough I fe€l the p.ice of rhis book i5 Fther prohabkivc to the mediol ltudeni I would fongly r€commend

iG r€rdins. Unlike mott texlb@ks

medicalsubjecB, this book like a good novel to pur down aat€r onc€ *ahins to .ead it,

INTRODUCIION

H.i,.Dd"r,

1954. pp

TO

NEUROSURGERY by

ll5.

The speciality ot Neu r6u.gert li.s hore within the ..ope of the pst gndu.k rnan rhe lnders.aduare, Nev€dhels, the rise ofnenrcurgery in the pist tew de.!d6 ha .lered 3ome of the pdsimkm whi.h ha

sunounded theneEorintEcanial disease.

Mr l€melt s l.trcd!.tion to N€urosLrgery' 6ve6 the s@pe ot mode.n neurd!.gial practice

with adniEble lucidttt and consciseness.

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