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Title:
Speculum: 1959
Date:
1959
Persistent Link:
http://hdl.handle.net/11343/24180
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Speculum: 1959
EDITORIAL.
RETROSPECTIVE —No. 1.
THE PRESENT STATE OF THE MEDICAL SCHOOL.
OUR OWN EPIDEMIC.
REPORT OF SUB-COMMITTEE RE
SENATE.
CLINICAL LECTURES.
MEDICAL SCHOOL SPORTS.
MEDICAL STUDENTS' DINNER.
ROWING.
MEDICAL FOOTBALL NOTES.
REPORTS ON CASES.
CORRESPONDENCE.
NOTES AND QUERIES
SPICULA.
nlbottitnq:
SAMUEL MULLEN, COLLINS STREET EAST
Registered at the General Post Office, Melbourne,
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As soon as a new men's fashion appears, Henry Buck's have it.
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SPECULUM
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cases wherein attacks of true migraine are induced by emotional upsets
such as travelling or excitement. This is not to be confused with headache of psychogenic origin which is not true migraine and appears to
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SPECULUM
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(Incorporated in N.S.W.
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SPECULUM
SPECULUM
The Journal of the
MELBOURNE MEDICAL STUDENTS' SOCIETY
SI SPECULUM PLACET, INSPICE
EDITOR :
J. A. WEARING SMITH
BUSINESS MANAGER :
J. WRIGHT-SMITH
First Published 1884
Oldest Established Student Journal In Australia
"Speculum" is published for private circulation among members of the M.S.S.
Copies are not supplied to non-members of the Society.
3
4
SPECULUM
Contents
,
Page
EDITORIAL
5
PRESIDENT, M.S.S.
8
THE MANAGEMENT OF MASS CASUALTIES
AUSTRALIAN JOURNEY
HISTORY OF PSYCHOLOGICAL MEDICINE
TO SMOKE OR NOT TO SMOKE . . .
ANSWER ALL QUESTIONS—
STAPHYLOCOCCUS AUREUS
CORTICAL REPRESENTATION
K. H. Heard 10
Geoffrey Asherson
15
P. de Gail
19
Bryan Gandevia 25
Sydney D. Rubbo 33
D.D. 41
VIEWPOINT ON THE GENERAL PRACTITIONER
IN THE BRITISH NATIONAL HEALTH SERVICE E. C. Gawthorn 43
A CONCISE DICTIONARY OF MEDICAL KNOWLEDGE "Herbie" 47
DIAGNOSTIC QUIZ
53
A NEW RUBAIYAT
0., My! 62
M.S.S. CHRONICAL
69
MEDLEY'S '58
75
YEAR NOTES
79
SPICULA
91
SPECULUM
5
EDITORIAL
A Reflection
"After much discussion and deliberation
the name 'SPECULUM' in its widest sense
has been chosen, as it is intended that this
journal shall reflect the ideas of the Melbourne medical student among his fellows,
and some light be thrown on the mind of the
outside public, which we fear has remained
hitherto in total darkness as to his social
condition and sort of education he has the
opportunity of obtaining."
Seventy-five years ago the above appeared
in the opening paragraph of the first editorial. Today you are reading the one
hundred and sixty-fourth editorial within a
cover which has incorporated a reproduction
of the front of that first Speculum.
Much has been written in previous years
and previous anniversary editions of
Speculum about its cover, its contents, and
the colorful path which it has carved in its
travels down the years. It, therefore, seems
fitting that a reproduction of that very first
cover should appear in the seventy-fifth year
of the journal's publication, the Medical
Students' Society being founded four years
prior to this. By contrast, the medical school
will be celebrating its centenary in three
years.
Melbourne Medical Students can well be
proud of Speculum, for not only is it wholly
organised and produced by students and one
of the few publications issued regularly by a
section of the student body, but it is the
oldest University student publication in
Australia—having won a race which developed between it and the Melbourne
University Review (which lasted only five
issues) by the narrow margin of two days in
July, 1884.
Since that time the cover of Speculum has
been altered a significant number of times
as has the number of editions appearing , n
any one year. While two issues of Speculum
were produced in 1884, by 1887 the number
had increased to four, whereas in latter
years only one issue has been forthcoming.
This, in all likelihood, has been brought
about by an expanding curriculum availing
less time for dabbling in production, and
also by the steady rise in cost of production.
The journal has, however, been enlarged—
the 1884 Speculum measuring as depicted
and having twenty pages compared with
today's dimensions which first appeared in
1921 and which has contained an increasing
number of pages. For the last five years
this has been in the vicinity of one hundred
pages.
Take another glance at the opening paragraph. It states, ". . . that this journal shall
reflect the ideas of the Melbourne medical
Ire
SPECULUM
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We are proud of our association in providing an essential part of the health services to the community. We are proud, too,
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BURROUGHS WELLCOME & CO.
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SPECULUM
student among his fellows . . ." In 1884 such
was the case, the issue being comprised
solely of students' contributions. Today the
emphasis seems to be on articles of a technical nature submitted mainly by graduates
—if this is a fault, then the responsibility
rests wholly with the students. Assuming
talent lies within the body of the Medical
students, why has it not been brought to the
forefront? Could it be that the burden on
the student has been getting too oppressive,
that the seekers and the sort-after have
been too deeply immersed in the pages of
their texts, or too deeply immersed in themselves?
Speculum today is most versatile in its
scope and should therefore provide the
students with ample opportunity to write
articles and to express openly their views
concerning the society. The so-called
"pointedness" of various aspects of the
magazine is now traditional and has been so
since attention was first drawn to this fact
in 1901. Major disciplinary action was taken
with regard to this "pointedness" in 1911,
1912, 1921 and 1933. In 1921 a whole issue
was recalled and Speculum has at times been
threatened with extinction. This has probably been a major factor in determining that
Speculum is now published for private circulation among members of the Medical
Students' Society, and it is—to quote again
from the opening sentence—no longer possible that ". . . some light be thrown on the
mind of the outside public, which we fear
has remained hitherto in total darkness as
to his social condition and sort of education
he has the opportunity of obtaining."
Speculum provides for both student and
graduate. The former looks to the journal
to read articles on subjects often new to him
and for relaxation. The latter probably
looks to it to find out what the students of
the present day think and do, and, in the
main, for relaxation from the cumbrous
matter in his many technical journals.
Thus, it seems reasonable that a greater
proportion of Speculum should be studentinspired and that voluntary contribution
should not be found wanting.
Turn back to the front of this Speculum.
Look again on the original pale blue cover
and reflect on what it stands for still.
SI SPECULUM PLACET, INSPICE
SED SI NON PLACET, MEMENTO QUID SPECTES
8
SPECULUM
PRESIDEN T, M. S. S.
Professor Sydney Lance Townsend is
welcomed back this year as President of the
Medical Students' Society, a position which
he has accepted on three previous occasions
from 1952-54 inclusive.
During his medical course Professor
Townsend was R. and L. Alcock Scholar at
Trinity College in 1932, 1933 and 1935 and
graduated M.B., B.S. at the University of
Melbourne in March, 1936, with honours
in Obstetrics and Gynaecology and in Surgery. He played rugby for the University
and was awarded a 'Blue' for rifle shooting.
He held hospital appointments in Bendigo, Melbourne and Tennant Creek after
graduation and went to London in 1938 and
studied at the British Post-Graduate School,
being admitted to Membership of the Royal
College of Obstetricians and Gynaecologists,
and to the Diploma of Tropical Medicine
and Hygiene in June, 1939. He was
appointed a Registrar in the Obstetrical and
Gynaecological Unit of the West Middlesex
Hospital, University of London, and held
the appointment for a year until his enlistment as Surgeon-Lieutenant in the Royal
Navy. He served afloat during the evacuation from Dunkirk, and in the Mediterranean station as a Senior Medical Officer at
Port Said. In 1943 he was promoted
Surgeon-Lieutenant-Commander and i n
June was transferred to the Far Eastern
Fleet, with headquarters, as Senior Medical
Officer at Colombo. Professor Townsend
received the King's Commendation for
Bravery, and was demobilised in August,
1946 with the rank of Surgeon-Commander.
He was made a Fellow of the Royal College
of Surgeons (Edinburgh) and spent a further
year as First Assistant at his old teaching
hospital, the West Middlesex, returning to
Australia at the end of 1947.
He commenced private practice as Consultant in Obstetrics and Gynaecology and
was appointed Demonstrator in Anatomy in
this University in April, 1948. He was made
a Fellow of the Royal Australasian College of Surgeons and a Member of the Honorary Staff of the Women's Hospital and the
Austin Hospital. He was the first appointment to the newly created Chair of Obstetrics and Gynaecology in December, 1950.
In 1951 he was made a Fellow of the Royal
College of Obstetricians and Gynaecologists.
He received his M.D. in December last year
for a thesis on "High Blood Pressure and
Pregnancy".
Professor Townsend is married and has
four children. He spends three weeks each
year with the Royal Australian Navy and
on the recreational side enjoys gardening
(done by his wife), and yachting when time
permits, hoping some day that the possession of his own yacht may be his lot.
SPECULUM
SYDNEY LANCE TOWNSEND
10
SPECULUM
THE MANAGEMENT
OF MASS CASUALTIES
K. H. Heard, M.B., M.R.A.C.P.
The advent of thermo-nuclear weapons
and the possibility of their use against cities
has posed problems in medical care of
casualties that have not previously needed
consideration.
It is not intended, in this paper, to consider the problems which belong to Civil
Defence, such as:
Organization of rescue squads.
Stockpiling of medical equipment.
Organization of medical teams and
zoning of hospitals.
It is of interest to note, however, that if
the city of Melbourne received a direct hit
from a megaton type weapon, any worthwhile medical aid would no longer be possible from our own resources. Sydney and
Adelaide would have to come to our rescue.
This paper is restricted to a study of the
problem which will confront the individual
medical officer who has the task of dealing
with mass casualties and who is responsible
for their initial medical treatment and their
evacuation to hospital or a place where
definite medical treatment is available.
The first and most important task is that
of giving priority to the most suitable cases.
The incidence of an overwhelming number
of casualties requiring major surgical treatment will prevent every case receiving the
optimal medical care that is given to civilian
with casualties occurring in a civilian popucasualties in peace time.
Optimal medical care pre-supposes that
the following requirements are available:
1. Sufficiency of medical personnel at
all stages of collection, evacuation
and treatment.
2. Hospital facilities for the medical
and surgical (including pathology
and X-ray) treatment of casualties.
3. An orderly and rapid transport system for evacuation of casualties.
It must be remembered that when dealing
lation, as opposed to an army in the field,
provision must be made for obstetric care
and the treatment of chronic diseases, diabetics, epilepsy, hemiplegia, etc., which are
excluded from army casualties by medical
selection at enlistment.
As the above requirements cannot possibly be met in a disaster of the magnitude
that may occur a new approach to the medical problem becomes necessary. This has
been called "the Group approach". Its
basic principles are:
1. Life is more important than limb.
2. Moribund cases must not occupy
more than the minimum time.
3. Casualties in good condition will be
given priority of treatment over
those whose condition is deteriorating to such an extent that they will
need extensive resuscitation before
definite treatment is possible.
This approach needs good judgment on
the part of all medical officers combined
with a ruthless rejection of cases that need
not be treated immediately.
As delayed medical care, and its cost in
mortality and morbidity, is not studied in
the normal way it becomes necessary to
enquire into this in three ways:
1. Elapsed time between wound and
treatment.
2. Types of wounds.
3. Anatomical sites of injury.
SPECULUM
Cost of delayed medical care:
The majority of those who die of wounds
die shortly after injury. Early and adequate
treatment affects the late mortality much
more than it does the early mortality.
There is practically no difference in the
percentage of wounded who died in the first
24 hours in the Crimean War and World
War II, and even for 48 hours the difference
is less than 2 per cent. But overall the
difference for wounded in action who died
is 12.5 per cent. 17 per cent. for the
Crimean War and 4.5 per cent. for World
War II. This 12.5 per cent. represents the
group which can be saved by early and
efficient treatment. In Korea under circumstances which were very favourable for
early treatment but which probably could
not be duplicated elsewhere, 3.6 per cent.
was the total overall mortality for WIA and
the 12.5 per cent. would become 13.4 per
cent.—an increase of less than 1 per cent.
despite an evacuation from R.A.Ps. and
massive and prompt resuscitation and quick
surgery. Abdominal cases were submitted
to operation 2.6 hours earlier in Korea
than in World War 11-6.3 hours against
8.9 hours (average). Beebe and De Bakey
have produced a table showing that, assuming 3.8 per cent. is the minimum death
rate for those treated adequately within 12
hours of wounding, the death rate will only
rise 100 per cent, for those who have to
wait five times as long, i.e., 60 hours, for
treatment. Early treatment should reduce
deaths from haemorrhage, shock and infection in all types of wounds. It is universally admitted that early control of external
haemorrhage greatly reduces mortality and
that it must always have first priority.
Shock will always be treated as early and
as thoroughly as possible. Infection is
always worsened by delayed treatment.
Even in civilian practice with presumably
infection occurs in 6.4 per cent. of soft
tissue wounds and 14.1 per cent. of cornearly treatment it is reported that serious
pound fractures; while in burns serious infection occurred in 8.1 per cent. of second
degree and 35.5 per cent. of third degree
burns.
In the case of burns this can seldom be
prevented by attention to the wounds or by
antibiotics. The importance of this is evident when one remembers that in 65 per
11
cent. of the casualties in Japan, burns were
the main disability and that 85 per cent. of
the casualties treated had some degree of
burns. Therefore it appears that delayed
treatment of burns whilst increasing the
mortality from shock will not greatly influence the morbidity from infection. The
incidence of gas-gangrene will increase both
the mortality and the need for urgent surgery. In Korea the incidence was 0.08 per
cent. and the mortality nil at one forward
hospital. In World War I at one hospital
where there was a delay of up to 48 hours in
receiving wounded, the incidence was 5 per
cent., and of these 5 per cent., 27.6 per cent.
died.
1. Central Nervous System
In World War II the following statement was made: "Contrary to previous
observations, in the recent war the age
of the wound at the time of operation,
up to 48-70 hours, made little difference in the incidence of infection or
the mortality. Therefore, criteria
other than the time-lag from wounding
are more properly used to determine
priority for surgery during this period,
providing the patient is receiving adequate supportive treatment and chemotherapy."
H. Thoracic Wounds
Open wounds limited to the thorax require formal thoracotomy. Open chest
wounds must be closed; pneumothorax and
haemothorax must be treated by aspiration,
not by tube drainage. Tracheotomy may
be required. The haemothorax is probably
never completely cleared by treatment so
that immediate treatment will probably not
influence greatly the incidence of empyema.
The difference in mortality will be in the
treatment of mechanical defects and blood
loss. The institution of this type of treatment early will save many lives—delay over
12 hours may quadruple the mortality rate.
III. Abdominal Injuries
Essentially all of these require laparotomy and rapid treatment in Korea reduced
the mortality from about 23 per cent. in
World War II to 12.6 per cent.
This is reported as due to:
General improvement in surgical care.
Earlier and wider use of antibiotics.
12
SPECULUM
Reoearch . . .
". . . . to merit and preserve the
confidence of the best element
in the medical and pharmaceutical professions . . . . to build
well, to last."
It was in these words that, over 90 years ago, the
founders of the House of Parke-Davis expressed their
policy for the future.
To meet these self-imposed and exacting demands,
research has been a constant feature of the Company's
activities. Over the years many contributions to Medicine have resulted: vegetable drugs such as Cascara
Sagrada; glandular products, including Adrenalin, Pituitrin, Pitocin, Pitressin, Antuitrin "S" and Eschatin; vitamin preparations; and many synthetic chemicals such
as Dilantin. Recent achievements include the antihistamines, Benadryl and Ambodryl, and the first synthetic
antibiotic, Chloromycetin.
Today, backed by a research programme more extensive than ever before, Parke-Davis offer the medical profession products worthy of their symbol, "Medicamenta
Vera" — truth in medicine.
PARKE, DAVIS & CO., LTD.
(Inc. U.S.A.)
BOX 4198, SYDNEY
SPECULUM
Earlier and more generous use of blood.
Quick pick-up and evacuation.
Operating time in Korea averaged 2.4
hours for abdominal wounds and 2.3 hours
for thoraco-abdominal wounds. In the first
24 hours these cases received on an average
over 3 litres of blood. Thus it is obvious
that with mass casualties these cases will
consume far more man hours in treatment
than their incidence (6-9 per cent. of all
wounds) warrants.
The patient who is in good condition
without resuscitation will take priority.
Those vomiting from radiation sickness will
be of a much lower priority.
IV. Orthopaedic Injuries
The increased hazard of infection following delayed debridement has been discussed.
The case fatality rate might not be greatly
increased by delay but the rate for traumatic
amputations doubtlessly would increase
sharply.
V. Vascular Injuries
The amputation rate following ligation of
peripheral arteries in World War II was 48
per cent. Primary repair within 12 hours
of injury in Korea reduced the amputation
rate to 7 per cent. and the incidence of gas
gangrene to 1 per cent. It was also found
in Korea that repair could often be achieved
as late as 24 hours after wounding.
In mass casualties saving of life must take
precedence over saving limbs and ligation
will probably be the only early treatment.
VI. Facio-Maxillary Injuries
Standard practice includes not only debridement but primary repair of these
wounds. Since only the more seriously
injured are admitted few patients could be
managed under local anaesthesia; many
would require endotracheal anaesthesia and
many would also require tracheotomy.
Primary repair after 24 hours would hardly
prove feasible. One surgical team could
not handle more than 10 cases per day.
VII. Burns
Since these patients can seldom have debridement done early, since antibiotics do
not prevent infection in undebrided wounds,
since all of these wounds will be contaminated at the time of admission, early treat-
13
ment will not materially affect the incidence
of infection. Is early treatment necessary?
Ziffren, speaking of the treatment of burns
in civilian practice, says: "In no instance in
this group of cases did a patient survive
who had 45 per cent. or more of the body
surface burned to a third degree depth. Immediate debridement under anaesthesia had
no effect on the mortality rate, and neither
did the early administration of antibiotics."
In view of this common experience, the
lowering of the mortality during the acute
stage must have resulted from the support of
the blood volume. Since the loss of blood
and plasma is progressive and cannot be
controlled, what will be the cost of delayed
therapy?
Burns of 40 per cent. or more will nearly
all die despite prompt therapy. Burns of
20-40 per cent. will frequently produce a
severe depletion of blood volume, shock
and death unless given early treatment
which will save many of them—without
early treatment many of them will die.
Shock is responsible for 80 per cent. of the
deaths from burns and as 35 per cent. of
the patients will be in the 20-40 per cent. of
surface area burned delayed treatment will
increase the over-all mortality by at least
15-20 per cent. The staff and supplies
needed to treat these cases is enormous.
Add to this the phenomenon of "Cross
Stress"—the synergism resulting when a
casualty suffers from both burns and radiation.
This apparently commences when the
dose of radiation exceeds 100 r. Taplin
estimated that the mortality rate for 10 per
cent. second or third degree burns increases
from 5-10 per cent. to 15-20 per cent. if
combined with a radiation dose of 100-250
r.
As the treatment for both burns and
radiation sickness is blood transfusion it
must be remembered that repeated transfusions from different donors may create
more hazard from the risk of serum hepatitis
than that from the original radiation exposure.
In the Hiroshima incident when no real
medical care was available for some days,
most cases that survived long enough to be
treated were relatively superficial flesh burns
of directly exposed surfaces plus burns
SPECULUM
14
from charring and ignition of clothing. The
more serious burns died before rescue.
SUMMARY
The early increase in mortality with delay
in treatment will be due primarily to delays
in correction of blood volume deficits and
mechanical defects; increased morbidity will
be due primarily to increased infection,
increased destruction of tissue, and delays in
secondary wound closure.
In order to give precedence to life over
limb and to provide the greatest care for the
greatest number, priority of supplies and
medical treatment must be given to:
The control of external haemorrhage.
Correction of blood volume deficits.
Treatment of burns of 15-40 per cent.
Amputation of mangled extremities.
"Non-operative" treatment of penetrating
chest wounds and, when possible, repair of penetrating abdominal wounds.
A mathematician named Sputz
Had a formula for smoking old butz,
The cube root of their weight
Plus tobacco less eight,
Was a third of a twelfth of . . . oh Nutz.
—Speculum, New York.
"Medmak"
Speculum is very happy to welcome the
Makere Medical Students' Society and their
magazine "Medmak" to the ever-increasing
group of student exchange journals.
Makere Medical School is at Kampala,
Uganda, and at the time of publication of
their first issue of "Medmak" had eightythree medical students. It is indeed inspiring to see such an enthusiastic group of
students produce a magazine worthy of
much merit. Articles included are by both
staff and students on historical, technical,
and non-technical subjects.
Owing to the burden of financial difficulties, which accompany every student
society's aspirations, "Medmak" does not,
as yet, contain photographs or illustrations,
but its editorial staff trust that these inclusions might be attained in their next issue.
We look forward to receiving future
exchange copies from our new brother.
*
*
*
The turtle lives twat plated decks
Which practically conceal its sex.
I think it's clever of the turtle
In such a fix to be so fertile.
MEDICAL AGENTS
FEDERAL SECRETARIAT PTY. LTD.
(B. A. CUSACK)
M.L.C. BUILDINGS, 303 COLLINS ST.. MELBOURNE
• Practices Transferred
• Partnerships Arranged
• Assistantships Organised
• Locum Tenens Provided
PHONES: 61 2107 — AFTER HOURS : FX 3668
62 5498
Managing 2irector
—
B. A. CUSACK
SPECULUM
15
AUSTRALIAN JOURNEY
Geoffrey Asherson,
M.A., B.M., M.R.C.P., (London)
British Memorial Fellow to the Clinical Research Unit of the Walter and Eliza Hall Institute
of Medical Research and the Royce Melbourne Hospital, 1958 - 1959
Going to Australia is quite an adventure.
I travelled as a ship's surgeon on the Sydney
Star, a large cargo ship with extensive refrigeration space. Most of the crew were
under 26 years of age and were undertaking
eight years in the Merchant Marine as an
alternative to National Service. They never
reported sick without good reason. It is
traditional that sea-faring men drink freely
and I saw one man with alcoholic pancreatitis and another with delirium tremens.
In my journey from England to Australia
we visited South Africa and New Zealand,
and I was impressed by the changing
medical scene, modified by climate, habits
and race. Thus, at Durban I visited the
King Edward VII Hospital which is the
native teaching hospital. Professor Adams
was conducting a statistical trial on the
effect of chlorpromazine on the prognosis
of tetanus. Despite favourable clinical impressions he was unable to demonstrate a
reduction in mortality. In the natives
amoebic dysentery may take a very severe
form resembling fulminating ulcerative
colitis and may even progress to perforation
of the colon. Recently liver biopsy at this
hospital has shown that acute amoebic
hepatitis is not really a distinct entity but is
due to the formation of many small abscesses. Heart failure of unknown cause is
frequently encountered among the natives
and is called "nutritional myocarditis" although it does not respond to dietary measures. Tuberculosis in all its forms is very
Common and I saw several patients with
tuberculous pericardial and peritoneal effusions.
The native Bantu mothers usually breast-
feed their children up to the age of two
The children then receive a diet
years.
adequate in carbohydrates but deficient in
protein. The disease kwashiorkor is
attributed to this imbalance. It is characterized by irritability, diarrhoea, protuberant
abdomen, skin lesions with both hyperpigmentation and depigmentation, and hair
changes with loss of the typical Bantu curliness and pigmentation. The liver is usually
enlarged and there is pancreatic damage
which may lead to steatorrhoea. In adults
cirrhosis and primary carcinoma of the liver
are common Curiously, iron deficiency
anaemia is rarely seen among the Bantu.
The factors involved have not been defined.
Sickle cell anaemia which is common in the
malarious areas of Equatorial Africa, does
not occur among the Bantu. Coronary
thrombosis is rare.
It is a curious and unexplained fact that
disseminated sclerosis is uncommon among
the white people in South Africa, although
it is one of the more common neurological
diseases in England and Holland and has a
familial incidence.
Reaching Auckland, New Zealand, I
found a copy of Laudor Brunton's Lectures
in Pharmacology in which he describes how
he discovered, while a resident at an Edinburgh hospital, the value of amyl nitrite in
angina pectoris. I visited Rotorua and saw
a unique landscape of geysers, volcanoes
and bubbling mud. The ornamental fountains in the town were played by natural
steam and there was a pool of boiling water
in the public park.
And thence to Australia where I was to
serve my Fellowship. Modern hospitals are
SPECULUM
16
Although there are few diseases peculiar
to Australia, the pattern of disease differs
from that in England mainly for social
reasons.
Disease due to alcohol is prominent in
Australian medicine. Bleeding oesophageal
varices are a more common cause of
haematemesis than in England. Pancreatitis
is decidedly rare in England: in Australia,
where about half the cases are due to
alcohol, it is possible to see all gradations
between classical severe acute pancreatitis
and attacks so mild that they can only be
diagnosed presumptively by their resemblance to previous attacks when the serum
amylase was raised. Alcoholic dementia is
uncommon in England and alcoholism is a
minor factor in mental hospital admissions.
The diagnosis of haemochromatosis is
more common in Australia than in England.
This is apparently not due entirely to the
ease with which the disease can be diagnosed by liver biopsy. Tuberculosis is less
common than in England and the classical
scar of the patient with tuberculous cervical
glands is rarely seen.
The distinctive contributions of the Clinical Research Unit with which I was closely
associated lie firstly in the extensive use of
gastric, hepatic and renal biopsy which is
establishing the natural history of the
diseases of these organs, and secondly in the
interest in auto-immune disease, that is to
say, disease in which the immunological
defence mechanisms of the body are turned
against itself. Perhaps the major problem
of modern medicine is the precise role of
the pride of Australia. Whereas in England
most of the hospitals were built in the last
century, some of the provincial hospitals
even being housed in modified "workhouses", in Australia most hospital building is recent and reflects the achitectural
requirements of modern medicine. Although
there is considerable hospital construction in
Australia today there has been little hospital building in England over the last 20
years. Despite the general feeling that there
is a shortage of hospital beds in Melbourne,
in point of fact the number of hospital beds
proportional to the demands is higher than
in England, and the surgical waiting lists are
far shorter.
It is paradoxical that, in spite of the
greater social stratification in England,
English patients are far more willing to
enter a public ward than Australians. To a
large extent this is financially determined as
there is no government-aided medical insurance in England for private patients; but
it also reflects the difficulty in obtaining
adequate resident nursing and medical staff
for private hospitals.
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immunological disorders as a cause of
disease. Systemic lupus erythematosus,
rheumatic fever, rheumatoid arthritis, certain chronic forms of renal and hepatic
disease, ulcerative colitis and sarcoid are
some of the diseases for which an immunological basis has been suggested and clarification is urgently required. In this field,
where clinical observation and laboratory
investigation are most valuable, the combination of a clinical unit with an academic
research unit facilitates progress.
Already, in 1957, D. C. Gajdusek, working at the Walter and Eliza Hall Institute,
had demonstrated the occurrence of complement fixing antibodies against human
tissues in the serum of patients with systemic
lupus erythematosus. As it was known that
the haematological manifestations of lupus,
such as anaemia and thrombocytopenia,
were often due to circulating antibodies, the
finding of antibodies against human parenchymal organs strengthened the view that
all the manifestations of lupus were autoimmune in nature. It has been shown that
these antibodies were active not only against
nuclei but also against cytoplasmic cell constituents.
As long ago as 1952 it was known that
the serum complement was depressed in
lupus and this was attributed to the binding
of complement by in vivo complement fixing
antibody antigen reactions. At that time
there was no independent evidence for the
existence of such antibodies. It has been
possible to confirm this observation and to
demonstrate complement fixing antibodies
in most patients with systemic lupus
erythematosus who have a low serum complement.
The last distinctive feature of the Clinical
Research Unit is the Friday morning postgraduate teaching "round". The cases are
presented in a definite manner and to enable
their essential features to be readily grasped
the significant positive clinical and laboratory features are written on the blackboard.
No case is ever presented in the absence of
the patient. Discussion is orientated around
some special aspect of the patient and this
type of discussion has often produced
valuable ideas.
Clinical instruction of students at the
Royal Melbourne Hospital is very similar
to that in England, but perhaps less is made
17
of the heuristic method and of asking
students to elicit physical signs at the bedside. There is also less emphasis on the
importance of knowing about conditions
which, although rare, are amenable to treatment. Undergraduate teaching sessions are
longer than in England despite the fact that
for most students the law of diminishing
returns is apparent after the first hour.
An important difference in emphasis
arises from the fact that in country areas in
Australia the general practitioner is expected to be competent in both medicine
and surgery. The teaching hospitals recognize this in the good facilities for operative
surgery given to their residents and in the
institution of rotating internships. The good
prospects in general practice lessen the competition for teaching hospital appointments.
All medical students at Oxford and Cambridge and some of the students at the other
medical schools in England obtain a science
degree before proceeding with the clinical
part of the medical course. Few students in
Australia follow this approach, which is
valuable and provides most of the people
who will later undertake clinical and
laboratory research.
These reflections on Australian medicine lead me to consider the value of travelling in medical education. At the beginning
of the century doctors travelled to Germany
and Austria to gain experience, but since
the First World War the centre of activity
has moved to English-speaking countries. In
the medical specialities doctors visit centres
to learn special techniques such as gastroscopy, which can only be acquired under the
personal instruction of a senior man, and to
see at first hand the techniques and approaches of the various leaders in their field.
The relative freedom accorded to the travelling fellow enables him to discover his true
clinical and research interests and capacities,
and this freedom is most valuable near the
beginning of his professional career.
For my wife and myself, our visit to
Australia has been enjoyable, fruitful and
memorable, and I would be ungrateful if I
did not record my most sincere appreciation
of the British Memorial Foundation who
made my visit to Australia possible, and of
the members of the Walter and Eliza Hall
Institute and the Clinical Research Unit of
the Royal Melbourne Hospital who have
introduced me to the Australian way of life.
SPECULUM
18
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SPECULUM
19
HISTORY OF
PSYCHOLOGICAL MEDICINE
P. as Gail
Throughout the history of medicine and
surgery, especially since the 17th century,
the steady advance has, as often as not, been
due to discoveries in the physical sciences.
This is not true of psychiatry. Psychological medicine, dealing as it does with
human emotions, ideas, and, very importantly, human goals, has been related much
more closely to the history of magic,
religion, and superstition.
The result is an intimate connection with
the history of society as a whole. The important thing to realise is that the way in
which mentally ill people are regarded in
any culture, i.e., the definition of psychosis,
depends on what the rest of society at that
time calls normal, and not on absolute
criteria, as in organic disease.
Psychological medicine originally had a
much broader scope than today. Until the
18th century, when the great organic discoveries were made, large numbers of
diseases were thought to have mental or
even supernatural causes. Thus even in
1780, William Cullen, the Edinburgh
physician, stressed "nervous irritability" or
"frayed nerves" as the cause of disease. "I
propose to comprehend, under the title of
neurosis, all those preternatural affections
of sense and motion which are without
pyrexia as part of the primary disease." He
included whooping cough, diabetes, tetanus,
and hydrophobia.
A key idea to grasp is the role of faith.
In all ages, to be healed, required faith, and
this implied the acceptance of authority,
whether witch-doctor, magician, priest, or
physician. The actual relationship between
patient and healer takes many forms in
history. The common language may be
demons, animal magnetism, Freudian
psychoanalysis, or anything else.
Among primitives, both in the past and
today, and also in the Christian religion,
possession by demons loomed large as a
cause of both mental and physical disease.
Sick people were exorcised, i.e., the demons
were driven from the body by various
methods. Thus the Assyrians sought to
frighten demons away by ghastly images of
the demons themselves. The North American witch-doctor dressed in animal skins,
shouted, raved, and pretended to suck out
the demon with a hollow tube. Amulets,
charms, and fetishes were carried as protection against the unseen hordes of devils
all seeking ingress to the body.
Early Greek medicine had a profound
psychological element. Between the Trojan
War and the 9th century B.C., the legendary
Aesculapius rose as the god of medicine.
Circa 400 B.C., temples to him at Cos, Pergamus, and Epidaurus were devoted to
dream healing. The patients were supposed
to have dreams in which Aesculapius would
reveal the cure for their diseases. White
linen garments were worn as being conducive to dreams. The patients slept at
SPECULUM
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night grouped round a statue of the god.
Aromatic (? narcotic) smoke pervaded the
air. A priest wearing a mask of the god
"did a round" during the night, aiding the
illusion with ventriloquism.
Christ apparently understood well the
psychic nature of many illnesses. The "man
of Gerasenes" who had "devils a long time"
and had to dwell in tombs "due to persecution" was cured by kind words from Christ
and this appeared miraculous to the observers.
With the rise of Christianity, the prevailing view was that faith in Christ, the
disciples, and the gospels would heal the
sick. "Is any sick among you? Let him
call for elders of the Church and let them
pray over him . . . the Lord shall raise him
up," says the Epistle of St. James. Thus
rational therapy implied a lack of faith.
Exorcism, laying on of hands, the use of
amulets, all had official sanction. Paintings
and woodcuts from early Christian times
onwards abound with scenes of saints exorcising lunatics.
In the sphere of organic disease, too,
prayer was important. There was even
specificity—the various saints were patrons
of parts of the body where they had
suffered. Thus St. Erasmus had had his
intestines torn out, so he protected against
intestinal disease. St. Agatha had her
breasts chopped off, so patients with pectoral pain invoked her aid.
The Church prescribed a routine of
exorcism, and there existed an Order of
Exorcists. Faith was the essential feature
in these procedures, but despite it, (or perhaps irrespective of it), many stubbornly
remained psychotic.
Lack of faith, (i.e., failure to be cured),
was tolerated well till the late Middle Ages.
In the 15th century, the stirrings of Renaissance science began to threaten the impregnability of the Church, and therefore lack
of faith in all its forms began to be severely
punished. The insane, together with
alchemists and heretics of all types, were
regarded as witches and sorcerers, that is,
possessed by devils, and the terrible era of
ridicule, the rod, the whip, and finally the
stake, began in earnest.
The German monk Spenger wrote in
1485 his book, "Malleus Maleficarum"—
the "Hammer of the Witches"—in which he
21
proclaimed that the devil had created madness, therefore the mad were bedevilled,
therefore they should be burnt. Torture of
the insane spread over Europe, and psychological medicine was at its lowest ebb.
However, Johan Weyer (1515-1588), a
Belgian physician, declared that witch hunters were madder than many witches by far.
In his "De Praestigiis Demonum", witches
were "deranged or perplexed old women
who believed in their own fantasies". He
believed that they should be in the hands of
doctors, not in dungeons.
Faith could fasten onto other things. The
laying on of the king's hands was an accepted belief. Thus Charles II of England performed this miracle each year. "I touch
you and God heals you." He would then
give the patient a coin. Gold-seekers were
weeded out beforehand from the truly sick.
Mental suggestion plus natural recovery
often produced cures, while those who remained sick were told that they lacked
faith. The king couldn't lose.
Valentine Greatrakes, an Irish country
squire, achieved fame for his cures by
"stroaking of the hands". He succeeded in
psychosomatic cases, anticipating Mesmer
by a century.
Throughout this period, there were a few
"hospitals" for the insane who dodged the
stake, but these simply "kept" the patients,
and often exposed them to the ridicule of
tourists. Until the 19th century, a trip
through Europe's first lunatic asylum, Bedlam Hospital in London, was considered
hilarious.
The medical fraternity, even in the 18th
century, regarded the insane as incurable
and insensitive to pain. Philippe Pinel, a
Paris physician, was prompted to take up
psychiatry in 1780, after a friend went insane, ran into the woods, and was eaten by
wolves. When chief physician at the
Bicetre Hospital in 1793, he unshackled the
insane patients and put them to useful work.
He taught that insanity must have organic
causes, and paved the way for the rise of
French clinical neurology.
The authoritarian relationship between
healer and patient was still found in the
18th century, but with demons in the decline, due partly to great clinicians like
Willis and Sydenham in the 17th century.
"Moral Management" was a therapy of
1.
22
SPECULUM
harsh discipline of behaviour for the patient,
combined with fear of the doctor, reinforced by individual attention. The English
Parliament passed a bill authorizing the
court physicians to scourge the lunatic King
George III. When this failed, Francis
Willis treated his insanity by Moral Management with success.
An interesting mass phenomenon of the
18th. century was mesmerism. So far we
have considered the psychotic, whereas then,
as now, psychoneurotics formed the majority
of mentally ill patients. (Thus in 1733,
Cheyne wrote of "The English Disease", a
disorder stemming from luxury, "with
atrocious and frightful symptoms" . . .
obviously psychoneurotic in origin. And in
1764, Whytt, under "diseases commonly
called nervous" referred to "flatulent, spasmodic, hypochondriac, or hysteric cases.")
Franz Anton Mesmer arrived in Paris in
1778. He taught that "animal magnetism"
pervades all things, and that its proper flow
was essential to health. He claimed to set
right the unbalanced flow in sick people,
and he achieved some remarkable cures.
Lavoisier and the French Academy debunked him, and he passed into obscurity,
but mesmerism's influence persisted.
It is interesting to note that, whereas
failure to be cured (i.e., lack of faith) had
been in the past followed by punishment of
the patient, in the case of Mesmer and his
followers, it fell on the doctor. Today, in
Western society, the mentally ill patient and
the psychiatrist are considered equally
queer, and feature as an odd duet in many
jokes.
There is still, today, a large element of
faith in psychotherapy. One of Sigmund
Freud's greatest contributions was the
"transference", or the relationship between
doctor and patient. His successors, the
psychoanalysts, have studied this in detail,
and it cannot be denied that there are
religious elements in the psychoanalytic
relationship. By suggestion, the patient is
converted to the same way of thinking, and
faith plays a large part in the cure, even
though the language used is in terms of repression of infantile sexual urges, etc.
So we have had dreams, demons, moral
suasion, animal magnetism, and psychoanalysis in turn serving as the means of
communication between the figure of
authority and the patient.
One notable feature of the history of psy-
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chiatry has been the succession of widely
differing theories on the causation of mental
illness. Therapy has been often even less
than empirical; it has been bizarre guesswork.
As mentioned before, possession by
demons has been probably the most prevalent view. (See Aldous Huxley's "The
Devils of Loudun", for an account of mass
"possession" of nuns in a 17th century
French convent.) In all ages, there have
been attempts to discover what type of man,
mentally and physically, develops what type
of mental illness. Empedocles, in 600 B.C.,
propounded the doctrine of four "humours",
viz., fire, earth, water, and air, as the basic
"stuff" of the Universe. Hippocrates
adapted these to a theory of humoral balance in health, i.e., blood (fire), phlegm
(earth), black bile (water), and yellow bile
(air) were in equilibrium. Personality
types such as the Sanguine were liable to
attacks of excitement, the Choleric to
apoplexy, and so on. These concepts were
revived at the medical centre of Salerno in
the 1 1 th century, and even today, words
such as melancholia, phlegmatic, etc., are
still in use.
Paracelsus (1493-1541)—real name,
Aureolus Philippus Theophrastus Bombastus von Hohenheim—was an astute psychiatrist and a forerunner of Freud. He
felt that man was composed of antagonistic
animal and godly spirits; the former must be
suppressed for fulfilment. (cf. Id and Superego of psychoanalysis.) He described the
manic-depressive state, and maintained that
psychoses were "natural" not demonological in origin. He knew that disease
could result from mental problems. "You
should treat the spirit, for it is the spirit that
lies sick". According to Paracelsus, "brute
intelligence" is brought on by madness,
while "human intelligence" is "not subject
to sickness". Here we have a clear discernment of primitive drives controlling the
psychotic, while reasoning power remains
intact, e.g., the keen logic of the paranoiac,
based on false premises.
Georg Ernst Stahl of Halle University
propounded (circa 1700) the doctrine of
"animism". Living processes were determined by "man's sensitive soul" (cf. subconscious personality). However, he missed
anticipating Freud by two centuries, in that
he thought that the "soul" knows more
23
about the body and how to rectify its malfunction than the physician. The doctor
can only watch passively the soul's efforts
to realign the body's imbalance.
Hypnotism was an outcome of mesmerism, the word "hypnotism" being coined by
James Braid, a Scottish surgeon, in 1843,
in his study of mesmerism, "Neurypnology,
or the Rationale of Nervous Sleep".
The full implications of hypnotic suggestion were not understood, however, until the
French clinical neurologists such as Charcot
had carried their organic theories of mental
illness to absurd lengths. This was in the
1860's, when theories of mechanism dominated all branches of science.
Jean-Martin Charcot (1825-1893) made
the Salpetriere hospital in Paris the leading
neuroclinical research unit of Europe. His
teachings on the neurological causes of
hysteria were controversial in an age when
the uterus was removed for this affliction.
He applied hypnotism for "grande hysterie",
but his cures were seldom permanent.
Bernheim, of Nancy, confuted Charcot by
saying that the varied symptoms had no
existence till induced by the physician. A
survival of Charcot's organic views of
hysteria was the teaching (up to the 20th
century) that hysterical anaesthesia existed,
without the patient knowing, until the
physician "discovered" it. It was not well
known until the World War that this could
be produced at will by the examining
physician, although Babinski had demonstrated it in 1906.
In the same period, the English were
busy with their own artefacts. Railway
accidents had produced a new disorder
called "railway spine", which the clinicians
of the time believed was due to spinal
injury. Thus, one sufferer could only walk
sideways! Occasionally, one can recognise
the real symptoms behind the artefacts. For
example, a young woman would walk along
a street till she came to an open space, and
then she fell down. We recognize an agoraphobia, but why did she have her clitoris
excised? Someone must have whispered
the word "hysteria".
Charcot's influence was strongly felt by
Sigmund Freud (1856-1939) who used
hypnotism to bring to the surface memories
repressed as a result of psychic trauma.
Psychoanalysis, with its two components of
free association and dream analysis, he later
24
SPECULUM
developed as being more effective. Freud's
realization of the labyrinth of mental processes occurring outside the sphere of consciousness was one of the landmarks of
science. Dubois and Degerine had independently worked out a therapy of exhortation and explanation. These developments in clinical psychology explain why,
with the spate of psychogenic "shellshocked" patients in World War 1, the
psychological equipment was available to
deal with them, and there never was any
serious reversion to queer organic theories,
as had been the case with "grande hysterie"
and "railway spine".
Are we any closer to knowledge of the
aetiology of mental disease than was Hippocrates, with his humours? So far, interest
has been mainly in constitutional factors,
but very little advance has been made. A
certain advance, amid a welter of nonsense,
was made by Franz Joseph Gall, the
Viennese neurologist, in 1810. He attempted
to link certain cranial configurations
("bumps") with certain mental characteristics. His system of "phrenology" put selfish
propensities such as oral drives, and libido,
in the temporal region. In view of modern
interest in temporal lobe psysiology, Gall's
work was the first serious attempt at cortical
localization of mental function.
More recently (1921), Ernst Kretschmer,
in his "Physique and Character", noted that
often, schizophrenics were lank and thin,
while manic-depressives were short and
stocky. The terms he used, asthenic and
pyknic, are still widely used. Sheldon, the
American anthropologist, has divided people
into endomorphs, ectomorphs, and mesomorphs, and has tried to correlate these
types with numerous mental and physical
disorders.
Twentieth-century psychiatry and psychological medicine is so vast that it would be
hopeless to try to outline it, in such a short
space. A revolution commenced with
Freud's discovery of the unconscious,
branched off into Adler's theory of the
power urge, and into Carl Jung's mystical
notions of racial memories. This revolution is still going on, and the outcome is
impossible to predict. All that one can say
is that psychological medicine will probably
become more and more scientific, less and
less wedded to its old partners—superstition, magic and religion.
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25
TO SMOKE OR NOT TO SMOKE • ••
Bryan Gandevia
Honorary Assistant Physician, Royal Melbourne Hospital
"Have you not reason, then, to be ashamed
and to forbear this filthy novelty? . . . In
the abuse thereof sinning against God, harming yourselves both in persons and goods .. .
a custom dangerous to the lungs, and in the
black stinking fume thereof, nearest resembling the horrible Stygian pit which is
bottomless . . ."
The above exhortation of King James I,
published some three and a half centuries
ago, had no more effect on stopping smoking than did the drastic physical punishments adopted at various times by national
and religious authorities. King James' contribution comes very early in the medical
bibliography of tobacco smoking, and it was
therefore with considerable misgiving that I
accepted the editorial invitation to review
the literature on the subject and to discuss
what advice is best given to patients in practice. However, on further consideration it
seemed that discussion might well be confined to the latter aspect, for the immediate
clinical value of the literature on smoking
is very nearly inversely proportional to its
volume.
I shall attempt, with perhaps unbecoming
brevity, to justify this contention under
several headings and I shall then outline my
own approach in practice. This personal
attitude is adopted
(a) because a candid statement of one
person's views is easier to present in a way
which illustrates the principles involved,
(b) because it is easy for the reader to
criticise and analyse, and
(c) because you may take it, leave it, or
modify it according to your own concepts
and personality without regard to the length
of the supporting bibliography of authoritative sources.
Experimental Aspects
Once upon a time I was deeply impressed
by experiments made on the isolated nicti-
tating membrane of the cat—actually I
doubt if it was isolated, but so many experimental organs and tissues are proudly described as such that the temptation to include
I am now much
the word is irresistible.
more impressed by the work of those with
the ingenuity, patience and skill to perform
reliable experiments on the intact human
animal, a very much more difficult task
from several points of view. Experiments
on the effect of smoking in man are comparatively few and mostly inconclusive but
there is evidence that by one mechanism or
another smoking decreases peripheral blood
flow, inhibits gastric motility and perhaps
increases the secretion of acid in the stomach, among other less important effects. As
far as I know there is no direct evidence as
to its effect on coronary blood flow. An
important point to be borne in mind is that
what happens in a normal subject is not
necessarily reproduced in subjects already
diseased. Smoking a cigarette has, for
example, been shown to produce an increase
in airways resistance in emphysematous
patients but not in normal subjects. Its
effect on appetite is well known; this is but
one of the interesting observations which
may be made on the effects of smoking by
the personal experiment of giving it up (even
with generous allowance for the fallacies of
such an elementary experimental design).
However, we do not know whether the
hunger of the reformed tobacco addict has a
pharmacological or psychological basis or
whether both mechanisms are involved. Uncertainty of this type exists in relation to
several facets of the smoking problem.
Epidemiological Aspects
Many epidemiological studies have been
conducted which purport to show that
smoking. is a factor in the development of
such disorders as carcinoma of the lung,
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chronic bronchitis, peptic ulceration and
coronary disease; other studies of similar
type fail to show a relationship. To illustrate one difficulty—we found in a survey in
Melbourne a much higher incidence of
cough and sputum amongst the smokers of
a defined population than amongst the nonsmokers, but even this simple observation
cannot be confirmed in London,* probably
because of differences in climatic and other
environmental factors. There is reliable
evidence to suggest that relapse of pulmonary tuberculosis occurs more frequently in
smokers than in non-smokers, and that
smokers with chronic bronchitis die younger
than those who do not smoke. In the main
these studies show correlations which do not
necessarily imply a direct cause and effect
relationship: for example, the urge to smoke
and a proneness to develop lung cancer may
be genetically linked. The arguments over
the fallacies attendant upon surveys of this
type and on the correct interpretation to be
placed on the figures obtained are legion,
but it is safe enough to conclude that a
reasonable case has been made out against
tobacco in all these conditions, especially in
carcinoma of the lung. The application of
these findings to the individual patient remains far from clear; satisfactory anterospective studies of prognosis in smokers
and non-smokers, which are essentially
what is required by the clinician, are difficult
to plan and carry out, and are, as far as I
am aware, universally lacking.
The Doctor's Attitude
Personal factors, involving both the
doctor and the patient, influence the advice
given to patients in regard to smoking.
Indeed, the influence of more academic
studies pales into insignificance beside the
influence of personal prejudice against
smoking on the part of the doctor. This
state of mind may be congenital or acquired,
the latter variety occurring almost exclusively in reformed smokers and being by
far the more virulent form. It may lead to
what had been termed the "terrorist approach", which in my opinion (with, as a
smoker, its bias in the opposite direction)
is rarely justified. In the interests of the
doctor-patient relationship justice should be
tempered with mercy; we should accept the
•Recent British studies have now both confirmed and extended this observation.
27
psychiatrists' advice to know something of
ourselves before advising others and at
least we should be aware of our own grosser
prejudices. There are no doubt doctors, as
there are patients, who smoke heavily and
who cheerfully tell their patients, "Look at
me; it's never affected me." This is bias;
in any case, it would probably be more
appropriate to listen in the mornings rather
than to look during consulting hours.
A very sound thoracic physician sought
to hang notices in his clinic in England,
reading "Smoking Harms Your Heart and
Lungs: Stop Now Before It Is Too Late."
A most humane and kindly man in all other
respects, deeply conscious of the social and
personal problems of the patients whose
physical disorders he managed so well, he
would not accept the view that the chief
effect of these notices would be to produce
chronic anxiety and fear. Who, of these
patients with established thoracic disease,
did not feel that it was perhaps already too
late? And were their hearts to be the next
to go? The medical staff, consisting of
smokers and anti-smokers of less radical
views, unanimously opposed the use of the
notices. This story is told so that you may
take sides yourself; you may care to analyse
your motives in doing so or your own likely
reaction to such notices.
The Patient's Attitude
Perhaps one day in the distant future I
may be able to state exactly why I give
somewhat different advice to different
patients with the same condition. I aim to
modify it according to the patient's personality and other circumstances—whether I
wish to encourage him, frighten him, entice
him, or cajole him into giving it up and
whether I feel he is likely to take the advice
anyway. The patient must know whether
he will be improved symptomatically, or
whether there will be no change in symptoms but merely a decreased risk of complications or a lessened rate of progression.
An intelligent person may wish to hear and
may accept more or less scientific arguments
which would be wasted on a person of lesser
ability. Nervous or emotional patients require reassurance that they are not being
advised to stop smoking because cancer is
suspected, or because they will inevitably
get cancer or some other horrible complaint
if they do not. Patients often fail to stop
SPECULUM
28
smoking and to have painted too gloomy a
picture too effectively beforehand sometimes proves a handicap to subsequent
management.
Patients who smoke less than ten cigarettes a day should almost certainly be left
in peace, except perhaps for those with
peripheral vascular disease. However, light
smokers can usually stop with comparatively
little difficulty.
Because of the unfavourable publicity
given to smoking in recent years, most
smokers have some feelings of guilt, shame
or fear. For one or other reason a patient
may refrain from raising the question of
tobacco, however much it may be in his
mind. A word or two on smoking is therefore often worthwhile, whatever the patient's
complaint, and it is mandatory if this situation is suspected.
I have no idea how successful my tactics
are. For better or worse, however, I believe
it is fundamentally unsound to reel off a
"set piece" to all patients. A casual "Don't
smoke" or "You'd be better off if you stopped smoking" is useless and amounts to
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Locum Tenens Provided
what is termed mental cruelty in another
context. If it is important, such a statement requires amplifying, explaining or
rationalizing; it deserves at least as much
time as is spent in telling them how and
when to take the mixture (which is nearly all
water anyway). If it is not important the
observation is better not made.
Allen, Barker and Hines (Peripheral
Vascular Disease, 1955) state that "we
occasionally* say to patients, 'You may have
your tobacco or your extremities, but not
both. If you must have your tobacco, you
cannot have your extremities; if you
wish to have your extremities, you must
cease the use of tobacco'." If any clinical
situation justifies a statement like this,
peripheral vascular disease does. Even so,
having been provoked to this approach myself on several occasions, I doubt whether
I have done more than satisfy my own conscience; I doubt if patients can regard such
an unreasoned statement, or frank threat,
as a satisfactory basis for giving up a
pleasurable and seemingly unrelated habit of
long-standing at a time of stress. Some will
react in precisely the reverse way, and
understandably so. Finally, the last clause
verges on dishonesty unless amplified; most
patients would construe this to mean that if
they stopped smoking they would not lose
their limbs. This will not be true in all
cases and the disillusioned patients will lose
faith in their medical advisers and their
treatment.
Notes on Specific Conditions
In all the conditions to be mentioned
many physicians would advise that smoking
* The bold face is mine; taken out of its
context this quotation probably appears blunter
than the authors intended.
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This is reasonable
be given up entirely.
advice and no examination marks would be
lost for giving it. However, with exceptions
to be mentioned, there is perhaps less
rational and less scientific evidence for this
advice than there is in support of the contention that everyone should stop forthwith
and that no one should be allowed to take it
up. The following suggestions are therefore
offered with this in mind, together with
other modifying factors mentioned in previous sections. Whether a firm "non-smoking" line or a less dogmatic approach is
adopted, the advice must be clear and an
explanation of the reason given for it. In
particular the patient must understand
exactly what stopping smoking has to offer
him.
Clinical,
Peripheral Vascular Disease.
and, to a less extent, experimental evidence
strongly indicates the desirability of giving
up smoking, or, indeed, the necessity for it.
smoking, or, indeed, the necessity for it.
Smoking, the patient may be told, further
narrows the vessels and accelerates progression of the disease. He probably cannot be
guaranteed arrest of the condition, nor improvement, although this may occur, nor
relief from pain or other symptoms. This
advice applies to all varieties of occlusive
vascular disease.
Chronic Bronchitis, with or without
emphysema. Here again there is strong
clinical evidence in favour of stopping
smoking, and it is supported by experimental and particularly by epidemiological
evidence. "Smoker's cough", which is mild
chronic bronchitis, ceases. In more severe
disease, the patient may be promised moderate to considerable reduction in the amount
of cough and sputum. Wheezing is often
improved dramatically but is sometimes
little affected; it should be remembered that
the element of reversible bronchoconstriction found to some extent in every patient
with emphysema is the main aspect of this
condition which is susceptible to treatment.
The patient may also be told that the tendency for bronchitis and/or emphysema to get
a little worse year by year—as even
"normal" lungs do—is minimised. He is
not told that one of the findings in a recent
survey was that the only patients with severe
bronchitis to show permanent clinical improvement were those who gave up smok-
2I
ing*; at least, he is not told in quite the
same words.
Asthmatic patients whose
Asthma.
wheeze is aggravated or precipitated by
smoking should stop. As with other conditions in which there is a clear relation between a main symptom (cough and the
epigastric pain of an ulcer are other common examples) the rationale of this advice
is obvious to the patient and he can
unequivocally be promised improvement.
Other patients with asthma should be told
of the tendency of smoking to produce or
aggravate bronchitis; the effect of stopping
smoking in these cases is sometimes striking, often disappointing and always unpredictable. At least one asthmatic doctor
advocates a cigarette on going to bed to help
cough up phlegm and thus ensure a peaceful
night. This practice is the "thin edge of the
wedge" to a former smoker and perhaps to
a non-smoker; smelling salts containing
ammonia should be equally effective. The
"anti-asthma" cigarettes still sold to these
patients can do no more than can be
achieved with conventional bronchodilator
therapy and should be replaced by it.
Other Respiratory Conditions. Patients
with pulmonary tuberculosis are advised to
give up smoking on the grounds that it reduces cough and sputum and hence the risk
of spread. They may also be told that the
risk of a relapse in years to come is greater
if they smoke.
Stopping smoking is justified in localized
bronchiectasis, recurrent sinusitis, bronchial
or pulmonary infection and recurrent or
chronic pharyngitis or laryngitis. No rash
promises should be made, although improvement can be great. Patients who have
cancer of the lung should be allowed unrestricted smoking; so seemingly obvious a
point is made only because I have once seen
the agonies of dying from lung carcinoma
aggravated by the torture of a foolish "nosmoking" regimen. After resection of a
lung or lobe for non-carcinomatous lesions
I suggest to patients that they should not
smoke "so your remaining lung, which will
* To this group may now be added the small
group of severe chronic bronchitics with grossly
purulent sputum in whom the long-term use of
antibiotics is considered justifiable (after careful assessment).
30
SPECULUM
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SPECULUM
have to do a lot more work over the years,
will stay as healthy as possible."
Impending Anaesthesia. Smoking should
be stopped for at least three days before an
elective operation is performed under
general anaesthesia. A recent study at the
Royal Melbourne Hospital has stressed the
importance of this and suggested that postoperative pulmonary complications would
be fewer if the volume of sputum produced
preoperatively could be reduced. This can
be achieved by stopping smoking. The fact
that many smokers have anaesthetics without trouble is no reason for complacency.
Although "tobacco
Cardiac Disease.
angina" is described, it seems to be rare for
a patient with angina, even if the pain is
precipitated by trivial exertion, to give a
clear history of aggravation or precipitation
of pain by smoking. Such a patient should
stop. Otherwise there seems little to be
gained by adding the stress of giving up
smoking to the patient's other troubles. One
might prefer that patients who had had myocardial infarcts, congestive cardiac failure,
pulmonary congestion, and so on, did not
smoke, but in all honesty one cannot promise these patients much in return for their
sacrifice.* Smoking is likely to be of small
prognostic significance in the presence of
these serious conditions, usually with structural and established causes. Patients with
mitral stenosis tend to develop bronchitis
over the years and should not smoke for this
reason. The effect of stopping smoking in
paroxysmal arrhythmias in my limited experience is disappointing but it should be
tried. Most patients with "palpitations"
require reassurance and treatment for their
anxiety; I do not know whether stopping
smoking stops extrasystoles (it didn't stop
mine) or whether or not it matters if it does,
but I doubt if it stops "palpitations".
Peptic Ulceration. This is easy because
so often smoking produces the pain. If the
patient persists in smoking in spite of its
obvious influence and his doctor's advice
and explanation, then he should smoke only
when his stomach is full.
* Note the emotional factor in the use of
words—a non-smoking physician would not use
this term and would therefore reject the reasoning.
Casual Enquiries. Patients often ask
whether they should give up smoking, without necessarily implying any relationship of
smoking to their current complaint. The
answer of course, is yes. Reasons are not
difficult to find. Young men who insist on
smoking should smoke a pipe, and why not
the women? Patients with diabetes or with
a strong family history of broncho-pulmonary disease are wise to stop smoking while
young.
General Advice
Patients should be advised to "cut it out"
rather than "cut it down". The latter is no
less difficult and stressful than the former
and is more frequently associated with relapse. Cutting it down may be resorted to
if cutting it out fails, and some patients do
seem able to stabilise their cigarette consumption at a lower level. Steps must often
be taken at the outset to prevent weight
gain; chewing gum is socially less acceptable
but also less fattening than sweets or biscuits.
Patients, poor, long-suffering, blind and
faithful creatures that they are, will ask you
how to give up smoking. You must, of
course, have an answer ready. With my
extensive personal experience of stopping
and starting smoking it would be sheer presumption to offer any suggestions. Sedation, hypnosis, silver nitrate mouth washes,
tranquillizers, temporary change of environment are all subsidiary to making the big
decision, but beyond that—well I should be
interested to know what you advise, doctor.
Perhaps we should do better with a clearer
understanding of the aetiology of the
disease.
Conclusion
It might be thought that I have presented
something of an apology for smoking. This
is not intended. I agree wholeheartedly
with King James, but in the presence of
established smoking habits and established
disease the problem is largely beyond solution. Let us take a lead from the preventive approach which has achieved so much
in the last century in the field of public and
industrial hygiene; let us stop people starting on their black, stinking, fuliginous
descent into the Stygian pit.
Hear about the bloke with the King size
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SPECULUM
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33
ANSWER ALL QUESTIONS
STAPHYLOCOCCUS AUREUS
(-Aloft/ 5o Pam a Written examination
Without ...Actua4 -Answering 3he Question)
By
Professor of Bacteriology
Sydney D. Rubbo
It is no fault of your Editor that he is
using this space in Speculum with a no-timeto-think sort of essay. The fault is entirely
mine. Months ago I promised him something unusual. And now, at this late hour,
when the space cannot be sold to the makers
of Sillipennin, the only antibiotic which is
definitely claimed to have no antibacterial
activity, we decided I must fill it—with
something unusual, of course. Accordingly,
I am going to write simultaneously on two
distinct problems (see above) and, hope,
get away with it. Anyway, the space will
be filled.
The topics I am tackling are difficult ones,
particularly the subsidiary subject. You
have all faced that unfriendly examination
paper which says, "Answer all questions or
else." In such an unpleasant circumstance
it would seem there is little scope for
manoeuvre. However, as part of my spacemanship (the art of filling and fooling in
space) I will demonstrate a few simple principles.
The first important thing, when cornered
as I am, and you might be, is to create an
impression of scientific precision. This is
done by a deliberate "semanticization" of
all technical terms appearing in the question,
however unnecessary that may be. Having
finished with the definition at the cost of
80 per cent. of your available hardware you
then spread the remaining 20 per cent of
your knowledge over an average of 6-8
pages. To do this all the tricks of creative
writing must be used. It is at this stage that
the second principle is applied, namely the
demonstration of scientific imagination. In
short, your answer must be research orientated. This will please the Professor for
it spares him the discomfort of discovering
how misleading his lectures have been in
matters of fact.
Apart from these two cardinal principles,
the student would be well advised to use
labelled sub-headings which can be read in
place of the text, to avoid split infinitives
and other obvious grammatical errors, and
above all, to quote freely from the unpublished work of your professors and lecturers (be sure to quote the Professor more
frequently than any others).
Such advice would be sterile (in the
literary sense) unless supported by example.
Let me illustrate the method. The question
is "Answer All Questions—Staphylococcus
aureus." At a first glance the telegrammatic
brevity of the question is disturbing but the
phrasing has obviously been intentional. The
question must be read a dozen times in
order to decipher its meaning, if any. Whatever may be expected one thing is certain—
we must start with a definition of the GrecoLatin binomial (principle No. 1) and then
proceed with the usual verbal gymnastics to
answer the question proper (principle No.
2). Here now is the start of our model
answer.
According to Gray, lecture 12 Division
II, 1959, Staphylococcus aureus is a
SPECULUM
34
microbe. This may appear to be a very
elementary statement but, in the historical
sense, it is not. This organism was first described in 1881 by Sir Alexander Ogston,
Professor of Surgery in the University of
Aberdeen (this superfluous detail never fails
to impress). Ogston found the organism
repeatedly in smears from abscesses but
never in tissues free from suppuration. To
quote from his writings, "My delight may
be conceived when there were revealed to
me beautiful tangles, tufts and chains of
round organisms in great numbers. The pus
on the microscope slide, which appeared to
indicate the solution of a great puzzle" (the
aetiology of wound infection) "filled me with
hope." In spite of this significant discovery
(Ogston was also the first to use the term
staphylococci=grouped-micrococci for these
pyogenic organisms) the British Medical
Journal refused to publish some of his
papers on infected wounds.
Later, with the development of cultural
techniques, it became possible to classify the
staphylococci on the colour of their colonies
(Rosenbach, 1884). The very frequent
association of the aureus (golden) strains
with suppuration eventually led to the firm
conviction that Staphylococcus aureus was a
common cause of abscess formation and the
only pathogenic species in this genus. Today, a strain of staphylococcus is not regarded as a potential pathogen unless it produces
an enzyme, coagulase, capable of coagulating human or rabbit plasma. The terms
Staph. aureus and Staph. pyogenes may, for
practical purposes, be regarded as synonymous for coagulase-positive staphylococci.
Passing now to the logarithmic phase of
our answer, we are faced with the problem
of sparking the examiner's interest in our
researchiness without raising suspicions of
our shallowness. This is how it is done (the
technique, I might add, applies equally well
to the preparation of Presidential addresses).
Much has been written in recent years on
the subject of staphylococcal infections and
a full review is beyond the scope of the present paper (this means I have a vague feeling the Prof. gave us a bibliography but I
haven't bothered to use it). Undoubtedly,
due to the brilliant investigations of the Melbourne School (the qualifying adjective need
not be underlined), answers to most ques-
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tions have been reached. It would, therefore, be more profitable not "to answer all
questions" but "to question all answers",
particularly as many of these come from
overseas and do not always coincide with
the views of the Melbourne School (Rubbo,
radio broadcast and lecture 39 or 40). For
instance, it has been said (by common consent no references are ever given in support
of this type of phrase) that the present
strains of staphylococci recovered from
patients infected in hospital are more virulent than those isolated in the pre-antibiotic
era. It has also been suggested (again,
don't bother about references) that the
staphylococcal disease pattern has changed
in recent years; that the prevalence of
multi-antibiotic resistant staphylococci is
due to the indiscriminate use of these drugs
and a breakdown in asepsis; that the dust
from hospital blankets is the main vehicle of
air-borne spread in wards. These and many
other points might be considered seriatim
(the poised use of a latin word often suggests a classical education and is markworthy. The reverse also applies to classical scholars using scientific terms).
Virulence of Staphylococcus aureus—past
and present
In the first place we must recognise that
none of the available in vitro tests gives a
true indication of the virulence of a particular strain of this organism and the coagulase
reaction only indicates a predictable potentiality. A case of staphylococcal septicaemia is not, as might be expected, due to
a strain of high virulence but is more probably the result of the accidental entry of infected emboli into the circulation at the
primary focus. Further, there is no laboratory approach to distinguish between epidemic and non-epidemic strains although
the phage type 80 has been commonly
associated with epidemic neonatal infections
in different parts of Australia.
The important fact to remember is that
Staphylococcus aureus is a frequent and
innocuous habitant in the nose, skin and
faeces of healthy individuals. Thus, the
biological accident of clinical disease is
more likely to result from a change in the
host rather than a change in the organism.
Viewed in this light, the explanation for the
apparent severity and frequency of staphy-
35
lococcal infections today must be sought in
factors affecting the resistance of the host.
These are numerous and varied. Some intrinsic factors are (a) the type of patient,
e.g., the premature baby, the adult with a
cirrhotic liver, the stabilized diabetic, etc.,
(b) the advanced type of disease which is
now treated surgically (e.g., cardiac, thoracic and plastic operations). Of the extrinsic factors which must be taken into account
we might list (a) the in-dwelling needles
used in intravenous therapy, (b) the repeated
injections, (c) the alteration of normal flora
by broad spectrum antibiotic therapy, (d)
the excessive use of sutures for cosmetic
reasons, (e) the use of anti-inflammatory
agents such as cortisone, and (f) the intercurrent infection or irritation of mucosal
surfaces (e.g., viral influenza and catheters,
to mention two extremes).
The combination of these extrinsic and
intrinsic factors inevitably leads to a lowering of host resistance. It would be foolish,
however, to suggest that a major surgical
operation should be withheld in an elderly
alcoholic patient or newborn infant with a
patent ductus arteriosus merely because of
the risk of post-operative infection. All we
would expect is that special precautions are
taken with such patients. We conclude this
section by stating that there is no evidence
to suggest that the staphylococci causing
disease at present are any more virulent
than those of the past (McDermott, 1956).
The staphylococcal disease pattern
One notable change in staphylococcal
disease has been the virtual disappearance
of haematogenous osteomyelitis but this is
probably due to antibiotic therapy. On the
other hand, three diseases which appear to
be more common today than previously are
staphylococcal enterocolitis, pneumonia
and wound sepsis.
Staphylococcal enteritis is usually a benign condition associated with symptoms of
nausea, vomiting and diarrhoea whereas
pseudomembranous enterocolitis is usually
fatal with signs of shock and peripheral circulatory failure. Susceptibility to enteric
infection is enhanced by the oral administration of broad spectrum antibiotics. These
latter facilitate the colonization of antibioticresistant strains by the elimination of the
normal flora. The "biological vacuum" so
produced seems to provide an easier oppor-
SPECULUM
36
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tunity for superinfection following ingestion
of food and fluids contaminated with the
"hospital staphylococcus."
Staphylococcal pneumonia is not an uncommon disease nowadays. It is usually
diagnosed radiologically and is characterised by destruction of lung tissue. Pulmonary oedema and intercurrent viral influenza
appear to be predisposing factors. A possible source of the organism in post-operative pneumonias is the lumen of unsterilized
anaesthetic breathing tubes.
Wound sepsis is probably not more common today than it was in the pre-antibiotic
era but the aetiology has changed. Whereas
some 10-15 years ago Group A haemolytic
streptococci were frequently found in wound
infections, today the principal organism is
the hospital staphylococcus. The incidence
of wound sepsis in the teaching hospitals of
Melbourne varies from 6-8 per cent. for all
surgical cases. Recalculating from Rubbo's
figures (1948) the economic wastage from
infection in a 500-bed hospital could
amount to £12,500 per annum on presentday costs, that is, 2500 patient-days prolongation of hospital stay per annum at £5 per
day.
This problem must be controlled for
humane and economic reasons. It is not
peculiar to the Australian hospital scene
but exists everywhere. The solution of
staphylococcal cross-infection in hospitals
depends on improvement in three directions
—architectural design, antibiotic therapy
and aseptic technique. Time and space
(never admit lack of knowledge) do not permit me to develop all of these as they
should. Most architects are curiously uninformed about the habits of the flying
microbe or even the behaviour of steam.
The design of operating suites, the installation of central sterilizing areas, the disposal
of infected laundry, the supply of sterile
water and the technique of ventilation and
air purification are challenges which are
often resolved at the aesthetic rather than
the aseptic level. The best solution to the
architectural aspect of cross-infection is to
catch your architect in flagrante delicto with
the sketch plans on his drawing board.
Antibiotics in relation to intramural
disease.
The prevalence of the "hospital staphylococcus", that is, the strain usually resist-
37
ant to penicillin, streptomycin and the three
tetracylcines but sensitive to chloramphenicol and erythromycin, is, in part, due
to too much antibiotic therapy and too little
aseptic care. The antibiotic environment,
which the present-day hospital is, provides
a selective advantage for the unrestricted
propagation of the resistant mutant. If an
organism, such as Staphylococcus aureus,
exhibits a high degree of mutability towards
resistance it follows that the resistant
mutants will eventually displace the sensitive wild types. If, on the other hand, the
mutation frequency is low, as in the case of
Group A haemolytic streptococci with the
antibiotics, then these organisms will tend to
disappear so long as antibiotic selection is
operative.
Another indirect contribution to the
cross-infection problem arising from broad
spectrum antibiotic therapy is the reduction
of the normal bacterial flora on mucosal surfaces of the respiratory and alimentary
tracts. This reduction in some way facilitates the colonization in these tissues of
foreign, and sometimes dangerous, parasites, most frequently yeasts (Candida
albicans) or drug-resistant staphylococci.
Freter (1955) showed that oral streptomycin
precipitated fatal disease in guinea pigs infected with Vibrio cholerae. Cooper (Melbourne Ph.D. thesis) modified Freter's technique and showed that Shigella infection in
mice could be induced with as few as 100
organisms in animals treated with erythromycin and streptomycin by mouth. These
observations lend strong support to the view
that staphylococcal enteritis might be a
sequential result of oral antibiotic therapy.
The question now arises, what, if any,
antibiotic control can be imposed on the
hospital staff. The Royal Women's Hospital has adopted with success a rigid rotational antibiotic programme On the collaborative advice of the bacteriologist and
clinicians only one antibiotic is available for
a period of approximately six months for
treatment of all staphylococcal infections.
After this time a different antibiotic is then
selected, and so the rotation of drugs continues. This we understand (Butler, personal communication) has been most successful in preventing the build-up of the
hospital staphylococcus. However, the circumstances surrounding this important ex-
SPECULUM
38
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periment do not apply to a general hospital.
For a general hospital the following recommendations might be considered:
1. No antibiotic or sulphonamide should
be given to any patient unless there are
clear indications for its use (clear indications means scientifically-based reasons, not inspired hunches).
2. All open infections (wounds, skin, alimentary, respiratory and urinary tract
diseases) should be treated with a
double drug therapy. In the case of
staphylococcal infections an antibiogram (drug sensitivity pattern.) must
dictate the choice of drugs; in other infections an antibiogram may or may
not be necessary.
3. Where possible, the first combination of
drugs used should include an antibiotic
and a triple sulphonamide.
4. The supply of certain antibiotics should
be carefully controlled, particularly
erythromycin, kanamycin and novobiocin. These may be invaluable for
disseminated staphylococcal infection
and should be reserved for the serious
case whenever possible.
The two principles underlying these
recommendations may be briefly mentioned.
In the first place, one can modify high
mutation frequency of an organism to a
single drug by exposing it to two dissimilar
drugs simultaneously. Survivors in this system must be resistant to both drugs and the
chances for the selective propagation of the
doubly-resistant mutants are many times
less than those for the mutants resistant to a
single drug. For example, if the frequency
of mutation is 1 in 10 6 cells towards resistance for antibiotic A and 1 in 10 6 for B,
then the mutation rate for resistance to A
and B will be 1 in 1012 cells. This rate is
so low that doubly-resistant mutants are unlikely to develop, a phenomenon well
demonstrated in the chemotherapy of tuberculosis and worthy of exploitation in staphylococcal and other infections.
The second principle behind these recommendations is an obvious one. As the open
infection constitutes the greater hazard of
cross-infection care must be taken to ensure
that the spread is not due to resistant strains.
The double drug treatment is aimed at preventing this contingency.
39
We might add in parenthesis that the reasons for recommending double drug therapy
here are quite different from those usually
put forward for some commercially available combinations. For many of these combinations synergistic action is claimed, but
seldom demonstrated. Nor is the use of
double drug treatment recommended as a
"blanket" measure to treat infections of unknown aetiology. Its success in preventing
the emergence of resistant mutants depends
on the fact that the causative agent is sensitive to both drugs.
Asepsis in relation to intramural
staphylococcal disease
Asepsis is a diffuse and complex subject
(this really means my knowledge of asepsis
is diffuse and complicated). In its broadest
terms it is concerned with the exclusion, removal and destruction of micro-organisms.
Asepsis in the operating theatre is designed
to protect the individual patient against infection but in the wards the protection is
extended to a community of individuals. In
the former situation aseptic discipline is
readily accepted; in the latter is is open to
many unsuspected breaches of application.
Acquired infection during an operation can
only result from contact or air-borne contamination. In the wards, infection by
contact, by air and by ingestion are all possible, the first two being more frequent.
Theatre asepsis demands effective preoperative sterilization of instruments, gloves,
textiles and skin and the maintenance of
sterility during the operation. While the
standards of surgical asepsis are particularly high improvements might be sought in
the surgical scrub-up and the use of longsleeved operating gowns. These problems
are now being investigated. The principal
causes of breakdown in theatre hygiene
often stem from circumstances outside the
surgeon's control. For instance, anaesthetists often enter theatres with gowns loosely
draped over their street clothes and many
do not bother to change, or even cover,
their footwear. The corrugated rubber
tubes and Y pieces of the anaesthetic machines are seldom sterilized and theoretically
provide a possible means of inducing postoperative staphylococcal pneumonias. The
air entering some operating theatres is often
unfiltered or is drawn by exhaust fans from
the hospital corridors or through dust-laden
SPECULUM
40
ducts. The unnecessary movement of individuals and the overcrowding of theatres
also contribute to the bacterial air loading,
which should never be higher than 10 organisms per cubic foot of air. In short, the
main weakness in operative asepsis is compounded of two elements—lack of personal
discipline and incredible architectural mistakes.
Ward asepsis is far more complex a
problem and we can neither answer all
questions nor question all answers connected
with it. One aspect of this problem is the
role of the woollen blanket as a reservoir
and disseminator of the hospital staphylococcus. It would appear that overseas and
South Australian workers consider the woollen blanket a more dangerous source of airborne infection than the cotton textiles,
sheets and pillow slips. A Melbourne
group (Rubbo, Stratford, Christie and Dixson) are now investigating this question. It
is too soon to report their findings but this
much can be said—of the two types of textiles, woollen blankets and cellulose sheeting, the latter invariably yields higher
staphylococcal and total counts. The top
sheet of any hospital bed is always more
111■•■•■••■■•■ ••••••••• •■•■■••■■•■ •■•■•••••■M•lx•-••••• ■•■■ •■■■•••••••■•••■•■•■•■••••■•■•••■■■••
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heavily contaminated than the blanket it
covers. Whether these cottons can spread
their heavy bacterial flora more effectively
than the less heavily contaminated blankets can only be determined by controlled
experiments of a type which are now being
carried out at St. Vincent's Hospital, Melbourne. It is hoped that the present studies
will help to define the problem of ward
cross-infection more clearly and to provide
some practical answers to it. Those of you
who hope to repeat Division II in 1960 will
have an opportunity of hearing these results
first hand.
As I have now filled the space for your
Editor there is no a priori reason for me to
continue, not even to try to answer all question on Staphylococcus aureus.
WHAT YOU SHOULD READ
Elek, S. D., "Staphylococcus pyogenes and
Its Relation to Disease", Livingstone, 1st
ed. 1959.
Hare, R., and Thomas, C. G. A., 1956,
"The Transmission of Staphylococcus
aureus", British Medical Journal, 2, 840.
Hospital Coccal Infections. "A symposium,
Medical Research Council Committee on
Cross-Infection in Hospital" Jan. 2nd,
1957.
McDermott, W., 1956, "The Problem of
Staphylococcal Infection" British Medical
Journal, 2, 837.
Robinson, R., 1958, "Hospital Staphylococcal Infections" Oxford Medical School
Gazette, 10, 78.
Rubbo, S. D., 1948, "Infection: A Hospital
Problem," Medical Journal of Australia,
2, 627.
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43.
Viewpoint on The General Practitioner
in The British National Health Service
By E. C. Gawthorn, M.B., Ch.B. (Bristol)
In 1948, as part of its "cradle to grave"
social services plan, the British Labour
Government introduced the National Health
Service. Under its terms the nation's health
services were mobilised to provide, for all,
"free" medical, dental, optical, pharmaceutical and hospital facilities.
The general practitioner found himself a
cog in the health service machine, and
found that the scheme, which many doctors
had welcomed, proved unsatisfactory in
many respects. These can be discussed
under the headings of remuneration, lack of
professional freedom, and interference with
the proper relationship which should exist
between patient and doctor.
The average fees of G.Ps. in Britain before the scheme were 3/6 for surgery consultations, 5/- for home visits for private
patients, and £1 per head per annum for
"panel" patients. These latter were workers
who, with their employer, paid for a doctor's
services on a per capita basis. The National
Health Service extended the panel scheme
to cover everyone and the G.P. was paid just
less than £1 per year per patient. The rate
was subject to review from time to time, but
the doctors have discovered the government
to be very slow to grant concessions. In
spite of enormous rises in wages and the
cost of living, the G.P. is now paid very
little more than he was in 1948.
The maximum number of patients the
doctor was allowed to have on his list was
4000, and this would give him an income of
approximately £4000 gross. However, it
has been found that a doctor cannot cope
properly with more than about 1500
patients and the good and conscientious
G.P. finds that he must restrict his list—
hence his income—in order to give his
patients a good and careful service. A gross
income of £1500 per annum when deductions are made for practice premises, a receptionist's wages, a locum tenens during
holidays, car running, income tax, etc.,
gives the doctor very little reward for long
hours of work and long years of unpaid
study. It is only the doctor's professional
pride and regard for his patients that has
prevented a major break-up of the service
and strike action by the doctors.
The National Health Service Act banned
the "sale" of goodwill, and the country is
divided into areas dependent on the ratio
of G.Ps. to the population. Hence, areas
are designated "over-doctored", "doctored",
or "under-doctored". No new practices may
be established, nor additional partners added to existing practices, in the first two catagories; and doctors must receive government
approval before taking up practice anywhere. There are only very few areas in
Britain which are designated "underdoctored"; thus it is virtually impossible for
a young man of initiative to put up his plate
and build up a practice.
The doctors were promised compensation for their practices but, after joining
the scheme, they discovered that the compensation was not to be paid until they
retired or resigned from the scheme. Since
the valuation of money has decreased considerably this results in doctors getting
(eventually) only a proportion of the relative
worth of their practice. The younger men,
who had not yet acquired a practice, held
the scheme as a wonderful change from the
old times of having to pay large sums for
goodwill. Little did they know that the
dP
SPECULUM
44
scheme that they hailed would result in a
tremendous pool of young—and ageing—
doctors of the assistant O.P. grade! These
young graduates are becoming more and
more disillusioned as the years go by, as
they have not succeeded in being appointed
to vacancies in G.P. Although there is a
superannuation scheme, there is little incentive for the older doctor to retire and make
way for the younger man, when he can retain the practice in name and employ a
"boy", cheaply, to do most of the work, and
easily replace him if he becomes ambitious.
Nor did the younger men realise that, whilst
goodwill was no longer saleable, they would
often have to pay the retiring doctor a very
high price for the house from which the
practice was conducted as a condition of
being "given" the practice.
This difficulty of obtaining jobs forces
many doctors to migrate abroad or to enter
fields of medical work other than general
practice. One doctor, who recently came
here, applied unsuccessfully for 289 appointments in G.P. in England. As a protest he
even registered with the Department of
Labour as an unemployed person. I know
of many other young doctors with similar
experiences.
The doctor is not paid for any extra service he gives the patient; therefore, no doctor in the scheme can run an X-ray machine
or equip himself with surgical instruments or
with many of the usual aids to diagnosis.
This, and other factors, result in a severe
curtailing of the doctor's professional freedom. Since the pathology and X-ray facilities of the hospitals are overburdened with
the enormous increase in work, the G.P. is
not allowed to order special investigations
on his own initiative. The G.P. does not
have access to beds in the hospital; thus
most of his interesting cases must be referred to a hospital for investigation and
treatment. He has to refer to the hospital
minor surgery such as cysts, abcesses, simple
fractures, lacerations, etc., which do much
to add to the interest of practice, and which
his training make him completely competent
to perform. These factors must reduce the
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level of the G.P.'s competence and clinical
acumen, and, after many long years of training, doctors become disgruntled when they
are reduced, in part, to a form-filling-sorting
clerk for the local hospital O.P. department.
The fact that no one can obtain "free" medicine, dressings, or surgical aids without a
doctor's prescription fills the doctor's waiting room with many people who only want
the doctor to write out their shopping list
for them! The doctor, therefore, has much
too little time for examining his patients
who are really sick—this again reducing his
competence as a clinician. Due to the overcrowding of the hospitals which results from
the above-mentioned, there is an enormous
delay in the O.P. department and a waiting
list for essential X-rays, etc., that is so long
as to be come dangerous. The G.P. loses
sight of his referred case and, several months
later, receives a letter from the hospital—
long after he has forgotten it.
The relationship between patient and
doctor is altered under the scheme. The
doctor's clinical records of his patient are
available for inspection, on demand, by a
lay government inspector, thus destroying
the much cherished and long established
tradition of professional secrecy. Since the
patients have all the rights under the scheme
and the doctor none they are, in general,
much more demanding in their attitude. A
patient may report his doctor to the local
health committee for many and various
"misdemeanors" for which the doctor can be
summarily fined without right of appeal. A
doctor was recently fined for refusing to see
a patient under the following circumstances:
the patient telephoned to say that his son
had swallowed several tablets accidentally.
The doctor, who was in bed with influenza,
told the father to take his son quickly to the
hospital which was very near to the patient's
house. The doctor telephoned the hospital
to forewarn them of the patient's arrival.
For not going to see the patient, although
this would have meant a delay in his treatment, the doctor was fined £25.
In the country areas the G.P. is slightly
better off than in the towns. Country G.Ps.
are allowed to charge mileage fees to the
government and are also allowed beds in the
small "cottage" hospitals where they can do
some minor surgery. The age of the G.P.
45
surgeon is dying, however, since the scheme
of itinerant consultants for small country
hospitals was started. In general, patients
in the country are less demanding with
trivial complaints than those in the cities,
and the country G.P. is able to practice
medicine in a more orthodox manner.
There are some advantages of the scheme
from the G.P's. point of view. He has no
bad debts, nor has he any accountancy fees.
In Australia, the G.Ps. have different rules
for prescribing, different fees, and different
types of certificates for private, Repatriation,
pensioner and workers' compensation
patients. In England all patients come
under the one scheme. The doctor in Australia must, on occasions, give the patient
less service than he really needs because the
patient feels he cannot afford ample medical
treatment. In England the doctor has no
such worry. With our limited State aid
here, and with the pension scheme, in the
industrial suburb in which I practice I find
very few people who cannot afford medical
treatment. If the enormous cost of the
British scheme is taken into account—it
costs £700,000,000 annually (ie., £14 per
head of the population)—the scheme results
in far more poverty for the community as a
whole.
From the above considerations it is evident that, from the G.P's. point of view, the
disadvantages of the British scheme far outweigh its advantages. This year there will
be more registrations of British doctors in
Victoria alone than the number of students
in the present final year at the Melbourne
University. There must be something
wrong with a scheme which is forcing doctors, in increasing numbers, to migrate
abroad. If an alteration of the present system in practice is contemplated in Australia,
it is essential that the medical profession
remain as free as possible so that the doctor
remains a free professional man and not a
State public servant; and that the harmony
of the private relationship which should
exist between patient and doctor is undisturbed by the eternal triangle made by State
interference.
Hear of the first year student who thought
a pseudopod was an ovarian tumour?
:
SPECULUM
46
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47
A CONCISE DICTIONARY OF
MEDICAL KNOWLEDGE
"Herbie"
The following is a symposium entitled
"Medicine via the Lacy Press". We see here
the reporting of medicine in simple, clear,
concise language, not necessarily with any
reference to the truth, and we feel: if ONLY
textbooks were written like THIS!
The following examples are not imaginary
and in all cases there is not the slightest
exaggeration. On request the author will
demonstrate a "trumped-up" article for
comparison.
The author can be contacted in person
now, but at the conclusion of the exams this
year will, regardless of result, be contactable
only in spirit (s?).
Bleeder's Digest
April 1st, 1959
Articles of lasting interest
DO YOUR BREASTS FEEL FUNNY?
By Dr. Harris B. Queenliegh
The author, an eminent American authority on Cancer, particularly in the mammary
glands (breasts, or something worse, to you)
tells how you can save yourself from this
frightful disease.
My article is addressed primarily to
ladies, although, as this is a family magazine, I daresay there will be some interest
to even the males of the family. This is
because even males have breasts, which is
not as confusing (really) as you might think.
Basically, there are two types of breast:
true and false, and the diseases of the latter
are two-fold only. Firstly, a diffuse hypertrophy, which often has an extremely acute
onset and leads occasionally to symptoms of
severe embarrasment—and even collapse.
Secondly, an acute sagging is described—
this can have almost catastrophic results,
with severe collapse. You may see someone stricken in this way in the street. To
treat such a patient, especially when collapsed, help her to lie down, but on no
account loosen the clothing as this could
prove an even greater embarrassment to the
constitution.
The true breast has only one disease.
Lumps. These come in varying sizes and
should always be examined under the light.
By this we mean a surgical examination,
not what you were thinking, you cad.
Some lumps are cancers just beginning
their death-march. Thousands of tiny little
cells all multiply, and next thing you know
you've lost weight, you can't eat, you're
unable to sleep—bang! you've had it.
But there's no need to worry.
To help you tell if you've got cancer we
attach this list. Just put Yes and No against
the questions.
(a) One yes only—you're safe.
(b) Three yesses—still benign.
(c) Five yesses—you're spastic.
(d) Seven yesses—definitely neoplastic.
SPECULUM
48
KANCER KWIZ
Losing weight?
Get up at night? (You can interpret that as
you like)
Do you like mulligatawny soup?
Ever been sick after oysters?
Ever dream at night?
How are your bowels?
Have you a little brother?
Do you love him?
Do you play sport?
Are you a gambler at heart?
Do you drink?
Smoke?
Interested in the opposite sex?
Is your I.Q. above 50?
Are you happy in your job?
Are you married?
Do you drive?
Have you any of the following complaints?
1. Night starvation
2. B.O.
3. Waking up tired
4. Bad breath
5. The "Shakes"
Footnote:
The author, Dr. Harris B. Queenliegh,
His mother
was born in a water closet.
says, "Harry was always one who wouldn't
wait."
He graduated M.D. from the Four Square
Christian College of Medicine, Wahoo,
Nebraska, in 1931.
Since leaving the A.M.A. he has mostly
written for the press, although he runs a
clinic for single girls on Saturday afternoons.
He has been married twice. Neither
marriage was a success because his wives
"just couldn't get along together."
There was once a young girl who, enthralled with her first love affair, arranged
for her boy-friend's face to be tattooed over
her heart. However, the friendship did not
last, and within a short time she had found
herself a new companion who, she felt, deserved also his imprint—this time tattooed
on the right side. This again broke up, but
her third venture was more successful, and
marriage took place. On the wedding night
she explained the significance of her tattoos
to her new husband. Instead of showing
jealousy he laughed heartily.
"Why do you laugh?" she asked.
"I was just thinking," he replied, "that
within a few years what long faces they will
have!"
The Soviet Cataract
April 1st, 1959
One reader writes: "I wonder could you
tell us something in your excellent magazine
of medicine as practiced in the U.S.S.R. I
am very interested in this subject.
Yours sincerely,
E.J.W., Ceylon."
In reply, we publish the following article.
Photographs are by E. Bearsky (People's
Medallion of Photography).
MEDICINE has been practised in
U.S.S.R. since time "in memorium". Since
the Revolution, however, great advances
have been made.
There are 30,000,000 doctors in U.S.S.R.,
of which some 500,000 are still alive. There
are many nurses and wardsmen. The hospitals are huge and thoroughly up to date.
One of Moscow's general hospitals has been
the most up-to-date in the world since 1929,
when it was built.
Disease is rare in Russia today thanks to
the excellent medical service of the third
"five-year plan". This has resulted in some
Russians living to the age of 140 and even
longer.
This lack of disease threatens unemployment in medical circles. Fortunately, many
doctors volunteered as labourers in the
highly successful "Virgin Lands" settlement
scheme.
Russians have been responsible for many
advances in medicine, and their names are
now household words all over the world.
Hence, we need not mention them in this
article.
SPECULUM
49
Mr. Nikita Kruscheff congratulating Mr. Letcher Poppinoffen before presenting his
wife with the Soviet Medal of Heroic Motherhood-10 children.
Our photographs show something of
medical teaching in Russia. It is regretted
that a poor coverage is being given to this
subject in this article. More may be learnt
about Russian medicine in the following
Medical students receiving advanced
training in temperature taking at the converted chapel in one of Moscow's large upto-date hospitals.
Soon they will get a chance to take a temperature themselves. (In Canitalist countries the students don't bother to take the
temperature.)
films, where doctors or medicine play a
part.
"1917—The Bloody Year", with E. Solmoy and D. Listokniff.
"Lenin The Great", with P. Petrovich and
G. Podsnoppikoff.
"The Birth of Lenin", with L. Pavlov (as
Lenin's mother) and several genuine
Lenin relics.
THE MOSCOW UNIVERSITY
SPECULUM
50
The Australasian Most
April 1st,
1959
YOUR GONADS
AND YOU
You've got these glands, see? All over
you. They make you what you are.
These glands aren't all as obvious to the
eye as others. They're deep inside the
body, pouring out their "secretions" (that's
the stuff they pour out) into the blood.
"So what?" you say. "What's it in the
blood for?"
Hah. That's the whole trick. It gets at
the cells of the body. Marvellous, isn't it?
And that, briefly, is how it works.
Grace Kelly was a wow of an actress.
Brother Jack was an Olympic sculler.
Scientists are sure that their pre-eminence
was due to their sex. If Grace had tried to
be a rower, where do you think she'd be?
And can you imagine Jack as an actress?
Charlie Flaherty, of Wahoo, Nebraska,
U.S.A., had a childish ambition to grow a
beard. He did, all right, but now his head
is as smooth as a billiard ball. Silly, isn't
it?
How did Sabrina get that way? The
scientist now knows the answer.
r"MEMIONE11.11111.111
SPECULUM
51
CHYME
April
1st, 1959
A weekly newsmagazine
MEDICINE
For years doctors have been puzzled by
one problem—how can you listen to a
patient's heart without embarrassment?
Many doctors claimed that the ear-to-breast
manoeuvre certainly elicited thrills, but often
provoked murmurs from the patient, especially if female.
Last week dapper, moustachioed French
medico Rene Laennec* came up with the
answer to a maiden's prayer. Laennec's
ear trumpet, made of rolled-up paper (price,
1 sou), can be used to listen to the heart
without actually placing the head on the
breast. Trust a Frenchman to think of the
ladies! Laennec now visualises his "stethoscope" as a quite elaborate affair of rubber
tubing.
Came to him in a flash:
Laennec, born in 1781, is now professor
of medicine at the College de France. His
other work centres about liver disease.
Laennec says the idea came to him "in a
flash".
Science awaits the results of this discovery.
*Full name: Rene Theophile Hyacinthe
Laennec.
WOMAN'S SAY?
April 1st, 1959
"A DOCTOR ANSWERS"
Send your medical queries to Dr. Howard
and he will answer them in this column each
week. He regrets his inability to enter into
any correspondence.
1. 0.—I have varicose veins and seem to
have this sore on my leg. What do
you think I should do? Also, do
you think I am overweight? I am
32 stone (dressed).
"Anxious," N.S.W.
A.—You may not be overweight. You
may be 9 feet tall or wear a lot of
clothes. You had better write to
me again.
2. Q.—I am a girl of 25 and recently I met
the man of my dreams. We just
clicked. Foolishly, I gave him
everything in an effort to keep him,
but he just hasn't contacted me
since. That was 6 months ago. Do
you think you could give me
hormones to make me more attractive?
"Anxious", Q'land.
A.—Well, I, er . . . .
Q.—And also I seem to have this discharge down below for the last few
years. What is it?
A.—I am sending you one gross of
assorted booklets which may help
you.
*
*
*
3. Q.—I am a woman of 62. I seem to
have horribly lumpy breasts lately
and am losing weight and coughing
Also my hand feels
up blood.
numb and my back hurts. Can
you help me?
"Anxious," Vic.
A.—Certainly. I am sending you the
name of a well-known proprietary
tonic which will soon put you on
your feet.
*
*
*
4. Q.—My young daughter aged 13 has
just started menstruating and I find
this rather odd as I have always
thought she was a pseudo-hermaphrodite.
"Anxious," S.A.
A.--Mother knows best.
52
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SPECULUM
53
DIAGNOSTIC QUIZ
SURGERY
Mr. T. H. Ackland
1. A patient with the diagnosis of chronic
nephritis finally died in a medical ward
with symptoms and signs which seemed to
be those of uremia. The blood urea before
death was 250 mg. per cent. However, a
visit to the P.M. room brought great discomfort to the physician concerned (and
also to the R.M.O., who was the writer).
What was found?
2. Cholecystectomy was performed on
a young woman of twenty-eight, a nurse.
Her convalescence was associated with what
seemed an inordinate amount of pain, and
then her wound refused to heal. Even after
five months, several sinuses were discharging pus freely, and a high pyrexia was
All investigations were
usually present.
negative, and driven to it, the surgeon reopened the abdomen to exclude a pack
being present. Again the wound continued
to discharge. Why?
3. A garage mechanic who had received
no injury complained of a hard swelling on
the back of his right wrist, made very obvious by palmar flexion. It seemed much
harder than a ganglion, and was slightly
tender.
4. A medical student came with a wrist
drop due to a right radial nerve paralysis
affecting the forearm extensors. It had been
present two weeks. He had had no fracture
of the humerus, and had not used crutches.
What was it?
5. A young woman of twenty-two was
referred from the country with the suggestion that she had an abdominal aneurysm.
She had no symptoms but there was visible
and palpable pulsation in the epigastrium.
What was the diagnosis?
6. Acute cholecystitis had been diagnosed confidently in a patient of fifty-five
with high temperature, pain, tenderness and
rigidity at the right costal margin, but at
operation embarrassment arose when a
ANSWERS
normal gall-bladder was revealed. This is
an important trap, because it is a common
one. What is it?
7. My garage attendant limps and wears
a toe spring for a permanent foot drop. He
acquired this four years ago after being in
hospital for the treatment of a badly infected
finger. How did this come about?
8. A woman of forty had suffered many
years of almost unbearable pain in the tip of
her right middle finger, shooting up her arm.
She had been to many doctors without obtaining relief and had recently been referred
She spoke of suicide.
to a psychiatrist.
Clinical examination was negative except
that she would not allow the end of her
finger to be touched.
9. A young girl came with a small
abscess over the left malar region. It was
treated as such, but six months later she
returned because there was still a discharge
of pus. What was the reason?
10. A young man of thirty-five had an
unexplained anaemia of such severity as to
require admission to a medical ward for
blood transfusion. He had no symptoms
other than weakness, and blood examinations did not enable a diagnosis to be made.
After discharge from hospital the anaemia
recurred and he was readmitted with a
haemoglobin of 45 per cent. What should
be thought of in all cases such as this?
11. An elderly man of seventy-six,
whose mental condition was not very good,
and who had been confined to his bed with
bronchitis for some time, was referred for
sigmoidoscopy because of troublesome
diarrhoea. What first thoughts before
arranging for sigmoidoscopy?
12. Following cholecystectomy and exploration of the common bile duct, the latter
had been closed by accurate suturing, and a
tube inserted to the gall-bladder bed. On
the 5th and 6th days the pulse rate rose to
120 and the abdomen became silent and
distended. There was only a little bloodWhat
stained discharged from the tube.
should be done?
ON PAGE 59
SPECULUM
54
MEDICINE
Dr. G. A. Pennington
1. Three young women were admitted
to the same ward within 24 hours with similar symptoms and signs—acute colicky general abdominal pain of 24 hours duration,
localising in the right lower quadrant, mild
pyrexia, frequency of micturition with slight
scalding, vomiting without relief of pain,
tenderness over McBurney's point but no
rigidity. P.R. N.A.D. Breath—"abdominal", tongue furred.
Microscopy of the urine revealed—
In (a) pus cells in profusion, red blood
cells and bacilli.
In (b) pus cells, and red blood cells: no
organisms seen.
In (c) many red blood cells, pus and
epithelial cells, granular casts and a
few cellular casts. Albumen was also
present in a moderate amount.
Would you advise operation?
2. A middle-aged ex-serviceman was
admitted with a history of right upper abdominal pain and tenderness of subacute
onset, persistent for two weeks. There had
been two previous attacks which had slowly
Tenderness over the liver was
subsided.
noted, maximum in the gall bladder area;
leucocyte count was normal. - Temperature
was remittent, maximum 37.8° C. No gall
bladder shadow was seen on cholecystography.
What course will you take?
3. A carpenter aged 50 who had spent
all his life in Victoria complained of diarrhoea of one week's duration following an
accident to his son. He had previously
suffered from intermittent diarrhoea coincident with domestic upsets, relieved by
superficial psychotherapy and sedation.
Sigmoidoscopy had previously revealed no
lesion and barium clysma examination was
normal.
What would be your management?
4. A male aged 60 was brought to hospital semicomatose and with a superficial
abrasion in the right frontal region. He was
a known chronic alcoholic. There were no
physical signs of a severe head injury or
He was
significant variation in reflexes.
irritable when roused and with recovery of
consciousness was confused, restless and
difficult to control. He talked incessantly
to the annoyance of others in the medical
ward.
Management, please.
5. A housewife in her forties was under
treatment for nutritional anaemia, her bone
marrow having shown normoblastic haemopoeiesis during a relapse.
She was given
folic acid orally and within a month became
psychotic and developed abnormal plantar
reflexes although they were not of classical
Babinski type. Moderate normocytic normochromic anaemia was present.
What would this sequence of events make
you suspect?
6. A housewife aged 55 suffering from
a refractory anaemia, with no symptoms
other than those due to anaemia, also had
signs of mitral stenosis. X-ray examination
to determine the cardiac size and contour
revealed the cause of her anaemia.
7. A farmer aged 24 years reported to
his doctor complaining of pain in the right
side of the chest and was found to have signs
consistent with a large pleural effusion.
Aspiration was complicated by coughing,
cyanosis, shock and expectoration of liquid.
Advice was requested by his doctor regarding resuscitative measures and explanation.
What would you advise and suspect?
8. A male student, aged 20, who had
"not been well" for two weeks found difficulty in riding his motor cycle home from a
parade because of an uncontrollable
tendency to veer to the left. On the following day he was dropping things from his left
hand, drowsy, irritable, and strange in his
behaviour. Headache was constant. He
was found to have neck stiffness and a left
hemiparesis. Fundi were normal. General
physical examination revealed no lesion in
cardiovascular, respiratory, alimentary or
genitourinary systems. He had had repeated
X-ray examination of his chest because of
some abnormality Mantoux test was negative.
Provisional diagnosis and investigations?
9. What is a relatively common cause of
auricular fibrillation which is inadequately
controlled by digitalis?
10. Under what circumstances is the intravenous administration of digoxin desirable?
SPECULUM
MI-DICAL MI -DLLYS
1959
"The
WIZARD
of OS"
KHiP
FRIDAY, 11th DECEMBER
55
SPECULUM
56
PAEDIATRICS
Dr. H. N. B. Wettenhall
1. A small boy aged twelve months
playing happily in the yard suddenly dropped what he was doing, screamed, and went
very pale. His mother attempted to comfort him without success but when the doctor arrived twenty minutes later the child,
apart from some pallor, appeared perfectly
normal. What diagnosis would you suspect and what action would you take in
such circumstances?
2. A child of ten months cries when
picked up and his mother notices that he is
unwilling to move his right leg. Possible
diagnosis and management?
3. A baby of four months weighs only
two pounds more than when he was born
and on examination is found to have a loud
His
systolic bruit over the praecordium.
heart is slightly enlarged and the liver is
palpable two fingers breadths below the
right costal margin. Diagnosis?
4. A boy, aged 8, had painful swollen
knees, ankles and wrists for two days. He
was feverish and there was a faint systolic
bruit audible in his heart. On careful examination a petechial rash was visible over
his ankles and buttocks. Diagnosis?
DOING FINALS ?
Then arrange to receive
SPECULUM
in future years and keep
in touch !
See your Year Representative
5. A baby had an upper respiratory
tract infection which had been treated with
penicillin. Five days after the onset the
baby refused his feeds, looked pale, and his
mother said he was not taking any notice of
her. What diagnosis would you suspect?
6. A girl, 5 years old, had fever up to
103°F for three days. The only findings
were a slightly runny nose and a cough. The
chest was clinically clear, but the child
looked sick. Diagnosis to suspect?
7. A boy, aged 21 years, had croup
when he was ten months old, and for the
past two months his mother had noted noisy
breathing and slight cough. He was otherwise well. X-ray chest showed clearer lung
fields on the right than the left, and his
mother said the boy often had peanuts to
eat. Diagnosis?
8. A girl of 6 had chicken pox, following which for two months she complained
intermittently of headaches on waking in
the morning. She had also vomited on three
occasions. On examination she was clinically normal. Diagnosis and management?
9. A boy, 8 years old, suffered from
epilepsy. He had been treated with dilantin
and mysoline, and for six months tridione
had been added. For two weeks he was noted
to be puffy round the eyes, his urine contained over half albumin on boiling. His
blood pressure was normal, and there was
no haematuria. Diagnosis?
10. A baby, aged 6 months, had a cold
which progressed to bronchopneumonia.
Staphylococcus aureus was grown from a
throat swab, and the baby was treated with
erythromycin. At first the baby improved,
but after a week the temperature was rising,
respirations were more rapid and there was
no doubt he was sicker.
Diagnosis and
management at this stage?
11. Mary, 51 years old, was brought to
the doctor because her younger sister, Jane,
was as tall as she was. Mary was also slow
in her reactions and looked sallow. She
did not eat much and was mildly constipated. Diagnosis?
12. While his mother was doing her
household chores the baby boy, aged 15
months, was playing happily on the floor.
His mother suddenly noticed that the baby
was deep blue in colour and rushed him to
hospital. Diagnosis and management?
UPV
57
SPECULUM
OBSTETRICS AND
GYNAECOLOGY
Dr. N. A. Beischer
The foetal heart immestage of labour.
diately became irregular and disappeared.
5. An 11-year-old female mental defective was brought to gynaecological outpatients' department suffering from an
offensive yellow vaginal discharge.
6. For card players: What is the gynaecological "Full Hand"?
A Patient's Privilege
MEMORANDA TO PATIENTS
From "Hospital & Community"
1853
1. A woman aged 22 years presented
complaining of four hours abdominal pain
which had become progressively severe, and
which radiated to the loins. Her last normal period had occurred 12 weeks previously. She had been unable to void since
the onset of the pain. Examination revealed a tender midline mass arising from the
pelvis, extending to the level of the umbilicus. The mass was smooth and dull to percussion. Vaginal palpation showed a tender
mass in the Pouch of Douglas projecting
into the vagina, the cervix being displaced
anteriorly behind the pubic symphysis.
2. A woman aged 75 years presented
with a 3-month history of post menopausal
Examination revealed a firm,
bleeding.
This
fixed mass in the right iliac fossa.
mass was palpable vaginally high in the
right fornix, and was the size of a tennis
ball. It was tender and seemed regular. The
uterus was small, anteverted, and mobile.
3. A woman aged 26 years presented at
32 weeks gestation with a history of acute
right upper abdominal pain following a bout
of coughing. Examination showed a tender
mass in the right hypochondrium. The
foetal heart was regular but the foetal parts
difficult to palpate.
4. A multigravida at term had a bright
painless two-ounce vaginal haemorrhage
when the membranes ruptured in the second
No patients shall play at cards or dice, or
gamble or smoke tobacco or spit on the
floor, or deface or injure any part of the
ward or any furniture, bedding or clothing therein, or sing, blaspheme, or use rude
or indecent language.
1953
Dear Patient,
It is unfortunate that you have had to
enter this hospital, but we wish to assure
you that we shall do everything possible to
make your stay with us as happy as circumstances permit. To us, the patient is
the most important person in this hospital,
and it will be the pleasant duty of everyone
—doctors, nurses, technicians, and others—
to work for the restoration of your health.
Your nurses will be happy to give you
information as to contacting Ministers of
Religion, posting letters, visiting hours, Red
Cross library service, daily newspapers, and
the service provided by honorary workers
who bring a trolley from the Kiosk, so you
may purchase toilet requisites, cigarettes,
sweets, and such like. If necessary, you will
also be visited by an Almoner to discuss
arrangements for your transfer later to a
convalescent home, and also other matters
concerning your welfare after you leave the
hospital.
May we express every good wish for your
speedy recovery?
Yours sincerely,
On behalf of The Royal Melbourne Hospital
Manager.
58
SPECULUM
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59
SPECULUM
ANSWERS TO DIAGNOSTIC QUIZ
SURGERY
1. Perforated pelvic appendicitis with
general peritonitis. It is difficult to be sure
whether it is more dangerous to have a
medical condition in a surgical ward or a
surgical condition in a medical ward!
2. The answer was provided on another
occasion when still further exploration was
carried out. A small ball of cotton wool
was found—material not used during operaShe was a confirmed pethedine
tions.
addict and had kept her wound from healing
by pushing in wool pledgets. Thermometer
readings had been kept elevated by some
form of deceit never discovered.
3. Carpal bossing (carpe bossu), a bony
overgrowth of the dorsal aspects of both the
capitate and the 3rd metacarpal, is a very
common condition not spoken about very
much. It is usually symptomless but in this
case tendons had been slipping over the
prominence.
4. Much questioning was needed to confirm the suspected diagnosis of "Saturday
night paralysis". Friends had come along
to watch T.V. They had a few drinks and
it was 4 a.m. when he awoke with his arm
"feeling funny", because it had been hanging over the back of the chair.
5. No abnormality was present,—in
some people, either thin or fat, the abdominal aorta is unexpectedly visible and palpable.
6. The patient had a pyonephrosis due
to a stone impacted at the pelvi-ureteral
junction, and this was removed with difficulty through the inappropriate anterior incision. Pyonephrosis should always be excluded before operating for acute cholecystitis.
7. Penicillin was injected into the sciatic
It is the
nerve causing nerve atrophy.
writer's opinion that no nurse has sufficient
knowledge of anatomy to be allowed to give
injections into either the buttock or the arm.
The radial and sciatic nerves have often
been permanently damaged in this way. The
anterior and lateral surfaces of the thigh
are the only safe places.
8. This patient has a sub-ungual glomangioma half the size of a pea. It could
only be seen when the nail had been removed and shelled out with ease. All
symptoms disappeared.
9. This was a sinus from an abscess
The
associated with a left upper tooth.
diagnosis was not so obvious as it might
have been on the lower jaw.
10. Carcinoma of the caecum, which
may present in this masked fashion with
tragic results. The anaemia in this case had
been present for six months before a barium
enema was carried out, and operation disclosed an inoperable lesion.
11. Yes—impacted faeces, the "diarrhoea" was mucus only.
12. The risk of a diagnosis of paralytic
ileus was too great and immediate re-openThere
ing of the abdomen was advised.
was choleperitoneum in spite of the fact that
no bile issued from the tube, and a fatal outcome was narrowly averted. When the
common bile duct has been opened it should
never be closed, but always drained; so
likely is bile, with its low surface tension, to
leak.
MEDICINE
1. The history and signs could not exThe leucocyte
clude acute appendicitis.
count was not helpful although raised in (c).
All were operated upon, the diagnosis
being:
In (a) acute appendicitis in addition to
and possibly causative of the pyobacilluria.
In (b) a normal appendix was removed—
acute pyelitis.
In (c) a gangrenous appendix was removed. Acute nephritis was also present and recovery occurred.
2. Enquiry elicited service in Middle
East and New Guinea. He had not suffered
from dysentery. X-ray revealed some elevation of right hemidiaphragm. Microscopy
of stools disclosed cysts of E. Histolytica.
Anti-amoebic treatment resulted in complete
remission of amoebic hepatitis.
3. General examination revealed no abStools were macroscopically
normality.
liquid and faecal with traces of mucus. Sig-
60
SPECULUM
moidoscopy was again carried out and revealed typical acute amoebic dysentery.
Vegetative forms of E. Histolytica were
demonstrable in a scraping from the edge
of an ulcer. He responded to treatment for
amoebiasis.
4. A person who is "fighting drunk" or
has abnormal behaviour, irritability or restlessness with evidence of even a minor head
injury must be suspected of having a
subarachnoid haemorrhage. X-ray examination revealed a fractured skull, and a
subarachnoid clot was evacuated after a
delay of five days.
5. Folic acid may precipitate neurological manifestations of B12 deficiency
especially subacute combined degeneration
of the cord, when given to a person suffering
from pernicious anaemia. Her bone marrow on three occasions was normoblastic;
but the first examination was vitiated by
prior administration of liver extract.
She responded well to B12 parenterally.
6. Symptomless carcinoma of the lung.
7. Puncture of a pulmonary hydatid was
suspected and treatment as for the apparently drowned with up-ending of the patient
was urged. He recovered and a shrunken
hydatid cyst was subsequently excised by
Mr. Hayward.
The signs of a pulmonary hydatid may be
those of pleural effusion and X-ray examination of the chest should precede aspiration as a routine measure.
8. In view of the short history, neck
stiffness, mental changes and the hemiparaesis in a young man with abnormal pulmonary findings radiographically, a provisional
diagnosis of tuberculous meningitis was
made.
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C.V.K.
Abnormally large hilar shadows were
present on X-ray examination and lumbar
puncture revealed increase in Lymphocytes
and protein and a fall in chlorides and sugar.
Mantoux test was negative and remained so
to the end. Acid fast bacilli indistinguishable from M. tuberculosis were isolated
from the urine on one occasion. Remissions occurred but death from hydrocephalus resulted 12 months later despite
streptomycin. Autopsy confirmed the diagnosis.
No reaction to the Mantoux Test does not
exclude tuberculosis.
9. Thyrotoxicosis.
10. When there are positive indications
for digitalization, the oral route is precluded
by vomiting, and digitalis or its glusosides
have not been taken for two weeks.
PAEDIATRICS
1. The history was suggestive of intussusception but initially no tumour was palpIt was considered that the child
able.
should be kept under observation and while
on the way to hospital he had another
attack of screaming and abdominal pain,
following which the typical sausage-shaped
tumour was palpated. The intussusception
was reduced at operation and the baby made
a complete recovery.
2. The most likely diagnosis is scurvy
though the mother may fear the child has
poliomyelitis. Osteomyelitis would be accompanied by fever, and trauma might need
to be considered in some cases. An X-ray
of the leg would clarify the diagnosis and
ascorbic acid would provide the cure.
3. This could be a ventricular septal
defect, patent ductus, pulmonary stenosis or
aortic stenosis. Patent ductus is the one to
suspect because unrecognised the child
could die, whereas surgery will cure.
4. This boy was a case of Henoch's
purpura. In about ten days time he developed the signs of acute glomerulonephritis from which he ultimately recovered completely.
5. Examination showed minimal neck
stiffness, and lumbar puncture revealed
purulent cerebrospinal fluid from which H.
influenzae was cultured.
6. On the third day the child had
Koplik's spots inside her cheeks, and the
SPECULUM
typical rash of measles appeared on the
fourth day. Always a starter in the early
school age child.
7. On bronchoscopy it was not the peanut that we confidently expected to find, but
granulation tissue infiltrating the bronchial
lumen from a tuberculous gland which had
produced the ball-valve obstruction. The
Mantoux test later became positive.
8. Lumbar puncture showed clear
cerebrospinal fluid both macroscopically and
microscopically but the pressure was over
This finding was repeated a
300 mms
month later, following which ventriculography was done and an astrocytoma was
found in the frontal lobe.
Moral.—Headaches in young children are
rarely functional.
9. Nephrotic syndrome, which cleared
with simple bed rest and the cessation of
tridione therapy.
10. Staphylococcal pneumonia in infancy is notorious for progressing to complications, of which suppuration in the lung
and empyema are the most common. An
X-ray of the chest suggested the presence of
an interlobar empyema which was confirmed
Following drainage of the
at operation.
empyema and the addition of chloromycetin
therapy the baby made a complete recovery.
Unfortunately results are not always so
satisfactory.
11. Mary was suffering from juvenile
An X-ray of her hands
hypothyroidism.
and wrists showed markedly delayed
epiphyseal development. Serum cholesterol
was 400 mgm, and Protein Bound Iodine
was 2.4 micrograms. She was treated with
Thyroid, grew six inches in the next ten
months, and became a happy, normal child.
12. The baby had drunk some liquid
furniture polish and was suffering from
methaemoglobinaemia. Following an intravenous injection of methylene blue he made
a prompt recovery.
OBSTETRICS AND
GYNAECOLOGY
1. Incarceration of the gravid uterus.
Acute on chronic urinary retention. Twin
pregnancy, later confirmed, explains the
early onset of symptoms.
2. Granulosa cell tumour of the right
ovary.
61
3. Extensive haematoma of right rectus
muscle.
4. Vasa praevia with velamentous cord
insertion.
5. Trichomonal vaginitis.
6. A young woman who, two months
following her first emotional experience,
presents with:
(a) Positive Aschheim-Zondek test.
(b) Positive Wassermann test.
(c) Gonococcal vaginitis.
(d) Pediculosis pubis.
(e) Tubal pregnancy.
THE OTHER FELLOW'S
MIND
I have studied the ways of my fellows,
A number of them are complex;
But there's one thing of which I am certain,
Yes, one thing of which I'm quite certain,
The mind of the medical student
Is constantly centred on sex!
He can give you a good dissertation
On bees, birds and flowers and their ways,
But a view he can air with assertion
Is why women shouldn't wear stays.
He knows all about nervous disorders
And numerous other upsets;
He possesses a great admiration
For the guy who invented curettes.
He knows well the osseous structure,
Especially the bones of the hand;
Which have a peculiar affinity
For the curve of the mammary gland.
He knows well the feel of the ankle,
The calf and the knee and the thigh;
And that ever so slight deviation
Which a man simply cannot pass by!
By now you'll have reached a conclusion
Quite possibly it is the worst—
Don't suffer from any delusion,
1 know, because I am a nurse!
There was a young lady named Rose,
Who had erogenous zones in her toes,
She remained enanistic
Till a foot fetishistic
Young man became one of her beaux.
—Speculum, New York.
SPECULUM
62
A New Rubaiyat
By 0., My!
(With Pedagogic Footnotes)
Awake! For boozing from the bowl all night
Has, I'm afraid, made me a little tight;
From dreams of Eastern damsels cease to
leer,
Review this (and many another) year.
When first I started on this course
My plan, to work without a pause,
Was born of fear of 1st year quota,
And so I spared not one iota.
Knowledge was my only aim
To fit me for profession;
Sex had reared not its ugly head,
Nor yet a drinking session.
Yet now, methinks, my hoary head
(Smoother than my age-lined face),
Is full of thoughts of other things—
Yet final year moves on apace.*
*Cf. Khayam: "The bird is on the wing,"
viz. also Durante, "de wing is on der
birdie."
■11■111111MMIEIM
Nir 111111111111
SPECULUM
Hogarth told the tale of the Rake,
Such a tale I could also make;
Yet of those men I will now tell
Who tried to rescue me from H
Over the years now let me glide,
Dealing with but the working side;
Forget the nights at Uni. Club,
The murmuring in the Beer-Loud Pub.t
Never will I forget the fright
I got when I saw Professor Wright;
This was nothing to my state
When I became his question-bait.
Fame never seems to come the way
Of friendly, smiling Lesley Ray;
And yet when he just grins at me
I know of places I'd rather be.
Nor can I forget my only tussle
(Thank God) with Professor Kenneth
Russell;
Why did he raise up such a fuss
Just 'cause I knew not the humerus.t
tCf. Yeats: "The Lake Isle of Innisfret•
tCf. Shakespeare: Know ye not Agincourt?
63
64
SPECULUM
ERYTH Roc
yrE
(ENt.ARico
In Division 1, Doctor Lavarack
We called (jestingly) Happy Jack,
Because, in two years, all that while
Never was he seen to smile.
Jack Legge's left handed hieroglyphic
Code, on the board, looks terrific;
But proves to all, I am afraid,
Biochemists are born, not made.
Professor Victor Trikojus claims
That Biochem's on the march;
Krebs and Ogsters laudable aims
"Cannot fail to ensure that this subject goes
forward to take its place at the forefront
of the medical sciences."
Pathology's Professor King
In his subjects acknowledged whiz ding!
Yet his pupils baffled looks wear
At the time he spends on wound repair.
SPECULUM
Then we have big Doctor Hurley,
Who talks to us on Wednesdays early;
Keith "Blows it up"—but we Ogilvie bring,
It's the only way we can draw the thing.
Amiable Charlie Green
In orals makes you feel serene;
Prof. Christie, on the other way,
May show that you have feet of clay.
Professor S. D. Rubbo's way
Is "Two beers, please, my friend will pay";
When he isn't going globe-flittin'
He'll take you on at distance spittin'.
Robert Wylie teaches "bugs"
And shows us how to cane 'em;
Dr. Wilson has some dogs—
Is sometimes seen to train 'em.
The Women's—Ah, fond memories!
We lived the life of a stallion!
We learned obstetrics and gynae there,
And also some Italian.
There is a man called S.L.T.
Whose fame should well be known;
"Your patient, doctuh?" tells you well,
You'll reap what you have sown.
65
SPECULUM
66
And then we have young E. McK.,
A gruff man, that is what they say;
Refresher may be a pleasant life,
It all depends upon his wife.
There is a Radiologist
Who likes to know your name, I wist;
He puts you on his little list
So never let him see you drunk.
Professor R. H. Lovell's fame
Rests (rightly) in what he knows;
A cold, you see, is not a cold,
Unless you have a runny nose.
Professor Ewing, I'd allow
To operate on me, I know;
As long as (this I must make clear)
He doesn't set the Middle Ear.
Many others there are, of course,
We must let them pass;
We thank them (of course) providing
They do the same for us.
For the moving finger writes 'tis true,
And soon we meet our doom;
And we are but some initials
In the med. north lecture room.
Weak we be (that's life's main charm),
Hungry times crumbling food;
Let us, we pray, do little harm,
And a teeny bit of good.
Deft Definitions:
Ansa hypoglossi:
Inaudible reply by a
student in viva.
Aponeurosis: Fear of nocturia.
PREDSOL
A range of products containing a completely soluble form of prednisolone;
of particular value in ophthalmic preparations when freedom from irritation
due to particle size is so important.
GLAXO LABORATORIES (AUST.)
PTY. LTD.
THE MEDICAL STUDENTS'
SONGBOOK
Gentlemen, John South's new edition of
the Medical Students' Songbook is about
to be published. We have been waiting for
this for a long time and guarantee that it
has surpassed all expectations.
All our old favourites are included in it.
There is "Foggy, Foggy Dew," "Bible Stories",
"Swimming Underwater", "Life Presents a
Dismal Picture", "The Tertiary Kind", the
nice girl with the "Crossed and bloodshot
eye and the gin spilt down her singlet," and
"H.O.P."—YAHOO!
Then there are hits from the Medleys of
the past few years like, "I Want a Bloody
Humerus for Orals," "The Drinking Song,"
"Sit Down for Piles of Fun," "The Stately
Homes of Carlton"—"have lots of girls on
tap"—"Thanks for the Mammary," and, of
course that song we haven't been able to
commission any "sweet young thing" to sing,
"The Bustin' Begins." Here's a preview of
the last verse:
I fell at the Melbourne,
Ah, but not completely,
He was still panting
When I told him sweetly,
Don't feel so bad
Cos I've been promised by my dad
To a rather backward lad
Who's a student from Prince Henry's.
Home of the Braves
Land of the Slaves,
Place where the bustin' begins.
Every student should buy at least one
dozen copies. They cost no more than 4/-,
and he can sell them to outside friends for
at least 10/-!! Take one to that next party
and you and your beer-sodden friends can
keep people awake all night with wellorganised harmony.
IT'S COMING SOON AND EVERYONE
SHOULD HAVE A COPY FOR MEDLEYS.
There was a young girl from Wantage
Of whom the town clerk took advantage,
Said the Borough Surveyor
You surely must pay her,
You've totally altered her frontage.
*
*
A glorious glamorous gigolo
Ruptured his tendon of Bigelow;
Which altered his stride
From a glimmering glide
To a rather ridiculous wriggle-o.
SPECULUM
WATCH FOR IT
PRICE 4'AVAILABLE FROM M.S.S. REPRESENTATIVES
67
SPECULUM
68
Tbe *eat of ill epenbabilitp
of
ethical Probuctz
• ANOREX—Appetite Suppresant
• B.C.M.—Vitamin and Mineral Tonic
• CODIPHEN—Analgesic-Antipyretic
• HEPASOL COMPOUND—Reconstructive Tonic
• MULTI-B FORTE—Vitamins B-Complex and C
• POLYHAEMEN with Liver and Vitamins—Iron Therapy
• TUSSINOL with PHOLCODINE—Cough Suppressant
G. p.
PTY. LTD. 74 MITCHELL ROAD, ALEXANDRIA, N.S.W.
69
SPECULUM
M.S.S. CHRONICAL
1958
77th ANNUAL GENERAL MEETING
Secretary's Report
Last year was one of the best years the
society has had for some time, both socially
and financially.
This year we welcome back as president
Prof. Townsend.
The Annual Dinner was held on Friday,
June 13th, in the Union buffet. Mr. Douglas
Donald was the guest speaker, and he enlightened us to the 'Anatomy and Physiology of the Artist's Model'. A new innovation at the dinner was the menu cards
and red and white wine was served during
the meal. This year the dinner is on
Friday, July 3rd, in the Union buffet.
Speculum appeared in September, ably
edited by Jim Wearing Smith. This copy
had a record number of sales and was completely sold out by Christmas. We thank
Jim for a terrific edition. This year marks
the 75th anniversary of our magazine.
Medical Medleys was held on Thursday,
December 11th, in the St. Kilda Town Hall,
and was called 'Thanks For The Mammary'.
This title was in no way connected with the
appearance of Sabrina. We wish to thank
Eric Cooper and Roger Buckle for what was
undoubtedly the 'best Medleys yet'. The
old bug-bear of incompetent sound for the
stage show was conquered, much to the
enjoyment of the 1100 people who attended.
The hall decorations aroused much comment, and we must thank Struan Sutherland
and Mick Adamson for their design and
execution. For the first time at a Medleys
Songbooks and Speculum were on sale, this
proved a success and will become a regular
feature of the ball.
A new Songbook is under way and is
being compiled and edited by John South.
New songs are being added to those already
in the book. John hopes to have the book
published later in the year.
Sport. In football we appeared on the
field on a number of occasions and enjoyed
the struggles, altho' not always in our
favour. We were again table-tennis champions, and the rowing saw us cross the line
first.
This year we are reviving the practice of
an end of First Term Cabaret, this is being
held in the Buff. on June 12th, Dennis
Farrington's orchestra will supply the music,
and dancing will be from 8.30 p.m. to 1
a.m. We would like to make this an annual
function again, but this depends on the
response.
Finally, the Executive Committee would
like to offer its sincerest thanks to Professor
Ewing, our retiring president, for the interest and time he has devoted to us. He has
been a tower of strength to the committee
and was responsible for many of the new
innovations which made the various functions more enjoyable. We hope he enjoyed
his term of office with us and we hope to
see him at many more M.S.S. functions.
N. SUTHERLAND,
(Hon. Sec.)
Editor's Note.—It is regretted that the First
Term Cabaret had to be cancelled owing
to lack of support, and apologise to the
six people who reserved places!
—
ri
SPECULUM
70
MEDICAL STUDENTS' SOCIETY
Statement of Receipts and Expenditure for
MEDICAL MEDLEYS—
Income:
£1091 0 0
Ticket Sales
Expenses:
. £30 0 0
Balloons, 1957
7 10 0
Refund, 1957
51 5 0
Balloons, 1958
Stage Properties .. 22 0 0
.. 5 2 0
Decorations
1 5 0
Liquor Licence
45 0 0
Liquor
66 14 6
Printing
30 0 0
Transfer
83 16 6
Hire of Hall
118 8 0
557 5 0
Catering ..
70 0 0
Band
6 19 0
Flowers
21 0 0
Honoraria
1116 5 0
Debit on Medical Medleys
MEDICAL DINNER—
Income:
Ticket Sales
Expenses:
£74 13 6
Catering
23 0 0
Liquor
4 4 0
Photos
Debit on Medical Dinner
£25 5
0
£68 0 0
101 17 6
period April 14, 1958, to May 1, 1959
MEDICAL SONG BOOKS AND BADGES
£112 19 11
Sales
54 9 10
Expenses
Credit on Song Books and Badges
1
NEURO ANATOMY NOTES—
£57 13 0
Sales
9 3 6
Expenses
Credit on Neuro-Anatomy Notes
"SPECULUM"Income:
£323 12 7
Advertisements
129 6 0
Sales
Graduate Members 23 10 0
47 9 0
Life Members
Expenses:
Printing
Refund
Postage
Typing
Honoraria
Banking
48 9 6
523 17 7
£357 16 0
2 10 0
25 6 8
5 5 0
5 5 0
1 7 6
Credit on "Speculum"
397 10 2
£126 7 5
M.S.S. GENERAL—
Expenses:
Stationery, Printing £34 17 6
Postage, Stamp Duty 5 15 0
.
15 0
Banking
41 7 6
£33 17 6
DEBIT
Cash in National Bank, 1/5/59:
M.S.S. General A/c. £204 8 0
"Speculum" A/c. 301 3 4
Bank Deposit (1960) 189 0 0
Bank Deposit (1959) 270 0 0
CREDIT
Cash in National Bank, 14/4/58:
M.S.S. General A/c. £197 18 5
"Speculum" A/c. 174 15 11
Bank deposit (1958) 189 0 0
Bank deposit (1959) 270 0 0
£964 11
£831 14 4
Income:
Medical Medleys, '58 £1091 0 0
68 0 0
Medical Dinner, 1958
Song Books, Badges 112 19 11
57 13 0
Neuroanatomy Notes
523 17 7
"Speculum"
£58 10
1853 10
£2685
6
4 10
4
Expenses:
£1116 5 0
Medical Medleys
101 17 6
Medical Dinner ..
54 9 10
Song Books, Badges
9 3 6
Neuroanatomy Notes
397 10 2
"Speculum" t
..
41 7 6
M.S.S. General
1720 13 6
£2685 4 10
J. WRIGHT-SMITH,
Hon. General Treasurer,
Medical Students' Society.
71
SPECULUM
ANNUAL DINNER
JULY
3rd., 1959
Going to Cover
Friday, July 3rd, saw 96 happy and wellprimed diners in the lower dining hall of the
Union Buff. This number of revellers is
the best on record for some years and we
hope the number will increase in the following years; judging by the scenes and comments after, we will need a circus tent in
the near future.
Sherry before the dinner commenced
helped many recalcitrant personalities, and
helped stabilise new friendships. The diners
then sat down to Creme of Asparagus, after
which the chairman, our president, proposed
the loyal toast. Schnapper Mornay, accompanied by some of Jimmy's best red plonk,
followed, and then the main course,
Supreme of Chicken Parisienne with vegetables and white plonk (also Jim's). The
secretary, Neil Sutherland, then proposed
the toast to the staff, to which Prof. Shaw
replied, saying that the staff weren't really
angels but they did their best; after all, if it
wasn't for us, they wouldn't have jobs.
After a further period of resuscitation,
Pansy delivered the toast to the students,
and in the inimitable style we well know, he
tempered his warning of becoming subjects
to a state, with a few well chosen anecdotes.
Bombe Cerises was the final item on the
menu, and with a few well chosen hiccups,
the treasurer replied to Pansy's address on
behalf of the students. Then the long
awaited event of the evening, Mr. J. B.
Colquhoun, in a rich Scottish brogue, told us
of people and places he had encountered in
the U.K. and America. This turned out to
be a succession of witty stories told in the
true dour Scot manner, and with Pansy's
repartee, it was one of those talks that stay
with you long after the night is over.
Jim Wearing Smith pulled himself together long enough to thank our guest of
honour, whereupon Pansy saw the light
again and delivered an impromptu speech
most of us will never forget. Then the
stories started, despite some of the weaker
sex, and the telling of these, and the many
interjections the raconteurs received were
enough to make the most moral of us
wonder what he had been doing for most of
his course. The songbooks were present,
and the old favorites were sung with a
Breaking Cover
SPECULUM
72
Full Cry
The Death
fervor that did honour to the C. & U.B. and
Jimmy's special brand.
All too soon did the president raise himself amongst the holocaust and declare the
dinner adjourned, and so it was with reluctance that we took ourselves away from the
scene of festivity, to other more potent
scenes, but with the comforting thought that
it is only 364 more days to the next dinner,
and Medleys yet to come!! See YOU at the
dinner next year.
To The Editor
to the scheme: nearly seventy of the year
assembled, looking little the worse for ten
years' wear and tear (so they thought). Professor R. D. Wright responded to the toast
of the teachers; it was getting rather late in
the evening but we understood him to say
that 1958 students were better than 1948.
The toast of The New Boys was ably and
wittily replied to by Professors Lovell and
Ewing. The guest of honour, Professor
Norval Morris, responding to the toast of
the University, took the opportunity to offer
much unsound advice on how to become a
world authority (on anything) and how to
make money (at anything). Great things
may be expected of Professor Morris.
There can be no doubt, if only on a basis
of the empties (bottles, not bodies), that a
highly convivial evening was had by all;
many old acquaintances were happily renewed and many stirring events of student
days re-lived. A dinner every five years is
now planned until such time as the thinning
ranks become too depressing. Other "years"
have held similar functions and the practice
can be highly commended to today's embryo
graduates.
GRADUATE DINNER
Dear Sir,
The medical graduates of 1948 held a
reunion dinner at Union House on the tenth
anniversary of their graduation. The organising committee, G. W. Cooper, J. T.
Hueston, J. H. Grant, R. M. Gray, J. J.
Murray O'Neill, C. W. E. Wilson, B. H.
Gandevia, were delighted at the response
CORLAN
(hydrocortisone hemisuccinate)
PELLETS
A NAME TO REMEMBER FOR
THE TREATMENT OF
APHTHOUS ULCERS
Another product of the
GLAXO LABORATORIES
SPECULUM
VONDENBERG
At the commencement of the third year
of the First World War the Germans discovered they were running short of nitre.
Hindenberg issued the following order:
"The women of Germany are hereby
ordered to preserve their chamber water as
it is essential to the fatherland. Waggons
with barrels and tanks will call daily to
collect same."
Signed: Hindenberg.
von Hindenberg, von Hindenberg, you are
a funny creature,
You've given to this awful war a new and
funny feature.
I always thought a woman's work was
keeping home and diddling,
But now you've put the pretty dears to
patriotic piddling.
von Hindenberg, von Hindenberg, where did
you get the notion
Of sending barrels round the town to gather
up the lotion?
You've made it plain while every man is
bound to be a fighter,
The women, bless their little hearts, must
save their pee for nitre.
von Hindenberg, von Hindenberg, pray do
invent a neater
And somewhat less immodest way of making your saltpetre.
Fraulein fair, with golden hair, with whom
we are all smitten,
Must join the line and pass the brine to kill
the blooming Briton.
von Hindenberg, von Hindenberg, we've
heard in song and story
How women's tears through all the years
have sprinkled fields with glory;
But ne'er before have women helped their
boys in deeds of slaughter,
Till German beauties dried their tears and
saved their chamber water.
No wonder, von, your boys are brave; who
wouldn't be a fighter
When every time he fired his gun, he fired
his sweetheart's nitre?
And vice versa, what could make an allied
soldier sadder,
Than dodging bullets fired from a pretty
woman's bladder?
We've heard it said an amine smell, still
lingers in the powder,
And as the smoke 'grows thicker and the
voice of battle louder,
That there is found in this compound a
serious objection—
A German cannot have a breath without
having an erection.
No wonder, von, desertion is so common in
your ranks,
An Arctic nature's needed to stand such
hanky pranks;
A German cannot stand the strain, once
he's had a smell,
He's got to have a girl or bust—the fatherland to Hell!
P.A.S.
Girls are like newspapers:
They have forms,
They always have the last word,
Back numbers are not in demand,
They have a great deal of influence,
They are well worth looking over,
You can't believe everything they say,
They carry the news wherever they go,
They are much thinner than they used to be,
You have to pay more for a good one,
Every man should have one of his own,
and not borrow his neighbour's.
—"Review", Adelaide.
An amoeba named Sam and his brother
Were having a drink with each other;
in the midst of their quaffing
They split their sides laffing,
And each of them now is another.
*
*
*
A young widgie was perplexed
To discover that chickens were 'sexed'.
She played chicken one night
And got such a fright
That now that young chicken expects.
*
*
*
Little Maggie full of hopes
Read a book by Marie Stopes;
Judging by her condition
She should have read the revised edition.
—Aboriginal Nursery Rhyme.
74
SPECULUM
WELL I SUPPOSE TMEY'L,I;
START SOMETIME
75
SPECULUM
MEDLEY'S '58
. . . And what mammaries! If it's a brina
you need to cap off a fine night then you
would have had one at last year's medleys.
The show, as usual, went on as a dress
rehearsal, i.e., for the producers and the
cast, but the audience (that's you) gave it a
marvellous reception.
Why was this Medleys one of the best?
Analysing a show after it has been and gone
is not profitable, you might say; but where
Medleys is concerned it is always profitable.
The main factor in this success was the
inclusion of that old board-walker and
grease paint stick, Roger Buckle, as a producer. Here we saw the master of perfection at work drumming "hard to interpret"
lines into "hard to interpret" heads and repeating and repeating, etc., the actions!
This year Roger won't be hampered by the
other co-producer, and should really turn on
a Bergere Folies Grande.
We again owe our deepest and sincere
thanks to long suffering Treth for amassing
an excellent orchestra, at one stage (practically evacuated the Con.) only to have the
irate producers pull them trombone from
flute until the bare essentials were left, and
yet the old maestro pulled through better
than ever.
The cast of this show was another big
help! The nucleus of last year's ('57) show
plus Richard the Smallwood and Harold
Caplan combined with the one and only,
that star of Stage, Screen, Radio and P.V.,
neilabdulblueeyesandbaldingsutherland.
The boys from the Women's (Ron 1 and
2, Rod, Geoff, John, Herb, Col., PeterAnita and Mario) turned on their best act
yet and showed commercialism how it
should be done. (See Divertissements.)
Our women were again as beautiful as
ever but still very scared (sorry) scarce.
Anne Harrison had so much doubling up
she thought her brassier clip was attached
to her suspender belt—actually it was. Jan
and Lou (the old stalwarts) again held the
chorus line together.
The final reason why this show showed
something was the inclusion of a "new" type
of gimmick. "Pichers"—good old Bill
spouted off his lines just as if he'd learnt
them, and brought the house down.
The back stage crew headed by that veteran of stage managers, Jim whose wearing
Smith, again surprised everyone and did an
excellent job.
Let's remember that "Mammary" was one
of the best but let's hope that this year's
('59) will be better.
Thanks to all of those not mentioned
above for their marvellous help.
The Aged Theatre Critic.
Opening Song:
Show's On
Tune: "Fleet's In"
Hey there, Mister, you'd better watch your
sister
Cos the show's on, the show's on.
Hey there Boozie, you'd better watch your
floozie,
Cos the show's on, the show's on.
If we do as well on the stage
As we do in the wards,
Well now Professor,
You can send us some broads.
(To us and we're not kiddin').
Watch her student, if you want to keep her
prudent,
Cos the show's on, the show's on.
We're the guys to lay 'em down in the aisles.
They may be dark or fair,
We actors don't care,
As long as they're wearing a gown,
So if you need her, better clothe and
feed her
Cos the show's in town.
If we've got the acts that you like,
Throw yourselves on the floor,
Clap and cheer and we will give you
some more.
76
SPECULUM
Madeira
She was young, she was pure, she was new,
she was nice.
She was fair, she was sweet seventeen.
He was old, he was vile, and no stranger to
vice,
He was base, he was bad, he was mean.
He had slyly inveigled her up to his flat
To view his collection of stamps—all unperforated,
And he said as he hastened to put out the
cat,
The wine, his cigar, and the lamp.
°PERITn tie
rilEnTREI
li
Hey there, Buster, be sure that you can trust
her,
Cos the show's on, the show's on.
We're the cast to lead them all astray,
They may be hault or blind,
We actors don't mind
As long as they're wearing a gown.
So if you love her, keep her under
cover,
Cos the show's in town.
DOING FINALS ?
Then arrange to receive
SPECULUM
in future years and keep
in touch!
See
your Year
Representative
Have some Madeira m'dear, you really have
nothing to fear,
I'm not trying to tempt you, that wouldn't
be right,
You shouldn't drink spirits at this time of
night.
Have some Madeira m'dear, it's very much
nicer than beer;
I don't care for sherry, one cannot drink
stout,
And port is a wine I can well do without,
It's really a case of chaud a son gout,
So have some Madeira m'dear.
Unaware of the wiles of the snake in the
grass,
Of the fate of a maiden who toped,
She lowered her standards by raising her
glass,
Her courage, her eyes, and his hopes.
She sipped it, she drank it, she drained it, she
did,
He quietly refilled it again,
And he said as he secretly carved one more
notch
On the butt of his gold-handled cane.
Have some Madeira m'dear, I've got a small
cask of it here
And once it's been opened you know it
won't keep,
So finish it up, it will help you to sleep.
Have some Madeira m'dear, it's really an
excellent year;
Now if it were gin you'd be wrong to say
yes,
The evil gin does would be hard to assess,
Besides it's inclined to affect me prowess,
So have some Madeira m'dear.
77
SPECULUM
Then there flashed to mind what her mother
had said
With an antipenultimate breath,
0 my child, should you look on the wine
when it's red
Be prepared for a fate worse than death.
She let fall her glass with a shrill little cryah,
Crash, tinkle, it fell to the floor;
When he asked "What in heaven" she made
(no reply)
Up her mind and dashed for the door.
Have some Madeira m'dear, rang out down
the hall loud and clear
A tremulous cry that was filed with
despair
As she paused to take breath in the cool
midnight air.
Have some Madeira m'dear, the words seem
to ring in her ear,
Until the next morning she woke up in bed,
With a smile on her lips and an ache in her
head,
And a beard in her earhole, that tickled and
said—
Have some Madeira m'dear.. .
—"At the Drop of a Hat".
Donald Swann
Michael Flanders
Parlophone Records.
Boy Scouts' Song
Be prepared. That's the boy scout's marching song,
Be prepared. As thro' life you march along
Be prepared to hold your liquor pretty well,
Don't write naughty words on walls if you
can't spell.
Be prepared to hide that pack of cigarettes,
Don't make books if you cannot cover bets,
Keep that reefer hidden where you're sure
That they will not be found.
And be careful not to smoke them when the
scout master's around
For he only will insist that they be shared.
Be prepared.
Be prepared. That's the boy scout's solemn
creed,
Be prepared and be clean in word and deed.
Don't solicit for your sister, that's not nice
Unless you get a good percentage of her
price.
Be prepared and be sure that you do
Your good deed when there's someone
watching you.
When you're looking for adventure of a new
and different kind
And you come upon a girl scout
Who is similarly inclined,
Don't be flustered, don't be frightened, don't
be scared,
Be prepared.
Tom Lehr.
Finale:
Thanks For The Mammary
Tune:
"Thanks
for the Memory"
Thanks for the Mammary
Of all we've done this year.
We've weathered all the storms of life
And saved ourselves a lot of strife
With bellies full of beer.
Yes, thank you so much.
Thanks for the Mammary
Of all we've had to know,
And how we trained the nurses
Inside the mortuary hearses,
Into giving it a go.
Yes, thank you so much.
The honoraries taught us quite well, sir,
Tho' some may have thought us uncouth.
Still we've found a lot we could sell, sir,
For a big fat fee to the Melbourne Truth.
Yes, thanks for the mammary
Of eve to morning crams,
When you swotted your anatomy,
My boy, now don't you flatter me,
The night before exams.
Yes, thank you so much.
Thanks for the Mammary
Of Pansy and of Lance,
Of Siddy and the other lads,
A pack of simple-minded cads
Who've led us such a dance.
Yes, thank you so much.
SPECULUM
78
We should have known at the start, sir,
For what we let ourselves in,
But now that it's time we should part, sir,
We're bloody glad we did medicine.
So thanks for the Mammary
Of good old pre-Med. days,
No money were we earning,
The fun we had when learning
All about the 40 ways.
We learnt some more
Until we saw
It's just a passing phase.
And thank you so much.
*
*
*
DIVERTISSEMENTS: Popular advertisements from the most popular (?) sketch of
the evening:
"T.V. OR NOT P.V."
Tune: "Coca Cola" Song:
When at work or at play
Any time of the day,
You should keep "Charlie Checkers" close
by.
They're electrically tested and they are the
best,
So a dozen or two you should try.
Chorus:
Fifty million times a day
For any normal heathy bloke,
There's nothing like a "Charlie Checkers"
For a decent
Tune: "Marlboro" Ad.:
You've got a lot to learn from a checker,
Thinner, stronger, smooth round top.
You've got a lot to learn from a checker,
Cheaper, safer, flip top box.
The most recent general
purpose oral diuretic
NaClex
(Hydroflumethiazide 50 mg.)
Another product of the
Glaxo Laboratories
c'EanciJm,i
While we're on the breast we may as well
handle the whole thing.
*
She didn't have any cerebral signs except
her toes went up and she was pretty spastic
all over and she had a fit five minutes after
we pulled out the lumbar puncture needle.
*
*
*
Menstruation is a happy event.
*
*
*
The business of getting pregnant is a combined effort—everybody has got to be in it!
*
*
*
And then there was the woman who got
pregnant under me.
*
*
*
You don't often get a husband coming in
and saying: "I can't have a baby."
*
*
*
Of course, it would happen to me that
a female medical student should come up
and say she was having labour pains. I
just told her that she had a colicky uterus,
to which she replied: "Well, I ought to
know, sir, because I've had a baby!!"
*
*
*
It's amazing what a couple of days inside
the vagina will do for you.
*
*
*
I had quite an interesting period for 2 to
3 years.
—Is this menorrhagia? or piles?
*
*
*
Brucey Sch
: "Her daughter got married in February this year and she noticed
shooting pains in the back passage."
Lance: "Had that got anything to do with
her daughter getting married?"
*
*
*
Ante-natal care should begin right from
the jump.
79
SPECULUM
YEAR NOTES
PRE-MEDICINE
In physics Rogers' echoes are no more,
His drowsy rumblings soothe not now the ear,
P.M.S. no longer holds the floor—
These days are gone for Mather now is here.
Fond farewells were bade at the end of
1958 to Doctor Rogers who has been at the
helm of Pre-Med. physics for 35 years. His
place has been taken by sprightly Keith
Mather whose experiences in the Antarctic,
on top of Everest, and in darkest Africa,
always meet with a roar of approval.
Doctor O'Donnell lectures in chemistry,
and everybody sits enthralled, until Miss
Thomas finishes marking the roll and
bounces out of the Masson—then it's back
to chemistry, ho hum.
Mr. Boardman's flashing smile greets us
at the commencement of each Zoo. lecture,
and one could hardly escape noticing the
copious secretion of genetics notes issuing
profusely from the portals of the Zoo.
school.
The atmosphere in lectures seems somewhat subdued—and for no apparent reason,
except perhaps a realisation of the fate con-
Were it not for that
fronted by failing.
green thing of Dick Briggs' which, on entry,
extracts squeals of delight, the air at the
start of the lecture would be positively electric.
One of our members wears a Fidel Castro
beard, and another wears a crash hat. The
others are positively suburban.
The weeks fly, and soon we will have to
face the dreaded music—until then we sit
and pray—and play.
FIRST YEAR
The year is made up of 161 who passed
Pre-Med., 1 doing a combined Sci.-Med.
course, 17 repeats (including one girl repeater—Stop it, Jan.) and 2 graduates. Ages
range from 18 (10) to 33 (1)—the largest
groups being 19 (57), 20 (60), and 21 (25).
Sexes: 158 male and 23 female. We have
4 Dip. Pharm., 2 Dip. of App. Chem., 1
B.A. and Dip. of App. Chem., 1 B.Agr.Sc.,
and 1 B.D.Sc., and even 11 sets of twins.
Among the repeats we find a not very fit
Graeme B. growing a little fat. Max M.
tells us this is something we will have to get
SPECULUM
80
Dui
used to. Jock C. and Bill D. complain that
their prosecting partner, Ray A.,
A. is consistbusily
antly missing from their table,
engaged in giving Applied Anatomy tutorials to certain un-named females in a corner.
Another repeat, 0.G., seems to be living up
to his name. We have a team of winners
in Craig Mc. and Robin M., especially as
regards the Physio girls.
Now to the 1st Year Div. lA's, where we
find Fedora T. victorious over last year's
rep. Well known gristle-grabber Ted H.
when asked to comment from his Hollywood-house after a Chinese dinner given in
his honour, said: 'Fedora in tight black
sweater and slacks had two points in her
favour. These I was unable to beat.'
Irene D. has been noticed coming into
lectures just on time with Maurie C. We
assume Maurie is waiting to introduce Irene
to Lee Gordon's Italian brother, Lee Zardo.
Our company of barber-surgeons,
Graeme B. and Bill D., seem to be littering
the locker-room with piles of hair while
Jock C. seems obsessed with the idea of
piles and piles of dirty brown paper. Jon
H., Steve C. and Paul D. have found a new
place for the study of Biochemistry—the
Mayfair.
As regards extra-curricular activities Bill
D. appears to have found a new outlet for
his talents with Elizabeth A. Rod M. also
seems quite happy. We also find that Peter
A. is being linked with Christine A. As we
go to press we are expecting to announce
the engagement of Alex E. and Jenny C. Of
course, there is also our pair Mary G. and
Ian R. The girls of the year appear quite
happy about their annual football match
with the Physios—cats and dogs weren't in
it.
A certain outstanding red-haired professor (let him remain anonymous) told us of
the time John Hunter discovered some vessels in the testes. His brother, William,
maintained that these were his own!
Not a bad year all round, so with a little
bit of work and Mary Patterson missing
from the streets, we'll see you in Div I.
SECOND YEAR
The saying for the year, as quoted by
Julian (would you mind) M., is: "in your
box". Wilfred B. says this means working
hard and not going out much because Div. I
is a hard year, but George S. disagrees.
Contrary to reports by Jane and Joe L. in
Farrago George does not sit on a white
frothy stool, chair, or desk—his output is
still up to scratch.
Stiff elbows this year seem to be due to
too much swotting and not the usual cause.
However, Bob's Thursday Raffle was devised to combat this; Trey S. won it and shot
through to the country. Good luck, son.
Heard: Hugh (colourful cough) N-J filled
the wide screen at J.W.'s—stick to T.V.
Hugh, it's only Black and White. Watch
out for Danny Z.—Susan is his Fair Lady,
if only for a bet.
Love must have its way—backways or
sideways—ask Su. What is Don waiting
for Marle? Daryl P. is on a Shaw thing for
Pharmacol. even though it was Liz's free
S.R.C. ticket. We notice Rex has not
bought a Policeman's helmet for Felicity
W-K—that man asks some stupid questions.
Dave D. is trying to engineer something and
Bob H. and Tom R. are now living together
in Carlton. Geoffrey, you will have to get
a monocle if you want to win Andy B.—he
is an Ex-man.
Someone should write an article on the
sleeping habits of Med. students for the
next edition. Ross (Geelong Road) C. and
Charlie (Tin Alley) L. would be learned
contributors. Willy R.'s dinner suit looked
very fashionable on the Saturday morning
after the Alfred Ball.
Don McO. could not hang on long
enough to collect his four hour volume and
John T. thinks the girls should use plastic
funnels. Bob R. has boasted of getting
caught in a 250m1. flash, but Jock thinks
this is a bit tall.
Sylvia P. says she has a vital capacity of
5 litres—wouldn't be surprised with those
lungs! It must be the run to get to lectures
on time!
Brian R. starred in inter 'varsity football
and it is not advisable to get punchy with
Joe M.—he's a judo man, but we think
Brian C. could walk over him any day.
Warren White is Year Rep. again and seems
to know all the answers to Treth's questions. As you can see it has been a quiet
year, but wait until after September!
To end this slander-ridden literature we
hope the vac. .is only for four weeks for
everyone and not six months.
81
SPECULUM
ROYAL MELBOURNE HOSPITAL
THIRD YEAR
Having thrown Gray and Starling to the
winds, we arrived last November at the
R.M.H. student quarters. Some of us
haven't progressed much further—with our
time quickly taken in playing solo, nurses,
and grog.
Horrie D. having left friend in Queensland, has taken to living in an hotel. When
a certain neurosurgeon returned from his
holiday Robin H. had to explain away large
numbers of empties. Talking of holidays,
what happened at Portsea? Did a camel
chase Mal B. or did Mal chase the camel?
One ball was unhappy when he received
his name-plate with the initials O.B.C. . .
Glamour was added to the year in an arrival
from Adelaide—hope you are enjoying Melbourne, Rena?
Clinics have been enjoyed by all—even
Eddie B., who asked a patient how her
water was, receiving the reply, "I haven't
had the plumbers in yet." Dr. Doyle asked
a student, "Who was Medusa," and had the
reply, "A French obstetrician."
Association with members of the opposite
sex has been in full swing. Bob K. has been
using the attraction of vintage model cars,
while Rex B. uses the power of a 21 litre
Riley. We are still wondering why Brian
W. has a mattress on the floor of his stationsedan. Eyelids have been fluttering at
eligible residents—any success yet, Jan?,
while Tom M. tells us Joan is an apt pupil
on a motor scooter.
Eddie B. has been setting the alarm clock
for 3.00 a.m. Congratulations, Eddie, and
to Roger K. and also to Roger B., who has
still to set a date.
Besides sports mentioned above, some of
us have become very athletic. In our cricket
match against St. V's. we were the victors of
the day (130 to 113), while in the football
match, St. V's. beat us (7-9 to 7-6), both
teams appearing anxious to get to the
"niner".
Did you hear that the mother of one of
our more pleasure-minded students had a
headache?—she mistook phenyl mercuric
acetate tablets for codeine—Wow! Rex
tells us (what is more) they cured her headache. No comment!
Finally Roger K. tells us that Webster's
dictionary may be a better investment than
Payling Wright.
Cheers to all, and kill 'em, folks!
FOURTH YEAR
They say that the best way to avoid a
mention in the year notes is to write them
yourself—so here goes.
Firstly, the list of fellers whose gonads
have got the best of them: George F. and
Warren K. have 'got themselves' married.
Others, not wishing to resort to such traumatic measures, merely became engagedGraeme McK., Paul F., Mike B., and Russ
McD. (and they used to be such nice blokes,
too). Sorry, Russ McD. went "off" on
Aug. 3rd. Engaged also is John B.
Sandy—bless his heart, the dear boy—
is rapidly establishing himself as an authority on the latest collagen diseases. We are
awaiting his monograph on the clinical
manifestations of polyarteritis nodosa of the
nutrient artery to the os trigonum (Spier's
syndrome).
A day the anaesthetics' department will
long remember: A certain illustrious group
of students were administering an anaesthetic. At 10 a.m. sharp the boys (being good
trade unionists) were off for morning tea.
Ten minutes later, enter Doctor J. to find
the patient blue and nobody there to worry
much about it. The gents in question were
then discovered in a secluded smoke-filled
room playing cards and drinking coffee!
Many records were broken at Medleys
last year. Pete "Have-a-go" Guy holds the
record for having broken the most records.
Pete is also doing research into the new
collagen disease, dysemesis spectaculare
(Spier's disease). Another record was
broken by Andy Saltups who, despite being
still plastered the day after Medleys, insisted
upon going on the wardround—he is the
first man ever to fall asleep on his feet while
in the middle of presenting a case to an
honorary!
From the psychiatry notes (this actually
82
SPECULUM
happened): An old Chinaman presented to a
G.P. with signs of intestinal obstruction.
The cause—a beer glass impacted in the
rectum. (For this the old gent was certified
as insane).
Doctor Cade's comment: "Obviously a
case of bottoms up!"
Meanwhile, back-on (with) the pants—or
should we say, over in Carlton—a very
select 50 per cent. of our stalwarts (along
with a few A.H. and P.H.H. sloughs (!) to
make up the numbers) were inveigling young
maidens (?) up to their flats—refer to
Medleys, '58—and we hear tell that one of
our young maidens (??) was inveigled elsewhere—many an invective was prompted by
inveiglement in certain quarters!
Yes, it has certainly been some half year
—10 weeks of glorious, hot beach weather
at the R.C.H., afternoons of solo, nights of
grog and women at Frankston Ortho., etc.,
and 10 forgotten weeks at R.W.H. Some
folks worked at the R.W.H.—good on you
Den R., Noel S., Geoff P., and all you other
pikers (especially the Faraday street mob),
some folks played—good on you MM, and
"Tiny" Mearez—and some folks . . . well,
just . .. "could have, boy, could have,"—
good on you Watto! What ho? It's
rumoured that Tiny used to knock before
opportunity had a chance—not to forget old
"Hamer" A. Eskell takes the "bun out of
the oven" with his story about the bat he
was P.V-ing in G.O.P. one day: on stimulating a certain region he claims that she
started giggling and when asked what
measures he took to prevent the situation
becoming rather "more than somewhat" embarrassing, he replied, "Why, I giggled too!"
No one knows whether or not they ended up
in an hysterical heap on the floor.
Perhaps the one we all loved most was
old "No hormone" (some might queery this)
—the pathology department never had need
of extra material for their A-Z tests—luckily!—because it wouldn't have been the
dorsal lymph saco "what copped it", but
the dorsal nymph sacs!
Well, everyone, the incidents that could
be quoted and the libel that could be written, are limitless, but as this l'il ol' magazine
has just gotta go to press sometime we'll
wind up by saying, "See ya in finals!"
FIFTH YEAR
"After me, all repeat.
This is a bone
called the Humerus."
"This is a bone called the Humplunmerus."
"No, no, try again, but this time get it
clearer. The sooner you get it right the
sooner we can progress."
The strain—great smouldering balls, of
fire; how it tells; how it bounces you around
like a baby seagull's bag of marbles in the
middle of a maelstrom—where does it end?
How does it end? "Be listening next Sunday night when we again present Martin's
Coroner, brought to you by your favourite
makers of sugar frosted, three minutes only,
rectal suppositories."
"Now this is the wick and there's the fuse
—you can't see where it goes but don't
worry—just light the end."
9 o'clock—they'll soon be open.
The trouble with Finals is not the answers
—any silly gunk knows them—it's the
blardy questions that have got us all tricked.
As I said to the Professor after he said
that we should all pass, "Well, I said, I said
well, if you know I'm gonna pass and I
know I'm gonna pass, let's tell the other
examiners and ask 'em to call the whole
thing orf."
I mean, it's silly, isn't it, just wasting all
that paper and ink, Ha, ha—ha, ha, ha—I
mean isn't it—ha, ha, ha, . .. ha. Don't
you all agree yo'all, yo' sweet little bunny
rabbits, all of yo' ha, ha, ha,—he, ha, aaah?
Men outside with green heads, four ears,
six arms—ha, ha a a a ha .. hum.
You can't frighten me—go away—shoo.
Nothing to worry about at all—green men.
Ha, ha, aa aa Ha he ho . . . hummm. White
jackets and padded walls—seems familiar.
They said he was gonna be a good resident,
too. Shouldn't believe all you hear, should
you, eh, eh, should you eh should .. .
There was a new vicar in the village, and
discussing the coming Sunday's sermon with
the Curate, said, "I think I will take for my
sermon this Sunday 'The Widow's Mite'."
The Curate, a young man who knew his
way around the village, said, "Well, Sir, I
don't know that that would be advisable,
because I happen to know they DO!"
33
SPECULUM
ALFRED HOSPITAL
THIRD YEAR
Our year at the Alfred seems to have
settled in very well (including our three
young ladies), if we can judge from the enthusiasm around the solo tables and the
occasional visit to ward 23. However, some
of this frivolity will probably fade slightly in
the ensuing few weeks, as this is all that is
left before our Pathology and Bugs exams.
We have had a few sporting tussles
against other hospitals, all of which have
been most successful. We played P.H. in
both tennis and cricket, the latter being a
picnic day at Wattle Park. This site was
chosen due to the fact that it possessed a
small metal cylindrical structure just by the
boundary, this providing more interest for
some than the cricket. One P.H. guy was
such an avid watchdog of this monument
that he even finished up asleep alongside it!
Our team was led very ably by Steinkel who,
as well as doing a grand job, also made top
score of 50 or so.
Both our football matches against R.M.H.
were played at Fawkner Park, each team
winning one match—being yery dry and
thirsty weather, ward 23 was again very
popular after the matches.
We finished up 1st term with a cocktail
party-cum-dance, which we considered to
be most successful as there were no serious
casualties (later effects such as gastric upsets, severe cerebral irritation, do not come
Into this category). We hope to have
another ding shortly (perhaps after "our
trial" in September), so good luck and au
revoir until next year.
FOURTH YEAR
Following the battle with the Path. and
Bugs bods, the eleven Alfred stalwarts
emerged triumphant with an exhibition and
the Ramsay prize (P.J. in bugs) and more
than their share of honours.
Paul continued his winning run by taking the Alfred Old Resident's Scholarship
with C.H. a close second.
A new-corner to our select group is Adele
Hanstein who, complete with husband and
two children, has migrated to this fair city
from the "city of the bridge".
The new year found us in two groups
making our presence felt at the Children's
and the Women's. At this latter establishment P.J. transferred his attention from P.R.
to P.V. with alarming enthusiasm.
We are still trying to find out what he
did with the foetus a certain nurse obtained
for him.
Fredrica has been knitting babies' clothes
—of course they are for Adele's little ones.
Harry has recovered from "cat-scratch
fever" but apparently it wasn't his face
grinning at us out of the Sunbeam after all!
Don has been keeping up with it by
turning over a Page a few times a week.
Who says opportunity never knocks twice?
Curly, who thinks there is significance in
an infant's first words being "Pee-pee" and
"Pot", doesn't believe in closing the gate
after his horse has bolted.
Paul received the prize for being the most
anti-social swot of all time at R.W.H. It's
a wonder he didn't develop a hibernoma!
Then to add insult to injury he gets top
marks in the exam.
Clive hasn't given us the drum on his nocturnal meanderings but they must have been
really something—you should have seen him
next morning!!
Cheerio for now, and we'll see us all in
finals next year.
FIFTH YEAR
The group at the Alfred is once more reunited having been split up over the past
year—the result is that very few of the
events of the past year have reached my
ears.
The "Matrimonial Stakes" is I.S.Q. The
only trend shown has been by Eric—our
very best wishes to you and Anna on your
engagement.
The rest of the boys are still sitting on
the fence—developments have been anticipated from Jim and John, and even Ian
84
SPECULUM
appears to be progressing. For the rest one
rather gives up hope after all this time.
Alice hit the headlines with her grand
effort in winning the prize for Industrial
Medicine, with Isla a close second. Congratulations, girls.
We had a minor scare during first term
when everyone was suspected of being about
to turn yellow, but apart from a universal
attack of ECHO we are all now well.
The appeal is well under way for Alfred
Redevelopment, but most of the boys are
working too hard to be of much use.
We hope this is goodbye for most of us to
this column, and take this opportunity of
wishing all our colleagues on the other beats
"Good luck".
Bob and Harry decided that as they each
were to be married on the same day, it
would be nice for them to book in at the
same honeymoon hotel. The morning after
their weddings Bob told Harry that he was
going to see a doctor.
"What on earth for?" asked Harry.
"I'm in a terrible state," quandered the
other. "Last night I failed to consummate
marriage!"
Terror suddenly appeared in Harry's face.
"Good Lord," he exclaimed, "I'm going
right off to see a psychiatrist!"
"Why's that, Harry?"
"I clean forgot to!"
GROUP II
ROYAL WOMEN'S HOSPITAL, 1959
Back Row (L. to R.) — S. L. Yong, P. J. Kornan, P. J. Hinchley, S. K. Sutherland, A. D. McG.
Steele, P. A. Jenner, A. P. Yung, C. R. Rumberg, C. Plane, E. Goldberg.
Middle Row — I. Rossiter, R. E. Abud, B. M. Schramm, F. B. M. Phillips, T. L. Reed, W. H. G.
Warr, N. Sutherland, I. W. Webster, G. R. Pearce, J. T. Lie.
Front Row — M. R. MacFarlane, J. Deacon, M. G. James, Prof. S. L. Townsend, A. L. Harrison,
C. G. Hocking, B. Wild, L. A. Hughes.
Seated — S. Levin, T. Wood, J. A. Wearing Smith, R. G. Robinson, C. R. Abery.
Absent — J. S. G. Biggs.
85
SPECULUM
ST. VINCENT'S HOSPITAL
THIRD YEAR
The entry into the clinical world of 39
new students to a North Fitzroy establishment was of momentous importance and
did not go unheralded. We soon started off
serious work in the shape of solo, billiards
and table tennis. Particularly did solo come
into ascendancy and it was realised by all
what a magnificent galaxy of sportsmen,
socialites, stayers, blowers, and scholars
were collected around the gaming tables of
Princess street.
The powers that be love us—yes, we must
not wear open-necked shirts, or corduroys,
we must sit up straight in lectures, we must
not be late for clinics, we must not sign the
p.m. roll and then absent ourselves from
the p.m.
The ward sisters love us—No, you may
not see that patient. No, you may not
speak to the nurses. Take your hands out
of your pockets . . . .
The nurses love us, or some of us at least.
The patients love us—it does your heart
good to see their beaming faces and taut
knuckles grip the nearest lethal object and
to hear their wail of anguish as we bear
down on them armed with the weapons of
scientific training.
This year was notable for two sporting
events—a dry cricket match which we lost
and a wet football match which we won. So
the moral is—next time we must have two
niners as all this activity is thirsty—ahvery thirsty work.
Unfortunately the girls did not participate. However we are assured that they
specialise on indoor sports like table tennis,
Chris Brederkis has had
wrestling, etc.
some titanic struggles on the table tennis
table.
Terry Vice and Ann Davey also
have "starred" in this arena. Terry informed all that the engagements are "beaut" and
has at present received numerous proposals
but with no success.
Adam and Eve are staunch supporters of
the library—it can become so cosy in there
on a cold day. At present we are running
a sweep on what time Joe Brennan gets up
each day. So far no one has guessed the
right answer—perhaps nobody knows it.
Toni Cook was Ava Gardner's wardrobe
mistress during "On The Beach". Her
popularity reached an all time high during
this period when she used to give a daily
report to envious fans Burgess, Murphy,
O'Hanlon and Ryan, on the back stage view.
Bill Renton Power and Gordon Mathews are
notable exponents of that "intellectual
game" solo. Mr. Renton Power comes
from Queensland and apparently they play
cards among other things up there. Gerry
Gibney became a father during the year—
what a marvellous excuse to miss clinics—
however there is a limit to the numbers of
times the excuse can be used. Franks,
Doyle and Edmonds form a terrible trio—
where do they go on Friday afternoons?
Dick McArthur usually forms a famous four
for solo and other things. John Garland is
the "eye man"—"It's amazing what you can
see if you look in the right places" and
hopes to publish a treatise on "Diseases of
the glass eye". Warrick Grebble hopes to
be an obstetrician and gynaecologist—says
he has great experience and also a fast car.
Exponents of the Volkswagon's merits are
Casanova Dupuche, Rocky Fink and U Jack
Rush, a formidable trio. Yes, Gay, back
seats are a great invention.
The "old men of the year" are Bernie
Rowe and Mike Jaska, who are inseparable
and whose paternal advice is much appreciated. John Chew should remember that
nurses in the operating theatre are sterile!
The title "lover boy" was duly bestowed
on Beppo. Perhaps it's the continental influence that makes him so popular or maybe
that month he spent in bed enjoying the
attention of the nurses and studying their
techniques, gave him a better chance to get
acquainted.
Could anybody drive a "Volks" faster
than Dave Phillips perhaps his brother
might. Henry L., the man with the name
no one can pronounce, is a great exponent
of large families and a great opponent of
clinicians who ask embarrassing questions.
Mickey Ng the man with the shortest but
-
-
-
—
—
86
SPECULUM
hardest name to pronounce—is often mistaken for a doctor of the same name—
starred in Cas. as the best suture man of the
year.
Shannon and Davies both drive over to
the hospital, however which one arrives first
is always a great gamble—Davies even runs
a book on the result.
Peter McC., the genius, has amazed
everybody even B.B. on how much he knows
about sarcoid and other things. Disciples
Dewdney, Shockman, Stannish, often hold
court in the library from where they pronounce the evils of alcoholism and women.
Yes, our livers were cirrhotic after the end
of term "ding".
Hugh Nial, genius No. 2, is always claiming he is an honorary member of the staff—
and it is below his dignity to wear a short
white coat—but his claim is always being
refuted.
U-Jackman Herrin knows all the answers
—yes, all of them. Bob Hope claims he
will never play football again after the
match with the R.M.H.—neither would we
if we were as crook as he was.
Benjamin is an expert on solo and electronic computers, and reckons that there
should be one in the students' quarters to
aid him to work on the "prop and cop"
combinations.
Last of all is Rosie Willis—we can't say
too much about her as we would never hear
the end of it. Yes, she talks a lot. No, we
don't understand what she says. Yes, her
symptomatology has us fascinated—when
she was asked for the causes of haematemesis—said piles. But she does put on a
good "ding".
Well, that is the end of the year and probably us after we are served with libel suits.
However, Pentridge does allow visitors!
Footnote.—The editor regrets that space
does not permit both sets of this year's notes
to be printed. They were hard to choose
between. It is, indeed, inspiring to see an
enthusiastic group who submit well thought
out contributions voluntarily.
MSS COMMITTEE, 1959
President
PROF. S. L. TOWNSEND
V.R.D., M.D.B.S., F.R.C.S. (Edin .), F.R.A.C.S., F.R.C.O.G., D.T.M. & H.
Vice-President
J. SOUTH
Secretary
N. SUTHERLAND
Treasurer
J. WRIGHT-SMITH
Editor of Speculum
J. WEARING SMITH
Medical Medleys' Production
R. BUCKLE
Sports Representative
C. MORRIS
Pre-Clinical Women's Representative
MISS L. DONALDSON
Clinical Women's Representative
MISS J. PEELER
Year Representatives:
Pre-Medical
J. KING
Div. IA
MISS F. TRINKER
Div. I
W. WHITE
Hospital Representatives:
R.M.H.
R. SMALLWOOD
A.H.
R. McLELLAN
St.V.H.
A. MacLEOD
P.H.H.
I. WEBSTER
S.R.C. Medical Representatives:
J. BEST, J. McENCROE,
MISS H. WANSBROUGH
87
SPECULUM
FOURTH YEAR
Fourth year, greatest year of the course
and already half completed. Yet, what an
immortal half-year it has been!
There is much to report, much on which
to comment.
J.E.B., I.H. and W.C.G. fell headlong
into the tender trap. We extend our condolences to them.
Even at this late juncture we extend our
heartiest welcome to Anne 0., who has
joined us from the "Sunshine State".
Sprog has taken to the "Hansom Cab" as
a means of entertainment and any Friday
evening can be seen cavorting in that vehicle
around town.
Joe B., living a hand-to-mouth existence
is the wonder of us all. Joe—responsible
for more monster acts than most of us put
together—claimed at the beginning of the
year that he has "reformed"!
L.J.—the gambler—states categorically
that he will play solo or "slippery" anytime,
anywhere and with anyone. Unhappily this
is expensive. Ask L.J.!
Tubby — one of our "Jack-men"—our
hope in the finals, mixes work and play both
day and night.
Our other "Jack-man", Radium Jack,
skinny, long, lean and mean—by these
names shall you know him—managed to
sandwich an Honoraries' clinical meeting
for "Jack-men" only between the Hay and
Wagga picnics.
J.G.—king of the "St. V.'s underworld"
—has cultivated interest in photography and
radio-therapy—a sinister motive? We leave
it to you.
P.V. and A.A.—our geisha-knocking,
sake-drinking, opium-smoking, fantan-pla ,ring, fiendish orientals—contributed much
to our enjoyment of this year.
George M., seeking yet another outlet for
his talents has taken, we hear, to the stage.
This fact, we are given to understand, will
in due course be circularised in the Nurses'
Home.
G.J.S., we are told, spent the long vacation doing his bit toward getting the Geelong and Warrnambool Hospitals back on
their feet. During the May vacation he
performed a similar task at the Bendigo
Hospital. At the end of last year we were
all most upset that we were not invited to
Val's "Going-Away" party. We have since
excused her on the grounds that she didn't
leave us!
We would dearly like to write more but
the mumblings of "propping" and "copping"
in the vicinity are relentlessly drawing us
back to the game . . . .
FIFTH YEAR
"The dignity of truth is lost with much
protesting" says a well-known 16th century
scribe, and it is assumed that the SAINTS
face up to 1959 finals with the exhibitions,
prizes and monies generally accounted for.
Since 1958 a great metamorphosis has
occurred. The former merry men of 5th
year 1958 have dismissed their frivolous
golfing, drinking and social pursuits in return for the serious, gaunt-eyed, shop-talking climate of final year. This being so,
little is to be said about extra-curricular
activities except to mention, in passing, the
astronomical feats of beer-drinking by a certain Faraday street group at the Women's.
Tom and his wife are to be congratulated
on the birth of their baby daughter who,
following the great tradition, was born POP,
or in other words, "with her head on backto-front". Social news includes the engagements of Anne, still the most popular girl
in the year (ref. Speculum '57, '58), and also
of Barry. Best wishes to both of you and
your fiances.
In the "man-bites-dog" section it has
become apparent that a certain vernacular
and idiom has crept into our language. Our
report would not be complete if such popular terms as the penthouse, little Sin Echo,
the Producer of Exquisite Tenderness, and
Jackmen were omitted. Jackmen has had
an unrivalled place of importance and it
would seem that it alludes to transgression
of that great student precept—"don't-lookas-though-you-are-working-hard-even-if-you
are."
Current questions: Why is Frank always
tired? Where does Brodes disappear to?
In conclusion and in all seriousness, we
extend thanks to all our honoraries, lecturers and tutors for their unselfish help, and
finally, grudging best wishes to our fellow
candidates from the lesser hospitals!
88
SPECULUM
PRINCE HENRY'S HOSPITAL
sword" says he. His verse describing the
THIRD YEAR
cricket match is published at the end of
After surviving Panz, Treth, and the rest
of the preclinical years, 23 of us finally
entered the honoured portals of P.H. eager
to spend our time between Flo's Fluzies (21
of us) and solo (all of us). We spent the
first two weeks finding our way to the 11th
floor—but then had to reorganise ourselves
in the basement.
Our first P.M. was almost a shambles
when Dave B. almost collapsed into the
middle of it.
The new wing was opened earlier this
year—a real highlight being the guys arranging dates with nurses in the "Guard of
Honour" (they couldn't move away to refuse!)
The cricket match against fellow students
at the Alfred proved to be a roaring shemozzle where more glasses of the amber
liquid were drunk than runs scored. Which
side won? It is claimed that the Alfred
won — but by the time a decision was
about to be reached nobody could count,
nobody could umpire (least of all Comrade
Jagoda of the Alfred!); in fact, nobody
cared. There were plenty of supporters to
cheer the players and abuse the umpires. Dr.
Trethewie honoured the assembled multitude with his distinguished presence and
also proved to be a judicious umpire for a
while. The admiral performed extremely
well at this affair—even though it is said
that he endeavoured to entice one of the
fairer sex into the trees during lunch. Hero
of the day was Graeme H., both as bowler
and batsman. Maurie K. kept wickets and
even though he suffered extensive lacerations to the skull he still loves us all madly.
John H. skippered the team—a dubious
honour? John B. officiated as barman and
his efficiency decreased exponentially. He
still suffers from G.I.T. symptoms. Shaw
R. was unavailable because of a "slipped
disc"—said he did it lifting weights—but
we wonder? Barry B. opened the bowling,
slightly erratically but we feel sure he was
out with Denise the night before.
John H. has forsaken the stethoscope for
the poet's pen—"pen is mightier than the
these notes. A "gasser", even if the characters described were unduly maligned. Legal
action pending?
Most of the fellows in the year have become quite adept at solo. Now it is being
realised that the game is all luck the more
intelligent chaps are turning to a game of
skill. Everybody seems to be winning,
especially Maggie her just deserts for having done a good job coaching us over the
pharmacy hurdle.
Judy was most unfortunate to fracture the
distal phalanx of her percussion finger—not
so bad though as it also excludes her from
prostatic palpation. Heard at P.M.:
Miss Mac: "The prostate and its adnexa
aren't important."
Pathologist: "You mightn't think so."
Congratulations to Bhagat on his recent
election to the "Black Act Society" for his
magnificent display at the P.H. Ball.
Other notables among our illustrious crew
are:
Bob C. always going solo.
Max H. has been receiving mysterious
letters from a certain nurse.
"Herk" G. plays solo and billiards (both
varieties).
Paul G. a nice guy, but we're sure he
has calcification of the aortic knuckle.
Bill C. former dentist, army captain,
daddy of us all, and sometime honours man
in pathology.
Jack W. slept a night at the Gill Memorial (to broaden his narrow mind)—it is
said that he returned with a pocketful of
"tray bits". Only has to go for an early
morning swim at St. Kilda to win a bet with
a certain distinguished surgeon.
Henry M. would buy the hospital if we
offered it for sale.
Peter W. uses the long curved stick on
Saturdays.
Heard at an afternoon clinic recently:
Dr. R.F.S.: "Have you been passing any
dark urine—the color of tea without milk?"
Patient: "No doctor, I always have milk
in my tea!"
—
—
—
—
—
—
—
—
—
ai
4(
s
89
SPECULUM
A bit corny perhaps, so what about this:
Same Honorary: "Where abouts do you
have your headaches?"
Patient: "In me head, doctor?"
Ugh!!
Many thanks to Dr. Funder, Dr. Drake
and Mr. Davidson for their generous tutorial assistance.
Finally one "gasser"—
Miss M. R. (to patient in Surg. 0.P.):
"What has been the trouble?"
Patient: "Well, the old fellow's been very
sore lately. It's been discharging, but my
wife dresses it for me every day."
Miss M. R.: "Perhaps we could have a
look at it."
Patient exposes his injury.
Miss M. R.: "Oh, it's your leg, is it?"
And here's the poem:
SOUTH OF TOWN
Tune: Little Angeline
South of town if you care to come down
You'll find the best two hospitals in
Melbourne town,
At the Chevron they meet for a beer each
week,
They're Prince Henry's and the Alfred.
A cricket match they arranged to play
The Wednesday after pharmacy was set as
the day,
Wattle Park was set as the ground to get
When Prince Henry's played the Alfred.
P.H. won the spin, sent the Alfred in
Both teams had set their hearts on winning
"The Bin."
After drinks all round the players entered
the ground
When Prince Henry's played the Alfred.
Well P.H. bowled quick, but Steinkel was
too slick,
He hit the bowlers' balls with his big long
stick;
There came a great roar, he was out for 54,
When Prince Henry's played the Alfred.
The battle was on between these two great
sides,
When Jack had an over the silly blighter
bowled wides;
The reason was clear he'd had too much
beer
When Prince Henry's played the Alfred.
As the last wicket fell there came a great
yell
That the niner of beer was as empty as hell,
So we got another keg, those boys could
drink until they're dead
When Prince Henry's played the Alfred.
The admiral was there, but he didn't care,
He's the guy who's got no hair;
After draining his glass he flaked out on the
grass
When Prince Henry's played the Alfred.
Oh Treth, oh Treth, you are beyond
compare,
As a cricket umpire you were the fairest
there;
You did a great job but you drank all the
grog
When Prince Henry's played the Alfred.
We continued to play in this merry old way
And we were all quite blind by the end of
the day,
But one thing's for sure, there will have to
be more
Of Prince Henry's playing the Alfred.
FOURTH YEAR
This is it, the year in which most of us
fulfill our wildest dreams of debauchery,
hard work and anything else that's been
cropping up since we started this life of
slavery. Why pick this year?—it'; the year
of the kids, no exams, and, THE
WOMEN'S!
In two separate groups we went to the
Children's and the Women's hospitals, and
the tales we've been hearing about some
You don't really
people—well, really!!
know the people you work with until you've
had to live with them under the same roof
for ten weeks.
Firstly, our congratulations to Johnny
Wolstenholme who is half-way to becoming
a respectable man. We had our fear for
Trev. Wood a couple of times at the
Women's—I think Trev. had a few worries,
too. There were quite a few of the Women's
staff with tinnitus after Trev's operations—
more women passed thro' his room than a
certain powder room on the second
floor. Congrats. to Hap Webster for
plunging half-way towards marriage also.
90
SPECULUM
Starchy's broom cupboard was usually a
sight for sore eyes, so was Starchy. (It's not
a holiday camp, you know!) Rachael took
her night shadowing so seriously she followed Peter McIsaac into the men's one night,
—wistful thinking? Quote Beryl at a case
presentation: "A green label on an obstets.
history means the patient is infertile!"
Col Abery got tangled up with some
Queenslander, but good old Bugle Steele
remained faithful to the Wells Street tribe,
—trips on the Murray! Hap Webster is
still the main source of revenue to the driveins, but Tom Springer reckons it's a waste
of time and one may as well stay at home—
you still pay to see nothing. Bryce is still
seen lurking around the tunnel, and Dave
probably has the big one. Jennifer caught
the right spirit on a couple of occasions, but
all Starchy's overtures were useless—we
think. Tony Bothroyd is still playing (golf),
and we hear Ian Rossiter and Brucey had
some very seamy sherry parties after midnight around in Faraday Street. Mick
Jonas' episiotomies were more like Manchester Repairs by the time he'd finished—
apparently New Australian fathers are still
HEAR YE, HEAR YE
Graduates and Students
All M.S.S. Members
PAST ISSUES OF
SPECULUM
stalking around the hospital with a gun in
their hand looking for him. Marie James
had the whole thing sewn up, even gave the
labour ward sisters some tutes. Graeme
McKinnon got his "Spinge" confused with
"Respire" and caught "it" about two feet
above the bucket.
The fourth stage of labour, in case you
haven't heard, is the washing up after.
And so we plod on, the big year is coming
up, so is Christmas, and Cynth and Mal are
just as thick as ever. Heads down, lads; see
you next year, and up the thea(r)tre, Starchy
dahling!
FIFTH YEAR
We started off the final lap in grand
style. Every final year student (almost)
"threw" himself into his work with great
zeal. There wasn't even time to eat lunch
as we crammed ourselves full of knowledge.
However, it was not to last, and under the
influence of the third year students most of
us returned to the solo school, and the work
has been piling up ever since.
Joe and Hymie have recommenced their
squabble—it seems that those two just can't
get on.
We must welcome Harry Blackmore, who
has returned from the "dead" after a threeyear let-off. Congratulations to Maurie on
getting caught. They tell me Fat John has
them in a vice-like grip and that Hymie has
gone "sex-crazy".
The wonderful organisation of the Hospital seems to have mislaid our certificate
books—let's hope they find them before
next year.
In all sincerity, many thanks to the clinical school and honoraries for their efforts.
Good luck to all—here's hoping that life in
the residents' quarters isn't too strenuous!
urgently required by the
MEDICAL LIBRARY
In particular, Nos. 145, 147. 151
for purpose of completing records
There was a young fellow called Blue
Who had an affair with a ewe,
He thought the result
Was rather occult
When the wretched thing started to moo.
"Orion."
*
*
A surgeon is one with no faith in nature's
capacity to heal before the operation, and
infinite faith in it afterwards.
SPECULUM
91
spicula
One of the clinicians has complained that
his students are not gripping their fundamentals.
*
*
*
An innocent girl told us she was practising squash, as a man was trying to get up a
women's team.
*
*
*
The penis mightier than the sword.
*
*
*
Then there was the patient who on
receiving an enema called the nurse a stool
Pigeon.
*
Confucius say: Girl who sit on anaesthetist's
knee get Hotten.
*
*
*
Operation list: Excision, glans in neck.
*
*
*
Gray's Anatomy: "The tip of the sternum
is often broken off in later age by
workmen with their tools."
*
*
*
Many a girl who tries to earn a living
on the square has to dodge the policeman
on his round.
Hell hath no fury like a woman spermed!
*
*
*
One of the Div. II girls thought that the
Dick Test was a W.R.
*
*
*
Advertisement in Tel Aviv Times:
Wanted, State Circumciser. Wages, one
dollar and tips.
*
*
*
Pharmacology lecturer: "Put your organ
in a bath .. •"
Braggard.
*
*
*
Hospital admission sheet: Girl, 13. Banjo
string in urethra.
Doubtless a G-string.
*
*
One of the R.M.H. boys (we're not saying who) calls his bed the Mayflower because many a puritan has come across in it.
*
*
*
Newspaper headline:
U.S. Rubber Controls Go.
—Immigration too slow?
92
SPECULUM
There is apparently above a certain
labour ward in Sydney the words "Primat
non nocere" (first do no harm). However,
it has been pointed out that other possible
translations include: "No harm is just once."
Birdsville Mail:
"The ceremony was consummated in the
vestry before the happy couple left the
church."
*
*
*
What is the difference between a vegetarian and a virgin?
A vegetarian is trying to diet.
*
*
*
Dr. G.: "Chronic gonococcal salpingitis:
this is the result of—unselfishness, I suppose. Sterility is assured."
*
*
*
Path Notes:
". . . increasing tortuosity of the glans in
the endometrium . . ."
*
*
*
Dr. G.: "In extopic pregnancies in the ovary
the ovum is attracted by chemotaxis
rather than good looks!"
*
*
*
The drug companies have a new one:
SEXIDRINE: Stops your back from pegging out and your peg from backing out.
*
*
*
Lecturer in Parisitology: "First get a piece
of faeces on the end of your stick . . ."
*
*
*
Ancient Egyptian Burial:
The body was raped in rage and made a
mummy.
*
*
*
And then there was the chap who when
accused of consorting with Pygmies said he
was just doing it for a little bit.
Did you know that the mink get their
young the same way that the young get their
mink?
*
*
*
Confucius say:
"Woman with psuedo-pregnancy
labouring under misconception."
*
*
*
is
Advice:
Don't let your glands
Make too many demands.
*
Dear old soul in Cas.: "I have the most
horrible septic system in my throat, doctor."
*
*
*
"Good night," she purred. "It was fun
`noing' you."
*
*
*
The young man came in complaining of
urethralgia. When asked if he had a discharge he replied: "No, I haven't been in the
Army yet."
*
*
*
A.H's. History: "Patient admitted passing
clots P.V. with doctor's letter."
*
*
*
Charlie F.: "We must think of haemolytic
Streptococcus A in regard to Semmelweiss
who died of a puerperal infection."
*
*
*
Chas. again: "A flushed young woman in
good general condition—that is, she's not
flat—er, I mean . . ."
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A variant, "WHITE CYLLIN," is miscible with
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Invaluable as hospital disinfectants.
sea
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00
SPECULUM
Doctor: The trouble with Mrs. B. is that she
cannot stand up to married life.
Social Worker: May I suggest that Mrs. B.'s
real trouble is that she cannot lie down to
it.
*
*
*
"Are you medical or surgical?"
"What do you mean?"
"Were you ill when you came into the
ward, or did the beggars make you ill?"
*
Herald Headline, Nov., 1958:
"Labour want change to P.R. voting."
*
Reported from Sydney:
Female Physics Lecturer: "That finishes
mechanics. Next lecture I'll be on heat."
*
*
*
VERSE FOR A NURSE
A Staff Nurse
Stopped suffering from the curse,
So she did a
Change to Midder.
Another version:
My dear!
Amenorrhoea
I fear.
Surgical evacuation
Will re-establish menstruation.
*
Clinician: "At this juncture it is not within the capacity of the recipient of therapy,
whose condition is now ameliorating, to tolerate a recumbent posture."
Student: "You mean 'e can't lie down!"
*
*
*
Sun, 13/4/58: STAGE CRASH-100
HURT.
—Some comedians take things a bit too
far.
*
*
*
Can't vouch for this, but there is:
A sign outside the Boston Maternity Hospital which reads: "Airport."
93
"So the doctor wouldn't give a certificate
for your late husband?"
"No, he says they want to hold a postpartem examination on him."
*
*
*
An American judge who was recently
asked to ban a book, announced that it was
not obscene. The author is expected to
appeal.
*
*
*
Heard of the latest about the Stone-Age
contraceptive?
Rock Around the Cock.
*
*
*
A Frenchman talking to an Englishman
gave forth the following: "I cannot understand it at all—ze pronunciation, look, you
call melanoma m-e-l-a-n-o-m-a, but zen I
heard a doctor pronounce it fatal."
*
*
*
Hon.: Now what is the dose of Cascara Sag?
Stu.: Half an ounce, sir.
Hon.: Good heavens, you'll kill the patient.
Stu.: No, sir, I took it myself last week.
Hon.: Oh, yes, and what happened?
Stu.: Only one stool, sir, lasted 24 days.
*
*
*
I'd like some powder, please.
Yes, ma'am; face, gun or bug?
*
*
*
Here about the bloke who banged a dog
while on his motor scooter?
*
*
Quotable Quote—Nurses' Examination:
The expectation of life today is much
better than when doctors had no glands.
*
*
*
"Why was the bull sweating?"
"He was in a tight Jersey."
*
*
*
Professor (in lecture): "The Aedes is a
civilised mosquito. It only breeds in manmade pools."
*
*
*
The policeman from Pakenham Junction
Whose little affair wouldn't function,
Spent years of his life
In deceiving his wife
By intelligent use of his truncheon.
SPECULUM
94
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/*
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Watch those eyes light up when
there's a Peters Ice Cream Family
Brick for dessert at your place !
Everybody loves the rich wholesome
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PoteTg
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95
SPECULUM
Ad. on 3DB: "Quickest tonic for the
blues: nine-pence worth of English Woman
71
This sounds most reasonable—almost a
"blue heaven".
*
*
*
Bung H.: "Because of chemotherapy it's
got to be a good man to get the gonnococous
these days."
A good man, yes—but a bad woman!
*
*
*
Mr. C-q-n at R.C.H.: "One would almost
say that bow legs was a case of 'on pleasure
bent'."
*
*
*
It has been said that an intersection is
like a roll of toilet paper because when the
motion ceases you tear across the dotted
line.
*
*
*
Bugs Notes: Brucella abortis — BANG
strain.
*
A good golfer never retires—he just
loses his balls.
*
Dr. G.: There is no glans on the vaginal
portion of the cervix.
*
*
*
Dr. McKay: What can you tell us about the
incidence of prolapse of the cord, Mr.
Sutherland.
Abdul: It's found more commonly in Mediterranean people, sir!
*
"They come
down the aisle with the organ swelling."
*
*
*
Bill W. (A.H.) has to take himself in hand
every time he walks into his room!
*
*
*
Eskell: . .. she was a pale, young-looking
woman in moderate spirits.
*
*
*
Starchy: "What are the five main causes of
an enlarged uterus?—Well, just one?"
floppy J. (sterility lecture):
Australasian Post, 19/2/59:
The CURSE is on Belinda.
—They are getting a bit personal these
days.
Notice in R.C.H. Nurses' Home:
Student Nurses' Association Meeting
Monday, 23rd March
Guest: Matron de N(ai)eve, speaking on her
experiences in India.
ALL WELCOME
*
Confucius say:
"Two Wongs can't make a white. It
must be occidental."
*
What a salesman! He talked his girl into
buying a new dress and then he talked her
out of it.
*
*
*
Overheard in ante-natal clinic at R.W.H.:
"Could the mass in this woman's abdomen be a red herring?"
Sounds a bit fishy to us!
*
*
*
PROGRESS:
1st Trimester: Excitation, euphoria, and
a tendency to lose touch with reality.
2nd Trimester: Inability to realise seriousness of condition.
3rd Trimester: Alternating constipation
and diarrhoea .. .
*
*
*
From "Review" (Adelaide) Staff List:
Reproduction Manager: Miss J. Rush.
*
Newspaper cutting:
PRIMATE ON ATOM BOMB
96
SPECULUM
He was getting on fine—until he took a
turn for the nurse.
*
*
*
"It's 'is ear, doctor, 'e's 'ad it off and on
since he was born."
*
*
*
Did you hear about the woman with
spoonerism who went into a grocer's shop
and asked for a grip of Tarzan's tube, the
stick that stuffs anything.
*
One way to stop the stork arriving—shoot
it in the air.
*
*
*
They were examining a young woman of
questionable appearance who had a secondary syphilitic rash.
"What diagnosis would you make in this
case?" asked the Hon. Dermatologist.
"Occupational dermatitis, sir," was the
reply.
*
*
*
Overheard the other day around the table
at a children's party:
What does your father do?
He's a doctor.
My dad's a solicitor.
My pop's a doctor, too.
My old man works!
COMPLAN
The complete planned food
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• Easily digested
• Contains all the essential vitaruins and minerals in addition to balanced proportions of protein, carbohydrat and fat.
A GLAXO PRODUCT
Did you hear about the vice-admiral's
vice?
The rear-admiral's rear.
*
*
*
Then there were the two queers who had
a backward child.
Notice in King Street:
POWER DRIVEN TOOLS.
Reminds us of the Engineer's story.
*
*
From R.M.H.:
Hon.: "How would you administer a local
anaesthetic for the prostate?"
Stu.: "Inject, then push further up not
withdrawing the needle."
Hon.: "Why wouldn't you re-inject?"
Stu.: "I would only want to give the
patient one painful prick."
*
*
*
Herald Headline, 23/8/58:
". . . SPOOF WAS GOOD FUN."
*
*
*
It was reported in the press recently that
tram conductresses were not satisfied and
would demand shorter periods, longer routes
and be allowed to put the pole up themselves.
*
*
*
Hula dancer—a snake in grass.
*
From the front page of The Lancet of
some years ago: "Our book of the month—
Contraceptive Technique—A Handbook for
Senior Students."
*
*
*
From a woman's magazine:
"James Mason does not approve of makeup in his parts."
h
t
97
SPECULUM
Seventeen-year-old patient: "Doctor, I
have a rheumatic heart with a mitral diastolic murmur."
*
*
*
She was only a farmer's daughter, but she
couldn't keep her calves together.
*
*
Doctor: "Any thrills?"
Patient: "No, I don't go out with boys."
*
*
*
Waiting room at the Post-natal clinic:
"Congratulations on your triplets, dear!"
"Thanks, love. Doctor says it only happens once in 50,000 times."
"Lor! When do you find time to do the
housework?"
*
*
For once the doctor was on the receiving
end of a proctoscope. After standing the
procedure as long as he could he remarked:
"I think you have gone far enough—I have
a metallic taste in my mouth."
*
*
*
Dr. M.: Condylomata are common around
the external genitalia—especially the anus."
—Queer bods they let lecture these days.
*
*
*
"The
young
man was
Press report:
astounded to find himself facing an angry
parent instead of the sweet young thing he
had expected to meat."
*
*
Herald: Senator wants sit-down of
women probed.
*
*
*
His loves, his hates, his hopes, his tears that
fell,
The joys of heaven, the bitter pains of hell;
His smiles, his signs, the whole preposterous
issue—
A gland or so and some erectile tissue.
—Middlesex Hosp. Journal.
*
*
*
He who goes not and knows that he goes
not, has retention.
He who goes and knows not that he goes,
is comatose.
He who goes not and knows not that he goes
not, is B.N.D. from anuria.
*
*
*
The earliest gynaecologists, judging from
their writings, were in their leisure moments
poets and romantics of no mean order.
One is almost tempted to suspect that the
Poets of their time were, in their leisure
moments, no mean gynaecologists.
Gynaecologist, talking about dysmenorrhoea: "Bathing and swimming have no
harmful effect during menstruation as
nothing ever goes up the vagina."
*
*
*
Headline: "Four die in manhole."
—It serves them right.
*
*
*
Then there was the dwarf who married—
someone put him up to it.
*
*
*
Hear of the curate who never got married
because his stipend was too small?
*
Student looking at X-ray: "The cavity
seems to be well circumcised."
*
*
*
Nurse's Exam Paper: "The perineum is
on the outside of the stomach."
*
*
*
Surgeon (speaking of maggots in surgery): "How would you sterilize maggots?"
Student: "Remove their ovaries, sir?"
*
*
*
From a history: "Malaena stools, worse
on walking."
*
*
*
Ambulance driver's exam. paper: "There
are three sorts of bleeding—arterial, capillary and venereal."
98
SPECULUM
There's many a girl today who would
agree that emotional drive is a motor phenomenon.
*
*
*
"You should see my new girl. She's as
beautiful as a mirage."
"That's the wrong simile. A mirage is
something you can see but can't get your
hands on."
"That's my girl."
*
*
*
Quote from a lecture: "Steel for naval
purposes is made by Sieman's process."
*
*
*
And then there was the woman who
named her children, Innocence, Accidence
and Negligence.
*
*
*
Film posters seen in the city:
"MOTHER DIDN'T TELL ME."
"AND BABY MAKES THREE."
Stu.: "Is it possible to have intercourse
with a pessary?"
Hon. Obstetrician (inspecting same): "I
should think not."
"IRON MISTRESS."
"NIGHT WITHOUT SLEEP."
*
*
*
Did you hear about the cautious surgeon
who built his house on piles?
Also:
The statistician whose wife had twins; he
baptised one and kept the other as a control.
*
*
*
Heard in lecture:
"Now this experiment can be finished in
one day if you don't congregate in groups
and talk about the weather."
Remark from front bench: "Whether she
will or whether she won't!"
Midnight Edition:
THE WEAK END
Net Sales:
2 Copies per Anus.
As finals approach, R.Q. says he likes his
women weakly.
*
*
*
Stu.: "How often do you get up at night?"
Senex (testily): "Let me ask you that when
you're 70, sonny!"
*
*
*
S.F.A. stands for saturated fatty acid.
*
*
*
Forensic lecture: "A man who hides a
dead woman's body is guilty of frustrating
the Coroner."
*
*
*
Letter to the Editor: Mr. or Mrs. Confucius of no fixed commode, writes: He who
burns candle both ends will soon be spending all his nights in the dark.
*
It should be pointed out that some
women miss everything and the rest drive
cars.
One 3rd year girl is slowly learning—she
now knows the difference between fraternity
and maternity.
Broadcast of a scene from the Melbourne
Cup:
The jockey is now being introduced to the
mayoress.
*
*
*
Demonstrator in clinical pathology:
"After the practical period, put your stools
under the bench."
*
*
*
Med. student (explaining to his friend
how it is done in the front seat of a car with
a floor gear change):
"Put the stick in third."
Puzzled friend: "What do you put in first
and second?"
99
SPECULUM
She was only a bootmaker's daughter but
she knew how to make a naughty last.
*
*
*
We hear tell that a famous penist's latest
T.V. show is called, "Have Bum, Will
Travel."
*
Then there was the iceman's daughter
who gave all the men icey-poles.
*
*
*
Advertisement in "THE SUN":
WHEN THE
KNOCK COMES
(and it could be tomorrow)
will you have your
P.V. LICENCE?
If not, you risk a heavy fine!
The same bloke's get a new car; the door
doesn't bang but the chauffeur does!
TRETH: ". . . then micturate for 20 minutes
. . . sorry; I mean at 20 minute intervals."
*
*
*
TRETH again: ". . . the Anglo-Saxons' only
contribution to hygiene was the dunny."
*
*
*
RED (on double optic foramina): ". . . so
keep an eye out when dissecting the
orbit."
*
*
*
One R.M.H. student's treatment for
trigeminal neuralgia: Inject the Neisserian
ganglion.
*
Lines to be hummed from the supine
position,
To the hummer's osteopathic physician:
For him who botches
That delicate neck trick,
There waits, my friend,
The fauteuil electric.
—Ogden Nash.
From the nurses' examinations:
"There are four symptoms of a cold. Two
I forget and the other two are too well
known to mention."
"Hypnotism is now used for producing
Some mothers recommend it
children.
from experience."
Dentist's Epitaph:
Stranger, approach these bones with gravity,
Doc. Brown is filling his last cavity.
B. Serf—"Reflex".
*
Dr. H-y-s (in lecture) on inheritance:
"What are my chances of doing as my
mother did?"
*
*
Rod B. (R.M.H—after at least three minutes of rectal examination): "It doesn't hurt,
does it?"
Patient: "Cripes, I didn't even know you
were in!"
Treth: "Banting had an unfortunate end."
Treth again: "Churchill is in his second
youth."
It was a neat, modern villa with a spacious porch off the kitchen.
Girl: "Would you rather play in the
dining room or the lounge?"
Boy: "Neither, thanks—I would prefer
the vestibule!"
She had a figure like an old bag.
bulged in places, but didn't give.
It
*
Infant Feeding:
"Aldrich states: 'The rooting reflex is the
first one to come into play'."
SPECULUM
100
"Sayings of the Great" from King's College
Hospital Gazette:
1. Lady B rt: "If you come across a
woman thirty-eight weeks pregnant who is
not engaged, you must think something is
wrong."
—
2. Mr. F r z: "Unless you are careful you
will lose your breeches."
*
*
*
3. Dr. D nn ss H 11: "He applied to the
Home Secretary for castration but the Home
Secretary was in no position to operate."
*
*
*
4. Pr-f-ss-r M-gn-s: "Neurologists always
have syphilis very much in their minds."
*
*
*
5. A. J. Yates Bell (filling out a psychology questionnaire): "I was a primip."
*
*
*
6. Overheard in Antenatal Clinic: "But I
thought homozygais men never married."
*
*
*
7. Dr. C tf rth: "Death is a prolonged
Stokes-Adams attack."
*
*
8. Dr. C tf rth: "If you take out six or
seven yards of gut and join the oesophagus
to the rectum, you would probably get
diarrhoea."
*
*
*
-
-
-
-
-
-
-
-
-
9. Dr. McD n ld: "This woman was having delusions; she thought all the doctors
were being secretive."
*
*
*
10. Dr. T Ib t (refulminating pneumonia):
and in these cases death is irreversible."
*
*
*
There was a young man from Lancashire
Who swallowed two blades of grass;
One grew out from his ear-hole
The other grew out from his nose.
-
-
-
-
.
"Don't worry," says the sly physician,
"It's just a cardiac condition."
The patient isn't fooled—she's smart,
And talks about her cardiac heart.
OVER THE HILL
It's not the grey hairs that make a man old,
Or the far-away look in his eyes, I am told;
But when the mind makes a contact the
body can't fill—
Then, you're over the hill, brother, you're
over the hill!
You may fool the young wife with the
cleverest of lies,
You can shear the young lamb and pull
wool o'er its eyes;
But if she calls for an encore and you say
you are ill—
Then, you're over the hill, brother, you're
over the hill!
When you gaze on a Venus and just heave
a sigh,
When you hear a weak joke and laugh till
you die;
When it's all in your head and you've lost all
the thrill,
Then, you're over the hill, brother, you're
over the hill!
Life is a conflict, the battle is keen,
There's so many shots in the old magazine;
When you've lost the last shell and just can't
refill,
Then, you're over the hill, brother, you're
over the hill!
Salvage the engine, old boy, if you can,
For testosterone can't help a man;
You can't make a man from a little pink pill
If you're over the hill, brother, you're over
the hill!
This is my story, alas and alack,
When you've drained the bottle you can't
put it back;
If you want to make whoopee, don't wait
until
You're over the hill, brother, you're over
the hill!
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54 COLLINS
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