1965 1
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dpciite
The 6st @oulcerei ol tbe ctiai@l rahe ot corftonevas uile in 1949. This sta ed a! ilteGive soltil-qirlesearch ior yeseiable stercids tlat cotrld te used as siartinsuterial lor the ecdomic syl|resis ol tle bolmode.In tletniteil Kineilom. clrxo Diddril a Briituh uo@sB utilisiasbe, oepDin dsreerl bon Esst Alrl@n s,sal $trtp. ItrhN'veilevelopnent ol this basic !:etbod bf,s €ubted Claio noioDjy io lroitu@ a raDge ol corlicostdoiits ior ail trT* otlrsfmeni but rtso DrosrNiyely to reiiu@ th€ir prices,
tire rcent inbodlclion oI b€tlD€thasoae was a@jot til@ce in this $e*, Eecruse jt is srler and mor€
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Dear Doctor,I have been taking
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GUIIDFORD . SI'RREY
GalenicalsUniversity of Bristol
Yol.21. No.1 1t6d.
BLACKBAG
Chairman :
Edilors :
Euslness Managers :
Disttibution Manager :
F. J. W. Lewis, M.8., Ch.B,
Howard SmilhElaine Flower
Geoftrey PerhamRichard Harding
Michael Ranson
Co-opted Membets:Sistor lvl. A. PriestSh€ila Toogood
Tass AllenJulia Lumley
'Synale?'with an occlusive dressingtechnique can producerapid involution of chronicpsoriasis even in manyhitherto intractable cases
"ln some patients with pso.iasis resistant to the conventionaltheraov a bramatrc imoiovement was achieved. One of themhad biaoues of pustdlar psoriasis that during 1| years ofhospitalization has resrsted all the customary forms of localtreatment, inc lud ing triamcinolone".
a.r. D.,n. v..., (1 e62), .2, 420
"lmprovement is noted in 3 to 4 davs and complete clea.ing,excdpt tor residuat eryrhema. usua y occff
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6
BLACK BAG Spring 1965
CONTENTS
Edlto.lal
Th€ Whlt€ Coatcd lm{c .
Profe.eor R. Mlln$ Wslk.r, C.B.E., M.s., F.R.CS., F.A.C.S.(Hoi,)
How to wln your v€ry own HoqlFJob
Th. Feud?l KlnSdomr
Blochamlatry .nd M€dlcal Stodcnts
Bonlgn..nd Malltnant Fru.tratlon
Ng.
I
t1
l6
t8
20
22
21
?3
3o
32
31
N€wr from G.lenlol3
Th€ 8lbll..l God
NlSht Nurr€
Pantomanla
Book Revl€w!
The man-size cigar for the price of a pint...
*,"",CASTELLACIGAR,S
EDITORIAL
Well here we are, bright and new, allSa/ andGill Sans. We hope you like it. The gen€ralresponse has been heartening. . . pl€a5€ l€t itcontinue. Let the Medic ofr his belly ris€!Seriourl), though, a lot of work has 8on€ intomakinS this a presentabl€ magazin€, Th€ oldstolid, reactionary image peopl€ had ofBLACK DRAG has now, we cross ears, gonefor good. You have something worth writing
Oh dear what ha! happened on the surgerlside BRll The colour-mindedness which foundsatisfactor), expression upon th€ walls and
doors of Outpatients hat run amok. Lots ofsqudgey pinks and yellows and blu€s inhorrible combinations. lfa bit mor€ restraint.nd subtletl had been exercised, the resultwould have been iust as 'jolly' aid fa. moreequible. You don't have to be sa.kh in orderto be 8ay.
There is a change. Somewher€, somehowthere has been a subtle alteration of attitud€amonSst the sixth /ear. This is the shortgribble to finals. The student cloak is cast offfor now they are 'Nearly Doctors'. No timemust be lost in the task of impressions to be
made'. A BRI house-iob becomes a monum€ntof priceless count to which the self must beoffer€d up. Senior rounds becom€ rituals inan efforr to get your face, that sad thing,recoSnlsed and perhaps even a nam€ attach€dto it. Of course thk hn't true for €v€ryone,not all Medical Students are depersomlis€d bythe time finals close in. But it
's a sad reflec-
tion on mentalities that so many a.e.
At a m€etin8 of the Medical Board held a
few weeks ago, it was agreed to stop theshowing of films in the lunch hour to pr€-.linical stud€nts. Films of a Seneral m€dlcal
nature, and selected by a m€mb€r of theAnatomy Staff had previously be€n shownonce a w€ek in the medical school, and an
arransement had be€n made with the Uni-versity Catering Dept. to provide a lunchseryice on thes€ da),s. The filmshows wereentirely voluntary, well supported andtho.oushly enjoyed by many preclinicalstudents- Th€n one of the Preclini.al Depts.insisted that th€ filmshows were encroa€hingon students freetime, that this was a bad
thidg and that as th€ s.heme was beingsponsored by th€ Professor of Anatomy, thisindicat€d that it was an integral part of th€Anatoml course and therefore ought to fitinto Anatomyteachingtime. Thus the M€dlcal
Board deemed it necessarl for the filmshows
lfthis policy is to be widely adopted by theUniv€rsity, the days of lunchtlme concertsand public lectures takinS place in €xtra-c'rrricular hours, appear to be numbered. Anemin€nt member of Galenicals commltteehas even been hea.d to query if 12.0 p.m.
post mortems <oont as lunch time enter-tainment, but it was suSSested that they weremerely an aperitit Some wonder how5.0_6-0 p.m. lectur€s manage to escape thecateSorl of usinS up th€ stud€nts' free time.Th€ lunch hour is a good time to show fllms,for it enables lst M.8., Hons. Physiology and
Biochemistry, and clinical stud€nts aho to s€€
them, and provides i pleasant relaxation inthe middle ofthe day. As the student body as
a whole is thoroughly in favour ofthese film-shows, which originally wer€ provided fortheir ben€fit and at no stage has any protestbeen rais€d ontheirpart, it has been suggested
that Galenicals takes ov€r the running of theshows. This would reli€ve the Universityofitsweighty responsibilit/ in "depriving thestud€nt of hk free time."
The co-editor k sufferlng from a conditionknown as National Health feet, the pres€ntingcomplaint ofthh disease being pain and crampin the toes. She is not sur€ ofthe aetiology ofthis state, but attributes it to w€arin8 one ofthe f€w pairs of white operating sho€s
provided. She does not f€el at all bitter thatshe is the only female m€dical student withsize 8 fe€t, but ls considering changing to thewhite, kinky boot! that abound on theelephantine feet of her male colleagues, b€in8confident that this would not endan8er thestate of the national economy as might theprovision of a few n€w pairs o{ shoes.
ln th€ last edition an article appeared pre-sencing rh€ patient's attitude to hef treat-ment at Glenside Hospital. That it was a
patl€nt's point of view was stressed at theend ofthe article, but all the same it has comein for som€ strenuous criticism. For som€ thewrit€. gave a dktorted view ofthe place, but
of course, thls was the point. lf th€ views had
been changed in any way it would have been
valueless-reality throuSh one pair of eyes isalwa),s distorted. All the same GlensideHospital is one of the most forward looking,and is run by an extremely enliShtened grouPof doctors under Dr. Early. Enormous effortsare belng made to briShten up and redecorate,and byfar th€ majority ofpatients do notwantto leave. Arrangem€nts are now such thatstudents doing their Psychiatry firm willspend a w€ek at Glenside and, like the editor,will see for thems€lves what a progr€ssive
From April the 6th to the loth, BristolFacultyof Medicine will be welcoming studentsfrom medical schools throuShout the UnitedKingdom for this year's National ClinicalConference. A programme of lectures and
demonstrations and 8ay, gay social €vents G
being arranSed. P€rhaps we'll see you th€re?
'UnderAlcoholImmersion'
The world of medicine appears to hav€ fa5-
cinated and intriSued the imagination of many
wrlters of note, the product of their f€.tileminds, bringing to fruition several ePic works,and at least three Nob€l Prizes in re€oSnitionof their genius.
The position of Doctors, with the P€culiaraura of mlstiqle, mysterl, if not doubtfulmagic, preyalent since Grecian Galen, and
certainly malntain€d by the Gra€co-Roman
nomen€lat!re of thk century's Pactitioners.ls fulll exploit€d and heiShtened by thesellterary masterpi€ces. lnterest is seeminSl/
unlv€rsal, a whole Samut of French, Russian,
German, Amerlcan nov€lists, namely Camus,
Pa3ternak, Thomas Mann, F. Scott FlizS€rald,and even the home-8rown Englishman
Lawr€nre Durr€ll, despite his voluntary exil€.
have all been arous€d by thk toPlc.Whether the interesl h due to medical
iarSon, slmpl/ as words aPPealing to a writ€rtmind (ln a similar wa/ lo the ilick, oftenfacile use of'bons mots"; wltne$ l4ann, who
aisumes hls reader to be billntual, with attlmes whole pates of French to trouble theunwlttlng, or to be hurried over uncomPre-
heidlnSl), b/ the cat0al fllPPer of leaves),
Or ls lt the layman's bllnd falth in an esoterlcprofesslon. PerhaPs it h the Position of theDoctor ln socl€ty, a confident and friend otthe recular world, someone to whom e Perloncan divulte hk personallt/ or lack of lt, wlih-out re€elvinS r€liSious Platltudes or moralis-ln8 censure.
"Doctots togethet with lavycrs ond parcons
arc pttvtlegcd to enqrire into the p.ivote liv€tof theit patients. Ihis is whol mdtes ,,fe
i nteresti ng ond sqiceY "Thes€ three professions have all enioyed a
vogue, and undergone Periods of debunkinS;thouSh from the juetified jibes of Moliere atthe quacks of the lTth c€ntury has emergedthe shiny incorruptibl€ image of th€ 2fthcentury honest to goodness G.P., onlt withinvery recent y€ars showing siSns of tarnish€d€xterior, if not a corrod€d core Less can be
TheWhiteCoatedlmage
said for the cleri.al lmage, the downgradeddo8-collar ls dellnitely out this decade.
Dr. RieuxThi! rivalr), berw€€n do.ior and Prlest h
rellected by Dr. Rieux, mouthPlece of camus
in 'La Peste'. who is enSaged ln a PerPetualdot-fi8ht for the lives of his Patlents wlth the
Jesuit prie* F:ther Pan€loux, who ls seeklnttheir souh. The latter in his dramatic sermon
to the plague-strl.ken citizens of Oran. . .
"Cdlonitt hds cone on you ny brcthen, ond
m), ,retrrren ),ou deserv€d it"to whlch Rieux retorts
"whot's true of oll the evilt ,n the world istue of plogue os weil- l. he/ps me, to r/se
obove .hemselves. Al, the sdne, wh€n you see
th. nisery it btings, you'd need to be a mod'
nan, or a coword, ot stone blind, to give intonely to Plogue."
Rieux believed himself to b€ on the 'rlghtroad' in fiShtin8 against creation a5 he found
it, suggesting there's no profit in PhilosoPhls-ing about evil or its origin, until it is eradi-
cated; and ironjcally, Paneloux contracts th€disease, loses his faith, and submits to hospital
Dr, Dick Diverln a different vein, Scotr-Firzserald's Dr.
Dick Diver, the all-American hero of hrs epicnov€|, "Tender is the Night", is portrayed as
the idealistic, Ivy leagu€ and Oxford RhodesScholar, doctor. He devotes himself to rhecar€ of one patient, a girl relapsing intoperlods of acute schjzophr€nia, whom hemarrles, eventually to su€cumb; defeated b),the uneven struggle of being Dr., husband,Iover, hrher', and ever/thin8 else rhar'sgoing. Scott-F., whos€ own wife enrered an'asylum' and became himself reduc€d roincreasing bouts of alcoholic debauch, reverlshis interest in, and even his own atrirude topsychiatr),, culled from his involv€ment witha psychotic in real llfe. He rarely dwells ondetails of medicine, the whole remainingclouded in obscunry, alrhough Diver in l9l6reaches Vienna in rearch of Freud and wrireshis pamphlet entlrled, "A PsycholoSy forPsychlatrists" later to b€ translated intoumpreen languages. and spends rhe rest ofhismarrled life, before his dissiparion, preparinS a
''An ottenpt aL o unifom and ptagr.i,otic.tasifi.ation of rhe ,eu'oses dnd psychoses
bosed on an exominatnn of 1500 Pre-Kroep€lrrand Post-kaepelin Cd\er. 05 the/ wou]d be
diagnoted in the teminolo\y of dtffercnLcontemporcty schools-together with a chrcno-I f ot su.h subdivisions of opiniont os haveo tisen independently ".This grandiose tltle, to be written in €ven
mor€ grandios€ Gothi€ cerman, ferments as
a pile of pap€rs on his desk, and norsurprjsinSly, this proposed accumulator ofdust is nev€r published.
7zhivagoPasternak's Dr. Zhivago is given a more
formal medical education than most (wjththe unsettled pre-revolution and abortive
uprisings of 1905 in Moscow, as a backsround).H€ takes a 4 year course, sp€nding one termon ly ofhis firsr year studying anatomy-a mostproper lengtfi of time one feels, for such amund:ne subiecr. The author\ description ofthe scene is reminiscent of the days spent inthe litde-laked and even less lamented otddissection rooms in our own Univ€rsity. . .
"k wot deep underyrcund in o botenen| ofthe univercity. You cdme down the vtindintstdr.cdse. Ihe.e werc atvays o ctowd ofdisheyeired stud€nrs, sone ho ot wotk overtheir tatteted kxtbooks and swunded bybon€s, or guiet/), disse.ti,g, eoch in his.omet,otlers &oli"g about, ctq.king jokes, andchosingrois..."Yura Zhiva8o is no humdrum student, to
the contrarl he is observed worktnS on anessay on rhe nervous sysrem of rhe e/e, fo-the Univ€rsity Gold Medal. He is intenselyconcern€d with the relarion between imageryin art and the logical srructure of ideas; and,he is no mean poet-his poems to be foundas a post€ript ro the main stor),. Yury quatifies,and soon reveals hjs clinical acumenl hediagnoses an echinococcus of the liver, inopposition to his superiors ind k provedright at the autopsy. He is cauSht up in thethroes of war, revolurion, counrer-revolu on.and reSular purSing, but sreadfasrly prac sethis medicine almosr oblivious of rh€ Bames o.politics around him-retains hrs poer'! eyeand quietly follows his own philosophy.
Magic MountainFrom Pasternak to Thomas Mann may
se€m an impossible leap in both style dndg€ogrrphy, from Russia to Swtrzerland, fromrevolutjon to a complacent principaliry; thetwo novels are however s€t in approximatelythe same decad€, the pre-first world waryears of this century. l.,lann's epic tome, the'l'1a8i€ f,lountain', des€ribing the relin€d .ndrarefied atmosph€re of a T.B. sanatorium forthe not so poor victims of the tlbercle, po.-trays the hero, a younS engineer by name ofHans Castorp, who on a visit to his cousin, a
t2
patient in this same institution, is fourd to be
tuberculous hims€lt His proposed three weekvisit stretches into a sev€n y€ar sentenc€.
Mann describes the life of l€isure, the reSimeof superlative food, strictly observed r€sthours, and the all embracint boredom. T€m-poral matters hinge on the thermometerritual, not the arbitrary hour or day; as Hans
remarks, becoming aware of his illness. -,"99.6, in broad daylight, hetween ten and half-post in the
'l,orning, thaa wos too mu.rr, it wds
The sanatorium is no primitiye placethough,all patient! are X-rayed, tapped and percussed,
and auscukated at regular intervak. . . and
recorded as faint, diminished or vesicular;rough, very rough and rhonchi- th€ latterbeing ominous. Dr. or Hofrat Behrens th€proprietor, practices the'Pneumothorax',and is r.egular dab at it. An incision is made
somewhere on the 5id€, then the), fill you upwith nitrogen, which has to be ren€w€d ev€rytwo vreeks; one girlacquir€5 the biza.re partytrick of being able to whistle with her
"When she has been walking rcthet fast, she
can noke it whistle, she uses up het nitrogen
when she do€s it, for she ,l os to be tefrlled once
Mann is no laSgard, and has Hofrat Behrens
speculating on med ical advan ces; he is cr€ditedwirh such a sag€ observation as. . .
"Everybody hos cocci and ony oss can have
and slightly off the tra.k. . ."we orcn t more tion three stePs from tfeconception thot tuberculosis is d dtsedse oftbe
Again, mention of u stepto-vacclne treat-ment, of which Behrens Promises himself'unheard of resolts', is made, and our herosubmits to bloodletting for culture justforth€inreresc of seeing his buSs grow.
BalthazarFinally a mention of Lawrence Durrell s,
Doctor Bakhazar, who gives his name to th€
second book ofthis monum€ntal qlartet. Thecomplexit/ and interwoven counterpoint ofthe theme p.esents dificulty in deriving a
clear imaSe of any .haracr€r, not the leastthis being true for Balthazar. A jew, andrrther a shadowy fi8ur€, but whose verypres€nce €manates strenSth-as lustine
"Balthozat is the onlf nan to whom I .an telleve{|i'hing. He only loughs. But somehow henelps ,ne to dispe/ the hollowness I feel in
A man with uSly hands (in his temporarylapse from g.ace, he even attempts to cutthem off, so deep is his despair, before beingrestored and revertinS to his former s€lf). Heem€rtes as a more than competent doctorwho appears to moye in an aura of wisdomaod benevolen.€; h€ is mentloned as spendingmuch of his working time in th€ Sovernment.linic for venereal disease. . .
" l live ot the .entrc ofthe .ity's life-its genito-utinoty j'stelx: it is a sobeting sott of pla.e".BalthMr is at times cajoled into philoso-
phising. revealing a subtle humour..."We get too .ertoin of outselves lJavelltngbockwads ond fotwotds olong the trcnlinesof el',piti.'al fad. Occosionolly one gets hitsoftly on the head by a strcy btick whi.h hasbeen loun hed fron sone othet rcCion."Perhaps rhen the strikang thing about the
doctors, porrrayed by these Sifted writ€rs, is
the vividness oftheir personalities. For them,the 'rakon d'etre' is not simpl), medicine;there is no hidinS behind the doctor's maskor the white coat image, they exkt as indi-viduals wirh their medical pseudon),ms, almosts an incidental. lf these fictitious charactersare painted unrealistically, then what a
misfortune for the doctors of Maudlin Street.
l3
JOHN ROUTH
Profe.ror R. Hilncs Walker, C.S.E., M.S.,F.R.c.s., F.A.c.s.(Hon.)
Many students io this country and abroad willrememberwlth esteem and affection ProfessorR. l,lilnes Walker who reilred as the firstfull-tlme Prof€ssor of Surg€ry ln th€ Unlverslryof grlstol io August last year. Comlng toBrlstol ln 1946, lmmedlately after the lastWorld War, he had to create a Universlt/Departmentof Suryeryata tlme when SurSeryitselfwas rapidly expanding, scle n illic researchwas €xtending into clincial surS€.y and manyof the cla$ical conc€pts of teaching were
Educat€d it Oundle School, where heexc€ll€d as a gymnrst, he trilned subsequenrlyat University College Hospitaland griduatedM.8.,8.S., with Distincrion in 1925. He passed
his M.S. in 1927 and wa5 awarded Gold l,ledalswith both degrees. He obtained rhe diplomaofFellowship of the Royal College of Surgeonsof England in lt8, his postSraduate trainingin surgery beint at the Coventr/ and WaFwickshire Hospital and the SurSi<al Unit atUnlversity ColleSe Hospital. He was electedto the Consultant Staffofthe Royal Hospital,Wolverhampton, in l9ll and rapidly estab-lished himselfas an outstandinS surgeon withwide experience and tremendols technicalabilitl. These qualities w€re recognised as
early as 194,t, when he was elected to theCourt of Examlners of the Royal ColleSe ofSurSeons of En8land, whilst siill ar a non-teachlnt hospltal-a rare dlstlnctlon,
ln Brhtolhe <ollected round hlrh men whomhe lmbued wlrh hls own enrhusiasm andmoulded them into a surSlcal unit whrch overthe yeaff nor onl), fulfill€d lhe Unlversiryrequirem€nts ln medlcal educarion, buracquired for its€lfa National and lnternanon.lreputation for surSery and rese.rch of rhehighest.alibre. He remained outslinding in
this Sroup and his pioneerworkin pulmonaryand €ard iac su rgery is widely r€coSnised. He is,
however, best known for his contributionsto the surgery ofthe liver, becoming a worldauthority on the treatment of portal hyp€r-tension, so that patients and visitors came
from far and wide to l€arn from and work inhl! department. ln addirion co these surgicalachievemenrs. he still found time for a lviderange of extra mural aciivities and followingel€ction to the Councll of th€ Royal Colleg€of Surt€ons ln 1953, he has served on man/nailonal and international commlltees ruchas the Medical Res€arch Council, the N!fiieldFoundation and the M€dical S€ction of theUniversity Grants Committ€e, all of whlchhave contributed Sready to the organhatlonand development of surgery in many parts ofthe world. He w"s elect€d a Fr€eman of theCity of London in l95l and in 1962 was madean Honorary Fellow of the American Coll€geof SurSeons. His advice and time were moreand more sought after and in 1964 at rhe ageof 5l years he retired from the Chair ofSurgery, being mad€ a Commander of theBritish Empire in th€ same year. H€ has
reason to b€ proud of the Deparrment hecreated and the services h€ has and stillcontinu€s to render to British SurSery. He isreSarded with admiration by all who have hadthe p.ivilege of working with him and hispersonal qualities of kindness, unassumingmodesty and enthusiasm have resuked in hi,s
acquirinS friends throuShout the world. Hiswife, Grace, and his famil/ have cont.ibutedmuch to University life and rhe hospltalir),they extended to a larSe nomber of srudentsand vhltors from abroad, irrespecrlve ofstatus, colouror cr€ed ls wellknown.
Both the students and stsffofthe Univer!iryover th€ last elthteen years have reason to be
trat€ful for the work done by the trsr full-time Professor of Slrgeq/ co the Universaryof Bristol and to wish him and his wlfe everyhapplness in the new €.a of their lives thathas just begun.
t. PEACOCK, F.R:C.S.
t4
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TO WIN YOUR VERY
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1-\is i€ t€n iactlul ind olbenelit to t.u i" .rr ro"tu or tay",F p.ciilly rlth r.g.rd t4 thF tdin.tn.r-nsie. ol the Chi€f.
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.lt ts €s..nii.l to gei, a eood r6pui.tio!on t,he Firn.EveryihinA tou do i. Doti..dand rill he reDebb€.ed by.6!eone.Youc.nDot be Loo .nreful nbout r.trr 6cti.naoD the Firornld Jou cirno( 6t.rl, too s'ooDon you. nit.rel to .onv.X . good i.pre8.-io! of tourself.
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.rlratB dress to n pror.ss iotr.l .tntrd.rd.Ih. ;nttent6 take t lot ol Dotic. of totr.ad it ir c.rL.itrlt re*.ber.d bJ e.ber.o! tn. !i.fl rh.ih.r i gttd.trt lookedcivitt.ed or lot.
4l.D6 dhe Loctrr if nt nll Doesible.Tiir eyloi teach you very Du.n .bout i,he d!bl..t.orc.rn".l,btrt t{ rill tedch tou t. b. !g.od ldDint.lEior(,hi.n is rhat .o.thoure.@n r.!llr ire ).
6.rpplt cartt ard car.tollt fo. rou.to..n ho!6Fjob.riD !t o.e too b.rcd good cbnc. ot g.iting,!!d kior rho.r. ton. riv.r. tor tL. po.t.
t,h.rk you for tt.
a.se sr.teful for rhe .ppoitrrEc!t,.abdqk" thc stal! tbi.k that EIl€r nllyN I'ave obly dole ihe ,irht it,iu_rn dptt rtal.g tol it.
rlter sll I hnve doDe !o. i,heD
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.rort :gg tsrd - rou ne.d Lh€ refer-ercc lor your future job3,
nF tou r.nllr rure You t.!i
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ADVICE BY TONY DROPPINGSt7
The Feudal Kingdoms
"/vled,col Scrroois ore not designed fot chonqe.
They ate feudat kingdons ||herc evety bo.onis all-powetful in his ovh castle."
Sir Charles lllingworth-
ln th€ New Year, delegat€s from medicalschools met in BirminSham under th€auspices of BMSA for a national conf€rence onMedical Edu.ation, to equip themselves withbattering rams needed to invade the mightyfort.esses of medlcil tradition. The result oftwo days hard dlscussion, was a document of47recommendations drawn up from a report byBMSA, and forwarded to the n€wly formedCommittee on Mediql Education of theG€neral Medical Council-
ln the training of a doctor, th€re a.e atpresent two €ntir€ly separate concepts ofthe basic principles on which a MedicalcLJrricul'im should b€ constructed. This st€msfrom the unanswerable question as to whetherMedicine is an art or science. Ther€ a.e thos€who consider that a three y€ar HonoursDegree course in Human BioloSy without anyclinical bias whatsoever, should prec€de prac-tical work in hospital and from a purelyscientific ground on which to base the clini€altraining. Thls ls oppos€d by an equally strongopinion thatthe p r€-clinical yea.s should be as
short as possible, and that th€ majo.ity ofmedical knowledge can be t?ught from thebedside, using the patient as a t€xtbook-
The ideal rurriculum would encompdsboth these views, but at pres€nt it dealssatisfactorily with neither. as the PreclinicalYears are us€d to push in the cannonloadsofscientific fact, instead of fostering an abilityto assimilate scientjfic knowledSe, which canthen be appli€d to the animate being, thepat'€nt, whose welfare rnd cure, is aft€r all,the purpose of the exercke.
f4any delegates, time after tim€, str€ssedthis need for a greater link, firstl/ berween
the Arts and Sciences at Pre-University l€vel,and secondly a greater co'ordination berw€€nthe diffe.ent parts ofthe curri.ulum, so as topres€nt a united course, combinirg a scientiJlcassimilation and its application.
TelevisionThe problem of how to improve the pre-
sentation of preclinical material was heatedlyattacked. D€monstrations of living anatomyand tutoriak on prepared specimens wered€manded rath€r than the traditional hoursspent on dissection. More us€ ofteaching aids,such as closed circuit television, was con-sid€red. Us€ of television has already beentried in some lvledical Schools. Jor clinicaldemonstEtions as well as preclinical, and was
widely acclaimed. At the Royal Free Hospital,pathological specimens at post mortem aret€levised (and consequently magnifed) withcommentary. thus enablinS a large number ofstud€nts to view in comfort, instead of th€perpetual n€ck-craning in hardly agre€abl€surroundings, At Newcastleand the l.4iddlesexHospital, tel€vision
's lsed for anatomical
demonstration-other hospitals have us€d itto show pharmacological experiments, andin the Psych'atry and E.N.T. departments;a television camera can apparently peerdown a throat much more efiicienrly thanth€ averag€ student.
Concentration of teachinSThere was great concern about the concen-
tration of medical education to 'teachinghospitals' only. This was particularl),stressedby delegates from some of the LondonHospitals where th€ patient student ratio is
v€ry low and where ther€ is a lack ofsome ofthe more common diseases. A period spent ina'non-teaching' hospital would not onlyenable the student to witness:lternativeapproaches to medicine, but aho to experiencea different clin ical climate. This wid€ning ofthem€dical horizon mightalso h€lp to remov€ the.egrettable socialstigma, that house jobs doneoutside a teachinS hospital ar€ only to be
t8
appli€d for ifall else fails. and are certainly nota stepping stone to a successful career. Thus
r€commendation 43 states: "At least one ofthe Pre-Resistration House lobs must be doneoutside the teaching hospital".
General PracticeThe establishment of Depts. of General
Practice and agreatercontact between Medical
Stldents and G.P's is also an essential factorin aiding the d€€entralisation of t€achin8.and widenin8 itr application. A most importanr resolution. seized on b), the Press, was
that General Practice Atrachment schemes ofat least 2 weeks should be €ompulsory for all
Students. This s.heme is already well und€rway at Bristol, but on a voluntary basis.
and exceedingly well subscribed to. Anexcellent P!blic Health firm here also €nables
the Bristol student to see an application ofmedicine outside the Facuky. lt was emPha-
sned that Elective Periods abroad are in-valuable in forminS an integral partofgeneralexperience, which it is ess€ntial for allstudents to acquire, and th:t th€re should be
greater encouragement and oPPortunities
Throughout the conferenc€, it was int€r-esting and pl€asing to note that this facultyhas b€en one of ihe foremost to attemPtexperiments in chanSin8 the curriculum.l'{any suggestions made by oth€r faculti€s, onth€ incorporation of additional courses, ormodernisation of €xisting ones, have alreadybeen tried or a.e in operation here- However,the emotions roused ,nd spent at th€ Confer-ence, and the scrength wi(h which views were
expressed by delegates. only emPhasrsed the
current demand, recognised in all m€dical
fields, for a complete review of m€dical
education. lt is hoped that the document and
recommendations forward€d by B.M S.A. tothe G.M.C., and expressing the opinion of12,000 students, will at least be read.
THE FORGOTTEN ONES_
ln the articl€ on lYedical Students publlshed
in Nonesuch News on Nov 6th, the authors
forgot to includ€ some tw€nty-five first ll.B.students who, having studied to'A'level,subiects not sp€cifi€ally required by themedical fa.ulty, are forced to sPend an extrayear at the beginninS ofthe coufse.
At its hard€st, this year means studyingPhysi.s, Chemistr), dnd BioloSy to about'A'level standard. This must be extremely difi-cult for the broad-minded arts student whohas turn€d to medicine.
At its easiert, this year means studyinS onlyone subject to complete the normal facultlrequirements for direct €ntry lnto the se€ond
year, the student in this aPParently fortunateposition finds himselfwith Plenty of free time
-too much in factl DesPite the two subsidlary
subjects that he must Pursle, he can easily
become academicall), lazy, havinS a workingweek of only twelve comPulsorl hours. As a
result, he may well be unable to adjust him-selfto the exacting work required right fromthe b€ginning of the second year. Surely itwould b€ ben€ficial for this student to attend
some ofthe 2nd f'1.8. lectur€s in Anatomy and
PhysioloSy and First Ald if onll to make thesecond year easier and to PreYent him frombecoming mentalll dull
Those pursuing this lst ll.B course are
entirely divorced from the m€dical school as
regards lectures and, aPart from the few who(ake med'cal statistrcs. Gal€nicak Providesthe onl/ contacl with actual medical subjeccs
The material of the course is s0<h that a
student may complete it wlth littleor no more
knowledge of medicine than he had when he
arrived at the University. Surely lt is hiSh
time that this course should be re'examined
in order to make it a real Part of the medical
ANNE MABBITTANd PETER HARDWCKELAINE FLOWER
l9
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.1ttl yu r kur t shotH not ask w antrtr
Tht luitx a lrc lotgi,t.qTL. nt' mmt d l tl , \iL .t
Thtough rtu X|cs; sky lilacAni a t@ a ltkd olits bara.
Dovr htre nr rb liharyAno gn hc ftdidtn\ anl rotu',
tud I,Ji Iaut l?e, thi kofydtO tsid. thk d pti.d tut tity.Btuod o,t vpdtutio a dtelva$ la"rhtet ,' tu yllaw tuatls of H'11.
NOVEMBER 6:t
70
HO'WARD SMITH
To E-S.
she lay thoe, whte, dfry of wrEnb rced 4 ha pair, frsBEdBy to snrll at swolba @s,she held ha* tM E6- I NH
'bt tutu ,
ot tzll het, a &c lay drn,
W,e of a,DiAM oJrynn,Nr ol ny hopkg rlat n w m rwrilx,Itu Hhtui b thdt \td. wl
E6ily &d izht uadd Md'iM.
POEM
a dd*erfu hedse of spikq adesqwhosh ro a ald tdaial fnat d tuthle$ 6tu in a flM shtuakigar uksifuof.1 1tlB st yud behw tfu slw mw of ttu thtuk rtut.hild that I@ d.i6 ledw tu n"clack n the hm oJ&z tydmItatle a *e satud drheLacI a the waalfu *c mrslovry chiflrg its pdl ifto the sndi'i"g skl
ALIN R()I'TII
POEMS
POEM
SMiIAottl4n @16
w h*li 6,ui& tuL
Specda n& n rchody.
JILL GR,EENATWAY
2t
BIOCHEMISIRY ANDMEDICAT STUDENTS
It is no great wonder that both students and
staffshould be dissatisfied with the traininS ofmedical students in the preclinical subjects,
and lfon€ side ofthis view is to be recorded, I
would like to pr€face my r€marks by: state-
ment of intent. At pres€nt Ph/siology,Anatomy and Biochemistry form the structureof a hard-worked five term course. These
subiects must be unshakeably rooted in Purelyscientific ground. They serve as a d€scriPtionol the nomal condition of man. Afrer 2nd
M.B. a scudent translates to the territory ofapplled scienc€-m€dicine. This should clearlyperluade thos€ who make PUerlle complaintsaboui the fact ihat fundam€ntal Blochemistrydoes not sufiiclently reveal lts importance and
slSnlficanc€ to m€dlcine, to make the mentalefforr ro adlust thelr vlslons and Intellects toreceive th€ benefits of lJnivertlty teachinS
We have been comp€lled for too long, toquote Slr Llndor Brown, "to extrude from ourcare half-baked, lll-tralned men who are
nelther sclentlsts to pracllse the sclence ofmedlclne, nor educated tentlemen to Practlselrs art." Thh scientlfic troundwork ln theprecllnlcal sublects ls . matter then of the
Sreatert lmportanc€. We all feel the welghl ofrhe responslbility to equlp Potential doctorswlrh lnformatlon now v.hlch is to serve th€mdependably for the next forty years. Thh task
A Glamorous BabyI and my colleagu€s leach the newest of
these subjects-Bioch€mirtry. lt has theadvantaSe and disadvantage of beinS a Slam-orous bab/. Press coverage of th€ recentNobel Prlze winners. and the wonders ofmole€ular biology tilt the mind of the newstudents into the nrm belief that th€ subjectshould b€ pr€sented in lectures and Practicalclass€s as a giddy, 8llltering cascade of breath-taking scoops. And it isn't like that at all.
Those headlines were made Possibly by thelong. patient acqunition of information over
the years when biochemistry matur€d into a
scientific subject in its olYn ri8ht, and it is thisstory, which has interest and signifi€ance that
There are a number of probl€ms over which
we are conc€rned. The major of these is
communication. We teach to a great vari€tyof classes and to a disparity of intellects withinany class. Whereas the ltudent k chrefly
con.erned in Passing an eiamination, and his
interest ls that the lectur€s should Providesufil€ient fodder offacts which together wi(h a
textbook will enable him to Pals (h€ rrial ouroutlook is l€ss short siShted and directed
nore io und€rstording !he subiect than lea'n-ln8 it, slnce only ln rhis way will che beneflt or
rhe subject accrue co the one-time s(udent
over that subsequ€nt dauntlng forty years
To rhk end a new course mounted chis
year for the nrst tim€, will Provlde the
necessitiet and Po,nt to slSnificant tr€nds
which the future docior mayfind relnforc€able'and ultlmately helPful lo his Patients at a
fl]!ure tlme. Bui on the int€rpretation ofthesewe remain formally sllent Our duty is topresent a coherent Plcture of Present-dayBlochemistry. not to forecart (he clinrcal dlvi-
dend of a sclentlfic facr. This demands of the
sludent a need to droP hk self imPortantpseudo-professlonal attltude to medlclne in
hlr first five terms, a wllllngness to accePt a
cerrain amount of doSmatlc statements in the
lectur€s, whlle still retaining a ldrg€ measure
of independ€nce of mind, in rhe knowledS€
that though much ls known a very great deal
more ls still unknown, and that only by
weighlng scienrlfic evid€nce ln his own mind
against his experlence of Proved theories can
he attempt to adjlst the balance.
Staff-student .elationshiPThough there may be a frrlure o'commun -
cation on our slde over thk matter, one Pointis of cardinal importance: that €ri.ichm by
students of the €ontenl or Presentation of
22
their courres should under no circumsrancesfulmanate around other deparrments, butquickly come back to th€ memb€rs of rhedep:rtment direcrl), concerned. This.riticismmust be well info.med and corre.tly per,spectived-the student who complains of theunintelligibilit/ of a certain lecture and then isfound never to have artended it, is asking fortrouble. That most difiicult ol things-thestaff-student relationship will improve andallow easi€r ex€hang€ of ideas and a mutualcorre.ting of standpoint. Tutorials in thisrespe€t are vital links in the improvement ofthis d€licat€ relationship, and ofl€r an environ-ment in which confid€nce on both sides cangrow with understanding of th€ people in-volved. The nomber of tuioriak, ar presentmarginally adequate musr be considerabtyexpanded in the next lears.
One attitude which h communicated to us,infrequently, by studenrs entering their clini-cal t€ars, is th€ air ofdisparagement cast overthe
'ntelle.tual content of the preclinicat
terms bI their new tea€hers. I hope this is
fictitious, for it hints ai an arrogance and toraljncomprehension of what all rhe pr€clinicatd€partments strive ro do. Weteach, acrossth€divid€ of the second 11.8. examination,different disciplines. Ours is, to repear, a
fundamental approach to pure sciencei theirs avital application of this to the unwell.
And ro to my final point. Though we reachlor a shor( period offive rerms in the Loral ofsix lo seven years of a doctors training, theSroundwork laid here, k so importanr thar itmust be laid well. We exercise our ingenuit/and talents at this end. We ma), sometimesfail, and if we do we should like direcr know-ledge ol this. New vhtas open: for lnstance itis the d€partmentt inrention ro make itpossibl€fora med ical stud€nr to read HonoursBiochemistrl after s€cond 1.1.B. provided h€has subsequentll taken rhe examination inSubsidiary Blochemistry. To those srudentswho find Biochemistry the exciting and stimu-latinS subject it is, the opportunity alwaysexists and is our hlghest object in reachinSand our only r€turn in 'profits', to produce
ProPerlI trained research workerr who canutilise this posr-graduate exp€rien€e toadvance their chosen field of specialisation.
Sir Lindor Brown asks "what hope hav€ we(in five terms) of inculcatinS th€ spirit of€nqoiryr th€ true scienrific attitude of mindthatis needed ifmedicine in this country k norto fall lamentably behind its rivals." I hopethis can be :nswered "yes there is hope".
c.F.P.
PICIGD IT UPA SONC IN TEE
sPtEH{, CAVE 1T ARECONIITIONM XIJC],EIJS
-ANN IT SOES LIKX A
!::!{ '.@ .'.' '.'.
23
BOB BUSH
MALIGNANTFRUSTRATION
Frustrarion is a ghastly awful disease, whichcan strike at any level or a8e in p.esen! dayso€iecy. lc is virtually impossible to d€fine a
normal l€vel of frustration, some inv€stiSatorssaying you can and others saying /ou can\,while rhe remaind€r say that in certain cat€syo! can, but of course in other cases you .an't,depending on che dew-poinr and lors of orherthings which miSht well be going on ar rhetime. We ourselv€s have sifred rhrolghrheaves of evid€nce and have come (nore orless) to the .onclusion that on the whole youcan, bur always b€aring in mind that quire
HistoryNow that wc have 8or a clear picrure of
Frustration in our heads we can proce€d. The<ondicion was flrst described by thar randy oldl4an of f,1€di.ine Harry Wolph, who w:s onceheard ro say in the Eored Room... "Theafilicrion o[ Frusrers is ye mosre unkinde ofall ye afilicrions, and doth corse men to acrein all mann€rr ofdavergencies, and corses themto whistle at l',1aiden s ankles and comelyshinns". The involuntary act of whastling atthe opposite SEX srill remains, a prim:rIf€ature of benign frusration, and is known as
Wolph s whistle !o rhis day.
ChemotherapyThe druS employed for trearmenc k 35-
Hydroxyphenyldood!m'meLhyurare whi.h is
the thirty-fifth derivative of Hydroxlpheny-
BENIGN
AND
74
ldood!m-methyuric acid (lmperial Em€ti.slndustries). The subsrance has been shewn robe of very little use, although it has causedrats to'throw-up'and eases miSraine in toads.22.000 rats were saoificed in the .ourse oftheexperiments and all were shewn to rhrow-upat the mere mention of the word hydroxy-phenyldoodum-merhyurare. Toads were ad-
ministered v/ith the compo!nd and thenhurled with ample force at shollder heightupon lhe last remaining rat, rendering thelatter unconcious. All the toads complainedbitterll of severe headache on completion ofthis procedure. The effects of rhe drug uponrhe hormone excretion of parient5 v/ich Erg\syndrome hev€ not yet been investig3red.
Case HistoriesItlr. P. came to our clinic complaining of
sporadic attacks. Every morninS whilst travel-ing on rhe Tube he woold deveiop a Playrex
advertisement fixation. When the fixationoc.urred he would either be decending oponthe down-escalxtor or ascending upon theup-escalator and would have to furiously markrime by runninS up the down-es.alator ordown the up-es.alator, as rhe .ase may be.
"The porte.s are beginning ro norice ' he s:id,"and anyway I keep missing my trains-" lr wa5
obvious rhat the man had an :dvanced form of
l,liss O. came to our Rooms in a severelyaSitated frame of mind. I keep getrang thesefrightful Urges doctor", when questioned a5
to rhe precise nature of these urges her nosequivered and she wa5 unable to speak. Ongiving her a glass of Ovuletine she regained
Typical facies in Frustration.l. Sir,;'qle Frustrotion
Z. Mani. Frustration
3. Cel i bati c F r ustrotion4. Extremely molignant Ftustt.tion5. Bizafte Frustrotion
6. I
her dem€anour and the entire truth came
out. . . Whilst she had been on holiday inMinorca sh€ had allow€d her best friends'poodle to ravlsh her, she was concernedabout the possible sequelae. We were able toreassure her on this point, but the generaldepleted state was one of f'lalignant
LIkt O.
Both patients improved markedly on initialadministration ofthe aforementioned drug, ineach case the libido was evidently depressed.l'4r. P. was shewn innum€rable copies ofEverywoman and Boy's Own, non€ of whichinduced an), rerponse. f4iss O. wis able tovisit Crufts and remained completely stablethroughout the proceedings. Even in thepresence of Bull Mustafrs she was onmoved!It must be mentioned however. that at thisjuncture I'lr. P. contracted a severe bout ofmumps which confused rhe Gsue somewhat.The great drawback of Hydroxyphenyl-doodum-methyurat€ is of co!rse .he throw-in8-up'. The inv€stigators w€re continuallydodginS and avoiding the !nexpected frontalassault, this made the €xperimeni exceedinSlyhazardous and many fell by the way-side.Mr. P. and fliss O. became socially unaccept-able and ev€ntuall), f€ll passionat€l), in lovewith each other. We went to their weddingit was all very gratifyinS.
D.R,G,H.G.S.
,;{, . , _.,.,-..t.l-- :a'-,--.'t.- .tr,:,l:.. E--r'
26
TheBiblicalGodRecently theologians and philosophers havelpeculated and conclud€d that the BiblicalGod k out ofdate and that His lmage most go.
The Bible also has.ome in for severecritisism in the term'nology
't employs
concerning God. The criti<s concluding lhatwhile God and His Book are inter€sring,they should not be tak€n too seriously andperhaps delegat€d to som€ Museum alongwith other relics of antiquity. Those stillbelieving being 'not quite with it' are advisedby these MODERN theoloSians to take theirplaces in the l'4useum and for ever hold their
May I, as on€ disagreeing with them and'not quite with it'offer an apoloSy for myfaith in God and Holy Scriprure. I ofer ithoping ),ou won't squirm too mu.h if I quotefrom the source of the controversy; a thingwhi.h theologians do not indulge in too often.
The Scripture makes it plain from thestart that asking questions abour God is
'Can a nan by wisdon frnd out God'asks one oI lsrael's ancient sages. Zophar theNaamathite asks the patriarcfi lob the same
'Con thou hy seotching fnd out the alnighty'Both Solomon ind .lob's tormentor receive
an answer to their question in the ApostlePaulk letter to the Corinthian Assembly,
'God will btirg to nothinE the undetstondingof the prudent \lhere is the wisel Whe.e is thesctibel Wherc is the disputet of the vlorld1Hos not God node foolish the wisdo of thewotldl for "The wotld by wisdon knew notGod" '
No ExplanationAt th€ threshold of our study we have tofacethefactthatthescripturesdo not setouttoprov€, discuss, orexplain the exisrence ofGod.
This fact is assumed from Genesis onward.The idea of God is left as an Axiom. Humanlogic and th€ Hum:n mind are quite inad€quateto deal with the problem and if we attempt toask questions about the nature ofGod wewillend up as confused as th€ modern theologian.Their confusion would be tolerable were itrestricted to themselves, bur they procl:imtheir insiSht abroad to the confounding of
One ofthe greatest difiiculties th€ moderntheologians find in Soipture is when God is
pictured as a man who G very bad tempered!(especially in the Hebrew) and liv€s inHeaven on a throne. This the), find an almostinsurmountable problem.
When scripture speaks of God in thismanner it is usanS the ngure called Anthro-PomorPhism or condescension.
ln fact scripture must refer to God in rhiswiy because if He is to be known, he must
This figurative languaSe is used in many
To the invisible God are ascribed hands,arms, €yes, nostrils mouth and feet (and toes?)
To God. who'is not a man that he shouldrepent', is ascribed a whole r:nge of humanfeelinss repentan.e, sorrow, jealousy, joy,zeal, pitl and anger.
We read of God instituting enquaries:sthough he would learn, of forSetting, of beang
reminded, of laughing and even hissinSlWe see Him sitting on a throne and dwell-
in8 in a sanctuary-hence the old man in
God is associated with time, with battle,with buildanSs, wirh inheriranc€, with wfirinSand €lothin8.
Not onl), are we asked to pictur€ God as aman with Human f€elin8s, but also as a lion,a lamb, and a dove, and at the same timeroaring and bellowing.
Th€ usage of ngurative language of thisnature is absolutely necessary, when a Godwho cannot be found by wisdom revealsHimself to lYan. Because God is beyondreason and loSi€ then he.an only b€ revealedby cond€scending into the human realm.
How .an Human reason that cannot evenhold the elusive atom or find the distanrgalaxyor di8 into th€ un€onscious be expectedto understand the nature of the Deity wh€nfaced with it in scripture. lt is not Divinelimitation that forces figurative languaSe onthe inspjred writers, but rather an acknow-ledgement of the limits ol the Human under-standing. This point cannot be str€ssed toomuch, ir is cenrral to all correct thought on
lf s€ripture only expressed God in theconcrete t€rms listed above then the theolo-gians might have an ex<use for their bewalder-ment. But this is not so.
Scriptore mak€s it clear that the God itdeals with is far removed from the ngures inwhich He condescends.
'No mon hos seen God at ony tine''The invisible God''lmnottol invisible''Dwelling in the light whi.h no man .an
'Grcot is the mystety of Godliness''God |9os the Log6'lf the above quotes do not latisfy the
critics taunt that God is still an old man inh€aven, then perhaps the apostle John willsilence them. He merely said:
"God is Spirit"and there the matter must rest, let the criticof th€ S€riptural God first describ€ spiritbefore he proceeds further.
The fact that God is unapproachable byreason or any othe. means makes it imper-ative that God condescends to the humanestate, if we are ever to know anything ofhim.
We are shut up to revelation and knownothing, absolutel), nothing, apart from thatone source. Scripture reveak all that we can
27
apprehend of the infinite and eternal God.Surely that is sufiicienti Even if it is in human
language, metaph),slcs may well be left alone.
So far as the nature and ittribltes of Godare concerned we muit remember that thewhole of lanSuage ls symbollc and that lnevery utterance concernlng God the revela-tlon ls llmlred by the necesslty of uslng
human forms of thoughc.
The MediatorAn llhrttration of thk may be drawn from
the well known propertles of'radlo waver',Throuth every room and house radlo wavesare passlng contlnually, sllent, lnvhlble,lncomprehenslble. The occupantr are entlrelyobllvlous of thelr pr€sence, and unmoved bytheir messaSe.
The human ear responds to the soundwaves in the alr. but needs the mediation ofthe wlreless r€celverto translate the ethereal.waves of which it is quite unconscious intosound which it can det€ct.
ln everyday lanSuage we may say that weheard a lecturer speaking over the radio butin reality we have only heard the wavesinterpreted by the rec€iver into sound.
ln the same wa), Scripture speaks of Godkface, yoice and hands, but this is only theinte.p.etatlon of unseen splrltual equival€ntsthat have no counterpart in Human exp€rienc€.
Apart from this condescension the spiritualrealities behlnd would remain for ever
Scrlprure is llk€ th€ receiver and lusr as
the human ear cannot tune to €lectronlcradlatlon so human logic cannot approachthe infinlte God wichout a recelver.
That human logic ls lnadeqoate to dealwlth the problem of God was made clearlont before the theolotlans 8ot mlxed 0p lnri!
The Hebrew DilemmaThe way Moses uses the Hebrew word for
God in the first chapt€r of Genesis dlsposesof an), theory that scrlpture reveals a Godlimlted to human reason-
The Hebrew word for God is ELOHIMthls h a pluralform, the endinS 'lM' occurringln other words such as CHERUB,TV. Althoughthe word is plural and should naturall), take aplural verb, we nevertheless find in a numberof occurrences that the verb is Lrsed in thesingular.
ln Genesls l.l we read
'ln the beginning God ueoted heoven ond eotth' .
ln thls verse the Hebrew verb for created, is
BARA; lc h the 3rd person masculine dng.perf€ct of the verb.
Later down the chapcer v/e come across
"And 6od satd (3rd p€r, masc, sJnS) 'Let ur,noke-(,trst per, piu.ol)mon tnou lnoge"'
The ldea that God took counsel wlth anSels
or rec€ived assirtance from any creature js
repudiated by many scrlptures.So henc€ we have the paradox ln one
chaprer concerninS such a fundam€ntal matteras the nature of God, a problem anvolving theuse of !ingular and pluralverbs.
We should not expect that Moses woulduse any words that wer€ misleading on such
a vital subject. He evidendy seeks to demon-strate the fact that God cannot be properl)/expressed wirh human lnnSuage. At the verystart ofs<ripture we are warned that there is
no polsible way of understandinS the natureof God in terms of human losic.
It seems that the theologlans have n€vereven started readlng rh€ divine r€cord.Had they only read Genesis I th€n they wouldnever have produced the pitiful tripe thatflows so eloquently from their pens.
Ruler of Grammar arise out of the Natureof thlngs. gecalre man ls male and female
we ne€d the pronouns He and She, Because
we sometlmes speak of man ln the dngularand plural we haye he and the),. But God dldnot arlse our of the nature of thlngs; lhat ls
why even the name of God In lhe Hebrew is
fraughr wi!h grammatlcal difrlcultles,
lAmThe hopelesrness of the human mind
28
approaching rhe divine is i utcrared again,nGod s reply ro Moses ar rhe burninS bush.
Moses speaking ot rhe mlssron ro Israet
"When I say the God of you fathers hass€nt ne to you: and they shotl say to mewhat tt. Hit nonet what shal t soy Lo Lhem? 'And cod soid to Moses.
"lAf| THAT lAl'4-sal-tAt1 has seht me',The idea ofa perp€tuat pr€senr, a condition
in y/hich rh€re is neither pasr nor future, malnot be the meaninS that should be attachedto these words. But whatever the truetranslation, the words convey ideas that are asmuch beyond the grasp of the great€stphilosoph€r as the/ wer€ b€),ond the towestEgyptian bondmen.
Christ echoed Jehovah's nam€ when her€plied to the Phartsee.
"Beforc Abrahom wos I on."This statement is not grammatical, ir has no
parallej in human experience and no lustr-fication in human lo8ic. ir is a ltimpr€ of.truth berond our knowledge. tc i! onty whenrhe I Atl 'sreps in condescension, r'hau wemay comprehend the messaSe.
This is why Jehovah adds in hts r€pty roMo'es.
"You shall soy to the .hildren of tsrcet. TheLold God ofYour fothets, the Go,t of Abrahom.the cod of tsoo. ond he God of la.ob has sentne to you. fhis is my non€ fo. rie ofe"Here the absolure I AM-€ondescends ro
human limilations and reveats Hrmsetf asso-ciited wirh a people-,your farhers'and wirha time 'for the a8e'.
When the absolute stoops to the relativewe immediately und€rstand.
While we do not know the I A!1 we knowthe God of Abraham be€ause of His mant-festation in History. We are never asked tospeculat€ over the lAt'1, thar rs bevond usBut we are asked to beti€ve in rhe L;rd cod
It must n€ver b€ forgotren that the God ofScripture is entirell removed from th€realm of tine. To him nor only is a thousand
years a da), but a day a thousand /ears. tt isimpossible for th€ human mind to operare ina realm when rhere i, neirher rime nor space.Theologians who wish ro enrer rhis r€atmmost use a language which is removed fromthe realm of human exp€rience and togic-perhaps that is 'ahat th€/ are doing-andwhy th€lr writinS ls so obscure.
Scripture must be accepted or reject€d.No hilf mdsure here. One must open theBook and accept it:! revelation, or leave jtfor€ver closed. lf on€ does open it one can besur€ that the God depicted is far r€movedfrom the Old Man in the sky of poputarimaginatlon.
The Bible will not allow man to me€t tthalf wa/, he must take tt or leave jt. Therecan be no room for compromise.
MICHAEL DENTON
The M€di@l Protectior Socicty
SY,!EPIOilUITLEGAL IJAZARDS OF MEDICAL AND
DENTAL PRACTICE
Crd,ftd,i Pllor. MrLNls W^[email protected]!,r:
R. c. Tiylor, M^, ;.cx. M!, FRcs. rRc'E.ro6 i! drc Csuaky Dcp.rthdlt
F. I. V. M.ilicld, LDsMishrys in rhc DNtJ Surgcry
Fhtrkis T. Evatrs, MR, r,Rcs, FFrncsAnasfictic Accidcnts
H. A. Constablc, urcs, rrcpxvcq'd.y Problcms of Mcdical protecrior
R. I. Milne, M., M!, Mno, sanisr€.-At-raw].l]c Coroner md thc Docror
DArE. . - TsuisD y, AnrL rsrTrM!,..2,3o ?.M,
PL^CE . . . LEcru$ TrurE, MlDrc^L ScEooLAI Mcdic.l dd Denral Studdrs in theircliniel y€m are welcome.
79
*NIGHT NURSE'O9.45 p.m.-Scene-r4ale l'4edical Wa.d-Statr Nurse in ofic€.Chief Chotoctets : l4r.'f .-zsed gG-lesless-in oxygen tent.
Mr. W.-Bronchial pneumonia-unconscioos, not exPect€d to survivethe niSht
Mr. L.-Coronary thrombosis.Mr. E.-Diabetic-tenile-Mr. P.-Coronary thrombosis-on cardio-rater machine which bleePs wh€n
pulse rate drops.Other patients, more or less routine fi€atm€nts, Plus two extra beds in middle
of ward.
Enter: I Junior, I second-year Nurse.Whisk briskly round giving sleepinS d.u8s-take report from S/N who then depans.
lmmediate bleeps from machin€- false
alarm, patient merely moved ! lunior calls
frantically, "Nurse, come and listen to Mr. W.
-isnt that Cheyn€y-Stokes ?" Agre€ that it is,
but attention drawn to agitated signal fromflr. T., who decides h€ must have a <ommod€immediately. Whilst fet€hin8 commode, h€armore bleeps from cardio-ater machine inother ward: abandon commode and dash toMr. P.---another false alarm-he moved his
arm! Back with <ommode to Mr. T.Enter Sister-whilst telling her about Mr.
W. and his Cheyney-Stok€s, Mr. L. shrieks-sev€re pain in chest-machine bleeps oncemore-dash to rescue, but am Sreeted bycheerful "O.K. Nurse, iust wanted a drink!"l'!r. T. d€cides he is no longer interested in th€commode, but Doctorarrives to s€e coronary,orders Pethadin+machine bleeps-Doctorand Nurserushtot4r. P. again-pu lse dropp€dto lo-Doctor deak with him- the coronaryshrieks again-and still poor Mr. T. is €n-
throned. l''lr. P's puls€ now 20-at last able todethrone I'lr- T.-tfiank goodness for thatl
Ring for S/N. to check druS-machine bleePs
againlBreathe once more, only another drinkof water! l'1r- \/!r'. g€ts worse, still hasn't had
his l0 o'clock feed, time now 12 midniSht!Doctors want cotree-impossible must makeir themselves-hal ha! Mr. T. gets out of his
oxygen tent, and protests loudly when putfirmly back again. Other pitient3 ako protest
loudly because they cannot sleep! Time12.30 a.m--Junior should go to lunch, cannotbe spar€d yet. S/N. comes again, hoping tocheck l2o'clock drugs-machine bleeps again
-pulse has dropped-quick, where's the
Doctor-Mr. W's feed given, perhapr thelast time! Diab€ti! complains he is hot and
sweity-not the onll one! An E.C.G. is beingdone on Mr. P.. and the machine is reset. Takea deep br€ath, interrlpted by yell from a farbed "Nurse,I'vetipped my bottle in th€ bed! 'Can t help for the moment, must sit out in
chair-machine bl€€ping madly- "Sorry, onlyscrat.hinS my l€gl" 1.30 a.m. send lunior tolunch-must change that wet bed-Doctorsstill hopef'rlly looking for coffee-anotherbottl€ want€d-don't you dare upset it,either-Mr. W. worse, must tell Sister. Head
spining, feet of lead-can't stop, more oxygen
n€ed€d, and ice too. Everyone wants tea-musr put kettle on as a gesture-must change
thar bed, patient still wrapped up, in chair.Ma.hine bl€eps, call lights ar€ on-rush toMr. P.-puke has dropped again-anotherE.C.G- m'rst be done-whar about the 2p.m. t-p.r ? 4 a.m. The machlne ble€ps-"Onlygetrin8 a drink, Nurse . Another E.C.G. itdon€, porterfi lk the i€e tank-S/N arrivesandth€ ma<hin€ Soes crazy-instead of movinS
from sideto side the pattern is going from top(o bottom! Doctors rushinS ever/where-can't they sleep either? More druts to Sive-and rr's time !o put the lr8hts on again-patients don't need any awak€nin8, and theb.ight and breezy day statrcom€ bouncin8 on
duty, rsking if we've had a nice quiet niSht!
30
News frornGalenicalsTh€ Booksta t964
Books were priced usin8 the fo owin8criteria; original price, edition, conditionand academi< value. A similar Sradins wasmade for other arti.les. Thus we t.ied roenrure a fair deal to borh buyer and se €r.For the srorag€ and sale we acquired rhe us€of a locked room at rhe Medicat S(hoot. Sin(eso many books had been 'unaccounted for'last year we attempted to enforce maximums€curit),. However we w€.e not entireltsuccessful due to lack of assistance, as bookstotaling {16 were missing. Most of these weare sor.)" to suSgest, were probabl/ removedduring sale.
Th€ accounts of the 1964 Sookstalt w€recomplicated by gross debts and unfinishedbusiness inherited from th€ pr€vious book-stall. The debts amounted to f55. I I . I formissinS books and I40 loan rrom Btack Ba8for purchase of instruments; ters ext€ndedcredit amounting to ft6. t8. 0, a batan<e offl . 7 . l0 and instruments valued ar C24. t5 . 9(ahhough we revalued rhem ar considerabtlles) We allo.evalued lhe missiog books rof42.17.6. Thus the actuat debr befor€commencing sale was {19. 16. L This y€ardespit€ a loss ofbooks amountingtoft6 -4.0we Jinished up with a n€tt profit off4t . t3 . Lwhich leaves us with : balance oI {1.17.7
Because of the incurr€d debt w€ increasedthe profit margin. Nevertheless we assum€that both buyers and sellers were satisfi€d aswe have so far receiv€d no comphints. Thefuture of the bookstall, which has become anaccepted amenity to medical students thanks
1963 Debr
Balan<e
to the efons of Chris Davis and colleagues3 years ago, is now uncerratn. We feel thatthe facilities it has to ofre. would be greattymissed if it were discontinued. However, inthe past the Bookstall has enjoyed only vaguecon nection with eith€r Black Ba8 or Galenicals.Now that it is in a position to starr afreshofrcial recoSnition is d€sirable.
Summart of l95d AccountTotalSellins Pric€ f494 17 7L€ss Books Missins { 16 4 0
f478 t3Total tu/in8 Price {410 6
75
t48 7 2f 6t3 6
{4t t3f 39 t6
8I
{ tt7 7
H. M. MURPHYM. H. ORNSTEIN
R. W. MORZARIA
It has been suggested that this need woutdbe satisfied by incorporation with the UnionEooktall, W€ feel such a merger would bedtastrous: th€ Bookstall should be run bypeopl€ who hav€ experienced preclanicalstudy and are in a position to alsist the newMedics, in th€ choi.€ of books; it is .un at themost convenient rime and place and it makesproyision for the sale of
'nstruments, tab
coats aod skeletons. These facilities theUnion gookrall would not be able to offer.Galenic control has been sugSested though sofar no adion has been taken. Since rhe affairsofthe Bookstall occupy most of the s€ssion, amember of Galenicals Coftmittee could bemade responsible p.eferably a cGopted 3rd.y€ar student. We would be wilting to assistand advise an/one who feels they woutd tik€to continue the venture
3t
PANTOMANIA I964For the connoisseur of hospital pantomim€sthis year provided a bumpercrop.There werethree to choose from, "L€t's Take the RoofOff" :t the Royal lnfirmary, "The Two WayMlrror" at the Dental Hospital, and "OneFine KniSht" at th€ G€nerJ Hospital. Ofcourse, bumper crop doesn't always mean
vintage year, but "Let's Tak€ the R@f off"did provide a most €njo),able eveninS's enter-tainm€nt during it's four niSht run. The stor),ofAladdin was suitabl/ €mbellished with local
and topical references which were sufiicientlyfeYY to r€main funn/.
The script its€lf was lma8lnatlv€ and oftenveryfunny but it was not altoSether d ramatic-ally successfu I since the characcers were rathersk€tchy and the dlalotue a littl€ forced. Theonly character who was funnyfor what he w5s
and noi for what he sald was How.rd Smith's"loseph Greentage". Here there was a Soodopportunlty for fun between the Pantomimecharacrers and the B.R.l. pofter. lt was a Pitythei so manl comlc sltuatlons withio thestory proper should have been lost because
they lacked definition. Thls could hav€ been
dlsSulsed most efectivel), had the productionof scenei been more lmaSinatjve and en€r-
tetic, but too often no (lse was mad€ of move-ment or exprestlon which even the mostsolld scrlpt needs. The more cr€dlt then tothose characters who livened up the proceed-ings, notably Andrew Walker ar WdowTwankey, Anrhony Clarke as the Wick€dUncle, and Ml(ha€l Richards as the Genie ofthe Lamp. Graham Purnell as Aladdln gave asolid performanc€ and the best moment olthe eveninS war undoubtedly bis
'rnconvincingrenderlng of "through all et€.nlty too" inthe wedding song.
The guita. trio of lan Mackenzi€, DouSlas
Sims and Howard Smith provided a livelyinterlud€ and it was a pity that greater use
waln't made ofthis verl efrective team in thechorus songs. Miss Jean Wyn-Jones'colourfulsers and costumes were much enhanc€d bI
the superb lighting of Robin Garnett. lt is tooedy to take this sort of thing for grantedbeeuse, lik€good mak€-up, it's not noticeable.Both 8ener3l lighting and the etrects (DavidGe.ring)w€relirstclass. Peter Curtis deservespraise for his overall direction of a yery
ln "TheTwo Way Mirror" David Lewls was
faced with considerable difiiculty in the shap€
of the Common Room. Although he was able
toconstructamore or less conventional sta8e,
it was a plt/ he did not simplify. The sets forexample, thou8h imatinative proved awkwardto manipulat€ in the confined working space.
The story was a Sood one. The characters vrereboldly drawn and enerSeticall/ played. Thlsshow had the admirable intention of notrel/lnt on d€ntal lok€s for lt's laught butunfortunately fell into the eq!ally dangeroussltoation of playlnS relentlessly to the audlenc€. Thk came ofr well wlth the natural.lown of Marrln Betts' "Soldier" but was toooften the excuse for a general go slow when€mplo)/ed by the less able.
The P.incess and "Prince". Anne Evans and
Martin Ell/att were well cast ar was Llndsay
Owen as Nlnette. Richard Joy as P.l. was su.premely Brltlsh, while Davld Phllllpr' "l'l/re"was a tood characterlz.tlon, John Luclaprovlded some excellent laughs as Griswoldbut it was a pity that he overplayed th€audi€nce. His orlginal music how€v€r, was
the surprise and delltht of the evening, Soodr/thmic numbers, well sung by a vigorouschorus and a hauntinS love them€.
Photogtophs, fton left to ttght
2. The Genies with loseph Gteengoge.
3. /vlembers oftl'e Chorus.
4. (Left to tight) EnPetor Phlooh,
Wishey-Woshey, Ptin.ess, Aladdin,
Emqrcss, Widow fwonkey, Uncle
5. Tfte 6rupe.6. High and Low Ptiests
(Pantononio, 6t. ftud p. t2J
The costumes were pleaiing and Jane
HlSSlnr' mllllnery wa! splendid. Technicallythe lnfluence of Rodne/ Staines was heardand felt to great efrect. This was a good startto a rradition which hai Sreat potentialfor theDenral School and David Lewis is to be coo-
Brarulared for hk eherty ln breaklnt newground agalnst conslderable odd5.
The General Hospltal's offerlnS of "OneFlne Knlghr" thouth not pretendint to be onio complex e rcale as the other two shows was
much more of a fourth form rat. lt had onesuperb momentt when a rtudent nurse. wlthSreat sklll, pushed a custard pie into the face
of a very tallant Dr. Hale, but as thir came atthe end, on€ felt it had been earned. Dr. Halesald that it was a Sood thing that the GeneralHospital was again trying to provlde someChristmas entertalnm€nt and I fully agree,
but preparatlons here wer€ mlnimal and a
weak script sagged between the time worncrutches of crudity and shop humour. I lostcount of how many times the "magic" wordchastity belt was invok€d in the hope of a
laugh. The sound €ffects vrere the brlthtspark of a rather drear eveflin8. lt was thesort of show that the cast thoroughlt
A. E. B. GIDDINGS.
lcot.nkots, .@r. ftun p. 3t )
The B.llThe Annual Ball was h€ld once more at theG..nd Spa Ballroom, on Nov€mber llth. Agreater numb€r of stud€nts w€re presentthan ev€r before as well as members of ouriiafrand d€leSates from other medical schook.Th€re wis a cabaret whose scrlpt wds punctu-ared by the more inebrlated (t!e!r who)membeB ofthe audlence. For some tlme now,It har be€n felt that the Grahd Spa k far toosmall for a Ball of thls slze and h k proposedthar as an exp€rlment lt should be held at theTop Rank Ballroom. Thk wlll be moreexpensive, but there wlll be room for morepeople and the faclllties are much b€tter.Ev€rybody wlll be seated and ltudent! as wellas staff, wlll be able to book table!. Theslccesr of this move will depend on support.It should be possible to make at one of themaior social events of the year.
Meanwhlle prepar€ yolrlelf for the n€xtsource of good food and entertainment, theDinner and Dance on March 23rd at theGrand Hotel.
FRED STAMP
BookReviews
RECENT ADVANCES lN I'lEDlclNE (Bcrumont rndDodds) larh Edition. Editcd bI E on Comprton indDano . tublkh.d ht Chut.hill. 50s,
A hi8hly inforn.tlk r6vi., otmrnt r.ceit.dv.nc€!in rhc th.ort .nd pr..d.. ol M.dlcal 3.lenc.. T.xtmateri.l nng.i from th..rotlc to th. m!nd.n. and,oft.. b.idSint th. t.p b.tw..n th. b.ddd. and th.l.bo..ro.y, wlll b. found ndt r.rd.bl.,
Th. .dlroB h.r. !o....d.d lnrhel..lm rotrodu.e rrorL fo. !h. rener.l m.dial r.ad... akhoueh I imvert .rd to note that they h.v. omhEd a .hipt.r on
It ir to be hoped that thl. v.luable .t.pplnt s!on6ro rhit now ovevh.lmi.s r..lh ol .h. 'louriolosl3fwill sn 6e drabllrhed ln th. medl.al llbrary.
c. T_ a. oavts
34
MEDICAL EMBRYOLOGY. b),1:n trngman.Bailliare, Tinddll & aot. Pti.e t0t.
Thk b@k is divided into two j€dionl the tiBrderling with Sener embrtolosy and the [email protected] with special €mbryoloy, The seaion ongeneEl embryoloSt cov€B 7l pa8$ of rhe lt2 pageb@k. The text ir extremely well laid out and veryre.dible and there are r grea. numbe. ot ve.y ctea.well rnnorited diasrams. The embryonicd€vetopnentis dividcd up into tametog€nisk, fedlizrtion bimplintntion, billmi.ar and rilahiner serm dis6,€mbryonic p€riod and fGtal period; th6e dive6ionralthoush naturilly rrtifi.ial are made in sensiblep€riods oI development rnd aid in the undedandinSolthe srowth oI the emb.yo a.d roerur,
Thc second se.don deils with the dev€lopment olthe bodt systens ind i. €ach secrion rhe no.matdcvelopment k descdbed followe.l by a .lear illusin-don ol the .ommoner congenital rbnormaliris.
Alihough I fe€l the p.ice of rhis book i5 Ftherprohabkivc to the mediol ltudeni I would fonglyr€commend iG r€rdins. Unlike mott texlb@ks onmedicalsubjecB, this book like a good novel isdifii.ultto pur down aat€r onc€ *ahins to .ead it,
D.S.
AN INTRODUCIION TO NEUROSURGERY by
H.i,.Dd"r, 1954. pp ll5.
The speciality ot Neu r6u.gert li.s hore within the..ope of the pst gndu.k rnan rhe lnders.aduare,Nev€dhels, the rise ofnenrcurgery in the pist tewde.!d6 ha .lered 3ome of the pdsimkm whi.h hasunounded theneEorintEcanial disease.
Mr l€melt s l.trcd!.tion to N€urosLrgery'6ve6 the s@pe ot mode.n neurd!.gial practicewith adniEble lucidttt and consciseness.
Otspe.ial interet to rtudents will be rhe chapterson tead injury. The increae in yiolent rccid€nis hrsled to the s€vere h€ad injury becoming a commonprobl€m in management itr all Seneral hospitak. Theadmetrr of the patient, fiat aid art€ntion andmlnagemeN throuth to convalg@nte are all wothwhile readitrS for hospital 5tafi o. 8en€.al pracritioneB.
The chapter on 3tereotaxic surSe.r will inte.estth6e who consider Partinsorism a pur€ly medical
Th. r€xt is well prsented rnd the illus$itions f,ood,B.H.C.
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