Speculum - University of Melbourne

EDITORIAL.RETROSPECTIVE —No. 1.THE PRESENT STATE OF THE MEDICAL SCHOOL.OUR OWN EPIDEMIC.REPORT OF SUB-COMMITTEE RESENATE.CLINICAL LECTURES.MEDICAL SCHOOL SPORTS.MEDICAL STUDENTS' DINNER.ROWING.MEDICAL FOOTBALL NOTES.REPORTS ON CASES.CORRESPONDENCE.NOTES AND QUERIESSPICULA.nlbottitnq:SAMUEL MULLEN, COLLINS STREET EASTRegistered at the General Post Office, Melbourne,

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SPECULUM 3SPECULUMThe Journal of theMELBOURNE MEDICAL STUDENTS' SOCIETYSI SPECULUM PLACET, INSPICEEDITOR :J. A. WEARING SMITHBUSINESS MANAGER :J. WRIGHT-SMITHFirst Published 1884Oldest 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.

4 SPECULUMContents,PageEDITORIAL 5PRESIDENT, M.S.S. 8THE MANAGEMENT OF MASS CASUALTIES K. H. Heard 10AUSTRALIAN JOURNEY Geoffrey Asherson 15HISTORY OF PSYCHOLOGICAL MEDICINE P. de Gail 19TO SMOKE OR NOT TO SMOKE . . . Bryan Gandevia 25ANSWER ALL QUESTIONS—STAPHYLOCOCCUS AUREUS Sydney D. Rubbo 33CORTICAL REPRESENTATION D.D. 41VIEWPOINT ON THE GENERAL PRACTITIONERIN THE BRITISH NATIONAL HEALTH SERVICE E. C. Gawthorn 43A CONCISE DICTIONARY OF MEDICAL KNOWLEDGE "Herbie" 47DIAGNOSTIC QUIZ 53A NEW RUBAIYAT 0., My! 62M.S.S. CHRONICAL 69MEDLEY'S '58 75YEAR NOTES 79SPICULA 91

SPECULUM5EDITORIALA Reflection"After much discussion and deliberationthe name 'SPECULUM' in its widest sensehas been chosen, as it is intended that thisjournal shall reflect the ideas of the Melbournemedical student among his fellows,and some light be thrown on the mind of theoutside public, which we fear has remainedhitherto in total darkness as to his socialcondition and sort of education he has theopportunity of obtaining."Seventy-five years ago the above appearedin the opening paragraph of the first editorial.Today you are reading the onehundred and sixty-fourth editorial within acover which has incorporated a reproductionof the front of that first Speculum.Much has been written in previous yearsand previous anniversary editions ofSpeculum about its cover, its contents, andthe colorful path which it has carved in itstravels down the years. It, therefore, seemsfitting that a reproduction of that very firstcover should appear in the seventy-fifth yearof the journal's publication, the MedicalStudents' Society being founded four yearsprior to this. By contrast, the medical schoolwill be celebrating its centenary in threeyears.Melbourne Medical Students can well beproud of Speculum, for not only is it whollyorganised and produced by students and oneof the few publications issued regularly by asection of the student body, but it is theoldest University student publication inAustralia—having won a race which developedbetween it and the MelbourneUniversity Review (which lasted only fiveissues) by the narrow margin of two days inJuly, 1884.Since that time the cover of Speculum hasbeen altered a significant number of timesas has the number of editions appearing ,nany one year. While two issues of Speculumwere produced in 1884, by 1887 the numberhad increased to four, whereas in latteryears only one issue has been forthcoming.This, in all likelihood, has been broughtabout by an expanding curriculum availingless time for dabbling in production, andalso by the steady rise in cost of production.The journal has, however, been enlarged—the 1884 Speculum measuring as depictedand having twenty pages compared withtoday's dimensions which first appeared in1921 and which has contained an increasingnumber of pages. For the last five yearsthis has been in the vicinity of one hundredpages.Take another glance at the opening paragraph.It states, ". . . that this journal shallreflect the ideas of the Melbourne medical

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SPECULUMstudent among his fellows . . ." In 1884 suchwas the case, the issue being comprisedsolely of students' contributions. Today theemphasis seems to be on articles of a technicalnature submitted mainly by graduates—if this is a fault, then the responsibilityrests wholly with the students. Assumingtalent lies within the body of the Medicalstudents, why has it not been brought to theforefront? Could it be that the burden onthe student has been getting too oppressive,that the seekers and the sort-after havebeen too deeply immersed in the pages oftheir texts, or too deeply immersed in themselves?Speculum today is most versatile in itsscope and should therefore provide thestudents with ample opportunity to writearticles and to express openly their viewsconcerning the society. The so-called"pointedness" of various aspects of themagazine is now traditional and has been sosince attention was first drawn to this factin 1901. Major disciplinary action was takenwith regard to this "pointedness" in 1911,1912, 1921 and 1933. In 1921 a whole issuewas recalled and Speculum has at times beenthreatened with extinction. This has probablybeen a major factor in determining thatSpeculum is now published for private circulationamong members of the MedicalStudents' Society, and it is—to quote againfrom the opening sentence—no longer possiblethat ". . . some light be thrown on themind of the outside public, which we fearhas remained hitherto in total darkness asto his social condition and sort of educationhe has the opportunity of obtaining."Speculum provides for both student andgraduate. The former looks to the journalto read articles on subjects often new to himand for relaxation. The latter probablylooks to it to find out what the students ofthe present day think and do, and, in themain, for relaxation from the cumbrousmatter in his many technical journals.Thus, it seems reasonable that a greaterproportion of Speculum should be studentinspiredand that voluntary contributionshould not be found wanting.Turn back to the front of this Speculum.Look again on the original pale blue coverand reflect on what it stands for still.SI SPECULUM PLACET, INSPICESED SI NON PLACET, MEMENTO QUID SPECTES

8 SPECULUMPRESIDEN T, M. S. S.Professor Sydney Lance Townsend iswelcomed back this year as President of theMedical Students' Society, a position whichhe has accepted on three previous occasionsfrom 1952-54 inclusive.During his medical course ProfessorTownsend was R. and L. Alcock Scholar atTrinity College in 1932, 1933 and 1935 andgraduated M.B., B.S. at the University ofMelbourne in March, 1936, with honoursin Obstetrics and Gynaecology and in Surgery.He played rugby for the Universityand was awarded a 'Blue' for rifle shooting.He held hospital appointments in Bendigo,Melbourne and Tennant Creek aftergraduation and went to London in 1938 andstudied at the British Post-Graduate School,being admitted to Membership of the RoyalCollege of Obstetricians and Gynaecologists,and to the Diploma of Tropical Medicineand Hygiene in June, 1939. He wasappointed a Registrar in the Obstetrical andGynaecological Unit of the West MiddlesexHospital, University of London, and heldthe appointment for a year until his enlistmentas Surgeon-Lieutenant in the RoyalNavy. He served afloat during the evacuationfrom Dunkirk, and in the Mediterraneanstation as a Senior Medical Officer atPort Said. In 1943 he was promotedSurgeon-Lieutenant-Commander and i nJune was transferred to the Far EasternFleet, with headquarters, as Senior MedicalOfficer at Colombo. Professor Townsendreceived the King's Commendation forBravery, and was demobilised in August,1946 with the rank of Surgeon-Commander.He was made a Fellow of the Royal Collegeof Surgeons (Edinburgh) and spent a furtheryear as First Assistant at his old teachinghospital, the West Middlesex, returning toAustralia at the end of 1947.He commenced private practice as Consultantin Obstetrics and Gynaecology andwas appointed Demonstrator in Anatomy inthis University in April, 1948. He was madea Fellow of the Royal Australasian Collegeof Surgeons and a Member of the HonoraryStaff of the Women's Hospital and theAustin Hospital. He was the first appointmentto the newly created Chair of Obstetricsand Gynaecology in December, 1950.In 1951 he was made a Fellow of the RoyalCollege of Obstetricians and Gynaecologists.He received his M.D. in December last yearfor a thesis on "High Blood Pressure andPregnancy".Professor Townsend is married and hasfour children. He spends three weeks eachyear with the Royal Australian Navy andon the recreational side enjoys gardening(done by his wife), and yachting when timepermits, hoping some day that the possessionof his own yacht may be his lot.

SPECULUMSYDNEY LANCE TOWNSEND

10 SPECULUMTHE MANAGEMENTOF MASS CASUALTIESK. H. Heard, M.B., M.R.A.C.P.The advent of thermo-nuclear weaponsand the possibility of their use against citieshas posed problems in medical care ofcasualties that have not previously neededconsideration.It is not intended, in this paper, to considerthe problems which belong to CivilDefence, such as:Organization of rescue squads.Stockpiling of medical equipment.Organization of medical teams andzoning of hospitals.It is of interest to note, however, that ifthe city of Melbourne received a direct hitfrom a megaton type weapon, any worthwhilemedical aid would no longer be possiblefrom our own resources. Sydney andAdelaide would have to come to our rescue.This paper is restricted to a study of theproblem which will confront the individualmedical officer who has the task of dealingwith mass casualties and who is responsiblefor their initial medical treatment and theirevacuation to hospital or a place wheredefinite medical treatment is available.The first and most important task is thatof giving priority to the most suitable cases.The incidence of an overwhelming numberof casualties requiring major surgical treatmentwill prevent every case receiving theoptimal medical care that is given to civilianwith casualties occurring in a civilian popucasualtiesin peace time.Optimal medical care pre-supposes thatthe following requirements are available:1. Sufficiency of medical personnel atall stages of collection, evacuationand treatment.2. Hospital facilities for the medicaland surgical (including pathologyand X-ray) treatment of casualties.3. An orderly and rapid transport systemfor evacuation of casualties.It must be remembered that when dealinglation, as opposed to an army in the field,provision must be made for obstetric careand the treatment of chronic diseases, diabetics,epilepsy, hemiplegia, etc., which areexcluded from army casualties by medicalselection at enlistment.As the above requirements cannot possiblybe met in a disaster of the magnitudethat may occur a new approach to the medicalproblem becomes necessary. This hasbeen called "the Group approach". Itsbasic principles are:1. Life is more important than limb.2. Moribund cases must not occupymore than the minimum time.3. Casualties in good condition will begiven priority of treatment overthose whose condition is deterioratingto such an extent that they willneed extensive resuscitation beforedefinite treatment is possible.This approach needs good judgment onthe part of all medical officers combinedwith a ruthless rejection of cases that neednot be treated immediately.As delayed medical care, and its cost inmortality and morbidity, is not studied inthe normal way it becomes necessary toenquire into this in three ways:1. Elapsed time between wound andtreatment.2. Types of wounds.3. Anatomical sites of injury.

SPECULUM 11Cost of delayed medical care:The majority of those who die of woundsdie shortly after injury. Early and adequatetreatment affects the late mortality muchmore than it does the early mortality.There is practically no difference in thepercentage of wounded who died in the first24 hours in the Crimean War and WorldWar II, and even for 48 hours the differenceis less than 2 per cent. But overall thedifference for wounded in action who diedis 12.5 per cent. 17 per cent. for theCrimean War and 4.5 per cent. for WorldWar II. This 12.5 per cent. represents thegroup which can be saved by early andefficient treatment. In Korea under circumstanceswhich were very favourable forearly treatment but which probably couldnot be duplicated elsewhere, 3.6 per cent.was the total overall mortality for WIA andthe 12.5 per cent. would become 13.4 percent.—an increase of less than 1 per cent.despite an evacuation from R.A.Ps. andmassive and prompt resuscitation and quicksurgery. Abdominal cases were submittedto operation 2.6 hours earlier in Koreathan in World War 11-6.3 hours against8.9 hours (average). Beebe and De Bakeyhave produced a table showing that, assuming3.8 per cent. is the minimum deathrate for those treated adequately within 12hours of wounding, the death rate will onlyrise 100 per cent, for those who have towait five times as long, i.e., 60 hours, fortreatment. Early treatment should reducedeaths from haemorrhage, shock and infectionin all types of wounds. It is universallyadmitted that early control of externalhaemorrhage greatly reduces mortality andthat it must always have first priority.Shock will always be treated as early andas thoroughly as possible. Infection isalways worsened by delayed treatment.Even in civilian practice with presumablyinfection occurs in 6.4 per cent. of softtissue wounds and 14.1 per cent. of cornearlytreatment it is reported that seriouspound fractures; while in burns serious infectionoccurred in 8.1 per cent. of seconddegree and 35.5 per cent. of third degreeburns.In the case of burns this can seldom beprevented by attention to the wounds or byantibiotics. The importance of this is evidentwhen one remembers that in 65 percent. of the casualties in Japan, burns werethe main disability and that 85 per cent. ofthe casualties treated had some degree ofburns. Therefore it appears that delayedtreatment of burns whilst increasing themortality from shock will not greatly influencethe morbidity from infection. Theincidence of gas-gangrene will increase boththe mortality and the need for urgent surgery.In Korea the incidence was 0.08 percent. and the mortality nil at one forwardhospital. In World War I at one hospitalwhere there was a delay of up to 48 hours inreceiving wounded, the incidence was 5 percent., and of these 5 per cent., 27.6 per cent.died.1. Central Nervous SystemIn World War II the following statementwas made: "Contrary to previousobservations, in the recent war the ageof the wound at the time of operation,up to 48-70 hours, made little differencein the incidence of infection orthe mortality. Therefore, criteriaother than the time-lag from woundingare more properly used to determinepriority for surgery during this period,providing the patient is receiving adequatesupportive treatment and chemotherapy."H. Thoracic WoundsOpen wounds limited to the thorax requireformal thoracotomy. Open chestwounds must be closed; pneumothorax andhaemothorax must be treated by aspiration,not by tube drainage. Tracheotomy maybe required. The haemothorax is probablynever completely cleared by treatment sothat immediate treatment will probably notinfluence greatly the incidence of empyema.The difference in mortality will be in thetreatment of mechanical defects and bloodloss. The institution of this type of treatmentearly will save many lives—delay over12 hours may quadruple the mortality rate.III. Abdominal InjuriesEssentially all of these require laparotomyand rapid treatment in Korea reducedthe mortality from about 23 per cent. inWorld 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 SPECULUMReoearch . . .". . . . to merit and preserve theconfidence of the best elementin the medical and pharmaceuticalprofessions . . . . to buildwell, to last."It was in these words that, over 90 years ago, thefounders of the House of Parke-Davis expressed theirpolicy for the future.To meet these self-imposed and exacting demands,research has been a constant feature of the Company'sactivities. Over the years many contributions to Medicinehave resulted: vegetable drugs such as CascaraSagrada; glandular products, including Adrenalin, Pituitrin,Pitocin, Pitressin, Antuitrin "S" and Eschatin; vitaminpreparations; and many synthetic chemicals suchas Dilantin. Recent achievements include the antihistamines,Benadryl and Ambodryl, and the first syntheticantibiotic, Chloromycetin.Today, backed by a research programme more extensivethan ever before, Parke-Davis offer the medical professionproducts worthy of their symbol, "MedicamentaVera"—truth in medicine.PARKE, DAVIS & CO., LTD.(Inc. U.S.A.)BOX 4198, SYDNEY

SPECULUM 13Earlier and more generous use of blood.Quick pick-up and evacuation.Operating time in Korea averaged 2.4hours for abdominal wounds and 2.3 hoursfor thoraco-abdominal wounds. In the first24 hours these cases received on an averageover 3 litres of blood. Thus it is obviousthat with mass casualties these cases willconsume far more man hours in treatmentthan their incidence (6-9 per cent. of allwounds) warrants.The patient who is in good conditionwithout resuscitation will take priority.Those vomiting from radiation sickness willbe of a much lower priority.IV. Orthopaedic InjuriesThe increased hazard of infection followingdelayed debridement has been discussed.The case fatality rate might not be greatlyincreased by delay but the rate for traumaticamputations doubtlessly would increasesharply.V. Vascular InjuriesThe amputation rate following ligation ofperipheral arteries in World War II was 48per cent. Primary repair within 12 hoursof injury in Korea reduced the amputationrate to 7 per cent. and the incidence of gasgangrene to 1 per cent. It was also foundin Korea that repair could often be achievedas late as 24 hours after wounding.In mass casualties saving of life must takeprecedence over saving limbs and ligationwill probably be the only early treatment.VI. Facio-Maxillary InjuriesStandard practice includes not only debridementbut primary repair of thesewounds. Since only the more seriouslyinjured are admitted few patients could bemanaged under local anaesthesia; manywould require endotracheal anaesthesia andmany would also require tracheotomy.Primary repair after 24 hours would hardlyprove feasible. One surgical team couldnot handle more than 10 cases per day.VII. BurnsSince these patients can seldom have debridementdone early, since antibiotics donot prevent infection in undebrided wounds,since all of these wounds will be contaminatedat the time of admission, early treat-ment will not materially affect the incidenceof infection. Is early treatment necessary?Ziffren, speaking of the treatment of burnsin civilian practice, says: "In no instance inthis group of cases did a patient survivewho had 45 per cent. or more of the bodysurface burned to a third degree depth. Immediatedebridement under anaesthesia hadno effect on the mortality rate, and neitherdid the early administration of antibiotics."In view of this common experience, thelowering of the mortality during the acutestage must have resulted from the support ofthe blood volume. Since the loss of bloodand plasma is progressive and cannot becontrolled, what will be the cost of delayedtherapy?Burns of 40 per cent. or more will nearlyall die despite prompt therapy. Burns of20-40 per cent. will frequently produce asevere depletion of blood volume, shockand death unless given early treatmentwhich will save many of them—withoutearly treatment many of them will die.Shock is responsible for 80 per cent. of thedeaths from burns and as 35 per cent. ofthe patients will be in the 20-40 per cent. ofsurface area burned delayed treatment willincrease the over-all mortality by at least15-20 per cent. The staff and suppliesneeded to treat these cases is enormous.Add to this the phenomenon of "CrossStress"—the synergism resulting when acasualty suffers from both burns and radiation.This apparently commences when thedose of radiation exceeds 100 r. Taplinestimated that the mortality rate for 10 percent. second or third degree burns increasesfrom 5-10 per cent. to 15-20 per cent. ifcombined with a radiation dose of 100-250r.As the treatment for both burns andradiation sickness is blood transfusion itmust be remembered that repeated transfusionsfrom different donors may createmore hazard from the risk of serum hepatitisthan that from the original radiation exposure.In the Hiroshima incident when no realmedical care was available for some days,most cases that survived long enough to betreated were relatively superficial flesh burnsof directly exposed surfaces plus burns

14 SPECULUMfrom charring and ignition of clothing. Themore serious burns died before rescue.SUMMARYThe early increase in mortality with delayin treatment will be due primarily to delaysin correction of blood volume deficits andmechanical defects; increased morbidity willbe due primarily to increased infection,increased destruction of tissue, and delays insecondary wound closure.In order to give precedence to life overlimb and to provide the greatest care for thegreatest number, priority of supplies andmedical 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 penetratingchest wounds and, when possible, repairof penetrating abdominal wounds.A mathematician named SputzHad a formula for smoking old butz,The cube root of their weightPlus tobacco less eight,Was a third of a twelfth of . . . oh Nutz.—Speculum, New York."Medmak"Speculum is very happy to welcome theMakere Medical Students' Society and theirmagazine "Medmak" to the ever-increasinggroup of student exchange journals.Makere Medical School is at Kampala,Uganda, and at the time of publication oftheir first issue of "Medmak" had eightythreemedical students. It is indeed inspiringto see such an enthusiastic group ofstudents produce a magazine worthy ofmuch merit. Articles included are by bothstaff and students on historical, technical,and non-technical subjects.Owing to the burden of financial difficulties,which accompany every studentsociety's aspirations, "Medmak" does not,as yet, contain photographs or illustrations,but its editorial staff trust that these inclusionsmight be attained in their next issue.We look forward to receiving futureexchange copies from our new brother.* * *The turtle lives twat plated decksWhich practically conceal its sex.I think it's clever of the turtleIn such a fix to be so fertile.MEDICAL AGENTSFEDERAL SECRETARIAT PTY. LTD.(B. A. CUSACK)M.L.C. BUILDINGS, 303 COLLINS ST.. MELBOURNE• Practices Transferred• Partnerships Arranged• Assistantships Organised• Locum Tenens ProvidedPHONES: 61 2107 — AFTER HOURS : FX 366862 5498Managing 2irector —B. A. CUSACK

SPECULUM 15AUSTRALIAN JOURNEYGeoffrey Asherson, M.A., B.M., M.R.C.P., (London)British Memorial Fellow to the Clinical Research Unit of the Walter and Eliza Hall Instituteof Medical Research and the Royce Melbourne Hospital, 1958 - 1959Going to Australia is quite an adventure.I travelled as a ship's surgeon on the SydneyStar, a large cargo ship with extensive refrigerationspace. Most of the crew wereunder 26 years of age and were undertakingeight years in the Merchant Marine as analternative to National Service. They neverreported sick without good reason. It istraditional that sea-faring men drink freelyand I saw one man with alcoholic pancreatitisand another with delirium tremens.In my journey from England to Australiawe visited South Africa and New Zealand,and I was impressed by the changingmedical scene, modified by climate, habitsand race. Thus, at Durban I visited theKing Edward VII Hospital which is thenative teaching hospital. Professor Adamswas conducting a statistical trial on theeffect of chlorpromazine on the prognosisof tetanus. Despite favourable clinical impressionshe was unable to demonstrate areduction in mortality. In the nativesamoebic dysentery may take a very severeform resembling fulminating ulcerativecolitis and may even progress to perforationof the colon. Recently liver biopsy at thishospital has shown that acute amoebichepatitis is not really a distinct entity but isdue to the formation of many small abscesses.Heart failure of unknown cause isfrequently encountered among the nativesand is called "nutritional myocarditis" althoughit does not respond to dietary measures.Tuberculosis in all its forms is veryCommon and I saw several patients withtuberculous pericardial and peritoneal effusions.The native Bantu mothers usually breast-feed their children up to the age of twoyears. The children then receive a dietadequate in carbohydrates but deficient inprotein. The disease kwashiorkor isattributed to this imbalance. It is characterizedby irritability, diarrhoea, protuberantabdomen, skin lesions with both hyperpigmentationand depigmentation, and hairchanges with loss of the typical Bantu curlinessand pigmentation. The liver is usuallyenlarged and there is pancreatic damagewhich may lead to steatorrhoea. In adultscirrhosis and primary carcinoma of the liverare common Curiously, iron deficiencyanaemia is rarely seen among the Bantu.The factors involved have not been defined.Sickle cell anaemia which is common in themalarious areas of Equatorial Africa, doesnot occur among the Bantu. Coronarythrombosis is rare.It is a curious and unexplained fact thatdisseminated sclerosis is uncommon amongthe white people in South Africa, althoughit is one of the more common neurologicaldiseases in England and Holland and has afamilial incidence.Reaching Auckland, New Zealand, Ifound a copy of Laudor Brunton's Lecturesin Pharmacology in which he describes howhe discovered, while a resident at an Edinburghhospital, the value of amyl nitrite inangina pectoris. I visited Rotorua and sawa unique landscape of geysers, volcanoesand bubbling mud. The ornamental fountainsin the town were played by naturalsteam and there was a pool of boiling waterin the public park.And thence to Australia where I was toserve my Fellowship. Modern hospitals are

16SPECULUMthe pride of Australia. Whereas in Englandmost of the hospitals were built in the lastcentury, some of the provincial hospitalseven being housed in modified "workhouses",in Australia most hospital buildingis recent and reflects the achitecturalrequirements of modern medicine. Althoughthere is considerable hospital construction inAustralia today there has been little hospitalbuilding in England over the last 20years. Despite the general feeling that thereis a shortage of hospital beds in Melbourne,in point of fact the number of hospital bedsproportional to the demands is higher thanin England, and the surgical waiting lists arefar shorter.It is paradoxical that, in spite of thegreater social stratification in England,English patients are far more willing toenter a public ward than Australians. To alarge extent this is financially determined asthere is no government-aided medical insurancein England for private patients; butit also reflects the difficulty in obtainingadequate resident nursing and medical stafffor private hospitals.ANGUS & ROBERTSON7 LTD.have avery large range ofMEDICAL AND DENTAL BOOKS 4 ,in their7 Medical Book Department 4 ,on the First Floor7at 4 ,66-68 ELIZABETH STREET,MELBOURNE.Phone: MF 64664,4,7„4,Although there are few diseases peculiarto Australia, the pattern of disease differsfrom that in England mainly for socialreasons.Disease due to alcohol is prominent inAustralian medicine. Bleeding oesophagealvarices are a more common cause ofhaematemesis than in England. Pancreatitisis decidedly rare in England: in Australia,where about half the cases are due toalcohol, it is possible to see all gradationsbetween classical severe acute pancreatitisand attacks so mild that they can only bediagnosed presumptively by their resemblanceto previous attacks when the serumamylase was raised. Alcoholic dementia isuncommon in England and alcoholism is aminor factor in mental hospital admissions.The diagnosis of haemochromatosis ismore common in Australia than in England.This is apparently not due entirely to theease with which the disease can be diagnosedby liver biopsy. Tuberculosis is lesscommon than in England and the classicalscar of the patient with tuberculous cervicalglands is rarely seen.The distinctive contributions of the ClinicalResearch Unit with which I was closelyassociated lie firstly in the extensive use ofgastric, hepatic and renal biopsy which isestablishing the natural history of thediseases of these organs, and secondly in theinterest in auto-immune disease, that is tosay, disease in which the immunologicaldefence mechanisms of the body are turnedagainst itself. Perhaps the major problemof modern medicine is the precise role ofRESEARCHAND THE MEDICAL PROFESSIONThe original British isolation ofvitamin Br, was achieved in 1948 byE. Lester Smith working in theGlaxo Research Laboratories. Sincethat date it has been available to themedical profession as Cytamen forparenteral use and Cytacon for oraladministrationCYTAMEN INJECTIONSin five potencies.CYTACONLiquid and Tablets

SPECULUM17immunological disorders as a cause ofdisease. Systemic lupus erythematosus,rheumatic fever, rheumatoid arthritis, certainchronic forms of renal and hepaticdisease, ulcerative colitis and sarcoid aresome of the diseases for which an immunologicalbasis has been suggested and clarificationis urgently required. In this field,where clinical observation and laboratoryinvestigation are most valuable, the combinationof a clinical unit with an academicresearch unit facilitates progress.Already, in 1957, D. C. Gajdusek, workingat the Walter and Eliza Hall Institute,had demonstrated the occurrence of complementfixing antibodies against humantissues in the serum of patients with systemiclupus erythematosus. As it was known thatthe haematological manifestations of lupus,such as anaemia and thrombocytopenia,were often due to circulating antibodies, thefinding of antibodies against human parenchymalorgans strengthened the view thatall the manifestations of lupus were autoimmunein nature. It has been shown thatthese antibodies were active not only againstnuclei but also against cytoplasmic cell constituents.As long ago as 1952 it was known thatthe serum complement was depressed inlupus and this was attributed to the bindingof complement by in vivo complement fixingantibody antigen reactions. At that timethere was no independent evidence for theexistence of such antibodies. It has beenpossible to confirm this observation and todemonstrate complement fixing antibodiesin most patients with systemic lupuserythematosus who have a low serum complement.The last distinctive feature of the ClinicalResearch Unit is the Friday morning postgraduateteaching "round". The cases arepresented in a definite manner and to enabletheir essential features to be readily graspedthe significant positive clinical and laboratoryfeatures are written on the blackboard.No case is ever presented in the absence ofthe patient. Discussion is orientated aroundsome special aspect of the patient and thistype of discussion has often producedvaluable ideas.Clinical instruction of students at theRoyal Melbourne Hospital is very similarto that in England, but perhaps less is madeof the heuristic method and of askingstudents to elicit physical signs at the bedside.There is also less emphasis on theimportance of knowing about conditionswhich, although rare, are amenable to treatment.Undergraduate teaching sessions arelonger than in England despite the fact thatfor most students the law of diminishingreturns is apparent after the first hour.An important difference in emphasisarises from the fact that in country areas inAustralia the general practitioner is expectedto be competent in both medicineand surgery. The teaching hospitals recognizethis in the good facilities for operativesurgery given to their residents and in theinstitution of rotating internships. The goodprospects in general practice lessen the competitionfor teaching hospital appointments.All medical students at Oxford and Cambridgeand some of the students at the othermedical schools in England obtain a sciencedegree before proceeding with the clinicalpart of the medical course. Few students inAustralia follow this approach, which isvaluable and provides most of the peoplewho will later undertake clinical andlaboratory research.These reflections on Australian medicinelead me to consider the value of travellingin medical education. At the beginningof the century doctors travelled to Germanyand Austria to gain experience, but sincethe First World War the centre of activityhas moved to English-speaking countries. Inthe medical specialities doctors visit centresto learn special techniques such as gastroscopy,which can only be acquired under thepersonal instruction of a senior man, and tosee at first hand the techniques and approachesof the various leaders in their field.The relative freedom accorded to the travellingfellow enables him to discover his trueclinical and research interests and capacities,and this freedom is most valuable near thebeginning of his professional career.For my wife and myself, our visit toAustralia has been enjoyable, fruitful andmemorable, and I would be ungrateful if Idid not record my most sincere appreciationof the British Memorial Foundation whomade my visit to Australia possible, and ofthe members of the Walter and Eliza HallInstitute and the Clinical Research Unit ofthe Royal Melbourne Hospital who haveintroduced me to the Australian way of life.

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SPECULUM 19HISTORY OFPSYCHOLOGICAL MEDICINEP. as GailThroughout the history of medicine andsurgery, especially since the 17th century,the steady advance has, as often as not, beendue to discoveries in the physical sciences.This is not true of psychiatry. Psychologicalmedicine, dealing as it does withhuman emotions, ideas, and, very importantly,human goals, has been related muchmore closely to the history of magic,religion, and superstition.The result is an intimate connection withthe history of society as a whole. The importantthing to realise is that the way inwhich mentally ill people are regarded inany culture, i.e., the definition of psychosis,depends on what the rest of society at thattime calls normal, and not on absolutecriteria, as in organic disease.Psychological medicine originally had amuch broader scope than today. Until the18th century, when the great organic discoverieswere made, large numbers ofdiseases were thought to have mental oreven supernatural causes. Thus even in1780, William Cullen, the Edinburghphysician, stressed "nervous irritability" or"frayed nerves" as the cause of disease. "Ipropose to comprehend, under the title ofneurosis, all those preternatural affectionsof sense and motion which are withoutpyrexia as part of the primary disease." Heincluded whooping cough, diabetes, tetanus,and hydrophobia.A key idea to grasp is the role of faith.In all ages, to be healed, required faith, andthis implied the acceptance of authority,whether witch-doctor, magician, priest, orphysician. The actual relationship betweenpatient and healer takes many forms inhistory. The common language may bedemons, animal magnetism, Freudianpsychoanalysis, or anything else.Among primitives, both in the past andtoday, and also in the Christian religion,possession by demons loomed large as acause of both mental and physical disease.Sick people were exorcised, i.e., the demonswere driven from the body by variousmethods. Thus the Assyrians sought tofrighten demons away by ghastly images ofthe demons themselves. The North Americanwitch-doctor dressed in animal skins,shouted, raved, and pretended to suck outthe demon with a hollow tube. Amulets,charms, and fetishes were carried as protectionagainst the unseen hordes of devilsall seeking ingress to the body.Early Greek medicine had a profoundpsychological element. Between the TrojanWar and the 9th century B.C., the legendaryAesculapius rose as the god of medicine.Circa 400 B.C., temples to him at Cos, Pergamus,and Epidaurus were devoted todream healing. The patients were supposedto have dreams in which Aesculapius wouldreveal the cure for their diseases. Whitelinen garments were worn as being conduciveto dreams. The patients slept at

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SPECULUM 21night grouped round a statue of the god.Aromatic (? narcotic) smoke pervaded theair. A priest wearing a mask of the god"did a round" during the night, aiding theillusion with ventriloquism.Christ apparently understood well thepsychic nature of many illnesses. The "manof Gerasenes" who had "devils a long time"and had to dwell in tombs "due to persecution"was cured by kind words from Christand this appeared miraculous to the observers.With the rise of Christianity, the prevailingview was that faith in Christ, thedisciples, and the gospels would heal thesick. "Is any sick among you? Let himcall for elders of the Church and let thempray over him . . . the Lord shall raise himup," says the Epistle of St. James. Thusrational therapy implied a lack of faith.Exorcism, laying on of hands, the use ofamulets, all had official sanction. Paintingsand woodcuts from early Christian timesonwards abound with scenes of saints exorcisinglunatics.In the sphere of organic disease, too,prayer was important. There was evenspecificity—the various saints were patronsof parts of the body where they hadsuffered. Thus St. Erasmus had had hisintestines torn out, so he protected againstintestinal disease. St. Agatha had herbreasts chopped off, so patients with pectoralpain invoked her aid.The Church prescribed a routine ofexorcism, and there existed an Order ofExorcists. Faith was the essential featurein these procedures, but despite it, (or perhapsirrespective of it), many stubbornlyremained 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 Renaissancescience began to threaten the impregnabilityof the Church, and therefore lackof faith in all its forms began to be severelypunished. The insane, together withalchemists and heretics of all types, wereregarded as witches and sorcerers, that is,possessed by devils, and the terrible era ofridicule, the rod, the whip, and finally thestake, began in earnest.The German monk Spenger wrote in1485 his book, "Malleus Maleficarum"—the "Hammer of the Witches"—in which heproclaimed that the devil had created madness,therefore the mad were bedevilled,therefore they should be burnt. Torture ofthe insane spread over Europe, and psychologicalmedicine was at its lowest ebb.However, Johan Weyer (1515-1588), aBelgian physician, declared that witch hunterswere madder than many witches by far.In his "De Praestigiis Demonum", witcheswere "deranged or perplexed old womenwho believed in their own fantasies". Hebelieved that they should be in the hands ofdoctors, not in dungeons.Faith could fasten onto other things. Thelaying on of the king's hands was an acceptedbelief. Thus Charles II of England performedthis miracle each year. "I touchyou and God heals you." He would thengive the patient a coin. Gold-seekers wereweeded out beforehand from the truly sick.Mental suggestion plus natural recoveryoften produced cures, while those who remainedsick were told that they lackedfaith. The king couldn't lose.Valentine Greatrakes, an Irish countrysquire, achieved fame for his cures by"stroaking of the hands". He succeeded inpsychosomatic cases, anticipating Mesmerby a century.Throughout this period, there were a few"hospitals" for the insane who dodged thestake, but these simply "kept" the patients,and often exposed them to the ridicule oftourists. Until the 19th century, a tripthrough Europe's first lunatic asylum, BedlamHospital in London, was consideredhilarious.The medical fraternity, even in the 18thcentury, regarded the insane as incurableand insensitive to pain. Philippe Pinel, aParis physician, was prompted to take uppsychiatry in 1780, after a friend went insane,ran into the woods, and was eaten bywolves. When chief physician at theBicetre Hospital in 1793, he unshackled theinsane patients and put them to useful work.He taught that insanity must have organiccauses, and paved the way for the rise ofFrench clinical neurology.The authoritarian relationship betweenhealer and patient was still found in the18th century, but with demons in the decline,due partly to great clinicians likeWillis and Sydenham in the 17th century."Moral Management" was a therapy of1.

22 SPECULUMharsh discipline of behaviour for the patient,combined with fear of the doctor, reinforcedby individual attention. The EnglishParliament passed a bill authorizing thecourt physicians to scourge the lunatic KingGeorge III. When this failed, FrancisWillis treated his insanity by Moral Managementwith success.An interesting mass phenomenon of the18th. century was mesmerism. So far wehave considered the psychotic, whereas then,as now, psychoneurotics formed the majorityof mentally ill patients. (Thus in 1733,Cheyne wrote of "The English Disease", adisorder stemming from luxury, "withatrocious and frightful symptoms" . . .obviously psychoneurotic in origin. And in1764, Whytt, under "diseases commonlycalled nervous" referred to "flatulent, spasmodic,hypochondriac, or hysteric cases.")Franz Anton Mesmer arrived in Paris in1778. He taught that "animal magnetism"pervades all things, and that its proper flowwas essential to health. He claimed to setright the unbalanced flow in sick people,and he achieved some remarkable cures.Lavoisier and the French Academy debunkedhim, and he passed into obscurity,but mesmerism's influence persisted.It is interesting to note that, whereasfailure to be cured (i.e., lack of faith) hadbeen in the past followed by punishment ofthe patient, in the case of Mesmer and hisfollowers, it fell on the doctor. Today, inWestern society, the mentally ill patient andthe psychiatrist are considered equallyqueer, and feature as an odd duet in manyjokes.There is still, today, a large element offaith in psychotherapy. One of SigmundFreud's greatest contributions was the"transference", or the relationship betweendoctor and patient. His successors, thepsychoanalysts, have studied this in detail,and it cannot be denied that there arereligious elements in the psychoanalyticrelationship. By suggestion, the patient isconverted to the same way of thinking, andfaith plays a large part in the cure, eventhough the language used is in terms of repressionof infantile sexual urges, etc.So we have had dreams, demons, moralsuasion, animal magnetism, and psychoanalysisin turn serving as the means ofcommunication between the figure ofauthority and the patient.One notable feature of the history of psy-FORSTUDENTANDRESEARCH WORKERReichert Microscopes and Accessories—a full rangeSinger MicromanipulatorMicromanipulatorsMicrodissectorsDissecting setsHaemacvtometersHaemaglobinometersPrepared slidesetc.H. B. SELBY & CO. PTY. LTD.393 SWANSTON STREET, MELBOURNE, C.1. FJ3661.SYDNEY, BRISBANE, PERTH, ADELAIDE,HOBART.

SPECULUM23chiatry has been the succession of widelydiffering theories on the causation of mentalillness. Therapy has been often even lessthan empirical; it has been bizarre guesswork.As mentioned before, possession bydemons has been probably the most prevalentview. (See Aldous Huxley's "TheDevils of Loudun", for an account of mass"possession" of nuns in a 17th centuryFrench convent.) In all ages, there havebeen attempts to discover what type of man,mentally and physically, develops what typeof 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. Hippocratesadapted these to a theory of humoral balancein health, i.e., blood (fire), phlegm(earth), black bile (water), and yellow bile(air) were in equilibrium. Personalitytypes such as the Sanguine were liable toattacks of excitement, the Choleric toapoplexy, and so on. These concepts wererevived at the medical centre of Salerno inthe 1 1 th century, and even today, wordssuch as melancholia, phlegmatic, etc., arestill in use.Paracelsus (1493-1541)—real name,Aureolus Philippus Theophrastus Bombastusvon Hohenheim—was an astute psychiatristand a forerunner of Freud. Hefelt that man was composed of antagonisticanimal and godly spirits; the former must besuppressed for fulfilment. (cf. Id and Superegoof psychoanalysis.) He described themanic-depressive state, and maintained thatpsychoses were "natural" not demonologicalin origin. He knew that diseasecould result from mental problems. "Youshould treat the spirit, for it is the spirit thatlies sick". According to Paracelsus, "bruteintelligence" is brought on by madness,while "human intelligence" is "not subjectto sickness". Here we have a clear discernmentof primitive drives controlling thepsychotic, while reasoning power remainsintact, e.g., the keen logic of the paranoiac,based on false premises.Georg Ernst Stahl of Halle Universitypropounded (circa 1700) the doctrine of"animism". Living processes were determinedby "man's sensitive soul" (cf. subconsciouspersonality). However, he missedanticipating Freud by two centuries, in thathe thought that the "soul" knows moreabout the body and how to rectify its malfunctionthan the physician. The doctorcan only watch passively the soul's effortsto realign the body's imbalance.Hypnotism was an outcome of mesmerism,the word "hypnotism" being coined byJames Braid, a Scottish surgeon, in 1843,in his study of mesmerism, "Neurypnology,or the Rationale of Nervous Sleep".The full implications of hypnotic suggestionwere not understood, however, until theFrench clinical neurologists such as Charcothad carried their organic theories of mentalillness to absurd lengths. This was in the1860's, when theories of mechanism dominatedall branches of science.Jean-Martin Charcot (1825-1893) madethe Salpetriere hospital in Paris the leadingneuroclinical research unit of Europe. Histeachings on the neurological causes ofhysteria were controversial in an age whenthe uterus was removed for this affliction.He applied hypnotism for "grande hysterie",but his cures were seldom permanent.Bernheim, of Nancy, confuted Charcot bysaying that the varied symptoms had noexistence till induced by the physician. Asurvival of Charcot's organic views ofhysteria was the teaching (up to the 20thcentury) that hysterical anaesthesia existed,without the patient knowing, until thephysician "discovered" it. It was not wellknown until the World War that this couldbe produced at will by the examiningphysician, although Babinski had demonstratedit in 1906.In the same period, the English werebusy with their own artefacts. Railwayaccidents had produced a new disordercalled "railway spine", which the cliniciansof the time believed was due to spinalinjury. Thus, one sufferer could only walksideways! Occasionally, one can recognisethe real symptoms behind the artefacts. Forexample, a young woman would walk alonga street till she came to an open space, andthen she fell down. We recognize an agoraphobia,but why did she have her clitorisexcised? Someone must have whisperedthe word "hysteria".Charcot's influence was strongly felt bySigmund Freud (1856-1939) who usedhypnotism to bring to the surface memoriesrepressed as a result of psychic trauma.Psychoanalysis, with its two components offree association and dream analysis, he later

24 SPECULUMdeveloped as being more effective. Freud'srealization of the labyrinth of mental processesoccurring outside the sphere of consciousnesswas one of the landmarks ofscience. Dubois and Degerine had independentlyworked out a therapy of exhortationand explanation. These developmentsin clinical psychology explain why,with the spate of psychogenic "shellshocked"patients in World War 1, thepsychological equipment was available todeal with them, and there never was anyserious reversion to queer organic theories,as had been the case with "grande hysterie"and "railway spine".Are we any closer to knowledge of theaetiology of mental disease than was Hippocrates,with his humours? So far, interesthas been mainly in constitutional factors,but very little advance has been made. Acertain advance, amid a welter of nonsense,was made by Franz Joseph Gall, theViennese neurologist, in 1810. He attemptedto link certain cranial configurations("bumps") with certain mental characteristics.His system of "phrenology" put selfishpropensities such as oral drives, and libido,in the temporal region. In view of moderninterest in temporal lobe psysiology, Gall'swork was the first serious attempt at corticallocalization of mental function.More recently (1921), Ernst Kretschmer,in his "Physique and Character", noted thatoften, schizophrenics were lank and thin,while manic-depressives were short andstocky. The terms he used, asthenic andpyknic, are still widely used. Sheldon, theAmerican anthropologist, has divided peopleinto endomorphs, ectomorphs, and mesomorphs,and has tried to correlate thesetypes with numerous mental and physicaldisorders.Twentieth-century psychiatry and psychologicalmedicine is so vast that it would behopeless to try to outline it, in such a shortspace. A revolution commenced withFreud's discovery of the unconscious,branched off into Adler's theory of thepower urge, and into Carl Jung's mysticalnotions of racial memories. This revolutionis still going on, and the outcome isimpossible to predict. All that one can sayis that psychological medicine will probablybecome more and more scientific, less andless wedded to its old partners—superstition,magic and religion.JOUBERT & JOUBERT PTY. LTD.575-9 Bourke Street, MELBOURNE MU 7277 (3 lines)LACTOBYL TAXOLROCARURALYSOLSTANNOXYL(Tablets and Ointment)ENTROSALYL(In Standard or Vitaminised Forms)NEUTRAPHYLLINE(Ampoules, Tablets with Phenobarbital,Tablets Plain)COLCHIPIRINEGENOSCOPOLAMINE(Amps , Solution and Pills)PANBILINE PILLSPANBILINE - METHIONINEPILLSURODONAL VI-GLOBEOLLYXANTHINEFLUSCORBIN

SPECULUM 25TO SMOKE OR NOT TO SMOKE • ••Bryan GandeviaHonorary Assistant Physician, Royal Melbourne Hospital"Have you not reason, then, to be ashamedand to forbear this filthy novelty? . . . Inthe abuse thereof sinning against God, harmingyourselves both in persons and goods .. .a custom dangerous to the lungs, and in theblack stinking fume thereof, nearest resemblingthe horrible Stygian pit which isbottomless . . ."The above exhortation of King James I,published some three and a half centuriesago, had no more effect on stopping smokingthan did the drastic physical punishmentsadopted at various times by nationaland religious authorities. King James' contributioncomes very early in the medicalbibliography of tobacco smoking, and it wastherefore with considerable misgiving that Iaccepted the editorial invitation to reviewthe literature on the subject and to discusswhat advice is best given to patients in practice.However, on further consideration itseemed that discussion might well be confinedto the latter aspect, for the immediateclinical value of the literature on smokingis very nearly inversely proportional to itsvolume.I shall attempt, with perhaps unbecomingbrevity, to justify this contention underseveral headings and I shall then outline myown approach in practice. This personalattitude is adopted(a) because a candid statement of oneperson's views is easier to present in a waywhich illustrates the principles involved,(b) because it is easy for the reader tocriticise and analyse, and(c) because you may take it, leave it, ormodify it according to your own conceptsand personality without regard to the lengthof the supporting bibliography of authoritativesources.Experimental AspectsOnce upon a time I was deeply impressedby experiments made on the isolated nicti-tating membrane of the cat—actually Idoubt if it was isolated, but so many experimentalorgans and tissues are proudly describedas such that the temptation to includethe word is irresistible. I am now muchmore impressed by the work of those withthe ingenuity, patience and skill to performreliable experiments on the intact humananimal, a very much more difficult taskfrom several points of view. Experimentson the effect of smoking in man are comparativelyfew and mostly inconclusive butthere is evidence that by one mechanism oranother smoking decreases peripheral bloodflow, inhibits gastric motility and perhapsincreases the secretion of acid in the stomach,among other less important effects. Asfar as I know there is no direct evidence asto its effect on coronary blood flow. Animportant point to be borne in mind is thatwhat happens in a normal subject is notnecessarily reproduced in subjects alreadydiseased. Smoking a cigarette has, forexample, been shown to produce an increasein airways resistance in emphysematouspatients but not in normal subjects. Itseffect on appetite is well known; this is butone of the interesting observations whichmay be made on the effects of smoking bythe personal experiment of giving it up (evenwith generous allowance for the fallacies ofsuch an elementary experimental design).However, we do not know whether thehunger of the reformed tobacco addict has apharmacological or psychological basis orwhether both mechanisms are involved. Uncertaintyof this type exists in relation toseveral facets of the smoking problem.Epidemiological AspectsMany epidemiological studies have beenconducted which purport to show thatsmoking. is a factor in the development ofsuch disorders as carcinoma of the lung,

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SPECULUM 27chronic bronchitis, peptic ulceration andcoronary disease; other studies of similartype fail to show a relationship. To illustrateone difficulty—we found in a survey inMelbourne a much higher incidence ofcough and sputum amongst the smokers ofa defined population than amongst the nonsmokers,but even this simple observationcannot be confirmed in London,* probablybecause of differences in climatic and otherenvironmental factors. There is reliableevidence to suggest that relapse of pulmonarytuberculosis occurs more frequently insmokers than in non-smokers, and thatsmokers with chronic bronchitis die youngerthan those who do not smoke. In the mainthese studies show correlations which do notnecessarily imply a direct cause and effectrelationship: for example, the urge to smokeand a proneness to develop lung cancer maybe genetically linked. The arguments overthe fallacies attendant upon surveys of thistype and on the correct interpretation to beplaced on the figures obtained are legion,but it is safe enough to conclude that areasonable case has been made out againsttobacco in all these conditions, especially incarcinoma of the lung. The application ofthese findings to the individual patient remainsfar from clear; satisfactory anterospectivestudies of prognosis in smokersand non-smokers, which are essentiallywhat is required by the clinician, are difficultto plan and carry out, and are, as far as Iam aware, universally lacking.The Doctor's AttitudePersonal factors, involving both thedoctor and the patient, influence the advicegiven to patients in regard to smoking.Indeed, the influence of more academicstudies pales into insignificance beside theinfluence of personal prejudice againstsmoking on the part of the doctor. Thisstate of mind may be congenital or acquired,the latter variety occurring almost exclusivelyin reformed smokers and being byfar the more virulent form. It may lead towhat had been termed the "terrorist approach",which in my opinion (with, as asmoker, its bias in the opposite direction)is rarely justified. In the interests of thedoctor-patient relationship justice should betempered with mercy; we should accept the•Recent British studies have now both confirmedand extended this observation.psychiatrists' advice to know something ofourselves before advising others and atleast we should be aware of our own grosserprejudices. There are no doubt doctors, asthere are patients, who smoke heavily andwho cheerfully tell their patients, "Look atme; it's never affected me." This is bias;in any case, it would probably be moreappropriate to listen in the mornings ratherthan to look during consulting hours.A very sound thoracic physician soughtto hang notices in his clinic in England,reading "Smoking Harms Your Heart andLungs: Stop Now Before It Is Too Late."A most humane and kindly man in all otherrespects, deeply conscious of the social andpersonal problems of the patients whosephysical disorders he managed so well, hewould not accept the view that the chiefeffect of these notices would be to producechronic anxiety and fear. Who, of thesepatients with established thoracic disease,did not feel that it was perhaps already toolate? And were their hearts to be the nextto go? The medical staff, consisting ofsmokers and anti-smokers of less radicalviews, unanimously opposed the use of thenotices. This story is told so that you maytake sides yourself; you may care to analyseyour motives in doing so or your own likelyreaction to such notices.The Patient's AttitudePerhaps one day in the distant future Imay be able to state exactly why I givesomewhat different advice to differentpatients with the same condition. I aim tomodify it according to the patient's personalityand other circumstances—whether Iwish to encourage him, frighten him, enticehim, or cajole him into giving it up andwhether I feel he is likely to take the adviceanyway. The patient must know whetherhe will be improved symptomatically, orwhether there will be no change in symptomsbut merely a decreased risk of complicationsor a lessened rate of progression.An intelligent person may wish to hear andmay accept more or less scientific argumentswhich would be wasted on a person of lesserability. Nervous or emotional patients requirereassurance that they are not beingadvised to stop smoking because cancer issuspected, or because they will inevitablyget cancer or some other horrible complaintif they do not. Patients often fail to stop

28SPECULUMsmoking and to have painted too gloomy apicture too effectively beforehand sometimesproves a handicap to subsequentmanagement.Patients who smoke less than ten cigarettesa day should almost certainly be leftin peace, except perhaps for those withperipheral vascular disease. However, lightsmokers can usually stop with comparativelylittle difficulty.Because of the unfavourable publicitygiven to smoking in recent years, mostsmokers have some feelings of guilt, shameor fear. For one or other reason a patientmay refrain from raising the question oftobacco, however much it may be in hismind. A word or two on smoking is thereforeoften worthwhile, whatever the patient'scomplaint, and it is mandatory if this situationis suspected.I have no idea how successful my tacticsare. For better or worse, however, I believeit is fundamentally unsound to reel off a"set piece" to all patients. A casual "Don'tsmoke" or "You'd be better off if you stoppedsmoking" is useless and amounts toNIALL & COGHLAN,Medical AgentsPractices TransferredPartnerships ArrangedLocum Tenens Provided127 COLLINS STREETMELBOURNEPhone MF 1983DIRECTORSM. D. COGHLAN R. H. VAN ASSCHEwhat is termed mental cruelty in anothercontext. If it is important, such a statementrequires amplifying, explaining orrationalizing; it deserves at least as muchtime as is spent in telling them how andwhen to take the mixture (which is nearly allwater anyway). If it is not important theobservation is better not made.Allen, Barker and Hines (PeripheralVascular Disease, 1955) state that "weoccasionally* say to patients, 'You may haveyour tobacco or your extremities, but notboth. If you must have your tobacco, youcannot have your extremities; if youwish to have your extremities, you mustcease the use of tobacco'." If any clinicalsituation justifies a statement like this,peripheral vascular disease does. Even so,having been provoked to this approach myselfon several occasions, I doubt whetherI have done more than satisfy my own conscience;I doubt if patients can regard suchan unreasoned statement, or frank threat,as a satisfactory basis for giving up apleasurable and seemingly unrelated habit oflong-standing at a time of stress. Some willreact in precisely the reverse way, andunderstandably so. Finally, the last clauseverges on dishonesty unless amplified; mostpatients would construe this to mean that ifthey stopped smoking they would not losetheir limbs. This will not be true in allcases and the disillusioned patients will losefaith in their medical advisers and theirtreatment.Notes on Specific ConditionsIn all the conditions to be mentionedmany physicians would advise that smoking* The bold face is mine; taken out of itscontext this quotation probably appears blunterthan the authors intended.You can bank on ...I NTRADEX(6% dextran in normal saline)The reliable plasma volume extender.Another Product of the GlaxoLaboratories.

SPECULUM2Ibe given up entirely. This is reasonableadvice and no examination marks would belost for giving it. However, with exceptionsto be mentioned, there is perhaps lessrational and less scientific evidence for thisadvice than there is in support of the contentionthat everyone should stop forthwithand that no one should be allowed to take itup. The following suggestions are thereforeoffered with this in mind, together withother modifying factors mentioned in previoussections. Whether a firm "non-smoking"line or a less dogmatic approach isadopted, the advice must be clear and anexplanation of the reason given for it. Inparticular the patient must understandexactly what stopping smoking has to offerhim.Peripheral Vascular Disease. Clinical,and, to a less extent, experimental evidencestrongly indicates the desirability of givingup smoking, or, indeed, the necessity for it.smoking, or, indeed, the necessity for it.Smoking, the patient may be told, furthernarrows the vessels and accelerates progressionof the disease. He probably cannot beguaranteed arrest of the condition, nor improvement,although this may occur, norrelief from pain or other symptoms. Thisadvice applies to all varieties of occlusivevascular disease.Chronic Bronchitis, with or withoutemphysema. Here again there is strongclinical evidence in favour of stoppingsmoking, and it is supported by experimentaland particularly by epidemiologicalevidence. "Smoker's cough", which is mildchronic bronchitis, ceases. In more severedisease, the patient may be promised moderateto considerable reduction in the amountof cough and sputum. Wheezing is oftenimproved dramatically but is sometimeslittle affected; it should be remembered thatthe element of reversible bronchoconstrictionfound to some extent in every patientwith emphysema is the main aspect of thiscondition which is susceptible to treatment.The patient may also be told that the tendencyfor bronchitis and/or emphysema to geta little worse year by year—as even"normal" lungs do—is minimised. He isnot told that one of the findings in a recentsurvey was that the only patients with severebronchitis to show permanent clinical improvementwere those who gave up smok-ing*; at least, he is not told in quite thesame words.Asthma. Asthmatic patients whosewheeze is aggravated or precipitated bysmoking should stop. As with other conditionsin which there is a clear relation betweena main symptom (cough and theepigastric pain of an ulcer are other commonexamples) the rationale of this adviceis obvious to the patient and he canunequivocally be promised improvement.Other patients with asthma should be toldof the tendency of smoking to produce oraggravate bronchitis; the effect of stoppingsmoking in these cases is sometimes striking,often disappointing and always unpredictable.At least one asthmatic doctoradvocates a cigarette on going to bed to helpcough up phlegm and thus ensure a peacefulnight. This practice is the "thin edge of thewedge" to a former smoker and perhaps toa non-smoker; smelling salts containingammonia should be equally effective. The"anti-asthma" cigarettes still sold to thesepatients can do no more than can beachieved with conventional bronchodilatortherapy and should be replaced by it.Other Respiratory Conditions. Patientswith pulmonary tuberculosis are advised togive up smoking on the grounds that it reducescough and sputum and hence the riskof spread. They may also be told that therisk of a relapse in years to come is greaterif they smoke.Stopping smoking is justified in localizedbronchiectasis, recurrent sinusitis, bronchialor pulmonary infection and recurrent orchronic pharyngitis or laryngitis. No rashpromises should be made, although improvementcan be great. Patients who havecancer of the lung should be allowed unrestrictedsmoking; so seemingly obvious apoint is made only because I have once seenthe agonies of dying from lung carcinomaaggravated by the torture of a foolish "nosmoking"regimen. After resection of alung or lobe for non-carcinomatous lesionsI suggest to patients that they should notsmoke "so your remaining lung, which will* To this group may now be added the smallgroup of severe chronic bronchitics with grosslypurulent sputum in whom the long-term use ofantibiotics is considered justifiable (after carefulassessment).

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SPECULUM 31have to do a lot more work over the years,will stay as healthy as possible."Impending Anaesthesia. Smoking shouldbe stopped for at least three days before anelective operation is performed undergeneral anaesthesia. A recent study at theRoyal Melbourne Hospital has stressed theimportance of this and suggested that postoperativepulmonary complications wouldbe fewer if the volume of sputum producedpreoperatively could be reduced. This canbe achieved by stopping smoking. The factthat many smokers have anaesthetics withouttrouble is no reason for complacency.Cardiac Disease. Although "tobaccoangina" is described, it seems to be rare fora patient with angina, even if the pain isprecipitated by trivial exertion, to give aclear history of aggravation or precipitationof pain by smoking. Such a patient shouldstop. Otherwise there seems little to begained by adding the stress of giving upsmoking to the patient's other troubles. Onemight prefer that patients who had had myocardialinfarcts, congestive cardiac failure,pulmonary congestion, and so on, did notsmoke, but in all honesty one cannot promisethese patients much in return for theirsacrifice.* Smoking is likely to be of smallprognostic significance in the presence ofthese serious conditions, usually with structuraland established causes. Patients withmitral stenosis tend to develop bronchitisover the years and should not smoke for thisreason. The effect of stopping smoking inparoxysmal arrhythmias in my limited experienceis disappointing but it should betried. Most patients with "palpitations"require reassurance and treatment for theiranxiety; I do not know whether stoppingsmoking stops extrasystoles (it didn't stopmine) or whether or not it matters if it does,but I doubt if it stops "palpitations".Peptic Ulceration. This is easy becauseso often smoking produces the pain. If thepatient persists in smoking in spite of itsobvious influence and his doctor's adviceand explanation, then he should smoke onlywhen his stomach is full.* Note the emotional factor in the use ofwords—a non-smoking physician would not usethis term and would therefore reject the reasoning.Casual Enquiries. Patients often askwhether they should give up smoking, withoutnecessarily implying any relationship ofsmoking to their current complaint. Theanswer of course, is yes. Reasons are notdifficult to find. Young men who insist onsmoking should smoke a pipe, and why notthe women? Patients with diabetes or witha strong family history of broncho-pulmonarydisease are wise to stop smoking whileyoung.General AdvicePatients should be advised to "cut it out"rather than "cut it down". The latter is noless difficult and stressful than the formerand is more frequently associated with relapse.Cutting it down may be resorted toif cutting it out fails, and some patients doseem able to stabilise their cigarette consumptionat a lower level. Steps must oftenbe taken at the outset to prevent weightgain; chewing gum is socially less acceptablebut also less fattening than sweets or biscuits.Patients, poor, long-suffering, blind andfaithful creatures that they are, will ask youhow to give up smoking. You must, ofcourse, have an answer ready. With myextensive personal experience of stoppingand starting smoking it would be sheer presumptionto offer any suggestions. Sedation,hypnosis, silver nitrate mouth washes,tranquillizers, temporary change of environmentare all subsidiary to making the bigdecision, but beyond that—well I should beinterested to know what you advise, doctor.Perhaps we should do better with a clearerunderstanding of the aetiology of thedisease.ConclusionIt might be thought that I have presentedsomething of an apology for smoking. Thisis not intended. I agree wholeheartedlywith King James, but in the presence ofestablished smoking habits and establisheddisease the problem is largely beyond solution.Let us take a lead from the preventiveapproach which has achieved so muchin the last century in the field of public andindustrial hygiene; let us stop people startingon their black, stinking, fuliginousdescent into the Stygian pit.Hear about the bloke with the King sizewith the filter tip?

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SPECULUM 33ANSWER ALL QUESTIONSSTAPHYLOCOCCUS AUREUS(-Aloft/ 5o Pam a Written examinationWithout ...Actua4 -Answering 3he Question)ByProfessor of BacteriologySydney D. RubboIt is no fault of your Editor that he isusing this space in Speculum with a no-timeto-thinksort of essay. The fault is entirelymine. Months ago I promised him somethingunusual. And now, at this late hour,when the space cannot be sold to the makersof Sillipennin, the only antibiotic which isdefinitely claimed to have no antibacterialactivity, we decided I must fill it—withsomething unusual, of course. Accordingly,I am going to write simultaneously on twodistinct problems (see above) and, hope,get away with it. Anyway, the space willbe filled.The topics I am tackling are difficult ones,particularly the subsidiary subject. Youhave all faced that unfriendly examinationpaper which says, "Answer all questions orelse." In such an unpleasant circumstanceit would seem there is little scope formanoeuvre. However, as part of my spacemanship(the art of filling and fooling inspace) I will demonstrate a few simple principles.The first important thing, when corneredas I am, and you might be, is to create animpression of scientific precision. This isdone by a deliberate "semanticization" ofall technical terms appearing in the question,however unnecessary that may be. Havingfinished with the definition at the cost of80 per cent. of your available hardware youthen spread the remaining 20 per cent ofyour knowledge over an average of 6-8pages. To do this all the tricks of creativewriting must be used. It is at this stage thatthe second principle is applied, namely thedemonstration of scientific imagination. Inshort, your answer must be research orientated.This will please the Professor forit spares him the discomfort of discoveringhow misleading his lectures have been inmatters of fact.Apart from these two cardinal principles,the student would be well advised to uselabelled sub-headings which can be read inplace of the text, to avoid split infinitivesand other obvious grammatical errors, andabove all, to quote freely from the unpublishedwork of your professors and lecturers(be sure to quote the Professor morefrequently than any others).Such advice would be sterile (in theliterary sense) unless supported by example.Let me illustrate the method. The questionis "Answer All Questions—Staphylococcusaureus." At a first glance the telegrammaticbrevity of the question is disturbing but thephrasing has obviously been intentional. Thequestion must be read a dozen times inorder to decipher its meaning, if any. Whatevermay be expected one thing is certain—we must start with a definition of the Greco-Latin binomial (principle No. 1) and thenproceed with the usual verbal gymnastics toanswer the question proper (principle No.2). Here now is the start of our modelanswer.According to Gray, lecture 12 DivisionII, 1959, Staphylococcus aureus is a

34 SPECULUMmicrobe. This may appear to be a veryelementary statement but, in the historicalsense, it is not. This organism was first describedin 1881 by Sir Alexander Ogston,Professor of Surgery in the University ofAberdeen (this superfluous detail never failsto impress). Ogston found the organismrepeatedly in smears from abscesses butnever in tissues free from suppuration. Toquote from his writings, "My delight maybe conceived when there were revealed tome beautiful tangles, tufts and chains ofround organisms in great numbers. The puson the microscope slide, which appeared toindicate the solution of a great puzzle" (theaetiology of wound infection) "filled me withhope." In spite of this significant discovery(Ogston was also the first to use the termstaphylococci=grouped-micrococci for thesepyogenic organisms) the British MedicalJournal refused to publish some of hispapers on infected wounds.Later, with the development of culturaltechniques, it became possible to classify thestaphylococci on the colour of their colonies(Rosenbach, 1884). The very frequentassociation of the aureus (golden) strainswith suppuration eventually led to the firmconviction that Staphylococcus aureus was acommon cause of abscess formation and theonly pathogenic species in this genus. Today,a strain of staphylococcus is not regardedas a potential pathogen unless it producesan enzyme, coagulase, capable of coagulatinghuman or rabbit plasma. The termsStaph. aureus and Staph. pyogenes may, forpractical purposes, be regarded as synonymousfor coagulase-positive staphylococci.Passing now to the logarithmic phase ofour answer, we are faced with the problemof sparking the examiner's interest in ourresearchiness without raising suspicions ofour shallowness. This is how it is done (thetechnique, I might add, applies equally wellto the preparation of Presidential addresses).Much has been written in recent years onthe subject of staphylococcal infections anda full review is beyond the scope of the presentpaper (this means I have a vague feelingthe Prof. gave us a bibliography but Ihaven't bothered to use it). Undoubtedly,due to the brilliant investigations of the MelbourneSchool (the qualifying adjective neednot be underlined), answers to most ques-ATTRACTIVEPOLICIES■ ■ IIIThink cf the satisfaction, the feeling of permanent securitythat comes from your choice of the RIGHT company when contemplatinginsurance.Financially sound and well organised, thy, B.M.I. is ready tohelp you solve your insurance problems quickly, easily andto your entire satisfaction.The following are a few only of the attractive policies offeredby the B.M.I.• Comprehensive MOTOR POLICY—covering damage by fire.Accident or Theft.• HOUSEHOLDERS' COMPREHENSIVE—combining Fire,Burglary, and damage by Burglary.• WORKERS' COMPENSATION, etc.DIRECTORATE.--Dr. W. W. S. Johnston, C.B.E., D.S.O.,• Chairman; Major-General Sir Kingsley Norris, K.13.E.,C.B., D.S.O. ; Dr. C. H. Dickson ; Dr. H. G. Funnell, C.B.E.,D.S.O. ; Dr. G. Newman-Morris.The Company is an agentfor a leading Life AssuranceCompany and our representativeswill gladly attendto any inquiries.ABRITISH MEDICAL INSURANCE Co.OF VICTORIALIMITED389-395 Lt. Flinders Street, Melbourne, C.1 'Phone: MB 2751 (9 lines)

SPECULUM 35tions have been reached. It would, therefore,be more profitable not "to answer allquestions" but "to question all answers",particularly as many of these come fromoverseas and do not always coincide withthe views of the Melbourne School (Rubbo,radio broadcast and lecture 39 or 40). Forinstance, it has been said (by common consentno references are ever given in supportof this type of phrase) that the presentstrains of staphylococci recovered frompatients infected in hospital are more virulentthan those isolated in the pre-antibioticera. It has also been suggested (again,don't bother about references) that thestaphylococcal disease pattern has changedin recent years; that the prevalence ofmulti-antibiotic resistant staphylococci isdue to the indiscriminate use of these drugsand a breakdown in asepsis; that the dustfrom hospital blankets is the main vehicle ofair-borne spread in wards. These and manyother points might be considered seriatim(the poised use of a latin word often suggestsa classical education and is markworthy.The reverse also applies to classicalscholars using scientific terms).Virulence of Staphylococcus aureus—pastand presentIn the first place we must recognise thatnone of the available in vitro tests gives atrue indication of the virulence of a particularstrain of this organism and the coagulasereaction only indicates a predictable potentiality.A case of staphylococcal septicaemiais not, as might be expected, due toa strain of high virulence but is more probablythe result of the accidental entry of infectedemboli into the circulation at theprimary focus. Further, there is no laboratoryapproach to distinguish between epidemicand non-epidemic strains althoughthe phage type 80 has been commonlyassociated with epidemic neonatal infectionsin different parts of Australia.The important fact to remember is thatStaphylococcus aureus is a frequent andinnocuous habitant in the nose, skin andfaeces of healthy individuals. Thus, thebiological accident of clinical disease ismore likely to result from a change in thehost rather than a change in the organism.Viewed in this light, the explanation for theapparent severity and frequency of staphy-lococcal infections today must be sought infactors affecting the resistance of the host.These are numerous and varied. Some intrinsicfactors are (a) the type of patient,e.g., the premature baby, the adult with acirrhotic liver, the stabilized diabetic, etc.,(b) the advanced type of disease which isnow treated surgically (e.g., cardiac, thoracicand plastic operations). Of the extrinsicfactors which must be taken into accountwe might list (a) the in-dwelling needlesused in intravenous therapy, (b) the repeatedinjections, (c) the alteration of normal floraby broad spectrum antibiotic therapy, (d)the excessive use of sutures for cosmeticreasons, (e) the use of anti-inflammatoryagents such as cortisone, and (f) the intercurrentinfection or irritation of mucosalsurfaces (e.g., viral influenza and catheters,to mention two extremes).The combination of these extrinsic andintrinsic factors inevitably leads to a loweringof host resistance. It would be foolish,however, to suggest that a major surgicaloperation should be withheld in an elderlyalcoholic patient or newborn infant with apatent ductus arteriosus merely because ofthe risk of post-operative infection. All wewould expect is that special precautions aretaken with such patients. We conclude thissection by stating that there is no evidenceto suggest that the staphylococci causingdisease at present are any more virulentthan those of the past (McDermott, 1956).The staphylococcal disease patternOne notable change in staphylococcaldisease has been the virtual disappearanceof haematogenous osteomyelitis but this isprobably due to antibiotic therapy. On theother hand, three diseases which appear tobe more common today than previously arestaphylococcal enterocolitis, pneumoniaand wound sepsis.Staphylococcal enteritis is usually a benigncondition associated with symptoms ofnausea, vomiting and diarrhoea whereaspseudomembranous enterocolitis is usuallyfatal with signs of shock and peripheral circulatoryfailure. Susceptibility to entericinfection is enhanced by the oral administrationof broad spectrum antibiotics. Theselatter facilitate the colonization of antibioticresistantstrains by the elimination of thenormal flora. The "biological vacuum" soproduced seems to provide an easier oppor-

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SPECULUM 37tunity for superinfection following ingestionof food and fluids contaminated with the"hospital staphylococcus."Staphylococcal pneumonia is not an uncommondisease nowadays. It is usuallydiagnosed radiologically and is characterisedby destruction of lung tissue. Pulmonaryoedema and intercurrent viral influenzaappear to be predisposing factors. A possiblesource of the organism in post-operativepneumonias is the lumen of unsterilizedanaesthetic breathing tubes.Wound sepsis is probably not more commontoday than it was in the pre-antibioticera but the aetiology has changed. Whereassome 10-15 years ago Group A haemolyticstreptococci were frequently found in woundinfections, today the principal organism isthe hospital staphylococcus. The incidenceof wound sepsis in the teaching hospitals ofMelbourne varies from 6-8 per cent. for allsurgical cases. Recalculating from Rubbo'sfigures (1948) the economic wastage frominfection in a 500-bed hospital couldamount to £12,500 per annum on presentdaycosts, that is, 2500 patient-days prolongationof hospital stay per annum at £5 perday.This problem must be controlled forhumane and economic reasons. It is notpeculiar to the Australian hospital scenebut exists everywhere. The solution ofstaphylococcal cross-infection in hospitalsdepends on improvement in three directions—architectural design, antibiotic therapyand aseptic technique. Time and space(never admit lack of knowledge) do not permitme to develop all of these as theyshould. Most architects are curiously uninformedabout the habits of the flyingmicrobe or even the behaviour of steam.The design of operating suites, the installationof central sterilizing areas, the disposalof infected laundry, the supply of sterilewater and the technique of ventilation andair purification are challenges which areoften resolved at the aesthetic rather thanthe aseptic level. The best solution to thearchitectural aspect of cross-infection is tocatch your architect in flagrante delicto withthe sketch plans on his drawing board.Antibiotics in relation to intramuraldisease.The prevalence of the "hospital staphylococcus",that is, the strain usually resist-ant to penicillin, streptomycin and the threetetracylcines but sensitive to chloramphenicoland erythromycin, is, in part, dueto too much antibiotic therapy and too littleaseptic care. The antibiotic environment,which the present-day hospital is, providesa selective advantage for the unrestrictedpropagation of the resistant mutant. If anorganism, such as Staphylococcus aureus,exhibits a high degree of mutability towardsresistance it follows that the resistantmutants will eventually displace the sensitivewild types. If, on the other hand, themutation frequency is low, as in the case ofGroup A haemolytic streptococci with theantibiotics, then these organisms will tend todisappear so long as antibiotic selection isoperative.Another indirect contribution to thecross-infection problem arising from broadspectrum antibiotic therapy is the reductionof the normal bacterial flora on mucosal surfacesof the respiratory and alimentarytracts. This reduction in some way facilitatesthe colonization in these tissues offoreign, and sometimes dangerous, parasites,most frequently yeasts (Candidaalbicans) or drug-resistant staphylococci.Freter (1955) showed that oral streptomycinprecipitated fatal disease in guinea pigs infectedwith Vibrio cholerae. Cooper (MelbournePh.D. thesis) modified Freter's techniqueand showed that Shigella infection inmice could be induced with as few as 100organisms in animals treated with erythromycinand streptomycin by mouth. Theseobservations lend strong support to the viewthat staphylococcal enteritis might be asequential result of oral antibiotic therapy.The question now arises, what, if any,antibiotic control can be imposed on thehospital staff. The Royal Women's Hospitalhas adopted with success a rigid rotationalantibiotic programme On the collaborativeadvice of the bacteriologist andclinicians only one antibiotic is available fora period of approximately six months fortreatment of all staphylococcal infections.After this time a different antibiotic is thenselected, and so the rotation of drugs continues.This we understand (Butler, personalcommunication) has been most successfulin preventing the build-up of thehospital staphylococcus. However, the circumstancessurrounding this important ex-

38 SPECULUMforrelief ofpain!a synergistic combination of Aspirin, Phenacetin and CodeinePhosphate.Ascotin tablets ease pain rapidly and the Codeine Phosphatesoothes the patient's nervous system. Extensiveclinical experience has proved the value of Ascotin.Each tablet contains: Aspirin Gr. 4Phenacetin Gr. 4Codeine Phosphate Gr. 1/6Available in tubes of 20 Tablets; in bottles of 100 Tablets.Prepared by the pharmaceutical division ofF. H. FAULDING CO. LIMITEDMANUFACTURING CHEMISTS • AUSTRALIA

SPECULUM 39periment do not apply to a general hospital.For a general hospital the following recommendationsmight be considered:1. No antibiotic or sulphonamide shouldbe given to any patient unless there areclear indications for its use (clear indicationsmeans scientifically-based reasons,not inspired hunches).2. All open infections (wounds, skin, alimentary,respiratory and urinary tractdiseases) should be treated with adouble drug therapy. In the case ofstaphylococcal infections an antibiogram(drug sensitivity pattern.) mustdictate the choice of drugs; in other infectionsan antibiogram may or maynot be necessary.3. Where possible, the first combination ofdrugs used should include an antibioticand a triple sulphonamide.4. The supply of certain antibiotics shouldbe carefully controlled, particularlyerythromycin, kanamycin and novobiocin.These may be invaluable fordisseminated staphylococcal infectionand should be reserved for the seriouscase whenever possible.The two principles underlying theserecommendations may be briefly mentioned.In the first place, one can modify highmutation frequency of an organism to asingle drug by exposing it to two dissimilardrugs simultaneously. Survivors in this systemmust be resistant to both drugs and thechances for the selective propagation of thedoubly-resistant mutants are many timesless than those for the mutants resistant to asingle drug. For example, if the frequencyof mutation is 1 in 10 6 cells towards resistancefor antibiotic A and 1 in 10 6 for B,then the mutation rate for resistance to Aand B will be 1 in 10 12 cells. This rate isso low that doubly-resistant mutants are unlikelyto develop, a phenomenon welldemonstrated in the chemotherapy of tuberculosisand worthy of exploitation in staphylococcaland other infections.The second principle behind these recommendationsis an obvious one. As the openinfection constitutes the greater hazard ofcross-infection care must be taken to ensurethat the spread is not due to resistant strains.The double drug treatment is aimed at preventingthis contingency.We might add in parenthesis that the reasonsfor recommending double drug therapyhere are quite different from those usuallyput forward for some commercially availablecombinations. For many of these combinationssynergistic action is claimed, butseldom demonstrated. Nor is the use ofdouble drug treatment recommended as a"blanket" measure to treat infections of unknownaetiology. Its success in preventingthe emergence of resistant mutants dependson the fact that the causative agent is sensitiveto both drugs.Asepsis in relation to intramuralstaphylococcal diseaseAsepsis is a diffuse and complex subject(this really means my knowledge of asepsisis diffuse and complicated). In its broadestterms it is concerned with the exclusion, removaland destruction of micro-organisms.Asepsis in the operating theatre is designedto protect the individual patient against infectionbut in the wards the protection isextended to a community of individuals. Inthe former situation aseptic discipline isreadily accepted; in the latter is is open tomany unsuspected breaches of application.Acquired infection during an operation canonly result from contact or air-borne contamination.In the wards, infection bycontact, by air and by ingestion are all possible,the first two being more frequent.Theatre asepsis demands effective preoperativesterilization of instruments, gloves,textiles and skin and the maintenance ofsterility during the operation. While thestandards of surgical asepsis are particularlyhigh improvements might be sought inthe surgical scrub-up and the use of longsleevedoperating gowns. These problemsare now being investigated. The principalcauses of breakdown in theatre hygieneoften stem from circumstances outside thesurgeon's control. For instance, anaesthetistsoften enter theatres with gowns looselydraped over their street clothes and manydo not bother to change, or even cover,their footwear. The corrugated rubbertubes and Y pieces of the anaesthetic machinesare seldom sterilized and theoreticallyprovide a possible means of inducing postoperativestaphylococcal pneumonias. Theair entering some operating theatres is oftenunfiltered or is drawn by exhaust fans fromthe hospital corridors or through dust-laden

40 SPECULUMducts. The unnecessary movement of individualsand the overcrowding of theatresalso contribute to the bacterial air loading,which should never be higher than 10 organismsper cubic foot of air. In short, themain weakness in operative asepsis is compoundedof two elements—lack of personaldiscipline and incredible architectural mistakes.Ward asepsis is far more complex aproblem and we can neither answer allquestions nor question all answers connectedwith it. One aspect of this problem is therole of the woollen blanket as a reservoirand disseminator of the hospital staphylococcus.It would appear that overseas andSouth Australian workers consider the woollenblanket a more dangerous source of airborneinfection than the cotton textiles,sheets and pillow slips. A Melbournegroup (Rubbo, Stratford, Christie and Dixson)are now investigating this question. Itis too soon to report their findings but thismuch can be said—of the two types of textiles,woollen blankets and cellulose sheeting,the latter invariably yields higherstaphylococcal and total counts. The topsheet of any hospital bed is always more111■•■•■••■■•■••••••••• •■•■■••■■•■ •■•■•••••■M•lx•-•••••■•■■•■■■••••••• ■•••■•■•■•■••••■•■•••■■■••The uses of"NOVOCAIN"TRADEMARKThe original Local Anaestheticare constantly extending:INTRAVENOUS APPLICATIONRECTAL DRIP APPLICATIONPOST OPERATIVE PAIN"NEURAL" . . . THERAPYSamples and Literature on request toJ. L. BROWN & CO.123 William Street, Melbourneheavily contaminated than the blanket itcovers. Whether these cottons can spreadtheir heavy bacterial flora more effectivelythan the less heavily contaminated blanketscan only be determined by controlledexperiments of a type which are now beingcarried out at St. Vincent's Hospital, Melbourne.It is hoped that the present studieswill help to define the problem of wardcross-infection more clearly and to providesome practical answers to it. Those of youwho hope to repeat Division II in 1960 willhave an opportunity of hearing these resultsfirst hand.As I have now filled the space for yourEditor there is no a priori reason for me tocontinue, not even to try to answer all questionon Staphylococcus aureus.WHAT YOU SHOULD READElek, S. D., "Staphylococcus pyogenes andIts Relation to Disease", Livingstone, 1sted. 1959.Hare, R., and Thomas, C. G. A., 1956,"The Transmission of Staphylococcusaureus", British Medical Journal, 2, 840.Hospital Coccal Infections. "A symposium,Medical Research Council Committee onCross-Infection in Hospital" Jan. 2nd,1957.McDermott, W., 1956, "The Problem ofStaphylococcal Infection" British MedicalJournal, 2, 837.Robinson, R., 1958, "Hospital StaphylococcalInfections" Oxford Medical SchoolGazette, 10, 78.Rubbo, S. D., 1948, "Infection: A HospitalProblem," Medical Journal of Australia,2, 627.CITRADEX• THE MULTI-VITAMIN SYRUPWITH THE FRESH FRUITFLAVOUR• ALL THE FAMILY WILL LIKECITRADEXAnother product of theGLAXO LABORATORIES■■•••■N■••■■■■•••■•■•••■■■•110.•••111••■••••••■•■■•■

SPECULUM 41outc LREPREsEHONORFI'SYT TIOby 131.VArt, nv.-6'ire arc(R0 q §E-DIV I 1°1'1(0 A I. ( 9 710 1.PizoifSPI.Oppoi44.1._ lis wri 9iftiOvji-"(?/pre#R.cre9esi) EVPr4 P-O s /•7A ofoCRS fRCO U RFKiIN MYwN,strt4 €1-- 0 •k\0°Uf.. 7 5— cvtotIVIIf) IkoGsCOF 'IrrAxel-070Oy.51K=4 -coogyovAlqwes s.FIS Siker+ HIMSELF I3 ef r4131, 57-krperrSTD EMT

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SPECULUM 43.Viewpoint on The General Practitionerin The British National Health ServiceBy E. C. Gawthorn, M.B., Ch.B. (Bristol)In 1948, as part of its "cradle to grave"social services plan, the British LabourGovernment introduced the National HealthService. Under its terms the nation's healthservices were mobilised to provide, for all,"free" medical, dental, optical, pharmaceuticaland hospital facilities.The general practitioner found himself acog in the health service machine, andfound that the scheme, which many doctorshad welcomed, proved unsatisfactory inmany respects. These can be discussedunder the headings of remuneration, lack ofprofessional freedom, and interference withthe proper relationship which should existbetween patient and doctor.The average fees of G.Ps. in Britain beforethe scheme were 3/6 for surgery consultations,5/- for home visits for privatepatients, and £1 per head per annum for"panel" patients. These latter were workerswho, with their employer, paid for a doctor'sservices on a per capita basis. The NationalHealth Service extended the panel schemeto cover everyone and the G.P. was paid justless than £1 per year per patient. The ratewas subject to review from time to time, butthe doctors have discovered the governmentto be very slow to grant concessions. Inspite of enormous rises in wages and thecost of living, the G.P. is now paid verylittle more than he was in 1948.The maximum number of patients thedoctor was allowed to have on his list was4000, and this would give him an income ofapproximately £4000 gross. However, ithas been found that a doctor cannot copeproperly with more than about 1500patients and the good and conscientiousG.P. finds that he must restrict his list—hence his income—in order to give hispatients a good and careful service. A grossincome of £1500 per annum when deductionsare made for practice premises, a receptionist'swages, a locum tenens duringholidays, car running, income tax, etc.,gives the doctor very little reward for longhours of work and long years of unpaidstudy. It is only the doctor's professionalpride and regard for his patients that hasprevented a major break-up of the serviceand strike action by the doctors.The National Health Service Act bannedthe "sale" of goodwill, and the country isdivided into areas dependent on the ratioof G.Ps. to the population. Hence, areasare designated "over-doctored", "doctored",or "under-doctored". No new practices maybe established, nor additional partners addedto existing practices, in the first two catagories;and doctors must receive governmentapproval before taking up practice anywhere.There are only very few areas inBritain which are designated "underdoctored";thus it is virtually impossible fora young man of initiative to put up his plateand build up a practice.The doctors were promised compensationfor their practices but, after joiningthe scheme, they discovered that the compensationwas not to be paid until theyretired or resigned from the scheme. Sincethe valuation of money has decreased considerablythis results in doctors getting(eventually) only a proportion of the relativeworth of their practice. The younger men,who had not yet acquired a practice, heldthe scheme as a wonderful change from theold times of having to pay large sums forgoodwill. Little did they know that thedP

44SPECULUMscheme that they hailed would result in atremendous pool of young—and ageing—doctors of the assistant O.P. grade! Theseyoung graduates are becoming more andmore disillusioned as the years go by, asthey have not succeeded in being appointedto vacancies in G.P. Although there is asuperannuation scheme, there is little incentivefor the older doctor to retire and makeway for the younger man, when he can retainthe practice in name and employ a"boy", cheaply, to do most of the work, andeasily replace him if he becomes ambitious.Nor did the younger men realise that, whilstgoodwill was no longer saleable, they wouldoften have to pay the retiring doctor a veryhigh price for the house from which thepractice was conducted as a condition ofbeing "given" the practice.This difficulty of obtaining jobs forcesmany doctors to migrate abroad or to enterfields of medical work other than generalpractice. One doctor, who recently camehere, applied unsuccessfully for 289 appointmentsin G.P. in England. As a protest heeven registered with the Department ofLabour as an unemployed person. I knowof many other young doctors with similarexperiences.The doctor is not paid for any extra servicehe gives the patient; therefore, no doctorin the scheme can run an X-ray machineor equip himself with surgical instruments orwith many of the usual aids to diagnosis.This, and other factors, result in a severecurtailing of the doctor's professional freedom.Since the pathology and X-ray facilitiesof the hospitals are overburdened withthe enormous increase in work, the G.P. isnot allowed to order special investigationson his own initiative. The G.P. does nothave access to beds in the hospital; thusmost of his interesting cases must be referredto a hospital for investigation andtreatment. He has to refer to the hospitalminor surgery such as cysts, abcesses, simplefractures, lacerations, etc., which do muchto add to the interest of practice, and whichhis training make him completely competentto perform. These factors must reduce theDesigned forDentists ...TelIn response to requestsfrom dentists for a softtoothbrush, Johnson &Johnson developed the TekMulti-Soft. This brush,with 4 rows of soft nylonbristles is particularly suitablefor gum massage. Alsoof interest is Tek Professionalwith 2 rows of tuftson a small head, allowingeasy access, and Tek Juniorwith soft nylon especiallyfor the kiddies.PROFESSIONALJUNIOR

SPECULUM 45level of the G.P.'s competence and clinicalacumen, and, after many long years of training,doctors become disgruntled when theyare reduced, in part, to a form-filling-sortingclerk for the local hospital O.P. department.The fact that no one can obtain "free" medicine,dressings, or surgical aids without adoctor's prescription fills the doctor's waitingroom with many people who only wantthe doctor to write out their shopping listfor them! The doctor, therefore, has muchtoo little time for examining his patientswho are really sick—this again reducing hiscompetence as a clinician. Due to the overcrowdingof the hospitals which results fromthe above-mentioned, there is an enormousdelay in the O.P. department and a waitinglist for essential X-rays, etc., that is so longas to be come dangerous. The G.P. losessight of his referred case and, several monthslater, receives a letter from the hospital—long after he has forgotten it.The relationship between patient anddoctor is altered under the scheme. Thedoctor's clinical records of his patient areavailable for inspection, on demand, by alay government inspector, thus destroyingthe much cherished and long establishedtradition of professional secrecy. Since thepatients have all the rights under the schemeand the doctor none they are, in general,much more demanding in their attitude. Apatient may report his doctor to the localhealth committee for many and various"misdemeanors" for which the doctor can besummarily fined without right of appeal. Adoctor was recently fined for refusing to seea patient under the following circumstances:the patient telephoned to say that his sonhad swallowed several tablets accidentally.The doctor, who was in bed with influenza,told the father to take his son quickly to thehospital which was very near to the patient'shouse. The doctor telephoned the hospitalto forewarn them of the patient's arrival.For not going to see the patient, althoughthis would have meant a delay in his treatment,the doctor was fined £25.In the country areas the G.P. is slightlybetter off than in the towns. Country G.Ps.are allowed to charge mileage fees to thegovernment and are also allowed beds in thesmall "cottage" hospitals where they can dosome minor surgery. The age of the G.P.surgeon is dying, however, since the schemeof itinerant consultants for small countryhospitals was started. In general, patientsin the country are less demanding withtrivial complaints than those in the cities,and the country G.P. is able to practicemedicine in a more orthodox manner.There are some advantages of the schemefrom the G.P's. point of view. He has nobad debts, nor has he any accountancy fees.In Australia, the G.Ps. have different rulesfor prescribing, different fees, and differenttypes of certificates for private, Repatriation,pensioner and workers' compensationpatients. In England all patients comeunder the one scheme. The doctor in Australiamust, on occasions, give the patientless service than he really needs because thepatient feels he cannot afford ample medicaltreatment. In England the doctor has nosuch worry. With our limited State aidhere, and with the pension scheme, in theindustrial suburb in which I practice I findvery few people who cannot afford medicaltreatment. If the enormous cost of theBritish scheme is taken into account—itcosts £700,000,000 annually (ie., £14 perhead of the population)—the scheme resultsin far more poverty for the community as awhole.From the above considerations it is evidentthat, from the G.P's. point of view, thedisadvantages of the British scheme far outweighits advantages. This year there willbe more registrations of British doctors inVictoria alone than the number of studentsin the present final year at the MelbourneUniversity. There must be somethingwrong with a scheme which is forcing doctors,in increasing numbers, to migrateabroad. If an alteration of the present systemin practice is contemplated in Australia,it is essential that the medical professionremain as free as possible so that the doctorremains a free professional man and not aState public servant; and that the harmonyof the private relationship which shouldexist between patient and doctor is undisturbedby the eternal triangle made by State :interference.Hear of the first year student who thoughta pseudopod was an ovarian tumour?

46SPECULUM(.71•71111WalrNIMUFWWWW1111111•1•1111•11,•1sz;es.SAPODERM (D.H.A.)Hexachlorophene (2%) SoapIn Theatre and SurgeryA three-minute scrub with Sapoderm is as effective asten minutes with plain soap, even when check countsare made ofter two hours.Dull. J. A., Tintel, H. A., Ellis, J. L., and Nicholls. A., Surg.,Gynec. and Obst.. 1950, LX.In Home, School or OffLceFor the general control of skin infection . . . and as anall-day deodorant — after lathering axillary regions.Non-LmtatmgFrom numerous tests and reports, Hexachloropheneappears to be non-irritating to the skin and to have nosensitizing effect.III1I1■II■■AVAILABLE IN LARGE 5 OUNCECAKESDistributed throughoutAustralia byALL D.H.A. HOUSESwwwwwwinrorMnevnffavarommmawarwacamransiwornivroisliva disi ragurisu

SPECULUM 47A CONCISE DICTIONARY OFMEDICAL KNOWLEDGEThe following is a symposium entitled"Medicine via the Lacy Press". We see herethe reporting of medicine in simple, clear,concise language, not necessarily with anyreference to the truth, and we feel: if ONLYtextbooks were written like THIS!The following examples are not imaginaryand in all cases there is not the slightest"Herbie"exaggeration. On request the author willdemonstrate a "trumped-up" article forcomparison.The author can be contacted in personnow, but at the conclusion of the exams thisyear will, regardless of result, be contactableonly in spirit (s?).Bleeder's DigestArticles ofDO YOUR BREASTS FEEL FUNNY?By Dr. Harris B. QueenlieghThe author, an eminent American authorityon Cancer, particularly in the mammaryglands (breasts, or something worse, to you)tells how you can save yourself from thisfrightful disease.My article is addressed primarily toladies, although, as this is a family magazine,I daresay there will be some interestto even the males of the family. This isbecause even males have breasts, which isnot as confusing (really) as you might think.Basically, there are two types of breast:true and false, and the diseases of the latterare two-fold only. Firstly, a diffuse hypertrophy,which often has an extremely acuteonset and leads occasionally to symptoms ofsevere embarrasment—and even collapse.Secondly, an acute sagging is described—this can have almost catastrophic results,with severe collapse. You may see someonestricken in this way in the street. ToApril 1st, 1959lasting interesttreat such a patient, especially when collapsed,help her to lie down, but on noaccount loosen the clothing as this couldprove an even greater embarrassment to theconstitution.The true breast has only one disease.Lumps. These come in varying sizes andshould 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 beginningtheir death-march. Thousands of tiny littlecells all multiply, and next thing you knowyou've lost weight, you can't eat, you'reunable to sleep—bang! you've had it.But there's no need to worry.To help you tell if you've got cancer weattach this list. Just put Yes and No againstthe questions.(a) One yes only—you're safe.(b) Three yesses—still benign.(c) Five yesses—you're spastic.(d) Seven yesses—definitely neoplastic.

48SPECULUMKANCER KWIZLosing weight?Get up at night? (You can interpret that asyou 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 starvation2. B.O.3. Waking up tired4. Bad breath5. The "Shakes"Footnote:The author, Dr. Harris B. Queenliegh,was born in a water closet. His mothersays, "Harry was always one who wouldn'twait."He graduated M.D. from the Four SquareChristian College of Medicine, Wahoo,Nebraska, in 1931.Since leaving the A.M.A. he has mostlywritten for the press, although he runs aclinic for single girls on Saturday afternoons.He has been married twice. Neithermarriage was a success because his wives"just couldn't get along together."The Soviet CataractOne reader writes: "I wonder could youtell us something in your excellent magazineof medicine as practiced in the U.S.S.R. Iam very interested in this subject.Yours sincerely,E.J.W., Ceylon."In reply, we publish the following article.Photographs are by E. Bearsky (People'sMedallion of Photography).MEDICINE has been practised inU.S.S.R. since time "in memorium". Sincethe Revolution, however, great advanceshave been made.There are 30,000,000 doctors in U.S.S.R.,of which some 500,000 are still alive. Thereare many nurses and wardsmen. The hospitalsare huge and thoroughly up to date.April 1st, 1959There was once a young girl who, enthralledwith her first love affair, arrangedfor her boy-friend's face to be tattooed overher heart. However, the friendship did notlast, and within a short time she had foundherself a new companion who, she felt, deservedalso his imprint—this time tattooedon the right side. This again broke up, buther third venture was more successful, andmarriage took place. On the wedding nightshe explained the significance of her tattoosto her new husband. Instead of showingjealousy he laughed heartily."Why do you laugh?" she asked."I was just thinking," he replied, "thatwithin a few years what long faces they willhave!"One of Moscow's general hospitals has beenthe most up-to-date in the world since 1929,when it was built.Disease is rare in Russia today thanks tothe excellent medical service of the third"five-year plan". This has resulted in someRussians living to the age of 140 and evenlonger.This lack of disease threatens unemploymentin medical circles. Fortunately, manydoctors volunteered as labourers in thehighly successful "Virgin Lands" settlementscheme.Russians have been responsible for manyadvances in medicine, and their names arenow household words all over the world.Hence, we need not mention them in thisarticle.

SPECULUM 49Mr. Nikita Kruscheff congratulating Mr. Letcher Poppinoffen before presenting hiswife with the Soviet Medal of Heroic Motherhood-10 children.Our photographs show something ofmedical teaching in Russia. It is regrettedthat a poor coverage is being given to thissubject in this article. More may be learntabout Russian medicine in the followingfilms, where doctors or medicine play apart."1917—The Bloody Year", with E. Solmoyand D. Listokniff."Lenin The Great", with P. Petrovich andG. Podsnoppikoff."The Birth of Lenin", with L. Pavlov (asLenin's mother) and several genuineLenin relics.Medical students receiving advancedtraining in temperature taking at the convertedchapel in one of Moscow's large upto-datehospitals.Soon they will get a chance to take a temperaturethemselves. (In Canitalist countriesthe students don't bother to take thetemperature.)THE MOSCOW UNIVERSITY

50 SPECULUMThe Australasian MostYOUR GONADSAND YOUApril 1st, 1959You've got these glands, see? All overyou. They make you what you are.These glands aren't all as obvious to theeye as others. They're deep inside thebody, pouring out their "secretions" (that'sthe stuff they pour out) into the blood."So what?" you say. "What's it in theblood for?"Hah. That's the whole trick. It gets atthe cells of the body. Marvellous, isn't it?And that, briefly, is how it works.Charlie Flaherty, of Wahoo, Nebraska,U.S.A., had a childish ambition to grow abeard. He did, all right, but now his headis as smooth as a billiard ball. Silly, isn'tit?Grace Kelly was a wow of an actress.Brother Jack was an Olympic sculler.Scientists are sure that their pre-eminencewas due to their sex. If Grace had tried tobe a rower, where do you think she'd be?And can you imagine Jack as an actress?How did Sabrina get that way? Thescientist now knows the answer.

"MEMIONE11.11111.111SPECULUM 51MEDICINEFor years doctors have been puzzled byone problem—how can you listen to apatient's heart without embarrassment?Many doctors claimed that the ear-to-breastmanoeuvre certainly elicited thrills, but oftenprovoked murmurs from the patient, especiallyif female.Last week dapper, moustachioed Frenchmedico Rene Laennec* came up with theanswer to a maiden's prayer. Laennec'sear trumpet, made of rolled-up paper (price,1 sou), can be used to listen to the heartwithout actually placing the head on theCHYMEApril 1st, 1959A weekly newsmagazineWOMAN'S SAY?April 1st, 1959breast. Trust a Frenchman to think of theladies! Laennec now visualises his "stethoscope"as a quite elaborate affair of rubbertubing.Came to him in a flash:Laennec, born in 1781, is now professorof medicine at the College de France. Hisother work centres about liver disease.Laennec says the idea came to him "in aflash".Science awaits the results of this discovery.*Full name: Rene Theophile HyacintheLaennec."A DOCTOR ANSWERS"Send your medical queries to Dr. Howardand he will answer them in this column eachweek. He regrets his inability to enter intoany correspondence.1. 0.—I have varicose veins and seem tohave this sore on my leg. What doyou think I should do? Also, doyou think I am overweight? I am32 stone (dressed)."Anxious," N.S.W.A.—You may not be overweight. Youmay be 9 feet tall or wear a lot ofclothes. You had better write tome again.2. Q.—I am a girl of 25 and recently I metthe man of my dreams. We justclicked. Foolishly, I gave himeverything in an effort to keep him,but he just hasn't contacted mesince. That was 6 months ago. Doyou think you could give mehormones to make me more attractive?"Anxious", Q'land.A.—Well, I, er . . . .Q.—And also I seem to have this dischargedown below for the last fewyears. What is it?A.—I am sending you one gross ofassorted booklets which may helpyou.* * *3. Q.—I am a woman of 62. I seem tohave horribly lumpy breasts latelyand am losing weight and coughingup blood. Also my hand feelsnumb and my back hurts. Canyou help me?"Anxious," Vic.A.—Certainly. I am sending you thename of a well-known proprietarytonic which will soon put you onyour feet.* * *4. Q.—My young daughter aged 13 hasjust started menstruating and I findthis rather odd as I have alwaysthought she was a pseudo-hermaphrodite."Anxious," S.A.A.--Mother knows best.

52 SPECULUMOFFERSYOUTHE FINESTINPHARMACEUTICALSDEPEND upon the I.C.I. range of Pharmaceuticalsas offered by the I.C.I. Representative.Backed by the vast I.C.I.resources and research these thoroughlytested I.C.I. products are your guarantee ofthe best and finest in Pharmaceuticals.ICI PHARMACEUTICAL PRODUCTSINCLUDE -• "Avloclor" Chloroquine Diphosphate— for malaria and amoebiasis.• "Avlosulfon" Dapsone B.P. — indicatedin all forms of leprosy.• "Cetavlon" Cetrimide B.P. — aninvaluable detergent and bactericide.• "Cetavlex" Antiseptic Cream — forwounds and burns.• "Fluothane" — the new inhalationanaesthetic.• "Hibitane" Chlorhexidine — the newICI antiseptic.• "Mysoline" Primidone — the newanticonvulsant for epilepsy.• "Paludrine" Proguanil HydrochlorideB.P. — a safe antimalarial.Made by theleaders inPharmaceuticalManufacture.• Penicillin with "sulphamezathine" —for topical application.• Pethidine — possesses analgesic, antispasmodicand sedative properties.• Phemitone — antiepileptic and antispasmodic.• "Icipen" V — phenoxymethyl penicillinfor oral use.• 'Siopel' Cream — skin protective forprevention of contact dermatoses andrelated skin conditions.• "Savlon" Antiseptic Liquid — themodern liquid antiseptic.• "Mepavlon" Meprobamate — foremotional and muscular tension.• "Sulphamezathine" SulphadimidineB.P. — a potent Sulphonamide.• "Trilene" Trichlorethylene — in analgesiaand anaesthesia.Products of Imperial Chemical Industries Ltd.Pharmaceuticals Division, EnglandIMPERIAL CHEMICAL INDUSTRIESOF AUSTRALIA AND NEW ZEALAND LIMITEDSales Offices, Melbourne, Sydney, Brisbane, Perth, Adelaide, Launceston, HobartMED .202% 5990

SURGERYMr. T. H. AcklandSPECULUM 53DIAGNOSTIC QUIZ1. A patient with the diagnosis of chronicnephritis finally died in a medical wardwith symptoms and signs which seemed tobe those of uremia. The blood urea beforedeath was 250 mg. per cent. However, avisit to the P.M. room brought great discomfortto the physician concerned (andalso to the R.M.O., who was the writer).What was found?2. Cholecystectomy was performed ona young woman of twenty-eight, a nurse.Her convalescence was associated with whatseemed an inordinate amount of pain, andthen her wound refused to heal. Even afterfive months, several sinuses were dischargingpus freely, and a high pyrexia wasusually present. All investigations werenegative, and driven to it, the surgeon reopenedthe abdomen to exclude a packbeing present. Again the wound continuedto discharge. Why?3. A garage mechanic who had receivedno injury complained of a hard swelling onthe back of his right wrist, made very obviousby palmar flexion. It seemed muchharder than a ganglion, and was slightlytender.4. A medical student came with a wristdrop due to a right radial nerve paralysisaffecting the forearm extensors. It had beenpresent two weeks. He had had no fractureof the humerus, and had not used crutches.What was it?5. A young woman of twenty-two wasreferred from the country with the suggestionthat she had an abdominal aneurysm.She had no symptoms but there was visibleand palpable pulsation in the epigastrium.What was the diagnosis?6. Acute cholecystitis had been diagnosedconfidently in a patient of fifty-fivewith high temperature, pain, tenderness andrigidity at the right costal margin, but atoperation embarrassment arose when aANSWERSnormal gall-bladder was revealed. This isan important trap, because it is a commonone. What is it?7. My garage attendant limps and wearsa toe spring for a permanent foot drop. Heacquired this four years ago after being inhospital for the treatment of a badly infectedfinger. How did this come about?8. A woman of forty had suffered manyyears of almost unbearable pain in the tip ofher right middle finger, shooting up her arm.She had been to many doctors without obtainingrelief and had recently been referredto a psychiatrist. She spoke of suicide.Clinical examination was negative exceptthat she would not allow the end of herfinger to be touched.9. A young girl came with a smallabscess over the left malar region. It wastreated as such, but six months later shereturned because there was still a dischargeof pus. What was the reason?10. A young man of thirty-five had anunexplained anaemia of such severity as torequire admission to a medical ward forblood transfusion. He had no symptomsother than weakness, and blood examinationsdid not enable a diagnosis to be made.After discharge from hospital the anaemiarecurred and he was readmitted with ahaemoglobin of 45 per cent. What shouldbe 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 withbronchitis for some time, was referred forsigmoidoscopy because of troublesomediarrhoea. What first thoughts beforearranging for sigmoidoscopy?12. Following cholecystectomy and explorationof the common bile duct, the latterhad been closed by accurate suturing, and atube inserted to the gall-bladder bed. Onthe 5th and 6th days the pulse rate rose to120 and the abdomen became silent anddistended. There was only a little blood-stained discharged from the tube.should be done?ON PAGE 59What

54 SPECULUMMEDICINEDr. G. A. Pennington1. Three young women were admittedto the same ward within 24 hours with similarsymptoms and signs—acute colicky generalabdominal pain of 24 hours duration,localising in the right lower quadrant, mildpyrexia, frequency of micturition with slightscalding, vomiting without relief of pain,tenderness over McBurney's point but norigidity. P.R. N.A.D. Breath—"abdominal",tongue furred.Microscopy of the urine revealed—In (a) pus cells in profusion, red bloodcells and bacilli.In (b) pus cells, and red blood cells: noorganisms seen.In (c) many red blood cells, pus andepithelial cells, granular casts and afew cellular casts. Albumen was alsopresent in a moderate amount.Would you advise operation?2. A middle-aged ex-serviceman wasadmitted with a history of right upper abdominalpain and tenderness of subacuteonset, persistent for two weeks. There hadbeen two previous attacks which had slowlysubsided. Tenderness over the liver wasnoted, maximum in the gall bladder area;leucocyte count was normal. - Temperaturewas remittent, maximum 37.8° C. No gallbladder shadow was seen on cholecystography.What course will you take?3. A carpenter aged 50 who had spentall his life in Victoria complained of diarrhoeaof one week's duration following anaccident to his son. He had previouslysuffered from intermittent diarrhoea coincidentwith domestic upsets, relieved bysuperficial psychotherapy and sedation.Sigmoidoscopy had previously revealed nolesion and barium clysma examination wasnormal.What would be your management?4. A male aged 60 was brought to hospitalsemicomatose and with a superficialabrasion in the right frontal region. He wasa known chronic alcoholic. There were nophysical signs of a severe head injury orsignificant variation in reflexes. He wasirritable when roused and with recovery ofconsciousness was confused, restless anddifficult to control. He talked incessantlyto the annoyance of others in the medicalward.Management, please.5. A housewife in her forties was undertreatment for nutritional anaemia, her bonemarrow having shown normoblastic haemopoeiesisduring a relapse. She was givenfolic acid orally and within a month becamepsychotic and developed abnormal plantarreflexes although they were not of classicalBabinski type. Moderate normocytic normochromicanaemia was present.What would this sequence of events makeyou suspect?6. A housewife aged 55 suffering froma refractory anaemia, with no symptomsother than those due to anaemia, also hadsigns of mitral stenosis. X-ray examinationto determine the cardiac size and contourrevealed the cause of her anaemia.7. A farmer aged 24 years reported tohis doctor complaining of pain in the rightside of the chest and was found to have signsconsistent with a large pleural effusion.Aspiration was complicated by coughing,cyanosis, shock and expectoration of liquid.Advice was requested by his doctor regardingresuscitative measures and explanation.What would you advise and suspect?8. A male student, aged 20, who had"not been well" for two weeks found difficultyin riding his motor cycle home from aparade because of an uncontrollabletendency to veer to the left. On the followingday he was dropping things from his lefthand, drowsy, irritable, and strange in hisbehaviour. Headache was constant. Hewas found to have neck stiffness and a lefthemiparesis. Fundi were normal. Generalphysical examination revealed no lesion incardiovascular, respiratory, alimentary orgenitourinary systems. He had had repeatedX-ray examination of his chest because ofsome abnormality Mantoux test was negative.Provisional diagnosis and investigations?9. What is a relatively common cause ofauricular fibrillation which is inadequatelycontrolled by digitalis?10. Under what circumstances is the intravenousadministration of digoxin desirable?

SPECULUM55MI-DICAL MI -DLLYS1959"TheWIZARDof OS"KHiPFRIDAY, 11th DECEMBER

56 SPECULUMPAEDIATRICSDr. H. N. B. Wettenhall1. A small boy aged twelve monthsplaying happily in the yard suddenly droppedwhat he was doing, screamed, and wentvery pale. His mother attempted to comforthim without success but when the doctorarrived twenty minutes later the child,apart from some pallor, appeared perfectlynormal. What diagnosis would you suspectand what action would you take insuch circumstances?2. A child of ten months cries whenpicked up and his mother notices that he isunwilling to move his right leg. Possiblediagnosis and management?3. A baby of four months weighs onlytwo pounds more than when he was bornand on examination is found to have a loudsystolic bruit over the praecordium. Hisheart is slightly enlarged and the liver ispalpable two fingers breadths below theright costal margin. Diagnosis?4. A boy, aged 8, had painful swollenknees, ankles and wrists for two days. Hewas feverish and there was a faint systolicbruit audible in his heart. On careful examinationa petechial rash was visible overhis ankles and buttocks. Diagnosis?DOING FINALS ?Then arrange to receiveSPECULUMin future years and keepin touch !See your Year Representative5. A baby had an upper respiratorytract infection which had been treated withpenicillin. Five days after the onset thebaby refused his feeds, looked pale, and hismother said he was not taking any notice ofher. What diagnosis would you suspect?6. A girl, 5 years old, had fever up to103°F for three days. The only findingswere a slightly runny nose and a cough. Thechest was clinically clear, but the childlooked sick. Diagnosis to suspect?7. A boy, aged 21 years, had croupwhen he was ten months old, and for thepast two months his mother had noted noisybreathing and slight cough. He was otherwisewell. X-ray chest showed clearer lungfields on the right than the left, and hismother said the boy often had peanuts toeat. Diagnosis?8. A girl of 6 had chicken pox, followingwhich for two months she complainedintermittently of headaches on waking inthe morning. She had also vomited on threeoccasions. On examination she was clinicallynormal. Diagnosis and management?9. A boy, 8 years old, suffered fromepilepsy. He had been treated with dilantinand mysoline, and for six months tridionehad been added. For two weeks he was notedto be puffy round the eyes, his urine containedover half albumin on boiling. Hisblood pressure was normal, and there wasno haematuria. Diagnosis?10. A baby, aged 6 months, had a coldwhich progressed to bronchopneumonia.Staphylococcus aureus was grown from athroat swab, and the baby was treated witherythromycin. At first the baby improved,but after a week the temperature was rising,respirations were more rapid and there wasno doubt he was sicker. Diagnosis andmanagement at this stage?11. Mary, 51 years old, was brought tothe doctor because her younger sister, Jane,was as tall as she was. Mary was also slowin her reactions and looked sallow. Shedid not eat much and was mildly constipated.Diagnosis?12. While his mother was doing herhousehold chores the baby boy, aged 15months, was playing happily on the floor.His mother suddenly noticed that the babywas deep blue in colour and rushed him tohospital. Diagnosis and management?

UPVSPECULUM57OBSTETRICS ANDGYNAECOLOGYDr. N. A. Beischerstage of labour. The foetal heart immediatelybecame irregular and disappeared.5. An 11-year-old female mental defectivewas brought to gynaecological outpatients'department suffering from anoffensive yellow vaginal discharge.6. For card players: What is the gynaecological"Full Hand"?1. A woman aged 22 years presentedcomplaining of four hours abdominal painwhich had become progressively severe, andwhich radiated to the loins. Her last normalperiod had occurred 12 weeks previously.She had been unable to void sincethe onset of the pain. Examination revealeda tender midline mass arising from thepelvis, extending to the level of the umbilicus.The mass was smooth and dull to percussion.Vaginal palpation showed a tendermass in the Pouch of Douglas projectinginto the vagina, the cervix being displacedanteriorly behind the pubic symphysis.2. A woman aged 75 years presentedwith a 3-month history of post menopausalbleeding. Examination revealed a firm,fixed mass in the right iliac fossa. Thismass was palpable vaginally high in theright fornix, and was the size of a tennisball. It was tender and seemed regular. Theuterus was small, anteverted, and mobile.3. A woman aged 26 years presented at32 weeks gestation with a history of acuteright upper abdominal pain following a boutof coughing. Examination showed a tendermass in the right hypochondrium. Thefoetal heart was regular but the foetal partsdifficult to palpate.4. A multigravida at term had a brightpainless two-ounce vaginal haemorrhagewhen the membranes ruptured in the secondA Patient's PrivilegeMEMORANDA TO PATIENTSFrom "Hospital & Community"1853No patients shall play at cards or dice, orgamble or smoke tobacco or spit on thefloor, or deface or injure any part of theward or any furniture, bedding or clothingtherein, or sing, blaspheme, or use rudeor indecent language.1953Dear Patient,It is unfortunate that you have had toenter this hospital, but we wish to assureyou that we shall do everything possible tomake your stay with us as happy as circumstancespermit. To us, the patient isthe 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 youinformation as to contacting Ministers ofReligion, posting letters, visiting hours, RedCross library service, daily newspapers, andthe service provided by honorary workerswho bring a trolley from the Kiosk, so youmay purchase toilet requisites, cigarettes,sweets, and such like. If necessary, you willalso be visited by an Almoner to discussarrangements for your transfer later to aconvalescent home, and also other mattersconcerning your welfare after you leave thehospital.May we express every good wish for yourspeedy recovery?Yours sincerely,On behalf of The Royal Melbourne HospitalManager.

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SPECULUM 59ANSWERS TO DIAGNOSTIC QUIZSURGERY1. Perforated pelvic appendicitis withgeneral peritonitis. It is difficult to be surewhether it is more dangerous to have amedical condition in a surgical ward or asurgical condition in a medical ward!2. The answer was provided on anotheroccasion when still further exploration wascarried out. A small ball of cotton woolwas found—material not used during operations.She was a confirmed pethedineaddict and had kept her wound from healingby pushing in wool pledgets. Thermometerreadings had been kept elevated by someform of deceit never discovered.3. Carpal bossing (carpe bossu), a bonyovergrowth of the dorsal aspects of both thecapitate and the 3rd metacarpal, is a verycommon condition not spoken about verymuch. It is usually symptomless but in thiscase tendons had been slipping over theprominence.4. Much questioning was needed to confirmthe suspected diagnosis of "Saturdaynight paralysis". Friends had come alongto watch T.V. They had a few drinks andit was 4 a.m. when he awoke with his arm"feeling funny", because it had been hangingover the back of the chair.5. No abnormality was present,—insome people, either thin or fat, the abdominalaorta is unexpectedly visible and palpable.6. The patient had a pyonephrosis dueto a stone impacted at the pelvi-ureteraljunction, and this was removed with difficultythrough the inappropriate anterior incision.Pyonephrosis should always be excludedbefore operating for acute cholecystitis.7. Penicillin was injected into the sciaticnerve causing nerve atrophy. It is thewriter's opinion that no nurse has sufficientknowledge of anatomy to be allowed to giveinjections into either the buttock or the arm.The radial and sciatic nerves have oftenbeen permanently damaged in this way. Theanterior and lateral surfaces of the thighare the only safe places.8. This patient has a sub-ungual glomangiomahalf the size of a pea. It couldonly be seen when the nail had been removedand shelled out with ease. Allsymptoms disappeared.9. This was a sinus from an abscessassociated with a left upper tooth. Thediagnosis was not so obvious as it mighthave been on the lower jaw.10. Carcinoma of the caecum, whichmay present in this masked fashion withtragic results. The anaemia in this case hadbeen present for six months before a bariumenema was carried out, and operation disclosedan inoperable lesion.11. Yes—impacted faeces, the "diarrhoea"was mucus only.12. The risk of a diagnosis of paralyticileus was too great and immediate re-openingof the abdomen was advised. Therewas choleperitoneum in spite of the fact thatno bile issued from the tube, and a fatal outcomewas narrowly averted. When thecommon bile duct has been opened it shouldnever be closed, but always drained; solikely is bile, with its low surface tension, toleak.MEDICINE1. The history and signs could not excludeacute appendicitis. The leucocytecount was not helpful although raised in (c).All were operated upon, the diagnosisbeing:In (a) acute appendicitis in addition toand 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 presentand recovery occurred.2. Enquiry elicited service in MiddleEast and New Guinea. He had not sufferedfrom dysentery. X-ray revealed some elevationof right hemidiaphragm. Microscopyof stools disclosed cysts of E. Histolytica.Anti-amoebic treatment resulted in completeremission of amoebic hepatitis.3. General examination revealed no abnormality.Stools were macroscopicallyliquid and faecal with traces of mucus. Sig-

60 SPECULUMmoidoscopy was again carried out and revealedtypical acute amoebic dysentery.Vegetative forms of E. Histolytica weredemonstrable in a scraping from the edgeof an ulcer. He responded to treatment foramoebiasis.4. A person who is "fighting drunk" orhas abnormal behaviour, irritability or restlessnesswith evidence of even a minor headinjury must be suspected of having asubarachnoid haemorrhage. X-ray examinationrevealed a fractured skull, and asubarachnoid clot was evacuated after adelay of five days.5. Folic acid may precipitate neurologicalmanifestations of B12 deficiencyespecially subacute combined degenerationof the cord, when given to a person sufferingfrom pernicious anaemia. Her bone marrowon three occasions was normoblastic;but the first examination was vitiated byprior administration of liver extract.She responded well to B12 parenterally.6. Symptomless carcinoma of the lung.7. Puncture of a pulmonary hydatid wassuspected and treatment as for the apparentlydrowned with up-ending of the patientwas urged. He recovered and a shrunkenhydatid cyst was subsequently excised byMr. Hayward.The signs of a pulmonary hydatid may bethose of pleural effusion and X-ray examinationof the chest should precede aspirationas a routine measure.8. In view of the short history, neckstiffness, mental changes and the hemiparaesisin a young man with abnormal pulmonaryfindings radiographically, a provisionaldiagnosis of tuberculous meningitis wasmade.Made In AustraliaIn addition to their range of injectablepenicillin and streptomycin preparations,Glaxo Laboratories now producepenicillin V at their Antibioticfactory at Port Fairy. Oral tablets asthe potassium salt are available asC.V.K.Abnormally large hilar shadows werepresent on X-ray examination and lumbarpuncture revealed increase in Lymphocytesand protein and a fall in chlorides and sugar.Mantoux test was negative and remained soto the end. Acid fast bacilli indistinguishablefrom M. tuberculosis were isolatedfrom the urine on one occasion. Remissionsoccurred but death from hydrocephalusresulted 12 months later despitestreptomycin. Autopsy confirmed the diagnosis.No reaction to the Mantoux Test does notexclude tuberculosis.9. Thyrotoxicosis.10. When there are positive indicationsfor digitalization, the oral route is precludedby vomiting, and digitalis or its glusosideshave not been taken for two weeks.PAEDIATRICS1. The history was suggestive of intussusceptionbut initially no tumour was palpable.It was considered that the childshould be kept under observation and whileon the way to hospital he had anotherattack of screaming and abdominal pain,following which the typical sausage-shapedtumour was palpated. The intussusceptionwas reduced at operation and the baby madea complete recovery.2. The most likely diagnosis is scurvythough the mother may fear the child haspoliomyelitis. Osteomyelitis would be accompaniedby fever, and trauma might needto be considered in some cases. An X-rayof the leg would clarify the diagnosis andascorbic acid would provide the cure.3. This could be a ventricular septaldefect, patent ductus, pulmonary stenosis oraortic stenosis. Patent ductus is the one tosuspect because unrecognised the childcould die, whereas surgery will cure.4. This boy was a case of Henoch'spurpura. In about ten days time he developedthe signs of acute glomerulonephritisfrom which he ultimately recoveredcompletely.5. Examination showed minimal neckstiffness, and lumbar puncture revealedpurulent cerebrospinal fluid from which H.influenzae was cultured.6. On the third day the child hadKoplik's spots inside her cheeks, and the

SPECULUM 61typical rash of measles appeared on thefourth day. Always a starter in the earlyschool age child.7. On bronchoscopy it was not the peanutthat we confidently expected to find, butgranulation tissue infiltrating the bronchiallumen from a tuberculous gland which hadproduced the ball-valve obstruction. TheMantoux test later became positive.8. Lumbar puncture showed clearcerebrospinal fluid both macroscopically andmicroscopically but the pressure was over300 mms This finding was repeated amonth later, following which ventriculographywas done and an astrocytoma wasfound in the frontal lobe.Moral.—Headaches in young children arerarely functional.9. Nephrotic syndrome, which clearedwith simple bed rest and the cessation oftridione therapy.10. Staphylococcal pneumonia in infancyis notorious for progressing to complications,of which suppuration in the lungand empyema are the most common. AnX-ray of the chest suggested the presence ofan interlobar empyema which was confirmedat operation. Following drainage of theempyema and the addition of chloromycetintherapy the baby made a complete recovery.Unfortunately results are not always sosatisfactory.11. Mary was suffering from juvenilehypothyroidism. An X-ray of her handsand wrists showed markedly delayedepiphyseal development. Serum cholesterolwas 400 mgm, and Protein Bound Iodinewas 2.4 micrograms. She was treated withThyroid, grew six inches in the next tenmonths, and became a happy, normal child.12. The baby had drunk some liquidfurniture polish and was suffering frommethaemoglobinaemia. Following an intravenousinjection of methylene blue he madea prompt recovery.OBSTETRICS ANDGYNAECOLOGY1. Incarceration of the gravid uterus.Acute on chronic urinary retention. Twinpregnancy, later confirmed, explains theearly onset of symptoms.2. Granulosa cell tumour of the rightovary.3. Extensive haematoma of right rectusmuscle.4. Vasa praevia with velamentous cordinsertion.5. Trichomonal vaginitis.6. A young woman who, two monthsfollowing 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'SMINDI 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 studentIs constantly centred on sex!He can give you a good dissertationOn bees, birds and flowers and their ways,But a view he can air with assertionIs why women shouldn't wear stays.He knows all about nervous disordersAnd numerous other upsets;He possesses a great admirationFor the guy who invented curettes.He knows well the osseous structure,Especially the bones of the hand;Which have a peculiar affinityFor 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 deviationWhich a man simply cannot pass by!By now you'll have reached a conclusionQuite 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 enanisticTill a foot fetishisticYoung man became one of her beaux.—Speculum, New York.

62 SPECULUMA New RubaiyatBy 0., My!(With Pedagogic Footnotes)Awake! For boozing from the bowl all nightHas, I'm afraid, made me a little tight;From dreams of Eastern damsels cease toleer,Review this (and many another) year.When first I started on this courseMy 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 aimTo 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 derbirdie."

Nir 111111111111■11■111111MMIEIMSPECULUM 63Hogarth told the tale of the Rake,Such a tale I could also make;Yet of those men I will now tellWho tried to rescue me from HOver 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.tNever will I forget the frightI got when I saw Professor Wright;This was nothing to my stateWhen I became his question-bait.Fame never seems to come the wayOf friendly, smiling Lesley Ray;And yet when he just grins at meI know of places I'd rather be.Nor can I forget my only tussle(Thank God) with Professor KennethRussell;Why did he raise up such a fussJust 'cause I knew not the humerus.ttCf. Yeats: "The Lake Isle of Innisfret•tCf. Shakespeare: Know ye not Agincourt?

64 SPECULUMERYTH Roc yrE(ENt.ARicoIn Division 1, Doctor LavarackWe called (jestingly) Happy Jack,Because, in two years, all that whileNever was he seen to smile.Jack Legge's left handed hieroglyphicCode, on the board, looks terrific;But proves to all, I am afraid,Biochemists are born, not made.Professor Victor Trikojus claimsThat Biochem's on the march;Krebs and Ogsters laudable aims"Cannot fail to ensure that this subject goesforward to take its place at the forefrontof the medical sciences."Pathology's Professor KingIn his subjects acknowledged whiz ding!Yet his pupils baffled looks wearAt the time he spends on wound repair.

SPECULUM 65Then 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 GreenIn orals makes you feel serene;Prof. Christie, on the other way,May show that you have feet of clay.Professor S. D. Rubbo's wayIs "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.

66 SPECULUMAnd 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 RadiologistWho likes to know your name, I wist;He puts you on his little listSo never let him see you drunk.Professor R. H. Lovell's fameRests (rightly) in what he knows;A cold, you see, is not a cold,Unless you have a runny nose.Professor Ewing, I'd allowTo 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) providingThey do the same for us.For the moving finger writes 'tis true,And soon we meet our doom;And we are but some initialsIn 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 astudent in viva.Aponeurosis: Fear of nocturia.PREDSOLA range of products containing a completelysoluble form of prednisolone;of particular value in ophthalmic preparationswhen freedom from irritationdue to particle size is so important.GLAXO LABORATORIES (AUST.)PTY. LTD.THE MEDICAL STUDENTS'SONGBOOKGentlemen, John South's new edition ofthe Medical Students' Songbook is aboutto be published. We have been waiting forthis for a long time and guarantee that ithas surpassed all expectations.All our old favourites are included in it.There is "Foggy, Foggy Dew," "Bible Stories","Swimming Underwater", "Life Presents aDismal Picture", "The Tertiary Kind", thenice girl with the "Crossed and bloodshoteye and the gin spilt down her singlet," and"H.O.P."—YAHOO!Then there are hits from the Medleys ofthe past few years like, "I Want a BloodyHumerus for Orals," "The Drinking Song,""Sit Down for Piles of Fun," "The StatelyHomes of Carlton"—"have lots of girls ontap"—"Thanks for the Mammary," and, ofcourse that song we haven't been able tocommission any "sweet young thing" to sing,"The Bustin' Begins." Here's a preview ofthe last verse:I fell at the Melbourne,Ah, but not completely,He was still pantingWhen I told him sweetly,Don't feel so badCos I've been promised by my dadTo a rather backward ladWho's a student from Prince Henry's.Home of the BravesLand of the Slaves,Place where the bustin' begins.Every student should buy at least onedozen copies. They cost no more than 4/-,and he can sell them to outside friends forat least 10/-!! Take one to that next partyand you and your beer-sodden friends cankeep people awake all night with wellorganisedharmony.IT'S COMING SOON AND EVERYONESHOULD HAVE A COPY FOR MEDLEYS.There was a young girl from WantageOf whom the town clerk took advantage,Said the Borough SurveyorYou surely must pay her,You've totally altered her frontage.* *A glorious glamorous gigoloRuptured his tendon of Bigelow;Which altered his strideFrom a glimmering glideTo a rather ridiculous wriggle-o.

SPECULUM 67WATCH FOR ITPRICE 4'-AVAILABLE FROM M.S.S. REPRESENTATIVES

68 SPECULUMTbe *eat of ill epenbabilitpofethical 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 SuppressantG. p. PTY. LTD. 74 MITCHELL ROAD, ALEXANDRIA, N.S.W.

SPECULUM69M.S.S. CHRONICAL195877th ANNUAL GENERAL MEETINGSecretary's ReportLast year was one of the best years thesociety has had for some time, both sociallyand financially.This year we welcome back as presidentProf. Townsend.The Annual Dinner was held on Friday,June 13th, in the Union buffet. Mr. DouglasDonald was the guest speaker, and he enlightenedus to the 'Anatomy and Physiologyof the Artist's Model'. A new innovationat the dinner was the menu cardsand red and white wine was served duringthe meal. This year the dinner is onFriday, July 3rd, in the Union buffet.Speculum appeared in September, ablyedited by Jim Wearing Smith. This copyhad a record number of sales and was completelysold out by Christmas. We thankJim for a terrific edition. This year marksthe 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 theappearance of Sabrina. We wish to thankEric Cooper and Roger Buckle for what wasundoubtedly the 'best Medleys yet'. Theold bug-bear of incompetent sound for thestage show was conquered, much to theenjoyment of the 1100 people who attended.The hall decorations aroused much comment,and we must thank Struan Sutherlandand Mick Adamson for their design andexecution. For the first time at a MedleysSongbooks and Speculum were on sale, thisproved a success and will become a regularfeature of the ball.A new Songbook is under way and isbeing compiled and edited by John South.New songs are being added to those alreadyin the book. John hopes to have the bookpublished later in the year.Sport.—In football we appeared on thefield on a number of occasions and enjoyedthe struggles, altho' not always in ourfavour. We were again table-tennis champions,and the rowing saw us cross the linefirst.This year we are reviving the practice ofan end of First Term Cabaret, this is beingheld in the Buff. on June 12th, DennisFarrington's orchestra will supply the music,and dancing will be from 8.30 p.m. to 1a.m. We would like to make this an annualfunction again, but this depends on theresponse.Finally, the Executive Committee wouldlike to offer its sincerest thanks to ProfessorEwing, our retiring president, for the interestand time he has devoted to us. He hasbeen a tower of strength to the committeeand was responsible for many of the newinnovations which made the various functionsmore enjoyable. We hope he enjoyedhis term of office with us and we hope tosee him at many more M.S.S. functions.N. SUTHERLAND,(Hon. Sec.)Editor's Note.—It is regretted that the FirstTerm Cabaret had to be cancelled owingto lack of support, and apologise to thesix people who reserved places!ri

70 SPECULUMMEDICAL STUDENTS' SOCIETYStatement of Receipts and Expenditure forperiod April 14, 1958, to May 1, 1959MEDICAL MEDLEYS—Income:Ticket Sales £1091 0 0Expenses:Balloons, 1957 . £30Refund, 1957 7 10 0Balloons, 1958 51 5 0Stage Properties .. 22 0 0Decorations .. 5 2 0Liquor Licence 1 5 0Liquor 45 0 0Printing 66Transfer 30Hire of Hall 83118Catering .. 557Band 70Flowers 6Honoraria 21Debit on Medical MedleysMEDICAL DINNER—Income:Ticket Sales £68 0 0Expenses:Catering £74 13 6Liquor 23 0 0Photos 4 4 0101 17 6Debit on Medical Dinner £33 17 6MEDICAL SONG BOOKS AND BADGESSales £112 19 11Expenses 54 9 10Credit on Neuro-Anatomy Notes 48 9 60 0 Life Members 47 9 019 00 01116 5 0£25 5 0CREDITCash in National Bank, 14/4/58:M.S.S. General A/c. £197 18 5"Speculum" A/c. 174 15 11Bank deposit (1958) 189 0 0Bank deposit (1959) 270 0 0£831 14 4Income:Medical Medleys, '58 £1091 0 0Medical Dinner, 1958 68 0 0Song Books, Badges 112 19 11Neuroanatomy Notes 57 13 0"Speculum" 523 17 71853 100 0 Credit on Song Books and Badges £58 10 1NEURO ANATOMY NOTES—Sales £57 13 0Expenses 9 3 614 6 "SPECULUM"-0 0 Income:16 6 Advertisements £323 12 78 0 Sales 129 6 05 0 Graduate Members 23 10 0523 17 7Expenses:Printing £357 16 0Refund 2 10 0Postage 25 6 8Typing 5 5 0Honoraria 5 5 0Banking 1 7 6397 10 2Credit on "Speculum" £126 7 5M.S.S. GENERAL—Expenses:Stationery, Printing £34 17 6Postage, Stamp Duty 5 15 0Banking . 15 0DEBITCash in National Bank, 1/5/59:M.S.S. General A/c. £204 8 0"Speculum" A/c. 301 3 4Bank Deposit (1960) 189 0 0Bank Deposit (1959) 270 0 0Expenses:Medical MedleysMedical Dinner ..Song Books, BadgesNeuroanatomy Notes"Speculum" t6 M.S.S. General ..41 7 6£964 11 4£1116 5 0101 17 654 9 109 3 6397 10 241 7 61720 13 6£2685 4 10 £2685 4 10J. WRIGHT-SMITH,Hon. General Treasurer,Medical Students' Society.

Going to CoverSPECULUM 71ANNUAL DINNERJULYFriday, July 3rd, saw 96 happy and wellprimeddiners in the lower dining hall of theUnion Buff. This number of revellers isthe best on record for some years and wehope the number will increase in the followingyears; judging by the scenes and commentsafter, we will need a circus tent inthe near future.Sherry before the dinner commencedhelped many recalcitrant personalities, andhelped stabilise new friendships. The dinersthen sat down to Creme of Asparagus, afterwhich the chairman, our president, proposedthe loyal toast. Schnapper Mornay, accompaniedby some of Jimmy's best red plonk,followed, and then the main course,Supreme of Chicken Parisienne with vegetablesand white plonk (also Jim's). The3rd., 1959secretary, Neil Sutherland, then proposedthe toast to the staff, to which Prof. Shawreplied, saying that the staff weren't reallyangels but they did their best; after all, if itwasn'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, hetempered his warning of becoming subjectsto a state, with a few well chosen anecdotes.Bombe Cerises was the final item on themenu, and with a few well chosen hiccups,the treasurer replied to Pansy's address onbehalf of the students. Then the longawaited event of the evening, Mr. J. B.Colquhoun, in a rich Scottish brogue, told usof people and places he had encountered inthe U.K. and America. This turned out tobe a succession of witty stories told in thetrue dour Scot manner, and with Pansy'srepartee, it was one of those talks that staywith you long after the night is over.Jim Wearing Smith pulled himself togetherlong enough to thank our guest ofhonour, whereupon Pansy saw the lightagain and delivered an impromptu speechmost of us will never forget. Then thestories started, despite some of the weakersex, and the telling of these, and the manyinterjections the raconteurs received wereenough to make the most moral of uswonder what he had been doing for most ofhis course. The songbooks were present,and the old favorites were sung with aBreaking Cover

72 SPECULUMFull Cryfervor that did honour to the C. & U.B. andJimmy's special brand.All too soon did the president raise himselfamongst the holocaust and declare thedinner adjourned, and so it was with reluctancethat we took ourselves away from theThe Deathscene of festivity, to other more potentscenes, but with the comforting thought thatit is only 364 more days to the next dinner,and Medleys yet to come!! See YOU at thedinner next year.To The EditorGRADUATE DINNERDear Sir,The medical graduates of 1948 held areunion dinner at Union House on the tenthanniversary of their graduation. The organisingcommittee, 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 responseCORLAN(hydrocortisone hemisuccinate)PELLETSA NAME TO REMEMBER FORTHE TREATMENT OFAPHTHOUS ULCERSAnother product of theGLAXO LABORATORIESto the scheme: nearly seventy of the yearassembled, looking little the worse for tenyears' wear and tear (so they thought). ProfessorR. D. Wright responded to the toastof the teachers; it was getting rather late inthe evening but we understood him to saythat 1958 students were better than 1948.The toast of The New Boys was ably andwittily replied to by Professors Lovell andEwing. The guest of honour, ProfessorNorval Morris, responding to the toast ofthe University, took the opportunity to offermuch unsound advice on how to become aworld authority (on anything) and how tomake money (at anything). Great thingsmay be expected of Professor Morris.There can be no doubt, if only on a basisof the empties (bottles, not bodies), that ahighly convivial evening was had by all;many old acquaintances were happily renewedand many stirring events of studentdays re-lived. A dinner every five years isnow planned until such time as the thinningranks become too depressing. Other "years"have held similar functions and the practicecan be highly commended to today's embryograduates.

SPECULUMVONDENBERGAt the commencement of the third yearof the First World War the Germans discoveredthey were running short of nitre.Hindenberg issued the following order:"The women of Germany are herebyordered to preserve their chamber water asit is essential to the fatherland. Waggonswith barrels and tanks will call daily tocollect same."Signed: Hindenberg.von Hindenberg, von Hindenberg, you area funny creature,You've given to this awful war a new andfunny feature.I always thought a woman's work waskeeping home and diddling,But now you've put the pretty dears topatriotic piddling.von Hindenberg, von Hindenberg, where didyou get the notionOf sending barrels round the town to gatherup the lotion?You've made it plain while every man isbound to be a fighter,The women, bless their little hearts, mustsave their pee for nitre.von Hindenberg, von Hindenberg, pray doinvent a neaterAnd somewhat less immodest way of makingyour saltpetre.Fraulein fair, with golden hair, with whomwe are all smitten,Must join the line and pass the brine to killthe blooming Briton.von Hindenberg, von Hindenberg, we'veheard in song and storyHow women's tears through all the yearshave sprinkled fields with glory;But ne'er before have women helped theirboys in deeds of slaughter,Till German beauties dried their tears andsaved their chamber water.No wonder, von, your boys are brave; whowouldn't be a fighterWhen every time he fired his gun, he firedhis sweetheart's nitre?And vice versa, what could make an alliedsoldier sadder,Than dodging bullets fired from a prettywoman's bladder?We've heard it said an amine smell, stilllingers in the powder,And as the smoke 'grows thicker and thevoice of battle louder,That there is found in this compound aserious objection—A German cannot have a breath withouthaving an erection.No wonder, von, desertion is so common inyour ranks,An Arctic nature's needed to stand suchhanky pranks;A German cannot stand the strain, oncehe's had a smell,He's got to have a girl or bust—the fatherlandto 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 brotherWere having a drink with each other;in the midst of their quaffingThey split their sides laffing,And each of them now is another.* * *A young widgie was perplexedTo discover that chickens were 'sexed'.She played chicken one nightAnd got such a frightThat now that young chicken expects.* * *Little Maggie full of hopesRead a book by Marie Stopes;Judging by her conditionShe should have read the revised edition.—Aboriginal Nursery Rhyme.

74 SPECULUMWELL I SUPPOSE TMEY'L,I;START SOMETIME

. . . And what mammaries! If it's a brinayou need to cap off a fine night then youwould have had one at last year's medleys.The show, as usual, went on as a dressrehearsal, i.e., for the producers and thecast, but the audience (that's you) gave it amarvellous reception.Why was this Medleys one of the best?Analysing a show after it has been and goneis not profitable, you might say; but whereMedleys is concerned it is always profitable.The main factor in this success was theinclusion of that old board-walker andgrease paint stick, Roger Buckle, as a producer.Here we saw the master of perfectionat work drumming "hard to interpret"lines into "hard to interpret" heads and repeatingand repeating, etc., the actions!This year Roger won't be hampered by theother co-producer, and should really turn ona Bergere Folies Grande.We again owe our deepest and sincerethanks to long suffering Treth for amassingan excellent orchestra, at one stage (practicallyevacuated the Con.) only to have theirate producers pull them trombone fromflute until the bare essentials were left, andyet the old maestro pulled through betterthan ever.The cast of this show was another bighelp! The nucleus of last year's ('57) showSPECULUM 75MEDLEY'S '58plus Richard the Smallwood and HaroldCaplan combined with the one and only,that star of Stage, Screen, Radio and P.V.,neilabdulblueeyesandbaldingsutherland.The boys from the Women's (Ron 1 and2, Rod, Geoff, John, Herb, Col., Peter-Anita and Mario) turned on their best actyet and showed commercialism how itshould be done. (See Divertissements.)Our women were again as beautiful asever but still very scared (sorry) scarce.Anne Harrison had so much doubling upshe thought her brassier clip was attachedto her suspender belt—actually it was. Janand Lou (the old stalwarts) again held thechorus line together.The final reason why this show showedsomething was the inclusion of a "new" typeof gimmick. "Pichers"—good old Billspouted off his lines just as if he'd learntthem, and brought the house down.The back stage crew headed by that veteranof stage managers, Jim whose wearingSmith, again surprised everyone and did anexcellent job.Let's remember that "Mammary" was oneof the best but let's hope that this year's('59) will be better.Thanks to all of those not mentionedabove for their marvellous help.The Aged Theatre Critic.Opening Song:Show's OnTune: "Fleet's In"Hey there, Mister, you'd better watch yoursisterCos the show's on, the show's on.Hey there Boozie, you'd better watch yourfloozie,Cos the show's on, the show's on.If we do as well on the stageAs 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 herprudent,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 andfeed herCos 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 yousome more.

76 SPECULUMMadeira°PERITn tierilEnTREIliHey there, Buster, be sure that you can trusther,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 mindAs long as they're wearing a gown.So if you love her, keep her undercover,Cos the show's in town.DOING FINALS ?SeeThen arrange to receiveSPECULUMin future years and keepin touch!your Year RepresentativeShe 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 tovice,He was base, he was bad, he was mean.He had slyly inveigled her up to his flatTo view his collection of stamps—all unperforated,And he said as he hastened to put out thecat,The wine, his cigar, and the lamp.Have some Madeira m'dear, you really havenothing to fear,I'm not trying to tempt you, that wouldn'tbe right,You shouldn't drink spirits at this time ofnight.Have some Madeira m'dear, it's very muchnicer than beer;I don't care for sherry, one cannot drinkstout,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 thegrass,Of the fate of a maiden who toped,She lowered her standards by raising herglass,Her courage, her eyes, and his hopes.She sipped it, she drank it, she drained it, shedid,He quietly refilled it again,And he said as he secretly carved one morenotchOn the butt of his gold-handled cane.Have some Madeira m'dear, I've got a smallcask of it hereAnd once it's been opened you know itwon't keep,So finish it up, it will help you to sleep.Have some Madeira m'dear, it's really anexcellent year;Now if it were gin you'd be wrong to sayyes,The evil gin does would be hard to assess,Besides it's inclined to affect me prowess,So have some Madeira m'dear.

SPECULUM77Then there flashed to mind what her motherhad saidWith an antipenultimate breath,0 my child, should you look on the winewhen it's redBe 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 downthe hall loud and clearA tremulous cry that was filed withdespairAs she paused to take breath in the coolmidnight air.Have some Madeira m'dear, the words seemto ring in her ear,Until the next morning she woke up in bed,With a smile on her lips and an ache in herhead,And a beard in her earhole, that tickled andsaid—Have some Madeira m'dear.. .—"At the Drop of a Hat".Donald SwannMichael FlandersParlophone Records.Boy Scouts' SongBe prepared. That's the boy scout's marchingsong,Be prepared. As thro' life you march alongBe prepared to hold your liquor pretty well,Don't write naughty words on walls if youcan'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 sureThat they will not be found.And be careful not to smoke them when thescout master's aroundFor he only will insist that they be shared.Be prepared.Be prepared. That's the boy scout's solemncreed,Be prepared and be clean in word and deed.Don't solicit for your sister, that's not niceUnless you get a good percentage of herprice.Be prepared and be sure that you doYour good deed when there's someonewatching you.When you're looking for adventure of a newand different kindAnd you come upon a girl scoutWho is similarly inclined,Don't be flustered, don't be frightened, don'tbe scared,Be prepared.Tom Lehr.Finale:Thanks For The MammaryTune:"Thanks for the Memory"Thanks for the MammaryOf all we've done this year.We've weathered all the storms of lifeAnd saved ourselves a lot of strifeWith bellies full of beer.Yes, thank you so much.Thanks for the MammaryOf all we've had to know,And how we trained the nursesInside 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 mammaryOf 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 MammaryOf Pansy and of Lance,Of Siddy and the other lads,A pack of simple-minded cadsWho've led us such a dance.Yes, thank you so much.

78 SPECULUMWe 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 MammaryOf good old pre-Med. days,No money were we earning,The fun we had when learningAll about the 40 ways.We learnt some moreUntil we sawIt's just a passing phase.And thank you so much.* * *DIVERTISSEMENTS: Popular advertisementsfrom the most popular (?) sketch ofthe evening:"T.V. OR NOT P.V."Tune: "Coca Cola" Song:When at work or at playAny time of the day,You should keep "Charlie Checkers" closeby.They're electrically tested and they are thebest,So a dozen or two you should try.Chorus:Fifty million times a dayFor any normal heathy bloke,There's nothing like a "Charlie Checkers"For a decentTune: "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 generalpurpose oral diureticNaClex(Hydroflumethiazide 50 mg.)Another product of theGlaxo Laboratoriesc'EanciJm,iWhile we're on the breast we may as wellhandle the whole thing.*She didn't have any cerebral signs excepther toes went up and she was pretty spasticall over and she had a fit five minutes afterwe pulled out the lumbar puncture needle.* * *Menstruation is a happy event.* * *The business of getting pregnant is a combinedeffort—everybody has got to be in it!* * *And then there was the woman who gotpregnant under me.* * *You don't often get a husband coming inand saying: "I can't have a baby."* * *Of course, it would happen to me thata female medical student should come upand say she was having labour pains. Ijust told her that she had a colicky uterus,to which she replied: "Well, I ought toknow, sir, because I've had a baby!!"* * *It's amazing what a couple of days insidethe vagina will do for you.* * *I had quite an interesting period for 2 to3 years.—Is this menorrhagia? or piles?* * *Brucey Sch : "Her daughter got marriedin February this year and she noticedshooting pains in the back passage."Lance: "Had that got anything to do withher daughter getting married?"* * *Ante-natal care should begin right fromthe jump.

SPECULUM79PRE-MEDICINEIn 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 of1958 to Doctor Rogers who has been at thehelm of Pre-Med. physics for 35 years. Hisplace has been taken by sprightly KeithMather 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 MissThomas finishes marking the roll andbounces out of the Masson—then it's backto chemistry, ho hum.Mr. Boardman's flashing smile greets usat the commencement of each Zoo. lecture,and one could hardly escape noticing thecopious secretion of genetics notes issuingprofusely from the portals of the Zoo.school.The atmosphere in lectures seems somewhatsubdued—and for no apparent reason,except perhaps a realisation of the fate con-YEAR NOTESfronted by failing. Were it not for thatgreen thing of Dick Briggs' which, on entry,extracts squeals of delight, the air at thestart of the lecture would be positively electric.One of our members wears a Fidel Castrobeard, and another wears a crash hat. Theothers are positively suburban.The weeks fly, and soon we will have toface the dreaded music—until then we sitand pray—and play.FIRST YEARThe year is made up of 161 who passedPre-Med., 1 doing a combined Sci.-Med.course, 17 repeats (including one girl repeater—Stopit, Jan.) and 2 graduates. Agesrange from 18 (10) to 33 (1)—the largestgroups being 19 (57), 20 (60), and 21 (25).Sexes: 158 male and 23 female. We have4 Dip. Pharm., 2 Dip. of App. Chem., 1B.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 fitGraeme B. growing a little fat. Max M.tells us this is something we will have to get

80 SPECULUMDuiused to. Jock C. and Bill D. complain thattheir prosecting partner, Ray is consistantlymissing from their table, A.,busilyengaged in giving Applied Anatomy tutorialsto certain un-named females in a corner.Another repeat, 0.G., seems to be living upto his name. We have a team of winnersin Craig Mc. and Robin M., especially asregards the Physio girls.Now to the 1st Year Div. lA's, where wefind Fedora T. victorious over last year'srep. Well known gristle-grabber Ted H.when asked to comment from his Hollywood-houseafter a Chinese dinner given inhis honour, said: 'Fedora in tight blacksweater and slacks had two points in herfavour. These I was unable to beat.'Irene D. has been noticed coming intolectures just on time with Maurie C. Weassume Maurie is waiting to introduce Ireneto Lee Gordon's Italian brother, Lee Zardo.Our company of barber-surgeons,Graeme B. and Bill D., seem to be litteringthe locker-room with piles of hair whileJock C. seems obsessed with the idea ofpiles and piles of dirty brown paper. JonH., Steve C. and Paul D. have found a newplace for the study of Biochemistry—theMayfair.As regards extra-curricular activities BillD. appears to have found a new outlet forhis talents with Elizabeth A. Rod M. alsoseems quite happy. We also find that PeterA. is being linked with Christine A. As wego to press we are expecting to announcethe engagement of Alex E. and Jenny C. Ofcourse, there is also our pair Mary G. andIan R. The girls of the year appear quitehappy about their annual football matchwith the Physios—cats and dogs weren't init.A certain outstanding red-haired professor(let him remain anonymous) told us ofthe time John Hunter discovered some vesselsin the testes. His brother, William,maintained that these were his own!Not a bad year all round, so with a littlebit of work and Mary Patterson missingfrom the streets, we'll see you in Div I.SECOND YEARThe saying for the year, as quoted byJulian (would you mind) M., is: "in yourbox". Wilfred B. says this means workinghard and not going out much because Div. Iis a hard year, but George S. disagrees.Contrary to reports by Jane and Joe L. inFarrago George does not sit on a whitefrothy stool, chair, or desk—his output isstill up to scratch.Stiff elbows this year seem to be due totoo much swotting and not the usual cause.However, Bob's Thursday Raffle was devisedto combat this; Trey S. won it and shotthrough to the country. Good luck, son.Heard: Hugh (colourful cough) N-J filledthe wide screen at J.W.'s—stick to T.V.Hugh, it's only Black and White. Watchout for Danny Z.—Susan is his Fair Lady,if only for a bet.Love must have its way—backways orsideways—ask Su. What is Don waitingfor Marle? Daryl P. is on a Shaw thing forPharmacol. even though it was Liz's freeS.R.C. ticket. We notice Rex has notbought a Policeman's helmet for FelicityW-K—that man asks some stupid questions.Dave D. is trying to engineer something andBob H. and Tom R. are now living togetherin Carlton. Geoffrey, you will have to geta monocle if you want to win Andy B.—heis an Ex-man.Someone should write an article on thesleeping habits of Med. students for thenext edition. Ross (Geelong Road) C. andCharlie (Tin Alley) L. would be learnedcontributors. Willy R.'s dinner suit lookedvery fashionable on the Saturday morningafter the Alfred Ball.Don McO. could not hang on longenough to collect his four hour volume andJohn T. thinks the girls should use plasticfunnels. Bob R. has boasted of gettingcaught in a 250m1. flash, but Jock thinksthis is a bit tall.Sylvia P. says she has a vital capacity of5 litres—wouldn't be surprised with thoselungs! It must be the run to get to lectureson time!Brian R. starred in inter 'varsity footballand it is not advisable to get punchy withJoe M.—he's a judo man, but we thinkBrian C. could walk over him any day.Warren White is Year Rep. again and seemsto know all the answers to Treth's questions.As you can see it has been a quietyear, but wait until after September!To end this slander-ridden literature wehope the vac. .is only for four weeks foreveryone and not six months.

SPECULUM 81ROYAL MELBOURNE HOSPITALTHIRD YEARHaving thrown Gray and Starling to thewinds, we arrived last November at theR.M.H. student quarters. Some of ushaven't progressed much further—with ourtime quickly taken in playing solo, nurses,and grog.Horrie D. having left friend in Queensland,has taken to living in an hotel. Whena certain neurosurgeon returned from hisholiday Robin H. had to explain away largenumbers of empties. Talking of holidays,what happened at Portsea? Did a camelchase Mal B. or did Mal chase the camel?One ball was unhappy when he receivedhis name-plate with the initials O.B.C. . .Glamour was added to the year in an arrivalfrom Adelaide—hope you are enjoying Melbourne,Rena?Clinics have been enjoyed by all—evenEddie B., who asked a patient how herwater was, receiving the reply, "I haven'thad the plumbers in yet." Dr. Doyle askeda student, "Who was Medusa," and had thereply, "A French obstetrician."Association with members of the oppositesex has been in full swing. Bob K. has beenusing the attraction of vintage model cars,while Rex B. uses the power of a 21 litreRiley. We are still wondering why BrianW. has a mattress on the floor of his stationsedan.Eyelids have been fluttering ateligible residents—any success yet, Jan?,while Tom M. tells us Joan is an apt pupilon a motor scooter.Eddie B. has been setting the alarm clockfor 3.00 a.m. Congratulations, Eddie, andto Roger K. and also to Roger B., who hasstill to set a date.Besides sports mentioned above, some ofus have become very athletic. In our cricketmatch against St. V's. we were the victors ofthe day (130 to 113), while in the footballmatch, St. V's. beat us (7-9 to 7-6), bothteams appearing anxious to get to the"niner".Did you hear that the mother of one ofour more pleasure-minded students had aheadache?—she mistook phenyl mercuricacetate tablets for codeine—Wow! Rextells us (what is more) they cured her headache.No comment!Finally Roger K. tells us that Webster'sdictionary may be a better investment thanPayling Wright.Cheers to all, and kill 'em, folks!FOURTH YEARThey say that the best way to avoid amention in the year notes is to write themyourself—so here goes.Firstly, the list of fellers whose gonadshave got the best of them: George F. andWarren K. have 'got themselves' married.Others, not wishing to resort to such traumaticmeasures, merely became engaged-Graeme McK., Paul F., Mike B., and RussMcD. (and they used to be such nice blokes,too). Sorry, Russ McD. went "off" onAug. 3rd. Engaged also is John B.Sandy—bless his heart, the dear boy—is rapidly establishing himself as an authorityon the latest collagen diseases. We areawaiting his monograph on the clinicalmanifestations of polyarteritis nodosa of thenutrient artery to the os trigonum (Spier'ssyndrome).A day the anaesthetics' department willlong remember: A certain illustrious groupof students were administering an anaesthetic.At 10 a.m. sharp the boys (being goodtrade unionists) were off for morning tea.Ten minutes later, enter Doctor J. to findthe patient blue and nobody there to worrymuch about it. The gents in question werethen discovered in a secluded smoke-filledroom playing cards and drinking coffee!Many records were broken at Medleyslast year. Pete "Have-a-go" Guy holds therecord for having broken the most records.Pete is also doing research into the newcollagen disease, dysemesis spectaculare(Spier's disease). Another record wasbroken by Andy Saltups who, despite beingstill plastered the day after Medleys, insistedupon going on the wardround—he is thefirst man ever to fall asleep on his feet whilein the middle of presenting a case to anhonorary!From the psychiatry notes (this actually

82 SPECULUMhappened): An old Chinaman presented to aG.P. with signs of intestinal obstruction.The cause—a beer glass impacted in therectum. (For this the old gent was certifiedas insane).Doctor Cade's comment: "Obviously acase of bottoms up!"Meanwhile, back-on (with) the pants—orshould we say, over in Carlton—a veryselect 50 per cent. of our stalwarts (alongwith a few A.H. and P.H.H. sloughs (!) tomake up the numbers) were inveigling youngmaidens (?) up to their flats—refer toMedleys, '58—and we hear tell that one ofour young maidens (??) was inveigled elsewhere—manyan invective was prompted byinveiglement in certain quarters!Yes, it has certainly been some half year—10 weeks of glorious, hot beach weatherat the R.C.H., afternoons of solo, nights ofgrog and women at Frankston Ortho., etc.,and 10 forgotten weeks at R.W.H. Somefolks worked at the R.W.H.—good on youDen R., Noel S., Geoff P., and all you otherpikers (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'srumoured that Tiny used to knock beforeopportunity had a chance—not to forget old"Hamer" A. Eskell takes the "bun out ofthe oven" with his story about the bat hewas P.V-ing in G.O.P. one day: on stimulatinga certain region he claims that shestarted giggling and when asked whatmeasures he took to prevent the situationbecoming rather "more than somewhat" embarrassing,he replied, "Why, I giggled too!"No one knows whether or not they ended upin an hysterical heap on the floor.Perhaps the one we all loved most wasold "No hormone" (some might queery this)—the pathology department never had needof extra material for their A-Z tests—luckily!—becauseit wouldn't have been thedorsal lymph saco "what copped it", butthe dorsal nymph sacs!Well, everyone, the incidents that couldbe quoted and the libel that could be written,are limitless, but as this l'il ol' magazinehas just gotta go to press sometime we'llwind up by saying, "See ya in finals!"FIFTH YEAR"After me, all repeat. This is a bonecalled the Humerus.""This is a bone called the Humplunmerus.""No, no, try again, but this time get itclearer. The sooner you get it right thesooner we can progress."The strain—great smouldering balls, offire; how it tells; how it bounces you aroundlike a baby seagull's bag of marbles in themiddle of a maelstrom—where does it end?How does it end? "Be listening next Sundaynight when we again present Martin'sCoroner, brought to you by your favouritemakers 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'tworry—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 theblardy questions that have got us all tricked.As I said to the Professor after he saidthat we should all pass, "Well, I said, I saidwell, if you know I'm gonna pass and Iknow I'm gonna pass, let's tell the otherexaminers and ask 'em to call the wholething orf."I mean, it's silly, isn't it, just wasting allthat paper and ink, Ha, ha—ha, ha, ha—Imean isn't it—ha, ha, ha, . .. ha. Don'tyou all agree yo'all, yo' sweet little bunnyrabbits, 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. Whitejackets and padded walls—seems familiar.They said he was gonna be a good resident,too. Shouldn't believe all you hear, shouldyou, eh, eh, should you eh should .. .There was a new vicar in the village, anddiscussing the coming Sunday's sermon withthe Curate, said, "I think I will take for mysermon this Sunday 'The Widow's Mite'."The Curate, a young man who knew hisway around the village, said, "Well, Sir, Idon't know that that would be advisable,because I happen to know they DO!"

SPECULUM 33THIRD YEARALFREDOur year at the Alfred seems to havesettled in very well (including our threeyoung ladies), if we can judge from the enthusiasmaround the solo tables and theoccasional visit to ward 23. However, someof this frivolity will probably fade slightly inthe ensuing few weeks, as this is all that isleft before our Pathology and Bugs exams.We have had a few sporting tusslesagainst other hospitals, all of which havebeen most successful. We played P.H. inboth tennis and cricket, the latter being apicnic day at Wattle Park. This site waschosen due to the fact that it possessed asmall metal cylindrical structure just by theboundary, this providing more interest forsome than the cricket. One P.H. guy wassuch an avid watchdog of this monumentthat 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 topscore of 50 or so.Both our football matches against R.M.H.were played at Fawkner Park, each teamwinning one match—being yery dry andthirsty weather, ward 23 was again verypopular after the matches.We finished up 1st term with a cocktailparty-cum-dance, which we considered tobe most successful as there were no seriouscasualties (later effects such as gastric upsets,severe cerebral irritation, do not comeInto this category). We hope to haveanother ding shortly (perhaps after "ourtrial" in September), so good luck and aurevoir until next year.FOURTH YEARFollowing the battle with the Path. andBugs bods, the eleven Alfred stalwartsemerged triumphant with an exhibition andthe Ramsay prize (P.J. in bugs) and morethan their share of honours.Paul continued his winning run by takingthe Alfred Old Resident's Scholarshipwith C.H. a close second.A new-corner to our select group is AdeleHOSPITALHanstein who, complete with husband andtwo children, has migrated to this fair cityfrom the "city of the bridge".The new year found us in two groupsmaking our presence felt at the Children'sand the Women's. At this latter establishmentP.J. transferred his attention from P.R.to P.V. with alarming enthusiasm.We are still trying to find out what hedid with the foetus a certain nurse obtainedfor him.Fredrica has been knitting babies' clothes—of course they are for Adele's little ones.Harry has recovered from "cat-scratchfever" but apparently it wasn't his facegrinning at us out of the Sunbeam after all!Don has been keeping up with it byturning over a Page a few times a week.Who says opportunity never knocks twice?Curly, who thinks there is significance inan infant's first words being "Pee-pee" and"Pot", doesn't believe in closing the gateafter his horse has bolted.Paul received the prize for being the mostanti-social swot of all time at R.W.H. It'sa wonder he didn't develop a hibernoma!Then to add insult to injury he gets topmarks in the exam.Clive hasn't given us the drum on his nocturnalmeanderings but they must have beenreally something—you should have seen himnext morning!!Cheerio for now, and we'll see us all infinals next year.FIFTH YEARThe group at the Alfred is once more reunitedhaving been split up over the pastyear—the result is that very few of theevents of the past year have reached myears.The "Matrimonial Stakes" is I.S.Q. Theonly trend shown has been by Eric—ourvery best wishes to you and Anna on yourengagement.The rest of the boys are still sitting onthe fence—developments have been anticipatedfrom Jim and John, and even Ian

84 SPECULUMappears to be progressing. For the rest onerather gives up hope after all this time.Alice hit the headlines with her grandeffort in winning the prize for IndustrialMedicine, with Isla a close second. Congratulations,girls.We had a minor scare during first termwhen everyone was suspected of being aboutto turn yellow, but apart from a universalattack of ECHO we are all now well.The appeal is well under way for AlfredRedevelopment, but most of the boys areworking too hard to be of much use.We hope this is goodbye for most of us tothis column, and take this opportunity ofwishing all our colleagues on the other beats"Good luck".Bob and Harry decided that as they eachwere to be married on the same day, itwould be nice for them to book in at thesame honeymoon hotel. The morning aftertheir weddings Bob told Harry that he wasgoing to see a doctor."What on earth for?" asked Harry."I'm in a terrible state," quandered theother. "Last night I failed to consummatemarriage!"Terror suddenly appeared in Harry's face."Good Lord," he exclaimed, "I'm goingright off to see a psychiatrist!""Why's that, Harry?""I clean forgot to!"GROUP IIROYAL WOMEN'S HOSPITAL, 1959Back 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.

SPECULUM 85THIRD YEARThe entry into the clinical world of 39new students to a North Fitzroy establishmentwas of momentous importance anddid not go unheralded. We soon started offserious work in the shape of solo, billiardsand table tennis. Particularly did solo comeinto ascendancy and it was realised by allwhat a magnificent galaxy of sportsmen,socialites, stayers, blowers, and scholarswere collected around the gaming tables ofPrincess street.The powers that be love us—yes, we mustnot wear open-necked shirts, or corduroys,we must sit up straight in lectures, we mustnot be late for clinics, we must not sign thep.m. roll and then absent ourselves fromthe p.m.The ward sisters love us—No, you maynot see that patient. No, you may notspeak to the nurses. Take your hands outof your pockets . . . .The nurses love us, or some of us at least.The patients love us—it does your heartgood to see their beaming faces and tautknuckles grip the nearest lethal object andto hear their wail of anguish as we beardown on them armed with the weapons ofscientific training.This year was notable for two sportingevents—a dry cricket match which we lostand a wet football match which we won. Sothe moral is—next time we must have twoniners as all this activity is thirsty—ahverythirsty work.Unfortunately the girls did not participate.However we are assured that theyspecialise on indoor sports like table tennis,wrestling, etc. Chris Brederkis has hadsome titanic struggles on the table tennistable. Terry Vice and Ann Davey alsohave "starred" in this arena. Terry informedall that the engagements are "beaut" andhas at present received numerous proposalsbut with no success.Adam and Eve are staunch supporters ofthe library—it can become so cosy in thereon a cold day. At present we are runninga sweep on what time Joe Brennan gets upST. VINCENT'S HOSPITALeach day. So far no one has guessed theright answer—perhaps nobody knows it.Toni Cook was Ava Gardner's wardrobemistress during "On The Beach". Herpopularity reached an all time high duringthis period when she used to give a dailyreport to envious fans Burgess, Murphy,O'Hanlon and Ryan, on the back stage view.Bill Renton-Power and Gordon Mathews arenotable exponents of that "intellectualgame" solo. Mr. Renton-Power comesfrom Queensland and apparently they playcards among other things up there. GerryGibney became a father during the year—what a marvellous excuse to miss clinics—however there is a limit to the numbers oftimes 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 fourfor solo and other things. John Garland isthe "eye man"—"It's amazing what you cansee if you look in the right places" andhopes to publish a treatise on "Diseases ofthe glass eye". Warrick Grebble hopes tobe an obstetrician and gynaecologist—sayshe has great experience and also a fast car.Exponents of the Volkswagon's merits areCasanova Dupuche, Rocky Fink and U-JackRush, a formidable trio. Yes, Gay, backseats are a great invention.The "old men of the year" are BernieRowe and Mike Jaska, who are inseparableand whose paternal advice is much appreciated.John Chew should remember thatnurses in the operating theatre are sterile!The title "lover boy" was duly bestowedon Beppo. Perhaps it's the continental influencethat makes him so popular or maybethat month he spent in bed enjoying theattention of the nurses and studying theirtechniques, gave him a better chance to getacquainted.Could anybody drive a "Volks" fasterthan Dave Phillips—perhaps his brothermight. Henry L., the man with the nameno one can pronounce, is a great exponentof large families and a great opponent ofclinicians who ask embarrassing questions.Mickey Ng—the man with the shortest but

86 SPECULUMhardest name to pronounce—is often mistakenfor a doctor of the same name—starred in Cas. as the best suture man of theyear.Shannon and Davies both drive over tothe hospital, however which one arrives firstis always a great gamble—Davies even runsa book on the result.Peter McC., the genius, has amazedeverybody even B.B. on how much he knowsabout sarcoid and other things. DisciplesDewdney, Shockman, Stannish, often holdcourt in the library from where they pronouncethe evils of alcoholism and women.Yes, our livers were cirrhotic after the endof term "ding".Hugh Nial, genius No. 2, is always claiminghe is an honorary member of the staff—and it is below his dignity to wear a shortwhite coat—but his claim is always beingrefuted.U-Jackman Herrin knows all the answers—yes, all of them. Bob Hope claims hewill never play football again after thematch with the R.M.H.—neither would weif we were as crook as he was.Benjamin is an expert on solo and electroniccomputers, and reckons that thereshould be one in the students' quarters toaid him to work on the "prop and cop"combinations.Last of all is Rosie Willis—we can't saytoo much about her as we would never hearthe end of it. Yes, she talks a lot. No, wedon't understand what she says. Yes, hersymptomatology has us fascinated—whenshe was asked for the causes of haematemesis—saidpiles. But she does put on agood "ding".Well, that is the end of the year and probablyus after we are served with libel suits.However, Pentridge does allow visitors!Footnote.—The editor regrets that spacedoes not permit both sets of this year's notesto be printed. They were hard to choosebetween. It is, indeed, inspiring to see anenthusiastic group who submit well thoughtout contributions voluntarily.MSS COMMITTEE, 1959PresidentPROF. S. L. TOWNSENDV.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-PresidentJ. SOUTHSecretaryN. SUTHERLANDTreasurerJ. WRIGHT-SMITHEditor of SpeculumJ. WEARING SMITHMedical Medleys' ProductionR. BUCKLESports RepresentativeC. MORRISPre-Clinical Women's RepresentativeMISS L. DONALDSONClinical Women's RepresentativeMISS J. PEELERYear Representatives:Pre-MedicalJ. KINGDiv. IAMISS F. TRINKERDiv. IW. WHITEHospital Representatives:R.M.H.R. SMALLWOODA.H.R. McLELLANSt.V.H.A. MacLEODP.H.H.I. WEBSTERS.R.C. Medical Representatives:J. BEST, J. McENCROE,MISS H. WANSBROUGH

SPECULUM87FOURTH YEARFourth year, greatest year of the courseand already half completed. Yet, what animmortal half-year it has been!There is much to report, much on whichto comment.J.E.B., I.H. and W.C.G. fell headlonginto the tender trap. We extend our condolencesto them.Even at this late juncture we extend ourheartiest welcome to Anne 0., who hasjoined us from the "Sunshine State".Sprog has taken to the "Hansom Cab" asa means of entertainment and any Fridayevening can be seen cavorting in that vehiclearound town.Joe B., living a hand-to-mouth existenceis the wonder of us all. Joe—responsiblefor more monster acts than most of us puttogether—claimed at the beginning of theyear that he has "reformed"!L.J.—the gambler—states categoricallythat he will play solo or "slippery" anytime,anywhere and with anyone. Unhappily thisis expensive. Ask L.J.!Tubby — one of our "Jack-men"—ourhope in the finals, mixes work and play bothday and night.Our other "Jack-man", Radium Jack,skinny, long, lean and mean—by thesenames shall you know him—managed tosandwich an Honoraries' clinical meetingfor "Jack-men" only between the Hay andWagga picnics.J.G.—king of the "St. V.'s underworld"—has cultivated interest in photography andradio-therapy—a sinister motive? We leaveit to you.P.V. and A.A.—our geisha-knocking,sake-drinking, opium-smoking, fantan-pla ,ring,fiendish orientals—contributed muchto our enjoyment of this year.George M., seeking yet another outlet forhis talents has taken, we hear, to the stage.This fact, we are given to understand, willin due course be circularised in the Nurses'Home.G.J.S., we are told, spent the long vacationdoing his bit toward getting the Geelongand Warrnambool Hospitals back ontheir feet. During the May vacation heperformed a similar task at the BendigoHospital. At the end of last year we wereall most upset that we were not invited toVal's "Going-Away" party. We have sinceexcused her on the grounds that she didn'tleave us!We would dearly like to write more butthe mumblings of "propping" and "copping"in the vicinity are relentlessly drawing usback to the game . . . .FIFTH YEAR"The dignity of truth is lost with muchprotesting" says a well-known 16th centuryscribe, and it is assumed that the SAINTSface up to 1959 finals with the exhibitions,prizes and monies generally accounted for.Since 1958 a great metamorphosis hasoccurred. The former merry men of 5thyear 1958 have dismissed their frivolousgolfing, drinking and social pursuits in returnfor the serious, gaunt-eyed, shop-talkingclimate of final year. This being so,little is to be said about extra-curricularactivities except to mention, in passing, theastronomical feats of beer-drinking by a certainFaraday street group at the Women's.Tom and his wife are to be congratulatedon 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 engagementsof Anne, still the most popular girlin the year (ref. Speculum '57, '58), and alsoof Barry. Best wishes to both of you andyour fiances.In the "man-bites-dog" section it hasbecome apparent that a certain vernacularand idiom has crept into our language. Ourreport would not be complete if such popularterms as the penthouse, little Sin Echo,the Producer of Exquisite Tenderness, andJackmen were omitted. Jackmen has hadan unrivalled place of importance and itwould seem that it alludes to transgressionof that great student precept—"don't-lookas-though-you-are-working-hard-even-if-youare."Current questions: Why is Frank alwaystired? Where does Brodes disappear to?In conclusion and in all seriousness, weextend thanks to all our honoraries, lecturersand tutors for their unselfish help, andfinally, grudging best wishes to our fellowcandidates from the lesser hospitals!

88 SPECULUMTHIRD YEARAfter surviving Panz, Treth, and the restof the preclinical years, 23 of us finallyentered the honoured portals of P.H. eagerto spend our time between Flo's Fluzies (21of us) and solo (all of us). We spent thefirst two weeks finding our way to the 11thfloor—but then had to reorganise ourselvesin the basement.Our first P.M. was almost a shambleswhen Dave B. almost collapsed into themiddle of it.The new wing was opened earlier thisyear—a real highlight being the guys arrangingdates with nurses in the "Guard ofHonour" (they couldn't move away to refuse!)The cricket match against fellow studentsat the Alfred proved to be a roaring shemozzlewhere more glasses of the amberliquid were drunk than runs scored. Whichside won? It is claimed that the Alfredwon — but by the time a decision wasabout to be reached nobody could count,nobody could umpire (least of all ComradeJagoda of the Alfred!); in fact, nobodycared. There were plenty of supporters tocheer the players and abuse the umpires. Dr.Trethewie honoured the assembled multitudewith his distinguished presence andalso proved to be a judicious umpire for awhile. The admiral performed extremelywell at this affair—even though it is saidthat he endeavoured to entice one of thefairer sex into the trees during lunch. Heroof the day was Graeme H., both as bowlerand batsman. Maurie K. kept wickets andeven though he suffered extensive lacerationsto the skull he still loves us all madly.John H. skippered the team—a dubioushonour? John B. officiated as barman andhis efficiency decreased exponentially. Hestill suffers from G.I.T. symptoms. ShawR. was unavailable because of a "slippeddisc"—said he did it lifting weights—butwe wonder? Barry B. opened the bowling,slightly erratically but we feel sure he wasout with Denise the night before.John H. has forsaken the stethoscope forthe poet's pen—"pen is mightier than thePRINCE HENRY'S HOSPITALsword" says he. His verse describing thecricket match is published at the end ofthese notes. A "gasser", even if the charactersdescribed were unduly maligned. Legalaction pending?Most of the fellows in the year have becomequite adept at solo. Now it is beingrealised that the game is all luck the moreintelligent chaps are turning to a game ofskill. Everybody seems to be winning,especially Maggie—her just deserts for havingdone a good job coaching us over thepharmacy hurdle.Judy was most unfortunate to fracture thedistal phalanx of her percussion finger—notso bad though as it also excludes her fromprostatic palpation. Heard at P.M.:Miss Mac: "The prostate and its adnexaaren't important."Pathologist: "You mightn't think so."Congratulations to Bhagat on his recentelection to the "Black Act Society" for hismagnificent display at the P.H. Ball.Other notables among our illustrious creware:Bob C.—always going solo.Max H.—has been receiving mysteriousletters from a certain nurse."Herk" G.—plays solo and billiards (bothvarieties).Paul G.—a nice guy, but we're sure hehas calcification of the aortic knuckle.Bill C.—former dentist, army captain,daddy of us all, and sometime honours manin pathology.Jack W.—slept a night at the Gill Memorial(to broaden his narrow mind)—it issaid that he returned with a pocketful of"tray bits". Only has to go for an earlymorning swim at St. Kilda to win a bet witha certain distinguished surgeon.Henry M.—would buy the hospital if weoffered it for sale.Peter W.—uses the long curved stick onSaturdays.Heard at an afternoon clinic recently:Dr. R.F.S.: "Have you been passing anydark urine—the color of tea without milk?"Patient: "No doctor, I always have milkin my tea!"ai4(s

SPECULUM89A bit corny perhaps, so what about this:Same Honorary: "Where abouts do youhave your headaches?"Patient: "In me head, doctor?"Ugh!!Many thanks to Dr. Funder, Dr. Drakeand Mr. Davidson for their generous tutorialassistance.Finally one "gasser"—Miss M. R. (to patient in Surg. 0.P.):"What has been the trouble?"Patient: "Well, the old fellow's been verysore lately. It's been discharging, but mywife dresses it for me every day."Miss M. R.: "Perhaps we could have alook at it."Patient exposes his injury.Miss M. R.: "Oh, it's your leg, is it?"And here's the poem:SOUTH OF TOWNTune: Little AngelineSouth of town if you care to come downYou'll find the best two hospitals inMelbourne town,At the Chevron they meet for a beer eachweek,They're Prince Henry's and the Alfred.A cricket match they arranged to playThe Wednesday after pharmacy was set asthe day,Wattle Park was set as the ground to getWhen Prince Henry's played the Alfred.P.H. won the spin, sent the Alfred inBoth teams had set their hearts on winning"The Bin."After drinks all round the players enteredthe groundWhen Prince Henry's played the Alfred.Well P.H. bowled quick, but Steinkel wastoo slick,He hit the bowlers' balls with his big longstick;There came a great roar, he was out for 54,When Prince Henry's played the Alfred.The battle was on between these two greatsides,When Jack had an over the silly blighterbowled wides;The reason was clear he'd had too muchbeerWhen Prince Henry's played the Alfred.As the last wicket fell there came a greatyellThat the niner of beer was as empty as hell,So we got another keg, those boys coulddrink until they're deadWhen 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 thegrassWhen Prince Henry's played the Alfred.Oh Treth, oh Treth, you are beyondcompare,As a cricket umpire you were the fairestthere;You did a great job but you drank all thegrogWhen Prince Henry's played the Alfred.We continued to play in this merry old wayAnd we were all quite blind by the end ofthe day,But one thing's for sure, there will have tobe moreOf Prince Henry's playing the Alfred.FOURTH YEARThis is it, the year in which most of usfulfill our wildest dreams of debauchery,hard work and anything else that's beencropping up since we started this life ofslavery. Why pick this year?—it'; the yearof the kids, no exams, and, THEWOMEN'S!In two separate groups we went to theChildren's and the Women's hospitals, andthe tales we've been hearing about somepeople—well, really!! You don't reallyknow the people you work with until you'vehad to live with them under the same rooffor ten weeks.Firstly, our congratulations to JohnnyWolstenholme who is half-way to becominga respectable man. We had our fear forTrev. Wood a couple of times at theWomen's—I think Trev. had a few worries,too. There were quite a few of the Women'sstaff with tinnitus after Trev's operations—more women passed thro' his room than acertain powder room on the secondfloor. Congrats. to Hap Webster forplunging half-way towards marriage also.

90 SPECULUMStarchy's broom cupboard was usually asight for sore eyes, so was Starchy. (It's nota holiday camp, you know!) Rachael tookher night shadowing so seriously she followedPeter McIsaac into the men's one night,—wistful thinking? Quote Beryl at a casepresentation: "A green label on an obstets.history means the patient is infertile!"Col Abery got tangled up with someQueenslander, but good old Bugle Steeleremained faithful to the Wells Street tribe,—trips on the Murray! Hap Webster isstill the main source of revenue to the driveins,but Tom Springer reckons it's a wasteof time and one may as well stay at home—you still pay to see nothing. Bryce is stillseen lurking around the tunnel, and Daveprobably has the big one. Jennifer caughtthe right spirit on a couple of occasions, butall Starchy's overtures were useless—wethink. Tony Bothroyd is still playing (golf),and we hear Ian Rossiter and Brucey hadsome very seamy sherry parties after midnightaround in Faraday Street. MickJonas' episiotomies were more like ManchesterRepairs by the time he'd finished—apparently New Australian fathers are stillHEAR YE, HEAR YEGraduates and StudentsAll M.S.S. MembersPAST ISSUES OFSPECULUMurgently required by theMEDICAL LIBRARYIn particular, Nos. 145, 147. 151for purpose of completing recordsstalking around the hospital with a gun intheir hand looking for him. Marie Jameshad the whole thing sewn up, even gave thelabour ward sisters some tutes. GraemeMcKinnon got his "Spinge" confused with"Respire" and caught "it" about two feetabove the bucket.The fourth stage of labour, in case youhaven't heard, is the washing up after.And so we plod on, the big year is comingup, so is Christmas, and Cynth and Mal arejust as thick as ever. Heads down, lads; seeyou next year, and up the thea(r)tre, Starchydahling!FIFTH YEARWe started off the final lap in grandstyle. Every final year student (almost)"threw" himself into his work with greatzeal. There wasn't even time to eat lunchas we crammed ourselves full of knowledge.However, it was not to last, and under theinfluence of the third year students most ofus returned to the solo school, and the workhas been piling up ever since.Joe and Hymie have recommenced theirsquabble—it seems that those two just can'tget on.We must welcome Harry Blackmore, whohas returned from the "dead" after a threeyearlet-off. Congratulations to Maurie ongetting caught. They tell me Fat John hasthem in a vice-like grip and that Hymie hasgone "sex-crazy".The wonderful organisation of the Hospitalseems to have mislaid our certificatebooks—let's hope they find them beforenext year.In all sincerity, many thanks to the clinicalschool and honoraries for their efforts.Good luck to all—here's hoping that life inthe residents' quarters isn't too strenuous!There was a young fellow called BlueWho had an affair with a ewe,He thought the resultWas rather occultWhen the wretched thing started to moo."Orion."* *A surgeon is one with no faith in nature'scapacity to heal before the operation, andinfinite faith in it afterwards.

SPECULUM91spiculaAn innocent girl told us she was practisingsquash, as a man was trying to get up awomen's team.* * *The penis mightier than the sword.* * *Then there was the patient who onreceiving an enema called the nurse a stoolPigeon.*Confucius say: Girl who sit on anaesthetist'sknee get Hotten.* * *Operation list: Excision, glans in neck.* * *Gray's Anatomy: "The tip of the sternumis often broken off in later age byworkmen with their tools."* * *Many a girl who tries to earn a livingon the square has to dodge the policemanon his round.One of the clinicians has complained thathis students are not gripping their fundamentals.* * *Hell hath no fury like a woman spermed!* * *One of the Div. II girls thought that theDick Test was a W.R.* * *Advertisement in Tel Aviv Times:Wanted, State Circumciser. Wages, onedollar and tips.* **Pharmacology lecturer: "Put your organin a bath .. •"Braggard.* * *Hospital admission sheet: Girl, 13. Banjostring in urethra.Doubtless a G-string.* *One of the R.M.H. boys (we're not sayingwho) calls his bed the Mayflower becausemany a puritan has come across in it.* * *Newspaper headline:U.S. Rubber Controls Go.—Immigration too slow?

92 SPECULUMThere is apparently above a certainlabour ward in Sydney the words "Primatnon nocere" (first do no harm). However,it has been pointed out that other possibletranslations include: "No harm is just once."Birdsville Mail:"The ceremony was consummated in thevestry before the happy couple left thechurch."* * *What is the difference between a vegetarianand 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 inthe endometrium . . ."* * *Dr. G.: "In extopic pregnancies in the ovarythe ovum is attracted by chemotaxisrather than good looks!"* * *The drug companies have a new one:SEXIDRINE: Stops your back from peggingout and your peg from backing out.* * *Lecturer in Parisitology: "First get a pieceof faeces on the end of your stick . . ."* * *Ancient Egyptian Burial:The body was raped in rage and made amummy.* * *And then there was the chap who whenaccused of consorting with Pygmies said hewas just doing it for a little bit.Did you know that the mink get theiryoung the same way that the young get theirmink?* * *Confucius say:"Woman with psuedo-pregnancylabouring under misconception."* * *Advice:Don't let your glandsMake too many demands.*Dear old soul in Cas.: "I have the mosthorrible septic system in my throat, doctor."* * *"Good night," she purred. "It was fun`noing' you."* * *The young man came in complaining ofurethralgia. When asked if he had a dischargehe replied: "No, I haven't been in theArmy yet."* * *A.H's. History: "Patient admitted passingclots P.V. with doctor's letter."* * *Charlie F.: "We must think of haemolyticStreptococcus A in regard to Semmelweisswho died of a puerperal infection."* * *Chas. again: "A flushed young woman ingood general condition—that is, she's notflat—er, I mean . . ."isA JEYES' PRODUCTCYLLINGERMICIDEManufactured by FEDERAL1) High Rideal Walker Co-Efficient.2) Perfectly Compatible with Soap.3) Stable in the presence of organic matter.4) A variant, "WHITE CYLLIN," is miscible with seawater and hard water.5) Invaluable as hospital disinfectants.CHEMICALS PTY. LTD., ABBOTSFORD, VIC.Ott•004:400:00:«1».”:4»:»«)•»:•:»••:«•:»40•:«000:4:0•««••:»4•.1•4»:**,1•0:«4•.:0•:•»».••»••.:4•«•*•.):••:04.4•000000

SPECULUM93Doctor: The trouble with Mrs. B. is that shecannot stand up to married life.Social Worker: May I suggest that Mrs. B.'sreal trouble is that she cannot lie down toit.* * *"Are you medical or surgical?""What do you mean?""Were you ill when you came into theward, 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 finishesmechanics. Next lecture I'll be on heat."* * *VERSE FOR A NURSEA Staff NurseStopped suffering from the curse,So she did aChange to Midder.Another version:My dear!AmenorrhoeaI fear.Surgical evacuationWill re-establish menstruation.Clinician: "At this juncture it is not withinthe capacity of the recipient of therapy,whose condition is now ameliorating, to toleratea recumbent posture."Student: "You mean 'e can't lie down!"* * *Sun, 13/4/58: STAGE CRASH-100HURT.—Some comedians take things a bit toofar.* * *Can't vouch for this, but there is:A sign outside the Boston Maternity Hospitalwhich reads: "Airport."**"So the doctor wouldn't give a certificatefor your late husband?""No, he says they want to hold a postpartemexamination on him."* * *An American judge who was recentlyasked to ban a book, announced that it wasnot obscene. The author is expected toappeal.* * *Heard of the latest about the Stone-Agecontraceptive?Rock Around the Cock.* * *A Frenchman talking to an Englishmangave forth the following: "I cannot understandit at all—ze pronunciation, look, youcall melanoma m-e-l-a-n-o-m-a, but zen Iheard 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 dogwhile on his motor scooter?* *Quotable Quote—Nurses' Examination:The expectation of life today is muchbetter than when doctors had no glands.* * *"Why was the bull sweating?""He was in a tight Jersey."* * *Professor (in lecture): "The Aedes is acivilised mosquito. It only breeds in manmadepools." * * *The policeman from Pakenham JunctionWhose little affair wouldn't function,Spent years of his lifeIn deceiving his wifeBy intelligent use of his truncheon.

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SPECULUM95Ad. on 3DB: "Quickest tonic for theblues: nine-pence worth of English Woman71This sounds most reasonable—almost a"blue heaven".* **Bung H.: "Because of chemotherapy it'sgot to be a good man to get the gonnococousthese days."A good man, yes—but a bad woman!* * *Mr. C-q-n at R.C.H.: "One would almostsay that bow legs was a case of 'on pleasurebent'."* * *It has been said that an intersection islike a roll of toilet paper because when themotion ceases you tear across the dottedline.* * *Bugs Notes: Brucella abortis — BANGstrain.*A good golfer never retires—he justloses his balls.*Dr. G.: There is no glans on the vaginalportion of the cervix.* * *Dr. McKay: What can you tell us about theincidence of prolapse of the cord, Mr.Sutherland.Abdul: It's found more commonly in Mediterraneanpeople, sir!floppy J. (sterility lecture): "They comedown the aisle with the organ swelling."* * *Bill W. (A.H.) has to take himself in handevery time he walks into his room!* * *Eskell: . .. she was a pale, young-lookingwoman in moderate spirits.* * *Starchy: "What are the five main causes ofan enlarged uterus?—Well, just one?"*Australasian Post, 19/2/59:The CURSE is on Belinda.—They are getting a bit personal thesedays.Notice in R.C.H. Nurses' Home:Student Nurses' Association MeetingMonday, 23rd MarchGuest: Matron de N(ai)eve, speaking on herexperiences in India.ALL WELCOME*Confucius say:"Two Wongs can't make a white. Itmust be occidental."*What a salesman! He talked his girl intobuying a new dress and then he talked herout of it.** *Overheard in ante-natal clinic at R.W.H.:"Could the mass in this woman's abdomenbe a red herring?"Sounds a bit fishy to us!* * *PROGRESS:1st Trimester: Excitation, euphoria, anda tendency to lose touch with reality.2nd Trimester: Inability to realise seriousnessof condition.3rd Trimester: Alternating constipationand diarrhoea .. .* * *From "Review" (Adelaide) Staff List:Reproduction Manager: Miss J. Rush.Newspaper cutting:PRIMATE ON ATOM BOMB*

96 SPECULUMHe was getting on fine—until he took aturn for the nurse.* * *"It's 'is ear, doctor, 'e's 'ad it off and onsince he was born."* * *Did you hear about the woman withspoonerism who went into a grocer's shopand asked for a grip of Tarzan's tube, thestick that stuffs anything.*One way to stop the stork arriving—shootit in the air.* * *They were examining a young woman ofquestionable appearance who had a secondarysyphilitic rash."What diagnosis would you make in thiscase?" asked the Hon. Dermatologist."Occupational dermatitis, sir," was thereply.* * *Overheard the other day around the tableat 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!COMPLANThe complete planned food• Quickly prepared• Easily digested• Contains all the essential vitaruinsand minerals in addition to balancedproportions of protein, carbohydratand fat.A GLAXO PRODUCTDid you hear about the vice-admiral'svice?The rear-admiral's rear.* * *Then there were the two queers who hada 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 localanaesthetic for the prostate?"Stu.: "Inject, then push further up notwithdrawing the needle."Hon.: "Why wouldn't you re-inject?"Stu.: "I would only want to give thepatient one painful prick."* * *Herald Headline, 23/8/58:". . . SPOOF WAS GOOD FUN."* * *It was reported in the press recently thattram conductresses were not satisfied andwould demand shorter periods, longer routesand be allowed to put the pole up themselves.* * *Hula dancer—a snake in grass.*From the front page of The Lancet ofsome years ago: "Our book of the month—Contraceptive Technique—A Handbook forSenior Students."* * *From a woman's magazine:"James Mason does not approve of makeupin his parts."ht

SPECULUM97Seventeen-year-old patient: "Doctor, Ihave a rheumatic heart with a mitral diastolicmurmur."* * *Doctor: "Any thrills?"Patient: "No, I don't go out with boys."* * *For once the doctor was on the receivingend of a proctoscope. After standing theprocedure as long as he could he remarked:"I think you have gone far enough—I havea metallic taste in my mouth."* * *Dr. M.: Condylomata are common aroundthe external genitalia—especially the anus."—Queer bods they let lecture these days.* * *Press report: "The young man wasastounded to find himself facing an angryparent instead of the sweet young thing hehad expected to meat."* *Herald: Senator wants sit-down ofwomen probed.* * *His loves, his hates, his hopes, his tears thatfell,The joys of heaven, the bitter pains of hell;His smiles, his signs, the whole preposterousissue—A gland or so and some erectile tissue.—Middlesex Hosp. Journal.* * *He who goes not and knows that he goesnot, has retention.He who goes and knows not that he goes,is comatose.He who goes not and knows not that he goesnot, is B.N.D. from anuria.* * *The earliest gynaecologists, judging fromtheir writings, were in their leisure momentspoets and romantics of no mean order.One is almost tempted to suspect that thePoets of their time were, in their leisuremoments, no mean gynaecologists.She was only a farmer's daughter, but shecouldn't keep her calves together.* *Waiting room at the Post-natal clinic:"Congratulations on your triplets, dear!""Thanks, love. Doctor says it only happensonce in 50,000 times.""Lor! When do you find time to do thehousework?"* *Gynaecologist, talking about dysmenorrhoea:"Bathing and swimming have noharmful effect during menstruation asnothing 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 marriedbecause his stipend was too small?Student looking at X-ray: "The cavityseems to be well circumcised."* * *Nurse's Exam Paper: "The perineum ison 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, worseon walking."* * *Ambulance driver's exam. paper: "Thereare three sorts of bleeding—arterial, capillaryand venereal."*

98 SPECULUMThere's many a girl today who wouldagree that emotional drive is a motor phenomenon.* * *"You should see my new girl. She's asbeautiful as a mirage.""That's the wrong simile. A mirage issomething you can see but can't get yourhands on.""That's my girl."* * *Quote from a lecture: "Steel for navalpurposes is made by Sieman's process."* * *And then there was the woman whonamed her children, Innocence, Accidenceand Negligence.* * *Film posters seen in the city:"MOTHER DIDN'T TELL ME.""AND BABY MAKES THREE.""IRON MISTRESS.""NIGHT WITHOUT SLEEP."* * *Did you hear about the cautious surgeonwho built his house on piles?Also:The statistician whose wife had twins; hebaptised one and kept the other as a control.* * *Midnight Edition:THE WEAK ENDNet Sales:2 Copies per Anus.As finals approach, R.Q. says he likes hiswomen weakly.* * *Stu.: "How often do you get up at night?"Senex (testily): "Let me ask you that whenyou're 70, sonny!"* * *S.F.A. stands for saturated fatty acid.* * *Forensic lecture: "A man who hides adead woman's body is guilty of frustratingthe Coroner."Stu.: "Is it possible to have intercoursewith a pessary?"Hon. Obstetrician (inspecting same): "Ishould think not."* * *Letter to the Editor: Mr. or Mrs. Confuciusof no fixed commode, writes: He whoburns candle both ends will soon be spendingall his nights in the dark.*It should be pointed out that somewomen miss everything and the rest drivecars.One 3rd year girl is slowly learning—shenow knows the difference between fraternityand maternity.Heard in lecture:"Now this experiment can be finished inone day if you don't congregate in groupsand talk about the weather."Remark from front bench: "Whether shewill or whether she won't!"Broadcast of a scene from the MelbourneCup:The jockey is now being introduced to themayoress.* * *Demonstrator in clinical pathology:"After the practical period, put your stoolsunder the bench."* * *Med. student (explaining to his friendhow it is done in the front seat of a car witha floor gear change):"Put the stick in third."Puzzled friend: "What do you put in firstand second?"

SPECULUM99She was only a bootmaker's daughter butshe knew how to make a naughty last.* * *Then there was the iceman's daughterwho gave all the men icey-poles.* * *Advertisement in "THE SUN":WHEN THEKNOCK COMES(and it could be tomorrow)will you have yourP.V. LICENCE?If not, you risk a heavy fine!TRETH: ". . . then micturate for 20 minutes. . . sorry; I mean at 20 minute intervals."* * *TRETH again: ". . . the Anglo-Saxons' onlycontribution to hygiene was the dunny."* * *RED (on double optic foramina): ". . . sokeep an eye out when dissecting theorbit."* * *One R.M.H. student's treatment fortrigeminal neuralgia: Inject the Neisserianganglion.Dr. H-y-s (in lecture) on inheritance:"What are my chances of doing as mymother did?"**Rod B. (R.M.H—after at least three minutesof rectal examination): "It doesn't hurt,does it?"Patient: "Cripes, I didn't even know youwere in!"Treth: "Banting had an unfortunate end."Treth again: "Churchill is in his secondyouth."We hear tell that a famous penist's latestT.V. show is called, "Have Bum, WillTravel."*The same bloke's get a new car; the doordoesn't bang but the chauffeur does!*Lines to be hummed from the supineposition,To the hummer's osteopathic physician:For him who botchesThat delicate neck trick,There waits, my friend,The fauteuil electric.—Ogden Nash.From the nurses' examinations:"There are four symptoms of a cold. TwoI forget and the other two are too wellknown to mention.""Hypnotism is now used for producingchildren. Some mothers recommend itfrom experience."Dentist's Epitaph:Stranger, approach these bones with gravity,Doc. Brown is filling his last cavity.B. Serf—"Reflex".It was a neat, modern villa with a spaciousporch off the kitchen.Girl: "Would you rather play in thedining room or the lounge?"Boy: "Neither, thanks—I would preferthe vestibule!"She had a figure like an old bag.bulged in places, but didn't give.*Infant Feeding:"Aldrich states: 'The rooting reflex is thefirst one to come into play'."*It

100 SPECULUM"Sayings of the Great" from King's CollegeHospital Gazette:1. Lady B—rt: "If you come across awoman thirty-eight weeks pregnant who isnot engaged, you must think something iswrong."2. Mr. F-r-z: "Unless you are careful youwill lose your breeches."* * *3. Dr. D-nn-ss H-11: "He applied to theHome Secretary for castration but the HomeSecretary was in no position to operate."* * *4. Pr-f-ss-r M-gn-s: "Neurologists alwayshave syphilis very much in their minds."* * *5. A. J. Yates Bell (filling out a psychologyquestionnaire): "I was a primip."* * *6. Overheard in Antenatal Clinic: "But Ithought homozygais men never married."* * *7. Dr. C-tf-rth: "Death is a prolongedStokes-Adams attack."* *8. Dr. C-tf-rth: "If you take out six orseven yards of gut and join the oesophagusto the rectum, you would probably getdiarrhoea."* * *9. Dr. McD-n-ld: "This woman was havingdelusions; she thought all the doctorswere being secretive."* * *10. Dr. T-Ib-t (refulminating pneumonia):. and in these cases death is irreversible."* * *There was a young man from LancashireWho swallowed two blades of grass;One grew out from his ear-holeThe 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 HILLIt'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 thebody can't fill—Then, you're over the hill, brother, you'reover the hill!You may fool the young wife with thecleverest of lies,You can shear the young lamb and pullwool o'er its eyes;But if she calls for an encore and you sayyou are ill—Then, you're over the hill, brother, you'reover the hill!When you gaze on a Venus and just heavea sigh,When you hear a weak joke and laugh tillyou die;When it's all in your head and you've lost allthe thrill,Then, you're over the hill, brother, you'reover 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'trefill,Then, you're over the hill, brother, you'reover 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 pillIf you're over the hill, brother, you're overthe hill!This is my story, alas and alack,When you've drained the bottle you can'tput it back;If you want to make whoopee, don't waituntilYou're over the hill, brother, you're overthe hill!P.A.S.

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