Apart from anatomy, new medical students study physiology, which included biochemistry in my day. I must say I was looking forward to this. At school I had been excited by the descriptions of DNA and protein chemistry in Scientific American. Was I disappointed! In the whole course DNA was not mentioned once. The Professor had qualified in 1923 and had been appointed in 1936. His knowledge was all pre-war and he was also a boring lecturer. Not as boring as some of his underlings who simply read out the relevant chapter of Bell, Davidson and Scarborough, the textbook we were using.
The practicals were designed like the anatomy practicals to coarsen our sensibilities. As I remember they consisted mainly of mutilating small animals. Our behaviour to frogs would nowadays have us petrol bombed by the Animal Liberation Front. It was necessary to stun the animal first. To do this one picked up the frog by its hind legs and swung it to give it a hefty clunk on the edge of the laboratory bench. Then using scissors one cut its head off leaving the lower jaw intact. The next operation was to 'pith' the frog by inserting a metal probe down its spinal cord and pulping it. This was such an unpleasant task that the girls got the boys to do it for them. After that it was necessary to remove a hind leg from the corpse whose heart was still beating. The leg had the femoral nerve attached for this was the purpose of the experiment. We were to show that passing an electric current down the nerve would make the frog's thigh muscle twitch. The electric current was generated by two pieces of wire wrapped round each other, one made of copper and one of zinc. This was an experiment first performed by Galvani (of galvanic current and galvanized buckets fame) in the eighteenth century. The twitching was recorded on a smoked drum.
Smoking drums took more of our time than smoking weed did of a subsequent generation. It was done within a fume cabinet using a Bunsen burner to which was attached a device that produced an evil and oily black plume. The paper covered drum was then placed in the smoke until it was fully blackened. The drum was then attached to a contraption that rotated it. A metal arm moved with every twitch of the frog’s muscle and traced a white line on the blackened paper. The paper was then removed and dunked in varnish to make the tracing permanent.
In our second year we moved from the old Victorian buildings into spankingly modern medical school. We hurried to see the new Physiology lab. Would there be new equipment, perhaps to do experiments with DNA? Of course not. What we saw were row upon row of new fume cabinets, each containing brand new, brass Bunsens to smoke a new generation of drums.
I pass over what we were supposed to do to rats and rabbits but it left me with a distaste for animal experiments. I recognize their necessity and in fact late in my career I became a Council member of the Research Defence Society and made a TV film defending animal experiments. But this was after the RDS had instituted its policy of reducing the number of animal experiments, replacing them with other techniques where possible and refining the way that animals are kept and experimented on so that suffering is kept to a minimum.
I had little personal experience of experimenting on animals myself – I kept a couple of goats and six rabbits that I vaccinated with a harmless vaccine that I had received myself and took blood samples from them (in a way that I had myself been bled). The animals were kept in luxurious conditions that were better than how some of my patients lived. From the days in the 1960s when animal experiments were often unnecessary and crudely performed, there has been a great improvement in animal husbandry and much better designed and humane experiments. Some people won’t listen. I found a great reluctance among scientists to be interviewed for my film, for fear of animal liberation terrorists, and I was advised by then police always to look under my car for bombs before setting out for work in the morning.
Biochemistry was a small part of physiology. We were lectured on the Kreb’s cycle and the glycolytic pathway and had practicals on measuring glucose and urea by simple chemical tests. The macro-equipment that we used made the equipment we had in school look like something out of the Space Age. We were taught by a plump, balding and bespectacled old gentleman and a lady who flirted with the young men. She was certainly over-40, but dressed to look 16. She wore bright red lipstick which always migrated to her teeth and consequently she was known as Dracula’s daughter.
Nobody liked physiology and we took to turning up at five past nine in the morning. The Lecture Theatre’s doors were locked ant nine.
Dave, my dissecting partner, wrote a song for the Christmas Smoker about Anatomy and Physiology. I can’t remember all the words but it was to the tune of Camp Granada (which some of my older readers may remember)
It began:
Hello Mother, Hello Father,
Here I am at my cadaver.
A later verse went something like this:
All around us dogs are dying
Frogs and cats we’re crucifying
It’s not science makes us willing
The truth is that we quite enjoy the killing
The chorus was something like this:
We have sins
Beer, gin and women,
Cigarettes,
The placing of bets.
Can’t you see
Though medicine is our bent
We… want…to…stay…stu…dents.
As I said, Dave left medicine after the fifth term. I often wonder what became of him. I’ve never seen his name in the credits of TV comedy shows.
Showing posts with label medical school. Show all posts
Showing posts with label medical school. Show all posts
Wednesday, July 15, 2009
Sunday, July 12, 2009
Living anatomy
As opposed to morbid anatomy. I remember well that first evening when I gained access to the dissecting room. It was in a gloomy Victorian building, constructed like a Gothic church. The only light was admitted through the high windows and was that of an orange, sodium streetlight. That October evening in 1962 is etched in my memory. The dissecting room was large with ten lead-topped tables arranged in two rows of five. On each was a body laid and covered with a green cloth so that all you could see was the body's shape - far more frightening than the body itself.
The smell, sweet and sickly, was a mixture of formalin and chalk dust. I'm not sure what scared me, but I was glad to be out of there having ascertained that I would be assigned table number 4 along with Roger, Adrian and Dave.
The next morning was altogether different. The lights were full on and there was an air of jollity, mainly engendered by those students who had done 1st MB, a sort of resits for failed A levels taken at the University instead of school. These, with their year's experience of University life, were the early leaders. We didn't realize at the time that they were the rich but dim kids whose parents could pay the extra cost of resitting their exams at University rather than school. It is easy to be cowed by confidence.
Looking back it is hard not to feel that the medical course was designed to coarsen our sensitivities. We were naive schoolboys (and girls) who needed to be toughened up. Perhaps that was a true perspective; I have since seen several young female residents and one male who found the rough and tumble of medical life too pungent to be tolerated. Interestingly, they have all been Christians. Are Christian doctors such delicate flowers that life and death in the raw are too unpalatable?
We began our dissection in the armpit. I had no idea that smelly armpits hid such a nexus of nerves. We called our body (or cadaver, to give it its professional name) Ernest (because we were always working in dead earnest). For six weeks I had a recurring nightmare. Ernest would be lying there with his great hook nose. As I stuck my scalpel in his armpit he suddenly raise himself up from the table laughing ans said, "Stop tickling!"
Each week we dissected something different or at least Roger and Adrian did - they were keen as mustard on the whole business - while Dave and I nipped down to the Refectory for coffee and to try writing something for the Christmas party. I wonder what became of my earnest colleagues. Last I heard of Dave he was driving a soda-pop delivery truck, having failed his 2nd MB twice. Roger only failed once and became a GP. I did hear that he had some trouble with the GMC; something to do with drugs and prostitutes, I believe. I think Adrian ended up in the Solomon Islands. Every week we had a viva-voce examination with one of the Demonstrators. The Demonstrators were trainee surgeons who were taking time out to learn some serious anatomy. Surgeons are among the few doctors who really need to know anatomy; for the rest of us it is an exercise in rote learning designed to keep us off the streets. The degree of detail is seldom any use to us during clinical practice. We generally managed to pass the vivas, even though Dave's usual answer was, "I think I have a mental block on that one."
On one occasion we all failed miserably. The viva was on the larynx and we had drawn a demonstrator who was a trainee anesthesiologist rather than a surgeon. Crico-aretinoid muscles were a mystery to me and still are.
Apart from cutting up dead bodies we also had a series of demonstrations of living anatomy. This meant we had to examine our own bodies. For some this had immense attraction as there were girls in the group. In fact there were 12 women out of 60 students. Since we were to be divided into groups of 8, it looked as if at least one group would be mixed. Alas for some the men were separated into 6 groups of eight and the women into 2 groups of six. One coarsened wag posted a poem about it on the anatomy notice board. I think I can remember it:
O living anatomy
Thou dost seem flat to me
Since they did segregate
The sexes into groups of eight
Or so.
O blow!
The shame and degradation
Never to have seen
An hemispherical elevation
Or touched one e'en.
Perhaps it would be best
To entertain our guests
With poetic tales of roses on twin crests,
Or accept the bland
A modified sebaceous gland
Divided by some fibrous strands,
Lest the shock should dull the mind
When in the course of time we find
That as we watch the garments fall
It wasn't really worth it after all.
The culprit was summoned to see Professor Yoffey the head of the Department of Anatomy, and then sent away to return wearing his blackstuff gown. He was given a final warning pending rustication.
Yoffey had more to worry about. Dick Smith, one of the students whose father was a GP, desperately did not want to be a doctor. Instead of dissecting bodies he used to drive in his little Standard Eight to Weston-Super-Mare and from there send Yoffey a postcard saying, "Wish you were here!"
Yoffey was interested in the lymphocyte, which he was convinced turned into red blood cells as it matured. After he retired he emigrated to Israel and became a Professor there. Years later I met his granddaughter who also happened to be related to Victor Hoffbrand, the Professor of Hematology at the Royal Free Medical School. She had written a play about the Song of Deborah and was astonished that anybody else had ever heard of it.
Dick Smith left Medical School and became an Army officer. I met him years later. He still had the old Standard Eight. In the trunk he had a case of smuggled gin, which he tried to flog me.
The smell, sweet and sickly, was a mixture of formalin and chalk dust. I'm not sure what scared me, but I was glad to be out of there having ascertained that I would be assigned table number 4 along with Roger, Adrian and Dave.
The next morning was altogether different. The lights were full on and there was an air of jollity, mainly engendered by those students who had done 1st MB, a sort of resits for failed A levels taken at the University instead of school. These, with their year's experience of University life, were the early leaders. We didn't realize at the time that they were the rich but dim kids whose parents could pay the extra cost of resitting their exams at University rather than school. It is easy to be cowed by confidence.
Looking back it is hard not to feel that the medical course was designed to coarsen our sensitivities. We were naive schoolboys (and girls) who needed to be toughened up. Perhaps that was a true perspective; I have since seen several young female residents and one male who found the rough and tumble of medical life too pungent to be tolerated. Interestingly, they have all been Christians. Are Christian doctors such delicate flowers that life and death in the raw are too unpalatable?
We began our dissection in the armpit. I had no idea that smelly armpits hid such a nexus of nerves. We called our body (or cadaver, to give it its professional name) Ernest (because we were always working in dead earnest). For six weeks I had a recurring nightmare. Ernest would be lying there with his great hook nose. As I stuck my scalpel in his armpit he suddenly raise himself up from the table laughing ans said, "Stop tickling!"
Each week we dissected something different or at least Roger and Adrian did - they were keen as mustard on the whole business - while Dave and I nipped down to the Refectory for coffee and to try writing something for the Christmas party. I wonder what became of my earnest colleagues. Last I heard of Dave he was driving a soda-pop delivery truck, having failed his 2nd MB twice. Roger only failed once and became a GP. I did hear that he had some trouble with the GMC; something to do with drugs and prostitutes, I believe. I think Adrian ended up in the Solomon Islands. Every week we had a viva-voce examination with one of the Demonstrators. The Demonstrators were trainee surgeons who were taking time out to learn some serious anatomy. Surgeons are among the few doctors who really need to know anatomy; for the rest of us it is an exercise in rote learning designed to keep us off the streets. The degree of detail is seldom any use to us during clinical practice. We generally managed to pass the vivas, even though Dave's usual answer was, "I think I have a mental block on that one."
On one occasion we all failed miserably. The viva was on the larynx and we had drawn a demonstrator who was a trainee anesthesiologist rather than a surgeon. Crico-aretinoid muscles were a mystery to me and still are.
Apart from cutting up dead bodies we also had a series of demonstrations of living anatomy. This meant we had to examine our own bodies. For some this had immense attraction as there were girls in the group. In fact there were 12 women out of 60 students. Since we were to be divided into groups of 8, it looked as if at least one group would be mixed. Alas for some the men were separated into 6 groups of eight and the women into 2 groups of six. One coarsened wag posted a poem about it on the anatomy notice board. I think I can remember it:
O living anatomy
Thou dost seem flat to me
Since they did segregate
The sexes into groups of eight
Or so.
O blow!
The shame and degradation
Never to have seen
An hemispherical elevation
Or touched one e'en.
Perhaps it would be best
To entertain our guests
With poetic tales of roses on twin crests,
Or accept the bland
A modified sebaceous gland
Divided by some fibrous strands,
Lest the shock should dull the mind
When in the course of time we find
That as we watch the garments fall
It wasn't really worth it after all.
The culprit was summoned to see Professor Yoffey the head of the Department of Anatomy, and then sent away to return wearing his blackstuff gown. He was given a final warning pending rustication.
Yoffey had more to worry about. Dick Smith, one of the students whose father was a GP, desperately did not want to be a doctor. Instead of dissecting bodies he used to drive in his little Standard Eight to Weston-Super-Mare and from there send Yoffey a postcard saying, "Wish you were here!"
Yoffey was interested in the lymphocyte, which he was convinced turned into red blood cells as it matured. After he retired he emigrated to Israel and became a Professor there. Years later I met his granddaughter who also happened to be related to Victor Hoffbrand, the Professor of Hematology at the Royal Free Medical School. She had written a play about the Song of Deborah and was astonished that anybody else had ever heard of it.
Dick Smith left Medical School and became an Army officer. I met him years later. He still had the old Standard Eight. In the trunk he had a case of smuggled gin, which he tried to flog me.
Saturday, July 11, 2009
Morbid Anatomy
I used to wear a hat in those days. Actually, I owned two; one was an oversized Homberg that my father had given me and the other was a 'Robin Hood' with a feather in the hatband, which I bought from Dunns the hatmaker. In 1963 most people wore hats. As a medical student I had been heavily influenced by the Richard Gordon books, 'Doctor in the House', and 'Doctor at Large'. My ambition was to take part in Rag Week, when the students got up to all sorts of pranks. I had been early disappointed by the fact that the medical course ran on facts from the 1930s, and all the recent science that I had done at school like DNA and molecular pathways hadn't penetrated the University. I did not take my studies seriously since there was no chance of being sent own at the end of the first year. I did enough to survive and treated the first year exams as a joke.
This was the year that General DeGaulle rejected Harold Macmillan's application to join the Common Market (as it was then called). We constructed a papier mache caricature of General DeGaulle with a caterpillar's body and called it 'de gall stones bug'. The nights before the Rag Parade we camped out guarding the effigy against the Engineers who had sworn to destroy our float. The Spring of 1963 was one of the coldest on record. It snowed heavily at Easter. The swimming costumed Rag Queen shivered as snowflakes landed on her bare flesh during the Rag parade. We won second prize, first going to the veterinary students who made a giant elephant which contained half a ton of rhinoceros dung that was shoveled out over the watching crowd at discrete intervals. Student humor!
Anyway, in the middle of this I attended a lecture in pathology. We were supposed to spend two hours the first half listening to a talk with slides on a particular pathological topic and then an hour looking down the microscope trying to identify what we had been lectured about. As soon as the lights went out I fell into a deep sleep. When the time came for us to troop out into the microscopy room, the other students left me there fast asleep. Eventually, a lecturer came in to wake me and I had to go and apologize to the Professor. For my pains I was invited to Sunday tea at his house. I didn't realize it at the time, but this involved an afternoon's back-breaking gardening!
I was reminded of this because my wife used the term 'morbid anatomy'. This is a phrase that has gone out of fashion. It used to be the term used to describe that branch of Pathology that did autopsies and looked at dead tissues to find out why someone died. Nowadays they call themselves 'histopathologists' and they mainly deal with the living. The autopsy has died. As a student I was a frequent attender at the mortuary. Every lunchtime there was an autopsy demonstration when three of four bodies that had been dissected that morning were displayed to students. We learned to recognize sago spleens and nutmeg livers. In my last year in practice the pathologist only conducted 11 autopsies in the hospital mortuary. In part this was due to the reluctance of relatives to allow post mortem examinations, but mostly it is a result of CT scans and MRIs. Hardly anyone dies undiagnosed now.
Out in the community people drop dead, but usually their family doctor knows that they had high blood pressure or a dicky heart and they are written up as 'stroke' or 'coronary' and a death certificate issued. People forget that an autopsy would often reveal several other diseases that the person was suffering from.
The reluctance of relatives to consent to autopsy stems from the Dutch Professor of Pathology at Liverpool who kept a collection of children's heats in formalin-filled pots in his office. He said that he needed them as 'research' though research on what no-one knew. More likely they were trophies.
Bereaved parents were outraged that little Betty's heart wasn't buried with them. (Shades of Michael Jackson's brain). This led to Draconian legislation that effectively barred any part of an autopsied body being retained. Distressed relatives were even asking for the paraffin block containing Junior's appendix, removed years before, so that they could exhume the coffin and bury it with the whole body in a new funeral service. Bizarre!
The legislation even extended to the dregs of blood tests, which would otherwise be tipped down the drain. The research on IgVH genes for which I made my name would have been impossible under the new legislation. there was even talk that hairdressers would have to return cut hair to the individual. Such 'reductio ad absurdo' softened the legislation.
Today histopathologists mainly work on the living. Most of their specimens come from biopsies not autopsies. The take part in many 'multi discipline team' meetings where they explain what the biopsies show and why it is important. Their role is vital.
When I was appointed at a Consultant Pathologist I was asked on what day did I want to do my autopsies. This was a perk, since autopsied requested by the coroner attracted a substantial fee. I replied that I had never done an autopsy in my life and I didn't intend to start then. I was one of the first to see hematology as a clinical discipline. I intended to treat patients with blood diseases who at that time were being mistreated by general physicians. But I also intended to build a laboratory where treatment was based on science not tradition. It took me a long time to get what I wanted, but on February 1st 1974 I made a start.
This was the year that General DeGaulle rejected Harold Macmillan's application to join the Common Market (as it was then called). We constructed a papier mache caricature of General DeGaulle with a caterpillar's body and called it 'de gall stones bug'. The nights before the Rag Parade we camped out guarding the effigy against the Engineers who had sworn to destroy our float. The Spring of 1963 was one of the coldest on record. It snowed heavily at Easter. The swimming costumed Rag Queen shivered as snowflakes landed on her bare flesh during the Rag parade. We won second prize, first going to the veterinary students who made a giant elephant which contained half a ton of rhinoceros dung that was shoveled out over the watching crowd at discrete intervals. Student humor!
Anyway, in the middle of this I attended a lecture in pathology. We were supposed to spend two hours the first half listening to a talk with slides on a particular pathological topic and then an hour looking down the microscope trying to identify what we had been lectured about. As soon as the lights went out I fell into a deep sleep. When the time came for us to troop out into the microscopy room, the other students left me there fast asleep. Eventually, a lecturer came in to wake me and I had to go and apologize to the Professor. For my pains I was invited to Sunday tea at his house. I didn't realize it at the time, but this involved an afternoon's back-breaking gardening!
I was reminded of this because my wife used the term 'morbid anatomy'. This is a phrase that has gone out of fashion. It used to be the term used to describe that branch of Pathology that did autopsies and looked at dead tissues to find out why someone died. Nowadays they call themselves 'histopathologists' and they mainly deal with the living. The autopsy has died. As a student I was a frequent attender at the mortuary. Every lunchtime there was an autopsy demonstration when three of four bodies that had been dissected that morning were displayed to students. We learned to recognize sago spleens and nutmeg livers. In my last year in practice the pathologist only conducted 11 autopsies in the hospital mortuary. In part this was due to the reluctance of relatives to allow post mortem examinations, but mostly it is a result of CT scans and MRIs. Hardly anyone dies undiagnosed now.
Out in the community people drop dead, but usually their family doctor knows that they had high blood pressure or a dicky heart and they are written up as 'stroke' or 'coronary' and a death certificate issued. People forget that an autopsy would often reveal several other diseases that the person was suffering from.
The reluctance of relatives to consent to autopsy stems from the Dutch Professor of Pathology at Liverpool who kept a collection of children's heats in formalin-filled pots in his office. He said that he needed them as 'research' though research on what no-one knew. More likely they were trophies.
Bereaved parents were outraged that little Betty's heart wasn't buried with them. (Shades of Michael Jackson's brain). This led to Draconian legislation that effectively barred any part of an autopsied body being retained. Distressed relatives were even asking for the paraffin block containing Junior's appendix, removed years before, so that they could exhume the coffin and bury it with the whole body in a new funeral service. Bizarre!
The legislation even extended to the dregs of blood tests, which would otherwise be tipped down the drain. The research on IgVH genes for which I made my name would have been impossible under the new legislation. there was even talk that hairdressers would have to return cut hair to the individual. Such 'reductio ad absurdo' softened the legislation.
Today histopathologists mainly work on the living. Most of their specimens come from biopsies not autopsies. The take part in many 'multi discipline team' meetings where they explain what the biopsies show and why it is important. Their role is vital.
When I was appointed at a Consultant Pathologist I was asked on what day did I want to do my autopsies. This was a perk, since autopsied requested by the coroner attracted a substantial fee. I replied that I had never done an autopsy in my life and I didn't intend to start then. I was one of the first to see hematology as a clinical discipline. I intended to treat patients with blood diseases who at that time were being mistreated by general physicians. But I also intended to build a laboratory where treatment was based on science not tradition. It took me a long time to get what I wanted, but on February 1st 1974 I made a start.
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