That was then; this is now.

When I trained as a medical student I was very disappointed in the course. I was excited by the discovery of the structure of DNA, by the interaction of actin and myosin in muscle and by the articles appearing in Scientific American every month about the new science of molecular biology. But the course at my University seemed not to have changed from the 1930s when the professors were students. We spent hours cutting up dead bodies. We killed frogs and experimented on their leg muscles using smoked drums to record the responses. We watched demonstrators kill rabbits and snatch their still beating hearts from them so that we could perfuse various chemicals through them. We were given bits of rat uterus to suspend in beakers of salt water while we dropped hormones on them. When we eventually visited the wards we were shown endless cases of rheumatic heart disease, or men who had a heart attack weeks ago, lying still and sedated while their hearts ‘rested’. There were lots of women with fractured hips lying in bed wearing Thompson’s splints until they healed, or more likely died form urinary infections or pulmonary embolus.

The wards were long ‘Nightingale’ rooms with solid fuel stoves at one end. The beds were rigidly marshaled with every sheet straight patrolled by nurses in ridiculous hats who were supervised by sisters who with menacing eye ensured that every stocking seem was also straight. As medical students we were forbidden to talk to the nurses; it seemed our only role was to take blood samples from patients using heavy glass syringes that had to be sterilized between patients and steel needles that must be sharpened and boiled between venepunctures. Fortunately, blood tests were seldom requested.

In the operating theatre the consultant surgeons were treated like gods as they performed operation named after famous practitioners – Halstead, Bilroth and Patey, I remember. In fact almost everything was named after some doctor, diseases, operations, surgical instruments, even the wards themselves. Despite their eminence, we seldom saw the ‘gods’. Presumably they were doing their private practice somewhere. The hospitals were run by the Senior Registrars, very competent men in their early forties who were waiting for dead men’s shoes.

As far as hematology was concerned we learned that there were 4 blood groups, A, B, O and AB, and that iron and B12 deficiency were important causes of anemia. I never saw a patient with leukemia and the only cancers we saw were treated surgically. It was commonplace when disseminated cancer was found at operation that the patient was kept unconscious until he died. Patients were never told they had cancer; euphemisms like ‘neoplasm’ or ‘mitotic lesion’ were used. Indeed patients weren’t even treated like people. They were teaching material. They were discussed from the end of the bed in the third person singular and if they interrupted they were told, “This doesn’t concern you.”

As students we were instructed as much on how to present ourselves as about medicine. Make sure you wear a clean shirt that your trousers have a sharp crease, that your shoes are polished, your hair short and your fingernails clean. After qualification you suddenly found responsibility and realized that you knew nothing. It was then that I began to meet people who were interested in the science of medicine. They were unpopular with the ‘gods’ because they questioned authority. They wanted evidence for doing things this way, and ‘we have always done things this way’ was not evidence. They were unpopular with the hospital administrators because the old ways were cheap and the new ways more expensive.

I began an intensive course of finding things out for myself. I found the textbooks to be largely useless. When I finally settled on hematology I had to describe things from my own observations down the microscope. It was necessary to get rid of the old men’s names. Who cared about Di Guglielmo or Helen Wills? There were diseases out there that were very common that nobody knew about. A textbook of Immunology stated boldly that nobody knew what lymphocytes did, but one thing could be certain: they were nothing to do with the immune response. My professor taught, from his experience with rats, that they were the precursors of red cells.

When I was appointed to Bournemouth there were three consultant physicians; now there are over thirty. I was the first haematologist and I doubled up as the first medical oncologist. There are now seven individuals doing these jobs. We used to deal with 80 blood counts a day; now they have more than 800.

We were advised to retire at 60, because if we waited until 65 we could expect less than 2 years of retirement – and we were lucky, average life expectancy for men was 64 and for women 68.

I write these things to give a flavour of how far we have come. If you look at the graphs of yesterday’s post you may be surprised at the rapid increase in expenditure. Don’t be. We can do much more than we used to be able to and we have the results to prove it.