1966 3

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Galenicals

University of Bristol Yol.72 No. 3 : F. J. W. Levis, M.8., Ch.B. Yice-Choirnon: Mr. K. G. Buckler, Choirman

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BTAGK BAG

Autumn 1e66

CONTENIS

Fce

Editorial

9

Galeni.als Prerident's The lnfirmary

At

Letter

tl

Bristol

of Biochemistry

Research in the Department

Graduate Service Overseas The Revealing Eye

.

t6

t9 21

.

Bristol . but where

l0

?

25

News and Views Supplement

17

The Origin of the Lymphatiâ&#x201A;Źs

39

Alumni of Galenicak

4t

Abortion and Psychialry

5t

Psychiatric Rehabilitation in Br;stol

53

Occupational Therapy and Prysiotherapy Depts-

55

A Glimpse Behidd the 'Curta;n'

58 60

Research Paper References

Examination Result5

65

Q. What are the positive benefits of ATROMID-S to

patients with angina pectoris, or with biochemical evidence indicating enhanced liability to myocardial infarction?

A.

ATRONffD-S has been shown to correct or favourably afrect all the blood lipid (cholesterol and triglyceride) and ihrombogenic factors which are correlated with enhanced liability to myocardial infarction.

Figures from controlleil trials of ATROMID-S are not available yet but it would certainly seem more than justifiable to use ATROMID-S at least selectively at

this stage.

In lonE-tern but uncontrollcd, trials in patients with angina pectoris and a history of myocardial infarction, the mortality ond recurrence tates are lower than those of other published. series of cases*

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Atromid-S A product of original ICI research lno.rirl chem'al lndunnâ&#x201A;Źr limnrd Phrmrceutic.h Plrk M:c.le eld chefiir.

Aldenâ&#x201A;Źy

Divnion

EDITORIAT Over the year many probl€ms have flc€d the editorial committ€es of Elack Bag, but one whi.h conrtrntly loons large ir that of obtaining sufficient copy. With the r€c€nt d€velopment of the Alumni s€ction under the guidance of Ron Sinpson and th€ incorporation of a Dental section rhe problem has ear€d consid€rably. Y€t we ar€ still wi orrt contribution ,rom the nain body of the sroden$ .nd arlempts ro gain interest from the nuBing hction of our <ornmonity has not met with encouraging success! perheps the hope of met€rial from thei€ sourc€s is too ide.lhtic. Many criticismr have b€en mad€ againrt the lack of humour in reaent editions of Black Bag, well, 'Iou lovers of humour' pleese *nd us som€ humoroul matedal.

ln an attempt to stimulat€ stud€nt inter€st

e 'N€ws and Viewr'

supplement has been incloded in this edition. li h hoped that th€ material being topical will be of interest to all those working in th€ Hospiral, sinc€ it

rel.ter directlt to th€m. More mat€rial has b€€n includ€d in this €dition than is perhaps financially h€althy, but it is hoped that these tactors v'ill help to revive tort

:ko

GALENICATS

President's Letter

from

ALBAN A. J. BARROS D'SA performance of his 'Hittory and Present Day Practice of Contraception ". For hir Presidential Address Mr. S. D. Loxton will

I am delighted to take this traditional oPPortunity of welcoming you to a session, which I hope will be an extremely haPPy and rewarding one for you and that certainly promises to be a briSht one for Galenicals.

speak on "The lndllction of Abortioni its technique and complications ". At the tr.ditional " Galenic Address " Mr. Purnell will exercise the immediate Past PretidenCs right to introduce a speaker of his choic€. Dr' Metcalf will doubtless displ:y his well known

Some progrest has been made. For examPle

the Dolphin Hous€ Extension is now a reality

and

k ir a great relief to find ourselves

in

spacious and well furnished s'rrroundinSs. One of the " quiet " roomt of the Common Room ruite will have to house books from rh€ Willway Library until an alt€rnativ€ accommodation is obtained The long term plan, however, it that the Students' Library

will be built on the ske of the

wit and humour when he lectures on '' University or saus.g€ llachine ". Or' Hemph;ll will remind us that three hundred /earr ago in September 1666, the Great Fire of London marked the €nd of three centuries

ot domin:tion of the

Present

PlaSue in England

with

its appalling consequences on Commerce, Society, Art, Religion and Medicine. There are several other well-known rpeakers.

Students'Djning Room.

We also have our own television now and this will prevent a recurrence of embarrass_ ing momentt caused by students swamPing the Reiidentt Television Room Howev€r' it has been emphasised that th€ television t€t is on hire and that if it is not trea(ed w;th great respect the hospital would withdraw jt a, they would have to cov€r the cost of

No vki$ haye been arr:n8ed except for the local visir ro Horfield Priron due to lack of support in previolt year3 resulting in considerable finan<ial lost.

When Liyerpool visit us thii Summer they

will be derermined to

regain the Debating

Cup which they lost to ut in Liverpool last May. The other annual debat€ with the University of Bristol Dental Studen$ Society should also prove very interesting.

\|r'e continue this year with the fortniShtly Thorsday me€tings that prov€d to be PoPular lart year. An ambitious series of lectures has been rrrang€d, rtarting off with the normal forensic one, this year by Mr. H. R. M. Johnson of the London Hospital. By the time thit

Apart from the Annual Ball and the Dinner Dance we now have an innovation to our programme. This ir the " Final Year Ball" which promises to be a rerounding

journal is out you will also have heard Dr. Peter Alexander of the Chester Beatry Resear.h lnstitute. London. and Prof6sor Sir Charles lllingworth of Glasgow. l''lr. J. S. Thomkinson, who in l 2 understandably drew the largest audience Galenicals has eyer teen until today, gives a .ePeat

Galenicals owes a great deal of its present day standing to the hard work put in by staff and students. I hope that this will b€ maintained by the continued enthusiasm and regular sopport from all its members.

t0

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ln the latter part of the lTth

Century

medical €are of the sick poor in England was sadly iacking. Most large towns had a public institution to which the poor were taken

when homeless or very ill-but on the whole they were dependent on rhe ch:rity

The

ln the feelings

€arly

of

Frt of the lSth

benevolence l€d

Century,

to the formation

of hospitals in London supported by voluntary contributions. The first of these was

I

N FI R

MA RY *il#l'"ril##t ;l#*+**

the first provincial hospital to be founded by voluntae/ subs.raptions, and admitted patientr ;n 1736, about I months before the Bristol lnfi.man/ was opened.

On November 22nd, 1735, iubscriptions were opened for the erection of a hospital in Bristol. The first meeting of subscribers

At

wat held on December 23rd of the same year :( which " persons of many perruasionr " appeared. At an energ€tic and burinettlike meeting the coniritution of the Society was drewn up. A board of Truste€t w:r appointed to meer monthly and decide

Bristol

the polic/ and rules of the hospiral.

At this itage the lnnrmary exirted only on

paper-: site for

i$

erection had

to

be

found. The plece eventually chosen was "a loft, war€houte, cellar and other buildings and waste ground in Maudlin Lane," which had once b€en a brewery.

On

R. WILSON B.Sc.

De€emb€r

l3th, i737,

the

House

"

was officially opened. The opening c€remony was held at l0 a.m. at the lnfirmary, where rubscribers met. A Service was then h€ld 5t. Jamel Church, the sermon €iven by Dr.

:t

C.eswick. Dean of Bristol. Afretuards rh€ company retired to the Nagg's Head, in \,r'ine Street, finishing the day " in emptying and .eplenishitrg mugs of fat Bristol ale-' Thir dinner became an annual event, and arguments over the affairs of the lnfirmary sometimer led to " broken heads and bloody

noses,"

After 40 years, such violence

eventually brougbt an end to the dinners. t3

French rapier must have cut elegant fi8ures.

wards were deYoad of Pictures and ornaments, ventilation dePended on the occasional opening of windows Bedsteads were wood€n and closer together than they are today. ln each ward there was a set of rulet, which were read to all the Patients each Tuetday morning The Patients were forbidden to play dice or cards The) were

The

frrt

The red cloak (or roqulare) and the French rapier, as much for prote€tion as decoration, w€re trade marks of many of the medical

ln the times when the lnfirmarv wis open

the doctor had litde to aid hit diagnosis' except observation, PalPation and exPerience. AugenbruCCer did not invent Percussion until 1761, clinical thermometers

not to smoke within the doors oI the lnfirmary, and curting, twearing or use of

abusive language was lorbidden. A large notice on the wall told that 'no Patients do lie in a Bed with their Cloathes-nor on the Bed with their rhoes."

Patienfi were admitied and discharged at the dkcretion of the House Committee' on Tuesday and Thursdil morn'nes Thev had ro <lean their clothes before admistron and Drovide their own linen Ma(on could Pro' uiO" the n""ay with clean niShtdresres and night caps. lt was her duty to tee that pati€nts ob€yed the rules of the houre Nursing was g€nerall/ of a low sEnda.d wom€n usually beins illiterat€ afld of -the querrionable character ! The Pay was 2s 6d Der w€ek. Relatives were allowed to nurse itreir o*n, ana able-bodred patients h€lPed ihe nurs€s to clean th€ wards.

were not available until the late 1800's, and the first stethoscope was Rrst introduced to Bristol by Dr. Thomas RileY, who was appointed physician in 1843.

Treatment dePended mainly

followinS morning he was Siven l0 g of calom€l I He recover€d. As late as I8'H the accounts show that I5,000 leeches, and 3* rons of linseed meal, for poultices, were purchased during the Y€ar.

Surgery was mainly restricted ro amPuta_ tions and " cut(ing for the stone." Anaes' thesia, wh€n given, consisred of oPium and brandy, and the patient was h€ld down.

Chloroform anaerthesia was first uted in th€ lnfirmary by Mr. Harrilon ;n August 1850. but ai the surgeons did no( with to e)(Periment on their Patients it wat not us€d again until May 1851. " Listerism " was introdoced ro Bristol rr 1880 when the great man himself gave a demonstrafion, inciring r ne(k abscesr under cloudi of carbolic tPrar' The patient made a raPid recovery.

When the lnfirmary was oPened 3'{ parienrs were admitted. During the next 50 yeart the hospital became incre:singly

in the

complaint was lodged by f4r. R Smith and other surgeons that " the gas liSht had gon€ out twice lately during operations " ln l89l lighling was srill deficrent. with ,ust one 8at Jer !o each ward. ln I90l ele(tric ligh( wa! introduced to the lnfirmary

The first election of stafi was held on May 20th, 1737, Dr. Bonython, William Logan, Hardwi.ke and Etw€ll were aPPointed

at

physicians. and

William Thornhill

and

Thomas Page as surgeons. Dr. Bonython with his laced rufilet, large wig and red cloak and

M.

leeching'

installed.

The records show thar in 1822 a certain f4r' Henry Alford was treated by bl€edin8 of 20 ozs. in the afternoon, 20 leeches were stuck on his forehead in the eveninS, and th€

lnfirmary depended on at 6s 3d a dozen. purchased larSe candles, only one candle at economy ln the cause of (ime each ward Candles to liSht was used a 1820's when untal the to be used continu€d ln f4ay 1828 a wat introduced. sas lighting LiShting

on

bleeding, diet, PUrging, and the use of poul$ces and some unPredictable drugs.

However, despite the desire to " cleanse " the body there appeared to b€ few washing facilitiesi and when the B.Rl was opened only one.old and one warm tlb were

Thornhill in his black velvet tuit and I,I

Hill donated the money to build two new wards-one whi.h bears his name, and the other which has now become incorporated into the Records Department. ln 1875. the B.R.l. was moved to a temporar/ home in Colston Street, after the water suppl) had been found to be contaminated with sewage. New saniration was introduced, and when patients returned the morbidity and mortality rates fell. The Cottage was buik in the grounds of the lnfirmary in 1875, and in l89l was given over to nursinS diphrheria patients in isolation. Soon after the new sanitation was

crowded. Beds were made up on tables, on

floors, and in the corridors- ln emergencies two patientt were put in one bed-though

this was kept to non-adukr whenever

ln 1782 it was decided that a new building was urgently needed and a subscription was opened. More land was acquired around the site of the existing lnfirmary and erection of the East Wing began in 1784, patients being admitted in 1786. The central part of the building was completed in 1792, and after a long delay the West Wing was finished in 1809. The hospital contained 180 beds- The buildins was divided equally between men and women, with strong iron gates between the two sides, which were to be locked each night. The building of the lnfirmary had take. 25 yearo. The main reason for delay was the Napol€onic Wars, which brought with them a rise in the cost of materialr. lnvasion was fek so imminent that in 1803 52 beds were put aside for " the reception of ruch volunteers and military of the garrison of Bristol that might be wounded." possible-

installed the wards were repainted, the floors

renewed, a new Posrmortem room and mortuary were built. These changes along with antisepsis, which was introduced in the 1880's had a further favourable effect on the mortality rate. By the lat€r part of the l9th

century

V and Queen Mary, and

The name of the Bristol lnfirmary was growing in stature and by 1827 it was accepted by the College of Surgeons as a training ground for their diploma-but even then pupils had to spend iwi.e as long training as at Glasgow, Aberdeen, Edin-

becoming re-

sursery

became

centralired in this building. ln l9l6 there were 548 beds in the B.R.l.. 300 in the new building. Military oc€upation ended in 1919, and the number of beds then fell to 350. ln 1935 balconies were added to the south side of the old buiiding, and the whole oa

burgh and Dublin.

the ground floor was taken over for

Litde other building was done until 1832 when a new Outpatients'Department was erected on the ground at the back of the

lnfrmary-but it was still

the hospital was

organired into departments, and in 1898 the first X-ray apparatus was instalied.

The King Edward Memorial building was opened on june 28th, 1912, by King ceorge

administration. The lnfirmary was now much as we know

it

today-

The lnfrmary has seen many changes but

there js st;ll overcrowding, long waits for outpatients-and, of course, rhe.om,

congested,

for long periods, and until 1848 men and women were patients were kept waiting

plaint mad€ in 1833 about trafilc making too much noise is still a problem today !

lt was not uDtil l9l5 that the new Outpatienti hall was

examined in the same room.

built.

I A HEto.y of the Brutol Royrr tnfirmlry (c.

Muro.Smith, M.D. 1917. Arrow5mrh). l Ih. Unired Bns@l Hospirrk (C j G. SaundeE.

ln

1850, H€r Maiesty Queen Victoria conferred the title Royal " on the lnfirmary,

1o65. Sor/d ol GovernoB of U.S.H., 3. M€diel Prcsre$ in Erhtol (A. V, Ne.le. 1964.

J6hn wrisht & sons).

4. A Short Hktory of Medi.ine (C. Sinler and E.

and so on October 22nd of that year it became the Bristol Ro)al Infirmary. Nine years later the museum and chapel were added to the East Wing, and in 1886 T. W.

Arhwo(h underwood. lc6l. O{tord

l5

Unrv€/siry

DEPARTM ENTAL REVI Evv ln o series of orticles in this ond future editions the Block Bo9 will otfempt to reveol to its reoders the qctivities of some of the moie progressive

deportments within the Medicol Foculty.

RESEARCH

in the DEPARTMENT o1

BIOCHEMISTRY The Departmenr of Biochemittry, though only two years old, had t€aching commitments this year probably exc€ed€d only b), the Physics Department of this Univertity With this number of students it would be forgiveabl€ if there were a c€rtain lukewarmness in retearch enterprhee. Tha( this k not so murt be attested by any visitor who squeezes past : jam of people and a complex of apparatus in our corridors, by the large number of original papers to journals, and by the fr€quent, l€ading presence of memberr of our department in colloquia and meetinls both in this country

He, who rec€ntly received the honour of

the I'linkowski Award. leadr a number of workers in studying a wide range of topict in th€ field of the biochemical asp€cts of dieb€tes. They have b€en joined during the

lart year by visitor5 from Auitralia, Singapore, South Americe and U.S.A. One of hit groups study the control of circulating leyek of insulin and growth hormone by studies on the mechanism of their release from isolated mouse pancreas hle$ and ox pituitary slicer rerp€ctively, using immunological assays, and by the investiga"

tion of the glucose metabolism of mouse kle$ and the d€rtruction of plarma ansulin by the liver.

Though the terrirory occupied by siochemistry ir incoDvenientl) randomised between the Medical School and the lnn€r Court Science buildings, there it a genuine espirit de corps that can only ultimately be traced to the stature (in all ways) of our Prof€ssor Philip Randle. The Medical Resear.h Council har acknowleds€d his unquestioned expertise by awarding him a resear€h group for the Study of Metabolic Control.

A

second group

mechankm

is mainly engaged in the

of control of

carbohydrate and

metaboljsm in muscl€ and adipose tissue, and the efects of insulin, experi-

lipid

mental diabetes and other factort on the inter-relationships found in the metabolism of fats and sugars. lsolated tissues have been used in thete studies, p:rticularly the perfused rat heart or incubated rat epididymal fat pads. Aspects that are under active investigation include the control of triglycerl6

ide and glycogen storage and breakdown in borh rhete trssue!, rhe conrrot of rhe oxido_ reduction of pyridine n'rcleotides ;n the rar heart and a study of heart hexokinase.

Dr. Chappell felt that the sophisticated

Research in Dr. Gartand'r taboratory has been con(erned wirh rhe reSutator), aspecrs

of a number of mitochondriat rea.tions, in particrlar those concerned in fatty acid oxidarion, pyruvare oxidat'on. and rhe conversion of aceryl-CoA ro cirrate or, rn liver.

flavour of his research coutd be <onveyed best in vene. The read€r is asked to imagine a high-pirched whine of etecBonic music a! background, puncruared by rhe flash of debnatine mirochondria. On( of his cot-

l. Our hope th.t

ln addirion, rhe nat,rre ot barriers and €ompartmentation P€rmeabiliq/ phenomena involved in m,tochondriat farry acid oxidation are also being activejy inv€stigared. More recently work has shrted on the continuous culture of yeasts and th€ pre_ paration of their mitochond'ia, with a yiew to exploiting conrrolled enzyme repr€ssion and derepression:r a rerearch toot in this fi€ld.

Eiochem;stry progress

ln metric form I'lt now diSress, Coocerning .ll things that are native To phorphoryiation oxidative: And m€chanisms to rety on For membrane transporr of cations (The same of anions apptjes Dep€nding on their nature, shape and tize.)

Phyrically based r€chniquer, such as et€c-

trodes

gy liv€r mitochondria As substratet thus tranrported are Between outer and inner phas€s By vector trantport permeases.

3. By usihg specially made micettes Of phospholipid, wherein the difference

Dr

Of cations und€r varying conditions Of activation and of inhibition.

i'

comp.n/ of hardy

ph)siological del'neation of the rize and com_

hind leg murcles and tiver, pertused under physiological conditions, to the 5trudure, size and shape of the chondroit;n sutphateprotein complexer from bovrne nasat sepra cartilage. A vasr bartery of physicat te(hn;gues are used in€luding viscometry, ormo_ metry, light scaftering photometr/ and uttra_ centrifugation. Prerent work also covers the rapidly expandiDg area of mucopoty,

issue

ditrerences between the tissues Brain, kidney, muscle, liver

ln behaviour of their mitochondria, mutcle roo comDared

With'ntect difierenr ways rhey are

rna

potition of rhe exracelluta. tpace,n rrr

Of

And

Phelpr has a

of working with rnot and rtime. tnterests among this group vary from rhe purety

<omes

impeded.

'rptake 5. Lastly we take up the

spectrophotomet4/, fluori_

souk who (an wrthrrand the jeers and jibes

From suspending in ammonium 5alc, and watching mirochondriat ,we ing As substrare anion ente.s, ako tefiing lf an acrivaror anion's needed.

Or if the

of

diab€tes m€llitus.

Twixt living and the artificial we can seek, By measuring such propertie! at leak

of infornation

oxygen and €arbon dioxide.

m€try, thinlaler and gas-tiquid chromato, 8.aphy, and redioacrive isotope techniquer, form a considerable par! of the experimentat aPproach. D€tpite the apparent remoreness ((o the casoal obs€rver) of rhese rech^iques and problemr from m€dicat pracric€. rhe studies heve led to a more fundamental lndefft.nding of lhe €nzymic basis of '' K€iorir ". and of wa/t in which n€w dn,gs could be developed for rhe nearmenr of

2. ln thes€ labt. our o€cupatjon k to look ar tubstrate oxidation

4. Another 5ource

for

verious formr

prepared.

l7

saccharide biorynthesis, where, at any moment, tranivesticised chicks, human umbilical cords, foetal rat 5kins, and sea" <ucumbers can be found.

and by comparing it wirh its very close structural neighbour, conalbumin, to localise the carbohydrate acceptor groups on the gty<oprotein and to determine the structure of these prosthetic groups. Dr. Hindley it working at present on the d€termination of the nucleotide sequences of the messenger

Honours Students reflects the hard work and great pains taken by Dr. Ashford, whose

of

A vital part in the development of any department is the careful telection of stldents for entry. The high standard ;n academic attainment of our own entering responsibility

it

is

to

RNA initiation site (the point of atta.hment ribosome to mesenger RNA).

Finally Dr. Gutfreund has iust joined the deparrment from Shinfield and brings with

select from over four

him a formidable reputation increased severalJold since the publication of hir masterly book on eizyme kinetict. ln this necersarily brief account of retearch in the Department, it is apparent that work coy€rs a large area of biochemical territory. lndeed in (he hazardous speculation of where biochemistry will develop rn the next decade. rr rs perhaps no( (oo atrogan! to believe that we have covered molt of the erits from ,ti

hundred students applying, thirty-five worthy

entrants. Dr. Cole, who carries the resPon-

sibility for the development of the Dental Students' Biochemistry Course, still finds time to follow her own research interests in the intestinal absorbtion of foodstuffs in ratt.

Of the newer arrivals. Dr. Williams and Dr. Hrndler both joined tLre department from the glamorous Molecular Biology Unit at Cambridge. Dr. Williams as puriuirg the problem of characterising the amino acid tequence of the glycoprotein. transferrini

oo

Present encamPment.

CF

PHELPS

DISoRDERS

o*tttHAr,Mor,ocY

THE cHRoMosoME An lniroduclion for Cliniciars.

"otlta*t-rs r,v H E. HoBBS. M.B.. F.R,c-s. = = tio;";;'. so ro.ot ptur... 55' 'rr". psl -=

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by FFRANccoN RoBERTS. M,A,, M.D., = DEpREsstoN AND IIs TREATMEN'f F.F.R. = i= tu r. o. poLttt,I. u.o. = &.6d ,d1= zr.. ua r0r pagd. ;if ;il.;ilGi;t....

EssENTtArs oF pAEDTATRTc suRGERy = ! run xerr,s rx orsresEF.R.C.P.

by P. D. SAMMAN. M.D.,

40.. ,/r = 140 page'. lJ2 illu' 2 col plate'.

-= crto\ To GFNER{L l lRoIoc\ i=rNrRoDt bv r. Nl. sol-L. e.s".. tl.o. lss ,pt poee' Jo irlu raLion' i ttil ._ = r]\rBooK oF VENERFAL DIsL{sF a\D = TR[po\EvarosEs. 2nd Ld.ion. = bv R R. wtlcox. M.D

= i = =

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HGilemann M€dical Books

2nd Editio

= h\ H H_ N|XON. M.A.. !.R.C,S,. cnd F R.C.S.. F.R.C.5.| = h.

5-uuur-vr.'

B- ODO\\I I I . V.( ":'", il*' '^):ll5s net = 344 pases, 72 illus. 2 @l plalcs

DIAGNOSIS AND TR.EATMENT

ne!

= =

OF

BLooD DlsE{sL = =

by M. c. o tsRAFts. M.s... v.D,. ch.B..= LR.(

2t2

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Ltd. 23 B€rford

cotou,ed

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w'C.l =

I8

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NATToNAT

NllU

sruDENrs

YIy

UNION OF

E

$

RADUATE

OVERSEAS SERVICE

providing technic.l assistance where numbers qualified personnel are limited, and for affording the British graduate a look into less developed and develoPing territories

'Graduate Seryice is .n attemPt to create dut 6f the raw stoff of ideals and good intentions a practical, realistic and efficient

of

venture in the conte)(t of overseas seruice by praduares. The ideals and good intentionr

Administration Six graduatet were sent from the National Union of students to Africa and South America in the Pilot y€ar of GSO. The variety of work undertaken and the broad spectrum of territory involved served as an adequate base on whi.h to assess the potentiality and relatiye merits of employing newly-qualified Sraduates in jobs demanding a high sense of responsibility and a certain tact and maturity. Later in 1962, a significant development took Place when, at the initi:tive of the Department of Technical Co-operation, voluntary organisationt in this field ome togerher in a co-ordinated com' mittee formed under the chairmanshiP of the lrte Sir John Ldkwood. These societies included Volunlary Service Overseas, lnternarional Voluntary Service, the United Nations Association and the NUS's Graduate Seryice Overseas. The Government agreed to find fifty per cent of the costs of the total prognmme and further financial suPPort was given by OXFAM and FFHC* and other

i." 'nt"."'ring and well known. They are imporRnt because service oveBeas is action in'trated very definirely by a PhilosoPhy which is outward looking and outward giving.

But the problems involved in Putting this

philosophy into Practice are immense.'

This quotation from 3 National Union of Srudents publication in I963 illustrates the thinking behind the NUS decision to Pan'cts

pate dire.tly in the activitl of sending graduares as volunteers on service overseas.

This decision led to rhe tormation of Graduate Service Overseas as an integral departmen. of the NUS. Now after completion of the fourth year of rrs actrviry we may look again at the success achieved in putting the original thinking into Pra.tice' DurinS the first 3 years oFihe DeveloPment De.ade of 1960-1970, several countries in the 'developed' world had taken stePs to implement the Te.hnical Aid Procrammes called for by the Unired Nations Most of these programmes meant little in Public opinion as too often Aid w.s rePresent€d bv a line of statistict identified with higher tax or a percentage of national exPenditure. The introduction of the Peace corPs, Volunteer Programmes and UniYersity Service was a new idea. The late President Kennedy was largely responsible for PUbl'cizing this new concept and, although the various nationrl proerammes differ in therr rcrmt of referen.e. the basic attributes of the American

An early d€cirion had to be reached on the territorial division of the world necessitated to ensure smoorh administration: thus it was that in 1963, Graduate Service Overreas Volunrce6 were s€nt to French west and southern Afri(a, Laun America and the Far East. Since that time the request for volun_ kers from every corner has so rnc.ealed (hat during 1965-66, G50 was workrng in 28 territories (ircluding most of the islands in rhe Caribbern) and there were volunteer!

Peace Corps and other voluntary Programmes

have been readily accepted by the develoPing

lrom Brira'n rn lome eighty

countries and Put to good use by them' Since its inception in 1962, Gnduate Service

Overseas has

Srown 'n

size and

countrie!

rhrou€hoot rhe world. and the requerti fo' volunteers continue

!rength:

to

come.

Work The increased requetts for volunteerr clerrly has diversified the scope of qualifica-

rervrce abroad is no longer a PhilosoPh)' without a.tron, an ideal wirhout motNe. lt

nons that €raduates can offer; t€achers have aiways been in grearest demand and for

at a rwo way Process needed' for where helP help for sivinC 's has been esHblished

20

*Fr.edom

froh

Hunper clmplien.

every l€vel

of inrtruction; in

small broiler batteries in the barrios and raising the chicks to be sold for food in the

literacy cim-

paiSns, adult education, primary, secondary

and technical schools,

in

universities :nd

colleges. lncluded in this higher number of requests there has been a significant recoSnition of the need for engineers: such is the demand for construction, road building, town

planning and development,

for

THE HARD FACTS Sin.e 1964. the Government has been contributing seventy-five per.ent of the

irrigation

total cost of the British Volunteer Programme. After further grants have be€n received from OXFAM and FFHC, each so€iety i! left to nnd approxamately fifre€n to twenty Per cent of its own Programm€.

The cost of sending a volunteer overe€as h

projects and land reclamation. Allied to this demand is the ne€d for land surveyors, quan-

thy

surveyorr, architects and accountants,

ln medicine, social service, community development, agriculture, forestry, administration, volunteers are ne€ded.

The aim of a volunteer's work and her

and so on.

approximately as foliows: I

place in the local community as well described

by Robjn Prosio who has been working with

ye.r

volunte.i!

200

Travel

ACCION, a community development programme in Ven€zuela. " The main theme of ACCION ", she writes, " is to help the barrio peopl€ to help themselves-to h€lp them realise their own potentialiti€i in order to improve their way of life, So oft€n they are content to sit back and wait until the local Sovernment agencies i€t to work on them, or else the/ iust seem incapable of making ure of their own capabilities or working for what they would lik€ to achieve. The work of the Accionista ir thar of guid€ and counsellor-showing the community what to do and how to do it, stimulating their interert and their r€lf-conndenc€ but. at the same time, making the community achieve their aims through their own efforts, n€ver impos" ing ideas but waiting until soggestionr arise

R€cruitment, selection,

l8 mo.thr or lonser

(26s)

(6s) (40) (30) I (s)

75 40 40

administration. etc. ...

Clothing allowance ...

Orientation lnsurance

220

7s 40 40 16

Hard furnishinSs, moped, etc.

70

(9s)

70

Superannuation

I20

Reretrlement allowance I00 ( 150) Mid-term allowance ...

200 75

-

533 say

(650)

f550

8s6

say f,{30 P€r year

As those delegates at the NUS April Council

1966 heard, craduate Service Ov€rseas is labouring under financial difficulties. ln February, its programme had to be cut from 150 volonteers to 20, mainiy because studen$ in Britain, on whom Graduate Service Overseas ir dependent to find the Ulte€n to twenty per cent needed to send €ach volunteer, had failed to maintain and continue the support so readily given in 1962. Th€ future of Graduate Servi€e Oversear is now in doubt.

A fund-raising appeal for a Shilling-a-Term contribution from each student in the

{rom the community itself so that any project fulflls a need felt by the community. The Accionista also has to involve other sectors of soci€ty in the problems of the barrio com-

munities, co-ordinating every rource of assistance avail.ble and tapping each possi-

bility. An Accionista nev€r has to let the ghost of an opportunity creep by which could be put to good ure in a b:rrio. For inttance, we were approached by a concern which ran a Chicken Hatchery-What coold we do with several hundred free chicks a

country was launched immediately after Council ;n April. lt will be renewed this

week ? Answer-the possibility of setting up

2t

physiotherapy (a V.S O. PhysiotheraPist works here; and a V.SO. laboratory tech' nician has just arrived, so that the future is brighter than the past).

Apart from the volunteers, the director (the hospitals surseon) and a Swedish nurse the statr is all Ethiopian. There is no lack of numbers. but most of the staff are not highly trained. For a total of 250 Patients there are, for examPle, only four trained

term. So far, resPonie to the aPPeal hls been sporadic, perhapr a little ditaPPointing' but we hope for higher returns this coming vear' It would be a tragedy, if so worthwhile an undertaking were to fail for lack of the small financial support required.

FROM DR. P. A. WILLMOTT

A

Later in the year, when the quota of doctors returns to normal (i.e. three) I expect to sPend much more time working in the provinces. My task there will be the supervision of leProsy control work, which will include the education of the PeoPle about leprosy (which is incidentally one of the most fascinating disear€s lknow), the finding of early cases and the Prevention of leprosy by B.C.G. vaccrnation (5ee Kinnear Brown et al, British Medical Journal 1966 I 7).

Alrhough r s necessary to clear uP the alrermath ol longstandrnC leProsy to me ir is infinrtely more rmporunt to attemPt to eradicate the disease. Thit will tak€ a long ome, but it rs the provincial work that will eventually accomplish it.

Why. you may wonder. do I bother I The work I do rs insiSnificant, when set in Perspecrive against the medrcal Problems of the less developed parts of the world. Personally I do it for the greater .linical freedom and responsibility, for the Pleasure of travel and lr'ing rn another (ountry, and in the knowledge that I can achieve far more here than ever lcould in Britain.

Added to this the hosprtal is being uPgraded and changed into a training centre in leprosy for the whole of Africa, and so the work I do at present ii Potentially increased by virtue of the number of people who will ultimately be trained here.

Too idealisric ? I don't think to. lt is a top practical Priority before the imbalance beween developed and underdeveloPed goes too far to redress. Besides, lenioy it.

MEMBER OF THE

VOLUNTARY MEDICAL SERVICE ABROAD lmasine an ordinary house job in EnSlandwith little responsibility, a registrar to fall back on. a consultant to tell vou whrt to do, and a total of perhaPs 40 Patients to look after. And now think of a hosPital job with 200 patients, all your own direct responsibility, with a larg€ outPatient dePart_ m€nt to run. Add to this an occasional tour of provincial treatment stationt; and set the whote in a beautiful country with a Pleasant

climate. And there you have the sort of transition that haPPened to me when I came

to

Ethiopia as

a

volunt€er doctor with

Graduate Service Overseat.

I went to the

Gov€rnment LePros)'

Hospital in Addis Ababa as assistant medical offi€er. My job at present is largely to run

the medical side of the hotPital (this

is

partly due to the ablence of another doctor)' for which I have comPlete clinical retPonsibility. Nearly all of the Patients have leProsy' but many of them raise Problems in other specialties, mainly Seneral and troPical medicine, dermatology, pa€diatrics and obstetrics.

My great satidaction lies in this clinical freedom-but offsetting this L a certain lack of facilities, for examPle most Pathology

ir either outside the scope of our laboratory beyond the purse of the Patients- And rhis goes for most paramedical care excePt

or

22

NEW BLACKWELL BOOKS AD Introduclion to Social Medicine TnoMrs McKEoMr,R-c.P.. and C. R. LowE. M.D-. pE.D- D.eH. Seplember, 1966,336 pases, 24

illusirations.

50s.

T€xtbook of Phamacolog/ Edited by W. C. BowMAN. pa-D.. B.ps^RM.. cr al. February, 1967. 840 pass- 78 illustmtions.

Aboul 80s.

A Collru in Rerrl Die:'s G- M-

B*Lhts,

M.8.,

Mx.c.p. 1966. 412 paees. 90 illusratons.

An Intodtrclior ao Elerhocardiography L. SctslMRoTs. M.*,c.p. Thi.d Elitio October, 1966. 208 paeEs. 191

illusrations

N.waAStunld.lTitl"s Bades 2296.

Ircrnre Notes or GyD&coloey lacltrre Noa6 oD lt€mrtoloa/

Ixctue Nol6 on \eurelogy

I 8s. 6dDraper IatnF Note oD Cdenl Ellis and Cal& 42s.

Jolly .

20s.

ImDunolog/ for Stdenas of

Clioical Tropical Di$as€s A- R. D. ADNS. M.D- F.R.c.p.. bx.M.. and B. C. M^EcR^rrr.

Fout h EA itio n. Qctober.

1966. 608 pag6. 7l illusiations. ?0s.

L€chII€ Noles on Obct€toic

FRlir. Mu$noE. 452 pases. 24

illusrratioDs-

D.^. Secon.t Edition. 1966.

5G.

Hrndbool ol Mcdi@l

25s,

BLACKWELL SCIENTIFIC PUBLICATIONS

.

oxFoRn

THE

MEDICAL PROTECTION SOCIETY FOUNDED I892 I'4E}lBERSHIP EXCEEDS,l5OOO MenbeBhip secures protecrion of profesionat inlerests by e persoDl advkort servi.€ and tbe prcvkion of unlimlred indemnirl againrt tetal costs and d.n.g6.

THE MEDICAI PROTECTION SOCIETY 50 HALLA}1 STREET. LONDON . W.I Ielepilone LANGHAT| 924t

LOS

z

,.4

q:t

\ooer..t-r5.

THE

f[

r^-:o \.,r

\,p,''

Q{r& DENT,SaRY.

REVEALING EYE Petall'd lris plucked for eyes, Whose pupil disc expose the beating pulse All laid bare, to see within strested emotions The silver'd vessel aged as the hair.

Its weaken'd wall gives way to others in their

coursing.

The tortuous path of ages are written on the

As ifconceived for this insight A recorded tapestry of life.

This inverted portal of the mind ls by its own reflection seen A flower in the garden of the face wilting on the Autumn'd edge of life.

Dr W. G. Hobbs-

BRISTOL but where ?

Each year many qualifled doctors leave Brstol after spending six years (or perhaps more) at the Univereity and Hospital, and travel to all parts of the country and world.

When rhey Jeave they take with them memorjes of places, faces, and incideirs.

Over the yeaB these may fade or beconre distorted. Here are picrures of a few ptaces which ma) revive oid memories. Can you remember where they are ? lf they revive

memories of incidents humorous. sad or inditrerent, please write and tell us about

sdals sEUIsriql

s

t

't

z

'I

Photography P. Garner.

Information on Searle products is vours for the asking

You @d obtain comploie infom6tioE on uv of the preparstioc boloF' rimply by complciing the cduPon

.

Drug

Fbau r.nntu

F----l

A'l.tM Ndodr n:

eta"oooe..e

I I

I Po-Bsthi"â&#x201A;Ź'

NSXIAOE IN THI IIf,RI'ICE

JJ'.'

IBB

OT

IiEDICI

l; S earle

26

ft .''; ifr,l:"ill;tli;

NEWS

& VIEWS

SUPPLEMENT

HABVHTS ,/9.:,a/

g1***

J;q1." "/:/*,..a--f-4-at/.-7;*3:"/zV5>.

&a//t/J.,

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Editorial Comment Man is by nature sregarious but none more

so rhan the medical student, doomed by circumstances to spend the maiority of his university career in the.ompany of other medical students. SharinC similar Problemr, noted for their similar ideas, and often for their lack of them. Communi.ation with students of other faculties is generally lost in the formative years of the .ourse, which differs so radically from those of most other faculties. Cliques form, and their bonds are strengthened during the clini.al course by the rlrm system. long periods of residency and the long summer term when most other st{dents have departed. Entertainment becomes a considerable problem Panicularly in the summer. Finances are strained' The conditioning effect of the course tends to

dull original thought and without new ideas a behaviour pattern when started rarely alters. hence social boredom. The iocial boredom being produced indirectly by the course in turn produces greate. aPathy towardr the course and the vicious circle is set in motion, and in many cases continues

throughout the course. This

Produces

doctors who might well be Proficient in the practice of pure medicine, since they resPond to various signs and symptoms by the right .onditioned reflexes. However, the caPacity to use higher intellect often atroPhies, sometimes irreversibly producing a doctor in name

but not as defined 'a learned man ''

THERE'S

A SNAIL IN OUR

KITCIIEN (Up at the B.R.I.)

A medical students life may be frusrating bur when he har to stand around waiting for his food he can justly feel disgruntled.

The queue for meals suddenly .omes to a halt for 15 minutes- why ? Theyve run oot of .hips, or peai, or meat, and only when the last morsel has gone is the kitchen PrePared

MR. LOXTON, THE NEW HON, PRESIDENT It is very appropriare rhat Mr. Loxton, with his long

associa.ion with shlps and boats, should find h;mself incumbent at the General, in the heart of Bristol's dockland.

His career began, al50 in Bristol with his qualitication in 1935, and a house job under Mr. Shepherd. His association with ships besan jusr six mon.hs larer, when he spent his firsr o week holiday period ai medical officer on a banana boat ro the Canary kies.

This seemed to suir him so much that over the next few years he akernated appointments on dry land with voyages to Jamaica, South America, and to the Canaries again.

Came the war and the asso.iation was renewed, when in 1940 he found himself in

to re.eive an S-O.S. for more. Hence a long famished wait as the dining room and corridor becomes congested with indignant students. This is not an isolated happening but sufiiciently frequent to cause numerous complaints, but ro no avail. Why the kitchen

has

to wait until existing sopplies

are

exhausted, and then rpend so long in answer-

ing the .all will probably remain

an

We are looking forward to the help

a Dutch cheese boat in the English Channel.

He had been a member of th€ ill-fated British Expeditionary Force to France that

diferent fields as Honorary President of

became stranded at Dunkirk, and the cheese boat was hk method of es€ape from the

Galenicals.

T. Hamblin.

After the war he took his Fellowsh;p of the Royal College of Surgeons of England in 1946, and his membersh;p of the Royal College

of Obstetricians and

VIEWPOINT The formation of a liaison €ommittee during the previous academi€ year is a valiant attempt by Galenicals. the medical

Gynaecologists

in 1948. Before becoming Consultant

students union, to improve communication between the students and the staff (the tutorial system having been only a very lukewarm success). This is an important rtep in making the yoice of the student heard

G)na€cologist and Obstetrician to the united Bristol Hospitak in 1951. he was resident

Obstetric and GyDae€ological Officer at Nottingham City Hospital, then Senior Obstetric ReSistrar to the professorial unit Bristol. and Lecturer in Obstetrics and Gynaecology to the L,nited Birmingham Hospitak. He was ele.ted Fellow of the Royal College of Obstetricians and Gynaecologists

in

within 'the halls of power' but ;ts success will depend on forceful and well orSanised represent-ation by the executive committee of Galenicals in conveying student opinion,

and therefore requires student support just as much as co,operarion from the staff, for without both of these it is doomed to failure from the start. No one is nearer to the

1967.

Honorary Vi(e-President

of

Galenicals in

well remember€d for his leture '' Canak and Waterways I Have Known."

Despite the G/naecological connotations of the tide, he v.as harking back to his old lov€ Ior boats. He keeps a boat at St lves in East 1962, he is

student problem than the student, and therefore ro understand the student problem it is

onll a

Anglia, and has spent many holidays cruising on the Norfolk Broads and on the canak of Northern and Central England. ln his youth he wa5 a crosecountry runner

commonsense that the staff must make communicate and not to

gr*ter effort to

At present the greatest cause for discontent amongst students is the curriculum and the poor standard of teaching and organisation on some of the firms. The curriculum has r{ently been altered and it

and indeed until quite recently coL'ld be seen running six miles around Coombe Dingle three timer a week- But cricket is his

in the throes of being altered again. It k at rhk point that student representarion can convey to the statr the problems which exist at present, and hence prevent useless repetition of such mktakes in the new curriculum. A s/mpathetic hearing from the staff will go a long way towards fostering better student staff relationship, and it is hoped will pave the way to breaking the barriers which at present exist. Disregard of student opinion is bound to lead to a worsening of the present situation and in.reased student apathy on the cliiical

first love. As a bo/ his hero was Harold Larwood, and he supported Nottinghamshire at the bottom of rhe.ounty table, through their years of greatness, and back to the bottom again. He also suppons Gloucestershire and Northamptonshire, of which club he is a patron and his wife a Apart from.ricket he lkts.ars as being among his great loves.

He k an expert amateur

and

guidance of a man so well yersed in so many

photographer,

and possesses a fine collection of old English 29

started his higher education at a Tea'her Training College in Nairobi, sPecialising in geography. After teaching for several vears hii elder brother gained hi5 degree' thus eating the financial situation at home, and allowing Alban to travel to England to start

He gained lst f'l B exemPrion at West Ham College (London) arrivtnC in Bristol Ocbber 1962. Hit a.tiYity within Galenicals started in l95l with his election as VicePresident, and continued through the years with potitions at Fourth Year RePretentative' Fifth Year Representative, Treasurer and Chairman of common Room. He has juttlv not dir€cted his interests 5olely within the medical faculty having h€ld the Position ot the President of the Kenya Srudents' Atsociation for Bristol and the West of England, sjnce 1964.

CALENICALS PRESIDENT I966-7-ALBAN BARROS D'SA wilh rhe termination of another addemic

He is .n :ctive hocke)' enthusiast' here with considerable success having repres€nted both the hotpi(al and the unive.sitv. again

He is an ever present figure at dances' Parties

year once again the ne*ly elected Pretident of Galen,cals takes over his arduo'rt and h,ehly respons,ble office This year the $sk falls to Alban, who has alr€adv set his stamP of friendly efficienc/ on the organisation of

:nd

fully used in carrying out the aims of Galeni€als in repret€nting stud€nt oPinion.

Galenicals.

Born in Kenya, one of a familv of six'

most other social activities' showing

there ir always tim€ for relaxation. I am lure that hit numerous.aPabilities will be force"

A

he

Fishtal

LIVING.IN

by R. Harding Srnce July.

rnd rhe oPening ol the

attend any emergency admitted to

new

the

hospital during the 24 hours he is on dut/ The sudentt lve in the new Extension and can easily be <alled during the night' since

DolDhi. House Extenlion. a new svstem of living-rn has been rn oPeration at (he B R I' Surgical and Medical clerks are asked ro live,n for a week a( a time, one member of ea(h firm being resident aI one rrme Thus there are foLrr medrcal and four surgi(al studenrs lrving-in a( any one time The student to the unrr on rake on anv given 'tteched day is given a bleeP and is exPected to

every room hat

a

tel€Phone When an

emergen.y comes in the student on take is expec.ed to call the others living-in so that they can all attend the case The student on take will have preference in Qking the history, examining the Patient. and in the

30

was remarked by the Danish visitors that little had been organised for them doring their itay in Br;stol, but at least this even' ing proved to be a success.

DENTAL STUDENTS' SOCIETY NEWS

The results of first and second part finak were heralded in the usual Bacchanalian manner in the Hors€ and Jockey. Notable drinkers included one, who ir is rumoured, over-indulged in the hard stuff and had to be .ared for quite intensively until Norman pupillary reflexes rerurned. lt is said that he war "on 5pirit5 to avoid a hang-over the

by R. Miller l'4r. John Lucia was elected as the new

president of the society in succession to I'ir. lan Kelly. It was felt that hk many talents could w€ll be harnessed by the society and

since his etrorts

following morning."

The €ommittee, on behalf of the societ/, have decided to withdraw fron the B.D.S.A. as from the start of the Autumn term, and anticipates a substandal saving of money in this respect. l'|embership is still, however. available to individual members of the Dental School via the B-D.S.A. representa-

in

producing last year's pantomime, playinq football and cricket for the Hospital team did not visibly seem to anterfere

with his

studies, great

faith

was

pla€ed in him in y€t another undertaking.

There were several sraff ve6us students matches when the sporting t)/pes had chance

to

shine- (1. Smith promised to bowl two maidens over.) The trvo cricket matches resulted in a draw for lst XI and a win for the 2nd Xl. The table-tennis match was won in an oveMhelming victory for the students.

We hope that the standard of play yielded no indication as to the time spent in this extra-mural course.

Yet another dance was provided in the Dental Hospital for the Danish studenrs. It

further treatment, including assisting

It is requested thar it

be kn@n that the

following members of the student body have left Top Flat 165 City Road-J, Cameron, l.

Smith, D. Gloyer, l'4. Goldring, R. Smith, P. Easton, j. Reece, J. Lucia, B, lzon, R, Miller, A. Murdoch, B. BinneEley, D. H-Mullins, S. Williams. The local residents €omplained of

be to isue all students living-in with

at

bleeps,

The system has met with genenl qualified approval, The main obiections are that : l. The Houseman does not always arrange for the student to be called; 2. The student on t-ek€ is often u<ed for fetching blood from Haematology. The con-

if

practicable.

These objections are hardly insurmountable, and the s/stem seems to be of much

more value than the old one- With the palatial facilities now available, noone <an call living-in the hardship it used to be. ln a week one can see a much wider sele.tion of cases than under the previous system, and also get to know the qualified staff (and

c€pt of blood student is suppded to be a part of past history. Porters are supposed to

do this job now, but apparently they have not been told this- A certain lack of liaison.

nurses) much better.

Once the initial difiiculties have

been

ironed out, living-in will become an enioyable and valuable exp€rience, not the chore

3.

Stodents without bleeps may be to contact, and so ma/ miss interestlng cases. The remedy here seemr to impossible

3l

Variation in teaching method

CLERKING

IN

BRISTOL

by R. Blocklock Bristol, the name conjures up pictures of docks, shipping, aDd a vast commercial town.

of normal and abnormal subjects 1l was used as a normal). He kindly showed me round the Cardiology Department ar the General Hospiial, and doring my s€y here I revisited the General Hospital to see catheterisationt and other investigations being carried out.

There is a similar teaching unit in one of the Edinburgh teaching hospitals, although in the Royal Infirmary, Edinburgh, there is also a specialised Coronary Care Unit in which the patient! E-C.G-, pulse presure, pulse nte, etc., are continually monitored in rn attempt to forestall cardiac arrest. Apparently there is at present no similar unit in

However, on arrival for a six week stay at the Eristol Royal lnfirmary I was pleasantly surprised by the spacioasness and cleanliness of the city in contrast to the drab and sooty streets of Leith, the dockland of Edinburgh, to which I was normally accustomed. ln Edinburgh the medical studenB have the normal university holidays until the fifth year of the course. However, at the end of the fourth year they have to complete a six week clerking elective iD any English speaking hospital, and several of my friends hrve choten hospitals as far apart as Mississippi and County Cork. \r'r'e have a fu'ther elective period of srudy in the fifth year which dn

the

B.R-1.

I quickly sertled down and found the frm very interesting and informal- BeinS clinically of the other stodents on the firm the teaching was not as high-powered as I feared it might be, and any ignorances of mine were not so apparent. The teaching was very good, comparing favourably with that in Edinburgh, however there were some differences in approach. One example is in the us€ of Homan's sign to elicit evidence of deep venous thrombosis- ln Edinburgh this is taboo

also be done in any English speaking hospital.

I chose Bristol for reasons varying from the advanta8e of clerkins in a teaching hospital to the fact that my girl friend lives in Brisrol. So it was that I arrived at the B.R-|.

a year in advance

during the first week of july.

The hospital struck me as unusual in being divided by a main road and despite various prominently displayed s;gns the atmosphere,

with the noise from the buildirg sites, bus routes and heavy traffic, is anything but quier. This becomes more appar€nt after

because of the posible risk of pulmonary embolus, whereas its use seeme the accepted

having spent my firsr night in the impressive new students'reside.t block, as my room overlooked Marlborough Street.

During the fourth year in Edinburgh we spend two terms studying medicine and one studyiog rurgery. The mornings from l0 a.m. p.m. rre spent on the wards and in th€ -l aftern@n there are lectures and practicals with particular emphasis on pathology and bacteriology, since we tike our professional examr in rhese subjects ar the end of the fourth year. Of rhe rhree hours spenc in rhe

On arrival I reported to the Clinical Dean, and as I expressed an inter€st in cardiology lwas assigned to the Medi.al Firm of Dr. Cares and Dr Barritt. I wenr down ro the General Hospital to meet Dr. Barritt and was immediately involved in his investigations on the effects of digitalis on the heans

hospitel ea(h day 32

ar

least rwo houri ir

to teaching, either on the ward or in the out-patient department. Th€ extent to which one clerks and examines patients varies from firm to firm- During one term

symposia a week. These take the lorm of a 'teach-in', where a panel of consultants or

devoted

a chairman deal with all clinical conditio^. There are illustrations with lantern slides and patients.

specialists under

aspe.rs

on a surgical firm I clerked only two patients, this was done in my spare time, the three hours during the day being devoted entirely

to

Students participate by asking relevant ques, tions and raising various points. For instance,

a symposium on peptic ulcer would be dis, cussed by a panel .onsisting of a physician, pathologist, surgeoD, radiographer and perhaps a specialist from the clinical chemlrtr/ deprtment. Attendance varies occording to the wether, subject, speakers, or th€ proximity of the exams, but it is generally

teaching.

Teaching method

of a

in Briitol is similar to

that in EdinburSh i-e. discusting the patient's case history sttesing relevant and related fac$, followed by a bed-side examinatior of the patient. However, owing to the emphasis placed on teaching we have littl€ opportunity for practical medicine or following

good.

our pati€ntl progress. The sys(em an Brktol wher€ stud€nts carry our their own rideroom investigations and by taking their parienr's blood can follow the invertigations being done on their pati€n$ is very 8ood.

Our day beSins with a nine o'clock lectlre and finish€s ofren ar five oclo.k 6r lar€r in one

rt

or oth€r of the laboratories We

have

least one exam each t€rm until finals, and

a great deal of

importan€e

is laid on the

to

As our cljnical teaching only lasrs rhree hourr a day stud€n$ onlt sp€nd a short part of ea.h day in any one hospiul, hence there

results, ensuring that we keep up

ar€ no amenities, e.8. dining-room, commonroom, living accommodation for studen$ in

many societies. The Royal f4edical Society, our equival€nt to Gal€nicals, is th€ only s.udent body to be granted a royal chart€r which it received before a charter was given

date

The Medical Faculty in Edinburgh

mort of th€ hospjtals, and it is onl) in rhe final year thar students live-in' for a short

period. Th€ newly jntroduced system in Brirtol, whereby one member of each of the medical and surgjcal firms live in for one w€ek, it very good. ln Edinburgh, each firm has 'waiting nights' i.e. when the firm is on take, however, ther€ ir Senerally no compulsion to attend the firm during the evening.

Similarly, any work done in the casualty departm€nt or any assisting at operations i! done in the studentt rpare time during the fourth year; though it is etsential later in the course that the student has exper;ence of these aspects of medicine. We are widely encouraged to attend fracture clinics, outpatient departments, casualty department, etc., and most students do so in their spare

has

to the Royal Society of Medi€jne. We have oor own publicatjon, sporting and recrea" tional societies. and in contrast to grisrol have a rtrong interelr and r€presentation in the B.M.S.A. The averaSe intak€ of srudenrs each year is about one hundred and flft),, and shortl/ to be increased. Thus th€ facult), makes its effects felt on the gen€ral university life, and the Men's Union (stricdy male) run on Oxbridge lines is dominated and run b/ medical srudents as ir the ofilcial

student's repretentative council. ln conclusion, I found my 5ix week clerking period in Brastol interesting, instructive and enjoyable: and while various contrasts and comparisons can be made between the teaching systems of Edinburgh and Bristol I feel that one is neither better nor worse than

ln Edinburgh the teaching is intensive and apart from the medical and surgical lectures

on the wards there are ako two.lini.al 33

B. D.S.A. The congress being held over the water' this year wxs an encouragement for many of those interested to take advantage of the situation and combine the Congress with a

The Congress, as alwayr, was a balanced mixture of social and academic functiont as well as the business of B.D.S A. and was this year well covered by the Press, radio and televasion, the results aPPearing both

in

N

lreland and England.

On the first day all the delegates were wel.omed by Professor P. r' stoy, Dent:l Dean, University of Belfast Professor stoy was appointed Dental Astistant Dean to the Dean of the Fa.ulty of f4edicine, University of Bristol in 1940. He left Bristol in 1948 to

become Professor of Dental surgery in Belfast. During one of his many sPe€ches during the Consre's Professor Stoy ( I ) said that in his early days in Bristol there were two possible placet for a student to study : either the Bristol Royal lnfirmary or Bristol General Hospital. lf a student was disatis_ fied with one he would pack uP his equiPment, all of whi.h he supplied himself, and

on the first evening, Monday, a cocktail party was held in the Great Hall, Qoeent Univerrity, where delegates met local dignitaries and the senior staff of the University. The Lord Mayor of Belfast €ntertiined delegates to coffee at the Ciry Hall, Belfast, on the Tuesday morning. The Minister of Health for N. lreland entertained us to tea on the Wednesday afternoon and pertonally showed us some of the 'sights' of Stormont-the seat of the Government of N.

lreland.

A barbe€ue was held near Bangor on the Wednesday evening; this was organised, and

coNGREss teb6 HELD IN BELFAST rhe food prepared, by the Horpital Sister and the Hospital Secretaryr the latter known to all ar Davis and 'loved' by all the students at Belfast Dental s<hool. Having been well fed, we were e^tertained to some ex€ellent folk singing around a large bonfire-

On the Thursday there wat an all day trip up the Antrim coast by coach, an excellent lunch being supplied by the local B.D.A. at Cushenden.

After beer and sandwiches (beer

was incidentally freely available throughout the trip) at a pub near Coleraine we went to the Girnts Causeway. Here we were able to see a perfect sunset in a cloudless sky.

Throughout the week we did not need rainwear of any sort and the sun was evident

On the last day we were given an excellent lunch by the Hospitals Authority and ended the Congress with the Annual Dinner and Dance. This created history in that a sitdown dinner was put on for th€ first time in the canteen of the Nurses'Home especially

for

B.D S.A.

THE DANES IN BRISTOL 1966 . , The annual summ€r visit to Bristol l'4edical School b) the Danes has come and €one.

Their visit, which lasts a month, is an event looked forward to by many Bristol l'ledical

Students who are faced with the dull prospect of rpending the summer in Brirtol.

Danish l',iedical Students come to Brittol, to other British Medical Schools for a .ourse in human disrection. They have the

and

mammoth task of dirsecting a cadaver ;n one

month. To the hard-working Danes, this

is

The Dental Stodents as well as the a dance, each of

During these many social eyents, apart business of 8.D.5.A. (see the December issue of the 8.D.5.A. lournal)

from the

Galenicals each orSanised

them well attended and proving very enjoyable. Although the Danes had very little time available, they very kindly gave a Danish Party at the GIen- This also went very well and included such off-beat entertainment as a mini-bicycle nce for the

there were six aGdemic papeB. There wxs a lecture and demonstration of Hypnotism, a lecture on Mouth Cancer, a lecture on Stainless Steel Dentures with a demonstration, a talk and film on a concept of the Dentirt\ posture while working, a lecture on forensic medicine and a much publicised talk. This talk was by Professor Scott known to mort Bristol students through his book on Dental Anatomy. He was to lecture on " The Principles of Anatomy as seen in the Oral Caviry," but instead he gave us a fatherly talk on how students should mix pleasure

ladies.

The f4edical School provided its own entertainment for the Danes and showed them the finer pdnts of pickling and other detailr in the preparation and preservation

of

anatomical specimens. There was aho, I am lnformed. a brisk tade in s*ond-hand

with work. He ako said that students should spend their lives asking questions-" no que(ion is a silly question." Amongst the advice was that one should learn to get drunk and not to show it, and that students should learn to drive a car, preferably a Jaguar. Studenrs should aho learn to talk to their patientr on any subject,

Our guests were organised in parties and shown over the B.R.l. by a few clinical medics, who found them very appreciative and interested in all that they saw. The theatre staff at the B-R.|. remained remarkabl) calm during their four-day invasion by the Danes.

The Congress was, once again, an excellent

It

opportun;ty for siudenrs from all schools to m€et each other and to meet the host school ard its staff. We l@k foerrd to the next Congress which is to be held in Birmingham or Manchester next Augurt Stoy, P. J. (1947) Th. Bristol Denhl School 1940. Brir-D€nr-j. 82,

l.u.

was very unfortunate that the tennis

tournament for the cup so kindll presented

by Professor Yoffey failed to materialirc.

Every effort must be made to get this very popular tennis match played off next year.

The Yoffey Cup is presented to the winners of the tournameDt and in 1965 was won by

1874-

a team drawn from both

Medics and

Dentalt.

Many of the Danes went to London for week-end visits- Another excursion they

onl/ a five &y wek nine to four iob, leaving plenty of time to enjoy being in a foreigd

made was

r

week-end <oach

trip to

M/ale!.

In spite of having to t.avel continuously for eight hours, the d;scomforts of the €oa€h

Galenicals otrers the Danes all the help they may need in organising their sightseeing tr;ps and also arnnge some social activities for them- There was a virit to the B.A.C. works, which had proved very

ride were offset by the beauty of

the countryside and a good time was had by all.

The tatk of ensuring that rhe Danish visit success i5 made very much easier by Mrr. Esden's wonderful emciency in organ, ising lodgings for them, many thanks go to her for dc'ing thi5.

ir a

popular with last year's group and which wat Ihi5 includes seeing a mock-up of the Concord followed

equally successful this year,

by an excellent tea provided gratis by our 35

MEDICS

I

CR IC KET A.orher season dies, with the wicket settling to a dark brown rugby Pitch colour, hav ng pa$ed rhrough the spectrum from green to yelTow Io gold, and

it

s sad to record also the

death of an era of cricker in

Bristo Th s has

always been the home of amareurism n .r cket. with the brilllant but erratic ind viduallst dominating the scene, suPPorred

b/

rhe

iondescript. the hoPeful. and the lucky

It al dates. one liket to think, back Io the last century when W G. Grace as a studenr here represented the HosPital, sramping his, nol the. so consderabe (or hisute), presence on the game The rradition has been continued in recent years by the already legendary Venti Lo si, and Paddy

Smith, xnd larterly by Tony Pearson, M ke We ch, and Peter Thompson.

Bur alas, these gendemen have al deParred .o higher realms. Let !s for however mourn rheir demise for too long, for in the Place of Oxford Sags and knee length swearer ihere has grown a new Profess onalism

ANGUS PRIDIE

ATHLETICS

Undoubtenly much of the new sPirir has been engendered by the security that the new ground at Brislington affords. We are also reaping rhe benefii of rhe good work of past secretar es, who have comPlled for us a large and resting 6xture lisr, and by rhe presenr efforts of the lreasurer, Mr' Bob

Ar Rodway Track, Mangorsfield, on Sat!rdav, 14ay l4th Brisrol Universiry Athlerics side challenged rhe Welsh Union Birmingham Unlversity, and Loughborough Col ege!

Alrhough the Brisrol side lrailed inro fourth place two excellent Performances were Produced by l.4edical students Angus Pridie' unive6ity shot charnPion, breaking his prevlous best Performance wo. rhe evenr with a throw of 45 ft 7 in Frank Smirh afrer a series of no throws in the discus, ended in good form with a rhrow of 126 ft 8j in. to take second place with Pridie third

Wilson. who has set the club on a much sounder fi.ancial footing than before ln rhe present leam Bob lzon has insPired us in all aspecrs bee. a8gressive,

l's l6

f," dr-g

of the game. His barting has hir bowling challenging, and

.-d f"lc-r"tting a' rapu:

har

ACTION.

a

a

a

always been of an attacking nature. The bowlers have often been depleted due to examinations, holidayt, and the call of the

under the Severn Bridge, and all pleasuret were well catered for. We have been asked

N.H.5., but when they were available, Welch, Thompson and Bell, all bowled well. Purnell was on€ of the three best wicket-k€epers

The results belie the achievement of the team. We won eight, lost twelve, and dr€w two matthes- However w€ played well and the defeats haye been narrow ones. Enoush

we saw rll

to return next year,

season. Binnersly and Ellyett

s€emed early in the searon to be firmly enrrenched as opening batsmen, but:s wedding bells chimed their ugly seductive tunes we were pleased to find Hetiey a stolid if nor

of the old

stylirh accruer of runs.

The tour of Devon was well up ro ks usual high ,tandard. The weather war fine, th€ food abundant,:nd th€ mackerel fishing was productive. The cricket was alto tense and exciting, the beer flowed like water

u z

REGULATION ALAZERS

remains

to mould the n€w team,

and much can be expected in th€ future.

I should like to record the thanks of the club ro Dr. D. W. Barratt. who has been a very helpful presidenr, and to I'lr. Bickell

and the Sround staff ar Brhlington house, who have done their best to prepare a good wirket. Ako we:re grat€ful to lan Smith for his h€lp in scoring durin€ the se:son.

T. Hamblii ( Hon. Sec.).

II

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FOODS

GIIILDFORD . SI'R,BEY

Ameri.an Association

of

Anatomists for

severalyears. Ir resulted in the publication of over a hundred lengthy papers. The disPute finally cooled down when members of the asso.iation not involved in the dispute

THE

ro leave if the subiect was not from the annual meetings. Since then, up to the present time papeB have rhreatened

ORIGIN

dropped

appeared supporting one or other of the two theories, and in fact the dispute although far less heated now still existt between pupils and followers ot the original workers.

OF

THE

At the centre of this controversy which filled a decad€ of American Medical literatore were Florence Sabin and her chief.

Professor Mall of john Hopkins University, Baltimore, and on the other side were Professors Hunrinsron and Mcclure of

LYMPHATICS

Columbia and Princetown UniveBities respectively- The controversy was whether lym-

itt origin from the embryonic venous system or whether it was derived directly from mesenchyme. Saxer in 1896 working on a 2.5 cm. bovine embr/o

On referring to the various textbooks of embryolog concerning the origin and development of lymphatics, one fact soon becomes apparent- All the books are similar

phatic endothelium had

in that they all devote a very small section

obseryed

on both sides of the neck a cystic cavit/' lined with flattened endothelium from which an oblique channel joined the adjacent venous trunk. Saxer had in facr discovered the jusular lymph sacs.

Sabin held the v;ew that these lymph sacs were ouErowths of the vein and were lined with venous epithelium, but Huntington refuted this and maintained that the sacs were of mesenchymal origin and that the connections with the vein were secondary.

We now take a brief look at the work of

to the l/mphataci, but differ in that

they mention one or other of the theories on the origin of the lymphatics as being the correct and <urrently held view.

The two theories are tho5e put fotuard by Huntington and Sabin. Grayt, Langmank and Arey's Embryology, refer to Huntington: theory as the commonly held view, whereas Hamilton, Boyd and Mossman and Patten ref€r to Sabin's. Most of these books in fact mention both theoriei and then support one, for example Grayl mentions both but refers to Huntingtonl as the commonly held view-

Sabin and Huntington.

Sabin based her work on that of the French histologist Louis Ranvier who in 1897 from h's work on pig embryos of 9 to i8 cm.

The cootroverry whi.h still exkts started and was most heated at the turn of this century. The dispute rather curiously was almost wholly confi6ed to the United States.

There were many vehement arguments ar to the origin of the lymphatics and the topic an fact dominated the annual meeting of the

had des.ribed the growth

of

lymph

vessels

in the skin. He injected the skin lymph with lndia ink and observed thar they gr€w by budding. This was in €ontradistinction to the view that Gulland put fotuard in 1894, namely that lymph vessel, capiUaries

l9

the veins and by budding lhemtelves rhey form the lymph ves'els. ( -l

developed from tissue spaces. ln his paper on the growth of lymphatics Ranvier suggested that the lymphatics could bud from the venous rysrem. bur could not establith thit ar his embryos were too old.

HuntinSton in his paperr s}rends much time actively criricising Sab'ns work. He refutes her work by 5taring rhar ir is furile to race developing lymph vesrels by rniection. He argues rhar injecrions can onl). ierve in dererminin8 rhe exr€nt of develop-

Sabin drd her own work on p'g embryo using the lndia ink technique of Ranvier. She first established by injections and the rtudy of seflal lectrons thar there were no lymph.ti.s present in a pig embryo rmaller than 14 mm. (corresponding to a human embn/o or five week'). She u'ed only rresh embryos and claims to have injected them whrlst the

hearr was

rtill

men( of the sy5tem and serve no purpose nor afford any clue as ro the origin of the vessels. Furthermore the rechnique faik to

the pres€nce or absence of mesenchymal inter.ellular spaces situated beyond the forthelt point reached by an injettion. His own theory ir based on the existence of such spaces. He regards th€ lymphadc vessels of th€ adult as the resutt of ruccessive furions of thete embryonal intercellular mesenchymal spaces uniting with each other in a centriperal (towerds demonstrate

bearng. Starting wrth older

embryos ray l0 cm. in rize and

the

'niecting pad of rhe foot she observed lymphatict mnning to rhe inguinal reg'on. As younger embryos were taken the vessek became ex'sted. These rmpossible to iniections led to the idea of a gradual Srowth of the lympharic system from the centre.

This it valid becaure at a sta€e when vessels could not be shown by injection in the limbs they could be demonrtrat€d in the body wall indicatifig that the vessels had not yet grown out to the limbs. She next investigated from where these skin vessels were originating.

Thir lhe did by injecting the vessels and then tracin8 them back by dissection and in sections. On injecting the neck of an old embryo she traced the vessel5 back to the subclavian vein. However on injecting a /ounger embryo she was able to race the v€ssels to a large sac jusr external ro the anterior cardinal vein. this in facr was the jugular lymph sac. UsinS this technique of injecting embn/os of varying ages she located four points from which the skin lymphatics originate; these being the paired jugular and iliac lymph sacs. lnternally rhe lymphatics originate from the retroperitoneal lymph sac and rhe cysterna.hyli.

Thii makes a total of six lymph sacs from which she claimed the entire lymphatic

the c€ntre) direction until they finatly €stablhh rheir connections with rh€ definitiv€ venous system. This way the lymphatic endoth€lium shows no specificity whereas Sabin" budding merhod necessarit)

means

is

Huntingron and M.Clure work, performed mainly on car embryos, consjsted ot .he study of s€rjal sections and graphic reconstruction wax modek. Their work may be tummed up as followr, the lymph ra€s, or

as they refer to them ahe

haemophoric

portion of the dev€loping lymphatic system, develop in a slighrly difrerent manner to the peripheral or non-haemophori. part of the system. The perjpheral yeisels first appear as intercellular mesenchymal spaces which join to form a system of channets. Th€ mesodermal parietal cetls modify to form lymphatic endothelium. ln fact a these rtages are similar to the development of the blood vas.ular channets. The tymph sacs develop from aggregations of mesenchymat spaces around the large embr/onic veins.

These spaces join to form one targe space and rhe cell lining becomes modified to form

We can summarise Sabin's th6ry by ing that the lymph

thar lymphatic endotheliun

sPecific.

saysacs arise as buds from

40

of inter-€ellular mesenchymal spaces.

Kampmeier, an American worker, who was in facr involved in the original dispute ov€r half a century ago in hjs PaPer rePorts his own

lymphadc endothelium. Mesenchymal cells then aggregate in vascular islands inside the sa€ and haemopoi€sis prceeds in the islands.

The free blood cells so formed then reach the €ir€ulation through the establishment of

gether

connection b€tween the sac and the adjoirins vein.

Huntington's theory. But the criticism which Clark levelled against Huntingon also hold againtr the work of Balankura and Kampmei€r, both of whom used thc serial sections

work on the chick embryo which supportt

a

As already menrioned Hunrington devoted of his papers ro criticising Sabin. Sabin herself thouSh was les, critical of Huntington in her l9ll review of the lit€rature.

However th€ bulk of the criticism levell€d at

part

Support for Sabin s theory that the lymphatics grew by budding in a direction away from the centre has ako .ome in. Growlng lymphatics have been directly observ€d in rhe tail of th€ frog larva. Sandison in 1924 in hk paper describing the study of growing

Huntington and llcclure .ame in l9l I from Clark in hir paper in the Anatomical Record; 'An Examination of the Methods used in th€ rtudy of the Lymphatic System.

Clark himself w.s a worker .t the lohn Hopkins Univerity and support€d Sabin in his paper. However his criti€isms

of

titsues by th€ tranrparent rabbit ear chamber method gave Clark the idea of using this technique to study the growth of the lymph-

Hunt-

ington and McClure method were quite valid and still hold. Clark doubts whether en) study of the growing lymphatics in serial lections k reliable becaus€ dl the

atics. Clark

paperr der€ribes his workt and findine which strongly support Sabin't theory. Under high maenification h€ observed that the lymphaiic capillaries Srew by bud-

lymphatic endothelium present at any period

cross section. Furth€rmore lymphatics can not be distinguished from blood vessels, perineural spaces

or

shrinkaSe spaces. Hunting-

based

on inding an

l9l8

ding. l. may be argued thar the fact that lymphatics regenerate by budding h no indication that they originated by budding.

This howev€r r€rves to show that th€ problem is not setded even now.

This whole con$oversy rerv€s to indicate how inadequate our knowledge in some field' is, but perhaps more important than this it mak€t one wonder how many of the facts

of development cannot be seen in a rtained

tont work h

in the course ot four

between 1932 and

inter-

cellular mesenchymal ipace in one embryo and then a l/mphatic in the same place in :n older embryo, but he give! no illurtration as to how the transformation t:kes place.

Clark fnally says that the fact that Mcclure had three times changed his mind as to how the lymph sacs originate is a further indi€ation as to the unreliability,o-f their work.

Despite Clark's criticiims\ support for Huntington has come in:Sahnkura, in l95l and more re.ently Kampmeier, in 1960.

Balankura, a worker at Oxford, did his work on sheep embryor using Huntington's technique. However he does admit to the venous origin of the jogolar and iliac lymph sacs, but he denier the existence of the retro, peritoneal and mesenteric sacs. H€ suppons Huntington in that he believes that the lymphatics originate from the joining to-

we read and are taught are really established,

and how many are still controversial.

Foad Nahai.

B.Sc.

REFERENCE5

B.lank"a N. K. (1924) Narure 168: 1t6.197, Cl.rk E. l. (lrll) An.t- R€c. 5: 395-414.

l..nd Clark E. R. (1932) Am€r. I. An:t Cl.rk E. L .nd Chrk E. R. (l9ll) Am.r. I An.t 52 i 271-105.

Cl.rk E. l and Clark E. R. (1917) Am.r. J. An .

60:151-294.

Hunrinsdon G- S. (lrl4) Am€r. J. An:t. 16: 259-.

Huntinston.nd McCIu.e, C-F.W. (1906) Anat. Rec. l: 16-41Krhph.ier O. (1960) Amer. r. Anii. 107: 15l-167.

S.6in F. R- {1902) Amer. L An.t. I 367. nbin F- R. (l9ll) Anai Rec. 5: 417-446.

Cl.rk E.

5l :49-47.

S.nditon l- C- ( 192,1) An.t. R€c. 28: 281 287.

1t

ANNUAL REUNION

Approximately 85 members and wivet met on Fridry, May 6th, in the Board Room at the B.R-1., and a most enioyable informal reception (with sherry and wine) was voted a su.cess by all. The Board of Governors are to be most sincerely thanked for allowing the event to be held, and for Providing

ALUMNI

rome excellent light refrethmentFit was very pleasant to meet in the B R l which it afrr all the main teaching centre in most

GALENICALS

members' memories.

On Saturday morninS, f4ay 7th, Southqead Hospital /rovi\ea a most inreresting medical prognmme, lnd our thanks are due to Dr. Page, Dr. Mather, Dr' Lewis, Mr' Slade, and all the contributo6 for such an instructive time. After " lntentive Care Unirs", "Spina 8ifida" and " Advances in Haemolytic Diseate", the members Partook of an excellent lunch indeed, arranged rhrough the Hospital l4anagement Committee and Mr. Hancock-their kind efforts will remain as the longest lasting memoris- of ihe 1966 meeting, I am quite sure I After

I fear that shortage of material caused me to infli.t the ramblings of my own grev matter on readers of the last issuâ&#x201A;Ź of the BLACK BAG. For this issue, at least l can ipare you further nmblings as I am Pleased ro repor( rhat my rn(omrng mail is increasrne; memben are at last beginnrnS to send me their news. and I have also raeived two interesting articles about medi.al Practice in other parts of the world. Dr. E. PhiliPp (36)

lunch, and lorry-five mrnu(es late. the A G l"1. wa! held at the Medical School-the Committee were re-elected and no rxdical (hanges Ihe week-end s pattern were

'n demanded. Professor Riddell and his team from the Department of Surgery gave the afternoon programme, and a good idea wds porrrayed of the wide scoPe of current surgical interests and proiecti within the

written about his l;fe in New Zdland' and Dr. Gleny' S. Kerr (n6e shute) ('59) has written about her life as " Doctor ad Housewife in East Africa "- I hoPe the writers of these articles will forgive me for putting them at the end of the Alumni Se.tion. but lam afraid the Government might accuse me of trying to encourage has

young doctors

to

1966

Tea was in the foyer, along with two display srands<ne by the B.M.A. and one b/ Mess6. Smrth, Kline and trench Ltd After tea the membe6 divided into two groups, and one toured rhe library with Mr' Roberts while the other visited the Anatomy Department with Dr. Mofatt, there being a change over at " half-time " ln the evening the main iocial event was held, the Boffet Reception at the Senior

emigrate-

First, lam grateful to osr very hard working Secretary and Treasurer' Tonv Dickens, for this official rePort of the 1966 Annual Reunion and the Preview of the 1967 4)

Dining R@m. The afternoon meeting will be in the Medical school-details are not yet finally settled. The Saturday evening Reception will be in the S.C.R. as before, and Sunday will ag.in be left comPletely free for members to make their own arrange"

Common Room of the University. 166 memberr and guests attended and the extension to midnight was fully utilised. So ended the Third Reunion-the largest yet, and we hoPe that thit encouraSing trend will continue into 1967. Professor Perry was at all the events and was a very efilcient Pr€sidentI would like to thank him for his coniinued guidance and leadership of the Society.

On Friday, July 7th, 1967, there will be a Special Bristol Dinner, during the Annual Me€ting of the B.M.A. here, and all Bristol graduates and staff (also any doctor working in Bristol) will be welcome. Attendance will be limited to 150. and the Dinner will be in the Wesrex Suite of the " Grand Hotel ", Broad Street Our member, Mr. Robert Cooke, will be the President of the B.M.A. in 1967la, znd we hope he will be able to attend at least part of the Dinner. This will

1967 PROGRAMME The Fourth Reunion will be held on Friday and Saturday, April 28th and 29th, so Please note the dates now and €ome along. The

be a v€ry speci'l occasion, and will not be repeated for some seventy yeart if the interval from the previous Annual MeetinS in Brittol is maintained for the next time ! we hope to see many members, old and new, at both functions-please note the dates now and bring your friends and fellow

Friday Reception w;ll be in the B.R.l.

Board-Room, and this will be Mr. Bickell's latt year before retirement, so we hoPe to have a big crowd of members there to wish him well. On April 29th Dr- Macrae will provide the morning programme at Ham Green (including showing the artificial kidney), and lunch will be on a cash basis in the new Studenti Un;on in Queen's Road, i. a private section of the fourth floor

graduates

in

1967.

A. I, G. Dickens, Secretary and Treasurer

holiday in England and made attending the reunion.

hope that Tony will forgive me for adding a few of my own commentt of the 1966 Reunion. Firsdy, it was gratifying to see how the attendance had increased over the previous years; I hope that these reunions will continue to snowball as th€ general air of bonhomie, with the pleasure of medng old friends, was most striking. Secondly, having conmeDted about the lar8€ number of emigrants to Australia and the very few who have ioined the Alumni, 1 was delighted to meet one member, Dr. w. R. " Bill" Cole (',f4), a Radiologist in Perth, who was on

I

a Point of

Although Bill Cole had travelled farther than anyone eke to the re nion there were many members who had travelled considerable distances, " in the hope

it

of

meeting old

was unfortunate that 50 many members from Bristol and the surrounding neighbourhood were unable to attedd. Perhaps I might mention one other member to whom distance is no object: Dr. C. D. Limon (?9), a Consultant Anaesthetist xt

friends":

43

one very successful feature of thk yeari

Southsea; he flew to the meeting in his own 'plane. Chris Linton is yery keen to persuade other members to ioin the 'Flying Doctors' Club'; personally I shall have to wait undl aeroplanes are issued free through the Health Service, or save Gree. shield stamps.

reunion was the " Silver Jubilee Dinner ". As this was organised separately by Dr. N. J. Brown (,tl ), Consultant Pathologist at Southnead, I have asked him to add his own comments on the occasion :

THE SILVER JUBILEE RE.UNION

graphs were studied and the Medical Dire.tory was thumbed. The men were easy to find as most of them had lodged at l€ast an accommodation address with the authorities but the women were more difficult. The Medical Directory will tell you a woman doctor's maiden name if you already know her married name but does not help with the reve.se process. lt may not be its function to be a marriage register but how useful it woold have been if it had retained merely the names of doctor maidens add given a cross referen.e to a fuller entr) under their present titles (" PEACH, Angel BLOGGS" for

Some time in 1965 the realisation came some of us who had qualified in l94l that shortly we should have been engaged in the practice of medicine for a quarter of a century- This seemed to call for some sort of €elebration and the suggestion arose that an effort should be made to get the entire "year" together for a dinner. During five or six years of studentship the members of a

to

''year"

become

fairly closely acquainted.

This was perhaps more so with the smaller

pre-war

"years" rhan ir is today. lt

was

particirlarly true of studenrs in the early war years, who not only met in the cou6e of day-to-day studies but were thrown together for much of the night as well in the course of " fire-watching " and other air-raid activi-

-$e

:xamPte)

a good deal of research the najority were traced. Explanatory letters and invitations were ient oLrt and replies were awaited. The response was However, after

ties. Ako, because of the war the various members had become dispersed s@n after qualifying and most of trs had nor met each other since. The idea of meeting "old soand{o " after 25 years and seeing what he or she looked like and wa' doing now proved irresistible and plans for a re-union began

most €ncouraging. Nearly everyone replied later-several after the dinner was ove.; almost all approved of the arrangement; some promised to come; some even sent the;r cheques. AmoDg the most interesting replies were lorg nostalgic letters from indiyiduals who longed to come but were prevented by distance or impoverishment from doing so; we gather that most of these will make every effort to come .ext

Ar the suggestion of the Galenicals' Alumni Committee, who were rather fearful of insufficient support, it was decided to invite graduates of 1940 and 1942 vintage as well in order to swell the numbers. A small group

DINNER

of

oreanisers was formed and the search was on. Lists of graduates were obtained from the University, old photo-

The €vening arrived and on 5th l4ay, 1966,

a party of forty-two 44

doctors, wives, hus-

bands and €onsonr assembled Hawthorns Hotel and began to

at tr/

the to

Dr. Dr. Dr. Dr.

and and and add Mr. 3nd

re€ognise one another. The exp€rience was

interesting. lnitial mktakes in identification rnd total lack ot re.ognition were not infrequent, but discret enquiries and a little

Dr. J. D. cardale Dr. and lqrs- l. Deighton

imagination soon sorted matters out and long before dinn€r was sened it was obvious that the evening was going to be a succers.

And so it proved. A most

Mrs. G. S. Andr€ws Mr5. D. L. Bayl€/ lvr5. N. ,. Erown Mrs. N. Brueton Mrs. T. ,. Eurl€r

Dr. f4argot Dickson Dr. Jean Fnser Dr. and Mrs. S. J. V. Gilson Dr. and f4rs. F. J. Goddard Dr. l4argaret Gyngell and Mr. Gyngell Dr. G. F. M. Hall Dr. Rosalie Hope-scott and Misr Hope-

enjoyable

eveniDg was spent and there seems little doubt that the experiment wat worth while.

The " Silve. J'jbilee" dinner is certain to become an annual event-moving on one year each tine so that each individual wiil have lhree chances of atterding. The initial doubts expressed by a number of individuals

Scott

Dr. and Mrs. W. G. Hunt Dr. D. tones Dr. Jo€elyn '. Kerr and Dr. R. Kerr Dr. P. Legat Dr. and Mrs. J. W. J, Newton Dr. and Mrs. J. L. Pardoe Dr. Christine Rendell Mr. and Mrs. N. Slade Dr. and f4rs. l. F, R. Sutherland Dr. and Mrs. M. H. Thomat Dr. G. H. Tovey.

as to whether the/ realb/ wanted to meet everyone again after so long an interval appear to have been resolved. The tubconscio'rs desire to do so was there and has been strengthened by the experienc€-they will come again next year-perhapt even to

a Golden Jubile€ Dinner.

The following is a list of those who attended the dinner on 6th May, 1966.

TWENTY-SEVEN YEARS When asthma forced me to leave Bristol 1939, 1 certainly did not expect to write an article on our New Zerland pra.tice of medicine 27 /ears later, without ever having set foot on to Eoropean soil since ! I suppose I felt like saying "oor" N.Z. practice, after lspent the war y€ars in the N.Z. army.

A

NEW ZEALANDER

to stand on our own economic fee( the more we become indust ialised, Until veq/ recently the born N.Z€r. used to talk of England as 'Home", now this ii chang;ng, hav€

in

the people fiDd their own indiyiduality, which shows in literature, music, art ?nd science adapted to our local conditions. We have our own arts council, the largest membership of any chamber-music societ/ in the world per head of population, but th€re are not yet three million of us ! Dunedin is still as Scottish as it can be and Christchurch could still stand somewhere in the West-

Here, once one knows so many " boys " like anywhere else in this world, one grows into the country. New Zealand is a very beautiful

country ext€nding from subarctic to subrropic, from sea to high alpine country and friendly people ev€r).where, \r'r'e are still a farming country, but dowly, the more we

P.T.O. 15

something to be Proud of The G P. still has a qrea( deal of resPonsibiliq and exPecred

Co'rntry. Wellingon is mainly an administra" tive and Auckland a busy rather American' ised business townlust as diveEified as this little countrv is in all aspects, so it i5 in medicin€. Conditiont var/ from the Blufi rn rhe South to Whanparei rn the North iust at much as from a

busy English industrAl rcwn

to a

's

to do all the spade work himself His rePutation depend! on good clinical acumen.

There is close personal working together between specialists and G P. I visit my hospital patients regularly even though they are not under my care. ldo not 8et P d for rhis, but it is expected from my Patients that I k€ep in concact with them and q'rite

sleePy

village practice.

We are Senerally neither under or overdoctored, but everybody chooses (o work where he likes and does what he likes- We are under the controt of olr B l'1.A. and the Health Dept., their various sub-organisations

rightl) so.

The payment is either direcdy bv the patient to the doctor or if you Prefer' you get Part-Payment from a tPecial government fund and the rett from the Patient himtelf'

and committees and under a central govern_ ment control, but nobody interf€res with our

We all pay hiSh taxes and are not wealthy' We see tomething for our taxes in our benefits and really I do not b€grodge it' even though twrce a /€ar mt account shows a sldden nasty droP ! l''lan),8raduat€s study in Dunedin; mort still go overseai regularly for Port'Sraduate expeflence and nowadays most come back to practice here. We had a large immigration from Britain during the last few yeart' sorn€ of these men are toP-notch, unfortunately iome are not. The overleas graduates are earily absorbed if they feel they want to belonS here and if they do a good iob, are conscientious and make friendt ln short, ldo not ne€d to underline that I have learned to love my adoPted fatherland and I lhall gladly answer any query from my old part of the world, if I €in do to

work. We are free to do, work' Pra(ti€€' charge, and live as we like. Some areas are over-doctored, some under-doctored. A beautjful sea-side town lik€ Tauranga seems to have a doctor's name Plate at €very tfieet corn€r and similar conditions seem to Pr€vail in part! of Auckland 3nd other Plac€t, whiht industrial areas like the Hutt or sle€Ping_ quarters like the distant suburbs of W€llin8ton are aa the moment looking for doctors Until now, the seParation of GP. and full' time specialist was not always clearly denn€d' bur as competition has vasdy increased dur_ ing the last few years, there it now a stricter supervision. Ihe ttandard of Practice is very high and in my .own of Wellington far more than half my colleagues heve €ot hiSher degr€es. The hospital standards too are ot the highest order end our medical care is

E. PHILIPP.

DOCTOR ond HOUSEWIFE

in

EAST AFRICA

Asian and European communities also' rhe latter b€ing composed of Government workers in Geologi€.| Survey, water DeveloPment, etc., and Missionaries-teachert and office statr mainly. There is a Government

It is abour three year' now since I came to Dodoma to work at a Doctor with the Diocese of Centnl Tanganyika in an unusual type of Missionary work. This is a town of about 10,000 people, mainly Afri.ans' with 46

U.K-, with

Hospital in town, but the nearest Mission Horpital is 25 miles away. l4y work here it that of a General Practitioner-seeing patientt in Surgery, and doing a few home visits and a little domicili.ry midwifery. A small fee is.harged and patients have to pay extra for iniections, dressings and m€dicines. There is a chemist Shop in the same building, where the patien$ go to buy their medicineThe illn€ss€s seen here ar€ similar to those se€n at home, with the addition of diseases specifi€ to tropical ar€as. Malaria is endemic, and tick-fever common, espec;ally among children in the wet season. infective hepatith is common, but s€ems to attack Europeant mostly. Breast-feeding is continued up to two years, with supplement, of maize porridge and little els€. Undernutrition and malnutrition occur all too frequently, giving a child who is lers able to cope with minor infections common cold, etc.

- than a healthy child is. A team of Doctor and Sister with African Assktants k working for the Save the Children Fund in this area, seeking to detect illness and to educate parents and children in hygiene, nutrition, etc.

Thk is a poor part of the cou.try, and if the rains are not adequate or at the expect€d time, partial famine ir liable to result. lt is dimcult to change lone-established customs and to teach more modern methodr of obtaining and conierving water, farming, nutrition, etc. This ir one of our aims, but it is a long-term policl only.

There is a great fear of illnes, whi€h leads on the one hand to neglect of s/mptoms, and on the other to overmuch concern for trivial things. This calls for a great deal of patienie for those of u5 engaged in medical

a

wide range

of

medicines,

cosmeti.s and sundries for sale. Supplies are increasingly difficult to obtain becaure of import restrictions and Customs DutyA wide varieq/ of customers comFfrom Af.ican village farmerr to we3lthy Asians and Government workers of :ll racer. The local people have no qualms about askinS for medicine for venereal diseaser, etc., as they

A Family Plannin€ Clinic har shrted here now, but people are reluctant to come for advice. lt is difficult to break down longstanding naditions among vjllage folk, and will tak€ m:ny years. The better educated do see the need tor spaced and limited families, but they do not readily pasr on thir inform, The climate here is very plearant. The wet season lasts from December to March only, and we have no rain at all at other times.

is ako the hot searon-southern hemisphere-but the rain helpr ro k€ep the temperature down. The days are n€ver cold, bur at can be cool in th€ evenings in the middle of the year, whi.h is rath€r pleesant.

Nearer the coast and lakes the climate is This

hotre. and werter, but at 3,800 feet

I

ir

i5

Since our ton was born in December 1965, have continued morning surgeri€s, leaving

Adrian in rhe tender care of hir father at the b:ck of the shop. No, he is not for 5ale would not get a Sood enough pri(e for -we him ! I also have weekly Clini€r at the Diocesan Boys' and Girl'' Secondary Schooh on the outskirts of Dodoma. and Adrian accompnies me to theseWe are going to Australia for 6 months

of this year, to whi€h looking forward, as are the Kerr family, as we h3ve not yet met. lt will be two or three yea.s after thar before we come to England, so it will be some time before I can renew acquaintance with other Old Galenials leave towards the end

lam

About 18 months after I arrived, the link between the Chemist Shop and Medical Department was made stronger when I marri€d the manager of the former. He has been here since 1960 and comes from Sydne/.

The shop is !imilar to a chemist shop in

GLCNNYS s. KERR (n6e Shute).

17

ln

NEWS

Dr. Doreen Ellis ('s0), has left Llandov€ry and is now in Practice at Bradford-on-Avon.

BR,IEF

I will close on the lighter note that Allan Dutton report€d favourable recePtion on Televirion, via T€ktar, of the world CUP Fi6al. This makes one realite that those

Professor Coralie Rendle short ('36), Ch.M., F.R.C.O.G., is now working at the Department of lvedicine, Haile Sellassie I Uniyersity. Addis Ababa. She d€scribes her-

Alumni in foreign parts are not so far away after all. I hope that many more will write to me in th€ future; articles, such at the two that follow, make interesting reading to those of us at home. Conversely. those abroad lik€ to hear about their former colleagl]es at home. Pleas€ send me your news and viewr; my addrers is still 144 Stoke Lane, Westbury-on-Trym, Bristol 9.

self as having an unusual job, so I am hoPing

for an article on it.

Dr. T. E. Dada ('51), M.R.C.O.G, is Conrultant Obstetri.ian and Gynaecologist at Lagos lsl:hd Maternity HosPital.

Dr. A. I.

('s2),

Rowl.nd

D.P.H.,

D.R.C.O.G., has recently b€en aPPointed

S€nior Medical Otrcer

(Epidemiology),

gristol Public Health Department.

RON SIMPSON

I.,IST OF AI,UIVINI IVIEMBERS 1966: Or A.

c. K. Brld!. (19t3) Prof. R. J. Bro.kl.huRt (1t2.)l Mr. G. l. A. Brown (lt6l) Dr. J. W. arown (l9al) Or. N. l. Srown (1941) Dr.

F. Alford (1925)

D.. G. s. Andr.wr ( I94l)

Anr.ll ltms

Mr. I.

(1921)

Dr. H. T. ADiimon (1955) Dr. D. t. A;cher (1953)

Dr. N. F. w. Bru.ton ( 1940) Dr, N, R, Br!.ron, n6. B.ldwin (rr42) Dr. C. N. Bruto. (1958) Dr. D. Br/ant ( 1952) Dr. I L Buckn.r (l9rl)r or. E. Eurs! (1t55) Or. w. L. Eurl.nd (1t57) or. D. Burn.n (1t50)* Dr. R. N. O'D. Burns (1912) Dr. G. R. BuEton (1962) or. R. H. Butcher (1940)'

wrlk.r (1950) ( 1957) Dr. P. M. arhu r. n6. l.wh Dr. L Ashl.y, nae Dr.

j.

S.

A. Ashhy

(1963)

t

LB.ihy(1953) Mr. A. M B.ln (195!)

Dr. v. B.ker ( l95a) Dr.

Dr,,A. K. Ball ( l96l ) Dr. R. F. B.rbour (192t)r

Lr.-Col. R. M. s.ine3 (1951)

Dr. I. H. B..Bon (19a7) Surs, Lt.-Cdr. E. P. S.ck (1956) Dr. A. T. Eeddoe (1919) Dr, P, M, Benn, na€ simpson

l.

o. B€nn.( (1939) Dr, E- c, B.ri..d (1927) Dr- A. G. Bl.ndrord (1960) Dr. R. l- Bodmrn (lt4r) Mn. M.

Mr. T. J. Sutrer (19a0) Or, A. M. G. Crmpb.ll (l9tt)t Mr. C. v. crtford (1951)

0940)

Dr, A, W, Caus.on, nae Prowse Dr. l- c. cru*on (lts2)

Dr. R, N, Chanberlain

(1944)

A. E- Ch.pm.n (1959) Dr. P. ,. Chapm.n ileaT) Dr. M. T. Chrne*on (1955) Dr. P. M. Che*.rfield,

Dr- A. R. Bolle. (1952) Dr. G. A. Bond (195,t) Dr. M. N. Bos (t948)r or J.M, Bourkc ( l94l)

Dr.

Dr. D. E. Bowden

Dr.

Mr. H. K. Bourns (19t0)*

Or. D. H. Bowden

L

( 1952)

l.

n!.

ApDl.r6n ( 1947 )

M. Child (1942) Dr. W, R, Cole (1t45)

(1957)

(19,18) (19,14)

Dr. A. B- Cl.udiurcole (1956) Dr. B. cokton (1952) Mr. N.. v. Cook€ (1926) Dr C. M. H. Cooper, na. lones

Dr. M. P. Box, na Orew

Or. F. N. Boxlll, h6c Srlisbury

(r932)

Mr. D.

J Bnin i1949) Dr.A G W Banch (1934)

Dr. A. Copp Brown (lt5l) Dr. B. o. Corner (193a)'

Dr. B. R. Bnnsilv€r. n6e D.vh

(1960)

48

(1944)

Dr. P. H. Cottrill

DLA F Hisr.rl (1953) Or- J. P. A. Hill (1960) Or l E. Hill.

(1960)

Mr. M. L. Cox (1954) Dr. H. E. Cranp (1956) Dr. O- J. Cummin, nae West

D..

Dr.

Dr

(rr49)

S M. o.ni€lr (1957) M. G_ D.sh (1960)

Dr. F. H. Hol|nsshed (1t25)

Dr

Major R- A- G. Huith (1958) Dr P. G. Hlnt (1953) DL R. l- Hunt (1952) D. w. G- B. Hunr (19a3)

Dr. J. Deishton (19,(2) Dr. o. V. oennk (ltl7) Dr. R. L. l. S. D.nh.m (lrl7) Dr. A. B. O. Des.lo (1961) Dr. A, I, G. Dicke.s (1963) Dr- R. W. Digby (195,1) Dr. M. D. Dixon (1941) Dr A. A. Dowlins (1918)

Dr c. T. HFR Dr.

ka6,

(lel7)

n6e Fos (1944) (1955)

Dr. J.

j.nerl.d€s (1951)*

Di

A. Jones (1962)

S.

Dr. C, W. Jenkins (r9s7) Dr l- w. lenkins {1952) D. P- K. J€nkins (1917) Dr. M- D. M- Johnton {1950) Dr- D- J- Jones (19a3) R_

Mr R. D- lon6 (1930) Dr. s. c. Jord.n (1t57) Dr M. v. Jot.elyne (1924) or- M. H. s.

Joyce (1952)

Dr. J. D. K€lly,

Dr.

P

n6€ Morr.y

shiii.ff

(195,1)

H. Keppi.h (1941)

G. Kcr. (1950) G- 5. Ke.i n6e sh(e (1t59) J- Ker.. n€e Brcdie (1941) J- M. KGr (1944)* G- D- K€El€y (19!l)* D.. M. A. R. King {1952)

Dr. Dr. Dr. Dr. Dr.

Dr. K. J. R. Fawcett (1952) Dr. G. N. F€bry (1954) Dr. H. F. M Finzel (1912) 196,1)

Dr. F. E. Fretcher ( l9l2)

Dr, M- 5. Kn.pp (1959)

Dr R- l. Kr6!h (1929) Dr E. J- Lac€ {1917) Dr. M. E. Lr.e, nle More.n Dr R. D. L.lloo (1953) DL P- M- LaDbert (1955) Mi G- f. Langley (1930)

H. R. fluss (1951) Dr. J. P. M. Forde (!937) D.. C. J. Fnse. (leto) D.. l. D. fraser ( 1957) Dr. S. E. Faser (1947) Mr. W. I. Gall ( 1947) Major P. T. G..dner ( 1958) Dr. N. O. ceiiish (1930) Dr. P- M. Gill (1t56) Prof. w. A. Gill€rpie (1916)+ Dr. N. G Glen (19+7) Dr. H. M. Goldins {1924)

(1t38)

n6e stephen ( l95t)

Dr. G. E. P. lee (l9.ti) Mr. H- L Leish (1950)

Prot G- G-

Lennon (193.1)'

Dr. M. LFn.rd, n€e Creishton

(1954)

Dr. J. H. r. Grirfin ( l9s5) Dr. G. H Gundy (r96t) Dr. j. a. A. H*e' (19s9) Dr. G- F. M- Hall (19,12) Dr. H. M. Hammond {1941) Dr- B. Hlnst€ad ( 196l )

w.

L€wir (l9la) Prca- M- M- L€wL (ltl8)

Dr. r.

Dr. Dr. M..

Dr. M..

D.. J. K. H.dwell (ltss) Dr. R. a. H.rvey (l95l) Dr. I. R. H,wkinP3 (194s) Dr w. H. H:y.s ( 1916)

Dr.w A Hefon-W.rd Dr. G. D Henley (1959)

(1926)

H- 116, n6e Silb€Btein

D.. a- J.

( 19,15)

(r9ll):

Dr. K. R. Gough

A

Dr. s.

D.- l- R. Duerdei (1e22) Di w. J. P. Dufi (19s2) Dr. M. 5. Dunnill (1951) Dr. w. A. w. Dutto. (1950) Dr. A. C. Edrarnt (1945) Dr. J. D. Eds€ll (1961) Dr. D. A. Ellis (1950) Dr. J. Eskell ( l9al ) Dr. C. D. Eva6 (1t32)* Prot. C- C. Ewins (1950) Mr. A. L. Eyre-Brcok (ltl2) Mr. H D. F:irman (l9i!,()* Dr. P. C. Far.nt (i949) Dr. D. F.ultn€. ( lt57) Or. T. G. F.ulkn.r Hudson

M. F FEher (

c.

R. G. How.rd (1t37) E. Hod$n (19,13) Dr. M, W. Hussins (1963)

Dr.

Dr. K. l. Davi€s (1959) Dr. P. L. Davies (1953) Dr. F, A. D.vis (1961)

Dr Dr

{19,17)

Dr. M. E. Hincks (ltsl) D.. W- G. Hobb (1956) Dr. D L D. Hods. (1956)

Dr- A. A. K. Dat. ( 1939) Dr. A. G. Davi.s (1961)

Dr. R. W. Or€wer

n6. M.nd.lb.uh

R- Hirl {1950)

J-

(196r)

C. D. tinron (1949) A- M. Lloyd {1963) S-

o. Loxton

(1915)

D. E. Mcconnell (1951)

M. P- M.Cormack (1t39)+ Dr- Ma.Donald Crilchl.y ( lt22) nae Gurnhill (1953) S. J- Mctiuchlan, n6e smith (1959) Dr. J. M. Mcr6d {1156) Dr j. E. Mackwonh (1918) Dr. R. M.sss (ltl3)

(19,14)

D.

Dr. M. Henford, n€e Caso {1919) Dr M. E. M. H.nford (lel7) Prof. T. F. Hew€. (1927) Dr- D. W. Hide (1961) 49

r

I.(J,

w. s€ldon (1956) Dr R A. Shrrp. (195€) Dr L D. sh.d (1919) Mr. H L Sh.pherd (l9ll) D.- L E. H. Shi€ld (195r) Mis o M shoiion Il9lt' Dr. M. N. simmonds (1951) D.. D. w simprcn (1955) Dr. R E D. S,npson (1951) Dr I S'mpson_white ( l9a7) Dr. F D. SLeiiett (1958) Dr. R. !. Skrine {1951 Dr- D.

Dr I. P. Mrriin (1949) Dr. D M Mr(yn lon€! (19't'1) Dr I. Mrn/ro$ian (1957) or. M. I M.,val (le6l) Dr. H. Mr"well (lt5l ) Dr. E. Mry ( 1927) Or. N. E. M.llin€ (1919) Mr. Ashron Miller (ltlr)'

Dr. B.

S. lrlilner ( 1958) Prof. R. Mil.es Walke. ( 1926)'

Dr. U. P, Mitchelmore,

n.. lon* (ltae) (19,17)

M.. N. sl.d€ (19a2)

D.. G. E. Mtr.h.lmor€

Dr- A. K. Sm€eton (1951) Dr. E. M. B. Smith (1955) Dr. I M. 5mith (19'19) Dr. P. I. s. smith ( l96r) M. o H K Sokru lltt4) Dr. W. B. SDry (1t53)

Dr. A. C. Moldcn (1934)

Mr

P.

j. w.

Monls

(let4)'

Dr. W. H. N. Moore (19,17)

Mr A. Morsan ( l9t7) Dr. A. G. Morsrn (1961)

Dr.D I sotte (1959) or P. G. sro.L (1910) Dr. D. w. c. stone (t952) Mr. A. A. Sionehill (1919) Dr. L sn.ton ( l9as )

Dr G. S. Mundy (1924) Mr.C D Mdrehv (1958) Dr. A. S. Nethercott ( 19,14) D. I. E. Newton (1910) Dr. L w. L N.wion (19a0) Dr I I. Nichoh' (1e60) Dr P. O. N,chotar (tost)

Dr. s. j. stronc (1956) Dr. D. T- l. stutt.ford (1951) Dr- l. surv.yor ( 1958) Dr. L F. R. juth.rli.d ( l9'12) Dr. M. O Srmes (1959)

M. A. Ni.hokon (1t35) Dr. V. E. Norm.n (1963) or. P. A. Normlnd.l. (194t)

Dr.

Dr M srmon3 (lta) Dr. R. L K. Talhck (lt'7) Mr N.'C T:nner ( l9l0) Dr G. D. Te,su. (194t) Dr. I. P Tellins (1956) Dr D F Th.ower, na. Bate

DrjHNork(1e.9) Dr I. P. No'ir (l9as) Dr. A B O.ler (1952)

Dr. R. H- Owen (1938) Dr. R. I. Pas.t 11963) Mr. o. s. Paintin ( I99) o. I. L. Prrdoe (lra2)

Dr. M. Pardo., na. Savile

(

(lt4l)

Dr. A. E. linkler (1940)3 Dr. G. H. Tov€y (19'10) Dr. N. C. Tri.ks (1951)

K M Prppy (1e56) Dr M. Prn, n€e T.l (1964) Dr.

Dr. D- B. Pe.cock (i949)

nae Garthwai(e ( l96l)

D' I t. Pelmore (19a2) D. C D. R. PenRelly (19,{3) Prof. C B. PGr/ (1926) Dr. E. Phi|pp

Dr T H A.

(

Dr V. VRwal'ncrm ( l9t8)

Dr. M. L. W.ire, nle Hrwkins

(1939)

Dr. S. C. W.ke (1912)

lel6)

Dr. W. Lumsd.n Wilker Dr. G. WatteB (1949) Dr. G. A. wahon (1942)

Pinniqer (1910)

Dr- O. V. Pl€.nnt ( 19,14)

J a Po.o.t (1928)r Or K N. I. Pocock (1949) Dr. M. G. Pope (1962) Miss M t. Po(.r (19J0) Dr. A. c. Price (1912) Snter M. A. Prie*, S,R.N, Dr. H. D PrLe (1920) Mr.

w. w.re ( l9s3) W:r (1961) Mr.Ajw.bb(1951) Dr M. H W€rs (1e47) Dr. W. G. Westlll (1962) Dr I. M. R. Whir. (1961) Dr. R. G Wilbond (lell) Dr. M. j. Willi.ms (19,11) Dr. E. €.

A P. Radford (194.)

Prof. P. I. R.ndle (1951)* Dr. A. E, A. Re.d (1950)* D.. C. M. Rendell (19,(l) c. w-

Dr. M. R. Wilk {1954)

Dr. G. wint€.

( 1948 )

Prot. R. C. Wofinden (1t37)* Dr. G. H wood (195I)

Rendr€-shoit (1936)

Dr, W. O. L. Revill (1957) Dr. K. P. Roche (It19)* Mr. K. H. Roddie (19,6)3 Dr. A. P. c. H. Roome (l9s€)

Dr.

(lt4l)*

Dr. l.

Dr.

Pror.

rr55)

Dr C M Wolf.

n6e

Orilli.r (

r94l)

Dr. W. 'Jr'oolley ( Iel2) Lt.-Col. D. E woGlay (1951)

P, J, Royl.nce (1955)

Dr. C. A. St. Hill (1919) Dr. R. J.s:ndry ( 19,|1) Dr. M. H. Silnd€4 (t958) or. H. s.very ( !954) Pror. H. schnieden ( l94t) Mr. P. W. S..rse.nt (19a7)

Dr A H. Wrilht (1918) Dr. D. W. Wrisht (19t2) Dr O. w zubhi (1e57) '=Gadlrie of another Medicrl

50

PSYCHIATRIC ond

SOCIAL MEDICINE

I ABORTION and PSYCHIATRY tion and hL recommendation must be strong enough to satitfy the turgeon who is responsible for carrying it out. The legal position and these factt should be explained to th€ patient and/or relatives at the time

This topic includes theraPeuti< termination of pregnancy, spontaneous abortion and mis carriage, and illegal abortion TERMINATION :

Termination of pregna.cy on Ps/chixtri€ groundt is usually atked for by Patients and rarely by the famil) doctor, and it is very

Danser

I

to

possible suicide.

lt

(a) lllicit pregnancy: The patient, alarmed and distressed at the fear of discovery and the consequences, ma/ threat€n suicide unlest pregnancy is terminatedThis is iurt blackmail, and provided there is not a genuine depressive illness the request can be refused. Thete catet, even wives of troops serying out of the €ountry, never commit su;cide.

dismissing the case.

Termination can only be recommended if is the only possible treatment to avert the danger of the mother's death or a serious

it

(b)

and prolonged illness. The psychiatrist should

not perform th€

Life

This would be due

seldom iuttified. Some Psychiatritts, whether because of ethical, religious or other convictions or relative inexperience, deny that it it ever ne€e$ary. ln fact there are sometimes indications, and thete Psychiatrists should take th€ advice of their colleagues or refer the patient to another Psychiatrkt before

rem€mber h€ doet

to

oPera-

5l

Depr€6sion I Depre'sion always carries the risk of suicade. The pregnant

(c)

exhaustion ma) result from her wild, restless behaviour. ln these cares termination sometimes hai to be advised. .khough the patient may obiect and the hurband will then be unwiliing to give

depressed patient can be treated in the psy.hiatric hosPital and if necessarv confined in the maternity hosPital. Termination is not indicated lhe Unwanted Ofirprins: Some women

hir permission.

married or unmarried' announce that the) cannot accePt a chrld or go through wrth the PregnancY and sPeak of suicide. They should know that the

(c)

mania and depression

baby could, if necessary' be adoPted Economic difilculties, a wide gaP betw€en childr€n, the un€xPected Pregnancy in the older woman, though stressful, do not iustify termination

treated ih a psychiatric hospital.

(d)

Termination

pr€gnancy. How€ver, in rare cases there

may be

a

st€ady deterioration with

it

the

patient's previous mental condition

has

3chizophrenic confuiion, €rp€ci.lly

treatment, refuses Psychiatric admisiion' and y€t m.y not b€ ill enough to be admitted under a Detention Order' These unfortunate and rather hoPeless

been bad and the personality poor.

Termination will then have to be con' sidered.

to be

considered as and if the cases, excePtional Ps/chiatrist i not able to convince himself that there is no significanr risk of suicide he must consider termination s€riously

(f)

Epilepsy: Epilepsy, with

or

withou(

psychosis, does not seem to be aggrava.ed by pregnancy, and in many cates

epileptic

fits

seem

to be rtabilired

during pregnancy rnd the puerperium.

S€rious lllne3r€s :

(g) Mental Subnormality: Although

Re<'rrrencc ot a pu€tperal P6y(hosit: There is about a I in l0 exPectatjon of a second attack of PuerPeral Psy.hork' so this rirk do€s not justify termination'

and abortion may be followed bY

I Thi' can osually be tre.ted to th€ preg"

hospital without risk

(e) Schizophrenia: There is no evidence that pregnancy pr€€ipitater schizophreni. relapse, and married schizophrenirs often seem to improve with

may have to be recommended where the mother is of Poor int€llig€nce' inadequate, unitable, cannot co-oPerate in

(a)

Deprcssion

in

the previout offsPrings hav€ been abnormal invites symPathy' but can rarely be an indication for termination.

people have

short

€hild bearins may be an unjustified stress complication, even if she is being

of

(d) lnadeqrate P€r.onalii/:

at very

intervals, perhaps l€ss than a few weekr,

having a mongol or of another handicapped or abnormal child wher€

Fear

Manic-depre'sive lllners: ln the case of a patient who has repeated atta.ks of

it

i,

distressing and regrettable for a mentall)

s!b-normal €irl who can hardly look after herrelf to become pregnant, mental subnormality by itself ls not a €round

for termination.

a

(h) (b) Mania: Uncontrollable mania in Pregnancy is a serious develoPm€nt A Prolonged manic illness that doet not

Neurotic Reaction: From time to time neurotic and hysterical unstable women rhow a great aggravation of anxiety and neurotic illness when pregnant. This

patienl's ment.l state may make it impossible for her to co-oPerate, and

may be related to circumstancei, fear of confinement, fear of pregnancy. .oupled with their innate mental make-up. They may appear to be quite irresponrible

respond to treatm€nt, if severe, ii a serious complic.tion of Pregnancy. A

52

and not settle to an/ form of ps/chotherapy. Each case has to be taken on its merits, but occasionally the psychiatrist can only foresee much ptychoneurotic illness during pregnancy and after the confinement, with grave consequerces both for the p?tient and for other members of the famill. lt may then appear that termination and possibly sterilisation otrer the only hope of prevent;dg dkaster.

Summarising the porsible indicationt, they are to be found in (l) caser of atypical deprersion, and short interval manicdepressive and depressive attacks, (2) prolonged manic states, (3) deteriorating s<hizophr€nics, (4) inadequate and unintetligent individuals with poor personatity because of risk of suicide, (5) sone psychoneurotic perrons with inadequate personalitaes because of serious protonged a€gravation of ps/choneurotic illne's.

SPONTANEOUS MISCARRIAGE

AND ABORNON : Depresrion frequently follows miscarriages, it is particularly difilcult to clear up

and

completely. ln anxiety-prone individuals a previous miscarriage may be the cause of great anxiety in a subsequent pregnancy, or the woman may be afraid to conceive ag:in, even thou8h rhe desires children.

Legal termination nay produce depression and enduring feelings of guilt. Papers from Scandinavia have reported that a significant Percentage of women haye regretted that they have consented to legal abortion.

IIIIGAL

ABORTION :

Although this is obviously common, it rarely appeaE as a factor of aetiological importance in psychiatric histories.

R. E. HEMPHILL, M-A., M,D., D.P.I'I.

2 PSYCH

IATRIC REHABILITATION

IN

BRISTOL @cur. The Ministry of Health predict that by 1975 the psychiatr;c bed requirements

Despite dev€lopments in psychiatry over the

last twenty-five years, along the lines of physical and chemotherapeutic techniques,

will

psychother3py, so.jal and xdministrative reform; one cannot escape the fact that hatf

have dropped

to

1.8 beds/t000 poputa-

tion as compared to 3.4 beds/1000 population at the prBent timeThe problem of the chronic patient js twofold, in addition to his primary psychiatric handicap, there is the secondary problem of inrtirutionalisation', This term may be used to describe ary behaviour which is evoked in an individual by the sociat prersures of an institution. lt consists of apathy, resignation, dependence, depersonatisation

of all the

hospital beds are ccupied by psychiatric patients. At the pr*ent time som€ 135,000 patients are considered to be chronic, i.e. hospitalised for two years or longer. By far the majority of these suffer from schizophrenia in one form or another.

Present day treatment is far more effective and dramatic, and ar a result a smaller percentage of patients are becoming'chronic' althouSh regrettably it k stall continuing to

and reliance on fantasy. ln a sense it may be regard€d as a process of a graduatty acquired 53

box making and dismantling telePhones. The scheme proved highly successful, and an December i959 almost 400 Patients were

contentment with institutional life' and an lpathy towardt outside events. This Procss k not only seen in Mental HosiPtak, but also prisons, orphanages, convents and anv segregated communityMany enquiries haYe been crrried

working. The patients worked 25 hours/ week. singly, in groups or teams, and were paid the recognised union rate for the iob The standard of work was high and had to equal thar of normal emplo)ees in order to sarisfy the induitrialkts. Working under rhese conditions was rewnrding to the padents in many ways, it was not just a

out on

the problems of institutionalisation, and;t has been clearly demonstrated that its efiects can be minimised if orientation is directed along hopeful therapeutic linet and not hopeless custodial ones. as in Pr€vious

d;version but purposeful activity. As a result of intenction, sdial and group pre$ures and incentives, the'r mental states improved and

Why are so many patients in hotPiBI for so long I The answen to this question are numerous and not all are medical. The main (I

)

their outlook also brightened and became more hopeful. Patients who had spent twenty years of their lives in hospital were now thinking of seeking employment and planning for the futureA number of firms were persuaded to visit the hospital and see the patients at work.

They soon saw the possibilities and offered their suppon in providing work, but felt rhat further employment traininS was required if these patients were to be employ€d in open iDdustry. with thit aim in view, the lndustrial Therapy Organisation

Active psychiatric illness, the severity of which warrants continuing hosPital care-

(2) lnstirutionalisation with loss of desire to leave hospital: dePendent on the degree of severity this varies between 1-i of the population.

(3) Loss of family ties and suPPort with resultant loss of home.

(4) f4any year5 of unemPloyment with loss of skills and aptitudes, and inability to accept work if it were ofiered.

On the other hand not all long staY

(Bristol) Limited was formed. lndustrial Therapy Organisation ( Bristol) Ltd. is a registered non profit making organkation limited by guarantee, which the se.ond war opened in March 1960. lt 's of the three stagesIr provrdes training under reali\tic factory conditions which are medically and indus tnally s'rpervit€d. Patients who Progress sufficiently at l-T.O. may enter into open industn/ direcdy. or rnro stage rhree whereby thq enter into open lacto./ cond,trons in small groups and are supervised by a stage nurse. Those who are succestful 'n emplo/er three are recommended to the concerned and join the factory statr.

For thos€ who ca'Dot make the grade in open employment. there is a sheltered workshop wirh rwent/ places wrthrn Li.O. Here the patients are registered as disabled and

patients are severely ill, and if their Patterns

of

behaviour are stable and

not sdially

embarrassing, these are suitable candidates

for rehabilitation. What is rehabilitation I lt is a process whereby one aftemPts to resetde a patient in work which is suitable to his .apabilities and handicaps, and return him to his own or similar domestic setting in the community where he may become a useful

that Dr. Donal a three one is Stage stage system of rehrbilitation.

Glenside work within industrial training and Hospital. This commenced as a Pilot scheme in January 1958 with fourtee. patients. The work conskted of ball point pen assembly,

It war Early of

against this setting

Glenside Hospital evolved

54

The Ministry of Labour will make good up to 75% of any losses incurred up to a maximrm

a.d aimed at allowing ex-patients to reorientate themselves to livinS in a normal domesti. setting as compared to the communal life within hospital. The hotel provides accommodation for nineteen guests.

Thus a total of ,{,{ places are provided by the association all with the minimum of super-

is

of f240 per place/annum.

LT.O. alto provides a car wash, which is its

only direct trading venture. Here patients come into direct contact with the generrl public. This service has rlways been economically successful and shows that .hronic pataents can be self supporring if

Each house a€commodates fiye people,

vision and economically seif supporting.

ln its first

conditions are suitable.

This three rtage plan realisrically illusrrares that it is possible to re,educate long stay pati€n$ to be economicaliy independent.

But what of their socirl and domesti. resettlement, so that they may return to the communhy as welcomed and useful citizens.

Within the hospital a gredjent of improv€d

five years there were

605

r€fenals to l.T.O., of these,228 have been fully employed for at le:lt 3 months or longer in open or 'rheltered' industry, some

conditions exists, so thrt patients may b€ mov€d to better wards with more facilities

82 having be€n continuously employ€d for 2 yearr or longer. Pataent earnings within LT.O. for 1966 amounted to over {,{1,000. lf it were not for this three stage plan of r€habilitation, how many of these men end women would still be veg€tating in horpital,

and less supervision.

Because suitable accommodation was slow

l€ading useless unproductive liver, lost and forgocen I What of the future, how many

to

materialise either

more of their 135,000 colleagues can be helped in a rimilar way to enjoy the privileees of citizenship which w€ take for granted I DR, R. V. MAGNUS.

on a Ministerial or

Local Authority level, l.T.O. formed its own

houtiflg asrociation. So far

it

has provided

five standard council hourcr (rented from the corporation) and en hotel in Clifron-

3

OCCUPATIONAL THERAPY and

PHYSIOTH ERAPY DEPARTM EN TS P,T.O, 55

tion of our department would not be complete without stretsing the constant

When asked r€cently to write an article on the work done by this dePartment' in true OccuPational TheraPy sPirit lgave (he that Job to a patienc! Senouslv l do feel rhe into rnsight paoenrs can give u5 some afrer which many atpects of rehabrlrratron all starts as soon as a Pe6on b€comes a Dadenr. The wrrter of the article below is one of the besr Patien6 and has Proved the valu€ of determination and co-oPeration When she first came to the dePartment on a srret.her she had a severe left hemiPlegia which to her meant the end of the world Stimulus had to be Provided to give her will (o lrve and th6 was done by tea(hing her how ro wash and aPPly make-uP with one hand. These activities helPed her to gain confidence rn a wheel-(harr and a vint to the shops to buy clothes brought a iense or normalrty aftFr weeks of hosPrtaliiatron By thit ome our Patient *at learnrng to srand and sranding tolerance was rncr"ased whrle she was happily emPloyed securelv tied to the krtchen s'nk. (ooking havrng Previou\lv been her trade. By this ome wheel'chair morivaHon was well established and we were abte to concentrate on the Problems o' rransferen(e from chair to (orlet or to bed Lventually she was able to stand and walk using a stick; her final triumPh being when the walked up the stePs into the.inema and .limbed on and off the bus.

dovetailing between Physiotherapy

and

Occupational Therapy and here we are lucky

looking forward

to a third

memb€r joining the rehabilitat;on team, the

who will fill a long-felt The Medical social workers help us ^eed.many of the problem' etpecially those with sp€ech therapist,

concerning resettlement

of

patients within

Being a short walking distance away from

seems to provide :n from visitors, and we are effective barrier so.ry not to see more people showing an interest in the department-they will always

rhe main hospital

O.cupational therapy, physiotherapy-what doer it mean to you ? To m€, twelve months ago it mea.t a little shop in a back street, where some elderly spinsterr and do-gooders met some crippled people who were shown how to make baskets. The baskets were then put in a shop window, and feeling very sotry and big-hearted you bought one.

May I tell you about myself and why Oc.upational Therapy and Ph/siotherapy have become such a big thing in my life.

Through ov€rwork I had a stroke and was unfortunate to be left for a number of days before the police took me to hospital. where I was made clean ind given food. From then on that is iust what the hospital did for me.

I just lay in bed like a cabbage-you tee, I am alone in the world; I had nobody who wanted me at home. It wxs no good watching the door in the hospital tor m) family because I hav€ none, perhapr this is the reason why I lay in bed not having enough will-power either to die or live. The doctors and nurses were wonderful but the ward is a busy place and what could they do with someone making no effort at all. Ihe ward sister did do som€thing, she rent me to Oc.upational Therapy and Phy'iotherapy.

all activrtiei that we (ake for we do our s(holastic achieveas granted. or work Prospects To our work menrs and the regaining of they mean the disabled and easy wavs of independence. Quick somedme! .ctivi(ie\' darly living managing return to normal the or gadgets, using aids *orking conditions or adaP(ed workrnS (on dirions. and the adjus(ment ol a Patrents emorionrl state with emPhasis on selfThese are

confidence, are all aspects of the occuPational therapist's work. We are Particularly lucky at the Brktol Royal lnfirmary to have a very line deprrtment with domestic workshoPs

and ligh( and heavy workshoPs A descriP-

56

like a picture of the to live again.

After being greeted by the porter you are taken into a lift and from a hall into a flat with a kitchen-dining room. The peace )ou feel ttraight away; the pace is slow and refrerhing after the bustle of the ward.

Perhaps ),ou would

me when my birthday was and would I like to make a birthday cak€. I made the cak€ which turded out so well that we decided to have a party, and for the second time, l4iss Lane took me shopping. We bought for the

place where I have been taught

Party a plasti€ tablecloth, sausager, cheeses and invitstion .ards. I made meringues, scones, salmon sandwiches.

On the day of the party lhad to do eyerything myrelfeven to la/ing rhe table. Have you ever tried to open a plastic trblecloth with one hand I I got so frustrated I just threw it down in the end. After quite a while it opened ef,ough to enable me ro 8et my fiitgers into it. Then I was able to spread it out rnd tay

The first .fternoon, for I was to 8o everl afternoon for a long time, a lady in a white coat who was brisk and a hundred per cent efiici€nt, literally swept me to the bottom of

the room where lwas put on what looked like a bed bate and my torture be8an. So many exercises until both Miss Coles and I were in a bath of perspiration. I had to be loosened up, so two physiotherapistt turned me onto my tummy for an hour of agony each morning. I listened to the radio through the headphones usually the first thing being the children's programme, st.rting with " Are you sitting comfortably ? " !

I invited twelve people who had hetped me reach that ,tage. A small thing you may

think to plan te3 for twelye peopte but everything on the table I had made with one hand, plus the fact that lwas in a wheel-

chair. lwas pleased and excited because it wa! one step nearer my 8oal, which is to be self tupporting I

There is a very large room where mott Oc€upataonal Therapy takes place equipped with gas and electric cookers, refrigerator, sink and trolley with cooking equipment. I arrived in this kitchen on !

I once thanked Miss Coles for itt rhe had done for me, and she said it had been a team efort. " Miss Lane, you and I without the

stretcher and a lad/ in a green overall and a charming smil€ said, " Come along, we must get you into a wheel-chair." lt took several to do that. Then she said, " l wonder if you would be to kind at to wash up for us ar we have been 50 very busy." I took one look at the cups and plater and saucepans and said

each

other-it

IUst could not

more important still, the

have

have

understanding,

both of the Physiotherapist and Occupationat Therapist. Without which lam quite certain I should never have walked asain.

have not got that matters it is what you have. You have a perfectly good right side and must use it-" lt took me over two hours to wash those things up bot I had accomplished something with one hand. ldo not sal . miracle had happened but I do think, without being €onscious of it, I etarted to

I

of

I am 5till in a wheel chair for most of the time, but roon I shall be out oI the wheetchair for good-thankr to the kindnets and,

onl) one hand, how can I with up ? " Miss Lane said, lt is not what you

''

I

help

END

A week went by, when Miss Lane asked if I do, and that day I

liked cooking, which

made scones. Then a few days later the asked 57

GLIMPSE

BEHIND THE .

CURTAIN' by o Brislol troined Gynoecologist.

for

maybe, Mr. Fitzgibbon, and Mr. Paulfor how long, I wat not sure ! He (hen y€lled out " I will mak€ ward-rounds ". Thh had an electrical effect-a porter was sent to fetch the matron, patients were collected up and pushed into beds, in fa<t one could only presume h€ did not go round very often. The

t looked more lik€ a prison than a place ot healing-a v€ry high wall all around, with spikei on the top, and th€ huge faded gr€en doorr studd€d with nails were firmly closed.

I found a little postern get+-knock€d. showed my letter of introduction and th€ suspiciou! looking Sate-keeper pointed up

a

path. At the (op was an ofiice marked Director. Here lentered:nd rat down to wait for the imporBnt gentleman. A window pane was cracked. there were no curtaint.

hospital contain€d about 600 beds, in pavilion

wards-250

pavilion was divid-

'urgical-€ach ed into about l0 smaller wards spotlessly cl€an,

:

they were

the floorr shone, and the

toilets were completely odourless. The in bed with a dull expression

a few white coats hung on the wall, and the green baize cloth on the table was covered with ink stainr. After a time he came in, rged abour 50. big and burly. " I do not think

patients lay

on each f:ce, f,one showing any emotion. I counted 20 large goirres in one pavilion alone. He informed me thar l<ould have l0 beds of my own, and rhar I could operaR ". lasked which days and he seemed surprised " When I tell you " was all he said. lwai then instructed to reporr the next day at 8.30 a.m. and dismissed.

At 8.30 a.m. daily we coll{ted in the Directort oflc-that is, all the doctoB on the surgical side----aD anaerthetist and a

will like it here " he said, "but as you are sent, we will see ":-Th€n he snapped " You good experienced doctor ? " I explained I had the Fellowrhip of one of the Royal Colleges of England and a surgical higher degree of my own university (Br;stol). He did not seem very impre$ed. " How many years, you hold retractor ? " he asked. I thought back a long time, holding retractorr you

58

radioloSist, about l0 of us. Tiny cups of sweet black cofee were brought in, a.d the Director appeared. X-rays were looked at notet studied and apparently a number of

rherist obviously disliked me intentely and would never give an anaesthetic unless the Director personally told him to do so. lwas determined to s€e my patientsgotsome sedation after operation, and tried ordering morphia and so on. lt was not usually given, " she k too weak ", was the excuse made.

I then found there were no such drugs on the wards, so I went down to try and find the pharmacy. When at last I located it, to my surprise, satting at a desk was a particu-

patients dirch.rged.

At 9 o'clock the operations started. The theatrer, by .omparison y/ith the hospital were rather dirty, and badly in need of paint.

There were no trained nurses, only orderlies, male and female wearing their street clothes and grubby gowns. A line of nervous lookinS patients clutching their case-theets were brought in, and told to sit down o' a hard wooden bench. The Director then chose whi.h .ases he would do. and which the asistant could do. Some poor souls seemed to appear day after day-only to be sent back. There was no pre-operative sedation.

The p.tients walked in, got up on the table. and the anaesthetic, usually local, would be giveo. f4:ny of the goitres took two or more hours, but the initial 'local " was never repexted-if they started to kick or strLrggle, they were firmly tied down. The theatres were not.leaned up between operations. On the first morning lsaw the second case-a child of about l0 was told to come in and she had to step over all the blood stained swabs and general mes on the floor in order to climb up on to the table. lalso discovered that post operative antibiotics were freely given, bl]t no morphia or an) druS for pain.

larly lovely blonde woman of about 30, as fragile as a china shepherdess, wearing a very rmart low cut black dress under her short white coat. I realized she must be the wife of the Director, so I was cautious when I enquired about stocks of morphia. She taid there was plenty bljt it was only r:rely asked for ! I enquired where she had trained in pharmacy-" I am not a qualified pharmacist", she remarked coldly, " I have a degree in nautical engineering | " I colld not think of any thing to say except " Oh ".

I became very fond of the patients who were all certifed as free " cases by a magirtrate. They hated having to admit their dire povert/, so by the time the) did so-their tumourt had grown to an enormous size, and their general .ondation was €xtremely poor. Some had no homes at all except the street, so found every reason to sta/ in. The Director never seemed to mind, and many

When it came to my turn to operate, the first case I was allocated was a complete procidentia. Whilst

I

waited three months or more for quite minor surgery. l.ppeared to be the only surgeon who did a regular ro!nd ro was alwayt being atked to ree thas and th.t case who

scrubbed up, the

abdomen was painted wath iodine by an orderly; I asked for lithotom/ positioneveryone seemed puzzled-apparentl) all

had been apparently forgott€r.

repairs previously, were done b/ the abdominal route. There seemed to be a great

Language was a great difficulty, as only one or two of the nurses spoke any English though some spoke German. The Dire€tor ruled with a rod of iron and nothing.ould be

shortxge of catgut, all I war ever offered wat very thick thread. One day I managed to get

of catgut, so hopefully asked for some more. To my surprise the anaesthetist growl€d out " No. you will not have catgut iust bad, extravagant British do€tor", -you and I never got any after that! The anaer one tube

don€ without hit permisrion. Although he onl/ rarely went and looked at his own patients, he often came and saw mine. " What is the matter with thii woman ? " he once enquired. 'lam not quite sure", 59

On one memorable o..asion whilst I was there, a Very lmporcant Person paid a viiit to the hospital, and I was interest€d to see him at such clore quarters. The big gates opened and the militarr suard appearedarmed to the teeth with tommy 8uns. At

I said, " I haye 8ot her in for itvestigation ". " lnvertigation l" he barked, " that shows you are bad Western doctor-good docto6

know-they do not investigate "- The Radiologist was a very jolly, smilinS little man, always trying to get me to come and look at hir " interestiDg pictures ". One day when no one was listening he whispered "You teach me English-please "- Anothe. day rhe out-patient dqtor told me he felt very unwell and ought to have a liftle holi-

last he rrrived in a big

Roll5-Royce

!

and

walked .round apparently looking at nothing.

A <ivilian followed, giving our noter valued each poor patient. The small children looked very pathetic and solemn, wdring battered carnival hats, complete with elasti< under the chin !

Just before I left, I noticed one morning

at about l5/- to

day. He certainly looked a grey colour. I was

stupid enough to enquire later if he was better, in the Director's hearing- He looked at m€ coldly " I never ill " was all he said.

The thing that upset me most of all was the abortion sessions. A number of poor, miserable looking women would attend with unwanted pregnancies, they would sign a paper, and then be taken into an out-Patient theatre, put up in the lithotomy position, about l0 mls. of novacaine rouShly;nie.ted, the cervix would be immediately dilated uP, and the foetus removed. lt was a brutal performance and even the most stalwart would yell with pain. Some no doubt wanted the baby, but were just too poor to bring it

that bottles of wine and large cakes appeared

on the Directork table. " To-morrow ", he said, "You, Western doctor, will look after the hospital, we have .elebrations "- I realized

it

was April 30th, and the next day wa5 May Ist! fortunately nothing too awful happened during my day in charge.

It

was certainly an interestjng experience

to get this opponunity of actually working in a " lron-curtain " hospit.l and it made me appreciate, as never before, what freedom and kindness really mean, and I thanked cod

for the

medical

tnditionr in w.bich lhad

BOOK REVIEWS in the terminoloSy he uses from to day. Also, a knowledge of the deriva-

reflected

M€dical T€rmr Their OriSin and Construction. Ffrangcon Roberts. 4th Edition. Heine-

day

tion of medical nomenclature will help him undeGtand the ever increasing number of words which he constantly has to become

As modern medicine becomes ;ncreasingly scientific both in its nature and aPPr@ch one tends to forget that the Profession had its origins in ancient Greek times. Presenr knowledge has been deriv€d from the accumulated experiences through the centuries, embra.ing maDy civilisations and

ln this short but interesting book the author syrtematically and logically follows the development of medical language from its origins. Sprinkled with interesting historical data, this book is both edu.ational and

languages, including Greek, Roman, A.abi<,

srench, and Anglo-Saxon.

It is to the students' benefit to know the history of his profession and the history is

F. ,, Hacking.

60

Pharha<olo8y

lor Mediel

Studen6.

G:ahAn. Oxford United P.e$ t8/-.

Until now, the.ange of

,- D.

Surg€rt for Dental Stud€nts. I'lichael F. A. Woodrutr, D.sc., M.D., M.S.(Melb.), F.R.C.S., F-R.C,S,E., F-R.A.C,S, 2nd Edition. 8/ockwerl.

P.

pharmacologl

to the mediol stodents with jurt sufficient material for 3rd M,B, Part I has been limited and hence this book is a books available

50/-.

Already well known and widel/

The material ir presented in a similar st/e Green's Physiology book, which enables

to

edition, but has been revi'ed, brought up to date and many sections completely rewritten. SeveEl diagrams have been redrawn and new illustrations added. The book attempis to describe precisety, but with adequate detail, the principles of general surger/ and a heavy d€ntat bias is obvious.

Several ot the sections of spe{ific dentat interest are extremell well wrin€n. Sectiont especially to be commended are those reviewing methods of Surgicat diagnosis, the ditrerential diagnosis of ulcentive lesions of the lips and oral cavity, and the chapter on tumours which is very welt ittustrated. The chapter dealing with antibiodcs and chemo_ therapy har been rewritten :nd proyides a wealth of p.actical intormation.

On one or two topics the author is unnecessarily vague and the habituat use of 'yide infra' rpoils the occasionat paragnph.

The book is, however, to be thoroughty recommended both as a text book for stldents prepa.ing tor e{aminations and also as a pocket reference for the dentat

the price to be kept low without limiting rhe amounr of knowledSe wirhin its coverr.

The presentation is logical and hence easy read. There are two chapters on 8en€ral

to

pharm:cology outlining the applietion of the \ubiect ro medicine. The author stresres the phyriologi.al actions of drugs and there are plenty of excellent diagrams helping to

iilustrate important points.

On the whole thir book i5 ver/ good and I think medical rtudent\ will ioon make this their standard book for the ph.rmacology P- Garncr

lmmediate and Replacernent D€nture6- John

AndeBon, 14.D.S., and Roy Storer, F.D.5.R.C.s. B,ockwe,/. 55/-,

used,

Professor Woodrutr's "Surg€ry for Dentat Students " now appears in its second edition.

The text has a simil.r layout to the previout

M.S<.,

This very readable book is a mosr welcome

addition to the limited range of modern textb@ks on prosrhe(ict available to rhe undergraduate. The text offers a by no means brief compend'um of prortheric trearment, tackling the subj€ct in chronologial order by sarting with the transition from the partially edentulous to the edentulout state, vir the immediate denture. ln this way, the book is unique, and is able to impart a degree of order to the subiect

C, F. Audrey.

Mig.ain€: EackAround and Tr€atm€nt. H. l- Wnsht & Sons. t316.

In this 6sily read littte book, the author clarifies the distinction be.ween m,graine and "ordinary' headaches. and presenB migraine as a real burden to those affticted, in contrast to the " malade ;mag,na,re.. which non-sufierers may rend ro picrure.

MiSraiDe hal been with us for c€nturies, and the opening chaprer deating w,rh its history gives it5 firsr descriprion as being Maxwell, M-D.

whach, to the average undergnduate on introduction, may appear unnecessarily con, There is little entirely technical m.tter to

complicate matterr and make reading tedious, but above all the text maintains the readert interest-a valuable asset. A recommended

add;tion to the student! Iiteran/ armoury, R. Miller

6l

a wealth of facti, but with need occasionally ro r€sort to well placed Seneralisations.

This is a provocative b@k which is useful,

made a few decades after the birth of Chr'st,

probably coincidental. Since thar time many attempts have been made to understand the

in{ormative and entertaining

background and nature of this disease, with consequent conf usion and conflicring st-atistical evidence. Dr. Maxwell, a Pyschiatrist,

Eviden.e in kience, by Kenneth Stone. John

Wright & Sons. l7 J6.

Studen6 are so engrossed in their ever increasing curricula, that they have (theorctically) little time to appr€ciate the basic principles of science- Here is a book of 116 pages, which fills this void with little expe.diture of time or effort on the part of the reader Kenneth Stone writes. in an eminently readable fashion, of lcientifre method, deduction, logic, observation and errors in observarion, controlled experiments on research, the whole being widely illustrated with examples from the biolosical sciencesReaders of this book cannot fail to examine more closely their own processes of reasoning. and be less osual in accepting scie.tific C. J. Streak.

brain lesions are dealt with in l€ss detail, and a chapter is devoted to the management

of the migrainous patient.

The chapters on pathological physiology and diferential diagnosis of headaches are headaches

are almost universal, and can be the symPtom of anythinS from a hangover to a tumour.

Dr. Maxwell

finishes

with a

question/

answer type of migrainous .atechism designed, it seems, ro tell the sufferer in the nicei possible way that his disease is psychologi-

Cunningha'h's l.lanual of Plactical Anatomy.

Revised G. J. Romanes. Vol. I. Upper and Lower Limbs- Oxfod Univercity Prcss.25l-.

The improvements immediately apparent in this edition are : the change in format whi€h allows two columns of type to each

D. l. M.

An

lntroduction

to

Psychopatholos/. D.

Russ€ll Davis. 2nd Edition.

anyone

R. H. D.

sets out some of the evidence in favour of the allergic and psycholog;cal theories, and comes down in favour of the latter, rather firmly after reviewing a number of studies from both camps, and gives a selection of illustrative cases from his own series. Other asso<iationr such as epilepsy and organic

useful guides, particularly since

for

interested in psychological medicine.

Oxfotd Unive6itr

Ihe second edition of Professor Russell Davis' book is shorter than the first and has been completely revised. lt forms a bridge between the psychological laboratory, with irs theories derived from.ontrolled experiment, and mental disorders as they present at the psychiatric clinic. A good review of current psychological theories is given with a long list of references for further reading.

Thi5 is. however, a short book and, with tuch a wide scope there tends in placer to be some lack of explanation of facts quoted.

Besides the author's own views on the

page, and the availability of the book ir a paper bound yolume. Both these changes are a boost to its dissecting room use.

Much of the text has been re-written and parts shortened in order rc remove unneces-

sary details. This is no doubt in step with the cuts taking place in the Anatom/ course

of most medacal

schools.

Many new and large illustrationt have been

added whilst existing oner have been clarified. Most of the radiographic illustrations,

which

previously

of.onfosion,

have been removed.

The overall impression is one

aetilogy of mental disorders, there is a critique of other theories, particularly those

of an im-

proved edition which will no doubt be a more efficient dissectaon guide.

F. Nahai.

concerned with inheritance and twin studies.

He makes his points very emphatically with 67

FOR YOUR REFERENCE : Reseorch Popers by Members of

Stoff.

I'IEDICAL BAIRD, D. T., GASSON, P. 1956

5

w. & DOIG,

A. The renosram in pregnancy. Amer. J. Obstet & cynae,

597-603.

BARRITT, D. W. & MAJEED AL-SHAMMA'A. Heart from unexptained cardiomyopathy_ Brit. Heart ). 1966 28 674-6n.

BENTLEY, P. J., FERGUSON, D. R. & MCGOWAN, G. K. The efects of arginine deficiency on the water and solute metabolkm of weaning rats. J. Physiot, 1966 t84 t0t5-1023.

CAPPER, W. f4., EUILER, T. l. & BUCKLER, K. G. Alkaline areas in the gastric mucosa after gastric surgery. Gut 1966 7 1m-122.

HEMPHILL, R. E. Historical witchcraft and psychiatri< illness in Western Europe. proc. Roy. Soc.

f4ed 1966 J9 891-902.

IOHN, H. T., wlLLS, lV. R. & MARCUS, R. T. Chang€s in ptasma calcium conc. fo owing subtotat thryoidectomy. Brit. J. Surg. 1966 53 585-688.

LINTON, K. B. & GEOR6E. E. ln:ct;vation of Chto'hexidine (Hibit:ne) by bark corks. Lancet r956 t t353-1355.

MCC,ARTHY, C. F., FRASER, l. D., EVANS, K. T. & READ, A. E. Lymphorericutar dysflnction in idiopathic rt€atorrhoea. Gut 1955 7 l,t0-1.t8.

MiDWINTER, R. E., APLEY, J. & BURMAN. D. Difiu'e intefftitiat putmonary fibrosi' with recovery, Arch Di' Childhood 1966 11 295-298.

OSMOND, D. G., ROYLANCE, P. J.,LEE, W. R., RAMSELL, T. G. & YOFFEY, l. M. The €ftect of unilareral limb rhi€lding on rhe haemopoi€.ic rerponse of rhe guinea pi8 to gemma irradiation.

(150r). Brit. J. Ha€matol. 1966 12 365-t75.

PENNOCK, C. A. Effect of hyperbarbic oxygen on rhe growth of :erobjc organisms in deep culture. Lancet 1966 t I3,{8-13.t9.

READ, A. E., I4CCARTHY, C. F., HEATON. K W. & LA|DLAW, J. Lactobaciltur acidophitus (Enpac) in tr€atment of hepatic encephalopathy. Brit. Med. I. t966 1 1267-1269.

RIDDELL, A. G. & DAVIES, R. P. clycogen storage diteas€ treated by porta-cavat tranlposirion.

Proc. R. Soc. Med. 1966 59 48,t.

ROBERTS, F. J, The t€eching of behavioural sciences to medicat students. Wortd Med. J. t966 tJ II8"t t9.

SY|4ES, M. O. Further observations on the growth of mouse mammary carcinomata jn the ,train of origin. Brit. J. Cancer. 1966 20 356-160.

SYMES, f4. O. & RIDDELL, A. G. The viabilirl of h'rman spleen cells after cooting in vitro. Brit.

J. SurE. 1966 33 794-798.

TRAPNELL, J. E. The natural hisror), and prognosis of acute pancreatitis. Ann. Roy. Co Surg. Eng. 1966

38

5-287.

VOYCE, M. A. & HUNT, A. C, CongenitJ tuberculosis. Arch. Dk. Chitdhood 1966 4t 299-300.

WALSHE, M. M. & ENGLISH, M. P. Fungi in nails. Brit J. Dernatol. 78 198-207.

DENTAL DARLING, A. L The physical features of caries-resisrant t€eth, CIBA Foundation Symposium on Caries-Resirtant Teeth, 1965, 149-161.

CHARLTON, G. A prefr.bri.ated pori and core for porcetain jacket crown! Brit. dent. .J 9: 452-456, 1965.

BERRY, D. C. & MAHOOD, M. Oral stereognosis and o.al ability in Brit. dent. J. 120: 179-185, 1966.

6l

relatio' to prosthetic treatment.

UNIVERSITY EXAI{INATION POSTAL INSTITUTION G. E, OATES,

M-D' M.R.C.P. London

POSTAL COACHING FOR ALL MEDICAL EXAMINATIONS CAREFI]LLY DESIGNED COURSES I'NDER THE SUPERVISION OF SPECIALIST TUTORS. ADVICE ON READING. GUIDANCE NOTES TO EACH LESSON AND SOLUTIONS TO ALL TEST PAPERS ARE PROVTDED

AND LIST OF TUI]oRS on application to Dr. G. E- Oates,

PROSPf,CTUS

17 RED LION SQUARE. LONIX)N W.C.I Telephone

: HOLborn

6313

ll you huve lufien your 2nd tl.B.or equivalent; or are just about t0 take

you crn

lmly

it-

l0r m R.l.l. c0delship woilh 0Ye1 C1,000 r

A @detship is s straietrdomail fo. n.fb @ rdr's f.I-tin. sflie and rery fan hargrh betser the Dedi@l studert ed the Royal EoD tn srd. wtt If ! for, €dc6hip. 1od .re lcprcd,^ppl\ J!u 066.

You !s@ to pndise nedicine for 5 re ommkimed s r P'ld pa! sd rhe lppropridc .nd y.rB $. Rolr! ,1ir Force M€didl 'Riec {FnFom rhi! rou llvc .c,on 1r fi'llv ,lronnc6 fd rdt lile .ny othe. n€diLil r.si*cred.

Wlm rotr sd vou .r ThcR.A.F., in ddm. plvs.ll \our tulml rei, yo m i'o-i,r.a glrd btegismtion tuidon crpenses rnd re6 Flril5 O6&ri dd shd yon Etc 'nd r resDedblc ash inmnc until ]on rour 66t R.A.F. .p!oin@t yon qualify. There is a $bshdal trp it i in th. hnt ofFlisht Lie{tnrnt, ssh sBtuilv if yon ierc rt thc end s. ddor m R.S-F. stition of s v*s. If You aE in66t€d in , sitn o?Frtuniti6 b go 36red.

P€rn,nmt Conni*id-thlt is. in

mtins rDu clIg in the R-A-F. Iou \ iU hrrc th€ oppffinit].ro 4ply

lini_a

b CrdetshiF

64

is by

applierion

yefi

For Dorc informltion plese srite, si\ins yonr age, nitionrlir!. and

dct.ilsofn dic dininq

in€ludins

erFded dit€ of gndMtion, b Squ.dron Led€. M. A. tauist€r, Minntry of Defo€e. r{ Tlristct Squre (:6 EBt, Lcndon. WCr.

SILVERSTONE, L. M. The primary tEnstucent zone of enam€t caries and of artifi€ial cariesjike lesions. Brit. dent.

120: 46t471, 196l_ POOLE, D. F. G. The use of the microscope in dentat research. Brit. dent.

71-79, 1966. ,.

GWINNETT, A. J. Normal Enamel. l. Quantirative potarized tight study. J. Dent. Res.45: l2o-t27, I956.

j.

l2t

GWINNETT, A. J. Normal Enrmel. lt. Quatitative potarized tight study. J. Dent. Res. 45.76t_165, 1966.

THO|4AS, N. R. Active

eruption-A breakthrough. Coloured supptement Black

Bas. Summer, t956.

EXAMINATION RESULTS Second

EkmiEtiotr for th€

D.greei of M.E-, ch.l.

-sith

JUNE lt66

FACULIY OF MEDICINE Th€ Desr.c of Doctor ot

R.lfu Adewrl. Sanni SALOCUN P.trl Andrey BOSWEII P.triri: An. SOULToN Elizheth EFm. SRADLEY Anthony Ri.hard COIMAN

Cyril HOGG Fersls Dane l6hn lANE Oavid How:.d LONC

April C.6l/n CROWTHER

Michael Fr.n.G O'DOWD

Oloferi B$rtunde

OGUNNAIKE

H.nr/ Oladehind€ SUBAIR P.ula VAN DER HTYDEN

Dlvid GGor!. Edwin WOOD

lhird Ehmin.iion for th. Dcireet ol M.8-, Ch.8, (P:rt n)

luNE lt66

Ehmrnuel Kunnujj Olu).inde Alan J.m6 APPIEBY

P.trici. M.rityn

Mkhael DUNN David Anthont EVANS Maur€en M.ri. FRANKLIN David Roben GERRING Rob.rt Vidor HAGUE John Frede.i.l HAMBLIN Richa.d Anthonr HAYES Anne HUGGINS Aryind Kum. J€THWA Anthony Chirl.s KNAPI{AN John

Dondn MINORS

M.rtin G.n.d MOTI

AASSETT

COATES

D.vid Fr.nk COCHRANE

Christ6Dher Masala NDUGWA C.role Ann NEWMAN J6h. Ri.hard NEWMAN J.ne Eliab€th PARIY Arthur John PEILOWE

MichaclJohn OENTON Ron.ld Mich.el cANNAWAY Valeri€ Phyllk GURNEY John David Louir HOLROYO Peter How.rd IACKSON

5.huel Alehnder

MichrelOlufemi MUNIS Harry Mich.el lhom.s MURPHY

John John

M.rkus H€nry ORNSTEIN

lohn Lr€n.e SlvlTER HoM.d ceorce sMITH P.t€r Drvid THOMPsON

William Roper PHItLIPS

Michrcl Lindsry RICHARDS Edwin Fred€r'.k Ch.rle' STAMP Gillian Rose orryille wAINSCOIT Qualifrins EEmin.tion lo.

D.sre.s of M.4., Ch.E.

thG

Ad.l

RESOULY

Festus QUIST

Martin Rich.rd Finch REYNOLDS

Anthonr RTCHARDSON

Mi(hr.l Chrlstopher ROUTH

Sh.ila M.rt THOMPSON Mark Andr€w WALKER

i.r€nce Alwyn WOOD

luNE It66

With S€ond CLss HonouE Jernif€r BENILEY

1966

Dils.rt tiont Approycd

David

Mldin Brevitt

Distindi'n in Pubti.

luNE

Bru.e Mi.hael BRYANT Mars.r€t Jennif.r FREER lohn Sernard FURSDON

G!.t

Timoihy G.ofrey Maden PERHAM

Ri.h.rd Sydn.r HARRtS Rosema4, Moniq READ The Dcsr.e

ruNE rt66

of Do.tor ot M.di.ine

Di5scrtatio. ApDrov.rt Ron.ld J6t€f ANCILL

Se.ond

tuN€

Eltin.tion

tor th.

r9aa

Christoph.r Johh BELL

Derel L€rli. ELACKWELL

willi:n

lohn BROWSE

Genrd M.hin fRASER-wn, Distin.tion tn Eio.heniate 6^d

in D.ntot Anatonr lohn st!:n cARFOiTH Chrkroph.r Prul GARTON John Ri.h:rd GREEN Rob€h Clive GROCOTT

Philip Andrew HODGE5

Lyndon

Tftfor

GrahaD Rex

Distin.tion

HOLDTNG

HOLLAND-rt,

n

Phtsiotql ond

Paul Edward HUGHES Pen.loDe l.ne l(tSTERToN Anthony Mi.h.et John LyNN_

with Ditrin tion

'n

D.nt l

Anthony Ed,ard MERCET Kelvin Robed MINCHTN

RoEn Mi.h.€l

MOORWOOD Ronrld Anth6ny RAMSAy

lohn Ri.ha.d Raf,rh:$ ROTHERY

tnilr

Ruth sCHOENTWALD

J€Frcy J.mes wATktNs

Willirm Rob.rt P.ndn..

9EVINGION

Mich:cl Edp.r WHTTEHOUSF

Gah.h tewis WTCKENS

Clive Spencer WILKtNS

65

i

C.irn HAWKESBY-MULLINS Ang$ HUTTON J:n.t willi.d Roben john IZON

ln s.ction I (AEtomy &

David

Phy3iolosr) C.mpl.tini the

ln S..tioh

Complctirg

ll (D.at l AMtont) th. E-niMtion

ln S.ctio. I

Physiolosr rhd aio<h.mirtrr)

dlt

Annrew David PHILPOTT

h

Se.iion

ll (DGntl Anatomt)

OWEN ROSSER

Dian. Eliabdh SMITH l.n Ch.isbpher M.Ebrll SMITH

Fi..l Emin:tid fo. rhe or 8.D5. (s..tion lll) luNE tr56

Degree

Terenc€ Campb.ll AOYD

Fr.d€ri.L Dennir HUTCHINSON Philp Jonn SIMMON5

lan Chrirbpher SHIMELD l.n lem6 STANDING

Anthony leoni.d WILD

SRISTOL ROYAL HOSPITAL

Find Erminlrion for ll'€ 6r f,.Ds- s.dion I luNE tt,6

D.qF -

Thc tollowins

.cslul

{

Nud!

ll

compl.tirg

ih.

,.

J.

Sird

Micha.l Leonard BARTON Richard Lenie BAYIIS Marcus Robeft BURNSIDE

K.thryn Mary HOPKINS

Anthony Lcilie M€redith IRELAND

Nreel Fan.is IOHN50N K.;ncth Robeir JONEs H€ather Fances KEASLE Charles Ri.hard MAISHALL

Chrisiooher William MAY

Drvid MORTON

Adrian Hamilton REED

,,

A. J- Penbefton

,,

j. R.sw€€tinch.m

RICHARDSON

V€roniq M.y

wer€ iuc-

lun. 1966 Prelinin_ ary Sbr. Ennin:tion:Palt I dd 2 tosedkr rhe

Christopher fhncis AUDRY

ln crorp

,, ., ,,

A- M.

W.lk.r

R. C. WiGon

D. E. woods

BRISTOL ROYAL HOSPITAL

tindey Myf.nwy

Christine Hele.

(Anatomy,

Nu.se M- Sl€ehrn

Th. follo{ing NuBes w€.e suc.t the Jun€ lt66 Fin.l

cessfll

Nu6e sUDGEN, B€.nrdette

., ,, ,, ,, .. .. ,, ,, ,, .. ,, ,, ,. ,, ,, ,,, ,, ,, ,, ,. ,, ,, ,, ,, ,, .. ,. ., ,.

CLARK, C.ryll Yvonne COLLINS. M.ry Rose

CUMBERLAND,l.ni.e CURTAIN,lenhiferAhn€ DAVIES, Srendr Mortydd DAVIES. Sheila Marsrret ESSEX,

lindr M.ry

FANSHAWE, Judjth Clare FARQUHAR, hn. ltl.rsaret FlsH, Jernettc Oliv€

(ne€ Prcwse)

GRANT, P.tricil J€anet.e GRIFFIIHS, Celia l.n.

HUDSON, Cyhthi. Anne JONES, lr€ne Winitred KELLY, GeBldine M:ry

IAWRENCE, Susan MCWHIRR,

Veronio Ann

MAWDITT. Br€nda Ann MEMERY, Ros€mary

f,llTCHARD.Ros€mary lnULLER, Philipp. Frances SHEPPARD,JtnerRos.mary (ne€ Ne€dh.m) SMIIH, Bridset Jane SMITH. Patrtci: Hurle VOYCE. Sue. Eliabeth

wRlGHT. Oebohh J.ne

BALOUZA, Eth€l Louk€ EDNEY, An.e Robert HODGES, Mi./ le.. (nee

HOOPER. Rd€mary Joy.e NlBI,ETT, lennifer M.rt SWAFFIEID, Jernnctte (n€e

SPENCER

Chis

Ralph WALTON Philip Edwird WARNER Andrew Godfrey WlLKltlsoN

PARFITT, Ann Carolyn

Fiml &aBi.ation for Thc D.ar€.

PARKINSON,IiII RANDOLPH,l.nct lern

B.D.S. (s.ction JUNE 1t66

ol

WATERSON. Ruth Eile.n BAltEY, Dirn. Joy (n€e

ll)

COUNCELL Mary Pairi.i.

Robert William BINNERSLEY Brendr Cecilia BURKe

willi.d

Jamer CAMERON

Martin Rich.rd ELLYATT Michael Howard lohn GOLDRING Rdn€r Walter Ct'.inopher

,,

M. R. King

RADMILOVIC, Jane R65ina RAWLINsON. kn.y Anne

HACKEMANN

66

VYhen you've plenty to think about a bank account makes life easier You want yourgrant orallowance to go as far as possiblc, but you don't want to spend too much time worrying about it.

And you needn't. A Lloyds BaDk

payments when you pay bycheque. You doD't Dccd to carry unnecessary amounts of cash around with you. And you have regular statements of account so you always know where you stand.

Call at your local branch today.

account hâ&#x201A;Źlps you keep an â&#x201A;Źye on

your spending you plan your

Let Lloyds Bank help you to plan

61

BRIDGE

SCORE

wlIAT DOES

STANI) FOB? lT

STANDS FOR security

rd

the doy you retire-8nd alteL

Fsce ol mird from th€ day you qualily-utrtil

IT STANDS FOR the prov'rsioD ot edvice on rll youl Profe3sioo€l Problerns. " ior le{al slrietance fu;ov difrc tv or plor€editrgs ot s professionel natute"' tor u imiaed indcmdty iD rcspecl ol damages snd cost itr the evert of an adv€Be verdict or a settlen*dl oul ol Court.

STANDS FOR IIIE MEDICAL DEI'ENCE UNION' the oldesl End laEest ;rg;nisalioo of its kind in the wo d. Foll p{iriculan can be obteined lrom

lT

THE MEDICAL DEFENCE UNION Tavistock House South, Tavistock Square, London, W.C-I. S€creary :

Dr. PHILIP H. ADDISON Dental S€cretary :

A. H. ROWE,

M.D.s., F.D.s.

Print€d by F. Baney

ed

Son

Ltd.

Duilet