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SPECULUM 1961 PAGE TWO SPECULU

JOURNAL OF THE MELBOURNE MEDICAL STUDENTS' SOCIETY

Edited by E. J. SHAW D. M. PHIDDIAN

Business Manager J. WOODWARD

"Speculum" is published for private circulation among members of the M.S.S. Copies are not supplied to non-members of the Society.

PAGE THREE SP ECULUM 1961 CONTENTS

Editorial 5 President, M.S.S. 8

Medical Study Tour, U.S.S.R., 1961 Dr. W. D. Counsel! 11

With the Red Cross in the Congo Dr. S. F. Hewitt Haughton 15

Arterial Mr. Neil Johnson 25

Some Modern Biological Methods Dr. S. Rose 31

Design, Dust and Disease Wilfrid Brook 37

Pulse Rate in Athletics Brian Connor 43

The All or None Phenomenon or The Three Stimuli S. Ceber 47

Quo Vadimus J. F. King 49

Mammon and the Muse Adam Fligelman 51

Obituary 53

Diagnostic Quiz

Surgery Mr. D. Donald 55

Medicine Dr. I. MacKenzie 55

Obstetrics Dr. P. Glenning 56

Gynaecology Dr. P. Glenning 57

Paediatrics Dr. J. Coldbeck 58

M .S. S. Chronicle 61 A.M.S.A. Conference 71 Year Notes 75 Spicula 91

PAGE FOUR SPECULUM 1961 EDITORIAL

Each year the Medical Students' Society Medical Association, so we thought we requires editors for its official organ, might take this opportunity of presenting Speculum. Since none but medical students some facts which, while well-known to our would be competent to compile this maga- graduate readers, may be new and of inter- zine, especially the last few pages, the edi- est to those of us still labouring to reach tors must be drawn from this group. This that status. makes the writing of an editorial difficult, Australia has always been to the fore in because being medical students we must improving the conditions of its residents, "ipso facto" have no literary ability. How- particularly that vociferous group, "the ever, a further consequence of our calling workers". The formation of the Trade is that we are slaves to duty; so we have set Union movement has greatly furthered their about the task. aims and the medical profession has seen Plumbing the depths of our literary the advantages which accrue if people with knowledge we discovered we had both seen like interests unite. the play, "Six Characters in Search of an Until now each State has had its own Author". This seemed to have some bear- medical association which sent delegates to ing on our case because we were "two edi- the Interstate Federal Council. However, tors in search of a subject". Further medi- as from 31st December this year, the indi- tation in this vein ended in death-in-utero vidual State bodies will cease to exist and of this idea. We thought of student apathy, be replaced by the Australian Medical the med. students' tie, and even made a Association. In passing, it is also interest- start on the question of hospital finance but ing to note that this is the first full year ran out of steam" when we found our in which there has been an Australasian prejudices were ill-founded. Then we Medical Students' Association. The forma- realised that a very important event in tion of such national bodies marks a mile- Australian Medical history is soon to take stone in Australian Medical history and we Place—the formation of the Australian feel that it would be of benefit to the corn-

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PAGE SIX SPECULUM 1961 ing generation of medical graduates to monwealth conferences we have been examine the potential value of the A.M.A. bracketed with such countries as Nigeria to us. and Sierra Leone. A National association, Australian medicine will benefit from the however, will enable Australia to take a formation of this body in two main ways. place of equality with nations whose medi- Firstly, the cumbrous organizational mach- cal problems resemble her own. inery which required that any decision of Our newfound national consciousness the Federal conference should be ratified parallels a world-wide growth of inter- separately by each State body, will be elimi- national consciousness which has been ex- nated, thus much time will be saved and pressed officially by the activities of such expenses reduced. This will give the Aus- organisations as World Health and Red tralian medical profession a more efficient Cross. Groups such as the delegation of and flexible means of action in issues con- Australian medical men who recently visited cerning its members, particularly in present- the U.S.S.R. have helped to break these ing to the Government their views concern- boundaries by personal contact. On a ing national health, both in its present form student level, Australia will be represented and with regard to its further extension. In for the first time at the International Medi- addition the views of a national body would cal Students' Conference to be held in have more influence with our academic Israel later this year. staffs at our various teaching centres; the Health is a matter of importance to all association could thus have an impact on people regardless of their political persua- the vexed question of differing standards in sions, and we who take the oath must en- the various States and also on the applica- deavour to ensure that man-made boundar- bility of the academic subjects of our earlier ies do not hinder the conquest of disease, years to clinical medicine as opposed to which is the ultimate aim of medicine. The medical research. formation of the A.M.A. will make it easier The second benefit stems from the fact for Australian and surgeons to that through the A.M.A. Australia will play their part in the health of our own have, for the first time, an official voice country and of the world. It is our privi- overseas. As a branch of the B.M.A. we lege, as the medical graduates of tomorrow, have only been able to attend international to maintain the traditions which have been Conferences as observers, while at Corn- established by our predecessors.

ACKNOWLEDGEMENTS:

The editors would like to record their of these people and the consolation and ad- Sincere thanks to all who have helped them vice of our many friends, our task would m the production of this issue in any way, have been infinitely more arduous. no matter large or small. We would like to acknowledge the re- Especially would we like to thank our ceipt of the following magazines: eOntributors, both published and unpub- The Leech, Johannesburg. lished, our advertisers, whom we recom- The Review, Adelaide. mend; our typist, who managed to make sense out of such a mass of illegible hand- Oxford Medical School Gazette. writing; Mr. Bill Panter, of Shipping News- Queen's Medical Magazine, Birmingham. papers, for his extreme patience in dealing Charing Cross Hospital Gazette. with our eccentricities, and particularly Mr. J°1111 Woodward for his sterling efforts both Montreal Medical. as business manager and distributing officer. St. Bartholomew's Hospital Journal. Without the untiring and unceasing efforts The Reflex, Perth.

PAGE SEVEN SP ECULUM 1961 PRESIDENT, M.S.S.

PROFESSOR V. L. COLLINS

This year we are honoured in having for now in the capacity of an honorary at the the first time Professor Vernon L. Collins Children's Hospital and a consultant in as President of our Society. Our constitu- private practice. He was also appointed tion provides that a president be elected honorary paediatrician at the Royal from among our teachers, either pre- Women's Hospital. He was disappointed clinical or clinical, and successive commit- in the standards of work in his old hospital, tees have been most grateful to those who and it became clear to him that if the three have so willingly given of their time and main functions of this teaching hospital— energy in guiding us in our deliberations. service to patients, teaching and research— Professor Collins is a true Australian, were to reach desirable levels, many born and bred in the Wimmera, and a changes were necessary. graduate of the University of Melbourne. In 1949, because of his experience in His formal education commenced at a rural overseas hospitals, Dr. Collins (as he was school and continued at Horsham High then) was invited to become the first Medi- School. Prior to his admission to Queen's cal Director of the Children's Hospital. His College, as a medical student, he spent a task was twofold—firstly, to plan the new year teaching at Hampton. During his hospital and secondly, to make changes in course, his main extra curricular interests the organisation and staffing of the old hos- were in inter-collegiate sport, representing pital to meet the rapidly growing needs of Queen's in both football and rowing. After the community. The honorary medical two years' residence at the Melbourne Hos- staff had already recommended a change in pital he obtained his M.D. His next the honorary system, as this method of appointment was at the Children's Hospital, medical staffing had failed to provide first as a resident and later as Medical sufficient consultants and specialists to meet Superintendent. Continuing to widen his the needs of patients at the hospital. Dr. field of experience, he then worked at the Collins had the task of working out a new Gresswell Sanatorium for a few months, dur- system of staffing where the honorary sys- ing which time he wrote his book, Infant tem had failed, and the next ten years Feeding, before leaving for the United brought many changes. A scheme of ses- Kingdom. Arriving there just before the sional payment was introduced to encourage outbreak of World War II, he entered the more young consultants into the field of Emergency Medical Service in London in paediatrics and to enable senior consultants 1940, working as a at the North and specialists to spend more time in the Middlesex Hospital. His interests were hospital. At the same time, opportunities now turned, of necessity, from children's to for senior full-time staff gradually increased adult work, particularly gastroenterology to the present large number. The Profes- and gastroscopy. sor feels that a balance between visiting and At the close of the war he returned to full-time medical staff in the hospital is of Australia once again to take up paediatrics, advantage to both groups and to the public.

PAGE EIGHT SPECULUM 19 61 le in al ee ly in as li- [is in of al in of ie et )r. s- rs s- of is le es !d 5- td of C. PAGE NINE SP ECULUM 1961 it The full-time men contribute much to re- U.S.A. and also paediatric centres in Eng- search, to organising departments and de- land and Europe. Having seen all this, and veloping new techniques, and the visiting knowing our resources, both at the Royal staff can disseminate these ideas among Children's Hospital and outside, he is most their professional colleagues and bring back optimistic about the future of paediatric, to the hospital some of the practical prob- here. As Professor, he is now able to lems met in the community. obtain a wider view of the subject as a whole, and in particular to concentrate on In 1959, Dr. Collins was appointed to teaching. It is in this latter sphere that we. the newly-formed Stevenson Chair of Child as students, have felt his impact most. Health. He visited the U.S.A. in 1951 and Finally, the M.S.S. Committee has asked investigated the organisation of teaching us, on their behalf, to thank Professor hospitals there, and in 1960, before com- Collins for his active interest and willing mencing his new post, he again visited the participation in our student affairs.

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PAGE TEN SPECULUM 1961 MEDICAL STUDY TOUR U.S.S.R., 1961

Dr. W. D. Counsell

News and comment on the U.S.S.R. is textile industry with 187 doctors, 71 con- as inconspicuous in our medical literature sulting rooms and 400 (rather ancient) beds. as it is clamant in the lay press and an Other industries have similar polyclinics. invitation to join a medical study tour of the Soviet at first automatically declined We saw an excellent concert of local was soon accepted. Medical men from artists and attended the splendid opera Australia have visited Russia before but house for "Rigoletto". not in a large party. This tour was arranged From Tashkent we flew over the Caspian by the Australian Soviet Friendship Society Sea and the Caucasus to Sochi, a holiday as part of a policy to exchange large pro- resort on the north-eastern shore of the fessional groups. As far as tourism was Black Sea. This is a region of great beauty concerned it was well run but we found and its many trees include Australian that arangements for clinical contacts fell eucalypts planted to absorb the mosquito far short of those promised and our indi- breeding swamps. Sochi contains 57 sana- vidual efforts were necessary to make the toria to which deserving workers and their trip worth while from the medical point of families are sent by their unions from all view. over the Soviet for 26 days holiday and The medical party consisted of 26 mem- treatment. The latter is largely of the bers of diverse professional fields including "hydro" type consisting of diet, rest and three women. We travelled with another physical medicine. An important part is Party of nine, consisting of laymen and the use of the local mineral water contain- relatives of the doctors. We all had friends ing hydrogen sulphide. This Matsesta or In both groups and some got to know the fire-water is applied externally and to most others so that apart from the trip the com- orifices for many diseases including obesity pany had its own internal interest. and sterility. A scientific institute is main- tained to pursue the subject with all the We left Sydney on 19th April and even- fervour of balneology in other parts of the tually arriving at Delhi flew from there world. north over Afghanistan to land in Central Asia at Tashkent. We had a pleasant time at Sochi and thence flew across the Crimea to Odessa, This famous city has now a population one of the four "hero cities" of the U.S.S.R. of about one million and is the prosaic Fapital of cotton growing Uzbekistan. The This is a very busy seaport with more ele- I gance afloat than ashore. Our hotel was nhabitants are largely of Mongolian descent Tsarist in period apparently preserving much and apparently reconciled to their place in of the original furniture. The famous opera the Soviet Union. Here we stayed at a f house is of the same period and there we our-storied hotel with an indescribable heard Galina Olinechenko in "Traviata." aroma eventually traced to the soap. We heard how Soviet public health had `liquid- Odessa is dotted with people having a ated" malaria, cholera, small pox, , pad over one eye and these have come from leprosy, sand fly fever, and far and wide to attend the famous Eye venereal disease. Despite our Australian Institute founded by Academician Vladimir cholera injections we all had to swallow an Petrovich Filatov (1875-1956). In 1931 ?ral cholera on arrival at Tash- Filatov established the use of homografts kent airport. Subsequent events showed from cadaver eyes and this important source that we had omitted to protect ourselves of graft material has since been extended against Salmonella. into many fields. We saw the well run polyclinic of the Wd were made very welcome at the

SPECULUM 1961 PAGE ELEVEN 1 Institute and shown a number of patients A British T.V. free-lance cinema man came r with excellent results from corneal grafts, in with us in a white coat and "scooped" etc. the scene. They bleed about 6 cadavers Filatov observed clearing in the scar tis- a day, 2-4 litres each, and use the blood sue of the host cornea around the graft and for most purposes. Other useful oddments ascribed to to some substances in the donor are collected from the corpse and stored. tissue. These were known as biogenic Professor Demikhov has done much work stimulators. That is, the vital but altered on organ transplants in dogs. We saw an tissue of the host was susceptible to the in- E.C.G. from a dog with two heart beats. fluence of the products of commencing cell These animals all die but tissue immunity is death in the graft responding by increased not accepted as the cause. vitality. The effect was later recognized as The Institute runs a large and efficient due to a general stimulation of the host. ambulance service with a central call room This principle of "tissue therapy" was ex- staffed by numerous telephonists and two tended to its use in various morbid pro- doctors. They have a special ambulance cesses such as pigmentary degeneration of with all equipment for dealing with stop- the retina, tuberculosis, acne, schizophrenia page of the heart. and "women's diseases." Tissues used were Professor Androsov showed us on post- skin, placenta, etc. implanted, but later in- mortem material the use of their mechanical jected as extracts. Finally vegetable extracts suturing machines — ingenious devices for as aloes and algae were found to contain inserting simultaneously many tantalum biogenic stimulators. One of our lay party staples in vessels or bowel by end-to-end was a middle aged man suffering from anastomosis, and in enclosing stomach or advanced diabetic retinopathy and travelling lung after resection. to the land of Sputniks in the hope of cure. He was worked over at the Filatov Insti- The next day, and here I am indebted tute and given a course of tissue therapy for this account to Dr. Harry Garlick, the to put in with his insulin. physicians visited the Institute of Therapy (Academy of Medical Sciences); Director, Some members of the party visited the Professor Miasakov. This institute is at Odessa Institute of Therapy. There are present concerned in a world plan for the 3000 students doing Medicine in Odessa study of atheroma. Research is conducted and this Institute is one of their clinical on animals, clinically and with bio- schools. Their course consists of: First chemistry and experimental . The year, Anatomy, Biology, Histology, , Russians are firm disciples of Pavlov and Chemistry, Foreign Language and History prefer the neurogenic theory of hyperten - of the Party. Second year, , sion. Professor Ivan Speransky showed a Biochemistry, Histology, Anatomy, Foreign well equipped cardiological department. Language and History of the Party. Third Electric sleep therapy is much used 1 0 year, Pathology, Pharmacology, and Intro- Russia and was employed here in hyper duction to Clinical Medicine and Surgery, plus a Foreign Language and History of tension. the Party. Fourth, Fifth and Sixth years, The same party visited the Institute of General Medicine, General Surgery, Gynae- Experimental Surgical Apparatus and In' cology, Pedriatrics and Public Health. struments. This remarkable establishment has all facilities for developing new instru - We arrived in Moscow just before the ments including animals and a museuni• great 1st May celebrations and three days This institute developed the mechanical of public holiday were given over to sight- suturing machines we saw. seeing. After this our first medical visit was to the Skilfosof sky First Aid Hospital, The Institute of Chest Surgery Director , meaning emergency or acute hospital. The Professor Kolesnikov—a leading place for building is 150 years old, a former alms heart surgery, was found to be well equip - house. It has 1000 beds, 280 doctors and ped. Valvotomy was being done under 13 professors. The director, Professor hypothermy and some open heart surgery M. M. Tarasov, demonstrated the taking of with a Malross heart-lung machine. The cadaver blood by "decanting" the corpse. assistant director, Doctor Zenziper, said 3

'PAGE TWELVE SPECULUM 1961 litres of blood were required to prime the the Institute of Science. (Science is be- machine and half a litre of vodka to prime yond Medicine). The next step is Professor the doctor. presumably dependant on vacancies and the The following is Dr. Garlick's "Routine highest award is "Academician." for Visiting a Hospital in U.S.S.R." In Leningrad the medical programme was (a) Get lost on the way — arrive late! not so intense and I resigned myself to one (b) Visit the cloak room. visit to the Leningrad Eye Hospital where (c) Don white coats and caps. the director and I, through a lay interpreter, (d) Meet the Director in the Board Room spent a pleasant morning trying to assess and be earbashed on (i) history and (ii) each other's abilities. The physicians visited statistics. a general hospital, apparently not a teach- (e) Eventually one sees something that is ing hospital and found the work there much interesting, but is is usually afternoon by as we would in a similar hospital in Aus- this time and one has missed lunch. tralia. (f) Receive pamphlets. We spent a very pleasant week in Lenin- (g)Write a message in the Visitors' Book. grad visiting galleries galore and nearly (h) Take photographs. every evening at the theatre. I visited four eye establishments in Mos- cow. The older ones suffer from out of Mr. John Zwar has contributed the fol- date buildings but I saw some good operat- lowing notes on the surgical clinics of ing and keen clinical work. The Moscow Russia: Eye Hospital follows the Filatov school and (1) Odessa. (Population 667,000). Two out of respect to the memory of the Acada- main surgical clinics. (a) Odessa Child- Mician uses tissue therapy. rens Surgical Clinic. The chief surgeon The most promising find was the eye Professor Dimitriev showed us around the department of one of the new outer ring old but very clean and tidy buildings. He hospitals with a fresh building, new equip- had recently been to meetings in New York ment and a young director Dr. M. Krasnow, and Belgium and is keen on orthopaedics. who speaks excellent English. The hospi- This is a teaching hospital with 80 beds tal is a teaching hospital. and a turnover of 1500 to 2000 cases a Medical schools are not at the universi- year. They had closed circuit T.V. in the ties but at institutes. At the Institute of operating theatre for students. Two tables Medicine of the medical schools of Moscow were in use at once. The wards were quite I found that the program was much as in clean but crowded. One typical small ward Odessa, with an annual examination. In contained a torticollis operation, fractured the final year the students do responsible humerus, bilateral C.D.H., injured knee, Work in various hospitals and at the end another C.D.H. The surgical staff were are examined in their own hospital by a doing research work on bone growth and government commission. The examination transplantations. is amost entirely oral. After satisfying the (b) Odessa Adult Surgical Clinic. The examiners in Marxism-Leninism, the suc- director was Doctor Ternovy. 1000 beds cessful students are awarded a diploma. The and its own ambulance service including 5 Institute of Medicine had 6000 students in planes and one helicopter. The chief sur- three faculties, Medicine, Hygiene and Pub- geon showed us round speaking a mixture lic Health. I could not find out what the of Russian and German and we managed latter two lead to but there were 600 final quite well with the common words. Again Year Meds. The diploma holder wishing to the wards were crowded and clean and the advance his position to that of "Candidate" cases similar to those you would find in a Must do an extended period of post-graduate general surgical ward of one of our teach- Work and write a thesis usually on some ing hospitals. For instance in one ward we aspect of research. I inspected some of saw cases of appendicectomy, kept in hos- the theses, each the size of a small fools- pital for 7 to 8 days, gastrectomy, incisional cap ledger and concluded that a formidable hernia ("first operation was done at an- a mount of research work must be storing up other hospital"), acute cholecystitis, thyroid- M Russia. The Candidate is a graduate of ectomy (home in 8 days),

SP ECULUM 1961 PAGE THIRTEEN) (in hospital for 15 days). In the theatre the assistant surgeon who discovered a can- we saw a gastrectomy done under L.A., cer and called his chief Professor Kolesnikof they are evidently keen on this here. My who took over and performed a pneumo- general impression of these two clinics was nectomy with skill. that good surgical work and research work Kolesnikof recently won the Lenin Prize were being done in crowded conditions. I for thoracic surgery. We then saw him doubt whether the standard of surgery was excise a rib for an osteogenic carcoma. quite up to ours but it is difficult to assess Prognosis was poor he told us. with a brief visit. In conclusion my general impression was (2) Moscow. that the surgery we saw was of a very high On the day following the visit to Skli- standard but I doubt if their general sur- fosovsky Institute described above with two gical standard is as high as our general others of our party I returned there to standard. Although they are doing most watch Professor Androsov operate. We interesting research work the statement ex- were met at the entrance by the Professor's pressed by a correspondent in the press assistant who took us to his chief's room that "they are far in advance in every as- where Androsov greeted us enthusiastically. pect of medicine and surgery" is in my We had no interpreter and he spoke little opinion quite wrong. English but we could follow quite well. The representatives of the other branches The patient for operation had a gastro- of medicine and surgery in our party did oesophageal anastomosis in 1952 by Yudin not find anything to alter the general im- but there was stricture formation at the site pression that has been conveyed above. Our of anastomosis. Professor Androsov dealt psychiatrist did not get anywhere at all. Our with this very competently by mobilising the orthopaedist, Mr. Alec Dawkins, of Perth, jejunum through an abdominal , push- was shown a case with an enormous bone ing the jejunum through the diaphragm into graft of the lower third of the femur which the thorax, closing the abdomen and then apparently had taken. opening the chest and anastomosing the jejunum to the oesophagus proximal to the In conclusion we found our colleagues in stricture. Anaesthesia was Myorelaxin, the U.S.S.R. keen, enthusiastic, courteous oxygen and intratracheal ether. During and helpful to a degree. Technically they were skilful and patient. The leading men operation 2 litres of cadaver blood were seemed to have a good theoretical know- used. ledge of established world trends but com- I was interested to note that no swab monly were a long way behind in practice. count appeared to be taken. It was my This may be due in part to their lengthy impression that the operation could not period of isolation. have been done more expertly. After the The official attitude to professional visits operation Professor Androsov along with as interpreted by Intourist is mysterious and Professor Demikhov of transplant fame capricious. It seems impossible to obtain entertained us to a most enjoyable lunch of a detailed programme before entering the Russian pancakes held down with Georgian U.S.S.R. and visitors both accredited and cognac. private have been told that they could not (3) Leningrad. go to this or that hospital. It appears that Here we visited the War Veterans Hos- all institutions may be inspected in detail pital (onr Repatriation). It was an old but close or protracted personal contacts looking hospital as were all I saw in Russia are discouraged. Most serious visitors have and was completed in 1935. It has 600 expressed the idea that a better understand- beds, 50% for veterans and 50% for ordi- ing between east and west is imperative and nary patients. 300 beds are for pulmonary that it can best be obtained by personal T.B. of which 70 are surgical. There are contacts at an unofficial level. 70 doctors. The hospital was well equipped In the words of John Gunter "The gulf, but appeared crowded. We later returned the chasm, the abyss, may seem too great to watch an operation. Again two were to be bridged. But we must try to bridge on at once in the same theatre. We saw it, because the world will have no rest an exploratory thorocotomy performed by otherwise."

PAGE FOURTEEN SPECULUM 196 1 WITH THE RED CROSS IN THE CONGO

Dr. Hewitt Haughton

POLITICAL BACKGROUND Lumumba. Moise Tshombe's secession of Katanga from the Central Government fur- On June 30th, 1960, the King of the ther worsened the situation with the result Belgians and the Belgian Government that Lumumba called upon United Nations granted independence to the people of the Organisation for assistance to maintain law former Belgian Congo, subsequently known and order. He also thought he could use variously as Congo, Congo Republique or UNO to assist him in retaking Katanga. Republique du Congo. No central govern- Following an emergency meeting of the ment has been in power long enough to Security Council of UNO a military force decide the official title. was formed from African member countries and air-lifted into Congo by U.S. Army Prior to independence an election was planes from Germany. This force started held under Belgian guidance to elect an to arrive from July 12th onwards. In addi- upper and lower house of democratic par- tion, there were UN technicians drawn from liamentary Government. The party, of permanent staff of all nationalities brought whom Patrice Lumumba was head, polled into the country to get the essential services the largest percentage of seats, Joseph working and to supervise their maintenance. Kasavubu was next. Patrice Lumumba These included sanitary engineers for water became the first Premier of the Congo inde- purification plants, engineers for electric pendent Central Government and Kasavubu supply plants, telecommunications, airport was appointed President. control, meterological forecasters, etc. On July 7th, 1960, the Force Public mutinied in Leopoldville and locked up or World Health Organisation undertook the killed their Belgian officers. Similar occur- survey of medical problems and acted as rences of mutiny occurred throughout the advisers to the mushrooming Congolese whole Congo. Whatever other antecedent Ministry of Health. The Minister of Health causes were present, this mutiny resulted in was a self-appointed Congolese Assistante- the beginning of a mass exodus of Belgian Medicau. This man had a high degree of Nationals throughout the whole country, ability and in the early days the Ministry with them went the majority of 760 doctors of Health was one of the few that was and over 3000 European trained white operating reasonably well. nurses. A report to U.N. by W.H.O. in July This mass exodus resulted in the decapi- showed that the medical problem was one tation of every technical activity in the of overiding urgency as the Congo could Congo. Amongst the native Congolese easily have become a pool of epidemic tro- there were no doctors, lawyers, engineers, pical disease that could have threatened the architects, electricians, nor specialised tech- medical health of the whole continent. nicians. In a population of 14,000,000 W.H.O. did not have the permanent staff there are 16 university graduates. One to cope with this vast problem and asked doctor qualifies late this year and two more for assistance. In 1963. The International Committee of Red Following the mutiny of the Force Public Cross were approached and in conjunction the Belgians appealed to the Government at with the League of Red Cross Societies home for assistance, they sent a Belgian they offered their assistance on what they paratroop regiment, who got the Force termed an emergency basis only. At that ..r11131. 1c under some sort of control but by time the emergency period was predicted 'nen* high-handed manner infuriated as three or at the most six months.

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SPECULUM 1961 PAGE SIXTEEN Red Cross assistance in a country not at ent state in S.E. Kasai with Bakwanga as war is normally under control of the League its capital, backed by the management of working through the National Society. In the Beceka Diamond Mines and called the Congo this was not possible as there was Etat Miniere. Into this area all the Baluba no National Society. International Red refugees of the Lulu-Baluba tribal war Cross, therefore, decided that in Congo a began to congregate; this war had been in state of war existed and they sent their progress since October, 1959, and had deputies to survey the problem. One of nothing to do with independence. On these was a Swiss living in Rhodesia called August 26th Lumumba sent the Congolese Mr. Sen, of whom more later. National Army—the renamed Force Public The League of Red Cross Societies at the and C.N.A. for short—to capture Bak- request of the International Committee, wanga and to annihilate the Etat Miniere. were asked to recruit from their member This they proceeded to do over the next nations medical teams consisting of a mini- three weeks until September 14th when mum of three, physician, surgeon and medi- Kasavubu deposed Lumumba as Premier, cal orderly, preferably male. Many coun- Col. Mobutu declared martial law and told tries sent much larger teams, Russia had a the Russian Embassy to leave, and team of 24 personnel. These medical teams U.N.O.C. negotiated a cease fire between began arriving in Congo about 15th-20th the C.N.A. and the Balubas. Bakwanga July and were assigned with all the possible was recaptured and reoccupied by Kalonji speed a very erratic U.N.O. air transport and the seceeding S.E. Kasai state pro- could muster. The Australian National claimed. This attempt at genocide plus his Red Cross sent, initially, two teams of three pro-communist leanings was the downfall for a period of six months, later two more of Lumuba, eventually leading to his death teams of two were sent for four months. I in February, 1961, in Katanga. was the leader of one of these first teams. With this summary of the political picture in mind, I will proceed to our ex- To return to the political situation which has a direct bearing on our experiences. The periences. U.N. military force operated under a man- date given by the Security Council which, FIRST GLIMPSES OF CONGO amongst other things, stated that it was to maintain law and order but not to interfere On August 19th, 1960, Drs. Dwyer, Fox with internal politics. The wording of this and Mr. Acol of Team No. 1, Dr. Willis, mandate restricted the functions of the Mr. Thompson and myself of Team No. 2 military force in such a way that much Australian Red Cross, departed from Aus- adverse criticism has been levelled at tralia bound for the Congo. We had no U.N.O.C., not only by the internal poli- information at all as to conditions in the ticians but also by international press re- Congo of medical practice apart from the Ports. alarming newspaper reports, so we expected L. umumba, amongst other local poli- primitive conditions and medical practice ticians, considered U.N.O.C. could be used on a village patrol level. On arrival in to further his own political aims. The Leopoldville on August 22nd we were various field commanders of U.N.O.C. units somewhat amazed at the magnificence of succeeded in steering a strictly neutral the city and its environs; during the week course through all these demands made we spent there awaiting assignment we were upon them. It is important to keep this able to explore these environs in more de- Peculiar position of the military force in tail. The European population before inde- mind as incidents in which we were in- pendence lived a life of luxury, their homes volved occurred where the unit commander and apartments were magnificent. They was confronted with only one possible had three country clubs, a golf course, course of action. In one particular incident cinema, night spots and many first class where I was captured by Kalonji's army, restaurants. the U.N.O. unit commander was powerless The atmosphere in Leopoldville is worth to effect my release. recording. Here was a city originally of Early in August, 1960, Albert Kalonji- 25,000 whites and 250,000 native popula- a Baluba tribesman—formed an independ- tion; it was a continental city of concrete

SP ECULUM 1961 PAGE SEVENTEEN apartments and office blocks with tree-lined and whose work has been retarded 30 years boulevards, shops, traffic lights, cafes and by independence, only two of the original restaurants. The city lighting remained on 50 European workers remained. The value night and day. By day the sun shone and of its research equipment runs into millions the trees were stirred by the breeze, but it of dollars and its slide library of the path- was a dead city, its owners and occupiers ology of tropical medicine has no equal in had gone. It was a silent city, especially the world. This institute is now idle and in the residential suburbs where the houses its fabulous equipment will rust away in the remained in their gardens with eddies of humid atmosphere, unprotected by the wind stirring the fallen leaves, paper and essential refrigerated airconditioning. The dust. Here again the electric light burned third place we visited was a recently con- night and day disclosing the interior of the structed and completed district hospital homes with their silent furnishings and lack serving a native suburb of about 70,000 of human occupants, a few windows were people with 300 beds. It was built on the broken, garages had cars in them, many detached chalet system connected by cover- burnt and wrecked cars lay about the city ed walks. It was being run by two Swiss streets. While the city was silent and dead Red Cross teams. The operating theatre it was not empty, there was a massive life block had two beautifully equipped theatres in the city, but it was alien. The city had with a central sterilising room, anaesthetic been occupied by a people who did not rooms and recovery ward that can best be understand it or know how to use it. By described as a picture of streamlined day they drove around in late model Ameri- chromium plate and stainless steel. This can cars, their women in the back dressed hospital under Red Cross management was incongruously in their village clothes; they fully operative and supplied service in Sur- ate in the cafes, they drank in the bars and gery, Maternity, , General Medi- they occupied the big tourist hotels. By cine and Tropical Medicine. T.B., leprosy, night they disappeared, the city was silent, and orthopaedics were diverted to specialist hushed and empty again, by night it became hospitals situated in and around Leopold- invaded by an air of stealth, broken or ville. aided by the sudden appearance of an unlit Also working in Leopoldville was the weapon carrier moving silently along loaded Central Blood Bank staffed by a special with Congolese National Army troops Red Cross Medical team from Holland. armed with F.N. rifles and automatic weap- ons, their black faces shrouded by dark green tin hats, some with bands of white or WORK BEGINS red painted on them. These were the feared Congolese Gendarmerie who were ruthless Our period in Leopoldville whilst inter- in their brutal handling of their captives. esting was becoming irksome as more and The atmosphere in Leopoldville was what more teams were arriving and we all waited I imagined, a city struck by an atomic ex- assignment; with us were teams from India, plosion would be like months after its radia- Pakistan, Poland and Ireland. About the tion hazard had ceased and it had become middle of the week we were visited by Sen re-occpuied by an alien civilization. who had recently arrived in Leopoldville from S.E. Kasai, where he had done a sur- Whilst in Leopoldville we visited three vey for the I.C.R.C. of the medical require- places of medical interest which to me were ments. Bakwanga, the centre of this area, an eye-opener of the magnificent standard had a normal native population of 20,000, of medical attention the Belgians gave to into this area another 120,000 had migrated the Congolese. One was a modern Lepro- as refugees; they were centred around a sarium recently completed, which brought place called Miabi where there was a 300- a modern scientific attitude to this one-time bed district hospital and an urgent need for dread disease. The fixtures, fittings and a Red Cross team. Sen had hair-raising appointments of this hospital are probably stories to tell of his experiences consequent unequalled anywhere. The second was the on the Lulua-Baluba tribal war, a war of no Princess Astrid Institute of Tropical Medi- quarter and no prisoners, with mutilation of cine, a rather uninteresting building housing the dead as a side line. He said the a tropical research unit that is world famous Balubas wanted medical assistance, would

PAGE EIGHTEEN SPECULUM 1961 we give it? We volunteered for the assign- post injury. In the theatre we had no ment, although U.N.O. security was not water, no autoclave, no sterilization and ex- available in the area we felt the need was cept for about four hours a day no elec- urgent. Our departure was delayed by tricity. In the wards we had no staff. The Lumumba sending the C.N.A. in to capture hospital was old and dirty and all the bed Bakwanga on August 26th. Three days linen had been looted. The theatre was later Bakwanga was reported all quiet and well equipped but most of the instruments, the C.N.A. had moved on towards the etc., had been removed to the European Katanga border. hospital. Hunger was even then a major On August 30th we left as a group for problem. We were able to get a small Bakwanga and Miabi. We arrived in what amount of relief food but not in quantity or proved to be a lull in a battle that had been sufficient variety. raging since dawn with an estimated 300 We had an excellent medical store, very dead in the bush surrounding the town. 150 well stocked, especially with Belgians, including one woman and 13 which we used liberally. It was an amazing Nuns, were besieged in their club surround- sight to see a badly infected compound ed by a thin guard of Tunisian U.N. troops, fracture carried in for treatment and 48 outside these were a ring of some 500 hours later up and walking about with his C.N.A. of whom all one could see in the infection under control and his fracture in tall elephant grass was their tin hats and the plaster. These people were stoically grate- muzzles of their FN rifles. ful and quite uncomplaining; we all felt Bakwanga is a mining town, owned lock, rather sorry for the Baluba. Later experi- stock and barrel by the Miniere Beceka and enuce of them changed my attitude com- is dependent on the mining of 60 per cent. pletely, they can be just as savage and of the world's supply of commercial dia- brutal as the C.N.A. monds, dull blue-grey blobs of crystal with Some incidents in the Bakwanga night- yellow streaks in them. There is a Euro- mare stand out, such as the burial of 50 pean residential area centred on the Club people killed in a massacre of innocent un- Cercle, a native employees' residential area, armed students in the Mission. On the way two hospitals, one for Europeans and one up to work one morning, Dr. Willis and Dr. for Congolese, a large Roman Catholic Mis- Dwyer found a dead man in the street, they sion with a maternity hospital, the sprawling buried him hastily in someone's front mine compound surrounded by a 10 foot garden and hoped the tropical rain would chain link fence, and beyond this the Con- not wash the top soil away. Then there golese hospital. There are no shops, was "'Orrible 'Arry" who believed that cinemas or amenities, all stores are pur- death from burning was better than being chased through the mine-owned store, shot, so he sat in his home and set fire to bakery and butchery. Some 35 kms. S.W. the roof which fell in upon him causing of Bakwanga along a bush dirt road is the severe burns of back, scalp, arms and legs. district hospital of Miabi. How he survived is a miracle. We used to The 15 days we spent in Bakwanga were dress him every second day, the whole pro- a nightmare. We lived in an unused mine cedure taking about three hours as we had house and ate in the club where everything no proper facilities. The lack of water was was rationed. We worked where we could, a nuisance, but we got around it. We serious injuries such as gunshot of found a good supply of Vichy water in the the abdomen being treated in the European medical store—drinkable but a bit salty. hospital, the remainder in the Congolese We washed ourselves and our underclothes hospital. Fighting between C.N.A. and in the Club swimming pool, shirts, etc., we Baluba continued with considerable fero- hung on the line and hoped the afternoon city. Some of us toured the battle areas in rain would make them a bit cleaner. Some a converted utility trying to collect the of us had dysentery and used to spend the walking wounded; more seriously wounded night running up and down the garden usually died in the bush before we could armed with a small trowel. The Tunisians get to them. Some 70 cases were brought gave us a party in their Mess—a one-time to the hospital mainly with grossly infected tourist hotel—we had a sheep barbecued compound limb fractures from 4-14 days Tunisian style and ended up drinking warm

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SPECULUM 1961 PAGE TWENTY Veuve-Cliquet in the dark as the power Hospital administration was entirely by the supply had failed again. Congolese with W.H.O. advising. They We were withdrawn from Bakwanga learnt by trial and error. rather hurriedly without notice on Septem- We worked from 7.45 a.m. to 5 p.m., ber 14th. Apart from visiting Miabi where with 11 hours off for lunch. Night calls conditions were impossible, we were not usually started about 7 p.m. and kept up able to work there. until midnight. This abrupt stoppage at midnight was due to the night staff locking the main entrance of the hospital, discon- CONDITIONS IMPROVE necting the telephone and going to bed. Sundays, apart from hospital rounds We arrived in Luluabourg on September and emergencies, were free. My work was 15th unheralded and unsung, no one knew a almost entirely operative. I did 310 major thing about us and the W.H.O. representa- operations and 111 minors from September tive was marooned without transport in 15th to January 30th, 1961. A bit of another part of the province. everything, including 71 hernias. The local hospital (600 beds) was work- ing with a Norwegian Red Cross team and My part of the hospital, the surgical sec- a Spanish Internist. Luluabourg was a tion (100 beds, operating theatre and X-ray breath of civilisation after the jungle and we department) was staffed by Sister Stella determined to stay there. When Dr. (Nursing Nun), who ran the theatre at first Nicholas, of W.H.O., came back he wanted but was later deposed by a Congolese one team to go to Luiza in south Kasai. Director. She gale anaesthetics. Also in On September 20th Drs. Dwyer, Fox and the theatre were three Congolese nurses and Mr. Acol went and remained there. Dr. two cleaners. The X-ray department con- Willis and myself joined the Norwegians in sisted of two Congolese trained radio- the base hospital for one month and took graphers who were very good for simple over from them in October, and continued radiography. The ward was run by M'lle on by ourselves. For the next 41 months Verheage—a Belgian trained nurse—two life settled down into a fairly placid routine male nurses, two female nurses and two during which we were grossly overworked cleaners. The male nurses took it in turns but contented. We had good living condi- to do night duty. Female nurses only tions, no recreation, but then we had no attended in the female wards. All children time for it, a number of good friends and requiring surgery were nursed in the pedi- numerous incidents. atric department. To give some idea of the problems in- volved in Luluabourg, it was like trying to SURGICAL HAZARDS run a Melbourne city hospital in which the nursing staff consists of 25 per cent. of the The work in the surgical section was, probationer nursing staff, three trained nurs- apart from accidents, entirely operative. es, four doctors, one pediatrician (150 Patients were referred by the Congolese-run patients), one surgeon (100 patients), one out-patient clinic when they considered obstetrician and gynaecologist (100 pati- operative interference necessary. Conse- ents), one internist (150 patients), one nurse quently we never saw patients not requiring with three years' experience in TB (100 operation or patients after they had been patients). The surgeon did ALL the emerg- discharged from hospital. The type of ency work, although later he was relieved of work was much the same as in any general the obstetrical emergencies. There was no surgical department, with hernias predomi- anaesthetist. nating. During the 41 months I worked The hospital served an immediate popu- there I saw a bit of everything and had to lation of 80,000 and a potential population be prepared to tackle any case that present- of 2,500,000 with no other qualified medi- ed from craniotomies to gastrectomies. cal attention available. The medical service Emergency work had priority and in fact, we were able to give was in-patient only, owing to the limitation of beds, elective we did no out-patient work at all. This was surgery was cut down to a minimum. done by Congolese Assistante-Medicaux. Emergenices were mainly bowel obstruc-

SP ECULUM 1961 PAGE TWENTY-ONE tions, compound fractures, Caesarian sec- but not sterilised that had been used the tions and hysterectomy for ruptured gravid night before for a gangrenous perforated uterus. intussusception. Major abdominal surgery was a hazard- Practically, without exception, if anaes- ous undertaking because we had no X-ray thesia by spinal or local block was impos- diagnosis service other than limb X-rays, sible then operation was impossible. Sister and for most of the time we were using a 10 Stella, our nurse anaesthetist, could, and ma. dental machine for these. We had no did, give many endotracheal anaesthetics, diagnostic laboratory service apart from un- but by herself she could not do everything. reliable blood counts and similar minor We had to adopt the Belgian system of examinations. In a population riddled with setting up the theatre which in practice dysentery and hookworm, only one faecal the surgeon does everything himself. There examination out of hundreds sent to the was no theatre sister, scrub nurse or suture laboratory was diagnosed positive. Fluid nurse. You draped your own trolley, and electrolyte balance control was purely arranged instruments, selected sutures and guess work and the Congolese nursing staff threaded your own needles. Here may I had no appreciation of the theory of physi- say how much we appreciated the split-eyed ology in IV therapy. Many of our patients spring needle which can be threaded by had not one abnormality but at least four, touch. the treatment of which was more imperative Post operative management of patients than operation. These were anaemia (Hb was frequently upset by the most unexpect- of 2.5gm-4.5gm. common), incipient mal- ed occurrences. These certainly made for aria, hookworm infestation and dysentery. variety but were frequently exasperating. If At an early stage, in consultation with the patient was not literally tied to the bed my physician colleague Dr. Willis, we de- he had often gone home the day after cided that there were so many cases requir- operation. Sometimes they disappeared be- ing attention by a doctor for general disease fore operation and turned up again 3-4 days that our time was better spent looking after later. One patient with a urethral fistula these patients than in concentrating on on whom I planned a two-stage reparative purely elective surgery. The chief medical technique, disappeared after the prelimin- needs in the Congo are for physicians, pre- ary cystostomy. I did not see him again. ferably who can undertake emergency sur- Patients with I.V. drips were the most diffi- gery and obstetrics! The general health of cult as the nursing staff interchanged normal the patients was so poor that getting them saline, dextrose and water and synthetic fit for major surgery such as partial gastrec- plasma substitutes quite indiscriminately tomy, nephrectomy, etc., would have taken without reference to instructions or physio- weeks under the care of a physician whose logical requirements. Patients receiving time was better spent in other fields. I.V. therapy for dehydration from pro- longed vomiting or dysentery would fre- Diagnosis of some abdominal conditions quently remove the needle after the first litre was of necessity by means of laparotomy had been given and go off home, or back to with consequent action on findings; this is jail in one case. The staff discontinued not a recommended method of practising drips if they required a change of bottles surgery. during the night, i.e., after midnight, no matter what the requirement of the patient. GENERAL PROBLEMS Interference by civil and military authori- ties was another hazard with which we had Other restrictions were also operating. to cope. One morning I arrived at the hos- For 21 months all our autoclaving of linen, pital to find the whole surgical section etc., had to be done at another institution seething with about 200 fully armed and as our main autoclave was out of order. very irate C.N.A. One of their number Sterilisation of instruments, etc., was entire- had been killed the night before in a motor ly by means of a dry heat oven without the accident and they were fully convinced that aid of coloured tapes, etc. A few accidents the driver of the car was hidden by me did happen as a result of this. A hernia somewhere in the hospital. Trying to con- was operated upon with instruments washed vince them to the contrary in a language

SPECULUM 1961 PAGE TWENTY-TWO that I could not speak was quite a job. This taking us to Bakwanga, the capital of eye for an eye idea is a feature of motor Kalonji's area. Curiously, the U.N. forces driving in Congo, it refers to white and in the area tried to rescue us but were black alike. If a native is killed in a motor themselves arrested and brought to Bak- accident, the driver of the car is always wanga. After an afternoon and night of killed if he can be caught. That is all there much talking and brandishing of FN's, etc., is to it. You tend to drive with great cau- we arrived in Bakwanga at 2.30 a.m. and were formally interviewed in the street by tion when there are natives on the road. the local army commander assisted by his My lack of understanding of the French staff. He was dressed in pyjamas and a language was the cause of an amusing inci- sten gun, the remainder ringing us round dent. I was called urgently one Sunday with FNs and sten guns. My Belgian afternoon to the hospital where I found friend eventually persuaded them we were about 30 people, mostly Congolese, in the not spies and we were allowed to go to the operating theatre, all milling around, talking U.N. forces HQ., where we spent the re- French nineteen to the dozen. Trying to mainder of the night. I returned by U.N.O. sort this out I gathered that one man, whom plane the following day still in a bathing I was told was Kasavubu's chef, had been costume but with the addition of the the subject of a bad beating up by the Ghanian Brigadier's raincoat. Baluba in Bakwanga during a visit by My work in Luluabourg ended on Janu- Kasavubu to Kalonji. This man was a ary 15th when W.H.O. commenced to get Lulua and his brother lived in Luluabourg. long-term doctors into the country to relieve When we got the patient into bed the bro- Red Cross personnel. I was relieved by a ther was very offensive and refused to have Belgian surgeon who had been in another him attended by Belgian Nuns and white part of the country. To finish the time of doctors. With things looking really nasty I my service I went to a Mission Hospital in decided to seek assistance through my Bel- South Kasai where I spent a very pleasant gian nurse as interpreter and the local 14 days in a small 70-bed hospital, being C.N.A. camp Commandant. M'lle Verheage well looked after by the A.P.C.M. This did all the talking for me and when she job was done at a much slower tempo and asked me who the man was I said, "Kasa- I was able to see more of the people of the vubu's cook". We succeeded in getting the country. We had the use of a privately- Congolese camp commandant to send a owned Cessna to fly around in. C.N.A. guard up to the hospital and got everything quietened down. Afterwards M'lle Verheage told me that the patient was THE CONGOLESE PEOPLE not Kasavubu's Chef de Cuisine but his Chef de Cabinet. In conclusion, let me say a word about While we had very little time for recrea- the people themselves. My experiences tion, had it been available, we did manage were with the Lulua tribe mainly; I also met to arrange reliefs for one short weekend members of the Basong, Basala and Bateke which we planned to spend at Lac Mucam- tribes. The latter are cannibals. Cannibal- ba, on the Lulua-Baluba territory border. ism in Congo is ritual and not a means of The Belgians had built up the surrounds of augmenting the protein deficiency in their this lake into a pleasant resort with a very diet. It is a part of the ritual of attaining Comfortable guest house and resources for manhood and position in the tribal hier- swimming, water ski-ing, etc. The lake archy. had no crocodiles or hippos in it. We spent The Congolese people outside the urban One afternoon learning to water-ski with areas while not entirely illiterate, have a moderate success. The following afternoon, low standard of education. Their loyalties dressed in nothing but a bathing costume, are tribal and they retain intact many of I went to the local airfield to meet some of their tribal beliefs and customs in spite of my A.P.C.M. friends and inadvertently their association with Christianity. They drove into a small group of Kalonji's army are reserved, shy and suspicious with white who promptly arrested me and the Belgian people, whom they inherently distrust. It who was with me. Efforts to identify our- is nearly impossible to get close to them selves were unavailing and they insisted on or to know what they are thinking. They

PAGE TWENTY-THREE S PECULUM 1961 will always tell you what you think you ganisation) would be a worthwhile experi- want to hear. ence for any medical graduate. A working Tribal customs keep the women in a con- knowledge of French is essential. dition of absolute slavery. They do all the Working with the International element manual labour and heavy work and are of the Red Cross organisation was an en- treated by their men folk with complete lightening experience for me. Of all the disdain. Fecundity is the highest ambition international organisations trying to help of a Congolese woman; if for any reason at the Congolese people the Red Cross suc- all they become sterile they are outcasts in ceeded completely in their aspiration and the village and form a high proportion of aims in Congo. Their operation was so the insane. successful that the period of service requir- The women plant and cultivate the gar- ed to be extended from six to twelve dens, prepare the food, carry on their heads months to allow other organisations to burdens up to 150 lbs. weight on all occa- mobilise replacement medical personnel on sions. They look after their husbands and a long-term basis. Twenty-four countries their children and are perpetually pregnant. supplied over 150 doctors, the largest num- Expectancy of life is about 45 years. The ber there at any one time was 104. These men sit around and talk politics, on a vil- figures are a drop in the ocean when you lage level. They are intensely fond of their consider the problems involved; however, children and it is the father invariably who it is interesting to note that during the brings the child for medical attention, his period of the Red Cross medical aid, there wife comes along too, usually with the rest was no outbreak of uncontrolled epidemic of the family, to do all the work. disease. To some extent this can be attrib- The staple diet, for the non-urban people uted to the excellent preventive system of is manios, maize, rice, peanuts and palm the Belgian administration and to the pres- oil. They augment this with fish, meat in ence of the epidemiological experts of some areas—antelope and hippo—bees and W.H.O.; the doctors on the spot were, how- flying ants eaten alive and raw. They are ever, Red Cross. Vitamin conscious and if they get the opportunity they will loot a hospital store 0,...... ,,—....0.....,,,...... ,...,...... 0..0...,,—.,0 for all its Vitamin tablets, especially the B i group. 1 A Restaurant known throughout 1 The children are delightful, they mature i in worldly wisdom at an early age; they do II Australia not seem to fight and squabble amongst 1 i themselves the way we do. Children of 11 I 6-10 years have taken over the care of their 1 1 younger brothers and sisters amongst fami- LL i lies orphaned by the tribal war. At 10 • ,, 1 years they go to school and then something enevteve changes them to their adult distrust. 1 i 1 1 THE CONTINUING PROBLEM ESPRESSO Working in Congo was a wonderful ex- I i perience, both in clinical experience and in COFFEE LOUNGE association with other nationals for a com- 1 1 mon aim. Congo is going to require doc- 1 tors for many years to come. It has been I estimated that it will take 60 years to train ! 233 Faraday Street, Carlton I Congolese doctors to replace the 760 Bel- gians and other nationals who served the FJ 4313 health requirements of the country. Pro- 1 Near the University 1 vided the political position was reasonably I I stable, I would consider 12 months' service i I in Congo under W.H.O. (World Health Or- 0...... ,,...... 0.....,,,,,,.....,.....,,,...... 0—...... )

PAGE TWENTY-FOUR SPECULUM 1961 ARTERIAL SURGERY

Mr. Neil Johnson

As our knowledge of pathology de- in the body. Whilst it was very satisfactory veloped, the importance of arterial lesions in dealing with small vessels (since the in causation of human disease has become blood supply was readily taken over clearly evident. in all sites of the by other small vessels) it was not satis- body may, with advancing years, become factory when applied to the larger arteries. blocked by atheromatous deposits, thus Ligation of the damaged popliteal artery reducing the blood flow to the organ sup- for instance, is followed by loss of the leg plied by the involved artery. Common in one-third of cases, and patients in whom examples of this arterial occlusion are seen the limb survives are likely to have severe in the heart, brain, kidneys and lower limbs. symptoms, due to diminution of blood Sometimes the artery instead of becoming supply to the muscles of the leg, as an blocked, becomes distended like a weak aftermath. Clearly, the rational method of tyre and an develops. These dealing with a damaged major artery is , or blow-outs, occur mainly at simply to sew it up again and thus restore the lower end of the aorta, and once started the continuity of the main vascular channel. tend to enlarge progressively until they It might be supposed that the vessel would burst with disastrous results. Moreover, bleed dramatically through the holes made the anatomically protected position of the by the needle and thread used to sew the neuro-vascular bundle is no match for the ends of the artery together, and indeed this ingenuity of accident-prone modern man, is so, but, provided that very fine thread is and major arteries and veins are not infre- used in the repair, and the stitches are quently severed in present day accidents. placed with great care, stops quite If a large vessel is severed, blood loss may soon, the needle holes becoming blocked rapidly terminate life, and even if the bleed- with small quantities of blood clot. ing is arrested the tissues supplied by the The techniques of repairing major vessels traumatised vessel (usually a limb) are un- were worked out and tested in the experi- likely to survive. Such then is the stimulus mental animal in the early 1900's by an to the vascular surgeon, his role is funda- American physiologist named Carrell, but mentally that of the plumber, to replace these techniques were not widely introduced weak pipes, to unblock blocked pipes and into clinical practice until after the Second to repair burst pipes. World War. This delay in clinical appli- cation of the techniques of arterial surgery Much of the history of surgery is centred is scarcely surprising since some degree of about the attempts of surgeons to deal with blood loss is inevitable in dealing with traumatised vessels. The cautery and hot major vessels, and thus progress in the field tar of the days of Nelson gave way to the of vascular surgery depended largely upon notion of seizing the bleeding vessel in for- the ready availability of blood. The well- ceps and ligating it with some suitable organised Blood Bank, as we know it today, material. Discovery of this method is a post World War II development. (haemostasis) was one of the fundamental developments which made possible the A cleanly severed artery could obviously surgical attack on all the deeper structures be repaired by direct suture, but if a length

PAGE TWENTY-FIVE S PECULUM 1961 of vessel was so badly damaged that it had present in the host vessel. Atheroma de- to be removed, the problem of breaching a veloping on its wall led to the occurrence of gap in the artery presented itself. Early late obstruction, and weakness of the wall attempts to deal with this problem were of the homograft allowed dilation and made using glass and silver tubes, but blood aneurysm formation in the grafted vessel. clotted in these channels within a few These phenomena gave great impetus to moments and they proved to be valueless. the careful study of the fate of the homo- It was natural that attention should now grafted artery and it was shown that, as turn to substitutes available from the body with most other homografted tissues, the and so autogenous vein grafts (obtained implant failed to survive as such in its new from the same individual) were employed to situation. The grafted artery was invaded bridge the arterial defect. By and large, and replaced by host granulation tissue, these proved to be of great value. There only the fibro elastic layers of the media was some tendency for the implanted vein persisting and acting as a scaffold for the to dilate under its new pressure relation- ingrowing host tissue. The arterial homo- ships but follow-up of these grafts showed graft was thus found to have the following that they survived in their new site and that defects. they soon acquired a structure similar to that of the arterial wall. Obviously the (1) The methods for obtaining and stor- vein used had to be an expendable one ing these grafts in a sterile condi- from the point of view of the venous circu- tion were time-consuming and lation and the largest vessel available is the somewhat uncertain since infection long saphenous vein, thus the size of the of the graft may occur in spite of available tissue reduced the applicability of all precaution. the technique of venous replacement to (2) The only subjects suitable for arteries of the size of the femoral and small- donors of such vessels were young er. In general, vessels smaller in size than subjects dying of trauma and in the brachial artery do not tolerate grafts most countries the supply of suit- A. well since it is difficult to adequately place able grafting material was an stitches without constricting the vessel. ever-present problem. (3) The graft did not stand up to pro- As experience with the treatment of trau- longed wear. matised major vessels developed, surgeons These defects, coupled with the discovery turned their attention to the use of similar that the fibro elastic tissue acted in a purely ';;;7',: •:;;,;', techniques in overcoming disease within the passive fashion, led to the investigation of arteries and attempts were made to deal artificial fibres to see whether a man-made with disease of the larger vessels including cloth could be used for arterial replacement. the aorta. Now any attempt at aortic re- placement demanded vessels of greater A vast amount of work with all manner diameter than was available from the veins of fibres has been done in this field and and attention naturally turned to the aortic even now no completely satisfactory arterial homograft, that is, a graft taken at autopsy substitute has been found. At the present from another individual of the same species. time, the most suitable materials are the Work in the experimental laboratory and in synthetic fibres of dacron and teflon knitted the clinical field soon showed that aortic or woven into tubes and used to replace replacement with homografted tissue was the diseased artery. Spaces between the readily accomplished and early results were fibres of these cloths enable granulation satisfactory. Methods were developed for tissue to grow in through the cloth and pro- obtaining the arteries in a sterile condition vide a lining to the lumen of the graft. They and for storing these vessels. It even be- also enable blood to escape from the tube in came possible to freeze-dry arteries and this a most dramatic fashion immediately flow enabled the storage of these vessels for pro- through the implant is instituted. Fortu- longed periods of time. Unfortunately, as nately this flow soon stops as the pores of time passed, it became apparent that the the vessel wall become occluded with blood replaced artery tended to develop the same clot but the surgeon using these artificial sort of disease processes as were initially prostheses must ensure that the patient is

SPECULUM 1961 PAGE TWENTY-SIX not exanguinated during the time that the Thus it can be seen that at present, the graft is becoming water-tight. Even today surgery of the major vessels is well estab- there is active discussion regarding the lished. In clinical practice it is possible to relative merits of these various types of anastomose vessels ranging in size from the arterial replacement and the general opinion aorta and pulmonary artery down to vessels is that arterial homografts, venous auto- of the brachial and popliteal size. Whilst grafts, and synthetic prostheses all have a in the experimental animal it is technically place in the management of vascular feasible to join vessels of smaller size than disease. the brachial, such procedures are rarely Paralleling the development in materials indicated in clinical practice where patho- used for arterial replacement, there have logical changes in the vessel wall make been developments in the techniques used satisfactory junction of such small vessels in inserting these various substances into impossible. Having considered the plumb- the body. The treatment of aneurysms of ing techniques available to the vascular sur- the major vessels is relatively standardised geon, let us now turn to a brief discussion and, in general, consists of excision of the on the types of disease with which he be- diseased vessel and replacement with an comes involved. arterial prosthesis. If, however, an attempt is made to remove a blocked vessel there are other factors which must be considered. DISEASE INVOLVING THE At first sight, simple excision and replace- LOWER LIMBS ment would seem the appropriate method of treatment. However, the occluded seg- One of the common areas to be involved ment is often of considerable length and by vascular disease is the lower limbs and when blockage occurs in a major vessel the in this area the effects produced by the occluded segment is by-passed by the en- reduction in blood supply vary with the site largement of collateral vessels. In an of the obstruction and the rate at which that operation designed to excise this segment, obstruction develops. In a vessel affected the collateral vessels are inevitably dam- by atheroma, the diameter of the vessel pro- aged and thus the blood supply to the distal gressively narrows and this reduces its tissues is still further reduced. Under these ability to transmit blood. This is essentially circumstances, should the implanted graft a gradual process, but, at, any stage during fail, the most disastrous results may follow: the evolution of the atheromatous plaque, the limb may die, making a major ampu- the blood flowing within the artery may clot tation inevitable. These problems have on the surface of the plaque and produce been overcome to a large extent by the use a sudden occlusion of the vessel. As the of the by-pass technique. In this technique, availability of blood for the tissues supplied the surgeon imitates nature and inserts a by the diseased artery diminishes the patient long, wide "collateral" vessel to bridge over may fmd that, whilst the blood flow is suf- the block in the host artery. The host ficient to meet the demands of the tissue at artery is exposed above the block, and the rest, it is insufficient to supply enough blood by-pass graft sewn in; the graft is inserted to the active muscles during exercise. Thus, blindly down beside the main vessel in such during exercise, metabolites accumulate a way that the collateral vessels are not within the active muscle and pain is pro- damagedk and is resewn to the host vessel duced. In the early phases this pain may °elow the graft. be produced only after prolonged activity, When dealing with blockages of the main but, if the disease progresses, pain occurs vessels such as the aorta and its major with less and less activity until ultimately branches it has been shown that excision of the patient is able to walk no more than a the media and diseased intima, together few yards. The muscles are not the only with the occluding thrombus, leaving just tissues to feel the effect of this reduction in the adventitia intact, results in a tube cap- blood supply; the skin becomes thin, the able of carrying blood. This operation, hairs fall out, the subcutaneous tissue known by the complicated name of Dis- atrophies, and the whole limb becomes cold Obliterative Endarterectomy, is suitable only —this symptom may be a major complaint for large arteries. on the part of the patient. Pain may

SPECULUM 1961 PAGE TWENTY-SEVEN point of may be saved or a man develop at rest in the blood-deprived tissues crippled by pain of intermittent claudication and this pain, which is felt mainly at night, may be restored to near normal activity. interferes with the patient's sleep. A limb in which the blood supply is grossly reduced is unable to withstand trauma or infection DISEASE OF THE RENAL ARTERY and either of these accidents is liable to result in the development of an ischaemic It has long been known that interference ulcer, a painful indolent lesion which re- with the blood supply to the kidneys in the fuses to heal. As the blood supply to the experimental animal may produce hyper- leg is reduced, tissues may die, followed by tension with all its attendant ill effects. the development of gangrene. Gangrene Recently it has been demonstrated that, in may be limited to the extremities of a toe man, atheromatous narrowing of one or or may involve a major part of the foot or both renal arteries may also be the cause of calf. When this occurs major severe hypertension. Recognition of cases is inevitable. in which stenosis of the renal artery is likely It is important to appreciate that arterial to be the cause of high blood pressure, and disease may involve any of the arteries in the demonstration of the site of the obstruc- the body, including the very important tion and the extent of the damage to the vessels supplying the heart, brain and kid- kidney is largely a matter for the physician ney, so the surgeon must make a careful and radiologist. In carefully selected cases, assessment of the state of these vital systems however, the arterial surgeon may, by over- before embarking on either the investigation coming the block in the renal artery, return or treatment of apparently localised vascular the blood pressure of the patient to normal. disease. If the patient is otherwise fit, and Recently a young married woman with one if the severity of the disability is such that child was found to have a blood pressure treatment is called for, surgery on the arter- of 240/120, as a result of which she had ial tree may be considered. Before any a very limited life expectancy. The severe decision can be made to operate on the hypertension did not respond to drugs and itz arterial tree the surgeon must have an X-ray investigation revealed that she had a picture of the diseased vessels. In order to marked narrowing of the right renal artery It seemed that this was an isolated arterial obtain this picture, a radio opaque dye is lesion. A teflon by-pass was inserted from injected into the aorta and its progress the lower end of her aorta to the right renal down the vessels of the limb is followed by artery beyond the block thus restoring nor- serial X-ray photography. This investiga- a tion, which is not without risk to the life mal blood flow to her kidney and, as and limb of the patient, calls for compli- result of this operation, her blood pressure cated X-ray apparatus and considerable has fallen to 120/80 and her medical out- look has dramatically improved. If a block skill on the part of the radiologist both in is detected on the left renal artery it may obtaining and interpreting the picture. be possible to sacrifice the spleen and sew Unfortunately, when these tests have the splenic artery into the side of the left been carried out not more than one in five renal artery beyond the block and thereby patients prove to have lesions suitable for restore to normal the diminished renal arterial re-construction, the main reason arterial blood flow. being the diffuse nature of the arterial disease. The surgeon can only produce DISEASE OF THE CAROTID worthwhile results if: ARTERY (1) The block is in a large vessel. (2) The block is localised, and A further fascinating development in this (3) The vessel below the block is in a field concerns the blood flow to the brain reasonably healthy condition. and the recognition that in many cases a is produced by a narrowing or occlu- When these requirements are fulfilled sion of the major vessels outside the skull arterial re-construction may result in the most dramatic improvement in the blood rather than by multiple changes within the supply to the ischaemic limb, a leg on the smaller intra-cranial vessels. This block $PEcutum 1961 PAGE TWENTY-EIGHT may occur anywhere from the origin of the for continuous supply of blood and that common carotid artery to the entrance of blood supply must be temporarily suspend- the internal carotid artery into the carotid ed during operations on the vessels. In canal and once again the surgeon may be some areas, such as in operations on the able to unblock or by-pass the occluded lower aorta, the tissues involved will toler- segment with marked improvement in the ate a total, or near total, cessation of the patient's cerebral function. Again the circulation during the time needed to carry recognition and selection of cases suitable out the operation. In other areas, such as for this vascular plumbing is largely the operations on the patent ductus arterio- concern of the neurologist and radiologist sis, it is possible to carry out the necessary and the vascular surgeon interested in such procedures without interrupting the blood problems must be prepared to co-operate flow through the main arterial channels. In with experts in a variety of disciplines. still other cases, such as operations on aortic coarctation, there has developed a collateral circulation adequate to supply INTRA THORACIC VESSELS blood to the tissues of the lower half of the body during the operative procedure. How- Amongst the earliest of vessels to receive ever, tissues such as the brain, spinal cord, the attention of surgeons have been the myocardium, and kidneys tolerate total major blood vessels within the chest. Occa- cessation of their blood flow or indeed any sionally the ductus arteriosis fails to close major reduction in the rate of flow badly, as it should, when respiration is established and when operations are carried out on the after birth, allowing blood to leak out of aorta or its major branches, which involve the high pressure aortic circulation into the reduction in the blood flow to these tissues, low pressure pulmonary circulation. This special steps must be taken to prevent lethal leak imposes a considerably increased bur- damage to these vital organs. den of work on the heart and patients possessed of such an abnormality often die In general, two techniques have been of cardiac failure in early adult life. It was evolved for dealing with this problem. One demonstrated that ligation of this vessel involves the controlled cooling of the body would not only close the aorto-pulmonary since it is known that, with a fall of body shunt, but also would restore the outlook temperature the time during which the of the patient to normal. Thus ligation of tissues will safely tolerate cessation of their the patent ductus arteriosis has become a blood flow is considerably increased. This routine operation in thoracic surgery. added safety margin may allow the surgeon to carry out the necessary manoeuvres. If, Another lesion which called for the early however, a greater time is required it is attention of the chest surgeon is coarctation necessary to perfuse the involved tissues of the aorta. In this condition the aorta with blood suitably oxygenated and pump- becomes markedly narrowed just below the ed into their vessels by mechanical means. Origin of the left subclavian artery and the Techniques such as this involve the use of a Obstruction produces a gross hypertension pump oxygenator and have enabled the sur- in the upper limbs whilst the lower limbs geon to extend his activities even into the are supplied by a series of dilated collateral interior of the chambers of the heart. vessels. Again the outlook of patients in- flicted with this condition is poor, but they It would be a mistake to suppose that all may be restored to normal health by resect- of the problems associated with vascular !nig the narrowed segment of the aorta and surgery had been worked out. The tech- Joining the divided ends together. niques involving the use of artificial means of oxygenating and perfusing the tissues with blood are complicated and involve PERSISTENT PROBLEMS careful team work which required much practise in the experimental animal labora- One of the major problems confronting tory. Moreover, there is no doubt that the the surgeon who wishes to interfere with most significant arterial lesion occurring to- the main blood vessels within the body is day is seen in the coronary arteries where that, in general, the tissues of the body call arterial occlusion produces cardiac failure SPECULUM 1961 PAGE TWENTY-NINE or sudden death, and as yet there are no adequate surgical techniques for dealing with this common lethal disease. The surgery of the major veins is still in its infancy and whilst direct suture of vein walls and diver- sion of venous blood by such procedures as anastomosis between the portal vein and inferior vena cava are well established, no satisfactory venous substitute has been de- veloped. Moreover, as our knowledge advances in the field of the interaction of host and graft- ed tissues, it may become possible to trans- plant organs from one individual to another, and here again the techniques and methods evoked by the vascular surgeon will be needed. Indeed, in this field the techniques are far in advance of the theoretical back- ground knowledge since the transfer of the heart from one animal to another has been frequently carried out in the laboratory. In man, organ transplant has only been pos- sible between identical twins, as in the case of one of a pair has had severe renal dam- age his partner has successfully donated a kidney to restore renal function in the diseased twin. 11_03 LEUKOPLAST

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SPECULUM 1961 PAGE THIRTY SOME MODERN BIOLOGICAL METHODS

Dr. S. Rose

The analysis of biological activityre- intermediate experimental levels between quires the study of biological organization. established techniques or which have com- Organization implies some sort of relation bined together a number of experimental between the components making up a com- levels so that the advantages of higher and plex entity. Ideally one should be able to lower experimental levels may be utilised. describe every relationship which exists between any one component and all others Intracellular Organization which make up the complex whole. The very nature of biological organization Cells are not simply bags of enzymes and forces us to use a more practical and sim- chemicals mixed in a homogeneous medium plified approach. Thus we study the imme- freely in solution and subject to classical diate and direct relationship between simple kinetics. Rather they are a complex hetero components as they exist to form small geneous system made up of subcellular complex units, and in the next step we study particles with a special architectural the relationship between complex units et arrangement. The past fifteen years have cetera. This stratifies biological methods seen tremendous advances in studying intra- into various levels of experimentation. A cellular organization which has shed light level of experimentation may be defined by on to such questions as (1) why are intra- the organizational complexity and number cellular structural units necessary at all, of units which are involved in the study. In and (2) what effect does structure have on these terms an in vitro system which only biochemical conditions and reactions in the involves a purified enzyme, inhibitors, acti- cell. Certain consistent generalities can be vators, substrates, et cetera, is at a lower observed, as a result of new data on intra- level of experimentation than a study of the cellular structures. Thus structure seems relationship between organs and tissues of to be involved in these situations where the the body. Lower levels of experimentation cell requires protection from disrupting are generally able to examine only simple agents which the cell must nonetheless phenomena. They do so with great pre- include as part of its overall organization. cision but often the data does not help to Enzymes, which if allowed loose in the cell understand how the cell functions. Higher would cause autolysis, can be included in levels of experimentation allow one to study this category. Structure also seems neces- a phenomena as it occurs in the whole sary in the general situation where synthesis organism, but the very complexity of the requiring sequental steps and an ordered system reduces the precision of the data and supply of energy is necessary. the certainty with which one can interpret the results. Stratification of biological In order to understand the role of intra- methods has caused a stratification of bio- cellular organization one must have clear logical investigators and an increasing gulf data of the biochemical and structural divides those who study the animal and its anatomy of the cellular organization. Tech- organs as a functional entity and those who niques to obtain this data have various e attempting to investigate the basic units limitations and possible artifacts. rr°111 which organs and animals are made. Disruption of cells or homogenization, This paper will describe especially those particularly in aqueous media like sucrose, techniques which have been designed as might yield misleading particles. After all

SP ECULUM 1961 PAGE THIRTY-ONE one should keep in mind that intracellular close to the object being exposed. Other injections of aqueous solutions are toxic, improvements have come through advances and during microsurgical transfer of nuclei in biochemistry which allow the selection of from one cell to another care must be taken precursors which label a limited number of to avoid the nucleus, coming into contact components of a cell and which allow for with the aqueous medium, otherwise it will differential enzymatic and non enzymatic not survive. These procedures are very extraction of specific components of the much more gentle than gross disruption of tissue. the entire cell in an aqueous medium. One of the most successful applications Surely under these experimental conditions of radioautography has been the use of the possibility exists that a chemical may tritiated thymidine as a specific precursor leave a particle and be found in the soluble of DNA. The resolution is sufficiently cell sap. Equally, it is possible that a accurate to show labelled and unlabelled chemical leaves one particulate component segments of single chromosomes. With and becomes attached to another. Despite this technique evidence has been obtained these obvious pitfalls a vast amount of bio- for a duplex type of template for DNA chemistry is devoted to the study of sub- synthesis. Cells or tissues are incubated in cellular particles obtained by homogeniza- the presence of tritiated thymidine for a tion and centrifugation. certain period and then the tritiated thymi- Organs or tissues from a multicellular dine is removed. All the chromosomes of organism are not made up of identical cells. a cell appear labelled at the first division Consequently homogenizing an organ means following removal of the labelled precursor. that you will be examining the subcellular However, these chromosomes reveal their components of a heterogeneous group of hybrid nature with regard to labelled and cells. This process, called somewhat face- unlabelled DNA, for when they duplicate tiously "Hamburger Biochemistry", imposes once more in a medium free of labelled another severe limitation on the methods of precursor, each regularly produces one studying subcellular organization. labelled and one unlabelled daughter chromosome. A radioautographic con- Other methods of studying subcellular firmation of Mendel's Theory! particles may also be criticised. The elec- tron microscope has become a powerful tool The site of synthesis of RNA and its in biology but our dependance on osmium movement in the cell has been studied by a fixation with the possibility of artifacts number of techniques. I want to briefly creates some doubt that too much meaning describe one particular set of studies be- can yet be attached to detailed appearance cause it combines radioautography and and precise measurements of membranes in . Acanthamoeba were cut with electron micrographs. Perhaps one of the a microneedle controlled by a micromanipu- most important contributions of the electron lator. Following the cutting procedure the microscope to biochemistry was the demon- nucleated and non-nucleated portions were stration that mitochondria of the cell sur- separated and incubated with labelled RNA vive homogenization and centrifugation precursors. Only the nucleated portions extremely well, and further, one can detect were able to synthesise RNA. Moreover, if if the mitochondrial prepartion is contami- a RNA labelled nucleus is transferred by nated by microsome fragments such as microsurgey to an unlabelled anucleate ribonucleoprotein granules or endoplasmic amoeba the label is transfered across the reticulum. nuclear membrane to the cytoplasm. These results support the notion that RNA is the One of the most direct approaches to in carrier of genetic information from the vivo biochemical events within subcellular nucleus to the cytoplasm. particulates is that of radioautography. The resolution of this method has increased con- I now wish to discuss a particular method siderably by the use of radiohydrogen of investigating intracellular organization (tritium) as a label because most of the beta because it demonstrates the value of an particles emitted by tritium are stopped by intermediate level of experimentation and a the first micron of a photographic emulsion combination of techniques. In an earlier and therefore the grains produced are very section I discussed the almost routine use of

SPECULUM 1961 PAGE THIRTY-TWO homogenization and centrifugation to obtain cellular organelles are exactly the same as and study the biochemical properties of found in the living cell. These examples various intracellular organelles. Despite all also demonstrate the value of a combina- precautions any such methods are extremely tion of techniques and an intermediate level brutal and one must doubt the identity and of experimentation namely in vivo centrifu- properties of the particles so obtained in gation. relation to how they may exist in their Before I leave the exciting area of intra- natural state. cellular organization I would like to men- In order to overcome these difficulties tion some of the micro-surgical and micro- and limitations techniques have been de- manipulative methods which can be used as veloped whereby cells are centrifuged, their tools in this field. With microsurgery one intracellular organelles and components are can remove the nucleus of a cell, one can stratified and can be studied by histo- replace a nucleus in an anucleate cell and chemical methods. The fungal hypa offer one can inject various portions of cytoplasm particular advantages for the study of from one cell to another. The Cartesian centrifuged cells. (a) Hyphae are 200 diver technique can measure the oxygen micron long tubular cells enclosed in a consumption of single cells. A torsion bal- resistant wall so that they can serve as ance has been devised which has a repro- ultramicrocentrifuge tubes. The cell dia- ducibility of 0.01 of a microgram. Using meter is about 10 microns and thus strati- interference microscopy the protein content fication in a long thin tube can be studied. of a single cell can be determined, and by (b) The main weakness of most cytochemi- X-ray absorption the density of cellular and cal reactions lies in their uncertain resolu- subcellular particles can be measured. An tion. However, since hyphae can be con- ingenious adaptation of chromatography has sidered long, thin ultra centrifuge tubes, been described which permits determination separation of the intracellular components of the total quantity of RNA from a single overcomes the difficulty of cytochemical cell. This RNA can be hydrolysed and the resolution. (c) The main advantage of nucleotite anaylsis of the RNA of a single using centrifuged cells in a study of cellular cell can be obtained by chromatography on structure lies in the fact that they remain a copper silk fibre. This method is one alive and therefore artifacts due to grinding, million times more sensitive than conven- absorption of chemicals on to a component tional methods. The above is by no means or loss of a chemical from a component, a complete list of all the microsurgical, does not occur. In summary, one is centri- micromanipulative and microanalytical fuging intracellular organelles in an intra- methods which are available. cellular millieu and with a force that does The question naturally arises as to why not destroy cell function even though it such sensitive methods are required. After temporarily and radically stratifies intra- all, we are often able to collect large cellular organelles. samples of biological material. The answer This paper will not analyse completely lies in the heterogenicity of biological the results obtained with centrifuged cells materials. The inside of a cell is not homo- but will simply describe two main differ- geneous and a tissue is not composed of a ences obtained with this technique as com- homogeneous collection of cells. In order pared to the more regular method of to study one portion of a cell, or in order to homogenization and centrifugation. In study one cell, micromethods must be used. homogenised preparations RNA (soluble) If we make estimations of the whole mass, and B galactosidase is found in the super- we are making estimations of mixed popu- natant. In the centrifuged hyphae RNA is lations of biological particles and averaging found in the nucleus, the microsomes and out the result. traces in the mitochondria, but none is found in the supernatant. Similarly, in Interorgan Relations centrifuged hyphae B galactosidase is found bound to mitochondria and not in the The functional activity of many biologi- supernatant. These examples show that cal systems is regulated by more than one biochemists should not assume with too mechanism. Some of these mechanisms are much assurance that their isolated intra- in the form of servo controlled systems and

SP ECULUM 1961 PAGE THIRTY-THREE others are specifically designed to alter the acting on one particular tissue to effect a activity level of the system. Each mechan- or duration. The usual methods are no ism is composed of a number of sequential longer applicable. If the acetylcholine is steps involving different anatomical and given intravenously it will not reach the functional units. These mechanisms are biological phenomena of slow development inter-related either at the final active tissue target site in sufficient concentration to be cell or at one of the intermediate steps of effective. If it is given intra-arterially as a the several mechanisms. single injection the (slow developing) bio- logical response will not occur. These diffi- The analysis of such controlled systems culties have been overcome by the use of a involves an anatomical and physiological continuous injector which can be buried mapping of the several steps of each mech- subcutaneously or attached to the animal. anism and the inter-relationship between them. Such studies are a pre-requisite to The injector can deliver drugs continu- the more detailed investigations of each step ously and constantly for many weeks to an in terms of biochemical mechanisms. unanaesthetised unrestrained animal. More- over, the drug is delivered directly to the The main difficulty in the design and site of interest by a fine polythene tube (50- interpretation of such experiments is de- 200 microm diameter) which is buried in termining the primary site of action of the animal. There are many obvious administered compounds. This difficulty advantages of this technique. Thus (a) for has been overcome when the compound acts compounds whose activity is quickly de- quickly and when operation, anaesthesia stroyed in vivo local infusion allows a and exposure of the area do not interfere physiological or pharmacological level to be with the experiment. Thus acetylcholine achieved at the site of interest. (b) The has been shown to be involved in the trans- local dose of drug is so arranged as to pro- mission of impulses at the neuro-muscular duce a significant concentration at that site junction. without an effective systemic concentration being reached. The local effects obtained But let us suppose that acetylcholine was may then be considered to be a direct effect on that tissue rather than a sequel to a change elsewhere in the animal. (c) The chemical structure of the drug at the extra- cellular fluid level of that tissue is known more precisely. (d) Many biological phe- nomena of slow development may be studied—thus the technique can be used to study the effect of prolonged altered chemical environment on the secretory function, metabolic activity, morphogenesis and growth of a variety of tissues. (e) Con- tinuous administration approaches more closely to normal physiological conditions when dealing with replacement type studies. To gain the above advantages workers have resorted to in vitro tissue culture tech- niques. This present approach has been envisaged as a bridge in the gap between in vitro tissue culture and whole animal studies so that certain disadvantages of both levels of experimentation can be avoided if necessary. A brief description of the technical aspects may be of interest. The motive power for the injector is the osmotic pres- Figure I. sure developed by a saturated solution of

SPECULUM 1961 PAGE THIRTY-FOUR congo-red. The injector has three compart- COLLINS STREET STORY ments. A water compartment is separated from the congo-red compartment by a cello- They told me I would never reach the top phane membrane. Water moving into the They assured me I was bound to be a flop congo-red compartment by osmosis com- My father said that gynae was obscenity presses a third compartment which ejects And couldn't I go up and read at Trinity the drug out of a coil reservoir. The drug a year's divinity. is then delivered to any organ by a fine To his dismay I simply answered Ha Ha Ha polythene tube. The entire arrangement is As a result of which I practise Ha Ha Ha shown in Fig. 1, the osmotic injector is sus- 0 my virility and their fragility pended by a thread, the drug reservoir coil Can cause my clientele to utter screams can be seen, and the tube entering the rat I'm blood and thunderful and simply won- through the tail is shown protected by glass. derful The rat is not stressed or restrained in any At applying all the contraceptive creams. way. The sign "Danger" on the rat con- It's sheer agility and their fertility tainer is a warning because in this particu- That's got me up to this position now lar instance a radioactive compound was It was a hard ascent up to this firmament being administered. But I'm a really famous obstetrician now. These are the methods being used by pre- My rivals said my treatment make them ill sent-day physiologlists and biochemists in That my sex appeal was absolutely nil the investigation of intercellular metabol- They said I'd never have sufficient learning, ism. I have tried to show that while in the To enable me to battle off the yearning and past the macro methods have held sway it is be discerning. now realised that micro methods must be But now I'm well accepted all through Col- devised. However, it is just as important lins Street now as before to recognize the limitations Because I've got a name for being discreet. of any one technique and to use many to So every Premiere you're sure to find me eventually reach the truth. there Discreetly advertising who I am I'm on the fashion page, my clothes are all the rage INTER-DENS Was there ever such a handsome looking man? • MEDICATED GUM MASSAGERS I've tied off hoards and hoards of umbilical In the drive against dental decay, the cords trend all over the world is towards And, oh hard it is with wear and tear interdental massage But it's the price you pay, when you can INTER-DENS surely say * Stimulate keratinization. * Assist the growth of epithelium after gingi- That it's worth a hundred guineas to be vectomy. there. * Help in the prevention and treatment of pyorrhoea So now I only pick the ones whose cure * Harden the gums, prevent decay, and promote is quick the complete health of the mouth. And must be rather slick, to miss the really sick So that I still may be the same old million- aire. RECOMMENDED BY LEADING Medical Medleys, 1960. DENTISTS EVERYWHERE * * Dr. McK.: "Suck sister!" (No response). Sold by "Suck! sister!" (still no response). "Sister! all Chemists Would you please use the suction appa- J. L. BROWN & CO., ratus!" 123 William Street, Melbourne 62 3027 Sister: "Oh, sorry, sir. I thought you were swearing."

SP ECULUM 1961 PAGE THIRTY-FIVE ff . . . power over the motion of the PP heart . . .

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SPECULUM 1961 PAGE THIRTY-SIX DESIGN, DUST and DISEASE

Wilfrid Brook

During their study of Physiology, on a still day, a light cloud of dust collects students become familiar by means of their above the ship. practical work with some of the principles and problems of experimental design under The dust, much of which is produced by laboratory conditions, where the aim is fre- attrition as tons of wheat enter the ship per quently to control as many variables as hour, consists of portions of husk and other possible, in order to "isolate" the factor parts of the grain, mould spores, pollen under study. However, the lessons learnt grains and other foreign material. It also in the laboratory may not apply in an ex- contains small amounts of free silica in the periment which, of necessity, must be form of opal which is deposited as such in carried out in a less manageable environ- parts of the wheat plant. Some interest ment. The purpose of this paper is to illus- attaches to possible pathogenicity of these trate some of the problems arising in an "phytoliths" in the lungs. investigation of this type. The study to be The investigation stemmed from the ob- described was designed to investigate the servation that some men developed marked effect of a short exposure to wheat dust on "asthma" on exposure to the dust, while a the ventilatory capacity of a group of men larger number complained of some difficulty exposed to high concentrations in the in breathing and/or of cough and sputum course of their work. No previous study persisting for 12 to 48 hours after exposure. of this question has been reported. In fact, about 15 per cent. of the work force available in the port were exempt from assignment to wheat ships. THE SITUATION

The subjects were waterside workers THE PROBLEMS loading wheat into a 10,000 ton cargo boat bound for Spain. The loading' procedure As it is not practical to study the whole is as follows: After fumigation in the silos population during exposure to wheat dust, or rail trucks, the wheat is conveyed to the a random selection of subjects is necessary ship by means of an overhead conveyor belt to ensure that the results are applicable to and then through a pipe to a trimming the group as a whole. Obviously, if the machine which ejects the wheat into the men undPr observation had been especially hold at considerable force in a stream about picked for the job because they were not 15 inches in diameter at the point of exit. affected by dust, then the results would not The direction of the stream is controlled indicate the reaction of the general working electrically, the men working in the hold population. This is a common problem in doing this being called "buttonmen". The occupational studies. process produces large quantities of dust in the confined space of the hold, so that visi- In addition, the studies of the men must bility may be reduced to a few feet. The be integrated with normal working routine, purpose of the trimming machines is to because of economic reasons, the experi- direct the stream of wheat so that the ship ment must cause minimum interference with remains on even keel, but trimming is only the loading of the wheat. required at certain critical phases of load- Furthermore, other variables apart from ing. However, even during the loading of wheat dust may influence the individual's "free" wheat moderate quantities of dust are response to exposure. These include the produced; some collects on the deck while, subject's past and present health, particu-

SPECULUM 1961 PAGE THIRTY-SEVEN larly as regards chest disease and his smok- tion which does not obtain in many dusty ing habits. In addition, exercise associated occupations, in which affected workers usu- with the performance of the job may of ally leave the industry altogether. The men, itself influence ventilatory capacity, usually both buttonmen and deckhands who did not producing an increase. Finally, there may work in the holds, were investigated during be a non-specific effect of any dust, not the routine of a normal day's loading. necessarily wheat, on ventilatory capacity; Normally the buttonmen wear a supplied air it is common experience that any dust is at mask looking rather like a spaceman's least uncomfortable if present in large helmet, but for the purpose of the investiga- amounts. tion these masks were not worn for the first spell below, thus deliberately exaggerating the working conditions of the men. If indi- EXPERIMENTAL DESIGN cated, a further trial could be done under normal working condtions to determine the (a) Population Studies. effectiveness of the masks. The experiment was conducted during Histories. the weekend of February 3rd to 5th on (b) waterside workers selected in the course of Clinical histories were taken from the the normal rostering system. This ensured men studied, using a questionaire based on random selection of the available personnel, one designed by the Medical Research but these are already selected in that those Council (United Kingdom) for studying most severely affected by dust are (pre- epidemiological aspects of chronic bron- sumably) among those members of the work chitis. These gave information not only on force specifically exempted from work on symptoms of exposure to wheat and other dusty cargoes. Hence the first problem, dusts, but also on personal history (past and that of random selection, has not been over- present) of symptoms with respect to smok- come. However, these exempt personnel ing, bronchitis, asthma or allergic manifes- are available for study separately, a situa- tations, and on the family history as regards chest disease. All these are possible factors in determining an individual's response to exposure to the dust, and any analysis of the results must take these into considera- Next time you strike that WEIGHT tion. CONTROL problem remember that (c) Tests used. Spirometry: The spirometer consists of a "BIO-MEAL" light metal bell inverted over water and connected to a pen writing on a drum re- is a safe, drug free, vitamin-dietary FOOD volving at a known speed. The subject is "BIO-MEAL" may be prescribed with asked to take the deepest possible breath confidence for patients with heart trouble, and exhale it into a flexible rubber tube leading to the bell. As the exhaled air blood pressure, ulcers, etc., with no ill moves the bell upwards the pen descends effects. and thus records a spirogram (Figure 1).

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SPECULUM 1961 PAGE THIRTY-EIGHT This type of instrument is used in third year meter. Some improvement may occur with Physiology experiments on respiration. practice but this "learning effect" was mini- mised by preliminary measurements on a From the shape of the spirogram, and day preceding the study, when this was the forced expiratory volume at one second possible. (that is, the volume of gas expired in the first second of the forced expiration), sub- (d) Performance of tests. jects may be classified into four groups: Spirometry and peak flow meter tests (i) Normal. were carried out in a cabin on the button- (ii) Obstructive type of ventilatory defect, men before they commenced their shifts in for example asthma. the holds, half an hour later, at the end of the shift, and at the end of the day. In (iii) Restrictive type of ventilatory defect, addition, three estimations of peak flow for example, loss of lung or chest were made in the hold during each shift. distensibility as in diffuse pulmonary The same tests were also carried out on the fibrosis or ankylosing spondylitis. five medical students who assisted with the (iv) Mixed obstructive and restrictive ven- experiment, and who made the observations tilatory defect. in the holds, thus giving a greater number Thus the spirometer not only enables a of results for statistical analysis. Also, the quantitative measurement of ventilatory medical students acted as controls in that capacity to be made, but also enables one the results of subjects not previously ex- to make a classification of defects. For posed to wheat dust could be compared present purposes the forced expiratory with the waterside workers who had pre- volume at one second was the index of viously been exposed. They also formed a ventilatory capacity chiefly studied. Be- control group in that they could perhaps cause of its bulk, the spirometer could not view the study more objectively. be taken into the hold to carry out measurements on the men while they were working. RESULTS Peak flow meter: The peak flow meter is There was a statistically significant fall in a portable instrument with a dial graduated ventilatory capacity, as judged by either in litres per minute. It is used in the same index, in the first half hour of exposure, and manner as the spirometer, and it measures this was greater by the end of the day. The the forced expiratory volume over a few fall, however, was small and, on the aver- milliseconds. The reading approximates to age, was insufficient to be evident to the the "peak" of expiratory flow, and is taken individual as respiratory embarrassment. directly from the dial. The advantage of Analysis of the results in terms of the this instrument was that it could be taken clinical histories is proceeding. into the holds, thus enabling measurements to be taken while the buttonmen were trim- ming. The disadvantage of the peak flow CRITICISM OF RESULTS meter was its variability from instrument to instrument (four meters were used in the ex- Comparison of the experimental design periment), but this was overcome by using with the problems encountered shows that the same instrument on the same men and there are still certain problems which were by appropriate calibration. However, error not overcome. The problem of random was introduced when the performance of the selection cannot entirely be overcome, and meters themselves was found to deteriorate thus we must regard the results as appro- on repeated heavy exposure to dust! A priate only to these men who are prepared possible source of error in both the spiro- to do this work. However, the other un- metric and peak flow measurements is the solved problems can be solved by future degree of co-operation on the subject's part. experiments. Thus the same type of ex- Poor co-operation is often easily detected periment will be carried out, with the same from inequalities of the spirographic curve, men if possible, loading a general non- which is normally smooth, but it is less dusty cargo (to see if ventilatory capacity readily observed in using the peak flow change is related to exercise or time of

SP ECULUM 1961 PAGE THIRTY-NINE day), and also loading (a) rock phosphate* culture for moulds and the preparation of and (b) sulphur cargoes (to see if ventila- extracts likely to contain any allergens. tory capacity change is due specifically to During the investigation quantitative evalu- wheat or is merely a non-specific effect of ation of the dust, by means of dust counts, any dust). was made and particle size estimated. Moulds have been grown from samples of the dust. EXPERIMENTAL CONCLUSION Moulds. The ventilatory capacity of a group of (a) men exposed to high concentrations of Some fungi may "infect" the bronchial wheat dust in the course of their work tree. This may be investigated by means of slightly decreases on exposure, but it has sputum cultures taken at the time of the not been proved if this decrease is due to experiment and repeated after a period away the wheat dust or some other factor. from the dust, and also by detection of anti- bodies and changes of antibody level after exposure. Limited studies along these lines POSSIBLE MECHANISM OF ACTION are being carried out. Assuming that the reduced ventilatory (b) Allergic reaction. capacity is due to wheat dust, then what is This may be investigated by the inhala- the mechanism? tion of extracts from the wheat dust with Investigation of the composition of the assessment of ventilatory capacity before dust may be carried out by microscopic ex- and after.* If positive results are obtained, amination of the dust, chemical analysis, then the extracts must be analysed to find

*Footnote.—Since this was written this in- *This has also been studied since this paper vestigation has been done and no fall in ventilatory capacity (on the average) was was written. Dramatic falls in ventilatory found. capacity occurred in several cases.

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SPECULUM 1961 PAGE FORTY the active constituents, for example, by SUMMARY using extracts prepared from individual moulds cultured from the dust, or by using This outline of the experimental design known pollen constituents. The simple for the study of the effect of an environ- screening method which was adopted dur- mental factor on an industrial population ing the experiment was to look for gives some idea of the practical difficulties eosinophils in nasal swabs and sputum in the investigation of problems of this type taken before and after exposure. These are and in the evaluation of the results. It two of the more obvious mechanisms. also indicates—and only part of the story has been told here—how a relatively simple observation and a relatively practical prob- PRACTICAL APPLICATIONS lem may open up wide fields of study, and with implications of wider significance than One partial solution to the problem of the particular problem at first suggests. dust is to use respirators with an external supply of air. These are worn only by the No matter what branch of medicine we buttonmen working below deck, but those ultimately practise, there will be opportuni- above deck suffer some exposure, and this ties for critical observation and research. may be repeated over many years. In We have no formal training in the medical general, dust should be prevented in indus- course on how to carry out a clinical ex- trial processes, or it should be controlled periment outside a laboratory, and so it has or removed at its source these measures are been valuable to gain some experience in not feasible in the present situation, and this field by assisting in the investigation one must fall back on personal protective described. measures. Acknowledgements: In the evaluation of possible long-term I would like to thank Dr. Bryan effects of repeated exposure to wheat dust Gandevia for supplying data so that this (the ultimate objective of the project), a report could be written. The other mem- knowledge of the effects of acute exposure bers of the team were Dr. Blair Ritchie, and, if possible, of the mechanism of any Miss Nancy Rogers, Tim Mathew, John such effects, is obviously helpful. Further- Frayne, Brian Cutter and Jim Long. more, a correlation of the clinical history, particularly of asthma, allergy and bron- The work is supported by a grant from chitis, with the observed changes of ventila- the Chamber of Manufacturers' Insurance tory capacity may indicate those most likely Co., and has the full co-operation of em- to be affected by dust, and might conceiv- ployer and employee organisations in the ably indicate a group who should not industry. undertake this work. Alternatively, as these simple tests of ventilatory capacity provide Reference: evidence of ventilatory difficulty on ex- Gandevia, B. (1960), "Tests of Ventila- posure, they afford objective support for tory Function." Royal Melbourne Hospital any claim for exemption from this work. Clinical Reports. 27 : 21.

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Brian Connor

What Makes a Champion Athlete? Do all good long distance athletes have low resting pulse rates? Fifty years ago the athlete did a minimal amount of training to avoid going stale and Athlete Event Pulse spent his time concentrating on style. Now our ideas are completely reversed. An H. Elliott World record holder, athlete is regarded as a complex highly de- 1 mile and 1500m. 46 veloped physiological machine. There is M. Lincoln One Mile Runner 45 daily strenuous training, diet planned for G. Watt Marathon Runner 34 every meal, regular pulse checks and even N. Freeman 20 Km. Walk 50 haemoglobin estimations to assess whether D. Keane Australian Walk or not an athlete is training too hard. It Record 52 is recognised that many factors contribute A. Hancock Australian Junior towards making a champion. Not only co- Walk Champion 48 ordination, reflexes and style, but heart size, J. Burke Victorian Junior pulse rate, respiratory capacity, and tem- Sprint Champion 65 perament are also important. Some of J. Hasker Victorian Hurdles these factors, naturally, are relatively more Champion 65 important for certain events, and it is in N. Regos Discus 67 long distance running and race walking C. Ridgway Olympic High Jump 65 especially that the physiology of the cardio- R. Filshie Australian Pole Vault respiratory system is vital in maintaining Record 75 oxygen supply and keeping the human P. Strange Discus 72 machine functioning under maximum con- Table No. 1 ditions of stress. In long distance events, e.g.-. three miles, less than a quarter of the energy From Table No. 1 it is seen that many supplied is by anaerobic mechan- long distance athletes do have low resting isms and thus the body relies heavily on an pulse rates, but this factor does not seem to adequate supply of oxygen to maintain the aerobic pathways and thus give first-grade be so important in other events, e.g., sprint, performance. hurdles, discus and high jump. To investigate this idea further, the rest- It was with these ideas in mind that I ing pulse rates of 12 competitors were taken decided to study the easiest physiological before a Victorian 3 mile walk champion- measurement in the human body—the ship. The time the athlete took to walk Pulse rate, its variations in athletics and the distance was graphed against the resting effect on performance. pulse.

SP ECULUM 1961 PAGE FORTY-THREE How soon does the pulse rate reach its

TIME IN MINS. maximum? 30 Fort 3 MILE RAGE To study this, I race-walked over increas- 19 ing distances at top speed and had my pulse taken at the start of each trial and at 28 the end. Recovery pulse rates were also taken until they returned to resting base level. 27 Pulse Pulse Distance Time Before After 26 100 metres 22.2 sec. 108 150 210 metres 50.2 sec 96 168 310 metres lm. 13.6sec. 102 174 lm. 39.0sec. 90 180 24 415 metres Recovery — Minutes 23 1 1 2 1 3 1 4 1 5 6 7

55 60 65 70 75 80 120 Put-SE BEFORE RACE 126 106 seats/m«. 138 120 108 102 150 123 114 — 114 108 96 Although a rigid correlation could not be It appears that pulse rate in a maximum seen, there was a definite tendency for those effort race rises to about 180 early in the athletes with lower resting pulse rates to race and that differences between distances have faster times. covered are reflected in the time taken for the pulse rate to return to normal. After What happens to the pulse rate during a longer distances the pulse rate takes longer race? to recover, as the body reserves are more depleted and it takes longer for the "oxygen The experiment mentioned in the preced- debt' to be repaid. The time for recovery ing paragraph also included the taking of of pulse rate has been found to be import- ;VI every athlete's pulse as he finished the race ant in tests done in Adelaide, in relation to and with two exceptions (one competitor training. The pulse should return to a was walking below top speed) they were all plateau recovery of 120 within two minutes 180. Pulse rates after sprint and middle of each training run. If it doesn't the distance running events similarly rise to 180 athlete is advised to discontinue that train- but after the field games the rise is only ing session. about 120-130. What changes occur as the pulse rate in- These findings are consistent with the fact that the normal heart must have a maxi- creases? mum pulse rate which cannot be exceeded so that time is allowed for diastolic filling Major biochemical changes occur with with each beat. (Respiratory rate seems to rise in level of blood lactate from 10-20mg. have an upper limit of about 60 after long per cent. to 100-200 mg. per cent. Mixed distance events.) The advantages of a low venous blood oxygen is reduced from 14 cc resting pulse rate now become obvious. per cent. to 3 cc per cent. and the oxygen The stroke volume increases with exercise consumption of muscles increased thirty- but if, for the sake of argument, we assume fold. The pulse rate increase is due to in- that it is constant, the resting pulse of 45 hibition of vagal tone, impulses from higher 1se to 180 with a subsequent four- centres, adrenaline secretion; excess CO2, can incre', deficiency in 02, and raised hydrogenion fold increase in cardiac output whereas the concentration in blood, and higher body resting pulse of 60 can only increase three temperature. The last four factors help times. SPECULUM 1961 PAGE FORTY-FOUR maintain the raised pulse rate during recov- The portly god strides in, the flock is silent, ery stage. Collapse of sound and laughter warm and young; How does an athlete develop a slow pulse The frowning glance, the snap of note-book rate? open, With pallid silence now the air is hung. Some athletes seem to have a naturally The heavy air stirs restlessly in wait, slow pulse rate but others can reduce it by Once more the glance 'neath temple cold training. The circulation, particularly that and round, of the muscles, becomes more efficient. The hem of cough, the indrawn breath of There may be increased vagal tone and par- self; tial heart block. The creatine and glucose Then mouths the oracle, while taut wrists reserve stores in the muscles increase and pound. the body becomes more accustomed to working under strain. Today he brings not bones nor plastic lung, For juvenile diversion, peg of sight However, many well-trained athletes On which to hang the wandering gaze, but cannot get their pulse rate below 50. Does words, this mean that they must train even harder Stale echoes of the text-book's musty rite. or that it is impossible, for example, be- cause of some genetic factor, to reduce their Some lads slump flaccid, others restive stir, pulse rates any further and that this fact Who know the ritual, sullen, pompous, flat: could stop them from becoming world Time-honoured travesty of ancient oath: record breakers? Students in trance upon the master's mat. A door cracks sharply, painted latchets Conclusion creak, The dreamer wakens in horrific dread, We know that many top sportsmen have The brow swells ruddy as a figure moves very low pulse rates and yet are not cham- And surging apex beat distils to lead. pion runners, but it seems that to be a long-distance champion a low resting pulse The sudden summons of Olympus' giant, rate is needed. This, however, is only one The query repartee then ruffled bane— of many other attributes including the right The click of empty steps fill corridor, psychological make-up which helps to break And stifled slumber grips the flock again. world records. Who dares to change one atom in that Here we see a very superficial aspect of shrine, medical research in sport. This is a com- A molecule of wit, a charge of doubt? paratively new field but a very important No, sluggish circulation pumps and breath one if we are to continue breaking records. With stagnant ventilation struggles out. The Russians are leading the field at the The monotone expires, the pencils slump, moment with research, nation-wide surveys The god strides out to morning scones and for likely future champions, and organized tea, medical examination and laboratory testing And mortals hum to life as puppets bidden of many top sportsmen. To coffee wend their way, drawn ennui. J.P. "Sport tests the functional reserves of the * * body in much the same way as disease. The main difference is that the stress of sport is "Stop." Intermittent and voluntary." (R. G. "I won't." "Well, at least I resisted." Bannister.) * * * Which do you prefer—wine or women? It depends on the vintage. * * * Girl in Skin Clinic with an itch between Hear about the woman who named her her toes. children Innocence, Accidence and Negli- Student: "Between which toes, dear?" gence. Girl: "Big ones."

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SPECULUM 1961 PAGE FORTY-SIX THE ALL OR NONE PHENOMENON

or THE THREE STIMULI

S. Ceber

Once upon a time there were three he kicked them, and if he kicked them stimuli. These three stimuli lived in a enough he could make Neddy shock, Kerry stimulator on a physiology prac. bench. contract and Gastroc to twitch slightly. So There was baby stimulus whose name was Papa and Mama Stimuli made another rule Subliminal, mama stimulus whose name was for Subliminal. "Until you grow up," they Threshold, and papa stimulus whose name said, "you must not kick anyone more than was Maximal. once, otherwise you could be breaking the Now outside the stimulator there was a All or None Law. If you do this and don't muscle called by the strange name of go to the chair then we will insulate you for Gastrocnemius von Toad. He was a very a week and you will just about die of bore- difficult character because he would not dom." twitch unless he was prodded. If Sublimi- Meanwhile, back at the pond there was nal gave him a kick he wouldn't twitch, if trouble. Big trouble. Jack the Ripper was Threshold gave him a kick he would give a at it again, slashing membranes left and little twitch, while if Papa Maximal gave right. Neddy the Nerve kept Jack at bay him the boot he would let go a mighty with a couple of well aimed action poten- twitch. tials. Kerry the Cardiac Kid started fibril- His friends, Neddy the Nerve and Kerry lating in fright and Jack couldn't get his the Cardiac Kid, were much easier to get scalpel to him—but he got Gastroc. Poor on with. Although Subliminal could get no Gastroc. Jack slashed his membrane from reaction when he booted him, mama could end to end, and in so doing wrecked his always get a shock from Neddy's head when sodium pump beyond repair. Jack left as she kicked his behind, and Kerry would quickly as he had come and left in his wake always contract for her. Even Papa could a badly frightened pair of tissues and Gas- not get a greater response from them. troc lying unconscious in the pond, drown- ing in excess sodium ions. One fine prac. class while the three friends were bathing in Ringer's pond an At this stage help in a diminutive form Inspector of Responses called at the Stimuli arrived. Subliminal, out for his daily walk, house. He said, "A new law has just been saw Gastroc drowning in the pool. So he issued by the Contraction Club in conjunc- dragged him out and tried to revive him by tion with the S.E.C. (Stimuli Electricity artificial stimulation. But alas, he had for- Commission), As from the beginning of gotten the All or None Law, and when at the International Contractile Year, minors last he got Gastroc to respond with a couple are not allowed to elicit responses from of weak twitches, he was a good candidate excitable tissues, which of course, include for the electrotonus chair Gastroc, how- your neighbors Neddy, Kerry and Gastroc. ever, did not revive completely and by the If Subliminal or any other minor is found time a new sodium pump arrived from spare guilty of this offence he will get the elec- parts he was completely depolarized. trotonus chair " Subliminal's trial took place under the Naturally, the Stimuli were worried, as in auspices of Judge Starling. Counsel for the the past Subliminal had been able to get defence was Perry Bowditch. Subliminal Neddy and Kerry and Gastro to turn red if was accused of eliciting a response from an

S PECULUM 1961 PAGE FORTY-SEVEN excitable tissue. In his defence Bowditch DOROTHY DICKS called as prime witness an eminent Pro- HUMAN INTEREST STORIES fessor of Law, Prof. R. D. Wright, who Dedicated to all those who are in love, said, "The All or None Law does not hold and all those who can remember it. in unphysiological conditions." Bowditch argued that Gastrocnemius von Toad was in * an unphysiological condition when Subli- "Worried"—I would report the suspected minial tried with the best of intent to revive lavatory seat to the State Health Depart- ment at once. him. * * * The twelve tissue jury retired to soak in Dear Miss Dicks, Ringers and consider the verdict. After A week ago I went to a smoko, where three hours they returned to the court. we enjoyed strip-poker. I was losing when "What is your verdict?" asked Judge Star- I passed out. Did I do wrong? ling. "Pam Pupertie". General De Gaullebladder, foretissue of Dear Pam Pupertie, Don't you remember? the jury, slowly rose to his feet, and the * * * court waited for his verdict with an air of ionic deficiency. "Not guilty," he said. "Lulu"—No, dear, you won't get the latest French stamps off them. The court adjourned with an uproar of * * * action potentials. Dear Miss Dicks, Several days later, back in the stimulator I am eligible for marriage and should like with Mama Threshold and Papa Maximal, your advice on how long girls should be Subliminal celebrated his twenty-first birth- courted. day. This made him a minor no longer. He "George". Vii ^i was promoted to Submaximal and he and Dear George, his family stimulated happily ever after. The same way as short girls. * * * Dear Miss Dicks, I am very keen on a boy of about 20 and

f*/ he likes me but has warned me that his morals are rather loose. What can I do? ANGUS & ROBERTSON 4, "Curious Queenie." 4, Dear Curious Queenie, LTD. /, /, That's up to you. /, * * 7 have a 4, 4, Dear Miss Dicks, 4 very large range of My mother says there are some things a 7 4 girl shouldn't do before twenty-one. MEDICAL AND DENTAL BOOKS "Young 'n' Sweet". 4, Dear Young 'n' Sweet, in their 4 Well, personally, I don't like a large audience either. 4, * * * 4, Medical Book Department /, 4, Dear Miss Dicks, on the First Floor 4, Why do I hate men? 4, 4, I hate men because they take me into at alleys, dance halls, taverns and bedrooms, 7 and they press me and feel me all over with 66-68 ELIZABETH STREET, /, their fingers. After they get me all hot, 4, 4, they hold me to their lips and drag the life MELBOURNE. 4, 4, out of me. They get what they want and 4 then they throw me aside and I'm only Phone: MF 6466 good for tramps. Why should they take 4, advantage of my white body? After all, I'm only a cigarette.

SPECULUM 1961 PAGE FORTY-EIGHT "QUO VADIMUS"

J. F. King

A true understanding of man can come ment. Man is not limited in this way. His only from placing him in perspective in the consciousness of his own history, his ability whole realm of life. The position he holds to inform succeeding generations, enable is brought sharply into focus by the concept each generation to modify its environment of natural evolution, which shows that the (within limits) in the light of experience. apparently designed nature and purpose of Man's environment, however, is now living organisms are not the product of world-wide and his dominance has now some personal purpose and intelligence, reached one stage where he is competing rather the outcome of a wholly material and with his fellow, within a closed arena of deterministic process. Homo sapiens was limited environment. It remains for scient- evolved and expanded to all corners of the ists not only to restrict possible directions earth dominating the environment in quite of development for man in this closed en- a unique fashion. He is the culmination of vironment, but to direct that development. evolution, as far as it has gone. When man disciplines himself to realise that Biological sciences which have investi- the fate of mankind rests on his shoulders, gated the past trends of development of he can direct the course of his own evolu- organisms and man, indicate that the physi- tion. If man fails to direct his destiny by cal evolutionary processes by which man use of his intellect, the law of the Jungle has evolved have now slowed down. This will prevail. leaves man with a dilemma. Is he to Can science provide a general philosophy accept the destiny to be handed out to him of life which will enable man to control his —degeneration—or can he maintain and environment by a set of standards? Per- develop his present status? haps it can. Science has already shown us Man has reached a unique and decisive where we stand, and has also pointed out stage in this complex evolutionary process, our cul-de-sac future if we do not avail our- for he is in a position to determine his fate. selves of our own capabilities. Science, Man, as distinct from other organisms, is unlike the "humanitarian" fields is detached conscious of his own history. Man's from political prejudice and national tradi- advantages have enabled him to exploit his tion. This enables the scientists to stand environment—this is his fundamental on common ground and provide oppor- supremacy, this enables him to control evo- tunity for co-operative effort in facing the lution. The course of animal evolution (as problems of mankind. How these problems distinct from human) is not directed by the are to be solved is for the present genera- organism itself but by the external environ- tion to decide.

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PAGE FIFTY SPECULUM 1961 MAMMON AND THE MUSE

Adam Fligelman

I feel it imperative to discuss here a most remember as getting ten for Maths. A at serious problem which faces most medical school, is infinitely better equipped for this students sooner or later in their arduous conquest. pursuit of what is euphemistically known as Let us consider your position objectively: their "social life". The story usually (a) You do not speak the lingo. (Why, begins in the caf., the Union Theatre, the you do not even know what "Transcend- Baillieu Library or on various lawns. You ance" and "Imminence" mean!) What will see her and you sum her up as "all right", you say when she gets around to the arche- which means desirable; you may be attract- typal forms in Blake (whatever they may ed by her eyes, hair, ankles or less readily be)? And believe me, this is a subject visible though clearly imagined assets. Of which you cannot avoid in the first half- course you want to know her (in the Bib- hour of her verbal gymnastics. lical sense) and once you make up your mind you will somehow wangle an intro- (b) Even if you knew these esoteric duction, for the predatory instinct of the words, you could apply them to very few medical student is of the strongest. things (frankly, talking about the trans- cendental flights of the blood urea in You will probably find the first date quite uraemia sounds somewhat ridiculous). Let's easy to arrange, for medical students are face it, the medical course just does not usually an unknown quantity and therefore equip one for this kind of intellectual inter- at a premium. course (whatever it may do for the other The great night finally arrives, you have varieties). When she mentions Frazer, she's sold your copy of Gray's, Ham and Have- talking about Boughs—not bones, and you lock Ellis, borrowed someone's dinner suit may very easily find yourself discussing the and duly taken her to dinner, followed by a significance of the mechanism of the suc- play or a ball. During supper trouble cession of the Kings in the Temple of starts: conversation turns on your respective Diana, or some such piffle unlikely to courses and to your horror you find she is appear in MB.BS finals. studying Philosophy III, Afganistan History Her conversation will include the pros and English III (Honours). At this stage and cons of the literary-allusion style so You can do one of three things: popular with T. S. Eliot, or else the modern trends in stream-of-consciousness-type lit- (1) Take her home, leave her there, erature excelled at by her friend B.A. (the forget her. one who got ten for Maths. A), the latest (2) Make a fool of yourself with same political developments in Afganistan, the result. points in which Shmoogelkopf diverges from the Classical philosophy of some ob- (3) Take my advice (vide infra). scure Greek (or was it an Afgan?), and the If you do (1) you will feel infinitely frus- mysticism of Tagore is added in for good trated, what's more, you will have wasted measure. It is quite pointless to try to des- Gray's, Ham and Havelock Ellis. That (2) cribe yesterday's P.M. to her or to go into will occur is unavoidable. The medical the natural harmony of the ossification of student is ill-equipped to woo and win this the sphenoid, or the course of the lesser modern version of the precieuse. Even the superficial petrosal nerve. Nothing will dullest Arts student (male), the chap you deter her. (However, if you casually roll

PAGE FIFTY-ONE SPECULUM 1961 "levator labii superioris alequi nasi" off because two days of stubble has a terribly your tongue, she may stop for a minute emetic effect on even the hardiest anti- thinking you are quoting Latin poetry to establishments. her—provide a suitable translation and do (c) Do not, repeat, do not bring her an not disillusion her). orchid, nor fig leaves which would make No matter how . desirable be her other your intentions too clear. Get an old attributes, it is the dubious attribute of her dilapidated copy of the collected works of tongue and "intellect" that are preventing Tolkien, preferably bound in sackcloth. your reaching first base and thence 'home". Make out that they are your most precious Example: possession and lend them to her. (If not Scene: Beach—lonely, dark, just right. Tolkien, then some other author into which Cast: He. any deep meaning could be read—Alice in She. Wonderland is most popular with Zen Bud- He (to the utmost of his poetic ability): dhists—and which is hard to get, for once The sea is quiet it looks green like the green you like a generally popular book you're of your eyes, which of course is caused by Out.) This will mark you as a Literary Giant and give scope to your discussion on deposition of melanin in the retina. Symbolism. She (unimpressed): "I remember, those are pearls that were his eyes. Look . . ." (d) Do not take her to a play or ball or "Phlebias the phonesian, a fortnight dead, anywhere else where people wear dinner Forgot the cry of gulls and the deep sea suits. Take her to an exhibition of Surreal- swell . . ." ist painting (about this you know as much as she does), a psychic seance in some (Here follows a long tirade in free verse, garret, Mick's roadside cafe . . . the possi- truly a tale "told by an idiot, signifying bilities are infinite. This makes you nothing", followed by half an hour of analy- definitely anti-establishment, and besides, is sis based on a critic chosen for his obscure inexpensive. language.) (e) Learn the following phrases by heart: He (at end of half hour): Yes, quite so. "The symbolic significance of any damn As you see, this will get you nowhere, thing (A.D.T.) is obscure." If she explains, except into some library reading Finnigans say that that was obvious and you were Wake (a dead loss). looking for a deeper meaning. Now, my friends, wipe your glasses, sit "A.D.T. can be transcendant or immi- up and take notice, for all, lock, stock and nent." barrel is about to be revealed to you. To "The Logoic elemental creative force of achieve your aim and fully gratify your any D.T." predatory instincts, you need not learn Finnigans Wake by heart, nor read all of "His intensity tends to become inconse- Wordsworth (whose collected works rival quential hysteria." the Encyclopaedia Britannica in volume, "The unfolding stages of human experi- weight and verbiage). ence are the eddies of life." (a) Do not sell Gray's, Ham and especi- "A.D.T. can have a natural, fecund dark ally not Havelock Ellis (you may need it). force." (b) Do not borrow a dinner suit (and especially not tails). To make any kind of "A.D.T. can have sterility of values." impression you must definitely intimate to To anything she says, you can reply any her that you, too, are "anti-establishment"; one or all of the above balderdash. This and this blessed state and dinner suits just will mark you as an intellectually superior do not go. In this matter you are some- person who, despite doing med., has time what at a disadvantage because profession- to absorb the "arts" (whatever they may be). ally beards, the badge and hallmark of anti- From then on, be you hunchbacked, establishmentship, are out. Wear old trous- physically repulsive, or possessing an I.Q. ers (the ones you clean the car in), desert of 25, it is she who will do the wooing. boots with pendulous soles (this is soulful (N.B.—Before next date, read Havelock and therefore endearing); shave, however, Ellis.)

PAGE FIFTY-TWO SPECULUM 1961 OBITUARY

PROFESSOR JOHN GERALD HAYDEN

It is with great sor- his few leisure hours; at the outbreak he was row that we record appointed O.C. Medical Division 2/7 Aus- the death of Professor tralian General Hospital and later became John Gerald Hayden, Commander of the Unit. He saw active on December 26th, service in both Egypt and New Guinea. For 1960. his services in the Middle East he was Professor Hayden created a Companion of the Most Excellent was born in Ballarat Order of the British Empire. Post War, he at the turn of the cen- continued his Army associations as con- tury, the eldest of six sultant physician to the Army and Repat- children. He was edu- riation Department. cated firstly at St. Students at St. Vincent's have benefited rick's College, Bal- greatly from his teaching over the past 30 larat of which he was years. Professor Hayden was one of the few dux, and later at men who had the vast and, what appeared Newman College, in to the undergraduate, inexhaustible know- the University of Mel- ledge, not only of his specialty but of bourne. medicine as a whole; and could expound so much of it, so clearly and authoritatively. His association with St. Vincent's Hos- His interest in the clinical school did not end pital began in 1921 when he entered the with his teaching rounds, but he continued clinical school as a student. After graduating to serve our interests as Sub-Dean and With honours he returned as a resident medi- Dean of the clinical school. cal officer and later as registrar, at the same time qualifying for the degree of M.D., with In 1942, when he was appointed Stewart obstetrics as his special subject. He then Lecturer in Medicine, in the University of continued his studies with Evarts Graham Melbourne, his impact was then felt by at St. Louis, and later in England where he students from all clinical schools. It was gained his M.R.C.P. diploma. noted with pleasure that his excellent teach- ing was just as effective in the lecture hall On returning to Australia, he entered as at the bedside. As time passed and the practice with Sir Hugh Devine and was ap- needs of the University changed, the Stew- pointed out-patient physician at his old hos- art Lecturers were replaced by Stewart Pro- pital. Six years later he was appointed in- fessors, and in 1956, Dr. Hayden was in- patient physician. In recognition of his vited to become the first Professor of Medi- brilliance he became a Fellow of the Royal cine at St. Vincent's Hospital. He still held College of Physicians and a Foundation that position at the time of his death, which Fellow of the Royal Australasian College of took place in his own department at St. Physicians, of which body he was later Vincent's. President. He is survived by his widow, a son and Prior to World War II he worked with daughter, and to them we extend our deep- the Australian Army Medical Corps during est sympathy.

PAGE FIFTY-THREE S PECULUM 1961 l Starving E • my kiddies of Vitamin Bl?"

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PAGE FIFTY-FOUR SPECULUM 1961 DIAGNOSTIC QUIZ

8. A surgeon operating for acute appen- SURGERY dicitis cannot find the appendix in R.I.F. Where is it? The position is constant. Mr. Douglas Donald 9. Mother brings her daughter of two years along because of a tumour behind the 1. A middle-aged man sprained his ankle severely three months ago. X-ray left knee. What is it? showed no bony damage. It responded 10. Two patients presented six months well to treatment, except for persistent apart with identical story. Males of fourth minor symptoms and swelling. Diagnosis? decade, in the previous twenty-four hours had consulted two doctors for pain near 2. A doctor's wife, well nourished, de- back passage. Both doctors had "re- scribed terrible pain across her epigastrium, assured them". Diagnosis? smiling through her tears. She had had a cholecystectomy eighteen months before. 11. Male, 18 years, had appendicec- Diagnosis? tomy eighteen months ago—since then vague symptoms till present attack same as 3. A gasfitter complained of loss of that before operation. Diagnosis? energy for a fortnight or so. He was pale, tired, listless and constipated. No history of significant sickness or injury except a 12. Man with splinter in sole of foot— stab wound with a chisel at work about a removed it with difficulty. Since then has month ago, but it healed readily. removed two more pieces but the tender- ness persists. 4. A man of forty with a discharge 13. A consultant at a country hospital from the penis. The prepuce could not be was presented with a patient in Sim's posi- retracted. What is the diagnosis till proved tion for sigmoidoscopy. He proceeded, to otherwise? be suddenly confronted with a cow feeding contentedly in a green field. How? 5. A young man, a few weeks after his knee was caught in a pack at football, noted a firm swelling on the outer aspect of the knee when the leg was straight. Only two conditions come readily to mind, what are they? 6. A girl of eighteen complains of a MEDICINE persistent pain in the wrist following a Dr. I. MacKenzie minor sprain twelve months before. X-ray N.A.D. No obvious physical anomaly. 1. A woman of 60 complains of con- What is the explanation? stant pain in the left leg for six months. She has impaired hearing, and on examination 7. A patient complains of under-arm body odour. It seems to have come on there is some enlargement and bowing of since he had a boil in the axilla several the left tibia, and it is appreciably warmer months ago. Aetiology? than the opposite limb. Diagnosis? PAGE FIFTY-FIVE SPECULUM 1961 2. A man of 40 complains of loss of also suffers from lassitude and headaches, libido and lethargy for three months. He and notices pruritus following bathing. He is pigmented, has loss of body hair, an en- has a high colour, prominent conjunctival larged firm liver, splenomegaly and testicu- vessels, and there is moderate splenic en- lar atrophy. Urine examination shows largement. No neurological deficit is found, glycosuria. Diagnosis? but peripheral pulses are absent in the right lower limb. Diagnosis? 3. A bachelor of 63 has a chronic duo- denal ulcer, which recently has caused con- 8. Uncommon, but important, and for siderable pain. He has treated himself with the astute observer. A girl of 18 is the sodium bicarbonate and a high milk in- daughter of a first cousin marriage. Two take, with relief of his ulcer pain, but has years previously she developed a progres- become lethargic, nauseated and anorexic, sive involuntary coarse tremor of her limbs, with some vomiting. There has been asso- followed by rigidity and intellectual deteri- ciated headache, pruritic and mental impair- oration. Examination reveals a fatuous ment, and no localising signs are found on looking girl, and confirms neurological examination of the central nervous system. state, with neither sensory loss nor pyra- Probable cause? midial tract signs. An enlarged, firm liver is palpable and glycosuria is present. What further clinical observation should be made 4. A man of 55 complains of three for confirmation of the diagnosis? months intermittent flushing of the face, becoming generalised. This symptom is often accompanied by borborygmi and diarrhoea. He also noticed occasional OBSTETRICS attacks of wheezing during this time. On ausculation he has a systolic murmur in the Dr. P. Glenning pulmonary area, and examination of the abdomen reveals a firm mass in the right 1. A grand multipara, Rh immunized iliac fossa, and an enlarged, irregular, hard was at 35 weeks gestation. Her pendulous liver. Diagnosis? abdomen made uterine size difficult to assess but there had been no apparent in- 5. A woman of 40 presents with a long crease in the uterine size for the past six history of intermittent haematuria and weeks. The patient still felt movements but occasional pain in the loins. Lately she has no foetal heart could be heard. She pre- p;'.r,,;1; ;.;;;•'; become lethargic, and has increasing thirst. sented with heavy haematuria of sudden On examination she looks unwell, pale, onset but was otherwise well. Give (a) with a dry furred tongue. B.P. 210/120 Differential diagnosis; (b) Treatment. and an irregular mass is palpable in each loin. Diagnosis? 2. A multigravida who had previously had a 4750 gm. baby vaginally came into 6. A woman of 22 has noticed that the labour at term and had an unstable lie. left pupil is larger than the right, but has Vaginal examination when the membranes no other complaints. The left pupil has a ruptured revealed a thick rim of cervix normal contour, but the reaction to light, through which there hung a pulsating loop both direct and consensual, is absent. The of cord. The vertex was felt high above reaction to accommodation is a slow con- the cord. No theatre was available for 45 traction, and on relaxation dilatation pro- minutes. Management, please. ceeds slowly. There were no other abnor- mal findings apart from absent ankle jerks. 3. A young Australian primigravida Diagnosis? had a persistent progressive anaemia during her visits to the ante natal clinic. She had 7. A man of 50 complains of inter- been taking iron tablets regularly and serum mittent claudication in the right leg of iron levels were normal. At 38 weeks her recent onset. Three months previously he Hb was 7.6 gm/100 cc. Differential diag- suffered a transient left hemiparesis. He nosis and management.

PAGE FIFTY-SIX SPECULUM 19 6 1 4. A young woman attending the ante natal clinic complained of increasing numb- ness over the median portion of her hand. Dr. P. Glenning Probable diagnosis and treatment, please. 1. A single woman aged 19 years pre- 5. A multigravida at term having had a sents with a history of sudden onset of normal ante natal course, had a heavy lower abdominal of two hours dura- "show" P.V. and was seen in the Labour tion, followed by right shoulder pains. Her Ward. No abnormality was detected and periods had been regular and there was a vaginal examination showed the cervix to be normal menstrual loss. On examination, partly taken up and the os 1 finger dilated. pale young woman, release tenderness and The vertex was presenting in the pelvic guarding over the lower abdomen with rig- brim. She spontaneously ruptured her idity, speculum examination — os closed membranes in the next few hours but had with small amount of blood from os, bi- not come into labour the next day. An manual examination—normal size uterus intramuscular med. stim. was given with no with a tender mass in the right fornix and effect. Following the final dose she had a tenderness on rocking the cervix. further small haemorrhage of 60-90 ml. and continued to lose mildly blood-stained liquor. The next day she still had not come 2. Married woman aged 45 years has a into labour. Management, please. history of increased period loss for 12 months with increasing lassitude and weak- ness for one month. On examination— 6. A young recently married woman general clinical examination normal except was being routinely examined at her first for pallor, bimanual examination revealed a attendance at the ante-natal clinic. On normal sized antiverted mobile uterus and speculum examination 2 small purple patch- the fornices were clear; speculum examina- es and another yellow patch were seen on tion, normal. Hb 7.2gms and a blood film the vaginal wall. Spot diagnosis. showed the presence of round and oval shaped macrocytes and poikilocytes. The reciculocyte count was raised.

3. Painful swelling of the left labium for four days in a women aged 24 years. On examination, large red fluctuant swelling of the left labium.

4. Married woman aged 49 years pre- sents with a history of increasing period loss for three years and intermenstrual bleeding for three months. On examination, uterus slightly enlarged, regular, antiverted and mobile; fornices clear. Vaginal examina- tion revealed no abnormality of the cervix nor vaginal epithelium.

5. Lower abdominal pain for two days with associated yellow vaginal discharge in a single woman aged 21 years. On examina- tion, febrile, tenderness in both iliac fossae with released tenderness and guarding, pro- fuse yellow discharge from a closed external os of the cervix and the uterus was of normal size. Tenderness was elicited in both fornices and on rocking the cervix.

PAGE FIFTY-SEVEN S PECULUM 1961 6. Single woman aged 20 years presents see you because mother says she is the with a history of primary amenorrhoea. Her otherwise normal. There was no history of general health had been excellent. Exami- trauma. Diagnosis? nation revealed that breast development was poor, axillary hair was absent and there 5. A girl aged 4 years is brought to see were a few pubic hairs only present. The you because of an offensive vaginal dis- hair lines were normal, the extremities short charge, present for the past three weeks. and plump and general stature small. The Diagnosis? patient's general appearance was that of a female. Examination under anaesthesia re- vealed the presence of a very small uterus 6. A baby boy aged three weeks has a but the ovaries were not felt. Vaginal two-day history of persistent vomiting. Re- cytology showed an atrophic smear and the moval of the napkin reveals the diagnosis. pattern was identical with a prepubical or post menopausal smear. Buccal smears in- 7. A boy aged seven years is brought dicated that only one X chromosome was to see you because of a two-year history of present. recurrent respiratory , and mother has noticed he is pale. Physical examina- 7. A young woman aged 18 years pre- tion reveals no abnormality. Diagnosis? sents in the early morning hours with a his- tory of sudden heavy vaginal bleeding of 8. A girl aged nine years is brought to recent onset. shortest girl in her class at school. Exami- nation reveals an intelligent, physically normal girl apart from her short stature. PAEDIATRICS Most likely diagnosis? 9. An apparently normal baby suddenly Dr. J. H. Coldbeck becomes cyanosed and dyspnoeic at the age of four hours. Examination reveals absent 1. A nervous girl of twelve years with breath sounds over the left chest and an a long history of asthma, presented with apparent dextrocardia. Diagnosis? another attack of asthma. She also com- plained of severe intermittent pain in the 10. A boy aged three years woke early left shoulder. She did not respond to ade- one night with a harsh cough and noisy quate doses of adrenalin and phenobarb. breathing. He was diagnosed as laryngo- She was admitted to hospital because she tracheo-bronchitis and placed in a steam had not shown her usual response to the tent and given antibiotics. There was no therapy. Diagnosis? response to therapy after 24 hours. Diag- nosis? 2. A baby delivered at 38 weeks by an emergency caesarian section because of 11. A baby aged five months had been severe vaginal bleeding from a placenta previously well until the past two days praevia, is reported to have passed a large when mother stated he had commenced melaena stool at the age 36 hours. Diagno- vomiting and was apparently anorexic. sis? What are the possibilities? 3. A baby aged 12 months is brought 12. A previously well baby aged three to the Doctor because of irritability for the weeks is noticed to be short of breath, par- past four days and a reluctance to move his ticularly when feeding. Examination re- right arm. Possible causes? veals a pulse rate of 160 per minute and the respiratory rate is 100 per minute. The 4. A girl aged 15 months is brought to liver edge was two fingers breadth and a see you because mother had noticed she murmur was heard at the apex. Diagnosis? appeared to be limping. She had started walking at the age of 12 months. Her mental and physical development was Answers on Page 89

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SP ECULUM 1961 PAGE FIFTY-NINE MEDICAL STUDENTS' SOCIETY

COMMITTEE MEMBERS, 1961-62

President: PROFESSOR V. L. COLLINS

Vice-Presidents: D. DE KRETSER

W. DARVALL

Secretary: D. CRANKSHAW

Treasurer: I. WOODWARD

Editors of Speculum: MISS E. J. SHAW

D. PHIDDIAN

Medical Medley's Producer: J. BEST

Sports Representative: P. NELSON

Pre-Clinical Women's Representative: MISS H. WANDSBOROUGH

Clinical Women's Representative: MISS KEAY FOSTER

Year Representatives:

First: B. RICHARDS

Second: J. O'SULLIVAN

Third: T. CHEATREL

Hospital Representatives:

R.M.H.:

A.H.: W. WHITE

St. V.'s H: W. MOONEY

P.H.H.: J. HART

S.R.C. Representative: MISS F. TRINKER

PAGE SIXTY SPECULUM 1961 M.S.S. CHRONICLE, 1961

SECRETARY'S REPORT These plans include lectures by eminent personnel, tours of Melbourne and its sur- 1960 was one of the most active and rounds, and numerous social events. Prosperous years for the Medical Students' In order to combat some of these ex- Society. The year saw the awakening of a penses and to reduce the cost of the con- true faculty spirit and once more the Medi- vention to interstate visitors, the committee cal Students' Society is a force to be reck- decided to donate £150 towards the costs oned with in the University. of the convention as it was felt that the The year was highlighted by several venture was worth the expense and also activities, beginning with the Miss Uni- your interest. versity contest, in which our candidate reached the final by raising £115, but Medical Medleys, "Whores de Combat", unfortunately did not triumph. However, was an outstanding success, and Mr. Bill the "Men in White Coats" seemed to domi- Blake is to be congratulated on a fine pro- nate the audience, and played a major part duction. It is estimated that the Society In re-establishing the Medical Students' made a financial profit of £50 on the ven- Society in the eyes of the University. ture. The Medical Dinner was held on Friday, Speculum 1960, although delayed, con- the 25th May, and was attended by 180 tinued in the same high vein, and Miss Jan students who enjoyed wining and dining in Peeler and Mr. Bill Crombie must be con- the University Buffet. The revelry was gratulated on a fine publication. lead by Dr. J. M. Sinclair, Psychologist at the Royal Melbourne Hospital, but was Another feature of the year was the alyb assisted by many of the diners. It is finalisation and production of a faculty tie unfortunate however, that the cost of the which will be on sale in the next few weeks Pinner will have to be lifted above the £1 for an approximate price of £1. Mr. John Irl future years, as the Society made a loss O'Sullivan is to be thanked for his handling of approximately £80 this year. of negotiations regarding the tie. During the May vacation about 30 Mel- An innovation in the Society was the oourrie students attended a convention of election of a Pre-Clinical sub-Committee, Australian Medical Students in Brisbane, which organised a series of lectures gener- and apart from enjoying the many social ally catering for the needs of the students in outings, drafted the constitution of the the Pre-Clinical years. This committee Australasian Medical Students' Association, played a major part in the organising of the of which this Society is now a member. Medical intervention in the Annual Marbles Match and helped to revive Faculty spirit. It was decided at this Convention to submit reports to the member Universities In conclusion, I should like to thank the on the following matters: rest of the committee for their help, and to (1) Student health schemes. particularly thank Associate Professor Gray (2) Commonwealth Scholarships. for his advice and help throughout the year. ,,,Melbourne is to be the host State for the David DeKretser, ' 96 1 convention, plans for which are now well advanced. Honorary Secretary.

SP ECULUM 1961 PAGE SIXTY-ONE TREASURER'S REPORT Speculum Perhaps the most striking thing in this Costs have continued to rise in printing year's balance sheet is the reduction in of Speculum; this year Speculum cost ap- Capital Assets during the period. This has proximately £40 more to publish than in been largely a result of quite deliberate 1960. In an effort to increase the income decisions regarding investment and dona- from advertisements the fee to advertisers tions. The cash at bank, however, remains was increased and an effort was made to quite high and should cover all normal attract new advertisers. fluctuations. In particular, the donation of Over 250 firms and Advert. Agencies £25 toward fares for last year's A.M.S.A. were contacted by post and of these about Conference in Brisbane and the donation of 40 replied, with 27 finally advertising in £140 toward this year's conference can be the magazine. This resulted in an income quoted as exemplifying the committee's from advertisements of £260: almost identi- opinion that the M.S.S. does not have the cal with that of the previous year. accumulation of money as its prime pur- Sales so far this year have yielded £170 pose. and with miscellaneous expenses the acount at the moment shows a net loss of £44. Medical Dinner However, sales to graduates have not yet been completed and, in the final analysis, Until the last few years the Med. Dinner this loss will be reduced: certainly to £20, has always been struggling for support. and we may well break even. Because of this the M.S.S. has always sub- sidised it. While there were 40-50 people It will require a lot of hard work on the attending this was not significant. In recent part of the incoming Treasurer if costs are years costs have risen steadily and as the to be covered and an even greater effort if ticket price has remained at £1 the subsidy any profit is to be made. per individual has slowly crept up. Although the results were disappointing The 1960 Med. Dinner was the most this year, perhaps the best hope lies in in- successful ever in terms of numbers with creasing the revenue from advertisements. over 170 people attending. However, each A more personal approach to business firms ticket sold meant an extra loss of approxi- and business personalities would undoubt- mately 15/- to the society so that as the edly result in an increase in the income ticket sales rose the Treasurer's morale fell. from this source. But I know from While the numbers attending should be re- personal experience that this is a frustrating peated the financial debacle should not. and time-consuming job.

Song Books and Badges Medleys When the retiring committee took over Despite the fact that it fell in the same office the society had no badges. This was week as one of the S.R.C. balls, Medleys rectified by the purchase of 600 badges and this year made a profit of £53. Much of there should now be enough song books and the credit for this should go to Keay Foster badges to last 3 to 4 years. It is obvious for her admirable management of the ticket chat a Balance Sheet that does not take sales. There is no reason why Medleys account of these assets does not give a should not continue to make a profit in the true indication of the Society's financial future. state. This could be corrected by stocktak- ing at the end of each year. If the incoming Note: Treasurer feels this is worth while I would be happy to prepare a statement of these As the A.M.S.A. Conference did not re - assets with him. This statement could be quire the £140 donation this remains with published in Speculum and would provide Melbourne M.S.S., thus significantly alter - a base-line for more adequate accounting in ing the Financial Report presented to the the future. Annual General Meeting.

SPECULUM 1961 PAGE SIXTY-TWO MEDICAL STUDENTS' SOCIETY Statement of Receipts and Payments for period April 4, 1960 to April 10, 1961

National Bank: Current Account

RECEIPTS PAYMENTS Balance B/F., 4/4/60: MEDICAL DINNER Cash at Bank Expenses Paid General A/c £256 19 6 Catering £220 15 0 Speculum A/c. 361 10 8 Liquor 39 0 3 Printing 10 10 0 £618 10 2 £270 5 3 MEDLEYS Receiptsneceipts Less Receipts Sale of Tickets 156 0 0 Sale of Tickets £1405 10 7 £114 5 3 Less Expenses Paid Tax £155 9 0 SPECULUM Catering 2 0 Expenses Paid 779 Printing £468 5 6 Hire Hall 91 15 9 13 10 0 Orchestra 95 10 0 Postage Sundries 3 0 0 ,,,Liquor 43 15 8 £484 15 6 tiOn'arium 10 10 0 Less Receipts Tickets and 0 Posters 10 17 6 Sales £173 10 Advts. 230 12 0 Programs 24 4 0 404 2 0 Costumes, £80 13 6 Make-up 17 0 0 Props 26 0 0 SONG BOOKS AND BADGES Lighting 18 0 0 Expenses Paid Sound 30 0 0 Badges £162 17 2 Balloons 35 0 0 Less Receipts Typing of Sale of Badges and Scripts 4 4 0 Song Books 70 2 2 Liquor £92 15 0 Licence 1 5 0 GENERAL EXPENSES Florist 6 12 0 Stationery Refund on and Print. £18 9 3 Ticket 2 15 0 Less £1351 19 11 S.R.C. Grant 1 19 3 £53 10 8 £16 10 0 Other Receipts Postage and Sundries 9 0 0 Interest— Affiln. Fee, A.M.S.A. 10 0 0 General A/c £24 11 11 Pre-Clinical Sub-Com. 6 13 0 .—Speculum A/c. 10 1 0 Bank Charge 1 6 Fixed'iced Deposit £42 4 6 transferred at DONATIONS AND GRANTS Maturity 189 0 0 Sub. Fares £223 12 11 to Q'land £32 17 6 Less S.R.C. Grant 7 17 6 £25 0 0 Donation W.U.S. 5 0 0 Donation AMSA Con. 140 0 0 £170 0 0 BALANCE C/F, 11/4/61 Cash in Bank and in hand, 11/4/61: General A/c. £104 17 4 Speculum A/c 290 18 2 £395 15 6

£895 13 9 £895 13 9

S P ECULUM 1961 PAGE SIXTY-THREE Statement of Income and Expenditure For period April 4, 1960 to April 10, 1961

EXPENDITURE INCOME MED. DINNER MEDLEYS Payments £270 5 3 Receipts £1405 10 7 Less Receipts 156 0 0 Less Payments 1351 19 11 Net Expense £114 5 3 Net Income . 53 10 8 SONG BOOKS AND BADGES INTEREST Payments £162 17 2 General A/c £24 11 11 Less Receipts 70 2 2 Speculum A/c 10 1 0 Net Expense 92 15 0 Net Income 34 12 11 SPECULUM Net Loss for Period C/F 205 6 0 Payments £484 15 6 Less Receipts £404 2 0 Less A/cs. for Adv. 36 8 8 440 10 8 Net Expense 44 4 10 GENERAL Net Expense 42 4 6 £293 9 7 £293 9 7 Net Loss for period B/D £205 6 0 Total Deficit for Period Donations and Grants 170 0 0 transferred to Accum. Funds 375 6 0 £375 6 0 £375 6 0 Statement of Assets and Liabilities — April 12, 1961 LIABILITIES ASSETS ACCUMULATED FUNDS CASH AT BANK Balance as at 4/4/60: Balance at 10/4/61: Gen. A/c. £256 19 6 General A/c. £104 17 4 Speculum 361 10 8 Speculum A/c. 290 18 2 Fixed Dep. 189 0 0 £807 10 2 £395 15 6 Less T1. Deficit Accounts for Advt. 36 8 8 for Period 375 6 0 £432 4 2 £432 4 2 £432 4 2

HOW TO TELL WHEN YOU ARE GOOD AND STINKO by Fizz-sick-an. (a) Under a table. The difference between a patient being (b) Atop the I.C.I. Building. "Stinko" and "Good and Stinko" is slightly (c) In Cuba. technical, but recognisable by sundry phen- without knowing how you got there. omena: 4. Awakening suddenly under a strange 1. Ridiculous sense of Excessive Athletic shower. Ability, such as leaping no hands over a There are several other methods: sofa, wrestling the hostess, five-minute falls, 5. Breathe on a piece of litmus paper• desire to indulge in non-scheduled boxing If it turns blue, you need dehydration. matches, etc. 6. Light match and hold to breath. 11 2. Inability to bunny-hug with hostess you ignite, yep, you are! without furniture intervening. 7. Drop around at the local cop shop and 3. Realisation that you are: take a written examination on the subject.

PAGE SIXTY-FOUR SPECULUM 1961 MEDICAL DINNER, 1961 SPORT One of the two social events of the medi- As usual, the med. faculty met with cal students' year took place in the Union mixed success in the sporting sphere. Pres- Buffet on the evening of the 12th July, in sure of studies no doubt deterred some of the year of our Lord 1961. Representa- our more noted sportsmen from participat- tives of both laity and hierarchy attended ing. Nevertheless we managed to field in goodly numbers and the early tone of the competent teams in football, tennis, table gathering was one of subdued gentility. To tennis, rifle shooting and hockey. begin, a little sherry was served as a con- Once again our football team provided cession to the more earthy elements. Its the highlights. Under the able leadership quantity and quality, however, were obvi- of "Gentleman Greg" we managed to gain ously designed to maintain a high level of two resounding victories. Of course our sobriety in keeping with the solemn nature best and fairest award of 1961 had to be of the event. All went well through the awarded to Treth, whose outstanding work soup, and the business of the evening was in the packs and around the goal turned begun when Mr. De Kretser, a well-known the tide against Arts. His splendid co- lay preacher, proposed the toast to the operation with full forward Jack Kennedy Queen. Since Her Majesty could not be delighted our supporters, "W.J." and the present, for geographical reasons, no reply ever vociferous "Harold." was forthcoming. Mr. Crankshaw then Frank Incani, "Tank" Metherall, Sam honoured our spiritual leaders by proposing Campbell and Geff Baker capably repres- a toast to the Staff. ented Div. 1. Incidentally it was most pleasing to see the way in which "Joe" It was at this point that the propriety of Cravana was able to tear himself away from the gathering was first assailed when the Nummo's to play one hectic quarter against high priest of Physiology, in his reply for Arts. the Staff, made some remarks which could only be described as humourous. The vul- Tennis gar crowd even encouraged this unfortunate trend by laughing uproariously. The dis- The men's tennis team, comprising W. A. order was immediately augmented by Dr. Le P. Darvall (captain), Arnold Jager, Vic Gershon, obviously acting under orders Teasdale and John Moore capably defended from his leader, who in proposing the toast the title which they won last year. to the students, continued to make jokes. Mr. John Woodward, apparently infected Results: Med. d. Engineering. by the general spirit of levity, did nothing Med. d. Law. to restore order when he replied on behalf of the students. Hockey All hopes of a quiet, educational and im- The med. faculty team led by Ian Cun- proving evening faded when Dr. Counsel, ningham has performed feats unknown as the guest representative of the Ophthalmo- we go to press. Those requiring more in- logical Religion, launched into a witty dis- formation had better see Ian Cunningham!! course on his travels through the U.S.S.R. Peter Nelson, as a guest of the Atheistic Communist Sports Rep. regime. His speech was loudly applauded * showing the dreadful deterioration that had occurred. Finally, the evening concluded A certain woman was taking her tem- with highly coloured jokes and even songs. perature P.V. and misplaced the thermo- In despair (perhaps because the sacrificial meter. Due to the worry she called in the Wine was exhausted) Mr. De Kretser declar- practitioner who searched the bed clothes, ed the dinner ended at 10 p.m. and gradu- toilet, etc., to no avail; in desperation ally the Buff was cleared, leaving only ordered an X-ray. The report came back. _Memories of sinful pleasure to haunt it. "The X-ray is satisfactory. The ther- There seems little hope that Med. students mometer is in the bladder, but I am sorry I can be converted to sober ascetics just yet. can't read the mercury level."

SP ECULUM 1961 PAGE SIXTY-FIVE PAGE SIXTY-SIX SPECULUM 1961 MEDICAL MEDLEYS, 1960 And Lance can never ask a girl to be his cutie On December 10th last, St. Kilda Town Although his female friends can be thought Hall reverberated to the noise of 1100 to accrue. medical students and their friends, whiling away the last night of the Academic year. 0, K. P. Russell, your embonpoint astound From the freshest pre-meder to the hardy us finals, everyone voted it a great success. Your portly state, your balding pate is The thanks of all go to Bill Blake for start- worshipped here ing the night in such a happy vein. Who will And Jackie Leggie in lectures very oft con- ever forget little Geof and his big red spot founds us or Grandad Mark? We are sure that Don's Although he makes good hearing with a pot scroll did much to enlighten the "friends" of beer. section of the guests, let's hope with no ill effects. Dennis Farrington's music kept the Chorus few who could still dance going till the early hours when those who were still capable 0, Doctor Tange your name in French continued their revelries at other more hos- sounds just like monkey pitable places. Comparison's embarrassin' you may be sure Just to refresh your memory here are And Mr. Elford's forced to be a general some of the lyrics which sent you rolling flunkey into those open arms next to you. To retire him or to fire him is the cure. Opening Song So now it's time for bells to chime the first They say Med. Medleys can't be done with- hot number out it's being blue Of Med. Medleys for the year we've just We leave it up to you, to judge if this is been through true But as it may, we first must say a word Our show tonight will seem alright most humble If when we're at the end To the few men that we can't get on with- Our subtleties the pure don't comprehend. out. For all us Med.'s this last year's been a Festive Occasion very good one For with much beer and hearty cheer we've Child: had our fill These may be months in which both fear A repulsive child with a large balloon. and anguish keep us I've hung the balloons up in the hall, Within the books, and with looks that now I've hung paper chains upon the wall, us chill. I've hung up my stocking in the Nursery, I've hung a little star upon the Christmas Chorus Tree, I've hung up some sprigs of bright red Although the Profs. we now and then may holly, disagree with I've hung some mistletoe to make it jolly, Treth, Sid and Lance as well as Pans we're I've hung up all the festive things, mad about Did I enjoy it? For if its knowledge pure and simple that Rather. we're seeking But best of all I've just hung father. Then they're the men we simply cannot do without. * * 0, Pansy Wright, we cry, we're dazzled by Dr. B.: "Should I?" your beauty What can I do? Although in books we've read of looks like How can I do it? yours it's true. Did I do it YES."

PAGE SIXTY-SEVEN SP ECULUM 1961 Do Rah Mee You will have to learn a dignified manner, Oblivious to the patient's screams and If you really want to be a sister howls, And to take up nursing as your lot, But the most important thing for any sister, You are not allowed to do Is to polish up a sister's vowels. What your mother wants you to Come now, dear. But be prone to share your charms in every cot. Closing Song Here's a hint I always give prospective They're Whores de Combat, that's what they sisters, are, It's a maxim that, if followed, never fails. They can pick at a glance what to romp at If a sister wants a doctor But you find out if they're caught they're Then the way to make him talk to her distraught Is to polish up a sister's vowels. And they'll fight and they'll scratch like a Tomcat. Ah, Oh, Ooh, I can't hear you at all, We know what's coming, Ah, Oh, Ooh, You are right on the ball, And if what they're at Ah, Oh, Ooh, You're playing a nurse's part. And if we meet them this evening Come on now. We'll just have a drink and a chat For they're Whores de Combat. Ah, Oh, Ooh, Keep it clear as a bell, Ah, Oh, Ooh, Good, you're doing it well, Ah, Oh, Ooh, You're warbling a sister's Chorus tale. Goodbye, There'll be jolly pitsy-patsying with the stu- It's time we sought some gin and lime dents, So that we may be to a large degree of With residential doctors nightly prowls, frustration free But the most important thing for any sister And so we go to indulge our vices low Is to polish up a sister's vowels. Although we know if you drink neat gin it Let's do it. it will lead to sin With a little drink and time to think Ah, Oh, Ooh, Do it right from the heart, We shall make our points and show them Ah, Oh, Ooh, Pretty good for a start, that love is a must Ah, Oh, Ooh, You're playing a nurse's part. And if they agree with all our pleas to come If you really want to be a sister, back to our joints Some decency and virtue you must show, You won't see our heels for the dust When at dawn with loving care you sponge We'll do or die you'll know the reason why a patient bare When told of the Bold Mad Students' stand You must forget the brute of half an hour for the rights of man. ago. As I said, the chief attraction of a sister We've finished jokin' Is a murmur with an overlying thrill, But what care we So the moment you get near her, We hope from your sleep you've been To listen, touch or feel her, woken. She may respond by giving out a trill. We've tried our best all night to be right Now the final farewells must be spoken. Ah, Oh, Ooh, Come, let there be no doubt, We'll now start drinking, that's what we'll Ah, Oh, Ooh, You must try out and out, do Ah, Oh, Ooh, You're playing a nurse's And in some far distant corner part. With a drink and a girl that's true Let's do it again, now! We'll start the night anew. Ah, Oh, Ooh, Keep it charming and light, Ah, Oh, Ooh, Good, that's perfectly right, Ah, Oh, Ooh, You're playing a nurse's She was only a lawyer's daughter, but she part. sure gave me a case.

PAGE SIXTY-EIGHT SPECULUM 1961 1714echcal Amociation MEDICAL HISTORY A prize of £10 will be offered for the best essay by a Medical Student on a Medico-Historical subject

ENTRIES TO BE SENT TO:- M. L. VERSO Hon. Secretary, Medico-Historical Branch BY 1st MARCH, 1962

SEE US FOR YOUR DISSECTING SETS STETHOSCOPES DIAGNOSTIC SETS AND ALL OTHER MEDICAL OR SURGICAL REQUIREMENTS INDIVIDUAL ATTENTION JOHN H. AUSTEN PTY. LTD. 222 VICTORIA PARADE, EAST MELBOURNE 41 4718 (Just a few doors past the Eye andEar)

PAGE SIXTY-NINE SP ECULUM 1961 PAGE SEVENTY SPECULUM 1961 A.M.S.A. CONFERENCE

the A.M.S.A. was very active. Soon after REPORT—OFFICIAL the Brisbane Convention, a statement was Report of the Second Annual Convention released to the Press throughout Australia, of the Australasian Medical Students' Asso- pertaining to the Association's policy with ciation, held in the University of Melbourne regard to the limitation of numbers at under the patronage of the British Medical Australian Medical Schools. While anxious Association of Victoria. that more University Medical Schools be established, so that those who want to take The Australasian Medical Students' a Medical course and who have a reason- Association—A Brief Historical Outline able chance of passing, may do so, never- theless, the Association firmly supports the The formation of the A.M.S.A. fulfilled principle of limitation of numbers within a need that had been considered by many each School. of the Medical Students' Societies of Aus- tralia to be an urgent one. Although Then at the beginning of July, 1960, the attempts had been made in the past by Executive Secretariat was handed over to both Sydney and Melbourne to form a the Melbourne Medical Students' Society National Association, it was not until 1960 and Mr. Bernard Carroll, Mr. John Mc- that the University of Queensland Medical Encroe and Mr. John Woodward, all fourth Society, with the support of the other year students, took office as President, medical schools, took the initiative, and Honorary Secretary and Honorary Treas- held what was to be the First Annual Con- urer. They obtained reports on the opera- yention of the A.M.S.A. in Brisbane, dur- tion of the Commonwealth Scholarships ing the May vacation, 1960. The Medical Scheme in each University, and critically Students' Societies of Queensland, Sydney, reviewed the Scheme as it served medical Melbourne, Adelaide and Perth were the students. A similar survey of Student foundation members of the Association, Health Services within Australian Universi- and Mr. David Scott, a fourth year student ties was also undertaken. from the University of Queensland, was At the National student political level, elected its first President. the Association is one of the affiliated The aims of the Association, set out in Faculty Bureaux of the National Union of its Constitution, are: to serve and represent Australian University Students, and has the medical students of Australasia and to received considerable assistance, financial Promote co-operation and understanding and otherwise, from N.U.A.U.S. Inter- among them; to encourage the interchange nationally, negotiations with the Inter- of ideas in all fields of Medical Education national Federation of Medical Students' and Practice and to uphold the ideals of Associations have resulted in affiliation University Medical Teaching; to facilitate with I.F.M.S.A., and Australia will be, most co--operation between the medical student appropriately, the centre for the South-East and the medical profession and where Asian countries. necessary to co-operate and affiliate with Negotiations with Otago University in other bodies having similar aims. New Zealand are expected to result in their During the first year of its existence, affiliation with the A.M.S.A. in the near despite some inevitable "teething troubles", future.

PAGE SEVENTY-ONE SP ECULUM 1961 The Melbourne Convention, 1961 An extensive social programme occupied most evenings, and included a cocktail During the May vacation, the Second party, dance, picnic in the Dandenongs, and Annual Convention of the Association was a river trip and barbecue. A Formal Dinner held in the University of Melbourne. Over was held at the University, Mr. Newman- three hundred students from every Austra- Morris and Dr. Sinclair were among the lian Medical School, including those of official guests. Monash University and the University of The guest speaker, Mr. Douglas Donald, New South Wales, attended. from Prince Henry's Hospital, combined the In a brief ceremony on the first day, the necessary entertainment with more serious Lord Mayor of Melbourne, Cr. Bernard reflections on the problems he considered Evans, welcomed the interstate visitors and likely to face the medical profession in the officially opened the Convention. Mr. near future. Geoffrey Newman-Morris, the President of During the week the students visited the Victorian branch of the B.M.A., Patron many hospitals and institutions in Mel- of the Convention, then wished the Asso- bourne, including the four teaching hospi- ciation success for the future, and Professor tals, Royal Park and Kew Receiving L. J. Ray, Professor of Anatomy, promised Houses, the Commonwealth Serum Labora- the co-operation and assistance of the tories, the Walter and Eliza Hall Faculty to the A.M.S.A. Institute and the National Gallery. Com- Throughout the week, a number of lec- plementary tickets for a League football tures was held. Topics were chosen which match were also issued to interstate visitors. would be of interest to the student at all The Convention concluded with the levels of training, and which are not empha- Annual General and Council Meetings at sized in the normal academic curricula. The which the University of New South Wales lectures given were as follows: Medical Society and the Monash University Medical Undergraduates' Fraternity were Mr. J. Legge: "The Biochemical Origins of formally welcomed to membership of the Life". Association, bringing the number of mem- Dr. Alex Sinclair: "Psychiatric Problems of bers to seven. Projected plans for the com- Medical Students". ing year include: efforts to stimulate inter- Mr. George Stirling: "Experimental Surg- est in extra-curicular activities among ery". medical students, and to include non-medi- Prof. K. F. Russell: "The Edinburgh Mur- cal subjects in the early years of medical ders". courses; establishment of a scheme whereby Dr. W. L. Carrington: "Marriage Counsel- medical students can obtain a trade reduc- ling in General Practice". tion on books and instruments: liason with Prof. G. S. Christie: Hydatid Disease". the Medical Education Sub-Committee of Sir J. C. Eccles: "What is Man". the Australian Universities Commission; Sir F. M. Burnet: "Auto-immune Disease". and the publication of a regular A.M.S.A. Dr. A. Sinclair Symposium— Newsletter. Dr. M. Blackwood j- "Sex and Above all, the Association is anxious to Dr. I. Martin Intersex" develop in a similar fashion as its British counterpart, the British Medical Students' As well as the lecture programme, special Association, who have supplied us with delegates from each University held a Pro- much information and advice, particularly gressive Seminar on Medical Education, in their reports on Medical Education. And and as a result of their discussion, the now, encouraged by the success of the Con- A.M.S.A. has established a standing com- vention, and on the advice and support of mittee on Medical Education. This will Mr. Newman-Morris, Dr. Sinclair and Mr. provide a proper service both to the medical Donald, the A.M.S.A. will seek to affiliate profession as a whole, and to medical teach- with the Australian Medical Association. ing staff, in the presentation of under- graduate thought and opinion on Medical John McEncroe, Education. Hon. Sec. A.M.S.A.,

PAGE SEVENTY-TWO SPECULUM 1961 REPORT—UNOFFICIAL Who stole the gong in Brisbane, and who ruined all our souls? Tune: Macnamara's Band It was our charming visitors, not mention- ing any names, We came to Melbourne in the fall of the Just wait till we get over there, we'll do the year of '61, bloody same. We've happy memories of it all, we had a lot of fun, Tho' Vondy and Co. left early, and went The hostesses in the Kew Town Hall, they to see the Snowy, all had lateral holes, The rest of us stayed on in town and had The coiffes prevented all the boys from a drink with Chloe. reaching their low goals. We had a look for South Wark but couldn't find a drop, Hooray for Moriarty's and for Jimmie So back we went to Chloe, and found we Watson too, couldn't stop. We wish that Mary Patterson had been The social organizer was Mr. Jaguar around to woo. George, he The dinner in the Union Buff, it was a jolly Took us up to Hawthorn where we had our show, own orgy. Until the jokes which Hazel told, they The jazz band played a merry tune, and we reached an all time low. all drank lots of beer, We all went down to wine and dine at For we feared the cops might lock us up Molina's down the road, without Madeira dear. Where Fuzz's pea in the butter dish was The lectures came from eminent men in not quite a la mode. the school of Anatomy, The waiter expected a great big tip, but got The scarlet waistcoat on one of them sug- such a surprise gested things to be. When Timothy offered a shiny zac, he We finished with a barbecue, we sailed far couldn't believe his eyes. up the creek, Who pinched them blooming pistols, who And the girls all hid their faces while the Pinched them sugar bowls, boys got out to leak.

MEDICAL STUDENTS —AS OTHERS SEE US! To preach idleness to the medical student Mrs. Raddle: "Do you suppose that I'm would be taking coals to Cardiff or peni- a-going day after day to let a fellar occupy cillin to St. Mary's. my lodgings as never thinks of paying his — Sir Heneage Ogilvie, K.B.E., F.R.C.S., rent, nor even the very money laid out M.D. for the fresh butter and lump of sugar Medical students are the best bartenders, that's bought for his breakfast, and the polite, hardworking, quick witted and with milk that's took in at the street door? Do a sense of humour. you suppose a hard-working and industrious — Bernard Miles. woman has nothing else to do but to work Samson Wright was quoted as having herself to death after a parcel of lazy, idle whimsically described the ideal medical fellows that are always smoking and drink- Student as "tall, handsome, of great personal ing, and lounging, when they ought to be integrity, beautifully mannered, cultured, glad to turn their hands to anything that highly intelligent, a tireless worker, original, would help 'em to pay their bills?" good with his hands, skilful in exposition, — Charles Dickens. a good mixer, athletic, devoting his spare time to extramural activities, with a good Mr. Pickwick: "They are fine fellows— family background," and so on and so very fine fellows—with judgments matured forth—a dazzling Olympian but certainly by observation and reflection; and tastes not to be found amongst men. refined by reading and study." — W. M. Arnott. — Charles Dickens.

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PAGE SEVENTY-FOUR SPECULUM 1961 YEAR NOTES

FIRST YEAR of good; all his experiments are working. That's not all, he has magical powers; he The Saints Came Marching In . . . . only has to pick up a rubber ball, immerse This year began with most of us wonder- it in air, throw it at the wall, and it shatters. ing how we managed to be here, and after But as the year's end approaches, we It first few lectures, wishing we weren't. begin to wonder who will be in next year's tt was as though we were scapegoats upon notes. With our fingers crossed, a little Which the lecturers could unleash their work, and a lot of luck most of us will get wrath. through. Somehow the fear of lecturers has worn Things could be worse, we could be ,Off, judging by the way the boys are stimu- doing Science. tating Eugenie Tuck's sensitive spot, much to Mr. Mather's disgust, causing her to emit SECOND YEAR bursts of Pleasurable laughter. Talking about sensitive spots, Ted Rafferty seems to Our first glimpse of the Almighty was in have done the trick; he has entered the state the form of Prof. Russell who assured us of married bliss. We all wish Ted the best that the Anatomy school is the only Uni- Of luck in both his studies and his private versity Department with its own act of research. Parliament. Red has asked that relations with Physiotherapy students be limited to Tony Sneezewell seems to be the out- the dissecting room tables. Closely follow- standing sportsman of the year. After win- ing was the suave Leslie John, whose potted ning the high jump in University Athletics tutes on surface anatomy are cherished by he travelled to Hobart and took the honours all. Others to be seen tripping through the again in the Inter-Varsity sports. Keith hallowed halls of Anatomy include Dr. Mather also starred this year; he was Lavarack whose happy laugh fills the Berry awarded a gold medal by Polydor for his every Wednesday morn. His series of lec- revival of the old hit tune "Down South". tures, "Seven years in the uterus", are Keith hopes his latest release, "North To always packed. Dr. Merrillees whisks in Alaska" receives as much response. We all do. and out, while Dr. Kenny rambles through the cerebral peduncles. Dr. Stranks mentions too often for coin- Among the guests who motored up from cidence that an Irish scientist by the name the Biochem. School were Drs. Finch and (1f Kohlrausch worked in Glasgow. Pos- Stone. The former, resplendent in his siblY a good hint for the finals. astronaut-type crew cut, has become notor- We are sorry that Mr. Mather does not ious for his heavy grogging during lectures. aPPreciate the enlightening discussion On a good day he can get through about groups held by the Back-Row-Boys during six beakers (the 400 ml variety). His asso- lectures. ciate, Dr. Stone, has proved once and for all that, providing no one particularly Mr. Boredom is giving serious thought wants to take notes, it is quite possible to to entering the umbrella industry so that he give a three-hour lecture in 50 minutes. c t an sell them to those students who have o sit up the back during Zool. lectures. Pansy's 11.45 siestas are looked forward to by all. Those in the know say we get Surfers must have done Dr. Stranks a lot on to Physiology next term sometime.

SP ECULUM 1961 PAGE SEVENTY-FIVE Patsy, of course, still runs the Thursday and THIRD YEAR Friday Physiol Prac. Clubs, though we believe on good evidence, that several 159 students were on the year roll when warnings have been made by the vice squad. the 1961 lecture season started. Thirteen The Med.-Physio. football match ended faces were missing due to 1960 mishaps; in a dimantenous defeat for the fair ladies several more faces were present for the of the medical school led by Judy Y. But second time due also to similar circum- their male supporters were not without their stances. revenge. Police reported later that several The year got underway with the usual young girls had been criminally tampered introduction to Treth—the Med. school's with and left distressed outside the V.D. Jack Little—and perhaps a more sombre clinic in Little Lon. introduction to Pharmacology—joke a week Social function of the year, of course, subject. However, most people having was the sherry party which claimed fewer reached the third year of their course de- victims than usual. Highlight of the floor cided that the time had arrived to settle show was Pansy's vivisection of Peter P. down to work from the first day, specially Heather got John McK. home safely, but with the big essay hanging over their heads. unfortunately the engagement of Henry F. Perhaps I should tell you of some of the and a certain demonstrator has been leading lights of the year. broken. Did you read the article about umpire Richard C. has been unanimously elected P.K. as he was presented to his fans, the as "Embryo of the year", no doubt for his youth of Melbourne, in the Young Sun. childish behaviour in the men's wash room. Also in the sporting spotlight recently is Fred (Scron) M. was reported to have C.P., who retained his seat in the Mel- been negotiating with Prof. Sunderland bourne crew at the inter-Varsity regatta in (during one of his recent trips to Australia) the first vacation. Perhaps he will be able to introduce bottle nights in the Histol. lab. to tell us himself why his crew did not bring So far nothing has eventuated. home the cake. Dawn E. has just purchased a brand new Hear about the girl who gave the thumbs International utility and is willing to give up sign to the lecturer? Obviously heading free rides to anyone interested. for a dismal fate, don't you think? Alec McG. couldn't wait until 4th year to start obstetrics and is now wallowing in a Another personality of note is I.C., who life of wedded bliss. managed to rig the elections and became the John W. has been living in college with University hockey team's vice-captain for some imported night club "entertainer" for the 1961 season. I see he hasn't been the past month. It is understood that un- giving himself the usual back pats in his less he cleans up the mess in his room he Farrago reports. will be sent down in 3rd term. Did you realize that G.K. became the As exams approach we turn our footsteps first anatomy lecturer for first year Occupa - from the Mayfair and wind our weary way tional Therapists this year? Don't worry back to the Med. library. about them, he didn't last very long. Then there was G.G., who arrived at a * * Saturday morning lecture in a dinner suit no one believed him but he tried hard. Girls are like newspapers. Must extend congratulations to J.F. on They have forms. her announcement of her engagement early They always have the last word. this year. Back numbers are not in demand. No other great romances to report, They have a great deal of influence. though several knowing looks are getting They are well worth looking over. passed by one couple in the dissection room. You can't believe everything they say. Did you hear about the ancient footballer , They carry the news wherever they go. but then Treth would not like any adverse They are much thinner than they used to be. comments about his ability. You have to pay more for a good one. Best of luck all in your exams this year Everyone should have one of his own and and also to those who will take your place. not borrow his neighbor's.

PAGE SEVENTY-SIX SPECULUM 1961 PRINCE HENRY'S HOSPITAL Keay's bongo drums have stopped play- ing at last, to the great delight of some of FOURTH YEAR us, but her appliance has now lost its cord — she's still searching! As in previous years, P.H. has once again Whilst Brian divided his time between a attracted all the talent (non-academic, this flat in Parkville and indulging in exercises time) . which placed his body in strange positions. It is pleasing to note that there has been Practising for some strange purpose? no card playing, liquor consumption, flirting Henry demonstrated his interest in Bugs with nurses (no wonder) or other time- by driving a hot-rod! No wonder Cas ad- wasting occupations. Boy, what a dead hole! mitted him with a cracked skull. One of the features of our hospital is the Jim must be wealthy or puritanical — close co-operation between the Clinical fancy refusing a quid to entertain a certain Supervisor and the students (ask anyone . . . veiled Blok. Whilst Bob seemed to take ask Fedora). On the "sporting" side, was great delight in giving injections I.M. highly successful cricket match against St. Don and Marlene gave us no surprise by V's. Result: 60 cans (and the P.H .team all announcing their engagement. To you two non-drinkers!) go our best wishes for the future. Just one The social highlight was a grog-on to question, Don—who was that naked woman suPport Irene, our Miss Med. (how she in your room? needs it!) Notable guests included Fedora While still on the topic, Peter P. seems to (last year's Miss Med.), Graeme G. and be Kronically singing "Irene Goodnight" black friend ("I thought this was going to until he disappeared to buy a ring. Heartiest be a square turn") and Sid! congrats to both of you. Noticed lately: The spirited side of Shirley was well in Dan K. has been going grey (with the evidence especially at that party in the Work?). Keith T's best friend is his M.U.M. R.M.O's lounge — ask a certain Dr. P.J. if life, (or is it Fred) B. still leads a double you don't believe us but you'll have a hard life, and Bill D's not tellin' nobody nothin'. job finding him — the shock was so great Fedora T.'s recently done a lot of her Best that he migrated elsewhere. work while "swingin' Sammy" M. sings soft Jack kept up the joystick of life for Calypsos in the basement. many weeks at a time. He certainly had a .As this issue goes to press, Elizabeth O's slip-happy fly. Gaby didn't always like his Hillman shows no recent dents. girls abducted, so why was Matron worried? Mark proved the adage "a little bull can FIFTH YEAR go a long way". Did you have connections With Path and Bugs behind us we entered with the signallers in the Nurses' Home? the new year with the approach of a runner Mick was certainly well known for his to the last phase of the race — keen in torso — a lean smooth frame well seasoned spirit but sadly lacking in energies. by exercise — his torso of course! But now Women's and Children's have Whilst still on the subject of rooms — drifted past and "the sands of time are W.R. are the initials of one of our num- slowly but surely running out". Incentive ber but we sincerely hope they are not previously lacking is slowly beginning to ap- pathognmonic of disease. Nevertheless ac- pear. quisition of a wife seems to have balanced The past year however revealed the true his character somewhat. characters of several of our number, es- Daryl seemed always occupied — we are pecially while sojourning at R.W.H. sure that he did not spend all that time in Ludwig's sole delight seemed to consist of his room studying. We hear he is a man of 'Be "banging of membranes", to the ac- stamina for he is now preparing for his cftpaniment of a calypso rhythm. second stretch at Women's. Adam's true character in summary con- Elizabeth's true form was also revealed sisted of — the temper of a hairy ape, the at that certain party. She suffered too, nurs- poet's love of Woman, the confidence of ing an herpetic lesion for some weeks after. °d Almighty, the hopeless confusion of a Michael's whereabouts and actions were surrealist and above all the one who was always a mystery — we're sure he had Most surprised at misguided conceptions. many close shaves!

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PAGE SEVENTY-EIGHT SPECULUM 196 Gideon — Eees it eeet — because you SIXTH YEAR Were thinking of Ann approaching event "Hague finem adimus" (We hope). that you spent so long in your own little library next to the bathroom?? After six long years those magic letters M.B.B.S. are now almost within our grasp. Lois and Dick, untouched by such Many changes have occurred since we first frivolity, seem to find a common interest in began at "The Shop". Dr. Rodgers has re- their work. tired, Dr. Brown has gone to Monash and Faraday Street has gone forever. The num- David de worked by day. Wonder what ber of students at "The Shop" has almost he did by night with his light out? doubled and now we have a new University. Peter H.:— It is interesting to look back over the last Rhymes in German you did make six years — remember Premed and that But you were found to be a fake caricature of Dr. Brown and how Physics Regarding a certain engagement affair and Chem. Prac. nearly drove us mad? Yet for a sweet little nurse you showed The first time we entered the Dissecting flair. Room in Div. 1A, the Mayfair, "The Flour So now it's on to final year and all its Battle" downtown with the police, that Pitfalls our next epistle is sure to be Sherry Party — and of course Panzee? shorter. Remember Div. 1 and how glad we were to finish Anatomy. Then to Bugs. and Path., and the first time we came to Prince Henry's, when the Student's Quarters were on the 11th floor, learning to play solo and Bugsy at the P.H. Ball? Remember last year — our stay at the Women's and our "sporting fixtures". Then there were Commencement Balls and Med. Dinners. And now final year — yes it's been a great six years. We finally did get together a football team and played R.M.H. at Hurstbridge football ground or swimming pool — we still don't know which. R.M.H. won a high scoring match — 2-11 to 1-1 though we're sure R.M.H. bribed Have Gun (the umpire). Maggie is still being rubbished for fronting Where's the barrel, Jackson? down to the river that day. Jackson said that he caught three four-pound Redfin during the match. Once again numerous members of our year took part in The Revue which un- fortunately clashed with Medleys. John H. and Paul G. were instrumental in writing many of the scripts. Supe's portrayal of Horatio V.D. and Scar was too good to be true. Here Jackson, Henri, John B. and Dave B. also displayed great acting ability. Jackson undeterred by the result of his bookmaking at the Women's Hospital con- tinued to run Sweeps with unceasing regu- larity at the slightest opportunity. It cer- tainly provides a few laughs, e.g., when Herc drew Summer Honeymoon in last year's

SP ECULUM 1961 PAGE SEVENTY-NINE Melbourne Cup Sweep, while holidaying The sapling of course still sleeps and it with Jan up at Wagga. By the way Herc, sleeps . . . a when is the big day? In conclusion we would like to thank the Congratulations are due to the following Honorary Staff at Prince Henry's and all the on their engagements. We might add that others who have taught us so diligently each of them regretted it just once— the during our time at this hospital and we only nights they visited the Royal Domain: Barry hope we can justify their efforts in the com- B., Graeme H., Dave B. and Harry N. have ing exams. all taken the plunge. Finally, good luck fellows, and please The admiral is still trying to convince us let's not see your name in the year notes of his virility — but we won't believe him next year. — not with those "retractiles". By the way, Maurie, has your auntie really got male ROYAL MELBOURNE HOSPITAL gonads? Leon L. looks much more handsome FOURTH YEAR C since his upper incisors have been repaired It is hard to tell how much work and J — how come you don't play squash (i.e. the how much play is being done this year. variety with the racquet) any more Leon? The Clinicians are optimistic and say C Graeme H. repeated his act with the B.P. that they expect a few honours in Path• bottles this year. We suggest that the P.O.W. this year after noting the attendances In machine "ties him down" with that shocking clinics. tie next time he tries it. Some of us have legitimate excuses. Alex We erected a statue to Henri ze great G. is now Editor of Farrago and we have French lovaire and now it sits on the not seen much of him since he took up this 'fridge in the lunch room — we are pleased position. Jack B. says that his biggest to note that recently a mate for it has ar- worry this year is being S.R.C. president, rived from Texas although they haven't got but we don't believe that it is. together yet — and that's no bull. Show poker seems to be replacing the We finally discovered what the S in J.S.R. more standard form of the game. Sid A. stands for — Stirling, following his mag- and Alec B. were not satisfied with winning nificent driving exhibition one Saturday a fiver in an afternoon, they now consider afternoon. a tenner reasonable return for a day ' s Our recent visit to the Blood Bank was work. most enjoyable. "Vampire" Barnes was so Every time we see Craig Mac. he is enthralled that he wanted to go back a either just coming from or going to drive second time. Jackson too was most im- somewhere a load of eighteens. He still pressed. After extolling the virtues of be- - coming a resuscitation officer stated: "Oh can't remember who he took to the barbe well fellows, I guess you'll all be getting me cue on the last day of the convention. to resuscitate your patients in ten years We had one interesting case this year, a time". You should have seen Jackson's face nun who had been raped in a park one when someone said "Oh yeah". night. It took two years to Bugsy went home to Fiji for the last long remove the smile from her face. vac. — tells us he behaved himself for six How long to go till the next inter-hospital weeks — if only his parents knew. cricket match? Could be sober enough to Boosy Bill still spends most of his time bowl a ball onto the pitch this time. between the army mess and the Graham. Sick joke: Dentist to patient, "Of course The big feature of the Refresher at the we won't have to remove all your teeth , Women's this year was the telly. King Kong sir, just the gums". Not so funny reallY. and Saxy Maxy both had square sore eyes following their two weeks there. FIFTH YEAR Starchy didn't waste any time with the The first intake at the Women's started telly — he was more interested in the quietly with Garney and the Stallion crack Pharmacy. ing their whips. These gun boys ("gun" I We are all surprised that the Woolly said) had been told to smarten up the stu - Bear has not been carted off to the Zoo by dent quarters after a particularly rowdy now. mob last year. In spite of these minor

PAGE EIGHTY SPECULUM 1 961 impediments the facts of life were learnt by finding John M. as a drink waiter in as well as practised. their hotel. Dave H. starred as usual by heading the Geoff G. had a rather delicate operation list in the test at the end of the ten weeks. performed but the scar isn't really notice- Could not even take time off to entertain able. After all, who goes round looking at Sue and Marg when mouster Don McO. s. Was called to sea. John M. has been a changed man since John (pounder) R. was on the spot in the new Falcon has been released. They his bedroom. say the Heart's Desire House is going to Major John H. finished up with a scoli- upset things a bit. °s1s because of so many deliveries (Defn: Carroll M. has been successfully fighting SeOliosis, a marked list). off advances and saving up for his own true love. Chinese Janitor Wilf (no relation) never A golf foursome was rather put off their ceased wondering at the sleepy figure of game at Yarra Bend the other day. Rumour Jack F. Each morning as this oriental has it that they are returning to the third gentleman came to take away the many hole with a Copuloscope to carry out a empties he would mutter, "Velly good par- clinical study. ty, velly good, nan velly good." S.M.S. is engaged: Congrats: The same Young Brown (of rugger fame) went too doyen of oriental cunning along with one Jar, when he jammed a middy in a baby Tony W. has been systematically winning Pram, sent the lift two floors to be greeted at the card tables. '3' the night sister on her late hospital Tom R. is said to be boycotting Dr. round. Cade's lectures following his statement that , Graeme M. engaged soon to be married "nine out of ten Scotsmen are alcoholics had a quiet time. Makes good coffee and the tenth is a depressive." Tom's ex- though. planation is that it's such an awful world Who was seen in the bathroom? that if it weren't for the wee droppy it Bob R. (son) spent more time playing wouldn't be worth going on. Cricket in the last week than learning ob- Alan E., Norm E. and Ian R. (our mar- stets as was found out. Or perhaps it was ried men) are still making ends meet Julie? (pending Ascheim Zondek). Harry Palmerston R. still brings home John S. and Mif have been revising thbacon . anatomy so thoroughly (?) that they are Barry D ("Dreamy Daniel") still in bed uncertain whether to layby for surgery °Ile morning about ten was asked by Garney honours or a layette. 1711Y he was not at a clinic. Barry replied Ian R. is connecting a direct line from e was not supposed to be at any clinic. He home to students' quarters as he isn't game Was supposed to be in Labour Ward. to go without Mary's approval. , Perhaps these notes should be concluded S.S. is reported to have had an affair °Y a list of just a few of our achievements: with a white Leghorn over the vacation 1. Planting a flag on top of the chimney. (not a rooster but a hen: there's nothing 2. Cooking carrots in Ward 19 autoclave. queer about S.S.). 3. Six nurses attending antenatal clinic. This resulted in J.S. passing through a We believe Wilfred does wonderful strange phase early in the year "Why have e°sMetically perfect sutures and is a strong women when you can can have the real believer in immobilizing his works of art thing?" However it didn't last long (Laurel th the position of function (his patient with says because he couldn't get up for down) fue lacerated penis is reported to have and is now happily engaged; Congrats. round Wilf's plaster so functional that he The most pathetic sight at R.M.H. is Ported back to O.P. two months later with Norm E. sitting in the Students' Quarters h,e plaster worn out and requesting a re- with a big bag of vegetables waiting for a Placement). lift home from S.S., who is finishing his t_1(oss A. doesn't know the difference be- round of the Nurses' Home. "en oral and rectal thermometers. Richard by any other name would still Allan E.'s honeymoon was rather upset be sweet.

SPECULUM 1961 PAGE EIGHTY-ONE FINAL YEAR End of R.C.H. was celebrated by morn - ing tea (and lunch and afternoon tea) at Mal B. (at party celebrating end of Jimmy Watson's. R.W.H.) was seen drinking out of ortho- Last year R.W.H. diaphragm. Group III — Kangaroo day. Ren B. gave blood also at R W H ; Kahn Group IV — West-side-rockets. ve, says W.R. was –ve, but!!!! Enjoyed Lance says: "There is only one official wife living at R.W.H. authority before exams." (Huh!) Roger B. is enjoying married bliss. "Best way to take temp. for ovu- Stuart B. (among the rushes of the Nile) lation chart is P.V." is upset because Pharaoh's lovely daughter Lance examined patient but forgot the is sailing away. breasts. Loo-C.C. — engaged. Owen C. — enjoyed trip to north. Voice from the back (Ren B.) "You'll Mike C. is our exponent on transferase fail." systems. Mal. D. continually frustrated. Even 3rd ALFRED HOSPITAL time not lucky. Tommy F. brought wife to Melbourne, FOURTH YEAR left baby in Malaya. Was it worth £20 not Having successfully negotiated the many to play cards at R.M.H.? traps for the unwary in the pre-clinical Binky F. to marry in January. years, 31 of us descended last November John G. just announced his engagement. to the delightfully antiquated surroundings Wal H. is not really asleep. Just ab- of the Alfred to be lulled by pleasant words, sorbed (in what?). cream cakes and tea into a state of false Dave J. frightened daylights out of fe- security and blissful ignorance. It all male colleagues and waitresses at R.W.H.; seemed so easy at first — any fool could decided to try a new method of induction see that the patient was as yellow as a of labour — walk through the labour ward pound of butter when the honorary was with a gorilla mask. taking the history. The only trouble was Roger K. "hasn't enough brains to be a that when you had to do it yourself, these doctor" said the milkman at R.W.H. after were the sort of things you completely for- a cracker exploded by his car. got even to look for. Bob K. still has that vintage look — likes good wines and good women. His Bugatti After Christmas, our numbers were is well preserved. boosted to 35, having lost Ian G., who left Peter L. took his girl friend to Sydney us for a year's "research" at PharmacologY , for a few days, under pretence of retrieving D., who wanted to and almost losing Paul a stolen car! go to the R.M.H. instead, but who thought Tom M. is after a roll too, in or at Hay. better of it after the Christmas Party. We Ian P. — Ken Cox's Matt Dillon. were joined by five from last year, includinS Dick P. didn't amuse Garney by taking Judith, "the one with the haircut, sir' • friend into eclamps ward. When are you going to finish knitting that Bruce R. plays the oboe. yellow monstrosity, Judy? Graeme R. is doing M.B.B.S. and Radio- For the first few months of the year, We graphy. amazed all others present by virtually re' Murray S. was carried away at Frankston fusing to play cards as a whole, but after Orthopaedic. the shocks inflicted by the Pharmacy exams, Ann S. and Fiona W. flat together. solos, both professional and amateur , many John S. is to marry at end of year. are now flourishing. On the sports side, Jim S. is engaged (unofficially that is). we had many conscientious tennis player s Maria S. now has two kids. last year, but they seem to have disar Jim W. — married 3/12. peared — not exams, I hope! As far as Eveyln W. — should we be officially inter-hospital sport is concerned, we have notified of your elevated status? not been very successful, for we lost (some' Brian W. — married. one cheated I'm sure) both cricket matches

PAGE EIGHTY-TWO SPECULUM 1961 Played against R.M.H. and St. V.'s. I hope FIFTH YEAR that better things come to be during the football season, Chevron or no Chevron. Against a background of wedding bells On the matrimonial side, the boys have and the threat of splashing christening fonts been very active. Long overdue congratu- we battled into the exam-free penultimate lations to Nelson W., who had, by exam year. time last year, produced his first. I hope Amongst those who couldn't wait was there are more to come, Nelson. Con- Ian McI. and John S. Appropriately (or gratulations also go to Darryl C., John B., inappropriately, depends on how you look Ritchie W., David F., who decided Christ- at it) they had hardly brushed the confetti mas was the time; and also to Peter den H. away before they were in the Women's for on his recent engagement, and on the fact 10 weeks incarceration. that he's a stronger man than I to last out Apparently Bob A. has been trapped at until after finals. last. Good thing . . . no more parking Heard during the year: offences. Eva S.: "To test urine for bilirubin, put a little fat in it." That well-known urban alpinist, Roger Eva again: "What iss zhiss bull?" "A M., has acquired a vehicle. It has S*X male cow, Eva!" on its number plate (amongst other places). Interesting stories about R.M., surfboards and double beds at Portsea: "We're just good friends, John." Ian McC.: "Dull, but tympanitic, sir." Mr. R. in surgery clinic: "Pancreatic juice smells just like new mown hay." Keen student, after smelling pancreatic fistula: "But that doesn't smell like hay, sir." Mr. R.: "You've obviously never rolled under a haystack in your life." Comment: Simple things for simple people." Same keen student in one of Dr. A.'s P.M. demonstration: "One of the causes of pulmonary hypertension is sex hormones, sir." Darryl C. at last got the long awaited bed in the Alfred. The only times we ever saw him, he was sleeping. Interesting thoughts as to what happened to the night staff. Have been hearing long grumbles that the nursing staff are thoroughly dissatisfied with us. Obviously Peter B. is losing his charm — not his money though. Dr. W. in Bry's lecture: There was a young man from Malay, Who thought Chancre was auld in a day, But now he's got tabes, And gummatous babies, And thinks he's the Queen of the May. ere glad to see Blair (the Crusher) C's cheery face at clinics ocasionally. This is enough slander and libel for 11°W, so the best of luck to all, and hope to see you in October.

S PECULUM 1961 PAGE EIGHTY-THREE MhDLI-TS 1961

Date: MONDAY, DECEMBER 4

IF

YOU PROVIDE SCRIPTS

SONGS AND CAST

PRODUCER: J. BEST

SPECULUM 1961 PAGE EIGHTY-FOUR Hugh N-J, an intrepid character as a rule, her knowledge. What's this great ugly mon- was seen clambering hurriedly from the ster of a shadow on this pelvic X-ray?, Ted "suicide" seat into the back as Rog headed wanted to know. An unusual shaped cal- for triple figures in Johnston street one culus? No. Barium? No. Good gracious, night after a "convention" party. woman. Don't you know a penile shadow It is said that John R. and George F. when you see one? both enjoyed the Women's very much. Guess what happened to Helen W.? We understand the New Zealand auth- Invites Mom and Dad down to have a look orities breathed freely for the first time in at Student's Quarters. Ushers them in with: weeks after Elliott R., Paul V. and Brian "This is my bed." Hurriedly backs out as R. finally headed back from their holiday she notices somnolent figure stretched out fling — a week late for the Kids. We there fully clothed. Brian S., suffering from understand they formed quite an attachment ethanol poisoning, had found the wrong for the Maori race. dormitory. Since then Paul has been making a great Robert W. and John H administered run on the sterility clinics — his friends themselves overdoses of the same toxin Wonder whether he is trying to pep himself but found the right room. up or damp himself down. The word is that John has coughed up Ever since, Elliott has been playing with for a ring at last. a couple of balls on a string given him by It's rumoured in some circles that Robert a Maori maiden (pois they are called). We is being pressed on this matter too. think Ron Kingston should probe this one. Warren W. scored a very doubtful full Perhaps Brian didn't crack it — anyway marks recently when, without blinking an he's been taking it out on the football field eyelid, he reeled off to a startled clinician ever since. We see in the Sun that he (who had asked him) half a dozen causes made the Demons. It's rumoured he made of persistent priapism. Top of the list was a deal with Lance — some free publicity psychogenic. for the Prof.'s new book in exchange for Dave C. has been wearing a worried an untroubled passage through final Obstets expression recently — ever since he judged and Gynae. that baby show. One mother reckoned he Bernie F. timed things nicely — he's was wrong in his decision and she also able to make a personal study of Obstets reckoned she was big and strong enough and paediatrics. to prove it. His friends report that Leon F. is grow- By the way, Conrons first started haunt- ing younger every day and was the liveliest ing Alfred corridors around 1950 and the person at the Women's. They think he hospital hasn't been without a Conron has hit the menopause and bounced back since — even got two at the moment. again. Activities on the solo front have been Has anyone noticed how thin Danny C. maintained under the leadership of William has been getting? His friends think this ("Four Trick") B. and that well-known is due to an attempt to live on the fruits misere caller Donald ("Ace Bare") R. of love. John T. is becoming known as the Al- , One of our girls raised Uncle Ted's eye- fred's top chest man. His interest in chests Prows recently. Bev. M., after examining has extended at times even to patients. At her O.P. male patient, came back and re- his first Gynae clinic, after digitalising the Ported: "Yes. I found tenderness in both patient, John was asked by Jimmy Buch. scrotums sir." how he thought it felt. He replied: "Feels By the way, which of the girls was in quite normal to me sir." such a hurry she just couldn't wait? Fact Peter R., after a five year gestation, re- is that someone knocked a great hole in cently gave birth to his alfa Romeo. Was the wall of the lady's lah with a motor telling Kevin Hinrichsen about it. Kevin car. Renee S. put up a written disclaimer sympathised with him for not being able that it wasn't she and her Fiat ("Chuffa"). to afford a newer car. How hurt can you , Paula has been around again. She's been look? boning up on her anatomy lately after By the way, who put the bra in the back Uncle Ted found an embarrassing gap in seat of Pete's car? Female vintage car

SP ECULUM 1 9 6 1 PAGE EIGHTY-FIVE ilLiv enthusiast ran across it on tour of inspec- ST. VINCENT'S HOSPITAL tion. Pete hurriedly explained that some drongo had draped it on the radiator cap FOURTH YEAR and that he had thrown it in the back himself meaning to get rid of it. Having successfully fooled the examiners Another big event of 1961 is Dave W.'s in Anatomy and Physiol., the cream of the 1960 Div. I year applied for St. V's, and, flat. There's nothing vintage about this happily enough, were accepted. These 31 except, perhaps, some of the grog and newcomers, together with four notorious females. "old hands" (Yari "Hamish" Hrychow, now co-editor of Farrago, Dick "Longfellow" SIXTH YEAR Vasta, Joe "evil eye" Goh and Gazer Instead of the well known six of us Varasdi — athlete, gentleman, scholar), being worried every month, now with comprise what is doubtless the elite of Div. seventeen weeks to go, all of us look ap- II Med 1961. prehensive. Here is a brief account of Leslie has left us to enter upon a life of how a few of us are bearing down, sorry marital bliss. Bill, on the other hand, finds "up" under the strain. that marriage in no way interferes with his Ted T. is paying the price for his hyper- work. gonadism and the happy event is due some Once again the most beautiful girls came time in September. Let's hope it doesn't to St. V's — and we're glad to have simulate it's father too much and cause them with us in clinics — the honoraries cephalo pelvic disproportion. have to think of somewhat more subtle ways There has been no word from the other of declaiming our ignorance. married members of the year. Evidently While Frank Power, Jock O'Connell (the they have been surviving the constant on- quiet man), Klaude Zd., and Lawrence (sex slaught, but I hear Bill has settled for the is best) Carrot prefer table tennis to next best and bought his wife a dog. Foster's, Norris ("I pass none") Carter, Ten Ken has been admitted to Ward 3 for Foot Terry and Dave Cade keep fit massag- a Ptorak operation (he insists it was a ing their fingers for the big Poker school. Bassini) and I am told he was holding in John Mac. and John W. helped to make the clinch . . . establishment and had a a success of the Med. Students' Convention rough time. Don't worry Ken, there is still by their sterling efforts. Darryl ("Glamour time to prove yourself. Boy") Nye who greatly impressed our can- What a thing these exams are. Even did observer with his social finesse at Kew Slammer Sammy is finding it hard to fit Town Hall would doubtless agree. his normal activity in with his work, and is The new slimline "Butch" and Martin trying to gain time by keeping a library "Parrots of the world" Hartnett are well seat warm all day . . . don't know what noted for a suave bedside manner while he does at night. Brian Thomas is looking the part too — he The therapeutics lectures are a bit of a drives a Rover. Otto and Chris have re- trial on the public — just watch Micka and nounced the demon drink following recent Cotta hitting 60 along Commercial road, at lectures on cirrhosis. 8.30 on Tuesday and Thursday morn- According to my source of information, ings. Nelson's casualness may have been grossly Nella and Jack have quietened down a overrated, while Jack "I love 'em all" Ken- bit, now you can only hear them two yards nedy continues to impress. Better watch out away. gents, because we heard that all the nurses Congratulations to Ben on another ad- have gone to "the Dogs" — half his luck. dition to his family. Now he must have Heard that Mick (the hole) Purcell is run out of long underpants. earning untold brass swatting at barflies As for the others, they have been keep- including solid citizens W.J. and Norman ing fairly quiet, probably doing some quiet "intervarsity" Resch. And did you notice work on the side. Let us hope it does M. G. (Barassi) Malone's swift return to fit- them some good, and that there are 23 of ness when he heard the Old Xays. game was us in the residency next year. on TV?

SPECULUM 1 9 6 1 PAGE EIGHTY-SIX

By the way, it is reported that Swarth) men, Arthur H., Robert P., Alan H., Thong Jock "Stilleto" Cravana has rejoined his V., Neil Sist, Gerry I., and Beppo, are Mafia comrades following the insidious living off the fruits of love. (But, please manner in which he pranged M.G's motor gentlemen, don't throw the peels out the scooter. window.) It's just a rumour mind you, but our Julian M. and Warner M. play a hard source says that Mike ("faith-healer") PR- game whether it be with poker, squash or lakis, while practising his PR technique on women. a pig, managed to cure two sides of bacon. Hoping to score 100 for the year, George — Since we find it impossible to con- has improved his chances by buying an clude on a sober note, we'll just wish us all M.G.A. Financial help for this has come the best of luck in the forthcoming exams from the discount he receives from the — we're sure we can fool 'em again. Drug Houses, as a bulk buyer and old customer. FIFTH YEAR Vince works the hardest in the year and we cannot tell you whether there is any The year opened with the return to St. romance in his life. No-one knows what Vincent's of the 36 of the laziest students Peter H. is up to either — but remember the hospital has known coming back to up- that "still waters run deep". hold their reputation. With no exams this Rees, the rhythm expert, finds his stereo year this has not proved difficult. To help a great help for entertaining, despite the while away the hours they made use of the nuisance of having to get up and change adjacent public houses, the poker tables and the record. During his recent stay in Hong the congenial company of the opposite sex. Kong Nick D. was learning a bit about So far this has not led to any increase in Oriental technique for when the Chinese Population but the results of the National come in 1970. Census are being anxiously awaited. "Maverick" I. is still very prominent at The girls have been rather quiet, but the card table and has recently been joined rumour has it that Felicity and "Rexual" by Jack E., renowned for his exploits in W. are still seeing rather a lot of each other the Tunnel of Love, with fast-talking Julian (they say that Rex had a crash in his hel- B. occasionally honors us with a personal met) and that Mary M. was a frequent appearance at a clinic. Does he play solo visitor at the R.W.H. when P.H. students by himself in his spare time? were there. Adrienne and Gwynne are still continuing their association, while Mary D. They say that Paul M. has bitten off was starring during the ball season and was more than he can chew!! He is trying to seen in some amorous situations. Joan run several girls at once. McK. and Jane A. refuse to divulge their Jo Chow has fulfilled his ambition and extra-curricular activities but we believe done a P.R. A pity he had to use his that they are on a non-profit-making basis. finger. Our Asian friends Lim, Lim and At the beginning of the year the boys Lim, have confounded the Health Depart- welcomed Mick S. from South Australia, a ment lyr introducing a resistant strain of noted drinker, smoker, gambler and runner, spirochete. and something of a Casanova. Bernie's Best of luck for next year to all the crew new V-W has suffered a lot of minor trau- of the good ship Venus. ma, as has Bernie. (The plastic surgeon will confirm this!). Jack C. has also joined SIXTH YEAR the V-W owners and reports that the lay- back seats make it much easier. Rupert Returned to home base after a short H. and Andy G. have been breaking more stay, no expenses at Tugger's private hotel hearts round the Nurses' Home and with with its varied night life, high class ameni- long practice their technique is becoming ties and as many women you could point More polished. a finger at. Ken F. has deserted us for his more al- The year's best comment: coholic colleagues at Newman — is this a Dr. J. H.: "What sort of people get Ray- manifestation of certain latent tendencies? naud's disease? The married, and "as-good-as-married" Students: Silence.

S PECULUM 1961 PAGE EIGHTY-SEVEN Dr. J. H.: People who work as riveters Laurie R. and Frank D. won the 4 ball and have vibrating tools. with 12 up. Lew blamed the win on the At the moment topical interest lies in leprechauns. the new appointment for Professor of Medi- Dave P. keeps up with all the hospital cine. gossip. How does he get all the inside Peter McC. is a hot tip for the job. information? Referring to the nasty subject of work, Eve Y. went for a boat trip down the John C. sees every patient who comes to river with the students from the congress. the hospital and even sees some twice. Strictly for entertainment purposes, SHE Bob W. surprised all by racing a R.W.H. SAID. employee off to the bush for the day — Kris B. is in great demand as an inter- presumably to study the birds and the bees. preter. She specialises in Serbo-Croatian. `Worker' G. is doing more tutes than any- Toni C. got stranded half way to Adelaide one in medical history. Also hopes to and has since bought a new sports car. educate the 'Yanks' in medicine next year. It's more convenient. Highlights from R.W.H. Ramm P. to clinician who said, "You'll After having a romance with his `legger' fail, Mr. P." replied "That's what I said, Henry L. spent his time at solo and distill- Sir." ing illicit 'liquor'. Val. M., Vip., and Ahmud make quite Kevin S. was the boy behind the "K for a trio with that extra touch of maturity. Kanga Day". Reduced poor Dr. M. K. to Sion B. is always conveniently able to a nervous wreck. hide himself in clinics behind Mike J., but Annie D. had a habit of straying into this has a disadvantage. Mike might tread other peoples' bedrooms wanting to play on him. games. Terry V. always sits next to Jonathan Jonathan R. used to get heavily scented R. — could there be anything in it? letters while "Stallion" Roy F. still gets John D. keeps the maternity hospital attacks of exhibitionism after his "Starkers" busy, while Peter D. has settled down to trot down the corridor. the rigors of married life, and recommends Bernie 'Pops' R. suffered from inversion it to all. of sleep rhythm and was heard often to Arthur F. and Ted. F. are such frequent wake at 3 a.m. and slowly begin to shout visitors in Cas that they have been offered about 'B placenta grinders!' honorary positions there. Dick McA. was kept busy defending Gerry G. still thinks that 5 o'clock Fri- students' rights while John B.'s mating call day night is the best time of the week. rang through the labour ward when the moon was full. Also doubled as ward Rene DuP., "The most eligible bachelor cleaner in his spare time. around the hospital" is a great protagonist P. O'H. was most annoyed by rude in- for lost weekends in Sydney. terruptions to his privacy, while Hugh N. Willie "Hamph" R-P. has become less spent his time pursuing women and devel- pugnacious as finals approach. However, oping special leer for same. Also did two he came to grips with Mr. R. H. on deep impromptu A.R.M.'s. sea fishing across an operating table. Vinem S. held the record for prolonged Laurie R., Bernie N. Gordon, Jack H., labour; 3 days and 3 nights and was re- and "Shocker" have finally weakened and warded by a stud fee from a grateful hus- are being wed after exams. "Shocker" is band. so hyperkinetic that his glasses are perpet- John G., Gordon M., Bob H. and Buck ually steamed up. He keeps mumbling divided their time between grog, cards, about disuse atrophy and putting his blue grog, women, grog, chimney climbing and hands into his pockets — viz. paragraph 2. "Charlie". Thought for the year Rosie W. scored well on the definition of Remember that the best contraceptive is dyspareunia — "I thought it didn't fit." a cup of coffee; not before, not after, but Back home golf interrupted the rat race. instead of. Chris S. ran away with the trophy — the Well that just about wraps everything up, only man to hit a ball straight all day. but remember: "Be kind to the examiners. "

PAGE EIGHTY-EIGHT SPECULUM 1961 ANSWERS TO DIAGNOSTIC QUIZ

SURGERY into spontaneous labour and delivered a macerated foetus. A brisk haemorrhage 1. X-ray in forced inversion position occurred just after ARM but was quickly shows torn lateral ligaments. controlled after fibrinogen and blood. 2. Duodenal ulcer penetrating pancreas. 2. The question is whether to wait for a 3. Lead poisoning from soluble lead theatre for LUSCS or proceed immediately compound on the chisel. with an internal version and breech extrac- 4. Epithelioma of penis-proved by tion. As the uterus was contracting dorsal slit. strongly and she had had previous large 5. Cyst of lateral meniscus and gang- babies it was thought that latter manoeuvre lion. gave the baby a greater chance. Result 6. Congenital collagen deficiency per- was successful. mitting abnormal movement of the joint- 3. Megaloblastic anaemia shown by relieved by a constraining bandage. blood film. Folic acid deficiency due to 7. It was not a boil but a suppurative poor diet. Management is to give folic acid hidradenitis of apocrine glands. orally and Hb will rise quickly. This case came into spontaneous labour soon 8. The base of the appendix is always after admission and was transfused because found at the ileocaecal valve in the angle of risk of foetal anoxia in labour. between ileum and caecum. 4. Carpal tunnel syndrome due to 9. Belly of semimembranosus muscle- oedema. Given chlotride 0.5 G b.d. with normal. rapid relief. 10. Ischio-rectal abscess. 5. Grade I or II placenta praevia could 11. Hydronephrosis. not be excluded. Therefore had E.U.A. in theatre when Grade II placenta praevia 12. Verruca plantaris - "splinters" are found and LUSCS performed! The moral blood pigment. is never to perform vaginal examination on 13. He was not told of the colostomy women who have had ante partum through which he was looking was the haemorrhage. theatre window. 6. Confetti! It gets everywhere!

MEDICINE GYNAECOLOGY 1. Ruptured right tubal pregnancy. I. Paget's disease of bone. 2. Bone marrow biopsy and the 2. Haemochromatosis. presence of a histamine fast achlorhydria 3. Milk-alkaline syndrome. confirmed the diagnosis of pernicious 4. Carcinoidosis. anaemia. 5. Polycystic kidneys. 3. Left Bartholin's abscess. 6. Adie's myotoric pupil. 4. Adenocarcinoma corpus uteri. 7. Polycythaemia vera. Gonococcal salpingitis. 8. Examination of the eyes for the 5. presence of Kayser-Fleischer rings, confirm- 6. Turner's syndrome. ing hepato-lenticular degeneration. 7. Ruptured hymen. PEDIATRICS OBSTETRICS 1. Physical examination in the ward, 1 . F.D.I.U. had occurred with develop- and a subsequent chest X-ray demonstrated ment of afibrinogenaemia. The "move- a left-sided pneumothorax. This case illus- ments" were probably bowel peristalsis. trates the importance of the history and full Clotting time was unrecordable. ARM physical examination, which in chronic was performed and patient given 5 gm fibri- diseases such as this, tend to be inade- nogen before onset of labour. She came quately elicited.

S PECULUM 1961 PAGE EIGHTY-NINE 2. Haemorrhagic Disease of the new- also consider a pneumothorax with these born would be a possibility, but this would signs. be rather early for it to occur. An APT 10. The repeat chest X-ray included a test confirmed that the blood passed by the view of the larynx and showed an opaque baby was of maternal origin. The principle foreign body in this region. A screw was of this test is to add a weak solution of subsequently removed from the region of sodium hydroxide to a suspension of the his epiglottis. In any small child with such melaena in water. If the blood is of mater- a history always enquire particularly about nal origin the suspension turns brown, the possibility of a foreign body, and always whereas if it comes from the baby it re- attempt to visualize the epiglottis. mains pink. This basis of this test is the fact that foetal haemoglobin is alkali resist- 11. Examination revealed a pale baby ant, while adult haemoglobin is not. with no neck stiffness, the frontanelle was 3. Having excluded trauma, one would tense and the temperature was 37 deg. C. think of osteomyelitis or perhaps polio. The Lumbar pucture confirmed the diagnosis of latter could be excluded if the baby had meningitis. Although other infection and had Salk vaccine. Physical examination re- a mechanical obstruction may produce this vealed bruising of the gums and prominent picture, always consider this diagnosis in a costochondral junction. X-ray of the right baby who is vomiting and not feeding, even humerus showed a large sub-periosteal if all the classical signs of meningitis as seen haematonia. X-ray of the epiglottis showed in an older child are not present. the typical changes of scurvy, and she made 12. Yes, congenital heart disease, with a full and rapid recovery with the adminis- early congestive cardiac failure. Shortness tration of ascorbic acid. of breath and a tachycardia are the earliest 4. Physical examination revealed limi- signs of C.C.F. in infancy. Adequate treat- tation of abduction of the right hip, and ment with digitalis and antibiotics is import- X-ray confirmed the diagnosis of congenital ant, because many of these defects can now dislocation of the hip. This case stresses be treated surgically with good results. the importance of early diagnosis in the neonatal period, when treatment is relatively ;..,...... 0.....„,„,._.0_,,....._„...... simple and complications are virtually un- 1 known. 5. A foreign body was removed and 1 NOVOCAIN the discharge cleared spontaneously. 1 the original I 6. Strangulated right inguinal hernia. 1 LOCAL ANAESTHETIC Always fully undress infants and children 1 . . . before commencing examination. with the passing of time, Novo- I cain remains the universally accepted, I 7. A full blood examination revealed a 1 dependable anaesthetic." i mild hypochromic normocytic anaemia. 1 NOVOCAIN is Further investigations were all normal. i Although more serious causes might be con- 1 — INVARIABLE —STABLE sidered, recurrent infection is the common- est cause of anaemia in children, and in this 1 — RELIABLE —SAFE l case the anaemia was considered the result — NON-TOXIC — NON-IRRITANT 1 of, rather than the cause of, current infec- 1 1 the choice of those who, above all, tion. 1 8. Yes, constitutional. Both mother demand quality. Before issue, every batch of Novocain is tested ■ and father were short. Always enquire 1 I about parental height in such cases before Ind passed by the Commonwealth Bureau of Dental i 1 Standards. considering less common causes. 1 I 9. A chest X-ray confirmed the diag- nosis of diaphragmatic hernia. Although .,. J. L. BROWN & Co. the percussion note over the left chest was I 123 William Street, Melbourne. 62 3027 i I ■ ■ apparently normal in this case, one should # 0 •••0411mo 0411..01m...0.1■.••••■■■•oio■o•alw.1■o■o■ww.o.

PAGE NINETY SPECULUM 1961 ri' ll1111■■1111L--

spicuia

In the Ante Natal Clinic: H.S.: "Any headaches?" Patient: "No" H.S.: "Any vomiting?" Patient: "No" H.S.: "Any specks before the eyes?" Patient: "Yes, but I've broke 'em. T' case is in my pocket." There was a new vicar in the village, and discussing the coming Sunday's sermon with From a recent class examination paper: the Curate, said, "I think I will take for my "The vessels of the Duodenum sermon this Sunday, 'The Widow's Mite'." I know they're there but haven't seen 'em The Curate, a young man who knew his About the muscles of the Rectum, way around the village, said, "Well, Sir, I I've got ideas but can't connect 'em" don't know that that would be advisable, because I happen to know they DO!" Dr. X: "I'm afraid I'll have to remove * * section of your bowel." * Patient: "Well, Doctor, better a semicolon than a full stop." From a letter from Registrar to G.P.: * * "This lady's domestic troubles are now * settled: the almoner has arranged for her The resident in playful mood asked the to sleep with a friend when her husband has psychotic patient who he was. The patient one of his drinking bouts." returned " I'm Napoleon." "And who told you that you were Napol- eon?" "God did." c Clerk: You say you have had sixteen Voice from two beds down— "I did not." hildren. Isn't that rather a lot? * * * Patient: Why, no, dearie, you see my A student asked by an examiner to des- husband is a very fascinating man. cribe the symptoms of phosphorous poison- * ing could think of nothing to say until in a moment of inspiration he blurted out, "The Heard during a conversation on contra- stools are luminous, sir." ception: "We get on all right, my wife's got Said the examiner: "Is that a flash in the it all sewn up." pan?"

SPECULUM 1961 PAGE NINETY-ONE Women can keep a secret just as well as Amelia of quite large proportion men but it takes more of them to do it. Took all contraceptive precaution, * * But poor little Ermyntrude Wisdom: Knowing what to do. Let one little sperm intrude. Foresight: Knowing when to do it. Does anyone here do abortion? Skill: Knowing how to do it. There was a young girl from St. Paul, Virtue: Not doing it. * * * Who went to a birth control ball, With syringes and pessaries One old soul in O.P.D. said that her hus- And all the accessories, band "had had the sugar debaters for But nobody asked her at all. years." Probably he could have given a * * * lengthy discourse on the sweet pea. There once was a youthful reporter, * * * Who thought that his girl was a snorter, Doctor to mother of five sets of twins: He put her to the test, and now he is blest "Do you always have twins?" With a highly specific aorta. "Oh, no, doctor. Plenty of times I have * * * nothing" A girl who was no good at tennis, * * * At swimming was rather a menace, Did you hear about the nauseated pixie: She took pains to explain, "It depends how she went to a goblin party. you train, * * I was a street-walker in Venice." * * * * Mary had a little girl, "Is the doctor in?" whispered the man With vernix white as snow, with the laryngitis into the phone. And every time the student grabbed "No," the nurse whispered back. "Come He slipped and let it go! very quiet." * * * on up, but be The bee's a busy little soul, He doesn't practice birth control; That's why in happy days like these, You see so many sons of B's! NIALL & COGHLAN Student, questioning a patient: "How PTY. LTD. many children have you had since your mar- riage?" Patient: "The bloody lot of course!" Medical Agents "How is it I find you making love to the cook?" his wife asked. "I don't know," he said, "unless it's be- Practices Transferred cause you wear rubber heels." Partnerships Arranged A patient consulting a psychiatrist Locum Tenens Provided learned that the fee would be £10 an hour, so in advance he drew an £100 check for 10 hours' treatment. When the psychia- trist looked at the check, he was amazed to see it signed "Napoleon." 127 COLLINS STREET "Of course," said the patient, "If I signed my real name, would I need you?" MELBOURNE Hear about the two peculiar judges? They Phone NV 1983

tried each other. DIRECTORS * * M. D. COGHLAN R. H. VAN ASSCHE The Girl Guide ran through the woods, with a bear behind. SPECULUM 1961 PAGE NINETY-TWO And the little downtrodden looking man United we stand, divided we fall. Eh! who timidly sat down in the psychiatrist's * * office and pulled out a cigarette. Without a The young doctor was taking his wife word, he carefully pulled the cigarette to out one evening, when a pretty girl smiled pieces, and stuffed the tobacco up his nose. and spoke to him. The wife, scenting an "Ah," said the psychiatrist, "can I help early love affair, inquired: "Who is the lady, you?" dear?" "Yes. Have you got a match?" "Oh, just a girl I met professionally." "No doubt," recoursed the wife, "but A bachelor is a man who comes to his office every morning from a different direct- whose profession? Yours or hers?" ion. * * * * Passionate kiss: When you stick your A young trapeze artist named Bract tongue so far down a girl's throat you taste Is faced with a very sad fact. the nicotine on your fingers. Imagine his pain * * * When again and again It's nice for children to have pets, until He catches his wife in the act. the pets start having children. * * * * * * A surgeon is one with no faith in nature's One doctor to another, in a military re- capacity to heal before the operation, and cruiting centre: "On the other hand, he's an infinite faith in it afterwards. not in any shape to be a civilian, either." * * * * * * Doctor: "Are you troubled by improver Husband to wife: "Sure you can have a thoughts?" fur coat. Who offered you one?" Patient: "No, I rather enjoy them." * * * * * * From Nurses' exam. papers: A rural schoolteacher drove up one after- 1. An ectopic pregnancy is a pregnancy noon to a combination gasoline-and-grocery in the Eustachian tubes. store characteristic of some more isolated 2. To disinfect stools, scrub them care- regions. Nobody came near her, so she got fully with methylated spirits and stand them out and approached a raw-boned farmer out in the sun. Who was dozing on the "loafers bench". * * * "Could you tell me whether or not I need She: I bet the men doing finals who are any oil?" she asked. going to get married after the exams won't The old codger turned his thoughtful gaze be able to do much work because of the on her, shifted his tobacco to the other excitement. cheek. "No, ma'am, I can't exactly tell if He (a Med.): Oh, getting married doesn't You need oil by just lookin' at you. But a worry Meds. good dose of oil never hurt nobody." She: Oh, yes, I suppose so. You do so * * * much already that the little extra doesn't "Look here, who said you could kiss me?" affect you. a girl indignantly asked her escort. * * * "Well," the guy answered, "if you must Notice on a church porch: know, just about everybody!" Owing to the great number of our young girls who have slipped and fallen of late, it Crossing the street one morning, I was is requested that the young men of the run down by an antiquated car literally parish refrain from throwing their banana skins on the footpath outside the church. overflowing with about a dozen children. Since the red light had been against the * * * Woman driver, as she came to a halt I Few articles are more expensive than a shouted: "Lady don't you know when to girl free for dinner. stop?" * * * Glancing back at the moppets, she Two homosexual spiders kept getting at answered icily: "They aren't all mine?" each other's flies.

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SPECULUM 1 PAGE NINETY-FOUR low "That young man of yours strikes me as Patient has been round Collins street, being a little unpolished, daughter." also Bourke street and consulted her "Yes, father. He's a little rough around friends. the 'edges." * * * * * "Breast milk bank"—look a bit silly He: "Please." going to make a deposit. She: "No." * * * "Just this once." Professor T.: "No, I said." Habitual aborter goes to the specialist "Aw, hell, Mum, all the other kids go who says: barefoot." "Between the two of us you will have a child." * * * * * * Breeches of Promise are not necessarily Aetiology of gastric mucosa in the oeso- Pants of Passion. phagus is the same as that of chronic cervi- * * * citis. A young man wanted to buy a present for his fiancee, and after much considera- Mr. Donald's Secretary has changed her tion, decided to buy a pair of gloves. So position. he went to a ladies' shop with his sister and * * * bought them. At the same time his sister bought a pair Mr. Mc. (on the relationship between of scanties, and when the salesgirl packed paraphimosis and infection): "It is a vicious them she got the parcels mixed, so his circle." sister got the gloves and his fiancee got the * * * scanties. Some of the representatives at the recent Sending them to his fiancee, thinking they Gynaecological and Obstetrical Conference were gloves, he wrote: in Melbourne were: "This is to remind you that I haven't Irish Representative: Luke O'Rea. forgotten you; and as you are not in the English Representative: Sir Vical Erosin. habit of wearing the enclosed, I send you French Representative: La Cont Racep- them. tion. "If it hadn't been for my sister I would * * * have got a larger pair, buttoned up the It happened at Footscray: back. This makes then easier to get on and Rising Resident (to boy complaining of off in the train or tram. The salesgirl swallowing a caterpillar): "Come back if showed me a pair she had been wearing for you get butterflies in the stomach." months, and in spite of the colour they were * * * hardly soiled. D.D.: Crutch palsy has nothing to do "I wish I could be there to put them on with the perineal musculature. for you for the first time. You will think * * * of me every time you wear them, won't You? Mr. H.: Become surgeons. Be men. , "I asked the salesgirl to try them on and * * * they looked very nice. When you put them Old girl having history taken, was asked away blow into them. if she was bedridden, replied, "Yes, They will naturally be a bit damp after hundreds of times." You have worn them. After a few times * * they will slip on and off easily. I hope you Quotable Quote: Will accept these in the spirit they are given Cade (on girl sent to Sunbury): "She was and will wear them to the dance tonight, as pathologically incapable of saying no . . . I will look at them. her genital tract was no stranger to the „ 'My sister says it is the fashion to wear Gram negative diplococci . . . she was a 'item undone and hanging down; lots of veritable Venus fly trap." People carry them in their hands instead of * * * Plating them on. "Pull down, tear up, 15 inches is ample." "Your beloved 99 —Sorbent.

SPE CULUM 1961 PAGE NINETY-FIVE A lecturer who is supposed to know all A Chinese farm couple named Wong had about sex was giving a talk on "The Facts 14 children but when the fifteenth arrived of Life" to a mixed group of teenagers and it was white. The father was very disturbed children whereupon a girl of about sixteen and went to the village elder to ask advice. stood up and asked, "Can I have a baby?" "How come I have fourteen children and "Yes," was the reply. the fifteenth is white?" he asked, distraught. Another girl of about fifteen stood up The elder shook his head. "I shall have to and asked the same question, in which she consult the sayings of Confucius," he said. got the same reply. Then a girl of about A week later the father returned to find five jumped up and asked the same ques- the answer. The elder looked at him slowly tion again. The lecturer was quite per- and declared: "Confucius say: Two Wongs plexed at this stage but he assuredly told can't make a white. It must be accidental." her that he did not think so. A little boy (about her age) who sat beside her said Heard in O.P.D.: confidently, "There you are, I told you not Woman: "I want an out-turn". to worry." Nurse: "No, you mean an intern". * * * "Oh, well, I want a contamination any- One day a little girl went into a candy way." store and asked the shopkeeper for a piece "No, no, you mean an examination." of chocolate in the shape of a boy. The "Alright, alright, in any case I want to go shopkeeper replied, "Why do you want a to the fraternity ward." chocolate boy and not a chocolate girl?" "No, no, it's the maternity ward you want. The girl replied, "It has more chocolate in "What the hell — out-turn, intern; con- a chocolate boy." * * * tamination, examination; fraternity, maternity. All I know is that I haven't Mr. B—y: I have been told that in order demonstrated for three months and I think to get the anal sphincter to relax, it is neces- I'm stagnant." sary to stroke it gently, but I've never been * * * able to bring myself to do it! * * * Darling, as Freud is true Mr. B. again (to 60-year-old man with And God's not up above, 21-year-old daughter): I'd swear to heaven that you "Bit young, isn't she?" Were my one and only love, "Yeah, but she was a bit of a mistake. If I wasn't going to bed With Fred. I've always been prone to accidents." * * * "Your wife younger than you?" "Actually, I'm on my third now—wore Visiting British surgeon, Mr. HedleY out the other two, and got rid of 'em. But Atkins, reports that the French name for don't you worry. I'm still as good now as peau d'orange is orange skin. I was at 30!" * * * * * The fastest moving object, next to a jet Mr. D.D.: "Has anyone besides Miss F. plane, is a nudist who has just spilled hot brought their tubes with them?" coffee on his lap. * * * Bugs Bunny has had a writ served for Item from an etiquette book: "A gentle; evading Income Tax. Seems he was man invariably follows a lady upstairs .. • stuffing his dough up a hollow log. * * * A mother is an invention of necessity. Speaker at recent convention (mixed audience): A woman's looks are as old as a man's "I have been asked to give a talk on Sex. feels. It gives me much pleasure." * * * He then sat down. Anon. A little danger is a learning thing. * * * * * * "What is the Lingula Copula?" Melbourne Herald, May 10, 1961: "The root of the tongue, I suppose." CAR BELTS FOR NSW PREMIER.

SPECULUM 196 PAGE NINETY-SIX

TEXTBOOKS 150

Discount

Over the past year students have been Anatomy School on Wednesday afternoons, able to obtain textbooks at 10 per cent. dis- and obtain a signed form on which is count from all city booksellers, but recently written the titles of the required textbooks. the Booksellers' Association has with- He is then able to present this form at drawn this service. However, the M.S.S. Collins' and receive his books at the re- Committee has arranged a co-operative duced rate. Negotiations are also under scheme with Collins Book Depot. This will way for the scheme to be extended to cover enable students to obtain textbooks at a dis- instruments and skeletons. Since the suc- count of 15 per cent. To obtain this ser- cess of the venture depends on the number vice students must see the committee repre- of orders received, it is up to you and your sentative, who will be available in the friends to help us to help you.

SPE CULUM 1961 PAGE NINETY-SEVEN "What you need is exercise. You should have a little sun and air. Better get mar- Photography ried first though." Two young matrons were discussing the number of women who seem to find older men attractive. One of the women com- In Action mented, "My grandfather was a perfect example of that. Women were crazy about him." "Is that so," said the second, "and how IN ART did your grandfather feel about it—did he enjoy their attentions?" "Well, not at first," was the reply, "but IN COMMERCE after a while it went to his head and he began to cut notches on his cane, one for every conquest. But I'm sorry to say that's IN INDUSTRY what killed him." "How do you mean, that's what killed him?" asked her friend. IN SCIENCE "You see," was the reply, "he made the mistake of leaning on his cane one day!" IN MEDICINE Two worms were fighting in earnest— poor Earnest. * * * IN EDUCATION "The Bishop said that in certain circum- stances adultery should be condomed."— Newspaper report. included in ILFORD productions are There was a girl with weak levatores ani PHOTOGRAPHIC RECORDING AND being treated at R.A.H. and told that soon COPYING MATERIALS they would be strong enough to crack nuts. Somebody had best be careful. For many years Words have played a * * * leading part in rendering photographic A pedestrian is a motorist who has suc- service to research workers all over the ceeded in finding somewhere to park his world and today the development of car. Ilford ensures a still greater productive effort. Then there was the ingenious soldier who obtained leave by explaining that his wife was going to have a baby. On his return his Captain asked: "Are the mother and baby alright?" ILFORD "What baby?" "The baby you said your wife was going to have." "Oh, don't be silly, sir, it takes nine Famous Throughout the World months." for Quality Did you hear about the psychiatrist who kept his wife under the bed because she ILFORD LIMITED was a little potty? Melbourne, Sydney, Brisbane, Adelaide, Perth Kept woman: One who wears all day and fox all night.

PAGE NINETY-EIGHT SPECULUM 1961

Being confined in a hospital for a com- Remember . . . "Prevention is better than plete check-up, Joyce, a very shapely blonde curette." was not surprised when a handsome chap * * dressed in white came in, pulled down the Histological anomaly—a ball of muscle! sheets and for some minutes looked her over. Shaking his head he left. Shortly he Science marches on! returned, pulled down the sheets and made A recently discovered method of deter- another examination. The third time he mining the legitimacy of pigeons: If the came in, the blonde in desperation inquired: birds are placed in a large cage and the "Say, what in the world am I here for, door opened, all the bastards fly out. observation or examination?" The chap in white replied: An innocent girl told us she was practis- "Darned if I know lady, I'm just doing ing squash as a man was trying to get up some painting in the hall." a woman's team. * * * It seems the elevator operator in a local Did you hear about: department store was quite a novice, pro- The med. student who kept his girl friend bably on his first tour. Suddenly the car out until the oui hours of the morning. Was brought to an abrupt stop. * * "Did I stop too quickly?" the operator Into a temperance hotel staggered a asked the passengers. drunk helped by his more sober friend. The "Oh, no, indeed," coolly replied a little manager looked at them in alarm. old lady in the rear of the car, "I always "You can't bring a drunken man in here. wear my bloomers down around my ankles." This is a temperance hotel." * "That's all right," said the friend. "He's The fair village was all agog over the too far gone to notice.' annual spelling bee. One by one the con- testants dropped out and even our fair A married couple were sleeping peace- schoolmarm was eliminated when she fully in bed when suddenly the wife shouted stumbled over "psittacosis." At last only in her sleep: "Good Lord! It's my hus- two remained, the village druggist and the band!" stableman, who was an Englishman. The husband, awakened by the cry, leapt They waited eagerly for the word. It out of bed and jumped through the window. Came: "How do you spell 'auspice'?" A young Lieutenant joined an Indian The stableman lost. Regiment. * * * "What's your name?" asked the Colonel. Did you hear about: "Cholmondley, sir," answered the Lieu- The new young woman golfer who tenant. thought that one-under-par was incest? "Any relation to Cholmondley of the * * * 62nd?" Do you know what good clean fun is? "Son, sir." No, what good is it? "Delightful. Married, Cholmondley?" "Yes, sir,—my wife was Miss Falking- ham." A prostatomegalic old gent was playing "Oh, indeed—Falkingham—any relation golf and of necessity was micturating fre- to Falkingham of the 65th?" quently. After some time he turned to the "Daughter, sir." Caddie and said: "Splendid. Have you brought your wife "What's the score?" with you to India?" The caddie replied: "I don't know about "Yes, sir, but now she's in her room with Your golf, but you're one up on the dog." cramp, sir." "What? NOT Cramp of the 73rd?" Heard at the Med. Ball: ". . . she wore * * * a dress with a neck-line low enough to They tell of the student who recently Make a baby cry." bought himself an electric "raiser".

S P ECULUM 1961 PAGE NINETY-NINE The differential diagnosis of this sad plight AIDS TO FINALS is, (Copyright in all countries signatory to the Acholuric, Physiological, Umbilical Sepsis, Berne Convention) Syphilis, Bile Duct Block and Hepatitis.

Keep Your Feet Still, To the tune of: What Shall We Do To the tune of: With The Drunken Sailor. Geordie Hinny. What shall we do with the yellow baby, Mrs. Jones of Blaydon had a baby last July, What shall we do with the yellow baby, And as bonny a bairn as you could wish to What shall we do with the yellow baby, see. Early in the morning. And all her friends and neighbours they could see no reason why Exsanguinary Transfusion, She shouldn't raise a healthy family. Exsanguinary Transfusion, Exsanguinary Transfusion, But they hadn't heard of Rhesus or the sub- Early in the morning. groups CDE, And they didn't know that Foetuses could Into the umbilical vein, drown, Put a catheter of polythene, They hadn't heard of Icterus and they If you fail you must try again, thought that Anti D Early in the morning. Was Mrs. Jones' sister Doris Brown. In and out with the 10 ccs., To the tune of: Excelsior. You can do it as long as you please, But Mrs. Jones was negative, If you're lucky you'll collect your fees, Little cde little cde, Early in the morning. And Mr. Jones was positive, Little c big DE; Hooray, the blood it rises, And so the doctors weren't surprised And everyone surprises, When Mrs. Jones was immunised, It's because we use catheters of bigger sizes, Little c and d and e, little c little d, Early in the morning. Little c but big DE, big D, big DE. Anti Anti Anti D-D-D. Now we have exchanged six hundred, The count's six million, so we can't have To the tune of: Waltzing Matilda. blundered, Through the placenta in hundreds and If you don't like the song there's nowt thousands, refunded, Antibodies freely cross, Early in the morning. Into the foetus, mucking up the red cells, Causing haemoglobin loss. To the tune of: The Dead March. But if alas the baby it should die, And comes to Bird for Au-top-sie, To the tune of: Lilli Marlene. Then shall we find: Low haemoglobin, high bilirubin, Hepatomegaly; Nucleated red cells as common as can be, Splenomegaly; Coombs' test positive, Wasserman is nega- Haemosiderosis; tive, Serous exudation; And in the serum free anti-D. Pulmonary haemorrhages; Bilirubin infarcts of the kidneys; To the tune of: Buttons and Bows. Lipoid streaking of the adrenal cortex; Examine now the new baby, Bilirubin staining of the basal ganglia, of For physical signs you'll find, the hippocampus and medulla oblon- Hepatomegaly, Splenomegaly, Jaundice, gata. Anaemia, some Oedema, Excess extra-medullary erythropoiesis. Petechial Haemorrhages on its behind. Peter Glenning.

PAGE ONE-HUNDRED SPECULUM 1961 100 Austr 5 Scientific discovery depends not on chance but on sheer hard work. A new drug, for example, is the fruit of lengthy research with a purpose carried out by highly qualified investigators. In the Geigy labora- tories, specialists in all branches

Geigy Pharmaceuticals of medical science perform Division of Geigy (Australasia) Pty. Ltd. thousands of experiments every at Hale Street, Botany, N.S.W. year. Their unceasing efforts (Tel. 666-9141) continue to open up new per- 189 Clarendon Street South Melbourne, S.C.5, VIC. spectives in therapy. (Tel. MX 2246) Geigy G62A Discovery and Development

SYNERMYCIN'' .. . discovery of Terramycin* after screening 100,000 soil TERRAMYCIN* samples . . . discovery of Tetracyn* (the original tetra- 'I'ETRACYN V cycline) and other antibiotics . . . demonstration of broad- TERRA-CORTRIL* scope antibiotic combination now finding clinical application DELIA-CORTRIL* in Synermycin . . . development of the first practical method CORTRIL* of deep vat fermentation which has assured a world-wide DIABINESE* sufficiency of antibiotics—behind all these arc the scientists VITERRA RANGE in the Pfizer research laboratories. OF VITAMINS* DARICON From their ceaseless searching and probing comes a never- ATARAX* ending flow of Pfizer therapeutic agents—bringing the fruits NIAMID* of research to all humanity—inspiring confidence and TYZINE* speeding recovery wherever people are afflicted, wherever VISINE* physicians practise. TOCLASE*

Science for the world's well being PFIZER CORPORATION

BOX 57, P.O., WEST RYDE

*Trademark of Chas. Pfizer & Co. Inc.

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Library Digitised Collections

Title: Speculum: 1961

Date: 1961

Persistent Link: http://hdl.handle.net/11343/24182

File Description: Speculum: 1961