Speculum - University of Melbourne

SPECULUM
MEDICAL STUDENTS' SOCIETY, UNIVERSITY OF MELBOURNE
1965
No 170
Registered at the General Post Office, Melbourne,
for transmission through the post as a Periodical.

SPECULUM
MEDICAL STUDENTS' SOCIETY, UNIVERSITY OF MELBOURNE
1965
Editor.•
Ralph Riegelhuth

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contents
Page
editorial 5
president, m.s.s. 6
behaviour patterns in childhood 8
fleet hermes and his magic rod 13
departmental reports 16
baldness, the poor man's alopecia 25
why psychiatry? 26
concepts of contraception 34
the contraceptive pill 40
approach to medicine 43
residents, and their salaries 46
diagnostic quiz — surgery 49
paediatrics 49
medicine 50
obstetrics and gynaecology 51
answers 54
miss medicine 57
medical students' society — committee and executive 58
chronicle, 1965 61
a.m.s.a convention 65
inter-faculty sports 67
i.f.m.s.a. 68
year notes 71
specula 80
medley's song 92
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editorial
In how many countries is it that the medical student, out of all the variety of the
university, who supplies the public at large with its archetypal image of the student? The
delightful stereotype, handsome and carefree, enjoying and indulging himself to the full in
sports, skirts and escapades; he may be smitten a month or so before the day with examination
fever that will keep him secluded in his room amid heaps of bones and dusty textbooks,
until he merges successful from the ordeal, to plunge once more in to the hectic mood of
jollity.
Few medical students will recognise this picture; perhaps it was true once, but higher
education in the 1960's, even for the medical student takes place, alas, according to very
much different models. We are frequently told that the whole structure of the university
population has changed in recent years. Whilst a large number of students still come from
the classes with a cultural tradition, far more are now coming from middle and lower classes.
This, of course, brings in itself many problems, but is this sufficient to excuse our present
public image, and on critical inspection of our own personal image? There are many facets to
this image, and while it may not be peculiar to our own university, one such facet warranting
attack is our deplorable lack of any real understanding of the English language and its
usage. It seems that it is no longer necessary to be proficient in the mother tongue before
specialising at the university, or even whilst specialising. Students seem to regard their deciplines
as ends in themselves, regardless of all else. I do not think that this is a problem
that can be entirely blamed on to the failings of our schools. Anyone who is intelligent
enough to reach the university should have the ability to appreciate and apply some of the
basic principles of writing English, even if it is only the simple practice of reading aloud
what has been written to see if it makes sense.
All this is but a particular expression of a more general problem, which may be due
partly to the changes in the nature of the student population and partly to the fact that in
an affluent society the majority of the students come by things easily, that they no 'longer care
about refinements like literature. Perhaps much can be blamed on our traditional Australian
suspicion of anything intellectual as being "pseudo"; traditional in the sense that we all succumb
to this attitude. We may quietly agree that intellectual things are worthwhile, but we
may not want anything to do with them.
Undoubtedly all of us have to do essays or similar written work at some stage during
our course, and this must necessitate some understanding of the mother tongue, but it seems
very doubtful whether we are able to extend our understanding of English to cover things
outside this narrow field. Consequently we must always endeavour to make the most of our
courses, not only because the degrees gained will find us employment, but because our courses
for the most part will be our only chance to gain any sound and concentrated education. A
medical course is but a narrow part of an education, the major part being self education in
wider fields. Some may say the course is too demanding to allow time for anything else,
but look closely and see how much spare time there is. There is a very great need to consider
thoroughly all aspects of life, and to make an endeavour to work out what we are trying
to do, whether what we are trying to do is worth doing, and how we mean to do it.
Perhaps the medical student of today can, after all, serve as the archetype for the rest
of the community.
—R.C.R.
Queen's College, N.2.
5

president m.s.s.
professor v. I. collins, m.d., b.s:, m.r. c.p., f.r.a.c,p:, d.ch:
The President of the Medical Student's Society this year is Professor V. L. Collins.
This is his second period as President—he previously held the position in 1961, shortly after
he had taken up his position as Professor of Child Health.
There has been a change in Professor Collins' title, however, for last year the name of
the Stevenson Chair was changed from Child Health to Paediatrics. There were a number
of reasons for this and foremost among these was the simple fact that the term paediatrics
was in common use—anyone commenting on this field of education spoke of the teaching
of paediatrics, the students were faced with examination questions in paediatrics, and there
were special fields such as neonatal paediatrics, paediatric surgery, social paediatrics, and
so on. Paediatrics literally means treatment of the child. In the U.S. and Europe, chairs
in this field are in paediatrics, but in England, in order to emphasise the preventive and
social aspects of child care, the term child health was used. Today, however, it is generally
accepted that just as the study of medicine includes all aspects from preventive medicine to
clinical and curative medicine, so we have preventive aspects and social aspects of child
health included in the term paediatrics.
Professor Collins would be amongst the first to acknowledge the changed emphasis that
has developed in paediatrics with the control of so much serious illness of childhood, particularly
the infective diseases which were the cause of so many deaths and physical handicaps
which are now prevented. During his medical life, he has witnessed the remarkable
changes in health brought about by the effective introduction of immunisation practices and
the results of antibiotic therapy, and the effects of good nutrition.
These changes, however, have made it clear that many paediatric problems today have
their origins in community and social problems; there is concern for emotional health as
well as physical health—patterns for adult behaviour and emotional reactions are laid down
in childhood. Professor Collins emphasises that the child must be understood and helped
in the context of the family, and the family as a unit in the community.
On the other hand, advances in biochemistry and micro techniques in the laboratory
have made it possible to measure the quantities of numerous substances in a few drops of
blood obtained from a skin prick, and have advanced greatly the scientic aspects of paediatric
medicine.
Professor Collins is deeply interested in changes in the medical curriculum and is at
present Chairman of a Faculty Committee concerned with changes in the first year curriculum.
He believes that students should come to the clinical years with a greater knowledge of the
behavioural sciences and a greater knowledge of the society in which they live.
6

ehaviour patterns in childhood
dr. john court
Gesell has stated that the behaviour pattern of a child is a definite response of the neuromotor
system to a specific situation. A study of this behaviour pattern is a means of establishing
a child's mental and neurological status and as growth implies change, so behaviour
patterns change with increasing age, and each age of childhood has its appropriate pattern
behaviour.
Interest in development patterns in children has been stimulated by a number of recent
advances in paediatrics. Principle amongst these has been the growing awareness of the
influence of emotional factors in inhibiting full development of the child, even in early
infancy. The accelerating biochemical knowledge of inborn and acquired metabolic disorders
has led to the recognition of a growing number of preventable or treatable metabolic causes
of mental retardation, and this renders early detection mandatory. Continuing vigilance in
obstetric care, and attention to the infant in the perinatal period have as one of their yardsticks
of success the satisfactory development of the infant. Finally, in Western medicine, at
least, the ability to control infection by prevention or chemotherapy, and the ability to control
and correct body fluid and electrolyte homeostasis, have led to greater leisure to investigate
and treat less dramatic, but equally challenging, aspects of paediatrics, such as the development
of human behaviour.
In 1960, Professor Illingworth, of Sheffield University, pointed out, in emphasizing the
neglect the study of child development was receiving, that a recent textbook on paediatrics
devoted approximately 3,500 words to the subject of congenital syphilis and only 90 words
to the subject of normal development and none to its variations. Congenital syphilis is a
condition of extreme rarity in our society, but mental retardation and emotional disturbance
is of increasing importance and concern to us all, and knowledge of the normal is necessary
for understanding the abnormal.
The developmet of children is largely an expression of four major factors: first, the
integrity and maturity of the nervous system, secondly the child's emergent personality,
thirdly the influence of environment factors on its expression, and finally the education and
stimulation to which the child is exposed.
Clearly the integrity of the nervous system is fundamental to the child's normal development.
The brain damaged child is likely to be retarded intellectually, and thus will achieve
developmental milestones late, if at all: the degree of retardation of development is likely
to reflect the degree of brain damage present. Specific defects of the nervous system may
show specific defects of development. The deaf child may achieve motor patterns such as
crawling, walking and manipulation early, but speech may not develop at the appropriate time.
Similarly, the child with a visual defect may seem normal until school age, when he fails
to develop reading skills. Of course, a deaf child may be intellectually bright, but his delayed
speech and understanding of speech and vacant impression may make him appear dull.
Although anatomical integrity of the nervous system, which may be affected by inherited and
congenital factors, accidental injury and disease, sets the stage for a child's development,
his environment has an overriding influence on his behaviour.
8

For the first few months, at least, the mother's handling of her infant, and her attitudes
towards him are paramount. As his awareness and contact with the rest of the family increases,
so their influence becomes more important. The child's position in the family may
be significant at this stage: the only child may have more attention and stimulation from
adults than one of a large family, and only children have been reported to be more intelligent.
The youngest child may be babied by his siblings, and the second child may be overshadowed
by his more advanced elder brother or sister, and frustrated in his attempts to
keep up, and so on.
Similarly, the father's role increases, both as a source of emotional security for the
mother and child, and as a source of affection and stimulation in the acquisition of new skills
and abilities.
The parents' attitude to the child, and their own emotional state may profoundly affect
his pattern of behaviour. The infant is peculiarly vulnerable to maternal influence (and to
deprivation) and this influence may well be of lasting effect. Observation of behaviour
patterns that vary substantially from normal at this age may be important in suggesting
faults in the parents' care and attitudes, and clearly this is the age at which guidance and
help may have the greatest prospect of helping the child's development into a normal and
well adjusted individual.
Numerous observations of infants' behaviour at various ages have led to the understanding
of certain broad principles in the development of behaviour.
First, development of motor control extends to a cephalocaudal direction. Control of
the head precedes control of the arms, which precedes that of the hands, trunk and later
legs. The infant is born with the ability to move the head in search of the nipple, and suck
and to swallow—all cephalic reflex actions, but has only the crudest ability to control arm
movement until the age of about sixteen weeks.
Secondly, development follows a pattern, and there is some correlation of behaviour
within this pattern. A normal child who has reached a certain level of motor development
will also have progressed to a similar stage in adaptive, social and speech development.
This must be qualified slightly in that spurts of rapid growth in one direction may be accompanied
by a stationary plan in other directions. This is only transient, however, and gross
deviation from the normal pattern should lead one to suspect specific defects in neurological,
psychological or skeletal integrity. It follows also that each stage must be passed though
before the next: it is quite literally true that a cnild must walk before he can run, and clearly
if he walks on time, he will probably run on time.
Growth involves, not merely increase in size, but increase in maturity. With maturity
of the nervous system tomes development of function and attainment of new abilities. These
allow characteristic patterns of behaviour.
In the infant, development can best be determined by appreciating patterns of behaviour
and how he behaves reflects very largely his physical, intellectual and emotional status.
It is convenient and conventional to consider behaviour under four headings for test
purposes. These are:
1. Motor development.
2. Adaptive behaviour.
3. Language development.
4. Social behaviour.
Motor development refers to the child's motor control—his ability to support his head,
guide his arms, stand and walk.
Adaptive behaviour describes how he uses these attainments as functional skills. This
is dependent on the development of more complex neurone connections and the competence
of memory. His ability to grasp allows him to use a spoon. His ability to place objects in
relation to one another enables him to build a little tower of blocks and ultimately a house,
or a bridge or a car.
Language implies communication. It starts with the child listening to sound. and making
unformed, throaty sounds himself at about four weeks, and it extends through babbling
to speech and comprehension, and to the contemplation and conveying of abstract and
reasoned thought.
9

Social development of the child, while still an index of his maturity, is overwhelmingly
influenced by his social environment and by his personality and temperament. It is the
response of the child to people and to society. His first smile at six weeks is an important
social landmark, and in time his patterns of play, his ability to dress himself and cope with
toileting, will measure his early social development.
There is a considerable documentation of behaviour patterns at various ages through
infancy and childhood. It is convenient to take a few key ages, and the following brief
outlines of behaviour at these ages represent a summary of what is regarded as normal
human behaviour.
At birth the infant, though almost totally dependent and unaware of his environment,
has a defined pattern of behaviour which can be observed, and set as a standard for assessment.
He sleeps most of the day, but wakes at intervals with hunger. A number of complex
reflexes are well developed, notably those related to feeding, such as crying, moving his
head towards contact in search of the breast, sucking and swallowing fluids.
Special senses, while present, are poorly localized, but the infant will, for instance, suck
on a sweet stimulus but grimace and reject a salty one. Many other less organized motor
reflexes are present and form the basis for a host of tests designed to demonstrate the integrity
of the nervous system.
At four weeks the infant regards his environment with a vague and staring gaze. He
indulges in symmetrical windmill-like movements of his arms and legs, and pursues objects
briefly with his eyes, but not with his hands. He responds to a social approach by attending
to and regarding his observer, and in the next two to three weeks he will start to .smile. His
earliest attempts at language are now apparent as little throaty noises.
At sixteen weeks he is far more alert. He is interested in his surroundings and looks
intently at his examiner. He, has greater control of arm and hand movement, and this allows
him to clutch a small object in a firm grasp. He is very social, but not discriminatory in
his social reaction, and laughs aloud, cries and squeals according to his mood, indicative of
his approach to communication.
At six months he can sit with support, having advancing trunk muscle tone. He has
improving manipulation, grasping crudely but effectively one or two objects, transferring
them readily to the mouth. A small pellet he cannot manage, but he can rake this along a
flat surface with his hand.
His speech has advanced to the point where he can make vowel sounds, and when
miserable he vocalises "m-m-mum": this his mother interprets (incorrectly) as his first meaningful
word and takes for herself. In his social development he is discriminating strangers,
and he is delighted with his mirror image.
At twelve months he sits unsupported, pulls himself to his feet, crawls and may walk
when only one hand is held. He can manipulate and combine a number of objects, understanding
the purpose of a container and the use of a spoon. This, together with his desire
to place objects in his mouth, sets the stage to learn to feed himself. Speech has advanced
appreciatively and now "Mum" and "Dad" and one or two other words can be spoken and
have meaning. He understands and obeys simple commands.
At eighteen months he walks unaided and uses a chair and table. He looks at pictures
in a book and can build a small tower with three or four blocks. He can hurl a ball, and
scribble with a pencil, but without form in his scribble. He feeds himself, rather messily,
and co-operates with toileting and dressing. He expresses himself better and can use about
ten words appropriately.
At two years he has become much more physically active, and his behaviour has become
unpredictable and variable, according to the mood of the moment. He can now run,
and kick a ball. He acts out scenes from home with his play or toys, names pictures in
a book, and speaks his immediate needs and experiences in simple phrases. He is content
to have other children near him so long as they don't interfere, and he has a well marked
sense of possession: "it's mine" characterizes his obvious lack of social grace.
At three he is developing better bodily control, and this allows him to build a tall tower,
show simple form in his drawing and pedal a tricycle. He is now more interested in other
children, can take turns and likes imaginative play. He can dress himself if he is helped
10

with buttons and orientation of clothes, and his vocabulary is very extensive, his speech facile
and he knows a few nursery rhymes.
At four his behaviour is notable for its high drive and energy, but inconsistent in performance.
His social sense has progressed and he plays well with other children. He likes
to tell tall stories and indulges in name calling, but is capable of simple logic questions "how?"
and "why?" rather than just "what?"
The five year old is thoroughly embarked on the preadolescent phase between infancy
and puberty, and developmental change will now be relatively slow and more of degree
than new development. Now he is more independent, co-operates well with others, accepts
formal teaching and concentrates and works hard. As he enters school, variations in personality
adjustment will be more apparent, and formal school achievement will aid in assessing
his intellectual development.
Though we accept the need for detecting early signs of delayed mental development, it
is often disputed that prediction of ultimate intelligence can be made with any degree of
precision in the first year of life. So many factors may influence how a child performs at
a particular stage, that we can only give a statement of the child's current status. If this is
normal, we can reassure ourselves and the child's parents. If development is retarded, then
we must make a prediction of the ultimate mental state by consideration pf all factors,
such as the parent's intelligence and emotional state, the presence of associated biochemical
and anatomical abnormalities and the knowledge of the natural history of disease. Then
some basis for investigation and treatment exists, and some possibility of an informed prognosis
presents itself. Only careful observation, with the passage of time confirms or confounds
us.
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12

fleet hermes
and his magic rod
dr. bruce robinson,
m.d., m.r.a.c.p.
Caduceus is the wonderful staff that was carried by the Greek god Hermes, and his
Roman counterpart Mercurius. It consists of a rod supporting two opposed serpents. Sometimes
it is used as a medical symbol, but incorrectly so, for as earlier shown (Robinson,
1960), the true medical symbol is the staff of Asclepius (Aesculapius) with its single serpent.
It carries, however, other important meanings. Some of these derive from attributes of its
bearer, others are its own.
Hermes was born as a result of some blissful hours of dallance between Zeus, who
never was a strictly faithful spouse, and Maia, a goddess of the plains. His first day of life
was unusual, for he stole Apollo's cattle, but he was able to placate his half brother with a
gift of the lyre, which already he had invented. In return, Apollo gave Hermes his magic
wand, which had the power of reconciling conflicting elements. In its oldest form it was a
shepherd's crook made from an olive branch, with the terminal shoots knotted together and
adorned by ribbons. These were replaced by the snakes, when Hermes finding two knotted
together while fighting, tested it by separating them. In amity they wound themselves around
it, and the rod thus crowned, became Cadaceus, symbol of the peace maker.
A darker version was given by Eliphas Levi (1913), who told how Tiresias of Thebes,
while walking in the fields, saw two serpents coupling. Mistaking union for warfare, he
wounded them by separating them with a stroke of his staff. Through this outrage against
Nature, he lost his own equilibrium, and became a female—he had not understood the
symbolism of the cadaceus, which illustrates the union of opposites, as of male and female,
intelligence and love, science and faith. Years later, again he separated them. This time he
reverted to his original sex. He now was asked to settle an Olympian dispute as to which
sex had the greater pleasure in love. He decided for the female and thus so angered Hera
that she struck him blind. However, Zeus recompenced this loss of outward sight by the
gift of in-sight or prophecy.
In his earliest form, Hermes may have been the demon or spirit of a stone set up by
the roadside for fertility or magical purposes. Later on, these hermes, carved with a human
13

head at the top and an erect membrum virile on the front, were used to mark boundaries or
cross roads. Thus, he became the protector of merchants, thieves and others using the roads.
Indeed, his broad hat and stout sandles show him well equipped to be god of travellers.
When wings are added to these and to his staff, he becomes the swift messenger of the gods,
the transmitter but not the originator, the channel rather than the source, the Logos, the
catalyst. rHe therefore was Hermes psychopompos, conductor of souls over another crossroad,
that into the underworld.
Sometimes he also was called Hermes oneiropompos, guide through dreamland; for the
Greeks who fashioned him, intuitively anticipated modern thought, which regards both myths
and dreams as projections, projections of unconscious contents. We therefore now can ask:
"Had T dreamed this story, what would its meaning be?" and then attempt to analyse it, and
perhaps even find an answer. ,Also, as myths with their recurring, universal and immemorial
contents, may flow from those antique, ever-present elements that Jung termed archetypes of
the collective unconscious, the meanings we now discover, might be the same as when first
projected. If, indeed, the attributes with which Hermes was invested represented these
universal archetypes, they should be found in the gods of other pantheons; and this is so.
As men gradually ceased to believe in these collections of gods and goddesses, the projections
which previously had been attached to them had to be withdrawn to fall back into
the unconscious, unless other hooks for attachment were discovered. Astrologers found
these in the heavenly bodies, where the swift-moving planet Mercury then held their imaginings.
The alchemists used the quick metal of that name. In their Hermetic Philosophy
they personified it as Mercurius, the amalgamator, without whose guiding presence the
conjunctio could not occur for the opus to proceed. Christ, too, provides a safe resting place
for these contents for he also is messenger, transmittor, catalyst and guide.
What happens, would you say, to him who has rationalized away all these hooks? On
which psychopomy can he now call, to guide him through the mysteries of the underworld,
the night side of his nature, or that part of his mind from whence these images spring?
Hermes also was the god of magic and science, but the Hermetic books, which dealt
with these subjects, collected about another Hermes, Hermes Trismegistus, or Thrice-greatest
Hermes, who is supposed to have lived in Egypt at about the time of Moses. He may once
have been a real man, but the legends with which he gradually became encrusted, i.e., which
were projected on to him, once more are those of Hermes and of his Egyptian counterpart,
Troth. He became regarded as the father of alchemy and the natural sciences; and the
hidden mysteries were his domain. Medicine had some roots in the Egyptian school, for
Asclepius is said to have studied there, as some of the Hermetic books are in his name.
One need not remind a sophisticated reader that the magic wand Caduceus, the talisman
wherein lay Hermes' power, is a phallic symbol. However, as with all such symbols, it is
important to recognise that it stands not only for the phallus itself, but for all the things
this number represents, such as strength, authority, mastery, control, virility, the active
principle, creative power, intellect or light. It is the omnipotent sceptre, the badge of rank
and authority, the marshall's baton, magician's wand, ring-master's whip and rod with which
Moses struck the rock, being the channel through which the mana is directed. Like any
phallic symbol it may carry one of these anxious meanings: "If only I could find it, all would
be mine," or else, "I now have it, but it might be stolen," or more sadly, "What once was
mine has now been taken from me".
A single serpent might well carry any of these, but two bound together will be rivals, such
as were Cain and Abel, of Jacob and Esau; or allies as Garth and Prof. Lumiere; each providing
qualities the other lacked, to make a unity. These pairs thus symbolize two sides of
one personality, of yours or of mine. In Caduceus they are equally balanced, but as a rule,
one will hold the stage at the expense of the other. One will be superior, the other inferior.
Thus, Marshall Dillon is the one we might hope to be, while Chester is the one we often fear
we are, and his follies may seem to justify our own. At other times, one of the pair might
represent intellect and consciousness, and the other, instinct and the unconscious. Mandrake,
with his shadow, Lothar, the giant Nubian, would well represent these.
Eastern philosophers also know that too little or too much is unhealthy; whether it be
14

of discipline or freedom, love or hate, aggression or or submission. Like Hermes' rod between
the serpents, their Middle Way lies between the extremes. It leads to peace and content, and
when the tension between the opposites is eased, to stability and, ultimately, to Nirvana.
The word symbol means thrown together. This has been well illustrated by our caduceus
with its many implications. But whether it is seen to represent a simple herald's wand or
the complicated state of affairs discussed, will depend on the eye of the observer, or, rather,
on which spectacles he is wearing at the time; rose coloured, dark, foggy or clear. If these
admit enough light, his mind could be illuminated by all these things, and his inner depths
stirred by a glimpse of the great god flashing by. This is why such symbols have persisted
since those ancient times when first they were evolved, and why they serve today as well as
they did then.
References
Levi, Eliphas (1913), "The History of Magic", Rider and Company, London.
Robinson, B. (1960), "Our Master Asclepius and His Wonderful Serpent", Speculum.
165:18.
Fig. 116. Mercurius as "uniting symbol."—From Valentinus, "Duodecin1
clave•:," 6, ix, p. 396.
NOTE —
The appearance of the "Speculum" has changed considerably since the last edition. We
have made these changes in order to present our material in a more attractive and interesting
fashion. The Editor will be pleased to hear your views on the "new look" "Speculum".
Queen's College, Parkville, N.2.
15

departmental reports
physiology
When the Editor invited me to contribute to "Speculum" and to say something of the
research activities of the Physiology Department I accepted with pleasure. The deadline for
receipt of my manuscript was still some months away and I felt it desirable that medical
students have a readily available summary of the various investigations of the Department.
It was only later, when the implications of the request became more obvious that there arose
the much more fundamental question as to why it had been made. At the risk of breaking
faith with my Editor and of failing to inform my readers I have decided to say nothing of
the experimental existences of dogs, cats, sheep and rats, of mice and men. Rather have I
chosen to speculate.
Editors solicit copy for many reasons. Occasionally, though possibly not in this instance,
the motive may be solely to fill space. Readers, a priori, expect to read. The daily press
and the weekly magazines which proliferate in a manner most unseemly bear eloquent witness.
At other times the motive may be to publish an author perhaps with nothing to say
who can be relied upon to do so with artistry and grace. "Speculum" has a wiser and more
perceptive Editor. Clearly, he felt there should be communication of ideas about the workings
of a large Pre-clinical Department to the Medical Students who are of its substance and
justification.
Arrival at the conclusion that Medical Students desired, but felt they had not already
obtained from other sources, an idea of the research activities of the Department, was most
disturbing. For students in the first year of their course this was understandable. They,
however, would probably still be integrating themselves into University life and would be
unlikely to be seeking detailed knowledge of disciplines they had yet to encounter. For
students in the second or later years of their courses, or any significant number of them, to
need an outline of Departmental research so brief that it could be given in an article such
as this was a grave indictment of our teaching system. If it were true, then there was a most
serious break down of communication, extending over five terms, between staff and students.
Lectures, Practical Classes, Tutorials, Hospital Classes, are all occasions of contact between
senior and junior staff and medical students. The contacts are both formal and informal and
range from an hour to all day. Could it be true that these contacts were so superficial that
students learnt nothing of staff research? Could it be true that a lecturer gave nothing of
himself, nothing of the work of his colleagues? Was his teaching only a sterile recapitulation
of text book material, copied year after year from the same sources, though possibly
modified after the publication of new editions? These were very serious questions which
demanded critical answers.
The staff of a large university department has varied interests and varied functions. Some
members are engaged solely in research and rarely meet undergraduate students. Whether
this is entirely desirable either for research worker or for student is a question too large for
adequate consideration in an article such as this. It should be remembered, however, that
such full time research workers have intimate contact with post graduate students and with
their colleagues engaged in teaching and research. The research activities of full-time workers
should thus be well known to all undergratuate students and should colour all teaching. It
is possibly in this field there is the greatest need for more direct information and contact.
The information and contact is already present, but the lines of communication could on
occasions be shortened. The further encouragement of students to have a look at the
experimental work of full-time research teams and of full-time research workers to talk to
students about their work, both in formal lectures and in informal discussion could be of
great value to all.
16

Apart from the full-time research workers in a university department all members of
the teaching staff are undertaking research work, sometimes as members of a large research
team, sometimes as individual workers. All undergraduate students are in daily contact with
teaching staff members and hence are daily exposed to their research interests and findings.
But more importantly, in their daily contact with their teachers all students should be exposed
to the research interests of all workers in the Department and of other departments not
only in this University but also of Monash University and the various Research Institutes.
Here again possibly more direct contact could profitably be arranged from time to time but
a great deal of the research being undertaken in Melbourne and elsewhere must be presented
to the student by his teachers. If we who teach are failing in this presentation of research
findings then we deserve student censure. If students are failing to avail themselves of opportunities
to observe and participate in the research of the University and of other institutions
in the belief that "it is all in the texbooks, anyway," then they deprive themselves of the benefits
of being members of a university. A university is an assembly of scholars seeking to
learn—let us resolve, teacher, research worker and student alike to try to be all three, for
only then will we deserve to call ourselves scholars.
There exists in this university an excellent publication which appears each year under
the title "Report of Research and Investigation". It currently runs to some 300 to 400 pages
and it gives an account of all research projects and of all the publications for the year of
each of the University Departments. These are very much the "thumb nail sketches" which
I have failed to present in this article. May I commend it as a beginning to those readers
who feel they know little of the University Research Interests and who would like to learn
more.
anatomy
There are many exciting and significant fields in which anatemical research is being
carried out throughout the world and in the School of Anatomy several of these are well
represented.
Spectacular advances in science have been made with the aid of the electron microscope
laboratory several years ago. Since that time the .fine structure of autonomic nerve
fibres in smooth muscle, and the organelles in glycerol extracted skeletal and cardiac muscle
with the Department of Zoology and the Baker Medical Research Institute at the Alfred
Hospital.
On the embryological side, work has been proceeding for some years on the chemistry
of the earliest stages of the development of the nervous system and also on the congenital
anomalies which are associated with the cases of spontaneous abortion.
Physical Anthropology is well represented, both in the large collection of Australian
Aboriginal skeletons, and also in the very active Child Growth Study. In the study, the
techniques of physical anthropology and radiology are combined in a longitudinal study of
the growth of normal and abnormal children, the dietary factors in growth being assessed
by the School of Biochemistry. As a result of this work, practising physicians and surgeons
are enlisting the aid of the anatomist for the assessment of the growth potential and the
changes which occur in children who are too tall or too short or who have limbs of unequal
length.
More traditional methods are used in the study of the pineal body and its neurovascular
relations, and in the study of the musculature of the pelvic floor, a region which is of great
interest to the practising surgeon. Also of surgical interest is the use of infection and radiological
techniques in the determination of the distribution of the (blood vessels within the
vertebrae and the long bones.
On the historical side, material is being collected for a history of anatomical teaching
in Britain, while the history of our own medical school is nearing completion. A tribute to
17

the value of this work lies in the recent gift to the University of £25,000 for the construction
of a section of Medical History in association with the new Medical Library, now under
construction.
While most of what the undergraduate student needs to know of Anatomy has been
accepted for many years, it may be of interest to note that, during the past five years, the
staff has published three books and 49 articles and that research is being supported by the
National Heart Foundation and the National Health and Medical Research Council, as well
as from university funds.
biochemistry
The very essence of research is to ask questions which are capable of being answered
and which lead to the next question. In those parts of the Russell Grimwade School of Biochemistry
which are only rarely visited by undergraduate students, research of this kind is
going on into many different types of problems.
The thyroid hormone, thyroxine, is stored in the gland as part of a large protein, thyroglobulin.
A reasonable question to ask here is how thyroxine is released from the protein.
As it seems likely that proteolytic enzymes are involved, Professor V. M. Trikojus, Dr. M. T.
Quillan, Dr. P. E. E. Todd and their students are probing into the properties and distribution
of the array of peptidases and proteinases which are present in cells. Also, they are
investigating the sizes and sorts of peptides produced by these enzymes from thyroglobulin.
On the third floor is the yellow world of sulphur. Here Professor F. J. R. Hird and
his group watch the polarograph as it traces out the curves which represent disulphide bonds.
The three dimensional structure of proteins is stablised by the interactions between the
"R" groups of the amino acids. One of the most stable of these bonds is the disulphide
bond formed between two cysteine residues. However, cells contain a tri-peptide Y-glutamylcysteinyl-glycine
which can disrupt these bonds by means of the following reactions:—
Professor Hird and his students not only wonder about these reactions, they also like
to think about rumens and why, here, fatty acids are turned into acetoacetate. What are the
advantages of rumens for humans? As well as all this they manage to keep alive a spirited
controversy about the movement of amino acid nitrogen as it is metabolised in tissues before
it is finally excreted as urea.
Dr. P. R Carnegie has one foot in the yellow world as he looks for disulphide peptides
in wheat flour, but he is also interested in the small basic peptides which can be obtained from
spinal cord. These can be purified by high voltage electrophoresis and ion exchange or exclusion
chromatography. Even a minute amount of these pure peptides can cause paralysis in
guinea pigs and it is thought they may be associated with an autoimmune disease which is
related to multiple sclerosis.
Dr. C. A. M. Mauritzen's group is interested in basic proteins rather than peptides:
that is, the chemistry and function of histones. These proteins are found in association with
DNA in the cell nuclei of higher animals. There is some biochemical evidence that histones
18

are cell specific and that they inhibit the biosynthesis of messenger RNA. Thus it is possible
that they may control cell differentiation by selectively inhibiting the transcription of genetic
information from DNA.
Dr. L. R Finch and his team also ask why cells differentiate and what changes occur
when they do. As well as this, they would like to know how cells produce a specific antibody
in response to an antigen. Not only do plasmacytes know when to do this but they
apparently have the precise information available to synthesise the correct protein to combine
with a specific antigen.
Another aspect of this work is concerned with the amino acid analogues which are lethal
to bacteria and which may lead to information about mechanisms for the control of the
production of RNA for protein synthesis. In conjunction with Mr. J. W. Legge and his
students this group is asking question about the replication of DNA in bacterial chromosomes
and how mistakes in genes can be rectified.
The biochemistry of bacteria is also being investigated in Dr. G. R. Jago's unit and here
for the extremely practical reason of finding why the flavours vary during the ripening of
cheese. They are asking the following questions: How do the populations of bacteria wax
and wane during this process? How do the enzymes vary? What compounds are formed
which activate or inhibit the various enzymes? What are the changes in fat and protein?
Why should oleic acid affect the metabolism of pyruvate?
Mrs. A. J. Cahn, who is in charge of the Nicholas Nutrition Laboratories, is the person
whose research, naturally, is most concerned with food. In her laboratories a long term
survey is being undertaken. It deals with the rate of growth of children and how this varies
with diet and how food intake and energy requirements can be correlated.
Dr. R. W. Henderson and his group are also interested in energy. Their work is concerned
with studies of the electron transport chain and especially with the structure and
function of cytochromes. What part does the protein play in the transport of electrons?
How do the proteins and porphyrins differ in different cytochromes? Has it occurred to
you that man lives by making water? These are the sorts of questions they are asking.
Cytochromes are Associate Professor W. A. Rawlinson's interest, too. But he is also
curious about the valency changes of the copper atom which replaces iron in the blood pigments
of Crustacae.
Carbohydrates and carbohydrases occupy Dr. B. A. Stone and his colleagues. They
grow tobacco and pearl barley and cultivate tiny Euglena protozoa. They talk about pachy
man, laminarin, lichenin and paramylon. Their work is complicated by the fact that the
enzymes they wish to purify hydrolyse carbohydrates. Many an enzyme has been isolated
by the use of columns of cellulose derivatives followed by dialysis in cellophane bags. A
moment's thought is enough to realize that carbohydrates present a special problem.
In Dr. F. D. Collins' laboratory questions are being asked about the role of fatty acids
in cell structures. Membranes are made of protein and phospholipid. Since animals cannot
synthesise certain unsaturated fatty acids which occur mainly in phospholipids, these
must be supplied in the diet. How do mitochondrial membranes of rats deficient in essential
fatty acids differ from those of normal rats? Why do the deficient rats develop fatty
livers? How does the metabolism of liver, kidney, heart and brain differ from normal rats?
Asking such questions, Dr. Collins hopes will help throw some light on diseases caused by
alterations in cell membranes.
This, then, is a brief summary of the projects being tackled in the Russell Grimwade
School of Biochemistry. To pursue these problems careful and thoughtful analytical work
is required, together with specialised equipment—high speed centrifuges that operate at constand
temperature, ultracentrifuges which will separate different protein molecules, recording
spectrophotometers, automatic analysers and radioisotopes and expensive counting equipment.
For these we need money. But also for our research we need time, we need opportunity for
discussion, and we need the stimulus and help of young postgraduate research students.
Currently, 38 members of the School of Biochemistry are engaged in research, including
23 who are proceeding to higher degrees.
19

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20

pathology
As we have no responsibility for providing a routine pathological service to any of the
teaching hospitals, and hence no automatic access to biopsy or autopsy material, the research
interests of members of the department lie largely in the field of experimental pathology.
For this type of work a wide range of equipment is available, enabling problems to be
studied by most modern techniques. In particular facilities exist, and are in current use,
for electron microscopy, autoradiography, spectroscopy and related biochemical techniques.
micro-dissection and histochemistry.
Dating from a time when facilities for research in Melbourne were much more limited
than they are today, this department has encouraged members to pursue their individual
interests rather than concentrating on a "departmental" line of investigation. Some of the
chief topics of current research may be brieflly listed as follows:—
(1) Experimental carcinogenesis, in particular the chemistry and mechanism of action
of the aminoazo dyes, and the relationship, if any, of the tumours induced by them to
tumours caused by viruses such as polyorna.
(2) The morphology and mediators of acute inflammation—in particular the distribution
of increased vascular permeability in different types of tissue injury, the fine structure
of inflamed vessels, and the mediators of the cellular responses.
(3) The production of developmental defects in chick embryos.
(4) Neuropathology, both human and experimental, including a study of experimental
allergic encephalomyelitis.
(5) Renal microdissection.
(6) The histological structure of normal lymph nodes, and morphological aspects of
their response to bacteria and basterial toxins.
(7) The study of transparent living tissue and its response to injury, using ear-chamber
and similar preparations.
microbiology
Microbiology allows great scope for training in biological research methods. This is
firstly because of the great variety of problems which may be studied using microorganisms.
The scope of research work carried out in the School of Microbiology illustrates this point.
Secondly, microorganisms have been used as experimental tools with increasing frequency
over the last 10 to 15 years to help solve major fundamental problems in biology. The
relationship between genes and enzymes, the nature and behaviour of genetic material, the
concepts of messenger and transfer RNA, the biosynthesis of small molecules and the process
of photosynthesis are all subjects which have been profitably studied with the aid of microorganisms.
In many cases the definite experiments could only have been carried out with
the microorganisms.
In the School of Microbiology, there are a number of individual research programmes
in which one or more staff members are involved, together with research students and sometimes
postdoctoral fellows. A very brief description of each general field of interest within
the school is set out below.
Several groups of workers are engaged on immunological problems. These problems
include a study of tetanus toxin and its conversion to toxoid with the aim of providing a
more efficient antigen than obtainable hitherto. Such a toxoid would give a maximal and
prolonged antitoxin response with minimal local reaction. This work is being directed by
Professor S. D. Rubbo, while Associate Professor D. F. Gray is concerned with the specific
and non-specific changes occuring in imunologically active cells when they are stimulated by
21

antigen. Such changes are of importance in diseases where protective antibody is either
not formed or plays a subordinate role in the immune response. Yet another aspect of immunology
is being studied by Dr. G. N. Cooper and his group. In this case antigens are
injected into isolated intestinal loops in rats and the fate of the antigen and the significance
of the lymphoid cells of the intestinal tract in the immune responses which occur are being
examined.
The virology unit, headed by Dr. D. 0. White, is studying, with influenza virus as a
model, the events which occur between the time a virus enters an animal cell and the production
of mature virus particles. It is hoped to find out something of the little understood
biochemical events which occur following infection of animal cells with viruses. The electron
microscopist, Dr. I. Holmes, is making a study of the growth of hepatitis virus in human
cells and is also using the electron microscope for other projects. These include studies on
the localization of oxidative enzymes in bacterial cells and bacterial conjunction.
Problems of chemical disinfection are also under study in the school, with Dr. J. Gardner
and Professor Rubbo examining the biocidal properties of glutaraldehyde and developing
laboratory procedures for assessing and evaluating chemical disinfectants.
Yet another aspect of research is the study by Dr. Rose Mushin of the factors which
influence the colonization of the gut by various bacteria, and the factors which influence the
competition for survival when various species of bacteria are introduced into the intestine.
Several projects are concerned with the study of the biochemistry and genetics of bacterial
cells. Professor Gibson and his colleagues are interested in the biosynthesis of the aromatic
amino acids and vitamins, while Dr. A. J. Pittard is working on genetic problems related to
aromatic biosynthesis. Dr. B. W. Holloway leads a group interested in the biology of
Pseudomonas aeruginosa, with particular emphasis on the genetics of this organism and the
phages which attack it. Some of the more non-medical aspects of microbiology are studied
by Dr. Nancy Millis, with particular reference to the continuous cultivation of microorganisms,
continuous fermentation and the biochemistry of organisms which can use hydrocarbons
as their sole carbon source.
These latter subjects may seem a far cry from medical microbiology, but it must be
remembered that many of the recent important advances in biology with applications to
medicine have come from academic studies with microorganisms.
Finally, it might be pointed out that the new School of Microbiology in Melbourne is
one of the biggest microbiology schools in the world. This has allowed the development of a
number of different research units within the school specializing in widely varying branches
of microbiology and has made for a stimulating atmosphere reflected in both teaching and
research.
pharmacology
The research programme of the Department may be divided into three main projects,
which approximate the interests of the three senior members of staff, Dr. S. E. Freeman,
Dr. K. D. Cairncross and Mr. D. W. Bruce.
The group led by Dr. Freeman is chiefly concerned with inter-relationships between
inorganic ions and metabolism, particularly with reference to the functioning of muscle. The
work has shown that muscle metabolism can be profoundly modified by changes in the
external ionic environment. For example, elevation of the external K+ concentration can
lead to marked increases in respiration and glycolysis in skeletal muscle. These changes are
associated with a changeover from a largely fat-based metabolism to carbohydrate oxidation.
Cardiac muscle, although it shows many similarities in its pattern of response to ionic
stresses, also shows differences which appear important from the point of view of functional
differentiation.
22

In so far as high external K+ levels mimic the depolarization associated with muscular
activity, it is expected that the work will increase our insight into mechanisms associated
with the active state in muscle.
As a corollary of this work, a project is in hand to determine the effect of a number
of pharmacological agents on metabolic processes in the isolated perfused mammalian heart.
The metabolic activation brought about by the catecholamines can be modified by a number
of drugs, some of which do not fit into the accepted category of beta blocking agents.
It may be felt that the work outlined here is far removed from the world of practical
medicine and therapeutics. This is not so, as was well illustrated a few weeks ago when the
unit was called upon to investigate a rare case of periodic paralysis, which appears to be
associated with a metabolic defect.
A second research project under investigation by Dr. Freeman concerns the mechanism
of neuromuscular transmission. The effects of various curarizing and decurarising agents
are studied in the cat, using techniques for recording the electrical activity of the phrenic
nerve and diaphragm. As part of this project the venom of a small octopus found in Port
Phillip Bay is being examined. This venom contains two neuromuscular blockers, one of
which is also a potent anticholinesterase.
Students who have visited Dr. Freeman's study have been entertained by the tank octopus,
who is fed with small crabs.
A research team, led by Dr. Cairncross, has made considerable progress in a study of
the pharmacology of the tricyclic antidepressant drugs. Much of the research has aimed at
elucidating the peripheral action of these drugs. The reason for this approach concerns the
difficulty of examining specific transmission mechanisms within the CNS. A complete understanding
of peripheral action will help in the final assessment of central action, and perhaps
indicate the basis of the depressed state.
The work encompasses a wide field. The effects of a range of structurally related
tricyclic antidepressants on the pharmacology of the autonomic nervous system has shown
them to affect both sympathetic and parasympathetic divisions. In particular, amitriptyline,
and to lesser extent notriptyline, reverse the pressor effect of adrenaline on the blood pressure
of the anaesthetized dog, whilst potentiating the effect of nor-adrenaline. Protripyline
does not reverse the adrenaline effect, but appears to possess stronger atropine-like anticholinergic
actions than other antidepressants of this type.
These findings have been followed up by an investigation of the effect of these compounds
on venous flood flow, and on synaptic transmission, through the superior cervical
ganglion. The latter investigation is related to the fact that all tricyclic antidepressants
potentiate the systemic actions of noradrenaline. Nordrenaline and other catecholamines
are known to modify synaptic transmission through this ganglion; the antidepressants also
effect the transmission process in characteristic ways.
Mr. Bruce and his co-workers are concerned with a study of the pharmacology of drugs
of addiction. The effects of morphine and its close structural analogues are currently under
investigation in experimental animals and isolated organ preparations. Studies of the metabolism
of morphine in the body are in hand. It has been found that the pattern of metabolic
degradation of morphine may be altered by drugs such as tacrine, which act as partial
antagonists of morphine. This work has led to the development of a new analgesic, which
is currently undergoing clinical trial at the Austin Hospital.
DEPARTMENTAL REPORTS
In response to the article by Professor S. D. Russo, in last year's magazine, namely,
"What's Wrong With Us?", the editorial staff has decided to attempt to inform students of
the current research in a number of departments, and to foster interest in it.
23

THE UNICORN
emblem of healing
For more than two thousand years the unicorn has
been credited in folklore with miraculous healing
properties. Today, as the House Mark distinguishing
the products issued by Burroughs Wellcome & Co.,
the unicorn is recognised throughout the world as a
guarantee of quality in pharmaceutical preparations.
The fourteen Associated Houses of Burroughs
Wellcome & Co., together with the various Wellcome
Research Laboratories and the Wellcome Historical
Medical Museum and Library created by the late
Sir Henry Wellcome, are all consolidated in The
Wellcome Foundation Ltd., London, formed in 1924.
Today, as a lasting monument to its founder, The
Foundation is dedicated to the cause of medical
research and the advancement of knowledge for the
benefit of mankind. To this purpose are devoted the
distributable profits from the world-wide
pharmaceutical manufacturing and trading concerns of
Burroughs Wellcome & Co.
BURROUGHS WELLCOME & CO. (AUSTRALIA) LTD.
liwt
24

aldness
the poor man's alopecia
For the afflicted, baldness is a way of life. It has all the comic invention of an acute
back combined with the sophistication of chickenpox. From the first gnawing anxieties of
onset to the final harsh confirmation by the barber, this is a disease about which your best
friends can tell you—and do time and time again. The amount of spurious sympathy a
victim can accumulate for a benign desease is phenomenal.
Baldness affects men, eagles, and mountains impartially. It is a disease of unknown
aetiology. This does not mean the cause of the disease is unknown. It is just that no two
people agree. Baldness is a civilized disease and the proponents of different aetiologies disagree
in a civilized way—by ignoring each other vehemently.
Baldness is attributed to tight hatbands and loose living. It is also a result of oily scalp
and dry hair or any matched pair of opposites. The significance of this is that when someone
becomes bald there is a very good reason.
The symptoms of baldness are those of an environmentally induced discomforture. For
example, anyone who is balding soon knows the entire repertoire of pertinent jokes; How to
avoid falling hair — step nimbly to one side. What to do with falling hair — put it in a
basket. How do you brush your hair? — With a towel. The subject is quick to acknowledge
what a fine head of skin he has To qualify as an expert in alopecia humour it is only necessary
to be bald for six minutes.'
The treatment of baldness is not entirely satisfactory. In the early stages kid stuff is
applied to the hair. The compounds which used elsewhere on the body, are termed ointments,
creams, lotions, tinctures, etc, when applied to the scalp are called tonics. Initially, tonics
are rubbed into the hair to make it stay in place—then just to make it stay. It is part of the
folklore of Madison Avenue that red-blooded males (is there another kind?) should apply
these tonics even if they do not result in hirsute preservation because they are also persistibly
aphrodisiacal.
I see potential palliation for the disease in the fact that women can remove eyebrows
and draw them on instead. Men could paint over an entire scalp. It could be done for all
time by having the crown appropriately tattoed. How much more sensible than having "I
Love Eleanor" tattoed on the forearm and then marrying Josephine.
to the final stages, when hope is abandoned but resignation has not yet ensued, a
prosthesis is indicated. Toupees today are for all intents and purposes indistinguishable from
the real thing. If you wear one, total strangers approach you and reassure you that they
hardly knew.
"THANKS!"
The Editor would like to thank all the contributors to "Speculum", those associated
with the production and distribution of the magazine, particularly my colleague, Robert
Fitzpatrick; and also our advertisers, whose support makes "Speculum" a reality.
25

why psychiatry?
prof. brian davies
When the Editor of "Speculum" asked me to write an article on psychiatry with particular
reference to medical students, I jotted down most of the things that seemed relevant.
However, on looking up various references I came across the following, which is an address
given by Sir David Henderson to medical students at St. Andrew's University This address
contains all the points I wish to make, and expresses them in a lucid way. It seemed best,
therefore, to ask your Editor to publish part of Sir David's lecture and to make some references
to the Melbourne scene.
But first a few words about Sir David. He died this year at the age of 80. Early in
his career he had worked with Kraeplin at Munich and Adolph Meyer at John Hopkins. In
1927, with R. D. Gillespie, he published a textbook of psychiatry, "Henderson & Gillespie",
which, until recent years, was the standard British textbook of psychiatry. This book had
a great influence in establishing the character of British psychiatry which differs from teutonic
psychiatry on the one hand and North American psychiatry on the other. In general,
British psychiatry is characterised by an approach to the patient that examines the influences
of psychological, physical and social factors in each individual patient and the relevance of
these factors to aetiology and treatment.
It is essentially an empirical approach and is not guided by any particular theoretical
frame of reference. This attitude is well shown in the following article.
In Melbourne the University Department of Psychiatry was started in April, 1964.
Faculty have agreed to certain changes in the teaching of psychiatry, some of which will be
implemented in 1966. In brief, these are the introduction of medical psychology as a prescribed
subject in the preclinical years--this course will be organised by Dr. Mowbray, who
has come to the Medical School as a Reader in Medical Psychology. An extension of the
system of clinical clerking in the fifth year to six weeks for Royal Melbourne Hospital
students will begin in 1966. Students will spend three weeks in the psychiatric ward of
Royal Melbourne Hospital and three weeks at a new Professional Unit at Royal Park, so
that students will clerk on out-patients, day patients and in-patients. It is hoped that these
changes will begin to help students to understand and deal with psychiatric problems when
they qualify.
There can be no doubt that for the family doctor, psychiatric problems are among the
most frequent he has to deal with. Dr. John Fry, reporting on his London practice, finds
that 10-15% of his work is with psychiatric problems representing 5 to 10 patients a day.
Similar problems are found in the medical and surgical wards and out-patient clinics of
hospitals, so that an understanding of the psychiatric approach is now a most important
part of medical education. As Sir David's lecture shows, psychiatry is of great social importance,
and also an expanding research field.
WHY PSYCHIATRY ?
By SIR DAVID HENDERSON, M.D., F.R.C.P., F.R.C.P., F.R.C,P,Ed,
Professor Emeritus of Psychiatry, University of Edinburgh.
The question I have posed as the subject-matter of this address is, I believe of fundamental
importance to anyone contemplating a medical career, whether as general practitioner
26

or as specialist. The psychiatric field is one of infinite possibilities. A vast number of problems
urgently demand solution, and in the clinical, academic, and research spheres, whether
at home, abroad, or in the Services, abundant opportunities arise for all who may feel
attracted into such work. It has been stated frequently, and I think with truth, that psychiatry
constitutes the other half of medicine, and yet, sad to relate, it continues to occupy a comparatively
minor part of the medical curriculum. That should be remedied. It will be as
soon as doctors of the future and the medical faculties of our universities recognize that
a new orientation requires to he effected. I say this because there seems to be a distinct
danger of medical work degenerating into a job of work—prescriptions and certificate writing
— rather than, a calling, a dedication to the service of others, wherein lies something
which makes an inspiring appeal to heart, soul, and medical skill.
In order to convey some idea of this field of work, and to justify the statement that
psychiatry constitutes the other half of medicine, allow me to mention a few facts. Of
every 100 children born, 8 will have a nervous breakdown and 3 will spend some part of
their lives in a mental hospital. On January 1, 1950, there were 272.540 persons mentally
ill or defective, compared with 230,299 occupied beds in hospital for all other disease put
together. The economic burden as represented by such figures is enormous, but the amount
of suffering to the individual and his family is something which defies definition. Here is
an opportunity for preventive medicine so that countless sufferers may benefit and great
pleasure and satisfaction can be derived from one's work. A far better health organization
can be built up than has ever existed. But as prerequisites there must be a comprehensive
undergraduate education and an opportunity to have had a good look round, so survey the
position carefully before making a final decision on one's future career. To a certain extent,
at least, latter proviso is secured now that a year's work in general or special hospitals is
obligatory before registration can be effected.
A NEW POINT OF VIEW
There are some students, the precocious ones no doubt, who from their schooldays have
decided to devote themselves to a particular type of medical career, and plan their experience
accordingly. They feel they have a special bent, or flair, or urge in one direction. These,
perhaps, are the fortunate ones. Others may take much longer to decide, and may be influenced
by chance or luck, or by association with someone who is regarded as a great example.
It has been my experience as a teacher of psychiatry that great numbers of students have
found that psychiatry opened up a new point of view, a different type of medical work; it
brought them intimately into association with the patients themselves, with patients as individuals,
rather than their diseases, thus constituting a really vital interest. They began to
realize that it was not enough to study physical diseases as such, but that the personality
and character and emotional level of those who were suffering also demanded investigation.
It is that wider appreciation of their medical responsibilities which will enable them to treat
their patients more successfully. Such a technique, the understanding of man in relation to
his disease, makes it implicit that the interrelationship of mind on body and body on mind
must be paramount. That, however, is not a matter which can be determined in a minute;
it has to be carefully weighed and evaluated and may take a longer time than is compatible
with certain natures.
During their training most students feel that their mission is to cure physical illness, to
relieve suffering quickly, and to see an immediate response to the powerful remedies which
they now have at their command. That is what actually happens. The spectacular and
often dramatic results that follow the administration of penicillin and other antibiotics, or
the marvels of chest, heart, and brain surgery, is work which appeals to practically everyone.
And such results are only the precursors of future clinical and experimental research which
will lead to marvels of healing which we can but dimly visualize. It is not surprising, therefore,
that medicine and surgery, in general, should be dominated by the essentially objective
mechanistic approach, which has so much to offer.
But not all the answer is there. We still have to understand the art of living, the ability
to adapt harmoniously to the sphere in which we are placed, and how we may effect a better
total integration leading to efficiency. That is the reason I have the temerity to ask the questtion:
"Why", or, perhaps better, "Why not psychiatry?" I cannot hope to stir in your hearts
27

and minds as responsively as the physician or surgeon might do. I cannot promise quick and
dramatic results. I can only offer "blood and sweat and tears" and long periods of painstaking
work which eventually may bring its due reward. But there is a wide vista in front
of you. Before entering into psychiatry, ask yourself these or similar questions: Is it worth
while? Is it sufficiently satisfying? Am I likely to be happy in it?
THE SCIENCE OF MAN
Personally, I have never regretted my choice. I have found psychiatry to be an absorbing,
fascination subject which during the past fifty years has evolved into an orderly body
of knowledge that can be specifically applied. It involves the study of constitutional environmental
phenomena leading to an ability to reach an understanding of personality and character
by means of a study of the individual's psycho-biological reactions. Psychiatry deals with
man himself. It is the science of man; the most backward, the most difficult, but potentially
the most fruitful of all the sciences. It requires people endowed with a contemplative,
philosophical outlook. But that, after all, is the brightest and highest characteristic of man;
a thinking person, one who can take stock and be hopeful of finding an adequate solution
to almost any tangle. To be optimistic without being too naive about it. Have you such
qualifications? Have you inquiring, questioning minds? Minds that are unwilling just to accept
everything at its face value but are happier when they are seeking for causes, asking questions,
and, above all, analysing the interplay of the somatic and psychic reactions. If you
feel that you have those greater interests, if the study of the speculative, subjective, emotional,
and instinctive appeals to you, then I would suggest that you might find in psychiatry that
branch of medical work which will give you entire satisfaction.
Let me hasten to add that psychiatry is not necessarily a subject for the specialist alone.
It is much more nearly allied to general practice than any other branch of medical work is.
Much of surgery, of ophthalmology, or radiology, and other specialties are essentially postgraduate
disciplines and are not especially important in general practice, but psychological
medicine is part and parcel of the vast majority of all clinical states which present themselves.
I have been so sure of this that in teaching psychiatry it has always been my main
object to present it in such a way that it might be used by the general practitioner, day in
and day out, in the course of his ordinary duties. All good general practitioners will give
me their support. They know that their success in practice is dependent on their ability to
understand and sense out the psychological background, whether centring in domestic disharmonies
or more individual personal problems.
This sort of psychiatry which I am trying to outline, the psychiatry which deals with
the interpretation and understanding of the facts of everyday life as led by ordinary people,
is very different from the psychiatry which was bounded by the high walls of the mental
hospital. That indeed was an intramural age, when the psychiatrist was regarded as just
another "mad doctor" who was not in very close touch with his colleagues. At that time
body and mind lived in watertight compartments, and the influence of one on the other was
sensed by only a few thoughtful physicians. Now the relationship is so close that we have
what we call psychosomatic medicine — an awkward-sounding combination, but one which
serves to stress the interlocking and transformation of emotional forces into physicial symptoms.
I believe, therefore, that the doctor of the future should, in addition to his knowledge
of the physical and objective side, be familiar with the more intangible personal, subjective
aspects which are closely bound up with social, domestic, marital and economic problems. It
is for that reason that I have welcomed this opportunity of outlining how psychiatry may be
advanced, how it may be more freely and expertly practised, and how the mental health
organization may be more closely co-ordinated with its sister branches, especially in general
practice.
MENTAL EXAMINATION
In his student days the undergraduate should become familiar with the methods of
conducting a mental examination. This is as important as to know how to percuss and
auscultate a chest. He may not understand the significance of all the sounds he elicits, but
at least he will be accumulating data which his experience will teach him to apply. So it is
with a mental examination. This can be effected quickly in an orderly manner so that the
state of emotional tension, the content of thought, the intellectual faculties, and the degree
28

of judgment and insight can be approximately evaluated. All this information is then correlated
with a detailed chronological history, a life study, which pin-points what happened in
infancy, in school-days, in work, in marriage, and in domestic relationships. It may seem
a formidable programme, but it is not nearly so complicated as it sounds, and it ensures a
complete and thorough examination. It is a great saver of time in the long run.
One of the important things to remember is that you must not be afraid to ask questions.
Tact, of course, is required; nothing must be said or done which will antagonize the patient,
but there is nothing a person likes better, whether he be sick or well, than to talk about himself.
This sort of approach establishes a rapport; the patient realizes that the doctor is interested,
that he is a good listener, and that he can be trusted. I know that all this is so,
because so many patients have said to me: "It is a great relief to talk about the intimate
details of my personal life, but the other doctors I have consulted did not seem to regard
it as important." Let me be a shade more explicit. We must be quite clear regarding the
family relationships, the difficulties encountered by the only child, the problems which may
have arisen in relation to sexual development, schooling, the choice of a career, the advisability
of marriage. These are some of the matters which arise in the practice of every family
doctor, and yet very often he does not feel that he has the knowledge or understanding, or
even that it is his business, to deal with them. It is my conviction, on the contrary, that it
is the family doctor, the trusted adviser, who is pre-eminently suited, by his knowledge of
the family circumstances, to guide and protect the respective members of the family and
their development. If he experiences any particular or special difficulties then he should call
the psychiatrist into consultation early rather than late. Unfortunately this is not the usual
practice. Many doctors hesitate to advise psychiatric consultations because they fear the
patient may feel insulted, and may transfer his complaints to another doctor. That is much
too narrow a view, and is seldom the case, but a change will not be effected until doctors
meet their responsibilities more courageously, and with more understanding of the efficacy of
the psychological explanation—not necessarily determined by psychoanalysis.
If we turn now to the more clinical aspects I would like to emphasize how much the
general practitioner with psychological insight can do to alleviate and treat these cases of
anxiety and depression which are the most frequent of all forms of nervous and mental
disturbances. They are nearly always complicated by the additional problem of sleeplessness,
which transforms night into something to be dreaded rather than welcomed. The root
cause of all such states of fear—something which is present with us from the cradle to the
grave. It pursues us throughout our lives, and may show itself in a multiplicity of forms.
We can always side-track it to a certain extent, but yet we long for security and protection,
for a feeling that there is always 'help at hand.
Fear has its beneficent and malignant aspects. We know, for instance, how in times
of stress or danger it may prove, physiologically, to be a valuable self-protective mechanism
whereby we can escape from critical situations; while often the fear of public exposure and
punishment may enable us to exercise an amount of self-discipline whereby we control those
impulses which would result in social misdemeanours. But when it is constantly present,
when worry and anxiety are perpetual, then our fear may express itself in the production of
physical symptoms—for example, peptic ulcer, palpitation, amenorrhoea, skin disorders —
none of which can be cured by physician or surgeon until the cause of the fear has been
elucidated. This is all very familiar, but to none more so than many of the great writers and
essayists such as Darwin, Mosso, W. H. Hudson, Conrad, George Moore, Victor Hugo and
Montaigne. All of them recognised the power that fear had in dominating not only the
actions but the thoughts of everyone.
Lord Frederick Hamilton, in autobiography entitled Days Before Yesterday, put it quite
simply and graphically when he recalled the terrors he had experienced from the age of 6,
when he made his way "nightly down the passage of many terrors which lay from the nursery
to the other part of the house where the grown-ups lived." A young man who had been
referred to me because of his anxious-minded state informed me from what a simple thing
it had arisen. He had been playing in a Rugby match, and a friend who had been watching
the game shouted out, "Oh, so-and-so is nothing but a funk; he's afraid to tackle his man."
That remark entered the boy's mind; it destroyed his confidence in himself, it acted as a
29

minute splinter in his flesh until many years later when he summoned up courage to speak
about it. That is not an uncommon, occurrence, and can be duplicated in the autobiographies
of many famous men, and in the life stories of men I have known who have been decorated
for their bravery, and whom I have been privileged to help; people who have feared they
might be cowards, people who have frequently had to prove themselves to themselves by
going to extreme limit of over-compensation amounting to exhibitionsm. No one ever expressed
the position better than a young lady who had suffered much and who embodied some
of her feelings in the following letter which she wrote to me:
"I think I understand things in general, as the important point is instead of letting the
bats in my belfry loose when they wished to fly around I have firmly locked them in. Now
I am to let them fly around I have firmly locked them in. Now I am. to let them out; I can't
say I like the idea, but I will try. After all, I didn't like having some teeth stopped, but I
always had to go through with it. I wish you had not disturbed so many bats all at once,
especially the ones that have grown beards. I see now why I cannot sleep, and why you
liken the process to the surgeon and the wound which must have the pus taken out of it
before it heals, and it is bound to hurt in the process. Please will you take care of all those
bats and some day, if you have time, will you discuss them, The very biggest and the oldest
is fear; he is as old as I am, he niggles by day and rules by night and his family is numerous.
I will never slay him by myself and I am sure he must be very septic and nasty. I have
had to go to such lengths as a child to hide my fears, and I hide them now, but they are all
there. When I lay so helplessly ill and was regaining consciousness all my dreams were
of fears I had suffered and hidden as I had carried on with whatever had to be done. I
talked to no one of them, and even now I have the awful fear that you might think I was
mad. I always think that all the bats spring from this root, fear. Fear of an anaesthetic,
of suicide, of doctors, parents, certain teachers, dreams. The suicide fear has a root all its
own."
That extract gives a vivid picture of the torment which so many children and adults
suffer from, and it is easy under these circumstances to realizse how difficult it must be not
only to concentrate on one's particular job but even to lead one's life at a reasonable level.
But perhaps the most disturbing feature is the feeling or fear of impending loss of control
leading to actions foreign to the person's disposition. Under such circumstances it is understandable
that the suicidal act may be the final touch.
SLEEPLESSNESS
Furthermore, you will appreciate why sleeplessness should be closely linked with such
a troubled state. Their minds are filled with morbid thoughts, thoughts which seem to freewheel,
a kind of mental whirlpool which never seems to reach a stage of peace and quietude.
To produce sleep mechanically by means of drugs when such states of anguish exist is almost
impossible. Some patients frequently say, "If I could only be put to sleep for a fortnight
I, should then be better," but even when continuous narcosis is used I have never found it to
act satisfactorily in such cases. It is, I believe, essential in the first place to give the person
some understanding of how and why their insomnia is present, and to explain that insomnia
or sleeplessness is closely identified with the idea of death and the fear of the unknown.
Sleep is the symbol of death, and many of these patients I refer to, while they long for sleep,
are yet afraid to sleep because they cannot sink back into a state of unconsciousness owing
to this fundamental fear. It is the anticipation of sleeplessness which produces it. The same
situation is evident, for instance, in those who fear an anaesthetic, and many anaesthetists
will tell you how certain people are very difficult to anaesthetize and some even refuse
general anaesthesia because of this underlying fear. Although they long for sleep, subconsciously
they fight it; they may be on the point of falling over when they will suddenly
awake with a start, or they may go to sleep for a short time, in the early part of the night,
but they waken suddenly and are unable to get to sleep again.
ANTIDOTES TO FEAR
These matters, I believe, are of very great practical importance and indicate the necessity
for general practitioners who are dealing with them to understand more than the prescribing
of a hypnotic. The essential thing is to have an appreciation of the psychological
mechanisms which are causing so much havoc and to be able to keep alive faith and hope.
30

which are the only really antidotes to fear. A good deal can be done by education, discipline,
example, the inculcation of the spirit which inspired the solders of the Birkenhead when
they stood at attention while the ship foundered in a shark-infested sea. That is what is
meant by morale, which was described by Dr. Edward Glover, in a book entitled Fear and
Courage, as our most important secret weapon. I have put this matter into the forefront
because I can use it more or less as a text on which to emphasise the wide sphere which a
doctor with psychological insight can not merely interest himself in but become absorbed in.
The concomitants of fear are of serious import and require equal if not even more consideration
than the sex problems and difficulties which have been supposed to be the root
of so many types of nervous and mental disturbances. A good deal more could be left to
natural development and bringing-up than to the type of instruction which is purveyed in
books, in school, and even over the wireless: certain types of health talk are apt to be very
much more disturbing than helpful.
HELPING THE PATIENT
A point of some practical importance is to prevent the patient from feeling that he must
take the full responsibility for helping himself. While he should be informed that his cooperation
is essential and that he must contribute from 25 to 50% in helping himself to get
well, yet he should always be assured that the doctor can help and is willing to keep in touch
with him. Doctors are sensitive about this; many feel, in dealing with nervous patients, that
they are not contributing anything, that their visits are of, no value, and in consequence they
lack confidence in their ability. That is, I believe, always a very serious fault, because the
mere fact that the doctor keeps in touch, even although his visits are of short duration, brings
an assurance and a confidence that may be of more value than anything else. The art of
medicine consists largely in the personal interest and kindness and enthusiasm brought to
bear, and these may help more than anything else. While we need the co-operation of the
patient, it is equally essential to enlist the entire co-operation of the relatives. The more they
can be kept in the picture and the more they can be given understanding of how they may
assist, the greater the encouragement and the quicker the result.
A RICH FARE
If the fly I have cast has attracted your notice you might even have gobbled it up and
have hooked yourself to psychiatry as a specialist. If you have done so, then a rich fare
awaits you, and you may partake in the academic, research, and clinical field or in a mixture
of all three of them.
Schools of psychiatry, as I have said before, should occupy a much more prominent
place in the medical curriculum. A chair of psychiatry should be established in every university
centre, and a professional examination in psychiatry should constitute part of the
final examination in medicine. A student should be as adequately trained in psychological
as in psysiological principles. Nor would I confine the study of psychiatric principles to the
clinical years only; they require to be inculcated early, and should seep through the whole
of one's medical training. I believe that every large general teaching hospital should reserve
from 5 to 10% of its beds for psychiatric cases, and that psychiatric units with adequate
out-patient departments and with facilities for research should be part of the general hospital
organization. This is not a visionary arrangement, because to a considerable extent it is
already in being in the United States, in Germany, and in Scandinavia.
Any research unit must be co-ordinated with both the academic and the clinical sides.
The answer we are seeking may not be found in the test-tube or the laboratory (bio-chemical,
neuropathological, or psychological) but in the study of man himself in his social relationships.
This, however, is only a surmise which constitutes problems to be solved. That was
brought forcibly before us at a Conference on Mental Health held at Oxford in 1952. There
were gathered together neuro-anatomists, pharmacologists, psychiatrists, biochemists, professors
of sociology, psychoanalysts, animal behaviourists, psysiologists, and endocrinologists,
who for two days discussed "what ignorances principally hamper our understanding of mental
illness." There were plenty, I can assure you. It is our aim to eliminate those ignorances,
to develop a knowledge which can be applied so that our thoughts and conduct can be sublimated
into better and higher channels. We can learn much from the co-ordination of
31

psychological, physiological and anthropological research through, for instance, electroencephalography,
which has already given us so much information of brain functioning;
through the improvement in technique in what is called psycho-surgery; through the personalit)/
studies postulated by Sheldon, as now being actively pursued at the Warneford Hospital,
Oxford; and the pharmacological studies of Elkes in Birmingham. These are all spheres
in which the clinician and the research worker must be in the closest harmony.
While there are many specialists who may be attracted into the essentially scientific
aspects of research, there are many others who find their satisfaction in working clinically
in some particular field. I might mention, for instance, psychiatry in relation to eugenics—
a grossly neglected subject, but one which is fundamental. I know there are those who
blatantly exclaim, "Heredity is bunk"; but those of us who have experience, who see family
groups involved seriously from generation to generation, or who have been impressed by the
significance of similar twin studies, or of the spread of various form of mental deficiency or
of conditions characterized by organic brain disease—for example, Huntington's chorea—
cannot take such a facile attitude. It is dangerous to accept all such states as a fort of fait
accompli, but rather must we do everything that is possible to improve the quality of the
race. All this work has its place in our mental hospitals and colonies for mental deficiency.
which should be live places for clinical research, and not merely custodial institutions.
These hospitals require improvement and modernization both in equipment and in medical
and' nursing personnel. They are grossly overcrowded, the ward units are much too
large, but even with all their defects they constitute important organizations which call for
the highest degree of administrative and medical skill. It is intensely disappointing today to
note that the highest positions in the mental hospital service, posts carrying with them so
much responsibility and which were so greatly prized, seem to have lost much of their former
appeal and attract comparatively few candidates I believe that the main reason for this
unfortunate state is because at that time of the introduction of the Mental Hospital Act the
special conditions in relation to mental hospital work did not receive sufficient consideration.
OTHER FIELDS
If, however, your inclination lies in some other direction, then I might offer you child
psychiatry, a subject which is calling out for more workers. Here we see team-work in
action. The psychiatrist, the psychologist, and the social worker pool their resources not
only in an effort to deal effectively with the child and the conditions surrounding it, but also
because the child is much more likely to react to satisfactory treatment than the adult. Childhood,
it has been said, is the golden period for mental hygiene; it is the plastic period of
development, the time when prophylactic work is likely to prove fruitful. Indeed, the vast
majority of the problems of childhood can be dealt with admirably by a modification of
environment and social circumstances and by dealing with the particular problem at a conscious
level. But again we need the full co-operation of parents, school-masters and all
organizations dealing with children. Our aim in all such work is to produce a state of
emotional and social security, which is the greatest safeguard for all subsequent disorder of
health and conduct.
Then there is a great need to improve our relationship to the law, to the Church, and
to industry. Each one of these fields is teeming with problems of great significance and
importance which would require separate consideration, and which I cannot attempt to deal
with here. I feel, however, that I must mention them, because psychiatry has a Feat contribution
to make to each of them. And then when one has accumulated one's experience you
may feel that your duty and your inclination is to spread the gospel of mental hygiene so
as to educate the public to take more realistic and more humanistic attitudes towards a subject
which is vitally concerned with human betterment.
These, then, are some of the reasons which have led me to ask the question: Why or
why not Psychiatry? I trust many of you may answer it affirmatively and that those of you
who do will find in it work which will prove of infinite value to you personally, and to those
whom you may be privileged to help.
32

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33
CIBA

concepts of contraception
i. j. marais
The term "birth control" was the coinage of Margaret Sanger in 1914. Family limitation,
however, was practised long before this. There is evidence, according to many authorities,
of a desire to control fertility by artificial means in every culture, from preliterate times
to the present day.
The oldest and possibly the most universal method is coitus interruptus. The Old Testament
of the Bible (Gen. XXXVIII 8,9,10) cites the sin of Onan, coitus interruptus for which
penalty was death. Whether the penalty was inflicted for the act itself, or for breach of
tribal custom whereby Onan was required to have a family by his brother's widow, is not
clear.
Methods of contraception have Varied with the type of culture and the amount of available
knowledge.
Casanova is alleged to have used one half of a cut lemon as a mechanical vaginal contraceptive,
the acidity of the juice providing additional chemical protection—ingenuity surely
unsurpassed in the annals of contraception.
A primitive and barbarous form of population control is destruction of the embryo or
infant. It is alleged that members of the Kung bushmen tribes living in and near the Kalahari
desert destroy any infant which is born while an older child is still suckling. Methods
of infanticide include crushing the child before birth by pressing the maternal body with
heavy stones, strangulation at birth and live burial in sand.
Methods of procuring abortion among primitive peoples appear similar to those employed
by present day civilised communities. The commonest methods involve insertion of a foreign
body (such as a stick) into the womb, and the internal administration of various concoctions.
The ancient Greek midwives were expected to have a competent knowledge of abortion as
part of their equipment, while in Britain during the 18th century the matter was so openly
accepted that abortionists advertised their services in the newspapers. Today abortion is
tolerated only in a minority of countries.
Many primitive societies are less ignorant about contraceptive methods than contemporary
under-privileged people. One of the oldest aboriginal races in Central and Western
Australia practise a unique and highly efficient method of birth control. An "operation" is
performed on males whereby reproduction becomes impossible. The operations are done
deliberately to prevent conception, as well as for eugenic reasons, for they are performed
only on those who have proved themselves the idolent and less useful members of the tribe.
According to investigators, operations on the male include several forms: the simplest
method is that in which a small incision (with a stone knife) is made into the urethra in
front of the scrotum, so that the semen ejaculates externally. Various other methods involving
the complete dissection of the urethra from in front of the scrotum to just below the glans
penis are also described.
Prohibition of sexual relations between spouses has been almost universal among primitive
peoples as a means of birth limitation. Periods of abstention have varied from two,
three, to even four years. Similarly, abstention until the child was weaned was widely practised
in ancient Egypt, India and Persia. In the 1930's this was apparently again in vogue
especially in Egypt, India, China and Turkey.
34

The oldest medical prescriptions on record for the prevention of contraception are those
described on an Egyptian papyrus (cira 1850 B.C.). One method advocates the use of
crocodile's dung mixed with a paste vehicle—probably a pessary for insertion into the vagina.
Another consists of irrigating the vagina with honey and natron (native sodium carbonate),
and yet another recommends a gum-like substance for vaginal insertion. Thus the modern
"sponge and chemical" formula was, in its essentials, practised nearly four thousand years
ago in ancient Egypt.
Aristotle discussed contraception as did Hippocrates and Soranus of Ephesus (A.D. 98-
138), the latter distinguishing clearly between contraceptives and abortifacients. The writings
of St. Thomas Aquinas (1225-1274) have had a great influence on present day thinking. His
views on contraception became those of the Roman Catholic church, with little modification
up to this day.
One of the earliest publications of really explicit and profound sex instructions is the
Kuma Sutra (the famous Hindu treatise on love), which is based on Sankrit texts of the
sixth century. The need for contraception was recognised by these early authors, and there
is evidence that the women of the East were aware of the benefit of contraception. Certain
prescriptions are to be followed when "it may be held desirable to limit the members of the
family". Many of these methods seem worthless and may have failed, but it is significant
that the ancient orientals should have considered this subject from so enlightened a point of
view.
No information concerning contraceptions in Mohammedan countries is available. Early
history of the subject in Europe is even more obscure, and what happened in early Christian
times is not really known. There, nevertheless, seems to be sufficient evidence to have convinced
authorities that practical methods of contraception were employed by the Ancient
Jews, the German tribes, Arabs, Greeks and Romans, though what their methods were is
not revealed in the literature. It is, however, reported that the Arabs ruptured the amniotic
membrane when abortion was desired. The assertion is also made that Arabian physicians
knew of the protective pessary and chemically treated suppositories. Indeed, an Arabic manual
publised in the 16th century gives advice concerning contraception, and was probably the first
widely published information on modern chemical means of contraception including the use
of alum.
The "condom", a contraceptive method still greatly in vogue, came into use about the
middle of the 16th century. This device, although probably much older, was first described
("to prevent infection") by Gabriello Fallopius, an Italian anatomist in 1564. By the 18th
century the condom was well known, openly sold and advertised in Britiain. At this time
the selling of condoms was a very active and lucrative trade, especially in France and Italy.
Sheaths were made at first of fine linen and subsequently from the dried gut (cacum) of a
sheep.
Strange actions or modes of procedure by either sex, not involving chemical substances
or appliances of any sort, have been employed from time to time as contraceptive measures.
A very ancient idea is that if a woman controls her own emotions so as to inhibit the
natural orgasm, she is safe from ensuing pregnancy, or, at any rate, her 'passivity materially
reduces the risk of its onset. This is certainly a primitive attempt at birth control, and it has
been reported that the women of Baru Island often have unions with strange men, but during
such unions they keep themselves very passive so as to avoid fertilization. This unreliable
method is reported to persist even among certain civilized women. Another method,
probably of prehistoric origin, consists of sitting upright immediately after ejaculation and
coughing violently or exercising to contract the pelvic muscles.
Many Bantu tribes in Africa prior to missionary contact, permitted intercourse but
condemned pregnancy before marriage, and hence they taught their young people how to
have intercourse without penetration.
Masturbation and refraining from sexual intercourse has also been used as a birth control
measure in marriage, especially during the seventeen hundreds. At the time this "evil"
method was denounced by certain authorities as being "the basest and most presumptuous
wicknedness, scarce to be named among the Gentiles". In any event this contraceptive
measure does not seem to have been very popular.
35

In 1798 Thomas Malthus, an English clergyman and economist, published his famous
essay on "The Principles of Population as it Affects the Future Improvement of Society". In
this work Malthus concerned himself with the world's expanding population, which he believed
would outrun the food supply, leading mankind into starvation and poverty. He advocated
a check on overpopulation through late marriage and continence. Malthus did not
approve of birth control practices, which he termed "improper arts".
By 1800 certain sophisticated elements on the Continent doubtless knew of effective
methods of birth control, especially in France, where such knowledge was rather widely
disseminated, even among the peasantry. But in general, the population of Western Europe
entered the 19th century with little knowledge of contraception.
CONTRACEPTION DURING THE NINETEENTH CENTURY
Contraception soon had its advocates. One of the first was Francis Place, a London
tailor and labour leader. Place, while accepting the Malthusian theory, pointed out the
futility of the remedy of deferred marriage and strongly advocated birth c -,ntrol. The father
of fifteen children, he decried the burden of large families upon people of limited means.
In 1823 Place and his associates distributed the famous "Diabolical Handbill". In this publication
the poverty and degradation brought about by large families was emphasized. The
diabolical document concluded by giving certain details "made public for the benefit of everybody".
"A piece of soft sponge about the size of a small ball, attached to a very narrow ribbon,
and slightly moistened (when convenient) is introduced previous to sexual intercourse, and
is afterwards withdrawn, and thus by an easy, simple, cleanly and not indelicate method,
no ways in jurious to health, not only may much unhappiness and many miseries be prevented,
but benefits to an incalculable amount be conferred on society".
This was the first public document giving details on contraception in Britain, and it
evoked severe criticism. Place was taken to task and accused of "publishing filthy pages and
most foul proposals, for rendering the young men of England catamites and the young
females prostitutes".
In a later publication Place also advocated coitus interruptus (La Prudence" or "La
Discretion") where the described precautions were not available, insisting that this method
is "not injurious to health and not offensive to the nicest delicacy".
Publications giving brief accounts of contraceptive methods as well as general arguments
in favour of their use appeared in rapid succession. Two books of interest were published
in America. They were "Moral Physiology" by Robert Dale Owen, and Charles Knowlton's
"Fruit of Philosophy", in which he gave various physiological facts and described several
contraceptive methods. Knowlton was fined and goaled.
A most important advance in contraception in the second half of the 19th century was
the popularization by Dr. Mensinga, of Flensburg, of convenient rubber vaginal cape. This
device was essentially a dome shaped, cap-like occlusive pessary made of rubber, designed
to be fixed over the cervix. Variations of such rubber cups were soon made and their use
rapidly spread on the continent and in Britain.
Explicit birth control information was calmly, publicly, and without interference making
its way through all the strata of society, and Dr. Knowlton's pamphlet had, been published
freely in England for forty years when, in 1877, the authorities decided to prosecute the
publishers of one of its editions. Anne Besant was tried and acquitted on a charge of Immorality
for republication of Knowlton's book in association with Charles Bradlaugh.
This prosecution was given wide publicity and resulted in the establishment of the Malthusian
League in England, founded by Bradlaugh. The organization issued a periodical
devoted to spreading the knowledge of contraception. Neo-Malthusian Leagues were also
established in Holland, Belgium, France and Germany.
In 1881 in Amsterdam a Dutch woman, Dr. Aletta Jacobs, started birth control sessions
for poor mothers in her own practice. At no time, however, did, Dr. Jacobs conduct a proper
clinic.
Bradlaugh and Besant were both atheists, which caused the Malthusian League to be
associated with atheism, and this eventually led to a general unpopularity of the League and
resulted in a severe set-back to public favour of contraception in England. The clergy be-
36

came active in opposing an "atheistic and materialistic doctrine", and the doctors kept silent,
so that during the closing years of the nineteenth century there was little progress in the field
of birth control.
THE TWENTIETH CENTURY
With the beginning of the new century many eminent men spoke out in favour of contraception,
indicating the evils of over population and endorsing birth control.
Although birth control problems were inspiring many of the serious thinkers of the
day, there was still only one society formed for public education of contraception, namely,
the Malthusian League. Because the League has accumulated only five hundred members
up to 1913, it decided to supplement its theoretical advocation of contraception by something
more practical and useful, and published its "Practical Leaflet", which gave a brief and uncritical
outline of a variety of contraceptive techniques. Wide distribution under League
auspices of the writings of Marie Stopes during the 1920's also went far towards acquainting
the population of Great Britain with birth control.
In 1916 an American nurse, Margaret Sanger, started giving birth control instruction
to poor women in Brooklyn, New York. Her establishment, however, was soon closed by
the police as a "public nuisance", and Mrs. Sanger put into prison for thirty days. After a
legal battle is was finally decreed by judicial decision that contraceptive information may be
furnished in New York "for the care and prevention of disease".
In 1921 the first properly conducted full-time birth control clinic in the world was
opened in England by Marie Stopes and her husband.
The first permanent birth control clinic in the United States was established by Mrs.
Sanger in New York in 1923, and later called the Margaret Sanger Research Bureau. Contraceptive
services were augmented by research and treatment in infertility and by marriage
counselling.
At first, despite all the expressions of public interest in contraception, the medical profession
still hesitated to play its proper part in investigation and leadership. Contraceptive
correspondence was even barred from medical weeklies in Britain until 1918.
During the late twenties, the thirties and the forties the use of scientific contraceptive
measures became widespread, and birth control movements in general suffered only minor
setbacks.
A wide variety of vaginal pessaries became available. Many powders, suppositories,
pastes and jellies were employed. A cheap method recommended especially during the
early thirties and claimed to have given excellent results consisted of using a sponge impregnated
with ordinary olive oil for insertion into the vagina.
Among the male devices the evergreen condom was still helding its own. An enterprising
gentleman developed a pin or stud-like apparatus supposed to close the urethra against
unpremeditated ejaculation which might take place before coitus interruptus was accomplished.
It was condemned by authorities and in any case its use does not seem to have
spread beyond the inventor.
The safe period, or rhythm method, which was first mentioned in the scientific literature
of 1842, and which restricts intercourse to the periods of physiological sterility in women's
cycle, was fully discused in contraceptive manuals of the thirties and forties.
In America, The Birth Control Federation of America Inc. was formed in 1939, changing
its name to The Planned Parenthood Federation of America Inc. in 1942. In the late
thirties the first "Mothers' Clinics" were established in South Africa without evoking any
serious criticism.
In 1963 in Stockholm The International Birth Control Federation was organized. It
embraces national organizations in many coutries of the world and publishes a monthly
newsletter from its headquarters in London.
By the mid twentieth century public acceptance of birth control had become widespread,
and government sponsored birth control programmes were actively seeking to limited population
growth in many countries.
CONTRACEPTION TODAY
The two most common contraceptives in use today are male techniques; coitus interruptus
or withdrawal, and coitus condomatus or use of a sheath. The condom has also be-
37
it

come the most widely used mechanical method of contraception in the world. The daily
production of the big American manufacturers was reported as on and a half million. Nowadays
caecal condoms made of animal intestines are still used, but most condoms are made of
rubber.
Intra-uterine and trans-uterine contraceptive devices such as the Graefenberg intrauterine
Ring are no longer recommended. The vaginal diaphragm is reported to be the most
frequently prescribed contraceptive method in America. The modern diaphragm consists
of a spring (flat or spiral) and a rubber membrane, and differs only in minor details from
that advocated by Mensinga in the second half of the nineteenth century. Cerivical caps,
mostly made of firm plastic material are also in use. Spermicidal chemical contraceptives,
in the form of tablets, jellies, gels and creams, are generally employed in conjunction with
mechanical devices, but are sometimes used alone. The Safe or Rhythm method is reported
to be rarely used by non-Catholics.
At present much research is being done on oral contraception. Gregory Pincus and
Gregory Pincus and associates have recently developed oral contraceptive tablets that contain
synthetic hormones. At present they appear the most promising of the oral contraceptives
and when taken daily from the fifth to the twenty-fifth day of the cycle, they suppress testing.
At present the price of the oral contraceptives is still prohibitive, and no final conclusions
can be drawn as to their safety.
Despite all the modern advances in contraceptives the world population is still rising
alarmingly. As the twentieth century is drawing to a close it is becoming evident that
advances in sanitation and control of infant mortality, disease, epidemics and plagues, have
resulted in an extension of life span without concurrently placing a check on the birth rate.
That is why thinking men and women the world over are eagerly awaiting the first truly
safe, simple and cheap contraceptive, for they have come to realise that alongside the atom
bomb, uncontrolled fertility has become the most ominous force in the world today.
38

SEE US FOR YOUR . . .
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JOHN H. AUSTEN Pty. Ltd.
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39

the contraceptive pill
dr. j. b. brown
The contraceptive pill is a combination of the two female sex hormones, oestrogen
and progestogen in the form of a tablet which is taken orally, usually from day five of the
menstrual cycle (five days after onset of bleeding) through to day 25. It suppresses ovulation
and thus produces a state of artificial infertility without inhibiting menstruation.
MECHANISM OF ACTION
The "pill" functions through the normal regulatory mechanisms which operate during
the ovulatory cycle. Maturation of follicles in the ovaries occurs under stimulation from
follicular stimulating hormone (FSH) produced by the pituitary; during maturation, the
follicle produces increasing amounts of oestradiol which operates back through the hypothalamus
to reduce the production of FSH by the pituitary. At about mid-cycle, there is a
surge in the output of the second pituitary gonadotrophin, luteinising hormone (LH), which
causes rupture of the follicle and extrusion of the ovum, the process known as ovulation.
This release of LH is mediated through the hypothalamus probably by the increasing levels
of oestradiol and finally by small production of progesterone by the follicle; it is very sensitive
to the levels of circulating hormones and is readily suppressed by the administration of
oestrogens and progestogens. After ovulation the follicle undergoes luteinisation and becomes
the corpus luteum which in the human secretes both oestradiol and progesterone. The life
span of the corpus luteum is also under pituitary control The oestradiol produced by the
developing follicle and the oestradiol and progesterone produced by the corpus luteum act
on the endometrium of the uterus to cause proliferative and then secretory changes, preparing
it for accepting the fertilised ovum. In the absence of pregnancy, the corpus luteum
regresses; the oestr"diol and progesterone support is removed and the endometrium is shed
as menstrual bleeding, "withdrawal" bleeding in contrast to "break-through" bleeding. The
doses of oestrogen and progestogen in the "pill" are adjusted so that in the majority of
women follicular development and thus all ovarion activity is suppressed through operation
of the feed-back mechanism. However, in a few, follicular development still persists, but the
dose is more than sufficient to suppress the surge of LH necessary for ovulation. The oestrogen
and progestogen in the "pill" replace the natural ovarian hormones in their effect on the
endometrium and menstrual bleeding occurs within a few days of discontinuing the treatment.
During pregnancy, oestrogens and progesterone produced by the placenta suppress
ovarian activity by the same mechanism as the contraceptive pill.
CONSTITUENTS OF THE "PILL"
The "pill" contains synthetic hormones with the same type of activeness as the two
ovarian hormones, oestradiol and progesterone. Those with progesterone-like activities are
termed "progestogens". The hormones are synthesised from diosgenin, a sapogenin obtained
from the root of the Mexican yam. The firm Syntex has a monopoly in this manufacture
and sells the products to other firms. The oestrogens most commonly used in the "pill" are
the 17-ethinyl derivative of the natural hormone, oestradiol, and its 3-methyl ether known as
"mestranol". These are added in amounts of 0.05 to 0.15 mg. per tablet. Progesterone
itself is not active when taken orally and a wide range of synthetic progestational compounds
are used in the various brands of "pills". The amounts depend on the activity of the compound
but are usually in the range of 1 to 5 mg. These progestogens can be divided into
40

two groups. The first are derivatives of the male hormone, testosterone, but unlike testosterone
possess progestational rather than androgenic activity. The most important of these is
norethisterone (172-ethiny1-19-nortestosterone), which is used in "Anovlar" (Schering) and
the closely related norethynodrel which is used in "Enavid", "Conovid" and "Conovoid E"
(Searle). These are synthesised via the oestrogens, and like testosterone itself, are metabolised
in the liver partly to oestrogns. They therefore possess intrinsic oestrogenic activity.
The other group of progestogens are derivatives of 17-hydroxy progesterone, and do not
possess oestrogenic activity. An important member of this group is "Provera" and another
is chlormadinone which is used in s "Sequens" (Eli Lilly). The earlier "pills" tended to contain
relatively large amounts of progestogen (4 to 5 mg), but as this constitutes the most
expensive ingredient, there has been a search for effective combinations containing smaller
amounts of progestogen. Such a product is "Ovulin" (Searle) which contains 1 mg. of
mestranol. There has, however, been no reduction in price to the consumer, since it is
claimed that the control necessary to maintain the quality of the article to within precise
limits is now the major cost in manufacture.
There are two schedules for administering the pill. Most firms produce a standard
oestrogen-progestogen combination which is taken from day five through to day 25 or 26 of
the cycle. This produces somewhat different changes in the endometrium from the normal,
the resulting environment is probably unsuitable for nidation of the fertilised egg and this
provides a third line of defence in contraception. A few firms have introduced a schedule
consisting of two "pills", one containing oestrogen only, which is taken for the first part of
the cycle, and the other containing oestrogen and progestogen which is taken during the
second part of the cycle. This is the sequence of the normal cycle, and a more normal
endometrial response is produced. It is claimed that the incidence of side effects is less.
"Sequens" (Eli Lilly) utilises such a scheme.
EFFECTIVENESS OF THE "PILL"
The "pills" on the market have been thoroughly tested on large groups of volunteers
and their effectiveness is practically 100%. Vast sums of money have been spent by drug
firms in this preliminary testing, often with the aim of showing that their product is as good
as someone else's. To prove the difference between 99.5% and 99.6% effectiveness requires
very large numbers of reliable subjects. The conclusions has been that practically all failures
are due to failures on the part of the subject to take the pill in the prescribed manner. A
lapse of as few as three days in the middle of the cycle may be sufficient to release the ovary
from inhibition, ovulation may occur and after that, recommencement of the "pill" has no
further inhibitory effect on that cycle.
Comparisons with other forms of contraceptives may be completely reliable when used
properly but suffer from the fact that they are applied at the time when reason is at its
minimum. In the case of the "pill", the precaution is taken at another time and, consequently,
mistakes are less frequent. Furthermore, when comparing overall failure rates, the
protagonists for the "pill' include human error in the figures for other methods, but do their
best to exclude them from their own. However, when human error is included, there is little
doubt that the "pill" is the most effective contraceptive available.
SIDE EFFECTS OF THE "PILL"
Nausea and break-through bleeding during treatment are common side effects of the
contraceptive pill and the main reasons for patient intolerance. Weight-gain, and loss of
libido have also been reported. Many of these effects may lead to complaints during the
first cycle of treatment but they usually become less marked on subsequent courses. When
they persist, the situation can sometimes be improved by changing to another brand of "pill".
The aim is to alter the dose level, or the type of oestrogen (ethinlyoestradiol or mestranol)
or the type of progestogen (oestrogenic or non-oestrogenic).
Women taking the "pill" are recommended to discontinue for a month in every six or
so, and to present themselves for a medical and pelvic examination each year. Furthermore,
the "pill" is available by doctors' prescription only. These are precautions which
have persisted from the early days when it seemed desirable to keep the new form of contraception
under medical supervision and there are valid arguments for continuing with
them. For example, the "pill" can mask the development of an underlying pathological
41

process and the examination is regarded as good gynaecological practise for all women past
the age of 25.
When the "pill" is discontinued, its effect is immediately reversible and ovulation and
normal fertility usually resume. Often the first cycle after treatment is prolonged for a week
or two due to a, slight delay in the release of the ovulatory mechanism. A state of amenorrhoea.
may develop but this is a rare sequela which usually corrects itself within a year.
LONG TERM EFFECTS
Although numerous workers have expressed their misgivings about suppressing a normal
function over a long period of time, there are as yet no valid contraindications for the long
term use of oral contraceptives. It has been estimated that there are more than four million
women in the U.S.A. taking the "pill" and approximately 400,000 in Australia. Although
the "pill" has been in common use for less than 5 years one might have expected that possible
harmful effects would have emerged by now in such a large population at risk. At present
no disorder has yet been shown to be significantly more common in women on the "pill"
than in the population in general. In fact, the protagonists for the "pill" are claiming other
beneficial effects; for example, they claim that cancer of the breast, uterus and cervix are less
common in the "pill" taking group. When questioned about the undesirability of treating
normal women with potent hormone preparations they express the view that the treatment
is for undesired pregnancies, and that any theoretical objection to the "pill" is much more
than counterbalanced by the reduction in the number of procured abortions. Nevertheless,
three undesirable social trends have been ascribed to the "pill", namely the current increase
in venereal disase, the increase in promiscuity and the decrease in birthrate in Australia.
THE "PILL" FOR POSTMENOPAUSAL WOMEN
When the "pill" should be stopped in a woman at the menopause has not been satisfactorily
decided. Many of the degenerative changes which occur after the menopause are
due to deprivation of the ovarian hormones. Some regard this cessation of oestrogen and
progesterone production as a biological accident made necessary by the undesirability of reproduction
after this time. Therefore, they prescribe hormones to be taken for life. This may
he an extreme view, and it will be interesting to see whether such universal use of hormones
becomes adopted here as it is in the U.S.A.
THE "PILL" FOR MEN
The testis is not a cyclic gland like the ovary, and its output of male hormone and
spermatozoa is a continuous process. The male hypothalamus, pituitary and gonad are not
geared to the cyclic processes of stimulation and suppression as in the female and therefore
do not respond satisfactorily to inhibition by a contraceptive pill, although many compounds
including oestrogens and progestogens are known to suppress spermatogenisis. During prolonged
suppression, changes occur in the testes which are difficult to reverse, and restoration
of normal fertility may take a long time or may be impaired permanently. There are
therefore many difficulties to be overcome before a "pill" for men becomes a feasible proposition;
not least of these are suitable volunteers for the trial.
FLAVOURED LIPSTICKS
These have opened man possible avenues of exploitation. the nutritive value of such
a foodstuff is doubtful, although increased metabolic activity can be demonstrated after
feeding. However, chemical analysis shows that the "orange" type has a low percentage of
Vitamin C Thus, obviously similar lipsticks could be used as a medium for the intake of
trace elements, vitamins and drugs. It has been suggested that lipsticks could be impregnated
and used as oral contraceptives, aphrodesiacs and as an anti-bacterial agent in the prevention
of disease transmission through the oral orifice.
42

approach to medicine
john matthews
Cannus observed that the world was divided into good and evil, and that despite man's
illusions of happiness, the good could never be realized while the evil was present. Thus to
achieve good, the evil must, in some way, be removed. Cannus recognised further, however,
that the struggle with evil is a never-ending struggle, but one which must be maintained
solidly even without hope.
This is a paradox which can be answered only within an answer to the meaning, or
purpose of life. Perhaps on a transcendental plane, evil and good are indistinguishable, both
being mere units of the amorphous nature of being.
Goodness and evil are meaningful to us only in relation to some other concept. For
example, knowledge is good if it induces understanding and tolerance, but evil if it breeds
arrogance. What then of disease? The relevant questions are whether the disease is totally
evil, and if so in what does its evil consist; if there is any good in disease where is it; and
if disease is evil, is it an ethical consequence to be bound to fight it?
I think the last question is probably the most difficult, and is therefore the most interesting.
An ethical consequence must be interpreted subjectively according to the ethics of
each individual. These could be broadly defined as religious or humanist.
In evaluating a religious approach to medicine it is tremendously important to remember
that Jesus Christ's mission on earth was a mission of healing—to repair broken bodies and
broken minds—whereas the process of healing was not the central issue in the Gautama's
meditation. Thus there was established in Christianity a benevolent altruism as revealed in
a desire to help the sick, which is quite lacking in other major religions. On this basis, the
over-zealous stoics who claim that suffering is the will of God, and what we can't understand
we should love, have little support. As Weatherhead pointed out, this dull acceptance implies
crediting God with an action which they should despise in a human being; the God they
worship is a God less themselves.
Rather, it is the will of God to permit suffering, as a logical consequence of permission
of free will. Thus to the Christian physician, healing involves both the repair of man's body
from the assault of other men, and repair of the mentality that wants to assault.
The principle aim of the West is to eliminate disease; the aim of the East is to live
with it. Thus the Eastern religions tend towards a more personal confrontation of disease,
bound deeply in the traditions of the caste. For example, a beggar who can cut off the feet
of a child so that it can have a reason for begging reveals not so much an antipathy to the
child but a mentality which accepts suffering as a basic premise of life, never to be alleviated.
The humanist's position is closely linked to that of Cannus above, in that he accepts
the "bounds" of the finite knowledge, and resolves to work within these bounds. Transcendency
has no meaning for him, being beyond the bounds of possible finite knowledge. The humanist
accepts the complexity of the individual from an analysis of the complexities of the natural
world. Thus for him the practice of medicine can never be ultimately successful, but this is
by no means a reason for quitting.
Creon woke up one morning to find himself king of Thebes, forced into a position of
compromise, intrigue and hate; forced to be the helmsman of a plunging, reeling ship, sinking
below the seas of anarchy. But he took the job. And so the humanist, when faced with a
crying child or a wounded soldier pleading for help, wastes no time in reflecting on the
ultimate absurdity of his position, but gets on with the necessities. As Cannus said, "A man
can not cure and know at the same time—so let us cure as quickly as we can. That is the
more urgent job."
The first questions concerning the nature of the good and evil in disease are intimately
concerned with the problem of suffering. The only "solution" to suffering, to which both
philosophical and theological arguments eventually come, is its inevitability.
43

On a natural basis, the only contact of an organism with another is by means of the
environment. This involves seeing, hearing and feeling. Then on a plane above sense perception,
but conditioned by it, is self-awareness and self-determinability. (Virchow, consistent
with his rather crude mechanistic concepts, defined culture rigidly as a neurological experience
of sense data.) Thus the sense came to be the agents of self-expression between individuals,
and could be used in a good, or an evil manner. And assuredly man has used them in an
evil manner.
More and more the modern physician is asked to treat in a patient the stupidity of his
fellow man—car accidents, domestic accidents and war accidents—but even more important,
he is asked to treat the mistakes of the patient himself. The more affluent the society, the
more determined it is to destroy itself in debauchery and pleasure, and the moral question
of to heal or not heal, is by no means clear.
But a solution to pain as the inevitable interaction between individual and matter,
individual and individual, seems to ignore the intense personal experience of pain. Surely
its very subjectivity denies the logical possibility of an objective discussion. To contemplate
the household of pain in surgery before anaesthesia, built brick by brick from the screams
of tortured bodies, is a nauseating experience. Thus it seems incredible that the clergy raised
earnest objections to the use of chloroform, as alien to the will of God that man must suffer,
and their very words seems to us to be the affirmation of a cold and stony misanthropy; the
words of a church long dead in vitality of thought and expression. And yet these were
passionate arguments based on the supreme conviction that suffering increases the wealth of
experience of man; it leads to a more profound appreciation of the incomprehensible workings
of God.
The debate over whether it was morally possible to administer anaesthetics to a woman
during childbirth raged for several years till Victoria settled the issue by inhaling nitrous
oxide for the birth of one of her children. Again this debate was based on a sincere interpretation
of God's wrathful words to Eve, "in sorrow should she bring forth children". Now
when a woman suffers greatly in labour and delivery, this would lead to an impaired
mother-child relationship, based on maternal resentment. But on the other hand it could
lead to deeper love between mother and child, a love which recalls the successful but bitter
struggle to bring a new life into the world. On an evolutionary scale, it is plain that as
material care increases so also does distress in bringing forth children.
The debates over the use of anaesthesia were settled, but the issues were not. In the
affluence of the modern society, superficiality, apathy, poverty of conviction or moral courage
are the dominant features. The easy way is always the preferred way—wage margins and
suicides increase at the same rate. Perhaps some of this confusion can be directly attributed
to the overall elimination of pain in our community, although most would be due to
changing social structure. However, it is certain that escapist policies such as giving a tiny
needle not to feel the big needle can only increase the dimensions of suffering when these
trivia are no longer available, for example in war.
If a particular society accepts the ethical consequence to heal disease and alleviate
suffering, it faces the very relevant question of how. From time immemorial the means to
achieve these ends have been as diverse as the societies themselves, and this discussion will
be limited to the Western Hemisphere, from the Greeks onwards.
The empirical basis of medicine as the science of healing was laid down traditionally
by the scholar and the physicians of the school of Kos, and their writings make up the
Hippocratic Corpus. This expounds the doctrine of disease as an imbalance of external
(dietary, climatic geographical) factors which induces an imbalance of internal (humoral)
factors. Thus the healing process consisted in restoring the balance. To elaborate, climatic
factors were direction and strength of winds, the season, and whether it was hot or cold, dry
or wet. These factors, together with geographical position, were of the utmost importance
in prognosis, as dealt with in the aphorisms and the Greek elements of preventive medicine.
All these imbalances in environment were reflected in changes in human physiology,
which the Greeks interpreted as changes in relative concentration of the four humorals,
blood, bile (yellow and black) and phlegm. These correspond to the natural elements air,
fire, earth and water, which were characterised respectively as hot and wet, hot and dry,
cold and wet, and cold and dry.
44

From modern experience such teaching would seem to be empirically derived. (This
was disputed by Galen, amongst others, who claimed that the art of healing was originally
invented and discovered by the logos in conjunction with experience.) However, these principles
were applied more and more in a dogmatic fashion, so much so that for 1,500 years
no questions were asked. Some interesting examples of Hippocrates' aphorisms include:
"Sudden death is more common in those who are naturally fat, than in the lean"—this
is perhaps an early description of cardiac failure.
"A pregnant woman is of good complexion if her child is male, of ill-complexion if
female."
Around the time when Copernicus and Galileo were questioning Aristotleian dogma in
astronomy, Paracelsus and Versalius were questioning Hippocratic dogma in the light of
experimental findings. Versalius made a thorough revision of human anatomy, and Paracelsus
introduced new alchemical principles into human physiology. Today his revisions may seem
grotesque, but this ignores the central issue of having the strength and conviction to be able
to question venerated dogma.
After Harvey's description of blood circulation, the old humoral pathology gave way
to the new. The blood now became the most important fluid in the body, the other humours
being relegated to incidental secretions. Disease was still interpreted as changing concentrations
in the blood (dyscrasias) and blood letting became a popular practice in the cure of disease.
The foundation of modern medical science was laid only a little over a century ago,
with the pioneering of cellular pathology, as distinct from humoral or corporate pathology,
by Rudolph Virchow and Claude Bernard. This immaterial view of disease, as the expression
of difference between two states, was violently opposed to the contemporary ontological
conception which attributed to disease the same reality of, say, a tree.
Today the means of alleviating suffering are legion. Hospitals, efficient nursing staffs,
ambulance services, vast prophylactic programmes, and so many other life-saving institutions
are taken for granted. Research is thrusting deep into the physical structure of life itself.
The manifold forms of disease are being traced to their origins in genetic constitution and
adaptability, and this leads to new concepts in treatment.
With the control or partial control of simple causative agents of disease, e.g. bacteria,
social and mental diseases assume new importance.
Alcoholism and drug addiction are diseases, but self-inflicted diseases, and the challenge
to the modern physician is to beat hurtful desire that brings addiction in its wake. But is
the authority of medical science today enough to counterbalance the weight of, say, prestige?
As contraception and abortion take on staggering dimensions, the principles behind them
tend to become obscured. It is not enough to debate on when life begins, or the legal rights
of the foetus, but on the fundamental purpose of sex and its relation to the ego. Moral
contraception implies more than a pun; it is the final regulation of teleology as a meaningful
doctrine, and with sex for sex's sake, carries forced acceptance of all homosexual, sadistic
and masochistic tendencies.
Of tremendous modern importance are eugenetic problems: the effect on future societies
of keeping alive and allowing to reproduce, a person whose genetic constitution has no place
in our environment, and whose continued life goes against all the rules of natural selection.
Vaccines and antibiotics when introduced into Asia had spectacular effects on reducing the
infant mortality rate; now there is a population explosion and widespread famine. The concentrated
suffering of the few has thus been diluted into the suffering of the whole community,
and where is the net gain?
To grasp these problems fully, and to have any hope of solving them, the physician is
dependent on his undergraduate training. The ideal medical student is described in the
Hippocratic canon as having a natural disposition, necessary instruction, favourable circumstances,
education, industry and time. Every one of these conditions is fulfilled by the modern
student, except the most important one: he lacks an education.
Descartes said that "if it were at all possible to enable the human race the means for
this could only be found in medicine". But while universities continue to train medical
undergraduates as if they were doing a technical course, then the future physician will be
just another figure on the golf course, and never be a force of any intellectual weight whatever.
In such a situation, the words of Descartes ring hollow indeed.
45

esidents,
and their salaries
bill richards
The following is an article discovered in the July 1915 edition of Speculum:
In these very strenuous times of national strife one is naturally disinclined to cavil at
the conditions under which we labour, or to unduly criticise the governing bodies who guard
our interests. But forgetting the fact, or even remembering it, that our nation is fighting for
its very existence, and that our national life is being sorely tried, one cannot help feeling
that it is high time that Residents at our hospitals were paid a reasonable wage.
A short review of the facts of the case, and a study of the salaries paid to Residents,
leads one to the inevitable conclusion that these men are positively underpaid, and that the
yearly stipend is in no way indicative of the services they render the institution in which
they are employed. It scarcely seems probable or believable that the Committees of Management
of these great public hospitals realise the changes which have taken place in the
medical course during the last twenty years.
It is an incontrovertible fact that, years ago, the medical course was reserved for the
sons of the rich and well-to-do men, and the number of poor and almost penniless students
formed a small percentage of the total number. So that, once these men received their
degrees, they were in a position to take their residentships for a paltry yearly salary, by
virtue of their private means. And the hospital authorities were cute enough, on this account,
to make the salary very microscopic.
But nowadays it is no uncommon thing for a man to work his way through the medical
course, and we all of us know many instances in which men who graduate immediately set
out to earn a living, because their meagre allowance cannot carry them any further. Some
do not sit for honours on this account, because they would be unable to take a hospital,
owing to their lack of private means, and because these hospitals refuse to pay their
Residents a living wage.
Our University education costs several hundreds of pounds up to the time we are
qualified, and it is a well-known fact that we pay through the nose for everything, and often
for very little. And it is a further fact that all these years we are subsisting on the charity
and generosity of our parents, this in some cases augmented by scholarships, exhibitions, fees
for coaching, and outside work in the vacations. And after all this work and expense we
are offered for services, which we all know are very strenuous and responsible, an amount
which does not constitute a living wage.
46

The boards of management will tell us, in reply, that we are getting valuable experience
from their institution—experience which we would be unable to obtain elsewhere. And,
further, they will inform us that the positions of Residentships are never vacant, and are
eagerly sought after.
That is all perfectly true. We do get undeniably valuable experience at a hospital, and
men are always willing, even if their private means are infinitesimal, to occupy the positions,
and accept the salary offered. But are the hospital authorities justified in taking advantage
of the zeal of the newly-qualified for experience, and callously asking them to obtain it at
the expense of both health and pocket? Is the bargain a fair one? And are the Residents
paid in accordance with their work?
Surely there is only one answer—the emphaticnegative—to such questions. Why are
the Residents, after their years of hardy study, with all the responsibilities which their
position entails, are at present paid only about one-third as much per annum as the men
who scrub the floors, polish the brasswork, and perform such like duties in the hospital? The
absurdity of the thing is appalling!
Do the authorities consider the work which a Resident performs is only one-third as
valuable to their institution, and to the public who pay for the upkeep of the hospital, as
that performed by attendants on the lifts, bathrooms, or mortuary?
Experience? Yes, certainly a Resident gets experience; but there is a large element of
hard work in it, a great deal of graft, responsibility, and hard knocks, far more than his
paltry salary would suggest. He is also serving the public, who support the hospital, and
whose money the committees spend, and the fact that he is gaining experience—a necessary
factor to success for all men in every walk of life—is not rational argument against his
being paid a living wage.
HAR-DUP.
Half a century later, in July 1965, research reveals little change in this situation. For
instance: when the wages of a Junior Resident Medical Officer are compared with those of
a hospital cleaner an appalling situation is revealed!
TIME = The approximate hours per week a Resident works = 103.5 hours.
WAGES = The wages a cleaner, on the award wage (£17/12/- or 9/- per hour) would
receive working the same number of hours. (Bearing in mind that the cleaner
is paid time and a half for hours worked in excess of eight hours (up to
twelve hours) in the same day; double time when he works in excess of
twelve hours on the same day; time and three-quarters on Saturday and
double time on a Sunday, when this time exceeds 40 hrs./week) — £66/1/4.
Times have not changed if the recognition of the R.M.O. by the hospital board is to
be any indication, since the R.M.O. earns £24 gross weekly which, to be fair, includes
board (worth approximately £ 5—although this may be doubted by the Resident), bringing
his wages to less than half that of a cleaner. Or, to look at it another way—for another
£6110/- per week a Resident works two and one-half times as long as the cleaner. In
addition to this he is on call during his sleeping hours and would average at least one call
per night, while the cleaner is home watching television or indulging in other forms of
relaxation! Also, the cleaner, if he works in the wards, would receive an extra 5/- per week
for working in nauseous conditions; 6d. per day risk rate for working in a ward where less
than 25 per cent of patients are suffering from V.D., cancer, TB, typhoid or meningitis or,
if more than 25 per cent, 21-d. per hour . . . and so it goes on ad nauseum!
So, you potential young medicos, just think . . . while you have been slogging your way
through six years of hell and frustration, each of the cleaners in the Melbourne Hospital
has pocketed £5,491/4/--and for several years after you graduate he will still be earning
relatively more than you . . . and what is more, he will have the spare time to enjoy it!
Up the workers!
HARDERUPPER '65.
47

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48

diagnostic quiz
paediatrics
1. A six year old girl with one month's history of excessive thirst and polyuria is
found to have hepatosplenomegaly, mild unilateral exophthalmos and a painless, firm, fixed
nodule overlying the sternum.
(i) Diagnosis?
(ii) What are the likely findings on X-ray of the skull?
2. A two year old who has been slow in mental development is found to be short for
his age. There is a history of general apathy, difficulty in maintaining temperature in infancy
and chronic constipation. On examination, in addition to being short and sluggish in his
movements he is pale, with dry hair and coarse features.
(i) Diagnosis?
(ii) Best screening test?
(iii) If (ii) is compatible with the diagnosis, confirmatory test?
3. A male infant aged four weeks presents with a history of vomiting, progressive over
the previous weeks. For the past four days the babe has vomited forcibly within half an
hour of each feed, but has continued to take his feeds hungrily. There has been no bowel
action for three days. He has lost 0.3 Kg in weight in the past week.
(i) Probable diagnosis?
(ii) Confirmatory findings on examination?
(iii) Most important investigation, and (iv) likely result?
(v) Treatment?
4. A male infant aged six weeks has failed to thrive since birth, is admitted to hospital
having had several convulsions in the past week. Each convulsion has occurred within one
hour of feeding. On examination there is slight jaundice and hepatomegaly. A nurse reports
that the urine contains both albumin and sugar.
(i) Diagnosis?
(ii) What is the cause of the convulsions?
5. A male infant aged six months who presents with a three day history of fever,
refusal of feeds and vomiting, is found to have pyuria. He has thrived well and has had no
previous illnesses. Management?
surgery
Mrs. M., a 54 year old housewife was admitted to hospital for investigation of
steatorrhoea.
For two years prior to presentation she had suffered from vague abdominal discomfort,
anorexia and malaise. Three months prior to presentation she developed diarrhoea with
pale, bulky, offensive stools which floated on water; upper abdominal pain radiating to the
back; and weight loss of about 1 stone.
A barium meal had been done and was reported as normal. Cholecystography failed
to reveal any calculi but the gall bladder was said to function poorly. In view of these
findings a laparotomy was performed six weeks prior to referral.
At laparotomy the stomach, small intestine, colon, pancreas and liver were inspected
and considered to be normal. The only abnormality was a solitary calculus in the gall
bladder and so the gall bladder was removed.
49

Following operation the diarrhoea continued unabated. She had up to 20 frothy stools
per day and her weight fell from 14 stone 6 pounds to 10 stone 2 pounds.
No other relevant findings were detected on questioning and the examination revealed
no abnormality apart from the laparotomy scar and a bruit under the left costal margin.
The following investigations were performed:
1. Full blood examination - within normal limits.
2. Serum alkaline phosphatase - 57 units.
3. Serum bilirubin - 1 mgm%.
4. Serum electrophoresis - normal.
5. Serum transaminase - 87 units.
6. Serum calcium - 9 mgm%.
7. Faecal culture - normal.
8. Occult blood - negative.
9. Barium meal and follow through - normal.
10. 24 hour faecal fat estimation on three occasions was 50.2 gms, 64.1 gms, 47.8 gms.
11. Xylose tolerance test - 6.8 gms were excreted within five hours of ingesting 25 gms.
12. Glucose tolerance test - compatible with mal-absorption.
13. Small bowel biopsy - normal.
14. Serum amylase - normal.
15. Folic acid - normal.
What is the most likely cause of this patient's mal-absorption?
How should this patient be managed?
medicine
Mr. A. D., a 45 year old builder, presented with a six month history of aches and
pains in the muscles and joints, malaise and weight loss of half a stone. Four months
later he suddenly developed acute pain. swelling and heat in the Rt. wrist joint together
with lesser discomfort in the knees and feet. He was given "red" tablets by his local doctor
and the pain settled down over the next week.
(1. In a middle aged man what form of acute arthritis must be excluded?)
(2. What laboratory test is pertinent?)
(3. What common drugs have an effect on this test?)
(4. What were the red tablets?)
Later the joint pains and swelling returned to effect most joints including the small
joints of the hands. He noticed that the joints were particularly stiff in the mornings on
awakening whilst after a few hours they appeared to loosen up.
(5. Significance?)
He had also noticed lumps behind the elbows which were not painful but seemed to
come and go.
(6. What are these?)
PAST HISTORY. One year previously he had an episode of redness and pain in the right
eye. This had resonded to drops containing "cortisone".
(7. Likely diagnosis?)
FAMILY HISTORY. No relations were known who had joint disease.
(8. Does this surprise you?)
INVESTIGATIONS. The urine was clear, ESR 60 mm. in 1 hour, (Westergren), serum uric
acid 5.8 m.g.%, Rose test - positive.
(9. What agglutinating particle is used in this test, what does it detect?)
(10. What is the diagnosis?)
(11. What X-ray changes would you detect in the joints in the early stages?)
50

He commenced treatment with aspirin — 15 tablets a day and weekly injections with
a drug which is on the N.H.S.
(12. What is this drug?)
(13. Is the doctor old-fashioned?)
(14. What are the important side effects?)
The patient managed to keep working but after 2 months' treatment claimed that he
could not continue. His ESR was still over 50 and he had a mild iron deficiency type anaemia
(Hb.10.5 gm.), occult blood tests were positive.
(15. Likely cause of anaemia?)
In view of these findings he was placed on prednisolone (15 mg./day) and the other
medication was discontinued.
(16. Is this a reasonable step?)
He improved gradually over the next six months but then noticed the presence of
burning pain in the legs and feet together with areas of numbness. The skin had become
dark in colour over several of the toes.
(17. Diagnosis?)
(18. What is the likely cause?)
If at this stage the patient also happened to have a gastric ulcer, diabetes mellitus,
hypertension, a psychosis, reactivated tuberculosis and osteoporosis what could you blame
(19)?
What will your reply be when the patient asks you:
Why haven't you cured his disease (20)?
Why isn't he on a special diet (21)?
Why have you given him aspirin when it is bad for the stomach (22)?
Why haven't you given him the miracle drug which was written up in Time Magazine
(23)?
Wouldn't he be better off in Queensland (24)?
gynaecology
Before you read on, write down the answer to each question. Count two marks for
each correctly answered, and one mark for anything less than that.
If you score more than-
40 — You are destined to immortality.
30 — A new Gynaecologist is born.
20 — What about Oodnadatta?
10 —It is not too late to join the Army.
As an added incentive, a prize of five guineas is offered to the reader who submits to
the Editor the best critical commentary in 800 words of the management of this case.
Frankly, Dr. Watt Sam Atta was worried. He had never seen his long-time friend and
patient, Oliva Gutzake so ill. For her 63 years, Oliva had been very healthy. Now, suddenly,
an attack of abdominal pain of considerable severity had doubled her up. She had vomited
three or four times too, she said, in the last 24 hours and she felt continuously nauseated.
When Dr. Atta looked at her, he found that she had a mild pyrexia of 37.5 deg. C.
and her pulse rate registered at 100 per minute. Her tongue was furred, but her breath
was not offensive. When he examined her abdomen he felt a firm, rounded, mobile mass
on the left side below the umbilicus, the size of a grapefruit. The mass was very tender
and Oliva did not like him touching it at all.
(Question 1 — What is the differential diagnosis?)
Because of her age, Dr. Atta thought that she must have either a chronic diverticulitis
with a pericolic abscess, a left hydronephrosis or possibly a complication of an ovarian
tumour.
51

He performed a rectal examination and felt no abnormality. On vaginal examination
he found that the vulva and the vagina were normal. The cervix was soft, slightly patulous
and admitted easily a finger, but Oliva had four children and this was expected. He
thought the uterus was enlarged and softer than one would anticipate in a patient of her age.
There was no mass palpable in the pelvis itself, but he was able to confirm the presence of
a mass above the pelvic brim on the left side.
(Question 2 — What is the clinical diagnosis?)
In order further to elucidate the diagnosis, a specimen of urine was obtained and
examined under a microscope. This proved to be quite normal.
Slightly nonplussed, Dr. Atta decided to consult his gynaecological colleague and sent
for Dr. P. V. Will Tellyer.
The specialist extracted a further point from Oliva's history, for six months she had
had irregular vaginal bleeding. "This surely is significant," said Dr. Tellyer.
(Question 3 — What is the significance of the vaginal bleeding?)
When he, in turn, inserted a speculum, he was able to show that blood was coming
through the cervix. A sound was introduced into the uterus and confirmed that the uterus,
which was anteverted, was 10 cms. in length.
When he withdrew the sound, the bleeding increased considerably. Dr. Tellyer arranged
for Oliva's immediate transfer to hospital.
(Question 4 — What is the next step in hospital?)
Having ascertained that Oliva had not eaten for four hours, Dr. Tellyer arranged for
an immediate laparotomy. His diagnosis was torsion of an ovarian tumour.
Oliva was prepared for a laparotomy and under a general anaesthetic, the abdomen was
opened. At operation, a hard, pale, pink tumour undergoing early necrosis, was found in
the site of the left ovary. The tumour had undergone torsion on its pedicle.
(Question 5 — Which way would the tumour rotate?)
(Question 6 — How would you treat this torsion of the tumour?)
Dr. Tellyer removed the ovary on the affected side.
(Question 7 — Was this the correct treatment?)
The specialist then closed the abdomen, bade his staff, goodnight and went home.
(Question 8 — What did he neglect to do?)
Dr. Atta thought to himself, "What about this vaginal bleeding? It has not been
investigated." But he reassured Oliva's husband that all was well and he, himself retired.
The tumour was submitted for section.
(Question 9 — What type of tumour might it be?)
The tumour was reported as "a solid ovarian tumour containing small polyhedral,
acidophilic, granular cells arranged in fasciculi, occasionally in vesicles resembling the
bodies of Call and Exner. There was much extravasated blood and necrosis suggesting torsion.
(Question 10 — What is the microscopic diagnosis?)
The pathologist concluded that this was a granulosa cell tumour of the ovary.
(Question 11 — With what changes in the uterus may a granulosa-cell tumour be associated?)
Dr. Atta telephoned Dr. Tellyer about the news, for here was a reasonably rare tumour.
"Ah", said Dr. Tellyer "we must curette the uterus".
(Question 12 — Is this the proper time to perform this operation?)
Dr. Tellyer performed a curettage after three days and produced very pale, fleshy and
bulky uterine scrapings.
(Question 13 — What could these curettings mean?)
He thought that these represented an endometrium of the cystic, glandular hyperplastic
type, which is associated with a granulosa cell tumour.
(Question 14 — Why does this hpyerplasia occur?)
(Question 15 — Is there any possibility of malignancy?)
The sections were submitted for microscopic examination and in two days a report
was made that adeno-carcinoma of the uterus was present.
(Question 16 — How could this misdiagnosis have been avoided in the first place?)
Dr. Tellyer said to Dr. Atta, "Really, it is my fault, I should have performed a
diagnostic dilatation and curettage before the laparotomy. One then could have instituted
better treatment than we can now and valuable time has been lost."
52

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•

(Question 17 — How would you treat the carcinoma of the endometrium?)
Dr. Tellyer consulted with the Radiotherapist, Dr. Cath O'Dray, who inserted a central
tube of Radon into the uterus and ovoids into the vaginal fornices. She administered a
dose of approximately 3000 r. to the uterus. Six weeks later, a total hysterectomy and
right salpingo-oophorectomy (the other tube and ovary having been removed previously) was
performed.
(Question 18 — Was this correct treatment?)
Dr. Tellyer opened the cavity of the uterus on the table and found that the growth
was polypoid in nature and was confined to the fundus.
(Question 19 — What would he do, were the growth on the lower part of the uterus?)
Had it been lower, he would have performed a rather more extensive operation by
dissecting out the ureters, removing a cuff of vagina with the parametrium surrounding it
and performing a lymphadenectomy on the lateral pelvic walls.
(Question 20 — What is the outlook for the patient?)
I am deeply indebted to :
1. Dr. K. Muirden — Medicine.
2. Dr. J. McDonald — Gynaecology.
3. Dr. B. Paine — Paediatrics.
4. Mr. A. Russell — Surgery.
answers
paediatrics
1. (i) Hand-Schuller-Christian syndrome.
(ii) Punched-out lesions in the vault of the skull. Possible erosion of the orbit and
expansion of the sella.
2. (i) Hypothyroidism.
(ii) X-ray of epiphyses. Normal epiphyseal development is incompatible with the diagnosis.
(iii) Protein-bound iodine.
3. (i) Pyloric stenosis.
(ii) Visible gastric peristalsis and a palpable pyloric tumour.
(iii) Serum electrolytes.
(iv) Hypochloraemic alkalosis.
(v) Pyloroplasty, after correction of dehydration and alkalosis.
4. (i) Galactosaemia.
(ii) Hypoglycaemia.
5. (i) Confirm the pyuria and infection with an adequate specimen.
(ii) Treat the infection.
(iii) Full investigation is indicated in any male infant with a urinary tract infection.
54

surgery
It was considered on the basis of the history and biochemical findings that the malabsorption
was of pancreatic origin — almost certainly due to a carcinoma of the pancreas
which had not been detected at the first operation. Accordingly, laparotomy was repeated
and an inoperable carcinoma of the pancreas was found.
Further management will consist of the administration of pancreatic extracts and symtomatic
measures to control diarrhoea and relieve pain.
medicine
1. Gout.
2. Serum uric acid.
3. Salicyclates in low dosage raise, in high dosage lower; Thiazide diuretics raise.
4. Phenylbutazone (Butazolodin).
5. The duration or morning stiffness is a good indication of the degree of inflammatory
activity.
6. Rheumatoid nodules.
7. Iritis — a known complication of connective tissue disease.
8. A positive family history is present in only 15% of cases.
9. Sheep red cells; rheumatoid factor, a gamma globulin.
10. Rheumatoid disease (really!!).
11. Periarticular osteoporosis.
12. Gold.
13. No, recent trials place its effectiveness beyond doubt.
14. Aplastic anaemia, dermatitis and nephritis.
15. This is the typical type of anaemia in Rheumatoid disease, positive occult bloods occur
in most people taking regular aspirin.
16. Before contemplating steroids the patient must have had the other items of conservative
management. This includes rest — usually a period in hospital with splints and
physiotherapy.
17. Arteritis causing peripheral neuritis.
18. A Rheumatoid complication commonest in patients on corticosteroids.
19. The prednisolone theraphy!
20. At the initial interview the nature of the disease must be explained. No one can promise
a cure although the disease may spontaneously remit.
21. Despite recent speculation there is no evidence that a special diet is beneficial.
22. All the useful anti-inflammatory analgesic drugs have gastro-intestinal side effects.
Aspirin is probably the most innocuous.
23. He means "D.M.S.O." which is not available in this country, and anyway is of doubtful
benefit in Rheumatoid arthritis.
24. With all these complaints — yes, so long as you don't intend to take your holidays there!
gynaecology
The answers mostly have been given in the narrative, but to underline them, here they
are in order:
1. The differential diagnosis is between some large bowel complication such as a
carcinoma of the sigmoid colon or chronic diverticulitis with a peri-colic abscess. Some
55

urinary tract complication, such as a left hydronephrosis must be excluded. Because of her
age, fibromyomata and hydrosalpinx are unlikely.
2. The clinical diagnosis is a torsion of an ovarian cyst, since the tumour is mobile,
rounded, firm, tender and associated with pain, vomiting and mild pyrexia.
3. Some ovarian tumours such as granulosa cell tumours, luteinomas and thecomas
produce vaginal bleeding. Even in the absence of an ovarian tumour, bleeding at the age
of 63 Is always significant and malignancy of the genital tract must be excluded before the
patient is discharged.
4. A cervical smear would be taken for cytological examination following the diagnosis
of torsion of an ovarian tumour and then an emergency laparotomy would be planned, but
this should have been preceded by a diagnostic curettage.
5. The tumour will rotate in the direction of supination of the forearm of the same
side (Kunstner's Law).
6. In emergency surgery, the simplest procedure should be performed. In this case.
the surgeon was correct simply to remove the tumour and close the abdomen. Had the
tumour not been twisted, a hysterectomy with removal of both tubes and ovaries was called
for.
7. The chance of malignancy is high, for in fact, more than 50 per cent. of ovarian
tumours in this age group are malignant. Dr. Tellyer should have inspected the other ovary
closely to make sure he was not dealing with bilateral tumours. During the laparotomy. he
should have palpated the abdominal contents carefully, particularly the stomach and large
bowel to exclude a metastatic tumour of the alimentary tract.
8. Dr. Tellyer had neglected to perform a diagnostic dilatation and curettage of the
uterus before the laparotomy. Had he done this and found the hypertrophic curettings, even
had he not had the advantages of a frozen section, he would have suspected a granulosa cell
tumour. With this diagnosis, the situation could have been best treated by a total hysterectomy
and bilateral salpingo-oophorectomy.
9. The tumour could be primary or secondary. Solid ovarian metastic tumours from
the bowel are bilateral and contain specific cells — "signet-ring" cells (Krukenberg's tumour).
Primary tumours are benign or malignant. Benign solid tumours of the ovary are fibromas,
granulosa-cell tumours, thecomas, luteinomas, Brenner's tumours and other rare moieties.
Granulosa-cell tumours, thecomas and luteinomas may be malignant occasionally (approximately
15 per cent.). The incidence of malignancy in these tumours increases with age.
10. The microscopic diagnosis is of a typical granulosa-cell tumour.
11. A granulosa-cell tumor is associated with hyperoestrogenism. The vagina is soft and
succulent, the cervix softened and the endometrium thick and hyperplastic.
12. Curettage should have been performed before the laparotomy.
13. Such curettings mean—
a. Cystic glandular hyperplasia.
b. Carcinoma of the endometrium.
14. Endometrial hyperplasia occurs because of the excessive oestrogen output of the
granulosa-cell tumour.
15. Carcinoma of the endometrium has an increased incidence in cases of granulosa-cell
tumour. About 15 per cent. of reported cases of this tumour have been associated with
carcinoma of the endometrium.
16. The error in diagnosis could have been avoided with vaginal smears and early
curettage. Frozen sections further would have accelerated treatment.
17. The treatment is described in the narrative. In summary it consists of intra-uterine
irradiation followed, in six weeks, by an extended hysterectomy and bilateral salpingooophorectomy.
18. A rather more extensive operation was called for — a cuff of vagina should have
been removed and a wide excision of the broad ligament. The uterus should have been
opened at the table and if the lower half was involved microscopically, a pelvic lymphadenectomy
was indicated.
19. A Wertheim radical hysterectomy would be performed.
20. The prognosis for this patient is quite good. The five year survival rate for carcinoma
of the uterus, treated in this way, is of the order of 70 per cent.
56

"miss medicine"
susie white
"Miss Med. judging —Lou Richards compere — Med. North," read the activities sheet,
and 800 people were nearly injured in the rush. Unfortunately nearly half had to be turned
away. The annual wrecking of Med. North commenced as soon as the judges entered.
This year's glamorous panel of experts were supplied by the M.S.S., Walton's Fashion
Department, and Ellie Lucas' Establishment, all ably led by Melbourne's own anatomy
expert, Prof. Ray.
After injuries sustained during Miss Med. '62, Lou Richards made a magnificent comeback,
entering Med. North from the left-back flank and bouncing rapidly to full-back.
Med. students teams did badly on the day, the percentage of scoring shots being low, as Lulu
ably defended the goals against all missiles.
The first of the 13 reluctant contestants was dragged into the yard from Med. South and
the show began. Auctioneer Lulu was in top form as he verbally undressed each girl in his
usual modest and subtle way. Skillfully handling abuse from the audience, Lulu kept the
ball rolling for nearly an hour. Only once, when annoyed, did he religiously discriminate
by inviting the audience to "have a go at the little bloke with the big nose" who had persisted
with juvenile heckling the whole time.
After deep consideration, the panel announced Susie White as Miss Med., 1965. Susie,
a second year student, has flares for Amnesty, hockey, and various other unspecified female
pursuits. She was quickly hustled away by some reporters and photographers (who did
not have pens or cameras) before the mob could reach her.
All-in-all it was a great success, and thanks must go to Lou Richards, Hon. Life
Member of the M.S.S., for bravery beyond the call of duty; and to Albert Kennedy, who
aged 10 years, as he watched his Med. North crumble; and to the judges who maintained
dignity throughout the whole performance; and finally to the organizers.
57

medical students' society
committee members
EXECUTIVE : July, 1964 — July, 1965 July, 1965 — July, 1966
President : Prof. G. C. de Gruchy. Prof. V. L. Collins.
Chairman : John Mackellar. Anton Cavka.
Vice-Chairman : Andrew Crapp. Damian Connelly.
Secretary : Robert Nave. John Wettenhall.
Treasurer : Andrew Roberts. Robert Rome.
Assistant Treasurer : Anton Cavka. Tony Incani.
EX-OFFICIO :
S.R.C. Members :
S.R.C. Faculty Reps.:
Editor of "Speculum" s
Producer of Medleys :
Sports Secretary :
Robert Hall.
Julie Cliff.
John Lynch.
Jamie Odham.
Nicholas Radford.
John Crouch.
Robert Rome.
John Lynch.
Diana Nash.
Ralph Riegelhuth.
David Bannister.
Rodney Guy.
ORDINARY MEMBERS:
Division I Rep. : David Francis. Gary Symukler.
Division IIA Rep. : Roger Haskett. Tony Holmes.
Division II Rep. :
Damian Connelly.
Division HI Rep. :
John Mackay.
WOMEN'S
REPRESENTATIVES :
Pre-Clinical : Diana Nash. Helen Noone.
Clinical : Ruth Markovic. Elizabeth Nash.
HOSPITAL
REPRESENTATIVES :
Alfred : Keith Waters. Keith Waters.
Prince Henry's : Simon Ceber. Simon Ceber.
Royal Melbourne : Max Haverfield. Max Havenfield.
St. Vincent's : Michael Martin. Michael Martin.
58

m.s.s. executive 1965-66
Anton Cavka,
Chairman.
Damian Connelly, Vice-Chairman.
John Wettenhall. Secretary.
Robert Rome, Treasurer :
Tony Incani. Asst. Treasurer.
59

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60

m.s.s. chronicle, 1965
secretary s report
The year 1964/65 has been one of unprecedented achievement in the history of the
Medical Students' Society and it is with much pleasure that I present to you my report of
the year's activities.
For the first time for 13 years, Medleys was held on two nights and proved an even more
outstanding social and financial success than previously, largely due to the effort of the
organiser, Peter Habersberger. In the revue, "Lawrence of Alabia," the producer John
Crouch, backed up by a talented cast, staged a most entertaining combination of subtle and
bawdy humour with songs, dances and film sequences. Medleys 1965 will again be held on
two nights, December 9th and 10th at St. Kilda Town Hall.
In April a huge faculty barbecue was run by the society at Frankston. While the more
energetic stomped and twisted in the dust to the music of the "Group", others gained sufficient
exercise in bending their elbows. I am sure all whom attended will agree that the
barbecue should become an annual function.
The other big social event, the Med. Dinner, was spoilt by a minority of irresponsible
individuals trying, with variable degrees of success, to drink themselves into oblivion. The
rest of the 160 guests listened to a most interesting and entertaining speech by Mr. E. S. R.
Hughes. Unfortunately, the management did not join in the spirit of the occasion and
Medical students have been declared "personae non grata" at the Delphic, resulting in the
loss of yet another venue.
During the May vacation about 40 members of the society migrated to Brisbane and
Surfers Paradise for the annual A.M.S.A. Convention. Melbourne students, while well represented
at all the social functions, were conspicuous by their absence from the lectures,
and most would have liked the whole convention to have been held on the Gold Coast. Next
year the A.M.S.A. Convention will be held in Melbourne and it is hoped that as many
students as possible will participate and return the hospitality of our interstate colleagues.
John Lynch, the, the National Director of S.C.O.M.E., has been chosen by the A.M.F.A.
committee to represent Australian medical students at the international (I.F.M.S.A.) conference
in Edinburgh in August. We wish him a most successful trip.
Robert Hall, our enthusiastic and capable Faculty Rep., has been appointed President
of A.M.S.A. for 1966, a position for which he is well qualified.
In the recent S.R.C. Elections only two medical students, Miss Diana Nash and Tom
Lynch were elected as General Reps.
In the Miss University Quest, although well represented by Miss Sue White, we were
again unsuccessful.
Negotiations have been completed with the Remington Publishing Company to produce
the 1965 edition of "Speculum" at no cost to the society in return for which they will solicit
all advertising. This agreement will result in a saving of over £200 by the society and should
result in reduction of the price of the magazine. The Editor, Ralph Riegelhuth, is happy
with the agreement and plans to produce "Speculum" with a new layout and a new cover,
making it more attractive and more readable.
Throughout the past year several new editions of "Student Medicine" have been produced
and the Editors are to be congratulated on the continuing high standard of their pub-
lication.
1965, was a well organised and well conducted initiation of Freshers
Orientation Week,
to the University way of life. Highlights included a sherry party and hospital tours. The
61

Directors, Damian Connelly, who also organised the barbecue, and Brian Stagoll, who is
running films for the society, did an excellent job.
In contradistinction to Blood Donation Week, to which student response was poor, many
students volunteered their services for the Anti-Cancer Campaign and over £3,000 was raised
by the University Students.
Participation in inter-faculty sport has met with mixed success. While we won the I.F.
athletics and have just suffered our first defeat in table tennis, the football team has won only
one match—by a walk-over.
The M.S.S. has accepted a sub-agency of the Scottish Amicable Life Assurance Society,
an agreement which involves us in no obligation, but for which the M.S.S. will receive £10
for every £1,000 life assurance cover sold to its members.
The other sources of income, viz., the Collins Co-operative Book Scheme, and the sales
of instruments and bones, have continued to be of great financial benefit to the society and
to the students themselves.
Following the trend set by our predecessors, the executive have on several occasions
had lunch with the Dean, and on one occasion a most enjoyable dinner. We are very grateful
to him for his invaluable advice and for the active interest he has shown in the society,
despite the heavy demand on his time.
In conclusion, I would like to thank our retiring President, Professor de Gruchy, for
his sound advice and support; Mr. Sanderson and Mr. Elford for their continued invaluable
assistance and, finally, the general committee, particularly John Mackellar, whose enthusiastic
chairmanship has been the inspiration for the successes achieved throughout the past year.
BOB NAVE.
* *
treasurer's report
In view of the unusual term of office of the current executive, the general committee
decided that the Treasurer should report on the society's financial activities for the period
1/4/64 to 30/6/65. As the annual general meeting will be held in early July of each year
in the future, the report shall then cover the period of the accepted financial year.
When one looks over reports of recent years they appear to range between a detailed
financial statement to vague half-page utterings with not a figure in sight. This as may be,
with the ever-increasing funds of the M.S.S., the aid of a financial wizard from the Commerce
School may prove very useful in the future. In the last 15 months the society has
handled a record amount of money. Highlights have been:-
1. Medleys' Profit. This is the result of two revues and is an all-time high. In view iof
the report by last year's Medleys organiser, it is felt that with more enthusiastic advertising,
earlier ticket sales, and exclusion of the cost refund system, a figure close to £800 can be
expected.
2. Faculty Barbecue. This function was not well supported, and is expected to result in
a loss of £40 (at time of report outstanding account of £45).
3. "Speculum" Account. As explained in the Secretary's Report, it has been decided
that the Remington Publishing Company shall now be responsible for the financing of the
production of "Speculum 65". In the past this has been a great burden to the Society's
finances (last year it cost £451/14/6, less approximately £200 in advertising revenue). This
amount was paid from the "Speculum" Account, and the balance of £130/18/5 was transferred
to the general funds, and the "Speculum" account closed. In the future proceeds
from the sale of "Speculum" will be net income and be deposited in general funds, as "goods
sold".
4. "Student Medicine". The first edition of this production was financially disastrous.
Both Mr. Knox and the executive made a bad mistake to the value of £190/5/4 from general
funds and £100/0/0 from savings account. After much debate it was decided that Mr. Knox
repay £75/0/0 to the society. However, to date only £30/0/0 has been forthcoming, despite
repeated requests for the balance. Legal action is not possible (and certainly not desir-
62

INCOME
MEDICAL STUDENTS' SOCIETY
Bank Statement (1/64) £70
Medleys '64 650
uSale of Goods 163
Barbecue . 6
Films . 2
Orientation 7
S.R.C. Grants . 4
(General and Stationary) 7
"Speculum" Account 130
Bank Interest 11
Transfer from Savings Account 200
Transfer from Trading Account 300
Unknown Deposit 6
8
16
6
18
10
7
8
18
18
1
0
0
0
2
2
0
8
0
7
0
9
5
000
0
0
£1,570 12 9
EXPENDITURE
Bank Statement (30/6/65) ....
Party Subsidies .
Convention, 1964 ........
Convention, 1965 .
Miss Med., 1964
Miss Med, 1965
Med. Dinner, 1964
Med. Dinner, 1965
"Student Medicine" .
Executive Dinner .
Miscellaneous:
'63 Account
"Medleys '63" Account .
Executive Expenses:
Open Day, 1964
Printing, 1964
Printing, 1964/65
Printing 1964/65
Farewell Gift
A.M.S.A. Subs.
R.W.H. T.V. Repair
Stokes Badges
"Speculum" Expenses, 1964
Postage, 1964/65 .
Cheque Books .
Transfer to Trading Account
"Medleys" Deposit, 1965
£536
107
87
106
17
36
106
138
190
20
13
4
8
16
10
1
4
11
12
4
15
1
36
17
2
15
2
20
25
£1,570
10
19
9
13
14
15
8
14
5
9
6
0
6
10
0
0
0
15
7
1
0
10
9
17
15
12
2
0
0
12
10
1
6
6
3
2
0
9
4
3
3
0
0
6
0
0
0
0
6
6
0
0
9
0
0
1
6
0
0
9
M.S.S. SAVINGS ACCOUNTS
INCOME
1/4/1964 £800 4
Interest 4 11
0
4
£804 15 4
EXPENDITURE
30/6/ 1965 .. £498
Transfer from RMH 200
Transfer from Nat. . 100
Dishonoured Cheque 6
Dishonour Fee 0
12
0
0
0
3
4
0
0
0
0
able), and whilst one doesn't like "passing the buck" to the next executive, one hopes they
shall redeem the outstanding £45/0/0.
5. Miss Medicine. Functions resulting in income towards Miss Medicine expenses are
still being held, hence the figure of £36/15/2, which we hope will be considerably reduced.
The society has given £100 annually to W.U.S. However, it seems a pity that we are
not able to raise more than this amount.
6. Dinners. These continue to remain controversial and inevitably a financial flop.
Tickets are reasonably priced at £1 / 10/0, but support is not very good. Some wish the
dinner to be more than an annual booze-up"--others disagree. As we are rapidly running
out of venues in Melbourne for this function. in its present form, we hope the new committee
will find a satisfactory answer to the problem.
Overall, the society's finances continue to be in a healthy state. With the A.M.S.A.
Convention to be held in Melbourne next year, the incoming Treasurer will have quite an
added load. It is hoped that with increasing Medley's profits, increasing "Speculum" profit,
and reduced "Student Medicine" costs, that the society's assets may really double. In time
this will be of great benefit to all of us, as medical students, throughout the next twelve
months, and in the years to follow.
63

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n.m.s.a. convention
1965
brisbane & surfers paradise
john mackellar
Well, Queensland is not exactly brown bosoms decked with white frangipani; however,
the hospitality of its "banana-benders," the warmth of its beer and the texture of its girls
cannot be matched elsewhere.
The Melbourne and Monash contingents which arrived late on Thursday, 21st May,
were personally escorted to their lodgings or entertained at the Medical School at Herston.
Thus Brisbane set the stage.
Next day, A.M.S.A. President Ed. Tweddell introduced Professor Gordon, Dean of the
Queensland Faculty who welcomed us to Brisbane, and then over tea and cakes more
introductions were in order — Brisbane's Dorothy Millar and David Pritchard (A.M.S.A.
Treasurer and Secretary became familiar faces, as did John Handy (Pres. U.Q.M.S.) and David
Weedon (Pres. Queensland Union). Quickly the lectures were underway with a discussion on
"Auto-Immune Diseases" followed by many subjects varying from "melanoma" to "medical
ethics." A seminar on hypertension was chaired by Melbourne's former Ass. Professor of
Pathology, George Christie, and popular Konrad Hirshfeld spoke to an enthralled audience
on "The romance of Medicine and the Medical Student."
The social programme was off to a bubbly start with a hop in the Union, followed
by a barbeque on Cape York Peninsula and a cabaret at Mt. Isia. Melbourne's "official"
joke-tellers at the Dinner were a reflection on their parentage. Despite the varied agenda,
which included three or more days at Surfers Paradise, many of us made our own arrangements.
ANNUAL GENERAL MEETING.
This again was poorly attended, but it was pleasing to see Melbourne and Monash
observers present. We hope that the Annual Meeting will be well attended in Melbourne
when it will be held immediately after a lecture.
STANDING COMMITTEE ON MEDICAL EDUCATION.
The Annual Meeting of S.C.O.M.E. was chaired by the National Director, John Lynch,
who accepted the position following the tragic drowning of Queensland's, Max McKenzie.
Mr. Lynch blamed poor liaison for the unavailablility of local reports. In presenting
Melbourne's report on "Compulsory Health Insurance," he said that such a scheme must:-
1. Provide adequate care and service to the whole population.
2. Be an economic feasibility.
3. Win the approval of the Medical Profession.
Students were found to agree in principle to a scheme mooted by Gold ("Bulletin,"
April, 1965). As a consequence, the 1965-6 topic is to be "A Nationalized Medical Service"—
which "must allow for a study of all possible methods of financing Medical care." Melbourne
offered £25 towards a prize for a national essay competition on this subject, the winning
essay to be presented at the 1966' Convention.
COUNCIL MEETINGS.
Melbourne was represented by myself as delegate with Robert Hall and Ruth Markovic
65

as observers. Representatives of all faculties from Papua to Perth attended. A.M.S.R.
Health Officer, Ross Forgan-Smith, and S.C.O.M.E. Director, John Lynch, were also present.
At the commencement of the meeting, President Ed. Tweddell read a letter from the
North Brisbane Hospital Board denouncing damage to the Students' Quarters "Lanoma." The
bevaviour of the two Sydney students involved and their refusal to pay for damage done
has forced me to exclude them from next year's convention.
(a) Constitution
Hugh Veness (U.N.S.W.) and Jenny Baker (Sydney) proposed:-
1. That Section ii, the words " 'Executive Society' means the Constituent Society"
be changed to ". . . Constituent Societies."
2. That in Section v, Clause 8, the words ". . . Constituent Society" be changed to
. .. Constituent Societies."
Melbourne blocked the motion but later rescinded and the changes were made.
(b) I.F.M.S.A.
Melbourne outlined A.M.S.A.'s problems with I.F.M.S.A. and the President agreed
that we gained little from the European dominated organization. However, after much
discussion it was agreed that Australia should retain its full membership. John Lynch spoke
of the need for increased Australian participation in international affairs and the hope that
A.M.S..A. could interest S.E. Asian countries in either I.F.M.S.A. or a smaller regional
association of Medical Societies. Jack was later selected as delegate to the General Assembly
of I.F.M.S.A. in Edinburgh. His report appears elsewhere in "Speculum."
(c) FINANCIAL STRUCTURE OF A.M.S.A.
Dorothy Millar read the report of investigations into the financial structure, suggested
plans for the future and pointed out that the A.M.S.A. image must be improved. Individual
societies are to prepare reports on A.M.S.A. finances. Miss Millar has assumed the title
"A.M.S.A. Finance Officer" and will report to the 1965-6 Executive on her further research.
Melbourne mentioned its happy association with Corindi Pty. Ltd. and a motion was
passed "that A.M.S.A. recommends to its members Corindi Pty. Ltd. and endorses its
dealings with students. As a result, constituent societies will receive 21% and A.M.S.A.
21% of the profits of sales to students.
(d) Exchange Schemes.
Perth's Eggleston spoke at length on. nothing in particular and submitted a similar report.
It was then decided "that A.M.S.A. is not yet prepared to launch a full exchange scheme
on behalf of its constituent societies." Melbourne would do well to look after its own
interests in this regard. See "Student Medicine," Vol. 3, No. 2, p. 5 and 22.
(e) Standing Committee on Student Health.
A new S.C.O.S.H. is to be appointed along lines similar to S.C.O.M.E. and the National
Director will be appointed by the new A.M.S.A. Executive. Health Officer, Ross Forgan-Smith,
obtained membership for A.M.S.A. in the Australian and New Zealand Student Health
Association during his recent visit to New Zealand.
It was decided that the S.C.O.S.H. project for 1965-6 is to be "The investigation of
the incidence of psychiatric disorders in the student population and the possible remedies
of these disorders."
(f) Papuan Common Room.
Queensland had failed to act on Perth Executive's plan for Medical Students at the
Papuan Medical College. Miss Millar said the plan was political in nature and therefore,
not the direct concern of medical students. Melbourne has been directed to finalise this and
other matters.
(g) Paramedical Bodies.
The membership of A.M.S.A. has now been restricted to students from Medical faculties.
All therapy students are henceforth excluded.
(h) Conscription of Medical Students.
Geoff Crawford and Hugh Veness U.N.S.W.M.S.) spoke of the high numbers of medical
students at U.N.S.W. conscripted for the new National Service Training. A.M.S.A. was
instructed to investigate this matter and to question the Federal Government on the selection
of conscripts. Later in August, N.U.A.U.S. was asked to investigate the whole student
population.
66

(i) 1966 Convention.
Melbourne is the site for next year's convention. M.U.M.S.S. is the Executive 1966-7. 6
whilst S.U.M.S. and U.N.S.W.M.S. are the provisional Executive Societies for
Monash is expected to help Melbourne in its preparations. The Convention Director is John
Silver.
In conclusion, I would like to thank the Brisbane Executive — Ed. Tweddell, David
Pritchard and Dorothy Millar for their great efforts during 1964-5. I would like also to
congratulate the new President, Robert Hall, who has already done much for A.M.S.A., the
Secretary, Joe Chiappalone, and the Treasurer, Julie Cliff.
Barbara Vaughan
and Helen Bloom
inter-faculty
sport
So far this year Med. has had a mixed amount of success in inter-faculty sport. The
highlight, undoubtedly, was in the Athletics, in which we beat all faculties, including Phys.
Ed. Our winners, Peter O'Brien and Graham Thompson (First Year), Doug. Coster and
Rod. Guy (Second Year) and Anton Cavaka (Fourth Year) are all to be congratulated. The
future for Athletics seems bright, as many of the above are at an early stage of the course.
These athletes, plus Robert Fitzpatrick (relay) represented Melbourne in Inter-varsity in Sydney,
where Doug. Coster and Rod. Guy were successful, and Graham Thompson and Anton
Cavaka gained places.
Another successful aspect of inter-faculty sport was football. Although Med. met with
little success on the field, there was a good atmosphere about the team which enabled the
players to really enjoy coming along on a Wednesday to play, even though generally on a
losing side. Best players included Eric Fairbank, Charlie Curry and Dave Chambers. Although
prac. prevented many good players attending, enthusiasm was not lacking. The
competition finished on a good note: we beat Applied Science by a walk-over and the niner by
tea-time.
This year Med. has been represented in Table Tennis and Rifle Shooting, the f ormer being the more successful. Also contemplated is Men's Basketball.
It is gratifying to see us well represented in sport, but more support is yet needed. Professional
relationships with people demands being people, and sport, more correctly sportsmanship
is an important and necessary part of our training.
67

• S
0 1 I •MOSOUO
fourteenth general assembly
The Australian Medical Students' Association approached the XIV G.A. with many
reservations. There was a large body of opinion which favoured withdrawal from the
Federation because Australian medical students had gained so little from the Federation's
activities. However, the main factor was the lack of information about I.F.M.S.A. It is
difficult to point to specific causes but high on the list was the lack of interest by the A.M.S.A.
executives and the failure of the Australian delegates to General Assemblies to produce a
report or to publicize the work of the Federation.
The XIV G.A. was held in that venerable home of the three Munros, Edinburgh,
Scotland. After the official opening on Monday, August 9th, the eighty delegates were
arranged into working committees, each of which considered a particular field of the
Federations activities. As in previous years the majority of delegates were from European
countries.
The following report is a resume of the deliberations. A more detailed report, the
publications mentioned or further information may be obtained from either Jack Lynch,
C/o S.R.C. Office, the members of the A.M.S.A. executive or your year representative.
MEDICAL EDUCATION
After years of frustration an opportunity has arisen for student opinions on medical
education to be expressed to an interested body. The World Medical Association is to hold
a conference in 1966 at New Delhi, India, on the topic "MEDICAL EDUCATION — a
factor in Socio-Economic Development".
Several European officers of I.F.M.S.A. have excellent personal contacts in W.M.A.
and are attempting to secure for I.F.M.S.A. delegate status to the conference. In addition
W.M.A. has recommended that all Medical Associations should include student representatives
in their preparatory discussions for the Delhi Conference.
STUDENT HEALTH
After the very successful Drug Appeal of last year the Federation is to embark on a
further campaign. In addition the Blood Appeal Week is to be continued together with a
very ambitious plan to detect sight deficiencies. Following a request from some member
countries an attempt will be made to collect surgical equipment for student-run clinics in
Ghona and India.
PUBLICATIONS
I.F.M.S.A. produces a wide spectrum of literature, all of high technical and editorial
quality. These include:
1. Biannual Magazine — containing both academic and articles of general interests. For
example:— Medical Education in Sweden; Folk Medicine in Malta; Sexual Characteristics
of the Bantu.
2. Quarterly News Review — a concise report of topical student activities, conferences,
summer schools and I.F.M.S.A. projects.
3. Introducing I.F.M.S.A. — a beginner's pamphlet, whose title is self explanatory.
4. How to go Abroad — interested in spending a few months at a foreign medical school,
who to contact, how much money is required, what to expect? It's all here.
68

5. A Guide to General Assemblies — what really happens at these mystic gatherings. Just
the book for the student politician who thinks he is in for a "free trip".
6. Songbook — a universal collection of songs so dear to med. students.
All these publications are available from your A.M.S.A. representatives, the Melbourne
Med. Students' Society or from the Medical Library.
STUDENT EXCHANGE •
Each year several hundred European Medical Students spend two months in a foreign
medical school. They do this not only to learn medicine, but also to gain an appreciation
of how a different community lives. These exchanges are aranged through I.F.M.S.A. and
are continually increasing in number. The ease of such exchanges varies. In England, the
students have a two month elective period which they may spend overseas. In the Scandinavian
countries a clinical student may take from 12 to 18 months off to pursue his own interests.
In Canada, clinical students are paid a wage while working in the hospitals. Australia has a
long way to catch up in this field. However, the Perth Medical Society has an exchange
scheme with the University of Ceylon. Furthermore, this year a party of Japanese medical
students, with their teachers, toured Thailand and Ceylon.
In the same vein 200 European students attended a Tropical Medical Course of two
weeks organized by the British Medical Students' Association. Similar numbers attended
a Students' International Clinical Conference held in Sweden earlier this year.
LIAISON
I.F.M.S.A. continually attempts to interest medical student associations in the activities
of the association. At the present time there are members of I.F.M.S.A. on all Continents,
however, these are very few. As a result it is difficult for such countries as Australia, to
arrange exchanges, seminars or drug appeals with nearby nations.
Australia was elected to supervise this work of liaison. It has particular importance this
year because following the visits of the writer to Asian countries, Australasian, a Medical
Students' Association has been established. After visiting medical students in Singapore,
Hongkong, Vietnam, Thailand, India and Ceylon, a decision has been made to hold a
conference of delegates from these countries in Singapore in March of next year.
By arranging the proposed Australasian Association on similar lines to I.F.M.S.A. it is
hoped to provide the same facilities for Australian students as are now enjoyed by
European students.
The foregoing remarks cover only the bare essentials of this year's General Assembly
but they should provide the context within which the work of A.M.S.A. over the next year
in these fields can be viewed with some degree of comprehension.
JOHN LYNCH,
Fifth Year,
IL MARE
DIE NEER
LA 11ER
THE SEA
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70

year notes:
first year
First year Medicine 1965 is the Al model from the Education Department's showrooms
this year. Faceting the superb craftsmanship of Mr. Bloomfield's hand picked professionals,
this model stands aloof from past vintages in style, grace, luxury and comfort. Following
a period of intensive last minute preparation — polishing the duco and brass fittings to a
brilliant gloss — the ED-Al drew lavish praise from the panel of judges at the recent
Matriculation Motor Show. One unfortunate omission from the panel was an engineer, so
that the engine of the ED-Al was left unexamined.
We took the liberty of consulting a top mechanic on the ED assembly line, who gave
us some interesting comments on the engine design. Revolutionary new principles were
introduced late in 1832, which have been found effective ever since. They were to triple engine
capacity to just over 150 cc's, to cut all wasteful connecting systems, to house the cylinders
in a strong box, thus sheltering it from disturbing outside influences, and to heighten smooth
performance by narrowing the full range.
The effects of radical changes in contemporary donkey engine design are obvious —
costs were cut and profits soared. Cost were cut: (a) the introduction of a cylinder block
led to cheap mass production; (b) high demands for fuel led to lowering of prices of
these commodities.
Profits soared: the ED could demand a higher price because of its larger, more imposing
engine.
But let us make an objective appraisal of this particular model — the first year Med.,
1965.
Although the motor is mass produced, the body work takes twelve years to complete,
(i)
with dedicated craftsmen working long hours to finish it in time.
The running in period for this model is six years, at the end of which the rough
edges
(ii)
(left by mass production) are supposedly worn off. During this period the engine attains
a high level of efficiency on its specific fuels, but the bodywork and upholstery have lost their
original lustre.
Both of the above illustrate the fundamental defect of the ED Al — non integrity.
(iii)
The engine and body are non integrated, one coming from an assembly line, the other
from superb craftsmanship. The engine itself is not an integrated machine — the cylinder
block is cut off from guiding influences, and is prone to overheating on long journeys. The
motor is unfortunately a cut-cost consideration more than a driving force.
Our consulting mechanic is of the opinion that 1965 is the year to supersede a steam
engine built on 1832 principles, before it becomes too late. In later years buyers of the
ED Al will be complaining of high fuel consumption, lack of pep in steep climbs and city
traffic, and inability to handle surprise situations that require either sudden steering or
braking. Due to the secrecy, and lack of communication between ED executives and judges
of the motor show, no suspicions have been roused of the car's unorthodox character.
Probably next year a new model the ED Al (66) will be bigger and glassier, and receive
even more lavish praise from the judges.
71

second year
Friends, Jews and Asians, lend me your ears. I have not come for the fungus infested
body on Bench 22, but rather to spread a bit of scandal about Div. IIA.
"For Christ's sakes Albert, speak to me!", the oath rang through Med. North over
the decapitated body of a white persian cat (not Albert), convulsing its last. These and other
mumbled obscenities marked our beloved Pansy's return to Div. IIA physiol.
Prof. Ray's simplified "Teach yourself anatomy" series were a great contrast to Dr.
Kenny's nerve-wrackers. It's obvious also that well read "don't-cut-the-big-toe-off" Russel
likes playing footsies during his lectures.
"In-your-box" Merrilees informed us on what to pump reluctant women with (before,
after and instead of).
"Milkless-Margarine" Marginson is top Biochem. philosopher. He started off on proteins
and finished saving the world with the missing essential amino acid.
Raph, our social secretary or organizer (and some-time beard-grower) has done a
magnificent job so far this year. The IIA "Sherry" party was a great success. I quote his own
words: "Beer, etc., were provided in quantities that more than satisfied all demands. The
erotic music, sensual lighting and exquisitely comfortable facilities of all descriptions
were used to their fullest advantage by those who were thus inclined." We hear Dr. Finch
likes "Sherry parties" too.
What about our personality lecturer, Happy Jack?; the moral of his first lecture is
"Don't ovulate immediately before coitus." We were a bit stiff he didn't tell us more.
This year our Neridah not only hostessed a house-wrecking sherry party, but had a
bit of a brush-up with a lecturer. When he heard that she had finished off strong-man
Andy H. in just two rounds, he stopped picking on her.
The year did start with a bang; Felicia was repeating. Wild and "woolly" romances
carried over from last year were still strong, especially Johnny M.'s. Fortunately, one's
left-handed and the other right or else they could never do it during lectures.
Glad to see (hic) that (hic) second year was (hic) so well (hic) represented at the
annual convention (hiccup ad nauseam).
Gnash, our two-dimensional namesake of the mythological huntress, is aiming her
arrow high in S.R.C. circles. Congratulations to Tony Incani and Miss Noone-pie also,
on being elected to M.S.S. officers.
Overheard from a female 2nd Year: "I wish those boys wouldn't grow beards; it makes
it so hard to recognise the dear little things."
Did you all give Fitz a present on his birthday? You didn't! Well Shan gave him an early
one at the Med. Barbeque. Speaking of the Barbeque, we heard Jeff Sch. had trouble
negotiating a two degree bend on the way back. Unfortunately our year rep. was well beyond
negotiating anything!
Our star full-back from last year's Physio-Med. footy clash keeps turning up, not
only in ravishing "Sportsgirl" gear, but with a different coloured head. She certainly keeps
the Newman boys guessing. Rumour has it she never sees eye-to-eye with her secret boyfriend.
Hear that Doug C. (Med. Grasshopper) hit it off in Sydney — no wonder he couldn't
walk the next week.
Tony (G—I am a good drinker) decided against his usual "Friday night 20," before
the first Term Trinity C.R.D. — possibly trying to avoid exhibiting brewers' syndrome to
Little C.
Tom H. has now been replaced as chief meat supplier for Noone's pies.
Last minute organization by Jerry Mc.D. allowed Med. to be represented in the
Great Trike Race from Portsea to Melbourne. The team stayed at Johnny B.'s the previous
night. The men drank bottled courage all night, to the haunting music of John C., Tony H.,
and Bondy. Merryl and Sue (Miss Med.) came along as mascots, chauffeurs and language
restrainers. Ted V. wasn't restricted however, after having difficulty digesting gin-beer mixtures.
Starting at six in the morning Rod G. (discus-throwing sports secretary), Lou and Brian
took the first shift. The bike didn't take the trip too well, but Bondy (006+) managed to get
it in working order to ride into the Uni. grounds.
72

Raph's second major success was the "Chicken and Champagne" orgy. The Vulgar-Vulgar,
being a rather intimate venue, left hardly any room for the breastless stripper to show
us her stars. Diagnosed as a potential varicose vein sufferer (especially in the gluteal region),
she did at least have some skill at revolving nipples. Highlights of the evening included the
mating habits of Robert Hall and other former high-ranking M.S.S. officials; Richard H.
and Judy on the bench seat; Lil trying to restrain Jerry racing off everyone; Raph's so called
American accent; some non-existent necklines; and finally the noticeable high percentage of
over-sexed females taken out by Med. students. Raph must be commended on a really great
job: it was still going at 5 a.m.!
Open day was again organized by second year. Graeme and Pete excelled in organization.
John P. magnificently explained X-rays of Robot Ray's lead-lined hand; Ian H. demonstrated
disemboweled toads (with rather active corneal reflexes) to astonished school girls; Dave K.
walked around with a stethoscope and lent on the E.C.G.; and a couple of willing pre-meds.
displayed their eggs.
Finally:
This little ditty marks the culmination,
Of the wild lives and cutaneous sensations,
Of HA wiles, and embarrassing situations.
And of our year notes in this dubious publication.
third year
As the first third year not to have Saturday lectures, many of us quickly found
alternative pastimes, as witnessed by Gaynor's engagement, Bob P.'s new arrival and Richard
S. becoming nuptially linked. By the way, after two years Boeinki has lost none of his dash
(should be tremendous on the wards).
The first term finished with the class full of Dr. Legge's biochemical conundrums; D.C.
sick in Prince Henry's after George's barbecue; and poor Carol, nearly took a shower and
a P.R. one at that. About this time Bob N. in newly acquired Healy and Hamish in "B"
type, racing through the haunted hills were dismayed to find that Ian W. with Tars and
Marty plus six dozen beat them both. The sequal was the fine effort by the Trinity prosector
in messing up the Tasman Sea off Wilson's Promontory, in fact, undaunted the same lad was
later drunk under the table by a certain hefty Biochem. lecturer.
At the sherry party Dave S. is thought to have swallowed his pewter in a fit of passion,
the same chap who weekly asks his tutor "Going home tonight, Doctor?"
On the studious side, Peter Little won the essay rize for being able to tell Pansie a few
more subtle postnatal physiological changes than the rest of us. Geoff (Embryology) B.,
strained himself in Med. North (we are not quite sure how!) and B.S. is reported to have
resigned from the North Balwyn Communist Party.
We now look forward to the practice of Anatomy, Physiol and Biochem., as the theory
has, as seen above, driven many of us to drink.
fourth year
Entrance into the clinical worlds of S.V.H. and R.M.H. was successfully achieved by
several parties — Mother Alphonsus subsequently banned such social gatherings at S.V.H.
Pete Mechon, Crapp and Hands Anderson pulled the beer.
Pharmacology was mastered viewing Doctor Cairncross on Seven's late late show. Useful
quote: "Attend the Last Lecture in Mat. Med." Whilst at the Pharmacy college, an Indian
pharmacist demonstrated to Jenny L. how to make pills. "He's gone right off!" said she.
73

Med. convention in May: Bob H. organised and elected himself President of A.M.S.A.
Julie C. and Heather M. represented the talent — Big Gal almost proposed. "Keep trying
boy, there's hope yet." Student relations were furthered by H.M. and Ian B. on the way back
from the Cabaret. Yet not all was fun and games. Peter Mottram visited the Casualty
department at the Brisbane General Hospital; an unknown resident sutured publicly; Simon
Williams assisted.
Bob W., social worker, investigated the problem of 10 a.m. closing; after a visit to the
Brisbane Gaol, his comment: "Inmates lack money, mattresses and blankets." Jack B. and
Peter D. visited 15 pubs in an afternoon. John C. acted as temporary almoner at the Mater —
his comment: "Nurses are receptive." The convention closed in Surfers.
Politically Julie Cliff (Vote Med I) was elected to S.R.C. and Union Council. Tony
Cauka is 1965-6 President of M.S.S. Chip is treasurer A.M.S.A.
An Epidemic of Matrimonial Fever was reported in June persisting with exacerbations
for the remainder of winter. Carriers isolated were Ray L. and Geoff M. — both fathers;
Dave married Joe; Barb also; Mullins engaged Sue; the Hicks-Harvey associated was
formalised; and Miss Bryant showed early manifestations.
Literary critics Andrew Kemp and Connor edited and wrote Student Medicine. Several
gentlemen entered college — crowded conditions at Trinity forced the movement of a drying
cabinet.
Socially there was a Sherry party in the Path. school, films and fluids in the Bugs (new)
school and the Med. dinner. Keith says "Downstairs toilets are not good."
Finally, it was good to see Jamie Oldham back after his illness in India — he organised
the Comm. Balls.
alf red hospital
final year
With the end of this year, a long association between the Alfred Hospital and Melbourne
University will be terminated. The present group of final year students is the last group to
go through the Alfred from the Shop, for from 1964 onwards the Alfred has been taken over
as a teaching hospital by the young upstarts from the "farm." The way patients reacted to
this is best illustrated by the comment to one of our group, viz., "Are you from Monash or
the University?"
What about the group though?
Dave A.: Future: First assistant to Hugh G.
Bill A.: Future: Medical adviser to A.A.
Greg A.: Future: Honorary Obstetrician to the V.R.C.
Tony A.: Future: Medical librarian in Tangyanika.
Geoff B.: Future: Raising own Paediatric clinic.
Mary B.: Future: Analysing Johnnie Walker in laboratory.
Andy B.: Future: Wears a bow tie — an obstetrician, what else?
Peter B.: Future: Psychiatric research.
Don B.: Future: May work for his living.
Benes B.: Future: Will not return to Royal Park.
Barry D.: Future: Out in the Mallee.
Peter D.: Future: Barry Jones of the Medical world.
Barry E.: Future: Marriage.
Judy D.: Future: Assured.
Herb E.: Future: Back to nature.
Al. F.: Future: Cardsharp.
74

Pam G.: Future: Will do better raising babies.
Neil G.: Future: Determined to keep brewery's profits at record levels.
Jack H.: Future: Will continue to give it to everyone in the manner of J.G.—Y.S.
John H.: Future: A specialist in the unimportant and irrelevant.
Peter J.: Future: Innocent smile may attract the ladies.
Bill L.: Future: Partowner of the T.A.B.
Frank M.: Future: Learning how to do it up at Wyndham North.
Heather M.: Future: Putting them into practice.
Rom M.: Future: Good record of D.'s and C.'s.
Peter D.: Future: Trying hard to get hole-in-one.
Mick R.: Future: Bright.
Hein R.: Future: Experience with people?
John R.: Future: Running the Government clinic at Gore Ctreet.
Len R.: Future: With psychiatrists.
Neil R.: Future: Soprano?
Joe S.: Future: Lost among the pyramids with Jeanne-Moreau.
Kevin S.: Future: Herbalist.
Ken S.: Future: After such exposure, seems highly doubtful.
Trevor C.S.: Future: In Moyambique Missionary Service.
Trevor J. SS.: Future: Eradicating the "clap" from Tasmania.
Col. S.: Future: Othopod at Buller.
Ken W.: Future: Barber-surgeon.
Irwin W.: Future: Dermatologist to the Surfies'.
Keith W.: Future: Waiting for a Kiwi to fly home.
Margaret W.: Future: Raising tulips.
Judy W.: Future: Weighing up the b . . .'s with Alex in "B" clinic.
Finally, we would like to thank Mr. Hunter and the three clinical supervisors over the past
three years, for all their help and guidance. Thanks also to the Honoraries for their teaching.
I hope they enjoyed it as much as we did! A special thanks to George G. for all those
fascinating P.M.'s.
prince henry's hospital
final year
This is the last year that any University of Melbourne Medical Student will be at
P.H. However, we wish all the Monash boys taking our place "all the best" and hope that
they will carry on with, and even improve the traditions of P.H.H. med. students.
South of the Yarra,
Down old P.H. way,
That's where I learnt to beat about the bush, whatever I say.
For soon it's exam time,
And I mustn't stray,
Out of the library,
Down old P.H. way.
Another year gone, and soon, yet another group of white coated morons will ne freed
to wreak havoc on patients, wards and nursing staff. We have been co installing b staing
T.V. in the twink, since, as the exams approach more and more of the boys seem to be
spending more and more of their time there.
On the social side there is plenty of activity: Married 6; babies 5 among 4; engaged 3;
single 17, with 2 in danger.
75

Dave A. and John H. have been observed flitting about in strange places. A certain
nurse at the R.C.H. has been replacing P . . . .Y lately. "Bloody George" has on several
occasions set the students' quarters AFLAME with his characteristic humour. Good on you,
George, need a LIFT anywhere? Bob S. is still running away from his problems and has
beaten several of them over an half mile during the year. John Mc. is very cool and confident
and is thinking of going skiing for the rest of the year. He thinks this will give Roger P.
(the •dodger) a fair chance.
Congratulations to Mick B., Mery J., and Mel. K. for becoming fathers this year.
Veteran Mick Bal just smiles and Fred B. winks knowingly.
Phil J. and G.L. are competing with each other for the exhibition in Public Health,
while Sid-er-ney is becoming a sigh-ky-a-trist. S.K. is having his XXY checked tomorrow —
it's some syndrome he is worried about. Don't worry S. — F.S.A. is the answer.
Lady J.A. and Mrs. X nee G. have finally decided that swearing should be allowed
in the student quarters, so from now on we will. M. Rof and I. Ray are still discussing
last year's exam papers whilst Harry F. is doing practical research into the sex life of the
Yo-Yo. (Alias the advantages of having your girl interstate). S.C. lives at P.H. — is it his
interest in the work? A.T. has almost satisfied her daily salt-up requirements and her work
is non electrifying. H. Van sneaks around the Alfred a lot — I wonder what engages
his attention so. John I.'s flat sounds like an interesting place — anyone for a seance?
Mitch S. is the strong silent type and doesn't say anything in contrast to Dan B. who will
tell you the clinical features and management of schistosomiasis, without batting an eyelid.
All in all we are a pretty average final year, and with the help of good sound knowledge
and brains, plus a myriad of tutors and clinicians, lots of luck, and a few hints on the exam
paper we might even scrape a pass.
st. vincent's hospital
fifth year
As predicted in last year's notes, certain of our better known bon vivants are no longer
with us. The remainder, as you will see, are no better for it.
Key. Kane, Mick. Keating, Peter Koch (spelt with a "ch") and Barry Lauritz are often
seen holding up the counter at the Eastern Hill pub, while Bonge would love to join A.A.
but is too drunk to find it.
At the Brisbane Convention, Ruth, Jack Mackellar and Andrey Kretsch all got their
bit, but poor Jack Lynch missing out, left for Europe fitted with his new Dutch cap. Late
arrivals Phil and Gary were quite put out to find the Convention finished by August. While
back in Melbourne, Mery Cass has become well known for his discriminating taste in
nymphomaniacs, and friend Con has key-hole conjunctivitis. Con, along with Frank
Rhodes, Pete Loughnan and Stewart Bath have taken the plunge and become engaged, and
Peter Loewy is threatening to join them. On the other hand, Col Scott has been put to
pasture, Key. Cronin isn't sure, and Rod. Westmore is eloping with his MG.
At the Women's, Serge and Myer worked their fingers to the bone, Ian McPherson starred
in his case presentation ably backed by Stew McCoubrie; while on the surgical side, Kien
Siu demonstrated a revolutionary new approach to episiotomies with his partial Asian vulvorrhaphy.
Talking of advancements, Mick Power now manning the entrance at the R.W.H.
during visiting hours hopes eventually to graduate to ticket collecting at Spencer Street.
Literary giants John Sutton, Arthur Klepfisz and Charlie Kazlauskas are collaborating
on their new novel, "Baldness be my Friend" which will compete with Pete Kuhlmann's
thesis "The Aesthetic appeal of red pubic hair".
Claude Crouch, fresh from his theatrical triumph at Med. Medleys has gone on to
bigger and better things and is now manufacturing nipple-shields for the African Ballet,
76

with precision design by Jack Dowling. The aetiology of bleeding from the nipples has
almost caused Elaine Ogilvie and Louise Deakin to come to blows, Miss Ogilvie vehemently
claiming endometriosis and Miss Deakin punting for denture-trauma. Of the other girls,
Maria Vice has shown a strong preference for circumcision while at the Women's, whereas
Ursula and Mary Brown are not nearly so adamant.
On the fashion field, our vote for Mr. Elegance goes to Stan and his red socks, closely
followed by our leather-jacketed wild ones Bendall and Wilson on their hot grids. Our
sportsman of the year, Viv Peterson, while being chased by many League clubs, and as a
result now financially secure, is still envious of Richie Fisher with his newfound toothless
kissing potential; and the bookies' friend Key. Fraser has vowed to open St. V's first TAB
office when his eyebrows finally meet.
The Newman boys, Ryan, Dwyer, Walton, Lourey and Gurry are hiring out rooms in
the new St. Mary's Hall, but for obvious reasons Martin Brown and Bob Fraser have been
asked to supply contraceptives, while Bob Millard gives medical advice.
In the same vein, although not well publicised but rivalling the hottest Hollywood
scandal, we hereby blushingly expose the Catona-Campbell affair which cannot be concealed
and longer. But the Giles-Constable relationship is public domain, and any further relevation
has no place in such a high class publication as Speculum.
royal melbourne hospital
fifth year
One hundred and five of us commenced the more competitive year at the Melb. —
some are leaving their run home till August next year so as to give chaps like Peter S. and
Dick L. a chance for honours.
The year was divided as usual, but as time passed it was easy to see those with Women's
and Kids' experience. Perhaps Dorothy C. will benefit from Dr. J.'s private tutorial in
"how a girl can have four babies in four years." Perhaps the best way to divide up the years
is into that group having had something to do with cars, and another group who have
decided on matrimony and the treasures it begets.
Bernie B. has decided to become a mechanic after finals, whilst Harold F. has a decision
between veteran car racing and a concert pianist.
The romance of the year is a result of five years of co-ordinated effort — Jill C. to
Stewart B. Others to have fallen by side are Max Cole, John Drew, Bill Leadston, John King,
"tall" Paul Kitchin, Mike Marshall, Gill Shardey, and last to acknowledge defeat, Andy
Campbell. Of course many have already tried the knot — Ted Rafferty, John Dickman, Garry
Cashmere, Bill Richards and Dave Robson — "Bless 'em all."
I wonder if Barb A. is still holding off advances by that well known A.C. (electrifying?).
Sportswise we have a number of representatives, all with attributes, playing for the
university: Bob Anderson, lacrosse; Jack Rodgers, football; Greg Mundy, baseball and
cricket; Ivan Burns, hockey; Dave Furphy and Peter Gay, water-skiing.
We don't know whether Lyn S. is holding out on us, but Ian W. swears he overheard
May C. say to Lyn: "You're kidding." ("No just putting on weight.")
Geoff E. is still having trouble keeping up with the wild happenings that the rest of
the group are pulling. John S. and Neil G. were both told by one honorary to pull themselves
together — immediately Doug D. became jealous. Have you noticed how thin Red S. has
become lately? — We believe he is living on the fruits of love. It has been rumoured that
Max H. has just about worn a hole in the mat outside the door of authority.
The rowdy elements of the year are kept in check by the iron fist of big Joan. M., and
henchwomen Dot C. and Rose W. It is also rumoured in this underworld that together with
77

May M., Liz L., Eugene T. and Lois P., are key figures in the illicit "happy pill" racket.
Seems most regular customers include Misses Kivec G., Sally K., Miss M. G.
Others hard to keep track of are the Trinity boys—Ian H., Bill W., Harbans Singh
(alias Charlie), and Johnny R. In opposition, and also not unnoticed are the Queens College
boys — Andy R., Ralph R. (who is in actual fact censoring these notes), Tim N., and
Peter F.
Adrian C. has yet to name a syndrome to explain himself — in fact it was related the
new born anencephalic woke up, saw Adrian, and called "Daddy."
I am sure there must be others worthy of mention, but where they hide is anybody's
guess.
final year
The year that none of us never really thought would come is now nearly over and
trembling (in various degrees) we face the prospect Of finals.
Since last year's notes Rob M., Bill A. and John J. were rather dramatically married;
meanwhile Donough O'B., John R., Russ C., Simon B., Judy Y. had joined the ranks too.
Engaged were Bill C., Doug T., Hugo H., Peter A., Peter C., Arnold S., Tek. T., Sammy W.
(Apologies to anyone omitted from either list).
The G.P. term provided some opportunity for initiative of various sorts. One Jim
(Dave) W. is said to have taken his "break" along too, while others — Tony L., Vin T., Bob
T. and Fred M., who travelled far north to a summer climate found the weather excellent
but the "whether" variable. At least one knew the ones to avoid! Jim M. spent most of his time
farming.
At least good old Harry R. keeps smiling through; I've heard it almost deters one
physician and notorious "student roaster" when Harry keeps it up for the whole hour.
One Andy B. really turns on a high pressure conning performance for the unattached
females at occasional parties — despite literally hurling himself into the path of the avalanche
he remains miraculously unattached too.
Mick S., who has a classification for everything imaginable told me that his car broke
down and he was late starting in the wards this morning — didn't make it till 7.30 a.m.!
John ("Good evening"—G.F.") maintains his pharmaceutical interests and clientele and
those dependent on him maintain good relations at any cost. (With whom you say?). Joe E.
is still alive despite a year or so's free reign at the mercy of his desires.
Roger S. tells how he established a delicate, intellectual relationship, a thing of infinite
beauty and tenderness, with a certain female but the relationship was rather shattered by one
George Z. who barked in with more basic approaches — and succeeded! I can almost
feel Mike L. showing disbelief at the possibility.
Although rarely seen above the ground floor, one Sammy W. is known to all because
of his insatiable thirst for — coffee.
Wal S. has another son as you all already doubtless knew.
Best wishes to all for finals.
78

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79

spicula
These days too many beautiful women are spoiling their attractiveness by using four
letter words, like "can't, won't, don't".
*
He: "Do you believe in free love?"
She: "Have I ever given you a bill?"
* * * *
"My husband just thinks about one thing, doctor, but that's the trouble; he just thinks
about it."
* * * *
"Why didn't you let John finish that sketch of you in the nude?"
"I found he only had a hazy idea of where to draw the line."
* * * *
Two little worms were crawling in the garden. One of them stopped and the other
crawled right on.
* * * *
Judge: "Did you say this man stole your money out of your stocking?"
Girl: "Yes, your . honour."
Judge: "Why didn't you put up a fight?"
Girl: "I didn't know what he was after."
Mrs. B.: "I am troubled with athletes' foot; in fact, it keeps me awake at night."
Doctor: "Well, I suggest you cut his toe nails."
* * * *
Scene: Room—piano, bed, metronome.
"Are you sure this is what they mean by the rhythm method?"
*
Male, presenting girl friend with certain item of black lingerie.
Girl: "What do you mean they will suit me down to the ground."
* * * *
Secretary: "Sir, I would like to inform you that I have found a new position."
Boss: "Fine; but let us leave it till after work."
* * * *
Trouble with being best man at a wedding is not getting a chance to prove it.
* * * *
Some necklines are so low they would make a baby cry.
* * * *
As the nudist commented: "There is nothing like a day in the sun to put the colour in
your cheeks."
* * * *
Then there was the hypochondriac who followed all the medical advice in the "Readers'
Digest" and died of a typographic error.
* * * *
Physiology. My young daughter wandered into the kitchen while her mother was nursing
the new baby and drinking a glass of milk at the same time.
"So that's how it's done." she exclaimed.
80

Blind girl — you had to hand it to her.
* * *
How to sex a chromosome — pull down its genes.
* * * *
Nurse: "Doctor, why are you using a rectal thermometer to write out a prescription?"
Doctor: "Some bum's got my biro."
* * * *
Two queer cowboys:
'Yup?"
"Yup."
* * * *
"My wife's not having any more children since she got a hearing aid."
"How come?"
"Well, before, when we went to bed, I would say shall we go to sleep or what. She
replied, 'What'."
"Do you smoke after intercourse?"
"Don't know; I have never looked."
* * * *
"Do you talk to your wife during intercourse?"
"Only if there is a phone handy."
* * *
Friend: "What a nice little boy, and such red hair. Does his father have red hair?"
"I don't know; he never took his hat off."
* * * *
The fisherman's daughter—she used to lift her leg and say "fillet".
* * * *
Eunuch—man cut out to be a bachelor.
* * *
"Where are your buccaneers?"
"Under my buccanhat."
The woman who had too many face lifts. Finally ended up with a beard.
* * * *
Apprehensive bridegroom asks doctor for some hormone powder to lift his performance.
At wedding breakfast asked waiter to put it in the soup. After waiting a long time, he asks
for his soup.
Waiter: "It's coming, sir, but we are having some trouble—we can't get the noodles to
lie down."
* * * *
Man teaching his wife Bridge, tells her to signal what cards she has. After fumbling
a hand, he asked her what she was signalling to him.
Wife: "I had a lot of hearts, so I patted my heart."
Husband: "I saw you patting your left breast, so I left it."
* * * *
Three women were comparing their husbands to a motor car.
Number I: "Mine is like a Jaguar—long, low, sleek and plenty of power.
Number 2: "Mine is like a Mini—short and stout, and darts in and out."
Number 3: "I dare say mine is like a veteran car. Appears only twice a year, and even
then needs a hand's start."
* * * *
The young pair who drove into the bush and stopped at a lonely spot. The girl clambered
out into the undergrowth, expecting him to follow. When he didn't appear she made
her way back to the car.
She: "If you don't hurry I will be out of the mood."
He: "Well, if I can get out of the mood, I'll be able to get out of the car."
81

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87

A young girl who was no good at tennis,
But at swimming was really a menace.
Took pains to explain
It depends how you train;
I was a streetwalker in Venice
* * * *
The weeping bride poured out her heart to the eminent marriage counsellor. "Isn't there
some way, without turning into a nag, that I can keep my husband in line?"
The counsellor scrowled: "Young lady, your husband shouldn't have to wait in line."
* * * *
"I am afraid that contraceptive was defective," said Tom paternally.
* * * *
A young lady was hobbling down the street, in a rather awkward manner. Two bystanders
discussing her whispered: "Perhaps she has met with an, ler . . . accident." "Oh, no;
probably a motor car accident."
Mystified, they decided to ask her, and offer help.
"Well, actually, it's neither. I am going to a nudist ball tonight and I put my hair in
rollers."
Nowadays the only way you can tell the difference between the sexes—where the zips
are placed. * * * *
Scene — Social.
Host — "Ale or screwdriver?"
Student — Straight ale."
Host— "Pale?"
Student — No; a glass is easier to handle, thanks."
* * * *
Father's Day — nine months before Labour Day.
Mother's Day — nine months after Father's Day.
* *
Girls are like pianos — when they are not upright, they're grand.
* *
"May I kiss your hand?"
"What's up; my mouth too dirty?"
* * * *
Man to work — as a garbage collector. El 8 a week and all you can eat.
* * * *
The Income Tax Department received from an unmarried student a form claiming tax
exemption for one dependant. The clerk examining the form returned it with the comment:
"This must be a typist's error."
"I'll say it was," the student replied.
* * * *
Student driving a sports car stuck out his hand and ruptured a cop.
* * * *
Dresses are getting so short, girls will soon have to powder four cheeks.
* * * *
A student, after attending an after finals celebration, entered the bar in
A slightly stewed
condition. He walked up to the bar and asked for two beers. The barman watched him
closely as be walked into the men's washroom with the beers. A few minutes later he came
out of the washroom and ordered two more beers. Again the barman watched as the student
repeated the procedure. After this occurred three times, the barman could no longer contain
his curiosity, so the barman asked the student why he was taking the beers into the
urinal. The student replied he was pouring them down the urinal. This puzzled the barman,
so he asked why on earth he was doing this.
"I am just tired of being the middleman," the student replied.
83

"Sir," I pulled your daughter out of the water, and resusitated her."
"Then, by George, you'll marry her."
Two students discussing girls.
First: "I know .a girl who goes to bed every night at nine. She doesn't smoke, drink, or
swear, and she never thinks of sex."
"Oh, yes, and she will be 5 years tomorrow."
* * * *
Q.: Is it proper to wear a bow tie with an athletic support and sandals?
A.: Since a bow tie is dress attire, it should not be worn with casual clothes.
* * * *
Q.: My girl friend, who is a prude, thinks that it is scandalous that I don't wear any
underwear. I say its my business. Who is right?
A.: It is your business all right—and if your girl friend is a prude how did she find out?
* * * *
Q.: Is it proper to remove a girl's fashion wig before making love to her?
A.: Only after you have tried everything else.
* * * *
Q.: My girlfriend has missed two. Should I take her to see this year's revue?
A.: You had me worried. Yes, of course.
* * * *
Q.: I am a psychopathic wringworm. I am in love with myself and Uncle Ebenezer
as well. Does this mean that G. Walton is full of occidentals, or blondes prefer marihuana.
A: Try growing a beard—it may help.
* * * *
Q.: I am 82, and have just married a girl of 17. I have been a bachelor all my life and
this is all very new to me, I want to raise a family, and would appreciate advice.
A.: My advice is to take in a lodger.
P.S. Thanks for your wonderful advice. I took in a lodger and now the wife is pregnant.
One thing: so also is the lodger.
* * * *
"Having finished with the more common forms of V.D., such as syphillis, we will now
turn to yaws."
"Whose?"
A Gynaecologist — when you go to a patient's home you don't do a P.V. straight away.
You take off your hat first.
* * * *
Examiner: "What would you like your sperm count to be?"
Student: "That depends on the occasion, sir."
* * * *
Vicar: "And we pray for those who are sick — particularly those at the Royal Melbourne
Hospital."
* * * *
The girl who presented at the front desk of an hospital casualty complaining of heart
trouble.
History:
"Oh, doctor, my heart stood still"—brief asystole.
"Oh, doctor, my heart was in my mouth" — an obvious indication of cardiomegaly.
Then:
On Examination:
The heart showed marked enlargement with the apex beat three and a ■ half feet from
the left kneecap.
The heart sounds /were classical (as opposed to pop). She said she had felt thrills, but
took offence when questioned further.
84

Hear about the drunk turtle and the army helmet.
* *
Lady Burnside, sat on her backside, and dusted her frontside with peroxide, because
she knew on the whole, gentlemen prefer blondes.
* * * *
There was a young woman who begat
Three husky boys, Nat, Pat and Tat.
They all yelled for food,
And a problem ensued,
When she found there was no tit for Tat.
* *
Difference between
(i) Amnesia and Magnesia — one of them can never remember where she is going.
* * * *
Psychiatrist to frigid patient: "Undress; now lie on the couch; close your eyes; now spell
out bedroom.
"B - E - D - R - 0 — oh, ooh, mmmbm!!"
* * * *
A loud-mouthed Texan was boring a group of people about the exploits of Texans,
when a patient fellow in the audience eventually rose and claimed that he knew a Texan so
big that when he died they needed two coffins to bury him in.
The Texan smiled.
"However, they gave him an enema, and buried him in a shoe box."
* * * *
A fencing instructor' named Lisk,
In duels was terribly brisk.
So fast was his action,
The Fitzgerald contraction
Foreshortened his foil to a disk.
* * *
"And what do you two think you are doing," roared the husband as he came upon his
wife in bed with another man."
The wife smiled at her companion. "See," she said, "I told you he was stupid."
* * * *
PROGRESS — Where you blast a two-ton boulder into a million fragments, gravel,
then put them back together again * with cement. * * *
The nun with the broken ankle—"HOPALONG CHASTITY."
* * * *
"Put it into your spalmolive."
"Not on your lifebuoy."
An aerial artist named Tracht
Is ,faced with a very sad fact.
Imagine his pain
When again and again
He catches his wife in the act.
* * * *
"I was abroad myself for two years, but a psychiatrist fixed me up."
* * * *
Pupil: "Me slept with Daddy last night."
Teacher: "No; I slept with Daddy last night."
Pupil: "Must have been after me fell asleep."
* * * *
THINK !
Punctuate: That that is is that that is that that that is not is not is
not that so.
Put five "ands" between pig and whistle.
85

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86

'H
:E
about
rseas,
otels,
and
hops,
and
that
:rvice
st of
!y go
s on
-2673
1 ;423
3445
3-242f
4-437 1
The seamstress who couldn't mend straight.
* * * *
A new lipstick is called piller-box red. Just the thing to catch the male!
* * * *
The prostitute, who after an appendicectomy, asked the surgeon to leave the incision open
so that she could make some money on the side.
* * * *
Definition:
HORMONE — sound heard outside a brothel.
* * * *
She was only a calendar girl, till she missed a couple of months.
* * * *
The James Bond brassiere — holds your 38's.
* * * *
Disease: Sex thrombosis, from lying in bed with a clot.
* * * *
A much worried mother once said,
"My dear, you've been kissing young Fred
Since six; it's now ten,
Do it once just again,
And then think of going to bed."
* * * *
The Russians, as a propaganda move, placed an order with the wishing American catn fire b
thousand condoms each 16" long and 4" wide. The Americans, n
to outdone,
sent the order back, packed in boxes
*
marked,
*
"Medium".
* *
The girl who married an homosexual. Didn't know which way to turn!
* * * *
"Pint of beer and twenty fags," snapped the young man. The barmaid looked at him
searchingly and asked his age.
"Fourteen," he replied.
Do you want to get me into trouble?" asked the barmaid.
The boy immediately said: "Look, cut out the sex talk and just give me the beer and
fags." * * * *
When an actor proposed to Miss Prout,
Her acceptance was tinged with some doubt.
At undress rehearsal
A sudden reversal
Made her see that she couldn't back out.
* * * *
Do you neck."
"That's my business."
Ah, at last, a professional." * * *
Young people who haunt picture palaces
Think nothing of psychoanalysis ,
And though Doctor Freud
Would be sorely annoyed,
They still cling to their long standing fallacies.
* * *
Definitions :
(i) A piebald mouse — one with 22/7 diameter.
(ii)
Dancing—navel clash, without loss of seamen.
(iii) Quickie — it won't hurt, did it?
87

There was a young man from Thrice,
Who remarked, "Although bigamy's nice,
Even two are a bore,
I prefer three or four,
For the plural of spouse is spice."
She had been married three or four times before—what you might call a busy body.
* * * *
Then there was the ghoul who sent his girl a heart for Valentine Day—still bleeding.
* * * *
"Joe," called Mama, "are you spitting in the fish bowl?"
"No, Ma; but I am getting closer with every shot."
* * * *
The girl who liked running around nude—got arrested for no gauze at all.
* * * *
P: "Everytime I breathe someone passes into eternity."
S: "Why don't you try a mouth wash?"
* * * *
Board of Trade— a bench in Fitzroy Gardens.
* * * *
"But, Henry, that isn't our baby."
"Shut up; it's a better carriage."
* * * *
She calls me clock — my hands go around her so fast that it alarms her.
* * * *
Should lovers be frank and earnest, or should one of them be a girl?
* * * *
"Mummy, Johnny threw up."
"Then why are you crying, Gladys?"
"Because he is getting all the big pieces."
* * * *
There are two kinds of people who don't make the same mistake twice — parachutists,
virgins.
* * * *
She was a girl who didn't have any principle — but she sure drew interest.
* * * *
He: "Some moon out tonight."
She: "Sure is."
He: "Some bright stars up there."
She: "Sure are."
He: "Some dew on the grass."
She: "Some do, I don't."
* * * *
Hear about the student suffering from alcoholic constipation — couldn't pass a pub.
* * * *
The fire chief announced recently that an increasing number of fires in homes and commercial
clothes dryers are being caused by the foam rubber in brassieres, which develops,
he says, a very low ignition temperature after about six months use.
Falsie alarm!
* * * *
If the whole world loves a lover, why is rape a crime?
* * * *
She was just a little country girl who always went out with city fellows, because farm
hands were too rough.
88

At a pathological conference a newly married student was asked to give a routine history
and physical narration. Having completed the history, he was now describing the percussion
and palpation of the chest when he remarked: "No change was noted until the seventh
intercourse. I mean interspace."
Polite laughter.
"Whenever I am sick," I told a friend, "my wife kisses and caresses me until I feel well
again."
"Sounds great," he said. "When can she give me an appointment?"
* * * *
A man stopped the doctor as he walking down the street. "Excuse me, doctor; a friend
recommended you to me, and I have some pain below my stomach. What should I do about
it?" "Well," answered the doctor, "I would have to examine you before I could give you any
advice. Pull down your trousers."
"Right here in public," he exclaimed, horrified.
"Certainly," the doctor replied. "Aren't you consulting me in public?"
* * * *
"That was a well-written essay. Who wrote it for you?"
"I am glad you liked it. Who read it for you?"
* * * *
Heart patient asks doctor how often to have sexual relations.
Doctor: "Say Monday, Tuesday, Friday and Saturday. The others I would leave off."
Patient: "I can't; those days are for the wife."
The accountant's daughter—she added up all night.
* * * *
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89

Then there was the enterprising man seen at the crematorium collecting ashes — packaged
and sent to the cannibals — INSTANT PEOPLE.
"Now you can see why I'm forgetting women — in fact, I'm all for getting some as
soon as possible."
* * *
HAPLOID speaks:
"First in, first served."
"Coming, ready or not."
"O.K., so it's all a suicidal mission."
* *
Love — the world's greatest indoor sport.
* *
Most girls readily admit men are trying — few admit they sometimes succeed.
* * * *
A woman went up to see a friend who had just given birth to triplets.
"Congratulations; this is quite an occasion."
"Yes," said the proud mother, "and you know this only happens once every 50,000
times."
"Good heavens, when do you get the house work done?"
* * * *
She to He: "I never knew that sitting up in a boat would frighten the fish."
* * * *
The unfortunate beginning to an important address.
"My subject is sex."
"Ladies and Gentlement, it gives •me great pleasure . .
* * * *
A pretty, but curious, young American tourist • found herself in conversation with a
ruggedly handsome Scot.
"Excuse my bluntness," she said, "but isn't anything worn under your kilt."
"Nay, lassie," he replied with a grin," "its as good as it ever was."
* * * *
Parked car .. moonlight . . . stars.
Goodness," she exclaimed, "its 3 a.m. I should have been in hours ago."
"So should I," he murmured disgustingly.
* * * *
Seeing an attractive young girl sitting alone in the cocktail lounge, the young man approached
her politely and offered to buy a drink.
"A motel . . ." she cried.
"No, no," he said, embarrassed. "I said a drink."
"You want me to go to a motel with you," she shrieked even louder.
Daunted, the young man fled to a corner, to avoid the stares of other patrons. Several
minutes later the girl came across to his side and whispered. softly: "I would like to apologise
for making you so uncomfortable at the bar. You see, I am studying psychology, and I
wanted to study the reactions of the people here."
To which the young man replied in a resounding voice: "25 guineas."
* * * *
Hear about the lightest baby in the Women's Hospital? They put it on the scales and
it blew off I
90

Concerned woman to doctor: "I can't understand why my boy has red hair. No-one
else in the family has it, and my husband is getting worried."
Doctor: "How often do you have intercourse?"
She: "About once a month."
Doctor: "That explains it—RUST."
Man in restaurant hears a terrible commotion coming from the kitchen. The manager
rushes inside, and the noise stops.
When paying the bill, the customer asks the manager what was wrong.
Manager: "The cook had his fingers caught in the dish washer."
Man: "So what did you do about it?"
Manager: "I fired them both." * * *
The well-known harlot was asked whom she had not slept with.
(i) Racing drivers—too hard into the corners.
(ii) Jockeys—because they ride too hard.
(iii) Politicians—because once in, awfully hard to get them out.
The girl who went to a fancy dress ball with a string of 43 beans around her neck, and
a half-topless dress. At the judging she was asked: "I can see what the beans mean, but
why the bare breast?"
"That's the one that tastes so good."
*
persuaded in
A Gynaecologist, having trouble finding a locum, finally protesting the
tadenetnistst
d
ti frinegnrdeedto,
do the examination whilst he was on holidays. After much
and placed his first patient in the lithotomy position.
"Open wide, wider. That's it. Now say `aah-.' "
A. P. F.
The 1964 edition is now available from the Victorian office of the publishers,
The Pharmaceutical Association of Australia, 381 Royal Parade, Parkville, or
from medical and pharmaceutical booksellers and pharmaceutical wholesalers,
at £2/2/- per copy.
Invaluable for practitioners and clinical students.
Contains: over 300 prescriptions,
prescribing and dispensing conventions,
doses for children,
treatment of poisoning,
useful tables,
index,
all in only 266 pages bound in a durable and handy pocket size.
91

medley's song
j. harris
(Tune: A Frog He Went a Courtin' He Did Go.)
Well a fellah went a courtin' he did ride, Ahuh, Ahuh,
Well a fellah went a courtin' he did ride, Ahuh, Ahuh,
Well a fellah went a courtin' he did ride,
With his box of tricks right by his side,
Ahuh, Ahuh, Ahuh.
Well he came to a party at the edge of town, Ahuh, Ahuh,
Well he came to a party at the edge of town, Ahuh, Ahuh,
Well he came to a party at the edge of town,
He found the barrel and scolled some down,
Ahuh, Ahuh, Ahuh.
Feelin' pretty fine, so he went some more, Ahuh, Ahuh,
Feelin' pretty fine, so he went some more, Ahuh, Ahuh,
Feelin' pretty fine so he went some more,
Started feelin' lonely so he looked around the floor,
Ahuh, Ahuh, Ahuh.
Eyes came to rest on a fine young breast, Ahuh, Ahaah,
Eyes came to rest on a fine young breast, Ahuh, Ahaah,
Eyes came to rest on a fine young breast,
Seemed a little blurry, but looked the best,
Ahuh, Ahuh, Ahuh.
Well he took her little hand, and she smiled so sweet, Ahuh, Ahuh,
Well he took her little hand, and she smiled so sweet, Ahuh, Ahuh,
Well he took her little hand, and she smiled so sweet,
She said a finer lookin' man I never want to meet,
Ahuh, Ahuh, Ahuh.
She looked up and smiled and led him to the door, Ahuh, Ahuh,
She looked up and smiled and led him to the door, Ahuh, Ahuh,
She looked up and smiled and led him to the door,
The burst of fresh air nearly sent him to the floor,
Ahuh, Ahuh, Ahuh.
They walked down the path, then settled on the grass, Ahuh, Ahuh,
They walked down the path, then settled on the grass, Ahuh, Ahuh,
They walked down the path, then settled on the grass,
The grass was wet, so they got a wet a—se,
Ahuh, Ahuh, Ahuh.
Alas he couldn't do it no matter how much he tried, Ahuh, Oh,
Alas he couldn't do it no matter how much he tried, Ahuh, Oh,
Alas he couldn't do it no matter how much he tried,
He tried, then he cried, it's ruined my pride,
Ahuh, Ahuh, Ahuh.
Now the moral of this story is somewhat of importance, Ahuh, Ahuh,
Now the moral of this story is somewhat of importance, Ahuh, Ahuh,
Oh yes the moral of this story is somewhat of importance,
Grog increases the desire, but lessens the performance,
Ahuh, Ahuh, Ahuh.
92

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