1 - University of Melbourne

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CONTENTSEditorial 5President, M.S.S. 8Medical Study Tour, U.S.S.R., 1961 Dr. W. D. Counsel! 11With the Red Cross in the Congo Dr. S. F. Hewitt Haughton 15Arterial Surgery Mr. Neil Johnson 25Some Modern Biological Methods Dr. S. Rose 31Design, Dust and Disease Wilfrid Brook 37Pulse Rate in Athletics Brian Connor 43The All or None Phenomenonor The Three Stimuli S. Ceber 47Quo Vadimus J. F. King 49Mammon and the Muse Adam Fligelman 51Obituary 53Diagnostic QuizSurgery Mr. D. Donald 55Medicine Dr. I. MacKenzie 55Obstetrics Dr. P. Glenning 56Gynaecology Dr. P. Glenning 57Paediatrics Dr. J. Coldbeck 58M .S. S. Chronicle 61A.M.S.A. Conference 71Year Notes 75Spicula 91PAGE FOUR SPECULUM 1961

EDITORIALEach year the Medical Students' Societyrequires editors for its official organ,Speculum. Since none but medical studentswould be competent to compile this magazine,especially the last few pages, the editorsmust be drawn from this group. Thismakes the writing of an editorial difficult,because being medical students we must"ipso facto" have no literary ability. However,a further consequence of our callingis that we are slaves to duty; so we have setabout the task.Plumbing the depths of our literaryknowledge we discovered we had both seenthe play, "Six Characters in Search of anAuthor". This seemed to have some bearingon our case because we were "two editorsin search of a subject". Further meditationin this vein ended in death-in-uteroof this idea. We thought of student apathy,the med. students' tie, and even made astart on the question of hospital finance butran out of steam" when we found ourprejudices were ill-founded. Then werealised that a very important event inAustralian Medical history is soon to takePlace—the formation of the AustralianS PECULUM 1961Medical Association, so we thought wemight take this opportunity of presentingsome facts which, while well-known to ourgraduate readers, may be new and of interestto those of us still labouring to reachthat status.Australia has always been to the fore inimproving the conditions of its residents,particularly that vociferous group, "theworkers". The formation of the TradeUnion movement has greatly furthered theiraims and the medical profession has seenthe advantages which accrue if people withlike interests unite.Until now each State has had its ownmedical association which sent delegates tothe Interstate Federal Council. However,as from 31st December this year, the individualState bodies will cease to exist andbe replaced by the Australian MedicalAssociation. In passing, it is also interestingto note that this is the first full yearin which there has been an AustralasianMedical Students' Association. The formationof such national bodies marks a milestonein Australian Medical history and wefeel that it would be of benefit to the corn-PAGE FIVE

ing generation of medical graduates toexamine the potential value of the A.M.A.to us.Australian medicine will benefit from theformation of this body in two main ways.Firstly, the cumbrous organizational machinerywhich required that any decision ofthe Federal conference should be ratifiedseparately by each State body, will be eliminated,thus much time will be saved andexpenses reduced. This will give the Australianmedical profession a more efficientand flexible means of action in issues concerningits members, particularly in presentingto the Government their views concerningnational health, both in its present formand with regard to its further extension. Inaddition the views of a national body wouldhave more influence with our academicstaffs at our various teaching centres; theassociation could thus have an impact onthe vexed question of differing standards inthe various States and also on the applicabilityof the academic subjects of our earlieryears to clinical medicine as opposed tomedical research.The second benefit stems from the factthat through the A.M.A. Australia willhave, for the first time, an official voiceoverseas. As a branch of the B.M.A. wehave only been able to attend internationalConferences as observers, while at Corn-monwealth conferences we have beenbracketed with such countries as Nigeriaand Sierra Leone. A National association,however, will enable Australia to take aplace of equality with nations whose medicalproblems resemble her own.Our newfound national consciousnessparallels a world-wide growth of internationalconsciousness which has been expressedofficially by the activities of suchorganisations as World Health and RedCross. Groups such as the delegation ofAustralian medical men who recently visitedthe U.S.S.R. have helped to break theseboundaries by personal contact. On astudent level, Australia will be representedfor the first time at the International MedicalStudents' Conference to be held inIsrael later this year.Health is a matter of importance to allpeople regardless of their political persuasions,and we who take the oath must endeavourto ensure that man-made boundariesdo not hinder the conquest of disease,which is the ultimate aim of medicine. Theformation of the A.M.A. will make it easierfor Australian physicians and surgeons toplay their part in the health of our owncountry and of the world. It is our privilege,as the medical graduates of tomorrow,to maintain the traditions which have beenestablished by our predecessors.ACKNOWLEDGEMENTS:The editors would like to record theirSincere thanks to all who have helped themm the production of this issue in any way,no matter large or small.Especially would we like to thank oureOntributors, both published and unpublished,our advertisers, whom we recommend;our typist, who managed to makesense out of such a mass of illegible handwriting;Mr. Bill Panter, of Shipping Newspapers,for his extreme patience in dealingwith our eccentricities, and particularly Mr.J°1111 Woodward for his sterling efforts bothas business manager and distributing officer.Without the untiring and unceasing effortsSP ECULUM 1961of these people and the consolation and adviceof our many friends, our task wouldhave been infinitely more arduous.We would like to acknowledge the receiptof the following magazines:The Leech, Johannesburg.The Review, Adelaide.Oxford Medical School Gazette.Queen's Medical Magazine, Birmingham.Charing Cross Hospital Gazette.Montreal Medical.St. Bartholomew's Hospital Journal.The Reflex, Perth.PAGE SEVEN

PRESIDENT, M.S.S.PROFESSOR V. L. COLLINSThis year we are honoured in having forthe first time Professor Vernon L. Collinsas President of our Society. Our constitutionprovides that a president be electedfrom among our teachers, either preclinicalor clinical, and successive committeeshave been most grateful to those whohave so willingly given of their time andenergy in guiding us in our deliberations.Professor Collins is a true Australian,born and bred in the Wimmera, and agraduate of the University of Melbourne.His formal education commenced at a ruralschool and continued at Horsham HighSchool. Prior to his admission to Queen'sCollege, as a medical student, he spent ayear teaching at Hampton. During hiscourse, his main extra curricular interestswere in inter-collegiate sport, representingQueen's in both football and rowing. Aftertwo years' residence at the Melbourne Hospitalhe obtained his M.D. His nextappointment was at the Children's Hospital,first as a resident and later as MedicalSuperintendent. Continuing to widen hisfield of experience, he then worked at theGresswell Sanatorium for a few months, duringwhich time he wrote his book, InfantFeeding, before leaving for the UnitedKingdom. Arriving there just before theoutbreak of World War II, he entered theEmergency Medical Service in London in1940, working as a physician at the NorthMiddlesex Hospital. His interests werenow turned, of necessity, from children's toadult work, particularly gastroenterologyand gastroscopy.At the close of the war he returned toAustralia once again to take up paediatrics,now in the capacity of an honorary at theChildren's Hospital and a consultant inprivate practice. He was also appointedhonorary paediatrician at the RoyalWomen's Hospital. He was disappointedin the standards of work in his old hospital,and it became clear to him that if the threemain functions of this teaching hospital—service to patients, teaching and research—were to reach desirable levels, manychanges were necessary.In 1949, because of his experience inoverseas hospitals, Dr. Collins (as he wasthen) was invited to become the first MedicalDirector of the Children's Hospital. Histask was twofold—firstly, to plan the newhospital and secondly, to make changes inthe organisation and staffing of the old hospitalto meet the rapidly growing needs ofthe community. The honorary medicalstaff had already recommended a change inthe honorary system, as this method ofmedical staffing had failed to providesufficient consultants and specialists to meetthe needs of patients at the hospital. Dr.Collins had the task of working out a newsystem of staffing where the honorary systemhad failed, and the next ten yearsbrought many changes. A scheme of sessionalpayment was introduced to encouragemore young consultants into the field ofpaediatrics and to enable senior consultantsand specialists to spend more time in thehospital. At the same time, opportunitiesfor senior full-time staff gradually increasedto the present large number. The Professorfeels that a balance between visiting andfull-time medical staff in the hospital is ofadvantage to both groups and to the public.PAGE EIGHT SPECULUM 19 61

leininasli-[isofalinofieet)r.s-rss-aleelyinofislees!d5-tdofC.itSP ECULUM 1961PAGE NINE

The full-time men contribute much to research,to organising departments and developingnew techniques, and the visitingstaff can disseminate these ideas amongtheir professional colleagues and bring backto the hospital some of the practical problemsmet in the community.In 1959, Dr. Collins was appointed tothe newly-formed Stevenson Chair of ChildHealth. He visited the U.S.A. in 1951 andinvestigated the organisation of teachinghospitals there, and in 1960, before commencinghis new post, he again visited theU.S.A. and also paediatric centres in Englandand Europe. Having seen all this, andknowing our resources, both at the RoyalChildren's Hospital and outside, he is mostoptimistic about the future of paediatric , here. As Professor, he is now able toobtain a wider view of the subject as awhole, and in particular to concentrate onteaching. It is in this latter sphere that we.as students, have felt his impact most.Finally, the M.S.S. Committee has askedus, on their behalf, to thank ProfessorCollins for his active interest and willingparticipation in our student affairs.The Doctor's Easiest Decision!INSURE WITH THEThe B.M.I. is backed by a wide knowledge and all the experienceof the needs of the Medical Profession and operates under theaegis of the B.M.A.Doctors who transact all their insurance through the B.M.I. arenot only guaranteed complete protection but also benefit theirown organization.B.M.I. Policies include —FIRE: Medical and Dental Equipment, Homes, Cars, Furniture, etc.THEFT: Instruments, Contents of Homes, Cars, Jewellery, Furs, etc.WORKERS' COMPENSATION: Domestics, Gardeners, etc.Personal Accident and Sickness.All Classes of Insurance Business transacted.Directorate: Sir William Johnston, K.B., C.B.E., D.S.O.,M.C., E.D., (Chairman); Major-Gen. Sir Kingsley Norris,K.B.E., C.B., C.B.E., D.S.O., Q.H.P., E.D.; Dr. C. H.)ickson; Dr. H. G. Furnell, C.B.E., D.S.O., E.D.; Dr. G.Newman Morris, E.D.This organisation also provides full LifeAssurance facilities backed by securityof the highest order.tritish 11111r,dica1 insurancieCOMPANY OF VICTORIA LTD.OF VICTORIA LTD.277-287 WILLIAM STREET, MELBOURNE (Opposite Royal Mint).Phone: 67 8531PAGE TENSPECULUM 1961

MEDICAL STUDY TOUR U.S.S.R., 1961Dr. W. D. CounsellNews and comment on the U.S.S.R. isas inconspicuous in our medical literatureas it is clamant in the lay press and aninvitation to join a medical study tour ofthe Soviet at first automatically declinedwas soon accepted. Medical men fromAustralia have visited Russia before butnot in a large party. This tour was arrangedby the Australian Soviet Friendship Societyas part of a policy to exchange large professionalgroups. As far as tourism wasconcerned it was well run but we foundthat arangements for clinical contacts fellfar short of those promised and our individualefforts were necessary to make thetrip worth while from the medical point ofview.The medical party consisted of 26 membersof diverse professional fields includingthree women. We travelled with anotherParty of nine, consisting of laymen andrelatives of the doctors. We all had friendsIn both groups and some got to know theothers so that apart from the trip the companyhad its own internal interest.We left Sydney on 19th April and eventuallyarriving at Delhi flew from therenorth over Afghanistan to land in CentralAsia at Tashkent.This famous city has now a populationof about one million and is the prosaicFapital I of cotton growing Uzbekistan. Thenhabitants are largely of Mongolian descentand apparently reconciled to their place inthe f Soviet Union. Here we stayed at aour-storied hotel with an indescribablea roma eventually traced to the soap. Weheard how Soviet public health had `liquidated" malaria, cholera, small pox, plague,leprosy, v sand fly fever, tuberculosis andenereal disease. Despite our Australiancholera injections we all had to swallow an?ralkcholera vaccine on arrival at Tash-ent airport. Subsequent events showedthat we had omitted to protect ourselvesagainst Salmonella.We saw the well run polyclinic of theSPECULUM 1961textile industry with 187 doctors, 71 consultingrooms and 400 (rather ancient) beds.Other industries have similar polyclinics.We saw an excellent concert of localartists and attended the splendid operahouse for "Rigoletto".From Tashkent we flew over the CaspianSea and the Caucasus to Sochi, a holidayresort on the north-eastern shore of theBlack Sea. This is a region of great beautyand its many trees include Australianeucalypts planted to absorb the mosquitobreeding swamps. Sochi contains 57 sanatoriato which deserving workers and theirfamilies are sent by their unions from allover the Soviet for 26 days holiday andtreatment. The latter is largely of the"hydro" type consisting of diet, rest andphysical medicine. An important part isthe use of the local mineral water containinghydrogen sulphide. This Matsesta orfire-water is applied externally and to mostorifices for many diseases including obesityand sterility. A scientific institute is maintainedto pursue the subject with all thefervour of balneology in other parts of theworld.We had a pleasant time at Sochi andthence flew across the Crimea to Odessa,one of the four "hero cities" of the U.S.S.R.This is a very busy seaport with more eleganceafloat than ashore. Our hotel wasTsarist in period apparently preserving muchof the original furniture. The famous operahouse is of the same period and there weheard Galina Olinechenko in "Traviata."Odessa is dotted with people having apad over one eye and these have come fromfar and wide to attend the famous EyeInstitute founded by Academician VladimirPetrovich Filatov (1875-1956). In 1931Filatov established the use of homograftsfrom cadaver eyes and this important sourceof graft material has since been extendedinto many fields.Wd were made very welcome at thePAGE ELEVEN

Institute and shown a number of patientswith excellent results from corneal grafts,etc.Filatov observed clearing in the scar tissueof the host cornea around the graft andascribed to to some substances in the donortissue. These were known as biogenicstimulators. That is, the vital but alteredtissue of the host was susceptible to the influenceof the products of commencing celldeath in the graft responding by increasedvitality. The effect was later recognized asdue to a general stimulation of the host.This principle of "tissue therapy" was extendedto its use in various morbid processessuch as pigmentary degeneration ofthe retina, tuberculosis, acne, schizophreniaand "women's diseases." Tissues used wereskin, placenta, etc. implanted, but later injectedas extracts. Finally vegetable extractsas aloes and algae were found to containbiogenic stimulators. One of our lay partywas a middle aged man suffering fromadvanced diabetic retinopathy and travellingto the land of Sputniks in the hope of cure.He was worked over at the Filatov Instituteand given a course of tissue therapyto put in with his insulin.Some members of the party visited theOdessa Institute of Therapy. There are3000 students doing Medicine in Odessaand this Institute is one of their clinicalschools. Their course consists of: Firstyear, Anatomy, Biology, Histology, Physics,Chemistry, Foreign Language and Historyof the Party. Second year, Physiology,Biochemistry, Histology, Anatomy, ForeignLanguage and History of the Party. Thirdyear, Pathology, Pharmacology, and Introductionto Clinical Medicine and Surgery,plus a Foreign Language and History ofthe Party. Fourth, Fifth and Sixth years,General Medicine, General Surgery, Gynaecology,Pedriatrics and Public Health.We arrived in Moscow just before thegreat 1st May celebrations and three daysof public holiday were given over to sightseeing.After this our first medical visit wasto the Skilfosof sky First Aid Hospital,meaning emergency or acute hospital. Thebuilding is 150 years old, a former almshouse. It has 1000 beds, 280 doctors and13 professors. The director, ProfessorM. M. Tarasov, demonstrated the taking ofcadaver blood by "decanting" the corpse.'PAGE TWELVEA British T.V. free-lance cinema man camein with us in a white coat and "scooped"the scene. They bleed about 6 cadaversa day, 2-4 litres each, and use the bloodfor most purposes. Other useful oddmentsare collected from the corpse and stored.Professor Demikhov has done much workon organ transplants in dogs. We saw anE.C.G. from a dog with two heart beats.These animals all die but tissue immunity isnot accepted as the cause.The Institute runs a large and efficientambulance service with a central call roomstaffed by numerous telephonists and twodoctors. They have a special ambulancewith all equipment for dealing with stoppageof the heart.Professor Androsov showed us on postmortemmaterial the use of their mechanicalsuturing machines — ingenious devices forinserting simultaneously many tantalumstaples in vessels or bowel by end-to-endanastomosis, and in enclosing stomach orlung after resection.The next day, and here I am indebtedfor this account to Dr. Harry Garlick, thephysicians visited the Institute of Therapy(Academy of Medical Sciences); Director,Professor Miasakov. This institute is atpresent concerned in a world plan for thestudy of atheroma. Research is conductedon animals, clinically and with biochemistryand experimental pathology. TheRussians are firm disciples of Pavlov andprefer the neurogenic theory of hyperten -sion. Professor Ivan Speransky showed awell equipped cardiological department.Electric sleep therapy is much used 1 0Russia and was employed here in hypertension.The same party visited the Institute ofExperimental Surgical Apparatus and In'struments. This remarkable establishmenthas all facilities for developing new instru -ments including animals and a museuni•This institute developed the mechanicalsuturing machines we saw.The Institute of Chest Surgery Director ,Professor Kolesnikov—a leading place forheart surgery, was found to be well equip -ped. Valvotomy was being done underhypothermy and some open heart surgerywith a Malross heart-lung machine. Theassistant director, Doctor Zenziper, said 3SPECULUM 19611r

litres of blood were required to prime themachine and half a litre of vodka to primethe doctor.The following is Dr. Garlick's "Routinefor Visiting a Hospital in U.S.S.R."(a) Get lost on the way — arrive late!(b) Visit the cloak room.(c) Don white coats and caps.(d) Meet the Director in the Board Roomand be earbashed on (i) history and (ii)statistics.(e) Eventually one sees something that isinteresting, but is is usually afternoon bythis time and one has missed lunch.(f) Receive pamphlets.(g) Write a message in the Visitors' Book.(h) Take photographs.I visited four eye establishments in Moscow.The older ones suffer from out ofdate buildings but I saw some good operatingand keen clinical work. The MoscowEye Hospital follows the Filatov school andout of respect to the memory of the Acada-Mician uses tissue therapy.The most promising find was the eyedepartment of one of the new outer ringhospitals with a fresh building, new equipmentand a young director Dr. M. Krasnow,who speaks excellent English. The hospitalis a teaching hospital.Medical schools are not at the universitiesbut at institutes. At the Institute ofMedicine of the medical schools of MoscowI found that the program was much as inOdessa, with an annual examination. Inthe final year the students do responsibleWork in various hospitals and at the endare examined in their own hospital by agovernment commission. The examinationis amost entirely oral. After satisfying theexaminers in Marxism-Leninism, the successfulstudents are awarded a diploma. TheInstitute of Medicine had 6000 students inthree faculties, Medicine, Hygiene and PublicHealth. I could not find out what thelatter two lead to but there were 600 finalYear Meds. The diploma holder wishing toadvance his position to that of "Candidate"Must do an extended period of post-graduateWork and write a thesis usually on someaspect of research. I inspected some ofthe theses, each the size of a small foolscapledger and concluded that a formidablea mount of research work must be storing upM Russia. The Candidate is a graduate ofSP ECULUM 1961the Institute of Science. (Science is beyondMedicine). The next step is Professorpresumably dependant on vacancies and thehighest award is "Academician."In Leningrad the medical programme wasnot so intense and I resigned myself to onevisit to the Leningrad Eye Hospital wherethe director and I, through a lay interpreter,spent a pleasant morning trying to assesseach other's abilities. The physicians visiteda general hospital, apparently not a teachinghospital and found the work there muchas we would in a similar hospital in Australia.We spent a very pleasant week in Leningradvisiting galleries galore and nearlyevery evening at the theatre.Mr. John Zwar has contributed the followingnotes on the surgical clinics ofRussia:(1) Odessa. (Population 667,000). Twomain surgical clinics. (a) Odessa ChildrensSurgical Clinic. The chief surgeonProfessor Dimitriev showed us around theold but very clean and tidy buildings. Hehad recently been to meetings in New Yorkand Belgium and is keen on orthopaedics.This is a teaching hospital with 80 bedsand a turnover of 1500 to 2000 cases ayear. They had closed circuit T.V. in theoperating theatre for students. Two tableswere in use at once. The wards were quiteclean but crowded. One typical small wardcontained a torticollis operation, fracturedhumerus, bilateral C.D.H., injured knee,another C.D.H. The surgical staff weredoing research work on bone growth andtransplantations.(b) Odessa Adult Surgical Clinic. Thedirector was Doctor Ternovy. 1000 bedsand its own ambulance service including 5planes and one helicopter. The chief surgeonshowed us round speaking a mixtureof Russian and German and we managedquite well with the common words. Againthe wards were crowded and clean and thecases similar to those you would find in ageneral surgical ward of one of our teachinghospitals. For instance in one ward wesaw cases of appendicectomy, kept in hospitalfor 7 to 8 days, gastrectomy, incisionalhernia ("first operation was done at anotherhospital"), acute cholecystitis, thyroidectomy(home in 8 days), cholecystectomyPAGE THIRTEEN)

(in hospital for 15 days). In the theatrewe saw a gastrectomy done under L.A.,they are evidently keen on this here. Mygeneral impression of these two clinics wasthat good surgical work and research workwere being done in crowded conditions. Idoubt whether the standard of surgery wasquite up to ours but it is difficult to assesswith a brief visit.(2) Moscow.On the day following the visit to SklifosovskyInstitute described above with twoothers of our party I returned there towatch Professor Androsov operate. Wewere met at the entrance by the Professor'sassistant who took us to his chief's roomwhere Androsov greeted us enthusiastically.We had no interpreter and he spoke littleEnglish but we could follow quite well.The patient for operation had a gastrooesophagealanastomosis in 1952 by Yudinbut there was stricture formation at the siteof anastomosis. Professor Androsov dealtwith this very competently by mobilising thejejunum through an abdominal wound, pushingthe jejunum through the diaphragm intothe thorax, closing the abdomen and thenopening the chest and anastomosing thejejunum to the oesophagus proximal to thestricture. Anaesthesia was Myorelaxin,oxygen and intratracheal ether. Duringoperation 2 litres of cadaver blood wereused.I was interested to note that no swabcount appeared to be taken. It was myimpression that the operation could nothave been done more expertly. After theoperation Professor Androsov along withProfessor Demikhov of transplant fameentertained us to a most enjoyable lunch ofRussian pancakes held down with Georgiancognac.(3) Leningrad.Here we visited the War Veterans Hospital(onr Repatriation). It was an oldlooking hospital as were all I saw in Russiaand was completed in 1935. It has 600beds, 50% for veterans and 50% for ordinarypatients. 300 beds are for pulmonaryT.B. of which 70 are surgical. There are70 doctors. The hospital was well equippedbut appeared crowded. We later returnedto watch an operation. Again two wereon at once in the same theatre. We sawan exploratory thorocotomy performed bythe assistant surgeon who discovered a cancerand called his chief Professor Kolesnikofwho took over and performed a pneumonectomywith skill.Kolesnikof recently won the Lenin Prizefor thoracic surgery. We then saw himexcise a rib for an osteogenic carcoma.Prognosis was poor he told us.In conclusion my general impression wasthat the surgery we saw was of a very highstandard but I doubt if their general surgicalstandard is as high as our generalstandard. Although they are doing mostinteresting research work the statement expressedby a correspondent in the pressthat "they are far in advance in every aspectof medicine and surgery" is in myopinion quite wrong.The representatives of the other branchesof medicine and surgery in our party didnot find anything to alter the general impressionthat has been conveyed above. Ourpsychiatrist did not get anywhere at all. Ourorthopaedist, Mr. Alec Dawkins, of Perth,was shown a case with an enormous bonegraft of the lower third of the femur whichapparently had taken.In conclusion we found our colleagues inthe U.S.S.R. keen, enthusiastic, courteousand helpful to a degree. Technically theywere skilful and patient. The leading menseemed to have a good theoretical knowledgeof established world trends but commonlywere a long way behind in practice.This may be due in part to their lengthyperiod of isolation.The official attitude to professional visitsas interpreted by Intourist is mysterious andcapricious. It seems impossible to obtaina detailed programme before entering theU.S.S.R. and visitors both accredited andprivate have been told that they could notgo to this or that hospital. It appears thatall institutions may be inspected in detailbut close or protracted personal contactsare discouraged. Most serious visitors haveexpressed the idea that a better understandingbetween east and west is imperative andthat it can best be obtained by personalcontacts at an unofficial level.In the words of John Gunter "The gulf,the chasm, the abyss, may seem too greatto be bridged. But we must try to bridgeit, because the world will have no restotherwise."PAGE FOURTEEN SPECULUM 196 1

WITH THE RED CROSS IN THE CONGODr. Hewitt HaughtonPOLITICAL BACKGROUNDOn June 30th, 1960, the King of theBelgians and the Belgian Governmentgranted independence to the people of theformer Belgian Congo, subsequently knownvariously as Congo, Congo Republique orRepublique du Congo. No central governmenthas been in power long enough todecide the official title.Prior to independence an election washeld under Belgian guidance to elect anupper and lower house of democratic parliamentaryGovernment. The party, ofwhom Patrice Lumumba was head, polledthe largest percentage of seats, JosephKasavubu was next. Patrice Lumumbabecame the first Premier of the Congo independentCentral Government and Kasavubuwas appointed President.On July 7th, 1960, the Force Publicmutinied in Leopoldville and locked up orkilled their Belgian officers. Similar occurrencesof mutiny occurred throughout thewhole Congo. Whatever other antecedentcauses were present, this mutiny resulted inthe beginning of a mass exodus of BelgianNationals throughout the whole country,with them went the majority of 760 doctorsand over 3000 European trained whitenurses.This mass exodus resulted in the decapitationof every technical activity in theCongo. Amongst the native Congolesethere were no doctors, lawyers, engineers,architects, electricians, nor specialised technicians.In a population of 14,000,000there are 16 university graduates. Onedoctor qualifies late this year and two moreIn 1963.Following the mutiny of the Force Publicthe Belgians appealed to the Government athome for assistance, they sent a Belgianparatroop regiment, who got the Force..r111311c . under some sort of control but by'nen* high-handed manner infuriatedSP ECULUM 1961Lumumba. Moise Tshombe's secession ofKatanga from the Central Government furtherworsened the situation with the resultthat Lumumba called upon United NationsOrganisation for assistance to maintain lawand order. He also thought he could useUNO to assist him in retaking Katanga.Following an emergency meeting of theSecurity Council of UNO a military forcewas formed from African member countriesand air-lifted into Congo by U.S. Armyplanes from Germany. This force startedto arrive from July 12th onwards. In addition,there were UN technicians drawn frompermanent staff of all nationalities broughtinto the country to get the essential servicesworking and to supervise their maintenance.These included sanitary engineers for waterpurification plants, engineers for electricsupply plants, telecommunications, airportcontrol, meterological forecasters, etc.World Health Organisation undertook thesurvey of medical problems and acted asadvisers to the mushrooming CongoleseMinistry of Health. The Minister of Healthwas a self-appointed Congolese Assistante-Medicau. This man had a high degree ofability and in the early days the Ministryof Health was one of the few that wasoperating reasonably well.A report to U.N. by W.H.O. in Julyshowed that the medical problem was oneof overiding urgency as the Congo couldeasily have become a pool of epidemic tropicaldisease that could have threatened themedical health of the whole continent.W.H.O. did not have the permanent staffto cope with this vast problem and askedfor assistance.The International Committee of RedCross were approached and in conjunctionwith the League of Red Cross Societiesthey offered their assistance on what theytermed an emergency basis only. At thattime the emergency period was predictedas three or at the most six months.PAGE FIFTEEN

THEAUSTRALIAN PHARMACEUTICAL FORMULARY,A.P.F.AN INDISPENSABLE STANDARD REFERENCEBOOK FOR STUDENTS AND PRACTITIONERSSpecial features of the current edition are:-A concise guide to prescribing practice and prescribing conventions.Monograph Section.General Therapeutic Formulae.Infants Section.Poisons and Antidotes Section.Table of B.P. Doses.Therapeutic IndexPRICE 25'-AVAILABLE FROM LEADING MEDICAL BOOKSELLERS,WHOLESALE DRUG HOUSES,and thePHARMACEUTICAL SOCIETY OF VICTORIACollege of Pharmacy,381 Royal Parade, Parkville Phone: 38 6254PAGE SIXTEENSPECULUM 1961

Red Cross assistance in a country not atwar is normally under control of the Leagueworking through the National Society. InCongo this was not possible as there wasno National Society. International RedCross, therefore, decided that in Congo astate of war existed and they sent theirdeputies to survey the problem. One ofthese was a Swiss living in Rhodesia calledMr. Sen, of whom more later.The League of Red Cross Societies at therequest of the International Committee,were asked to recruit from their membernations medical teams consisting of a minimumof three, physician, surgeon and medicalorderly, preferably male. Many countriessent much larger teams, Russia had ateam of 24 personnel. These medical teamsbegan arriving in Congo about 15th-20thJuly and were assigned with all the possiblespeed a very erratic U.N.O. air transportcould muster. The Australian NationalRed Cross sent, initially, two teams of threefor a period of six months, later two moreteams of two were sent for four months. Iwas the leader of one of these first teams.To return to the political situation whichhas a direct bearing on our experiences. TheU.N. military force operated under a mandategiven by the Security Council which,amongst other things, stated that it was tomaintain law and order but not to interferewith internal politics. The wording of thismandate restricted the functions of themilitary force in such a way that muchadverse criticism has been levelled atU.N.O.C., not only by the internal politiciansbut also by international press re-Ports.L. umumba, amongst other local politicians,considered U.N.O.C. could be usedto further his own political aims. Thevarious field commanders of U.N.O.C. unitssucceeded in steering a strictly neutralcourse through all these demands madeupon them. It is important to keep thisPeculiar position of the military force inmind as incidents in which we were involvedoccurred where the unit commanderwas confronted with only one possiblecourse of action. In one particular incidentwhere I was captured by Kalonji's army,the U.N.O. unit commander was powerlessto effect my release.Early in August, 1960, Albert KalonjiaBaluba tribesman—formed an independ-SP ECULUM 1961ent state in S.E. Kasai with Bakwanga asits capital, backed by the management ofthe Beceka Diamond Mines and called theEtat Miniere. Into this area all the Balubarefugees of the Lulu-Baluba tribal warbegan to congregate; this war had been inprogress since October, 1959, and hadnothing to do with independence. OnAugust 26th Lumumba sent the CongoleseNational Army—the renamed Force Publicand C.N.A. for short—to capture Bakwangaand to annihilate the Etat Miniere.This they proceeded to do over the nextthree weeks until September 14th whenKasavubu deposed Lumumba as Premier,Col. Mobutu declared martial law and toldthe Russian Embassy to leave, andU.N.O.C. negotiated a cease fire betweenthe C.N.A. and the Balubas. Bakwangawas recaptured and reoccupied by Kalonjiand the seceeding S.E. Kasai state proclaimed.This attempt at genocide plus hispro-communist leanings was the downfallof Lumuba, eventually leading to his deathin February, 1961, in Katanga.With this summary of the politicalpicture in mind, I will proceed to our experiences.FIRST GLIMPSES OF CONGOOn August 19th, 1960, Drs. Dwyer, Foxand Mr. Acol of Team No. 1, Dr. Willis,Mr. Thompson and myself of Team No. 2Australian Red Cross, departed from Australiabound for the Congo. We had noinformation at all as to conditions in theCongo of medical practice apart from thealarming newspaper reports, so we expectedprimitive conditions and medical practiceon a village patrol level. On arrival inLeopoldville on August 22nd we weresomewhat amazed at the magnificence ofthe city and its environs; during the weekwe spent there awaiting assignment we wereable to explore these environs in more detail.The European population before independencelived a life of luxury, their homesand apartments were magnificent. Theyhad three country clubs, a golf course,cinema, night spots and many first classrestaurants.The atmosphere in Leopoldville is worthrecording. Here was a city originally of25,000 whites and 250,000 native population;it was a continental city of concretePAGE SEVENTEEN

apartments and office blocks with tree-linedboulevards, shops, traffic lights, cafes andrestaurants. The city lighting remained onnight and day. By day the sun shone andthe trees were stirred by the breeze, but itwas a dead city, its owners and occupiershad gone. It was a silent city, especiallyin the residential suburbs where the housesremained in their gardens with eddies ofwind stirring the fallen leaves, paper anddust. Here again the electric light burnednight and day disclosing the interior of thehomes with their silent furnishings and lackof human occupants, a few windows werebroken, garages had cars in them, manyburnt and wrecked cars lay about the citystreets. While the city was silent and deadit was not empty, there was a massive lifein the city, but it was alien. The city hadbeen occupied by a people who did notunderstand it or know how to use it. Byday they drove around in late model Americancars, their women in the back dressedincongruously in their village clothes; theyate in the cafes, they drank in the bars andthey occupied the big tourist hotels. Bynight they disappeared, the city was silent,hushed and empty again, by night it becameinvaded by an air of stealth, broken oraided by the sudden appearance of an unlitweapon carrier moving silently along loadedwith Congolese National Army troopsarmed with F.N. rifles and automatic weapons,their black faces shrouded by darkgreen tin hats, some with bands of white orred painted on them. These were the fearedCongolese Gendarmerie who were ruthlessin their brutal handling of their captives.The atmosphere in Leopoldville was whatI imagined, a city struck by an atomic explosionwould be like months after its radiationhazard had ceased and it had becomere-occpuied by an alien civilization.Whilst in Leopoldville we visited threeplaces of medical interest which to me werean eye-opener of the magnificent standardof medical attention the Belgians gave tothe Congolese. One was a modern Leprosariumrecently completed, which broughta modern scientific attitude to this one-timedread disease. The fixtures, fittings andappointments of this hospital are probablyunequalled anywhere. The second was thePrincess Astrid Institute of Tropical Medicine,a rather uninteresting building housinga tropical research unit that is world famousand whose work has been retarded 30 yearsby independence, only two of the original50 European workers remained. The valueof its research equipment runs into millionsof dollars and its slide library of the pathologyof tropical medicine has no equal inthe world. This institute is now idle andits fabulous equipment will rust away in thehumid atmosphere, unprotected by theessential refrigerated airconditioning. Thethird place we visited was a recently constructedand completed district hospitalserving a native suburb of about 70,000people with 300 beds. It was built on thedetached chalet system connected by coveredwalks. It was being run by two SwissRed Cross teams. The operating theatreblock had two beautifully equipped theatreswith a central sterilising room, anaestheticrooms and recovery ward that can best bedescribed as a picture of streamlinedchromium plate and stainless steel. Thishospital under Red Cross management wasfully operative and supplied service in Surgery,Maternity, Pediatrics, General Medicineand Tropical Medicine. T.B., leprosy,and orthopaedics were diverted to specialisthospitals situated in and around Leopoldville.Also working in Leopoldville was theCentral Blood Bank staffed by a specialRed Cross Medical team from Holland.WORK BEGINSOur period in Leopoldville whilst interestingwas becoming irksome as more andmore teams were arriving and we all waitedassignment; with us were teams from India,Pakistan, Poland and Ireland. About themiddle of the week we were visited by Senwho had recently arrived in Leopoldvillefrom S.E. Kasai, where he had done a surveyfor the I.C.R.C. of the medical requirements.Bakwanga, the centre of this area,had a normal native population of 20,000,into this area another 120,000 had migratedas refugees; they were centred around aplace called Miabi where there was a 300-bed district hospital and an urgent need fora Red Cross team. Sen had hair-raisingstories to tell of his experiences consequenton the Lulua-Baluba tribal war, a war of noquarter and no prisoners, with mutilation ofthe dead as a side line. He said theBalubas wanted medical assistance, wouldPAGE EIGHTEEN SPECULUM 1961

we give it? We volunteered for the assignment,although U.N.O. security was notavailable in the area we felt the need wasurgent. Our departure was delayed byLumumba sending the C.N.A. in to captureBakwanga on August 26th. Three dayslater Bakwanga was reported all quiet andthe C.N.A. had moved on towards theKatanga border.On August 30th we left as a group forBakwanga and Miabi. We arrived in whatproved to be a lull in a battle that had beenraging since dawn with an estimated 300dead in the bush surrounding the town. 150Belgians, including one woman and 13Nuns, were besieged in their club surroundedby a thin guard of Tunisian U.N. troops,outside these were a ring of some 500C.N.A. of whom all one could see in thetall elephant grass was their tin hats and themuzzles of their FN rifles.Bakwanga is a mining town, owned lock,stock and barrel by the Miniere Beceka andis dependent on the mining of 60 per cent.of the world's supply of commercial diamonds,dull blue-grey blobs of crystal withyellow streaks in them. There is a Europeanresidential area centred on the ClubCercle, a native employees' residential area,two hospitals, one for Europeans and onefor Congolese, a large Roman Catholic Missionwith a maternity hospital, the sprawlingmine compound surrounded by a 10 footchain link fence, and beyond this the Congolesehospital. There are no shops,cinemas or amenities, all stores are purchasedthrough the mine-owned store,bakery and butchery. Some 35 kms. S.W.of Bakwanga along a bush dirt road is thedistrict hospital of Miabi.The 15 days we spent in Bakwanga werea nightmare. We lived in an unused minehouse and ate in the club where everythingwas rationed. We worked where we could,serious injuries such as gunshot wounds ofthe abdomen being treated in the Europeanhospital, the remainder in the Congolesehospital. Fighting between C.N.A. andBaluba continued with considerable ferocity.Some of us toured the battle areas ina converted utility trying to collect thewalking wounded; more seriously woundedusually died in the bush before we couldget to them. Some 70 cases were broughtto the hospital mainly with grossly infectedcompound limb fractures from 4-14 daysSP ECULUM 1961post injury. In the theatre we had nowater, no autoclave, no sterilization and exceptfor about four hours a day no electricity.In the wards we had no staff. Thehospital was old and dirty and all the bedlinen had been looted. The theatre waswell equipped but most of the instruments,etc., had been removed to the Europeanhospital. Hunger was even then a majorproblem. We were able to get a smallamount of relief food but not in quantity orsufficient variety.We had an excellent medical store, verywell stocked, especially with antibioticswhich we used liberally. It was an amazingsight to see a badly infected compoundfracture carried in for treatment and 48hours later up and walking about with hisinfection under control and his fracture inplaster. These people were stoically gratefuland quite uncomplaining; we all feltrather sorry for the Baluba. Later experienuceof them changed my attitude completely,they can be just as savage andbrutal as the C.N.A.Some incidents in the Bakwanga nightmarestand out, such as the burial of 50people killed in a massacre of innocent unarmedstudents in the Mission. On the wayup to work one morning, Dr. Willis and Dr.Dwyer found a dead man in the street, theyburied him hastily in someone's frontgarden and hoped the tropical rain wouldnot wash the top soil away. Then therewas "'Orrible 'Arry" who believed thatdeath from burning was better than beingshot, so he sat in his home and set fire tothe roof which fell in upon him causingsevere burns of back, scalp, arms and legs.How he survived is a miracle. We used todress him every second day, the whole proceduretaking about three hours as we hadno proper facilities. The lack of water wasa nuisance, but we got around it. Wefound a good supply of Vichy water in themedical store—drinkable but a bit salty.We washed ourselves and our underclothesin the Club swimming pool, shirts, etc., wehung on the line and hoped the afternoonrain would make them a bit cleaner. Someof us had dysentery and used to spend thenight running up and down the gardenarmed with a small trowel. The Tunisiansgave us a party in their Mess—a one-timetourist hotel—we had a sheep barbecuedTunisian style and ended up drinking warmPAGE NINETEEN

you'll find a NATIONAL BANK Cheque Account.No matter who they are, what they do or where they live, you'll find men andwomen everywhere using their National Bank Cheque Accounts.National Bank Cheque Accounts are designed for the everyday benefit ofeveryone . . . They make life easier in these modern times and help thetidy arrangement of your finances.The Manager of your nearest National Bank will gladly open an accountfor you today.Whatever your walk in life you need aNATIONAL BANKWeyue0/we/tadTHE NATIONAL BANK OF AUSTRALASIA LIMITED, (lac. in Vic.)5406/83/57PAGE TWENTYSPECULUM 1961

Veuve-Cliquet in the dark as the powersupply had failed again.We were withdrawn from Bakwangarather hurriedly without notice on September14th. Apart from visiting Miabi whereconditions were impossible, we were notable to work there.CONDITIONS IMPROVEWe arrived in Luluabourg on September15th unheralded and unsung, no one knew athing about us and the W.H.O. representativewas marooned without transport inanother part of the province.The local hospital (600 beds) was workingwith a Norwegian Red Cross team anda Spanish Internist. Luluabourg was abreath of civilisation after the jungle and wedetermined to stay there. When Dr.Nicholas, of W.H.O., came back he wantedone team to go to Luiza in south Kasai.On September 20th Drs. Dwyer, Fox andMr. Acol went and remained there. Dr.Willis and myself joined the Norwegians inthe base hospital for one month and tookover from them in October, and continuedon by ourselves. For the next 41 monthslife settled down into a fairly placid routineduring which we were grossly overworkedbut contented. We had good living conditions,no recreation, but then we had notime for it, a number of good friends andnumerous incidents.To give some idea of the problems involvedin Luluabourg, it was like trying torun a Melbourne city hospital in which thenursing staff consists of 25 per cent. of theprobationer nursing staff, three trained nurses,four doctors, one pediatrician (150patients), one surgeon (100 patients), oneobstetrician and gynaecologist (100 patients),one internist (150 patients), one nursewith three years' experience in TB (100patients). The surgeon did ALL the emergencywork, although later he was relieved ofthe obstetrical emergencies. There was noanaesthetist.The hospital served an immediate populationof 80,000 and a potential populationof 2,500,000 with no other qualified medicalattention available. The medical servicewe were able to give was in-patient only,we did no out-patient work at all. This wasdone by Congolese Assistante-Medicaux.SP ECULUM 1961Hospital administration was entirely by theCongolese with W.H.O. advising. Theylearnt by trial and error.We worked from 7.45 a.m. to 5 p.m.,with 11 hours off for lunch. Night callsusually started about 7 p.m. and kept upuntil midnight. This abrupt stoppage atmidnight was due to the night staff lockingthe main entrance of the hospital, disconnectingthe telephone and going tobed. Sundays, apart from hospital roundsand emergencies, were free. My work wasalmost entirely operative. I did 310 majoroperations and 111 minors from September15th to January 30th, 1961. A bit ofeverything, including 71 hernias.My part of the hospital, the surgical section(100 beds, operating theatre and X-raydepartment) was staffed by Sister Stella(Nursing Nun), who ran the theatre at firstbut was later deposed by a CongoleseDirector. She gale anaesthetics. Also inthe theatre were three Congolese nurses andtwo cleaners. The X-ray department consistedof two Congolese trained radiographerswho were very good for simpleradiography. The ward was run by M'lleVerheage—a Belgian trained nurse—twomale nurses, two female nurses and twocleaners. The male nurses took it in turnsto do night duty. Female nurses onlyattended in the female wards. All childrenrequiring surgery were nursed in the pediatricdepartment.SURGICAL HAZARDSThe work in the surgical section was,apart from accidents, entirely operative.Patients were referred by the Congolese-runout-patient clinic when they consideredoperative interference necessary. Consequentlywe never saw patients not requiringoperation or patients after they had beendischarged from hospital. The type ofwork was much the same as in any generalsurgical department, with hernias predominating.During the 41 months I workedthere I saw a bit of everything and had tobe prepared to tackle any case that presentedfrom craniotomies to gastrectomies.Emergency work had priority and in fact,owing to the limitation of beds, electivesurgery was cut down to a minimum.Emergenices were mainly bowel obstruc-PAGE TWENTY-ONE

tions, compound fractures, Caesarian sectionsand hysterectomy for ruptured graviduterus.Major abdominal surgery was a hazardousundertaking because we had no X-raydiagnosis service other than limb X-rays,and for most of the time we were using a 10ma. dental machine for these. We had nodiagnostic laboratory service apart from unreliableblood counts and similar minorexaminations. In a population riddled withdysentery and hookworm, only one faecalexamination out of hundreds sent to thelaboratory was diagnosed positive. Fluidand electrolyte balance control was purelyguess work and the Congolese nursing staffhad no appreciation of the theory of physiologyin IV therapy. Many of our patientshad not one abnormality but at least four,the treatment of which was more imperativethan operation. These were anaemia (Hbof 2.5gm-4.5gm. common), incipient malaria,hookworm infestation and dysentery.At an early stage, in consultation withmy physician colleague Dr. Willis, we decidedthat there were so many cases requiringattention by a doctor for general diseasethat our time was better spent looking afterthese patients than in concentrating onpurely elective surgery. The chief medicalneeds in the Congo are for physicians, preferablywho can undertake emergency surgeryand obstetrics! The general health ofthe patients was so poor that getting themfit for major surgery such as partial gastrectomy,nephrectomy, etc., would have takenweeks under the care of a physician whosetime was better spent in other fields.Diagnosis of some abdominal conditionswas of necessity by means of laparotomywith consequent action on findings; this isnot a recommended method of practisingsurgery.GENERAL PROBLEMSOther restrictions were also operating.For 21 months all our autoclaving of linen,etc., had to be done at another institutionas our main autoclave was out of order.Sterilisation of instruments, etc., was entirelyby means of a dry heat oven without theaid of coloured tapes, etc. A few accidentsdid happen as a result of this. A herniawas operated upon with instruments washedPAGE TWENTY-TWObut not sterilised that had been used thenight before for a gangrenous perforatedintussusception.Practically, without exception, if anaesthesiaby spinal or local block was impossiblethen operation was impossible. SisterStella, our nurse anaesthetist, could, anddid, give many endotracheal anaesthetics,but by herself she could not do everything.We had to adopt the Belgian system ofsetting up the theatre which in practicethe surgeon does everything himself. Therewas no theatre sister, scrub nurse or suturenurse. You draped your own trolley,arranged instruments, selected sutures andthreaded your own needles. Here may Isay how much we appreciated the split-eyedspring needle which can be threaded bytouch.Post operative management of patientswas frequently upset by the most unexpectedoccurrences. These certainly made forvariety but were frequently exasperating. Ifthe patient was not literally tied to the bedhe had often gone home the day afteroperation. Sometimes they disappeared beforeoperation and turned up again 3-4 dayslater. One patient with a urethral fistulaon whom I planned a two-stage reparativetechnique, disappeared after the preliminarycystostomy. I did not see him again.Patients with I.V. drips were the most difficultas the nursing staff interchanged normalsaline, dextrose and water and syntheticplasma substitutes quite indiscriminatelywithout reference to instructions or physiologicalrequirements. Patients receivingI.V. therapy for dehydration from prolongedvomiting or dysentery would frequentlyremove the needle after the first litrehad been given and go off home, or back tojail in one case. The staff discontinueddrips if they required a change of bottlesduring the night, i.e., after midnight, nomatter what the requirement of the patient.Interference by civil and military authoritieswas another hazard with which we hadto cope. One morning I arrived at the hospitalto find the whole surgical sectionseething with about 200 fully armed andvery irate C.N.A. One of their numberhad been killed the night before in a motoraccident and they were fully convinced thatthe driver of the car was hidden by mesomewhere in the hospital. Trying to convincethem to the contrary in a languageSPECULUM 1961

that I could not speak was quite a job. Thiseye for an eye idea is a feature of motordriving in Congo, it refers to white andblack alike. If a native is killed in a motoraccident, the driver of the car is alwayskilled if he can be caught. That is all thereis to it. You tend to drive with great cautionwhen there are natives on the road.My lack of understanding of the Frenchlanguage was the cause of an amusing incident.I was called urgently one Sundayafternoon to the hospital where I foundabout 30 people, mostly Congolese, in theoperating theatre, all milling around, talkingFrench nineteen to the dozen. Trying tosort this out I gathered that one man, whomI was told was Kasavubu's chef, had beenthe subject of a bad beating up by theBaluba in Bakwanga during a visit byKasavubu to Kalonji. This man was aLulua and his brother lived in Luluabourg.When we got the patient into bed the brotherwas very offensive and refused to havehim attended by Belgian Nuns and whitedoctors. With things looking really nasty Idecided to seek assistance through my Belgiannurse as interpreter and the localC.N.A. camp Commandant. M'lle Verheagedid all the talking for me and when sheasked me who the man was I said, "Kasavubu'scook". We succeeded in getting theCongolese camp commandant to send aC.N.A. guard up to the hospital and goteverything quietened down. AfterwardsM'lle Verheage told me that the patient wasnot Kasavubu's Chef de Cuisine but hisChef de Cabinet.While we had very little time for recreation,had it been available, we did manageto arrange reliefs for one short weekendwhich we planned to spend at Lac Mucamba,on the Lulua-Baluba territory border.The Belgians had built up the surrounds ofthis lake into a pleasant resort with a veryComfortable guest house and resources forswimming, water ski-ing, etc. The lakehad no crocodiles or hippos in it. We spentOne afternoon learning to water-ski withmoderate success. The following afternoon,dressed in nothing but a bathing costume,I went to the local airfield to meet some ofmy A.P.C.M. friends and inadvertentlydrove into a small group of Kalonji's armywho promptly arrested me and the Belgianwho was with me. Efforts to identify ourselveswere unavailing and they insisted onS PECULUM 1961taking us to Bakwanga, the capital ofKalonji's area. Curiously, the U.N. forcesin the area tried to rescue us but werethemselves arrested and brought to Bakwanga.After an afternoon and night ofmuch talking and brandishing of FN's, etc.,we arrived in Bakwanga at 2.30 a.m. andwere formally interviewed in the street bythe local army commander assisted by hisstaff. He was dressed in pyjamas and asten gun, the remainder ringing us roundwith FNs and sten guns. My Belgianfriend eventually persuaded them we werenot spies and we were allowed to go to theU.N. forces HQ., where we spent the remainderof the night. I returned by U.N.O.plane the following day still in a bathingcostume but with the addition of theGhanian Brigadier's raincoat.My work in Luluabourg ended on January15th when W.H.O. commenced to getlong-term doctors into the country to relieveRed Cross personnel. I was relieved by aBelgian surgeon who had been in anotherpart of the country. To finish the time ofmy service I went to a Mission Hospital inSouth Kasai where I spent a very pleasant14 days in a small 70-bed hospital, beingwell looked after by the A.P.C.M. Thisjob was done at a much slower tempo andI was able to see more of the people of thecountry. We had the use of a privatelyownedCessna to fly around in.THE CONGOLESE PEOPLEIn conclusion, let me say a word aboutthe people themselves. My experienceswere with the Lulua tribe mainly; I also metmembers of the Basong, Basala and Bateketribes. The latter are cannibals. Cannibalismin Congo is ritual and not a means ofaugmenting the protein deficiency in theirdiet. It is a part of the ritual of attainingmanhood and position in the tribal hierarchy.The Congolese people outside the urbanareas while not entirely illiterate, have alow standard of education. Their loyaltiesare tribal and they retain intact many oftheir tribal beliefs and customs in spite oftheir association with Christianity. Theyare reserved, shy and suspicious with whitepeople, whom they inherently distrust. Itis nearly impossible to get close to themor to know what they are thinking. TheyPAGE TWENTY-THREE

will always tell you what you think youwant to hear.Tribal customs keep the women in a conditionof absolute slavery. They do all themanual labour and heavy work and aretreated by their men folk with completedisdain. Fecundity is the highest ambitionof a Congolese woman; if for any reason atall they become sterile they are outcasts inthe village and form a high proportion ofthe insane.The women plant and cultivate the gardens,prepare the food, carry on their headsburdens up to 150 lbs. weight on all occasions.They look after their husbands andtheir children and are perpetually pregnant.Expectancy of life is about 45 years. Themen sit around and talk politics, on a villagelevel. They are intensely fond of theirchildren and it is the father invariably whobrings the child for medical attention, hiswife comes along too, usually with the restof the family, to do all the work.The staple diet, for the non-urban peopleis manios, maize, rice, peanuts and palmoil. They augment this with fish, meat insome areas—antelope and hippo—bees andflying ants eaten alive and raw. They areVitamin conscious and if they get theopportunity they will loot a hospital storefor all its Vitamin tablets, especially the Bgroup.The children are delightful, they maturein worldly wisdom at an early age; they donot seem to fight and squabble amongstthemselves the way we do. Children of6-10 years have taken over the care of theiryounger brothers and sisters amongst familiesorphaned by the tribal war. At 10years they go to school and then somethingchanges them to their adult distrust.THE CONTINUING PROBLEMWorking in Congo was a wonderful experience,both in clinical experience and inassociation with other nationals for a commonaim. Congo is going to require doctorsfor many years to come. It has beenestimated that it will take 60 years to trainCongolese doctors to replace the 760 Belgiansand other nationals who served thehealth requirements of the country. Providedthe political position was reasonablystable, I would consider 12 months' servicein Congo under W.H.O. (World Health Or-PAGE TWENTY-FOURganisation) would be a worthwhile experiencefor any medical graduate. A workingknowledge of French is essential.Working with the International elementof the Red Cross organisation was an enlighteningexperience for me. Of all theinternational organisations trying to helpthe Congolese people the Red Cross succeededcompletely in their aspiration andaims in Congo. Their operation was sosuccessful that the period of service requiredto be extended from six to twelvemonths to allow other organisations tomobilise replacement medical personnel ona long-term basis. Twenty-four countriessupplied over 150 doctors, the largest numberthere at any one time was 104. Thesefigures are a drop in the ocean when youconsider the problems involved; however,it is interesting to note that during theperiod of the Red Cross medical aid, therewas no outbreak of uncontrolled epidemicdisease. To some extent this can be attributedto the excellent preventive system ofthe Belgian administration and to the presenceof the epidemiological experts ofW.H.O.; the doctors on the spot were, however,Red Cross.0,.........,,—....0.....,,,............,...,..........0..0...,,—.,0i 1A Restaurant known throughout 1IIiAustralia1i1 I1 1LL•1enevteve ,,1 i1 1ESPRESSOIiCOFFEE LOUNGE11 !233 Faraday Street, CarltonIFJ 43131 Near the University1IIiI0......,,...........0.....,,,,,,.....,.....,,,........0—.....................)SPECULUM 1961i

ARTERIAL SURGERYMr. Neil JohnsonAs our knowledge of pathology developed,the importance of arterial lesionsin causation of human disease has becomeclearly evident. Arteries in all sites of thebody may, with advancing years, becomeblocked by atheromatous deposits, thusreducing the blood flow to the organ suppliedby the involved artery. Commonexamples of this arterial occlusion are seenin the heart, brain, kidneys and lower limbs.Sometimes the artery instead of becomingblocked, becomes distended like a weaktyre and an aneurysm develops. Theseaneurysms, or blow-outs, occur mainly atthe lower end of the aorta, and once startedtend to enlarge progressively until theyburst with disastrous results. Moreover,the anatomically protected position of theneuro-vascular bundle is no match for theingenuity of accident-prone modern man,and major arteries and veins are not infrequentlysevered in present day accidents.If a large vessel is severed, blood loss mayrapidly terminate life, and even if the bleedingis arrested the tissues supplied by thetraumatised vessel (usually a limb) are unlikelyto survive. Such then is the stimulusto the vascular surgeon, his role is fundamentallythat of the plumber, to replaceweak pipes, to unblock blocked pipes andto repair burst pipes.Much of the history of surgery is centredabout the attempts of surgeons to deal withtraumatised vessels. The cautery and hottar of the days of Nelson gave way to thenotion of seizing the bleeding vessel in forcepsand ligating it with some suitablematerial. Discovery of this method(haemostasis) was one of the fundamentaldevelopments which made possible thesurgical attack on all the deeper structuresS PECULUM 1961in the body. Whilst it was very satisfactoryin dealing with small vessels (since theblood supply was readily taken overby other small vessels) it was not satisfactorywhen applied to the larger arteries.Ligation of the damaged popliteal arteryfor instance, is followed by loss of the legin one-third of cases, and patients in whomthe limb survives are likely to have severesymptoms, due to diminution of bloodsupply to the muscles of the leg, as anaftermath. Clearly, the rational method ofdealing with a damaged major artery issimply to sew it up again and thus restorethe continuity of the main vascular channel.It might be supposed that the vessel wouldbleed dramatically through the holes madeby the needle and thread used to sew theends of the artery together, and indeed thisis so, but, provided that very fine thread isused in the repair, and the stitches areplaced with great care, bleeding stops quitesoon, the needle holes becoming blockedwith small quantities of blood clot.The techniques of repairing major vesselswere worked out and tested in the experimentalanimal in the early 1900's by anAmerican physiologist named Carrell, butthese techniques were not widely introducedinto clinical practice until after the SecondWorld War. This delay in clinical applicationof the techniques of arterial surgeryis scarcely surprising since some degree ofblood loss is inevitable in dealing withmajor vessels, and thus progress in the fieldof vascular surgery depended largely uponthe ready availability of blood. The wellorganisedBlood Bank, as we know it today,is a post World War II development.A cleanly severed artery could obviouslybe repaired by direct suture, but if a lengthPAGE TWENTY-FIVE

A.';;;7',: •:;;,;',of vessel was so badly damaged that it hadto be removed, the problem of breaching agap in the artery presented itself. Earlyattempts to deal with this problem weremade using glass and silver tubes, but bloodclotted in these channels within a fewmoments and they proved to be valueless.It was natural that attention should nowturn to substitutes available from the bodyand so autogenous vein grafts (obtainedfrom the same individual) were employed tobridge the arterial defect. By and large,these proved to be of great value. Therewas some tendency for the implanted veinto dilate under its new pressure relationshipsbut follow-up of these grafts showedthat they survived in their new site and thatthey soon acquired a structure similar tothat of the arterial wall. Obviously thevein used had to be an expendable onefrom the point of view of the venous circulationand the largest vessel available is thelong saphenous vein, thus the size of theavailable tissue reduced the applicability ofthe technique of venous replacement toarteries of the size of the femoral and smaller.In general, vessels smaller in size thanthe brachial artery do not tolerate graftswell since it is difficult to adequately placestitches without constricting the vessel.As experience with the treatment of traumatisedmajor vessels developed, surgeonsturned their attention to the use of similartechniques in overcoming disease within thearteries and attempts were made to dealwith disease of the larger vessels includingthe aorta. Now any attempt at aortic replacementdemanded vessels of greaterdiameter than was available from the veinsand attention naturally turned to the aortichomograft, that is, a graft taken at autopsyfrom another individual of the same species.Work in the experimental laboratory and inthe clinical field soon showed that aorticreplacement with homografted tissue wasreadily accomplished and early results weresatisfactory. Methods were developed forobtaining the arteries in a sterile conditionand for storing these vessels. It even becamepossible to freeze-dry arteries and thisenabled the storage of these vessels for prolongedperiods of time. Unfortunately, astime passed, it became apparent that thereplaced artery tended to develop the samesort of disease processes as were initiallyPAGE TWENTY-SIXpresent in the host vessel. Atheroma developingon its wall led to the occurrence oflate obstruction, and weakness of the wallof the homograft allowed dilation andaneurysm formation in the grafted vessel.These phenomena gave great impetus tothe careful study of the fate of the homograftedartery and it was shown that, aswith most other homografted tissues, theimplant failed to survive as such in its newsituation. The grafted artery was invadedand replaced by host granulation tissue,only the fibro elastic layers of the mediapersisting and acting as a scaffold for theingrowing host tissue. The arterial homograftwas thus found to have the followingdefects.(1) The methods for obtaining and storingthese grafts in a sterile conditionwere time-consuming andsomewhat uncertain since infectionof the graft may occur in spite ofall precaution.(2) The only subjects suitable fordonors of such vessels were youngsubjects dying of trauma and inmost countries the supply of suitablegrafting material was anever-present problem.(3) The graft did not stand up to prolongedwear.These defects, coupled with the discoverythat the fibro elastic tissue acted in a purelypassive fashion, led to the investigation ofartificial fibres to see whether a man-madecloth could be used for arterial replacement.A vast amount of work with all mannerof fibres has been done in this field andeven now no completely satisfactory arterialsubstitute has been found. At the presenttime, the most suitable materials are thesynthetic fibres of dacron and teflon knittedor woven into tubes and used to replacethe diseased artery. Spaces between thefibres of these cloths enable granulationtissue to grow in through the cloth and providea lining to the lumen of the graft. Theyalso enable blood to escape from the tube ina most dramatic fashion immediately flowthrough the implant is instituted. Fortunatelythis flow soon stops as the pores ofthe vessel wall become occluded with bloodclot but the surgeon using these artificialprostheses must ensure that the patient isSPECULUM 1961

not exanguinated during the time that thegraft is becoming water-tight. Even todaythere is active discussion regarding therelative merits of these various types ofarterial replacement and the general opinionis that arterial homografts, venous autografts,and synthetic prostheses all have aplace in the management of vasculardisease.Paralleling the development in materialsused for arterial replacement, there havebeen developments in the techniques usedin inserting these various substances intothe body. The treatment of aneurysms ofthe major vessels is relatively standardisedand, in general, consists of excision of thediseased vessel and replacement with anarterial prosthesis. If, however, an attemptis made to remove a blocked vessel thereare other factors which must be considered.At first sight, simple excision and replacementwould seem the appropriate methodof treatment. However, the occluded segmentis often of considerable length andwhen blockage occurs in a major vessel theoccluded segment is by-passed by the enlargementof collateral vessels. In anoperation designed to excise this segment,the collateral vessels are inevitably damagedand thus the blood supply to the distaltissues is still further reduced. Under thesecircumstances, should the implanted graftfail, the most disastrous results may follow:the limb may die, making a major amputationinevitable. These problems havebeen overcome to a large extent by the useof the by-pass technique. In this technique,the surgeon imitates nature and inserts along, wide "collateral" vessel to bridge overthe block in the host artery. The hostartery is exposed above the block, and theby-pass graft sewn in; the graft is insertedblindly down beside the main vessel in sucha way that the collateral vessels are notkdamaged and is resewn to the host vessel°elow the graft.When dealing with blockages of the mainvessels such as the aorta and its majorbranches it has been shown that excision ofthe media and diseased intima, togetherwith the occluding thrombus, leaving justthe adventitia intact, results in a tube capableof carrying blood. This operation,known by the complicated name of Dis-Obliterative Endarterectomy, is suitable onlyfor large arteries.SPECULUM 1961Thus it can be seen that at present, thesurgery of the major vessels is well established.In clinical practice it is possible toanastomose vessels ranging in size from theaorta and pulmonary artery down to vesselsof the brachial and popliteal size. Whilstin the experimental animal it is technicallyfeasible to join vessels of smaller size thanthe brachial, such procedures are rarelyindicated in clinical practice where pathologicalchanges in the vessel wall makesatisfactory junction of such small vesselsimpossible. Having considered the plumbingtechniques available to the vascular surgeon,let us now turn to a brief discussionon the types of disease with which he becomesinvolved.DISEASE INVOLVING THELOWER LIMBSOne of the common areas to be involvedby vascular disease is the lower limbs andin this area the effects produced by thereduction in blood supply vary with the siteof the obstruction and the rate at which thatobstruction develops. In a vessel affectedby atheroma, the diameter of the vessel progressivelynarrows and this reduces itsability to transmit blood. This is essentiallya gradual process, but, at, any stage duringthe evolution of the atheromatous plaque,the blood flowing within the artery may cloton the surface of the plaque and producea sudden occlusion of the vessel. As theavailability of blood for the tissues suppliedby the diseased artery diminishes the patientmay fmd that, whilst the blood flow is sufficientto meet the demands of the tissue atrest, it is insufficient to supply enough bloodto the active muscles during exercise. Thus,during exercise, metabolites accumulatewithin the active muscle and pain is produced.In the early phases this pain maybe produced only after prolonged activity,but, if the disease progresses, pain occurswith less and less activity until ultimatelythe patient is able to walk no more than afew yards. The muscles are not the onlytissues to feel the effect of this reduction inblood supply; the skin becomes thin, thehairs fall out, the subcutaneous tissueatrophies, and the whole limb becomes cold—this symptom may be a major complainton the part of the patient. Pain mayPAGE TWENTY-SEVEN

itzdevelop at rest in the blood-deprived tissuesand this pain, which is felt mainly at night,interferes with the patient's sleep. A limbin which the blood supply is grossly reducedis unable to withstand trauma or infectionand either of these accidents is liable toresult in the development of an ischaemiculcer, a painful indolent lesion which refusesto heal. As the blood supply to theleg is reduced, tissues may die, followed bythe development of gangrene. Gangrenemay be limited to the extremities of a toeor may involve a major part of the foot orcalf. When this occurs major amputationis inevitable.It is important to appreciate that arterialdisease may involve any of the arteries inthe body, including the very importantvessels supplying the heart, brain and kidney,so the surgeon must make a carefulassessment of the state of these vital systemsbefore embarking on either the investigationor treatment of apparently localised vasculardisease. If the patient is otherwise fit, andif the severity of the disability is such thattreatment is called for, surgery on the arterialtree may be considered. Before anydecision can be made to operate on thearterial tree the surgeon must have an X-raypicture of the diseased vessels. In order toobtain this picture, a radio opaque dye isinjected into the aorta and its progressdown the vessels of the limb is followed byserial X-ray photography. This investigation,which is not without risk to the lifeand limb of the patient, calls for complicatedX-ray apparatus and considerableskill on the part of the radiologist both inobtaining and interpreting the picture.Unfortunately, when these tests havebeen carried out not more than one in fivepatients prove to have lesions suitable forarterial re-construction, the main reasonbeing the diffuse nature of the arterialdisease. The surgeon can only produceworthwhile results if:(1) The block is in a large vessel.(2) The block is localised, and(3) The vessel below the block is in areasonably healthy condition.When these requirements are fulfilledarterial re-construction may result in themost dramatic improvement in the bloodsupply to the ischaemic limb, a leg on thePAGE TWENTY-EIGHTpoint of gangrene may be saved or a mancrippled by pain of intermittent claudicationmay be restored to near normal activity.DISEASE OF THE RENAL ARTERYIt has long been known that interferencewith the blood supply to the kidneys in theexperimental animal may produce hypertensionwith all its attendant ill effects.Recently it has been demonstrated that, inman, atheromatous narrowing of one orboth renal arteries may also be the cause ofsevere hypertension. Recognition of casesin which stenosis of the renal artery is likelyto be the cause of high blood pressure, andthe demonstration of the site of the obstructionand the extent of the damage to thekidney is largely a matter for the physicianand radiologist. In carefully selected cases,however, the arterial surgeon may, by overcomingthe block in the renal artery, returnthe blood pressure of the patient to normal.Recently a young married woman with onechild was found to have a blood pressureof 240/120, as a result of which she hada very limited life expectancy. The severehypertension did not respond to drugs andinvestigation revealed that she had amarked narrowing of the right renal arteryIt seemed that this was an isolated arteriallesion. A teflon by-pass was inserted fromthe lower end of her aorta to the right renalartery beyond the block thus restoring normalblood flow to her kidney and, as aresult of this operation, her blood pressurehas fallen to 120/80 and her medical outlookhas dramatically improved. If a blockis detected on the left renal artery it maybe possible to sacrifice the spleen and sewthe splenic artery into the side of the leftrenal artery beyond the block and therebyrestore to normal the diminished renalarterial blood flow.DISEASE OF THE CAROTIDARTERYA further fascinating development in thisfield concerns the blood flow to the brainand the recognition that in many cases astroke is produced by a narrowing or occlusionof the major vessels outside the skullrather than by multiple changes within thesmaller intra-cranial vessels. This block$PEcutum 1961

may occur anywhere from the origin of thecommon carotid artery to the entrance ofthe internal carotid artery into the carotidcanal and once again the surgeon may beable to unblock or by-pass the occludedsegment with marked improvement in thepatient's cerebral function. Again therecognition and selection of cases suitablefor this vascular plumbing is largely theconcern of the neurologist and radiologistand the vascular surgeon interested in suchproblems must be prepared to co-operatewith experts in a variety of disciplines.INTRA THORACIC VESSELSAmongst the earliest of vessels to receivethe attention of surgeons have been themajor blood vessels within the chest. Occasionallythe ductus arteriosis fails to closeas it should, when respiration is establishedafter birth, allowing blood to leak out ofthe high pressure aortic circulation into thelow pressure pulmonary circulation. Thisleak imposes a considerably increased burdenof work on the heart and patientspossessed of such an abnormality often dieof cardiac failure in early adult life. It wasdemonstrated that ligation of this vesselwould not only close the aorto-pulmonaryshunt, but also would restore the outlookof the patient to normal. Thus ligation ofthe patent ductus arteriosis has become aroutine operation in thoracic surgery.Another lesion which called for the earlyattention of the chest surgeon is coarctationof the aorta. In this condition the aortabecomes markedly narrowed just below theOrigin of the left subclavian artery and theObstruction produces a gross hypertensionin the upper limbs whilst the lower limbsare supplied by a series of dilated collateralvessels. Again the outlook of patients inflictedwith this condition is poor, but theymay be restored to normal health by resect-!nig the narrowed segment of the aorta andJoining the divided ends together.P ERSISTENT PROBLEMSOne of the major problems confrontingthe surgeon who wishes to interfere withthe main blood vessels within the body isthat, in general, the tissues of the body callSPECULUM 1961for continuous supply of blood and thatblood supply must be temporarily suspendedduring operations on the vessels. Insome areas, such as in operations on thelower aorta, the tissues involved will toleratea total, or near total, cessation of thecirculation during the time needed to carryout the operation. In other areas, such asoperations on the patent ductus arteriosis,it is possible to carry out the necessaryprocedures without interrupting the bloodflow through the main arterial channels. Instill other cases, such as operations onaortic coarctation, there has developed acollateral circulation adequate to supplyblood to the tissues of the lower half of thebody during the operative procedure. However,tissues such as the brain, spinal cord,myocardium, and kidneys tolerate totalcessation of their blood flow or indeed anymajor reduction in the rate of flow badly,and when operations are carried out on theaorta or its major branches, which involvereduction in the blood flow to these tissues,special steps must be taken to prevent lethaldamage to these vital organs.In general, two techniques have beenevolved for dealing with this problem. Oneinvolves the controlled cooling of the bodysince it is known that, with a fall of bodytemperature the time during which thetissues will safely tolerate cessation of theirblood flow is considerably increased. Thisadded safety margin may allow the surgeonto carry out the necessary manoeuvres. If,however, a greater time is required it isnecessary to perfuse the involved tissueswith blood suitably oxygenated and pumpedinto their vessels by mechanical means.Techniques such as this involve the use of apump oxygenator and have enabled the surgeonto extend his activities even into theinterior of the chambers of the heart.It would be a mistake to suppose that allof the problems associated with vascularsurgery had been worked out. The techniquesinvolving the use of artificial meansof oxygenating and perfusing the tissueswith blood are complicated and involvecareful team work which required muchpractise in the experimental animal laboratory.Moreover, there is no doubt that themost significant arterial lesion occurring todayis seen in the coronary arteries wherearterial occlusion produces cardiac failurePAGE TWENTY-NINE

or sudden death, and as yet there are noadequate surgical techniques for dealing withthis common lethal disease. The surgeryof the major veins is still in its infancy andwhilst direct suture of vein walls and diversionof venous blood by such procedures asanastomosis between the portal vein andinferior vena cava are well established, nosatisfactory venous substitute has been developed.Moreover, as our knowledge advances inthe field of the interaction of host and graftedtissues, it may become possible to transplantorgans from one individual to another,and here again the techniques and methodsevoked by the vascular surgeon will beneeded. Indeed, in this field the techniquesare far in advance of the theoretical backgroundknowledge since the transfer of theheart from one animal to another has beenfrequently carried out in the laboratory. Inman, organ transplant has only been possiblebetween identical twins, as in the caseof one of a pair has had severe renal damagehis partner has successfully donated akidney to restore renal function in thediseased twin.11_03LEUKOPLASTAdhesive PlastersMedicated Plastersand SoapsCrepe and GauzeBandagesIDEAL FOR ALLMEDICALUSERocke, Tompsitt & Co. Ltd.292-298 Flinders Street,li.s.6MELBOURNEPAGE THIRTYSPECULUM 1961

SOME MODERN BIOLOGICAL METHODSDr. S. RoseThe analysis of biological activityrequiresthe study of biological organization.Organization implies some sort of relationbetween the components making up a complexentity. Ideally one should be able todescribe every relationship which existsbetween any one component and all otherswhich make up the complex whole. Thevery nature of biological organizationforces us to use a more practical and simplifiedapproach. Thus we study the immediateand direct relationship between simplecomponents as they exist to form smallcomplex units, and in the next step we studythe relationship between complex units etcetera. This stratifies biological methodsinto various levels of experimentation. Alevel of experimentation may be defined bythe organizational complexity and numberof units which are involved in the study. Inthese terms an in vitro system which onlyinvolves a purified enzyme, inhibitors, activators,substrates, et cetera, is at a lowerlevel of experimentation than a study of therelationship between organs and tissues ofthe body. Lower levels of experimentationare generally able to examine only simplephenomena. They do so with great precisionbut often the data does not help tounderstand how the cell functions. Higherlevels of experimentation allow one to studya phenomena as it occurs in the wholeorganism, but the very complexity of thesystem reduces the precision of the data andthe certainty with which one can interpretthe results. Stratification of biologicalmethods has caused a stratification of biologicalinvestigators and an increasing gulfdivides those who study the animal and itsorgans as a functional entity and those whore attempting to investigate the basic unitsr° 111 which organs and animals are made.This paper will describe especially thosetechniques which have been designed asSP ECULUM 1961intermediate experimental levels betweenestablished techniques or which have combinedtogether a number of experimentallevels so that the advantages of higher andlower experimental levels may be utilised.Intracellular OrganizationCells are not simply bags of enzymes andchemicals mixed in a homogeneous mediumfreely in solution and subject to classicalkinetics. Rather they are a complex heterogeneous system made up of subcellularparticles with a special architecturalarrangement. The past fifteen years haveseen tremendous advances in studying intracellularorganization which has shed lighton to such questions as (1) why are intracellularstructural units necessary at all,and (2) what effect does structure have onbiochemical conditions and reactions in thecell. Certain consistent generalities can beobserved, as a result of new data on intracellularstructures. Thus structure seemsto be involved in these situations where thecell requires protection from disruptingagents which the cell must nonethelessinclude as part of its overall organization.Enzymes, which if allowed loose in the cellwould cause autolysis, can be included inthis category. Structure also seems necessaryin the general situation where synthesisrequiring sequental steps and an orderedsupply of energy is necessary.In order to understand the role of intracellularorganization one must have cleardata of the biochemical and structuralanatomy of the cellular organization. Techniquesto obtain this data have variouslimitations and possible artifacts.Disruption of cells or homogenization,particularly in aqueous media like sucrose,might yield misleading particles. After allPAGE THIRTY-ONE

one should keep in mind that intracellularinjections of aqueous solutions are toxic,and during microsurgical transfer of nucleifrom one cell to another care must be takento avoid the nucleus, coming into contactwith the aqueous medium, otherwise it willnot survive. These procedures are verymuch more gentle than gross disruption ofthe entire cell in an aqueous medium.Surely under these experimental conditionsthe possibility exists that a chemical mayleave a particle and be found in the solublecell sap. Equally, it is possible that achemical leaves one particulate componentand becomes attached to another. Despitethese obvious pitfalls a vast amount of biochemistryis devoted to the study of subcellularparticles obtained by homogenizationand centrifugation.Organs or tissues from a multicellularorganism are not made up of identical cells.Consequently homogenizing an organ meansthat you will be examining the subcellularcomponents of a heterogeneous group ofcells. This process, called somewhat facetiously"Hamburger Biochemistry", imposesanother severe limitation on the methods ofstudying subcellular organization.Other methods of studying subcellularparticles may also be criticised. The electronmicroscope has become a powerful toolin biology but our dependance on osmiumfixation with the possibility of artifactscreates some doubt that too much meaningcan yet be attached to detailed appearanceand precise measurements of membranes inelectron micrographs. Perhaps one of themost important contributions of the electronmicroscope to biochemistry was the demonstrationthat mitochondria of the cell survivehomogenization and centrifugationextremely well, and further, one can detectif the mitochondrial prepartion is contaminatedby microsome fragments such asribonucleoprotein granules or endoplasmicreticulum.One of the most direct approaches to invivo biochemical events within subcellularparticulates is that of radioautography. Theresolution of this method has increased considerablyby the use of radiohydrogen(tritium) as a label because most of the betaparticles emitted by tritium are stopped bythe first micron of a photographic emulsionand therefore the grains produced are veryPAGE THIRTY-TWOclose to the object being exposed. Otherimprovements have come through advancesin biochemistry which allow the selection ofprecursors which label a limited number ofcomponents of a cell and which allow fordifferential enzymatic and non enzymaticextraction of specific components of thetissue.One of the most successful applicationsof radioautography has been the use oftritiated thymidine as a specific precursorof DNA. The resolution is sufficientlyaccurate to show labelled and unlabelledsegments of single chromosomes. Withthis technique evidence has been obtainedfor a duplex type of template for DNAsynthesis. Cells or tissues are incubated inthe presence of tritiated thymidine for acertain period and then the tritiated thymidineis removed. All the chromosomes ofa cell appear labelled at the first divisionfollowing removal of the labelled precursor.However, these chromosomes reveal theirhybrid nature with regard to labelled andunlabelled DNA, for when they duplicateonce more in a medium free of labelledprecursor, each regularly produces onelabelled and one unlabelled daughterchromosome. A radioautographic confirmationof Mendel's Theory!The site of synthesis of RNA and itsmovement in the cell has been studied by anumber of techniques. I want to brieflydescribe one particular set of studies becauseit combines radioautography andmicrosurgery. Acanthamoeba were cut witha microneedle controlled by a micromanipulator.Following the cutting procedure thenucleated and non-nucleated portions wereseparated and incubated with labelled RNAprecursors. Only the nucleated portionswere able to synthesise RNA. Moreover, ifa RNA labelled nucleus is transferred bymicrosurgey to an unlabelled anucleateamoeba the label is transfered across thenuclear membrane to the cytoplasm. Theseresults support the notion that RNA is thecarrier of genetic information from thenucleus to the cytoplasm.I now wish to discuss a particular methodof investigating intracellular organizationbecause it demonstrates the value of anintermediate level of experimentation and acombination of techniques. In an earliersection I discussed the almost routine use ofSPECULUM 1961

homogenization and centrifugation to obtainand study the biochemical properties ofvarious intracellular organelles. Despite allprecautions any such methods are extremelybrutal and one must doubt the identity andproperties of the particles so obtained inrelation to how they may exist in theirnatural state.In order to overcome these difficultiesand limitations techniques have been developedwhereby cells are centrifuged, theirintracellular organelles and components arestratified and can be studied by histochemicalmethods. The fungal hypa offerparticular advantages for the study ofcentrifuged cells. (a) Hyphae are 200micron long tubular cells enclosed in aresistant wall so that they can serve asultramicrocentrifuge tubes. The cell diameteris about 10 microns and thus stratificationin a long thin tube can be studied.(b) The main weakness of most cytochemicalreactions lies in their uncertain resolution.However, since hyphae can be consideredlong, thin ultra centrifuge tubes,separation of the intracellular componentsovercomes the difficulty of cytochemicalresolution. (c) The main advantage ofusing centrifuged cells in a study of cellularstructure lies in the fact that they remainalive and therefore artifacts due to grinding,absorption of chemicals on to a componentor loss of a chemical from a component,does not occur. In summary, one is centrifugingintracellular organelles in an intracellularmillieu and with a force that doesnot destroy cell function even though ittemporarily and radically stratifies intracellularorganelles.This paper will not analyse completelythe results obtained with centrifuged cellsbut will simply describe two main differencesobtained with this technique as comparedto the more regular method ofhomogenization and centrifugation. Inhomogenised preparations RNA (soluble)and B galactosidase is found in the supernatant.In the centrifuged hyphae RNA isfound in the nucleus, the microsomes andtraces in the mitochondria, but none isfound in the supernatant. Similarly, incentrifuged hyphae B galactosidase is foundbound to mitochondria and not in thesupernatant. These examples show thatbiochemists should not assume with toomuch assurance that their isolated intra-SP ECULUM 1961cellular organelles are exactly the same asfound in the living cell. These examplesalso demonstrate the value of a combinationof techniques and an intermediate levelof experimentation namely in vivo centrifugation.Before I leave the exciting area of intracellularorganization I would like to mentionsome of the micro-surgical and micromanipulativemethods which can be used astools in this field. With microsurgery onecan remove the nucleus of a cell, one canreplace a nucleus in an anucleate cell andone can inject various portions of cytoplasmfrom one cell to another. The Cartesiandiver technique can measure the oxygenconsumption of single cells. A torsion balancehas been devised which has a reproducibilityof 0.01 of a microgram. Usinginterference microscopy the protein contentof a single cell can be determined, and byX-ray absorption the density of cellular andsubcellular particles can be measured. Aningenious adaptation of chromatography hasbeen described which permits determinationof the total quantity of RNA from a singlecell. This RNA can be hydrolysed and thenucleotite anaylsis of the RNA of a singlecell can be obtained by chromatography ona copper silk fibre. This method is onemillion times more sensitive than conventionalmethods. The above is by no meansa complete list of all the microsurgical,micromanipulative and microanalyticalmethods which are available.The question naturally arises as to whysuch sensitive methods are required. Afterall, we are often able to collect largesamples of biological material. The answerlies in the heterogenicity of biologicalmaterials. The inside of a cell is not homogeneousand a tissue is not composed of ahomogeneous collection of cells. In orderto study one portion of a cell, or in order tostudy one cell, micromethods must be used.If we make estimations of the whole mass,we are making estimations of mixed populationsof biological particles and averagingout the result.Interorgan RelationsThe functional activity of many biologicalsystems is regulated by more than onemechanism. Some of these mechanisms arein the form of servo controlled systems andPAGE THIRTY-THREE

others are specifically designed to alter theactivity level of the system. Each mechanismis composed of a number of sequentialsteps involving different anatomical andfunctional units. These mechanisms areinter-related either at the final active tissuecell or at one of the intermediate steps ofthe several mechanisms.The analysis of such controlled systemsinvolves an anatomical and physiologicalmapping of the several steps of each mechanismand the inter-relationship betweenthem. Such studies are a pre-requisite tothe more detailed investigations of each stepin terms of biochemical mechanisms.The main difficulty in the design andinterpretation of such experiments is determiningthe primary site of action ofadministered compounds. This difficultyhas been overcome when the compound actsquickly and when operation, anaesthesiaand exposure of the area do not interferewith the experiment. Thus acetylcholinehas been shown to be involved in the transmissionof impulses at the neuro-muscularjunction.But let us suppose that acetylcholine wasPAGE THIRTY-FOURFigure I.acting on one particular tissue to effect aor duration. The usual methods are nolonger applicable. If the acetylcholine isgiven intravenously it will not reach thebiological phenomena of slow developmenttarget site in sufficient concentration to beeffective. If it is given intra-arterially as asingle injection the (slow developing) biologicalresponse will not occur. These difficultieshave been overcome by the use of acontinuous injector which can be buriedsubcutaneously or attached to the animal.The injector can deliver drugs continuouslyand constantly for many weeks to anunanaesthetised unrestrained animal. Moreover,the drug is delivered directly to thesite of interest by a fine polythene tube (50-200 microm diameter) which is buried inthe animal. There are many obviousadvantages of this technique. Thus (a) forcompounds whose activity is quickly destroyedin vivo local infusion allows aphysiological or pharmacological level to beachieved at the site of interest. (b) Thelocal dose of drug is so arranged as to producea significant concentration at that sitewithout an effective systemic concentrationbeing reached. The local effects obtainedmay then be considered to be a direct effecton that tissue rather than a sequel to achange elsewhere in the animal. (c) Thechemical structure of the drug at the extracellularfluid level of that tissue is knownmore precisely. (d) Many biological phenomenaof slow development may bestudied—thus the technique can be used tostudy the effect of prolonged alteredchemical environment on the secretoryfunction, metabolic activity, morphogenesisand growth of a variety of tissues. (e) Continuousadministration approaches moreclosely to normal physiological conditionswhen dealing with replacement type studies.To gain the above advantages workershave resorted to in vitro tissue culture techniques.This present approach has beenenvisaged as a bridge in the gap betweenin vitro tissue culture and whole animalstudies so that certain disadvantages of bothlevels of experimentation can be avoided ifnecessary.A brief description of the technicalaspects may be of interest. The motivepower for the injector is the osmotic pressuredeveloped by a saturated solution ofSPECULUM 1961

congo-red. The injector has three compartments.A water compartment is separatedfrom the congo-red compartment by a cellophanemembrane. Water moving into thecongo-red compartment by osmosis compressesa third compartment which ejectsthe drug out of a coil reservoir. The drugis then delivered to any organ by a finepolythene tube. The entire arrangement isshown in Fig. 1, the osmotic injector is suspendedby a thread, the drug reservoir coilcan be seen, and the tube entering the ratthrough the tail is shown protected by glass.The rat is not stressed or restrained in anyway. The sign "Danger" on the rat containeris a warning because in this particularinstance a radioactive compound wasbeing administered.These are the methods being used by present-dayphysiologlists and biochemists inthe investigation of intercellular metabolism.I have tried to show that while in thepast the macro methods have held sway it isnow realised that micro methods must bedevised. However, it is just as importantnow as before to recognize the limitationsof any one technique and to use many toeventually reach the truth.INTER-DENSMEDICATED GUM MASSAGERSIn the drive against dental decay, thetrend all over the world is towardsinterdental massageINTER-DENS* Stimulate keratinization.* Assist the growth of epithelium after gingivectomy.* Help in the prevention and treatment ofpyorrhoea* Harden the gums, prevent decay, and promotethe complete health of the mouth.RECOMMENDEDBY LEADINGDENTISTSEVERYWHERESold byall ChemistsJ. L. BROWN & CO.,123 William Street, Melbourne 62 3027SP ECULUM 1961COLLINS STREET STORYThey told me I would never reach the topThey assured me I was bound to be a flopMy father said that gynae was obscenityAnd couldn't I go up and read at Trinitya year's divinity.To his dismay I simply answered Ha Ha HaAs a result of which I practise Ha Ha Ha0 my virility and their fragilityCan cause my clientele to utter screamsI'm blood and thunderful and simply wonderfulAt applying all the contraceptive creams.It's sheer agility and their fertilityThat's got me up to this position nowIt was a hard ascent up to this firmamentBut I'm a really famous obstetrician now.My rivals said my treatment make them illThat my sex appeal was absolutely nilThey said I'd never have sufficient learning,To enable me to battle off the yearning andbe discerning.But now I'm well accepted all through CollinsStreetBecause I've got a name for being discreet.So every Premiere you're sure to find methereDiscreetly advertising who I amI'm on the fashion page, my clothes areall the rageWas there ever such a handsome lookingman? •I've tied off hoards and hoards of umbilicalcordsAnd, oh hard it is with wear and tearBut it's the price you pay, when you cansurely sayThat it's worth a hundred guineas to bethere.So now I only pick the ones whose cureis quickAnd must be rather slick, to miss the reallysickSo that I still may be the same old millionaire.Medical Medleys, 1960.* *Dr. McK.: "Suck sister!" (No response)."Suck! sister!" (still no response). "Sister!Would you please use the suction apparatus!"Sister: "Oh, sorry, sir. I thought youwere swearing."PAGE THIRTY-FIVE

ff. . . powerover themotionof theheart . . . PP— William WitheringIn 1785 William Withering wrote down many still-validprinciples in the use of the Digitalis plant. He used itprimarily for relieving dropsy, though he recognised that"It has a power over the motion of the heart to a degreeyet unobserved in any other medicine .. ."Precise, balanced digitalisation is ensured when Tanoxin'is written on all prescriptions for Digoxin, the glycosidediscovered in The Wellcome Research Laboratories in 1930and recognised today as the one of choice in cardiac therapy.To guarantee that patients receive the product on which allmedical experience has been based,always writeILANOXIN'on all Pharmaceutical Benefit prescriptions..1! BURROUGHS WELLCOME & CO. (AUSTRALIA) LTD., SYDNEY, N.S.W.PAGE THIRTY-SIXSPECULUM 1961

DESIGN, DUST and DISEASEWilfrid BrookDuring their study of Physiology,students become familiar by means of theirpractical work with some of the principlesand problems of experimental design underlaboratory conditions, where the aim is frequentlyto control as many variables aspossible, in order to "isolate" the factorunder study. However, the lessons learntin the laboratory may not apply in an experimentwhich, of necessity, must becarried out in a less manageable environment.The purpose of this paper is to illustratesome of the problems arising in aninvestigation of this type. The study to bedescribed was designed to investigate theeffect of a short exposure to wheat dust onthe ventilatory capacity of a group of menexposed to high concentrations in thecourse of their work. No previous studyof this question has been reported.THE SITUATIONThe subjects were waterside workersloading wheat into a 10,000 ton cargo boatbound for Spain. The loading' procedureis as follows: After fumigation in the silosor rail trucks, the wheat is conveyed to theship by means of an overhead conveyor beltand then through a pipe to a trimmingmachine which ejects the wheat into thehold at considerable force in a stream about15 inches in diameter at the point of exit.The direction of the stream is controlledelectrically, the men working in the holddoing this being called "buttonmen". Theprocess produces large quantities of dust inthe confined space of the hold, so that visibilitymay be reduced to a few feet. Thepurpose of the trimming machines is todirect the stream of wheat so that the shipremains on even keel, but trimming is onlyrequired at certain critical phases of loading.However, even during the loading of"free" wheat moderate quantities of dust areproduced; some collects on the deck while,SPECULUM 1961on a still day, a light cloud of dust collectsabove the ship.The dust, much of which is produced byattrition as tons of wheat enter the ship perhour, consists of portions of husk and otherparts of the grain, mould spores, pollengrains and other foreign material. It alsocontains small amounts of free silica in theform of opal which is deposited as such inparts of the wheat plant. Some interestattaches to possible pathogenicity of these"phytoliths" in the lungs.The investigation stemmed from the observationthat some men developed marked"asthma" on exposure to the dust, while alarger number complained of some difficultyin breathing and/or of cough and sputumpersisting for 12 to 48 hours after exposure.In fact, about 15 per cent. of the work forceavailable in the port were exempt fromassignment to wheat ships.THE PROBLEMSAs it is not practical to study the wholepopulation during exposure to wheat dust,a random selection of subjects is necessaryto ensure that the results are applicable tothe group as a whole. Obviously, if themen undPr observation had been especiallypicked for the job because they were notaffected by dust, then the results would notindicate the reaction of the general workingpopulation. This is a common problem inoccupational studies.In addition, the studies of the men mustbe integrated with normal working routine,because of economic reasons, the experimentmust cause minimum interference withthe loading of the wheat.Furthermore, other variables apart fromwheat dust may influence the individual'sresponse to exposure. These include thesubject's past and present health, particu-PAGE THIRTY-SEVEN

larly as regards chest disease and his smokinghabits. In addition, exercise associatedwith the performance of the job may ofitself influence ventilatory capacity, usuallyproducing an increase. Finally, there maybe a non-specific effect of any dust, notnecessarily wheat, on ventilatory capacity;it is common experience that any dust is atleast uncomfortable if present in largeamounts.EXPERIMENTAL DESIGN(a) Population Studies.The experiment was conducted duringthe weekend of February 3rd to 5th onwaterside workers selected in the course ofthe normal rostering system. This ensuredrandom selection of the available personnel,but these are already selected in that thosemost severely affected by dust are (presumably)among those members of the workforce specifically exempted from work ondusty cargoes. Hence the first problem,that of random selection, has not been overcome.However, these exempt personnelare available for study separately, a situa-Next time you strike that WEIGHTCONTROL problem remember that"BIO-MEAL"is a safe, drug free, vitamin-dietary FOOD"BIO-MEAL"may be prescribed withconfidence for patients with heart trouble,blood pressure, ulcers, etc., with no illeffects.tion which does not obtain in many dustyoccupations, in which affected workers usuallyleave the industry altogether. The men,both buttonmen and deckhands who did notwork in the holds, were investigated duringthe routine of a normal day's loading.Normally the buttonmen wear a supplied airmask looking rather like a spaceman'shelmet, but for the purpose of the investigationthese masks were not worn for the firstspell below, thus deliberately exaggeratingthe working conditions of the men. If indicated,a further trial could be done undernormal working condtions to determine theeffectiveness of the masks.(b) Histories.Clinical histories were taken from themen studied, using a questionaire based onone designed by the Medical ResearchCouncil (United Kingdom) for studyingepidemiological aspects of chronic bronchitis.These gave information not only onsymptoms of exposure to wheat and otherdusts, but also on personal history (past andpresent) of symptoms with respect to smoking,bronchitis, asthma or allergic manifestations,and on the family history as regardschest disease. All these are possible factorsin determining an individual's response toexposure to the dust, and any analysis ofthe results must take these into consideration.(c) Tests used.Spirometry: The spirometer consists of alight metal bell inverted over water andconnected to a pen writing on a drum revolvingat a known speed. The subject isasked to take the deepest possible breathand exhale it into a flexible rubber tubeleading to the bell. As the exhaled airmoves the bell upwards the pen descendsand thus records a spirogram (Figure 1).'BIO-MEAL' (Registeredstood the test of years.Victoria No. 7940) has011KIllutYFECTF10 ■ 1441.■ttivirluirecv►OOFFIOO OFraw.. IFI1F144T14NSAFE! EFFECTIVE! INEXPENSIVE!Details and pamphlets from:Bio-Chemic Laboratories,Box 4116, G.P.O., Melbourne, or1 Carson Place, off 256 Collins St.[1r440110•41rt. forc•ct...km._ of one secondVE NT I L ATOArt CRP/KITEM PIN ATORLY SPIRCIGIMM5.F CI 4re.. I.PAGE THIRTY-EIGHTSPECULUM 1961

This type of instrument is used in third yearPhysiology experiments on respiration.From the shape of the spirogram, andthe forced expiratory volume at one second(that is, the volume of gas expired in thefirst second of the forced expiration), subjectsmay be classified into four groups:(i) Normal.(ii) Obstructive type of ventilatory defect,for example asthma.(iii) Restrictive type of ventilatory defect,for example, loss of lung or chestdistensibility as in diffuse pulmonaryfibrosis or ankylosing spondylitis.(iv)Mixed obstructive and restrictive ventilatorydefect.Thus the spirometer not only enables aquantitative measurement of ventilatorycapacity to be made, but also enables oneto make a classification of defects. Forpresent purposes the forced expiratoryvolume at one second was the index ofventilatory capacity chiefly studied. Becauseof its bulk, the spirometer could notbe taken into the hold to carry outmeasurements on the men while they wereworking.Peak flow meter: The peak flow meter isa portable instrument with a dial graduatedin litres per minute. It is used in the samemanner as the spirometer, and it measuresthe forced expiratory volume over a fewmilliseconds. The reading approximates tothe "peak" of expiratory flow, and is takendirectly from the dial. The advantage ofthis instrument was that it could be takeninto the holds, thus enabling measurementsto be taken while the buttonmen were trimming.The disadvantage of the peak flowmeter was its variability from instrument toinstrument (four meters were used in the experiment),but this was overcome by usingthe same instrument on the same men andby appropriate calibration. However, errorwas introduced when the performance of themeters themselves was found to deteriorateon repeated heavy exposure to dust! Apossible source of error in both the spirometricand peak flow measurements is thedegree of co-operation on the subject's part.Poor co-operation is often easily detectedfrom inequalities of the spirographic curve,which is normally smooth, but it is lessreadily observed in using the peak flowSP ECULUM 1961meter. Some improvement may occur withpractice but this "learning effect" was minimisedby preliminary measurements on aday preceding the study, when this waspossible.(d) Performance of tests.Spirometry and peak flow meter testswere carried out in a cabin on the buttonmenbefore they commenced their shifts inthe holds, half an hour later, at the end ofthe shift, and at the end of the day. Inaddition, three estimations of peak flowwere made in the hold during each shift.The same tests were also carried out on thefive medical students who assisted with theexperiment, and who made the observationsin the holds, thus giving a greater numberof results for statistical analysis. Also, themedical students acted as controls in thatthe results of subjects not previously exposedto wheat dust could be comparedwith the waterside workers who had previouslybeen exposed. They also formed acontrol group in that they could perhapsview the study more objectively.RESULTSThere was a statistically significant fall inventilatory capacity, as judged by eitherindex, in the first half hour of exposure, andthis was greater by the end of the day. Thefall, however, was small and, on the average,was insufficient to be evident to theindividual as respiratory embarrassment.Analysis of the results in terms of theclinical histories is proceeding.CRITICISM OF RESULTSComparison of the experimental designwith the problems encountered shows thatthere are still certain problems which werenot overcome. The problem of randomselection cannot entirely be overcome, andthus we must regard the results as appropriateonly to these men who are preparedto do this work. However, the other unsolvedproblems can be solved by futureexperiments. Thus the same type of experimentwill be carried out, with the samemen if possible, loading a general nondustycargo (to see if ventilatory capacitychange is related to exercise or time ofPAGE THIRTY-NINE

day), and also loading (a) rock phosphate*and (b) sulphur cargoes (to see if ventilatorycapacity change is due specifically towheat or is merely a non-specific effect ofany dust).EXPERIMENTAL CONCLUSIONThe ventilatory capacity of a group ofmen exposed to high concentrations ofwheat dust in the course of their workslightly decreases on exposure, but it hasnot been proved if this decrease is due tothe wheat dust or some other factor.POSSIBLE MECHANISM OF ACTIONAssuming that the reduced ventilatorycapacity is due to wheat dust, then what isthe mechanism?Investigation of the composition of thedust may be carried out by microscopic examinationof the dust, chemical analysis,*Footnote.—Since this was written this investigationhas been done and no fall inventilatory capacity (on the average) wasfound.culture for moulds and the preparation ofextracts likely to contain any allergens.During the investigation quantitative evaluationof the dust, by means of dust counts,was made and particle size estimated.Moulds have been grown from samples ofthe dust.(a) Moulds.Some fungi may "infect" the bronchialtree. This may be investigated by means ofsputum cultures taken at the time of theexperiment and repeated after a period awayfrom the dust, and also by detection of antibodiesand changes of antibody level afterexposure. Limited studies along these linesare being carried out.(b) Allergic reaction.This may be investigated by the inhalationof extracts from the wheat dust withassessment of ventilatory capacity beforeand after.* If positive results are obtained,then the extracts must be analysed to find*This has also been studied since this paperwas written. Dramatic falls in ventilatorycapacity occurred in several cases.JOUBERT & JOUBERT PTY. LTD.575-9 Bourke Street, MELBOURNE 62 7277 (3 Lines)LACTOBYL TAXOLROCARURALYSOLSTANNOXYL(Tablets and Ointment)ENTROSALYL(In Standard or Vitaminised Forms)NEUTRAPHYLLINE(Ampoules, Tablets with Phenobarbital,Tablets Plain)COLCHIPIRINEGENOSCOPOLAMINE(Amps., Solution and Pills)PANBILINE PILLSPANBILINE - METHIONINEPILLSURODONAL VI-GLOBEOLLYXANTHINEFLUSCORBINSSPAGE FORTYSPECULUM 1961

the active constituents, for example, byusing extracts prepared from individualmoulds cultured from the dust, or by usingknown pollen constituents. The simplescreening method which was adopted duringthe experiment was to look foreosinophils in nasal swabs and sputumtaken before and after exposure. These aretwo of the more obvious mechanisms.PRACTICAL APPLICATIONSOne partial solution to the problem ofdust is to use respirators with an externalsupply of air. These are worn only by thebuttonmen working below deck, but thoseabove deck suffer some exposure, and thismay be repeated over many years. Ingeneral, dust should be prevented in industrialprocesses, or it should be controlledor removed at its source these measures arenot feasible in the present situation, andone must fall back on personal protectivemeasures.In the evaluation of possible long-termeffects of repeated exposure to wheat dust(the ultimate objective of the project), aknowledge of the effects of acute exposureand, if possible, of the mechanism of anysuch effects, is obviously helpful. Furthermore,a correlation of the clinical history,particularly of asthma, allergy and bronchitis,with the observed changes of ventilatorycapacity may indicate those most likelyto be affected by dust, and might conceivablyindicate a group who should notundertake this work. Alternatively, as thesesimple tests of ventilatory capacity provideevidence of ventilatory difficulty on exposure,they afford objective support forany claim for exemption from this work.SUMMARYThis outline of the experimental designfor the study of the effect of an environmentalfactor on an industrial populationgives some idea of the practical difficultiesin the investigation of problems of this typeand in the evaluation of the results. Italso indicates—and only part of the storyhas been told here—how a relatively simpleobservation and a relatively practical problemmay open up wide fields of study, andwith implications of wider significance thanthe particular problem at first suggests.No matter what branch of medicine weultimately practise, there will be opportunitiesfor critical observation and research.We have no formal training in the medicalcourse on how to carry out a clinical experimentoutside a laboratory, and so it hasbeen valuable to gain some experience inthis field by assisting in the investigationdescribed.Acknowledgements:I would like to thank Dr. BryanGandevia for supplying data so that thisreport could be written. The other membersof the team were Dr. Blair Ritchie,Miss Nancy Rogers, Tim Mathew, JohnFrayne, Brian Cutter and Jim Long.The work is supported by a grant fromthe Chamber of Manufacturers' InsuranceCo., and has the full co-operation of employerand employee organisations in theindustry.Reference:Gandevia, B. (1960), "Tests of VentilatoryFunction." Royal Melbourne HospitalClinical Reports. 27 : 21.0*:":•00404,4*:.:«1«roi:40.00 ■04•44+:.)::;4+2,00:X.4.).:.:;44:4:;44:444,44:«X44:«:44•0■4:404.:KKK.:404:44.0.:K.0.14C.04:44.K.C.X.A JEYES' PRODUCTCYLLIN1)High Rideal Walker Co-Efficient.G E R M I C I D E2) Perfectly Compatible with Soap.3) Stable in the presence of organic matter.4) A variant, "WHITE CYLLIN," is miscible with seawater and hard water.5) Invaluable as hospital disinfectants.Manufactured by FEDERAL CHEMICALS PTY. LTD., ABBOTSFORD, VIC.:":'•:•***oc.*tx•oo:•:«c«:•x•o•xa:««:oo:«*t:tx«:«•tx«: ,4:•t)i)tw.«::«:«x«x.K..•...)oc«:«:.. 4x•oc..x.:«:«::.:«:S PECULUM 1961PAGE FORTY-ONE

wo more Gypsoaa b ndagesandthatFast setting Gypsona means economy in time for thesurgeon. Gypsona bandages have maximum plastercontent and casts are hard-wearing with a porcelain-likefinish. No wonder Gypsona P.o.P. bandages are standardequipment in plaster rooms and theatres all over the world.For those who prefer Gypsona with low-plaster-lossproperties, L.P.L. Gypsona is available.C295APAGE FORTY-TWOGyipcoirta.TRADE EARKPLASTER OF PARIS BANDAGES B.P.C.SMITH & NEPHEW (Aust.) Pty. Ltd., P.O. Box 342, Broadway, Sydney, N.S.W. _1. SEMSPECULUM 19 61

PULSE RATE IN ATHLETICSBrian ConnorWhat Makes a Champion Athlete?Fifty years ago the athlete did a minimalamount of training to avoid going stale andspent his time concentrating on style. Nowour ideas are completely reversed. Anathlete is regarded as a complex highly developedphysiological machine. There isdaily strenuous training, diet planned forevery meal, regular pulse checks and evenhaemoglobin estimations to assess whetheror not an athlete is training too hard. Itis recognised that many factors contributetowards making a champion. Not only coordination,reflexes and style, but heart size,pulse rate, respiratory capacity, and temperamentare also important. Some ofthese factors, naturally, are relatively moreimportant for certain events, and it is inlong distance running and race walkingespecially that the physiology of the cardiorespiratorysystem is vital in maintainingoxygen supply and keeping the humanmachine functioning under maximum conditionsof stress. In long distance events,e.g.-. three miles, less than a quarter of theenergy supplied is by anaerobic mechanismsand thus the body relies heavily on anadequate supply of oxygen to maintain theaerobic pathways and thus give first-gradeperformance.It was with these ideas in mind that Idecided to study the easiest physiologicalmeasurement in the human body—thePulse rate, its variations in athletics andeffect on performance.SP ECULUM 1961Do all good long distance athletes havelow resting pulse rates?AthleteH. ElliottM. LincolnG. WattN. FreemanD. KeaneA. HancockJ. BurkeJ. HaskerN. RegosC. RidgwayR. FilshieP. StrangeEventWorld record holder,1 mile and 1500m.One Mile RunnerMarathon Runner20 Km. WalkAustralian WalkRecordAustralian JuniorWalk ChampionVictorian JuniorSprint ChampionVictorian HurdlesChampionDiscusOlympic High JumpAustralian Pole VaultRecordDiscusTable No. 1Pulse464534505248656567657572From Table No. 1 it is seen that manylong distance athletes do have low restingpulse rates, but this factor does not seem tobe so important in other events, e.g., sprint,hurdles, discus and high jump.To investigate this idea further, the restingpulse rates of 12 competitors were takenbefore a Victorian 3 mile walk championship.The time the athlete took to walkthe distance was graphed against the restingpulse.PAGE FORTY-THREE

;VI30192827262423TIME IN MINS.Fort 3 MILE RAGE55 60 65 70 75 80Put-SE BEFORE RACEseats/m«.Although a rigid correlation could not beseen, there was a definite tendency for thoseathletes with lower resting pulse rates tohave faster times.What happens to the pulse rate during arace?The experiment mentioned in the precedingparagraph also included the taking ofevery athlete's pulse as he finished the raceand with two exceptions (one competitorwas walking below top speed) they were all180. Pulse rates after sprint and middledistance running events similarly rise to 180but after the field games the rise is onlyabout 120-130.These findings are consistent with the factthat the normal heart must have a maximumpulse rate which cannot be exceededso that time is allowed for diastolic fillingwith each beat. (Respiratory rate seems tohave an upper limit of about 60 after longdistance events.) The advantages of a lowresting pulse rate now become obvious.The stroke volume increases with exercisebut if, for the sake of argument, we assumethat it is constant, the resting pulse of 45can incre' ,1se to 180 with a subsequent fourfoldincrease in cardiac output whereas theresting pulse of 60 can only increase threetimes.PAGE FORTY-FOURHow soon does the pulse rate reach itsmaximum?To study this, I race-walked over increasingdistances at top speed and had mypulse taken at the start of each trial and atthe end. Recovery pulse rates were alsotaken until they returned to resting baselevel.Distance100 metres210 metres310 metres415 metresTimeRecovery — Minutes1 1 2 1 3 1 4 1 5 6 712012613815010612012322.2 sec.50.2 seclm. 13.6sec.lm. 39.0sec.108114PulseBefore1089610290102— 114 108 96PulseAfter150168174180It appears that pulse rate in a maximumeffort race rises to about 180 early in therace and that differences between distancescovered are reflected in the time taken forthe pulse rate to return to normal. Afterlonger distances the pulse rate takes longerto recover, as the body reserves are moredepleted and it takes longer for the "oxygendebt' to be repaid. The time for recoveryof pulse rate has been found to be importantin tests done in Adelaide, in relation totraining. The pulse should return to aplateau recovery of 120 within two minutesof each training run. If it doesn't theathlete is advised to discontinue that trainingsession.What changes occur as the pulse rate increases?Major biochemical changes occur withrise in level of blood lactate from 10-20mg.per cent. to 100-200 mg. per cent. Mixedvenous blood oxygen is reduced from 14 ccper cent. to 3 cc per cent. and the oxygenconsumption of muscles increased thirtyfold.The pulse rate increase is due to inhibitionof vagal tone, impulses from highercentres, adrenaline secretion; excess CO2,deficiency in 0 2, and raised hydrogenionconcentration in blood, and higher bodytemperature. The last four factors helpSPECULUM 1961

maintain the raised pulse rate during recoverystage.How does an athlete develop a slow pulserate?Some athletes seem to have a naturallyslow pulse rate but others can reduce it bytraining. The circulation, particularly thatof the muscles, becomes more efficient.There may be increased vagal tone and partialheart block. The creatine and glucosereserve stores in the muscles increase andthe body becomes more accustomed toworking under strain.However, many well-trained athletescannot get their pulse rate below 50. Doesthis mean that they must train even harderor that it is impossible, for example, becauseof some genetic factor, to reduce theirpulse rates any further and that this factcould stop them from becoming worldrecord breakers?ConclusionWe know that many top sportsmen havevery low pulse rates and yet are not championrunners, but it seems that to be along-distance champion a low resting pulserate is needed. This, however, is only oneof many other attributes including the rightpsychological make-up which helps to breakworld records.Here we see a very superficial aspect ofmedical research in sport. This is a comparativelynew field but a very importantone if we are to continue breaking records.The Russians are leading the field at themoment with research, nation-wide surveysfor likely future champions, and organizedmedical examination and laboratory testingof many top sportsmen."Sport tests the functional reserves of thebody in much the same way as disease. Themain difference is that the stress of sport isIntermittent and voluntary." (R. G.Bannister.)Hear about the woman who named herchildren Innocence, Accidence and Negligence.SP ECULUM 1961The portly god strides in, the flock is silent,Collapse of sound and laughter warm andyoung;The frowning glance, the snap of note-bookopen,With pallid silence now the air is hung.The heavy air stirs restlessly in wait,Once more the glance 'neath temple coldand round,The hem of cough, the indrawn breath ofself;Then mouths the oracle, while taut wristspound.Today he brings not bones nor plastic lung,For juvenile diversion, peg of sightOn which to hang the wandering gaze, butwords,Stale echoes of the text-book's musty rite.Some lads slump flaccid, others restive stir,Who know the ritual, sullen, pompous, flat:Time-honoured travesty of ancient oath:Students in trance upon the master's mat.A door cracks sharply, painted latchetscreak,The dreamer wakens in horrific dread,The brow swells ruddy as a figure movesAnd surging apex beat distils to lead.The sudden summons of Olympus' giant,The query repartee then ruffled bane—The click of empty steps fill corridor,And stifled slumber grips the flock again.Who dares to change one atom in thatshrine,A molecule of wit, a charge of doubt?No, sluggish circulation pumps and breathWith stagnant ventilation struggles out.The monotone expires, the pencils slump,The god strides out to morning scones andtea,And mortals hum to life as puppets biddenTo coffee wend their way, drawn ennui.J.P.* *"Stop.""I won't.""Well, at least I resisted."* **Which do you prefer—wine or women?It depends on the vintage.* * *Girl in Skin Clinic with an itch betweenher toes.Student: "Between which toes, dear?"Girl: "Big ones."PAGE FORTY-FIVE

A PROFESSIONALATTITUDETHAT INSTILS• ConfidenceSince their inception, thepolicy of Johnson & Johnsonhas been directed toensuring that all their productsmeasure up to thesame high standards ofquality.The Johnson & Johnson laboratory staff not only testraw materials and finished products but conduct endlessresearch in chemistry, surgery and bacteriology.This is the J. and J. attitude that has gained the worldwideconfidence of the medical profession.PTY.LTD.WALL CHARTSPHYSICS BIOLOGYTECHNOLOGY NUTRITIONClearly printedCloth reinforcedApproximately33 in. x 46 in.Inexpensive and immediately available from stockH. B. SELBY & CO.PTY. LTD.393 Swanston Street, Melbourne, C.1 34 3661SYDNEY BRISBANE PERTH ADELAIDEHOBARTPAGE FORTY-SIXSPECULUM 1961

THE ALL OR NONE PHENOMENONor THE THREE STIMULIS. CeberOnce upon a time there were threestimuli. These three stimuli lived in astimulator on a physiology prac. bench.There was baby stimulus whose name wasSubliminal, mama stimulus whose name wasThreshold, and papa stimulus whose namewas Maximal.Now outside the stimulator there was amuscle called by the strange name ofGastrocnemius von Toad. He was a verydifficult character because he would nottwitch unless he was prodded. If Subliminalgave him a kick he wouldn't twitch, ifThreshold gave him a kick he would give alittle twitch, while if Papa Maximal gavehim the boot he would let go a mightytwitch.His friends, Neddy the Nerve and Kerrythe Cardiac Kid, were much easier to geton with. Although Subliminal could get noreaction when he booted him, mama couldalways get a shock from Neddy's head whenshe kicked his behind, and Kerry wouldalways contract for her. Even Papa couldnot get a greater response from them.One fine prac. class while the threefriends were bathing in Ringer's pond anInspector of Responses called at the Stimulihouse. He said, "A new law has just beenissued by the Contraction Club in conjunctionwith the S.E.C. (Stimuli ElectricityCommission), As from the beginning ofthe International Contractile Year, minorsare not allowed to elicit responses fromexcitable tissues, which of course, includeyour neighbors Neddy, Kerry and Gastroc.If Subliminal or any other minor is foundguilty of this offence he will get the electrotonuschair "Naturally, the Stimuli were worried, as inthe past Subliminal had been able to getNeddy and Kerry and Gastro to turn red ifS PECULUM 1961he kicked them, and if he kicked themenough he could make Neddy shock, Kerrycontract and Gastroc to twitch slightly. SoPapa and Mama Stimuli made another rulefor Subliminal. "Until you grow up," theysaid, "you must not kick anyone more thanonce, otherwise you could be breaking theAll or None Law. If you do this and don'tgo to the chair then we will insulate you fora week and you will just about die of boredom."Meanwhile, back at the pond there wastrouble. Big trouble. Jack the Ripper wasat it again, slashing membranes left andright. Neddy the Nerve kept Jack at baywith a couple of well aimed action potentials.Kerry the Cardiac Kid started fibrillatingin fright and Jack couldn't get hisscalpel to him—but he got Gastroc. PoorGastroc. Jack slashed his membrane fromend to end, and in so doing wrecked hissodium pump beyond repair. Jack left asquickly as he had come and left in his wakea badly frightened pair of tissues and Gastroclying unconscious in the pond, drowningin excess sodium ions.At this stage help in a diminutive formarrived. Subliminal, out for his daily walk,saw Gastroc drowning in the pool. So hedragged him out and tried to revive him byartificial stimulation. But alas, he had forgottenthe All or None Law, and when atlast he got Gastroc to respond with a coupleof weak twitches, he was a good candidatefor the electrotonus chair Gastroc, however,did not revive completely and by thetime a new sodium pump arrived from spareparts he was completely depolarized.Subliminal's trial took place under theauspices of Judge Starling. Counsel for thedefence was Perry Bowditch. Subliminalwas accused of eliciting a response from anPAGE FORTY-SEVEN

Vii ^ iexcitable tissue. In his defence Bowditchcalled as prime witness an eminent Professorof Law, Prof. R. D. Wright, whosaid, "The All or None Law does not holdin unphysiological conditions." Bowditchargued that Gastrocnemius von Toad was inan unphysiological condition when Subliminialtried with the best of intent to revivehim.The twelve tissue jury retired to soak inRingers and consider the verdict. Afterthree hours they returned to the court."What is your verdict?" asked Judge Starling.General De Gaullebladder, foretissue ofthe jury, slowly rose to his feet, and thecourt waited for his verdict with an air ofionic deficiency. "Not guilty," he said.The court adjourned with an uproar ofaction potentials.Several days later, back in the stimulatorwith Mama Threshold and Papa Maximal,Subliminal celebrated his twenty-first birthday.This made him a minor no longer. Hewas promoted to Submaximal and he andhis family stimulated happily ever after.777ANGUS & ROBERTSONLTD.have avery large range ofMEDICAL AND DENTAL BOOKSin theirMedical Book Departmenton the First Floorat66-68 ELIZABETH STREET,MELBOURNE.Phone: MF 6466f*/4,4,/,/,/,4,4,444,44,4,/,4,4,4,4,/,4,4,4,4,44,DOROTHY DICKSHUMAN INTEREST STORIESDedicated to all those who are in love,and all those who can remember it.*"Worried"—I would report the suspectedlavatory seat to the State Health Departmentat once.* * *Dear Miss Dicks,A week ago I went to a smoko, wherewe enjoyed strip-poker. I was losing whenI passed out. Did I do wrong?"Pam Pupertie".Dear Pam Pupertie,Don't you remember?* **"Lulu"—No, dear, you won't get thelatest French stamps off them.* * *Dear Miss Dicks,I am eligible for marriage and should likeyour advice on how long girls should becourted."George".Dear George,The same way as short girls.* * *Dear Miss Dicks,I am very keen on a boy of about 20 andhe likes me but has warned me that hismorals are rather loose. What can I do?"Curious Queenie."Dear Curious Queenie,That's up to you.* *Dear Miss Dicks,My mother says there are some things agirl shouldn't do before twenty-one."Young 'n' Sweet".Dear Young 'n' Sweet,Well, personally, I don't like a largeaudience either.* * *Dear Miss Dicks,Why do I hate men?I hate men because they take me intoalleys, dance halls, taverns and bedrooms,and they press me and feel me all over withtheir fingers. After they get me all hot,they hold me to their lips and drag the lifeout of me. They get what they want andthen they throw me aside and I'm onlygood for tramps. Why should they takeadvantage of my white body?After all, I'm only a cigarette.PAGE FORTY-EIGHTSPECULUM 1961

"QUO VADIMUS"J. F. KingA true understanding of man can comeonly from placing him in perspective in thewhole realm of life. The position he holdsis brought sharply into focus by the conceptof natural evolution, which shows that theapparently designed nature and purpose ofliving organisms are not the product ofsome personal purpose and intelligence,rather the outcome of a wholly material anddeterministic process. Homo sapiens wasevolved and expanded to all corners of theearth dominating the environment in quitea unique fashion. He is the culmination ofevolution, as far as it has gone.Biological sciences which have investigatedthe past trends of development oforganisms and man, indicate that the physicalevolutionary processes by which manhas evolved have now slowed down. Thisleaves man with a dilemma. Is he toaccept the destiny to be handed out to him—degeneration—or can he maintain anddevelop his present status?Man has reached a unique and decisivestage in this complex evolutionary process,for he is in a position to determine his fate.Man, as distinct from other organisms, isconscious of his own history. Man'sadvantages have enabled him to exploit hisenvironment—this is his fundamentalsupremacy, this enables him to control evolution.The course of animal evolution (asdistinct from human) is not directed by theorganism itself but by the external environ-ment. Man is not limited in this way. Hisconsciousness of his own history, his abilityto inform succeeding generations, enableeach generation to modify its environment(within limits) in the light of experience.Man's environment, however, is nowworld-wide and his dominance has nowreached one stage where he is competingwith his fellow, within a closed arena oflimited environment. It remains for scientistsnot only to restrict possible directionsof development for man in this closed environment,but to direct that development.When man disciplines himself to realise thatthe fate of mankind rests on his shoulders,he can direct the course of his own evolution.If man fails to direct his destiny byuse of his intellect, the law of the Junglewill prevail.Can science provide a general philosophyof life which will enable man to control hisenvironment by a set of standards? Perhapsit can. Science has already shown uswhere we stand, and has also pointed outour cul-de-sac future if we do not avail ourselvesof our own capabilities. Science,unlike the "humanitarian" fields is detachedfrom political prejudice and national tradition.This enables the scientists to standon common ground and provide opportunityfor co-operative effort in facing theproblems of mankind. How these problemsare to be solved is for the present generationto decide.S PECULUM 1961PAGE FORTY-NINE

THE MUTUAL LIFE & CITIZENS' ASSURANCE CO. LTD.(Incorporated in N.S.W. Founded 1886)More than 1,750,000 Life Policies in force, assuring over £700,000,000Enjoy the convenience of placing all your insurance needs through the one officeor representative, with the M.L.C.FOR YOUR LIFE ASSURANCEAll classes of Business including:Personal, Superannuation, Partnership,Probate, Investment Policies.FOR YOUR GENERAL INSURANCEThrough the M.L.C. Fire and General Insurance all classes of business including:Fire Householders Houseowners ProfitsGlass Burglary Fidelity Guarantee MotorPublic Liability Personal Accident Employers' LiabilitiesTheM.L.C.305 COLLINS STREET, MELBOURNE, C.1 62 0371ML 96PAGE FIFTYSPECULUM 1961

MAMMON AND THE MUSEAdam FligelmanI feel it imperative to discuss here a mostserious problem which faces most medicalstudents sooner or later in their arduouspursuit of what is euphemistically known astheir "social life". The story usuallybegins in the caf., the Union Theatre, theBaillieu Library or on various lawns. Yousee her and you sum her up as "all right",which means desirable; you may be attractedby her eyes, hair, ankles or less readilyvisible though clearly imagined assets. Ofcourse you want to know her (in the Biblicalsense) and once you make up yourmind you will somehow wangle an introduction,for the predatory instinct of themedical student is of the strongest.You will probably find the first date quiteeasy to arrange, for medical students areusually an unknown quantity and thereforeat a premium.The great night finally arrives, you havesold your copy of Gray's, Ham and HavelockEllis, borrowed someone's dinner suitand duly taken her to dinner, followed by aplay or a ball. During supper troublestarts: conversation turns on your respectivecourses and to your horror you find she isstudying Philosophy III, Afganistan Historyand English III (Honours). At this stageYou can do one of three things:(1) Take her home, leave her there,forget her.(2) Make a fool of yourself with sameresult.(3) Take my advice (vide infra).If you do (1) you will feel infinitely frustrated,what's more, you will have wastedGray's, Ham and Havelock Ellis. That (2)will occur is unavoidable. The medicalstudent is ill-equipped to woo and win thismodern version of the precieuse. Even thedullest Arts student (male), the chap youSPECULUM 1961remember as getting ten for Maths. A atschool, is infinitely better equipped for thisconquest.Let us consider your position objectively:(a) You do not speak the lingo. (Why,you do not even know what "Transcendance"and "Imminence" mean!) What willyou say when she gets around to the archetypalforms in Blake (whatever they maybe)? And believe me, this is a subjectwhich you cannot avoid in the first halfhourof her verbal gymnastics.(b) Even if you knew these esotericwords, you could apply them to very fewthings (frankly, talking about the transcendentalflights of the blood urea inuraemia sounds somewhat ridiculous). Let'sface it, the medical course just does notequip one for this kind of intellectual intercourse(whatever it may do for the othervarieties). When she mentions Frazer, she'stalking about Boughs—not bones, and youmay very easily find yourself discussing thesignificance of the mechanism of the successionof the Kings in the Temple ofDiana, or some such piffle unlikely toappear in MB.BS finals.Her conversation will include the prosand cons of the literary-allusion style sopopular with T. S. Eliot, or else the moderntrends in stream-of-consciousness-type literatureexcelled at by her friend B.A. (theone who got ten for Maths. A), the latestpolitical developments in Afganistan, thepoints in which Shmoogelkopf divergesfrom the Classical philosophy of some obscureGreek (or was it an Afgan?), and themysticism of Tagore is added in for goodmeasure. It is quite pointless to try to describeyesterday's P.M. to her or to go intothe natural harmony of the ossification ofthe sphenoid, or the course of the lessersuperficial petrosal nerve. Nothing willdeter her. (However, if you casually rollPAGE FIFTY-ONE

"levator labii superioris alequi nasi" offyour tongue, she may stop for a minutethinking you are quoting Latin poetry toher—provide a suitable translation and donot disillusion her).No matter how . desirable be her otherattributes, it is the dubious attribute of hertongue and "intellect" that are preventingyour reaching first base and thence 'home".Example:Scene: Beach—lonely, dark, just right.Cast: He.She.He (to the utmost of his poetic ability):The sea is quiet it looks green like the greenof your eyes, which of course is caused bydeposition of melanin in the retina.She (unimpressed): "I remember, thoseare pearls that were his eyes. Look . . .""Phlebias the phonesian, a fortnight dead,Forgot the cry of gulls and the deep seaswell . . ."(Here follows a long tirade in free verse,truly a tale "told by an idiot, signifyingnothing", followed by half an hour of analysisbased on a critic chosen for his obscurelanguage.)He (at end of half hour): Yes, quite so.As you see, this will get you nowhere,except into some library reading FinnigansWake (a dead loss).Now, my friends, wipe your glasses, situp and take notice, for all, lock, stock andbarrel is about to be revealed to you. Toachieve your aim and fully gratify yourpredatory instincts, you need not learnFinnigans Wake by heart, nor read all ofWordsworth (whose collected works rivalthe Encyclopaedia Britannica in volume,weight and verbiage).(a) Do not sell Gray's, Ham and especiallynot Havelock Ellis (you may need it).(b) Do not borrow a dinner suit (andespecially not tails). To make any kind ofimpression you must definitely intimate toher that you, too, are "anti-establishment";and this blessed state and dinner suits justdo not go. In this matter you are somewhatat a disadvantage because professionallybeards, the badge and hallmark of antiestablishmentship,are out. Wear old trousers(the ones you clean the car in), desertboots with pendulous soles (this is soulfuland therefore endearing); shave, however,PAGE FIFTY-TWObecause two days of stubble has a terriblyemetic effect on even the hardiest antiestablishments.(c) Do not, repeat, do not bring her anorchid, nor fig leaves which would makeyour intentions too clear. Get an olddilapidated copy of the collected works ofTolkien, preferably bound in sackcloth.Make out that they are your most preciouspossession and lend them to her. (If notTolkien, then some other author into whichany deep meaning could be read—Alice inWonderland is most popular with Zen Buddhists—andwhich is hard to get, for onceyou like a generally popular book you'reOut.) This will mark you as a LiteraryGiant and give scope to your discussion onSymbolism.(d) Do not take her to a play or ball oranywhere else where people wear dinnersuits. Take her to an exhibition of Surrealistpainting (about this you know as muchas she does), a psychic seance in somegarret, Mick's roadside cafe . . . the possibilitiesare infinite. This makes youdefinitely anti-establishment, and besides, isinexpensive.(e) Learn the following phrases by heart:"The symbolic significance of any damnthing (A.D.T.) is obscure." If she explains,say that that was obvious and you werelooking for a deeper meaning."A.D.T. can be transcendant or imminent.""The Logoic elemental creative force ofany D.T.""His intensity tends to become inconsequentialhysteria.""The unfolding stages of human experienceare the eddies of life.""A.D.T. can have a natural, fecund darkforce.""A.D.T. can have sterility of values."To anything she says, you can reply anyone or all of the above balderdash. Thiswill mark you as an intellectually superiorperson who, despite doing med., has timeto absorb the "arts" (whatever they may be).From then on, be you hunchbacked,physically repulsive, or possessing an I.Q.of 25, it is she who will do the wooing.(N.B.—Before next date, read HavelockEllis.)SPECULUM 1961

OBITUARYPROFESSOR JOHN GERALD HAYDENIt is with great sorrowthat we recordthe death of ProfessorJohn Gerald Hayden,on December 26th,1960.Professor Haydenwas born in Ballaratat the turn of the century,the eldest of sixchildren. He was educatedfirstly at St.rick's College, Ballaratof which he wasdux, and later atNewman College, inthe University of Melbourne.His association with St. Vincent's Hospitalbegan in 1921 when he entered theclinical school as a student. After graduatingWith honours he returned as a resident medicalofficer and later as registrar, at the sametime qualifying for the degree of M.D., withobstetrics as his special subject. He thencontinued his studies with Evarts Grahamat St. Louis, and later in England where hegained his M.R.C.P. diploma.On returning to Australia, he enteredpractice with Sir Hugh Devine and was appointedout-patient physician at his old hospital.Six years later he was appointed inpatientphysician. In recognition of hisbrilliance he became a Fellow of the RoyalCollege of Physicians and a FoundationFellow of the Royal Australasian College ofPhysicians, of which body he was laterPresident.Prior to World War II he worked withthe Australian Army Medical Corps duringS PECULUM 1961his few leisure hours; at the outbreak he wasappointed O.C. Medical Division 2/7 AustralianGeneral Hospital and later becameCommander of the Unit. He saw activeservice in both Egypt and New Guinea. Forhis services in the Middle East he wascreated a Companion of the Most ExcellentOrder of the British Empire. Post War, hecontinued his Army associations as consultantphysician to the Army and RepatriationDepartment.Students at St. Vincent's have benefitedgreatly from his teaching over the past 30years. Professor Hayden was one of the fewmen who had the vast and, what appearedto the undergraduate, inexhaustible knowledge,not only of his specialty but ofmedicine as a whole; and could expound somuch of it, so clearly and authoritatively.His interest in the clinical school did not endwith his teaching rounds, but he continuedto serve our interests as Sub-Dean andDean of the clinical school.In 1942, when he was appointed StewartLecturer in Medicine, in the University ofMelbourne, his impact was then felt bystudents from all clinical schools. It wasnoted with pleasure that his excellent teachingwas just as effective in the lecture hallas at the bedside. As time passed and theneeds of the University changed, the StewartLecturers were replaced by Stewart Professors,and in 1956, Dr. Hayden was invitedto become the first Professor of Medicineat St. Vincent's Hospital. He still heldthat position at the time of his death, whichtook place in his own department at St.Vincent's.He is survived by his widow, a son anddaughter, and to them we extend our deepestsympathy.PAGE FIFTY-THREE

El Starving•my kiddies ofVitamin Bl?"iiNutritional research proves even thebest Australian diets are deficient inessential Vitamin B 1 . Delicious Vegemitedaily corrects this deficiency in yourfamily's diet.Children of all ages — and adults, too— need Vitamin B1 every day for —• healthy nerves • sound appetite• good digestion • vitality, good healthVegemite is the only pure concentratedyeast extract . . . andyeast is the richest known naturalsource of Vitamin B.Important — the body cannotstore up Vitaminfrom day to day ... it needsa fresh supply daily. Vegemitealso gives essentialVitamin B2 and Niacin.pp,Correct your children's daily Vitamin B1deficiency with Vegemite — let themenjoy it every day.For baby: Spread Vegemite on rusks, breador toast fingers — or mix it with strainedvegetables.For toddlers: Spread Vegemite on bread,toast, biscuits — mix with vegetables, soups.For school children: Spread Vegernitr onlunch sandwiches.VEGEMITE — made by Kraft .KR1 41Available in 2 and 4-oz.jars, and 6 and 8-oz.glasses. For big savingsbuy the 16 and 32-oz.family-size jars.PAGE FIFTY-FOURSPECULUM 1961

DIAGNOSTIC QUIZSURGERYMr. Douglas Donald1. A middle-aged man sprained hisankle severely three months ago. X-rayshowed no bony damage. It respondedwell to treatment, except for persistentminor symptoms and swelling. Diagnosis?2. A doctor's wife, well nourished, describedterrible pain across her epigastrium,smiling through her tears. She had had acholecystectomy eighteen months before.Diagnosis?3. A gasfitter complained of loss ofenergy for a fortnight or so. He was pale,tired, listless and constipated. No historyof significant sickness or injury except astab wound with a chisel at work about amonth ago, but it healed readily.4. A man of forty with a dischargefrom the penis. The prepuce could not beretracted. What is the diagnosis till provedotherwise?5. A young man, a few weeks after hisknee was caught in a pack at football, noteda firm swelling on the outer aspect of theknee when the leg was straight. Only twoconditions come readily to mind, what arethey?6. A girl of eighteen complains of apersistent pain in the wrist following aminor sprain twelve months before. X-rayN.A.D. No obvious physical anomaly.What is the explanation?7. A patient complains of under-armbody odour. It seems to have come onsince he had a boil in the axilla severalmonths ago. Aetiology?SPECULUM 19618. A surgeon operating for acute appendicitiscannot find the appendix in R.I.F.Where is it? The position is constant.9. Mother brings her daughter of twoyears along because of a tumour behind theleft knee. What is it?10. Two patients presented six monthsapart with identical story. Males of fourthdecade, in the previous twenty-four hourshad consulted two doctors for pain nearback passage. Both doctors had "reassuredthem". Diagnosis?11. Male, 18 years, had appendicectomyeighteen months ago—since thenvague symptoms till present attack same asthat before operation. Diagnosis?12. Man with splinter in sole of foot—removed it with difficulty. Since then hasremoved two more pieces but the tendernesspersists.13. A consultant at a country hospitalwas presented with a patient in Sim's positionfor sigmoidoscopy. He proceeded, tobe suddenly confronted with a cow feedingcontentedly in a green field. How?MEDICINEDr. I. MacKenzie1. A woman of 60 complains of constantpain in the left leg for six months. Shehas impaired hearing, and on examinationthere is some enlargement and bowing ofthe left tibia, and it is appreciably warmerthan the opposite limb. Diagnosis?PAGE FIFTY-FIVE

p;'.r,,;1 ; ;.;;;•';2. A man of 40 complains of loss oflibido and lethargy for three months. Heis pigmented, has loss of body hair, an enlargedfirm liver, splenomegaly and testicularatrophy. Urine examination showsglycosuria. Diagnosis?3. A bachelor of 63 has a chronic duodenalulcer, which recently has caused considerablepain. He has treated himself withsodium bicarbonate and a high milk intake,with relief of his ulcer pain, but hasbecome lethargic, nauseated and anorexic,with some vomiting. There has been associatedheadache, pruritic and mental impairment,and no localising signs are found onexamination of the central nervous system.Probable cause?4. A man of 55 complains of threemonths intermittent flushing of the face,becoming generalised. This symptom isoften accompanied by borborygmi anddiarrhoea. He also noticed occasionalattacks of wheezing during this time. Onausculation he has a systolic murmur in thepulmonary area, and examination of theabdomen reveals a firm mass in the rightiliac fossa, and an enlarged, irregular, hardliver. Diagnosis?5. A woman of 40 presents with a longhistory of intermittent haematuria andoccasional pain in the loins. Lately she hasbecome lethargic, and has increasing thirst.On examination she looks unwell, pale,with a dry furred tongue. B.P. 210/120and an irregular mass is palpable in eachloin. Diagnosis?6. A woman of 22 has noticed that theleft pupil is larger than the right, but hasno other complaints. The left pupil has anormal contour, but the reaction to light,both direct and consensual, is absent. Thereaction to accommodation is a slow contraction,and on relaxation dilatation proceedsslowly. There were no other abnormalfindings apart from absent ankle jerks.Diagnosis?7. A man of 50 complains of intermittentclaudication in the right leg ofrecent onset. Three months previously hesuffered a transient left hemiparesis. Healso suffers from lassitude and headaches,and notices pruritus following bathing. Hehas a high colour, prominent conjunctivalvessels, and there is moderate splenic enlargement.No neurological deficit is found,but peripheral pulses are absent in the rightlower limb. Diagnosis?8. Uncommon, but important, and forthe astute observer. A girl of 18 is thedaughter of a first cousin marriage. Twoyears previously she developed a progressiveinvoluntary coarse tremor of her limbs,followed by rigidity and intellectual deterioration.Examination reveals a fatuouslooking girl, and confirms neurologicalstate, with neither sensory loss nor pyramidialtract signs. An enlarged, firm liveris palpable and glycosuria is present. Whatfurther clinical observation should be madefor confirmation of the diagnosis?OBSTETRICSDr. P. Glenning1. A grand multipara, Rh immunizedwas at 35 weeks gestation. Her pendulousabdomen made uterine size difficult toassess but there had been no apparent increasein the uterine size for the past sixweeks. The patient still felt movements butno foetal heart could be heard. She presentedwith heavy haematuria of suddenonset but was otherwise well. Give (a)Differential diagnosis; (b) Treatment.2. A multigravida who had previouslyhad a 4750 gm. baby vaginally came intolabour at term and had an unstable lie.Vaginal examination when the membranesruptured revealed a thick rim of cervixthrough which there hung a pulsating loopof cord. The vertex was felt high abovethe cord. No theatre was available for 45minutes. Management, please.3. A young Australian primigravidahad a persistent progressive anaemia duringher visits to the ante natal clinic. She hadbeen taking iron tablets regularly and serumiron levels were normal. At 38 weeks herHb was 7.6 gm/100 cc. Differential diagnosisand management.PAGE FIFTY-SIX SPECULUM 19 6 1

4. A young woman attending the antenatal clinic complained of increasing numbnessover the median portion of her hand.Probable diagnosis and treatment, please.5. A multigravida at term having had anormal ante natal course, had a heavy"show" P.V. and was seen in the LabourWard. No abnormality was detected andvaginal examination showed the cervix to bepartly taken up and the os 1 finger dilated.The vertex was presenting in the pelvicbrim. She spontaneously ruptured hermembranes in the next few hours but hadnot come into labour the next day. Anintramuscular med. stim. was given with noeffect. Following the final dose she had afurther small haemorrhage of 60-90 ml. andcontinued to lose mildly blood-stainedliquor. The next day she still had not comeinto labour. Management, please.6. A young recently married womanwas being routinely examined at her firstattendance at the ante-natal clinic. Onspeculum examination 2 small purple patchesand another yellow patch were seen onthe vaginal wall. Spot diagnosis.GYNAECOLOGYDr. P. Glenning1. A single woman aged 19 years presentswith a history of sudden onset oflower abdominal pains of two hours duration,followed by right shoulder pains. Herperiods had been regular and there was anormal menstrual loss. On examination,pale young woman, release tenderness andguarding over the lower abdomen with rigidity,speculum examination — os closedwith small amount of blood from os, bimanualexamination—normal size uteruswith a tender mass in the right fornix andtenderness on rocking the cervix.2. Married woman aged 45 years has ahistory of increased period loss for 12months with increasing lassitude and weaknessfor one month. On examination—general clinical examination normal exceptfor pallor, bimanual examination revealed anormal sized antiverted mobile uterus andthe fornices were clear; speculum examination,normal. Hb 7.2gms and a blood filmshowed the presence of round and ovalshaped macrocytes and poikilocytes. Thereciculocyte count was raised.3. Painful swelling of the left labiumfor four days in a women aged 24 years.On examination, large red fluctuant swellingof the left labium.4. Married woman aged 49 years presentswith a history of increasing period lossfor three years and intermenstrual bleedingfor three months. On examination, uterusslightly enlarged, regular, antiverted andmobile; fornices clear. Vaginal examinationrevealed no abnormality of the cervixnor vaginal epithelium.5. Lower abdominal pain for two dayswith associated yellow vaginal discharge ina single woman aged 21 years. On examination,febrile, tenderness in both iliac fossaewith released tenderness and guarding, profuseyellow discharge from a closed externalos of the cervix and the uterus was ofnormal size. Tenderness was elicited inboth fornices and on rocking the cervix.S PECULUM 1961PAGE FIFTY-SEVEN

6. Single woman aged 20 years presentswith a history of primary amenorrhoea. Hergeneral health had been excellent. Examinationrevealed that breast development waspoor, axillary hair was absent and therewere a few pubic hairs only present. Thehair lines were normal, the extremities shortand plump and general stature small. Thepatient's general appearance was that of afemale. Examination under anaesthesia revealedthe presence of a very small uterusbut the ovaries were not felt. Vaginalcytology showed an atrophic smear and thepattern was identical with a prepubical orpost menopausal smear. Buccal smears indicatedthat only one X chromosome waspresent.7. A young woman aged 18 years presentsin the early morning hours with a historyof sudden heavy vaginal bleeding ofrecent onset.PAEDIATRICSDr. J. H. Coldbeck1. A nervous girl of twelve years witha long history of asthma, presented withanother attack of asthma. She also complainedof severe intermittent pain in theleft shoulder. She did not respond to adequatedoses of adrenalin and phenobarb.She was admitted to hospital because shehad not shown her usual response to thetherapy. Diagnosis?2. A baby delivered at 38 weeks by anemergency caesarian section because ofsevere vaginal bleeding from a placentapraevia, is reported to have passed a largemelaena stool at the age 36 hours. Diagnosis?3. A baby aged 12 months is broughtto the Doctor because of irritability for thepast four days and a reluctance to move hisright arm. Possible causes?4. A girl aged 15 months is brought tosee you because mother had noticed sheappeared to be limping. She had startedwalking at the age of 12 months. Hermental and physical development wasPAGE FIFTY-EIGHTsee you because mother says she is theotherwise normal. There was no history oftrauma. Diagnosis?5. A girl aged 4 years is brought to seeyou because of an offensive vaginal discharge,present for the past three weeks.Diagnosis?6. A baby boy aged three weeks has atwo-day history of persistent vomiting. Removalof the napkin reveals the diagnosis.7. A boy aged seven years is broughtto see you because of a two-year history ofrecurrent respiratory infections, and motherhas noticed he is pale. Physical examinationreveals no abnormality. Diagnosis?8. A girl aged nine years is brought toshortest girl in her class at school. Examinationreveals an intelligent, physicallynormal girl apart from her short stature.Most likely diagnosis?9. An apparently normal baby suddenlybecomes cyanosed and dyspnoeic at the ageof four hours. Examination reveals absentbreath sounds over the left chest and anapparent dextrocardia. Diagnosis?10. A boy aged three years woke earlyone night with a harsh cough and noisybreathing. He was diagnosed as laryngotracheo-bronchitisand placed in a steamtent and given antibiotics. There was noresponse to therapy after 24 hours. Diagnosis?11. A baby aged five months had beenpreviously well until the past two dayswhen mother stated he had commencedvomiting and was apparently anorexic.What are the possibilities?12. A previously well baby aged threeweeks is noticed to be short of breath, particularlywhen feeding. Examination revealsa pulse rate of 160 per minute andthe respiratory rate is 100 per minute. Theliver edge was two fingers breadth and amurmur was heard at the apex. Diagnosis?Answers on Page 89SPECULUM 1961

'Sdkii;idirrairnnanioNnin,t 10:0111..trade m¢rkMETRONIDAZOLEis an important new systemic drug acting specifically on Trichomonas vaginalis.It is taken orally, in tablet form, and has proved effective in thousands of cases,with a success rate of over 80 per cent.If you would like detailed information on Tlagy1', we will be pleased to send youa booklet on request.Please mention your medical school, and say whether your studies are pre-clinicalor clinical.MANUFACTURED BYMAY & BAKER LTDAn 11611 brand Medical ProductMA8719/85Distributors MAY & BAKER (AUSTRALIA) PTY LTD • INC. IN. N.S.W.P.Q. BOX 41 • FOOTSCRAY W.11 • VICTORIA • TEL: MM 9131 • 10-14 YOUNG STREET • SYDNEY • TEL: BU 361'4SP ECULUM 1961PAGE FIFTY-NINE

MEDICAL STUDENTS' SOCIETYCOMMITTEE MEMBERS, 1961-62President:Vice-Presidents:PROFESSOR V. L. COLLINSD. DE KRETSERW. DARVALLSecretary:Treasurer:Editors of Speculum:D. CRANKSHAWI. WOODWARDMISS E. J. SHAWD. PHIDDIANMedical Medley's Producer:Sports Representative:Pre-Clinical Women's Representative:Clinical Women's Representative:J. BESTP. NELSONMISS H. WANDSBOROUGHMISS KEAY FOSTERYear Representatives:First:Second:Third:B. RICHARDSJ. O'SULLIVANT. CHEATRELHospital Representatives:R.M.H.:A.H.:St. V.'s H:P.H.H.:S.R.C. Representative:W. WHITEW. MOONEYJ. HARTMISS F. TRINKERPAGE SIXTY SPECULUM 1961

M.S.S. CHRONICLE, 1961SECRETARY'S REPORT1960 was one of the most active andProsperous years for the Medical Students'Society. The year saw the awakening of atrue faculty spirit and once more the MedicalStudents' Society is a force to be reckonedwith in the University.The year was highlighted by severalactivities, beginning with the Miss Universitycontest, in which our candidatereached the final by raising £115, butunfortunately did not triumph. However,the "Men in White Coats" seemed to dominatethe audience, and played a major partIn re-establishing the Medical Students'Society in the eyes of the University.The Medical Dinner was held on Friday,the 25th May, and was attended by 180students who enjoyed wining and dining inthe University Buffet. The revelry waslead by Dr. J. M. Sinclair, Psychologist atthe Royal Melbourne Hospital, but wasably assisted by many of the diners. It isunfortunate however, that the cost of thePinner will have to be lifted above the £1Irl future years, as the Society made a lossof approximately £80 this year.During the May vacation about 30 Meloourriestudents attended a convention ofAustralian Medical Students in Brisbane,and apart from enjoying the many socialoutings, drafted the constitution of theA ustralasian Medical Students' Association,of which this Society is now a member.It was decided at this Convention tosubmit reports to the member Universitieson the following matters:(1) Student health schemes.(2) Commonwealth Scholarships.,,,Melbourne is to be the host State for the' 96 1 convention, plans for which are nowwell advanced.SP ECULUM 1961These plans include lectures by eminentpersonnel, tours of Melbourne and its surrounds,and numerous social events.In order to combat some of these expensesand to reduce the cost of the conventionto interstate visitors, the committeedecided to donate £150 towards the costsof the convention as it was felt that theventure was worth the expense and alsoyour interest.Medical Medleys, "Whores de Combat",was an outstanding success, and Mr. BillBlake is to be congratulated on a fine production.It is estimated that the Societymade a financial profit of £50 on the venture.Speculum 1960, although delayed, continuedin the same high vein, and Miss JanPeeler and Mr. Bill Crombie must be congratulatedon a fine publication.Another feature of the year was thefinalisation and production of a faculty tiewhich will be on sale in the next few weeksfor an approximate price of £1. Mr. JohnO'Sullivan is to be thanked for his handlingof negotiations regarding the tie.An innovation in the Society was theelection of a Pre-Clinical sub-Committee,which organised a series of lectures generallycatering for the needs of the students inthe Pre-Clinical years. This committeeplayed a major part in the organising of theMedical intervention in the Annual MarblesMatch and helped to revive Faculty spirit.In conclusion, I should like to thank therest of the committee for their help, and toparticularly thank Associate Professor Grayfor his advice and help throughout the year.David DeKretser,Honorary Secretary.PAGE SIXTY-ONE

TREASURER'S REPORTPerhaps the most striking thing in thisyear's balance sheet is the reduction inCapital Assets during the period. This hasbeen largely a result of quite deliberatedecisions regarding investment and donations.The cash at bank, however, remainsquite high and should cover all normalfluctuations. In particular, the donation of£25 toward fares for last year's A.M.S.A.Conference in Brisbane and the donation of£140 toward this year's conference can bequoted as exemplifying the committee'sopinion that the M.S.S. does not have theaccumulation of money as its prime purpose.Medical DinnerUntil the last few years the Med. Dinnerhas always been struggling for support.Because of this the M.S.S. has always subsidisedit. While there were 40-50 peopleattending this was not significant. In recentyears costs have risen steadily and as theticket price has remained at £1 the subsidyper individual has slowly crept up.The 1960 Med. Dinner was the mostsuccessful ever in terms of numbers withover 170 people attending. However, eachticket sold meant an extra loss of approximately15/- to the society so that as theticket sales rose the Treasurer's morale fell.While the numbers attending should be repeatedthe financial debacle should not.Song Books and BadgesWhen the retiring committee took overoffice the society had no badges. This wasrectified by the purchase of 600 badges andthere should now be enough song books andbadges to last 3 to 4 years. It is obviouschat a Balance Sheet that does not takeaccount of these assets does not give atrue indication of the Society's financialstate. This could be corrected by stocktakingat the end of each year. If the incomingTreasurer feels this is worth while I wouldbe happy to prepare a statement of theseassets with him. This statement could bepublished in Speculum and would providea base-line for more adequate accounting inthe future.PAGE SIXTY-TWOSpeculumCosts have continued to rise in printingof Speculum; this year Speculum cost approximately£40 more to publish than in1960. In an effort to increase the incomefrom advertisements the fee to advertiserswas increased and an effort was made toattract new advertisers.Over 250 firms and Advert. Agencieswere contacted by post and of these about40 replied, with 27 finally advertising inthe magazine. This resulted in an incomefrom advertisements of £260: almost identicalwith that of the previous year.Sales so far this year have yielded £170and with miscellaneous expenses the acountat the moment shows a net loss of £44.However, sales to graduates have not yetbeen completed and, in the final analysis,this loss will be reduced: certainly to £20,and we may well break even.It will require a lot of hard work on thepart of the incoming Treasurer if costs areto be covered and an even greater effort ifany profit is to be made.Although the results were disappointingthis year, perhaps the best hope lies in increasingthe revenue from advertisements.A more personal approach to business firmsand business personalities would undoubtedlyresult in an increase in the incomefrom this source. But I know frompersonal experience that this is a frustratingand time-consuming job.MedleysDespite the fact that it fell in the sameweek as one of the S.R.C. balls, Medleysthis year made a profit of £53. Much ofthe credit for this should go to Keay Fosterfor her admirable management of the ticketsales. There is no reason why Medleysshould not continue to make a profit in thefuture.Note:As the A.M.S.A. Conference did not re -quire the £140 donation this remains withMelbourne M.S.S., thus significantly alter -ing the Financial Report presented to theAnnual General Meeting.SPECULUM 1961

MEDICAL STUDENTS' SOCIETYStatement of Receipts and Paymentsfor period April 4, 1960 to April 10, 1961National Bank: Current AccountRECEIPTSBalance B/F., 4/4/60:Cash at BankGeneral A/c £256 19 6Speculum A/c. 361 10 8£618 10 2MEDLEYSReceipts neceiptsSale of Tickets £1405 10 7Less Expenses PaidTax £155 9 0Catering 779 2 0Hire Hall 91 15 9Orchestra 95 10 0,,, Liquor 43 15 8tiOn'arium 10 10 0Tickets andPosters 10 17 6Programs 24 4 0Costumes,Make-up 17 0 0Props 26 0 0Lighting 18 0 0Sound 30 0 0Balloons 35 0 0Typing ofLiq Scripts uor4 4 0Licence 1 5 0Florist 6 12 0Refund onTicket 2 15 0£1351 19 11£53 10 8Other ReceiptsI nterest—General A/c £24 11 11.—Speculum A/c. 10 1 0Fixed 'iced Deposittransferred atMaturity 189 0 0£223 12 11£895 13 9PAYMENTSMEDICAL DINNERExpenses PaidCatering £220 15 0Liquor 39 0 3Printing 10 10 0£270 5 3Less ReceiptsSale of Tickets 156 0 0£114SPECULUMExpenses PaidPrinting £468 5 6Postage 13 10 0Sundries 3 0 0£484 15 6Less ReceiptsSales £173 10 0Advts. 230 12 0404 2 0£80 13 6SONG BOOKS AND BADGESExpenses PaidBadges £162 17 2Less ReceiptsSale of Badges andSong Books 70 2 2GENERAL EXPENSESStationeryand Print. £18 9 3LessS.R.C. Grant 1 19 3£16 10Postage and Sundries 9 0Affiln. Fee, A.M.S.A. 10 0Pre-Clinical Sub-Com. 6 13Bank Charge 1DONATIONS AND GRANTSSub. Faresto Q'land £32 17 6LessS.R.C. Grant 7 17 6£25 0 0Donation W.U.S. 5 0 0Donation AMSA Con. 140 0 0£170 0 0BALANCE C/F, 11/4/61Cash in Bank and in hand, 11/4/61:General A/c. £104 17 4Speculum A/c 290 18 2£395 15 6000065 3£92 15 0£42 4 6£895 13 9S P ECULUM 1961PAGE SIXTY-THREE

Statement of Income and ExpenditureFor period April 4, 1960 to April 10, 1961EXPENDITUREMED. DINNERPayments £270 5Less Receipts 156 030INCOMEMEDLEYSReceipts £1405 10 7Less Payments 1351 19 11Net Expense £114 5 3 Net Income . 53 10 8SONG BOOKS AND BADGESINTERESTPayments £162 17 2 General A/c £24 11 11Less Receipts 70 2 2 Speculum A/c 10 1 0Net Expense 92 15 0 Net Income 34 12 11SPECULUM Net Loss for Period C/F 205 6 0Payments £484 15 6Less Receipts£404 2 0Less A/cs.for Adv. 36 8 8440 10 8Net Expense 44 4 10GENERALNet Expense 42 4 6£293 9 7 £293 9 7Net Loss for period B/D £205 6 0 Total Deficit for PeriodDonations and Grants 170 0 0 transferred to Accum. Funds 375 6 0Statement of AssetsLIABILITIESACCUMULATED FUNDSBalance as at 4/4/60:Gen. A/c. £256 19 6Speculum 361 10 8Fixed Dep. 189 0 0£807 10 2Less T1. Deficitfor Period 375 6 0£375 6 0 £375 6 0£432 4 2£432 4 2and Liabilities — April 12,ASSETSCASH AT BANKBalance at 10/4/61:General A/c. £104 17 4Speculum A/c. 290 18 2Accounts for Advt.1961£395 15 636 8 8£432 4 2HOW TO TELL WHEN YOUby Fizz-sick-an.The difference between a patient being"Stinko" and "Good and Stinko" is slightlytechnical, but recognisable by sundry phenomena:1. Ridiculous sense of Excessive AthleticAbility, such as leaping no hands over asofa, wrestling the hostess, five-minute falls,desire to indulge in non-scheduled boxingmatches, etc.2. Inability to bunny-hug with hostesswithout furniture intervening.3. Realisation that you are:ARE GOOD AND STINKO(a) Under a table.(b) Atop the I.C.I. Building.(c) In Cuba.without knowing how you got there.4. Awakening suddenly under a strangeshower.5.If it6.you7.takeThere are several other methods:Breathe on a piece of litmus paper•turns blue, you need dehydration.Light match and hold to breath.11ignite, yep, you are!Drop around at the local cop shop anda written examination on the subject.PAGE SIXTY-FOUR SPECULUM 1961

MEDICAL DINNER, 1961One of the two social events of the medicalstudents' year took place in the UnionBuffet on the evening of the 12th July, inthe year of our Lord 1961. Representativesof both laity and hierarchy attendedin goodly numbers and the early tone of thegathering was one of subdued gentility. Tobegin, a little sherry was served as a concessionto the more earthy elements. Itsquantity and quality, however, were obviouslydesigned to maintain a high level ofsobriety in keeping with the solemn natureof the event. All went well through thesoup, and the business of the evening wasbegun when Mr. De Kretser, a well-knownlay preacher, proposed the toast to theQueen. Since Her Majesty could not bepresent, for geographical reasons, no replywas forthcoming. Mr. Crankshaw thenhonoured our spiritual leaders by proposinga toast to the Staff.It was at this point that the propriety ofthe gathering was first assailed when thehigh priest of Physiology, in his reply forthe Staff, made some remarks which couldonly be described as humourous. The vulgarcrowd even encouraged this unfortunatetrend by laughing uproariously. The disorderwas immediately augmented by Dr.Gershon, obviously acting under ordersfrom his leader, who in proposing the toastto the students, continued to make jokes.Mr. John Woodward, apparently infectedby the general spirit of levity, did nothingto restore order when he replied on behalfof the students.All hopes of a quiet, educational and improvingevening faded when Dr. Counsel,the guest representative of the OphthalmologicalReligion, launched into a witty discourseon his travels through the U.S.S.R.as a guest of the Atheistic Communistregime. His speech was loudly applaudedshowing the dreadful deterioration that hadoccurred. Finally, the evening concludedwith highly coloured jokes and even songs.In despair (perhaps because the sacrificialWine was exhausted) Mr. De Kretser declaredthe dinner ended at 10 p.m. and graduallythe Buff was cleared, leaving only_Memories of sinful pleasure to haunt it.There seems little hope that Med. studentscan be converted to sober ascetics just yet.SP ECULUM 1961SPORTAs usual, the med. faculty met withmixed success in the sporting sphere. Pressureof studies no doubt deterred some ofour more noted sportsmen from participating.Nevertheless we managed to fieldcompetent teams in football, tennis, tabletennis, rifle shooting and hockey.Once again our football team providedthe highlights. Under the able leadershipof "Gentleman Greg" we managed to gaintwo resounding victories. Of course ourbest and fairest award of 1961 had to beawarded to Treth, whose outstanding workin the packs and around the goal turnedthe tide against Arts. His splendid cooperationwith full forward Jack Kennedydelighted our supporters, "W.J." and theever vociferous "Harold."Frank Incani, "Tank" Metherall, SamCampbell and Geff Baker capably representedDiv. 1. Incidentally it was mostpleasing to see the way in which "Joe"Cravana was able to tear himself away fromNummo's to play one hectic quarter againstArts.TennisThe men's tennis team, comprising W. A.Le P. Darvall (captain), Arnold Jager, VicTeasdale and John Moore capably defendedthe title which they won last year.Results: Med. d. Engineering.Med. d. Law.HockeyThe med. faculty team led by Ian Cunninghamhas performed feats unknown aswe go to press. Those requiring more informationhad better see Ian Cunningham!!Peter Nelson,Sports Rep.*A certain woman was taking her temperatureP.V. and misplaced the thermometer.Due to the worry she called in thepractitioner who searched the bed clothes,toilet, etc., to no avail; in desperationordered an X-ray. The report came back."The X-ray is satisfactory. The thermometeris in the bladder, but I am sorry Ican't read the mercury level."PAGE SIXTY-FIVE

PAGE SIXTY-SIXSPECULUM 1961

MEDICAL MEDLEYS, 1960On December 10th last, St. Kilda TownHall reverberated to the noise of 1100medical students and their friends, whilingaway the last night of the Academic year.From the freshest pre-meder to the hardyfinals, everyone voted it a great success.The thanks of all go to Bill Blake for startingthe night in such a happy vein. Who willever forget little Geof and his big red spotor Grandad Mark? We are sure that Don'sscroll did much to enlighten the "friends"section of the guests, let's hope with no illeffects. Dennis Farrington's music kept thefew who could still dance going till the earlyhours when those who were still capablecontinued their revelries at other more hospitableplaces.Just to refresh your memory here aresome of the lyrics which sent you rollinginto those open arms next to you.Opening SongThey say Med. Medleys can't be done withoutit's being blueWe leave it up to you, to judge if this istrueOur show tonight will seem alrightIf when we're at the endOur subtleties the pure don't comprehend.For all us Med.'s this last year's been avery good oneFor with much beer and hearty cheer we'vehad our fillThese may be months in which both fearand anguish keep usWithin the books, and with looks that nowus chill.ChorusAlthough the Profs. we now and then maydisagree withTreth, Sid and Lance as well as Pans we'remad aboutFor if its knowledge pure and simple thatwe're seekingThen they're the men we simply cannot dowithout.0, Pansy Wright, we cry, we're dazzled byyour beautyAlthough in books we've read of looks likeyours it's true.SP ECULUM 1961And Lance can never ask a girl to be hiscutieAlthough his female friends can be thoughtto accrue.0, K. P. Russell, your embonpoint astoundusYour portly state, your balding pate isworshipped hereAnd Jackie Leggie in lectures very oft confoundsusAlthough he makes good hearing with a potof beer.Chorus0, Doctor Tange your name in Frenchsounds just like monkeyComparison's embarrassin' you may be sureAnd Mr. Elford's forced to be a generalflunkeyTo retire him or to fire him is the cure.So now it's time for bells to chime the firsthot numberOf Med. Medleys for the year we've justbeen throughBut as it may, we first must say a wordmost humbleTo the few men that we can't get on without.Festive OccasionChild:A repulsive child with a large balloon.I've hung the balloons up in the hall,I've hung paper chains upon the wall,I've hung up my stocking in the Nursery,I've hung a little star upon the ChristmasTree,I've hung up some sprigs of bright redholly,I've hung some mistletoe to make it jolly,I've hung up all the festive things,Did I enjoy it?Rather.But best of all I've just hung father.* *Dr. B.: "Should I?"What can I do?How can I do it?Did I do it YES."PAGE SIXTY-SEVEN

Do Rah MeeIf you really want to be a sisterAnd to take up nursing as your lot,You are not allowed to doWhat your mother wants you toBut be prone to share your charms in everycot.Here's a hint I always give prospectivesisters,It's a maxim that, if followed, never fails.If a sister wants a doctorThen the way to make him talk to herIs to polish up a sister's vowels.Ah, Oh, Ooh, I can't hear you at all,Ah, Oh, Ooh, You are right on the ball,Ah, Oh, Ooh, You're playing a nurse's part.Come on now.Ah, Oh, Ooh, Keep it clear as a bell,Ah, Oh, Ooh, Good, you're doing it well,Ah, Oh, Ooh, You're warbling a sister'stale.There'll be jolly pitsy-patsying with the students,With residential doctors nightly prowls,But the most important thing for any sisterIs to polish up a sister's vowels.Let's do it.Ah, Oh, Ooh, Do it right from the heart,Ah, Oh, Ooh, Pretty good for a start,Ah, Oh, Ooh, You're playing a nurse's part.If you really want to be a sister,Some decency and virtue you must show,When at dawn with loving care you spongea patient bareYou must forget the brute of half an hourago.As I said, the chief attraction of a sisterIs a murmur with an overlying thrill,So the moment you get near her,To listen, touch or feel her,She may respond by giving out a trill.Ah, Oh, Ooh, Come, let there be no doubt,Ah, Oh, Ooh, You must try out and out,Ah, Oh, Ooh, You're playing a nurse'spart.Let's do it again, now!Ah, Oh, Ooh, Keep it charming and light,Ah, Oh, Ooh, Good, that's perfectly right,Ah, Oh, Ooh, You're playing a nurse'spart.PAGE SIXTY-EIGHTYou will have to learn a dignified manner,Oblivious to the patient's screams andhowls,But the most important thing for any sister,Is to polish up a sister's vowels.Come now, dear.Closing SongThey're Whores de Combat, that's what theyare,They can pick at a glance what to romp atBut you find out if they're caught they'redistraughtAnd they'll fight and they'll scratch like aTomcat.We know what's coming,And if what they're atAnd if we meet them this eveningWe'll just have a drink and a chatFor they're Whores de Combat.ChorusGoodbye,It's time we sought some gin and limeSo that we may be to a large degree offrustration freeAnd so we go to indulge our vices lowAlthough we know if you drink neat gin itit will lead to sinWith a little drink and time to thinkWe shall make our points and show themthat love is a mustAnd if they agree with all our pleas to comeback to our jointsYou won't see our heels for the dustWe'll do or die you'll know the reason whyWhen told of the Bold Mad Students' standfor the rights of man.We've finished jokin'But what care weWe hope from your sleep you've beenwoken.We've tried our best all night to be rightNow the final farewells must be spoken.We'll now start drinking, that's what we'lldoAnd in some far distant cornerWith a drink and a girl that's trueWe'll start the night anew.She was only a lawyer's daughter, but shesure gave me a case.SPECULUM 1961

1714echcal AmociationMEDICAL HISTORYA prize of £10 will be offered for thebest essay by a Medical Studenton a Medico-Historical subjectENTRIES TO BE SENT TO:-M. L. VERSOHon. Secretary, Medico-Historical BranchBY 1st MARCH, 1962SEE US FOR YOURDISSECTING SETSSTETHOSCOPESDIAGNOSTIC SETSAND ALL OTHER MEDICAL OR SURGICAL REQUIREMENTSINDIVIDUAL ATTENTIONJOHN H. AUSTEN PTY. LTD.222 VICTORIA PARADE,EAST MELBOURNE41 4718(Just a few doors past the Eye andEar)SP ECULUM 1961PAGE SIXTY-NINE

PAGE SEVENTY SPECULUM 1961

A.M.S.A. CONFERENCEREPORT—OFFICIALReport of the Second Annual Conventionof the Australasian Medical Students' Association,held in the University of Melbourneunder the patronage of the British MedicalAssociation of Victoria.The Australasian Medical Students'Association—A Brief Historical OutlineThe formation of the A.M.S.A. fulfilleda need that had been considered by manyof the Medical Students' Societies of Australiato be an urgent one. Althoughattempts had been made in the past byboth Sydney and Melbourne to form aNational Association, it was not until 1960that the University of Queensland MedicalSociety, with the support of the othermedical schools, took the initiative, andheld what was to be the First Annual Conyentionof the A.M.S.A. in Brisbane, duringthe May vacation, 1960. The MedicalStudents' Societies of Queensland, Sydney,Melbourne, Adelaide and Perth were thefoundation members of the Association,and Mr. David Scott, a fourth year studentfrom the University of Queensland, waselected its first President.The aims of the Association, set out inits Constitution, are: to serve and representthe medical students of Australasia and toPromote co-operation and understandingamong them; to encourage the interchangeof ideas in all fields of Medical Educationand Practice and to uphold the ideals ofUniversity Medical Teaching; to facilitateco--operation between the medical studentand the medical profession and wherenecessary to co-operate and affiliate withother bodies having similar aims.During the first year of its existence,despite some inevitable "teething troubles",SP ECULUM 1961the A.M.S.A. was very active. Soon afterthe Brisbane Convention, a statement wasreleased to the Press throughout Australia,pertaining to the Association's policy withregard to the limitation of numbers atAustralian Medical Schools. While anxiousthat more University Medical Schools beestablished, so that those who want to takea Medical course and who have a reasonablechance of passing, may do so, nevertheless,the Association firmly supports theprinciple of limitation of numbers withineach School.Then at the beginning of July, 1960, theExecutive Secretariat was handed over tothe Melbourne Medical Students' Societyand Mr. Bernard Carroll, Mr. John Mc-Encroe and Mr. John Woodward, all fourthyear students, took office as President,Honorary Secretary and Honorary Treasurer.They obtained reports on the operationof the Commonwealth ScholarshipsScheme in each University, and criticallyreviewed the Scheme as it served medicalstudents. A similar survey of StudentHealth Services within Australian Universitieswas also undertaken.At the National student political level,the Association is one of the affiliatedFaculty Bureaux of the National Union ofAustralian University Students, and hasreceived considerable assistance, financialand otherwise, from N.U.A.U.S. Internationally,negotiations with the InternationalFederation of Medical Students'Associations have resulted in affiliationwith I.F.M.S.A., and Australia will be, mostappropriately, the centre for the South-EastAsian countries.Negotiations with Otago University inNew Zealand are expected to result in theiraffiliation with the A.M.S.A. in the nearfuture.PAGE SEVENTY-ONE

The Melbourne Convention, 1961During the May vacation, the SecondAnnual Convention of the Association washeld in the University of Melbourne. Overthree hundred students from every AustralianMedical School, including those ofMonash University and the University ofNew South Wales, attended.In a brief ceremony on the first day, theLord Mayor of Melbourne, Cr. BernardEvans, welcomed the interstate visitors andofficially opened the Convention. Mr.Geoffrey Newman-Morris, the President ofthe Victorian branch of the B.M.A., Patronof the Convention, then wished the Associationsuccess for the future, and ProfessorL. J. Ray, Professor of Anatomy, promisedthe co-operation and assistance of theFaculty to the A.M.S.A.Throughout the week, a number of lectureswas held. Topics were chosen whichwould be of interest to the student at alllevels of training, and which are not emphasizedin the normal academic curricula. Thelectures given were as follows:Mr. J. Legge: "The Biochemical Origins ofLife".Dr. Alex Sinclair: "Psychiatric Problems ofMedical Students".Mr. George Stirling: "Experimental Surgery".Prof. K. F. Russell: "The Edinburgh Murders".Dr. W. L. Carrington: "Marriage Counsellingin General Practice".Prof. G. S. Christie: Hydatid Disease".Sir J. C. Eccles: "What is Man".Sir F. M. Burnet: "Auto-immune Disease".Dr. A. SinclairSymposium—Dr. M. Blackwood j- "Sex andDr. I. MartinIntersex"As well as the lecture programme, specialdelegates from each University held a ProgressiveSeminar on Medical Education,and as a result of their discussion, theA.M.S.A. has established a standing committeeon Medical Education. This willprovide a proper service both to the medicalprofession as a whole, and to medical teachingstaff, in the presentation of undergraduatethought and opinion on MedicalEducation.PAGE SEVENTY-TWOAn extensive social programme occupiedmost evenings, and included a cocktailparty, dance, picnic in the Dandenongs, anda river trip and barbecue. A Formal Dinnerwas held at the University, Mr. Newman-Morris and Dr. Sinclair were among theofficial guests.The guest speaker, Mr. Douglas Donald,from Prince Henry's Hospital, combined thenecessary entertainment with more seriousreflections on the problems he consideredlikely to face the medical profession in thenear future.During the week the students visitedmany hospitals and institutions in Melbourne,including the four teaching hospitals,Royal Park and Kew ReceivingHouses, the Commonwealth Serum Laboratories,the Walter and Eliza HallInstitute and the National Gallery. Complementarytickets for a League footballmatch were also issued to interstate visitors.The Convention concluded with theAnnual General and Council Meetings atwhich the University of New South WalesMedical Society and the Monash UniversityMedical Undergraduates' Fraternity wereformally welcomed to membership of theAssociation, bringing the number of membersto seven. Projected plans for the comingyear include: efforts to stimulate interestin extra-curicular activities amongmedical students, and to include non-medicalsubjects in the early years of medicalcourses; establishment of a scheme wherebymedical students can obtain a trade reductionon books and instruments: liason withthe Medical Education Sub-Committee ofthe Australian Universities Commission;and the publication of a regular A.M.S.A.Newsletter.Above all, the Association is anxious todevelop in a similar fashion as its Britishcounterpart, the British Medical Students'Association, who have supplied us withmuch information and advice, particularlyin their reports on Medical Education. Andnow, encouraged by the success of the Convention,and on the advice and support ofMr. Newman-Morris, Dr. Sinclair and Mr.Donald, the A.M.S.A. will seek to affiliatewith the Australian Medical Association.John McEncroe,Hon. Sec. A.M.S.A.,SPECULUM 1961

REPORT—UNOFFICIALTune: Macnamara's BandWe came to Melbourne in the fall of theyear of '61,We've happy memories of it all, we had alot of fun,The hostesses in the Kew Town Hall, theyall had lateral holes,The coiffes prevented all the boys fromreaching their low goals.Hooray for Moriarty's and for JimmieWatson too,We wish that Mary Patterson had beenaround to woo.The dinner in the Union Buff, it was a jollyshow,Until the jokes which Hazel told, theyreached an all time low.We all went down to wine and dine atMolina's down the road,Where Fuzz's pea in the butter dish wasnot quite a la mode.The waiter expected a great big tip, but gotsuch a surpriseWhen Timothy offered a shiny zac, hecouldn't believe his eyes.Who pinched them blooming pistols, whoPinched them sugar bowls,MEDICAL STUDENTSTo preach idleness to the medical studentwould be taking coals to Cardiff or penicillinto St. Mary's.— Sir Heneage Ogilvie, K.B.E., F.R.C.S.,M.D.Medical students are the best bartenders,polite, hardworking, quick witted and witha sense of humour.— Bernard Miles.Samson Wright was quoted as havingwhimsically described the ideal medicalStudent as "tall, handsome, of great personalintegrity, beautifully mannered, cultured,highly intelligent, a tireless worker, original,good with his hands, skilful in exposition,a good mixer, athletic, devoting his sparetime to extramural activities, with a goodfamily background," and so on and soforth—a dazzling Olympian but certainlynot to be found amongst men.— W. M. Arnott.S PECULUM 196 1Who stole the gong in Brisbane, and whoruined all our souls?It was our charming visitors, not mentioningany names,Just wait till we get over there, we'll do thebloody same.Tho' Vondy and Co. left early, and wentto see the Snowy,The rest of us stayed on in town and hada drink with Chloe.We had a look for South Wark but couldn'tfind a drop,So back we went to Chloe, and found wecouldn't stop.The social organizer was Mr. JaguarGeorge, heTook us up to Hawthorn where we had ourown orgy.The jazz band played a merry tune, and weall drank lots of beer,For we feared the cops might lock us upwithout Madeira dear.The lectures came from eminent men inthe school of Anatomy,The scarlet waistcoat on one of them suggestedthings to be.We finished with a barbecue, we sailed farup the creek,And the girls all hid their faces while theboys got out to leak.—AS OTHERS SEE US!Mrs. Raddle: "Do you suppose that I'ma-going day after day to let a fellar occupymy lodgings as never thinks of paying hisrent, nor even the very money laid outfor the fresh butter and lump of sugarthat's bought for his breakfast, and themilk that's took in at the street door? Doyou suppose a hard-working and industriouswoman has nothing else to do but to workherself to death after a parcel of lazy, idlefellows that are always smoking and drinking,and lounging, when they ought to beglad to turn their hands to anything thatwould help 'em to pay their bills?"— Charles Dickens.Mr. Pickwick: "They are fine fellows—very fine fellows—with judgments maturedby observation and reflection; and tastesrefined by reading and study."— Charles Dickens.PAGE SEVENTY-THREE

SUCRETS'soothesorethroats/`SUCRETS'ANTISEPTIC LOZENGESFOR MOUTH & THROATINFECTIONSOBTAINABLE FROM CHEMISTS ONLYPAGE SEVENTY-FOURSPECULUM 1961

YEAR NOTESFIRST YEARThe Saints Came Marching In . . . .This year began with most of us wonderinghow we managed to be here, and afterIt first few lectures, wishing we weren't.tt was as though we were scapegoats uponWhich the lecturers could unleash theirwrath.Somehow the fear of lecturers has worn,Off, judging by the way the boys are stimutatingEugenie Tuck's sensitive spot, muchto Mr. Mather's disgust, causing her to emitbursts of Pleasurable laughter. Talkingabout sensitive spots, Ted Rafferty seems tohave done the trick; he has entered the stateof married bliss. We all wish Ted the bestOf luck in both his studies and his privateresearch.Tony Sneezewell seems to be the outstandingsportsman of the year. After winningthe high jump in University Athleticshe travelled to Hobart and took the honoursagain in the Inter-Varsity sports. KeithMather also starred this year; he wasawarded a gold medal by Polydor for hisrevival of the old hit tune "Down South".Keith hopes his latest release, "North ToAlaska" receives as much response. Weall do.Dr. Stranks mentions too often for coincidencethat an Irish scientist by the name(1f Kohlrausch worked in Glasgow. PossiblYa good hint for the finals.We are sorry that Mr. Mather does notaPPreciate the enlightening discussiongroups held by the Back-Row-Boys duringlectures.Mr. Boredom is giving serious thoughtto entering the umbrella industry so that hecan sell them to those students who havet o sit up the back during Zool. lectures.Surfers must have done Dr. Stranks a lotSP ECULUM 1961of good; all his experiments are working.That's not all, he has magical powers; heonly has to pick up a rubber ball, immerseit in air, throw it at the wall, and it shatters.But as the year's end approaches, webegin to wonder who will be in next year'snotes. With our fingers crossed, a littlework, and a lot of luck most of us will getthrough.Things could be worse, we could bedoing Science.SECOND YEAROur first glimpse of the Almighty was inthe form of Prof. Russell who assured usthat the Anatomy school is the only UniversityDepartment with its own act ofParliament. Red has asked that relationswith Physiotherapy students be limited tothe dissecting room tables. Closely followingwas the suave Leslie John, whose pottedtutes on surface anatomy are cherished byall. Others to be seen tripping through thehallowed halls of Anatomy include Dr.Lavarack whose happy laugh fills the Berryevery Wednesday morn. His series of lectures,"Seven years in the uterus", arealways packed. Dr. Merrillees whisks inand out, while Dr. Kenny rambles throughthe cerebral peduncles.Among the guests who motored up fromthe Biochem. School were Drs. Finch andStone. The former, resplendent in hisastronaut-type crew cut, has become notoriousfor his heavy grogging during lectures.On a good day he can get through aboutsix beakers (the 400 ml variety). His associate,Dr. Stone, has proved once and forall that, providing no one particularlywants to take notes, it is quite possible togive a three-hour lecture in 50 minutes.Pansy's 11.45 siestas are looked forwardto by all. Those in the know say we geton to Physiology next term sometime.PAGE SEVENTY-FIVE

Patsy, of course, still runs the Thursday andFriday Physiol Prac. Clubs, though webelieve on good evidence, that severalwarnings have been made by the vice squad.The Med.-Physio. football match endedin a dimantenous defeat for the fair ladiesof the medical school led by Judy Y. Buttheir male supporters were not without theirrevenge. Police reported later that severalyoung girls had been criminally tamperedwith and left distressed outside the V.D.clinic in Little Lon.Social function of the year, of course,was the sherry party which claimed fewervictims than usual. Highlight of the floorshow was Pansy's vivisection of Peter P.Heather got John McK. home safely, butunfortunately the engagement of Henry F.and a certain demonstrator has beenbroken.Richard C. has been unanimously electedas "Embryo of the year", no doubt for hischildish behaviour in the men's wash room.Fred (Scron) M. was reported to havebeen negotiating with Prof. Sunderland(during one of his recent trips to Australia)to introduce bottle nights in the Histol. lab.So far nothing has eventuated.Dawn E. has just purchased a brand newInternational utility and is willing to givefree rides to anyone interested.Alec McG. couldn't wait until 4th year tostart obstetrics and is now wallowing in alife of wedded bliss.John W. has been living in college withsome imported night club "entertainer" forthe past month. It is understood that unlesshe cleans up the mess in his room hewill be sent down in 3rd term.As exams approach we turn our footstepsfrom the Mayfair and wind our weary wayback to the Med. library.* *Girls are like newspapers.They have forms.They always have the last word.Back numbers are not in demand.They have a great deal of influence.They are well worth looking over.You can't believe everything they say.They carry the news wherever they go.They are much thinner than they used to be.You have to pay more for a good one.Everyone should have one of his own andnot borrow his neighbor's.PAGE SEVENTY-SIXTHIRD YEAR159 students were on the year roll whenthe 1961 lecture season started. Thirteenfaces were missing due to 1960 mishaps;several more faces were present for thesecond time due also to similar circumstances.The year got underway with the usualintroduction to Treth—the Med. school'sJack Little—and perhaps a more sombreintroduction to Pharmacology—joke a weeksubject. However, most people havingreached the third year of their course decidedthat the time had arrived to settledown to work from the first day, speciallywith the big essay hanging over their heads.Perhaps I should tell you of some of theleading lights of the year.Did you read the article about umpireP.K. as he was presented to his fans, theyouth of Melbourne, in the Young Sun.Also in the sporting spotlight recently isC.P., who retained his seat in the Melbournecrew at the inter-Varsity regatta inthe first vacation. Perhaps he will be ableto tell us himself why his crew did not bringhome the cake.Hear about the girl who gave the thumbsup sign to the lecturer? Obviously headingfor a dismal fate, don't you think?Another personality of note is I.C., whomanaged to rig the elections and became theUniversity hockey team's vice-captain forthe 1961 season. I see he hasn't beengiving himself the usual back pats in hisFarrago reports.Did you realize that G.K. became thefirst anatomy lecturer for first year Occupa -tional Therapists this year? Don't worryabout them, he didn't last very long.Then there was G.G., who arrived at aSaturday morning lecture in a dinner suitno one believed him but he tried hard.Must extend congratulations to J.F. onher announcement of her engagement earlythis year.No other great romances to report,though several knowing looks are gettingpassed by one couple in the dissection room.Did you hear about the ancient footballer ,but then Treth would not like any adversecomments about his ability.Best of luck all in your exams this yearand also to those who will take your place.SPECULUM 1961

PRINCE HENRY'S HOSPITALFOURTH YEARAs in previous years, P.H. has once againattracted all the talent (non-academic, thistime) .It is pleasing to note that there has beenno card playing, liquor consumption, flirtingwith nurses (no wonder) or other timewastingoccupations. Boy, what a dead hole!One of the features of our hospital is theclose co-operation between the ClinicalSupervisor and the students (ask anyone . . .ask Fedora). On the "sporting" side, washighly successful cricket match against St.V's. Result: 60 cans (and the P.H .team allnon-drinkers!)The social highlight was a grog-on tosuPport Irene, our Miss Med. (how sheneeds it!) Notable guests included Fedora(last year's Miss Med.), Graeme G. andblack friend ("I thought this was going tobe a square turn") and Sid!Noticed lately:Dan K. has been going grey (with theWork?). Keith T's best friend is his M.U.M.life, (or is it Fred) B. still leads a doublelife, and Bill D's not tellin' nobody nothin'.Fedora T.'s recently done a lot of her Bestwork while "swingin' Sammy" M. sings softCalypsos in the basement..As this issue goes to press, Elizabeth O'sHillman shows no recent dents.FIFTH YEARWith Path and Bugs behind us we enteredthe new year with the approach of a runnerto the last phase of the race — keen inspirit but sadly lacking in energies.But now Women's and Children's havedrifted past and "the sands of time areslowly but surely running out". Incentivepreviously lacking is slowly beginning to appear.The past year however revealed the truecharacters of several of our number, especiallywhile sojourning at R.W.H.Ludwig's sole delight seemed to consist of'Be "banging of membranes", to the accftpanimentof a calypso rhythm.Adam's true character in summary consistedof — the temper of a hairy ape, thepoet's love of Woman, the confidence ofs °d Almighty, the hopeless confusion of aurrealist and above all the one who wasMost surprised at misguided conceptions.SP ECULUM 1961Keay's bongo drums have stopped playingat last, to the great delight of some ofus, but her appliance has now lost its cord— she's still searching!Whilst Brian divided his time between aflat in Parkville and indulging in exerciseswhich placed his body in strange positions.Practising for some strange purpose?Henry demonstrated his interest in Bugsby driving a hot-rod! No wonder Cas admittedhim with a cracked skull.Jim must be wealthy or puritanical —fancy refusing a quid to entertain a certainveiled Blok. Whilst Bob seemed to takegreat delight in giving injections I.M.Don and Marlene gave us no surprise byannouncing their engagement. To you twogo our best wishes for the future. Just onequestion, Don—who was that naked womanin your room?While still on the topic, Peter P. seems tobe Kronically singing "Irene Goodnight"until he disappeared to buy a ring. Heartiestcongrats to both of you.The spirited side of Shirley was well inevidence especially at that party in theR.M.O's lounge — ask a certain Dr. P.J. ifyou don't believe us but you'll have a hardjob finding him — the shock was so greatthat he migrated elsewhere.Jack kept up the joystick of life formany weeks at a time. He certainly had aslip-happy fly. Gaby didn't always like hisgirls abducted, so why was Matron worried?Mark proved the adage "a little bull cango a long way". Did you have connectionswith the signallers in the Nurses' Home?Mick was certainly well known for historso — a lean smooth frame well seasonedby exercise — his torso of course!Whilst still on the subject of rooms —W.R. are the initials of one of our numberbut we sincerely hope they are notpathognmonic of disease. Nevertheless acquisitionof a wife seems to have balancedhis character somewhat.Daryl seemed always occupied — we aresure that he did not spend all that time inhis room studying. We hear he is a man ofstamina for he is now preparing for hissecond stretch at Women's.Elizabeth's true form was also revealedat that certain party. She suffered too, nursingan herpetic lesion for some weeks after.Michael's whereabouts and actions werealways a mystery — we're sure he hadmany close shaves!PAGE SEVENTY-SEVEN

SEEING IS BELIEVINGClarity of vision — the fundamental essential for Opthalmoscopes and Otoscopeshas been achieved by Keeler of England, through their constant policy of workingin close conjuction with leading Opthalmologists and Otorhinologists. As a resultthe name of Keeler in the field of Diagnostic Instruments has become the criterionof quality. Together with quality of performance, keeler features:MODERN STYLINGKeeler instruments are most attractively finished in a modern styling.Instruments that grace a Physician's desk and give pleasure in using.Here are two 'Popular' members of a wide Keeler range:"POPULAR" OPHTHALMOSCOPE FEATURES :• Exceptionally clear, wide angle fundus picture.• Brilliant clear-cut circle of 'white' light.• ± 20 D Lens Range.• Ilinminated and magnified lens power Dial.• Lightweight metal handle with durable polychromatic grey finish."POPULAR" OTOSCOPE FEATURES :• Five Keeler all-nylon specula, sizes 2.5, 3.5, 4.5, 5.5 and 8 mm.,unbreakable and boilable.• Swing-over focusing lens with wide-angle field of view.• Brilliant homogeneous light.• Robust and streamlined.• Lightweight metal handle with grey polychromatic finish to ensuremaximum durability.Diagnostic instruments byKEELER OF ENGLANDare distributed throughout Australia byGLAXO ALLENBURYS (AUSTRALIA) PTY. LTD.MELBOURNE AND SYDNEYPAGE SEVENTY-EIGHT SPECULUM 196

Gideon — Eees it eeet — because youWere thinking of Ann approaching eventthat you spent so long in your own littlelibrary next to the bathroom??Lois and Dick, untouched by suchfrivolity, seem to find a common interest intheir work.David de worked by day. Wonder whathe did by night with his light out?Peter H.:—Rhymes in German you did makeBut you were found to be a fakeRegarding a certain engagement affairYet for a sweet little nurse you showedflair.So now it's on to final year and all itsPitfalls our next epistle is sure to beshorter.Where's the barrel, Jackson?SP ECULUM 1961SIXTH YEAR"Hague finem adimus" (We hope).After six long years those magic lettersM.B.B.S. are now almost within our grasp.Many changes have occurred since we firstbegan at "The Shop". Dr. Rodgers has retired,Dr. Brown has gone to Monash andFaraday Street has gone forever. The numberof students at "The Shop" has almostdoubled and now we have a new University.It is interesting to look back over the lastsix years — remember Premed and thatcaricature of Dr. Brown and how Physicsand Chem. Prac. nearly drove us mad?The first time we entered the DissectingRoom in Div. 1A, the Mayfair, "The FlourBattle" downtown with the police, thatSherry Party — and of course Panzee?Remember Div. 1 and how glad we wereto finish Anatomy. Then to Bugs. and Path.,and the first time we came to PrinceHenry's, when the Student's Quarters wereon the 11th floor, learning to play solo andBugsy at the P.H. Ball?Remember last year — our stay at theWomen's and our "sporting fixtures". Thenthere were Commencement Balls and Med.Dinners.And now final year — yes it's been agreat six years.We finally did get together a footballteam and played R.M.H. at Hurstbridgefootball ground or swimming pool — westill don't know which. R.M.H. won a highscoring match — 2-11 to 1-1 though we'resure R.M.H. bribed Have Gun (the umpire).Maggie is still being rubbished for frontingdown to the river that day. Jackson said thathe caught three four-pound Redfin duringthe match.Once again numerous members of ouryear took part in The Revue which unfortunatelyclashed with Medleys. John H.and Paul G. were instrumental in writingmany of the scripts. Supe's portrayal ofHoratio V.D. and Scar was too good to betrue. Here Jackson, Henri, John B. andDave B. also displayed great acting ability.Jackson undeterred by the result of hisbookmaking at the Women's Hospital continuedto run Sweeps with unceasing regularityat the slightest opportunity. It certainlyprovides a few laughs, e.g., when Hercdrew Summer Honeymoon in last year'sPAGE SEVENTY-NINE

Melbourne Cup Sweep, while holidayingwith Jan up at Wagga. By the way Herc,when is the big day?Congratulations are due to the followingon their engagements. We might add thateach of them regretted it just once— thenights they visited the Royal Domain: BarryB., Graeme H., Dave B. and Harry N. haveall taken the plunge.The admiral is still trying to convince usof his virility — but we won't believe him— not with those "retractiles". By the way,Maurie, has your auntie really got malegonads?Leon L. looks much more handsomesince his upper incisors have been repaired— how come you don't play squash (i.e. thevariety with the racquet) any more Leon?Graeme H. repeated his act with the B.P.bottles this year. We suggest that the P.O.W.machine "ties him down" with that shockingtie next time he tries it.We erected a statue to Henri ze greatFrench lovaire and now it sits on the'fridge in the lunch room — we are pleasedto note that recently a mate for it has arrivedfrom Texas although they haven't gottogether yet — and that's no bull.We finally discovered what the S in J.S.R.stands for — Stirling, following his magnificentdriving exhibition one Saturdayafternoon.Our recent visit to the Blood Bank wasmost enjoyable. "Vampire" Barnes was soenthralled that he wanted to go back asecond time. Jackson too was most impressed.After extolling the virtues of becominga resuscitation officer stated: "Ohwell fellows, I guess you'll all be getting meto resuscitate your patients in ten yearstime". You should have seen Jackson's facewhen someone said "Oh yeah".Bugsy went home to Fiji for the last longvac. — tells us he behaved himself for sixweeks — if only his parents knew.Boosy Bill still spends most of his timebetween the army mess and the Graham.The big feature of the Refresher at theWomen's this year was the telly. King Kongand Saxy Maxy both had square sore eyesfollowing their two weeks there.Starchy didn't waste any time with thetelly — he was more interested in thePharmacy.We are all surprised that the WoollyBear has not been carted off to the Zoo bynow.PAGE EIGHTYThe sapling of course still sleeps andsleeps . . .In conclusion we would like to thank theHonorary Staff at Prince Henry's and all theothers who have taught us so diligentlyduring our time at this hospital and we onlyhope we can justify their efforts in the comingexams.Finally, good luck fellows, and pleaselet's not see your name in the year notesnext year.ROYAL MELBOURNE HOSPITALFOURTH YEARIt is hard to tell how much work andhow much play is being done this year.The Clinicians are optimistic and saythat they expect a few honours in Path•this year after noting the attendances Inclinics.Some of us have legitimate excuses. AlexG. is now Editor of Farrago and we havenot seen much of him since he took up thisposition. Jack B. says that his biggestworry this year is being S.R.C. president,but we don't believe that it is.Show poker seems to be replacing themore standard form of the game. Sid A.and Alec B. were not satisfied with winninga fiver in an afternoon, they now considera tenner reasonable return for a day ' swork.Every time we see Craig Mac. he iseither just coming from or going to drivesomewhere a load of eighteens. He stillcan't remember who he took to the barbe -cue on the last day of the convention.We had one interesting case this year, anun who had been raped in a park onenight. It took two years plastic surgery toremove the smile from her face.How long to go till the next inter-hospitalcricket match? Could be sober enough tobowl a ball onto the pitch this time.Sick joke: Dentist to patient, "Of coursewe won't have to remove all your teeth ,sir, just the gums". Not so funny reallY.FIFTH YEARThe first intake at the Women's startedquietly with Garney and the Stallion cracking their whips. These gun boys ("gun" Isaid) had been told to smarten up the stu -dent quarters after a particularly rowdymob last year. In spite of these mino rSPECULUM 1 961itaCJC

impediments the facts of life were learntas well as practised.Dave H. starred as usual by heading thelist in the test at the end of the ten weeks.Could not even take time off to entertainSue and Marg when mouster Don McO.Was called to sea.John (pounder) R. was on the spot inhis bedroom.Major John H. finished up with a scoli-°s1s because of so many deliveries (Defn:SeOliosis, a marked list).Chinese Janitor Wilf (no relation) neverceased wondering at the sleepy figure ofJack F. Each morning as this orientalgentleman came to take away the manyempties he would mutter, "Velly good party,velly good, nan velly good."Young Brown (of rugger fame) went tooJar, when he jammed a middy in a babyPram, sent the lift two floors to be greeted'3' the night sister on her late hospitalround., Graeme M. engaged soon to be marriedhad a quiet time. Makes good coffeetho ugh.Who was seen in the bathroom?Bob R. (son) spent more time playingCricket in the last week than learning obstetsas was found out. Or perhaps it wasJulie?Harry Palmerston R. still brings homethbacon .Barry D ("Dreamy Daniel") still in bed°Ile morning about ten was asked by Garney1 711Y he was not at a clinic. Barry repliede was not supposed to be at any clinic. HeWas supposed to be in Labour Ward., Perhaps these notes should be concluded°Y a list of just a few of our achievements:1. Planting a flag on top of the chimney.2. Cooking carrots in Ward 19 autoclave.3. Six nurses attending antenatal clinic.We believe Wilfred does wonderfule°sMetically b perfect sutures and is a strongeliever in immobilizing his works of artth the position of function (his patient withfue lacerated penis is reported to haveround Wilf's plaster so functional that hehPorted back to O.P. two months later with,e plaster worn out and requesting a re-Placement).t_ 1(oss A. doesn't know the difference be-"en oral and rectal thermometers.Allan E.'s honeymoon was rather upsetSPECULUM 1961by finding John M. as a drink waiter intheir hotel.Geoff G. had a rather delicate operationperformed but the scar isn't really noticeable.After all, who goes round looking ats.John M. has been a changed man sincethe new Falcon has been released. Theysay the Heart's Desire House is going toupset things a bit.Carroll M. has been successfully fightingoff advances and saving up for his owntrue love.A golf foursome was rather put off theirgame at Yarra Bend the other day. Rumourhas it that they are returning to the thirdhole with a Copuloscope to carry out aclinical study.S.M.S. is engaged: Congrats: The samedoyen of oriental cunning along with oneTony W. has been systematically winningat the card tables.Tom R. is said to be boycotting Dr.Cade's lectures following his statement that"nine out of ten Scotsmen are alcoholicsand the tenth is a depressive." Tom's explanationis that it's such an awful worldthat if it weren't for the wee droppy itwouldn't be worth going on.Alan E., Norm E. and Ian R. (our marriedmen) are still making ends meet(pending Ascheim Zondek).John S. and Mif have been revisinganatomy so thoroughly (?) that they areuncertain whether to layby for surgeryhonours or a layette.Ian R. is connecting a direct line fromhome to students' quarters as he isn't gameto go without Mary's approval.S.S. is reported to have had an affairwith a white Leghorn over the vacation(not a rooster but a hen: there's nothingqueer about S.S.).This resulted in J.S. passing through astrange phase early in the year "Why havewomen when you can can have the realthing?" However it didn't last long (Laurelsays because he couldn't get up for down)and is now happily engaged; Congrats.The most pathetic sight at R.M.H. isNorm E. sitting in the Students' Quarterswith a big bag of vegetables waiting for alift home from S.S., who is finishing hisround of the Nurses' Home.Richard by any other name would stillbe sweet.PAGE EIGHTY-ONE

FINAL YEARMal B. (at party celebrating end ofR.W.H.) was seen drinking out of orthodiaphragm.Ren B. gave blood also at R W H ; Kahnve, says W.R. was –ve, but!!!! Enjoyedofficial wife living at R.W.H.Roger B. is enjoying married bliss.Stuart B. (among the rushes of the Nile)is upset because Pharaoh's lovely daughteris sailing away.Loo-C.C. — engaged.Owen C. — enjoyed trip to north.Mike C. is our exponent on transferasesystems.Mal. D. continually frustrated. Even 3rdtime not lucky.Tommy F. brought wife to Melbourne,left baby in Malaya. Was it worth £20 notto play cards at R.M.H.?Binky F. to marry in January.John G. just announced his engagement.Wal H. is not really asleep. Just absorbed(in what?).Dave J. frightened daylights out of femalecolleagues and waitresses at R.W.H.;decided to try a new method of inductionof labour — walk through the labour wardwith a gorilla mask.Roger K. "hasn't enough brains to be adoctor" said the milkman at R.W.H. aftera cracker exploded by his car.Bob K. still has that vintage look — likesgood wines and good women. His Bugattiis well preserved.Peter L. took his girl friend to Sydneyfor a few days, under pretence of retrievinga stolen car!Tom M. is after a roll too, in or at Hay.Ian P. — Ken Cox's Matt Dillon.Dick P. didn't amuse Garney by takingfriend into eclamps ward.Bruce R. plays the oboe.Graeme R. is doing M.B.B.S. and Radiography.Murray S. was carried away at FrankstonOrthopaedic.Ann S. and Fiona W. flat together.John S. is to marry at end of year.Jim S. is engaged (unofficially that is).Maria S. now has two kids.Jim W. — married 3/12.Eveyln W. — should we be officiallynotified of your elevated status?Brian W. — married.PAGE EIGHTY-TWOEnd of R.C.H. was celebrated by morn -ing tea (and lunch and afternoon tea) atJimmy Watson's.Last year R.W.H.Group III — Kangaroo day.Group IV — West-side-rockets.Lance says: "There is only oneauthority before exams." (Huh!)"Best way to take temp. for ovulationchart is P.V."Lance examined patient but forgot thebreasts.Voice from the back (Ren B.) "You'llfail."ALFRED HOSPITALFOURTH YEARHaving successfully negotiated the manytraps for the unwary in the pre-clinicalyears, 31 of us descended last Novemberto the delightfully antiquated surroundingsof the Alfred to be lulled by pleasant words,cream cakes and tea into a state of falsesecurity and blissful ignorance. It allseemed so easy at first — any fool couldsee that the patient was as yellow as apound of butter when the honorary wastaking the history. The only trouble wasthat when you had to do it yourself, thesewere the sort of things you completely forgoteven to look for.After Christmas, our numbers wereboosted to 35, having lost Ian G., who leftus for a year's "research" at PharmacologY ,D., who wanted to and almost losing Paulgo to the R.M.H. instead, but who thoughtbetter of it after the Christmas Party. Wewere joined by five from last year, includinSJudith, "the one with the haircut, sir' •When are you going to finish knitting thatyellow monstrosity, Judy?For the first few months of the year, Weamazed all others present by virtually re'fusing to play cards as a whole, but afterthe shocks inflicted by the Pharmacy exams ,solos, both professional and amateur , manyare now flourishing. On the sports side,we had many conscientious tennis player slast year, but they seem to have disarpeared — not exams, I hope! As far asinter-hospital sport is concerned, we havenot been very successful, for we lost (some'one cheated I'm sure) both cricket matchesSPECULUM 1961

Played against R.M.H. and St. V.'s. I hopethat better things come to be during thefootball season, Chevron or no Chevron.On the matrimonial side, the boys havebeen very active. Long overdue congratulationsto Nelson W., who had, by examtime last year, produced his first. I hopethere are more to come, Nelson. Congratulationsalso go to Darryl C., John B.,Ritchie W., David F., who decided Christmaswas the time; and also to Peter den H.on his recent engagement, and on the factthat he's a stronger man than I to last outuntil after finals.Heard during the year:Eva S.: "To test urine for bilirubin, puta little fat in it."Eva again: "What iss zhiss bull?" "Amale cow, Eva!"Interesting stories about R.M., surfboardsand double beds at Portsea: "We're justgood friends, John."Ian McC.: "Dull, but tympanitic, sir."Mr. R. in surgery clinic: "Pancreaticjuice smells just like new mown hay."Keen student, after smelling pancreaticfistula: "But that doesn't smell like hay, sir."Mr. R.: "You've obviously never rolledunder a haystack in your life."Comment: Simple things for simplepeople."Same keen student in one of Dr. A.'sP.M. demonstration: "One of the causes ofpulmonary hypertension is sex hormones,sir."Darryl C. at last got the long awaited bedin the Alfred. The only times we ever sawhim, he was sleeping. Interesting thoughtsas to what happened to the night staff.Have been hearing long grumbles thatthe nursing staff are thoroughly dissatisfiedwith us. Obviously Peter B. is losing hischarm — not his money though.Dr. W. in Bry's lecture:There was a young man from Malay,Who thought Chancre was auld in a day,But now he's got tabes,And gummatous babies,And thinks he's the Queen of the May.ere glad to see Blair (the Crusher) C'scheery face at clinics ocasionally.This is enough slander and libel for11°W, so the best of luck to all, and hopeto see you in October.S PECULUM 1961FIFTH YEARAgainst a background of wedding bellsand the threat of splashing christening fontswe battled into the exam-free penultimateyear.Amongst those who couldn't wait wasIan McI. and John S. Appropriately (orinappropriately, depends on how you lookat it) they had hardly brushed the confettiaway before they were in the Women's for10 weeks incarceration.Apparently Bob A. has been trapped atlast. Good thing . . . no more parkingoffences.That well-known urban alpinist, RogerM., has acquired a vehicle. It has S*Xon its number plate (amongst other places).PAGE EIGHTY-THREE

MhDLI-TS 1961Date: MONDAY, DECEMBER 4IFYOU PROVIDE SCRIPTSSONGS AND CASTPRODUCER: J. BESTPAGE EIGHTY-FOURSPECULUM 1961

Hugh N-J, an intrepid character as a rule,was seen clambering hurriedly from the"suicide" seat into the back as Rog headedfor triple figures in Johnston street onenight after a "convention" party.It is said that John R. and George F.both enjoyed the Women's very much.We understand the New Zealand authoritiesbreathed freely for the first time inweeks after Elliott R., Paul V. and BrianR. finally headed back from their holidayfling — a week late for the Kids. Weunderstand they formed quite an attachmentfor the Maori race.Since then Paul has been making a greatrun on the sterility clinics — his friendsWonder whether he is trying to pep himselfup or damp himself down.Ever since, Elliott has been playing witha couple of balls on a string given him bya Maori maiden (pois they are called). Wethink Ron Kingston should probe this one.Perhaps Brian didn't crack it — anywayhe's been taking it out on the football fieldever since. We see in the Sun that hemade the Demons. It's rumoured he madea deal with Lance — some free publicityfor the Prof.'s new book in exchange foran untroubled passage through final Obstetsand Gynae.Bernie F. timed things nicely — he'sable to make a personal study of Obstetsand paediatrics.His friends report that Leon F. is growingyounger every day and was the liveliestperson at the Women's. They think hehas hit the menopause and bounced backagain.Has anyone noticed how thin Danny C.has been getting? His friends think thisis due to an attempt to live on the fruitsof love., One of our girls raised Uncle Ted's eye-Prows recently. Bev. M., after examiningher O.P. male patient, came back and re-Ported: "Yes. I found tenderness in bothscrotums sir."By the way, which of the girls was insuch a hurry she just couldn't wait? Factis that someone knocked a great hole inthe wall of the lady's lah with a motorcar. Renee S. put up a written disclaimerthat it wasn't she and her Fiat ("Chuffa")., Paula has been around again. She's beenboning up on her anatomy lately afterUncle Ted found an embarrassing gap inher knowledge. What's this great ugly monsterof a shadow on this pelvic X-ray?, Tedwanted to know. An unusual shaped calculus?No. Barium? No. Good gracious,woman. Don't you know a penile shadowwhen you see one?Guess what happened to Helen W.?Invites Mom and Dad down to have a lookat Student's Quarters. Ushers them in with:"This is my bed." Hurriedly backs out asshe notices somnolent figure stretched outthere fully clothed. Brian S., suffering fromethanol poisoning, had found the wrongdormitory.Robert W. and John H administeredthemselves overdoses of the same toxinbut found the right room.The word is that John has coughed upfor a ring at last.It's rumoured in some circles that Robertis being pressed on this matter too.Warren W. scored a very doubtful fullmarks recently when, without blinking aneyelid, he reeled off to a startled clinician(who had asked him) half a dozen causesof persistent priapism. Top of the list waspsychogenic.Dave C. has been wearing a worriedexpression recently — ever since he judgedthat baby show. One mother reckoned hewas wrong in his decision and she alsoreckoned she was big and strong enoughto prove it.By the way, Conrons first started hauntingAlfred corridors around 1950 and thehospital hasn't been without a Conronsince — even got two at the moment.Activities on the solo front have beenmaintained under the leadership of William("Four Trick") B. and that well-knownmisere caller Donald ("Ace Bare") R.John T. is becoming known as the Alfred'stop chest man. His interest in chestshas extended at times even to patients. Athis first Gynae clinic, after digitalising thepatient, John was asked by Jimmy Buch.how he thought it felt. He replied: "Feelsquite normal to me sir."Peter R., after a five year gestation, recentlygave birth to his alfa Romeo. Wastelling Kevin Hinrichsen about it. Kevinsympathised with him for not being ableto afford a newer car. How hurt can youlook?By the way, who put the bra in the backseat of Pete's car? Female vintage carSP ECULUM 1 9 6 1 PAGE EIGHTY-FIVE

enthusiast ran across it on tour of inspection.Pete hurriedly explained that somedrongo had draped it on the radiator capand that he had thrown it in the backhimself meaning to get rid of it.Another big event of 1961 is Dave W.'sflat. There's nothing vintage about thisexcept, perhaps, some of the grog andfemales.SIXTH YEARInstead of the well known six of usbeing worried every month, now withseventeen weeks to go, all of us look apprehensive.Here is a brief account ofhow a few of us are bearing down, sorry"up" under the strain.Ted T. is paying the price for his hypergonadismand the happy event is due sometime in September. Let's hope it doesn'tsimulate it's father too much and causecephalo pelvic disproportion.There has been no word from the othermarried members of the year. Evidentlythey have been surviving the constant onslaught,but I hear Bill has settled for thenext best and bought his wife a dog.Ken has been admitted to Ward 3 fora Ptorak operation (he insists it was aBassini) and I am told he was holding inthe clinch . . . establishment and had arough time. Don't worry Ken, there is stilltime to prove yourself.What a thing these exams are. EvenSlammer Sammy is finding it hard to fithis normal activity in with his work, and istrying to gain time by keeping a libraryseat warm all day . . . don't know whathe does at night.The therapeutics lectures are a bit of atrial on the public — just watch Micka andCotta hitting 60 along Commercial road, at8.30 on Tuesday and Thursday mornings.Nella and Jack have quietened down abit, now you can only hear them two yardsaway.Congratulations to Ben on another additionto his family. Now he must haverun out of long underpants.As for the others, they have been keepingfairly quiet, probably doing some quietwork on the side. Let us hope it doesthem some good, and that there are 23 ofus in the residency next year.PAGE EIGHTY-SIXST. VINCENT'S HOSPITALFOURTH YEARHaving successfully fooled the examinersin Anatomy and Physiol., the cream of the1960 Div. I year applied for St. V's, and,happily enough, were accepted. These 31newcomers, together with four notorious"old hands" (Yari "Hamish" Hrychow, nowco-editor of Farrago, Dick "Longfellow"Vasta, Joe "evil eye" Goh and GazerVarasdi — athlete, gentleman, scholar),comprise what is doubtless the elite of Div.II Med 1961.Leslie has left us to enter upon a life ofmarital bliss. Bill, on the other hand, findsthat marriage in no way interferes with hiswork.Once again the most beautiful girls cameto St. V's — and we're glad to havethem with us in clinics — the honorarieshave to think of somewhat more subtle waysof declaiming our ignorance.While Frank Power, Jock O'Connell (thequiet man), Klaude Zd., and Lawrence (sexis best) Carrot prefer table tennis toFoster's, Norris ("I pass none") Carter, TenFoot Terry and Dave Cade keep fit massagingtheir fingers for the big Poker school.John Mac. and John W. helped to makea success of the Med. Students' Conventionby their sterling efforts. Darryl ("GlamourBoy") Nye who greatly impressed our candidobserver with his social finesse at KewTown Hall would doubtless agree.The new slimline "Butch" and Martin"Parrots of the world" Hartnett are wellnoted for a suave bedside manner whileBrian Thomas is looking the part too — hedrives a Rover. Otto and Chris have renouncedthe demon drink following recentlectures on cirrhosis.According to my source of information,Nelson's casualness may have been grosslyoverrated, while Jack "I love 'em all" Kennedycontinues to impress. Better watch outgents, because we heard that all the nurseshave gone to "the Dogs" — half his luck.Heard that Mick (the hole) Purcell isearning untold brass swatting at barfliesincluding solid citizens W.J. and Norman"intervarsity" Resch. And did you noticeM. G. (Barassi) Malone's swift return to fitnesswhen he heard the Old Xays. game wason TV?SPECULUM 1 9 6 1

By the way, it is reported that Swarth)Jock "Stilleto" Cravana has rejoined hisMafia comrades following the insidiousmanner in which he pranged M.G's motorscooter.It's just a rumour mind you, but oursource says that Mike ("faith-healer") PRlakis,while practising his PR technique ona pig, managed to cure two sides of bacon.— Since we find it impossible to concludeon a sober note, we'll just wish us allthe best of luck in the forthcoming exams— we're sure we can fool 'em again.FIFTH YEARThe year opened with the return to St.Vincent's of the 36 of the laziest studentsthe hospital has known coming back to upholdtheir reputation. With no exams thisyear this has not proved difficult. To helpwhile away the hours they made use of theadjacent public houses, the poker tables andthe congenial company of the opposite sex.So far this has not led to any increase inPopulation but the results of the NationalCensus are being anxiously awaited.The girls have been rather quiet, butrumour has it that Felicity and "Rexual"W. are still seeing rather a lot of each other(they say that Rex had a crash in his helmet)and that Mary M. was a frequentvisitor at the R.W.H. when P.H. studentswere there. Adrienne and Gwynne are stillcontinuing their association, while Mary D.was starring during the ball season and wasseen in some amorous situations. JoanMcK. and Jane A. refuse to divulge theirextra-curricular activities but we believethat they are on a non-profit-making basis.At the beginning of the year the boyswelcomed Mick S. from South Australia, anoted drinker, smoker, gambler and runner,and something of a Casanova. Bernie'snew V-W has suffered a lot of minor trauma,as has Bernie. (The plastic surgeonwill confirm this!). Jack C. has also joinedthe V-W owners and reports that the laybackseats make it much easier. RupertH. and Andy G. have been breaking morehearts round the Nurses' Home and withlong practice their technique is becomingMore polished.Ken F. has deserted us for his more alcoholiccolleagues at Newman — is this amanifestation of certain latent tendencies?The married, and "as-good-as-married"SPECULUM 1961men, Arthur H., Robert P., Alan H., ThongV., Neil Sist, Gerry I., and Beppo, areliving off the fruits of love. (But, pleasegentlemen, don't throw the peels out thewindow.)Julian M. and Warner M. play a hardgame whether it be with poker, squash orwomen.Hoping to score 100 for the year, Georgehas improved his chances by buying anM.G.A. Financial help for this has comefrom the discount he receives from theDrug Houses, as a bulk buyer and oldcustomer.Vince works the hardest in the year andwe cannot tell you whether there is anyromance in his life. No-one knows whatPeter H. is up to either — but rememberthat "still waters run deep".Rees, the rhythm expert, finds his stereoa great help for entertaining, despite thenuisance of having to get up and changethe record. During his recent stay in HongKong Nick D. was learning a bit aboutOriental technique for when the Chinesecome in 1970."Maverick" I. is still very prominent atthe card table and has recently been joinedby Jack E., renowned for his exploits inthe Tunnel of Love, with fast-talking JulianB. occasionally honors us with a personalappearance at a clinic. Does he play soloby himself in his spare time?They say that Paul M. has bitten offmore than he can chew!! He is trying torun several girls at once.Jo Chow has fulfilled his ambition anddone a P.R. A pity he had to use hisfinger. Our Asian friends Lim, Lim andLim, have confounded the Health Departmentlyr introducing a resistant strain ofspirochete.Best of luck for next year to all the crewof the good ship Venus.SIXTH YEARReturned to home base after a shortstay, no expenses at Tugger's private hotelwith its varied night life, high class amenitiesand as many women you could pointa finger at.The year's best comment:Dr. J. H.: "What sort of people get Raynaud'sdisease?Students: Silence.PAGE EIGHTY-SEVEN

Dr. J. H.: People who work as rivetersand have vibrating tools.At the moment topical interest lies inthe new appointment for Professor of Medicine.Peter McC. is a hot tip for the job.Referring to the nasty subject of work,John C. sees every patient who comes tothe hospital and even sees some twice.Bob W. surprised all by racing a R.W.H.employee off to the bush for the day —presumably to study the birds and the bees.`Worker' G. is doing more tutes than anyonein medical history. Also hopes toeducate the 'Yanks' in medicine next year.Highlights from R.W.H.After having a romance with his `legger'Henry L. spent his time at solo and distillingillicit 'liquor'.Kevin S. was the boy behind the "K forKanga Day". Reduced poor Dr. M. K. toa nervous wreck.Annie D. had a habit of straying intoother peoples' bedrooms wanting to playgames.Jonathan R. used to get heavily scentedletters while "Stallion" Roy F. still getsattacks of exhibitionism after his "Starkers"trot down the corridor.Bernie 'Pops' R. suffered from inversionof sleep rhythm and was heard often towake at 3 a.m. and slowly begin to shoutabout 'B placenta grinders!'Dick McA. was kept busy defendingstudents' rights while John B.'s mating callrang through the labour ward when themoon was full. Also doubled as wardcleaner in his spare time.P. O'H. was most annoyed by rude interruptionsto his privacy, while Hugh N.spent his time pursuing women and developingspecial leer for same. Also did twoimpromptu A.R.M.'s.Vinem S. held the record for prolongedlabour; 3 days and 3 nights and was rewardedby a stud fee from a grateful husband.John G., Gordon M., Bob H. and Buckdivided their time between grog, cards,grog, women, grog, chimney climbing and"Charlie".Rosie W. scored well on the definition ofdyspareunia — "I thought it didn't fit."Back home golf interrupted the rat race.Chris S. ran away with the trophy — theonly man to hit a ball straight all day.PAGE EIGHTY-EIGHTLaurie R. and Frank D. won the 4 ballwith 12 up. Lew blamed the win on theleprechauns.Dave P. keeps up with all the hospitalgossip. How does he get all the insideinformation?Eve Y. went for a boat trip down theriver with the students from the congress.Strictly for entertainment purposes, SHESAID.Kris B. is in great demand as an interpreter.She specialises in Serbo-Croatian.Toni C. got stranded half way to Adelaideand has since bought a new sports car.It's more convenient.Ramm P. to clinician who said, "You'llfail, Mr. P." replied "That's what I said,Sir."Val. M., Vip., and Ahmud make quitea trio with that extra touch of maturity.Sion B. is always conveniently able tohide himself in clinics behind Mike J., butthis has a disadvantage. Mike might treadon him.Terry V. always sits next to JonathanR. — could there be anything in it?John D. keeps the maternity hospitalbusy, while Peter D. has settled down tothe rigors of married life, and recommendsit to all.Arthur F. and Ted. F. are such frequentvisitors in Cas that they have been offeredhonorary positions there.Gerry G. still thinks that 5 o'clock Fridaynight is the best time of the week.Rene DuP., "The most eligible bacheloraround the hospital" is a great protagonistfor lost weekends in Sydney.Willie "Hamph" R-P. has become lesspugnacious as finals approach. However,he came to grips with Mr. R. H. on deepsea fishing across an operating table.Laurie R., Bernie N. Gordon, Jack H.,and "Shocker" have finally weakened andare being wed after exams. "Shocker" isso hyperkinetic that his glasses are perpetuallysteamed up. He keeps mumblingabout disuse atrophy and putting his bluehands into his pockets — viz. paragraph 2.Thought for the yearRemember that the best contraceptive isa cup of coffee; not before, not after, butinstead of.Well that just about wraps everything up,but remember: "Be kind to the examiners. "SPECULUM 1961

ANSWERS TO DIAGNOSTIC QUIZSURGERY1. X-ray in forced inversion positionshows torn lateral ligaments.2. Duodenal ulcer penetrating pancreas.3. Lead poisoning from soluble leadcompound on the chisel.4. Epithelioma of penis-proved bydorsal slit.5. Cyst of lateral meniscus and ganglion.6. Congenital collagen deficiency permittingabnormal movement of the jointrelievedby a constraining bandage.7. It was not a boil but a suppurativehidradenitis of apocrine glands.8. The base of the appendix is alwaysfound at the ileocaecal valve in the anglebetween ileum and caecum.9. Belly of semimembranosus musclenormal.10. Ischio-rectal abscess.11. Hydronephrosis.12. Verruca plantaris - "splinters" areblood pigment.13. He was not told of the colostomythrough which he was looking was thetheatre window.MEDICINEI. Paget's disease of bone.2. Haemochromatosis.3. Milk-alkaline syndrome.4. Carcinoidosis.5. Polycystic kidneys.6. Adie's myotoric pupil.7. Polycythaemia vera.8. Examination of the eyes for thepresence of Kayser-Fleischer rings, confirminghepato-lenticular degeneration.OBSTETRICS1 . F.D.I.U. had occurred with developmentof afibrinogenaemia. The "movements"were probably bowel peristalsis.Clotting time was unrecordable. ARMwas performed and patient given 5 gm fibrinogenbefore onset of labour. She cameS PECULUM 1961into spontaneous labour and delivered amacerated foetus. A brisk haemorrhageoccurred just after ARM but was quicklycontrolled after fibrinogen and blood.2. The question is whether to wait for atheatre for LUSCS or proceed immediatelywith an internal version and breech extraction.As the uterus was contractingstrongly and she had had previous largebabies it was thought that latter manoeuvregave the baby a greater chance. Resultwas successful.3. Megaloblastic anaemia shown byblood film. Folic acid deficiency due topoor diet. Management is to give folic acidorally and Hb will rise quickly. Thiscase came into spontaneous labour soonafter admission and was transfused becauseof risk of foetal anoxia in labour.4. Carpal tunnel syndrome due tooedema. Given chlotride 0.5 G b.d. withrapid relief.5. Grade I or II placenta praevia couldnot be excluded. Therefore had E.U.A. intheatre when Grade II placenta praeviafound and LUSCS performed! The moralis never to perform vaginal examination onwomen who have had ante partumhaemorrhage.6. Confetti! It gets everywhere!GYNAECOLOGY1. Ruptured right tubal pregnancy.2. Bone marrow biopsy and thepresence of a histamine fast achlorhydriaconfirmed the diagnosis of perniciousanaemia.3. Left Bartholin's abscess.4. Adenocarcinoma corpus uteri.5. Gonococcal salpingitis.6. Turner's syndrome.7. Ruptured hymen.PEDIATRICS1. Physical examination in the ward,and a subsequent chest X-ray demonstrateda left-sided pneumothorax. This case illustratesthe importance of the history and fullphysical examination, which in chronicdiseases such as this, tend to be inadequatelyelicited.PAGE EIGHTY-NINE

2. Haemorrhagic Disease of the newbornwould be a possibility, but this wouldbe rather early for it to occur. An APTtest confirmed that the blood passed by thebaby was of maternal origin. The principleof this test is to add a weak solution ofsodium hydroxide to a suspension of themelaena in water. If the blood is of maternalorigin the suspension turns brown,whereas if it comes from the baby it remainspink. This basis of this test is thefact that foetal haemoglobin is alkali resistant,while adult haemoglobin is not.3. Having excluded trauma, one wouldthink of osteomyelitis or perhaps polio. Thelatter could be excluded if the baby hadhad Salk vaccine. Physical examination revealedbruising of the gums and prominentcostochondral junction. X-ray of the righthumerus showed a large sub-periostealhaematonia. X-ray of the epiglottis showedthe typical changes of scurvy, and she madea full and rapid recovery with the administrationof ascorbic acid.4. Physical examination revealed limitationof abduction of the right hip, andX-ray confirmed the diagnosis of congenitaldislocation of the hip. This case stressesthe importance of early diagnosis in theneonatal period, when treatment is relativelysimple and complications are virtually unknown.5. A foreign body was removed andthe discharge cleared spontaneously.6. Strangulated right inguinal hernia.Always fully undress infants and childrenbefore commencing examination.7. A full blood examination revealed amild hypochromic normocytic anaemia.Further investigations were all normal.Although more serious causes might be considered,recurrent infection is the commonestcause of anaemia in children, and in thiscase the anaemia was considered the resultof, rather than the cause of, current infection.8. Yes, constitutional. Both motherand father were short. Always enquireabout parental height in such cases beforeconsidering less common causes.9. A chest X-ray confirmed the diagnosisof diaphragmatic hernia. Althoughthe percussion note over the left chest wasapparently normal in this case, one shouldalso consider a pneumothorax with thesesigns.10. The repeat chest X-ray included aview of the larynx and showed an opaqueforeign body in this region. A screw wassubsequently removed from the region ofhis epiglottis. In any small child with sucha history always enquire particularly aboutthe possibility of a foreign body, and alwaysattempt to visualize the epiglottis.11. Examination revealed a pale babywith no neck stiffness, the frontanelle wastense and the temperature was 37 deg. C.Lumbar pucture confirmed the diagnosis ofmeningitis. Although other infection anda mechanical obstruction may produce thispicture, always consider this diagnosis in ababy who is vomiting and not feeding, evenif all the classical signs of meningitis as seenin an older child are not present.12. Yes, congenital heart disease, withearly congestive cardiac failure. Shortnessof breath and a tachycardia are the earliestsigns of C.C.F. in infancy. Adequate treatmentwith digitalis and antibiotics is important,because many of these defects can nowbe treated surgically with good results.;..,..........0.....„,„,._.0_,,....._„........... 11 NOVOCAIN11 the original ILOCAL ANAESTHETIC1 . . . with the passing of time, Novo- Icain remains the universally accepted, I1 dependable anaesthetic." i1 NOVOCAIN is1 — INVARIABLE —STABLE1 — RELIABLE —SAFE l— NON-TOXIC — NON-IRRITANT 11 1the choice of those who, above all,1demand quality.111Before issue, every batch of Novocain is testedIInd passed by the Commonwealth Bureau of Dental iStandards.J. L. BROWN & Co..,.I 123 William Street, Melbourne. 62 3027 iI# 0■•••0411mo■ 0411..01m...0.1■.••••■■■•oio■o•alw.1■o■o■ww.o.i■IPAGE NINETY SPECULUM 1961

i'll1111■■1111L--spicuiaThere was a new vicar in the village, anddiscussing the coming Sunday's sermon withthe Curate, said, "I think I will take for mysermon this Sunday, 'The Widow's Mite'."The Curate, a young man who knew hisway around the village, said, "Well, Sir, Idon't know that that would be advisable,because I happen to know they DO!"* * *From a letter from Registrar to G.P.:"This lady's domestic troubles are nowsettled: the almoner has arranged for herto sleep with a friend when her husband hasone of his drinking bouts."Clerk: You say you have had sixteenc hildren. Isn't that rather a lot?Patient: Why, no, dearie, you see myhusband is a very fascinating man.*Heard during a conversation on contraception: "We get on all right, my wife's gotit all sewn up."SPECULUM 1961In the Ante Natal Clinic:H.S.: "Any headaches?"Patient: "No"H.S.: "Any vomiting?"Patient: "No"H.S.: "Any specks before the eyes?"Patient: "Yes, but I've broke 'em. T'case is in my pocket."From a recent class examination paper:"The vessels of the DuodenumI know they're there but haven't seen 'emAbout the muscles of the Rectum,I've got ideas but can't connect 'em"Dr. X: "I'm afraid I'll have to removesection of your bowel."Patient: "Well, Doctor, better a semicolonthan a full stop."* * *The resident in playful mood asked thepsychotic patient who he was. The patientreturned " I'm Napoleon.""And who told you that you were Napoleon?""God did."Voice from two beds down— "I did not."* * *A student asked by an examiner to describethe symptoms of phosphorous poisoningcould think of nothing to say until in amoment of inspiration he blurted out, "Thestools are luminous, sir."Said the examiner: "Is that a flash in thepan?"PAGE NINETY-ONE

Women can keep a secret just as well asmen but it takes more of them to do it.**Wisdom: Knowing what to do.Foresight: Knowing when to do it.Skill: Knowing how to do it.Virtue: Not doing it.* * *One old soul in O.P.D. said that her husband"had had the sugar debaters foryears." Probably he could have given alengthy discourse on the sweet pea.* * *Doctor to mother of five sets of twins:"Do you always have twins?""Oh, no, doctor. Plenty of times I havenothing"* * *Did you hear about the nauseated pixie:she went to a goblin party.* * *Mary had a little girl,With vernix white as snow,And every time the student grabbedHe slipped and let it go!* * *The bee's a busy little soul,He doesn't practice birth control;That's why in happy days like these,You see so many sons of B's!Student, questioning a patient: "Howmany children have you had since your marriage?"Patient: "The bloody lot of course!""How is it I find you making love to thecook?" his wife asked."I don't know," he said, "unless it's becauseyou wear rubber heels."A patient consulting a psychiatristlearned that the fee would be £10 an hour,so in advance he drew an £100 check for10 hours' treatment. When the psychiatristlooked at the check, he was amazed tosee it signed "Napoleon.""Of course," said the patient, "If Isigned my real name, would I need you?"Hear about the two peculiar judges? Theytried each other.* *The Girl Guide ran through the woods,with a bear behind.PAGE NINETY-TWOAmelia of quite large proportionTook all contraceptive precaution,But poor little ErmyntrudeLet one little sperm intrude.Does anyone here do abortion?There was a young girl from St. Paul,Who went to a birth control ball,With syringes and pessariesAnd all the accessories,But nobody asked her at all.* * *There once was a youthful reporter,Who thought that his girl was a snorter,He put her to the test, and now he is blestWith a highly specific aorta.* * *A girl who was no good at tennis,At swimming was rather a menace,She took pains to explain, "It depends howyou train,I was a street-walker in Venice."* * *"Is the doctor in?" whispered the manwith the laryngitis into the phone."No," the nurse whispered back. "Comeon up, but be very quiet."NIALL & COGHLANPTY. LTD.Medical AgentsPractices TransferredPartnerships ArrangedLocum Tenens Provided127 COLLINS STREETMELBOURNEPhone NV 1983DIRECTORSM. D. COGHLAN R. H. VAN ASSCHESPECULUM 1961

And the little downtrodden looking manwho timidly sat down in the psychiatrist'soffice and pulled out a cigarette. Without aword, he carefully pulled the cigarette topieces, and stuffed the tobacco up his nose."Ah," said the psychiatrist, "can I helpyou?""Yes. Have you got a match?"A bachelor is a man who comes to hisoffice every morning from a different direction.*A young trapeze artist named BractIs faced with a very sad fact.Imagine his painWhen again and againHe catches his wife in the act.* * *A surgeon is one with no faith in nature'scapacity to heal before the operation, andan infinite faith in it afterwards.* * *Doctor: "Are you troubled by improverthoughts?"Patient: "No, I rather enjoy them."* * *A rural schoolteacher drove up one afternoonto a combination gasoline-and-grocerystore characteristic of some more isolatedregions. Nobody came near her, so she gotout and approached a raw-boned farmerWho was dozing on the "loafers bench"."Could you tell me whether or not I needany oil?" she asked.The old codger turned his thoughtful gazeon her, shifted his tobacco to the othercheek. "No, ma'am, I can't exactly tell ifYou need oil by just lookin' at you. But agood dose of oil never hurt nobody."* * *"Look here, who said you could kiss me?"a girl indignantly asked her escort."Well," the guy answered, "if you mustknow, just about everybody!"Crossing the street one morning, I wasrun down by an antiquated car literallyoverflowing with about a dozen children.Since the red light had been against theWoman driver, as she came to a halt Ishouted: "Lady don't you know when tostop?"Glancing back at the moppets, sheanswered icily: "They aren't all mine?"SP ECULUM 1961United we stand, divided we fall. Eh!* *The young doctor was taking his wifeout one evening, when a pretty girl smiledand spoke to him. The wife, scenting anearly love affair, inquired: "Who is the lady,dear?""Oh, just a girl I met professionally.""No doubt," recoursed the wife, "butwhose profession? Yours or hers?"* * *Passionate kiss: When you stick yourtongue so far down a girl's throat you tastethe nicotine on your fingers.* * *It's nice for children to have pets, untilthe pets start having children.* * *One doctor to another, in a military recruitingcentre: "On the other hand, he'snot in any shape to be a civilian, either."* * *Husband to wife: "Sure you can have afur coat. Who offered you one?"* * *From Nurses' exam. papers:1. An ectopic pregnancy is a pregnancyin the Eustachian tubes.2. To disinfect stools, scrub them carefullywith methylated spirits and stand themout in the sun.* * *She: I bet the men doing finals who aregoing to get married after the exams won'tbe able to do much work because of theexcitement.He (a Med.): Oh, getting married doesn'tworry Meds.She: Oh, yes, I suppose so. You do somuch already that the little extra doesn'taffect you.* * *Notice on a church porch:Owing to the great number of our younggirls who have slipped and fallen of late, itis requested that the young men of theparish refrain from throwing their bananaskins on the footpath outside the church.* * *Few articles are more expensive than agirl free for dinner.* * *Two homosexual spiders kept getting ateach other's flies.PAGE NINETY-THREE

NEW PHARMACEUTICALSON THE WAYSigma Company Limited maintains constantcontact with leading overseas pharmaceuticalcompanies.Sigma executives travel thousands of milesevery year--overseas and throughout theCommonwealth—to bring the benefits ofthe latest- medical and pharmaceuticalresearch to the Australian MedicalProfession.Q,S*ItA)SIGMA COMPANY LIMITEDllokers of line pharmaceutical productsMELBOURNE, AUSTRALIAA member of A DCA (Associated Drug Companies of Australia Pty. Ltd.)PAGE NINETY-FOURSPECULUM 1

"That young man of yours strikes me asbeing a little unpolished, daughter.""Yes, father. He's a little rough aroundthe 'edges."* * *He: "Please."She: "No.""Just this once.""No, I said.""Aw, hell, Mum, all the other kids gobarefoot."* * *Breeches of Promise are not necessarilyPants of Passion.* * *A young man wanted to buy a presentfor his fiancee, and after much consideration,decided to buy a pair of gloves. Sohe went to a ladies' shop with his sister andbought them.At the same time his sister bought a pairof scanties, and when the salesgirl packedthem she got the parcels mixed, so hissister got the gloves and his fiancee got thescanties.Sending them to his fiancee, thinking theywere gloves, he wrote:"This is to remind you that I haven'tforgotten you; and as you are not in thehabit of wearing the enclosed, I send youthem."If it hadn't been for my sister I wouldhave got a larger pair, buttoned up theback. This makes then easier to get on andoff in the train or tram. The salesgirlshowed me a pair she had been wearing formonths, and in spite of the colour they werehardly soiled."I wish I could be there to put them onfor you for the first time. You will thinkof me every time you wear them, won'tYou?, "I asked the salesgirl to try them on andthey looked very nice. When you put themaway blow into them.They will naturally be a bit damp afterYou have worn them. After a few timesthey will slip on and off easily. I hope youWill accept these in the spirit they are givenand will wear them to the dance tonight, asI will look at them.„ 'My sister says it is the fashion to wear'item undone and hanging down; lots ofPeople carry them in their hands instead ofPlating them on.99"Your belovedSPE CULUM 1961Patient has been round Collins street,also Bourke street and consulted herfriends.* *"Breast milk bank"—look a bit sillygoing to make a deposit.* * *Professor T.:Habitual aborter goes to the specialistwho says:"Between the two of us you will have achild."* * *Aetiology of gastric mucosa in the oesophagusis the same as that of chronic cervicitis.Mr. Donald's Secretary has changed herposition.* * *Mr. Mc. (on the relationship betweenparaphimosis and infection): "It is a viciouscircle."* * *Some of the representatives at the recentGynaecological and Obstetrical Conferencein Melbourne were:Irish Representative: Luke O'Rea.English Representative: Sir Vical Erosin.French Representative: La Cont Raception.* * *It happened at Footscray:Rising Resident (to boy complaining ofswallowing a caterpillar): "Come back ifyou get butterflies in the stomach."* * *D.D.: Crutch palsy has nothing to dowith the perineal musculature.* * *Mr. H.: Become surgeons. Be men.* * *Old girl having history taken, was askedif she was bedridden, replied, "Yes,hundreds of times."* *Quotable Quote:Cade (on girl sent to Sunbury): "She waspathologically incapable of saying no . . .her genital tract was no stranger to theGram negative diplococci . . . she was averitable Venus fly trap."* * *"Pull down, tear up, 15 inches is ample."—Sorbent.PAGE NINETY-FIVE

A lecturer who is supposed to know allabout sex was giving a talk on "The Factsof Life" to a mixed group of teenagers andchildren whereupon a girl of about sixteenstood up and asked, "Can I have a baby?""Yes," was the reply.Another girl of about fifteen stood upand asked the same question, in which shegot the same reply. Then a girl of aboutfive jumped up and asked the same questionagain. The lecturer was quite perplexedat this stage but he assuredly toldher that he did not think so. A little boy(about her age) who sat beside her saidconfidently, "There you are, I told you notto worry." * * *One day a little girl went into a candystore and asked the shopkeeper for a pieceof chocolate in the shape of a boy. Theshopkeeper replied, "Why do you want achocolate boy and not a chocolate girl?"The girl replied, "It has more chocolate ina chocolate boy."* * *Mr. B—y: I have been told that in orderto get the anal sphincter to relax, it is necessaryto stroke it gently, but I've never beenable to bring myself to do it!* * *Mr. B. again (to 60-year-old man with21-year-old daughter):"Bit young, isn't she?""Yeah, but she was a bit of a mistake.I've always been prone to accidents.""Your wife younger than you?""Actually, I'm on my third now—woreout the other two, and got rid of 'em. Butdon't you worry. I'm still as good now asI was at 30!"* *Mr. D.D.: "Has anyone besides Miss F.brought their tubes with them?"* * *Bugs Bunny has had a writ served forevading Income Tax. Seems he wasstuffing his dough up a hollow log.* * *Speaker at recent convention (mixedaudience):"I have been asked to give a talk on Sex.It gives me much pleasure."He then sat down.Anon.* * *"What is the Lingula Copula?""The root of the tongue, I suppose."PAGE NINETY-SIXA Chinese farm couple named Wong had14 children but when the fifteenth arrivedit was white. The father was very disturbedand went to the village elder to ask advice."How come I have fourteen children andthe fifteenth is white?" he asked, distraught.The elder shook his head. "I shall have toconsult the sayings of Confucius," he said.A week later the father returned to findthe answer. The elder looked at him slowlyand declared: "Confucius say: Two Wongscan't make a white. It must be accidental."Heard in O.P.D.:Woman: "I want an out-turn".Nurse: "No, you mean an intern"."Oh, well, I want a contamination anyway.""No, no, you mean an examination.""Alright, alright, in any case I want to goto the fraternity ward.""No, no, it's the maternity ward you want."What the hell — out-turn, intern; contamination,examination; fraternity,maternity. All I know is that I haven'tdemonstrated for three months and I thinkI'm stagnant."* * *Darling, as Freud is trueAnd God's not up above,I'd swear to heaven that youWere my one and only love,If I wasn't going to bedWith Fred.* * *Visiting British surgeon, Mr. HedleYAtkins, reports that the French name forpeau d'orange is orange skin.* * *The fastest moving object, next to a jetplane, is a nudist who has just spilled hotcoffee on his lap.Item from an etiquette book: "A gentle;man invariably follows a lady upstairs .. •A mother is an invention of necessity.A woman's looks are as old as a man'sfeels.* * *A little danger is a learning thing.* * *Melbourne Herald, May 10, 1961:CAR BELTS FOR NSW PREMIER.SPECULUM 196

TEXTBOOKS150DiscountOver the past year students have beenable to obtain textbooks at 10 per cent. discountfrom all city booksellers, but recentlythe Booksellers' Association has withdrawnthis service. However, the M.S.S.Committee has arranged a co-operativescheme with Collins Book Depot. This willenable students to obtain textbooks at a discountof 15 per cent. To obtain this servicestudents must see the committee representative, who will be available in theAnatomy School on Wednesday afternoons,and obtain a signed form on which iswritten the titles of the required textbooks.He is then able to present this form atCollins' and receive his books at the reducedrate. Negotiations are also underway for the scheme to be extended to coverinstruments and skeletons. Since the successof the venture depends on the numberof orders received, it is up to you and yourfriends to help us to help you.SPE CULUM 1961PAGE NINETY-SEVEN

PhotographyIn ActionIN ARTIN COMMERCEIN INDUSTRYIN SCIENCEIN MEDICINEIN EDUCATIONincluded in ILFORD productions arePHOTOGRAPHIC RECORDING ANDCOPYING MATERIALSFor many years Words have played aleading part in rendering photographicservice to research workers all over theworld and today the development ofIlford ensures a still greater productiveeffort.ILFORDFamous Throughout the Worldfor QualityILFORD LIMITEDMelbourne, Sydney, Brisbane, Adelaide,PerthPAGE NINETY-EIGHT"What you need is exercise. You shouldhave a little sun and air. Better get marriedfirst though."Two young matrons were discussing thenumber of women who seem to find oldermen attractive. One of the women commented,"My grandfather was a perfectexample of that. Women were crazy abouthim.""Is that so," said the second, "and howdid your grandfather feel about it—did heenjoy their attentions?""Well, not at first," was the reply, "butafter a while it went to his head and hebegan to cut notches on his cane, one forevery conquest. But I'm sorry to say that'swhat killed him.""How do you mean, that's what killedhim?" asked her friend."You see," was the reply, "he made themistake of leaning on his cane one day!"Two worms were fighting in earnest—poor Earnest.* * *"The Bishop said that in certain circumstancesadultery should be condomed."—Newspaper report.There was a girl with weak levatores anibeing treated at R.A.H. and told that soonthey would be strong enough to crack nuts.Somebody had best be careful.* * *A pedestrian is a motorist who has succeededin finding somewhere to park hiscar.Then there was the ingenious soldier whoobtained leave by explaining that his wifewas going to have a baby. On his returnhis Captain asked:"Are the mother and baby alright?""What baby?""The baby you said your wife was goingto have.""Oh, don't be silly, sir, it takes ninemonths."Did you hear about the psychiatrist whokept his wife under the bed because shewas a little potty?Kept woman: One who wearsday and fox all night.SPECULUMall1961

Being confined in a hospital for a completecheck-up, Joyce, a very shapely blondewas not surprised when a handsome chapdressed in white came in, pulled down thesheets and for some minutes looked herover. Shaking his head he left. Shortly hereturned, pulled down the sheets and madeanother examination. The third time hecame in, the blonde in desperation inquired:"Say, what in the world am I here for,observation or examination?"The chap in white replied:"Darned if I know lady, I'm just doingsome painting in the hall."* *It seems the elevator operator in a localdepartment store was quite a novice, probablyon his first tour. Suddenly the carWas brought to an abrupt stop."Did I stop too quickly?" the operatorasked the passengers."Oh, no, indeed," coolly replied a littleold lady in the rear of the car, "I alwayswear my bloomers down around my ankles."*The fair village was all agog over theannual spelling bee. One by one the contestantsdropped out and even our fairschoolmarm was eliminated when shestumbled over "psittacosis." At last onlytwo remained, the village druggist and thestableman, who was an Englishman.They waited eagerly for the word. ItCame:"How do you spell 'auspice'?"The stableman lost.* * *Did you hear about:The new young woman golfer whothought that one-under-par was incest?* * *Do you know what good clean fun is?No, what good is it?A prostatomegalic old gent was playinggolf and of necessity was micturating frequently.After some time he turned to theCaddie and said:"What's the score?"The caddie replied: "I don't know aboutYour golf, but you're one up on the dog."Heard at the Med. Ball: ". . . she worea dress with a neck-line low enough toMake a baby cry."S P ECULUM 1961Remember . . . "Prevention is better thancurette."* *Histological anomaly—a ball of muscle!Science marches on!A recently discovered method of determiningthe legitimacy of pigeons: If thebirds are placed in a large cage and thedoor opened, all the bastards fly out.An innocent girl told us she was practisingsquash as a man was trying to get upa woman's team.*Did you hear about:The med. student who kept his girl friendout until the oui hours of the morning.* *Into a temperance hotel staggered adrunk helped by his more sober friend. Themanager looked at them in alarm."You can't bring a drunken man in here.This is a temperance hotel.""That's all right," said the friend. "He'stoo far gone to notice.'A married couple were sleeping peacefullyin bed when suddenly the wife shoutedin her sleep: "Good Lord! It's my husband!"The husband, awakened by the cry, leaptout of bed and jumped through the window.A young Lieutenant joined an IndianRegiment."What's your name?" asked the Colonel."Cholmondley, sir," answered the Lieutenant."Any relation to Cholmondley of the62nd?""Son, sir.""Delightful. Married, Cholmondley?""Yes, sir,—my wife was Miss Falkingham.""Oh, indeed—Falkingham—any relationto Falkingham of the 65th?""Daughter, sir.""Splendid. Have you brought your wifewith you to India?""Yes, sir, but now she's in her room withcramp, sir.""What? NOT Cramp of the 73rd?"* * *They tell of the student who recentlybought himself an electric "raiser".PAGE NINETY-NINE

AIDS TO FINALS(Copyright in all countries signatory to theBerne Convention)To the tune of: Keep Your Feet Still,Geordie Hinny.Mrs. Jones of Blaydon had a baby last July,And as bonny a bairn as you could wish tosee.And all her friends and neighbours theycould see no reason whyShe shouldn't raise a healthy family.But they hadn't heard of Rhesus or the subgroupsCDE,And they didn't know that Foetuses coulddrown,They hadn't heard of Icterus and theythought that Anti DWas Mrs. Jones' sister Doris Brown.To the tune of: Excelsior.But Mrs. Jones was negative,Little cde little cde,And Mr. Jones was positive,Little c big DE;And so the doctors weren't surprisedWhen Mrs. Jones was immunised,Little c and d and e, little c little d,Little c but big DE, big D, big DE.Anti Anti Anti D-D-D.To the tune of: Waltzing Matilda.Through the placenta in hundreds andthousands,Antibodies freely cross,Into the foetus, mucking up the red cells,Causing haemoglobin loss.To the tune of: Lilli Marlene.Low haemoglobin, high bilirubin,Nucleated red cells as common as can be,Coombs' test positive, Wasserman is negative,And in the serum free anti-D.To the tune of: Buttons and Bows.Examine now the new baby,For physical signs you'll find,Hepatomegaly, Splenomegaly, Jaundice,Anaemia, some Oedema,Petechial Haemorrhages on its behind.PAGE ONE-HUNDREDThe differential diagnosis of this sad plightis,Acholuric, Physiological, Umbilical Sepsis,Syphilis,Bile Duct Block and Hepatitis.To the tune of: What Shall We DoWith The Drunken Sailor.What shall we do with the yellow baby,What shall we do with the yellow baby,What shall we do with the yellow baby,Early in the morning.Exsanguinary Transfusion,Exsanguinary Transfusion,Exsanguinary Transfusion,Early in the morning.Into the umbilical vein,Put a catheter of polythene,If you fail you must try again,Early in the morning.In and out with the 10 ccs.,You can do it as long as you please,If you're lucky you'll collect your fees,Early in the morning.Hooray, the blood it rises,And everyone surprises,It's because we use catheters of bigger sizes,Early in the morning.Now we have exchanged six hundred,The count's six million, so we can't haveblundered,If you don't like the song there's nowtrefunded,Early in the morning.To the tune of: The Dead March.But if alas the baby it should die,And comes to Bird for Au-top-sie,Then shall we find:Hepatomegaly;Splenomegaly;Haemosiderosis;Serous exudation;Pulmonary haemorrhages;Bilirubin infarcts of the kidneys;Lipoid streaking of the adrenal cortex;Bilirubin staining of the basal ganglia, ofthe hippocampus and medulla oblongata.Excess extra-medullary erythropoiesis.Peter Glenning.SPECULUM 1961

100 Austr 5Geigy PharmaceuticalsDivision of Geigy (Australasia) Pty. Ltd.at Hale Street, Botany, N.S.W.(Tel. 666-9141)189 Clarendon StreetSouth Melbourne, S.C.5, VIC.(Tel. MX 2246)G62AScientific discovery dependsnot on chance but on sheer hardwork. A new drug, for example,is the fruit of lengthyresearch with a purposecarried out by highly qualifiedinvestigators. In the Geigy laboratories,specialists in all branchesof medical science performthousands of experiments everyyear. Their unceasing effortscontinue to open up new perspectivesin therapy.Geigy

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