At the circus – how medicine was taught 50 years ago

Stephen Glascoe was at medical school in the ‘Life on Mars’ era. Lectures were theatrical, students were often humiliated, and the patients little more than props

Location: UK
Last reviewed: 9 December 2021
42581 lecture hall

A medical school in northern England. 1973: the whole of the fifth and final year are congregating in a venerable, oak-built lecture theatre.

Three medical students are about to be quizzed by a panel of distinguished consultants about three patients, who will be wheeled on to the stage on hospital gurneys.

There they will lie, probably scared out of their wits, while the students, no less terrified, question them, prod them, and then expound to the assembled masses on what they have been able to elicit.

I am in the fifth year, a year still to go before I sit my final exams, but the spectre of finals already looms large; I must drink in every drop of knowledge now, lest I fall into the death zone: the dreaded bottom 10 per cent of students who are failed each year.

And I am there, like everyone else, because I know the ‘circus’ provides, over and above its huge entertainment value, an unbeatable venue for learning how to pass the clinical components of the final exams.

The student under interrogation begins to waffle, always a bad sign. Sir Arthur Robertson now takes centre stage. Better known as ‘Blackjack’, he has zero tolerance for waffling. He leaps to his feet and pushes the student aside.

Like some sort of conjurer he produces several large, dangerous-looking needles from an inside pocket. ‘Watch carefully. I am going to place needles in this gentleman’s thighs.

‘Is that all right, Sir?’ Without waiting for an answer Blackjack leans over the patient and thrusts a needle deep into each of the man’s upper thighs. He winces as the needles go in. ‘Did you feel that at all, Mr Jones?’

The man has gone pale.

‘Yes Sir.’ ‘Now, watch carefully.’ He then goes round to the foot of the gurney and plunges a needle into each of the man’s calves. This time he doesn’t even flinch.

‘And did that hurt, Mr Jones?’ With a triumphant grin, he replies: ‘No Sir!’ The patient is wheeled out of the lecture theatre to loud applause, the needles still sticking in him as if he has been undergoing acupuncture.

 

Ignorance is not bliss

Stephen glascoe GLASCOE: ‘Patients scared out of their wits, students no less terrified’

The second case is one of the most extraordinary I have ever seen. A woman in her mid-50s is brought out sitting in a wheelchair, and the student is invited, not to examine her but to take a history. 

He doesn’t get very far. She is about to answer his first question but breaks down into uncontrollable sobbing. Tears run down her face. A moment later she is roaring with laughter, all but slapping her sides in manic glee. Then she is weeping again. The audience is stunned into silence.

‘Any thoughts gentlemen?’

There are about 40 women in the audience, though they are presumably designated honorary men for the day. One brave soul offers: ‘Hysteria, sir?’

‘Good guess, but no. Any other ideas?’

There aren’t any. 

‘Pseudobulbar palsy, gentlemen. And how do you treat it?’

The student thinks for a moment, then admits he doesn’t know.

‘You don’t know. I see.’

The audience holds its breath.

‘As it happens, neither does anyone else. Pseudobulbar palsy is untreatable.’  

There is a collective sigh of relief. The reason for the reprieve? The student admitted his ignorance openly. No waffling. 

 

An eye for trouble

And now the third case. An older man is brought in on a gurney who is clearly not well.

Even from the back of the theatre his jaundice is clearly visible. This man is cachectic, dying, probably of cancer.

But what kind? To his immense relief, the student has been able to detect the patient’s grossly enlarged liver.

Step forward Henry Bignall-Brown, known to everyone as ‘BB’. He is questioning the student on stage when he spots me whispering to my neighbour and calls me out.

‘You, boy, in the bright red sweater.’ ‘Who, me sir?’ ‘Yes, you sir.’ He hands me an ophthalmoscope. ‘Now boy, examine his eyes and tell us what you find.’ I take a look.

The right eye looks fairly normal, though the other looks completely black.

‘The right looks normal to me, Sir, though the left may have suffered a vitreous haemorrhage.’

‘Really? Watch this.’ BB produces a silver pencil from his top pocket, goes over to the patient and proceeds to stab him in the eye with it. There is a loud clacking sound.

Slowly the truth dawns. ‘Show him, would you, Mr O’Flannery?’ Mr O’Flannery removes his glass eye and gives it to me.

I then drop it and it rolls away across the floor. I run to retrieve it but fall over my own feet and land on the floor with a crash.

The place erupts. BB calls for silence and helps me to my feet. He picks up the eyeball himself, polishes it with his handkerchief and returns it to the patient, who pops it back in place.

Then he says: ‘Here’s one to remember, boys. Beware the glass eye and the big liver. Glass eye and big liver, eh? Now, I have to go. I have a post-mortem to attend, and my dog is getting puckish.’

With that he sweeps off the stage leaving me standing there. I am greeted with a thunderous round of applause, to which I can only bow. What did BB mean by his enigmatic remarks? It would be years before we figured it out… 

Stephen Glascoe is a retired GP from Cardiff. Some names have been changed

Photo: Alamy