again.
'Liver,' I tried.
'What!' exclaimed the surprised man. The other examiner, who had returned to his writing, slammed down his pencil in disgust and glared at me.
'I mean lung,' I corrected.
'That's better. What's wrong with it?'
I could get no help from the specimen, which was still tossing in swirling white particles, so I took another guess.
'Pneumonia. Stage of white hepatization.'
The surprised man nodded. 'How do you test diphtheria serum?' he demanded.
'You inject it into a guinea-pig, sir.'
'Yes, but you've got to have an animal of a standard weight, haven't you?'
'Oh yes…a hundred kilogrammes.'
The two men collapsed into roars of laughter.
'It would be as big as a policeman, you fool!' shouted the first examiner.
'Oh, I'm so sorry,' I stammered miserably. 'I mean a hundred milligrammes.'
The laughter was renewed. Ors or two of the examiners at nearby tables looked up with interest. The other candidates felt like prisoners in the condemned block when they hear the bolt go in the execution shed.
'You could hardly see it then, boy,' said the surprised man, wiping his eyes. 'The creature weighs a hundred grammes. However, we will leave the subject. How would you treat a case of simple sore throat?'
'I would give a course of sulphonamide, sir.'
'Yes, that's right.'
'I disagree with you, Charles,' the other interrupted forcibly. 'It's like taking a hammer at a nut. I have an excellent gargle I have been prescribing for years which does very well.'
'Oh, I don't know,' said the surprised fellow warmly. 'One must make use of these drugs. I've always had excellent results with sulphonamides.'
'Did you read that paper by McHugh in the _Clinical Record_ last winter?' demanded the first examiner, banging the table again.
'Certainly I read it, George. And the correspondence which followed. Nevertheless, I feel it is still open to doubt-'
'I really cannot agree with you-'
They continued arguing briskly, and were still doing so when a second tinkle of the bell allowed me to slide out and rush miserably into the street.
The days after the viva were black ones. It was like having a severe accident. For the first few hours I was numbed, unable to realize what had hit me. Then I began to wonder if I would ever make a recovery and win through. One or two of my friends heartened me by describing equally depressing experiences that had overtaken them previously and still allowed them to pass. I began to hope. Little shreds of success collected together and weaved themselves into a triumphal garland. After all, I thought, I got the bottle right, and I knew about tetanus… then I forgot about it in my anxiety over the last section of the examination, the clinical.
The clinical is probably the most chancy of the three parts. The student may be allotted a straightforward case with sounds in the chest that come through his stethoscope like the noise of an iron foundry; or he may get something devilish tricky.
The cases for clinical examinations were collected from the out-patient departments of hospitals all over London, and were in the class referred to by physicians informally as 'old chronics.' They have their lesions healed as far as possible; now they walked round in fairly good health but with a collection of clicks, whistles, or rumbles inside them set up by the irreversible process of their diseases. These are just the sort of things examiners like presenting to students. A case of vague ill-health or an indefinite lump are too arguable, but a good hearty slapping in the chest gives a right to fail a man forthrightly if he misses it.
For this service the patients were given seven-and-six and free tea and buns. But most of them would happily have performed with a strictly amateur status and provided their own sandwiches. The six-monthly visits to the examination were their principal outings of the year. They attended their own hospitals monthly to show off the signs they proudly possessed to a single doctor and discuss their ailment with fellow-patients on the benches outside, but in the exam they were inspected by hundreds of doctors-or as good as-and chatted to the йlite of fellow sufferers. It is much the same as winning an international rugby cap.
I arrived at the examination building in plenty of time, to find out what I could of the cases from men who had already been examined. I knew Benskin had been in early and looked for him in the hall to ask what there was upstairs.
'There's an asthma in a red scarf, old boy,' he said helpfully. 'And an old man with emphysema just behind the door as you go in-if you get him be sure to examine his abdomen, he's got a couple of hernias thrown in.'
I made a mental note of it.
'Then there's a little girl with a patent ductus-you can't miss her, she's the only child in the room. Oh, and a woman with burnt-out tabes. He'll ask you what treatment you'd give her, and he expects the answer 'None'.'
I nodded, thanked him, and made my way to the examination room.
My first impression of the clinical examination was of a doctor's surgery gone into mass-production. Patients were scattered across the room on couches, beds, and wheel-chairs, the men divided from the women by screens across the centre. They were in all stages of undress and examination. Circulating busily between them were a dozen or so nurses, examiners in white coats, and unhappy students dangling their stethoscopes behind them like the tails of whipped puppies.
I was directed to a pleasant, tubby little examiner.
'Hello, my lad,' he began genially. 'Where are you from? Swithin's, eh? When are you chaps going to win the rugger cup? Go and amuse yourself with that nice young lady in the corner and I'll be back in twenty minutes.'
She was indeed a nice young lady. A redhead with a figure out of
'Good morning,' I said with a professional smile. 'Good morning,' she returned brightly.
'Would you mind telling me your name?' I asked politely.
'Certainly. Molly Ditton, I'm unmarried, aged twenty-two, and my work is shorthand-typing, which I have been doing for four years. I live in Ilford and have never been abroad.'
My heart glowed: she knew the form.
'How long have you been coming up here?' I asked. 'You seem to know all the answers.'
She laughed.
'Oh, years and years. I bet I know more about myself than you do.'
Just the thing! There is a golden rule for clinical examinations-ask the patient. They attend the examination for so many years and hear themselves discussed so often with the candidates they have the medical terms off pat. All I had to do was play my cards correctly. I talked to her about Ilford, and the wonderful advantages of living there; of shorthand-typing and its effects on the fingernails; of her boy friends and her prospects of matrimony (this produced a few giggles); of the weather and where she went for her holidays.
'By the way,' I said with careful casualness, 'what's wrong with you?'
'Oh. I've mitral stenosis due to rheumatic fever, but I'm perfectly well compensated and I've a favourable prognosis. There's a presystolic murmur at the apex, but the aortic area is clear and there are no creps at the bases. By the way, my thyroid is slightly enlarged, they like you to notice that. I'm not fibrillating and I'm having no treatment.'
'Thank you very much,' I said.
The tubby man was delighted when I passed on to him the patient's accurate diagnosis as my own.
'Capital, capital!' he beamed. 'Spotted the thyroid, too…glad some of you young fellers use your powers of observation. Been telling my own students for years-observe, observe, observe. They never do, though. Right you are, my lad. Now just take this ophthalmoscope and tell me what you can see in that old woman's eye.'
My heart, which had been soaring like a swallow, took a sharp dive to earth. The examiner handed me the little
