Crisis

mind but was accepted because he was good at his job, and when it came to pathology there was none better.

Bannerman looked at the sea of faces, trying to spot a few who might become ‘real’ doctors. It was practically impossible but he always tried. It was easier to spot the ones who wouldn’t, the loud-mouths who would bluster their way through the course, the quiet note-takers who would copy everything down and rely on hours of study and a retentive memory to see them through exam time. There would be some who would fail, of course, and not necessarily because they were bad students. Although the course was tough and academically demanding the entry standards ensured that not many idiots reached the starting line. The ‘failures’ were often students who discovered that they were square pegs in round holes; they were simply doing the wrong subject.

Bannerman always took time to reassure such students that it was better to have found out at an early stage than to have been faced with the truth when someone’s life was resting in their hands. He always had much bigger problems with the students who passed the exams yet clearly were not cut out to be physicians. The frustrating thing was that there was little he could do about it. He would do his best to instil a genuine concern and regard for the sick in them but he suspected that many would go through their entire careers without ever seeing patients as anything more than ‘cases’, temporary intellectual puzzles to be solved along the path of their careers.

Despite not being able to spot the ‘real’ doctors in his audience Bannerman knew that they would be there and saw it as his duty to deliver the best possible lectures he could for their sake.

‘Today we shall continue with our study of diseases of the central nervous system,’ he announced. ‘A subject I know will be close to your hearts because your essays on the subject of my last lecture suggest that many of you are suffering from one or other of them …’

There was general laughter because although Bannerman had an acid tongue he was popular with the student body. He was a good lecturer, always on top of his subject and had never been known to prevaricate when asked a question to which he did not know the answer. Instead, he would say so immediately and tell the student to look it up and let him know. This saved a lot of time and the students appreciated it. Too much course time could be wasted by lecturers waffling to cover up deficiencies in their knowledge. The words, ‘I don’t know’ were too seldom uttered in the realms of academia.

‘Creutzfeld Jakob Disease and Kuru are the two conditions we will consider today. Both result in nervous degeneration, loss of coordination of the limbs and mental deterioration. Both are invariably fatal.’ Bannerman switched on the slide projector and clicked in the first slide with a hand held controller. ‘On the left is a brain section from a patient who died of CJ disease. The section on the right is from a normal brain. Note the spongioform appearance of the diseased brain and the typical SAP fibrils.’

Bannerman changed the slide and altered the focus slightly with his thumb. ‘This is a photograph of a patient who contracted CJ disease after corneal graft treatment. Note the vacant expression in the eyes and the lack of facial muscle tone.’

A voice from the darkness said, ‘Are you suggesting that the patient got the disease from the graft?’

‘Almost certainly,’ said Bannerman.

‘Then this is an infectious condition?’

‘Yes, but not conventionally so.’

There was a murmur of amusement as the student body began to believe that they had caught Bannerman about to prevaricate at last.

‘Yes or no?’ demanded the cocky student voice.

‘Officially the diseases are said to be caused by unconventional slow viruses.’

‘How unconventional?’

The truth is that no virus has ever been isolated from an infected brain but in all other respects the material behaves as if an infectious agent is present.

‘Then the disease can be transmitted?’

Yes.’

‘Are there any other diseases like these?’

‘Several, in animals.’

‘Such as?’ asked the student, determined to catch Bannerman out if he could.

‘Scrapie in sheep; Bovine spongioform encephalopathy in cattle.’

‘Mad cow disease?’ asked the student.

‘Yes, also transmissible encephalopathy in mink.’

‘But surely a bit of research would determine the cause of these conditions?’ said the student.

For a moment Bannerman was taken aback at the arrogance of the proposition then he said, ‘Mister …?’

‘Marsh,’ replied the student.

‘Mr Marsh, there is a small but significant graveyard containing the careers of several top flight researchers who insisted they had discovered the cause of these diseases. Perhaps you would care to do “a bit of research” and give me your written submission on where you think they went wrong? Shall we say by next Wednesday?’

‘Yes sir,’ mumbled the student, all trace of youthful arrogance gone.

‘Is there a species barrier?’ asked a female student voice.

‘Good question Miss ‘…?’ said Bannerman.

‘Lindsay.’

‘Good question Miss Lindsay. Everyone thought there was a barrier until Mad cow disease caught us on the hop. Recent research suggests that the cattle got it from eating foodstuffs containing Scrapie-infected sheep brains.’

Then it’s not inconceivable that man could contract brain disease from eating infected animals?’

‘It’s not inconceivable, but there’s no evidence to support such a view.’

‘At the moment,’ added the student.

‘At the moment,’ conceded Bannerman.

‘It could be that Creutzfeld Jakob Disease in man is actually derived from eating infected meat?’

‘I repeat, there’s no evidence to support such a view.’

‘But you would advocate a vegetarian lifestyle anyway,’ said a student at the back.

There was general laughter and Bannerman joined in. ‘I have no intention of becoming vegetarian,’ he said.

‘At the moment,’ added Miss Lindsay and there was more laughter.

‘What about Alzheimer’s. Is it related to slow virus disease?

‘There are distinct differences in pathology.’

‘Is it known what causes Alzheimer’s?’

‘There is a genetic form of the disease but no clear proof about the more common type apart from the suggestion of some chemical involvement.’

‘Aluminium?’

‘There is some published evidence about the involvement of aluminium,’ agreed Bannerman.

‘Would it be true to say that research on dementia is woefully inadequate, Doctor?’ asked a confident voice.

Bannerman looked at the student who held his gaze from beneath a mop of red hair which clashed with the colours of his medical school scarf. There was almost an air of insolence about him but Bannerman had seen it too often before to be upset by it. It was simply the holier-than-thou righteousness of the young. ‘Yes I think it would,’ he said evenly.

‘Why?’ demanded the red-haired young man.

‘Every society has a limited amount it can spend on research,’ said Bannerman. ‘Dementia is primarily a disease of the old. There are enough diseases of the young to occupy our resources. It’s as simple as that.’

‘Personally I think it’s disgraceful,’ said the student.

Bannerman could feel that the sympathy of the class was not with him. ‘Perhaps you should be reading social sciences, not medicine,’ he said.

‘Or politics,’ suggested another student voice to a murmur of laughter.

‘Medicine is a practical business,’ said Bannerman. ‘You work with the resources you have and make decisions accordingly. If you are faced with two patients in kidney failure and you have only one kidney machine it’s no good shouting about how disgraceful it is. You have to decide which one lives and which one doesn’t.’