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his houseman to tell his secretary what to say as a matter of fact.When one comes to the section on principal other conditions orcomplications and on chronic disabling conditions, things getmore difficult. Is the blood-pressure reading sufficient to

warrant an entry of hypertension and, if so, under whichheading ? Is that smoker’s cough enough to write chronicbronchitis ? It is all far too nebulous and one must think hardabout the possibility of removing opinion from such a statisticalmatter as hospital activity analysis. There is already enoughroom for mistakes among the facts.

But I digress. Knowing that I had to enter hospital for alaparotomy, I was interested to read Birley’s 1 mention of thev.i.p. syndrome. Such patients upset the usual mechanism of ahospital-they are generally well favoured, more liberal visitingis allowed, and senior registrars are asked to perform the tasksnormally performed by housemen. By no stretch of the

imagination could I be termed a v.i.p. I am a K.A.F. V.I.P.I know a few v.i.p.s.

I went to see the surgeon on the old-boy net and myadmission was arranged to suit my diary. Theatre was con-vened on a normally fallow afternoon and the full first xi wasin the field, all in clean flannels. Postoperatively, I luxuriatedin a single room, was fed on a special diet, was allowed toreceive visitors as they appeared, and was generally a completenuisance to the ward routine. I being a doctor, minor compli-cations of course arose. I had a prolonged ileus with distensionof the abdomen and very minor linear atelectasis in both lowerlobes. This kind of picture is clinically to be expected of doctorpatients, and of two other classes, and if no one has yet puta name to it, let us formulate the hypothesis of intraprofessionalmisadventure thus: " Despite meticulous attention, the medicalcare of doctors, of doctors’ wives, and of nurses will be fraughtwith crises, so that the hospital staff will always be pleased, andrelieved, when such patients go home."The registrar who tended to my needs was sympathetic

and friendly. The fact that he referred to his chief by hischristian name (when out of earshot) and informed me of what" we " found at the operation shows that he was altogethera friendly soul. Unfortunately he owned a motor car and, asa budding surgeon, used to practise on the engine. I am surethat the oil around his cuticles was scrubbed to the point ofsterility, but it used to make me wonder occasionally about thesocial, let alone surgical, graces of clean (-looking) hands.There must come a time in the life of a mechanically mindedsurgeon when he has to take the decision to wear gloves in thepresence either of his patient or of his car.When I was a houseman, with a consultant the same age as

me on the firm, I vowed that I would never tell a housemanabout " my

" day, but, avoiding " my " and " his " day, I mustquery modern teaching. It was necessary for this young doctorto perform rectal examinations; I was taught that the procedureshould end with the use of a gauze swab to save the patientremaining uncomfortable in a patch of jelly for the rest of thenight. My friend scored 50%-one gauze, one no gauze, in twoexaminations. He joined others I have met in telling me that itis more painful to have a local anaesthetic than to have a dispos-able dripset needle plunged directly through the skin and,eventually, into a vein. I stuck to my guns and, on the secondrequest, duly had a local anaesthetic. Perhaps every medicalstudent should experience the insertion of an intravenous drip-set needle. But, these are the tiny criticisms of a well-cared-forspell as a patient.

Before I left, I thanked the hospital secretary for all theattention I had had from so many members of the staff;I suggested that he had earned a day off, but he replied, " No.Now we have to work to keep up these standards and toimprove on them." There can’t be much wrong with sucha service, can there ?

Yours,ToNY

1. Birley, J. L. T. Lancet, 1968, ii, 1181.

In England Now

A Running Commentary by Peripatetic Correspondents

I am not much at home with horses, but when my veteri-narian friend rang me to discuss a thoroughbred foal who hadsyncope on exertion, I was intrigued and immediately agreedto have a look at it. At the stud farm the foal and its mare were

together in a loose-box, and there was a rather exciting strugglewhile the patient was being separated from her wide-eyedmother. I stayed outside at a respectful and apprehensivedistance, and the elderly stable-lad, who waited with me, didnothing to help my confidence. " Shouldn’t go in there if I wasyou. If she don’t bite, she’ll kick you " he cheerfully assuredme. It is difficult in a bad light to be sure whether a black foalis cyanosed or not, but auscultation has its particular hazards.I found that listening to a foal’s chest using a stethoscope withthe usual length of tubing involves bending right under thebeast with one’s bottom high in the air. The slow tempo ofthe beat needs special concentration, and this was not helped bythe restlessness of the mare close behind. One cannot be sureof an ejection click when the chief thought in one’s mind is," Will the bite come before the kick or vice versa ?". Eventuallythe mare could bear it no longer, and further help was neededto control her. A shout, meant to summon my old friend thestable-lad, was greeted with, " Not bloody likely, I won’t comein there. My insurance doesn’t cover that sort of thing ". Idoubted if mine did either and decided it was time to finish theexamination. I think vets probably earn their money. I haveseldom been bitten or kicked by my usual patients.

*’ *’ *’

It is a common experience to read or hear a strange word,and then to come across it again a short time later. Coincidence ?Some Higher Educational Power at work ? More likely, onehas seen the word often before but could never be bothered tofind out what it meant and skipped quickly past it; only whenthe will-power is strong or the dictionary to hand does the wordreally register, and from then on the eye or ear takes it inproperly. But an experience the other evening has made methink again. I’ve never read Middlemarch (I know, I shouldhave done) nor did I see it on T.v. Tertius Lydgate meantnothing to me when my wireless warmed up for Music at Nightto the sound of his name on that evening’s Book at Bedtime.The music didn’t satisfy, so I turned to book at bedside. Crime ?Biography ? Science ? My hand hovered uncertainly, and then,almost unwillingly, reached for a book on molecular biology atthe bottom (naturally) of the pile. I don’t know why (it cannothave been a voluntary act, for I read science books methodically;I have to) but I found myself starting at a late page, well beyondwhere I had got to. And what did I see at the foot of the thirdpage in this book about a very much 20th-century subject ? Ofcourse, you’ve guessed by now-a quotation from Middlemarchabout the ambitious Dr. Lydgate. I’ll stick to Late Night Extraand crime thrillers in future.

*’ * *

It was heartening to hear from a general-practitioner friendthat, despite assertions to the contrary, the doctor-patientrelationship still flourishes with a modicum of intimacy. Onreceipt of the following letter, my friend had no difficulty intaking appropriate action: " Dear Doctor, Wind. Car in dock.Cdtton wool. The usual. Sincerely..." He of course realisedat once that this sufferer from a lower-limb muscular dystrophywas unable to attend his surgery as she was habitually mal-steering her Ministry vehicle, so he sent by return (first-classmail) the E.C. 10 for the wool and soothing cream needed for thecalliper, together with Mist. Mag. Carb. for the chronic milddyspepsia.

......... *

The Plight of the MesiatriciansWe could not face the Old, which being knownFate led us to them, hoodwinked and forlorn.