At the time of our 50th reunion it was suggested that it would
be interesting to record our memories of training at Guy’s, as things have
changed so much in the years since we were medical students. Some years later
Anne Chamberlain and I decided to follow this up with emphasis on our
experiences as female students. We submitted our memories to the GKT Gazette,
and they agreed to publish it in three parts. The first two were in the Spring
and Summer 2019 issues but the third fell foul of the pandemic.
The first
part described our preclinical training and the hospital buildings as we knew
them.
Guy’s,
King’s and St Thomas’s were then separate hospitals with their own medical
schools, as were most medical schools at the major London teaching hospitals.
The Guy’s campus was small, including the front courtyard with the statue
of Thomas Guy. The surgical wards and theatres were above the Colonnade, which
opened onto the central park. This was surrounded by the principal buildings.
The medical school, nursing school and Shepherd’s House (Physiotherapy and
Physical Medicine), were on one side; Hunt’s House (the Medical block), on the
other and Nuffield House, then a private hospital, at the far end. Other departments
such as the Dental School and York Clinic (psychiatry) were all nearby. The College, now demolished, where the
resident doctors lived, was in Great Maze Pond. This provided living
accommodation, a staff dining room and in the basement "The Spit" for student
meals. There was also a flat for one of the consultant staff, who acted as a
warden to the college. During our
studies New Guy’s House (now Borough Wing, Tabard Annexe) was completed and
surgery moved there. Southwark, Bermondsey and Tower Wing did not exist. We undertook all our training on the Guy’s
Hospital site with occasional visits to peripheral hospitals.
Guy’s
Hospital first admitted female students in 1947. With the inception of the NHS
in 1948, all medical schools were finally opened to women, as their funding
depended on the medical cohort being 15 – 20% women, as it was when we were
admitted.
We came from
slightly different backgrounds. Anne came from the Midlands, had never been
away on her own before and had only visited London once. She had attended an all-girls selective day
school where it was unusual to do science and no one had previously studied
medicine. None of her family had been to university. She was awarded a State Scholarship
which paid for most of the cost of accommodation in a University Hall of
Residence near King’s Cross, and all her tuition fees. Anne was overawed and
somewhat daunted to be at Guy’s. In the first few days many of her
contemporaries repeatedly asked how she came to be there. Even with the scholarship money was tight.
There were no loans in those days. Some students on grants had a really hard
time, especially when they moved from preclinical to clinical years when,
without long holidays, there was no opportunity to do paid work. When Anne was
offered the chance of doing an Intercalated BSc she was relieved to find that
her state scholarship would be extended to cover this.
Rosemary had
been to boarding school and lived in London with her parents while a student.
Her father was a GP who had qualified at Guy’s and numbered several Guy’s
consultant staff amongst his patients, some of whom he knew socially and
Rosemary had met. Her tuition was funded by her father and an uncle.
The status
of women in those days was very different; they were still not really expected
to have a professional career or to work after marriage. There were many
inequalities; for example, single women could not get a mortgage. As women
medical students we did not suffer any disadvantage but although in medicine men
and women were paid the same, which was also unusual, the number of women who
reached the top of the profession or had positions of power was low. We had few
female role models to follow. There was only a handful of women on the teaching
staff at Guy’s, a few as registrars and even fewer consultants. We doubt they
were represented in the power structure of the hospitals, possibly with the
exceptions of matrons.
The status
of students was also very different. We had little power or right of redress.
There was no real pastoral care or support for students and certainly no
special care for female students. The recommendation in the Student Union Hand
Book of 1954 for medical students was that ‘they can always discuss their
difficulties with the heads of departments in which they were working or with
the Dean, Sub Deans or the School Secretary’!
Marriage
while a student, or even a young doctor, was not regarded favourably. This
applied particularly to women and students and newly qualified doctors were
certainly not expected to have children. When Anne got engaged during her first
house job the consultant surgeon for whom she worked said ‘that’s the end of
you: you will never practise medicine.’ It is doubtful if such a comment
would be acceptable nowadays. Contraception
was less reliable (it was just before the days of the pill). It was not
available to unmarried women and living with one’s partner or having a child
outside marriage was not acceptable.
Both of us
entered Guy’s at the second MB level having obtained the required A Levels at
school to make us exempt from first MB year. All the preclinical teaching was
done on campus in the medical school. This included anatomy, physiology,
biochemistry and pharmacology. We had
excellent teachers, some of whom were rather eccentric. Many were involved in
good research, but teaching was a high priority.
Dissection
of a whole body was a major part of anatomy and went on throughout the 18
months of second MB. Going into the dissecting room for the first time was nerve-wracking. Groups of six students were allocated to each body. We had anatomy
vivas every two weeks when we were tested on the body part we had just
dissected, including the relations of the nerves, blood vessels and other
structures. The teaching staff were assisted by anatomy demonstrators, young
doctors training to be surgeons and working for their primary FRCS. We also we
had lectures and practicals on normal histology.
Physiology
training consisted of excellent lectures by the gentlemanly Prof Spurrell and
much practical work. Some of the
physiology readers conducted research involving student volunteers. One such
project concerned the relationship of gastric secretions to the menstrual cycle
so required females. We had to swallow large rubber nasogastric tubes early in
the morning when repeated samples were taken. We were rewarded by a small
amount of money (2/6=12 p) and occasional parties on Regents Park Canal with
champagne and strawberries.
There were
no Ethics Committees at that time to which such studies could be submitted and
it is doubtful whether students would now be permitted to participate.
Amongst
other teachers who stand out in our memory was Agnes (Aggie) Shaw, a reader in
biochemistry, who taught us extremely well but inspired fear in all. It was
rumoured that she was an exceptional racing car driver and thus was admired by
the male students. She was rare as a woman who excelled in a field dominated by
men.
The second
part of the series described our clinical studies in medicine and surgery on
the wards of Guy’s. We were not allowed to start our clinical studies until we
had passed 2nd MB.
In the three
months prior to going on the wards we had an intensive introductory course
given by Dr George Scott. We were taught system by system: first, the correct
way to take a history, then how to do a good clinical examination. He taught us
to look at the patient as a whole. We practised first on ourselves then on
‘professional’ patients, with known diagnoses and good clinical signs. They enjoyed
coming and were keen that we learnt from them. This superb course is a still
remembered for its high quality some 60 years later. Furthermore, these
clinical skills have recently been transmitted, with little modification, to
doctors in developing (LMIC) countries and are essential where costly
investigations such as MRI and CT are not available. The diagnoses obtained are
normally sufficient where therapeutic options are limited.
Basic
pathology was taught in parallel with this three month introductory course.
This fundamental part of medical training seems somewhat neglected today. We
continued to use books such as Boyd’s Textbooks of Surgical and Medical
Pathology throughout our clinical years as a basis of systematic learning. We
also learnt from post mortems, then more frequent. Later, as clinical students,
we were expected to present the history if one of our patients died. Often many
more lesions were found than suspected in life (this was before the advent of
MRIs and CTs).
Whilst we
disliked post mortems we acknowledged their value in learning, as was studying
pathological specimens in the Gordon Museum. Some of the forensic pathologists
were particularly colourful. Dr Keith Simpson was known internationally. We
remember him as thin, somewhat macabre with a pale lined face and thin dull red
hair. He had many gory projection slides. One showed a corpse which he examined
in Egypt. Seemingly normal on the front, when turned over there was a knife
sticking into the back. Dr Mant gave instructive lectures to a full audience -
during one he pulled out different types of guns one by one from pockets of his
very large overcoat!
The basis of
all our clinical teaching was apprenticeship, learning from clinical ‘cases’
and seeing the evolution of diseases. In addition, we had to attend 100 hours
of lunchtime lectures and occasional special courses. Then, as now, much
learning was self-directed. During our clinical years we were taught in groups
of 5 or more students who remained together throughout this training, rotating
every 3 months throughout the clinical specialties. In each specialty the
student group was attached to a Firm usually consisting of a senior and a
junior consultant, senior and junior registrar and one or more house officers.
Consultant
ward rounds took place weekly. The sister, registrar and houseman went round
beforehand to ensure that all investigations were available. The patients were
neatly tucked up in bed with starched white sheets. Not a bed pan was in sight.
Smoking was allowed in the hospital in those days, but patients were prevented
from smoking in advance of and during the round. The wards were large with tall
ceilings and large windows (Nightingale wards) with the only privacy provided
by curtains. Neither histories nor examinations were able to be done in
private. It was much as shown in the film ‘Doctor in the House’. The student
who was allocated to a particular patient presented the case, was told to
demonstrate the clinical abnormalities and asked for a differential diagnosis
and treatment. The patient would get a kindly nod from the consultant before he
moved to the next patient, but no opportunity to interact. The registrar was
expected to inform the patient afterwards, and the houseman to keep notes, of
what was to be done before the next ward round. All stood for some two hours or
so at the end of the beds as the round progressed. At the end consultant and
registrar repaired to Sister’s office for a cup of tea. It was common for
sisters to remain in charge of their ward for many years. Ward rounds with the
registrars were more frequent, less formal and with more in-depth discussion.
Students
were allocated patients on the wards by the houseman with whom we argued if we
believed we were not getting our fair share of patients. We recorded our
clinical histories and examinations which became the definitive archived notes.
We took blood samples when requested. Students were not allowed into the wards
until 10am when the doors opened to the ‘vampires’ as patients called us! Some
veins were difficult to access and students as well as patients suffered.
Needles were not disposable and thus were often blunt, even after being
sharpened by the nurses on night duty. The students did the erythrocyte
sedimentation rates and tested urine samples in the ward laboratory. Samples
for more complex tests were sent to the hospital laboratories.
Students on
surgical firms, called ‘dressers’, acted as porters for their patients, taking
them on trollies to and from the operating theatre. We watched the operation
either over the shoulder of the surgeon or from the balcony above the theatre
where one could also have a covert game of chess! Rarely the student assisted
but usually only in stitching up at the end of an operation.
The medical
and surgical firms were on call for emergencies (on ‘take in’) a week at a time
admitting primarily to their own beds which, if possible, had been emptied in
preparation. During this week the students, registrars and house men lived in
the hospital. There were daily rounds with the registrars to review all the
admissions of the day. On Sunday night the students cooked for the registrars
and house officers. Everyone shared the costs and it was an enjoyable occasion.
When we were
living in on take or during the obstetrics training the men were housed in the
college, but the women had to walk down a dark road at the back of the
hospital, to the psychiatric outpatient unit in Snowsfields, where there were
bedrooms. Snowsfields was a horrible dark building, and we were sometimes there
entirely alone and worried that there might be a patient left behind! At the end of some rotations we had a Firm
dinner, sometimes cooked in a student flat or more frequently held in a
restaurant and paid for by the students although many consultants chipped in.
Some
consultants were gentle and courteous to their students whilst others could be
rude or off hand and we had no come back, no route for complaints. Some were
dismissive of general practice which was thoughtless as their practice depended
on GPs referring their patients – and many of us would be going on to choose
general practice as a career. Most treated their patients with great kindness
regardless of their status but there was a general assumption that the patient
would not understand things medical and certainly this must have been true for
many ‘Borough’ patients who had few educational opportunities. Patients were
not encouraged to ask questions, no explanatory leaflets were available and
their permission to be examined by, or in the presence of, students was not sought.
Although
teaching of medicine in terms of diagnosis and management was good, we were not
taught how to communicate with either patients or relatives. When a patient had
a fatal diagnosis, they would generally be shielded from this knowledge even
though the relatives were told. This caused problems for junior staff, students
and indeed the family. The only way we learnt was by observation. Dr Philip
Evans a senior consultant paediatrician was an exemplary communicator whose way
of talking with parents of a sick child taught us a much. Students were also
taught in the outpatient department. This was next to the medical block and
consisted of a large central waiting area surrounded by small consulting rooms
where the anxious patient was confronted by students as well as the doctor.
We did two 3
month periods in medicine and surgery but all others were for a single period
and some specialties were learnt simultaneously. Many of today’s specialties
did not exist as such, although some consultants had a special interest in
particular aspects of medicine or surgery. There were departments of cardiac
and thoracic surgery and of dermatology, neurology and chest medicine but no
specialist departments of renal, cardiac or gastroenterological medicine nor of
geriatrics, immunology, or rheumatology. There was a large department of Physical Medicine in Shepherd’s
House but students were not taught about locomotor disorders nor did we learn
of the valuable work of physiotherapists, occupational therapists, speech
therapists or others such as dieticians.
Many of the
diseases we saw differed from nowadays; we saw intractable heart failure and
rheumatic heart disease, rarely treatable as medications were greatly limited
and open heart surgery was in its infancy. Patients with active pulmonary TB
were isolated for many months on a cold veranda opening off one of the medical
wards. We saw venereal diseases including all stages of syphilis; we saw
infections and fractures but few road traffic accidents. Many patients with
instructive diagnoses were referred to Guy’s by consultants also working at
peripheral hospitals.
During the 3
month obstetric and gynaecological rotation we lived in for a week to undertake
deliveries both in the wards and at home ‘on the district’ nearby. There was
intense competition to perform deliveries both between students and trainee
midwives. When called out to a delivery in the district we travelled by old
Guy’s bicycles. We felt perfectly safe and we knew no one would take a Guy’s
bicycle. To gain more experience some students were sent to other hospitals
including Pembury, Farnborough, Brighton and Lewisham.
The
diagnostic criteria of modern psychiatric disease were not fully developed.
Effective treatments were few. We were alarmed by many of the patients we
encountered and clerked in that department, especially those with schizophrenia
and we had no idea how to approach them or evaluate the histories they gave us.
There was a particularly distressing occasion when a circle of students
surrounded an impotent young man being interviewed very publicly by the
psychiatry registrar who somehow thought such an interrogation therapeutic.
Both students and patient were mortified.
Although
most of our training was at Guy’s we made several visits to other hospitals
including the fever hospital at Hither Green (closed in 1997). Here there was a
‘diphtheria bell’ at the hospital entrance which was rung as a diphtheria
patient was brought in to alert medical staff that a tracheotomy might be
needed. There were also patients many years post-acute polio still maintained
in an ‘iron lung’. Visits were also made to the Evelina Children’s Hospital
which was then a separate hospital in Southwark Bridge Road. Male students went
to The Seaman’s Hospital at Greenwich (closed in 1986) to learn about venereal
diseases; women students were not allowed and only saw female patients with venereal
disease who were treated in a small unit at Guy’s Hospital directed by one of
the few female consultants. She was a role model to us in her understanding of
her patients. We had a short, but disturbing, visit to the Fountain Hospital in
Tooting (closed in 1963) where there were babies and children with heads so
heavy with hydrocephalus that they could not lift them; others had major
learning and physical disabilities. They appeared to be just milling around a
big yard, not cared for, as now, in small homely groups.
After each 3
month period the registrars and consultants wrote a report on each student’s
performance. We did not see these routinely but they were important as they
determined who was appointed to the coveted House Officer posts at Guy’s
Hospital.
In the third section we described our experiences in general
practice which was offered towards the end of our clinical training and we also
reflected on medical training now and then.
Rosemary went to a general practice in West Wittering
in Sussex and stayed with the GP’s family. She shadowed him both on his regular
daily home visits, which were usual practice in those days, and consultations
in his surgery.
Anne’s experience was unusual. She went to John Fry’s
practice in south London. He was a brilliant teacher whose expertise is still
remembered by the annual John Fry Lunch held at Guy’s Hospital. He arranged
that she should visit a man with Ankylosing Spondylitis who had a big family, a
small house and had great difficulty in working. Dr Fry saw this man frequently
and encouraged Anne to visit him on numerous occasions over a short time
period, charting the flare ups of his disease and their relation to his work,
his family and his finances. This sparked off her interest in rheumatology and
later rehabilitation.
It is difficult now to look back on an era where there
was no evidence base for practice and text books bore no references. Treatment
options were limited. The number of drugs available was considerably fewer.
Alcohol, in the form of sherry to stimulate the appetite, stout to increase
calorie intake and brandy as a sedative, was frequently prescribed.
Most consultants worked part time at Guy’s. Many had
private Harley Street practices which sometimes took precedence. The old idea
of the voluntary hospital where the consultant did voluntary, unpaid work
lingered on. Others worked at hospitals in the south east with strong links to
Guy’s where students frequently went for clinical training, and later for house
appointments. The London Teaching Hospitals were late in appointing academic
clinical posts.
There were only two professors we can remember; the
professor of surgery, Sir Hedley Atkins, and John Butterfield, the professor of
medicine. Academic staff were whole time university employees and any money
raised from private practice was put to charitable or research funds making
such posts unpopular.
The social life of students was variable depending on
whether they lived at home, in digs or hostels near Guy’s or in the university
halls of residence where all London University activities were accessible.
There were numerous social and sports clubs attached specifically to Guy’s. The
latter were mainly for male students. At this time it was possible for men to
get a place at Guy’s if they excelled in rugby, while the Guy’s ladies squash
club could barely muster up enough players for competitions!
The ‘Borough’ people living around Guy’s were often
poor, with many housed in bad accommodation such as the Peabody and Guinness
buildings. We did not recognise that these were an improvement on what they had
experienced before. We just saw flats that did not have their own toilets;
these were shared and off the communal staircase and often blocked or
unsanitary. Ironically some of these buildings have now been upgraded to highly
sought after,
expensive apartments. The social milieu was much like
that shown in ‘Call the Midwife’. The ‘Borough’ people were loyal to Guy’s,
recognised that the hospital provided them with the best medicine available and
never questioned the doctors or students. At this time few had any idea of the
concept of human rights as applied to patients (and students), those with
disabilities, gender or race. Ideas of transparency or audit were yet to be
developed. There were very few women in a position of power in the country be
it politics, civil service, business or anything else.
Reflecting on what we have written we recognise
several things. Our training throughout was good: we had extensive exposure to
patients and much practice in developing our clinical skills which remain the
bedrock of medical practice. However, we recognise that clinical practice has
changed beyond recognition and that accurate diagnosis has been greatly
enhanced by modern technology, as have treatment options. Nevertheless, many
now worry that continuity of care has been lost, as have the values and support
embodied by the Firm.
We did not appreciate at the time the full
significance of the 1944 Education Act which gave much increased free access to
grammar schools. State and County Major Scholarships similarly allowed those
who could not afford the fees to study for degrees including medicine, although
this still only included some 10% of the population. These changes meant that
doctors now came from a wider section of society.
The position of women has improved immeasurably in all
society. In medicine, their ability to contribute at every level is now widely
recognised and valued. This opening of society to women was beginning when we
entered medical school. In 1962 when we qualified 5% of medical degrees were
conferred to women; by 2010 this was 43% (Bolton). Parity in numbers overall
has now been achieved and many women are found at the highest levels of the
profession. One can speculate as to whether this correlates with modern more
patient-centred practice.
