Student Memories of Guy's, by Anne Chamberlain and Rosemary Millis

 

At the time of our 50^th 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.