In the early 1950s when Richard Gordon published Doctor in the House, medical students and young doctors recognised the world that he described. Nearly every medical school had its share of autocratic surgeons and physicians with an occasional Carry On matron, eccentric professor or formidable ward sister thrown in. Not only had them, in fact, but boasted of them. Students tended to revere these hospital ‘characters’ and eagerly passed on their latest doings and sayings, even though most were distinguished less by wit than by offensiveness. In those post-war years, deference was still a virtue; the virtuous knew ‘their place’ and were not ‘too big for their boots’. So laughing at feeble jokes made by your superiors was a mark of respect, as it still is in hierarchical institutions.
Yet, though hierarchies encourage deference, they also promote subversion, and the stories most cherished by the medical other ranks of the 1950s were those in which patients got their own back on the ‘characters’. One such was reported from Dublin by Dr Seamus Cahalane who, like Richard Gordon, was an anaesthetist, and therefore handily placed to observe the antics of surgeons.
In the 1950s, according to Cahalane, Dublin could easily match London in autocratic surgeons. One of the most notorious confined his preoperative contact with patients to entering the ward with his acolytes on the day before operating, then striding down the aisle between the beds, pointing at each patient in turn, and announcing his intention in a single word: ‘Cholecystectomy … appendicectomy … laparotomy.’
The patients, better known then as ‘teaching material’, were expected to respond with a quick tug at the forelock and a humble, ‘Thank you, sir.’
In those days, elderly men with prostatic cancer were offered treatment by physical rather than chemical castration, so one day the surgeon’s list went, ‘Laparotomy … castration … appendicectomy …’
‘Hang on a second, sir,’ piped up the little man in the second bed with unforgivable impertinence. The surgeon and his retinue had already moved on, but they now paused in mid-stride. The patient, encouraged, continued: ‘This castration business, sir? What exactly would that involve?’
The surgeon, perplexed rather than offended, moved to the patient’s bedside.
‘A simple matter, my man,’ he said. ‘We’ll just remove your testicles. At your age, they’re no use to you.’
‘Oh, I know that, sir,’ said the patient. ‘But they are kind of … dressy.’