How we treat bilharzia

A. M. Daniels

It is always pleasant and instructive to see one's profession in a new light. I therefore considered my admission to hospital an excellent opportunity to discover whether there was any validity in the criticisms sometimes levelled by lay journalists against doctors.

I had an enlarged liver — not, I hasten to add, the result of an excessive intake of alcohol — and as I had spent several years in the tropics, it was thought prudent to admit me to a hospital famous for the treat- ment of tropical diseases. I presented myself accordingly to the hospital recep- tion, to be confronted by a dishevelled porter wearing a union badge calling for a totally new and different kind of society.

I was taken to a four-bedded room. There was a splendid view from the window of an extensive cemetery. The youth in the bed opposite mine said: 'I was feeling all right until I come in here.'

He was suffering from bilharzia, and the curative drugs were causing him to vomit hourly.

The other patient in the room was a very fat young car salesman who had been admitted to find out why he was so fat. 'At first they thought it was my glands,' he said. 'But now they think I've got Low Metabolic Rate.'

At that moment, there was a tremendous crash. Through the doors came a tea trolley, propelled from behind by a Southern European lady slightly less than four feet tall. (The National Health Service has an inexhaustible supply of such ladies.) `Teaorcoffeemilkansugar,' she said.

Low Metabolic Rate selected tea with milk and four sugars.

Then it was time for me to be examined by a junior doctor. When she learnt that I

too was a doctor she began to tremble. She percussed my chest as though there were an unexploded bomb inside. Halfway through

'Where are you going this Winter?' the examination, Sister put her head through the curtains.

'Professor wants you,' she said.

Hastily stuffing her equipment back into her pockets, the junior doctor promptly forget my existence and dashed off.

The highlight of the hospital week was undoubtedly the Professor's ward round. Every patient in the hospital, whether the Professor's or not (and I was not), was re- quired to lie quietly in bed in pyjamas until the round was over. As the Professor was frequently very late, some irritation resulted amongst the patients. But the nurses told us that if we were not in our beds when the Professor arrived, they — the nurses — would be severely admonished.

At last the Professor arrived. We heard some whispering outside the door. Then he entered, followed in strict hierarchical order by his juniors and the Sister. He was a very tall man of ascetic thinness, in a dazzling white coat. Gold-rimmed half-moon spec- tacles perched at the end of his nose. He looked at the youth with bilharzia.

'I hear you haven't been feeling terribly well,' he said.

'That's right,' said the youth. 'I haven't.'

'Well there's one consolation for you,' said the Professor. 'The worms inside you are feeling much worse. I wish you good morning.'

With that he left, followed (again in strict hierarchical order) by his juniors.

By the next week the patients had changed. There was a jolly Nigerian student of accountancy who had failed his exams six times in succession, and an aspiring young artist who had gone to India in search of enlightenment, and had returned with dysentery.

The Nigerian was the Professor's patient. This time he entered with an enormous entourage of about 60, composed of students, foreign professors, consultants and others. The temperature in the room rose immediately. They gathered round the Nigerian's bed, but only the Professor spoke.

Without explaining who all these people were, or why they were there, the Professor started to question the patient, who was expected to answer monosyllabically. Halfway through the questions, the aspiring artist turned over the page of the magazine he was reading. The Professor spun round and pointed an accusing finger at him. 'Sister!' he exclaimed.

Sister dutifully trotted over to the miscreant.

'Could you make a little less noise, please?' she said.

'But I didn't make any noise,' replied the artist.

'Yes you did,' said Sister. 'You turned over the page.'

When quiet had been restored, the Pro- fessor resumed his questions.

'And how is your water?'

The Nigerian began to describe the new well in his village back home.

`No, no, man. Your urine!'

The questions over, the Professor ex- amined the patient, pointing out the pathological features of his body to the entourage, who all craned forward to have a better look. Having completed the examination, the professor began a disquisition on all the dreadful complications that could arise from the Nigerian's disease. He prefaced his remarks with a clear instruction to the Nigerian: 'Now don't you listen to any of this!'

The Professor turned to go. A passage opened up in the entourage for him, like the waters of the MGM studio parting for Charlton Heston. As he reached the door, the Nigerian said: 'Wilt I be in hospital long, then?'

The entourage gasped. Oliver Twist had asked for more!

'It's impossible to say,' said the Pro- fessor. 'It depends on so many things.' With that he was gone.

I need hardly say, of course, that my own practice required no revision in the light of my experience.