British Association of Clinical Anatomists: origin and future

srgry02A paper for the meeting of the British Association of Clinical Anatomists at the Burton on Trent meeting, 14 December 2017

In the beginning was the Word, and the Word was with God, and the Word was the Anatomical Society and the Journal of Anatomy. They were in the beginning with God, and without them was not anything done in anatomy that was done. And the Professors of Anatomy saw themselves as the Lord Almighty. They terrorise and pulverise. They march through the breadth of the earth to possess the dwelling places that are not theirs. They are terrible and dreadful, their judgment and their dignity proceed from themselves. And lo, it came to pass that the people rebelled inwardly in their hearts. They cried to the Lord “wilt not thou deliver us from these bitter and hasty foes?” And the Lord raised up prophets, Coupland of Nottingham and Scothorne of Glasgow. And through them the Lord came to the aid of the oppressed. And lo! BACA was born.

It’s fun to see the formation of BACA in these Biblical terms, and it is not inaccurate. But there’s a bigger story to tell, and since this year marks BACA’s fortieth birthday, I shall do so. Of course, I’m not an historian, but I’m one of the few people alive who witnessed BACA’s birth in 1977 just along the corridor from my office in Nottingham. My recollections are thus first-hand and are as reliable as memory ever is.

First, a brief autobiographical sketch. I was at Cambridge for preclinical studies and then King’s College Hospital in London for clinical training and preregistration house jobs, as they were then known. I went to Nottingham as anatomy demonstrator in 1976 then Lecturer in 1977. In 1988 I began as Professor of Anatomy at the Royal College of Surgeons in Ireland, in Dublin—a medical school as well as a postgraduate college—and then in 2003 was appointed to Nottingham’s Graduate Entry Medical School at Derby. In 2006 I was ordained into the Church of England, becoming Vicar of Burton in 2014.

The origins of BACA are intertwined with two main medicopolitical trends: first, the decline of anatomy as a discipline in the medical curriculum, and second, the loss of medical graduates from departments where they had been predominant. I know that I am talking today to a mixture of scientists, physios and medics, and I apologize if what follows seems irrelevant to many of you, but it is important in the embryonic development of the society, so bear with me.

The decline of Anatomy

I enjoyed undergraduate anatomy. I was riveted by the first lecture in October 1969 concerning lemurs and lorises and thumbs, part of a series on the evolution of Man. Subsequent anatomy memories centre on Max Bull, the doyen of Cambridge anatomy teachers, who gave us a definition of anatomy that has stayed with me: “the study of the structure and function of the growing and changing living organism, not necessarily human”. It’s not elegant but, like a thong, it covers the essentials, especially, as Max was at pains to emphasize, the growing and changing bit.

I was fortunate in the Cambridge anatomists of that time, who with one exception were affable, approachable and interested in students. So when during clinical years I realised that practising medicine was not for me, I thought that if being an anatomist involved what Max Bull did—welfare and nurturing of students using the vehicle of a subject that interested me—then an anatomist is what I would be.

In the third clinical year I approached several professors of anatomy about a job, and ended up in Nottingham because it was a lovely day when I visited and Rex Coupland, the professor, was charismatic. It was a good decision. I immediately saw the value of the brand new systems-based course that resulted in anatomy being significantly trimmed down, with much less time spent on dissection.

Listening to colleagues who had done time at other places, I realized how fortunate I’d been in Cambridge. I heard that more than a few Professors of Anatomy elsewhere were belligerent and irrational, and bullied their juniors and students. I witnessed it in external examiners

This is relevant to the decline of anatomy. In the 1970s and 80s, all the influential people in medical schools had had to endure hours wasted on dissection, all had been made to learn anatomy in excessive detail, and a fair few had suffered from the bad behaviour of some anatomists. Not surprisingly, they resented anatomy and they resented some anatomists. They were determined to cut anatomy down to size. They were abetted by the new discipline of Medical Education, then on the march, many of whose enthusiasts stated openly that doctors no longer needed to have facts at their fingertips. There was growing opposition to what they, wrongly, called didactic teaching

Things did not get better. The systems-based curriculum developed in many places in a way that may have suited metabolic processes but all but wiped out regional anatomy. The understanding of human biology as a product of evolution and adaptation, as imprinted upon me by Max Bull, sank without trace. I must be one of the last medical students to have enjoyed a term studying serial sections of pig embryos as part of an undergraduate course.

What was to be done?

With their clinical training and their clinical eyes—Coupland had begun to train in neurosurgery—BACA’s founding fathers were certain that only medically qualified staff were capable of teaching clinical anatomy. But there were hardly any left. So the question for them, given the image problem and the brain drain, was: how can we in anatomy recruit and retain medics?

The answer, they thought, was twofold: money and status. Rex told me that he saw BACA as a trade union that would lobby for preclinical medics to be paid more. Furthermore, the founders saw it a means of having medical anatomy recognized as akin to a clinical specialty. The trouble was that Rex and Ray didn’t know how to achieve these aims—indeed, given that they were both adept medical politicians in university life, they displayed surprising naivety.

First, money. Formerly, medics in preclinical departments had been paid more than non-medics doing the same job, but this differential had been abolished some years back. No salary committee in its right mind would reverse that decision for the sake of a miniscule number of peculiar medics. Perhaps the founders were thinking in terms of a salary enhancement, for Rex was the recipient of a hefty NHS merit award for which he attended at most one ward round a week. If he thought that that arrangement would catch on with NHS administrators, he must have seen pigs with wings. As for payment for clinical duties undertaken by anatomy staff, of which I was for over a decade a beneficiary, the resentment created by my not being available for university duties for one session a week was considerable. That wouldn’t have survived in the increasingly regulated NHS.

Second, status. I’m afraid Rex and Ray were living in cloud cuckoo land in imagining that clinicians would support any proposal to give senior anatomists clinical privileges. Unless the definition of clinical was twisted to mean what it patently does not, anatomists could never be clinical. At that time I became a member of the BMA Medical Academic Staff Committee, and believe me I know just how little support there was for such an idea. The clinicians simply laughed. In any case, Rex and Ray were wrong. Neither money nor status would have dealt with the image problem. Medics in anatomy were in many cases rightly considered maimed, unable to cope clinically, or, like me, deranged in turning their backs on clinical practice and salary.

It was all too late. King Canute couldn’t stop the waves, and neither could BACA.


In the eyes of junior staff, BACA was compromised from the beginning. It was snobbishly hierarchical. For full membership you had to be a medic, and a senior anatomist to boot. Anything else meant a lesser category. And right at the bottom—sorry about this, all you scientists—were the ‘mere’ PhDs. The Association looked like an exclusive club for Rex’s and Ray’s friends and relations. My non-medic colleagues were outraged. The powers that be eventually relented, and this discrimination was abolished, though not soon enough. It left a bitter taste, and non-medic anatomists shunned BACA in favour of other scientific societies, leaving BACA meetings in the early days with little of great worth other than a good meal.

How did clinicians view BACA? I can only go by what I deduced from meetings. I should say that I was never a great meetings enthusiast. As a teacher I felt an impostor as scientist. As someone who did one ENT clinic a week, I felt an impostor as clinician. I was at home with students, provoking them to explore, to think, to imagine, to learn, and to ask questions, but to be on the receiving end of a comment from an eminent scientist which began “Dr Monkhouse, I listened to your paper and I have a question” was to render me incoherent in the sure and certain knowledge that evisceration was imminent. But to proceed. Many of the presentations at early BACA meetings came from only a handful of research groups—we’re back to the private club. Most surgeons looked elsewhere to flex their academic muscles, and few were enthusiasts for BACA or indeed anatomy. I was astonished to hear a Professor of Surgery tell me, the Professor of Anatomy, that he didn’t care what a structure was, or what it was called, or how it developed: all he cared about was whether or not he could cut it.

For these and other reasons, BACA was viewed by non-medical staff as elitist, and by clinicians as not really kosher. BACA meetings and the journal Clinical Anatomy came to be regarded by some in both camps as second or third best. It was fighting for its life as soon as it was born.

The future

I’ve been off the game for over a decade, so what value my comments have is for you to judge. However, as Max Bull remarked over 45 years ago, I have an analytical brain, added to which the view of the forest is better from the edge than from the middle.

The organization I work for at the moment is run by yesterday’s people making decisions for tomorrow without heeding the concerns of those that will have to bear the consequences. Is this true of BACA? Judging from your website, I think not, indeed I have the impression that you have worked hard to move on from those incestuous and hierarchical early days.

The future of an organization depends upon its capacity to be of service to others. So I suggest that you continue in that direction in the knowledge that you are on the right course. The future of BACA depends not on juniors tugging the forelock to grand old men, but on the extent to which those with experience can be useful to those trying to acquire it.

You rightly offer yourselves as a forum for gaining experience to anyone who wishes to explore clinical anatomy, no matter how tangentially. Find out what trainees need and work with them to provide it. Help them build their portfolios, and gain skills in presentation, writing and editing. Think back to when you were young and ask yourself what made you anxious. Help trainees to master these things.

Your committees will need to include more than a token trainee, so sling off the superannuated. If trainees are hard pressed to find time to serve, then organize things to suit them. I don’t want to get overly theological about this, but didn’t someone once say that the first would be last and the last first?

Many of the scientists among you will know more embryology than the medics. Teach them! It is hugely important in several clinical and scientific areas. How can anyone understand the function and layout of the cranial nerves except in terms of evolution and embryology? How can anyone understand how a weak voice might signal a mediastinal tumour except in terms of evolution and embryology? The medics among you can help nonclinical staff get to grips with some of the more obscure consequences of regional anatomy in terms of diagnosis and treatment. Work with the Anatomical Society—after all they are wealthy while you, I understand, are merely comfortable.

Is there anything to be gained by working with the Royal Colleges in training programmes? I know it’s difficult to work with surgeons, especially those who are big in the Royal Colleges, for as with Yorkshiremen, you can’t tell them anything: they are multitalented and omniscient. But there are other disciplines …

Another flight of fancy. Alternative medicine is on the up. See if you can cooperate with some of its more anatomical branches. I was in terrible trouble early in my Dublin days for having conversations with osteopaths and physical therapists about how we could help with their training. My knuckles were well and truly rapped by protectionist surgeons. I still see nothing wrong with those conversations and remain unrepentant, especially since they had money to pay us. One of the things I learnt from osteopaths was the way in which neglected ideas from the past surface years later. For example, the gut brain, once sneered at, has a new lease of life. It was an osteopath that directed me to a book entitled “The Autonomic Nervous System” by the unfortunately named Albert Kuntz, published in 1929. There are some prescient nuggets in there that might repay imaginative thought.

Now there’s a word: imaginative. Imagine how you could serve. Imagine how things might develop and plan for them. Maybe that’s the best advice anyone could give the Association as it looks towards the next forty years. You’ve done well to come from a precarious postnatal period to the state you’re in now, so keep your eyes open and your antennae alert and let your imaginations flower. You can be proud of yourselves.


When I saw that BACA was coming to Burton, my first thought was “perhaps they’ll give an honorary member, or whatever I am, a free dinner”. And so you did, last night. It pays to be cheeky: “ask and you shall receive” is a phrase I read somewhere. It’s lovely to meet you, to renew friendships, and a real pleasure to begin to get to know Neil Ashwood. When we first met he asked me if I knew any connexions between Burton and Anatomy to which he could refer in his speech. I said modestly “not really, only me.”

Friends, thank you for your invitation, for feeding me, and for listening to me. May the Lord light up your life ….

…. any scholar of Carry on up the Khyber knows that the correct response to this is: and up yours.

Placentas and pizzas



Mrs Windsor née Middleton is pregnant. It’s in the newspapers so it must be true.

First, I have to get this hobbyhorse off my chest. The correct spelling of fetus is fetus, not foetus, the word being related to felix, femina, etc. The incorrect spelling occurs first in the late writer Isidorus (570-636 AD) who fancied that the word could be derived from foveo (I cherish) instead of feo (I beget). So there.

Now to the hard stuff.

Is it an embryo that is taking root in Mrs Windsor’s genital system? Yes indeed. Is a fetus? Is it a baby? Is it a child? Embryo and fetus are defined by convention: you can look them up if you like. Baby is a meaningless term. Is it a parasite? Well, it steals mama’s nutrients and dumps its rubbish on her. It guzzles into her flesh so that its placenta can plug itself in to mammy’s tissues and get up close and personal with her blood vessels. It consumes the contents of parental wallets for at least two decades. Make up your own mind.

Some people worry about when the fetus becomes human. Not I. It’s human because the spermatozoön and ovum that produced it came from gonads belonging to humans. Reputedly. Anyhoo, however royal this fetus may be, it’s also a chordate, a vertebrate, a mammal, an ape and a primate. This is much more important than royalness.

The royalness will doubtless induce the Church of England to produce a prayer for the royal products of conception—it may already have done so—the usual crass, meretricious, tendentious, wordy drivel that comes from Lambeth. Products of conception include placenta, amnion, chorion, umbilical cord. Are they royal too? Are we to have a prayer for the royal placenta? Will a specially consecrated pair of scissors be used to cut the royal umbilical cord?

Killing the fetus

When do you think it should be permissible to kill the fetus? Or perhaps, when should it no longer be permissible? Well here’s the thing as I see it. Despite what the law may say, there is no single moment during the whole course of pregnancy at which the fetus is significantly different from what it was the moment before. There is no event that takes place that sufficiently differentiates what the fetus was before that event from what it is after the event. Fetal development is a continuum. From this point of view, if it’s permissible to kill a fetus at 18 weeks, then it’s permissible to kill a postnatal child or an adult. For those of us who have a little list of people not one of whom would be missed, this is comforting.

Why are we born when we are born?

The short answer is nobody knows. Brain size must have something to do with it. If we stayed inside any longer, our heads would grow so big that we wouldn’t be able to get through mama’s pelvis. But like I say who knows?

We are born very immature. A newborn horse can canter off pretty soon after birth, but not a newborn human. Unfortunately. Neurologically (spinal cord tract myelination—look it up), some of us mature more quickly than others. If earlier, we shall be better at physical activity and sport at an earlier age. If later (like me, dear reader), we shall have the shit kicked out of us at school for being physically inept.




Placenta in Latin means flat cake. It is a most interesting organ, much under-researched. Its evolution is fascinating. Some mammals have lots of little placentas. Some, like mice and humans, have a single placenta. A primate (therefore human) placenta is about the size of a small pizza. Looks like one too. Some twins have separate placentas, some share.

A mouse placenta is similar in size to the head of a small drawing pin. Believe me, I know. I’ve dealt with hundreds of them in my time. When our three products of conception were little, the eldest drew a picture of me at work with the caption “my daddy studies mices kidneys”. Adrenals, actually, and fetal ones at that, but the gist was spot on. She had not mastered the apostrophe by that stage (like an increasing number of adults, but don’t get me going), but had grasped that plurals are normally formed by the addition of a terminal s, and that in conjugating the verb ‘to study’, y sometimes becomes ies. Pretty good, huh?

Please understand, dear reader, that the placenta is fetal. Entirely fetal. The only bit of maternal tissue that comes out with the placenta is that which is torn away from the uterine lining when the placenta detaches itself, hopefully after birth. This is why bleeding may occur.

The placenta, like the infant that it nourishes, is a foreign organism as far as the mother’s immune system is concerned. Why is the placenta, which comes into intimate contact with maternal tissue, not rejected? Well, sometimes it is. And so arise spontaneous abortions and other obstetric headaches.

A bit of history

In the fourth, fifth and sixth Egyptian dynasties the placenta was held to be the seat of the external soul. There existed the ceremonial position of Opener of the King’s Placenta. Some have suggested that in Abigail’s flattery of King David (1 Samuel 25:29) she calls on this image, the ‘bundle of life’ (KJV) being the placenta, though this is not mentioned in recent Biblical commentaries. Some societies suppose the placenta to be ‘the twin brother or sister of the infant whom it follows at a short interval into the world’ — and in a way, it is. In central Africa a belief in reincarnation leads to the afterbirth being buried at the doorway, or under the threshold of a hut, practices connected with the divine doorkeeper and the widespread custom of carrying the bride over the threshold.

The great fry up

And now, children, finally for today’s “Listen with mother”, remember that the placenta is a most nutritious organ. It’s not that different from black pudding: blood, connective tissue and other bits and pieces.

Fried with eggs, mushrooms bacon and tomatoes it would make a right royal breakfast.

Four in 10 students say university not good value

drainWhat a surprise!

During my quarter of a century teaching at the University of Nottingham and the Royal College of Surgeons in Ireland I’ve seen the growth of ‘educationalists’. They purport to improve teaching standards by fostering an interest in the ‘discipline’ of ‘pedagogy’ (why do they insist on pronouncing this ‘pedagodjee’?)

Have they done so?


They manufacture more and more hoops for those at the chalk-face to jump through.

They spin all sorts of guff about improving the student experience. They do this by giving the students questionnaires to fill in every week about this, that and the other. They are asked to grade individual staff on the basis of quality of handouts, or use of technology, or approachability, and much more.

They write garbage such as:

  • purposeful reflection (thinking, but at €100 an hour);
  • impactful research (difficult, since Medical Education Journals are pretty risible);
  • student centered e-portfolios (students do something online, the teachers ignore it);
  • the flipped classroom (getting students to read ahead and then asking questions during a ‘lecture’);
  • dynamic/personalized/bespoke Learning Environments (A place online to dump powerpoints);
  • student-led teaching, peer teaching (letting the students do the work while the staff do experiential research into different varieties of coffee);
  • interprofessional education (talking to each other).

As sociology was once defined as the study of those who don’t need to be studied by those who do, so medical education is the study of those who teach by those who can’t, won’t, and certainly shouldn’t.

And the sad thing is that the tail now wags the dog. Educationalists now call the shots. The result is that students are not now taught anything much. Students must reinvent the wheel for themselves. They are lectured about the ‘science’ of learning—in truth not a science at all, merely tendentious opinion.

University ‘teachers’ are appointed to lectureships on the basis of knowing a great deal about hardly anything. What matters for their career advancement is how many publications they produce, and in what journals. Chances are that to them the teaching and nurturing of students is a distraction. The ability to distil complex concepts as an introduction for the neophyte matters not one jot.

Students pay fees. At the College of Surgeons medical school (despite the name, for undergraduate medics not just surgeons), a medical student now pays over €50K a year. Just think what could happen if the students started to use this power. Oh yes, of course, silly me, what would happen is that they would not get their degrees, so they would not be able to earn enough money to pay off their student loans.

What is the solution?

Simples, as Aleksandr Orlov might say:

  • separate teaching and research and fund research separately;
  • abolish student fees.
  • let students pay teachers directly, on the spot: they would flock to the good ones who would be suitably rewarded.

O taste and see

Camel_in_Singapore_ZooAnother avenue of pleasure closed off. The World Health Organisation tells us not to drink camel’s urine.

I was wondering why I was tired. I’m overweight. I was 64 (65 now). It’s very tiring to have people dumping their expectations on one—the lot of the Vicar. Then, listening to SWMBO, a type 2 diabetic (when I say listening, I mean being aware of faint buzzing sound somewhere to the left), I wondered if I was developing diabetes. That would account for tiredness. It would mean that I was drinking a lot. Now, I’m a copious tea drinker, though not in Bennite quantities, so how would I know? It would mean I was peeing a lot, and given the amount I drink, I don’t. And it would mean that my urine would taste sweet.

O taste and see. So I did. Nothing really. A bit salty perhaps, but I am a salt lover. I’ve never been a sugar lover. As a child I was known as the odd one who likes sandwiches not cakes. So no diabetes. Why bother with expensive tests when taste buds come free?

As a medical student I learnt the importance of always checking piss (in the Bible, don’t moan at me) and dung (also there, but less likely to provoke moaning). Here, boys and girls, is what to look for.

First, blood. This might be pinkness or redness or blackness from huge quantities of the stuff. Mind you, chances are you’ll already be at death’s door if it’s black—unless you’ve just returned from a night on Arthur’s best in Dublin. Blood in wee means something wrong with kidneys, bladder or connecting tubes. Blood in poo means something wrong with large intestine. Blood on poo means probably piles, which are kind-of blood blisters. Don’t sit on radiators or you’ll get thermopiles. Blood is a danger sign. Blood is good, but only confined to blood vessels. End of.

Now urine: colour, smell, pain. Note any change in what’s normal for you. I drink a lot, so mine is anything between clear and a delicate Piesporter. It doesn’t smell. Smelly dark urine often means infection, unless you’ve been perilously convivial the night before and have a head like a constipated turnip. If you’ve recently partaken of asparagus, your pee will smell pretty vile. It soon passes. If you’ve recently had a bum-burner, it might well sting a bit to pee. Don’t fret unnecessarily: use your common sense, should you have any left after last night.

Poo: colour, consistency, pain. Again, note any change from normal for you. Poo colour comes mainly from bile, which digests fats. If bile is unable to flow into the intestine, fats will not be digested so poo will be fatty, chalky coloured, smelly, and will float. In such cases, the bile is excreted from the body not in poo but in urine, so urine is dark. Pale stools and dark urine—always bad news: bile tubes are blocked. You’d be amazed how many doctors miss this, though not if they’ve been through my hands they shouldn’t.

Consistency: the function of the colon is to remove water from stools. So runny poo means that stuff is hurrying, or being hurried, through. There are several reasons why this might happen, often an infection by some of God’s non-human creatures. I once had a dreadful episode at Johannesburg airport that made the check-in lady enquire if I was well enough to board. I crossed my legs I can tell you. Read about it: Letter from Malawi. Parishioners who have had part of their colons removed have always responded well to being addressed as semi-colons (“oh no, it hurts to laugh”). I could go on, but maybe you’ve had enough for today. I shall deal with the ear next, I think. Quite fascinating.

From now on, look and sniff before flushing. Leave the tasting to others. Or machines.

Keeping an eye on people

Imago deiThe Mission office emailed us with ‘tools’ for keeping track of people who come to church. There are detailed spreadsheets to be filled in for every Sunday of the year, spreadsheets for names of regulars, names of visitors, space for notes as to what they do where they come from, where they go to, and why they came or went. And more.

It’s reassuring to know that Diocesan workers have parish clergy in mind as they create forms for us to fill in. We only work half a day a week, if that, and so there’s plenty time to make notes on where Mrs So-and-so was last week, and where her grandchildren were the week before. After the blessing at the 9;30 Mass, as I leave for the 11.00 service elsewhere, I brush aside people who wish to talk to me in order that I can fill in the forms before the memory fades.

This is an effort, I’m told, to make my job easier and help me keep watch over my flock. The Stasi were good at that. A correspondent wonders how this sits with Data Protection legislation. I really can’t think why the anonymity of Cathedral worship attracts more and more people.

But I am puzzled as to why properly trained clergy should need to be told pastoral practice. I’m put in mind of Medical Educationalists who are supremely gifted in the ability to tell others how to teach, despite never having taught themselves.

Little Weed

scaulbandbWatch with Mother on Wednesday afternoons in the 1950s and 60s (the BBC) was Bill and Ben the Flowerpot Men. It was set in the garden shed down at the bottom of the garden. When the gardener went for lunch, Bill and Ben came to life spouting curious gobbledegook like ‘Babap ickle Weed’ and ‘flobble-op’ (like church and university committees). Bill and Ben seemed strangely attracted to Little Weed that grew between them, though perhaps it’s better not to delve too deeply into the nature of the relationship. Maybe weed is not unrelated to the Flowerpot Men’s speech patterns.

Little Weed in the form of tobacco officially gets short shrift here in Ireland, for there is unalloyed joy at 10 years of the ban on smoking in the workplace. This includes pubs. Yes, pubs. Wikipedia tells me that the republic was the first state in the world to introduce such a ban.

We are told that as a result, the death rate from lung cancer is falling. Wonderful. But since we all die of something, the death rates from other things must be rising. Mind you, treatment for heart disease has come on so much that folk who used to die of heart disease now die of something else—cancer probably—so maybe not. The success of cardiologists must have caused deaths from cancer to rise.

While I’m on this little scherzo, I don’t understand all the fuss about fat in food. I am fat. I like fried eggs. Low fat food is chock full of sugar, so if you don’t get heart disease from too much fat, you’ll get kidney disease and have your feet chopped off because of the diabetes from too much sugar. And then you’ll die of cancer.

There’s another way of dealing with the tobacco problem, and it’s quite simple. If everyone were forced to smoke, lots of people would die from cancer, but all those who were genetically resistant to developing lung cancer would survive and reproduce. So then everyone would be resistant. The tobacco industry would have nothing to worry about, and the government could take more and more revenue from tax on tobacco. Problem solved. Simples.

I like salt too. I don’t like food police. There’s a lot of them about.

Bleeding rain

red_white_blood_cells‘Been thinking about you all morning.’

A siren song assailed my left ear as I was in the filling station waiting to pay. It’s not something I expect to hear from ladies in queues. She’d been deliberating about whether or not to go for her morning run, and was just about to settle on ‘no’ because the weather was so vile, when her daughter piped up ‘Stanley said yesterday it didn’t matter if you got wet because once you were wet you wouldn’t get any wetter and anyway you’d soon dry.’ So she went.

That’s the first evidence that anybody ever listens to anything I say.

Yesterday’s Maryborough School Assembly was about water. My views about wetness come from experience from the age of 10 onwards. When you’ve grown up around Penrith, and got soaked most mornings walking the mile or so from King Street bus stop to the Grammar School, you get used to rain, and you realise pretty quick that once you’re wet through (after about 20 seconds, I recall), you don’t get any wetter. Furthermore, before long you dry out. Never mind that the first 35 minute class is endured amidst steam rising from damp uniforms and viewed through steamed up specs.

I also said how magic our dog’s coat was for it was self-cleaning. And maybe our skin was. And maybe we shouldn’t wash so much because being too clean did nothing for our immune systems. This did not go down well with the teachers.

After assembly I took the seniors for a short biology discussion about blood. There had been a recent death from leukaemia, so we did types of blood cells, what they do, and what goes wrong when they don’t. And a bit of Greek with erythro and leuko and cyte and aemia. As far as I can judge from their attitude and lack of fistling, they were seriously interested. They certainly asked intelligent questions.

There’s a market for public lectures about how the body does and doesn’t work.

A nose that runs in the family

Workhouse, then City General, then University (so full circle)

Workhouse, then City General, now University (so full circle)

Carlisle hospitals saw quite a bit of me when I was young. Chatsworth Square Nursing Home took my tonsils when I was about 5. All I can remember is dark green walls and glass partitions. The Ear, Nose and Throat fraternity made me one of theirs after that, with a sinus job, two nasal polypectomies and an operation on the nasal septum when I was about 17. Somewhere in all this came appendix, two teeth operations (they’re wonky at the front), and an arm job. Mostly, I was at the City General, but the appendix and arm were done at the (old) Cumberland Infirmary where for the appendix in 1960 I was in Ward 18 opposite grandfather W P Monkhouse, then in his 80s.

For one of the nose jobs I was in a side room with a boy from Workington whose sister was called—and this is what it sounded like to me—Hughery. I’d never heard of that name and asked him to say it again, just to be sure. Yes, it sounded like Hughery. So that’s what I said. It wasn’t until years later that it dawned on me that it was Hilary, and he was probably in for a palate operation, so pronouncing ‘l’ was a problem. He thought he was saying Hilary and I heard Hughery. No wonder he was cross with me: I suppose he thought I was making fun of him.

One thing illness does for you, popular wisdom has it, is make you patient. It makes you take each moment as it comes. It teaches you not to have too many expectations. You learn that when doctors say you might be home at the weekend, you equally well might not. You learn to laugh off these little disappointments. When you expect to be going for an operation on Tuesday, and it’s cancelled because you have a chest infection, you learn to take it in your stride. That’s what popular wisdom says illness does for you.

Let me tell you that popular wisdom is piffle. Complete twaddle. Especially if you’re a child. As is well known, I am the most patient and even tempered of God’s creatures, but not even I was able to bear with equanimity the unpredictability of illness. I was in despair when some sign of progress did not materialize as I thought it should.

Dangerous rubbish

Dangerous rubbish

My nose would have been less inclined to run in the family had I not had cow’s milk shoved down my throat ‘when I were a lad’. It should come in bottles marked ‘poison’. Cow’s milk for cows, human’s milk for humans. It’s a snot generator. In the 1990s an Ear, Nose and Throat colleague told me my nose would be better if I stopped milk. I have, except in tea, and it is. The other thing that affected me was grain and meal that, since my father ran an agricultural feed manufacturing plant, put money in our pockets.

Milk and wheat are not good for Rambling Rector. I wonder how different my life would have been if I’d known sooner. As for cats, which always know that I’m allergic to them, the best place for them is under the wheel of a heavy truck.

One of Grimm’s Fairy Tales has a man whose nose grows so long that people trip over it.