Post 7 Urine tests, loose stools and syphilis

The clinical assessment, essentially a practical examination, was the critical part of the final examination which would decide whether I was fit to put the letters MB ChB after my name and commence my life as a doctor.  It began with a requirement to analyse a specimen of urine.  With three other equally apprehensive candidates, I was shown into a small side room off the main hall.  
On a long wooden laboratory bench there were four glass phials each holding about 50 mls of fluid.   Alongside was a Bunsen burner, already alight, and a variety of chemical reagents in thick brown bottles identified by their labels, such as  Fehlings A and Fehlings B.

“Each of these bottles contains a sample of urine,” the adjudicator said.  “One sample contains sugar from a diabetic patient, one contains protein, one has blood in it and the final sample is normal.  You will each be given one of these urines and you will have twenty minutes in which to analyse it using the reagents provided.”

It seemed odd that in a so called modern teaching hospital we were expected to analyse the samples using methods from the Victorian era.  The nurses on the ward could test urine for all three abnormalities in 30 seconds flat using commercially available paper strips.

Did they still treat syphilis by rubbing mercury into the skin of sufferers I wondered?   I suppose we had to be grateful that they hadn’t turned the clock back to the days when the test for sugar was to put a finger in the urine and taste it for sweetness!

I looked at the four samples.  One was red, the other three were straw coloured.  Clearly the red one was the sample that contained blood and my silent prayers were answered when I was indeed handed the red urine to test.  Within five minutes I'd run the test and confirmed the presence of blood.  I then waited to be called into the main examination hall to face my examiner.

 I was nervous, incredibly nervous, and felt an urgent need to use the loo. Anyone who suggests that there is no connection between anxiety and physical symptoms, particularly gastrointestinal symptoms, must have led a very sheltered and stress free life!   Certainly they cannot have experienced the pressure felt by medical students as they approach the final examination of the medical course.  Pass and you become a doctor.  Fail and you spend the next 6 months swotting and praying that you will be luckier next time.

As I waited to be grilled by the examiners, it seemed inevitably that having found blood in the sample of urine that I’d analysed, the initial questions would revolve around the causes of blood in the urine and the treatment of these conditions.  I therefore began to formulate in my head a list of all the possible sites in the urinary tract from which bleeding might occur.
 I started at the kidney where urine is formed and considered each part of the system down to the tip of the penis from which urine is voided – at least it is in men! (I mention this to prove that I am indeed a bona fide doctor and have a working knowledge of anatomy.)   I also prepared a list of the various diseases that might be responsible for blood loss from each of these possible sites.  Having done so, I felt reasonably happy.  I was as ready as I was ever likely to be to face my inquisitors.

I would however have had much less confidence had I known what dastardly trick the examiner was about to play on me!
Paul’s encounter with his examiner will be subject of a future Blog

 He had ambitions to become a sex maniac but he failed his practical.                                                                                                              Les Dawson 1934-1993

Comment   In years gone by when urine had to be tasted to detect the presence of sugar, a trick was practised by senior medics. They dipped their middle finger into the urine but then surreptitiously inserted their index finger into their mouths before passing the urine sample to one of their juniors with a frown and saying. “I’m not sure about this. Tell me what you think.”
Mentioning syphilis brought to mind Voltaire’s account of King Charles VIII (of France) military invasion of Northern Italy in 1495. “On their flippant way through Italy, the French casually picked up Genoa, Naples and syphilis. They were thrown out of Naples and Genoa but they did not lose everything; syphilis went with them”.

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