'Do you know anything about this, damn you?' he demanded.
'Me, sir?' Benskin asked innocently. 'Not at all, sir. I think it may have been someone from Bart's.'
15
To a medical student the final examinations are something like death: an unpleasant inevitability to be faced sooner or later, one's state after which is determined by the care spent in preparing for the event.
The examinations of the United Hospitals Committee are held twice a year in a large dingy building near Harley Street. It shares a hidden Marylebone square with two pubs, a sooty caged garden, an antique shop, and the offices of a society for retrieving fallen women. During most of the year the square is a quiet and unsought thoroughfare, its traffic made up by patrons of the pubs, reclaimed women, and an unhappy-looking man in sandals who since 1931 has passed through at nine each morning carrying a red banner saying 'REPENT FOR YE DIE TOMORROW.' Every six months this orderly quiet is broken up like a road under a pneumatic drill. Three or four hundred students arrive from every hospital in London and from every medical school in the United Kingdom. Any country that accepts a British qualification is represented. There are brown, bespectacled Indians, invariably swotting until the last minute from Sir Leatherby Tidy's fat and invaluable _Synopsis of Medicine;_ jet-black gentlemen from West Africa standing in nervous groups and testing their new fountain-pens; fat, coffee-coloured Egyptians discussing earnestly in their own language fine points of erudite medicine; hearty Australians, New Zealanders, and South Africans showing no more, anxiety than if they were waiting for a pub to open; the whole diluted thoroughly by a mob of pale, fairly indifferent, untidy-looking British students conversing in accents from the Welsh valleys to Stirlingshire.
An examination is nothing more than an investigation of a man's knowledge, conducted in a way that the authorities have found to be the most fair and convenient to both sides. But the medical student cannot see it in this light. Examinations touch off his fighting spirit; they are a straight contest between himself and the examiners, conducted on well-established rules for both, and he goes at them like a prize-fighter.
There is rarely any frank cheating in medical examinations, but the candidates spend almost as much time over the technical details of the contest as they do learning general medicine from their text-books. We found the papers set for the past ten years in the hospital library, and the five of us carefully went through the questions.
'It's no good wasting time on pneumonia, infant diarrhoea, or appendicitis,' Benskin said. 'They were asked last time. I shouldn't think it's worth learning about T.B. either, it's come up twice in the past three years.'
We all agreed that it was unnecessary to equip ourselves with any knowledge of the most frequent serious illnesses we would come across in practice.
'I tell you what we ought to look up,' said Evans. 'Torulosis.'
'Never heard of it,' Benskin said.
'It's pretty rare. But I see that old Macready Jones is examining this time, and it's his speciality. He has written a lot of stuff about it in the B.M.J. and the Lancet. He might quite easily pop a question in.'
'All right,' I said. 'I'll look it up in the library to-morrow.'
My chances of meeting a case of torulosis after qualification were remote, and I wouldn't have recognized it if I had. But to be well informed about torulosis in the next fortnight might make the difference between passing and failure.
Benskin discovered that Malcolm Maxworth was the St. Swithin's representative on the Examining Committee and thenceforward we attended all his ward rounds, standing at the front and gazing at him like impressionable music enthusiasts at the solo violinist. The slightest hint he was believed to have dropped was passed round, magnified, and acted upon. Meanwhile, we despondently ticked the days off the calendar, swotted up the spot questions, and ran a final breathless sprint down the well-trodden paths of medicine, snatching handfuls of knowledge from the sides where we could.
The examination is split into three sections, each one of which must be passed on its own. First there are the written papers, then _viva voce_ examinations, and finally the clinical, when the student is presented with a patient and required to turn in a competent diagnosis in half an hour.
On the morning the examination began the five of us left the Bayswater flat early, took a bus along Oxford Street, and walked towards the examination building in a silent, sickly row. I always found the papers the most disturbing part of the contest. They begin at nine o'clock, an hour when I am never at my best, and the sight of other candidates _en masse_ is most depressing. They all look so intelligent. They wear spectacles and use heavy fountain-pens whose barrels reflect their own mental capacity; once inside they write steadily and sternly, as though they were preparing leaders for the next week's _Lancet;_ and the women students present such an aspect of concentration and industry it seems useless for men to continue the examination at all.
I went with a hundred other students into one of three large, square halls used for the examination. The polished wooden floor was covered with rows of desks set at a distance apart that made one's neighbour's writing completely indecipherable if he had not, as was usually the case, already done so himself. Each desk was furnished with a card stamped with a black examination number, a clean square of pink blotting-paper, and a pen apparently bought second-hand from the Post Office. The place smelt of floor-polish and freshly-sharpened pencils.
A single invigilator sat in his gown and hood on a raised platform to keep an eye open for flagrant cheating. He was helped by two or three uniformed porters who stood by the doors and looked impassionately down at the poor victims, like the policemen that flank the dock at the Old Bailey. The students scraped into their chairs, shot a hostile glance at the clock, and turned apprehensively to the buff question paper already laid out on each desk.
The first paper was on general medicine. The upper half of the sheet was taken up with instructions in bold print telling the candidate to write on one side of the paper only, answer all the questions, and to refrain from cribbing at peril of being thrown out. I brought my eyes painfully to the four questions beneath. At a glance I saw they were all short and pungent.
_Give an account of the sign, symptoms, and treatment of heart failure_ was the first. 'Hell of a lot in that!' I thought. I read the second and cursed. _Discuss the changes in the treatment of pneumonia since 1930._ I felt the examiners had played a dirty trick by asking the same disease two papers in succession. The next simply demanded _How would you investigate an outbreak of typhoid fever?_ and the last was a request for an essay on worms which I felt I could bluff my way through.
Three hours were allowed for the paper. About halfway, through the anonymous examinees began to differentiate themselves. Some of them strode up for an extra answer book, with an awkward expression of self-consciousness and superiority in their faces. Others rose to their feet, handed in their papers, and left. Whether these people were so brilliant they were able to complete the examination in an hour and a half or whether this was the time required for them to set down unhurriedly their entire knowledge of medicine was never apparent from the nonchalant air with which they left the room. The invigilator tapped his bell half an hour before time; the last question was rushed through, then the porters began tearing papers away from gentlemen dissatisfied with the period allowed for them to express themselves and hoping by an incomplete sentence to give the examiners the impression of frustrated brilliance.