SURGO

May 2014 86:4

SURGO


SURGO

1 Editors note
2 Medical news
3 Interview: Sir Graham Teasdale
5 Psychiatric illness and prescription highs
7 Insanity: a rational adjustment to an insane world?
8 Mad, bad, sad or dangerous?
9 Change is changing: the penny drops
11 Word-search, horoscopes and Yules yarn
12 Remembering Manvir Singh

Contents
James Tajkarimi
Assistant Editor
Josh Neilsen
Production Editor
Tom Baddeley
Finance Editor
David Boyle
Arts Editor
Contents
SURGO

Editors note
1
Editors Note
Editors note
Welcome to this years final Surgo and my final issue as editor; I think youll agree that
over the past 3 editions weve tackled almost all of the big issues facing healthcare and
the NHS today. From what Iain Swan actually does (aside from scaring Ayr students
away from club de mar), right through to how best to dress like cancer , curing all
hangovers everywhere along the way. Its been a pretty great year and this is a pretty great
finale
As summer gets closer and our collective mental health hits an all-time low, we bring you
an aptly themed issue. One filled with all things mental, a welcome antidote to the SL-
induced social anxiety, OSCE OCD and chronic placement fatigue that youre all
undoubtedly experiencing. If youre not, youre coping far too well. A few of you may
have noticed our first ever hand-drawn front cover, courtesy of James Yule, art teacher
and brother of Lady Anna Yule of Glen Coe. Have a gander at School of Yule on
YouTube to see the cover being made (alongside many videos on everything art). We start
this issue as usual, with medical news, before moving swiftly on to assistant editor James
Tadjkarimis interview with Sir Graham Teasdale, co-founder of the Glasgow Coma
Scale. After that, in true Surgo fashion, we dabble with a few more recreational drugs to
see if they have any place in the treatment of psychiatric illness (Jamie Henderson, pg 5).
To continue the theme, Tom Baddeley gives us an insight into the life and times of R D
Laing, psychiatrist and avid user of LSD. Contributor Mike Pretswell follows this with a
look into the past at all the famous, but mildly insane, figures of yesteryear.
Once youve got through all that, it gets distinctly more trivial. From health, to wealth
David Boyles last hurrah as arts editor, before he leaves the Surgo editorial team in
favour of the dizzying heights of Med-chir publicity; Change is changing; the penny drops
(pg 9) looks at a myriad of coping strategies for when our beloved one pence piece is
discontinued. If you make it through this, have a go at our wordsearch, read another of
Yules lengthy yarns and check out your
horoscope courtesy of our resident psychic, Jane
Hamilton. We unfortunately end this issue and
the year, on a very sad note with the death of
medical student Manvir Singh; his family and
friends say a few words on page 12.
And so, thats it. As a final few words, Id like to
say a massive thank you to this years editorial
team and army of contributors. All of whom have
devoted many hours to a few genuinely
interesting articles and much Surgo silliness. We
reached an all-time high this year, both in number
of reads online at Scribd (593 no less - if thats
not a measure of ubiquity, I dont know what is)
and in bank balance, thanks mostly to our
fantastic treasurer Tom Baddeley. After a land-
slide victory at the med-chir AGM, Tom will be
taking the reigns as our new editor in chief,
guiding light, champion piggy-backer and Surgo
BNOC for the next year so watch this space.
Enjoy this issue and have a fantastic summer!
Ella Bennett
SURGO

2
News
Deep brain stimulation causes
Johnny Cash obsession
A Dutch man who received deep brain stimulation to help
treat his OCD has become obsessed with the music of
Johnny Cash. Mr B had an electrode implanted into his
nucleus accumbens (the brains reward centre) in an effort
to treat crippling compulsions and anxiety. As an
unexpected side effect, Mr B has now become obsessed
with Johnny Cash listening to him near constantly and
purchasing his entire record collection (and all his DVDs).
When the electrode is turned off Mr B instantly reverts to
his previous musical taste, the Rolling Stones.
New study links cynicism to
dementia
A study from Finland has shown that those with the
highest levels of cynicism are three times more likely to
develop dementia than their more trusting peers. The study
graded levels of cynicism by asking subjects to agree or
disagree with statements such as "It is safer to trust
nobody" and "I think most people would lie to get ahead".
They then followed them up on a variety of health points
over the course of 8 years. The study also reinforced
previous findings that link cynicism to heart disease and
depression, but did not find an impact on overall life
expectancy. So the good news for the cynics amongst us,
not that Surgo would ever be cynical, is that you still have
plenty of time to grow old and miserable.
Iron-age false teeth unearthed in
France
Builders on a luxury housing development in Frances C
hampagne region have unearthed an iron age burial chamber
containing the remains of noble woman. What is more
incredible is that archaeologists have found an iron tooth
in what remains of her jaw. This object is thought to be the
worlds oldest implant. Some of the team involved have even
suggested that poor sterile technique in this ancient surgery
may have been the cause of the womans death.
Medical News
Response to social drinking may
predict future alcoholism
Do you enjoy a pint down the pub with friends? Is your first
response after not being knocked back from Viper to dive
towards the bar for a double vodka coke? These are
undoubtedly characteristics of half of the med school, but
unfortunately, this may be bad new. A new study has found
that those who receive a buzz or high while drunk are more
likely to become dependent than people with a more sedative
effect. So if you tend to doze off in a corner youre fine but
if after a couple of drinks youre a legs out, lashes on, queen
of the dance floor kind of guy, you may want to cut back.
CIA told to stop using vaccination
programs for spying
The White House has agreed to ban the use of vaccination
programmes as cover for spy operations. This follows a
year long campaign by US medical schools and public
health experts. They feared that such activities led to
increased attacks on healthcare workers abroad and lent
credence to radical imams claiming that vaccination
programs are an American plot to sterilise children.

The issue came to light in 2012 when Dr Shakil Afridi was
convicted in Pakistan of using a fake vaccination program
to obtain DNA samples for the CIA. These samples when
then used to locate a concentration of Osama Bin Ladens
relatives in the town of Abbottabad, and led directly to the
2011 assassination of the al-Qaeda leader.
GMC claims entry test for foreign
doctors is too easy
At present 95,000 internationally trained doctors practice in
the UK, making up nearly 25% of the total NHS work force.
Research conducted by University College London however,
has criticised the current licensing exams claiming that they
make gaining a UK medical licence too easy. The grounds for
this claim surrounds statistics suggesting that of the 1300
foreign graduates that pass the exam each year, up to half
encounter serious issues after starting work. In addition to
this, of the 669 doctors struck off by the GMC over the last 5
years, 420 were trained abroad. This dangerous statistic has
prompted the suggestion to raise the exam pass mark by 13 as
a quick fix but ultimately, the GMC are looking at moving to
a different exam entirely.
Your handy summary of all things new and exciting
(did we mention trivial?) in the world of healthcare
courtesy of contributing writer Mike Pretswell.
SURGO

Interview
W
hen you ask a member of the
public what they think of when
you mention Glasgow, more often than
not theyll reply with buckfast, The Old
Firm, or deep fried anything. Ask a med-
ical
professional, and theyll almost certainly
say the Glasgow Coma Scale: the jewel
in our proverbial healthcare crown.
The Glasgow coma scale, or GCS, was
developed and conceived by two of our
best and brightest neurosurgeons; Mr.
Graham Teasdale and Prof. Bryan
Jennett, published the journal article
detailing the GSC - Assessment of Co-
ma and Impaired Consciousness: a Prac-
tical Scale - in The Lancet in 1974.
With a whopping 8500+ citations and
almost 40 years of clinical use, the scale
has revolutionised how we stratify
patients with neurological deficit.
Whats more, in all this time nobody has
come up with an assessment scale that
can do it better.
The GCS started life as an answer to the
inconsistency in monitoring of those with
head injuries that existed in the days of
yore. Various papers had been written on
grading coma, but these relied heavily on
subjective opinion that was often
difficult to document correctly. Another
problem was that many used obtuse,
largely incomprehensible words to
describe patients like stuporose
semistuporose and obtunded (defined
as: a disorder of alertness associated with
psychomotor retardationapparently.)
This meant that many of these scales
were as useful as a bag of cats and
altogether erratic.

Following the publication of the GCS,
Teasdale and Jennett were tasked with
selling it to the masses to secure its use
in clinical practice. They decided to use
Glasgow in the title rather than their
surnames as they felt it would be more
widely accepted, and were probably far
more humble than your average neuro-
surgeons. Teasdale jetsetted all over the
world to promote the scale and thanks
mainly to widespread nurse endorsement,
the GCS was soon being used globally.
(with the exception of Edinburgh, one of
the last places in the UK to adopt it. No
surprises there.)
The beauty of the GCS is that its easy to
use, and allows anyone to assess and
communicate the severity of a head
injury in a practical, reproducible way.
Its basis is simple. When assessing a
patient with a neurological deficit,
responses are split into 3 sections: name-
ly best eye, verbal and motor
responses. The combination gives you an
overview of the degree of impairment
and aids monitoring, a key factor in
making crucial decisions about patient
management. It is also possible to put
numerical values on the scale to form a
total GCS score of between 3 -15. The
quick witted ones of you will have
noticed that 3 is the lowest score you can
be accredited with...
The scale isnt without its critics. Some
in A&E feel its too complex, others in
critical care think it oversimplifies neuro-
logical damage. Some also feel that it
shows too much variability, particularly
as, though it was only standardised for
use in head injuries, in practice it is used
for almost all acutely ill patients. Some
have called for the scale to be changed
and several newer systems have been
compared to the GCS in terms of
inter-rater reliability (i.e how many
different doctors will reach the same
score when testing the same patient.)
Newer tests have been shown to be
better, but not significantly so. None
have approached the popularity of the
GCS which is used in over 80 countries
across the world and has been translated
into more than 60 languages - even
Gaelic!
Criticism aside, apart from being pretty
easy to use, communicable and a good
monitoring tool in neurological trauma, it
has over the years given us a good idea
of prognosis. As youd expect, those
with a lower GCS have been shown to
have higher all-cause mortality. But
thats why its useful; it allows you to
stratify patient care accordingly. Over
the years GCS has been tinkered with,
tested and tried in many different
situations, and although it may have
changed slightly over the years, its
essence remains the same, and it will
always be the research that put Glasgow
on the medical map.
We managed to scoop an interview with
Sir Graham Teasdale a few weeks ago;
very abruptly mind you, but what follows
are some answers to the rubbish
questions we asked.
3
Sir Graham Teasdale: 40 years of the
Glasgow Coma Scale
Assistant editor, James Tadjkarimi, meets Graham Teasdale, one of two pioneering neurosurgeons that
brought us the world-renowned neurological classification tool that is the GCS.
SURGO

Interview
4
Surgo: What has been your biggest
inspiration throughout your career?
Graham Teasdale. InspirationI dont
know, theres probably a bit of hubris
about that. I think one of my biggest
influences was a doctor I worked for in
Newcastle, a neurologist called Henry
Miller. He was a giant character with
mordant wit who loved to take the mick-
ey out of psychiatrists; he made academ-
ia and neurology exciting to me. And
then theres Brian Jennett (co-author of
the famed 1974 paper) who was the rea-
son I stayed here in Glasgow. Brian had
a very clear, logical mind and wasnt
afraid of tackling big issues. In the 80s
and 90s there were big controversies
about brain death and organ transplanta-
tion. Brian took on validating the concept
of brain death. I guess the third influence
would be a girl with a head injury called
Connie.
S. A patient?
G. Yes. Patients are your biggest
stimulus. Connie had a head injury aged
11 and we had agreed to do a documen-
tary in the BBC Visit series with
Desmond Wilcox, husband of Esther
Rantzen. We followed Connie from day
1 through her recovery for 6 months and
then came back 10 years later. I got very
close to Connie and her family; seeing
the strengths of ordinary people and how
Connie progressed despite moderate dis-
ability, to become a happy, lovely person
was very inspirational. In a way patients
come and go, but her story made me
aware of how badly head injuries are
managed and it acted as a stimulus to do
something about it.
S. And how about something you most
regretted? Either doing or not doing?
G. Difficult, I think of times when things
went wrong in operations, and you know,
they come back to keep you grounded.
That doesnt mean I regret doing the
operation, but its good to keep a sense
of reality. In professional terms, no Ive
no regrets, except doing more research
than I ever had time to write up and
spending too much time working and not
enough with the family.
S. What would you say is the most
bizarre thing that ever happened to you?
G. Being on a KLM flight, a call came
out for a doctor which happened to be a
head injury back in the canteen,. I arrived
and discovered that the stewardess was a
neurosurgical nurse from Rotterdam.
S. So how do you feel about Jeremy
Hunt as health Secretary?
G. One think I like about Jeremy hunt is
that he makes it very clear that issues
need to be sorted. Whether he manages
to sort them only time will tell, but I
think in a way, far more so than any oth-
er health secretary hes willing to admit
that this system is just about broke. Now
fixing it by central reorganisation is not
how to do it, but at least hes making that
very clear. Its interesting, the
evolution of it all. There was a time
when the health ministers of England and
Scotland were the head of the health
service and defended it. But now whats
happened is theyve become at arms
length its worst critic. Very subtle, clever
politics, you position yourself as the
patients advocate and criticise the health
service on their behalf rather than
defending what the health service is
doing for patients.
S. Lets say you were given the NHS
budget tomorrow, what would you do?
G. A radical reduction in the number of
buildings, radical restructuring to bring
together primary and secondary care. If
thats not addressed its going to fail.
There has to be more medical practice
outside of hospital buildings.
S. how do you feel about the upcoming
referendum, I m sure youre fed up of
being asked about it?
G. I think in our house all the votes will
cancel out. Ill say no more.
S. In terms of a yes vote, do you think it
change much? Will Scotland have the
sufficient funds to keep things like free
prescriptions for all?
G. I think theres a slight issue concern-
ing what Scotland can and cant afford
and a lot of things have been promised.
Some policies are popular, but not neces-
sarily sustainable. I think wed see some
changes that are not quite as popular but
necessary, though I dont see great
changes to the way healthcare is
organised. Compared with England its a
much more organised system. Its chaos
down there.
S. So apart from GCS, what do you think
the most important change or discovery
in neurology has been ?
G. Its not one single invention or thing.
Its the way a number of things came
together to make it more successful
CT scanning came along, understanding
of brain physiology and intensive care
came along and these improved our out-
comes in theatre. It was a golden period,
It just all came together.
S. what advice would you give medical
students that wanted to get into
Neurosurgery; that ill-fated career?
G. Go and have a pint and think again.
(laughs) Its very difficult now, but Id
take a balanced approach. Dont spend
all your time reading Grays Anatomy,
see enough of it to be reasonably aware
and get an intercalated degree on the way
through. Partly because of educational
benefit; learn to think and be rigorous.
Doing an intercalated degree in
neuroscience is the best thing you can do
as an undergraduate.
SURGO


5
Everyones heard of the benefits
that come with the variety of
substances on offer in Subclub on a
Saturday night but not so many
would consider these a form of actual
medical treatment. In some senses
theyd be right; over the counter LSD
is undoubtedly a distant dream/
nightmare . But, is the clinical
potential of these substances being
ignored due to fears of exploitation
and damage to (the already fantastic)
NHS reputation?

MDMA (Ecstasy)

Developed by Merck in 1912, MDMA
(ecstasy) was ignored as a compound for
a long time as it was thought to be
useless. It remained this was the US
Army decided to test any compound they
could get their hands on, even using it
through a mind control program. The
details from these studies were released
in 1973, by which time many had
discovered the fun one could have with
the addition of a little MDMA. Soon
after this, politicians realised how much
fun people could have and promptly
banned it.
Although lots of research was conducted
before the ban, it has come back into
pharmaceutical research fashion over
recent years. Clinical trials started in the
2000s looking into the benefits of
MDMA in sufferers of Post Traumatic
Stress Disorder (PTSD). This was
followed up by two further trials where it
was used as an adjunct to psychotherapy
sessions. Though both study sizes were
small the use of ecstasy within
psychotherapy did appear to have a
beneficial effect; predictable enough felt
more able to sharing their feelings.
Basically if you suffer from PTSD
attending a rave during the 90s may
have helped your outcome and listening
to Moby in an abandoned warehouse
may not have been the worst thing after
all.


Ketamine

Ketamine is arguably the most common-
ly used recreational drug in medicine at
the moment, and is becoming more and
more prevalent with expanding research.
Its status as an illegal drug began
reasonably late with it achieving class C
status in 2006 following a series of cases
detailing bladder problems with
excessive use. Fair enough really, as
personally, I d rather not have a
bladder that holds only 100ml.

Ketamine has been used as an
anaesthetic for years; it is even carried on
Air Ambulances as part of their standard
kit. But recently and more excitingly, it
has been trialled for use in those with
resistant depression. A group from the
Oxford Health NHS foundation trust
have just released data on a small study
of 28 resistant patients, of which 18
proceeded into remission following
treatment with ketamine.

Magic Mushrooms

Magic mushrooms are one of the most
natural and native of illegal
substances; just go out exploring in the
Scottish countryside and youll easily
find these hiding in the woods. Classified
as a Class A drug in 2005, theyre not the
greatest thing to be caught with on the
streets of Glasgow. The active
ingredient, psilocybin, although tightly
controlled, has been used in many
clinical trials as a potential treatment for
a range of conditions.Psilocybin was first
investigated during the hippy 60s by
some rebel researchers at Harvard.
Ultimately however, the project was
doomed as some killjoys in the
department said it was not the best use of
their time. This coincided with the
Psychiatric illness
Contributing writer Jamie Henderson looks into the psychiatric benefits of recreational drugs
SURGO

Inside the mind
6
FDAs decision to ban the drug
preventing anyone pursuing research
involving it, even within a clinical
setting (way-to-go, politics!).

It wasnt until the noughties that further
research into the clinical applications of
shrooms was conducted. One of the most
successful of these studies investigated
the use of psilocybin in the treatment of
obsessive compulsive disorder (OCD).
Although, yet again a small study, it did
report a decrease in symptoms of 23-
100%. Whats more, these effects were
maintained for several hours
post-psychedelic episode.

It is well accepted that magic
mushrooms can help you to relax; this
prompted a study investigating their use
in the treatment of depression in patients
with terminal cancer. A recently
published study noted that doses of
psilocybin significantly improved mood
for up to 6 months. In addition to these
benefits, it has been reported that
sufferers of cluster headaches also
experienced a reduction in symptoms
following magic mushroom use.

LSD

LSD was first made in 1938 and as per
usual was banned in the 1960s when
people started having too much fun with
it. Following its prohibition, LSD was
not used in any research until 2008. In
the 50s and 60s, LSD was a relatively
common addition to psychotherapy and
many doctors using it in the UK reported
clinical benefits in a wide range of
conditions. Despite relaxation of the
legislation surround LSD, studies into
its clinical use are rare; there is some
data suggesting benefit to cluster
headache sufferers though research is
confined to case reports at the moment
so more work must be done to fully
investigate the perceived benefits.

The work into the uses of these
recreational drugs for medicinal purposes
is mostly in its infancy, due mainly to
stigma and legislation. Nonetheless
researchers are beginning to explore
these uses again and look to be getting
ever closer to proving that these
substances are serious contenders in the
treatment of many psychological
conditions.


and prescription highs
SURGO

Inside the mind
7
Insanity: a rational adjustment to an
insane world?
Finance editor, Tom Baddeley, looks into the life and works of Glasgow-trained psychiatrist, writer and
patient, Dr R D Laing.
R
onald David Laing was born
into a middle class family in
Govanhill, Glasgow in 1927.
Despite being financially stable,
with Laing attending good local
schools, it was a bizarre
upbringing; Laings parents
forbade him from playing with
other children, keeping him on a
leash when they left the house.
Laings father and grandfather
fought frequently and his mother
was said to burn the familys
rubbish inside their home to
conceal it from the neighbours.
Laing also describes being repeatedly
told he was evil whist his mother stuck
pins in an effigy of her son, with the
intention of giving him a heart attack
(which coincidentally, he later dies of).
Though undiagnosed, Laings parents
undoubtedly struggled with mental health
issues, something that was also to effect
Laing throughout his life.
Laing experienced several schizophrenic
episodes during his lifetime as well as
struggling with depression and alcohol-
ism throughout his career. It is this first
hand experience of being a psychiatric
patient that gives his books and theories
such unique insight. Laing attended our
very own medical school and graduated
in 1951. Following this, he worked as a
psychiatrist for the Bristish army before
becoming the youngest consultant in the
country at Gartnavel Royal Hospital.
Here, Laing quickly developed his own
approach to psychiatry; he called this the
interpersonal approach, a philosophy
that gained him recognition as part of the
anti-psychiatry movement, a description
that Laing himself rejected. His theories
surrounded the notion that the feelings
expressed by his patients, largely
schizophrenics, should be taken as valid
descriptions of life experiences as
opposed to symptoms of a separate,
underlying disorder.
Laing devoted large amounts of time to
quietly sitting with people in their cells,
listening and talking to his patients. In
addition to this, he organised a so-called
Rumpus Room; a day room for
patients allowing them periods of social
interaction. Laing criticised the practice
of psychiatry for disregarding the social,
cultural and environmental aspects of
mental illness and even went so far as to
reject psychiatric diagnosis entirely.
Laing argued that a diagnosis could not
be made solely on behaviour if no
pathological basis could be found; he
believed many of his patients were
simply reacting sanely to and insane
situation; Laing believed that
schizophrenia is a way of escaping
family pressures, negative experiences
and other emotional miseries, and that by
falling ill, the patient has in fact taken the
first step towards self-recovery.
Laing put these notions into practice in
Kingsley Hall, London; here the
staff and schizophrenic patients
lived together, and the patients were
treated with kindness and respect
whilst being given space to explore
their internal chaos. Sean Connery
famously sought help from Laing
here as he was struggling to come
to terms with his new fame.
Controversially, several patients
and employees were given, then
legal, high grade LSD to release
their inner demons or buried
childhood trauma. Many patients
did indeed achieve full recovery but
Kingsley Hall was seen as dangerous by
the GMC and was closed down after 5
years of activity. Laing was later struck
off after admitting in a BBC radio
interview that he was clinically
depressed and suffered from alcoholism.
His distinctive ideas about mental illness
were undoubtedly influenced by his own
experiences and suffering as a patient.
Unfortunately, this affected Laings own
family gravely; his son described him as
gentle but wild, cruel when hed had a
drink. A tragic situation, where as his son
aptly put, dad solved other peoples
problems but not his own.
Laing died in 1989 at the age of 61.
Perhaps unsurprisingly, the Laingian
treatment model has now been largely
abandoned. This is partly because it is
very expensive to run but also due to a
commitment to medicalising psychiatric
illness. Laings legacy remains in some
areas however, with a much wider
acceptance of the social and
environmental aspects of psychiatric
illness, and a much greater respect for
patient needs and autonomy.
SURGO

8
Mad, bad, sad or dangerous?
Its said that madness and brilliance are two sides of the same coin. Contributor Mike Pretswell, delves
into the past looking at some of our most famous, and in hindsight, most unwell, historical figures.
Michelangelo
Diagnosis: Autism
The great painter and sculptor may have produced some of the most beautiful works
ever seen but his eye for aesthetics did not extend to his own body. Weve all
squeezed an extra day (or two) out of questionably clean placement clothes but
Michelangelo wore his for months at a time and even sleeping in them. This meant
that when he finally did remove them most of his skin came with. He also hated baths
and supposedly smelled so bad that it was a challenge to be in the same room as him
(even by 15 century standards).
Michelangelo also hated company and was known for walking away from
conversations mid-sentence. His contemporaries (including the pope) assumed he was simply a weird, unpleasant individual but
modern psychiatrists suspect that he suffered from a form of high functioning autism.
Nikola Tesla
Diagnosis: Obsessive compulsive disorder
Quite possibly the most prolific inventor of the 20th century Tesla working on
everything from the electric motor to x-rays. As an electrical engineer, Tesla is
responsible for hundreds of tiny components that youve never seen but will be
found in everything from your oven to your iPod. He had a fantastic obsession with
detail and exactnessboth undoubtedly key to his success but also caused him a
few practical problems; Tesla couldnt enter a building until hed walked round it
three times and would only stay on the 3rd floor of a hotel in a room number
divisible by 3. Even more challenging given his work as an engineer, was his
phobia of circles and all things circular.
In the final years of his life, Tesla transitioned into the archetypal mad scientist dedicating more than a decade to the invention
of a super weapon to end all wars , coining the term death ray to describe it.
Isaac Newton
Diagnosis: Attachment disorder and Mercury poisoning
One of Britain's greatest scientist Newton certainly did a few crazy things, notably sticking pins in his own
eyes to see if he could still see them, but well chalk that up to curiosity. He was also however , very poor in
social situations and extremely angry at all times. On two separate occasions he nearly beat men to death
after they commented on the size of his nose. Later in life Newton became extremely paranoid and began
hallucinating. Studies carried out on sections of his hair have suggested that this was likely to be caused by
mercury poisoning resulting from long years of experimentation.
Abraham Lincoln
Diagnosis: Depression
Its relatively well known that honest Abe probably had Marfans but he also suffered from terrible bouts
of melancholy. He was incredibly empathic and claimed to feel the suffering of every one of his fellow
citizens. During the American civil war he reportedly spent days alone in his tent weeping for the
suffering of others.
Prototype death ray

SURGO


9
As the nights drew in over winters, and
the embers were glowing in the dungeons
of Surgo HQ we realised that life is not
as static as Phil Hanlon would have us all
believe. The current environment within
which we prosper will change in
countless ways and there is very little we
can do about it. What is change? An act
or process through which something
becomes different seems like a
reasonably legitimate definition to the
simple-minded amongst you. But stop.
Drop. And rollout your pockets to
unleash a savage barrage of coins upon
this beautiful earth. Trot about any
densely populated land mass and your
hear the symphony of change as we all
heard; countless almost-worthless pieces
of legal tender. 1ps are the bane of my
life and it appears that the Royal Mint
agrees with me; we may be about to
follow in the footsteps of other pioneer-
ing nations, like Canada & Brazil, and
strip the penny away from our paws.

Before we analyse the future, lets
address the past. First issued on the 15
th

of February 1971 Decimal Day to the
scholars within our 6-person strong
readership the 1p coin has been a main-
stay of British culture ever since. Many
pennies tried before but none have quite
done the job that the 1p coin has done.
Featuring Betty looking the wrong way
since day 1 has been some task.

Weighing a hefty 3.56g pennies have
been a burden on our wallets but a
blessing in our lives. The childhood
favourite Penny sweets have led to the
loss of at least 926 diabetic feet across
the land
[1]
. However nothing is exempt
to the harsh economic downturn that we
are experiencing; the inflation on these
sweets has reached 50% in some regions
of the UK leaving pennies utterly
redundant. Pennies have led to countless
sessions for punters on the puggies and
ultimately mass bankruptcy for genera-
tions. But, once again, inflation has led to
the decline of these machines with
extortionate 2p machines replacing them.
It is the perceived lack of function and
use in modern society that has led to the
question as to whether we really need
pennies in our society? Countries like
Brazil, Canada, Singapore and a host of
others have withdrawn the equivalent
penny from their circulation and
reaped the almost unrecognisable
rewards. However, as long as we
continue to use and abuse the penny it
will forever be part of our lives. It is
down to the people of the Union to
march to Downing Street and cast it back
into the fiery chasm from whence it
came. It is a simple case of supply and
demand. There is no doubt that
economies can cope without them and
will thrive without the burden of having
to produce them.

Currently there are 11.3 billion coins
causing mischief and struggling to fit in
across the British Isles. That is a
staggering 113million quelle surprise.
What could we do with that?!? Well very
little to be quite honest as 1ps are only
legal tender up to the value of 20p. So as
such ,we here at Surgo, decided that we
would take control and find 10 very
viable solutions. We asked part-time
contributor and full-time misogynist
Daniel Taylor-Sweet for 10 things he
would do with all 11.3 billion coins...

Change is Changing: The
Penny Drops
The artist formerly known as Druid Boyle undertakes an introspective analysis of the future of our young
money cash money.
Ten things you can do with change:
1. 37 one pence pieces could be melted down and formed into a single bullion. This, we would send to the formidable gulags of
North Korea, where they would be formed into a miniature epitaph of Kim Jong Un. The statue would then be presented to the
president of South Korea, thus solving the long conflict on the Korean peninsula.
2. If one wanted to feel the exact weight of president Bill Clinton then 27,012 pennies placed in 5 empty pillowcases would give
you a fairly good idea.
3. A single coin could be hammered repeatedly until only several molecules thick this sterling sheet of metal could then be
shaped into a 2-piece double-breasted suit, which could be worn for weddings and other formal occasions.
4. 8 Lockheed C-130 Hercules bombers could be filled with spare change, flown over Chernobyl and dropped into the open
reactor damping the radiation making Pripyat finally habitable after almost 30 years

SURGO

Change, life and the mind
10
Do you have an interest in writing or medical journalism?
Do you like graphics, enjoy art or want to draw us a cartoon?
Do you have an opinion or perspective that you think should be heard?
Or just want to CV-build like a boss...?
Join the writing team at
Surgo!

Rancid (- Rebekah Patton), Visionary ( - Hamilton Orr)
The scalpel-sharp edge of modern medical journalism ( - Iain Swan)

If you want to get involved, find us on facebook or email us at surgo_editor@hotmail.com
At this point I should point out that if youve made it this far you have far less of a life than I could ever dream of having. Its
been tough but education, education, education has to be delivered. The chances are the penny will remain forever more but
should we ever take the plunge into the pool of uncertainty, youll know fine well that Surgo speculated first...

Science. Choice. Change. Life.
Until next time...keep it relish.


Disclaimer: Views of Daniel Taylor-Sweet are not representative of the Surgo Ideology as set out in our manifesto for choice
5. Fat Joe and Lil Wayne are planning a re-release of their 2009 hit Make it rain in which a 2000L vat of molten one pence
pieces will be sprayed over Huddersfield.
6. Coins could be glued end to end making long cylinders. These cylinders could then be attached together to form a raft which
Ben Fogle would row to Iceland in and deliver as a gift to the people of Iceland, stimulating their faltering economy
7. The copper which coats post September 1992 coins, can be extracted using calcium hydroxide. It can then be given to
patients with Menkes disease, thus earning me a Nobel Prize and world-wide global fame.
8. 208 one pence pieces could placed on top of each other replicating the great length (but not so much, girth) of the mighty
Jonah Falcon.
9. One could, if desired, melt all the pennies in circulation down to form a battery that could be used to power the small town of
Grimsby for exactly 18 hours.
10. All of the coins ever produced, in the entire world could be shuttled into orbit by Soyuz shuttles and dispersed around the
outer atmosphere. This would provide a coin-based shield, giving earth vital protection against asteroids, Sandra Bullock and
solar storms.
SURGO

11
In Silloth in the 60s there lived a young GP called Bobby. Silloth often saw lots of ships coming to deliver grain to the local Carrs
water cracker factory(other crackers are available). On this particular day an African gentleman from the grain ship walked into
the surgery looking terrible. He was pale and emaciated and he said to Bobby, Doctor, Im dying. Bobby saw that he was only a
young man and asked him why he thought this. To his shock the man replied that a Witch Doctor had put a spell on him.

Though used to all sorts of stories from the local townsfolk of Cumbria, this was a new one for Bobby. So, he examined him
thoroughly, surely there was an obvious cause for this mans illnessBut alas, everything was normal. Puzzled, Bobby realised
that he would have to take a different approach. He reached for the mirror on his desk, held it up to the man and said, I am
putting this mirror between you and the Witch Doctor. It will reflect the evil spirits back to Africa and break the spell.

One year on and an African gentleman with a spring in his step, a picture of health, comes into the surgery. He says he is here to
thank Bobbybut Bobby does not recognise him. After recounting his story Bobby realised that this was the very same
gentleman who had come to him, dying, just 1 year ago. The man told him that not only had he recovered, but on returning to
Africa, the Witch Doctor was dead. The mans mind was healed...and the power of suggestion had won.
Inside the mind
BRAINWAVE
CHANGE
CRAZY
DRUGS
ILLUSION
MADNESS
KETAMINE
MANIA
MIND
PSYCHIATRY
RORSCHACH
DEPRESSION
GRAHAM-TEASDALE
SCHIZOPHRENIA
Word-search
Look for 17 mystery hidden messages and 14 words with a
psych theme . Well post the answers up on facebook. Try not
to get too paranoid now...
+ 17 hidden messages (were watching you)
Jane Hamilton explores the
future through alternative
means.

Capricorn: Be prepared
for you local apocalypse
and sign up for pet
apocalypse insurance. Only
$135 per pet, no returns.

Sagittarius: Time is
moving quickly and things
are changing. Viper is
open, you must make the
most of this opportunity.

Scorpio: you will find love
in a hopeless place. Just
keep looking over your
shoulder.

Libra: There is no need to
X-Ray those around you.

Virgo: you are a highly
sexual individual. Consider
a medic sport.

Leo: Having flatmate
issues? This month you are
the issue. Take the bins out
more often.

Cancer: A new Chinese
takeaway has opened on
Dumbarton road. Take a
risk. Order a chow mein.

Gemini: You may feel that
your creative talents are
wasted in medicine. Think
Surgo. There is always
room for you.

Taurus: the new moon on
June 10th will bring good
fortune to those sitting their
OSCEs. Unless you forget
your chaperone. Then
youre on your own.

Pisces: You yearn for
attention and recognition.
As Mercury moves in with
Mars next March your luck
will improve. Consider
performing in next years
Revue.

Aquarius: An exciting
opportunity will be
presented to you over sum-
mer. This is something you
should worry about.

Aries: Consider predicting
your own death at http://
www.death-clock.org
Horoscopes
Yules Yarns
SURGO


12
Manvir Singh, known to those
close to him as Sonu, was such
a smart and multi-talented
individual. The 21 years he
spent in this world were far too
brief, but his achievements
excelled others his agewho
could only dream of doing what
he had done. He was the star of
Glasgow, there wasnt anyone
who didn't know his name, of
his kind heart, let alone his
infectious smile.

When he shall die, take him and cut him out in little stars,
and he will make the face of heaven so fine, that the world will
be in love with the night and pay no worship to the garish
sun.
Sonus sister, Honey, feels that he was and will always be the
best brother anyone could ask for. His whole family are very
thankful for having him in their lives and feels that the time
spent with him was a rollercoaster of happiness and enjoyment
that was cut too short. Sonu was a good-hearted individual
and he would always be the one that people went to for help.
He was the kind of person that helped others and didn't really
ask for any help himself. You would find Honey always with
him, from watching movies, to
baking, to driving trips. Honey was
one of, if not the closest person to
him. Honey said:

I would always hang out with him
in his room and talk to him about
the most random stuff. My mum
and I would sit waiting for him to
bring food from work, which
surprisingly he would openly share.
Most weekends mum, dad, Sonu
and I would all sit together
watching a film that he picked out.
I love him more than words can
describe, he was definitely the most
entertaining and loving brother I
could ever ask for.
A well-mannered pupil who was adored by all. He was
extremely intelligent, curious and keen to learn new things.
He never really needed to study for long hours, everything was
last minute revision, yet he still managed to accomplish
straight As in all his subjects in school. His best friends at
school fondly remember him as a cheeky, easy-going and
mischievous boy. Sonus commendable achievements for
various subjects throughout his years at school were
recognised at his schools annual Awards Ceremony.
Sonus most significant time of his life was with the dance
team Punjabi No.1. He was one of the first and original
dancers, dancing since 1999 when the group was first
established. As the group became more successful, he toured
the whole world seeing new places, meeting new people and
showcasing his talent. They performed in some of the most
prestigious venues including the SECC, Clyde Auditorium,
London Hammersmith Apollo and Wembley Arena, for high
profile events such as BBC Children in Need, Brit Asia Music
Awards and the MOBO Awards to name a few. The group
grew close from the many adventures they had on stage,
backstage, on tours and outside of the dance group. They were
best of friends and Sonu will be cherished in their hearts
forever.

A son, brother, friend, he meant so much to everyone. Sonu
was undeniably one of a kind!

Death leaves a heartache that no one can heal, but love
leaves a memory no one can steal.

If you have been affected by this in any way and would like to speak
to someone please contact the Medical School welfare team
(rona.miller@glasgow.ac.uk).
In loving memory of
Manvir Singh
Words of remembrance from Manis family and friends.
SURGO