Forty years on.
Authors: R J Lemberger
Journal: BMJ (1981)

It was 10 00 am and John Smith, BMedSci (Open University), MB (Harvey School of Medicine), FRCS (UK), MD, PhD (Scunthorpe), was very bored. He had tried to spin out his morning list but had been unable to pretend that his first case, a dermoid, was anything but simple. Worth a frozen section though, you could never be too careful. He was taking a respite before the last remaining operation and had left his senior registrar to close the wound and registrar to apply the povidone dressing. As the decaffeinated coffee arrived through the wall hatch there was time for reflection. What would he do with himself when he retired next year  At 50 he might live another 60 years. He flipped a Mannitol spansule into the drink to ease his congested nose. It could not be any more dull than at present though. After all, there was very little left to operate on. As a student he had seen some of the very last cases of peptic ulc?ration, the addition of cimetidine to the water supply had seen to that. Nursery school bran had replaced cod liver oil, and this had made extinct most diseases of the large bowel. As a houseman he could just remember the theatre crowded with excited observers as a blustering Sir Heneage Hopkinson explored a diverticular abscess. It's 10 years since I last saw one of these! he extolled, gleefully splashing the pus about. Pass the sucker please, nursey.  what, Sir ? Of course medical research had a lot to answer for. He pontificated with some anguish and had to shift the weight off his chrome-cobalt ischial tuberosity acquired after a mishap on a Space Shuttle package holiday. Regrettably nearly all disease could be treated medically or simply prevented from even occurring. He mused over some scientific milestones. The latter day scourges of blackheads, baldness, piles, and halitosis had all met with their respective cures, severely diminishing waiting lists and general practitioners' surgeries. Interferon had seen off practically all infections, even the common cold. Gall stones could be dissolved in a few hours with a simple tablet. Cancer melted away with Rubean. This derivative of runner bean had been discovered by pure chance. A laboratory technician had been surreptitiously eating his lunch near a tumour tissue culture and, as his knife skidded across the plate on cutting his tough steak, a piece of runner bean fell in. He hid the bottle. Some days later the culture was found to be dead, and the terrified technician became famous. Atheroma was certainly caused by cigarettes but its severity did not fall when imitation tobacco was made compulsory. Of course it didn't, the causative agent was in the paper. Cigarettes were now made of shredded tobacco glued into columns and very nice they were too. There was so little trauma. Private transport had recently been abolished, and the safety record of the State system was 100%. There was no street violence as there were simply no streets. Mental illness had vanished with the addition of endorphin to table salt. Fortunately, it was stable with iodine, magnesium, caffeine, and stilboestrol. Irony furrowed his brow and dimpled his cheeks. Here he was being rueful about his present lot when he was partly responsible for vanquishing appendicitis. His friend Arnold had really cracked it though, one of the last great unknowns of medical science had yielded its secrets. For some years Arnold's exclusive task had been to delineate the cause of appendicitis and he had found it. The application of an epsilon-squared Pupil's S test had proved it conclusively. He relived the secretive childish titter he had enjoyed as he had enumerated the previous incriminations: tobacco inevitably, autoimmune inflammation, aspirin, and salami rind. Nor was it lack of bran. Of course, Africans emigrating to the United States increased their incidence of appendicitis but it wasn't the fibre. Oh no, it was the talcum powder. And that was why it was commoner in children: mothers smothering their kiddies in the stuff. To think, from then on every container had to carry a government health warning. With sadness he recalled bidding Arnold farewell. No longer needed, Arnold, a computer, was switched off, closing down his memory banks forever.