IELTS Academic Reading Practice Test 327

John Hunter was born in 1728 at Long Calderwood, a farm near East Kilbride in Scotland, the youngest of ten children. His father worked the land, and the boy's formal schooling was brief and undistinguished. The family were tenant farmers, and money was always short. For a time he worked on the farm himself, with no obvious prospect of anything better. What changed his life was his elder brother William, who had left Scotland, trained in medicine and, by the late 1740s, was running a successful school of anatomy in London. In 1748 John travelled south to join him.

William's school supplied London's medical students with the anatomical knowledge they could not obtain elsewhere, and it depended on a steady supply of human material. John's first job was to prepare the dissections that his brother used in lectures, and he proved unusually quick and dexterous at it. He had found the work he wanted. In 1756 he was appointed house surgeon at St George's Hospital, and his reputation there grew quickly, though his income did not. The fees from teaching and from the small number of patients he could attract left him chronically short of money.

In 1760 he was commissioned as an army surgeon, and the following year he sailed with an expedition to Belle Île, off the French coast; in 1762 he served in Portugal. The experience shaped his thinking for the rest of his career. Army surgery at the time rested on the belief that gunshot wounds were poisoned by the bullet and must be treated with cautery and elaborate dressings, and that damaged limbs should be amputated early. Hunter concluded that much of the damage he saw was caused not by the bullet but by the treatment, and that surgeons had badly underestimated the body's own capacity to repair itself.

He returned to London in 1763 and settled into practice, but progress was slow. He was elected a Fellow of the Royal Society in 1767, and in 1768 he became surgeon to St George's Hospital. By then he had begun the collection of anatomical preparations that would absorb his money and his energy for the next twenty-five years, buying specimens at auction and paying for dissections out of his own fees. In later life he was appointed deputy surgeon-general to the army, a post that brought him a steady income at last.

Hunter's methods were direct and sometimes reckless. In the 1760s, wanting to understand how venereal disease spread, he is generally believed to have inoculated himself with matter taken from a patient, although some historians think the subject was someone else. The person inoculated developed the symptoms of both gonorrhoea and syphilis, and Hunter concluded that the two were stages of one disease, a mistake that shaped medical teaching for decades. The episode is often presented as an act of self-sacrifice; it was at least as much a consequence of his conviction that knowledge came only from experiment, and if he was indeed the subject, he was fortunate to survive it.

His most quoted experiments concerned transplantation. He grafted a human tooth into the comb of a cockerel, and later moved a spur from one bird onto the leg of another. In each case new blood vessels grew into the grafted tissue, an early demonstration that a graft can acquire a blood supply from its host. He also transplanted the testes of cockerels, in an attempt to understand how organs influence the body at a distance. His book on the natural history of the teeth, published in two parts in the 1770s, grew out of this work.

Money interested him only as a means of buying specimens. He acquired a country house at Earl's Court, then a village outside London, and filled its grounds with animals: leopards, jackals and monkeys, alongside the ordinary creatures of an English farmyard. The menagerie was not a hobby. Hunter dissected almost every animal that died there, and he used the collection to study hibernation, body temperature and the structure of organs that no London surgeon had seen before.

His influence spread mainly through his pupils. Among the young men who came to work under him were Edward Jenner, who would later become famous for vaccination, and John Abernethy, who became a leading London surgeon. Hunter took them into his house, set them to dissect and encouraged them to question everything, teaching by example rather than by the elegance of his prose. Jenner came to London in 1770 and lived in Hunter's household for two years before returning to his native Gloucestershire. His own writing was notoriously dense and poorly punctuated, and much of it appeared only after his death, edited by friends and former pupils.

He died on 16 October 1793, at St George's Hospital, after an argument at a hospital board meeting brought on an attack of angina. His collection, by then some fourteen thousand preparations, was bought by the government in 1799 for £15,000. It was handed to the surgeons' company, the forerunner of the Royal College of Surgeons, where it formed the core of the Hunterian Museum. His brother-in-law Everard Home, who had promised to prepare his papers for publication, later destroyed many of them, a loss that has frustrated historians ever since.

Standing upright is a precarious achievement, and the spine is the structure that makes it possible. It is not a single bone but a column of small bones called vertebrae, stacked one on another with pads of cartilage between them. Most anatomy textbooks describe 33 vertebrae in the human body: seven in the neck, twelve in the chest, five in the lower back, five fused into the sacrum and four fused into a small tail. In an adult, these fusions reduce the count to 26 separate bones. The column supports the head and trunk, allows the body to bend and twist, and forms a bony tunnel that protects the spinal cord.

The seven cervical vertebrae are the smallest and most mobile. The first, which supports the skull, is a ring of bone with no body at all. The second has a peg-like projection, the dens, that points upward through the ring of the first. This arrangement allows the head to turn: most of the movement of shaking the head from side to side happens between these two bones, while the rest of the neck provides the nodding and tilting. The cervical spine must also carry a head that may weigh five kilograms or more, which is why its muscles are in almost constant use.

Below them sit twelve thoracic vertebrae, each joined to a pair of ribs, and the ribs are in turn joined to the breastbone at the front. These joints are one reason the chest is much stiffer than the neck: the rib cage must hold its shape so that the lungs can expand. Each thoracic vertebra also has a long, downward-pointing spinous process, and in the middle of the back these projections overlap like tiles on a roof, limiting how far the trunk can be extended backwards.

The five lumbar vertebrae are the largest and heaviest, because they bear the weight of everything above them. Their bodies are broad and their projections thick, and their joints are shaped to allow bending forwards and backwards but very little rotation. Between them run the thickest discs in the body, and the whole section is braced by powerful ligaments. This is why twisting injuries so often damage the lower back rather than the neck.

At the base of the column, five sacral vertebrae fuse in early adulthood into a single triangular bone, the sacrum, which locks into the pelvis and transmits the weight of the upper body to the legs. Below it, three to five tiny coccygeal vertebrae fuse into the coccyx, a remnant of the tail that other mammals possess.

Between the vertebrae lie the intervertebral discs, which make up roughly a quarter of the column's length. Each has two parts: a tough outer ring, the annulus fibrosus, built of concentric layers of fibrous cartilage, and a soft, water-rich core, the nucleus pulposus. The nucleus behaves like a cushion under pressure, deforming as the load changes, while the annulus holds it in place and resists twisting. Discs contain no blood vessels. Their cells are fed by diffusion from the vertebral endplates above and below, and this limited supply helps to explain why damaged discs repair so poorly and why they lose water and elasticity with age.

Running through a canal formed by the vertebrae is the spinal cord, the bundle of nerve tissue that carries signals between brain and body. In adults it ends at about the level of the first or second lumbar vertebra, well above the bottom of the column. Below that point the canal contains a sheaf of nerves known as the cauda equina, Latin for horse's tail. Thirty-one pairs of spinal nerves leave the column through openings between vertebrae, each serving a particular strip of skin and set of muscles.

The column is held together by ligaments that run along its front and back, and by short elastic bands between the arches of neighbouring vertebrae. Deeper still, small muscles connect one vertebra to the next and adjust its position, while larger superficial muscles produce movements of the trunk. Seen from the side, the column forms an S: a forward curve in the neck, a backward curve in the chest and a forward curve in the lower back. Only the thoracic curve is present at birth; the cervical and lumbar curves develop as a baby learns to hold up its head and then to walk.

Pain in the spine is among the commonest reasons for visiting a doctor, yet scans are a poorer guide to what a patient feels than most people suppose. In 1994 researchers in the United States examined magnetic resonance scans of the lower backs of volunteers who had never had back pain, and found that many had bulging or degenerated discs. Later work has repeated the finding. Researchers therefore argue that imaging should be used to rule out serious disease rather than to explain ordinary pain. Treatment remains contested: surgery relieves some kinds of nerve compression, exercise and physiotherapy help others, and laboratory work on ways of regrowing disc tissue is at an early stage.

Every year, medical schools turn away far more applicants than they admit. The question of how the successful ones should be chosen matters more than most arguments about university admissions, because the students selected today will shape the medical workforce for decades. Yet the methods used to select them have changed less than one might expect. For much of the twentieth century, and in many countries still, the main currency was school examination grades, above all in chemistry and biology. These were supplemented by an interview intended to test motivation.

Grades do predict something. A student who cannot master basic biochemistry at eighteen will struggle with pharmacology at twenty-two. But the predictive power of school results fades quickly. Studies that follow medical students through their training suggest that school grades correlate with performance in the first two or three years, when examinations still test the recall of science, and much less with performance in clinical placements, where communication, teamwork and judgement matter more. Other measures are being tried as well: situational judgement tests, in which candidates respond to written scenarios about difficult situations, appear to predict aspects of later professional behaviour.

There is a second problem with using grades as a gate. They measure schools as much as they measure students. A pupil at a well-resourced school, with small classes and specialist teachers, is far better placed to obtain the top grades than an equally able pupil at a school where science is taught in a laboratory built for half the number of students. In Britain, independent schools educate a small minority of children but supply a disproportionate share of medical students, and the same pattern appears in other countries. If the profession is to serve the whole population, that imbalance matters.

Aptitude tests were introduced partly to level the field. The University Clinical Aptitude Test, taken by applicants to most British medical schools, examines reasoning, numeracy and situational judgement rather than factual knowledge. The evidence that such tests widen access is mixed. Coaching helps, and familiarity with the format favours those who can afford preparation; scores, like grades, correlate with socio-economic background. Their real virtue is comparability: every applicant's result can be set beside that of a candidate from a school whose teachers have never prepared anyone for such a test.

The interview, once little more than a conversation about why the candidate wanted to be a doctor, has also been reformed. The multiple mini-interview, developed at McMaster University in Canada in the early 2000s, replaces one long conversation with a circuit of short stations, each judged by a different assessor. Research on selection suggests that structured formats of this kind are more reliable than the traditional panel, and less vulnerable to the halo effect, in which one impressive answer colours an assessor's whole impression. Even so, no format removes bias: assessors still respond to confidence, accent and manner, qualities that are unevenly distributed among eighteen-year-olds.

Some commentators go further and propose a lottery. Applicants above a threshold would be selected at random. Such a scheme would be transparent, cheap and impossible to game; it would also end the advantage of the polished candidate whose parents can pay for coaching. The objection is that it ignores the qualities the profession says it needs, and that patients would be unsettled to learn that their doctor had been chosen by chance. My own view is that a lottery has a limited but genuine place: when candidates are indistinguishable on the evidence, chance is more defensible than an interview that rewards fluency.

The most promising reforms, however, concern context. Contextual admissions adjust the grades required of applicants from disadvantaged schools or from care, on the grounds that a grade obtained against the odds says more about ability than the same grade obtained with every advantage. Evidence from several countries suggests that students admitted in this way perform no worse than their peers, and are more likely to practise in areas where doctors are scarce. The weakness is crudeness: postcodes and school type are rough proxies for disadvantage, and some able applicants from ordinary backgrounds are neither helped nor harmed by them.

What, then, is the fairest system? In my view it has two stages. The first should establish that every candidate has reached a threshold of academic competence high enough to make safe practice possible; below that line, no amount of enthusiasm should count. The second should rank those who clear it using structured assessments of the qualities that matter at the bedside, read in the light of what each candidate has had to overcome. What should be abandoned is the pretence that a single number, whether a grade or a test score, can order human beings by merit.