925

1. National Income and Expenditure, 1960.

In England Now

A Running Commentary by Peripatetic CorrespondentsRECENTLY we formed a Supporters’ Association. This is, of

course, to be distinguished from the hospital’s League ofFriends, which exists essentially to do good. The Supporters’Association is frankly for the benefit of its members. It arose in

this way.We long ago observed that a considerable number of patients

attended the hospital but evidently did not wish to see thedoctor, since they paid little attention to the advice given ortreatment recommended. Did they (we wondered) come to seethe nurses, to enjoy one another’s company, or just to enjoy thegeneral hospital scene ? Careful research showed that all threeelements played a part. We found that when we put all theattractive nurses in the casualty department the number ofyoung men with sprained ankles, foreign bodies in eyes, wax inthe ear, &c., reached astronomical proportions. We observedthat certain patients came in groups; if Mrs. B came thenMrs. C would come also, and so on. A third section of patientsapparently came to enjoy the hospital scene-to witness thelittle contests between patient and doctor or sister and house-surgeon.

It was clear, therefore, that if the Supporters’ Associationwas to be a success it must provide all three types of amuse-ment and adequate variety; and the results of doing so haveexceeded all expectation. Though the number of hospitalattendances trebled in two years, the numbers of outpatientconsultations, minor operations, X-ray examinations, and

pathological examinations have all fallen to about a quarter.Moreover we have the extension to our outpatient depart-

ment so often rejected by the regional board for lack of funds.On the last occasion we reported their refusal to the secretaryof the Supporters’ Association, who at once came to our rescue.On the day when a visit by an official from the Ministry ofHealth and our local Member of Parliament was arranged, theSupporters turned up in force and the scene resembled anIndian railway-station. The visitors were visibly impressedand went away badly shaken. A few days later the treasurerof the regional board informed us that there had been a

special capital allocation of E25,000.Some discussion arose on how this should be spent, for the

Supporters very reasonably felt themselves entitled to a share.They suggested that a news-reel be provided in the outpatients;but in agreeing to this our committee stipulated that Supportersshould not enjoy the outpatients’ amenities and the news-reeland also visit the doctor or have an X-ray examination. We feltit was our duty to protect our fellow taxpayers’ pockets. Thiswas accepted and there was yet a further fall in the number ofoutpatient consultations-so much so that one or two physicians,becoming quite fearful for their jobs, have lately been givingfree cups of tea with the consultation.On the whole we may justly claim that the system has been

a success, and that we now provide a better public service.Students of social medicine should certainly visit our hospitaland see this pioneer experiment.

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For the princely sum of six shillings, readers of The Lancet(and less fortunate mortals too) can acquire a handsome paper-back from the respectable presses of Her Majesty’s StationeryOffice,l whence, if they will rustle up their slide-rules, or leafthrough their log books, they may place themselves securely inthe Great Chain of Materialist Being, verify, if they will, thelogarithmic law of income, or plot some pleasant percentilecurves.

Do you, Sir, a struggling registrar, cry nightly " God forHarry (Pilkington, of course) ? Believe me truly, not morethan 1 in 10 of our island population is your financial peer, andbetween you almost a third of the national cake is. yours for thesharing. Or are you older now, the grey hairs of senior registrar-dom lending distinction to your brow? For you too I have news: ;

not 1 in 20 of your fellows can boast a fatter wallet. But alas,the going is harder now and the curve steeper, for you sit (littledid you know it) an awkward saddle, at a discontinuity of slope.You guessed as much? Take heart: even your supertaxed andlearned seniors have almost half a million men to keep themcompany.

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Well, we’ve certainly got ourselves on the map though wewere almost washed off it in the process. Our little seaside townhad just said goodbye to its summer visitors and was slowlypreparing for hibernation when the rains came. It rained for aweek and hundreds of houses were flooded, and then it reallyrained. We became top priority in the news, and our littlebrook won world fame. The streets were filled with little boatsbringing food, water, and firewood to well over a thousandmarooned in their upstair rooms. The Army helped, theMarines helped, and the voluntary organisations worked won-ders. Water was pumped out of houses. Money was pouredinto a relief fund and the floods subsided. Now there is onlythe mopping-up left.What has all this taught us ? Where are the pneumonias and

chills so gloomily predicted ? Surgeries and visiting lists are nolonger or shorter than usual. The people of the West Countryare tough and that it takes more than a big splash to knock themoff their feet.

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Every October worried parents bring their eleven-year-oldsto the surgery. He, or she, is off colour, won’t eat, can’t sleep,or has begun wetting the bed again. Full examination andreassurance satisfies the doctor, but the mother wants a diagnosis." It is the 11 +," I tell them. Monthly observation is offered-if it wasn’t I should get a weekly emergency call for each newsymptom. As E-day approaches tension mounts; diarrhoea andvomiting alternate with constipation and frequency. Thencomes the report of the trial. I have to listen patiently to aquestion-by-answer commentary of the ordeal undergone.Four months of relative quiet ensue. The examination papersmature in some council office. By June they are ripe and theverdict is given. The education officer allocates the place in thenew school: Johnny is going to the grammar school; Mary tothe secondary modern; Willie to the technical school;and Frances has got one of the two places at the girls’ publicschool.

Sometimes I am. surprised at the outcome. Occasionally theparents are mystified. Herbert, who has been as regular anattender for the past nine months as an expectant mother, cameto see me last week with Mrs. Brown, who told me: " He’s goingto one of them new contraceptive schools, doctor."

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First it’s cells, now it’s tissues, and soon whole organs willbe refrigerated into indefinitely suspended animation, said ourconsultant optimist. Banks for blood, banks for marrow andbone and arteries-simply a matter of time and we shall allenjoy a comprehensive service for reliable spare parts. Thenext step will be to store the body complete and thaw it outwhen we feel that the time is ripe to return it to physiologicaland social circulation. We shall then be able to stockpile ourexisting geniuses for future scarcity or the edification of

generations to come. Take the virtuoso musician off the icein A.D. 3000 long enough for them to hear his Bach, and then

. pop him back into cold-storage for another century or so. Letus deep-freeze Lord X, Sir Y, and Mr. Z and bring them outas a coalition or individually (depending on the political pre-ferences of the time) when England is in peril. One refrigeratorshould serve for all three; it will be quite economical. Only

, take care to label the body correctly, and posterity will do therest.

l Deuced awkward for posterity, observed our consultant

. pessimist, if there’s a longish power-cut.

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: Overheard in the ward.-" This patient’s son is to be married nextweek. Can she have compassionate leave to go to the wedding ?"