Mr. Stassen's Granny
By SIR HENEAGE OGILVIE (Editor of the Practitioner) RANNY IS GONE " is the title of an article by Harold E. Stassen in the Reader's Digest for February, 1950. The article has been reprinted for circulation to all doctors in the United States.
" Granny " was a lady of sixty-two who died in London (Eng) in February, 1949, of lobar pneumonia, after the Emergency Bed Service had failed to find her a hospital bed. Her case was reported in our newspapers at the time. Such incidents, unfor- tunately, still happen in England as well as in America, but this one is used, together with a few facts chosen to give the semblance of verisimilitude, as the text for a naive essay on the working of the National Health Service in England intended for American consumption. Mr. Stassen came to Britain to make an intensive study of the National Health Service. The Prophet Jonah also travelled a long way, but he didn't see much either.
Granny died seven months after the beginning of the new Health Service, when the dislocation inevitable in the change-over was probably at its worst, and at a time of year when the incidence of seasonal illness is at its highest. She might have lived had a bed been found for her ; she might not. Mr. Stassen rightly points out that much of the difficulty in securing admission to hospital for old people in an emergency is due to the prolonged occupation of hospital beds by other old people who no longer have any need for hospital treatment. When everyone can demand hospital care as a right, those who have once secured admission are loath to leave until they are, in their own opinion, as fit as they were before.
Grandpa is aged eighty. He is in a London hospital. He fractured his right femur on August 3rd, 1949. The fracture was firmly united by the end of October. By Christmas Grandpa was walking round the ward with a stick. He is still walking round the ward, helping sister and doing all he can to help his fellow patients. He walks very well. He does not walk perfectly, and he probably never will, but he walks better than many men of eighty who have never fractured their femurs. However he lives in a flat up two flights of stairs with no lift, and he does not think he can manage the stairs. He cannot be found a convalescent home by the almoner. So till some local authority can find him a house or a ground-floor flat, or till he dies, Grandpa will go on using the hospital as a first-class hotel that costs him nothing, taking away meanwhile 5 per cent. of the teaching potential of the surgical unit that houses him, and preventing two dozen duodenal, ulcers or three dozen hernia or acute appendices a year from being cured by operation. While the National Health Act has undoubtedly aggravated the bed-shortage by blocking hospital wards with patients who need no more than bed and breakfast, it cannot be blamed for all the other crimes that Mr. „Stassen has piled on to Granny's funeral oration. He says that it is almost impossible to be operated on for hernia in London without a year of waiting. He says that the total amount of surgery being performed is decreasing. These would be good propaganda points if they were true. He says that " Londoners are now getting less than they once did and at higher cost—of that we may be sure." Of course we may be sure of anything we want to believe ; many people are sure that the earth is flat.
He says that " since 1948 there has occurred a slight decrease in the number of young men studying medicine." This statement will interest the Deans of Medical Schools, who are trying to cope with the most fantastic rush of applications in history. Throughout the country there are a hundred men and women anxious to study medicine for every ten who can be accepted. He says that the Act is " indirectly responsible for the startling jump in Britain's death rate in the first quarter of 1949—a rise to 150 per 10,000 from 123 in the same quarter of 1948." These figures are nearly accurate. The mortality in 1949 was 149 and not 150 as stated, and that in 1948 was 123. But the corresponding figure for 1947 was 171, so if Mr. Stassen had turned back one more page he need not have been startled. 'Mortality statistics, taken over as short a period as a quarter, fluctuate considerably from year to year, being influenced by such factors as weather and epidemics.
Since Mr. Stassen seems to be interested in statistics he might have turned to those referring to infant mortality, which is less subject to these seasonal influences, and is therefore a more accurate index of the efficiency of the health service of a nation. The avail- able figures, showing decreases or increases in the infant death-rate per ten thousand live births as compared with the same quarter of the previous year, since the inception of the National Health Service in Britain are as follows:— England 1948 and Wales. Scotland. N. Ireland. U.S.A.
July-Sept. –4 –10 – I –1 Oct.-Dec. –3 –13 –15 –1 1949 Jan.-March –1 –1 +2 –1 April-June –1 –7 –6 –2 July-Sept. –2 –5 +2 –2 Average improvement per quarter .. 2.2 7.2 3.6 1.2 Mr. Stassen seems to have derived many of his opinions from " a brilliant young medical student more than half-way through his course. There was a touch of pathos in his voice as he told me he had decided to go out somewhere in the Empire to practise medicine." Ten years ago there were one or two brilliant young British athletes halfway through their careers, who didn't like the war. They went overseas to Hollywood and preached moral rearmament with a touch of pathos in their voices. We got on very well without them.
Every Briton who knows the United States has the greatest admiration for the American medical profession. He admires its independence, its courage, its fertility in new ideas. He cannot but be perturbed by the wave of socialised-medical-hysteria which is clouding its usually clear outlook at the present time, and demanding this sort of dishonest rubbish to allay its fears. A number of American doctors are hiding their heads in the sand, as the ostrich is fabled to do at the threat of danger, only lifting them out to hear the comforting chirrup of a Stassen or a Fishbein.
They say, " We don't need socialised medicine and we won't have it." It is only the more far-sighted among them who are prepared to admit that change of some kind is at hand, and to examine the facts that make that change inevitable. The real ostrich faces danger, and, if he cannot run away from it, he turns to fight it. When he fights, he usually wins.
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