A Doctor's Journal
Virus and After
By MILES HOWARD
WHY have so many people felt miserable and below par these summer months? One reason is that we are passing through a second wave of the virus Infec- tions which caused such havoc in the spring. A lesser wave, it is true—but if this happens in July, true—but if this happens in July, how about February, 1960? I am no virologist, but to the clinical observer there seem to be two groups—the viruses of influenza, and another and similar set, responsible for vomiting and diarrhoea and other disturbances of the gut. Infection with the viruses of either group is followed, in a propor- tion of the victims—what proportion, I cannot like : this is one of the many questions I would hke to explore, if only there were time—by the "'too-familiar picture of the post-viral state, in one Of its many guises. Illness that 'shadows' a v ctus infection is quite often acute and thus the "'n be_ntre of an 'emergency situation' for patient, may and doctor. tol,:),°king back over the past few years, it seems " e that we are reliving the epidemic years of 1,1'2 ".19. The virus strains have changed and their Lethal Power, thank heaven, is very much less— Partly because of antibiotics, partly because it is now possible to protect the citizen against attack, with a vaccine prepared for the occasion. I had lunch lately with the man who advises one of our largest companies on vaccine production, and heard about preparation of the stocks for 1960 : mainly 'A-Asian' and the latest strain of B. Having Buttered a middling severe attack of post-viral depression and malaise in 1955, I am not in any doubt whatever on what is to be done—I im- Enutuse everytine around me, and any patient likely to be in England from December to April, especially if he lives in the metropolitan area. Perhaps I am wrong here—most of my patients, of course, do live in and around the Great Wen— but my impression is that the country-dweller is less prone to infection and its aftermath.
The vaccine 1 have been using is Invirin, and I err on the safe side by giving not one but three doses of it : this year, it will be two, at the begin- ning and end of October, and a third 'booster' dose in early January. Invirin has to be kept at a low temperature—in my house, the lowest layer in the ice-box is full of it, and there it will keep quite safely for a year or more. Before inject- ing a dose (one millilitre or so) into his patient, the doctor is well advised to let the vaccine warm up for a time. I learned this lesson the hard way—howls and abuse by friends who had Invirin straight off the ice shot into their arms : it is pain- ful then, simply because it is cold. Immunisation has no ill effects, as far as I know; it gives a 'protection-rate' of about 80 per cent.
A friend in industry told me lately that a num- ber of firms offer immunisation to their employees —a wise precaution : it is estimated that in the 1957 epidemic some 8 to 10 million people were infected, and if only a quarter of these had a post- viral illness, that is 24 million. What a vast volume of depression, discontent and impairment—of productivity, of effectiveness, of enterprise--this must represent ! What strikes an 'outsider, like myself, looking in upon the English, is their capacity to deny the importance, or even the existence, of this 'plague' of our time—It's only flu', they will say. 'Only flu'—when, during an epidemic, 1,400 people die from flu with sub- sequent pneumonia every month. I suppose it is the same kind of mechanism that enables the natives of these islands to deny the plain 'truth about the weather, and behave as if they were living in a mild climate, with small range of variation : so, in the winter they do not heat or insulate or 'seal' their houses; and in a tropical summer, tramp about the city streets in thick worsted suits, and even waistcoats. Of course it is irrational—but then 'tribal' behaviour, in certain areas, is dictated by group-feeling, not reason, and has always been : only the most naive rationalist could expect `mass reactions' to be governed by logic. To be fair, though, one must say that British inertia is, in its way, a virtue—the British are less likely to be 'sold' by the bogus salesman, in politics or elsewhere.
should have replied earlier to the letter from A. J. Blake (July 24) were it not for the curious and unexpected wave of emergencies mentioned above.
Of course, the lay administration of the Health Service is in the hands of men and women who work hard, and often overtime, in the cause of duty, and are devoted to their task; I say this sincerely and from experience, since I have often had reason to be grateful to them. If anything I wrote conveyed a different impression, I am sorry —nothing could be further from my mind than to rail at my lay colleagues.
What I was trying, albeit clumsily, to say was that to someone taking a look over the Service as a whole it does seem that the effective direction of affairs is moving over from doctors to laymen : whether this is, in itself, a good thing or not is for others, who are better fitted, to judge. This 'power- shift' is, surely, part of the pattern of evolution of the Service as it was first de■Ased and is thus, in a sense, inevitable. Perhaps the only arbiter is time : wait twenty years and take another look.
Another feature of the Health Service 'govern- ment'-not peculiar to this field, heaven knows— is what one might term the morbid enlargement, or obesity, of committees. Say the Board, or Staff Meeting, or Medical Committee—or whatever its name is—reaches fifty, or sixty, or even seventy : to the observer, untrained in administration, it is plain that no business can be transacted by so numerous a body. One of Parkinson's celebrated laws applies here: a sub-committee, or ginger group, or 'Cabinet,' forms itself, meets, and makes all the decisions that matter. The function of the main body is, then, to ratify these, and to argue over trivia. For myself, I wonder if the law might be extended farther still—perhaps the decisive events take place in the minds of a few men--two or three?—around whom a sub-committee grows, as a crystal will grow in solution, though more quickly.
Let us presume the prime virtue, in development of a health service, to be initiative or enterprise : it seems, a priori, very unlikely indeed that a committee of seventy men could actually start a`nything. It might help to keep the machine tick- ing, and adjust it here and there, but advances wall come, not from the committee, but from the per- sistent prodding and nagging of a few—who will be regarded by the rest as tiresome and one-track trouble-makers, or applauded : that will depend on the 'pattern of forces' operating just then, the prevailing mood of the committee, appraisal of public opinion, and who knows what. besides.
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