OH, WHAT A HEALTHY WAR!

Theodore Dalrymple finds fewer

hypochondriacs than before in bombed Serbia

THE late Professor Michael Shepherd of the Maudsley Hospital once proposed the motion at the World Health Assembly, the World Health Organisation's 'parliament' or talking shop, that war was bad for health. Precisely as he had expected, each delegation argued that, while war in gener- al was bad for health, the particular war that its country was currently waging was a healthy war.

The delegates were quite right, of course. This was confirmed when I visited Belgrade recently. I spoke there to the director of the city's emergency medical services, who provided irrefutable evi- dence. It is now clear in retrospect that Nato's bombardment of that city was con- ceived as a health measure to aid the inhabitants, who have reason to be grateful to the much-maligned Western alliance.

Each emergency call in Belgrade is answered by an ambulance from a central depot, a doctor travelling with it to provide urgent treatment. During the bombard- ment, calls to the service declined by a half. In the three months before the bomb- ing, they averaged 8,340 per month; in the two full months of the bombardment, they averaged 4,288. They started to increase again once peace was declared.

Of course, these figures require careful interpretation; one must not rush to hasty conclusions. Some inhabitants fled the city for the countryside, but they were mainly children, and the population did not decline in anything like the same propor- tion as the number of calls.

The decline was real, then. It was not a purely seasonal phenomenon — no such decline had been noted during these months in previous years. The director told me that, before the war, his doctors judged 50 per cent of emergency calls to be neces- sary; during the war, the figure rose to 94 per cent. This establishes what I have long suspected: that those patients who attend doctors for trivial complaints are perfectly capable of distinguishing between serious and minor illnesses and choose to go to the doctor through boredom or for some other equally inadequate reason.

But the desire to act responsibly as long as the war lasted does not entirely explain the decline. While calls due to the compli- cations of diabetes remained much the same through the war months, illustrating the readiness of people to call the services when necessary, calls due to heart attacks declined by an average of 105 per month to 52 per month. Since these heart attacks were diagnosed according to objective cri- teria, the decline probably represented a real decrease in the number that occurred in the city during the bombardment. It is unlikely that, even during a war, people would suffer heart attacks at home in silence without seeking medical assistance.

This interpretation is strengthened by the fact that calls resulting from acute pul- monary oedema, unstable angina, conges- tive cardiac failure and strokes (all conditions of similar underlying patholo- gies) also declined precipitously during the war from 77 to 45, from 596 to 316, from 359 to 119, and from 286 to 192 respective- ly. Bombing is good for the heart.

Catastrophe in general, however, is not. When an earthquake struck California, the rate of heart attacks went up. The differ- ence between an earthquake and bom- bardment is that, while the former is arbitrary and meaningless, the latter is full of human signification. Bombardment gives people a purpose in life — a reason to go on living. It is hatred and defiance of an enemy and fear of death that give meaning to life and keep people alive who might otherwise die. War is thus the answer to our existential problems.

This suggests a new interpretation of the decline in the rate of heart attacks and strokes seen in Britain during the second `Weren't you in Eyes Wide Shut?' world war. Traditionally, epidemiologists those secret lusters after power — have attributed it to the controlled and supposed- ly healthy diet that was imposed upon the population. I have never found this interpre- tation very plausible and it brings with it the implication that we should let the epidemiol- ogists take control of our kitchens if we want to be healthier. It now seems that it was hatred of the Germans and fear of death that kept the British alive during the war.

Also interesting is the fact that the monthly number of calls for injuries in Bel- grade during the bombardment declined, from 565 to 456. Since the bombing itself caused quite a number of injuries, the decline in the numbers caused by careless- ness and interpersonal human malignity must have been much greater. I suspect that domestic violence decreased greatly during the bombardment and that the leo- nine husband lay down with the ovine wife as long as it lasted.

None of this will altogether surprise any- one who has visited a British casualty department after nine o'clock in the evening. It is quite clear even on casual inspection that the vast majority of the cases waiting to be treated have injuries that are, in the broadest sense, self-inflicted. Even when patients have been subjected to unpro- voked attack, they have chosen to frequent places where unprovoked attacks are to be expected, and where they themselves have probably indulged in unprovoked attacks in the past. There is often little to choose, by way of moral qualities, between the perpe- trator and his victim, and which is more often a question of chance than of design.

So what are the great medical lessons to be drawn from the bombardment of Bel- grade? The first is that bombing is good for the health. The second is that it is good for morale. The third is that it improves the behaviour of the population beyond recog- nition, in respect both of its social conduct and its use of emergency services. I there- fore heartily recommend the Belgrade model of health maintenance.

We in Britain are facing a crisis in our healthcare system — one that is now perma- nent. So far, efforts to resolve it have been mere tinkering, attempts to banish symp- toms without ever getting to the root cause. And what is the root cause? The appalling misbehaviour of the British population, of course, which results from the meaningless- ness of its existence. People call out doctors and ambulances without good cause, attend hospitals for no good reason, and inflict untold injury upon themselves.

There is only one solution to the health- care crisis: we must provoke America to bombard our cities. Our health and temper will improve, life will become meaningful for those who are otherwise lost souls, and our use of medical facilities and doctors' time will at last become sensible. The experiment carried out on Belgrade was a complete success; it is time now to use the same methods in Britain.