The King's Illness : What Can We Learn From It
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NOW that at long last the anxiety of the whole Empire -1-1 has been relieved and the King would seem to be well on. the, to recovery, it may be 'useful to inquire what lessons can be learned from His Majesty's illness.
Towards the end of November, 1928, the King began to suffer from what was described as a feverish cold and sent for his usual doctor, a general practitioner. The' next day, this doctor, feeling a little uncertain whether the very best possible was being done, called in a consulthig physician, who recognized the, signs of congestion in the right lung which had by this time developed: To find out the nature of the. germs which were, responsible for the illness, the services of a bacteriologist were requititioned, and a general blood infection as well as a local involvement of the chest was discovered. Soon after this the help of a radiologist to take X-Ray photographs of the chest and help to determine the extent and nature of the disease in the lung was required. As the King's condition at the end of a week still remained serious, the opinions of two other consulting physicians were obtained, and a little later fresh X-Ray photographs 'were taken. Recognizing by, them and other means that an abscess had formed in the chest, the King was put to sleep by a skilled anzesthe- tist and an operation performed by a surgical specialist.
But even so, the King did not make rapid progress towards recovery. His blood-pressure had fallen, his appetite was poor, and an examination of the blood now showed a deficiency of calcium and other changes. A specially prepared antiseptic was sent over from America, but apparently it was not found necessary to use this. Of the various curative agents which were selected by the doctors in charge to assist in the King's recovery, light must be especially mentioned. In the early stages of the illness, ultra-violet light was administered to small areas of skin for short periods, with the object, amongst other things, of stimulating the activity of certain glands and increasing the power of the blood' to destroy germs. As improvement was obtained it was found' possible twapply treatment by means of the carbon arc lamp with its more penetrating luminous rays, and it is of interest to note that Craigweil House, to which the King has been re- moved, has been equipped with rooms especially designed for' sun treatment, so that the fullest advantage can be taken of the stay at the seaside.
Up to the present, therefore, the help of about a dozen different doctors, at least five nurses, and a good many technicians in connexion with bacteriology, X-Ray and light treatment, have been required. But may it not be asked; were all these doctors with their diverse schemes for examination and treatment really necessary ? May it not have been that because the patient was the King, much of what was dime' was merely of a precautionary nature" and could quite well have been done without ?
yor my own part•I do not think so. Commenting on His Majesty's present stage of recovery, and recognizing how seriously ill he was at one time, the British Medical Journal remarks : " Only the combination of a sound Constitution, the will to live, and perfectly co-ordinated medical care could have achieved this," and to my mind the history of His Majesty's illness is a fine_ example of What co-ordinated effort—team work—in medicine can do.
• But surely there . was something . exceptional and peculiar about the King's illness ? I do not think so. There are probably in England to-day at least a hundred --possibly even a thousand—people suffering from exactly the same sort of illness as the King, and in all probability there are every year tens of thousands suffering from all kinds of illnesses whose lives could be much more easily saved could they but obtain the same co-ordinated Medical care that the King obtained. After all, the art of healing is very much like the art of gardening or even playing golf,' and though, of course, the element of hick can never be entirely eliniinated, generally speaking the 'results obtained are roughly in proportion to the amount of. care and trouble taken. The general practitioner, Often rushed and over-worked, however keen and able he may be, has not the time to work out and study his cases that the consultant has Above all, the science of medicine is becoming so vast and so complex that no single person, however capable he may be, can really pretend to knoW more than a small fraction of it. Therefore, the consultant or specialist., who is concerned only with diseases of a small region of the body or with a special line of treatment, is likely to know" Much-more about his limited sphere than is the general practitioner.
Nevertheless, the geer practioner is all-important. It will always be his job to diagnose the nature of the 'disease and, even if he cannot do this at first, to determine what special examinations shall be made, and which con- sultant shall be called in, as well as to deal with the simpler and less serious affections. I am convinced that we have in .Britain an abler and better type of general practitioner than has any other country. Nevertheless, as the science of medicine develops he is bound to need more and more help from outside.
A good many people fail to recognize that a, lot of disease is preventable ; bow much more is curable if taken early and dealt with efficiently ; and what an enormous loss disease is to the community. It has been calculated that the net loss from sickness in Great Britain Itlone, as the result of decreased earning power and cost of treatment, is nearly. £300 million annually. But this does not take any account of the loss of lives that might be saved by more efficient treatment. We must remember that the maintenance and training of a child is a costly business, and that the child does not commence to be a productive unit until he.is at least fourteen years of age.
Further, that should death of an individual occur before the time at which, through old age, he ceases to be a pro- ducer, the capital - sum invested in his maintenance, education, and training is lost. Therefore, it is an economic proposition for the State to take care of the health of its people and to see to it that the best possible is done for them in case of sickness. .
Unfortunately, at the present time very imperfect pro- vision is made either for the preservation of health . or treatment Of disease by the State. For about one-quarter of the population the services of a . general practitioner, the panel dOetor, are provided.. But specialization is almost entirely unknown under the panel. All that is expected of the panel doctor is a degree of knowledge and skill such as is possessed by every other panel doctor in the district. That some of these practitioners give to their patients much more than this is but a tribute to the public spirit of a profession working amid insurmountable difficulties. As I have said, no specialized treatment and no operations are provided under the panel, and so incomplete is the service that, were it not for the help of the poor law and voluntary hospitals, the whole system must break down entirely.
For the remaining three-quarters of the population, except for the provision of treatment for a few special affections like tuberculosis and venereal diseases, the State does nothing. These individuals have to obtain their treatment for disease just as they obtain most other commodities : in other words, those who can afford to pay for it get it, and those who cannot go without ; or perhaps • more correctly we should say the middle classes get the family doctor with an occasional specialist, the working classes the family doctor if they can afford to pay his fee, and the very poor, if they can brave the for- bidding attitude of the relieving officer, get the services of the underpaid parish doctor, provided by the deterrent poor law. It is only the very rich who are able to obtain anything like the co-ordinated medical care that the King received when he was ill.
But, you will say, what about the hospitals ? In the big general hospitals, with medical schools attached, all the necessary specialists, together with modern methods of diagnosis and treatment, arc usually to be found, and as a general rule, in spite of some minor discomforts, those fortunate enough to obtain in-patient treatment in them are really well looked after, for in these institu- tions alone real team-work exists in the recognition and cure of disease. But the trouble is that it is not nearly as easy to get taken into one of these 'hospitals as many people imagine. Most large hospitals have waiting lists of 'many hundreds, and even urgent cases have to be refused admission for want of beds ; indeed, some hos- pitals are so pressed for beds that they will only take people in if they are seriously ill, and then it may be too late. But the most serious difficulty of all is that the specialists who give their services in hospital do not sec people in their homes as readily as they saw the King. They have to charge fees that put their services for any- thing excepting an occasional visit beyond the means of any but the well-to-do.
What is required then ? Surely it is that the public should realize the vastness of the national loss through untreated or imperfectly treated disease, and the risk that they themselves run through the absence of any adequate system to help in their own cure when they arc sick. They should recall how much was done by 'co- ordinated medical care when the King was ill, and demand of the politicians that in the national interest no less should be done for any citizen who may need it.
SomEa v I I.1?, HASTINGS, M.S., F.11.C.S.
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