![]() Lobar pneumonia was common, and with the more fortunate patients, there was a crisis about the seventh day. Patients with diphtheria or scarlet fever were taken away in a yellow fever van to the infectious diseases hospital for at least six weeks no visitors were allowed. Otherwise, the mortality was about 20 per cent. Antiserum was one of the few active treatments available to the GP, and if given within 24 hours of onset, the results were excellent. ![]() ![]() Diphtheria was endemic and every sore throat was viewed with suspicion. Visits usually numbered about 50 and were made by bicycle. There was rarely any attempt at examination. Having listened to the complaint, he turned to the dispenser to order the appropriate remedy. The doctor called the next patient to come forward. 6 Behind stood the three doctors and, behind them, the dispenser. CAH Watts, a GP writing of his experiences in a mining community before the second world war, recalled the waiting room with rows of seats for about 60 patients who sat facing a high bench like a bank counter. ![]() In inner cities, overcrowding led to domestic violence, lice infestation and skin diseases such as impetigo. This picture was in stark contrast to the day-to-day pattern of the GP’s life. Nursing should be available, based with the doctor in the primary health centres Dawson envisaged. He should play a part in antenatal supervision, child welfare, physical culture, venereal disease and industrial medicine. He would attend in childbirth and advise on how to prevent disease and improve the conditions of life among the patients. 5 The GP should be accessible, attend patients at home or in the surgery, carry out treatment within his competence and obtain specialist help when it was needed. The work of the GP had been described in idealistic terms by Lord Dawson in his report of 1920, which laid out the structure a health service might take. 4 When they were sick, it was the GP to whom people wished to turn. General practice covered workers under Lloyd George’s National Insurance Act of 1911, but not their wives and families, whose proper demands were curtailed by the need to pay fees for service. The next ten years saw dramatic improvements in treatment greatly accelerated by research and development carried out by the medical equipment and pharmaceutical industries. In 1948 it had been little more than a decade since the first sulphonamide gave doctors a powerful weapon against streptococcal, meningococcal and gonococcal infections. There were prestigious voluntary hospitals, municipal hospitals displaying the entire spectrum of standards and entrepreneurial cottage hospitals in which local doctors could resurrect dormant surgical skills. Hospitals were in a muddle and financially at the end of their tether. On the basis of wartime experience it was the hospital service that was most in need of reorganisation. Some countries, such as New Zealand and Sweden, had forms of health service but they were not used as models insularity of outlook prevented that. The service was a rationalisation of what existed, conditioned by a need to cajole rather than coerce somewhat reactionary interest groups. The designers of the NHS did not start with a clean sheet of paper. The Rt Hon Jennie Lee MP, Minister of State, Department of Education and Science (Aneurin Bevan’s widow) 3 Many of us have associations with the between-the-wars health service a great patchwork, a good deal of good intentions, a great deal of inadequacies. Of course the health service in this country did not begin in the year 1948. Sir George Godber 1972 2 Introduction – the inheritance of the NHS Having been at the centre since the earliest planning day I am well aware of the many occasions on which mistakes have been made and yet, not withstanding considerable knowledge of comparable services of other countries, in a time of need for myself or my family I would now rather take my chance at random in the British National Health Service than in any other service I know. We shall probably do the same with our health services. We make things work even when they seem, by theory, to be unworkable.
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