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In England NowA Running Commentary by Peripatetic Correspondents

WHY are we doctors often so unpredictable ? Why doesour attitude to our patients vary so much according to theirenvironment ? Of course I had always realised that a few doc-tors were inclined to treat their patients in hospital like ratherdeaf overgrown children, but I certainly didn’t. However ithas been brought home to me very kindly but pretty plainlythat perhaps I am no better than the rest.My patients, two rather charming elderly ladies, had been

to see a physician in his consulting-room and were delightedwith the way he carried out the examination. In fact we unitedin saying what a thoroughly nice person he was. But thencame the pill in the jam. " Why, doctor," they asked me, " ishe so different when you are an inpatient in hospital ? Heshouts across the ward. He is always in a hurry. His actualtreatment is above reproach, but you are no longer a person,you are just a number, and when tackled he admitted it him-self." I murmured the usual platitudes and left it at that.But later I remembered that at different times both these oldladies had been in hospital under me, and how had I treatedthem ? Certainly not as I treated them when I visited them athome. I had asked them questions but had looked to thenurses for a reply. I had prescribed treatment but had left itto the Sister to explain what it was meant to do. I had spokento them from the foot of the bed. It is easy enough to saythat I find a hospital ward inhibiting, to blame the hospitalstaff, and feel that they tend to serve the patient up to usrather like a broken piece of machinery which, acting on ourinstructions, they are endeavouring to clean up, polish, andput in working order. They appear to resent a request toleave us alone with the repaired article, and on busy days it iseasier to acquiesce, to talk over the patient’s head, to forget thatremoval from home to hospital has not changed an intelligentperson into someone who is unable to hear easily or answerquestions.My patients never hinted that they thought I was at all to

blame. They are kinder than their doctor and would not hurtmy feelings for anything; but it made me think, and whatI thought wasn’t exactly pleasant.

* * *

Twenty years ago, the gynxcology in my hospital was doneby the general surgeon, because there was no gynaccologist atthat time. The theatre nurse was one of the loveliest girlsI have ever seen: she was known as " the houseman’s heart-break ", and her beauty was equalled by her competence.I was engaged in the removal of two ruptured dermoid cysts;the cyst wall was adherent to both large and small intestine.Finger dissection was impossible, and the precarious processof separating the adhesions at the point of a sharp scalpel wasarduous. At last I got the operation successfully completed,and closed the skin, remarking somewhat sententiously to thenurse,

" Well, Nurse, finis coronet opus, if you know what thatmeans." She replied, " Yes, Sir," and I asked, " Well, whatdoes it mean, Nurse ? " She answered, " I don’t know anyLatin, but I suppose it means it looks all right when the skinis closed."

Maybe I do look a square to the hep cats. Theirs is a hastyjudgment. My bathroom mirror would tell a different tale;a more curvaceous profile would be hard to find, if you arenot too fussy about segmental distribution. Anyway, a manshould carry all before him with a permanent dignity of miendenied to the overpublicised fallout of the film stars, or hismore transient competitors in the third trimester of expectantjoy. But the hep cats are more scornful of my mind than mereflesh. It is positively indecent that Father should still have ayen to dig that crazy rhythm, and frantically pathetic when Itry. Five stone and thirty years ago was where I came in, withmy Oxford bags boring holes through the ballroom air. Thebags are now under my eyes, the fireside chair needs re-spring-ing, but somewhere up in the frontal lobes the old arterioles

jive into spasm when the offbeat pulses stir up the past.Skiffle sends me. Sends me back, not only to the sentimentalmemories of the sweetest music this side of Heaven and thedecorous gaiety of swing, but schizophrenically back to thehalf-lit cellars of Harlem, the throbbing primordial drumbeat,that curious scent, the dime-a-dance magnetic contact withinborn basic rhythm. No, Siree, only the years elbow me outof the groove. But I am fighting back.As I mushroom over the bar stool, swilling the talc dust from

my tonsils, and doing a surreptitious hand jive, I think how

unenterprising are the youth of today. Their terminology is soboringly monotonous. If they have chosen to call themselveshep cats, why stop there ? There is the whole range of veterin-ary pathology to give descriptive colour to their convulsions.Encephalomalacia has a pleasant syncopation in its own right,but they could really go to town on its synonym, crazy chickdisease. What scope for the pop singer to shriek in his opistho-tonos " Dig that crazy rhythm, Chicks, I’ve crazy chickdisease." And the touching euthanasia of his partner’s requestto be put down forthwith. Strychnine seems to be doing thejob quite adequately: cyanide would be too good for some ofthem.

Localised copper deficiency is just inviting swayback at

midnight ballroom orgies. Beware of the hep with hepatitis,foot-stab is the recognised treatment in the best veterinaryand chuckerout circles. Foot-and-mouth is the cry for song anddance in the cabaret: foot-rot marks the sitters out. Surely acysticercus would be a more attractive title than a jam sessionon a tape recorder, and much more hospitable. If the ideacatches on, just think of the vibriosis on the floor, the warble ofmuted clarinets, the curled tongue trumpeters, the push andpullorum of jiving, the free range, the coolness of the cats.Those kids don’t know they’re alive yet. Wait till my new dietmelts the corners off. I’ll show them I’m no square.

* * *

On my last flight home from New York altitude went to myhead and British reserve forsook me. There were, of course,extenuating circumstances, for the lady who took the seat

beside me was at least 70 years old and travelling alone.

Courtesy dictated that I should help her in every way. Shehad flown in from San Francisco and was going on to Mainz,her home until 1906; her command of the English tongue couldhardly have improved since. My respect for her grew as sheordered a manhattan from the stewardess, but there lay myundoing-or was it perhaps the bourbon I had taken myself-for as the stewardess reappeared I offered the second, which tomy surprise she accepted. Her tongue was loosened and herlife story unfolded. Fifty years a chiropractor! Case-historyfollowed case-history against the tamponade of aero-engines-worse than any surgical meeting. There was the governor ofAlaska’s daughter cured of blindness by cervical manipulation,and the lack of consideration in her husband who chose to be

acromegalic without deviation of the spine. He died-anddeserved to, or so I seemed to detect. Each case-history endedwith the moral, monotonously drawn, " We must not jump atconclusions."

Chiropraxis now has a firm grip upon San Francisco; but ithad not been without a struggle, for those villainous doctors(how thankful I was that I had not slipped so far as to revealmy profession) had done all they could in an endeavour to makeit illegal. Eventually victory had been easy. Deft manipulationof the cervical spine had cured a boy who hitherto had squintedlike an owl. It was only necessary to send him round the townto gaze each citizen straight in the eye, while at the same timedisplaying an early school photograph, for all prejudice to beovercome. The chiropractic law was passed.

I was thankful when we passed into cloud which disturbedour even flight. The flow of words gradually ceased, a handmoved surreptitiously to handbag and a pill was passed quicklyinto her mouth.

* * *

Overheard in outpatients (as chest physician wearing red goggleswalks through to the X-ray department)-" Look, Mummy, thatspaceman from Mars smiled at me."