1064

8. Courter, R. S., Moffat, J., Fowler, N. O. Circulation, 1963, 27,1034.

9. Goldman, M. J. Am. Heart J. 1950, 39, 884.10. Imperial, E. S., Carballo, R., Zimmerman, H. A. Am. J. Cardiol.

1960, 5, 24.11. Wright, J. C., Hejmancik, M. R., Herrmann, G. R., Shields,

A. H. Am. Heart J. 1956, 52, 369.12. Master, A. M., Dack, S., Jaffe, H. L. Am. J. med. Sci, 1938, 196,

513.13. Mintz, S. S., Katz, L. N. Archs intern. Med. 1947, 80, 205.14. Penton, G. B., Miller, H., Levine, S. A. Circulation, 1956, 13, 801.15. Martin, R. H., Cobb, L. A. J. Lab. clin. Med. 1966, 68, 224.16. Chatterjee, K., Sutton, R., Davies, J. G. Lancet, 1968, i, 511.17. Lown, B., Fakhro, A. M., Hood, W. B., Thorn, G. W. J. Am.

med. Ass. 1967, 199, 188.18. Kimball, J. T., Killip, T. Am. Heart J. 1965, 70, 35.19. Harris, A. Br. J. Hosp. Med. 1969, 2, 1131.20. Sowton, E., Leatham, A., Carson, P. Lancet, 1964, ii, 1098.

Personal Papers

ON THE SPOTANN ARMSTRONG

PAPER has its therapeutic uses, especially in thesedays of disposables, but when it is combined withprinters’ ink it surpasses all other rehabilitationmaterial for those of us who were once deemedincurable.The printed page has played, is playing, and will

continue to play a vital part in helping people wholive without the walls of hospital or long-stay insti-tutions with their rehabilitation. It happens on threedifferent levels:

1. The public platform where the voices of newlyrehabilitated people, their families, and their friends tellus their stories and so help the newly afflicted to a stateof mental and spiritual recovery where physical recoveryis impossible.

Fourteen years ago, when I had polio, it was very rareto read of respirator-dependent disabled people surviving,let alone working or living in the community. Nowadaysarticles on the subject appear regularly in the nationalPress and specialised publications, women’s magazines,medical papers, and so on. Disabled people themselveshave joined in with a will to make known the gap betweenwhat legally should be done to help them and what in factis being done, as well as letting us know what they aredoing to help themselves.As Britain’s only respirator-aided journalist I am

delighted to encourage every disabled person I know toattempt a letter or an article for a paper of his choice. Thestimulus of seeing one’s own work thought highly enough ofto be printed is often the spur that sets a disabled personin pursuit of a particular story which he feels he can write.

I have two principles concerning encouraging otherdisabled people to work with words. One is I never ask

anyone to do what I have not attempted myself; and theother is to advise a disabled person with writing aspira-tions to start by writing about the things he knows about,and if possible to take a course with a good school ofjournalism or story-writing.My own magazine The Responaut, which is by, for, and

about respirator-aided and other gadget-aided people,carries promising first efforts. When my contributorsshow great tenacity to their tasks, I invite them to guest-edit a whole issue of The Responaut.

I started The Responaut in 1963 because I could notanswer the letters which I received asking for help andguidance after my own articles had been printed in TheGuardian.

It seems astonishing now that in those bad old daysthe devotion of doctors and their auxiliary staffs-throughthe highest motives-with the new " miracle " drugs andrevitalising equipment and procedures, produced livingyoung people who literally could not lift a finger, feed,wash, or dress themselves, nor even draw their own breathwithout the help of machinery and other people’s hands.We paid a terrible price for their pains, being left sanseverything, knowing that euthanasia was being discussedas the best way to end everyone’s problem--ours, thedoctors’, the politicians’, and the Treasury’s.

I can remember being humoured when I demandedresponsible work to do. I recall my need to leave hospitaland run my home, my job, and my voluntary work throughother hands. I expect I succeeded because, despite beingaware of many pressing difficulties, I could never haveimagined the whole impossible structure of life withoutthe use of my body at a time when I needed it most.

I am most grateful for the luck, love, and practical helpwhich enabled our siege sheet, which started as a news-letter printed with paper and ink bought from the sale ofmy first articles, to become the illustrated therapeuticpublication which many of us work on together to keepin orbit. Incredibly, Fleetway approached us in 1965 andoffered to print and post The Responaut free to any part ofthe world. " The biggest and strongest", they said, " musthelp the smallest and weakest."

Only this week I had a letter from a new reader whotells us how useful he has found the lists of helpfulorganisations and other publications concerning specificdisabilities and societies, as well as the strength he foundin knowing that other people have battled through cir-cumstances similar to his own and won.

2. On the private level, disabled people are now beinghelped through the many kinds of writing, reading, andteaching aids which proliferate. My own typewriter, thePILOT, was invented by Dennis Collins at Queen Mary’sHospital, Roehampton. It is worked by shining a lightfrom a tiny torch strapped to my head on to the letter Irequire on a keyboard. When the light shines on thephoto-electric cell, it relays a signal to the electric type-writer to print.

In this way I have, this year, typed articles for The

Times, Medical News, Woman and Home, and a couple ofbroadcasts, in spite of the fact of exhausting setbacks,complicating my already infuriating physical condition.I have also edited this coming December Responaut aswell as overseeing three guest editors’ issues, includingone from Tasmania.The biggest thrill of having the typewriter has been in

being able to type private letters to friends to thank them,inadequately, for the constant support with every aspectof my multidisciplined life.

3. On the personal level I have been able to get to knowmyself very well. In the absence of my own handwritingI have become unacquainted with the way in which Iwork. Now, with my typewriter as my writing hand, Iam finding out and following up the subjects which reallyinterest me in the most personal possible way. I amenjoying the most satisfying creative life in the subjectwhich for all I know is my own peculiar bent-that ofverbal archaeology.

I know from the letters received that other people tooare finding the gaps in communications with the publicor with their friends or with themselves are being closed.They do not feel so disoriented or threatened withdisintegration.These dialogues, which we are taking part in all the

time while moving about in an able body, become increas-ingly important when we no longer have movement toconvey our attitudes and feelings. When your words

1065

have to tell the whole story for you, it becomes imperativethat you should be able to send these words if you are

going to remain a living presence in the community witha viable personality.

It becomes increasingly important that words are usedaccurately. Words such as " vital " and " viable ", whichare much abused, are taken under our paralysed wings andgiven back their true personality.

It pleases me to think that the intravenous ironwhich my general practitioner administers is com-

plemented by the fortifying intake of ink on paper.

Round the World

U.S.A.SERVICE FOR ALL

It sounds quite incredible but now, save for a few voicesoff stage, we all want a national health insurance scheme-the Federal Government, the Governors of the States, someof the State legislators, the trade unions, the old, the young,the middle-aged, and, believe it if you can, the A.M.A.True, no-one agrees what sort of national health servicewe should have, how it should be paid for, and how it shouldrelate to Medicare and Medicaid. The American HospitalsAssociation is coming up with another scheme, and it seemsthat making schemes for national health services will be asactive an industry in this country as constitution-makingwas a decade or so ago in Britain for countries anxious tobecome independent.

I have before me in tabular form no less than seven pro-posed schemes, and the breakdown is interesting. Two,including that of the A.M.A., are based primarily on theindividual State; they call for a voluntary programme,based on insurance by private insurers (what noble self-sacrificing non-profit-interested people they are), whichshould be paid for by juggling with income tax, withFederal credits financing the poor. These schemes wouldeliminate Medicaid as would Mr. Rockefeller’s scheme,which is also State-based and would use Federal Govern-ment and private insurers; but premiums would be paidby employer-employee and State government, and it wouldbe compulsory. The other schemes, those of Mr. Reuther,of Senator Javits, and of the A.F.L.-C.I.O. are based oncompulsory membership, and employer-employee/FederalGovernment financing administered by Federal agency, and,save for the Javits’ scheme, would eliminate both Medicareand Medicaid. Other schemes will surely beput forward.

In much of this material there seems a great deal ofnaivety and no suggestion of the sort of homework and legwork that should be done to consider the experience ofother countries, or even to consider lessons from this

country’s own experience. State schemes will inevitablyvary widely and folk will migrate to take advantage of bettermedical-insurance schemes, just as they migrate to takeadvantage of better welfare payments. States with betterwinter climates will attract more of the elderly folk and theirmedical problems. One would feel much happier if someof the proposers would take a cool hard look at the experi-ences of other countries. Sure the U.S.A. is unique; butthat’s no reason why the errors and inadequacies of othercountries’ schemes (as well as the advantages) should not becarefully considered. It seems likely that every error madeelsewhere will be made here-and, of course, Americanstyle, on a bigger scale.

SLOW JUSTICEThe Supreme Court has spoken again, unanimously

under the new Chief Justice-decisively, clearly, and per-haps once more in revolutionary terms. It has dealt oncemore with the vexed and immensely difficult subject of

school desegregation, this time in the State of Mississippi,where, as elsewhere in the south, the dual school system stillin part exists and more on a de jure basis than in the northwhere it’s a defacto system based on residence. For reasonsnever clearly enunciated, and suspected by liberal minds,the Administration had suggested that Mississippi be givenfurther time to put its house in order. The answer wasflat: it was that further delay would not be tolerated; for" deliberate speed " read " immediately ". The decision isobviously a rebuke to the Administration, a stem warningto the foot-draggers, and a clear light to the progressiveseven if the problems now to be tackled are immense andmade worse by fifteen years of obstruction, inertia, andopposition.But once again, as history rolls on, it may be in the

nuances that the true importance of this decision lies. It’snot perhaps a nuance so much as a secondary judgmentmade in a minor key but which may have dramatic effects.For the court also ruled that further appeals on this problemwill only be heard after desegregation has been effectivelybrought into being. Even a layman can see the tremendousimpact that this decision will have if the Supreme Courtstarts to make this a rule of general application. Thisshould be read in the light of reports on violence in oursociety, on the prevalence of crime, and on the chaos of ourjudicial system. The latest report has drawn attention tothe utter lack in this country of any effective system ofjustice to deal with crime. Probably no subject causes moreindividual concern than crime in our streets. It is unsafe towalk in many areas of our cities at night, and it’s oftenunwise by day. The last presidential election took placeafter Negro rioting in many cities and much-publicisedstudent violence. Liberal opinion then seemed to take theview that those who called for " law and order " and" safety in the streets " were largely reactionaries and anti-Negro elements, but I think this was quite wrong. Riots-

Negro or student-will have been witnessed, other than ontelevision screens, by only a small minority of the popula-tion. But crime, and violent crime, comes into the orbit ofevery citizen; and many are demanding that they, theirwives, and not least their children should not be " mugged ",stabbed, beaten up, robbed, raped, or killed if they shouldwish to walk in the streets or parks of their own cities.Some see the answer in better, and more, policing, and

there is need for improvement in this field. Generally thepolice in this country are underpaid, under-rewarded, andunder-appreciated. And they are as frustrated by the courtsas is the ordinary citizen. The court procedures are sodilatory, so long-drawn-out, so complex, and subject to somany delays that, if justice is actually done at last, few,save those involved, see it and the public at large has longlost interest. The costs are immense, and a wealthy male-factor can hope to delay proceedings against him for manyyears by timely judicial appeals in court after court. Papersmay be hawked round numerous judges till one will sign.The real key to crime in this country seems to be the morerapid administration of justice. What we want is not theRed Queen’s method-" sentence first: trial after "-whichis what we have so long had in the newspapers. If the

Supreme Court is now going to say, as it seems to be

signalling, "trial first, appeals after", this will get usstarted on the right path. Perhaps if it went further andsaid that all grounds of appeal must be consolidated andbrought forward at the same time, this would be a stepforward too. Perhaps also if it were ordered that no judge,save in exceptional circumstances, could intervene in amatter before some other court till the hearing is terminated,that might speed things up. The National Commissionon the Causes and Prevention of Violence has describedthe U.S. machinery of justice as fragmented, inadequate,and archaic; and some would put it much more violently.