This year, on July 5th, the NHS celebrated its 50th anniversary. There are relatively few people now who retain a clear memory of pre-NHS medical practice in Crich. I recently spoke to Mrs. Olive Cooke who is able to remember back to the days of Dr Rankin (circa 1920), the assistant to Dr Geoffrey MacDonald who owned the practice at that time.
The surgery was established at the building on the corner of The Dimple and Surgery Lane, in the house known as Roskeen, where there had been surgery premises since around 1840. Mrs. Cooke recalls that he did all his house calls on foot. He would frequently hitch a lift on the steam engine driven by her father up to Hilts Quarry on his way back from visiting patients in Fritchley. This would save him a long walk up the incline. She vividly remembers him taking a shortcut through the back kitchen where she lived in Hilts Cottages, calling a cheerful greeting as he passed through, and occasionally dropping off some buns for the children that had been sent via him from a Fritchley acquaintance. He was evidently an extremely well liked and hardworking doctor, whom Mrs. Cooke fears was rather 'put upon' by some of his patients! It is interesting to note that whilst this worthy man was labouring along the rough paths and hills of the area, his boss Dr MacDonald was attending his patients in a chauffeur-driven car!
Dr MacDonald was succeeded on his death by Dr Eileen MacDonald, his daughter, in 1936. She remained at the practice for ten years with the help of an excellent female assistant whose name I have not been able to find. Dr Eileen was a rather formidable lady who had a reputation for being rather strict with her patients. Her assistant was perhaps rather more approachable. Dr John Twist took over in 1946 and worked within the NHS from its inception, still in the same practice premises on Surgery Lane. He was joined later by Drs Alan and Margaret Wilson, husband and wife, for a short time, and then in the 50s by Dennis and Joyce Ward, who between them looked after Crich and area for the next thirty years.
Before the NHS, of course, the doctors had to charge patients for their services. A large proportion of the population avoided large medical bills by paying regularly into a Doctor's Club. A number of different organisations facilitated this and would arrange a quarterly payment to the doctor for providing care to their members and families. The poor of the parish were paid for by the county at the princely rate of 1/3 per person per annum, to include the cost of any medicines. This was in the 1940s and puts today's cost-efficient prescribing in the shade! Private fees to wealthier patients no doubt helped to offset this extreme example, and as in many rural areas of the country, people were always very generous with gifts of eggs, butter and other home produce.
The changes in health and medical treatments have changed dramatically over the fifty years encompassed by the NHS. Technology has leapt forward, diagnostic investigations and therapeutic procedures have reached levels of sophistication undreamed of in 1948. Life expectancy has increased over this time from 66 to 75 years in men, and from 71 to 80 years in women. Death rates have dropped most markedly in children aged from 1 to 14 years, from 104 to 18 in every 100 000, a fall of 80%. This change has come about partly from a reduction in infectious diseases brought about by effective treatment for TB, mass immunisation programmes and the introduction of antibiotics. (Mrs. Cooke remembers the great fear when she was young of pneumonia, an illness that could kill a previously fit child or adult within a few days. It is not surprising that people took a great deal more care then in wrapping up warmly against the cold weather to guard against catching their 'death of cold'.) Cancer treatments in children have also radically reduced death rates from leukaemia and other childhood malignancies. Now the most common cause of death in children and young adults is accidental, from injuries or poisoning.
Despite these changes, statistics show that over the last fifty years we have doubled the number of days taken away from work due to illness. Our changes in lifestyle have contributed to changes in health. Although we now consume fewer calories now compared with 1960, because of our relative inactivity, 1 in 6 adults in England is classed as obese. This figure was 1 in 14 less than twenty years ago. Our alcohol intake has doubled over 50 years and so has the death rate from alcohol-related liver disease. These figures take no account of the illness and misery that inevitably keeps pace alongside. Better news is that we have almost halved the proportion of the population who smoke, over the same period of time, but a disturbing fact remains that the number of children who smoke is currently increasing.
Future challenges for the NHS include helping the increasing numbers of people who are living to a greater age to look forward to a healthy and active old age. We need to reduce heart and circulatory disease and cancers. The task here is to tackle the increase in smoking in the young, adopt healthier eating habits and greater physical activity. Much of our routine work now in general practice is central to these aims.
It is interesting to reflect on the next 50 years and whether the NHS will survive given the soaring costs of modern medicine. It is to be hoped in the interests of the majority that it can. Perhaps if we all take a greater responsibility for our health this hope can be realised.
Written by Dr Alexandra Knight, with thanks to Dr Twist and Mrs. Cooke for their help and information. 1998
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