The Good Old Days; Curing piles with red hot poker.

Conservatives are fond of harking back to the good old days when ‘medicine was an art not a science,’ it was also nasty. Save for sawing off limbs, curing piles with a red-hot poker or a knife in the groin to relieve bladder stones, there were few cures. The bewigged physician rode up to the house, the relatives assembled around the bed, the dying patient’s stool was sniffed, a vein was lanced and a useless prognosis offered. Medicine was a play reminding us that we were mortal, nothing more. The play finally closed in 1928 when Alexander Fleming accidentally left a Petri dish by an open window, which grew a mould called penicillin. When the Americans manufactured it in large quantities in 1943 the medical industrial age was born. Penicillin was followed by a multiplicity of drugs, new vaccines, organ transplantation, genetic engineering, heart surgery and cancer cures. Death rates fell spectacularly. In 1964 people expected to live five years after retirement. Fifty years on we expect twenty. The price is a rising tide of dementia. The Irish call it ‘outliving your brains’. Rich and poor suffer alike. Dements can be found immobile in urine-soaked armchairs in state nursing homes, or staring blankly through the windows of expensive flats. The badly neglected can be found rooting in rubbish bins behind supermarkets. Dements often die alone. Lose your mind and you lose your friends. Ambulance men will tell you stories of finding grandma’s body days after she has died in her basement flat, curtains drawn, a row of full milk bottles on the step, neighbours walking past too busy on their mobile phones to notice. Ask a city priest how often he conducts a funeral where the only mourners are the undertakers. There are 850,000 dements in Britain, by 2025 there will be a million. At present 650,000 people care for them. It is naturally a matter of great concern. Which is why if you are over seventy, and you smoke, drink, are fat, or had a serious neurological illness, your GP may ask you to remember three objects and later tell her what they were, subtract a sequence of sevens from ninety-seven, then copy one shape inside another. Called the mini mental exam, it separates demented sheep from normal goats. If she thinks you are losing it she may order an MRI scan and blood tests. Fail and you might say farewell to your driving licence and control of your affairs. Such tests should be done selectively and with great sensitivity. This is because those who their GP suspects may be in the early stages of the illness are often devastated, their lives consumed with anxiety for the future. A similar plan is for the middle-aged to be told the ‘real’ age of their dwindling brains, often shrunk by feasting and alcohol, compared with its chronological age. The difference can be huge. Enter the government with a plan to pay GPs £55 for every mini mental test thus greatly increasing the number of ‘dements’ and in turn creating a vast service industry to care for them. It caused a furious reaction. Who wants to be told they have a disease nobody can treat which will rob them of their faculties? Very few except officialdom. As we go to print the £55 per test has been dropped due to pressure from GP leaders, who for once got off their backsides to resist state directed medicine. Despite this rebuff officialdom will be back. We are now in the age of industrial medicine and the ‘total state’ in which all considerations of privacy and autonomy are set-aside in the interests of ‘the community’ – and its officials. Like overpopulation, dementia is a side effect of medical progress and like all technology it sweeps aside democracy. If we choose to extend our lives by technology we must accept its total rule, however arbitrary, wrong or intrusive. A cure, restoring the family, persuading people to take their elderly parents or the old and lonely into their homes and offer them love is impossible in a society driven further and further apart by technology. The alternative, state departure clinics, cannot be far off. As I began this editorial the House of Lords was debating ‘assisted dying’. Are we about to call time on the aged?