Editorial

In this issue of Brain Simon Shorvon looks back 70 years at the foundation of the National Health Service and how this changed the practice of neurology in the UK. Among the most vociferous opponents to the introduction of the NHS was Sir Francis Walshe, who edited this journal between 1937 and 1953 and never took up the offer of a salary from the state. Neurology was, however, a very small branch of medicine in the 1940s, and provision of the meagre diagnostic, and ever rarer therapeutic, services to the overwhelming majority of the British population became the responsibility of the NHS on 5 July 1948. Recent surveys in the USA have shown neurologists to be less likely to describe themselves as fiscally conservative or to be registered as Republicans than the average for medical practitioners. Psychiatrists are further to the political left than neurologists and, together with infectious disease specialists, are the sans-culottes of the medical profession. Whether this pattern applied to 1940s Britain is impossible to know, but at face value it would suggest that psychiatrists might have been more welcoming of the nationalization of their trade than neurologists. Psychiatry was, however, almost left out of the NHS, and its absorption at the last minute came with a peculiarity dating back to the Local Government Act 1937, whereby Mental Health Officer status was conferred on 'mental hospital employees', allowing them to retire on a full NHS pension at 55. This incentive, irksome to other medical practitioners, was only very recently phased out, and is only one of many factors that played a part in the last-minute inclusion of psychiatry in the NHS. It is, for instance, important to remember that almost 150 000 people diagnosed with serious mental health disorders lived in approximately 100 asylums in the countryside and on the outskirts of major cities. Most were certified or detained under the Mental Health Act, and if treatment was attempted, according to a Ministry of Health Report in 1950, it was often with electroconvulsive therapy, insulin shock treatment or prefrontal leucotomy.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader https://ift.tt/2I1a0oo