Posts tagged ‘England’

November 10, 2014

The Scots, the English and Mutiny on the Bounty – Buchan’s Domestic Medicine

 

William Buchan's Domestic Medicine

William Buchan’s Domestic Medicine

Life in Scotland in the 18th century was filled with dangers not least from physicians’ treatments of sick patients. Some ‘cures’ might provide clues to the prevalence of early deaths.

A single example will illustrate what I mean.

Severe constipation might be tackled by immersing the patient’s lower extremities in cold water, or making them walk along a wet pavement (flagstones/setts) and dashing the legs and thighs with cold water. If this didn’t result in producing a stool, and I’d be surprised if it did, then a quantity of quicksilver (mercury) was called for, as much as one pound, to be swallowed by the unfortunate sufferer. If the quicksilver proved too much for the patient he or she was suspended by the heels to encourage the quicksilver back out through the mouth.

Healing was often the result of long-term observation by physicians and trial and error attempts to deal with illnesses which might prove successful or might not. When the Scottish physician William Buchan decided to put his observations and recommendations into print so others might benefit from his knowledge he made himself unpopular with colleagues who wanted to preserve an aura of mystery around the art of medicine.

The first edition of Buchan’s book appeared in Edinburgh in 1769 and proved a great success from the start. His Domestic Medicine or A Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines was to become a standard work not only in this country but across the world. It was reprinted in over 140 English language editions selling some 80 000 copies and it was translated into several languages. Domestic Medicine proved particularly popular in America with several cities reprinting their own editions so it would be found in homesteads and plantations and carried on journeys west by pioneers – a medical bible that advised on just about any physical or mental danger that might afflict a person. Catherine the Great of Russia showed her appreciation of the great man by awarding Buchan a gold medal for his comprehensive guide to medicine.

 

Ships captains, responsible for the health of their sailors away from home for months at a time, would carry Buchan’s Domestic Medicine with them on voyages. When mutiny broke out on HMS Bounty Captain Bligh’s copy was one of the pieces of property purloined by the mutineers, led by Fletcher Christian, when they abandoned ship and went into hiding on Pitcairn Island.

Today Buchan’s work is a curiosity, a glimpse into a world very different from ours, where death was never far away from a stricken patient. But not all treatments sound outrageous for the good doctor’s keen observational skills can strike a chord with us on several ailments, such as gastric difficulties, when he warns of over-indulgence in fatty and rich foods.

Buchan was an enthusiast for exercise and fresh air which he recognised was essential to generally good health. He was also a keen advocate of the Scottish diet – simple and nutritious and gentle on the stomach and gut.

At a time when personal hygiene was not easy to achieve because of poor supplies of clean water he, nevertheless, advocated frequent washing. It is easy to see how such sensible advice would in time provide the groundwork for recongising that adequate and clean water supplies in our expanding and overcrowded towns and cities were essential to improving human health during the 19th and 20th centuries.

In his section on diet, Buchan examines the differences between the average Scottish and English habits of eating during the eighteenth century. He despairs at the quantity of animal meat consumed in England (when it could be afforded) because he warned too much animal meat led to circulatory and gastric problems, to nausea and excessive thirst (leading to the over-consumption of beer which he regarded as expensive and wasteful of money that might otherwise have been spent on nutritious food).

The more sedentary the occupation the less animal meat that should be eaten he cautioned. What meat was consumed should be mixed with vegetables was his advice. He came across too many people in England, where he also practised medicine, who ate too few vegetables with the result scurvy was extremely common in England. He also blamed an excess of meat for blunting the imagination and inducing ferociousness in individuals. His conclusion was too much meat made people angry, produced lethargy and rotten teeth through scurvy while at the same time was an expensive way to eat. Mixing meat and vegetables in soups or stews, he reasoned, would feed more people for the same cost as one person’s serving of meat but in England when meat was boiled it would be taken out of the water and the stock was thrown away, so discarding the nutritious juice that could have provided a tasty soup.

Cooking meat, he observed, was largely limited to the most expensive methods of roasting and broiling so that little money remained for clothes so the common people he came across in England appeared scruffy and poorly dressed.

He wrote that the English diet was the most restricted in all of Europe consisting of little more than meat, bread, butter, cheese, ale and porter. Even children in England were encouraged to drink alcohol from an early age

Buchan noted that the consumption of bread was as great in France as it was in England but the French made ‘copious use of soups and fruits’ whereas the English largely confined themselves to bread (and meat when affordable) eaten mainly with butter – which he condemned as excessively oily and detrimental impact on the stomach. Despite this children of the poorest of the population in England virtually lived on bread and butter.

Bread, he argued, was a wasteful way of utilising grain – better to eat the grain directly – and bread and flour were open to all manner of adulteration such as chalk, alum and lime. He recommended eating a variety of breads made from different types of flour – rye, potato, rice, oat, maize, buckwheat, Indian corn and barley rather than be confined to costly wheat.

Oat bread, he points out, was universally eaten in Scotland. Bread then referred to any solid made out of flour such as bannocks and oatcakes not just loaf. Buchan held up the Scottish mixed diet as preferable to the English while admitting it tended to be quite restricted and unvaried, certainly among the poorest people, it was nevertheless wholesome and affordable.

Buchan's Domestic Medicine

Oatmeal, milk, broth, vegetables, occasional meat formed the bulk of the Scottish diet. Instead of the large quantities of beer drunk in England, Scots tended to drink more water. (Of course there was whisky but I haven’t come across references to that.) The result, according to the doctor, was a population that was cheerful, active, healthy and strong. In an aside aimed at Samuel Johnson who derided the Scots habit of eating oats which he regarded only fit for horses, Buchan suggests if English horses ate less of it and English men more- it would be to their advantage and, ‘lessen the expense of living.’

If you remember Buchan thought grain best eaten directly. He advocates hasty pudding as an ideal means of serving them. Hasty Pudding could be made from any grain boiled up with water or milk and a little butter or molasses- such as porridge, rice, Indian corn or wheat puddings that might be varied with the addition of spices such as cinnamon or ginger.

He regrets the very few types of grains cultivated in Britain and dependence on foreign imports and he deplored the number of horses that ate large quantities of what grain was grown. Buchan estimated some 2 million horses were kept in Britain which required the equivalent of 3 acres of grain each, totalling some 6 billion acres of grain consumed by horses, enough grain he wrote to feed half the population of Britain. Many of those horses were used to draw carriages ferrying men and women around who he concluded would be far healthier if they got out and walked instead.

The growing popularity of the herb tea also came to his attention which he criticised for its lack of nourishment and how it was drunk with milk and sugar which he noted could be better utilised in the preparation of a nutritious meal.

He accused women taking tea of being too partial to eating too many muffins, crumpets and other spongy bread soaked in liquid butter and consuming fatty pastries  who would then complain to doctors about indigestion. Despite his side-swipes at ignorance and over-indulgence Buchan was not against perfectly good food such as butter, only its excessive use on bread and buns foods of low nutritional value. He did recommend those undertaking hard physical labour should add butter to vegetables and non-oily fish but not people who sat around all day or people in sedentary occupations because too much butter would make them sluggish and the addition of cheese could produce ‘fires in the blood’ and constipation as well as drink cravings, presumably due to its salt content. Instead he urged greater consumption of roots and fruits.

Potatoes he regretted were too little eaten except in Scotland and Ireland despite being easily grown and he recommends them boiled or roasted or as a meal served with milk, butter or gravy. Where potatoes were to be stewed or made into broth he recommends boiling them first to get rid of poisons – because the tattie, as he points out, is related to nightshade.

A variety of vegetables in the diet such as Jerusalem artichokes, parsnips, carrots, salsify, beets, cabbage, kale, cauliflower, onions, leeks and broccoli perhaps made into cheap and nourishing stews and soups were recommended by Buchan to easily improve health in individuals but cautioned against too many at one time for fear of wind and flatulence. However, he concluded this was not as serious as consuming too much meat for animal food led to the accumulation of bile and subsequent inflammation affecting parts of the body which is more or less where we began.

William Buchan died in 1805 and is buried in Westminster Abbey in London.

http://www.oxforddnb.com/templates/article.jsp?articleid=3828&back=

 

 

 

March 25, 2014

Reasons to Vote Yes: Privatisation and the NHS

Private businesses operating within the National Health Service must be pretty pleased with how policies pushed by successive governments at Westminster have allowed their interests to flourish. Why would they not be? Opportunities in this area of social provision are staggering and perfect to boost company profits. Shareholders must be drooling at the prospect.

There was a time when those responsible for safeguarding and running the NHS – politicians – were proud to declare it the best health service in the world  and one of the greatest achievements in history – and some still do though what they mean by this now is less clear. The NHS became something of a sacred cow – a marker for how civilised the UK was compared with other countries with their piecemeal services based on health insurance and unequal access to care.  

You don’t hear so much of that now – now that the NHS is steadily heading towards the American health care model – the steady incursion of private providers such as Serco and Circle increasingly managing aspects of public health care.  Serco’s expertise takes in everything from nuclear weapons to health. Circle, established by former banker Ali Parsa,  is run along mutual lines with doctors holding a stake in the business.  I should point out in passing that just last week Serco’s finance director of outsourcing was on the point of resigning over a financial scandal involving the government.

National Health Service

In 1948 the NHS was started as a comprehensive health and rehabilitation service for the prevention and cure of diseases  in response to the miserable health provision available to the majority of people in the UK. The NHS was established as free at the point of delivery and available to all, paid for by the people through public taxation.

We all know how successful the NHS proved to be, and rather than fewer people accessing its services the healthier the population became, the scale and variety of specialist care led to increasing numbers turning to the NHS with issues never envisaged at its initiation e.g. IVF treatment for fertility problems and gastric bypasses.

When a national health service was proposed opposition from some quarters, notably well-off doctors who feared a loss of income through restrictions on private practice, were well aired. For most ordinary people, however, the NHS was welcomed and proved a revelation. Lives were saved and improved enormously. It is not possible for any of us in the UK today who didn’t live through the years before 1948 to fully comprehend the awful misery inflicted on the poor having to make choices between paying out paltry earnings on keeping a roof over their heads, putting something in their bellies or paying for essential medical treatment.

Over the last half century the lives of people in the UK have been transformed by the opportunities for decent care provided by the National Health Service and life expectancy as a result has risen by around 10 years.

The cost of upkeep of the NHS has also risen year on year which is why Westminster governments have looked to ways of offsetting some of that financial burden  onto the private sector – outsourcing to private companies to manage aspects of care. The private sector is regarded by some as more efficient than the public. That efficiency does come at a price – private is more ruthless in regards to its employees but it is not per se any better at the job it does although it does bring in alternative means of funding such as raising cash through shareholders.

So where is the NHS heading?

I fear that in England there is little chance of what today we would recognise as the NHS still being around in another 10 to 15 years time with increasing numbers of health trusts outsourcing multi-million pound contracts on the open market for everything from mental health provision to tests and diagnosis. In Scotland things are a little different. Here there has been strong resistance to interfering with what is regarded as a vital system of health care.

But in England there is a different perspective, from government at least. A choice between direct infusion of funds into the NHS or outsourcing to the private sector has come down firmly in favour of private. Austerity measures drive this to an extent, it is argued, but that doesn’t wash in a country that supports Trident. Funding for the NHS is ideologically driven and pretty well shared by Labour, Conservative and Liberal Democrats.

England’s move into privatisation will no doubt lead to patients becoming clients and will be accompanied by the well-rehearsed refrain of those clients being provided with greater choices over their care. That  great myth of choice and the right to choose – such choices are always conditional in such circumstances.  The concept of choice so loved by rightwing commentators from both Labour and Conservative sides is not absolute – in some areas there will never be real choices of provision and moreover choice is mainly exercised by the wealthy and the middle classes creating gulfs in what was once a fairly equitable health service.  

A health care system operated by the markets will have as its number one goal, irrespective of claims from business people and politicians (sometimes the same people), the company’s profits.  Why would they not? That after all is their raison d’être.

Why are privately operated companies more likely to employ temporary rather than permanent employees? How does having transitory staff in hospitals fit in with putting the patients’ interests first?

Any private health care business will think carefully about where it operates to try to ensure success. Their bottom line is never going to be the service to be provided irrespective of cost. So what happens to the universal provision of care – does it become ghettoised? Like schools? Replacing the notion of universal care for competition at the heart of health planning has meant private providers are able to get more snouts into more troughs of readily available public cash.

In these so-called times of austerity NHS budgets are squeezed. Deciding that aspects of NHS care should be opened up to private companies is a political decision. It is dressed up as opportunities to improve care through competition therefore enabling ‘best value’ for patients or taxpayers or whoever – ie us. The slick, market-oriented operators breathing down the necks of cash-strapped health trusts are having a field day.

A second rate service provided by the state as a kind of safety net for the socially excluded and those not willing or capable of exercising their choices  will probably jog along for a time but the best service, the one that will be held up at election times as epitomising the best of British, will be that which is used by the better-off and the determined or pushy.

Of the billions of pounds paid out by UK taxpayers to provide essential services much will be siphoned off to pay for outsourced services from enterprising agencies and this is a national disgrace.  

Such a trend has meant ‘putting multinational companies in the driving seat of the NHS,’ according to former health secretary Frank Dobson. He was talking about the Labour government’s push to contract out to private and third sector providers.

Health care in England is being transformed and unlike the public body that is the NHS private enterprise does not have a duty to provide a comprehensive range of services only ‘such services or facilities as it considers appropriate.’

 

Who then is making decisions about health priorities in the UK?

Circle’s profits have risen from £170.3million to £192.7million encouraging the company to build more private hospitals in England. It and Capita (the UK’s biggest outsourcing company which earns half its turnover from the public sector) expect to continue to pick up contracts from NHS trusts whose incomes are stretched to breaking point. Privatisation in England is there to stay – hospitals and clinics springing up in Cambridgeshire, Manchester, Birmingham, Bedfordshire, Nuneaton, Bath, Reading – anywhere and everywhere.

For those who judge the NHS by the state of its waiting rooms and chipped paint corridors such rampant privatisation will be just what the doctor ordered. For those who recognise that each time a contract is put out to tender and won by a company operating for profit another part of the NHS is being undermined. At some point the whole edifice will go in all but name with implications for staff as well as patients. Actually the terminology has already changed from National Health Service with all that suggests to healthcare market.

Health care is devolved thank goodness. In Scotland at present the SNP government is adamant that the structure of the NHS is safe and there are no moves into the kind of health privatisation happening in England.

I don’t think we should be complacent however. Scotland has seen examples of reckless behaviour from Holyrood. In 2005 when Scottish Labour was in coalition with the Scottish Liberal Democrats Andy Kerr then Minister for Health and Community Care announced a Scottish Regional Treatment Centre pilot at Stracathro funded under PPI which was duly opened in a blaze of publicity in 2007 by Jack McConnell then First Minister. The white elephant of the Golden Jubilee National hospital in Clydebank also established under New Labour had to be bought by the NHS.

While both the Scottish National Party and the Green Party in Holyrood have stated opposition to any privatisation of clinical services in Scotland’s NHS  there must be a question mark over what will happen in the future if Scottish Labour and the Liberal Democrats and Tories (those two in coalition presumably) get back into power.

 http://www.keepournhspublic.com/pdf/SRTCshort.pdf

Scottish Labour and the Scottish Liberal Democrats  have been criticised for their underhand methods when it comes to privatising health care – omitting mention of it in their election manifestos.  The Labour Party, very keen on Public Private Initiates, did include references to mixing private and public health care in its Westminster manifesto of 2005 – all in the guise of providing better, ‘more quality healthcare’ to ‘expand provision’ and ‘reduce waiting times’ but there was nothing in its Scottish manifesto before setting up the pilot at Stracathro and the National Waiting Times Centre later renamed Golden Jubilee National hospital –  all £180million of it built in 1994 and having consequently failed, bought by the public purse as an NHS hospital in 2002.

John Reid one-time Health Secretary at Westminster under Tony Blair tried to persuade Scots the ‘the medical market place’ was the way to go. Reid would no doubt welcome chief executive of LaingBusiness (a so-called healthcare intelligence company) William Laing’s observation that Circle’s success is ‘significant for all private sector providers to the NHS.

There doesn’t seem any way back for the NHS in England but here in Scotland we have a chance to hold onto what has proved an excellent provision for the past 60 plus years. Voting no in the referendum will put Scotland’s NHS at risk of going the way of England’s. It’s time for people to wake up to the real danger of losing this brilliant health service.

A positive vote for independence is the only chance we have to retain our universal health service, free at the point of use. Use your vote well.

March 2, 2014

Granny’s heilan’ hame and expat Scots: Ian Jack and his friendly union

The impending independence referendum is now clarifying the thoughts of quite a few expat Scots over their relationship with Scotland.   saltire

‘All the best folk have left’ was Ian Jack’s father’s conclusion on the drift into England from Scotland, of which he was part, as economic migrants seeking a more prosperous future for their families. In his column Ian Jack (Guardian 1 March 2014) reflects on where independence would leave people like him were Scotland to cast off its dependency reputation and take up its place in the world as a thriving independent nation.

Jack is in melancholic mood. He reminds us his father’s view was shared by the poet Edwin Muir who wrote in 1935 of the impact of mass migration out of Scotland then emptied of, ‘ its spirit, its wealth, industry, art, intellect and innate character.’ This was of course in the hungry thirties when jobs were scarce throughout most of Britain.  But Muir concluded dolefully that this led to ‘the increasing centralisation of all vital energies in London’ which turned Scotland ‘into a country where ‘meaninglessness and despondency hangs round.’

This all begs the question that if people were compelled to leave to improve their lot what does this say about the success of such a Union?

And what does it say about those who left for work and opportunity – who held such self-preening opinions? Were they the best? Do they consider themselves better than Scots who chose to stay and  invest their futures in with Scotland’s? Are we who have remained the dregs of a dead culture?

Jack writes of friendship between England and Scotland as if that would be broken by Scotland becoming a more confident and prosperous neighbour. This friendship we are told enabled Britain to become the economic powerhouse it undoubtedly was, through the fusion of the intellects of both Scotland and England and that this friendship gave us great institutions such as the British Museum, the British Linen Bank and the BBC. Jack marvels at the British Museum collections, rightly, which are available free to all and sundry. True except that such enthusiasm should be qualified for it is not free access to me or anyone in Scotland as it cost hundreds of pounds to get to it in the first place. So while I am pleased that Jack can visit often and it costs him nothing I feel no affinity for the collections, they might as well be housed in Beijing as London. Personally I would prefer if the British Museum had been built in Aberdeen.

Curiously when Jack refers to the heights of achievement of the Union’s pooled intellects during the 18th and 19th centuries he omits that other major institution, the British Empire. Perhaps it doesn’t fit in with his gilded message. Instead we are steered towards London, to  gawp at this marvellous creation that is the ‘world’s greatest trading city’ but which from this side of the border looks like a giant drain into which eye-watering amount of wealth flow at the expense of almost everywhere else in these islands.

The golden age of the Enlightenment Jack hints might not have happened were it not for the Union which enabled intercourse between Jocks and, well what is the derogatory term for ‘the English’? This is of course that same period when Scottish intellectuals were ridiculed and mocked in England for their coarse way of speaking, their curious accents and quaint vocabulary. And irrespective of this the roots of the Enlightenment are pre-1707, growing as they did from the distinctive Scottish Presbyterian Kirk. So irrespective of a political union the Enlightenment, with all that conjures up, would have occurred here in Scotland.

There appears to be growing awkwardness, a sense of incomprehension among some expat Scots over how much Scotland has changed in recent years. They desperately cling onto their fond remembrances of the old country, taking subscriptions to the Sunday Post, attending classes in  Scottish country dancing and raising a nip glass to the Bard each year and perhaps like Jack fondly recalling rail journey’s north from their homes in England, on trains puffing clouds of white smoke (I only remember the soot that blew in open windows) as it chug chugs across Scotland’s barren heather muirs in search of granny’s heilan’ hame or a weekend but ‘n’ ben.  Those with such views have only misplaced sentimentality to offer and that is never going to enrich the minds and bodies of Scotland’s children or take care of our elderly population.

The reality is that Scotland has outgrown the Union. The drab arguments of BetterTogether hark back to the past viewed through rose-tinted spectacles. If the past was so great in the Union that formed the United Kingdom why did so many of ‘the best folk’ like Jack’s father, as he would have us believe, feel compelled to leave their homeland to evade poverty and lack of opportunities? Some golden age that.

I don’t doubt Jack feels confused and regards the prospect of an independent Scotland with ‘a personal sense of loss’ but then he lives in England whereas those who chose to stay and develop Scotland’s economy and society and retain what is distinctly Scottish, our strong sense of collective, will suffer no loss but will grasp out future with both hands.

We cannot live in the past. We owe it to our children and grandchildren and the generation of Scots yet unborn to provide them with a sustainable future so that they do not have to run away to make a living. For all the Jacks out there it is a pathetic outlook that expects the old country to remain set in aspic, just so they can venture north for an occasional holiday at home or that our rural areas should continue to be cleared of people to preserve them as playgrounds for the huntin’, shootin’ and fishin’  brigade.

We who live in Scotland in the here and now don’t inhabit granny’s heilan’ hame or a wee but ‘n’ ben and we don’t exist in some Scotch misty- eyed Brigadoon – we live in an industrial age, sustained by the dynamics of fossil fuel extraction, agriculture and a future in renewable energies that will transform the lives of our children.

The Union was unpopular when it was formed back in 1707 but came to be accepted by most in Scotland, especially the ones who benefitted economically from it, but there has always been disquiet about the impact it had on the life and culture and yes, economy of Scotland.

Times change – England is changing and is becoming a less tolerant place. In England the NHS is under major threat and more and more we are finding that the differences between our two societies is growing ever greater.  Much has been written about the collective nature of attitudes in Scotland – because it is true. Scots are looking to the future to create a fairer and more equal society which must start with Scotland having its own voice in the world and not being a mere echo of the London-based political establishment that looks after itself first and foremost.

None of the main political parties run from England can offer us anything that is in any way good enough. The alignment of attitudes so long assumed by these parties are thankfully dissolving.  

As happy as Jack’s folks were to cross the border to improve their lives what they did should not be regarded as something positive – the notion of the ambitious Scot ready to get on his/her bike  but an indictment on the Union which sacrificed Scotland to the ultimate benefit of the southeast of England.

We don’t need this Union cobbled together in 1707. It’s time to dispense with the past, with the sentimentality that keeps Scotland as a dependency of its bigger neighbour. Scots will always come off second best in that contest. What we have to do is simple, to vote positively in September and if our friends and family in the south complain that we are not the place they fondly remember then I say that’s good because it means we have not in fact grown stagnant but are a dynamic and forward looking nation.

April 24, 2012

A look back at England’s green and pleasant land – and some punk rock

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