THERE are a number of reasons which help to explain if they do not justify the conclusion that the record of the Health Service is one of progress and success. Some of the more important ones become explicable only when it is understood how far-reaching were the effects of the Second World War on the British economy. The whole fabric of organized medical care, public and private, suffered particularly. Inevitably, the highest priorities in medicine were reserved for the military and civil defence forces. Even as early as June, 1943, the standard of medical care available for the civilian population was, in the judgment of the War Cabinet, ‘dangerously low’. By the end of the war, the ranks of the general practitioners had been depleted by over one-third; of those who remained 10 per cent were over seventy years of age, and in many industrial areas elderly doctors, educated before the First World War when general practice was little more than an empirical bedside art, were struggling with lists of 4,000 to 5,000 patients.

So far as hospital care is concerned I make only two comments. For over fifteen years from 1939 no new hospital was built in Britain. Many of the voluntary hospitals which, by 1939, were virtually bankrupt and were only saved during the war by heavy Government subsidies, faced, at the end of the war, an even more serious threat to their future. Not only were these subsidies being withdrawn but the costs (and the standards expected) of medical care in hospital were rising on an unprecedented scale. The scientific revolution in medicine, beginning in the late 1930s (some of the implications of which I shall discuss later) represented to most of the voluntary hospitals in Britain a sentence of death. Historically regarded, the first wave of applied scientific change has nearly always been economically expensive to established institutions and the voluntary hospitals, with little time in which to put their war-disorganized houses in order, found themselves in a critical situation. Unlike the position in the United States, there were few wealthy foundations to come to their rescue.