". . . Have some strong beef tea made ready to give her as soon as the fever goes down. She can have the grapes now, and beef essence - and soda water and milk, and you'd better get in a bottle of brandy. The best brandy. Cheap brandy is worse than poison."
From The Railway Children by Edith Nesbit
GETTING better was once an important part of being ill. Convalescence - from the Latin valescere meaning "to grow strong" - was accepted by doctors and patients from the earliest times as a vital period of recovery following an acute illness, injury or surgery.
In parts of North Africa and Asia Minor where followers of the cult of Asclepius, the god of medicine and healing, settled, archaeologists have unearthed bronze statuettes of a smiling figure dressed in a cloak and cowl. He was, according to legend, Telesphorus, a minor deity but an important one; the god of convalescence or "he who brings to a perfect end".
It is becoming clear that this "perfect end" has no place in the future of health care in Britain. Convalescence is a word that has all but disappeared from the vocabulary of the modern health service. A survey of nursing staff last month suggested that hundreds of patients are being discharged from hospital before they are better. Bed shortages and financial constraints imposed by the new internal market were blamed.
But this is also a question of deliberate policy. The future, as described earlier this year by Virginia Bottomley, the Secretary of State for Health, involves bedless hospitals which "through-put" their patients as day cases. For patients with complications or those who cannot go home the same day, there will be "hotel" accommodation - cut-price, short-stay NHS beds, with medical staff on call nearby. "It is clearly better to be at home than in a hospital. Keeping people in hospital is costly for the NHS and inconvenient for them," Mrs Bottomley said.
She has a point. Hospitals are unhealthy places; homes are preferable - but only if patients have someone to care for them, look after their children and pets, answer the phone and deal with all the other daily pressures, with the back-up of GPs, district nurses, and social services if necessary. But few of us will ever have this luxury of care. Being at home is equated with being well, of ignoring the signs that mind and body would benefit from a period of convalescence.
Mrs Bottomley's conveyor-belt approach would, in the words of an 1867 Times leader on the importance of convalescence, "bring the poor man back from the gates of death and lead him with the utmost care over the first part of the journey, but . . . suddenly drop him at the most crucial part of the road".
Florence Nightingale could not have endorsed Mrs Bottomley's vision either. In her Notes on Hospitals in 1863 she agreed that "no patient ought ever to stay a day longer in …