“The most effective screening programme ever,” this was Richard Doll’s gentle jest when I was director of national screening programmes. Aware of my efforts to ensure that screening did much more good than harm, using every improvement technique I could learn from IHI, Toyota, and wherever, he would point out that the auscultation of the heart of young recruits in the first world war led to large numbers of them being deemed to be unfit for the front because of a sign we now know to be without pathological significance – a systolic murmur.
DAH, disorderly action of the heart, or soldiers’ heart, spared many people from being exposed to an environment where the mortality was 50% , hence Richard’s proposition, made as usual with humility and humour. The review of Ford Madox Ford’s “Good Soldier” by Theodore Dalrymple showed just how much energy these “troubled hearts” had, although many of them were crippled for life, or chose to be invalids.
Richard Doll would have enjoyed it greatly and teased me again with his reminder of “the most effective screening programme ever.”
Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.