The iron lady rides again

Abstract

In a week when the Prime Minister has been deciding the fortunes of doctors is there cause for doctors to consider the wellbeing of the Prime Minister? That she is a case for clinical study there can be no doubt. Not because she is sick, but rather the opposite?her astonishing good health. On Monday next Margaret Thatcher will have been Prime Minister continuously for eight years. That is longer than any of her predecessors this century apart from Asquith, whom she will overtake in six months or so. Moreover, she seems poised for a third term and a potential span of 12 or 13 unbroken years in office. The question is not whether we can stand it but whether she can. What should be the medical advice? If it is to be based on past studies of the pathology of power then Mrs Thatcher plainly defies precedent. Case histories raise daunting questions about the state of body and mind of national leaders long before they have reached Mrs Thatcher's tenure. In the BMJ's spring books section two weeks ago Dr Hugh L'Etang reviewed the fearful record of sick men in power, including Churchill, Hitler, and Roosevelt (18 April, p 1013). Of the 18 British premiers this century perhaps only two, Alec Douglas-Home and Edward Heath, resigned in as good health as when they began?and that was thanks to their terms being prematurely cut short. Voices of experience, notably Stanley Baldwin and Robert Peel, advise that no prime minister should serve longer than five years, yet here is Margaret Thatcher heading for at least 10 and still in good shape. She is adding a new chapter to the medical study of political power. In his Anatomy of Power (1979) my late colleague, James Margach, whose experience went back to the 1920s, wrote that taken over the years the health record of prime ministers was appalling. Campbell Bannerman (1908), Bonar Law (1923), Ramsay MacDonald (1935), and Neville Chamberlain (1940) all died within weeks or months of resigning. Baldwin's apparent indolence was really nervous exhaustion. Attlee was in hospital for duodenal surgery at the time that Bevan resigned. Churchill declined with organic brain syndrome after a series of strokes, and Anthony Eden's wretched health was fearfully obvious. Harold Macmillan gave up because he believed he would not recover from prostate trouble (James Callaghan thought his career was ended for the same reason, but went on to become prime minister). The mystery of Harold Wilson's resignation is partly explained by mental and physical exhaustion at the age of 60, from which he never fully recovered. As Margach said, far too many left No 10 Downing Street physical and nervous wrecks. He added that while at No 10 they obviously aged at twice or three times the normal rate of advancing years. It is an observation that any Westminster watcher could confirm. Nor is it surprising given the demands put on all prime ministers. Other heads of government on visits to parliament are often shaken by the sight and sound of prime minister's question time. I recall Richard Nixon before he became president of the United States confessing that no American president could face up to that kind of ordeal twice a week. Given the job specification and the clear case histories available, there is good justification for every prime minister's dispatch box to carry a government health warning. Few in my experience even stick to the simple rules of health campaigns, such as the one launched by the new Health Education Authority last week. Most prime ministers do not smoke and they do go easy on alcohol, but they cannot be said to eat healthily, take exercise, or avoid stress. As medical history shows there comes a point after a few years when neurological disorders often influence decision making with historically disastrous consequences. The besetting sin of prime ministers is the tenacity with which they cling to office long after that point is reached and in some cases while suffering a fatal illness, though none has actually died in office. But now students of prime ministerial morbidity are having to reckon with the phenomenon called Margaret Thatcher. Her record of longevity in office is about to break not only this century's record but most of last century's as well. What is more, at 61 her energy and drive show no sign of slackening and she is rather more than a match for male opponents who are still in their 40s. Whatever the issues at the election, the Prime Minister's health will not be one.