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HOSPITALS IN SCANDINAVIA
207 HOSPITALS IN SCANDINAVIA
the newly admitted patient embarks for subsequent transport to the ward. Indeed, Swedish patients submit to elusive than THE Philosopher’s the best way of planning a hospital-or a hospital service. a rugged discipline; their luggage and clothes are removed The ideal in hospital design, provision of beds, and deploy- for central storage, and they are issued with hospital pyjamas and dressing-gowns. ment of specialties is far from being agreed. Scandinavians In design and equipment, the main difference between have a reputation for both administration and design, and Scandinavia and Britain seems to be that what is theory it is very interesting to have an account1 of a tour of hospitals in Norway, Sweden, Denmark, and Finland by a here has been put into practice there. So much in our medical administrator and an architect from the New- hospitals reflects our capacity for knowing what should be castle Regional Hospital Board-Dr. Stewart, the senior done and yet not doing it. Perhaps this report will be an inducement to some useful changes, not only in the administrative medical officer, and Mr. Pallister. Newcastle Of the four countries, Finland alone lays responsibility region but also elsewhere. for building new general hospitals on the central Government ; in the other three, the initiative lies with the local LUMPS IN THE LIVER authorities, while the Government exercises sanctions by DEMONSTRATIONS of affection by a properly responsive giving or withholding financial aid. In Stewart and are gratifying to its master-despite the growing dog lack Pallister’s view, this of positive central direction leads realisation that a gift of canine parasites may be included. to over-provision in cities and centres, at the expense of The dog tongue worm, Linguatula serrata, and round outlying districts. Moreover, the idea of a single hospital service has yet to be accepted: even in Finland, where worm, Toxocara canis, are two species liable to be transcentralisation is most advanced, there are separate plans ferred to man in the course of a friendly lick. The former for the development of general, mental, and tuberculosis lives in the paranasal sinuses of the animal and sheds its hospitals. Such fragmentation can be wasteful, since one ova into the nasal secretions. In a state of nature, contype of hospital may be crowded while there are beds to tamination of pasture then leads to ingestion of the ova by a herbivorous animal, the intermediate host, in whose spare in another. The trend, however, is towards regional hospitals of a general and comprehensive type, with gut the larvse hatch. Penetration of the bowel wall and visceral dissemination follow, the larvae finally encysting specialist units in the main centres only. In all four countries, some form of health insurance in liver, spleen, or mesenteries. Development into the operates. Generally speaking, inpatient treatment is free; adult worm depends on the larva reaching the nose of but the patient pays at least a proportion of the cost of the definitive host, and this becomes possible when a dog outpatient consultation, and he pays for the services of his eats the infected carcass. Domesticity introduces man general practitioner. In Sweden, general and hospital as an alternative to the herbivore, although the life-cycle practice are completely divorced from each other. By is broken and the larvx eventually perish in their uncontrast, in the country districts of Norway and Finland, natural environment. Hitherto, their presence has not the same doctor is often responsible for general practice, been thought to trouble the human host: no symptoms hospital practice, and public health. Throughout Scan- have been attributed to the infestation and no eosinophilia dinavia, outpatient and inpatient services tend to be demonstrated-even when larva: have been recovered strictly separate: the consultants who see a patient in the from the liver. Toxocara canis, on the other hand, can outpatient department are not usually those who will care cause trouble in children. The larvae are widely disfor him after admission. Outpatient consultation after seminated and have given rise to endophthalmitis and referral by a general practitioner is much less common retinal granulomas which have been mistaken for than in this country. But the role of the hospitals is seen malignant tumours.1 Now Drury2 has suggested that the recognition of increasingly as extending into the community: in Maimo, for example, home care of sick old people is undertaken by linguatulid infestation in man is of more than academic interest and that the condition is commoner in this the hospital service. As in Britain, administrators in Scandinavia take an country than is generally believed. He describes 3 cases almost excessive interest in numbers of beds. In Sweden in which single larval nodules were found in the liver at there are at present about 15 hospital beds per 1000 of the laparotomy, and a 4th where multiple nodules were population; this compares with 8-4 in Finland, 9-7 in discovered. Each was whitish, small, smooth, and firm, Norway, 12-1 in Denmark, and 10-4 in England and and was situated in, rather than under, the capsule of Wales. But in terms of service these figures mean little; the liver. Histological examination revealed whorls of in Sweden, for instance, the acute shortage of nurses hyaline fibrous tissue around a central cavity, with very commonly necessitates closure of wards. Yet Swedish little cellular reaction. In 1 case the cavity, like the planners, although adept at assessing future needs from linguatulid larva, was crescentic, and in 2 the source of statistical trends, are still apt to equate expansion of the parasitic debris could be identified as linguatulid; in the hospital service with more beds, rather than with more 4th case the central debris was amorphous and calcified, and its origin could not be determined. Drury maintains efficient use of existing beds. that, although histological examination is needed to In Scandinavia, Stewart and Pallister say, the 800-bed that a hepatic nodule is a larval granuloma, a confirm hospital is generally accepted as the most economic and wieldy unit. Centralisation of non-nursing procedures presumptive diagnosis can be made at laparotomy from is the guiding principle of design. " Central bed prepara- its macroscopic appearance-provided the possibility of tion has been introduced: after patients’ discharge, beds parasitic infestation is borne in mind. Recognition of larval nodules is important where there is a question of are cleaned and remade in a single department, and there metastatic carcinoma (as in 2 of his 4 cases) and may 1. Stewart, R. H. M., Pallister, L. K. Report on a Tour of Hospitals in Scandinavia (including Finland) made under the auspices of the World determine whether radical surgery is undertaken. Drury Stone
was never more
"
Health Organisation. 1962. Copies are obtainable from Dr. Stewart at the offices of the Newcastle Regional Hospital Board, Benfield Road, Walker Gate, Newcastle upon Tyne, 6.
1. Lancet, 1962, i, 35. 2, Drury, R. A. B. Gut, 1962, 3, 289.
the newly admitted patient embarks for subsequent transport to the ward. Indeed, Swedish patients submit to elusive than THE Philosopher’s the best way of planning a hospital-or a hospital service. a rugged discipline; their luggage and clothes are removed The ideal in hospital design, provision of beds, and deploy- for central storage, and they are issued with hospital pyjamas and dressing-gowns. ment of specialties is far from being agreed. Scandinavians In design and equipment, the main difference between have a reputation for both administration and design, and Scandinavia and Britain seems to be that what is theory it is very interesting to have an account1 of a tour of hospitals in Norway, Sweden, Denmark, and Finland by a here has been put into practice there. So much in our medical administrator and an architect from the New- hospitals reflects our capacity for knowing what should be castle Regional Hospital Board-Dr. Stewart, the senior done and yet not doing it. Perhaps this report will be an inducement to some useful changes, not only in the administrative medical officer, and Mr. Pallister. Newcastle Of the four countries, Finland alone lays responsibility region but also elsewhere. for building new general hospitals on the central Government ; in the other three, the initiative lies with the local LUMPS IN THE LIVER authorities, while the Government exercises sanctions by DEMONSTRATIONS of affection by a properly responsive giving or withholding financial aid. In Stewart and are gratifying to its master-despite the growing dog lack Pallister’s view, this of positive central direction leads realisation that a gift of canine parasites may be included. to over-provision in cities and centres, at the expense of The dog tongue worm, Linguatula serrata, and round outlying districts. Moreover, the idea of a single hospital service has yet to be accepted: even in Finland, where worm, Toxocara canis, are two species liable to be transcentralisation is most advanced, there are separate plans ferred to man in the course of a friendly lick. The former for the development of general, mental, and tuberculosis lives in the paranasal sinuses of the animal and sheds its hospitals. Such fragmentation can be wasteful, since one ova into the nasal secretions. In a state of nature, contype of hospital may be crowded while there are beds to tamination of pasture then leads to ingestion of the ova by a herbivorous animal, the intermediate host, in whose spare in another. The trend, however, is towards regional hospitals of a general and comprehensive type, with gut the larvse hatch. Penetration of the bowel wall and visceral dissemination follow, the larvae finally encysting specialist units in the main centres only. In all four countries, some form of health insurance in liver, spleen, or mesenteries. Development into the operates. Generally speaking, inpatient treatment is free; adult worm depends on the larva reaching the nose of but the patient pays at least a proportion of the cost of the definitive host, and this becomes possible when a dog outpatient consultation, and he pays for the services of his eats the infected carcass. Domesticity introduces man general practitioner. In Sweden, general and hospital as an alternative to the herbivore, although the life-cycle practice are completely divorced from each other. By is broken and the larvx eventually perish in their uncontrast, in the country districts of Norway and Finland, natural environment. Hitherto, their presence has not the same doctor is often responsible for general practice, been thought to trouble the human host: no symptoms hospital practice, and public health. Throughout Scan- have been attributed to the infestation and no eosinophilia dinavia, outpatient and inpatient services tend to be demonstrated-even when larva: have been recovered strictly separate: the consultants who see a patient in the from the liver. Toxocara canis, on the other hand, can outpatient department are not usually those who will care cause trouble in children. The larvae are widely disfor him after admission. Outpatient consultation after seminated and have given rise to endophthalmitis and referral by a general practitioner is much less common retinal granulomas which have been mistaken for than in this country. But the role of the hospitals is seen malignant tumours.1 Now Drury2 has suggested that the recognition of increasingly as extending into the community: in Maimo, for example, home care of sick old people is undertaken by linguatulid infestation in man is of more than academic interest and that the condition is commoner in this the hospital service. As in Britain, administrators in Scandinavia take an country than is generally believed. He describes 3 cases almost excessive interest in numbers of beds. In Sweden in which single larval nodules were found in the liver at there are at present about 15 hospital beds per 1000 of the laparotomy, and a 4th where multiple nodules were population; this compares with 8-4 in Finland, 9-7 in discovered. Each was whitish, small, smooth, and firm, Norway, 12-1 in Denmark, and 10-4 in England and and was situated in, rather than under, the capsule of Wales. But in terms of service these figures mean little; the liver. Histological examination revealed whorls of in Sweden, for instance, the acute shortage of nurses hyaline fibrous tissue around a central cavity, with very commonly necessitates closure of wards. Yet Swedish little cellular reaction. In 1 case the cavity, like the planners, although adept at assessing future needs from linguatulid larva, was crescentic, and in 2 the source of statistical trends, are still apt to equate expansion of the parasitic debris could be identified as linguatulid; in the hospital service with more beds, rather than with more 4th case the central debris was amorphous and calcified, and its origin could not be determined. Drury maintains efficient use of existing beds. that, although histological examination is needed to In Scandinavia, Stewart and Pallister say, the 800-bed that a hepatic nodule is a larval granuloma, a confirm hospital is generally accepted as the most economic and wieldy unit. Centralisation of non-nursing procedures presumptive diagnosis can be made at laparotomy from is the guiding principle of design. " Central bed prepara- its macroscopic appearance-provided the possibility of tion has been introduced: after patients’ discharge, beds parasitic infestation is borne in mind. Recognition of larval nodules is important where there is a question of are cleaned and remade in a single department, and there metastatic carcinoma (as in 2 of his 4 cases) and may 1. Stewart, R. H. M., Pallister, L. K. Report on a Tour of Hospitals in Scandinavia (including Finland) made under the auspices of the World determine whether radical surgery is undertaken. Drury Stone
was never more
"
Health Organisation. 1962. Copies are obtainable from Dr. Stewart at the offices of the Newcastle Regional Hospital Board, Benfield Road, Walker Gate, Newcastle upon Tyne, 6.
1. Lancet, 1962, i, 35. 2, Drury, R. A. B. Gut, 1962, 3, 289.