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A REST FROM INDUSTRY
607
Reconstruction FROM INDUSTRY workers in industry often follows The quiet sensible man, after common patterns. twenty years of steady service, may become depressed, bewildered, unable to concentrate or to complete his REST
A
BREAKDOWN
among
ordinary day’s work ; the young man or ning to take responsibility may be overwhelmed by domestic or emotional disasters ;
the
energetic
woman
begin-
of treatment to make sure that on discharge the patient will return to surroundings and a job which will help to consolidate his recovery : it would be pointless to send him back to working conditions under which he would break down again. The average stay of patients is about 6 weeks ; they take a planned course of treatment in which their time is fully occupied. A good part of every day is spent in the occupational workshops and in physical
methodical
may develop oband for others life is
middle-aged secretary
sessional fears ; spoiled by morbid anxiety.
These people serious problem for the industrial doctor. He may feel sure that given time and opportunity most of them will recover, but it may not be easy for the firm to spare them for long without replacing them, their home surroundings may not favour recovery, and they may be unable to get treatment which would hasten it. Two years ago the National Council for the Rehabilitation of Industrial Workers appealed to employers to establish a model reablement centre for the investigation and treatment of such patients, and any others whose standard of health was below normal. Many contributed, and the substantial fund raised was used to purchase Roffey Park, a large Sussex house built in the ’twenties and standing in fine grounds. An executive committee was set up under the chairmanship of Lord Horder, and the vice-chairmanship of Mr. Samuel Courtauld, who have been active promoters of the whole plan. Essential alterations were carried out as soon as labour could be found, and the centre was opened on June 1, 1944. By the end of that year 200 men and 230 women had been treated, and there is now accommodation for 106 patients. A party of industrial medical officers and other interested doctors who visited the centre on Sept. 22 were able to see the buildings and equipment, and the patients engaged in their usual activities. On admission patients are investigated medically and psychologically, any necessary X-ray and laboratory examinations being carried out with the help of Horsham Hospital. Sometimes a listless young woman is found to have tuberculosis, sometimes a patient with a physical symptom proves to have a troubled mind. It seems likely that many of the patients would not have needed treatment if their abilities and environmental needs had been properly assessed when they started work. Dr. T. M. Ling, the medical director, regards it as part are
often
a
Brains Trust.
Since their physique and nutrition are seldom first-class on admission, they are fed abundantly, rations being supplemented with vegetables and fruit from the gardens. Salads appear at the two main meals of the day and are received with growing approval. Even on Christmas day the patients themselves insisted that a salad should be added to the traditional dinner. A dietitian has charge of the dining-room, kitchen, and all the catering. Patients help the resident horticulturalist and all share in the, work of the centre, keeping their own rooms tidy and helping in the kitchen and dining-room. A patients’ committee meets each week to plan social activities and to make suggestions to the medical director and staff. In the workshops, supervised by experts, the machines are well kept and are used for making needed equipment ; the carpenter’s shop, besides making such things as bookcases and bed-tables, turns -out solid toys which are either used in the day nursery attached to the centre, or sold to visitors. The day nursery is maintained for the children of members of the staff, and the
training.
women
patients spend part
of their time
with the children. They also have their own workroom, for needlework and handicrafts, housed in a large army hut, one side of which can be fully opened in fine weather. In the main building patients have a dance-room, which can also be used for physical training, and handsome commonrooms ; the men’s common-room, panelled in modern linenfold, has a Grinling Gibbons mantelpiece. The pictures are reproductions from the works of great ancients and moderns, and the library is made up of books chosen by patients. Each bedroom takes three or four patients ; the beds are easy, their covers made in light colours. The long diningroom has two good murals, one by a Belgian artist, the other by two patients who had not tried that kind of thing before but had an undoubted turn for it. Staff and patients eat together and the food is the same for all.
Though they In the
workshops.
rooms,
the
have
sexes
are
separate commonnot kept apart.
608
They work together during the day and relax together in the evenings, and these evening gatherings are an important part of their community life. They include brains trusts, programmes of music, film shows, CEMA concerts, mock trials, debates, talks from informed’ guests, and a weekly dance. Modern psychotherapeutic methods are used when necessary ; electric convulsant therapy, given at the centre itself, has shortened the course of mental disorder in some patients ; four were recommended for prefrontal leucotomy and sent to hospital for the operation ; they have done well, one of them making an exceptionally good recovery. A follow-up of the first 200 patients showed that six months after discharge 82% were well and doing full-time work-a high proportion considering the types of cases treated. THE NURSING STAFF
The democratic atmosphere of the centre has penetrated to a most unusual quarter-the nurses’ home. This is a separate building and is occupied not merely by the nurses but by all resident members of the staff. Doctors, nurses, and secretaries when off duty share the same dining-table. Every nurse’s room is her own ; she can arrange it as she likes, keep it as untidy-or tidyas she likes, smoke in it as much as she likes. She can also go out and come in when she likes. This hostel is run by a housekeeper-hostess without nursing training. All the nurses are State-registered, and they usually come for a year to gain experience in this specialised branch of nursing. The matron finds no difficulty in getting staff. She herself is qualified in general, industrial, and mental
nursing. ADMISSION
,
Cases are referred to the centre by the firms associated with its foundation, by local authorities, and by voluntary hospitals ; industrial doctors send a few, but they are using this. opportunity as fully as they might. Some patients are admitted on the recommendation of their private doctors. The fees of 4l guineas a week are met in various ways, sometimes by the Hospital Saving Association or the Hospital Saturday Fund, sometimes by local authorities or the patient’s employers. Patients are drawn from among managers, secretaries, and accountants, as well as from those who earn their living with their hands ; and this mixing of people from a wide range of economic and social backgrounds has never presented any difficulties ; it has, in fact, benefited both patient and community. About 150 personnel managers and nearly 100 doctors visited Roffey Park in 1944, and day training courses in industrial health were arranged. It is hoped in the future to develop resident training courses.
still not
On Active Service
In A
England
Running Commentary by Peripatetic Correspondents
HONG KONG struggles slowly back to life. The first glimpse of it from the air showed little obvious damage, and in fact the damage due to enemy action is slight. But when one walks about the streets one realises what looting means. I had always thought of looting as a kind of petty larceny-the brick through a window and the snatched ring sort of thing-but the looting here was done in the grand manner. A looted house has four walls left ; roof, ceilings, floors, windows, doors, and stairs are pulled off, hacked out, and carted away ; no scrap of woodwork is left and the shell is scraped clean. There The Peak is dotted with are streets full of these shells. them. I took one glance at my old house and walked on. The hospitals seem to have suffered less, because the Japanese took them over early and used them as hospitals. They were filthy and neglected, but they could be and are being restored. My room had one thing in it -a slide cabinet with its 20 trays of slides intact and even notes in the hated language ! Books, records, photographs, MSS were all carefully destroyed, but curiously enough many of the University Library books have survived, especially the technical and scientific ones. Power has come back with the arrival of coal, and lifts and lights now work. So do the trams, but buses are only running on a very restricted scale and the ferry service is abominable. Transport is one of the great difficulties at the moment. Food is going to be scarce this winter, and it is difficult to make certain of getting things if you live in a private house. Being billeted in an hotel and fed on Army rations seems the only practicable way of existing. The people are slowly returningabout 1000 a day from the interior-and there is much more life in the streets now than when I arrived 5 days ago, though they are still patrolled by armed pickets. Every day I meet men I taught coming back from the interior, and one of my old HPs lunched with me today He gave me a fascinating account of 3 k years of imprisonment. An epidemic of gravis diphtheria broke out in the camp in 1943. The victims died like flies and the Japs refused to recognise the disease and supply serum. Finally they produced a niggardly supply, and although the dosage was perforce small, the results were dramatically successful, and no case which received serum died. They also had a mild epidemic of dysentery, probably a Sonne infection ; but mild though it was the disease carried off quite a number of the half-starved prisoners. And, of course, there were many forms of deficiency disease, ranging from frank beriberi, usually of the dry type, to the ariboflavinosis syndrome with scrotal eczema, cheilitis, and retrobulbar neuritis. Most unfortunately he was not able to keep notes-he was an admirable history-taker-because they had no paper in the camp. *
CASUALTIES KILLED
Surgeon
Lieutenant C. NOLAN,
Captain
JAMES RAYMOND DUNN, MRCS,
Sii2geon
WOUNDED Lieutenant JOHN WEDGWOOD, MRCS,
RNVR ‘
DIED RAMO
RNVR
AWARDS MENTIONED IN DESPATCHES
Surgeon Lieutenant
P. H. CARDEW, MROS,RNVR RAMC -
Captain (cont.)
l4Tajors
E. M. GRIFFIN G. M. C. SMITH H. A. TucK D. J. WATERSTON,
MBE
Captains
G. M. I3AIER 1. GLTJCK
I
J. KRAUS D. T; PR1
EUGEI3IOF SOCIETY.-On Tuesday, Nov. 20, at 5.30 rM, at the rooms of the Royal Society, Burlington House, Piccadilly, London, WI, Mr. A. S. Parkes, sc D, FRS, will speak on problems of reproductive physiology.
Now
*
*
’
At this place we have a special psychiatric unit for returned prisoners of war. The lads seem to be doing well; the hospital, standing among quiet woods, seems ideal for them, and we have tried in various ways to get them back to normal mood and spirits. Besides the usual occupational therapy they work with farmers in the district, help in garages, serve in local shops, and are taken regularly by bus to a neighbou-ring technical college for courses. They even take part in running the hospital itself ; and they mix with the other patients who have come in for ordinary medical or surgical troubles. Their social life is quite lively : besides having regular cinema shows, they join in PT, have organised games, take part in musical afternoons, and have dances twice a week at which they meet the nurses and any girl friends whom the neighbourhood affords. But one of the most successful of our ventures has been a weekly paper, started by one of the doctors but edited and written by patients for patients. This periodical is called The Grapev-ine-slang for passing round the news (in all prisons and Army huts the news is passed round by the grapevine method). Articles, pictures (coloured, too !), news, comments, and poetry appear on duplicated foolscap pages, many of which bear a footnote : " The G-rapev’ine is your paper : we want your contributions." It has been a success, partly because it gives patients an outlet for grouses and grumbles. Indeed they com
Reconstruction FROM INDUSTRY workers in industry often follows The quiet sensible man, after common patterns. twenty years of steady service, may become depressed, bewildered, unable to concentrate or to complete his REST
A
BREAKDOWN
among
ordinary day’s work ; the young man or ning to take responsibility may be overwhelmed by domestic or emotional disasters ;
the
energetic
woman
begin-
of treatment to make sure that on discharge the patient will return to surroundings and a job which will help to consolidate his recovery : it would be pointless to send him back to working conditions under which he would break down again. The average stay of patients is about 6 weeks ; they take a planned course of treatment in which their time is fully occupied. A good part of every day is spent in the occupational workshops and in physical
methodical
may develop oband for others life is
middle-aged secretary
sessional fears ; spoiled by morbid anxiety.
These people serious problem for the industrial doctor. He may feel sure that given time and opportunity most of them will recover, but it may not be easy for the firm to spare them for long without replacing them, their home surroundings may not favour recovery, and they may be unable to get treatment which would hasten it. Two years ago the National Council for the Rehabilitation of Industrial Workers appealed to employers to establish a model reablement centre for the investigation and treatment of such patients, and any others whose standard of health was below normal. Many contributed, and the substantial fund raised was used to purchase Roffey Park, a large Sussex house built in the ’twenties and standing in fine grounds. An executive committee was set up under the chairmanship of Lord Horder, and the vice-chairmanship of Mr. Samuel Courtauld, who have been active promoters of the whole plan. Essential alterations were carried out as soon as labour could be found, and the centre was opened on June 1, 1944. By the end of that year 200 men and 230 women had been treated, and there is now accommodation for 106 patients. A party of industrial medical officers and other interested doctors who visited the centre on Sept. 22 were able to see the buildings and equipment, and the patients engaged in their usual activities. On admission patients are investigated medically and psychologically, any necessary X-ray and laboratory examinations being carried out with the help of Horsham Hospital. Sometimes a listless young woman is found to have tuberculosis, sometimes a patient with a physical symptom proves to have a troubled mind. It seems likely that many of the patients would not have needed treatment if their abilities and environmental needs had been properly assessed when they started work. Dr. T. M. Ling, the medical director, regards it as part are
often
a
Brains Trust.
Since their physique and nutrition are seldom first-class on admission, they are fed abundantly, rations being supplemented with vegetables and fruit from the gardens. Salads appear at the two main meals of the day and are received with growing approval. Even on Christmas day the patients themselves insisted that a salad should be added to the traditional dinner. A dietitian has charge of the dining-room, kitchen, and all the catering. Patients help the resident horticulturalist and all share in the, work of the centre, keeping their own rooms tidy and helping in the kitchen and dining-room. A patients’ committee meets each week to plan social activities and to make suggestions to the medical director and staff. In the workshops, supervised by experts, the machines are well kept and are used for making needed equipment ; the carpenter’s shop, besides making such things as bookcases and bed-tables, turns -out solid toys which are either used in the day nursery attached to the centre, or sold to visitors. The day nursery is maintained for the children of members of the staff, and the
training.
women
patients spend part
of their time
with the children. They also have their own workroom, for needlework and handicrafts, housed in a large army hut, one side of which can be fully opened in fine weather. In the main building patients have a dance-room, which can also be used for physical training, and handsome commonrooms ; the men’s common-room, panelled in modern linenfold, has a Grinling Gibbons mantelpiece. The pictures are reproductions from the works of great ancients and moderns, and the library is made up of books chosen by patients. Each bedroom takes three or four patients ; the beds are easy, their covers made in light colours. The long diningroom has two good murals, one by a Belgian artist, the other by two patients who had not tried that kind of thing before but had an undoubted turn for it. Staff and patients eat together and the food is the same for all.
Though they In the
workshops.
rooms,
the
have
sexes
are
separate commonnot kept apart.
608
They work together during the day and relax together in the evenings, and these evening gatherings are an important part of their community life. They include brains trusts, programmes of music, film shows, CEMA concerts, mock trials, debates, talks from informed’ guests, and a weekly dance. Modern psychotherapeutic methods are used when necessary ; electric convulsant therapy, given at the centre itself, has shortened the course of mental disorder in some patients ; four were recommended for prefrontal leucotomy and sent to hospital for the operation ; they have done well, one of them making an exceptionally good recovery. A follow-up of the first 200 patients showed that six months after discharge 82% were well and doing full-time work-a high proportion considering the types of cases treated. THE NURSING STAFF
The democratic atmosphere of the centre has penetrated to a most unusual quarter-the nurses’ home. This is a separate building and is occupied not merely by the nurses but by all resident members of the staff. Doctors, nurses, and secretaries when off duty share the same dining-table. Every nurse’s room is her own ; she can arrange it as she likes, keep it as untidy-or tidyas she likes, smoke in it as much as she likes. She can also go out and come in when she likes. This hostel is run by a housekeeper-hostess without nursing training. All the nurses are State-registered, and they usually come for a year to gain experience in this specialised branch of nursing. The matron finds no difficulty in getting staff. She herself is qualified in general, industrial, and mental
nursing. ADMISSION
,
Cases are referred to the centre by the firms associated with its foundation, by local authorities, and by voluntary hospitals ; industrial doctors send a few, but they are using this. opportunity as fully as they might. Some patients are admitted on the recommendation of their private doctors. The fees of 4l guineas a week are met in various ways, sometimes by the Hospital Saving Association or the Hospital Saturday Fund, sometimes by local authorities or the patient’s employers. Patients are drawn from among managers, secretaries, and accountants, as well as from those who earn their living with their hands ; and this mixing of people from a wide range of economic and social backgrounds has never presented any difficulties ; it has, in fact, benefited both patient and community. About 150 personnel managers and nearly 100 doctors visited Roffey Park in 1944, and day training courses in industrial health were arranged. It is hoped in the future to develop resident training courses.
still not
On Active Service
In A
England
Running Commentary by Peripatetic Correspondents
HONG KONG struggles slowly back to life. The first glimpse of it from the air showed little obvious damage, and in fact the damage due to enemy action is slight. But when one walks about the streets one realises what looting means. I had always thought of looting as a kind of petty larceny-the brick through a window and the snatched ring sort of thing-but the looting here was done in the grand manner. A looted house has four walls left ; roof, ceilings, floors, windows, doors, and stairs are pulled off, hacked out, and carted away ; no scrap of woodwork is left and the shell is scraped clean. There The Peak is dotted with are streets full of these shells. them. I took one glance at my old house and walked on. The hospitals seem to have suffered less, because the Japanese took them over early and used them as hospitals. They were filthy and neglected, but they could be and are being restored. My room had one thing in it -a slide cabinet with its 20 trays of slides intact and even notes in the hated language ! Books, records, photographs, MSS were all carefully destroyed, but curiously enough many of the University Library books have survived, especially the technical and scientific ones. Power has come back with the arrival of coal, and lifts and lights now work. So do the trams, but buses are only running on a very restricted scale and the ferry service is abominable. Transport is one of the great difficulties at the moment. Food is going to be scarce this winter, and it is difficult to make certain of getting things if you live in a private house. Being billeted in an hotel and fed on Army rations seems the only practicable way of existing. The people are slowly returningabout 1000 a day from the interior-and there is much more life in the streets now than when I arrived 5 days ago, though they are still patrolled by armed pickets. Every day I meet men I taught coming back from the interior, and one of my old HPs lunched with me today He gave me a fascinating account of 3 k years of imprisonment. An epidemic of gravis diphtheria broke out in the camp in 1943. The victims died like flies and the Japs refused to recognise the disease and supply serum. Finally they produced a niggardly supply, and although the dosage was perforce small, the results were dramatically successful, and no case which received serum died. They also had a mild epidemic of dysentery, probably a Sonne infection ; but mild though it was the disease carried off quite a number of the half-starved prisoners. And, of course, there were many forms of deficiency disease, ranging from frank beriberi, usually of the dry type, to the ariboflavinosis syndrome with scrotal eczema, cheilitis, and retrobulbar neuritis. Most unfortunately he was not able to keep notes-he was an admirable history-taker-because they had no paper in the camp. *
CASUALTIES KILLED
Surgeon
Lieutenant C. NOLAN,
Captain
JAMES RAYMOND DUNN, MRCS,
Sii2geon
WOUNDED Lieutenant JOHN WEDGWOOD, MRCS,
RNVR ‘
DIED RAMO
RNVR
AWARDS MENTIONED IN DESPATCHES
Surgeon Lieutenant
P. H. CARDEW, MROS,RNVR RAMC -
Captain (cont.)
l4Tajors
E. M. GRIFFIN G. M. C. SMITH H. A. TucK D. J. WATERSTON,
MBE
Captains
G. M. I3AIER 1. GLTJCK
I
J. KRAUS D. T; PR1
EUGEI3IOF SOCIETY.-On Tuesday, Nov. 20, at 5.30 rM, at the rooms of the Royal Society, Burlington House, Piccadilly, London, WI, Mr. A. S. Parkes, sc D, FRS, will speak on problems of reproductive physiology.
Now
*
*
’
At this place we have a special psychiatric unit for returned prisoners of war. The lads seem to be doing well; the hospital, standing among quiet woods, seems ideal for them, and we have tried in various ways to get them back to normal mood and spirits. Besides the usual occupational therapy they work with farmers in the district, help in garages, serve in local shops, and are taken regularly by bus to a neighbou-ring technical college for courses. They even take part in running the hospital itself ; and they mix with the other patients who have come in for ordinary medical or surgical troubles. Their social life is quite lively : besides having regular cinema shows, they join in PT, have organised games, take part in musical afternoons, and have dances twice a week at which they meet the nurses and any girl friends whom the neighbourhood affords. But one of the most successful of our ventures has been a weekly paper, started by one of the doctors but edited and written by patients for patients. This periodical is called The Grapev-ine-slang for passing round the news (in all prisons and Army huts the news is passed round by the grapevine method). Articles, pictures (coloured, too !), news, comments, and poetry appear on duplicated foolscap pages, many of which bear a footnote : " The G-rapev’ine is your paper : we want your contributions." It has been a success, partly because it gives patients an outlet for grouses and grumbles. Indeed they com