- Email: [email protected]
HOSPITAL FARMS
686 of general practitioners particluarly experienced in the work. Unfortunately this has not always worked out in practice, and for the most part it is open to any general practitioner to undertake midwifery if he so chooses. We should like to see this work restricted to keenly interested practitioner-obstetricians who, though probably with smaller lists, would continue in general work so as to remain in touch with the whole field of general practice. Family doctors not doing maternity work should refer their cases to these colleagues. A group practice would almost always include at least one practitioner-obstetrician. Future entrants to the " obstetric list " would gain their experience and qualify for admission to the list by association with practitioner-obstetricians. Where local-authority medical officers continue in the service they should be given the opportunity to conduct their midwifery practice on the same terms as general practitioners-i.e., he, or she, must be able to visit the expectant mother at home where necessary and attend the confinement in this labour-ward unit. In any maternity scheme the needs of the mother and baby are paramount. For some years now it has been our experience that mothers approach their confinement with much less fear than formerly. This is due, we feel, to over-all antenatal supervision as well as instruction in relaxation. We make a point of telling the mother, by discussion, film strips, and diagrams, as much as we think she ought to know about the course of labour and assure her that we will be with her when she needs us. All the same there remain the hazards of any normal delivery, and many mothers are aware of these. It may be said that " the only normal delivery is the absolutely normal one which has just been completed." We feel that our scheme would have a wide appeal, for the mother would know that she could be delivered in a place where all the resources of a maternity hospital were readily available should things go wrong, and yet be able to return home immediately for her subsequent care. We should like to record
our
appreciation
to Dr. R. C.
Wofinden, medical officer of health, Bristol, for his advice and constructive criticism in the
preparation
Farquharson, E. L. (1955) Lancet, ii, 517. Redman, T. F., Walker, S. C. B. (1954) Brit. med. J. ii, 41.
HOSPITAL FARMS IN his reports1 on the National Health Service accounts for 1954-55, the Comptroller and Auditor-General, Sir Frank Tribe, again refers to hospital farms and market gardens. An expert committee reviewed the farming activities of 190 hospitals with 40,000 acres of farmland acres of market gardens. They found number of instances, farming had been developed for its own sake, and the maintenance of pedigree herds and dairy farming had become a major preoccupation with some hospital authorities." In the light of the committee’s report, the Ministry of Health advised hospitals that they had no authority to run farms except in so far as they were an essential part of hospital management, and they asked hospitals to review their farms. By Oct. 31, 1955, 207 farms had been surveyed by regional boards. Decisions had been reached about the future of 126, and it had been decided that farming should cease at 47 hospitals and be reduced at a further 38, involving the disposal of 17,598 acres of land. Trading accounts for hospital farms and gardens in England and Wales in 1954-55 showed an excess of income over expenditure of £60,000. Farms showed a surplus of £140,000 and market gardens a deficiency of £80,000 (these figures do not include small market gardens). In Scotland farms recorded a net profit of over £58,000, but market gardens showed a loss of just under £10,000.
nearly 4000
that, in
a
"
Acts, 1946 to 1952, Accounts 1954-55. H.M. Stationery Office. Pp. 41. 2s. 6d. National Health Service (Scotland) Acts, 1947 to 1952, Accounts 1954-55. H.M. 1s. 9d. Office. 26. Stationery Pp.
1. National Health Service
A
England
Now
Running Commentary by Peripatetic Correspondents
ART critics have come under the brush at Burlington House this year. Sir Alfred Munnings leads the way. Besides the usual reliable na,gs from his stable, he has entered a likely outsider-his witty but good-natured satire on modern art, Docs the Subject Matter Of his circle of critics, I got the feeling that Munnings was backing the dog. Mr. A. R. Thomson urbanely offers us The Selection Committee 1955 in an entertaining and elegant crescent before a red curtain. But with Mr. Richard Eurich the gloves are off and his version of The Critics is as harsh as it is accomplished. There is no formal royal portrait of the year, and the place of honour is given to a large study of The Duke of Wellington in ducal robes. People seemed to be turning with relief from its uncertain grandeurs to the smaller portraits, such as Sir Gerald Kelly’s blue and grey picture of Sir Geoffrey Jefferson, M.S., F.R.S., who sits at ease looking out sleepily yet shrewdly from beneath heavy lids. Though Mr. A. R. Middleton Todd has painted Lord Adrian, O.M., F.R.S., in academic robes, he too sits at ease before a not too tidy bookcase, looking In Mr. Frederick over his well-known half spectacles. Hlwell’s picture. lllrs. Rosemary Adams, F.R.C.S., sits in a draped dress of rich red before a small open desk. Mr. Uric Kennington’s effective pastel of Sir Russell Brain, P.R.C.P., hangs in the select small south room. Among the sculpture there is the now almost inevitable head of The Lato Sir Alexander Fleming, F.R.S.-this time a less familiar one of him in his early 50s-and a bronze of Dr. Roger Bannister, by Josephina de Vasconcellos. Mr. Allan U. Wyon’s silver medallion will later be a suitable prize for 111eritorious anatomy students at Leeds. Sir Winston Churchill, who has been an honorary R.A. longer than he has been an honorary F,R.C.S., hws two pictures hung. including a dark but attractive interior of Sir John Latwry’s Studio. After-dinner speakers will turn with a shudder from Mr. Buskin Spear’s Unaccustomed us I am. But surely no medical dinner was ever half as horrible as this macabre postprandial occasion.
of this article.
REFERENCES
and
In
*
*
*
Now that automation is so much used in anaesthesia, occasionally able to contemplate phenomena not directly concerned with the unconscious patient in front of me. 1 havee two long orthopædic sessions each week and here some curious problems have so far eluded solution. A popular method of securing a bloodless field in limbs is to apply an Esmarch’s bandage and then to inflate a modified I
am
after which the rubber bandage is removed. On the pressure-gauge of the instrument are two " red lines at 250 and 500 mm. Hg respectively marked " arm and leg." Now why use a pressure considerably higher than the systolic blood-pressure and why use twice this pressure, on the leg ? I have posed these queries to two orthopaedie surgeons, a physicist, and a hydraulic engineer, and they all gave different answers. I pass over briefly the peculiarities of orthopods as to the time for which tourniquets or their equivalents can be applied. One is insistent that I remind him when twenty minutes have elapsed in the ease of an arm while his opposite number seems quite annoyed if I venture to remark that an hour has gone by. Even more remarkable is the attitude towards asepsis In the private wing of a London teaching hospital, if a surgeon drops an instrument it is boiled for ten minutes by the clock and handed back. If, however, an orthopaedic surgeon does the same thing in the same theatre, twenty minutes elapse. At an equally famous London teaching hospital, they boil dropped instruments for two minutes " just to make sure " as their professor of bacteriology has shown that thirty seconds is ample provided that the water in the steriliser does not go off the boil when the instrument is dropped in.
sphygmomanometer cuff, "
general
It is all very puzzling and I think that in future I must keep my mind on really simple matters of anæsthesia, such as the mode of action of chlorpromazine. *
*
*
our
appreciation
to Dr. R. C.
Wofinden, medical officer of health, Bristol, for his advice and constructive criticism in the
preparation
Farquharson, E. L. (1955) Lancet, ii, 517. Redman, T. F., Walker, S. C. B. (1954) Brit. med. J. ii, 41.
HOSPITAL FARMS IN his reports1 on the National Health Service accounts for 1954-55, the Comptroller and Auditor-General, Sir Frank Tribe, again refers to hospital farms and market gardens. An expert committee reviewed the farming activities of 190 hospitals with 40,000 acres of farmland acres of market gardens. They found number of instances, farming had been developed for its own sake, and the maintenance of pedigree herds and dairy farming had become a major preoccupation with some hospital authorities." In the light of the committee’s report, the Ministry of Health advised hospitals that they had no authority to run farms except in so far as they were an essential part of hospital management, and they asked hospitals to review their farms. By Oct. 31, 1955, 207 farms had been surveyed by regional boards. Decisions had been reached about the future of 126, and it had been decided that farming should cease at 47 hospitals and be reduced at a further 38, involving the disposal of 17,598 acres of land. Trading accounts for hospital farms and gardens in England and Wales in 1954-55 showed an excess of income over expenditure of £60,000. Farms showed a surplus of £140,000 and market gardens a deficiency of £80,000 (these figures do not include small market gardens). In Scotland farms recorded a net profit of over £58,000, but market gardens showed a loss of just under £10,000.
nearly 4000
that, in
a
"
Acts, 1946 to 1952, Accounts 1954-55. H.M. Stationery Office. Pp. 41. 2s. 6d. National Health Service (Scotland) Acts, 1947 to 1952, Accounts 1954-55. H.M. 1s. 9d. Office. 26. Stationery Pp.
1. National Health Service
A
England
Now
Running Commentary by Peripatetic Correspondents
ART critics have come under the brush at Burlington House this year. Sir Alfred Munnings leads the way. Besides the usual reliable na,gs from his stable, he has entered a likely outsider-his witty but good-natured satire on modern art, Docs the Subject Matter Of his circle of critics, I got the feeling that Munnings was backing the dog. Mr. A. R. Thomson urbanely offers us The Selection Committee 1955 in an entertaining and elegant crescent before a red curtain. But with Mr. Richard Eurich the gloves are off and his version of The Critics is as harsh as it is accomplished. There is no formal royal portrait of the year, and the place of honour is given to a large study of The Duke of Wellington in ducal robes. People seemed to be turning with relief from its uncertain grandeurs to the smaller portraits, such as Sir Gerald Kelly’s blue and grey picture of Sir Geoffrey Jefferson, M.S., F.R.S., who sits at ease looking out sleepily yet shrewdly from beneath heavy lids. Though Mr. A. R. Middleton Todd has painted Lord Adrian, O.M., F.R.S., in academic robes, he too sits at ease before a not too tidy bookcase, looking In Mr. Frederick over his well-known half spectacles. Hlwell’s picture. lllrs. Rosemary Adams, F.R.C.S., sits in a draped dress of rich red before a small open desk. Mr. Uric Kennington’s effective pastel of Sir Russell Brain, P.R.C.P., hangs in the select small south room. Among the sculpture there is the now almost inevitable head of The Lato Sir Alexander Fleming, F.R.S.-this time a less familiar one of him in his early 50s-and a bronze of Dr. Roger Bannister, by Josephina de Vasconcellos. Mr. Allan U. Wyon’s silver medallion will later be a suitable prize for 111eritorious anatomy students at Leeds. Sir Winston Churchill, who has been an honorary R.A. longer than he has been an honorary F,R.C.S., hws two pictures hung. including a dark but attractive interior of Sir John Latwry’s Studio. After-dinner speakers will turn with a shudder from Mr. Buskin Spear’s Unaccustomed us I am. But surely no medical dinner was ever half as horrible as this macabre postprandial occasion.
of this article.
REFERENCES
and
In
*
*
*
Now that automation is so much used in anaesthesia, occasionally able to contemplate phenomena not directly concerned with the unconscious patient in front of me. 1 havee two long orthopædic sessions each week and here some curious problems have so far eluded solution. A popular method of securing a bloodless field in limbs is to apply an Esmarch’s bandage and then to inflate a modified I
am
after which the rubber bandage is removed. On the pressure-gauge of the instrument are two " red lines at 250 and 500 mm. Hg respectively marked " arm and leg." Now why use a pressure considerably higher than the systolic blood-pressure and why use twice this pressure, on the leg ? I have posed these queries to two orthopaedie surgeons, a physicist, and a hydraulic engineer, and they all gave different answers. I pass over briefly the peculiarities of orthopods as to the time for which tourniquets or their equivalents can be applied. One is insistent that I remind him when twenty minutes have elapsed in the ease of an arm while his opposite number seems quite annoyed if I venture to remark that an hour has gone by. Even more remarkable is the attitude towards asepsis In the private wing of a London teaching hospital, if a surgeon drops an instrument it is boiled for ten minutes by the clock and handed back. If, however, an orthopaedic surgeon does the same thing in the same theatre, twenty minutes elapse. At an equally famous London teaching hospital, they boil dropped instruments for two minutes " just to make sure " as their professor of bacteriology has shown that thirty seconds is ample provided that the water in the steriliser does not go off the boil when the instrument is dropped in.
sphygmomanometer cuff, "
general
It is all very puzzling and I think that in future I must keep my mind on really simple matters of anæsthesia, such as the mode of action of chlorpromazine. *
*
*