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In England Now
570
In
Letters
England Now
A
Running Commentary by Peripatetic Correspondents FOR many years the with it doctor has kept up with the literature by studying medical items in popular digest publications. More recently it has been good policy to be aware of "
"
features in the national press, often based on reports of exotic developments in foreign parts only remotely concerning the ailments we meet every day. We have also had to come to terms with entertainment programmes with a medical background, with articles in women’s magazines giving cosy advice on everything from birth-marks to the eccentricities of senility, and with postgratuate medical demonstrations on the ubiquitous screen, which may make us wonder what our patients think of us when advances in medicine have to be explained in such simple terms. A chance journey with my wife, at a time when doctors tend to be rather busy, enabled me to make the acquaintance of yet another programme, which combined all these qualities. This hour, devoted to the fair sex, included a medical section which not only told the audience how they should view a particular symptom, but also instructed the doctor on how to avoid the danger of giving outdated advice or treatment. Perhaps we must now ask our receptionists to monitor these radio transmissions. *
*
*
BREAKTHROUGH IN
FREQUENCY-AND-RESPONSE ANALYSIS The incidence or happening of fortunate events, As Biggs, A. J. in Nature 3, i, ’61 comments, Inversely is proportional in every tested field To merit or enjoyment, thereby minimising yield.
The contrapunctual thesis is investigated in A paper by J. Tompkinson (current Proc. Soc. Linn.) He purports to show that things vexatious, grim, or frightful, Have logarithmic frequency as they become more spiteful. I now wish to elucidate the interesting way These contradictory findings are resolved by factor K. Statistical analysis shows K’s effect to be Exerted to its maximum, 1/93.
K symbolises Cussedness, neglected or deplored, An all-pervading influence, a peril when ignored. " The more events turn out the way the more you wish wouldn’t." To couch it in more subtle terms " I’ve striven, yet I couldn’t ".
they
to
the Editor
THE COMMUNITY PÆDIATRICIAN
SIR,-The letters from Dr. MacGregor (Feb. 22, p. 421) and (March 1, p. 463) are welcome. There is indeed a new generation of doctors, some of them general practitioners, some of them hospital consultants, who see and practise medicine in its clinical, developmental, and social settings. With children a brief development and social assessment Dr. Kershaw
should be part of the routine examination whenever a child is seen by a doctor. Children with handicaps need more detailed developmental assessment and usually need more help from the community, and they can be identified early only by total
community screening. To meet the needs of all children we need paediatricians who clinically, developmentally, and socially aware; but, though the number of handicapped children is small, they need a great deal of time and certain special skills. I suggest that we need a doctor who will do the following: are
1. Teach pasdiatric development screening to all front-line doctors, keeping himself and them up to date, so that all children with development delay are recognised early.
2. Work in the assessment centre for handicapped children as a clinical specialist in the difficult art of detailed developmental and social screening of handicapped children. 3. Work in the assessment centre with the paediatrician or paediatric neurologist to plan the best care of the handicapped child and mobilise community services such as the home help and special-care day nursery-for the child and his family. 4. Maintain the community’s observation register of handicapped children, keeping in touch with them in their homes and in their day nurseries or schools, and taking responsibility for their follow-up.
The hospital paediatrician has community responsibilities, and so has the doctor described; both are community peediatricians. The predominant concern of this doctor is with advanced levels of developmental screening and the more social aspects of the care of the handicapped child. The contribution of the paediatrician is specialised knowledge of diagnosis and treatment. Working together, both will gain something of each other’s special knowledge. Diagnosis of neuro-development disorder in infancy is so largely dependent on a knowledge of development as well as of neurology that no paediatrician working in this specialty can possibly have his attention diverted from development. It seems to me logical that the doctor described would be a senior member of the local-authority medical service, especially since his work would be intimately related to the child-welfare and school-health services. Newcomen
Clinic, Guy’s Hospital,
Recording learned instances needs four to form a series. Three are mere coincidence " provoking caustic queries. By those who grace the M.R.C., I’ve often heard it said,
London S.E.1.
RONALD MAC KEITH.
"
The first three you’re dead.
come two
weeks apart, the fourth
one
when
MENTAL-HOSPITAL ADMINISTRATION
Sailors and pathologists well recognise the way, When wind is right and tide is right, it isn’t your half-day. Or if it is, the coroner subserves K factor function And times his court for half-past three which puts you up the junction. The patient you recall with shame-the mem’ry haunts you stillProclaims your sterling qualities and puts you in his will. The one you salvaged from the brink (sublime self-
satisfaction) Accuses you of negligence and threatens
legal
action.
Whatever realm
or incident, K’s influence applies. technocrat, you’ll watch it if you’re wise. All the world’s a stage my friend; I’ve been a modest actor,
Boffin,
sage,
But now I’ll factor.
or
storm
the halls of fame with Larkin’s cussed
SIR,—The letter from Dr. Barton and Dr. Bickford (March 1,
466) makes gloomy reading. It is sad to see those whom one previously regarded as progressives putting forward such negative views. They assume that democracy will inevitably lead to the " electors " choosing the worst candidates, and have so little confidence in their own profession that they are reduced to advocating naked paternalism with father unchallenged and unchangeable. Many mental hospitals can be regarded as the last strongholds of the feudal system, and it is p.
has
this that Dr. Barton and Dr. Bickford seem to wish to perpetuate, not necessarily because they want to remain as lords of the manor, but because they fear the effects of democratising mental hospitals. That there are dangers in this is true, but there are also great possibilities in a democracy for harnessing the latent skills of all staff, medical, nursing and social workers, and patients, and of replacing individual leadership by multiple
leadership.
In
Letters
England Now
A
Running Commentary by Peripatetic Correspondents FOR many years the with it doctor has kept up with the literature by studying medical items in popular digest publications. More recently it has been good policy to be aware of "
"
features in the national press, often based on reports of exotic developments in foreign parts only remotely concerning the ailments we meet every day. We have also had to come to terms with entertainment programmes with a medical background, with articles in women’s magazines giving cosy advice on everything from birth-marks to the eccentricities of senility, and with postgratuate medical demonstrations on the ubiquitous screen, which may make us wonder what our patients think of us when advances in medicine have to be explained in such simple terms. A chance journey with my wife, at a time when doctors tend to be rather busy, enabled me to make the acquaintance of yet another programme, which combined all these qualities. This hour, devoted to the fair sex, included a medical section which not only told the audience how they should view a particular symptom, but also instructed the doctor on how to avoid the danger of giving outdated advice or treatment. Perhaps we must now ask our receptionists to monitor these radio transmissions. *
*
*
BREAKTHROUGH IN
FREQUENCY-AND-RESPONSE ANALYSIS The incidence or happening of fortunate events, As Biggs, A. J. in Nature 3, i, ’61 comments, Inversely is proportional in every tested field To merit or enjoyment, thereby minimising yield.
The contrapunctual thesis is investigated in A paper by J. Tompkinson (current Proc. Soc. Linn.) He purports to show that things vexatious, grim, or frightful, Have logarithmic frequency as they become more spiteful. I now wish to elucidate the interesting way These contradictory findings are resolved by factor K. Statistical analysis shows K’s effect to be Exerted to its maximum, 1/93.
K symbolises Cussedness, neglected or deplored, An all-pervading influence, a peril when ignored. " The more events turn out the way the more you wish wouldn’t." To couch it in more subtle terms " I’ve striven, yet I couldn’t ".
they
to
the Editor
THE COMMUNITY PÆDIATRICIAN
SIR,-The letters from Dr. MacGregor (Feb. 22, p. 421) and (March 1, p. 463) are welcome. There is indeed a new generation of doctors, some of them general practitioners, some of them hospital consultants, who see and practise medicine in its clinical, developmental, and social settings. With children a brief development and social assessment Dr. Kershaw
should be part of the routine examination whenever a child is seen by a doctor. Children with handicaps need more detailed developmental assessment and usually need more help from the community, and they can be identified early only by total
community screening. To meet the needs of all children we need paediatricians who clinically, developmentally, and socially aware; but, though the number of handicapped children is small, they need a great deal of time and certain special skills. I suggest that we need a doctor who will do the following: are
1. Teach pasdiatric development screening to all front-line doctors, keeping himself and them up to date, so that all children with development delay are recognised early.
2. Work in the assessment centre for handicapped children as a clinical specialist in the difficult art of detailed developmental and social screening of handicapped children. 3. Work in the assessment centre with the paediatrician or paediatric neurologist to plan the best care of the handicapped child and mobilise community services such as the home help and special-care day nursery-for the child and his family. 4. Maintain the community’s observation register of handicapped children, keeping in touch with them in their homes and in their day nurseries or schools, and taking responsibility for their follow-up.
The hospital paediatrician has community responsibilities, and so has the doctor described; both are community peediatricians. The predominant concern of this doctor is with advanced levels of developmental screening and the more social aspects of the care of the handicapped child. The contribution of the paediatrician is specialised knowledge of diagnosis and treatment. Working together, both will gain something of each other’s special knowledge. Diagnosis of neuro-development disorder in infancy is so largely dependent on a knowledge of development as well as of neurology that no paediatrician working in this specialty can possibly have his attention diverted from development. It seems to me logical that the doctor described would be a senior member of the local-authority medical service, especially since his work would be intimately related to the child-welfare and school-health services. Newcomen
Clinic, Guy’s Hospital,
Recording learned instances needs four to form a series. Three are mere coincidence " provoking caustic queries. By those who grace the M.R.C., I’ve often heard it said,
London S.E.1.
RONALD MAC KEITH.
"
The first three you’re dead.
come two
weeks apart, the fourth
one
when
MENTAL-HOSPITAL ADMINISTRATION
Sailors and pathologists well recognise the way, When wind is right and tide is right, it isn’t your half-day. Or if it is, the coroner subserves K factor function And times his court for half-past three which puts you up the junction. The patient you recall with shame-the mem’ry haunts you stillProclaims your sterling qualities and puts you in his will. The one you salvaged from the brink (sublime self-
satisfaction) Accuses you of negligence and threatens
legal
action.
Whatever realm
or incident, K’s influence applies. technocrat, you’ll watch it if you’re wise. All the world’s a stage my friend; I’ve been a modest actor,
Boffin,
sage,
But now I’ll factor.
or
storm
the halls of fame with Larkin’s cussed
SIR,—The letter from Dr. Barton and Dr. Bickford (March 1,
466) makes gloomy reading. It is sad to see those whom one previously regarded as progressives putting forward such negative views. They assume that democracy will inevitably lead to the " electors " choosing the worst candidates, and have so little confidence in their own profession that they are reduced to advocating naked paternalism with father unchallenged and unchangeable. Many mental hospitals can be regarded as the last strongholds of the feudal system, and it is p.
has
this that Dr. Barton and Dr. Bickford seem to wish to perpetuate, not necessarily because they want to remain as lords of the manor, but because they fear the effects of democratising mental hospitals. That there are dangers in this is true, but there are also great possibilities in a democracy for harnessing the latent skills of all staff, medical, nursing and social workers, and patients, and of replacing individual leadership by multiple
leadership.