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Public Health
1237
commercially impossible because of high development costs and
In
small markets. Mr. T. G. LOWDEN said that industrial accidents and accidents from other sources all received the same hospital treatment, and should all be channelled into the same accident service. He anticipated a nation-wide accident service in the reorganised Hospital Plan. Most accidents would be sent to hospitals designated for accident work, and, when special care was indicated, to central accident units. Total disability was common in minor cases; closer liaison between the accident units and the peripheral first-aid centres would ensure swift diagnosis and accurate disposal, and offer the best prospects of recovery.
Dr. C. E. WATSON discussed first-aid in industry, with special reference to coalmining. There was no excuse for complacency, for there was still much bad first-aid. Examiners were often pressed for time, were encouraged to be too charitable with their candidates, and were faced with too exhaustive a syllabus. He hoped for a revision of the standard courses of training, and for a simpler system of first-aid with a smaller number of essential procedures. These could then be applied by a larger number of trained people more promptly, and nearer to the scene of the incident. Mr. W. J. W. SHARRARD emphasised that much of the physiotherapy of twenty years ago had been valueless, and that most patients could carry out their own rehabilitation at home or at work. Rehabilitation centres had to be associated with the work to which the patients were expected to return, and had to concentrate on those unable to achieve this themselves. He referred particularly to the ones who would not, rather than could not, and stressed that the most important factor in rehabilitation was the financial incentive of returning to work. Dr. A. ZINOVIEFF examined the problems of resettlement in the mining industry, comparing the results after back injuries with those after cartilage operations. Dr. Zinovieff agreed with Mr. Sharrard that laminectomy was seldom followed by return to the original occupation, but that this might reflect the severity of the original complaint rather than failure to convalesce from the operation. The majority of back cases returned to work in the same industry but in a less strenuous capacity. Dr. Zinovieff observed that the younger men tended to find another occupation after injury, and the older ones to return to the pits; he regarded this as a side-effect of the contraction in the mining industry. Dr. A. TREVITHICK described a large steel-works with its own rehabilitation centre and resettlement organisation. Employees were rehabilitated, sent to convalescence, and given physiotherapy within the organisation, the majority continuing at work while treatment was in progress.
Throughout the discussion there was deep concern at the time taken for many cases to return to work. Close cooperation between industrial medical officer, general practitioner, and consultant was regarded as most important in getting men fit enough in the shortest possible time.
Public Health Equipment for Vector Control A W.H.O. report1 on equipment for the application and dispersal of pesticides is based on experience gained in various campaigns, and on the work of a sprayer evaluation team in Nigeria and Iran. Health workers, especially in tropical
countries, will welcome the clear recommendations choice and 1.
use
of apparatus for this
Equipment for Vector 1964. Pp. 200. 26s.
on
the
important task.
Control. Geneva: World Health Organisation. 8d. Obtainable from H.M. Stationery Office, P.O. Box 569, London S.E.1.
England
Now
A Running Commentary by Peripatetic Correspondents To call them damsilly visits is unnecessarily harsh. The N.H.S. has plenty of shortcomings but the domiciliary consultative service is surely not one of them. Much has been written about the diminished status of the general practitioner and the difficulty he has in keeping touch with consultant colleagues and with the hospital world in general. But through the domiciliary he can not only give his patient a very fair deal, if a second opinion seems to be needed, but at the same time make friends and influence people in the alien camp. And yet the service is not all that widely used. This is mysterious. So also is the method (or non-method) by which doctors select patients for visitation. I do not mean those whom the doctor hopes to get into hospital, but the run-of-the-mill cases whom he hopes to be able to treat at home. In pondering this problem a strange fact has been borne in upon me. I do a fair amount of visiting in long suburban roads. Here are living the decent white-collared folk who have more trouble than most in keeping abreast of an affluent society. And time after time when I reach the front door I find it is the one that has newly been painted. Why should this be so ? What strange mechanism of cause and effect can possibly be operating ? Does a patient who is houseproud claim more attention from his doctor; or is more attention automatically conceded by the doctor to a quality of houseproudness inherent in some of his patients ? Who can say ? The question, I daresay, will never be answered, but I have a feeling that there may be hidden here some vital secret. Psychologists and social workers
please note. And, incidentally,
I wonder how many consultants have away from a visit to a small terraced house, five pounds the poorer and carrying a concert flute, off pitch, and not, let us be truthful, in very good working order. come
*
*
*
I sleep badly when travelling abroad, and I never carry hypnotics in my sponge-bag. The chemist was very sympathetic ; as he had my assurance that I was a doctor he was happy to dispense a scheduled drug for me. He shyly apologised for charging me the full price. " It is difficult for me," he explained. " You see, anyone could come in and ask for a professional discount, and I have no proof that you are really a
doctor.’’
*
*
*
Mental illness, it appears, is no great leveller. Two inmates of our local institution were overheard discussing the erratic behaviour of a third. " You see, dear, the thing is she’s a mental case, we’re nerves." *
*
*
In my day, justice was rough but easily understood. Smoking and drinking at school were equally felonious; first offenders got a ceremonial beating from the headmaster, and recidivists were expelled. Thirty years on, as I light up after morning chapel, sixth-formers tell me that today everything is confused. A pint of beer, which they consider healthy or at worst harmless, incurs public exposure, loss of privileges, or the cruder penalties of a past age. But smoking, which even the smokers among them deplore, is a mere peccadillo. Supplies are confiscated-and restored at the end of termthe housemaster hides his ashtrays and delivers a short homily, and the matter is closed. On the other hand, when their parents come down for a weekend the boys can drink what they like, but if they are seen smoking they are sent straight to the headmaster. I tell them that injustice of this kind is universal, and it is useless to fight it. I must keep them quiet; if they persist with their complaints the headmaster may see the light and introduce real justice: beer in the prefects’ tuck-shop, and six of the best for any parent caught smoking within five miles of the quad-
rangle. it
’*’
’*’
’*’
I’ve spent three days dictating reports into a machine. I got bunch of violets yesterday, but it didn’t work any better.
a
commercially impossible because of high development costs and
In
small markets. Mr. T. G. LOWDEN said that industrial accidents and accidents from other sources all received the same hospital treatment, and should all be channelled into the same accident service. He anticipated a nation-wide accident service in the reorganised Hospital Plan. Most accidents would be sent to hospitals designated for accident work, and, when special care was indicated, to central accident units. Total disability was common in minor cases; closer liaison between the accident units and the peripheral first-aid centres would ensure swift diagnosis and accurate disposal, and offer the best prospects of recovery.
Dr. C. E. WATSON discussed first-aid in industry, with special reference to coalmining. There was no excuse for complacency, for there was still much bad first-aid. Examiners were often pressed for time, were encouraged to be too charitable with their candidates, and were faced with too exhaustive a syllabus. He hoped for a revision of the standard courses of training, and for a simpler system of first-aid with a smaller number of essential procedures. These could then be applied by a larger number of trained people more promptly, and nearer to the scene of the incident. Mr. W. J. W. SHARRARD emphasised that much of the physiotherapy of twenty years ago had been valueless, and that most patients could carry out their own rehabilitation at home or at work. Rehabilitation centres had to be associated with the work to which the patients were expected to return, and had to concentrate on those unable to achieve this themselves. He referred particularly to the ones who would not, rather than could not, and stressed that the most important factor in rehabilitation was the financial incentive of returning to work. Dr. A. ZINOVIEFF examined the problems of resettlement in the mining industry, comparing the results after back injuries with those after cartilage operations. Dr. Zinovieff agreed with Mr. Sharrard that laminectomy was seldom followed by return to the original occupation, but that this might reflect the severity of the original complaint rather than failure to convalesce from the operation. The majority of back cases returned to work in the same industry but in a less strenuous capacity. Dr. Zinovieff observed that the younger men tended to find another occupation after injury, and the older ones to return to the pits; he regarded this as a side-effect of the contraction in the mining industry. Dr. A. TREVITHICK described a large steel-works with its own rehabilitation centre and resettlement organisation. Employees were rehabilitated, sent to convalescence, and given physiotherapy within the organisation, the majority continuing at work while treatment was in progress.
Throughout the discussion there was deep concern at the time taken for many cases to return to work. Close cooperation between industrial medical officer, general practitioner, and consultant was regarded as most important in getting men fit enough in the shortest possible time.
Public Health Equipment for Vector Control A W.H.O. report1 on equipment for the application and dispersal of pesticides is based on experience gained in various campaigns, and on the work of a sprayer evaluation team in Nigeria and Iran. Health workers, especially in tropical
countries, will welcome the clear recommendations choice and 1.
use
of apparatus for this
Equipment for Vector 1964. Pp. 200. 26s.
on
the
important task.
Control. Geneva: World Health Organisation. 8d. Obtainable from H.M. Stationery Office, P.O. Box 569, London S.E.1.
England
Now
A Running Commentary by Peripatetic Correspondents To call them damsilly visits is unnecessarily harsh. The N.H.S. has plenty of shortcomings but the domiciliary consultative service is surely not one of them. Much has been written about the diminished status of the general practitioner and the difficulty he has in keeping touch with consultant colleagues and with the hospital world in general. But through the domiciliary he can not only give his patient a very fair deal, if a second opinion seems to be needed, but at the same time make friends and influence people in the alien camp. And yet the service is not all that widely used. This is mysterious. So also is the method (or non-method) by which doctors select patients for visitation. I do not mean those whom the doctor hopes to get into hospital, but the run-of-the-mill cases whom he hopes to be able to treat at home. In pondering this problem a strange fact has been borne in upon me. I do a fair amount of visiting in long suburban roads. Here are living the decent white-collared folk who have more trouble than most in keeping abreast of an affluent society. And time after time when I reach the front door I find it is the one that has newly been painted. Why should this be so ? What strange mechanism of cause and effect can possibly be operating ? Does a patient who is houseproud claim more attention from his doctor; or is more attention automatically conceded by the doctor to a quality of houseproudness inherent in some of his patients ? Who can say ? The question, I daresay, will never be answered, but I have a feeling that there may be hidden here some vital secret. Psychologists and social workers
please note. And, incidentally,
I wonder how many consultants have away from a visit to a small terraced house, five pounds the poorer and carrying a concert flute, off pitch, and not, let us be truthful, in very good working order. come
*
*
*
I sleep badly when travelling abroad, and I never carry hypnotics in my sponge-bag. The chemist was very sympathetic ; as he had my assurance that I was a doctor he was happy to dispense a scheduled drug for me. He shyly apologised for charging me the full price. " It is difficult for me," he explained. " You see, anyone could come in and ask for a professional discount, and I have no proof that you are really a
doctor.’’
*
*
*
Mental illness, it appears, is no great leveller. Two inmates of our local institution were overheard discussing the erratic behaviour of a third. " You see, dear, the thing is she’s a mental case, we’re nerves." *
*
*
In my day, justice was rough but easily understood. Smoking and drinking at school were equally felonious; first offenders got a ceremonial beating from the headmaster, and recidivists were expelled. Thirty years on, as I light up after morning chapel, sixth-formers tell me that today everything is confused. A pint of beer, which they consider healthy or at worst harmless, incurs public exposure, loss of privileges, or the cruder penalties of a past age. But smoking, which even the smokers among them deplore, is a mere peccadillo. Supplies are confiscated-and restored at the end of termthe housemaster hides his ashtrays and delivers a short homily, and the matter is closed. On the other hand, when their parents come down for a weekend the boys can drink what they like, but if they are seen smoking they are sent straight to the headmaster. I tell them that injustice of this kind is universal, and it is useless to fight it. I must keep them quiet; if they persist with their complaints the headmaster may see the light and introduce real justice: beer in the prefects’ tuck-shop, and six of the best for any parent caught smoking within five miles of the quad-
rangle. it
’*’
’*’
’*’
I’ve spent three days dictating reports into a machine. I got bunch of violets yesterday, but it didn’t work any better.
a