RESOLUTIONS ON REMUNERATION

1099 With these exceptions, most patients should be seen by the geriatric doctor either in the outpatient department, or along with the family doctor at home, so as to decide whether treatment at home or as an outpatient will be adequate. The hospital waiting-list should be carefully investigated with the object of keeping out all patients who do not need, or no longer need, admission. The work of a geriatric hospital is thus intimately linked up with the responsibilities of the local authorities, and a liaison should be arranged so that they work hand in hand.

acute hospital, but they must pass through. third die in three months from admission, a third go home, and the remaining third must not be allowed increasingly to block the hospital; they must gradually pass on to hostels if well enough or to long-stay annexes or less active hospitals. Nurses should interchange to some extent. This will keep up the standard of the less active hospitals for the elderly. It will be good for nurses in training in acute hospitals to have some experience of geriatric nursing.

through About

A GERIATRIC HOSPITAL

Let us now turn to the principles which should be observed in setting up a geriatric hospital. The service centres on the efficiency and devotion of its chief medical officer. It does not much matter whether he is a physician or surgeon or orthopaedic surgeon or He must, however, be fully has other qualifications. acquainted with the possibilities of modern treatment of the elderly, the good results now obtainable, and the He must be prepared to give methods employed. individual care, or see that it is given, to each patient. Such a medical officer will inspire confidence and obtain enthusiastic cooperation. He will win all concerned to a liking for the work-sisters, nurses, orderlies, physiotherapists, occupational therapists, almoners, and last but not least the patients themselves and their relatives. A good geriatric hospital is a happy place. Treatment should begin early in the course of a disease, both ifi inpatient and outpatient departments, and patients should not be neglected after treatment ceases, for want of a follow-up. Relapses should be treated early. During their stay in hospital patients should, if possible, remain in the same ward under the same sisters and nurses, and they should certainly remain under the same doctor. This ensures continuity of treatment, and increases the doctor’s sense of responsibility ; his interest inspires confidence in the patient and avoids the unnecessary and wasteful labour entailed if a fresh medical officer has to investigate and understand the case anew. The chief medical officer should have available to him the services of consultants and X-ray and pathological facilities. It is desirable to have together under one roof or at least connected by covered way the following parts of the hospital :

Registration and record room, doctor’s room and examinaX-ray rooms, pathological rooms, physiotherapeutic unit, occupational therapy department, almoners’ accommodation, waiting-room for patients and friends, canteen, typists’ room, accommodation for coats and hats, toilet accommodation, possibly an injection and dressing room, dispensary. The block should have a non-slippery floor, be well tion rooms,

heated and ventilated, be free from draughts, and have rails on the walls to help the elderly in walking. The question of grouping together patients suffering from the same disease was considered. It appears better in the treatment wards to arrange them according to prospect of ultimate recovery, with a favourable ward and a ward for less favourable cases. Separate wards are required for the mentally confused and for the incontinent, and patients who are bad influences in a ward and those of dirty habits should be segregated. Some accommodation should be reserved for those about to die. Patients should not be discharged home without first passing through a ward in which they can spend an active period to better-fit them for home life. Wards should be bright and airy, with flowers and tasteful decorations, and there should be diversions such as music, concerts, or films. Occupational therapy fills a place. If tasks are useful and earn a reward, this is an excellent incentive. A day room and recreation room are desirable. The usefulness of a hospital depends -partly on its turnover. Patients pass more slowly through a geriatric than

an

a

GERIATRICS AS A SPECIALTY

Thomson2 stresses the necessity of bringing the aged chronic sick into the main stream of medicine, admitting them to the general hospital wards for accurate diagnosis and thorough treatment. He does not believe that a should be made geriatrics specialty, but considers that the treatment of these patients should fall to the general physician. While conceding that many aged patients will continue to need general hospital accommodation we are in favour of a specialised geriatric service, for many °

reasons.

existing clinics where geriatric patients are successfully treated are in the charge of doctors who have developed a special interest in the work and who are in fact geriatric specialists. The long-term illness from which most of these patients are suffering requires the intensive and persistent application of medical treatment and nursing care. This is more likely to be given in a centre devoted to geriatric problems. The work appeals only to certain physicians and surgeons. In a general hospital ward geriatric cases may be easily relegated to an inferioi status as of less interest than acute cases, and slower in their response to treatment. Again, the number of potential patients who can be given treatment, and who can be prevented from entering hospital, by an efficient geriatric outpatient service is large enough to justify the geriatric specialty. We also hold that continuity of treatment is essential in these cases and can best be obtained by a special service whose medical officers supervise treatment and assess progress The

=

long periods. pendulum at the moment has begun to swing strongly in favour of better treatment, medical and socio-economic, for the increasing number of elderly people of the nation. It has not yet swung nearly far enough, but care must be taken, if the total amount of hospital accommodation is limited, not to deprive the younger, active, working, and therefore more valuable individuals of the facilities for speedy restoration to work, by transferring too many old people permanently to hospitals, institutions, and hostels. This complex problem, many aspects of which have been discussed in our report, will ultimately reach a state of equilibrium which will give as full expression to the national instinct

over

The

of human kindness

as

economic conditions will permit.

RESOLUTIONS ON REMUNERATION AT a meeting on Dec. 1, the General Medical Services Committee considered the Minister of Health’s refusal3 to increase the amount of the central pool for the remuneration of general practitioners. The committee passed the following resolutions : 1. That in the view of the committee the reply of the

Ministry of Health

dated Nov. 14 to the request of the conference of the local medical committees for a recalculation of the central pool in the light of the facts now available is entirely unsatisfactory, and that an interview be sought to demonstrate its inaccuracies, to calculate the sum by which the central pool is short, and to reiterate the demand for an adjustment of the central pool to meet this deficiency. 2. Thomson, A. P. Brit. med. J. 3. See Lancet, Nov. 26, p. 1005.

July 30, p. 243.

1100 2. That before the January meeting of the General Medical Services Committee an assurance be sought of the Ministry of Health that the central pool will be continuously adjusted so as to maintain in the futurewhatever the changes necessitated by the heavy burden of work falling on general practitioners and whatever the increase in the number of doctors-the levels of remuneration recommended in the Spens Report which were accepted by the Government.

WELLCOME HISTORICAL MEDICAL LIBRARY

reopening of this library was celebrated on Dec. 2 luncheon attended by librarians and bibliophil doctors. Presiding as chairman of the Wellcome Foundation, Mr. H. Sier welcomed the guests, who returned thanks through Sir Arthur MacNalty and Sir Henry Thomas. Dr. E. Ashworth Underwood, director of the Wellcome Historical Medical Museum and Library, gave an account of the library and its origin. THE

at

a

It a

was founded by the late Sir Henry Wellcome to provide comprehensive collection for students of the history of

medicine and the allied sciences, and has been built up over the past fifty years by purchase at publicand private sales, supplemented by gifts and bequests. It now contains about 200,000 printed books, pamphlets, and journals ; 5000 manuand 100,000 autograph letters of medical and scientific interest, as well as other documents. Almost all the landmarks in the history of medicine are represented by

scripts ;

original

texts.

Of books printed before 1500 (incunabula) it possesses 612 complete works and 22 fragments. This is one of the largest collections of medical incunabula in the world, its nucleus being formed of accessions from three famous private libraries, -those of William Morris, Dr. J. F. Payne, and Kurt Wolfftogether with a smaller - number from that of Prince Dietrichstein. A detailed catalogue will soon be in the press. The sixteenth-century books number over 4000, with 700 English books printed before 1640, some of which are not to be found elsewhere outside the British Museum. The library contains more than 10,000 books printed in the seventeenth century. From this century onwards all important advances in medicine and science are signalled by original texts. There is also a wealth of less well-known clinical and scientific material, including a wide range of early periodicals, which awaits the notice and study of the historian. The library is very rich in special collections. In addition, there is a very comprehensive collection of modern bibliographical and reference works, so that only rarely need a reader look elsewhere for information on any topic. Current periodicals and new books dealing with the historical aspects of medicine and the sciences are acquired as they appear. The autograph letters, which number more than 100,000, The library also has a large are still largely unexplored. collection of Oriental man,2cscripts and many modern printed works in the Oriental languages.

The task of cataloguing and arranging so vast a collection has hitherto occupied the full energies of the staff, and post-war conditions have made equipment and furnishing very difficult. But some temporary expedients have been adopted which will now enable the library to fulfil its function as a centre of medical and historical research. It is open at the Wellcome Research Institution, 183, Euston Road, London, N.W.l, from 10 A.M. to 5 P.M., from Monday to Friday throughout the year, except bank holidays. No books can be lent, but prints, lantern slides, and photostats can be supplied, and there is also a microfilm service with a reading machine. A general catalogue in short-title form is now being prepared for the press. Historical and bibliographical inquiries can be dealt with by the staff : they should preferably be made by letter, but in exceptional circumstances requests for information by telephone will be accepted. Exhibitions will be held from time to time, and conducted visits for special parties can be arranged with the director or the librarian, Mr. W. J. Bishop. -

THE ROYAL FACULTY CELEBRATES FROM

A

CORR8PONDNT

DOCTORS are alleged to be excessively jealous of their traditions and privileges, and in northern latitudes to be a bonny fighter is a coveted title. In the celebrations of the 350th anniversary of the Royal Faculty of Physicians and Surgeons of Glasgow, it was obvious that the temper of the fellows is militant as well as jubilant. There were frequent reminders of past relationships between the Faculty on the one hand, and the Church, the University, contemporary professional institutions, and the city fathers on the other. The Faculty in its day has crossed swords with most of these bodies in the northern kingdom, and has displayed the qualities of resourcefulness and doggedness which spring from a realisation that the privileges of the Faculty are inseparable from responsibilities. This was the central idea which guided the Faculty during its long period of over an area of Scotland almost that now entrusted to the Western Regional Board, and its influence in the 17th and 18th century was far-reaching, as described in these columns on Nov. 26.

professional jurisdiction identical

with

SERMON

The Minister of Glasgow (the Rev. Nevil Davidson), who preached the sermon at the cathedral service of commemoration, reminded the fellows that the Church had provided the pioneers who tended those sick in body or in mind. Basing his observations on the text : "I am come that they might have life, and that they might have it more abundantly," he emphasised that the Church today is still deeply concerned with physical as well as with spiritual health. Dr. Davidson also urged the president and fellows to consider whether it mighf not be possible to achieve a greater measure of collaboration between the minister of religion and the medical practitioner, suggesting that the means of achieving this liasion might be examined at a joint conference of the two professions. The service was concluded in the churchyard, where the president, Dr. W. R. Snodgrass, placed a wreath on the tomb of Dr. Peter Lowe while a snell wind made merry with gowns and hoods. HONORARY FELLOWSHIPS

In the Faculty hall on Nov. 28, honorary fellowships were conferred on Emeritus Prof. E. P. Cathcart, F.R.S., Emeritus Prof. G. B. Fleming, Sir Hector Hetherington, Prof. Hilda N. Lloyd, P.R.C.O.G., Lord Moran, P.R.c.p., Dr. R. Barclay Ness Dr. W. D. D. Small, P.R.C.P.E., Sir Cecil Wakeley, P.R.C.S., Mr. W. Quarry Wood, P.R.C.P.E. The ceremony took place in the large hall, which was crowded to the doors and down the main staircase by the fellows and their guests. It was a most impressive and colourful ceremony. The honorary fellows were introduced by the learned clerk of the Faculty, Mr. T. L. Grahame Reid, whose orations though brief were as vivid as they were felicitous. After the conferment, congratulatory messages were presented by the presidents of the sister corporations of the United Kingdom and by the Principal of the University of Glasgow. Professor Cathcart, thanked the Faculty on behalf of the honorary fellows. Pointing a warning finger at the principal of Glasgow University, he explained to Sir Hector Hetherington that the honorary fellowship did not entitle him to practise physic. DINNER

The celebrations were rounded off with a dinner in the hall on Nov. 29-the penultimate day of the month mentioned in the charter 350 years ago. Wit and ingenuity were well matched in Prof. G. B. Fleming’s comprehensive speech when he toasted The Guests. The Lord Provost, replying for the guests, expressed the pride which the city felt in having such a lively Faculty in its midst, and his personal relief that the fellows were too well behaved individually and collectively to be a source of trouble to the magistrates. He attributed to Professor Fleming the writing of the very attractive prescription that appeared on the menu card and which included Amontillado, Chateau Leoville Barton 1934, Clicquot 1937, and Cockburn 1927; adding that he felt that the time had come to transfer his National Health Service card to Professor Flemi g’s file. Sir Hector Hetherington, proposing the toast-The Royal Faculty of Physicians and Surgeons-said that the old feud between

faculty